HomeMy WebLinkAbout3221 H STREET MINOR MOD 2013HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH
Permit No. Permit No. Permit No. Permit No.
File Number:
Date Received:
Other.
Comments:
AST
Permit No.
UST
Permit No.
4 A
Address: A/ 57
Bakersfield, CA 933
Business Name: ,q F
BUILDING SQUARE FEET: INSPECTION LOG
Building Sq. Feet:
Calculation Bldg. Sq. Ft: I.
Z.
3.
4.
Date Time
Signature
SYSTEM:
New Mod.
Commercial Hood System
Fire Alarm System
Fire Sprinkler System
Spray Finish System
Aboveground Storage Tank
Underground Storage Tank
minor
mod cat rground Storage Tank
removal Underground Storage Tank
Other.
Comments:
AST
Permit No.
UST
Permit No.
4 A
Address: A/ 57
Bakersfield, CA 933
Business Name: ,q F
BUILDING SQUARE FEET: INSPECTION LOG
Building Sq. Feet:
Calculation Bldg. Sq. Ft: I.
Z.
3.
4.
Date Time
Signature
UNDERGROUND STORAGE TANK
PERMIT APPLICATION
TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
1Perrnit *
TYPE OF APPLICATION:
CHECK ONE ONLY)
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Streetr. *—. s " Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 - 852 -2171
AG"IrIfF -
Page 1 of 1
NEW TANK INSTALL/NEW FACILITY NEW TANK INSTALL/EXISTING FACILITY(
MODIFICATION OF FACILITY MINOR - MODIFICATION OF FACIUrrY_ 1
STARTING DATE/ PROPOSED COMPLETION I1ln2Otr Zo(
F CILITY NAME ,, _ __5A EWSTTNG FACILITY PERMn #y `
Il—LE / QN < to /ham' 0
FACILITY ADDRESS ZIP CODE
TYPE OF BUSINESS 11_ APN #
IMwVV lC
TANKR
OSsWNER _ jNEPF 1{
S{33A2(oGt7 LtvKlvld (Av nvh 7 w'1
C NTRACiOR', CA LICENSE # ICG #
ADDRESS" ZIP CODE;
HONE AKEFELD SNESLICENSE
4;6
R 5 C P # IN E
fz
BRIEFLY DESCRIBE THE WORK TO BE DONE: f2 oJL:5 (/U C SOYA a T
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE
OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? 10 SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES NO YES NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK A VOLUME;' z UNLEADED`. REGULAR PREMIUM- -. >.'" a -: DIESEL ': OTHER°
t
Tank Testing Company
NAME F TESTING COMPANY
I
PHONE NUMBER /? 1 CA L'JIFbPLV_ J
MAILING ADDRESS
NAME OF TESTER -
Rau L.0 3-L
ICC* 1 6-iZ
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER
PENALTY OF PER3URY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED T $ APPR ;By,
Q'•
FD2086 (Rev 08/09)
a
r..
U 1
i ..
S
i`
a., PROPERTY OWNER
a DATE COMPLETION DATE NAME
i2-
NAME ADDRESS PHONE#
ADDRESS CITY BLtICFiR S IFLI% STATE CA Z_
lVI 3 C,
CONTRACTOR INFORMATION
Oil well (Installation, Inspection, or re- inspection) X 96 /hr
TOR NAME CA LICENSE #
73u
TYPE OF LICENSE EXPIRATION DATE
I-tAz
PHONE #
drzv. t3.5
96 /tent
TOR COMPANY NAME FAX #
After -hours inspection fee 121 /hr (2 hrs minimum) = $242
ZIP CODE
a_ _ -__i L. ___!_____J _i___J _J _ - -.J ww ww TA wl.A Tom. .T./ •AwV
1. '/V•.... .i •.. Y`ii VV •V.V VY .iiYl..'/VY N..Y Nrr•v r.Y • iv. •v rrvi.... i..v .. v... .
BANK OF AMERICA, N.A. 47155 .
