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UNDERGROUND TANK-C-8/16/94 (2)
,' HAZARDOUS MATERIAL DIVISION ~./-~-f-_~_q.~::~ 2130 G Street, Bakersfield, CA 93301 '~ (805) 326-3979 TANK REMOVAL INSPECTION FORM COllaTOR ~ ~ e~e/ CONTACT PERSON J~ ~SO~TO~ S. C~ ~ 0F StaPLeS ~ T~ST ~W~ODOLO~ ~ ~/ ~ ~~ P~LI~ARY ASSESSMENT CO.'~m~ C~ CO.ACT PERSON C% RECIEPT ~ LEL% W, O O=% PLOT P~ CONDITION OF PIPING' CONDITION OF SOIL ~",~/%,')~, ~'?),,~_ 7 DATE INSPECTORS N~FJ__/ ,,~- ' l~akersfield Fire De~ P~RM,T No. f~-~.~.) HAZARDOUS MATERIALS DIVISION UNDERGROUND STORAGE TANK PROGRAM ,. , PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION ~ ~ SITE ~~ ~ ~DDRESS ~ ~ ~ ZIP CODE APN FACILI~ NAM~/~GE ~ ~/x~/~ . CROSS STREET ~ ,~ · TANK OWNER/OPERAT~/~~~ PHONE No. ~- ~/~ MAILING ADDRESS ~ /~ ,.~ CIW ~W~ ZIP CODE CONTRACTOR INFORMATION ~ ~- COMPANY ~~/~ ~5/~ PHONE No. ~ LICENSE No. ~/~ ADDRESS/~/~ ~~~ /~' ' CIW ~~ ZIP CODE INSURANCE CARRIER ~~ ~~ WOEKMENS COMP No. PRELIMANARY~SSEMENT INFORMATION COMPANY X[~G~ PHONE No. ~-~~ LICENSE No. ADDRESS/~/. ~H/~ ~ , , CIW ~~ ZIP CODE INSURANCE CARRIER ~!~/~ ~/~/~ WOEKMENS COMP NO. rAN~ C~EAN~NG ~NFORM~r~ON ~ / / COMPANY ~~ · /~ PHONE No. . ADDRESS ~~' CI~ / ~ ZIP CODE / / WASTE TRANSPOET~ IDENTIFICATION NUMBER NAME OF RINSTATE DISPOSAL FACILI~ ~/~~/ ADDRESS ~G I ~/~ ~ CIW ~~ ZIP CODE FACILI~ INDENTIFICATION NUMBER TANK ~ANSPORTER INFpRMATION COMPANY ~/P~~ PHONE No. ~//~/ LICENSE No. ADDRESS ~~ ~/~N/~ CIW ~~ ZIP CODE TANK DESTINATION ~D~/ux ~~ ,. TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES CHEMICAL ~TORED STORED PREVIOUSLY STORED ................... ............... ...... .................................................................................... .......................... ....... - .............. ~ ................. · .................. ,:~.-.-...~:.-?~-.... .......... ..::--,:.:~:..~..:: .,:..:,::~:~ ..~ ....... .:::~ ........... ~:~i~::~:~:::::::::::::::::::::::::::: .............. : ............. :'..~ ....... :~ .... [iiii:~!::i::!::!i!::i::!::iiii!i~!!i!ii:~iiii:~i::!~i!i!:~iiiii!i~!~!~i~!~!!!:i:!~i~i~!~!~!!!:~::~::i~i~!~!~!~i~::~`~:::::~:~:::~:~:~::?~:~:~:~:::~:~:~::::~::::::::::::::::::::::::::::::::::::::::::::::: ......................................................................................................... THE APPLICANT HAS RFC RIVED. UNDERSTANDS. A ND WILL COMPLY WITH THE A'I'I'ACH ED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF'MY KNOWLEDGE, IS TRUE AND CORRECT. THIS APPLICATION BECOMES A PERMIT WHEN APPROVED RECORD OF TELEPHONE CONVERSATION Business Name: Con~ N~e: Busin~ Phone: F~: insp~or's N~e: ~me of C~I~ D~e: Type of C~I: Incoming ~ Outgoing [ ] Returned Content .of Call: '13me Required to Complete Activity # Min: !~ CITY of BAKERSFIELD "WE CARE" August 17, 1994 FIRE DEPARTMENT 1715 CHESTER AVENUE M. FI, KELLY BAKERSFIELD, 93301 FIRE CHIEF 326-3911 Gerald Chase 440 19th Street Bakersfield, CA 93301 RE: Soil Analysis at 440 19th Street in Bakersfield, CA Dear Mr. Chase: This is to inform you that this department has reviewed the results of the soil analysis dated August 5, 1994 associated with the previous gasoline dispenser area. Based upon the information provided, this department has determined that appropriate response actions have been completed, that acceptable remediation practices were implemented, and that, at this time, no further investigation, remedial or removal action or monitoring is required at the above stated address. Nothing in this determination shall constitute or be construed as a satisfaction or release from liability for any conditions or claims arising as a result of past, current, or future operations at this location. Nothing in this determination is intended or shall be construed to limit the rights of any parties with respect to claims arising out of or relating to deposit or disposal at any other location of substances removed from the site. Nothing in this determination is intended or shall be construed to limit or preclude the Regional Water Quality Control Board or any other agency from taking any further enforcement actions. This letter does not relieve the tank owner of any responsibilities mandated under the California Health and Safety Code and California Water Code if existing, additional, or previously unidentified contamination at the site causes or threatens to cause pollution or nuisance or is found to pose a threat to public health or water quality. Changes in land use may require further assessment and mitigation. If you have any questions regarding this matter, please contact me at (805)-326-3979. Sincerely, Howard H. Wines, III Hazardous Materials Technician HHW/ed cc: R. Huey Purgeable Aromatics and Total Petroleum Hydrocarbons CALPI P O BOX 6278 Date of BAKERSFIELD, CA 93386 Report: 08/0S/94 Attn.: PAT 589-5648 Lab ~: 94-07987-1 Revised Sample Description: CHASE SPECIALTIES: 11 FEET BELOW DISPENSER SAMPLED ON 7-26-94 BY DAV-/D RITT~ATHOUSE TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Indlvidual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Date Sample Collected: Date Analysis 07/26/94 Received ~ Lab: Completed: ..... o7/26/~4 0~/0.~/~4 · '/: Practical ~ Analysi s Report ing Quanti ration R~sults ~ Liml t Benzene Toluene None Detected mg/ks 0'. 1 " · None Detected mg/k9 0'.'1' Ethyl Benzene None Detected mg/kg 0.1 ':... Total Xylenes None Detected ms/kg Total Petroleum 0.2 Hydrocarbons (gas) 32. mS/ks · . . 20... Note: High reported PQL's due to high concentration 6f non-tarset analytes. Sample chromatogram not typical of gasoline. California D.O.H.S. Cert. ~1186 ' .. .:... Department Supervisor ~ re~It~ ~ s~d ln ~ls m~ are ~ ~e exdu~e u~ of ~ su brnl~ patty, gC ~m~des, l~ as~m~ no responsi~l~ ~ m~ ~m~n, Ml:mmlton, de~men~ or ~rd ~ ~m~ t~n. ~ '~ ~ '0N ~ ~8~ b66~'G~'88 ~0~ ~U~-16--94 TUE ll~ -'~ 76~1~48255~9467 ~m~ P. : ~pl, Charge Bakersfield, CalJl'ornla 93308 CHAIN OF CUSTODY Matrix (S) Soil (SL) Sludge (W) Water (O{her) Samples rec. cold (y/n · Custody Seals (y/n) Results Needed by: Date & Time Number and Container Type UST STATUS Date: AddresS: Active UST Abandoned UST on.Site US.T closed - Tanks Removed UST Closed ?.,'Tanks .Removed -' Release Reported UST Closed.