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Home My WebLink AboutBUSINESS PLAN (7)11 ~ ~ - -_ ii COSTCO WHOLESALE , Ii38O0 ROSEDALE HWY i~ ,~_~' ;; I ;~ -, Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Costco Wholesale Corporation gas station #688 Facility ID #: 215-000-001105 , Facility Address: BAKERSFIELD, 3800 Rosedale Highway, Bakersfield; CA, 93308 Reason for Submitting this Form (Check One) ® Change of Designated Operator Facility Phone #: (661) 636-0822 ^Update Certificate Expiration Date Designated UST Operator(s) for this Facility PRiMARV Designated Operator's Name: Josh Beckham Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 ^ Service Technician ^ Third-Party International Code Council Certification #: 5293433-UC Expiration Date: 8/29/2008 Ai,TF.RNATF. 1 /nniinnal) Designated Operator's Name: Brian Irvin Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation, LA Regonal Office ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 741-7761 ^ Service Technician ^ Third-Party International Code Council Certification #: 5280168-UC Expiration Date: 7/21!2008 ALTERNATE 2 (Optional) Designated Operator's Name: See attached pages 2 through 7. Relation to UST Facility (Check One) Business Name: ^ Owner ®Operator ^Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at.the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f1. Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: October 29 2007 OWNER'S PHONE #: (425) 313-8100 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca.~ov/ust/contacts/cupa ac s~tml. 2) NOTIFY THE.LOCAL_AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. Costco Wholesale Designated Operator Alternates ALTERNATE Designated Operator's Name: Ruben Cordero Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (760) 241-5384 ^ Service Technician ^ Third-Party International Code Council Certification #: 5280168-UC Expiration Date: 3/22/2008 ALTERNATE Designated Operator's Name: Karl Kakiba Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 364-0217 ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: 10/17/2009 ALTERNATE Designated Operator's Name: Jason Clark Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 364-02.17 ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: 9/15/2009 ALTERNATE Designated Operator's Name: Juan Vizcara Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 ^ Service Technician ^ Third-Party International Code Council Certification #: 5297892-UC Expiration Date: 12/22/2008 ALTERNATE Designated Operator's Name: Mark Munger Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 530-3198 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243824-UC Expiration Date: 10!30(2008 ALTERNATE Designated Operator's Name: Mike Dell'Olio Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 582-0764 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257814-UC Expiration Date: 9/12/2009 ALTERNATE Designated Operator's Name: James Dotson Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 434-2926 ^ Service Technician ^ Third-Party International Code Council Certification #: 5285938-UC Expiration Date: 6/23/2008 November 2004 Page 2 of 7 Costco Wholesale Designated Operator Alternates ALTERNATE Designated Operator's Name: Enedina Morales Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 334-8069 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243848-UC Expiration Date: 10/13/2008 ALTERNATE Designated Operator's Name: Tom Prinkleton Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 983-1509 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243714-UC Expiration Date: 11/3/2008 ALTERNATE Designated Operator's Name: Tony Wong Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 281-1960 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243764-UC Expiration Date: 12/15/2008 ALTERNATE Designated Operator's Name: Ron Legault Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 281-1960 ^ Service Technician ^ Third-Party International Code Council Certification #: 5280199-UC Expiration Date: 3/17/2008 ALTERNATE Designated Operator's Name: Jared Harsma Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 279-1360 ^ Service Technician ^ Third-Party International Code Council Certification #: 5300059-UC Expiration Date: 12/14/2008 ALTERNATE Designated Operator's Name: Rick Taurick Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (760) 202-1354 ^ Service Technician___ ^, Third-Party_~ International Code Council Certification #: 5273952-UC Expiration Date: 12/26/2007 ALTERNATE Designated Operator's Name: Chuck Del Piano Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 453-0391 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243843-UC Expiration Date: 10/13/2008 November 2004 Page 3 of 7 Costco Wholesale Designated Operator Alternates ALTERNATE Designated Operator's Name: Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (951) 697-4612 ^ Service Technician ^ Third-Party International Code Council Certification #: ~ Expiration Date: Ai,TERNATF, Designated Operator's Name: Stephen Yamas Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 465-6321 ^ Service Technician ^ Third-Party International Code Council Certification #: 5309500-UC Expiration Date: 4127/2009 ALTERNATE Designated Operator's Name: Aaron Guerro Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 891-1585 ^ Service Technician ^ Third-Party International Code Council.Certification #: 5243801-UC Expiration Date: 8/30/2008 ALTERNATE Designated Operator's Name: Adam Hart Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 478-0963 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257827-UC Expiration Date: 5/30/2009 ALTERNATE Designated Operator's Name: Jamie Feehan Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 823-8046 ^ Service Technician ^ Third-Party International Code Council Certification #: 5311533-UC Expiration Date: 5/12/2009 ALTERNATE Designated Operator's Name: Alex Mesa Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 770-5641 ^ Service Technician ^ Third-Party International Code Council Certification #: 525785b-UC Expiration Date: 4!27!2009 ALTERNATE Designated Operator's Name: Alex Chavez-Romo Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (760) 775-0363 ^ Service Technician ^ Third-Party International Code Council Certification #: 5297808-UC Expiration Date: 12/12/2008 November 2004 Page 4 of 7 Costco Wholesale Designated Operator Alternates ALTERNATE Designated Operator's Name: Bruce Addison Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 837-2026 ^ Service Technician ^ Third-Party International Code Council Certification #: 5282016-UC Expiration Date: 4/14/2008 ALTERNATE Designated Operator's Name: Cesar Aguila Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 536-0214 ^ Service Technician ^ Third-Party International Code Council Certification #: 5268549-UC Expiration Date: 10/14/2007 Ai.TF.RNATF. Designated Operator's Name: Mario Rebollar Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 260-9546 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243755-UC Expiration Date: 11/3/2008 ALTERNATE Designated Operator's Name: Douglas Johnson Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 557-3783 ^ Service Technician ^ Third-Party International Code Council Certification #: 5261186-UC Expiration Date: 11/10/2007 ALTERNATE Designated Operator's Name: Julia Jett Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 581-3737 ^ Service Technician ^ Third-Party International Code Council Certification #: 5280195-UC Expiration Date: 3/10/2008 ALTERNATE Designated Operator's Name: Mark Stanley Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 839-2491 ^ Service Technician ^ Third-Party International Code Council Certification #: 5311576-UC Expiration Date: 6/19/2009 ALTERNATE Designated Operator's Name: Karo Babaian Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 839-2491 ^ Service Technician ^ Third-Party International Code Council Certification #: 5246019-UC Expiration Date: 2/21/2009 November 2004 Page 5 of 7 Costco Wholesale Designated Operator Alternates ALTERNATE Designated Operator's Name: Crystal Newman Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 575-5004 ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: ALTERNATE Designated Operator's Name: Josh Beckham Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 ^ Service Technician ^ Third-Party International Code Council Certification #: 5293433-UC Expiration Date: 8/29/2008 ALTERNATE Designated Operator's Name: Michael McDonald Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 425-9176 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243744-UC Expiration Date: 10/13/2008 ALTERNATE Designated Operator's Name: Keith Crawford Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 541-7000 ^ Service Technician ^ Third-Party International Code Council Certification #: 5293439-UC Expiration Date: 1/27/2009 ALTERNATE ,Designated Operator's Name: Wesley Gillen Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 541-7000 ^ Service Technician ^ Third-Party International Code Council Certification #: 5303229-UC Expiration Date: 1(27(2009 ALTERNATE Designated Operator's Name: Traci Howard Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 761-3810 ^ Service Technician ^ Third-Party International Code Council Certification #: 5297833-UC Expiration Date: 11/4/2008 ALTERNATE Designated Operator's Name: Rebecca Rodriguez Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 942-8565 ^ Service Technician ^ Third-Party International Code Council Certification #: 5280214-UC Expiration Date: 3/15/2008 November 2004 Page 6 of 7 Costco Wholesale Designated Operator Alternates ALTERNATE Designated Operator's Name: Steve Wenzel Relation to UST Facility (Check One) Business Naine: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 942-8565 ^ Service Technician ^ Third-Party International Code Council Certification #: 5261319-UC Expiration Date: 9/26/2009 ALTERNATE Designated Operator's Name: Deshay Scott Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 695-9908 ^ Service Technician ^ Third-Party International Code Council Certification #: 5293501-UC Expiration Date: 8/7/2008 ALTERNATE Designated Operator's Name: Larry Garnica Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (562) 690-0041 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243868-UC Expiration Date: 10/29/2008 ALTERNATE Designated Operator's Name: Veronica Rivas Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 338-1933 ^ Service Technician ^ Third-Party International Code Council Certification #: 5315316-UC Expiration Date: 7/21/2009 October 2007 Page 7 of 7 ,~ _ -=~- ~~, ;,~ o~, ~~ ~~, ~ . 3aDD .ee. . .:, _ r~ -~„ , .; r. it-:..... ~ I ~ U Costco Wholesale Expense Payables Dept. P.O. Box 34305 Seattle, WA 98124-1305 ESTELLA THOMPSON, (425) 313-8748 ' 07/31/07 03957-00 CITY OF BAKERSFIELD PO BOX 2057 BAKERSFIELD, CA 93303-2057 Attention: Credit Manager Invoice#: 071507688 3~~~ ~~ To process the above-referenced invoice, we need to have our seven digit vendor number on the invoice. Please submit all future invoices with the information requested to the address above, and we will process upon receipt. Thank you for your attention to this matter. ~u ~f ®o~ ~~ ~'~ J n,} V ~ ~ ~J COSTCO 0688 Manager GARY MCELMURRY Location: 3800 ROSEDALE HWY City BAKERSFIELD CommCode: KCFD STA 66 EPA Numb: CAR000114611 SiteID: 015-021-002412 BusPhone: (661) 852-2640 Map 102 CommHaz High Grid: 23C FacUnits: 1 AOV: SIC Code:5311 DunnBrad:10-339-1843 Emergency Contact / Title Emergency Contact / Title GARY MCELMURRY / WHSE MANAGER MINDA ROMERO / ADMIN MANAGER Business Phone: (661) 852-2643x Business Phone: (661) 852-2643x 24-Hour Phone (661) 900-4533x 24-Hour Phone (661) 599-0533x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: RSs Fire Press React ImmHlth De1Hlt~i .............. Contact ~~ l~i~,-GE-MRi~PA'TtZICK ~~; i/NVII?6N~''1~1~ Phone: (425) 313-2591x MailAddr: 999 LAKE DR R.~'DNS~ P~tNtuGn State: WA City ISSAQUAH Zip 98027-5366 Owner COSTCO WHOLESALE CORP Address 999 LAKE DR City ISSAQUAH Period to Preparers Certif'd: ParcelNo: Phone: (425) 313-8100x State: WA Zip 98027-5366 TotalASTs: = Coal TotalUSTs: = Coal RSs: Yes Emergency Directives: PROG A - HAZMAT PROG H - HAZ WASTE GEN PROG T - ABOVEGROUND STORAGE TANK PROG U - UST ~Nfi~~ ~ ~ ~ ~ ~Q~~ Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the informatian is true, accurate, and complete. Signature Dat ~~p~~ -1- O1/29/2b07 ~ .