HomeMy WebLinkAbout2690 ROOSEVELT ST; ; CBR2022-1151; Permit (2){city of
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT P~::;:
DeveloQment_~ervices_
B-59 ,,-,.,,"
~PR O 4 2022
Building Division
1635 Faraday Avenue
760-602-2719
www.carlsbadca.gov
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Many of the materials generated from your project can be recycled. You are required to list materials that will be
reused, recycled or disposed from your project. If you have questions about the recycling requirement or completing
this form, please contact Waste Management at (760) 929-9400, a certified C&D recycler, or the Carlsbad Building
Division at (760) 602-2700. Please note: Unless you are self-hauling, Waste Management or approved haulers must be
used for all construction projects within the City of Carlsbad.
PART 1 Complete and submit this form when applying for a Building Permit. Note: Permits will n_c,t be issued
without a completed Construction Waste Management Plan.
Applicant Information
Permit No. CiQJ d -\ \ 5 ( Project Title
Project Address Ul D ~~£.A!-'.l-,,2.,. '.; )(;--( __ ,
Applicant Name
Project Type
(check all that apply):
Residentia(
0
Please check the appropriate box:
Commercial
□
Architect Other
0 0--
,CJ I plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction.
,, '~ :: EJ I ~Ian on self-hauling to a certified recycling facility and will provide all receipts after construction.
---~is is a proposed LEED certified project and I plan on separating materials on site in conjunction with WASTE
MANAGEMENT.
Acknowledgement: I certify under penalty of perjury under the laws of the State of California that the information
provided in and with this form pertains to construction and demolition debris generated only from the project listed
in PART 1, that I have reviewed the accuracy of the information, and that the information ls true and correct to the
best of my knowledge and belief.
,.,.----..
Print Name ¼ 1~ d~,r7"
J
Page 1 of 4 Rev. 7/1/20
PART 1 Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Permits will
I {cont'd} not be issued without a completed Construction Waste Management Plan.
DEBRIS RECYCLING ESTIMATE:
Permit No. --~---~~~ __ Project Title ...:i.k!l,e, l-~ Ve ft'-:)/ ,+wi-
Project Address, _ __,2"'--"(,,_,1_,_o_· _---e.,-==-"--'~'--'--,.,_,---'-\ •"-~-/4--'·,,'--J-e_--''----------APN U 'J -{ <> 7,,. --J ')
Applicant Name '.T A¥W < orlP. Phone ( 7"' D) if 'f f -+ 3 +4
Last First . lo~
SECTION B Complete :the following table with estimated waste tonnage to be generated by your project.
ThiS is your plan for construction waste management. Changes can be made on the final recycle report.
Goal: the diversion rate shall be 65% by weights of debris.
A B C
Material Type Estimated
Waste Quantity
(tons)
Place a (u) check Place a (0) check next Place a (0) check next
Complete this line of the table only if
only using WASTE MANAGEMENT
roll-off bins.
Mixed C&D Debris
Asphalt & Concrete
Brick/ Masonry/ Tile
Mixed Inert Debris
Cabinets, Doors, Fixtures,
Windows (circle all that apply)
Carpet
Carpet Padding/ Foam
Cardboard
Ceiling Tile (acoustic)
Drywall (used, new, scrap)
Landscape Debris (brush, trees,
stumps, etc.) No dirt.
Unpainted Wood & Pallets
Roofing Materials
Scrap Metal
Stucco
Other:
TOTAL
SECTION C
next to items to be
reused or salvaged
□
□ □ □
□
□
□
□
□
□
□ □
□
□
□ □
to items to be to items to be
recycled disposed at landfill
□ □
□ □
□ □
□ □
□ □
□ □
□
□ □
□ □
□ I □
□ □
□ □
□ □
□ / □
□ □
/::: ., ,---/,;;.' I/ To meet 65% Diversion Requirement (estimate) -~b~✓~•c.__c'-'~-~•----x 0.65 ::: ____ ~7 ________ tons
1,,,.,,-----" Total Estimated Waste from above
Contractor/Owner Signa::re ,, L ;;,~_,,---Date ~'=',"t.~'".~"'-~---;>"'-'-.:""---"------------
Page 2 o/4
Minimum Required Diversion
I 9':, I I .,; i U I -z,'L
I
Rev. 11/12118
P.O.