--"Tanks in Place UST Closed - Tanks in Place- Release Reported UST Closed - Mitigation in ·Progress Computer Updated: October 25, 1991 Gerald Chase Chase Specialties 440 19th St. Bakersfield, CA 93301 RE: Laboratory results from preliminary site assessment conducted at the facility located at 440 19th St., Bakersfield Dear Mr. Chase, Upon review of the recently submitted laboratory results from your facility, this office has determined that the extent of the contamination plume has not been adequately defined and may pose an evironmental risk. This office requires (in accordance with chapter 6.7 of the California Health and Safety Code and chapter 16, Title 23 of the California Code of Regulations) that further assessment be done to define the vertical and horizontal extent of the contamination plume. Please submit a work plan for further assessment, to this office, with in 30 days from receipt of this letter. The work plan should follow guidelines found in: Appendix A - Reports~ Tri - Regional Board Staff Recommendations for Preliminary Evaluation and Investiqation of Underqround Tank Sites; January 22, 1991. If you have any questions, please call me at (805) 326-3979. Sincerely, Joe A. Dunwoody Hazardous Material Specialist Underground Tank Program STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE MARKONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION Z'~7 PERMANENTLY CLOSED SITE ONEITEM [] 2 INTERIM PERMIT ~ 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADORESS - (MUST BE COMPLETED) TO INDICATE ~ COR~RATION ~DIVIDUAL ~ P~TNERSHIP ~ L~AL-AG~CY ~ COUP-AGENCY ~ STATE-AGENCY DISTRICTS [ ~ ~ ,FINDIAN,,OFTANKS/TSITEI E.P.A. LD.,(~ti. al) ~PE OF BUSINESS ~ 1 GASSTATtON ~ 2 DISTRIBUTOR ~ RESERVATION ~ EMERGENCY CONTA~ PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY). optional DAYS: NAME (~ST. FIRS~ ~ PHONE 8 WiTH AREA CODE DAYS: NAME (LAST. FIRS~ NIGHTS: NAME (LAST. FIRS~ / PHONE ~ WITH AREA CODE NIGHTS: NAME (LAST. FIRS~ PHONE ~ WITH AREA CODE I1. PROPERTY OWNER INFORMATION - {MUST BE COMPLETED) NAME ~ CARE OF ADDRESS INFORMATION . MAILING OR STREETADDRESS-- - ~ ~ ~x~indicate ~ INDIVIDUAL ~ LOCAL-AGENCY ~ STATE-AGENCY ~ PARTNERSHIP CI~ E - PHONE ~ WITH AREA CODE III, TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER ~ CARE OF ADDRESS INFORMATION MAILING OR ~TREET ADD RESS- ~ ~ ~ ~x ~ indicale ~ INDIVIDUAL ~ LOCAL-AGENCY ~ STaTE-AGENCY / © COR~RA~ON ~ PARTNERSHIP ~ COU~-~GE~Y ~ FEDE~L-~GENCY CI~ NAME [ STATE ZIP CODE PHONE ~ WITH AREA CODE IV, BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 323-9555 if questions arise. V. PETROLEUM MST FINANCIAL RESPONSIBILITY- (MUST BE COMPLETED) - IDENTIFY THE METHOD(S) USED ~ ~x~indicate ~ 1 SELF-iNSURED ~ 2 GUARA~EE ~ 3 INSURANCE ~ 4 SURE~ ~ND ~ 5 LE~EROFCREDIT ~ 6 ~EMP~ON VI, LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is. checked. [ CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: I.~ ~111. ~ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLiCANT NAME (PRINTED & SIGNATURE) .~ [ APPLiCANtS TITLE MONTH/DAY. EAR LOCAL AGENCY US~~ - ~ ' - / COUN~ ~ JURISDICTION ~ FACILI~ ~ LOCATION CODE - OPNONAL CENSUS TRACT ~ - OPTIONAL SUPVISOR - DISTRICT CODE - OPTIONAL m THIS FORM MUST BE ACCOMPANIED BY.AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B~ UNLESS THIS IS A CHANGE OF SEE INFORMATION ONLY. FO RM A (5-91 ) FOR~3A-5 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] $ TEMPORARY TANK CLOSURE .,,,~8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: C/~ I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY ~ UNKNOWN A. OWNER'STANK ,.0., / B. MANU AC II. TAN K C~TE~S ~¢ A-1 IS MARKED, COMPLETE ITEM C. UI .LADED 3 DIESEL ~ 6 AVIATION GAS ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WAS~ ~ 2 lEADED ~ 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S. ~: I1~. TANK CONSTRUCTION UA"KON~IT~UONLY~"aOX~S*,a,*NOC, A.O*LL~ATA. PUES~NBOXDA.D~ A. ~PEOF ~UGLE WALL ~ 3 SINGLE WALL WITH E~ERIOR LINER ~ 95 UNKNOWN SYSTEM ~ 2 SINGLE WALL ~ ~ 4 SECONDARY CONTAINMENT (VAULTED TANK) ~ 99 OTHER MATERIAL ~ 5 CONCRETE ~ 6 POL~INYL CHLORIDE ~ 7 ~UMINUM ~ 8 1Om/. ME~ANOL COMPAT~BLEW/F.. (PrimaryTank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 O~ER C. INTERIOR ~ ~ RUBBER UNED ~ 2 ~D LiNiNG ~ 3 EPO~ LINING ~ 4 PHENOLIC LINING LINING ~ 5 GLASS UNING ~NLINED ~ 95 UNKNOWN ~ g90~ER ~s UN~NG UAT~.~AL COU.~T~aL~ W~T. 1~ UE~ANOL* YES__ D. CORROSION ~ 1 POLYET.YLENE W.AP ~ 2 COATINe ~ 3 VINYL WR~ ~ 4 FIRE.GLASS .EIN~O.CED .LAST~C PROTE~ION ~ 5 CATHODIC PROTECTION~NONE ~ 95 UNKNOWN ~ 99 O~ER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) ~ OVERFILL PR~ENTION EQUIPMENT INSTALLED ~EAR) IV. PIPING INFORMATION' CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUND. BO~ IF APPLICABLE A. SYSTEMTYPE ~ SUCTION A U 2 PRESSURE A U 3 GRAVI~ A U 99 O~ER B. CONSTRUCTION ~ SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND ~ BARESTEEL A U 2 STAINLESS ST~L A U 3 POLWINYL CHLORIDE(PVC)A U 4 FIBERG~SS PiPE CORROSION A U 5 ~UMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING PROTE~tON A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTiON A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR ~ 2 LINE TIGHTNESS TESTING ~ 3 INTERSTITIAL MONEORING ~ 99 O~ER V. TANK LEAK DE~ECTION ~ 1 VISUAL CHECK ~ 2 INVENTORY RECONCILIATION ~ ~E MONITORING ~ 4 AUTOMATIC TANK GAUGING ~ 5 GROUNDWATER MONITORING ~ 6 TANK TESTING ~ 7 INTERSTITIAL MONITORING ~1 NONE ~ 95 UNKNOWN ~ ~ OTHER VI. TANK CLOSURE INFORMATION [ 1. ESTIMATED DATE LAST USED (MO/DAY, R) ] 2. ESTIMATED QUANTI~ OF ~ 3. WAS TANK FILLED WiTH yES THIS FORM HAS BEEN COMPLE I ~D UNDER PENAL ~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT J APPLICAN~S NAME ~ ~. - Z ' DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMff APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORo~ UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT EMERGENCY HAS STATE OFFICE OF EMERGENCY SERVICES j ~ SIGNATURE ~ OWNE~PE~TOR ~ A~RESS / ~ ~ME ~NT~T PE~ON P~NE ~ (1) ~ ~ NA~E _} QU~TI~ LOST (G~LON~) ~ UNKNO~ ~ ~TEDI~O~RED Y ~WDI~OVE~D ~ IN~ORY~ROL ~ SUBSURFACE MONITORING ~ NUISANCE~NDIT~NS ~ ~ ~URCE OF DI~HARGE " CAUSE(S) 5 ~ ~ T~K~ ~N~O~ ~ OVERF~L ~ RUP~R~FAILURE ~ SPILL m ~ ~E~ ONE ONLY ~E~ ONE ONLY ~ ~ ~ NO ACTION TA~N IMINA~SITE~E~ME~R~N SUBM~D ~ POLLUTION CHA~C~RI~T~N ~ ~ L~BEI~NFIRMED ~ PRELIMINA~SI~SESSME~UNDERWAY ~ POST ~NUP MONITORING IN PROGRESS ~ REMEDIATION P~ ~ CASE ~OSED (C~UP ~MP~D OR UNNECESSAR~ ~ ~EANUP UNDERWAY CHE~ ~PROPRIA~ ACTION(S) ~ EXCAVA~ & DISPOSE (ED) ~ REMO~ F~E P~CT (F~ ~ ENH~CED B~ ~GRADATION (1~ --~ ~ C~SlTE(CD) ~ EXCAVA~&TREAT(E~ ~ r'UMP&TREATGmUNDWATER(G~ ~ REP~ SUPPLY (RS) ~ ~ CONTAINMENT BARRIER (CB) ~ ~ACT~NREQUIRED(NA) ~ TREATMENTAT~OKUP(HU) ~ VENT SOIL ~S) 0 INSTRUCTIONS EMERGENCY Indicate whether emergency response personnel and equi~anent were involved Preliminar~ Site Assessment Workplan Submitted - workplan/proposal at any time. If so, a Hazardous Material Incident Report should be filed requested of/submitted by responsible party to determine whether ground with the State Office of Emergency Services (OES) at 2800 Meadowview Road, water has been, or will be, impacted as a result of the release. Sacramento, CA 95832. Copies of the OES report form may be obtained at Preliminary Site Assessment Underway - implementation of workplan. your local underground storage tarhk'permitting agency. Indicate whether Pollution Characterization - responsible party is in the process of fully the OES report has been filed as of the date of this report, defining the extent of contamination in soil and ground water and assessing " impacts on surface and/or ground water. LOCAL AGENCY ONLY Remediation Plan - remediation plan submitted evaluating long term To avoid ~uplicate notification pursuant-t~ Health and Safety code Section remediation options. Proposal and implementation schedule for appropriate 2§180.7, a designated government emp~6yee ~houl8 sign and date the form in remediation options also submitted. this block. A signature here does not mean that the leak has been Cleanup Underway - implementation of remediation plan. determined to pose a significant threat to human health or safety, only Post Cleanup Monitorin~ in Pro~ress - periodic ground water or other that notification procedures have been followed if required, monitoring at site, as necessary, to verify and/or evaluate effectiveness of remedial activities. ~ REPORTED BY Case Closed - regional board and local agency in concurrence that no ~.