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Home My WebLink AboutUNDERGROUND TANK (5) City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (661) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit forthe " facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. lns:.r,actions to the issuing agency.': Use the space below to enter the following information in the format of ,:'our choice: name or' owner; name o~' operator: name of facility; street address, city, and zip code of facility; Facility identification number (t'rom Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 12TM February, 2002 to: EZ STOP MOBILE Permit #015-021-001856 101 19TM Street Bakersfield, California 93301 CITY OF BAK~FIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 (' INSPECTION R[CORD POST CARD AT JOB SITE INSTRUCTIONS: Please call tbr an inspector only when each g~up of inspections with the same number are ~ady. They will mn in consecutive order beginning with number I. DO NOT cover work for any numbe~d group until all items in that ~up a~ signed offby the Perilling Autho~ty. Following these instructions will ~duce the number of ~qui~d inspection visits and the~fore prevent ~sessment of additional fees. TANKS AND BACKFILL INSPECTION I DATE I INSPECTOR Backfill of T~k(s) Spark Test Ce~ification or Manuhctu~s Method Cathodic Protection of Tank(s) PIPI~G SYSTEM Piping & Raceway w/C°llecti°n Sump m~ ~1~ ~1~ *~> O~ Co.sion P~tection of Piping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) Cathodic P~tection System-Piping Dispenser P~ SECONDARY CO~AINME~, OVE~ILL PROTE~ION, LEAK DETECTION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensor, Float Vent Valves P~duct Compatible Fill Box(es) Product Line Leak Detecto~) Leak Detectors) for Annual Space-D.W. Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Gmundwater Spill P~vention Boxes FINAL Monito6ng Wells, Caps & Locks Fill 8ox Lock Monito6ng Requirements Typ~ 1' Autho~zation tbr Fuel Drop PERMIT APPLICATION~ CONSTRUCT/MODIFY ~ Bakersfield Fire Dept. UNDERGROUND STORAGE TANK Environmental Service PERMITNO' I' ~ ~ t il '~ Bakersfield, CA 93301 Tel: (661)326-3979 TY~£ OF APPUCAT~O~ rl NEW FACILITY ~[ MODIFICATION OF FACILITY ~! NEW TANK INSTALLATION AT EXISTING FACILITY PROPOSED COMPLETION DATE STA~TIN~ DATE 8/7/03 8/7/03 FACILITY NAME EXISTING FACILITY PERMIT NO. Easy Stop Mobil S-3328 FACILITY ADDRESS CITY ZIP CODE 101 19th Avenue Bakersfield 93301 TYPE OF BUSINESS APN # C-Store TANK OWNER PHONE NO Boun Chi Ly (661} q72-q058 ADDRESS CITY same as above ZIPCODE CONTRACTOR CA LICENSE NO. Franzen-Hill Corp. ~O~ ADDRESS CITY 11ah Mn~-fh I c,f Tulare. CA 4 PHONE NO. ' ' ]' -BA[<I~S'FI~I'd ClYY BYSFN~SS LICENSE NO. VV{)RKMAN COMP NO. / INSURER -800¢655-3~16 0356909 044-020108-ql State Compensation IBRIEFLY DESCRIBE THE WORK TO BE DONE Repair fexible pipe from secondary to primary WATER TO FACILITY PROVIDED BY City of Bakersfield DEFTH TO SOIL TYPE EXPECTEDAT SITE GROUND WATER NO. OF TANKS ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COLNTER MEASURES PLAN ON FILE TO BE INSTALLED n /a ~3 YES~ NO ~[YES~ NO THIS SECTION IS FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION Not installing tanks THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO (IF KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFICIAL USE ONLY FACILITY NO: ' :~ =~' ' NO. OFTANKS FEES$.:. p The applicant has received, understan.d~, and will comply with the attached conditions of the permit and any, othe stat,~, ~qcal and federal r}~tulations. This form has been completed under penalty of er'~, o~d to thl~ b~st of.my kr~wled~[, ij'true and correct. .. APPROVE-DaY: ~ -- ~ ~ ~j ] A~PLICA~'NAME (PRINT) ' ' ° APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ; Po, s~age $ , ,~,.. ' ~ Cer~ed Fee .... nuqutred) ' ~ .Re.st~tctedD~live Postmark