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HomeMy WebLinkAbout3401 CHESTER AVENUE MOD 2013HOODS ALARMS SPRINKLER SYSTEMS SP P Y BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: 32,7G Address: 3-416l S- C eS (,1" A°- Bakersfield, CA 933 Date Received: -V-.2 Y— / 3 _ Business Name: SYSTEM: BUILDING SQUARE FEET: F INSPECTION LOG New Mod. mi modQtion removal Commercial Hood System Fire Alarm System Fire Sprinkler System Spi,ay FWsh System Aboveground Storage Tank Underground Storage Tank nderground Storage Tank Underground Storage Tank Other: Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. 2. 3. 4. Date Time Signature 7-4-s,;j Comments: L\ 5-21;'72 82- eyO, r% /s EXP Yl19 /} BIDING & PERMIT STATEMENT Iiullliliihpip.' 1 BAKERSFIELD FIRE DEPARTMENT IN Prevention Services A R fYPERMIT # 2101 H Street JI I fljpUl Bakersfield, CA 93301 Phnna- f,F1- ';7A-';Q79 • Fax' F1 -R5i- 171, LOCATION OF PROJECT CH GS U— ^ 1 % QJ O. j` PROPERTY OWNER STARTING DATE COMPLETION DATE . NAME FPROJECT NAME Co N uQ T E tat Ry ..C3=tzD-T RE ?LoCEme, 3T ADDRESS Q C T E PHONE Y PROJECT ADDRESS j / + r T _' 1 V ` 5 , ` 1 t" CITY F AICFiRSF1 FiL_D STATE CiA ZIP CODE CONTRACTOR INFORMATION CONTRACTOR NAME CA LICENSE CARRSLLQ It,-4;212 ( P 0F LICENNSE EXIRATION DATETYPE C6% J O6 PH ` E A-Ti 'T CONTRACTOR COMPANY NAME S Z t 1C. FAX • 5 ADDRESS 6630 ,Z 6 5 F_ *C) H LF- 1A W -1 #_ii7 CITY I Iz F iZS t- ( E Lb ZIP CODE < 1 Please make checks payable to CITY OF BAKERSFIELD. Thank you. mmm J TOTAL 13 Alarm - New & Modification (minimum charge) $280 DUE I 7177 ACCT i,10 Over 10,000 sq ft 0 ,028 x sq ft Sprinkler - New & Modification (minimum charge) 280 i Over 10,000 sq ft 0 ,028 x sq ft i Sprinkler - Minor Modification ( <10 heads) 96 (inspection only) 84 Commercial Hood (New & UL 300 Upgrade Modification) Additional Hood 235 58 Commercial Hood - Minor Modification (add /move nozzle) 96 (Inspection only) 84 Spray Booth (New & Modification) 235 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 G/ 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 O 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 I Portable LPG (Propane): # of Cages? _ 96 /hr 84 _ Explosive Storage 266 84 i Copying & File Research (File Research fee $50 /hr) 0.25 /page 84 Miscellaneous 84 e .n 1,•'.: UNDERGROUND STORAGE.TANK PERMIT APPLICATION TO CONSTRUCT- INSTALL NEW TANK (NEW FACILITY) /NEW TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD Permit # 1 I TYPE OF APPLICATION: NEW TANK INSTALL /NEW FACILITY NEW TANK INSTALL/EXISTING FACILITY l- rICI,K UINt UNLT U MUU1r1LAI IUN Ur rALi L11 T M M1NUK MUU1rILAI 1UIN Ur I-ALIU I Y STARTING DATE/ PROPOSED COMPLETION DATE ` ,. F FACILITY NAME EXISTING: FAC1LIlY: P. ERMTT {N :.t:;'; ?;::;:'.'i,i: -'S' CHEsYEZ L_ coo iZ FACILITY ADDRESS CITY ZIP CODE O S. c HE'CE2 BAKE`'` -Z V'7kr TYPE OF BUSINESS %k + 61 D APN # F f ajsou.1E o sP ti'sl i FACI ><Ty TANK OWNER a© 3 B PHONE # ADDRESS CITY BAK ZIP CODE E 2 t ELD BRIEFLY DESCRIBE THE WORK TO BE DONE: Cjo! r-) e- ,rat'-k1 1 I=mo- t) iv- 'c,- (u4 Winos . (A c TEST WATER TO FACILITY PROVIDED BY L*1-y_2I:R GXctT4 1PI01M.