~t~-E~t~f your name, telephone number, and address' Indicate which party you further work is necessa-~y--a%-~he-s-i-te~ ~ represent and provide company or agency name. IMPORTANT: THE INFORMATION PROVIDED ON THIS FORM IS INTENDED FOR GENERAL RESPONSIBLE PARTY STATISTICAL PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REPRESENTIHG THE Enter name, telephone number, contact person, and address of the party OFFICIAL POSITION OF ANY-GOVERNMENTAL AGENCY responsible for the leak. The responsible party would normally be the tank owner. REMEDIAL ACTION Indicate which action have been used to cleanup or remediate the leak. SITE LOCATION Descriptions of options follow: Enter information regarding the tank facility. At a minimum, you must provide the facility name and full address. Cap Site - install horizontal impermeable layer to reduce rainfall infiltration. IMPLEMENTING AGENCIES Containment Barrier - install vertical dike to block horizontal movement of Enter names of the local agency and Regional Water Quality Control Board contaminant. involved. Excavate and Dispose - remove contaminated soil and dispose in approved site. SUBSTANCES INVOLVED Excavate and Treat - remove contaminated soil and treat (includes spreading Enter the name and quantity lost of the hazardous substance involved. Room or land farming). is provided for information on two substances if appropriate. If more than Remove Free Product - remove floatin~ product from wate~ table. two substances leaked, list the two of most concern for cleanup· Pump and Treat Groundwater - generally employed to remc/e dissolved contaminants. DISCOVERY/ABATEMENT Enhanced Biode~radation - use of any available technology to promote Provide information regarding the discovery and abatement of the leak. bacterial decomposition of contaminants. · Replace Supply - provide alternative water supply to affected parties. SOURCE/CAUSE Treatment at Hookup - install water treatment devices at each dwelling or Indicate source(s) of leak. Check box(es) indicating cause of leak.' other place of use. Vacuum Extract - use pumps or blowers to draw air through soil. CASE TYPE Vent Soil - bore holes in soil to allow volatilization of contaminants. Indicate the case type category for this leak. Check one box only. Case No Action Required - incident is minor, requiring no remedial action. type is based on the most sensitive resource affected. For example, if both soil and ~round water have been affected, case type will be "Ground CO~I~ENTS - Use this space to elaborate on any aspects of the incident. Water". Indicate "Drinking Water" only if one or more municipal or domestic water wells have actually been affected. A "Ground Water" SIGNATURE - Sign the form in the space provided. designation does not imply that the affected water cannot be, or is not, used for drinking water, but only that water wells have not yet been DISTRIBUTION affected. It is understood that case type may change upon further If the form is completed by the tank owner or his agent, retain the last copy and forward the remaining copies intact to your local tank permitting agency investigation, for distribution. CURRENT STATUS 1. Original - Local Tank Permitting Agency · Indicate the category which best describes the current status of the case· 2. State Water Resources Control Board, Division of Loans and Grants, Check one box only. The respons~ should be relative to the case type. For ~ Underground Storage Tank Program, P.O. Box 944212, Sacramento, CA 94244- example, if case type is "Ground ~ater", then "Current Status" should refer 2120 to the status of the ground water investi§ation or cleanup, as opposed to 3. Regional Water Quality Control Board that of soil. Descriptions of options follow: 4. County Board of Supervisors or desi§nee to receive Proposition 65 notifications· No Action Taken - No action has been taken by responsible party beyond 5. Owner/responsible party. initial report of leak. Leak. Bein~ Confirmed - Leak suspected at siLe, but has not been confirmed. UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT YES ~NO REPORT SEEN FILED ? [] YES NAME OF INDIVIDUAL FILING RE~RT PHON~' J SIGNATURE 0,'~= ~:~ ~.. ......... ~ (. ) REPRESEmlNG ~ OWNE~OPERATOR ~ REGIO~L~A~ mMP~ORAGEUCVN~E A~RESS ~ME ~NT~T PE~ON } P~NE ADDRES~ OPE~TOR~, I P~NE F~ILI~, NAME (IF APPLIC~L~ , .' ,/ · ~ ( - // ADDRESS CROSS STRE~ L~AL AGENCY AGENCY ~ME ~TACT PER~ P~NE , ..... , ... ~/~/~.~'~".'>/=: - ~/~"~ '~. C: ,.'.,'~ ~..~.~ ~. ~'~ ..... * . , - . REGION~:~ ~ARD ~ P~NE .'~,~: ~. / ~.~ , , ,t NAME OU~TI~ LOST (G~LONS) (1) ,, ~ UNKNO~ DATE DInG. RED-- mW DISCOVEreD ~ IN~ORY ~ROL ~ SUBSURF~E MONITORING ~ NUISAmE reNDITIONS ( MI ?'MI ':~1 tD~ ~'.t'YI Y ~ TANK~ST ~YANKREMOVAL ~ O'ER ~TE DI~HARGE BE~N M~OD USED TO STOP DI~HARGE (CHECK ~L ~T ~PL~ ~1 .I .I Gl ~1 ~1 ~'~,ow, ~ ~MOVE~N~NTS ~ REP~ET~K ~T~K ~SDI~HARGEBEENSTOPPED? ~ ~PAIRT~K ~ REPAIR PIPING ~ CH~GEPR~EDURE ~URCE OF DI~HARGE CAUSE(S) mE~ ONE ONLY ~~RMINED ~ ~ILONLY ~ GROUNDWA~R ~ DRINKING WA~R - (CHECK ONLY IF WA~R ~LLS HAVE AC~LY BEEN AFFECTED) CHE~ ONE ONLY ~ NOACTION TAKEN ~ PRELIMINA~SI~ESSME~RKP~NSUBM~D ~ POLLUTION CHA~C~R~T~N ~ L~ BEI~ ~NFIRMED ~ PRELIMINA~ SI~ ~E~ME~ UNDERWAY ~ POST ~NUP MONITORING IN P~GRESS ~ REMEDIATION P~ ~ CASE ~EO (C~UP COMP~TED OR UNNECESSAR~ ~ CL~NUP UNDERWAY CHE~ ~PROPRIA~ ACTION(S) ~ EXCAVA~ & DISPOSE (ED) ~ REMO~ F~E P~CT (F~ ~ ENHANCED BD ~GRADATION (1~ ~ C~SITE(CD) ~ EXCAVA~&TREAT(E~ ~ PUMP&TREATG~UNDWA~R(G~ ~ REP~CESUPPW(RS) ~ CONTAINMENT BARRIER (CB) ~ ~ACT~NREQUIRED(NA) ~ TREATMENTAT~OKUP(HU) ~ VENT SOIL ~S) VACUUM E~RACT ~)~ OTHER (O~ ~(tl/8~ INSTRUCTIONS EMERGENCY Indicate whether emer&ency response personnel and equipment were involved Preliminary Site Assessment Workplan Submitted - workplan/proposal at any time. If so, a Hazardous Material Incident Report should be filed requested of/submitted by responsible party to determine whether ground with the State Office of Emergency