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HomeMy WebLinkAboutUNDERGROUND TANK-C-7/6/98 ENVIRONMENTAL MANAGEMENT CONSULTANTS June 8, 1998 Mr. Steve Underwood Bakersfield Fire Department Hazardous Materials Division 1715 Chester Avenue, Suite 300 Bakersfield, California 93301 Subject: TANK CLOSURE REPORT FOR THE MEMORIAL HOSPITAL SKILLED NURSING CENTER 430 34TH STREET, BAKERSFIELD, CALIFORNIA (PERMIT #BR-0211) Dear Mr. Underwood: This report presents the results of soil sampling performed by Holguin, Fahan & Associates, Inc. (HFA) in association with the removal of a single 500-gallon diesel UST from the above-referenced site (see Figure 1 - Site Location Map). The tank removal activities were performed under Permit #BR-0211 with the Bakersfield Fire Department Hazardous Materials Division (BFDHMD) in association with the replacement of the UST, which was used to fuel a backup generator ifor the Skilled Nursing Center at Memorial Hospital, with an AST to serve the same purpose. BACKGROUND Memorial Hospital contracted with Industrial Contamination Extraction Services, Inc. (ICES) to remove the single 500-gallon, single-walled, steel, diesel UST used to fuel the emergency generator and to install an AST to serve the same purpose (see Figure 2- Plot Plan). On April 16, 1998, the UST was removed. HFA was contracted to provide a California registered geologist to collect a soil sample from beneath the location of the former UST at the direction of Mr. Steve Underwood with the BFDHMD. TANK CLOSURE SOIL SAMPLING On April 16, 1998, soil sample TK-1-9 was collected from 1 foot beneath the invert at the center' of the 500-gallon diesel UST (see Figure 2 for the tank removal soil sample locations). Because the UST was tied down to an underlying concrete pad, the soil sample was collected from the fill material beneath the UST, which was directly above the underlying concrete pad. In additionj ENVIRONMENTAL: S, CIENTIST,~ · GEOLOGISTS · ENGINEER/S Contaminated Site Assessments Phase i Audits Site Remediation · Hazardous waste Managem, ent I 143 South Figueroa Street 16570 Aston Street 3 157 Pegasus Drive 2600 North 44lh Street, # 104 Ventura, California 93001 lrvine, California 92606 Bakersfield~ California 93308 Phoenix, Arizona 85608 (805) 652-0219 (714) 442-6665 (805) 391-0517 (602) 957-8234 (805) 652-0793 FAX (714) 724-0446 FAX (805) 391-0826 FAX (602) 957.-801 !. FAX lnternet: first_last@hfa.com lnternet: first_last@hfa.com lnternet: firsl_lasl@hfa.com Interne1: fir.$1_lasl@ph.hfa.com ~ HOLGUIN, Mr. Steve Underwood FAHAN BFDHMD ~ June 8, 1998 - Page 2 &ASSOCIATES, INC. ENVIRONMENTAL MANAGEMENT CONSULTANTS the concrete pad was exposed fo inspect for any evidence of a petroleum release, and none was observed. All sampling equipment was washed with a non-phosphate cleanser, pre-rinsed with tap water, and finally rinsed with deionized water prior to sampling. The soil sample was collected from the backhoe bucket immediately following excavation. The soil sample was stored in a 2-inch-diameter brass tube, sealed with TeflonTM liners and end caps, labeled, placed in an ice chest at a temperature of less than 4oc, and transported to a California state-certified laboratory for analysis. Sample identification and chain-of-custody procedures were followed for the sample to ensure sample integrity and to document sample possession from the time of collection to the ultimate destination. The sample label identified the job number, sampler, date and time of collection, and a sample number unique to the sample. ANALYTICAL METHODS AND RESULTS The soil sample was analyzed for TPH as diesel using EPA Method 8015 (M) and BTEX and MTBE using EPA Method 8020. TPH as diesel, BTEX, and MTBE concentrations were not detected in the soil sample collected from beneath the 500-gallon diesel UST, with the exception of a trace toluene concentration (see Figure 2 for the soil sample location, Table 1 - Summary of Soil Sample Analytical Results, and Attachment 1 for the laboratory report). RINSATE AND STORAGE TANK DISPOSAL Prior to tank removal, the UST was triple rinsed. The rinsate was transported by Cole's Services, Inc., to Evergreen Environmental Services' facility in Fresno, California, under Non-RCRA Hazardous Waste Manifest (see Attachment 2 for the Non-RCRA Hazardous Waste Manifest). An LEL meter was utilized to verify that the hydrocarbon vapor concentrations were less than 5 percent of the LEL. Subsequently, Z] pounds of dry ice per 1,000 gallons of tank capacity were introduced into the UST, and oxygen metering was conducted to verify that the level of oxygen within the UST was less than 12 percent. With the approval of the BFDHMD, the storage tank was removed, placed on a flatbed truck, and transported by Bradford & Sons Inc., to Golden State Metal's Bakersfield facility for destruction (see Attachment 3 for the tank destruction certificate). FAHAN Mr, Steve Underwood BFDHMD & IATES, INC. June 8, 1998- Page 3 ENVIRONMENTAL MANAGEMENT CONSULTANTS CONCLUSIONS Based on the soil sampling and laboratory analytical results, hydrocarbon concentrations were not found in the soil beneath the former diesel UST, with the exception of a trace toluene concentration. The BFDHMD will not likely require additional site investigation and may consider the site for closure. This report has been prepared for the exclusive use of Memorial Hospital, and its representative, Industrial Contamination Extraction Services, Inc., as it pertains to the referenced property in Bakersfield, California. The services performed by Holguin, Fahan & Associates, inc., were conducted in a manner consistent with the level of care and skill ordinarily exercised by members of its profession currently practicing under similar conditions in the state of California. No other warranty is expressed or implied. Thank you for this opportunity to have been of service. If you have any questions regarding this report or the information contained herein, please contact me at (805) 39143517 or at e-mail address Mark_Magargee@bk.hfa.com. Respectfully submitted, Mark R0 Magargee~ Senior Hydrogeologist Holguin, Fahan & Associates, Inc. MRM:rri Enclosures: Figure 1 - Site Location Map Figure 2 - Plot Plan Table 1 Summary of Soil Sample Analytical Results Attachment 1 Laboratory Report Attachment 2 Non-RCRA Hazardous Waste Manifest Attachment 3 Tank Destruction Certificate cc: Mr. Peter Armstrong, Memorial Hospital Mr. Ron Vuocolo, ICES  HOLGUIN, Mr. Steve Underwood FAHAN BFDHMD & ASS(:X::IATES, lNG. June 8, 1 ~8- Page 4 ENVIRONMENTAL MANAGEMENT CONSULTANTS "' ' · ~.~ '-~ :.', .-' ee ~.."'2~" , "":.' ~lt~.~ II11t, I , ...... ~ .............. ~. . ...... '~.. ~ ~; ~.