22000 HWY 99 (3)it?
IN 2 000 FIRE PREVENTION
ServingBrier, Irc-urnurlds, and 12425 Meridian Ave S INSPECTION REPORT.
8140ROxi I SH Co. 9EDMONDS
p Mountlake Terrace Everett, WA-98208
69. 11 . -1WZ' [I BRIER
Phone (425) 551-1200 [1 MOUNTLAKE TERRACE
UNINCORPORATED
DISTRIL'u-T www.FireDistrictl.org Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION: 22000 Highway 99 98026
Annual
20-B
BUSINESS NAME:Jackson's #6 . 09 -
4257714315
SCHEDULED Feb 2017
PHONE:
DATE DUE �
571
MAILING
LIFIR
ADDRESS:3450 Commercial Ct, Meridian, ID 83642
BUSINESS OWNER:Linville, Jill
HOME PHONE:
Hanna, Madgy%/
2069095756 e—
IN
EMERGENCY- 1:
HOME PHONE: CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
BUSINESS
A F-1
EMAIL:
LICENSE
el
PERSON CONTACTED:
INITIAL INSPEC�ON D E
NAME OF INSPECTOR: (,72-C)
FIRE SYSTEMS: FE lj4f 3/1-1
Date Last Serviced:
SNOHOMISH CO.
FIRE
DIS-7
Serving Briei; Edinonds, and
Mountlake Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
[3 BRIER
[3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY
STATION & SHIFF*�
LOCATION:
22000 Highway 99 98026
Anr
20-A
BUSINESS NAME:
Jackson's #609
PHONE:
4257714315
SCHEDULED
DATE DUE I' Feb 2016
MAILING
LIFIR 1' 571
ADDRESS:
3450 Commercial Ct, Meridian, ID 83642
__J
BUSINESS OWNER:
Linville, Jill
HOME PHONE:
.EMERGENCY-1 :
Hanna, Madgy
HOME PHONE:
2069095756
CURRENT
KEY ACCESS-2:
HOME PHONE:
YES NO
CITY
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED: 1011
INITIAL INSPECTION DATE
NAME OF INSPECTOR: At,
1 7 (Z)
FIRE SYSTEMS:
FE 1/15—)
. t� I
D.qtp I q-qt Rprvirprf- 1, 11 to
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
o_\
2
2
3 ... . ............... .....
__ 4
5
3
-4
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the item(s) that were noted during. our inspection which require attention to bring them into compliance
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations, of the fire regulations does not imply approval of such conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
Serving Briet; Ednionds, and 12425 Meridian Ave S
Mozintlake Terrace Everett, WA 98208
Phone (425) 551-1200
� tw FireDistrictl'.org Fax (4.15) 5514t72
i 4
LOCATION: 22000 Highway99 98026
Jackson's #609 4257714315
BUSINESS NAME: PHONE:
MAILING 3450 Commercial Ct, Meridian, ID 83680
ADDRESS:
BUSINESS OWNER: Linville, Jill HOME PHONE:
FIRE PREVENT1014
INSPECTION REPORT
�16MMONDS
El BRIER
[I MOUNTLAKE TERRACE
El UNINCORPORATED
FREQUENCY STATION & SHIFF")
Annual 20-D
SCHEDULEcFeb 2015
DATE DUE I'
571
UFIR
Jackson's Food Stores 2088886061
EMERGENCY-1: M C (.,HOME PHONE: URREN
KEY ACCESS-2: M An ca je 9)-2W1()o1I5 -15 HOME PHONE: ITY T YES/ NO
BUSINESS F_ I
EMAIL: LICENSE
PERSON CONTACTED: 1 a C�oi INITIAL INSPECTION DATE
NAME OF INSPECTOR:
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
Alr,
2
2
3
3
4
4
1 5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE;
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
12
6
2
6
DATE:
CODE
SECTION:
5
3
7
.3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED [-] YES NO
8
FIRE DEPARTMENT COPY
-idian Ave S
Serving Briei: Edmonds, and 12425 Mei
SNOHOMISH CO.