Lr) (Endorsemn,~,~ ~Fee Here , ~ '"-"~eqmred) i rr~ T°ta/P°stage & Fees ~ · Complete items 1, ~',~ and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. X I // [] Agent la Print your name and address on the reverse ~ ~ [] Addressee so that we can return the card to you. B. Received/b~V4'Printed4Vam~) C. Dat~ of Delivery "= Attach this card to the back of the mailpiece, or on the front if space permits, D. Is delivery address different from item 17 [] Yes 1. ArticlseAddressed to: If YES, enter delivery address below: [] No cm [¥ EZ S~I'OP MOBIL 101 19m STREET BAKERSFIELD CA 93301 3. Service Type ,J~ Certified Mail[] Express Mail ............ -~ [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Rsstdcted Delivery? (Extra Fee) [] Yes 2. ArficleNumber 7002 3150 0004 9985 3585 (Transfer from service label) PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540 D July 23, 2003 Bonn Chi Ly CERTIFIED MAlL EZ Sto~ Mobil 101 19"' Street Bakersfield, CA 93301 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE F~RE CHIEF ~o~ ~z~ RE: Failure to Perform/Submit Three Year Cathodic Protection Certification ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 Dear Customer: VOICE (661) 326-3941 FAX (661) 395-1349 According to our records, your three year Cathodic Protection Certification ispast due. SUPPRESSION SERVICES You are in violation of Section 2635 2(a) Failure to Perform/Submit Cathodic Protection 2101 "H" Street Testing results. Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Section 2635 2(a) is as follows: PREVENTION SERVICES 1715 ChesterAve. "Field-installed cathodic protection systems shall be designed and certified as adequate by Bakersfield, CA 93301 a corrosion specialist. The cathodic protection systems shall be tested by a cathodic VOICE (661) 326-3951 FAX (661) 326-0576 protection tester within six months of installation and at least every, three years thereafter." ENVIRONMENTAL SERVICES The cathodic protection is part of your leak detection system and is a condition of your 1715 Chester Ave. Permit to Operate. Therefore, prior to August 23, 2003, you shall either perform or Bakersfield, CA 93301 VOICE (661) 326-3979 submit evidence of cathodic protection testing. Failure to comply will result in revocation FAX (661) 326-0576 of your Permit to Operate. TRAINING DIVISION 5642 Victor Ave. Should you have any questions, please feel free to contact me at 661-326-3190. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661)399-5763 Sincerely, Ralph Huey Director of Prevention Services by~ ~ Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db cc: Don Dozah, Stuarts Petroleum ~- ~R ~)u/b/ -:, ~.t~ ! ' k~/' CERTIFIED MAIL ~a'revn='~rr~Jar ~.~"' .' ' ' ' ,l ' Bakersfield, CA ~ ~0 [ Re: Failure to Perform or Submit Three Year Cath~ic Protection Ce~ification FiR~ CHIEF ~c~ ;~z~ NOTICE OF VIOLATION A~ AOMINISTaA~V~ SERVICES SCHED~E FOR CO~LIANCE 2101 'H' ~tr~t Baker~eld, CA 9~1 D~ Customer VOICE (661) 32~3~1 F~ (661) 395-1~9 According to o~ records, your ~ ye~ Cath~ic Proration Certification is p~t du~~ You ~e in violation of s~tion 2635 2Ia) Failure to Peffo~Submit SUPPRESS~ON ssawcas 210~ 'H" Street Cat~ic Proration T~ting result. 8akeatie~d. CA VOICE (66 I) 326-3941 F~ (661) 395.1~9 S~iO~ 2635 2Ia) is ~ follows: PREVEN~ON SERVIC~ "Ficld-insmll~ ca~ic proration systems shall ~ designed and ceAifi~ as 1715 Chester Ave. ad~tc by a co~osion sp~ialist. Thc cath~ic proration systems shall ~ t~t~ Bakersfield, CA 9~1 by a ca(h~ic proration roster wi~in six momhs of insmllafion and at least every VOICE (661) 326-3951 F~ (661) 326~576 thr~ y~s thereafter." ENVIRONMENTAL SERVICES ~h¢ ca~ic proration is p~ of yo~ l~k dct~tion system and iS a qqndit~n of 1715 ChesterAve. your Pc~ m O~ra{o. Therefore. prior m ~, you shall m~cr ~ ' Bakers~eld, CA VOICE (661) 326-3979 pC~O~ or submit evidence of camac proration testing. Failure to comply will F~ (66i) 326~576 result in rev~adon of yo~ Petit to O~rate. TRAINING DIVISION Should you have any questions, pl¢~o f~l ~0¢ to comac{ mc at 661-326-3 Ig0. 