The URL can be used to link to this page

Home My WebLink AboutCorrespondence APPLICANT 8/29/2007 ". R BALZHISER & HUBBARD ENGINEERS LETTER OF TRANSMITTAL 100 \!\Iest 13th Avenue, Eugene, Oregon 97401 (541) 6116-[;478 (phone) / (541) 345-5303 (bx) www.bhcngincers.co1ll tv1cch.1nic<ll. EleClriG11. Civil .Surveying Project: From: Amy Chinitz August 29, 2007 SUB Water 202 South 18th Street Springfield, OR 97477 PacificSource Health Plans, Springfield: Emergency Generator (DRC 2007-00028) Janet L. Pardee, P.E. To: Company: Address: WE ARE SENDING YOU THE FOllOWING: ITEM 1. 2. COPIES DATE DESCRIPTION 1 1 8/29/07 8/29/07 Revised DWP Overlay Narrative Hazardous Materials Management Plan (HMMP) which includes the Hazardous Materials Inventory Statement (HMIS) Applicable MSDS for the emergency generator 3 1 REMARKS: This is our revised DWP Overlay Permit submittal based on city of Springfield and SUB Water review comments and DWP Overlay District Permit Notice of Decision dated May 30, 2007. Please review and let us know if there is anything further required by us, or revisions to be made, to complete the approval process of this permit. COPIES: . Steve Ord, PacificSource Health Plans, 110 International Way, Springfield OR 97477 John Bramwell, RobertsonlSherwoodlArchitects, PC., 132 E Brqadway, S~ite 54Q, Eugene OR 97401 Linda Pauly, City of Springfield Planning Dept., 225 Fifth Street, ,Springfield OR 97477 File RECEIVED AUG 2 9 2007 BY: P:\770Q-008-06\Generator Permits\tm jlp 070829to SUB re revised DWP submittal.doc Page 1 of 1 l. PacificSource Health Plans Emergency Generator I nstallation Drinking Water Protection Overlay March 26, 2007 Revised: August 29, 2007 ~u~nu] g':l-Q-67 I By BALZHISER & HUBBARD ENGINEERS Mechanical. Electrical. Civil. .Transportation . Surveying '""_"_n_."__ 100 West 13tl-i Avenue, Eugene, Oregon 9740l. P.O. Box-l 0347, Eugene, Oregon 97440 Phone: (541) 686-8478. Fax: (541) 345-5303 , www.bhengilleers.com Drinking Water Protection Overlay District PacificSource Health Plans - Emergency Generator Installation (revised: August 29, 2007) WRITTEN STATEMENT Request The applicant, PacificSource Health Plans, proposes to install an emergency generator with associated concrete slab and structure, enclosure and utility infrastructure improvements on their existing Corporate Office Headquarters on International Way in north Springfield, Refer to the attached Overall Site Plan, A2.0, for existing site layout and location of the proposed improvements. Background In 2002, the property was approved for construction ofa 61,440 square foot, two-story office building with associated parking, landscapihg and utility infrastructure. Included with the approval was the proposal for future (second phase) development of an additional office building and associated parking area (sized similarly to the first phase of development). The secondary parking area was designed to be located within the floodway, conforming to the requirement that the development does not result in any increase in flood levels during the occurrence of the base flood discharge, Construction of the first phase of work was completed in 2004 with the secondary parking lot constructed the summer of2006, The Owner now wishes to construct/install an emergency generator assembly to supply emergency power to both the existing and future buildings. This design element was not included in the original land use approval, thus a Site Plan Review Modification (Type II) is required. The emergency generator assembly, enclosure ,and associated construction are proposed to be located along the west property line and north of the proposed future building. The structure will be set at an elevation of 431.00, one foot above the 100- year floodplain elevation and matching the finished floor elevation of the proposed future buitding. Time of Travel Determination This application is required because the applicant proposes to use petroleum products and fertilizers within the 2-5 year Time of Travel Zone (TOTZ) for the Sports Way Wellhead (see attached Time-of- Travel map for reference), Required Information In accordance with Drinking Water Overlay Protection (DVIP) application submittal requirements, all required information haS been provided as follows:' . . 1. A complete application page, A completed and signed applicatioll page was previously submitted on Marcil 26, 2007. 2. Uses of hazardous materials that pose a risk to groundwater that existed on the property prior to May 15, 2000, if applicable. The site, prior to the Phase I development in 2002, was bare land with a few trees and shrubs and did not contain hazardous materials that posed a risk to groundwater. The site is now 75% developed as . 'ppro"~d ,,"", ~'~'g'""IS'. PI" R""w Appro,,' "'"dJ,,,, 2002. ~ ~ ~. ~ BID. ~ ] ~_2Dj~D1 B.L__ 3. Applications shall include six cooie~ ofthefollowing information: a, A Hazardous Material Inventory Statement and a Material Safety Data Sheet for any or all materials entered in the Statement unless exempted under 17.060 of this article, Hazardous material weights shall be converted to volume measurements for purposes of determining amounts - 10 pounds shall be considered equal to 1 gallon in conformance with Uniform Fire Code 8001.15.1; Hazardous Material Safety Data Sheets (MSDS) are included with this narrative and as required for each substance proposedfor use in association with the generator, which includes dieselfuel, coolant and lubricating oiL Refer to the attached to view each individual MSDS listing. The applicant notes that all products are/will be delivered to the site in standard containers and in nonnal quantities provided by the manufacturer or distributor. All materials are/will be stored in accordance with the specifications ~or the applicable substance. While the specific quantities of each of the cleaning products stored on site are not known at this time, the total quantity of materials stored on site does not exceed 500 gallons, The only exception to this will be the proposed diesel fuel storage necessary for the proposed emergency generator. The'generator will have a single 850-gallon, double-walled, above-ground fuel tank. The tank will be fully enclosed and located under the emergency generator. The double-walled tank provides the required secondary containment for any potential leaks or failures of the main storage compartment. The generator manufacturer provides a spill containment kit that will be stored in the generator enclosure for access.