Mountlaw Terrace Ei)erett, WA 98208
FIRE
Phone (425) 551-1200
.Twww.FireDistrictl.org Fax (425) 551-1272
DIST -
FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
El BRIER
[I MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY
STATION& SHIFT-*'
LOCATION:
22000 Highway 99 .0-8028
11�
Ar
20-C
I
BUSINESS NAME:
.'i i
Jackson' #609
PHONE: 4257446091
SCHEDULED Feb 2014
DATE DUE
q?_ 5 7-7/ Y3 15
MAILING
LIFIRV11
ADDRESS:
3450 Commercial C(,, Meridian, 10 AA 6 C, 0
BUSINESS OWNER:
Linville, Jill
HOME PHONE:
EMERGENCY-1:
Jackson's Food Stores
HOME PHONE: 2088886061
"'CURRENT -
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
BUSINESS
S�
1:1
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OFINSPECTOR:
_S co-rr T7,- 1z pcJ r,- c
FIRE SY�TEMS:
FE 3 1 Iq
HAZARDS FOUND AN151OCATIONS / COMMUNICATIONS
2 /V Li U
1-old iovi
z///
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY
2- 2-
Westfall, John
From: Westfall, John
Sent: Wednesday, July 10, 2013 2:10 PM
To: Thornquist, Linda; Harrison, Marie; Zweber, Kevin
Subject: LP Gas Bottle Exchange at Retail
Maybe more than you wish to know, except for Kevin...
Thanks for the building department information: no permits required to install or exchange propane exchange
cabinets at retailers.
Retailer does require an operational permit that FID administers IFC 105.6. Retailer pays $40 annually for the
LPG storage permit. No fire construction permits are required due to small size of cylinders IFC 105.7.
Placement of storage cage is important in relation to building openings and exits. NFPA 58 guides where the
storage can go.
In this case of Jackson's (Shell) on 220th & Hwy 99, FID already issues a permit for fuel gas storage and
dispensing, I would add to the existing annual permit. Also in this case, Pinnacle Propane is a different
exchange service than the existing service they already have with Blue Rhino or other. All they will do is
replace Blue Rhino product storage with the Pinnacle storage so no changes required.
John J. Westfall
Fire Marshal
Fire Prevention Services
.425-771-0213 Desk
425-775-7721 Fax
425-231-3644 Mobile
FIN
1
a
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
Jacksons #609
-Ed-mo-nds Location :-- -_
22000 Highway 99
In conformity with the
-terms of the -International
Fire Code, application is
hereby made to store, use
Storage and sale of Class 1, 11, and III flammable and/or
or maintain the following
combustible liquids.
activity, storage or pro-
cesses:
c/o Jacksons Food Stores, Inc
Mailing Address:
3450 Commercial Ct
-Meridian, ID-83642.
EFD UFIR #:
57151202Z107
(for office use)
Your Signature
T
Your Name (print)
CkA v� FED
Your Title
61OL11VO�UMCAj�tAl IVIAVA3etl
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
Rec'd
Check#
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
March 7, 2011
Please verify and correct the following information:
M
WAM
Name of Company; DBA
Jacksons #609 EDMONDS RRE DEF
-1
Edmonds Location
22000 Highway 99
In conformity with the terms of
Storage and sale of Class 1, 11, and III flammable and/or
the International Fire Code,
combustible liquids.
application is hereby made to
store, use or maintain the
following activity, storage or
processes:
Mailing Address:
Jacks ns Food Stores, Inc
�'A'
3450 Commercial Ct
Meridian ID 83642
EFD UFIR #:
57151202Z107
(for office use)
Your Signature
Your Name (print)
I �C' I C.1-A
Your Title
--j
6VL-1 IAAA.)A3e--
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire Marshal POSTED
Department of Fire Prevention
121-5 th Avenue North MAR 2 2 2011
Edmonds, WA 98020
6d� - 66`10 - 00
(A
i
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT
January 1, 2011 571-512-02Z-107 December 31, 2011
Date of Issue LIFIR Number Date of Expiration
I This PERMIT is issued to: I Jacksons #609 1
I located at: 122000 Highway 99 1 Edmonds, WA I
I To engage in the business, occupation or process of: -F I
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Storage and sale of Class 1, 11, and III flammable and/or combustible liquids.