5642 ~ctor Ave, Bakemfield, CA 93~8 VOICE (661) 399-4697 Sincerely, F~ (661) 399-5763 Ralph E. Hucy Dir~tor of Prevention So. ices Steve Underw~ Fire lns~ctor~nvironmental C~e Enforcement Officer Offico of Environmental Services ~SU/db D July 23, 2003 Boun Chi Ly CERTIFIED MAIL EZ Sto~ Mobil 101 19 Street Bakersfield, CA 93301 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE FiRE CHIEF Ro~l ;R,~ZE RE: Failure to Perform/Submit Three Year Cathodic Protection Certification ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 Dear Customer: VOICE (661) 326-3941 FAX (661) 395-1349 According to our records, your three year Cathodic Protection Certification is past due. SUPPRESSION SERVICES You are in violation of Section 2635 2(a) Failure to Perform/Submit Cathodic Protection 2101 "H" Street Testing results. Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Section 2635 2(a) is as follows: PREVENTION SERVICES 1715 ChesterAve. "Field-installed cathodic protection systems shall be designed and certified as adequate by Bakersfield, CA 93301 a corrosion specialist. The cathodic protection systems shall be tested by a cathodic VOICE (661) 326-3951 FAX (661) 326-0576 protection tester within six months of installation and at least every three years thereafter." ENVIRONMENTAL SERVICES The cathodic protection is part of your leak detection system and is a condition of your 1715 ChesterAve. Permit to Operate. Therefore, prior to August 23, 2003, you shall either perform or Bakersfield, CA 93301 VOICE (661)326-3979 submit evidence of cathodic protection testing. Failure to comply will result in revocation FAX (661) 326-0576 of your Permit to Operate. TRAINING DIVISION 5642 Victor Ave. I Should you have any questions, please.feel free to contact me at 661-326-3190. Bakersfield, CA 93308 VOtCE (661) 399-4697 FAX (661) 399-5763 Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db cc: Don Dozah, Stuarts Petroleum 7-2E;'21~03 9: 32AM FRO ALVALLEY E~I P 1 ~ 1 ~2~2~29 P. 2 GAL V~Y EQUI~T.,. ~ Gilmore Ave Bake~effi. ~ 933~ ~1-3~-9341 Fax ~1-32~252g IMP~ED CURRENT CA THODIC PROTECnON CE~nON B~uc~m ~ 8oil Po~nflal Re~dlngs F~ Prevlou~ In,~ll~d 8y~mt (8~ ~ ) . . ~ ' " ~m~ ~e T~p~ , Uhe I Une IE~Tank o[Ta~. ~Tant C~Uit ' .,. I Uhe I ~:~:z!g~ank ofTa0k, ~ofTank,:~uR~l July 30, 2002 E Z Mobil 101 19th Street Bakersfield CA 93301 REMINDER NOTICE FIRE CHIEF RE: Necessary Secondary Containment Testing Requirements by December RON FRAZE 3 l, 2002 of Underground Storage Tank (s) Located at ADMINISTRATIVE SERVICES the Above Stated Address. 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear Tank Owner / Operator: FAX (661) 395-1349 If you are receiving this letter, you have not yet completed the necessary SUPPRESSION SERVICES 2101 "H' Street secondary containment testing required for all secondary containment Bakersfield, CA 93301 components for your underground storage tank (s). VOICE (661) 326-3941 FAX (661) 395-1349 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California PREVENTION SERVICES Health & Safety Code) of the new law mandates testing of secondary FIRE SAFETY SER~lCES · ENVlR~IMENTAL SER~CES 1715 ChesterAve. containment components upon installation and periodically thereafter, to insure Bakersfield, CA 93301 that the systems are capable of containing releases from the primary VOICE (661) 326-3979 FAX (661) 326-0576 containment until they are detected and removed. PUBMC EDUCATION Of great concern is the current failure rate of these systems that have been 1715 Chester Ave. Bakersfield, CA 9.3.301 tested to date. Currently the average failure rate is 84%. These have been due VOICE (661) 326-3696 to the penetration boots leaking in the turbine sump area. FAX (661) 326-0576 FIRE INVESTIGATION For the last four months, this office has continued to send you monthly 1715 ChesterAve. reminders of this necessary testing. This is a very specialized test and very few Bakersfield, CA 93,301 VOICE (661) 326-3951 contractors are licensed to perform this test. Contractors conducting this test FAX (661) 326-0570 are scheduling approximately 6-7 weeks out. TRAINING DIVISION The purpose of this letter is to advise you that under code, failure to perform 5642 Victor Ave. Bakersfield, CA 93308 this test, by the necessary deadline, December 31, 2002, will result in the VOICE (661) 399-4697 revocation of your permit to operate. FAX (661) 399-5763 This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Steve Underwood Fire Inspector Environmental Code Enforcement Officer ~:~' 1715 Chester Ave., Bakersfield, CA 93301 (661) 326 3979 --' ~ '~' UNDERGROUND ~TO~Off TANK~ - TANK PAGE; 1 L T~K ~ z ~~ 0~ ~~ 0 4. ~ 0~. o~ ~~(~ Os.~ T~W~ Oz~I Ot~~ Ot~ S~L~O~ ~t~n ~ ~(~M~ ~1 ~~NE~:~~n ~ ~ ~(~~~ ~ ~ ~r~~(~O) ~ ~. ~(~w~V~T~ UPCF (7/ge) S:,,.CUPAPORMa'~WRCB'8'WP 0 SAFE SU~'I'~N S~'~itM~ (NO VALV~cS 114 BELOW ~ ~) ~ ~N ~ (~ V~S IN ~ow ~ ~ (~) 1o. ~~ ~ ~~R~D~ ~~~(~ ~ a. ~O~OFF~A~~ ~ a. ~~OFF~A~~ ~ 15, A~O~~~OR~~~~~ ~ 15, ~O~L~OR~.0~ · ~ ia. ~~aT(0. t ~) ~ 16. ~I~GR~TE~(0.1 ~) ~ ~~T~ 81ONA~RE UPCF (7/gg) 8:~CUPAFORM~WRCg'B.WPD '1715 Chester Ave., Bakersfield, CA 93301 (661) 326 3979 UNDERGROUND STORAGE TANKS- TANK PAGE ~ ~'YF~ 0P ACT~N ~ 1, N~ ~ITE ~T ~ 4, ~O ~R~T ~ ~. C~ OF I~O~TION) ~ 6. ~Y SITE CLO~RE L TANK DESCR~ 0ATE INST~D (~) ~ T~ ~AC~ IN ~0~ ~ ~ OF ~~S LMT. ?ANK II).J~.l 2 VI' W C(3N~TRUCTN3N (C:N~ M Mt ll~y) .. ,~'.--~ UNDERGROUND PIPING ABOvEGIK)UND PIPING SYST~ i~PRE$$URF [] 2. SUC?ION I-] 3. (3~AVITY 4M I--I t PRESSUR£ I-] CONSTRUCTiON/~./SINGLEWALL I--1 3. LINED TRENCH r'"199. OTHER 460 I--I ?. $INGLEWALL i--] gs. UNKNOWN 46: MANUFACTURER I~. i3OUBLE WALL [] g~. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER 461 MANUFACTURER r-I 1. 8ARE STEEL [] 8. FRPCOMPATIBLEW/100CA, METHANOL ~] 1. ~U:~ESTEEL I"""] 8. FRP COMPATIBLE W/100% ~ MATERIALS AND i l'--I 2. STAINLESS STEEL [] ?. GALVANIZED ~'EEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL CORROSION I P~OTECTION i[] ~ I:~..ASTIO COMPATIBLE WITH CONTENTS ~,19~. UNKNO'V'v~I [] 3. Pt. ASTIC COMPATIBLE WITH CONTENT$ [] 8. Ft. EXIBLE(HDPE) r'"~99. OTHER !1~ FIBER~ [~[~'. FLEXIBLE (HOPE) [] 99. OTHER [] 4. FIBERCV..ASS I'"] g. CATHODIC PROTECTION I[] 5. $TEELW/COATIN{3 [] g. CATHOOICPROTECT~ON 484 [] 5. STEEL W/ COATING 1'"]95. UNKNOWN 465 UNDERGROUND PIPING ,I~OVEGROUND PIPING ~NGLE WALL HPiJ~ 466 ~NDLE WALL PtPIND 467 PRESSURIZED PIPING (C/~Jc ~ that 41AO/y): PRESSURIZED PIPING (Check [] 1. ELECTRONIG UNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP ~4UT OFF FOR [:] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 G, PH TEST WTI'H AUTO I:~JMP SHUT OFF FOR LEAK. LEAK, SYSTEM FAILURE, AND SYSTEM DI~C(NqlNECTION + AUOISLE AND VISUAL SYSTEM FALURE, ANO SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS A~A~q~S [] 2.. MONTHLY 0.2 Ca=H TEST [] 2. MON'11'ff. Y0.2Gi~TEST [] 3. ANNUAL INTEGRITY TEST (0. t Gi~I) [] 3. ANNUAL INTEGRITY TEST (0.1G/~) r'"] 4. DAJL.YVI,~JALCHECK CONVENTIONA~ SUCTION SYSTEIvI~: CONVENTIONM. SUCTION SYSTEI~ (Check M/tMt [] $. DAILY VISUAL MONITORING OF PUIVlI~NG SYSTEM + ~ Pg=ING INTE~ [] $. DAILY VISUAL MONITOf?JNG OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [] 6. TRIENNUU. INTECg~rrY TEST (0.1 SAFE SUCTION SYSTEMS (NO VALVES IN ~=L.OW GROUND PIPIHG): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITOmNG GRAVITY FLOW:. GRAVITY FLOW (CheGt all that apply): [] 9. BIENNIAL INTEGRffY TEST (0.1 GPH) [-) 8. DAILY VISUAL MONITORJNG [] g. B~.NNtAL WTEGRITY TEST (O.l GPH) ~ECONIMd~LY