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Home My WebLink About706 UNION AVENUE LINE TEST 2013HOODS ALARMS SPRINKLER SYSTEMS SP ° ° V BOOTHH AST UST Permit No. Permit No. Permit No. Permit No. Permit No. Permit No. File Number: Date Received: Address: KC S S Bakersfield, CA 933 Business Name: U ST Comments: 1. 2. 3. 4. INSPECTION LOG Date Time Signature SYSTEM: r BUILDING SQUARE FEET: New Mod. Commercial Hood System Building Sq. Feet: Fire Alarm System Calculation Bldg. Sq. Ft: Fire Sprinkler System Spray Finish System Aboveground Storage Tank Underground Storage Tank minor modification Underground Storage Tank removal Underground Storage Tank Other. U ST Comments: 1. 2. 3. 4. INSPECTION LOG Date Time Signature Kern County Superintendent bfSchools Office of Cbrisline LiZardi Frazier ...advocatesfor children April 1, 2013 Bakersfield Fire Department Attn: Ernie Medina 2101 H. Street Bakersfield, CA 93301 To Whom It May Concern: Enclosed please find the Certification of Financial Responsibility and the Letter from Chief Financial Officer for the Kern County Superintendent of Schools. If you have any questions or comments, please call me at 661- 636 -4755. KAS:kac Sincerely, Christine Lizardi Frazier Kern County uperin ndent of Schools Kim Sloan, Financial Operations Officer Internal Business Services 130017th Street - CITY CENTRE, Bakersfield, CA 933014533 661) 636 -4000 • FAX (661) 6364130 • TDD (661) 636 -4800 • www.kern.org Printedon regdedpaper Partner - Kern County Network for Children NOTE:_ Effective July 1.,.1995, California .Small Businesses.and California.Busiriesses with 500 employees -or less must- demonstrate at least $5,000, exclusive of the. UST Cleanup Fund, 6asiioesses with over 500 - employees must demonstrate,atleast $1.0,00.0: (Chap. 6.75 H &SC Sect..25299.32) The Cliieffinancial Officer or, the. owner or operator must sign,.undcr- penalty ;ofperjury, a, letter worded EXACTLYas follows,oryou °may complete`this letter by filling in the blanks.with:appropriate information: LETTER FROM CHIEF FINANCIAL .OFFICER 1 ani-the-ChiefFinancial Officer for- Kern County Superintendent of Schools Rusineca name.,'business address ,'and correspondence address ofowner or operntor)' This letter ;.is.in support-.ofthe use of the Underground. Storage Tank Cleanup Fund to demonstrate financial. responsibility for taking:corrective action and/or eompensatirigthird parties-for bodily injury and p operty damage,caused>by an unauthorized release of petroleum,,in the amount,bf atleast 1 , 000,000 per occurrence and $.1 , 000,000 annual aggregate-coverage. Dollar-Amount) (Dollar.Arn unt} Underground storage tanks arthe f illowi"ng-facilities are assured by thisletter: 705 South Union Ave. Bakersfield, CA. 93304 Name dad address of each faciliiy. forwhich financial responsibility is being demonstrated.) 1. Amount otannual aggregate-coverage being assured. by thissletter .....................I....:... 10,000O ........................... $ 2. Total tangible assets ............................... ............................... S 285,460,236 3. Total liabilities .... : ............. ......•......•.......... ...........•................... $ 145,158,832 4. Tangible _netV.6tt. h (sub"tr"act line. I from line.2. 140,301,404Lihe, 4:must be,at',least.10 "times line , l.)., .:.., ::........................ $ lherebycertify that the woiding.of'this lettenis identical to the wording specified.in siibsection,2808.r(d)(1), Chapter 18, Division 3, Title 23 of the California. Code of Regulations. I declare under penalty ofpedury that the1oregoing is true and correct to the best.of.my knowledge and belief Executed ai Bakersfield, CA Place of.Execution) On 4/1 eate)' Signature) Kim Sloan Printed.Name). Financial Operations Officer Title) UST02FR- revised 4195 p State of California For State Use Only siate Water. Resources Control, Boardter Division P.O. Box.944212 Sacramento,CA 94244 =2121 lnstruotigns on reverse-side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. tam requlred'to demonstrate Finandal'Responsibility in the-regyired amounts as specfied in'Calirornla Code of Regulations (CCR), 7111e,23, D'Msion 3, Chapter 18;:Sedion2807, FX1500,000 dollars per`oecurrence 1 milllon dollars annual aggregate or AND or 1`million dollars `per occurrence 2 milliondollars- annual aggregate B. Kern Co. Supt of Schools hereby certiiires'thbt it is in compliance with'ihe'requirements of'Section,2807, fNsme'of Tank- -0Wner or:Opeiator) Ca1if6mWCode _ofRegulations,. Title 23,. Division 3, Chapferf8, Article 3, Section 2807. The- mechanisms used to demonstrate financial responsibi* as required by Sectiow2807 are. as :tbllows: C. Mechanism Mechanism Coverage Coverage Corrective rhird.Party. T Name and Address of Issuer Number Amount Period Acton. Comp State Cleanup Fund. 990,000 pe State State Fund PO Box 944212 N/A Occurence Fund Yes Yes Sacramento, CA 990,000 Pei Coverage 94244 -2121 Annual Agg. Continou Kern County Supt. 10,000 per RenewedChiefFinancialofSchools NSA occurrence Annually Yes Yes Officer Letter 1300 17th Street 10,000 Bacer_sfield,CA 9330 1 annual Agg. Note: Note: IPyouare -using tha .State Fund as any part -ofyour demonstration of financial responsibility, your ezecutlon and submission of this certification also certifies thatyou are incompliance and "shall maintain compliance.wiWall conditions for- participatiomin the Fund:. Seetinstrucflons. D. Facility Name Facility Address Kern County Superintendent of Schools Mail:1300 17th St. Ba{ersfield,CA 93301 Schools Service Center Phys:705 So.Union Ave.Bacersfield CA.933 Facility' =Name Facility Address Facility. Name Facility Address E: SI n ture of Tenk Owner.o- Op ator Date Name and Title:of Tank Owner orOperator Mary Barlow,Assistant Superintendent Signture o Witnessor Notary Date Name.of.Witness or Notary Karen Brown, Administrative Secretary CFR (Reyi §ed 11/08) FILE: Original Local Agency Copies - FacllitylSite(s) h _ . . , a .. _ INSTRUCTIONS CERTIFICATION, OF FINANCIAL RESPONSIBILITY Please type or print; information clearly, AII, UST:site's owned oroperated may be listed op•one form, therefore, a separate certification lis.not requiredo' r each site: DOCUMENT INFORMATION A. Coverage.Required Check the. appropriate boxes. B. NameofTank Qwner Full name of. either the'tank, owner or the operator or Operator C. Mechanism.Type Indicate which'approved.mechanism(sj are. being used_ to show financial responsibility either. as contained in ,the federal regulations,. 