HomeMy WebLinkAboutApplication APPLICANT 11/16/2007
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City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Phone: (541) 726-3759
Fax: (541) 726-3689
SPRINGFIELD
DWP Overlay District
. Application, Type I
Applicant Name '1#1tU-~(L.17f ()lle/rPiJ &4t,,~
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Property Owner Name f/Mte- tf1' MtJv?
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Propeliy Address ~~T-:r- \K..~,x iDy
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Zoning of Property I1t M I Vrt-- f4lJl /c# . .
Size of Property Acres
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Tax Lot No. . '117 Z-
or Square Feet L '5 t? fOt>'
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Existing Use of Property
Specific Description of Proposal
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W~s this devel~pmeni proposal reviewed by the City through a Pre-application Report? Yes_I No_
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e information in this a~plication in cQrre,ct ~nd aC~J.lr~i~:'::.::::::._:'~,. '
. Applicant'Signature'
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permission for the applica~t't~_act in hislher behalf
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If the applican"t is ot~er than the owner,
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For Office Use Only:
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Joum~l No.h\2C7~ ~-()1g<;1'L- .
Map No.J1.o?>;:1a..-DO
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Received BY~:: .
Tax Lot No. q O~ . .
Date Accept~d asComplete
. Date Received:
Planner: AL
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II PeaceHealth
November 16, 2007
RiverBend Medical Pavilion-
Drinking Water Protection Overlay District Application
Narrative
Applicant/Owner:
PeaceHealth Oregon Region
P.O. Box 1479
Eugene, OR 97440
Representative:
Philip Farrington, AICP
Director, Land Use Planning & Development
123 International Way
Springfield, OR 97477
Phone: (541) 686-3828 * Fax: (541) 335-2595
ofarrington@oeacehealth.org
1. Land Use ReQuest
The Applicant seeks approval ofthis Drinking Water Protection (/DWP) Overlay District
Application in support of the project to develop the RiverBend Medical Pavilion (RMP)
in Springfield's Gateway area.
The RMP and other elements of Sacred Heart Medical Center at RiverBend were
previously granted Site Plan approval (DRC2006-00059), with a condition of approval
requiring approval of a DWP application. DWP approval was granted for other portions
of the medical center project in 2004.
SDC 3.070(1)(n) establishes Type I review of the DWP application. The application
includes this narrative, a copy of the deed showing PeaceHealth ownership of the subject
property, and all supporting materials consistent with SDC 3.050, SDC Article 17 and
DWP application requirements.
2. Prior Uses
The DWP application requires identification of past uses of hazardous materials on-site
that poses a risk to groundwater but existed on the property before May 15, 2000. The
prior property owner of the RiverBend property commissioned a Phase 1 Environmental
Site Assessment (Omnicon Environmental Management, May 21,2001) to identify
Date Received:
Planner: AL
/I/;6/)c07
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Drinking Water Protection Overlay District Application
RiverBend Medical Pavilion
November 16. 2007
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Page 2
potential environmental exposures on-site. The assessment found that the site has been in
small-scale agricultural and rural residential uses, and that past uses have posed no
demonstrable risk to groundwater.
3. Sprinl!field Development Code Article 17
SDC Article 17, Drinking Water Protection (DWP) Overlay District, sets forth
procedures and standards protecting Springfield's groundwater resources. SDC 17.030
and 17.040 establish Time of Travel Zones (TOTZ) within the City and areas subject to
the provisions of SDC Article 17. For the subject site, digital files taken from the City's
adopted Drinking Water Protection Area Maps were overlaid on the Site Plan for the
proposed project to illustrate the applicable TOTZ in relation to planned improvements
(Attachment 1).
SDC 17.040 Time of Travel Zones
The parcel created by the approved subdivision within which the RMP and medical
center are located (i.e., Lot 8) is comprised of several existing tax lots. The RMP is
located in Tax Lot 902 (Attachment 2), and the 1-5 year TOTZ crosses this tax lot and
through the RMP building itself. SDC 17.040(3)(c) states that for tax lots covering more
than one TOTZ, regulations in the more restrictive zone would govern. Therefore, the
RMP is governed by the more restrictive provisions of the 1-5 year TOTZ established in
the SDC.
SDC 17.050 Review
This DWP Overlay District Application is required when criteria under SDC 17.050(1)(a)
and (b) are met. Since the subject site previously had agricultural and/or rural residential
uses and is now proposed to house a medical office building, the change in land use
meets criterion (a) I. Although no use or storage of materials associated with the 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 Article 80 of the Uniform Fire
Code..." Because the nature of the use requires materials that are so classified in Article
80 of the Uniform Fire Code, the proposal meets criterion (b)2. Having met criteria from
SDC 17.050(1)(a) and (b), this application is therefore required.
Irrespective of the requirements in SDC 17.050(1), as noted above, the application is
required pursuant to condition of approval #15 in the Site Plan Modification approval for
the RMP and other improvements at the north end of the medical center.
Application requirements outlined under SDC 17.050(4) are addressed below.
Date Received:-L' (;J.. /""0-'
Planner: AL t ;-=-"-"--
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Drinking Water Protection Overlay District Application
RiverBend Medical Pavilion
November ]6. 2007
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Page 3
a) A Hazardous Material Inventory Statement and a Material Safety Data
Sheet for any or all materials entered into the Statement unless exempted
under 17.060 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 in conformance with
Uniform Fire Code 8001.15.1;
An inventory of hazardous materials is included in tabular format (Hazardous Material
Inventory Statement) in Annex A of the RMP Hazardous Material Management Plan
(HMMP), which is included with this application. The RMP building will not store or
use any substances not already reviewed through the approved hospital DWP application.
Material Safety Data Sheets (MSDS) for all materials listed in the HMIS were previously
submitted to the City of Springfield and Springfield Utility Board during the review of
the DWP application for the medical center. In the unlikely event that there will be
materials used in the RMP that would not be included in the medical center, additional
MSDS sheets will be submitted to the City and SUB. However, the existing MSDS
inventory on-file at both agencies should be inclusive to suffice covering all materials
included in the HMMP for the RMP and providing them separately would be redundant.
b) A list of the chemicals to be monitored through the analysis of
groundwater samples and a monitoring schedule if ground water
monitoring is anticipated to be required;
There is no need for on-going groundwater sampling and monitoring at the RMP because
no DNAPL chemicals will be lIsed on-site, and there will be no releases of hazardous
chemicals into the environment that could pose a risk to groundwater quality.
c) 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 17.070(J)(a);
SDC 17.070(1)(a) establishes quantity limitations for hazardous materials within the 0-1
year TOTZ. No portion ofthe subject site is within the 0-1 year TOTZ; therefore, the
above criterion is not applicable to this project.
d) A description of the primary and secondary containment devices
proposed, and, if applicable, clearly identified as to whether the devices
will drain to the storm or sanitary sewer;
PeaceHealth will provide secondary containment for hazardous materials to be stored at
the RMP in accordance with the Springfield code (Article 17), which incorporates
Uniform Fire Code 8003.1.3.3 by reference. This section of the UFC states:
Date Received:4~oo7
Planner: AL
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Drinking Water Protection Overlay District Application
RiverBend Medical Pavilion
November 16. 2007
Page 4
UFC - 8003.1.3.3 Secondary containment for hazardous materials liquids
and solids. When required by Table 8003.I-A, buildings, rooms or areas
used for the storage of hazardous materials liquids or solids shall be
provided with secondary containment in accordance with this section
when the capacity of an individual vessel or the aggregate capacity of
multiple vessels exceeds the following:
Liquids: Capacity of an individual vessel exceeds 55 gallons (208.2 L) or
the aggregate capacity of multiple vessels exceeds 1,000 gallons (3785 L).
Solids: Capacity of an individual vessel exceeds 550 pounds (248.8 kg) or
the aggregate capacity of multiple vessels exceeds 10,000 pounds (4524.8
kg).
