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Home My WebLink AboutUNDERGROUND TANK-C-4/19/89ASSOCIATED AUTOMATIC FIRE PROTECTION COMPANY ALL DIMENSIONS ARE APPROXIMATE. GAS STORAGE TANKS ARE APPROXIMATELY LOCATED WITHIN 5' OF GAS PUMP. ... .' FILE CONTENTS SUMMARY Activity Date · Of Tanks Cements ":' .. COUNTY OF KERN' .. Environmental Health Services Department 2700 "M" Slreel; 'Sui~ .300 Bakersfield, CA 9330! (805) 861-3636 (805) 861-3429 Fax Number ' "'~ 310 30th Street Bakersfield, CA 93301' Re: Remov. al of two lOOC~;gallon underground gasoline storage tanks located at R.L. Hardcastle-Company, 'Inc., 310 30th Street in Bakersfield, California. Dear Hr. Hardcastle: This is to advise you that this Department has reviewed the project results for' the 'preliminary assessment associated with the removal of two 1000 gallon underground gasoline storage tanks located at R.r.. Hardcastle Company, Inc., 310 30t.h Street in Bakersfield, California' Based upon the findings described in the, report, this Department is satisfied .that the assessment is complete and no significant soil contamination resulting from fuel tank leakage was detected' at the site. Thank you for your:cooperation in this matter - Sincerely, Environm~Ittal Healtl~--Sp~cialist I '-- Hazardous Materials Management Program AEG: cd ~' (green\hardcast. !e) LABORATORIES, Inc. PET,~OI£HM __ J' J' EGLIN, REG. CHEM. ENGR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 Petroleum Hy~lrocarbons (SOIL) · 7808 Olcott Ave. Report: O1-Nov-88 Bakersfield, CA 93308 " Attention:Bryan McNabb " ~ .. l.~b' No.: 7591-1 · ::~ ! ~ S~ple Desc : 310 30th St, meg Bakersfield - - · ., ' ' · i DATE SAMPLE ·DATE' SAMPLE DATE SAMPLE DATE ANALYSIS , .... 12-Oet-88 12-O0t-88 25-O0t-88 :~ ................. :~:' Reporting Analysis Reportin~ '. "' Constituent Units Results Level Benzene u~/g None Detected O. 10 Toluene ug/g None Detected 0.10 Ethyl Benzene ug/g None Detected O. 10 p-Xylene ug/g None Detected O. l0 m-Xylene ug/g None Detected O. 10 o-Xylene ug/g None Detected .0.10 : IsoPropyl benzene ug/g None Detected O. 10 "' Petroleum Hydr~carhons ug/g None Detected tO. O0 Total Pet. Hydrocarbons ug/g None Detected O. lO TEST METHOD: California State D.O.H.S.T.P:H. for Diesel (Carbon Disulfide Extraction) Dry Matter Basis Con~nents: PETROLEUM HYDROCARBONS: O~antification ~f g~.trole,mn hydrocarbons I utilizing a diesel standard. As outlined by the California D.O.H.S. I.... These petroleum hydrocarbons are in addition to the constituents ii:.. specifically defined on 'this report. I' TOTAL PETROLE[~ HYD9OCARBONS: The s~m~ t~)tal of all constituents I'' on tkis re~rt. Chemis~ ENVIRONMENTAL HEAL- RATORIES. InC. :~' J.J. EGLIN, REG. CHEM. ENGR. PETROL[II,¥ 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 Petr~oleum Hydrocarbons (SOIL) McNabb ~ns%~ction. ~ of ?808 Ol~t% Ave. ' Re~: 31-~%-88 ~: ~ersfield, OA 93308 , At~ntion :B~ McNabb · ,,~:~:t~le~.: 7691'2 ._ .-' ~ "'" . ' "; i':_ ~L '~ ~" '[~" No~h---~. 6~:-~ot-~e.--~--. :2m: ', . 'n:?? ' '....; .... ~.' ~2-~%-88 ' ' '12-~%-88 "?':~'"'. 