HomeMy WebLinkAboutApplication APPLICANT 4/17/2009
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City of Springfield.
Development Services Department
225 Fifth Street" I
Springfield, OR 91477 'i
Drinking wafer Protection Overlay District Development
Applicant Name: I
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1
Carolyn Duquette, Executive Director
US Oncoloqy
.
I Fax:
683-5001
683-1422
Company:
Address:
520
OR 97401
IAOOlicant's Reo.: I
Icompany: I
IAddress: 1
Loren Berrv
I ~hone
I Fax:
485-3970
485-3402
Berry Architects
,
460 East 2nd Avenue,
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OR 97401
I Property Owner: 1 Tamara Miller
Icomoanv: 1 PeaceHealth, Property & Planninq Div:
IAddress: 1123 International Way, Sprinqfield, OR 97477
I I TAX LOT
ASSESSOR'S MAP, NO: 17-03"22-00 NOeS): gw. .t.tID2-
I Property Addres~: 3377 RiverBend Drive, Sprinqfield, OR 97477"
I Size of I Acres 0
Phone 686-7198
Fax: "
984-4215
[zoning:
I Existing Use:
I
lI:1edical Services
I .
lI:1edical Services
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If you areJilling in this form by hand, please attach your proposal description to this application.
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Description of VYillamette Valley Cancer Center to be constructed on exi?ting vacant 5th Floor of
ProDosal:, RiverBend Pavilion buildinq,. '
ISi natures: PleasJ siqn and rint your name and date in the a
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Associated Cases: t.::ffT'1 ~7 -()();r8'o &:. ..7'--' I
lease NO.:.tll2chs-OQ-VCX:JIS' I Date: 'I-( /1'7/ 09 IReviewed bY:~_~
IAPPlication Fee: J IO?O .00 I Technical Fee: $ 'r:; (.00 I Postage Fee: $0
. TOTAL FEES: $ ',10'1 \. Db I PROJECT NUMBER:
uate KeCelVea:
APR 1 7 2009
C riginal Submittal
Revised 1(15(09 ddk
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1 of 5
Signatures
Applicant:
The undersigned acknowledges that the information in this application is correct and accurate.
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(J"" k J~ ) ,Du...u.;flt?5' Date:.t11 f b ~ 0 I
Signature (J
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(!t1A-/J ~ j "" ~ "9!'~
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If the applicant IS not thiile owner the owner hereby grants permiSSIon for the applicant to act In his/her behalf.
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M1~k ti [)CJ- L-~ a-... - Date: 4/1 G /00
Signature I I '.
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Owner:
Print
__~ark H. Dahl:J1!'!Iar~ E. Mille.!........ .
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Date Received:
,
APRi' 1 7 2009 .
Original SUDmitt~1
Revised 1(15(09 ddk
2 of 5
DWP Oyerlay District Development Submittal Requirements Checklist
NOTE: If you feellan item does not apply, please state the reason why and attach the
explanation to this form,
[gJ Submitted Concurrently with Site Plan Review or Minimum Development Standards
applications, where applicable,
[gJ 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 Services
Department, The applicable application, technology, and postage fees are collected at the
time of complete application submittal.
[gJ DWP Overlay District Development Application Form
D Copy of the Deed (See Narrative)
D Copy of a Preliminary Title Report issued within the past 30 days documenting
ownership and listing all encumbrances. (See Narrative)
[gJ . 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,
[gJ
[gJ
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 '12" by 11" outlining the applicable
TOTZ boundaries in relationship to the property boundaries
Three (3) Copies of the Following:
[gJ Use of hazardous materials that pose a risk to groundwater that existed on the
property prior to May 15~ 2000, if applicable
[gJ 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 b'e
considered equal to one .gallon)
[gJ List of chemicals to be monitored through the analysis of groundwater samples and a
monitoring schedule if groundwater monitoring is anticipated to be required
[gJ 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
[gJ 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 .
[gJ Proposed Hazardous Material Management Plan forlt~le,faejlit:y.~hat,jl'1dicates
L (iLe "'''''''V':>U. .
procedures to be followed to prevent, control, collec I anJ'dispose of any unauthorized
release of a hazardous material
APR 1 7 2009
Revised 1(15(09 ddk
4 of 5
Original Submittal
~ Description ofthe procedures for inspection and maintendnce 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
Date Received:
APR 1 7 2009
Original Submittal
Revised 1/15/09 ddk
5 of 5
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
"f'!INQFlIl1., ~IirI",'
Wii'." .
C' 'If Springfield Official Receipt
D~. dopment Services Department
Public Works Department
RECEIPT #:
1200900000000000273
Date: 04/17/2009
10:58:58AM
Paid By
LEE CONSTRUCTION
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 9961 In Person
. Payment Total:
Amount Due
1,020.00
51.00
$1,071.UU
Job/Journal Number
DRC2009-000 15
DRC2009-000 15
Description
CTY Drinking Water Protection
+ 5% Technology Fee
Payments:
Type of Payment
Check
Amount Paid
$1,071.00
$1,U7I.UU
Date Received:
APR 1 7 2009
Original submittal
cRcccintl
Page I of 1
4/17/2009
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CITY OF SPRINGFIELD
VICINITY MAP
DRC2009-00015
3377 RiverBend Drive
Riverbend Pavilion Bldg - 5tb Floor
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Map 17-03-22-00
Tax Lot 4102
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RECEIVE)
APR 1 7 2009
By:
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Willamette Valley Cancer Center
at RiverBend Pavilion ,
Drinking Water Protection Overlay District
Development Application
Narratiye
Applicant:
. US Oncology
520 County Club Road
Eugene, OR 97401
Representative:
Loren Berry
Berry Architects
460 East 2nd Avenue, Eugene, OR 97401
Phone: (541) 485-3970; Fax: (541) 485-3402
Iberrv(ci)berrvarch.com
1, land Use Reauest
The Applicant seeks approval of this Drinking Water Protection (DWP) Overlay District Development
Application in support of the project to develop the Willamette Valley Cancer Center atthe RiverBend
Pavilion, 5th Floor on the RlverBend Medical Campus in Springfield, Oregon (hereinafter referred to as
"WVCC").
The WVCC in Springiield, Oregon will be a medical services facility to be located on the 5th Floor of the
RiverBend Pavilion at 3377 RiverBend Drive. The RiverBend Pavilion, owned by PeaceHealth was
previously granted Site Plan approvai (DRC2006-0059) and DWP Overlay District Development
Application approval (DRC2008-00072). In addition, a copy of the deed and preliminary title report for
this property was previously submitted to the City as part of the Site Plan approval process for the .
RiverBend Pavilion by PeaceHealth. This Application is limited to the US Oncology development and
operation of theWVCC on the vacant 5th floor of the RiverBend Pavilion.,
Springfield Development Code (SDC), Chapter 5.1-125 establishes Type I review of the DWP Overlay
District Development Application. The Application includes this narrative and all supporting materials
consistent with SDC; Chapters 3.3-200 and 5.4-105 and the DWP Overlay District Development
Application requirements.
2. Prior Use
The DWP Overlay District Development Application requires identification of past uses of hazardous
materials on site that pose a risk to groundwater but existed on the,property before May 15, 2000. As
described in previous PeaceHealth submittals, the prior property owner of the PeaceHealth RiverBend
Date Received:
APR 1 7 2009
__1--
Original Submittal
Drinking Water Protection Overlay District ,Development Application
Willamette Valley Cancer Center at RiverBend Pavilion
Anril R 2009
Page 2
property commissioned a Phase 1 Environmental Site Assessment (Omnicon Environmental
Management, May 21, 2001) to Identify potential environmental exposures on-site. The assessment
found that the site has been in small-scale agricultural and rural Jesidential uses, and that past uses have
posed no demonstrable risk to groundwater.
Sorinafield Develooment Code. Chaoter 3.3-200
Springfield Development Code (SDC), Chapter 3.3-200, Drinking Water Protection (DWP) Overlay
District, sets forth procedures and standards protecting the City of Springfield's groundwater resources.
SDC, Chapters 3.3-210 and 3.3-220 establish Time of Travel Zones (TOTZ) within the City and areas
subject to the provisions of SDC, Chapter 3.3-200. For the subject site, the footprint of the PeaceHealth
RiverBend Pavilion property was overlaid onto a digital file taken from the City's adopted Drinking Water
Protection Area Maps to illustrate the applicable TOTZ in relation to planned Improvements (refer to
Attachment 1, which was previously submitted with the RiverBend Pavilion DWP Application).
SDC 3.3-220 Time of Travel Zones
The WVCC in the RiverBend Pavilion is located within Tax Lot 902 and both the 1-5 year TOTZ and the
5-10 year TOTZ cross this taxM. The boundary line crosses through the RiverBend Pavilion building
itself. SDC, Chapter 3.3-220 C.3. states that for tax lots covering more than one TOTZ, regulations in the
more restrictive zone would govern. Therefore, the WVCC is governed by the more restrictive provisions
of the 1-5 year TOTZ established in the SDC. .
SDc 3,3-225 Review
This DWP Overlay District Development Application is required when criteria under SDC, Chapter 3.3-225
A.1. and 2. are met. Since the subject site previously had agricultural and/or rural residential uses and Is
now proposed to house a medical services building, the change in land use meets criterion A.1. Although
no use, storage, or sale of materials associated with the property's use will pose any risk to groundwater,
the proposed use will result in an increase in the quantity of "hazardous materials," which the Code
defines as "those chemicals or substances which are physical or health hazards as defined and classified
in Chapter 27 of the Springfield Fire Code..." Because the nature of the use requires materials that are
so classified in Chapter 27 of the Springfield Fire Code (SFC), the proposal meets criterion A.2.
Having met criteria from SDC, Chapter 3.3-225 A.1. and 2.. this application is therefore required.
Application requirements outlined under SDC, Chapter 3.3-225 D. are addressed below.
1. A Hazardous Material Inventory Statement and a Material Safety Data Sheet for any or
all materials entered into the Statement unless exempted under Section 3,3-230 of this
article. Hazardous material weights shall be converted to volume measurement for
purposes of determining amounts - 10 pounds shall be considered equal to 1 gallon as
specified in Springfield Fire Code 2703.1.2;
An inventory of hazardous materials is included in tabular format (Hazardous Material Inventory
Statement) in Appendix A of the WVCC Hazardous Material Management Plan (HMMP), which is
included with this application. Material Safety Data Sheets (MSDS) for each material or product listed on
the HMIS will be provided in electronic format.
Date Received:
APR 1 7 2009
Original Submittal
Drinking Water Protection Overlay District Development Application
Willamette Valley Cancer.Center at RiverBend Pavilion
Aoril 9 2009
Page 3
2. 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;
There is nO need for ongoing groundwater sampling and monitoring at the WVCC because no products
containing DNAPLs will be used or stored on site, and there will be no releases of hazardous chemicals
into the environment that could pose a risk to groundwater quality.
3. A detailed description of the activities conducted at the facility that involve the storage.
handling, treatment, use, or production of hazardous materials 'in quantities greater than
the maximum allowable amounts as stated in Section 3.3-235 A.;
SDC, Chapter 3.3-235 A.1. establishes quantity limitations for hazardous materials within the 0-1 year
TOTZ. No portion of the subject site is within the 0-1 year TOTZ; therefore, the above criterion is not
applicable to this project. . .
4. 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 or sanitary'
sewer;
WVCC will provide secondary containment for hazardous materials to be stored at the WVCC in
accordance with the SDC, Chapter 3-3-200, which incorporates SFC 2704.2.2 by reference. Secondary
containment provisions for hazardous materials and applicabie personnel training are described in the
HMMP.
5. 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 attached HMMP describes the procedures for protection, control, collection. and disposal of
hazardous materials, including any unauthorized releases of hazardous materials.
6. A description of the procedures for inspection and maintenance of containment devices
and emergency equipment; .
The HMMP outlines the procedures for inspection and maintenance as required.
7. 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
t,ansportation and proposed routes.
The attached HMMP describes as required above the protocols and procedures for proper disposition of
hazardous materials and waste materials. The WVCC is unlikely to generate regulated hazardous waste
at this time. All expired hazardous materials will be returned to the product vendor. Any hazardous'
materials or waste materials that must be disposed will be collected by an approved waste material
disposal vendor and disposed in accordance with State and local requirements. The waste material
disposal vendor will collect these items from the WVCC waste storage area of the RiverBend Pavilion 5th
Floor for transport off the RiverBend property via RiverBend Drive and MLK Parkway.
SDc 3,3-230 Exemptions
Prior communications with Springfield Utility Board staff for PeaceHealth RiverBend DWP approval and
implementation indicated that materials designed for human consumption, including ingested or
administered medications, may be considered exempt from DWP provisions. However, those materials
Date Received:
APR 17 2009
Original Submittal
Drinking Water Protection Overlay District Development Application
Willamette Valley Cancer Center at RiverBend Pavilion
Aoril 9 2009
Page 4
which may be considered hazardous materials would not be exempt from appropriate storage
requirements where there is a risk to groundwater.
SDC 3.3-235 Standards for Approval of DWP Overlay District Applicati.ons Within
Time of Travel Zones
Since the '-5 year TOTZ Standards are applicable to the WVCC, the standards in SOC, Chapter 3.3-235
B. apply.
1. The storage, handling. treatment, use, application, or production or otherwise keeping on
premises of more than 20 gallons of hazardous materials that pose a risk to groundwater
in aggregate quantities not containing DNAPLs are allowed only upon compliance with
containment and safety standards specified by the most recent Fire Code adopted by the
City.
No products containing ONAPLs will be used or stored or sold at the WVCC. Other hazardous materials
meeting the above criterion and identified herein shall comply with all containment and safety standards
established in Chapter 27 of the SFC.
2. Unless exempted, all hazardous' materials that pose a risk to groundwater shall be stored
in areas with approved secondary containment in place (Springfield Fire' Code 2702.1
and 270422).
As identified in response to SOC, Chapter 3.3-225 0.4. above, secondary containmentwill be provided as
required in accordance with the above criterion. Such containment features within the WVCC are
outlined in Section 5.0 of the attached HMMP and comply with the above-cited provision in the SFC and
this criterion.
. 3. All new use of DNAPLs shall be prohibited.
No products containing ONAPLs will be used or stored at the WVCC, so the proposal complies with the
prohibition of this criterion. . ,
4. Any change in type of use or an increase in the maximum daily inventory quantity of any
DNAPL shall be considered a new use and shall lie prohibited.
