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Home My WebLink AboutBUSINESS PLAN~ ~I L yr YI J esi ', ~ wt W 1, ~ N N ''•-O ~ N ~~ ~ ~ ~ ,~. -_~ ~, Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF .PERMIT ON REVERSE SIDE This ~ermit is issued for the following; [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials Permit ID #:: 015-000-001231 [] Risk Management Program ' ~ F I E STA L I Q U O RS[3 Hazardous Waste On-Site Treatment 'LOCATION: 2023 BAKER ST IELD TANK HAZARDou§Sd~TAN~ ~:.~:,:~ CAP~F[Y:~ DISPENSER~p;~NS:MONITORING o~5-ooo-oo~23~-ooo2 UNLEADED REGULAR ~SOLIN~i~7 015-000-001231-0003 UNLEADED PREM' UI~I GASOLINE ~.~ .... ~: ~ ~,, ..~,..- OFFICE OF ENWR ONMENTAL SER WCES 1715 Chester Ave., 3rd Floor --. Approved by: C~p~.~.fi~ ~ss.e ~te ~ Bakersfield, CA 93301 om~or~~~: Voice (661) 326-3979 ~~~ "F~ (661) 326-0576 ExpimtionDate: ~~ 30. ~OO3 San Joaquin Valley . Unified Air Pollution Control District PERMIT TO OPERATE PERMIT NO: s42~2-4-1 EXPIRATION DATE: 0~/3~/200~ LEGAL OWNER OR OPERATOR: JEFFRIES BROTHERS INC ' MAILING ADDRESS: P O BOX ~40 WASCO, CA 93280 LOCATION: 2023 BAKER, BAKERSFIELD 'SECTION 20 TOWNSHIP 29S RANGE 28E EQUIPMENT DESCRIPTION: 3-12,000 GALLON UNDERGROUND STORAGE TANKS SERVED BY PHASE I VAPOR RECOVERY SYSTEM (G-70-97) AND 6 NOZZLES SERVED BY HIRT VCS-200 VACUUM ASSIST PHASE II VAPOR RECOVERY SYSTEM (G-70-33) AT 2023 BAKER ST. CONDITIONS ' 1. The vapor recovery system and its components shall be installed, operated, and maintained in accordance with the State cerufication requirements. 2. The District shall be notified by the permittee 15 days prior to each test. The test results shall be submitted to the District no later than 30 days after each test. 3. All testing requirements contained in this permit shall be performed at least once every five years. This Permit to Operate remains valid th,'ough tile per,nit expiration date listed above, sub. iect to payme,~t of annual permit fees and eo,npliance with permit co,~ditions and all applicahle local, state, aqd feder.'fi regulatio,~s. This permit is valid only at the location specified above, and becomes void upon any transfer of ownership or location. Any modification of the equipment or operation, as defined in District Rule 2201, will reqt,ire a new permit. This permit shall be posted as prescribed in District Rule 2010. DAVID L'. CROW Executive Director/APCO Sonthern Regional Office *2700 M Street, St,itc 275 *Bakersfield, Califo,'nia 93301 *(805) 862-5200* FAX (805) 862-5201 erm · Hazardous Materials/Hazardous Waste Unified Permit ~ ,' CONDITIONS OF PERMIT ON REVERSE SIDE T~K H~OUS S~ST~CE C~AC~ ~:G~ ~;~:.:: T~K T~K /7' ~k PIP~G PIPING PIP~G Issu~ by: ' O~CE OFE~O~AL 1715 Cheaer Ave., 3rd Floor B~e~fiel~ CA 93301 Voice (805) 32~3979 F~ (805) 3264576 . 'Exp~tionDate: June 30~ 2000 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (8OS) 320-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information inthe format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 15th day of April, 1999 to: FIESTA LIQUORS Permit #015-021-001231 2023 Baker Street Bakersfield, California 93305 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE --* This permit is issued for the following: Materials Plan round Storage of Hazardous Materials PERMIT ID# 015-021001231 Program FIESTA LIQUORS Waste LOCATION 2023 * BAKER TAN HAZARDOUS SUBSTANCE a,. PIPING PIPING - ' METHOD ONITOR ')001 UNLEADED PLUS GASOLINE **' ~,/ PRESSURE ALD UNLEADED REGULARGASO S PRESSURE ALD UNLEADED PREMIUM GASO PRESSURE ALD OFFICE OF ENVIR ONMENT,4L SERVICES 1715 Chester Ave., 3rd Floor Bakersf~ld, CA 93301 Voice (80.5)326-3979 December 22ct998 FAX (805) 326-0576. Expiration Date: U derground Hazardous Materials Storage Facility State I.D. No. o ~to/ ...... ,,...:-.,.::.:~.,.~...:.....,......::,..:~..~::...,:.-.,:-.,,:, ..... ,,~ -, CONDITIONS !i ~i. ,::P:~?~i~ '""~h ~EVERSE SIDE Tank Hazardous G~ii:~?~%:.;.?.;?:: .... Y~?: .... :~ ~'.~Tank ":~;::;~;~:~:~.::~;':~;??:?:~ Piping Piping Piping Number Substance Ca~:~.~:¥..:?' in~'{~i~?.;.'::::.. ~ {~'.::~Type Mo~'!{~6~6~:'~'.::;~':~;::~ Type Method Monitoring HAZARDOUS MATERIALS DIVISION .............. 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 (805) 326-3979 ~0 ~ ._, ~ ~ , APproved Ralph E. Huey, Hazardous Materials Coordinator Valid lrom: '~ 2Z ~';~<~ ~ lo: '?~=~- ~'~ ~::~:;~, 1700 Flower Street : '-KERN COUNTY HEALTH DEPARTME ,,~, .EALTH OFFICER Bakersfield, California 93305 '.. . Leon M Hebertson, M.D. Telephone (805) 861-3636 ...-~ ENVIRONMENTAL HEALTH DIVISION ., ..~ .. . TO opERATE: ' l~[ ~.~% PERMIm~el4OOO~FC _'.__U.N~__R~ROUND HAZARDOUS SUBSTANCES~ :~ ...~.'.'.,~. ,,NOTE: A~'INTERIM REQUIREMENTS EST~SISHED BY THE PE~ITTING DA~ P~IT ~IT,~: ~U~ ~ 5 1~8~ DA~ P~IT ~K 'LIST ~~: . , ' , I uor: (CHECX ONE) SIT~ DIAGR.~I FACiLI~ (Inspector's Comments): -OFFiCiAL USE ONLY- - ~_ FIESTA LIQUORS SiteID: 015-021-001231 Manager SUNG (MARY) LEE Location: 2023 BAKER ST City BAKERSFIELD BusPhone: (661) 323-4684 Map 103 CommHaz Moderate Grid: 20D FacUnits: 1 AOV: CommCode: BFD STA 04 EPA Numb: SIC Code: DunnBrad: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (661) 323-4684x Business Phone: ( ) - x 24-Hour Phone (661) 323-4684x 24-Hour Phone ( ) - x Pager Phone (661) 477-3568x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact SUNG (MARY) LEE Phone: (661) 323-4684x MailAddr: 2023 BAKER S T State: CA City BAKERSFIELD Zip 93305 Owner JUNG CHO LEE & SUNG S LEE Phone: (661) 323-4684x Address 13013 NANTUCKET PL State: CA City BAKERSFIELD Zip 93314 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif~d: RSs: No ParcelNo: Emergency Directives: PROG A HAZMAT ENr~~ o ~ ~ ~ ~oo 7 PROG U - UST Eased on my inquiry of these individuals resncnsiblz for obtaining the information, I certify under penalty of law that ! have personaNy examined and am familiar with the information submitted and believe• the information is true, accurrte, and compl~,te: /~- ~ Signa r Date -1- 07/11j2007 ,,, :, - "*' F FIESTA LIQUORS SiteID: 015-021-001231 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: FIESTA LIQUORS Cross Street Business Type: Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP {RICH ENVIRO} ICC Nbr: 5246167 PROPERTY OWNER INFORMATION Name Phone: ( ) - x Address: City State: Zip: Type INDIVIDUAL Name Address: City Type INDIVIDUAL BOE UST Fee# Financ'1 Resp: Legal Notif Date: Name:JUNG CHO LEE State UST # TANK OWNER INFORMATION Phone: State: Zip: Phone : (15 ) 6 - Ttl:OWNER 1998 Upg Cert#: x x -2- 07/11/2007 5 i i F FIESTA LIQUORS SiteID: 015-021-001231 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED PLUS GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED REGULAR GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED PREMIUM GASOLINE F IH DH L 3000.00 GAL Mod -3- 07/11/2007 _4_ 07/11/2007 -; F FIESTA LIQUORS ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME UNLEADED PLUS GASOLINE Location within this Facility Unit W END OF PROP STATE TYPE PRESSURE Liquid TMixture ~ Ambient SiteID: 015-021-001231 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE ~~ CONTAINER TYPE Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 4000.00 GAL 2000.00_.__. GAL t~~titc~uu5 wi~irulvr~lvl~ oWt. RS CAS# 100.00 Gasoline No 8006619 riAGKKL ASJ~551~1r;1V~15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ COMMON NAME / CHEMICAL NAME UNLEADED REGULAR GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W END OF PROP CAS# 8006-61-9 LiTAid Mixture PRESSURE TEMPERATURE CONTAINER TYPE qu' T -~ Ambient ~ Ambient ~ UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 4000.00 GAL 2000.00 GAL riEiGL-~tCLVUA 1..V1~lYV1V~1V 1.7 %Wt. RS CAS# 100.00 Gasoline No 8006619 riHGHtCL 1-1J~~,J~1~1~1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 07/11/2007 F FIESTA LIQUORS ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME UNLEADED PREMIUM GASOLINE Location within this Facility Unit W END OF PROP STATE TYPE PRESSURE Liquid Mixture Ambient SiteID: 015-021-001231 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION - Largest Container Daily Maximum Daily Average 12000.00 GAL 3000.00 GAL 2000.00 GAL •- HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006619 ru~~r~xli r~~a~aai~ir,iv 15 TSecret RS BioHaz RadioactivejAmount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 07/11/2007 r 2 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 10/30/2000 ~ CALL 911. Employee Notif./Evacuation 05/26/2006 NOTIFICATION WOULD BE VIA RADIO CONTACT AND PHONE CONTACT BY OUR JEFFRIES BROS INC DRIVERS. EVACUATION OF THE BLDG VIA DOORS. Public Notif./Evacuation 05/26/2006 DIAL 911 AND EVACUATE PUBLIC. CONTACT JEFFRIES BROS 758-3072. USE SHUT-OFF EMERGENCY SWITCH AT CONSOLE. USE EXIT DOORS. Emergency Medical Plan 10/30/2000 CALL 911 VIA PHONE. -7- 07/11/2007 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/26/2006 ~ EMERGENCY AUTOMATIC SHUT-OFF VALVES AT BASE OF EACH GASOLINE DISPENSER IN THE EVENT OF BEING EMPACTED. EMERGENCY SHUT-OFF AT THE CONSOLE INSIDE THE STORE. LEAK DETECTORS IN THE DISPENSERS. STORE OWNER WILL CONTACT OUR COMPANY IN THE EVENT OF A PROBLEM. OUR JEFFRIES BROS INC DRIVERS DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER CHANNELING PERSONS TO CONTACT. Release Containment 05/26/2006 OVER-SPILL BOX AT EACH FILL, DRIVERS OR DELIVERY PERSONNEL KNOW WHAT TO DO AND WHO TO NOTIFY. Clean Up 05/26/2006 IMMEDIATELY CONTAIN, IF POSSIBLE, AND CALL OR NOTIFY PROPER AUTHORITIES. V1.11C.L 1CC~7'VULC:C EiC:l.1VdL1OI1 -$- 07/11/2007 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ -~ -,- V j.J G V 10.1 110. 4 0.1 1A.7 Utility Shut-Offs 03/27/2007 GAS - E SIDE OF STORE S END ELECTRICAL - S SIDE OF STORE E END WATER - S SIDE OF STORE W END Fire Protec./Avail. Water 04/03/2006 PRIVATE FIRE PROTECTION - NO PRIVATE FIRE PROTECTION. FIRE HYDRANT - SW CRNR BERNARD & BAKER. Building Occupancy Level 04/03/2006 1 EMPLOYEE -9- 07/11/2007 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/26/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUNIl~IARY OF TRAINING PROGRAM: MSDS FOR 3 GRADES OF GASOLINE, PLUS DECALS ON PUMPS AND WINDOW PROP 65. rayc c raciu i.vt r u~.utc vac nC.i.u ivi ru~uic u5C -10- 07/11/2007 T i FIESTA LIQUORS Manager Su-" 4'-'~e ~~/ Location: 2023 AKER ST City BAKERSFIELD CommCode: BFD STA 04 EPA Numb: BusPhone: Map 103 Grid: 20D SIC Code: DunnBrad: 3~~~ SiteID: 015-021-001231 (661) 323-4684 CommHaz Moderate FacUnits: 1 AOV: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (661) 323-4684x Business Phone: ( ) - x 24-Hour Phone (661) 323-4684x 24-Hour Phone ( ) - x Pager Phone (661) 477-3568x Pager Phone ( ) - x Hazmat Hazards: Fire- ImmHlth DelHlth Contact : 56~' ~=~- ~~~~ Phone: (661) 323-4684x MailAddr: 2025 BAKER ST State: CA City BAKERSFIELD Zip 93305 Owner JUNG CHO LEE & SUNG S LEE Phone: (661) 323-4684x Address 33-(~ /30'13 ~~~~~~L-, State : CA City ~~;RE1~S'FIEL~ f ` ~ - C~ ~33~~ Zip -. ~~ Period to TotalASTs: - Gal Preparers TotalUSTs; = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ~O Based on my inquiry of those individuals responsible for obtaining the information, I certify AA~~ , ~ under penalty of law that I have personally examined and am familiar with the inform ti IY` ~ ~~~ ~ a on submitted and believe the information is true, ® ~~p, accurate, and comple 3so na r Date -1- 01/31/2007 F FIESTA LIQUORS SiteID: 015-021-001231 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: FIESTA LIQUORS Cross Street ~~,7j.L~~, .S'T: Business Type: (,~ S~~• Org Type: Total Tanks 3 IndnRes/Trust: No PA Contact: Dsg Own/Oper AARON KOOP {RICH ENVIRO} ICC Nbr: 5246167 PROPERTY OWNER INFORMATION Name ~~-^'~ C,~w ~---e'er • Phone : ( ) - x Address: (J City State: Zip: Type INDIVIDUAL TANK OWNER INFORMATION Name i ~ic*-~- ~-~'~ ~~'e- Phone : ( ) - x Address: City State: Zip: Type INDIVIDUAL BOE UST Fee# Financ'1 Resp: Legal Notif Business Mailing Address Date: Phone: (5 6) 625- x Name:JUNG CHO LEE Ttl:OWNER State UST # 1998 Upg Cert#: -2- 01/31/2007 ,, F FIESTA LIQUORS SiteID: 015-021-001231 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers. on Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP UNLEADED PLUS GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED REGULAR GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED PREMIUM GASOLINE F IH DH L 3000.00 GAL Mod -3- O1j31j2007 '4' 01/31/2007 .. .; F FIESTA LIQUORS ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME UNLEADED PLUS GASOLINE Location within this Facility Unit W END OF PROP STATE TYPE PRESSURE Liquid TMixture T Ambient SitelD: 015-021-001231 ~ Facility Unit: Fixed Containers on .Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 4000.00 GAL 2000.00 GAL HAZARDOUS COMPONENTS %Wt. RS CAS# 100.00 Gasoline No 8006619 riE~G1~tCL AaJi';S~Jl~1L' 1V 1 J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME UNLEADED REGULAR GASOLINE Location within this Facility Unit W END OF PROP STATE TYPE PRESSURE Liquid TMixture Ambient Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient -~ER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 4000.00 GAL 2000.00 GAL nr~~titcLUUa ~vriruiv~ly 1~~ %Wt. RS CAS# 100.00 Gasoline No 8006619 t1E~G1~KL 1~J ~ t; ~ J1~1L' 1V l TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -5- 01/31/2007 F FIESTA LIQUORS ~ Inventory Item 0003 COMMON NAME / CHEMICAL NAME UNLEADED PREMIUM GASOLINE .Location within this Facility Unit W END OF PROP STATE TYPE PRESSURE Liquid TMixture_~Ambient SiteID: 015-021-001231 ~ Facility Unit: Fixed Containers on Site ~ Days On Site 365 Map: Grid: CAS# 8006-61-9 TEMPERATURE CONTAINER TYPE Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 12000.00 GAL 3000.00 GAL 2000.00 GAL riE~GKKLVUS C:V1~lYV1Vt;1Vl5 sWt. RS CAS# 100.00 Gasoline No 8006619 t1AGHKL A~JJJSS1~1~1V"1"5 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Mod -6- 01/31/2007 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Notif./EvacuationjMedical Overall Site ~ ~ Agency Notification 10/30/2000 ~ CALL 911. Employee Notif./Evacuation 05/26/2006 NOTIFICATION WOULD BE VIA RADIO CONTACT AND PHONE CONTACT BY OUR JEFFRIES BROS INC DRIVERS. EVACUATION OF THE BLDG VIA DOORS. Public Notif./Evacuation DIAL 911 AND EVACUATE PUBLIC. CONTACT JEFFRIES BROS 758-3072. EMERGENCY SWITCH AT CONSOLE. USE EXIT DOORS. 05/26/2006 USE SHUT-OFF Emergency Medical Plan 10/30/2000 CALL 911 VIA PHONE. -7- 01/31/2007 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 05/26/2006 ~ EMERGENCY AUTOMATIC SHUT-OFF VALVES AT BASE OF EACH GASOLINE DISPENSER IN THE EVENT OF BEING EMPACTED. EMERGENCY SHUT-OFF AT THE CONSOLE INSIDE THE STORE. LEAK DETECTORS IN THE DISPENSERS. STORE OWNER WILL CONTACT OUR COMPANY IN THE EVENT OF A PROBLEM. OUR JEFFRIES BROS INC DRIVERS DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER CHANNELING PERSONS TO CONTACT. Release Containment 05/26/2006 OVER-SPILL BOX AT EACH FILL, DRIVERS OR DELIVERY PERSONNEL KNOW WHAT TO DO AND WHO TO NOTIFY. Clean Up 05/26/2006 IMMEDIATELY CONTAIN, IF POSSIBLE, AND CALL OR NOTIFY PROPER AUTHORITIES. V1.11C1 ,RC.7Vt111.:C t]l~I. .L VCLL1V11 -8- 01/31/2007 :, F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ •7t1C 1~1Q1 nac~cti u~ Utility Shut-Offs A) GAS - E SIDE OF STORE S END B) ELECTRICAL - S SIDE OF STORE E END C) WATER - S SIDE OF STORE W END D) SPECIAL - NONE E) LOCK BOX - NO 10/30/2000 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - NO PRIVATE FIRE PROTECTION. FIRE HYDRANT - SW CRNR BERNARD & BAKER. 04/03/2006 Building Occupancy Level 1 EMPLOYEE 04/03/2006 -9- 01/31/2007 3 F FIESTA LIQUORS SiteID: 015-021-001231 ~ Fast Format ~ ~ Training Overall Site ~ ~ Employee Training 05/26/2006 ~ MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: MSDS FOR 3 GRADES OF GASOLINE, PLUS DECALS ON PUMPS AND WINDOW PROP 65. rays a nciu iul. ru~uic u~c Held for Future Use -10- 01/31/2007 [: alT' .'~ 'r + FIESTA LIQUORS ______________________________________ SiteID: 015-021-001231 + Manager BusPhone: (661) 323-4684 Location: 2023 BAKER ST Map 103 CommHaz Moderate City BAKERSFIELD Grid: 20D FacUnits: 1 AOV: CommCode: BFD STA 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (661) 323-4684x Business Phone: ( ) - x 2 4 -Hour Phone :. ((,(~ ( ) 33.