20-105047-UP-HAZARDOUS MATERIALS INVENTORY-12-29-2020-V140k
C I T Y O F �r.►P
Federo%
al Way
DEPARTMENT OF COMMUNITY DEVELOPMENT
33325 8`h Avenue South
Federal Way, WA 98003
253-835-2607; Fax 253-835-2609
w\vw.cityoffcdcralwaycom
HAZARDOUS MATERIALS INVENTORY STATEMENT
CRITICAL AQUIFER RECHARGE AND WELLHEAD
PROTECTION AREAS
I. WHY SHOULD THIS INVENTORY STATEMENT BE FILLED OUT?
Critical Aquifer Recharge (CARAs) and Wellhead Protection Areas (WHPAs) are considered "critical
areas" pursuant to Federal Way Revised Code (F WCC) 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 10 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.
II. ACTIVITIES GOVERNED BY CARA AND WHPA REGULATIONS
The inventory statement must be filled out for the following activities:
• Construction of any residential structure, including single-family development
• Construction of any barn or other agricultural structure
• Construction of any office, school, commercial, recreational, service, or storage building
• Construction of a parking lot of any size
• Other minor new construction (see WAC 197-11-800[2])
• Additions or modifications to or replacement of any building or facility (does not include
tenant improvements)
• Demolition of any structure
• Any landfill or excavation
• Installation of underground tanks
• Any division of land, including short plats
• Change of use, which involves repair, remodeling, and maintenance activities
• Dredging
• Reconstruction/maintenance of groins and similar shoreline protection structures
• Replacement of utility cables that must be buried under the surface of the bedlands
• Repair/rebuilding of major dams, dikes, and reservoirs
• Installation or construction of any utility, except for on -going operation and maintenance
activities of public wells by public water providers
• Personal wireless service facilities
Project Name Jump Start Espresso
Project Location 3450 SW 320th Street
Applicant
Tracking No.
III. TYPES AND QUANTITIES OF HAZARDOUS MATERIALS
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.
MATERIAL
LIQUID(gallons)
SOLID(pounds)
(1) Acid or basic solutions or solids
N A
(2) Antifreeze or coolants
(3) Bleaches, peroxides, detergents, surfactants,
disinfectants, bactericides, algaecides
(4) Brake, transmission, hydraulic fluids
(5) Brine solutions
(6) Corrosion or rust prevention solutions
(7) Cutting fluids
(8) Deicing materials
(9) Dry cleaning or cleaning solvents
(10) Electroplating or metal finishing solutions
(11) Engraving or etching solutions
(12) Explosives
(13) 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 1) Transformer, capacitor oils/fluids, PCB's
(32) Waste oil
(33) Wood preservatives
(34) List OTHER hazardous materials or deleterious
substances on a separate sheet.
Bulletin #056 — January 1, 2011 Page 2 of 3 k:\Handouts\Hazardous Materials Inventory Statement
Project Name _
Project Location
Jump Start Espresso
3450 SW 320th Street
IV. FURTHER INFORMATION
Applicant _
Tracking No.
Provide the approximate quantity of fill and source of fill to be imported to the site.
Approximate Quantity of Imported Fill
Source of Fill
N/A
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 I11. Check box(s) #2
through #5 (and fill in appropriate blanks) of the below table if they apply to your facility or activity.
#1
The proposed development will not store, handle, treat, use, produce, recycle, or dispose of any of
the types and quantities of hazardous materials or deleterious substances listed above.
#2[ ]
Above ground storage tanks, having a capacity of gallons will be installed.
#3 [ ]
Construction vehicles will be refueled on site.
Storage within wholesale and retail facilities of hazardous materials, or other deleterious
#4 [ ]
substances, will be for sale in original containers with a capacity of _ gallons liquid or
_pounds solid.
The presence of chemical substances on this parcel is/will be for "temporary" non -routine
#5 [ ]
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.
#1 ]
Stormwater infiltration system (e.g., french drain, dry well, stormwater swale, etc.)
#2 [ ]
Hydraulic lifts or elevator, chemical systems, or other machinery that uses hazardous materials
#3 [ ]
Cathodic protection wells
#4 [ ]
Water wells, monitoring wells, resource protection wells, piezometers
#5 [ ]
Leak detection devices, training for employees for use of hazardous materials, self-contained
machinery, etc.
SIGNA E L
Sigiia. ire
2t
A.
Print Name
Date
If you have any questions about filling out this application form, please contact the Department of
Community Development's Permit Center at 253-835-2607, or permiteenter*cityoffedealway.com.
Please be advised that an application for a development permit lacking the required information will
not be accepted.
Bulletin #056 — January 1, 2011 Page 3 of 3 k:\Handouts\Hazardous Materials Inventory Statement