The proposed medical service activities at the WVCC will not include the use or storage of any products
containing DNAPLs, which is consistent with this criterion.
5. The following certain types of facilities or changes in chemical use and/or storage of
hazardous materials that pose a risk to' groundwater shall be prohibited:
a. Hazardous material product pipelines used to transport the hazardous material
off of the tax lot where iUs produced or used;
b. Injection wells, except dry wells for roof drainage; ,
c. Solid waste landfills and transfer stations;
d. Fill materials containing hazardous materials;
e. Land uses and new facilities that will use, store, treat, handle, and/or produce
DNAPLs.
The proposed medical service activities at the WVCC will not include any of the listed activities.or
facilities, consistent with this criterion.
Date Received:
APR 1 7 2009
Original Submittal
Drinking Water Protection Overlay District Development Application
Willamette Valley Cancer Center at RiverBend Pavilion
Aoril 9 2009
Page 5
6. Requirements found in Springfield Fire Code 2704.2.2.5 for a monitoring program and in
2704.2.2.5 for monitoring methods to detect hazardous materials in the secondary
containment system shall be met for all amounts of hazardous materials that pose a risk
to groundwater except those exempted.
The attached HMMP includes provisions in Section 5.0 and 10.0 for monitoring methods and
monthly inspections.
7. Requirements found in Springfield Fire Code 2704 for inspection and recordkeeping
procedures for monthly in-house inspection and maintenance of containment and
emergency equipment for all amounts of hazardous materials that pose a risk to
groundwater shall be met untess exempted.
The attached HMMP includes provisions in Section 10.0 for monthly inspections and in Section
11.0 for record keeping procedures.
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Date Received:
APR 1 7 2009
Original Submittal
ATTACHMENT 1
LOCATION MAP WITH TOTZ
Date Received:
APR 1 7 2009
Original Submittal
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KTA ASSOC'kJ'~ Inc.
KTA Associates, Inc. Phone 206.447.1450
800 Fifth Avenue, Suite 4100 Fax 206.374.2279
Seattle, WA 98104 www.KTAinc.net
Hazardous Material and Waste
Management Plan
RiverBend Pavilion
Willamette Valley Cancer Center
April 2009
KTA
A Professional Em'ironmental Seryice Corporation
Date Received:
APR 1 7 2009
Original Submittal
.' ,
T F CONTENTS
1.0 HAZARDOUS MATERIAL AND WASTE MANAGEMENT PLAN PURPOSE AND
OBJECTIVES ............................. ............... .................................... .............................. .......... ...... 1
2.0
PLAN REVIEW AND REViSiONS.............
......3
3.0 HAZARDOUS MATERIAL AND WASTE MANAGEMENT ROLES AND RESPONSIBILITIES. 4
4.0 HAZARDOUS MATERIAL INVENTORY STATEMENT AND STORAGE............. ................. 6
5.0 HAZARDOUS MATERIAL SECONDARY CONTAINMENT AND SPILL PREVENTION ......... 8
6.0 WASTE DETERMINATION AND MANAGEMENT REQUIREMENTS ..,.....
.....10
7.0
CHEMICAL EMERGENCY / SPILL RESPONSE,.........................................
...............13
8.0 WASTE DISPOSAL AND SHIPMENT .....................................................................,.........,.......15
9.0 PERSONNEL TRAINING FOR HAZARDOUS MATERIAL AND WASTE MANAGEMENT..... 17
10.0 MONTHLY INSPECTIONS OF HAZARDOUS MATERIAL AND WASTE MANAGEMENT AND
CORRECTIVE ACTION SySTEM..................................................................,...... .......... ... ........... 19
11.0 RECORDKEEPING ................................
......................................20
Attachments - Forms
Waste Determination Form 1
Hazardous Waste Monthly Inspection Form 2
Maintenance/Corrective Action Form 3
Training Record Form 4
Environmental Coordinator Assignment Form 5
Hazardous Materials Storage Monthly Inspection Form 6
~
Annexes
A - Hazardous Material Inventory
B - Hazardous Material Storage Location Drawings
APRIL 9, 2009
Date Received:
APR 1 7 2009
Original Submittal
. . ,
.1.0 HAZI:'RDOUS MATERIAL AND WASTE MANAGEMENT PLAN
PURPOSE AND OBJECTIVES
The Hazardous Material and Waste Management Plan ("Plan") for the organization medical facility
("Facility") has two purposes.
First, the Plan establishes responsibilities, policies, prevention measures and procedures for storage
of hazardous materials used at the Facility. Requirements for hazardous materials have been
established by the Springfield Utility Board (SUB) Drinking Water Protection (DWP) Overlay District
and rely on the Springfield Fire Code. One purpose of the Plan is to meet DWP requirements and
protect the groundwater used as a city drinking water supply from contamination by discharges of
hazardous materials that pose a risk to groundwater. The Plan addresses the following hazardous
material management processes (the applicable section of the Plan is identified in parentheses):
. Allowable hazardous materials to be used at the Facility (Section 4.0);
. Hazardous material storage locations (Section 4.0);
. Secondary containment for hazardous material containers and spill prevention measures
(Section 5.0);
. Spill control, collection and disposal procedures (Section 7.0), and;
. Inspection and maintenance of containment devices and emergency equipment (Section
10.0).
Second, the Waste Management portion of the Plan for the organization hospital or clinic establishes
responsibilities, policies, work practices, and proceduies to ensure that solid, hazardous,and medical
wastes are handled, packaged, collected, treated and disposed of in accordance with applicable
regulations' This Facility is unlikely to generate hazardous wastes in quantities that require
special management, however, the information is provided in this Plan to be consistent with the
overall RiverBend medical campus plans. The Facility's wastes generally fit within four major
categories: hazardous wastes, universal wastes, non-hazardous wastes, and medical wastes. The
purpose of the Plan is to meet Hazardous Waste requirements and address the relationships
between waste streams. that are managed as hazardous wastes and waste streams that are
managed under other programs at the facility. Hazardous wastes are defined by the federal
Resource Conservation and Recovery Act (RCRA) and corresponding Oregon. laws and primarily
includes waste chemicals. Universal wastes are a separately regulated subset of hazardous waste,
including fiuorescent ligtit bulbs and batteries. Non-hazardous solid wastes are comprised mainly of
paper, plastic and food wastes. Non-hazardous liquid wastes are discharged to the sanitary sewer.
Medical wastes include sharps and non-hazardous infectious solids and liquids. In addition
pharmaceutical wastes are generated at the Facility which may be hazardous, medical or non-
hazardous wastes. .
This Plan addresses the following waste management processes (the applicable section of the Plan is
identified in parentheses):
. Waste management roles and responsibilities (Section 3.0);
Date Received:
APR 1 7 2009
KTAASSOCIATES. INC. APRIL 2009
1 Other wastes such as radioactive medical wastes are addressed by separate plans.
Original Submittpl
1
,1
o Waste identification to determine applicable storage, use, and disposal requirements (Section
6.0);
o Waste disposal and shipment (Section 8.0);
o Personnel training (Section 9.0);
o Inspections (Section 10.0);
o Emergency response (Section 7.0); and
. Recordkeeping (Section 11.0).
This Plan addresses requirements for the environmental regulation areas described above. Although
there are several hazardous materials safety and use guidelines included in this Plan, Health and
"-
Safety and Hazard Communications are covered by a separate program at the Facility, ,
Date Received:
KTAASSOCIATES, INC. APRIl2009
APR 1 7 2009
2
Original Submittal
2.0 PLAN REVIEW AND REVISIONS
The Facility will'ensure the Plan is kept current and updated as necessary to reflect any change in the
storage of hazardous materials. It is anticipated that the list of hazardous materials submitted to the
SUB is comprehensive would only occasionally require updating for additional materials. Hazardous
material storage, management and spill response procedures in this Plan will be reviewed periodically
and updated as necessary.
In addition, the Facility will ensure the Plan is kept current and updated as necessary to reflect any
. change in the types or quantity of waste generated. Generation of a new or different waste will
require preparation of a Waste Determioation Form (WDF) (see Section 6.0, below).
Under applicable RCRA and state hazardous waste regulations, the Facility may generate
unregulated quantities of hazardous waste and is classified as a "Conditionally Exempt Small Quantity
Generator" (CESQG). A CESQG must generate less than 220 Ibs/mo. of hazardous waste and store
2,200 Ibs. or less on"site. A SQG generates more than 220 Ibs/mo. but less than 2,200 Ibs/nio. or
stores more than 2,200 Ibs. on-site (see "Determining Your Generator Category," in the Oregon DEQ
Small Quantity , Hazardous Waste Generator Handbook at
htto:/lwww.deoetAt..oruslwmclhw/r..elibhwoen.html).Anincrease in the quantity of hazardous
waste generated exceeding the SQG threshold would subject the Facility to additional requirements.
A change to SQG status will require a revision of this Waste Management Plan.
If hazardous waste is generated, the monihly inspections will review the need for new Waste
Determination forms or changes in RCRA generator status.
Date Received:
KTA ASSOCIATES, INC. APRIL 2009
APR 1 7 2009
3
Original SubmittRI
"
3.0 HAZARDOUS MATERIAL AND WASTE MANAGEMENT ROLES
AND RESPONSIBIUTI~S
The Facility will assign hazardous material management and waste management roles and
responsibilities to carry out the Plan. Individuals will be assigned to roles by Facility management.
Individuals will be trained to fulfill roles and carry out responsibilities as described in Section 9.0. The
Facility organization for hazardous material and waste management is shown as follows:
Facility Manager
,
IEnvironmental Coordinator
H Peace Health Environmental I
Coordinator
3.1 Erwiron, .:...1 Coord", . "
The Environmental Coordinator (EC) will have primary responsibility for hazardous material
and waste management within the hazardous waste guidelines and regulations. The Facility
management will assign a person to fulfill the role of Environmental Coordinator. The EC
assignment will be documented on Form 5 and maintained in the file. The EC'will have the
following responsibilities.
. Own the facility Hazardous Material and Waste Management Plan, including an annual
review and update as necessary. Provide waste management support to facility
personnel as requested-be the "Go To" person for hazardous material and waste
management.
. Manage the environmental file including the Plan, Hazardous Material Inventory
Statement, the Waste Determination Forms (WDFs) with backup materials and required
recordkeeping.
. Receive training on' hazardous materials and waste management, and applicable
regulations and requirements.
. Ensure that hazardous materials are stored in secondary containment,' if required by the
Plan.
. Conduct monthly inspections of hazardous material storage locations, as described in
Section 10.0
. Review new products with the SUB Water Quality Protection Coordinator to ensure that
products do not contain DNAPLs; update the Hazardous Material Inventory Statement as
needed.
. Be familiar with the waste streams generated by each work group of department. Prepare
and WDFs for new reguiated waste streams as needed. .
KTAASSOCIATES, INC. APRIL2009
Date Received:
4
APR 1 7 2009
Original Submittal
. If any hazardous waste is generated at the Facility, determine the facility hazardous waste
generator status each, month. If necessary, the Environmental Coordinator wili: 1)
Conduct inspections; 2) Coordinate shipping and disposal for universal and haiardous
wastes for departments in the facility and for solid wastes where appropriate to ensure
hazardous waste requirements are met; 3) Establish arrangements with waste disposal
contractors and coordinate waste disposal services, and 4) Maintain records of
inspections, corrective actions and waste disposai as described in 11.0.
. If a spill or release occurs, contact the Facility Emergency Coordinator. Take initial
response and cleanup actions as appropriate for the material.
Coordinate with the PeaceHealth Environmental Coordinator for consistency on
environmental issues and obtain assistance on hazardous material or waste management
questions, support or policies. The environmental coordinators for the facilities on the
RiverBend medical campus may establish a, networl< of periodic meetings.
Date Received:
KTA ASSOCIATES, INC, APRIL2009
APR 1 7 2009
5
Original Submittal
4.0 HAZARDOUS MATERIAL INVENTORY STATEMENT AND,
STORAGE
The hazardous materials management requirements include maintaining an inventory of hazardous
materials used at the Facility and identification of the storage locations. The hazardous materials
covered by this Plan are a unique subset of the broad classification of "hazardous material", it is
important to understand the definition of hazardous material asit applies to this Plan.
4.1 t.-' :onofHaurdousl\:c.,j._:....r
Hazardous materials are substances, as defined in City of Springfield Land Use Development
Code Chapter 3.3-200 for the Drinking Water Protection (DWP) Overlay District that may be
stored, handled, treated, used or produced at the Facility. As the Facility. is located in area
specified to be a drinking water wellhead Time of Travel Zone of 1-5 years, restrictions apply to
hazardous materials to protect groundwater. The Springfield Development Code defines
Hazardous Materials as those substances (liquid or solid) which pose a risk to groundwater
quality (Chapter3.3-205 A.1.) a class of liquid chemicals or substances which are physical
or health hazards to groundwater). The class of hazardous materials is based on
Chapter 27 of the Springfield Fire Code (SFC) which has been as adopted and amended
by the City, including materials in both usable or waste conditions.
City of Springfield Land Use Development Code, Chapter 3.3-230 exempts several types of
SFC hazardous materials because they do not pose a risk to groundwater, these
exemptions include: (1) Hazardous materials in fuel tanks and fluid reservoirs attached to (i) a
private or commercial motor vehicle and used directly in the motoring operation of that vehicle,
or (ii) machinery, including but, not limited to fuel, engine oil and coolant; (2) Fuel oil used in
existing heating systems; (3) Hazardous materials contained in properly operating sealed units
(transformers, refrigeration units, etc.) that are not opened as part of routine use; (4) Local
natural gas distribution lines; (5) Fuel for emergency generators located at facilities that provide
essential community services (hospitals, fire/life safety, police, public shelters, telephone
systems etc.); (6) Any commonly used office supply - such as correcting fluid for typewriters,
toner for computer printers or cleaners for windows and bathrooms.,. where the supplies are
purchased off- site for use on-site.
4.2 Hazardous MateriaUnWntory ~,:-~,....ant
The Facility has developed a comprehensive Hazardous Material Inventory Statement which
lists all hazardous materials used at the Facility, maximum quantity and storage location within
the building. This list accompanies this Plan and is located in Annex A.