Services (OES) at.2800 Meadowview Road, water has been, or will be, impacted as a result of the release. Sacramento, CA 95832. Copies of the OES report form may be obtained at Preliminary Site Assessment Underway - implementation of workplan. your local underground storage tank permitting agency. Indicate whether Pollution Characterization - responsible party is in the process of fully the OES report has been filed, as of the date of this report, defining the extent of contamination in soil and ground water and assessing impacts on surface and/or ground water. LOCAL AGENCY ONLY Remediation Plan - remediation plan submitted evaluating long term To avoid~uplicate notification pursuant-t~ Health and Safety code Section remediation options. Proposal and implementation schedule for appropriate 25180.7, a designated government employee .should sign and date the form in remediation options also submitted. this block. A signature here does not mean that the leak has been Cleanup Underway - implementation of remediation plan. determined to pos6 a significant threat to human health or safety, only Post Cleanup Monitorins in Pro~ress - periodic ground water or other that notification procedures have been followed if required, monitoring at site, as necessary, to verify and/or evaluate effectiveness of remedial activities. REPORTED BY Case Closed - regional board and local agencyin concurrence that no Enter your name, telephone number, and address. Indicate which party you further work is necessary at the site. represent and provide company or agency name. IMPORTANT: THE INFORMATION PROVIDED ON THIS FORM IS INTENDED FOR GENERAL RESPONSIBLE PARTY STATISTICAL PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REPRESENTING THE Enter name, telephone number, contact person, and address of the party OFFICIAL POSITION OF ANY GOVERNMENTAL AGENCY responsible for the leak. The responsible party would normally be the tank owner. REMEDIAL ACTION Indicate which action have been used to cleanup or remediate the leak. SITE LOCATION Descriptions of options follow: Enter information regarding the tank facility. At a minimum, you must provide the facility name and full address. Cap Site - install horizontal impermeable layer to reduce rainfall infiltration. IMPLEMENTING AGENCIES Containment Barrier - install vertical dike to block horizontal movement of Enter names of the local agency and Regional Water Quality Control Board contaminant. involved. Excavate and Dispose - remove contaminated soil and dispose in approved site. SUBSTANCES INVOLVED Excavate and Treat - remove contaminated soil and treat (includes spreadin~ Enter the name and quantity lost of the hazardous substance involved. Room or land farming). is provided for information on two substances if appropriate. If more than Remove Free Product - remove floating product from water table. two substances leaked, list the two of most concern for cleanup. Pump and Treat Groundwater - generally employed to remc/e dissolved contaminants. DISCOVERY/ABATEMENT Enhanced Biode~radation - use of any available technology to promote Provide information regarding the discovery and abatement of the leak. bacterial decomposition of contaminants. Replace Supply - provide alternative water supply to affected parties. SOURCE/CAUSE Treatment at Hookup - install water treatment devices at each dwelling or Indicate source(s) of leak. Check box(es) indicatin~ cause of leak. other place of use. Vacuum Extract - use pumps or blowers to draw air through soil. CASE TYPE Vent Soil - bore holes in soil to allow volatilization of contaminants. Indicate the case type category for this leak. Check one box only. Case No Action Required - incident is minor, requiring no remedial action. type is based on the most sensitive resource affected. For example, if both soil and ground water have been affected, case type will be "Ground COF~4ENTS - Use this space to elaborate on any aspects of the incident. Water". Indicate "Drinking Water" only if one or more municipal or domestic water wells have actually been affected. A "Ground Water" SIGNATURE - Sign the form in the space provided. designation does not imply that the affected water cannot be, or is not, used for drinking water, but only that water wells have not yet been DISTRIBUTION affected. It is understood that case type may change upon further If the form is completed by the tank owner or his agent, retain the last copy investisation, and forward the remaining copies intact to your local tank permitting a§ency for distribution. CURRENT STATUS 1. Original - Local Tank Permitting A~ency Indicate the category which best describes the current status of the case. 2. State Water Resources Control Board, Division of Loans and Grants, Check one box only. The respons,~ should be relative to the case type. For Underground Storage Tank Program, P.O. Box 944212, Sacramento, CA 94244- example, if case type is "Ground Water", then "Current Status" should refer 2120 to the status of the ground water investigation or cleanup, as opposed to 3. Regional Water Quality Control Board that of soil. Descriptions of options follow: 4. County Board of Supervisors or designee to receive Proposition 65 notifications. No___~Action Taken - No action has been taken by responsible party beyond 5. Owner/responsible party. initial report of leak. Leak Being Confirmed - Leak suspected at site, but has not been ~nfirmed. UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT ~ ~ ~ E:~:~:?:" ~:::~::~:~:~:~:?:~::::~:~:~::~:~:~;?:~:~:~:~:~:~[:~:~:?::~?~ ~:~::~:~:~:~:[~:~[~:~:~[::~:~::~:::[::~:~:~:~::~:::~ ::~::::..::~:~: ~ _ ~ N~ME OF INDI~DOAL FIL3~ ~RT PH~ SIGNORE A~RESS ~DR~SS F~ILI~ NAME (IF APPLIC~L~ I OPE~TOR ] P~NE ~RES~ c~ c~ CROSS ST~ . I/ L~AL AGENCY AGENCY ~ME ~TACT PER~N P~NE P NAME QU~T~ LOST (G~LONS) ~o~ ~ DIe. RED ~W DI~O~D , ~ IN~ORY ~ROL ~ SUBSURF~E MONITORING ~ NUISA~E ~NDIT~NS TANK~sT ~KREMOVAL : O~ER ~ DI~HARGE BE~N U~OD USED TO STOP DI~HARGE (CHECK ~L ~T ~PL~ ~ r~K~ ~N~O~ ~E~ ONEONLY ~E~ ONE ONLY ~ NO ACTION TA~N~IMINA~SI~E~ME'~R~NSUBM~D ~ ~LLUTIONCHA~C~R~T~N ~ L~BEI~NFIRMED '. ~ PRE~ ~ LIMINA~SI~E~ME~UNDERWAY ~ POST~NUP MONITORING IN P~GRESS ' ~ REMEDIATIONPI~ ~ CASE~OSED(C~UPCOMP~DORUNNECESSAR~ ~ ~NUPUNDERWAY CH~ ~PROPRIATE ACTION(S) ~ ~CAVA~ & DISPOSE (ED) ~ REMO~ F~E P~CT(FP) ~ ENH~CED B~ ~GRADATION (1~ ~ C~SITE(CD) ~ EXCAVA~&TREAT(E~ ~ r'UMP&TREATG~UNDWA~R(G~ ~ REP~CE SUPPLY (RS) ~ CONTAiNMeNT aARR~R (Ca) CONSTRUCTION RECEIVED OCT 0 7 1991 1014191 HAZ. MAT. DIV. Bakersfield City Fire Dept. Haza~-dous Mate~-ial Division 2130 G Street Bakersfield~. Ca. 93301 Attention: Joseph A. Dunwoody RE: Tank Removal Chase Specialities 44-0 19th St~eet Bakersfield~ Ca. Find Enclosed the following document for your file. If any additional information is needed~ please contact us. 1) Copy of Haz-Mat Permit ~137924 2) Tank disposal Forum ~10094 3) Manifest ~.91580683 4) Chain of custody.