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Home My WebLink AboutUNDERGROUND TANK-C-5/6/88 .. FILE CONTENTS SUMMARY ' PE~IT ~: Oq O0~% ENV. SENSITIVITY .~5 :, A~ivt~y Date · Of Tanks Comments 2700 M STREET .,ERN COUNTY HEALTH DEPARTMI:NT .eALTH OFFICe, MAlUNG ADDRESS Leon M Hebertson, M.D. 1415 TRUXTUN AVENUE ENVIRONMENTAL HEALTH DIVISION BAKERSFIELD, CA 93301 DIRECTOR OF ENVIRONMENTAL HEALTH (805) 861-3636 Vernon S. Reichard Nay 6, 1988 John MaCutt AT&T 1530 20th Street Bakersfield, California 93301 Dear Mr, MaCutt, This is to advise you that this department has reviewed the project results for the fuel seepage Investigation that was conducted at the AT&T T.S.P.S. Bakersfield, 3701 Auburn Street, in Bakersfield, California. Based upon the findings described tn · the report, this department is satisfied that ·the assessment is complete and no significant soil contamination resulting from the fuel tank leakage exists at the site. Thank you for your cooperation in this matter. Sincerely, is Lefiman %/ Environmental Health Specialist Hazardous Materials Management Program JL/gb DISTRICT OFFICES PAS 580 115"~ 96-5005 (Rev. 1-84) SMC kaboratory Analytical Chemistry Client Name: George Sweet Address : P.O. Box 80963 Bakersfield, CA 93380-0963 Date sample received ~ : 4-25-88 Date analysis completed:. 4-26-88 "Date-Of .................................report Laboratory No. 754 through 757 Project Name: AT&T Auburn & Oswell RESULTS OF ANALYSIS #754 ID: Sample #1 ~ 2' ugm/gm MQL,ugm/gm Benzene ND 0.1 TPH (Diesel) ND 10 #755 ID: Sample #2 ~ 2' ugm/gm MQL,ugm/gm Benzene ND 0.1 TPH (Diesel) ND 10 #756 ID: Sample #3 @ ~.' ugm/gm MQL,ugm/gm Benzene ND 0.1 TPH (Diesel) ND 10 #757 ID: Sample #4 @ ~' ugm/gm MQL,ugm/gm Benzene ND 0.1 TPH (Diesel) ND Method of Analysis: California DOHS LUFT manual. MQL = Minimum Quantitation Level TPH = Total Petroleum Hydrocarbons ugm/gm = microgram per gram ND = Not detected Stan Comer 3155 Pegasus Drive · Bakersfield, CA 93308 · (805) 393-3597 P.O. Box 80835 · Bakersfield, CA 93380 i Environ-r~enlal , 4~33 Oui~n II~od~ ',! ' ":?~::'~? ~ P, O~ ht 8096:3 :, ' ( ]'. -:.[" ':~l~p.l|~ldo ~ 93:360393.4370. 09,:3 7 CHAIN OF CUSTODY RECORD ~ '' . A~um & O~ell~ ~ersfteld ~ AT&T,~. . _ ~ .. -~ . ' ~ 0 ~ ~ s...o,o,,,T~ ~ ~ si.,~.to~,~, co.,.~.., ~ o ,.-~, 1 ' : ' , 'D~I T~' Re. ived by: }S,~rmf) Rel~ui~ by: t.~ru, el Date Tim Re~ ~: fS,~r~l .. Reli~ai~by:/~rum/~. OlteTime'' Re~iv~by: (S~ruml ~ Reli~ui~by:l$,9~rurel OateTime Re~: · ~ · . Rd~ ~: ~l' O~e T~ R~iv~ for La~ratmy by: ~q~t : rs~,.,.~ ~harge to: Crisp Construction : At~: ~rk Crisp Well Drilling Conlraclor ? Z~ Regi$1ered Envlronrnenlal Assessor .- Environmental Contractor ~ ~ '., ' 423~ Qulnn l~ad ~, ?~'r)~'.?.~. ~... . P. O~ Bo~ 80963 :, ' ' ' ~.~ , ":"'"~8~[~lS[~ld, CA 93380- 0963 ', SAMPLING ANALYSIS REQUEST PART I: FIELD SECTION Samples collected by George SWEET Date April 25,, 1988 .Temperature: Max~gP Min(~I Weather ............... Project_.description AT& T Buildinqf Auburn & Co!umbusf .Baker?fi. el~ C~ .' _..