HomeMy WebLinkAbout6201 LAKE MING BOULEVARD FMC 2013HOODS ALARMS SPRINKLER SYSTEMS SPRAY BOOTH AST UST
Permit No. Permit No. Permit No. Permit No. Permit No. Permit No.
3 /Gt9 CJ33
File Number: 3a S-^ (- =' -
Date Received: 7 — q — 3
Address: &Z 0 / Z..4 k e Gl/f, ,
Bakersfield, CA 933
Business Name: Wt d ,a,4AQ;b
SYSTEM: BUILDING SQUARE FEET:
New Mod.
Commercial Hood System
Fire Alarm System
Fire Sprinkler System
Spray Finish System
Aboveground Storage Tank
Underground Storage Tank
minor
modification Underground Storage Tank
removal Underground Storage Tank
U, Other. C_
Building Sq. Feet:
Calculation Bldg. Sq. Ft:
a.
3.
U.
INSPECTION LOG
Date Time
Signature
Signature
Comments: 7&.h: LA2,1-jclav Esau
1CG 0 5S28y9,0 4550 S /2-?/lr-
VA1 &)P' S / /O / /s'
jk ;,rev
MONITORING SYSTEM CERTIFICATION
For Use By All Jurisdictions Within the State ofCalifornia
Authority Cited: Chapter 6.7, Health andSafety 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 prepared for each
monitoring system control pane] 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 of this form to the local agency regulating UST systems within 30 days of test date.
A. General Information
Facility Name: RIO BRAVO MOBIL
Site Address: 6201 LAKE MING BLVD
Facility Contact Person:
Make/Model ofMonitoring System: GILBARCO
B. Inventory of Equipment Tested/Certifled
Check the appropriate boxes to indicate specific equipment inspected/serviced:
Bldg. No.:
City: BAKERSFIELD Zip: 93306
Contact Phone No.: ( )
Date of Testing/Servicing: 7/30/2013
Tank rD: UNL871SPLIT Tank ID: PREM 91 /SPLIT
In -Tank Gauging Probe. Model: MAG In -Tank Gauging Probe. Model: MAG
Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420
Piping Sump t Trench Sensor(s). Model: 208 Piping Sump / Trench Sensor(s). Model: 208
Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model:
Mechanical Line Leak Detector. Model: RED JACKET Mechanical Line Leak Detector. Model: RED JACKET
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 m: 1 -2 Dispenser ID: 3-4
Dispenser Containment Sensor(s). Model: 208 DispenserContainment Sensor(s). Model: 208
Shear Valve(s). Shear Valve(s).
Dispenser Containment Floats) and Chain(s). DispenserContainment Floats) and Chain(s).
Dispenser ID: Dispenser ID:
Dispenser Containment Scnsor(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).
Dispenser ID: Dispenser ID:
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 -I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers'
guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is
correct and a Plot Plan showing the layout of monitoring a uipment. For any equipment capable ofgenerating such reports, I have also
attached a copy of the report; (check all that apply): System set -up Alarm history report
Technician Name (print): BRANDON MASON Signature:
Certification No.: 5284980 -UT 1834335 License. No.: C611 D40 809850
Testing Company Name: RICH ENVIRONMENTAL Phone No.: (661) 392 -8687
Testing Company Address: 5643 BROOKS CT. BAKERSFIELD, CA 93308 Date ofTesting/Servicing: 7/30/2013
Page 1 of 5
UN -036 —1/4 www.unidocs.org Rev. 01/17/08
v
Monitoring System Certification
D. Results of Testing/Servicing .
Software Version Installed: 15.01
Complete the following checklist:
Yes I 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 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? If yes: which sensors initiate
positive shut -down? (Check all that apply) ® Sump/Trench Sensors; N Dispenser Containment Sensors.
Did you confirm positive shut -down due to leaks gj& sensor failure/disconnection? ® Yes; No.
Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e., no
N 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? If so, at what percent oftank capacity does the alarm trigger? %
Yes* N No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced
and list the manufacturer name and model for all replacement parts in Section E, below.