4.3 Hazardous Material S:. c",_ L. _:.;__.~
The hazardous material storage locations are listed in the Hazardous Material Inventory
Statement in Annex A. :In addition; the hazardous material storage locations are marked on a
floor plan drawing. This drawing is included in Annex B.
The Hazardous Materials and Waste Management Plan with the Hazardous Material Inventory
Statement list and facility drawings with hazardous material storage locations are to be
submitted to the SUB with the DWP Overlay Development Application.
KTAASSOCIATES,INC, APRIL2009
D~te Received:
6
APR 1 7 2009
Original Submittal.
"
4.4 Hazardous Material Ma c"'~ ,em
All hazardous materials defined above, will be stored, handled, treated, used or produced at
the Facility according to the guidelines outlined in this Plan. Hazardous materials will be
purchased only where necessary and used only for the intended purpose. Hazardous
materials will only be stored indoors, with secondary containment. Hazardous materials will
not be stored outdoors. Hazardous materials will only be used outdoors with precautions to
prevent hazardous materi?1 from entering stormwater or infiltrating into the ground.
Personnel will take precautions to prevent releases of hazardous materials during storage and
use, and any releases that do occur will be controlled, cleaned-up up promptly and disposed of
appropriately.
Individual containers of products that are not highly hazardous or toxic, and which are
frequently used may be kept at the use location without. secondary containment. Examples
would be household products such as dish detergent or hand soap on or under the sink in
employee break rooms or restrooms. Another example is a quart bottle of isopropyl alcohol
kept on the counter of an exam room; the bottle would be easily visible and any spills could be
cleaned up quickly.
Pharmaceuticals may be hazardous materials and will be managed appropriately.
The Facility will not purchase, store or use any Dense Non-Aqueous Phase Liquids (DNAPLs).
A DNAPL is one of a group of hazardous materials that are denser than water, have low
solubility rate, and degrade slowly to other compounds that are even more of a health hazard.
(A list of DNAPLs regulated within the Drinking Water Protection Overlay District is maintained
by the SUB). Examples of DNAPLs are Perchloroethylene or 1,1,1- Trichlorethane. MSDSs
for new hazardous materials proposed to be used at the Facility must be reviewed by the
SUB Water Quality Protection Coordinator before purchase to ensure.the product does
not contain any DNAPLs.
The Facility will maintain a log of all products reviewed for potential DNAPLs.
The Facility will submit an updated HMIS to the SUB when new hazardous materials are
added or removed from the HMIS. The HMIS will be updated with new products as they are
approved; the HMIS will be submitted to the SUB in electronic format. when new hazardous
materials are added or removed from the HMIS, or upon request by the SUB.
Date Received: .
KTAASSOCIATES, INC. APRIL 2009
APR 1 7 2009
7
Original Submittal
5.0 HAZARDOUS MATERIAL SECONDARY CONTAINMENT AND
SPILL PREVENTION
Hazardous materials will be stored, handled and used with precautions to avoid spills.
5.1 Secondary Containment
r
Secondary containment for storage of hazardous materials that pose a risk to the groundwater
will be provided in accordance with the applicable regulatory requirements, Chapter 3.3,235
B.2. of the DVIIP Program. This requirement specifically states that:: Except those exempted,
all hazardous materials that pose a risk to groundwater shall be stored in areas with approved
secondary containment in place (Springfield Fire Code 2702.1 and 2704.2.2. Secondary
containment may be provided by one of the following means:
. Liquid-tight sloped or recessed floors;
. Liquid-tight floors with raised or recessed sills or dikes;
. Sumps and collection systems;
. Drainage systems leading to a controlled location;
. Secondary containment devices, such as spill pallets, decks, tubs or trays for containers.
Secondary containment systems will be ,sized to accommodate a spill from the largest
container. In addition, the sizing needs to accommodate fire-protection water (20 minute
discharge volume). The materials of construction of the secondary containment system must
be compatible with the hazardous materials to be stored. Incompatible hazardous materials
will be separated from each other in the secondary containment system. The secondary
containment system will have a monitoring method, such as visual observation. Materials..
should be stored away from doorways and drains to prevent spills or leaks from leaving the
secondary containment area.
Most of the hazardous materials to be stored and used at this Facility are cleansers and
disinfectants in 1'gallon (or less) contain,ers. All liquid hazardous .materials and hazardous
materials that could be dissolved in water (e.g., powdered products), will be stored in
secondary containment. The secondary containment devices, such as plastic tubs, will allow
easy access and quick inspection to determine if any release of hazardous materials has
occurred. The secondary containment tubs or trays will have sufficient depth to contain the at
least 11 0% volume of the largest container.
In hazardous material use areas where products are. used frequent.ly and easily visible,
individual containers of products that are not highly hazardous or toxic do not need to be kept
in secondary containment. Examples would be a quart bottle of isopropyl alcohol in an exam
room or dish detergent or hand soap at or under a sink. Materials not in current use should be
returned to storage in secondary containment.
Hazardous materials that. are individually packaged in sealed foil or plastic packets will not
require storage in secondary containment, unless the material poses a high risk to
groundwater. ,,.
Date Received:
KTAASSOCIATES, INC. APRIL2009
8
APR 1 7 2009
Original Submittal
Storage devices such as Pixis medication dispensing units and drawer carts, such as a crash
cart provide adequate secondary containment.
5.2 Spill Prevention
In addition to secondary containment, Facility personnel will follow precautions in hazardous
material storage and use to prevent spills. . The following measures will be used for spill
prevention:
. Containers of hazardous materials will be stored in designated areas in each clinic.
Individual clinics and departments will be responsible for their hazardous materiais and will
establish guidelines and training for safe storage and use, in conjunction with Facility
safety procedures.
. Hazardous materials should not be left on the loading docks, freight elevator lobbies,
hallways or any other unrestricted locations.
. All containers of hazardous materials will be labeled with the identity of contents and
chemical components.
. Hazardous material containers must be in good condition, compatible with the materiai
stored therein, and not in danger of leaking. Containers should be kept closed except
when the material is in use. Non-compatible materials should not be stored next to each
other.
. Containers stored in cabinets, closets and on-shelves should be at eye-level or below.
. Storage areas should be well-lit. Hazardous material storage areas should be secured or
locked, if appropriate, to protect against unauthorized access.
. Hazardous material storage areas should have signs to provide safety information and
spill cleanup procedures.
. Spill cleanup kits should be available near hazardous material storage areas.
. Floor drain mats should be kept in all hazardous material storage area with floor drains to
prevent accidental spills from reaching the sanitary sewer system.
. Hazardous material containers must not be opened,handled, or stored in a manner that
may rupture' the container or cause them to leak .
. Proper handling and storage information is explained in Material Safety Data Sheets,
available for all hazardous materials used at the Facility.
. Empty containers previously used for storage of hazardous materials will be free of
residual material before appropriate disposal.
Date Received:
KTAA.sSOCIATES, INC. APRIL 2009
APR 1 7 2009
9
Original Submitt"l
6.0 WASTE DETERMINATION AND MANAGEIVIEtjlT REQUIREMENTS
6.1 Waste Detenninatioo Forms and Waste Management Requirements
Specific waste handling, storage and disposal requirements for each type of hazardous,
universal, solid and medical waste are specified in the Waste Determination Form 1 ("WDF")
maintained in the WDF "file. Example WDFs are provided in Attachment 1. This Plan
describes generally applicable requirements related to handling and storage of wastes,
particularly hazardous wastes.
6.2 Waste c.o : _.... ties
Some waste streams are not classified as "solid wastes" and are excluded from further
consideration as hazardous wastes. Examples'are'
. liquid wastes which are discharged to the sanitary sewer as permitted by the Publicly
Owned Treatment Works.
. Materials that are reused, recycled, recovered or reclaimed.
Waste streams that cannot be excluded are considered solid waste streams, which are
classified into four major categories:
. Solid waste, for example, office waste, used oil, recovered silver and construction waste.
. Hazardous waste: Chemical waste regulated under RCRA and Oregon hazardous waste
regulations, for example,organic solvents, chloroform, inorganic and organic solids such
as reactive wastes, mercury based waste, and lead based waste.
. Medical waste: Non-hazardous waste that is potentially infectious. Medical waste is any
solid waste generated in the diagnosis, treatment or immunization of humans or animals
or related research, or in the production or testing of biologicals. Examples include
sharps, cultures and stocks, pathological wastes, biological waste, such as human blood
and blood products.
. Universal wastes, for example, fluorescent lights and ballasts, and batteries.
Pharmaceutical wastes may be reyclables, reusables, medical wastes or hazardous wastes.
6.3 C_..~.JWasteMa ..._ "entl \., atioo
A Waste Determination Form (WDF) will be prepared for each waste stream generated by the
Facility, unless it is a general solid waste, where no specific question has arisen .or .
management requirement is necessary. It is anticipated that few WDFs will be necessary
for this Facility. The PeaceHealth Environmental Coordinator maintains an extensive file of
WDFs for the RiverBend Medical Center; these WDFs would likely cover any needed for this
Facility, and would provided a con~istent waste management process.
Date Received:
KTAASSOCIATES, INC. APRIL 2009
APR 1 7 2009
10
Original Submittal
Unless allowed by the pertinent WDF, no waste may be dumped down a drain, discharged to
a sanitary sewer, be discarded with regular trash or be allowed to evaporate to the
atmosphere;
'6A HazardousWaste-;~..~..JMa c",_ _ lProcedures
It is anticipated that very little hazardous waste will be generated at the Facility. It is
unlikely that the hazardous waste management procedures below will be necessary.
6.4.1 Hazardous wastes may be stored either at the point of generation or in a central
location. The appropriate storage requirements for each hazardous waste stream will
be described in the WDF for that waste stream.
6.4.2 Hazardous waste may be stored in a clinic or department, at or near the point of
generation, e.g., labs, and under the control of the personnel who generated the
waste. By regulation, no more than 55-gallons of hazardous waste (or one quart of
acutely hazardous waste, P-waste) may be accumulated in a single location, and
waste exceeding the 55-gallons limit must be moved to the central storage area within
72 hours. However, to maintain CESQG status, satellite accumulation containers will
be allowed to contain no more than 10 gallons. When a container accumulates 10
gallons, it will be moved to the central waste storage area. Typically, the hazardous
waste will be collected by the waste disposal vendor directly from the container
location, so that moving hazardous waste to a central location will not be necessary.
Each department's hazardous waste accumulation container will be marked
"Hazardous Waste" and with words that identify the contents of the container (see
WDF for proper labels.)
6.4.3 The Facility also stores hazardous waste in one or more central locations, described in
the WDFs. Hazardous waste is stored for no more than 180 days before it is shipped
off-site for disposal or recycling. In general, storage and handling in these areas must
adhere to the following precautions:
. Incompatible materials are not stored near each other.
. Chemical in small containers are segregated and the labeled chemical containers
are packaged in strong cardboard packing boxes. Containers are sorted by
chemical compatibility using separate boxes for each group.
. Adequate ventilation, lighting and security are provided.
. All hazardous waste is stored below eye ievel.
. Hazardous waste containers must be inspected at least monthly.
6.4.4 The Hazardous Waste containers and packaging requirements are:
. Hazardous waste containers must be in good condition, .compatible with the
waste stored therein, and not in danger of leaking.
. Hazardous waste containers must not be opened, handled, or stored in a manner
that may rupture the container or cause them to leak.
Date Received:
KTAASSOCIATES, INC. APRIL 2009
11
APR t 7 2009
Original submittal
. Hazardous waste containers must be closed at all times during storage, except
when waste is being added. In the case of liquid chemical hazardous waste,
regulations do not permit funnels to remain in waste containers after filling.
. Hazardous waste must never be left on the loading docks, freight elevators,
lobbies, hallways or any other unrestricted locations.
. Secondary containment is required for containers of liquid hazardous waste.
Plastic tubs can be used as secondary containments.
6.4.5 Labeling requirements are:
. For Hazardous Waste:
Generally, all hazardous wastes must be labeled at the time the waste is first
placed into the container. The following information must be completed on the
label: 0
Chemical name of the contents in words, not abbreviated and no formulas
(e.g., "Waste Sulfuric Acid, not H2S04).
The associated hazard(s) of the waste (Ignitable, Corrosive, Reactive, or
Toxic)
The date on which.the accumulation began. Labels may be re-dated when
the waste has been transferred to a central storage area; with the date
storage begins in the central storage area, as indicated on the label.
If the waste is a mixture, identify the chemical waste constituents by proper
chemical name including any deactivators/disinfectants used and the
approximate quantity or concentration. See WDFs for specific la~eling
requirements.
. Universal Wastes: Waste Lamas and Ballasts and Batteries
RCRA and staie hazardous waste regulations promote the collection of
universal wastes, such as waste lamps and ballasts and batteries.
Fluorescent lamps and high intensity discharge lamps, including mercury
vapor, high pressure sodium and metal halide can contain levels of mercury
and lead that make them a hazardous waste when disposed. Batteries
include the common types of batteries used in electronic equipment and
flashlights, but do not include lead-acid batteries (which are subject to a
different set of requirements). The Facility stores these types of universal
wastes in central locations (See WDFs). Specific storage, handling and
disposal requirements are described in the WDFs for "Waste Lamps and
Ballasts" and "Waste Batteries."
/
Date Received:
KTAASSOCIATES, INC. APRIL 2009
APR 1 7 2009
12
r
Original Submittal
7'.0 CHEMICAL EME~GENCY I SPILL RESPONSE
7.1 c:."..".~1
Personnel who work with or around chemicals will be trained in these procedures (see Section
9.0). Hazardous material and hazardous waste container storage areas will be managed to
minimize the possibility of fire, explosion or any unplanned release of chemicals or hazardous
waste to the environment.
7.2 en-gency Requ.o O...J
The Facility maintains an emergency plan which includes the following elements required for
hazardous material and hazardous waste management:
. Communications and fire control equipment, including periodic testing to ensure
equipment will operate properly in time of emergency.
. Arrangements with local authorities.
