HomeMy WebLinkAboutApplication APPLICANT 6/3/2021City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
SPRINGFIELD
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Drinking Water Protection Overlay District Development
Required Project Information (Applicant., complete this section)
Applicant Name: Zack Reeves Phone 541-729-0045
Company: North Lake Property Management Fax:
Address: 36997 Goats Road, Springfield, OR 97478
Applicant's Rep.: Mikael Shields, P.E.
Phone 541-338-9483 x1008
Company: Johnson Broderick Engineering
Fax:
Address: 325 W. 13th Avenue, Eugene, OR 97401
MM
Property Owner: Zack Reeves Phone541-729-0045
Company: North Lake Property Management
Fax:
Address: 36997 Goats Road, Springfield, OR 97478
ASSESSOR'S MAP NO: 17-02-32-23
TAX LOT 400
Property Address: 4155 E Street, Springfield, OR 97478
Size of Property: 0.52 Acres X❑ Square Feet ❑
Zoning: HI Heavy Industrial
Existing Use: Vacant Land
Description of If you are filling in this form by hand, please attach your proposal description to this application.
Proposal: See attached narrative
Si natures: Please si n and Drint your name and date in the acicirociriate box on the next page.
Required Property Information (City Intake Staff. complete this section)
Associated Cases:
Case No.:
Date:
Reviewed by:
Application Fee: $
Technical Fee: $
1 Postage Fee: $0
TOTAL FEES: $
PROJECT NUMBER:
Revised 1/15/09 ddk 1 of 5
Signatures
The un0essigned a&nowWges tfMt Me Information In MIs apply oo Is mrre and accurate.
gate:
Signature
Date: S
nature
Rwlsed 1/15/09 Wk 2 of 5
Drinking Water Protection Application Process
1. Applicant Submits a Drinking Water Protection Application to the Development &
Public Works Department
The application must conform to the Drinking Water Protection Submittal
Requirements Checklist on pages 4-5 of this application packet.
Planning Division staff screen the submittal at the front counter to determine
whether all required items listed in the Drinking Water Protection Submittal
Requirements Checklist have been submitted.
Applications missing required items will not be accepted for submittal
2. City Staff Conduct Detailed Completeness Check
• Planning Division staff conducts a detailed completeness check within 30 days of
submittal.
• The assigned Planner notifies the applicant in writing regarding the completeness of
the application.
• An application is not be deemed technically complete until all information necessary
to evaluate the proposed development, its impacts, and its compliance with the
provisions of the Springfield Development Code and other applicable codes and
statutes have been provided.
• Incomplete applications, as well as insufficient or unclear data, will delay the
application review process and may result in denial.
3. City Staff Review the Application and Issue a Decision
• This is a Type I decision and thus is made without public notice and without a public
hearing since there are clear and objective approval criteria and/or development
standards that do not require the use of discretion.
• Decisions address all the applicable approval criteria and/or development standards.
• Applications may be approved, approved with conditions, or denied.
• The City mails the applicant and any party of standing a copy of the decision, which
is effective on the day it is mailed.
• The decision issued is the final decision of the City but may be appealed within 15
calendar days to the Hearings Official.
Revised 1/15/09 ddk 3 of 5
DWP Overlay District Development Submittal Requirements Checklist
NOTE: If you feel an item does not apply, please state the reason why and attach the
explanation to this form.
❑ Submitted Concurrently with Site Plan Review or Minimum Development Standards
applications, where applicable.
❑ Application Fee - refer to the Development Code Fee Schedule for the appropriate fee
calculation formula. A copy of the fee schedule is available at the Development & Public
Works Department. The applicable application, technology, and postage fees are collected
at the time of complete application submittal.
❑ DWP Overlay District Development Application Form
❑ Copy of the Deed
❑ Copy of a Preliminary Title Report issued within the past 30 days documenting
ownership and listing all encumbrances.
❑ Narrative explaining the proposal and any additional information that may have a bearing
in determining the action to be taken, including findings demonstrating compliance with
the Standards for Hazardous Materials within Time of Travel Zones (TOTZ) listed in SDC
3.3-235.
NOTE: Before the Director can approve a DWP Overlay District Development request,
information submitted by the applicant must adequately support the request. All of the
Standards for Hazardous Materials within TOTZ must be addressed. Incomplete
applications, as well as insufficient or unclear data, will delay the application review
process and may result in denial. In certain circumstances, it is advisable to hire a
professional planner or land use attorney to prepare the required findings.
