12-1354 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t . !t 4 4Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 12-00001354
Property Address: 79795 HIGHWAY 111
APN: 600-020-033- -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: COMMERCIAL PARK
Application valuation: 135000
Applicant:
I hereby affirm under penalty of pe
Section 7000) of Division 3 of the
License Wass: ,A
Architect or Engineer:
rRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with
lals Code, and my License is in full force and effect.
License No.: 888712
][ Date:.__.�}�-,�, Contractor: {/�/' ./\
• \ �� OWNER -BUILDER DECLARATION
I hefaby offlrm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7D31.5, Business and Professions Code: Any city cr county that requires a permit to
wrmcupt, alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for the
permit to file a signed ststement ttint )te or she Is licanred pursuant to the provisions of the Cornfactor's State
License Law lCitapter 9 leornmencing with Saollan 70001 OF Division 3 of the Business and Professions Code) or
that he or site Jr. exempt therefrom and ilia basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant Ior a pemilt subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 ! I, as owner of tlto propefty. Or my empleyoas with wages as their Sala compertaatlort, will do the work, and
tita structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Busltxres and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or Improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit Is issued (Sec. 3097, Civ. C.)•
Lender's Name:_
Lender's Address:
LQPERMIT
Owner:
COSTCO WHOLESALE CORP
999 LAKE DRIVE
ISSAQUAH, WA 98027
Contractor:
W S K & SONS INC
34455 SUNLIGHT DR
YUCAIPA, CA 92399
(951)906-3023
Lic. No.: 888712
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/29/13
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' comps tip In ce, as required by Section 3700 of the Labor
Code, for the performance of the wor for It Y�lt Is permit Is issued. My workers' compensation
insurance carrier and policy number a :
Carrier NORGUARD INS CO Pau Nu b WSWC318899
I certify that, in the perform "' of the ark fo w loh this permit is issued, I shall not employ any
person in any manner so to e s j L a the workers' compensation laws of California,
and agree that, if I shout bowr a bj . t t a workers' compensation provisions of Section
3700 of the Labor Cod I hat for th ply with those provisions.
�IfNG
Applicant:
WARFAILURE TO SECURE WORKERS' CO PE14SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify d hold harmless the City
of La Quints, its officers, agents and employees for any act or fission 1od to the work being
performed under or following issuance of this permit. 11
2. Any permit issued as a result of this application becomes nut n voi I )grork is not commenced
within 180 days from date of issuance of such permit, or s so tion f work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a eve infor U is or t. I agree to comply with all
city and county ordinartoas and state lairs relating to buildl cone)truc vn a i eby authorize representatives
of t111s County to,ontor upon t" above-mantloned property or fine ctt n urp
pats: Signature (Applicant or Agent): L
Application Number . . . . . 12-00001354
Permit .. . . BUILDING PERMIT
Additional desc .
Permit Fee 762.00 Plan Check Fee 495.30
Issue Date Valuation 135000
Expiration Date 9/25/13
Qty Unit Charge Per Extension
BASE FEE 639.50
35.00 3.5000 THOU BLDG 100,001-500,000 122.50
----------------------------------------------------------------------------
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
ELEC-MISCELLANEOUS
27.50 Plan Check Fee . . 6.88
Valuation . . . . 0
9/25/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE
1ST 20
1.50
1.00 11.0000 EA ELEC MISC
11.00
^^ Special Notes and Comments
1500 GALLON UNDERGROUND FUEL ADDITIVE
TANK PER ENGINEERED PLANS. INCLUDES
PIPING, CONDUITS AND ASSOCIATED
ELECTRICAL INSTALLATION. ENGINEER: HAL
P. GRUBB C 67814
-
-----------------:-:------------___�----------_------------
Other Fees . . . . . . . BLDG STDS ADMIN
(SB1473)
6.00
Fee summary Charged Paid Credited
'~
Due
Permit Fee Total 789.50 .00
.00
789.50
Plan Check Total 502.18 .00
.00
502.18
Other Fee Total 6.00 .00
.00
6.00
Grand Total 1297.68 .00
.00
1297.68
LQPERMIT
-40
BCE#11453
Bin #
CBuilding
City. of-4 Quints
8C Safety Division
P.O. Box 1504,78-495 Calle Tamplco
la.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #1
�J✓✓
Project Address:79795 Highway 111
Owner's Name:.COstCo Wholesale
A. P. Number.
Address: P.O. Box 35005
Legal Descriptio
Contactor: Ut t0 1 btwbf✓ .
City, sT, zip: Seattle; Washington 98124
Telephone: (425) 313-8100
..........
Address:
Project Description: Installation of a 1,500-gallon
City, ST, Zip: \js kL Snl�t S
automated underground fuel additive storage tank
Telephone:''
": - "<.i
system, which includes minor excavation for the tank,
piping, access to the existing underground storage tank
State Lie. # :
City Lic #;
Arch., Engr., Designer, Hal P. Grubb, P.E.
sumps -,.and access to spare conduits.
Address: 18215 = 72nd Avenue South
city, ST, zip: Kent, Washington 98032
425 Telephone: //.2 `'
P () 25.1 -622� � Construction Type:. Occupan'cy:
State Lic. #: 67814 ''"
-,:.. ,....<�,.��'"� Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Alexia lnigues Sq.Ft.: NSA #Stories: NSA #Unit$: N/A
Telephone # of Contact Person: 4 2 5 . `2 5 1=6 2 2 2 Estimated Value of Project: $135,000 .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
:� �C
Item Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Perso a 4d
1
Plan Check Balance.