~j - ~bd'j~ x 2 4 -Hour Phone ( ) - x Pager Phone (. 66 () !~/~ -35~~ x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact Phone: (661) 323-4684x MailAddr: 2023 BAKER ST State: CA City BAKERSFIELD Zip 93305 Owner JUNG CHO LEE & SUNG S LEE Phone: (661) 323-4684x Address 3108 LA COSTA ST D State: CA City BAKERSFIELD Zip 93306 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif ids ~-- - -_~._ _ _ - - -- RSs:~No -~- - - y- - ParcelNo: Emergency Directives: PROG A - HAZMAT PROG U - UST ENT MAY 2 6 2006 ~/ ~~ Based on my inquiry of those individuals responsible for obtaining the information, I certify ~,~' under. penalty of law that I have personally ~~ examined and am familiar with the information submitted and believe the 'nformation is true, accur , and complete. O f Signatur Date -1- 04/03/2006 ~. } •~~ 4 UNIFIED PROGRAM INSPECTION CHECKLIST: APF°E'-''-:~M~ P"vy d{°n`.G~°i~r.n .. 1. (.._ .F C~'..',i'::. ... .i;. '. :. i-.... :': n.. ~.'~v '. -.;%.. -w :. •...., ~..:. x:... .. .._ .~. SECTION 1: Business Plan and Inventory Program ~,. BASERSFIELD FIRE DEPT s Prevention Services ~It~ 900 Truxtun Ave., Suite 210 ARrr Bakersfteld, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME ` ' NSPECTION DATE ' NSPECTION TIME j~S7,q , f ~ / 3/d ~ ;ate ADDRESS HONE NO. O OF EMPLOYEES 7 /! ,~. ~ ~d° ~ ` FACILITY CONTA T ~ USINESS ID NUMBER 15-021- Section 1: Business Plan and Inventory Program ^ ROUTINE ~ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT D RE-INSPECTION C V (c=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND . ^ BUSIftASS PLAN CONTACT INFORMATION ACCURATE -^ VISIBLE ADDRESS ^ -^ ^ CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES ~[ ^ (/ ~ VERIFICATION OF LOCATION ~ ^ ^ PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITY ^ VERIFICATION OF HAZ MAT TRAINING /~Ii.'1 ^ VERIFICATION OF ABATEMENT SUPPLIES AND R CEDURES ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING F~'~ ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN ^ YES ,~-N~- QUESTIONS REGARDING THIS iNSPECT10N4 PLEASE CALL US AT (881) 326-3979 Inspector (Please Print) Fire Prevention / 1u In / Shift of Sile/Stetion q BtuinE White - Prwention Services Yellow -Station Copy Pink -Business Copy FD2049 (Rw. 02105) a - ;q- ,. - ~L - ~~~w4~' `~~ \ CITY OF BAKERSFIELU FIRE DEPAR'TMF.NT ~~ ~ ~ ~~ OFFICE OF ENVIRONMENTAL fiERVICES ~`~ yob UNIFIED PROC:RAM INSPECTION CHECKLIST \~w ~gti,,~'~~ 1715 Chester Ave., 3n`' Floor, Bakersfield, CA 93301 ,,~~ FACILITY NAME /- i fS7r¢ ~ i q~Qlls INSPEC"TION DATE ~~ 3/ ~_ Section 2: Underground Storage Tanks Program ^ Routine mbined ^ Joint Agency ^Multi-Agency ~ ^ Complaint ^ Re-inspection Type of Tank S. .,~~/1 ~./~w,T? ~f "~ Number of Tanks Type of Monitoring ~;ll~tcd Type of Piping L,= w~1 7~ OPERATION C V COMMENTS Proper tank data on file Pmper owner/operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current -7 ~ z %o atv .~ Maintenance records adequate and current r Failure to correct prior UST violations Has there been an unauthorized release? Yes NO r `~' ~~:~ Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE.. CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? Ifyes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N-NO Inspector: ~ N ~~,2zA- Office of Environmental Services (661) 326-3979 white - inv. Svcs. Business Site Re ~ ~ ble Party Pink -Business Copy STA LIQUORS SiteID: 015-021-001231 Manager : BusPhone: (661) 323-4684 Location: 2023 BAKER ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 20D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (661) 323-4684x Business Phone: ( ) - x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 323-4684x MailAddr: 2023 BAKER ST State: CA City : BAKERSFIELD Zip : 93305 Owner JUNG CHO LEE & SUNG S LEE Phone: (661) 323-4684x Address : 3108 LA COSTA ST D State: CA City : BAKERSFIELD Zip : 93306 Period~ : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal certif'd: RSs: No ParcelNo: Emergency Directives: _ Do hereby certify that i have reviewed the attached hazardous materials manage- ment plan for~./~<~ ~t~ ~- Iql~dY~at it along with (Name of Business) - any corrections constitute, a complete and correct man- agement plan for my facility. -1- 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 = Hazmat Inventory By Facility Unit -- MCP+DailyMax Order Fixed Containers on Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax IUnit MCP UNLEADED PLUS GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED REGULAR GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED PREMIUM GASOLINE F IH DH L 3000.00 GAL Mod 2 04/0~/2004 FIESTA LIQUORS SiteID: 015-021-001231 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W END OF PROPERTY CAS# 8006-61-9 F STATE --~ TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 12000.00 GALI 4000.00 GALI 2000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretI ~SIBioHazI Radioactive~Amount EPA HazardsI NFPA USDOT# I MCP No N No No/ Curies F IH DH / / / Mod MISC. LOCAL AGENCY DATA Ag.Definedl: Ag.Defined2: Ag. Defined3: Ag.Defined4: Ag.Defined5: Ag. Defined6: Ag. Defined7: Ag. Defined8: Ag. Definedg: Ag.Definel0: -- Ag.Definell 3 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 = Inventory Item 0001 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: W END OF PROPERTY TANK DESCRIPTION Tank ID#: 2 Mfr: MOSIER BROS (1977) Compart Tank: N Installed: 0/ 0 Capacity: 12000 Gals No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: UNLEADED PLUS/MIDGRADE Marl Name:UNLEADED PLUS GASOLINE Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): BARE STEEL Lining : EPOXY LINING Installed: Corr Prot: CATHODIC PROTECTION Installed: Spill Cnt : 1999 Alarm : Exempt: No Drop Tube : 1999 Ball Float : Striker Plate: 1999 Fill Tube S/O: 1999 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wall: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -4- 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: LINED TRENCH Mfgr : Mtl : FIBERGLASS & : Corr : Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT Installed: Type: NONE OWNER/OPERATOR SIGNATURE Date: 05/11/1999 Name:JUNG CHO LEE Ttl:OWNER Prmt Number: 1231 Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST :04/21/1997 PASSED CP CERT. :08/29/2002 PASSED MANWAY INSP. :12/22/1998 UST MONIT. CERT:09/02/2003 -5- 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 9 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~U~ ~Vl~ / ~£~ ~vl~ ~LE~ED REGU~R GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W END OF PROPERTY CAS# 8006-61-9 Liquid Pure A~ient A~ient ~DER GRO~D TANK AMO~TS AT THIS LOCATION Largest Container [ Daily Maximum Daily Average 12000.00 GAL~ 4000.00 GAL 2000.00 GAL ~ZARDOUS COMPONENTS 100.00 Gasoline N 8006619 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod MISC. LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: ~.Defined3: ~.Defined4: Ag.Defined5: Ag.Defined6: Ag.Defined7: Ag. Defined8: Ag. Definedg: Ag. Definel0: -- ~.Definell 6 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: W END OF PROPERTY TANK DESCRIPTION Tank ID#: 2 Mfr: MOSIER BROS (1977) Compart Tank: N Installed: 0/ 0 Capacity: 12000 Gals ~ No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE FUEL Petrol Type: REGULAR UNLEADED Marl Name:UNLEADED REGULAR GASOLINE Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): BARE STEEL Lining : EPOXY LINING Installed: Corr Prot: CATHODIC PROTECTION Installed: Spill Cnt : 1999 Alarm : Exempt: No Drop Tube : 1999 Ball Float : Striker Plate: 1999 Fill Tube S/O: 1999 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wall: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No 7 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: LINED TRENCH Mfgr : Mtl : FIBERGLASS & : Corr : Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT Installed: Type: NONE OWNER/OPERATOR SIGNATURE Date: 05/11/1999 Name:JUNG CHO LEE Ttl:OWNER Prmt Number: 1231 Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST :04/21/1997 PASSED CP CERT. :08/29/2002 PASSED MANWAY INSP. :12/22/1998 UST MONIT. CERT:09/02/2003 8 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site UNLEADED PREMIUM GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W END OF PROPERTY CAS# 8006-61-9 r STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 12000.00 GALI 3000.00 GAL 2000.00 GAL HAZARDOUS COMPONENTS , %Wt. I ~S CAS# 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecret[ ~S BioHaz Radioactive/Amount I EPA Hazards NFPA I USDOT# MCP No N No No/ Curies F IH DH / / / Mod MISC. LOCAL AGENCY DATA Ag. Definedl: Ag. Defined2: Ag.Defined3: Ag. Defined4: Ag.Defined5: Ag. Defined6: Ag. Defined7: Ag.Defined8: Ag. Definedg: Ag.Definel0: -- Ag. Definell -9- 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 9 = Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 1 of 2 Last Action Type: Location In Site: W END OF PROPERTY TANK DESCRIPTION Tank ID#: 3 Mfr: MOSIER BROS (1977) Compart Tank: N Installed: 0/ 0 Capacity: 12000 Gals No. Of Comparts: Additional Info: TANK CONTENTS Tank Use: MOTOR VEHICLE PUEL Petrol Type: PREMIUM UNLEADED Matl Name:UNLEADED PREMIUM GASOLINE Cas #: 8006-61-9 TANK CONSTRUCTION Type : SINGLE WALL W/INT LINER & C.P. Material(p): BARE STEEL Material(s): Lining : EPOXY LINING Installed: Corr Prot: CATHODIC PROTECTION Installed: Spill Cnt : 1999 Alarm : Exempt: No Drop Tube : Ball Float : Striker Plate: Fill Tube S/O: 1999 TANK LEAK DETECTION Sgl Wall: AUTOMATIC TANK GAUGING Dbl Wall: TANK CLOSURE INFORMATION/PERMANENT CLOSURE IN PLACE Last Used: Qty Remaining: Was Filled: No -10- 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 ~- Inventory Item 0003 Facility Unit: Fixed Containers on Site STORAGE CONTAINER DATA (UST FORM B and AGENCY-DEFINED) Page 2 of 2 PIPING CONSTRUCTION UnderGround Piping AboveGround Piping Type : PRESSURE Const: LINED TRENCH Mfgr : Mtl : FIBERGLASS & : Corr : Prot : PIPING LEAK DETECTION UnderGround Piping AboveGround Piping AUTOMATIC LEAK DETECTORS DISPENSER CONTAINMENT Installed: Type: NONE OWNER/OPERATOR SIGNATURE Date: 05/11/1999 Name:JUNG CHO LEE Ttl:OWNER Prmt Number: 1231 Approved: Yes Expiration Date: 06/30/2006 AGENCY DEFINED TANK/LINE TEST :04/21/1997 PASSED CP CERT. :08/29/2002 PASSED MANWAY INSP. :12/22/1998 UST MONIT. CERT:09/02/2003 -11- 04/06/2004 FIESTA LIQUORS SiteID: 015-021-001231 Manager : BusPhone: (661) 323-4684 Location: 2023 BAKER ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 20D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (661) 323-46841 Business Phone: ( ) - x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (661) 323-46841 MailAddr: 2023 BAKER ST State: CA City : BAKERSFIELD Zip : 93305 Owner JUNG CHO LEE & SUNG S LEE Phone: (661) 323-46841 Address : 3108 LA COSTA ST D State: CA City : BAKERSFIELD Zip : 93306 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: Res: No EmergenCy Directives: ---- Hazmat Inventory / One Unified List 9 --Alphabetical Order Ail Materials at Site ~ Hazmat Common Name... ISpooHazlEPA HazardsI Frm DailyMax IUnit]MCP! UNLEADED PLUS GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED PREMIUM GASOLINE F IH DH L 3000.00 GAL Mod UNLEADED REGULAR GASOLINE F IH DH. L 4000.00 GAL Mod I, ")~j~._~r.~'~ Do hereby certify that I have ' - ('i'ype~ or ,~'~tnh~ame) reviewed the attached hazardous materials manage- ment plan for '~c~J~... . and that it along with · (Name of Business) any corrections constitute a complete and correct man- agement plan for my facility. t x. ~ g3~' -1- Da~ 07/15/2002 FIESTA LIQUORS SiteID: 015-021-001231 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: W END OF PROPERTY CAS# 8006-61-9 FSTATE TYPE PRESSURE i TEMPERATURE i CONTAINER TYPE Liquid PureIi Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 12000.00 GAL 4000.00 GAL 2000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl ~slBioHaz Radioactive/Amount EPA Hazards NFPA USDOT# I MCP No N No No/ Curies F IH DH / / / 'Mod ~- Inventory Item 0003 Facility Unit: Fixed Containers on Site 9 UNLEADED PREMIUM GASOLINE " Days On Site 365 Location within this Facility Unit Map: Grid: W END OF PROPERTY CAS# 8006-61-9 F STATE ~ TYPE PRESSURE --[ TEMPERATURE CONTAINER TYPE Liquid '1 Pure I Ambient Ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 12000.00 GALI 3000.00 GALI 2000.00 GAL HAZARDOUS COMPONENTS %Wt. RI RSl CAS# 100.00 Gasoline~ 8006619 HAZARD ASSESSMENTS TSecretI oRSlBioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod 2 07/15/2002 FIESTA LIQUORS SiteID: 015-021-001231 ~ = Inventory Item 0002 Facility Unit: Fixed Containers on Site UNLEADED REGULAR GASOLINE Days On Site ' 365 Location within this Facility Unit Map: Grid: W END OF PROPERTY CAS# 8006-61-9 FSTATE TYPE PRESSURE i TEMPERATURE i CONTAINER TYPE Liquid PureIi Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION [ Largest Container I Daily MaximumI Daily Average 12000.00 GAL ~ 4000.00 GAL 2000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl ~slBioHaz Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No N No. No/ Curies F IH DH / / / Mod 3 07/15/2002 F FIESTA LIQUORS SiteID: 015-021-001231 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 10/30/2000 CALL 911. -- Employee Notif./Evacuation 10/30/2000 NOTIFICATION WOULD BE VIA RADIO CONTACT AND PHONE CONTACT BY OUR JEFFRIES BROS INC DRIVERS. EVACUATION OF THE BLDG VIA DOORS. Public Notif./Evacuation 10/30/2000 DIAL 911 AND EVACUATE PUBLIC. CONTACT JEFFRIES BROTHERS @ 758-3072. USE SHUT OFF EMERGENCY SWITCH AT CONSOLE. USE EXIT DOORS. Emergency Medical Plan 10/30/2000 CALL 911 VIA PHONE. -4- 07/15/2002 F FIESTA LIQUORS SiteID: 015-021-001231 · Fast Format = Mitigation/Prevent/Abatemt Overall Site --Release Prevention 10/30/2000 EMERGENCY AUTOMATIC SHUT OFF VALVES AT BASE OF EACH GASOLINE DISPENSOR IN THE EVENT OF BEING EMPACTED. EMERGENCY SHUT OFF AT THE CONSOLE INSIDE THE STORE. LEAK DETECTORS IN THE DISPENSORS. STORE OWNER WILL CONTACT OUR COMPANY IN THE EVENT OF A PROBLEM. OUR JEFFRIES BROS INC DRIVERS DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER CHANNELING PERSONS TO CONTACT. --Release Containment 05/22/1992 OVERSPILL BOX AT EACH FILL, DRIVERS OR DELIVERY PERSONNEL KNOW WHAT TO DO AND WHO TO NOTIFY. -- Clean Up ' 05/22/1992 IMMEDIATELY CONTAIN IF POSSIBLE AND CALL OR NOTIFY PROPER AUTHORITIES. Other Resource Activation -5- 07/15/2002 FIESTA LIQUORS SiteID: 015-021-001231 Fast Format F Site Emergency ~Factors Overall Site Special Hazards --Utility Shut-Offs 10/30/2000 A) GAS - E SIDE OF STORE S END B) ELECTRICAL - S SIDE OF STORE E END C) WATER - S SIDE OF STORE W END D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 10/30/2000 PRIVATE FIRE PROTECTION - NO PRIVATE FIRE PROTECTION. FIRE HYDRANT - SW CORNER BERNARD AND BAKER. Building Occupancy Level -6- 07/15/2002 FIESTA LIQUORS SiteID: 015-021-001231 Fast FOrmat = Training Overall Site -- Employee Training 05/30/1997 WE HAVE 1 EMPLOYEE AT THIS FACILITY. ' WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: MSDS FOR 3 GRADES OF GASOLINE - PLUS DECALS ON PUMPS AND AND WINDOW PROP 65. -- Page 2 I -- Held for Future Use / Held for Future Use 7 07/15/2002 FIESTA LIQUORS SiteID: 015-021-001231 Manager : BusPhone: (805) 323-4684 Location: 2023 BAKER ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 20D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (805) 323-4684x Business Phone: ( ) - x 24-Hour Phone : (805) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: ( ) - x MailAddr: 2023 BAKER ST State: CA City : BAKERSFIELD Zip : 93305 Owner JLTNG CHO LEE & SUNG S LEE Phone: (805) 323-4684x Address : 3108 LA COSTA ST D State: CA City : BAKERSFIELD Zip : 93306 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: -- Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax UnitlMCP UNLEADED PLUS GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED REGULAR GASOLINE F IH DH L 4000.00 GAL Mod UNLEADED PREMIUM GASOLINE F IH DH L 3000.00 GAL Mod Do hereby certify that I have ~ype or pdn! name)~ revie~:l: ~he a~acfled hazardous materials manage- (9~a,~e, eH~usiness) -- any corre~ions co~s~te a complete and correct man- agement p~ [or my facit~ty. _ . s~ig r;1- ~ 10/25/2000 FIESTA LIQUORS SiteID: 015-021-001231 ~ -- Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST END OF PROPERTY CAS# 8006-61-9 Ambient Ambient UNDER GROUND TANK Pure Liquid AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 12000.00 GALI 4000.00 GAL 2000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecret , RS , BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP NoINo I No No/ Curies F IH DH / / / Mod = Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ UNLEADED REGULAR GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST END OF PROPERTY CAS# 8006-61-9 F STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 12000.00 GALI 4000.00 GAL 2000.00 GAL %Wt. S CAS# 100.00 Gasoline N 8006619 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod 2 10/25/2000 FIESTA LIQUORS SiteID: 015-021-001231 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site UNLEADED PREMIUM GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: WEST END OF PROPERTY CAS# 8006-61-9 STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Pure I Ambient I Ambient I UNDER GROUND TANK I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 12000.00 GAL 3000.00 GAL 2000.