HomeMy WebLinkAbout3221 H STREET (8)aW
January 19, 2012
UST Compliance
Bakersfield City Fire Department
2101 H Street
Bakersfield, CA 93301
RE: Letter of Transmittal
FedEx Tracking 7979- 6635 -0253
To whom it may concern,
Enclosed please find copy(ies) of:
Monitoring Response Plan Package for the Site(s) listed below:
SA098 - 3221 S H St, Bakersfield
Please return applicable correspondence to:
Steven 3 Hall
C/O AT &T EH &S
308 South Akard St. Room 1700
Dallas, TX 75202
If you have any questions or require any additional information, please feel
free to contact me at (214) 464.3131 or by email at sh19754att.com.
Thank you for your help complying with this requirement.
Sincerely,
Steven 3 Hall
Manager, Environment, Health & Safety
AT &T Services Inc.
CC: AT &T EH &S National Tank File Retention
SA098
FILE THIS DOCUMENT IN THE HAZARDOUS
MATERIALS PLAN, PROGRAMS, PERMITS,
and PLANS BINDER
SECTION
3
UST Monitoring and Response Plan
and Tank Registration Forms
2012
Pacific Bell Telephone Company dba AT &T California - BKFDCA 14 - SA098
Facility Name and ID)
3221 S H ST
Facility Address)
BAKERSFIELD
Facility City)
KERN
Facility County)
Maintain this UST Monitoring and Response Plan Package until replaced, and/or updated with a new plan.
THIS DOCUMENT IS REQUIRED TO BE POSTED ON SITE AND AVAILABLE FOR REVIEW BY
GOVERNMENT AGENCY INSPECTORS, SITE ASSESSORS OR AUDITORS. THIS IS A CONDITION
OF THE UST OPERATING PERMIT.
Monitoring Plan(s) Revised 1/9/2012
Response Plan Revised 1/9/2012
Facility Information Form Revised 1/9/2012
Tank Information Form(s) Revised 1/9/2012
Site Plan Revised 1/9/2012
SA098
UNIFIED PROGRAM CONSOLIDATED FORM
UNDERGROUNDSTORAGETANK
MONITORING PLAN -(Page 1 of 2)
TYPE OF ACTION 1. NEW PLAN ® 2. CHANGE OF INFORMATION 490 -'
PLAN TYPE ® I. MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY,
Check one item only) 2. THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM($):
490 -2
1. FACILITY INFORMATION
FACILITY ID # (Agency Use Only) - _ 2
BUSINESS NAME (Same as FACILITY NAME) Pacific Bell Telephone Company dba AT &T California SA098/BKFDCA 14 3
BUSINESS SITE ADDRESS 3221 S H ST 103 CITY BAKERSFIELD 0A
11. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE
Testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) must be performed at the frequency
specified by the equipment manufacturers' instructions, or annually, whichever is more frequent, and that such work must be performed by qualified personnel.
23 CCR 2632, 2634, 2638, 2641)
MONITORING EQUIPMENT IS SERVICED ® L ANNUALLY El 99. OTHER (Specify): P )'
490.3u
490.36
111. MONITORING LOCATIONS
1. NEW SITE PLOT PLAN /MAP SUBMITTED WITH THIS PLAN. 2. SITE PLOT PLAN /MAP PREVIOUSLY SUBMITTED. (23 CCR §2632,
2634)49(1-4
IV. TANK MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S):
CONTINUOUS ELECTRONIC TANK MONITORING OF ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT
VAULT(S) WITH AUDIBLE AND VISUAL ALARMS. (23 CCR §2632,2634)
SECONDARY CONTAINMENT IS: ® a. DRY b. LIQUID FILLED c. PRESSURIZED d. UNDER VACUUM
490 -5
490 -6