~ F COSTCO 0688 SiteID: 015-021-002412 ~ STORAGE CONTAINER DATA (UST FORM A) --- Last Action Type: FACILITY/SITE INFORMATION -- Business Name: COSTCO 0688 Cross Street : j;,~Min~v D~ ~~a c0uaZr Business Type: ~ENC2f~L M~Ct~Afit~a(5E Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper SHERI PUOLPON ICC Nbr: 5243840-UC PROPERTY OWNER INFORMATION ~- Name Phone: (661) 852-2643x Address: City State: Zip: Type CORPORATION Name MINDA ROMERO Address: City Type CORPORATION BOE UST Fee# 039958 Financ'1 Resp: SELF INSURED Legal Notif Date:08/15/2006 Name: State UST # TANK OWNER INFORMATION Phone: (661) 852-2643x State: Zip: Phone: ( ) - Tt1: 1998 Upg Cert#: x -2- Ol/29/2b07 ~, F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP HAND & BODY SOAP IH L 1976.92 GAL Est STAIN REMOVER E F P IH L 182.60 GAL F+~t BATTERIES R IH S 7317.70 LBS Vii. BATTERY ACID R IH L 2899.05 LBS iii BLEACH IH L 1008.56 GAL Hi DEODORANT F P DH S 702.48 LBS H3 TOILET BOWL CLEANER (HYDROCLORI IH S 697.81 LBS Hi BLEACH IH S 444.39 LBS ~# ~~1~FE' D~~~1~ E F P DH G 244.28 FT3 Hi DRAIN OPENER F IH DH L 150.00 GAL Hi SULFURIC ACID (BATTERIES) R IH L 100.00 GAL ~i BUG-B-GON F IH L 97.94 GAL iii WAX STRIPPER IH L 55.00 GAL Hi REGULAR UNLEADED GASOLINE F IH DH L 40000.00 GAL Mbd PREMIUM UNLEADED GASOLINE F IH DH L 20000.00 GAL Mbd LYSOL F DH L 4604.53 LBS Mbd WASTE SOLIDS CONTAINING FLAMMAB F IH DH S 1100.00 LBS Mbd GLASS CLEANER E IH DH L 1092.03 LBS Mbd CONDITIONER L 818.05 GAL Nrbd ALL PURPOSE CLEANERS F IH L 801.09 GAL Mbd GLASS CLEANER IH DH L 740.00 GAL Mbd -=H'~I~- ~~(~`~ F R IH S 7 0 0. 0 0 LBS Mbd WD 40 F P IH L 657.94 GAL Mbd LYSOL F DH L 558.11 GAL Mbd LEMON CLEANER F IH L 321.75 GAL Mbd TUB & TILE CLEANER IH L 206.25 GAL Mbd OIL EATER IH L 92.13 GAL Mbd ORANGE HAND CLEANER F L 82.50 GAL Mbd CAR WAX F DH L 73.43 GAL Mbd INK & TONER CARTRIDGES F IH L 57.00 GAL Mbd WASTE GASOLINE F IH DH L 55.00 GAL Mbd LAUNDRY DETERGENTS DH S 38018.54 LBS Lt-iw LAUNDRY DETERGENTS F IH DH L 4645.21 GAL Lbw CHLORODIFLOUROMETHANE P IH DH G 3400.00 LBS Lbw SHAMPOO IH L 1261.06 GAL Lbw LOTION IH L 696.72 GAL Lbw ROUND UP IH L 287.04 GAL Lbw ~ DIESEL FUEL F IH DH L 200.00 GAL Lbw WOOLITE LAUNDRY DETERGENT L 115.50 GAL Lbw FLOOR FINISH F IH L 101.75 GAL LbW ANTIFREEZE (COOLANT) F IH DH L 92.40 GAL Lt~w NITROGEN P DH G 5625.00 FT3 Min CARBON DIOXIDE REFRIGERATED LIQ P DH G 4370.00 FT3 Min MOTOR OIL F IH L 2000.25 GAL Min BATHROOM CLEANSER IH DH L 1003.06 GAL 1~In ~S- D~LE~ P DH G 786.72 FT3 1t+In DISHSOAP F IH DH L 779.09 GAL Min INSECTICIDE F IH L 234.30 LBS Min -3- O1/29/2b07 71 r' F COSTCO 0688 ~ Hazmat Inventory = ~ MCP+DailyMax Ordez = SiteID: 015-021-00241:2 ~ By Facility Unit ~ Fixed Containers on Sits ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit l~+t~P ENGINE TREATMENT F IH DH L 171.60 GAL lain TIRE CLEANER IH L 150.56 GAL $+tn FERTILIZERS IH S 16455.34 LBS fJfiR CHARCOAL IH S 14 8 2 3. 6 0 LBS t7fiR BAR SOAP IH S 7936.09 LBS UriR AUTOMATIC DISH DETERGENT IH S 5526.48 LBS UiiR OXI-CLEAN IH S 3748.80 LBS FJfiR -~A~C~- ~A~ 17 EL,~"( ~ F I H S 9 0 0. 0 0 LBS ~J~iR AUTOMATIC DISH DETERGENT IH L 807.67 GAL tJ~iR FABRIC SOFTENER F IH L 804.50 GAL ~JiiR LEMON SPRAY E P I H L 7 2 2 .8 2 LBS ~Jf1R HERBICIDE IH DH S 709.50 LBS rt7t1R USED LEAD ACID BATTERIES R IH L 483.00 LBS UzR FIRELOGS IH S 475.20 LBS t:T~iR FUJI I H DH L 3 7 6. 8 8 GAL U1R INSECTICIDE F IH L 347.00 GAL LJnR SUNCREEN I H L 2 6 7. 5 6 GAL ~7iR CAR WASH F IH L 264.00 GAL F7nR AEROSOL HAIR SPRAYS E F P L 188.65 LBS UfiR SHAVE GEL E P IH L 187.65 GAL tT~iR SPOT REMOVER IH DH L 169.13 GAL LInR FLOOR CLEANER F IH L 16 6 .3 8 GAL ~TitiR CLEANER/DEGREASER F IH L 123.75 GAL Uf1R -4- O1/29/2b07 -5- O1/29/~b07 ,, F COSTCO 0688 ~ Inventory Item 0050 COMMON NAME / CHEMICAL NAME, HAND & BODY SOAP Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixture Ambient SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map:l Grid:G-2 -- CAS# TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 2.25 GAL 1976.92 GAL 1976..92 GAL I11-1GEitVJVVA LV1~lYV1VtS1V1J %Wt. RS CAS# 95.00 Water No 773215 riAGL~ttlJ AJJL' J,71~1t;1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MiC No No No No/ Curies IH / / / Ext ~ Inventory Item 0067 COMMON NAME / CHEMICAL NAME STAIN REMOVER Location within this Facility Unit RETAIL SALES FLOOR Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: ( Grid:i3"~ -~- CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE -~ Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 2.60 GAL 182.60 GAL 182.60 GAL _ 11L'~GtS1SLVU.7 l'VCIYVIVP~1V1~7 %Wt. RS CAS# Mineral Oil No 8020835 Propane Yes 748$6 Isobutane Yes 752$5 Petrolatum No 8009[738 11LiGti.[CL tiJ .7 P~J.71°1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Eft -6- O1/29/2~07 ~, F COSTCO 0688 ~ Inventory Item 0075 COMMON NAME / CHEMICAL NAME BATTERIES FORKLIFT/PALLET JACK BATTERIES Location within this Facility Unit RECEIVING AREA SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: I Grid: -- ~~~-3 cAS# ~SolidE T Mixture ~ AmbRent~E ~ A~PeRATURE OTHERONTSPECIFYYPE AMOUNTS AT THIS LOCATION -- Largest Container Dail Maximum Dail Average 558.50 LBS y7317.70 LBS y7317.70 LBS tiL-~GEittLV U.7 1.V1~lYV1Vl;1V 1 J , %wt. Rs cAS# 40.00 Sulfuric Acid (EPA) No 7664939 60.00 Lead - -- No 7439921 tLHGLittL F~J~i',5a1~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCfi No No No No/ Curies R IH / / / Hi ~ Inventory Item 0034 COMMON NAME / CHEMICAL NAME BATTERY ACID. Location within this Facility Unit AUTO/MARINE LEAD-ACID BATTERY Days On Site 365 Map : Grid : _--- I~yS~~ cAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE - Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10..50 LBS 2899.05 LBS 2899.05 LBS nsyc~s-u~LV~a ~.vriYVlV1;tV1~ %Wt. RS CAS# 40.00 Sulfuric Acid (EPA) No 7664539 53.00 Lead No 7439521 I1tiL~tiRL H. 7 J P~ J J1~1L.1V 1 w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / Hi Facility Unit: Fixed Containers on Site ~ -7- 01/29/2007 ,~ r ~ COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Sites ~ COMMON NAME / CHEMICAL NAME ~~ BLEACH Days On Situ 365 Location within this Facility Unit Map: Grid: ~- RETAIL SALES FLOOR `' -2 ~ CAS # i STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE --"- Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 180.00 GAL 1008.56 GAL 1008.56 GAL riAGHtCLVUA lrV1~lYV1VL'1Vlb oWt. RS CAS# 100.00 Sodium Hypochlorite No 7681529 tl1~GHKL HJJL' ~51~11;1V lJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi ~ Inventory Item 0041 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME "- DEODORANT Days On Sit+ 365 Location within this Facility Unit Map:l Grid:G-2 ~-- RETAIL SALES FLOOR CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE --- Solid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION "- Largest Container Daily Maximum Daily Average 0.25 LBS 702.48 LBS 702.48 LBS HAZARDOUS COMPONENTS swt RS CAS# t1EiGHKL 1-L7~L' ~.71~1L"1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P DH / / / Hi -8- 01/29/2007 ,qy .. F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0070 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- TOILET BOWL CLEANER (HYDROCLORIC ACID) Days On Site TABS 365 Location within this Facility Unit Map: Grid: --- RETAIL SALES FLOOR ~ i~_y~~ CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid TMixture Ambient ~ Ambient Box AMOUNTS AT THIS LOCATION ~--- Largest Container Daily Maximum Daily Average 0.22 LBS 697.81 LBS 697.81 LBS tIL~GfiCCLVUD LV1°1rV1YL'r1V1.S %Wt. RS CAS# Sodium Tetraborate Pentahydrate No 1330434 Hydroxyethyl Cellulose No 9004620 Acid Blue 9 No 3844459 Sodium Sulfate No 7757326 Sodium Dodecylbenzene Sulfonate No 251553b0 t11~GKKL H. 7JJ.,.7.71~1~1V 1.5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / H ~ Inventory Item 0037 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME "-"- BLEACH Days On Site 365 Location within this Facility Unit Map: Grid: -- RETAIL SALES FLOOR ~ ~-2I5 CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Solid TMixture ~mbient ~ Ambient BOX AMOUNTS AT THIS LOCATION Largest Cont7i49rLBS Daily 444139m LBS I Daily 444r39e LB5 ruiG.y1~1~V V a ~.Vlnrvivr.ly 1 S %Wt. RS CAS# 100.00 Bleach No 7681529 I3HGt1KL Ljw 7.7L' .7~71~1L'.1V 1.7 TSecret RS, BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Hi -9- O1/29/2b07 '~ F COSTCO 0688 ~ Inventory Item 0021 COMMON NAME / CH_E..-MI~CAL NAME ~R6~' ~ li ~~ I Location within this Facility Unit SEASONAL AISLE STATE TYPE PRESSURE Gas TMixtur~Above Ambient SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: ~- CAS# 74-98-6 TEMPERATURE CONTAINER TYPE Ambient PORT. PRESS. CYLINDER___ AMOUNTS AT THIS LOCATION --~ Largest Container Dail Maximum Daily Average Y 14.10 FT3 244.28 FT3 244.28 FT3 I1HGE3t[_1lVUw7 l..Vl"lYV1VL~1V l.S oWt. RS CAS# 94.00 Propane Yes 74g$6 t1L3GHKL 1~~7 X71; ~ 51~1~1V 1 ~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P DH / / / Hi ~ Inventory Item 0043 COMMON NAME / CHEMICAL NAME DRAIN OPENER Location within this Facility Unit RETAIL SALES FLOOR Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: ( Grid: --- ~- 2~~ cAS# STATE TYPE PRESSURE Liquid TMixture ~-Ambient TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION "-- Largest Container Daily Maximum Daily Average 1.25 GAL 150.00 GAL 150.00 GAS HAZARDOUS COMPONENTS ~Wt. RS CAS# 10.00 Sodium Hypochlorite No 7681529 2.00 Sodium Hydroxide No 1310732 1.00 Hydrogen Peroxide No 7722$41 nric~ru~L sia a~~~rirJty t ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Hi -10- O1/29/2b07 ~~ ~. F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0018 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- SULFURIC ACID (BATTERIES) Days On Site 365 Location within this Facility Unit Map: Grid: -- HARDLINES AISLE 223 ~ ~~j--3 CAS# STATE TYPE PRESSURE Liquid. TMixtur~Ambient TEMPERATURE ~' CONTAINER TYPE Ambient - I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION ---- Largest Container Daily Maximum Daily Average 100.00 GAL 100.00 GAL 100.00 GAL t1AGE~tCLVUJ 1.V1~lYV1VL'1V1J %Wt. RS CAS# 40.00 Sulfuric Acid (EPA) No 7664539 t11~GHKL 1-~.7JtS~J1~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No Yes No No/ Curies R IH / / / Hi ~ Inventory Item 0088 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --" BUG-B-GON Days On Site 365 Location within this Facility Unit Map:1 Grid:D-4 -- RETAIL SALES FLOOR CAS# STATE TYPE PRESSURE ~' TEMPERATURE ~~ CONTAINER TYPE ~-" Liquid TMixtur~Ambient I Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 0.42 GAL 97.94 GAL 97.94 GAL HAZARDOUS COMPONENTS --~ %Wt. RS CAS# Diazinon No 3334].5 t1HGEiKL H~7.7~.7~71~1.C 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Hi -11- 01/29/2007 F COSTCO 0688 SiteID: 015-021-00241:2 ~ ~ Inventory Item 0072 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME WAX STRIPPER Days On Site 365 Location within this Facility Unit Map: + Grid:Z -~ RETAIL SALES FLOOR ~._ /3 CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~mbient ~ Ambient ~LASTIC CONTAINER AMOUNTS AT THIS LOCATION ~- Largest Container Daily Maximum Daily Average 128.00 GAL 55.00 GAL 55.00 GAL t1HG1-itCLVU.7 ~.VrirVivlJlyl.S °sWt . RS CAS# 6.00 Sodium Hydroxide, Solution No 1310732 10.00 2-Butoxyethanol No - 111752 - 5.00 2-Hydroxyethylamine No 111422 ru~~tircL tj~~r.a~ln~lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MC1~ No No No No/ Curies IH / / / Hi ~ Inventory Item 0029 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ~- REGULAR UNLEADED GASOLINE Days On Site 87 OCTANE 365 Location within this Facility Unit Map: Grid: - GAS STATION 2' ~'~ S/(Q CAS# 8006-61-9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~-"- ~Liquid TMixture-Ambient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION ~-- Largest Container Daily Maximum Daily Average 20000.00 GAL 40000.00 GAL 20000.00 GAL I1t1GriKLVU.7 I..VP'1rV1VL"1V 1.7 oWt. RS CAS# 100.00 Gasoline No 8006519 riHGHiCL ti~ J1=,~~71~1~1V1~ _ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCf~ No No No No/ Curies F IH DH / / / Mr~d -12- Ol/29/2b07 F COSTCO 0688 ~ Inventory Item 0030 COMMON NAME / CHEMICAL NAME PREMIUM UNLEADED GASOLINE 91 OCTANE Location within this Facility Unit GAS STATION STATE TYPE PRESSURE Liquid TMixtur~-Ambient SiteID: 015-021-00241:2 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: ~ Grid: --- ~- ~J(o CAS # 8006-61-9 __... TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 20000.00 GAL 20000.00 GAL 10000.00 GAL nr-~c~ticci,uu~ COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006519 tiL~GL'.KL 1~~ J~~J1~1~1V 1 J -- TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA' No No No No/ Curies F IH DH / / / Mrt ~ Inventory Item 0051 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -~ LYSOL Days On Site AEROSOL 365 Location within this Facility Unit Map:l Grid:B-2 ---- RETAIL SALES FLOOR CAS# STATE TYPE PRESSURE TEMPERATURE Liquid TMixtur~Above Ambient Ambient CONTAINER TYPE Can AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 1.19 LBS 4604.53 LBS 464.53 LBS nc-ic~ritcLVUa ~.vrirulvr,lvl~ %Wt. RS CAS# 79.00 Ethanol No 64175 4.00 Carbon Dioxide No 12489 riL-~G1itC1J 1-~J JtSJ51~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F DH / / / Mdti -13- 01/29/2007 F COSTCO 0.688 SiteID: 015-021-002412 ~ ~ Inventory Item 0081 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- WASTE SOLIDS CONTAINING FLAMMABLE LIQUIDS Days On Site 365 Location within this Facility Unit