(o those refueling the generator. A wellhead protection sign will be posted on or near the generator enclosure to remind those refueling the storage tank that leaks and spills are to be avoided with the spill kit utilized as necessary during refueling operations. Also included with the generator installation is a spill detection system that alerts the property owner's facilities staff of any leaks and/or failures. Should a failure occur, an audible alarm will be heard within the maintenance closet, alerting the facilities staff of the failure. If the tank fails and fuel is released into the secondary containment, the double-walled fuel tank would be completely removed and replaced, b, A list of the chemicals to be monitored through the analysis of groundwater samples and a monitoring schedule if groundwater monitoring is anticipated to be required. No ground water monitoring is anticipated to be required as part of this request; All materials listed in this request. are/will be stored and utilized either within the interior of the buitding, through secondary containment or off-site. All cleaning materials, motor coolant and engine oil are delivered to the s~te and stored in individual containers sized for commercial use applications. All landscaping supplies/materials are utilized for the'maintenance and care ofthe site landscaping areas. The materials are common commercial lawn care and weed prevention products and are utilized in relatively small quantities on a'weekly or as-needed basis. Fo~ the record, a private landscape contractor currently provides the on-site lawn care services. Said contractor stores all substances and materials used at their own place of work. The products/materials are brought to the site for use at the time they are being applied. The landscape contractor then removes any remaining and/or unused substances upon completion of product application/use. c. A detailed d. escription of the activities conducted at the facility that involve the storcfe...1umd ~. . treatment, use or production 'of hazardous materials in quantities grel'~:r1lafNh~ffx\!J. u{f I allowable amounts. \.i; \!!) I As mentioned above, the only hazard'ous material to be utilized in quantiti, eat~~;h~ri the" -- ,_} . ~/2'1'D1 By maximum allowable amount is diesel fuel for the proposed emergency generator. Fuel will be brought to the site via approved fuel transport equipment, pumped into the doubled-walled fuel tank located under the generator assembly, and utilized by the generator for emergency power to both the existing and proposed future buildings. d. A description of the primary and secondary containment devices proposed and if applicable clearly identified as to whether the devices will drain to the storm orsanitary sewer. As mentioned above, the generator will have a single 850-galion, double-walled, above-ground fuel tank, The tank will be fully enclosed and located uflder the emergency generator. The double-walled tank provides the required secondary containment for any potential leaks or failures,.thus neither a sanitary or stann service is required, The motor oil and engine oil will remain in their original containers and stored within the maintenance closet located on the first floor of the office building. Refer to the first floor plan, sheet Al.O in the attached Hazardous Materials Management Plan (HMMP). The maintenance closet contains a floor drain that discharges directly to the private sanitary sewer system. Should a spill of either of these materials occur,fluids will drain into the sanitary system and not into the on-site private storm system.. e. A 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. The area surrounding the emergency generator as well as all janitorial and maintenance roomslfacilities storage areas will be signed with safety information and cleanup procedures in accordance with PacificSource's company policy as well as all local, state and federal standards. f A description of the procedures for inspection and maintenance of containment devices and emergency equipment. During construction, the construction site foremen will be responsible for regular inspection, maintenance and cleaning of all containment areas and construction eqUipment. Emergency equipment, as required for building and fire code compliance, will be inspected at the direction and on a schedule established by the fire marshal. Facilities staff will be responsible for weekly inspection of the generator enclosure and tank and associated equipment. g. A 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. All materials, with the exception of the diesel fuel, will be delivered to the site in containers with quantities below five gallons. Fuel will be brought to the site via approved fuel transport equipment, pumped into the doubled'walled fuel tank located under the generator assembly, The fuel will be used in its entirety by the generator during times of emergency power usage and/or monthly exercising operations. Given the nature of the material, no disposal beyond nonnal anticipated use is expected. 4. A completed DWP Overlay District Development Application, together with. Jl::t;etJl!!S"d?rm1e'iiillSi: \ shall be accepted by the Director prior to the review of the request as speciil '~)'i@!&Il~ lo.w, ~ '\ I Appilcation submittal , -I ~ Acceptance of this application, written statement and attachments by the Directo UlL demonstrate By ~-.JC\-D1 compliance with this standard. 5. 'A concurrent Minimum Development Standards or Site Plan Review Application may be required. A concurrent Site Plan Review Modification (Type II) application has been submitted in accordance with the standards contained in the Springfield Development Code. 6. . Before the Director can approve a DWP Overlay District Application, there must be information submitted by the applicant which adequately supports the request. If insufficient or unclear data is submitted by the applicant, there is a good change that the application will be denied or delayed. The applicant has attempted to provide clear and complete data to support this request. If additional infonnation is required, the applicant will submit it in a timely manner. This revised submittal includes a complete HMMP and Hazardous Materials Inventory Statement (HMIS) as conditioned by city staff in their Notice of Decision letter dated May 30, 2007.. 7. The application fee, In accordance with the current fee schedule, the applicant will submit a check for $957.00,.at the time of Tentative Site Plan Review. The review fee was submitted to the city at time of original submittaL 8. A copy of the deedto show ownership. A copy of the deed is included herewith, A copy of the deed was provided at the time of original submittaL Conclusion The applicant recognizes the importance of spill prevention and safety/security measures necessary to minimize negative impacts to the drinking/ground water supply, Throughout the construction phase, wellhead orotection silms. meetim' Sorimdield Utilitv Board's (SUB) standards. will be oosted as recommended bv SUB's wellhead orotection staff. Construction documents will address approved and unapproved construction activities to avoid negatively impacting the drinking water wells. Also to be addressed on construction documents will be the requirement that Dense Non-Aqueous Phase Liquids (DNAPL's) are not to enter the site either via construction materials, heavy equipment orconstruction vehicles. ]u~um~] By~'2q/D1 "", -~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION I: FACILITY DESCRIPTION Site Address 110 International Way Subdivision . Springfield, Oregon 97477 Lot Assessor's Map 17-03-15-40 Tax Lot 100 General Information Business Name: PacificSource Health Plans Address: 110 International Way City: Springfield Primary Contact Person: Wayne Neal Phone:: (541) 684.5449 State: OR Zip: 97477 Phone: (54!) 686-1242 Title: Maintenance Specialist Emergency Contacts: Name Wayne Neal Title Home Phone Work Phone David Tillett Maintenance Specialist. (541) 895-2749 IT Infrastructure Services Manager (541) 607-1664 Human Resourced Director (541) 505-8923 (541) 684-5449 (541) 684-5240 Paul Wynkoop (541) 684-5257 Principal Business Contact: Ken Provencher . Phone:: (541) 684-5286 Property Owner: PacificSource Health Plans Address: 110 International Way City: Springfield State: OR Zip:97477 Phone: (54!) 