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17831 59th Ave Ne_BLD3457_2026
OPERATING PERMIT APPLICATION Department of Community& Economic Development City of Arlington-18204 59th Ave NE-Arlington,WA 98223-Phone(360)403-3551 Part I Applicant/Building Information 11 [ Applicant's Name: .r line , 4,> /I Applicant's Address: 3 q-1F Ao; e /Ve W Contact Person:QLV tj-d;u A Telephone: Address of Premises for which Operating Permit is requested: Same as above ❑ Other(specify): Tax Parcel ID#: Current Occupancy Class: Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s) of Operating Permit(s)requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403- 3551.) ❑ Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in the Fire Code(see Appendix A.) Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled(attach additional sheets if necessary): Revised 4/l/08 Page 1 of 4 Part H(cont'd) ❑ Conducting a hazardous process or activity, including,but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fiuit and crop ripening,waste handling, spray operations, and high-piled storage (see Appendix B.)Describe the process(es) or activity(ies)to be conducted(attach additional sheets if necessary): ❑ Use of pyrotechnic devices in assembly occupancies (see Appendix C.)Describe the devices to be used and type of event(attach additional sheets if necessary): VAboveground Storage Tank(AST)(see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service Permanent tank closure Brief description: M S+,4(l4T,'OA _ no ❑ Underground Storage Tank(UST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Temporary Membrane Structures, including tents and canopies (see Appendix E.) Brief description of structure and use: Cc: Fire Department Page 2 of 4 Part II(cont'd) ❑ Special Event Operating Permit-An Operating Permit is required for any special event that takes place within an occupied building,or an outdoor mass gathering,which is outside the scope of the permitted use(see Appendix F.)Brief description of type of gathering proposed: Part Ill Premises/Building Information 1. Date of last inspection of Premises: 2. Has a Certificate of Occupancy been issued for the premises? Z Yes ❑No Type:9 Permanent ❑ Temporary Date of Issuance: 3. Are there currently any open Building Permits associated with the premises? ❑ Yes XLNo If yes,please describe (attach additional sheets if necessary): 4. Additional Comments: SIGNATURE OF APPLICANT I herby certify that the foregoing information(and all information in attached sheets, if any) is true and complete. 1-10Z Ito Ik �U_ Y-/�- 1 Signature of AplMicant 4 Authorized Representatives Signature Date Name ana Title (if plicable) of person signing Application(Please print) Cc: Fire Department Page 3 of 4 - ° Above Ground Storage Tank Application Community and Economic Development Department City of Arlington • 18204 59th Ave NE • Arlington,WA 98223 • 360-403-3551 1. AST FACILITY 11. OWNER/OPERATOR INFORMATION Facility Compliance Tag#: Owner/Operator Name: SC AST ID#: 315o g Business Name: Site Name: Address: Ij i G1 Xe- (VE 1300 .-4- Site Address: ( ;3 r �C�-k-� e �City: w +6" State: Wft Zip: lem City: V � c 2 2 Phone: 3� q q Phone: S �, `� �' Email: l'KQ, (s,�,rncJ7�'S 111. CERTIFIED SITE O. Service Provider Name: jq�0 Scj-Arn�CLAI Company Name:as Cell Phone: ZUIo-51 3SEmail:�ycro�ry���h,�c-r,Si Address: 3��jUve Certification#:NL PCjAUL-03C} Exp.Date: S Z 12 I City: (Z VV, &6L( k State:GA Zip: 90�0(5 T DATE SITE CHECK ORANK ID TANK CAPACITY LAST SUBSTANCE STORED ASSESSMENT CONDUCTED V. REASON O, ASSESSMENT(check one) New tank location ❑ Increased Tank ❑ Other(describe): V11. REQUIRED SIGNATURE Signature acknowledges the Site Check or Site Assessment complies with UST regulations WAC 173-36OA-0730 through 0750. Print or Type Name Signature of Certified Site Assessor Date COA(Revision September 2020) It FIRE LINE Employee SOP Protocol for High M Alarm Plants require carbon dioxide (CO2) to conduct photosynthesis. The atmospheres of greenhouses may (if of large size, must) be enriched with additional CO2 to sustain and increase the rate of plant growth. Any area or room where CO2 gas is discharged or generated shall be provided with a control system that utilizes CO2 sensor(s) and limits the CO2 levels to a maximum of 5,000 parts per million (ppm.) as an 8-hour time-weighted average (TWA) concentration, set by current OSHA standards. Any room or area within a building where CO2 is stored or where CO2 gas is discharged shall be provided with a CO2 alarm system, alerting employees with siren sound and strobe light combination. The alarm system shall consist of continuous gas detection that activates a local alarm within the room or area and on the outside of the entrance to each area when CO2 accumulations reach 5,000 ppm. In addition, the alarm shall be transmitted to an on-site location that is staffed by trained personnel and digitally alerted by email to active operator. Carbon Dioxide can displace oxygen at high concentrations, it is a colorless, odorless, and tasteless gas. CO2 exposure can cause symptoms such as headache, dizziness, rapid breathing and increase heart rate, in extreme cases, unconsciousness and death can result. Signage shall be provided on the exterior door of each grow cultivation room/area utilizing CO2 and, in each room, storing CO2 stating: Caution —Carbon Dioxide Gas. �tWARNING Carbon dioxide gas to can cause injury or death. When alarm operates, vacate immediately. SAFETY DATA SHEET Airgas, Carbon