- 141 SOIL TYPE EXPECTED AT SITE OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 13 I YES NO YES NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION Tank Testing Company NAME OF TESTING COMPANY ' 1 C• w PHONE NUMBER , ©yc =r —4 MAILING ADDRESS 1G- C1Li 66 3 0 R05 EDA t_.0 NAME OF TESTER I D E L Lo ICCJI 5 v15 of 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 PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER ICCS TIaEL cAZ2,LLo 5A5 -9 P, ar-1Z THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 FIRM Phone: 661 - 326 -3979 •Fax: 661 - 852 -2171ARrNf Page 1 of 1 Permit # 1 I TYPE OF APPLICATION: NEW TANK INSTALL /NEW FACILITY NEW TANK INSTALL/EXISTING FACILITY l- rICI,K UINt UNLT U MUU1r1LAI IUN Ur rALi L11 T M M1NUK MUU1rILAI 1UIN Ur I-ALIU I Y STARTING DATE/ PROPOSED COMPLETION DATE ` ,. F FACILITY NAME EXISTING: FAC1LIlY: P. ERMTT {N :.t:;'; ?;::;:'.'i,i: -'S' CHEsYEZ L_ coo iZ FACILITY ADDRESS CITY ZIP CODE O S. c HE'CE2 BAKE`'` -Z V'7kr TYPE OF BUSINESS %k + 61 D APN # F f ajsou.1E o sP ti'sl i FACI ><Ty TANK OWNER a© 3 B PHONE # ADDRESS CITY BAK ZIP CODE E 2 t ELD BRIEFLY DESCRIBE THE WORK TO BE DONE: Cjo! r-) e- ,rat'-k1 1 I=mo- t) iv- 'c,- (u4 Winos . (A c TEST WATER TO FACILITY PROVIDED BY L*1-y_2I:R GXctT4 1PI01M.- 141 SOIL TYPE EXPECTED AT SITE OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE? 13 I YES NO YES NO THIS SECTION IS FOR STORAGE TANK IDENTIFICATION Tank Testing Company NAME OF TESTING COMPANY ' 1 C• w PHONE NUMBER , ©yc =r —4 MAILING ADDRESS 1G- C1Li 66 3 0 R05 EDA t_.0 NAME OF TESTER I D E L Lo ICCJI 5 v15 of 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 PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. NAME OF TESTER ICCS TIaEL cAZ2,LLo 5A5 -9 P, ar-1Z THIS APPLICATION BECOMES A PERMIT WHEN APPROVED FOR OFFICIAL USE ONLY C NCO c) _a 66 WZd Secondary Containment Testing Report Form 7'hisform is inrendeeifor use by contractors performing periodic testing of ! t17'secunelrn7 rornlainment n stems. Use. the upproprurie pages of11d.5.jvrm to report ra -vulimft>r• all components te.vtecL The r emnpletetlfnim, written test procedures, oral printnuttfirm le.rls (Ifapplicahle'), ,should hr. provided to llie facility Io dur local repulatopy omenty. 1. FACILITY 1NFCIRMATInN Facility Notnc: — -051 1 QN10Z lletu ul' I•cslin : — 1 Facility Addrms: S Facility Contact: Nhunu: A& 1 -- Date Local Agency Was Notified of Testing : Name of Local Agency Insiwutur (i (prersent thiring team,): tv t.,& 1 [ M ED t 1-1 A 2. TECTING roNTRACTOR INFORMATMN Cum my Name: z t NC. Technician C:onduuting Tust: 'r% L CO 1 L 1-0 C'rLdLn(itils: I I CS1,13 Limmed Contractor I SWRC13 I.icen.4M U* Tester I.ia nsc T (Cc: c: ManufLcturor I. eenso Nutntwr: Manurncturer TrHlninu Cum x)nunt s Datu Trtinii , I ?x tirus TRiA1S Q., N v1E.Le r.1 C — { 3. SUMMARY nF TF'ST RFSi1LT5 If hydromatic testing was puiur ned. dmtibc what was done: with the water after completion of tests: CERTIFICATION OF 'TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my know kdge, the factr stared in thfr document are accurate and In full compliance with kRal requirement, Te:chnician's 5igmiture: 7— Q `_. taMaS xe j << lute: %A — a 5 i SG01 0E-1?0 -£10Z ZMEMIM MME osomammm memo msom m0aM sMmM o° omm mm MMMM If hydromatic testing was puiur