686-1242 Principal Business Activity: Insurance Company Number ofEniployecs: 275 Number of Shifts: I Title: President & CEO Hours of Operation: 7:00 am - 6:00 pm Declaration: By Signature, I stilte I have authority to sign this application as vested in me as the property owner or as delegated to me by the property owner, that I am the responsible party and will be held accountable for this application, and agree I have carefully examined the complete application and do hereby certify all information herein is true and correct. Signature: ~j?;JL Date: ? /2-7/01- I Print Name: Kenneth P Provencher Title: President & CEO (Must be signed by owner/operator or designated representative) ~~ [lm TI I!) F] ~~11'-D1 J 8', General Facility Description/Site Plan SEE A TT ACHED SHEET: ~~~~~m~] R --- By \ / "- 111_7 ij/~ '~-~"S "'~~ - ~ '-L- ______ __ _ _ ,\ -~ ~-,- -~'.;~- ----- \\\~, F.Y-- . ______~---- )v~;; "'- , N . ~ -'- ~ ~:. -~~/Y --- =-----------7 /./ /- --- ~ /' ,;/ -;:?; -~ - - - -- ----:>~0;::;:: - -- <>/ ''>:I /' --,', .----- -- ;:--..J i-"-:.-. ->-,~'::~'--- --/~--T- ~ " .----- ~....., I ~'- ., '-."...... I , ~ ~-- - -- ---'r:---- (----;== . / '.,,:\ \ \ ( / ,,\ \ \ I " ., \ \, \, ,--:---;.--_/ r, ""'~, \ \ -....\ "'- \' \ I I , \ ~,\ \ ' :;---~\ ~~~ \~ JJ~ I ..... II I ,1:/ !'" v I II ,( " ,,--;7""',,1 ''----_ ...._/---l~~t-...:._...:.: . ~ , < @ ~:::RALL SITE PLAN - ~ 1 ! KEYED PLAN NOTES: '0. TRENCH AND BACKfILL AS REOUIRED TO INSTALl CONDUIT. TYP. REMOVE AND REPlACE EXISTING POROUS PAVEMENT SYSTEN AS REQUIRED. SAWCUT EXISTING PAVEMENT, AS REQUIREO. REPAIR All DISTURBED CONDITIONS TO MATCH EXlSTlNG VERIFY ttRMlNATlON POINTS WITH CI'M<lER (1)" - EXTEND GRAVEL ROAD TOPROVlDE FUEL TRlICKACCESS o - Sl...A&FLOOR DRAIN WITH 'COWS lOUNGE' OUTFALl . ! ~ . -=:..1_ ~ " r I ~ , I" I' , . I I \ J~I v -y- " h T-2" I F- G) GENERATOR PLAN ~,,~-- ool:lN.5CllU"I-........... r~~ ~ '31.0 T.O.Sl.A8 "'" W[TAI,.SCRaN ~ t ~.~ ft....... RET_lNGtl.o.u. @ ~::ERATOR ELEVATIONS DOOR & DOOR FRAME SCHEDULE OR. I DOOR NO. MTL TYPE GLASS I lo:;o.o:JUTOIl 1-- 1-- 1-- ROOM NAME '" ~ 16'-2" " ..../ fA'.. --.& ~ ",j. ;:~_"~...r, -~ ... '"I I .' ~ _0- ~{- ~f e " . "-0' "-0. I I "~fi " .. . " . ~ ~ 1 i I ! u ! ~ I Vl ~ U OJ I c: ~ 0 .c :;: u .!!! ~ ;;; <t ~. ~ '" "'C .. =- .. 0 ., ~ 0 .i.i 0 :it ~ .. ... ~ .. .. c: .c .. VI " " , .. u 0 ;;6 ~ CII " .... .tG; 0 ... a CII .. ~ .c .. 0 u .. 0:: 2!! ll. ~CqSS Sl"-"l -'" @ l~l>J.SCll((N ACCtSSSTArll ;~~n",-..... t "'"" , C_nn_n"n FRAME NTL I TYPE m HARDWARE GROUP RATING COolant ,.u.......c WALl . " . . j .. COolOlEltll(1.s-..~- ---~-----:~---~ , REMARKS z <( Z-, <(ll. -'0 ll.<( Wll. !::o: VIa -'f- -'<( <(0: o:w wz >w a<o z w W 0: U VI 0: VI az f-a <(j:: 0:<( w> Zw w-' <Ow DOOR AND DOOR FRAME SCHEDULE GENERAL NOTES sttS(CTlON0l!I7100l'ftO(SPEonc...TlONSfOllH.ulI;IWNl(GfIlOUf'UST"C:S.....:lSPEOFlCAnONS. _""'Tl(lNSNl(ASfcu.OlIS: HOl.LOor\ltT>J. STl sltn. ~ ~ o " ~ I' ~r~DW~~ 8' 81-Qt By Facility Map c, .. SEE ATTACHED SHEETS: Al.O (FIRST FLOOR PLAN) AND A[,[ (SECOND FLOOR PLAN) ~~@~Dw~r}I' Jl -- ~ 8y 2/}.1~Ol -0 ~ I ~ E . . e t G'; A .~- ~, E ~ i I ~ ! e t (0 (C) '" (C) (~ r;i;) r (0 ~------}f-----~------~-, , , I: " , .' , ' -_i1.....~.,,~~~i:...,.., <\) ~~:...., <\) :..\ i -. t_71;r' ...- I~ f-@ ,[ .-- AA~ '" I I @ I (7 1 /P '; ri;) " I T~ .~ I I ~~ Oc:::::J I ..L~""~r....~J~.....~..... . I . 1'-10./'2' 11,_lC,. I tJ':J , 1 ., ~ ~ "..,.. ..,~".... ~.." '''-01/'' i ~. 'p L :r r lr-4l/~ W-I1I/"- ""'" Dill . 00 r_r .....1/<.. ".... . ,,~ ""'" Dill T . , . """ ~@j'0..lD-.1JjjJ I "~~\ , , . ~ " ""'" Dill , 1,J'-IOJ/4-::- 1 ~ ""'" IJjjJ 0#-41/'. E$) ~ r~ h . -- om q ~ 't_ !...v.. ~ ......... Dill _,'_,01<<;11 .." -~ !Jill U~f/" """""" = l:. ":,llOCTlr(.~;: < ClliJ ~ - = [!!!J o ..'~ ,- I ~1IOM 'f I [ffi] rl-I"- 10 ~ · 1'-'01' "-""- -t~ - ,- 1: ~ I I . 5"-5 11l'1 I 11'-1 lIT ~~- d.;: ~ ~ -~:.:.. t ,~".. ~~ ..,..1", "'I" -~J -~ "-~~I 1..) , I ' . r.F.\I. 1 ~ 1~i ;;; ;0 t,P ~ - -" I 100 " -,~ <.:.> ..sf.o..I1 f'D:;' ~ "'" ~~ _..~1''''1/4 1 t"J .., n 1 ~ 1 ; i~ 1:. IUS DID -@::-"-;;';-I; ~' ..~". '-D!IJ;Jj' . 1,0~ @!j'l@j,DIDI 'N'-.)J/." ~;.:jy '!! ~. I~o!!]~ '1 UI !! !; ""'" ""t ~ :." I !-.".-, ;A) . I D I ",_'v' ~<- 7--\ ""I:": I:",,' J,,~ ~~ 'm' ):. -.- .;: -El~iJ,~-,,* f--~;,r '" 1 ~ J~.~.::~...~ ----r 0 .~ 1 0ID'~1<Vj "SOJ'\i-ror: 19[-(1) '--~~ -r:'-'''~ ,,~v"<:::f~ : ~ ~_ ~~*. DID ~:$-.;:-r-~~' '-;;:.;:-~~--- _ :; _ ,[,:1> 1 ,CRl 0- tmJ ~ ~ 4'-4 vrl e Z $ [illJ ~..I mo l' "'~~ )~".... <i~~0".... ~~.:_=r "-""- "4"'"_, .~ i 0 <D ~j @ (# ~iiJ ~@ !. 'N '" ~.' ----1-, s..:.to vr - I ~ "@t _ ~ 1 ~ 1~4. ! ~:. ~ _. [1ID I I' : =j,P :. f 1.--4 t--j I "i."",,~.... I 1-~--- ........L:~;:.~:'...bP' ....,,+7* ~---@""-+"--"---- 'Cm.__"_~l__"m.r' 'if 0 ~" - ~"'~-"="'-'!'::::::~-~--f~~:c~~~':~~~~:~~~ > ~ I 4;t L~mh_hm_ d-----l 1 ~-' -n-_n_:_nnn___L_________:. 1 ,: ~\os~t~ ~ @ ~ ~ l----~~----~---/1 ~ --------J '" o ~ ~*. , DEl --I".. "_11/4" ~r .....v.. ~f ~ o 1 '" (C) FIRST FLOOR PLAN @ A \~_1:0,: 1/8""'-0" KEYED PLAN NOTES WALL TYPE LEGEND 0~CCUlltll-1IO @ ~~~MO"""~rrr=,~~~.."-q"rwtw ~ """"'-""' @lUUIftlA/<<<J ([) IOUIfOl/4Oll @lUUIlOC/t/1O ....-- ...,.. ~HII[ IllFM%.or-.(N01[:~..u.I MIl: llN.l TW(" u....O') 0~ 0- ) 1/rtlCflll nos ""ro.c. _ItrC'PSJIIllN.llOoUlOu.ol ~ towtlllll(f'~_~ -.N\'1VJ'JPf:ol 1Ml.l._IOIN[~cr~onx-. WI.LS"""TIIII[~1tlllOAnlO4'ftl1lCIO'l1lJIlor1M:n..o<lIt,/IlCa' (IEClCtK,lU......\I[--..:wTOUfI'lB..A'l...O::CIIlOC.x or_ A$SOOly.llOUtlUiQlOlIE7\LC1UlCD..RtOf'VINfUI~,"",T"'TTAOl 101NI:~CIP"~CItl:K.FU_0l.,,",,_AOClIJS'1lC.N,. 1ICSlLA-.........'.........,.AS~ 11!r'lIl(I'lIln.osAYM"o.c:._III"'G'lI"SUIlllN.llOoUlOtotOlsot III ..-,' JJF. 0..0.. IWJ.'~ (N.ft;Nu.1t MU) 0""""" 0- rcT.III.P.I:l$A'lro.c. _1M Itr~ -"'_M SlOt. 10 lOTfOItor~___ _lOJlPI:o. llN.l_JOM~or~lltOl__ -U1llol'NlLlOICIIAtmllO"nACMftllKlOtlI:IWor1M(~ D(aC"UIU.tIA\I[IIIDUOIl(JUH'tQ....TI..Qe(lllQO[Ia[OI'1M[ ~T._llUOlQlIU\LCftD<UJIfIIl'lNlfUl-...uW400'.1T_ :.:::~~~=:::I1\mCAWTT.'"~ 10" WT/Ilsn.os A' M" 0.(, .1tI-.o' DViJMl!1. AT 14' OC,:__ ~~G'lt'UI_~==-~~~~~AO< ~~~~~~1:I\.(JCA"TT.TI1~ o lUllIa.oocrM:ll.,,~r-....flWII!:_~_ ~ 0~1t.CICM:__~"MI__~ @ llO'IIDsCXlHCllltTt......lIO~_"SflIl[.TU'IOII:~.TH IICUAIXXT fl.OOIIl'lNG€$. ~', . @ NQOlfATlCIlCOlTUl IlUDllOSfIO:IIlCA'b:;IlSfI3III~ ;" o r-.cp.uc.s. _lO$l'(On(.fl~fI3IIISlza. @ ~z.~)l.A\'tM$i'W"c;rr.;IJOlllO"llOlO(.OOl_rJl-.uA' 0- 0........ ~:J (V <1> @ E ~ C') ~I E E z < '" ~ ~ @, ~ ill ~ ] <6 ';L1 ,.() 1 By A1.0 10 0) I (C) I l ..... 5'5 " 1 ~ 8 :~ l'il'l5 . . ~ tr-l".. ~I~ "J"" . I "1_ I1J1il I o 8 8 8 .0 ~ L '------~--:iL-{:?'>-f l ' "'-"~ ~I ..::l=~ ,"~ ~_. _L__' . 'I ~' Cll!J ftC 15'-0" . I<DL6'-"HQl'AlU~ - I 0~ I .rt-lV,r; _ llATA I f7'-.lJ/~ I o Lr..... (]:!!!] "-ll/~ 1"-'11""'1. ff-7V'" 0'.. I ' _Mi. -;.i) U.....J/ IE' ~ -+ a...-s . . lEI [l;!I] I ~__~I I <,;t I I I I I I I I I I I I _~PJI <t~~-_ "-ol/~ ;1" ~ 111'-41/"- - - , -~ '~ It . I -0 T SIll I . "_U/~ ~ I ~ S'-U31/t'f" ~I I ._~ ...- <'; ~ [;;;;:] <'; tI'-4I/'" tt1-t1IS/1J1J" <D- I ..___, :"'~+~- <'; :n'~7 JI'" ""'" lEI a'-21/'" :~,},~:,,~~~~~: .' l..~.. "-<9-r-~+.. ...~.i ~ ~ ~ SECOND FLOOR PLAN A \1';~./ l/a-~I'-o- KEYED PLAN NOTES 0----'IIIl o g:as~_""".1€::a':~~~~rt-o"'- (D'IUliIl-..cl(rM%.OfOMT-.L_II1II-.c._ o 'IOIn.ulM: -..ora l11li Gl'QlMl.