. An Emergency Coordinator for the Facility has been designated with the responsibility' for
coordinating all emergency response measures
. Spill response procedures: the level of response to a chemical spill will depend upon the
physical characteristics and volume of materials being handled, their potential toxicity, and
the potential for releases to the environment. The following are general guidelines to be
followed for a chemical spill: -
o The individual who caused or discovers the spill is responsible for immediate
response and cleanup until the Emergency Coordinator arrives.
o Immediately alert area occupants and supervisor, and evacuate the area, if
necessary.
o If a volatile, flammable material is spilled, immediately wam everyone, control
sources of ignition and ventilate the area.
o If there is a fire that cannot be extinguished with a portable fire extinguisher,
call the local Fire Department at 911.
o Atlemptto contain the spill (with absorbent material) to the smallest practical
area.
o As appropriate, spills should be cleaned up by chemical treatment,
absorption, or neutralization. If the spill is too large for the responsible
individual or Emergency Coordinator to handle, or may' pose a risk to
groundwater:
. Call 911to contact:
. Fire Department hazardous materials unit
. Police Department
KTAASSOCIATES, INC. APRIL2009
Date Received:
13
APR 1 7 2009
Original Submittal
. Springfield Utility Board
. PeaceHealth RiverBend, Emergency Coordinator
o
Attend to any people who may be contaminated. Contaminated clothing
, must be removed immediately and the skin flushed with water for no less
than fifteen minutes. .
o
Wear personal protective equipment, as appropriate to the hazards. Refer to
the Material Safety Data Sheets or Waste Determination Forms for
appropriate personal protective equipment.
o
Consjder the need for respiratory protection.
o
Protect floor drains or other means of environmental release. Floor drain
mats or spill socks and absorbents may be placed around drains.
o Bulk absorbents and many spill pillows do not work with acids.
POWERSORB (3M) products and their equivalent will handle acid. Acids
should be neutralized if possible.
o When spilled materials have been absorbed, use brush and scoop to place
materials in an appropriate container. Polyethyiene bags may be used for
small spills. Five gallon pails with polyethylene liners may be appropriate for
larger quantities.
o For spills of hazardous material, the waste product and spill control materials
. might be classified as a hazardous waste. For spill of hazardous material,
label the container to identify the material as Spill Material Involving "XYZ
Chemical". Contact the Emergency Coordinator for advice on storage and
packaging for disposal.
o For spills of known hazardous waste, complete a hazardous waste sticker
identifying the material as Spill Material Involving "XYZ Chemical" and affix
onto the container. Spill control materials should be disposed of as
hazardous waste. Contact the Emergency Coordinator for a9vice on storage
and packaging for disposal.
o Decontaminate the surface where the spill occurred using a mild detergent
and water, when appropriate.
. The Emergency Coordinator will complete or assign necessary reporting to authorities and
agenCies on an incident form. The Emergency Coordinator will assess environmental
reporting by talking with the Environmental Coordinator. The Emergency Coordinator and
Environmental Coordinator may contact or coordinate with the PeaceHealth Emergency
Coordinator and Environmental Coordinator for assistance.
Date Received:
KTAASSOCIATES; INC. APRIL 2009
APR 1 7 2009
14
Original Submitt~1
8.0 WASTE DISP - ND SHIPMENT
The disposal method for each waste stream is based on the type of waste. The disposal methods for
each type of waste are described below. The WDFs specify more specific requirements, where
applicable. In particular, hazardous waste disposal methods vary for the individual waste and specific
disposal determination is made for each hazardous waste and documented on the WDF.
8.1 GeneraJ/NorWfazardous Waste
Office waste should be dispOsed of in a trash receptacle that is lined with a plastic bag. The
housekeeping personnel will collect it on a daily basis. Note: Office areas may generate
hazardous waste in the form of unused cleaning products or other specialty items.
Discarded materials will be recycled as practical to reduce waste that must be disposed.
Glass/plastic lab ware that cannot readily be decontaminated must be disposed of as medical
waste.
8.2 Sanitary Sewage Wastewater
Only allowable wastewater should be discharged to the sanitary sewer. Disposal of any
hazardous waste/material into the sanitary sewer is not allowed. Any materials that may
interfere with sanitary sewage plant operations may not be disposed into the sanitary sewer.
When the Facility obtains a pretreatment permit from the sanitary sewage system operator, it
will specify the types of materials that may be discharged. Generally, the materials that can be
discharged into the sanitary' sewer system include:
. Sterilization wastewater
. Liquid formalin, formaldehyde and gluteraldehyde
. Cidex and other cleaning and wastewaters
The sanitary sewage system operator may restrict the disposal of some pharmaceuticals to
the sanitary sewer. .
8.3 Medical Wastes
In general, medical wastes are managed according to a separate facility procedure.
Medical wastes that are classified as Infectious Wastes by Oregon regulation include four
categories: biological waste, cultures and stocks, pathological wastes and sharps. Infectious
wastes must be treated, .typically by incineration or autoclaving, before disposal in landfills.
The infectious medical waste must also be collected and stored in special bags and containers
marked "Biohazard". Hazardous waste or outdated pharmaceuticals are not managed with
infectious waste. If pharmaceuticals can'not be retumed to suppliers and must be discarded,
each product must be reviewed for possible hazardous waste classification before disposal.
Date Received:
KTAASSOCIATES, INC. APRIL2009
15
APR 1 7 2009
Original Submittal
8.4 Hazardous Wastes
Although unlikely at this Facility, many chemicals, e.g., acids/alkalines, organic
solvents, are classified as a hazardous waste and must meet applicable shipping and
disposal requirements. The WDF for each waste stream will specify whether it is a
hazardous waste and identify .any unique storage, shipping and disposal requirements.
Hazardous waste will be removed from the facility by a hazardous waste' contractor and
disposed of at a RCRA licensed facility. The WDF will specify whether a waste stream is
subject to RCRA Land Disposal Restrictions. Prior to shipment, responsible Facility personnel
must ensure that the containers are marked as a "HAZARDOUS WASTE", and include date
waste was first added and information on the waste characteristics or hazards. In addition, a
proper manifest is prepared. (An example hazardous waste manifest is Includ~d in the file).
The transporter shall be responsible for:
. Having a valid EPA 10. No.
. Keeping copies of the manifest in the vehicle.
. Proper DOT placarding.
. Signing the manifest.
. Returning the manifest to the Facility and distributing copies of the manifest as
specified on the form, postmarked within five business days of shipment. The Facility
must keep copies of manifests for at least three years.
. Filing an exception report if the receiving facility manifest copy is not received within
45 days of the waste leaving the Facility.
8.5 Universal Wastes
Universal wastes, such as fluorescent lamps and batteries will have specific requirements for
shipping and disposal. Typically, the requirements are more stringent than general non-
hazardous solids wastes and less stringent than hazardous wastes. Refer to the Waste
Determination Form for specific requirements for individual universal wastes.
"
Date Received:
KTAASSOCIATES, INC. APRIL2009
APR 1 7 2009
16
Original Submittal
9.0 PEIJSONNEL TRAINING FOR HAZARDOUS MATERIAL AND
WASTE MANAGEMENT
In general, Facility personnel will receive direction or training from their supervisors, as necessary for
each position, in hazardous material and general waste management and recycling. General training
given to all employees in their group does not need to be documented. All employees receive training
for awareness of the sensitive area that the Facility occupies and special precautions needed to
protect the drinking water. In addition, the SUB representatives may talk with facility personnel during
visits to increase awareness of groundwater protection roles.
Facility personnel who handle hazardous materials or hazardous waste will receive basic training and
direction for:
. Awareness of the sensitive area that the clinic occupies and special precautions needed to
protect drinking water.
. Familiarization with the HMMP.
. Precautions in using hazardous materials such as cleansers and disinfectants.
. Storing hazardous materials in secondary containment.
. Determining what is a hazardous waste.
. 'Adding hazardous waste into containers.
. Transporting hazardous waste from the department generation and storage area.
. Responding to spills or other hazardous waste or hazardous material related ~mergencies.
At the Facility, specific hazardous waste training that requires documentation would oniy be required if
hazardous waste will be generated. The Environmental Coordinator will have waste management
training with annual update training. Training will be documented on the Training Record (Form 4)
9.1
Em- .
ental Coordinator Training
The Environmental Coordinator (EC) will be familiar with the regulatory requiremenis and
DWP permit conditions for hazardous material management. The EC will be familiar with the
hazardous material storage and use requirements and the waste management requirements
of this Plan:
. Types of hazardous materials used at the Facility
. Types of wastes generated at the Facility (non-hazardous solid, medical waste, hazardous
waste, universal waste).
. General hazardous material storage and use guidelines.
. General waste management guidelines, induding need for special waste storage, shipping
and disposal for hazardous wastes. .
Date Received:
KTAASSOCIATES"INC. APRIL 2009
17
APR 1 7 2009
Original $ubmittal
. Preparation ofthe Waste Determination Form.
. VVho to contact if a spill or release occurs. Initial response for spill or releases.
KTA ASSOCIATES, INC. APRIL 2009
Date Received:
A~R \ 7 2009
. Original submittal
18
(;
~
r
)'
10.0 MONTHLY INSPECTIONS OF HAZARDOUS MATERIAL AND
WASTE MANAGEMENT AND CORRECTIVE ACTION SYSTEM
Monthly inspections of hazardous materials and hazardous wastes will be conducted. This Facility
is unlikely to generate regulated hazardous wastes, therefore, only the hazardous material
monthly inspections would be required. However, any quantities of hazardous wastes are
hazardous materials, must be stored in secondary containment and included in the monthly
hazardous material inspection. As necessary, documented periodic inspections of storage areas are
required for hazardous material and hazardous waste management at the Facility.
10.1 Hazardous Waste Manag _ _ t Monthly I. .....~_lions
The quantities of hazardous wastes generated at this Facility are unlikely to require
monthly inspections, If necessary, monthly inspections of hazardous waste storage areas
would be performed using the standard Hazardous Waste Monthly Inspection Sheet Form 2
(attached).
The Inspection Sheet includes a list of items to be checked at each area. Each Inspection
Sheet has sufficient space to record inspection of four hazardous waste management areas.
The inspector will check the posted WDF for each waste stream and determine if any
additional wastes are generated in the area that are not documented by a WDF.
The inspection will also include confirmation that the facility has not triggered Small Quantity
Generator (SQG) status and recommendations, if appropriate, on waste accumulation and
storage procedures to maintain CESQG status. .
When the inspection discovers compliance issues, corrective action will be performed. The
Environmental Coordinator will assure that corrective action is performed and fill out the
Maintenance/Corrective Action Form 3 (attached).
10.2 Hazardous Material Storage Monthly Inspections
Monthly inspections of hazardous material storage areas will be performed using the standard
Hazard~us Material Monthly Inspection Sheet Form 6 (attached).
The Inspeclion Sheet includes a list of items to be checked at each area. In particular,
secondary containment devices (tubs and trays) and emergency equipment must be
inspected. The inspector will look for events or practices which could lead to an unintended
release of hazardous material. The inspection form must also be reviewed a'nd signed by the
Office Manager. Completed inspection forms will be maintained in a binder or file.
When an inspection discovers compliance Issues, corrective action will be performed. The
Facility may use a computer-based maintenance management system to initiate and track'
both preventative and corrective maintenance activities. The Environmental Coordinator will
assure that corrective action is performed and fill out the Maintenance/Corrective Action Form
3 (attached).
Date Received:
KTAASSOCIATES, INC. APRIL2009
APR 1 7 2009
19
Original Submittal
f
V
11.0 RECORDKEEPING
11.1 Recordkeeping
The Environmental Coordinator will establish and maintain an environmental file. Generally, all
environmental files should be kept for a minimum of 3 years. As necessary, the filing system
should include:
. Hazardous Material and Waste Management Plan
. Hazardous Material Inventory Statement and location drawings.
. Correspondence with agencies, consultants, etc. (Keep 3 years)
. Reports submitted to environmental agencies
. Completed hazardous waste'monthly inspection forms (Form 2)
. Completed maintenance/corrective action forms (Form 3)
. Personnel Training records (Form 4)
. Responsibilities including Environmental Coordinator assignment form (Form 5)
. Waste Determination Forms (Form 1) ina folder for each waste stream
. Waste disposal vendor information and any Waste Manifests Exception Reports, and
Land Disposal Restriction Paper Work for shipping wastes to disposal
. Completed hazardous material monthly inspection forms (Form 6)
11.2 R _.". I"ng
As long as the Facility maintains status as a Conditionally Exempt Small Quantity Generator,
submission of written reports to the Oregon DEQ or other agencies should not be required.
Hazardous material management does not involve any required reporting, although approval
of new hazardous materials added to the Hazardous Material Inventory Statement (HMIS) by
the SUB would be necessary by submitting the MSDS and the updated HMIS:
KTAASSOCIATES, INC. APRIl2009
Date Received:
APR 1 7 2009
20
Original submittal.
, ~ .
r;-'
ATTACHMENTS- FORMS
Date Received:
: APR 1 7 2009
. . _. ....
VII!::jlllcll \5UUIIIIUc::Il
./
C--
WASTE DETERMINATION FORM 1
I Waste Name: Medical wastes - .solids I Waste ID ~umber: I Date: 2/25/04 . [
Is the Waste Hazardous as Defined by Oregon Administrative Rules ("OAR") Chapter 340, Division
,101 (includes RCRA Hazardous Waste Definition)? Yes _ No ~
Medical waste solids are solid waste, but do not meet any criteria of hazardous waste. Medical waste that may
be infectious is regulated in Oregon as infectious waste under OAR 340-093-0190. Infectious waste must be
treated before disposal, cultures and stocks must be incinerated or autoclaved, and pathological wastes must be
incinerated (with some exceptions). In addition, infectious waste definitions, handling, treatment, and storage
times and temperatures are addressed by the Health Services Oregon Administrative Rules OAR 333-056-0010
through 333-056-0050. .
Products Included in the Waste: Infectious medical wastes solids include: 1) Biological waste: which
includes blood and blood products, excretions, exudates, secretions, suctionings and other body fluids
that cannot be directly discarded into the municipal sewer system, and waste materials saturated with
blood or body fluids. 2) Cultures and stocks: which includes etiologic agents and a'ssociated biologicals,
including specimen cultures and dishes and devices used to transfer, inoculate and mix cultures, wastes
from production of biologicals, and serums and discarded live and attenuated vaccines. 3) Pathological
waste: which includes biopsy materials and all human tissues, anatomical parts that emanate from
surgery, obstetrical procedures, autopsy and laboratory procedures.
Infectious medical wastes solids does not include liquid or soluble semi-solid biological wastes (WDF SH-
6), sharps (WDF SH-5) or pharmaceuticals (WDF SH-7l
Source of Information use for Hazardous Waste Determination (attached): Process knowledge
Waste Generation Description: Medic~1 waste solids are generated from medical procedures,
laboratory and patient care.