Title 24 Cales,
Plans picked up
Construction
Flood plain plan
Plans resubmitted_ .
Mechanical
Grading plan
tad Review, ready for correction issu
Electrical
Subcontactor List
Called Contact Person
plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
..r
Plans resubmitted
Grading
IN IIOUSE:-
'^' Review; ready for corrections/issue4Devpeloper
Impact Fee
Planning Approval
✓
7
Called Contact Person
.P.
Pub. Wks. Appr
x
Date of permit is a �j
SchoolFees
i 2>G
✓�
t i
Y
Total Permit Fees
Y
t4 444�rw
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
To: Burt Hanada, Plans Examiner, Inspection Supervisor
From: Les Johnson, Planning Director
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Building Plans Approval
To CDD:
Due Date:
Status:
The Community Development Department has reviewed the Building Plans for the
following project:
Description:
Address or general location: %'?- 711.5 OCU/CO
Applicant Contact: ``� t t.¢G A/X " a,-5-1 - & 2 2 Z
The Community Development Departmentfindsthat:
❑ ...these Building Plans do not require Community Development Department
approval.
...these Building Plans are approved by the Community Development
Department.
❑ ...these Building Plans require corrections. Please forward a copy of the attached
corrections to the applicant. When the corrections are made please return them to
the C4munity D velopment Department for review.
Les Johns , PlalmiN Director Date
received
NOV 15.2912
city of Lo 9uinta
Planning Department
� W
- - BCE# 11453
CITY OF LA QUIN A-'UBLIC WORKS DEPARTMEN— GREEN SHEE-
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERVIT-
Form updated & effective M5/2009
Green Sheet approvals are forwarded to the Building; & Safety Department directle by Public WorkE. =Please DO NCT
submit the Green Sheet (Public Works` Clearance) Packet to'the Public Works Dep.3rtmeit until'ALL"requirements listed
below are complete. Incomplete applications,or applications which cannot be processed w-Il be returned :o applicant.
Date: 2 [1 / 13 Developer: Costco Wholesale coo Alexia Inigues, Barghausen Consulting Engin sers, Inc.
Tract No.: Tract Name: Lot No.(s):
Address(s): 79-795 Highway 111 ��m5 �Gc� Phone Number. 4( 25 ) 251- S2 2 2
The following are the requirements for Public Work: Clearance to authorize issuance of a building permit fram the
Building & Safety Department:
s CUSTOM HOMES: PROVIDE ITEMS #2, #3, *4A. #5 & 97 BELOW
s• TRACT HOMES: PROVIDE ITEMS 91, #2, #S & #a EELOW
❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE IIEMIS #1, #2, #3, #5 & #7 BELOW
s WALLS, SIGNS, OTHER: PROVIDE ITEM #6 BELOW
N/A 1. Attach Pad Elevation Certificates in compliance with the approved design elevation for Ebuilcl-ne pad (rnaxirrum
all:)wable deviation of +/- 0.1 foot). Fad Elevation Certificates must be current (wfthin 6 montns of current date't.
If a precise grading plan creates the pad for approval, please withhold green sheet submittal until a Pad Elevatio
Certificate can be provided.
N/A 2. Attach geotechnical certification of grading plat compliance 'secluding compaction reports from a licensed Sails
Engineer. Recently rough graded residential developments which have a previously appmv-3d geolleehn cal
ce-tification are exempt from this requ_rement.
NSA 3. Attach recorded final map or title information/grant deed showing proposed buildinglocations ape liegal lots.
4. Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information Form, PM1) plan &
agreement or provide alternative & valid City approved PM10 plan set reterence number or hard copy plan_
PM10 plans for commercial & residential developments (beyond 1 lot) are submitted sepaisatelywith grading plans
& are subject to additional requiremen_s. A current PM10 certif cation number is req-fired.
N:!A 5. Attach a copy of the rough or precise grading plan to the Public Works Department showing bufding locafior{s)
for pad elevation verification. AO flood zone developments wiU require an approved flood plain development plan.
N/A 6. Attach supporting documentation=, for wall plan, monument sign:, grease trap or -special facility installations.
7. Complete and sign the attached water quality management plan (WQMP) exemption form, if applicable_ PW
approved building construction projects require either a WQMF or a completed WQMP exemption form.
:approved maps/plans may be viewed at the following link: http//www.ta-guinta.orq/PlanChe:ck/m searob.atspx
I have reviewed and confirmed the requreme>-its listed above as presented and find -the improvements tb be suifidertly
complete for construction of the proposed buildings/structuresrwalls/signs on the subject lor(s). Pursuant to my Indings.,
the above project may be released for building permit issuarl-e.
4h•s section completo by Ci staff.
r 3 Recommended byA 1i^ Date: Z
VV ;Public Wms Dist ' on: ( _Green Sheet to Building & Safety
( ) Green Sheet to Planning Department
Declined for approval for reason(s) as fol w(sX please oorreet and resubmit:
i
i
i
i=
T-kChacklists - Forns& Applications\Forrns & Applications\GREEN SHEET cover & PM10 lea than Ace Revised 9?5-09.doc
6
City cA La Quiinta - 10 FugitW& RY D'Ust CbrArd Project Informatiol n
i.0 itiru'ction Phase7PM10Jkg 6 fill Pr6ject) I
0 hi regiment (<1, acne/lot or_ In
Pr ecilifformation Project Contractor: JoneE Covey Gr4jp- Inc.