CALIFORNIA HAZARDOUS SERVICES INC. 16-66/1220
2205 S. YALE ST DATE (acNECK Ab'
SANTA ANA, CALIFORNIA. 92704
714) 434 -9995 AMOUNT
16
zP 11 1 N L J II '
DRAFTING BY: WD 5ERV1(-
Underground Storage Tank (Minor Modification) MTM 167 /site 82
Underground Storage Tank (Removal) TR 573 /tank 84
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
F02021 (Rey 05/111
zP 11 1 N L J II '
DRAFTING BY: WD 5ERV1(-
POST CONSPICUOUSLY* BUSINESS TAX CERTIFICATE
Business name ..: CALIFORNIA HAZARDOUS SERVICES
Location address .: OUTSIDE CITY
Lic Nbr /Class ..: 14 00124248 CONTRACTORS
Issue date ....: 6/02/13 Expiration date .: 6/30/14
CALIFORNIA HAZARDOUS SERVICES
2205 S. YALE ST
SANTA ANA CA 92704
Owner /Officer
CALIFORNIA HAZARDOUS SERVICES,
BAIN, BELINDA
BUSINESSTAX CERTIFICATE IS HEREBY GRANTED. LICENSEE ISTO COMPLY WITH ALL LAWS AND ORDINANCES. ISSUANCE OFTHIS LICENSE DOES NOT CONSTITUTE AUTHORIZATION TO
CONDUCT BUSINESS IF LICENSEE HAS NOT OOMPUED WITHALLAPPLICABLE LAWS AND ORDINANCES. THIS LICENSE IS ISSUEDWITHOUT VERIFICATION THATTHE LICENSEE IS SUBJECT TO
OR EXEMPTFROM LICENSING BYTHE STATEOFCALIFORNlk
CALIFORMA- HAZARDOUS S_ ERVICES, "INC.A.
X Complef6 Fuel Tank Service. Company
ATTN: Building and 'Planning Department
Fire Department,
Environmental Health,
Hazardous. Materials Department
Re:. Authorized Agent Letter
Dear -Sir /Madame,
This letter is to authorize Ernie Bravo to _submit permit applications
along with plans in addition to. pickup, approved plans/permits/Jobcards on
behalf of California, Hazardous ..-Services- Inc.
Should you have any questions, feel free to contact our office.
Sipperely,
k4
B ihda Bain
President
3132.West,Adams SbrW ' Santa.Ans, CA 92704
TO: -(714) 434.9995 Fax: (714) 434:9998
Contractors License #734854 " SBA 8(i)1(B0):&- (.S'OB')- C6O*ed * WBE
WWWCOazborh
State Of California
f CONTRACTORS STATE LICENSE BOARD
Cnasumur ACTIVE LICENSE iAIr.
734.854 E CORP
CALIFORNIA HAZARDOUS
SERVICES INC
a.,,w, A HAZ
Em*400M 04/30/2015 www.cslb.c8.g0v
N
BEE/
A Ilu Resaoroe Gw mr
January 17, 2013
CALIFORNIA HAZARDOUS SERVICES, INCORPORATED
2205 SOUTH YALE STREET
SANTA ANA, CA 92704 -4426
Re: Barrett Business Services, Inc. ( "BBSI ")
Letter of Self- Insurance for Workers' Compensation Coverage
For CALIFORNIA HAZARDOUS SERVICES, INCORPORATED, CSLB license number
734854
821233
As the named addressee of this Letter, your company's required workers' compensation coverage is provided through
BBSI's state approved Self- Insured Workers' Compensation Plan. As a party to a co- employment contract with BBSI,
which is effective from 1/30/2013 until 01/30/14, California Labor Code §3602 allows CALIFORNIA HAZARDOUS
SERVICES, INCORPORATED to obtain its workers' compensation coverage from BBSI.
BBSI's California customers can also verify BBSI's state certification at http: / /www.dir :ca.gov /osip /PrivateRoster.pdf; then
scroll down to Barrett (the list is alphabetical by company name). Additional information is as follows:
State: California Employer Liability Limits:
Self Insurance Certification #: 2246 $5,000,000.00 Each Accident
5,000,000.00 Disease Coverage Limit by Client
5,000,000.00 Disease; Each Employee
Notice of Termination: In the event the contract between BBSI and CALIFORNIA HAZARDOUS SERVICES,
INCORPORATED is terminated, BBSI must provide notice of the termination within seven (7) days to the California
Contractors State License Board ( "CSLB ").
Other Comments (place an "X" if applicable):
X Named "Letter Holder": LA CITY FIRE located at 221 NORTH FIGUEROA STREET, 15TH FLOOR, SUITE 1500,
LOS ANGELES, CA 90012
Other: FOR ALL OPERATIONS IN THE STATE OF CALIFORNIA.
Additionally, BBSI's self - insured program is further supported by an excess workers' compensation insurance policy with
ACE American Insurance Co. Copy of certificate is available upon request.