Dioxide an Air Liquide company Section 1. Identification GHS product identifier Carbon Dioxide Chemical name Carbon dioxide, gas Other means of Carbonic, Carbon Dioxide, Carbonic Anhydride, R744, Carbon Dioxide USP identification Product type Gas. Product use Synthetic/Analytical chemistry and Medical use. Synonym Carbonic, Carbon Dioxide, Carbonic Anhydride, R744, Carbon Dioxide USP SDS# 001013 Supplier's details Airgas USA, LLC and its affiliates 259 North Radnor-Chester Road Flreline Cannabis Suite 100 Radnor, PA 19087-5283 1783159th Ave NE Bldg #1 1-610-687-5253 24-hour telephone 1-866-734-3438 Arlington WA 98223 Section 2. Hazards identification OSHA/HCS status This material is considered hazardous by the OSHA Hazard Communication Standard (29 CFR 1910.1200). Classification of the GASES UNDER PRESSURE-Liquefied gas substance or mixture Simple asphyxiant. GHS label elements Hazard pictograms 000, Signal word Warning Hazard statements Contains gas under pressure; may explode if heated. May displace oxygen and cause rapid suffocation. May increase respiration and heart rate. Precautionary statements General Read and follow all Safety Data Sheets (SDS'S)before use. Read label before use. Keep out of reach of children. If medical advice is needed, have product container or label at hand. Close valve after each use and when empty. Use equipment rated for cylinder pressure. Do not open valve until connected to equipment prepared for use. Use a back flow preventative device in the piping. Use only equipment of compatible materials of construction. Always keep container in upright position. Prevention Use and store only outdoors or in a well ventilated place. Response Not applicable. Storage Protect from sunlight. Store in a well-ventilated place. Disposal Not applicable. Hazards not otherwise In addition to any other important health or physical hazards, this product may displace classified oxygen and cause rapid suffocation. May cause frostbite. Carbon Dioxide Section 3. Composition/information on ingredients Substance/mixture Substance Chemical name Carbon dioxide, gas Other means of Carbonic, Carbon Dioxide, Carbonic Anhydride, R744, Carbon Dioxide USP identification Product code 001013 CAS number/other identifiers CAS number 124-38-9 Ingredient name % CAS number Carbon Dioxide 100 124-38-9 Any concentration shown as a range is to protect confidentiality or is due to batch variation. There are no additional ingredients present which,within the current knowledge of the supplier and in the concentrations applicable, are classified as hazardous to health or the environment and hence require reporting in this section. Occupational exposure limits, if available, are listed in Section 8. Section 4. First aid measures Description of necessary first aid measures Eye contact Immediately flush eyes with plenty of water, occasionally lifting the upper and lower eyelids. Check for and remove any contact lenses. Continue to rinse for at least 10 minutes. Get medical attention if irritation occurs. Inhalation Remove victim to fresh air and keep at rest in a position comfortable for breathing. If not breathing, if breathing is irregular or if respiratory arrest occurs, provide artificial respiration or oxygen by trained personnel. It may be dangerous to the person providing aid to give mouth-to-mouth resuscitation. Get medical attention if adverse health effects persist or are severe. If unconscious, place in recovery position and get medical attention immediately. Maintain an open airway. Loosen tight clothing such as a collar, tie, belt or waistband. Skin contact Flush contaminated skin with plenty of water. Remove contaminated clothing and shoes. Get medical attention if symptoms occur. Wash clothing before reuse. Clean shoes thoroughly before reuse. Ingestion As this product is a gas, refer to the inhalation section. Most important symptoms/effects, acute and delayed Potential acute health effects Eye contact No known significant effects or critical hazards. Inhalation No known significant effects or critical hazards. Skin contact No known significant effects or critical hazards. Frostbite Try to warm up the frozen tissues and seek medical attention. Ingestion As this product is a gas, refer to the inhalation section. Over-exposure signs/symptoms Eye contact No specific data. Inhalation No specific data. Skin contact No specific data. Ingestion No specific data. Indication of immediate medical attention and special treatment needed, if necessary Notes to physician Treat symptomatically. Contact poison treatment specialist immediately if large quantities have been ingested or inhaled. Specific treatments No specific treatment. Carbon Dioxide Section 4. First aid measures �I Protection of first-alders No action shall be taken involving any personal risk or without suitable training. It may be dangerous to the person providing aid to give mouth-to-mouth resuscitation. See toxicological information (Section 11) Section 5. Fire-fighting measures Extinguishing media Suitable extinguishing Use an extinguishing agent suitable for the surrounding fire. media Unsuitable extinguishing None known. media Specific hazards arising Contains gas under pressure. In a fire or if heated, a pressure increase will occur and from the chemical the container may burst or explode. Hazardous thermal Decomposition products may include the following materials: decomposition products carbon dioxide carbon monoxide Special protective actions Promptly isolate