~=:.~ .~,.~.~- ~' .. ~,~' ", ~ ~ ~'~ .'i" .* : ~ , . ~;, -,,~---. .... }.. + '_ · . ~- ~=~ '~' . ., . ~.: ~ · ~%Q~' ..". ': ¢ ............... {- .~I-'" "' ' ' ,,'-:-"':'.''  ~ ~ . ,... . ~ - ' ..... '~~~~l , - · oo0, ~'~ ~A~ ~ · . .~. '..., -. -,, '. ~ ' '~= ~,... ~ ~ . I ~_ ~,~ .... .. ~.. ',-;~ .,' ,:- :' I~ ,~,o ~.:~...'..s./X ~ L,~~ ~ ~ s°~'°~ . .. ,,,.;~0 ' "~ z/'-,. ~-!'~ - LEGEND ICES  MEMORIAL HOSPITAL o o.~ ~ U~LE SKILLED NURSING CENTER k.. I~' I I } ~ I I I ] ~,~ *~ ~,~ ~,~ ~ Ii%,J/ 4~0 34TH STREET ~ H ~ ~ ~ ~ BAKERSFIELD, CALIFORNIA O 0.5 1 KILOMETER t ~ ~ ~ ~ ~ I FIGURE1- SITE LOCATION MAP USGS OILDA~ 7.5 MINUTE SERIES QUADRANGLEI ~O~, ~ ~ ~C~. ~C. i ~ HOLGUIN, Mr. Steve Underwood : ~ FAHAN BFDHMD ~ June 8, 1998 - Page 5 ~ & ASSC~IATES, INC. ENVIRONMENTAL MANAGEMENT CONSULTANTS BUILDING EXISTING AST EMERGENCY GENERATOR CONCRETE PAD - -. ' - FORMER ' DIESEL UST :.':-..-. -::'. ¢iTK.1.9 FORMER PRODUCT PIPING SCALE IN FEET 0 15 3O LEGEND ICES MEMORIAL HOSPITAL · SOIL SAMPLE LOCATION SKILLED NURSING CENTER 430 34TH STREET BAKERSFIELD, CALIFORNIA FIGURE 2 - PLOT PLAN HOLGUIN, FAHAN & ASSOCIATES, INC. REVISION DATE: JUNE 8, 1998: RRI  HOLGUIN, Mr, Steve Underwood FAHAN BFDHMD ~ June 8, 1998 - Page 6 ~ & ASSC~IATES, INC. ENVIRONMENTAL MANAGEMENT CONSULTANTS TABLE 1. SUMMARY OF SOIL SAMPLE ANALYTICAL RESULTS MEMORIAL HOSPITAL SKILLED NURSING CENTER, BAKERSFIELD, CALIFORNIA I DATE t SAMPLEI TPH AS i I ETHYL- TOTAL SAMPLE SOURCE SAMPLED DEPTH I.D. j DIESEL~tBENZENEiTOLUENE BENZENE XYLENES MTBE REF (fbg) , '~ (mg/kg) i (mg/kg) i (mg/kg) (mg/kg) (mg/kg) (mg/kg) EPA ANALYTICAL METHOD ! 8015 (M) I 8020 N/A METHOD REPORTING LIMIT I 10! 0.0051 0.005 0.015 0.015 0.02 N/A Center of Diesel USTI 4-16-98 I 9 I TK-1-9 . NDl NMI 0.01 ND ND ND; A REF = Report reference. N/A -- Not applicable. ND = Not detected. A = Holguin, Fahan & Associates, Inc.'s, current repod. ~ HOL©UIN, ~ FAHAN ~ &ASSOCIATES, INC. ENVIRONMENTAL MANAGEMENT CONSULTANTS ATTACHMENT 1. LABORATORY REPORT ENVIRONMENTAL LABORATORIES 143Sou~ FlgueroaSheet, Ven~ra, Callfornla 93001° (805)652~219 *FAX:(805)652~793 REPORT OF ANALYTICAL RESULTS May 8, 1998 Page 1 CLIENT~ Analyzed ~: N. Abadeer ICES Sampled ~: M. Magargee Units: w/kg Matrix: Soil PROJECTz Me, rial Hospital SK. Med Nursing Facility Analyses Meth~: ~: EPA 8020 TPH: 8015-M CONCENTRATION OF TOTAL PETROLEUM HYDROCARBONS (TPH) WITH BT~X DISTINCTION CONSTITUENT TPH- TPH- Ethyl Total Percent Lab Sample Dates S~pled, Gasoline Diesel Benzene Toluene Benzene Xylenes MTBE Surrogate No. No. Received and Tested RL RL RL RL RL RL RL Recove~ 981426 TK-1-9 4/16/98 4/20/98 4/20/98 ND ND ,01 ND ND ND 105% i0 .005 .005 .015 .015 .02 RL = Reporting Limit (may vary with Dilution Factor) ND= Not Detected at or above RL Lab Certification: CAELAP #1878; 1/3]/00 Laboratory Manager: HOLGUIN, FAHAN & ASSOCIATES INC ENVIRONMENTAL LABORATORIES ' ' 143 South Figueroc~ ,Sfreef. VenturcL Cc~lifornic (805) 652-0219 FAX (805) 652-0793 METHOD BLANK REPORT REPORT OF ANALYTICAL RESULTS Date Analyzed: ~ /~0/98 QC Batch ID: MBS Analyzed By: N. Abadeer Analysis Method: 8015/8020 CONCENTRATION OF TOTAL PETROLEUM HYDROCARBONS (TPH) WITH BTEX DISTINCTION in m g/kg (soil) TPH- Ethyl Total Client Gasoline Benzene Toluene Benzene Xylenes Lab No. Sar~le No. Matrix MRL MRL MRL MRL MBS Method Blank Soil ND ND ND ND ND 10 .005 .005 .015 .015 Volatile fuel hydrocarbons are quantttated agalns[ a gasoline standard. Hydrocarbons detected by this method range from C6 to C15. Analytes reported as ND were not present above the stated limit of detection. MRL = Method Reporting Limit ND = Not Detected at or above MRL LAB CERTIFICATION: CAELAP t1878; 1/]1/00 HOLGUIN, FAHAN & ASSOCIATES, INC. ENVIRONMENTAL LABORATORIES 2550 Eastman Ave., Unit 1, Ventura, CA 93003¥(805) 650-7750¥FAX (805) 650-6810 Date: 20-Apr~98 Instrument: HP 5890 GC-1 Standard ID: SV-108 STD CONC: 100 ng/uL Analyst: NHA Amt Inj. · 6 ul/10 ML Water Matrix: Soil Water matrix-Continuing Calibration Verification EPA Method 8020 Compound Ave. CF CF daily %RPD Area Conc. MTBE 2415 2142 11 1.29E+06 600 Benzene 5126 5060 1.3 3.04E+06 600 Toluene 7734: 8224 6.3 4.93E+06 600 Ethylbenzene 6997 7193 2.8 4.32E+06 600 m,p-Xylenes 8456 8738 3.3 5.24E+06 60C 0-Xylenes 6739 7074' 5.0 4.24E+0~ 600 4-BFB(Surr.) 5895 5641 4.3 1.41 E+06 250 *Must be less than or equal to 1.5. [~ [HOLGUIN FAHAN & ASSOCIATES INC ..1~.,1,,,1,,.~. ENVIRONMENTAL LABORATORIES 2550 Eastman Ave., Unit 1, Venfura, CA 93003¥(805) 650-7750¥FAX (805) 550-5810 Date: 20-Apr-98 Standard ID: 5V-099 Instrument: HP 5890 GC-I Analyst: NHA Matrix: Soil Water Matrix-Continuing Calibration Verification EPA Method 8015 Modified STD Conc:20 ug/uL Area Conc.(ug) Inj. Amou :2 ul/10 ML Water 9.02E+07 40 Compound Ave. CF CF daily %RPD* I'VPH as 2356094 2256060 4.2 Gasoline * Must be less than or equal to 15. HOLGUIN, FAHAN & ASSOCIATES, INC. ENV[RONMENTAL LABORATO[~[ES 2550 Eastman Ave., Unit 1, Ventura, CA 93003¥{805) 650-7750¥FAX (805) 650-6810 Sample ID: Date Analyzed: 20-Apr-98 Lab No: 981395 Matrix: Soil Instrument ID: HP 5890 GC-1 Dilution Factor: 1 Injected Amount: 1 uL/10ML WATER SID Concentraion: 100 ng/uL Matrix Spike Worksheet EPA 8020 Matrix Spike Results ~ompound Sample Matrix Spike Spike Sol. Recovery Conc.(ppb) Conc.(ppb) Conc.(ppb) (%) MTBE 0.00 21.0 ~20 t05 Benzene 0.00 18.1 20 91 toluene 0.00 20.4 20 102 Ethylbenzene 0.00 19.6 20 98 m,p-Xylenes 0.00 20.6 20 103 o-Xylene 0.00 20.5 20 103 Matrix Spike Duplicate Results Compound Sample Matrix Spk. Dup Spike Sol. Recovery Conc.(ppb) Conc.(ppb) Conc.(ppb) (%) MTBE 0.00 21.3 20 107 Benzene 0.00 16.9 20 85 Toluene 0.00 20.1 20 101 Ethylbenzene 0.00 19.5 20 98 m,p-Xylenes 0.00 20.2 20 101 o-Xylene 0.00 20.6 20 103 Average Recovery & RPD Data Compound Average Control %RPD Control Recovery Limits Limits MTBE 106 46-166 1.4 < 16 Benzene 88 42-145 6.9 <14 Toluene 101 70-130 1.5 <12 Ethylbenzene 98 64-118 0.5 < 19 m,p-Xylenes 102 53-149 2.0 < 14 o-Xylene 103 69-133 0.5 <9 HOLGUIN,! FAHAN ASSOCIATES, INC. '..~,.~1.,.