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Home My WebLink AboutBAKER ST 17425 (2) CITY OF L'AK C?qLSlA0RE E BUILDING & SAFETY DREAM EXTKEMETM 130 South Main Street PERMIT PERMIT NO: 12-00000407 DATE : 4/18/12 JOB ADDRESS . . . . . : 17425 BAKER ST DESCRIPTION OF WORK DEMOLISH SING FAM RES OWNER CONTRACTOR GLOBAL SIGNAL ACQUISITIONS IV WIRELESS CONSTRUCTION 849 EAST STANLEY BLVD #185 LIVERMORE, CA 94550 LIC EXP 0/00/00 A. P. $# . . . . . 378-020-039 8 SQUARE FOOTAGE 0 OCCUPANCY . . . GARAGE SQ FT 0 CONSTRUCTION FIRE SPRNKLR VALUATION 500 ZONE . . . . . . NA DEMOLITION PERMIT QTY UNIT CHG ITEM CHARGE 1 . 00 X 30 . 0000 DEMO PERMIT PER UNIT 30 . 00 FEE SUMMARY CHARGES PAID DUE PERMIT FEES DEMOLITION PERMIT 30 . 00 . 00 30 . 00 OTHER FEES PROF.DEV. FEE 1 TRADE 5 . 00 . 00 5 . 00 PLAN RETENTION FEE . 52 . 00 . 52 TOTAL 35 . 52 . 00 35 . 52 SPECIAL NOTES & CONDITIONS DEMO OF SFR 1037 SF 420 SF GARAGE Qxr: CURIE Tyyppee' 1F 1ra�-r: I I1ate: 9/18/12 18 f�ipt no: 413 Z012 4U7 aJIi. N PERM i s35.5z Trans naer Trans date; 9/la/12 TiW: �33:10 City of Lake Elsinore Please read and initial Building Safety Division 1.1 am Licensed under the provisions of Business and professional Code Section 7000 et seq.and my license is in full force. Post in conspicuous place 2.l,as owner of the property,or my employees w/wages as their sole compensation will do the work on the job and the structure is not intended or offered for sale. 3.l,as owner of the property,am exclusively contracting with licensed contractors to construct the You must furnish PERMIT NUMBER and the project. JOB ADDRESS for each respective inspection: 4.1 have a certificate of consent to selfinsure or a certificate of Workers Compensation Insurance Approved plans must be on job or a certified copy thereof. at all times: 5.1 shall not employ any person in any manner so as to become subject to Workers Compensation Laws in the performance of the work for which this permit is issued. Note:If you should become subject to Workers Compensation after making this certification, Code Approvals Date linspector you must forthwith comply with such provisions or this permit shall be deemed revoked. ELO I Temporary Electric Service PLO] Soil Pipe Underground EL02 Electric Conduit Underground BPO1 Footings BP02 Steel Reinforcement BP03 Grout BP04 Slab Grade PLOI Underground Water Pipe SSO1 I Rough Septic System SWOT On Site Sewer BP05 Floor Joists BP06 Floor Sheathing BP07 Roof Framing BPO8 Roof Sheathing BP09 Shear Wall&Pre-Lath PL03 Rough Plumbing EL03 Rough Electric Conduit EL04 Rough Electric Wiring EL05 I Rough Electric/ T-Bar ME01 Rough Mechanical ME02 Ducts,Ventilating PL04 Rough Gas Pipe/Test PL02 Roof Drains BP 10 Framing&Flashing BP 12 Insulation BP 13 Drywall Nailing BPI 1 Lathing&Siding PL99 Final Plumbing s , EL99 Final Electrical ME99 Final Mechanical BP99 JFmal Building 1 Code Pool&Spa Approvals Date Inspector OTHER DIVISION RELEASES Deputy Inspector Department Approval required prior to the P001 Pool Steel Rein./Forms building being released by the City P001 Pool Plumbing/Pressure Test P003 Pre-Gunite Approval Date Inspector EL06 Rough Pool Electric Planning Sub List Approval Landscape P004 Pool Fencing/Gates/Alarms Finance r En P005 Pre-Plaster Approval Engineering g P009 Finale Pool/Spa CITY OF�Oi�;� LAKE LSIO FEE DREAM E�CT RE M E r.. 130 South Main Street APPLICATION 'FOR ' APPLICATI0 f0 BUILDING PERMIT APPLICATION EC ED DATE � • VALUATION CALCULATIONS 1st FLOOR }� �CII�Q b sF 2nd FLOOR SF 3rd FLOOR SF O GARAGE SF bw W STORAGE S E F R DECK S BALCONIES SF provisions o chapter 9(commencin with section 7000)of division J of the business and professions code,and OTHER: SF C my license is in full force and effect. O LICENSE a CITY BUSINESS N AND CLASS({��o�� TAX a VALUATION: D TNAMIZ R IN\R?