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Home My WebLink About22-4194City of Zephyrhills 5335 Eighth Street Zephyrhills, FL 33542 Phone: (813) 780-0020 Fax: (813) 780-0021 milwam BGR-004194-2022 Issue Date: 05/31/2022 REINSPECTION FEES: (c) With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c) the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection, whichever is greater, for each subsequent reinspection. Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit required from other governmental entities such as water management, state agencies or federal agencies. •a 11• ............. I•I z,r,•. • -- . i r T s.- .. - ..... . . 23131�� Complete Plans, Speccations add fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. CONTRACTOR SIGNATURE PE IT OFFICEV PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER i 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Phone Contact for Permitting Owner's Name Sixth Avenue LLC C/0 DUfi & Phelps, A oll &e Number Owner's Address 917 W Washington MS 316 Chicago IL 6 607ownerPhoneNumber Fee Simple Titleholder Name Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS 39462 Tabetha Drive Unit 116 LOT# SUBDIVISION PARCEL ID# 12-26-21-0028-00500-0000 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED e NEWCONSrRB ADD/ALT = SIGN DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR COMM OTHER TYPE OF CONSTRUCTION 0 BLOCK FRAME STEEL DESCRIPTION OF WORK demo and legal disposal of SF mobile home BUILDING SIZE I SQ FOOTAGE 9®0 HEIGHT =BUILDING $5900.00 VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL 1$ PLUMBING $ '_....._._....__.._ MECHANICAL 1$� =GAS 0 ROOFING FINISHED FLOOR EL ONS BUILDER SIGNATURE Addres ELECTRICIAN SIGNATURE Address PLUMBER SIGNATURE Address MECHANICAL SIGNATURE Address OTHER SIGNATURE Address 11IIIIII RESIDENTIAL COMMERCIAL SIGN PERMIT AMP SERVICE 0 PROGRESS ENERGY 0 W.R.E.C. VALUATION OF MECHANICAL INSTALLATION $ SPECIALTY = OTHER (� FLOOD ZONE AREA =YES NO ( �.Py'�, e Cf �(w✓� ,ntt��° p -;'°' REGISTERED 1706 E. Tr pry d"'ant City FL 33566 COMPANY REGISTERED I COMPANY REGISTERED COMPANY �a REGISTERED �- --� COMPANY REGISTERED I/IIIIIIIIIIIIII11111/I111111 Johnson's Excavation & Services, Inc. Y / N FEE -CUR -RE -I` Y / N License# CBC059540 Y / N FEE CURREN License # a Y/ N FEE CURREN Y I N License # Y / N FEE CURREN _Y / N License # �® Y / N FEE CURREN I Y / N License #^� I I I I I III I I I I I I I I I I I I/ I I I I I I I Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forays; R-O-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects Attach (2) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance Attach (2) sets of Engineered Plans. -PROPERTY SURVEY required for all NEW construction. . Directions: Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A1C upgrades over $7500) — Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences (PloUSurvey/Footage) Driveways -Not over Counter if on public roadways -needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations, The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division —Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that 1, the applicant, have been provided with a copy of the "Florida Construction Lien Law —Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "owner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection -Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. Southwest Florida Water Management District -Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers -Seawalls, Docks, Navigable Waterways. Department of Health & Rehabilitative Services/Environmental Health Unit -Wells, Wastewater Treatment, Septic Tanks. US Environmental Protection Agency -Asbestos abatement. Federal Aviation Authority -Runways. I understand that the following restrictions apply to the use of fill: Use of fill is not allowed in Flood Zone'V'unless expressly permitted. If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. If the fill material is to be used in Flood Zone "K in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application, for lots less than one (1) acre which are elevated by fill, an engineered drainage plan is required. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. 16-104 kIL"912 I ILIA 1 ..0 Notary Public Commission No. Commission typed, printed NT MAY RESULT IN YOUR AIN FINANCING, CONSULT rimed) before me this .Johnson me or has/have produced as identification. Ufflkf��X5 s ff I k7 ,t7l� Ell QW IN I mm—Mmme I igimm, INSTR#2022118027OR BK10621 PG1984 Page 1 of 1 05/26/2022 09:27 AM Rcpt: 2460878 Reo: 10.00 DS: 0.00 IT: 0.00 Nikki Alvarez-Sowles, Esq., Pasco County Clerk & Comptroller Permit Numbor, Mate of Rorlda, County NO =ICIE OF COMMENCEMENT of The undersignea harery give nojffh-jt�MPMVamont will be mode to certain real proporty, and in aomrdanoo with Chaptw 713, n- 004 Stalifts, the followinp l*rmollon Is mvicled In this Nod o of Commencement. 11 Z 9 AcIdmss 4, Conftctor 15. Surety (, applicable, a copy Xalephc�v Number 113��752-709�7 _Telephone Wuhiber�__ 7, ftrsom - w , I , t - h1i , n . th I e Ir Side -of Florida desil kry owl nor up - on Wbom notice$ or other 400"monts MM be servod as provided by Flodda StAbAoa, Name-- 7alephone Number_ 'A 8, Inadtliftv to himself or horself, Owner doslonates the follomdag to Moolvo a CORYOM* L110nors Notlov as proielded in §713.1�(I)(b), F1041da -SWIAWS. _-Telephone Nurnber_ FlW'di" be! year ffm ft date (x unless a different datt Is'spooffied) SUSAN'— KOWAL 4s011ally Known JO R Produced ID EXPIRES: October 12,2023 Type of ID Produced _-------�- oFlorida Department of DEP Form 62-257.900(l) lx Effective 10-12-08 ronmrio Page 1 of 2 Enviental Potectn Division of Air Resource Management NOTICE OF DEMOLITION OR ASBESTOS RENOVATION TYPE OF NOTICE (CHECK ONE ONLY): Z ORIGINAL [:] REVISED ❑ CANCELLATION El COURTESY TYPE OF PROJECT (CHECK ONE ONLY): Z DEMOLITION El RENOVATION IF DEMOLITION, IS IT AN ORDERED DEMOLITION? []YES M NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? MYES [I NO IS IT A PLANNED RENOVATION OPERATION? FIYES M NO I. Facility Name Sixth Avenue LLC Address 39462 Tabetha Dr City Zephyrhills —State FL Site Unit 116 Building Size 900 Zip 33542 Consultant Inspecting Site County Pasco Terracon (Square Feet) #of Floors 1 Building Age in Years 50 Prior Use: ❑ School/College/University El Residence E] Small Business M Other Present Use: ❑ School/College/University M Residence M Small Business M Other II. Facility Owner Sixth Avenue LLC Phone ((813) 52-7097 Address 917 W. Wasington IVIS 316 C/o Duff & Phelps, A Kroll Business City Chicago State IL Zip 60607 Ill. Contractor's Name JOHNSON'S EXCAVATION& SERVICES, INC. - DONATHAN A JOHNSON Phone ((813) ,�52-7097 Address 1706 E Trapnell Rd City. Plant City State FL Zip 33666 Is the contractor exempt from licensure under section 469.002(4), F.S.? E] YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start: Finish: — Demo/Renovation (mm/dd/yy) Start: 06/13/2022 Finish: 06/30/2022 V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components, demo done by excavator and legal disposal of removed product by roll off Procedures to be Used (Check All That Apply): VI. Procedures for Unexpected RACM: Stop, Contain area, call environmental compliance services VII. Asbestos Waste Transporter: Name JOHNSON'S EXCAVATION & SERVICES, INC. - DONATHAN A JOHNSON Phone ((813) 52-7097 Address 1706 E Trapnell Rd City Plant City — State FL —Zip 33566 4936 VIII. Waste Disposal Site: Name ENTERPRISE