❑ Three (3) Copies of a Plot Plan reduced to 8 1/2' by 11" outlining the applicable TOTZ
boundaries in relationship to the property boundaries
❑ Three (3) Copies of the Following:
❑ Use of hazardous materials that pose a risk to groundwater that existed on the
property prior to May 15, 2000, if applicable
❑ Hazardous Material Inventory Statement and Material Safety Data Sheet for all
materials entered on the Statement. Hazardous material weights shall be converted to
volume measurement for purposes of determining amounts (i.e. 10 pounds shall be
considered equal to one gallon)
❑ List of chemicals to be monitored through the analysis of groundwater samples and a
monitoring schedule if groundwater monitoring is anticipated to be required
❑ Detailed description of the activities conducted at the facility that involve the storage,
handling, treatment, use, or production of hazardous materials in aggregate quantities
greater than 500 gallons
❑ Description of the primary and any secondary containment devices proposed, and, if
applicable, clearly identified as to whether the devices will drain to the sanitary sewer
or stormwater system
Revised 1/15/09 ddk 4 of 5
❑ Proposed Hazardous Material Management Plan for the facility that indicates
procedures to be followed to prevent, control, collect, and dispose of any unauthorized
release of a hazardous material
❑ Description of the procedures for inspection and maintenance of containment devices
and emergency equipment
❑ Description of the plan for disposition of unused hazardous materials or hazardous
material waste products over the maximum allowable amounts, including the type of
transportation and proposed routes
Revised 1/15/09 ddk 5 of 5
NEW STORAGE FACILITY FOR OOC STORAGE
DRINKING WATER PROTECTION OVERLAY DISTRICT
In accordance with the DWP Overlay District submittal requirements, this written statement and the
enclosed attachments demonstrate that the proposal complies with the relevant criteria under
Springfield Development Code (SDC) 3.3-200.
Project Information: DOC Storage (OOCS) proposes to construct a vehicle and equipment storage
facility on currently undeveloped property located at 4155 E Street in Springfield. The proposed
building footprint is approximately 4728 S.F. and includes an attached two-story office area that is
approximately 848 S.F. in size. Uses that will occur on the property will include storage of vehicles and
equipment primarily those used for other businesses such as landscape maintenance and construction.
The storage spaces will be rented or leased individual units within the same structure. Tenants will be
required to declare and inspect storage of any hazardous materials in their leased spaces.
Site Information: The subject site is located at 4155 E Street, (Tax Lot 17-02-32-23-00400) comprising
approximately 0.52 acres. The property is zoned Heavy Industrial (H I). The site is located within the 20 -
year Time of Travel Zone for SUB wellhead protection. The most recent use of the property was
residential housing. To the best of our knowledge, no known use of hazardous materials that pose a risk
to groundwater existed on the property prior to May 15, 2000.
Approval Criteria:
Springfield Development Code 3.3-135 Criteria
D. Ten to Twenty Year TOTZ Standards. The storage, handling, treatment, use, production or
keeping on premises of more than 10 gallons of hazardous materials that pose a risk to
groundwater in aggregate quantities is allowed only upon containment and safety standards
specified by the mast recent Fire Code adapted by the City. (6138)
No more than 20 gallons of hazardous materials will be stored or used on the site, therefore the
proposal complies with this section of the code.
Conclusion: Based on the information provided and findings contained in this written statement,
associated drawings, and Hazardous Materials Management Plan, the proposed storage facility meets
the Drinking Water Protection Overlay District review criteria contained in the Springfield Development
Code. Therefore, the applicant requests that the City of Springfield approve the proposal. If you have
any questions about this written statement or associated materials, please contact Mikael Shields at
(541) 338-9488 x1008 or email at: mike@jbe.us.com.
T
CASCADE
TYTLE
GD.
STATUS OF RECORD TITLE REPORT
SUPPLEMENTAL
TAMMY REEVES Date: OCTOBER 29, 2020
36997 GOATS ROAD Our No: CT -0321635
SPRINGFIELD, OR 97478 Charge: $300.00
As requested, Cascade Title Co. has searched our tract indices as to the following
described real property:
( A T T A C H E D)
and as of: OCTOBER 21, 2020 at 8:00 A.M., we find the following:
Vestee:
ZACHARY REEVES AND TAMERA KJAR
as tenants by the entirety
Said property is subject to the following on record matters:
1. Taxes, Account No. 0983559, Assessor's Map No. 17 02 32 2 3, 4400, Code 19-00,
2020-2021, in the amount of $1,056.48, NOW DUE AND PAYABLE.
2. Easement to Eugene -Springfield Land 6 Water Company for irrigation purposes,
including the terms and provisions thereof, as disclosed in deed recorded June 20,
1940, Reception No. b205 p023, Lane County Oregon Deed Records.