['~ IWUAC1IMEIt. Ii' _CIlItCJlnI:.....fO~_fJlfSTllME-.r:fOR~_ \,:J .wu.o.coa f\.OCIt -.:s.. @~...'II\lIl~IlI7OtIQ..:ancA_RllltI2D. (!)r...-e'olMIl..S.liOtIII01f'02'lCA_fllIIISItt1 @l'IlOWIt(2lLAootS5/1"lM'SUoI~ro[.A()(Sl)(fJIf-..u..s..., VMl.T~ :> c' T ~ ~ f" ',~ I (f~ ~--- t -- -T- -- ,..- ........ " J I I I I~C.,~1=-=- -~,dL~...., 10'....1/... \ i n,lM 113'-IJ/"'''' 11".r '$. , \ /1 I';' I==- I r-l J/"- . ""'" 'r' I I lEI .""", ~ U!D j' _ (E -~ '00' r" ~ :w '''_7 lIt" -1____" -- r ([1 "f/ i o r I <2.. I ~ Ir~~~:"'~, <'> } ~-1J/'" ~ - ..~ ~ ~ (;) I'ili5 ~ --........ @] s ..- CIID l0. 15'_1" J . ~ (,J ~,~ ". I~ G) _~I 1.....'--.. . S 0, , ~ , . , :~ ...~" ..... 0-1.. -'L__~_ . ~ . ~ ~- []ill ..... o f ~. ~-----... -c.::,~. ~ ~., ~ , ' ~ . T ------' -..\- -.-- " ~.. i r~-::hJ ~.: \rl:~I~-:t- I __ t'-oJf~. UEJ U A, t-@ : ~ ~ rEl ~<;r ,,~,,~ I . :~. YiID D .1V;~ I K'-oS!~ _ 0'fICI:.' I rnD [E!] "-oJf~ DID /1. 7 C'I r- t.. I i .<::11.....''''' ,.~-;~~~t- L___'" aID I J~ ~ ,... ~- ll!!.I I tl'-'S!~ .'ZW - C1ill - [jjjJ -~-- ';V.- "-' -.,." ~ Qill s 1 L 1 -G.L---'; . 2/ ~ ~. J t'liD~ <$ .....S!4" --- -- rEl ~---~" ;'1 R. -." "~"I -'::!~~-- ---- --~-~ . 1 1 '7'-..vr -1'":.:.:. = ~~~ l~" ""'" ~ Ili!l :s IICI'....J/~ ~ 1 - , ~ 0'fICI: 0 , rna I'~"~~', r"'''4" ~ "" ~ .....JI.. . ~ ~~IIY-{ A """," ..--_-~~ l-_~l . '.dJ:' ..-<!:>-~ .. .-.. I I . (\ L,----~- ---..., I '- -' I ...---------J..__. I I I. ~ ~ 1.1........_~-----1.l 1 -------....~ o 0 @ c0 0 -~ ~ ~ IZ _[~-:__, ~ ...... - C1ill. ~ .......V4" - rEl I5i!5 ;'---1 .O..-----<-~'" ~ ~ WALL TYPE LEGEND .--......... -- ...... __ Nfl. III ria. 01'....... (M01E:;..- wu.s Nfl. wu,,1"II"I!: "UJl..O.) <D IVUI to AI_ <D ~'~~~~~cr--..MJ.IOMUUGllIClt. <D IIIiIIIII:III <D =:'':T':~1m~':~~~~' 0'__ CItl:JlawJ.""""~~AT..OCOMClN[.x(lf'M: ;:;::o::.~DQJ<. ~":==-~- 1IStl.A1lCIIl.-'TIlUtJlM7AS~ <D --.... :O'~I~-r.~:u..";.~(r-1DIIA~~IOMUUGI-..: <D D!!IlEm ..w:T....Pm ATW (LC. _ ttr C'lPSUr wu"."..., UGI alL to IC/f'RIlIfSl\.IXIIl,,4IIl)nt-.;A8O\€. . . .......lOf'ofII:O'1IIU_1lI'M:~(lfI'\.OOlVlllOOl'iXQ("lllM. WIWI~TNIIl._1UlII)A"A04lO'M:~OI'Kfl..OOIVlloar ClC:JC1tWLHA'<I[IIIES.IEKT~Aftroe(llOlCtDtOl'_ A$SOI&l'.fID1JI,IUOlO~Cltll.MPl.JIMfOII-.u1HATA1'fN)l lO_~fS~oo:x.f'lLSlWCAIm'.IKAD:Il.mlCIt. -.....___TIIto'Il.MlT...~ IG"IIlnN.SNDSAf.Wo.c. _IIDlDTOIAMCI.Af WOI:,OIE_ :C~~.~.~__~,~,A"~~_~~,~ '-, ., _-.0",_" .,. __t_. (!) 1VU11O~_ <]) 1VU11O C/<<1O (i) 8 8 :z .. -' a. '" o o ~~wn~1 <6rll- Ol ;y A 1.1 SECTION II: HAZARDOUS IhATERIALS INVENTORY STATEMENT SEE ATTACHED SHEETS ] ~ @ ~ ~W ~ : ~/1.1-D1 IBy , Address: 110 International Way, Sprinqfield OR 97477 , Page: 1 / 1 Contact: Wayne Neal, Maintenance Specialist: (541) 684-5449 Product Name Manufacturer Hazardous Hazard UN/NNCAS Max Volume Storage State of Material Open/Closed NFPA 704 Ingredients Classification I.D. Number Stored/Used On-Site Temp/Pressure Gas/LiquidlSolid Use H/FIR ** * lbs/gal * Compleat HTF EG Premix Cumrnins Ethylene Glycol 4.5 107-21-1 N-1-4 Liquid Closed 2/1/0 (Theylene Glycol Based Coolant) Filtration Diethylene Glycol 111-46-6 Petroleum-Based The Valvoline N-1-4 Liquid Closed 1/1/0 Lubricating Oil Company Paraffinic Mineral Oil 64742-54-7 Chevron Phillips Alkanes, C-14-C16 90622-46-1 Diesel Fuel hemical Company, L Distillate Hydrotreated'Middle 64742-46-7 (Low Sulfur Certification) Distillate, Alkylate 64741-73-7 Naptha, Heavy Catalytic Reformed 4.5 64741 :68-0 850-gallons A-1-4 Liquid Closed 1/2/0 Kerosine C9-C16 8008-20-6 Solvent Naptha, Heavy Aromatic 64742-94-5 Distillates, Hydrotreated Light 64742-47-8 Distillates,Hydrotreated Light Paraffinic 64742-55-8 * See Attached Tables ** Refer to attached plan for location of chemicals stored *** Material Safety Data Sheets for all Materials Attached NOTE: Materials containing DNAPL's are prohibited on the property. All new products/materials are to be reviewed by the SUB Water Quality Protection Coordinator prior to use. !uum~J \) "'.., r\., Code I 1.1 1.2 1.3 1.4 1.5 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 5.1 5.2 6_1 6.2 6.3 6.4 6.5 7.3 8 9 Hazard Classification Codes Class Class A Explosives Class B Explosives Class C Explosives Blasting Agents Insensitive Explosives Flammable Gases Nonflammable Gases Poison Gases Flammable Liquid (FP< 00 F) Flammable Liquid (00<FP<730F) Flammable Liquid (730F<FP<1410F) Flammable Solids Spontaneously Combustible Material Dangerous When Wet Reactive Material Combustible Materials Oxidizers Organic Peroxides Poisonous Materials Etiologic Materials Acute Health Hazard Chronic Health Hazard Pesticide Radioactive Materials Corrosives Misc. Hazardous Materials \~[! @~TI ~~] &-:nol ~ @L_-.---. Code I A B C D E F G .H I J K L M N o P Q R S 'Codel 1 2 3 4 5 6 7 Storage Codes Type of Storage Aboveground Tank Underground Tank Tarue Inside Building Steel Drum Plastic or Non-Metallic Drum Can Carboy Silo Fiber Drum Bag Box Cylinder Glass Bottles orJugs Plastic Bottles or Jugs. Totebin Tank Wagon Railcar Other Dewar Temp/Pressure Codes Storage Condition (Pressure) Normal Pressure Greater than Normal Pressure Less than Normal Pressure (Temperature) Normal Temperature Greater than Normal Temperature Less than Normal Temperature Cryogenic Conditions W[i!~nW~ l ~ --,j.l-Dl ,By SECTION III: SEP ARA TION, LJNT AINMENT AND MONITORING Storage Area Identification (as shown on site plan and floor plans): PART A - ABOVE GROUND STORAGE AREAS (1) Emergency Generator Enclosure - Fuel Tank (per site plan) (2) Maintenance Closet and lanitorial- Housekeeping.Products (per floor plans) I. Storage Type: X X Original Containers Inside Machinery 55-Gallon (208.2 L) Drums or Storage Shed Pressurized Vessel Other: 850-gallon, double-walled, above-ground fuel tank Safety Cans Bulk Tank Outside Barrels 2. Storage Location: X Inside Building (cleaning and janitorial) X Outside Building (fuel) Secured 3, Separation: X All Materials Compatible Separated by 20 Feet (6096 mm) Other: One Hour Separation WalllPartition Approved Cabinets 4. Secondary Containment: Approved Cabinet Secondary Drums Tray Bermed, Coated Floor Vaulted Tank X Double-Wall Tank (Fuel) X Other: Plastic bins sized to contain the volume of the material stored within the bin + 10% 5. Monitoring: Visual Continuous X (janitorial and cleaning) X Other: Fuel tank monitored electronically and visually by owner Attach specifications if necessary 6. Monitoring Frequency: Daily Weekly X (housekeeping materials) X (fuel) X Other: Engine Coolant and Motor Oil (maintenance closet) Attach additional sheets as necessary t~~D~~~ By S~.