Although beyond the requirements in the UFC and Springfield Code, PeaceHealth agrees
to ensure the storage of corrosive compounds (as defined by the UFC), in quantities less
than the thresholds included in the UFC, are maintained in locations that have compatible
secondary containment. This will likely include storing the small quantities of corrosive
materials in plastic tubs.
Secondary containment provisions for hazardous materials and applicable personnel
training are described in the HMMP.
e) A proposed Hazardous Material Management Plan for the facility that
indicates procedures to be followed to prevent, control, collect and
dispose of any unauthorized release of a hazardous material;
The attached HMMP describes the procedures for protection, control, collection and
disposal of hazardous materials and wastes, including any unauthorized releases of
hazardous materials.
f) 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.
g) A description of the plan for disposition of unused hazardous materials or
hazardous material waste products over the maximum allowable amounts
including the type of transportation and proposed routes.
The attached HMMP describes as required above the protocols and procedures for proper
disposition of hazardous materials and/or wastes. Uses at the RMP fall under the
definition of Conditionally Exempt Generator (CEG) of hazardous waste as defined by
Oregon DEQ and U.S. EP A regulations. As such, uses at the RMP will not generate any
hazardous wastes, and in no instance will disposal of hazardous materials and/or wastes
Date, F!..eceived:4,/;;-,o7
Planner: AL I
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Drinking Water Protection Overlay District Application
RiverBend Medical Pavilion
November 16. 2007
Page 5
exceed maximum allowable amounts. Medical wastes will be disposed through the RMP
service/dock area, with transportation routed to RiverBend Drive and MLK Parkway for
transport off-site.
SDC 17.060 Exemptions
Prior communications with Springfield Utility Board staff for DWP approval and
implementation at the RiverBend medical center indicated that materials designed for
human consumption, including ingested or administered medications, may be considered
exempt from DWP provisions. The Uniform Fire Code (UFC, Article 80, Section 8001,
8001. 1. I) specifically exempts "medicines" from provisions in the UFC.
As noted below, applicable sections of SDC Article 17 (i.e., SDC 17.070(2)(a) and (b)),
specifically reference the UFe with regard to hazardous materials that may pose a risk to
groundwater.
Article 2 in the SDC defines "hazardous materials" as: "Those chemicals or substances
which are physical or health hazards as defined and classified in Article 80 of the
Uniform Fire Code as adopted or amended by the City whether the materials are in usable
or waste condition." Since the UFC specifically exempts medicines from provisions for
hazardous materials, and since there are substantial physical and procedural methods in
place to contain potentially hazardous materials such that there is little risk of harm to
groundwater resources, the applicant requests that uses proposed be considered exempt
per SDC 17.0600.
SDC 17.070 Standards for Approval of DWP Overlay District Applications Within
Time of Travel Zones
Since the 1-5year TOTZ standards are applicable to the RMP, the standards in SDC
17.070(2) apply.
(a) The storage, handling, treatment, use, 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 shall be
allowed upon compliance with containment and safety standards set by
the most recent Fire Code adopted by the City.
No DNAPLs will be used, stored, or produced at the RMP. Other hazardous materials
meeting the above criterion and identified herein shall comply with all containment and
safety standards established in Article 80 ofthe Uniform Fire Code.
Date Received:
Planner: AL
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Drinking Water Protection Overlay District Application
RiverBend Medical Pavilion
November 16.2007
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Page 6
(b) Except as exempted, all hazardous materials that pose a risk to
groundwater shall be stored in areas with approved secondary
containment in place (Uniform Fire Code Articles 2 and 8003.1.3.3).
As identified in response to SDC 17.050(d) above, secondary containment will be
provided as required in accordance with the above criterion. Such containment features
within the building are outlined in Section 5.0 of the attached HMMP and comply with
the above-cited provision in the Uniform Fire Code and this criterion.
(c) All new use of DNAPLs shall be prohibited.
No DNAPLs will be used or stored at the RMP, so the proposal complies with the
prohibition in this criterion.
(d) 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 be
prohibited.
The proposed medical uses will not include any use or storage ofDNAPLs, consistent
with this criterion.
(e) 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:
1. hazardous material product pipelines used to transport the
hazardous material off of the tax lot where it is produced or used;
2. injection wells, except dry wells for roof drainage;
3. solid waste landfills and transfer stations;
4. fill materials containing hazardous materials;
5. land uses and new facilities that will use, store, treat, handle,
and/or produce DNAPLs.
The proposed medical uses at the RMP will not include any of the listed activities or
facilities, consistent with this criterion.
(j) Requirementsfound in Uniform Fire Code Appendix II-E 3.2.6for a
monitoring program and in 8003.1.3.3 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.
Date Received: II ~
Planner: AL /~
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Drinking Water Protection Overlay District Application
RiverBend Medical Pavilion
November 16. 2007
Page 7
The attached HMMP includes provisions in Section 5.0 and 10.0 for monitoring
methods and monthly inspections.
(g) Requirements found in Uniform Fire Code Appendix II-E Section 3.2.7 for
inspection and record keeping 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 except
those exempted shall be met.
The attached HMMP includes provisions in Section 10.0 for monthly inspections
and in Section 11.0 for record keeping procedures.
L),'!;, ;-'.~eceived:2~h ~D1
Planner: AL R.t1.
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Date. Received: /P
Planner: AL
EXISllNG TAX LOTS
5/31/07
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Division of Chief Deputy Clerk
Lane County Deeds and Records
l~~l.~~~on
After Recording Return to:
Roger M. Saydack
Arnold Gallagher Saydack Percell
Roberts & Potter, PC
P.O. Box 1758
Eugene, OR 97440-1758
"'"11111111 "'111I11I1111'" 1111 "'1111 II 111111 $46.00
00247068200100885720050055
12/31/2001 08:17:26 AM
RPR-DEED Cnt=l Sln=6 CRSHIER 05
$25.00 $11.00 $10.00
Until a Change is Requested
Mail Tax Statements To:
PeaceHealth, a Washington
Non-profit Corporation
P.O. Box 1479
Eugene, OR 97440-1479
GRANTOR:
Arlie & Company, an Oregon Corporation
722 Country Club Road
Eugene, OR 97401
GRANTEE:
PeaceHealth, a Washington Non-profit
Corporation
P.O. Box 1479
Eugene, OR 97440-1479
After Recording Return To:
Western Title & Escrow Company
497 Oakway Rd Suite 340, Eugene OR 97401
30 -".3" 3 <f " I
STATUTORY WARRANTY DEED
(
Arlie & Company, an Oregon corporation, hereinafter called Grantor, hereby conveys and
warrants to PeaceHealth, a Washington non-profit corporation, hereinafter called Grantee, and all of
Grantee's heirs, successors and assigns, all of that certain real property with all tenements,
hereditaments and appurtenances thereto belonging or in any wise appertaining, situated in the County
of Lane, State of Oregon, described as follows, to-wit:
See Exhibit A attached hereto and by this reference specifically made a part hereof,
together with the Grantor's interest, as Lessor, under any and all leases pertaining
thereto.
To Have and to Hold the same unto the Grantee and Grantee's heirs, successors and assigns forever.
And the Grantor hereby covenants to and with the Grantee and Grantee's heirs, successors and assigns
that the real property is free from all liens and encumbrances except as shown on Exhibit B . attached
hereto. The true and actual consideration for this conveyance stated in terms of dollars is Ten Million
Six Hundred Seventy-eight Thousand Six Hundred Seventy-two Dollars ($10,678,672). **which is
paid to an accomodator pursuant to an IRS 1031 Exchange.
In construing this deed, where the context so requires, the singular includes the plural and all
grammatical changes shall be made so that this deed shall apply equally to companies and to
individuals. .