Map: Grid= -. ~---- GAS STATION DATA HUT Z ~/F-~ ~,, CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Solid TWaste Ambient ~ Ambient DRUM/BARREL-METALLIC AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 550.00 LBS 1100.00 LBS 550.00 LB5 t1HGtlt'cUVUJ ~:vinrviv~iv 1 %Wt. RS CAS# 20.00 Waste Gasoline No 800619 20.00 FM-187 Hydrocarbon Mitigation Agent No I~/A 20.00 ABSORBENT TOWELS, UNIVERSAL No N/A 40.00 GAS FILTERS (CIM-TEK HYDROSORB-2) No N/A tiHGAtCL A~.7L" JA1~lI:,1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mid -14- Ol/29/2d07 F COSTCO 0688 ~ Inventory Item-0084 COMMON NAME / CHEMICAL NAME GLASS CLEANER AEROSOL Location within this Facility Unit RETAIL SALES FLOOR SiteID: 015-021-00241.2 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map:l Grid:B-2 -- CAS# STATE TYPE PRESSURE TEMPERATURE Liquid TMixtur~Above Ambient Ambient Can CONTAINER TYPE AMOUNTS AT THIS LOCATYON ---~ Largest Container Daily Maximum Daily Average 1.19 LBS 1092.03 LBS 1092.03 LBS riAGHKL V V .7 l: Vl~lY V1V ~1V 7 J aWt. RS CAS# 5.00 Ethyl Alcohol No 641'75 5.00 2-Butoxyethanol No 11172 Propane Yes 749$6 n-Butane Or Butane Mixture Yes 1065'78 riHGHKL AJ7L''SJ1~11';1V1~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Mr~f3 -15- 01/29/2007 F COSTCO 0688 ~ Inventory Item 0040 COMMON NAME / CHEMICAL NAME CONDITIONER Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixture ~-Ambient SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map:l Grid:G-2 -- CAS# TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 0.63 GAL 818.05 GAL I 818.05 GAL HAZARDOUS COMPONENTS %Wt. 1,2-Propylene Glycol Isopropyl Alcohol Ethoxydiglycol Glycerine RS No No No No CAS# 5756 6730 1115b0 56815 t1HGHKL A55J;551~1L"1V1A TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies / / / Mr~t1 ~ Inventory Item 0031 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -"- ALL PURPOSE CLEANERS Days On Site 365 Location within this Facility Unit Map: Grid: ---- RETAIL SALES FLOOR ~ [~i~-Z-~3 CAS# Liquid TMixtur~Ambient~E ~ AmbientT~E ~ PLASTIOCTCONTAINERE ---J __ AMOUNTS AT THIS LOCATION -" Largest Container Daily Maximum Daily Average 2.50 GAL 801.09 GAL 801.09 GAL i1EiGHCCLVUJ L.V1~lYUlVC~1V 1.7 %Wt. RS CAS# 5.00 Ethylene Glycol Monobutyl Ether No 111`752 I11~GXKL H~.7L' J.71~1L" 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Mr~ti. -16- 01/29/2007 F COSTCO 0688 ~ Inventory Item 0060 COMMON NAME / CHEMICAL NAME GLASS CLEANER LIQUID Location within this Facility Unit RETAIL SALES FLOOR STATE Liquid SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map:l Grid:B-2 -- CAS# = PRESSURE TEMPERATURE _ Ambient ~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 2.50 GAL 740.00 GAL ~- ru-~~titcuvuJ ~.vriruivnly 1 J %Wt. RS CAS# 95.00 Water No 77321E35 5.00 Isopropanol No 773285 t1HGHKL 1-~J~~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA' No No No No/ Curies IH DH / /_/ Mod ~ Inventory Item 0023 COMMON NAME / CHEMICAL NAME Location within this Facility Unit SEASONAL AISLE Map: Grid: Days On Site 365 CAS# ~SolidE TMixtur~mbientURE ~ TA~PeRATURE TSTOICTCONTAINERE AMOUNTS AT THIS LOCATION - "--- Largest Container Daily Maximum Daily Average 70.00 LBS 700.00- LBS 700.00 LB5 rui~rucLV ~a ~.vrirvtv~ty t J %Wt. RS CAS# 80.00 Calcium Hypochlorite No 7778~~3 20.00 Sodium Chloride No 7647i~45 I1tiL~tiLCL HJ JLiJ JI.1L'1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MRCP No No No No/ Curies F R IH / / / Moil TYPE _ Mixture Daily Average . 740.00 GAL Facility Unit: Fixed Containers on Side ~ CONTAINER TYPE --- PLASTIC CONTAINER -17- O1/29/2b07 ~, F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0073 Facility Unit: Fixed Containers on Site ~ COMMON NAME./ CHEMICAL NAME -- ~WD 40 Days On Site 365 Location within this Facility Unit Map:l Grid:D-4 ~- RETAIL SALES FLOOR CAS# STATE Liquid TYPE PRESSURE TMixtur~-Above Ambient TEMPERATURE CONTAINER Ambient Can TYPE Largest Container 0.23 GAL AMOUNTS AT THIS LOCATION Daily Maximum. 657.94 GAL Daily Average 657._94 GAS t1t~G.'~tc1JVUJ w1~1r~1vtSly 1 ~ %Wt. RS CAS# 70.00 ALIPHATIC PETROLEUM DISTILLATES- No 8052413 3.00 Carbon Dioxide No 1243$9 t1E~L,HKL H~51'SJ~l~li'~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F P IH / / / Mdt ~ Inventory Item 0083 COMMON NAME / CHEMICAL NAME LYSOL LIQUID Location within this Facility Unit RETAIL SALES FLOOR Days On Site 365 Map: Grid: I ~-2~3 cAS# Liquid TMixtur~AmbRent~E ~ Tp~Pe~TURE ~STCICTCONTAINERE Largest Container 2.25 GAL AMOUNTS AT THIS LOCATION Daily Maximum 558.11 GAL Daily Average 558.11 GAL HAZARDOUS COMPONENTS ~~~ sWt• RS CAS# 5.00 Diethylene Glycol Monobutyl Ether No 1.12345 2.70 Alkyl Dimethyl Benzyl Ammonium Chloride No 8001545 llriGtiiCL L-1J .7~.7J1.1P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M~1? No No No No/ Curies F DH / / / Mod Facility Unit: Fixed Containers on Side ~ -18- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0094 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME LEMON CLEANER Days On Site 365 Location within this Facility Unit Map:ii Grid: -- RETAIL SALES FLOOR I ~ -Z/.~ CAS# STATE TYPE ~~ PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture I Ambient ~ Ambient ~LASTIC CONTAINER AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 2.25 GAL 321.75 GAL 321.75 GAL HAZARDOUS COMPONENTS ~--- oWt. RS CAS# 20.00 Pine Oil No 8002n93 7.00 Isopropyl Alcohol No 67530 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M~1~ No No No No/ Curies F IH / / / Mryd ~ Inventory Item 0071 ~ COMMON NAME / CHEMICAL NAME I TUB & TILE CLEANER Facility Unit: Fixed Containers on Site ~ Location within this Facility Unit RETAIL SALES FLOOR Days On Site 365 Map: Grid: ~ 6-Z/~ cAS# Liquid TMixture ~-AmbRient~E ~ T~PeRATURE plasticTBottles/Jug AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 0.50 GAL 206.25 GAL 206.25 GAL n1-1Gti~[.UV U J l.Vl~lYV1VL,1V 1 J cwt.. Rs cAS# 28.00 Phosphoric Acid No 76643$2 IIEiGtitCL HJ J~.7J1"1L~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies IH / / / Mad -19- O1/29/2n07 F COSTCO 0688 SiteID: 015-021-00241:2 ~ ~ Inventory Item 0033 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME OIL EATER Days On Site 365 Location within this Facility Unit Map: Grid: -- RETAIL SALES FLOOR ( ~~-S CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~Ambient ~ Ambient Plastic Bottles/Jugs AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 1.25 GAL 92.13 GAL 92.13 GAL --- i1HG1~iiCLVU.7 LV1"lYV1V1:a1V1J °sWt. RS CAS# 5.00 Sodium Metasilicate Pentahydrate No 6834520 5.00 2-Butoxyethanol No 11172 IIHGHLC.L L-]w7 .7 L' J J1~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Mr ti -20- O1/29/2b07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0095 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ORANGE HAND CLEANER Days On Site 365 Location within this Facility Unit Map: Grid: RETAIL SALES FLOOR C Q-2/3 CAS# Liquid TMixtur~Ambient~E ~ AmbientT~E ~ PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION -" Largest Container Daily Maximum I Daily Average 0.50 GAL 82.50 GAL 82.50 GAL HAZARDOUS COMPONENTS °sWt. RS CAS# D-Limonene No 59892`75 5.00 1,2-Propylene Glycol No 57556 11HGtiKL 1~J .7r,.7J1~1ra1V 1D TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# M No- No= =No- = No/ Curies= =F= _ _ _ _ _ / / / - _ =Mc~t1= ~ Inventory Item 0038 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ~-- CAR WAX Days On Site 365 Location within this Facility Unit Map:l Grid:D-4 RETAIL SALES FLOOR CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE -- Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 0.25 GAL 73.43 GAL 73.43 GAL HAZARDOUS COMPONENTS -"- ~Wt- RS CAS# 11ri4tiRL riO AP~J J1"1L'1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Mot'i -21- 01/29/2007 F COSTC0.0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0056 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME INK & TONER CARTRIDGES Days On Site 365 Location within this Facility Unit Map: Grid- -- RETAIL SALES FLOOR , ~-S CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~-- ~Liquid TMixtur~Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum I Daily Average 0.25 GAL 57.00 GAL 57.00 GAL riE~Gt1KLVUJ 1.V1~lYV1VJ;1V1J %Wt. RS CAS# 2.00 Carbon Black No 1333854 89.00 Hydrotreated Heavy Naphtha No 647424$9 6.00 Wax No. 90028$4 riHGE~tCL H~JL" ~.71~1J~,1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M No No No No/ Curies F IH / / / Mid ~ Inventory Item 0077 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ---- WASTE GASOLINE Days On Site i INCIDENTAL SPILLS & ABSORBENT 365 Location within this Facility Unit Map: Grid: -- GAS STATION ~~ ~/f=-~~(~ CAS# Liquid TWaste ~-AmbRient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION --"-- Largest Container Daily Maximum I Daily Average 55.00 GAL 55.00 GAL 28.00 GAL ntiatucl~v~a ~.vllrvivr,tVtJ %Wt. RS CAS# 100.00 Waste Gasoline No 8006519 IlEiGHtt1J Ei JJP~JJI~IP~IVIJ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M~1~ No No No No/ Curies F IH DH / / / Mad -22- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ .Inventory Item 0085 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME LAUNDRY DETERGENTS Days On Site SOLID 365 Location within this Facility Unit Map: Grid: -~- RETAIL SALES FLOOR ~ ~'"~ CAS# STATE TYPE PRESSURE TEMPERATURE Solid TMixture Ambient ~ Ambient Largest Container 37.50 LBS AMOUNTS AT THIS LOCATION Daily Maximum 38018.54 LBS BOX CONTAINER TYPE Daily Average 38018.54 LB5 HAZARDOUS COMPONENTS oWt. RS CAS# Sodium Carbonate No 497158 Subtilisin ~ - No 9014011 r~~titcL x~~~~5ri~ivla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies DH / / / Levu ~ Inventory Item 0054 COMMON NAME / CHEMICAL NAME LAUNDRY DETERGENTS LIQUID ,Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixtur~-Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map:l TEMPERATURE Ambient Grid:B-2 CAS# CONTAINER TYPE PLASTIC CONTAINER Largest Container 4.69 GAL AMOUNTS AT THIS LOCATION Daily Maximum 4645.21 GAL Daily Average 4645.21 GAS ruic~t~cLVUa ~.uinrvtvr~tvt~ %Wt. RS CAS# ALCOHOL ETHOXYLATES No 68131355 Sodium Silicate No 13440$5 IlE~GH2CL Ha ~tSJ~1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Li~w -23- 01/29/2007 F COSTCO 0688 SitelD: 015-021-002412 ~ ~ ~ Inventory Item 0074 Facility Unit: Fixed Containers on Sites ~ COMMON NAME / CHEMICAL NAME CHLORODIFLOUROMETHANE Days On Site 365 Location within .this Facility Unit Map: ii Grid: --- REGRIGERATION SYSTEM i ~'y-~{ CAS# 75-45-6 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~- Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 850.00 LBS 3400.00 LBS 3400.00 LBS HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Chlorodifluoromethane No 7556 ti!'iGHKL L-~ JJ~.7J1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH DH / / / Lta~ly ~ Inventory Item 0064 Facility Unit: Fixed Containers on Sites ~ COMMON NAME / CHEMICAL NAME ~-" SHAMPOO Days On Site 365 Location within this Facility Unit Map: Grid: --- RETAIL SALES FLOOR 1 ~-2~3 CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE -" Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION "-- Largest Container Daily Maximum Daily Average 0.63 GAL 1261.06 GAL 1261.06 GAL nric~tu~l~v~J ~.vl•1rviV.aiv 1 J oWt. RS CAS# ---- Sodium Laureth Sulfate No 688913$3 Citric Acid No 77929 Propylene Glycol No 5756 Laureth No 9002520 Water No 77321$5 ruic~tilclJ s-~a ar~aJl~ir,lvia TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Ldw -24- O1/29/2b07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0052 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME LOTION Days On Site 365 Location within this Facility Unit Map: Grid: ~-- RETAIL SALES FLOOR ~ Cat-~~ CAS# Liquid TMixture I Ambient~E ~ AmbientT~E ~PLASTOICTCONTAINERE AMOUNTS AT THIS LOCATION -"- Largest Container Daily Maximum Daily Average 0.75 GAL 696.72 GAL 696.72 GAL riEiGHKLVU.7 L.V1~lYV1VP~1V1J %Wt. RS CAS# 15.90 Mineral Oil No 8020835 0.60 Lanolin Oil No - - --- ---- Glyceryl Triacetate No Mixtiz~e Propylene Glycol No 57856 Water Glass No 77321$5 ri1~GEitCL E~.7w7L' JJ1~1L' 1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M~C1~ No No No No/ Curies IH / / / Love ~ Inventory Item 0020 COMMON NAME / CHEMICAL NAME ROUND UP Location within this Facility Unit SEASONAL AISLE STATE TYPE PRESSURE Liquid TMixtur~ Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map : i Grid; ,, ii - ~- -"I CAS # 1071836 TEMPERATURE CONTAINER TYPE Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION "--- Largest Container Daily Maximum Daily Average 0.84 GAL 287.04 GAL 287.04 GAL HAZARDOUS COMPONENTS -- %Wt. RS CAS# nr~a.