}l-Ol ~ SECTION III: SEPARATION, ~JNTAINMENT AND MONITORING PART B-UNDERGROUND STORAGE AREAS SINGLE W ALL TANKS AND PIPING Tank'Area Identification (as shown on facility map): N/A 1. Backfill Vapor Wells ~ Model and Manufacturer: Continuous Bi-Monthly Testing: 2. Groundwater Monitoring Wells 3. Monthly Precision Tank Test 4. Piping- Monitoring Method: Frequency: Other: DOUBLE WALL TANKS AND PIPING Tank Area Identification (as shown on facility map): I. Method of monitoring the annular space: 2. Frequency: Continuous Other: Daily Weekly 3. List the type of secondary containment for piping: 4. List the method of monitoring the secondary containment for piping: 5. Are there incompatible materials within the same vault? Yes No If yes, how is separate secondary containment provided? Note: If you have continuous monitoring equipment, you shall maintain copies of all service and maintenance work. Such reports shall be madeavail~ble for review on site, and shall be submitted to the fire prevention bureau upon request. Attach additional sheets as necessary ill~unu] ~ -::n.._____D1 By SECTION IV: WASTE DISPO~nL Discharge to the Sanitary Sewer - Wastes: Pretreatment - Wastes: Licensed Waste Hauler- Wastes: Recycle - Wastes: Other- Describe Method: Wastes: X No Waste SECTION V: RECORD KEEPING Description of our inspection program: Daily use/inspection of cleaninglhousekeeping products and/or monthl>: inspection by maintenance staff on products stored within the building. Weekly inspection by maintenance staff of the emergency generator, enclosure and assembly. We will use the attached sample forms in our inspection program. X We will not use the sample forms. We have attached a copy of our own forms. ~ ~ ~. ~ ~_W ~ ' m J, ~.'J-l-01 ' By SECTION VI: EMERGENCY-~..,PONSE PLAN 1. In the event of an emergency, the following shall be notified: A. On-site responders: Name WaYne Neal David Tillett Title Maintenance Specialist IT Infrastructure Services Manager Phone (541) 684-5449 (54]) 684-5240 B. Method of notification to responder: X Automatic Alarm Manual Alarm ' Other: Phone Verbat C. Agency Phone Number Fire Department: 9-1-1 State Office of Emergency Services: Other: DIAL 9-1-1 IN THE EVENT OF AN "EMERGENCY OR SPILL" 2. Designated Local Emergency Medical Facility: Name McKenzie Willamette Medical Center Address t460 G Street, Springfield OR 97477 Phone (24 hours) (541) 726-4400 3. Mitigation Equipment: A. Monitoring Devices: Toxic or flammable gas detection X Fluid detection Other B. Spill Containment: X Absorbents (fuel tank) X Other: Double-Walled Fuel Tank and/or plastic bins For materials stored within the building. C. Spill Control and Treatment: Vapor Scrubber Pumps/vacuums Neutralizer X X Mechanical Ventilation Secondary Containment Other: Manufacturer-provided spill containment kit 4. Evacuation: X Immediate area evacuation routes posted Entire building evacuation procedures developed Assembly areas preplanned Evacuation maps posted Other: rn~ :,:~_:; 1 By ! 5. Supplemental hazardous materials emergency response plan on site. Location: Office, room #100 - southwest comer of the building on the first floor Responsible Person: Pan Long and/or Wayne Neal Phone: (541) 686-1242 SECTION VII: EMERGENCY-.&:SPONSE TRAINING PLAN t. Person responsible for the emergency-response training plan: Name Title Pam Long and/or Wayne Neal Safety CommitteelMaintenance Specialist Phone (541) 686-1242 2. Training Requirements: A All employees trained in the following as indicated: X Procedures for iriternal alann/notification X Procedures for notification of external emergency response organizations X Location and content' of the emergency-response plan X Awareness of the facilities proximity to sensitive drinking water protection area X Drinking Water Protection Information Training/Preseniation ** "SUB Water Quality Protection Coordinator Amy Chinitz(S41-744-374S) - contact for presentation/training B. Chemical handlers are trained in the following as indicated: 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: X Procedures for shutdown 'of operations 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. A more comprehensive and detailed emergency-response training plan is maintained on site, Location: N/ A Responsible Person: Phone: NOTE: A limited number of personnel will be involved with the storage, operation and maintenance of the emergency generator. These staff members are the only ones that will be trained in operating and inspecting the generator enclosure and equipmcnt, as such they will be responsible for emergency response and weekly inspection of the generator as described in this HMMP. The remainder of the staff within the building will be notified of the hazardous nature of the generator and its associated products/chemicals. Wellhead protection signs have already been installed in two locations on the site to better inform staff and visitors of the importance of reporting and cleaning up any spills. ~~ @~BW~ ] ~ ~)..l-ol By PacificSource Health Plans, Springfield Oregon Emergency Generator Hazardous Materials Inspection Form Instructions: 1. Use this form to inspect ermergency generator enclosure, tank and oU and coolant materials within the building. 2. Contractor will inspect the tank & enclosure weekly during construction, with PacificSource staff providing the weekly inspection after construction. 3, PacificSource staff will inspect the maintenance closet and stored materials within the closet monthly following construction. 4. Evaluate the.condition of the tank, enclosure & maintenance closet-checking for leaks, odors, etc, & for items listed below to ensure safe storage conditions. 5. Report any item needing corrective action to Wayne Neal (541) 684-5449, Month: I I DMe: I I Area is free from leaks and or spills. I Tank/Enclosure I Maintenance Cioseti Appropriate emergency equipment I (spill kit) is in place. Tank/Enclosure I Maintenance Closetl All chemicals are segregated. I Tank/Enclosure I Maintenance Closet I All containers are properly labeled. I Tank/Enclosure I Maintenance Closet I All containers are closed and sealed. I Tank/Enclosure' Maintenance Closetl Secondary leak proof containers were inspected and no damage noted. I Tank/Enclosurel ~ ,.:... ~'~~tPn"~losetl Notes: 1'< ~. = Problems Detecte~ll: G'iiiJ I Resolution: I; (X'\ lo3) I :II~ 9: I -=zJ1 I ~ Iru1J --t } I I I I I I I J I I I I i I I I I I I I I I I I I I I I I I I I 11 21 31 41 5 61 71 8 9 10111112 13114115 16117118119120 21122 231 241 251 261 271 281 291 30 I 1 I I I 1 I 1 I 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I i I I I I I I I I I I I I I I I i 1 I I I ! I 1 ! I I 1 1 I I I I I I++++- I I I I i I I I I I I I I I I 1 I I I I I 1 I I I 1 1 I I I I I I I I I I I I I '/ ,,..,. ,I~ HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION I: FACILITY DESCRIPTION SUe Address 110 International Way Springfield, Oregon 97477 Subdivision Lot Assessor's Map 17-03-15-40 Tax Lot 100 General Information Business Name: PacificSource Health Plans Address: 110 Internalional Way City: Springfield Primary Contact Person; Wayne Neal Phone:: (54l) 684-5449 State: OR Zip; 97477 Phone; (541) 686-1242 Title: Maintenance Soecialist Emergency ContactS: Name Title Home Phone Work Phone Wayne Neal Maintenance Specialist (541) 895.2749 (541) 684-5449 IT Infrastructure Services David Tillett Manager (541) 607-1664 (54t) 684-5240 Human Resourced Paul Wynkoop Director (541) 505-8923 (54!) 684-5257 Principal Business Contact: Ken Provencher . Phone;: (541) 684-5286 Property Owner; PacificSource Health Plans Address: I to International Way City: Springfield State: OR Zip: 97477 Phone: (541) 686-1242 Principal Business Activity: Insurance Company Number ofEmp!oyecs: 275 Number of Shifts: 1 Title: President & CEO Hours of Operation: 7:00 am - 6:00 pm Declaration: By Signature, I state I have authority to sign this application as vested in me as the property owner or as detegated to me by the properly owner, that I am the responsible party and will be held accountable for this application, and agree I have carefully examined the complete application and do hereby certify all information herein is true.and. correct. Signature: ~;/.;tfl Dale: ? /'[7/01- , Print Name: KetUleth P Provencher Title: President & CEO (Must be signed by owner/operator or designated representative) ~~@mJ~: ~L, g~.?:~.:DI .!