~ ..... CRISP CONSTRUCTION~ Contractor j #~ Analysis Requested: Contaminant Test Test to be analysed Parameter Method Gasoline Benzene SW-846 Toluene EPA 8020 / 602 Xylene Total Vo.l. atiJ.e .N.¥drocarbons DHS Method Diesel Fuel Total Petroleum Hydrocarbons DHS Method SW-846 · ~ Benzine EPA 8020 / 602 Waste Oil Total Hal°genated Organics, TOX EPA Method Total Recoverable Petroleum Hydro- SW-84§ carbons EPA 418.1. Other Special Handling and/or Storage: ~ Soil Samples: Cool to 4°C during transport. Keep frozen during laboratory storage. Holding time 14 days maximum. I Water Sample: Cool sample~ to 4°C (not frozen) during transport'-and laboratory storage. Holding time 14 days maximum. ---] Other: PART II: LABORATORY SECTION SMC Laboratory 3155 Pegasus Drive P. O. Box 80835 .......................... :Bakers'field';'-Califorhia-'93380 E.r~'~:rb. r~'rn e'fi t a I '~o ntr act · ;~ ~ . '4233 Quinn .Road ' ' : ..... ~'l~hfl*la~:.P.,~,.,~3380 - 0963 ' : ,,. . .., ....... ~,,. ..... Z ....... DAILY DIARY REPORT NO. I FO~ George SWEET OATE Apr±i 25, i988 ( M ) T W T F $ S (CIRCLE DAY) 'I arrived at the A.T. & T. Company, T.S.P.S. facility, 3701 Auburn Street, Bakers' ..... ._ .~field, Califomnia. at 0945 hours and found the sinRle_15OO.~allon_diesel fuel', under~round steel, storaRe tank'uncovered to the top of the tank and washinR in orom~ess.. Criso Construction Company nerso'nnel were washing the tank~ Bakersfield/Pacific Oil (Hazardous Waste NallTer): 2100 ~ene Drive: Bakersfield: CA g3306: (ROS)R71-B683: was h'andlina the ' was comopleted and excavation around the sides and end of the tank was nearin~ completion. The following persons were in attendance besides myself: i __ I James D. PARKER. - Gregg & Associates, Inc. Consulting in Environmental Eng'r... et. al. 597 Center Avenue, Martinez, CA 94553 ~ (415)372-3637 2601 "F" Street Bakersfield, CA 93301 After some initial difficulty the tank was raised from it's location ~th the steel support saddles attached. The hold-downs had been previously cold ~ut' to allow the tank to be removed, A Portland Cement Concrete hold-down pad'was found to exist under th~ tank and this precluded the prel±m±n~r¥ a~essment that was specified ±n the permit, ~r, Br~etain: Boyle Engineering recommended that the slab be ~eft ~n place. Kern County rep- resentative agreed to a modified samplin~ plan (by telephone) and sam~lin~ was ~one accord-- ~ngly. S~mples were taken, pres0rved, transported and del±vered to SHC Laboratory in eh~ 1'~,1al m~nner. Crisp Cnn~t2 Supervisor requested that I remJad.the labozt~ry of the SIGNATURE . b 4. 8. SMC- LaboratoD' Analytical Chemist Ci ient. Name: George Sweet Add~,'ess ; P.O, Box 80963 Bakersfield, CA 93380-09'63 Dat.e sample received : 4-25-88 ..................... Date.analysis .o.o~p~l. et.~d: 4-26-88 Date of report . '-4~'Z6-88 ......................................................................... l.