the scene by removing all persons from the vicinity of the incident if for fire-fighters there is a fire. No action shall be taken involving any personal risk or without suitable training. Contact supplier immediately for specialist advice. Move containers from fire area if this can be done without risk. Use water spray to keep fire-exposed containers cool. Special protective Fire-fighters should wear appropriate protective equipment and self-contained breathing equipment for fire-fighters apparatus(SCBA)with a full face-piece operated in positive pressure mode. Section 6. Accidental release measures Personal precautions. protective equipment and emergency procedures For non-emergency No action shall be taken involving any personal risk or without suitable training. personnel Evacuate surrounding areas. Keep unnecessary and unprotected personnel from entering. Avoid breathing gas. Provide adequate ventilation. Wear appropriate respirator when ventilation is inadequate. Put on appropriate personal protective equipment. For emergency responders If specialized clothing is required to deal with the spillage, take note of any information in Section 8 on suitable and unsuitable materials. See also the information in"For non- emergency personnel'. Environmental precautions Ensure emergency procedures to deal with accidental gas releases are in place to avoid contamination of the environment. Inform the relevant authorities if the product has caused environmental pollution (sewers,waterways, soil or air). Methods and materials for containment and cleaninct up Small spill Immediately contact emergency personnel. Stop leak if without risk. Large spill Immediately contact emergency personnel. Stop leak if without risk. Note: see Section 1 for emergency contact information and Section 13 for waste disposal. Section 7. Handling and storage Precautions for safe handling Protective measures Put on appropriate personal protective equipment(see Section 8). Contains gas under pressure. Avoid breathing gas. Do not puncture or incinerate container. Use equipment rated for cylinder pressure. Close valve after each use and when empty. Protect cylinders from physical damage; do not drag, roll, slide, or drop. Use a suitable hand truck for cylinder movement. Avoid contact with eyes, skin and clothing. Empty containers retain product residue Carbon Dioxide I Section 7. Handling and storage Advice on general Eating, drinking and smoking should be prohibited in areas where this material is occupational hygiene handled, stored and processed. Workers should wash hands and face before eating, drinking and smoking. Remove contaminated clothing and protective equipment before entering eating areas. See also Section 8 for additional information on hygiene measures. Conditions for safe storage, Store in accordance with local regulations. Store in a segregated and approved area. including any Store away from direct sunlight in a dry, cool and well-ventilated area, away from incompatibilities incompatible materials (see Section 10). Cylinders should be stored upright, with valve protection cap in place, and firmly secured to prevent falling or being knocked over. Cylinder temperatures should not exceed 52 °C (125 °F). Keep container tightly closed and sealed until ready for use. See Section 10 for incompatible materials before handling or use. Section 8. Exposure controls/personal protection Control parameters Occupational exposure limits Ingredient name Exposure limits Carbon Dioxide ACGIH TLV(United States, MOW).Oxygen Depletion [Asphyxiant]. STEL: 54000 mg/m3 15 minutes. STEL: 30000 ppm 15 minutes. TWA: 9000 mg/m3 8 hours. TWA: 5000 ppm 8 hours. NIOSH REL(United States, 10/2016). STEL: 54000 mg/m3 15 minutes. STEL: 30000 ppm 15 minutes. TWA: 9000 mg/m310 hours. TWA: 5000 ppm 10 hours. OSHA PEL(United States,6/2016). TWA: 9000 mg/m3 8 hours. TWA: 5000 ppm 8 hours. OSHA PEL 1989(United States, 3/1989). STEL: 54000 mg/m3 15 minutes. STEL: 30000 ppm 15 minutes. TWA: 18000 mg/m3 8 hours. TWA: 10000 ppm 8 hours. Appropriate engineering Good general ventilation should be sufficient to control worker exposure to airborne controls contaminants. Environmental exposure Emissions from ventilation or work process equipment should be checked to ensure controls they comply with the requirements of environmental protection legislation. In some cases,fume scrubbers,filters or engineering modifications to the process equipment will be necessary to reduce emissions to acceptable levels. Individual protection measures Hygiene measures Wash hands,forearms and face thoroughly after handling chemical products, before eating, smoking and using the lavatory and at the end of the working period. Appropriate techniques should be used to remove potentially contaminated clothing. Wash contaminated clothing before reusing. Ensure that eyewash stations and safety showers are close to the workstation location. Eye/face protection Safety eyewear complying with an approved standard should be used when a risk assessment indicates this is necessary to avoid exposure to liquid splashes, mists, gases or dusts. If contact is possible, the following protection should be wom, unless the assessment indicates a higher degree of protection: safety glasses with side- shields. Carbon Dioxide Section 8. Exposure controls/personal protection Hand protection Chemical-resistant, impervious gloves complying with an approved standard should be worn at all times when handling chemical products if a risk