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Home My WebLink AboutALL DOCS - 12-00322 - 944 University Blvd - South Exit Travel Center - Demolition35N IrE Rexburg, lD 83440 Application for Demolition Permit #: $25.00 Fee Paid: Yes/No Permit Approved: Yes/No Applicant Information Name: )K €rzc1'rtt^ Applicant'sAddress: -SY ,S 4.,r?ft- 4af-1" City/ST/Zip:/,:,., --, f €a,.rrt4 z Business Phone: 6U/ ' t c/Z/ - )'9 q/ Cctflt6he Contact Information Person or Company doing the demolition: Address:City/ST/Ztp: Business Phone:Cell Phone: Demolition Information Property Owners: Site Address Start Date: Summary of what is being demol-ished: The U.S. EnvLonmental Protection Agency @,PA) regulates the abatement and disposal of asbestos-containing materials from any public or private building involving demolition, renovation, repair, construction, and maintenance activities. http:/ /deq.idaho.gov,/airlprog issues/pollutants /asbestos.cfm BPA certifies aod licenses asbestos-removal coritractors, inspects asbestos-abatement proiects, and enforces laws regarding the proper removal and disposal of asbestos-containing materials. Currendy, EPA and DEQ contract with lndustrial Hygiene Resoutces in Garden City, Idaho, to regulate asbestos removal and disposal projects in Idaho. For more information about asbestos abatement and disposal in Idaho, contact: Industrial Hygieoe Resource 206 Murtay St Garden City ID 83714 208-323-8287 www.industrialhygieneresouces.com I understand the EPA requirements regarding and agree to provide information showing compliance with the tegu 4o the Ciw of Signature of Applicant: to demolition. Proposal TO: Kipp Johnson, PKL Services From: Idaho Abatement & Insulation LLC Date: 9/1412012 Re: Asbestos Removal Remove of the roohng that tested positive for Asbestos from the Chewon and Burger King Building located in Rexburg Idaho at 944 University Blvd on September 23'd urd September 24,2}l2,before the Demo. Notices were filed with the EPA for removal and Demo. All EPA regulations, OSHA Air monitoring Hauling and disposal All labor and materials for removal Bradley Pratt0S/14/12 Idaho Abatement & Insulation LLC (208)s2e-6837 (208)523-9221 Fax Asbestosl@ida.net s 4.800.00 Kipp Johnson Digitally signed by Kipp Johnson DN: cn=Kipp Johnson, o=PKL Services llc, ou=Member/ Manager, email=pkl6rapidwave. net, c=US Date: 201 2.09.14 I 4:28:00 -06'00' IDAHO ABATEMENT & INSULATION LLC P.O. Box 3918 Idaho Falls, tdaho 83403 September 7,2012 Kipp Johnson PKL Services 5a Shaggy Mountain Road Herriman, Utah 84096 Dear Kipp: On September 5,z0lz,Idaho Abatement completed a survey onthe building located at l44Unlersity Blvd, in Rexburg, Idaho for the presence of any asbestos-coitaining building materials. Bulk samples of suspect materials were collected and sent to EHS.Environmental Hazards Services for analysis using polarized Light Microscopy. Beverly Pratt 0ffice Manager Enclosure: Copy ofthe Lab Results from testing, and an EpA Notification for theremoval and Demo The results of this sampling show no asbestos containing materials, with the exception ofsample # 12-09-00470-014; BK-14 which is a sealant used on roofing to seal areas thatplpes or chimney stacks protrude from the roofing. Sampled were flior tile, joint compound, ceiling tiles, textured ceilings, sheet rock, roofing and roofing tar. BULK SAMPLE LOG @ IDAHO A,BATEMENT & 'NSULATION L.L.C. P.4.80X39t&-, ,DAHO FAttS, IDAHO 83tt(r3.3918 TELEqHONE (2$) 52*W7 FAX(ffit) 623.9221 Pno'rtrcr.. B4-/e.