-, F" General Facility Description/Site Plan SEE ATTACHED SHEET: i~@~~W~~ < R - - ..J! b" ~)7.{) 7 ' l....L-..m I f ;/ / I ! / / I I , " ". (--"" \ '. \. '~ " " "- , , \ ----- ~/ ---- '. \ \ "'"" -,~, " ) --~-~- _-1- ~- ( 1-- \ I \ I \, I I , ~ ~m @ ~~:RALL SITE PLAN ~ . ! i ~ . KEYED PLAN NOTES: 0) . TRENCH AND BACKFilL AS REQUlREO TO INSTALL CONDUIT _ 1'(1' .RE.MOVE.~O REPl.ACE EXlSllNG POROUS PAVEMENT SYSTEPJ AS REQUIRED. SAWCUT EXISTING PAVEMENT, AS REQUIRED. REPAIR ALL DISTURBED CONDITIONS TO MATCH EXISTING VERIFY TERMINATION POINTS WITH OWNER 0' - EXTEND GRAVEL ROAD TO PROVIDE FUEL TRUCK ACCESS CD . SLAB/flOOR DRAIN WITH 'COWS TOUNGE' OUTFAlL v -~ :' ,J'I '-~l:) ~ HI; J~" ~F' (j) I' e . ~ ~- i~-~ I~r~~'- , I I , @-/ , \ '" U , " -I /:[ 15"-2- , "'...':-.' -""4~ " , I I , -< "'. - -,g, @ l~:,:ERATOR-PLAN ~ @ "01lTH l.!(lAlSCllEEN "'"" , . J Aca:S:>SlAll! j"'n LV_"'-"" I ~_l;"h+ L _ _ _ _ _ _ _ _. _ ')- ~,~,CREf!; n _'NeWAll ~ , '0 "" rOlETOJ..SCRECN , . t ~.~~n",-"" 1;:'0.., _I :!I ,~~'" 'm~'~' -.~\-j - -- - - - - L --11 , , '. """ RrTAlNINCWAll /2\ GENERATOR ELEVATIONS ~ll...r-<l" DOOR & DOOR FRAME SCHEDULE ., ROOM NAME DR. DOOR FRAME HARDWARE NO. ;..elL I lYPE GLASS "" I TYPE GROUP RATING "^ ~ . " I I I REMARKS ~NOl"'Oll DOOR AND DOOR FRAME SCHEDULE GENERAL NOTES SET SECTlOOl M7.a OF fl<( Sl'f:orrc""OOIs r(lll HMlOWAA( GROUP usr"GS ANO SPEOflCAnONS l. ABSR(\oAnONSAA(ASrOllQWS HOllOW..(TAl SR STEEL \\J " li 11 a ~ j u I ~ '" ~ U Q) I c: ~ 0 ..c :;:: u .!!! ~ ;;; <( b ~ .. -0 ~:;' .= -- 0 ~;!; li 0 ~~ ~ ~ '" '- ~ OJ " c: ..c " U'l C> C * " U 0 - ~ 1Il .>i!l => ... g 0 '- " 1Il OJ H ,g ,Q 00 u 0 '" a: ~~ "- z '" Z Z -' '" a. '" '" -' 0 0: a. '" u '" a. '" I- 0: '" in 0: 0 0 Z -' l- I- 0 -' '" '" ;:: '" 0: 0: '" 0: '" '" > '" Z Z '" > '" '" -' 0 '" C> '" . ~ i N 0 . 0 ~ , ~ , Ar @ ~ U \l) ~ J ~'17,[)7 (31-..__ Facility Map SEE ATTACHED SHEETS: AI.O (FIRST FLOOR PLAN) AND AU (SECOND FLOOR PLAN) ~ ~ @U\TI~ :1 By~~l1-{)1 <C.l '" <C'l re, ~ (~, \~ _ Al.O _______ "f' L....---- ----, i ....1 e!--1 , , , , , , , los: 0 ......L....Y-......,,' '" r:;) T (H) T I ~ (i T ~) \t (o\, ,( (f I I i~) i ~ \.2) L J - ~~ . 'I'-l,tr' ~'-. 1/2" '1 . I ~r @J: ~~'"'' <l> ..1.. <l> <-r 12"-4.10" """ 13'-'0"<:;. """ [ill] DEl ~ <'> , I ,1.. <l> .L~...., L I T P <l>,..:..:~, ~:: ~-o 1/0- -;1~ ~$LOEJ t~ ~ '<~'-If y i5~:f ~ Dill .; <l> <l> <l> <l> <l> <l> <l> <l> <l> <l> "i", t"". ......1/..1 10'-111/0" 1'-10 lIT 32"-cr 11'..... ""'" Dill < , ~ o i. ~~ , , T . ~ """ (fill 40'_41/0' € l I ! ~ . S HoOU....y DEl ~}~ -'l\~: (j)-lJi , , ~ 0- , I~~ I ., . -- [ill] , ;, , " 0' ~~ ~ Dill <~ ~ - Dill 1-"_1'_ - U'-e'I'" " . llOCTAL stR...a:s;: :-, [ffi] ~ ~~ ~ = -0 ~. '/2" ,~ -.sllllA!DC = 1I"-IItr c:::::J ~~ o:ill .. 1-1"_ "" ~ , 1'-;;;i.it>~U:w.4il ~.-J:~,{' IUU-....y ~ J"'!O~;::;:\ m;J <l> i T_~ 1/'" I <-"".\ I tjV:;.'; ...' <Dt cd ~<15t.W ~I-~ - n~'0 ...:::- c J :; ~ 1110 ftC-" T'l'P ,'-.3;0" ~ 1$, 1/~" I I -0 -1~:--~~---~,~~ ,-;" non I - ~ (~', \ i:C~ ~ ~0' Dill" I . / Af -'~H"-A ~ WN.l- 0- -r~- t I . , -fk~ (2, '''' , . ~ o 5 7 . f 3'-13/.... ,1 (,) , . I t ',' ~'I [jj[J , . ,~ -~~ lJE] A -~- ~ ~ffi";;" ~PI.JrII 14"-33/." s ~ ,- Dill (.' 1 Jl1-1J/'" ~~@-y .' -~~.. -~. '3M . L.. ""'HIQl, . . -.u, '.. ~1'-';3/'-2' I '1'-41/4 s ~ [illJ s <l> ~" DID , ~ 4f .1 --'} , s ~ ~ <l>~ ~ <l>IJ' n ~@?f ~, ';'i" ---:! ~. Jill --'-'-Ill c:r;:p ~~ -;::-- i ,.-, "'" ; E~ 1 ~ ~ ~~lIAT [00 ~DiD ~ I <: og[] .m!J" .. ; I f;" .';. " '------------j.10 ,..., il.~ ~. ~ - -~,.~~ iii I" ....~ n MAl. - II ~~l~~+Lr~...; 1 . , <l>' L.!l!!!..J I I [E[J J llll."__ rouT ~ ~" ~ .t: 1 ~00ll<<D · 1 '''', @] ~ 1@][lli]I"-"-, J .~ r:; '<!Y~ ." 1 0j , ~ ' '" : 1m"""""" J ",Jht: ,~, -, "" _ ~ I ~ --1-. ;;:BIIIl: W"\ ~~ 3: v';'/. %~. I! 15 I '.. I '~o=-...."""""",- I ~........ l"'-r............. _ .. i! I :.::. m I {2, ~:'::);:.L, r ~ _, ..... j~-Ll-Lr'-,.. :::r:,. ~ !I I ~::. DEl ~ l L~r-@""'./Z!.' '" _A.. 1H' i:. : 1'l I I - l:'. ,r-t'1 ,.'-03/."' "0 ~ FijP.;)-~';:I:;n=cr' - j ~ I ~- I 0t=' ;[:' II! \--!-r--L~~Rl', Co,; ___uo ":';~~~~J,_L'n_. _W-@tDID" -, I"'........ ......,...., ,.. ...............'I.~.... 'l-0-/....,~ ' 'L---C;"-"~l__l___:i" '"------"-<!)-"--"--- '~ '" ''''I'' ~ [ill'1l ,,'---=-"':""~"'""----J' ;___J ------ - : I . ~ - -t . \i:----- .:. I mo..\f\te.n ~(\( e... ~ l~____________ _______, i~ f~) , -------------------L__ c.,\os~ +1 J 4l l--<~- ------~-->/r ! ,--- ~j \:;) ~ (0 ~ (::) (21 (8) CCJ (1i) 0- ~ ,,-, l1'_Zl/." """ rm:J ts'-31jr '~4.! 10'..... _. DEl ' ~ il W....3/.. ,(1'-4'/4' ,.'-111/.- ~fu .~ ~ or-""'_I~ ,~'i] ~ I Dint ~~~:0-~;\';";L~~~' ';' ---- --- " - = l"-ll/r ~M , I: ------ J / --- r , L .'.J / A '; \A1.0J "............. FIRST FLOOR PLAN @ 1/8""'.0" .' KEYED PLAN NOTES W ALL TYPE LEGEND 0_TIOlCtUlIUl-T8lJ o :SS~~'Tr~--<::C"~~~'~~<Fllaol -, ..........., 0J1Ut11tTO~/'<<J (DlIUOITOl/olOll (DJlUtlltTOC/olOll Il1IIIllIl....l 0M0l9Of<SME TOrAlXOF"-.{ltCITE: IN_~Nft. ........llP(I,U.N.O') <D~ 0_ .., "1lET"'-S'lUlS~T'''o.e.lIlnt$/I.C'l'I'SIJIl.''l.l.~EJD<5IDLTO lIO'mlIlOF"fLO(JO;~FRNollNCiI8O'oE. -.o.IlTOllP(o. -.J._1OlHElIOmlUOF"F\.OOIII..-oc:rllECK~ ..<US nu.TNlE.OE$Ool~lUl TO .TTAO-l TO TKlIOmlUOF ~fU)OII/'I'IOOl' PECK !HAU.H~\oIEIIESIOENTCtl-e.~T I'. OCCJ'l ON( ilID!:OI' M ~T. 1I[1OI000000Tl:Iouu:l;tU)<<J...MIl'VIIf"(>>I-..u.s1H~T~"""" ~n:.~~~:fX~S1UD CA"TYII,,:!,A(;(IlISl>CN.. Ul" U(T.... sn.os ~T I'- o.e. lIlm -.oIT Ctl-e. ~T ... oe. ONI!: ~ AIel S/I" t"rPSUIl-.J.IlOMO (AQ<:!lIDE. .TTAOI Tl:IIIOTltIoIOI'f1.OOI'I/'I'IOOl' OK:!( 0II0'0L JI(f'(lt ALSO 10 IlUlLClUleu.l'tGl"l.N(f'l:II WAI.l.S nt.T~"""" TO 1HE8OT1Ool OF"F\.OOI'IjRO(J'Ol:(X. ruS'lW CA"TYllnt.o.car.;lICAI. ~T\OIt.~"'USEJt.AllTAS7'[OFlED. o o 'oUIlf'T.ou:o\oIE~lIlntOPDlAlll(I'MmKIN"Nf.JfAC1\OlOI. -' ]1/2.IlCT....Sll.DS.'I..o.e._S/I"C"IPSlJIlW#l,l8QNl](AalSD:. TOIIQT1OIlOF"fLO(JO;...-oorF1'l.O.lM(:~ SUJIIIIllTll"lA.WAU._T01HEIOTt1;I.IOFnooll/llOOrOl:CI(AllO'L WAU5 1H~T /rIlE lIESIQl.lUl TO ~TTIl(:H TO 1HE IlOTTt'loI OF" lHE FI.OOII/IIOOf" !XCK$IlAllHA.\oIEIIIOIl.oo'Ctl-..,I'.OCCJ'lON(SlD(OFlHE A$SD8.T. NFUI olUo TO II01..EelUl COl.ItGft.NI FOI w.ou.s THAT ~"AOl TO ntElIOTT!:II OF"n.tloII/IlOOf"otCK.fU.STUO CA"TY.1I1 ACOUSllC:AI. t<SI.A.AllCIN........y~TASSPEcIFG. ]1/2"IIET....sn.os...'I..o.e..1'NS/I"C'"'-'Il."l.l._UoOlSlD( TO.._I./JF. (Loww..u.PMTITlCIl) (....TDI'Wt:1lO.2) 0_ 0~IAC:lCrN:%0F"0JI\T","-.J.f1UoIl(.1'N-.J._ o o o o o DEPfIESS (;(IN(;IIl(''I[ LOe TO AllOW 1'0' or STOH( TU: ro.: ftlJSH lIlTH ~~...... 0~^'~ PIIE$OIT.'lCllCO<IUl.II[1OIT05PECIf1CA1lOHSFOI$l2ES. F"lIIICPNtEl5.It(I'tJ\TOSP(CIllCo'o'ICIISf"(>>Isrns. PftOWlE (2l U\\'UIS S/1I. C'rI'$UllIlOAAO TO UO< SIll( OF".'<us ~T V.o.ll.T2lI2. t'.J (0 o ~ € ~ C3) (.1) E E z -< ~ "- GO '" ~~@~~DW~J R :, - ~'J-1'Dl ~y A1.0 8 8 8 <2 G ~ r-- I I I I I I I I I I I I I , A \~1}/ ~"-"'." I..-".M^L"-' ---i:El- ,. , .,.-"':----, i, .___~. .---:'-' ":-__-, . .~, ._~ ~ __, J1 ~~L ."'........~,..' ...., 14".d'i~ I ,.~= ,"-<!)-..I t-<V-J i ~ .1 _J L-0-'" '"-(9.'" '"-0-'" . "- I J ... -l- ... ~. i , i ,) to'> \.,/ J 0f I' 01 <l> <l> <l> <l> o ".. -=!:!..