PrcjEct Phase
Project Namc-2 Costco Gasodne (Loc._iI`.Jo.633) Fuel AdJilvF_Projecill
(check one)
Project TractA..ot Numbers.
Cor-struction
'Demolition
s: 79-795 Highw4y 11
Project Stree� Addres--!
Total Acres in Active
Anticipated Start Date: 1 j 1 f., 13' -.2 1 /13
A.-i-iticipated Cc-n-DIetion Date:
t6nstr--._ctibq (<1 acre ppr•,
Lot): 0,05AC
PM110 COM3&-..
Please note: Dust control is requirec 24 hours a 64, :7 rclao a -week, regardless of.
1-iforrnetion s =
construction status. Person fisted below is responsible ky dust control du:-'ing business and. -
non -business hours. Z
Walter Friese-ii
;UU6:
Program Mane-ger
Company Narne:l
J o 'Covey Group, Inc. nes
Mailing Address:
9595 Lucas Winch Road, Suite 100
City, State, ZIP
Rancho Cucamonga, CA 91730
ry M
-PrimaPhone
(888) 972-7581 J
A
Fax:
i
(909) 484-0300'
24 Hour EmerEA!91CY
-1 Z -7 C
Phofie#
Cell Phone #:
q391
Email Address:
=
w friesen@jonscovey.com
IPNI1�0 Certificate #:
0, V 1 2 -:3
%
Tf E abore stated Property, owner (or authorized representa:iwe):,
ShEll,act as his-'ffe-r- acknowledgerneft of dust contild, re'4uxerwants a -id their e4orc-eability, piirsuant to SCACIVID
Rul �s 403, 4031. 4.01, 402, 201, 203 and PIERP-
JiEW!constitute an Agreement to comply with all p�6j6ct coi-Iditoris as'iclentified --n' the apWoved dust control plan.
:�hr-,:)wledges let' -dust control is required tv:enty-our i24) tbu'ri�a day, seve6-(7) days a week throughout the
pariod of projec! ee!�Iormance, regard'.ess of p-,oject size or staius;
+ Shall -ensure that; each ,and every sort -actor, subccfftradd..-,arcs al 6fier perso-n2s c-Bisxia_ecl with the project shall
.
be n-i continuous '
with all requirements ce he a�prjy6d- d ua�t control pl'ar,; E
4- i3hcWtake all nek'awary precautions --c, minimize &st, 44e_if 'addticlial measures beyon-�J th6se listed in the dust
cornr4l.plan are neoessary;
❖ S h.c 11 :authorize, pbesentatives of Cit�.,Countyto erjer tl•e properti for inspkti-xi and.;or aa'bateme-1 purposes;.
❖ Small holcl harrrlessthe City/County amcl its reores&itatives fr&m h'abifty for aw ac:16ns rElatea to -this dust co--itrol
pan or any CityWC:Dunty initiated abatement acitivitiE
J d
Ll
/Signature of Pro perty Owner uthr!zed Represe�ntari Dat4, D'
T:\Ci-ckfists- =orris 3 ApplicationsTcrrm &Applicabons\GREEN SHEET -cover & PMIQ less tli�m -Acre Re fised.i-25-W.doc
COSIC0.
-'-'ESCLE
December 16, 2011
RE: Agent Authorization for Barghausen Consulting Engineers, Inc.
Costco Fuel Additive Program
Costco Gasoline
To Whom It May Concern:
Costco Wholesale Corporation hereby. authorizes Barghausen Consulting Engineers, Inc. and their
designated personnel under their employment to act on our behalf for the purposes of processing all
land use entitlement and development permit related documents where Costco Wholesale Corporation
is the legal property owner of record in any district within the United States and Canada. Work may also
include representation at entitlement hearings or planning meetings for design review and similar
services.
Please call me at (425) 313-8100 should you have any questions on this matter.
Respectfully,
VP-40
David H Rogers
Real Estate Deb
NOTARY
On this day of December, 2011, before me; the undersigned, a Notary Public in. and for the State
of Washington, duly commissioned and sworn personally appeared RPNV IW- eV6e8 known to
me to be the duly authorized representative of Costco Wholesale, the corporation that executed the
foregoing instrument, and acknowledged said instrument to be the free and voluntary act and deed of
said corporation, for the purposes therein mentioned, and on oath stated that he was authorized to
execute said instrument. WITNESS my hand and official seal: hereto affixed the day and year in the
certificate above written.
[J7EENNIFER I SIPADAFORA
( gnature) NOTARY PUBLIC,
STATE OF WASHINGTON
d M11&Ji' j �nn a COMMISSION EXPIREt
c NOVEAM9tR 19. 2013
(Printed Name)
NOTARY PUBLIC in and for the State of Washington residing at 1&ca-k wjq
My commission expires:
999 Lake Drive -• Issaquah, WA 98027 • 4251313-8100 • www.costco.com
SCOPE OF WORK
Costco Gasoline -Fuel Additive Program
Costco Wholesale is seeking a permit to install a 1,500-gallon underground fuel additive storage tank at
their existing Costco Gasoline fueling facility. The purpose of the underground tank is for the storage and
dispensing of a proprietary fuel additive into the gasoline product.
The fuel additive is a Class I-C flammable liquid. The fuel additive is a fuel enhancement to improve fuel
efficiency and engine performance. Most retail gasoline includes additives that have solvent/lubricant
mixture compositions that are unique to that particular brand. While the mixture is proprietary it is similar
to the additives used by other petroleum companies. This product meets the requirements of the U.S.
Environmental Protection Agency (EPA) and California Air Resources Board (CARB) for additives.