✓LDS S r^CTry S j'R-u�"Tt b A FEES �+ C ADDRESSr-L(ck T CITY STATE/ZIP PHONE BUILDING PERMIT s R �I�/�L � A L755-p f q4 PLAN CHECK NAME LI EN E a PLAN REVIEW A R MAiLIN SEISMIC C ADDRESS H I Y TA E/ZI PH N PLAN RETENTION Q NEW OCC GRP_! CONST, QADDITION DIVISION: TYPE: QALTERATION NUMBER OF NUMBER OF OTHER STORIES: BEDROOMS SINGLE FAMILY ZONE- CIAPARTMENTS I certify that I have read this application and state that the []CONDOMINIUM HAZARD YES above information is correct. I agree to COmpfy with all city TOWN HOMES AREA? and county ordinances and state laws relati to building NO � g COMMERCIAL SPRINKLERS construction,and hereby authorize representatives of this O INDUSTRIAL REQUIRED? YES City to enter upon the above-mentioned property for insp- NO O REPAIR PROPOSED USE OF BLDG Lion purposes_ (Q DEMOLfSH PRESENL USE OF BLDG, JOB DESCRIPTION Signature of Applicant or Agent Date Agent for contractor ❑ Owner Agents Name Agents Address Professional Environmental Consulting Working for a clean environment and Training 2279 Eagle Glen Pkwy,Suite 112-206 www.allstate-services.com Corona,CA 92883 Email: info@allstate-services.com Alktate Services (951)245-3700 (800)497-LEAD Fax(951)245-3753 March 13, 2012 Wireless Construction Mr. John Roush,President Universal Cell Site Services 4683 Chabot Drive, Suite 380 Pleasanton,California 94588 RE: Lead-based paint testing at 17425 Barer Street,Lake Elsinore,California Dear Mr. John Roush: In accordance with your request and authorization, Allstate Services conducted lead- based paint testing at 17425 Baker Street in Lake Elsinore,California on March 13, 2012. Please note that only selected areas were tested for lead-based paint at this time. The on-site work was performed by Steven J. Travers,California Certified Lead Inspector/Assessor 0 361 using an XRF Analyzer following all regtured protocols. No lead-based paint was identified on the selected surfaces tested at the above-mentioned property- Please see the attached Detailed XRF Testing Results for further details. if you need any farther assistance after reviewing your report,please do not hesitate to contact me, Allstate Services remains available to assist you in anyway possible, Sincerely, 2&^ A Steven J. Travers Director of Operations Attachments: Detailed XRF Testing Results,Calibration Log, Inspector Certification Copy, 8552 Farm DEMMLED AR MS �1 ONG RESUL70 17425 HakerSCreet, Lake Elsinore,California Leas! Quantities Room Side (ring! For Entire Sample Area Equivalent tested_ Component Substrate Color Conc_hitio_n cmt)_ Results Area Comments 1 Exisriar House A wall Plaster Ore Far 0.27 Negative 2 Exterior House _ _ 8 Wall Plaster (3rey Failr 0.38 Me alive 3 Exterior House �� C wall Plaster ore Fair 0,19 Ne og five _ 4 Exterior House D Well Plaster Grey Poilir 0,21 Negative S Exterior House A Door Wood MW Intact 0.29 Negative B Exterior House A Door Frame mod Whirs Intact 0.36 Ne aive 7 Exterior House A Wihdiow Frame Wood (are Foor 0.27 Ne alive a Interior Bathroom A wall D wall Mft Poor 0.19 Ne a4ve 9 Interior 8ethroom B wall b watt Mite Poor 0.31 Ne alive 10 Interior Bathroom I C Iwall Drywall Whim