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Home My WebLink About167 Cherry Ave; ; CBR2017-1815; Permit(City of Carlsbad Residential Permit Print Date: 07/25/2018 Permit No: CBR2017-1815 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: # Dwelling Units: Bedrooms: Project Title: 167 Cherry Ave BLDG-Residential 2042321800 $6,776.00 -1 167 CHERRY AVE DUPLEX Work Class: Demo Lot#: Reference#: DEV16050 Construction Type: Bathrooms: Orig. Plan Check#: Plan Check#: Description: TAYLOR: DEMOLISH EXISTING SFD IN PREPARATION FOR FUTURE DUPLEX BUILDING PERMIT FEE $2000+ BUILDING PLAN CHECK FEE (BLDG) 581473 BUILDING STANDARDS FEE STRONG MOTION-RESIDENTIAL SWPPP INSPECTION FEE TIER 2-Medium BLDG SWPPP PLAN REVIEW FEE TIER 2 -MEDIUM Total Fees: $1,397.07 Owner: MATIHEW TAYLOR 656 Arcadia Bluff Ct San Marcos, CA 92069-8125 760-500-7020 Total Payments To Date: $1,397.07 Status: Applied: Issued: Permit Fina led: Inspector: Final Inspection: Balance Due: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. \f you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitation has previously otherwise expired. Closed -Fina!ed 08/09/2017 08/25/2017 AKrog 7/25/2018 6:54'45AM $0.00 $88.35 $61.84 $1.00 $0.88 $883.00 $362.00 1635 Faraday Avenue, Carlsbad, CA 92008-7314 I 760-602-2700 I 760-602-8560 f I www.carlsbadca.gov §E ~dt'LOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: OPLANNING 0 ENGINEERING 0 BUILDING O FIRE O HEALTH O HAZMAT/APCD I J C City of Building Permit Application Plan Check No~R2..0\,-lK'I ~ 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value lo ,,u - Carlsbad Ph: 760-602-2719 Fax: 760-602-8558 Plan Ck. Deposit email: building@carlsbadca.gov www.carlsbadca.gov Date 8 -q-11- JOB ADDRESS SUITE#/SPACE#/UNIT# 1204 -2.32 -l <o -00 l"l C.~o.rru Av-t CT/PROJECT # I ILOT# I PHASE# I# OF UNITS I# BEDROOMS # BATHROOMS I TENANT BUSINESS NAME ii CONSTR. TYP~I. occ. GROUP RE :!r.:·n1 '!"·· DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) -., _...., ~e.r\.\fN\ ()~ ~)\\~ s~~k +A.~~,, Vic,"'"" tv.J.. WV! S~vc)-tc,.,i of' ~ J..vp(.t,.>t . AUG O 9 2017 ,, ,oo ~ CiT'r OF . , _ i::u,, f ~ LI .. I"<~ . : AO ~I Nt • H /1 • -' 11 11,1 EXISTING USE FIREPLACE ~~~~,ki-,\ I PROPOSED USE J GARAGE (SF) 1li>-}d.li\kAJ\ t'\v\~: ~ q1,<, 1\1 PATIOS (SF) I DECKS (SF) q,1 $ '1-=l-~4 YESf8.)ti. I AIR CONDITIONING I FIRE SPRINKLERS NOD YES ~No0 YES~NoO APPLICANT NAME Y\ . .lll •• ' .'"'1,v PROPERTY OWNER NAME Primary Contact 5~ ADDRESS ADDRESS ~SG.. Arv,.J..rr\. 'R\1111 vi- CITY STATE ZIP CITY STATE ZIP ~ ty\,i.('(/11> (A q;)..OCP'l PHONE IFAX PHONE I FAX -=J.W • S'OO • -:}()-;;i., 0 EMAIL M~, \\\ (',)', c.\ni1!.,.. uo"" EMAIL DESIGN PROFESSIONAL CONTRACTOR BUS. NA/, 1 ( ,I ('\1 -·-'"IL... , / ADDRESS ADDRESS - CITY STATE ZIP CITY STATE ZIP PHONE IFAX PHONE I FAX EMAIL EMAIL I STATE UC.# STATE UC.# 'CLASS I CITY BUS. UC.# (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law {Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or that he is exempt therefrom. and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: I hereby affirm under penafty of perjury one of the following declarations: D I have and will maintain a certificate of consent to self-Insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which lhis permil is issued. D I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for lhe performance of the work for which lhis permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. Policy No. Expiration Date ---------- This section need not be completed if the perm ii is for one hundred dollars ($100) or less. C8J Certificate of Exemption: I certify that in the performance of lhe work for which this permit is issued, I shall not employ any person in any manner so as to become subjecl to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100.000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, Interest and attomey's fees. ~ CONTRACTOR SIGNATURE O AGENT DATE I hereby affirm that I am exempt from Contractor's License Law for fhe following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do lhe work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himse~ or through his own employees, provided that such improvements are nol intended or offered for sale. If, however, the building or improvement is sold within one year of complelion, the owner.builder will have the burden of proving lhat he did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting wilh licensed contractors to construe! the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who buiids or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Seclion Business and Professions Code for this reason: 1. I personally plan to provide lhe major labor and malerials for construction of the proposed property improvement. 0 Yes 0 No 2. I (have I have not) signed an application for a building permit for the proposed work. 3. I have contracted wilh the following person (firm) to provide the proposed construclion (include name address I phone I conlractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name I address I phone I contractors' license number): 5. I will provide some of the work, but I have contracted (hired) lhe following persons lo provide the work indicated (include name I address I phone I type of work): ~ PROPERTY OWNER SIGNATURE 0AGENT DATE 8-r-11- Is the applica11t or future buildi11g occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Yes No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Yes No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. lender's Name I certify that I haw read the application and state that the above lnfonnation isoorrectand that the infonnation on the plans is accurate. I agree to comply with all Cltyordinanc:esand State laws relating to bulldlngoonstruction. I hereby au~ooze representalive of ~e Cly of Carlsbad to enter upon ~e above menliooed propef1y for inspection purposes. I ALSO AGREE TO SAVE. INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: MOSHA permit is required for excavations over 5'0' deep and demolition or construction of structures over 3 stories in hekJht. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such permit or if the building or work authorized by such pennit is suspended or abandoned at any time after the work is oommenced for a period of 180 days {Section 106.4.4 Unifoml Building Code). A$APPLICANT'SSIGNA~URE ~~ DATE STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Fax (760) 602-8560, Email building@carlsbadca.gov or Mail the completed form to City of Cansbad, Building Division 1635 Faraday Avenue, cansbad, California 92008. CONTACT NAME ADDRESS CITY STATE PHONE EMAIL DELIVERY OPTIONS PICKUP: MAIL TO: CONTACT (Listed above) CONTRACTOR (On Pg. 1) CONTACT (Listed above) CONTRACTOR (On Pg. 1) ZIP FAX OCCUPANT (Listed above) OCCUPANT (listed above) MAIL/ FAX TO OTHER:----------------- ~APPLICANT'S SIGNATURE CO#: (Office Use Only) OCCUPANT NAME BUILDING ADDRESS CITY STATE ZIP Carlsbad CA OCCUPANT'S BUS. LIC. No. ASSOCIATED CB#------------ NO CHANGE IN USE/ NO CONSTRUCTION CHANGE OF USE I NO CONSTRUCTION DATE ' 0 . . . PeRMIT t~SPECTION HISTORY REPORT (CBR2017-1815) Permit Type: BLDG-Residential Application Date: 08/09/2017 Owner: Work Class: Demo Issue Date: 08/25/2017 Subdivision: Status: Closed -Finaled Expiration Date: 02/21/2018 Address: IVR Number: 5588 Scheduled Date Actual Start Date Inspection Type Inspection No. Inspection Status Primary Inspector 07126/2018 July 25, 2018 BLDG-Final Inspection 064968-2018 Checklist Item BLDG-Building Deficiency BLDG-Plumbing Final BLDG-Mechanical Final BLDG-Structural Final BLDG-Electrical Final Passed Paul Burnette COMMENTS MATTHEW TAYLOR PALISADES HEIGHTS REFILED 167 Cheny Ave Carlsbad, CA 92008 Re inspection Passed No No No No No Complete Complete Page 1 of 1 ASBESTOS SURVEY CONDUCTED AT 167 Cherry Avenue Carlsbad, CA 92008 JMR JOB# 1-647 Matt Taylor July 20, 2017 .......... ............ . .. ----··-""_,.,, .. ,,. Matt Taylor Mrt111@icloud.com July 20, 2017 JMR Job #1-647 RE: 167 Cherry Avenue, Carlsbad CA 92008 PROJECT: . Asbestos Survey An asbestos survey was performed by JMR Environmental Services, Inc. (JMR) at 167 Cherry Avenue, Carlsbad CA 92008 on July 14, 2017. The purpose of this survey was to determine the presence of friable (easily crumbled by hand pressure) and non-friable asbestos-containing materials within the structure. This survey addressed the following types of building materials: • 12'x12' Floor Tile • Roofing Material • Floor Adhesive • Roof Penetration Mastic • Black Floor Mastic • Drywall / Joint Compound This report includes laboratory results and a list of asbestos-containing materials with estimates of square and linear footage. Recommendations as to the most practical remedial action shall also be provided. Procedure Sample analysis of bulk materials was performed in accordance with EPA.600/R-931116 Test Method: Method for the Detennination of Asbestos in Bulk Building Materials. This procedure involves examination of the samples with a petrographic microscope utilizing polarized light, a procedure commonly known as polarized light microscopy (PLM). All results generated via bulk. asbestos analysis are reported in terms of approximate percent by volume. Laboratory results and field data sheets are attached. --------------------------:-::,c:c-=c~ 167 Cherry Avenue, carts~~~: 4560Alvarado Canyon Re)., Suite 2D, San Diego, CA 92120 Tel: (619) 858-7260 Fax: (619) 858-7264 i .... ·····-······------.. -··-··-------·----· Asbestos Results The following tables include an inventory of the identified asbestos-containing materials for this project. Material / I qeatipo Roof Penetration Mastic - House and Garage Type_ .. Chrysotile Total% by Volume 5% -Th& fa/b.wlg condition ~ Wlffll used to-!ti. e t 1 kXMlflWlinQ material(>. Approx.• Ouantitv 3 Sq. Ft GOOd Good -~isJtilar;tatl<J.iJ!Olt'Snoa,gm.of~or~. NQditbriSGP'f}W1t, Fait ~-~or~. oWatenaf rs breakfn9 upinlo la}ersor befilinning lo«,n»Ioa.w ilOm /JI& Slibstfale. Th,i, material ir. ~ m ,sm8II -Minor deoos may b8' (JlflHnt, Poor &Nore damage Of~ Thtt/1VJfflftalis ~-Pll,cesa,e M/odgtdlln</dsbrl$1$ev/dt(,t. Mm-lriablem«elial hBsbec:ome friabJa Un/rnOVnt -Matenahl localed bd impoUloJe lo assess, i Ss, IJJ'lf:J,srn&at MW tindhos. Discussion/Recommendations All accessible areas were inspected for possible asbestos-containing materials. If materials that are similar to those found to be asbestos containing are observed they must be assumed positive until tested to prove otherwise. Due to the non-destructive nature of the survey, inaccessible areas (such as inside walls) were not sampled. If during renovation suspect materials are observed in these areas, bulk sampling and analysis is recommended prior to resuming the renovation activities. Penetration Mastic Asbestos fibers were detected in the penetration mastic located on the house roof. The penetration mastic is in good condition. This material was identified at roof penetrations (vents, ducts, etc.) on the roof. This material is non-friable and presents a very low potential for fiber release if intact. No remedial action is required unless renovation or demolition is planned. If asbestos-containing materials are to be removed or disturbed for demolition or renovation then a licensed, California Division of Safety and Health (Cal/OSHA) registered asbestos abatement contractor must be used and the work must conform to Title 8, Section 1529 of the California Code of Regulations. If asbestos is present in quantities greater that 1 % then all work must also conform to Federal Environmental Protection Agency (EPA) regulations Title 40 CFR 61 Final Rule, and Federal Occupational Safety and Health Administration (OSHA) regulations Title 29 CFR 1926.1101. Various other federal, state, or local regulations may apply as well. Asbe$t0$ Survey 167 Cherry Avenue, Carlsbad CA 92006 JMR Environmental Services Inc. appreciates the opportunity to provide these services. Sincerely, David Weaver, Operations Manager JMR Environmental Services Inc Asbestos Certification #15-5474 Asbestos survey 167 Cherry Avenuo, CWbad CA Q2008 -----······-- ASBESTOS LABORATORY RESULTS Asnes1as: Survey 167 Cherry Avenue, Carlsbad CA 9200,8 Project: 167 Cherry Avenue JMR Lab Number 1-647-071417-A Carlsbad, CA 92008 Date Analyzed July 19, 2017 Room Temperature 25°C Type of Total Other Sample Asbestos Percentage Materials Gross Number Sample ID Present by Volume Present Appearance 192386 01. 12xl2 Floor Tile None Detected Cellulose l o/o Homogeneous Garage Calcite Non-Fibrous Vinyl/Plastic Gray White 192387 02. Floor Adhesive None Detected Cellulose 3% Homogeneous Garage Calcite Non-Fibrous Adhesive Tan 192388 03. Floor Adhesive None Detected Cellulose 3% Homogeneous Garage Calcite Non-Fibrous Adhesive Tan 192389 04. Floor Adhesive None Detected Cellulose 3% Homogeneous Garage Calcite Non-Fibrous Adhesive Tan 192390 05. Drywall I Joint Compound-None Detected Cellulose 10% Layered Composite Paint Fibrous Garage Calcite White Gypsum 192391 06. Drywall I Joint Compound-None Detected Cellulose 10% Layered Composite Paint Fibrous Garage Calcite White Gypsum 192392 07. Drywall I Joint Compound-None Detected Cellulose 10% Layered Composite Paint Fibrous Garage Calcite White Gypsum 192393a 08. Roof Core None Detected Calcite Homogeneous Garage Quartz Fibrous (Quartz Shingle) Bitumen Blue Black 192393b 08. Roof Core None Detected Fiberglass 25% Homogeneous Garage Bitumen Fibrous (Fiberglass Layer) Black 192393c 08. Roof Core None Detected Cellulose 30% Homogeneous Garage Bitumen Fibrous (Felt) Black 192394a 09. Roof Penetration Caulking None Detected Calcite Homogeneous Garage Adhesive Non-Fibrous (Clear Adhesive) Clear Environmental Services, Inc Project: 167 Cherry Avenue JMR Lab Number 1-647-071417-A Carlsbad, CA 92008 Date Analyzed July 19, 2017 Room Temperature 25-C Type of Total Other Sample Asbestos Percentage Materials Gross Number Sample ID Present by Volume Present Appearance 192394b 09. Roof Penetration Caulking None Detected Calcite Homogeneous Garage Binder Non-Fibrous (White Calking) White 192395a 10. Layered Flooring Material None Detected Cellulose 40o/o Homogeneous House, North Living Area Below Calcite Fibrous Ceramic Tile Gray (Flooring) 192395b 10. Layered Flooring Material None Detected Cellulose 40% Homogeneous House, North Living Area Below Calcite Fibrous Ceramic Tile Gray (Leveling Compound) 192396 11. Black Floor Mastic None Detected Cellulose 3% Homogeneous House Kitchen Area Under Ceramic Calcite Non-Fibrous Tile Gypsum Black Bitumen 192397 12. Black Floor Mastic None Detected Cellulose 3% Homogeneous House Kitchen Area Under Ceramic Calcite Non-Fibrous Tile Gypsum Black Bitumen 192398 13. Black Floor Mastic None Detected Cellulose 3% Homogeneous House Kitchen Area Under Ceramic Calcite Non-Fibrous Tile Gypsum Black Bitumen 192399 14. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum 192400 15. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum 192401 16. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum 192402 17. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum 192403 18. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum Envlronmental services, Inc Project: 167 Cherry Avenue JMR Lab Number 1-647-071417-A Carlsbad, CA 92008 Date Analyzed July 19, 2017 Room Temperature 25•C Type of Total Other Sample Asbestos Percentage Materials Gross Number Sample ID Present by Volume Present Appearance 192404 19. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum 192405 20. Drywall/Joint Compound None Detected Cellulose 10% Layered Composite Paint Fibrous House, Interior Throughout Calcite White Gypsum 192406a 21. Roof Core None Detected Calcite Homogenous Hose, Roof Quartz Fibrous (Quartz Shingle) Bitumen Blue Black 192406b 21. Roof Core None Detected Fiberglass 25o/o Homogenous Hose, Roof Bitumen Fibrous (Fiberglass Layer) Black 192406c 21. Roof Core None Detected Calcite Homogenous Hose, Roof Quartz Non-Fibrous (Quartz Shingle) Bitumen Black Gray 192406d 21. Roof Core None Detected Cellulose 30% Homogenous Hose, Roof Bitumen Fibrous (Felt) Black 192407 22. Roof Penetration Mastic Chrysotile 5% Paint Homogeneous House, Roof Calcite Fibrous Bitumen Black 192408 23. Roof Penetration Mastic Chrysotile 5o/o Cellulose 1% Homogeneous House, Roof Calcite Fibrous Quartz Black Bitumen Blue 192409 24. Roof Penetration Mastic None Detected Calcite Homogeneous House, Roof Binder Fibrous Gray Environmental Services, Inc JMR ENVIRONMENTAL SERVICES, INC 4560 ALVARADO CANYON RD, STE#2D, SAN DIEGO CA 92120 TEL: 619.858.7260 FAX: 619.858.7264 I JMR LAB m# PAGELoF.5 J I -C..1-{ 'l f'\.-()'1 I'-\\ '1 I ASBESTOS BULK CHAIN OF CUSTODY -FIELD USE CLIENT NAME fV\1>-it Tc>.:-1 \o.r CONTACT ADDRESS CllY, STATE & ZIP JMRJOB# lbl ('.._~ ~ PROJECT LOCATION: (;ru:\::l\:,,4 cA qi...o'S } SERVICE (PLEASE CHECK ONE): )isURVEY oCLEARANCE o INVESTIGATION o SAMPLE COLLECTION o OTHER •sPECIFY IN COMMENTS REPORTDUEDATE:~~~~~~~~~~~~~~ LABNERBAL TURNAROUND TIME: o RUSH o NEXT DAY o 2 DAYS ~3 DAYS o 4 DAYS JMRLAB# SAMPLE# MATERIAL SAMPLED LOCATION RESULT I ti1_ -.,~c.. 01 \ 1.. )(. i1 fl .i.;l\.. ( -Nb -:Z.8t . I Nb --0 "2,. CJ~,_, 11 , .... ~ ~Gi?,~ ti'.) r rvti ~ !:I.'\ O'-t I? ND ':?,Ct t) t:>, i\. ..• u/~h-~' ..I. --l'{<., /\)"\) 3 q_ I b~ . I . . Nb 3 <tZ. "'' I, N1) 3q3 \:>'g :, ,._r_ r.. --o.,b l-;. ND .. ~'1'-l O'l 11......~ ~1<>.\:~ ....... fuuU'->"-• a,b-:. Nb 3q~ I"" (-......, I.A'f~ ~ .... /--~<-l -Hbl.>5,c,._. ~ ,. 1,,,..f"'t'\ (1'4t._ ~ n 1.._ I :.--h. c(, h :: /,Ji) RELINQUISHED BY: I. ~ ~\d~rl \AA I -. ) A I\ \.Orl COMMENTS:~• : SA;.1, le, tW .. : de-r fiJt . ..,, jJ.IO": P\,,0 c:-. DATE: D'1 -l<../ "'l..';>\\ .::,'!ME: r5 ·, t~ __ \ h: f.'l>,rils. f, .. , b: IJ,,l. f h Ike, b: 1-e,,.1,.,n;,...., .. ,1 RECEIVEDBY: L~~ ~ DATE: 1:)-Z-!C(-fu~; (!'.\f t: ro PAYMENT METHOD:-------- REPORT DUE DATE: ____________ ,--_____ _ AMOUNT:------ ~ev,s;o 712015 L·twt-, ~\'\::S +c. ~' JMR ENVIRONMENTAL SERVICES, INC JMR LAB lo# PAGE 4560 ALVARADO CANYON RD, STE #2D, SAN DIEGO CA 92120 TEL: 619.858.7260 FAX: 619.858.7264 i -<o'-111\-O"l 14 1 'l ASBESTOS BULK CHAIN OF CUSTODY -FIELD USE CLIENT NAME Mo::\\. :f~c, CONTACT ' ADDRESS CITY, STATE & ZIP JMR JOB# I Ci:>., ~~ p.,,~ PROJECT LOCATION: V!,cl'5\o~ ~ '.'t'"Ue,o'e, SERVICE (PLEASE CHECK ONE): }t-,URVEY oCLEARANCE o INVESTIGATION o SAMPLE COLLECTION o OTHER *SPECIFY IN COMMENTS REPORTDUEDATE:~~~~~~~~~~~~~~ LABNERBAL TURNAROUND TIME: o RUSH o NEXT DAY D2DAYS ,t3DAYS o4DAYS JMR LAB# SAMPLE# MATERIAL SAMPLED ( LOCATION RESULT i 9 l. ?>''f <::. I \ ~o,t...l!-I{\-<"' ~ ~ '-t'c::.J.;..,..., IC..~ ~ \)~~ ~:i.... 1\1 'i'\ ,, ~' \1.. ~1 J I Nb 3, ~ 'i!, l1 ¥ \ 10\) l> '1., 1 "l ti.\ 'D<-(-i.., (;:si:,i«l< """""..,.}... G::>""("') ·~ (J.,o,.., '1."~ I I . r A N'i'. 4 l::>C::, l; 4 c:, l ({. I..\.<::, '2 l'l 4o~ l'\3 . 4s::.'-l l '"I I-{ t::/5' 1..P( ---...,, l7 I l7 RELINQUISHED BY: . L ~ »1.d:,.\ A j, ,A.}\ \D_r( M~~· C\J-l'{-~ti _l'IME: I '.~",ts -- RECENEDBY: L~~ v:~ DATE: Or -\'{ .i_;; ~: l~ REVIS~ 7)2015 . ' J 1\/'t> N~ f\)i) fl\'(\ tJ1"1 17 Nb COMMENTS: AMOUNT:-------PAYMENTMETHOD:_~~~~~~- REPORTDUEDATE:~~~~~~~~~~~~~~~~~~~ JMR ENVIRONMENTAL SERVICES, INC 4560 ALVARADO CANYON RD, STE#20, SAN DIEGO CA 92120 TEL: 619.868.7260 FAX: 619.858.7264 JMR LAB lo# PAGE 5 OF .:5 -----1 I-'=,t.{l 1\-0l l'i Ir ! ASBESTOS BULK CHAIN OF CUSTODY -FIELD USE CLIENT NAME M"'~ ::te>-':1\1;2.r- CONTACT ' SERVICE {PLEASE CHECK ONE); !iSURVEY D CLEARANCE ADDRESS D INVESTIGATION CITY, STATE & ZIP o SAMPLE COLLECTION D .OTHER 'SPECIFY IN COMMENTS JMR JOB# l(o"""{ ~ ~ PROJECTLOCATION: ~$ ji_;;;; REPORTDUEDATE: ________ ~----~ LABNERBAL TURNAROUND TIME: o RUSH o NEXT DAY 02 DAYS )it 3 DAYS o 4 DAYS JMRLA8# SAMPLE# MATERIAL SAMPLED I l '"t 1-.._l-( Db 2. \ ~~ ~.£.., Ye,1 ,._z.. ~~ ~.J.c,._,ls:,\-;:,.,_ ~~~~</ "-\ ,z, ~I 1-.'?. l D '-{, \:>"\ 7-,'j ~ (~ .L RELINQUISHED BY: ~ ~AJ \t-,k~ DATE: cf1 4 (<..{-'Uc,!""t e: is::ir\ I '< RECEIVEDBY: LY~~~ DATE: Ct -t\.l-L<:,,l"',-' TIME:l ~\ REVISf;O 7 /2015 LOCATION RESULT I LI-.... ~ a. .h l., d.: J./f) '5"-f. c~ St. U1 v Wo COMMENTS: -#-2,/ ~ .'~"'ll., ~(,i,J:/&t.,,,) b: F:l,;r1l,,> L.v,,- PAYMENT METHOD: <. ; 11<. -'"11~ {IJ\;;Ji/t.-;J q· F'.t.H· AMOUNT: _____ _ REPORT DUE DATE: __________________ _ LEAD PAINT INVESTIGATION CONDUCTED AT 167 Cherry Avenue Carlsbad, CA 92008 JMR JOB # 1-647 Matt Taylor July 20, 2017 " .... _ ..... -....... ------------------------ Matt Taylor Mrt111@icloud.com RE: 167 Cherry Avenue,.Carlsbad CA 92008 PROJECT: Lead Paint Investigation July 20, 2017 JMR Job #1-647 An investigation to identify the presence of lead-based paint (LBP) was performed by JMR Environmental Services Inc. (JMR) at 167 Cherry Avenue, Carlsbad CA 92008 on July 14, 2017. JMR's survey included a thorough inspection of each room in the subject buildings, including the exteriors. The purpose of this survey was to determine the presence and assess the condition of LBP on fDced and painted surfaces. Many building components at this site appeared to be homogeneous. The building located on this property is currently scheduled for demolition. Equipment used to perform the survey was an X-Ray Fluorescence (XRF) Niton Xlp 300A Spectrum Analyzer. This report includes XRF results and a site map. Also attached are a summary of CaVOSHA's Lead in Construction Standard Title 8, CCR Section 1532.1 and a copy of the California Department of Public Health (CDPH) Inspector's Certification. lead Standards Several government agenc,ies have definitions for what amount of lead GOnstitutes paint to be considered "lead-based." The Department of Housing and Urban Development (HUD) has designated the amount to be 1.0 mg/cm2, via XRF, or 5,000 ppm, via Atomic Absorption Spectrometry (AAS). The HUD regulations are related to potential hazards in the home environment and not to construction activities. CDPH has created lead0 related regulations that have been adopted into Title 17 of the California Code of Regulations. These regulations also define LBP as surface coatings containing lead concentrations of 1.0 mg/crn2, via XRF, or 5,000 ppm, via AAS. The CDPH regulations apply only to lead hazard abatement activities. The Consumer Product Safety Commission (CPSC) has defined lead-based paint as -----/-l.ead&uvey 167 ~ Aven~ Carlsbad CA 92008 4560 Alvarado Canyon Rd., Suite 2D, San Diego, CA 92120 Tel: (619) 858-7260 Fax: {619J 858-7264 I surface coatings containing lead concentrations greater than 90 ppm, via AAS. tn 1978, the CPSC banned the sate of lead-based paint to consumers and the. use of lead-based paint in residences and public buildings. The California Department of Occupational Safety and Health (Cal/OSHA) Lead in Construction Standard (Title 8, CCR Section 1532.1) requires contractors to protect their workers when there is a potential for lead exposure due to the construction activities. Currently, Cal/OSHA has no lead concentration listed where contractors are exempt from Title 8, CCR Section 1532.1. Test Procedures Representative fixed, painted, surfaces were tested using the Niten Xlp 300A Spectrum Analyzer. Results greater than 1.0 mg/cm2 are considered to be positive for lead. Paint chip samples are collected from representative components when XRF results are inconclusive. Paint chip samples are also collected from damaged paint with negative XRF results. Paint chip samples are then analyzed in a laboratory using Atomic Absorption Spectrometry (AAS). A total of O paint chip samples were collected during this investigation. Sites are surveyed using the clockwise theory. When using this theory the inspector must first identify the main entry point of the unit, enter at that location, sample that room first, and then sample all remaining rooms in a clockwise rotation. The wall numbers are also identified using the clockwise theory. Walls are numbered in the following manner. When an inspector is standing in the entry way to a room, that entry wall is wall A; the wall immediately to the inspector's left is wall B; the wall opposite the inspector is wall #C; and the wall to the inspector's right is wall #D. XRF assays were performed using the "unlimited" mode. At this setting the XRF continues to assay the substrate until it has determined the painted surface to be either positive or negative with a confidence level of 95.