ned. dmtibc what was done: with the water after completion of tests: CERTIFICATION OF 'TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my know kdge, the factr stared in thfr document are accurate and In full compliance with kRal requirement, Te:chnician's 5igmiture: 7— Q `_. taMaS xe j << lute: %A — a 5 i SG01 0E-1?0 -£10Z f `J 4 SWR(':R. Lnmary ?IYI? 7. UNDER - DISPENSER CONTAINMENT UDC TESTING PlIgC _ or TL -t Method Developed Iiv: 1 UDC Monufw:tmr NTndustly Standard I I Pmfessimial Engineer I I other (' ci&) Test Method UsLd: t l Pressure L! Vaellum R1 Tlydrostalic I I Other ('*.0fv) Test FquipmentUsed: _ STsr li uipmcnt Resolution: O,OOOo'L111UUCp ( UDC # UDC H 9- I11)C' Manufnelu777 Ib L dori-M!t PA V-. CANT N T 7. UDC Material: LptS1111iCuDuthe I (eight Crum TTT7C: 1iotUun t of I Iighest Piping Penetration: I le ight I'roln UDC Bottom to I -owest Etco rical Penetration: r rre 3 rr rr Condition of MX' prior to testing: 0 iC 0 V-1 d iL 0 IL Portion of UDC; Toslet) u Does turbine shut down when 1.JDC sensor detects liquid (both lrlklucl and water)? - 14o"1'es U Nu I ' NA te+?es I I No : INA t Kos I I No I I NA AYLN I I No I i NA Turbine sllutduwn ru.422nse time 3-seCW-OS S - 5 F. E-0NWE is aystem progntmmW for fail- safe shutdown','* V*,rycs U No I I NA I *Tes U No UNA IleYL% I I No I.1 NA W, YYes I! No LI NA Was tail -safe yeritia;d to be o rational' ? - es ; ; No (I N/1 flew 1 IM, ' I NA Yes I I No ! I NA IHYes J No , c NA Wait tines botwmn applying pressttre/vaeutun/water and gstarlin lust rJ ! , 1 j M r N, l M t o, r MI". 0 Test Stan Time: 10 I'l 04 M Tnitial Reading 'RI): Test F.nd Time: M O "Aa Am t Ch 0 0 I'irwI Reading Rr : L l wt r d. its tn , Test Dt"tion: Change in Retldi R2 -R ): 00 0 nl(Nofll I. 0,0010 I er Pass/I'311 ,111retihUld or Criteria: 10 0 ' 0 .001a 0 ,00 d O0 Test Result_ M"PRIe U Fail aea t 11rai1 aaa U Fail Was sensor removed lie lesling? VVev U No l I NA V076; I INo I I NA Tm I INo I INA 6t-Yes I INu I INA Was sensor prlperlh' replaced anLl vail'i d I'unetional after testing? es LI No I I NA N L I No I I NA Yaw I INo I! NA 1*11 LI Nu LANA Comments — (inrkrdr infornrark>rr on ro rirxmadeprior to resting, and ree-ommenderdf)iknv -rtpforfeited rests) I C the entire depth of the M X is not tested, spceify how much was tested. If the answer to any ol'the questions indicated with an asterisk (') is "NOY' or "NA ", the entire UDC must he tested. (flee SWRCH LG -1A0) WE d AanaaS xaj << S1:01 OE- 00-EIOZ Wt d J@AJaS Xej << SVOI OE-t0-00E X L 340180.r,'HESTF)P ALIT. 2401(;O,CHESTFK- AVE. 0 :jk INC.. -TESTFR- INi,,. -TEST ER- I m 04/25/2013 lo."je 6 F)-6ul,"c TF'!3T F:7ARTEED END TTMF irl: 711• h, TUT si-ArTED P . , mE END -..EvE 21 CHD LEVEL ; h TEST RESU'_7 Afe :"HOLD TESTST RES PAS5irrl END TIME 10,AQ, AT END LEVEL 4.571C. 1 TEST STAFTkf) TEST VARTED 9137 Ah: BE CJJN L.E'jE- 3.7 ElEGIN LEVEL 5.318!y 1 -N EK) DATE P,4/?5,,26. D 7 1 lji ' EHD DATE 04/251201,_5 EAK THRESHJ):D 0.0 -12 l! LEAK' THRESHOLD O.OWII ;N 10 7, T7qT -,'ESULT J@AJaS Xej << SVOI OE-t0-00E 3401936. 