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HomeMy WebLinkAbout3225 BUCK OWENS BOULEVARD SPILL TEST 2013HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. 13-160 6s File Number: 3n!5- Co Address: Date Received: sa5 - i3 Business Name: Bakersfield, CA 933 Comments: 1. 2. 3. 4. INSPECTION LOG Date Time S 0%13 &-1 Signature Signature SYSTEM: r BUILDING SQUARE FEET: New Mod. Commercial Hood System Building Sq. Feet: Fire Alarm System Calculation Bldg. Sq. Ft: Fire Sprinkler System 5pg'ay FWsh sy/seam Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank 0--" Other k ems- 1 es= Comments: 1. 2. 3. 4. INSPECTION LOG Date Time S 0%13 &-1 Signature Signature 2560 Soquel Avenue Ste 202 Santa Cruz CA 95062 T: 831.475.8141 F: 831.475.8249 CA Lie# 693807 A-HAZ Secondary Containment Testing Report Form 1. Facility Information Facility Name: Valero 3074 Date of Testing: 05/30/2013 Facility Address: 3225 Buck Owens BLVD Bakersfield, CA 93308 Facility Contact: 1 Phone: 661-324-9481 Date Local Agency Was Notified of Testing 0511712013 i Name of Local Agency Inspector (if present during testing): 2. - Testing Contractor Information Manufacturer Component Expiration Date INCON TS-STS 12/12/2014 3. Summary of Test Results Component P F N Component P NTJ RM Spill Buckets: All 1:1 0 El D El 0 0 0 0 CERTIFICATI To the best ofmy knowledge, Technician's Technician's Narqk: Jonath6n Ocker I of 2 TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING Y stated in t,)4s doco(nr%t are accurate and infidl compliance with legal requirements Date: 05/30/2013 4. Spill /Overfill Containment Boxes Test Method Developed By: Tank Manufacturer 0 Industry Standard Professional Engineer Test Method Used: Pressure vacuum Hydrostatic Test Equipment Used: Incon TS STS Leak Detector Equipment Resolution: ±0.002 Spill Box # 87 I Spill Box # 91 I Spill Box # Diesel I Spill Box # Bucket Diameter: Bucket Deoth: 14" 14" 14" Wait time: i 15 min 15 min 15 min Test Start Time: 4:13 7.9925 . _ • 4:56 6.9553 3:41 Initial Reading:.. 6.9203 Test End Time: 3:56 4:28 5:11 Final Reading: 6.9198 7.9926 6.9562 j Test Duration (hh:mm) : Change in Reading: 00:15 0.0005 j 00:15 0.0001 i 00:15 0.0009 00:00 0.0000 Pass /Fail Threshold or Criteria: 0.002 0.002 0.002 0.002 e8ti1R0Sll tk i i Ii 'r t a PaSSti y Q FaII p pptk t T Comments: 2 of 2 VALERO 3074 VALERO 3074 VALERO 3074 3225 BUCK OWENS BLVD 3225 BUCK OWENS BLVD 3225 BUCK OWENS BLVD BAKERSFIELD CA 93308 BAKERSFIELD CA 93308 BAKERSFIELD CA 93308 661 - 324 -9481 661 -324 -9481 661- 324 -9481 05/30/2013 4:28 PM 05/30/2013 5:11 PM 05/30/2013 3:56 PM SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT SPBX -91 SPBX -D SPBX -87 TEST STARTED 4:13 PM TEST STARTED 4:56 PM TEST STARTED 3:41 TEST STARTED 05/30/2013 TEST STARTED 05/30/2013 PM TEST STARTED 05/30/2013 BEGIN LEVEL 7.9925 IN BEGIN LEVEL 6,9553 IN BEGIN LEVEL 6;9203 IN END TIME 4:28 PM END TIME 5:11 PM END TIME END DATE 05/30/2013 END DATE 05/30/20133:55 PM END DATE 05/30/2013 END LEVEL 7.9926 IN END LEVEL 6, 9 62 -,IN END LEVEL 6,9198 LEAK THRESHOLD 0,002 IN LEAK THRESHOLD 0,002 IN IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSED TEST RESULT PASSED TEST RESULT PASSED VALERO 3074 I 3225 BUCK OWENS BLVD BAKERSFIELD CA 93308 VALERO 3074 661 - 324 -9481 3225 BUCK OWENS BLVD VALERO 3074 BAKERSFIELD CA 93308 3225 BUCK. OWENS BLVD 05/30/2013 4 :12 PM 661- 324 -9481 BAKERSFIELD CA 93308 661 -324 -9481 SUMP LEAK TEST REPORT 05/30/2013 4:45 PM 05/30/2013 5:26 PM SPBX -87 SUMP LEAK TEST REPORT SUMP LEAK TEST REPORT EST STARTED 3:56 PM SPBX -91 LEST STARTED 05/30/2013 SPBX -D BEGIN LEVEL 6,9197 IN TEST STARTED . 4:30 PM END TIME 4:12,PM TEST STARTED '05/30/2013 TEST STARTED 5:11 PM END DATE '05/30/Q13 BEGIN LEVEL 7,9926 IN TEST STARTED 05/30/2013 END LEVEL 6,9198 IN END TIME 4 :45 PM BEGIN LEVEL 6,9562 IN LEAK THRESHOLD 0,002 IN END DATE 05/30/2013 END TIME 5:26 PM TEST RESULT PASSED END LEVEL 7,9926 IN END DATE 05/30/2013 LEAK THRESHOLD 0,002 IN END LEVEL 6,9562 IN TEST RESULT PASSED LEAK THRESHOLD 0.002 IN TEST RESULT PASSED 0- UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD/LINE TESTING/ SB989 SECONDARY CONTAINMENT TESTINGITANK TIGHTNESS TEST AND FUEL MONITORING CERTIFICATION Please note that these are separate Individual tests and will be charged per separate type test accordingly.) PERmrr.* I I It.. LL ARrAW 4%OC BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 18I i EmKmmo LEAK wmcnow U14E TESTING sB-99qsEmNmRyCONTAINMENT TAWTIGHTNESS FUEL moNrr=NG CERTIFICATION tk 'o,+- — -- rah SITE INFORMATION FACUTY —I NAME & PHONE # OF CONTACT PERSON3D7tjr ADDRESS 275- ?htrA(- OL aevjc ficad --AxkwRta OA 16-61. sw - Ut ovaim NAME C's T I&vwld S ?n C, • (41r"V!4&(L t Amu"m q!tr- OPIWATOR "C PERMIT TO OPERATE OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES E3 NO VOLUME CONTENTSTANK0 A- 1 1S LUA WAIA W- IOV.