LF & RECYC (FKA SID LARKIN & SON, INC.) Class Address 41111 Enterprise Rd City Dade City State FL Zip 33525 1589 IX RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and 11 nonfriable ACM. physical assessment, sampling and analysis for suspect material Amount of RACM or ACM* X. Fee Invoice Will Be Sent to Address in Block Below: (Print or Type) 0 square feet surfacing material 0 linear feet pipe 0 cubic feet of RACM off facility components 0 square feet cementitious material 0 square feet resilient flooring 0 square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: 0 Other materials or facility components description:. (R)ACM to remain in place during demolition: I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on -site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. Donathan Johnson 05/23/2022 (Print Name of Owner/Operator) (Date) 05/23/2022 (Signature of Owner/Operator) (Date) Mr. Nicholas Eilerman Environmental & Compliance Project Manager Realty Systems, Inc. c/o Equity LifeStyle Properties 5100 W. Lemon Street Tampa, Florida 33609 Re: Pre -Demolition Asbestos Survey 6 1h Ave MHP (Loc. #7800) Unit 116 39345 6th Ave Zephyrhills, FL 33540 Project No. H4217407 Dear Mr. Eilerman: W, r-: (813) 282-5973 E: nicholas eiIerman15__u;41tff--'1, le.com Terracon conducted pre -demolition asbestos sampling associated with the planned demolition of Unit 116. As requested through a task order, dated October 25, 2021, our scope of service included the collection of bulk samples of suspect asbestos -containing materials (ACM). Samples were submitted to an accredited laboratory for analytical analysis and reporting of results. F*ksbestos sampling was performed on November 11, 2021 by Mr. Karl Kologiski, an AHE - accredited building inspector. Twenty-six (26) bulk samples were collected from thirteen (1 homogeneous areas of suspect ACM. Bulk samples were submitted under chain of custody 01 Cates Laboratories, Inc. for analysis by polarized light microscopy with dispersion staini techniques per EPA/600/R-93/116. I Based on the results of laboratory analysis of the designated, suspect materials, the followin* materials were found to contain asbestos: -A NESHAPOSHA Work Location SaMpje!� Description Asbestos Classification Est Quantity Class Kitchen F1-5 12" Square Pattern 65% Bathroom F1-6 Vinyl Shoot Flooring 2 nd Layer Non -Friable Cat 1 200 S.F Work Class 11 r_ior_T rim 60 S.F Windows - E11-111 Gray Sealant Gasket 10% Non -Friable Cat 11 2 Entry Doors, Work Class 11 Doors frames E1-12 Under Trim 11 Windows Original Roof 112-19 White/Tan 5% I Non -Friable Cat 1 500 S.F Work Class 11 R2-20 Roof Coating Roof Drip Rail Gray Sealant Gasket 3 OSI. F Cap R3-22 Under Trim 10% Non -Friable Cat 11 1 Work Class 11 Terracon Consultants, Inc. 5463 West Waters Avenue, Suite 830 Tampa, Florida 33634 P [8131221 0050 F [8131221 0051 terracon.com Pre -Demolition Asbestos Survey SmAve K0HP(Loc#78OO)Unit 11Gm Zephyrhi|ls.F|ohda s.t=Square Feet [)ChrysotileAobesta (l Estimated quantities are to be verified by contractor prior to disturbance and not to be relied upon for bidding urnotification purposes. |naddition tOhaving the ACM properly abated, vverecommend contacting your local regu for confirmation of their pre -demolition requirements and to maintain a copy of the survey onsite. Asbestos sampling was conducted |Oamanner consistent with the level of care and skill ordinarily exercised by members ofthe profession currently practicing under similar conditions in the same locale. The naauU3, findings, condueionS, and recommendations expressed in this report are based On conditions observed during the S80p|iOg event If other suspect A(3WY are identified, please CODtaotT8rrgcoO S0that vve can aSs8SS the