For additional information, please contact your local BBSI office at: SANTA ANA
949) 255 -5322
Very truly yours,
doc: LOSI -3
Michael L. Elich
President and Chief Executive Officer
CALIHAZ -01 CARKE1
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DWYYYI()
2/12/2013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
V) Heffernan Insurance Brokers
Wilshire Blvd., Suite 1801
Los Angeles, CA 90017
CONTACT
NAME:
PHONE 1 213 622 -6500 AX No : 1 (213) 623 -1388AIC
MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC 0
2/1212014
INSURERA: Starr Surplus Lines Insurance Company
1,000,000
PREMISES Ea occurrence)
INSURED INSURER B:
5,0
INSURER C :
1,000,00
California Hazardous Services Inc.
INSURER D:
GENERAL AGGREGATE
2205 S. Yale Street
Santa Ana, CA 92704 INSURER E:
E 2,000,000
INSURER F :
5,000,000
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE 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.
ILTR TYPEOF INSURANCE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
POLICY NUMBER MMIDD FF MWDD LIMITS
A
17
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE Fx-1 OCCUR
X Professional Llabili
SLSLEIL72029813 211212013 2/1212014
EACH OCCURRENCE 1,000,000
PREMISES Ea occurrence) E 50,000
MED EXP (Any one person) 5,0
PERSONAL & ADV INJURY 1,000,00
GENERAL AGGREGATE 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOCCT
PRODUCTS - COMP /OP AGG E 2,000,000
CONTRACTORS POL 5,000,000
AUTOMOBILE LIABILITY
ANY AUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
NNON-OWNEDHIREDAUTOSAUTOS
Ea accident)
SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PER ACCIDEN s
S
A
X UMBRELLA LJAB
EXCESS LAB
X OCCUR
CLAIMS -MADE SLSLXNV73022213 2/1212013 211212014
EACH OCCURRENCE 5,000,000
AGGREGATE 5,000,000
DED I X I RETENTION $ 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YINANY. PROPRIETOR/PARTNER/EXECUTWE
OFFICERIMEMBER EXCLUDED?
Mandatory In NH)
H yyea describe under
DESCRIPTION OF OPERATIONS below
NIA
WR STATU- 0TR - LIM
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYE
E.L. DISEASE - POLICY LIMIT t
DESCRIPTION OFOPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IF more space Is required)
EVIDENCE OF INSURANCE
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2010/05)
C 1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2010/05)
C 1988 -2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
i .
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Certification Detail Page I of 1
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Contact
Certified Professional Information: Information
Last, First MI: Ochoa, Raul
I- eea- scc -sAFe
Certified under this name: Raul Cictloa (422 - 7233), ext.
Address: 1424 Pleasant View Ave 6624
City, state zap: Corona, CA 92882
Certification rype(a): California UST Service Technician (expires 11J29/2013) Contact Us
UST Installation/Retrofitting ,-..,— I ---
Vapor Recovery System Installation and Repair )
Listings here maynot reflect today'schanges, additions, exam results, or certificationsfrom organizations other than ICC (including BOCA, ICBO. and SSCCI)
Listings are updated nightlyon this web site, so please allow a full 24 hours forcharges to be reflected here ICC certification for code enforcementprofessions
attests to competent knowledge of construction codes andstandards in effect on the date of certification or renewal
ICC does its best to mamtam the privacy requests of its members and constituents If you believe that phone numberor address information fisted here should not
be tbsplayed please comas us at 1- 8884CC -SAFE (422.7233) between Sam and 7pm (CT) for personal assistance
Terms of Use: This fisting is provided as a serviceto the constituents of ICC for these purposes locating a certified professional or contractor in your area, or
confirmingstatus for mdvduals Any other use, safe, transfer, or reproduction in any form without the expresswritten consent of ICC is strictly prohibited. ICC
reserves theright toincorporate some false names to detect improper use of this service
One Resource— Multiple Green Rating Systems
hops:// av .icesalc.org /cwch /l)viiamicl)age. asps'? WehC :odc= ICC'Clt'l'[)ctail &cst_kcy= 0275... 4/10/2012
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GENERAL NOTES:
I . PREPARE AND SECURE AREA AS REQUIRED FOR THE
EXECUTION OF THE WORK TO BE COMPLETED.
2. CONTRACTOR SHALL PERFORM ALL REQUIRED
INSPECTIONS AND TESTING PER GOVERNING AGENCY
REQUIREMENTS.
3. ALL PARTS SHALL BE INSTALLED PER MANUFACTURERS
SPECIFICATIONS.