Yes* N No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply)
Product; Water. Ifyes, describe causes in Section E, below.
N Yes No* Was monitoring system set -up reviewed to ensure proper settings? Attach set up reports, if applicable
N Yes No* I 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 8
VN-036 — 2/4 www.unidoes.org Rev. 01/17/08
Monitoring System Certification
F. In -Tank Gauging / SIR Equipment: Check this box iftank gauging is used only for inventory control.
Check this box ifno tank gauging or SIR equipment is installed.
This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring.
Complete the following checklist:
Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults?
Yes No* Were all tank gauging probes visually inspected for damage and residue buildup?
Yes No* Was accuracy ofsystem product level readings tested?
Yes No* Was accuracy ofsystem 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):
Cmmnlete the following checklist_
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 offif any portion ofthe monitoring system malfunctions
10 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 aectlon H, below, describe now and when these deficiencies were or will be corrected.
H. Comments:
VN -036 — 3/4
Page 3 of 5
www.unidocs.org Rev. 01/17/08
Monitoring System Certification
UST Monitoring Site Plan
Site Address: _ p b tAu-6 WS -'Ll iAb v BA F'LI> a 9.g _IC(o
1 ' . . . . . . . . . . . .
I ...................... .
I ............. .
r.
c
I ...... I ................
I........
I ....... I . ............................ . ...................... ............................ .
I .......... ..................
I ............................ .
Date map was drawn: //.
Tne +rzvn +inns
If you already have a diagram that shows all required information, you may include it, rather than this page, with your
Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify
locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular
spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak
detectors; and in -tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan
was prepared.
Page of 05100
v% 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: RIO BRAVO MOBIL
FACILITY ADDRESS: 6201 LAKE MING BLVD, 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 PASS
YES 11SERIAL # MECHANICAL
pREM91 L/D TYPE: RED JACKET PASS
YES 11SERIAL # MECHANICAL
LID TYPE: _ PASS
YES
SERIAL # FAIL
LID TYPE: PASS
YES
SERIAL # P.AIEL
I 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: BRANDON MASON
SIGNATURE: DATE: 7/30/13
SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform and
printouts from tests (fapplicable), should be providedto thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACRM INFORMATION
Facility Name: RIO BRAVO MOBIL I Date of Testing: 7/30/13
Facility Address: 6201 LAKE MING BLVD, BAKERSFIELD
Facility Contact: I Phone:
Date Local Agency Was Notified ofTesting: 7/9/13
Name of Local Agency Inspector (fpresent during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: RICH ENVIRONMENTAL
Technician Conducting Test: BRANDON MASON
Credentials': 0 CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester 0 Other (Specify)
License Number(s): 5284980 -UT
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic 0 Vacuum Other
Test Equipment Used: VISUAL Equipment Resolution: 0
Identify Spill Bucket (By Tank
Number, Stored Product, etc.
I REG 87 -FILL 2 PREM 91 -FILL 3 4
Bucket Installation Type: X Direct Bury
0 Contained in Sump
X Direct Bury
0 Contained in Sump
0 Direct Bury
0 Contained in Sump
0 Direct Bury
0 Contained in Sum
Bucket Diameter: 12' 12"
Bucket Depth: 14" 14"
Wait time between applying
vacuum/water and start oftest,.
30 MIN 30 MM
Test Start Time (TO: 9:30 9:30
Initial Reading (Rj): 14" 14"
Test End Time (TF): 10:30 10:30
Final Reading (RF): 14" 14"
Test Duration (TF — Tj): 60 MIN 60 MIN
Change in Reading (RF- R1): 0 0
Pass/Fail Threshold or
Criteria: 0 0
Test Result. X Pass 0 Fail X Pass Fail 0 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 certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements.
Technician's Signature: L Date: 7/30/13
State laws and regulations do not currently require testing to be performed by a qualified contractor.. However, local requirements
may be more stringent.