25-~%-88 ,.: Re~i~ ~alysis Re~~ ~ti~ent ~i~ Resul~ ~vel ~nzene ~g None ~~ Toluene. ~/g ~ne ~~ 0.10 Et~l ~nzene ~/g None ~~ 0.10 ~Xylene ~/g None ~~ O. 10 ~lene ~/g None ~~ O. 10 o-~lene ~/g None ~~ 0.10 Isop~l ~nzene ~/g None ~~ 0.10 Pet~le~ ~~ ~/g None To~l Pet, ~~~ ~/g ~ None ~~ 0.10 TEST ~OD: ~lifo~ia S~ D.O~H.S. T,P.H. for Diesel (~n Dis~fide ~traction) ~ Mater ~sis - - ~n~: P~OL~ ~R~Ns: ~tifi~tion of ~t~le~ utiliz~ a diesel s~d~.As outlin~ ~ the ~lifo~ia D.O.H.S, ~ese ~t~le~ ~~ns ~ in addition ~ the ~nsti~en~ s~ifi~lly def~ on t~s ~, T~ P~ROL~ ~A~NS: ~e s~ ~1 of all ~nsti~en~ on t~s ~. ~1 i~' Ro~m Plais~c~ ~e:~st LABORATORIES, InC. PET~OL£UI~ 4100 PIERCERD., BAKERSFIELD, CALIFORNIA 93308 PHONE Petrolet~n Hydrocarbons McNabb Construction Date of ' 7808 Olcott Ave. 'Report: 31-0ct-88 . ~.Ba~ersfield, CA 93308 Attention: Bryan McNabb ' Sample Desc.: 310 30th Street Bakersfield " i.. ;.. -.,, -..,,. 'DATE SAMPLE ~'' 'DATE SAMPLE DATE SAMPLE DATE ANALYSIS COLLECTED: ' RECEIVED @ LAB: EXTRACI1ED: COMPLY: 12-0ct-88 12-0ct-88 25-0ct-88 26-0ct-88 Minim~ · : Reportin~ Analysis Reportin~ Constituent ' Units ~ Results Level · Benzene ug/g None Detected O. 10 Toluene u~/g None Detect~d~ O. Eth~l Benzene u~/~ None Detected O. p-Xylene u~/~ None' Detected O. 10 ' m-X~lene u~/g None Detected . O. 10 o-Xwlene u~/g None Detected O. Isopropyl benzene ug/g None Detected O. 10 Petroleum Hydrocarbons u~/~ None Detected 10. O0 Total Pet. Hydrocarbons u~/g None Detected O. 10 TEST METHOD: Cali£orni~ State D.O.H.S. T.P.H. ~or Diesel (Carbon Disul£ide Extraction) - I)rF Matter Basis - PETROLEUM HYDROCARBONS: Q~antification of petroleum hydrocarbons utilizing a diesel standard. As outlined by the California D.O.H.S. These petroleum hydrocarbons are in addition to the constituents specifically defined on this report. TOTAL PETROLEUM HYDROCARBONS: The s~n total of all constituents ~z~. ,~. F_~in ~ ~¢,t~rt Plaisance (.,h..m:t s t. AG~II~,IJL TU~&c ~T~L[U~ J' j' EGLIN, R~. CHEM. ENGR. 4100 PIERCE RD., BAKERSFIELD, CALIFORNIA 93308 PHONE 327-4911 Pet~le~ ~ar~ns (~IL) 7808 Ol~tt Ave. Re~: 31-~t-88 ~ersfield, CA 93308 At~ntion: B~ McNabb ~ti~ent Uni~ Res~ ~vel . Et~l ~ene ~/g None ~~ O. 10 p-~lene ~/g None ~~ O. 10 o-~lene ~/g None ~~ O. 10 Isop~l ~nzene ~/g ~ne ~~ 0.10 Pet~le~ ~~~ ~/g 18. O0 10. O0 To~l Pet. ~~~ns ~/g 18. O0 O. 10 ~ST ~OD: ~lifo~ia S~ D.O.H.S; T.P.H. for Diesel (¢~n Disulfide ~traction) ~ROLE~ ~R~NS: ~tification of ~tmle~ utilizi~ a diesel s~d~. As outlin~ ~ the ~lifomia D.O.H.S. ~ese ~tmle~ ~~ns ~ in addition ~ 'the consti~en~ s~ifically defin~ on t~s ~. T~AL P~L~ ~R~A~NS: ~e s~ ~1 of all consti~en~ ~e~st Date Rec.'d:' . . ,fi ..... ~ "BC CHAIN OF CUSTODY NO. L- 0 ] Client:" ' Name: ' Name: ' Soil (specify) Attn:Ad~css'~< .......... ~ '. 'Re~nqu : . ed By: ate T~e: ..,. ..... Ye~ow: BC ~b Copy .'~'~ ..... : '¢;... ...... ,: '..}-. h.:~,, . - . .~ ,, : ,' . ~;OOr~w~ Sir.* ' KERN COUNTY HEALTH DEPARTMENT HEAL~140FFlCER B&keraf~kl, California g330S · ' Leon M Hebeftao~, M.D. Telel~one (805} 861-3636 ... '' ENVIRONMENTAl. HEALTH DIVISION Facility Name · . ~~ Kern County Permit -.