3. Right of way to use slough for irrigation, including the terms and provisions
thereof, as disclosed in deed recorded August 21, 1912, Reception No. b094 p634,
Lane County Oregon Deed Records.
4. Covenants, conditions, easements and restrictions, including the terms and
provisions thereof (but omitting covenants or restrictions, if any, based upon race,
color, religion, sex, sexual orientation, familial status, marital status,
disability, handicap, national origin, ancestry, or source of income, as set forth
in applicable state or federal laws, except to the extent that said covenant or
restriction is permitted by applicable law) in Deed recorded April 27, 1953,
Reception No. 1953-002495, Lane County Oregon Deed Records.
MAW OFHCE FLORENCE OFFICE VILLAGEPLAZAOFFICE
811W LA TTESM 915 HWY 101' FLORENCE OREGON 97439 47M VE,LAGE PLAZA LOOP SUITE 100
EUGENE, OREGON 97401 MAN.ING: PO BOX 508' FLORENCE OREGON 97439 EUGENE OREGON 97401
PH: (541) 689-2233 * FAX: (541)185-0309 PH: (541) 99]341] * FAX: (541)9978246 PH: (541) 653-8622 * FAX: (541) 8444626
Order No. 0321635
Page 2
NOTE: This report is being supplemented to update taxes
This report is to be utilized for information only. This report is not to be used as a
basis for transferring, encumbering or foreclosing the real property described.
The liability of Cascade Title Co. is limited to the addressee and shall not exceed the
premium paid hereunder.
CASCADE TITLE CO., by:
mm: Title Officer: DOUG PIERCE
Order No. 0321635
Page 3
PROPERTY DESCRIPTION
Lot 2, in Block 3, of MORROW PLAT, as platted and recorded in Book 19, Page 6, Lane
County Oregon Plat Records, in Lane County, Oregon.
EXCEPT: Beginning at the Northwest corner of Lot 2, Block 3, MORROW PLAT, as
platted and recorded in Book 19, Page 6, Lane County Oregon Plat Records, in Lane
County, Oregon; run thence Easterly along the Northerly line of said Lot 2 on the
arc of a 256.40 foot radius curve right (the long chord of which bears South 71°
10' 30" East 77.66 feet) a distance of 77.93 feet to the end of curve as located
in said MORROW PLAT; thence leaving the North line of said Lot 2 and run South 19°
00' 30" West 193.49 feet to a point on the South line of said Lot 2 that is 10.0
feet North 89° 52' East of the Southwest corner of said Lot 2; thence South 89°
52' West 10.0 feet to said Southwest corner; thence North 0° 08' West along the
West line of said Lot 2, 200.03 feet to the point of beginning in Lane County,
Oregon.
T
CASCADE TITLE CO.
MAP NO.
17-02-32-23
2
1M,
5
400 AVENUE
2 e
,- 300
SE COR
LCOMEGYS
D -L -C- NO.81
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THIS MAP/PLAT IS BEING FURNISHED AS AN AID IN LOCATING THE HEREIN DESCRIBED LAND IN
RELATION TO ADJOINING STREETS, NATURAL BOUNDARIES AND OTHER LAND, AND IS NOT A SURVEY
OF THE LAND DEPICTED. EXCEPT TO THE EXTENT A POLICY OF TITLE INSURANCE IS EXPRESSLY
MODIFIED BY ENDORSEMENT, IF ANY, THE COMPANY DOES NOT INSURE DIMENSIONS, DISTANCES,
LOCATION OF EASEMENTS, ACREAGE OR OTHER MATTERS SHOWN THEREON.
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TO K4pG AND TO BOLD....thB._ said premisee, with theiry ePPnttr :niece,
and asoigne _mevr.
i -on, vneenent to and with tlm acid__.._,Q aal.al Eur............
Leis end mearns, tLaL_thRy....ara___1'M1annnee9.__.in Pee xlmple of
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.TOFOREGON ` ¢s.. to it npmamllBPod tbft o¢ EILO 2-EILLOy of 3nas A. 9y 194Qx
00[1NTY pE LANE ) ompe[ ally "me he...Notary PaL11. _In nnd£rc sail
Jde n _
Gtg......_ _ttnwAhin nameC Aer46LtrtBveyhex Yw13oTTaT of 3Sertlo A. HvrgheS-.aodnDe&... .