~ soil sampl, e analysis~ plot plan CordiaIly~ Wege~e~- Const ~-uct ion DouG Wegenep 1710 CALLOWAY BAKERSFIELD, CALIFORNIA 93312 (8051589-5570 FAX (805) 589-1161 LIC. NO. 413913 N©_ 10094 TANK DISPOSAL FORM GOLDEN STATE METALS, INC. P. O. Box 70158 · 2000 E. Brundage Lane i Da ,19 Bakersfield, California 93387 t~.,,~(_~'~, t./~.~ {~/ Phone (805) 327-3559 · Fax (805) 327-5749 Contr~tor,sr Scrap Metals, Processing & Recycling License No.. Contractor's Phone No. DESTINA~ON: G.S.M. · 2000 E. BRUNDAGE LANE · BAKERSFIELD, CA 93387 HAULER: ~ J LICENSE NO: ~~ - 25e .14 COUNTY: .................... s50 .24 1000 - 6 ff .61 TANK INSPECTION 2ooo .97 30O0 1.32 5000 2,42 ~ 0XYGEN CONTENT 7soo 3.2e DISPOSAL FEE ~ SCRAP VALUE ~2000 4.93 OTHER TOTAL All fees incurred are per load unless specified. Terms are net 30 days from receipt of tank. Contractor's signature represents acceptance of terms for payment, and confirms CONTRACTOR'S SIGNATURE ~. CERTIFICATE OF TANK DISPOSAL / DESTRUCTION THI~ TO CERTIFY THE REC~T AND ACCEPTA~ OF THE TANK(S) AS SPECIFIED ABOVE. ALL MATERIAL SPECIFIED WiLL BE COMPLETELY AUTMORIZED REP, DATE WHITE-- Oon~ctor Oo~y · YELLOW ~ CitY OF BAKERSFIELD ~' -',;' -/"' ~ .,'] CALIFORNIA .,L ,J .t ~: ~ ~. .p,~.~_Z~___:___q~___:~:~_ o^,~ .... , ~-/~ ...... ,~?~-- ~o~__~__~__~_~~__ ~~ ~--~~- S~ES T~ FORM 640470 ~ Finance Director Rel :.' ~ Analysis Requested I Cerumen: ' Billinglnfo: R~h~ ~(~ c[/7.~/~ Date: Time: Name: ~/"'~;) ~ ~ .~_ ~ei[nquished b~(Signature) Received by: (Sig'nature~ Date: Time: City ~/~. f State ~_~ Relinquished by: (Signature) Received by: (Signature) Date: Time: Altention: Relinquished blt: {Signature) Received by: {Signaturel Date: lime: Time: .. Miles: Flelinquished by: {Signature) R~¢e~edby: {Skjnature) . Date: lime: ~ Disposal P.O.# Relinquished by: (Signature) Received by: (Signature) Date: Time: .~nsal @ 5.00 ea. .. to client ENViRONYENTAL : , ~ '-," LABORATO PETROLEUM J' J~ EOLiN, REG. CHEM. ENGR. .~ '~.: 4100 ATLAS CT., BAKERSFIELD, CALIFORNIA 93308 PHONE (805) 327-4911 FAX (805) 327-1918 , :. ..: ..::? . :. "Pei::roleum *Hydrocarbons . NOR.~VZCO, Tncorporated Date o:f 6501 Schirra Court, Suite 400 Report: 09/26/91 Bakers:field, ~ 93313 Lab ~: 104'76-1 Attn ': .R~TD¥ T,v'HE~T 832-4842 SamPle DeScription CH.Z~ES CENTER 2', S.z~,'ZPT,ED 9-20-91 BY RANDY WHEAT Tndivldual constituents by EPA Hethod 50:30/8020. Sample Matrix: S0il Date Sample Date Sample Date Analysis Collected.~'.' Received ® Lab: ' Completed: 09/20/91 ~ 09/20/91 09/25/91 '.'; ' ' "~ ' ' Minimum ". :' Analys s · ' ,' , Reporting Reporting Constituents ~. Results Units Level Benzene , ~ None Detected mg/kg 0. 005 Toluene None Detected .. mg/kg 0. 005 Ethyl Benzene None Detected mg/kg 0.005 o-Xylene None Detected mg/kg 0. 005 m-Xylene None Detected mg/kg 0. 005 p-Xylene None Detected mg/kg 0. 005 Total Petroleum Hydrocarbons (gas) None Detected mg/kg 1. Comments: C~lifornia D.O.H.S. Cert. ~1186 Dep~rtment Supervisor ENVIRONMENTAL ' : . ', ' ~ ; LABORATORIES, 'INC. pETROLEUM J' J' EGLiN, REG. CHEM. ENGR. · '. 4100 ATLAS CT. BAKERSFIELD~ CALIFORNIA 93308 PHONE (805) 327-4911 FAX (805) 327.1918 "' '" :'/~' ": ''~ petr°'le~un; 'Hydrocarbons ' NORAMCO, incorporated Date of 6501 Schlrra Court, Suite 400 Report: 09/26/91 Bakersfield, CA 93313 Lab ~: 10476-2 Attn.: RANDY WHEAT 832~4842 sample Description: CHASES - CENTER 6', SAMPLED 9-20-91 BY RANDY WHEAT TEST:METHOD: TPH by D.'O:H':S~/"L.U.~.~?'M~nual Method - Modified EP~% 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample .. Date Sample Date Analysis Collected: Received ~ Lab: Completed: · i 09/20/91·~ , :,. . ~ 09/20/91 ,.,, ~,. 09/25/91 . ., .% ' , , .? -, . :' ' ~.'i .; " ...!' ., ' Minimum :' :,' , .... :','" ~ , . Analysis ,'-,',. - Reporting Reporting · Constituents .. Results . ' Units Level Benzene None Detected mg/kg 0. 005 Toluene .: : ' None Detected mg/kg 0 005 Ethyl BenZene None 'Detected mg/kg 0. 005 o-Xylene None Detected mg/kg 0. 005 m-Xylene i' None Detected . mg/kg 0.005 P-Xylene None Detected ' mg/kg 0. 005 Total Petroleum Hydrocarbons (gas) None Detected mg/kg 1. Comments: ... · California,D:O.H.s~ Cert.. ~11.86 . -.:, ".. Department ', Supervisor . ENVIRONMENTAL LABO RATO RI F?,_. INO. PETROLEU¥ J' J~ EGLIN, REG. CHEM. ENGR. 4i00 ATLAS CT., BAKERSFIELD, CALIFORNIA 93308 PHONE (805) 327'-4911 FAX (805) 327'-1918 Petroleum Hydrocarbons NORAMco, Incorporated Date of 6501 Schirra Court, SUite 400 Report: 09/26/91 Bakersfield, CA 93313 Lab ~: 10476-3 Attn.: RANDY WHEAT 832-4842 Sample DesCriptiOn: CHASES - DISP. 2', sAMPLED 9-20-91 BY RANDY WHEAT TEs~ METHOD: TPH by D2~H'.'SJ~y'L.u.F.T.*Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Date Sample Date Analysis Collected: Received ~ Lab: Completed: 09/20/91 '. 09/20/91 09/25/91 Minimum Analysis Reporting Reporting Constituents Results Units Level Benzene None Detected mg/kg 0.5 Toluene 1.0 mg/kg 0.5 Ethyl Benzene None Detected mg/kg 0.5 o-Xylene None Detected mg/kg 0.5 m-Xylene None Detected mg/kg 0.5 p-Xylene None Detected mg/kg 0.5 Total Petroleum Hydrocarbons (gas) 2100. mg/kg 100. Comments: California D.O.H~S. Cert. #1186 De~)artment SUpervisor ENVIRONMENTAL :. :LABORATORIES. INC. P~7'ROL£UM ~ ' J' J' EGCIN, FIEG. CHEM. ENGR. ' ~1~ AT~S CT., BAKERSFIELD, CALIFORNIA 9~ PHONE (~ 32~911 ~ (805) Petroleum Hydrocarbons NORAMCO, Incorporated Date of 6501 Schirra Court, Suite 400 Report: 09/26/91 Bakersfield, CA 93313 Lab ~: 10476-4 Attn.: RANDY WHEAT 832-4842 Sample Description~. CHASES - DISP. 6', SAMPLED.9-20-91 BY RANDy WHEAT TEST-METHOD~ TPH Dy D~O'.H;Si /~L.U.FiTi Manual M~th~d-= Modified EPA 8015 Individual constituents by EPA Method 5030j8020. -' Sample Matrix: Soil Date Sample'. ~ Date Sample Date Analysis Collected: Received ® Lab: Completed: 09/20/91 09/20/91 09/25/91 Minimum Analysis Reporting Reporting Constituents Results Units Level Benzene .... None Detected mg/kg 0.5 Toluene '' None Detected mg/kg 0.5 Ethyl BenZene. None Detected' mg/kg 0.5 o-Xylene 0.6 mg/kg 0.5 m-Xylene . None Detected mg/kg 0.5 p-Xylene None'Detected' mg/kg 0.5 Total Petroleum : Hydrocarbons (gas) 1900. mg/kg 100. Comments:' California D.O.H.S..Cert. ~1186 Department Supervisor ,S.'a~e ~ Ca~omta~.Hea~n and We~am Agency Departme~ See In~tructions on back of page 6. Zox~ Su~an~"~"~oaram Please pdnt or type. Formde~foruaeoneB'e(12-pltchtypewriteO. UNIFORM HAZARDOUS I i. Generato~$ US EPA ID No. --Manif~tDocurmmtNo. 2. Pogel II'~ogmatloninlheIt~x~areal WASTE MANIFEST , , , , 3. Genmatofs Nanle and MaJng Address ,5. Tronspogter I C..o,~5,-~Name 6. LIS EPA ID Number 7. T~ ~:~ter :2 Company Name 8. L~ EPA ID Number I I I I I I I I I I $ 10. U~ EPA ID Number Containe~ 13. Total I I. US DOT De~rl~tlon (lmluding P~ol>er ~l~plng Name, Haza~ Cla~, and ID N~be0 (3. 