APPENDIX H HAZARDOUS MATERIALS …

1 APPENDIX HHAZARDOUS MATERIALS management plan ( hmmp ) ANDHAZARDOUS MATERIALS INVENTORY STATEMENT (HMIS)INSTRUCTIONSThe provisions contained in this APPENDIX are not mandatory unless specifically referenced in the adopting Part A(See Example Format in Figure 1).1. Fill out items and sign the Part A of this section is required to be updated and sub-mitted annually, or within 30 days of a process or man-agement Part B General Facility Description/Site plan (SeeExample Format in Figure 2).1. Provide a site plan on 81/2- by 11-inch (215 mm by 279mm) paper, showing the locations of all buildings, struc-tures, outdoor chemical control or storage and use areas,parking lots, internal roads, storm and sanitary sewers,wells and adjacent property uses.

2 Indicate the approxi-mate scale, northern direction and date the drawing Part C Facility Storage Map Confidential Infor-mation(See Example Format in Figure 3).1. Provide a floor plan of each building identified on thesite plan as containing HAZARDOUS MATERIALS on 81/2-by11-inch (215 mm by 279 mm) paper, identifying thenorthern direction, and showing the location of eachstorage and use Identify storage and use areas, including hazard wastestorage Show the Accesses to each storage and use Location of emergency Location where liaison will meet Facility evacuation meeting point The general purpose of other areas within Location of all aboveground and undergroundtanks to include sumps, vaults, below-gradetreatment systems, piping, Show hazard classes in each Show locations of all H occupancies, controlareas.

3 And exterior storage and use Show emergency hmmp short with themaximumallowable quantities or less per control areain (10) through (4) of theInternational FireCodeand where the threshold planning quantities at EPA 40 CFR Part 355, Sections 302 and 304 are not exceeded, shall beallowed to file a short-form hmmp which shall include all ofthe following components:1. General facility A simple line drawing of the facility showing the loca-tion of storage facilities and indicating the hazard class orclasses and physical state of the HAZARDOUS materialsbeing Information that the HAZARDOUS MATERIALS will be storedand handled in a safe manner and will be appropriatelycontained, separated and Assurance that security precautions have been taken,employees have been appropriately trained to handle thehazardous MATERIALS and react to emergency situations,adequate labeling and warning signs are posted.

4 Ade-quate emergency equipment is maintained and the dis-posal of HAZARDOUS MATERIALS will be in an which have prepared, filed and submitted a Tier IIInventory Report required by the Environmental Protec-tion Agency (USEPA) or required by a state which has securedUSEPA approval for a similar form shall be deemed to havecomplied with this Inventory statement HMIS Summary Report (see Example Format in Figure4). Complete a summary report for each control areaand H The storage summary report includes the HMISI nventory Report amounts in storage, use-closedand use-open Provide separate summary reports for storage, use-closed and use-open IBC/IFC Hazard Inventory Amount.

5 [Solid (lb), Liquid (gal), Gas (cuft, gal or lbs)]. IBC/IFC Maximum Allowable Quantity per controlarea (MAQ). (If applicable, double MAQ for sprin-kler protection and/or storage in cabinets. Forwholesale and retail sales occupancies, go to Tables2010 OREGON FIRE CODE4511M:\data\CODES\STATE CODES\Oregon\2010\Fire\Final VP\ , November 03, 2009 9:49:41 AMColor profile: Generic CMYK printer profileComposite Default and of theInternational FireCodefor MAQs.).2. HMIS Inventory Report (see Example Format in Figure5). Complete an inventory report by listing prod-ucts by Product Components.

6 (For mixtures specify percent-ages of major components if available.) Chemical Abstract Service (CAS) Number.(For mixtures list CAS Numbers of major com-ponents if available.) Location. (Identify the control area or, if it is anGroup H occupancy, provide the classification,such as H-2, H-3, etc.) Container with a capacity of greater than 55gallons (208 L). (If product container, vessel ortank could exceed 55 gallons, indicate yes incolumn.) Hazard Classification. (List applicable classifi-cations for each product.) Stored. (Amount of product in storage condi-tions.) Closed.

