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Madrona K-8 UST Documentation.pdfThis Shipping Ord©r must be legW1 filled In, 1111Ilk indellblg Pond1, or In Carton, and rMANVid by thF agent Shipper NO. Page I. of! 5 "' cam: w-e (Nerrrg ofoNpr) (9CAC} Cn Ca act ;,', De i.e�' 1ti:mA•ld �hn iPizr, tiiN m\ql ri0vr e; era co•n 'e -umr o• m eNer:Ave rxc.tYd Ih N- �:L, ep;.1, TO: Gonslgoaa d Street T�b1•-�f� r .' w�3. !�c�t 1�� {� — city . _ _ • 1 State ZIP Code ROWB — 0aai units FKMPi C?irttaln6r Troy Camer No, 7_ 0 11 1 n� Date o'7 G FFit)M shiper b Street ��i�3•& Cr4 State �� ZIP Code - I ?a hr. Ema;: :v Contacr BASIC DESCRIPTION TOTAL QUANTITY UN or NA Number, P;pper Shipping Narnf;, Hezerd Cleea, PeCKing Oroep (t/INght.Wurn0. Gallon:. vtc.) vehlde Number tSlblc.-t to I RATE I (For Co rise PLACARDS TENDERED: YES G7 NO E:3 REMIT noel — 'I) Al -ore the r= u Iz"rdart on •una, Ahppd- ere n:1JnA -O rrnle ll.r:V,,d�aN1AIIh8cw'renlsnryl(q C,O.D TO: -pdclrciir inwnlr,e d g ]td tuo- arrkrdd 'AU11 cl the prapd�l'. W. kl orrs 'Th. mn! nmanl nee ful• an ADDRESS ;gmc �r CBx.9vd \rVu et Ind PrAvaly a ham-rj 3aaai-el v el" ny Ind \�:,:re. to S 1 � YVJeIa f aerw eluodrg P.-I S:e alas] oerr.A lt'the amaw d'Ip"3 C O.D. FEE. 121%%hle the ct9lstld toll offs enc am r. aaNlhsX PodcA dd, CO.D. �tD ❑ pv�tnn tin olyartuld tie hWet dfe ldtMronno: g � r .] n:liOYA J' a yaw oorl.md�n a i1e :Itl• ar nOr/:kd Ordkoa bt r p t vrk n � sk Amt. Y •p Kd ifs ehUaer eocn h�l mleem ;n nl 2-0ecv T pR;,er rndtl�n (rr COLIEGT ❑ � the cerrl-.f, IkNlny Cekaz a vJttd Iva ceme�a red7ty' Htdl 6e I mird I� ma PU1drr. pVrhdO �/ WONpr:u.cNChk 4ee N1.1FC ntcd 172 ' fthfi{1QI aoxdYA Iv r k:ehH 3.1j>t:. Ia Fntl-.n 7 A l.v w. IM f, Y,:a . Ina E ura :kl.Nea r. to TOTAL ti.)t Umrnallrm rs.TJY,na 1ppcil yr tJblrntv,l Irdkrru77rl•1 yfl nafnna ,�7rentnmlA -en�Ynt•: rltlwi �xavru o•. IIN anfljnx. Na oce�.v. !n?ll LOr, the �jAri�g 6 LNrA v' or"-. n I \ Eaa se a qq MNrjr mr«,e l: mus to a� nkyyC end ++-Y.iQ(j od -jereui .Va 11Pili(t`M1on. Eaa Fs�;lbt' 2(d.'c+f rea.N^�. n,: Mrda W01 by .-try dt1Nr.•f At ihb atprnxt "Mr,ttt :ufinen: 'Y FAEf3Hi �>•t1tAUE6 Ild,,, A37. BIK :/ �YJh7. FrrgM slip hid 3xemcmt �� ChBnjee yid 9xlta• 1(h) d rn.jjm end al It-.. Ltrld Ih]yA FaEYFRE01-FO ARG:a�re-or n Iha COnYer, `cm: Artd C�nd do-e lnr o IN: d exh artl:m. -- _ 81nn9IWp _ IKan d[a r aron X. ''lt,f pc a Cb.rrann ryd u :t.�•NA L� :A nt RECoh'ED.hmrtnlrya!r,4Vcnsx.dx1h1 dlr[IcnraCwar-4", dcavrldllaQrG, Walton6hdatooehn.NjjBleTftlnnimltd8lddideloronpAq'Qpkvgny,t,:afay'BdNie]a t» Pr,�,Y"J tllvrted ¢n.g t A'go7'r. Pox :,r6r• dll;tf4 m rr�] �� YdrA1 ire ca,orf rr J1 c'r- I!V1t: N 7a0ryje! J-h'o:.r', nwnvd. ror�G,tx, rn] artthtrJ ea I-c and am.y With add aMr rrf jdCWe-f i'WM'3f1 moda.bimm y Ivald'lfi:�o lame oa.o-dixra'n �teowa'•l ig r.No- 'Im .a ce,tu teft xde'llox trn,g-o,J lis cv�da t:a mytrinj f'V a>rso- rr cerpaanm m Nl rirlcnor Ina ;Kd Mahtmea:. F ;k,] i nIlt:ipcn.ry J)da dte U.1"WI)aP"'e CY'rt'IOIIS Y..kl a(r;yla31\]n'za:1, jQT Rw: hays/ chlrrm IhM he h Wriiiii Alh el Ink t:1h� I•'m; Ko cn bllord n Iw relLn,ll x ry'a/ry;. "crAhAtc ]H1w7 vvir rrayarcrtite �.jir \f(glnnlv't II'am.n" 3rejAmft y9&,d9-.81cn Arrltl y aidtara Ara cxSrvnsareharatj og"d I'J 7f Naa qr a lhlad nlf e0na0 a9h, K nccy rler cr al« anfcf,-wCJ-wcrPV "pj oryq 6-pufox otay:l•r,Ia r.da e:[e9lod Yr NrcbdEend hla tYY.►�d, SHIPPER L; to , _ �) '7PE RRIER — �?orPER 1 R 1� DATE Pormarient pp7.Office addr,�,Sg d shipper STILE F3TSs �j1' LABELMAMA rnlvr_ocrc���riW:n,=a+ r.um►n+ (p {t,C9}821-59<)9 '.►•,\•.