implications. This letter report has been prepared on behalf of and exclusively for use and reliance by Realty Systems, Inc. This report is not a bidding document. Contractors or consultants reviewing this Smrnp|inQ report must draw their own conclusions regarding further investigation or remediation deemed necessary. Tern3coD does not warrant the work of regulatory agencies, laboratories or other third parties supplying infOrnlaUOO, vvh|oh may have been used in the preparation of this report. No vvarn3ntv. expressed or implied, is made. Tenac0n appreciates the opportunity to provide this service to R88Uv Systems, Inc. If you have any questions regarding this asbestos survey r8pOrt, please contact the undersigned at /813\ 221-OO5U. Sincerely, Florida Asbestos Business License Number ZA-337 Prepared by: Karl Kologiski AHERA Building Inspecti Attachments: Analytical Results Reviewed by. Tom Holley, C] H. Florida Licensed Asbestos Consultant AX75 Authorized Project Reviewer PLM REPORT SUMMARY Cates Laboratories NVLAP Lab No. 200569-0 1339 Motor Circle TDSHS License No. 30-0287 Dallas, Texas 75207 (214) 920-5006 Client: Terracon Lab Job No.: PLM-27689 Proj ect (Line 1): 6th Ave. M H P, U n it 116 Set No.: 40426 Project (Line 2): 39345 6th Ave., Zephyrhills, Florida Report Date: 11/16/2021 Project No: H4217407 Sample Date: 11/11/2021 Identification: Asbestos, Bulk Sample Analysis Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 Pagel of`3 On 11/12/2021, twenty-six (26) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS. Copies of the lab data sheets are attached, additional information may be 'found therein. The results are summarized below: Lab Client Sample Description/Location Asbestos Content Sample No. Field I.D. CL966419 Cl-I Textured Ceiling Panel - Living Room None Detected CL966420 C 1-2 Textured Ceiling Panel - Kitchen None Detected CL966421 WI-3 Wall Panels - Kitchen None Detected - Paper None Detected - Wallboard Material CL966422 WI-4 Wall Panels - Hallway None Detected - Paper None Detected - Wallboard Material CL966423 FI-5 12" White Square Pattern VFT - Kitchen None Detected - Floor Tile None Detected - Yellow Mastic None Detected - Sheet Flooring 65% Chrysotile - Fibrous Backing CL966424 FI-6 12" White Square Pattern VFT - Bathroom Not Analyzed - Positive Stop CL966425 F2-7 12" White Diamond Pattern VFT- Kitchen Cabinets None Detected - Floor Tile None Detected - Clear Adhesive CL966426 F2-8 12" White Diamond Pattern VFT - Front Steps None Detected - Floor Tile None Detected - Clear Adhesive CL966427 MI-9 Interior Caulking - Bathroom None Detected CL966428 MI-10 Interior Caulking - Bathroom None Detected CL966429 EXI-11 Grey Gasket Material - Entry Door Frame 10% Chrysotile CL966430 EXI-12 Grey Gasket Material - Side Window Not Analyzed - Positive Stop CL966431 EX2-13 Black Spray -On Sealant - Porch Ceiling None Detected CL966432 EX2-14 Black Spray -On Sealant - Porch Ceiling None Detected CL966433 EX3-15 Black, White Caulking - Porch Roof, Wall Joint None Detected - Black Sealant None Detected - Caulking CL966434 EX3-16 Black, White Caulking - Porch Roof, Wall Joint None Detected - Caulking These samples were analyzed by layers. The overall percent asbestos for the sample is reported when relevant. The EPA considers a material to be asbestos containing only if it contains greater than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) — materials that are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. CatesLab utilizes CVAE on a routine basis and does not include point counting unless specifically requested by the client. The results may not be reproduced except in ful I. PLM REPORT SUMMARY Cates tones NVLAP Lab No. 200569-0 SO 1339 Motor Circle W TDSHS License