%. XRF assay results are given on the following pages. Positive assay results greater than 1.0 mg/cm2 (5000ppm) are shaded. Discussion In this summary the tested surfaces are grouped into one of two ranges of lead content. The purpose of this is to categorize the surface lead content as relatively high, mid-ranged, or relatively low. This will help in complying with the Cal/OSHA lead standard as explained later. Furthermore, this categorization identifies which surface coatings HUD, CDPH, and CPSC consider "lead-based." Lead Survey 167 Cherty AV,et1Ue, Catlsbad CA 92006 Based on XRF results, the following surfaces are considered to contain lead concentrations in excess of 1.0 mg/cm2 or 5,000 ppm. • House; Ceramic floor tile throughout. Northeast bathroom: Ceramic shower and countertop tiles • House: Exterior wood walls. wood window sills, eaves and fascia A visual inspection determined the painted surfaces to be in "poor" condition at the time of the inspection. • House: Exterior wood wall Loose and peeling paints must be removed and remaining paint stabilized prior to building demolition. Please note that although some of the tested paints did not exceed the HUD/CDPH definition of LBP, all site paints should be considered having a lead content requiring dust controls and personal protection during building demolmon or renovation, in compliance with Title 8, CCR Section 1532 1. This is further explained in the following section. Cal/OSHA Compliance Recommendations Title 8, CCR Section 1532.1 requirements apply to all construction activities where lead is disturbed and a potential for employee exposure exists. Since common lead analysis methods have a minimum detection limit, a painted surface cannot be shown by practical means to be completely lead-free. In effect. Cal/OSHA's requirements apply to all paint that is disturbed by an employee. Newer paints often contain small amounts of lead (up to 90 ppm is allowed) due to contamination during the manufacturing process. When any amount of lead is disturbed an employee initial exposure assessment must be performed. If an employer has exposure data (air sample results) from similar workplace operations and conditions within the past 12 months then this data can be utilized. If employee exposure data from similar workplace operations are not available, then initial air monitoring is required. Several provisions are required during the initial air monitoring including respiratory protection, protective clothing, changing areas with storage facilities, hand washing facilities, biological monitoring, and various types of training (see the included summary of Title 8, CCR Section 1532.1). We recommend initial air monitoring begin in areas where painted surfaces have higher Lead Survey 167 Cherry Avenue, Carlsbad CA 9to08 lead concentrations so that the results, if favorable, can apply to other painted surfaces with similar or lower lead concentrations (if the work practices are similar). Favorable results would be those that are below the action level of 30 micrograms per cubic meter of air (µg/m3). Inspection Limitations This investigation was planned, developed, and implemented based on previous experience in performing LBP investigations. This inspection was patterned after Chapter 7 of the HUD Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing (1997 Revision). JMR utilized state of the art practices and techniques in accordance with regulatory standards while performing this investigation. Evaluation of the relative risk of exposure to lead identified during this investigation is based on conditions observed at the time of the investigation. JMR cannot be responsible for changing conditions that may alter the relative exposure risk or for future changes in accepted methodology. JMR Environmental Services Inc. appreciates the opportunity to provide these services. Sincerely, David Weaver, Operations Manager JMR Environmental Services Inc CDPH Certification # 15363 Lead Survey 167 Cheny Avenue, Carlsbad CA 92008 Appendices: XRF Results XRF Calibration Form Site Plan Lead Survey 167 Cherry A1<enue, Car1sbad CA 92008 XRF RESULTS lead Sul'\/ey 167 Cherry Avenue. Cat1sbad CA 92008 Customer: Matt Taylor JMR Environmental Services Site: 167 Cherry Avenue 4560-20 Alvarado canyon Rd San Diego, CA 92008 San Diego, CA 92021 Units s WALL COM PON SUIJST J! COf,IQmQN R~ p SHUTIER_CAL cps 383.89 2.09 0.35 0 0 PAINT mg/cm"2 F'inal LIVING ROOM A ENTRY DOOR WOOD INTACT Negative 1 < LOO 0.03 < LOO O.Q3 < LOO 2.08 PAINT mg/ cm"2 Final LIVING ROOM A ENTRY DOORJAMB WOOD INTACT Negative 1 <LOO O.o3 < LOO 0.03 <LOO 2.69 PAINT mg/cm112 Final LIVING ROOM A WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 1.96 PAINT mg/ cm "2 Final LIVING ROOM B WALL DRYWALL INTACT Negatlve 1 <LOO 0.03 < LOO 0.03 < LOO 2.4 PAINT mg/cm"2 Fina I LIVING ROOM C WALL DRVWAL.L INTACT Negative 1 <LOO 0.03 < LOO 0.03 < LOO 2.25 PAINT mg/cm"2 Final LIVING ROOM C DOORJAMB WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.79 PAINT mg/cm"2 Final LIVING ROOM C BASEBOARD WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.72 l>AINT mg/ cm 112 Final LIVING ROOM 0 DOOR WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.31 PAINT mg/ cm "2 Final LIVING ROOM 0 DOORJ.AMB WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <lOD 2.6 PAINT mg/ cm "2 Final LIVING ROOM 0 WALL DRYWALL INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 2.6 PAINT mg/cm"2 Final NE BEDROOM A DOOR WOOD INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 2.02 PAINT mg/cm "2 Final NE BEDROOM A DOORJAMB WOOD INTACT Negative 1 < LOO 0.03 < LOO 0.03 <lOD 2.47 PAJNT mg/cm "2 Final NE BEDROOM A WALL DRYWALL INTACT Negative 1 < LOO 0.03 < LOO 0.03 <100 2.27 PAINT mg/cm"2 Final NE BEDROOM B WALL INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 2.18 PAINT mg/cm"2 Final NE BEDROOM 1 < LOO 0.03 < LOO 0.03 < LOO 2.59 PAINT mg/ cm"2 Final ·NE BEDR02.M.