PANEL MANUFACTURER: Veeder -Root 4911 -7. MODEL #: TLS -350 Plus 490-8
LEAK SENSOR MANUFACTURER: Veeder -Root 49(1 -9. MODEL #(S): (LI) 794390-420
El 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S), (23 CCR §2643)
PANEL MANUFACTURER: 4911 -12. MODEL #:
4`'0 -11
490 -13
IN -TANK PROBE MANUFACTURER: 490-14. MODEL #(S): - - - -- 4`0-15
LEAK TEST FREQUENCY: a. CONTINUOUS b. DAILY/NIGHTLY c. WEEKLY
d. MONTHLY e. OTHER (Specify):
490 -16
490.17
PROGRAMMED TESTS: a. 0.1 h. b. 0.2 h c. OTHER (Specify): g•P• g.p.h. (P fy): 490-28
490-19
3. MONTHLY STATISTICAL INVENTORY RECONCILIATION (23 CCR §2646.1): 490-20
4. WEEKLY MANUAL TANK GAUGING MTG) (23 CCR 2645. TESTING PERIOD: a. 36 HOURS b. 60 HOURS 490-22
490-22
El 5. TANK INTEGRITY TESTING (23 CCR §2643.1):
TEST FREQUENCY: a. ANNUALLY b. BIENNIALLY c. OTHER (Specify):
490-223
490-15
99. OTHER (Specify): 490-26
a90-n
V. PIPE MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply)
1. CONTINUOUS MONITORING OF PIPE/ PIPING SUMP(S) AND OTHER SECONDARY CONTAINMENT WITH AUDIBLE AND
VISUAL ALARMS. (23 CCR §2636)
SECONDARY CONTAINMENT IS: ®a. DRY b. LIQUID FILLED [1c. PRESSURIZED d. UNDER VACUUM
490-28
49x29
PANEL MANUFACTURER: Veeder -Root 490-30 MODEL #: TLS -350 Plus _ 490-31
LEAK SENSOR MANUFACTURER: Veeder -Root 490-32 MODEL #(S): (L3) 794380 -208 - 490 -33
PIPING LEAK ALARM TRIGGERS AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN. a. YES ® b. NO
FAILURE /DISCONNECTION OF THE MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a. YES ®b. NO
490 -34
490-35
2. MECHANICAL LINE LEAK DETECTOR (MLLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF
PRODUCT FLOW WHEN A LEAK IS DETECTED (23 CCR 2636 490-36
MLLD MANUFACTURER(S): 490 -37 MODEL #(S): - 490-38
3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS (23 CCR §2636) 490-39
ELLD MANUFACTURER(S) 490-01. MODEL #(S): _ - 490-41
PROGRAMMED IN LINE LEAK TEST: 1. MINIMUM MONTHLY 0.2 g.p.h. 2. MINIMUM ANNUAL 0.1 g.p.h. - -
ELLD DETECTION OF A PIPING LEAK TRIGGERS AUTOMATIC PUMP SHUTDOWN. a. YES b. NO
ELLD FAILURF/DISCONNECTION TRIGGERS AUTOMATIC PUMP SHUTDOWN. a. YES b. NO
49042
490-43
490-44
4. PIPE INTEGRITY TESTING 490-45
TEST FRE UENCY a. ANNUALLY b. EVERY 3 YEARS c. OTHER (Specify) 490 - 46490 -47
S. VISUAL PIPE MONITORING.
FREQUENCY a. DAILY b. WEEKLY ® c. MIN. MONTHLY & EACH TIME SYSTEM OPERATED-
Allowed for munitori of unburied enter enmmur fuel piping only HSC 25281.5(6 3)
490-x8
490-49
6. SUCTION PIPING MEETS EXEMPTION CRITERIA 123 CCR §2636(x)(3)). 490-50
7. NO REGULATED PIPING PER HEALTH AND SAFETY CODE, DIVISION 20, CHAPTER 6.7 IS CONNECTED TO THE TANK SYSTEM
490,5L
99. OTHER (Specify) 490-52
490-53
UPCF UST -D Rev. (12/2007)
SA098
UNIFIED PROGRAM CONSOLIDATED FORM
UNDERGROUNDSTORAGETANK
MONITORING PLAN (Page 2 of2)
VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING
1. UDC MONITORING IS PERFORMED USING THE FOLLOWING METHOD 490 -54a
x90 -54b
1. CONTINUOUS ELECTRONIC MONITORING 2. FLOAT AND CHAIN ASSEMBLY 3. ELECTRONIC STAND -ALONE
4. NO DISPENSERS 99. OTHER (Specify):
PANEL MANUFACTURER: 490 -11 MODEL #: 490 -56.