CONTAJNED PIIqNG 8ECONDARJLY CONTAtNED PIPING PRESSURIZED PIPfNG (Check all ~t apply): PRESSURIZED PIPING (Check af 1 o. CONTINUOUS TURBINE SUMP ~,.NSOR WITH AUDIBLE AND VISUAL.N.ARMS AND (Chec~c ~ne) 10. CONTINUOUS TURBINE SUMP SENSOR WTTH AUDIBLE AND VISUAL ALARMS AND (check one) ~] a. AUTO PUIVlP SHUT OFF WHEN A LEAK OCCUR~ [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] I). AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] I). AUTO PUMP SHIJT OFF FOR LEAK~. SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION 1~], 11/~. Al. AUTOc NO AUTO PUMP SHUT OFF . [] c. NO AUTO PUMP SHUT OFF MATIC LINE LEAK DETECTOR (3.0 GPH ~ WITH FLOW SHUT OFF OR [] 11. AUTOMATIO LEAK DETECTOR RESTRICTION ~ ANNUAL INTEC~rTY TEST (0.1 (3~) I-1 ~2. ANNUAL INTEC4~TY TEST (0J G~) SUCTIOI'~RAV'/TY SYSTEM: SUCTION/G~VITY SYSTEM: [] 13. CONT]NUOUS SUMP SENSOR ,, AUDIBLE AND VlSUAL ALARM8 [] 13. CONTINUOUS SUMP ~ENSOR + AUDIBLE ANO VISUAL ALARMS EMERGENCY GL=NERATOR~ ONLY (CJ~.k M M N)ply) EMERGENCY G~ ONLY (~ M ~t ~ ~STRICT~N I 16. ~NU~ I~GR~ ~ST (0.1 ~) J ~ 16. ~NUAL I~EGR~ ~ST (0.1 ~) 17. DAILY~SU~CHE~ ~ ~ 17. O~LYVI~U~ECK i ~E OF O~E~TOR (p~ll / ~ ~ / -- 47~ T~E OF O~E~TOR 472 UPCF (7/99) S:~CUPAFORMS~WRCB-B.WPD WR~EN MONITORING PRO~[;DURES UNDERGROUND STORAGE TANK MONITORING PROGRAM ~ momtormf pm~rmn must be ~ ar the UST loc~on at all ~ The informmion on ,hi~, moam3ri~ prognun a~e comfi~om of the oper~ pmmc Thc permit bokigr must nm~ the Office of Enviroummml S~l~c~ within ]0 d,W/S Of at~y ~ to tl~ I~onitofizlff p~:~l~ ~ ~ tO ~in ~ ~ mak/~ the change. R~quired by Sec~om 2632(d) and 2641(h) CCR. F~it~ Name Fecilit7 Address I ~ A. Describe ~he fi'eq.ueacy of pe~'o~g the monitoring: Piping c~ ~' B. What meflmds and equipment, idem~ied by name and model, will be used for peffomin8 the monkorins: Piping ( L t ( C. Describe the location(s) where ~he monitoring will be performed (facility plot plan should be at~ached): D. List the name(s) and title(s) of the people responsible for performing the monitoring and/°r .~Zi~S ~uipm--t: £. Reporfin~ Forma~ for monitoring: ,~ Piping t~/-t~ , F. Describe the prevendve maintenanc~ schedule for th~ motoring ~luipm~. Not~: Maintenance mu~t be in accordance with .the manufacturer's maintenance schedule but not le~s than every 12 months. ~ (3. Describe the training necessary for the operation of UST system, including pipin& and the monitoring equipment: EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This mOnitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name Facility Address 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion haTard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notified 2. Describe the proposed methods and equip_ment to be used for re,moving ap_d properly disposiag of any hazardous substance. ~m~. rl~- {4~ ~r~.¢{,C_ 3. Describe the location and availability of the. required cleanup equipmem in item 2 above. 4. Describe the maintenance schedule for the cleanup equipment: 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan: " CER I IPICAi'ION OF FINANCIAL RESPONSIBILITY FOR UND~ 81'ORA(~ TANK8 C0~NNI~ ~~ .~.~. CITY OF BAKERSFIELD · ,' Olde OF ENVIRONMENTAL ~RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STOI~GE TANKS- TANK ~ ~p ~T~N ~ t. ~ ~ITE ~R~T '~ 4. ~0 ~R~ ~ 5. C~ OF I~OR~T~ON) ~ 6. TE~Y SITE CLO~URE (C~ec~ o~ ,~ ~) 4 LO~T~N ~IN ~ (~) ' ~'- ' I, TA~K OE~I~ 0ATE I~T~O ( ) ~ T~ ~A~ IH~O~ ~ ~R OF CITY OF ~AKF-A~FIELD OFFICE OF ENVIRONMENTAL SERVICE/ ~ Chllter Ave., ~ker~fl®ld, CA 9~1 (M1)3~979 ~ - T~ P~E 2 SYSTEM ~ ~ ESSURE CONSTRUCTiO~ ~ ~EWALL ~ 3. LINEDTRE~ ~. O~ER 4~ ~NU~ACTURER]~UBLE WA~ ~ ~. UN~ ~ 2. ~U~E W~L ~ ~. OTHER ~ ~UFA~E~ 461 ~NUFACTURER ~TER~LS AND ~ 2. STAI~ STEEL ~ Z. ~V~ ~L ~ 2. 5TAINLE~ ~TEEL ~ 7. ~V~D ~EEL ~ 3. ~N~~(0.1~ ~ 4. ~Y~E~ ~ 7. SE~ ~N~O~ RESTRICT~N ~ 17. OAILY~SU~CHE~ ~ 17. ~ILYVI~ECK UPCF (7/~) S:~CUPAFORMS~C~B.