- * * UNDERGROUND TANK ~)isPo~ITION TRACKING RECORD * * This fora ts to be returned to the Kern County Health Department ~lthin 14 .............. -~days-of- ~acceptance ,.-d£.ff-~nk(s)--/~i~.-~{J~gposal or-recycling --~acllity holder of the permi't ~ith ~uaber noted above is responsible for insuring · that this form is ¢oapi. eted a~d returned. - b~ tank removal contractor: Secttoa 2. - T_~o b_~e fllle______d out by contracto__r "decontaminatlm~ tank(s}:, . Authorized representa~/ve o~ con~ractor cer[lgles by signing belo~ tha~ ~--- ta~ia} have been deco.t~Jnated tn accordaace ~Jth Aer. Co~ty - Bepa~t~ent requt~e.ents.. SectJoa 3 -T~ b~ ~t[[ed eu~ and stEned ~ a~ authorized representative treatment, stor~Ee, or disposal ~acJ]Jt~ acceptJn~ tank(s): '~ Date Tanks~ No. of Ta~s ...... (Authorized Representative) · * * ~ILING INSTRUCTIONS: Fold In half and .staple. postage and mailing label have already been affixed to outside for your convenience. (Form ~II~P-150) i '.-~-~--.;Stal® of C.,; li~ li~l I~ and We~ ~ ~eaae, im ~ ~. [Po~ aes~n~ r~ use on ~i UNIFORM ....B~,,~ ..I .'~:%"WASTE MANIFEST' · 7. Tmn~ 2 ~pany Name .... ~ .... ~ I ! [,'"I' 1' I ! [ [ I I I ~'~"~'~?"~'~77~- 9. ~at~ F.c,~ Neme ~-~e ~-~ '::~' ~ ~.'~'~.'~ ?~'~Z - :- -:; :. :,'-- ~ ..':k .-' :z:'~ ~5:'--::: ~ ~:... :?~ ~ ~ "" ~IV~ "'<~'., ''' '~" N ' ~ -,~c:~:~.'::? :...~...~,~.'.~.::,,.;-'~,~::~;',;~;~ .... ~.:'.,... .. _ ' ~'~ ~"~ -'~' ~ .... .- .. -...-~..-. · :.:~:::'~.;~.~'~. · '~-:.:.'......; ..... . ..'._ --. '-~-:':.:'-c:.:-~:?~:~-? ........ . .... . -. ~,~-' .~-~....~.:: ;..:_' .... : ... ~NERATOR'S CER~ON: I h~eby d~lare that the C~t~a ~ mia ~gnment are ful~ ~nd a~at~ de~ a~ve by pr~p~ shipping ~' " :'~ ~ are clasaifi~, pack~, ma~ed,, and label~, and are ~ all teapots in p~op~ ~nditi~ f~ ~a~ ~ hi~y acco~ng to appli~ble · ~.-, ~t~l and national govemm~t r~ulation~ . ~ I am a large quantity g~erator, I ce~i~ that I have a program in place to r~uce the volume and tox~ ~ ~e g~at~ to the d~ree I have dete~i~ to be economically practicable and that I ~ve sel~t~ the predicable method of treat~, ~ge, ~ d~osal ~ently available to .. · me ~i~ minimizes the present and future threat to human health and the ~vironm~t; OR, if I am a ~a~ ~m~ g~tor, I' ~ve ma~e a good ~ith e~ to minimize my waste gen~ation and sel~t the best waste management method that is available to me a~ t~t I ~n afford.. :':: ..... ~/T~ -:.L..~..~:~5.... . ~'~.,,:...~., .'~ ...... :,:...= I 17. Tr~s~ 1 Acknowl~gement of R~eipt of Material= /' -" · -. ~/' ·. - .. · .. · . ....... .... , .. N ~ 18. ~ansp~ 2 Acknowledgement of Receipt of ~at~al~ ~ : P~at~/~ Name ' E :" · 1~, Discrep~ Indication ~pace I' 20. Facil~ ~er or Ope~tor Ce~ication of receipt ol hazar~us materials covered by this manliest except as not,.In Ite~..19. - ' ' P~nted/Typ~ Name OHS ~22A(1/SD GREEN; HAU~R R~AIN~'''<':' INS~UC~ONS ON THE BACK EPA 87~22 - (Rev. ~86) Pr~ioue ~iona are obaolete. IN CASE OF AN EMERGENCY OR SPILL, CALL THE NATIONAL RESPONSE CENTER 1-800-424-8802~ WITHIN CALIFOR~A CALl. ;-800-852-7550 ,,~ COUNTY HEALTH DEPARTMEN