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 TSecret S BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod 3 10/25/2000 F FIESTA LIQUORS SiteID: 015-021-001231 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 01/07/1990 CALL 911 01/07/1990 . Employee Notif./Evacuation NOTIFICATION WOULD BE VIA RADIO CONTACT AND PHONE CONTACT BY OUR JEFFRIES BROS INC. DRIVERS EVACUATION OF THE BUILDING VIA DOORS ~ Public Notif./Evacuation 01/07/1990 DIAL 911 AND EVACUATE PUBLIC CONTACT JEFFRIES BROTHERS @ 758-3072 USE SHUT OFF EMERGENCY SWITCH AT CONSOLE USE EXIT DOORS Emergency Medical Plan 01/07/1990 CALL 911 VIA PHONE -4- 10/25/2000 FIESTA LIQUORS ~~~~~~ SiteID: 015-021-001231 i i~ Mitigation/Prevent/Abatemt ~~~~~ Overall Site i i~ Release Prevention ~/~~~~~~ 05/22/1992 i o EMERGENCY AUTOMATIC SHUT OFF VALVES AT BASE OF EACH GASOLINE DISPENSOR IN o THE EVENT OF BEING EMPACTED. EMERGENCY SHUT OFF AT THE CONSOLE INSIDE THE o STORE. LEAK DETECTORS IN THE DISPENSORS. STORE OWNER WILL CONTACT OUR o COMPANY IN THE EVENT OF A PROBLEM. OUR JEFFRIES BROS INC. DRIVERS o DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER o CHANNELING PERSONS TO CONTACT. ° o i~ Release Containment ~~~~~~ 05/22/1992 i o O o OVERSPILL BOX AT EACH FILL, DRIVERS OR DELIVERY PERSONNEL KNOW WHAT TO DO o ° AND WHO TO NOTIFY. o O o i~/~ Clean Up ~i~/5~~~~~~~ 05/22/1992 0 o o IMMEDIATELY CONTAIN IF POSSIBLE AND CALL OR NOTIFY PROPER AUTHORITIES. o o o 0 0 0 o -5- 10/25/2000 FIESTA LIQUORS ~~~~~~ S iteID: 015-021-001231 i~ Site Emergency Factors ~~~~~~ Overall Site i~ Special Hazards o o i6~ Utility Shut-Offs ~~~~~6~~ 05/22/1992 o A) GAS - EAST SIDE OF STORE SOUTH END ° B) ELECTRICAL - SOUTH SIDE OF STORE EAST END o C) WATER - SOUTH SIDE OF STORE WEST END ° D) SPECIAL - NONE ° E) LOCK BOX - NO o O i~ Fire Protec./Avail. Water ~~~~6~~ 05/22/1992 O PRIVATE FIRE PROTECTION - NO PRIVATE FIRE PROTECTION o O O o FIRE HYDRANT - SW CORNER BERNARD AND BAKER o O i~ Building Occupancy Level o O -6- 10/25/2000 FIESTA LIQUORS ~~~~~~ SitelD: 015-021-001231 i~ Trai~ng ~~~~~~~~ Overall Site i~ Employee Traiffing ~~~~~g~~ 05/30/1997 i o WE HAVE 1 EMPLOYEE AT THIS FACILITY. o o WE ~VE ~TE~AL SAFETY DATA SHEETS ON FILE. o o B~EF SUMMARY OF T~INING PROG~M: MSDS FOR 3 G~DES OF GASOLINE - PLUS o DECALS ON PUMPS AND AND WINDOW PROP 65. o o o o i~ Held for Fumre Use o O i~ Held for Fumre Use ~g~EE~E~EEE~E~E~EEEE~EEE~EE~EE~i O o -7- 10/25/2000 MISCELLANEOUS RECEIVABLES ADJUSTMENT ,~ ./ /-v~ ADORESS CHANGE ' CLOSE ACCT j · FINANCE CHARGE !. ' OTHER ADJ I"~ SITE ADDRESS PARCEL NUMBER ADJUSTMENT ~ CHG DATE CHARGE CODE ADJUSTMENT AMOUNT ! . EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notif3' the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless requi .red to obtain appwval before making the change. Required by Sections 2632(d) and 2641(h) CCIL Facility Address -7-~.~9 ~a.~-~ 5-(". 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary comainment within 8 hours, or deteriorate the secondary containment~ then the Of Fi.ce of En~ronmental Services,must be notifie/d within 24 hours. ()~oet~r{i~;, ~ ~,c /Ya_~r'c e, ~- qpt {[ (" ,,qt~o,~?' , 2. Describe the proposed methods and equipment to. be used for removing and properly disposing of, any hazardous substance. ~t~¥ (o,at~cc t3'~ o.~e~ff' 3. Describe the location an. cl availability of the required cleanup equipment in item 2 above. 4. Describe the maintenance schedule for the cleanup equipment: 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan: WR EN MONITORING PRO D S UNDERGROUND STORAGE TANK MONITORING PROGRAM This momtorin$ program must be ir_~-pt at the UST location at all ~ T'ne information on this monitmin~ program am conditiom ~th~ ope~nting permit The permit holder m,t~ notify the O~ce of ~n~om~m~ S~'vi~ within 30 da~ of any ~ to th~ monitonng procedureS, unless required to ot~i- al~oval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name A. Describe the ft'equency of performing the monitoring: f Piping B. What methods and equipment, identified by name and model, will be used for perfoming the monito 'nn.g: Tank Piping C. Describe the location(s) where the monitoring will be performed (facility plot plan should be attached): ~ D. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: E. Reporting Format for monitoring: Tank Piping F. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturet°s maintenance sehednle but not l~s~ than every 12 months, ace G. Describe the training necessary for the operation of UST system, in~uding pip. in8. and the monitoring equipment: ~Cc~,,c {~,~, /a,,ot~ '/tf, t,,.,,,-f ~ ....CEFITIFICATION OF FINANCIAL FIESPON$1BILITY FOR UNDER{~elOUND 8TORAGE TANK8 CONTAINING PETROLEUM [---~ ~0.~00 doflarsp~r oecurmnm ~ l mh doflars muuai a~ropto or AND or [~'~Z mi~o~ doib~ imf occ~ ~ 2 minion doll~z ~u~l ~-J (2 L~ hereby certifies that it is in compliance with the requirements of ~l, ion 2807, Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial resl~onsibility as required by Section 2807 are as follows: Coi~e~ I11ird. Party Note: If you are using the d~tate Fund as any part of your demonstration of financial responsibility, your execuSon and submission of this cerffifcation also certiEes that you are in compliance with all conditions for participation in the Fund. pm~li~yNamo Fs~ityA~,~ ~NSTRUCT~ONS ' .......... PLem tyl:m or print cLearLy eLL ~f0rmtiml on Certtficetton of FI~tiL R~ibJtJ~ fo~.' ALL fecJLJtJ~ ~ lJt~ W or ~r8~ my b LJsc~ ~ ~ foe; therefore r~J~ for ca~ D~NT A. ~ ~j~ - ~Kk the 8~roprJace ~xes.. B. ~ of T~W - FuLL ~ of e~Cher the cafl~ o~er or the ~ ~cor C. ~Jm T~ - l~J~te ~Jch State o~rov~ ~hani~Cs) are ~ing r~ibiiJty eJVher as con~8~ ~ Vhe f~r8[ r~iaCi~, ~0 CFR, Parc 280, S~rV fi, S~Vi~ 280.90 ~hrough 280.~0~ (S~ FJ~aL R~Jb~LJ~ Guide, for ~re infection), or S~on 2802.1, Chapver 18, DJvJsJ~ 3, TJ~ie ~, CC~. ~ ~ I~ - LisV aLL ~ o~ ~resses of c~flies a~/or i~ivJ~Ls issuing coverage. ~j~ U~ - L~st Jd~tJ~n~ fl~r for each ~chaflJsm ~. Ex~te: iflsura~e ~LJcy ~r or fiLe ~r as i~icaz~ on ~m or doc~;. (State F~) Leave bLank.) ~ ~t - l~icate ~t of coverage for each t~ of ~hanJ~(s). If ~re than ~e ~ani~ is i~icat~, total ~st ~ai 100~ of f~iaL res~biLity for each f ac i L i ty. ~ P~j~ - l~cate the effective da~e(s) of ai~ fina~aL ~hani~(s). (State F~ coverage u~Ld ~ c~t~ as Long as you ~inta~fl c~iia~e a~ r~ifl eLigibLe to cmt~ ~rt~c~tion iff the F~.) ~j~ ~jm - l~Jcate y~ or fla. Does the s~ifi~ f~iai ~anJ~ provide co.rage for corr~tJve acti~? (if using state F~, i~cate "y~".) ~J~ PorW - i~Jcate y~ or fla. Ooes the s~c;f~ fi~aL ~hanism provide coverage for ~tJ~ third ~rty c~a~iofl? (if ~ing State F~, ~icate "y~".) D. F~JLJ~ - Prov~ aLL facility a~/or site ~s a~ ~r~ses. l~tJm E. $J~ B~ - Pro~J~ sig~ture a~ da~e sign~ by tank o~r or o~racor; ~ t~tLe of t~k o~r or o~rator; sjg~ture of uitness or ~tary a~ ~te sig~; a~ prJnt~ or ~ nam of uitness or notary (~f notary sig~ as ,Jtfl~s, p~ease place mtary seal next to ~tary's s~g~ture). ~here to ~blaj ~ Certification: PLease send original to your LocaL agency (agency uho issues your UST permits). Keep a copy of the certification et each facility or site Listed on the form. Questions: [f you have questions on financial responsibility requirements or on the Certification of Financial ResponsibiLity Form, pLease contact the State UST CLeanup F~d 'at (916) 7'~9-2475. No~e: P~tfes for FaiLure taCt m pLy uith Financial Res~ibi[izyRequire~ents: FaiLure to comply may result in: (1) jeopardizing cLaimant eLigibiLity for the State UST CLeanup F~d, and (2) LiabiLity for civil penalties of up to $10,000 doLLars per day, per underground storage tank, for each day of violation as stated in ArticLe 7, Section 25299.76(a) of the CaLifornia HeaLth and Safety Cocle. OF ENVIRONMENTAL VICES I gt g I 1715 Chester Ave., CA 93301 (661) 326-3979 ..~...,,.,~~~. ~,~,... UNDERGROUND STORAGE TANK FACILITY [] 1 NEW SITE ~ 3 RENEWAL PERMIT ~5 CHANGE OF INFORMATION (State type of change) [] 7 PERMANENTLY CLOSED SITE TYPE OF ACTION PERMIT [] 4 AMENDED PERMIT [] 8 TANK REMOVED 400 (Check one item only) [] 6 TEMPORARY SITE CLOSURE I. FACILITY I SITE INFORMATION BUSINESS NAME,Same aa FACILITY NAME or DBA - Doing Business As)F~'~ ~'+~' Z'"I-- ~'' ~t/' ~: 3 FACILITY ID # [ .~. ~ ! E~ I' ' NEAREST CROSS STREET / 401 FACILITY OWNER 'PtPE [] 4 LOCAL AGENCY/DISTRICT* []tCORPORAT, ON 0. COUN YAGENCY' BUSINESS [~1 GAS STATION E] 3 FARM [] S OTHER 403 1~2 INDIVIDUAL [] 6 ST.ATE AGENCY' TYPE [] 2 DISTRIBUTOR [] 4 PROCESSOR [] 6 COMMERCIAL [] 3 PARTNERSHIP [] 7 FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS I Is facility on Indian Resewation or *If ore, er of UST a public agency: name of supervisor of REMAINING AT SITE I trustlands? division, section or office which operates the UST. (This is the contact person for the tank records.) 404 O Yes j~3 No 405 406 II. PROPERTY OWNER INFORMATION MAILING OR STREET ADDRESS 409 CITY p~g $/~/d· 410 I STATE CA 411 ZIP 9~O~ 412 PROPERTY OWNER TYPE ~2 ~ND~VIDUAL [] 4 LOCAL AGENCY/D~STR~CT [] 6 STATE AGENCY 4~3 [] 1 CORPORATION /'[~ 3 PARTNERSHIP [] $ eOU~etY AGENCY [] 7 FEDERAL AGENCY III. TANK OWNER INFORMATION- MAILING OR STREET ADORESS 416 TANK OWNER TYPE ~2 INDIVIDUAL [] 4 LOCAL AGENCY / DISTRICT [] 6 STATE AGENCY 420 [] 1 CORPORATION [] 3 PARTNERSHIP [] 5 COUNTY AGENCY [] 7 FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER 421 V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(S) D 1 SELF-INSURED [] 4 SURETY BOND ~'7 STATE FUND ltI 10 LOCAL GOV*T MECHANISM [] 2 GUARANTEE [] 5 LEI'TER OF CREDIT [] 8 STATE FUND & CPO LETTER [] 99 OTHER: 422 [] 3 INSURANCE [] 6 EXEMPTION [] 9 ,~';ATE FUND & CD VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. [] 1 FACILITY ~[~ 2 PROPERTY OWNER [] 3 TANK OWNER 42~ Legal noflflcotlon and mailing will be sent to the tank owt~et' unless box I or 2 is checked. VII. APPLICANT SIGNATURE cettil'ica~n: I certify that the information provided herein ia ~ & accurate to the best of my knowledge _ SIGNATURE DATE 424 PHONE 425 NAMEOPAPPLICANT(prI'nI) ~" ~"~"'--' 426 TITLE OF APPLICANT 427 i Form A OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ""'*~' "-' UST Tank - 1 Page __ of TYPE OF ACTION [] 1 NEW SITE PERMIT [~3 RENEWAL PERMIT {~5 CHANGE OF INFORMA'IqON (State type of change) [] 7 PERMANENTLY CLOSED ON SITE Check one item only [] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE [] 8 TANK REMOVED 429 I. TANK DESCRIPTION TANK ID # 430 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK [] Yes 432 (~,,4 ,/v~, ~",,.,~ L~ ,,t~.. If 'Yes'. complete one form for each compartment. OATE INSTALLED (YEAR/MO) 433 TANK CAPACITY IN GALLONS 434 NUMBER OF COMPARTMENTS 435 ADDITIONAL DESCRIPTION (For local use only) 436 II. TANK CONTENTS TANK USE 437 VEHICLE FUEL TYPE 438 [] 1 MOTOR VEHICLE FUEL [] la REGULAR UNLEADED [] 2 LEADED [] 5 JET FUEL (if marked, complete Vehicle Fuel Type) ~bb PREMIUM UNLEADED [] 6 AVIATION FUEL [] 2 USED OIL [] lc MIDGRADE UNLEADED [][] 43 GASOHoLDIESEL [] 99 OTHER [] 3 CHEMICAL PRODUCT [] 4 HAZARDOUS WASTE COMMON NAME (from Hazardous Materials Inventory page) 439 CAS # (from Hazardous Materials Inventory page) 440 [] 95 UNKNOWN II1. TANK CONSTRUCTION TYPE OF TANK I SINGLE WALL [] 3 SINGLE WALL WITH [] 5 INTERNAL BLADDER SYSTEM 441 Check one item only [] 2 DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95 UNKNOWN [] 4 SINGLE WALL IN A VAULT [] 99 OTHER TANK MATERIAL (primary tank) ~ 1 BARE STEEL [] 4 STEEL CLAD W/FRP [] 5 CONCRETE [] 95 UNKNOWN 442 Check one item only [] 2 STAINLESS STEEL [] 3 FIBERGLASS E] 8 FRP COMPATIBLE W1100% METHANOL [] 99 OTHER TANK MATERIAL (secondary tank) I~ 1 BARE STEEL ~ 4 STEEL CLAD WI FRP [] 8 FRP COMPATIBLE W/100% METHANOL [] 95 UNKNOWN 443 Check one item only [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 9 FRP NON-CORRODIBLE JACKET [] 99 OTHER. [] 5 CONCRETE [] 10 COATED STEEL INTERIOR LINING OR COATING [] I RUBBER LINED ~[~3 EPOXY LINING [] 5 GLASS LINING [] 95 UNKNOWN 444 Check one item only [] 2 ALKYD LINING ~4 PHENOLIC LINING [] 6 UNLINED OTHER OTHER CORROSION [] I MANUFACTURED CP [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN 445 PROTECTION tF APPLICABLE Check one item only [] 2 SACRIFICIAL ANODE ,~4 IMPRESSED CURRENT [] 99 OTHER SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) /-/-" ~"~ "'- c~/~, OVERFILL PROTECTION EQUIPMENT INSTALLED (YEAR) (~_..~..Ta~ ~ 446 ~ 447 Check all that apply DROP TUBE ' ,,[~'es [] No 448 ~1 ALARM STRIKER PLATE J~Yes [] No 449 [] 2 BALL FLOAT [] 3 FILL TUBE SHUT OFF VALVE i: }'....:'~::' " i '.b'.'i'~:.'"' ." "IV'.: :TANK LEAK oET'~'i'ON'i"~?: ':' .'. Z' :" IF SINGLE WALL TANK iChecl~ all that apply): IF DOUBLE WALL TANK (Check one item only): 450 [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 8 VISUAL (SINGLE WALL IN VAULT ONLY) ~2 AUTOMATIC TANK GAUGING (ATG) [] 6 VA•OS• ZONE [] 9 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 4 STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 99 OTHER BIENNIAL TANK TESTING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MOIDAY) 451 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 452 GAS TANK FILLED WITH INERT MATERIAL? 453 : gal [] Yes [] No Form E! i 7 ~k CITY OF BAKERSFIELD 5 I~ OFFICE OF ENVIRONMENTAL SERVICES ; 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3~J79 UBT · TANK PAGE Page =' VI. PIPING CONSTRUCTION (Check all that apply) ,; ................ AS E OU~D PIPING',FO"MATION · UNDE."G. U,D P,PINO,NFORMATIO" ' SYSTEM TYPE [] 1 SUCTION ~'2 PRESSURE [] 3 GRAVITY 454 [] I SUCTION ~]"2 PRESSURE [] 3 GRAVITY 455 ~i ............. '--~1 'SINGLE WALL [] 95 UNKNOWN r"], SINGLE WALL /~3 LINED TRENCH [] 99 OTHER CONSTRUCTION ,= [] 2 DOUBLE WALL [] 99 OTHER 450 [] 2 DOUBLE WALL [] 95 UNKNOWN 454 MATERIALS AND [] 6 FRP COMPATIBLE WI 100% METHANOL [] 1 BARE STEEL [] 6 FRP COMPATIBLE WI 100% METHANOL CORROSION [] I BARE STEEL PROTECTION [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 3 PVC COMPATIBLE WITH CONTENTS [] 95 UNKNOWN [] ~¢~VC COMPATIBLE WITH CONTENTS [] 95 UNKNOWN [] 4 FIBERGLASS [] 8 FLEXIBLE [] 99 OTHER 1~4 FIBERGLASS [] 8 FLEXIBLE [] 99 OTHER t [] 5 STEEL W/COATING [] 9 CATHODIC PROTECTION 455 [] 5 STEEL'W/COATING [] 9 CATHODIC PROTECTION 456 Vii. PIPING .... ' ": LEAK DETECTION (Check all that apply) ABOVEGROUND PIPING INFORMATION UNDERGROUND PIPING INFORMATION SINGLE WALL PIPING 457 SINGLE WALL PIPING 456 PRESSURIZED PIPING (Check all that apply): ,~,~r'~'SSURIZEO PIPING (Check all that apply): [] 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEBT WITH AUTO PUMP SHUT OFF FOR LEAK. ~ I ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBL~ AND VISUAL ALARMS FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AN,? VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 2 MONTHLY 0.2 GPH TEST : [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) [] 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 4 DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM TEST (0.1 GPH) [] 6 TRIENNIAL iNTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: SAFE SUCTION SYSTEMS: [] 7 SELF MONITORING [] 5 SELF MONITORING GRAVITY FLOW (Check all that apply): GRAVITY FLOW: [] 8 DALLY VISUAL MONITORING [] 6 3IENNIAL INTEGRITY TEST (0.1 GPH) [] 9 BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check ail that apply): [] 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (check one) [] 7 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM [] c NO AUTO PUMP SHUT OFF DISCONNECTION [] 11 AUTOMATIC LEAK DETECTOR ';J [] c NO AUTO PUMP SHUT OFF [] 12 ANNUAL INTEGRITY TEST (0.1GPH) [] 8 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) SUCTION/GRAVITY SYSTEM: [] 9 ANNUAL INTEGRITY TEST (0.1 GPH) [] 13 CONTINUOUS BUMP SENSOR + AUDIBLE AND VISUAL ALARIvl$ EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14 CONTINUOUS SUMP SENSOR WITHQUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS VISUAL ALARMS [] 15 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 11 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16 ANNUAL INTEGRITY TEST (0.1 GPH) [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) [] 17 DAILY VISUAL CHECK [] 13 DAILY VISUAL CHECK .... " ' '" ' ~':";' ; NUdiST--- : · ",, '?, :. ,¥"~" VIII. DISPENSER CONTAI DISPENSER [] 3 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER CONTAINM~_E~I,T [] 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE .... [] Yes {~ No r-] 2 CONTINUOUS ELECTRONIC SENSOR + AUDIBLE AND VISUAL ALARMS + AUDIBLE AND VISUAL ALARMS [] 4 DALLY VISUAL CHECK IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is lrue & accurate to the best of my knowledge. ~A'-J~-O'~'~WO ~E~I/OPERA~)R (print) 463 TITLE OF OWNER/OPERATOR 464 ........ c _o Form B CITY OF BAKERSFIEi OFFICE OF ENVIRONMENTAL SERVICES / 1715 Chester A ve., Bakersfield, CA 93301 (661) 326-3979 Page ~ of TYPE OF ACTION [] 1 NEW SITE PERMIT ~.,3 RENEWAL PERMIT [~ CHANGE OF INFORMATION (State type of change) [] 7 PERMANENTLY CLOSED ON SITE Check one item o.nly [] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE [] 8 TANK REMOVED 429 'BUSINESS 3I FACILITY ID # NAME (Same as FACILITY NAME or DBA - Ooing Business As) I. TANK DESCRIPTION ', TANK ID # 430 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK ~1'-I Yes ~No 432 DATE INSTALLED (YEAR/Mo) 433 TANK CAPACITY IN GALLONS 434 NUMBER OF COMPARTMENTS 435 436 ADDITIONAL DESCRIPTION (For local usa only) II. TANK CONTENTS TANK USE 437 VEHICLE FUEL TYPE 438 '~ 1 MOTOR VEHICLE FUEL [~ la REGULAR UNLEADED [] 2 LEADED [] 5 JET FUEL (If marked, complete Vehicle Fuel Type) -~,.,~ b PREMIUM UNLEADED [] [] 6. AVIATION FUEL [] 3 DIESEL 2 USED OIL ~'1c MIDGRADE UNLEADED [] 3 CHEMICAL PRODUCT [] 4 GASOHOL [] 99 OTHER [] 4 HAZARDOUS WASTE COMMON ~'~ME (from Hazardous Materials Inventory page) 439 CAS # (from Hazardous Materials Inv6-%ry page) 440 [] 95 UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK [~1 SINGLE WALL [~SINGLE WALL WITH [] 5 INTERNAL BLADDER SYSTEM 441 Check one item only [] 2 DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95 UNKNOWN [] 4 SINGLE WALL IN A VAULT [] 99 OTHER TANK MATERIAL (p~tmar/tank) E~'~RE STEEL [] 4 STEEL CLAD W/FRP [] 5 CONCRETE / [] 95 UNKNOWN 442 Check one item only [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 8 FRP COMPATIBLE W1100% METHANOL I [] 99 OTHER TANK MATERIAL (secondary tank) ~1 ~RE STEEL [] 4 STEEL CLAD W/FRP [] 8 FRP COMPATIBLE WI100% METHANOL [] 95 UNKNOWN 443 Check one item only [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 9 FRP NON-CORRODIBLE JACKET [] 99 OTHER. [] 5 CONCRETE [] 10 COATED STEEL INTERIOR LINING OR COATING [] 1 RUBBER LINED [~'~POXY LINING [] 5 GLASS LINING [] 95 UNKNOWN 444 Check one item only [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER OTHER CORROSION [] I MANUFACTURED CP [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN 445 PROTECTION IF APPLICABLE Check one item only [] 2 SACRIFICIAL ANODE []~IMPRESSED CURRENT [] 99 OTHER. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) ~/'~'~.~ ?' ~ ~ OVERFILL PROTECTION EQUIPMENT INSTALLED (YEAR) Cff"o~ 3' ?/q~ 446 447 Check all that apply DROP TUBE ' ~Ye, [] No 448 [:]~'1'~A1 ALARM STRIKER PLATE ~es [] No 449 [] 2 BALL FLOAT [] 3 FILL TUBE SHUT OFF VALVE ' ""i ':"~::,: ~ LEAK DETECTION ~ : "' ~i ?';' """'NK ,:'i:?::::!?? : · ' ' ': ' IF SINGLE WALL TANK (Check all that apply): IF DOUBLE WALL TANK (Check one item only): 450 [] 1. VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 8 VISUAL (SINGLE WALL IN VAULT ONLY) [~2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 9 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG ~ 7 GROUNDWATER [] 4 STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 99 OTHER BIENNIAL TANK TESTING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MOIDAY) 451 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 452 GAS TANK FILLED WITH INERT MATERIAL? 453 gal [] Yes [] No Form B I/] ~-~ CITY OF BAKERSFIELD · OFFICE OF ENVIRONMENTAL SERVICES ~) $ Chester Ave.. Bakersfield, CA 93301 (805) 326-~"-J79 UST. TANK PAGE 2 Page ~ Of VI. PIPING CONSTRUCTION (Che~ck all that a~ly) AB~ROUND PIPING INFOR~ON UNDER~OUND PIPING INFO~TION ~ PRESSURE ~1~ 4~ ~ 1 SUCTION ~ 2, PRESSURE ~ 3 G~VI~ 455 ~ 2 DOUBLE WALL ~ 99 ~H~,, 450 ~ 2 DOUBLE WALL ~ 95 UNKNOWN 4~ ~TERIALS AND ~ 1 BARE STEEL ~ ~ 6 FRP COMPATIBLE'WI~I~% MET~NOL ~ 1 ~RE STEEL D 6 FRP COMPATIBLE W/100% MET~NOL CORROSION ~ PROTECTION ~ 2 STAINL~ ~ 7 ~LVAN~ED STEEL ~ ~ 2~TAINLESS STEEL ~ 7 ~LVANIZED STEEL ~~PATIBLE Wl~ CONTENTS ~ ~ UN~OWN ~/PVC COMPATIBLE WITH CO~ENTS ~ 95 UN~OWN ~ 4 FIBERG~SS ~ 8 FL~I~LE ~ ~ O~ER ~4 FIBERG~SS ~ 8 FLEXIBLE ~ 99 O~ER ~ 5 STEEL WI COATING ~ 9 ~OOIC PROTECTION 455 ~ 5 STEEL W/COATING ~ 9 ~THODIC PROTECTION 456 VII. PIPING LEAK~DET~CTiON ~Check ail ~at apply) ABOVEGROUND PIPING INFOR~TION UNDERGROUND PIPING INFOR~TION SING~ WALL PIPING 457y SINGLE WALL PIPING 456 PRESSURIZED PIPING (Ch~k all ~at app,): ~SSURIZED PIPING (Ch~k ~at ~ 1 ELEC~ONIC LINE L~K D~E~OR 3.0 GPH ~ST ~ A~O ~MP SH~ OFF FOR L~. ~ 1 ELECTRONIC LINE L~K D~ECTOR 3.0 GPH ~ST WI~ AUTO PUMP SH~ OFF SYSTEM FAILURE FOR L~ SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUOIBLE ~D VISU~ A~S ~ 2 MON~LY 0.2 GPH ~ST D 2 MOLLY 0.2 GPH TEST : ~ 3 ANNUAL I~EGR~ TEST (0.1 GPH) ~ 3 ANNUAL I~GR~ TEST (0.1 GPH) ~ 4 DAILY~SUAL CHECK CO~IO~L SUC~ON SYSTEMS: CONVE~IO~L SUCTION SYSTEMS (C~ all ~at apply): ~ 4 DAILY ~SUAL MONITORJNG OF PUMPING SYS~M + TRIENNIAL PIPING I~GR~ ~ 5 SYSTEM ~ST(0.1 GPH) ~ 6 TRIENNIA; (0.1 GPH) SAFE SUCTION SAFE SUCTION SYSTEMS: D 7 SELF ~ 5 SELF MONITORING G~VI~ FLOW :h~k all ~t a G~VI~ FLOW: ~ 8 D 6 BIENN~L I~EGRI~ST(0.1 GPH) ~ 9 BIENN~L I~GRI~TEST(O.I SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Ch~k all ~at app,): PRESSURIZED PIPING (Ch~k all ~t app~): ~ 10 CON~NUOUS ~RBINE SUMP SENSOR ~ (~ one) D 7 CO~INUOUS ~RBINE SUMP SENSOR WITH AUDIBLE AND VISUAL A~ AND (Ch~k one) ~ a ~ a A~O PUMP SH~ OFF WHEN A L~K ~CURS ~ b AUTO PUMP SHUT OFF AND SYS~M DISCONNECTION ~ b A~O PUMP SH~ OFF FOR L~KS. SYSTEM FAILURE AND SYSTEM ~ c NO AUTO PUMP SH~ OFF DISCONNECTION ~ 11 AUTOmaC L~K DETECTOR ~ c NO A~O PUMP SHUT OFF ~ 12 ANNUAL I~EGRI~TEST D 8 A~O~TIC LINE L~K DE~OR (3.0 GPH TES~ SUCTIO~G~VI~ SYS~M: ~ 9 ANNUAL I~GRI~ TEST (0.1 GPH) ~ 13 CO~NUOUS SUMP SENSOR ~ ~D VISUAL ~ EMERGENCY ',~TOR8 ONLY (C~ a~ ~t app,) EMERGENCY GENE~TORS ONLY (C~ a~ ~t apply) ~ 14 ~ITHO~A~OPUMPSH~OFF+AUDIBLE~D ~ 10 CO~NUOUSSUMPSENSORWlTHOUTA~OPUMPSH~OFF+AUDIBLEAND VISUAL A~RMS VISUAL A~RMS ~ 15 AUTO~TIC LINE L~K ~ 11 A~O~TIC LINE L~K D~CTOR (3.0 GPH TEST) ~ 16 ANNUAL (0.1 GPH) ~ 12 ANNUAL INTEGRI~TEST(0.1 GPH) ~ 17 DALLY VISUAL CHECK D 13 DAILY VISUAL CHECK ~.~ Z' ..~' ''' ~'~ VIIL DISPENSER CONTAINMENT DISPENSE~ ~ 3 CO~INUOUS OISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER CONTAI~NT ;H~R VALVE ~ Yes ~No ~ 2 CONTINUOUS ELECTRONIC SENSOR + AUDIBLE AND ~SUAL A~MS + AUDIBLE AND VISUAL A~S ~ 4 DAILY VISUAL CHECK IX. OWNE~OPE~TOR SIGNATURE I ceAi~ that the inflation pmvid~ herein is ~e & accurate to the best of my ~edge. ~A~O~OPE~OR (print): 463 TITLE OF OWNE~OPE~TOR 4~ Form 8 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 '"'" ~'~'~*' "--' UST Tank - 1 Page m of [] t NEW SITE PERMIT ~-3 RENEWAL PERMIT ~Y*5 CHANGE OF INFORMATION (State type of change) [] 7 PERMANENTLY CLOSED ON SITE TYPE OF ACTION Check one item only [] 4 AMENDED PERMIT I-~ 6 TEMPORARY SITE CLOSURE [] 8 TANK REMOVED 429 BUS,NESS NAME (Same as FACIUTY NAME or DBA - Doing Business As)~'~'~[ /'~ ' ILf~lJ 0 ~~-~ 3 FACILITY ID . ~~ I J 1 LOCATION (~)p~al) ' ' ' I. TANK DESCRIPTION TANK ID # 430 TANK MANUFACTURER 431 COMPARTMENTALIZED TANK [] Yes ~o 432 O ,, *Yee'. comp,eta one ,o m ,o, each compa,m ,,. OATE INSTALLED (YEAR/MO) 433 TANK CAPACITY IN GALLONS 434 NUMBER OF COMPARTMENTS 435 ADDITIONAL DESCRIPTION (For local use only) 436 II. TANK CONTENTS IMTANK USE 437 VEHICLE FUEL TYPE 438 OTOR VEHICLE FUEL [] la REGULAR UNLEADED [] 2 LEADED [] 5 JET FUEL (If marked, complete Vehicle Fuel Type) [] lb PREMIUM UNLEADED [] 3 DIESEL [] 6 AVIATION FUEL [] 2 USED OIL II'cc MIDGRADE UNLEADED [] 99 OTHER [] 3 CHEMICAL PRODUCT [] 4 GASOHOL [] 4 HAZARDOUS WASTE COMMON NAME (from Hazardous Materials Inventory page) 439 CAS # (from Hazardous Materials Inventory page) 440 [] 95 UNKNOWN III. TANK CONSTRUCTION TYPE OF TANK ~1 SINGLE WALL [] 3 SINGLE WALL WITH [] 5 INTERNAL BLADDER SYSTEM 441 Check one item only [] 2 DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95 UNKNOWN [] 4 SINGLE WALL IN A VAULT [] 99 OTHER TANK MATERIAL (primary tank) {~1 BARE STEEL [] 4 STEEL CLAD WI FRP r"l 5 CONCRETE [] 95 UNKNOWN 442 Check one item only [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 8 FRP COMPATIBLE W/100% METHANOL [] 99 OTHER__ TANK MATERIAL (secondary tank) ~1 BARE STEEL [] 4 STEEL CLAD W/FRP [] 8 FRP COMPATIBLE WI100% METHANOL [] 95 UNKNOWN 443 Check one item only I"] 2 STAINLESS STEEL [~] 3 FIBERGLASS r"l 9 FRP NON-CORRODIBLE JACKET [] 99 OTHER [] 5 CONCRETE [] 10 COATED STEEL INTERIOR LINING OR COATING [] 1 RUBBER LINED ~3 EPOXY LINING [] 5 GLASS LINING [] 95 UNKNOWN 444 Check one item only [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 8 UNLINED [] 99 OTHER OTHER CORROSION [-I 1 MANUFACTURED CP ["1 3 FIBERGLASS REINFORCED PLASTIC r"] 95 UNKNOWN 445 PROTECTION IF APPLICABLE Check one item only [] 2 SACRIFICIAL ANODE [~4 IMPRESSED CURRENT [] 99 OTHER SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED {YEAR) t~-..~ ~ - ~/~ OVERFILL PROTECTION EQUIPMENT INSTALLED (YEAR) q~ ~ ~ 446 447 Check all that apply DROP TUBE ' [~ [] No 448 [] 1 ALARM STRIKER PLATE [~es [] No 449 [] 2 BALL FLOAT r"l 3 FILL TUBE SHUT OFF VALVE IF SINGLE WALL TANK (Check all that apply): IF OOUBLE WALL TANK (Check one item only): 450 [] 1_VISUAL (EXPOSED PORTION ONLY) J--~ 5 MANUAL TANK GAUGING (MTG) [] S VISUAL (SINGLE WALL IN VAULT ONLY) ~AUTOMATIC TANK GAUGING (ATG) 6 VADOSE ZONE [] [] 9 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] ? GROUNDWATER [] 4 STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 99 OTHER SIENNIAL TANK TESTING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YRJMO/DAY) 451 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 452 GAS TANK FILLED WITH INERT MATERIAL? 453 gal [] Yea [] No Fora1 S I ~ ~1 CITY OF BAKERSFIELD .~. -'" OFFICE OF ENVIRONMENTAL SERVICES O 5 Cheater Ave., Bakersfield, CA 93301 (805) 326-3'979 UET · TANK PAGE Page ~ Of VI, pIPING CONSTRUCTIOI~ (C.heck all that apply) ABOVEGROUND PIPING INFORMATION UNDERG~,IND PIPING INFORMATION ~E-~'~P-~'- I'-] 1 SUCTION ~2 PRESSURE [] 3 GRAVITY 454 I'"11 SUCTION -- [~ PRESSURE [] 3 GRAVITY 455 CONSTRUCTION ~I-N~ WALL ~ 95 UNKNOWN r"~, SINGLE WALL 1~3 LINED TRENCH [] 99 OTHER [] 2 DOUBLE WALL [] 99 OTHER 450 [] 2 DOUBLE WALL [] 95 UNKNOWN 454 MATERIALS AND [] 1 BARE STEEL [] 6 FRP COMPATIBLE WI 100% METHANOL [] 1 BARE STEEL [] 6 FRP COMPATIBLE W/100% METHANOL CORROSION PROTECTION [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL {~F3 PVC COMPATIBLE WITH CONTENTS [] 95 UNKNOWN [] 3 P. VC COMPATIBLE WITH CONTENTS [] 95 UNKNOWN IBERGLASS [] 8 FLEXIBLE [] 99 OTHER [~4 FIBERGLASS [] 8 FLEXIBLE [] 99 OTHER [] 5 STEEL WI COATING [] 9 CATHODIC PROTECTION 455 [] 5 STEEL W/COATING [] 9 CATHODIC PROTECTION 456 VII. PIPING LEAK'DETECTIO~ (Check all that apply) ABOVEGROUND PIPING INFORMATION UNDERGROUND PIPING INFORMATION SINGLE WALL PIPING 457 SINGLE WALL PIPING 456 PRESSURIZED PIPING (Check all that apply): P__R.~URIZED PIPING (Check all that apply): [] I ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST ~t¥1TH AUTO PUMP SHUT OFF FOR LEAK. L~ I ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 2 MONTHLY 0.2 GPH TEST : [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) [] 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 4 DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM TEST (0.1 GPH) [] 6 TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: SAFE SUCTION SYSTEMS: [] 7 SELF MONITORING [] 5 SELF MONITORING GRAVITY FLOW (Check all that apply): GRAVITY FLOW: [] 8 DALLY VISUAL MONITORING [] 6 BIENNIAL INTEGRITY TEST (0.1 GPH) [] 9 BIENNIAL INTEGRITYTEST(O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): [] 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (check one) [] 7 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM [] c NO AUTO PUMP SHUT OFF DISCONNECTION [] 11 AUTOMATIC LEAK DETECTOR [] c NO AUTO PUMP SHUT OFF [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) [] 8 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) SUCTION/GRAVITY SYSTEM: [] 9 ANNUAL INTEGRITY TEST (0.1 GPH) [] 13 CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14 CONTINUOUS SUMP SENSOR WlTHQUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS VISUAL ALARMS [] 15 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 11 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST [] 16 ANNUAL INTEGRITY TEST (0.1 GPH) [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) [] 17 DAILY VISUAL CHECK [] 13 DAILY VISUAL CHECK ~::/!,..~'!.? !.':~'.=. ~Vili: :~)i'~Ei~sER CONTAINMENT := DISPENSER [] 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 3 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER CONTAINMENF [] Yea [~/~io [] 2 CONTINUOUS ELECTRONIC SENSOR + AUDIBLE AND VISUAL ALARMS + AUDIBLE AND VISUAL ALARMS [] 4 DAILY VISUAL CHECK IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is ~rue & accurate to the beat of my knowledge. SIGNATURE OF OWNER/OPERATOR DATE 462 NAME OF OWNER/OPERATOR (print) 463 TITLE OF OWNER/OPERATOR 464 IPermit Numl3er (For local uae only) Permit Approved Permit Expiration Date Form 8 ~ CITY OF. BAKERSFIELDI OFI=~E OF ENVIRONMENTAL S~ICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS-INSTALLATION CERTIFICATE OF COMPLIANCE One form per tank Page I. FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILI~I~t' NAME or DBA - Doing Business As) FAc,L,~,o# "~ -~- [] ,, T^.K,O # I I I~I]__LI._L_I~ I ! I I I I I ......................... II. INSTALLATION Check 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. ~/x". The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. .~AII work listed on the manufacturer's installation checklist has been completed. The installation contractor has been ce~fied or licensed by the Contractors State License Board. [] Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify_ method: III. TANK OWNER/AGENT SIGNATURE I certify that the information provided herein is true & accurate to the best of my knowledge Fon~ C ~ BAK~iSFIELD CITY FIRE DEPAI~ENT ~ HAZARDOUS. MATERIALS DIVISION INSPECTION RECORD POST CARD AT JOBSITE FACILITY F~/~ C '~ OWNER ~ ~ ADDRESS ~ ~ ~r ADDRESS "~0 ~ ~ ~ c~, z~P .