4. ALL WORK SHALL BE PERFORMED OR SUPERVISED BY
AN INDIVIDUAL WHO POSSESSES ALL APPLICABLE
VALID I.C.C. * MANUFACTURERS CERTIFICATION.
5. ALL REPAIRS TO BE MADE FROM IN51DE SUMPS. NO
EXCAVATION IS REQUIRED.
G. PRIOR TO D15CONNECTING THE VEEDER -ROOT TL5-350
MONITORING SYSTEM FOR ANY REASON,
CONTRACTORS MUST NOTIFY CAM (CALIFORNIA
ALARMS MANAGER) AND RECEIVE WRITTEN
CONFIRMATION 48 HOURS IN ADVANCE OF ACTIVITY,
CONTRACTORS MUST AL50 PROVIDE 15 MINUTE
ADVANCE NOTICE TO THE CAM @ I -800- KNOW -EH5;
PROMPT 2 -1 -2 ALL VEEDER -ROOT WORK, INCLUDING
DISCONNECTS, MUST BE DONE BY A VEEDER -ROOT
CERTIFIED LEVEL 4 TECHNICIAN.
7. ALL EXISTING BUILDINGS, STRUCTURES AND
EQUIPMENT SHALL REMAIN EXISTING UNLESS NOTED
OTHERWISE
SCOPE Of WORK:
O PIPING SUMP PENETRATIONS TO BE REPLACED. SEE DETAIL
AND PAKT5 LIST.
O PIPING 5U MP COLLAR TO BE REPAIRED. SEE DETAIL AND
PARTS LIST.
3O SUPPLY AND RETURN LINE TEST BOOTS IN PIPING SUMP TO 0BEREPLACED. SEE DETAIL AND PAKT5 LIST.
4. AFTER COMPLETION OF WORK ALL BAKRICADE5 AND DEBRIS
TO BE REMOVED AND 51TE RESTORED.
n
PIPING SUMP FILL SUMP
W/ SENSOR W/ SENSOR
I . 2. 3.
ANNULAR SENSOR
VENT LINE G K. DIESEL
TRANSITION SUMP W/ UST
SENSOR n
VENT RISER -\
PAN SENSOR
PIPING SUMP
PLAN VIEW
NOT TO SCALE
J
O
Y
SITE PLAN
GEOPAK 5AO96
NOT TO SCALE
PARTS LIST
ITEM PART NO. DESCRIPTION QTY.
OIKF 4151.4 ICON - SPLIT FLANGE REPAIR FOR CONDUIT 2
O IRE L3.5 LP ICON - SPLIT REPAIR FITTING LOW PROFILE I
O IRE L 4.8x1 .8x1 .4 ICON - LARGE ENCAPSULATING SPLIT REPAIR BOOT I
OIAC FASTFUSE FA5TPU5E - 5PLIT FITTING REPAIR BONDER NN
OIAC P5EALG2G PAKASEALANT G2G ,"G'ASKET SEALANT AND 6007 FILLER A/N
OAC 8007 WESTERN FI6EKGLA55 COLLAR REPAIR KIT AIN
O15K 1 .9 x 1 .9A ICON - 5PLIT REDUCER REPAIR BOOT W/ AIR
OISK 2.4 x 2.4A ICON - SPLIT REDUCEK REPAIR 6007 WJ AIR
NOTE: ALL COMPONENTS SHALL BE FURNISHED AND INSTALLED
PER MANUFACTURER5 INSTALLATION INSTRUCTIONS AND
STANDARD CONSTRUCTION PRACTICE.
I—
W
W
R/
Z
Z
D
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S-)
WILSON RD.
z
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PLANZ RD.
SITE VICINITY MAP
II CONSULTANT STAMP
BMD SERVICES
fOR
CALIFORNIA HAZARDOUS SERVICES, INC.
2205 S. YALE STREET, SANTA ANA, CA., 92704
C5LB Lic. # 734854
PHONE # (71 4) 434 -9995
REVISIONS / AUTHORIZATIONS
NO, REVISIONS / AUTHORIZATIONS DATE I BY
i
B— ,P DDEN'DLlIVI°f OJADB?OT.. ._ sflgii'3
PROPRIETARY AT &T INFORMATION
NOT FOR GENERAL USE OR DISCLOSURE OUTSIDE OF AT &T
THIS INFORMATION MAY ONLY BE USED BY AUTHORIZED
PERSONNEL OF THE LOCAL GOVERNMENT AGENCY IN CONNECTION
WITH APPLICATION FOR PERMITS AND AUTHORIZATIONS FOR
BUILDINGS, CONSTRUCTION, AND/ OR ZONING CHANGES.