SYSTEM SETUP
JUL 30, 2013 11:02 AM
SYSTEM UNITS
U.S.
SYSTEM LANGUAGE
ENGLISH
SYSTEM DATE/TIME FORMAT
MON DD YYYY HH:MM:SS xM
RIO BRAVO MOBIL
BAKERSFIELD CA
SHIFT TIME 1 : DISABLED
SHIFT TIME 2 : DISABLED
SHIFT TIME 3 : DISABLED
SHIFT TIME 4 : DISABLED
TANK PERIODIC WARNINGS
DISABLED
TANK ANNUAL WARNINGS
DISABLED
LINE PERIODIC WARNINGS
DISABLED
LINE ANNUAL WARNINGS
DISABLED
PRINT TC VOLUMES
ENABLED
TEMP COMPENSATION
VALUE (DEG F ): 60.0
STICK HEIGHT OFFSET
DISABLED
H- PROTOCOL DATA FORMAT
HEIGHT
DAYLIGHT SAVING TIME
ENABLED
START DATE
APR WEEK 1 SUN
START TIME
2:00 AM
END DATE
OCT WEEK 4 SUN
END TIM£
2:00 AM
RE- DIRECT LOCAL PRINTOUT
DISABLED
SYSTEM SECURITY
CODE : 000000
COMMUNICATIONS SETUP
PORT SETTINGS:
COMM BOARD :.2 (RS -232)
BAUD RATE : 1200
PARITY : EVEN
STOP BIT : I STOP
DATA LENGTH: 7 DATA
AUTO TRANSMIT SETTINGS:
AUTO LEAK ALARM LIMIT
DISABLED
AUTO HIGH WATER LIMIT
DISABLED
AUTO OVERFILL LIMIT
DISABLED
AUTO LOW PRODUCT
D I SAILED
AUTO THEFT LIMIT
DISABLED
AUTO DELIVERY START
DISABLED
AUTO DELIVERY END
DISABLED
AUTO EXTERNAL INPUT ON
DISABLED
AUTO EXTERNAL INPUT OFF
DISABLED
AUTO SENSOR FUEL ALARM
DISABLED
AUTO SENSOR WATER ALARM
DISABLED
AUTO SENSOR OUT ALARM
DISABLED
RB -232 SECURITY
CODE : 000000
RS -232 END OF MESSAGE
ENABLED
I N-TANK
T 1:UNLEADED 87
PRODUCT CODE
THERMAL COEFF
TANK DIAMETER
TANK PROFILE
FULL VOL :
96.1 INCH VOL
64.1 INCH VOL
32.0 INCH VOL
FLOAT SIZE: 4.0 IN
WATER WARNING
HIGH WATER LIMIT:
MAX OR LABEL VOL: OVERFILL LIMIT
HIGH PRODUCT
DELIVERY LIMIT
LOW PRODUCT
LEAK ALARM LIMIT:
SUDDEN LOSS LIMIT:
TANK TILT
MANIFOLDED TANKS
T #: NONE
LEAK MIN PERIODIC:
LEAK MIN ANNUAL
PERIODIC TEST TYPE
STf
ANNUAL TEST FAIL
ALARM DIE
PERIODIC TEST FAIL
ALARM DIE
GROSS TEST FAIL
ALARM DIE
ANN TEST AVERAGING
PER TEST AVERAGING
TANK TEST NOTIFY:
TNK TST SIPHON BREF
DELIVERY DELAY :
J
T 2 :SUPREME 92
PRODUCT CODE 2
THERMAL COEFF 000700
TANK DIAMETER 128.10
TANK PROFILE 4 PTS
FULL VOL 8029
96.1 INCH VOL 6475
64..1 INCH VOL 4034
32.0 INCH VOL 1587
FLOAT SIZE: 4.0 IN. 8496
WATER WARNING 2.0
HIGH WATER LIMIT: 2.5
MAX OR LABEL VOL: 8029
OVERFILL LIMIT : 95%
7627
HIGH PRODUCT 95%
7627
DELIVERY LIMIT 10%
802
LOW PRODUCT 500
LEAK ALARM LIMIT: 99
SUDDEN LOSS LIMIT: 99
TANK TILT 0.00
MANIFOLDED TANKS
T#: NONE