STATUTORY WARRANTY DEED-I
N:\P -1\PeaceHealth Olllgon Region 13967\Arlic & Company I 3967.0004\Documents\Slat.War.Deed.Parcel A.wpd
Date: Received:4~
Planner: AL
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THIS INSTRUMENT WILL NOT ALLOW USE OF THE PROPERTY DESCRIBED IN THIS
INSTRUMENT IN VIOLATION OF APPLICABLE LAND USE LAWS AND REGULATIONS. BEFORE
SIGNING OR ACCEPTING THIS INSTRUMENT, THE PERSON ACQUIRING FEE TITLE TO THE
PROPERTY SHOULD CHECK WITH THE APPROPRIATE CITY OR COUNTY PLANNING
DEPARTMENT TO VERIFY APPROVED USES AND TO DETERMINE ANY LIMITS ON LAWSUITS
AGAINST FARMING OR FOREST PRACTICES AS DEFINED IN ORS30.930.
IN WITNESS WHEREOF, the Grantor has executed this instrument effective
Dec.El<113I::1'<. 31 , 2001.
Grantor:
STATE OF OREGON )
) ss.
County of Lane )
The foregoing instrument was acknowledged before me thisol'S..tday of December, 2001, by
Sl-/zA7JA./6" /.(. A,2t..i~ , the P.el:sd;)6VI of Arlie & Company, on behalf of the
corporation.
Notary ublic for Oregon
My Commission Expires:
OFFICIAL SEAL
KAREN EICHELBERGER
NOT.~RY PUBLIC- OREGON
COMMISSION NO. 338910
MY COMMISSION f.!<P!!!ES OCT. 13 2004
STATUTORY WARRANTY DEED - 2
N:\P -l\PeaceHealth Oregon Region 13967\Arlie & Company 13967-0004\Documenls\SlaI.War.Deed.Parcel A.wpd
Date Received:
Planner: AL
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EXHIBIT A
A parcel of land located in the Northeast 1/4 of Section 22, and the Northwest
1/4 of Section 23, Township 17 South, Range 3 West, Willamette Meridian, more
particularly described as follows:
Commencing at the Northeast corner of the William M. Stevens Donation Land
Claim No. 46, Township 17 South, Range 3 West, Willamette Meridian; thence
South 260 39' 56" East along the East line of said william M. Stevens Donation
Land Claim No. 46, 981.30 feet to the true point of beginning; thence South
260 39' 56" East along said East line, 445.17 feet'to the Northeast corner of
that property as described in that deed recorded on Reel 1747, Instrument No.
92-11169, Lane County Oregon Deed Records; thence leaving said East line South
630 18' 39" West, 225.00 feet to the Northwest corner of that property
described in said deed recorded on Reel 1747, Instrument No. 92-11169; thence
North 480 25' 14" West, 13.21 feet; thence South 350 11' 42" West, 13.52
feet; thence South 310 36' 21" West, 42.87 feet; thence Southwesterly, 106.97
feet along the arc of a 105.74 foot radius curve right, (the chord of which
bears South 520 451 20" West, 102.47 feet); thence North 890 581 0011 West,
322.04 feet; thence North, 18.21 feet; thence North 890 58' 00" West, 1012.99
feet to a point on the East line of that property conveyed to the City of
Springfield as described in that deed recorded on Reel 843, Instrument No.
77-22531, Lane County Oregon Deed Records; thence along said East line North
30 53' 37" West, 391.66 feet to a 5/8 inch iron rod marking the Northeast
corner of said City of Springfield property; thence South 890 56' 00" West
along the North line of said City of Springfield property, 425.58 feet to a
5/8 inch iron rod on the East margin of Game Farm Road (County Road No.3) ,
30.00 feet from, when measured at right angles' to the centerline of said Game
Farm Road; thence North 20 54' 56" West along said East margin, 110.62 feet to
a 5/8 inch iron rod; thence North 40 II' 55" West along said East margin
320.76 feet to a 5/8 inch iron rod; thence continuing along said East margin
North 890 211 57" East, 5.00 feet to a point, 35.00 feet from, when measured
at right angles to the centerline of said Game Farm Road; thence continuing
along"said East margin North 40 111 5611 West, 122.6B feet to a 5/8 inch "iron
rod; thence leaving said East margin North 890 591 16" East, 347.61 feet to a
5/8 inch iron rod; thence NOl'th 000 09' 13" East, 65.02 feet to a 5/8 inch
iron rod; thence North 000 061 43" East, 156.20 feet; thence North 890 591 16"
East, 308.00 feet; thence South 260 431 44" East, 654.70 feet; thence North
890 56' oon East, 992.70 feet to the point of beginning, in Lane County,
Oregon.
Date Received: !f~lJ.btJ7
Planner: AL
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EXHIBIT B
The rights of the public in and to that pore ion of ~he premises herein
described lying wi~hin any public road or highway.
An eaSemen~ created by instrument, including the terms and provisions
thereof,
Recorded: February 28, 1991
Recorder's Reception No. 91-09965
Lane County Oregon Official Records
In favor of: City of Springfield
An easement created by instrument, including the ~erme and provisions
thereof,
Recorded: March 5, 1991
Recorder's Reception No. 91-10574
Lane County. Oregon Official Records
In favor of: City of Springfield
An easement created by instrument. including the terms and provisions
thereof,
Recorded: December 14, 1990
Recorder's Reception No. 90-59952
Lane County'Oregon Official Records
In favor of: City'of Springfield
An easement created by instrument, including the terms and provisions
thereof,
Recorded: October 22, 1991
Recorder's Reception NO. 91-50861
Lane County Oregon Official Records
In favor of: Ci ty of Springfield
An eAsement created by instrument, inclUding the terms ana provisions
thereof,
Recorded: August G, 1947
in Book 353, Page 220
Lane County Oregon Deed Records
In favor of: United States of America
An easement created by instrument, including the terms and provisions
thereof,
Recorded: April 25; 1968
Recorder's Reception No. 22343
Lane County Oregon' Official Record.
In favor of: City of Eugene
Fence line encroachment along the North line as' disclosed-by Branch
Engineering Survey
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Annexation Agreement, including the terms and provisions thereof, between
the City of Springfield and Arlie & Company, an Oregon corporation,
recorded June 8, 2001, ReCOrder's Reception No. 2001-0~4114, Lane County
Oregon Official Records.
Fence line encroachment along the'North line as disclosed by BlOanch
Engineering Survey, Project No. 94-151.
An'easement created 'by instrument, including the terms and provisions
thereof,
Recorded: April 18, 1977
Recorder's Reception No. 77-22531
Lane County Oregon Official Records
In favor of: City of Springfield
Easements'set forth in that certain Lot Line Adjustment Deed recorded
October 2, '2001, Recorder's Reception No. '2001-064919, Lane County
Oregon Official Records.
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bate, Received:~~
P',3nner; AL
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KTA Associates, 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 Medical Campus
RiverBend Medical Plaza
August 2007
. ~~ "". "fr, - ~.. I, ~ , i :J#' ~ 4.. ~:, ~:_;id, "" ~~'.". ,;; '"
:~~ I{iotes'SiQ"Iita;1 En~~b~m~~t~f S~~~rice; OoJipo1rarion
-~ . ~ "'" ~ , "" - ~ "
DatE1 Received: ///6/;;0177
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Planner: AL
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TABLE OF 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
1 0.0 MONTHLY INSPECTIONS OF HAZARDOUS MATERIAL AND WASTE MANAGEMENT AND
CORRECTIVE ACTION SySTEM............................................................. .................................... 18
11.0 RECORDKEEPING ........................................................................................................................ 19
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 Monthiy Inspection Form 6
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Annexes
A - Hazardous Materiai Inventory
B - Hazardous Material Storage Location Drawings
C - Reference Procedures
AUGUST 15, 2007
Date f~eceived:. 1~'/6/;;o07
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Planner: AL
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1.0 HAZARDOUS MATERIAL AND WASTE MANAGEMENT PLAN
PURPOSE AND OBJECTIVES
The Hazardous Material and Waste Management Plan ("Plan") for the organization medical center or
clinic or the parking garage ("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 Uniform 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 medical office, clinic or
parking garage establishes responsibilities, policies, work practices, and procedures 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 infonnation is provided in this
Plan to be consistent with the overall RiverBend medical campus waste management plans.