-1 1.9 0.7 1.9 0.7 < LOO 5.4 PAINT mg/ cm "2 Final NE BEDROOM B DOORJAMB INTACT 1 <LOO 0.03 < LOO O.D3 < LOO 2.54 PAINT mg/cm"2 Final NE BEDROOM B DOORJAMB WOOD INTACT Negative l < LOO 0.03 < LOO 0.03 <LOO 2.59 PAINT mg/cm "2 Final NE BEDROOM D WALL DRYWALL INTACT Negatlve l < LOD 0.03 < LOD 0.03 <LOO 2.08 PAINT mg/cm"2 Final NE BATHROOM A DOOR WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.52 PAINT mg/ cm "2 Final NE BATHROOM A DOORJAMB WOOD INTACT Negative 1 <LOO 0.03 < LOO O.o3 < LOO 2.28 PAINT mg/ cm"2 Final NE BATHROOM WALL DRYWALL Negative l < LOD 0.03 < LOO 0.03 <LOO 2.73 PAINT mg/cm"2 Final j.Nl;BATHROOM • COUNJE~TOP Pos1t111e 1 1.5 0.4 1.5 0.4 <LOO 4.2 PAINT mg/ cm"2 Final NE ATHROO_k1 C WAll 1 1.4 0.4 1.4 0.4 <LOO 3.6 PAINT mg/ cm "2 Final NE BATHROOM D WALL DRYWALL 1 <LOD 0.03 < LOO 0.03 < LOO 2.68 PAINT mg/ cm"2 Final DINING ROOM A WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03. <LOO 2.15 PAINT mg/ cm "2 flnal DINING ROOM A DOORJAMB WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.94 PAINT mg/cm"2 Final DINING ROOM B WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.19 PAINT mg/cm "2 Final DINING ROOM C WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03 < LOO 2.17 PAINT mg/cm"2 Final DINING ROOM C DOOR WOOD INTACT Negative 1 < LOD 0.03 < LOO 0.03 <lOD 2.07 PAINT mg/ cm"2 Final DINING ROOM C DOORJAMB WOOD INTACT Ne8atlve 1 < LOO 0.03 < LOO 0.03 < LOO 2.91 PAINT mg/ cm "2 Final DINING ROOM D WALL DRYWALL INTACT 1 < LOO 0.03 < LOO 0.03 < LOO 2 PAINT mg/ cm "2 Final D WOOD 1 <LOO 0.03 < LOO 0.03 <LOO 2.24 PAINT mg/ cm "2 Final 0 1 1.4 0.2 1.4 0.2 <LOO 1.95 PAINT mg/cm"2 Final A DOOR WOOD INTACT 1 < LOO 0.03 < LOO 0.03 < LOO 2.74 PAINT mg/ cm "2 Final A DOORJAMB WOOD INTACT NegaUve 1 <LOO 0.03 < LOO O.Q3 < LOO 2.3 PAINT mg/ cm 112 Final DINING ROOM A WALL DRYWALL INTACT Negative 1 <LOO O.Q3 < LOD 0.03 < LOO 1.18 PAINT mg/cmA2 Final OINlNGROOM B WALL DRYWALL INTACT Negative 1 < LOO 0.03 < LOO 0.03 < LOO 2.2 PAINT mg/ cm "2 Final OINlNGROOM B DOOR WOOD INTACT Negative 1 <; LOO 0.03 < LOO 0.03 < LOO 2.32 PAINT mg/cm"2 Final OININGROOM 8 DOORJAMB WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.74 PAINT mg/ cm "2 Final DINING ROOM C WALL DRYWALL INTACT Negative 1 < LOO 0.03 <LOO 0.03 <LOO 2.3 PAINT mg/ cm"2 Final DINING ROOM D WALL DRYWALL INTACT Negative 1 < LOO O.Q3 < LOO 0.03 <LOO 1.25 PAINT mg/cm "2 Final KITCHEN A WALL DRYWALL INTACT Negative 1 < LOO 0-03 < LOO O.Q3 <LOO 2.33 Customer: Matt Taylor JMR Environmental Services Site: 167 Cherry Avenue 4560·2D Alvarado Canyon Rd San Diego, CA 9W08 San Diego, CA 92021 PAINT mg/cm•2 Final KITCHEN B WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 1.27 PAINT mg/cm •2 Final KITCHEN a COUNTERTOP CERAMIC INTACT Negative 1 <LOO 0.11 < LOO 0.11 <LOO 4.51 PAINT mg/ cm "2 Final KITCH(N B COUNTERTOP CERAMIC 1 <LOO 0.23 < LOD 0.23 <LOO 4.26 PAINT mg/cm•2 Final C WALL DRYWALL 1 <LOO 0.03 < LOO 0.03 <LOO 1.84 PAINT mg/cm •2 Final D 1 <LOO 0.03 < LOO 0.03 <LOO 1.15 PAINT mg/cm •2 Final 1 1.8 0.6 1.8 0.6 <LOO 4.5 PAINT mg/cm•2 Final SOUTH ROOM A WALL Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.07 PAINT mg/cm•2 Final SOUTH ROOM 8 WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO. 0.03 <LOO 2.S2 PAINT mg/cmh2 Final SOUTH ROOM 8 DOOR WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.68 PAINT mg/cmh2 Final SOUTH ROOM B OOORJAMB WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.59 PAINT mg/ cm 112 Final SOUTH ROOM 8 DOORJAMB WOOD INTACT Negative 1 <LOO 0.03 <LOO 0.03 <LOO 2.27 PAINT mg/ cm •2 Final SOUTH ROOM C DRYWALL INTACT Negative 1 < LOO 0.03 <LOO 0.03 <LOD 2.46 PAINT mg/ cm 112 Final Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.32 PAINT mg/cm'2 Final ositlve 1 1.5 0.4 1.5 0.4 <LOO 3.75 PAINT mg/cm'2 Final A DOORJAMB WOOD INTACT Negative l <LOO 0.03 < LOO 0.03 <LOO 2.19 PAINT mg/cm h2 Final LAUNDRY ROOM A WALL DRYWALL INTACT Negative l <LOO 0.03 <LOO 0.03 <LOO 1.25 PAINT mg/cm"2 Final LAUNDRY ROOM 8 WALL DRYWALL INTACT Negative 1 <LOO 0.12 < LOO 0.12 < LOO 2.41 PAINT mg/cm "2 final LAUNDRY ROOM B WALL DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOD 1.13 PAINT mg/cm h2 Final LAUNDRY ROOM B ENTRY DOOR WOOD INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOD 2.22 PAINT mg/cm"2 Final LAUNDRY ROOM B OOORJAMB WOOD INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 2.79 PAINT mg/cm"2 Final LAUNDRY ROOM 0 WALL DRYWALL INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 1.24 PAINT mg/cm"2 Final LAUNDRY ROOM D COUNTERTOP CERAMIC INTACT Negative 1 <LOO 0.06 < LOO 0.06 < LOO 4.31 PAINT mg/cm"2 Final EXTERIOR, HOUSE A ENTRY DOOR WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2 PAINT mg/ cm 112 final EXTERIOR, HOUSE A DOORJAMB WOOD INTACT Negative 1 <LOO 0.03 <LOO 0.03 <LOO 2.31 PAINT mg/cm"2 Final EXTERIOR, HOUSE A OOORJAMB WOOD INTACT Negative 1 <LOO 0.23 < LOO 0.23 <LOO 2.34 PAINT mg/cm"2 Final EXTERIOR, HOUSE A WALL WOOD INTACT Negative 1 0.5 0.2 0.5 0.2 <LOO 0.6 PAINT mgJcm"2 Rn al 1 0.9 0.2 0.9 0.2 u OA PAINT mg/cm"2 Final 1 1.7 0.6 1.1 0.3 1.7 0.6 PAINT mg/cm"2 Final EAVES WOOD INTACT Negative 1 <LOO 0.13 < LOO 0.13 <LOO 1.08 PAINT mg/cm"2 flnal EXTERIOR, HOUSE A EAVES WOOD INTACT Negative 1 <LOO 0.18 < LOO 0.18 <LOO 2.02 PAINT mg/cm"2 Final EXTERIOR, HOUSE A HANDRAIL WOOD INTACT Negative 1 < LOO 0.2 < LOO 0.2 <LOO 2.3 PAINT mg/cm "2 Final EXTERIOR, HOUSE A WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 1.07 PAINT mg/cm •2 Final ·EXTER!OR1 HOUSE WOOi) POO Positive. 1 1.3 0.3 1.3 0.3 1.4 0.5 PAINT mg/cm"2 Final EXTERIOR, HOUSE A EAVES WOOD INTACT Negative 1 < LOO 0.06 <LOO 0.06 <LOO 1.08 PAINT mg/cm "2 Final EXTERIOR, HOUSE A PORCH CONCRETE INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 1.8 PAINT mg/ cm "2 Final EXTERIOR, HOUSE A DECK CONCRETE INTACT 1 < LOO 0.03 < LOO 0.03 <LOO 2.01 PAINT mg/cm"2 Final EXTERIOR, HOUSE A WOOD 1 <LOO 0.22 < LOD 0.22 <LOO 2.25 PAINT mg/ cm "2 Final EXJliRIOR, HOU§E ,/;; 1 3.1 1.1 1.2 0.5 3.1 1.1 SHUTIER_CAL cps Final 2.14 0 0.35 0 0 0 PAINT mg/ cm "2 Final EXTERIOR, HOUSE A WINDOWSILL WOOD Negative 1 <LOO 0.03 < LOO 0.03 <LOO 1.96 PAINT mg/ cm "2 Final EXTERIOR, HOUSE A FASCIA WOOD 1 <LOO 0.03 <LOO 0.03 <LOO 2.42 PA.INT mg/ cm "2 Final EXTERIOR, HOUSE A. FASCIA wooo 1 1.6 0.6 1.6 0.6 <LOO 3 PAJNT mg/cm"2 Final ~XTERlOR{HOUSE I,/ EAVES WOOD 1 3.4 1.8 3.4 1.8 <LOO 4.5 PAINT mg/cm"2 Final EXTERIOR, HOUSE A ENTRY DOOR WOOD Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.4 PAINT mg/ cm "2 Final EXTERIOR, HOUSE A ENTRY DOORJAMB WOOD Negative 1 < LOO 0.03 <LOO 0.03 <LOO 2.32 Customer: Matt Taylor JMR Environmental Services Site: 167 Cherry Avenue 4560-20 Al\larado Canyon Rd San Diego, CA ~2008 San Diego, CA 92021 PAINT mg/ cm "2 Final GARAGE A ENTRY DOOR wooo Negative 1 < LOO 0.03 < LOO 0.03 < LOD 2.02 PAINT mg/ cm "2 Final GARAGE A DOORJAMB WOOD Negatlve 1 <LOO 0.03 < LOO 0.03 < LOO 3.09 PAINT mg/ cm "2 Rnal GARAGE A WAil_ MASONRY INTACT Negative 1 < LOO 0.03 < LOO 0.03 <LOO 1.62 PAINT mg/ cm "2 Final GARAGE B WAil_ MASONRY INTACT Negatl\le 1 < LOO -0.03 < LOO 0.03 <LOO l.84 PAINT mg I cm ,,.2 Final GARAGE C WALL MASONRY INTACT Negative 1 <LOO 0.03 < LOO 0.03 < LOO 1.67 PAINT mg/cm"2 Final GARAGE D WALL MASONRY INTACT Negative 1 <LOO 0.03 < LOO 0.03 < lOD 1.83 PAINT mg/ cm "2 Final GARAGE D CEILING DRYWALL INTACT Negative 1 <LOO 0.03 < LOO 0.03 <lOD 2.05 PAINT mg/cm"2 Final GARAGE,EXTERJOR D CEILING DRYWALL INTACT Negative 1 <LOD 0.03 < LOO 0.03 < LOO 2.6 PAINT mg/ cm "2 Final GARAGE,EXTERIOfl. A ENTRY OOORJAM8 WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 < LOD 2.76 PAINT mg/ cm ,,.2 Final GARAGE,EXTERIOR A ENTRY D00RJAM8 WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 < LOD 3.02 PAINT mg/ cm "2 Flnal GARAG£,EXTERIOR A WALL MASONRY INTACT Negative 1 <LOO 0.15 < LOO 0.15 < LOO 1.6 PAINT mg/cm"2 Final GARAGE,EXTERIOR A WINDOW COMPONENT WOOD INTACT Negative 1 <LOO 0.06 < LOO 0.06 <LOO 2.54 PAINT mg/ cm "2 Final GARAGE,EXTERIOR A EAVES WOOD INTACT Negative 1 0.5 0.3 0.5 0.3 < LOO 2.85 PAINT mg/cm"2 Flnal GARAGE1EXTERIOR A EAVES WOOD INTACT Negati\le 1 <LOO 0.48 < LOO 0.48 < LOO 2.64 PAINT mg/ cm "2 Final GARAGE,EXTEfl.lOR A WALL WOOD INTACT Negative 1 <LOO 0.03 < LOO 0.03 <LOO 2.35 PAINT mg/ cm "2 Final GARAGE,EXTERIOR A EAVES WOOD POOR Negative 1 <LOO 0.19 < LOO 0.19 <LOO 2.55 PAINT mg/ cm "2 Final GARAGE,EXTERIOR A EAVES WOOD POOR Negath1e 1 <LOO 0.45 < LOO 0.45 < LOO 2.98 PAINT mg/cm"2 Final GARAGE,EXTERIOR A FASOA WOOD !NT ACT Negative 1 < LOO 0.75 < LOO 0.75 < LOO 2.43 SHUTTER_CAL cps Final 381.15 2.18 0 0.3 0 0 0 PAINT mg/ cm 112 Final SRM 2573 Positive 1 1.1 0.1 1.1 0.1 < LOO 0.42 PAINT mg/ cm 112 Fina! Sfl.M 2573 Positive 1 1 0.1 1 0.1 < LOD 0.42 PAINT mg I cm "2 Final SRM 2573 Positive 1 1 0.1 1 0.1 < LOO 0.42 XRF CALIBRATION FORM Lead Survey 167 Cherry Avenue, Carlsbad CA 92008 XRF CALIBRATION FORM Inspector: David Weaver Date: July 14. 