The 1,500-gallon tank is of double -wall fiberglass construction with double wall monitored fiberglass
containment sump. Delivery of this product to the site will occur via delivery tanker trucks. From the
delivery tanker truck the additive is transferred to the underground storage tank by positive pressure
operation through flex piping and tight fill connection.
Before gasoline is brought to the site and delivered into the existing underground gasoline storage tanks
(UGST) the "Costco Gasoline" attendant will program the new batch controller panel in the controller
enclosure to inject a pre -determined amount of additive into the fill riser of each individual gasoline tank
(e.g., 3.5 gallons of the liquid additive into Tank #1, etc.). Once the additive is in the UGSTs, the gasoline
product is then delivered into the tanks resulting in the combined additive -gasoline mixture.
The specific scope of the work to be performed as part of the underground installation is as follows:
• Install one (1) 1,500-gallon double -wall fiberglass underground tank for Class I-C liquid.
• Replace existing tank manway lids at each existing gasoline fill sump to include additional bungs.
• Install 2" double -wall fiberglass product manifold line from new 1,500-gallon additive tank, to the
existing gasoline fill containment sumps and 2" double -wall fiberglass vent line from new
1,500-gallon additive tank, to the new vent stack location. New piping interstitial space is to be
continuously monitored with vacuum.
• Install new concrete slab over new underground tank.
• Install fill/spill containment assembly and fittings on new underground additive tank, along with
new Veeder-Root electronic annular sensor and automatic tank level gauge, and program for high
level alarm.
• Install "Flow Dynamics" Batch controller panel in the existing controller enclosure.
• Install a flow meter at the new 1,500-gallon additive tank turbine's discharge.
• Install one (1) new 24-volt solenoid valve at each existing gasoline fill sump.
• Install one (1) conduit and wiring for electrical power to solenoid valves at existing gasoline fill
sumps. Install one (1) conduit with power wiring to new 1,500-gallon additive tank for turbine
pump power. Install one (1) new conduit and data wiring to new 1,500-gallon additive tank for flow
meter sensor. Install one (1) conduit and wiring to 1,500-gallon tank for annular monitoring and
automatic tank gauge. New conduits to be equipped with seal -offs at hazardous zones.
• Install new double wall vent transition sump with Veeder-Root sensor at lowest point.
• Adjust landscaping and restore as required (when applicable). 0 V E
• Patch and repair asphalt as may be required.
F7RN09V 1 5 20.12
CA
Lubrizol
00
Material Safety Data Sheet
LUBRIZOLO 9888
Prepared according to 29CFR 1910.1200.
1
Chemical Product and Company Identification
The Lubrizol Corporation
29400 Lakeland Boulevard
Wickliffe, Ohio 44092
%�8 ziivrf
Tel. (440) 943-4200
N0ilon8lSN09 M04
Product Trade Name
CAS Number
LUBRIZOLD 9888
Not applicable for mixtures.
(13/ \ O a d�yd V
Synonyms
None. i
'1d3Q U3�dS T 0N1C 11n8
Generic Chemical Name
Mixture. I
` IN I n o ` i �O "w
v v J
Product Type
Multipurpose.
Preparation/Revision Date
29 July 2011
Transportation Emergency Phone
FOR TRANSPORT EMERGENCY call CHEMTREC: (+1) 703-527-3887 (outside the U.S.), 1-800-424-9300 (iri the
No.
U.S.)
MSDS No.
31037240-3427457-0017111-102103
2
Hazards Identification
Appearance Clear liquid.
Odor Aromatic hydrocarbon
Principal Hazards Danger. 0 V
. Flammable liquid. may create a flash fire hazard. D
• Harmful ifinhaled.
• Causes skin irritation.
• Causes respiratory tract irritation. N O V 1 5 2012
• May be harmful if absorbed through skin.
o May cause eye irritation.
• Contains components which may cause cancer.
• May cause chronic health effects.
Target Organs: Blood Central nervous system Heart Kidney Liver
See Section 11 for complete health hazard information.
3 Composition/Information on Ingredients
Hazardous Ingredients
JUNNELCiMp
ylene
#CAS No.
1330-20-7
Percentage (by nt.)
38%
Carcinogen
N/E
Ethyl benzene
100-41-4
9.5%
IARC Suspect Carcinogen
Petroleum naphtha
64742-94-5 .
From 1 to 4.9 percent
N/E
Polyether amine
Confidential.
From 1 to 4.9 percent
N/E
Naphthalene
91-20-3
0.5%
IARC Suspect Carcinogen NTP Carcinogen
Toluene
108-88-3 1
From 0.1 to 0.9 percent
N/E
(N/E) - None established
14 I First Aid Measures
Eyes Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. If eye
irritation persists, get medical attention.
Skin Immediately remove all contaminated clothing. Rinse skin with water / shower. Remove contaminated clothing. If skin' `
irritation occurs, get medical attention. Launder contaminated clothing before reuse.
Inhalation Remove victim to fresh air and keep at rest in a position comfortable for breathing. If breathing is labored, administer oxygen.
If breathing has stopped, apply artificial respiration. Call a poison center or doctor.
Oral DO NOT INDUCE VOMITING. Get immediate medical attention. Never give anything by mouth to a person who is losing
consciousness, unconscious or convulsing. Call a poison center or doctor if exposed or you feel unwell.
Additional Information If exposed or concerned: Get medical attention.