0. Sughgn _�
to
mn on0i, Inion , to be the'id tl 1 11"InIa.--imomild in andwho axe ted la th 1UL-1.1no.
o4ost1o06o£ W methsttbgy ,e a steJtt¢enme Seely d oluntardy........_Soetho nage jaaa,
Witness my hand and's¢nl thie'26tri day ¢£ oss. A. F., 194,
o. G. Davis
Notary PabLlo for Onoyon
NOtflrial 6ea1 Ny Covm3s¢iOn Rssire¢ I]Bnember 26th, 1S
COMPANY, a Washington corporation, of Tacoma, Washington, Grantor,
in consideration of the aum of Ten Dollars ($10,00) and other good .
and valuable consideration, -receipt sof which is hereby acknowledged,
has bargained and sold and by these presents does grant, bargain,
sell and convey unto KENNETH X. WILY and MARY MARGARET W=,
husband and Wife, of 4155 E. Street,Springfield, Oregon, as tenants
by the entirety, Grantees, all the following described real property,
situated in County of Lane State of Oregon: -
Lot 2 of Block 3, Morrow Plat, Lane County, Oregon,
according to the map and plat thereof on file and of .
record in the office of the County Clerk of said County.
Subject to:
(1) The right of the Grantor, which is hereby reserved in
the Grantor, to eatabllsh, constrnot, maintain and conduct, on
any and all of the real property by it noir owned, situated in -
Sections 19, 20 and 28 to 33, inclusive, Township 17 South,
Range 2 West of W, M., and Sections 4 and 5. Township 18 South,
Range 2 West of W. M.., said Lane County, or hereafter acquired
by it in said sections, operations of any and every nature,
without limitation, for the manufacture and processing of
products from wood, by any means, .process or processes now or
hereafter (mown to the Grantor and in any mill, plant or other
structure presently existing orhereafter constructed on said
property.
In consideration'bf the conveyance hereby made, Grantees
specifically covenant and agree, and without which covenant and
agreement Grantor would not make this conveyance, that neither
of said Grantees, nor any person or persons whomsoever for them
or in their names, shall at any time hereafter make or assert
1.
maintain
ang `suit, action or prooaadingbased. upon, growing
out of or resulting .from any manufacturing or processing oper-
ations conducted by the Grantor pursuant to its reserved rights;,_:-,
hereinabove set forth, including but not limited to operations
of the
-Grantor resultingin the discharge of chemicals,,_..$sea,.._ __..
smoke or fumes from the Grantorts mills and plantae The fora- -
going covenants and agreements made by the Grantees are and
shall be annexed to, inherent In and connected with the real
property hereby conveyed and the occupancy arfd enjoyment thereof
by the Grantees, and it 1s the intention and agreement of the
parties hereto that such covenants and agreements shall run
with the land, that is, the property hereby conveyed, and
become and remain binding upon the Grantees and their respective
heirs, representatives, vendees, successors and assigns; and --.
(2) All rights of and easements to Eugene -Springfield Land
and Water Company of record in theoffice of the Clerk of said
Lane County,
together with all and singular the tenements, hereditaments and
appurtenances thereto belonging or in anywise appertaining.
The terms, agreements, covenants, reservations and conditions
of this deed shall inure to the benefit of and be and become binding
on the respective heirs, representatives, vendees, successors and
assigns of the parties hereto,
To have and to hold, the above described and granted premises
unto the said Grantees, their heirs and assigns, forever,
IN WITNESS WtIENEOF, said 'Granaor has caused these presents
to be signed and Its corporate seal to be hereunto affixed by its
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WSYEUAE! TMER- COKPANY •.
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ce res
Atte a-.; A
Seeretar
STATE OF V OTON) -
) Be.
COUNTY OF PIERCE ) _...._...._.. _.. _._
On this 17th day of Apri1,1953, before me personally _.
appeared Chas. H. Ingram, to me known to be the Vice President of" -
Weyerhaeuser Timber Company, the corporation that executed the
within and foregoing instrument, and acknowledged said instrument
to be the free and voluntary act .and deed of said corporation,
for the uses and purposes therein mentioned, and on oath stated
that he was authorized to execute said instrument and that the
seal affixed is the corporate seal of said corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed
my. official seal the day and year first above written.
,r
No'Ejy<. PUblIcin and'iorifiie Sisk
of Washington, residing at Tacoma.
MY commission expires 10/21/54
IN WITNESS WHEREOF, the Grantees above named have hereunto
-_ set their hands and seals this /$fhday of ✓i/ 1953.
STM OF ORMON >
— .-- ) Be.
COUNTY on LANG
Personally appeared the above named Kenneth N. Wiley and
Mary Margaret Wiley, husband and wife,. and acknowledged the
foregoing instrument to be their: voluntary act and deed. Before
me:
rM�-�L.. _..