HEAL, OFFICER 27~ M Street Bakersfield, California EN~RONMEN~L HEAL~ DI~SION Leon M Hebertson, M.D. Mailing Address: . -" "' DIRECTOR OF EN~RONMEN~L HEAL~ 1415 ~uxtun Avenue' ~rnon S. Re,hard Bakersfield, California 93301 (~5) 861-3636 PERMIT FOR PERMANENT CLOSURE PERMIT NUMBER A783-06 OF UN~ERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY FACILITY NAME/ADDRESS: OWNER(S) NAME/ADDRESS: CONTRACTOR: R.L. Hardcastle Co., Inc. R.L. Hardcastle ~cNabb Construction 310 30th Street 310 30th Street ?808 Olcott Avenue Bakersfield, CA Bakersfield, CA Bakersfield, CA 93308 License # 474331 Phone: 805-322-9344 Phone: 805-399-4?42 PERMIT FOR cLOSURE OF PERMIT EXPIRES December 21, 1988 2 TANK(S) AT ABOVE APPROVAL DATE _ September ~k, 1988 LOCATION APPROVED BY . _ ', POST ON PREMISES ' CONDITIONS AS FOLLOW: 1. It is the responsibility of the Permittee to obtain permits which ma% be required by other regulatory agencies prior to beginning work. 2. Permittee must obtain a City Fire Department permit prior to initiating - closure action. - 3. Tank closure activities must be per Kern County Health and. Fire Department approved methods as described in Handbook UT-30. 4. A minimum of two samples must be retrieved beneath the center of each tank at depths of approximately two feet and six feet. 5. All samples must be analyZed for benzene~ toluene, xylehe, and total petroleum hydrocarbons. DISTRICT OFFICES Delano · Lamont · Lake Isabella · Mojave · Ridgecrest · Shafter · Taft PERMIT FOR PERMANENT CLOSURE PERMIT NUMBER A783-0~ ._CE_UNDERGROUND HAZARDOUS ........... ADDENDUM ....... ~ .... _ SUBSTA~Es-~T6~G~-F-ACiLiTY 6. If' any contractors other than those listed on permit and permi~ application are to be utilized, prior approval must be granted by the '~pecialist listed on the permit. 'l=___C_opi_es o,f transpg~ation manifes~s__~ust be submitted .... to the H?alt? Department within five days of waste disposal. 8. All applicable, state laws for hazardous waste disposal, transportation, or treatment must be adhered to. The Kern County Health Department must be notified before moving and/or disposing of any contaminatec soil. 9. Permittee is responsible for making sure that "tank dispositior tracking record" issued with this permit is properly filled out ant returned within 14 days of tank removal. 10. AdVise this office of the time and date of the proposed sampling wit~ 24 hours advance notice. Results must be submitted to this office within three days of analysi~ completion. ACCEPTED BY: -DATE AEG:cas 0921-08 ,d~i~PL I CATT ON FOR PIERI~I T FO.R PERM. AIqlEIq'Z~ CLOSURIE/~od~A.L%TDONIVIIENT O]EP V..TI%TE)BRGROUND HAZ,~i~DOUS SUBST,d~lqCE$ STOI~ekGIE FACT LT ~ THIS APPLICATION IS POR ~RE~OVAL. OR . E~ .ABANDONMENT IN PLACE (FILL OUT ON_..~ APPLICATION PER PAClLITY) ............... DAYS-' ~ ' ' ' ~ -"-- ' .... : ...... ~- ~ ,': , :ii' .. ~RKER' S C~P~TXON $ IN~ PH~ ~EST ~A~R ~E~ - Ol~ DI~Cg ~ D~CRIBE ~g I~ ~ITHIN ~ B~ I$OIL ~E AT ~ILI~ ~[S ~R ~L ~E ~ GROU~A~ O~ DET~I~TION -- -- A I I DES~IBE H~ RESIDUE ~N T~K(~) ~D PI~ING I$ ~ B~ R~0~ DISPOS~ OF (~CLUDE ~8~ATION .