I Allowed Occupant.Load: I --
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
-EDMONDS
CITY OF
121 5TH AVENUE N. - EDMONDS, WASHINGTON 9W20 (425) 771-0215
FIRE DEPARTMENT
4j' t
way 99
LOCATION: 22000 High
13USINESS NAME: Jacksons-#609
MAILING 3450 Commercial Ct.
FIRE PREVENTION
SAFETY SURVEY
Y-2!�_7_71 '1315—
PHONE- -426i44fF894---
FREQUENCY
STATION& SHIFT
365
20 D
SCHEDULED
02/01/11
DATE DUE 1�
LIFIR i� 571 5122107
ADDRESS: Meridian 83680
BUSINESS OWNER: Jacksons Food Stores HOME PHONE: ACTIVE
EMERGENCY-1: Mosier, Gina HOME PHONE: 2089918030
KEY ACCESS-2: Linville, Jill HOMEPHONE: 2086311206
INITIAL INSPECTION DATE
PERSON CONTACTED: -n
NAME OF INSPECTOR: (N e-7
A%4�7 D�-1
FIRE LPG Sales FE,�21L/_U
SYSTEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
A10 t-fA 2'Ae_3<�'
ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
-
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
8
LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES E] NO
� 1
j FIRE DEPARTMENT COPY
j,
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION: 22000 Highway 99
FIRE PREVENTION
SAFETY SURVEY
BUSINESS NAME:
Jacksons #609
PHONE:
4257446091
MAILING
3450 Commercial Ct.
ADDRESS:
Meridian
83680
BUSINESS OWNER:
Jacksons Food Stores
HOME PHONE:
2088886061
EMERGENCY-1:
Mosier, Gina
HOME PHONE:
2089918030
KEY AbCESS72:
Linville, Jill
HOME PHONE:
2036311206
FREQUENCY
STATION 1, SHIFT
365
20 C
I
SCHEDULED
02,101110
DATE DUE 1�
UFIR 0 571
5122107
AC-nVE
f, INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: ftj 0
eslk , /-z f I
FIRE LPG Sales I FE f j_L_�
SYSTEMS: ANNUAL
I
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
AM m � omwo =�w
John A Price Texaco Relining and Marketing Inc P 0 Box 2969
Regional Manager Pacific Northwest Region 10602 NE 38th Place
Kirkland WA 98083
206 827 0761
October 25, 1993
TO WHOM IT MAY CONCERN:
Enclosed please find corrected SARA III reports. The original
reports listed two super unleaded products stored on site. All
Texaco facilities have regular, unleaded and super unleaded
gasoline products. The CAS number and all other information
remained the same.
Also, . I have enclosed MSDS information on all products, which
will give you a little more information, in case of an emergency.
if you have any questions or need additional information, I can
be contacted at (206)827-0761.
Thank you for your assistance.
Sincerely,
#'Vzk-�
Lynn A. Chun
Environmental, Health and Safety Specialist
RECEIVED
NOV 0,1t 1993
EDMONDS FIRE DEEM.
0
Building on a Tradition of Ouality
SOUND TESTING, INC.
PV.BOX-16204 SEATTLE,WAq8l16
(2b6) 932-0206
Survey Requested by
A `/ ,
1� � V, ;4
vlaisel
MARINE CHEMIST CERTIFICATE
SERIAL NK! 40851
vessei uviner or Agent
Date
Last Thrlive Cargoes
Test Method Time Survey Completed
—14(
VA -7-/( ),4/
FARM
SAW041111iArn.iiiii. ovum*: 1 rNn8TWr OT OnliMBI Or mainiptuartion Or VOIVSS Or coosure equipment tending to filter canditions In pipe lines, tanks or compairtmeonts
subject to gas accumulation, unless specifically approved in this Certificate, requires inspection and endorsement or reissue of Certificate for the spaces so
rothicted. All lines, vaints, hearting coils, valves, and similarly enclosed appurtionjances shall be considered "not safe" unless otherwise specifically
designated.