Wastes generally fit within four major categories: hazardous wastes, universal wastes, non-
hazardous wastes, and medical wastes. The purpose of the Plan is to 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 fluorescent light bulbs and batteries. Non-hazardous solid wastes are comprised mainly of
paper and plastic. Non-hazardous liquid wastes are discharged to the sanitary sewer. Medical
wastes include sharps and non-hazardous infectious solids and liquids.
This Plan addresses the following waste management processes (the applicable section of the Plan is
identified in parentheses):
. Waste management roles and responsibil~ies (Section 3.0);
. Waste identification to determine applicable storage, use, and disposal requirements (Section
6.0);
1 Other wastes such as radioactive medical wastes are addressed by separate plans.
KTA ASSOCIATES, INC.
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. Waste disposal and shipment (Section 8.0);
. Personnel training (Section 9.0);
. Inspections (Section 10.0);
. 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.
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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 matenals. It is anticipated that the list of hazardous matenals submitted to the
SUB is comprehensive and would only rarely require updating for additional matenals. Hazardous
matenal 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 regulated waste generated. Generation of a new or different waste
will require preparation of a Waste Determination Form (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 Ibslmo. of hazardous waste and store
2,200 Ibs. or less on-site. A SQG generates more than 220 Ibslmo. but less than 2,200 Ibslmo. 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
http://www.dea.state.or.us/wmclhw/reslibhwaen.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 monthly inspections will review the need for new Waste
Determination forms or changes in RCRA generator status.
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3.0 HAZARDOUS MATERIAL AND WASTE MANAGEMENT ROLES
AND RESPONSIBILITIES
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:
Department Safety
Department Safety
3.1 Environmental Coordinator
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 (HMIS), 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
. Be familiar with the waste streams generated by each department, office or clinic. Prepare
and WDFs for new regulated waste streams as needed.
. If any hazardous waste is generated at the Facility, determine the faciiity hazardous waste
generator status each month. If necessary, the Environmental Coordinator will: 1)
Conduct inspections; 2) Coordinate shipping and disposal for universal and hazardous
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
KTAASSOCIATES, INC.
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contractors and coordinate waste disposal services, and 4) Maintain records of
inspections, corrective actions and waste disposal 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 Environmental Coordinators in other RiverBend fadlities for
consistency on environmental issues and obtain assistance on hazardous material or
waste management questions, support or pclicies. The environmental coordinators for the
facilities on the RiverSend medical campus may establish a network of periodic meetings.
KTAASSOCIATES, INC.
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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 as it applies to this Plan.
4.1 Definition of Hazardous Material
Hazardous materials are substances, as defined in City of Springfield land Use Development
Code Article 17 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 (Article 17.020 (1)(a) a class of liquid chemicals or substances which are physical
or health hazards to groundwater). The class of hazardous materials is based on Article
80 of the Uniform Fire Code (UFC) 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, Article 17 exempts several types of UFC
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 property 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, firenife 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 Material Inventory Statement
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. No hazardous materials will be stored at the parking garage. This list
accompanies this Plan and is located in Annex A.
4.3 Hazardous Material Storage Locations
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
set of detailed facility drawings. These drawings are 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.
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4.4 Hazardous Material Management
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 material 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 aicohol
kept on the counter of an exam room; the bottle would be easily visible and any spills could be
cleaned up quickly.
All outdoor landscaping chemical use will be conducted by a Service Contractor; the contractor
will not store any landscaping chemicals at the Facility. The landscaping chemicals to be used
are described in Annex A.
Hazardous materials will not be stored in the Par1<ing Garage.
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. All new hazardous materials proposed to be used at the Facility will be
reviewed before purchase to ensure the product does not contain any DNAPLs.
PeaceHealth has established a procedure for reviewing new products internally based on
Information in MSDSs. The product review procedure Is in Annex C. Under the procedure,
most new products will not require MSDS submittal and review by the SUB. The HMIS will be
updated with new products as they are approved; the HMIS will be submitted to SUB annually
or upon request by the SUB.
KTA ASSOCIA lES, INC.
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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
Secondary containment for storage of hazardous materials that pose a risk to the groundwater
will be provided in accordance with the applicable regulatory requirements, Article 17.070
(2)(b) of the DWP 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 (Unifonm Fire Code Articles 2 and 8003.1.3.3.)". 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 collecton 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 constructon 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. Each secondary
containment system will have a monitoring method, such as visual observation.
Most of the hazardous materials to be stored and used at this Facility are cleansers and
disinfectants in 1 gallon (or less) containers. 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 detenmine if any release of hazardous materials has
occurred. The secondary containment tubs or trays will have sufficient depth to contain the
volume of the largest container.
In hazardous material use areas where products are used frequently 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.
KTAASSOCIATES.INC.
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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 on each floor in
secondary containment. Individual work groups and departments will be responsible for
their hazardous materials and will establish guidelines and training for safe storage and
use, in conjunction with Facility safety procedures.
. Hazardous materials should not be left at the loading docks, freight elevator lobbies,
hallways or any other unrestricted locations.
. Hazardous materials will not be stored in the Parking Garage.
. 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 material
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.
. 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.
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6.0 WASTE DETERMINATION AND MANAGEMENT REQUIREMENTS
6.1 Waste Detennination Fonns 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 Pian
describes generally applicable requirements related to handling and storage of wastes,
particularly hazardous wastes.
6.2 Waste Categories
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, e.g., office waste, domestic waste, plastic, etc.
. Hazardous waste: Chemical waste reguiated under RCRA and Oregon hazardous waste
regulations, e.g., organic solvents, chloroform, inorganic and organic sclids 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 inciude
sharps, cultures and stocks, pathological wastes, bioiogical waste, such as human blood
and blood products.
. Universal wastes, e.g., ftuorescentlights and ballasts, and batteries.
Medical wastes, universal wastes and hazardous wastes are regulated with special handling
and disposal requirements.
6.3 General Waste Management Infonnation
A Waste Determination Form (WDF) will be prepared for each regulated 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 wouid likely cover any
needed for this Facility, and would provided a consistent waste management process.
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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.
6.4 Hazardous Waste General Management Procedures
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 localion, 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 direcly 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 handiing 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 compatibiiity using separate boxes for each group.
. Adequate ventilation, iighting and security are provided.
. All hazardous waste is stored below eye level.
. 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.
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. 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 waste under the
following circumstances:
When waste is stored in 55-gallon drums
When waste is stored on the floor
When necessary to separate incompatibles or high hazard wastes
Note: 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:
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 ~egins 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 VVDFs for specific labeling
requirements.
. Universal Wastes: Waste lamps and Ballasts and Batteries
RCRA and state 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 leveis 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 VVDFs). Specific
storage, handling and disposal requirements are described in the VVDFs for
"Waste lamps and Ballasts" and "Waste Batteries."
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7.0 CHEMICAL EMERGENCY I SPILL RESPONSE
7.1 General
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 Emergency Requirements
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 ievel 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 responsibie 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 wrth a portabie fire extinguisher,
call the local Fire Department at 911.
o Attempt to 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, contact the local fire department, and the Facility's response
contractor.
. Call 911 to contact:
KTAASSOCL'lTES, INC. 13
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. Fire Department hazardous materials unit
. Police Department
. Springfield Utility Board
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 Consider the need for respiratory protection.
o Protect floor drains or other means of environmental release. 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. Polyethylene 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 advice 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.