~1.1~! ENVIRONMENTAL LABORATORIES 2550 Ecs~mon Ave., Uni! 1, Venlura, CA 93003¥(805) 650-7750¥FAX (805) 650-6810 M~HOD BLAh:K: RE¢ORT REPORT OF ANALYTICAL RESULIS OC:3otChiD : MBS Do,eExJrocled: glZ8 I~ Anolys~s k/.elhod: 8016M Anal~ed Dy : ~ CONCENTRATION OF TOTAL PI~ROLEUM HYDROCARBONS (lphJ AS DIESEL in rog/Kg ~soil) '[PH- C;ien! Diesel '_ob No. Sample No. l¢,olr]x //,RI Iv, ES Melhod ~lank Soil ND I0.0 -Extractable fuel hydrocarbons are quanlitated against a diesel slondald. Hydocarbons delected by this melhod range flora Cl0 tO C24. Analy~es leporled as ND were not piesenJ above ihe stated limi! of delectlon. MRL = Method Reporlir~g Limil ND = Not Delected c~ or obcve I,',RL DSLCHK.XLS Date Analyzed: 7-May-98 Standard ID: SV~096 Instrument ID: HP 6890 GC-3 Analyst: NHA EPA Method 8015 Modified Calibration Verification Compound Ave CF CF daily %RPD* TVPH as 8529 8785 3 Diesel [Area 8.78R+04]C°nc' 10[ *Must be less than or equal to 15 5/8/98 8:20 AM HP 5890 Headspace HOLGUIN, FAHAN & ASSOCIATES, INC. ENV]F~ONMENTAL LABOF~ATOF~[ES 2550 Eadman Ave., Unit 1, Ventura, CA 93003¥(805) 650-7750¥FAX (805) 650-6810 Sample ID: Date Extracted: 28-Apr-98 Lab No: 981426 Date Analyzed: 7-May-98 Instrument ID: HP 6890 GC-3 Matrix: Soil Matrix Spike Worksheet EPA Method 8015-M Matrix Spike Results Compound Sample Matrix Spk. Spike Sol. Recovery Control Conc.(UG) Conc.(UG) Conc.(UG) (%) Limits TPH as 0.000 8.5 10 85 35-165 Diesel Matrix Spike Duplicate Results Compound Sample Matrix Spk. Dup. Spike Sol. Recovery Control Conc.(UG) Conc.(UG) Conc.(UG) {%) Limits TPH as 0.000 7.4 10 74 35-165 Diesel Average Recovery & RPD Data Compound Spike Matrix Spk. Dup Average %RPD Control Recovery Recovery Recovery Limits TPH as 85 74 80 13.8 <31 Diesel Client Name ~ ~'~- ect Name Client Contact/Phone No. Contract Code _~.,Z,~_./'~ report to: Sampler's Name Sampler's Analyses Requested Holguin, Fahan & Associates, Inc. 143 South Figueroa Street Sample .~ent~r.a,.,~ 93_001 Matrix (soil, Other Information Attn: HFA ground water (e.g., sampling Iocat on, depth, ~ ~/'N-- -- Sample # air, water) soil boring or MW #, elc.) SPECIAL INST CTI S (i.e., turnaround time, etc.) ....... REQUIRED DETEr,ON LIMITS ~ Los Angeles County ~'~__l California LUFT [] Santa Barbara County [] SW-846 [] Venlura County [] Other see reverse for required detection limits SAMPLE RECEIPT Yes No Sample Seal Intact Sample Condition Acceptable Sample Temperature Appropriate [] PRESERVATIVE ADDED? [] .o [] ye, All samples stored overnight at HFA are refrigerated at 4°C. Samples are transporled to the laboralory Jn coolers filled with Blue IceTM. Delivered to HFA's refrigerator for temporary storage on ~ ('Initials) . Relinquished By: (Signature/Organization) Date/Time Received By: (Signature/Organization) : - e nquished By: (Sj~ature.~rgani~ation) Date/Time Received By: (Signature/Organization) Re,inquished By: (Signature/Organization) Date/Time -- ~R.~e~//l~y: (S~gnature/Organization) ~al Hazards Here: f'ormup<~a,edS/93) Return sample(s)icooler t~: Holg~Jin, Fal' ~ ~ ~;tree~~ 0v, t,-,,-,~ 652-0219 · FAX # (805) 652-0793 I,HOLGUIN, FAHAN & ASS(~IATES, INC. ENVIRONMENTAL MANAGEMENT CONSULTANTS ATTACHMENT 2. NON-RCRA HAZARDOUS WASTE MANIFEST ~1A~'--2~--g8 01 :5 1PM ! C E S 80558c}c)5 1 · ~o~ ~~c , _96 7~.543~ ~;~4~~ ~ _ . h:'f~,,~'~m~, ~ ' ",~ -, ..,. I I . ~:~ "~ Nome ' ' '"'~'~'""~' .......... T~''''''' -1"";""' ":";'= .... J~~ ~z~/~ ~"" . ,,_.,.,,, - .D~~/ ...... ~:...~..~.~:~, ~0 NOT Wti~ a~OW ~ HOLGUIN, ~ FAHAN ~ & ~IATES, INC. ENVIRONMENTAL MANAGEMENT CONSULTANTS ATTACHMENT 3. TANK DESTRUCTION CERTIFICATE GOLDEN STATE METES, INC. P. O. BOx 70158 · 2000 E. Brundage Lane Phone (~5) 327~9 · F~x {~5) 327.5?49 ~Phone No. )DRESS: ES~NA~ON: G.S.M. · 20~0 ~ BRUNDAGE LANE · BAKERSFI~, CA 9~87 :OUN~: 550 N .4HSPEC~ON ~0 1,32 ~ RESIDUALS PRESENT (REJEC~ .............. . ................ LEL RFADING ~0 ~.42 ~ OXYGEN CONTENT ~- 7~ ~ DISPOSAL FEE ~o ~.82 ~ SCRAP VALUE ~ 4.93 ~ TOTAL represents acceptan~ of terms for payment, end confirms ' ~ ~ ~ "~'~::'~ CERTIFICATE OF TANK )ISPOSAL / DESTRUCTION HiS LS ~ERTLFY THE RECEIPT AND ACCEPTANCE OF THE TANK(,5) AS SPECIFIED A~VE, ALL MATERIAL SPECIFIED WILL BE COMPLETELY )ESTR~Y~OR SCRAP RECYCLING PURPOSE~ ONLY. W~T~ ~ C=~ct~ C~py . Y~LOW ~ Rfe Copy · ~NK ~ ~.~nt B, SFIELD FIRE DEPARTMENT ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM FACILITY PERMIT TO OPERATE9 CONTRACTOR~c.e.%' CONTACT PERSON LABORATORY /-~1~,.~ ~ ~ ~ #OFSAMPLES ~]~ / TEST METHODOLOGY qq~D ~ PRELIMANARY ASSESSMENT' CO. ~Jo~n P~A~ CONTACT PERSON CO~ RECIEPT ~d ~e //~ LEL% ~ PLOT PLAN CONDITION OF TANKS ~TE INSPECTORS ~E SIG~TURE  HAZARDOUS MATERIAL~DiVISION , ' UNDERGROUND STORAGE T~.K PROGRAM ~ ~T '~'~ :!~r,-'--~.C..~. "'.~: ,~::.. t,. ":,;t.':' ': ..~ .. ./. PERMIT APPMCATION FOR REMOVAL OF AN" ERGROUND STO ETA SITE H~HOR[A~ HOSP[?A~ ADD~ES$430 34TH STRUdelPcODE93303 APN FAClU~NAM~HgHOR[AL HOSP[~A~ CR~ STREET SAN D[HAS " TANK OWNER/OPERATOR HgHOE~A~ ~SP[?A~ PHONE No. 3 MAIUNG ADDRESS gANg CI~ ZIP CODE COMPANY [NDDS?R[A~ CON?AH[NA~NENo, 589-9039 LICENSE No. CA 726775 ADDRESS p.o. BOX 20370 CI~B~SF~D ~P CODE 93390 INSURANCE CARRIER D[~gDO DgF[NDgS WOEKMENS COMP N~366128 PRELIMANARY ASSEMENT INFORMATION COMPAN~b~u~N ~'~ ~ ~uC;, PHONE No.652-0219 LICENSE No.~A~[878 ADDRESS [43 S. F[G~OA CI~NTU~A ZiPCOD~UU INSURANCE CARRIER WORKMENS COMP No. TANK CLEANING INFORMATION COMPANY CO~'S S~V[C~S PHONENo~22-8258 ADDRESSP.O. ~OZ [0764 CI~ ZIPCOD~ WASTE TRANSPORTER IDENTIFICATION NUMBER 3239 NAME OF RINSTATE DISPOSAL FACILI~ ~V~G~N ADDRESS 4~ ~. V~T,E~mTNO S~ Ci~ ~SNO ZiPCODE937[[ FACILI~ INDENTIFICATION NUMBER 9R~44~8~ ' TANK ~ANSPORTER INFORMATION COMPANY~AD~O~D ~ND 5ON PHONE No~3 [-6836 LICENSE NO. 62646[ ADDRESS p.n. ~o~ 7~77~ CI~ B~SF~D. ZiPCOD~z TANK DESTINATION GO~D~N S~ TANK INFORMATION TANK NO. AGE VOLUME CHEMICAL DATES CHEMICAL STORED . STORED PREVIOUSLY STORED 1 1 ~YRS ~ DIESEL THE APP[ICA N~ HAS ~EC RIVED, UNDERSTANDS, A ND WILl COMPLY WITH THE A~ACHED CON~IIIONS OF THIS PERMI~ ANO ANY OTHER" STA~E LOCAl ANDFEDERAL REGULATIONS. :cz, . PLICANr NAME (PRIN~ - APPLICANY ~IGNATU~E THIS APPUCATION BECOMES~ PERMIT.WHEN. APPROVED . '~,~' · '" -MA~F ~HECKS PAYABLE TO THE "CI~ OF BAKERSFIELD" BAKERSFIELD FIRE DEPARTMENT February 24, 1998 Mr. Pete Armstrong Memorial Hospital 420 34th Street FIRE CHIEF Bakersfield, CA 93304 MICHAEL R. KELLY ADMINISTi TNESEWICES UNDERGROUND STORAGE TANK UPDATE 2101 'H' Street ~ ".; BaRe,field, CA 93,301 (805) 326-3941 FAX (805)395-1349 Dear Underground Storage Tank Owner: SUn,~SS,ON s~cra The City of Bakersfield has some exciting news regarding loan monies, which has just 2101 'H' Street Bakersfield, CA 93801 become available through the Small Business Loan Association (SBA). (805) 326-3941 FAX (805) 395-1349 Pollution Control loans, thru the SBA, are intended to provide loan quarantees to eligible small businesses for the financing of planning, design, or installation of pollution prevention I~EVENI]ON SI;IF/ICES 1715 Chester Ave. controls, which includes underground storage tank facilities. Bakersfield, CA 93301 (805) 326-3951 FAX (805)326..0676 The vast majority of businesses are eligible for financial assistance fi.om the SBA. The SBA defines an eligible small business as one that is independently owned and operated and not ENVIla:)NMENTAI,$EE~ICE$ dominant in its field of operation. For those applicants that meet the SBA's credit eligibility 1715 Chester Ave. standards, the agency can quaranty up to eighty percent (80%) of loans of $ 100,000. Seventy five Bakersfield, CA 93301 (805) 326-3979 percent (75%) of loans above $100,000. Lynn Knutson, Chief of Finance for the SBA says, "If FAX (805)326-0576 customers apply immediately, and meet the requirements, funding is available". TRAINING DIVISION The City of Bakersfield hopes all of our underground storage tank owners take advantage 5642 Victor Street Bakersfield, CA 93308 of this opportunity. For more information on SBA, Pollution Control Loans, please call or write to: (805) 399-4697 FAX (805) 399-5763 Lynn Knutson, Chief Financial Officer Small Business Loan Association 2719 North Air Fresno Drive, Suite 200 Fresno, CA 93727 Phone # (209) 487-5785, Ext 130 Don't delay, start today!!! Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services cc: Ralph Huey NO SMOKING FLAMMABLI: DII::~SI:L FIRE SAFETY SERVICES & OFFICE OF ENVIRONMENTAL SERVICES ':~, ~ ' 1715 CHESTER AVE. BAKERSFIELD, CA 93301 R.E. HUEY R.B. TOBIAS, HAZ-MAT COORDINATOR FIRE MARSHAL (805) 326-3979 (805) 326-3951 October 25, 1995 Dear Underground Storage Tank Owner: Enclosed is your updated Permit to Operate for the underground storage tank(s) located at the referenced place of business. Please take a moment to review the information printed on the permit to make sure everything is correct. If any corrections need to be made, please call the discrepancies to our attention immediately. Your Permit to Operate is a legal document and its accuracy determines whether you are in compliance with the law. If you are the tank owner and not necessarily the tank operator at the site, please make a copy of this permit for your own files. Forward the original permit to the tank location so that it may be conspicuously posted on site. If you have any questions regarding the Permit to Operate or your responsibilities as an underground storage tank owner, please call the Office of Environmental Services at (805) 326-3979, or write to us at the letterhead address. Sincerely, Hazardous Materials Coordinator Enclosure erate Underground Hazardous Materials Storage Facility CONDITION: P EVERSE SIDE Tank Hazardous G:~Jii~i?~;~!~::~:!?:.?i? .... Ye:~iiiii?~?:::.::::, ~ii:: i?,:~Tank ':'::ii:ilT:~i~ii?iiiii'::i?!?~:~: Piping Piping Piping Number Substance C'~a~(!~%?:'' In"~'{:~ii~i~?::.. i?..?Type Moh:if~i~:i~::?i?:: Type Method Monitoring 01 DIESEL :;ii~ii~O~ii: i!!?~' :.:: ~:;:::..;~.9~ ;;:: ~?~ ~ ~;~E. c~ :: '::~ .::.~: ~ SWF SUCTION LTT 02 DIESEL ~:::'::':::~ 300 ~? :::::':;:;;;;:'"":::~'~?~;~ ?:~?'SW~'?::~:::?; ...... M~?~ ' :.::~] SWS SUCTION LTT 03 DIESEL :{~:2~;000~?[.??'::':i~85":":.]~:~??:?::;D~E::;:~:~::?.~..:?';?~:~:. cLM .~:"::~:::;;~SWF SUCTION LTT · .:.:..........:.. .-.:..":.. . ...... : ....... ..j.:: ...: j:~:' Issued By:  ~akcYsfi¢ld FiYc Dept. "::::%:;;:';;':;:'": :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ........ BAKERSFIELD MEMORIAL HOSPITAL HAZARDOUS MATERIALS DIVISION 420 34TH STREET 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 BAKERSFIELD, CA 93301 (805) 326-3979 Approved by: ~"Materials Coordinator tq .... ~ ..... '~Ra,~ E. Valid from:l~_~_~ ~ HOV-23-93 TUE 8:!8 E, , EER!i'iG FAX ~.!0, i806 ?, 02 UNOERGROUND STORAGE TANK F~RMIT APPLICATION FOR~ A M~K 0NI Y ~ ~ N~W P~Mt~ ~'~ 3 ~ENEWAL ~MIT ?-~ ~ CH.AN~ ~ tNFO~MA~ICN ~""'~ 7 ~MAN~NTLY ~. ~ .................................................................................... EME~GENC'Y CONTACT PERSON (~.ARY) E~/~RO~'NOY CO~T,~C'T PERSON (SEOONO~H~ PROPERTY OW/,iE~ INFOHNiATiON - (MUST BE COMPLETED) 'i4.-' ~ - '' ) ~ ,-.'. ' '. ~ T'~ '','- ~,'~ , 4, BOARD gF EQUALiZATiON UST ~OA.~GE FEE ACCOUNT HUMBE~., ~-~ ,,, ~.~ _. · , C~CX ONE ~OX tNDiC,AT~N~ ~,~iCH ,~OVE ADCR~SS ~OULC, 3B USeD :OP i.:G. AL ,'.~:~T'C,~S ~.Nq, ~,tL~N~ '.'~ H, ~,~'] Ti,. r'-~ ' FF,US ~QRM >tAS BEEN C~MP~'TSD UNDE~ P~NA~ TY OF ~;ER,,iU~ ~ ,,~t;D 'FO THE B~,S T ~ MY KNOWL ED~E, t,9 )'R~]E AND COPP~ECT ~[;~L'CAN'FS ~AME [Pa.N'~D ,& S,GhtATL, qE) 'J AcPLICAN'F'~ T;'TL.~ I DATE ........ ~,v ~ ,~ FAC~LfFY ~ NOV-23-93 SUE 8:20 X~!}( :BO, S TSS06 .K 04 CERTIFICATION OF COHPL~ANC~ FOR UNDERGROUND STORAG6 TANK iNSTALLATiON H,a C ti, INSTALLATION (ma,'k aJI tha~. apply): The instailer has beer, certified by +,he lank and piping rr,an(,,,..c,u..,r.. 'The "~m~l. ahahon'- ' has been inspected and codified by 'fhe instaI~atiOr~ has been ~f~speotod ~nd approved by the imptementin~ a~enoy. All work i~sted on me m~ngac.urer s ' ,' t · ' m,,tm,at on checklist t~as ba~n completed. The installation ConIrac~or has been codified Or ~icensed by the Con[rectors State Licsnse Board. Arloth~r method was used as allowed by the imp~ementin~ agency, IlL OATH t certify that the infoFmafion provided is true to ihe best of m~, belief and knowledge, LOCAL AOGNCY USE ONt. Y -- ~'~' ~ ~, TH)S FORM ~,R.~ AUCO~,!PAN~ B~ P~:~IT ~,P~LICAT)ON FOF~,~ A ~ e UNLESS THEY H~v~ ~N FIL~O PREVIOUSLY ~ ....... r APPLICATION IS BEING SUBMI?TED FOR THE FOI,LOWING REASON: ..... ~~~_~/,'~ ,,'~ :, . 7¢ . · -.. · ~ LOC~ZO~ E~ERGENCY CONTACT tankt vo~-~'~-"~te installed substance stored p,revioua substancr~ j DO 'Yoga }lave a HAZARD~-' - ": -" ~:~h:~'~'~"-~'~]'r~t't'-['~ ...... ~ s.t gna ture - .V.?,',~.~;" ~,"LW~,",',',~%~¥ "7 ~' ......... - ...... :.~:~%,,..L~ ~ .... : ?~:.~:f;~:~:.~:(~ ~ ~., .-,, ~,.~om~ KE~N VIEW HGSPITAL~ lNG, ' '..~.':,¥ 0anuary 9, ~992 -- ~'.'":'~'::'::~:?,':~ ' :' .(':')2~ ~ 19 q ~'¥"'~ ''':~'':':',':'~:e~:'~'~'~'~":'~ ~:"" ':'¥':~'d'~:'''~'' ~ .",'.:,t~ PA Y "' ;2' : ":C,?~] :...;:..y~ -- ,...' :,: :,:4.~ ,~ ~ . . ., ~:'::::~:: :~ ~: jr~ ~ '1 ~ f'~ l ~ ~ m ~ ~ ~ - .- ~ ~ " ' . ~ ,; '~; . . . .: ~ .-.,~ ..,- .. p · .:.. . ...~:~ · .,...:.'.'.~ I/r,c ~q~ 2~2q 56 00 ~ ~ · . .,,Z-z.~ -- . :,v,,:? ~ i [ ! .....:.>:.:~+ , . : ' X-'T - ......... , ,,-,.~:.~ ~~"?:?- ~:-: ........ :~~ ..... . .... - ;; .-~ .;~ . .,-;,:,~F't~4'2.,. , ., ~, ~'5..9,-?,~'.