~-~lcl~ t~ ~r,~arir~ly 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies IH / / / Low -25- O1/29/2(?07 F COSTCO 0688 ~ Inventory Item 0089 COMMON NAME / CHEMICAL NAME DIESEL FUEL Location within this Facility Unit SE CRNR WHSE OUTSIDE STATE TYPE PRESSURE Liquid TMixtur~mbient SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map:2 Grid:~5 _ . CAS# C,~-3 TEMPERATURE CONTAINER TYPE Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum I Daily Average 200.00 GAL 200.00 GAL 200.00 GAL r~t~tircLVUJ ~.vrirvivaiviS %Wt. RS CAS# 100.00 DIESEL FUEL NO. 2 No 6833435 t1L~GEitCL EiJ J~JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCf~ No No No No/ Curies F IH DH / / / Lava ~ Inventory Item 0086 COMMON NAME / CHEMICAL NAME WOOLITE LAUNDRY DETERGENT Location within this Facility Unit RETAIL SALES FLOOR Facility Unit: Fixed Containers on Site ~ Days On Site, 365 Map: ~ Grid: " j3'-Z CAS# STATE TYPE ~~- PRESSURE Liquid Mixture I Ambient TEMPERATURE CONTAINER TYPE Ambient ~STIC CONTAINER AMOUNTS AT THIS LOCATION --" Largest Container Daily Maximum Daily Average 1.50 GAL 115.50 GAL 115.50 GAL n1-~G1-l.CCLVUJ l.Vl"1rV1VP~1V1J ~oWt. RS CAS# 10.00 Sodium Lauryl Ether Sulfate No 900424 10.00 Sodium Dodecylbenzene Sulfonate No 251553b0 L1LiGEiiC.U H JJP~J J1~1~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies / / / Lr~w -26- Ol/29/2b07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0061 Facility Unit: Fixed Containers on Sites ~ COMMON NAME / CHEMICAL NAME -~ FLOOR FINISH Days On Sits 365 Location within this Facility Unit Map: Grid: --- RETAIL SALES FLOOR I (~-~ j1-~- CAS# 107-21-1 Liquid TMixtur~Ambient~E ~ AmbientT~E DRUM/BARRELEMETALLI~ AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 2.50 GAL 101.75 GAL 101.75 GAL - ril'~GEi.tCLVUA 1.V1~lYV1V~1V1.7 oWt. RS CAS# 1.00 Glycol Ether EE No 1117`13 riAGKKL A7~7t'~551~11'~1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F IH / / / Lt7vu ~ Inventory Item 0032 Facility Unit: Fixed Containers on Si~~ ~ COMMON NAME / CHEMICAL NAME ~"~ ANTIFREEZE (COOLANT) Days On Sites 365 Location within this Facility Unit Map: r Grid: ---- RETAIL SALES FLOOR I jJ'"S CAS# 107-21-1 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION "- Largest Container Daily Maximum Daily Average 1.00 GAL 92.40 GAL 92.40 GAL 111-1GriRLVIJJ l,Vl"!t'V1VP~1V1J %Wt. RS CAS# 100.00 Ethylene Glycol No 107211 L12iGtiRL tiJ JP~J J1"11J1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M~f? No No No No/ Curies. F IH DH / / / Law -27- Ol/29/2i~07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ ~ Inventory Item 0082 Facility Unit: Fixed Containers on Sites ~ COMMON NAME / CHEMICAL NAME --- NITROGEN Days On Sites 365 Location within this Facility"Unit Map: Grid: TIRE SERVICE CENTER I ~-(P CAS# 7727-37=9 ' ~GaSATE ~ TYPE ~Abo~SAm~bEent A~PeRnAtTURE CONTAINER TYPE Pure ~ PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION -~--- Largest Container Daily Maximum Daily Average 5625.00 FT3 5625.00 FT3 2813.00 FT3 HAZARDOUS COMPONENTS °sWt. RS CAS# 100_.00 Nitrogen No 77273`79 riE~GtitCL 1~J~JI;.7J1~1tS1V 1 w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P DH / / / Mai ~ Inventory Item 0078 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --~-- CARBON DIOXIDE REFRIGERATED LIQUID Days On Site 365 Location within this Facility Unit Map: Grid: -- FOOD SERVICE AREA ~ i.~-~ CAS# 124-3~=9 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~-" Gas TPure ~-Above Ambient Below Ambient FIXED PRESS. CYLINDER AMOUNTS AT THIS LOCATION -- Largest C3496100rFT3 Daily4370100m FT3_ I Daily2185r00e FT3 ruiGrucl~v u a ~.v1~1rv1.v 1,1v t J %Wt. RS CAS# 100.00 Carbon Dioxide No 1243$9 IlEiGEitCL H. 7 J L' .7.71~1P~1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P DH / / / Midi -28- O1/29/2b07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0012 Facility Unit: Fixed Containers on Site ~ COMMON-NAME / CHEMICAL NAME -~ MOTOR OIL Days On Site 365 Location within this Facility Unit Map:l Grid:B-2 ---- RETAIL SALES FLOOR CAS# STATE T TYPE ~~ PRESSURE TEMPERATURE CONTAINER TYPE Liquid I Mixture I Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 0.25 GAL 2000.25 GAL I _ 2000.25- GAL_ %Wt: RSA CAS# HAZARD A SSESSMr.lvl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA _USDOT# MCA No No No No/ Curies F IH / / / Mia ~ Inventory Item 0036 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME BATHROOM CLEANSER Days On Site LIQUID 365 Location within this Facility Unit Map:l Grid:B-2 -~- RETAIL SALES FLOOR CAS# 7631-86=9 Liquid Mixture PRESSURE TEMPERATURE ~STOICTCONTAINERE T ~-Ambient ~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average- _-- 2.13 GAL 1003.06 GAL I 1003.06 GAL ru~uru.~uV V J \..V1•lrVlVr,tV 1 e7 %Wt• RS CAS# 75.00 Calcium Carbonate No 1317653 rJ.t][~tiRL 1'i JJ~JJl"1~1V la TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies IH DH / / / Mi#i HAZARDOUS COMPONENTS -29- O1/29/2b07 ~I F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0058 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- 343A4 .rTrTV _ ~~~ Days On Site 365 Location within this Facility Unit Map: Grid: '- RETAIL SALES FLOOR CAS# 7440-59-7 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE -~ Gas Pure Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 14.90 FT3 786.72 FT3 786.72 FT~_ nxarucLVUa t,.urirutvniv l ~ °sWt . RS CAS# 100.00 Helium No 744057 _- ns-~~t-ucL r~a a~aai~i~ivl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MSC No No No No/ Curies P DH / / / Mii ~ Inventory Item 0042 COMMON NAME / CHEMICAL NAME DISHSOAP Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixture l Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map : ~ Grid • -- -- 13'z- CAS# 143191 TEMPERATURE CONTAINER TYPE Ambient -~STIC CONTAINER AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum _ Daily Average 1.41 GAL 779.09 GAL I 779.09 GAS aicac~ru~vvv~ ~.vi•trvi~r,1~ 1.S - %Wt• RS CAS#-- 10.00 Ethanol No 64155 1.00 Subtilisin No 9014011 riti[~riRL ti. 7 ~J ~.7 J1"1LilV 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M~C1~ No No No No/ Curies F IH DH / / / Miff -30-' 01/29/2007 S F COSTCO 0688 SiteID: 015-021-00241:2 ~ ~ Inventory Item 0055 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -- INSECTICIDE Days On Site 365 Location within this Facility Unit Map:l Grid:D-4 ---- RETAIL SALES FLOOR CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixtur~-Above Ambient Ambient Can .AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum Daily Average 0.94 LBS 234.30 LBS 234.30 LBS riAGHKLVVJ 1:V1~lYV1V~1V1-J oWt. RS CAS# 0.05 Pyrethrum- No 8000337 0.40 Permethrin ---- - - - No - -5 2 6 45 5-3-1~ riLiGH-t'CL f-~J DI;JJ1~11;1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MSC No No No No/ Curies F IH / / / Mfi - ~ Inventory Item 0044 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- ENGINE TREATMENT Days On Site 365 Location within this Facility Unit Map: Grid: --- RETAIL SALES FLOOR ( ~_S CAS# 802035 STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~ Liquid TMixtur~-Ambient ~ Ambient Plastic Bottles/Jugs I AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 0.25 GAL 171.60 GAL 171.60 GAL ii<-lud]1:WVV~J l.Vl•lr V1V J:ilV1J -- sWt. RS CAS# 90.00 Petroleum Naphtha No 64742`78 2.00 1,2,4-Trimethylbenzene No 9536 ritlutiRL ti~ JL~J .71.1L` 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F IH DH / / / Min. -31- Ol/29/2~07 ~ F COSTCO 0688 ~ Inventory Item 0069 COMMON NAME / CHEMICAL NAME TIRE CLEANER Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixture ~ Ambient . SiteID: 015-021-00242 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: ~ Grid• _~ - - ~ CAS# TEMPERATURE CONTAINER TYPE _ Ambient Plastic Bottles/Jugs AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 0.44 GAL 150.56 GAL 150.56 GAL t1HGt1K1JVUJ l.Vi~lYV1V~1V75 °sWt. RS CAS# 100.00 Water No 7732i~5 50.00 _ _ Silicone Emulsion - No --- 10.00 Sorbitol --- No -507b4 5.00 Armor All Concentrate No nri~tucL s-~~ ~~aal~ir~ivl~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies IH / / / Mai -32- O1/29/Zb07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Sits ~ COMMON NAME / CHEMICAL NAME -- FERTILIZERS Days On Site 365 Location within this Facility Unit Map: Grid: Il -~ SEASONAL AISLE ~ ~ ~-I CAS# ~SolidE TMixtur~-Ambient~E ~ AmbientT~E ~ PLASTICTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 25.OO~LBS 16455.34 LBS 16455.34 LBS nx~titcL~uJ ~vl~ir~ivl~;lv_1_J %Wt. RS CAS# Potassium Nitrate No 7757'151 Sodium Nitrate No 7631554 Urea No 5736 Monoammonium Phosphate No 7722'71 ritiGF1KL S~JJr,JJ1~1~1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies IH / / / UnR -33- 01/29/2007 F COSTCO 0688 ~ Inventory Item 0039 ~ COMMON NAME / CHEMICAL NAME CHARCOAL Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Solid TMixture ~-Ambient SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 TEMPERATURE Ambient Map:l Grid:D-4 BAG .AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 24.00 LBS 14823.60 LBS 14823.60 LBS HAZARDOUS COMPONENTS -- %Wt. RS CAS# - 15.00 Limestone No 131753 HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies IH / / / I U#~R ~ Inventory Item 0035 ~ COMMON NAME / CHEMICAL NAME BAR SOAP Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Solid Mixture Ambient Grid:G-2 CONTAINER TYPE Facility Unit: Fixed Containers on Side ~ Days On Site 365 Map:l TEMPERATURE Ambient CAS# CAS# .CONTAINER TYPE BOX AMOUNTS AT THIS LOCATIONI -- Largest Cont0130rLBS Daily7936109m LBS_ 1 Daily7936r09e LBS 11HGH[CLV U.7 1..V1~lYV1V~1V 1 J %Wt. RS CAS# Stearic Acid No 57114 riHl~1-1tCL Hb w7 L" .7 ~1~1L" 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA' No No No No/ Curies IH / / / Ui~i:R -34- 01/29/2007 F COSTC0.0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0091 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- AUTOMATIC DISH DETERGENT Days On Site SOLID 365 Location within this Facility Unit Map: Grid: -~ RETAIL SALES FLOOR ~ ~j.-2/~~ CAS# ~SolidE TMixtur~-Ambient~E ~ AmbientTURE BOX CONTAINER TYPE ~~- AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 6.88 LBS 5526.48 LBS 5526.48 LBS nrjc~xrcUOUS COMPONENTS %Wt. RS CAS# Subtilisin No 90140711 riL-~GHKL 1-~J~7L' ~7~7P7L',1V 1 w7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies IH / / / U3 ~ Inventory Item 0062 COMMON NAME / CHEMICAL NAME OXI-CLEAN Location within this Facility Unit RETAIL SALES FLOOR Days On Site 365 Map: ~. Grid: --- g-2~3 CAS# ~SolidE TMixture ~ Ambient~E ~ ATE~MPeRATURE PlasticTBottles/Jug AMOUNTS AT THIS LOCATION -- Largest Con12100rLBS - Daily3M48180m LBS I Daily3A48r80e LBS - _ - r1HG1-liCLVUJ l.VllYV1VP.,1V1.7 %Wt. RS CAS# Sodium Percarbonate No 1563094 Sodium Carbonate (Soda Ash) No 497198 I1LiGtiLCL ti A.7AA.7P7P~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M0/7? No No No No/ Curies IH / / / Uf~:R Facility Unit: Fixed Containers on Site ~ -35- 01/29/2907 F COSTCO 0688 ~ Inventory Item 0063 COMMON NAME / CHEMICAL NAME PACE TABS CHLORINE Location within this Facility Unit RETAILS SALES FLOOR STATE TYPE PRESSURE Solid TMixture Ambient SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: --- l B - 2~ 3 cAS# TEMPERATURE ~~ CONTAINER TYPE Ambient I PLASTIC CONTAINER AMOUNTS AT THIS LOCATION -- Largest Container Daily Maximum I Daily Average 40.00 LBS 900.00 LBS 900.00 LBS - r1.yGtitcLUUa ~.vrirulvl;ivla %Wt. RS CAS# 100.00 Trichloro-s-triazinetrione. No 87941 t1F~GL3tCL HJ.7~J.71~1~1V 1 ~ TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / Ui~R ~ Inventory Item 0090 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -- AUTOMATIC DISH DETERGENT Days On Site LIQUID 365 Location within this Facility Unit Map: Grid: -~ RETAIL SALES FLOOR i g- ~~~ CAS## STATE TYPE PRESSURE TEMPERATURE _ Liquid TMixtur~mbient ~ Ambient AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 2.43 GAL 807.67 GAL HAZARDOUS COMPONENTS %Wt. Daily Average 807.67 GAL RS CAS# riHGEitCU 1-~J 51;b~1~1~1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / U# CONTAINER TYPE PLASTIC CONTAINER -36- Ol/29/2b07 F COSTCO 0688 ~ Inventory Item 0045 COMMON NAME / CHEMICAL NAME FABRIC SOFTENER Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixture ~mbient AMOUNTS AT THIS LOCATION -~ Largest Container Daily Maximum Daily Average 2.11 GAL 804.50 GAL 804.50 GAL - HAZARDOUS COMPONENTS %Wt. RS CAS# 5.00 Ethanol No 64:55 riAGKKL A~~~SJlYlt;1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH / / / U~iR ~ Inventory Item 0053 COMMON NAME / CHEMICAL NAME LEMON SPRAY Location within this Facility Unit RETAIL SALES FLOOR SiteID: 015-021-002412 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: ---- ~j -- 2 j~ CAS# _... . TEMPERATURE CONTAINER TYPE Ambient ~ PLASTIC CONTAINER Facility Unit: Fixed Containers on Site ~ -Days On Site 365 Map: f Grid: --- ~-Z~3 cAS# Liquid TMixture ~-AboveSAmbEent TAmbientT~E METAL CONTAINRTNONDRUN! Largest Container l.ll LBS AMOUNTS AT THIS LOCATION Daily Maximum 722.82 LBS Daily Average _ 722.82 LBS,.., rll-1GtittLVU~7 1.V1~lYV1V P~1V 1.7 oWt. RS CAS# 10.00 Isoparaffinic Hydrocarbon Solvent No 6892009 5.00 Propane Yes 74886 5.00 Isobutane Yes - 75285 5.00 Butane Yes 1065`78 7.00 Silicone Surfactant No 9016406 I1HGEiKL ti.7J~~Jl~lt!;1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies P IH / / / UriR -37- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0057 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME HERBICIDE Days On Site PREEN 365 Location withim this Facility Unit Map: ~ Grid: -~~ RETAIL SALES FLOOR ~•-~ CAS# ~SolidE TMixture I Ambient~E ~ ATtE~MPeRATURE rgETALOCONTAINRTNONDR~ AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum I Daily Average 15.00 LBS 709.50 LBS 709.50 LBS nx~tucLVUa ~.vrirvlvaivl~ %Wt. RS CAS# Trifluralin No 1582098 ritiGHKL 1-]. 