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Home My WebLink AboutB10-0097 NOTE: TH/S PERMIT MUST BE POSTED ON JOBSITE AT ALL T/MES .� �wxo�vn¢ � Town of Vail, Community Development, 75 South Frontage Road,Vail, Colorado 81657 p. 970.479.2139, f. 970.479.2452, inpsections 970.479.2149 ADD/ALT COMM BUILD PERMT Permit #: B10-0097 Project #: Job Address: 100 E MEADOW DR VAIL Status. . : ISSUED Location......: VAIL VILLAGE INN PLAZA PHASE III Applied . . : 05/05/2010 Parcel No....: 210108261004 Issued. .. : O6/09/2010 Expires. ..: 12/06/2010 OWNER STAUFER COMMERCIAL LLC 05/05/2010 100 E MEADOW DR VAIL CO 81657 APPLICANT HOME IMPROVEMENTS SOLUTIONS 05/05/2010 Phone: 720-404-9227 9830 W 59TH PL ARVADA CO 80004 License: 1046-B CONTRACTOR HOME IMPROVEMENTS SOLUTIONS 05/05/2010 Phone:720-404-9227 9830 W 59TH PL ARVADA CO 80004 License: 1046-B Description: DEMO OF INTERIOR NON BEARING WALLS, EXPLORATORY ONLY FOR POSSIBLE FUTURE TENANT Occupancy: MIXED Valuation: $300.00 Type Construction:IlA Total Sq Ft Added: 0 ................................................................................. FEE SUMMARY .........................,..............,,..,..._..,,,__•__..............,...., Building Permit Fee------> $23.50 Will Cal Fee---------------------> $4.00 Total Calculated Fees-------------> $42.78 Plan Check--------------------> $15.28 Use Tax Fee-------------------> $0.00 Additional Fees-----------------------> $0.00 Add'I Plan Check Hours-> $0.00 Restuarant Plan Review-----> $0.00 TOTAL PERMIT FEES--------------> $42.78 Investigation-----------------> $0.00 Recreation Fee-----------------> $0.00 Payments-----------------------------> $42.78 Total Calculated Fees--------> $42.78 BALANCE DUE-----------------------> $0.00 •weYltYlrtftY(fi(ff f�kftiri�*ffA}Rfft V 4AR44RehenMfrtY'trA'A'fiNKrt�kY(41�4'kf�RRLif1f44df*A!1`1et`4*�fi##�R4x4xtr1RR�Rtrh#Yr�k�krtYrrt4LY(44444I`#1rR41(1`+�+RR V+l4w4e�kkf�ktrtr9'fi1'rtfiitRY�#�kiFf#rt4ilLi(Y'444tilirttff4�4##!1`�ltiffRlRw�t��t4 DECLARATIONS I hereby acknowledge that I have read this application,filled out in full the information required,completed an accurate plot plan,and state that all the information as required is correct. I agree to comply with the information and plot plan,to comply with all Town ordinances and state laws,and to build this structure according to the towns zoning and subdivision codes,design review approved, International Building and Residential Codes and other ordinances of the Town applicable thereto. REQUESTS FOR INSPECTION SHALL BE MADE TWENTY-FOUR HOURS IN ADVANCE BY TELEPHONE AT 970.479.2149 OR AT OUR OFFICE FROM 8:00 AM-4:00 PM. � � � 06�0�I/�v Signature of ner o Contractor Date ��y� W�O Print Name bid_alt_construction_permit 041908 iwwHirtN�ki*fxffw�WWk*xxtfff*M1w*xk*fw/ffNwkf��4ffxeikrt#�x�*ff��ffMffit*wk#*/S�ife�ffwwwY*if�if**4fN4wYwttt+ftf�Xe*W#ef*�4*+�itxf�kwwwwlw**�ffYifftftYtwYw�****f44+4f+#Mwwww*f*f#4f+4 APPROVALS Permit#: 610-0097 as of 06-09-2010 Status: ISSUED ...........................................................................................................................»