340180.r,'HESTF)P ALIT. INi,,. -TEST ER- 04/25/2013 lo."je 6 F)-6ul,"c TUT si-ArTED 0! C;7 21 TESI' STARTED 04/2V29.;., END T ?hE 0:5- iATF END TIME 10,AQ, AT END LEVEL 4.571C. 1 END LEVEL TES7 RiFll,-_T TEqT RESULT PASSED 7*ES7 SThR 7EL 10 7, TES'r STARTED 9:53 Av. 8E6IN LEVEL' 0: BEOIN LEO-EL 15.3109 IN END DATE 04,125-,201_:, ENO DATE 04^12b/204'i LEAK THRESHOLD 0.002 1!• FAV THRESHOLD A.Ar" J@AJaS Xej << SVOI OE-t0-00E 1 8830 Reeedale Hwy # B Bakersfield, CaNfomia 9.'i.'i08 Phone: 661 588 2777 Fax: 661 588 2786 Fax 17 /I d TO: Fax: Plrorror Rai Bakersfield Fire— Emle Medina een -%A'. Fromm Kelly Tacked Dates 4 -30-13 Pages: Chester Liquor & Market CCa 3401 S. Chester 0 UrgentO For Review 0 Pbbase Comment 0 Please Reply Cl Please Recycle Cemrnent4: Hi Ernie, Attached are test results. Please call if you have any questions. Thanks, Kelly AanaaS xej << SVOI 0£- 00 -EIOZ r Appendix VI Copies of Monitoring System Certificatlon form and UST Monitoring Plot Plan available ai MONITORING SYSTEM CERTIFICATION For Use ByAll ,/u isorblona Wllh/n the State at CaNlorrrld Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, T1tle 23, California Code ofRegulations This form must be used to document testing and servlcing of monitoring equipment. A separate Oerllfloation or report must W prepared tareachmonitoringsystemcontrolpanelbythetechnicianWhoperformsthework, A copy of this form must be provided to the lank systemowner /operator. The Owher /operator must Submit a copy of this form to the 1=1 agency regulaling UST systems within 30 days Of test date. A. General Information Facility Name: I= ` cT sL c %f1 _cSheAddress, 3_y o 1 -5 .,- CH S E.11( ]1 E ... City: 0&KFR3!ElE Lb- ZIP: C4 P L -- Facility Contact Person: ,. ,. Contact Phone No,; C b )_6_'J.rL- 5.0,'S Mee/Model of Monitoring System: QEEErE (2 -OUT/ L * _ $ O Date of TestfnWsaNIcinQ: S--/-,a-A.z.. ,.- B. Inventory of Equipment Tested/Cenifled Choi* the avaroorlate bozee to Indacata anaMle ranylernant Inansrtfsel/rtarulrte . f Tank ID: Tank ID: Q EIrY11 Q EVA OrIn -Tank Gauging Probe. Model; A `/ V 0110 t O: WIn -Yank Gauging Probe. Model: Jo-j. i Annular Space of Vauh Sensor. Model; _ 1 Annular Space or Vault Sensor. Model; 1 Piping sump / Trerxh Sensor(:). 4"I Sump Sensor(s). 'STp Model: Model: Piping Sump I Trench Samr(s). Sump Sensor(a). Model: — - 9'Mechanlcaf Line teak Detector. Model: 5T P WWachanfcal Line leak Detector. Model: O - C Ql Model; i Electronic Line Leak Detector. Model; i Electronic Line Leek Detector. Model:.._. 1 TVK Ovor1W / Hlgh•Level l,3erleor. Model; 1 Tank Overfill / Hlph•Level Sensor, Modal: 1 Oth er (opucify4mlomerANOR and model in Section E on is 21. 1 Other IM021 typeI0 and model in Section E on Pa 2). Tank ID: Tank ID: 1 In -Tank Gauging Probe. Modal;- ,.• 1 In•Tank au rip Probe. Model: I Annular Space or Vauh Sensor. Model: 1 Annular Space or Vault Sensor. Model: 1 Plping Sump / Trench Senwr(e). Mader: _ -, 1 Piping bump / Trench Sonsor(s). Model: Fill Sump Sar=r(e)• Model: 1 FIH Sump $enWS)• Model: 1 Mechanical Line leak Detector. Model: _ —_ I Mechanical Line Leak Detector. Model: I Electronic Line Leak Detector. Model: I Electronic Una Leak Detector. Model: .._.......... I Tank Overfill / High-Laval Sensor. Model; _ -.... _ 1 vaTankOWN / Hlgh•Level Sensor. Model: _ -_ 1 Other (GPDCOY e on Pa 2). 1 Other (sD@dfv agulpmeM and model in Section E on Pa 2). Divpenssr l0: I I A-___ Dispense 10: ; . !i WDispensor Containment Sensor(e). Model; - 00 I WDispenser Containment Sensor(s). Model; p-,,;Q(_ VeShear Valve(e). vshoar VaNO(s)• i Dkwansar COnlalnment Floors and Chain e . 1 la near on F t Dtspenser ID: r Dispenser CoMatn nl6ensor(s). Model; im,49 ; 0141wser ID: vVeperserContaln rmogs). Modsl:Zom =120av'Shear Valve(s). So"Shear VaNe(s), I Die CoMalnmant Float a and Chal s . I I 0ioDenser Containment F ate and Chain e . 01sppssnsarID'. DlsppariserID: 1 Dta"neor Conlainmem 8anecr(s). Model: _ 1 Dlapanaer Containment neoris)• Model;---.,- .. I ShearValveis). 1 Shear V"(s). 1 Dispenser Contefrunent Floats Ch s DisDenser Containment Fba a and Chain a . if the Iaclity contains more tanks ordispensers, copy this form. Include Information for every tank and dispenser at the facility. C. 0ortiflcalion • I osrttly that the equipment Identified In this document Was Inspeetedlservlced In accordance with the manufactufars' guldsUnes. Attached to this Certification Is Information (sg. manufaolurare' checklists) necessary to verify that this Infortnallon Is oorreef and a plat won showing the layout of monhorinp qulpment. For any equipment capable of gensrating such reports, I have also attached acopyofthereport; (check all that apply} It yystern set-up aAlarm history report Technician Name (print): Vt dE L C 12.•,.L0 -. Signature: ]LAJ -1 L C1 .. ... ... Certification No.: A a.11 u{ I License, No,;.. 6' dLl! a _-- Testing Company Name: 6S52 -11-NIL. . Phone No.;( -" -) .. 5.M.- 9 Testing Company Addrtats: KA -'- ,)p_ RL)SE i) a t (_I j.' ft," * __.6_ Date of Testing/Sarvloing: t-j zu I Z Monitoring System Certifloation Page 1 all 4 12/07 LIZ d 2/21/07 aanaa5 XeA << SEMI 10- 170 -ElOZ v n 0. Results o'restlnWElervIcIng C'QIIware Version Installed: P.nntelara rho Inllnu.inn v"Yes No' Is the audible alarm operational? No' Is the visual alarm operational? es I tvo. Were all sensors vlsuaillIr Inspected, functionally tut , and con lrrned o atioml? Yes o vvere all sensors Installed at lowest point of Secondary Containment and positioned s0 that other equ pmenl will nol interiors with their2roparration? Yes No' II alarms are relayed to a remote monitoring elation, is all =nmunk:ations squlpmenl (e.g. modem) operational? Yes t No• For pressurized piping systems, does t e turbine automat shut down it the Oping secondary containment monitoring syatamiNIAdetectsaleak, fable to operate, or Is electrically Wsconnectod? It yea. which sensors Iniliato posrtive shut -down? (Check an that awly) w'SumprTrench Senors; a'Dlepener Containment Sensors, Did you confirm posh" ahul-down due to leaks Ln eeneortattufoldionnection? • 't I Yes No' For tank systems that utilize the monitoring system as the primary tank ovedili warning device (1.e. no rnec nEal overlie p(evanti0nyaWAvalveisInstalled). is the overfill warning alarm visible and audible at the tank fill poim(s) and Operating properly? If so, at what perserlloftankcapwftvdoesthemntrigger? Yes' K No Was any monitorng equipment rOolaoud7 If yes, iderrIlly specific sensors, probes, or other equipment replace an tst dw Mnpfacturer name and dal for Be re acemertt All in Section E below. Yea' rr No Was Ikluid lound ins' a any 990ondary contalamWd systems designed as dry systems? (Cho& all rust yup)y) I Pro w; t Water. IfesdescribeInSectionEbelow. Yes i No' Wu rwnitwing system eat -up rev to ensure proper settinge Attach eel up reports, If applIvable Yes 7 No' Is all monitoring equipment operational per manufacturer's specifications? ' wo...,..v ,.. w. ....e.....nav vnr.vtme rra w a yr wul Da corre ea. E. Comments:. C,Lj. C - - -- Monitoring System CeMI}Icallon Page 2 Of 4 2 12107 2/2 E /U7 UE d AaAAaS xeA « 9E:11 10- 00 -EIOZ 11 F. In-Tank Gauging / $IR Equipment: , Check this box If tank gauging Is used only for Inventory control. 0 Check thls pox II no lards gauging Or SIR equipment is installed. This section must pe completed If In tank gauging equipment Is used to perform teak detection monitoring, orrilmole inn, Yes tollowtn o kllst: Has all input wiring been Inspected for proper entry and terminaffon, inclu ng iestIrV for ground faults? Yes a ere all cards gauging probes visually Inspeofed lor damage and re a buildup? as No' Was accuracy of ByetAm product level readings test G' Yes D No' Was acouraoy of system water a! readings tested V Yes U Are all probea refnst ed property tY Yes No' Were alt home on the equipment manufastur s ma ntenance checklist Completed? In the S@etton H. below. crlbe how and Whan thaw& daMrAo Lsa u m nr uAll w .,.." G. Line Leak Detectors (LLD): u Check this box if LLD$ are not installed. Comolats the teanwlnn ehankilar. r •.— , — 1w •-- w - A11 -1 V-7W V VIW1Vra1IM AOM Qr V"11 00 Wffug;U 7. H. Comments: Mordtoring System CaU}Ioolon Page 9 of 4 3 17107 2/21/07 Ub d somas xeA « 9E :I1 10- bO-£IOZ u No' 0 N/A For equipment start -up or annu equipment canificdtlon, eras a leak simulated to verify LLD performance? (Check all that aArJy) Simulated leak L01Erate: g.p.h.; 0.1 g,p,h ; 0.2 g•D•K u Nc' Were aft LLDs confirmed operational grt accurate t In regu atory requirements? 7 No' Was the test ng apparatus property calibrated u No. For mechanical LLDs, does the LLD reav product flow It 4 dolooto a leak? 0 N/A Yes 0 For electronic LLDs, does the turbine automatically shut off it the LLD detects a [oak? OC WA lI Yes No' For electronic LLM. does the turbine autornifialy shut off If any portion of the monitoring system is disa ed orJKN/A disconnected? Yes No' or eledrorIc LLOs, does the turbine automatically shut off It any portion of the monitoring system malfunctions oritN/A falls a test? n Yes No' For a ecirordo LL a, ha—yed 006866 wiring connections been visually inspected? 1L WA Yes No' Were al ems on the equ pmem manufacturer's maintenance chockllst completed r •.— , — 1w •-- w - A11 -1 V-7W V VIW1Vra1IM AOM Qr V"11 00 Wffug;U 7. H. Comments: Mordtoring System CaU}Ioolon Page 9 of 4 3 17107 2/21/07 Ub d somas xeA « 9E :I1 10- bO-£IOZ L a Monitoring System C"Icatlon UST Monitoring Site Plan Size Addresa; 34 d 4 S Hit E 9 r-w E C:Mda,; .. ea , TA0f :. . , . TROK . . . . i C) '. A6lX • . . . . . . C? ir Q . No pi57ftaWz .......... Na DvGM -ASER . . rya /a.:::::::: ::: p n.i p .31.1 .... . Date map was drawn: _3_J.2A/_La. Instruotlons If you already have a diagram that shows all mqulmd Informatlon, you may Include It rather than thle page, with your Monitoring System lvenif'icadon. On your elte plan, show the general layout of tanks and piping, Clearly Identity locations of the following equipment, if Installed: monitoring system control Weis; eenaars monkoring tank annular eppaaceS, Sumps, dispenser pans, spill contalners, or other secondary cOtltainment areas; mechanical or elet ttonlc line leak detectors; and InAank I)quld lave) probes (it used for leak detection). In the space provided, We the date this Site Plan was prepared, Mornttoring System GftHloatlon Page 4 914 12107 4 2/21/07 VS d AaAaaS XQJ « L£:ll 10- 00 -EIOZ 0 SWRCB, )emu+uy 2006 SPHIMueket Testing RcpQi-t Form Thisform is intendedjbr use by contractors performing annual testing of UST spill containment structures, The completedform aril printoutsfrom tests (ifapplicable), should be provided to the facility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Facility Address., ?40% Facility Contact: Date Local Agency Was Notified of Testing; Name of Local Agency Inspector (!fpresent du, 2. TESTING Date of Testing: 3 Phone: 661- , - 5 0 Lt--'Is CYI Dir SA R INFORMATION Contpurty Name: C35Z 2 t tJ C . Technician Conducting Test: % pf L CA 0 R i L L d Credenlials : CSLA Contractor B'fCC Service Tech, 0 SWRCB Tank Tester Other (Spec02, LicenseNumber(s): kCC Tt<Ct{ # $i '418a ial l '74l rs_ 3. SPILT, RThf'W1r.T TTTCTTNr'_ TNVAV1L4eTrnW Test Method Used; gfiydrostadc Vacuum Other Pest Equipment Used: Equipment Resolution: ldentil'y Spill Bucket (By Tank Yvwber. Stored Product, etc.) 1 2 Q( 3 4 h3uckel Insmiladon Type; VDirect Bury 0 Contained in Sump 01 nirect Bury Contained in Sump 0 Direct Bury 0 Contained in Suinp Direct Bwy to Contained itu Sump Bucket Diameter; t t t Bucket Depth: 3/ Wait time between applying vacuunVwater and start of test: M M Test Start Time (O; 10 ' '00 Arvx t o ': 00 Inilial Reading A): 1 Test End Time (Tp): y , O C) l - O CD Final Reading (RF); I ' j " Test Duration (TF —Tt): A HOU MS A Ho %je-s Cluutige in Reading (RI, - R: PisvFail Threshold or Criteria; O,UOoa 0,0004 Test Result; @Taus d Fail S14ass 0 Fail Pass trail Pass U Fail Lon] — (include information on repairs made prior to testing, and mcommendedfollow- upforfalled tests CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING 1 hereby certify that all the information contained In this report is true, accurate, and infull compliance with legal requirements. Teclu&ian's Signature;_ C" C 0&Lkt Date; Stale laws and regulations do not currently require testing to be performed by a qualified contractor, However, local requirements way be more stringent, L19 d 1anaa5 xe4 << LEM 10- b0 -Eloz I I i ik W.t 1.1r,R 2-2. "Cl Ij 9;()r: f1j.1 I tif-IK iiLHM I U1 0, u lhM LlL d Ell JaAJaS Xej << XII 10-00-EIOZ A 68.90 nosodelo Hwy 0 B Bakersfield, CaVomla 93308 Phone f3f31 5682777 Fax; 881 588 2786 FaX Tot Bakersfield Fire — Emie Medina Fam 852 -2171 PUom Re: Chester Liquor & Markel 3401 S. Chester From Kelly Tackett Dslrc 41 -13 tlrgsntO For RwWww Ph Conownt Phmmo Reply O Please Rsoyaw Cafnue snt: Hi Emie, Attached are monitor certification results. Please call if you have any questions. Thanks. Kelly Lll d aaMa5 xeJ « 9E :11 10-b0 -EIOZ