Poor 0.16 Ne alive 11 Interior Bathroom _ D wall Drywall White Poor I O.D9 Ne aive 12 Interior Bathroom A Door Wood Whiles Poor 0.19 Ne aive 13 Interior Bathroom A Door Frame Wood White Poor 0.27 Ne aive Allstate Services Page 1 Project#12.068 A LSTATE SERVICES XRF CALAJRAYTON FORM Address/Unit: 2335 Bear Valley Parknmy,Lake Elsinore California Device: KEY MASTFRIMAP-4 M41533 Date: March 13 2012 Inspector: Steven J. Travers Calibration Check Tolerance Used: 0.6 m cm2- 1.2 cm2(Inclusive) Use Level III(1.02 mg/cm ) NIST SRM Paint film First Calibration Check Time:4: 50 p.m. l s`Reading 2"d Reading 3Td Reading 1"Average 0.98 0.93 1.04 0.98 Second Calibration CIggli Time: S 0 p.m. 1st Reading F2-d Reading 3rd Reading 2"d Average 0.93 F 1.11 1.04 1.03 Third Calibration ChecklIf Needed) Time: V"Reading 2nd Reading 3�d Reading and Average a Use the Test Mode Reading a Tolerance Values for KEY MASTER/MAP-4: 0.6 mg/em2-1.2 mg/cm, (Inclusive) State of California—health and Human Services Agency California Department of Public Health LEAD HAZARD EVALUATION REPORT Section 1 — Date of Lead Hazard Evaluation 3/13/12 — - — — Section 2 — Type of Lead Hazard Evaluation(Check one box only) Z Lead Inspection ❑ Risk assessment ❑ Clearance inspection ❑ Other(specify) Section 3 --Structure Where Lead Hazard Evaluation Was Conducted Address[number,steel,apartment(if applicable)] City County Zip Code 17425 Baker Street-Selected Areas Only Lake Elsinore Riverside Construction date(year) Type of structure Children"in structure? of structure ❑ Multi unit building ❑ School or daycare ❑ Yes ❑ No Unknown ❑ Single family dwe ling ❑ Other Don't know Section 4 — Owner of Structure(if businetWagency,list contact person) Name Telephone number John Roush 925-980-4145 Address[number,street,apartment(if applicable)) City State Zip Code 4683 Chabot Drive, Suite 380 Pleasanton Califomia 94588 Section 5 — Results of Lead Hazard Evaluation(check all that apply) No lead-based paint detected ❑ Intact lead-based paint detected ❑ Deteriorated lead-based paint detected ❑ No lead hazards detected ❑ Lead-contan0ated dust found �J Lead-contaminated sal found ❑ other Section 6 — Individual Conducting Lead Hazard Evaluation Name T M Telephone number Steven J. Travers 951-245-3700 Address[number,street,apartment(if appticabie)j City state Zip Code 2279 Eagle Glen Parkway, Sine 112-206 Corona California 92383 CDPH certification number Signature Date �ITM�W'�J�sWmkatlt�aw_a j I-361 Steven J Travers' "� �. �� 3/13112 ,_/ Ctrtr.X32nii� siIT.30 aTU7 Name and CDPH certification number of any other individuals conducting sampling or testing(if applicable) Section 7— Attachments A.A foundation diagram or sketch of the structure indicating the specitc k)caiions of each lead hazard or presence of lead-based paint; B. Each testing method,device,and sampling procedure used; C.All data collected,including quality control data, laboratory results, including laboratory name,address,and phone number. First copy and attachments retained by inspector Third copy only(no attachments) mailed or faxed to: Second copy and attachments retained by owner California Department of Public Health Childhood head Poisoning Prevention Branch Reports 850 Marina Bay Parkway,Building P,Third Floor Richmond,CA 94804-6403 Fax:(510)620-5656 CDPH 8552 JtA7) i Professional Environmental Consulting Working for a clean environment and Training 2279 Eagle Glen Pkwy,Suite 112-206 "-w.allstate-services.com Corona,CA 