...,.....,.,.,.,,,.....,.......,..,.,.....,.,,,,...,,.,., Item: 05100 BUILDING DEPARTMENT 05/18/2010 cg Action: AP SCOPE OF WORK PER PLAN ONLY Item: 05600 FIRE DEPARTMENT 05/19/2010 McGee Action: COND Submit Scope Letter Permit Application from Fire Alarm and Fire Sprinkler registered contractors to mitigate false alarms, relocate devices and make repairs as necessary. A>xt�t�MA'4rtYrk4ft�l4Lf4xRRhN�i�i4ff}ffileYrYrFf'frili(#i�4+ltff�rkYril'frwY(f4t44�f�Rllrfwfixi4i4V rtrt4�i4i(i(fff4xffff+FthtYr9'#'4�k#ffftfftri4ftrttrffY`Ytff1`1(fteffxfi�khhrttrtr#rti(Yi(f#ttfffxxx4RYrtrtrfrti`ftftttt44l1eR�lefrt4il'iR4t See the Conditions section of this Document for any that may apply. bld_alt_construction_perm it_041908 •wwYrttt4�4#4ffANfwwkwt�ff�ffRffwwffM�f��ff�fxf�wkrtY�fAfRflffff�fxfwfwRwYw*�**�x��eff#kfkwww�**#*#fffexwww#t/f��4i#f��*ww*w*4xti�lt*ftff4w�wffwwwff�#Y#+#��>ffRitxkxwfwfrt#t��4ti+ffe CONDITIONS OF APPROVAL Permit#: 610-0097 as of 06-09-2010 Status: ISSUED Rxx V1rff4Li4f1f4t1`�f**!V�*tRfA'#*fY�flr4RfkRRtlrktf#f4fe*fe�flk*RxRRfiiFYrY�kfiir**4*4d*4fRiR#/Y'MffYeY`�k4f+fiLlrl`*R#ffR�kA'trA�kiti�#ff*��f1e4*4#�kfii1'Ye�kil�i(t#R4#ff#�f�f VAf1f V ffriFY`Y`M ir1frt4444}fff�}f*1rR�Rf VAffYiftirif Cond: 1 (FIRE): FIRE DEPARTMENT APPROVAL IS REQUIRED BEFORE ANY WORK CAN BE STARTED. Cond: 12 (BLDG.): FIELD INSPECTIONS ARE REQUIRED TO CHECK FOR CODE COMPLIANCE. Cond: CON0011430 Submit Scope Letter Permit Application from Fire Alarm and Fire Sprinkler registered contractors to mitigate false alarms, relocate devices and make repairs as necessary. bld_a It_co nstructio n_pe rm it_041908 B10-0097: Entries for Item:90 - BLDG-Final 16:05 11/22/2013 Action Comments By Date Unique_ Ke AP UNIT COMPLETELY REMODELED FOR JMONDRA 01/31/2012 A000148 CURRENT TENANT. OK TO CLOSE OUT GON 818 PERMIT. Total Rows: 1 Page 1 � ****************************++++********************+**************+++*+*****************+** TOWN OF VAIL, COLORADO Statement *+******�************++**************+++******�*****************+**********�**************** Statement Number: R100000650 Amount: $42.78 06/09/201003 :56 PM Payment Method: Cash Init: SAB Notation: CASH - JOYCE W00 ----------------------------------------------------------------------------- Permit No: B10-0097 Type: ADD/ALT COMM BUILD PERMT Parcel No: 2101-082-6100-4 Site Address: 100 E MEADOW DR VAIL Location: VAIL VILLAGE INN PLAZA PHASE I2I Total Fees: $42.78 This Payment: $42.78 Total ALL Pmts: $42.78 Balance: $0. 00 ***************************�*************************************************�***+********** ACCOUNT ITEM LIST: Account Code Description Current Pmts -------------------- ------------------------------ ------------ BP 00100003111100 BUILDING PERMIT FEES 23 .50 PF 00100003112300 PLAN CHECK FEES 15.28 WC 00100003112800 WILL CALL INSPECTION FEE 4.00 ----------------------------------------------------------------------------- � ��` ,; �,Y ,� �� '� ��x� Department,of Community Development; . .. . `� �`�•.� 5_.� 75 South Frctntage . o _ , . � � � '�� Vail,:C rac�:. , . , '��. . `�'��` � r �'��,` � . �+u .R . ��, r �=�y_. � 4� 'G�i . . . . W i ` �� P . . �, _ _ Q , -�. .,�1 en �` BUILDING PERMITAPPLICATION Separate permits are required for electrical, plumbing, mechanical, fireplace, etc. Project Street Address: Office Use: � �� / � 68 EAST MEADOW DRIVE Project#: l,V 'U � (Number) (Street) (Suite#) DRB#: Building/Complex Name: VILLAGE INN PLAZA 2ND LEVEL � �n —/��(�� Building Permit#: sL—C I Contractor Information: ��,,L. Lot#: Block# Subdivision: Company:�DYLL_4�1✓�c_.<,�2 v-E-v��.✓1�'$ �v..'