MOODY'S
EL CORAZON RECLAMATION
POBOX969
BONSALL, CA 92003
(760) 433-3316 • FAX (760) 433-6691
~
JOB# DATE
CASH CHECK . GHAAGE COMMERCIAL RESIDENCE TIME
NAME
CITY OF ORIGIN
JOB LOCATION
,/ ~ ~ .... ...,,_. __ , c4 (""J
PU TRAILER FLATBE0 BOBTAIL rO-~l"IEEL IENDDUMP IT&T
MATERIAL
LOAD COUNT .
1 2 3 4 5 6 7 8 9
--.
#LOADS X PRICE OTHER CHARGES
SIGNATURE
All bills due upon presentatidn unless otherwise
arranged in advance. Open accounts subject to
1 1/2% month, charge after 30 days unpaid
balance.
$
TOTAL
TRUCK#
MOODY'S is not responsible for damage to
vehicle while being loaded or unloaded in
yard.
JOB COPY 1
10
MOODYS
3210 OCEANSIDE r
BONSALL, -OA. ••-••
--760-631-0342
SALE
REF#: 00000021
Batch #: 084
08/17/22
APPR CODE: 017435
ENCRYPTED BY ELAVON
Trace: ·21
14:07:29
VISA Manual CP
************2068
AMOUNT
SURCHARGE
TOTAL
**/**
$800,00
$32.00
$832.00
APPROVED
THANK YOU
CUSTOMER COPY
I
INLAND PACD'IC RESOURCE RECOVERY, LLC.
l-a. -w
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GREEN' & WOOD RECYCLING
P.O. BOX 877 LAKESIDE, CA 92040
(619) 390-1418 Fax (619) 390-1449/7918 DATE
www.iprrgreen.com
RECEIVED FROM ___ \----->ci~"~'•~· _________ $
TRUCK# .) \ TIME: ---~------~~~-----------
BY
,.___ __________________ Thank You I
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INLAND PACD'IC RESOURCE RECOVERY, LLC.
GREEN & WOOD RECYCLING
P.O. BOX 877 LAKESIDE, CA 92040
(619) 390-1418 Fax (619) 390-1449/7918
www.iprrgreen.com
DATE ______ ~
RECEIVED FROM ______________ $
TRUCK# ___________ T~l=M=E~: ---------~
FOR ___ ~_L_-'----'-~-------'S~U~R=C~H=A=R=G=E~: _______ _
BY -----------------._ ___________________ Thank You!
INLAND PACD'IC RESOURCE RECOVERY, LLC.
l-a.
GREEN & WOOD RECYCLING
P.O. BOX 877 LAKESIDE, CA 92040
(619) 390-1418 Fax (619) 390-1449/7918
www.iprrgreen.com
TE ' I'\ ' DA' ,, , i \ :• '. -w RECEIVED FROM_\----\--)-'!--l.-J\)-1------------$ \i 1,
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PO# ./~eue/f Sf·
L-------------------Thank You!
INLAND PACIFIC RESOURCE RECOVERY, LLC.
l-a. -w
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GREEN & WOOD RECYCLING
P.O. BOX 877 LAKESIDE, CA 92040
(619) 390-1418 Fax (619) 390-1449/7918 DATE
www.iprrgreen.com
.__ ___________________ Thank You!
I
INLAND PACD'IC RESOURCE RECOVERY, LLC.
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GREEN&: WOOD RECYCLING
P.O. BOX 877 LAKESIDE, CA 92040
(619) 390-1418 Fax {619) 390-1449/7918 DATE
WWW. iprrgreen .com -------
RECEIVED FROM_ .. _•\..,..; __ \,...'i_\,,._1 _)+----------$ '
.__ ___________________ Thank You!
INLAND PACIFIC RESOURCE :RECOVERY, I.LC.