-- II \\"-i U:;.: ~ II.... 6]!1. IX-73/.:&vr- , ~' @-l: i i =-~ l)liJ o o ~~ft.Oal ll'_l" LY4 : ,.._w....u. "_71f"'0' 0- :~~~ = , . 0i 0j ...- []ill <l> ,,:rr '!'" ,'_," ~~N.:.~ --'0 ~~t400........ ,.~"." :-1'. "'4"" ---:- "@..,-ij- -0 ~ T 110 . .!.'-'3/~ :t <t'5'_i5Ul~. ...- = ,-,~ .~- <!> <!> i.-<9-~ I cb , , (1" \iJi _/ SECOND FLOOR PLAN 1/8-01'.0" KEYED PLAN NOTES 011ECO"'l1<>>10CUltDHllD CD _"'SS~~~'":~~~~~.'-o"~ o o o <;) __ IN;Io\,.a. llF aIOIT~_'II1M -.l.rH:lH. ~~~.THOPEIU8..EPNlfl1'Klll".tflIJf"ACIlJlIIOl, llD'IlIE$S~sueTOH..LOW"""o..5lllNETU:lOlII(fUI5H"lM -.::u<TR.OORfINSK;$. I'lII($!JIT,,_COI1tK.lID'DITOSPl:CIfICA_Sf'OllSlzo. 0F~PNe.S.Ilf;FEJITO!PtCIfICAllON5f'OllSllES- 0~:t8<i)LAlUtS'tre'l'PSl.lolllOAROT\)[,t.Ol5lOE:llF...w;.r r;:' T ~-.h 'j' Jt ,.... ~ ~ -t i=@n;;-- L ~ aID" 0~,'10L"_"H:::l-<D_ . J lr_,v," I DATA . ~' If_I 1/'. . I . ',-.=----,/~ 00 I' ...- = ~ ". - ~ <met '01[ r:1]E] ~'-"l :!: .). '""".-:. -'1 T -~~ II , , , , h , ~ ~~' ~Uill $-''''. ~ ~~".. ! " ~___~,. IZ ._fY:T ':_. ~ r---' ~ <1> ..C,~ ,,,,",,";.= ~ ..-.._~~ c~~ ..-q)-~ ~4-~! -- _e_~===-~~~_ : - ~ ~ ~'9 I I ---iU )"" '\V (0, \'(' I I Ct) ~ ~ T) C'j r Co) 1 --'-----_ 11 ('1'- -"1 Ii II I I I '==-",,-,-=<k~ <l> J lT~I/2. <l> <l> <l> <l> <l> o <l> <l> (1) <1> ..~~.- 'I U'_2' 12'-"3/'.' 1"-1 V'. CFna: ~ m!J J"-e" ~~.~/'.~: ~YA.r~ I .'-il1j.. ;.!. LmlI 011 '__V, 00 I'~: h, , '7 .:. I~ I Qill ~4' Tr,~ N; 1'-_" - ).--,=;. .; H' ~_~" '" ""l::,:@ im-~ j~ ~ ." -"~-- "~ b ~". l ~ aIDT c- ~~'t" != 't_ ~rT --T~::,~~: - ~_.:-1T ~ (to:,! 2 PI c'iEJ- II n:e pm: " k ' ~ri~,~ " t~":!t I j ~ .0.4.2 0;!1 11"_, 1/'" I ~ /0. ! .:.:...,. 1 24'_' .)/t" r ama: ~ \ I [2] L_i,-.., I ~ ,.~".-I,~"IT"I\R~ I _ / ~-- -~'- ~~ f "-4'1~~Y J 10'-93/.. llal~~ 1l...t.....J 111"_,11/'"1 '"'""I't""/Tl :~/ ~ : I c~~_~~_, j@.~ ~-"- ;':;i!"'" n~ m ~4 , ~ I ; ~ ~ []ill -~"""'" = 1"_" (,J- 0'~ ':P 1..-- 0. "'-71/'" 1~_7" ll'" ,---t-,,-~ t ' - @ - -- [~~..i_ _~__ , /, --t I I crmT I I -~ = ~ . , , o 0- ~ $ , -w .r , , It""" 1:_-=--' I -- [lj!] 1'-'3/...1 h ~ "-'0'/"_ ~ . I. ; ~0--01 --- -- tEJ , I I /,' \C/ " .~ 'IT~:; "4 V.' [~I_:~W~~ ,+"" .-- " L,----------, I '-/ I r--------_.L..__ /.\. .... ~.) --- (1 * ~ (t--~-----2 d)-- ,~ , ~ _,.r.- .l-.~'~_ WALL TYPE LEGEND ~""IC tm:BaL.:Il.U.S_Nltt.1V'M:(lFfHSH..(lf01[,IlIlDl1011..IU.$Nltt.ao.u.mo(:..U....O.) (1)llO'tIllOA/4OfJ C[) IlO'tIlTOI/OOO CS> IlO'tIlmc/MJIJ (;) (;) ~ 1/2.1oIEl'.... SYI.(l5 ~T'" o.c. ~ '/II"C'l'PSl.lM WIO._UOISIIl(. 1l)lOm;IlfTfLOOlI~~~ -...o.lITOm>'EA. ........iIIIJIorlOlHIEllOTl\:lIIlaFFl.Ql;Jt/l'!OOF"OEO<,o,aa,(. llAU.S mAT .<.REOE$IIGIlA\m lO.l.1T.o,011V 1lE:lOTTOlIlF THtflOOll/l'!OOF" D[Ql91AllHAYEflOIlllXTOlAMt[L...Tl."OCONOl\IE$ID(OfIHE ASSOOIl:r, IIO'DlAl5OlO~lmQJl.MCl"I.NIf'l;IlI.AU.SIH"'T"'TT.t01 T01HEIIOTlOoIlFFl.OCIIIfltOof"lXO<.~$1UOe.o."'lT.lH.o.coustlC.fl. 1II$lU_.APPI:r$E.Ol.N(TASSPEclFUl. ',/1.OI(T....snm.T'..a.c.~,/fi"~.AU._tAO<SIOE ml'_'" AFr. (LOWIUQPMllnQl)(I<(.IUIICA1(HO.l) 0- <D~ ~1I[T""'Sl\.CSAT'''o.C..lH5.trC'l'P$l,llol.,tU._(.t,(HSlOC.l1J 1IOl1OII000f\.OaI't/ROOf"~N!IfN<. -.o.IIlOT'Il"!:D. aou_ro1HElIOnowlF!\.OQlltllOOf"DtOl__ WAlLS 1H,o,'Nltt.OE5ICN"1tD 11) AnA(>< lO TK ",now Of" IHEFUlOIl/flOOF DEOCSWLHA'o(lIICSU;1lTCHANtEl.....'...OCOHOl\IE!ZI[CFlHE A,$SOoIllI.Y. llO'ER AlSO TOlUUCfUlcn.tG l'UoHf'OIIllAU.S lHA'.l.1T1DI TO lHIElOTlaI OFflOOIlfllCXFOI:Ck..fU. SlIJIl Co\I<<Y.TIIAa;1l.r.;TlCAl. W$U...O._..........V$E.OUOlTA$SPl:GWlED. lITWET....snm...' ".o.c. .1IlllllCSl.nTCtWtMn"'11"oc,o<<!ZI[ .o,IG5/8.~.H..l_[.o.Ql:llO(....TTAQ1lQlIO,.",..aFnotII/flOOF DEOC~--...,..,. .,.'_.... -"_",,,,"_' 0- 0_ \' r' i <> ~ I "'-",," -bill ~ ~ t :~ 1:1"_1 5/'"f <1> ~ ~ I ~, _~ ,~<l> !0 -- [;ill ~ I f.\i ,-l' ~ If ~i t W-73/" 10 I , ;0 ~ , @ 8 CD i<e> @ ~ o 8) z '" -' Q. 0: o o -' "- o z o J ~@ ~ a ill ~~ UL Z<ll;bl JJ By -_Al=1 SECTION II: HAZARDOUS MAI'ERIALS INVENTORY STATEMENT SEE ATTACHED SHEETS ffi ~ @ ~ Bill ~] By g'd-.1-01 J ..-...- . . HAZARDOUS MATERIALS INVENTOR'r STf\TtME'T Facility: Address: Contact: PacificSource Health Plans 110 International Way, Springfield OR 97477 Wayne Neal, Maintenance Specialist: (541) 684-5449 Date: Page: AUQust29,2007 1 / 1 Product Name Manufacturer Hazardous Hazard UN/NA/CAS Max Volume Storage State of Material Open/Closed NFPA 704 Ingredients Classification J.D. Number StoredlUsed On-Site Temp/Pressure Gas/LiquidlSoIid Use H/FIR .. * Ibs/gal * - Ethylene Glycol 4.5 107-21-1 N-1-4 Liquid Closed 2/1/0 Diethylene Glycol 111-46-6 N-1-4 Liq uid Closed 1/1/0 Paraffinic Mineral Oil 64742-54-7 Alkanes, C-14-C16 90622-46-1 Distillate Hydrotreated Middle 64742-46,7 Distillate, Alkylate 64741-73-7 Naptha, Heavy Catalytic Reformed 4.5 64741-68-0 850-gallons A-1-4 Liquid Closed 1/2/0 Kerosine C9-C16 8008-20-6 Solvent Naptha, Heavy Aromatic 64742-94-5 Distillates, Hydrotreated Light 64742-47-8 Distillates,Hydrotreated Light Paraffinic 64742-55-8 Compleat HTF EG Premix Cummins (Theylene Glycol Based Coolant) Filtration Petroleurn-Based The Valvoline LubricatinQ Oil Company Chevron Phillips Diesel Fuel hemical Company, L (Low Sulfur Certification) * See Attached Tables , . ** Refer to attached plan for location of chemicals stored *** Material Safety Data Sheets for all Materials Attached ~ ~ @ ~ UW~ ~I B 8,l1~Dl J y-- Code I 1.1 1.2 1.3 1.4 1.5 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 5.1 5.2 6.1 6.2 6.3 6.4 6.5 7.3 8 9 Hazard Classification Codes Class Class A Explosives Class B Explosives Class C Explosives Blasting Agents Insensitive Explosives Flammable Gases Nonflammable Gases Poison Gases Flammable Liquid (FP< 00 F) Flammable Liquid (00<FP<730F) Flammable Liquid (730F<FP<1410F) Flammable Solids Spontaneously Combustible Material Dangerous When Wet Reactive Material Combustible Materials Oxidizers Organic Peroxides Poisonous Materials Etiologic Materials Acute Health Hazard Chronic Health Hazard Pesticide Radioactive Materials Corrosives Misc. Hazardous Materials ~~@~U~~J ~JJJ'01 ~ Storage Codes Code I A B C D E F G H I J K L M N o P Q R S ~y?e of Storage Aboveground Tank Underground Tank Tank Inside Building Steel Drum Plastic or Non-Metallic Drum Can Carboy Silo Fiber Drum Bag Box Cylinder Glass Bottles or Jugs Plastic Bottles or Jugs. Totebin Tank Wagon Railcar Other Dewar Temp/Pressure Codes , Code I Storage Condition (Pressure) I Normal Pressure 2 Greater than Normal Pressure 3 Less than Normal Pressure (Temperature) 4 Normal Temperature 5 Greater than Normal Temperature 6 Less than Normal Temperature 7 Cryogenic Conditions ill u ~ un II g,:J-l;()1 :.~'/ SECTION III: SEPARATION, LJNTAINMENT AND MONITORING PART A - ABOVE GROUND STORAGE AREAS (I) Emergency Generato~ Enclosure - Fuel Tank (per site plan) (2) Maintenance Closet and lanitorial- Housekeeping Products . , . . . (per floor plans) .. , Storage Area Identification (as shown on site plan and floor plans): I. Storage Type: X X 2, Storage Location: X 3, Separation: X Original Containers Inside Machinery 55-Gallon (208,2 L) Drums or Storage Shed Pressurized Vessel Other: 850-gallon, double-walled, above-ground fuel tarik Safety Caris Bulk Tank .... Outside Barrels Inside Building (cleaning and janitorial) X Outside Building (fuel) '-', Secu'red .'.. ' All Materials .. Compatible Separated by 20 Feet (6096 mm) Other: .. One Hour Separation WalllPartition . Approved Cabinets . . ",\! J "." ." ,;',1.. :',,' ,'. ..: .