2017 JMR Job#: 1-647 Device: NITON XLP 300A Job Name: Matt Taylor Job Address: ___ 1,.,6,.,_7...;C..,hcee.,r.!.Jry...,Ac,.v.,_,e"-n"'u"'e~. C=arl'-"s"'b"'a,,,dwC,,,A..:..x9.,_20"'0,.,8'----------- Calibration Check Tolerance Used: -0.06 mg/cm2 & +0.06 mg/cm2 Use Level Ill (1.04 mg/ cm2) NIST SRM 2573 Paint film First Calibration Check Time: ___ 1,_1cc:4:r.,5'---- 1st Reading 2nd Reading 3rd Reading 1•1 Average 1•• Average -0.31 ma/cm2 1.1 1.0 1.0 1.03 -0.01 Second Calibration Check Time: ____ _ 1st Reading ' 2nd Reading 3'" Reading 1" Average 1•1 Average -0.31 ma/cm2 ·--- Third Calibration Check (If Needed) Time: --------- 151 Reading 2°d Reading •use the Test Mode Reading "Tolerance Values: ---.----· 3rd Reading 1"'Average Minus Value = -0.06 mg/cm2 Positive Value = +0.06 mg/cm' -·-·--·---· 1st Average -1.02 ma/cm2 I I • ' SITE PLAN . ---··--------- Lead Survey 167 Cherry Avenue. Carlsbad CA 92008 , \ I J . . u i • I j""~ Northeast Bedroo l ___ c:==: / Family Room ' Uvlng Room 167 Cherry Avenue, Carlsbad CA . Dining Room South Room I,. .. Room Kitchen ~ I ~ r -· --------~-------~-----1 i I Garage ··-·--············--[ (city of Carlsbad DEMOLITION REQUIREMENTS B-9 Development Services Building Division 1635 Faraday Avenue 760-602-2719 www.carlsbadca.gov The following items must be completed prior to issuance of a demolition permit. ~pleted Application and Plans: A demolition permit may only be issued to the owner of the property or the State Licensed Contractor that is doing the work. An application and four (4) sets of plans should be submitted. Building, Planning, Engineering and Fire ~ivisions will review and comment/approve the submittal. ~ Completed Storm Water documents required by the appropriate Tier level as determined by the extent of construction. D A Mobilization Plan, outlining the schedule for demolition, shall be provided to the Building division after the pre-construction meeting with the CM&I division. ~ Letter from Property Owner: The contractor must provide a letter, signed and dated by /he property owner, giving permission for the building to be demolished. ef Demolition Asbestos Certification: This certification must be completed, signed and have the correct square footage of the structure being demolished, as well as its use. If asbestos remediation is required, proof of application to the APCD must also be provided. Asbestos or lead paint remediation must occur prior to issuance of a demolition permit by /the City. ~ San Diego Gas and Electric: Applicant must provide a letter from San Diego Gas and Electric stating that the utilities have been disconnected. --D B-9 Waste Management Plan: Comply with Green Code waste disposal and recycling management program (65%). Sec. 5.408.1 I 4.408. Complete the attached B-59, Waste Management Plan. • Public Property: If applicable provide plans and details demonstrating measures to protect public property and walkways. 't--1/ A Additional items that will be required or discussed in review are: 1. Water Agency: Arrange for appropriate Water Agency to remove water meter unless construction of replacement structure is to begin shortly. 2. The Planning Division will determine if the structure is in the Village Review area, the South Carlsbad Review area, the Coastal Zone or if discretionary mitigation conditions apply. (760) 602-4610 3. The Land Development & Engineering Division will determine if a Haul Route, Right-of-Way Permit or Storm Water Permit is required. (760) 602- 2773, 602-2775 or 602-2741. 4. Fire Department may need the use of the building for training purposes. (760) 602-4665. Page 1 of 2 Rev. 01/2016 AUG 0 9 20'? I. ', <" / DEMOLITION ASBESTOS CERTIFICATION ADDRESS: I IP 1-C-\llb"'1 A11-e... USE OF BUILDING TO BE DEMOLISHED: ------------- SQUARE FEET ,,.,_.. /100 X NUMBER OF STORIES ( PROPERTY OWNER: (Yl<I...~ T~/v- ADDRESS: (p ~r, /It' r C ,._,4\-.. r1wlf vJ. PHONE ~qfr~ APPLICANT: (11,<.t-l r~lv ADDRESS: u 'i7P l"lrcw-4'.... 73 l vfr C::J-PHONE 7(,()-,;w-~?, C? Section 19827.5 of California Health and Safety Code states in part: "A demolition permit shall not be issued by any city ... as to any building or other structure except upon receipt from the permit applicant of a copy of each written asbestos notification regarding the building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project." As applicant for a demolition permit in the City of Carlsbad, I certify that; I have read the excerpt from Section 19827.5 of the Health and Safety Code provided above; the information I have provided on this form is true and correct; and I further certify the following: (><) On the attached pages are copies of all written asbestos notifications regarding the above referenced building that are required to be submitted to the United States Environmental Protection Agency or to Part 61 of Title 40 of the Code of Federal Regulations, or successor to that part. l.JlJ".:> it"\C\.n 3 CJ=- ( ) I declare that the written asbestos notification is not applicable to the scheduled demolition project. ~ Date soqf A a' Sempra Energy u11111y~ AUG O 9 2017 :~'.Li}r,.·i .·,·~ ::::·,, Notice of Service Discontinuance PERMIT DEPARTMENT, CITY OR COUNTY OF: CARLSBAD SERVICE WILL BE DISCONTINUED TO: ADDRESS: 167 CHERRY AVENUE BY: (Date) August 7, 2017 [3J ELECTRIC METER NO. 05165638 ~~~~~~~~~~ [3J GAS METER NO. _0~1~0~9~87~8~5~~~~~~~ ALL SERVICE LINES WILL BE REMOVED. THIS BUILDING CAN BE MOVED OR RAZED AFTER THE ABOVE DATE. SAN DIEGO GAS & ELECTRIC BY: MAYLEH DELEON PHONE: 760-476-5621 DATE: August 7, 2017 PM Forms: NoticeofSeiviceDiscontinuance Revised: 6/20/06 To Whom It May Concern, I, Matthew Taylor sol owner of 167 Cherry Ave. give permission for the site to be completely demolished. Sincerely yours, Matthew Taylor July 27th 2017 ~\JG O 9 20\7 STORM WATER POLLUTION PREVENTION NOTES 1. ALL NECESSARY EQUIPMENT AND MATERIALS SHALL BE AVAILABLE ON SITE TO FACIUTAlE RAPID INSTALLATION OF EROSION AND SEDIMENT CONTROL BMPs WrlEN RAIN IS EMINENT. 2. THE OYINER/CONTRACTOR SHALL RESTORE ALL EROSION CONTROL DE'v'ICES TO WORKING ORDER TO THE SAllSFACTlON OF THE CITY INSPECTOR AFTER EACH RUN-OFF PRODUCING RAINFALL 3. THE OYINER/CONTRACTOR SHALL INSTALL ADDITIONAL EROSION CONTROL MEASURES AS MAY BE REQUIRED BY THE CITY INSPECTOR DUE TO INCOMPLElE GRADING OPERATIONS OR UNFORESEEN CIRCUMSTANCES YiHICH MAY ARISE. 4. ALL REMOVABLE PROTECTIVE DEV1CES SHALL BE IN PLACE AT THE ENO Of" EACH WORKING DAY 'M-lEN THE Fl\.'£ (5) DAY RAIN PROBABILITY FORECAST EXCEEDS FORTY PECENT ( 40%). SILT AND OTHER DEBRIS SHALL BE REMOVED AFTER EACH RAINFALL 5. ALL GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM AGGREGATE. 6. ADE QUA TE EROSION AND SEDIMENT CONlROL AND PERIMETER PROTECTION BEST MANAGEMENT PRACTICE MEASURES 1.4UST BE INSTALLED AND MAINTAINED. 