GREEN &WOOD llCYa.JNG
P.O. BOX877 LAKESIDE, CA 92040 I-(619) 390-1418 Fax (619) 390-1449/7918 DATE a. www.iprrgreen.com ----RECEIVED FROM l l/ 1) $ w
0 TRUCK# TIME: <' .
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0:: ffense vt;) ±: PO# 'S±-,
BY
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PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS
TARE
NET
34,800
28,860
5,940
Tracking Qty: 0.00
Qty
2.97
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Scale In
Tare Out
100%
Ticket #: 2441273
Weighrnaster: rivernol
In:
Out:
Vehicle:
Ref:
BOL:
August 12, 2022
August 12, 2022
A52145
INBOUND
INVOICE
Rate
$87.54
Extension
$259.99
Tax
$0.00
Total
Paid
Change
2:07 pm
2:07 pm
Total
$259.99
$259.99
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 35,780 Scale In
Ticket #: 2441328
Weighmaster: marticy
In:
Out:
Vehicle:
Ref:
BOL:
August 12, 2022
August 12, 2022
A52145
TARE
NET
28,860 Tare Out INBOUND
INVOICE 6,920
Tracking Qty: 0.00
Qty
3.46
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
100%
Rate
$87.54
Extension
$302.89
Tax
$0.00
Total
Paid
Change
3:30 prr,
3:30 pm
Total
$302.89
$302.89
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760) 603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS
TARE
NET
Tracking Qty:
34,340
28,860
5,480
0.00
Qty
2.74
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Scale In
Tare Out
100%
Ticket #: 2441124
Weighmaster: marticy
In:
Out:
Vehicle:
Ref:
BOL:
INBOUND
INVOICE
August 12, 2022
August 12, 2022
A52145
Rate Extension
$87.54 $239.86
Tax
$0.00
Total
Paid
Change
11 : 2 6 am
11: 2 6 am
Total
$239.86
$239.86
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS
TARE
NET
32,520 Scale In
28,860 Tare Out
3, 660
Tracking Qty: 0.00
Qty
1. 83
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
100%
Ticket #: 2441023
Weighmaster: marticy
In:
Out:
Vehicle:
Ref:
BOL:
August 12, 2022
August 12, 2022
A52145
INBOUND
INVOICE
Rate
$87.54
Extension
$160.20
Tax
$0.00
Total
Paid
Change
9:02 am
9:02 am
Total
$160.20
$160.20
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS
TARE
NET
33,400
28,860
4,540
Tracking Qty: 0.00
Qty
2.27
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Ticket #: 2440977
Weighmaster: aceveos
Scale In
Tare Out
100%
In:
Out:
Vehicle:
Ref:
BOL:
August 12, 2022
August 12, 2022
A52145
demo
INBOUND
INVOICE
Rate
$87.54
Extension
$198. 72
Tax
$0.00
Total
Paid
Change
7:51 am
7:51 am
Total
$198.72
$198.72
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760) 603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 34,000
TARE 28,860
NET
Tracking Qty:
5, 14 0
0.00
Qty
2.57
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Ticket #: 2441068
Weighmaster: marticy
Scale In
Tare Out
100%
In:
Out:
Vehicle:
Ref:
BOL:
August 12, 2022
August 12, 2022
A52145
INBOUND
INVOICE
Rate
$87.54
Extension
$224.98
Tax
$0.00
Total
Paid
Change
10:08 am
10:08 am
Total
$224.98
$224.98
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 35,380
TARE
NET
28,860
6,520
Tracking Qty: 0.00
Qty
3.26
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Ticket #: 2441195
Weighmaster: marticy
Scale In
Tare Out
100%
In:
Out:
Vehicle:
Ref:
BOL:
August 12, 2022
August 12, 2022
A52145
INBOUND
INVOICE
Rate
$87.54
Extension
$285.38
Tax
$0.00
Total
Paid
Change
12:43 pm
12:43 pm