~D DI~ ~S): ~ ' / I ' ' ' P~E ~OV~Dg IN~ON REQ~D ON R~Z SIDE OF ~IS S~ BE~RE S~HI~ZNG ~PtlCA~TON ~R R~T~ ' ' (Po~ 1~-140) PROVIDE DRAWING OF PHYSICAL ~YOUT OF FACILITY USING SPACE AT,T, OF THE FOLI32~ING I~FORMATION MUST BE INCLUDED IN ORDER FOR APPLICATION TO BE PROCESS~: TANK(S), PIPING & DISPENSER(S), INCLUDING L~GTHS AND DIMENSIONS / PROPOSED SAMPLING LOCATIONS DESIGNATED BY THIS SYMBOL "~" NEAREST STREET OR INTERSECTION ~ ANY WATER W~T,Lq OR SURFACE WATERS WITHIN 100' RADIUS OF FACILITY 1700 Flower Street KERN COUNTY HEALTH DEPARTMEN'I HEALTH OFFICER t Bakersfield, California 93305 ".? Leon M Hebertson, M.D. Telephone (805)861-3636 .. ENVIRONMENTAL HEALTH DIVISION "' DIRECTOR OF ENVIRONMENTAL HEALTH Vernon ~ Relchard II~TTERT[V~* PEi~'FT :, PER~IT~eO6OO190 TO OPERATE = , T SST~ED= jUn¥ 1, [986 EXPI' RI~--S = JULY 1, 1989 UNDERGROUND EAZARDOUS SUBSTANCES FACILITY: - ' } OWNER: · .ASSOC. AUTOMATIC FIRE PROTECTION } HARDCASTLE,' ROBERT & MICHAEL 310~30TH STREET , ~ 310 30TH STREET BAKERSFIELD, CA ~ BAKERSFIELD, CA. 93301 TANK # AGE(IN YRS} SUBSTANCE CODE PRESSURIZED PIPING? · i UNK MVF 3 NO 2 13 MVF 3 NO NOTE: .ALL INTERIM REQUIREMENTS'ESTABLISHED BY THE PERMITTING.. AUTHORITY MUST BE MET DURING THE TERM OF THIS .PERMIT NON--TRANSFERABLE * * * POST OI~X PREMI SIS DATE PERMIT MAIT,k'T~: JAN Z DATE PERMIT CH~CK LIST RETURNED: . .... Kern County .ealth Depart_mile~ ' Permi~Jo. f,-'~ Division ct. Environmental .th' Application--Date 1700 Flower Street, Bake.rsfield, CA 93305 · APPLICATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type o__f ~ (check): l-]New Facility-~]Modification of Facility E]Existing Facility []Transfer of Ownership A. ~ergency 24-Hour Contact (name, area ~ode, phone): Days 805-327-4209 Nights ...... Facility Name ASSOCIATED AUTOMATIC FIRE PROTECTION CO .. No .~o£~anks ..... 2__' .... Type of Business (check): J'lGasoline Station ~]Other (des~ribe) CONTRAC--~-~ Is Tank(s) Located on an Agricultural Farm? []Yes Is Tank(s) Used Primarily for i~gricultural Purposes? []Yes Facility Address 310-30th Street Nearest Cross St. Union' T ~ R SEC (Rural LocatiOns 0nly) Owner Robert T. & Michael L. Hardcastle Contact Person Robert T. Hardcastle Address 310-30th Street Zip 93301 Tele[/~one 327-4209 Operator Robert T. & Michael L. Hardcastle Contact .Person--Rd'bert_T.,.HardcastI_e Address - 310-30th Street " ZiP. 93301 · Telephone 327.-4209 B. =Fr_to Fa.cil.~t~..Pr.ov.id_ed .by. Public Utilities Depth to: GI;oundwataN Unknown · unaracterlS~lCS at Faclllty Sandy ' · - Basis for Soil Type an~ Groundwater Depth 'Deteminations., Visual _ ' - C. Contractor N/A CA Contractor's License No'. '" ' posea .