~D PREMIER BUSINESSOWNERS POLICY PREMIER RETAIL LIABILITY DECLARATIONS Policy Period; Policy Number: ACP BPR 7801006379 From 12-06-01 To 12-06-02 WE PROVIDE INSURANCE ONLY FOR THOSE COVERAGES INDICATED BY A LIMIT OR BY "INCLUDED". COVERAGES LIMITS OF INSURANCE Liability and Medical Payments Per Occurrence $1,000,000 Medical Payments Coverage Sub Limit Per Person $.~000 Tenants Property Damage Legal Liability Sub Limit Per Covered Loss ~300,000 Personal and Advertising Injury Per Person Or Organization {~].,000,000 Products - Completed Operations Aggregate All Occurrences ~;2,000~000 General Aggregate All Occurrences ~2,000,000 (Other than Products - Completed Operations) AUTOMATIC ADDITIONAL INSUREDS STATUS The following persons or organizations are automatically insureds when you and they have agreed in a written contrad or .agreement that such person or organization be added as an additional insured on your policy. Co-Owners of Insured Premises Included in Liability & Medical Payments Limit Contf~olling Interest Included in Liability & Medical Payments Limit Grantor of Franchise or License Included in Liability & Medical Payments Limit Lessors of Leased Equipment Included in Liability & Medical Payments Limit Managers or Lessors of Leased Premises Included in Liability & Medical Payments Limit Mortgagee. Assignee or Receiver Included in Liability & Medical Payments Limit Owners or Other Interest from Whom Land has been Leased Included in Liability & M.edical Payments Limit State or Political Subdivisions - Permits Relating to Premises Included in Liability & Medical Payments Limit PROPER'FY DAMAGE DEDUCTIBLE Car Wash Property Damage Deductible Amount SlX) Per claim OPTIONAL COVERAGES Liquor Liability ]:ncluded in Ltab~.l~.ty & Hedical Payr, en~s L:bai~ PB 81 03 (Ol-Ol) DIRECT BILL 7SQG MS INSURED COlbY UID 27 78 3~68 pREMtER 6UstNESSOWN S POLICY .......... LIABILI~ DECLARATIONS Policy Perio~ Policy Number: ACP BPR 7801006379 From 12-05-01 To 12.06-02 WE PROVIDE INSURANCE ONLY FOR THOSE COVERAGES INDICATED BY A LIMIT OR BY "INCLUDED", COVERAGES LIMITS OF INSURANC Liability and Meclical Payments Per Occurrence ~[,000~000 Medical Payments Coverage Sub Limit Per Person ~$~000 Tenants Property Damage Legal Liability Sub Limit Per Covered Loss ~300~000 Personal and Advertising Injury Per Person Or Organization ~1,000,000 Products - Comple'Ied Operations Aggregate All Occurrences General Aggregate ~2, 00O,000 (Other than Product's - Completed Operations) All Occurrences $2,000,000 AUTOMATIC ADDITIONAL INSUREDS STATUS The following persons or organizations are automatically insureds when you and they have agreed in a written contract or.agreement that such persori or organization be added as an additional insured Ol1 YOUr policy. Co-Owners of Insured Premises Controlling interest included in. Liability & Medical Payments Limit Grantor ol~ Franchise or License Included in Liability & Medical Payments Limit Lessors of Leased Equipment Included in Liability & Medical Payments Limit Managers or Lessors of Leased Premises Included in Liability & Medical Payments Limit Mortgagee, Assignee or Receiver Included Jn Liability & Medical Payments Limit Included in Liability & Medical Payments Limit Owners or Other Interest from Whom Land has been Leased Included in Liability & Medical PaymenTs Limit ....... State or Political Subdivisions. Permits Relating to Premises InCluded in Liability & M~dicaJ Payments Limit PROPERTY DAMAGE DEDUCTIBLE Car Wash Property Damage Deductible Amount $00 Per claim OPTIONAL COVERAGES Liquor Liability Znc.7.uded J.n Liability & Hectica.1. Payments Limit PB al 03 (ol-ol) MS INSURED COPY UIO 27 7a 3~$e CALIFORNIA STATE BOARD Of EQUALIZATION SELLER'S PERMIT ACCOUNT NUMBER i 11/15/2.OO1' SR arH 97-9~2533 E Z STOP JqOBIL BOUN CH I LY ~//s PEFiM/T DOES