7.7~.7J1~1~1V 1.7 TSecret RS BioHaz .Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH DH / / / Un:1~ ~ Inventory Item 0079 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME USED LEAD ACID BATTERIES Days On Site 365 Location within this Facility Unit Map:l Grid:E-6 ~- TIRE SERVICE CENTER CAS# STATE TYPE T PRESSURE TEMPERATURE CONTAINER TYPE Liquid TWaste 1 Ambient ~ Ambient OTHER - SPECIFY AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 10.50 LBS 483.00 LBS I 241.50 LBS nt~c~nttLV ua ~.vi~iruty c,lv t a %Wt. RS CAS# 35.00 SULFURIC ACID ELECTROLYTE No 7664939 34.00 Lead No 7439921 31.00 Lead (II) Oxide No 1309~b0 1.00 Lead (II) Sulfate and Mixtures thereof No 744612 171•iL+ri[CL ri~ 7JP~.7J1"1P~1Vl~J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies R IH / / / UH12 -38- O1/29/2b07 ~, F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0048 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -- FIRELOGS Days On Site 365 Location within this Facility Unit Map: ~ Grid~`'Q -~- RETAIL SALES FLOOR ``ii CAS# ~SolidE TMixture I Ambient~E ~ AmbientT~E BOX CONTAINER TYPE AMOUNTS AT THIS LOCATION ----- Largest Container Daily Maximum Daily Average 6.00 LBS 475.20 LBS 475.20 LBS t1AG[~L[LVU~ ~v1~1rv1vntvla %Wt. RS CAS# 60.00 Petroleum Wax No -- 34.00 Non-Hazardous Ingredients(Sawdust,etc) - No tiL'~L,HK1J 1~JJ~JJ1~1~1V 1~5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies IH / / / - UiZR -39- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0076 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -- FUJI Days On Site BLEACH 3 STARTER, REPLENISHER,CONDITIONING,STABILIZER 365 Location within this Facility Unit Map: Grid: -- 1-HOUR PHOTO PROCESSING ~ ~~~(~-Iv CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE -- Liquid Mixture Ambient Ambient Plastic Bottles/Jugs AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 139.00 GAL 376.88 GAL 376.88 GAL riL-~GHKUV U5 lrV1~lYV1Vr,1V 1.7 %Wt. RS CAS#- Potassium Acetate No 1270$2 Water No 77321$5 ~- Potassium Hydroxide - - No - - 131053 Potassium Carbonate No 58417$7 Sodium Bicarbonate No 144558 Aminocarboxylic Acid Derivative No 140012 Para-Phenylenediamine Derivative No 140012 _ Ferric Ammonium PDTA No 77321$5 Ammonium Bromide No 12124579 ri!-~G1itC1J 1-~.7 ,~r,D~1~1~1V1~7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# M No No No No/ Curies IH DH / / / UR -40- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0087 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -- INSECTICIDE Days On Site 365 Location within this Facility Unit Map:l Grid:D-4 -- RETAIL SALES FLOOR CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid TMixture ~ Ambient ~ Ambient ~ PLASTIC CONTAINER AMOUNTS AT THIS LOCATION --- Largest Cont6i0ne0rG~ Daily 347100m GAL I Daily 347r00e GAL HAZARDOUS COMPONENTS -~- %Wt. RS CAS# I'LEiGEi2CL H~ 7.7~J.71~1L~1V1.7 -- TSecret RS BioHaz =Radioactive/Amount= =EPA Hazards= =NFPA-~ =USDOT#= =MCP= No No No No% Curies F IH / / / UnR ~ Inventory Item 0068 COMMON NAME / CHEMICAL NAME SUNCREEN Location within this Facility Unit RETAIL SALES FLOOR STATE TYPE PRESSURE Liquid TMixture ~ Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map : ~ Gri~i ~~~ CAS# TEMPERATURE CONTAINER TYPE Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION "- Largest Container Daily Maximum Daily Average 0.19 GAL 267.56 GAL 267.56 GAL °sWt . HAZARDOUS COMPONENTS RSA CAS# HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies IH / / / Uiz12 -41- Ol/29/~007 I F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0092 Facility Unit: Fixed Containers on Sites ~ COMMON NAME / CHEMICAL NAME -- -CAR WASH Days On Site 365 Location within this Facility Unit Map: ~ Grid: ---- RETAIL SALES FLOOR ~._~' CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~- Liquid Mixture Ambient Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION --~ Largest Container Daily Maximum 1.00 GAL 264.00 GAL HAZARDOUS COMPONENTS- %Wt. RS CAS# til-~GKKL 1~5J~5J1~1~1V 1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCf~ No No No No/ Curies F IH / / / Uf5:f2 ~ Inventory Item 0059 Facility Unit:-Fixed Containers on Site ~ STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE ~- Liquid Mixture Above Ambient Ambient Can AMOUNTS AT THIS LOCATION -"--- Largest Container Daily Maximum Daily Average 0.88 LBS 188.65 LBS 188.65 LBS ru-sc~rucLVUa ~.ui~trvtvr,lvta %Wt. RS CAS# Water No 77321$5 Dimethyl Ether Yes 11516 Sodium Benzoate No 532321 ritiLiriRL Li4 7 JL~.7471.1P~1V 147 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F P / / / UiiR Daily Average 264.00 GAL -42- Ol/29/2b07 !, F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0065 .Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ---- SHAVE GEL Days On Site 365 Location within this Facility-Unit Map: Grid: -- RETAIL SALES FLOOR (~-Z CAS# Liquid TMixture ~AmbRent~E ~ T~EMbPeRATURE Can CONTAINER TYPE AMOUNTS AT THIS LOCATION ~-- Largest Container Daily Maximum Daily Average 0.15 GAL 187.65 GAL 187.65 GAL tiE1G1-~tCUUUa 1:V1~lYU1VLIV 1 a °sWt . RS CAS# 85.00 Water No 77321$5 13.00 Palmitic Acid - - No 571b3 10.00 Oleth-20 No 90049$2 5.00 Isopentane Yes 78'7$4 7.00 Isobutane Yes 7525 t1L-~GL-1tCL 1~.7.7L' .7 J1~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MAP No No No No/ Curies P IH / / / UriR -43- Ol/29/2b07 P COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0066 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME --- SPOT REMOVER Days On Site 365 Location within this Facility Unit Map: Grid: -- RETAIL SALES FLOOR ~ ~-,Z/~ CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE --- Liquid Mixture Ambient- Ambient PLASTIC CONTAINER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 0.50 GAL 169.13 GAL 169.13 GAL ririalittLwJ l.Vl"lYV1V2S1V 1.7 _ -- - --- -- %Wt. RS CAS# 5.00 Ethylene Glycol Buty Ether No 111762 5.00 Diprophylene Glycol Methyl Ether No 34590848 t11~GtiKL HJJ~JJL~1r,1V1J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No - No/ - Curies IH DH _/. / / U#R ~ Inventory Item 0049 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME -~- FLOOR CLEANER Days On Site 365 Location within this Facility Unit Map:, Grid: ----- RETAIL SALES FLOOR ~ ~ ' z/7~ CAS# Liquid I Mixture I Ambient~E ~ AmbientT~E DRUM/BARRELENONMETAL AMOUNTS AT THIS LOCATION --- Largest Container Daily Maximum Daily Average 2.50 GAL 166.38 GAL 166.38 GAL HAZARDOUS COMPONENTS %Wt. RSA CAS# H13as~tci, riJ J~JJri~lvla TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MSC No No No No/ Curies F IH / / / UDR -44- Ol/29/2b07 F COSTCO 0688 SiteID: 015-021-002412 ~ ~ Inventory Item 0093 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME ----- CLEANER/DEGREASER Days On Site 365 Location within this Facility Unit Map: Grid,: ---- RETAIL SALES FLOOR ~ ~ Drs CAS## Liquid TMixture ~-AmbRent~E ~ AmbientT~E ~LASTIOCTCONTAINERE AMOUNTS AT THIS LOCATION Largest Container Daily Maximum 2.50 GAL 123.75 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# nxZARD AS SESSMENTS _ -- TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCA No No No No/ Curies F IH / / / UtiR Daily Average 123.75 GAL -45- 01/29/2607 -. UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - cxEMICAL DESCRIPTION (one a e er material er buildin or area) ®ADD ^DELETE ^REVISE 20o Page 1 of 2 I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Costco Wholesale #0688 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA zoz Retail Sales Floor (Seasonal) ^ YES ® NO t MAP# (optional) 203 CiRID# (optional) 204 FACILITY ID # t 1 D-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^ Yes ®No 206 If Subject to EPCRA, refer to instructions COMMON NAME zoo zos EHS* ^ Yes ®No Aqua Chem " 3" Tablets Plus CAS# zo9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) zto OXY1, COR HAZARDOUS MATERIAL TYPE (Check one item only) ^ a. PURE ©b. MIXTURE ^ c. WASTE 211 RADIOACTIVE ^ Yes ®No 212 213 CURIES PHYSICAL STATE 214 (Check one item only) ®a. SOLID ^ b. LIQUID ^ c. GAS 215 LARGEST CONTAINER 40 Ibs FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT zts ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 1,440 1,440 N/A N/A 221 DAYS ON SITE: 222 UNITS• ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS Check one item onl * If EHS, amount must be in ands. ,~ 80 STORAGE CONTAINER ^ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f. CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 224 STORAGE TEMPERATI)RE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 94.05 226 Trichloro-S-Triazinetrione 227 ^ Yes ®No zzs 87-90-1 229 2 5 230 Trade Secret Ingredient 231 ^ Yes p NO 232 N/A 233 3 234 235 ^ Yes ^ NO 236 z3~ q z3s z39 ^ Yes ^ No zao zal $ 2a2 243 ^ Yes ^ NO 244 24s If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets o f paper capturing the required information. NFPA HAZARD INDENTIFICATION: HEALTH s FLAMMABILITYo REACTIVITY ~ SPECIAL HAZARDoxv za6 HAZARD CLASS OR DIVISION # N/R UN# N/R If EPCRA, Please Sign Here OES Form 2731 Revised (5/03) • UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - cHEM><caL nESCR><rT><oN (one a e er material er buildin or area) ®ADD ^DELETE ^REVISE zoo Page 2 of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 Costco Wholesale #0688 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA zoz ^ YES p No Retail Sales Floor (Seasonal) 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY [D # ~ 1 D-4 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ^ Yes p No lob If Subject to EPCRA, refer to instructions COMMON NAME zoo zoa EHS* ^ Yes p No HTH Sock It Shock N Swim Shock Treatment CAS# zo9 *If EHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 OXY2, COR HAZARDOUS MATERIAL 211 TYPE (Check one item only) ^ a. PURE ®b. MIXTURE ^ c. WASTE ®No 212 RADIOACTIVE ^ Yes 213 CURIES PHYSICAL STATE zla (Check one item only) ®a. SOLID ^ b. LIQUID ^ c. GAS 215 LARGEST CONTAINER 16 Ibs FED HAZARD CATEGORIES 216 (Check all that apply) ®a. FIRE ^ b. REACTIVE ^ c. PRESSURE RELEASE ®d. ACUTE HEALTH ^ e. CHRONIC HEALTH AVERAGE DAILY AMOUNT z1~ MAXIMUM DAILY AMOUNT zta ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 3,200 3,200 N/A N/A 221 DAYS ON SITE: 222 UNITS• ^ a. GALLONS ^ b. CUBIC FEET ®c. POUNDS ^ d. TONS 180 Check one item onl * If EHS, amount must be in ands. STORAGE CONTAINER ^ a. ABOVE GROUND TANK ®e. PLASTIC/NONMETALLIC DRUM ^ i. FIBER DRUM ^ m. GLASS BOTTLE ^ q. RAIL CAR ^ b. UNDERGROUND TANK ^ f CAN ^ j. BAG ^ n. PLASTIC BOTTLE ^ r. OTHER ^ c. TANK INSIDE BUILDING ^ g. CARBOY ^ k. BOX ^ o. TOTE BIN ^ d. STEEL DRUM ^ h. SILO ^ I. CYLINDER ^ p. TANK WAGON 223 STORAGE PRESSURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT 22a STORAGE TEMPERATURE ®a. AMBIENT ^ b. ABOVE AMBIENT ^ c. BELOW AMBIENT ^ d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 40-55 zz6 Calcium Hypochlorite 227 ^ Yes ®No 22a 7778-54-3 229 2 25-35 230 Magnesium Sulfate Heptahydrate 231 ^ ves p No 232 10034-99-8 233 3 5-15 234 Sodium Chloride 235 ^ Yes ®No 236 zs~ 7647-14-5 a 0.5 z3s Calcium Hydroxide 239 ^ Yes ^x No 240 1305-62-0 zal s 0.4 242 Calcium Chlorate 243 ^ Yes ®No 244 10137-74-3 245 If more hazardous components are present at greater than 1 % by weight if non-carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the require information. NFPA HAZARD INDENTIFICATION: HEALTH s FLAMMABILITY o REACTIVITY 2 SPECIAL HAZARD oxv 2a6 HAZARD CLASS OR DIVISION # N/R UN# N/R If EPCRA, Please Sign Here OES Form 2731 Revised (5/03) F COSTCO 0688 SiteID: 015-021-002412 Fast Format ~ Notif./Evacuation/Medical Overall Site ~ Agency Notification 08/15/2006 THE WAREHOUSE MANAGER OR MANAGER ON DUTY WILL NOTIFY EMERGENCY RESPONSE SERVICES, REGIONAL OPERATIONS AND CENTRAL RISK MANAGEMENT. E r!Tr"cT Ai~[~A~~~J ~(~T TTTTTTL~C~ R~~,~ .~~ ~. ~Fev~cuccliov~ ~' e,w~ery}ev~cy no~-i~icm;liov~ "~n v~ecessla.~~,1.'e,rhpioi~s cad cusbme:rx- iui~l be ~orit=iec~ vtOL bit iv~oe~v+ ve,~rb wtiecw~s. ~ ' dloneS cz.P~, par4-u;6 resdie~1 lie used•-'~nq~ en~p[m and hci~t,~t o~i~~unc~cts ~tit.e s-iuc~.lion ~,;~ve~n~ts. e~~~ Gp a_ E~1~~~~~~~v`Pe~- ~v- s ar~~C~~9ne__sl~o T7TT /"~ nTj T T~TT rvTTT TTS ~Lj• .c n__ r DER . .T~s,~RHCE'DtiR~ W3~i.~ ~ F6i,3~9WE~ rt.~l oS i~®t.tld be ~SP~ . f~£~S Fr3R P~iYv I~CAI~ °' , -NfE-MSS , -~O L~A~~ g`I~~~I~I~7G ~ 9 Employee Notif./Evacuation 07/03/20173 THE WA~~HOUSE MANAGER OR MANAGER ON DUTY WILL NOTIFY EME~t{~ENCY RESPONSE---- SERVICES, AL OPERATIONS AND CENTRAL RISK A~EMENT. THE WAREHOUSE MANAGER WILL COO ~A EVACUATION ACTIV T~~'S TO ASSURE MEMBER AND EMPLOYEE SAFETY. ~~~~ THE DECISION TO EVACUAT~F~ COSTCO W USE WILL REST WITH THE WAREHOUSE MANAGER. HIS PROC DLfiR S WILL BE FOLLOWED. EMPLOYEES ULD PLAN ASSISTANCE FOR PHYSICALLY HANDICAP MPLOYEES, MEMBE VISITORS, OR VENDORS WHO ARE UNABLE TO LEAVE THE BUIL G OR AREA: Public Notif./Evacuation 07/26/1994 A COMMAND ST WOULD BE SET UP AT THE MEMBERSHIP DESK WHI ~'S~LOCATED NEAR THE MAIN ENT D EXIT TO THE BUILDING. ~-t.