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Home My WebLink AboutUNDERGROUND TANK FILE #1~~ (UNDERGROUND STORAGE TANK) (NILE #2) ~ i'' HOWARD'S MINI-MARKET #6 - 4201 BELLE TERRACE ~„ .~ `j9 ~~~~ . I II ~ ~ ~ °~ ~~ ~ ' Hazardous. Materials/HaZardous Waste Unified Permit .~ CONDITIONS OF,~PERMIT ON REVERSE SIDE .' ~ H~ous ~al9 P~n Permit ID ~:: 015~00~00621 ~ Risk~~tP~mm HOWARDS MINI MARKET ~6 LOCATIOn: 4201 BfiLLfi TER~G~ 015-000-000621-0001 UNLADED GAS~t~;, ' ,Z "-~:~ ~~LINER MoN:I~I,~G~ 015-000-000621-0002 UNLADED PLU~?,.;' 015-000-000621-0003 UNLADED REG~It 015-000-000621-0004 UNLEADED PREh 1U~ ~': [':~ .... ,:;'' 'T~'~2~ " I~u~ by: Ba[er~field Fire D~paament OFFICE OF EN~R ONMENTAL SER ~CES' ' 1715 Chester Ave., 3rd Floor .: Appmv~by: Bakersfield, CA 93301 . Voice. {661) 326-3979 " ~ F~ (661) 326-0576 ~... · .- ..',:~'~;,~:'-Expmt~on Date: . Permit Opera :e Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE [ ............ ;~,,,?~,~,~,,~,,,~,~,~,, ................ This permit is issued for the following: UNLEADED GASOLINE GAL""~::,,, 10/1~'"~':'"'~::~, FCS ATG /~7~' LPT F PRESSURE ALD 0003 UNLEADED PLUS 12,000'~[00:~GAL .:'5~:,::,.40/!/84 %,.SW' FCS A~ /~,.",,f: LPT F PRESSURE ALD 0004 UNLEADED REGULAR 000.00: 'GAL~'.' '~ ']=01;~/8~:' r,. SW ECS::~'~:5 ,,,,:~:.:,5' ATG .,,(L'::~ ,~" LPT F PRESSURE ALD ls~ by: ~ ~~ B~er~field Fke D~a~ment Approv~ by: ~~~' O~CE OFE~RO~AL S~ B~e~el~ CA 9~301 Voice (805) 3~979 FAX (80S)~16-0S76 Expiration Date: ~n~ ~O~ ~000 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 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 in the format of your choice: name of owner; name of operator; name of facility; street ad&ess, 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 2nd day of November, 1998 to: HOWARDS MINI MARKET #6 Permit #015-021-000621 4201 Belle Terrace Bakersfield, California 93309 ~~'~ ~~MONITORING SYSTEM CERTIFICATIO For Use By All ,jurisdictions Within the State of California ,4uthorlty Cite& Chapter 6 7, Health and Safety Code; Chapter J6, Division ?, 7'it e 23, Californla Code ofRegulations This form must be used to document testing and servicing of monitoring equipment. AseQarate certification or report must be t~revare for each monitorin~~stem control panel by the technician who performs the work. A copy of this forth must be provided to the tank system owner/operator. The ownerloperator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: N~~~~S '6'`Rzt..1'~. ~A~~ 13tdg. No.: Site Address: ~a~ ~ ~IL .r. j ~. R ~ _ _ City l~l~~~~,~~~ Zip: ~~?~Q Facility Contact Person:,G~l~.~h,~ Contact Phone No.: (Cotel )3~'~- ~~_ Make/Model. of Monitoring System: ~[t..,~- ~~Q,~ Date of Testing/Servicing: ~/ ~ / m~ B. Inventory of Equipment Tested/Certified INSPECTOR ON-BYTE YE~ NAME: ~ pt~,,t~~o0 rr,,.~4 rhN ~ nrnnr;orP hnvPC rn ;nri;enrP cnecifie enuipment inspected/serviced' Tanlt 1D: l l_ yZ~~1Q~D ~~ Tank 1D,: ~~>~~.,U-~ Q ~.In-Tank Gauging Probe. fvlodel:,~'(1 S,2 •$!n-Tank.GaugingProbe. Model: (Y1~(a d l o M t ~ • ~'Anntllar Space or Vault Sensor. Model: ~ Piping Sump /Trench Sensor(s). Model: : Sens r. o e Space or Vaul Annular ~ P.iping Sump /Trench Setlsor{s). Model: $~Filt Su+np Sensor(s). .Model: $Fifl Sump Sensor(s). Model: ~ Mechanical Line Leak Detector. Model: ~X ~ $Mechanical Line Leak Detector. Model: >~.~ ^ Electronic Line Leak Detector.. Model: ^ Electronic Line Leak Detector. .Model: Tank Overfill /High-Level Sensor. Model : ~ {~ ~'`1'ank ~Overfilt /High-Level Sensor. Model: m ~ ~ C~ Other (s ecif a ui ment t e and model in Section E on Pa e 2 . D Other (s eci a ui ment a and model in Section E on Pa a 2). Tank fD: ~~~S~~R Tank ID: '~-In-T'ank Gauging Probe. Model: m~~,7 1] ~Jn-'Tank Gauging Probe. Model: -~ Annular Space or Vault Sensor. Model: k,l'~. j£,Q~ Q Annular•Space or Vault Sensor. Model: ____ ~-P.;ping Sump/ Trench Sensor(s). Motlel: ~Q?~ O Piping Sump /Trench Sensor(s). Model: -J~-Fill Swnp Sensor(s). Model: ~,j~~ ^ FiIJ Sump Sensor(s). Model: ~'Mecitanical Line Leak Detector. Model: _ O Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model; ^ 1lectronic Line Leak Detector. Model: $! Tank Overfill /High-Level Sensor. Model: ~(.