Notary Public for Oregon
My .commission expires Va, Af 194J
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INVOICE
TAMMY REEVES
36997 GOATS ROAD
SPRINGFIELD, OR 97478
ATTN: EMAIL: OREGONATIVE68@GMAIL.COM
PAGE
OUR NO: 0321635
YOUR NO: --
DATE
DATE: 08/11/2020
OFFICER: DOUG PIERCE
SELLER:
1.10X1 t7 A.VwO/AWat7elONIC61
Description Policy Amount Premium Amount
08/06/20 Status of Record Tide Rep 300.00
Grand Total
PLEASE SHOW OUR NUMBER ON YOUR REMITTANCE
811 Willamette Street ♦ Eugene, Oregon 97401
Phone: (541) 687-2233 ♦ Fax: (541) 485-0307 ♦ email: info@cascadetide.com
300.00
LEGEND
— DIRECTION OF FLOW
\" \� DWP SIGN
H
, RIM nfN,=463.8E
AIr
STORMWATER
PLANTER \ v
f 10-20 YR.
TOTZ <-- _
PAVED PARKING 'a
' AREA F, ,� f
DWP SIGN
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i
n a
� OFFICEISTORAGE
e BUILDING s
ii
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NV ELEV= 482
C2.1 1, 30. NORTH
JBEJOHNSON pate 2021.04.09
BRODERICK OOC STORAGE FACILITY Pmied A. 20031.03
ENGINEERING 4155 E STREET Orewn By CMR
Civil and Structural Engineers SPRINGFIELD, OREGON 97478 ch -Ned ar' AVE
325 W. 13th Ave Tel (541) 338-9488 RI.
Eugene, OR 97401-3402 Fax (541) 338-9483
www.JBE.US.com Tlue: SITE PLAN Sheet. C2.1
92021 JOHNSON BROGEWCK ENGINEERING. No fan of Nk d¢umeiM1—M.,.u.dMH.Uthe woft Nev.— ho. JSE. 1325 WEST 13TH A NUE EUGENE OREGON 97401.(511)3%M u(az(1133S81 1
SPRINGFIELD UTILITY BOARD
HAZARDOUS MATERIALS MANAGEMENT PLAN
OOC STORAGE FACILITY
OOC Storage (DOCS) Facility is located within the 10 to 20 -year time -of -travel zone to one of Springfield's
municipal drinking water wells as shown on the map below. This means that chemicals that spill or leak onto
the ground surface have the potential to contaminate the well between 10 and 20 years' time. DOCS is a
committed partner in the effort to protect Springfield's drinking water supply. Our hazardous materials
management program emphasizes the importance of preventing chemical leaks and spills and responding
promptly and effectwely should a release occur. We strive to increase awareness that the property lies within a
sensitive drinking water protection area among our employees and the public who visit our business.
This hazardous materials management plan outlines OOCS's protocol for preventing, controlling, collecting,
and disposing of any unauthorized releases of hazardous materials. The plan also identifies the greatest areas
of risk within our facility and outlines the steps we take to reduce the risk. Any questions about this plan or
how DOCS manages its hazardous materials should be directed to Zack Reeves, OOCS's Owner/Operator, at
541-729-0045.
a�mw.vQrr�erm�es
W ®A.@AD PRO]SCI'ION AP E1
FM4 Wn
Section I: Facility Description
Part A —General Information
1. Business Name: DOC Storage Facility
Phone: 541-729-0045
Address: 4155 E Street, Springfield, OR 97478
2. Person Responsible for the Business:
Name Title
Phone
Zack Reeves Owner/Operator
541-729-0045
3. Emergency Contacts:
Name Title
Home Phone
Zack Reeves Owner/Operator
541-729-0045
Tamara Reeves On-site Manager
541-554-3384
4. Person Responsible for the HMMP:
Name Title
Phone
Zack Reeves Owner/Operator
541-729-0045
5. Property Owner:
Name Address
Phone
Zack Reeves 36997 Goats Road
541-729-0045
Springfield, OR 97478
6. Principle Business Activity:
Storage facility for vehicles and equipment
7. Number of Employees:
Two
8. Number of Shifts:
One
9. Hours of Operation:
7:00 am — 6:00 pm, Monday — Friday
Work Phone
541-729-0045
541-554-3384
I certify that the information above and on the following parts is true and correct to the best of my
knowledge.
Signature:Date: 57— lf7
Print Name: Z-GLkFr- ' `eCV eS Title: V W ,-Er
Page 2 of 14
Part B — General Facility Description/Site Plan
The site occupies 0.52 acres of Heavy Industrial zoned land at 4155 E Street in Springfield. The primary
business is rental/lease of space for storage of vehicles and equipment within a 4728 S.F. building. The
eastern portion of the storage area is reserved for the owner's personal use. The western portion of the
building contains a two-story office. The site includes a 7231 S.F. paved parking and driveway area. All
stormwater runoff from the building and paved areas is directed to a stormwater planter area for treatment
and infiltration. Tenants of the leased spaces will be responsible for declaring use and storage of
hazardous materials using a tenant intake form (example attached). The tenant intake form be received by
OOC management staff at the beginning of tenancy and will be kept on file in the management office.