~T~ SECURITY PERSONNEL WOULD BE D CHE EACH EMERGENCY EXIT. THIS WOULD REQUIRE FOUR INDIVIDUALS TO CO UTHERN SIDE OF THE BUILDING. TWO INDIVIDUALS WOU ~~ DISPATCHED FROM THE COQ POST TO ASSIST MEMBERS TO THE NEAREST RGENCY EXIT. FO VALUATION PLAN DISCUSSED AT MONTHLY SAFETY MEETINGS - FRON K TC) BE CENTRAL CONTROL AREA IN CASE OF EMERGENCY. ~ ;ine ~~tir-eti,v~e Me,-- wiU ~vordtnq~-~•-e~va.~u.a~iv~ r~.r~-ivrFj2s ~-'ta ass~,t,re ntie,~er c.~.d ew~pf-~yee s-a.:Fe~. ~rnAlotj-ees sl~i ~~-~e Gt.ssistanc~ far pl~.~si+..~i1~ 4~t;1t,~:tc~pec~ ~~leye2s , tv~ers , vis ilzc~r, or vehc~,a~ ~~,a cv2 urn albl e ~I v t ea,v e -f~ b~,i (,~,i n ~ Qr Q,6'ece - ~ i ke ~ e ei s l av~ -i~, •e va,cu.~r? o~ (;os`tzo i~1ae-~ h ous e w; u r es ~-- w i ~}-ti fl~.e W ttr ei~ o use. FM.c.;~~,r ~xt.d ~Follow'~~ ~r~cxt~,~.tres wi~1 be Fol[swec~. })Sig:eels ~~a~- wi be Used -b ~tnt~iia~ TivttCi,~cc~lovl inrkrc~e aru.o~,tie.i~me.Yi~, Waft a b~,U hvrn ; vevloc,,~ -v~euhs cr,~~ era ce.U pl'ten.estp~r~kible racUos (Nex}ei) .-1-{~c~' ~ ~ersonhei Ufit~ ~e . ~) ~va.rua~-~to~ wiU occur ~~-r~.v~,,~l~ ~tt~e ne~si- wneX _ ey ~i~i~ •-f~c.~-c~xe ioca~ed ~~" •-{-f~,z peri ntief~+- vF .~ buald.i~.. Gk13 ctre ,:ter~riy ~urkec~ ~;+~++in s~ -it~~uvurud'i~ Sins . `t~hQ 2vacrw~v~ Sfiaginy tU-~ is ~in ~hY c~~ , ~-H1e ~ui(~iitc~ i ~-Fi~ Pa.riciruj I,o-1-. ~----. ~n -lam ev?-~ci- ova. re~r~le relPrrse or incicQ~.vit', •-t-r~,2 t~-eL~o~we NI~~;~Q,"_°r- o>t cry wiU ;,~ofi~`y U~vter'~u~ry res por,se serv~c,~s j Re~inruxl O~iakim s ~ - 4 6 - C`A-+i~"rR.l fl-i sk M,cuv;~~evac:up~tjon O 1 / 2 9 / 2 0 0 7 Dr emergenu~ ~,a~fiFtec°~}ivn .~ riec~sssaa~rcc.{{.. er~b~ees utalc~ e+.i.s~'o~nei~ wiU, be hofiF~ed pia .~ b~.tl h,;~-v~ ar~.d C~el~bc.I pvle~ra1S. CeiA pl~one~ rznd ~vr~fulole r~DS ~.n ~,e u5ecl~+o no~Fvl -P.mpio~ees Arid n.ei hborir~ Fac~lrfiest~S ~}~ s~w~-c~a#'-ov~ u,urranfs. j„ ~-i1e e,~ee~(-~F a Pew~r~uture, vexbal mu~+s anal ceU pyres/por~k~~e r-nclrof wmuid be ~se~ • i F COSTCO 0688 SiteID: 015-021-002412 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Emergency Medical Plan 08/15/20C~i~ ~ THIS FACILITY HAS DESIGNATED INDUSTRIAL MEDICAL GROUP AS THEIR PRIMARY MEDICAL FACILITY IN CASE OF AN ACCIDENT OR INJURY INVOLVING HAZARDOUS MATERIALS. STOCKDALE MEDICAL, 3857 STOCKDALE HWY, 832-1666. -47- 01/29/2007 F COSTCO 0688. SiteID: 015-021-002412 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 07/03/20n3 ~ IN ORDER PREVENT A RELEASE FROM PROPER HAZARD ~J ,TERIALS HANDLIN MATERIALS ARE KEPT IN HE'I~-4Ri,G N APPROPRIATELY TIED OFF R SHRINK-W INSPECT PRODUCT. A DAILY BASIS. ~° ~ ,~~ Cl~1~Ni ~N ti CiJRRING' ALL EMPLOYEES ARE TRAINED ON ND STORAGE PROCEDURES. HAZARDOUS CONTAINERS AND MERCHANDISE IS '~E~-. DEPARTMENT PERSONNEL VISUALLY l~ i:L~T~ Release Containment 08/15/20~1G IN THE EVENT OF SPILL, THE WAREHOUSE MANAGER AND SUPERVISOR/DEPARTMEI~T'T' MANAGER WILL IMMED ELY BE NOTIFIED. THE REL AREA WILL BE IMMEDIATEL~t MARKED AND CLEARED OF STOMERS AND NON-ES IAL PERSONNEL. THE PRODUCT WILL BE IDENTIFIED AND, I~'~S FE TO DO THE RELEASE WILL BE STOPPED AT TAE SOURCE . ~ ~=~-~ DRAINAGE INTO SEWERS OR STO~I~'bRAINS WI~BE BLOCKED . fem. ~ ~ j ~} C ~~ ~N ~ EMERGENCY RESPONSE SE CES, IE, THE FIRE DEP ENT, WILL BE NOTIFIED AND EVACUATION PROCED S WILL BE IMPLEMENTED AS THE UATION WARRANTS. IN THIS EVENT, C CO REGIONAL OPERATIONS AND CENTRAL RISK MANAGEMENT WILL AL50 Clean Up 08/15/20(7 IF IT TS~ETERMINED THAT IN-HOUSE EMPLOYEES HAV .~'T~E KNOWLEDGE AND PPE TO SAFELY CLE THE BE CONTACTED FOR EMPLOYEES WILL THEN GUIDELINES. HAZARDOUS WASTE WIL,~ PROPERLY LABEL. AS HAZARDOUS WASTE. ALL WASTE ~ARF~ DISPOSED OF IN ACCORDAN TH LOCAL, STATE, AND FEDERAL REGULATIONS. SPILL, THEN THE SPILL WILL BE OBTAINED AND 3E WILf~ ICAL-SPECIFIC C~ -UP AND PPE ADVISEMENT. TRAINED CL HE SP.I~'~ PER MATERIAL SAFETY DATA SHEET -~Z~'T-~ L BE PLACED INTO SE NON-REACTIVE CONTAINERS AND -48- O1/29/2~07 F COSTCO 0688 SiteID: 015-021-002412 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Sit~.~ ~ Other Resource Activation 07/03/2003 ~ THE WAREHOUSE MANAGER OR ASSISTANT WAREHOUSE MANAGER WILL BE RESPONSBILE FC7R NOTIFYING THE APPROPRIATE AGENCIES AND CORPORATE OFFICIALS IN CASE OF A SPILL OR RELEASE OF HAZARDOUS MATERIAL. -49- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ Fast Format ~ ~ Site Emergency Factors Overall Sites ~ Special Hazards Utility Shut-Offs 01/29/200`7 A) GAS - OUTSIDE. SE CRNR OF BLDG B) ELECTRICAL - S WALL REC C) WATER - SW WALL REC D) SPECIAL - NONE E) LOCK BOX - ABOVE MAIN ENTR DOOR Fire Protec./Avail. Water 01/29/2007 PRIVATE FIRE PROTECTION: AUTOMATIC SPRINKERS, FIRE EXTINGUISHERS, AND FIRE AT~ARM SYSTEM. FIRE HYDRANTS: FIRE HYDRANTS ON ALL SIDES OF SITE, THE COST.CO FACILITY OPERATES THREE 30,000-GALLON DOUBLE-WALLED FIBERGLASS, UNDERGROUND STORAGE TANKS FOR GASOLINE. THE USTS ARE MONITORED BY AN ELECTRONIC LEAK DETECTION MONITORING SYSTEM WHICH IS MANAGED BY VERTEX SERVICES. THE SYSTEM ALARM AND MONITORING PANEL IS TYPICALLY LOCATED. IN THE DATA HUT NEAR THE GAS STATION. IF THERE IS A RELEASE, LEAK OR OTHER EMERGENCY, SYSTEM ALARMS WILL SOUND AT THE GAS STATION. THE ALARMS WILL AUTOMATCIALLY NOTIFY VERTEX OF THE EMERGENCY AND THE GAS STATION WILL AUTOMATCIALLY SHUT DOWN. COSTCO EMPLOYEES WILL_EVACUATE THE AREA AND THE WAREHOUSE MANAGER AND OPERATIONS MANAGER WILL BE NOTIFIED. THE APPOINTED CONTRACTOR WILL THEN DISPATCH CLEAN-UP CONTRACTORS TO THE FACILITY TO ASSESS THE SPILL OR LEAK AND WILL TAKE PROPER STEPS TO REMEDY THE SITUATION. WATER: SW WALL OF BLDG AT RECEIVING -50- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ Fast Formal:t ~ ~ Site Emergency Factors Overall Sites ~ ~ Building Occupancy Level 02/08/2006 ~ 320 EMPLOYEES -51- 01/29/2007 F COSTCO 0688 SiteID: 015-021-002412 ~ Fast Forme ~ ~ Training Overall Sits ~ ~ Employee Training 08/15/200 ~ MATER3AL SAFETY DATA SHEETS ON FILE. BRIEF S OF TRAINING PROGRAM: EMPLOYEESEIVE APPROPRIATE SAFETY TRAINING DURIN EW HIRE ORIENTATION, WHEN OSED TO NEW SUBSTANCES, PROCESSES, PROCED OR EQUIPMENT WHI~~OSE NEW OR ADDITIONAL HAZARDS, Al ON A RECURRENT BASIS, NEEDED, BAS~FD ON THE TYPE OF JOB/HAZARD EXPOSURE. TRAINING TOPICS INCLUDE BUT OT LIMITED TO TO THE FOLLOWING: EVACUATI0~1 PROCEDURES, HAZARDOUS MATE GALS NTIFICATION, USING MATERIAL SAFETY DATA SHEETS, UNDERSTANDING T OSHA HAZ OMMUNICATION STANDARD, ABILITY TO RECOGNIZE LABELS AND KINGS, FAMILIARI -WITH EMERGENCY RESPONSE PLAN--ANJ3 =- PROCEDURES . ~~l.~j~ TRAININGp~P~P~~f S PLACE ON AN ANNUAL BASIS AND DURING MaN-THEY SAFETY MEETINGS ALL TRAI G IS DOCUMENTED. s~ ~-r r~c~~~~~ rage ~ na.i.u ivi r u~uie use -52- 01/29/2007 F COSTCO 0688 SiteID: 015-021-0024.2 ~ Fast Formdt ~ ~ Training Overall Sites ~ Held for Future Use --- -53- O1/29/2n07 RELEASE PREVENTION: Costco maintains hazardous chemicals primarily in prepackaged consumer products merchandised for retail sale. Products merchandised are stocked in such a manner as to preclude accidental damage, and to prevent spills or accidental mixtures. In order to prevent a release from occurring, all employees are trained on proper hazardous materials handling and storage procedures. Hazardous materials are kept in their original containers, and merchandise is appropriately tied off or shrink-wrapped. If a secondary container is used, the container must be labeled with either an extra copy of the original manufacturer label or a generic label which lists the products name and hazards. Department personnel visually inspect products and work areas on a daily basis to ensure safe practices are being followed. There are also monthly inspections of personal protective equipment, fire system, and eyewash stations. In order to reduce or prevent potential exposure to chemical hazards, Costco utilizes engineering measures such as ventilation systems in the fork lift battery areas, and administrative measures such as purchasing and using less hazardous products. Costco provides safe work policies and procedures, safety training, proper PPE, and distribute MSDS, product safe work practice memos, and merchandising guidelines. Emergency communication systems, fire protection equipment and spill control equipment are tested and maintained on a regular basis to ensure proper operation. RELEASE CONTAINMENT: In the event of a spill, the Warehouse Manager and the Supervisor/Department Manager will immediately be notified and evacuation procedures will be implemented as the situation warrants. Employees who have had Hazard Communication training and specific departmental training with the proper PPE and spill cleanup equipment may respond to incidental releases. An incidental release is one that does not cause imminent health or safety hazard to employees and does not have to be cleaned up immediately to prevent death or serious injury to employees. Upon response, the release area will be immediately marked and cleared of customers and non-essential personnel. The product will be identified, and if safe to do so, the release will be stopped at the source during the time of release. Drainage into sewers or storm drains will be blocked. For all other releases too large or beyond the scope of Hazard Communication training and specific departmental training, an off-site contractor will be contacted for professional assistance to clean up and dispose of hazardous material. Emergency response services (i.e. fire department) will be notified and evacuation procedures will be implemented as the situation warrants. In this event, Costco Regional Operations and Central Risk Management will also be notified. CLEAN UP: If it is determined that in-house employees have the ability to neutralize, absorb, or otherwise control at the time of release using PPE, then the product will be identified, the release will be stopped/contained, the Spill Cart will be obtained. 3E will be contacted for chemical-specific clean up information, poison control, MSDS, and local spill cleanup and disposal companies, as the hazard requires. Hazardous waste will be placed into seal-able, non-reactive containers, and properly labeled as "hazardous waste." All wastes are disposed of in accordance with local, state and federal regulations. UST PREVENTION/MITIGATION/ABATEMENT: This Costco facility operates three 3 gallon double-walled fiberglass underground storage tanks for gasoline. The USTs are monitored by an electronic Veeder Root 350R leak detection monitoring system, which is managed by Vertex Services. The system alarm and monitoring panel is typically located in the "data hut" near the gas station. In the event of a large spill (a large spill can be defined as spilled gasoline covering an area larger than the size of a car) the gas station attendant will immediately press one of the emergency shut off alarms, and if necessary call 911. The alarms will automatically notify Vertex of the emergency, and the gas station will automatically shut down. Costco employees will evacuate the area, and the Warehouse Manager and Operations Manager will be notified. Vertex Systems will then dispatch clean-up contractors to the facility to assess the spill or leak and will take proper steps to remedy the situation. In the event of a small gasoline spill at the gas station, the gas station attendant will use the proper PPE and either FM186-2 or absorbent towels as instructed. The waste that is generated from small spills is placed in sealed 55-gallon drums or other waste containers, and stored .and properly labeled as "hazardous waste." All wastes are disposed of in accordance with local, state and federal regulations. Records of all gasoline spills are kept at the Data Hut. EMPLOYEE TRAINING: Employees are provided with information and training in the proper use and handling of hazardous chemicals in their work area to which they maybe exposed under normal conditions of use, or in a reasonably foreseeable emergency resulting from work place operations. Training shall be conducted upon initial assignment, reassignment to a new work area, and whenever a new type of hazard is introduced into the work area. Training topics include, but are not limited to, an overview of OSHA training requirements, details of Costco's written hazardous communication program, work area operations where hazardous materials are present, and procedures that maybe used to detect a hazardous substance release in the work place and protect themselves from hazards. For any employee participating in anon-routine (activity not part of their everyday work schedule), the warehouse manager is responsible for ensuring the employee is trained in any hazards associated with the task, i.e. information generally