~. ~ ~ ~ c,~, z~P¢~ -. ¢~ INS~UCTIONS: Please ~11 for an ins~r on~ when each group of ins~ons w~ ~e same numar are ma~. They will run in ~nsecu~e order ~ginninI w~ numar 1. ~ NOT ~ver work for any num~md group until all ~ms in ~at group am signed off by ~e Perm~ng Aurora. Following ~ese ins~u~ons will reduce ~e numar of required ins~on vis~ and ~erefore prevent assessment of add~onal fees. TANKS AND BACKFILL INSPECTION I DA~ I INSPECTOR ~c~ll of Tank(s) S~rk Test Ce~on or Manufa~res Me~od Ca~odic ProlCon of Tank(s) PIPING SYSTEM Piping & Raceway w/Collection Sump Corrosion Protection of Piping, Joints, Fill Pipe Electrical Isola~on of Piping From Tank(s) Cathodic Protection System. Piping SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION Liner Installation - Tank(s) 5/.?z Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annular Spaca-D,W, Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) fOr Vadose/Groundwater FINAL II .. I Monitoring Wells, Caps & Locks %" I Fill Box Lock I Monitoring Requirements CONTRACTOR ~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ffl¢,Slw,, h~.voc5 INSPECTION DATEo[.tdgs ADDRESS ~(~3 3 .~l'rr 6T- PHONE NO..'~3-/'l(o~ ~.l ' FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section I: Business Plan and Inventory Program [~ Routine [21 Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand ~/ Business plan contact intbrmation accurate ~/ Visible address [/ Correct occupancy jr Verification of inventory materials V Verification of quantities ~ Verification of location bt' Proper segregation of material sot Verification of MSDS availability b/ Verification of Haz Mat training ~ Verification of abatement supplies and procedures V/ Emergency procedures adequate p/ Containers properly labeled ~ Housekeeping t,/ Fire Protection ,p/ ~ Site Diagram Adequate & On Hand '~' C=Compliance V=Violation Any hazardous waste on site?: [] Yes [] No Explain: Questions regarding this inspection? Please call us at (805) 326-3979 Business ponsible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ie~'~ h,~.Oor5_ INSPECTION DATE ~l[l!fS Section 2: Underground Storage Tanks Program [~Routine [~l Combined ~ Joint Agency [] Multi-Agency [~1 Complaint [] Re-inspection Type of Tank _-q¢~./-~ Number of Tanks ~ Type of Monitoring tqm' ~ Type of Piping /_ ~o/- OPERATION C V COMMENTS Proper tank data on file 9/ Proper owner/operator data on file V/ Permit fees current Certification of Financial Responsibility V/r Monitoring record adequate and current Maintenance records adequate and current ~r Failure to correct prior UST violations V, Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS sPcc available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? Inspector:C=C°mpliance '~V=Vi°lati°n~ Y=Yes N=NO [fll~__~/l~..~ Office of Environmental Services (805) 326-3979 Bus~nesskJSt[e ~espons~ble Party White - Env. Svcs. Pink - Bus/ness Copy FIESTA LIQUORS ~ SiteID: 215-000-001231 Manager : [~' ~A¥ ~91997 ~i BusPhone: (805) 323-4684 Location: 2023 BAKER ST ~ j~ ~ Map : 103 CommHaz : Low City : BAKERSFIELD f~ / Grid: 20D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title JUNG CHO LEE / OWNER / Business Phone: (805') 323-4684x Business Phone: ( ) - x 24-Hour Phone : (805) - x 24-Hour Phone : ( ) - x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Agency-Defined Topic Title ~ Hazmat Inventory One Unified List -- MCP+DailyMax Order Ail Materials at Site Hazmat Common Name... ISpeoHazlEPA HazardsI Frm DailyMax Unit MCP UNLEADED PLUS GASOLINE F IH DH L 4000 GAL Mod UNLEADED REGULAR GASOLINE F IH DH L 4000 GAL Mod UNLEADED PREMIUM GASOLINE F IH DH L 3000 GAL Mod I, "'~,o,.\r[ ,~.~'.,'~ 5_ Do hereby certify that I have - ' - (T~-pe or p~int name) reviewed th~ ,..,~:~,~,ed hazardous mmerials mar:age- ment p~z~"~ ~cr~.C.....~.~~and thru it along with any cor~c~ions ~nstitute a complete and corre~ man- agement plan for my facili~. 1 05/14/1997 f FIESTA LIQUORS SiteID: 215-000-001231 = Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit WEST END OF PROPERTY CAS# 8006-61-9 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS STORED AND IN USE Lrgst Cent.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 4000.00 2000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Gasoline No 8006619 -2- 05/14/1997 FIESTA LIQUORS SiteID: 215-000-001231 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site UNLEADED REGULAR GASOLINE Days On Site 365 Location within this Facility Unit WEST END OF PROPERTY CAS# 8006-61-9 ~ STATE TYPE PRESSURE i TEMPERATURE i CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS STORED AND IN USE Lrgst Cont.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 4000.00 2000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Gasoline No 8006619 -3- 05/14/1997 FIESTA LIQUORS SiteID: 215-000-001231 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site UNLEADED PREMIUM GASOLINE Days On Site 365 Location within this Facility Unit WEST END OF PROPERTY CAS# 8006-61-9 Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS STORED AND IN USE Lrgst Cent.this Loc GAL DailyMax this Loc GAL DailyAvg this Loc GAL 3000.00 2000.00 DailyMax Stored GAL DailyMax Open Use GAL DailyMax Closed Use GAL HAZARDOUS COMPONENTS %Wt. EHS CAS# 100.00 Gasoline No 8006619 -4- 05/14/1997 FIESTA LIQUORS SiteID: 215-000-001231 Fast Format ~ Notif./Evacuation/Medical Overall Site -- Agency Notification 01/07/1990 CALL 911 Employee Notif./Evacuation 01/07/1990 NOTIFICATION WOULD BE VIA RADIO CONTACT AND PHONE CONTACT BY OUR JEFFRIES BROS INC. DRIVERS EVACUATION OF THE BUILDING VIA DOORS -- Public Notif./Evacuation 01/07/1990 DIAL 911 AND EVACUATE PUBLIC CONTACT JEFFRIES BROTHERS @ 758-3072 USE SHUT OFF EMERGENCY SWITCH AT CONSOLE USE EXIT DOORS Emergency Medical Plan 01/07/1990 CALL 911 VIA PHONE -5- 05/14/1997 FIESTA LIQUORS SiteID: 215-000-001231 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 05/22/1992 EMERGENCY AUTOMATIC SHUT OFF VALVES AT BASE OF EACH GASOLINE DISPENSOR IN THE EVENT OF BEING EMPACTED. EMERGENCY SHUT OFF AT THE CONSOLE INSIDE THE STORE. LEAK DETECTORS IN THE DISPENSORS. STORE OWNER WILL CONTACT OUR COMPANY IN THE EVENT OF A PROBLEM. OUR JEFFRIES BROS INC. DRIVERS DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER CHANNELING PERSONS TO CONTACT. -- Release Containment 05/22/1992 OVERSPILL BOX AT EACH FILL, DRIVERS OR DELIVERY PERSONNEL KNOW WHAT TO DO AND WHO TO NOTIFY. -- Clean Up 05/22/1992 IMMEDIATELY CONTAIN IF POSSIBLE AND CALL OR NOTIFY PROPER AUTHORITIES. Other Resource Activation 6 05/14/1997 FIESTA LIQUORS SiteID: 215-000-001231 Fast Format ~ Site Emergency Factors Overall Site Special Hazards -- Utility Shut-Offs 05/22/1992 A) GAS - EAST SIDE OF STORE SOUTH END B) ELECTRICAL - SOUTH SIDE OF STORE EAST END C) WATER - SOUTH SIDE OF STORE WEST END D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 05/22/1992 PRIVATE FIRE PROTECTION - NO PRIVATE FIRE PROTECTION FIRE HYDRANT - SW CORNER BERNARD AND BAKER Building Occupancy Level [ 7 05/14/1997 FIESTA LIQUORS SiteID: 215-000-001231 Fast Format ~ Training Overall Site -- Employee Training 01/07/1990 WE HAVE 1 EMPLOYEE AT THIS FACILITY WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE MSDS FOR 3 GRADES OF GASOLINE - PLUS DECALS ON PUMPS AND AND WINDOW PROP 65 Page 2 I Held f°r Future use I Held for Future Use 8 05/14/1997 INSPI~ION ' ~akersfield Fire Dept. i ..~ OF ENVIRONMENTAL SERVICES HAZARDOUS MATERIALS 1715 Chester Av.c. Bakersfield, CA 93301 Date Completed3//o/,~ 7 Business Namei r~-M-,- A,~e c4 Location: ~Oz.~ ~l'~r ~r' Business Identification No. 215-000 1 2.S I (Top of Business Plan) Station No. Shift Inspector ..4'k%,~. d¢~/cro..,~( Arrival Time: Departure Time: Inspection Time: Adequ~qu~te Inadequate Adequate Inadeq~a!e Address Visable I~' i-I Emergency Procedures Posted 13 Correct Occupancy ~ 13 Containers Properly Labled I~ 13 Verification of Inventory Materials ~ 13 Comments: Verification of Quantities I~~ 13 Verification of Location ~ 13 Verification of Facility Diagram I~ 13 Proper Segregation of Material I]3/ r'l Housekeeping ~ 13 Fire Protection I~' 1:3 Comments: Electrical ~ 13 Comments: Verification of MSDS Availablity E1 ~ Number of Employees: ,~ UST Monitoring Program ~z' 13 Comments: Verification of Haz Mat Training 13 I~ Permits I~. 13 Comments: Spill Control I~z. 13 Hold Open Device ~ 13' Verification of Hazardous Waste EPA No. Abbatement Supplies and Procedures I-I ~ / Proper Waste Disposal I~1'. 13 comments: Secondary Containment ~f/ 13 Secudty ~ 13 Special Hazards Associated with this Facility: Violations: Mo ,J~,Jt-kor, z~d 1~,~(¢,,~c_ ~%oo~c__ Plan..~o m~os ~ ~,~ <~'g~& ~ ~ ,' < ~ ~ All Items O.K Business O~erlManag~ PRINT NAME ~ ~IG~UR~ ' CorrecUon Needed ~ite-H~ Mat Div. Yellow-S~tion C~y Pink-Business Copy UNDERGROUND STORAGE TAI INSPECTION e Bakersfield Fire Dept. FACILITY NAME /~-Y~-~ll~.. ,~f~Var~ BUSINESS I.D. No. 215-000 FACILITY ADDRESS ~flZ.~ ~c ~ Cl~ ,~ ~ ZIP CODE FACILI~ PHONE No. ~ ~ INSPECTION DATE ~/10/~7 t ~ ~ P~ Pr~ TIME IN TIME OUT cl~ ~[~'~ ~J~ ~ INSPECTION ~PE: / ~7~ /~7~ S~e' S~e ROUTINE ~ FOLLOW'UP i~,~ ~ /~ ~ REQUIREMENTS ~ no ~a y~ ~ ~a la. F~s A & B Su~ 1 b. F~ C Su~ lc. O~ing F~ Pa~ ld. S~te Sumharge Pa~ le. S~te~nt of Fi~l Res~nsibil~ Su~ lf. Wr~en Contract E~sts ~n ~ & O~ to O~e UST ~. ~lid O~mting Pe~ 2b. Ap~ov~ Wr~en Ro~ine MonR~ng Pr~ure 2c. Una~h~ Relea~ Res~n~ Plan ~. Tank Int~r~ Test in ~a 12 M~ths /n/u/~ 3b. Pre~u~ Piping Int~r~ Test in Last 12 U~t~[ ' ~. Suction Piping ~ghtness Test in Last 3 Years ~. Gmvi~ FI~ Piping T~htn~ T~ in Last 2 Y~m ~. Test ResuRs Subm~ Within ~ Da~ 3f. Dal~ ~sual MonR~ing of Su~i~ Pr~t Piping ~. Manual Invento~ R~cil~ti~ Each Month ~. Annual Invento~ R~iliati~ Statement Su~ ~. Metem Calibmt~ Annually 5. W~ Manual Tank Gauging R~ds f~ Small Tan~ 6. Month~ Statisti~l Invento~ R~ciliation R~uBs 7. Monthly A~atic Tank Gauging Resu~s 8. Ground Water MonR~ing 9. ~r MonRoring 10. Continuous IntemtRial MonRodng f~ Doubl~Wal~ Tan~ 11. M~hanical Line Leak Det~tom 12. El~tmnic Li~ Leak Det~om 13. C~tinuous Piping MonRoHng in Sum~ 14. A~atic Pump Shrift Ca~bil~ 15. Annual Maintenan~Calibration of Leak Det~t~ Equi~nt 16. Leak Det~tion Equipment and T~t Meth~s L~t~ in L~113 Se~ ~ 17. Wr~en R~ords Maintain~ on SRe 18. Re~ Chang~ in U~g~Conditions to O~ti~nR~ng Pr~ures of UST S~tem WRhin ~ Da~ 19. Re~d~ Una~hor~ Relea~ WRhin 24 H~m ~. Approv~ UST S~tem Re~im a~ U~md~ 21. R~rds S~ng Cath~ Pmt~t~ Ins~ti~ ~. ~ur~ MonR~ng Wells ~. Drop Tu~ ~__-~ .~ F RE-INSPECTION D~ ~ RECEIVED BY: FD 1~9 BULK TRANSFER NEW O~ERS ~DRESS ~/oF ~ ~o~ ~ ~. ~ DATE OF T~SFER THIS I~O~TIO~ . ~aza~dou~ PREMIUM UNLEADED CG E)~ON COMPANY, U.S.A. A DIVISION OF EXXON CORPORATION DATE ISSUED: O1/24/97 SUPERSEDES DATE: 09/11/95 MATERIAL SAFETY DATA SHEET EXXON COMPANY, U.S.A. P.O. BOX 2180 HOUSTON, TX 77252-2180 A. IDENTIFICATION AND EMERGENCY INFORMATION PRODUCT NAME PRODUCT CODE PREMIUM UNLEADED CG 000002 - 11131 THIS PRODUCT DOES NOT MEET THE REOUIREMENTS FOR REFORMULATED GASOLINE AND MAY NOT BE USED IN ANY REFORMULATED GASOLINE COVERED AREA. This Material Safety Data Sheet is valid for all EXXON UNLEADED SUPREME and UNLEADED PREMIUM Conventional Gasolines. PRODUCT CATEGORY Conventional Motor Gasoline PRODUCT APPEARANCE AND ODOR Clear colored liquid (typically orange) Gasoline hydrocarbon odor MEDICAL EMERGENCY TELEPHONE NUMBER (713) 656-3424 B. COMPONENTS AND HAZARD INFORMATION CAS NO. OF APPROXIMATE COMPONENTS COMPONENTS CONCENTRATION Product is a variable complex mixture of components, principally hydrocarbons, blended to performance, rather than chemical specifications and tYPically contains the following: Naphtha (petroleum), light catalytic 64741-55-5 cracked Naphtha (petroleum), heavy catalytic 64741-54-4 cracked Naphtha (petroleum), full-range 68919-37-9 ..reformed Naphtha (petroleum), full-range 64741-64-6 alkylate Naphtha (petroleum), sweetened 64741-87-3 Butane 106-97-8 Proprietary'additives Proprietary It may include varying amounts of the following identifiable components: Benzene 71-43-2 0-4.9% Cumene .' 98-82-8 0-1% Cyclohexane 110-82-7 0-1% Ethylbenzene 100-41-4 0-3% Naphthalene 91-20-3 0-1% n-Hexane 110-54-3 0-3% Toluene 108-88-3 0-20% Xylene 1330-20-7 0-10% It may also include varying amounts of oxygenates such as the following: Di-isopropyl ether 108-20-3 0-18% Ethanol 64-17-5 O-10% Ethyl-tertiary-butyl ether 637-92-3 O-18.5% Methyl-tertiary-butyl ether 1634-O4-4 O-16% Tertiary-amyl-methyl-ether 994-05-8 O-18.5% 945-0277(MWH001) PREMIUM UNLEADED CG This product, as manufactured by Exxon, does not contain polychlorinated biphenyls (PCB's). All components of this product are listed on the U.S. TSCA inventory. See Section E for Health and Hazard Information. See Section H for additional Environmental information. HAZARDOUS MATERIALS IDENTIFICATION SYSTEM (HMIS) Health Flammability Reactivity BASIS 1 3 O Recommended by Exxon EXPOSURE LIMIT FOR TOTAL PRODUCT BASIS 1OO ppm (300 mg/m3) for an 8-hour Recommended by Exxon. OSHA Regulation workday 29 CFR 1910.1000 and the American Conference of Governmental Industrial Hygienists (ACGIH) list Threshold Limit Values (TLV) of 300 ppm (900 mg/m3) for gasoline for an 8-hour workday; 500 ppm (1500 mg/m3) STEL. 50 ppm (180 mg/m3) for n-hexane OSHA Regulation 29 CFR 1910.1000 and for an 8-hour workday recommended by the American Conference of Governmental Industrial Hygienists (ACGIH) 50 ppm (187 mg/m3) for toluene Recommended by the American Conference (skin) for an 8-hour workday of Governmental Industrial Hygienists (ACGIH) 50 ppm (180 mg/m3) for methyl- Recommended by Exxon tertiary-butyl ether for a 15 minute STEL The airborne benzene level shall OSHA Regulation 29 CFR 1910.1028 not exceed I ppm for an 8-hour workday; 5 ppm STEL C. PRIMARY ROUTES OF ENTRY AND EMERGENCY AND FIRST AID PROCEDURES EYE CONTACT If splashed into the eyes, flush with clear water for 15 minutes or until irritation subsides. If irritation persists, call a physician. SKIN In case of skin contact, remove any contaminated clothing and wash skin with soap and water. Launder or dry-clean clothing before reuse. If product is injected into or under the skin, or into any part of the body, regardless of the appearance of the wound or its size, the individual should be evaluated immediately by a physician as a surgical emergency. Even though intial symptoms from high pressure injection may be minimal or absent, early surgical treatment within the first few hours may significantly reduce the ultimate extent of injury. INHALATION If overcome by vapor, remove from exposure and call a physician immediately. If breathing is irregular or has stopped, start resuscitation, administer oxygen, if available. INGESTION If ingested, DO NOT induce vomiting; call a physician immediately. 