Part C — Facility Maps/Hazardous Material Storage Locations
Page 3 of 17
LEGEND
— DIRECTION OF FLOW
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\" \� DWP SIGN
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"� cH'ssa w, r H
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AIr
STORMWATER
PLANTER \ v
f 10-20 YR.
TOTZ <-- _
hot
PAVED PARKING 'a
' AREA F, ,� f
DWP SIGN
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C2.1 1, 30. NORTH
JBEJOHNSON oaa 2021.04.09
BRODERICK OOC STORAGE FACILITY Preied A. 20031.03
ENGINEERING 4155 E STREET Grown By CMR
Civil and Structural Engineers SPRINGFIELD, OREGON 97478 cheered ar' AVE
325 W. 13th Ave Tel (541) 338-9488 Reumnn.
Eugene, OR 97401-3402 Fax (541) 338-9483
www.JBE.US.com Tlue: SITE PLAN Sheet. C2.1
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Page 4 of 17
LDN
�11ST FLOOR OFFICE �12ND FLOOR OFFICE
52.1 1"= 10' 52.1 1"= 10' OWN Pe qTnpArp Apph
OFFICE
SEE
3152.1
HAZARDOUS MATERIAL
STORAGE CONTAINER
SPILL KIT
X11 ST FLOOR PLAN
1^=20'
JBEJOHNSON owe 20210.
BRODERICK NORTH LAKE PROPERTY MANAGEMENT vmiec u: 200311.0303
ENGINEERING 4155 E STREET Dnewh By: CMR
CiVll and Structural Engineers SPRINGFIELD, OREGON 97478 checked 9y: AMB
325 W. 13th Ave Tel (541) 338-9488 xemsiee.
Eugene, OR 97401-3402 Fax (541) 338-9483
www.JBE.US.com Txe: FLOOR PLAN sheet. S2.1
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Page 5 of 17
Section II: Hazardous Materials Inventory Statement
PRODUCTS STORED ON-SITE
Hazardous
storage
Llass.des n
Maximum
Apprpx.
ManufaRurer's
Hazardous
Lodes
Chemical
Quanfity
Paazge of
Coazdtioazs
OPed
NFPA 764
lAralionof
Name&Product
u
Ingredientsartd
Amari
fsmv&Table
(Survey Ta le
Unit
Contmner
Material
M4enf
Us
Lbsed Use
Llassifirafion
Chemical Stared
Narne
Lpnrenhalion
N)
Services No.
Noted
sires
N&V)
Ethaml
6417-5; A&
Toluene
6&3; 95!36;
Mnmz's S[arage Area
Gasoliue(All Grades)
1,3,4Iri,oetbYlbenzene
]1.43-Y; 110
5G��
SGallanar
Liquid
Open
aneatemof
Benzene
54.3
less
building In Fluor
n hexane
Tihuimn Biaxide
1346.3.6]-];
gynez's S[arage Area
Litex Print
Amorphous Motorcar—Earth
61]90-53-3; 5]-
SGallen
1Gallonor
Liquid
Open
mzeat end of
Propylene Glycol
551;64]4365-
Less
building 1 -Floor
Hear, Paraffinic Oil
0
PRODUCTS USED ON-SITE AND STORED OFF-SITE (examples include landscape chemicals and/or fertilizers and janitorial supplies)
hazardous material inventory changes, this HMIS shall be updated to reflect those changes and provided to SUB for review for compliance with SDC
3.3-200 on an annual basis.
Page 6 of 17
Section III: Separation, Secondary Containment, and Monitoring
Part A - Above Ground Storage Areas
Storage Area Identification (as shown on Site plan and Floor Plan): Owner's Storage Area (see Floor Plan)
1. Storage Type:
X Original Containers
Inside Machinery
55 -Gallon Drums
Pressurized Vessel
2. Storage Location:
X Inside Building
3. Separation:
All Materials
X Compatible
Separated by 20 feet
4. Secondary Containment*:
X Approved Cabinet
X Tray
Vaulted Tank
5. Monitoring:
X Visual
6. Monitoring Frequency:
Daily
X Monthly
X Safety Cans
Bulk Tank
Outside Barrels
Other:
Outside Building
Secured
One -Hour Separation Wall
Approved Cabinets
Other:
Secondary Drums
Bermed, Coated Floor
Double -Wall Tank
Other: N/A
Continuous
Weekly
*All hazardous materials and wastes, regardless of container size, must be kept in secondary
containment.