No. 30-0287 Dallas, Texas 75207 (214) 920-5006 Client: Terracon Lab Job No.: PLM-27689 Project (Line 1): 6th Ave. MHP, Unit 116 Set No.: 40426 Project (Line 2): 39345 6th Ave., Zephyrhills, Florida Report Date: 11/16/2021 Project No: H4217407 Sample Date: 11/11/2021 Identification: Asbestos, Bulk Sample Analysis Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 Page 2 of 3 On 11/12/2021, twenty-six (26) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS. Copies of the lab data sheets are attached; additional information may be found therein. The results are summarized below: Lab Client Sample Description/Location Asbestos Content Sample No. Field I.D. CL966435 RI-17 Roof Coating, Black, White - New Roof Overlay None Detected - Surfacing Material None Detected - Roofing Tar CL966436 RI-18 Roof Coating, Black, White - New Roof Overlay None Detected - Surfacing Material None Detected - Roofing Tar CL966437 R2-19 Roof Coating, White/Tan - Original Roof Deck None Detected - White Coating 5% Chrysotile - Silver Paint CL966438 R2-20 Roof Coating, White/Tan - Original Roof Deck Not Analyzed - Positive Stop CL966439 R3-21 Roof Seam Gasket, Grey - Roof Drip Rail 10% Chrysotile CL966440 R3-22 Roof Seam Gasket, Grey - Roof Drip Rail Not Analyzed - Positive Stop CL966441 EX4-23 Concrete - Porch Slab None Detected CL966442 EX4-24 Concrete - Carport None Detected CL966443 EX5-25 Brick & Mortar - Planter Box None Detected - Brick None Detected - Mortar CL966444 EX5-26 Brick & Mortar - Crawlspace Barrier None Detected - Brick None Detected - Mortar These samples were analyzed by layers. The overall percent asbestos for the sample is reported when relevant. The EPA considers a material to be asbestos containing only if it contains greater than one percent asbestos by Calibrated Visual Area Estimation (CVAE). EPA regulations also indicate that Regulated Asbestos Containing Materials (RACM) — materials that are friable or may become friable — be further analyzed by point counting when the results indicate less than ten percent asbestos by CVAE. CatesLab utilizes CVAE on a routine basis and does not include point counting unless specifically requested by the client. The results may not be reproduced except in full. 49 Cates Laboratories 1339 Motor Circle Dallas, Texas 75207 (214) 920-5006 Client: Terracon Project (Line 1): 6th Ave. MHP, Unit 116 Project (Line 2): 39345 6th Ave., Zephyrhills, Florida Project No: H4217407 Identification: Asbestos, Bulk Sample Analysis Test Method: Polarized Light Microscopy/Dispersion Staining (PLM/DS) EPA Method 600/R-93/116 On I I / 12/202 1, twenty-six (26) bulk samples were submitted by Mr. Karl Kologiski of Terracon for asbestos analysis by PLM/DS. Copies of the lab data sheets are attached, additional information may be found therein. NVLAP Lab No. 200569-0 TDSHS License No. 30-0287 Lab Job No.: PLM-27689 Set No.: 40426 Report Date: 11/16/2021 Sample Date: 11 /11 /2021 Page 3 of 3 The samples were analyzed in general accordance with the procedures outlined in the Method for the Determination of Asbestos in Bulk Building Materials, EPA/600/R-93/116 or the U.S. Environmental Protection Agency EPA 40 CFR Appendix E to Subpart E of Part 763, Interim Method of the Determination of Asbestos in Bulk Insulation Samples, by polarized light microscopy. The results of each bulk sample relate only to the material tested and the results shall not be used by the client to claim product certification, approval, or endorsement by NVLAP, NIST, or any agency of the Federal Government. Specific questions concerning bulk sample results shall be directed to the Laboratory Director. Analyst: Kathy Schosek Laboratory Director: John R. Cates, P.G. Approved Signatory: A NVLAP LAB CODE 200569-0