Project # 8321-2017

Contractor: Cody Martin Excavating
Contact Person: Cody Martin
Phone: (573) 489-9547

Owner: Joseph H. Boer
Project Site: The Potted Steer Restaurant
Project Address: 5085 Hwy. 54
City: Osage Beach
County: CAMDEN
Regional Office: SWRO
Demo Start Date: 05/10/2017
Demo Complete Date: 05/25/2017
Total # of Days: 15

Comments: Floor tile not listed on notification,no report,only lab results. Report recd 4/27/17-160sf n-f flr tile/mstc.

Present Use: vacant
Prior Use: restaurant
Asbestos Type: floor tile
Asbestos Qty: NF: 160sf
Amendments: N/A
Inspections: N/A
Postmark Date: 03/03/2017
Date Received: 03/07/2017

Paid: Yes