DRAWINGS PREPARED FOR
00 at&t CORPORATE
READ ESTATE
PROJECT TITLE1
AT T (SA098)
3221 5. "H" STREET BAKERSFI ELD
CA., 93304
SERVICE TICKET# CH- I 1 77 * CH -1 175
SHEET TITLE+ SITE PLAN V
PIPING SUMP PENETRATIONS
TEST BOOT REPAIR
AT &T PROJECT NUMBER: DATE: 08/09/ 13 SCALE: NOT TO SCALE
GEOPAK SA098 DRAWN BY: E. BRAVO CHECKED BY:
AT &T AUTHORIZATION;
AUTHORIZATION -SIGNATURE
SHEET: OF:
DRAWING NO,;
13- 197 -0
SHEETS SHEET NO.
I
SHEET-TITLE NO
SP
0
0
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9
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SITE LOCATION W
Z 3221 S. H ST. H-1
CL/ J
C
Z
N
PLANZ RD.
SITE VICINITY MAP
II CONSULTANT STAMP
BMD SERVICES
fOR
CALIFORNIA HAZARDOUS SERVICES, INC.
2205 S. YALE STREET, SANTA ANA, CA., 92704
C5LB Lic. # 734854
PHONE # (71 4) 434 -9995
REVISIONS / AUTHORIZATIONS
NO, REVISIONS / AUTHORIZATIONS DATE I BY
i
B— ,P DDEN'DLlIVI°f OJADB?OT.. ._ sflgii'3
PROPRIETARY AT &T INFORMATION
NOT FOR GENERAL USE OR DISCLOSURE OUTSIDE OF AT &T
THIS INFORMATION MAY ONLY BE USED BY AUTHORIZED
PERSONNEL OF THE LOCAL GOVERNMENT AGENCY IN CONNECTION
WITH APPLICATION FOR PERMITS AND AUTHORIZATIONS FOR
BUILDINGS, CONSTRUCTION, AND/ OR ZONING CHANGES.
DRAWINGS PREPARED FOR
00 at&t CORPORATE
READ ESTATE
PROJECT TITLE1
AT T (SA098)
3221 5. "H" STREET BAKERSFI ELD
CA., 93304
SERVICE TICKET# CH- I 1 77 * CH -1 175
SHEET TITLE+ SITE PLANV
PIPING SUMP PENETRATIONS
TEST BOOT REPAIR
AT &T PROJECT NUMBER: DATE: 08/09/ 13 SCALE: NOT TO SCALE
GEOPAK SA098 DRAWN BY: E. BRAVO CHECKED BY:
AT &T AUTHORIZATION;
AUTHORIZATION -SIGNATURE
SHEET: OF:
DRAWING NO,;
13- 197 -0
SHEETS SHEET NO.
I
SHEET-TITLE NO
SP
0
0
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BILLING & PERMIT STATEMENT
f BAKERSFIELD FIRE DEPARTMENT
9 R s P B D Prevention Services
PERMIT # PINE 2101 H StreetANyms
Bakersfield, CA 93301
Dhnnc• AA1 _'V)A:ZQ7Q Fav• F,F,1 _RS7_71 71
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
Alarm - New & Modification (minimum charge) $280
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) $470
Additional Hood 58 hood
Commercial Hood - Minor Modification add /move nozzle 8496 (inspection only)
1 Spray Booth (New & Modification) $470
boveground Storage Tank (1 inspection per installation) AST
SITE INFORMATION
LOCATION OF PROJECT PROPERTY OWNER
T 45 T3Z-57 6,
STARTING DATE COMPLETION DATE NAME
A'U 67 •Z.(d IZb1_j ^ U C-7 76 (3
Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR
PROJECT NAME ADDRESS PHONE #
PRO ECT ADDRESS CITY g ERS IFLp STATE C/-C ZIP
0
CONTRACTOR INFORMATION
82
CONTRACTOR NAME CA LICENSE #
734
TYPE OF LICENSE EXPIRATION DATE PHONE #
C c_ . o 2 tA cis 2v. 854 Os. I (s4Z - 15 c,RS
CONTRACTOR COMPANY NAME FAX #
ADDRESS
2-_? Q5 S 1_
Y A ZIP CODE
1 i 2-?0
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK.