- muzw 13 20V- t>ieW TANX TESTING COMPANY TESTING COMPANY_ AME It PHONE 0 OF CONTACT PERSON M ADDRESS -; G AWRESS z Suo 44-"a AvOyAlL #U2-- SM '0,M-3- CM062- NAME & PHONE * OF TESTER OR SPYaAL INSPECTOR CB07FICXTION # DATE &TIMEE TEST TO BE CONDUCTED A- fcc 0 TEST 4ETHoD 16ot CA1000 AMIC%NT 5[ RE DATE S= L'-IN 2A 2 a A THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVEo 91 DATE a, &— e FD2095 (Rev 03108) 16 UMMD PROGRAM CONSOIMATBD FORM UNDERGROUND STORAGE TANK OPERATING PERWr APPLICATION - TANK INFORMATION (ow &rm w U ACnONnWMV (Chwkom item only. Foren UST ppmmaeut olceme or mmoval, oompleto only this sectionaad.Swlooe I,'II, III, IV, and IX below) IT 3. RENEWAL PERMIT S, CHANGEOF INFORMATION 6. TEMPORARY UST CIASURE 9, USTPERMANENT CLOSURE ON SITS 8. UST REMOVAL 4X DATE USTPERMANENTLY CLOSED: DATE EXISTING UST DinmVERED t T( '.Q.'" FACILrN ID q (Agony IkeOnly) BUSrMS NAME (Samess,FACILTIY NAME or DBA -Doing Business As) 54AA i f 0yj BUSINESS STI'O ADDRESS CITY1229-BuCK t"WCPatI I OTC DN TAI41(ID q 4n TANK MANUFACTURER rrr (i TANK CONFIGURATION: TRISTAMIS ASTAND-ALONE TANKM2: ONE INA CMeARFMEN18DUNIT. DATE UST SYSTEM D STAR ED 4m YANK CAPACITY GALLONS NUMBER OF AR INTHEUNIT t, r A21fiU TANK USE Is. MOPOR VBNNXBflIBLINO O 1b, MARINA LM Ia AVIATION FUBLWO 3. CHEMICALPRODUCT STORAGE 4. HAZARDOUS WASTE (Laddwed MQ (3 LEMERORMYOBNIEFtATOR PURL (BSc psnu" 6.0THEROBNER mR'FUEL cl 95. UNKNOWN Q 99.OTHER mew1b. 4S90 CONTEM PETROLEUM: Is, RSOUI.AR UNLEADED Q la MIDORADB UNLEADED lb. PREMIUM UNLEADED 3. DIESEL O S. ISTPURL 6. AVIATION OAS Q a.PHTROLNUMBLENDFUEL 9. OTHER PBIAOLSUM Ispecift, 8 414 NO)d -PHT OLWM 1. USEDOIL 10. ETHANOL I I.OTHBR NON- PEIROLeUM 440 1`V: . •CU1V83'1ttJL'I'IdN " TYPE OF TANK 0 I, SINOLS WALL 2. DOUBLEWALL P 95, UNKNOWN PRIMARYOOMAINMgM 1, STEM ML 3.IID 6.114THRNALBLADDER T, MRL 4 D,ITBRNAL LININO 95. UNKMWN 99.OTIIBR 444 SECONDARY CONTAINMENT I. STBBL . FIBERGLASS 6. EXTERIOR MEMBRANELINER T.IACKETBD 90. NOT1H 95. UNKNOWN Sus MAZER N I. AUDIBLE d VISUAL 2. FALL FWAT 3. FILLTUBE SHUT-0FP VALVE 4. TANK MRKT9 RSQUIRSMIDM FOR EXEMPTION FROM OVERPI L PREVENTION EQUIPMENT V.' PRO UCT / WAM PIPING GOrIBT$UC"ONQ SW .99. QTMPHINGCONSTRUCTION1. OLB- WALLED WL DOUBL&WALIBD 40 gygTyM TYPE I. PRESSURE 0 L GRAVITY W 3. CONVBNTIONALSULTION P 4. SAFBSUCT[ON d CIR PRIMARY COMAB4H8NT I. STERN RL 4. PIDSROLASB a. PLEMLE Lj I& RIGID P C 90. NONE P 93. U14MWN 9D, OTH 464. SECONDARY ODMAIT4MBNlI 1. JIBm <. FIBERGLASS lJ B. tnBIXIBLE 0 10. woo PLA8TIC 90.NONE 95. UNKNOWN 99, OTHER lyl: r6k PIpq*n anM CONTAINMENT SUMPTYPE t. SINOIdiWALL CR LDOUBLE WALL 90, NONE VJ.1 NT, VAFQR.RRtvO Y ANp RIM / nLL PIPE PUgNG CONSTRUCTION VENTPRIMARYCOWTARAINNT IWI.STHM 4.FIBER 0.RMIDPLATM E3 90. NOM Q 90, antER. fteft) •' VENTOWWWRYCONTAINMENT Ll 1. STEM U 4. PIBBROLASB 10. RiOm . NONE 99.OTNER (8psatm VRPRIMARY CONi'AMMHNT 0 1. MEL PVJ.PMnOLASS Ej 10• R101D PLASTIC El 90. ) VROBODNDAAYCOMABOA M 1, STE]B. 0 4. FIBERGLASS IA RIGID PLASTIC 90. NONE 99. OTHERMUM IilYl VBHI PIPINO IRON BUMPTYPE 1, SINOLB WALL 2. DO ELE WALL 0. RISERPRIMARYCONTAINMEN 1. STEEL U CKHRROLASS F. U to. RIGID PLASTIC Li 90. 99. OTHER RIMSECONDARY CONTAINMENT ' LMEL 13 4. 10.11OIDPLASTIC WKNONII . OTHIM (Spec I FBICOMPONENTS INSTALLED 81gLLB 3.8TRD= PIATEMOTTOM PROTECTOR q 4. CONTAIt4MENTSUMP 4SIva V-m UND9k DISPINM CONtAOMM (UDC) CONSTRUCTIONTYPE f. 8[NOLB WALL 2. DOUEIB WALL. 3. NO DISPE43BR8 90. NONE CONSTRUCTION MATERIAL 1. STEEL 4. PIEBROLA89 10. RIGIDPLASTIC 99.O7TTER ( 45Wc VM. COR11Rb8I0N PRQ1ECMf4 STEEL COMPONENTPROTECTION 2. SACRIFICIAL ANODB(S) 4. IMPRESSED CURRENT Q 6. ISOLATION I . &PP4ICAM SIGNATUn CSnmcArDN: I tuft tbA!pUST sy.tem mpatl1* with &e baurdm substance stored and thatthe mforelatl8m provided herein h tree, aeeerah, and d fidl.A6olllanes wIJeWreqWreWmtw, APPLICANTSIONAM j DATE 4706 tAPPLICANTNAME rAAJ APPL(CANf TITLE ct UPCF VST•B • in Rev. (111200'1) UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION One tbrm per UST) TyPEOF ACTION (Chad onoItemonly. ForanUST PRmaneot closure or renwvel, complete only this eeel)nn and &cation I, II, lM iV, andDf below) 4" SF 11. NEW PIRtIMTI' 3. RENEWALPERMIT [15. CHANGE OF INFORMATION 6.7TMPORARY UST CLOSURE 0 7. USTPHRMAMENT CLOSURE ON Sfl'E Q & UST REMOVAL DATE UST PERMANERMY CLOSED- U0 DATE MGS` NG UST DISCOVERED': FACHIN ID g (AgencyUse Only) BUSDM NAM (Same as FACILITYNAME orDBA -DoingBusiroar Ae) a-lev o i` - s . b BUSINESS SITE ADDRESS CirY• a TANX M 0 TANK MANUFACTIMER 4LJ U TANK OONPIOl1RATION: THIS TANK 19 A STAND•ALONSTANK NOtX114PARTl1WM IDd1' . one rQeadt io 04 DATE UST S ALLED 433 TANK C/ IN GALLONS 436 NUMBER OF COMPAR INTHE UNIT 4 TANK USE la.