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.