KTAASSOCIATES, INC.
14
Date !~eceived:
Planner: AL
II h/Jci' 7
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8.0 WASTE DISPOSAl!. AND SHIPMENT
The disposal method for each waste stream is based on the type of waste. The disposai methods for
each type of waste are described below. The WDF s 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 GenerallNon-Hazardous 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 containers 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.
The sanitary sewage system operator 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 generai, medical wastes are managed according to a separate facility procedure.
Medical wastes that are classified as Infectious Wastes by Oregon regulation inciude 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 cannot be retumed to suppliers and must be discarded,
each product must be reviewed for possible hazardous waste classification before disposal.
KTAASSOCIATES, INC.
15
Date, R:eC8ived:4~l>7
Planner: AL
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8.4 Hazardous Wastes
Although unlikely at this Facility, many chemicals, e.g., acidslalkalines, 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 wili 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 included 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.
. Retuming 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.
KTAASSOCIATES, INC.
16
Date Received:~#..2"'/'7
Planner: AL
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9.0 PERSONNEL 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. Facility personnel who handle
hazardous materials and hazardous waste may need basic training and direction if their position has
responsibility for:
. Awareness of the sensitive area that the ciinic occupies and special precautions needed to
protect the drinking water
. Using and storing hazardous materials such as cleansers and disinfectants.
. 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 emergencies.
At the Facility, specific hazardous waste training that requires documentation would only 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 Environmental Coordinator Training
The Environmental Coordinator (EC) will be familiar with the regulatory requirements 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, including need for special waste storage, shipping
and disposal for hazardous wastes.
. Preparation of the Waste Determination Form.
. Who to contact if a spill or release occurs. Initial response for spill or releases.
KTAASSOCIATES, INC.
17
Date Receivect:4;!)<:>b7
Planner: AL
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10.0 MONTHLY INSPECTIONS OF HAZARDOOS MATERIAL AND
WASTE MANAGEMENT AND CORRECTIVE ACTIO,., 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. As necessary, documented periodic inspections of
storage areas are required for hazardous material and hazardous waste management at the Facility.
10.1 Hazardous Waste Management Monthly Inspections
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 ~ems 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 indude 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
Hazardous Material Monthly Inspection Sheet Form 6 (attached).
The Inspection Sheet includes a list of items to be checked at each area. In particular, all
secondary containment devices (tubs and trays) and emergency equipment must be visually
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 and signed by the
safety manager.
When an inspection discovers compliance issues, corrective action will be performed. The
Facility utilizes 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).
KTA ASSOCIATES, INC.
18
Date, Received:
Planner: AL
IIM/JoC7
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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) in a 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 Reporting
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 either
SUB approval of new hazardous materials added to the Hazardous Material Inventory
Statement, or periodic submittal of the HMIS to the SUB when new hazardous materials are
reviewed intemally, would be necessary.
KTAASSOCIATES, INC.
19
Date. Heceived: 1I)~/;;.,D7
Planner: AL
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ATTACHMENTS. FORMS
Date Received: II//~
Planner: AL
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Peace Health
WASTE DETERMINATION FORM 1
Waste Name: Medical wastes - solids I Waste ID Number: I Date: 2/25/04
SH-4
Is the Waste Hazardous as Defined by Oregon Administrative Rules ("OAR") Chapter 340, Division
101 (includes RCRA Hazardous Waste Definition)? Yes - No 2L
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 fiuids
that cannot be directly discarded into the municipal sewer system, and waste materials saturated with
blood or body fiuids. 2) Cultures and stocks: which includes etiologic agents and associated 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-7)
Source of Information use for Hazardous Waste Determination (attached): Process knowledge
Waste Generation Description: Medical waste solids are generated from medical procedures,
laboratory and patient care.
Analvsis
1. Does the waste exhibit the ignitability, corrosivity, or reactivity characteristics as defined by
40 CFR ~ 261.21-237 Yes_ No L Not Applicable _
Explanation: The medical solids waste is not an ignitable waste because it is a solid material, althou9h
may contain absorbed liquids. The waste is dry or water-based and does not have exhibit a fiash point.
The medical solids waste is not a corrosive waste because it is a generally solid material with absorbed
liquids, 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 thatfail the TCLP level as defined by 40 CFR ~ 261.247
Yes _ No L 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.
Date Received: /1 ~YJoo7
Planner: AL r
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Peace Health
WASTE DETERMINATION FORM 1
Waste Name: Medical wastes - solids I Waste ID Number: I Date: 2/25/04
SH-4
3. Is the waste a listed waste as identified in 40 CFR!i 261.30-.34?
Yes - No -1L- Not Applicable _
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 IMII be managed as follows:
. Medical waste solids must be collected and stored in leak-resistant bia-hazard bags which are stored in
labeled leak-proof containers according to procedure or guideline?_.
. Medical wastes IMII be stored in the Sio Waste area.
. Medical waste solids IMII be transported, treated and disposed by _Stericycle?_.
Date Received: / ~~7
Planner: AL
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Peace Health
WASTE DETERMINATION FORM 1
Waste Name: Fluorescent light bulbs I Waste ID Number: I Date: 2/1/05
SH-8
Is the Waste Hazardous as Defined by Oregon Administrative Rules ("OAR") Chapter 340, Division
101 (includes RCRA Hazardous Waste Definition)?
YesL No -
Fluorescent lamps and ballasts may be hazardou~ 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 !i 273 and OAR 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
Products Included in the Waste: Mercury, Barium and Lead
Source of Information use for Hazardous Waste Determination (attached): Process knowledge
Waste Generation Description: Disposal of fluorescent lights containing small amounts of mercury,
barium and lead.
Analvsis
1. Does the waste exhibit the ignitability, corrosivity, or reactivity characteristics as defined by
40CFR!i261.21-23? Yes_ NolNotApplicable_
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 chemical 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 261.241
Yes -L 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-.341
Yes _ No lL Not Applicable_
Explanation: This waste stream is not a listed waste.
Date Received: II/;i/:}()d7
Planner: AL / I
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Peace Health
WASTE DETERMINATION FORM 1
Waste Name: Fluorescent light bulbs I Waste 10 Number: I Date: 2/1/05
SH-8
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 3261.33(e) or 10 percent of a constituent identified in 40 CFR 3261.33(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
appiicable 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 originai 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 ionger 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:~;@/,h(}7
Planner: AL
Peace Health
HAZARDOUS WASTE MONTHLY INSPECTION SHEET - FORM 2
Lab, Storage Area or Satellite Accumulation Area(s)
Date
Name
General Work Area Waste Mana ement
Storage area'acx:umulation area is maintained secure; door is locked, when unattended. Waste container's contents are identified and container is labeled as "Hazardous Waste" or as .Universal
Waste-l...amps,~ 'Waste Lamps: "Used Lamps:
.Universal Waste-Batteries: "Waste Batteries: or "Used Batteries,"
Nosmokin in area is rrritted. 9O-d waste containers are labeled 'Mth lhe dale accumulation o.
"Dancer-Hazardous Wastf?Unauthorized Personnel Kee Out"si nis sled. Waste containers are keot closed.
Waste rontainers are stored within seconda containment.
Eme eoc E ui en! loccm "bIe wastes are ated in seconda containment.
Rre ex1inouisher is Dresen! and fu "', Containers are not lealdna, rusted, buloina or damaaed.
Date of last fire extin uisher inspection. The base under containers is in condition free of cracks, andim Nious to leaks.)
Spill control equipment (neutrafael'S, absorbent pads). Waste is not aBO'Ned 10 be stored more than 90 days in container storage area The facility has not generated more than 220 lbslmonth
of hazardous waste
and is storing less than 2,200 Ibs. Waste in container stOIaOe area is shiooed off...site for cfisposal within 90 days.