STANDARD SAFETY DESIGNATIONS
SAFE FOR WORKERS Means that in the compartment or space so designated (a) the oxygen content of the atmosphere is at least 19 5 percent by volume, and that, (b)
toxic materiaTS in t7e atmosphere are within permissible concentrations, and that, (c) the residues are not capable of producing toxic materials under existing atmospheric
conditions while maintained as directed on the Marine Chemist's Certificate
NOT SAFE FOR WORKERS Means that in the compartment or space so designated, the requirements of Safe for Workers has riot beer) met.
S 1E FOR H WORK: Means that in the compartment so designated: la) oxygen content of the atmosphere is at least 19.5 percent by volume, with the exception of
J _ _gl
ffi
in . p.Fias or where external hot work is to be performed; and that, (b) the concentration of flammable materials in the atmosphere is below 10 percent of the lower
flammable limit; and that, 10 the residues are not capable of producing a higher concentration than permitted by (b) above under existing atmospheric conditions in the
presence of fire, and while maintained as directed on the Marine Chemist's Certificate; and further, that, (d) all adjacent spaces have been cleaned sufficiently to prevent
the pread of fire, or are satisfactorily inerted, or, in the case of fuel tanks, or lube oil tanks, or engine room or fire room bilges, have been treated in accordance with the
M s
anne Chemist's requirements.
NOT SAFE FOR HOT WORK Means that in the compartment so designated, the requirements of Safe for Hot Work have riot been met
SAFE FOR REPAIR YARD ENTRY Means that the compartments and spaces of the flammable cryogenic liquid carrier so designated. (a) have been tested by sampling at
remote sampling stations, anU results Indicate the atmosphere tested to be above 19 5 percent oxygen, and less than 10 percent of the lower flammable limit, or (b) are
I nerted
CHEMIST'S ENDORSEMENT This is to certify that I have personally determined that all spaces in the foregoing I ist are in accordance with NFPA 306- 1980 Control of Gas
Hazards or) Vessels and have fuund the conditiori of each to be in accordance with its assigned desiyodtion
-The undersigned acknowledges receipt of this Certificate under Section 2 3 of NFPA 306 1,980 T1 C f aX ased un condi(ioiis existirig at ilie nine ite set
and understands conditions and limitations under which it was issued P;Stebd and is issued subject to compliance with all fflications and
Signed Signed
VESSEL POSTING
STAr
89 0
STATE OF WASHINCTON
DEPARTMENT OF ECOLOGY
Mail Stop PV-11 e Olympia, Washington 98504-8711 * (206) 459-6000
July 27, 1991 F-�RECEIVED
Ms. Robin Lane
Texaco Refining & Marketing, Inc.
P.O. Box ' 2969 LAUG 2 -1991
10602 NE 38th Place
Kirkland, WA 98003-7997
COMM
COMMUNITY DEVELOPMENT
Dear Ms. Lane:
This is to acknowledge receipt of your 30-day notice of intent to close
underground storage tank(s) located at 22000 S.W. Hwy. 99, Edmonds,
Washington.
We received your letter on July 23, 1991.
Your 30-day notice has been forwarded to the appropriate regional
office. A field person with the Underground Storage Tank Program may
visit your site within the 30-day period. However, with the many tank
closures now taking place, it will not be possible to visit every site.
You may proceed with closure thirty days from the date we received your
letter (noted above).
If you did not request a full closure packet, but would like to receive
one, you may do so by calling 1-800-826-7716 (in Washington state only)
or (206) 459-6293. This closure packet contains forms entitled "Notice
of Permanent Closure of Underground Storage Tank(s)" and "Site
Check/Site Asssessment Checklist". Please complete the forms and return
them to the Department of Ecology when tank closure is complete.