Page 1 / 6
5 Fire Fighting Measures
Flash Point 32 °C, 89.6 °F PMCC (Typical)
Extinguishing Media. CO2, dry chemical, or foam. Water can be used to cool and protect exposed material.
r
Firefighting Procedures Recommend wearing self-contained breathing apparatus. Water may cause splattering.
Unusual Fire & Explosion Hazards Toxic fumes, gases or vapors may evolve on burning. Vapors may be heavier than air and may travel along the ground to a
distant ignition source and flash back. Container may rupture on heating. See section 10 for additional information.
6 Accidental Release Measures
•S�p Yes--- - May form explosive mixtures with air. Immediately evacuate all personnel from danger area. Personal Protective Equipment
must be wom, see Personal Protection Section for PPE recommendations. Take precautions to avoid release to the
environment. Eliminate all sources of heat, sparks pilot lights, static electricity and open flames. Ventilate spill area. Prevent
i LA 4 nC j�entry into sewers and waterways, dispose of in accordance with all federal, state and local environmental regulation. Pick up
tom comfree liquid for recycle and/or disposal if can be accomplished safely with explosion proof equipment Residual liquid can be
bB 0 /� � E absorbed on inert material. Check under Transportation and Labeling (DOT/CERCLA) and Other Regulatory Information
WyTl_EjASection (SARA) for hazardous substances to determine regulatory reporting requirements for spills.
7 9=. (31 1 Handling and Storage
Pumping Temperature Not determined.
Maximum Handling Temperature Not determined.
Handling Procedures Keep away from ignition sources such as heat, sparks and open flame. No smoking. Keep containers closed when not in
use. Do not discharge into drains or the environment, dispose to an authorized waste collection point. Use appropriate
containment to avoid environmental contamination. Avoid breathing dust, fume, gas, mist, vapors or spray. Ground / bond
container and receiving equipment. Use explosion -proof equipment. Take precautionary measures against static discharge.
Use only non -sparking tools. Use only outdoors or in a well -ventilated area Wash thoroughly after handling. Launder
contaminated clothing before reuse. Empty containers retain material residue. Do not cut, weld, braze, solder, drill, grind or
expose containers to heat, flame, spark or other sources of ignition. Dispose of packaging or containers in accordance with
s! n �-
----- —local; regional; national and intemational regulations.
cm
Maximum Storage Temperature =j I Not determined
k, �u ! 1
Storage Pro +edures' Do not storvnear potential sources of ignition. Isolated outside storage is preferred. Inside storage area should be in a
p
flammable liquidseabinet or storage area. Take precautions to avoid release to the environment. Store in a well -ventilated
t place. Keep cool: Keep container tightly closed: See section 10 for incompatible materials.
Maximum Loading Temperature Not detemrined. ,
8 `;' Exposure Controls/Personal Protection
Exposure Limits
----
Exposure Guidelines — - — --
OSHA
•ACGUi
'Other
. Comp
TWA
STEL
TWA
STEL
_ TWA
_ STEL
Xylene
100 ppm
N/E
100 ppm
150 ppm
N/E
N/E
Ethyl benzene
100 ppm
N/E
100 ppm
125 ppm
N/E
N/E
Petroleum naphtha
N/E
N/E
N/E
N/E
100 ppm (1)
N/E
Naphthalene
10 ppm
N/E
10 ppm (s)
15 ppm
N/E
N/E
Toluene
1 200 ppm
300 ppm (c)
20 ppm
I N/E
N/E
N/E
(s) -Skin exposure
(p) - Proposed limit
(c) - Ceiling exposure
(l) - Recommended exposure limit
(u) - Supplier recommended exposure
limit
(N/E) - None established
Other Exposure Limits
None known.
Engineering Controls
Use local exhaust ventilation to control mists or vapors. Additional ventilation or exhaust may be required to maintain air
concentrations below recommended exposure limits. Use explosion proof equipment.
Gloves Procedures
Viton. Teflon. Polyvinyl alcohol. Note: polyvinyl alcohol gloves are water soluble and should not be used when there is
potential for water contact.
Eye Protection
Safety glasses. If potential for splash or mist exists, wear chemical goggles or faceshield ,
Respiratory Protection
Use NIOSH/lvlSHA approved full face respirator with a combination organic vapor and high efficiency filter cartridge if the
recommended exposure limit is exceeded. Use self-contained breathing apparatus for entry into confined space, for other
poorly ventilated areas and for large spill clean-up sites. Consult with an industrial hygienist to determine the appropriate
respiratory protection for your specific use of this material. A respiratory protection program compliant with all applicable
regulations must be followed whenever workplace conditions require the use of a respirator.
Clothing Recommendation
Gloves, coveralls, apron, boots as necessary to minimize contact.` Wear a chemically protective apron when contact with
material may occur. Do not wear rings, watches or similar apparel that could entrap the material and cause a skin reaction.
Launder contaminated clothing before reuse.
Page 2 / 6
0
9 Physical and Chemical Properties
Flash Point
32 °C, 89.6 °F PMCC (Typical)
Upper Flammable Limit
Not determined.
Lower Flammable Limit
Not determined.
Autoignition Point
Not determined.
Explosion Data
Material does not have explosive properties in the liquid state, but vapors may form explosive mixtures with air.
Vapor Pressure
0.02503 psi (Cale) (0 °C)
0.03367 psi (Cale) (4 °C)
0.0886 psi (Calc) (20 °C)
0.23811 psi (Cale) (38 °C)
1.46259 psi (Calc) (77 °C)
pH
Not determined.
Specific Gravity
0.9 (15.6 °C)
Bulk Density
Not determined.
Water Solubility
Insoluble.