Analysis.
1. Does the waste exhibit the ignitability, corrosivity, or reactivity characteristics as defined by
40 CFR!i 261.21-23? Yes -'- NoL Not Applicable_
Explanation: The medical solids waste is not.an ignitable waste because it is a solid material, although
may contain absorbed liquids. The waste is dry or water-based and does not have exhibit a flash point.
The medical solids waste is not a corrosive waste because it is a generally solid material with absorbed
'Iiquids, and it not known to exhibit pH outside the range of 2.0 -:- 12.5. -
The medical'solids waste does not react violently with water or appear to be reactive. Therefore, it is
concluded that the waste does not exhibit the reactivity characteristic.
2. Does the waste contain contaminants that fail the TCLP level as defined by 40 CFR !i 261.24?
Yes _ No.lL Not Applicable _
Explanation: The medical solids waste of the types described above does not potentially contain any of
the chemicals on the TCLP constituent list. .
I 3. Is the waste a listed waste as identified in 40 CFR !i 261,30-.34?
Date Received:
APR 1 7 2009
Original Submittal
'/. ..
Waste Name:
WASTE DETERMINATION FORM 1
Medical wastes - solids I Waste 10 ~umber:
Yes _ No..L Not Applicable_
I Date: 2/25/04
Explanation: The mediCal solids waste is not a listed waste.
4. Does the Waste fall under the'Additional Waste Definitions included in OAR 340-101-033?
Yes _ No L Not Applicable ~
Explanation: The medical waste solids does not potentially contain any of the chemicals on the list of
constituents in OAR 340-101-033
5. How will the Waste be stored, labeled, and disposed? Universal Waste _; Hazardous Waste
_; Conditionally-Exempt Hazardous Waste _; Medical Waste _; Solid Waste _; Other.lL .
Explanation: The medical waste solids will be managed as follows:
. Medical waste solids must be collected and stored in leak-resistant bio-hazard bags which are stored in
labeled leak-proof containers according to procedure or guideline?_.
. Medical wastes will be stored in the Bio Waste area.
. Medical waste solids will be transported, treated and disposed by company?_.
Date Received:
APR 1 7 2009
Original Submittal
,
/
WASTE DETERMINATION FORM 1
I Waste Name: Fluorescent light bulbs I Waste 102Number: I Date:. 2/1/05
Is the Waste Hazardous as Defined by Oregon Administrative Rules ("OAR") Chapter 340, Division
101 (includes RCRA HazardousWaste Definition)?
Yes L No
Fluorescent lamps and ballasts may be hazardous waste due to mercury, barium and lead, and are
assumed to be hazardous waste by the DEQ and EPA unless tested or determined not to be hazardous.
Fluorescent lamps may be handled as Universal Wastes per 40 CFR S 273 and Ojl,R Chapter 340,
Division 113. Although the universal waste requirements are less stringent than hazardous waste'
requirements, universal wastes must be ultimately be treated, disposed or recycled at universal waste
destination facilities
I Products Included in the Waste: Mercury, Barium and Lead
I Source of Information use for Hazardous Waste Determination (attached): P'rocess knowledge
Waste Generation Description: Disposal of fluorescent lights containing small amounts of mercury,
barium and lead.
^
. Analysis
1. Does the waste exhibit the ignitability, corrosivity, or reactivity characteristics as defined by
40 CFR !i 261.21-23? Yes _ No..x.' Not Applicable _
Explanation:
The material is a solid and is not capable, under standard temperature and pressure, of causing fire
through friction, absorption, or moisture or spontaneous chemicai changes. Therefore, it does not exhibit
the ignitability characteristic.
The material is a solid. Therefore, the waste does not exhibit the corrosivity characteristic.
The waste does not react violently with water or appear to be reactive. Therefore, it is concluded that the
soil does not exhibit the reactivity characteristic. '.
2. Does the waste contain contaminants that fail the TCLP level as defined by 40 CFR!i 261.24?
Yes...x.- No _ Not Applicable _
Explanation: Typically, fluorescent light bulbs fail the TCLP'level for mercury and lead. Fluorescent
light bulbs will be presumed to fail the TCLP but will be managed as Universal Wastes.
3. Is the waste.a listed waste as identified in 40 CFR!i 261.30-.34?
Yes _ No L Not Applicable_
Explanation: This waste stream is not a listed waste.
Date Received:
APR 1 7 2009
Original Submitt"'l
WASTE DETERMINATION FORM 1
Waste Name: Fluorescent light bulbs I Waste 102Number: I ~ate: 2/1/05
4. Does the Waste fall under the Additional Waste Definitions included in OAR 340-101-033?
Yes _ No l Not Applicable_
Explanation: DEQ requirements indicate that if the waste contains over 3 percent of a constituent
identified in 40 CFR S 261.33(e) or 10 percent of a constituent identified in 40 CFR S 261.33(1), the waste
must be classified as an Oregon hazardous waste. As indicated above, the contaminants of concern are
Mercury, Barium, and Lead. Because this waste is presumed to fail the TCLP test, this question is not
applicable and is answered "No". '
5, How will the Waste be stored, labeled, and disposed?' Universal Waste l; Hazardous Waste
_; Conditionally-Exempt Hazardous Waste _; Medical Waste _; Solid Waste _; Other _'
Explanation: Although the.facility qualifies as a conditionally-exempt hazardous waste generator, it has
chosen to manage the Waste as a Universal Waste (40 CFR 273 and OAR 340, Div. 113) subject to the
following requirements:
. Waste lamps will be stored in cardboard boxes or fiber drums, which are adequate to prevent breakage,
at maintenance shop. Preferably, they will be stored in their original containers.
. The containers will be closed. '
. Lamp breakage will be minimized and immediately cleaned up.
. Broken lamps will be stored in a closed, structurally sound container.
. Each container will be labeled with one of the following phrases: "Universal Waste-Lamps," "Waste
Lamps:' or "Used Lamps."
. Waste lamps will be stored for no longer than one year.
. Waste lamps will be disposed of at a universal waste destination facility for recycling or disposal (such
as Ecolights Northwest or other, see "Waste Disposal Vendor" file for currently approved vendors).
. Employees who handle waste lamps will receive training on proper handling and emergency
procedures.
Date Received:
APR 1 7 2009
'Original Submittal
~
HAZARDOUS WASTE MONTHLY INSPECTION SHEET - FORM 2
Storage Area or Satellite Accumulation Area(s)
Date/time
Name
HGf!M!m' Work An>-a
Lab/storage area/accumulation area is maintained secure; door is locked, when
unattended.
I No smokinQ in area is oermitted.
I "Oanaer-H"azardous Waste-Unauthorized Personnel Keeo Out" sian is cested.
I
~ Eme~ncv ~ouinrrv!nt
Fire extina~ishef is Dresen! and fully charoed,
Date of last frre extinauisher insoedion.
Spill control equipmen"t (neutralizers, absorbent pads).
Safety shower working and nol blocked.
I Dale of last safelv shower insoectlon.
I
H(:ommllnir:minn ~v,o;.lF!""",
Phone accessible.
Emeruencv phone numbers casted next to ohone.
I
Protective EnuiDfllP.nt
Chemical soiash aoaales are available.
Prooer aloves are available_
Area
ll/o{aste Slream(s)
10 Number(s)
Comments:
"" -~a n -....-:.''''....'
UGH .i"'_..-~.
ArK. I ( t.UU~
Original Submittal
Waste Manaaement
Waste container's contents are identified and container is-labeled as "Hazardous Waste" or as "Universal Waste-Lamps: "Waste Lamps," 'Used Lamps:
"1lniversal WAste-Batteries," "Waste 8atterif'fi" or "llfied Batteries."
9O--dav waste containers are labeled with'the'daie accumulation beqan.
W:>'fite r.onl.'linem ;lre kenl rJm;erl
Waste containers are stored within secondarY containment.
Inr~mpatible wastes are seariwated in secondarY Containment.
r:~ntainers are not lea kino. rusted, bulr1inf1 or damaned.
-p,e base under COntainers is in,good.condition Jfree of cracks_ oao.s and irnoP.rVious to leaks.\
Waste is not allowed to be stored more than 90 days in container stOfage area. The facility has not generated more than 220 Ibsfmonth of hazardous waste
and is storin.!J.less than 2200 Ibs. Waste in container storage area is s~io~ off-site for disoosal within 90 davs.
Waste in satellite accumulation areas may not exceed _Ibs, L gallons).
V\ttlen that volume is met. waste is moved to container storaae area.
Universal wastes have been stored less than one year.
All oersons manaoino hazardous waste have received proper trainino.
..
Waste Oetelll1ination Fonns
~e Determination Form (WDF) comoleted for each waste generated in area.
WDFs posted information u~lo-date.
WDFs oosted or available at waste aeneration area
Inspection,Topic
General Work Area
Emergency Equipment
COmmunications Systems
Protective Equipment
Waste Management
Waste Determination'Forms
General Work Area
Emergency Equipment
Communications Systems
Protective Equipment
Waste Management
Waste Determination Forms
General Work Area
Emergency Equipment
Communications Systems
Protective Equipment
Waste Management
Waste Determination Forms
General Work Area
Emergency Equipment
, Communications Systems
Protective Equipment
Waste Management
Waste Determination Forms
IOK
Comments
/' .
MAINTENANCE/CORRECTIVE ACTION - FORM 3
Forward to the Environmental Coordinator upon completion
for review and filing in the facilitv Waste Maintenance/Corrective Action file
1. What is the problem being resolved through the corrective action:
2. Who performed the maintenance or corrective action:
3. What date was the maintenance or corrective action completed:
4. Describe the maintenance or corrective action performed:
5. Describe whether any follow-up evaluation shouli! be performed to ensure the maintenance or corrective
action is effective:
6. Signature indicating the maintenance or corrective action is complete:
Signature:
Date:
Date Received:
APR 1 7 2009
Original Submittal
f'
TRAINING RECORD - FORM 4
Forward to the Environmental Coordinator upon completion
for review and filinq in the facility Waste Traininq file
1. Date of training:
2. Description of training provided (should be consistent wtth the training requirements'fromthe Waste
Management Plan):
3. Personnel who attended the training:
Name
Deoartment
Sionature
4. Signature of training instructor indicating the information on this form is accurate:
Name:
Date:
Position:
Date Received:
APR 1 7 2009
Original Submittal
Date of change
F-
ENVIRONMENTAL COORDINATOR ASSIGNMENT. FORM 5
Forward, to the Environmental Coordinator upon completion
for review and filing in the facility Waste Roles & Responsibilities file
Name of Environmental
Coordinator
Name & Position of Authorizing
Individual
"
Date Received:
APR 1 7 2009
Original Submittal
Storage Area(s)
HAZARDOUS MATERIAL MONTHLY INSPECTION SHEET. FORM 6
C,;p,lV!rnl WnrtS.Arna
lab/storaae area is maintained secure: door is locked. when unattended.
No smokina in area is oermitted.
I Inspection Topic
l---c;eneral Work Area
I Emergency Equipment
I Communications Systems
I Protective Equipment
I Secondary Containment
8plll Prev~ntion Measures
General Work Area
Emergency Equipment
Communications Systems
Protective Equipment
I Secondary Containment
I Spill pr=-,v~ntion Measures
~alWorkArea
I Emergency Equipment
I Communications Systems
I Protective Equipment
Secondary Containment
I t:!.eUl Preven~or:!. Measures
General Work Area .
I Emergency'Equipment
I Communications Systems
I Protective Equipment
I Secondary Containment
I Spill Prevention Measures
=.,.....'''.-....., El1uioment
Fire extinQuisher is oresent and fully charoed.
Date of last fire extinauisher-inspection.
. Spill control eauipment (neutralizers. absorbent cads\.
P.:lmmlJni...~nn Svstems
Phone accessible.
Emeraencv ohone numbers costed next to chane.
Pmtf!(':tivl'! Er..,i......-
-chemical sclaShaOOQles and crooer Qloves are available.
Area
Hazardous Materials
Com"EJ'~te Received:
APR 1 7 2009
Original Submittal.
Date/time
Name
Reviewed bv
~t:nnd;lrv Coryt~illrrKmt
Hazardous material containers stnmd in secondalV r.ontainment
Containers are not leakina, ruste'd bulaina or damaQed. .. ,.
The base under containers is in Qood condition (free of cracks. Qaps and I~uid-t~qht.l
Sumps and collections systems in oood condition. draina{le system to controlled location
Containers of stronq acids are stored In polvethvlene lravs or tubs
Incompatible materials stored separatelv
Soil! P~v"nt~n M":l';:Ii~
Hazardous material containers are labeled
Hazardous material containers are kept closed
All oersons manaoino hazardous materials have received praDer trainino.
Storaae areas clean. well--liohted. aood condition
No hazardous materials stored inapprooriate locatiot'l.~
Emptv containers rnanaQed properly
OK Comments
I
I
J
..;
j
I
1
I
I
1
I
I
I
I
I
1
)
, , .
ANNEX A- HAZARDOUS MATERIAL INVENTORY STATEMENT
Date Received: .
APR 1 7 2009
Original Submittal
,..,,"'-,.... ,.04 1",1u.-
"- H_do....""'_.ntl ...
ONAPL.
J'Ntorlll C",nin, ProducII
C<>mo< "-'-" Clllawn~. Nono ..... -, - - ,.
Nono 1311-63.<88'l\. '-'" lmOl_ p....~'*' - ''''- IiNIlh.SIlghl(IJ --
PoMl.-CI__WIIh EVSclc>Mt.15 R.I'" ~... tb>e(0) "'"
C_ -~. f'leadMly. None (0)
CONfJ.-R-OUST """""'~. ,-...... " '" 1J38...43.8,<5'11o: 19....",P8IEVS15I1~OI.... ",",eo. .... """'" --".S6Ighl{11 -- ,.
~~m ........ 74-~.<5'11o, cIoMIl.3g'" F.2.... ~I<e. 58_.(41 "'"
:eobl"Uo,. 76-2&-5.<10'll0: qNdrvlly_None(O)
UghlfWIphtt.nlcd.BlIIllII. ~141""""2,10-
1"P8fat1inlC ..... 84142....~
.-. ~,<10'll0
::O"ll'wIdeO...... s_ Nono No~ No~ 148Qll.-4lG.1: 19a1loopelEVS ,,,aIonOl'" F'IeItIcbollle - StOlage >iedt>.Slighl!11 -- ,.