~ ^ Tank Overfill /High-Level Sensor. Model: ^ Other (specify equipment type and model in Section E on Page 2). iJ Other (specify equipment pe and model in Section 6 on Page 2). Dispenser ID: { Dispenger ID: 3 .Dispenser Containment Sensor(s). Motlel: ~\ ` f~Dispenser Containment Sensor(s). 1Vfodet: ~, •~ Shear Valve(s). Shear Valves}. ' ^ Dis enser Containment Floats and Chains . • ^ Dis enser Containment Floats and Chains . Dispenser IU: Cj1~Q Dispenser ID: '®' Dispenser Containment Sensor(s). Model: _ ~®( , i 7~Dispenser Containment Sensor(s). Mod et: ~ j ,~. Shcar Valve(s}. 'Shear Valve(s). `,,. O Dispenser Containment Float(s) and Chain(s). ^Dis ehser Containment Floats and Chains . Dispenser' lD: • pispenser IDc ^ Dispenser Containment Sensor(s). Motlel: p Dispenser Contafnment Sensor(s). Model: O Shear Valve{s). D Shear Valve(s). ODispenser Containment Float(s) and Chain(s). Q Dis enser Containment Floats and Chains . ~ if the facility contains mare tanks or dispensers, copy thfs form. Include information for every tank and dispenser at the facility. C. C0Tt1f CatlOtl - i certify that the equipment identified in this doctlmettt was inspected/serviced in accordance with the manufacturers' guidetlnes. Attached to this Certification Is information (e.g: manufacturers' checklists) necessary to verify that this information is correct and a Piot Plan showl»g the layout of monitoring equipment. For any equipment capable of generating such reports, l have also attached a copy of tl:e report; (chec%al! that apply); System set-up ~Alar istory report Technician Narne (print): ~^[•~~~ ~Q~-T-~ Signature: Certfticatfon No.: _ A a ~~~j ~ License. No.: _~o~l(p (a~.4 ~D" u`T Testing Company Narne: RICH ENVIRONMENTAL Phone No.:,C 661~,~_ 3g2_g687 Site Address: Nafa~ QC~ T~~..2~Aere Z~\( ~~T'F ~ ~T~, Date of Testing/Servicing: ~/~/~~- Page ! of 3 031 U 1 Monitoring System Certification -- ... i ~,t-c~5 D. Results of Testing/Servicing Software Version Installed; c~`a-~ . Ca 1 V V11{ IYIY Yes {11Y {V{IV 1. O o Is the audible alarrn o erational? ~. Yes ^ o Is the visual alarm o erational? -~. Yes ^ o Were all sensors visually ins ected, functional) tested, and confin-ned o erational? -I,~ Yes O o Were all sensors installed at lowest point ofsecoridary contaiiunent and positioned so that other equipment will not interfere with their proper operation? ^ Yes Q o Jf alarms are relayed to a remote monitoring station, is aJJ communications equipment (e.g. modem) ~ N/A operational? `f~ Yes O o Far pressurized piping systems, does the turbine automatically shut down if the piping secondary containment D N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? i'fyes: which sensors initiate positive shut-down? (Check all that apply) ~5ump/Trench Sensors; .O Dispenser Containment~Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ".Yes; O No. Yes O o For tank systems that utilize the monitoring system as the primary tank overfil! warning device (i.e. no ^ N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating pro erly? If so, at what ercent offank capacity does the alarm trigger? Q ^ es '~ No Was any monitoring equipment replaced? Ifyes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for afl re lacement arts in Section 13, below. O es '~ No Was liquid found inside any secondary. containment systems designed as dry systems? (Check all that apply) d Product; O Water. If es describe causes iri Section E below. . ~ Yes ^ o Was monitorin s stem set•u reviewed to ensure ro er settin s? Attach set u re orts, if a licable Yes ^ o !s all monitoring equipment operational per manufacturer's specifications? in ~ecr+on r1 ne+ow, aescnue notiv and wnen rnese getrc+enc+es were or wUr ne corrected. Page 2 of 3 03 i O 1 [ ~t-t, `L F. In-Tank Gauging /SIR Equipment: ^ Check this box if tank gauging is used only for inventory control. ^ Cheek this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. LVIII IC~C -Yes lllc 1VIlV Y O o ~'~U cuc,.nnu.. Has alt input wiring been inspected for proper. envy and termination, including testing for ground faults? ~ Yes O o Were all tank gauging probes visua!!