92883 Email: info{aallstate-services.com Albtate Servkes (951)245-3700 (800)497-LEAD Fax(951)245-3753 March 13,2012 Wireless Construction Mr. John Roush, President Universal Celt Site Services 4683 Chabot Drive, Suite 380 Pleasanton, California 94588 RE: Asbestos Sampling @ 17425 Baker Street,Lake Elsinore, California Dear Mr. John Roush: in accordance with your request and authorization,Allstate Services has prepared the attached asbestos sampling of directed materials. The sampling was conducted by Stacey J. Phelps, a California Certified Asbestos Consultant_ Asbestos Containing Material was identified in some of the sarnpl_es coill-ected. Please see the attached tables for further details. Should you have any questions after reviewing the conclusions and recommendations contained within this report,please do not hesitate to contact the undersigned at(951)245a3700. Allstate Services remains available to assist you in any way possible_ Sincerely, Allstate Services,LLC 26k^ h"Oft Steven 1. Travers California Certified Asbestos Consultant Certification No.: 97-2275 TABLE 1 Asbestos Sampling Results-- March 13, 2012 17425 Baker Street Lake Elsinore, California Building Area Type of Sample Sample Locations Quantity Sample Description Condition IPLM Percent Area Code Material Number(s) Result Building Exterior 1 Stucco ST-1 Southeast House Wall 2,500 Ft2 Exterior Stucco Damaged NO 0% ST-2 West Garage Wall NO 0% Building Exterior 2 Plaster P-2 North Wall P-1 North Wall 2,500 Ft2 NO 0% Exterior Plaster Damaged NO 0 Building Interior 3 Plaster P-3 Kitchen 1,000 Ft2 Interior Plaster Damaged NO 0% P-4 LivingRoom NO 0% Building Exterior 4 Roofing GRR-1 Garage Roof 400 Ft2 Garage Rolled Good ND 0% Roofing Building Exterior 6 Roof Mastic GPM-1 Roof 5 Ft2 Garage Penetration Good ND 0% Mastic oof Building Exterior 6 Roof Mastic RPM-1 Roof Ft2 Penetration atioouse nMastic Good CH 3% Building Exterior 7 Roofing RS-1 Roof 1,000 Ft2 House Roof Shingles Damaged ND 0% Building Interior 8 1 Drywall DW2 Garage DW 1 Room 6-Bedroom 1,500 Ft2 Drywall, Tape & Mud Goad ND 0% NO 0% Building Interior 9 Flooring L-1 Garage Steps 8 Ft2 Green 12"x12" Floor Damaged NO Oro Tile& Mastic NO 0% Building Interior 1 10 Flooring L-2 kitchen 1o0 Ft2 Brown 12"x12" Floor Damaged NO Ore Tile& Mastic NO 0!0 Building Interior 11 Flooring L-3 Bathroom 30 Ft2 Beige Linoleum & Goad ND Ora Mastic NO 0% Building Interior 12 Flooring L-4 Room 6-Bedroom E20Ft2 Off-White Linoleum & Good NO 0% Mastic NO 0% ND=None Detected CH-Chrysotile CR=Crocidolite .A=Amosite NIAJNot Ann yzed AfP=Assume Positive ACCM=Asbestos Containing Construction Material(This material has certain requirements for handling and notification per Cal-OSHA.) TABLE 2 ASBESTOS CONTAINING IWATERIALS 17425 BAKER STREET LAKE ELSINORE,CALIFORNIA Building Address Material Quantity Material Location Recommendations Building Exterior Penetration Mastic 5 Ft2 House Roof Footnotes 2 & 4 Footnote 1: No action needed. Footnote 2: Non-Friable asbestos; do not cat,sand,drill,polish,or damage the material; Operations and Maintenance Program is suggested. Footnote 3: Friable asbestos; remove,encapsulate,enclose,or repair any damaged material; Operation and Maintenance program is suggested Footnote 4: Remove prior to demolition/renovation. ACC[ r'NGIlVEERIl�h'G &�'NVIK�A'IVIENTAL SERVICES WWW.ACMENV.COtM 26598 U.S,20 WEST SOUTH BE, IN 46628 P:(574)234-8465 F:(574j234-6800 ANALYSIS OF SUSPECT ASBESTOS CGNTAINING BUILDING