•.laralrnaeter.com UilI1i5T9 JA P-W y Marine Vacuum Service, Inc. P0. Box 24263 Seattle, Washington 98124 GENERAL CONTRACTOR Telephone (206) 762-0240 CONTRACTORS LICENSE # MARINVS097JA FAX (206) 763-8084 1-800-540-7491 AST/UST STORAGE TANK PUMP & RINSE CERTIFICATE Tank Size: o(v, OCR 6 � L--- Last Contents Tank Location: 9,3(12 41Ar -`7; Yj'&w, , W,� Marine Vacuum Service, Inc_ certifies that the above mentioned tank(s) have been triple rinsed in accordance with the industry standard as outlined in 40 CFR PART 280.70, WAC I 73-360- 380(I), API 1604, API 2015 and that all residual product and rinsate has been disposed of in accordance with Federal, State and Local regulations. Tanks listed above are NOT GAS FREE or NOT SAFE FOR HOT WORK Tank Owner: i�ItAI-0145 Contractor: z—l-(— r l L M.V. S_ Representative: A/Uf V6?1�r Zw Date: ?^7,01 � e. Notes: DBE # D4M1302341 EPA # WAD980974521 A MINORITY BUSINESS ENTERPRISE ID # D4M1302341 This Shipping Order Page of must be legibly filled in, In Ink Intlelibte Pencil, Orin 0,ar bon, and retained by the agent MARINE VACUUM SERVICE INC. (Nome of cmlea) _ _____ _ . _ _.. _� __ �_o„.„ ....�.�.. �� ,,,,,r, ww.r wv. w:w 9rn. s nrry �' � obn►atse 7GN0etl F him acw, 30;.1. TO: COt1SiFjnacl MARINE VACUUM SEP[V>1Cf. INC Street 151fi SQU'fR GR1�EE? - city SEATTLE state WA ap Cotla 98108 Route No, of units FHM R Container Tyog Shipper No. 1$982 Carrier No. Date ;SCACj PROM: r, Strait 't1 � � % 7/ : , 'I V E" ;6 City _C i 11% o o Wate &u'`i zip Code C.61EWTa 14X*N' 6&aM 24 hr Emergencyr.Cnhct T�,,! , CXX"'K40T MIwi36276'�_� BASIC DESCRIPTION UN or NA Number, Proper Shipping (Nome, Hazard Clegg, Packing Oroup 1 TT X (DIX SPEC TANK REOLM11W) UN1863 FUEL, Al bMON, TURSIN ENGINE, CLASS 3, PG I I TT X (Dar SPEC UNK REQ�l1 M UN1203 GASGUNE MiMFIE CLASS 3 pG 11 1 IT X i= SPEC TANK REGUIRED1 LIN1 Pal; C;ASOLINE GLASS q P * 11 t TT X NA19931)1ESEL MIXTURE. CLASS S. PG 01 TT X NA1993 DIESEL CLASS a PG III 1 77 X NA1270 PETROLEUM 011, CLASS 3, PG I I TIT X NA1270 PETROLEUM OIL, MMRE. CLASS 3. PG r 1 TT OILY WASTE WATER NON REG $Y DOT I T"T WASTE WATER NON REG BY DOT I TT MARINE VESSEL SEWAGE NON FEG BY DOT I TT STREET WASTE STORM PIPE CLEANING A1bw RI~Ci avow FLAVARDS TENDERED: YES t3 NG c3/ KMIT C.UD. TO: ADDRESS Nets — (t) Wh- rlw ree.'s tkpa►7rd an %0^ *t,pera No pe(a Wd e. zU,ip epetrksy'. � +wfty +a booed or dorism ,eta d #w 'ir►t I rahYll dlCkre d-- -Mwbg d � wway. 0 Fula'.: WWd 01 derbr.d l- 0114 PM-Vk—12WLGtb dab. W Nehpp cunslpnrrYsnl ,re fidhr and uown"y dbso E01g100�otlrA Oar rhv �'ry I,. Lh4 D""j, rrtt� tt�� IWIW and ere abwAo, [/�■ COD ta111arebe.{p�'WAOLiNpo.Orbrts�etltYdtriL�fonaC,.c.nW�9reGArd'nrr,t peCtaye( • COW" rr a vaJuc Ard.r,Ufon t7 do .n�J,.r .na Iw .ntpa .o.. rpt ro►a� iM 0~0I.>5iiar or dMar.. W y[y I.r rA,, Z kt1lrV anNl b'3 WriW b fw n1°M1Po end htntedtsemrnoQ rYq" In all rv:p.o}y h Or�cer wrJ,Yi� rod ate toi ax 6xM AOAbd Ny errJ, yet M0`, Sx rrMFC IWn 172 r[grrYAp yeYykl wab111.n.V card Or dl`Wllen n rwd" Or V91hOcr1 acoor.u19 rn dDO& earn_ Ir.a+tpCYN adr�tfrelfp.Vfl./ltrYi Mme(�C6to gomnwdlkc n;r0rpytiaL Sea r.OsrM IM GYAOr E Ibm 3f,0, faFjt a �tl r�0.09n,.nb �cb%clanLallwa �� 1GMn type N n.Sl,tstl all ctl .,p C�xmetl Tema and Cp10i60rr.lor a let d uM srliia. — _ Sigf181Urr -- pw.ayw. maw b tin dLmav w K4 tdrih b dkd on 91e do all dm scw r' fig ad lalq} IV crcvw,r dacrdq Worn a q,<ar.rt poratsJM,.rvyt m .