Total
$285.38
$285.38
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760) 603-0153
333366 -TVD INC
PO BOX#1205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 35,380
TARE 28,860
NET
Tracking Qty:
6,520
0.00
Qty
3.26
Unit Description
TN MSW
Origin: CAMP PENDLETON
Signature:
Scale In
Tare Out
100%
Ticket #: 2442020
Weighmaster: marticy
In:
Out:
Vehicle:
Ref:
BOL:
August 15, 2022
August 15, 2022
A52145
INBOUND
INVOICE
Rate
$87.54
Extension
$285.38
Tax
$0.00
Total
Paid
Change
9: 2 0 am
9:20 am
Total
$285.38
$285.38
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760) 603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: COMM-GATE
GROSS
TARE
NET
Tracking Qty:
Yr. 200
31,840
28,860
2,980
0.00
Qty
1. 49
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Scale In
Tare Out
100%
Ticket #: 2442395
Weighmaster: gomezda
In:
Out:
Vehicle:
Ref:
BOL:
INBOUND
INVOICE
August 16, 2022
August 16, 2022
A52145
Rate
$87.54
Extension
$130.43
Tax
$0.00
Total
Paid
Change
6: 2 4 am
6: 2 4 am
Total
$Ll0.43
$130.43
$1J.OO
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 33,540
TARE 28,860
NET
Tracking Qty:
4,680
0.00
Qty
2.34
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Scale In
Tare Out
100%
Ticket #: 2442273
Weighmaster: marticy
In:
Out:
Vehicle:
Ref:
BOL:
INBOUND
INVOICE
August 15, 2022
August 15, 2022
A52145
Rate Extension
$87.54 $204.84
Tax
$0.00
Total
Paid
Change
2:35 pm
2:35 pm
Total
$204.84
$204.84
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760) 603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 34,340
TARE 28,860
NET
Tracking Qty:
5, 4 8 0
0.00
Qty
2.74
Unit Description
TN MSW
Origin: CARLSBAD
Signature:
Ticket #: 2442184
Weighmaster: cisneadl
Scale In
Tare out
100%
In:
Out:
Vehicle:
Ref:
BOL:
August 15, 2022
August 15, 2022
A52145
INBOUND
INVOICE
Rate
$87.54
Extension
$239.86
Tax
$0.00
Total
Paid
Change
1:03 pm
1:03 pm
Total
$239.86
$239.86
$0.00
$0.00
PALOMAR TRANSFER
5960 EL CAMINO REAL
CARLSBAD, CA 92008
(760)603-0153
333366 -TVD INC
PO BOX#l205
CARDIFF, CA 92007
Contract: INDUSTRIAL-GATE 2
GROSS 34,820 Scale In
TARE 28,860 Tare Out
NET 5,960
Tracking Qty: 0.00
Qty
2.98
Origin:
Signature:
Unit Description
TN MSW
CARLSBAD 100%
Ticket #: 2441962
Weighmaster: aceveos
In:
Out:
Vehicle:
Ref:
BOL:
INBOUND
INVOICE
August 15, 2022
August 15, 2022
A52145
Rate Extension
$87.54 $260.87
Tax
$0.00
Total
Paid
Change
8:01 am
8:01 am
Total
$260.87
$260.87
$0.00
$0.00
DATE:07/20/2022
ATTN:
Randolf Cherewlck
The following acknowledgement Is a summery.for the Abatement Services listed below:
2690 Roosevelt Ave.
Carlsbad Ca. 92008
LIC#572682
Janus Corporation is a Licensed Abatement Contractor, license# 572682 classes A, ASB, B, C-2 HA2, DOSH certificate
224. We have successfully removed and disposed of the ACM and lead containing from the location mentioned above,
per the Altec Asbestos and Lead Survey dated 1/25/2018 Project# 419-2018110. Work was performed starting
4/11/2022 completed 4/14/2022 In accordance with methods and procedures out lined in CCR title 8.1529, Asbestos
waste will be disposed at South Yuma County Landfill, 19536 South Ave El, Yuma AZ. 85365. All painted surfaces were
stabilized for demolition and disposed of. Please contact me If you have any questions at (619)571-6047.