7 (Amount of product in use-closed sys-tems.) Open. (Amount of product in use-open sys-tems.)SECTION H103 EMERGENCY PLAN1. Emergency Notification. (See Example Format in Figure6.)2. Where OSHA or state regulations require a facility to haveeither an Emergency Action plan (EAP) or an EmergencyResponse plan (ERP), the EAP or ERP shall be included aspart of the H104 REFERENCED STANDARDSEPA 40 CFRPart 355 2008 Emergency Planning and IBC-09 International Building IFC-09 International Fire , OREGON FIRE CODEAPPENDIX H2M:\data\CODES\STATE CODES\Oregon\2010\Fire\Final VP\ , November 03, 2009 9:49:41 AMColor profile: Generic CMYK printer profileComposite Default screen2010 OREGON FIRE CODE453 APPENDIX HFIGURE 1 HAZARDOUS MATERIALS management PLANSECTION I.

8 FACILITY DESCRIPTION1. Business Name: _____Phone: _____Address: _____2. Person Responsible for the BusinessNameTitlePhone_____3. Emergency Contacts:NameTitleHome NumberWork Number_____4. Person Responsible for the Application/Principal Contact:NameTitlePhone_____5. Principal Business Activity:_____6. Number of Employees: _____7. Number of Shifts: _____a. Number of Employees per Shift_____8. Hours of Operation:_____3M:\data\CODES\STATE CODES\Oregon\2010\Fire\Final VP\ , November 03, 2009 9:49:41 AMColor profile: Generic CMYK printer profileComposite Default screen4542010 OREGON FIRE CODEAPPENDIX HFIGURE 2 HAZARDOUS MATERIALS management plan SECTION I: FACILITY DESCRIPTION_____4M:\data\CODES\STATE CODES\Oregon\2010\Fire\Final VP\ , November 03, 2009 9:49:41 AMColor profile: Generic CMYK printer profileComposite Default screen2010 OREGON FIRE CODE455 APPENDIX HFIGURE 3 HAZARDOUS MATERIALS management PLANSECTION I.

9 FACILITY DESCRIPTIONPART C FACILITY MAPB usiness NameDateAddressPage of5M:\data\CODES\STATE CODES\Oregon\2010\Fire\Final VP\ , November 03, 2009 9:49:42 AMColor profile: Generic CMYK printer profileComposite Default screen4562010 OREGON FIRE CODEAPPENDIX HFIGURE 4 SECTION II HAZARDOUS MATERIALS INVENTORY STATEMENT (HMIS) HMIS SUMMARY REPORTa(StoragebConditions)cIBC/IFC HAZARDCLASSHAZARD CLASSINVENTORY AMOUNTIBC/IFC MAXIMUM ALLOWABLE QUANTITYd(Abbrev)Solid (lb)Liquid (gal)Gas (cu ft, gal, lb)Solid (lb)Liquid (gal)Gas (cu ft, gal lb)CombustibleLiquidC25120C3A330C3B61320 0 Combustible FiberLoose BaledCryogenics,FlammableCryO-Flam45 Cryogenic,OxidizingCryO-OX45 Flammable GasFLG(Gaseous)1501000(Liquefied)

10 30 Flammable LiquidF1A30F1B & F1C5120 Combination (1A, 1B, 1C)5120 Flammable SolidFLS125 Organic PeroxideOPU0OP15OP250OP3125OP4 NLOP5 NLOxidizerOX40OX310OX2250OX14000a. Complete a summary report for each control area and H Storage = storage + use-closed + use-open systemsc. Separate reports are required for use-closed and use-open systemsd. Include increases for sprinklers or storage in cabinets, if applicable.(This is an example; add additional hazard classes as needed.)6M:\data\CODES\STATE CODES\Oregon\2010\Fire\Final VP\ , November 03, 2009 9:49:42 AMColor profile: Generic CMYK printer profileComposite Default screen2010 OREGON FIRE CODE457 APPENDIX HFIGURE 5 SECTION II HAZARDOUS MATERIALS INVENTORY STATEMENT (HMIS) HMIS INVENTORY REPORT(Sort Products Alphabetically by Location of Product and then Alphabetically by Product Name)Product Name(Components)cCASN umberLocationaContainer> 55 galbHazClass 1 HazClass 2 HazClass 3 Stored(lbs)Stored(gal)Stored(gas)dClosed (bls)Cloxed(gal)ClosedgasdOpen(lbs)Open( gal)ACETYLENE(Acetylene gas)74-86-2 ControlArea 1 FLGUR2150 BLACK AEROSOLSPRAY PAINT(Mixture)