�tyd t'�rarrE are mnO430 G mrr 61IM9 Or Nrkpc rrNw'rr}, rhl,teid. wrrtr,A errd 069iad w ►dieNOA Bbnn vAhh mtl G91IW Ow sac ca"w Wng u,da�arQ t rouF� ht 1 i oo notl W rwd p wy p6w n a oamamr, 4 pls>m":�devu ,.,der av ur1 r9 Pgdea tom a carry to as abate ma" 0said deeF rieaon / on M rpar. awrrt+o W deF.ab, arattrr aRTAr on.w rrafe q 9eid d.tlrutd,. a 1i R111F nl �..ro rH ao 9xh cony a.1 u e11Y af, ead vgarry oMa r a sry P'jIr/, deeN r.ul. m en SHIPPER �t ) PER TOTAL QUANTr it lalght. vaum-, V9hICl9 Number WaGHT iSuup_ar, to Arnr $ n) d dw omOfttr.. IN, wp,-n h to d darwo Law* n/OMJI.. al Fla tare y.n, M mYANr Frei son T. Il�ra M'Mo dINSY of C,Y •l/r-1 vMnaut p./n:M M CHARGES RATE (Fir Car tyr VeaOnV, —_ CHARGES qe. , grYalw:l bCo a ualon and vs 10le it pab at e.rt�r//.rro IRI.N.'ted h ali a dry dell ProDf`b. lfol oMry f.rKCp W be pabnrnd hasunrdr7bt10e at►M W tll Ia dl d N,frc snru an0 umlanT Ye �a"t9 our 9WAMM on dm dab ar w+C1nw11. S 4*'M twat i amyl¢ .,a, NN Is ramiku WM oil ft Jkli,g lame aN oeN:Mlw4L h d4. 7AwAn' p dmarLf W and b 911 tarry BMI Mrk ikre am hw" O"W It by to cht:per and KVCM Far hbsar wq tu, ortl;Fn PER DATE J STYL E P378a 02012 LAMA P'em,enent p06t-0tf ad*eMof di :pet ew,unn car 0"w* 1, wtcii #= u:+r,bsurecwrnK L�1�1lLkl. L` * (9130} w-moe www.rsbOrrdaster.carn Philip Dovinh - U.S. Marine Chemists & Engineerin'_MARINE C >EMIST P O. Box 63, Mukilteo, VVA 98275 Office: 1206) 20M912 Fax: Cell: (206) 2OM912 Email: pdovinh@comcast.net Joe Phan--MarVacjon Ross, Marine Vacuum ServlcetAscendent Ascendent LLC LLC (Jon Ross -Project Mgr) Survey Requested by Vessel Owner Agent UST Underground Storage Tank Vessel Type of Vessel Diesel (3X) 02, LEL, Visual, CO, H2S �t Three 3 oadin9s ests P- ear armed Inspected Spaces: Group 1. —ONE (1) 10.000 GALLON UST (DIESEL) Test Results °A 0, % LEL CO Inspected. spaces group 1 <3 57k 0%3 a ppm CERTIFICATE Serial Uv r-ij4U34 Page 1 of 1 Sep 10. 2018 Date 9300 236th SW Edmonds. WA 98020 Specific Location of Vessel 1 d:26 Time Survey Completed $afety Designations: NOT SAFE FOR WORKERS SAFE FOR LIMITED HOT WORK LIMITATION$: Specific Location: —riot Work Limited To Excavation & Transport Of Tank To Marine Vacuum Service For Oscomrnissroning & Scrapping0isposal Only. Hot Work Type: ---00 NOT COT. TORCH, CRUSH, BURN, YJ�LL. OR ' " : ' : "AlIC-41 ' --!E T RA T E TANK Areas to be Excluded and Limitations:—KEEPALL OPENING CLOSED EXCEPT FOR ONE 1/8" VENT HOLE FOR TRANSPORT. INFPTr , Inert Madlum: —Carbon Dioxide (CO2) Method for maintaining safe conditions: —Keep Tank Closed & Secured. —Keep All Openings Plugged Measures for safe disposal of inert gas. —Keep Inerted Spaces Chased, Secured As A Means Of fried Gas Disposal. Other instructions: :AVATION & rRANSF. THIS F�IIVK MIUSi 6E CJMPLEizD BY 1700H ON SEPTEMBER 11, 2019. OTHERWISE. CALL THE UNDERSIGNED MARINE CHEMIST. —DO NOT ENTER INSIDE TANK OR SUMP —DO NOT OPEN MAN HOLE. H2S 0 ppm Limits of Detection 0.5°/a 02, 1 % LEL. 0,1 ppm H25, I pprn CO, 0.1 ppm Benzene, 0.1 ppm THGaA1nCs vrlPID. 0.1 ppb THCWVOCs vdPp6 PID In the event of physical or atmospheric changes affecting the STANDARD SAFM DESIGNATIONS assigned to any of the above tPaceB, this certificate is voided; spaces not listed on the CertifIcate. are not to be entered unless authorized on another Certificate andtor maintained in accordance with OSHA 29 CFR 1915: or If in any doubt, Immediately stop all work and contact the undersigned Marine Chemist, Unless otherwise stated on the Cert►ficate, all spaces and affected adjacent spaces are to be reinspected daily or more often as necessary by the competent person or the authority having Jurisdiction as applicable in support of work prior to entry or recommencement of work. awe. ,�•�. �•, ,,,�,,,p...:..n, �, •aoen m ewmwrc W mcrn fin,7rq D3 M& ixn]mcaa-n d Fria, tranFa� or carrper+rrent9 akoj6el la !lid cWS jr`gn, uN54A BCroJ,irsy ItNlyf,10„ern�ill p'D' V� +•6tiBdl I, c iIsfiPUa rr {d(A::5 a Al Itlrli, 'Mn1B, ne`dlhp [tills, 1'�r, '��F. sr.1 81.11IN ard4w appnrj'Asn,:8a elur t' a»s�irM �n... :.TV unlL'v `c lo,nUar wkis NA Cerlrfr:ils unlBSs Mr -Ma If d* .r4e v.Ialn Ine tsolry twy tvierl spa3dcFlly sNnoi:ed oil :5itundY�la 'IO JS: {plre kt {?Sre�Ylre:eO Ndrtl VFp 305. $I.P39e'll:rr1:4.31 thnlJ�t 4.L.E) ejt'r In +4, cirrprfDTAn: a t0i3re w ml:inrr'n. n fsi Ins D.ay¢n mn"it of 71s suite twAl ahAl dt at "It I St r CWOBrrt 9ntl no+ ViWer trwr12e pNxM bf %,ourro, it.) the .ul�"I iTiYllow 11 PmTsA-n Of TO Ih nI (c) airy try je m:ranels In Ve elfrr SONN'A'VmjAni Will) "jo, UN. I&A e*-linpz Irnrlrki rrA JLrne. Of K^Gmnts rtE IonP 9' Ina Irnn of ie irgpoArxi. In U19 Q�mPSNAI-Yit a- apemz ski MPljn9'6d a,H,y ,h nll nrr De pennittad. US: In IFie Q7a1NerI1ren1 Of z,eoc co r>.M?nsfed Mtry'of w1:6. I% pennttao anti if cardt'ane -f Fir -par pv.dLtr,,a eClijpmant a eblfIng. or MA. or et of &w afr:rvnardbnvi, ed ,ar-t 1 Va f":)T !1-1D9K In the darn"alrr+en1 or PRYA En dadv rW,&i JRI Ine ot,,,pi,l [ollertl of .he rlrnoFpha'e le r3t,felkr "ten V tawat by wdume, kb) t!y oinol lath i4 oi;nmStle n7UrjolP In Irn ' 0 Ilerce,ll of We I,ii%r enolook-a rmd, (C) the Mg-JA ?., ,'i.� Ot proadr:-Yl,a. "re ns are even � A envy to rrH+ant me foraid of flne eriJ are ncl b9 cd,>)Nv c•f prodetir 9 hk3naf Qvicenlrzmm than perinlaaa 6F' Se) cc (D:+ j-11 Gil aSYArr dw9c qo:ntenha cy ": h,1 cccl�med rle111111 Ile cY Lvft*L ibl: mXrir'NW ±i1311 bs eum. ciw: r rrsd of MNOAd, dean, Or p'nxrl11.1 aa4,gi rO pM•iefY tie 7pra94 of ara; or .nVj 9M harm hW8 fue( tonk.o. Ube, tenye, ey anom morr, or flre room Glees ar other mqh jlr,ry, %.9Le� dRm braa�d in a=4V31-9 viti ale b.ad,vl (4rrnI3f3 ror�urvrnacty SAFE =, IM17ED h:OT VnRN; In Ih5 :afte&rwnj nr cracA to sas'Onexd soil For. -- I3 0' Ine %Lam me6A the nOuinrnem sY-? by Met WcA ara FSmed CluMno, w eppic!bh rn It) Ine WAL-a11 11M. e ,• eutrllleril: fey S-fr for H-t WOtk, Ira tut'o*t IS rTVA7 6a 10 fCAM- U ebfo ; (C; piwilon> of Me%o1r9ce 'hill merit 119 rti/j.Jlren6o rIb forSefa fcr Hr[ IJ-brk, 9b aporc abl9: BM at nmrnre or rye of tut wor4: zra I be lrnlMd or taaM,'4ia NOT SAFE FIR In Mr- arnpF•fitar,l or 60:A Go de-AGnete4, riot is tut parminei. CHEN11919 EHOORE2MENT. Trlra'e to C,b'/ify Mmet hpd par,onrlly dal9i mired that all KQ0;Q lrl lha fi!Mgunp Iyare In iw=rde,loa vilh NFPA °[Y Cormol at Gas K!,13rdd m Ve:mrs erQ nFna rmad Ina mndSgldea<Yl to 6e Ir. acwo:ncR»tit•?xsadt3nyi 6,69 man 're.nieKJne]arrael.wldw.e;Apt cm Mr Ce1fWa,mL,rlJ='q Jx n 3, 1. n1w, Fv ea la m mj I7nId1J-e lmuru'211n1hMIM1IRI'1TeY0',hYS4nurl VW.-m brq'mey a-dlf beats n K waf bu:•d. ant Itr. ro}Fwme-N rt marml- va:fa �vld,h ,r.[XKb nnkJ a•gr%Ih a14e n�a1a-a aro L•eUutlrrr.. ' 1 / Jon Ross, Project Mgr Sep 10, 20 to Authorized Representative Company Date Signed Marine Chemist 667 CMG No. Philip Dovinh - U.S. Marine Chemists & Engineerir•__MARrINE C�IFI�ri1ST CERTIFICATEP.O. Box 63, MUKIRGO, VVA 98275 Office: (206) 200-6912 Fax. tr Serial 667-04034 Cell: (206) 200-6912 Email: pdavinh@a c0M0&st ne Page 1 of 1 Joe Phan--MarVac/Jon Ross- Marine Vacuum Service/Ascendent Sep 10. 2018 Ascendent LLC LLC (Jon Ross -Project Mgr) Survey Requested by Vessel Owner Agent Date UST Underground Storage Tank 9300 236th SW Edmonds, WA Vessel 98020 Type of Vessel Specific Location of Vessel Diesel (3X) 02, LEL, Visual, CO, H2S i ast Three oadings bests Nedorma Inspected Spikes: Group 1. —ONE (1) 10,000 GAt LON UST (01ESEL} Pest Results "A 0, % LEL CO Inspected spaces group 1 <3.5% 0°1G 0 ppm 14:26 Time Survey Completed Safety designations: NOT SAFE FOR WORKERS $AV-. -OR LIMITED HOT WQr2K LIMITATIONS: Specific Location: —Not Work Limih5d 7p Excavation A, f <1 i; ;cart Of Tenk To Mantle Vacuum Service For Decammissloning & Scrapping/Disposal Ortly. Hot: Work Type: —DO NOT CUT, TORCH, CRUS11, BURN. HEA . , , �L '�, On ","RATE t"ANK. Areas to be Excluded and Llmltatiorts: —KEEP ALL OPENING CLOSED EXCEPT FOR ONE 1/8' VENTHOLE FOR TRANSPORT Inert Medium:---C,srbon Dioxide (CO2) Method for maintaining safe Conditions: ---Keep Tank Closed 8 Secured. —Keep All Openings Plugged. Measures for safe disposal of inert gas: —Keep Inerfed Spaces Closed, Secured As A Means Of Inert Gas Disposal. Other instructlons. :"A VA TION 8r TRANSPOR THIS i AN X M (),,>; 3E 0,QZ'VPLL i'"-p BY 17OOH ON SEPTEMBER 17, 2018. OTHERWISE, CALL THE UNDERSIGNED MARINE CHEMIST. —DO NOT ENTER INSIDE TANK OR SUMP, —CEO NOT OPEN MAN HOLE. H2S 0 ppm Limits of Detection 0.5% 02, 1% LEL, p 1 ppm 1­12S, 1 ppM CO. 0.1 ppm Benzene. 0.1 ppm THC6iV0Gs w;PID, 0,1 PPI) THGs,NOCs. w,'PP6 PID In the event of physical or atmospheric changes affecting the STANDARD SAFETY DESIGNATIONS assigned to any of the above spaces, this certificate Is voided: spaces not listed on the Certificate are riot to be entered unless authorized on another Certificate andror maintained In accordance with OSHA 29 CFR 1915: or if in any doubt, immediately stop all work and contact the undersigned Marine Chemist. Unless otherwise stated on the Certificate, all spaces and affected adjacent spaces are to be reinspected daily or more often as necessary by the competent person or the authority having jurisdiction as applicable in support of work prior to entry or recommencement of work. uwvauueW,u... moarvgtowwr.wnnuoIsmpppeelilaater*R,OfwfnCt,Ur•er47Jtj 10p95�i�mVygr�JNK'�.'�06uicel� urrr, InaFeci7in Or Rlr�316 fe, Trc9ik it elreCle]. All 11ne7, vent;, Ihd9tln2 C61a, oal,ai, It'd 9 MS' uft�O*-d epptl .riancw eball C9 aan-idllrsd'r*t rate• u jetm '�. kimwnen(oT LM yr-ci'"nit;; ftNlcerr_ b_allin%-31ii�19CGMfiG9ta,rle Shn11p fApia%tfb91•..1th'n the T9:fnty Ila'D6.a11F8:'Dilly yllholudorl-hie certlptVto i Ipr•)5: ;[F9RNI IaL M30119sad TrOrn NFP SC6. 5tbraol019 4.3.1 rinfoul, y, 3.6J rorflralr'1e n q s[-i r4 666.�nSted (d? lhA 0 419aa O]al:80 of 1(19 o1ro rf18re VIull to er rest 1 J.5 NrCent 8nd Idol 9-99W plan 22 9-& CLV 1 by � IJ", �tl p19 ir$1l1:^b'IC:1 1 D 1:erae',tuF pr_ Ivr9. 97y1CJi •,6 lrniC (cJ ar7 tOMC malardlY in tfr- alms;; *rw a6wclotei •mrh WZQ. Wei, to A OftliAgs. irNr.'q rna(I'LOW, of =,ffngantx Vr, I at the Gme cl 111R * 15ml09. '1190.lmp6i4reil or -3111 Fri 1568 nntvq ermy shell nU. to pegw Fen In It. cufnpudt Afd cc WF" W %b,)-1Si8d. e,trp L,r'rcrk IS pe"ded cnb' H cir-clue. or peoper pro-ecpa6 a4uOrn6nt o' cbfNnq, or Urne, or yl v he fffWW9111oned, ea S• FE FrJR P)T IAORK I i T a ccrnFti7n9it 0r llrekr) ft deil(Inatid •;el the Oaggen C-Ce tp ll 0T IN &MOTQhere is tilt gT. Zer 1111 22 rein( ty '� 9larlld; lb) the � nocnnapl 01 ryfirrritlti imrcripiv In liv. iu a . 10 CcYCaYfI ttf ilia 1Y/.T,r 6,4oioeive frntl; (mil tl'e •9aglea. ecttq Or priwv311v6 cde 149 all Ghneled fuffl�;Sntly 1e "%V9t pia BCr A of Lire and 'a(*- IN De eaF�Ua of pr39txiry a hi3h9r CO'r:vin M9,ri the t p9rmlC&3 by (al " (b;( ;41 `Ef &a'l-n: fperRq wASr) la 7 FQVI'U r,)llalna] flerlfnablo Cc vfr,t{�Y.-EIe r194-rnl• itlen G9 ell'f176h111• dtiarCl Cr rrQ.lgJe6, 6cdla Of prC7pr�ytth'. ,mqw ner M pie ier }1p 3{ib3] G Iffa; ur }1� ray nytle0 hiF's fug( M•hk1, We tn•i;•e, Cr ong w rce,rn O; fife (cam al elt. or C-14rif rued n urx...f, 9'd treated in yucWylre Y.IpI N5a it&lne C' nmlira mgtafl�R,'9�pr 11 rYl' �P SAFE"IkIITED I-1T'NORk: 111r9'jGfngnlm9n: or a3ana lk ]ezpn9:9d ?qI por'oia & the "q rn9et 1T14 le3urtrlerrr 56fe for MI. %'Ark end Pat1N (;K-9'Irlt� , e9 i,Fpice6le, cr (b)1he r,pure a OurmAMI9 f0' Safe br W QJ(k, a ni h)t 1vti1 I5 r-;.nl-'Iid to eperafV. br6d0'16; (G polliune of ha WOCIR 5r1911 (11%i tle requlfeme'1I5 fQl