NOT 101-19TH STREET AUTHORIZE THE HOLDER BAKERSFIELD, CA eUS/NESS CC~'m~,e~' POSSESS OR OPEF~TE , ~ ILLEC~.L DEVICE. IS HEREBY .'uJTHoRIZ~D PURSUANT TQ ~ ~1~1:1 USE T~Z I. AW TO ENQAQE IN THE BUSINESS OF SELLING T~NCIIBLE PEF~ONAL PROPERTY AT THE ASoVE LO~TION THIS PERMIT IS VAUD UNTIL REvOKED OR C~C. ELED BUT 18 NOT TI~SFEJ~E, IF YOU SELL YOUR OR DROP OUT OF A PARTNERSHIP, NOTIFY US OR YOU COULD BE RESPONSIBLE FOR S~LE$ KD USE TAXF_~ Not va/~ at eny other OWED BY THE NEW OPERATOR OF THE BUSINE..e,S. ' FOR GENERAL TAX QUESTIONS, PLEASE TELEPHONE OUR INFORMATION CENTER AT 1-800-400-71 ~E-442-R REv. 13 (6-00) NOTICE TO INDIVIDUALS REGARDING INFORMATION FURNISHED TO THE BOARD OF EQUALIZATION The Information Practices Act of 1977 and the Federal Pdvacy Act requires this agency to provide the following notice to individuals who are asked by !he St-ate I~.c~!=~cl o_f Equallzatior!..(Board) to sul31~ly information, including the disclosure of the individual's s~ciaJ s~curity account nUrSe,ar. IndMduas'ap~i~;ing for permits, certificates, or licenses', ~-filing ~x fo,,ms, Sl~'ements, or other forms preac~~ agency, at~ include their social security nt~mbers for proper identification. {See Title 42 United States Code section 405(c)(2XC)(I)]. It is mandatory to furnish ,all the a~propriate information requested by applications for registration, applications for permits or licenses, tax returns and other related data. Failure to provide all of ttle required information requested by an application for a permit or license could result in your not being issued a permit or license. In addition, the law provides penalties for failure to file a return, failure to furnish specific inforrnat~on required. ~lure to supply information required by or regulations, or for furnishing fraudu{ent information. Provisions contained In the following laws require persons meeting certain requirements to file applications for registration, applications for permits or licenses, and tax returns or reports in such form as prescribed by the State I~ard of Equaliation: Alcoholic Beverage Tax, Sections* 32001-32556; Childhood Lead Poisoning Prevention Fee, Sections 43001-43651, Heath & Safety Code, Sections 105275-105310; Cigarette and Tobacco Products Tax, Sections 30001-30481; Diesel Fuel Tax, Sections 60001-60709; Emergency Telephone Users Surcharge, Sections 41001-41176: Energy Resources Surcharge, Sections 40001-40216; Hazardous Substances Tax, Sections 43001-43651; Integrated Waste Management Fee, Sections 45001-45984; International Fuel Tax Agreement, Sections 9401-9433; Motor Vehicle Fuel License Tax, Sections 7301.8405; Occupational Lead Poisoning Prevention Fee, Sections 43001-43651, Health & Safety Code, Sections 105175.105197; Oil Spill Response, Prevention, and Administration Fees, Sections 46001-46751. Government Code, sections 8670.1o8670.53; Publicly Owned Property, Sections 1840-1841; Sales and Use Tax, Sections 6001-7279.6; State Assessed Property, Sections 721-868, 4876-4880, 5011-5014; Tax on Insurers. Sections 12001-13170; Timber Yield Tax, Sections 38101-38908; Tire Recycling Fee. Sections 55001-55351. Public Resources Code. Sections 42880-42895; Underground Storage Tank Maintenance Fee, Sections 50101-50161, Health & Safety Code, Sections 25280-25299.96; Use Fuel Tax, Sections 8601-9;355. The principal purpose for which the requested infoml&tion will be used is to adrr~nlster the laws identified in the preceding paragraph. This includes the determination and collection of the correct amount of tax. Information you furnish to the Board may be used for the purpose of collecting any outstanding tax liability. As aUthorized by law, information requested by an application for a permit or license could be disclosed to other agencies, including, but not limited to, the proper officials of the following: 1) United