LEAK MIN PERIODIC: 0%
0
LEAK MIN ANNUAL 0%
0
PERIODIC TEST TYPE
STANDARD
ANNUAL TEST FAIL
ALARM DISABLED
PERIODIC TEST FAIL
ALARM DISABLED
GROSS TEST FAIL
ALARM DISABLED
ANN TEST AVERAGING: OFF
PER TEST AVERAGING: OFF
TANK TEST NOTIFY: OFF
TNK TST SIPHON BREAK:OFF
DELIVERY DELAY : 5 MIN
LEAK TEST METHOD
TEST ON DATE : ALL TANK
JAN 1, 1996
START TIME : DISABLED
TEST RATE :0.20 GAL /HR
DURATION : 2 HOURS
LEAK TEST REPORT FORMAT
NORMAL
LIQUID ^SENSOR SETUP- - -
L I:ANNULAR
TRI -STATE (SINGLE FLOAT)
CATEGORY : ANNULAR SPACE
L 2 :87 STP SUMP
TRI -STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L 3 :92 STP SUMP
TRI -STATE (SINGLE FLOAT)
CATEGORY : STP SUMP
L 4 :DISPENSER PAN 1 -2
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
L 5:DISPENSER PAN 3 -4
TRI -STATE (SINGLE FLOAT)
CATEGORY : DISPENSER PAN
EXTERNAL -INPUT SETUP - -
NONE
7t
OUTPUT 3' -
R 1:87
TUOIN
CONTROL
STA CLOSED
ldO'f
AveR
LL21Fo
L 4 AAL,A ALARM
L 5 • $EItSOR OUT ALARTq
L5s OUT ALA
92
TUYBIN
CONT
VpE
N6 yCLOSED
R A1.
LIQUID
3 FuARM
L gFUEL AL ALP
ORL3' OUT
L agsaR aUT Ali
ALAS
H1gTORY R
5EPISOR AI
APiNULAR
AIyNULAR La Au
S Q ,a2013
FULL 3LA013
SU
2R ,
010
24
Or2P
V, 3
ALARM HISTORY FtFUK1
SENOR ALARM --
L 2:87 STP SUMP
STP SUMP
SENSOR OUT ALARM
JUL 30. 2013 10:18 AM
FUEL ALARM
JUL 30, 2013 10:11 AM
SENSOR OUT ALARM
JUL 24. 2012 10:07 AM
x x x x X END X x x x x
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 3:92 STP SUMP
STP SUMP
SENSOR OUT ALARM
JUL 30. 2013 10:18 AM
FUEL ALARM
JUL 30. 2013 10:12 AM
SENSOR OUT ALARM
JUL 24, 2012 10:07 AM
x* x w x END X X x m x
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 4:DISPENSER PAN 1 -2
DISPENSER PAN
SENSOR OUT ALARM
JUL 30. 2013 10:18 AM
FUEL ALARM
JUL 30. 2013 10:13 AM
SENSOR OUT ALARM
JUL 24. 2012 10:07 AM
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 5:DISPENSER PAN 3 -4
DISPENSER PAN
SENSOR OUT ALARM
JUL, 30, 2013 10:18 AM
FUEL ALARM
JUL 30, 2013 10:13 AM
FUEL ALARM
JUL 24, 2012 1:22 PM
xmxmX END *xxxx
ALARM HISTORY REPORT
SENSOR ALARM - - - --
L 6:
OTHER SENORS
5 \'Jq't//
MONITOR CERT. FAILURE REPORT
SITE NAME: RIO BRAVO MOBIL DATE: 7/30/13
ADDRESS: 6201 LAKE MING BLVD TECHNICIAN: BRANDON MASON
CITY: BAKERSFIELD SIGNATURE: -
THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE
TESTING.