C........ '" .OOle 21116-81-0; ;:Io&eI"Jllallo.. ...,~ F... None (0) "'"
oW IlOI6-45-g R...d",~y.Nonoo(OI
......""
::.--.o..cyT_ "'alkyl0l<nelhyl8enzyl CUroow HeelhHal.-d " 56424-8S-1. 19a1loope<EVS 1".....01_ "- ..... .... '...... -lMItl.H'IIh(3) J-.Ion8lcloHts ,.
....0-- .......... )06'110; 1841-01-C1DMII.3g..... N.l'" F...None(OJ :EVS)
.- 0.23% Q"'df'/lly. Slighl (I)
er- N<<*. NA ....-...... =--...- ,,~ " 5ll3ll1'()1-5,<I!l"" 1 gallon 1* EVS IgllllooOl'" "- ..... - """'" ......$IIghl(11 --. ,.
-- ~1N.<U% ~.3g"'" ...,~ Fir............(21 EVS)
t,Io;yl_hyl~. !1~J...O,<5'11o q~"None(OJ
If'J'll'J"OOOIUmchkJod.
,.mOft ,.,,"~ F.............G_ ""'... " 10&01-8. tJO.10'll0: I geIIon pel Ev5 15n~OI"" $pIeyCan ,. '- ........~(11 -- ,.
C*-'u G..... R__ ........ 74-88-tl,2O-3O"ll.. '*-811.311..... F.2'" F....s.-.(..) EVS)
,-""'"' EIhyl.lo::ahll 54-11-5 q~.None(O)
k-.HD23Bowl -- CUroow ......alhHazard " 7G41.()I.o.23"". IlIalloope<EVS IgalonOl_ PI~bollle - -.,. ~.High(J) JwvtooaldoMlS ,.
CO- ...."" ;J016-45-9 cloHI.JII..... ...,~ F....None(O) EVS)
RMdMly"S/IwhI(I]
Coulwid.0<8tIg.Gal ~I.cnoxylale Nono No~ No~ 1101l1:i--4"1l.1t>o 1 gallon pe<toVS IgallooOlIeu. PI_bOlIle - SIOfage _1th"Sll\lhl(l) J"""'lal doHls ,.
""- can. _1Iet. "%. cloHIl.3gellonol N.l.4 Fir..tb>e(O) "'"
~Q-54-0.5G-1MI ~eedMty. None(O)
~eO<""II.OI "".ngeOll Nono No~ No~ /IUll,<I:>"". 18a1Ioope<EVS IgallooOf.... PllOllbcbOftle .,., SIOf8lJ" _nh. SII\lhl 1') J"",lonaldDMII. ,.
...." .MlXed __ 01 &.\lv ead "<15"4 i:loe:8l..Jg..... ...,~ F...SI9ltIII EV"
RNdrvIlv..f<<Jne(OI
t::ollslwKl..ReIlecboo "'......alapltltll ~lIimmabiol>quld " " 54141-85-',26- 1 gallon~ EvS z::;nOUl1l;8801"1M& $p'.vClIn .",. SI01""II" _1IIl.Mod"'81et2 JlII1IIorIal~ ,.
....- ...., 84141..(16. ::to...c.38811o.... F.2'" FIf..S._.(4) evs)
,.., \,' .... !."o-5O'll.. 812. 'l:eedMty" None (0)
1ol.....0ll )0..4.<$"". .,,,
UqUlliedpetraleu'nIl_ 41-6,1S,2O'!l.,
5&U6-M-1. 1~
Shin.up Lemon ,...~ Fll\l1101ablellquid " " 10&-91-8. <~"". ".""""'1"".-..... Sp'.VC.o .,., Slofl>ge IHufth. None (0) J8nIlornolcl::lMlts ,.
........ 14-N-8,<5'11o cIoseI.JIIIIlIo F-2-4 F....S._.(4) EV"
,......... 16-2&-5.<5"". 'l:iMdrvity..None(O)
-.--. S41"1-&&.e,
s_ 8314&-82.0
SlrldeC~rus Sup.. >\k:ohoI.ttlO.yIal_ ,.~ H_hH&Z.iIrd " 3431il&-01'1, ,~ 19a1loope<EVS 19<>lIooOl".... PlMibCbolUe - S1orag. IiNlIh"Mod..81.t2 J.monaIdo8oIQ ,.
Sod,um.yten....lIonat. ""' cIo&eI..3I1RIlo.. N.l.4 F....None(O) 'EVSI
1300.12.1 ReM:If'/lly" None (01
::\Itc !'1~c~i' 'Cll"
I _ _.. ..
WVCC HMIS Pll9.1
APR 1 7 2009
::>riginal Submittal
I H.."dm M~""1",7nIO Statemlnt tor WiIlamltt. v'~:41:..r Cu~ April', 2001
. -- _......&.. - - I
.....,"'_,.... ".04.. OfCtsfC CfC/SFC Haufd -I... - ~~ ,..-:::- ._... ""1''''''. I ''':M<]
"I 1_- Condition. a..-of
.,.. t--..., --. [-- ._- CAS' ~(.i'nit OltUIM,ISI&" (ClIlTK hb"" M....III1 Clanlfk:ahon LGCMiGoIt C_~
Mat.'IaIN_ ._IIIIC.... tCIlTKhb..', lunlt...otIIdl DMAI"U
G,8S8CleAr.---..... ~emo'":;rat:- -~-~ - None /l84~6-3.s. 19a1loop:"E\!S ;':8IonorleM PlMllcbollle .... Slofeg. IHMllnaSlighl(11 J8IllIOfialctos.olla -Ill"
ConcentlltleSulll8lnable NoniontcMlICllInl ''''' 68\1$1- ::loMC=311"lkmll N-'.... :....None(O) (EVS)
Earth (11 t&-G,5-10% ~udiYCy" None (0)
N_IIlMulI.......Cleaner H\<drogenpero...ide No" No" NoM 7722_84-1.""%: 1 gallon per EvS 11IalIonorlBall Pl....tiebonltl .... StorllQ8 l1eaKh*Slight(1) Janitorialclo$ats ,,,
SU8t.._bIeEarth64 Ak;ohoIIllh<>Jlylal.. :l843~46-3.1o- ::lo5eIa3galklllf N-'. :n..None(O) EVS)
,,% 'l:8lIQllnty" None (O)
......vyDuly Gener.1 clYdrogenperol<ida No" No" No" M3QI-0l-5.<3%: Igallon~EvS 19a1looor_ Plasll<;boltlto ~quid Storage 'ielI1th=Sloghl(1) lanl!<.>nalck>6ela ,.
I'>ur-poseCleaner AA:oha'eCh'''yllrl" ~()Q.2J..O.I5- ::lo5eI_3gallo.. N-'. Fif""None(O) eVS)
SUOll8lllableEarth65 "'" ROItdrv'y'" None (0)
SE6tlO....Iad.llrI "'kyldomethylbenzyt TOJIic H.....IlhHazard " il83111-01-5,5%; 19a1lonperEVS Igallonor....... PlastJcbollle .... Slorag. rlf;allh = Mooel.,. d Janrtortel do&8l$ ,.
Senibl"r iIIlYTlOnlUmd*lnd. !5409-23-0,5% :10&81 = 3g&IIo/'lll N.l.... ~ir. = Slight(l) ,EVS)
'lkyldimelhyl9l11ylbMlZJ 'lsadiYlly" Nooe (0)
lIITlmOniumchlond.
....estvoom C"-- ~ydrog811pero.id. """. ~" No" aB3fll-ll1-5,<3%: IgallonperEVS 'llallonor...... Ph...bebollle .... Slorage ,....Ilh= Slighl(l) JanIlofialdo6ets ,.
Su.teonablo Earth 70 \b:!holelho.y\aI. il6409-23-0,I5- :Io5eI=3galloflOl N-'~ =". = None (0) EVS)
"'" 'boaCllvrty " Nor>e(O)
ColUltwideVIef'r&llh oflablo bederl8l cull.... """. NoM No" .......5-15%; 'lIe1lonperEVS 19a1lon"'.... P185bcbolll. ."'" Storag. ",earthsSlIght!l) Janrtonaldosata ,.
""""0.., ~sylaledfeny8lcol'o1 Ml221_Z1-0,<5% =loeel"3galloflOl N-'. 1"'-_'01 EVS)
Readrvlty '" None (0:
C"""UBnI.Boy E...... """. No" ~~ 114-17-5.5,3%: ,....". EI"."~"" F'l85bcbol1le liquid Slorage """'llh=None(O) Jarvtorialc:lloMls ,.
^"'"""" 1004-41.7,1.6% do&el"3gallo N-H =ir. s None (0) EVS)
Reaa....rty" None (0)
C~,Ga~.. - - - -- - . --
Oxygen Tanks (Soz. E) 0._ OxodoZ>"Il G.. Phyaoeal~d 51.22 "112....7 'SX1.ooll l.'C<.llLc~ C._ - s"",," '__"_rO) n"'oreg. ,.
",","", l-2""" ~... '" None (01 nlu8'OfllOOm
.144001'1 luc~Wy. ~ (01 1ll:Ir"ll"
SPeC;OeI-OXY
OxyyltnTaoks(Sil.E) :::'xygen O>Jdizlnv G.. Pllya;c.l11uar<l 6.1:22 1182"'4-7 lXZ.oo,1l ~.1ClJfLc~ C_ ... """ _.... " None (0) ,Jr,...t>eeIodcart ,.
~8l1l l-2""" ~i,,," None (0)
_48cu,1l "leacR.,tysNOI'\8(0) nlusionroorn
~_oxy
Co",-_ H.allhHaZBrd
- - -
" '7681.52-9.615%,'lgllllo.- '1 gallon or""'" Plast1o;botueljugl liquid
13Io.1J..2,"'1% N.I-4
',0 1681-52-U, "'1% '........ 3Qxol5pollndsor Bo. w"'
_-100 K_1-4
nd,vidualtypackag.
.,.
" 51-63-0,10% S boxes (s1ofaglt 1 1b0l Ie6s box 01 Bo. '"'"
l"=1611 lJd,vdualpackell> K.I-4
51""_ ."'t."lIIl" Uod_1t(:Z"Tnag"lIlorag8
~ir.: None (0) ar....
~eactn/Ity.. None(O)
,.
r..., 'P'....... . - . 'ft' .
~.tljnt Tl1IltrIlltnl & SUfport ........ Ind PNrmuy
aleed1 s&.lllm hypo<:hlor~" l:c,...__ H.lIllh Hazard
!Cloooxor aimilB') Sod'OO1hydrol<id.
5IeachW"",(Alcavie) Sod'llmhypochlolillt
SIot_ -leaIlh=I.lQd"r81e(~ PhlUTnllCY
Fif"_None(O)
~88dM1y" Nor>.. (0)
,.
\la>I101.....~& 11IOpropyIaloohol
alooholprappada
:Webcx>I)
Trll'illll$ Ie_Ie
Flammabl&l.iquid
Slorage ....aIIh.S1ighl:(l) Infusionroorn.
~ir. a H'lIh (3) Trlaga.w.-age
~9ItdNIty. None (0) "-811, .......
<l;IOfJl&.mnlilJft
~
,.
Date Received:
WVCC HMIS
Pag"2
APR 1 7 2009
Original Submittal
-
~-~
"""
lI4-11-5.J&.40%:
1~21-(1.'!>-
l2%; 8000-13-
S.3-<4%;
lbo~MtlO 10ampuleapertxn
ImpUIMIboX8nd
3.33m11""""""l
lmlzeO.\
"'00
IChIorllPrepfREPP 1I&opr1)pylBla;!hol ,....- ,B_tC .. ~7.aJ..O. 10"ll0; lbo:",,,"2Sx Il.5m1per""P'Jllicalof Plashcyialin
AppIICBI<K1.5m1 ChkKheJr.idlrMlgkK:llnale Flammable liquid 18412-51-0,2% 15m1_15rn1" 11 packag... 25 po>r .,..".
cOlgallon box R.''''
C.r8BlIllRXdeodonzer INo hazardous iflg,erhnl CDmbl.ooWe l.JquId .. '" E6t20CII"=~ '?5MOI.nC86OfI_ Spray Can
speaf>8donMSDS T.... F-2-4
.....
.....
1"""'~""'_ITo' ...~ ''''''''-''''''''' ..... No_ ""'H~ NonaSpeci6Bdon 'gallon IgallonDfI8ll4 PlasIJcboltJe """ Storage
Of comparable) tIiod"'llrmableamofllc IoISDS N-'~
Madam.
10Ish de1erllunll pOwd.... Sodium Cart>onala; - - ""'H~ 4\)7.111--8; 5pounda 5p<>U1ldboxor1e5s ... lioO~d Slor"'ll<'
(CIIIiCIIde01 colt1parllble: Sod'OOlS~icat.. 13<<-011-8: K.l-'1
Sod,umPerCltlbonala; '563().f1~
Hl!f'IdS","I)l"...-IP..elOf :lhI'lAlootlol: Flsmmabl81tquid " .. 114-17-5.62"iIo; lllal:loo& 16 ft Oun<;8 or I..... PIaslH;bot\18 ..... Storage
~ab"'l "'- 87-63-0.<5% N-1-4
-- Hydlogll<1P..-ou:la, Flltmm_Uqo..Id " ." 1122-84-1.'"-5%; Ig8llon 8OZo'....... PlaGbcbotlle ..... $loragll
IElhllflCH.me1hanoll\1l,o; !lOl~52-3.~ N-'~
IHydrog9llJlO'O'4da3% HydR>!Jenperoula - ,-
f>ho&p/1oficacid
Y8l<iwlpalilerTrOcide laopropylaloohol T..ataa "
- 1000al8mary amomum FlammablelJquld
C"PO
l,4etriguard I80PIOP""OI Flammable liquid' "
aurf_dl6lllllltCtantJ Elhyl8nelJlycol
~ec:ontamnanl ca-r rnonobutylulhtM
SupelS~ l80propylalcohol T...at.... "
3&rmiddalWope(POI) OualernalYUlT'IJnrurTl FlammlIbleLiquld
'"PO
"=''''"''1''''''''''' P'.IIChlo~n...laxytenol ..... No_
Ernoll'8OlS8nd
""''''''....