Alarm - New & Modification (minimum charge) $280
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) $470
Additional Hood 58 hood
Commercial Hood - Minor Modification add /move nozzle 8496 (inspection only)
1 Spray Booth (New & Modification) $470
boveground 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
44 Underground Storage Tank (Minor Modification) MTM 167 /site 82
Underground Storage Tank (Removal) TR 573 /tank 84
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
TAI T
MI.NO TO TN! CNAL lNG!
September 27, 2013
VIA FED EX: 7967 8804 4090
Bakersfield Fire Department
2101 H Street
Bakersfield CA 93301
Re: Secondary Containment Testing
Pacific Bell Telephone Co. dba AT &T California
3221 S. H STREET, BAKERSFIELD, CA
GEOPAR: SA098
To Whom It May Concern:
Enclosed are the results for the following tests completed on September 20,
2013:
Secondary Containment Testing Report Form
Please do not hesitate to call me if you have any questions.
Very r y Yours,
M enison
Manager
CA Iic# 588098 1 AZ Iic# 095984 1 NV lic# 0049666 1 TX Iic# CR0000041
Secondary Containment Testing Report Form
Thisform is intendedfor use by contractors performingperi odic testing of UST secondary containme ni systems. Use the
appropriate pages ofthis form to report resultsfor all components tested The completedform, written test procedures, and
printouts from tests (ifapplicable), should be provided to the facility owner /operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION Facilitv ID: SA098
Facilit Name: Pacific Bell Telephone Co. dba AT &T California Date of Testing: 9/20/2013
Facility Address: 3221 S. H STREET, Bakersfield, CA 93304
Facility Contact: Grant Annstrong Phone: (661) 327 -6903 r Initial r Repair Test
Date Local Agency Was Noti fied Of Testing: 8730/2013 r 6 Month r Other
Name of Local Agency Inspector (if present during testing): Ernie Medina r' Triennial
2. TESTING CONTRACTOR INFORMATION
Company Name: Tait Environmental Services
Technician Conductin Test: Richard Hairebomee
Credentials: P—j CSLB Licensed Contractor r SWRCB Licensed Tank Tester r ICC UST Service Technician
License Type: A B ASB C -10 HAZ License Number: 588098
Manufacturer Training
Manufacturer Component(s) Date Training Expires
ICC 5252138-UT 1/28/2014
Franklin Fueling- Incon STS 1636763701 4/5/2014
r rl r r
Fill Sump- SA098U001
3. SUMMARY OF TEST RESULTS
Component Pass Fail Not
Tested
Repairs
Made Component Pass Fail Not
Tested
Repairs
Made
Annular- SA098UOOI r—n r r r r rl r r
Fill Sump- SA098U001 r r r r r r r 12
Piping Sump- SA098U001 v; j- I r r r r r r
Vent Secondary-SA 098U001 r!—. r r r r r r r
Supply Sec.- SA098U001 r r r r7l r r r
Return Sec: SA0980001 r!—11 r1 17 r—i r—j r r r
r r r r r r r r
El r r r r r r r
E r r r r r r r
L-_ r I r r r r r r
If hydrostatic testing was performed, describe what was done with the water after completion of tests:
Test water returned to Tait's shop
For any equipment capable ofgenerating a printout of test results, you must attach a copy of the test report to this
certification r!—! System printout attached.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
To the best ofmy knowledge, the facts stated in this document are accurate and in full compliance with legal requirements
Technician's Signature: Q, Date: 19/20/2013 `
4. TANK ANNULAR TESTING
Test Method Developed By: r Tank Manufacturer r Industry Standard F Professional Engineer
r Other(Specify)
Test Method Used: r Pressure F vacuum F Hydrostatic
r Other(Specify)
Test Equipment Used: 4" Dial Guage Equipment Resolution: .2
k,
LAl
T
Tank
SA098U001
Tank Tank Tank
Is Tank Exempt From Testing? Yes F No r Yes F' No r Yes F No F Yes No
Tank Capacity: 6000 Gal
Tank Material: Clad Steel
Tank Manufacturer. Modern Welding
Product Stored: Diesel
Wait time between applying
pressure/vacuum/waterand
starting test:
I Hour
Test Start Time: 10:00 AM
Initial Reading (R1): 10" HG
Test End Time: 11:00 A M
Final Reading (Rd: 10" HG
Test Duration: 1 Hour
Change in Reading (RF -Rj): 0
Pass/Fail Threshold or Criteria: 0
Test Result: F Pasts Ci Fail Pasts Fail i Passim C Fail Pasts Fail
Was sensor removed for testing? r, No I_f' NA
F—
I ,, Yes 1 ! No 1 NA rI _i Yes I_J1 No F NA
rr
1__ Yes 1_ No I_i NA
Was sensor properly replaced and
verified functional after testing?
r r rI .. Yes Imo! No' NA Yes F' No I NA
r rf Yes F No' NA
r rrYesr— Nor -1 NA
umments — (mcluae lnjormauon on repairs made prior to testing, and recommendedjollow -upjorjail ea
Sensor was reinstalled at lowest point but not verified functional.
1) Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary
containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic
containment testing. ICaliforniaCode of Regulations, Title 23, Section 2637(a)(6))
5. SECONI)ARV PIPE TE.qTINC.
Test Method Developed By: F Piping Manufacturer F Industry Standard F Professional Engineer
Other(Specify)
Test Method Used: F Pressure F Vacuum r Hydrostatic
F Other(Specify)
Test Equipment Used: 4" mDial Guage TEquipment Resolution: .2
1V01 '
Piping Run
Suppy Sec. SA098U00 I
Piping Run
Retum See, SA098U00I
Piping Run
Vent Sec. SA098000I
Piping Run
jPiping Material: Poly Poly Fiberglass
Piping Manufacturer: Western Fiberglass Western Fiberglass A.O.Smith
Piping Diameter: V, 1.5" 3"
Length of Piping Run: 35' 35' 35'
Product Stored: Diesel Diesel Diesel
Method and location of piping-run
isolation: Test Boot Test Boot Test Boot
Wait time between applying
pressure/vacuum/water and
starting test:
15 Min 15 Min 15 Min
ITest Start Time: 9:00 AM 9:00 AM 9:00 AM
Initial Reading (R,): 5 PSI 5 PSI 5 PSI
Test End Time: 10:00 AM 10:00 AM 10:00 AM
Final Reading (RF): 5 PSI 5 PSI 5 PSI
Test Duration: I Hour I Hour I Hour
Change in Reading (RFRj): 0 0 0
Pass/Fail Threshold or Criteria: 10 0 10 1
Test Result: I FF Pass 7' Fail F!_1 Pass F Fail I F-1 Pass r--', Fail I F Pas
L_uitiitiviits —(inctuae injormation on repairs maae prior to testing, ana recommenaeajoitow-up jor jailea
6. PIPING SUM PTESTING
Test Method Developed By: r Sump Manufacturer F Industry Standard r Professional Engineer
r Other(Specify)
Test Method Used: r Pressure r Vacuum F Hydrostatic
Other(Specify)
Test Equipment Used: Incon STS Equipment Resolution: .0006
Sump ump Sump Sumphi0SA0980OOI
Sump Diameter: 48"
Sump Depth: 51 "
Sump Material: Fiberglass
Height from Tank Top to Top of
Highest Piping Penetration: 22
Height from Tank Top to Lowest
Electrical Penetration: 15„
Condition of sump prior to Good
testing :
Portion of Sump Tested (1) 2" above penetration
Does turbine shutdown when
sensor detects liquid (both rrY.1 .1 No 1- NA
r r rI . Y. I No 1 NA
r r rIIY. 1 No I .: NA r r rt : Y. I . ! No I NA1sump
product and water) ?*
Turbine shutdown response time NA
Is system programmed for fai I- r- F Y. r_ No I NA r r— F Y. I No NA t— F Yes 1 No I NA r I— 1 Yes No I..., NAsafeshutdown ?*
Was fail -safe verified to be r r r
I Ym 1 No 1- NA r r r
L.. Ym I No I NA
r r r1iYmINoIi NA r
Ya I No NAoperational ?* i
Wait time between applying
pressure /vacuum /water and 15 Min
starting test:
Test Start Time: 9:44 AM 10:00 AM
Initial Reading (Rt): 4.6704 4.6704
Test End Time: 9:59 AM 10:15 AM
Final Reading (RF): 4.6703 4.6703
Test Duration: 15 Min 15 Min
Change in Reading (RF.Rt): 0001 0001
Pass/Fai I Threshold or Criteria: 002 1.002
Test Result: Pass r Fail r IPass Fail r Pass f - Fail r Pass r Fail
Was sensor removed for testing?
fir-:
F Y. r No 1_,_ NA r Ym Nor NA r Yes r No r NA r Yes r No r NA
Was sensor properly replaced and rrY. 1- No r NA r r r
1 Yes 1. No 1 NA r1 Yes r No r NA r Y. ' Nor NAverifiedfunctionalaftertesting?
Uo11 meats - (include information on repairs made prior to testing, and recommendedfollow -up for failed tests)
Sensor was reinstalled at lowest point but not verified functional.