SLS: sd
Sin( erely,
She ., - lSectoion WSecretary
i Dotson
Underground Storage Tank Section
R EC E I. V.E D
AUG 0 6 14191
EDWNDS FIRE DEeL
%I
, , .-W
iiiFe—mm UNDERGROUND STORAGE TANK
M@M 30 Day Notice of Intent to Close/Decommission Tanks
Vi,;TiVy
The purpose of this form is to provide the Department of Ecology with notice of intent to close/decommission an UST. It
must be received 30 days prior to the closure activities. It must be signed and dated by either the owner/operator of the
UST to be closed or his/her authorized representative. (nis could be the firm contracted to do the work.) Ecology will
notify the identified person of the earliest date closure/decommissioning activities may commence.
For questions on completing this form please call (206) 459-6293.
hj i L
Please type or use ink. Underground Storage Tank Section G E 7AN" (S
Department of Ecology
The completed checklist should be mailed to: Mail Stop PV-1 1 JUL 2 3 1991
Olympia, WA 98504-8711
.1. TANK OWNER AND: LOCATION
UST Owner/Operator: TEXACO REFINING AND MARKETING INC
Owners Mailing Address: ()'()g N_;r—,Agth Place P.O. BOX
2969
P.O. BOX
VYWA 9 Ft 0 A -A State
ZIP -Code
Telepho ne: (206 ) 827-0761
Site ID Number (on invoice or available from Ecology if tank -is registered): 003307
Site/Business Name: TFXACO STATTnN
Site Address: 991100 R-W- 14W)Z- 99 Snohomish
Street
Courity
Edmonds, WA 98020
city State
ZIP -Code
2. TANK PERMANENT CLOSURE:TO BE PERFORMED By'(if kn&i4h)':
Firm:
Address: '71
Street
P.O. BOX
city state
ZIP -Code
Telephone: Contact Name:
3. TANK INFORMATION
p
Tank Identification Approx. Closure Date Tank Capacity Tank Age
Last Substance Stored
1 1991 (gallons) (years)
8000 1970
Unleaded
2 1991 4000 19bi
unleaded
3 1991 4000 1961
Unieade(i
1991 6000 1961
Regular
5 1991 500 1961
Used Oil
4. SIGN��TUf3E PFTANK OWNERIPPERATOR OR AUTHORIZED REPRESENTATIVE:
4� Enviromental Analyst
7/22/91
VCY MIA% Tft
Oft
5
REC IN
'-E- -E-D—
Texaco Refining and Marketing Inc P 0 Box 2969
10602 NE 38th Place
Kirkland WA 98083-2969 MAR 3 1997
2068270761 EDIVIONDS FIPF nF-P
February 27, 1997 CERTIFIED MAIL
Emergency Management Director:
Enclosed are our 1996 Tier Two Hazardous Chemical Inventory Reports as required
under Section 312 of SARA Title 111, and due March 1, 1997. This letter will serve as
notice to you that the undersigned has the authority and capacity to sign these forms on
behalf of TEXACO REFINING AND ' MARKETING INC. This letter will also certify
that the submitted information is true accurate, and complete.
If you have any questions please contact me at (206)889-3253.
Sincer I
5yr---�
TE)KCO FIFINING AND MARKETING INC
Health & Safety Coordinator
RLUMJR
u:mjr\CRTK.doc
Enclosures
RADugger-file
Es
100 Building on a Tradition of Quality
Atlanta199k
PROUD SPONSOR
C--;,,
Rev(sed Ncry/ember 1990 WASHINGTON COMITY RIGHT—TO—K04 #: WAD
I -age 1 1 POO*.
Form Appoved OMB No. 2050-W?2
0,
Texac.o..Station
I __
Hsi" Texaco Ref & MktR, Inc. a63889i3253*
I
sit" K151 =015091
Tier Two
.
MalAddro"P.O.Box 2969, Kirkland, WA 98083
cily ro
EMERGENCY
AND
HAZARDOUS
CHEMICAL
N
MISS'. UN." a
IMIM-11. 10. MO.