LEAK SENSOR MANUFACTURER: 490 -57 MODEL #(S): 490 -5e
DETECTION OF A LEAK INTO THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a. YES b. NO 490-59
UDC LEAK ALARM TRIGGERS AUTOMATIC PUMP SHUTDOWN a. YES b. NO 490 -b0
FAILURE / DISCONNECTION OF UDC MONITORING SYSTEM TRIGGERS AUTOMATIC PUMP SHUTDOWN. a. YES b. NO 490 -61
UDC MONITORING STOPS THE FLOW OF PRODUCT AT THE DISPENSER. a. YES b. NO 490 -62
2. UDC CONSTRUCTION IS Eli. SINGLE-WALLED 2. DOUBLE - WALLED 490-63
IF DOUBLE WALLED: 490-64a
UDC INTERSTITIAL SPACE IS MONITORED BY: 1. LIQUID 2. PRESSURE [13. VACUUM
A LEAK WITHIN THE SECONDARY CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS a. YES b. NO 490 -64b
VII. PERIODIC SYSTEM TESTING
1. ELD TESTING: THIS FACILI'T'Y HAS BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT ENHANCED 44G -65.
LEAK DETECTION E D MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED. 23 CCR 2644.1)
2. SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. 490 -66
3. SPILL BUCKETS ARE TESTED ANNUALLY. 490 -67
VI11. RECORDKEEPING
The following monitoring/maintenance records are kept for this facility:
Alarm logs 490 -68o ® Visual Inspection Records 490 -69b Tank integrity testing results 490 -6xc
SIR testing results (and supporting documentation records). 49tt -68d Tank gauging results (and supporting documentation records). 490 -15ee
ATG Testing results (and supporting documentation records). 490-68f Corrosion Protection 60-day logs 490-68g
Equipment maintenance and calibration records. 490.6eh
IX. TRAINING
Personnel with UST monitoring responsibilities are familiar with all of the following documents relevant to their job duties. 490 -69:
REFERENCE DOCUMENTS MAINTAINED AT FACILITY[:) (Check all that apply)
THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) 490 -69b
OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 490 -6w
CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 49o-69d
CALIFORNIA UNDERGROUND STORAGE TANK LAW 490 -69e
STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS - MANUAL AND
STATISTICAL INVENTORY RECONCILIATION" 490 -691'
SWRCB PUBLICATION: "UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" 490 -69g
OTHER (Specify): M69h, M69i
This facility has a "Designated UST Operator" who has passed the California UST System Operator Exam administered by the International Code Council (ICC).
The "Designated UST Operator' will train facility employees in the proper operation and maintenance of the UST systems annually, and within 30 days of hire. This
training will include, but is not limited to, the following:
Operation ofthe UST systems in a manner consistent with the facility's best management practices
The facility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan
7 The facility employee's role with regard to spills and overfills as specified in the UST Response Plan
Names ofcontact person(s) for emergencies and monitoring alarms. 490-70
X. COMMENTS /ADDITIONAL INFORMATION
Provide additional comments here or indicate how many pages with additional information on specific monitoring procedures are attached to this plan. 490-71
Fill Tube Shut -OffValve is the Primary Overfill Protection Device on this system, set to 95% oftank capacity. Overfill Alarm is set to 90a/u oftank capacity.
L2 ) Fill Sum & (L4 ) Transition Box Sensors 2) — 794380 -208; (LS ) Pipins Pan Sensor — 794390420
XI. PERSONNEL RESPONSIBILITIES
The UST Owner /Operator is responsible for ensuring that: 1) the daily /routine UST monitoring activities and maintenance of UST leak detection equipment covered by
this plan occurs, 2) all conditions that indicate a possible release are investigated, and 3) all monitoring records are maintained properly.
The following person(s) are responsible for performing the monitoring and equipment maintenance:
NAME Tait Environmental Services 490-72 TITLE AT &T Authorized Vendor Contact List Available Upon Request) 490-73
NAME AT &T Environment Health & Safety 490-74 TITLE Call Center 49x75
The Designated Operator shall perform a monthly visual inspection of the facility, provide a report to the owner /operator, and inform the owner /operator of any
conditions that need follow -up action.
XI1.OWNER/OPERATOR SIGNATURE
CERTIFICATION: I certify that the informatio rovided herein is true and accurate to the best of my knowledge.
APPLICANT SIGNATURE 490-76 DATE: 490-77
1/9/2012
APPLICANT NAME (print): nwt 7s APPLICANT TITLE: 490 -79
Steven 1 Hall Manager, EMS
UPCF UST -D Rev. (12/2007)
SA098
Agency Use Onit) This plan has been reviewed and: Approved Approved With Conditions
Local Agency Signature: Date:
Comments or Special Conditions:
UPCF UST -D Rev. (12/2007)
SA098
UNDERGROUND STORAGE TANK
RESPONSE PLAN - PAGE 1 (One forth per facilit
TYPE OF ACTION I. NEW PLAN ®2. CHANGE OF INFORMATION R01.