Percent Solid
Not determined. r
Percent Volatile
Not determined.
Volatile Organic Compound
— 53.7%
Vapor Density
Not determined.
Evaporation Rate
Not determined.
Odor
Aromatic hydrocarbon
Appearance
Clear liquid.
Viscosity
23 Centistokes (0 °C)
10 Centistokes (25 °C)
7 Centistokes (40 °C)
Odor Threshold
Not determined.
Boiling Point
137 °C, 278.6 °F(hutial)
Pour Point Temperature
< -40 °C, < -40 °F
Melting / Freezing Point
Not determined.
The above data are typical values and do not constitute a specification. Vapor pressure data are calculated
unless otherwise noted
10
Stability and Reactivity
Stability
Material is normally stable at moderately elevated temperatures and pressures.
Decomposition Temperature
Not determined.
Incompatibility
Strong oxidizing agents.
Polymerization
Will not occur.
Thermal Decomposition
Smoke, carbon monoxide, carbon dioxide, aldehydes and other products of incomplete combustion. Nitrogen oxides.
Conditions to Avoid
Not determined.
11 Toxicological Information
— ACUTE EXPOSURE —
Eye Irritation
Weak to moderate eye irritant. Does not meet EU R36 criteria. Based on data from similar materials.
Skin Irritation
Skin irritant. Based on data from similar materials. Prolonged or repeated skin contact as from clothing wet with material may
cause dermatitis. Symptoms may include redness, edema, drying, and cracking of the skin.
Respiratory Irritation
Nose, throat and lung irritant. Based on data from components or similar materials. Exposure to a high concentration of
vapor or mist is irritating to the respiratory tract.
Dermal Toxicity
The LD50 in rabbits is > 2000 mg/Kg. Based on data from components or similar materials. Components of this material
may be absorbed through the skin.
Inhalation Toxicity
The LC50 (1 hr.) in rats for vapors of this material is > 200 mg/I. Based on data from components or similar materials. High
concentrations may cause headaches, dizziness, fatigue, nausea, vomiting, drowsiness, stupor, other central nervous system
effects leading to visual impairment, respiratory failure, unconsciousness and death.
Oral Toxicity
The LD50 in rats is 2000 — 5000 mg/Kg. Based on data from components or similar materials. The oral LD50 (rat) of
xylene is 3.5 g/kg.
Dermal Sensitization
No data available to indicate product or components may be a skin sensitizer.
Inhalation Sensitization
No data available to indicate product or components may be respiratory sensitizers.
— CHRONIC EXPOSURE —
Chronic Toxicity Repeated overexposure to petroleum naphtha can cause nervous system damage. Xylene has been found to cause cardiac,
liver and kidney effects, anemia and eye damage in laboratory animals. Prolonged and repeated inhalation of hydrocarbon
Page 3 / 6
solvents such as xylene can cause chronic neurological disturbances. Chronic exposure to xylene has been shown to cause
hearing loss in experimental animals and is synergistically enhanced when xylene is combined with n-hexane.
Carcinogenicity
A two-year National Toxicology Program (NTP) study found an increased incidence of tumors of the nose in rats exposed
to naphthalene by inhalation. In mice similarly exposed, increased incidences of alveolar/bronchiolar adenomas were
observed. Naphthalene has been classified by the International Agency for Research on Cancer (IARC) as a possible human
carcinogen (Group 2B) on the basis of sufficient evidence of carcinogenicity in experimental animals but inadequate evidence
in exposed humans. A National Toxicology Program (NTP) study found an increased incidence of renal tubule neoplasms in
male and female rats exposed to ethylbenzene by inhalation for two years. In male and female mice similarly exposed,
increased incidences of alveolar/bronchiolar neoplasms, and hepatocellular neoplasms, respectively, were observed.
Ethylbenzene has been classified by IARC as a possible human carcinogen (Group 2B) on the basis of sufficient evidence of
carcinogenicity in experimental animals but inadequate evidence in exposed humans.
Mutagenicity
No data available to indicate product or any components present at greater than 0.1 % are mutagenic or genotoxic.
Reproductive Toxicity
No data available to indicate either product or components present at greater than 0.1 % that may cause reproductive
toxicity.
Teratogenicity
Xylene is fetotoxic in rats and rabbits in the absence of maternal toxicity. Prolonged and repeated exposure of pregnant
animals to toluene by inhalation has been reported to cause adverse fetal developmental effects.
— ADDITIONAL INFORMATION —
Other No other health hazards known.
12 Ecological Information
— ENVIRONMENTAL TOXICITY —
Freshwater Fish Toxicity
The acute LC50 is 1 - 10 mg/L based on component data.
Freshwater Invertebrates Toxicity
The acute EC50 is 1 - 10 mg/L based on component data..
Algal Inhibition
The acute EC50 is 1 - 10 mg/L based on component data.
Saltwater Fish Toxicity
Not determined.
Saltwater Invertebrates Toxicity
Not determined.
Bacteria Toxicity
Not determined.
Miscellaneous Toxicity
Not determined.
— ENVIRONMENTAL FATE —
Biodegradation
At least 25% of the components in this product show moderate biodegradation based on OECD 302-type test data.
Bioaccumulation
1 - 10°/u of the components potentially bioconcentrate, based on octanol/water coefficients.
Soil Mobility
Not determined.
13 Disposal Considerations
Waste Disposal This material, if discarded, is a hazardous waste under RCRA Regulation 40 CFR 261. Material, if discarded, is expected to
be hazardous waste under RCRA due to ignitability (D001). 0.005% Benzene, CAS no. 71-43-2, D018. Treatment,
storage, transportation, and disposal must be in accordance with applicable Federal, State/Provincial, and Local regulations.