•MOTOR VIMKU FUELMO ld MARINA FUddNO le. AVIATION FUELING 3. CH8MW-AL PRODUCT STORAGE, D 4. HAZARDOUS WAMfWdadslbod010 S. BMFROBNCY OBNSAATOR PURLtMC PMLSIdJ Cl 6.07HERGE NBRATOR FUEL Cj 91 UNKNOWN 99. OTHER 433A CONTEN73 PETROLEUM:, 13 1R REGULAR UNLEADED la MIDORADEUNLEADED Grib. PREMIUM UNLEADED 3. DIESEL - 3. JET FUEL O 6. AVIATION OAS 8. FETROLEUM BLEND FUEL 9.OTIBRPETROLEUM 40 NWPFPETROIBUM: 7. USED OIL 10. ETHANOL 11.OTMM NON•PUMLAUM 1176 IV; 1AWORMOCtION TYPE OF 1. SINGLE WAts s. DOUBLE WALL 9s. UNKNOWN PRIMA &Y CONTAINMEM El I. STEEL WU PBB 6. INTERNAL BUDDER I.STEM- +JNTERNALI= 95. UNKNOWN V. On= 4% SBCANVDARY 0ONTAINMHNf 1. STEEL FIBERGLASS 6. M* MIJOR MEMBRANE LINtIt 7. IACKSTED 90. NONE 13 95. UNKNOWN ".OTHER 41L OVBUPBLPREVBNfION i 1. AUDIBLE AVISUAL ALARMS 2. HILA FLOAT 3. FRITUBESHUT -OFF VALVE 4. TANK MOM REQUIREMENTS FOR MCBMPi'ION FROM OVELFBL FREVWmN H UJPMHNT V. ' PitOOIICT / WASTE PIPING CO1VS]1 IICLYON FIFMCONSTRUCTION 1. SGNOLE- WALLED 2. DOUBC.B-WALLED 99. OTHER SYSTEMT YPH I. PR838URB 14 2. GRAVITY q 3. CONVBNTTONAL SUCTION 4. SAFE Sl1CTlONmCCA PRIMARY CONTAINMENT- 0 1.8--- n 4. PTBEAOLAES Ll S. FLEXIBLE Ll 10. RIGID PLASTIC El 90. No" 95, i1M0gWN 99. 164 SECONDARY COMAINWW I, STEED 4. FTBBROM 8. FLEXIBLE L0. RIGID PLASITC O 90. NONE j 95. UNKNOWN O 90. OTHER 4640 p1PIN0I1URSINE CONTAINMENT SUMP TYPE 91W. SMGLB WALL ET2. DOUBLE WALL N 90. NH VL VNT, VAPQR (V ) AND MISER l Fil L.PIPE PIPING CONRTRUCTION VENT PRIMARY CONTAINMENT 1. STEEL 4. F[Bi%.GLASS U 1D.RMIDILASTIC El 9A NONE 99. OTHER Mm*) VBNTSRCONDARY COMALNMBNfI. STBBL Ll 4. FIBERGLASS 13 10. RIOCD PLASTIC . NONE 0 9o. OTHER (SpedW CVRPRIMARYCONfAINMENfI. NnML W4. FIBERGLASS Q 10, RIOW FU=- Lj 90. NONE 0 90. 0' WM.(9pecifjl VR SECONDARY CONrAnQAW 0 1. STEEL 4. FIBERGLASS Cl 10. RJOtO PLASTIC 99. OTHERftft*) 46Q 4661 VENTPJPIW f17ON SUMPTYPE 0 1. SINGLE WALL 2. DOUBLE WA 95. NONEBEIRISERPRIMARYCONTARWENT49LSTEELEl4. FIBEROLASS t0. RIGID PLASTIC U 90. NONE El 99. OTHER (Sp g') RXERSECONDARY COMAINMHNP 0 Emmi, C KBERGLAW (0. RIGID PLASTIC 0 90. NONE 0. OTHER 461k1 FILL COMPONENTS INSTALLED mmi.spimiuckur El 1 STRIKER KATEMOTTOMPRO'fSMOR QU.commmumnw YtL IINMDISkNS MICONTARWEW ' CONSTRUCTION TYPB LSINGLE WALL 2. DOUBL E WALL 3. NODISPSNSORS ' 9Q NONE CONS RucnON MATELIUAL' 1, 87HEL 4. FIBERGLASS Ej 10. RIGID PLAM Q 99.OTNeR YIIL COAPOMON PROTECTION STEELCMUGNHNTFRUfEMON. 2.8ACRIFICIALANODB(S) 4. IMPRESSED CURRENT 6.ISOIATION w1 X. 0111 SIGNATURE CERTIFICATION: I certlfy tbo& USTsyslsm U eompatHde with the bazardow substance stored and that the lafarautldn provided herein Is true, accurate, and M f0wompliam rea nts. APPLICANT'S DATE APMMANT NAME t) 4T1. APPLICANT TTfI.B UPCF USTB - IR Rev. (I212001) UNIFIED PROGRAM CONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION tow Ibrm TI TYPE OF ACTION (Chock one item only. Foran UST pelmmmtcimn orremoval, complete only this action and Sections 1,16 HL IV, sad IX below} W1. NEW PERMIT 3. RENEWAL PERMIT S. CHANGE OF INFORMATION 6 . TEMRARY UST CLOSURE 0 7. USTPERMANENT CLOSURE ON SITE Q 8. USTREMOVAL DATE USTPRRMANENfLY C1,08ED. 4 DATE WSTING UST DISCOVBRIM AC[:LTY; INFO TION . FACUN ID6 (Agvxy Are Only) I I3USMM NAME (Sameas FACILITY NAME or DBA -Doing Business As) evv BUSINESS SITE ADDRESS - uc c dwflv5 i { M TANK DESCRIMON TANK E) 8 432 TANK FACTURF-R SAD TANK CONPIOURATION: Txt4TANKis 4 I. A STAND -ALONE TANK 2 .ONE IN A COMPARTMENTEDUNIT. Wreed esh. DATE UST AILED 435 TANK!!W OALLONS 4M NUMBER OF COMPARTIOT IN THE UNIT 437 M. TAN&USk AND CONTENTS TANK USE a MOTOR VEHICLE FUEDEVO 0 ib MARINA FuBLN0 le.AVATION FUELM 3. CNBABCAL PRODUCTSTORAGE 4. HAZARDOUS WASTE (mdede, UsedO0 S. EMERGENCY OENERATORPURL [HOC RS281s(c0) 6.Of B1ROBNBRATORFUEL a 95. UNKNOWN 99. OTHER ly): 43% CONTENTS PETROLEUM: la. REGULAR UNLEADED la MIDORADE UNLEADED IL PREMIUM UNLEADED Of 3. DIESEL S. JETFUEL 6. AVIATION OAS 1 PETROLEUM BLENDFUEL 9. OTHER PLTROIEUM Ilse NON-PETROLHUMt 1 OIL 10, ETHANOL 11.OTHER NON - PETROLEUM 44eb IV. TANK CONSTRUCTION TYPE OF TANK 13 I. SINGLE WALL 9.2. DOUBLE WALL El 95. UNKNOWN PRIMARY CONTAI4hRNr U I'STHEL W73, FMBRGIASS 6. INTERNAL BLADDER 7. STEEL + INTERNAL UMNO 9S. CItiKNOWN 99. GRIN (8 44(e SECONDARY CONTAINMENT I- STEEL FIBERGLASS 6. BXTBRIOR MEMBRANE LINER 7. JACKE711D 90. NONE !H: UMMWN 99.OVER S 44se OVMWTL . PRBVBM'ION 1. AUDIBLE A VISUALALARMS 2. BALL PLOAT 3. PILLTUBE SHUT -OFFVALVE 451 4. TANK MEMS REQUWMAINTS FOR EXEMPTION FROM OVERFILL PREVPNIION EQUIPMENT V. * PRODUCT / WASTE PIPING CONSTRUCTION PIPING CONSTRUCTION 1. SMOL S- WALLFD GU DOUBLE - WALLED 99.OTH8R SYSTEM TYPE 1. PRESSURE 0 2.0RAVITY Ij 1 CONVENTIONAL SUCTION 0 4. SAFESUCTION OCR ) ) PRIMARYCONTAINMENT U I. STEM UL4.FIBHRGLASS El 8. PLEMBLE El 10. RIGID PLASTIC 90. NONE Q 93. UNKNOWN 99.OTH f . 