945-0277(MWH002) DATE ISSUED: O1/24/97 PAGE: 2 SUPERSEDES DATE: O9/11/95 PREMIUM UNLEADED CG D. FIRE AND EXPLOSION HAZARD INFORMATION UNUSUAL FIRE AND EXPLOSION HAZARD EXTREMELY FLAMMABLE VAPORS CAN TRAVEL AND EXPLODE FLASH POINT (MINIMUM) AUTOIGNITION TEMPERATURE FLAMMABLE - Per DOT 49 CFR 173.120 Approximately -38°C (-36°F) Approximately 456°C (853°F) National Fire Protection Association's Guide on Hazardous Materials NATIONAL FIRE PROTECTION ASSOCIATION (NFPA) - HAZARD IDENTIFICATION Health Flammability Reactivity BASIS 1 3 O' Recommended by the National Fire Protection Association HANDLING PRECAUTIONS This liquid is volatile and gives off invisible vapors. Either the liquid or vapor may settle in low areas or travel some distance along the ground or surface to ignition sources where they may ignite or explode. Keep product away from ignition sources, such as heat, sparks, pilot lights, static electricity, and open flames. FLAMMABLE OR EXPLOSIVE LIMITS (APPROXIMATE PERCENT BY VOLUME IN AIR) Estimated values: Lower Flammable Limit 1.4% Upper Flammable Limit 7,6% EXTINGUISHING MEDIA AND FIRE FIGHTING PROCEDURES Foam, water spray (fog), dry chemical, carbon dioxide and vaporizing liquid type extinguishing agents may all be suitable for extinguishing fires involving this type of product, depending on size or potential size of fire and circumstances related to the situation. Plan fire protection and response strategy through consultation with local fire protection authorities or appropriate specialists. The following procedures for this type of product are based on the recommendations in the National Fire Protection Association's "Fire Protection Guide on Hazardous Materials", Tenth Edition (1991): Use dry chemical, foam or carbon dioxide to extinguish the fire. "Water may be ineffective", but water should be used to keep fire-exposed containers cool. If a leak or spill has ignited, use water spray to disperse the vapors and to protect persons attempting to stop a leak. Water spray may be used to flush spills away from exposures. Minimize breathing of gases, vapor, fumes or decomposition products. Use supplied-air breathing equipment for enclosed or confined spaces or as otherwise needed. NOTE: The inclusion of the phrase "water may be ineffective" is to indicate that although water can be used to cool and protect exposed material, water may not extinguish the fire unless used under favorable conditions by experienced fire fighters trained in fighting all types of flammable liquid fires. DECOMPOSITION PRODUCTS UNDER FIRE CONDITIONS Fumes, smoke, carbon monoxide, sulfur oxides, aldehydes and other decomposition products, in the case of incomplete combustion. "EMPTY" CONTAINER WARNING "Empty" containers retain residue (liquid and/or vapor) and can be dangerous. DO NOT PRESSURIZE, CUT, WELD, BRAZE, SOLDER, DRILL, GRIND OR EXPOSE SUCH CONTAINERS TO HEAT, FLAME, SPARKS, STATIC ELECTRICITY, OR OTHER SOURCES OF IGNITION; THEY MAY EXPLODE AND CAUSE INJURY OR DEATH. Do not attempt to clean since residue is difficult to remove. "Empty" drums should be completely drained, properly bunged and promptly returned to a drum reconditioner. All other containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. For work on tanks refer to Occupational Safety and Health Administration regulations, ANSI Z49.1, and other governmental and industrial references pertaining to cleaning, repairing, welding, or other contemplated operations. 945-0277(MWHO02) DATE ISSUED: 01/24/97 PAGE: 3 SUPERSEDES DATE: 09/11/95 PREMIUM UNLEADED CG E. HEALTH AND HAZARD INFORMATION VARIABILITY AMONG INDIVIDUALS Health studies have shown that many petroleum.hydrocarbons and synthetic lubricants pose potential human health risks which may vary from person to person. As a precaution, exposure to liduids, vapors, mists or fumes should be minimized. EFFECTS OF OVEREXPOSURE (Signs and symptoms of exposure) High vapor concentrations (greater than approximately 1OOO ppm) are irritating to the eyes and the respiratory tract, and may cause headaches, dizziness, anesthesia, drowsiness, unconsciousness, and other central nervous system effects, including death. Prolonged or repeated liduid contact with the skin will dry and defat the skin, leading to possible irritation and dermatitis. NATURE OF HAZARD AND TOXICITY INFORMATION WARNING: Concentrated, prolonged or deliberate inhalation of this product may cause brain and nervous system damage. Prolonged and repeated exposure of pregnant animals to high levels of toluene (levels greater than approximately 15OO ppm) has been reported to cause adverse fetal developmental effects. Prolonged or repeated skin contact with this product tends to remove skin oils, possibly leading to irritation and dermatitis; however, based on human experience and available toxicological data, this product is judged to be neither a "corrosive" nor an "irritant" by OSHA criteria. Product contacting the eyes may cause eye irritation. This product may contain up to a maximum of 4.9 weight percent benzene, CAS # 71-43-2, as a natural constituent of various gasoline blend components. Benzene can cause anemia and other blood diseases, including leukemia (cancer of the blood-forming system), after prolonged or repeated exposures at high concentrations (e.g., 50-500 ppm). It has also caused fetal defects in tests on laboratory animals. Contains light hydrocarbon components. Lifetime studies by the American Petroleum Institute have shown that kidney damage and kidney cancer can occur in male rats after prolonged inhalation exposures at elevated concentrations of total gasoline. Kidneys of mice and female rats were unaffected. The U.S. EPA Risk Assessment Forum has concluded that the male rat kidney tumor results are not relevant for humans. Total gasoline exposure also produced liver tumors in female mice only. The implication of these data for humans has not been determined. Certain components, such as normal hexane, may also affect the nervous system at high concentrations (e.g., 1OOO-15OO ppm). The presence of n-hexane (normal-hexane) in this product represents a distinct hazard of producing peripheral polyneuropathy, a progressive disorder of the nervous system, which with sufficient high exposure has the potential of becoming irreversible. This disorder has been observed in individuals exposed repeatedly to high vapor concentrations (1OOO-15OO ppm) of n-hexane over a period of several months. Exposure to this product should be controlled to keep the maximum level below 1OO ppm, which will result in n-hexane exposure of 50 ppm or less. The OSHA 8-hour Time Weighted Average-Permissible Exposure Limit (TWA-PEL) is 50 ppm for n-hexane. Simultaneous exposure to the vapors of n-hexane and methyl ethyl ketone (MEK) or to n-hexane and methyl isobutyl ketone (MIBK) increases the risk of adverse effects from n-hexane. Evidence in laboratory animals and humans indicates that in the presence of MEK or MIBK the neuropathy associated with n-hexane is produced in a shorter time or at lower exposure concentrations. This interaction has been reported when the exposure to n-hexane is below the American Conference of Governmental Industrial Hygienists (ACGIH) limit of 50 ppm and MEK is below the ACGIH limit of 200 ppm or when MIBK is below the ACGIH limit of 50 ppm. Product has a low order of acute oral and dermal toxicity, but minute amounts ... aspirated into the lungs during ingestion or vomiting may cause mild to severe I pulmonary injury and possibly death. This product is judged to have an acute oral LD50 (rat) greater than 5 g/kg of 945-0277(MWH002) DATE ISSUED: O1/24/97 PAGE: 4 SUPERSEDES DATE: O9/11/95 PREMIUM UNLEADED CG body weight, and an acute dermal LD50 (rabbit) greater than 3.16 g/kg of body weight. Inhalation of components of exhaust from burning, such as carbon monoxide, may cause death at high concentrations. Exposure to the exhaust of this fuel should be minimized. PRE-EXISTING MEDICAL CONDITIONS WHICH MAY BE AGGRAVATED BY EXPOSURE Benzene - Individuals with liver disease may be more susceptible to toxic effects. Hexane - Individuals with neurological disease should avoid exposure. Petroleum Solvents/Petroleum Hydrocarbons - Skin contact may aggravate an. existing dermatitis. F. PHYSICAL DATA The following data are approximate or typical values and should not be used for precise design purposes. BOILING RANGE VAPOR PRESSURE Approximately 21°C (70°F) IBP Varies seasonally from to 225°C (437°F) FBP approximately 5 to 15 psi Reid Vapor Pressure SPECIFIC GRAVITY (15.6°C/15.6°C) VAPOR DENSITY (AIR = 1) Approximately 0.74 Approximately 5 MOLECULAR WEIGHT PERCENT VOLATILE BY VOLUME Complex mixture, components vary 100 from approximately 45 to 185 EVAPORATION RATE e I ATM. AND 25°C DH (77°F) (n-BUTYL ACETATE = 1) Essentially neutra] Approximately 10-11 SOLUBILITY IN WATER e I ATM. POUR, CONGEALING OR MELTING POINT AND 25°C (77°F) Less than -38°C (-36°F) Negligible; less than O.1% Pour Point by ASTM D 97 VISCOSITY Approximately 0.5 cst @ 25°C G. REACTIVITY This product is stable and will not react violently with water. Hazardous polymerization will not occur. Avoid contact with strong oxidants such as liquid chlorine, concentrated oxygen, sodium hypoch~orite, calcium hypochlorite, etc., as this presents a serious, explosion hazard. H. ENVIRONMENTAL INFORMATION CLEAN WATER ACT / OIL POLLUTION ACT This product may be classified as an oil under Section 311 of the Clean Water Act, and under the Oil Pollution Act. Discharges or spills into or leading to surface waters that cause a sheen must be reported to the Nationaq Response Center (1-800-424-8802). STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED Shut off and eliminate all ignition sources. Keep People away. Recover free product. Add sand, earth or other suitable absorbent to spill area. Minimize breathing vapors. Minimize skin contact. Ventilate confined spaces. Open all windows and doors. Keep product out of sewers and watercourses by diking or impounding. Advise authorities if product has entered or may enter sewers, 945-0277(MWH002) DATE ISSUED: O1/24/97 PAGE: 5 SUPERSEDES DATE: O9/11/95 PREMIUM UNLEADED CG watercourses, or extensive land areas. AsSure conformity with applicable governmental regulations. Continue to observe precautions for volatile, flammable vapors from absorbed material. THE FOLLOWING INFORMATION MAY BE USEFUL IN COMPLYING WITH VARIOUS STATE AND FEDERAL LAWS AND REGULATIONS UNDER VARIOUS ENVIRONMENTAL STATUTES: THRESHOLD PLANNING OUANTITY (TPO), EPA REGULATION 40 CFR 355 (SARA Sections 301-304) No TPQ for product or any constituent greater than 1% or 0.1% (carcinogen). TOXIC CHEMICAL RELEASE REPORTING, EPA REGULATION 40 CFR 372 (SARA Section 313) This product may contain: Up to 4.9% benzene. Up to 1% cumene. Up to 1% cyclohexane. Up to 3% ethylbenzene. Up to 16% methyl-tertiary-butyl ether. Up to 1% naphthalene. Up to 3% n-hexane. Up to 20% toluene. Up to 10% xylene. HAZARDOUS CHEMICAL REPORTING, EPA REGULATION 40 CFR 370 (SARA Sections 311-312) EPA HAZARD Acute Chronic Fire Pressure Reactive Not CLASSIFICATION CODE: Hazard Hazard Hazard Hazard Hazard Applicable XXX XXX XXX TOXIC SUBSTANCE CONTROL ACT This product may contain the following TSCA 12b reportable chemical substance(s): Isopropanol (IPA) CAS # 67-63-0 Methyl-tertiary-butyl ether (MTBE) CAS # 1634-04-4 Tertiary-amyl-methyl-ether (TAME) CAS # 994-05-8 I. PROTECTION AND PRECAUTIONS VENTILATION Use only with ventilation sufficient to prevent exceeding recommended exposure limit or buildup of explosive concentrations of vapor in air. No smoking, or use of flame or other ignition sources. RESPIRATORY PROTECTION Use supplied-air respiratory protection in confined or enclosed spaces, if needed. PROTECTIVE GLOVES Use chemical-resistant gloves, i? needed, to avoid prolonged or repeated skin contact. EYE PROTECTION Use splash goggles or face shield when eye contact may occur. OTHER PROTECTIVE EQUIPMENT Use chemical-resistant apron or other impervious clothing, if needed, to avoid contaminating regular clothing, which could result in prolonged or repeated skin contact. WORK PRACTICES / ENGINEERING CONTROLS Keep containers closed when not in use. Do not store near heat, sparks, flame or strong oxidants. Adequate ventilation required sufficient to prevent exceeding recommended exposure limit or buildup of explosive concentrations of vapor in air. Tanks that have been in leaded gasoline service may have lead-containing residue. Special precautions needed in cleaning. See American Petroleum Institute publications 2013, 2015 and 2015A. No smoking, flame or other ignition sources. To minimize fire or explosion risk from static charge accumulation and discharge, effectively ground product transfer system in accordance with the National Fire Protection Association standard for petroleum products. 945-0277(MWH002) DATE ISSUED: O1/24/97 PAGE: 6 SUPERSEDES DATE: O9/11/95 PREMIUM UNLEADED CG For use as a motor fuel only. Do not use as a cleaning solvent, or thinner, or for other non-motor fuel uses. Do not siphon by mouth. Minute amounts of liquid gasoline aspirated into the lungs may cause potentially fatal chemical pneumonitis. In order to prevent fire or exolosion hazards, use appropriate equipment. Information on electrical equipment appropriate for use with this product may be found in the latest edition of the National Electrical Code (NFPA-70). This document is available from the National Fire Protection Association, Batterymarch Park, 0uincy, Massachusetts 02269. PERSONAL HYGIENE Minimize breathing vapor or mist. Avoid prolonged or repeated contact with skin. Remove contaminated clothing; launder or dry-clean before re-use. Remove contaminated shoes and thoroughly clean and dry before re-use. Cleanse skin thoroughly after contact, before breaks and meals, and at end of work period. Product is readily removed from skin by waterless hand cleaners followed by washing thoroughly with soap and water. J. TRANSPORTATION AND OSHA RELATED LABEL INFORMATION TRANSPORTATION INCIDENT INFORMATION For further information relative to spills resulting from transportation incidents, refer to latest Department of Transportation Emergency Response Guidebook for Hazardous Materials Incidents. U.S. DOT HAZARDOUS MATERIALS SHIPPING DESCRIPTION Gasoline, 3, UN 1203, II OSHA REQUIRED LABEL INFORMATION In compliance with hazard and right-to-know requirements, where applicable OSHA Hazard Warnings may be found on the label, bill of lading or invoice accompanying this shipment. DANGER! EXTREMELY FLAMMABLE LONG-TERM, REPEATED EXPOSURE MAY CAUSE CANCER, BLOOD AND NERVOUS SYSTEM DAMAGE CONTAINS: BENZENE Note: Product label may contain non-OSHA related information also. The information and recommendations contained herein are, to the best of Exxon's knowledge and belief, accurate and reliable as of the date issued. Exxon does not warrant or guarantee their accuracy or reliability, and Exxon shall not be liable for any loss or damage arising out of the use thereof. The information and recommendations are offered for the user's consideration and examination, and it is the user's responsibility to satisfy itself that they are suitable and complete for its particular use. If buyer repackages this product, legal counsel should be consulted to insure proper health, safety and other necessary information is ~ncluded on the container. The Environmental Information included under Section H hereof as well as the Hazardous Materials Identification System (HMIS) and National Fire Protection Association (NFPA) ratings have been included by Exxon Company, U.S.A. in order to provide additional health and hazard classification information. The ratings recommended are based upon the criteria supplied by the developers of these 945-0277(MWH002) DATE ISSUED: O1/24/97 PAGE: 7 SUPERSEDES DATE: O9/11/95 PREMIUM UNLEADED CG rating systems, together with Exxon's interpretation of the available data. FOR LUBRICANTS TECHNICAL ASSISTANCE CALL: 1-800-443-9966 FOR FUELS TECHNICAL ASSISTANCE CALL: T13-656-4955 FOR AN MSDS OR ASSISTANCE WITH AN MSDS, DIRECT INQUIRIES TO THE ADDRESS BELOW OR CALL: MARKETING TECHNICAL SERVICES EXXON COMPANY, U.S.A. ROOM 2344 P. O. BOX 2180 HOUSTON, TX 77252-2180 (713) 656-5949 IF YOU HAVE AN IMMEDIATE NEED FOR AN MSDS, DIAL 1-800-298-4007 FOR A FAXED COPY. 945-0277(MWHO02) DATE ISSUED: 01/24/97 PAGE: 8 SUPERSEDES DATE: 09/11/95 WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name ~ Facility Address A. Describe the frequency of performing t~,~e.m, onitoring: Piping ~tff ?~:/.~ . ,/~ _~_~~ B. What methods and equipment, identified by name and model, will be used for perfoming the monitor~r~g: Piping ~ C. Describe the location(s) where the monitoring will be performed (facility plot plan should be attached): D. List the name(s) and title(s) of the people responsible for performing the monitoring and/or m .aj3. !~aining. th9 equipment;, E. ReportingTank /I/tg/4'!F°rm'a$/c/rf°r mo~g: ~--5 I F. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. G. Describe the training nec.essary for the operation of UST system,, inclu_~,d'mg piping, .and the monitoring equipment: .J~t._Of//]ffq ~g>Aqg:~/.~~ ~ O{;~-'ti5 ~a/~i',% ~' "service , IP.O...B°'x ~i383. Bakersfield, CA 93380· 805-392-1-135 / Fax 805-392-1649 l Order ' = ' ITEM MAKC MODEL SERIAL NO. WARRANTY: .~'~ .. COMPANY: ~': ITEM: WARRANTY EXPIRATION: WARRANTY SERVICE DATE SENT IN DATE CREDIT RCD. DATE c,OM~LETED __.