<*anf $AilPLER:- JOB #- - DATE: 9-s-tz T SAilPLE DATE: JOB # LOCAfiON Raltmutzd Bx1 7,/a;ta 7-t Lt* - ,fu.* -/?Jr" 8r2 a-z T.t -e - J4n-y' .c--^ t2lD Bp3 .,4--tC,?, . - ,Q-a k tAsy ,-ttt2-a RK4 A-^.tr -^-.a^..^.t\ - rlnzlr 2na ,^)a-z-2 Bx5 a€ilJ^ra Tt LE ar6 Tax rrzze-r\ Lst t,t^t t2 - Et A<1,< R,-^ BrT ?/.>'n Tu' /r' - RnCk a'?attF t?-I<rL R.v 8 ,,Z.-t-r' a o Pv9 tZ'*tT QW.eouNb = .a.bnatB t?.x,^ .?*10 SllE-E t' 2aak ' .Prdla)rt o-)rt' GbilEt t?p11 9/*ET .4aa-* - )?zrtrtzts .lra). .Prz.a-re2 RP12 SAt-rf ..ea</? t5ntt/aa4 z/a<€7 Er13 EaFzu4 742 Er14 ?Ar*rffi Aoos,n z TAP 15 2sA X 4 o 16 17 18 19 20 E IUOIE$: --,-iH, tr@ Labontories- Environmental Hazards Services, L.L.C. 7469 Whitepine Rd Richmond, VA23237 Telephone: 800.347.401 0 Cllent ldahoAbatement&lnsulation P.O. Box 3918 ldaho Falls, lD 83403 Asbestos Bulk Analysis Report ReportNumber: 12-09-00470 Received Date: 09106112012 AnafyzedDate: 09rc7n012 ReportedDate: 09n72:012 Prcfecurest Addrees: 944 univelsrty Blvd; chevron/ Burger King; Re$ury, tdaho Client Number: 1T2222 Laboratory Results Fax ilumben 20&|52}|9221 lab Sample Number ClientSamfle ilumber Layer Type Lab Gross llescription Asbestoe Other lleterlab 12-0940470-001A BK-1 Flooring Gray Granular; Homogeneous NAD 1fi)% Non-Fibrous 12-09-00470-001 B BK-1 Mastic YellowAdhesive; Homogeneous NAD 4% Cellulose 96Yo Non-Fibrous 12-09{0470-002A BK-2 Floodng Gray/Ofi-\MiteGranularl NAD Homogeneous 10006 Non-Fibrous 12-0/540d704028 BK-2 Mastic YellowAdhesive: Hornogeneous NAD 57o Cellulose 95% Non-Fibrous 12{9{0470-003 BK.3 White Brittle: White Pliable; lnhomogeneous 2% Cellulose 987o Non-Fibrous Page I ot 4 Glient Number: ProjecUTest Address: Environmental Hazards Services. 13-2222 944 University Blvd; Chewon/ Burger King; Rexbury, ldaho L.L.C Reportf{umber: 12-09-0@70 Lab Sample Numbor Client Sample Layerrype lab Gross D,escrlptionNumber Asbectoo Other Itlaterials 12-09{0470404 BK4 Write Brittle;White Pliable; Inhomogeneous NAD 2% Cellulose 98% Non-Fibrous 12-09-00470{05 BK-5 Pale Gray to Tan Fibrous; NAD White Brittle; Inhomogeneous 45% Cellulose 35% Fibrcus Glass 20% Non-Fibrous 124940470{06 BK6 Otr-m ite/vVh ite B rift le: Tan Fibrous;While Pliable; lnhomogeneous NAD 17% Cellulose 506 Fibrous Glasg 78% Non-Fibrous 12-09-004704074 BK-7 Flooring Gray Granular; Homogeneous NAD 1(X)% Non-Flbrous 12-09-004704078 BK-7 Mastic YellowAdhesive; Homogeneous NAD 5% Cellulose 95% Non-Fibrous 12.0,940{-70407C BK-7 Leveling Comp. Off-White Britle; Homogeneous NAD 3% Cellulose 97% Non-Fibrous 12-09{0470-008 BK€White Bdftle; Pale Belge Fibrous; Write Pliable; lnhomogeneous NAD 25% Cellulce 75% Non-Fibrous 12-09{0470409 BK-9 l/\/trite Bdttle;White Pliable; Inhomogeneous 27o Cellulose 98% Non-Fibrous Page 2oI 4 Environmental Hazards Services, L.L.C Glient Number: Project/Test Addreee: 13-2222 944 Universlty Blvd; Chewon/ Burger King;Rexbury, ldaho Report Number: 12-0940420 