~2,'.' Ii0V-23-93 ?UE 8'22 Fa}: i% P, 07 STATE BOARD OF EQUALIZA'FION BAKERSFIELD ATTN: KERN VIEW HOSPITAL - .................. .3600 SAN BI,AS $]REET 8AKERSFiELO, CA 93]0! ~ .......... *"'"~ The Underground Storage Tank ~ -, ;-,ccoun~ Number listed above has been assigned pursuant ~o your recent teiephone call tO this office. This account number Board "Underground Storage Tank Permit Appl ic~t[om-.Form A", Section 25299.ql of the H~2alth ~nd Safety Code s~ates that ever;, Qwner of An ~Jnderground storage tank who is required to obtain a permit to o~,r. cr operate that tank must pay a storage fee Lo [he Board of Equal ~zatio~. The fee app] [es to petroleum products ptacad in your tank during the reporting c, er[ You wilt receive qua~t_erly re~urn~ to report a~d pay your fee. The return and payment ~s dLle on the 25~h da~ of ~he mon'~h following the quarter for ~hich YOU are r~portic~9. If You have ar~y' r'~t.lrA$ due or overdue, ~hey are enclosed wi~h this In[tar. fhay should be completed and mailed back ~o [hi- office within fifteen (lays. P~ease keep this let. tnt for your record~ as confirmation of registration and refer tO the enclosure for f~rther information on this program. have any ques[ions~ please contact (zr e i Program '~ ' Special Taxes O/vision UNDERGROUND STORAGE TANK MAINTENANCE FEE PROGRAM Senate ~il! .{:004, Chapter 1366 imposed a quarterly fee effective January 1, 1991 of $0~005 for each ga3..lon of petroleum placed into an underground storage tank. ' . ~h~ new quarterly fee is due on the 2Sth of the month following the end of the quarter and applies '%o owners of undergrot%nd storage tanks. You will receive the return approxi~,~ately one 'month before t. he 'due date. "Owner" includes, but is not limited to, any city~ county, cr district, or any agency or department thereof~ but does not include the state or any agency or department ~hereof~ or the federal government. All site locations of an owner will be r~=~o.~t~.d on one return. The fee does not apply to petroleum products placed in underqround storage tanks 'that: -' ! Are ~.c,~-~ r=,~].~en~e, and used to - =v~=~.~ or~ a farm or ' store motor fUel for nancommercial purposes and have a capacity of 1,!00 gallons or less. 2. Store hea~ing oil for consumption or, the pre~Lises where stored. PLEASE NOI'~I: If you are ne~_ 1:he o.:cner of an underground storage tank, or you think you might c~anlify under one. of the e×empticns provided, contact us :~t ~he address or phone number listed below, so t?:at appropriate corrections can be made to your account. In addition, if you have received mere than. one copy of this letter, you probably have more than one account issued in your name. If this .is th~ case, please contact us so that al!. of your accounts can be combined into one account to report the new fee. If you have any further %Juesr. ions regarding the application of the underground storage tank fee: or have questions regarding your account, please contact the. Environsental Fees Section of the Special Taxes Division at the address or phone number listed be!o~;. Special Ta}:es Division 'Environ~*.er':tai Fee~.~ Section P~O. box 942879 Sacrament:o, CA 94279-0001 (91_6) ~23-955S '1 ,,~,[ OF P,O. BOX 64? BOARD OF EQUALIZATION ~LiFORNiA SACRAMENTO. (]~, 9~803-0647 UNDERGROUND STO~G[ ~ANK FEI RETURN ~a,~ ~o: USTC RVTK0! 1 ~91 T~ ~q 44--03386] S%~'YE BOAR[.) OF EQUALIZATION ..?:O. 8OX 64F BAKERSFIEL,D NE;~OR:[At. HOSPITAL ..... ' " . ......... ,,., " ' ... ....... " o~ addras~ [~ ~ncOr,'eC't. : . GENE~At. INFOgMATtON AND DEFINITIONS ~'~"~gk~~g underground sIotage tank ~ho is ~equimd to obtain a perr~it to own or operate a tank pursuant to Sec/ion 25284 of lI~e Meal/h and Safepf Code ~h~ll pay a ~tor~ge fee lot each fialk*n of petroleum Droducts p~aced in ~e "O'WNE~" does not include the state government, feder;[ govemme-~, or an operator who rs not art owner, "Petroleum" is defined as crude oil or any fraction thereaC which ;s Uq,Jid at s~andard conditions of temperature [60 degrees Fahrenheit) and pressure (14.7 pounds per square "Underground Storage Tank:~ means any one or combination of tanks, {nch~ding pipes cormecr~d to the tanks, used [or the ~torage of h~ardou~ substances and located substantially or ~otally beneath ~he surface of the g,'ound. - The fee does nor ~pply ~o p~{ro]elJn'~ product¢ ~!aced in underground ~[orage ~ . ,an,.o that: 1, Are localed on a farm OF residet~Ce, and used to StOre motor ~el for hon.-commercial pur'posei and have a capac:iw of 1/100 8afioas or less, 2, Store heating off for <:o~sumpdon on the premises where stored. Ebe~ tank owner who holds a permit fo~ an underground tank shal~ file a qua~erly sro¢age fee return. Thi~ return is due on or before ih[ 25{'h day of O'~e month following ~he calendar qua~er f,:,~ which"the fee ~ due. ~l[&. re~urn mu~t be filed even thouBh you have no Iiabill~, for Ibc fee. {.ate pavmeH( iht=rest at an aeJ~usted rate established pursuant h9 Secfio~ 659%5 of tile Revem~e and T&<ation Code, I NSTRU~IONS ....... ~ OtC you the .OWNER of an undergi'ound storage tank? Check On(: · - 'Yes~ · NOD ............. If you checked ye~,'complete lines !-4. l~ you checked n°, please furnish the foHow~ng information about the owner: OWNER'~ NAh~ ADDRESS, Cl~', SI~ATL ZIP PHONE NUMBER ~ u n ~; ~no ~.'st¢ 8~at number i~'~ column C, Kate of Fee To'l:~[ Fe~ Due .......... L (Col. .. ' ....... t ...... ................ 0.0o6 2. Penal~' of '10% (,' O) if payment ~ made after due date ndh:atod . 3. IS DUE IF PA.Y*ENT I.S' MADE AFTER THE DUE N0V-23-93 ?UE 8:23 RiN0 FAF,' i'i0, . 275806 P, I0 -' ~T^TIi OF P-O. BO× 647 BOARD Off EQU.~.LI',,Z,A'flON ~NDERGROUND STO~GE TANK FEE RETURN ~ Mai~To: USTC RVIffOl ~IB~ T'E Hf~ /~4-03386~ STATE BOARD OF [QU &U~A'TIOH ~CISE T~ES DIVISION ' B,~KER~,~IEL.D ~&~ORIAI. HOSPIRAL SAC~M~NTO, CA, 95803-0647 A2~N: KE'RN' ~' ~ ' vI~ HOSPITAL 3600 ~4,,, S']'~ 8ET ~[,~o BAKERSFIELD, CA 93301 - . . B[FO~[ ..... : ..... '.. ..... . ............ - ....M~e Ch0nge~ G[NE~RAJ. iNFO~'~A"FION ,,~F4D DEF~NI'UONS Ever,/OWN'ER of an underground ~to,'age tank who is requh'ed to obtaiB a.c'ermit to own of operate a tank pursuant to Section 25284 of the Heahh and Safeb' Code shalt pa>~ a str~rage fee for each gaUon o¢ petroleum products pi.aced {n the tank. '- - - "OWNER" does not include the state gov*m~menb federaf government, o;' an operator who is no~ an owner, "Petroleum" ~s defined as crude oll or any haction thereof, wlnich ~s liquid ar standard conditions of temperature (60 degrees Fahrenheit) and pcessure (14.7 pounds per square c derground Storage Tank" means any one or combination of tanks,. Including pipe~ connectod to tl~e tanks, used for the ~tocage of h~3rdous substances and located st b~tantfal v or totally beneafh the sudac, e o{ the ground, ' .  ' /he fee does not apply to petroleum product~ placed in under, round cdora~e tanks *~ 1. Are ~ocated on a farm or residence, and used rD~=k;._n'~ motor, fuel, . for non-commm-c[al purposes and have a capadty of ],100 8ailons or lest. 2, Store heating DJ} for consumption on lhe premises where stored, Every tank owner who holds a pe~nit for an underground tank shll file a quarterly storage fee return.. This return i~ due on or before the 25[h day of the month (ol]owk~g the calendar qua~ler for which the fee fs due. II~is return must be fi~ed even though yc~t, h. ave no ~/abil~T for the fee, Late payment re~uh_q ~n a penalty' of 10% and [nterest at an adjusted rate established pursuant to Sec;tien 659'l~5 of the Revenue and T'axa~ioa Code. . .