1'00__- -- T..."'.... "
SulytE5IlWofF'VMIMA FlalTWTJ8blellQUld
:opo!ymefwlullOn
"-<:8IytlnbutylCltfale
So_ -.c,llazard01...inyred,etil- No", -None
spea(oedonMSDS
Date Received:
APR 1 7 2009
Oriainal Submittal
,- 1722-.84-1,3%, L_lhanl 16 II ouno:e P'IastictoolllB ~qllrl ,~~
1664-3&-2 ,Om N-l-4
33 61-63-0.55%; Zcont.m--s.{131b0f1es4p1aslK: P'lasllCcont_ ~.. Storage
68391-01-5/6656- b=61b ~1&p<lfl&Bf COl1l3lnef N-l-4
7~6.<1'lto
" 1174J3-0,I7,2%; E3I20_.. 12llounceOfIeo>l; PlasllCbonlelj14 ..... ,~~
111-16-2,3% 12llol=5 N-l-4
T....
... e7-63-0.S5%; ,",TO 31b0fleo>l;plIIfitic Pla6tlCcont_ .,,, SIO....{Ie
68391-01-51 ;:on!a1nBl1l.31b ~I6pBfJS8fCOf~_ N-l-4
t181l!;6-7tl-6.<1% .".
No",
!lB-04-1.3<lIo:
""
5POllndS Ind.\l'lduellyW\'epped """" ~quicl SIOfage
nBo.Ofp\8flt!C Fl-l-4
lcont_er
a 12 IbOf Ie66 bOJI 01 51. ... ~.. Storage
ndlVldualpad<e18 K-l-4
.,
61-63-0:
25119-88-0:
17-f#G.l
No",
""
Zgallorvl
121l0unc:e0l1e68
P'Iastictoonle
N-'~
-
WVCC HMIS
"'PA1a"
Cl...if!f;euon
1_-,- -I~
baluatetl
.. L~' ~ ~~ D,.':;.L.
InIusionroom V_
>0..,,,,,,,
"K>neSpealiedon
,,",SOS
Slofege IiBaIlh=Slighl(l) nfus.ionlOOm
Fir8=Hlgh(3)
~ead:MlycN<>oe(O)
SIotage Heallh= Slighl(1) Infuslonroom.
Fire=Slighl(l) TrUtgeGlor"lle
ReadMty" None (0) .........em
l)(>fn&,conauft
-~
HeaKh=Sllghl(1) IBreakroom
Fir8=SlIlIhI(1) tIlutntional....
Reactivily=tIlone(O)
H8a11hc$l'llhl(1) :lrOPltroom
~ife = None (0)
~eadlYoty" None (0)
Heallh " Slighl (I) Vanouswon.
Fire = H'Ilh(3) ~allD""
Reactivity" None (0)
HeaIlh=Mod....ale(2 nlusionroom.
Fife "Modefale(2) Tn"gell1orage
~eactiv1tY" ...........am
\4oderlJ\8(2) ~.QDfI5U.
-,
--
H....1Ih= SlIghl(11
Fn = Slighl (1)
'teadlvoty "None (0)
nlusiOfllOOm.
TriagelJlorage
"u
-1eallh"S1ighl(l) Tn"llillJloragll
jFire= Hig/l (3) ......
Reactiv~y"None(O)
HeaIlh"Sfigl1l(1) Infu5lOnroom.
Fire=t.4od....ale(2) Triage6lor"lle
R....d:rvlty=NonejO) Jrea.elUUTl
~_COfl""'.
-1&al1l1"S1ighl(II Infusoonroom.
Fife-HIfJh(3) Tnagestorage
ReaclMly"tIlone(O) ........e....m
roornI.COOSlln
-
>iealthaSlighlll1 :>harmaCy,
~lre" None (0) Triage &Ior8ge
Reacl,vlty a None (01 .......
-1eallha S1lghl (I) "n!uIIIonlDDfll
Firil "H'Ilh (3)
Readiv~y" None (O)
SID/age :-IeafthaSlighl(l) nfu&ionlOOm.
~ife" None (0) rriage *"age
~ead:ivity" None (0) ..........em
'OOmS.conauJ
-.
'-
Sautlbrumw<th
"CMXdeleryenl
--
,-
,-
,~
,-
,-
,-
,-
,-
,-
,-
,~
,-
,.,.,
I t..mdO", ur"ri"'.".to'Y .....m..t lor WIlIom... V,II., em,,' ~'" Apri", "01 ~;rII:iiT~::M'
I~' - - I - I - - ~r I' i -,-.. Stof.... .
O'CtaFC OFC18'C HaufO I r "alIliI Open 01 ..F'A704
_am. I~':':i J ::... ~ Haurlllo". NQ..4ou. .r: \ fjlWlll CAS. M.. Qll"ntJty 'OtC'ontaiOi.t 111.1" C:onditlonl ~-: C..... CI...iftcatlon ,.......
III' -'-181"'_ ~ialC".. ICIl:TKh,...1 lunllnOModI luniJ""'"l tCIl:T1(T.b". - -ffr-
[s..~........_ c:;;:::-..=:-- -,:::::-- -lI/l,I- -....1 "".!I-""'" ,'1'- I ~~Ii i ~ Coo -- SIo.lt!}9 Healh.Slight(l) Tflt\IelllDrag8
powd...(oo""....llblIllo So<llumcarbona1e 4Ql-1Q-8; F-l.... "ire_None(O} 0"
Bon Ami) "eIdapar 08476-25-5 'l.MdIY'y"'N<lo8(O)
Slrl....SaI.. Sodiuml'lypochlorile To.;';; H_h HBZMd " 'll81-[;2-1I.2%: '..... 1 gallon or IeM Pl88bcbonle "'" SkMage -ieafth.Uod....le(' '0- ''"
Sod,umhydrolUda 1313-73-2. N-'''' "ir...None(O)
Sod'umlaurytsullllle cQ07%. 'l.eadivty_
151-21-3 '.Iod<lrale(2)
?ovrlonelOdine PovidolMtlod.....a>mpIe' - "~ Non. Specified 2SllS5-4141,3'llo '" llborles6bo.ol5C" ... ... SlDr&g" -I8aIlhcSbllhl(l) rnagesto.age ''"
twabStid<I(Betlld,no) onUSeS ndMdualpacklltl K.l.... ".,"'None(O) .ea..xam
'l.8ltClivily._(O) QOf1'W.,COl1S1Jft
-
.,niSolveWipes llOpropylalcohol Tlul"" " " '1-63-0; 1 bOx. "41b lIl>OfI~boltof5t Bo. ... Slorage .ieaIh ~ Slight (I) Tfiag"sIor8IJ" ,.
CIQ-1111lOp/ir"ffin FlanYnablellquod G4142"'a.,,: nd,Vldualpackal5 K-I-4 Fire ~ High (3) v...."ltaITI
OIpropyleneglyoolnKllh, 3ol5llO-g,4..8 'lead'Ylty ~ No"" (0) "00""', CO/'''IU~
- ~
iAbW:torY
iI>Jcoh:>lpoepp8ds I'SOpn:lpylalwhol TrMas 18_1C " ~l.ll3-O. 10% 2110.._411> '~lborl_boxof Bo. ~.. Sk>l&g" '-iea/lh ~ $Irgl1l(1) .." ,.
:WebcoVCunty) F_...... oo'vdualpadllN K.I-4 F.... High (3)
Reedivity.. Nooe (0)
::lharolr~1of ;lhyllllcotd F_...... " " 34-11-6.~: 12ft~c 12f1ouncesorkoss pt"r;bcbollkl '''''' StOlag" Heafth..Slllll1l(l) .." ,.
TOSOH ,Methyl alcohol 51-66-1.5'1.: )~galloo8 N.I'" Fir,,_High(3)
:.:lPlopylalcohol 51-63-0.5'1. Q...dlV1ly.. None (D)
:lecdownAnl'microblal No hazardouaingred..,.,. - NoM NOM '" 1 gallon 12 ftounc:esOf 1_ Ptasbcbollle ..... Sloreg" i"leallh..Nooe(D) ~, ''"
'""'~., opecdiedonMSDS N-'~ F.,,_None(D)
'l:..adMl'f-/IO.>nIi(OI
:JaOOown Gel IElhylalcohol FlammabIeUquid " " 34-11-5.62% ,....., 12ftolft:8&orlesll PllI5bcbollle ..... Slorrog" -iee1th_None(OJ .." ,,,
N-'''' rir" " High (3)
ReedlVfty..No",,(O)
!larJ< 1I CIeen up K. Nonhazilrd<:></llZorbrlol - NoM NoM '" ,. 5lborle&s Bo. .... Slo'age -leallll" None (0) -." ''"
PlIapotl'f"M K.'-4 FirecNone(D)
Read,VlIY" None (0)
Benzall\OniUmchlonde Non..> 1'1. No". ""'" No". '^ ~ box...... 4lb ZIbOf......boxol Bo. .... Stolage 1"_"_'" '"",, ,,,
:Owel8l1911 ndiVldu81pacl<eta K.I'" F......None(D)
Reed"'."... None (0) ,
".." ISodlUmilypodllol... COlTOoi.... Heall.tll'lazard I " '681-52-1:1.5,25% :lOftounces..D,~ .34ftoullC(t5wl_ PlastIcbottl&'jo-. ..... -... 'l-Ieallh=Slighl(1) lL8b ,.
J..... N-1'" F.....None(D)
Reed,viIy" None (0)
SuperSllI1icloth I'"'''''''''''''' T".a1as " " al-63-0.55%; ". <llbofind,""'ua1 Bo. solid SkU8g.. l1ee/lh=Slighl(l) ... ,,,
G"nm;:o::I8IWIPl> QuatBfn"'Y8n.,mum FIemm8bleUquod 583"'-0'-51 -.. K.I.... F~e" Hrgh(3)
.8loodb0m8Pil1hog.... C"'" $8lI56-1Q-6.<I% ~....dJYlly",No.....(O)
'_por,,;..k~)
BonAmldaarni<tf ICalciumC41llollltttl - NoM NoM 1311-60-3: ,. IlbOft..8 Pltperlubttl'Clln -- Storage 1-i8alth.Sllghl(1) ~, ''"
Sod,umcartx>nat.. '''1-1~8: R-1.... t..,,_None(D)
F_, 58416-25-5 j;l83dlYlIy '" Non" (D)
IC_"'''''~'' 1".- I'-~'. " " 57-56-1. 84-g4%; 1.25gallon I gaRon Of 1_ Plasltcbolllel)""'l ~quid S~... -leallh"Mod...-ItI..(2 _lib ,,,
QutdcSIeinFIltaI....8 """".. 5;2-5G-8.<1% N-'. F..... Hlgh (3)
'leect....y" None (0)
::hkKaprep2,Q% IISOpropa"lOl FlammablttL/quld " " Gf.c3-0.1D%: lbo.....=.lb llbOfI_bQxol Gl/I&8viBl "". ,~... -ieellh _ Moder_(2 .." ,..
..-... Chlo/heXld....gluwnal.. 180672-51-2.2% nd,wualpacl<elsol M.l.... =ir.._Higtl(3j
~lasa vial ill5lde 'l:eectMly" None (0)
_m
/""","",,."",m..- ,....."... Ja NoM - NoM !l8-O4-O. L25~ Ig8110n 1 gallonorl8u ~-I ..... -... -1....lIh.No.....(D) .." Used in lab liOep ,..
IotionliOap . N.I'" F.,,-None(DJ -
IJ.:m:o ~~C'~~\_" : R....dMly .. None (0)
V'NCCHMIS p....
APR 1 7 2009
Original Submittal
I H'I.,d SIot'II',
r..II"_r.......odll Haulclolls l",'''_nb OpHor NfPA1U
.- CI..lificatiotl CAS' C.... C"nlfiutll>n
1(;~TKT.~...)
Envy F09lnll'll ......y1dlmlllhylbenzy1 flammabklLiquld " 32 tlB3Ul.o'.5.,'"4; 'gallon l5 nOU0C8SOf 1_ Spray Can .... ..- HezlIIh_Sloghl(l) '"" YM
:lir;in!ectlrnlcleaner IofTlITlOfliumchlolide iSllIl56-1H,,1%; f-2-4 Fire_ExIreme(.t)
'l-A1kyld"'**'yt 145gMI4-8.<5%; 1teadMly"Nor.e(Q)
lIthylbonzyla........mum 15-2&.5,<5%
""'....
O1propylonegl'fallmetnl
1::O~a...
FOlmallnlO% 4%; ,,~ Health Hazard " ~.4%; 12WJl......wml"\omlYlal G'" _ - Storage "Iea1lh_Mod...-lIIe!2 -"" ?n><ludcontaroer YM
SO::llumPhosphal" 1()()4g..21':;,<I'Yo; 2880mI"_ M+4 Fir..Shllhl(l) .epllns68ied
1>OfIObasic."'I%: 155a.lg..4.<1% ihan11lallon R...cflVlty.No.....(Q) :Jlasticbag
Sod,umF'tm6ph.at..
.:loasic.<l%
3asOust. 1,1.0 .. Flammable gas loquidfied " 15-31-G 1118110n zsnoUllC8SOflesa $pfllyCan .... SIoUll18 """"kh_Shghl(l) '"" YM
f-2-4 F....Sever.I..)