C6re Tu' HCt V1tr}:, as erflrceWb: 9M N) nh err or Tyo9 of hot wod. shill Da Ilrnitid ce meld tj KOT SAFE FI)R I-GT O47R<: I I W ccrlFa'Tnern ,X br:xA :o cle4gletel, not it not pe—Mel. CMEMISTS ENDORSEMENT. Thla'a ;o Ce"Iy that ' hq%V NNOlyly cicrmlrrtl plat 911 9;uC81 :11" f n'211nA N are in 9I03rdkrw wlh NFP,A &39 CCrtlfml of Gas Yazeda 01 Veraal: end h9K, T-yl)tl Ine xndticn o' 11901 t0 beII 60Mt3gC*- lth't6566i;Irsd citrrarr3lun "Te'.n9ef99-,000WOWA0ilyrr fr0eltd Ma Ca•{R::t na,r H==03v� E nJ:ra:,rTa, rtnSlyfe en]rflflNr. tMa/w•ich k 5va E6tlea PC IlK ,w7, tema'1: r:! my,m�'1'g ih.s>rJry' Authorized Representative Lht re:rwQ la ta. A m a dmm.. e•'ay Y Irw i„r Ik PM.r'. 11-4 r.n'd R, v», y-r-kA.•n]H to ,:f 1;. mnNa'o• MIA 91 n'ijirkm" an: n:IN-lcra Jon Ross, Project Mgr Sep 10, 201E Company Date Signed Marine Chemist 667 CMC No Philip Dovinh - U.S. Marine Chemists & Engineer,n_-;MARfE ICEEMIST P.O. Box 63, Mukiiteo. VVA 98275Offiice- (206) 200-6912 Fax: Cell: (206) 200-6912 Email; pdovinh@comcast,r,c: Joe Phan—MarVaclJon Ross- Marine VaCutIM ServlcelAscendent Ascendent LLC LLC (Jon Ross -Project Mgr) Survey Requested by Vessel Owner Agent UST Underground Storage Tank Vessel Type of Vessel Olesel (3x) 02, LEL, Visual, CO, 1­12S l ast Three 3 Loadings Tests Pero me-d— Inspected Spaces:_ Group 1. —0 NE (1) 10.000 GALLOP! UST i01ESEL) Test Results % O, % LEL CO Inspected spaces group 1 <3,5% 0% 0 ppm CERTIFICATE Serval 667-04034 Page 1 of 1 Sep 10, 2018 Gate 9300 236th SW Edmonds, WA 96020 Specific Location of Vessel 14:28 Time Survey Completed Safety Designations: FOR WORKERS FUR ' , ITEO HOT WORK LlifTATIONS: Specific Location: —Hof Work Limited To Excavation & T:3.'spo-i yr lank is Marine Vacuum Service For Dgi rj,?llT?i ,i! nr,:r & ScrappinglVisposaf Only. Not Work Type: —00 NOT CUT TORCH, CRUSH, BURN, ;Er - .HANICAL L Y PENETRA T E TANK, Areas to be Excluded and Limitations: —KEEP ALL OPENING CLOSED EXCEPT FOR ONE 1/8- VENTHOLE FOR TRANSPORT. I�IK�;.iF'r Inert Medium: —Carbon Dioxide ('CO2) Method for maintaining safe conditions: —Keep Tank Closed & Secured. —Keep All Openings Plugged. Measures for safe disposal of inert gas: --Keep Inertia Spaces Closed, Sei;ured As A Means Of Inert Gas Disposal. Other instructions: —EXCAVATION & IRA,;_ '.3RT OF THIS AtvK C.0, tPLETED BY 1700H ON SEFiTEMSER 11, 2018. OTHERWISE, CALL THE UNDERSIGNED MARINE CHEMIST. —DO NOT ENTER INSIDE TANK OR SUMP —DO NOT OPEN MANHOLE. H2S 0 ppm Limits of Detection 0.5 n CYO, 1% LEL 0.1 ppm H25, 1 ppm CID. 0.1 ppm Senzena, 0.1 ppm TH(;&A/OCs'a1PID. 0.1 ppb THCsNOCs w1PPS Ptp In the event of physical or atmospheric changes affectJng the STANDARD SAFETY DESIGNATIONS ass►gne-j to any of the above spaces, this certificate Is voided; spaces not listed on the Certificate are not to be entered unless authorized on another CoMfi ate andlor maintained In accordance with OSHA 29 CFR 1915; or if in any doubt, immediately strop all work and contact the undersigned Marine Chemist. Unless otherwlee oteted on the Certificate, all spaces and affected adjacent spaces are to be reinspected dairy or more often as necessary by the competent person or the authority having jurisdiction as applicable in support of work prior to entry or recommencement of work. ' v enab3la raqui'as �r, fu'� " `„u-rwlauul ur,ar od rr uooua aMe.�nrent �endn3 to UV. zonW reelam,[,, or N-blrme laor caoCefill"Wta a,u[jen to par r1?9IjnnU r,. urlefA •4, •;rnl y spa: $en al(I a a.yw cbmrk9r.5 ill• 8poowo E) affeaed. All lima! viantE, I'Pa7n] COIe, valvaa, ar.i Ifni a, W11owo �ptlh'ridnnf small ba 05n91oKbd'.Ut !AW Urlexe, hbM1I,Sb apes!1� q.FI➢ra14d rt0,arnhrlt of a wL;wl ffohl :to U-36i ^ k.,atkn 4Cia; Me Ctstmeela Uri a_; shtw9l; of 115'.