16. GENERATORS CI~I~iiI-ICATION: I hereby declare that the co~tents of this comignmerd ore fury ~ occulotely clescribed above by proper ~ ~ ogld ore c~ pocked, rna~ed, ond Iobeled, and o~'e in al respects in proper condition fog tto~ by highwoy occon:ling to oppracoble kltefnationot and notlorat goven~q~mt mgulatlom, If I am a large quantity generator. I cerlify that I have o program in place to reduce the volume and tox~-ify of waste generated to the degree I have detemdned to be ecortornicolly I:xocttcoble ~ thor I hove sekt~ the pn:x:flcoble method of treatment, dogoge, or dispol~l currently ovok]ble to me which rn~lmlzes the present anti futta~ tl"~eat to human hec~h and the envirOnnl~f, * ;,OR. If I am a ~ Q~::~ttty gene~:ltog, I hove mode o good folth effort to rnirimiae my woste gene~atl0n and select the be~ ~vo~te mom:~ement method that ts ovoaoble tO me ca-tel that i con offofll Pfinted/l'ypecl N~,m Moglffl ~ Year 20. F~,;-iii?t' Oyster or Op~-u~o~ Cedif,~k~ of receipt of hozGrC~m materiols covered by this manifest except as noted in item 19. Pc';,;ud/lyl:~:l Nam~ DO NOT WRITE BELOW THIS UNE. DHS 8022A (12/90) White: TSDF SENDS 1¥11S COPY TO DHS WITH1N 30 DAYS. ' Bakersfield Fire Depe ~ERMIT No. HAZARDOUS MATERIALS DIVISION UNDERGROUND STORAGE TANK PROGRAM PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE ~-~--~ ADDRESS ~ ZIP CODE APN ' FACILITY NAMF~_~#/~_ g ~_~z-~/~__~-~' CROSS STREET ~/' TANK OWNER/OPERATO~//~~~ . PHONE NO. ~ ~/~ ' MAILING ADDRESS ~ /~ ,~ CIW ~J~ ZIP CODE CONTRACTOR INFORMATION ~ ~ ~- ~~ COMPANY ~~/~ ~ ~ PHONE No. ~ LICENSE No. ADDRESS/~/~ ~~~ /~. CIW ~~ ZIP CODE INSURANCE CARRIER ~~ ~~ WOEKMENS COMP NO. PRELIMANARY ~$SEMENT INFORMATION COMPANY Z[~G~ PHONE No. ~-~~ LICENSE NO.~~ ADDRESS/~/. ~/~ ~ , , ClW ~m~ ZIP C~DE - ' . INSURANCE CARRIER ~¥~lb~ ~/~[~ WOEKMENS COMP NO. ~/~/~ TANK CLEANING INFO~TION COMPANY ~~~ /~ PHONE NO. / / ADDRESS ,~~ CIW' / ~ ZIP CODE / / WASTE TRANSPORT~ IDENTIFICATION NUMBER NAME OF RINSTATE DISPOSALFACILI~ ~/~~/ ~/~ . ADDRESS ~ ~ ~/~ ~ CI~ ~¢~ ZIP CODE FACILI~ INDENTIFICATION NUMBER TANK ~ANSPOETEE INFpEMA~ON COMPANY ~ ~/~>~ PHONE NO. ~-/~/ LICENSE No. ADDRESS ~o ~t o~ CIW ~~ ZIP CODE TANK DESTINATION ~~/~/ ~--~ ~~ / TANK INFORMATION TANK NO. AGE VOLUME CHEMICAL DATES CHEMICAL STORED STORED PREVIOUSLY STORED THE APPLICANT HAS RECEIVED, UNDERSTANDS, A ND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OFMY KNOWLEDGE. IS TRUE AND CORRECT. -"'A'PP~T NAME (PRINT) / APPLrC/i, nT SIgNaTURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED PLOT P L~"~ ~ Plot Plan .must show the following: 1. Roads and alleys 2. Buildings N 3. location of tanks, piping, and dispensers 4. utilities "' ._. - .:, 5. SCALE 6. water wells (if on site) 7. any other relevent information ~0 BAKERSFIELD FIRE DEPARTMENT " HAZARDOUS I~TERTAL DIVTSION ~ ~LJ/ 130 G Street, Bakersfield, CA 93301 ~// (805) 326-3979 ~ CERTIFICATION STATEMENT OF TANK DECONTAMINATION I, .~~~]~/~% an authorized agent of na~ . ~~ ~d~~~] here by 'at test under penalty of 0 contracting co. a~d~re s~~ perjury that the tank(s) located at 7YO /?. and s being removed under pe~it%/~~O~ ~ has been cleaned/decontaminated properly and a LEL (lower explosive iimit) reading of no greater than 5% was measured i~ediately following the cleaning/decontamination process. date name (prin~) .' - -/ign~ur~ · FILE CONTE.~ITS SUMMARY PEmIT ~: /bO/~ ENV. SENSITIVITY:,, , Activity Date # Of Tanks Oomments . BAKERSFI, ELD, CA 93301 Appzicotion Dute APPLICATI ON FO ATE UNDERGROUND HAZARDOUS S IAGE FACILITY Type Of Application (cheCk): [-]New Facility r~Modtftcatton Of Facility r~Existtng Facility []Transfer Of ownership ~ Emergency. 24-Hour Contact (name, area code, phone): Days 3~/--~ ~ ~ ~-~/C;~;/~r__~ Nights ,~TNo/' Facility Name __~}~ -~_?~t'gOf Type Of Business (check): [-]ga~line Station ~Other (describe) ~b/~/~/~; Is Tank(s) Located On An Agricultural Farm? [~Yes ~No Is Tank(s) Used Pr. imarily For.~grtcultural Purposes? [-]Yes ~No Facility Address ~/'/~3 /9~'~, ~VT~ ' Nearest Cross St. T R SEC _ (Rural Locations Only) ' ' - ~uure~-~ 7'7(-'./~/ .~-' ~:r~,-~- _ ui~y/s. ~at e~~~_ ~_34z . Telephone .~-~'i,~,~' cp~L fgT/'-~' / · Operator --~'~Y~ /g~ ~P{/zc Contact Person ~c/ ~.~o,0//9-.4~_~ ' Address .t .. -x Zip ~_~zP ! Telephone B. Water To Facility Provided By Depth to 8roundwater Sci] Characteristics At Facility Basis For Soil Type and Groundwater Depth Determinations C. Contractor CA Contractor's License No. Address Zip Telephone Proposed Starting Date Proposed Completion Date Worker's Compensation Certification No, Insurer D. If This Permit Is For [4odtflcatton Of An Existing F~ctltty, Briefly Descrtb~ Modifications Proposed E. Tank(s) Store (check all th'at apply): Tank # Waste Product Motor Vehicle Unleaded Regular Premium Diesel Waste F,uel 0 0 [] 0 0 0 [] 0 0 [] 0 [] [] 0 0 0 [] [] 0 [] [] [] F. Chemical Composition Of ~tatertals Stored (not necessary for motor vehicle fuels) Tank # Chemical Stored (non-commercial name) CAS # (If known~ Chemical PF_evtously Stored (if different) Date ~~~-~ ~- Z ~-- ~ c~ Previous Owner /~,-~/J4 ~?~4~ Previous Facility Name ~~/9~J~ ~~~ I, ~~ /~9~ accept fully-all obligations of Permit No./~--tssued to ~~ ~~/ I understand that the Permitting Authority may review ~d- modify or terminate the transfer of the Permit to Operate this underground storage facility upon receiving this completed form. This form has been completed under penalty of perjury and to the best of my knowledge is true and correct. __ :~--~- T~]~ . ' /".. ~ ~ ',~ ~ //'" /t d.'~- March 2~ 1990 ?~ Nina Mayer~ Accounts Receivable FROM~ Ralph E. Huey~ Hazsrdous Materials Coordinator SUBJECT~ Lowder Electric Inc. Nina~ Aocount # 438101 is now operating its business in the county~ however they were in operation in the City from July until September. They will need to have a prorated bill sent to them at 5551 Midsummer #B~ Bakersfield~ Ca. 93308 and close the account for this handler. Thank You Valerie * 1700 Flower Street ~:RN COUNTY HEALTH DEPARTME HEALTH OFRCER Bakersfield, California 93305 Leon M Heberlson,·. M.D. Telephone (805) 861-3836' ENVIRONMENTAL HEALTH DIVISION · '' ~ DIRECTOR OF ENVIRONMENTAL HEALTH .... - NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY.THE 'PERMITTING ~" /' ~"':AUTHORITY'NUST BE MET DURING THE TERM OF.~THIS~:~~ :. ~: . ..... -....;~ .. ,' ~::~ -- " .DA~ P~IT ~CK LIsT ~: .' .... ...... ..... ; . ..... .. . Permit Ouestionnaire Normally, permits are sent to facility Owners but since many Owners live outside Kern County, they may choose to have the permits sent to the Operators of the facility where they are to be posted. Please fill in Permit # and check one of the following before returning this form with payment: rot PERMIT # ~/~1. Send all Information to Owner at the address listed· on invoice (if Owner is different than Operator, it will be Owner's responsibility to provide Operator with pertinent information). 