found on the MSDS. Responsibilities of Staff: • Warehouse Manama Ensuring all staff receives general and departmental specific Hazard Communication Training, MSDS information is communicated, all employees know how to access an MSDS, appropriate signage is posted, and PPE/Spill equipment are adequate and readily available. • Department Managers/Supervisors: Provide in-depth MSDS training reviewing chemicals used in department, hazards, exposure symptoms, PPE, and first aid/spill cleanup procedures, especially if working near unlabeled pipes that contain hazardous chemicals. Ensure employees understand training information, protective measures, process for obtaining MSDS, and that employees are aware to question management when in doubt regarding handling product, wearing PPE, etc. • Employees: Aware of chemicals that they work with prior to working with them, including asking supervisor/manager about anything unlabeled, potential hazards, and safety precautions. Follow established safety and health guidelines, wear PPE, and ask any applicable questions when in doubt about proper handling, use, or cleanup of a hazardous product. Types of employees who regularly handle hazmat: • Photo Lab Tech - 1 Hour Photo has a department specific training program. Employees are required to complete this training before working in the department, and re-train (annually) • RTV/ Receiving Clerk -Receive DOT Haz Mat Awareness Training (annually) • Managers and Supervisors -Warehouse Managers, Asst. Managers, and Receiving Manager receive DOT Haz Mat Awareness and Shipping Training (annually) • Merchandising -Receive Costco Hazardous Communication Training (annually) ~ Facilities Maintenance -Receive Costco Hazardous Communication Training (annually) • Tire Center -Receive Costco Hazardous Communication Training (annually) • Gas Station Clerk (if applicable)- Gasoline specific shipping and handling training (new and annually) Frequency and duration spent on training for each type of employee listed above: • DOT Awareness Training- approx 2 hours- CD-Rom • DOT Shipping Training- approx 2 hours- CD-Rom • Costco Hazardous Communication Training- conducted by supervisor- approx. '/Z to 1 hour • Photo Shop Training- conducted by supervisor- approx. 1-2 hours • Gasoline Training- Gasoline specific shipping and handling training-conducted by supervisor- approx 1-2 hours Personnel in charge of training and the qualifications of personnel conducting the training: Most training is conducted via hand out, video, or CD-Rom. The warehouse manager is ultimately responsible for ensuring compliance and training requirements are met. Department Managers and Supervisors conduct the training, based on a detailed leaders guide and their experience in the field. If necessary, copies of training materials can be sent to the jurisdiction. The Administration Manager documents that all appropriate and required training has been completed. After attending the training session, each Employee is to sign off to verify that he/she attended and understands the training. CALIFORNIA ANNOTATED SITE MAP BUSINESS NAME: (SITE ADDRESS:3800 ROSEDALE HWY I Map #:1 OF' 2I C^STCO WHOLESALE #688 BAKERSFIELD, CA 93308 A B C D E F G H I ., 1 ' ~ 3 f t 7 F ^ F F h® O - - - 2 ® LJ 1 ~ ~ ~ Qn ;off . ~ m ~ SK ~ j (It m I V I t _ ~J a _..._ __._ _. ..__.._._ __ 3 ~ 3 0 1 ~ e =w ~ ® • :... I i} , ® ® 0 ~ °° _'.. O .. e__L__ _~~ .~_ .._ ___ WW_~~ ~F .._ .. ~ . ._ f ~ >__- -- _._ _ ~ ~ _.__. ~REGEIVIN6 a ~ ~ j ~ ~ ~~ 4 + F ~ _ ~ 3 ~ ~ r~nl~ O O ~ w S ~~ ; F U m ~ Z 41 ~~ 3Qi7 ~ i { } E c a ~ ~ ~ ~ r~ __ _ _._ _ _ ;. . _.__ . . __. . _ 1 °~ . _..~ ..._..~_. __ .. .. .......... ._ .. _ _... .. R 22 . -MEAT ___ ~ ._..., _.. . . _ ~ _ ._. _ . .. 3 "~ 5 ~ F ~m 0 I 3 } ~ } ~ ® 11 ^yu ~ , lln la ~ BAKERY s 7 Y X -- 3 ~__ ~ .~ . i i 3E NOR E C m~ €m`F` e m 1~1~ {mom mid 'i 3 O ELECTRIC MAIN O GAS MAIN O WATER MAIN FIRST AID FIRE EXTINGUISHER LB LOCK BOX MATERIAL SAFETY MSDS DATA SHEETS & HEP BUSINESS EMERGENCY PLAN Q9 FIRE RISER UB USED BATTERIES BATTERIES (POR uPr equrP.) m COMPRESSED. GAS W CYLINDERS (NITROCBN) COMPRESSED GAS CYLINDERS (CARBON DIOXIDE) R-22 REFRIGERANT (CALIFORNIA ANNOTATED SITE MAP (BUSINESS NAME (SITE ADDRESS~3800 R^SEDALE HWY I Map #~2 OF 2I C^STC^ WHOLESALE #688 BAKERSFIELD, CA 93308 A B C D E F G H I 1 COSTCO #66 ~~IIItII ~s 2 3 4 5 6 ~' _~ RI^ C r 3 W J a ra W 0 ® ® a 4 0o oo a . ~ a 1 _m _L II iriii~I~- J W H ~~0 Ab'MI-!^IH NORT i uiiti~~ti~LU tiiiiiri_tiLw z ~ € ~uii'iiiiw ~ E ~~~~ iononoi C^STC^ GAS STATION 3E ~, e; ~{ SAFE REFUGE AREA ® STORM DRAIN FIRE HYDRANT OW OIL/WATER SEPARATOR UNDERGROUND 20,000; STORAGE TANK FOR GASOLINE }qS WASTE SOLIDS IqG WASTE GASOLINE EMERGENCY GEN GENERATOR Y X -~ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Costco Wholesale Corporation gas station #688 Facility ID #: 215-000-001105 Facility Address: BAKERSFIELD, 3800 Rosedale Highway, Bakersfield, CA, 93308 Reason for Submitting this Form (Check One) ® Change of Designated Operator Facility Phone #: (661) 636-0822 ^Update Certificate Expiration Date Desi;;nated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Josh Beckham Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 ^ Service Technician ^ Third-Party International Code Council Certification #: 5293433-UC Expiration Date: 8!29!2008 ALTERNATE I (Optional) Designated Operator's Name: Brian Irvin Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation, LA Regonal Office ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 741-7761 ^ Service Technician ^ Third-Party International Code Council Certification #: 5280168-UC Expiration Date: 7/21/2008 ALTERNATE 2 (Optional) Designated Operator's Name: See attached pages 2 through 7. Relation to UST Facility (Check One) Business Name: ^ Owner ®Operator ^Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 27I5(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: January 30, 2007 OWNER'S PHONE #: (425) 313-8100 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: www.waterboards.ca_ Gov/ust~contactscu~a®agys.html. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. January 2007 Page 1 ~ - _- ALTERNATE 3 Designated Operator's Name: Ruben Cordero Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 (#022) ^ Service Technician ^ Third-Party International Code Council Certification #: 55280168-UC Expiration Date: 3/22/2008 ALTERNATE 4 Designated Operator's Name: Daron Cox Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 (#048) ^ Service Technician ^ Third-Party International Code Council Certification #: 5257803-UC Expiration Date: 4/6/07 Ai.TF,RNATF. 5 Designated Operator's Name: Jorge Ramirez Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 (#048) ^ Service Technician ^ Third-Party International Code Council Certification #:5257875-UC Expiration Date: 4/6/07 ALTERNATE 6 Designated Operator's Name: Juan Vizcara Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 (#048) ^ Service Technician ^ Third-Party International Code Council Certification #:pending Expiration Date: 12!22!2008 ALTERNATE 7 Designated Operator's Name: Mark Munger Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 530-3198 (#126) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243824-UC Expiration Date: 10/30/08 ALTERNATE8 Designated Operator's Name: Mike Dell'Olio Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: ((805) 582-0764 (#128) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5257814-tiC Expiration Date: 4/22!07 ALTERNATES Designated Operator's Name: James Dotson Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 434-2926 (#411) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5285938-UC Expiration Date: 6/23/08 ALTERNATE 10 Designated Operator's Name: Enedina Morales Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 334-8069 (#412) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243848-UC Expiration Date: ]0/13/08 January 2007 Page 2 ALTERNATE ll Designated Operator's Name: Tom Pinkleton Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 983-1509 (#420) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243714-UC Expiration Date: 11/03/08 ALTERNATE 12 Designated Operator's Name: Tony Wong Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 281-1960 (#428) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243764-UC Expiration Date: 12/15/08 ALTERNATE 13 Designated Operator's Name: Ron Legalt Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 281-1960 (##428) ^ Service Technician ^ Third-Party International Code Council Certification #: 5280199-UC Expiration Date: 3/17/08 ALTERNATE 14 Designated Operator's Name:Jared Harsma Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 279-1360 (#432) ^ Service Technician ^ Third-Party International Code Council Certification #: pending Expiration Date: 12/14/08 ALTERNATE 15 Designated Operator's Name: Rick Taurick Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (760) 202-1354 (#441) ^ Service Technician ^ Third-Party International Code Council Certification #: 5273952-UC Expiration Date: 12/26/07 ALTERNATE 16 Designated Operator's Name: Chuck Del Piano Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 453-0391 (#454} ^ Service Technician ^ Third-Party International Code Council Certification #: 5243843-UC Expiration Date: 10/13/08 ALTERNATE 17 Designated Operator's Name: Louis Flores Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (951) 697-4612 (#455) ^ Service Technician ^ Third-Party International Code Council Certification #: 5280179-UC Expiration Date: 3/22/08 ALTERNATE 18 Designated Operator's Name: Robert Quiroga Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 465-6321 (#473) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 52541 13-UC Expiration Date: 2/25/07 January 2007 Page 3 ALTERNATE ]9 Designated Operator's Name: Arron Guerro Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 891-1585 (#476) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243801-UC Expiration Date: 1 I/4/06 ALTERNATE 20 Designated Operator's Name: Adam Hart Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 478-0963 (#478) ^ Service Technician ^ Third-Party International Code Council Certification #: 5257827-UC Expiration Date: 5/27/07 ALTERNATE 21 Designated Operator's Name: Manuel Medrano Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 823-8046 (#479) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5246266-UC Expiration Date: 10(20/08 ALTERNATE 22 Designated Operator's Name: Alex Mesa Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 770-5641 (#627) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5257856-UC Expiration Date: 4/28/07 ALTERNATE 23 Designated Operator's Name: Alex Chavez-Romo Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 837-202b (#b38) ^ Service Technician ^ Third-Party International Code Council Certification #: 5282016-UC Expiration Date: 4/14/08 ALTERNATE 24 Designated Operator's Name: Bruce Addison Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 837-2026 (#643) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5282016-UC Expiration Date: 4/14//08 ALTERNATE 25 Designated Operator's Name: Thomas Henderson Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 536-0214 (#671) ^ Service Technician ^ Third-Party International Code Council Certification #: 5254067-UC Expiration Date: 2/4/07 January 2007 Page 4 ALTERNATE 26 Designated Operator's Name: Angelina Hooven Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 536-0214 (#671) ^ Service Technician ^ Third-Party International Code Council Certification #: 5268549-UC Expiration Date:10/14/07 ALTERNATE 27 Designated Operator's Name: Cesar Aguila Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 536-0214 (#671) ^ Service Technician ^ Third-Party International Code Council Certification #: 5257831-UC Expiration Date:4/I/07 ALTERNATE 28 Designated Operator's Name: Mario Rebollar Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation (#677) ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 260-9546 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243755-UC Expiration Date: 11/3/08 ALTERNATE 29 Designated Operator's Name:Doug Johnson Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 260-9546 (#677) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5261186-UC Expiration Date: 11/10/07 ALTERNATE 30 Designated Operator's Name: Julia Jett Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 557-3783 (#678) ^ Service Technician ^ Third-Party International Code Council Certification #: 5280]95-UC Expiration Date: 3/10/08 ALTERNATE 31 Designated Operator's Name: Rod (Forrest) Rivers Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 621-4302 (#686) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243794-UC Expiration Date: 10/6/08 ALTERNATE 32 Designated Operator's Name: Josh Beckham Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 (#688) ^ Service Technician ^ Third-Party International Code Council Certification #: 