assessment indicates this is necessary. Considering the parameters specified by the glove manufacturer, check during use that the gloves are still retaining their protective properties. It should be noted that the time to breakthrough for any glove material may be different for different glove manufacturers. In the case of mixtures, consisting of several substances,the protection time of the gloves cannot be accurately estimated. Body protection Personal protective equipment for the body should be selected based on the task being performed and the risks involved and should be approved by a specialist before handling this product. Other skin protection Appropriate footwear and any additional skin protection measures should be selected based on the task being performed and the risks involved and should be approved by a specialist before handling this product. Respiratory protection Based on the hazard and potential for exposure, select a respirator that meets the appropriate standard or certification. Respirators must be used according to a respiratory protection program to ensure proper fitting, training, and other important aspects of use. Respirator selection must be based on known or anticipated exposure levels,the hazards of the product and the safe working limits of the selected respirator. Section 9. Physical and chemical properties Appearance Physical state Gas. [Compressed gas.] Color Colorless. Odor Odorless. Odor threshold Not available. pH Not available. Melting point Sublimation temperature:-790C (-110.2 to OF) Boiling point Not available. Critical temperature : 30.85°C (87.5°F) Flash point [Product does not sustain combustion.] Evaporation rate Not available. Flammability(solid, gas) Not available. Lower and upper explosive Not available. (flammable) limits Vapor pressure 830 (psig) Vapor density 1.53 (Air= 1) Liquid Density@BP: Solid density=97.5 Ib/ft3 (1562 kg/m3) Specific Volume (ft a/lb) 8.7719 Gas Density(lb/ft 3) 0.114 Relative density Not applicable. Solubility Not available. Solubility in water Not available. Partition coefficient: n- 0.83 octanol/water Auto-ignition temperature Not available. Decomposition temperature Not available. Viscosity Not applicable. Flow time(ISO 2431) Not available. Molecular weight 44.01 g/mole Carbon Dioxide Section 10. Stability and reactivity Reactivity : No specific test data related to reactivity available for this product or its ingredients. Chemical stability : The product is stable. Possibility of hazardous Under normal conditions of storage and use, hazardous reactions will not occur. reactions Conditions to avoid No specific data. Incompatible materials No specific data. Hazardous decomposition Under normal conditions of storage and use, hazardous decomposition products should products not be produced. Hazardous polymerization Under normal conditions of storage and use, hazardous polymerization will not occur. Section 11. Toxicological information Information on toxicological effects Acute toxicity Not available. Irritation/Corrosion Not available. Sensitization Not available. Mutagenicity Not available. Carcinogenicity Not available. Reproductive toxicity Not available. Teratogenicity Not available. Specific target organ toxicity(single exl2osuLqj Not available. Specific target organ toxicity (repeated exposure Not available. Aspiration hazard Not available. Information on the likely Not available. routes of exposure ,Potential acute health effects Eye contact No known significant effects or critical hazards. Inhalation No known significant effects or critical hazards. Carbon Dioxide (Section 11. Toxicological information Ingestion : As this product is a gas, refer to the inhalation section. Symptoms related to the physical, chemical and toxicological characteristics Eye contact No specific data. Inhalation No specific data. Skin contact No specific data. Ingestion No specific data. Delayed and immediate effects and also chronic effects from short and long term exposure Short term exposure Potential immediate Not available. effects Potential delayed effects Not available. Long term exposure Potential immediate Not available. effects Potential delayed effects Not available. Potential chronic health effects Not available. General No known significant effects or critical hazards. Carcinogenicity No known significant effects or critical hazards. Mutagenicity No known significant effects or critical hazards. Teratogenicity No known significant effects or critical hazards. Developmental effects No known significant effects or critical hazards. Fertility effects No known significant effects or critical hazards. Numerical measures of toxicity Acute toxicity estimates Not available. Section 12. Ecological information Toxicity Not available. Persistence and degradability Not available. Bioaccumulative potential Product/ingredient name LogP.. BCF Potential Carbon Dioxide 0.83 - low Mobility in soil Soil/water partition Not available. coefficient(Koc) Carbon Dioxide (Section 13. Disposal considerations Disposal methods The generation of waste should be avoided or minimized wherever possible. Disposal of this product, solutions and any by-products should at all times comply with the requirements of environmental protection and waste disposal legislation and any regional local authority requirements. Dispose of surplus and non-recyclable products via a licensed waste disposal contractor. Waste should not be disposed of untreated to the sewer unless fully compliant with the