7. THE CITY INSPECTOR SHALL HAVE THE AUTHORITY TO ALTER THIS PLAN DURING OR BEFORE CONSlRUCTION AS NEEDED TO ENSURE COt.4PUANCE WITH CITY STORM WATER QUALITY REGULATIONS. OWNER'S CERTIFICATEc I UNDERSTAND AND ACKNOWLEDGE THAT I t.4UST: (1) IMPLEt.4ENT BEST MANAGEMENT PRACTICES (BMPS) DURING CONSTRUCTIOO ACTIVITIES TO Tl-lE MAXIMUM EXTENT PRACTICABLE TO AVOID Tl-lE MOBIUZA110N OF POLLUTANTS SUCH AS SEDlt.4ENT ANO TO AVOID THE EXPOSURE OF STORt.4 WATER TO CONSTRUCTION RELATED PCUUTANTS: AND (2) ADHERE TO, AND AT All Tlt.4ES, COMPLY WITH THIS CITY APPROVED TIER 1 CONSTRUCTION S\lf'PP Tl-lROOGHOUT Tl-lE DURATION OF Tl-lE CONSTRUCTION ACTIIJITIES UNTIL Tl-lE CONSTRUCTION 'NORK IS COMPLETE AND APPROVED BY THE CITY OF CARLSBAD. OYINER(S)/OWNEifS AGENT NAME (PRINT) OYINER(S)/OYINER'S AGENT NAt.4E (SIGNATURE) ·oATE E-29 STORM WATER COMPLIANCE FORM TIER 1 CONSTRUCTION SWPPP E-29 CB~2Dll-l'Olo SW BEST MANAGEMENT PRACTICES (BMP) SELECTION TABLE Best Management Practice" (BMP) Description ----, CASQA Designation ~ Construction Activity Grading/Soi Disturbance TrenchingjExccvotion Stockpiling Drllllng/Borlna Concrete/Asphalt Sawcuttina Concrete Flatwork Paving Conduit/Pipe Installation Stucco/Mortar Work Waste D!sposal Staging/lay Down Area Equipment M~intenance and Fuelina Hazardous Sul;li;ltance Use/Storoge Dewaterlng ~te Access Across Dirt Other """"mstf; Erosion Control '"" -1i " ~-~ C 0 lj C O"i;j ~ ]~ ~ a g, "8 ~-~ i WO ~ I ro I ~ D c1 D w w w i l ' ~ ! ~ ' l>I X X Sediment Control BMPs ~ 5 ~ ~ ~ -~ ! .5 ro il-g !!!c. g' ·~ &: -~ !s ii £ ro ~-~ g' O:;:: i ~ 1: 1 ]§ ,g E _M C O 0 ~ t;: (5 ~> ~ vid:: ~ ~ ~ w ~ ro 0 ' J, ' ' ' ' ' l>I w w l>I l>I l>I ~ ~ ~ X X Tracking Non-Storm Water Control BMPs Management BMPs ! ~ ~ ! • il ~ £ ·E E ~ I -~ ~. 8 ; l " 8~ ~. ~ ll~ ]~ •• •• •o ~] . ~~ ~~ " j·; :c ~ :§8 ce ~ &; g' cg ~8 ~~ l< a: cl'" ' N ' ~ ~ ro ' ' ' ' I" I" ~ ~ ~ ~ z z z z X X ~ 5 .i ~ i g' c.S "~ ' ii! Waste Management and Materials Pollution Control BMPs < . ~ E C • 0 8' C .. 6 ,g ~ ::E ~ 1 t !~ ::E vi br8 ] 1! ij !i ~ E 6 E :1E=8, --e8. :2 g l;l g 0 0 O 0 U'>::E :I:::E NI nl ~ I~ I I I I ii! ii! i! i! w ' i! X X X X X Instructions: 1. Check the box to the left of all applicable construction activity (first column) expected to occur during construction. 2. Located along the top of the BMP Table is a list af BMP's with it's corresponding Colifamia Stormwater Quality Association (CASQA) designation number. Choose one or more Bt.4Ps )l:IU intend to use during construction from the list. Check the box where the chosen activity row intersects with the BMP column . .3. Refer to the CASQA construction handbook for information and details of the chosen BMPs ood how to apply them to the project. SHOW THE LOCATIONS OF ALL CHOSEN BMPs ABOVE ON THE PROJECTS SITE PLAN/EROSION CONTROL PLAN. SEE THE REVERSE SIDE OF THIS SHEET FOR A SAMPLE EROSION CONTROL PLAN. PROJECT INFORMATION Site Address; ______________ _ Assessor's Parcel Number:---------- Emergency Contact: Name: ______________ _ 24 Hour Phone: ___________ _ Construction Threat to StO!lTl Water Quality (Check Box) 0 MEDIUM 0 LOW ii •E ] g'1 •• u" 'l' ii! X X X Page 1 of 1 REY 02/16 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY RECORDID#~~~~~~~~~~~~~~~~~~I PLANCHECK#~~~~~~~~~~~~~~~~~I BP DATE Business Name Business Contact Telephone# Project Address /lo+ r City Applicant E-mail \I 1 c.\ou L, · CU"' State C,f.1 State APN# Plan File# Telephone# 7/i,O · S 00 · rt' ;z.. 0 The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT -HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: (not required for projects within the City of San Diego): Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. Occupancy Rating: Facility's Square Footage (including proposed project): 1. Explosive or Blasting Agents 5. Organic Peroxides 9. Water Reactives 13. Corrosives 14. Other Health Hazards 2. Compressed Gases 6. Oxidizers 10. Cryogenics 3. Flammable/Combustible Liquids 7. Pyrophorics 11. Highly Toxic or Toxic Materials 15. None of These. 4. Flammable Solids 8. Unstable Reactives 12. Radioactives PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH HAZARDOUS MATERIALS DIVISION (HMDl: If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 5500 Overland Avenue, Suite 110, San Diego, CA 92123. Call (858) 505-6700 prior to the issuance of a building permit. 0 CalARP Exempt I FEES ARE REQUIRED Project Completion Date: Expected Date of Occupancy: 1. 2. 3. 4. 5. 6. 7. 8. YES NO D ~ D lill D 181 D D D D D 18:1 18:1 ~ 181 181 (for new construction or remodeling projects) Is your business listed on the reverse side of this form? (check all that apply). Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business store or handle Hazardous Substances in quantities greater than or equal to 55 gallons, 500 pounds and/or 200 cubic feet? Will your business store or handle carcinogens/reproductive toxins in any quantity? Will your business use an existing or install an underground storage tank? Will your business store or handle Regulated Substances (CalARP)? Will your business use or install a Hazardous Waste Tank System (Title 22, Article 1 O)? Will your business store petroleum in tanks or containers at your facility with a total facility storage capacity equal to or reater than 1,320 allons? California's Above round Petroleum Stora e Act). Date Initials 0 CalARP Required I Date Initials 0 CalARP Complete I Date Initials PART 111: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT (APCDl: Any YES" answer requires a stamp from APCD 10124 Old Grove Road, San Diego, CA 92131 apcdcomp@sdcounty.ca.gov (858) 586-2650). [*No stamp required if Q1 Yes and Q3 Yes and Q4-Q6 No). The following questions are intended to identify the majority of air pollution issues at the planning stage. Projects may require additional measures not identified by these questions. For comprehensive requirements contact APCD. Residences are typically exempt, except -those with more than one building ... on the property; single buildings with more than four dwelling units; townhomes; condos; mixed-commercial use; deliberate burns; residences forming part of a larger project. [ ... Excludes garages & small outbuildings.) 1. 2. 3. 4. 5. 6. YES NO 181 D Jg] D ~ D D Will the project disturb 160 square feet or more of existing building materials? Will any load supporting structural members be removed? Notification may be required 1 O working days prior to commencing demolition. (ANSWER ONLY IF QUESTION 1 or 2 IS YES) Has an asbestos survey been performed by a Certified Asbestos Consultant or Site Surveillance Technician? 181 D D (ANSWER ONLY IF QUESTION 3 IS YES) Based on the survey results, will the project disturb any asbestos containing material? Notification may be required 10 working days prior to commencing asbestos removal. D Will the project or associated construction equipment emit air contaminants? See the reverse side of this form or APCD factsheet (www.sdapcd.org/info/facts/permits.pdf) for typical equipment requiring an APCD permit. D (ANSWER ONLY IF QUESTION 5 IS YES) Will the project or associated construction equipment be located within 1,000 feet of a school bounda Briefly describe business activities: Briefly describe proposed project: I declare under penalty of perjury that to the best of my knowledge and belief t e responses made herein are true and correct. OJ~illvw ,""11.... ~ -1. .?-. Name of Owner or Authorized Agent Signature of Owne?or Authorized Agent 8 I t I I+ Date FOR OFFICAL USE ONLY: FIRE DEPARTMENT OCCUPANCY CLASSIFICATION: ________________________________ _ BY· DATE· I I EXEMPT OR NO FURTHER INFORMATION REQUIRED RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY RELEASED FOR OCCUPANCY COUNTY-HMO* APCD COUNTY-HMO APCD COUNTY-HMO APCD *A stamp m this box only exempts businesses from completing or updating a Hazardous Materials Business Plan. Other permitting requrrements may still apply. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division LIST OF BUSINESSES WHICH REQUIRE REVIEW AND APPROVAL FROM THE COUNTY OF SAN DIEGO DEPARTMENT OF ENVIRONMENTAL HEAL TH -HAZARDOUS MATERIALS DIVISION Check all that apply: AUTOMOTIVE 0 Battery Manufacturing/Recycling D Boat Yard D Car Wash D Dealership Maintenance/Painting D Machine Shop D Painting D Radiator Shop D Rental Yard Equipment D Repair/Preventive Maintenance D Spray Booth D Transportation Services D Wrecking/Recycling CHEMICAL HANDLING D Agricultural supplier/distributor D Chemical Manufacturer D Chemical Supplier/Distributor D Coatings/Adhesive D Compressed Gas Supplier/Distributor D Dry Cleaning D Fiberglass/Resin Application D Gas Station D Industrial Laundry D Laboratory D Laboratory Supplier/Distributor D Oil and Fuel Bulk Supply D Pesticide Operator/Distributor CHEMICAL HANDLING D Photographic Processing D Pool Supplies/Maintenance D Printing/Blue Printing D Road Coatings 0 Swimming Pool D Toxic Gas Handler D Toxic Gas Manufacturer METAL WORKING D Anodizing D Chemical Milling/Etching D Finish-Coating/Painting D Flame Spraying D Foundry D Machine Shop-Drilling/Lathes/Mills D Metal Plating D Metal Prepping/Chemical Coating D Precious Metal Recovery D Sand Blasting/Grinding D Steel Fabricator D Wrought Iron Manufacturing AEROSPACE D Aerospace Industry D Aircraft Maintenance D Aircraft Manufacturing OTHERS AND MISCELLANEOUS D Asphalt Plant D Biotechnology/Research D Chiropractic Office D Co-Generation Plant D Dental ClinidOffice D Dialysis Center D Emergency Generator D Frozen Food Processing Facility D Hazardous Waste Hauler D Hospital/Convalescent Home D Laboratory/Biological Lab D Medical Clinic/Office D Nitrous Oxide (NOx) Control System D Pharmaceuticals D Public Utility D Refrigeration System D Rock Quarry D Ship Repair/Construction D Telecommunications Cell Site D Veterinary ClinidHospital D Wood/Furniture Manufacturing/Refinishing ELECTRONICS D Electronic Assembly/Sub-Assembly D Electronic Components Manufacturing D Printed Circuit Board Manufacturing NOTE: THE ABOVE LIST INCLUDES BUSINESSES, WHICH TYPICALLY USE, STORE, HANDLE, AND DISPOSE OF HAZARDOUS SUBSTANCES. ANY BUSINESS NOT INCLUDED ON THIS LIST, WHICH HANDLES, USES OR DISPOSES OF HAZARDOUS SUBSTANCES MAY STILL REQUIRE HAZARDOUS MATERIALS DIVISION (HMD) REVIEW OF BUSINESS PLANS. FOR MORE INFORMATION CALL (858) 505-6880. LIST OF AIR POLLUTION CONTROL DISTRICT PERMIT CATEGORIES Businesses, which include any of the following operations or equipment, will require clearance from the Air Pollution Control District. CHEMICAL 47 -Organic Gas Sterilizers 32 -Acid Chemical Milling 33 -Can & Coil Manufacturing 44 -Evaporators, Dryers & Stills Processing Organic Materials 24 -Dry Chemical Mixing & Detergent Spray Towers 35 -Bulk Dry Chemicals Storage 55 -Chrome Electroplating Tanks COATINGS & ORGANIC SOLVENTS 27 -Coating & Painting 37 -Plasma Arc & Ceramic Deposition Spray Booths 38 -Paint, Stain & Ink Mfg 27 -Printing 27 -Polyester Resin/Fiberglass Operations METALS 18 -Metal Melting Devices 19 -Oil Quenching & Salt Baths 32 -Hot Dip Galvanizing 39 -Precious Metals Refining ORGANIC COMPOUND MARKETING (GASOLINE, ETC} 25 -Gasoline & Alcohol Bulk Plants & Terminals 25 -Intermediate Refuelers 26 -Gasoline & Alcohol Fuel Dispensing COMBUSTION 34 -Piston Internal -Combustion Engines 13 -Boilers & Heaters (1 million BTU/hr or larger) 14 -Incinerators & Crematories 15 -Burn Out Ovens 16 -Core Ovens 20 -Gas Turbines, and Turbine Test Cells & Stands 48 -Landfill and/or Digester Gas Flares ELECTRONICS 29 -Automated Soldering 42 -Electronic Component Mfg FOOD 12 -Fish Canneries 12 -Smoke Houses 50 -Coffee Roasters 35 -Bulk Flour & Powered Sugar Storage SOLVENT USE 28 -Vapor & Cold Degreasing 30 -Solvent & Extract Driers 31 -Dry Cleaning ROCK AND MINERAL 04 -Hot Asphalt Batch Plants 05 -Rock Drills 06 -Screening Operations 07 -Sand Rock & Aggregate Plants 08 -Concrete Batch, CTB, Concrete Mixers, Mixers & Silos 10 -Brick Manufacturing OTHER 01 -Abrasive Blasting Equipment 03 -Asphalt Roofing Kettles & Tankers 46 -Reverse Osmosis Membrane Mfg 51 -Aqueous Waste Neutralization 11 -Tire Buffers 17 -Brake Debonders 23 -Bulk Grain & Dry Chemical Transfer & Storage 45 -Rubber Mixers 21 -Waste Disposal & Reclamation Units 36 -Grinding Booths & Rooms 40 -Asphalt Pavement Heaters 43 -Ceramic Slip Casting 41 -Perlite Processing 40 -Cooling Towers -Registration Only 91 -Fumigation Operations 56 -WWTP (1 million gal/day or larger) & Pump Station NOTE: OTHER EQUIPMENT NOT LISTED HERE THAT IS CAPABLE OF EMITTING AIR CONTAMINANTS MAY REQUIRE AN AIR POLLUTION CONTROL DISTRICT PERMIT. IF THERE ARE ANY QUESTIONS, CONTACT THE AIR POLLUTION CONTROL DISTRICT AT (858) 586-2600. HM-9171 (08/15) County of San Diego -DEH -Hazardous Materials Division , INDUSTRIAL WASTEWATER DISCHARGE PERMIT SCREENING SURVEY Date. ___ _ Business Name. __________________________ _ Street Address, __________________________ _ Email Address __________________________ _ PLEASE CHECK HERE IF YOUR BUSINESS IS EXEMPT: (ON REVERSE SIDE CHECK TYPE OF BUSINESS) D Check all below that are present at your facility: Acid Cleaning Ink Manufacturing Nutritional Supplement/ Assembly Laboratory Vitamin Manufacturing Automotive Repair Machining I Milling Painting I Finishing Battery Manufacturing Manufacturing Paint Manufacturing Biofuel Manufacturing Membrane Manufacturing Personal Care Products Biotech Laboratory (I.e. water filter membranes) Manufacturing Bulk Chemical Storage Metal Casting I Forming Pesticide Manufacturing I Car Wash Metal Fabrication Packaging Chemical Manufacturing Metal Finishing Pharmaceutical Manufacturing Chemical Purification Electroplating (including precursors) Dry Cleaning Electroless plating Porcelain Enameling Electrical Component Anodizing Power Generation Manufacturing Coating (i.e. phosphating) Print Shop Fertilizer Manufacturing Chemical Etching I Milling Research and Development Film I X-ray Processing Printed Circuit Board Rubber Manufacturing Food Processing Manufacturing Semiconductor Manufacturing Glass Manufacturing Metal Powders Forming Soap I Detergent Manufacturing Industrial Laundry Waste Treatment/ Storage SIC Code(s) (if known):---------------------- Brief description of business activities (Production I Manufacturing Operations): _____ _ Description of operations generating wastewater (discharged to sewer, hauled or evaporated): Estimated volume of industrial wastewater to be discharged (gal I day): _______ _ List hazardous wastes generated (type I volume):---------------- Date operation began/or will begin at this location:--------------- Have you applied for a Wastewater Discharge Permit from the Encina Wastewater Authority? Yes No If yes, when:--------------------- Site Contact~ _____________ Title'-------------- Signature Phone No.·----,----,---,------ ENCINA WASTEWATER AUTHORITY, 6200 Avenida Encinas Carlsbad, CA 92011 (760) 438-3941 FAX: (760) 476-9852 DISCHARGE PERMIT EXEMPT LIST The commercial enterprises listed below are a partial listing of businesses that are exempt from industrial wastewater discharge permitting under normal operating conditions. They are exempt because (a) they discharge no process wastewater (i.e., they only discharge sanitary wastewater with no pollutants exceeding any local limits), and (b) they have no potential to negatively impact the EWPCF or other wastewater treatment plants in the ESS. Any questions regarding exemptions should be referred to EWA Source Control staff. Automobile Detailers Barber/Beauty Shops Business/Sales Offices CarpeUUpholstery Cleaning Services Childcare Facilities Churches Community Centers Consulting Services Contractors Counseling Services Educational Services (no auto repair/film developing) Financial Institutions/Services Fitness Centers Gas Stations (no car wash/auto repair) Grocery Stores (no film developing) Home-based Businesses Hotels/Motels (no laundry) Laundromats Libraries Medical Offices (no x-ray developing) Mortuaries Museums Nail Salons Nursing Homes Office Buildings (no process flow) Optical Services Pest Control Services (no pesticide repackaging for sale) Pet Boarding/Grooming Facilities Postal Services Public Storage Facilities Restaurants/Bars Retail/Wholesale Stores (no auto repair/film developing) Theaters (Movie/Live)