466 SECONDARY CONTAINMENT I • STEEL FIBERGLASS C3 10. RIGID PLASTIC 466 90. NONE 93. UNKNOWN 99. OTHER (S "40 PIPLNOITUREINECONTAINMENT SUMP TYPE I. -WALL 2. DOUBLE WALL ".NONE VL VENT, VAPOR RECOVERY (VR ) AND RISER / FILL PIPEPIPING CONSTRUCTION VENTPRIMARY CONTAINMENT Lj Emit. JiURBERNA11 u i0. RIGIDPLASTK Li 90. NONE El 99. OTHER (Speoi) e 461N VENTSECONDARY CONTAINMENT 0 1. STEEL 4. FIBERGLASS D 10. RIO1DPLASTIC NONE U 99.OTHBR (SpK*) 46HI VR PRIMARY CONrAINMBNT t3 1. STEEL 194. FIBERGLASS 13 10. RIGIDPLASTIC 0 90. NONE L3 99,anm(spedly) 41M VR SECONDARY CONTAINMENT El I. STEEL Lj 4. FMBRGLAaS 10. RIGIDPLASTIC 6WO. NONE ".OTHER (8peelly) 4660 VENTPIPING TRAN3ITI NSUMP TYPE 0 LSINGLEWALL 2. DOUBLE WALL NONE 4. FIBERGLASSRISERPRIMARYQDtITADWNT -1.3 LA ID PLASTIC . NCNB E3 99. OTHER (SpedM 401LHI1090 4601 RISER SECONDARY CONTAINMENT 13 1. FmL 4: PIBERO I0. RIGIDPLAST . NONE 99. OTHER (Spec*) 4" 4 FiLLCOM)WNIDNT8tr87aLLED N4.SPILLBUCKET Cl 3, ER TP/BOTfOMPROTECTOA aA. CORrAINMHWrSUMP VII. UNDER DISPENSER CONTAINMENT CONSTRUCTIONTYPE I. SINOLB WAU 2. DOUBLE WALL 3. NO DISPENSERS 90.NONE CONSTRUCTION MATERUL S7REL 4. FIBERGLASS LO. RIGID PLASTIC Q 99.0THER (Spw*) VIII. CORROSION PROTECTION STEELCOMPONENT PROTECTION 2. SACRIFICIAL ANODB(S) [14. IMPRESSED CURRENT 6. ISOLATION 44L PL APPLICANT SIGNATURE CERTMCATION: 1 certify thatos UST system is a with the hmrdous substance stored and that the information provided herein Is true, aeeursts, and In fml m (lance with I h. APPLICANT SIONA DATE t" N j 11 06 m APPUCANTNAME(pr(al APPLICANTTITi -E v UPCF UST -B -112 Rev. (1712(107) Coagratulational Ybu have demonshatad a commtby nt to the Code enforcement profession by successlUlly achieving ICC aert>flcatlon. Your certification lnformallon will be posted on the Cartlf)cstion Webaite as an Active Certification. W4- AtaMfffe.oM CERTtFI"TION RENEWAL - Certi icadon Is vaild for a three year period. For Renewal Information see the l3crlletin at ASTAIST Certf kadon R©newal - Ceffkation IsvaUd for a two year period. For Renewal InIbrmetion am the Sualn at XQ:ED Certification Renewal - MAIMED must receive your application for ran and documentation at least 6D days Prior to the w*atlon data of the current certiflcaLion Renewal of cer0mido s fa lire resaorrslbM of Om c»tli/edktdTrid o Pisses make sure you Ass track of your renewel sj, and adite ICC of arty CHANGE OFADORES& "AckwaftmM U you have achleved a NAFED certification you must notify,PdA ED of any change of address. ww.nsfed.= Hest wishes for cwntlnued success In your career, and thank you for your Interest to the Certifltation Programs of the International Code Council. loweamnodw- echoes+ .lonoemnoetar -wras" USTftftbhwfiWFuftQ -KV.Or MAM COMMUST fttaRA=1Mr- 64.OVr7MS r SewwTectsin- E]P.@WMM V "ftReW#"ems16*VgadRepW- BqL aQ129M4 Rem, ve card at perifor -Won and FOLD In center mare placing In wallet state ofcaunmbXT&0M RAiCMS STATE 00640 DOM ACMUCEW 693$07 so CORP REMEDIATION RISK MANAGEMENT INC DBA TRITON CONSTRUCTION o w. A HAZ 8 ASe 08/31/2014 www.cslb_ca,gov ., 1 Policy Number. OrBrEIL70033613 Date Entered: 03/26/2013 A`C>Rtf CERTIFICATE OF LIABILITY INSURANCE 53/2 » THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMA71VP-LY 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), AUTHORRED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT- ff the cer0cabe holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, stMect to the berme and conditions of the policy, certain policies may require an endorsement. A Statement on this certificate does not confer rights to the Call cats holder In Ow of such endorsemen e PRODUCER KMG INSDRMCB SERVICES 739T Sognel Dr Aptos, CA 95003 PCIICY Nur®en NL (831)688 -1434 s (831)662 -9635 ADDRESSO IMMERM AFFOnosro oov®wDe NAIL a INeu A:Starr Indemnity i Liability Co INSURED Remediation Risk Management, Inc. dba Triton Construction 2560 Soquel Ave 4202 Santa Crux, CA 95062 INSURER B:Gran a state Insurance Co 24/2013 INSURMQ:Kid— Century Insurance Company EACH OCCURRENCE INSURER D i MM, INSURER E; MED EXP one INSURER PERSONAL a ADV INJURY COVERAGES CERTIFICATE