Lab Sample Number Glient Sample llumber Layerrlpe lab Groos D,escripffon Asbestoa Other Materials 12-09-00470410 BK-10 Off-White Brittle;Tan NAD Fibrous; Inhomogeneous 15% Cellulose 5% Fibrous Glass 80% Non-Fibrous 12-0940470411 BK-11 Off-White Brittle;Tan NAD Fibrous; lnhomogeneous 15% Celluloss 5% Fibrous Glass 80% Non-Fibrous 12-094U70412 BK-12 Off-l/Vhite/\,Vh ite B rittle: Tan Fibrous;Pab Beige Pliable; Inhomogeneous 15% Callulorc 3% Fibrous Glass 82Yo Non-Fibrous 1249{0470-013 BK-13 124940470414 Black Pliable to Brittle; Inhomogeneous Black Pliable to Brittb; Silver Brittle; lnhomogeneous NAD 350,6 CEllulose 65% Non-Fibrous 5% Cellulose 2% Wollastonite 78% Non-Fibrous TotalAsbestoo: 16% Page 3of 4 Client Number: ProiecUTest Addrces: Environmental Hazards Services, 13-2222 944 Universig Blvd; Chevron/ Burger King;Rexbury, ldaho L.L.C ReportNumber: 12-09-00470 Lab Sample Client Sampte LayerType l-ab Gross Deecription Asbestoo OtherNumber Number ilaterials QG Sample: QG Blank: 10-M1-1993-3 SRM 1866 Fiberglass Reporting Llmlt 1% Asbestos Method: Analyet: EPA Method 600/R-93/116, EPA Method 600/M4€2-020 I Marftcase 4 t f Revieured ByAurhorized signarory: 74'*- Eda'[A/ Tasha Eaddy QA/QC Clerk The condi{on of the samples anatyzed rvas aoep{abtte upon teceipt per laboratory protocol unless o{herwbe not€d on thb loport. Eecfi distinctcomponenl in an ir$omogenedr$ sampb was analyzed separately and r€poded as a compooite. R€srIb tepfesent ttle analFis of sanplos $.bmittedby the dient. Sample location, desctlption, area, vdume, etc-, was prowed by the dbnt. This rBport cannot be used by the di6rn b daim product endorsement by NVTAP or arry ag€ncy of the U.S. Gov€tntrEnt. This repfi shall not be Gproduced except ln fldl, withoul the writbn consent of theEnvironmefltal Hazards SeNbe, L.L.C. Calibrnia Cerilficatbn #2319 NY ELAP *11714. NJ information conceming sampllrq tocailon, date, and tfnecan be fourd on Chain-of-Ctstody. Environmental Hazads Seryioes, L.L.C. do€s not perfum any eample colledbn. ErMtonrnental Hazatds S€rvices, L.L.C. lecommends reanaly3ic by point count (for nxrre accurate qtnnlifrcatbn) or Transmisslon Etectron Microscopy(TEM)' (tor enhanced detection capabilitles) for materiats regutated by EPA NESI{AP (National EmiEsioo Standads for Hazarddrs Air po[utanh) endfourd to contain less than ten p€rcent (<10%) asbestos by polarized light nilcroscopy (PLM). Bor| s€rvices are svailabb fur an addlfonal fee. 40o Pom cou.lt Analysis, wtEre nded, performed per EPA Method 60XyR-93/116 with a Reporting Umit of 0.2s%. * Afl Cafibmia samdes anetfzed by Pdarized Ught Microecopy, EPA Method 600/M+n-020, Dec. 1982. LEGEND:NAD = no asbesrbs detected Page 4oi 4 NOTIFICATION OF DEMOLITION AND RENOVATION u.s. ENVTRo*#*roL pRorEcroN AGENcy -st.t rDAHo 1of )perator Project C&BK4 1 Dostmark )ate Received {otification # Type of Notiftcation (check one): [Sloriginat l_JReviseo l-JCanceted Facility Dccription ding Name'. Cheveron & Burger Kin lress: 944 University Blvd Rexburo Strate: ldaho *83440 County: Madison Location : Same as above ding Size (square feet) 1,200 # of Floors: ! Age in Years: rent Use: Empty Prior Use: Retail ll. Type of operation (check onel:lxJoemo l-lP"rti"t o"ro [-lRenovatlon l-lemerg.ncy RenovatillFire Training V. lsAsb6toePresent?