5293433-UC Expiration Date: 8/29/08 ALTERNATE 33 Designated Operator's Name: Michael McDonald Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator pEmployee Designated Operator's Phone #: (949) 425-9176 (#690) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243744-UC Expiration Date: 10113!08 January 2007 Page 5 ALTERNATE 34 Designated Operator's Name: Keith Crawford Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator pEmployee Designated Operator's Phone #: (805) 541-7000 (#741) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: pending Expiration Date: 1(27109 ALTERNATE 35 Designated Operator's Name: Wesley Gillen Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 541-7000 (#741) ^ Service Technician ^ Third-Party International Code Council Certification #: pending Expiration Date: 1/27109 ALTERNATE 36 Designated Operator's Name: Thomas McConnell Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 761-3810 (#748) ^ Service Technician ^ Third-Party International Code Council Certification #: 5257330-UC Expiration Date: 3/24/07 ALTERNATE 37 Designated Operator's Name: Traci Howard Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 761-3810 (#748) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: pending Expiration Date: 11/14/08 ALTERNATE 38 Designated Operator's Name: Jared Drinville Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 761-3810 (#748) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5268587-UC Expiration Date: 9/16/07 ALTERNATE 39 Designated Operator's Name: Steve Wenzel Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 942-8565 (#762) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5261319-UC Expiration Date: 6/1/07 ALTERNATE 40 Designated Operator's Name: Gary Sosebee Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 942-8565 (#762) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5257362-UC Expiration Date: 5!6107 ALTERNATE 41 Designated Operator's Name: Rebecca Rodriguez Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #:(661) 942-8565 (#762) ^ Service Technician ^ Third-Party International Code Council Certification #: 5280214-UC Expiration Date: 3/15/2008 January 2007 Page 6 ALTERNATE 42 Designated Operator's Name: Deshay Scott Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 695-9908 (#769) ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5293501-UC Expiration Date: 8/7/08• ALTERNATE 43 Designated Operator's Name: Larry Gamica Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (562) 690-0041 (#777) ^ Service Technician ^ Third-Party International Code Council Certification #: 5243868-UC Expiration Date: 10/29/08 ALTERNATE 44 Designated Operator's Name: Brian Irvin Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 741-7761 ^ Service Technician ^ Third-Party International Code Council Certification #: 5240765-UC Expiration Date: 7/21/2008 January 2007 Page 7 ,~' r, Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: Costco Wholesale Corporation gas station # 688 Facility ID #: 215-000-001 105 Facility Address: 3800 Rosedale Highway, Bakersfield, CA 93308 Reason for Submitting this Form (Check One) ® Change of Designated Operator Facility Phone #: (661) 636-0822 ^Update Certificate Expiration Date Desi;?nated UST Operator(s) for this Facility PRIMARY Designated Operator's Name: Sheri Puolpon Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243840-UC Expiration Date: 10/27/2006 ALTERNATE l (O tional) Designated Operator's Name: See attached Relation to UST Facility (Check One) Business Name: ^ Owner ®Operator ^Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: ALTERNATE 2 (Optional) Designated Operator's Name: Relation to UST Facility (Check One) Business Name: ^ Owner ®Operator ^Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compliance with the requirements (statutes, regulations, and local ordinances) applicable to underground storage tanks. NAME OF TANK OWNER (Please SIGNATURE OF TANK OWNER: DATE: August 10, 2005 OWNER'S PHONE #: X425) 313-8100 NOTE: 1) SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY (NOT THE STATE WATER RESOURCES CONTROL BOARD) BY JANUARY 1, 2005. THE LOCAL AGENCY LIST IS AVAILABLE AT: w~v«~.w°~terboards.ca.~~ov:usi%contactsrcu~a ag~s.lxtml. 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. Page 1 of 5 November 2004 r,,, ALTERNATE3 Designated Operator's Name: Robert Luna Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243699-UC Expiration Date: 12/6/06 ALTERNATE4 Designated Operator's Name: Daron Cox Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator pEmployee Designated Operator's Phone #: (818) 989-3577 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257803-UC Expiration Date: 4/6/07 ALTERNATES Designated Operator's Name: Jorge Ramirez Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 989-3577 ^ Service Technician ^ Third-Party International Code Council Certification #:5257875-UC Expiration Date: 4/6/07 ALTERNATE6 Designated Operator's Name: Mark Munger Relation to UST Facility (C/teck Orie) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 530-3198 ~ ^ Service Technician ^.: Third-Party International Code Council Certification #: 5243824-UC Expiration Date: 10/29/06 ALTERNATE7 Designated Operator's Name: Kevin Bosworth Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation _ ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 582-0764 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243848-UC Expiration Date: 12/3/06 ALTERNATE8 Designated Operator's Name: Mike Dell'Olio Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: ((805) 582-0764 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257814-UC Expiration Date: 4/22!07 ALTERNATE9 Designated Operator's Name: Enedina Morales Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 334-8069 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257814-UC Expiration Date: 10/27/06 ALTERNATE 10 Designated Operator's Name: Tom Pinkleton Relation to UST Facility (C,/aeck O~:e) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (805) 983-1509 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243714-UC Expiration Date: 10/29/06 Page 2 of 5 November 2004 ~t-S r~ ALTERNATE 11 Designated Operator's Name: Tony Wong Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 281-1960 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243764-UC Expiration Date: 12/16/06 ALTERNATE I2 Designated Operator's Name: Chuck Del Piano Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 453-0391 ^ Service Technician ^ Third-Party [nternational Code Council Certification #: 5243843-UC Expiration Date: 10/29/06 ALTERNATE 13 Designated Operator's Name: Robert Quiroga Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 465-6321 ^ Service Technician ^ Third-Party International Code Council Certification #: 5254113-UC Expiration Date: 11/4/06 ALTERNATE I4 Designated Operator's Name: James McCoy Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 891-1585 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243832 Expiration Date: 10/28/06 ALTERNATE IS Designated Operator's Name: Arron Guerro Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ~ ~ ^- Gwner ®Operator ^Employee Designated Operator's Phone #: (310) 891-1585 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243801-UC Expiration Date: 11/4/06 ALTERNATE 16 Designated Operator's Name: Manuel Medrano Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 823-8046 ^ Service Technician ^ Third-Party International Code Council Certification #: 5246266-UC Expiration Date: 11/12/06 ALTERNATE 17 Designated Operator's Name: Sean Harvey Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 823-8046 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257298-UC Expiration Date: 3/23/07 ALTERNATE I8 Designated Operator's Name: Thomas Henderson Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 536-0214 ^ Service Technician ^ Third-Party International Code Council Certification #: 5254067-UC Expiration Date: 2/4/07 Page 3 of 5 November 2004 ALTERNATE 19 Designated Operator's Name: Angelina Hoover Relation to UST Facility (Check Or:e) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 536-0214 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257831-UC Expiration Date:4/1/07 ALTERNATE 20 Designated Operator's Name: Mario Rebollar Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (818) 260-9546 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243755-UC Expiration Date: 11/15/,06 ALTERNATE 2l Designated Operator's Name: Karo Babarian Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (626) 839-2491 ^ Service Technician ^ Third-Party International Code Council Certification #: 5246019-UC Expiration Date: 11/24/06 ALTERNATE 22 Designated Operator's Name: Rod (Forrest) Rivers Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (909) 621-4302 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243794-UC Expiration Date: 10/28/06 ALTERNATE 23 Designated Operator's Name: Sheri Puolpon Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation . r ^` Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243840-UC Expiration Date: 10/27/06 ALTERNATE 24 Designated Operator's Name: Michael McDonald Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (949) 425-9176 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243744-UC Expiration Date: 10/29/06 ALTERNATE 25 Designated Operator's Name: Debbie Swift Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 942-8565 ^ Service Technician ^ Third-Party International Code Council Certification #: 5243902-UC Expiration Date: 10/26/06 ALTERNATE 26 Designated Operator's Name: Steve Wenzel Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 636-0822 ^ Service Technician ^ Third-Party International Code Council Certification #: 5261319-UC Expiration Date: 6/1/07 Page 4 of 5 November 2004 s ALTERNATE. 27 Designated Operator's Name: Gary Sosebee Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (661) 942-8565 ^ Service Technician ^ Third-Party International Code Council Certification #: 5257362-UC Expiration Date: 516/07 AI.TFRNATF 2R Designated Operator's Name: Larry Garnica Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (310) 695-9908 ^ Service Technician ^ Third-Party Intemational Code Council Certification #: 5243868-UC Expiration Date: AI TFRNATF 1Q Designated Operator's Name: Brian Irvin Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (714) 741-7761 ^ Service Technician ^ Third-Party International Code Council Certification #: 5240765-UC Expiration Date: 8/5!06 AI.TRRNATF. 30 Designated Operator's Name: Dennis Bock Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation p Owner ®Operator ^Employee Designated Operator's Phone #: (425) 427-7653 ^ Service Technician ^ Third-Party International Code Council Certification #: 5236638-UC Expiration Date: 6/22/06 ALTERNATE 3l Designated Operator's Name: Ed Navarro Relation to UST Facility (Check-One) Business Name: Costco Wholesale Corporation . - Q Owner ®Operator ^Employee Designated Operator's Phone #: (425) 313-6910 ^ Service Technician ^ Third-Party International Code Council Certification #: 5236685-UC Expiration Date: 6/24/05 ALTERNATE 32 . Designated Operator's Name: Dwight Larsen Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: (425) 313-6945 ^ Service Technician ^ Third-Party International Code Council Certification #: 5238523-UC Expiration Date: 7/1/06 AI,TF.RNATF.:i3 Designated Operator's Name: Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: AI,TF.RNATF. 3A Designated Operator's Name: Relation to UST Facility (Check One) Business Name: Costco Wholesale Corporation ^ Owner ®Operator ^Employee Designated Operator's Phone #: ^ Service Technician ^ Third-Party International Code Council Certification #: Expiration Date: Page 5 of 5 November 2004 :~;~ ~~~~~~ cona~ur~-r~ rESrrnr~ Computer Test Report International Cade Council Computer Exam Report DATE: 09/lU/2005 E7SAH TITLL s ICC Underground Storage Tar:k Installation/Retrofitting - U1 (CUR) N,AxKE : pULiI, JdE LOCATOR: PLTl~0002 EXI~'iI?i,A''~ZON RBSCTLT: PAS$ Gongratulatioans! You have passed the ZCC i]nderground,Storage Tank Instal7.ation/Retrofittinq - U1 (CUR) Your TCC aertifYOate and wallet card will be mailed to you within si.x weeks after the end of-the month in which you passed the exam. Your name as it appears above do this notice will be printed on your certifxcat~s and wallet card. It xs very important that you nc~txfy LaserGrade and SCC of any changes ix~ your name and/or address. ICC requires s change of address in writing. Tease fax your change Of address to ICC at (562) 592-2845 or mail it to: YGC CertS.ficatxan $ervi.aes 53b0 Workman Mill Road Sincerely, LaserGrade Applicant Locator: PUKR0002 LaserGrade Computer Testing Testing provided by LAS93202 P O Hax 87245 Ring-Sheffield Hanford ~'lt Ctr LLC Vancouver, WA 98687-7245 775 Foggy Hcattom Road 800-211.-2754 or 360-896-9111 Hanford, GA 93230 www.7,aseargzade.com 559-582-3974