RMctiv.y.Slighl(lJ
We,", G~ Heel and ham Sodoum acelale ""~ Noo. .... lu-og..3 .,. ~ l/bofond,,"dUIII """ - ''''- ",..aJ\h"Slighl{l) -"" YM
..- -.. K.1-4 F.... "S11Q1ll (1)
ReadMly" None (0)
-- ~~anPr'~~ FIom"'_lJ4.Od " " 1122.&4-'.<5"4; .._than 1 aozorleM Pllllillcbollle ..., StOfl'lIe -woallhot.lod9<ale(2c.ab YM
9Ot~52_3.~ ~"'''n N-'. ~inl"Moder"'e(2)
RNd'wy=
Moderele(2)
Hydrochloril:&e*l(HCI) t-tydroehloncacld ....... He"llhH~rd .. 7041.01.0.3,65% 15OOmI"0_13 """" G..._ .... Storage HeaanoHIQh(3) '"" YM
IN8Olulion ~a1lon M_'''' ~ife" None (0)
Read.lVityII 5light(1l
H'fIlrogenperoxld.3% Hyd.ogenperoXKle - - N_ lU24U---l.J"JIo; Ig"'lon 12nouncee.o.-l..... ..._cbollle ,,~ 51"'_ Health " Sllght(l) -"" Y-
PhosphoncltCid rll64-a&-2 N-'''' ~"e. Sfighl (1)
ReadiV1ly = None (OJ
"-- SodlUmhypc;idlIont" ~- H....lthHazard .. rti81.52-Q,0525% . pounds 3oxor..poundsOf ,," -" ,~- He.a1lh*Mod",,"e(2..ab YM
.....-100 K.I-" F... 0 None (OJ
ndl\fiduallypackag& Reaclwdy "'None (0)
-
Ifl1mMSIOn o~ ~hazard~ - N_ N_ NA 1 gallon 12 n ounces Of""'" P186l1cbollle liquid ~- t-t"altn " None (OJ ~, Y-
.., ,leq>henyl N-'. Fino- None{Ol
llI1dttMpheny\ R...d''Iify=None(o)
10000!.-p<tJJ>If_1 ,-"""""'" f'lernmable~ " " 57~.10"Jl0 32 nOUflCN '" 12oz, Of leas P1asticbottt" - SIOf"'il" -ltNlllhaSI'll"'(1) .... YM
'WbbngAloono' 025gaf/on$ -,,- N-l--f .,u, " Hlgh (3)
R....wv~y = None (0)
Kleen and O'Y. comput... l""pfOpyI...~hoI flllalas lEl_1C " 57-63-0.30%: lbox..."'4lb 2 1b0l """'box 01 "'. -" Star"!!,, -leallh=Shghl(l) _00 YM
fO"eM>clea.- Ammonlum hydroxide FlamrnableUquld 71164-41_7.0_05%; nd'w.!ualpackl'ltsor K-l'" F"..=H'IIh(31
,lJkytdomolhyt~ ll83"'-Ol-5,O.l%; ~asbcdlSJ>OflS'lf ReadMly" None (0)
ammonium c:tIIolid.. 1189$6.7\1-(\.01% ..mla,ntM
I". ,-"" """
benzyl"rrtTIOfUum
-....
r'~- ,-"""""'" Flammable Uquod " " ~1-63-0.172%: 19a1lon 12ftoWlOll P1astiC"fl'8y .quid ,~- ~1tIl=Skght(l) -"" 'M
.....acedl&inlect..-cl Elhylen&lIlyool 111-76-2.3% ...,. IFire = Mod...-81" (2)
d..... .deane. -- N-I-" ReadlVlly " None (0)
"'"' Trielhy!eoelllyOOl FlarrrnableUquid " " '12-21-6,6%: 19a11on 25 ft()uncesorlasa S",ayC..., ,- Slo.age -ltNl'U.,"'H.eIIh(21 .... 'M
IlIObut_ 15-211-5,<13%: 1'.2'" ~.." Se.....'.(4)
_0. 14-91l-t1;<13%; RINIdl'i~y ~ Noo..(O)
I'"~ 106-"7-8.<20%,
,- ~11_5.<70%
Date Received:
APR 1 7 2009 WVCC HMIS Pag,,5
Original Submittal
I HIZUdoUII Material Inventory Statement for WIII.mette Viney Cane., Cut~prll'. 200.
r --- J - - - j .,o;,e -I-O'~'C I H~ I l--~'~"-'~'j .... - ~ -a_...=- -
C'''":::' ".., """!.=1. :,::.::" .:=::-.:.. . .:=~~::.. l;::;~:::;' .... ~::~~-::::''7 ..~:::~ ,e;~;:'=':. .-.. Open 01 HfPA704 L.......
1II_1a1 e..... CIa..~lon
:k:r!:l\;:!;" ~_ 'i=tJi;1.l-/1- " i7..Jf~ rJ~I!l.- Iii,. "'_""'. ..'" -... l-iH~h ~ Hlgh(3) 'Jl'--
?oIyvinVlAlc:oholfi1.ative~K;acid .....w H&aIlhHlIZMd " $4-1Q.l.5%; ... M.l"", F.e_Hogh(31
;JolyWlylltloohol ';1002-89-5.5%; ",eactlV~y ~ Nooe (0)
l,4...curicchlonde '''81.04-7,3.4%;
:otycerol >6.81-6.1_6%:
Hydrod*mc acid 7647.01.0,14%
Par,..PakZn-PVA Glycerol FlammablelJquod " " ~1-5.1_Q%: 1118100 ~olorleM.III_ Glaasbollle -- Storage '-l""Ilt1"Uoderlll.(i~ ,~
GlaciallOC8licadd To~1C HoalttlHazaro " fl4.1g.7,4.lI%; ""'" M'l-. ~..... H'Ilh(3)
ZlI>Csu"ate 144l>20-0,7.fI'Io "l.lOllcb'tlly"Nooe(OI
Poly vIflyl8k:ohol 1lOO2-89-5.46%;
Reagente~~ fl4-11-5.2$%.
Reag...ntnl8lhy1alwhol 51056-1.1.4%:
Fl:eago.>nlilOOprOpyt 87-63-0,1.4%
"""""
:>rotoooIBLdI.....WI'l!iIIi.s Sodlumphosphale ~~ .... .... 15-g-8-7~."1%: 11lalbn Ig.al!ooOfI8A P\asllCbotIleJjUll liquid Storage >i....Ith"'Sllghl(ll "" ,.
iJuffll,$ot.Jbon pH 6." jibasic 1118-11-fJ,<1% N-'~ ~ife = NonIl(OI
JoIlydrogenpola&alum 38'124-ll5-1,<1% ~lNldiv~y: Nane(O)
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-lyllffWW3500
~nbawOpClcs(H~C:O) 'lofl-.elcoholaolwent .... ,- .... '^ 1 gallon 12l1Of..nC8lJOflll&a P18611cboltle .,,,, ,~- H....Ilh"'Slight(t) -., ,.
"Y"lIlasade...... SurlaGtant N-l." ~ife"' NonIl(O)
C:_'Ullbklod ~eadMty"' None (0)
SpeIIkle""1 SodllJmcerbonale Toxic Healtt1Hazard " 4111.1ll-8,<3O%; ,. 5 IbOf I..... So. "'''' ,~- -lealth= Mode'aI..(J ~ V.
......ydf0U6 aGl6-45-II.<IO%; K-l" ~if"" None (0)
Ethy\enllDI<id. 25155-30-0,<10% R.lNldivlly a None (0)
~--
Sodium
Jodecylben~lQnat
IS....._~(KlfIr.land leopropytak.ohol Tr..al.... '" ,,' 81-63-0.8%; Zbol<....="1b ZIbOf less bol<of So. """ Sto,age -lealh a None (0) -., 'n
......"""', Qualemaryammonium FlammilbleUquid ZHN-28-3,<1% ndMdualpadlelSDf K-I." ~","Mod..ate(2)
Ct.4PO ~B6lJCd~ ~...d"'lly ~ None (O)
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ND-"O 6Jlph8lH;pIlIn>Ieum FlammaDleLlQuld '" " llO52..1.3,10%; 1 gallon 25 . Dune- Of IeH C.. liquid StOfIl\lIl i"iIlalth"' Mod8lale(<llab 'n
dlStdlale6 "'1"2-&5-0,20% F.2.4 F.e" Moderale(2)
P"cn:>leumba&&DfI Readllllly = Noott(O)
l(.() PlUIl Odol N_81IZEI E:._aloils COfTlPDf;nd .... .... .... "".1%; 'gallon 32 II ouncas 01 IIlSS P181ilicboltle Mquid ,~- H6a1lh = None (0) .." ,~
A1kylpolYIIlyooaidll 11061lH7.1I,1%; N-'~ Fife" None (0)
Quaternary ammonlUff1 !lOO4-24.(l.I% ReadiWlly" None (0)
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C81ylpyrid,niumdllolide 0
~
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ceu..o ~ 'N.fI_ HOB OuaterneIY ammon""" TDI<1e H"""hHua<d " NA.3.57%; 'x~Oml~376i~n~ Pl85llcc:onl_ -- Slorag. -tea1lh"t.4odelate(2~ IorkilIiooIllCEU.. 'n '3'
'NOCll'"' ... !IOOl.!>4.5,3.57%; Tllalgallon N-'~ F... " None (0) DYNnHlIgf"fl."'" III
BfllWHkonIumehk>ridll 81,63-0.286%, ~ll&dlVlly=NooIl(O) ,.on-haz",dous. /
11IOpropylalc:ohol 541ll-11-1.168% "'rthle/t....slBl'"9 (fJ )> Q)
ioiydn;ll<yIa<rrnanlUtl1 '10 MSDS'* -
C ""t:J CD
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I"m.o," eN-On o.ff Qu8lllffi8fYllrrmonium CombustfbleLJquK " '/A,30% 1l<3.8~lo.,.:1 3.81118111 Plao;t,cc:onlaln.. ..... SIOIagll Haalh '" None (0) .." ,~ 3 :;0
lyseReagWll ... 57-63-0.2.66% ~aalo.... N-'~ FIf.'" ModIl,,""(2) ;:;: CD
'eopropylakohol ~fIIlCI''''''y. None (0) - ..... 0
III
lem"'," " 'bhalaJdOUSIh9'IId'...JI 121<3m1..36mt3m1 PI8$licc:onlain", ,,- -... -lllakh" None (0) '"" ,. '" CD
.... ,- ,~ '^ = <'
H<<naIologyControII,lI, specifNMlDnMSDS :<0.1I1a/1on N-t..4 ~illl '" NooIl(O) =
'" R....d'w~y.. None (0) u:> CD
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=EU.oVNt':nzym.l.ic ."'. To~1C HealthHlIza"d " NA.22.33%; SOml"'<O.1 "''" PIMlicc:onta..,.. ~quid Storage HeeKh"'ModIlf.e(i Lab ,.
C1e8"er Concenlralll 1,2-propyt_gIVCOl 51.55-8,2025%, ~...Ion N-1-4 FN.= None (0)
'"oIyol<yelhylfmeeth... NA,5.3O%; R....d'Wlly=None(O)
Subtlli6in aGI4.01-1,2,67%,
NA.l.56"t.
WVCC HMIS Pll\le6
Hlurdoul Ult.rilllnvlntory SUitlmlnt' r Willam.n. Villi)' Clnclr C. 't Atril I. 200.
~"j 1 o'~'e I o'","e .....~ 'T""'""" 81Of",' - -1I1Of",. 1--- I _Uj__j
"_.. I Mh. Q....,llty ~ '.l~1 , .J.' .1, C0n4ItkMl, a- of o~ 0' IiI'PA7lH lval...ted
.l,;;,t, . , ......... "....., ......." "_..~. CI..,mc.Wi1 CA8' l..nll"",") ~=~":"' ICIIITKTa~"4 .....1.11 CIo.... C:la..If1cMlOn L....... C_tt for
MMfi,IaIN_ ....'..IC.... ICJIITKTa~~~ ,_..._. DNAPl'
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rtrrcrrt:tt Sod,umllLide TOKlC H83IlhH_d " 2662&-22-8.<1%: h.l00ljl:400{IOOljl Plasticw"'lIin do ""'- 1"'1lh" Moderllle(~ "'" ,.
ConeentraleSet ......,"'" '110\.<1'110 .,,,,,,,, N+4 'Ne"NoneIO)
'l....ctMty..None(O)
rA-PAeKW""'-Ll""~""" To~ic HealU1HlIl.-d " 2662&-22-8.<1%. 12 hlen." 32 2 1rt81 contaonen; P1I111lieCOflla;n8' ~quid SIof-U. -wallh" Mod_e(2 ,uob ,.
SolutIon ProcIin300 ~.<1'" ,..... N.I-4 F....NoneIO)
'l....dJvlly "None(O)
,t,1A-P,t,CKDd.-.t Sodiumlllide TO~I(: HeallhHazanl " 2002&-22-8."1%; hlOOml"4Od ",,'" Plasllccont_ .,.., ,,,- Heallh.Moderalej2 "'" ,.
ConcenlraleSel 111"0,1 gallon N-1-4 "we_ None (0)
'leadivrlV" None (0)
o\JA..PACKR""II&nt Sodoumazide TO~I(: HeallhHllZJIrd " 2662&-22.8.<1%; 32 ~ 1 mi. 32 mI IOml I'1lI8ticcont&lll8' "',. '''- "'....IUl:Mod...81eli Lab ,.
,- ",<O,lgallon ...,~ File "N<lne (0)
'leadJv~V" Noroe(O)
AIA-PACKCalibralion Sod'umiOZide TOlUc HeallhHlIDrd " 2662&-22-8.<1%: 4 ~ 100g" 400, l00ljl Pla6bcwntainer .... Slor_ H.....1Ih..Moderele(2 Lab ,.
SBIlM(sohd) "- N-1_4 Fire" None (0)
<taadlV~V" None (0)
41A-PACK CMbrabon Sodiurnazrde Toxic H....IlhHIl.l.l"d " 2662&-22-8."1%; .6~ 1 m1~ 48~ 1 ml PlaalK:wntainel ..... ,,,- H9aIlh:Moderllle!i Lab ,.
$81_(IoqUld) ""0.1 gallon ...,~ Fre" None (0/
~eadivily" None (0)
'1A-PI\CKClIirbre\oon Sod,umazide To~ic HeallhHlIzlIrd " 26e26-22-8.<1%: .x100g*400,IOOg PlIl8tiCconllllnBl ~" '''- 'ieallh ~ Mod8lelet1 Lab '.
"eriflC8l00n Sel (soh:l) .,,,,,,,, ...,. Fire ~ None (0)
F'teadlVlly" None (0)
AIA_PI\CKCelibrat;oo Sodium azide '''"'' HeallhHQZard " 26628-22_6.<1%: 40~ 5m1.. 200 rI I; mI Plll8ticoonlaineo .,.., ..- .....lIh.Mod...llle(i ..ab ,.
VanficationSel(liquid) ~ <0,1 gallon N-l-4 Fire "None\O)
~eadiv~y" None (0)
41A-PACKSublltrlll.aII Sod,umllZlde TO.I(: He.allhHlI.Z.IIrd " 26628-22-8.<1%: 8x 10011 ~ 800~ 100 II Plll8ticcontain.. "'. ""'- Heallh"ModBrllte(2 Lab ,.
'0 :2pounds N-l-" F... ~ None (0)
~eadlV~Y" None (0)
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ANNEX B - HAZARDOUS MATERIAL STORAGE LOCATlON DRAWINGS
Date Received:
APR 1 7 2009
Original Submittal
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