2. Send all information to Owner at the followtnz corrected address: 3. Send all information to Operator: Name: Address: (Operator can aake copy of permit for Owner). · , PERMIT CHECKLIST This checklist is provided to ensure that all necessary packet enclosures were received and that the Permittee has obtained all necessary equipment to implement the first phase of monitoring requirements. Please complete this form and return to KCHD in the self-addressed envelope provided within 30 days of receipt. Check: Yes Ho A.~The packet I received contained: L~~' .1) Cover Letter, Permit Checklist, Interim Permit, Phase I Interim Permit Monitoring Requirements, Information Sheet (Agreement Between Owner and · Operator), Chapter 15 (KCOC t6-3941), Explanation of Substance Codes, Equipment Lists and Return Envelope. ~ . 2) Standard Inventory Control Monitoring Handbook tUT-10. f__ 3) The Follo~tn~ Forms: a) Inventory Recording Sheet b) Inventory Reconciliation Sheet ~tth summary on reverse * c) Trend Analysts Worksheet ~ 4) ~ Action Cb,art (to post at facility). B. I have ex~lned the information on my Interim Permit, .Phase I Monitoring Requirements, and Information Sheet (Agreement between O~ner and Operator), and flnd o~ner's name and address, facility n~e and address, operator's n~e and address, substance codes, and number of tanks to be accurately listed (if "no' Is checked, note appropriate corrections on the back slde of this sheet). C. I have the following required equipment (as described on page 6 of Handbook): 1) Acceptable gauging instrument 2) "Striker plate(s)" tn tank(s) 3) Water-finding paste D. I have read the information on the enclosed "Information Sheet" pertaining to Agreements between O~ner and Operator and hereby state that the o~ner of this facility ts the operator (if "no" ts checked, attach a copy of agreement between owner and operator). ~ E. I have enclosed a copy of Calibration Charts for all tanks at this faciltt~ (if tanks are identical, one chart ~tll suffice; label chart(s) ~lth corresponding tank numbers listed on permit). ~ F. As required on page 6 of Handbook tUT-15, all meters at this facility have had calibration checks ~tthtn the last 80 days and ~ere calibrated by a registered device repairman ~f out Of tolerance (all meter calibrations must be recorded on "Meter Calibration Check Form" found tn the Appendix of Handbook). G. Standard Inventory Control Monitoring ~as started at this faclllty in accordance with procedures described tn Handbook tUT-lO. Dat S arted SXgnature o~ Person CompZetXn~ Check~st~ Title: ~ ~/~ ~ 17~ Flower Street KERN COUNTY HEALTH DEPARTMENe HEALTH OFFICER L~n M Hebedson, M.D. *Bakersfield, Camornla 93305 ENVIRONMEN~L HEALTH DIVISION ~lephone (~5) ~1-3636 ' ' DIRECTOR OF EN~RONMENTAL HEALTH ~rnon · Retcha~ Date: Re: Permit Checklist Dear Tank Owner or Operator: This department has received the informatipn you were , ~requested to return from your Standard Inventory Control Per'it Packet. 'The following required items were not, included: [-~Lacklng notation of having required equipment (see below) O Oaugtng Instrument O Striker Plate O Water-finding Paste If any of the above are checked an equipment supplier list will be enclosed with this letter Comments: .[~Agreement between owner and operator (see attached checked) Comments: ~Lackin~ Tank Calibration Chart(s) ~ac~in~ ~eter Calibration Co~en~s: Please submit the necessar~ ~or~atton checked above ~thin 1~ da~. ~nother per.it checklist has been included ~or ~our ~ convenience. ~ ~ou have an~ questions or are havin~ a proble~ necessar~ equip~ent or services please call ~e at (80~) 861- 86~6. Sincerely, " Bill Sche~de Hazardous ~atertals ~ana~e~ent Pro~ra~ H~P - ~00 DIS~I~ OFFICES - Delano . ~amont . ~akelsa~eila · ~ojave . ~dgecTest · Shafter Taft KERN COUNTY HEALT{ I N~I~NTORY RECOR] EQUAT I ON 1 1 2 3 4 5 6 I ? OPENING OPENING CLOSING CLOSING METER DAILY METER DATE 6AUG I NO I NVENTORY I NVENTORY READ I NO - READ I NG = ME'II SA{ DAY/HOUR INCHES GALLONS GALLONS GALLONS GALLONS GAL{ /-~- · ' /~ ~74,~ ~7,~,~ ~,~ ~ - /-~z- /~. ~s. I ~ ~. I .... [1~.~, ~/~ I -..e I H~R~BY C~RTIFY TNAT THIS IS A TRU~ AND ACCU~TE R~PORT. SIGNATURE ~v; Health 580 4113 1018 (6/861 PER~IT CHECKLIST This checklist is provided to.ensure that all necessary packet enclosures were received and that the Permittee has obtained all necessary.equipment to implement the first phase of monitoring requirements. Please complete this form and return '- '""./~ · ..-~.~ ~,~ -:.idressed envelope providec within 30 days of receipt. Check: 'Yes No A. The packet I received containea: ~/ 1)-Cover Letter, ~Permlt Checklist,,-I~terim Permit, Phase I Interim Perml Nonitoring Requirements, ~lmformation Sheet (Agreement Between -O~ner an( Operator), ~Chapter 15 (KCOC $6-3941), ~planation of Substance' Codes ~uipment Lists and ~rn Envelope. . / 2) Standard Inventory Control Nonitoring Handbook $~T-10. . /__ 3) The Following Forms: a) Inventory Recording Sheet~" b) Inventory Reconciliation Sheet with summary on reverse~-' c) Trend Analysis Worksheet /__ 4) An Action Chart (to post at facility)~ B..I have examined the lnfornation on ny Interim Permit, Phase I Nonttorin Requirements, and Information Sheet {Agreement between 0~ner and Operator), a~ find Owner's na~e and address, facility na~e and address, operator's na~e a~ address, substance codes, and number of tanks to be accurately listed (if 'nc is checked, note appropriate corrections on the back side of this sheet). ./ .... C. I have the following required equipment (as described on page 6 of Handbook): 1) Acceptable gauging instrument 2) "Striker plate(s)" in tank(s) 3) Water-finding paste D. I have read the information on the enclosed "Information Sheet" pertaining t Agreements between Owner and Operator and hereby state that the o~ner of th! facility is the operator (if "no" is checked, attach a copy of agreement betwe~ owner and opera, or). ,/' E. I have enclosed a copy of Calibration Charts for ail tanks at this facility (i tanks are identical, one chart will suffice; label chart(s) With correspondlr tank numbers listed on permit). [~/ F. As required on page 6 of Handbook #UT-10, all meters at this facility have h~ calibration checks within the last 30 days and were calibrated by a register~ device repairman ~f out of tolerance (all meter calibrations must be recorded 'Neter Calibration Check Form" found in the Appendix of Handbook). J fl. Standard Inventory Control Monitoring.~a~started at this facility in accordan with procedures described in Handbook #UT-10. Date Started /--Z~7 Siffnature of Person Completin~ Title: Note: I. All meters must have calibration checks a minimum 9_[ ~wice a e.~, which may include checks done by the Department of Weights and Measures. 2. Before starting calibration runs, wet the, calibration can with product and return product to storage. 