**All hazardous materials shall be property labeled
Page 7 of 17
Section IV: Waste Disposal
Discharge to Sanitary Sewer
Wastes:
X Licensed Waste Hauler
Wastes: General office waste
material
Describe Method:
Wastes:
nrnraFrr;
Pretreatment
Wastes:
X Recycle
Wastes: Pacer, glass, metal
Page 8 of 17
Section V: Record Keeping (Inspection and Maintenance)
Description of our Inspection Program: Inspection of the owners' storage space will take place on a monthly
basis. Any materials stored in tenant spaces are required to be identified on the HMIS Tenant Intake Form with
required monthly inspections and documentation on that form (example form attached). The owner will be
responsible for inspecting his personal storage area and documenting the inspections on the attached form.
Tenants are required to perform inspections of their spaces with documentation recorded on the HMIS Tenant
Intake Form. The owner will review the HMIS Tenant Intake Form for compliance every 6 months. Completed
inspection forms will be kept on site in the DOCS management office for a period of 7 years. All secondary
containment devices will be inspected on a monthly basis. Any detected problems will require correction
within 24 hours.
Page 9 of 17
EXAMPLE HMIS TENANT INTAKE FORM
OOC Storage HM IS Tenant Intake and Reporting Form -Drinking Water Protection
Required Information (To he completedby tenant)
Name: Phone:
Business Name: Shop 7t:
Date of commencement of tenancy:
Describe the nature of the use or business:
The undersigned acknowledges that the information included on this form is correct and accurate. The undersigned also certifies that the inventory of
hazardous materials inventory kept in the unit will not exceed or differ from the list below. If the inventory changes, this form shall be updated and
resubmitted to CDC Storage management.
Tenant Signature Date
Tenant Print Name
List all hazardous materials that are used, stored, or produced in the unit (e.g., household & industrial cleaners, paint
and paint products, pesticides, fertilizers, maintenance supplies, petroleum products, automotive chemicals, solvents,
pharmaceuticals, printing chemicals, laboratory chemicals, hobby chemicals). Attach additional sheets if necessary.
TOTAL QUANTITY =
. fbzordous materiol weights shop be converted to mbme measurementfor purposes ofdeterminirg amounts, 10 pounds shah be considered equal tome
galbn as specified in Springfield Fire Code 2703.1.2.
To be completed by OOC Storage management:
Exempt from DWP: Yes" O No (Proceed to Page 2) O
Date of review: Reviewed by:
"Exempt businesses shall submit updated form on an annual basis
FName:
Phone:
Business Name:
DOCS Sho
p:
Page 10 of 17
MONTHLY COMPLIANCE & INSPECTION: Year: January—June ❑ July - December ❑
Provide the information requested below and inspect monthly.
Tenant
Tenant Printed Name
January - June (year): 71
Date of
July -December (year): ❑
Reviewed by:
Date
Page 11 of 17
What kind of secondary containment are your chemicals
F
Z
stored in?
JAN
FEB
MAR
APR
MAY
JUN
JAN
FEB
MAR
APR
MAY
JUN
g
H
❑
❑
❑
❑
❑
❑
z
Y
J
d
R
JUL
O
AUG
O
SEPT
❑
OCT
❑
NOV
❑
DEC
❑
H
NOTES:
z
z
O
JUL
AUG
SEPT
OCT
NOV
DEC
Inspect that all secondary containment is in place and check
❑
❑
❑
❑
❑
❑
y
C
for leaking containers. Fix problems if applicable.
Q
Z
NOTES:
O
u
un
!n
Tenant
Tenant Printed Name
January - June (year): 71
Date of
July -December (year): ❑
Reviewed by:
Date
Page 11 of 17
What is the location of your spill ll
JAN
FEB
MAR
APR
MAY
JUN
❑
❑
❑
❑
❑
❑
H
Y
J
d
Inspect that spill kit is easily accessible, fully stocked, and
signed. Fix problems if applicable.
JUL
O
AUG
O
SEPT
❑
OCT
❑
NOV
❑
DEC
❑
H
NOTES:
Tenant
Tenant Printed Name
January - June (year): 71
Date of
July -December (year): ❑
Reviewed by:
Date
Page 11 of 17
Section VI: Spill Prevention
Measures that the business will take to prevent spills include storing containers at eye -level, securing shelves to
walls, segregating incompatible materials, using and monitoring secondary containment, maintaining all
containers in good condition, conducting regular employee training, storing all chemicals inside, and requiring
tenants to comply with these spill prevention measures. The business will protect the storm drain system by
monitoring the paved area that drains to the stormwater facility and containing and cleaning up any spills
before they reach that area. The trash enclosure is hydraulicly isolated from the storm drain system and
includes a catch basin connected to the wastewater system. The trash enclosure area will be inspected for spills
on a weekly basis. Any spills detected will be cleaned up immediately. A spill kit will be located in the owners
storage area and each tenant will be required to keep on hand a spill kit appropriate for the type of materials
stored in the leased spaces.