~e you. the OWNER of an underground storage lank? Check Or,e: Yes~ No~ "' If you checked ye~, complete lh-~es 1-4.. If you checked no, please fumeS, ';he fo, lowhag [niorma~ior~ about the OWNER'S PHONE Nb,4BER. i, Total gallor~s~ of petroleum placed ~n alt tanks owned, =2. ~ ~ 0 2. Penal/' of 10% (.10) if payment is made after dt/~ date ind;cared above. Penalty IS DUE 1F PAYgENT l,S ,~ADE. ~FTER !HE DUE DATE, intere~ 4, TOTAL ,~OUNT DUE AND ,WqYmB~E' ' (Line '1 pJus Unes 2 am~ 37 N0¥-2~-~3 TUE 8:24 ~NG % ?7~80fq P, 1 ~LIFORN!A ~.C~,MEN'FO. CA ~S803.0~47 E,XCISE TA~E5 STATE ~O,A~ OF EQUALtZA, T]ON EXCISE TAXES DiVISK)N ~.O. 8OX 647 .; BAKERSFZ~LD N~r'~'"~' ""F'~Tm~~ _ SAC~MENTO.. CA, 95803-0647 ATrN': KER~ VIEW }~C)SPITAL 2600 SAN Di}b~.S S"['~EET ~x,a gAKERSFIELD, CA ~ ........ BEFORE PR[PAR~NQ ' '. :" ' : ' '" ..- ' ,- . . . M~ke change~ (]ENE}~L iNFORMATION AND D~F~bff~C)NS to Section 2528e' of the ~eaith at~d Safety Code shall pay a storage fe~ for eacl~ ~a~lom of petroleum products placed in the t~nk "OWN[F~" Es de~'ied to w,c:k~de a~). person as well ~s ~m,, ctW, county, dJsthct, a~encv, ~-~c ud~ng depa~men~. "OWNER" does not ~'~c~ud~ the ~rate govemmem, federal government, or an operator wh~ i~ not an owner. "Petroleum" is defined a~ crude oil or an5, fractien tl~ereo( whk:h i5 }iqu{d a~ star, doral co~ditkms of temperature (6f~ .egrees FahrenheiO and pressure (1,4.7' pounds per squar.f inchL YUndergrour, d Storage Tzt~k" meaqs 8ny one or comb~naG~r, of [anks, including pipes connected to the [anks, used for the ~tc,..Be of hazardous 5ubst~qce~ and located sug~Dnt/~U,>, or Iota ]y beneath ~he ~ud~ce of the ground. l'he leg doe~ not appfy (o pe~romum, prc:ducts pieced in ur'~dergro~ pd storxee t,nk5 1. Are io(;ate:: cna term or residence, and used to ~,.~.re motor fl,i~ for ~oc.-cc. mr'netc/a! purposes and have a ~:ap~c'ily' of t.t00 ' 2. Store he~tMg oil ' ,r ccm~.umF, tlor, on the p ..... ' ...... where stored. is due o~ Or b...fo, .. ; ~ · , -o l,~,. 25tk, day ef the mond~ }'ollowfftg the c~]endar quarter tot which the fee is due. This return ,near. be EJe~ wen though you ha,~,e ho ii,billb. ~or the ~ee. ~'- , . inter~st at an adjusted r' ~= e-r-,hl;~ ,,,~ ~, ....... , ........ ~t~ payment re~u2s M a. penalt~ of I[~% and -' Are you the OWNE~ of an under'ground st0ra~ tank? C[56ck One: ' Ye~ ~o~ ..... . .... If you checked yes, complete /ir:es' !-4. I':: you '-~ ' ' ~ ~,~¢c,,:e¢ no, p~ease f'um~sh the follov4ng [mormatio~ about the OWN E'P,'S NAME AODR~'<< Ci~, STATE 7 P .... 7";~ ..... :-TT-U'"T'V-':'~ .......... : .......... : ................ : owrt~ by you in column A; multiply b), the ~ate ;r, } who~ O~lom On~ R~te of ~e ToTal Fee ....................................................... F ........................ (C~I. A X L ro.m gahons at p~troleum placed n a tank< owr, e-~ J ..5 Z~: t) 2, Pe,q~l~ of t0% (.10) ?~ paYmen( ;t mad~' ~fter d'u~ date i '~" - ¢ , .-- - n=,~ateJ above, pcna~B, J- tS DUE IF PAYHENT iS HADE AFTER THE DUE DATE. HOV-23-93 TUE 8:26 .... ;[% ~mv !'JO, !75806 F', .:.--.;/'UNDERGROUND sTo~AGE TANX F~E RETURN "" ' t = .... . ._ - 0iI2~/9Z O~ OCTOBER - DECE~,~ER 13~! - ' i USTC RVTK01 ~lSl [ ~I~ Hq ~4J-~33861 STATE BOA.RD OF EQUAiJZATION SPEC~L T~ES DtVtS~ON ~. ...................... P.O. BOX 647 ~' *~'r ~"~' ~ , -~, o ~.,~.~;XS, ~E!,D :~IO. IAL HOSPITAL SA0~tENTO. CA 9580a-0~47 ATT.~: ' . ,,.. ...... .... · . .. , 'XE~sX viEW .. . ,;~,~ .D.LH~D STREET READ iNFORMATiON ' BA~:RSF!iL.D, Ca 9330t B~FORE P~EPAF~NC~. ~ ' ~ address }~ ~correcL ,;. '" ::..;..f:.':'L:Y::z'. :' :.:" .z!'.:'.~: ' ' ." };: jf~/f/.:-;;: . .... -- -'.' .... ':' ' .... . . :.. '..:.. ::: .: ,:-...,...,....~ ..:._: ....: .:.? '4 .... """ ; GE~NE,c%':~L tNFO!qM,-'~?'~O,~,~ .AND m::z-, m.,r-,,,~ ................................... in the ~nk "' :,. , 'P~o~eum' Is defined as '~de oi¢ ~r ~ny f.*'-~'--~ - ~, - . ' ' .... ,~,,9,,5 of the Revenu~ ~d T&x~tion O;2do. The return must be/Hod eva~ ...... ' ~ U~e current owr;~r aJ~d (hs~r ¢ ". *. _,.,,. pc~es~/'lot;fy [h]s o~co. l~ you are riot the ~a~k owner, please indicate '~. ,',~ ,t~ ~'!ho,~ Gs~ (:os On~ ~ Rat~ o~ F~ Toi~ ....... t¢t~ Ho I ,..,.?.. · . : . . . : ,,. ..... . ( ) :. , . ; :-. . - · AM'a:~ wd~ your ~,~ num~- 5a 3~3u-t chiS; c~' mo,~ey order. Ma~ a ~py Of ~ do,::ume~t f~ your r~co~d~ ') · .':. ........ .:.. r_'b ...... ,._ ,..,.~ STATE r~F O~J~ ,F ~ ~ ;,t,,~ STAT~ ~OARD OF SP~C~AL TAXES (316) 323'"9669 ".-..?K H~ 44-o33~ ' " ' ~oo s~.~.~ ~, BAKERSFIELD FIRE DEPT HAZARDOUS MATERIALS DIVISION Operating·Permit: ~_5'~'C,.~ ' ~/~ Date Completed Business Name: ~ ~ ~ /~(~t' Location: NA.~ ,3~~ ~ Business Identification No. 215-000 ~o~ ~op of Business Plan) Number of Tanks: / ~.~C Type:'~,/ ~' ~ [[ Containment:. ~ Lines; _~J ~,~/( Contact Information" Owner: Emergency Contacts: ~ .~,'~ Adequate '-' Inadequate Monitoring Program _~' _ Records Maintenance _~ _ Testing .~ _ Inventory Reconciliation _.~ _ Response Plan Emergency Plan _~ _ Ail Items OK Correction Needed Business Owner "BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 RECEIVED Z ~,~CATION ~ PER~OR~ A TIGHTNESS TEST 1993 DIV. i , FACILITY N'~Ko~t~ ~o~ p~AL ~DRESS H~o 3~ t~ PE~IT TO OPE~TE ~ O~ ~o~ OPE~TORS N~E ~ A~- O~ERS N~E ~ER OF T~KS TO BE TESTED ~ IS PIPING GOING TO'BE TESTED TANK# VOLUME CONTENTS I 300 D ~ WSe < TANK TESTING COMPANY ~o=~ ~¥ $ ADDRESS TEST METHOD ~b~ NAME OF TESTER~-~%~ '~oc~u4~m CERTIFICATION # STATE REGIST~TION % -~.~.: ,~-~%,~ HAZARDOUS MATERIAL DIVISION ~ ~:~ ¢~ 2130 G Street, Bakersfield CA 93301 (805) 326-3979 kP~LICATION IS BEING SUBMITTED FOR THE FOLLOWING REASON: PREVIOUS~TANK O~ZR (if applicable}' -: . ' ~D~SS ~!LLIN~ DORESS . '3a~e TA~ OPE~TOR-(if different from owner) APPLICANTS N~E (if different from owner) T~K LOCATION EMERGENCY: CONTACT TANK INFO~T~ON tank~ volume date installed substance stored previous substanc Do You Have an OWNER - OPERATOR AGREEMENT? Have You r~-±~I Gut a n~,'uu,~ i~A~ERiAL BUSINESS PLAN? ~{~ date · name (print) signature STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION. FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARKONLY ~' 1 NEW PERMIT L~ 3 RENEWAL PERMIT E~ 5 CHANGE OF INFORMATION [~ 7 PERMANENTLY CLOSED ONSITEJ ONE ITEM [] 2 INTERIM PERMIT E~ 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [~] 8 TANK REMOVED DBAOR FAClLITY NAME WHERE TANK IS INSTALLED: K~ V/~W Ho~p~/j I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A, OWNER'S TANK I.D.