I. FACILITY INFORMATION
FACILITY ID # (Agenev Use OnI.0 t
BUSINESS NAME (Same as FACILITY NAME) 3,
Pacific Bell Telephone Company dba AT&T California SA098
BUSINESS SITE ADDRESS 103. BUSINESS SITE CITY 104.
3221 S H ST 1 BAKERSFIELD
H. SPILL CONTROL AND CLEANUP METHODS
This plan addresses unauthorized releases from UST systems and supplements the emergency response plans and procedures in the facility's Hazardous Materials
Business Plan (HMBP).
If safe to do so, facility personnel will take immediate measures to control or stop any release (e.g., activate pump shut -off, etc.) and, if necessary, safely remove
remaining hazardous material from the UST system.
Any release to secondary containment will be pumped or otherwise removed within a time consistent with the ability of the secondary containment system to
contain the hazardous material, but not greater than 30 calendar days, or sooner if required by the local agency. Recovered hazardous materials, unless still suitable
for their intended use, will be managed as hazardous waste.
Absorbent material will be used to contain and clean up manageable spills of hazardous materials. Absorbent material which has become too saturated to be
effective or which is no longer intended for use will be managed as hazardous waste unless a waste determination in accordance with 22 CCR §66262.11 finds that
it is non - hazardous. Used absorbent material, reusable or waste, will be stored in a properly labeled and sealed container. Waste material shall be disposed of
appropriately.
Facility personnel will determine whether any water removed from secondary containment systems, or from clean -up activity, has been in contact with any
hazardous material. if the water is contaminated, it will be managed as hazardous waste unless a hazardous waste determination in accordance with 22 CCR
66262.11 finds that it is non - hazardous. If the water has a petroleum sheen (i.e., rainbow colors), it is contaminated. A thick floating petroleum layer may not
necessarily display rainbow colors. Water (hazardous or non - hazardous) from sumps, spill containers, etc. will not be disposed to storm water systems.
We will review secondary containment systems for possible deterioration ifany of the following conditions occur:
1. Hazardous material in contact with secondary containment is not compatible with the material used for secondary containment;
2. Secondary containment is prone to damage from any equipment used to remove or cleanup hazardous material collected in secondary containment;
3. Hazardous material, other than the producUwaste stored in the primary containment system, is placed inside secondary containment to treat or neutralize
released product /waste, and the added material or resulting material from such a combination is not compatible with secondary containment.
III. SPILL CONTROL AND CLEAN -UP EQUIPMENT
PERIODIC MAINTENANCE: Spill control and clean -up equipment kept permanently on -site is listed in the facility's Hazardous Materials Business Plan. This
equipment is inspected at least monthly, and after each use, supplies are replenished as needed. Defective equipment is repaired or replaced as necessary.
EQUIPMENT NOT PERMANENTLY ON -SITE, BUT AVAILABLE FOR USE IF NEEDED: (Complete only i a licable)
EQUIPMENT LOCATION AVAILABILITY
R10. R20. Ran.
RI 1. R21. R31.
R12. R22. R32.
R13. R23. R33.
R14. R24. R34.
R15. R25. R35.
IV. RESPONSIBLE PERSONS
THE FOLLOWING PERSON(S) IS /ARE RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THIS RESPONSE PLAN:
NAME Rao. TITLE R50.
Grant Armstrong AT &T Environmental Site Manager
NAME R41. TITLE R51.
AT &T EH &S Call Center (Employee Contact List Available Upon Request)
NAME R42. TITLE R52.
AT &T OICC Emergency Control Center
NAME R43. TITLE R53.
V. MONITORING INDICATORS
IF MONITORING INDICATES A POSSIBLE UNAUTHORIZED RELEASE, STEPS TO VERIFY THE RELEASE WILL BE MADE AS FOLLOWS:
I. ADDITIONAL SYSTEM TESTING OR DATA COLLECTION ® 2. INSPECTION BY QUALIFIED PERSONS ® 3. RECALIBRATION OF EQUIPMENT Rho.