MATERIALS METHOD.,All analyses and quantifications are perfonned in accordance with the U.S.Lrnvirtinmontal Protection Agency's"Method for the Determination of Asbestos in Bulk Miding Matadde,EPA/600/R-93/116.The method utilizes stcreo4eopic l examination of bulk samples,as weft as utilizing the}notarized light Weroscope(PLM). To detemrine the refractive index,the central stop dispersion staining method is used,as well as matching with retractive index oil and using tight matching the sodium D tine wavelength. Identifiration of non- asbestos species is I=rigorous,as they am of secondary inttrtW(_ If applicable,please be advi=d that the Stereo ScopeJPLM methods have limitations regarding floor tilt analysis far asbestos content. Historically, the production of floor file has included the grinding of asbestos into submicroseopio partions. Therefore,this method of analysis may produce incorrect resttlfs flu tests of floor talc which pz+oduce negative finding fi)rasbestos. Gross samples are examined under a I QX or 2OX stereoscope where hamogweity(need for sub-snrnples),hexlnre and lot any other distinguishing characteristics are determined.Sub-eampies are prepated ifneeded. Any fibrous matcris)is mounted in high dispersion oil for further microscopcticamination Utilizing PLM. Any possible asbestos fibt:rs are analyzed for morphhairicgy,eotor and pleochroism, index of refmclion parallel and perpendicular to elongation,birefringence,extinction characteristic and sign of elongation,and any other distinguishing characteristics observed, The percentage of asbestos and other fibrous materials are then deternun d according tQ sample area coverage and thickness. Ilia limit of qualification is one percent(l Vie). 'tire above is recorded on the laboratory analysis sheet and maintained for three years.The error involved for reported percentages of fibrous is 100%error for 1°fo to S%,St1°/•error for$%to 20%,and 25%error for 20%to 100%, All Percentages will be reported in a range indicating error or a single value,in which case the above errar should be applied. When the value 1 IN.or greater is reported this indicates asbestos is present in the sample. TIRE RMIIT: The attached report quantifies the fibrous mmerials found in each sample submitted for analysis. A complete fibrous analysis of samples is given for each Sample followed by a breakdown analysis of any sub-samples for heterogeneous material. • This first column is the client sample timber identification. • Tlis sa vnd colrouu is the laboratory sample number. The laboratory number for the overall sample analysis is a digit number. The laboratory number followed by a letter designation(A,%C.cm)indicates a sub-sample analysis. + The third cohimir is the sample fdentif)callon,which indicates whether the sample is homogmeous or heterogeneous,the color of the sample,and the physical description(cementitious,fibrous,cloth,etc.) • The fburrh column indicates the types acid pet center of asbestos identified if any. • Thefif h cvltmui indicates the typos and pt rccritages of collulose(CELL)non-asbestos identified. + The slrth column indicates the types and perr entages of non-11bronrs,non-asbestosmateriai(Nt7N-MB NON-ACBM)identified. • The seventh column indicates the types and percentages of fibrous non-asbcstos material(FIB ANON ACI3M)in the sarnvtc or sub-sample. SAMPLE KLTEIYUON.