__~ SERVICE REP. I WORK RECEIVED BY W & MEASURES CALLED , DESCRIPTION OF WORK PERFORMED TRAVEL TIME ....... · PARTS BEING USED _.~TY~.. PRICE. TOTAL LABOR TOTAL MATERIALS , TAX TOTAL ~~- :' POSTED BY DATE PRODUCT PRICE PERGAL TOTAL GALLONS TOTAL MONEY ' ~ ' ACCURACY ;~.~ 0 COMPUTER CHANGE OLD GALS.' OLD MONEY NEW GALS. ,NEWMONEY PRODUCT PUMP# pRODUCT PUMP# ,,f PRODUCT PUMP# .PRODUCT: O-NLEA/)ED GASOLINE .. SECTION III PHYSICAL ~ CHEMICAL CH~_R3~CTERISTICS DESCRIPTION: A clear or red liquid with a characteristic gasoline odor. MELTING POINT: NA SOLUBILITY (WATER) Negligible BO%LING POINT/R3~NGE: 75-410° F SPECIFIC GPJtVITY: 0.74-0.79 V~_POR PRESSURE 8-14 psi ~ 100° F API GRAVITY:. 47-60 % VOLATILE BY VOLUME: 100% VISCOSITY Less than 30 SSU ~ 100° F VAPOR DENSITY: Heavier than air POUR POINT: NA EVAPORATION RATE:- Slower than ether SECTION IV - FIRE ~ EXPLOSION HAZARD INFORMATION FI2~SH POINT (METHOD): -45° F/PMCC AUTOIGNITION TEMP: 536-853° F EXPOSURE LIMITS (% BY VOLUME/AIR): LOWER: 1.2% UPPER: 7.6% F~ILITY CLASS (OSHA): IB FIRE/EXPLOSION HAZARDS: This material is a severe fire and explosion hazard and may be ignited by ignition sources under almost all conditions. Vapors may travel to ignition source and flash back. Containers may explode in fire. Vapor explosion hazar~ indoors,'.-outdoors or in sewers. Empty Containers retain flammable and explosive vapors. CO5~USTION PRODUCTS: Carbon dioxide, carbon monoxide and water vapor. C, EXTINGUISHING MEDIA: Carbon dio>:ide, dry chemical, foam and water ~pray. Fi~ FIGHTING PROCEDURES: Wear protective e.cfuipment and clothing when fighzing fires, including a self-contained breathing apparatus for fires in enclosed spaces. Use water spra'~, :o cool fir~-exposed contain~ers, to dilute and disperse vapors, protect personnel, and to f!u~ u~nited s~ills from fire. SECTION V - CHEMICAL REACTIVITY INFOP34ATION ST;~ILI%"f: Stable under normal conditions of s~orage and handling. R?3~CTIVITY: Reacts vigorously with strong acids and oxidizing agents. INCOMPATIBILITY: Incompatible with strong acids and oxidizing agents. HA~B]IDOUS REACTION/DECOMPOSITION PRODUCTS: Burning produces carbon dio>:ide and carbon monoxide. May release acrid smoke and irritating fumes. COI~ITIONS CONTRIBITTING TO HAZARDOUS POLYMERIZATION: Hazardous polymerization has not been reported-'to occur under normal temperatures and pressures. C PRODUCT: D]FLE3uDED GASOLINE ' ., SECTION VII PRECAUTIONS FOR SAFE HANDLING ~D USE ~IPPING INFORMATION: D.O.T. SHIPPING NAME: Gasoline D.O.T. ID AK3MBER: 3, UN 1203, II D.O.T. HAZARD CI2~SSIFICATION: Flammable liquid. SHIPPING. REGUI2~TIONS: Flammable liquid label required. See DOT regulations 49CFR 173 for packaging requirements. STORAGE: Store only in closed containers designed for gasoline storage, in a cool well- ventilated area away from all heat and ignition sources and strong oxidizing agents. Containers ~hould be electrically bonded and grounded when transferring materials. H3d~DLING: Use in a well-ventilated area and wear recommended protective equipment and clothing. Use explosion-proof tools and equipment. Avoid eye contact, breathing vapors or mists and prolonged or repeated skin contact. Label all unattended containers. MISUSE OF EMPTY CONTAINERS CAN BE ~[AZARDOUS. COMPLETELY DRAIN ~ HAVE COmmERCIALLY CLE~ED BEFORE ANY REUSE. KEEP CONTAINERS CLOSED. ~ USE TO MIX OR STORE ~Y OTHER MATERID~S BEFORE THEY HAVE BEEN COMMERCIA/~LY CLEANED. DQ NOT C[~, WELD. DRILL OR SUBJECT CONTAINERS TO H~_3~T OR' FiJ%MES 2' VAPORS MAY IGNITE D2~D EXPLODE. SPECIAL PRECAUTIONS AArD COMMENTS; Enclosed or head spaces in material ~n~s. pipes or gontainers may contain hazardous concentrations of fumes or vapors. Exercise'--caution and wea~ recommended protective equipment and clothing when opening valves or tank and maintenance or samplin~ where there is a potential for exposure to these fumes or vapors. SPILL OR LEAK PROCEDURES: Evacuate area around large spills. Remove all ignition sources a~d provide explosion-proof ventilation. Wear recommended protective clothing and equipment. Dc not allow spills to enter sewers, streams or surface waters. Dike and contain spills. Us inert absorbent to reduce fumes and to pick up spill. Collect for later disposal. D~SPOSAL PROCEDURES: DISPOSE OR IN ACCORDANCE WITH FEDER3%L, STATE D2~D LOCD~ REGLrLATIONS. Tk/s material is classified by the EPA as a hazardous waste under RCRA, No. D001 I~nitab!e Waste. Emery containers should be commercially cleaned and reconditioned for reuse. SECTION VIii - PERSON~L PROTECTION ~2~D ENGINEERING CONTROLS ~-~_~ ~ FACIAL PROTECTION: Chemical ~oggles are recommended to prevent eye con,acs. SF~N PROTECTION: Protective ~loves and clothin~ are recommended when prolonged contact with t~e concentrated material may occur. RESPIRATORY PROTECTION: In situations where vapor concentrations exceed the recommended e)~osure limits, a NIOSH approved organic vapor cartridge or air-supplying respirator should wcrn. ~TII2~TION: E~plosion-proof general mechanical ventilation and local exhaust are recommended to maintain vapor concentrations below the recommended exPosure limits. O-~q.~ER: An eye wash and a source of running water should be available to flush or wash tk eyes and skin. pR~.~UCT: UN-LEADED GASOLINE --' SECTION VI HEALTH HAZARD AND FIRST AID INFORMATION GENERAL: This material is a highly flammable liquid, an aspiration hazard and defers the skin. Breathing vapors at high concentrations may cause central nervous system depression. This material contains a small amount of benzene, which has been shown to cause leukemia and blood disorders in humans and adverse reproductive disorders in laboratory animals. There is no evidence that gasoline causes cancer in humans. OCUIJ%R/EYE: This material may cause eye irritation. Contact with the liquid may cause burning, tearing, and redness. DERMAL/SKIN: ..-This material may cause skin irritation. Prolonged or repeated contact may cause burning, redness, drying and cracking of the skin, and dermatitis. INHALATION/BREATHING: Exposure to mists or to excessive vapor concentrations may cause irritation of the nose, throat, and respiratory tract; defers the skin; and signs of central nervous system depression; i.e., headache, nausea, drowsiness and dizziness. INGESTION/SWALLOWING: Accidentally swallowing this material can cause irritation of the stomach and digestive tract. Larger ingestions may cause signs of central nervous system depression; i.e., headache, nausea, drowsiness and'dizziness. This material is an aspiration 'hazard and may enter the lungs'when swallowing or vomiting and cause ser'ious.lUng damage. CF~ONIC/OTHER: No known chronic.effects. MEDICAL CONDITIONS AGGRAVATED BY EXPOSURE: pre-existing skin disorders. Chronic pulmonaz%,. disease. ' FIRST AID: OCULAR/EYE CONTACT: Flush the affected eye(s) with.water. If irritation develops, seek ~'Xcal assistance. D~.~ULL/SKIN CONTACT: Remove contaminated clothing and flush contact areas with water and then thoroughly cleanse contact area by washing with soap and water. If irritation or redness develop and persist, seek medical assistance. ISE~AJ~ATION/BREATHING: IF VICTIM IS NOT BREATHING OR IF BREATKING DIFFICULTIES DEVELOP ARTIFICIAL RESPIR3~TION OR OXYGEN SHOULD BE ADMINISTERED BY QUALIFIED PERSONNEL. If symptoms persist, seek medical assistance. I~'GESTION/SWALLOWING: DO NOT INDUCE VOMITING/ASPIRATION KAZARD. If victim is conscious and alert, give milk or water to drink. Seek immediate medical assistance. ,, (Instructions ou reverse) ..... CERTIFICATION OF FINANCIA_ RESPONSIBILIlY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. [ am r~quir~d to dem _o?,~"am lr~ Respoasibtlty in the required ,mounts as slMcifi~d in ~q~_~_;oa 2807, Chal~m' 18, Div. 3, Ti.tie ~ r=-JSOO,OOOdoila~peroecurrence r-=]lmi~ioadolhrsnnnudafzre~ato~·. , or AND or ' ['----} 1 minion dollars per occurrence [ [ 2 million dollars annual B. hereby cert/fies that if is in compliance with the requirements of Section 2807, Article 3, Chapter 18, Division 3, 7?tie 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section'2807 are as follows: Note: if you are using the ~tate Fund as any part of your demonstration of financial responsibility, your execution and submission of this certJEcation also certifies that ~,ou are in compliance with all conditions for participation in the Fund. Fa, cility Namo Fa~tTNamo Fm3ity Addrms Facility Namo Facilit7 Acl~ '~ FAX ~'ansmittai B A K E R S F I E L D Cover Sheet CAU~OLN~ Bak ersfield Fire Dept. O ce of Environ ental Services 1715 Chester Ave. · Bakersfield, CA 9~801 FAX No. (805) ~26-0576 · Bus No. (805) ~26-8979 Toctay's Date '7/5'/~ Time / ~:/~'~ No. of Pages BakersfieldFire Dept. · Office of Environmentali::$e~ices ~aC met/teds and ecluipmen=, identified by name and model, will bm used for performing the moniCoring: Tan~ Piping C. Describe The location(s) where =he moni=oring wall bm performed (facility ~1o= plan s~ould be at=ached): .... a(s) of the people responsible for Lis= =he name(s) and t~-~ performing The monitoring and/or maintaining =he equipment Reporting Format for moni=crzng: Tank F. Describe the preventive maln=enance schedule for Tile monitoring equipment. No=e: Maintenance mus= be in accordance wiC~ =~e manufac:urers' mainCe~=e se~e~ule bu~ no= less =hen every 12 months. Describe the training necessary for the opera=ion of UST system, including.~i~ing, and the monitoring ecluipm~=: ThimmmmmamsmmmmmmmmmWawmmmmmUsTmmm-nmlmmmm. 'llmimlmsmmlmmmm#-_~ ~ 2._ ! -_-_ onnslilkmel Im. iJ 11~lmml ImMstm m~ ,,- . P'a~&l£ty' tqm Fa¢i.1..i. Cy Addrmmm !. 32~ an unaur, horized release occurs, how will ~-he h~ou~ : su~tan~ Me cl~n~ up? No~es X~. ~e%~ ~ s~mmm reaoh ~he enviro~enC, i~ ~he ~ o~ e~Aosion ~as~d~ a~e hoc cleaned up ~ C~o s~ con~~C vithin a ho~s, or dmCerioraCo ~hm ~~ conCai~c, c~en .- ..... . -, .... .- aunt ~ noC~od v~Ch~n 24 ho~. £. Describe =ne proposea methods and equipment =o be use~ for removing and properly disposing of any hazardous substances. 2. Describe the !oca=ion and avai!a~ili=y of the required cleanup equiDmen= in item 2 anove. 4. Describe n~e ma£n=enance scneaule for =he cleanup 5. Lis= =~e name(s) and =i=le(s) of the person(s) responsible for au=~crizing any wor~ necessary under the response plan: underground storage tank between visu~inspections. The evaluation of the length of time the hazardous substance remains observable shall consider the volatility of the hazardous substance and the porosity and slope of the surface immediately beneath the (C) The liquid level in the tank shall be recorded at the time of each inspection. (D) ff any liquid is observed around or beneath the primary containment system, the owner or operator shall; ff necessary, have the liquid analyzed in the field Using a method approved by the local agency or in a laboratory to determine ff an unauthorized release has occurred. The owner or operator shah have a tank integrity test conducted, if necessary, to determine whether the primary containment system is leaking. If a leak is confirmed, the owner or operator shall comply with the applicable provisions of Article 5, Article 6, and Article 7. (2) A monitoring program which relies on the mechanical or electronic detection of the hazardous substance in the interstitial space shall include one or more of the methods in Table 3.2. The following requirements shall apply when appropriate: (A) The interstitial space of the tank shall be monitored'using a continuous monitoring system which meets the requirements of section 2643(0. (B) The continuous monitoring system shall be connected to an audible and visual alarm system approved by the local agency. (C) For methods of monitoring where the presence of the hazardous substance is not determined directly, for example, where liquid level measurements in the interstitial space are used as the basis for determination, the monitoring program shall specify the proposed method(s) for determining the presence or absence of the hazardous substance in the interstitial space if the indirect methods indicate a possible unauthorized release. (d) All monitoring programs shall include the following: (1) A written procedure for monitoring which establishes: (A) The frequency of performing the monitorin§i (B) The methods and equipment, identified by name and model, to be 3-6 used for performing the monitoring; (C)The location(s), as identified on a plot plan, where the monitorin will be performed; (O)The name(s) and titles(s) of the.person(s) responsible.for performing the monitoring and/or maintaining the equipment; (~.Thc reporting fomut; (F) The prevenl~h~e maintenance schedule for the 'monitorinS equipment. The maintenance schedule shall: be in accordance with the rnanufacnu~t~s instructions; and (G)A description of the training necessary for the.operation of both the tank system and the monitoring equipment. (2) ~ response plan which demonstrates; to the satisfaction of the local a~encT, that any unauthorized release will be removed from the ~4,~e'.\xq ability of the secondary containment system to contain the hazardous substance, but not more than 30 calendar days or a longer period of time as approved by the local agency. The response plan shall include, but is not limited to, the foUowing: (A) A descriptiora of the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances, including the location and availability of the required equipment if not permanently on-site, and an equipment maintenance schedule for the equipment located on-site. (B) The name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. (e) When implementation of a monitoring program or any other condition indicates that an unauthorized release may have occurred, the owner or operator shall comply with the release reporting requirements of Article 5. If the release came from the tank system, the owner or operator shall replace, repair, or close the tank in accordance with Articles 3, 6, or 7, respectively. Authority.: Health and Safety Code 25299.3, 25299.7 Reference: Health and Safety Code 25281, 25291, 40 CFR 280.20. 2633. Alternate Construction Requirements for New Undergronnd Storage Tanks Containing Motor Vehicle Fuel (a) This section sets forth alternate construction requirements for new underground storage tanks which contain motor vehicle fuels. Owners of new underground storage tanks which contain only motor vehicle fuels may comply 3-7 ,~ CCR, TITLE 23, DMSION ~HAPTER lO, UNDI~RLiROUNI~ ~'lu~c~tst: IAf~?d:bUCA'll~Or~ ARTICLE 3. NEW UNDERGROUND STORAGE TANK DESIGN, CONSTRUCTION, AND MoNn'OR NG REQU m E WS 2630. General Applicability of Arti':le (a) The requirements in this article apply to owners of new underground storage tanks. Underground storage tanks installed after January'l, 1984~~ may be deemed to be in compliance with the requirements in this article if they were installed in accordance with federal and state requirements that existed at the time of installation. However, the applicable repair and upgrade requirements in Article 6 shall be complied with. (b) Sections 2631 and 2632 specify design, construction, and monitoring' requirements for all new underground storage tanks. New underground storage tanks which store only motor vehicle fuels may be constructed and monitored pursuant to the requirements specified in sections 2633 and 2634 in lieu of those specified in sections 2631 and 2632. However, if the tank is constructed according to requirements in section 2633 the monitoring requirements of section 2634 shall also be met. (c) All new underground storage tanks, piping, and secondary containment systems shall comply with sections 2635 and 2636. (d) Ail monitoring equipment used to satisfy the requirements of sections 2632, 2634, and 2636 shall be installed, calibrated, operated, and maintained in 'accordance with manufacturer's instructions, including routine maintenance and service checks (at least once per calendar year) for operability or running condition. Written records shall be maintained as required in section 2712 of Article 10. Authority: Health and Safety Code 25299.3, 25299.7 Reference: Health and Safety Code 25281, 25291, 40 CFR 280.20 2631. Design and Construction Requirements for New Underground Storage Tanks (a) Ail new underground storage tanks including associated piping used for the storage of hazardous substances shall have primary and secondary of containment. Primary containment shall be product-tight. Secondary containment may be manufactured as an integral part of the primary containment or it may be constructed as a separate containment system. (b) The design and construction of all primary containment including any integral secondary containment system, shah be approved by an independent testing 3-1 .