3. Run 5 gallons with nozzle wide open into the can. Hote gallons and cubic inches drawn, and return product to storage. 4. Run 5 gallons with the nozzle one-half open into t~ can. Note gallons and cubic inches drawn, and return product to storage. 5. After all product for one calibration check is returned to storage, remember to record the volume returned to storage in column 9 of the Inventory Recording Sheet. · 6. If the volume measured in a 5-gallon calibration can is more than 6.~ cubic - inches abOve or below the 5-gallon mark, the meter requires calibration by a registered device repairman. orlTank */ Fast Flow Slow Flow Volume Returned Calibration[ Device Repairma------~--- Date of Date/Time Hose Required? [ Used for alibration } 5-0a11 Draft t° St°ra~e yes ~ { Calibration Pump f Product i-Gallon Draft on ,. ' .Is Cu. Inches {a~{Cu. inches Oallons ' ~ Owner or OperatOr Signature '/--'~ ': Calibrator's Signature ~k~~. Registration ' ~_~ SUBMIT A COPY OF THIS FOR~4 WITil ANNUAL REPORT. ,. }' AUTOMOTIVE - INDUSTRIJ~L ( ~}. u · u. ·. EQUIPMENT " .......... SERVICE INVOICE INSTALLATION - MAINTENANCE .~.~.~,,~ SA ~S A~L s 704 BAKERSFIELD, CAEIFORNIA 93307 sHou~ "" (805) 834-1100 CACIF. CONTRACTORS LIC. NO. ~4074 ,~ INVOICE NO. DATE REQUESTED BY PHONE NO. CUSTOMER ORDER NO. TO I ' ~ ¢~_~?*f'~ ~ t'm tr-~,f'c3.~'~ ~.C~;~'{"~'~o'""~''~ '; .... '""~' ..~ ,_ _~P,:,,,z':: ,-' .. .. ... . .... -.- , . ...- ~,.....;,~......,.,..,,..:.~.,.: .:~: -.?;, ~:,.:.. - ' '* : . SERVICE ' * ·" ,- · - MILEAGE . .. -. .~:, Ren~Is OTY, PART NO. DE5~R IPTION ! ~x X Supplies ~ ~mpleted :,..-'...t ,' ~ ..~?~ Technician(~); ~LL,"~. ''~J './- ....... I *r"' ~ ~ TOTAL ~iv~ & Ac~pted By __~',;' ..., r~ ~, ?" · ..... ..' ,, EASE PAY FROM THIS INVOICE. ~.MS: Net due u~n Receipt PLEASE RLW EQUIPMENT Finan~ Charge of 2%~r Month REMIT~u~ P.o. BOX 6AO after 30days, O COM~UTER CHANGE I~ALI~RATiON Record of Compute range, Meter Change, or Calibration D .E.E. CHANGE E] W,~ "O',F,EO /~OO ~ ~C I ~MP~AK~ AND MODE~ ~ ~ ~ ISE~IAL'NUMBER READINGS ' .~NEY I U -- ~ /~ ~ IGACL'~S ~ ~ -- TOTALIZER SEALED METER SEALED . CHECKED ~JUSTE~ TO TOTALIZER FINISH .... READINGS " MUaEY GALLUNS ~OTAL IZEH S~LED MEYER ~EALEO ' ' CHECKED ADJU5 rED 1'O TOTALIZER FINISH . READINGS /MONEY ~A~ ~ O.~ ~OrA[,ZE~ S~A~EO u~E. SEA,.EO / . J- CALI~RATION AOJUS1 ~O TO ~ (J 1 AL IZER FINISH MONEy ~(~Ar L<~N~ I~A= r --~Uw ' ~ ULOW CHECKED I' ADJusTED TO TOTALIZER FINISH ~ I''S* ~Ow CALI~RATION CHECKED ADJUSTED TO - ~MONLY IGALL UNS F ASr I SLOW FAST t ~t OW Division' ot Environmental Heal App!Jcatiop Date-- 1700 Flower Street, Bakersf CA 93305 'APPLICATION FOR P~RMIT TO OPERATE UNDERGROUND " HAZARDOUS SUBSTANCES STORAGE FACILITY Type of Applicati-on (check): DNe-~' FaCility DModification of Facility ~Existing Facility [']Transfer of Ownership A. Emergency 24-Hour Contact (name, area code, phone): Days ~'~"~ ~D~U~_ Facility Name fO~)f-~ ~.IJ~CT'~C IAz~. Nol of Tanks Type of Business (check): ['iGaS°line Station ~]Other. (describe) Is Tank(s) Located on an Agricultural Farm? [~Yes ~_No Is Tank(s) Used Primarily fg, r A~ricultural Purposes? [-]Yes ~No ~,,.,/. ..- Facility Address ~ ~ ~T~, Nearest Cross St. ~ ' T R SEC (Rural Locations Only) Owner . - ' ~ (:~{9 ~ Contact Person ~ Address ~ Zip ~(~ Telephone ~9i'-{~4'.05A'] · ODerator ~,4;4~ ~ . . Contact Person Address ~ ~ ~. Zip Teleimhone B. Water to Facility Provided by ~ Depth to' Groundwater Soil Characteristics' at Facility ~[l~ . Basis for Soil Type ar~] Groundwater Depth Determinations . C. Contractor CA Contractor' s License No. Addr ess Zip Telephone Proposed Startin~ Date Proposed C~mPletion Date Worker's C~pensation Certificati°n ! Insurer D. If This Permit Is'For Modification Of An Existing Facility, Briefly Describe Modificati(~s Proposed E. Tank(s) Store (check all that apply): Tank J Waste Product Motor Vehicle Unleaded Regular Premium Diesel Waste ~uel F. Chemical Ccmposi,;ion of Materials Stored (not necessary for motor vehicle fuels) Tank ! Chemical Stored (non-commercial name) CAS ! (if known) Chemical previously Stored (if different) G. Transfer of Ownership) Date of ~-~nsfer Previous Owner Previous Facility Name I, accept fully all ~bli-gations of Permit No. issued to · I understand that the Permitting Authority may review and modify or terminate the transfer of the Permit to Operate this ~dergr. o~d storage facility upon receiving this completed form, This form has been c~npleted Under penalty of perjury and to the best of my knowledge is true and correct. Signatu .re~~~~~ Title T~K ~ ~' ' (FILL OUT HEPA~TE FO~ ~ T~K) ~. 1. Tank is: ~Vaulted" ~Vault~ ~uble-Wall ~Si~le~all 2. ~ ~terial ' Car~n Steel ~S~inless Steel ~l~inyl C~oride ~Fi~rglass~l~ Steel · Fi~rglass-Reinforc~ Plastic ~Concrete ~in~ ~Bronze Other (de~ri~) 3. Priory .Contai~nt ~te Install~ ~ic~ess (Inches) Ca.city (Gallons) ~nufacturer 4. Tank Secondar~ Contai~ent ~l~Wall ~ ~thetic Liner ~Lin~ Vault ~ne~~o~ ~Other (de~ri~): ~nufacturer: ~ ~ ter ial Thic~ess (Inc~s) Ca. city .(Gals. 5. Tank Interior Lini~ ~~r ~k~ ~xy ~enolic ~Glass ~Clay ~lin~ ~Other (de~ri~): 6. Tank Corrosion Protection Cath~fc Protection. ~ne ~pres~ ~rrent S~t~ ~criflcl~l 7. Leak ~tectfon, ~,ftori~, .a~ Int~'rceptfo~ a. Th~: ~Vl~l (vault~ t~ks only) ~Gro~ter ~nitori~ ~Vadose Zone ~nitori~ ~ll(s) ~U~ Wi~ut ~ner ~ Pressure Sen~r In ~ular S~ce of ~ub~e Wall Tank- - ~fly ~f~ & I~entory Reconciliation ~Peri~ic Tigh~e~ ~None ~o~ ~ner . b. Pipit: ~l~Restricti~ ~ak ~tector(s) for Pressuriz~ Pipi~ ~nftori~ S~p ~th ~ce~y ~al~ ~crete ~ce~y U~no~ ~ ~her Tighmess ~st~? es ~ ~kno~ 9. Tank ~ . '~te (s) of ' ~ri~ Re. irs 10. ~erfill Protection ator Fills, Controls, & Visually Monitors ~vel Fl~t Ga~e ~Fl~t Vent Valves ~ Auto Shut- Off Controls citance ~r ~al~ Fill ~x ~ne Other: List ~ & ~el For ~e ~ices 11. Pipi~- a. ~dergro~d Pipit: ~Yes ~ ~o~ ~terial Thickne~ (inch.) Di~eter Manufacturer ~Pressure ~S~tion ~Gravity ~proxi~te ~ of Pi~ b. Undergro~ Pipi~ Corrosion Prot~ti~ : ~lvanized ~Fi~rglass~l~ ~ess~ ~rrent ~crificial ~e ~Electrical Isolati~ ~Vinyl Wrap ~Tar or ~lt olye~yle~ Wrap nkno~ ~None ~her (de~ri~): c. Undergrou~ Pipit, Seco~ary Contai~ent: ~l~Wall ~S~thetic Liner ~st~ ~ne~kno~ ~Other (de~ri~): BAKERSFIELD FIRE DEPARTMENT BUREAU OF FIRE PREVENTION I:~te APPLICATION ^pplicatlon No. In co~fo~i~ with provisions of ~ine~ ordinance, c~es and/or regulations, application is made Name of ~a~ Add~ ~ ~ to display, ~om, i~afl, u~, o~mte, seti or haste ~terials or pr~e~ involving or creating con- ~flons deemed hazardous to Hfe or pm~ as foii~s: · Permit denied Date · . .~ ·· ~ * -~' ' ~""C"~ ~y~^~'.ou~v ~o.M.: ' ~ ·'- , and ~ d~'~ foll~ws: as fe~Zmvs: ,. ~eOtnning'a% a :' ' ~: ' ''""' .' .t ....... point on the ~e~h line'o . .= . a~ong_said North' line' ~' ~-~- ~_:~ ; .... o~9~h Street,_ ........... , u~ng co ~he Hap the~f ~'~ ~O~nt ;'~of. h~g{n~in~ be ~ .... . 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