�wv�.S Company Address: q�� ,J ,�I`�'1�� • Detailed Scope and Location of Work: DEMOLITION ONLY City: �� State: � Zip: �UOdLf SEVERAL NON-BEARING TENANT SPACE WALLS Contact Name: � Uue.l ��-�C,��- TO BE REMOVED AND DISTURBED DRYWALL PATC Contact Phone: _]ZU -`{U�-(G(Z.Z� EXPLORATORY CEILING HOLES CUT THEN PATCHE I (use additional sheet if necessary) E-Mail o�l �� Dv`�'��S'�. ��-�- Work Class: Town of Vail Contractor Registration No.: � ULl�- �� New( ) Addition( ) Remodel( ) Repair( ) Other(�/) X Work Type Contra r Signature(requir Interior(�/) E�erior( ) Both( ) Property Information Type of Building: Parcel#: 210108254003 (�-�� (�� (p(UU C� Single-Family( ) Duplex( ) Multi-Family( ) (For parcel#,contact Eagle County Assessors Office at 970-328-8640 or visit www.eaglecounty.us/patie) � Commercial(✓) Other( ) � /� Tenant Name: ��(,�G'Z' ��GC� GC, C�=/C� �Does a Fire Alarm Exist? Yes��) No� ) � �� Monitored Alarm? Yes( /� No( ) Owner Name:�, �YLl2 f�«'1/L �� t-f� �� V' Does a Sprinkler System Exist? Yes(✓j No( ) Valuations(Labor&Materials) #&Type of Existing Fireplaces: Gas Appliances � Gas Log Wood/Pellet Wood Burning Building: $ � �� #&Type of Proposed Fireplaces:Gas Appliances Plumbing: $ Gas Log Wood/Pellet Wood Burning Electrical: $ Date Received: Mechanical: (including fireplace) $ � � r n � vZ' D L '� � Total: $ � l�C c�. �-t�vt ��-�c.,� ��v� t�� MAY �5 2010 _ � �2..7�5 TpWN ��'�,�� O� �AIL o� an-10 v��FlaE R�RO�Mcra�s Vail Fire Department Asbe.stos Testing&Ababement Requirements Asbestos testing and abatement protects workers, homeowners, neighbors and emergency services responders from ex- posure to harmful asbestos. The Town of Vail asbestos abatement program is in addition to the State of Colorado's regu- lations. It is your responsibility to be in compliance with the State. Please contact the State directly for their requirements at the contact info listed below. When is asbestos testing reauired? ANY building projects disturbing more than these threshold levels of building materials require asbestos testing: One-and Two-Family Dwellings: 32 square feet All Others (wmmercial spaces, hotel rooms, etc): 160 square feet Definition of a single-family dwelling: any dwelling unit that is used primarily for a single family, induding multi-family/condominium units, and fracdonal fee units. Asbestos testing results must be provided with your application for a building permit. Tests which identify POSI'TIVE results at more than 1% require abatement by a State-certified and Vail-registered abate- ment contractor. An asbestos abatement permit must be approved, and the clearance letter must be submitted to the Town of Vail before the building permit will be issued. Project Checklist My project falls irrto the category checked below: � Will not disturb more than the threshold limits identified above. Tested negative, or at 1% or below (2 copies of test results included) � Tested positive at more than 1%, requires abatement (2 copies of test results included) Tips&Facts: • Even recent construction projects may include asbestos-containing materials, so buildings of�age require testing. • The "1989 Ban" on asbestos-containing materials is commonly misunderstood. "In fact, in 1991 the U.S. Fifth Circuit Court of Appeals vacated much of the sacalled "Asbestos Ban and Phaseout" rule and remanded it to the EPA. Thus, much of the original 1989 EPA ban on the U.S. manufacturing, importation, prooessing, or distribution in commerce of many asbestos-containing product categories was set aside and did not take effect." - CDPHE Asbestos test results and abatement permit applications