NUMBER: REVISION NUMRER2 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 CONTRACT OR 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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPB OP INSURANCE No BUBB PCIICY Nur®en LADIB A 08MRALLIANUTY COMMERCIALLMrEERAIL UASLITY CLAMC6#MDE ® OCCUR Cont Pollution SIBIZIL70035613 24/2013 24/2014 EACH OCCURRENCE 1,000,000 MM, 50,000 MED EXP one 5,000 PERSONAL a ADV INJURY 2,000,000 GENERALAWReoATE t2,000,000 0&?LAA0RIMATEUWrT APPLESPM POLICY im LOC PRODUCTS - COApAPAGO 2,000,000 C C AuroNOBUX LUeam ANY AUTO LLOWNW AUTO®U AUTOS H>A ®AUTOS Atr®® TOS 604818589 11/2013 11/2014 166 fiaaftm eO01LYINJURYftPMw* 1, 000, 000 s SWILY1hUURY (Perm>eldenq i s s A ummm L • UAB EXCIDISLUe HoCCUR CLADAS OE SISIXtM1015413 24/201 24/2014 EACH OCCURRENCE 4,000,000 AGGREGATE 4,000,000 8 WORIMRS COUPENsAnON AND EYPLOYLRIr LYIBILIrY YIN ANYPRdPPoETORIPART1 x TiVE OFFICIPMEMSF3i EXCLUDED? in I" R = TMN 7IONS N/A NCO01113001 1/3019 1/2014 WC STATLL TORY 1.1ham ER EL EACH ACCIDENT 1,000,000 E.L DISEASE - EAEA01PLOYEE 1, 000,ODO EL.DISFASE- POLICYUUrr 1,000,000 A Prof Liability SISIEIL70035613 54/2013 24/2014 Occurrence 01,000,000 Aggregate 02,000,000 OFOPERATIONS ILOCATIONS IVEHICM (ARach ACORD 101, AftM W ,w, Nman 1 notice of cane ei due to non payment and 0 day notiee loi all other reasons. OR LS SHOULD ANY OF THE ABOVE DEOCRI13ED POL=E9 BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTMFIZED REPRESENTATIVE ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD P! uftFarms aaasPis salt ma_ www.Fa mW3ou mn: Irtp *Wm Pubkhkv BQ11.208.1WR 2560 SOQUEL AVENUE, SUITE 202 SANTA CRUZ, CALIFORNIA 95062 TEL: 831.475.8141 FAX: 831.475.8249 Project #: c8 -:50Dk td Make check payable to: QA Tai. ?vkcyc W Phone #: ja Z 1 , 86:5q Is this check for services provided? Yes No If yes, list Tax ID Number: Today's Date: S Requested by: Amount required: $ Reason for check: C,11Lt tY e ry,ryi,} Date check is needed by: T06(4u ,r iva,AL— Authorization: CHECK REQUEST PERMIT * ENKAN= LEAK mTwnoN 13 TANKTIGHTNESS BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 o Fax: 661-852-2171 Pape I of I LINE TESTING 58-909 SECONDARY CONTAINMENT FUEL mo"IToRm CERTIFICATION Acom SITE INFORMATION FACILITT VAIM S)Oon t4b. NAME & PHONE 0 OF CONTACT PERSON Law UNDERGROUND STORAGE TANKS 0VWMR NAME CS T V) OPStATOR NAME PERMIT TO oFERATe f `j OF TANKS TO BE TESTEO: TANK 0 CO., APPLICATION arTOPERFORMELD/LINE TESTING 4AF4rffr S6989 SECONDARY CONTAINMENT MU41W - TESTINGITAW TIGHTNESS TEST AND 2*v- FUEL MONITORING CERTIFICATION Please note that these are separate individual tests and will be charged per separate type test accordingly.) TANK TESTING COMPANY TESTIMIO C(PWANY "Ail. PHONE # -C)FCON'TACT PERSON L MAILING ACDRESS Bub. vsuo gq *'R" awr& avu-j- PERMIT * ENKAN= LEAK mTwnoN 13 TANKTIGHTNESS BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 o Fax: 661-852-2171 Pape I of I LINE TESTING 58-909 SECONDARY CONTAINMENT FUEL mo"IToRm CERTIFICATION Acom SITE INFORMATION FACILITT VAIM S)Oon t4b. NAME & PHONE 0 OF CONTACT PERSON Law ADDRESS 32 -75 X81• Sb6.6s 0VWMR NAME CS T V) OPStATOR NAME PERMIT TO oFERATe f `j OF TANKS TO BE TESTEO: TANK 0 IS PIPING GOING TO BE TESTED? C3 YES 13 NO VOLUME CONTENTS Vr I 1510 LOA Ulu" r7— 10114- MU41W - 2*v- TANK TESTING COMPANY TESTIMIO C(PWANY "Ail. PHONE # -C)FCON'TACT PERSON L MAILING ACDRESS Bub. vsuo gq *'R" awr& avu-j- NAME& PHONE r OF oR spraAL mspecrm DATE aTite TesT TO BE CONDUCTED 03D2AVSE0 trA CERTIF10%TION fcc k O TEST MOD ftR10 APPUCANr ShbOURE DATE Q N 29. 2 1'x THIS APPLICATION BECOMES A PERMIT WHEN APPROVED APPROVED SY DATE 2A a-0 13 FD2095 (Rev 03/08) UNIFIED PROGRAM CONSOL1 DATEDFORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK DMRKATION (oac ft= ptrUFF:opA;j:0N Cbeek wo item only. For ea USTppmleneat obmge or ramml, complete only thin awdw and.Sawl me T, II, III, TV, and D( betcrr) NOW MIT 3. RENEWALPORMTT O S. CHANGE OF INFORMATION OAAY UST CLOSURE 7. UST PERMANENT CLOSUREON SITE S. USTREMOVAL DATE UST P100AANiMNI'I.Y CID=: DATE EXi MO UST D1RQ( MID FACE.RY ID ti UB' may) t BUSMAN NAMB (Same ae.FACUAW NAM orDBA -Dobtg lh,id aAs) BUSITJ888 sITE ADDTtTIS9 .2 WcK _ OAA" t, * 1 t TwitB 433 TANK MANUFACTURER rr ti se -D TANKCONFICIURATEM THS TANKIS A $rAND-ALONB TANK 2 ONE INACOMPART14BrfNBDUNIT. DATE UST S 435 TAMC'CAP OALLONS NUMBOR OF AR INTHEUNIT TAM USE j$ la. MOTOR VSHICLEFUSUIq O lb, MAWNA PUBLINO O In AVIATION FURLWD 3.t MICAI.MODUCTSTORAGE O 4.HAZARDOUSWASTE(DdMntlyd0O O 3.EmEROE4CYOIDBBtAmRmmpmcp=jjw 6.OMERGENERATORFUEL El 93.UlfKNOWN 99, OTHER 4m CONTI M PS7ROLEIIM