22-102123-UP-Hazardous Materials Inventory Statement-05-09-2022CITY OF
Dnpl,nrnrnur or Connnnuxrrv Dnvn,lopMENT
33325 8th Avenue South
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www. cityo ffederalway. c omFederal Way
HAZARDOUS MATERIATS INVENTORY STATEMENT
CRITICAT AQUIFER RECHARGE AND WEIIHEAD
PROTECTION AREAS
L Wnv sHouLD THrs rNvENToRy STATEMENT BE F'TLLED our?
Critical Aquifer Recharge (CARAs) and Wellhead Protection Areas (WHPAs) are considered "critical
areas" pursuant to Federal lf/ay Revised Code (FWCC) Title 14, "Environmental Policy." This
inventory statement must be filled out by the applicant or agent for any proposed activity listed in
Section II of this handout, and which are located within Wellhead Capture Zones 1, 5, and l0 as shown
on the Critical Aquifer Recharge and Wellhead Protection Areas Maps. Please refer to the handout on
Critical Aquifer Recharge and Wellhead Protection Areas for a description of the review process.
U. Acrrvrrrns GovERNED By CARA AND WHPA RncurarroNs
The inventory statement must be filled out for the following activities:
o Construction of any residential structure, including single-family development
r Construction of any barn or other agricultural strucfure
e Construction of any office, school, commercial, recreational, service, or storage buildingr Construction of a parking lot of any size
o Other minor new construction (see WAC 197-11-800t21)
o Additions or modifications to or replacement of any building or facility (does not include
tenant improvements)
r Demolition of any structure
o Any landfill or excavation
r Installation of underground tanks
. Any division of land, including short plats
r Change of use, which involves repair, remodeling, and maintenance activities
. Dredging
o Reconstruction/maintenance of groins and similar shoreline protection strucfures. Replacement of utility cables that must be buried under the surface of the bedlandso Repair/rebuilding of major dams, dikes, and reservoirs
I Installation or construction of any utility, except for on-going operation and maintenance
activities of public wells by public water providers
r Personal wireless service facilities
proj ect Name Fede ra I Way M emoria I Fiel d I m provem e nLiplicant Federal Way Public Schools
ProJ ect Location 1300 S 308th Street Tracking No.22-101.129-PC
UI. Twns AND QUANTTTTES oF HAZARDoUs MATERTALs
Please provide the approximate quantity of the types of hazardous materials or deleterious substances
that will be stored, handled, treated, used, produced, recycled, or disposed of in connection with the
proposed activity. If no hazardous materials will be involved, please proceed to Section IV.
M.q,rnRrar,Lrourn (eallons)Sor,m (nounds)
(1) Acid or basic solutions or solids
(2) Antifreeze or coolants
(3 ) B leache s, peroxide s, detergents, surfactants,
disinfectants. bactericides. aleaecides
(4) Brake, transmission, hydraulic fluids
(5) Brine solutions
(6) Conosion or rust prevention solutions
(7) Cutting fluids
(8) Deicing materials
(9) Dry cleaning or cleaning solvents
(10) Electroplating or metal finishing solutions
(1 1) Engraving or etching solutions
(12) Explosives
( I 3) Fertilizers
(14) Food or animal processing wastes
(15) Formaldehyde
(16) Fuels, additives, oils, greases
(17) Glues, adhesives, or resins
(18) Inks, printing, or photocopying chemicals
(19) Laboratory chemicals, reagents or standards
(20) Medical, hospital, pharmaceutical, dental, or
veterinary fluids or wastes
(21) Metals (hazardous e.g. arsenic, copper,
chromium, lead, mercury. silver. etc,)
(22) Paints, pigments, dyes, stains, varnish, sealers.
(23) Pesticides, herbicides or poisons
(24) Plastic resins, plasticizers, or catalysts
(25) Photo development chemicals
(26) Radioactive sources
(27) Refrigerants, cooling water (contact)
(28) Sludges, still bottoms
(29) Solvents, thinners, paint removers or strippers
(30) Tanning (leather) chemicals
(3 l) Transformer, capacitor oils/fluids, PCB's
(32) Waste oil
(3 3) Wood preservatives
(34) List oTHER hazardous materials or deleterious
substances on a separate sheet.
Bulletin #056 - Jarnnry 1,2011 Page2 of 3 k:\Handouts\Hazardous Materials Inventory Statement
proj ect Name Fede ra I Way M em o ri a I Fi eld I m provemenAiplicant Federal W Public Schools
Proj ect Location 1300 S 308th Street Tracking No.22-L01r29-P
IV. FunrnuRlNpoRvr.lrroN
Provide lhe approximate quantity of filI and source of fill to be imported to the site.
Approximate Quantitv of Imported Fill Source of Fill
1,200 cy Corliss Resources, Federal Way or similarfacility
Check box # 1 if you do not plan to store, handle, treat, use, produce, recycle, or dispose of any of the
types and quantities of hazardous material or deleterious substance listed in Section trI. Check box(s) #2
through #5 (and filI in appropriate blanks) of the below table if they apply to your facility or activity.
#t Ll The proposed development will not store, handle, treat, use, produce, recycle, or dispose ofany of
thc types and quantities ofhazardous materials or deleterious substances listed above.
#21 )Above ground storage tanks, having a capacity of _ gallons will be installed.
#3t l Construction vehicles will be refueled on site.
#41 I
Storage within wholesale and retail facilities of hazardous materials, or other deleterious
substances, will be for sale in original containers with a capacity of _ gallons liquid or
pounds solid.
#stl The presence of chemical substances on this parcel is/will be for "temporary" non-routine
maintenance or repair of the facility (such as paints and paint thinners) and are in individual
containers with a capacity of _ gallons liquid or pounds solid.
Check any of the following items that currently exist or are proposed in connection with the
development of the site.
SrcNlrunn
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Signature Date
L.c\.V'€-\LJ tuf J(_
#t tA Stormwater infiltration system (e.g., french drain, dry well, stormwater swale, etc.)
#2 l1 Hydraulic lifts or elevator, chemical systems, or other machinery that uses hazardous materials
#3 I l Cathodic protection wells
#4 I I Water wells, monitoring wells, resource protection wells, piezometers
#stl Leak detection devices, training for employees for use of hazardous materials, self-contained
)etc.
Print Name
If you have any questions aboutfilling out this applicationform, please contact the Department of
Community Development's Permit Center at 253-835-2607, or permitcentet@lcityoffedealway,com.
Please be advised that an application for a development permit lacking the required information will
not be accepted.
Bulletin #056 - lanuary 1 ,2011 Page 3 of 3 k:\Handouts\Hazardous Materials Inventory Statement