Respec~
/.:nton
Project Manager
1220 Keystone Way Vista Ca 92081
760-598-7374 fax 760-598-8294
WORK ORDER: t7648
cow.-111111 JNIIUlil CORN>RATJON c.......,...._ JANUSCORPORATION
Ad ... a: 1220 KEYSTONE WAY
VLS RECOVERY SERVICES, LLC
14121 :lohnlon Av..-.ue, II~ CA 12020
(tat) 441~11:ll Fa(flt) 441•21:11
a.ts 05/06/2022
Cllr, VISTA, CAIJfORNlA 92081
COllt&e MARICELA LAM~
Deecripllen.,Servlc.:
P.O.#:
!PAID: .
Pho...: 760·59'·73"4
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CIP Number. 1374
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14. Special Handling Instructions and Additional Information
1 "~ -.~ _.,.,nt.;imm.:i lf,11~te ER~i171 ·""•.lld ( or.ti _, ,ei!!._oroo.r FPE 1r \Jndeliveooe, r.tum t Q fli, :t,1
t -f -• .. ~"" "':..,~ i-r-J''-':'l!JS,;-r, ,I ilc; •• t, • f11tr •• ,d11t.a,u..,1 • .:.v ..... , .. lJ..;h,:.. •:,..II 1. ... t-~ • IU,
15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hel8by declare that the contents of this consignment are fuHy and accurately described above by the proper shipping name, an! are classified, packaged,
marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable International 811d national governmental regulations. If export shipment and I am the Primary
Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA~ of Consent.
I certify that the waste minimization statement Identified In 40 CFR 262.27(a) (If I am a large quantity ge,nerator) or (I/) (lfl am a small quantity generator) is true.
Gene~O('sl':"erofs Prinled/T~ Name Signature Month Day Year .. w--/ I I I I -'-\ ..... '\ _, 16. International Shipments
0 Import to U.S. 0 Export from U.S. Port of entry/exit ~ z Transporter signature (for exports only): Dale leaving U.S.:
a:: 17. Transporter Aoolowledgment of Receipt of Materials ---~ :r~r 1 Printed/Typed Name 2 (\. r\,\ of\. /\.. t.. 1r J
Signature~ I , Month Day Year ~ t'.,.~\l\r) I ,. ~./),_/ ~ I '5 I ( ... , -✓ ~ Transporter 2 Printed/Typed Name Signature ---~ Month Day Year ~ I I I I
l 18. Discrepancy
188. Discrepancy Indication Space 0 Quantity □Type 0Residue 0 Partial Rejectlon 0 Full Rejection
Manifest Reference Number. 5 18b. Alternate Facility (or Generator) U.S. EPA ID Number
c3
I if Facility's Phone:
C 18c. Signature of Alternate Facility (or Generator) I Month I Day Year w =c I z C, 19. Hazardous Waste Report Management Method Codes Q.e., codes for hazardous waste treatmen~ disposal, and recycling systems) in ~ 1. I~ ll 14.
l 20. Designated Facility Owner or Operator: Cerlfflcation of receipt of hazardous materials covered by the man ff est except as nded In Item 18a
Printed/Typed Name Signature Month Day Year
I I I I
EPA Fonn 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY
0 Department of Toxic Substances Control
Jared Blumenfeld
Secretaiy for
Environmental Protection
Meredith Williams, Ph.D.
Director
1001 "I" Street
P.O. Box 806
Sacramento. California 95812-0806
***HAZARDOUS WASTE TRANSPORTER REGISTRATION***
HAZARDOUS WASTE OF CONCERN TRANSPORTER
NAME AND ADDRESS OF REGISTERED TRANSPORTER
JANUS CORPORATION
1081 SHARY CIRCLE
CONCORD, CA 94518
TRANSPORTER REGISTRATION NO: 2698
EXPIRATION DATE: AUGUST 31, 2022
Gavin Newsom
Governor
THIS IS TO CERTIFY THAT THE FIRM NAMED ABOVE IS DULY REGISTERED TO
TRANSPORT HAZARDOUS WASTE IN THE STATE OF CALIFORNIA IN
ACCORDANCE WITH THE PROVISIONS OF CHAPTER 6.5, DIVISION 20 OF THE
HEAL TH AND SAFETY CODE AND TITLE 22 OF THE CALIFORNIA CODE OF
REGULATIONS, DIVISION 4.5.