99. OTHER (Specify): R61.
UN -022B www.unidocs.org Rev. 12/2010
SA098
UNDERGROUND STORAGE TANK
RESPONSE PLAN - PAGE 2
VI. REPORTING AND RECORD KEEPING
We will report /record any overfill, spill, or unauthorized release from a UST system as indicated in this plan.
Recordable Releases: Any unauthorized release from primary containment which the UST operator is able to clean up within eight (8) hours after the release was
detected or should reasonably have been detected, and which does not escape from secondary containment, does not increase the hazard of fire or explosion, and does
not cause any deterioration of secondary containment, must be recorded in the facility's monitoring records. Monitoring records must include:
The UST operator's name and telephone number;
A list ofthe types, quantities, and concentrations ofhazardous substances released;
A description of the actions taken to control and clean up the release;
The method and location ofdisposal of the released hazardous substances, and whether a hazardous waste manifest was or will be used;
A description of actions taken to repair the UST and to prevent future releases;
A description ofthe method used to reactivate interstitial monitoring after replacement or repair ofprimary containment.
Reportable Releases: Any overfill, spill, or unauthorized release which escapes from secondary containment (or primary containment if no secondary containment
exists), increases the hazard of fire or explosion, or causes any deterioration of secondary containment, is a reportable release. Reportable releases are also recordable.
Within 24 hours after a reportable release has been detected, or should have been detected, we will notify the local agency administering the UST program of the
release, investigate the release, and take immediate measures to stop the release. If necessary, or if required by the local agency, remaining stored product /waste will
be removed from the UST to prevent further releases or facilitate corrective action. Ifan emergency exists, we will notify the California Emergency Management
Agency at (800) 852 -7550.
Within five (5) working days of a reportable release, we will submit to the local agency a full written report containing all of the following information to the extent
that the information is known at the time of filing the report:
i The UST owner's or operator's name and telephone number;
A list ofthe types, quantities, and concentrations of hazardous materials released;
The approximate date of the release;
The date on which the release was discovered;
The date on which the release was stopped;
A description ofactions taken to control and/or stop the release;
A description of corrective and remedial actions, including investigations which were undertaken and will be conducted to determine the nature and extent of
soil, ground water or surface water contamination due to the release;
The method(s) of cleanup implemented to date, proposed cleanup actions, and a schedule for implementing the proposed actions;
The method(s) and location(s) of disposal of released hazardous materials and any contaminated soils, groundwater, or surface water.
Copies of any hazardous waste manifests used for off -site transport of hazardous wastes associated with clean -up activity;
A description ofproposed methods for any repair or replacement of UST system primary/secondary containment systems;
i A description ofadditional actions taken to prevent future releases.
We will follow the reporting procedures described above if any of the following conditions occur:
7 A recordable unauthorized release can not be cleaned up or is still under investigation within eight (8) hours of detection;
Released hazardous substances are discovered at the UST site or in the surrounding area;
Unusual operating conditions are observed, including erratic behavior of product dispensing equipment, sudden loss of product, or the unexplained presence of
water in the tank, unless system equipment is found to be defective and is immediately repaired or replaced, and no leak has occurred;
Monitoring results from UST system monitoring equipment /methods indicate that a release may have occurred, unless the monitoring equipment is found to be
defective and is immediately repaired, recalibrated, or replaced, and additional monitoring does not confirm the initial results.
Record Retention: Monitoring records and written reports of unauthorized releases must be maintained on -site (or off -site at a readily available location, if approved
by the local agency) for at least 3 years. Hazardous waste shipping/disposal records (e.g., manifests) must be maintained for at least 3 years from the date of shipment.
VII. OWNER/OPERATOR SIGNATURE
CERTIFICATION: 1 certify that the information pr ided herein is true and accurate to the best ofmy knowledge.
OWNER/OPERATOR SIGNATURE DATE R70.
1/9/2012
OWNER/OPERATOR NAM print) Rat' OWNER/OPERATOR TITLE R72.
Steven J Hall Manager, EH &S
Agen(y Use On/t) This plan has been reviewed and: Approved Approved With Conditions Disapproved
Local Agency Signature: Date:
UN -022B www.unidoes.org Rev. 12/2010
SA098
UNIFIED PROGRAM CONSOLIDATED FORM
UNDERGROUND STORAGE TANK
OPERATING PERMIT APPLICATION - FACILITY INFORMATION
One fort per facility)
TYPE OF ACTION I. NEW PERMIT ® 5. CHANGE OF INFORMATION 7. PERMANENT FACILITY CLOSURE 400.