~ ~4~~ B. MANUFACTURED BY: KOHLE~ O0 II. TANK CONTE~S ~FA-1 IS MARKED, COMPLETE ITEM C. A. ~ 1 MOTOR VEHICLE FUEL ~ 4 OIL B. C. ~ la REGULARuNLEADED ~ 3 DIESEL ~ 6 AVIATION GAS UNLEADED ~ 5 JET FUEL ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 OTHER (DESCRIBE IN ITEM D. BELOW)J II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANOC, ANDALLTHATAPPLIESlNBOXDANDE A. TYPEOF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WITH EXTERIOR LINER ~ SYSTEM ~ 2 SINGLE WALL -- ~ 4 SECONDARY CONTAINMENT (VAULTED TANK) B. TANK ~ 1BARESTEEL ~ 2 STAINLESS STEEL ~ 3 FIBERGLASS ~ ~'~ -- 3LASTIC MATERIAL ~ 5 CONCRETE ~ 6 POLYVINYL CHLORIDE ~ 7 ALUMINUM (PrimaryTank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN C, INTERIOR ~ 1 RUBBER LINED ~ 2 AL~D LINING ~ 3 EPO~ LINING ~ LINING ~ 5 GLASS LINING ~ 6 UNLINED ~ 95 UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES~ NO__ D. CORROSlON ~ 1 POLYETHYLENE WRAP ~ 2 COATING ~ 3 VINYL WRAP ~ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ~ 5 CATHODIC PROTECTION ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER E, SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED ~EAR) IV, PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND, BOTHIFAPPLICABLE A. SYSTEMTYPE A~ 1 SUCTION A U 2 PRESSURE A U 3 GRAVI~ A U 99 OTHER B. CONSTRUCTION A~I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND A~ 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POL~INYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 10~/~ METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIO PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR ~ 2 LINE TIGHTNESS TESTING ~ 3 INTERSTITIAL MONffORING ~ 99 OTHER V, TANK LEAK DETECTION ~ O TANK TESTING ~ 7 INTERSTITIAL MONITORING ~ 91 NONE ~ 05 UNKNOWN ~ 90 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY. R) 2. ESTIMATED QUANTI~ OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS iNERT MATERIAL ? YES TH/S FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOOAL ABENOY USE ONLY THE STATE I.D. NU~BE~ IS OOMPOSED OF THE FOUR NUMBERS BELOW COUNTY ~ JURISDICTION ~ FACILITY ~ TANK ~ PERMtT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM B (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERM~ APPLICATION. FORM A, UNLESS A CURRENT FORM A HAS BEEN FILER. FORO~a-~ STATE OF CABFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY~SITE MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED SITE ONE ITEM i---] 2 INTERIM PERMIT [~ 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FACILITY NAME NAME OF OPERATOR ADDRESS - - ) NE.~E~.. C..~ STREET PARCEL # (OFTIONAL) ~t~o~ £ an D,'m'~£ .¢7: CITY NAME STATE ZiP CODE SITE PHONE # WITH AREA CODE ' ~ ~ / _d._p/,_qp'P.//,~ CA ~$~0! (o~oS ~' BOX TO INDICATE ~CORPORATION [---[ INDIVIDUAL [---] PARTNERSHIP ~-~ LOCAL-AGENCY [~ COUNTY-AGENCY E~ STATE-AGENCY [---I FEDERAL-AGENCY DISTRICTS TYPE OF "USINESS [-~ 1 GASSTAT'ON r-"-~ 2DISTRISUTOR~ 3 FARM ~ 4 PROCESSOR ~ 5 OTHER I J--"'~ ~" 'F INDIAN '# OF TANKS AT SITE I E'P'A' "D'#(°pti°nal)~oRRESERVATIONTRuSTLANDS ' EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional I DAYS: NAME (LAST, FIRST) __-- PHONE# WITH AREA CODE DAYS: NAME (LAST, FIRST) PHONE. WITH AREA CODE I I NIGHTS: NAME (LAS'~, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) iNA . CARE OF ADDRESS INFORMATION 420 .~-t-- ~'f'reef- ~co..O~AT,O. ~.AR~N~.S.,. ~COUNTY.AGENCY ~EDERAL-AGENOY CITY NAME -- I.~HON~# WITH AREA CODE STATE z,PCOOE III. TANK OWNER INFORMATION - (MUST BE cOMPLETED) NAMIPF OWNER cARE OF ADDRESS INFORMATION ~el.'b VI;eh~ ['/osp/'b'~ [ , z/IO. MAILING OR sTREET ADDRESS ' I '/ box to indicate 6---I INDIvIDuAL ~ LocAL-AGENcY ~ sTATE-AGENcY 3¢00 san D/mag St. /~.co..o.A~O. :~PART.E.S.,P r~COUNTY*GE.CY ~EDERA.-AG[NCY CITY NAME -- -- / STATE I ZIP CODE I PHONE # WITH AREA CODE Iv. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 if questions arise. V, LEGAL NOTIFICATION ANB BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY COUNTY # JURISDICTION # FACILITY # I 1ol ol51 LOCATION CODE - OPTIONAL /CENSUS TRACT # - OPTIONAL SUPVlSOR - DISTRICT CODE - OPTIONAL / THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR IVlORE PERMIT APPLICATION - FORM B~ UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY, FORM A (9-90) FOROO33A-R2 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION STREET 3~) .~q ~)]f/7~ -5"7';', CITY '~~.~'-/"~ COUNTY /"~ I'/'3 I1. INSTALLATION (mark all that apply): ~ The installer has been certified by the tank and piping manufacturers. ~ The installation has been inspected and certified by a registered professional engineer. The installation has been inspected and approved by the implementing agency. All work listed on the manufacturer's installation checklist has been completed. The installation Contractor has been certified or licensed by the Contractors State License Board. [] Another method was used as allowed by the implementing agency. (Please specify.) III. OATH I certify that the information provided is true to the best of my belief and knowledge. TankOwner/Agent ,~i-i"l ~/'/t~, /_t/0,¢tD1,1,.~/ .~ .]Tt'] ~, Date /~/.~//~'~ Print Name '~ ~',Z',/-- /O,~/.~ ~C"/~t ,.V~__~ ~~ Phone Address 34m 5~ b,~ ~ ~H~¢/~ ~ LOCALAGENCYUSE ONLY STATE COUNTY # JURISDICTION # FACILITY # TANK # FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FOR003507 ~.,. ~:.' . · ,. ~ :'~ .............................................. ~ . . , . . ~ ' .": ~'.'4' ' · ' ' ~ ' ~ , ' ' ' ' 'F'"* ' . d~ '" ' '~ ~'''' B~RSFIgLD CI~" FI~ ;DgP~~ ?* :" , JOg D~00D~ , ~' . ~;. ,, . ~'::: Total. Amount Remitted.to SWRCu' .... ~, : ~-, ',. Contact Person .... . ...... ~ nus 6% Local Implement!ng.~ 6ggncy~· ~ ~ .. ,~ ~ : , ~ :~,~, .~,;~ (Collected amount m~ ) ' 2130 O ST~ET :':':::~ ~: ~'~ ~: ~ ~' . ~ ~:3~05.:,)_'~.6-3979 ~ · ".~?: ': Number:of Tanks for which ~:.:. :- ~ ...:.. '. ~ .:, 'rele none::,.,.. :. ~- · - ';'".;. Address ~ ~ ':'~'~ ~'~ ~ "'~"~: i g'~' ~-~ '~ '~ ' ~ ~': ~'' '~ - ' ''~: Surcharges. Remitted , .,.... ~-~ · .. ,,. , ...... - ~ ~-,, ~-,.. .~ .~ · · , ,.- . 2/92 ...... · ."'~F.- ".; '~ ;~ ~ ' ~ '... ~.,: ~: : ,.'. ~ , ~ · ~ ....... ~ Collection~.Period_ , , B~RSFI~D, ,CA.. ~, . ~.-~:z · .:'., ~ ' c, .~ ..... · ., ... .~:: ,~, . ..... ~ .... (month/year) Tan~rOhar~e D'-'-- '"' 52.64 ~-n~l-nnnS05-000001,~- '- Kern V~ew~,Hosp . : , .::. . .,. ,:? ~;, ~; ~. .:..:.......; , · .. 15-021-001403-000001 Y · gal Weste~n,.T~ansP.or ' ~.: .., :...: .. , ~, .. · . r .,~ ... :: ,,. ', ;~ .... ',:' '. ,. " ' ' '~ ," ~','~F ., .: , ,... '; t~ :t C '', '~.. .:;. ...... ,' .:.¥,~;.~ .... ;.' ;~ ' Board 1 i v') , ,, $ F?:'. ~ " : ~{ "~f%- ' ~, ;-, : .'~, l.,~,.~: :",::.., . . ~ Stat~ ~ater Resources Contro~ h~ ~ ':~'~ ~'' *;~ ....."'