- Samples',rill be rctaiiicd for 6 montths unim otherwise instructed. After this period,the sawle(s)will be;disposed tit appropriately. Upon written request,the samples will he returned by mail or delivery for a nominal fee to cover postage and handling There would be no Charge fvr s8rnpics picked-uli tit ACM Engrrtaeting&$nviromrimial Services. ! C S N AND RECOMMEi+IDATIOWS: In order to reduce the risk of introducing asbestos fibers into the air,care dtould be taken not to disturb the asbestos containing building materials. If renovation,demolition or other activities might disturb known asbestos containing building materials,a reputable asbestos consultant should be contacted to help effectively design and implement an asbestos management program. C0MFQNMTS DESCMPTION- ASB MATERIAM hLON-ASBEST08 MATERIALS A —Amosite CF Cvmrnic Fibers N —Nylon AC =Acthnolite CO =Cotton 0 =Other A.N a Anthophylite G a fibrmw tr m S =synthetics C a Cltrysotilc H A Hair V =Venniculite CR =Grucidolite M a Mineral Woo) T =Tremolite ---- R No Asbestos Detected NOTE;ACM Enginccring&lahvironnimtal Services does not deviate from the test method described in this report Ibis ngxut roust not be used by the cliart to claim product endoraoment by NVLAF or achy agahcy of the U.S.Government.This report relates only to the itenn above.This report must not be reproduced, except in hrl},without the written cpagCnt of ACM}:agineecting&Euvirortn enfal services. Report prepared by: / � j PatrltkT.Griffin,PrO ACMrngtneer nz& ntal Services A.C'VI ENGINEERING&EN5ppNMENTAL SERVICES wWw ACMErry cony 26598 U.S.20 WEST,SOUTH BEND,IN 46628 P:(574)234-8465 F. (574)234-68iDO CLIENT: Allstate Services Environmental ANALYM METHOD: EP9/600/R_g3-l;6 2279 Eagle Glen Parkway,Ste, 112-206 NVLAAaP LAB ID#; 101977 Corona,CA 92883 MATRIX: Bulls LOCATION: 17425 Baker Street Sample Date, 318112 Lake Elsinore,CA Analysis Date: 3/9/12 AGM PROJECT#: 18609 ST1 1203191 EXTERIOR STUCCO I% 99% = ST2 1203192 XURIO PI 1203193 EXTERIOR PLASTER 1% 99% -s-e : PZ a203I94 E-X TERiQ1tPLA$ P3 1203195 INTERIOR PLASTER 2°p. ......•.,:99% - - : GRRI 1203197 GARAGE ROLLED ROOFING --- 38% 62.% ---- G�MX' ._ I20319-$- 'GAR.AGEPENBTRATI,ONMASTIC 6% .;:'�94?/b �•';.....--- . . RPMl 1203199 ROOF PENETRATION MASTIC 3%C 8% R81p2U0ROQFS-III�IGI DWI 1203201 DRYWALL --•• 13% 87% 'PW2 1�1fl32 D Ll 1203203 GREEN 12X12 FLOOR TILES --- 97% 3%0 L2 1203204 BROWN 12X12 FLOOR TILE •.» --- 96016 4%fl I42 12032Q+IA 3VIASIC --�- % 8°la L3 1203205 BEIGE LINOLEUM ---- 46°!° Sd% -.__ lei 3'C 24/a 98% L4 1203206 - - OFF-WHITE LINOLEUM y e --- Gl% 34% 7 j t ACM RECOMMENDS POINT COUNTTNG ANAL YSIS ON ALL BULK SAMPLES j WIT�1,ES THAN 10% (<I0Yv)ASBESTOS CONTENT. � Microscopist: t/ 2aTit1e: 0 Date:ate: I � BUAK SAMPLE ,'gIES7'FORM U��Lf V 4 e- 1 0 f- a CLIENT NAME&ADDRM: DATE: F Ia Allstate Services Environmental, Inc. Circle the Metbod and 2279 Eagle Glen Pkwy, Suite 112-206 Turn Around ' e Corona, CA 92883 2r� 4nr ahr/Ext Send ReaUUa To: !nf ma a - ►ic .cn n Piz: (951) 245-3700 Fx: (951) 245-3753 ANALYZE TO IST SITIVE? YES/ O CONTACT: S#(Xk t'1 L P smndar Point Count Gravintetry Pre P.Q. : JOB: TEM: QUAL. / QUANT. / WATER SITE: ` ` ,�} '{ ' BQ LQ(- -I_ AA/Ftame AA/Furnace ICP �--O K Q- O S I noq), G (4 METALS: DATE SAMPLE NUMBER COLLECTED SAMPLE LOCATION/DESCRIPTION -I�Q_rIQY r or Pl P 0o (� C) nc c Sample by: , Date: - Time: Relinquished bye n ` DatvTime: ��\J�r 1�� -<<.�Q}[; Received by, U Datemme: ,�j" f O� Seated Condition(circle one ES/ Relinquished by: --� DateMme: Received by: DatelTime: Delivered to: L Seated Condition(circle one) YES/NO Lab Name Date: Fed-Ex fit: Date: Receiver!b ; BUL s LB RE s o I (�►(.