THIS REGISTRATION CERTIFICATE MUST BE CARRIED WITH EACH SHIPMENT
OF HAZARDOUS WASTE.
FOR REGISTRATION INFORMATION, PLEASE CALL (916) 440-7145.
(AUTHORIZED SIGNATURE)
AUGUST 4, 2021
(DATE)
..a..1 San Diego County
•
Air Pollution
Control District
10124 Old Grove Rd .
San Diego, CA 92131
PHONE: (858) 586-2650
apcdcomp@sdapcd.org APCD2022-ASB-000323
Submitted: Mar 18, 2022@ 2:51 PM
NOTIFICATION: ASBESTOS REMOVAL, RENOVATION, AND DEMOLITION OPERATIONS
Project Type: Renovation and Demolltlon
Faclllty Name: Roosevelt Nine Condominium
Faclllty Location: 2690 Roosevelt Street, Carlsbad, CA 92008, (425) 345-2773
F■cllll)' Owner: Roosevelt Nine LLC, 2033 San Eli]o Ave., Ste. 423, Cardiff, CA 92007, (425) 345-2773
Renovation -Start Date: Monday, Apr 4, 2022
Demolition • Start Date: Thursday, Apr 07, 2022
End Date: Wednesday, Apr 6, 2022
End Date: Friday, Apr 29, 2022
Regulated AsbNtoa Containing Material (RACM)
Type Category Condition Removal Method
Stucco or plaster Category II Non-Friable Poor Hand tools
Paper backing on vinyl Friable Good Hand tools
sheets flooring
Asbestos to be removed: Yu
AsbNtoa Survey Information ------
Amount
2500
80
Total RACM: 2a!l
Regulated
y
y
·Asbestos Surveys are required prior to Renovation or Demolition. A copy of the survey must be maintained on site for the duration of the project. Survey not conducted
because suspect materials presumed to contain asbestos (asbestos to be handled/disposed of per Rule 1206).
Survey Conducted:~ Date Conducted: Jan 25. 2018 Asbestos Present:~
Survey Company: Allee Testing & Engineering, Inc
Certification: Certified Asbestos Consultant (CAC)
Detection Procedures: 1000-oojnt coynt I Byik Sampling/ PLM
Asbestos Work Practices:
Surveyor: Mason Adams
Certification Num: 15-5479
3 Stage Deacon/ Amended Water/ Critical Barriers / HEPA Vacuum/ Negative Air Machines
Bulldlng lnfonnatlon
Title: CAC
Certification Exp Date: Nov 17, 2018
Size I Age I Floors I Units I Prtor Use I Present Use
2150 I 40 I I I House/Condo/Apartment I House/Condo/Apartment
AabNtoe Removal Contractor: JANUS CORPORATION ------------------Contact Person: Jim Denton Address: 1220 Keystone Way. Vista, CA 92081 Phone: (760) 598-7374 ------------Dem ol ltlon Operation -------------------ACM Disturbed by Demolition: t:i.Q
RACM Remain in Building: t:i.Q
Demolition with Category I Materials: t:i.Q
Category I / Category II Materials: ~
Demolition Work Practices:
Hammers/ Excavator/ (Skid Loaders/Bobcats/Top Loaders)
A II RACM Previously Removed: t:i.Q
Supporting Structural Members Demolished: ~
Demolition with Category II Materials: No
Demolltlon Contractor: JANUS CORPORATION
Contact Person: Jim Denton Address: 1220 Keystone Way, Vista, CA 92081 Phone: (760) 598-7374 -------------------Con tinge n cy Plan --------------------------------------------Immediate demarcation of area, immediate bagging, HEPA vacuuming, wet wiping, possible engineering controls. / Isolate Area / Post Signs / Secure