}~ inspected for damage and residue buildup? ~- Yes O o Was accuracy of system product level readings tested? ~ Yes ^ o Was accuracy of system water level readings tested? '~ Yes ^ o Were all probes reinstalled properly? ~ Yes ^ o Were alt items on the equipment manufacturer's maintenance checklist completed? * to uie ~ectlon ti, below, aeserioe uow ana rvnen mesa ocuCiCeclcs,wc,c V. w~u uc cv~ ~cucu. G. Lit1e Leak Detectors (LLD): Q Check this box.if LLDs are not installed. !~`n.n nlnha fha rnll..w~nrt nharl[~ic1~ Yes O No` f or equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ N/A (Check a/lThal apply) Simulated leak rate: ~~ g.p.h., ^ 0. I g.p.h , ^ 0.2 g.p.h. ~ Yes O o Were all LLDs confirmed operational and accurate within regulatory requirements? ~' Yes ^ o Was the testing apparatus properly calibrated? Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? O NIA O Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a Teak? ,'E~ N/A O Yes O o For electronic LLDs, does the turbine automatically shut offif any portion of the monitoring system is disabled ~ N/A or disconnected? O Yes ^ o For electronic LLDs, does the turbine automatically shut off ifany portion of the monitoring system malfunctions ~N/A or faits a test? ' D Yes O o For electronic LLDs, have all accessible wiring connections been visually inspected? ~ N/A z~-Yes ^ o Were al! items on the equipment manufacturer's maintenance checklist completed? ~„ tuc VC~lfUll rl, UCIUIY, UCJl:71UC IIVw 11i1U w,ie+I mese ae>i~ctencres were or wUt oe corrected. H. Comments: Page 3 of 3 ~ 03.141 t v -~-~ .~ • LG lb3-l, Enc. D •Monitorlrig System Certiflrcation Form: Addendum for Yacuu~n/Pressure Interstifisl Sensors Y, Results of Vacuum~Pressure Monitoring Egtupmellt Testing This page should be used to document testing and•servicing of vac~lum acrd p~esstlre lntts'sttt~ seusors• A copy of this form mast be included with the Monitoring •System Certification Form, which ~ t~tCertific ~,~ Form to ~ system owner/operator. The owner/operator must.submit a copy of the Monitoring Sys . local agency regulating UST systems within 30 days of test daze. . Mo~ei: ~ System 7'ype:~ Pressure; ^'Vacuum Manufacturer: ' Sensor ID . Component(s) Monitored by thlr Sensor: Scasor Functionality Test R.csult: ^ Pass; ^ Fail Iatesetitis3 Commuuiaation Test R:esu2t: ^ Pass; n Fail Component(r}Monitored by this Sensor:' Sensor Functionality Tcst Result: ^ Pass;' ~ }] Fail ,Interstitial Comuiuaication Te9t Result: ^ Pass; ^ Fail • Component(s)Monitored bythis~Sensor: Sensor Futicti onality Test Result: ~ Pass; ~] Fail Intcrstiti$I Communication Teat Result: ^ Pass; ^ Fail Component(s) Monitored by this Sensor: Sensor F~wetionaIity Test }'Lesult: ^ Pass; ^ Fai! Xiittrstitial Communication Test Result: ^ Pass; ^ Fail ' 'component(s) Monitored by thit Senior: ' Sensor Functionality Test Rrsuit: II Pass; `^ Fail Xnirsstibial Cominuuication Test Result: [] Pass; ^ Fail ' Component(s) Monitored by th7r.Sensor: ~ ~ ~ ~ ' Sensor Functionality Test Result: ^ Pass; i~ Fa~7 Tntersdtial Communication Test Result: ^ Pass; ^ Fail Component(s) Monitored 6y'this Sensor: Seasar Functionality Test Result: ^ Pass; ^ Fad Interstitial Communication Teat Result: ^ Pass; ^ Fail Component(r) Monitored by this Sensor; Sensor FtuutionaLity Test Resuli: ^ Pass; ^ .Fail . Interstitial Co}++'+*+t*n*cation'Tcst Rcstxlt: ^ Pass; ,^ Psi1 Component(s) Monitored by this Sensor: Stnsos Fusicfionality Test Result: ,^ Pass; ,^ Fail ~ Iutcxttitial Cotumuzticatiori Test Result: ^ Pass; ,^ Fail Component(r) Monitored by this Sensor:' ' Sensor Functionality Test R,esuItr ^ Pass; ~ Fail Tntcrslitial Communication Test Result: ^ Pass; ,^ Fail How was interstitial communication verged? ' . (] Leak Introduced ~atFat Fnd of Interstitial Space;! ^ Gauge; . ^ Visual ~ e~etion; .