HomeMy WebLinkAbout2732 BRUNDAGE LANE FMC 2013HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
File Number: Address: a7 3 2 &r y
Bakersfield, CA 933
Date Received: -2-30 — 13
Business Name: L cam'
SYSTEM: I I BUILDING SQUARE FEET:
New Mod.
Commercial Hood System
Fire Alarm System
Fire Sprinkler System
Spray FWsh System
Aboveground Storage Tank
Underground Storage Tank
minor
modification Underground Storage Tank
removal Underground Storage Tank
0-' Other. - v&A C,
Building Sq. Feet:
Calculation Bldg. Sq. Ft: 1.
2.
I
4.
F INSPECTION LOG
Date Time
rA.113 &I I 'N5R'-C76e
Signature
Signature
Comments: 72 54 1«sfDA64 e ll2_knis
V4 p' -9 ?4110L E'x/ 9fts.y
V^1 i Ir 2..538" 6>°/' - 1141 --Ji3
BILLING & PERMIT STATEMENT
PERMIT # F /R6
DePAIPT/IiMT
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Dhnna• 1;A1- '4?A -RQ7Q a PAY- AA1 -A';? -0171
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
PERMITTYPE FEE CALCULATION TOTAL
DUE
Alarm - New & Modification (minimum charge) $280
ONLY
TREASURY
ACCT NO
SITE INFORMATION
LOCATION OF PROJECT PROPERTY OWNER
D & G Liquors Jaco Hill
STARTING DATE NAME
8/14/13 9:00am Omero Garcia Maintenance Manager
PROJECT NAME ADDRESS PHONE #
D & G Liquors PO Box 82515 661- 393 -7000
PROJECT ADDRESS CITY PEA ICER SF I E LD STATE CA ZIP CODE
2732 Brunda e Ln Bakersfield CA 93304 93380 -2515
CONTRACTOR INFORMATION
Sprinkler - Minor Modification (<10 heads) 96 (inspection only)
CONTRACTOR NAME CA LICENSE # TYPE OF LICENSE EXPIRATION DATE PHONE #
Bradley Se kora 1804904 C61 D40 13Z31/14 661 -631 -3870
CONTRACTOR COMPANY NAME FAX #
Confidence UST Services Inc. 661 -587 -9758
ADDRESS CITY ZIP CODE
16250 Meacham Road I Bakersfield 93314
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
PERMITTYPE FEE CALCULATION TOTAL
DUE
Alarm - New & Modification (minimum charge) $280
ONLY
TREASURY
ACCT NO
Over 10,000 sq ft 0 .028 x sq ft
Sprinkler - New & Modification (minimum charge) 280
Over 10,000 sq ft 0 .028 x sq ft
Sprinkler - Minor Modification (<10 heads) 96 (inspection only) 84
Commercial Hood (New & UL 300 Upgrade Modification)
Additional Hood
470
58 hood
Commercial Hood - Minor Modification (add /move nozzle) 96 (inspection only) 84
Spray Booth (New & Modification) 470
98
Aboveground Storage Tank (1 inspection per installation) AST 180 /tank 82
Additional Tank ATI 96 /tank 82
Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR 109 /tank 82
Underground Storage Tank (Installation /Inspection) NI 878 /tank 82
Underground Storage Tank (Modification) MOD 878 /site 82
Underground Storage Tank (Minor Modification) MTM 167 /site 82
Underground Storage Tank (Removal) TR 573 /tank 84
N Mandated UST Testing: Fuel Mont Cert/SB989 /Cath. Prot.
NOTE: $96 /hr for each type of test/per site /per UST system
even if scheduled at the same time
96 /hr (2 hrs minimum) _ $192 82
Oil well (Installation, Inspection, or re- inspection) X 96 /hr 82
Tent # 96 /tent 84
After -hours inspection fee 121 /hr (2 hrs minimum) = $242
Pyrotechnic (1 permit per event, plus an inspection fee of
96 /hr during business hours) PY
NOTE: After hours Pyrotechnic event inspection is @ $121 /hr
96 /hr + (5 hrs min standby fee /insp) _ $576
5 hrs min standby fee /ins = $605
84
Re- inspection /Follow -up Inspection 96 /hr 84
Portable LPG (Propane): # of Cages? _ 96 /hr 84
Explosive Storage 266 84
Copying & File Research (File Research fee $50 /hr) 0.25 /page 84
Miscellaneous 84
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING /TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please note that these are separate
individual tests and will be charged per
separate type test accordingly.)
