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PS Form 3811, July 2015 PSN 7530-02-000-9053
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ACM+ ENVIRONMENTAL SERVICES
DOSH #1201
CSLB #97965,
DATE: May 16, 2022
JOB #: 0322003WC
Certificate of romp(etion -Asbestos d Lead 1 emovaCWWork
CLIENT NAME: THOMAS JAMES HOMES
PROJECT ADDRESS: 225 CORAL AVENUE, NEWPORT BEACH, CA 92662
SCOPE OF WORK: REMOVAL OF ASBESTOS AND LEAD CONTAINING MATERIALS FROM THE UNIT.
THE ABOVE REFERENCED WORK HAS BEEN COMPLETED IN COMPLIANCE WITH ALL FEDERAL,
STATE AND LOCAL REGULATIONS GOVERNING THE PERFORMANCE OF ASBESTOS AND LEAD
ABATEMENT WORK. THIS CERTIFICATE ONLY APPLIES TO THE DESCRIPTION OF WORK
REFERENCED ABOVE.
THANKYOU FOR GIVING US THIS OPPORTUNITY TO WORK WITH YOU.
COMPANY REPRESENTATIVE: ' �2ao 7T[P w
DATE: May 16 2022
South Coast Air Quality Management District Facility ID Notification Number
21865 Copley Drive, Diamond Bar, CA 91765-4182 18475� 694915
Phone:(909) 396-2336
www.agmd.gov
Rule 1403 Notification of Procedure 13 Asbestos Removal
Please maintain a copy of this Notification at the job site, either electronic or paper.
Project Type
Project Type
Asbestos Removal
Project Urgency
Routine
Origin Date
4/7/2022 5:04:40 PM
Completed By
Alfredo Amato
Phone Number
(562) 633-3862
User Email
info@acmplus.com
Contractor Information
Company Name
ACM+ENVIRONMENTAL SERVICES
Address
7101 ROSECRANS AVE
City
PARAMOUNT
State
CA
Zip
90723
CSLB License #
979651
OSHA REG #
1201
Supervisor #1
Manuel Camacho
Phone
(818) 322-6246
Supervisor #2
Jose Luis Macias
Phone
(323) 501-6551
Supervisor #3
Baltazar Aviles
Phone
(818) 415-6746
Site Information
Site Name
Thomas James Homes
Project #
03252022-4
Site Street #
225
Street Name
CORAL AVE
Cross Street
BALBOA AVENUE
Site County
ORANGE
City
NEW PORT BEACH
State
CA
Zip
92662
Contact Name
Cory Singer
Contact Phone
(312)801-6589
Site Owner
Thomas lames Homes
Owner Address
400 Corporate Pointe, Suite 750
City
Culver City
State
CA
Zip
90230
Project Start Date
4/11/2022
Project End Date
4/13/2022
Project Work Shift(s)
Day
Building Size in Sq.ft
1264
Number of Floors
2
Building Age (years)
94
Number of Building/Dwelling Units
0
Building Prior Use
House
Asbestos Survey
Yes
Asbestos Found
Yes
Asbestos Removed
No
Building to be Demolished
Yes
Describe Work
Abatement
Describe Work Location
Interior/Exterior
Project Information
Asbestos Information
Amount of Asbestos in each type in Sq.Ft
Acoustic Ceiling
0
Linoleum
230
Insulation
Ducting
0
Dry Wall / Joint Compound
0
HEPA Vacuum & wet wipe
Mastic (Non -friable)
0
Floor Tiles(Non-friable)
0
Transite
Stucco
0
Plaster
0
Other (Friable)
Mastic (Friable)
255
Floor Tile (Friable)
0
Other (Non friable)
Transite (Damaged)
30
Nonporous Contents, HV&W W
0
Asbestos Amount to be Removed in Sq.Ft
FRIABLE
515
CLASS I
0
CLASS II
0
Total
515
Asbestos Removal From Surfaces, Pipes, Components
Asbestos Detection Procedure(s) Survey, Bulk Sampling , Inspection,
PLM
Survey Information
Certified Asbestos Inspector Name Ryan Deker
Survey Plan Date 2/23/202212:00:00 AM
Email lab@dekerenv.com
Waste Information
Waste Transporter BDC SPECIAL WASTE SERVICES
Address 1211 WEST GLADSTONE AVENUE
State CA
Landfill Azusa Land Reclamation
Address 1211 W Gladstone St
State CA
Revision History
Control Procedures
0
Fire Proofing
0
0
Personal Contents, Disposed
0.
0
Roofing
0
_0
Coal Tar Wrap
0
0
Contaminated Soil
0
Certification Expiration Date
Phone Number
City
Zip
City
Zip
1,3
5/12/2022 12:00:00 AM
(310)994-1686
AZUSA
91702
Azusa
91702
Notification #
I Project Start Date
I project End Date
Quantity of Asbestos
Revision Comments
Revised Date
694915
/11/2022
/13/2022
515
Revise Dates
/7/2022 5:12:S0 PM�j
693254
/8/2022
/15/2022
1515
1
K/7/2022 5:12:51 PM
Fee Payment
Total Amount of Asbestos to be Removed in sq.ft 515
Tracking Number 3980760
Project Size Fee 0
Additional Fee 25.22
Total Fee $ 25.22
Payment Made $ 25.22
Balance Due $ 0
By clicking the Sign & Submit button, I certify that an individual trained in the provisions of SCAQMD Rule 1403 and the Asbestos NESHAP (CFR Title
40, Part 61, Subpart M) will be onsite 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. In addition, I certify that all of the information contained herein and information
submitted with this Notification is true and correct.