requirements of all authorities with jurisdiction. Empty Airgas-owned pressure vessels should be returned to Airgas. Waste packaging should be recycled. Incineration or landfill should only be considered when recycling is not feasible. This material and its container must be disposed of in a safe way. Empty containers or liners may retain some product residues. Do not puncture or incinerate container. Section 14. Transport information DOT TDG Mexico IMDG IATA UN number UN1013 UN1013 UN1013 UN1013 UN1013 UN proper CARBON CARBON CARBON CARBON CARBON shipping name DIOXIDE DIOXIDE DIOXIDE DIOXIDE DIOXIDE Transport 2.2 2.2 2.2 2.2 2.2 hazard class(es) Packing group - - - - - Environmental No. No. No. No. No. hazards "Refer to CFR 49 (or authority having jurisdiction) to determine the information required for shipment of the product." Additional information DOT Classification Limited quantity Yes. ,Quantity limitation Passenger aircrafttrail: 75 kg. Cargo aircraft: 150 kg. TDG Classification Product classified as per the following sections of the Transportation of Dangerous Goods Regulations: 2.13-2.17(Class 2). Explosive Limit and Limited Quantity Index 0.125 Passenger CariyjngRoad or Rail Index 75 IATA Quantity limitation Passenger and Cargo Aircraft: 75 kg. Cargo Aircraft Only: 150 kg. Special precautions for user Transport within user's premises: always transport in closed containers that are upright and secure. Ensure that persons transporting the product know what to do in the event of an accident or spillage. Transport in bulk according Not available. to Annex 11 of MARPOL and the IBC Code Section 15. Regulatory information J U.S. Federal regulations TSCA 8(a) CDR Exempt/Partial exemption: This material is listed or exempted. Clean Air Act Section 112 Not listed (b) Hazardous Air Pollutants (HAPs) Carbon Dioxide Section 15. Regulatory information Clean Air Act Section 602 Not listed Class I Substances Clean Air Act Section 602 Not listed Class II Substances IDEA List I Chemicals Not listed (Precursor Chemicals) IDEA List II Chemicals Not listed (Essential Chemicals) SARA 3021304 Composition/information on ingredients No products were found. SARA 304 RQ Not applicable. SARA 311/312 Classification Refer to Section 2: Hazards Identification of this SIDS for classification of substance. State regulations Massachusetts This material is listed. New York This material is not listed. New Jersey This material is listed. Pennsylvania This material is listed. International regulations Chemical Weapon Convention List Schedules 1. II & III Chemicals Not listed. Montreal Protocol (Annexes A, B, C, E,) Not listed. Stockholm Convention on Persistent Organic Pollutants Not listed. Rotterdam Convention on Prior Informed Consent(PIC) Not listed. UNECE Aarhus Protocol on POPs and Heavy Metals Not listed. Inventory list Australia This material is listed or exempted. Canada This material is listed or exempted. China This material is listed or exempted. Europe This material is listed or exempted. Japan Japan Inventory(ENCS):This material is listed or exempted. Japan Inventory(ISHL): This material is listed or exempted. Malaysia Not determined. New Zealand This material is listed or exempted. Philippines This material is listed or exempted. Republic of Korea This material is listed or exempted. Taiwan This material is listed or exempted. Thailand Not determined. Turkey This material is listed or exempted. United States This material is listed or exempted. Carbon Dioxide Section 16. Other information Hazardous Material Information System (U.S.A.1 Health 1 1 Flammability 0 Physical hazards 3 Caution: HMIS®ratings are based on a 0-4 rating scale,with 0 representing minimal hazards or risks, and 4 representing significant hazards or risks.Although HMIS®ratings and the associated label are not required on SDSs or products leaving a facility under 29 CFR 1910.1200,the preparer may choose to provide them. HMIS® ratings are to be used with a fully implemented HMIS®program. HMIS®is a registered trademark and service mark of the American Coatings Association, Inc. The customer is responsible for determining the PPE code for this material. For more information on HMIS® Personal Protective Equipment(PPE)codes, consult the HMIS®Implementation Manual. National Fire Protection Association (U.S.A.) Flammability Health , Instability/Reactivity SA Special Reprinted with permission from NFPA 704-2001, Identification of the Hazards of Materials for Emergency Response Copyright©1997, National Fire Protection Association, Quincy, MA 02269.This reprinted material is not the complete and official position of the National Fire Protection Association, on the referenced subject which is represented only by the standard in Its entirety. Copyright©2001, National Fire Protection Association,Quincy, MA 02269. This warning system Is Intended to be interpreted and applied only by properly trained Individuals to identify fire, health and reactivity hazards of chemicals.The user is referred to certain limited number of chemicals with recommended classifications in NFPA 49 and NFPA 325,which would be used as a guideline only.Whether the chemicals are classified by NFPA or not, anyone using the 704 systems to classify chemicals does so at their own risk. Procedure used to derive the classification Classification Justification GASES UNDER PRESSURE-Liquefied gas Expert judgment History Date of printing : 2/12/2018 Date of issue/Date of : 2/12/2018 revision Date of previous issue : 4/25/2017 