REPAIRS: NONE
LABOR: NONE
PARTS INSTALLED: NONE
NAMEE: 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 - COMPLIANCE.
A COPY OF THIS DOCUMENT HAS BEEN LEFT ON -SITE FOR YOUR
CONVIENENCE.
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
C___ _ __ _ _ ___ _ _ TANK TESTING _
l-7 C- 7 3A/i? ;;;,
UST REMOVAL
DESCRIPTION DATE SIGNATURE
AST NEW INSTALL
DESCRIPTION DATE SIGNATURE
MODIFICATIONS MINOR / MAJOR
0
AST REMOVAL
DESCRIPTION DATE SIGNATURE
EVR UPGRADE
PRIOR:T_O'OPERATION OF ANY SYSTEM,;
ALL`USTAND /_OR__AST- SYSTEMS SHALL BE
INSTALL, COMPLETE A_ND ACCEPTED BY
MISC. ACTIVITY THE-BA KERSFIELD.CITY FIRE DEPARTMENT.
FIRE DEPARTMENT_(FINAQ '7777
EMARKS:
BUILDING ADDRESS: G 26
JOB DESCRIPTION: OCCUPANCY TYPE:
OWNER: p f air PERMIT NO. -
CONTRACTOR: PHONE # Z-56
FD 1743
r
BIDINw
G & PERMIT STATEMENT
PERMIT NO.:
NP. BAKERSFEELD FIRE DEPT..
D Prevention ServicesLB1600TnlxtunAveSte4011Mf
Bakersfield CA 93301
Tel.: (6611326-3979 • Fax: (6611852-2171
SITE INFORMATION
LOCATION OF PROJECT
J
PROPERTY OWNER
96.00 (per hour) 84
STARTING DATE ` _ OMPLETION DA ,_,,,
I U
NAME ; EcaiTn
Portable LPG (Propane): NO. OF CAGES? _ 96.00
PROJECT NAME ADDRESS
Explosive Storage 266.00
PROJECTADDRESS
84
CnY STATE
CLkW
Copying & File Research (File Research Fee $50.00 per hr)
ZIPC
CONTRACTOR NAME CA LICENSEN
J i m cS c tt 113001ST0
INFORMATION
TYPE OF LICENSE. EXPIRATION DATE
r 4 aN 1 0.201
PHONE NO.
g 2 -8 i
CONTRACTOR COMPANY NAME
84
FAX NO.
ADDRESS CITY ZIPL.wt
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT. 01
Ell PERMIT TYPE FEE CALCULATION TOTAI.
DUE
Alarms - New & Modifications - (Minimum Charge) $280.00
TREASUR
ACCT
ONLY
140M
98
Over 10,000 Sq. FL Sq. Ft. x.028 = Permitfee 84
98
Sprinklers - New & Modifications - (Minimum Charge) 280.00 84
98
Over 10,000 Sq. Ft. q. F .028 =Permit fee 84
98
Minor Sprinkler Modifications (< 10 heads) Inspection Onl RECEIVE 94
98
Commercial Hoods — New & Modifications C4J470.000 84
98
Additional Hoods 58.00
98
ti.
RICH ENVIRONMENTAL
SERVICE STATION SERVICES
LIC1809850
5643 BROOKS CT
BAKERSFIELD, CA 93308 -3708
661) 392 -8687
CHASE
JP Morgan Chase Bank, N.A.
Bakersfield, CA 93308
M r1LLFOR
AML. 1po2 i .o --EcrL
i AN
90- 7152/3222 4245
DATE
OLt AR
sf
F
W°
AUTHORIZED NA RE
FD 2021 (Rev. 06/07)
1 - ORIGINAL WHITE (to Treasury) 1- YELLOW (to File) 1 -PINK (to Customer)
Rfill
96.00 (per hour) 84RE- INSPECTION(S) /FOLLOW -UP INSPECTION(S)
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
pq', E
bt
UNDERGROUND STORAGE TANKS
APPLICATION
TO PERFORM ELD /LINE TESTING/
SB989 SECONDARY CONTAINMENT
TESTING/TANK TIGHTNESS TEST AND
FUEL MONITORING CERTIFICATION
Please note that these are separate
Fndividual tests and will be charged per
separate type test accordingly.)