Waste in satellite accumulation areas may not exceed 40 Ibs. (5 gallons).
VIIhen that volume is met, waste is moved 10 rontainer storace area.
UnivelSal wastes have been stored less than one vear.
All rsonsman i hazardous waste have received "' rtrainin.
Communication S lems
Phone accessible. Waste Detennlnation Fonns
Eme eo hone numbers nexllo phone. Waste Determination Form cem eted for ea:h waste neraled in area.
V\lDFs posted information urHo-dale.
Protective E ui en! WOFs ed or available at waste neralion area
Chemicals h Ies are available.
Prooer aloves are available.
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Area WasteSlream(s) 10 Number(s) Insoection Tooic OK Comments
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 Fonns
Comments:
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Peace Health
MAINTENANCE/CORRECTIVE ACTION. FORM 3
Forward to the Environmental Coordinator upon completion
for review and filing in the facility Environmental Maintenance/Corrective Action file
1. What is the problem being resolved through the corrective action:
2. Who perfonmed the maintenance or corrective action:
3. What date was the maintenance or corrective action completed:
4. Describe the maintenance or corrective action perfonmed:
5. Describe whether any foliow-up evaluation should be perfonmed to ensure the maintenance or corrective
action is effective:
6. Signature indicating the maintenance or corrective action is complete:
Sianature: Date:
Date Received: /:/;~;Joo7
Planner: AL
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Peace Health
TRAINING RECORD - FORM 4
FOfWard to the Environmental Coordinator upon completion
For review and filing in the facilitv Environmental Training file
1. Date oftraining:
2. Description of training provided (should be consistent with the training requirements from the Waste
Management Plan):
3. Personnel who attended the training:
Name Department Siqnature
4. Signature of training instructor indicating the information on this form is accurate:
Name: Date:
Position: /
Date Received: 11//b/;)oP7
I I
Planner: AL
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Peace Health
ENVIRONMENTAL COORDINATOR ASSIGNMENT - FORM 5
Forward to the Environmental Coordinator upon completion
for review and filino in the faci/itv Environmental Roles & ResDonsibi/ities file
Date of change Name of Environmental Name & Position of Authorizing
Coordinator Individual
Data ReCejved:~//6/.;HJo7
Planner: AL /
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Peace Health
HAZARDOUS MATERIAL MONTHLY INSPECTION SHEET - FORM 6
Storage Area(s)
Date/time
Name
Reviewed b
General Work Area
Sto area is maintained secure; door is Jocked, when unattended.
No smoki in area is rmitted.
Seconda Containment
Hazardous material containers stored in seconda containment
Containers are not Ieaki , rusted, bLd in or d
The base under containers is in condition free of cracks, and ~ uicJ..ti hi.
Sum and coDections s stems in condition, drai tem to controlled location
Containers of stro acids are stored in h ene tra s or tubs
Incom ible materials stored se aratel
Erne e E ui ment
Fire exti Lisher is resent and ful cha ed.
Dale of last fire exti uisher ins ion.
S ~J control wi ment neutralizers, absorbent s .
Communication S ms
Phone accessible.
Erne hone numbers
eel next to ne.
S ill Prevention Measures
Hazardous material containers are labeled
Hazardous material containers are k dosed.
All ns ma i hazardous materials have received ro traini
Slo areas dean, well-l' hied, ood condition
No hazardous materials stored ina ro 'ate locaIions
Em containers ma ed ro
.
Protective E ui
Chemical s ash
ent
Ies and aves are available.
Area Hazardous Materials Inspection T oDic OK Comments
General Wbrk Area
Emergency Equipment
Communications Systems
Protective Equipment
Secondary Containment
Spill Prevention Measures
General Work Area
Emergency Equipment
Communications Systems
Protective Equipment
Secondary Containment
Spill Prevention Measures
General Work Area
Emergency Equipment
Communications Systems
Protective Equipment
Secondary Containment
Spill Prevention Measures
General WOIk Area
Emergency Equipment
Communications Systems
Protective Equipment
Secondary Containment
Spill Prevention Measures
.
Comments:
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ANNEX A- HAZARDOUS MATERIAL INVENTORY
Date Received: 1~6/d-D07_
Planner: AL
Isopropanol rts each in (8)
Sodium Hydroxide Housekeeping
Ortho-Benzyl-Para- closets/Supplies room-
Chlorophenol Maximum of 40 Ibs.
Ortho-Phenylphenol
Para~ Tertiary-Amylphenol
GP Forward SC Ethoxylated nonylphenol 26027-38-3; (2) 2.5 Qrts each in (8) 1 gallon or less Plastic bottle liquid Health Slight (1) 1. Housekeeping Closets on each floor,
(general purpose Water 7732-18-5 Housekeeping Fire = None (0) Materials/Supplies on 1 st .
cleaner) closets/Supplies room - Reactivity = None (0)
Maximum of 40 lbs.
Glance RTU (glass 2-Butoxyethanol 111-76-2; 7732- (2) 2.5 Qrts each in (8) 1 gallon or less Plastic bottle liquid Health None (0) 1. Housekeeping Closets on each floor,
cleaner) Water 18-5 Housekeeping Fire = None (0) Materials/Supplies on 1 st
closets/Supplies room - Reactivity = None (O)
Maximum of 40 Ibs.
NuSheen Petroleum Distillates 8002-05-9; 111- (2) 2.5 Orts each in (8) 1 gallon or less Plastic bottle liquid Not Specified on MSDS 1. Housekeeping Closets on each floor,
Diethanol Amine 42-2 Housekeeping Materials/Supplies on 1 st
closets/Supplies room -
Maximum of 40 Ibs.
Virex II 256 n-Alkyl Dimethyl Benzyl 68391-01-5; (2) 2.5 Orts each in (8) 1 gallon or less Plastic bottle liquid Health - Slight (1) 1. Housekeeping Closets on each floor,
Ammonium Chlorides 7732-18-5 Housekeeping Fire = None (0) Materials/Supplies on 1st
Water closets/Supplies room - Reactivity = None (0)
Maximum of 40 Ibs.
Cidex Glutaraldehyde 111-30-8; 7732- (2) gallons each in (8) 1 gallon or less Plastic bottle liquid Not Specified on MSDS 1. Housekeeping Closets on each floor,
Water 18-5 Housekeeping Materials/Supplies on 1st 2.
closets/Supplies room - Endoscope Processing on 2nd
Maximum of 130 Ibs.
Disinfectant N.alkyl Dimethyl Benzyl 68391-01-5; (2) gallons each in (8) 1 gallon or less Plastic bottle liquid Health 511gh1(1) 1. Housekeeping Closets on each floor,
Coverage HBV Ammonium Chloride 68356-79-6; 64- Housekeeping Fire = None (0) Materials/Supplies on 1 st 2. Endoscope
'"OC"' N-alkyl Dimethyl Ethyl Benzyl 02-8; 111-76-2; closets/Supplies room - ReaCtiVIty = None (0) Processing on 2nd
-, Ammonium Chloride 111-90-0 Maximum of 1~O Ibs. .
IT> ..
::, t
:::l Soap Cleanser Skin Chlohexidine Gluconate 018472-51-0; 67- (2) gallons each in (8) 1 gallon or less Plastic bottle liquid Health None (0) 1. Housekeeping Closets on each floor,
(i) -"":. Hibiclens Isopropyl Alcohol 63-0; 7732-18-5 Housekeeping Fire = Slight (1) Materials/Supplies on 1 st 2. Pharmacy
:: r:, Water closets/Supplies room. Reactivity = None (0) on 1st 3. laboratory Processing on 1st
C.
)> ~<. Smaller containers in other 4. Endoscope Processing on 2nd
,<. locations - Maximum of
(j,; 1501bs.
a.