should be submitted to: Town of Vail, Community Development, 75 S Frontage Rd, Vail, CO, 81657. Town of Vail Contact: State of Colorado Contact: David Rhoades, Fire Inspector Colorado Department of Public Health Vail Fire Department and Environment 75 S Frontage Rd Asbestos Compliance Assistance Group drhoades@vailgov.com 303-692-3158 970-477-3454 asbestos@state.co.us www.vailgov.com www.cdphe.state.co.us O1-Jan-10 �� e os Fn�irnnnir.nl�il Ili�,��l��r Kie�l��n�liun, Inc. Date: 4.27.2010 Asbestos Sampling Report Page 1/1 To:John Martin Regarding: Woo tenant spaces Mr. Martin, Per your request,on 04/24/2010, ECOS Environmental & Disaster Restoration Inc.conducted a limited asbestos inspection of VISIBLE suspect asbestos containing materials which may be impacted during the proposed remodel of the tenant spaces owned by Mr. Woo in the Village Plaza Inn structure. If other suspect materials become visible/apparent during demolition or construction activities (particularly behind non-suspect ACM wall coverings),work in that area should be halted and more sampling/testing must take place, per Colorado regulations. A limited bulk sampling of suspect ACM from interior wall and ceiling materials was conducted in accordance with Colorado State Requirements. Said requirements state: For each homogenous area of less than 1000 SF,a minimum of three samples must be collected randomly. For each homogenous area of 1000-5000 SF,a minimum of five samples must be collected. For areas larger than 5001 SF a minimum of seven samples must be collected, respectively. A homogeneous area is defined as one which shares suspect material,texture,color, location,and/or apparent time of construction. Craig Thompson,a Colorado Department of Public Health& Environment certified building inspector, certification number: 16928, performed the inspection on 04/24/2010. Samples taken were sent to the lab Reservoirs Environmental, in Denver,for PLM (Polarized Light Microscopy)analysis. Attached are the lab's documents with analyses and findings. Please feel free to contact Craig Thompson with queries or to make arrangements for any necessary abatement activities. His direct line is 970.471.0591. DESCRIPTION OF SAMPLING AREA Retail spaces in a large commercial building. SUSPECT MATERIALS SAMPLED Drywall,Texture,and Joint Compound CONCLUSIONS Asbestos was NOT found in any of the sampled materials. Town of Vail vFF�c� co�r REI LAB Rese�-vvirs Envit-onmenta/, /nc. April 26, 2010 Laboratory Code: RES Subcontract Number: NA Laboratory Report: RES 190373-1 Project#/P.O.# John Martin Project Description: Commercial Space to be Craig Thompson converted to restaurant ECOS Environmental P.O. Box 11936 Aspen CO 81611 Dear Customer, Reservoirs Environmental, Inc. is an analytical laboratory accredited for the analysis of Industrial Hygiene and Environmental matrices by the National Voluntary Laboratory Accreditation Program (NVLAP), Lab Code 101896-0 for Transmission Electron Microscopy (TEM) and Polarized Light Microscopy (PLM) analysis and the American Industrial Hygiene Association(AIHA), Lab ID 101533-Accreditation Certificate #480 for Phase Contrast Microscopy (PCM) analysis. This laboratory is currently proficient in both Proficiency Testing and PAT programs respectively. Reservoirs Environmental, Inc. has analyzed the following samples for asbestos content as per your request. The analysis has been completed in general