~: I'.. .' '.i " 4. Secondary Containment: X Approved Cabinet Tray Vaulted Tank Other: 5, Monitoring: X X Secondary Drums Bermed, Coated Floor 'X' --- - Double-Wall Taii8,rFuel) . ........ Visual Ganitorial and cleaning) Other: Fuel tank monitored electronically and visually by owner . Attach specifications if necessary " /; .: J.:lf"' :;.,. li':'t T,:. Continuous .'1 .' f: :~"':.' ' !: d. 6. Monitoring Frequency: Daily X (housekeeping materials) Other: . .' . ..... , ";.:!.: , " Weekly;" - (fuel) , ;/,. ~ ,~ ')1' .' X -. '. . Attach additional sheets as necessary ., . . < f . ., ." ',' I j' JI:j,:!" I' t. ., ~~~~Hm~~ g-1-1-DI By SECTION III: SEPARATION, el5NTAINMENT AND MONITORING PART B - UNDERGROUND STORAGE AREAS SINGLE WALL TANKS AND PIPING" Tank Area Identification (as shown on facility map): " N/A' '. ," , ~ ~. , 1. Backfill Vapor Wells -. .. Model and Manufacturer: .:il. Continuous Bi-Monthly Testing: 2. Groundwater Monitoring Wells 3, Monthly Precision Tank Test -. 4. Piping - . ~ I' , Monitoring l\iIethod:" Frequency: " ~ ,;1 L:~. Other: DOUBLE WALL TANKS AND pjpING' -.'..: Tank Area Identification (as shown on facility map): ~ ".; : :r: "',:-:1 ': :(;..::,"\.;. 1. Method of monitoring the annular space: 2. Frequency: "!1~'"/ rv.l. '.").; ,'I J:'i. ". .~.,." . J". ': 1 .:..~;r'h.....: Continuous , ,. _ . , . 'f'--'" Other: ". . Daily" Weekly Iii I.. 3, List the type of secondary containment for piping: 4. List the method of monitoring the second;J-y containment for piping: , .': I.. ._ 1..' . 'i" J .~. ( ."- S. Are there incompatible materials within the same vault? Yes No If yes, how is separate secondary containment provided? " ./':." Note: If you have continuous monitoring equipment, y()u shall maintain copies of all service" imd maintenance work. Such reports shall be made available for review on site, and shall be submitted to the fire prevention bureau upon request. Attach additional sheets as necessary ~~@~OW~J ill --- - ------ By ~/').1/D1 SECTION IV: WASTE DISPO~__L. x Discharge to the Sanitary Sewer - Wastes: Floor drains within Janitorial and maintenance Closets to waste system. Pretreatment - Wastes: .T.: , . I", . ~". / Licensed Waste Hauler- Wastes: r 1:,:': , Recycle - Wastes: Other- Describe Method: Wastes: ,. No Waste ---- - ...- --. . !('" . SECTION V: RECORD KEEPING , ",-. ~P <... "::: :, .J-' 'J, -.,.j -i' I~ ;-.... ;.! ',.. .... ;. ""1' " i _,,'r,J, -(; . , I.' ~.. .,': ,. J Description.of,ou~ inspection program: Daily use/inspection of cleaninglhousekeeping products by maintenance staff on products,within the building. Weekly inspection by maintenance staff of the emergency generator; enclosure and assembly. " '., . '0' ~ @ ~O ill ~ ~ ill - - - --- 1 ~ ,]1/()1 x We will use the attached sample forms in our inspection program. We will not use the sample forms. We have attached a copy of our own forms. _._+---- -. - --.,. ... -.- -.,.- . ..-.-- ._L_~! : ::. ' , .' ; ....' ..tH. . :_f",," :'!D; \; :' '" ! t - ,,-...:- ...-, "_'.;:'. ~.; ,,~;!:. rJ~'.~:":.~: _..~'I.. ;, ",'" .~ ';', ;';','.. ~; . J " f ,; . ".;:',',' By ., .l,":II',',1 ." j f _ '.. :;;", .:~!, " .! " I ' ., ' '.; d:JJ ~ .r --- .,~) -- - --- .' :j:i ,;. .!i;). I;~ ' '. , ....: hi: "", ,,'; t. ",'. 'r .Lfi'. I," ': . ..1/"~; . _,C.. SECTION VI: EMERGENCY-liliSPONSE PLAN I. In the event of an emergency, the following shall be notified: A. On-site responders: Name Wayne Neal David Tillett ^.;, Title Maintenance Specialist IT Infrastructure Services Manager Phone (541) 684-5449 (541) 684-5240 I .1' B. Method of notification to responder: X Automatic Alarm Manual Alarm Other: Phone Verbal .. ,", c. 'Agency Fire Department State Office of Emergency Services: Other: DIAL 9-1-1 IN THE EVENT OF AN "EMERGENCY OR SPILL" Phone Number 9-1-1 '" ... I . " . :. .~. "'~'.l.' . 2, Designated Local Emergency Medical Facility: Name .' , Address'" McKenzie Willamette Medical' 1460 G Street, Springfield OR. Center 97477 '-";(, .. "Phone' (24 hours) . _''''':(541)'726-4400 ,'r";. . 3, Mitigation Equipment'" A, Monitoring Devices: Toxic or flammable gas detection X Fluid detection Other " ','J.,. .' i', .. 'j~".r }_,.,:' jO '!' ., B. Spill Containment Absorbents X Other: Double-Walled Fuel Tank C. Spill Control and Treatment Vapor Scrubber Pumps/vacuums Neutralizer X X Mechanical Ventilation Secondary Containment Other: Manufacturer-provided spill containment kit 4. Evacuation: X Immediate area evacuation routes posted Entire building evacuation procedures developed Assembly areas preplanned Evacuation maps posted Other: ~~ ~_~.D_~_ ~ II lill J C """"'_-t {}-I--I-Ot I \ ,By 5. Supplemental hazardous materials emergency response plan on site. Location: Office, room # 100 - southwest comer of the building on the first floor Responsible Person: Pan Long and/or Wayne Neal Phone: (541) 686-1242 SECTION VII: EMERGENCY:1~SPONSE TRAINING PLAN I. Person responsible for the emergency-response training plan: Name Title Pam Long and/or Wayne Neal Safety CommitteelMaintenance Specialist Phone (541) 686-1242 2, Training Requirements: A, All employees trained in the following as indicated: X Procedures for internal alann/notification X Procedures for notification of external emergency response organizations X Location and content of the emergency-response plan B. Chemical handlers are trained in the following as indicated: 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: X Procedures for shutdown of operations 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. A more comprehensive and detailed emergency-response training plan is maintained on site, Location: N/A Responsible Person: Phone: NOTE: A limited number of personnel will be involved with the storage, operation and maintenance of the emergency generator. These staff members are the only ones that will be trained in operating and inspecting the generator enclosure and equipment, as such they will be responsible for emergency response and weekly inspection of the generator as described in this HMMP, The remainder of the staff within the building will be notified of the hazardous nature of the generator and its associated products/chemicals, Wellhead protection signs have already been installed in two locations on the site to better infonn staff and visitors of the importance of reporting and cleaning up any spills, By ~/'llDI ~ PacificSource Health Plans, Springfield Oregon Diesel Fuel Hazardous Materials Inspection Form Instructions: 1. Use this form to inspect ermergency generator enclosure and tank. Contractor will inspect daily during co using 2, Evaluate the condition of the tank and enclosure, checking for leaks, odors, etc. and for items listed below to ensure safe storage conditions. 3. Report any item needing corrective action to Wayne Neal (541) 684-5449. Month: I I 1 2 3 4 5 6 7 8 9 10 11 I 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 291 301 31 I I I I 1 I I I I I I I I I I I I I I I I I I i I I I I I I I I I I I I I I 1 I I I I 1 I I I I I I I I I I I I I I I Date: Area is free from leaks and or spills. Approl?riate emergency equipment (spill kit) is in place. All chemicals are segregated. All containers are properly labeled. All containers are closed and sealed. Secondary leak proof containers were inspected and no damage noted. Notes: Problems Detected: Resolution: OJ l.----,...--.. I ~'---' uJ-.. "9 ~ ~ , C> -...\ I , ' \5C.I @ = 8 @ 'J l.