~r. ar:~ng Date Propose~l C(m~pletlon Date : Worker"s Ccmpensatton Cert.1fJcation ~ Insure~ ' ' E, Tank(s) Store (check all that apply)-- .. ' . ' Tank _~ Waste Produc~_ Notor Vehicle ' Unleaded Regular Pr, eeium ' Diesel -----_ [] [] . .. ___o o [] B B B "B" B ~. ch~uical Canposi~on of ~terials Stored (oo~ necessary lief noto~ vehicle feels! ' Tank t Che~Lcal Stored (non-co~nercial ruin-) CAS t (if kno~a~) Chemlca[L Previoosl~ Stored (it~' dlft[eren~) G. Transfer of Ownership Date of~-ansfer N/% Previous Owner Unknown Previous Facility Name Unknown I, Robert T. Hardcastle accept fully all obligations of Permit No. issued to Ass_cc. Auto. Fire Protect~io~ understand that the Permitting Authority may review and modify or terminate the transfer of the Permit to Operate this ~dergro~d storage ' facility upon receiving this cm}pleted form. , Sig . Title Chief ExecutiveDate 4-12-85 .... bfficer Facility Name ASSOCIATED A~OMATIC FIRE PROTECTION CO Pemit No. TANK ~ 1 (FILL OUT SEPARATE FORM FOR EAuL1 TANK) FOR EACH SECTION, CHECK ;~[,r. APPROPRIATE BOXES H. 1. Tank is: [].Vaui~d ~-~Non-Vaulted [~Double-Wall I-]Single-Wall 2. ~ Material Carbon Steel [] Stainless Steel [~Polyvinyl Chloride []Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [] Concrete [~ Al~ninum [] Bronze []Unknown [] Other (describe) 3. Primary Containment Date Installed Thickness, (Inches) Capacity (Gallons) Manufacturer ............. tin kn ~wn unknown .... 10 0 0 ......... unknown 4. Tank Secondary Containment []Double-Wall ~Synthetic Liner []Lined Vault []None ~-]Other (describe): Manufacturer: [~]Material ' Thickness (Inches) Capacity (Gals.) 5. Tank Interior Lining --~Rubber {']Alkyd []Epoxy []Phenolic []Glass []Clay []Unlined []Other (describe): ..... 6~.-Tank Corrosion Protection ' ........ k .... ' ............... ' --'~Galvanized ~a~s-Cl~- []Pol~thylene Wrap ~]Vinyl Wral~lng []Tar or Asphalt ~Unkno~n []None []Other (describe).- " Cathodic Protection: []None []Impressed Current System ~lSacrificial ~ System Describe System & Equi~ment: ,, , 7. Leak Detection, Monitorin~, and Interce~)tion a. Tank: ~Vis~al (vaulted~ks only) []Ground~ter Monitori~ Well(s) []Vadose Zone Monitoring ~ll(s) []U-Tube Without Liner ~U-Tube with Compatible Liner Directing Flow to Monitori~ We.il(s)* [~] Vapor Datector* [] Liquid Level Sensors [] Conductivity Sensorw ~ Pressure Sensor in Annular Space of Double Wall Tank7 []Liquid Betrie~al & Inspection From U-Tube, Monitori~ Well or A~ar [] Daily Gauging & Inventory Reconciliation [] Periodic Tigh~ness I-I None [] Unknown [] Other b. Pipits: Flow-Restricting Leak Detector(s) for Pressurized Pipin~w []Monitoring S~p w~th Race~y []Sealed Concrete ~ace~y OHalf-Cut Compatible pipe Raceway []Synthetic Liner Race~¥ []None []Unknown [~ Other SUCTION *Describe Make & ~odel: 8. ~en Tightness Tested? ~qYes []No Date of Last Tightness Test Results of Test Test Name ~sting Company 9. Tank Tank Repaired? []Yes ~]No []unknown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection ~-~Operator Fills, Controls, & Visually Monitors Level [']Tape Float Gau~e [']Float Vent Valves []Auto Shut- Off Controls Capacitance Sensor []Sealed Fill Box []None []Unknown Other: List Make & Model Fo~ Above Devices a. Underground Piping: [~Yes ~NO ~Unknown Material Thickness (inches) Diameter Manufacturer []Pressure ~'~Suc~ion []Gravity Approximate Length of Pipe ~ Unknown ........... b._ U_nderground ?ipin~ .Corrosion Protection : ....... [~]Galvanized []Fiberglass-Clad []Impressed Current []Sacrificial A~ode []Polyethylene Wrap ~Electrical Isolation ~Vinyl Wrap []Tar or Asphalt ~]Unknown []None []Other (describe): c. Underground Piping, Secondary Containment: ~Double-Wall []Synthetic Liner System [-]None ~-]Unknown []Other (describe): Facility Name ASSOCIATED Aj~MA. PIC FIRE PROTECTIOM CO Pe~ait NO. TANK ~ 2 (FILL OUT SEPARATE FORM FOR E~.~ TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: ~]Vaul{~d ~-~Non-Vaulted [-~Double-Wall []Single-Wall 2. ~ Materi~l Carbon Steel [] Stainless Steel [q Polyvinyl Chloride []Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [] Concrete [] Alunin~ [] Bronze []Unknown [] Other (describe) 3. ~ Containment Date Installed Thickness (Inches) Capacity (Gallons) Manufacturer 1972 we believe 3/8" 10000 unknown 4. Tank Secondary Cor{tainment ...... '--' [']Double-Wall []Synthetic Liner []Lined Vault ~']None ~]Unknown ~]Other (describe): Manufacturer: []Material Thickness (Inches) Capacity (Gals.) 5. Tank rnterior 'Lining --'~RUbber OAlkyd []Epoxy ~]Phenolic []Glass ~]Clay []~li~ed []Other (describe): ........ 6. Tank Corrosion Protection ...... ' '--~Galvanlzed ~ass-Cl~d UPo'][~e~J~i;ne Wrap' []~in¥i-Wr~i~ []Tar or Asphalt .~Unknown ~]None []Other (describe) : Cathodic Protection. [~l~.ne []Impressed Current S~stem "~lSacrifl¢lal ~ System ~--~ribe System & Equil:ment: 7. Leak Detection, Monitoring, and Interception a. Tank: []Visual (vaulted tanks only) Ii]Groundwater Monitoring' []Vadose Zone Monitoring Well(s) ~U-Tube Without Liner ~[].U.-Tube with C.a~,pa_tible Liner Directi~] Flow to Monitorin~ WeLl(s)* vapor Datector ~Liquid Level Sensorw ~lConductivitv Sensor* [] Pressure Sensor in Annular Space of Double Wall Tank* [] Liquid Retrieval & Inspection From U-Tube, Monitorin~ Well or Ann~ar S~ace ~-~Dall¥ Gau~in~ & Inventory Reconciliation []Periodic Tight:ness Te~tin~ [] None O Unknown [] Other b. Piping: Flo~-Restrictir~ Leak Detector(s) for Pressurize~ Plpin~w []Monitoring S~p with Race~y '[]Sealed Concrete Raceway []Half-Cut Compatible Pipe Raceway []Synthetic L~nex Raceway []Mo~e ' ~1 Unknown ~ Other SUCTION *Describe Make & Model: 8. Tank Tightness ~ls Tan~ Been Tightness Tasted? OYes []No ~i~Unknown Date of Last Tightness Test Results of Test Test Name Testing Company 9. Tank ~ ~ Ret~lred? OYes ~]NO []unknown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection ~Operator Fills, Controls, & Visually Monitors r~-vel []Tape Float Gau~e 0']Float Vent Valves [-]Auto Shut- Off Controls B Capacitance Sensor []Sealed Fill Box ~None [-]Unknown Other: List Make & Model For Above Devices 11. Piping a. Underground Piping: [-~Yes [-]No []Unknown Material Unknown Thickness (inches) Diameter Manufacturer []Pressure ~]Suc~i°n []Gravity Approximate length 6f Pipe !%~ Unknown b. Underground .Pipir~ Corrosi. on Protection : [~Galvanized []Fiberglass-Clad []Impressed Current []Sacrificial An~e' []Polyethylene Wrap ~Electrical Isolatio~ [qVinyl' Wrap ~Tar or Asphalt ~]Unknown []None []Other (describe): c. Underground Pipir~3, Secondary Contair~ent: []Double-Wall []Synthetic Liner System []None ~]Unknown []Other (describe):