PERMIT #
ENHANCED LEAK DETECTION
TANK TIGHTNESS
S P 3 Rr
P /R!
ANTR I f
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
Page 1 of 1
LINE TESTING SB -989 SECONDARY CONTAINMENT
FUEL MONITORING CERTIFICATION
SITE INFORMATION
FACILITY
G Liquors 10meroNAME & PHONE # OF CONTACT PERSON
Garcia (661) 393 -7000
ADDRESS
2732 Brundage Lane Bakersfield CA 93304
OWNER NAME
Jaco Hill
OPERATOR NAME PERMIT TO OPERATE #
OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO
TANK # VOLUME CONTENTS
TANK TESTING COMPANY
TESTING COMPANY
Confidence UST Services Inc.
NAME & PHONE # OF CONTACT PERSON
Karli Karns (661) 631 -3870
MAILING ADDRESS
16250 Meacham Road Bakersfield CA 93314
NAME & PHONE # OF TESTER OR SPECIAL INSPECTOR
R-raciley Seykora (661) 487-9'155
CERTIFICATION #
B40738
DATE & TIME TEST TO BE CONDUCTED
8/14/13 at 9:00 am
ICC #
8111231 -UT
TEST METHOD
APPLICANT SIGNATURE
n &..'
DATE
b
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED BBY,., { /" /
1/' % /
1
DATE
FD2095 (Rev 03/08)
r
BAKERSFIELD CITY FIRE DEPARTMENT — INSPECTION RECORD
Post this Card at the Job Site and DO NOT Remove for Duration of Work
Inspection Request Phone No. (661) 326 -3979
UST NEW INSTALL
DESCRIPTION DATE SIGNATURE
BACKFILL
PRIMARY PIPE
SECONDARY PIPE
SECONDARY CONTAINMENT
SENSORS
AUTHORIZATION FOR FUEL
ELECTRICAL SEAK -OFF
TANK TESTING
UST REMOVAL
DESCRIPTION DATE SIGNATURE
EVR UPGRADE
MISC. ACTIVITY
REMARKS:
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR / MAJOR
AST REMOVAL
DESCRIPTION DATE SIGNATURE
PRIOR-TO OPERATION OF ANY SYSTEM,},
ALL UST AND /OR AST SYSTEMS SHALL BE
INSTALL, COMPLETE AND ACCEPTED BYj
RHE BAKERSFIELD CITY FIRE DEPARTMENTi.
FIRE DEPARTMENT (FINAL) $/G
BUILDING ADDRESS: 6?73,;)- vf J L-.,L)
JOB DESCRIPTION: -t l-t-k C-- J OCCUPANCY TYPE:
OWNER: - G c Li g. PERMIT NO. Z,3-/0C-)(n0 36
CONTRACTOR: PHONE # /—
FD 1743
MONITOR NG S'Y'ST'E'M( GE'RTI +FICA.TI.QN
For Use BY- .411 JuHsdiciions Within the State of California
Authority Cited: Chapter 6 7, Healih and Safety, Code: Chaplet 16, Division 3, Title 23, California Coda ofRegulations
This lbrm must he used to document testing and servicing of monitoring equipment. A separate certification or report must be Prepared tier each
monitoring System control panel by the technician who performs the work. A copy of this form must be pn)vided to the tank system
owner /operator. The ownerhifierator must submit a copy ofthis form to the kwal agency regulating UST systems within 30 days oftest date.
A. General Information
Facility Nalne: #2233 D 8t G Liquors Bldg. No.:
Site Address: 2732 i3inindsge Lane City. Bakemfield, CA "Lip: 93304
Facility Contact. Perwn:. Omer Garcia Contact: Phone. No.: ('661)- 393 -7000,
Mak'e.lModcl: ofMonitoring; System: Veeder -Root TLS 360 Date. of 1 sting,/Servicing: Sf1, 2013.