Area I Stabilize / Stop Work / Survey
APC294_Online_Asbestos_Submission_Notification v2.0 (11/2021} Page 1 of 2
San Dl~go County
Air Pollution
Control District
10124 Old Grove Rd.
San Diego, CA 92131
PHONE: (858) 586-2650
apcdcomp@sdapcd.org APCD2022-ASB--000323
Submitted: Mar 18, 2022 @2:51 PM
Transport and Landfill Contacts -------------------------APCD ASB Transporter:
Business Name: JANUS CORPORATION Address: 1220 Keystone Way Vista, CA 92081 Phone: (760) 598-7374
APCD ASB Landfill:
Business Name: South Yuma County Landfill Address: 19536 South Avenue 1E Yuma, AZ 85365 Phone: (928) 341-9300
APCD ASB Transporter Non-Asbestos:
Business Name: JANUS CORPORATION Address: 1220 Keystone Way Vista, CA 92081 Phone: (760) 598-7374
APCD ASB Landfill Non-Asbestos:
Business Name: Sycamore Landfill Address: 8514 Mast Blvd. Santee, CA 92071 Phone: (619) 562--0530
Completed By:
Afflllatlon: Janus Corporation Date: Mar 18, 2022
Certifies all of the following:
1. An individual trained in accordance with District Rule 1206(f)(8) will be on site during asbestos removal; and,
2. Documentation that the required training has been completed and is current will be made available to the District upon request: and,
3. The information on this notification is complete and correct and I am accepting legal responsibility for the information on this form.
Original notifications must be submitted to the District at least 10 wor1dng days prior to removal or demolition. Revised notifications must be submitted prior to the original
start date. The District must receive payment by close of business of the next working day after the effective date of the notification. The District considers submitted
Notifications (original and revised) without the required fee(s) as stated in Rule 40(f)(2) to be considered invalid. Notifications shall expire within 365 days from the effective
date.
APC294_Online_Asbestos_Submlsslon_Notification v2.0 (11/2021) Page 2 of2
TEMPORARY WORKSITE NOTIFICATION FOR ASBESTOS
and METHYLENEDIANILINE-RELATED WORK
Job Number: 322056
Date of Notification: 18-Mar-22
Company: JANUS CORPORATION
Contact: Jim Denton, (619) 247-5354
*Contractors State License Board License Number:
DOSH-OCCU (CAUOSHA) *Asbestos Registration Number:
and/or "Report of Use" Registry Number:
Company/Employer Name: Roosevelt Nine LLC
Headquarters Address: 2033 San Elijo Ave. Ste. 423
Address of Temporary Worksite and Precise Location:
2690 Roosevelt Street Carlsbad
site
Nearest Intersection: Laguna Drive
Type of Business: Residential
*Name of Certified Supervisor: Jesus Garcia
Revision#:
Date of Revision:
572682
224
Cardiff Ca. 92007
CA
*Name of Qualified Person in Charge of Air Monitoring, Laboratory Work, and Respirators:
Jesus Garcia
*Name of Certified Consultant:
Projected Job Starting Date: _4_-_A.._pr_-_22 ___ D Phased
Projected Completion Date: 6-Apr-22
Describe Type, Scope and Work Practices of Job:
80 sqft sheet vinyl, 10 sqft roof mastic, 12 LF transite pipe, (10) -window putty
Wet removal within a negative pressure containment with HEPA filtration, workers wearing protective suits and proper HEPA
respirators, and HEPA vacuum
Evaluation of Potential for Exposure: LOW
Estimated Number of Employees on this Job: 4
92008
According to Title 8 CCR Sections 341.9 and 1529(r) for Asbestos and 5200(p) for MDA, please send this
completed notice to the nearest district compliance office (see attached listing), not to DOSH headquarters or to
DOSH consultation, prior to commencement of any such work activity.
NOTE: Any change to the information provided to the district office by the written notice shall be reported to the
district office within 24 hours of such change.
• The star denotes asbestos Inquiry only
DOSH Office Notified: 7575 Metropolitan Dr. Ste. 207, San Diego, CA 92108
address/city/state/zip
(619) 767-2280 (619) 767-2299
phone fax
CAUOSHA 1838
May, 1993
J:\JOBS\JOB FILES\3 Vista\2022\322056\JBD21-161 2690 Roosevelt Nine condominium.xlsm