^ Other (Describe to Sec. J, belotiv) Vacuuw was restored to operaHn~ levels in all interrtitial spaces: ^ Yes. ^ No {~jnv, describe in Sec. J, below) J. Comments: _N 1 a ~ ~ ~ . '---~--- Page of .,~. ~ If the Sensor successfully detects a simulated vacuutnlpressure leak intraduccd in the interstitial space at tba fisrthest point from the sensor, vacuum/pressure has been demonstrated to bo eommuaieatimg tluouehout the iateratioc. _ Monitoring System Certification US7' Monitoring _Site Plan Site Address: __---tea--- - -=~-------------, :-~----~ -----~ -- _----- - _ ~ ---_-- :'ANN~J.~A _- - ------------------- -------- - ~~--- - ~.~.R,OX --_ - - - - - - - - - - - - - - - - - - - - - - - - - ` - _ - _ _ - ~jcVAPo2QO~C= F;5- ~sts-S~r~nP - --=------------- --------- - ------ a_-~Q~.~. - -----•---------- --------- -N- ------ m-~~s~-- - ---------------- ------ - fi!- -----_ ~-~~E~u.o~r~cc - - - - - - - - - - FpA -~racY bJE~ita,A~ - -----_._.--_....__--------•----- -_-----W-- -'~--- - -------------------~------------_-- ___...___...5------ Date map was drawn: { (/ ~' /,~~' Ins'~uctions H Z If you already have a diagram that shows ail required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection), In the space provided, note the date this Site Plan was prepared. Page of osioo 5 6~ ~ BROQ~S C',~ &'~:~C~RBF~EI,,A. ~C.A,. 93 3 0 $ OFFTCE (66~,y 392&s8q ~='~,~c (s6~~~392~aB27. M3~C.t3k~T~:A~i~ T~Bx- n~~:~c~roR ~~S-~ Sc~U.~SS: ~~ (~~~~ L w/off: k'ae :i. l i by ~+Tarne ; W R Q~ 'CC1~TtJS m f~+C'i' ~`ac:l.~.~~y' .Addx~ss: Px•Qc;tueC L~.2ze Tie {Praasisxe Suction, ~zav~,by} P~tc:-DLJCT LEAK :i~.ETECTOR TKL~E TEST T'RT$ PAS~I~ sr~r,ax~ ~vt~raa~R 8~L0~1 PSI QR 8~ L/A ~~a 5a ,~* ~~ L/D ~'x&R ~L~ ~~'PC+~„cam" 2 r 4i~( C ' - o x.~ # SR~ 0 _-._.. 2d D.. ~ID FA~T,i T./U. 2YPE -s.Ktic~2..~.~..~ S ~ ~~~t. 8&R~AL '# mo~„~ ._, ~d0 ~ Q~ FAIL' .T,/J~ x'7t'PJ~ 'X'~S PASS' SFCR~~ # NO FASL' Y ;:ertify the aba~re tests were cdnductar3' on this datp aocoxding ~o Bed ~;taa.~et trumps field tePi: ap~,axatus test~.ng px'oceduxe axi llmitaC.~a21,a. xZL:~ Meck~axkir.al Leak Detectox xes~ pass / ~a,~]. is• d•eter~nined by u9ing a lcru ~Elaw tk~reshol~l trip. rate of 3 gaZ].ou'per haux' ox' leas at 1q &+SZ. r .aicknowl~dg~ that aa.1 dp,ta aallected~ ie ,true ldlld aaX~r~at tt~ the beet of rr4~ knowledge . ~. xech : sC,'~,~.~~ D3 I,~ . S zgrie~ t ure . t „L~~~ ~ Date t .] k.; ~` • ~~' 4'. l ~ `'c, -r { SWRCB, January 20~ . Spi.U~Bucket ~'estiug;R~epor~ Form This form Is Intended for use by contractors performing annual testing of ClS7'~ill eontainritent structures •The completed form m printoutsfrom.tests (ifappltcable), should be provided to the fa~ility`.oFiunerfdperatorfor submittal.to the local regulatory agency. ' 1. FACILITY II~IFORM~iTIbN Facility Name ~ (71 Z ~ ~ (~`'": ~ :. ~ . Date of TCStin ': ' + Facility Address: ~ ~ ~ ~ . Facility Contact: ~(~ V ,~ , i~ ~ ' ~ ~. Phone; Date Local Agency Was Notified of Testing ::t ( . Name of Local Agency Inspector (~present.during testit~: ; 'tV S, Q.. _. • 3. SPILL Identify Spill Bucket (By°Tank ~ ~ Number, SYoredProduct, etc. I -~ 2 ~ , . • q ^~'Z t.l. 3 4 1D~.L£ Bucket Installation Type: . Dint B ontained in S D ` ~ fain Direct B Direct Bury ntainrd in S Contained in Sum Bucket Diatnctcr: a '~ ~ ~ (a"r ~ ( , ~ . Buclcst Depth: ~ 4 " ~'~-~. ~ ~ r Wait time bctwcrn apP1Y~8 vacuum/water and start of test: c~ tYl Z i`.1 ~ . fY1Z N ~, ~ M'L, N ' Test Stara Time (T~: ~ ('D q ~ 4 Initial Reading (R~; . ' . .. 4 { (~j' ' ~ ' (, Q~" Test l:ud Time {1'p); ~ `Qj ~ :., ~ . ~; ~ Final Reading (RF): L t~p" •t ~A" ~ ~ l ' ' Test Duration{Tp-TtJ: -l-~ fZ ~~~Qt1~.. ~,-I~OC,~r'. Change itt Reading {RF - Its: la ~ , Pass~Fail Threshold or Criteria: ~ . ~ © ~ • ~ ~ ~ . +~ (.:t)II1Y118IItS ~- (include' i~for»ratlon on repairs madeprior to testing, and recommendedfollow•~rplorfailed tests'. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby cerirfy.that all the !i{formatYnn contained in this report is true, accirt~ate; and !n fit11 compliance with legal requirements Technician's Signature: ~ ` ~ . 