la RB0ULARUNLEADED I4 MIDORADE UNLRADI It PRBMIUI( UNLEADED 3. DIEM O S. JETFUEL O 4AVIATION OAS B. PETROL8l1MBLENDFUEL 9. OTHERPETROLEUM usymift, 44N NON?HTR LSLI 7. USED OIL 14 ETHANOL 11. OTHER NON4TvWLSIIM 411b Iceff tVL"1 ON TYPBOF TANK I. SINGLEWAIL DOUBLE WALL Q 91 UNI040WN PAIMARYOOMTAD&ABNT Ll 1. STEEL 3. PM 6.INTSIMLBIADOBR 7.SI88L +BN(BRNALLINWG 93.11MC?IOWN OL07MM 444m SECONDARY OONtAWIAM XXFMERGIASS 6. HXTBAIOA M&GIRANG LINER 7. IAIXETBD 90. NW48 0 P& UNKNOWN OTHER Wu OVERFILL PRSVW0ION I. AUDIBLE VISUAL 7. HALL FLOAT 3. PIiLTUBB SHUT-OFFVALVE 4. TANKblERT8 E?M FOR ID(MeTION FROM OV RMPRIMMON BQUIIWENT V.' PRODUCT / WARTE PIMG CONST$IIC'! ION PIPINGCONSTRUCTION 1. SDNOLB-WAISAD L DOlJaL8 WALL® 99. HY87HMTYPE 1. PREEBURB L GRAVITY 3. CONVENTIONALSUCTION 4. SAFESUCTION OCR PR7MARYCONTAINMENT I. STEE 4. PIBSRGLA88 L P LE IQRIGID PLASRC 90. NONE 93,UNKNOWN 99. 4641 SECONDARY AIFBaM I, STENR. 4. MMOL.ASS & PI81(IEI.B !0. RIGIDPLATTIC 110 ?IO?NH 93. UNKNOWN 99.OTHER 4i4o PIPRNQJTURBINBCOl1TAMMENT 81A4P TYPE I.BDIOLE WALL L DO WALL 90. NCNB ANp RIM / FlU PIPE Y'iPD G CONSI'RDCTION V PRIMARY 1. 4. 30.R1OID 99, (S VENT YCONTAI NMENT 1. STEEL 4. PTBEROLASd 10. RIOIb PLASTIC 9A OTHER ( 4t /G VR PRNARY CONMBN dE NI ESTEE . PIBBRO To. RIGID PLASTIC 90. I VR 86CONDARY CONTADDMI?T 1. STEE TFTBE MAN I0. RIGID PLASTIC 90. NONE 90.OTHE( oowm VET ITT SUMP TYPE 1. SINGLE WALL L BLEW LL RISER PRDAARY CONTAINMENT 1. STEEL 4. FIBERO A. 0. RR7ID C 90. 99.OTHER ftmM Rl88R YCONTADDAE f 1.879E 4. 10 OmPLASTIC W.OrHER(Bpw 464k4141 FILL COMPONENTS INSTALLED . SPD.L BUta(BT 3.87RDLERPIATEIBOTTOM PROT lICTOR 4. CONTA SIB4P K DISpk t CO AINMENT CONSfRLICTTONTYPE I. smaLS PALL LDOUBLE (HALL 3. NO D18P8NSEt8 ' 90. NONE CONSTRUCTION MATERIAL t. STEE 4. FIBERGLASS 10. RIGIDPLASTIC 99.OT7MBA VM. CORRbOM PRQTZCTION STEEL CDMPOi EwrPR07E(R10N 2. SAt7 MC1AL ANODOM O 4. DAPRB8,4FDCURRENT O 6.180LATMN M APKICANT $"AT= CKRTIF1CAlMON: I earttTy that UST tyatem tbh w1tb W haaardam aebafanee staredand thatthe Mlbrmatdn prc M6W hereb h &a4aeenrale, andm ee wl mmente. APPLICANT SM J DATE 1APPLICAtITNAME AJ /117 rJmcANfME LV Q4 1°/v UPCF U37' -B -1/2 Rev. (12/1007) 2560 SoQuEL AvEmm, SUITE 202 SANTA CRUZ, CALIFORNIA 95062 TEL: 831.475.8141 FAX: 831.475.8249 Project #: C83DD uetd Make check payable to: Ct1JhP 5WOC k)d Phone #: lalo I Zto Rio Is this check for services provided? Yes No Ifyes, list Tax ID Number: Requested by:xv 1 Today's Date: S Amount required: $ JAI-0.0 Reason for check: ; \\ 'Tess- .,+z,,, Date check is needed by: — CodotM Authorization: CHECK REQUEST UNTRIED PROGRAMCONSOLIDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION onotore OFACTION (Chao![ one item0*. PeranUHT paomotm domeof ranovai, completeoaty thissection and Sections I. U. III; IY, and Dlbelow) 1. NSW mw 3. R@BWAL PBRWr S. CHANGE OFDRMMA770M 6 7 0RAILYUSTCLOSURE 0 7. UST PERMANENTCLOSURE ON SITE D 9. UST REMOVAL DATE UST PERMANENTLYCLOSED 410, DATE marm0 USTDISCOVPRBD': FACILMY ID f (4elt:y UnOnly) _ BUSS= NAM (SeatsasFACE.IPYNAME or DBA -DrMudinm As) aJe BUSING s ADD CITY/ IDTANK 0 TANK FACIiJRIOt u S<b TAwtCONE m1RAum TRlBTANL B 10 1 A STAND -ALOIMTANK 2.OB®,HAOIIL@ArMONTSDUMT. DATEUST ABED TANK C/ iN oALLONS Q NUMBER ofCOMP INTHEUNIT TANK USE ls,U0TCR FLMLINO D IL MARINA PUELINO laAVIATION PUBL.IMG 3. CHEIWAL PRODUCT 97MAGE 0 4. HAZARDOUSWASUBanemmundO@ $. BMEROE>KY OBNBRATORFUELi9ZP=t-W 6.OTHBR(DIVERATORFUEL Cl 9L UNKNOWN Q 99 mum CONTENTS PH1RO18U)L. 13 Is. REGULAR UNLEADED Q to' MIDORAORUNLEADED Ib.PEEMIU hIUNLRAD3D Q I. DIESEL ' E] 3. JET FUEL, 6. AVIATION OAS L BLSNDFUIEL 9.OTIIBRPSTROLOW 410, NONFBTROLEUM: 7. USEDOIL El 10. ETHANOL 11.0THBR NON- PH11tOlBllld 4th TA . NMtiCON TYPE OPT 1. S840L.eWALL 2. DOUBT WALL 93. UNKNOWN PR04ARY CONTA08dBNT U 1.31 WJ. FIBERGLASS 6. INTERNAL BLADDER 7.8TB1R. +INTBIWALIWBVO 93. UNKNOWN 0 99. OTHER 444 SECONDARYCONTAINMENT 1. STmL lupmBROLASS 6 SXTELIOR MEMBRANELINEa 7. JAMUM 90.NONH 0 95.U?QmWN 99.071188 44A OVIDWILLPRISVENTION I. AUDMW & VISUALALARMS U Z. BAILPIAAT 3. PILLTUBE SNVi -OFF VALVE 4. TANK MOMNMMMIEM FOR EXEMPTION FROM OVERFILL PREVENTION EQUPMENT Uz W PRODUCT I WASTE PIPING C'ONSTRUCIftON PIPMCONSTRUCTION 03,1MMWALLED 3.DOLS-WALIED 99.07HER SYST®dTYPE I. PR898URB 1. GRAVITY 1CONVENTIONAL: SUCITON Q 4. SAFESUCTION PJOCR MUMM PRIMARYCON'AINMSI:T 1. STEEL X 4. PIRCROLASS 0 1. P18X1B1I! 10. RIOmPLASTIC 90. 93. UMK4DVFN 99. 