Version : 0.03 Key to abbreviations : ATE =Acute Toxicity Estimate BCF = Bioconcentration Factor GHS=Globally Harmonized System of Classification and Labelling of Chemicals IATA= International Air Transport Association IBC = Intermediate Bulk Container IMDG= International Maritime Dangerous Goods LogPow=logarithm of the octanol/water partition coefficient MARPOL= International Convention for the Prevention of Pollution From Ships, 1973 as modified by the Protocol of 1978. ("Marpol"=marine pollution) UN = United Nations References Not available. Notice to reader Carbon Dioxide Section 16. Other information To the best of our knowledge,the information contained herein is accurate. However, neither the above-named supplier, nor any of its subsidiaries, assumes any liability whatsoever for the accuracy or completeness of the information contained herein. Final determination of suitability of any material is the sole responsibility of the user.All materials may present unknown hazards and should be used with caution.Although certain hazards are described herein,we cannot guarantee that these are the only hazards that exist. r MEMORANDUM OF INSURANCE DATE 14-Sep-2020 This Memorandum is issued as a matter of information only to authorized viewers for their internal use only and confers no rights upon any viewer of this Memorandum. This Memorandum does not amend, extend or alter the coverage described below.This Memorandum may only be copied, printed and distributed within an authorized viewer and may only be used and viewed by an authorized viewer for its internal use. Any other use, duplication or distribution of this Memorandum without the consent of Marsh is prohibited. "Authorized viewer" shall mean an entity or person which is authorized by the insured named herein to access this Memorandum via https:Hmarshdigital.marsh.com/marshconnect/viewMOI.action?clientId=2122. The information contained herein is as of the date referred to above. Marsh shall be under no obligation to update such information. PRODUCER COMPANIES AFFORDING COVERAGE Marsh USA Inc. Co.ANational Union Fire Insurance Company of ("Marsh") Pittsburgh,PA INSURED Co.B AIU Insurance Company American Air Liquide Inc.,Air Liquide USA LLC Co. c American Home Assurance Company 9811 Katy Fwy. co.D New Hampshire Insurance Company Suite 100,Houston 'Texas 77024 co.E United States Co.F COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MEMORANDUM MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPE OF POLICY POLICY LIMITS POLICY NUMBER EFFECTIVE EXPIRATION LTR INSURANCE DATE DATE LIMITS IN USD UNLESS OTHERWISE INDICATED A LGENER L GL 7032409 01-Jul-2020 01-Jul-2021 GENERALAGGREGA USD6,000,000 Commercial PRCOODUCTS-COMP/OP USD6,000,000 General PERSONAL AND ADV USD2,000,000 Liability INJURY EACH OCCURRENCE USD2,000,000 Occurrence FIRE DAMAGE(ANY ONE FIRE) USD2,000,000 MED EXP(ANY ONE USD 1,000 PERSON) A AUTOMOBILE CA 7269932 01-Jul-2020 01-Jul-2021 LIABILITY COMBINED SINGLE USD2,OW,000 A (AOS) 01-Jul-2020 01-Jul-2021 LET Any Auto BODILY INJURY(PER A CA 7269933 01-Jul-2020 01-Jul-2021 PERSON) (VA) BODILY INJURY(PER ACCIDENT) CA 7269934 PROPERTY DAMAGE (MA) EXCESS EACH OCCURENCE LIABILITY AGGREGATE B wORKERs WC 63850840 01-Jul-2020 01-Jul-2021 COMPENSATION/ B EMPLOYERS (AOS) 01-Jul-2020 01-Jul-2021 LIABILITY WC 63850837 WORKERS COMP Statutory C THE 01-Jul-2020 01-Jul-2021 LIMITS D PROPRIETOR (FL) 01-Jul-2020 01-Jul-2021 EL EACH ACCIDENT USD2,000,000 /PARTNERS/ WC 63850839 EL DISEASE-POLICY EXECUTIVE (CA) LIMIT USD2,000,000 EL DISEASE-EACH USD2,000,000 OFFICERS See additional EMPLOYEE ARE Included information Receiveri section SEP 2 2 2020 r � The Memorandum of Insurance serves solely to list insurance policies,limits and dates of coverage.Any modifications here to are not authorized. MEMORANDUM OF INSURANCE DATE 14-Sep-2020 This Memorandum is issued as a matter of information only to authorized viewers for their internal use only and confers no rights upon any viewer of this Memorandum.This Memorandum does not amend,extend or alter the coverage described below.This Memorandum may only be copied,printed and distributed within an authorized viewer and may only be used and viewed by an authorized viewer for its internal use.Any other use,duplication or distribution of this Memorandum without the consent of Marsh is prohibited. "Authorized viewer"shall mean an entity or person which is authorized by the insured named herein to access this Memorandum via https://marshdigital.marsh.com/marshconnect/viewMOI.action?clientId=2122.The information contained herein is as of the date referred to above.Marsh shall be under no obligation to update such information. PRODUCER INSURED Marsh USA Inc. American Air Liquide Inc.,Air Liquide USA LLC ("Marsh") 9811 Katy Fwy. Suite 100,Houston Texas 77024 United States ADDITIONAL INFORMATION Workers Compensation Coverage continued: Policy Effective Date 7/1/2020-7/1/2021 Insurer B-Policy No.WC 63850838(MA,ND,OH,WA,WI,WY) Insurer B-Policy No.WC 63850840(AK,AL,AR,AZ,CO,CT,DC,DE,GA,HI,IA,ID,IL,IN,KS,KY,LA, MD,ME,MI,MN,MO,MS,MT,NC,NE,NH,NJ,NM,NV,NY,OK,OR,PA,RI,SC,SD,TN,TX,UT,VA,VT, WV) Named Insureds on the above referenced policies include but are not limited to the following companies. American Air Liquide Inc. American Air Liquide Holdings,Inc. Air Liquide Helium America,Inc. Air Liquide Advanced Technologies U.S.LLC Air Liquide America L.P. AL America Holdings,Inc. Air Liquide USA LLC Air Liquide Industrial U.S.LP Air Liquide Large Industries