21-101296-Hazardous Materials Inventory Statement-05-12-2021-V1DeplRriurwr oF CoMMUNrrv Dr,veropMENT
33325 8tr'Avenue South
Federal Way, WA 98003
253 -83 5 -2607 ; F ax 2 5 3 -83 5 -2609
www. cityoffederalway. comFederal Way
CITY OF
HAZARDOUS MATERIATS INVENTORY STATEMENT
CRITICAL AQUIFER RECHARGE AND WELLHEAD
PROTECTION AREAS
I. Wsv sHouLD THIs INvENToRy sTATEMENT BE FTLLEo our?
Critical Aquifer Recharge (CARAs) and Wellhead Protection Areas (WHPAs) are considered "critical
areas" pursuant to Federal Way 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 l, 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. Acrryrrrus GovERNED By CARA AND WHPA RncurarroNs
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 197-11-800t21)
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
Changc of usc, 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 facilitiesa
Project Name FWPS Olympic View K-8 Applicant Federal Way Public Schools
Project Locarion 2626 SW 327th St Tracking No
ilI. Types AND QUANTTTTES oF HAZARDoUS M,rrnnrnrs
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.
MnrEnrar.Lroutn (sallons)Solln (nounds)
(l) Acid or basic solutions or solids
(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 5 gal
(10) Electroplating or metal finishing solutions
( I I ) Engraving or etching solutions
( l2) Explosives
( I 3) Fertilizers
( l4) Food or animal processing wastes
(15) Formaldehyde
(16) Fuels, additives, oils, greases 5 gal
(17) Glues, adhesives, or resrns 5 gal (Construction)
( I 8) 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.300 gal (Construction)/1 0 gal
(23) Pesticides, herbicides or poisons 5 gal
(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 l,20ll Page 2 of 3 k:\Handouts\Hazardous Materials Inventory Statement
Project Name FWPS O m View K-8 Applicant Federal Wav Public Schools
Project Location 2626 SW 327th St Tracking No.
IV. FuRrnnRlnroRvrlrrols
Provide the approximate quantiry of fill and source of fill to be imported to the site.
Approximate Ouantitv of Imported Fill Source of Fill
3,000 cy Corliss Resources, Federal Way
Check box # 1 if you do not plan to store, handle, treat, use, produce, recycle, or dispose of any of the
fypes and quantities of hazardous material or deleterious substance listed in Section III. Check box(s) #2
through #5 (and filI in appropriate blanks) of the below table if they apply to your facility or activity.
#lI l The proposed development will not store, handle, treat, use, produce, recycle, or dispose ofany of
the fypes and quantities ofhazardous tnaterials or deleterious substances listed above.
#2x Above ground storage tanks, having a capacity of 500 gallons will be installed.
#3t l Construction vehicles will be refueled on site.
#4t 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.
#5[l
The presence of chemical substances on this parcel is/will be for "temporary" non-routine
maintenance or repair of the faciliry (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.
SrcunruRn
5- /2 -d I
Signature
/\4t c)/.r LL
Date
H^t^ sktr
#1 x Stormwater infiltration system (e.g., french drain, dry well, stormwater swale, etc.)
#2 ><Hydraulic Iifts or elevator, chemical systems, or other machinery that uses hazardous materials
#3 I l Cathodic protection wells
#4 I l Water wells, monitoring wells, resource protection wells, piezometers
#s t l Leak detection devices, training for etnployees for use ofhazardous materials, self-contained
machinery, etc.
Print Name Fw AS FBolz<:f M,s a 4 6 {<
If you have any questions about jilling out this application form, please contact the Department of
Community Development's Permit Center at 253-835-2607, or permitcentet@cityoffedealway,com.
Pleuse be advised thut an application for a development permit lacking the required information will
not be uccepted.
Bulletin #056 - January l, 201 I Page 3 of 3 k:\Handouts\Hazardous Materials Inventory Statement