~ Detergent Isopropanol 67-63-0 (2) gallons each in (8) 1 gallon or less Plastic bottle liquid Not Specified on MSDS 1. Housekeeping Closets on each floor,
Klen/Orthozym Housekeeping Materials/Supplies on 1st 2. Endoscope
't closets/Supplies room - Processing on 2nd
Maximum of 130 lbs.
~ Isopropyl Alcohol Isopropanol 67-63-0 16 oz. Bottles X 5 bottles x 1 Ib or less bottles. Plastic bottle liquid Not Specified on MSDS 1. Materials/Supplies Room on 1st
10 locations - Maximum of 2. Medications closets 3. Pharmacy on
501bs. 1st 4. Laboratol"j Processing on 1st
Ha:z;~rdoui N[aterialCI n_vento.y State';e~t~f6r River~enl~ed ic'!LJ>la-za
" '_:;: : : ': ]i-, -:'i, ': : ",",":, f, :',,:' '-, :.,,~c ",'c"" '~\' ;;:; :"~,-;;,,,_ ",~",,-,t-;; ': ::,;:;~;,"",. '::, :""'_.:!,::,,,, : "'-',,:, _,:'-'" ,:\r:;':,:"', :t':;"'.'
. ;,,~ "ccH~zardous Material.lnventoryStiitemenUo~ RiverBend Medical Plaza
, -",1,_'"' ";;"',""" '",,,,,' "" '" '" ,,,,""_",'; ',' '~,,"",' ',"'-'::,", ,,' C' ,""c_,,__ ,,",' -;:" ,r.",,;'''' ,::" ,,,' ','<::'.."-'",,' ;;';;'i-I"", ,,','" "'I"" ",', """,,,,
Sodium Chloride 1310~73.2; 7647- (2) gallons each in (8) 1 gallon or less Plastic bottle liquid Health = Moderate (2) 1. Housekeeping Closets on each floor,
Sodium Hydroxide 14-5; 7681~52~9: Housekeeping Fire = None (0) Materials/Supplies on 1st. 2.
Sodium HYPochlorite 7732-18-5 closets/Supplies room- Reactivity = None (0) Endoscope Processing on 2nd
Water Maximum of 130 Ibs.
Adhesive Tape Isoparaffinic Hydrocarbons, 64742-48-9; 12 packages ~ Maximum of 1 gallon or less Plastic bottle liquid Health - Slight (1) 1. Materials/Supplies Room on 1st
Remover Hydrotreated Heavy 64742.89~8; 67- 201bs. Fire = Severe (4) 2. Medications closets
Light Aliphatic Naphtha 63-0 Reactivity = None (0)
Isopropanol .
Snow & Ice Calcium chloride 10043-52-4 2 . Maximum of 100 Ib 5 gallon Plastic solid Health - Slight (1) Materials/Supplies Room on 1 st
melting pellets Fire = None (0)
Reactivity = Slight (1)
SpillX-S Activated carbon 7440-44-0 5 - Maximum of 5 Ib lib plastic solid Health - Slight (1) Materials/Supplies Room on 1st
Fire = None (0)
Reactivity = None (0)
landscaping Services (Not Stored Oil-Site)
AB Cutrine Plus Copper Carbonate 12069-69~1; 141~ Useage vanes, but less 55 gallon or less 55 gallon and liquid Health - Slight (1) Not stored on site.
Monoethanolamine 43~5; 102~71-6 than SO Ibs/mo. less Fire = None (0)
Triethanolamine Reactivity = Slight (1)
CalPril Non-Hazardous Ingredient Not Specified on Useage varies, but less SO Ib bag or less Paper or plastic solid Not Specified on MSDS Not stored on site.
MSDS than 50 Ibs/mo. bag
Casoron 4G 2,6-0ichlorobenzonitnle 1194~65~6 Useage varies, but less 50 Ib bag or less Paper or plastic solid Not Specified on MSDS Not stored on site.
than 50 Ibs/mo. bag
Crossbow Herbicide 2,4-0ichlorophenoxyacetic 192~97~3; Useage varies, but less 55 gallon or less 55 gallon and liquid Health - Slight (1) Not stored on site.
Acid, 3~Butoxyethyl Ester 64700~56~7; than 100 Ibslmo. less Fire = Moderate (2) .
-CD (2.4~D Esters) 8008-20-6 Reactivity = None (0)
m LJ Triclopyr Butoxyethyl Ester
::J [,' Kerosene
'"
ro ...;~,
~1 m Pendulum 2G Pendimethalin 40487 -42~ 1; Useage varies, but less 50 lb bag or less Paper or plastic solid Health - Not Rated Not stored on site.
(.1 granule herbicide N~methylpyrrolidone 872-50-4 than 50 Ibs/mo. bag Fire = Not Rated
:r> CD
r <' Reactivity = None (0)
Q) Pro Ornamental Ammonium Sulfate 77B3~20~2 Useage varies, but less 50 Ib bag or less Paper or plastic solid Health - High (3) Not stored on site.
0.. Fertilizer than 50 Ibs/mo. bag Fire = None (0)
j':' Ammonium Sulfate Reactivity = None (0)
r Royal Ammonium Sulfate 77B3~20~2 Useage varies, but less 50 Ib bag or less Paper or plastic solid Health = High (3) Not stored on site.
Green/Ammonium than SO lbs/mo. bag Fire = None (0)
Sulfate Reactivity = None (0)
Roundup Pro Isopropylamine Salt of 38641-94-0 Useage varies, but less 55 gallon or less 55 gallon and liquid Not Specified on MSDS Not stored on site.
Herbicide Glyphosate than 100 Ibs/mo. less
',:,="'~'c!i,-"'" ,"U("-:-: .',. "', :."-, ~'. __ i ',~"",;~i;., T :"-q~.: .'; '",;,"':---.. ,-!" ,c::",!.'1,r!"[l:i:""",iL"'j':\,,,-,,",!-!,~,.':q,,;,:8..~~:!!-,:";"S,'~'~:
,__<;~Hazardous Materiall'iventi:lry StateinenUor RiverBend'Medic'al' Pla'!'a::;-"I:t ,-:J
"Uo
mill
::iq)
;:j :.,.
co ,h.j
:'1 ro
o
~ 9!_
r<
(I)
0-
~
t
Speed-Zone
Broadleft Turf
Herbicide
2, 4-Dich lorophenoxyacetic
Acid, Isooctyl (2-Elhylhexyl)
Ester (2,4-D Esters)
3,6.Dichloro-o-anisic Acid
(Dicamba)
Carfentrazone-ethyl
R(+)2(2.Methyl4.
chlorophenoxy) Propionic
Acid (MCPP)
1928-43-4;
1918-00-9;
128639.02-1 ;
16484-77-8
Useage varies, but less
than 100 lbs/mo.
55 gallon or less
55 gallon and
less
liquid
Health = Moderate (2)
Fire = Slight (1)
Reactivity = None (0)
Not stored on site.
.
.
.
.
ANNEX B - HAZARDOUS MATERIAL STORAGE LOCATION DRAWINGS
Date: f(eceived: /l~/;)o67
Planner: AL
LABORATORY PROCESSING
11!
MATERIALS/SUPPLIES
PHARMACy
HOUSEKEEPING
o
,
I'll
.
HAZARDOUS
MATERIALS
THIS PLAN IS PRELIMINARY. HAZARDOUS
MATERIAL STORAGE LOCATIONS MAY CHANGE
Peace Health
RiverSend Medical Pavilion
uate, r,eceived: ) ~~/Job7_
Planner: AL
SHT: HAZ-l
Hazardous Materials
January23,2007
ANSHEN+ALLEN
_1_ro_nWlgln*""OKig<1
Scale: '/32" = "-0"
...
...
HOUSEKEEPING
ENDOSCOPE PROCESSING
HOUSEKEEPING
...
.