1 ~ • T ' ~~ ~~~ Date: State laws and rcguladons do not currently rcquise testing t0 lac performed by a 4valiSr~c3 contractor. Flowever, local requirements may be more 6l~ingGnt. ~ , ,. ,. Company Name: fZL ~ N 'L 120 ~G cJ'f~L~ ' ~ ~ ~ ~ ' .Tcclanician Conducting Test: Q ~ . Credentialst: CSLl3 Contractor„ C Servi ~ SWRCB Tank Tester. Other ( `eet ) License Number(s): t C J\VV.JV J vVLL J ~ (~ ( 7 Y i~ri n l S i vKr 1CGrvfS i PRODUCT CODE ,L THERMAL COEFF :.000700 R 1:87 THERMAL COEFF :.000450 TANK DIAMETER. 113.75 ~- IIV-TANY, ALARI°1 ---°- TANK DIAMETER !13.75 TANK PROFILE 1 PT TYPE: 3:PREMIUPI TAtVK PROFILE 1 PT FULL VOL .5037 FULL VOL 10074 STANDARD NORMALLY CLOSED :RFILL ALARM a 24. 2007 5:27 PM FLOAT SIZE: 4.0 IN. FLOAT SIZE: 4.0 ItV. LIQUID SEIVSOR ALMS WATER WARNIIVG 2.0 L i:FUEL ALARM J PRODUCT RLARI°I WATER WARNIfVG 2.0 HIGH WATER LIMIT: 2.5 L 2:FUEL ALARM ~ lOJ 2003 8:05 AM HIGH WATER LIMIT: 2.5 L 3:FUEL ALARM MAX OR LABEL VOL: 10074 R 2;91 .I VERY NEEDED MAX OR LABEL VOL: 5037 OVERFILL LIMIT 90~ OVERFILL LIMIT 90'~ 9066 TYPE: 1 10. 2003 8:05 ANI 4533 HIGH PRODUCT 99'~ STANDARD HIGH PRODUCT 99i 9973 NORMALLY CLOSED . 4986 DELIVERY LIMIT l00 DELIVERY LIMIT l0i 1007 ~ 503 L I QU I D SEtJSOR ALMS LOW PRODUCT 500 L 7:FUEL ALARM LOW PRODUCT 500 LEAK ALARM LIMIT: 99 L B:FUEL ALARM LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 R 3:DSL SUDDEN LOSS LIMIT: 50 TANK TILT 0.00 TYPE: TANK TILT 0.00 PRONE OFFSET 0.00 STANDARD PROBE OFFSET 0.00 NORMALLY CLOSED SIPHON MANIFOLDEU TANICS SIPHON MANIFOLDED TANKS Ttt: NONE Ttl: NONE LIQUID SEfVSOk ALMS LItVE MANIFOLAED TANKS LINE MANIFOLDED TANKS Tit: NONE L 4:FUEL ALARM Tp: NONE L S:FUEL ALARM L b:FUEL ALARM LEAK MIN PERIODIC; 146, LEAK MIN PERIODIC: l0i 1007 R 4:OVERFILL 503 TYPE: LEAK MIN ANNUAL l0i STANDARD LEAK t~1IN ANNUAL l0i 1007 NORMALLY OPEN 503 PERIODIC TEST TYPE IN-TANK ALARMS PERIODIC TEST TYPE STANDARD ALL:OVERFILL ALARM STANDARD ALL:HIGH PRODUCT A. ANNUAL TEST FAIL ALL:MAX PRODUCT AL. ANNUAL TEST FAIL ALARM DISABLED ALARM DISABLED PER I OD I C TEST FA i L CATEGORY ~-: A'Ni.u:.. , FER I OD I C TEST FA I L ALARNi DISABLED ALARM D I SAI3LED GROSS TEST FAIL GROSS TEST FAIL i ALARM DISABLED L 3:87 FILL ALARNI DISABLED ~ TRI-STATE (SINGLE Fi ANN TEST AVERAGING: OFF CATEGORY OTHER SEI ANN TEST AVERAGING: OFF .PER TEST AVERAGING: OFF PER TEST AVERAG I tVG : OFF TANK TEST NOTIFY: OFF TANK TEST NOTIFY: OFF L 4:DSL STP TNK TST SIPHON BREAK:OFF TRI-STATTr {SINGLE F] TNK TST SIPHON BREAK:OFF CATEGORY STP SUMF> DELIVERY DELAY 15 MIN DELIVERY DELAY 15 MIN PUMP THRESHOLD~ 10.00% PUMP THRESHOLD 10.00% ~ ~ -- -~---r"`-~- ~ - - "~` ALARM HISTORY REPORT L 5:DSL ANNULAR ..... __. TRI-STATE {SINGLE F1 ALARM HISTORY REPORT -.._ _. ---- I N-TANK ALARM ----- CATEGORY ANNULAR -~-- IN-TANK ALARM ----- T 1:REGULAR T 2:DIESEL OVERFILL ALARM L 6:DSL FILL LOW PRODUCT ALARM OCT 18. 2007 5:45 PM TRI-STATE (SINGLE F1 CATEGORY OTHER SEI OCT 20. 2007 6:41 PM DELIVERY NEEDED DELIVERY NEEDED NOV 1. 2007 11:31 AM 2007 9:06 AM SEP !0 L 7;91 STP OCT 20. 2007 5:05 PM . TRI-STATE (SINGLE F1 CATEGORY STP SUf°1P L 8:91 FILL TRI-STATE (SINGLE FI CATEGORY OTHER SEI `'_ "_" "' "J'"' "` _ _ - - SYSTEM SETUP L 2: B7 ANNULAR ..__...... .._,_. _~.~.~,.~ _ _ - - ANNULAR SPACE ----- SYSTEM ALARh1 1:REGULAR NOV 7,.2007 9:26 AM SENSOR OUT ALARM PAPER OUT 'ODUGT CODE 1 NOV 7. 2007 11:20 AM NOV 5. 2007 2:48 IERh1AL COEFF :.0007D0 FUEL ALARM ~ PRINTER ERROR NOV 5 200? 2:48 INK GIAI°IETER 113.75 INK PROFILE 1 PT SYSTEf°I UNITS NOV 7 • 200'7 -10:19 AM , BATTERY I S OFF FULL VOL 15023 U'S' SYSTEM LANGUAGE NOV 10. 2003 8:00 ENGLISH ALARM HISTORY REPOT ,OAT S I ZE : 4.0 I N . SYSTEM DATEiTIME FORMAT MON DD YYYY HH : Mh1: SS xM "-"' ALARM H I STORY REPORT ---- I N-TANK. ALARI°1 TIER WARNING 0,0 HOWARDS MINI MART ----- SENSOR ALARM ----- T I:REGULAR GH WATER LIMIT: 2,5 4201 BELLE TERRACE L 3:87 FILL ~X OR LABEL VOL: 15023 BAKERSFIELU.CA 93309 OTHER SENSORS SENSOR OUT ALARM OVERFILL ALARM 'ERFILL LIMIT 90~ 661-397-7600 NOV 7. 