~ " ' *' '*~ L' I ANO CHECK '~1 P- O..Box 100 .. ~' ,.~ .:~ .. ~. ~:' ~ * I HAIL FORH "l'Acco~t{ng Office * (1/1/92) HAZARDOUS MATERIALS DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3970 "7~,oo I' '- UNDERGROUND TANK QUESTIONNAIRI= RECEIVED I. ' ' I E No. OF TANKS HA? MAT D!V. DBA OR FAClI. ITY NAME INAME O~ OPERATOR /~/-m V,'~W //osp/~-a/. ~/C. /~e/-, v,'e,,v, ~a_c~//-BI .~,vc.' ADORE~ IN~R~T CRO~ STRE~ C~ ~ME ~ ~XTOINDICATE ~R~ON ~IND~IDUAL ~PA~E~IP ~L~ALAGENCY O~lC~ ~COU~ AGEN~ ~STA~ AGENCY ~FEDE~L AGENCY WPE ~ BUSlNE~ ~ I GAS ~AnON ~ 2 D~IBUTOR J ~ COUN~ PERMff ~ 3 FARM ~ 4 P~E~R ~OmER J TO OPE~ ~. .... ~?.~ ......... EMERGENCY CONTACT PERSON (PRIMAR~ EMERGENCY CONTACT P~RSON'(SECONDAR~ optional o~s: .~u[ (~S~. ~mn PHO.e ~. w~m AR~ COO~ I O~VS: .~U~ (~S~. nm~ .HON~ ~. w~m AR~ CODe II. PEOPERW OWNER INFORMATION (~UST BE COMPLETED) NAME CARE ~ ADDEE~ IN~RMA~ION Cl~ NAME ~ II1. TANKOWNER INFORMATION (MUST BE COMPLETED) NAME CARE ~ ADDRE~ INFORMAHON MAILING OR STREET ADORE~ ~ BOX ~ INDIVIDUAL ~ LOCAl. AGENCY ~ STA~ AGENCY ClW NAME STATE J ZIPCOOE J PHONE No. WITH AR~ CODE OWNER'S DATE VOLUME PRODUCT IN TANK No. INSTALLED STORED SERVICE Y/N Y/N Y/N Y/N Y/N DO'YOU HAVE FINANCIAL RESPONSIBILITY')..~ON TYPE '~* ..... Fill one segmen~t for each tank, unless ~ tanks and piping are constructed of tlTe same materials, style afl-type, then only fill one segment out. please identify tanks by owner ID #. I. TANK DESCRIPTION COUPLE~ ALL ITEMS - SPECIFY IF UNKNOWN TANK II1. TANK CONSTRUCTION A. ~p~ OF ~ ~ ~UaL~ W*~L ~ ~ S[N~ W~ W~ ~mO. U.~. ~S UNKNOWN SYSTEM ~ 2 SINGLE WALL ~ 4 SECONOA~ ~TAINMENT (VAUL~DTAN~ ~ ~ O~ER B. T~K ~t ~RESTEEL ~ 2 STAINLESS S~ ~ 3 FIBERG~S ~ 4 STEEL C~D Wl FIgERG~ REINFORCED P~TIC MATERI~ ~ S ~RE~ ~ e mL~l~ ~LORI~ ~ 7 ~UMINUM ~ 8 1~ ME~ANOL ~MPATIBLEW~RP (PHm~T~k) ~ g BRON~ ~ 10 ~LVANI~D S~ ~'~ UN~O~ ~ ~ O~ER ~ ' RUBBER LINED ~ 2 ~D L..G ~ 3 ~ LIN,~ ~ 4 ~ENOL< LINING C. INTERIOR UNING ~ 5 ~ UN,~ ~ "UNLINED UN~ ~ ~ OmE" Ig LINING MATERI~ ~MPATI~E ~TH 1~ ME~A~ ? YES__ ~ ~ O. CORROSION ~ I ~L~NE WR~ ~ 2 ~A~ ~ 3 ~ ~ ~ 4 FIBERG~S REINFORCED ~S~C PROTEC~ON ~ 5 ~ PROTECT~ ~ 91 ~NE ~ UN~ ~ ~ OmER N. PIPING INFORMATION cmc~ A IFASOVEGR~NDOR U IFUN~RGROUND. BO~IF~L~A~E k SYSTEM TYPE ~ 1 SUC~ON A U 2 PRESSURE A U 3 G~VI~ A U ~ O~ER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 ~USLE W~ A U 3 LINED T~CH . A (~)~ UN~OWN A U ~ O~ER C. MA~RIAL AND a U 1 ~RE STEEL A U 2 STAINLESS S~ A U 3 ~L~IN~ CHLORIDE(PV~A U 4 FIBERG~S PIPE CORROSION a U 5 ~UMINUM A U 8 ~NCRE~ ~ U 7 STEEL W/ ~ATING A U 8 1~ ME~ANOL ~MPAT;BLEW~RP PROTE~ION A U g ~LVANI~D S~EL A ~ l0 CATH~PROTECT~N A~95 UNKNOWN A U ~ O~ER D. LEAK D~ECTION ~ I ~TOMATIC LINE LEAK DE~CTOR ~ 2 LINE T~H~ESS TESTING V. T~K LEAK D~ECTION MONITORING ~ 6 TANK TESTING ~ 7 IN~RSTITIALMONITORING ~ gl ~E ~;5 UNKNOWN I. TANK DESCRIPTION COMPLET~ ALL ~T~aS- SP~C~ ~ UNK~ A. OWNER'S TANK L O., B. MANUFAC~REO --" C. DATE INST D (MO/OAY~EAR) D, T~K C~ACI~ c0"ST.uc o. ....." SYSTEM ~ 2 SlN~W~LL ~ 4 SECONDARY CONTA~NUENT ~U~OT~N~ ~ ~ O~E~ 8. T~4K ~ ' ~RESTE~ ~ 2 STAINLESS STEEL ~ 3 FIBERG~S ~ 4 STEEL C~O W/FISERGLASS R~I~FORCEDPLASTIC MATERJ~ ~ 5 ~NCRE~ ~_ ~ 6 ~LWI~L CHLORIDE ~ 7.,~bMINUM ~ 8 1~. ME~ANOL ~MPATIBLEW~RP (PHm~Tank) ~ 9 BRON~ ~ 10 ~LVANI~O S~ ~% UN~OWN ~ ~ O~E, C. INTERIOR ~ ~ RUaSER L,NEO ~ '~O L..G //'~ 3 ~O~ UNINO ~ 4 ~ENOLC UN,NG IS LINING MATERIAL ~MPATIBLE ~TH 1~ ME~A~? YES NO D. CORROSION ~ ~ ~LYE~YLENE W.AP ~ 2 ~A~G ~ 3 ~L WR~ ~ 4 FIgERGL~S "E~NFORCED P~ST~C IV. PIPING INFORMATION cmc~ A IFA~O~GROUNDOR U IF UNDERGROUND. BO~P~ICAeLE A. SYSTEM TYPE a U 1 SUCTION / A U 2 PRESSURE A U 3 GRAVIW ~".~ A U ~ O~ER 8. CONSTRUCTION A ~ 1 SINGLE A ~ 2 ~UBLE WALL A ~ ~ LINED TRENCH ~ ",,%A ~ g5 UNKNOWN A U ~ O~ER C. MA~RIAL AND a ~ ~ ~RE ~EEL A ~ 2 STAINLESS S~EE A ~ ~ ~IWINYI CHLORIOE (P~C) A ~ 4 FIS~RG~S PIPE CORROSION A ~ 5 ~U~INUM A U 6 CONCRE~ A U 7 STEELWICOATING "'A ~ 8 1~. ME~ANOL COMPAT;8LEW/FRP PROTE~ION a U 9 ~LVANI~D S~EL A ~ 10 CATHOO~PROTECTION A ~ g5 UN~OWN A ~ ~ O~ER D. LEAK D~ECTION ~ 1 ~TOMATIC LINE LEAK DE~CTOR ~ 2 LINE T~H~ESS TESTING ~ 3 INTERSTIT~L ~NUORING ~ ~ O~ER V. TANK LEAK DETECTION 6 T~NK TCSTING ~ I 7 INTERSTITIAL MONITORING 9l NONE ~ 95 UNKHOWN / IBEX Pre,cision Tank Test BROCKWAY'S TANK TESTING Bakersfield, CA. USA (805) 834-1146 Performed for: Memorial Hospital Test Location: 701 34th Street Bakersfield, CA Test Identification : 1078-1 Test Date : 08-23-1994 Start'Data Collection : 08:!9:35 Ending Test Period : 10:24:33 Time Filled for Test : + 24 hrs. ---- Tank Data ---- TANK I~. :Kern View Generator CONTENTS :DIESEL Volume '" :300 Diameter :48 Depth Bury :50 Product level :90 Groundwater :> 15 FT Pump Type :Suction Tank Type :1 Wall Steel Water in Tank :0 Test Fluid :DIESEL Vapor Recove:ry :N/A ** Test Report ** Average Rate of Change is based on 244 Data Points Standard Deviation .............. 0014 Gallons - Volume change of Tank Contents - Net Volume * ( 60 min/Test Time) .041 Gal. * ( 60/ 61.32 min.) = .0402 Oph. - Volume change due to Temperature Avg. Temp. * Volume * Goer. of Expn. * (60 min./ Test Time) -.0088 Deg. F * 300 Gal. * 0.00047 * 60/ 61.32 = -.0012 Gph. Net change = Level Volume - Temperature Volume NET CHANGE . . . O.O414 (]PH. Based on the Information provided and the Data Collected This Tank & Flooded Lines Test has ...... PASSED Certified Tester : Robert Brockman # 92-125'1 {~~ .~_~~.~ This Test complies with U.S.EPA and NFPA requirements. P~,ocluc t DI F. SI~L ~Test Date'. ~8-23-1994 "" Length (M~n,) 61,32 Ir mmmmmmmmmm mmmm mmmmmmmm m m mm mmmmmm mmmm mmm mm mmmmmmimmmmmm mm m mmmm m mm Leve I ?~eo ~ s ~eMp, P~eoision 2S gal,- · ..................... 5gal,_: Level: 8,6402 Gph, NET CHANGE .... ..,m~.-,mmmlmWJdkiiWmlkmmdmlmd lmm milliliiliim mmmm mmmm ~ Li~uicl Level 99 .... · ,...--.mui,lmimlmmkmmwmmmmmmlmmmluiml,,lllimmWm,mmm, ~ GPouncT Wa )~tical Scale I: ,'01 gal, 6,3 Min. ~%~.._..._ ,.../ ',§ ga ..... , _._.~/. 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST PERMIT TO OPERATE # O00.~..~-J_~ . OPERATORS NAME.-~.J';W A- OWneRS N~ . - - -~ ~ER OF T~S TO BE TESTED / IS PIPING ~ING TO'BE TESTED .Y~ T~ VOL~ CONTE~S TANg TESTTNG COm~a~r~-~z~c~-~'S ~D~SS~./~. D~ ~~a ~o ~ TEST ~THOD '~Z~ .......... N~ OF TESTER~o~r~ ~/~z~zW~ CERTIFI~TION % STATE ~GIST~TION % ~/~/ DA~E & ~ ~ES~ IS TO BE CONDUCTED ~//.7 o~ ~ ~ROVED BY: DATE SIGN~ OF ~PLi~ B;tKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION'TO PERFORM A TIGHTNESS TEST FACILITY ~'~o ~'~/%~. ~o~ p?c^L' ADDRESS PERMIT TO OPERATE # O O cD ~ o ~ ~ OPERATORS NAME ~ A ~- OWNERS NAME NUMBER OF TANKS TO BE TESTED I IS PIPING GOING TO'BE TESTED TANK% VOLUME CONTENTS TANK TESTING COMPANY TEST METHOD N~ OF TESTER DATE