Min�a.
INVEMORY
='cod* Dn S &ad
N n r
$PatPhone
TIC
0 t889--3253 1206-1340�5563
24 Me. Phone -
by Chemical
.,Darrell Watbon, Maintenance., oordinator
............
Ode pleashred
Phorw Z06-4897MO 24 Mr. P (206--1,340-5589
Important: Read
i v
all Instructions before completing form Reporting Period F—Jwuary
I lo,Dawrtw3l. . . . . . . . . ......
jan
TE TrIdeM
CASI 8101016 M61 sold
X 1114
0 4
B. 1 4 Underground Storage tank
Chem. Nam. Automotive Lead -Free
sum" p4w"
at PM"um
Pad area
Gasoline
PAN"
X
1:
CAothaN 0
El M E] a] ED
"efrij:
PUN mix wid Liquid 0. eig
I X I DolyW
. . . . . .
EHS Name
. . . . . . . . . . . . . . . . . . . . . . . . .
TrIAG
CAS
Fire.
Chem. Name
Sudden FIA
d Pnmvm
Reactivity
Put* mig adw uquw am ENS
EHS Nam
Dolned (ch—b)
......... . . . . . . . . . . . . .
T16ft
CAS1. I I I T_= E 3
Fh
Chem. Name
sudd@"
d pressurg
0 El El 0 El 13
"for#,: Puri .,mix Sam Liquid Gas E113
Dsloved (ChTnial
ENS Name
50.
MW
I owftvr!dor penalty of law that I heft personally owardrod and arn WMar ofth the Information fttrnNed In pages one andthm1b"ed
an M Inquiry d time %&Advah cosponsItAs for diAsIning the Inforrnallo.% I bollem that the subrifted blonnoi
I haveaff-o' askopla"
I hove an&~ a Pal cc $110
Rob1ja-_-_L.*Lane, EH&S Coordinator 2/21/97
Date signed
I have offachad a dweerlptic)n of
d1lurs " other safeguard rneasurve
A1111k
Texaco Refining and Marketing Inc P 0 Box 2969
Pacific Northwest Region 10602 NE 38th Place
Kirkland WA 98083-2969 (,:CF. IV tu
2068279761
JAN 18 1996
'nNDS FIRE -- ---
January 17, 1995
Edmonds Fire District
250 Fifth Avenue North
Edmonds, WA 98020
Subject: SARA Section 312 Reports
Attached are Tier Two Hazardous Chemical Inventory Reports for the Texaco facilities that we
oversee in your area.
If you have any questions, please contact me at (206)889-3253.
RLUsjr
uffile\FireDist.doc
Enclosure
RADugger-SARAfile
iealth & Safety Specialist
Building on a Tradition of Quality
1 1 m.. �
Rovised November 1990 kA—(:;HING7CN C"ITY RIGff-T0-KN0W #: 1 �5'9 .5-03
0 0
Page of i pages
Fcxm Approved OIAB No. 2050-0072
- Fachily lde�tjhcatlon
:Owner/OPerst6rN.afni*::.
Tier Two
Wn. TFXACQ S ATION
..---TEXACo
REFINING MKT, INh__2G6-88)9-325
Sir"
Mail
KIRKLAND—, 98U8_5
EMERGENCY
AND
rAyact rn
HAZARDOUS
CHEMICAL
INVENTORY
sic code Dun & Brad
Emwqency Contact
ROBMI.,
LANE, ENVIRO. ''HEA�J_H & 'SAFETY
Y
Numb of
Nanne
'Phons
sjpec�hc
.
Phone (2ft s88`9-5255
24 1,4. (20b A81
Infortwtiost
by Chem4cal
FFIcIAL:
ID o
N.,.DO�ELL WAIaQN,
MAINTENANCFe.COORDINATOR*
ILI
Dalsi Recialved
Phone (206)889-3230
t206 )643 -
'4603
Important: R ad all instructions before completing form
Reporting Pwlod From January I to Disoornber 31. 1995
1.0
.014111
Chernicat.'OLascr ption
Ph sleal
al
On 0 th
i, - -:s, ..