Check one item only) 3. RENEWAL PERMIT 6. TEMPORARY FACILITY CLOSURE 9. TRANSFER PERMIT
I. FACILITY INFORMATION
TOTAL NUMBER OF USTs AT FACILITY a w. FACILITY ID # 1.
1 Agency Use OnlV)
BUSINESS NAME (Sumo usFACILITY NAME., DBA Dning Business As) 3.
Pacific Bell Telephone Company dba AT &T California SA098
BUSINESS SITE ADDRESS 103. CITY 104.
3221 S H ST BAKERSFIELD
FACILITY TYPE 1. MOTOR VEHICLE FUELING 2. FUEL DISTRIBUTION 403. Is the facility located on Indian Reservation or
405.
3. FARM 4. PROCESSOR ® 6.OTHER Trust lands? Yes ® No
U. PROPERTY OWNER INFORMATION
PROPERTY OWNER NAME 407. PHONE 408.
Pacific Bell Telephone Company dba AT &T California 1 214 464 -5591
MAILING ADDRESS 409.
2600 Camino Ramon - Room 3E000
CITY 410. STATE 411. ZIP CODE 412.
San Ramon 1 CA 1 94583
III. TANK OPERATOR INFORMATION
TANK OPERATOR NAME 428-1. PHONE 429'2
Pacific Bell Telephone Company dba AT &T California 214) 464 -55911
MAILING ADDRESS 428.3
2600 Camino Ramon - Room 3E000
CITY azx a STATE 4 -'x 5 ZIP CODE 428-6
San Ramon CA 94583
IV. TANK OWNER INFORMATION
TANK OWNER NAME 414. PHONE 415.
Pacific Bell Telephone Company dba AT &T California 214) 464 -5591
MAILING ADDRESS 416.
308 S. Akard St. Room 1700
CITY 417. STATE 418. ZIP CODE 419.
Dallas 1 TX 75202
OWNER TYPE: 4. LOCAL AGENCY /DISTRICT 5. COUNTY AGENCY 6. STATE AGENCY 420.
7. FEDERAL AGENCY ® 8. NON - GOVERNMENT
V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER
TY (TIC) HQ 44- 1 0 13 1 1 19 1 1 4 1 Call the State Board of Equalization, Fuel Tax Division, if there are questions. 421
VI. PERMIT HOLDER INFORMATION
Issue permit and send legal notifications and mailings to: ® 1. FACILITY OWNER 4. TANK OPERATOR 423
3. TANK OWNER 5. FACILITY OPERATOR
SUPERVISOR OF DIVISION, SECTION, OR OFFICE (Required For Public Agencies Only) 406.
VII. APPLICANT SIGNATURE
CERTIFICATION: 1 certify that the informs ,Pon provided herein is true, accurate, and in full compliance with legal requirements.
APPLICANT SIGNATURE DATE 424, PHONE 425.
1/9/2012 1 214 ) 464 -3131
APPLICANT NAME (print 426. APPLICANT TITLE 427
Steven J Hall Manager, EH &S
UPCF UST -A Rev. (12/2007)
SA098
UNIFIED PROGRAM CONSOLIDATED FORM
UNDERGROUND STORAGE TANK
OPERATING PERMIT APPLICATION - TANK INFORMATION (One form per UST)
TYPE OF ACTION (Check one item only. For an UST permanent closure or removal, complete only this section and Sections 1, 11, 111, IV, and IX below) 430
I. NEW PERMIT 3. RENEWAL PERMIT ® 5. CHANGE OF INFORMATION
6. TEMPORARY UST CLOSURE 7. UST PERMANENT CLOSURE ON SITE 8. UST REMOVAL
DATE UST PERMANENTLY CLOSED: 4311n DATE EXISTING UST DISCOVERED: 430b
1. FACILITY INFORMATION
FACILITY ID # (Agency Use Only) I
BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3
Pacific Bell Telephone Company dba AT&T Califomia SA098
BUSINESS SITE ADDRESS 103 CITY 104
3221 S H ST I BAKERSFIELD
II. TANK DESCRIPTION
TANK 1D # 432 TANK MANUFACTURER 413 TANK CONFIGURATION: THISTANK 1S 434
SA0980001 MODERN WELDING I. A STAND -ALONE TANK
2. ONE IN A COMPARTMENTED UNIT.
Complete tine puge for each compartment in the unit.