14 Transport Information
ICAO/IATA I
ICAO/IATA II
IMDG
IMDG EMS Fire
IMDG EMS Spill
IMDG MFAG
MARPOL Annex II
USCG Compatibility
U.S. DOT Bulk
DOT NAERG
U.S. DOT (Intermediate)
U.S. DOT Intermediate NAERG
U.S. DOT Non -Bulk
U.S. DOT Non -Bulk NAERG
Canada
Mexico
Bulk Quantity
Intermediate Quantity
Non -Bulk Quantity
UN 1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) , 3 , III
UN 1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) , 3 III, Marine Pollutant (Petroleum naphtha)
UN1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) , 3, M , Marine Pollutant (Petroleum naphtha)
F-E
S-E
'Subsection 4.2
Not determined.
Not determined.
UN 1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) 3, ID, Marine Pollutant (Petroleum naphtha), RQ
(Ethylbenzene, Xylene)
128
UN1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) 3, III, Marine Pollutant (Petroleum naphtha), RQ
(Ethylbenzene, Xylene)
128
UN1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) 3, III, RQ (Xylene)
128
UN1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene), 3 ,III, Marine Pollutant (Petroleum naphtha)
UN 1993 Flammable liquid, n.o.s. (Petroleum naphtha, Xylene) , 3, III , Marine Pollutant (Petroleum naphtha)
85000 KG, 187391 lbs.
11000 KG, 24251 lbs.
400 KG, 882 lbs.
l;
Page 4 / 6
LUBRIZOL® 9888
^
Review classification requirements before shipping materials at elevated temperatures.
15
Regulatory Information
- Global Chemical Inventories - '
USA
All components of this material are on the US TSCA Inventory or are exempt.
Other TSCA Reg.
e'
Section 8D (Benzene, ethyl-).
EU
All components are in compliance with the EC Seventh amendment Directive 92 /32/EEC. ,
Japan
This product requires notification in Japan.
Australia
All components are in compliance with chemical notification requirements in Australia. "
New Zealand
May require notification before sale under New Zealand regulations.
Canada
All components are in compliance with the Canadian Environmental Protection Act and are present on the Domestic
Substances List.
Switzerland
All components are in compliance with the Environmentally Hazardous Substances Ordinance in Switzerland.
Korea
All components are in compliance in Korea.
Philippines
All components are in compliance with the Philippines Toxic Substances and Hazardous and Nuclear Wastes Control Act of
1990 (R.A. 6969).
China
This product maybe imported to China only by Lubrizol China. •.
Taiwan All components of this product are listed on the Taiwan inventory.
- Other U.S. Federal Regulations -
SARA Ext. Haz. Subst. This product does not contain greater than 1.0% of any chemical substance on the SARA Extremely Hazardous Substances
list
SARA Section 313 38% Xylene (mixed isomers), CAS no. 1330-20-7; 9.5% Ethylbenzene, CAS no. 100-41-4; 0.5% Naphthalene, CAS no.
91-20-3 +
SARA 311 Classifications
CERCLA Hazardous Substances
Acute Hazard
Yes
Chronic Hazard
Yes
Fire Hazard
Yes
Reactivity Hazard
No
Transit Reportable Quantities
-
Component
Reportable Quantity RQ
Units
Reportable Quantity RQ
119
,Units
KG
Xylene
263
lbs.
Ethylbenzene
10558
lbs.
4789
KG
Naphthalene
20704
lbs.
9391
KG
- State Regulations -
Cal. Prop. 65
This product contains the following chemical(s) known to the state of California to cause cancer and/or birth defects:* 0.005%
Benzene, CAS no. 71-43-2 0.377% Toluene, CAS no. 108-88-3 0.483% Naphthalene, CAS no. 91-20-3 9.5% Ethyl
benzene, CAS no. 100-41-4
- Product Registrations -
U.S. Fuel Registration
This fuel additive is registered in the United States.
Finnish Registration Number
Not Registered
Swedish Registration Number
Not Registered a t
Norwegian Registration Number
Not Registered
Danish Registration Number
Not Registered "
Swiss Registration Number
Not Registered
Italian Registration Number
Not Registered
- Other / International -
Miscellaneous Regulatory ' Not determined.
Information
16 Other Information
"
US NFPA Codes fHealth Fire Reactivity p S ecial
- ,
2 1 3 1 0 - - - N/E
(N/E) - None established
HMIS Codes 17 - -- --..—r ----- *0- jty
Health Fire ' � Reactivity .
2* 3 --- 0 -
Page 5 / 6
Precautionary Labels Danger.
. Flammable liquid. may create a flash fire hazard
. Harrrrfirl if inhaled
. Causes skin irritation.
. Causes respiratory tract irritation.
. May be harmful if absorbed through skin.
. May cause eye irritation.
. Contains components which may cause cancer.
. May cause chronic health effects.
Revision Indicators Section: 3 Hazardous ingredients.
Section: 4 Oral first aid.
Section: 8 Hazardous ingredients.
Section: 14 UADG Code shipping description.
Section: 15 EU EINECS.
Section: 15 Other TSCA regulations.