B. Inventory of Equipment Tested/Certified
C'lu ckthe grapride hoxem to ludkUe ecirw e4ttijamut ins e&%ervlced:
Tank ID: 12,000 gal. Regular Tank ID: 12,000 gal. Super
in -Tunic Gauging 1'mhe. MmIel: 847390 -107 hi-Tank Gauging PrAw. Model: 847390.107
Annular Space (w Vault Sewo)r. Mtxk+ Annular Space nr Vault Setivcw. Mcxicl:
Piping Sump' "Urcnch SLmir(s). Mcxk1. I'ipirgSump i Trench Scwr(s)• Model:
fill Sump Scr T(s). Mcxlel: Dill Sump scvm ta). Mcxtel:
Mechanical [sine I,.rak Iklect(w. Model: Mcch:mic:al Line Link IkKe-e:lex. Mcxicl:
itleetromic I,inc Leak Docclur. Model: WPLLD hlectrcnic Line Leak t.kKeclor. Malel: WPLLD
Tank Overfill / IIiplAevel Seitcrx% Model: 847390-107 C9 Tank Ovil lill / I I igh• LcvO Sntxw. 414.nlel: 847390 -107
rlaer fapxzily equipment typ e.a nd rrmxk-1 in Section ti on I'age. 2 ). Win, (spxcify equipmrrt typcand nxxka in Sectiruh E m Cage 2).
ID: 112;000 qaK Diesel Tank ID: ITank
0 fn,Touk-Gauging,f'rc -Ae. Mode(: 647330 -107 Q fn -Tank Gauging Pruhe. Modet:
Annular Space m Vault Smmw. M(xi<l: Annular Space nr Vault Smmx. Mcxicl:
E2, Piping,Sump("f,*nchSeresnrtss, IVlcxLf: 13 Nplhs Sump;"I'micfl Smc+r(n}. tLiadcf:
D bill SUMPScnwr('sl: Mix O: I Fill Sump Sea w4ls). Model:
Mec:hanical tine I -Cak I.kKectcx. Model: Mechanical Une t.emk Udcetor. Model:
F.lectnmic Line Leak Detector. Mcxicl: WPLLD Muctrtmic Litz Leak lletect(w. Mcxicl:
rank Overfill / Iligh- l-cvcl Sensor. Mcxicl: 847390407 Tank gvetfpll / Iligh- Levu! Soism. Malel:
Other (stimiry cxpuirntnrrt type and inod l in Section E on Page 2). Chhcr (Alecily cyuip ]WIll hype anti nxxkl in Scotian ti cot Page 2).
Dispenser ID: 1 8 2 Dispenser ID:
Pispe'rrser Containment Se'rtiot(s). Model: 794380 -208 Dispenser Containment Scrtsor(s ). Model:
Sher Valve(s). Sht-er ValvOs).
I)icpxnser C6iltainmemt Float(s) mxl C'}witgs). Dispenwr Containim-ni Fhral(s) and On, inls).
Dispenser ID: Dispenser ID:
nispx+cser Containment ScmorlQ. Model: Dispenser• Containment Senm*s). Model:
Sher Valvels). Shear Valvc(s).
1)isperrwr Cnnlairnnent I'k>1t(:c) and Clmin(s). Qisp,crrser Ccnnainnrem Hintl(s) and C:lmin(sl.
Dispenser ID: Dispenser ID:
Dispenser Containment Serrcu(s). Mcxkl: DispenserContainment Sensrn(s). Model:
Shear Valvc(s). 0 Shear Valve(s).
i)isp olserContainm ni Fluul(s) and Chain(s). Dispenwr Conwimnion Fkurl(s) and Chain(s),
ifthe facility contains nuxe tanks or dispensers, copy Ihio form. Include information lix every tank and dispenser at the tacilily.
C. Certification - 1 certify that the equipment identified in this document was inspected /serviced in accordance with the
manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this
information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such
reports, i have also attached a copy of the report; (check all that applt): ® System set -up ® Alarm history report.
Technician Name Kristopher Kams Signature:_c jcrw4•.
Certification No.: 834106 License. No.: 804904
Testing Company Name: Confidence UST Services Phone No.: (800) 339 -9930
Site Address: 2732 Brundage Lane, Bakersfield, CA 93304 Date of Testing /Servicing: 8/16/2013
Page 1 of 3
Monitoring ,System Certification
D. Resuitis of Testing/Servicing
Software. Version tnstalled: 327.04
mm lnfn. fhn fnit'navnno; ,hshou11ef.
I M N16; No* I is the audihtc atarttt Qvperatic%X
Yes p No* Is the visual alarm operational?
Yes No* Were all sensors visually inspected. functionally tested; and confirmed operational''
Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment
will not interfere with their proper operation'?