4.0 CFR:Part 280 Subpart H, Sections 280.93-through 280.107, or Section, 2808:1 Chapter 18, Div. 3',Titlie 23; CCR (see Financial Responsibility Guide for more. information). (See the Financial Responsibility Guide for more Information at: If using the State Cleanup Fund to demonstrate financial responsibility, you must meet all applicable eligibility requirements'contairied In California Health and - Safety. Code, Chapter - 8:75;, Division 20 and Title 23 of the.Caiifornla Code of Regulations, Division 3, Chapter -18. Thepayment of UST storage fees imposed pursuant to- Articles of Chapter 6.75' of Division ;20 of the Health and.Safety Code- does not guarantee =fundin'g — persons using the State Cleanup Fund must:satisfy all applicable eligibility requirements. Name of Issuer List all names =and . address of companies. and /or individuals issuing coverage. Mechanism Number; List identifying number for each mechanism ;used. Example: insurance policy nurrib.er, Letter of ;Ceedit'nuniber,. etc., etc. If using-the State Cleanup Fund, leave blank: Coverage Amount Indicate'amount,of. coverage ; for each listed mechanism. If more than. one: mechanism is.indicated, total must equal 100 % of financial responsibility-for each site: Coverage Period, Indicate the effective date(s) of all mechanisms: State Cleanup Fund coverage.is continuous as long as you maintain compliance: and remain eligible to participate in<the Fund. Corrective Action Indicate.yes or no. Does,.the specified financial assurance mechanism provide coveragefor corrective action? It is.a required coverage. If using the State Cleanup Fund, indicate "yes;" Third'Party. Indicate yes or no. Does the specified financial assurance mechanism provide Compensation coverage. for.corrective action? Itis :a required coverage: If using the State Cleanup Fund,-indicate ' yes! D. Facility. Provide all facility and or,site names and addresses. Information E. Signature Block. Provide signature and date signed by tank owner or operator; printed,or'typed name and title.of tank owner or'operator;.signature of witness or notary: and date signed; and printed or typed name of Witness or notary. .(If notary signs please attach documentation:). Where to Mail certification: Please send original ,to.your. local agency(ies) [agency(ies) that issues the UST permits]. Keep a copy of the certification at each listed site. For information on your local agency(ies) refer to:. http;// www. calcupa.neticontact/default.asr). Questions: Ifyou have questions about financial responsibility requirements or about the Certification; of Financial Responsibility form, please contact the State, Water Resources Control Board, Underground Storage Tank.Cleanup Fund at1= 800 - 8:13; FUND (3863) or:r-efer to Note: uuparaay, per unaergro the California Health and Code, or tTia tale , leanup Fund, and.2) liability.forcivil for each day of. violation as- stated in Article 7, Kern County Superintendent bf Schools 1300 17th Street - CITY CENTRE Bakersfield, CA 93301 -4533 RETURN SERVICE REQUESTED Bakersfield Fire Department ATTN: Ernie Medina 2101 H Street Bakersfield, CA 93301 neopostm 04/03/2013 e E ihrf FIRST -CLASS MAIL PRSRT 00.433 ZIP 9330 041L12202100 6 Z1RZ1PkkMP 9330 , I` I' li Iltl i il iIIIIIIIIIItIIIIIIII fill 1I11IFI1111Ji 'l'I 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 Wi Y , 1. > f7A .. UST REMOVAL DESCRIPTION DATE SIGNATURE AST NEW INSTALL DESCRIPTION DATE SIGNATURE 0 MODIFICATIONS MINOR / MAJOR AST REMOVAL DESCRIPTION DATE SIGNATURE EVRUPGRADE PRIOR TO OPERATION OF ANY SYSTEM, All. UST AND /OR AST SYSTEMS SHALL BE INSTALL, COMPLETE AND ACCEPTED BY MISC. ACTIVITY I THE BAKERSFIELD CITY FIRE DEPARTMENT. FIRE DEPARTMENT (FINAL) REMARKS: BUILDING