DATE UST SYSTEM INSTALLED 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS IN THE UNIT 437
5/1/2004 6016 I
III. TANK USE AND CONTENTS
TANK USE la. MOTOR VEHICLE FUELING lb. MARINA FUELING lc. AVIATION FUELING 439
3. CHEMICAL PRODUCT STORAGE 4. HAZARDOUS WASTE (Includes Used oil) ® S. EMERGENCY GENERATOR FUEL [HSC §25281.5(c)]
6. OTHER GENERATOR FUEL 95. UNKNOWN 99. OTHER (Specify): 439a
CONTENTS PETROLEUM: la. REGULAR UNLEADED Ic. MIDGRADE UNLEADED lb. PREMIUM UNLEADED 440
3. DIESEL 5. JET FUEL 6. AVIATION GAS
8. PETROLEUM BLEND FUEL 9. OTHER PETROLEUM (Specify): 440a
NON - PETROLEUM: 7. USED OIL 10. ETHANOL
11. OTHER NON - PETROLEUM (Specify): 440b
IV. TANK CONSTRUCTION
TYPE OF TANK 1. SINGLE WALL ® 2. DOUBLE WALL 95. UNKNOWN 443
PRIMARY CONTAINMENT ® 1. STEEL 3. FIBERGLASS 6. INTERNAL BLADDER 444
7. STEEL+ INTERNAL LINING 95. UNKNOWN 99. OTHER (Specify): 444.
SECONDARY CONTAINMENT 1. STEEL ® 3. FIBERGLASS 6. EXTERIOR MEMBRANE LINER 7. JACKETED 445
90. NONE 95. UNKNOWN 99. OTHER (Specify) : 445a
OVERFILL PREVENTION 1. AUDIBLE & VISUAL ALARMS 2. BALL FLOAT 3. FILL TUBE SHUT -OFF VALVE 452.
L TANK MEETS REQUIREMENTS FOR EXEMPTION FROM OVERFILL PREVENTION EQUIPMENT
V. PRODUCT / WASTE PIPING CONSTRUCTION
PIPING CONSTRUCTION I. SINGLE - WALLED ® 2. DOUBLE- WALLED 99. OTHER 460
SYSTEM TYPE 1. PRESSURE 2. GRAVITY ® 3. CONVENTIONAL SUCTION 4. SAFE SUCTION [23 CCR §2636(a)43)j 456
PRIMARY CONTAINMENT 1. STEEL 4. FIBERGLASS 0 & FLEXIBLE 10. RIGID PLASTIC 464
90. NONE 95. UNKNOWN 99. OTHER(S cif ): 464u
SECONDARY CONTAINMENT I. STEEL 4. FIBERGLASS ® 8. FLEXIBLE 10. RIGID PLASTIC 464b
90. NONE 95. UNKNOWN 99. OTHER (Specify): 464c
PIPINGrFURBINE CONTAINMENT SUMP TYPE ID 1. SINGLE WALL 2. DOUBLE WALL 90. NONE 4644
VI. VENT, VAPOR RECOVERY (VR) AND RISER / FILL PIPE PIPING CONSTRUCTION
VENT PRIMARY CONTAINMENT 0 I. STEEL 4. FIBERGLASS 10. RIGID PLASTIC 90. NONE 99. OTHER (Specify) 464e
464e1
VENT SECONDARY CONTAINMENT 1. STEEL ® 4. FIBERGLASS 10. RIGID PLASTIC 90. NONE 99. OTHER (Specify) 464f
464n
VR PRIMARY CONTAINMENT 0 1. STEEL 4. FIBERGLASS 10. RIGID PLASTIC 0 90. NONE 99. OTHER (Specify) 4646
4640
VR SECONDARY CONTAINMENT 1. STEEL 4. FIBERGLASS 10. RIGID PLASTIC 0 90. NONE 99. OTHER (Specify) 464h
464h1
VENT PIPING TRANSITION SUMP TYPE 1. SINGLE WALL D 2. DOUBLE WALL 0 90. NONE 464i.
