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2000, 10-03 Critical and Hazardous MaterialsCritical and Hazardous Materials List Please fill out the following list as per instructions, return to the Division of Building and Code Enforcement, and retain a copy at your place of business. Feel free to make copies, attach additional pages, and/or add explanatory notes, if appropriate. CompanyName: yName: C_��JL� Property Address: F' Y 7 ai fry, �-���-- PRODUCT 1 Product and/or Chemical Name: PA I Y.) /Pi r ,Q Maximum Quantity (Gals, Lbs, Cu.Ft): � C Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 2 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): �-{ `�� � Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 3 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): / ,t 1:'-/7 J7 Tc" Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 4 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 5 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 6 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): Material Classification (UBC Tab1e3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 7 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: PRODUCT 8 Product and/or Chemical Name: Maximum Quantity (Gals, Lbs, Cu.Ft): Material Classification (UBC Table 3D, 3E): MSDS Sheet etc.: Area Stored and/or Used: Proposed Method of Storage: The above is a true arid,e)orrect ting of the chemicals intended to be used and/or stored at the referenced facilities. Signed by: Date: I`/ate FOR OFFICE USE ONLY Activity SIC Code: Designation: Critical Use Activity Not a Critical use Activity Reviewed By Date Aiik SPOKAE ComY Critical and $Jazardous Materials Division of Building and Code Enforcement To assure permanent protection of our primary source of drinking water, the Spokane County Code requires many non-residential building permit applications to include a Critical and Hazardous Materials List, which is a listing of any chemicals (solid or liquid) used or stored in or on the site. If a sufficient quantity of chemical is present, measures need to be taken to prevent contamination of the aquifer in the event of a spill: 1) Facilities need to be designed so that any spilled or leaked materials are contained on site and cannot infiltrate into the ground; and, 2) No permanent disposal of any waste containing critical materials shall be allowed on a site within the ASA. When underground storage of any critical materials is included in the design of any facility, the storage vessel and associated piping and transfer equipment needs to be protected by a secondary containment system. In addition, many commonly used chemicals or other materials may be designated as a physical and/ or health hazard as defined by UBC Chapter 3 and UFC Article 80. For example, gasoline is classified as a flammable liquid with a I-B rating (physical hazard); motor oil is classified as a combustible liquid with a III-B rating (physical hazard). Some materials may be a multiple hazard. An excellent example of a multiple hazard is chlorine. Chlorine is classified as a physical hazard in UBC Table 30D (oxider) and also as a health hazard in UBC Table 3-E as a corrosive, an irritant, a sensitizer, and other health hazards. Requirement for report The building official may require a technical opinion and report to identify and develop methods of protection from the hazards presented by the hazardous material. The opinion and report shall be B27 prepared by a qualified person, firm or corporation approved by the building official and shall be pro- vided without charge to the enforcing agency. The opinion and report may be included, but is not limited to, the preparation of a hazardous material management plan (HMMP); chemical analysis; recommendation for methods of isolation, separation, containment or protection of hazardous materials or processes, including appropriate engi- neering controls to be applied; the extent of changes in the hazardous behavior to be anticipated under conditions of exposure to fire or from hazard control procedures; and the limitations or conditions of use necessary to achieve and maintain control of the hazardous materials or operations. The report shall be entered into the files of the code enforcement agencies. Proprietary and trade secret information shall be protected under the laws of the state or jurisdiction having authority. EXCEPTION: When an HMMP is required, the applicant may submit the report(s) used for compliance with requirements of 40 CFR "Hazard- ous Chemical Reporting and Community Right -to - Know Regulations" under Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA). Additional information may be requested if it is determined that critical, hazardous, or toxic materi- als are used and/or stored at your location. For more information or an appointment contact: Spokane County Division of Building and Code Enforcement Permit Center - 1026 W. Broadway Avenue Spokane, WA 99260-0050 (509) 477-3675 SPOKANE COUNTY PRINTING DEPT. (827) 02/00 E Instructions All chemicals maintained on the site must be listed for the purpose of determining occupancy require • - ments as they relate to the use or storage of hazard- ous or toxic materials under UBC Chapter 3, Sec. 307, Table 3D and 3E and determining "critical material" containment requirements under Chapter 3.15 and 14.706 of the Spokane County Code. Please include the following on the list: a. The proposed type of chemical by name, including common chemical names generally associated with the material, including waste chemicals; and b. The total amounts of each chemical along with container sizes; and c. Material classification under UBC Tables 3D or 3E (UFC Table 8001.13A or 8001.13B); d. MSDS Sheets: attach MSDS sheets, flash point or other information pertinent to the chemical to this list; and Critical Materials Example: e. Areas of the building where the product is used or stored; and £ Methods of storage: if critical materials are known to be involved, proposed methods of containment should be noted. Make sure to list all items such as process and other chemicals, pesticides, fertilizers, cleaning solutions, hazardous solids and other substances. The department will then review the list to deter- mine the applicability of critical material/hazardous material requirements. Critical materials requires double containment design, clean up procedure, and name of hazardous material disposal company to be submitted. Please be as complete as possible. a. Product and/orChemicalName: Pre stone - Antifreeze (Ethylene Glycol) b. Maximum Quantity (GYals,Lbs,Cu.Ft): 8 Gallons (8-1 Gallon) c. Material Classification: (UBC Table 3D, 3E) : None d. MSDS Sheet, etc: None e.Area Stored. and/Used: Stored - storage room, Used - repair shop f.ProposedMethodofStorage: Storage room - metal pan - double containment, area of shop with sealed concrete and no floor drains Hazardous Materials Example: a.Productand/or Chemical Name: Quaker State 10-40 (Motor oil) b. Maximum Quantity (Gals, Lbs, Cu.Ft): 110 Gallons (2-55 gallon barrels) c.MaterialClassification (UBC Table 3D,3E): Combustible Liquid-III-B d. MSDS Sheet, etc; 5 (Attached) e.Area Stored an/orUsed: Stored - storage room, Used - repair shop f.ProposedMethodofStorage: Storage room - concrete diked floor with resistant vinyl liner (see details) Shop - sealed concrete with no floor drains.