accordance with the appropriate methodology as stated in the attached analysis table. The results have been submitted to your office. RES 190373-1 is the job number assigned to this study. This report is considered highly confidential and the sole property of the customer. Reservoirs Environmental, Inc. will not discuss any part of this study with personnel other than those of the client. The results described in this report only apply to the samples analyzed. This report must not be used to claim endorsement of products or analytical results by NVLAP or any agency of the U.S. Govemment. This report shall not be reproduced except in full, without written approval from Reservoirs Environmental, Inc. Samples will be disposed of after sixty days unless longer storage is requested. If you have any questions about this report, please feel free to call 303-�4-1986. Sincerely, , � _, = - - �--�r -,�_ .z. �- -,�- / - Jeanne Spencer Orr President / _ 1 ;'�(,'�L-G�C�J��-C�G�S�� Analyst(s): Paul D. LoScalzo Wenlong Liu Michael Scales Rich Wegrzyn Anita Bridges James Venendaal Adam Kinch Louis A. Church Jr. Robert R. Workman Jr. P:303-964-1986 5801 Logan Street, Suite 100 Denver, CO 80216 1-86f�RESI-ENV F: 303-477-4275 www.reilab.com Page 1 of 5 RESERVOIRS ENVIRONMENTAL, INC. NVLAP Lab Code 101896-0 TDH Licensed Laboratory#30-0136 TABLE PLM BULK ANALYSIS, PERCENTAGE COMPOSITION BY VOLUME RES Job Number: Client: Client Project Number/ P.O Client Project Description: Date Samples Received: Analysis Type: Turnaround: Date Analyzed: RES 190373-1 ECOS Environmental John Martin Commercial Space to be converted to restaurant April 24, 2010 PLM, Short Report 2 Hour April 24, 2010 Page 2 of 5 �en a L sbestos ontent on on Sample ID Number A Sub Asbestos Fibrous Number Y Physical Part � Fibrous Component E Description (%) Mineral � visua� omponents (%) R ; Estimate(% % A1 EM 562488 A White joint compound 3 ND 0 100 B White tape 3 ND 80 20 C White joint compound w/pink paint 4 ND 0 100 D White drywall 90 ND 10 90 A2 EM 562489 A White joint compound 4 ND TR 100 B White tape 6 ND 85 15 C White joint compound w/ pink paint 10 ND TR 100 D White drywall 80 ND 40 60 A3 EM 562490 A White tape 3 ND 90 10 B White joint compound 4 ND TR 100 C White joint compound w/ pink/multicolored 8 ND TR 100 paint D White drywall 85 ND 10 90 A4 EM 562491 A White compound w/ pink paint 2 ND 0 100 B White compound w/white/multicolored 3 ND 0 100 paints C White drywall 95 ND 6 94 A5 EM 562492 A White tape 4 ND 0 100 B White joint compound 5 ND 85 15 C White joint compound w/pink paint 6 ND 0 100 D White d wall 85 ND 15 85 ND=None De[ected TR=Trace,<1%Visual Estimate Trem-A c[=Trem ol ite-A c[i nol i te Note:Further analysis by TEM is recommended for organically bound material(i.e.floor tile) if PLM results are4%. �w�w�.a w Data QA RESERVOIRS ENVIRONMENTAL, INC. NVLAP Lab Code 101896-0 TDH Licensed Laboratory#30-0136 TABLE PLM BULK ANALYSIS, PERCENTAGE COMPOStT10N BY VOLUME RES Job Number: Client: Client Project Number/ P.O. Client Project Description: Date Samples Received: Analysis Type: Turnaround: Date Analyzed: RES 190373-1 ECOS Environmental John Martin Commercial Space to be converted to restaurant April 24, 2010 PLM, Short Report 2 Hour April 24, 2010 Page 3 of 5 �en a L estos ontent on on Sample ID Number A Sub Asbestos Fibrous Number Y Physical Part � Fibrous Component E Description (%) Mineral � visuai omponents (%) R ; Estimate(% % B1 EM 562493 A Off white masking tape w/orange/white 2 ND 35 65 paint B White tape 8 ND 85 15 C White joint compound 10 ND 0 100 D White joint compound w/white/multicolored 15 ND 0 100 paint E White drywall 65 ND 35 65 B2 EM 562494 A White tapes (2 layers) 15 ND 90 10 B White joint compounds 25 ND 0 100 C White joint compound w/white/multicolored 60 ND 0 100 paint B3 EM 562495 A Yellow woven tape 2 ND 65 35 B White joint compound w/white paint 23 ND 0 100 C White drywall 75 ND 10 90 B4 EM 562496 A White compound w/white paint 10 ND 0 100 B White drywall 90 ND 80 20 ND=None Detected oba�.�.=a TR=T�ace,<��/Visual Estimate o Trem-Act=Trem ol ite-Ac[i n ol ite Note:Further analysis by TEM is recommended for organically bound material(i.e.floor tile) ��np if PLM results are4% �ata QA RESERVOIRS ENVIRONMENTAL, INC. NVLAP Lab Code 101896-0 TDH Licensed Laboratory#30-0136 Page4of5 TABLE PLM BULK ANALYSIS, PERCENTAGE COMPOSITION BY VOLUME RES Job Number: Client: Client Project Number/ P.O. Client Project Description: Date Samples Received: Analysis Type: Turnaround: Date Analyzed: RES 190373-1 ECOS Environmental John Martin Commercial Space to be converted to restaurant Apri124, 2010 PLM, Short Report 2 Hour April 24, 2010 ien a L s estos ontent on on Sample ID Number A Sub Asbestos Fibrous Number Y Physical Part � Fibrous omponent E Description (%) Mineral � visuai omponents (%) R ; Estimate(% % B5 EM 562497 A White compound w/white paint 2 ND 0 100 B White joint compound w/white/pink paints 2 ND TR 100 C White tape 2 ND 80 20 D White joint compound 2 ND 0 100 E White tape w/light pink paint 2 ND 70 30 F White joint compound 2 ND 0 100 G White drywall 88 ND 10 90 B6 EM 562498 A White compound w/white paint 3 ND TR 100 B White tape w/orange/white paints 3 ND 70 30 C White joint compound 3 ND TR 100 D White drywall 91 ND 20 80 B7 EM 562499 A White tape 2 ND 90 10 B White compound 3 ND 0 100 C White joint compound w/ pink and white 3 ND 0 100 paints D White drywall 92 ND 10 90 B8 EM 562500 A White compound w/white paint 6 ND 0 100 B White compound w/white paint 6 ND 0 100 C White drywall 88 ND 45 55 ��a ND=None Detected TR=Trace,4%Visual Estimate � Trem-Act=Tremolite-Actinolite +oN»�� Note:Fudher analysis by TEM is recommended for organically bound material(i.e.floor tile) if PLM results are<1% �ata QA RESERVOIRS ENVIRONMENTAL, INC. NVLAP Lab Code 101896-0 TDH Licensed Laboratory#30-0136 TABLE PLM BULK ANALYSIS, PERCENTAGE COMPOSITION BY VOLUME RES Job Number: Client: Client Project Number/ P.O. Client Project Description: Date Samples Received: Analysis Type: Turnaround: Date Analyzed: RES 190373-1 ECOS Environmental John Martin Commercial Space to be converted to restaurant April 24, 2010 PLM, Short Report 2 Hour April 24, 2010 Page 5 of 5 ien a L s estos ontent on on Sample ID Number A Sub Asbestos Fibrous Number Y Physical Part � Fibrous Component E Description (%� Mineral � visua� omponents (%) R ; Estimate(% % B9 EM 562501 A White joint compound 5 ND 0 100 B White tape 15 ND 80 20 C White joint compound 15 ND 0 100 D White compound w/white paint 15 ND 0 100 E White drywall 50 ND 40 60 ND=None Detected TR=Trace,<l%Visual Estimate Trem-Act=Trem ol ite-Actin o I i te Note:Further analysis by TEM is recommended for organically bound material(i.e.Floor tile) if PLM results areQ%. �..,, Data QA Due Date: �. RES 190373 � Due Time: ' " ' R��-A`� R�seruoir� Er�rvironm�n�a/, �!?C. raye � �� 5B01 Loyan St.Denvar,CO 90216•Ph-303 964-?gP,o•Fax 303-477-42i 5 •Toll Free�.86fi RES�-ENV —_ . SUBMITTED BY: INVOICE TO: CONTACT INFORMATION: ASBESTOS LABOFtATORY HOURS:Weekda s: 7am-7 m REQUESTED ANALYSIS VALID MATRIX CODES LAB NOTES: PLM/PCM!TEM �RUSH(Same Day)�;�;`PRI�RITY(Next Day),�STANDARD � � p Air=A Butk=B (Rush PCM=2hr,T�M=6hr.) ; c� � o Dust=D Paint=P CHEMISTRY LABORATORY HOURS:Weekda s: Sam-5pm � ,'. � � o Soil=S wipe=W Metal(s)I Dust _RUSH_24 hr._3-5 Day a o� � � Drinking Water=DW ""Prlor noUf(cetlon Is r � � � N WaSte Water=V11V1! RCRA 8/Metals 8 Welding g N c ¢ ao RUSH 5 day_10 day requlred ior RUSH �° — _ � Other=0 Fume Scan I TCLP — — � � o �n 14 ui tumarounda." � _cn p � � m o � � � "ASTM E1792 approved wipe media only"' Organics _24 hr. _3 day 15 Day J ; $ o N g� r � b � � 3'i j X "Analyaia tumarounds are subject to laboratory semple volume and are not guerenteed.You wlll be notlflted °a � � � � u- H � it delayc are expected.Additional tees apply for afterboure and holldays for all analycis types."" � � � o � Q c m � � N o W - o o , � v� o 'g d Speciallnstructlons , J � N a � n ~ � � Z � m � U '� Date Time `` �� ` � t � � � � a a a W °� � o Collected Collected EM Number(�abor�to W a�i U 7 W U pC r m ^ @ V mm/dd/ hhlmm a1 Use Ot1 Client sam le ID ttumbe� (Sample fD's must be unique) � � �n a v � � O o cn d � at YY ° N1 1 � r- � ;�. ��. Z 7—' :i `r; +'/ 3 f �� 4 t� � f. �'' �- 6 1";, ; `j _=S ,, 7 (=. i �-✓ 8 '' � 1 7 9 � 10 -t :� 11 : i I : �� 12; .� :..; 9 3 c� r, .? ;- Number ot samples received: (Additlional samples snall be I�sted on attached tong torm.) NOTE:REI will enaryze inwming samplas based upon Intormation received and will not be responsible Po�errora or omissions in calculations reaulting from the Inaccuracy of orlginal data.By signing clienUcompany representative agrees thet submission oi the following semples for requested anelysis as indicated on this Chain ot Custody shall constitute en anafytical services agreement wlth payment terms of NET 30 days,failure to comply with payment terms mey resuN in a 1.5%monthly interest sumherge. % i � Relin uished B L,] r_�.i�� `�?�.f��i,�� — � ��J`�'' {�r' ��'J'�'1 Date/Time: �r- , 5ample Condition: On Ice 5ealed Intact , L8b01'8t0�'y L1S@ Of11y _.•�1f, � ' �, -i�, l �,. . �� ,, ! �: Temp.(F°) YIN Y/N YM Received By: ��-4� ;.�� ,_. ` DatelTime: �' ^7 , �.- Carrier�, _ �i _`� Results: Contact Page Phone Email Fax Date Time Initials Contact Page Phone Email Fax Date Time Initials Contact Page Phone Email Fax Date Time Initials Contact Page Phone Email Fax Date Time Initials REQUESTED ANALYSIS --�ff�`''�_ .1 +�� R��e►rvnir� Environment�rl, /nc_ � 3 � o 5801 Logan St.Denver,CO 80215•Ph,303 964-1966•Fax 3R3-477-4275 •T oll Free:866 RESI-ENV o d y c,.� �' a v`�i � `+ �' w a o n. � i7s"�� a � � � tn � o �r� '�' � RES Job# �r � l�'°�'� � � � � Page_2_of �.. � o � ¢ � °° _ rn r a p � � � m c � � � � o �a V� ! > > p N Submitted by: ,�' --�-m� �' ` g J � � � �� ;, , .. , . , , � _ � ' _. � a � o � � a m - t S C V�' F- � F' f� fn Q � n � o0 2 � � � g � u�i ra- � � s Client sample ID number (Sample ID's must be unique) � � � a c � � o 0 41 42 43 44 VALID MATRIX CODES Air=A Bulk=B Dust=D Paint=P Soil=S Wipe=W Drinking Water=DW Waste Water=WW Other=O "'ASTM E1792 approved wipe media oi LAB NOTES: � 7 y N O � y` � d U '� Date Time �¢ c o Collected Collected EM Number � � � � mm/ddlyy hhimm a�p (Laboratory Use Oniy)