1) Ifthe entire depth of the sump is not tested, specify how much was tested Ifthe answer to any of the questions indicated
with an asterisk ( *) is "NO" or "NA ", the entire sump must be tested. (See SWRCB LG -160)
8. FILL RISER CONTAINMENT SUMP TESTING
Facility is Not Equipped With Fill Riser Containment Sums r
FiI I Riser Containment Sum s are present, but were Not Tested r
Test Method Developed By: F Sump Manufacturer F Industry Standard r— Professional Engineer
r Other(Specify)
Test Method Used: r Pressure r Vacuum r Hydrostatic
F Other(Specify)
Test Equipment Used: Incon STS Equipment Resaollutiioon:.0006
11
2 IY
J `
Ako ;:it '"Cr'",.Se!`fi${ ^- +if`ff.":91
Fill Sump Fill S um Fill Sump
SA09811001
FillSump
Sump Diameter: 48"
Sump Depth: 50"
Height from Tank Top to Top of
Highest Piping Penetration: NA
Height from Tank Top to Lowest
Electrical Penetration: 12
Condition ofsump prior to
testing :
Good
Portion ofSump Tested: 2" above pen.
Sump Material: Fiberglass
Wait time between applying
pressure /vacuum /water and
starting test:
15 Min
Test Start Time: 9:44 AM 10:00 AM
Initial Reading (RI): 2.0119 2.0121
Test End Time: 9:59 AM 10:15 AM
Final Reading (RF): 2.0121 2.0122
Test Duration: 15 Min 15 Min
Change in Reading (RrRt): 0002 0001
Pass/Fai I Threshold or Criteria: 002 1.002
Test Result: Passs Fail Pass F', Fail PasssF! Fail PasssF Fail
Is there a sensor in the sump?
rF
F, Yes r No
r
F Y. I_1 No
r
r__I Ye I_1 No 1_J Y. I_I No
Does the sensor alarm when either
product or water is detected?
rr rYes1-1 No ' --% NA r r rYmrNo1 - NA
rrYes ' -, No - NA
r rJYesF No r - - NA
Was sensor removed for testing? r rr rl Yes L_1 No rJ NA r-J Yes 1—; No 1_,[ NA rr r
I J Yes r_.1 No 1
Jk
NA Yes 1_I No F. NA
Was sensor properly replaced and
verified functional after testing? r ;; 1, _' Yes Ri No F NA r— r- ri Yes F No 1 _ I NA F-1 ''; r
Yes r.. it No 1 : NA
r— rr F I j Yes 1_' No I _' NA
Comments — (include information on repairs made prior to testing, and recommendedfollow -upfor failed tests)
Sensor was reinstalled at lowest point but not verified functional.
9
ATT I ATT
3221 S,H STREET 3221 S,H STREET
BAKERSFIELD BAKERSFIELD
CALIFORNIA CALIFORNIA
TAIT ENVIRONMENTAL TAIT ENVIRONMENTAL
09/20/2013 9 :59 AM 09/20/2013 10:15 AM
SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT
FILL FILL
TEST STARTED 9:44 AM TEST STARTED 10:00 AM
TEST STARTED 09/20/2013 TEST STARTED 09/20/2013
BEGIN LEVEL 2,0119 IN BEGIN LEVEL 2,0121 IN
END TIME 9:59 AM END TIME 10:15 AM
END DATE 09/20/2013 END DATE 09/20/2013
END LEVEL 2,0121 IN END LEVEL 2,0122 IN
LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED TEST RESULT PASSED
PIPING PIPING
TEST STARTED 9:44 AM TEST STARTED 10:00 AM
TEST STARTED 09/20/2013 TEST STARTED 09/20/2013
BEGIN LEVEL 4,6704 IN I BEGIN LEVEL 4,6704 IN
END TIME 9:59 AM END TIME 10:15 AM
END DATE 09/20/2013 END DATE 09/20/2013
END LEVEL 4,6703 IN END LEVEL 4.6703 IN
LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN
TEST RESULT PASSED TEST RESULT PASSED
l
TEST DATE: 9/20/2013 CLIENT: AT &T GEOPAR: SA098 PAGE ^I_ OF -1. -