~. ,,? tv 15'2~ 7902.6.5.3-7902.6. 1994, U~~FIRE CODE 1. Have an alarm which provides an audible and visual signal when the quantity of liquid in the tank reaches 90 percent of tank capacity, 2. Automatically shut off the flow when the quantity of liquid in the tank reaches 95 percent of tank capacity, or 3. Reduce the flow rate to not more than 15 gallons per minute (0.95 L/s) so that, at the reduced flow rate, the tank will not overfill for 30 minutes, and automatically shutooff flow into the tank so that none of the fittings on the top of the tank are exposed to product due to overfilling. 7902.6.6 Inventory control. Daily inventory records shall be maintained for underground stor- age tank systems in accordance with Section 5202.3.9. 7902.6.7 Locations subject to flooding. Where a tank could become buoyant due to a rise in the level of the water table or due to location in an area that is subject to flooding, the tank shall be anchored in place. See Appendix II-B or manufacturer's installation instructions. 7902.6.8 Leaking tanks. Leaking tanks shall be promptly emptied and removed from the ground or abandoned in accordance with Section 7902.1.7.4 or 7902.1.7.2.4, respectively. 7902.6.9 Used tanks. Reinstallation of used tanks is allowed when such tanks comply with the requirements of Sections 7902.1.8 and 7902.6.15. See also Section 7902.6.16.4. 7902.6.10 Tank lining. Steel tanks are allowed to be lined only for the purpose of protecting the interior from corrosion or providing compatibility with a material to be stored. Only those liquids tested for compatibility with the lining material are allowed to be stored in lined tanks. Tank opening, cleaning, preparation, inspection, lining, closing and testing shall be in accord- ance with U.F.C. Standard 79-6. For permits to alter a tank, see Section 105, Permit f.3.6. Interior-lined underground tanks shall be protected from corrosion in accordance with Section 7902.6.15. 7902.6.11 Secondary containment. An approved method of secondary containment shall be provided for underground tank systems, including tanks, piping and related components, where a leak from such a system would pose an immediate hazard to persons or property, as determined by the chief. See Appendix II-G. 7902.6.12 Leak detection required. Underground storage tank systems shall be provided with an approved method of detecting leaks from any component of the system which normally contains liquid. 7902.6.13 Leak-detection installation and maintenance. Leak-detection devices and methods shall be in accordance with nationally recognized standards. See Article 90, Standard u.3.2. Such devices shall be inspected and tested at least annually, and the test results maintained for at least one year. 7902.6.14 Leak reporting. Any consistent or accidental loss of liquid, or other indication of a leak from a tank system, shall be reported immediately to the fire department. 7902.6.15 Corrosion protection. 7902.6.15.1 General. Underground tanks and piping shall be properly designed, installed and maintained, and protected from corrosion in accordance with Section 7902.6.15.2 or 7902.6.15.3. EXCEPTION: If conditions, based on adequate proof, warrant the deletion of the corrosion-protection requirements, the chief may waive the corrosion-protection requirements. ~ See Article 90. Standards a.3.10, n.l.2, s.l.1, u.l.14 and u.2.1. 7902.6.15.2 Cathodic Protection. Cathodic protection systems provided for corrosion protec- tion shall be in accordance with nationally recognized standards. 1-266 Petroleu'm Distributors and Cardlock fuels ~'. JEFFRIES BROS., INC. .-- I, JEFFRIES BROS., INC., owner of underground storage tanks located at ~,%~ ~ i~z~'~,? ,.~-. have entered into this written contract with , the operator of same, to fulfill a requirement of my Permit to Operate, #~¢.~~. I have provided the operator with a copy of the Permit to Operate and Chapter 15 of the Ordinance. I, , operator of underground tanks located at c~O;~'~ 1~'~,~' _~-. have received from Jeffries Bros. Inc., owner of same, a copy of Permit to Operate # 1~0007~. and Chapter 15 of the Ordinance describing fines and penalties for non-compliance. I have read and unders.t, and my responsibilities under this Permit and agree to do the following: -- monitor the underground tanks as specified .. in the Permit to Operate. " --maintain appropriate records as required. by the Per.mit to Operate. -~ implement all Ceporting procedures as required by the Permit to Operate. " -- properly close the underground tanks as required by the Permit to Operate. "- ' Jeffries Bros. Inc. (Owner) ~¢~'/) Ltr-.fu'df/~ (Operator) W~¢ P. J~H'eCr~s~-dent ~ ~' - "" ' ' Dated./~ / /¢¢'¢ . Dated/~. (805) 758-3072 · FAX (805) 758-3077 P. O. Box 640 Wasco, Calif. 93280 04/20/92 FIESTA LIQUORS 215-000-001231 Page 1 Overall Site with 1 Fac. Unit General Information Location: 2023 BAKER ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 04 Grid: 20D F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- YOUNG H. WON (805) 366-2228 x ( ) - Administrative Data Mail Addrs: 2023 BAKER ST D&B Number: City: BAKERSFIELD State: CA Zip: 93305- Comm Code: 215-004 BAKERSFIELD STATION 04 SIC Code: Owner: CHONG K YUN Phone: (87~) Address: 6116 DIAMOND OAKS State: CA ,City: BAKERSFIELD Zip: 93306- Summary RECEIVED MAY 2 O' 1992 HA~.. kaAT. r)lV. |, ~; Do hereby certify that ! have reviewed the attached hazardous .materials manage- for~and that .it along with ment ptan any corrections constitute a complete and correct man- agement plan for my facility. 04/20/92' FIESTA LIQUORS 215-000-001231 Page 2 02 - Fixed Containers on Site Hazmat Inventory Detail in Reference Number Order' 02-001 UNLEADED PLUS GASOLINE Liquid 4000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form:, Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL Daily Average GAL AnnuaI Amount GAL m 4,000 I 2,000.00 I 48,000.00 Storage Press T Temp~ Location UNDER GROUND TANK Ambient~Ambientl'WEST END OF PROPERTY -- Conc Components MCP List 100.0% IGasoline ModerateI 02-002 UNLEADED REGULAR GASOLINE Liquid. ~j~Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL --Daily Max~GAL I Daily Average2,000.00GAL.--~---- Annual Amount60,000.00GAL Storage~~Press T Temp Location UNDER GROUND TANK IAmbient~AmbientlWEST END OF PROPERTY -- Conc Components MCP List 100.0% .IGasoline. IModerateI 02-003 UNLEADED PREMIUM GASOLINE Liquid 3000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL -- Daily Max GALI Daily Average GAL I Annual Amount GAL 3,000 ~ 2,000.00 45,000.00 Storage Press T TempI Location UNDER GROUND TANK AmbientlAmbientlWEST END OF PROPERTY -- Conc Components I MCP List ~100.0% IGasoline ~ModerateI ~4/20/92 FIESTA LIQUORS 215-000-001231 Page 3 00 - Overall Si%e <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation NOTIFICATION WOULD BE VIA RADIO CONTACT AND PHONE CONTACT BY OUR JEFFRIES BROS INC. DRIVERS EVACUATION OF THE BUILDING VIA DOORS <3> Public Notif./Evacuation DIAL 911 AND EVACUATE PUBLIC CONTACT JEFFRIES BROTHERS @ 758-3072 USE SHUT OFF EMERGENCY SWITCH AT CONSOLE USE EXIT DOORS <4> Emergency Medical Plan CALL 911 VIA PHONE 04/20/92 FIESTA LIQUORS 215-000-001231 Page 4 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention EMERGENCY AUTOMATIC SHUT OFF VALVES AT BASE OF EACH GASOLINE DISPENSOR IN THE EVENT OF BEING EMPACTED. EMERGENCY SHUT OFF AT THE CONSOLE INSIDE THE STORE. LEAK DETECTORS IN THE DISPENSORS. STORE OWNER WILL CONTACT OUR' COMPANY IN THE EVENT OF A PROBLEM. OUR JEFFRIES BROS INC. DRIVERS DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER CHANNELING PERSONS TO CONTACT. <2> Release Containment <3> Clean Up <4> Other Resource Activation i 04/20/92 FIESTA LIQUORS 215-000-001231 Page 5 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - EAST SIDE OF STORE SOUTH END B) ELECTRICAL - SOUTH SIDE OF STORE EAST END C) WATER - SOUTH SIDE OF STORE WEST END D) SPECIAL - NONE, E) LOCK BOX - NO <3> Fire .Protec./Avaii. Water PRIVATE FIRE PROTECTION - NO PRIVATE FIRE PROTECTION FIRE HYD~RANT- ? <4>' Building Occupancy Level 04/20/92 FIESTA LIQUORS 215-000-001231 Page 6 00 - Overall site <G> Training <1> Page 1 WE HAVE 1 EMPLOYEE AT THIS FACILITY WE HAVE MATERIAL SAFETy DATA SHEETS ON FILE MSDS FOR 3 GRADES OF GASOLINE - PLUS DECALS ON PUMPS AND AND WINDOW PROP 65 <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use ,,' . CITY of BAKERSFIELD ~,~-'--,, .. ,,,,, ;"-"--~,, :...~ ,..., ~:. .~.., WE CA RE" ~ ~ . ,;,~ "'~':",~4'"' ~:::. :-,';k~ ; '/ - , ~-~e or ~rin~ name) ~AZ. MAY. DiV. Do hereby oert~ ~-- ' -' _~,~ that I have reviewea the attached Hazardous Fiaterials busihess Dlan~ name of business) and that it along with the attached additions or corrections constitute a comDlete and correct K. yu f Business Plan for ~ facility. BUSINESS NAME FIESTA L ORS ID NIJME tS-000-001231 LOCATION 2023 BAKER Sl' HIGH HAZARD RATING 1. OVERVIEW LAST CHANGE 11/14/88 8Y UAL JURIS CODE Z1S-004 SURIS BAKERSFIELD STATION 04 MAP PAGE 103 GRIO'ZOO FACILITY UNITS ! HAZARD RATING RESPONSE SUMMARY ZR SEC 4) NO PRIVff[E RESPONSE TEAM Ei"IERGENCY CONTACTS ZA SEC Z) CNONG K. YUN - 323-4G84 OR 8"72-1702 YOUNG H. WON- 366-2228 UTILITY SHUI'OFFS 'ZA SEC 3) R) GAS - E S10E OF STORE S ENO B) ELECTRICAL - S SIDE OF STORE E ENO [~) WATER -' S S.IDE OF STORE W.END O) SPECIAL - NONE E) LOCK BOX - NO Z, NOTIFICATION / PUBLIC EVACUATION < NO INFORMATION RECORDED FOR THIS SECTION > errY PAGE 1 12/Z~188 lO:4Z ' MATERIAL SAFETY DATA SYSTEMS, INC, (805) G48-GB~O 8U~tNESS NAME F'IESTR LIQUORS ID NUM[ Z1S-OOO-OO1Z.31 LOC~tTION Z023 BFtKER ST HIGH HAZFtRD RATING Z MRT TR6tlNING SUMMARY . LRST CHANGE / / < NO INFORMRIlON RECORDED FOR THIS SECTION LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 11/14/88 BY VAL SEC S) CALL BI1 VIA PHONE PAGE 2 1Z/ZZI8B l~'~'~Z" : MATERIAL sAFETY DATA SYSTEMS, INC. (805) G48-B800 BUSINESS NAME FIESTA L'~UORS ID NUM 1S-(~-~2~1 LOCATION ~0~ BAKER Sl' HIGH HAZARD RATING ~ FACILITY UNIT 01 A. 09ERAL. L H~Z~RDOUS MATERIALS INVENTORY LAST CHANGE 1~/14/88 BY VAL ID TYPE NAME MAX RMT UNIT HAZARD LOCATION CONTAINMENT USE ! PURE REGULAR GASOLINE 4(~0 G~L. HIGH UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LIST ~18~.00 100,0 SASOLINE HIGH 2 PURE UNLEADED REGULAR GASOLINE 4000 GAL HIGH UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LIS]' t18~,00 1(~,0 GASOLINE HIGH 3 PURE UNLEADED PREMIUM GASOLINE 3000 GAL HIGH UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LIST .. b. FIRE PROTECTION / ~RTER SUPPLIES LAST CHANGE 11/14/88 BY VAL SEC 4) 'NO PRIVATE FIRE RESPONSE TEAM SEC S) FIRE HYDRANT ? PAGE ~ 1Z/ZZ/A8 10:4Z MATERIAL SAFETY DATA SYSTEMS, INC, (805) G48-G800 BUSINESS NAME FI''°'' E~IA LIQU(]RS ID NUMBER Z1S'"'OOO-OOlZ31 LOCATION Z02~ BAKER ST HIGH HAZARD RATING D- EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE 11/14/B8 BY UAL. 38 SEC Z) NOTIFICATION WOULD BE VIP RADIO CONTACT AND PHONE CONTRCI' BY OUR JEFFRIES BROS INC. DRIVERS EVACUATION (IF THE BUILDING VIA o00Rs E. MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 11/14/88' BY VAL SEC I) EMERGENCY AUTOMATIC SHUT OFF VALVES AT BASE OF EACH GASOLINE DISpENSOR IN THE EVENT OF BEING EMPACTEO. EMERGENCY SHUT OFF AT I'HE SONSOLE INSIDE THE STORE LEAK OETECTORS IN THE DISPENSORS STORE QWNER WILL CONTACT OUR COMPANY IN THE EVENT OF A PROBLEM OUR JEFFRIES BROS INC DRIVERS DELIVERING THE GASOLINE ARE TRAINED TO REACT TO AN EMERGENCY BY PROPER CHANNELING PERSONS TO CONTACT PAGE 4 1Z/Z~/88 10:4Z MATERIAL. SAFETY DATA SYSTEMS, INC. (80S) 848-8800 CITY of BAKERSFIELD i .,~ N 0 N -- T R A D ~ S E C re ~ T S , p,,.[_, o~ ~.. LOCATION: ~3 ~k~ ~ I ADDRESS: q~/t S~l/"~.' STANDARD IND. ~S~ CODE: C~TY, ZIP: ~A~¢~ CITY, ZIP:' ~S~ ~0~ ~ DUN AND BRADSTREET NUMBER PHONE ~: ~-~ PHONE ~: ' ~7~-/~O~ -- __ - - ~ ~ Z~U~O~ ~ ~0~ COD~ (~ ~e Mt Mt Est Un,ts ~l . T~ ~1 TM ~ .. St~ tn FKtltIy~- ~ I~t~ti~ .L~ Hazard ~--~ ~tivity ~--J ~il~ ~--J ~ hl~ ~--~ I~iltl ~lth of Pm~ ~lth · : - : ....... P~icai ~ ~lth HaZi~ C.l.S. ~ ~ ~t II ~ & C.A.S. ~ (C~k ill t~t 4~ly) ....... --~ [--] r--~ ~t ~ ~&C.A.S. ~ ~lth of Pm~ ~lth .,, ,., ..,,, .................. - _ ._, , H~lth of P~su~ ~lth .... L_L .......... L ........... 1 ........... l I __1 .... l_~__l__A (C~ ii! t~t ~ly) C~t 12 ~ & C.A.S. Certificati~ (Read and sJ~ after compJ~tJng 8]] [ clrttf~ ~d~r ~lty Of 1~ t~t I ~ve ~rsm~llye~amn~ a~ ae f~l~ar ~th t~ tnformt~m.~ttt~ t, thts ~ett~~ts. ~ tMt ~s~ ~ W ~W of t~e 1~tv~ls for obtaining t~ tn~ttm.al ~lteve t~t t~ su~ttt~ info~tt~ ~s t~. accurate. *nd cm~dt~ ~ // // ' -~-~r~ r~, ~o~ ~ -~ ~~ ~ ...................... RECEIVED .~? ,, ~ERSFIELn Cr~ r~RE ~EPAR~'X~,'~ MAR 2 5 1988 2130 "G" SmEET B~ERSF!ELD, CA 93301 OFFICIAL USE ONLY ".'" BUS INESS FORM 2A .~ , ' INS~UCTIONS: ~ "~ :'" ' ' 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answe~ the questions below for the business as a whole. 4. Be as br~eg and concise as SECTION 1: BUSI~SS IDE~IFICATION DATA SECTION 2: EArERGENCY NOTIFICATIONS In case of an emergency involving the release or threatened release of a hazardous material, call 911 and 1-800-852-T5~0 or 1-916-427-4341. This will notify your local fire department and the. State 0ffime of Emergency Services as required by EMPLOYEES TO NOTIFY IN CASE 0F EMERGENCY: ,. NAME AND TITLE , ~ ~- ". 'DURING BUS,.~. AFTER BUS. HRS. SECTION 3: LOCATION OF UTILI/"f SHUT-OFFS FOR BUSINESS AS A WHOLE A. NAT. GAS/PROPANE~ B. ELECTRICAL: ' - ~. E. LOC~ 80X YES /~.~ IF YES,,LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? YES / NO MSDSS? YES / NO ... FLOOR PLANS? ./ XO KEYS? YES / .~0 SECTION 4: PRIVATE RESPONSE TE'.tM FOR BUSINESS AS A WHOLE 'SECTION' 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE SECTION 6: EMPLOYEE TRAINING EMPLO%~RS ARE REQUIRED T0 HAVE A PROGRAM WHICH PROVIDES EMPLOYEES WITH iNITIAL AND REFRESHER TRAiXING IN THE FOLLOWING AREAS. CIRCLE YES 0R NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS >~TERIALS ' (YES.)NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES C. PROPER USE OF SAFETY EQUIPMENT:. ................. ~.~N0 YES NO D. EMERGENCY EVACUATION PROCEDURES: ............ a .... .~ES~.~NO YES NO E. DO YOU MAiNTAiN E:,IPLO~nE TRAINING RECORDS:~/~..~ NO YES NO DOES YOUR BUSINESS ~NDLE HAZARDOUS ~TERIAL IN QUANTITIES LESS THAN 500 POUNDS 0F A SOLID, 55 GALLONS OF A LIQUID, 0R.200 CUBIC FEET 0F A COMPRESSED GAS: ...... YES NO I, , certify that the above information is accurate. I understand that this information will'be used to fulfill my firm's obligations under the new California Health and Safety code on Haznrdous M~Zeei~ls (Div. 20 Chapter 6.95 Sec. 25500 Et Al.) and that inaceu~atetinfgrmation constitutes - 2B - BAKERRF!E:D CITe FIRE DEPART}.tEXT 2~30 "G" STREET BAKERSFIELD. CA 93301 GFFiCL4L USE ON:Y ~ ID: .= ~. BUSINESS NA>IE:~ , ~.:_~.,~ -, - ~ BUS I NESS SINGLE FACI LI T'I F 0 R/V~ 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS. IN ENGLISH. 3. Answer the questions below' for THE FACILITy t~%.'IT LIST~._D BELOW 4. Be as BRIEF and CONCISE as possible. '"' SI~CTION 1: MITTGATION~ PREaTTNTTON. ABA~ ~O~S SECTION 2: NOTIFICATION A.N~] EVACUATION PROCEDL~,£S AT T~IS L~.'iT 05%7 l, , FOIIII 4A-I i' ill: ,: ...... IIAg AITI:ICIU6 AIA*I'B Il I AbS' Z H X)'IC H'I'O ITY ,I.', ~li;' a (,ITY,ZIPI - ~ -'' ~3;;~~FACII'ITY IIIil T IIAFIE: ll~,l: ~. PIIIJIIB II (~'~--/~o~ [(IFFI(:IAh USE (:FLITS (:(~l~f' - ~ ~ ' -- '- I (Ittl,' .. llG~ ~/lllll~l, I,(I(:ATIIlll Ill Till9 · fly II~ZAIIll II i) I