2007 11:20 AM OCT 18. 2007 5:45 13520 GH PRODUCT 99~ SHIFT TIME 1 DISABLED FUEL ALARM HIGH PRODUCT ALARh1 14872 SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED NOV 7. 2007 10:22 AM NOV 7. 2007 10:35 'LIVERY LIt°lIT 10° SHIFT TIME 4 DISABLED -. PROBE OUT 1502 ALARM HISTORY REPORT NOV 7, 2007 10:34 W PRODUGT 500 TANK PER TST NEEDED WRN AK ALARM LII°IIT: 99 DISABLED TANK ANN TST fVEEDED WRN ----- SENSOR ALARM ----- L 4:DSL STP DELIVERY NEEDED DDEPJ LOSS LIh1IT: 50 Op dVK TILT 0 DISABLED STP SUMP NOV 1, 200711:31 . OBE OFFSET - 0 00 SENSOR OUT ALARM SEP 10. 2007 9:06 , LINE RE-ENABLE METHOD NOV 7. 2007 11:20 AM PASS LINE TEST MAX PRODUCT ALARM PHON hIANIFOLDED TANKS LINE PER TST NEEDED WRN FUEL ALARM NOV 7. 2007 10:11 AM ~ NOV 7. 2007 10:35 fVONE D I SABLEA ALARM HISTORY REP01 fVE MAN I FOLDED TAIVKS NONE LINE ANN TST NEEDED WRN ALARM HISTORY REPORT ---- IN-TANK ALARf°1 DISABLED AK I°IItV PERIODIC: 1Di PRINT TC VOLUMES `- SENSOR ALARM ----- L 5:DSL ANNULAR T 2:DIESEL 1502 ENABLED ANNULAR SPACE LOW PRODUCT ALARM AK h1IN ANNUAL l0i TEMP COMPENSATION SENSOR OUT ALARM NOV 7. 2007 11:20 AM OCT 20. 2007 6:41 1502 VALUE <DEG F ): 60.0 STICK HEIGHT OFFSET FUEL ALARM HIGH PRODUCT ALARhI DISABLED NOV 7, 2007 10:15 AM NOV 7. 2007 10:33 R I OD I C TEST TYPE DAYLIGHT SAVING TIME D I SABLED .__._._~._ PROBE OUT STANDARD i .__ ---....._..__.. LARM HISTORY REPORT . NOV 7. 2007 10:32 NUAL TEST FA1L ~ `~~U ~EfVSOR ALARM - ALARM DISABLED j SYSTEM SECURITY S ---- fiILL OTHER DELIVERY NEEDED C RIODIC TEST FAIL CODE 000000 { SENSORS SENSOR OUT - O T 20, 2007 5:05 - ALARM DISABLED CUSTOM ALARM LABELS ~ ALARM ~ NOV 7. 2007 11;20 AM ALARM HISTORY REPOh ASS TEST FAIL . DISABLED _ .. FUEL pLgRM ---- IN-TANK ALARM ALARM DISABLED ... ~ LI~dUID SENSOR-SETUP - - - ~ NOV 7. 2007 10:14 ANl T 3:PREMIUM v TEST AVERAGING: OFF I - - - - - - FUEL ALARM 1 TEST AVERAGING: OFF L 1 :87 STP NOV 7, 2007 70:12 --....-~. R I L RM V}: TEST IVOTIFY: OFF TRI"STATE (SINGLE FLOAT} ,.._ -.~...... AM ~ ALARM HISTORY REPORTT~^' AUG 24 . 2007 5:27 CATEGORY.: STP SUfhP ~ LOW PRODUCT ALARh1 < TST SIPHON BREAK:OFF -'--- SENSOR ALARM ----- L NOV 10. 2003 8:05 7:91 STP ~IVERY DELAY 15 M!N •1P T L 2:87 ANNULAR TRI-STATE (SINGLE FLOAT) STP SUMP °"" ~ SENSOR OUT ~ HIGH PRODUCT ALARI°1 HRESHOLD 10.OOi -• ~ "~~~ ~T AR SPACE ALARM NOV 7 NOV 7, 2007 10:31 ~K TEST h1ETHOD - . , 2007 1 1:20 AM - :T MONTHLY ALL TANK . SOFTWARE REVISION LEVEL FUEL ALARM NOV 7 PROSE OUT NOV 7. 2007 10:30 .K 1 SUN VERSION 324,01 . 2007 10:23 AM ART TIt°1E 2:00 AM SOFTWAREtt 346324-1OD-B ~'"' ~T RATE :0.20 GALiHR CREATED - 03.1!.10.17.15 AL qR~.l _--.._......... HI DELIVERY NEEDED 'ATION 2 HOURS NO SOFTWARE MODULE STORY REpp'.... "~ kT NOV 7. 2007 10:30 NOV 10. 2003 8:05 'EARLY STOP:DJSABLED SYSTEM FEATURES: FERIODIC IN-TANK TE L $: 9i SENSOR pL OTHER fiILL ARM "' ALARM HISTORY REPOR' }; TEST REPORT FORh1AT STS A1VIVUAL I N-TANK TESTS - SENSORSfluTORS ----- SENSOR ALARM ENHANCED • 2007LAR 2 fiU ~ TP . 0 Aty l: A STP SUMP NOU 7LA2 Q SOR 0 o pLARM 7 l0:26 NOV 2 o 20 H M FUJri. ALARM ' Nf}V 7. 2007 10:18 -_ •! < a ~ Gi ' MQN~ITQR~ CERT. FAILI;~RE REPORT ITE -VAME: A CZ z tv :: ~1~A 2~- DATE: ~ ~' • ~- ~ ` ADDRESS t-I acD t '~,~~.S~i~2Ar~ TECHNICIAN: ~'t'~ ~ ~ ~ ~ dt3€S THE•T4.OLL0~'IHG COMPONENTS VYERE.REYLAL:L~'1)lK~~rt3~~~ iv ~.vi~ira.,~aa. TESTII~TG. ~ ~ • LABORr ~QN ~ ~ - - ~ •. 1 ' ~ ~ ~~ 4. PARTSINTALLED: N ~ t~J ~ • NAME:. TITLE: SIGNATURE: ~ ~ ~ ~ . •" THE ABn'VE NAMED PERSON TAKES FULL RESPON$TBILYTY OF NOT'IF'YII~IG THE AP~ROPRL4TE PARTY TO HAKE CdRREGITVE ACTION TAKEN TO R~'AIR THE ABit~VE LISTED. P$OBLEMS AND NOTIFYING RYCH ENVIRON1~ANrAI, FOR ANY NEEDED RETESTIl~TG. THIS ALSO RELEASES RICHENVERONl12CNTAL OF~ ANY FIl`IES OR PENA7:,TtE5 OCCUItING FROM NON C02tZPISANCE, . A COPY~OF TffiS DOCUMENT HAS BEENLEFT ON-SITE FOR YOUR . CONVIENENCE: ~ ..... ~ . ..~, -'~:: PROPANE EXCHANGE STORAGE TANK(S) ~, ~` APPLICATION ~~ B $~~R~ I n FOR INSTALLATION / REMOVAL OF a_~~~ ~` PROPANE EXCHANGE TANK(S) .