PERMIT #
P - 40 !m P I
wiar
ARrAF r
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
Q%Ot t-t sZREET
Bakerstield, CA 93301
Phone: 661-326-3979 • Fax: 661-852-2171
Page 1 of 1
ENHANCED LEAK DETECTION 11 SB -989 SECONDARY CONTAINMENT
11 TANK TIGHTNESS FU=ONr=0RING CERTIFICA N
SITE;INF ONl .
FACILITY NAME & PH9" OF CONTACT PERSON
ADDRESS 1 '
OWNER NAME
OPERATOR NAME PERMIT TO OPERATE #
OF TANKS TO BE TESTED: IS PIPING GOING TO BE TESTED? YES NO
TANK # VOLUME CONTENTS
2
TANKTESTING:COMPANY.` .
TESTING COMPANY NAME & PHONE # OF CONTACT PERSON
tD 1
MAILING ADDRESS
NAME A PHONE # OF ESTER OR SPE IAL INSPECTOR CERTIFICATION #
180 l ^ sU
DATE & TIME TEST TO BE CONDUCTED
C ^ A I `fit
ICC # TEST METHOD
APPLICA NATURE
I MQAL^-
DATE
o1 (3
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
APPROVED B DATE
FD2095 (Rev 03/08)
Y
BILLING & PERMIT STATEMENT
PERMIT NO.:
B Ai IE A rF1 D
FIRS
ARTm r
BAMRSFEELD FIRE DEPT.
Prevention Services
1600 Tnmdun 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.
F-11 PERMIT TYPE
Alarms - New & Modifications - (Minimum Charge)
SITE INFORMATION
TOTAL TREASURY
DUE ACCT NO
84
98
LOCATION OF PROJECT PROPERTY OWNER
STARTING DATE MPLETION DA
iJ
NAME
o •
PROJECT NAME - ADDRESS
O\ •
lPJ
E O.
PROJECT ADDRESS CITY STATE ZIP C
CONTRACTOR INFORMATION
CONTRACTOR NAME CA LICENSE N
J+'lESR Ct
TYPE OF LICENSE. EXPIRATION DATE PHONE NO
ipSO4oAPA30VC9'2
CONTRACTOR COMPANY NAME FAX NO.
1 G V O
ADDRESS CITY ZIP tuut
G
All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK ON THAT PROJECT.
F-11 PERMIT TYPE
Alarms - New & Modifications - (Minimum Charge)
FEE CALCULATION
280.00
TOTAL TREASURY
DUE ACCT NO
84
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 Onl RECEIVE e4
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 (lnstalladonlinsp. -l" Time) 180.00 82
Additional Tanks 96.00 82
Aboveground Storage Tanks (RemovaNnspection) 109.00 82
Underground Storage Tanks (InstallationAnspection) 878.00 (per tank) 82
Underground Storage Tanks (Modification) 878.00 (persite) 82
Underground Storage Tanks (Minor Modification) 167.00 82
Underground Storage Tanks (Removal) 573.00 (per tank) 84
Oilwell (Installation) 96.00 84
Mandated Leak Detection (Testing) kuel Moni .Cert/SB989.
Note: $8600for each type of test / pers' scheduled
at the same time)
1 8:fi@{pe site,L r-% a, ,0 n 82
Tents 96.00 (per tend 84
Pyrotechnic - (Per event, Plus Insp. Fee @ $96 per hour) 96.00 + (5hrs. min. standby fee Anspection)=$576_00 84
After hours inspection fee 121.00 84
RE- INSPECTIONS) /FOLLOW -UP INSPECTION(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)