RISER PRIMARY CONTAINMENT 1. STEEL 4. FIBERGLASS 10. RIGID PLASTIC 90. NONE Ll 99. OTHER (Specify) 4641
464' I
RISER SECONDARY CONTAINMENT I. STEEL 4. FIBERGLASS 10. RIGID PLASTIC 90. NONE 0 99. OTHER (Specify) 464k
464k1
FILL COMPONENTS INSTALLED ® 1. SPILL BUCKET ® 3. STRIKER PLATE/BOTTOM PROTECTOR ® 4. CONTAINMENT SUMP 4514 -c
VII. UNDER DISPENSER CONTAINMENT (UDC)
CONSTRUCTION TYPE I. SINGLE WALL 2. DOUBLE WALL ® 3. NO DISPENSERS 90. NONE 469a
CONSTRUCTION MATERIAL 1. STEEL 4. FIBERGLASS 10. RIGID PLASTIC 99. OTHER (Specify) 469b-
VIII. CORROSION PROTECTION
STEEL COMPONENT PROTECTION 2. SACRIFICIAL ANODE(S) 4. IMPRESSED CURRENT ® 6. ISOLATION 446.
IX. APPLICANT SIGNATURE
CERTIFICATION: 1 certify that this UST system i ompatible with the hazardous substance stored and that the information provided herein is true, accurate,
and in full com liance with r uir s.
APPLICANT SIGNATURE DATE 470.
1/9/2012
APPLICANT NAME (prim) 471. APPLICANT TITLE 472.
Steven J Hall Manager, EHBS
UPCF UST-111 Rev. (12/2007)
Monitoring Plan Site Map General Fuel System Layout
at c't Drawing NOT to Scale
Business Name_
Business Address:
Ven
Pacific Bell Telephone Co. dba AT&T Cal. (SA098) Date: 1/9/2012
3221 S H St Bakersfield Zip Code: 93304
SA0980001 Fill Sump w/ Piping Sump w/ 6K UST Diesel
Sensor U) — Sensor (L2),
Overfill F
Drawing prepared by:
Steven J Hall / AT&T
N
NN E
S
SA098
BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3
Pacific Bell Telephone Company dba AT &T Califomia SA098
5/27/2008
BUSINESS SITE ADDRESS
3221 S H ST
103I CITY
BAKERSFIELD
1114
Revised 1/19/2012
Monitoring Plan Change History
Revision Date Reason for Revision
5/27/2008 Revised to new UniDocs forms
6/24/2009 Section IV: Revised Annular Sensor Model #; Section V: Added Monthly Visual Pipe Monitoring; Section V111: Added
Visual Inspection Records; Section X: Added Fill Tube Shut -Off Valve as Primary Overfill Prevention Device, Added
Transition Box & Piping Pan Sensors; Section XI: Replaced ESM with Vendor
1/7/2010 Section X: Revised Piping Pan Sensor Model #
1/9/2012 Section IV & V: Specified TLS Model #; Sections IV, V & X: Specified Sensor Locations; Section X1: Offered Vendor
Contact List Upon Request
Response Plan Chan a History
Revision Date Reason for Revision
5/27/2008 Revised to new UniDocs forms
6/24/2009 Removed Shaw from Section III and Added ESM to Section IV
4/18/2010 Updated to latest UniDocs form
1/9/2012 Updated to latest UniDocs form; Section IV: Offered Employee Contact List Upon Request
Facility Information Form Change History
Revision Date Reason for Revision
5/27/2008 Revised to new UniDocs forms
6/24/2009 Section IV: Revised Tank Owner Info to Dallas address; Section VI: Revised Permit Holder Info to Tank Owner
1/9/2012 Section VI: Revised Permit Holder Info to Facility Owner
1/9/2012 Section VI: Revised Vent Primary Piping Material to Steel
Tank Information Form Change History
Revision Date Reason for Revision
5/27/2008 Revised to new UniDocs forms
6/24/2009 Section I1: Updated Tank ID #, Specified Tank Capacity; Section III: Changed Fuel Usage from Other to Emergency
Generator; Section VIII: Added Isolation
3/26/2010 Section VI: Added Vent Secondary Fiberglass
1/9/2012 Section VI: Revised Vent Primary Piping Material to Steel
Site Plan Change History
Revision Date Reason for Revision
1011612007 & 11/5/2007 Stantec Site Plan
6/24/2009 New Site Plan created
1/9/2012 Added Tank ID #(s), Sensor Locations, ATG, AG Piping, Pan Sensor & Generator; Relocated Transition Box, Overfill
Alarm & Vent Riser