States governmental a~lencies: U.S. Attorney's Office; Bure~J of Alcohol, Tobacco and Rrearms; Depts. of Agriculture, Defense, Justice; FederaJ Bureau of Investigation; General Accounting Office; Internat Revenue Service; the Interstate Commerce Commlssl.on; 2) State of California governmental agencies and officials: Air ReSources Board; Dept. of Alcoholic Beverage Control; Auctioneer Commission; Employment Development Department; ~nergy Commission; Exposition and Fairs; Fcx3cl & Agriculture; Bc~ard of Forestry; Forest Products Commission; Franchise Tax Bcard: Dept. of Health Services; Highway Patrol; Dept. of Housing & Community Development; California Parent Locator Service; 3) State agencies outside of CaJifornia for tax enforcement purposes; and 4) city attorneys and city prosecutors; county district attorneys, sheriff deper[Tllants. AS an individual, you have the right to access personal information about you in records maintained by the State Board of Equalization. Please contact your local Bcerd office Jisted in the white pages of your telephone directory for assistance. If the local Board office is unable to provide fl~e information sought, you may also contact the Disclosure Office in Sacramento by telephone at (916) 445-2918. The Board officials responsible for maintaining this Information, who can be contacted by telephone at (916) 445-6464, are: Sales ami Use Tax, Deputy Director, Sales and Use Tax Department, 450 N Street, MIC:43, Sacramento, CA 95814; Ex, else Taxes, Fuel Ta=~s aaa Environmental Fees, Deputy Director, Special Taxes Department. 450 N Street, MIC:31, Sacramento, CA 95814; Pmp~rb/Tazas, Deputy Director, Property Taxes Department, 450 N Street. MIC:83, Sacramento. CA 9S814. i~I~_FICE OF ENVIRONMENTAI~IgERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY Page __ of __ TYPE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5. CHANGE OF INFORMATION (Specify change - [] 7. PERMANENTLY CLOSED SITE (Check one item only) local use only) [] 8. TANK REMOVED 400. 4. AMENDED PERMIT [] 6. TEMPORARY SITE CLOSURE I. FACILITY / SITE INFORMATION NEAREST"'~ROSS STRE~ET' ~ J ' 401. FACILITY OWNER TYPE [] 4. LOCAL AGENCY/DISTRICT' 101 Iq [] 1. coRPORAT,o. COUNTY AGENCY- ~t~DIVIDUAL [] 6. STATE AGENCY' BUSINESS [~,~AS STATION [] 3, FARM [] 5. COMMERCIAL TYPE [] 2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER 403. L_J 3. PARTNERSHIP [] FEDERAL AGENCY* 402. TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST a public agency: name of supervisor of REMAINING AT SITE trustladds? division, section or office which operates the UST, (This is the contact person for the tank records. ~ ~' [] Yes EZ~ ~o~. 4o~. " ' ,' '. Ik PROPERTY OINNER INFORMATION PROPERTY OVtANER NAME ~ 407. PHONE 408. MAILING OR ST S 409. ~2. INDIVIDUAL 4. LOCAL AGENCY / DISTRICT 6, STATE AGENCY 413. [] 1. CORPORATION ~[] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY TA,,,K OWNER,,"[ CkL 41,,. T PHONE 41S. MAILING OR STREET ADDRESS - -- - 416. [] 1. CORPORATION ~1~i PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER . TY (TK) HQ 4 4 . Call (916) 322-g669 if questions adse 42~. -: pETRoLEUM UsT FiNANCiAL REsPON$iBIi. iTY INDICATE METHOD(S) ~1. SELF-INSURED [] 4. SURETY BOND [] 7. STATE FUND [] 10. LOCAL GOV'T MECHANISM [] 2, GUARANTEE [] 5. LE'I-FER OF CREDIT [] 8. STATE FUND&CFO LETTER [] 99. OTHER: [] 3. INSURANCE [] 6. EXEMPTION [] 9. STATE FUND & CD 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS Ched( one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank ow~or unless box 1 or 2 is checked. 1. FACILITY [] 2, PROPERTY OWNER [] 3. TANK OWNER 423. VII. APPLICANT SIGNATURE Certification: I certi~ that the information provided herein is true and accurate to the best of my knowledge, NAMEOFAPP'CANT,,,," /b_ , . 42". TITLE OF APP"CANT 42'. UPCF (7/99) S:\CUPAFORMS\swrcb-a.wpd