~abo~'atory No. 7~4 through 7~7 Project Name: AT&T A,uburn & Oswell RESULTS OF ANALYSIS ~754 ID: Sample ~1 ~ 2~ ugm/gm MQL,ugm/~m Denz~rl~ ND 0,1 TPt{ (Diesel) ND #755 ID: Sample #2 e 2' ugm/gm MOL,ugm/~n, [~enzene ND TPH (Diesel) ND 10 #?56 ID: Sample #3 @ 6' ugm/gm MQL,ugm/gm Benzene ND 0.1 TPH IDiesel) ND 10 ~7 Tn: ~amDle #4 ~ 6~ ugm/gm. M~b,u~m/gm Benzen~ ND 0',1 TPH (Diesel) ND 10 Method of Analysis: Ca].iforn].& DOHS LUFT manual MQL = Minimum Quantitation Level TPH = Total Petro].~um Hydrocarbons ugm/gm = micrggram per gram ND = Not. detected · S%an Comer ; 3] 55 Pegasus ~)rive · Bakersfield, CA 93308 . (805) 393.3597 P.O. Sox 80835 · Bakersfield, CA 933~0 . KERN COUNTY HEALTH DEPARTMENT. 1700 Flower Street AIR POLLUTION CONTROL DISTRICT LEON M HEBERTSON, M.D. B a k e;~i iee~ hd~) nCea Ii~)r5~ i: 6913;'33 ~ ~'14'1 9 I~ ~ .... A[Dr I r;o~u°~io°nf ~Uobnll rCo ~4 eO~ ~che r ---5 -Ufi6 OUND RAZAP, DOUS ..... SUBSTANCES STORAGE FACILITY FACILITY NAME/ADDRESS: OWNER (S) NAME/ADDRESS: CONTRACTOR: ~ '"_.A.T~%_..T_._S_.? P...,S ..... Bakersfield .......... AT&T .........,.__~, ............_i ...... ~ .......... '-C~-s..P. ~P~s-~-r.u---c~t°n ~''': >- '_c _. ?.. 3701 Auburn Street .1520 20th Street P.O. Box 1066 . . ~ Bakersffield CA Bakersfield, CA Vlsalia, CA' ~." · .. :.'.' .~ ;. :-,.~;. '~ -'-:~:.~. . License No.'"478335 Phone #(805} 325-0564 Phone #(20g) 734-6361 -'- PERMIT FOR CLOSURE OF PERMIT EXPIRES July 8, 1988 ! TANK(S) AT ABOVE APPROVAL DATE ' April 8, 1988 '~':'""' '"'" 'i'" LOCATION. APPROVED BY ~~~ ~/~~~ Janis L~hma~ ........................ POST ON PREMISES ................... CONDITIONS AS FOLLOW: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work. 2. Permittee must obtain a City Fire Departemnt. permit pribr to initiating closure action. 3. Tank closure activities must be per Kern County Health and ~ire Department approved methods as described in Handout #UT-30. 4. A minimum of four samples must be retrieved one-third of the ~ay 'in from the ends of each tank at depthis of approximately t~o feet'and six' feet. 5. If any contractors other than- those listed on permit and permit application : are to be utilized~ prior approval must be granted by the specialist listed ~ on the permit. 6. A minimum of two samples must be retrieved at depths of approximately two feet and six feet for every 15 linear feet of pipe run and also near the dispenser area(s). : 7. All diesel samples must be--'analyzed for total petroleum hydro'carbons and : benzene. PERMIT FOR PERMANENT CLOSURE PERMIT NUMBER A674-09 OF UNDERGROUND'HAZARDOUS 'ADDENDUM SUBSTANCES STORAGE FACILITY 8. Copies of transportation manifests must be submitted to the Health Department within five days Of waste disposal., 9. All applicable state laws for hazardous waste disposal, transportation, or treatment must be adhered to. The Kern County Ilealth Department must be notified before moving and/or ~ffsposlng oC any contaminated soil. '. 10.Permittee is' responsible for making -sure ~-that "'tank disposition -tracking 14 days of tank removal. . . 