ADDRESS: 7 6 ti is Y3 JOB DESCRIPTION: a'-lc- OCCUPANCY TYPE: OWNER: KG CO- PERMIT NO. CONTRACTOR: PHONE # OCo -- 32, FD 1743 J 5. ;' r . l 1 BILLING &PERMIT STATEMENT BAKERSFIELD FIRE DEPARTMENT Prevention Services PERMIT # F1RS 2101 H StreetwRr Bakersfield, CA 93301 Dhnno• r%r%1- 'A7A -ZQ7Q a GAY• AAA- RS7.7171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. Li I UPIUCIa1VUIIU JLVrdgC 1011K tmmor mooincanon) mT SITE INFORMATION LOCATION OF M03EU PROPERTY OWNER Kern Count Su t. of Schools Same STARTING DATE COMPLETION DATE NAME PROJECT NAME ADDRESS PHONE 4 PROJECTADDRESS 706 S. Union Ave. CITY B tKER.S :Fl L..D STATE C zIPCODE INFORMATION 96 /hr CONTRACTOR NAME Advanced Compliance 97259 C61 D40 3/31/2014 PHONE 661- 706 -4321 CONTRACTOR COMPANY NAME FAX # Advanced Compliance 661- 589 -9329 ADDRESS crry ZIP CODE 3704 Littlefalls Ct. Bakersfield 93312 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. Li I UPIUCIa1VUIIU JLVrdgC 1011K tmmor mooincanon) mT alb/ /site 82 Underground Storage Tank (Removal) TR 573 /tank 84 1111 Mandated Leak Detection (test) /Fuel Mont Cert/SB989 NOTE: $96 /hr for each type of test/per site even if cheduled at the same time TT 96/hr (2 hrs rm1nimum) =$192 i ` !IZ-A i Z tj 2 Oil well (Installation, Inspection, or re- Inspection) X 96 /hr 82 D Tent * 96 /tent 84 After -hours Inspection fee 121 /hr (2 hrs minimum) =.$242 Pyrotechnic (1 permit per event, plus an inspection fee of 96 /hr during business hours) Py OTE: After hours Pyrotechnic event Inspection Is @ 121 /hr 96 /hr + (5 hrs min standby fee /Insp) =$576 5 hrs min standby fee Ins = 605 84 Re- Inspection /Follow -up Inspection 96 /hr 84 Portable LPG (Propane): * of Cages? _ 96/hr 84 Explosive Storage 266 84 Copying & File Research (File Research fee $50 /hr) 0.25 /page 84 Miscellaneous 84 M21121 (Airy 041161 BILLING & PERMIT STATEMENT ' BAKERSFIELD FIRE DEPARTMENT Prevention Services PERMIT # Fiae 2101 H Streetwwsr Bakersfield, CA 93301 oti.,..e. 491 -214 -20'70 . Cmv f41 -01Z1 -1171 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. Im 0 V n 0 1*0 E 1f G Alarm - New & Modification (minimum charge) Over 10,000 sq ft Sprinkler - New & Modification (minimum charge) Over 10,000 sq ft Minor Sprinkler Modification ( <10 heads) Commercial Hood (New & Modification) Additional hood Spray Booth (New & Modification) kboveground Storage Tank (1 inspection per installatioi Additional Tank Aboveground Storage Tank (Removal, Mod,or Inspect'i Underground Storage Tank (Installation/Inspection) Underground Storage Tank (Modification) Underground Storage Tank (Minor Modification) Underground Storage Tank (Removal) Mandated Leak Detection (test) /Fuel Mont Cert/SB989 NOTE: $96 /hr for each type of test/per site even If scheduled at the same time Oil well (Installation, Inspection, or re- Inspection) 280 0.028 x sq ft 280 0.028 x sq ft 96 (Inspection only) 470 58 470 AST $180 /tank ATI $96 /tank i TR $109 /tank NI $878 /tank IOD $878 /site RTM $167 /site TR $573 /tank 96/hr (2 hrs minimum) =$192 TT lo lv1 3. C 2_1 0j x I tarn" Tent # $96 /tent After -hours inspection fee $121/hr (2 hrs minimum) =$242 Pyrotechnic (1 permit per event, plus an Inspection fee of $96 /hr + (5 hrs min standby fee/Insp) =$576 961hr during business hours) Py 40TE: After hours Pyrotechnic event Inspection is @ 121 /hr 5 hrs min standby fee ins = 605 Re- inspection /Follow -up Inspection $96 /hr Portable LPG (Propane): # of Cages? _ $96/hr Explosive Storage $266 Copying & File Research (File Research fee $50 /hr) $0.25 /page Miscellaneous 112. ' 98 82 82 82 82 82 82 84 92 82 84 M 84 84 84 84 84 4 SITE INFORMATION LOCATION OF PROJECT PROPERTY OWNER Kern County Su t. of Schools Same STARTING DATE COMPLETION DATE NAME PROJECT NAME ADDRESS PHONE 3 PROJECT ADDRESS 706 S . Union Ave. jary 1 -AK- ER.rSFI F STATE 'A 11) CODE CONTRACTOR INFORMATION CONTRACTOR NAME Advanced Compliance CA LICENSE # 971259 TYPE OF LICENSE EXPIRATION DATE C61 D40 3/31/2014 PHONE a 661- 706 -4321 CONTRACTOR COMPANY NAME FAX a Advanced Compliance 661- 589 -9329 ADDRESS CITY ZIPCODE 3704 Littlefalls Ct. Bakersfield 93312 All permits must be reviewed, stamped, and approved PRIOR TO BEGINNING WORK. Im 0 V n 0 1*0 E 1f G Alarm - New & Modification (minimum charge) Over 10,000 sq ft Sprinkler - New & Modification (minimum charge) Over 10,000 sq ft Minor Sprinkler Modification ( <10 heads) Commercial Hood (New & Modification) Additional hood Spray Booth (New & Modification) kboveground Storage Tank (1 inspection per installatioi Additional Tank Aboveground Storage Tank (Removal, Mod,or Inspect'i Underground Storage Tank (Installation/Inspection) Underground Storage Tank (Modification) Underground Storage Tank (Minor Modification) Underground Storage Tank (Removal) Mandated Leak Detection (test) /Fuel Mont Cert/SB989 NOTE: $96 /hr for each type of test/per site even If scheduled at the same time Oil well (Installation, Inspection, or re- Inspection) 280 0.028 x sq ft 280 0.028 x sq ft 96 (Inspection only) 470 58 470 AST $180 /tank ATI $96 /tank i TR $109 /tank NI $878 /tank IOD $878 /site RTM $167 /site TR $573 /tank 96/hr (2 hrs minimum) =$192 TT lo lv1 3. C 2_1 0j x I tarn" Tent # $96 /tent After -hours inspection fee $121/hr (2 hrs minimum) =$242 Pyrotechnic (1 permit per event, plus an Inspection fee of $96 /hr + (5 hrs min standby fee/Insp) =$576 961hr during business hours) Py 40TE: After hours Pyrotechnic event Inspection is @ 121 /hr 5 hrs min standby fee ins = 605 Re- inspection /Follow -up Inspection $96 /hr Portable LPG (Propane): # of Cages? _ $96/hr Explosive Storage $266 Copying & File Research (File Research fee $50 /hr) $0.25 /page Miscellaneous 112. ' 98 82 82 82 82 82 82 84 92 82 84 M 84 84 84 84 84 4 UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD / LINE TESTING SB989 SECONDARY CONTAINMENT TESTING TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ENHANCED LEAK DETECTION TANK TIGHTNESS TEST AB RTR P I D A&rm , T BAKERSFIELD FIRE DEPT. Prevention Services 1501 Truxtun Ave., ls' Floor Bakersfield, CA 93301 Tel.: (661) 326 -3979 Fax: (661) 852 -2171 Page 1 of 1 X LINE TESTING SB -989 SECONDARY CONTAINMENT TESTING TO PERFORM FUEL MONITORING CERTIFICATION Cathodic Protection Testing SITE INFORMATION FACILITY Kern County Supt. Of Schools NAME & PHONE NUMBER OF CONTACT PERSON ADDRESS 706 S. Union Ave. Bakersfield, Ca. OWNERS NAME Same OPERATORS NAME Same PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES NO TANK# VOLUME CONTENTS 1 87 UL 2 Diesel TANK TESTING COMPANY NAME OF TESTING COMPANY Advanced Compliance Bruce W. Hinsley 661- 706 -4321 MAILING ADDRESS 3704 Littlefalls Ct. Bakersfield, Ca. 93312 Bruce W. Hinsley 661- 706 -4321 CERTIFICATION #: A25212 DATE & TIME TEST TO BE CONDUCTED Icc #: 8032698 SIGNATURE OF APPLICANT 4 DATE 6/5/2013 APPROVED BY DATE FD 2095 (Rev. 09/05)