U.S.LP Air Liquide Electronics U.S.LP Air Liquide Healthcare America Corporation Air Liquide Global E&C Solutions US Inc. Air Liquide Technical Services LLC Air Liquide America Specialty Gases LLC Air Liquide Global E&C Solutions Mexico LLC Air Liquide Holdings LLC Air Liquide LLC Progressive Resources,LLC Well-Gen Services,LLC Plains Nitrogen,LLC Air Liquide Advanced Materials Inc. Air Liquide Advanced Materials LLC Airgas,Inc. Airgas USA LLC E Memorandum of Insurance serves solely to list insurance policies,limits and dates of coverage.Any ifications hereto are not authorized. CITY OF ARLINGTON 18204 59th Avenue NE,Arlington,WA 98223 INSPECTIONS:360-403-3417-Permit Center:360-403-3551 BUILDING PERMIT Permit# 3457 1783159TH AVENUE NE PERMIT EXPIRES 180 DAYS AFTER DATE OF ISSUANCE. Parcel#:31052200403600 Valuation: .00 OWNER APPLICANT CONTRACTOR ARLINGTON ADVANCED Fireline Cannabis Airgas USA,LLC MANUFACTURING PARK 720.N lOTH ST STE Ail$ 17831 59th Ave NE 3737 Worsham Ave RENTON,WA 98057 Arlington,WA 98223 Long Beach,CA 90,608 360-999-6645 503-481-8002 LIC:AIRGAUL.873C7 EXP_05/22/2021 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Operating CODE YEAR: STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL The issuance or granting of this permit shall not be construed to be a permit for,or approval of,any violation of this Code or any other ordinance or order of the City,of any state or federal law,or of any order,proclamation,guidance advice or decision of the Governor of this State.To the extent the issuance or granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or federal law,or order,proclamation,guidance advice or decision of the Governor of this State,this permit shall not authorize such work and shall not be valid.The building official is authorized to prevent occupancy or use of a structure where in violation of this Code,any other City ordinances of this jurisdiction or any other ordinance or executive order of the City,or of any state or federal law,or of any order,proclamation, guidance advice or decision of the Governor.The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,inaccurate or incomplete information,or in violation of any City ordinance,regulation or order,state or federal law,or any order,proclamation,guidance or decision of the Governor. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HISMER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBCI I0,(IRC1I0. SALES TAX NOTICE: Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax retu forma co d City of Arlington#3101. f(20 Signa re Print Name Date Released By Dge CONDITIONS 1.CO2 monitoring shall be install installed in all areas where CO2 is generated,routed through and/or discharged(anywhere CO2 may leak from the CO2 distribution system).2.Signage shall also be placed on the exterior of all man-doors installed in the exterior walls of the building so as to alert any person of the possible presence of CO2 before entering the building.3.Strobe lights shall not be red,clear or blue in color.4. Step 5 in Protocol shall be changed to call 911 about CO2 leaks. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS, MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 12/14/2020 Inspection Fee $75.00 12/14/2020 Processing/Technology Fee $25.00 Total Due: $I00.00 Total Payment: $100.00 Balance Due: $0.04 CALL FOR INSPECTIONS Call by 3:30 pm for next day inspection,allow 48 hours for Fire Inspections When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon CITY OF ARLINGTON 18204 59th Avenue NE,Arlington,WA 98223 INSPECTIONS: 360-403-3417-Permit Center: 360-403-3551 BUILDING PERMIT Permit#:3457 17831 59TH AVENUE NE PERMIT EXPIRES 180 DAYS AFTER DATE OF ISSUANCE. Parcel#: 31052200403600 Valuation: .00 OWNER APPLICANT CONTRACTOR ARLINGTON ADVANCED Fireline Cannabis Airgas USA,LLC MANUFACTURING PARK 720 N 10TH ST STE A128 17831 59th Ave NE 3737 Worsham Ave RENTON,WA 98057 Arlington,WA 98223 Long Beach,CA 90808 360-999-6645 503-481-8002 LIC:AIRGAUL873C7 EXP:05/22/2021 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Operating CODE YEAR: STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: OCC LOAD: PERMIT APPROVAL The issuance or granting of this permit shall not be construed to be a permit for,or approval of,any violation of this Code or any other ordinance or order of the City,of any state or federal law,or of any order,proclamation,guidance advice or decision of the Governor of this State.To the extent the issuance or granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or federal law,or order,proclamation,guidance advice or decision of the Governor of this State,this permit shall not authorize such work and shall not be valid.The building official is authorized to prevent occupancy or use of a structure where in violation of this Code,any other City ordinances of this jurisdiction or any other ordinance or executive order of the City,or of any state or federal law,or of any order,proclamation, guidance advice or decision of the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect,inaccurate or incomplete information,or in violation of any City ordinance,regulation or order,state or federal law,or any order,proclamation,guidance or decision of the Governor. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY,NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC110/IRC110. SALES TAX NOTICE: Sales tax relating to construction and construction materials in the City of Arlington must be reported on your sales tax return form and coded City of Arlington#3101. Signature Print Name Date Released By '-Dtee CONDITIONS 1. CO2 monitoring shall be install installed in all areas where CO2 is generated,routed through and/or discharged(anywhere CO2 may leak from the CO2 distribution system).2. Signage shall also be placed on the exterior of all man-doors installed in the exterior walls of the building so as to alert any person of the possible presence of CO2 before entering the building.3.Strobe lights shall not be red,clear or blue in color.4. Step 5 in Protocol shall be changed to call 911 about CO2 leaks. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS, SIDEWALKS,DRIVEWAYS, MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERNUT FEES Date Description Fee Amount 12/14/2020 Inspection Fee $75.00 12/14/2020 Processing/Technology Fee $25.00 Total Due: $100.00 Total Payment: $100.00 Balance Due: $0.00 CALL FOR INSPECTIONS Call by 3:30 pm for next day inspection,allow 48 hours for Fire Inspections When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon Date: 05/11/2026 Permit#: 3457 Permit Date: 10/05/2020 Review Date: 10/27/2020 Permit Type: OPERATING Review Type: OPERATING Target Date: 11/03/2020 Scheduled 00:00 Time: Completed Date: Description: When service elements must be visible from the street follow 2.3.3.2 Screening Dumpsters and Trash Areas. (Provide a durable and attractive structure to screen dumpsters and trash areas (not chain link or even slatted chain link). Trash areas may not open directly onto the sidewalk. Dumpsters must never be located in the pedestrian right-of-way. ) Review Status: Assigned To: Josh Grandlienard Time In: 00:00 Time Out: 00:00 Hours: 0.0 Property Information Parcel#: 31052200403600 ARLINGTON ADVANCED MANUFACTURING PARK ARLINGTON ADVANCED MANUFACTURING 720 N 10TH ST STE A128 PARK 17831 59TH AVENUE NE RENTON, WA 98057 Zoning: 637 Warehousing & Storage ServicesLot: 7131ock: Permit#: 3457 Permit Date: 10/05/20 Permit Type: OPERATING Project Name: Fireline Cannabis Applicant Name: Fireline Cannabis Applicant Address: 17831 59th Ave NE Applicant, City, State, Zip: Arlington,WA 98223 Contact: Philip Nelson Phone: 360-999-6645 Email: philip@firelinecannabis.com Scope of Work: Installation of 3000 liter Co2 tank AST Valuation: 0.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 12/14/2020 Permit Expires: 04/03/2021 Form Permit Type: Status: EXPIRED Assigned To: Raelynn Jones Property Parcel# Address Legal Description Owner Name Owner Phone Zoning LOT 7 TGW EQ&UNDIV INT TRS 994,995,996,997 &998 OF ARL BSP ARLINGTON 31052200403600 17831 59TH AVENUE NE PLN20110043& ADVANCED 637 Warehousing& PWD20110076 REC AFN MANUFACTURING Storage Services 201112205001;BEING A PARK PTN N1/2 SE1/4 OF SD SEC Contractors Contractor Primary Contact Phone Address Contractor Type License License# 3737 Worsham CONSTRUCTION Labor and Airgas USA,LLC Aaron Lothrop 503-481-8002 AIRGAUL873C7 Ave CONTRACTOR Industries Plan Reviews Date Review Type Description Assigned To Review Status 10/05/2020 OPERATING BUILDING 1.CO2 monitoring shall be install installed in all areas where CO2 is generated,routed through and/or discharged (anywhere CO2 may leak from the CO2 distribution system). 2.Signage shall also be placed on the exterior of all man- 10/05/2020 OPERATING doors installed in the exterior walls of the building so as to FIRE alert any person of the possible presence of CO2 before entering the building. 3.Strobe lights shall not be red,clear or blue in color. 4.Step 5 in Protocol shall be changed to call 911 about CO2 leaks. When service elements must be visible from the street follow 2.3.3.2 Screening Dumpsters and Trash Areas.(Provide a 10/27/2020 OPERATING durable and attractive structure to screen dumpsters and Josh Grandlienard trash areas(not chain link or even slatted chain link). Trash areas may not open directly onto the sidewalk. Dumpsters must never be located in the pedestrian right- of-way.) Fees Fee Description Notes Amount Inspection $75.00 Processing/Technology $25.00 Total $100.00 Attached Letters Date Letter Description 12/14/2020 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 12/14/2020 Philip Nelson 83934528 $100.00 Outstanding Balance $0.00 Notes Date Note Created By: 10/05/2020 Verify Fees Raelynn Jones 10/05/2020 Running in conjunction with Comm.Mechanical BLD-3456 Raelynn Jones Uploaded Files Date File Name 12/14/2020 7842780-3457 Issued Permit.pdf 10/05/2020 7466147-3457 Application Packet.pdf Date: 05/11/2026 Permit#: 3457 Permit Date: 10/05/2020 Review 10/05/2020 Date: Permit Type: OPERATING Review OPERATING Type: Target Date: 10/12/2020 Scheduled 00:00 Time: Completed 11/10/2020 Date: Description: 1. CO2 monitoring shall be install installed in all areas where CO2 is generated, routed through and/or discharged(anywhere CO2 may leak from the CO2 distribution system). 2. Signage shall also be placed on the exterior of all man-doors installed in the exterior walls of the building so as to alert any person of the possible presence of CO2 before entering the building. 3. Strobe lights shall not be red, clear or blue in color. 4. Step 5 in Protocol shall be changed to call 911 about CO2 leaks. Review Status: Assigned To: FIRE Time In: 00:00 Time Out: 00:00 Hours: 1.0 Property Information Parcel#: 31052200403600 ARLINGTON ADVANCED MANUFACTURING PARK ARLINGTON ADVANCED MANUFACTURING 720 N 1 OTH ST STE A128 PARK 17831 59TH AVENUE NE RENTON, WA 98057 Zoning: 637 Warehousing & Storage ServicesLot: 7131ock: