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Home My WebLink About402 CHESTER FMC 2013HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. 3 /7/ File Number: Date Received: 3108 SYSTEM: New Mod. Commercial Hood System Fire Alarm System Fire Sprinkler System Spray FWsh System Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank Address: o z S • %S - Bakersfield, CA 933 Business Name: e e-- S rc `YI/Ip G L' (- BUILDING SQUARE FEET: INSPECTION LOG Building Sq. Feet: Calculation Bldg. Sq. Ft: 1. a. 3. 4. Date Time a19nazure Signature 1--"Other. Comments: e) l) 5:,5:vsar2 s -,Lo Bc e oczr-°7FIS'% 71 E P2a .,2,5VZ &51'7"i Vii ye-e 874 FfrD EXza VA4" & 21q* 4D e 4/2-1ice MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State ofCalifornia Authority Cited: Chapter 67, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be nrenared for each monitoring systam control panel by the technician who performs the work. A copy ofthis form must be provided to the tank system owner /operator. The owner /operator must submit a copy ofthis form to the local agency regulating UST systems within 30 days oftest date. A. General Information Facility Name: ONE STOP MOBIL Bldg. No.: Site Address: 402 S. CHESTER City: BAKERSFIELD Zip: 93304 Facility Contact Person: GIL Contact Phone No.: (661) 835 -9544 Make /Model ofMonitoring System: INCON - INSP. ON SITE ERNIE Date of Testing/Servicing: 612412013 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicates iflc ui ment ins ed/serviced: Tank ID: REGULAR 87 Tank m: PREMIUM 91 In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG Annular Space or Vault Sensor. Model: LS-3 Annular Space or Vault Sensor. Model: LS4 0 Piping Sump / Trench Sensor(s). Model: LS -3 Piping Sump / Trench Sensor(s). Model: LS -3 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1V Mechanical Line Leak Detector. Model: FX1V Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: FLAPPER Tank Overfill / High -Level Sensor. Model: FLAPPER Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2). Tank ID: Tank ID: In -Tank Gauging Probe. Model: In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Other (specify equipment type and model in Section E on Page 2). Other (specify equipment type and model in Section E on Page 2). Dispenser ID: 112 Dispenser ID: 314 Dispenser Containment Sensor(s). Model: 001 Dispenser Containment Sensor(s). Model: 001 Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser ContainmentSensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser 1D: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). Ifthe facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification -1 certify that the equipment identified in this document was inspectedlserviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy ofthe report; (check off that apply): M System set -up M Alarm history report Technician Name (print): RICHARD MASON Certification No.: 5297857 -UT / B36880 Testing Company Name: RICH ENVIRONMENTAL Signature: Tj -- License. No.: CA D40 809850 Phone No.: (661) 392 -8687 Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date of Testing/Servicing: 6/24/2013 Page 1 of 5 UN -036 —1 /4 www.unidocs.org Rev. 01/17/09 71'07, Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: .99909 Complete the following checklist: Yes No* Is the audible alarm operational? Yes No* Is the visual alarm operational? Yes No* Were all sensors visually inspected, functionally tested, and confirmed operational? Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g., modem) N/A operational? Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? Ifyes: which sensors initiate positive shut -down? (Check all that apply) ® Sump /Trench Sensors; Dispenser Containment Sensors. Did you confirm positive shut -down due to leaks and sensor failureldisconnection? ® Yes; No. Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? Ifso, at what percent oftank capacity does the alarm trigger? % Yes* No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. If yes, describe causes in Section E, below. Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable Yes No* 1 Is all monitoring equipment operational per manufacturer's specifications? In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of S UN -036 — 2/4 www.unidocs.org Rev. 01/17/08 Monitoring System Certification F. In -Tank Gauging / SIR Equipment: Sco13 Check this box iftank gauging is used only for inventory control. Check this box ifno tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist; Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes No* Was accuracy of system product level readings tested? Yes No* Was accuracy of system water level readings tested? Yes No* Were all probes reinstalled properly? Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): C'mmnlete the fnl,nwina rheeklint! Check this box if LLDs are not installed. Yes No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A Check all that apply) Simulated leak rate: ® 3 g p.h.; [10. 1 g.p.h ; 0.2 g p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes No* Was the testing apparatus properly calibrated? Yes No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off ifthe LLD detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled N/A or disconnected? Yes No* For electronic LLDs, does.the turbine automatically shut off ifany portion ofthe monitoring system malfunctions N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: UN -036 — 3/4 Page 3 of 5 www.unidoes.org Rev. 01/17/08 M-- a v L, 1 4 '4 4 41; A. A• it t 5 m V-,*) RICH ENVIRONMENTAL 5643 BROOKS CT. BAKERSFIELD, CA. 93308 OFFICE (661)392 -8687 FAX (661)392 -0621 PRODUCT LINE LEAK DETECTOR TEST WORK SHEET W /0 #: FACILITY NAME: ONE STOP MOBIL FACILITY ADDRESS: 402 S. CHESTER, BAKERSFIELD PRODUCT LINE TYPE: PRESSURE PRODUCT LEAK DETECTOR TYPE TEST TRIP PASS BELOW P.S.I. OR SERIAL NUMBER 3 G.P.H. FAIL UNL87 L/D TYPE: RED JACKET YES 10 PASS SERIAL # 4761 PREM91 UD TYPE: RED JACKET YES 10 PASS SERIAL # 7142 LID TYPE: - PASS YES SERIAL # FAIL L/D TYPE: PASS YES SERIAL # FAIL 1 CERTIFY THE ABOVE TESTS WERE CONDUCTED ON THIS DATE ACCORDING TO RED JACKET PUMPS FIELD TEST APPARATUS TESTING PROCEDURE AND LIMITATIONS. THE MECHANICAL LEAK DETECTOR TEST PASS / FAIL IS DETERMINED BY USING A LOW FLOW THRESHOLD TRIP RATE OF 3 GALLONS PER HOUR OR LESS AT 10 P.S.I. I ACKNOWLEDGE THAT ALL DATA COLLECTED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. TECHNICIAN: RICHARD MASON SIGNATURE: f DATE: 6124/13 j w% 0 SWRCB, January 200 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors performing annual testing of usr spill containment structures. The completedform and printoutsfrom tests (ifapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ONE STOP MOBIL Date ofTesting: 6/24/13 Facility Address: 402 S. CHESTER BAKERSFIELD Facility Contact: GIL I Phone: (661) 835 -9544 Date Local Agency Was Notified of Testing: 6/5/13 Name of Local Agency Inspector (ifpresent during testing): ERNE MEDINA 2. TESTING CONTRACTOR INFORMATION Company Name: RICH ENVIRONMENTAL Technician Conducting Test: RICHARD MASON Credentials: p CSLB Contractor X [CC Service Tech. SWRCB Tank Tester Other (Spec) License Number(s): 5297857 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic Vacuum Other Test Equipment Used: VISUAL Equipment Resolution: 0 Identify Spill Bucket (By Tank Number Stored Product etc. 1 REG87 -FILL 2 PREM91 -FILL 3 4 Bucket Installation Type: X Direct Bury Contained in Sump X Direct Bury Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 12" 12" Bucket Depth: 14" 14" Wait time between applying vacuum/water and start oftest: 30 MIN 30 MIN Test Start Time (Tj): 9:00 9:00 Reading (R,): 10" 10" Initial Test End Time (TF): 10:00 10:00 Final Reading (RF): 10" 10" Test Duration (TF — Tj): 60 MIN 60 MIN Change in Reading (RF -Rj): 0 0 Pass/Fail Threshold or Criteria: 0 0 Test Result: X Pass Fail X Pass Fail Pass Fail Pass Fail Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING IHereby certo that all the information contained In this report is true, accurate, and infull compliance with legal requirements. Technician's Signature: Date: 6/24/13 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. SCHD INUTRY NONE TIME1 INUTR 12:00 AM TIME2 INUTR 12:00 AM TIME3 INUTR 12 :00 AM SCHD INURC NONE TIME1 INURC 12:00 AM TIME2 INURC 12:00 AM TIMES INURC 12:00 AM SCHD DLHST NONE TIME1 DLHST 12:00 AM TIME2 DLHST 12:00 AM TIME3 DLHST 12:00 AM SCHD ALHST NONE TIME1 ALHST 12:00 AM TIME2 ALHST 12:00 AM TIME3 ALHST 12:00 AM SCHD ACT AL NONE TIME1 ACTAL 12:00 AM TIME2 ACTAL 12:00 AM TIME3 ACTAL 12:00 AM SCHD ALST NONE TIME1 ALST 12:00 AM TIME2 ALST 12:00 AM TIME3 ALST 12:00 AM CONFIDENCE 99.0% LEAK TEST 0.i0 SCHD TEST ON TANK 1 LAST DAY TANK 2 LAST DAY TIME TEST r TANK 1 11:00 PM TANK 2 11:00 PM ALARM ON TIMEOUT 30 HIGH LIM ON LOW LIM OFF HIGH HIGH ON LOW LOW ON WATER LIM ON LEAK LIM ON SYSFAIL ON THEFT ON RELAY 835 -9544 TIMEOUT 30 HIGH LIM ON LOW LIM OFF HIGH HIGH OFF LOU LOW OFF WATER LIM ON LEAK LIM ON SYSFAIL ON THEFT OFF STD ALARM Stu ALARM 1 ON ALARM 2 ON ALARM 3 ON ALARM 4 ON ALARM 5 OFF ALARM 6 OFF ALARM 7 OFF ALARM 8 ON STD RELAY ALARM 1 ON ALARM 2 ON ALARM 3 ON ALARM 4 ON ALARM 5 ON r ALARM 6 ON ALARM 7 ON ALARM 8 ON ONE STOP MOBIL MART. STD 402 S. CHESTER ALARM 1 S.U. SUMP BAKERSFIELD, CA. 93304 ALARM 2 S,U.AN,SPACE SITE # 805 835 -9544 ALARM 3 R.U..SUMP ALARM 4 R.U.AN.SPACE 6/24/2013 11:15 AM ALARM 5 NONE ALARM HISTORY REPORT " ALARM 6 NONE ALARM 7 NONE 6/24/2013 10•'12 AM ALARM 8 NONE S U.AN.SPACE SENSOR TYPE j 6/24/2013. 10:13 AM SENSOR 1 STD R.U.AN.SPAiCE SENSOR 2 STD SENSOR 3 STD 6/24/2013 10:13 AM SENSOR 4 STD i R.U..AN.SPACE SENSOR 5 STD SENSOR 6 STD 4tA'`1 F/2013 10:23 All SENSOR 7 STD POWER DOWN.,.,. SENSOR 8 STD 6! 2412013 10:24 AM CONTROL OUTPUT POWER UP GRACE PERIOD 0 6/24/2013 10:28 AM LOW LOW 1 NONE R.U. SUMP LOW LOW 2 NONE 6/24/2813 10:29 AM LOW 1 NONE R.U. SUMP LOW 2 NONE 6/24/2013 10:29 AM HIGH WTR 1 NONE R.U. SUMP HIGH UTR 2 NONE 6/24/2013 10:30 AM HIGH 1 NONE S.U. SUMP HIGH 2 NONE 6/24/2013 10:31 AM S.U. SUMP HIGH HIGH i NONE HIGH HIGH 2 NONE SYSTEM FAIL NONE STD 1 ALL . STD 2 ALLSTD3ALL STD 4 ALLSTD5ALL STD 6 ALL STD 7 ALL STD 8 ALL STOP MOBIL MART. 02 S.. CHESTER SFIELD, CA. 93304 805 835 -9544 013 10:19 AM fEM SETUP REPORT 4RE VERSION 0.9910 ION 1 ONE STOP MOB ION 2 IL MART. T 1 .402 S. CHEST T 2 ER 1 BAKERSFIELD 2 CA. ODE 93304 805 835 -9544 1NI TS UNITS UNITS STYLE STYLE IGHT SAU TIME DATE GALLONS INCHES FAHRENHEIT 12 HOUR MM /DD /YY ENABLED 10:20 AM 06/24/2013 TANKS LIMIT T LIMIT V LIMIT iL MODE T SNTNL SNTNL V DELAY RT DELIU RT ALRMS RT TESTS OF ALARMS vT INTERVAL E CHAN i D CHAN 1 A BITS 1 P BITS 1 ITY 1 URITY 1 ESS 1 NE 1 1IAL 1 ESS 2 NE 2 IAL 2 ESS 3 NE 3 IAL 3 ESS 4 NE 4 DIAL 4 AL DELIU AL ALARM AL LEAK 2 2.00 10.00 200.00 OFF 12100 AM 12:00 AM 15 ENABLED ENABLED ENABLED 10 5.00 NATIVE 1200 8 1 NONE DISABLED DISABLED DISABLED DISABLED ONE STOP MOBIL MART. 402 S. CHESTER BAKERSFIELD, CA. 93304 SITE # 805 835 -9544 6/24/2813 09:54 AM TANK SETUP REPORT TANK NO. 2 12000 GAL UNLEADED REG TANK TYPE JOUR TANKS TANK DIMS 111.5}1 258.5 TANK SIZE 12800 TANK SHAPE CYLINDER DIAMETER 111.50 LENGTH 258.50 PRODUCT UNLEADED REG OFFSET P 2.25 OFFSET W 2.25 MANIFOLD NONE PROBE STD 113 FLOATS 2 FLOAT TYPE GASOLINE GRADIENT 8.9731 SENSOR LENGTH 113 HIGH LIMIT 99.00 LOW LIMIT 535.00 HIGH HIGH 102.00 LOW LOW 252.00 WATER LIMIT 4.00 TEMP COMP API 6B/548 API GRAVITY 63.50 ALPHA 320.00 NO. RTDS 5 RTD LOC 1 12.90 RTD LOC 2 34.80 RTD LOC 3 51.68 RTD LOC 4 68.10 RTD LOC 5 86.90 STRAPPING DATA INCHES GALLONS 0.000 0.0 5.000 173.8 10.000 484.7 15.000 877.6 20.000 1331.0 25.000 1831.4 30.000 2369.0 35.000 2935.9 40.000 3525.2 45.000 4131.1 50.000 4748.0 55.000 5370.7 60.000 5994.1 65.800 6613.3 70.000 7223.0 75.000 7817.9 80.000 8392.2 85.000 8939.4 90.000 9451.9 95.000 9920.6 100.000 10333.4 105.000 10672.0 lip-RAM 10899.7 ONE STOP MOBIL MART. 402 S. CHESTER BAKERSFIELD, CA. 93304 SITE # 805 835 -9544 6/24/2013 09:53 AM TANK SETUP REPORT TANK NO. 1 8000 GAIL UNLEADED SUP TANK TYPE JOOR TANKS TANK DIMS 111.5 X 191 TANK SIZE 8000 TANK SHAPE CYLINDER DIAMETER 111.50 LENGTH 191.00 PRODUCT UNLEADED SUP OFFSET P 0.91 OFFSET W 0.91 MANIFOLD NONE PROBE STD 113 FLOATS 2 FLOAT TYPE GASOLINE GRADIENT 8.9633 SENSOR LENGTH 113 HIGH LIMIT 96.00 LOW LIMIT 358.00 HIGH HIGH 90.00 LOW LOW 168.00 WATER LIMIT 4.08 TEMP COMP API 66/548 API GRAVITY 51..30 ALPHA 320.00 NO. RTDS 5 RTD LOC 1 12.90 RTD LOC 2 34.80 RTD LOC 3 51.60 RTD LOC 4 68.10 RTD LOC 5 86.90 STRAPPING DATA INCHES GALLONS 0.000 0.0 5.000 128.4 10.006 358.1 15.000 648.4 20.000 983.4 25.900 1353.2 30.000 1750.4 35.000 2169.2 40.000 2604.7 45.000 3052.4 50.000 3508.2 55.000 3968.3 60.000 4428.9 65.000 4886.4 70.000 5336.9 75.000 5776.5 80.000 6200.8 85.080 6605.1 90.000 6983.8 95.000 7330.1 100.000 7635.1 105.000 7885.3 11A.AA0 8053.6 MONITOR CERT. FAILURE REPORT SITE NAME: ONE STOP MOBIL DATE : 6/24/13 ADDRESS: 402 S. CHESTER TECHNICIAN: RICHARD MASON THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS • NONE LABOR: NONE PARTS INSTALLED: NONE NAME • TITLE: SIGNATURE: THE ABOVE NAMED PERSON TAKES FULL RESPONSIBILITY OF NOTIFYING THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTIFYING RICH ENVIRONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIRONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON- COMPLUdiNCE. A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR CONVIENENCE. 1, 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) 3 REMARKS: BUILDING ADDRESS: Z es JOB DESCRIPTION: ^J/vl C.- OCCUPANCY TYPE: OWNER: 7 ( PERMIT NO. /3- / 02 CONTRACTOR: , " PHONE # 2— FD 1743 w BILLING & PERMIT STATEMENT PERMIT NO.: B 8 R Sp 1 D 4 FIRE ARrm r BAKERSFIELD FIRE DEPT. Prevention Services 1600 Truxtun Ave Ste 401 Bakersfield CA 93301 Tel.: (661) 326 -3979 • Fax: (661) 852 -2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. 1 CALCULATION10PERMITTYPEFEE DUE Alarms - New & Modifications - (Minimum Charge) $280.00 rommm ONLY ACCT NO 98 Over 10,000 Sq. Ft. LOCATION OF PROJECT a& %w ft\& SITE INFORMATION PROPERTY OWNER nkllvvr STARTING DATE ' 1 COMP ION DATE NAME 98 PROTECTNAME Sq. Ft. x.028 = Permit fee A, „ ADDRESS O n , n (, _ i+ lX PJ NE NO. PROJECT ADDRESS CRY n STATE ZIP CODE CONTRACTOR CONTRACTOR NAME CALICENSE NO. JI m S ct-t 0 50 INFORMATION TYPE OF LICENSE. EXPIRATION DATE f 4t gN l 30.201 PHONE NO. 22.8 CONTRACTOR COMPANY NAME tc ENV 84 98 FAX NO. OO ADDRESS 5L Ll `a 58.00 CITY ^ ZlPwue 9 :6 -a All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. 1 CALCULATION10PERMITTYPEFEE DUE Alarms - New & Modifications - (Minimum Charge) $280.00 rommm ONLY ACCT NO 98 Over 10,000 Sq. Ft. Sq. Ft, x.028 = Permit fee 84 98 Sprinklers - New & Modifications - (Minimum Charge) 280.00 84 98 Over 10,000 Sq. Ft Sq. Ft. x.028 = Permit fee 84 98 Minor Sprinkler Modifications (< 10 heads) 96.00 (Inspection Only] 84 98 Commercial Hoods — New & Modifications 470.00 84 98 Additional Hoods 58.00 84 98 Spray Booths - New & Modifications 470.00 84 98 Aboveground Storage Tanks (Installadontinsp. -1 s' Time) 180.00 82 Additional Tanks 96.00 82 Aboveground Storage Tanks (RemovaYinspection) 109.00 82 Underground Storage Tanks (Installadon.11nspection) 878.00 (per tank) 82 Underground Storage Tanks (Modification) 878.00 (per site) 82 Underground Storage Tanks (Minor Modification) 167.00 82 Underground Storage Tanks (Removal) 573.00 (per tank) 84 Oilwell (Installation) 96.00 E68 (pefsitel ,O n 84 82MandatedLeakDetection (Testing) /Fuel omit. B981 Note: $96.00 for each type of test /per site ( n If ulaH at Me same time) Tents 96.00 (per tens) 84 Pyrotechnic - (Per event, Plus Insp. Fee ® $96 per hour) 96.00 + (5 hrs. min. standby fee /Inspection) - X576..00 84 After hours inspection flee 121.00 84 RE- INSPECTION(S) /FOLLOW- UP/NSPECTION(S) 96.00 (per hour) 84 Portable LPG (Propane): NO. OF CAGES? _ 96.00 84 Explosive Storage 266.00 84 Copying & File Research (File Research Fee $50.00 per hr) 250 per page 84 Miscellaneous 84 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) R 14 BILLING & PERMIT STATEMENT PERMIT NO.: B B R S P I ID F1R6 ARTmAfr BAKERSFEELD FIRE DEPT. Prevention Services 1600 Truxtun Ave Ste 401 Bakersfield CA 93301 Tel.: (661 ) 326 -3979 a Fax: (661 ) 852 -2171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. 1 Alarms - New & Modifications - (Minimum Charge) 1 Over 10,000 Sq. Ft. 280.00 Sq. Ft x.028 = Permit fee 84 9A Undergroun Storage an (Minor Modification G INFORMATIONSITE Underground Storage Tanks (Remove!) 573.00 (per tank) LOCATION OF PROJECT S4 PROPERTY OWNER Oilwell (Installation) 96.00 V 84 Mandated Leak Detection (Testing) / Fuel onit. B98! Note: $96.00 for each type of test /per site (&kn if ul,-' at the same time) 9t399-(peFSiteL ,o C 96.00 (per tent) STARTING DATE L' ' COMP ION DATE NAME Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) 96.00 + (5 hrs. min. standby fee /inspection)-_W&.00 PROJECT NAME 84 ADDRESS xO /t • C PONE NO. PROTECTADDRESS 1 (\ „ VY/ IVtCI CnY STATE ZIP CODE B4 CONTRACTOR s 96.00 CONTRACTOR NAME CALICENSE NO. J TYPE OF LICENSE EXPIRATION DATE PHONE NO. 7IfYYlESCO O t vR N 1 30 201 g 2 CONTRACTOR COMPANY NAME Copying &File Research (File Research Fee $50.00 per hr) 250 per page FAX NO- pIC Miscellaneous 84 OO ADDRESS , 6U CnY ZIPL.wt All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. 1 Alarms - New & Modifications - (Minimum Charge) 1 Over 10,000 Sq. Ft. 280.00 Sq. Ft x.028 = Permit fee 84 9A FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) Undergroun Storage an (Minor Modification G Underground Storage Tanks (Remove!) 573.00 (per tank) S4 Oilwell (Installation) 96.00 84 Mandated Leak Detection (Testing) / Fuel onit. B98! Note: $96.00 for each type of test /per site (&kn if ul,-' at the same time) 9t399-(peFSiteL ,o C 96.00 (per tent) 82 84. Tents Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) 96.00 + (5 hrs. min. standby fee /inspection)-_W&.00 84 Afterhours inspection fee 121.00 84 RE- INSPECTIONS) /FOLLOW -UP INSPECTION(S) 96.00 (per hour) B4 Portable LPG (Propane): NO. OF CAGES? _ 96.00 84 Explosive Storage 266.00 84 Copying &File Research (File Research Fee $50.00 per hr) 250 per page 84 Miscellaneous 84 FD 2021 (Rev. 06/07) 1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer) i .: 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.) PERMIT # Apm§i ARfI jr BAKERSFIELD FIRE DEPARTMENT Prevention Services alot Vk S-mv—ET Bakersfield, CA 93301 Phone: 661-326-3979 . Fax: 661- 852 -2171 Page 1 of 1 ENHANCED LEAK DETECTION LINE TESTING SB-989 SECONDARY CONTAINMENT TANK TIGHTNESS FUEL MONITORING CERTIFICATION ITE N FACILITY NAME & PHONE 0 OF CONTACT PERSON ADDRESS OWNER NAME OPERATOR NAME PERMIT TO OPERATE # OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO TANK aR VOLUME CONTENTS TANK TESTING.COMPANY; TESTING COMPANY NAME & PHONE A OF CONTACT PERSON MAILING ADDRESS Jla -13 t3C eOh.S GT. — Z h\ EtRSF l'ELO ,. C A °13308 NAME & PHONE 3 OF TESTER OR SPECIAL INSPECTOR 1 Ica - 8(0S9 CERTIFICATION # S09 6 sv DATE & TIME TEST 0 BE CONDUCTED Cp I3 9ram ICC A TEST METHOD X1c4>v APPLICANT SIGNATURi D TE SI v HIS APPLICATION BECOMES A PE T WHEN APPROVED APPROVED BY DATE FD2095 (Rev 03/08) I3 7, a D Name ONE. STOP 1: MOBIL 116 ES Pendi_n_g: 4 Previous: ENVIRONMENTAI Deposit;: I /1 F-67-1Q1 13 stamen Statements Processed 1 5/01/13 stmrn statements Processed 1 4/01713 stmrn Statements Processed F— 3701/13- stmrn Statements Processed 1- 2/01/13 stmrn IStatements Processed 1 01 13 stmrn IStatements Processed F 11,2/01/12 stm=n Statements Processed F- F11/01/12 WO .11. MAT FEE GROUP 11 F- 11 Q1 12 HMO17 WZ MAT ANNUAL INSPECTION