HAZARDOUS
MATERIALS
THIS PLAN IS PRELIMINARY. HAZARDOUS
MATERIAL STORAGE LOCATIONS MAY CHANGE
PeaceHeahh
RiverBend Medical Pavilion
D.:.t.., i'c;8ceived:
Planner: AL
/ I J~/Jo177
/
SKI: KAZ.2
Hazardous Materials
Januaf)'23,2007
ANSHEN+AllEN
ArchitecW", PIan"*"lllnl9'1or Du9>
Scale: 1/16' '" 1'-0'
MEDICATIONS
III II II
HOUSEKEEPING
MEDICATIONS
.
HAZARDOUS
MATERIALS
THIS PlAN IS PRELIMINARY. HAZARDOUS
MATERIAL STORAGE LOCAT10NS MAY CHANGE
PeaceHeahh
RiverSend Medical Pavilion
Date Received: /;j00o 7
Planner: AL
SHT:HAZ.3
Hazardous Materials
January 23. 2007
ANSHEN+ALLEN
Arc!IIloclUroPlonninlll_DosilJn
Scole: 1/16" '" 1'-0"
III
III
MEDICATIONS
HOUSEKEEPING
MEDICATIONS
III
.
HAZARDOUS
MATERIALS
THIS PLAN IS PREUMINARY. HAZARDOUS
MATERIAL STORAGE LOCATIONS MAY CHANGE
PeaceHealth
RiverBend Medical Pavilion
SHT:HAZ-4
Hazardous Materials
January2J.2007
ANSHEN+ALLEN
ArctutlK:llK8PlannlnglnlllriorDeolgl
Date Heceived:...LI;Yt/).t<?7
Planner: AL / /
Scale: 1/16" = 1'-0'
I.
I
I
rn
I
I.
~
I
I
I
'"
~
I
I
I.
I
I
.
HAZARDOUS
MATERIALS
THIS PLAN IS PRELIMINARY, HAZARDOUS
MATERIAL STORAGE LOCATIONS MAY CHANGE
PeaceHealth
RiverBend Medical Pavilion
Date ReCeiVeL.L#~/Jr,o 7
Planner: AL
SHY: HAl.5
Hazardous Malerlals
January23,2007
ANSHEN+ALLEN
A.rch1lecW"'PlIonnOlgI_O..q,
Scole: 1/16" = 1'-0.
. 0;
.
.
ANNEX C - REFERENCE PROCEDURES
L,,,,l'iii F:eceived: / / /; h ~t?t>7
Planner: AL / /
. ,
.
.
RiverBend Hazardous Material Review Procedure
Purpose: Review new products that may contain hazardous materials to determine whether or not the
products contain DNAPLs. The City of Springfield Drinking Water Protection (DWP) Overlay District
requirements prohibit the use, storage, handling or production of hazardous materials that contain
DNAPLs.
The City of Springfield definitions of Hazardous Materials and DNAPLs are:
HAZARDOUS MATERIALS. Those chemicals or substances which are physical or health hazards as
defined and classified in Article 80 of the Uniform Fire Code as adopted or amended by the City whether
the materials are in usable or waste condition.
DNAPL. (Dense Non-Aqueous Phase Liquids). A group of hazardous materials that are denser-than
water) specific gravity greater than 1), have low solubility rate, and degrade slowly to other compounds
that are even more of a health hazard. For the purpose of Springfield's drinking water protection, DNAPL
chemicals are defined as "all chemicals displaying the characteristics of a DNAPL chemical or a material
containing a substance considered a DNAPL chemical." A list of DNAPLs regulated within the Drinking
Water Protection Overlay District shall be as adopted by SUB on November 10,1999. However, the list
does not contain all chemicals that could be considered DNAPLs, and SUB regularly adds products to the
DNAPL list.
Common DNAPLs are chlorinated solvents, including:
. Chlorobenzene
. Chloroform
. Carbon tetrachloride
. 1,2-Dibromoethane
. 1 ,2-Dichlorobenzene and 1,3-Dichlorobenzene
. 1,1 ,2-Dichlorobenzene and 1,2,4-Dichlorobenzene
. Dichloromethane, [methylene chloride)
. Tetrachloroethylene (PCE), [Perchlorethane, Perc)
. Trichloroethylene (TCE), [trichloroethene]
. 1,1,1-Trichloromethane (TCA) , [Methyl chloroform, chloroethene]
Procedure:
1. The User of the new product will obtain a Material Safety Data Sheet (MSDS) and contact the
facility Environmental Coordinator. Products must be reviewed and approved before purchase
and brought to RiverBend.
2. The User will complete the top portion of the RiverBend Hazardous Material Review and Approval
Form and provide the form and the MSDS to the Environmental Coordinator for review and
approval.
3. The Environmental Coordinator reviews the MSDS and the intended product use and completes
the bottom half of the RiverBend Hazardous Material Review and Approval Form. No products
containing DNAPLs are allowed at RiverBend. (The Environmental Coordinator should review
the product review process with the SUB before initiating the new procedure and at least annually
thereafter.)
. Most products used at RiverBend are easily determined not be DNAPLs, because they are
aqueous water-based or do not contain petroleum products or hydrocarbons.
. Products having a specific gravity < 1.0 and/or a high solubility rate> 1 % are not DNAPLs.
Examples are petroleum products such as mineral spirits, naphtha, xylene, toluene, methyl
ethyl ketone, kerosene, diesel or gasoline.
. Products with specific gravity> 1.0 and solubility rate < 1% are likely to be DNAPLs.
DNAPLs often contain chlorinated, bromated or fluoridated compounds.
. If the Environmental Coordinator cannot confidently determine that a new product is not a
DNAPL from the MSDS information; then the Environmental Coordinator should contact SUB
with the product information for product review. The SUB Water Protection Coordinator is
Amy Chinitz at 541-744-3745 or e-mail atAmvClalsubutil.com
Date ~eceived: II/; 6 hot)"?
Planner: AL ;- /
. .
.
.
4. The Environmental Coordinator contacts the User and advises them of the approval and any
special precautions (such as storage in secondary containment). Review and approval will be
completed by the Environmental Coordinator, or designee, within three (3) business days of form
submittal.
RecordkeepinQ:
1. The Environmental Coordinator adds the chemical to the Hazardous Material Inventory Statement
(HMIS) master spreadsheet.
2. The RiverBend Hazardous Material Review and Approval Form and MSDS in the Product Review
File.
Review bv SUB:
The Product Review File and HMIS will be available to the SUB at any time. If the SUB
representative determines the review and approval process was not followed, that will be a
violation of the DWP Overlay District Approval Conditions. The HMIS will be submitted to the SUB
annually or more frequently if requested by the SUB.
Rev. 7/3/07
Date Received:4~~t> 7
Planner: AL
.
.
RiverBend Hazardous Material Product Review and Approval Form
Pumose:
The City of Springfield Drinking Water Protection Overlay District approval conditions require that all new chemical
products be reviewed prior to use and added to the Hazardous Material Inventory Statement.
Information from User:
Name of Product:
Use of Product:
Location where Product will be used?
Maximum Quantity stored or in use:
Type and size of Product containers:
Review Material Safety Data Sheet IMSDSI:
Hazardous Materials/CAS # in Product:
DNAPLs (Dense Non-Aqueous Phase Liquids) are prohibited -- No DNAPLs are Present
[Most Common DNAPLs are chlorinated solvents: 1,1, I-Trichloroethane (methyl chloroform), Dichloromethane
(methylene chloride), Trichloroethylene (TCE), Tetrachloroethane (Perchloroethane, PCE), Dichlorobenzene,
Trichlorobenzenej
Storage and Use Precautions:
Reviewed and Approved By:
Date:
Product added to Hazardous Material Inventory Statement (HMIS)
Completed Form and MSDS filed in Product Review File
Date: Received: j;/t/J-t;o7
Planner: AL