10 Yes CI No* If alarms are relayed to a remote monitoring station, is all ctmununications equipment (e.g., modem)
N/A operational?
Yes p No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment
NIA monitoring system detects a leak, fails to operate, or is cicctricallydisconnected7 Ifyes: which sensors initiate
positive shut - dawn'? (Check all that apply) Sumpti'rench Sensors: ® Dispenser Containment Sensors.
Did you confirm positive shut -down due to leaks and sensor failure/disconnection? ® Yes.. No.
Yes No* For tank systems that utilize the monitoring system as the primary tank. overfill warning device. (i.e., no
Q NIA mechanical overfill prevt mion valve is installed). is the overfill warning alarm visible and audihYe at the tank
fill points) and cVrating properly'? If so, at what perccnt of tank. capacity does the alarm, trigger.' 90%
0, Yes' El No Was any monitoring equipment•. replaced? If yes, fd't;ntily specific sensors, probes, or, other. equipment
mcpl'eced ands ITSU the manufacturer name.and model for al,11 replacement parts in. Section F'. helaw:
Yes* 01 Was liquid found inside. any secondary containment systems designed as d'ry systems? (Gierk'all that apply)
0 pt.mact: 0, Lti Mer, f )es, &A riheC.2vrri in Swim E, Wow,
13 Yes i p, No* Was monitor.ing system, wt up reviewed, to ensure. proper. settings'." Attach, sct up. reports, if applicahl''e.
U Y6 C1 Nit* 6, all aumiturias cW4m= kVaa6(,xx* l per %MA%L(actuccr' vti ;tuatioct•'!'
In Section E below, describe- how and when these deficiencies were or will be corrected.
E. Comments: I replaced Veeder Root Battery, the 3.5 Gal. Phil Tile Spill Bucket on Diesel and Phil Tite Fill Adaptor
due to failing test, and the 5.0 Gal. Phil Tite Spill Bucket on the Super due to a failing test. After all the repairs were
made everything was re- tested and confirmed operational.
Page 2 of 3
1146tu'toring System Ckrtifcation
F. In -Tank Gauging / SIR Equipment: ® Check this box iftank gauging is used only for inventory control.
Check this box ifno tank gauging or SiR equipment is installed.
This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring.
Complete the following; checklist:
Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
Yes. No* Were aUP tank gauging probes visually inspected for damage and'. residue. buildup'?
0 Yes. No'* Was accuracy ofsystem product levcU readings. tester!'!'
Yes Nn* Was accuracy of Ry:dcm ivatcr kevel reading 1"ad'?
a Yes No* Were all probes reinstalled properly?
Yes No* Were all items on the equipment manufacturer's maintenance checklist completed'?
In the Section H, below, describe how and when these deficiencies were or will be corrected.
G. Line Leak Detectors (LLD):
Cmmnlntr the fibllnwina chpekli"!
Check this box if LLDs are not installed.
Yes No* For equipment start -up or annual equipment certification, was a leak simulated to verify LLD performance'?
N(A. Check all iitca afrfdp) Simulated leak rate: 0,, 3 g.p.h_ 0. t g.p.h ; I t 0.2 g.p.h.
91 Yes No:" Were all LEDs confirmc& operational! and accurate, within regulatory reyuirctuents?
p Yes No* Was the, testing, apparatus properly calibrated'?
1 Yes No* For mechanical LMs.. does. the 111.1), restrict product flow if it detects a. leak' ?'
3 N/A
Yes No* For electronic LLDs. does the turbine automatically shut off ifthe LLD detects a leak'?
N/A
Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion of the monitoring system is disabled
N/A or disconnected?
Yes No* For electronic LLDs, does the turbine automatically shut oil' if any portion of the monitoring system
N/A malfunctions or fails a test'?
Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected'?
N/A
Yes No* I Were all items on the equipment manufacturer's maintenance checklist complewd?
In the Section 11, below, describe how and when these deficiencies were or will be corrected.
H. Comments:
Page 3 of 3
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SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use bill conlractorc peg fo+ming annual loving qJ' USTspill containment stnictures. The completed fotnt and
printoulsf -om tests (ifapplicable), should he provided to thefacility oitaierloperator,for.tinhmiltcrl to the tonal regulator. agent-,.