Inve ry
Storage 6d es and L6��tl6ns
Hazards
0" ri thei mom
F.
torage
CAs 18101 0 1 Tied*
S4WX01
x
Fire
M" Daily.
3-1-
4
11NnF:Rr.Pni iNn qTQRArr: I
GASOLINE UNLEADED
Sudden Ariliss"
A �i K S
PAn
CMm. Name
of Pleasure
Reactivity
ARPA
CAwA .11
"arpity: 0 121 El M 0 El
Ininnedwe (soullail
Puts mix Solid Uquid Gas EHS
D.Iyed (.hioi.)
(do ys)
EHS Name
1
CAs181n1n1= Secret
F kne
[]NnFgGgniiNn STngAnp
114"! (*odo)
TANKS
Chem.Name GAsoi iNF UNi_FAr)ED +
Sudden PAi""
of Pressure
Relaclivily
::Ava� 0"
PAT) AREA
ChwAall
0 'El El 0 0 El
Delayed (duonlc)
Puts mix Solid L*W GM EHS
EHS Name
T,&doE2]
CASIRIninl= seast
Fins
Max. Dally
U14 -Amount
UNDERGROLJND STORAGE TANKS
Che(n.Name GiASOI TNI: S1112F:R HNi
_x
Sudden Relesise
of Plesauns
oode)
: ..
PAD AREA
I I
Roadway
A ''
MI,
El El M1 El El
_x
W. was (&"*I
.
pule Mix Solid Liquid Gail EHS
De4yed (chronc)
I'lloil
0844NYSY
(4u a)
EHSName
I I
f
C"flostion Read and 4F Wei, oe�ifis Z wtiol�q.
I owdy under Penalty of low that I have pwsonajli� exannined and sun Im"bu with the information subm"ed in pages anto through that ballad
uiry 4A those individuals responsible lot able" the' lomation. I believe that the Subrilitled information is true, accura JL'
I hisve affischad a "a plan
1'
0 / rJ L . L_,�-1,JC5 — �� V. -
UZ , ZL__� i =±
/5 Z�7 fe-,
1 he" 411A&W a Iiiat of site
in&10 ablWili"all(M
Narne and otliaal tills of "nor/operialor OR owner/operidoetlauthonred rWwdienlat" Siqn��
/ ) 96e
siqneG(
have sinached a descript ion of
dikes aind 01he, saleguard irwasu,"
CITY OF EDMONDS LARRY S. NAUGHTEN
CIVIC CENTER * EDMONDS. WA 98020 * (206) 775-2525 MAYOR
FIRE DEPARTMENT.
1 890 . 194 -
October 20, 1988
Dave's Sno-King Shell
22000 Highway 99
Edmonds, WA 98020
Dear Sir,
We are in the process of confirming that "leak detection" has
been installed on all flammable liquid dispensers in the City of
Edmonds. Please provide us with the most'durrent test results for
each pump in your system.
If it is determined that leak detection is not provided in your
system, one will be required based on the following code section:
The Uniform Fire Code, 1985 Edition, Sections 79.904(e) re-
quires that "each pump shall have installed on the discharge an
approved leak -detection device which will provide an indication
if the piping and dispensers are not essentially liquid tight".
If you have,.any questions, please call me at 775-2525, #233,
Monday through Friday.
GLM: be
Sincerely,
taGary
Fire Marshal
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
April 23, 1984
MEMO TO: Hal Reeves
Building Official
FROM: Gary L. McComas
Fire Marshal
SUBJECT: REMOVE AND REPLACE FUEL TANKS AT THE SHELL STATION
22000 HIGHWAY 99
After review, the fire department has the following require-
ments:
1. Pump out all product and inert tanks prior to re-
moval from ground.
2. Remove tanks from site the same day they are re-
moved from the ground. Used tanks shall not be
retained on site over night.
3. Installation shall comply with Article 79 of the
Uniform Fire Code.
GLM: be