Section: 15 Taiwan -
Changed: 26 February 2011
Changed: 26 February 2011
Changed: 26 February 2011
Changed: 29 July 2011
Changed: 1 December 2010
Changed: 29 July 2011
Changed: 29 July 2011
As the conditions or methods of use are beyond our control, we do not assume any responsibility and expressly disclaim any liabilityfor any use of this product. lnformation
contained herein is believed to be true and accurate but all statements or suggestions are made without warranty, expressed or implied, regarding accuracy of the information, the
hazards connected with the use of the material or the results to be obtained from the use thereof. Compliance with all applicable federal, state, and local regulations remains the
responsibility of the user.
Page 6 / 6
ITEM #85 & #86
VEEDER-ROOT
January 30, 2006 MSR 01-06-C
2 to 1 Sensor Input Box Sensor Kits and 4
Probe / 4 Liquid Sensor Interface Modules
3.19 1.22
[81mm] REF [49mm] RE
Q��01
tTD9 RN=2mmM1lf941!
� '9�mtiCealiT'
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
O
.� .e..� FOR CONSTRUCTION
- -
O CR08E/LIOt11D SfIKOR INIER�ACE NODUIE O DATEBY
1.0 Purpose
This Marketing Sales Release (MSR) announces the availability of two new
solutions for ISD systems that have TLS input constraints:
• Sensor kits that utilize the 2 to 1 Sensor Input Box for wiring two sensors into
one input
• The 4 Probe / 4 Liquid Sensor Interface Module
2.0 Product Description and Overview
With Veeder-Root's ISD Executive Order and mandatory ISD and AB2481
implementation in California, many sites have had to make sacrifices when it
comes to maximizing the number of zones protected by Veeder-Root's
Secondary Containment Vacuum System due to the numb
.required. �C
D
NOV 1 5 2012
MSR 01-6-C
ITEM #85 & #86
In those few cases where the site has a large number of dispenser pan and tank
sumps, customers can now reduce the number of interstitial sensor inputs by
utilizing one of the two sensor kits that allow for two sensors to be wired into one
TLS input on the Interstitial/Liquid Interface Module (P/N 329358-001) via the 2 to
1 Sensor Input Box output cable.
The two kits are as follows:
Hydrostatic Dispenser Pan/Sump Sensor Kit (P/N 330020-536)
Consisting of:
One (1) Mini -hydrostatic sensor (P/N 794380-304)
One (1) Dispenser Pan/Sump Sensor (P/N 794380-208)
One (1) 2 to 1 Sensor Input Box
And
Position Sensitive Hydrostatic Dispenser Pan Kit (P/N 330020-537)
Consisting of:
One (1) Mini -hydrostatic sensor (P/N 794380-304)
One (1) Position Sensitive Sensor (P/N 794380-323)
One (1) 2 to 1 Sensor Input Box
s!`Aseeond option for ISD systems with input constrains, is the 4 Probe / 4 Liquid
T:3 rj YT!§Pnsor:Interface Module. This module has inputs for up to four (4) Probes and
r,, -.Nfour i(4),Series 7943 Liquid Sensors. This module enables the customer to not
{ ` • T, have,to�-purchase anladditional Interstitial Sensor module in the case that
T4� � d M1 4-; / 1 JRY I , av a
aj �dltlonal slots are unavailable.
�_:_.. __ 3.0_---Alarm-Notification for 2 to 1 Combo Box Kits
Sensor Condition
TLS350 Displays
Dispenser Pan Sensor Alarm
FUEL ALARM
Mini -Hydrostatic Alarm
LOW LIQUID ALARM
Both Sensors Alarm
FUEL ALARM
Missing Sensors or Position Sensitive
Sensor out of position
SENSOR OUT ALARM
Conditions Normal
SENSOR NORMAL
4.0 Launch Schedule
As of the date of this MSR, these kits and interface module are available for sale
into California with ISD systems.
ITEM #85 & #86
5.0 Product Nomenclature & System Requirements
The following table contains product description (capacity), part numbers as well
as list price for the new kits.
Part Description
Part Number
List Price
Hydrostatic Dispenser Pan/Sump Sensor Kit
Consists of:
One (1) Mini -hydrostatic sensor
330020-536
$605.00
One (1) Dispenser Pan/Sump Sensor
One 1 2 to 1 Sensor Input Box
Position Sensitive Hydrostatic Dispenser Pan Kit
Consists of:
One (1) Mini -hydrostatic sensor
330020-537
$710.00
One (1)Position Sensitive Sensor
Replacement 2 to 1 Sensor Input Box
857390-102
$450.00
Probe Liquid ensor Intefface o u e
-
The above kits are compatible with the TLS-350 series (excluding TLS-350J ,
EMC J and Red Jacket ProMax), EMC Enhanced and EMC with BIR consoles
with an ISD SEM (330160-004 / 330160-104) and version 26B Software or
greater.
The 2 to 1 Sensor Input Box interfaces with the Eight (8) Input Interstitial/Liquid
Interface Module (P/N 329358-001). A maximum of eight (8) 2 to 1 Sensor Input
Boxes can be wired into one Interstitial/Interface Module.
6.0 Application Assistance
For further information, or for application assistance, contact:
Veeder-Root Company
Customer Service
PO Box 1673
6th Ave, at Burns Crossing
Altoona, PA 16603
Tel: 1-800-873-3313
Fax: 1-800-234-5350
Other Contact Information:
Veeder-Root Company, Simsbury, CT U.S.A.
Veeder-Root Company, EMEA (Corp. Office/Italy)
Veeder-Root Company, France
Veeder-Root Company, GMBH
Veeder-Root Europe, Middle East and Africa
1-860-651-2700
39-055-30941
33-(0) 1 4879 5599
49-716-390-9400
39-055-30941
MSR 01-6-C