11, Advlse this .office of the time a"d date .of the proposed .sampilng ,!wi.t.h~.24 12. Results must be submitted to this office 'within 'three days of-'anal~sis' KERN COUNTY HEALTH DEPARTivlENT 1700 Flower Street AIR POLLUTION CONTROL DISTRICT LEON M HEBERTSON, M.D. Bakersfield, California 93305-4198 Director of Public Health Telephone (805) 861-3621 ~ ~ Air Pollution Control Officer ~arch 29, 1988 To Permit Applicant This department has reviewed the application and plans submitted for the underground storage facility located at "Auburn Street", Bakersfield, California, known as AT&T T.S.P.S. - Bakersfield.' Based on this r.eview, your application has been denied for the reasons listed below: 1. Incomplete permit application. The areas highlighted on the original permit application must be completed, along with the back side of-the permit application. We are returning the original permit application and plans. After maki'ng required corrections and/or modifications, the application may be resubmitted for review.. If you have any questions regarding our requirements, please call me at (805) 861-3636. Sincerely, anis Lehman ._ nvironmental Health Specialist Hazardous Materials Management Program JL/gb cc: John MaCutt Enclosure INTERNAL USE 0,~ 1~00 FLOWER STREET. BAKERSFIELD, CA-'93305 * O~ T~ ~ BE AB~NED {805) 861-3636 L~GTH 0F PIPING ~ ~N CLOSURE/~DONNENT OF UNDERGROUND HAZARDOUS SUB~T~CES STORAGE FAC[L;T~ THiS APPLICATION IS P0R ~ R~0VA~, 0R ~ ~D0~ IN P~C; (Fl~ 0~ 0N~ ~PLI~TION PER FACILI~) --- PROJECT CONTA~ ........................................... {PHONE ~ -- _ ........ {SEC/T/R- ~ FACILI~ N~E ~DR~S N~ ~OSS STRE~ ~ O~ER ~DDRESS PRONE ..... ~i~ ....... ~0~ ................. {-"~6':&r-7~ ............... } ..... I ~ ~ PRELININARY SITE ASSES~ ~R ~DR~S ' · PHO~ ~OR~ER'S COMPENSATION I IIIS~ER PHON~ ~0~TORY Ti~T ~{LL ~ALYZE ~PL~ ~DR~S .... ~'~'~'~ ............. ~ ...... : .........~,,~~ ,.'.~.~~x~~.:,~,+~:~.:/ DHENICAL COIIPOSITION OF ~TERI~ STORED ~ 'ANK ~ VOL~,IE C~I~ S~RED (HOH-C0~<~RCIAL N~IE) DA~ S~R~ CH~II~ PR~IOUSLY ST0~ED ! HATER TO FACILI~ PROVID~ BY [DE~ ~ GRO~ m ~ N~REST ~AT~R HEL~ - GIVE DIST~CE AI{D DESCRIBE ~g I~ ~IT~IN ~00 FE~ SOIL ~E AT FACILI~ ~ ~ B~IS FOR SOIL ~PE ~D OROUItDliAI'~ DEaN TOTAL HU~BSR OP S~iPLES TO BE ~ [S~L~ ~ILL gg ~I~YZED FOR: ]ESCRIBE HOi/ RESIDUE IN.T~K{S) AHD PIPING I9 ~ BE R~O~ ~ DISPOSED OF (INCLUDE ~NSPO~ATION ~D DISPOSAL ~ ]ESCRIBE BOTll THE DIS~SAL ~IOD ~ DISPOSAL L~TION YOR: PIPING ~ ' Pf, ElSg PROVID~ IN~R~T[O~ REQUESTED ON RE~RSE SlD~ OF THIS SHE~ BB~RE S~NI~[NO APPLICATIO~ THIS FO~ HAS EEEN C~D U~ER PEHAL~ OF PERJURY AHD ~ ~E B~ST OF ~ ~OMLEDOE IS ~UE A~ CflRRE~. SIONAmRE _ ' TITLE ~ DATE (For~ INTERNAL USE ONLY: DIVISION OP ~VI~ONN~AL H~LTH APPLI~TION 1700 FLOWER STREET, e~ees~eLe, ~ .'93308 I (605) 861-3636 IL~GTH 0~ PIPI~ APP~Z C~TZ ON CLOSURe/AD--DOCeNT O~ U~D~ROUND HAZARDOUS SUBSTUCES STORAGE FAC] LZTY THIS ~PLICATION lB FOR ~ ~VAL, OR PROJECT COt~A~ ~PHONE t,~ tS~/T/R (R~ ~TI~S ~LY) ' D~ER ~DRESS PHONE T~K R~VAL ~ORI~ IP~ ...... ................. I ~RKER* S COMPEN~TION ~ INS~ER PHO~ ' ~ ~RY ~T MILL ~AL~E ~ ~DR~S PH~ CHEMICAL COMPOSITION O~ ~T~I~ ~RED ~ TANN · VOL~E ~I~ ~ (~N-~Cl~ N~) ~S ~ ~I~ ~I~SLY ~R~ ~ATER ~ FACILI~ PROVID~ BY IOEffi ~ ~0~ ~ o SOIL z- ~EST ~A~R NELL - GI~ DIST~CE ~0 DESCRIBE ~E I~ NITHIN 500 FE~ ~E AT FAClLI~ DES~IBE HOM RESIDUE IN.T~KIS) ~O PIPI~ IS ~ BE R~O~ ~ DISPOSED 0F (INCLUDE ~S~ATION ~ DIS~ ~IES): T~l(S) ' ' PL~E PROVIDE I'~TTON REQ~D O~ RE~RSE .... m~s' ~ORN HaS'seeN coMpLE~D' ~eR ~AL~'OF (Po~ *~-140 ) ?~-PROVIDE DRAWING OF PHYSIC JUT OF FACILITY USING SPACE .DED BELOW. ALL OF THE FOLLOWING INFORMATION MUST BE INCLUDED TN ORDER FOR 'APPLICATION TO BE PROCESSED: TANK(S), PIPING & DISPENSER(S), INCLUDING LENGTHS AND DIMENSIONS __ PROPOSED SAMPLING LOCATIONS DESIGNATED BY THIS SYMBOL "(~" NEAREST STREET OR INTERSECTION /6/~' ANY WATER W~TI~q OR sURFACE WATERS WITHIN 100' RADIUS OF FACILITY :-- = ............. -'::: "'NORTH "ARROW'"':~" ...... '-'--' ....... -:' - '~ .....-:~"-:-:"~ ....... ' ...........- - ....---~--'-' - ' ...... '~: ........ : .................. .-: O HA I N , OF 0 U S T O D Y DATE. NAME DATE NAME ' COMMENTS DAMES & MOORE Tank Testing Service 8145 Byron Road Whittier. California 90606 (21 ) 9¢5 7537 ~'-~--=---~ Tank~ Own e r :--A TAT-COHMUN I CA T I ON S '- ......'::- ............ ---~'- ' :~'- ...... : -' ' ~Te'~-b At~-i:-:'~/2'4/86'--'~-' ......... Tank Address: ~?01 AUBURN STREET Tank No.: 1 BAKERSFIELD, CA Product: DIESEL Capacity (gal): 1500 Attention: ~JOHN STRAND Following are the ~esults of precision tests conducted in accordance ..... --with-'NFPA'329-~nd"state'of~'California"~iteria on the tank noted above. IX] System tested tight. [ ] Test indicates a leak. [ ] Test was inc6nclusive. Test period: Lower elevation 30 minutes/Upper elevation 61 minutes. IX] No significant loss/gain observed. [ ] Test indicates tank is tight. IX] Test has similar gain/loss at both elevations;indicates a tight system. IX] Tank tes~ at elevation ~ inches showed (gain) of ~O~0343 gal/hour. IX] Piping/system test at elevation _~A showed (loss) of ..0.0084 gal/hour. IX] Test at elevation 10~ showed (loss) of _Q.0124 gal/hour. [ ] Loss/gain attributed to thermal contraction/expansion. ['~] Correction f~r thermal expansion/contraction was gal/hr. [ ] Gain attributed to vapor pocket.[ ] System must be vented and retested. [ ] Retest must be scheduled (see attached Recommended Procedure). [ ] Check valve leaks. COMMENTS Leak. indicated between and inches from tank bottom. Leak indicated at bung or pipe connection to tank top. Leaking manhole cover suspected. Elevation of leak could not be determined due to leaking check valve, vapor, or cocked fill pipe. -Date.: -12/29/.86 ................................... " ~~L]~~- DAM~S & MOORE TANK TESTING SERVICE · ~' DATA SHEET Owner : Al&T COMMUNICATIONS Test Date: 12/24/86 Address: P.O. BOX 4140 SAN LUIS oBISPO, CA 93405 Contact: JIM BOURN TANK DATA Tank Number: J Construction ~ material: STEEL/1981 Operator: AT&T COMMUNICATIONS 95506 pump: N/A Capacity: 1500 oallons. Product: DIESEL Vapor.recovery system: N/A TANK DIMENSIONS Diameter: 65 inches. Top of fill pipe to top of tank: 29 inches. Length: 108 inches. ~ill ~°ipe Diameter: 4 inches. Bottom of tank to top of fill:' 94 inches. MISCELLANEOUS Date/time system was filled: 12'18-86 lype of product used.to ~ill: DIESEL Coefficient o~ expansion for produqt: 0.0004500 Depth to groundwater (if known): UNKNOWN Comments: NO WATER. Test Conducted By: DAN GUIELORY ) '~ ' DAMES & MOORE _~ TANK TESTING SERVICE TEST REPORT Owner : AT&T COMMUNICATIONS Test Date: 12/24/8b Address: P.O. BOX 4140 SAN LUIS OBISPO, CA Contact: JIM BOURN TEST DATA / Tank Number: I · Test No: I Time Star~: 10~5 ....... Elevation i~n' 'Yank': ..... 6-5-i'nche~. Time Finish: 1102 Product ~empermture: 17.90 Deq. C. Ambient Temperature: 15.00 Deg. C. CaIibration: Cmlculation Data: Start: 20 mi 41.A lines. Time: 16 minutes. End : 2(~ ml 41.0 lines. Number of lines: 71.0 Calcul ati on: 20 mi cml. 71.0 line=_ x 60 = 12c~.88 mi/hour 41.0 lines cal. 16 minutes Resul ~:s: Test shows a o.a~n of I2~.878 mi/hour. ( 0.0545 gal/hour) TEST DATA Tank Number: 1 Test 'No: 2 Time Start: ~105 Elevation in Tank: 84 inches. Time Finish: 1255 Product Temperature: 17.80 Deg. C. Ambient Temperature: l~.O0~e~ Calibration: Calculation Data: Start: 100 ml 2~.5 li~e~. Time: 21 minutes. End : 100 ml 2~.5 lines. Number o~ lines: .~.0 Cal cul ation: x x 60 = 51.75 ml~'hour 27.0 lines cal. 21 minutes Resul ts: Test sho~.~s a loss of ol.746 al/hour. ( 0.0084 oal/hour) TEST DATA Tank Number: 1 Test No: 5 Time Start: 1507 Elevation in ~ank: 101 inches. Time Finish: 1408 F'roduct Temperature: ~7.80 De0~. C. Ambient Temper~t~re: 16.0(, De0. C. Calibration: Calculation Data: S~art: 50 ml 42.5 lines. ~ime: 55 minutes. End : 50 ml 41.5 lines. Number of lines: 25.0 Cai cul ati on: x x 60 = 46.94 al/hour 42.0 lJ. nes cal. 55 minutes Resul ts: Test shows· a loss of 46.959 mi/hour. ( 0.0124 gal/hour) 1700 Flower Street ' r~ERN COUNTY HEALTH DEPARTMEN I HEALTH OFFICER Bakersfield, California 93305 ~' Leon M Hebertson, M.D. Telephone (805) 861-3636 .. ENVIRONMENTAL HEALTH DIVISION . .. - - DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Reichard 1- NTER'i- M PERMT T '.. [ PERLV/T T~eO 900 2 8 C T S S U~-D: h~DVEMBER 1, 'i98~ ~-.X~>-i- l~-~.S: [~v~v~]~ 1, 1989 UND~.RGROUND HAZARDOUS SUBSTANCES FAC TLITY: I 0NNER: : " BAKERSET~.LD T.S.P. S~ I AT&T C0NNUN[CATTONS 3701. AUBURN STREET I 5925 N. LAS P0SZTAS ~. . ..... . , :..~:...~.,.~ ~ .' ~. ,., .~.-~. NON--TRANSFERABSE * * * P'OST ON PREMISES Division o~ En,~ir,or~m:r~tal ! Il Applica~iol ~t:e-'{~--~-~ 1700 Flower Street, Baker::~ CA 9~305 ~PPL[CATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type of Application (check): ~]New Facility r']Modification of Facility ~Existing Facility [-]Transfer of Ownership A. Emergency 24aHour Contact (name, area code, phone): Days~wso& ~oo Nights .... Facility Name ]-~f~t<r:[~SFi~fb -]--5.~-~', .. No. of Tanks / Is Tank(-~) Located on an Agricultural Farm? [-]Yes ~No Is Tank(s) Used Primarily for Agricultural Purposes? DYes ~IINO Facility Address 3'7~i /~uSu;~ ag- Nearest Cross St. 'T R SEC (Rura'l Locations Owner /~'¢~-7' ~z~/~v/~/vl~rl¢¢%~j Contact Person b157. /M(=E - ~/-~6~-~,.~- Address ~-92_5 'wv', /~W5 /~o5lTRa Pt~f~J Zip ~ Telephone z//5 x/Lo &5om .. Operator /~-~T C~¢/~fZZ~/~T;O..~j 'Dm. ~ Contact Person (7 ,/=-- ..... d~_Addr.ess../ff&O ~-~O7/4 57' ....... 5'~¢~.4- -.'~ ....Zip ._.q330/......Telephone.~05-. B.Water to Facility Provided by ~/~¢~-¢o~_~ coa%sE Depth to Groundwater Soil Characteristics at Facility Basis for Soil Type and Groundwater Depth Det6rminat~'ons C. Contractor CA Contractor's License NO. Add r ess Ztp Telephone Proposed Starting Date Proposed C~pletion Dste Worker's Ccmpensation Certifi6ati6n ! Insurer D. If This Permit Is For Modification Of An Existing Facility, Briefly Describe Modifications Proposed E. Tank(s) Store (check all that apply): Tank ! Waste Product Motor Vehicle Unleaded _Regular Premi~ Diesel Waste ~uel [] [] [] [] [] [] [] [] F. Chenical Composition of Materials Stored (not necessary for motor vehicle fu~ls) Tank ~ Chemical Stored (non-commercial name) CAS # (if known) Chemical Previously; St~red (if different) G. Transfer of Ow6ership Date of T~-~nsfer Previous Owner Previous Facility Name I, accept fully all obligations of Perm'it No. __ issued to · ' I understand that the Pemitttng Authority may review and m~dify or terminate the transfer of the Permit to Operate this t~ndergro~d storage facility upon receiving this ccmpleted fora. This form has been completed tinder penalty of perjury and to the best of my knowledge is true and correct, e /],c~/bc~ Signa tuts __~~~~,. ~ Titl cc~t~ Date TANK ~ I (FILl. OUT :;I'iI'AI~A'I'E F(')RM FOR ~%~1 T~K) ~OR E~C~ SEt. ION, ~ECK ~ ~PROPRIATE ~)XES i. Tank is: ~Vaul't~ ~n-Vauit~ ~uble-Wall ~Si~le~all 2. ~ ~te[tal Car~n Stol ~S~inless Steel ~l~iny1 C~oride ~Fl~r~lass~l~ S~i Fi~rglass-Reinfo[c~ Plastic ~Co~rete ~~in~ Other (de~r l~) 3. ?r i~ry Contai~nt .~te Ins~ll~ ' ~lc~ess (Inches) Ca~c~ty (~11o~) ~ufactur.r 4. Tgnk ~°~ary C9h~a,l~nt ~1~11 ~thetic Line~ ~Li~ Vault ~Ot~r (de~ri~): ~ufac~rer~ ~te~ial ~i~ess (Inc~s) 5. Ta~ Inter~or"Llnl~ OOt~r (de~ri~): ........................... . 6~ Ta~ Corrosion Protectf~ ~Ivanl~ ~a~l~ O~l~yle~ ~ap ~nyl .~Tar or ~lt .~~ ~~ O~r (de~rl~) = .." ul nt= .... 7. Leak ~t~tlon~ ~itori~, a~ OV~o~ Z~ ~ito~l~ ~11(.) ~~ ~i~ut Va~ ~t~tor= O U~id ~el ~r" O C~tlvit~ Pre~u~e ~r ~ ~ula~ S~ of ~le ~11 Ta~- Ll~id ~t~i~al ~ Ins~ction F[~ U-~, b. Plpi~ Fl~Restrictl~ ~ak ~t~tor(s) ~or ~l~t C~.tible Pi~ ~y ~~ttc Li~ .,,. *~ri~ ~ & ~1~ .... 8. ~en Ttgh~ss ~st~? ~Yes ~ ~st ~e - ~stt~ ~y ...... 10. ~eriill Pro~ction ~rator Pills, c~trols, i Vl~lly ~nitors ~vel ~Ta~ Fi~ ~e ~Fl~t Vent Valv~ ~ ~ S~- Off ~trols 11. Pipi~ a. .~ergro~ Pipl~ ~Yes ~ ~~ ~rial ~lck~ (l~hes) Dieter ~ufac~rer ~essure ~t:'t~ - ~Gr~ity ..... ~roxi~ b. U~ergro~ Pipt~ Corrosi~ Prot~tl~ : ~lvani~ ~Fl~rglas~l~ ~ess~ ~Polye~yla~ Wrap ~El~tri~l I~latl~ ~Vlnyl'Wr~ ~Tar ~ ~lt c. U~ergro~ Pipig, Seco~ary Contal~nt: ~1~11 ~~etic Liar ~st~ ~ ~o~