Page 12 of 17
Section VII: Emergency Response Plan
1. In the event of an emergency, the following shall be notified:
A On -Site Responders:
Name Title Phone
Tamara Reeves On -Site Manager 541-554-3384
Zack Reeves Operations Manaqer 541-729-0045
10
C.
Method of Notification to Responders:
Automatic Alarm
Manual Alarm
Other:
X Telephone
Verbal
Agency Phone Number
Fire Department 911*
Oregon Emergency Response System 1-800-452-0311
Other Dial 911 in the event of an emergency or hazardous
material spill
* The standard procedure for notification of a hazardous material release in Springfield is to call 911. The
first responder will dispatch information to Springfield Utility Board, which must be notified as soon as
possible if a chemical release has the potential to contaminate municipal wells.
2. Designated Local Emergency Medical Facilities:
Name Address Phone
Peace Health Riverbend 3333 Riverbend Dr., Springfield, OR 97477 541-686-6931
McKenzie Willamette 1460 G Street, SDrinafield, OR 97477 541-726-4400
Page 13 of 17
3. Mitigation Equipment:
A Monitoring Devices:
Toxic or flammable gas detection
X Fluid detection
Other:
B. Spill Containment:
X Absorbents
C. Spill Control and Treatment:
Vapor Scrubber
Pumps/Vacuums
Neutralizer
Other:
Mechanical Ventilation
X Secondary Containment
Other:
4. Evacuation:
X Immediate area evacuation routes posted
Entire building evacuation procedures developed
Assembly areas pre -planned
Evacuation maps posted
Other:
5. Supplemental Hazardous Materials Emergency Response Plan on Site:
Location: DOCS management office
Responsible Person: Zack Reeves
Phone: 541-729-0045
Page 14 of 17
Section XIII: Emergency -Response Training Plan
1. Person Responsible for the Emergency -Response Training Plan:
Name Title Phone
Zack Reeves Operations Manager 541-729-0045
2. Training Requirements:
A All employees trained in the following as indicated:
X Procedures for internal alarm/notification
X Procedures for notification of external emergency -response organizations
X Location and content of the emergency -response plan
X Awareness of the facility's proximity to sensitive drinking water protection area
X Drinking water protection presentation (contact SUB Water Quality Protection Coordinator,
Amy Chinrtz, at 541-744-3745)
B. Chemical handlers are trained in the following as indicated:
X Safe methods for handling and storage of hazardous materials
Proper use of personal protective equipment
X Locations and proper use of fire- and spill -control equipment
Specific hazards of each chemical to which they may be exposed
C. Emergency -response team members are trained in the following:
Procedures for shutdown of operations
X Procedures for using, maintaining and replacing facility emergency and monitoring equipment
3. The Following Records are Maintained for All Employees:
X Verification that training was completed by the employee
Description of the type and amount of introductory and continuing training
Documentation on and description of emergency -response drills conducted at the facility
4. Amore comprehensive and detailed emergency -response training plan is maintained on site.
Location: DOCS Management Office
Responsible Person: Zack Reeves Phone: 541-729-0045
Page 15 of 17
Section IX: Process for Updating HMMP
The HMMP will be reviewed annually by OOCS management and updated as required. Copies of the
HMMP will be kept on-site in the OOCS management office.
Section X: Notes
Wellhead protection signs are installed on-site to inform staff and visitors of the importance of reporting
and cleaning up spills.
These signs are located at the building entrance and the covered trash enclosure. Damaged or missing
signs should be replaced.
EXAMPLE OWNER INSPECTION FORM
Page 16 of 17
HAZARDOUS MATERIAL STORAGE MONTHLY INSPECTION FORM
Completed inspection sheets are to he maintained in the inspection log for at least threeyears
Storage Area Date & Time Inspector Name
Reviewedby
Instructions:
INSPECTION TOPIC
OK
COMMENTS
PROBLEMS DETECTED
RESOLUTION (Include dates and times
corrective actions taken
Area is free ofleaks and/or
spills
Secondary containment devices
intact and secured to shelves
Original containers not leaking,
rusted bulging or damaged
Hazardous material containers
me properly labeled
Containers closed and sealed
Spill kit accessible with signage
and instructions
Incompatible materials are
stored separately
Floor free of cracks and other
dam e
NOTES:
Page 17 of 17