461+ SECONDARY LWNTAINMENT 1. STEEL 4. FIBBROL A88 B. FLEXIBLE 0 10. RIGIDPLASTIC O 90. NONE 93. UNKNOWN Q 9ROTHER 46b PIPI OAVRBHNB CONTAINMENTSUMP TYPE . SINOLE WAIL Q 1. DOUBLE WALL N 90 NE VL'V , , YAnn * IWF0 RISER 1 FMLPIPE PIPING CONSTRIICI'ION vffi# Rtzry CONTAIMMOrr U I. S7IDlL K4.FMEWLASS LI I&RIOMPLATM U 91L Noma U 99.OTHERMaw 46Nt VENTUDOWDARYCONTAINMENT 0 I. STEEL El 4. PIBBROLASS 13 10. RI011) PLIBTIC OTHER b') VRPR(MARYODNAROM r Ll 1. 8788[ W4.vmmaLAm 0 to. R[OmnAST(C 0 90. VR SECONDARY CONrAVQMBN1' I. STEEL 0 4. 10. RI PLASTIC MO. M Ll 09. OTHER 4661 VENT I9PIN0 17TON TYPE M 1. SOM.11 WALL 0 7. DOUBLE WA RIM PRIMARY CONTAINMENT qW 1. STEEL U 4. FIBERGLASS U l0. tUGWPLASTIC U 90. NONE E3 OTIIERC3pWfflSp RISER SECONDARY COWAINMENT I-STEEL 13 4. 0. RIGIDPLASTIC AD 90. NONE 0 0.0-T-H-ER-ft-ocig- 46W PAL COMPONENTS INSTALLED eFl.SplLLBUCm 7.3. 0ATmorrmpRar8CTOR WjXONTAMMEWEIMP 43f" UN .MWg%qmtCO •ATNM1td1 T CONMI. CTIONTYPB 1401 B WALL Q 1 DOUBLE WALL 3. NODISPENSERS 90. NONErtCONMUCTIONMATERIALp4. FIBERGLASS 10. RIGIDPLASTIC 99. OTHER lgVL C0901MONPROTECMN tITmDOMPONBTR PROTECTION, Q t. SACRIFICIALANODBM Q 4. IMPRESSED CURRENT C ISOLATION JiP1tT LCA vT i9TGNAT[JRE CSRPl1 iCATiON* I certify UST systam U esmpatblewith Use haardm eubstamce stared and thatthe lufasu atlom provided hereto, M true, accurate, and In flammulmeo w1dwoulimalrements, APPLICANTSIONA DATE 2A 11Ay3SLr. APPLTCA?1TNAM l) 467A4r- 0 h ot APPLLCANTTTII.E UPCF US7:B - m Rev. (ITl3 en UNIFEW PROGRAM CONSOUDATED FORM UNDERGROUND STORAGE TANK OPERATING PERMIT APPLICATION - TANK INFORMATION Ow ftmperumFR., OF (Choot weitem Doty. Foran UST ptemenenl alone, or romm4 oornptate easy ttde wcSm and 8eotbns I. U. TIL IV, mod IX below) Aa I D 3. RENEWALPERMIT S. CHANGEOF INFORMATION Y UST CLOSURE 7. UST PERMANENT CLOSUREON SITE S. UST REMOVAL BATSUSTPERMANBNTL.YCIASHD: 1 DATE MaS77N0_ USTDISCOVEIM L •:FAC'UJrY: VMRMA71ON M FAWN ID 0 (ASmxy the 0nly) SUSRi3M NAME (Same u FACIEJTY NAME orDBA-DoingBusinm An) vcj oc) augows SRE DDB J u &00k$ INU CR E k{ IL TANK DESCRIPTION TANK ID0 432 TANK M ACTURM 413 TAN IcOomirmRAnm Tma TANK 18 1. AErANX -ALONE TANK 21.ONE IN A COMPARTMENTED UNIT. Mad DATE UBT A ]) 03 TANK!=0ALlOM--M NUMBER OF COMPARTAOT IN THE UNIT " I III. TANKIIS$ AND CONI'ENIt TANK USE a MDIORVBHICLB FUB1=10 Ib. MARINA D I& AVIATION PUBLOM 3. CEB CAL PR0O STORAOE 0 4. HAZARDOUS WASTE aaftds !used01q O S. BMBROBNCY OMQUTOR PUHLIRBC 173:,1 d(e)I 6 an= OENBRAIOR FUEL 93. UNKNOWN D 99.unna 43% CONTENTS PI TROIBI31M: Is. RBOULAR UNISADHD 0 la MIDORADE UHLBADKD 0 lb. PREMIUM UNLEADED 3. DIESEL C3 S. ESTPURL Q 6. AVIATION GAS 1. PETROLEUM BLED PUE a 9.OTHERPETROLEUM 446a NON!- PBMOLEUM 7. USED OIL 0 10. ETHANOL 11. OTHER NON - PETROLEUM 440b IV. TANK CONSTRUCTION TYPHOPTANK I. S! WALL WU DOUBLEWALL 97, UNKNOWN PRIMARY CONTAINMENT EJ 1. STEM . FIBERGLASS U 4. INTERNALBLADDER 7. STEEL + D f m" u NDNO 9S. UNS(NOwN 99L OIiiER 4414 SECONDARY CONTAINMENT 1.17'8!31. FIBERGLASS 6. ECIBUOR MSMBRA ff13t 7. IACKBTED 90. NONE 93. UNKNOWN 99.077NHA 4Ue OVERFILL 1. AUDIBLE A V19UALALARMB 2. BALL RLOAT 3. PEI SHUT -o" VALVE 4. TANK MBET3 REQUIREMENTS FOR BXE MPTION FROM OVBRFIIA PRBVDITION UUMU!Nr V. ' PRODUCT / WASTE PIPING CONSTRUCTION PIPINGCONSTRUCTION I. SINGLE- wALLED C DOUBLE- WALLED 99. oT7[BR SYSTEMTYPE RLI.PRESSURE P 2.GRAVITY Z S.00NVElfTIONNALK -X7-M ff 4LSAFBSIICn0N CisPRIMARYCONTAIaCM1. STEEL W 4. FIBERGLASS Ll SPL=BLE 0 10. RIGID PLASTIC 90. NONE 9S. UNKNOOWN 99.OTN 4643 SECONDARY CONTAINMENT 1. STBm- PIBERGLA98 S FLEXIBLE 0 10. RIGID PLASTIC 90. NONE 93, UNKNOWN El 99.OTTIBA 8 4640 PIPLNOLRIABIB CONIABNM3MTSUMPTYPE W.SWLEWALL Q LDOUBLE WALL 13 90. NONE VL VENT, VAPOR RECOVERY M AND RISM / RILL PIPE PIPING CONSTRUCTIONVENTPRIMARYCONTAINMENTU1. 87881. WJ. FIBERGLASS U 10. RIGID PLASTIC 0 9& NCNB 99. UffiWaip6) 4d4v e VENTSECONDARYCONTAINMENT 0 1. STEEL Er 10. RIGID PLASTIC MLANONE o 99.OTNBit (Bpedry) 434n VASLIMARY CONTAIMOINI 0 1. .V1510t SA88 E3 10-RGwPLA=C 0 9(kNONH 0 99- anmapedly) imVRSBCONDARYCONTAINMENT0J. STEEL U 4. FIBERGLASS 0 10. RIGID PLASTIC WCNONs 13 99.OTHBR Mpedw 46w1 VENTPIPING TRANS11TION SUMP TYPE tj EIRKILEWALL El 2 BLEWALL NONE RAM PRIMARY t)DNrA1NMEJT - E STEEL u 4. PI88RO[ASS u IQ ID PLASTIC 0. NONE o 99.OTNBR (1pedm 46411 RISERSECONDARYCONTADM(ENT 13 I. ST -9 C- tc.RJOIDTtAxrlC RMNONE C3 99.0771HR pedly) FILL COMPONENTS INSTALLED 1A.SPRIBER10, Q &STRIKERPLATBIBOTTOMPROTWTOR SLAXON'TATNIAONTSUMP VIL UNDER DISPENSER CONTARMENT CONSTRUCTIONTYPE 1. SLNOLE WALL s DOUBLEWALL O 3. NO DISPENSERS 90.NONE CONSTRUCTION MATERIAL . STBl9 4. FMERGLABS =55015PLAme 13 manmispedw VIII- CORROSION PROTDMON STEELCOMPONENT PROTECTION D 2. SACRIFICIALANODES) D 4. IMPRESSED CURRENT D 6. ISOLATION 44 IX. APPLICANT SIGNATURE CERTMCATION: 1 ewft tbstpb UST system