~ INSTALL ^ REMOVE PERMIT:. # BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FACILITY o ~ ~•~s ~ ~ ~ fi~ ~~~ ~ 6 ADDRESS OPERATORS NAME .e~,v~ c~~. ~ OWNERS NAME ~v° C~~~ NUMBER OF CAGES TO BE INSTALLED ` /REMOVED TOTAL NO. OF TANKS VOLUME NAME OF COMPANY INSTALLING & / R REMOVING~NK(S) l ~ d~ ~~ ~ l ' MAILING ADDRESS S~ v1W ~`V~ ~~~~~ ~ C~ ~J~ NAME & P E NUMBER OF CONTACT PERSON /~ c; DATE 8 TIME'TO BE INSTALLE OR REMOVED = ccS SIGNATURE LICANT DATE \_ - f-- 4 APPROVE BY '~ ~ f DATE 13 ~ga FD 2115 (Rev. os/o5> ~1NI~IE® PROGRAM INSPECTION CHECKLIST SECTAON 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NA;~E INSP CTIO DATE INSPECTION TIME ADDRESS ~~ PHO E No. No. of Employees ------ ~~ (_ ~~~~ ,_.~~s~~,------..-------------- --------- ~~sg~, _ __ Jam- -_. __ ---- -- FAC IL ITYCONTACT t 15-~21- Section 1: Business Plan and Inventory Program ^ Routine ombined O Joint Agency OMulti-Agency ^ Complaint ^ Re-inspection ~% V \V=Voatolnnce~ OPERATION COMMENTS L`6~ ® APPROPRIATE PERMIT ON HAND L~ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS _----.._ ~^ CORRECT OCCUPANCY I CII~ ^ VERIFICATION OF INVENTORY MATERIALS ^ VERIFICATION OF QUANTITIES __ ~^ VERIFICATION OF LOCATION ~^ PROPER SEGREGATION OF MATERIAL LT ^ VERIFICATION OF MSDS AVAILABILITYE LAY ^ VERIFICATION OF FIAT MAT TRAINING C3 ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES <'J ^ EMERGENCY PROCEDURES ADEQUATE C~7 ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING LI ^ FIRE PROTECTION L~f ^ SITE DIAGRAM ADEQUATE 8c ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES i3 NO EXPLAIN: QUESTIONS CARDING T IS INSPECTIONS PLEASE CALL US AT ~C6'I ~ 326-3979 r~ 7 - - ~-rI _.... . __ -----------------. Inspector Badge No., White -Environmental Services Yellow -Station Copy usiness Site Responsible Party Pink -Business Copy :~ .~~_ UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. l ~ Q ~'~ BAKERSFIELD FIRE DEPT. ~iR~ Prevention Services ARTr ! 900 Truxtun Ave., Ste. 210 -. Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LIN ^ SB-989 SECONDARY CONTAINMENT TESTING n TGIJK TIRNTNFRC TKCT Tn PFRF(1RM FI IFI 6A(1NITl1RWC: CFRTIFICATInN 1 FACILITY -` NAM 8 PHONE NUMBER OF CONTACT PERSON ADDRESS I,~ ~ ~} ,~ ~~ <i~ OWNERS NAME OPERATORS NAME PERMIT TO OPERATE N0. NUMBER OF TANKS TO BE TESTED IS PIPING GOIN TO BE TESTED? ^ YES ^ NO TA K # VOL ME CONTENTS c~-- ' TANK;TESTING COMPANY NAME OF TESTING CO ANY {, AME & PHON UMBER OF C NTACT PER~N ~ -- MAILING ADDRESS ! p ~7 _ 1 NAME 8~ PH NUMBER OF TESTER OR SPECIAL INSPECTO ~ CERTIFICATI #: DATE & TIME T T TO BE CO DUCTED /~~~l V~ ICC #: TEST METHOD SIGNATURE OF APPLICA T ~ DATE .~ ~ _~ . APPROVED BY DATE ~~ Q FD 2095 (Rev. 09/05) .~~ ~ ~ ! ur ~5 Bfi~.LlNG & PERMiT STATEMENT BAKERSFIELD FIi2E D PT. Prevention Services rt~r 900 Truxtun Ave^ue, ~u:te 210 PEFtMfT NO.: ARTM r Bakersfield, CA 9 ~C' •• ~ • LOCATION OF PROJECT ? ~~ J/1'~r ~ -1~ ) PROPERTY OWNER ~• ;1~ ~ '~ !t ~ _ PROJECT NAME ' ~ u, ADDRESS . ~ f 1 _ =~:'~° N .~ ~ PROJECT ADDRESS J -~ ~ ^ ~ '-~-`~q i/} q /` ~ Crtt ~ STATE - ! ~.L°J: JOE • •• •' • CONTRACTOR NAM£ 5 ~ ~ CA LICENSE N0. l 1 ~ ~~ cr' ~ ~' v TYPE OF LICENSE. EXPIRATION DATE ~ ~+?ONE NO ~ ~, ~~ COlSrRACTOR COMPANY NAME ~ ~ ~ ~ r, n Y ~ ~'~ y0• ADDRESS ~' ~ ~) I Cn-Y ~ '~~ ~ . OFFICE USE ^ Alarms - t`lew 8 Modifications - (Minimum Charge) • $262 50 ~ ~ ~ , . 98 Over 20 000 Sq Ft FL x 013125 =Permit fee Sq ~ ^ , . . . . 98 ^ Sprinklers -New & Modifications - tMinimum Charge) $210 00 ~ . 98 ^ Ft A Over 5 000 Sq Sq FL x 042 = Permit fee ~ , - . _ . . _ 98 ^ ~ ___ Minor Sprinkler Modifications (< 10 heads) $ 93.00 (inspection Only) ~ 98 ^ _ Commercal Hoods -New & Modifications __ $ 398.26 ~ 98 ^ Additional Noods $ 36.00 ~ ... 98 C1 Spray 8oc~ths -New & Modifications $458 00 ~ . 98 ^ Abovegroumd Storage Tanks {/nstailationllnsp.