I. FACILITY INFORMATION
Facility Name: #2233 D R Cy Liquors Date ofTesting: 4/l 5/2013
Facility Address: 6401 White Lane, Bakersfield, CA 93309
Facility Contact: Omero Garcia I Phone: 661 - 393 -7000
Date Local Agency Was Notified ofTesting: Ernie Medusa
Name ofLocal Agency Inspector (ifpre:sem during lesmrg): 7/24/2013
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials': X CSL,B Contractor X ICC Service Tech. X SWRCB Tank Tester 0 Other (Specify)
License Number(s): CSLB 4804904 ICC 115264406 -UT SWRCB #09 -1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic 0 Vacuum 0 Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (Big Tank
Number, Stored Product, etc.)
I Regular 2 Super 3 Diesel 4
Bucket Installation Type: 0 Direct Bury
Contained in Sump
0 Direct Bury
Contained in Sump
0 Direct Bury
Contained in Sump
0 Direct Bury
0 Contained in Sump
Bucket Diameter: 14.00" 14,00" 14.00"
Bucket Depth: 12.00" 12.00" 12.00"
Wait time between applying
vacuum /water and start of test: 5 min. 5 min. 5 min.
Test Start Time (Ti): 10:30 AM 10:30 AM 10:30 AM
Initial Reading (Rj): 10.75" 10.75" 10.75"
Test End Time (T,:): 11:30 AM 11:30 AM 11:30 AM
Final Reading (Rr): 10.75" 10.75" 10,75"
Test Duration (Tr — 7'i): I hour 1 hour l hour
Change in Reading; (R, >- Rj): 0.00" 0.00" 9.00"
Pass/Fail Threshold or
Criteria: 0.0625" 0.0625" 0.0625"
Test Result:. Pass Fail Pass Fall 11 Pass Fail Pass Fail
Comments — (include information on repairs made prior to testing, and rcconnnendcei follow -tip forfailed tests)
The passinu results above reflect the repairs that were made to the Surer and
Diesel to get_ passim results. I replaced the Diesel 3.5 Gal Phil Tite SDill Bucket
and the Phil Tite Fill Adaptor on the Diesel. I also had to replace the 5.0 Gal.
Phil Tite Spill Bucket on the Super. After the repairs everything- was re- tested
and confirmed operational.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUC•rlNG THIS TESTING
I hereby certify that all the information containedin this report is true, accurate, and infull compliance with legal requirements
Technician's Signature: 4,& Date: 8/16/2013
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
WS I LEGEND
P!VVENTS
L1 UDC I.2
H HEALY CAS
ANODE f / P PRODUCT SPILL BUCKET
V VAPOR SPILL BUCKET
ATG AUTOMATIC TANK GAUGE
ESO EMERGENCY SHUT-OFF
WS WATER SHUT-OFF ® STREET /
W-8 WATER SHUT -OFF BLDG '
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SITE PLOT PLAN for:
0 !#233 D 8 G MARKET
Ll 2732 Brundage Lane
1 Bakersfield, CA 93304 IO (661) 326 -1083
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Confidence US7'
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Uc.970703 Lic.804904
Toll-Free M 1-800- 339 -9930
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Stour E y Signature:
w
Job Order I Invoice #: 31 ( % a
Date Called Time - b Whom -- - Repair Date-
a u (:-
9!lti 13 ! ?. C v V-A C ..
Name: Confidence US7' Site Name:
Street: 16250 Meacham Road Street:
City: Hakcrsliuld CA 9:3314 City: - Z l State: L• Zip:
Terms:,
Technician Print Name:
Stour E y Signature:
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Store No:
ISA13 Techni an Signature; Taffl/
Description of work performed:
r! - G• i ( i U r ' Sl7'AV?, r i :F _ -S 2czzl
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1 Aq i
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TRAVEL and LABOR 0.5 Hour Minimum Labor Charge) OVERTIME 5:00 PM - 7:00AM)
Date, Technician(s) Name Start End Total OT Start OT End OT Total
d ' Travel
Labor c trl5ti
Travel
Date Tachnician(s) Name Start End Total OT Start OT End OT Total
Travel
Labor
Travel
Dale Techniclan(s) Name Start End Total OT Start OT End OT Total
Travel
Labor
Travel
SUPPLIES - MATERIALS - RENTALS Check One
Qty. UST Parts Site Parts
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11"VttIr - Wril l m SITE - CANARY
COMMENTS
Store Employee Print Name: Technician Print Name:
Stour E y Signature:
w ISA13 Techni an Signature; Taffl/
11"VttIr - Wril l m SITE - CANARY