��I o ��— CLIENT NAME&ADDRESS: DATE: } Allstate Services Environmental, ine. Circle the Metbod and 2279 Eagle Glen Pkwy, Suite 112-206 Turn Around Time Carona, CA 92883 hrllz 4t /48hr/Ext Send Results To: of pia e-x ca,n Ph* (951)245-3700 Fg: (951)24S-3753 ANALYZE TO Isr PQSITwp? YES NO CONTACT: � C►��V'( Q- PL Standard/Point Count Gravirmtry Pre P.O.#: JOB: TEM. QUAL. J QUANT. / WATER SITE: j —IL} J ,Kor &F AA✓Flame U r I AA/Furnace ICP Uk nQ — l S I ncj rc METALS: DATE SAMPLE NUMBER CO ECTED SAMPLE LOCATION/DESCRIPTION L_ 1 r10�ra on l I f'�c�or s i 4IU E Sample by: Date.J Time: ReiiQq�� by; Dat&Timev� }�QV� Received by. 'n 1_ Dat&Time: 3 d / Reilnquished by: Sealed Coai ition{circle one YES NO DatwTimc.- Received by: Date/Time: Delivered to: Sealed Condition(circle One) YES/NO ._-(_., Lab Name Date: Fed-Ex#: Date: Received b 1 II � f State of California Division of Occupational Safety and Health ? Certified Asbestos Consultant ' Stacey J Phelps I3 ` Certification No. 01.2888 Expires on 009112 Oompfmw sa"y ad HMM as o by 3ectae 7180 0 m4 d ft ass and i Pr> Code. II ! 1 i i I i i i 1 I i ,I I State of California ~ Division of Occupational Safety and Heafth Certfffed Asbestos Consultant 1 Steven J Travers iarm Certification No: 97-2275 Expires on 1t11u12 • ra,s won was�ar me�,d del Safay and Heelth as armed by SOCWm 718D d seq.of{fie Basi and Pontessm Coda. Professional Environmental Consulting Working for a clean environment and Training 2279 Eagle Glen Pkwy,Suite 112-206 www.allstate-services.com Corona,CA 92883 Email info@allstate-services.com Allstate Serves (951)245-3700 (800)497-LEAD Fax(951)245-3753 March 13, 2 D 12 Wireless Construction Mr. John Roush,President Universal Cell Site Services 4683 Chabot Drive, Suite 380 Pleasanton, California 94588 RE; Lead-based paint testing at 17425 Baker Street, Lake Elsinore,California Dear Mr, John Roush: In accordance with your request and authorization, Allstate Services conducted lead- based paint testing at 17425 Baker Street in Lake Elsinore, California on March 13, 2012. Please note that only selected areas were tested for lead-based paint at this time. The on-site work was performed by Steven J. Travers, California Certified Lead Inspector/Assessor 0 361 using an XRF Analyzer following all required protocols. No lead-based paint was identified on the selected surfaces tested at the above-mentioned property. Please see the attached Detailed XRF Testing Results 1:or further details. if you need any further assistance after reviewing your_report, please do not hesitate to contact me. Allstate Services remains available to assist you in anyway possible, Sincerely, 2*04- reV440 Steven J. Travers Director of Operations Attachments: Detailed XRF Testing Results, Calibration Log, Inspector Certification Copy, 8552 Form DD ET64LEDD ARF TERVONG QDRMLM 17425 Baker Street, lake Elsinore, California Lead Quantities Room Side (mg! For Entire Sarpp a Area Equivalent Tested Component Substrate Color Condition cros)_ Results Area _ Comments xteri 1 Eor House A Walt Plaster Gray— Fair 0.27 Me alive 2 Exterior Hausa B walk Plasterr Or® Faiir 0.38 Me alive 3 Exterior Houss C WAR Plaster Ore Fair 0.18 Na alive _ 9 Exterior Hausa b Walk Pkaetar Gray Fair 0.21 Ne alive 5 Exterior House A Door Wood _ White Intact 0.29 Ne alive 6 Exterior House A Door Frame _ Wood White Intact 0.36 Mega�ve 7 Exterior House _ A Window Frame Wood Orgy Poor 0.27 Ne alive 8 Inrinr 8afhroom A Waft Dryvraff _ 1Maikae Poor 0.19 __Nege6vs 9 Interior Bathroom B Walt Dryvmll � White Poor 0.31 Ne alive 10 Inl$rior Bathroom C wall D wall White Poor 0,18 alive11 interior Bathroom D wall D vrall White Poor 0.08 Native12 Interior Bathroom A Doof Wood White Poor 0.18 !Ne Nagative 13 Interior Bathroom A Door Frame Wood White Poor 0.27 No alive Allstate Sarvices Page 1 Project 02-088 ALLSTATE SER VICES XRF CALIBRATION FORM AddressfUnit: 2335 Dear Valley Parkway,Lake Elsinore, California Device: KEY MASTER/MAP-4 M41533 Date: March 13, 2012 Inspector: Steven J. Travers Calibration Check Tolerance Used: 0.6 mg/cm_ 2- 1.2 m; cm2 (Inclusive) Use Level III(1.02 mg/cml) MIST SRM Pant film First Calibration Cheek Time: 4: 50 p.m. V Reading 2"d Reading 3rd Reading I"Average 0,98 0.93 1.04 0.98 Second Calibration Check Time: 5:20 p.m. I"Reading 2nd Reading Yd Reading 2'a Average 0.93 1.1.1 1.04 1.03 Third Calibration Check(If Needed) Time: Reading 2"d Reading Yd Reading Yd Average • Use the Test Mode Reading • Tolerance Values for KEY MASTER/MAP-4. 0.6 mg/em3-1.2 mg/cmz (inclusive) State of California—Health and Human Services Agency California Department of Public Health LEAD HAZARD EVALUATION REPORT Section 1 — Bate of Lead Hazard Evaluation 3113/12 Section 2 —Type of Lead Hazard Evaluation(Check one box only) Q Lead Inspection L Risk assessment ❑ Clearance inspection ❑ Other(specify) Section 3 — Structure Where Lead Hazard Evaluation Was Conducted Address[number,street,apartment(it applicable)) City County Zip Code 17425 Baker Street-Selected Areas Only Lake Elsinore Riverside Construction date(year) Type of structure Children wing in structure? of structure ❑ Multi-unit building ❑ school or daycare ❑ Yes ❑ No Unknown 0 Single family dwelling ❑ Other Q Don't Know Section 4— Owner of Structure(if busineWagency,list contact person) Name Telephone number John Roush 925-980-4145 Address Inumber,street,apartment(it applicable)) City State Zip Cade 4683 Chabot Drive, Suite 380 Pleasanton California 94588 Section 5 — Results of Lead Hazard Evaluation(check all that apply) E] No lead-based paint detected ❑ Intact lead-based paint detected ❑ Deteriorated lead-based paint detected No lead hazards detected ❑ Lead-contaminated dust found ❑ Lead-contaminated soil found ❑ Other Section 6 — Individual Conducting Lead Hazard Evaluation Name Telephone number Steven J. Travers 1951-245-3700 Address(number,street,apartment(if applicable)] City State Zip Code 2279 Eagle Glen Parkway, Suite 112-205 Corona California 92883 CDPH certification number Signature Date 1-361 Steven J Travers -�5 .� ba[c 2U12W.1714A23D-07'dd Name and CDPH certification number of any other individuals conducting sampling or testing(if applicable) Section 7—Attachments A.A foundation diagram or sketch of the structure indicating the specify locations of each lead hazard or presence of lead-based paint; B. Each testing method,device,and sampling procedure used; C.All data collected,including quality control data,laboratory results,including laboratory name,address,and phone number, First copy and attachments retained by inspector Third copy only(no attachments)mailed or faxed to: Second copy and attachments retained by owner Califomia Department of Public Health Childhood Lead Poisoning Prevention Branch Reports 850 Marina Say Parkway,Building P,Third Floor Richmond,CA 94W4-6403 Fax:(610)620-5656 CDPH 8552(W07)