U with the hsardous mbasn . stored and that theintormallan provided herein V true, aeearatq and In hMjrmibmce whh kQ molotte. APPLICANT SIONA DATE Corn d / /) n y i' t' APPLICANT NAME (print - I 4 7r+ 7 v I APFLLCANT TITIILE G/W UPC]! UST-B -1/2 Ray. (1212007) Canal lbu have demonstrated a commftrent to the axle entree ent prollessbn by suxoessfuuy echW4V ICC certlflaaflon. Yotw oerditation Information wHI be posted on the CertU>cetfon Webslte as an Ac" C wtftadon. om CERTIFICATION SAL - Cron is valid for a three Year period. For Renewal Information we the Bulletin at ASTAIST CWIM Wmu INAmm l - Cerflficatlon Is valid for a two year period For RenwM Information am the Bukan at WW HARD CeMcafdon PAnewal -QED mud reu *4s, ym rapplioetm for recertiticatlon anid documentation at least 60 days priorto the eopratfon date of the current certification. WLCH- MONOW of sera to in gieMW onWAtrio out flRe car~ MdlS fidtraL PhOW Mks wire yotr ASS &=* of yornr renewvi ddaft endadAw 1CC of any CHANGE OFADDRES& cnvrirfrt e al e.ourr If you how achieved a NAFED certlfluffian you must notify RAM of any derange of addres& m+±u o3fed.mg Beat wishes for cmdh ued success In your career, and thank you for your Interest In the Certif caffw Programs of the hterrmtionaf Code Council. aao.naart- J000 aon..- loueer llFC31 W-Sw- Qtn3M4 C#MftotlFrSt 1- Opnapor-6G M7WS Iddro ilSr Tidnld- BgxOYtS f4 vVipa taeioMepb-TlOg-dRlp@W-BgL MRS04 t.yquinwe cWd at parkezvon and p®LO in t*nw WOM pier.-Jag In W e llet 't s0 oresr"" NTRACT STATEBOARD AMMUCENK 693807 -w CORP REWDIATION RISK MANAGEMENT _ INC DBA TRITON CONSTRUCTION moo) A HAZ B ABB d to OWIMO14 www.celb.ce.gov 0-ffi1 Policy Number: BIBIZIL70035613 Date Entered: 03/26/2013 JE!Ri CERTIFICATE OF LIABILITY INSURANCE 5/ 3/20138/3/2013 THIS CERTIFICATE 19 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. IMPOFrrANr H the oertffftW holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, oertetn po0des may require an endorsement. A ststemeni on thls oertlfleate does not confer rights to the certfllasto holder in lieu of such endorsernn s . PRODUCER INSQRAN 8ERVIC&S 7397 DrT39T8ognelDr Aptca, CA 95003 POLICY NUMBER a ,,(831)688-1434 (831)662 -9635 0"ERR APPOROere COVERAGE s N91REtA:Starr Iademity a Liability Cc oreuREo Aamediation Risk Management, Inc. dba Triton Construction 2560 Soquel Ave #202 Santa Cruz, CA 95062 I RE+a., r to tats Insurance Cc 2412013 OWREROI Kid- Century Insurance Ccupmy EACH OCCURRENCE RABURER0: MED EXP ero INPURER e: 5,000 IFISURER 11000400 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 CONTRACT OR 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. IT TYPEOF 24SUPANCE VAM POLICY NUMBER LANTN A o@AERALLIAIMM COMMERCIAL GENERAL CLAMMWAADE ® OCCUR Cont Pollution SISZZIL70035613 2412013 24/2014 EACH OCCURRENCE S1,000,000 MED EXP ero 50, 000 5,000 PERSONAL 6ADVINJURY 11000400 GENERALAGGREGATE 2,000,000 Wf1.AGORI!GATELWTAPPLIES PUL POLICY LOC PRODUCTS.COWWAGG 2,000,000 C C AUTONOMELIA8LnY ANYAUTO ALLOWNED AUTOS SCHEDULED HIRED AUTOS AUTOS 604818589 11 /sou 11/101• 1,000,000 BODILY INJURY (Pe pMw) BODILY INJURY (Par aaaldwm A UMBRELLA L140 eCCOSLIAS OAR CLAIMSMADE BISIXNV71015413 24/2013 24/2014 I EACHOCOl1RRENCE 4,000,000 AQGREQATE 4,000,000 DWI lft-TFK f B vlomamOOypo"710114 ANDEMPLOYERS' LIAeRRY ANYPROPr:IETORIPAarIJFRiO 111E a ICEaME EZCLU0ED9 Mmuld yki ne B de TOON da TIDNe bukw N/A liPC001113001 1/2013 1/2014 WC STATI-LKITORYLINM E- L EACH ACCIDENT 1,000,000 AL DISEASE - EA EMPLOYEE 1 000,000 E.L. DIBFJIBE -POLICY LIMB 1,000,000 A Prof Liability SISIZIL70035613 24/2013 24/2014 Occurrence $1,000,000 Aggregate 82,000,000 OFOPERATIONSI LOCAnoVI VEHICLES (Att+oh AOORO 101, Adduk" Hcan spins b 1 notice of cancel dna to nos payment an 0 y notice for all other reasons. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIEG BE CANCELLED BEPORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SAMIS AUTHORIZED RWRESIMATIVE '$ 1986.2010 ACORD CORPORATION. All rights reserved. ACORD 28 (2010!08) The ACORD name and logo on regleivred marks of ACORD Pl &*W uftFainta0mFWtORtmsaw,w.FMMBWLCWM krOM-Iva RMftgS*208.18TT 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 AST NEW INSTALL DESCRIPTION DATE SIGNATURE MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE EVR UPGRADE PRIOR -TO OPERATION OF ANY SYSTEM, ALL UST AND /OR AST SYSTEMS SHALL BE INSTALL, COMPLETE AND ACCEPTED BY MISC. ACTIVITY THE BAKERSFIELD CITY FIRE DEPARTMENT.: FIRE DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: S c 2 S JOB DESCRIPTION: OCCUPANCY TYPE: OWNER: 2 'le PERMIT NO. CONTRACTOR: PHONE # /-- FD 1743