+?Fw1 ithit live f2dih' h13b bean 2PSC" _'1ly Sijft.=.ad an 019 rcr1111C9Iia S7,. ANGARD4FE . v DE31C+NF.TIG115'. Parlial lic:. Pay,tlreaed frclvl NF^ 3M, Subet+Olals 0.3.': tlfaVah 41,6; 1 - - f , , n a,e PumpR"T"T or bt:�1a ec dot!a Jl@ai (al 7» OX^;Hn 3onert of 1II.3 Hrnt�f*lare Jill by s b� 1 B 5 f+rrtrnt aM lul r�i.:.vLY Tan 2; Pe;,NIt try •,durrra: (b) ra ­. I I c'Ara".0 p,,,rwnt Cr 0'M iCMer '3+9btnc irn't (e,1 Wy tON4 fr0�`Js in till dime%Fha(P .9Pbe,33hd 'will •alp, no t9nk W9 ,Y]b, irr3nYla nY_dun15, C! NRrf}911.9 a/a " I71n C5Mvfiibla w� r4Vr Wr* at bra ofrra Of IM in5PU_',hn. M77 Sp}}E For WOPMRS. In ilk tJNlpa'lr1M11 Cr ;Pave a• o5A�? tEd, ena'j b1al1 Iv1 be RnT'-ntsd 5: In ra t7.19P Vf.WI or eC,vCA E13 diwia vi:0, entry For xo* is parnhtai only If aYollum is a :'2pw plplrk*A) 9qulPrna.11, or hth'n], CC MR CC all of the alOYtnsnt:erraV, e5 ". c- FOR 10T lyLRIC ht D1a mmPt+Inlent cf *{No) ba des'?nara (a) "W o<yakl 03090 N Mn atfr,31pharr 15 ncr rEa1e• lh:s, 21 pr4wo fly'rUvrle (t) !It Uncenb'stim of 1Vmna9b a rnatfalsla 'n the 1 C ;.9rGsnt of the locipw 9+iVoti'.!i Ilmit (C) Mr resldi,*6. K136, Ce predwvab 09 np d:J dd9ne9 UA C48M?] toPrit-mrJ Mr, sprmd Of lira and 2m not b5 o{tatle Of pfaOeCrV u h gler caninns.tlui than NTIldad by (oj or 1j: (d1 all 3dJJ.4ltt eDJ-A-. "Welning or hjHng Gentaiied ^a,trrlallo or kNrnbebhtle MJk?n nal$ srl t,o arfrl-Wao sy ClffarNof ml:d�(, iw, , of ;�Mbdrl�bl�a ..Celiag•S In pa:ant TP 5rmad or Tie; Or May ara Ira',req, &10'a "I lama, hiba 19r" or rw)dlnh f;Ml 3r fire r3orn DI g7?, Dr ollfef Mchinerj epppe=,. ere, Ir%tad 111 S=Vdanm ,IT, 14 Mooing ;Harriers nsqulrc,menm SA;t FOR t.IFAfrED ;FT '.t01111 In OR c<rnl;arment. O' ailace sD d<rl ow (a) . CAion9 of ft eF.az, rra-;k r19 r+lulr6nl�rilt Safe •or Hot Jon, <,no pslYh CI�ninp, as aR1t•u,19, or iCl Vee bpb a is w. ti rbjeiferry3nt5 brSala rof Hol I/,b* am3 har Aqr< l; rFa1dCM] h aCb. (Ie Ip11pn5; {Cj p tcob G Uh i;5. ?re I Ineq 1Ao fNS��rarnarrR fcr Side for Hot vo' (t as is hPaSt1 is and 1ne balufd Cr gj 01 NA 0.Ork alall th Intdeo or re71dJvd. NOT :M,O FF FOP HOT 'd•7HK In the xrn;,9rMbilC or Ep"_ so d9jigr649d, nor Ib 101 Do—r ed. CI£N11S•TS UJCI0Mr ENT, Tina is to cenify VWn I I'mea rei-w 9lty date nest ftt al e{k3Cfla id *If,o3mgDina 11vt 79 n ao:bn:anc-%viU NFPA 366 Con"I 01. Gas H-JXNdt on Vic-sls and Fyv9 fourd ON, Cr..n(liUnDre9d11obainaCwfowl"Awn 1459bbantidesPnsdon. 'Ina-1-swes amwmAcomr=x a m-clrirtal,Urfa,wpa.ax cnd Uf,Wagm,err. Irtri tL`m V,Y, tf'rtkn r.VN] n,iwJ eT 1'/. T1hYn YR] %! nil Y,I,Ap ta'I] kty.- Authorized Representative The r,wm,,Il Y, ass] do ar.Sr�ro av:l;l9 al t, tl-a Te MRy. ote:/l 'troM1 �r[ r�7�...�w run xis+am t v'w'v �+�:��a.:T,r hn:e v.7 al au:rfa:I\!n i•O lip;. �c'i �.r Jon Ross, Project Mgr Sep 10, 2018 Company Date Signed Manne Chemist 667 CMC No. v rJtf CITY CIF EDMONDS 121 51714 AVENUE NORITI - EnNtONDS, WA 990) ', <• 1 *a.. PfIONC (425) 771.0220 - FAX: (425) 771-02.21 .STATUS: ISSITEI} 0-j/lU/2111li Permit #: BLD20181077 FaViratiun Untc: 02/1 1 /2019 Project Address: .9300 236TH ST SW, EDMONDS Pared No:'.70336004(I4GU(1 N-IAURONA WHOOL 41K1-.NDFN1* LI_(: Ati('I-*VbI:N'I' LL(' rW ? ,WHOOL DIsr 15 rsDmi)NDS 00 JON RO 8 00 )INN R()SS A04_11691 li AVEYUE k%' PO Box 1 ISO PU BOX 1150 I YNNWuaD, WA 9MI116 SUNINER, 1VA "39n YJMNT'R, w a 9839u (=S31149.423H f2531249-4233 1101:Nsil.. s AK'GNI!446N4 I'�C1 11�1111h,'U 1 7 tclmovrr 10.000 gN d healing ail underground lack. Tank will be pinTed, rinsed iuld fcn)M VALUATION. So PERKIIr TYPE': Commen::al PERMIT Gltr)IIP 711- Tan6mFuel WADING 1• CYbs: D TYPE OF CONSTRUCTION' RTrAINfNG % ALL ROCKERY: ()CCUPANr GRO P- nC'CUPAN'I' LOAD FL:lacr•., u x n Fr.' C'UDF. OTHER- ---- ()THBR DIRW ZONL . ti L"\41jFR OF SrORI Eti; YEST CLI DAT E. \iIMIN.ROFTI ELLINGIIYITC u I'm 1 11---�N�� ASEMUN'I 0 t�T.LOOR (i 2NDFLOOR. (I 3R0 FLOOR n GAkAr,E 0 DFCK 0 OTHER: 0 13EnROOM-ti• a BATHROOMS. 