(checkone): lflV"" U No Faeility fnformation Owner Name: Three Deserts Development Address: 2280 Main Street City: Salt Lake Citv State: Utah ztP * 8/.112 Contact Kipp Johnson Telephone: 801.?41-89a1 Fax: Removal Gontractor l,lame: ldaho Abatement & Insulation LLc Ucsnse # RCE 4802 Address: P.O. Box 3918 Crty: ldaho Falls State: ldaho Zip Code: 83403 Gontact Bradlev Pratt Telephone: 208-5296837 Fax:208-559221 Other Operator (demolition/general): PKL Services Address: 54 Shasqv Mountain Road City: Herriman State: Utah ' 84096 Contact: Kipp Johnson Telephone: 801-2444941 Fax: fl. l,noceoure, Incrucrng anaurcar meoloos, emp|oyeo ro osrecr mo proeenco or ano to ea$mate me quan[y ot RACM and Category I and Category ll non-friable ACM: Bulk samples read PLM at an EPA approved Lab as perAppendix E., Su@art E., 40 CFR part 763, section 1. /ll. Approximate Amount of Asbestos Materials: IACM to be Removed tlon-friable Asbestos Material to be Removed tlon-friable Asbestos Materir NOT to be Removed )ategory |Category ll )ategory |Category ll Surface Area Lineal Feet sealant 300 lurface Area /fll. Scheduled Dates Demolition or Renovation: Start:09124112 Gompfete 1OlO1l12 X. Dates forAsbestos Removal (MM/DD/YY) StartO9l24l12 Complete:09125112 )ays of the Week: I Monday Tuesday lWednesday lThursday I Friday Saturday Sunday .lours of Operation: 18 til 5 8tir5 lstirs I atils I 8ril5 lompbte all unshaded spaoes, excepf demoni{tns wtrk$ involrre less than 26O lirrcar fuet- 1 6t0 Square ftet or 35 <r.6ic ftet of RACM need not )ompleb spaces Vll, Xl. X|l, Xltl, XlV, and XV Notificalions for ErnerSency Demofilions or Emersenoe Reruvalixe nust suDolv attachrrents u. s. E Nv I Ro * fi oI- P RorEcrlo N AG E-N9Ir s-1T :l^t PAOnonrtcnri6N oF DEMoLlrloN AND RENovATIoN 2ot2 including demolition or renovation techniques to be used and a description of affected facili$ components: Removal of roofing sealant before demo including asbestos removal and waste handling emissions control procedures: Containhent using approved procedure, critical baniers, wet method, double bagged with 6 mit poly Asbestos wasfe Eags . Dispose of wet asbesfos at an approved EPA landtill. ldaho Abatement & Insulation LLC Name: Address: ci$:State: ldaho ZiP code: 83450 {. Atttach a copy of the Order to this notice- NA 2. Name of Authority lssuing Order: NA 3. Authority of Order (Citation of Code): NA 4. Date of Order (MM/DD/Y[: NA Date Ordered to Begin NA . XXX EmefgenCy Renovation (Attach separate sheetwith thcfolknring inbrmation if poiect is EmergencyRenovatbn') 1. Date and Hour of the EmergencY: 2. Description of the Sudden' Unexpected Event 3. Explanation of how the event caused unsafe conditions or equipment damage or an unreasonable ACM becomee crumbled, pulverEed, or reduced to powder' or Renovation, and svidence that the rcquired training hc wlll be available during normal bueinoss hours- thls notlflcation are true, accurate, and complete. Pe or Print Name and Title ' {Monday - Frilay excluding weekends) Before demolition or renovation begins, except emefgency dernolitions ard ernergency rcnovations (see Fguhtirn)