0 - Eli HASE14P.NT n IbT FHmR 11 2VVFtDOR:O 3RD 1`1.00R a 41ARAIrr. a III;('I; p 01'Flt'k• n 1314 RCI()Ibls: a []AT I1Rf,UMti a kEQCrRGU. PIt+31►u,�'Ir rtl;c}t;Ucl:n PROVOSEU R> QUIRrJI: I'kOPU D IIEIrjnr ALL07F,D C PRr)P05E1).(1 KEOUIRF-1): PROPOSFA SLI-BAC'K TOTES APPROVALPERMIT AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLKMN AND IN DOr?r, TI-{E WORK AVfHORV ED T HFIRE'1t Y, NO FE RSON WILL BE- BAPLOYE) IN VfOLA71ON OF THE LABOR CODE OF THES rA rF OF WASHINGTON RELATING TO WORKMEN'S COPAPENSATKn INSURANCF.AND RCW 1R:27. THIS 11PR- K A r10N IS NCYT'A MF3?1v111' UNTL SIGNED BY THE BVILM OFF11CIAL OR HISA$2 DUTY ANDALL FEF&ARE PAID. Prim Name ed Daw ATTENTION IT IS L'NI.AWFUL 10 1t55 OR OCCfIPY ABUILDI11; OR STR C'R[ RC I.NM A FINAL nSP&I'1{QN' HAS lit FN MADE AND APPROVAL OR A CERTfF7i XIF OF UC('[IP,9,NI'Y 1;.15 3E31 GR:�MTEp. UB(:IUq:1BC : r 0� :kl'I I U L--_I nm = APPUCAti"i' = ASSESSOR U carry Construction Progress Card City of EdlTtonds 121 5th Ave N Edmonds WA 980220 To schedule your inspections: I B - building; 1. Go to: ww,%a,.ed=ndswa.gov 2. Then: Services 3. Them: Pernvls/Devclopment 4. T7ien: Online Permit Itifo 5: If you dolt have one ah-eady, create a login (upper right hand comer) 6: Schedule %Our inspection E - engineering: 425.771.0220 ext. 1326 F - fine: 425.775.7720 P - planning: 425.771.0220 B - building front desk druulg office houm. 425.771.0220 Call 24 hoens in advance for u-ispectiQns Scope ofworkt Remove 10,000 gal heating oil underground tank. Tank %Q1 be pumped, rinsed and removed. Permit #: BLD20181077 Project Address: 9300 236TH ST SW, EDMONDS Parcel #: 27033600404600 O%ner: MADRONA SCHOOL COt]h'3l' T: ASCFNDLXT LLC 00 SCHOOL DJST 15 EDMONDS eta JON ROSS 20420 69T H AVENUE W PO ROX 1 150 LYNNWOOD. WA 98636 WNINEK 14A 48399 LICENSER ASCENL4996N9 EXP-89108;2019 Constntctiatt hours are lam - 6pm on weekdays. 10am - 61)m Saturdays. OYSPI+J<'11Ql� MPI C MR DATE COMM IN 1:-Tank inspection _ l F-Rre Final - , I - '� BILL OF LADING PRODUCT TRANSPORT MANIFEST MARINE VACUUM SERVICE, INC. 24 HOUR EMERGENCY. PHONE NUMBER (206) 762-0240 FAX NUMBER 206-763-8084 TRUCK NUMBER DATE 61' d- I TO DESTINATION NAME I •i .,,< ;/:,.eve'i'l 54 L STREET 1a 1 L S 6-L=L•,.:tt 1 2 f— CITYlSTATE 4 f -r i-Lol QUANTITY IPROPER SHIPPING NAME SLUDGE RECEIVER DATE ff- (,;"' NOTE: NO 19902 FROM SHIPPER NAME 1�-•�6}.�•��" �P;n o t fr r3��1%C_ STREET `f 1 >[- CITY/STATE k •.l,.-,1 S • �i . HIPPER UN (PLACARD) NUMBER Customer warrants that the waste petroleum products being transferred by the above collector do not contain any contaminates including without limitations, pesticides, chlorinated solvents at concentrations greater than 1000 PPM, any detectable levels of PCBs, or any other material classified as dangerous or hazardous waste by 40 CFR Part 261, Subpart C and D (implementing the Federal Resource Conservation and RecoverAct), or by any equivalent state dangerous or hazardous substance classification programs. Should laboratory tests find this waste not in compliance with 40 CFR Part 261, customer (generator) agrees to pay for all disposal costs incurred. aW 7i, y ,1 , At AZ ! a.�• � � ��yrT 'fit wf�+ •.�^ 1a •�, + � `?fIk't A R t 4 4)" If ;l ON, I , S{. b�,' .i ` 1 �'��t �� I ' "• � , ^ ,'t �t 7t` ` 'rs .Y. � +,Y . 1�J 1 L! i A (i� bf 'a �,� r� •, � �I 1 1 . "`t•t 1' #tip`' �• ... S , �; �� 1 ,\ — ! 1 v 414,- Za- Mott aw A AV , 41 �JN kq tt + r JI, 41 Pj