•1nTime) $165.00 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Ramoval/Inspection} $109.00 82 ^ Underground Storage Tanks (Installation.Jlnspection) $878.00 (per tank) 82 ^ Undergratlnd Storage Tanks (Modification) $878.00 (per site) 82 ^ Underground Storage Tanks (PAinor Modfigtion) $155.00 82 ^ Underground Storage Tanks (Rernovaq $675.00 (per tank) ~ G Oilweli {Installation) $ 72.00 ~ _ Mandated leak Detection (~e~~Fuel Monit. Cert. $ 81.00 (persite) t32 _ ^ Tents ~ ~~ __ _. _... _ _.__.-- $ 93.00 (per tent) ~ ^ ~ Afterhours inspection fee $122.00 ~ ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 nrs. min, stand -by tee /Inspection) =5510,00 84 ^ RE-1NSPI:~CTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane)_ NO. OF CAGES? $66.00 ~ ^ Explosive Storage $249.00 ' _ ~ ^ Copying 8 File Research (Fite Research Fee $33.00 per hr) 25¢ per page ' ~ ^ Miscellaneous ; 84 FD 2021tRev.09lD5) t • QRIGINAt WHITE (to Treasury} !-YELLOW (to FI{e) 1•PINK (to Customer ~~ BILLING & PERMIT STATEMENT ~~ PERMIT NO.: BAKERSFIELD FIRE DEPT. D Prevention Services P/R~ 900 Truxtun Avenue, Suite 210 ~Rrr r Bakersfield, CA 93301 • LOCATION OF PROJECT - - • ROPERTY OWNER STARTING DATE ~l -' _. CO PLETION DATE!-'~ NAME - PROJECT NAME ~ ADDRESS ) P ON N PROJECT ADDRESS ~-r` I CnY STATE ZIP CODE CONTRACTOR NAME CA LICENSE NO. i TYPE OF LICENSE. EXPIRATION DATE PHONE N0. _~~ CONTRACTOR COMPANY NAME ~~~t v V ~ ~ `n ~ FAX NO. -~ ADDRESS ~ CnY I ~ ll ZIP C J • • ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 • ~ • . 98 Over 20 000 Sq Ft 013125 =Permit fee Sq FL x ~ ^ , . . . . 98 ^ Sprinklers -New & Modifications - (Minimum Change) $210 00 ~ . 98 ^ Over 5 000 Sq. Ft Sq FL x 042 =Permit fee ~ , . . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only] ~ 98 ^ Commercial Hoods -New & Modifications $ 398 26 8'4 . 98 ^ Additional Hoods $ 36 00 ~ . 98 ^ Spray Booths -New & Mod cations $458 00 ~ . 98 ^ Aboveground Storage Tanks (Installation/lnsp.-1~Time) $165.00 82 ^ Additional Tanks ~ $ 26:00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 ^ Underground Storage Tanks (Installation./Inspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modfication) $878.00 (persife) 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (Removap $675.00 (pertank) 84 ^ Oilwell (Installation) $ 72.00 ~ ~ Mandated Leak Detection (Tes ' / Fuel 11Aonit. Cert. ~ $ 81.00 (per site) 82 ^ Tents $ 93.00 (per tent) 84 ^ After hours inspection fee $122.00 84 ^ Pyrotechnic - (Per event, Plus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand --by fee Anspedion) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) &1 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 ~ ^ F~cplosive Storage $249.00 ~ ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ; 84 ^ Miscellaneous ; 84 FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer) _ _ -ew''~ot ec~ i~)1S . I~~gS MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of Cali ornia Authority Cite& Chapter 6 7, Health and Safety Code; Chapter 16, Division 3, Tit e 23, California Code ofRegulations This form must be used to docwnent testing and servicing of monitoring equipment. A separate certification or report must be prepare for each monitoriLtg_~stem control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ~}PO./d.IL,Q~S ~"'1 t2~/ r'y.4Ai Bldg. No.: Site Address: ~/db/ B~c..L-.F '1~`ll~-d~-~E Ciry: (~Rt!_~'.~ il,i~~.-tQ ZiP~ _s~~ Facility Contact Person: Contact Phone No.: (~~ Make/Model of Monitoring System: I ~-. ~~'~ _ Date of Testing/Servicing: mil) t I l~ 13. Iuventory of Equipment Tcsted/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced• Tank IU: l~ u 1 ~7 Tank IDt ~'/1 °/ / ~ .,t ~ In-Tank Gauging Probe. Model: j~~b~ 1 ~ In-Tank Gauging Probe. Model: y/l.~-(..a 1 _ Fvrnular Space or Vault Sensor. Model: ~~, ~ Annular Space or Vault Sensor. Model: ~ Piping Sump /Trench Sensor(s): Model ~~ ®Piping Sump /Trench Sertsor(S). Model: ~••~ fy-] Fill Sump Sensor(s). Model: ~~ ~ Fill Sump Scnsor(s). Model: ?CJSr ~ Mechanical Line Leak Detector. Model: ~ ~ J ~6[.Ic~ _ ~ Mechanical Line Leak Detector. Model: ~'~3'~G Kul` ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ~ Tartk Overfill / I-ligh-Level Sensor. Model: h~1,4(~ ,® Tank Overf Il /High-Level Sensor, Model: n (_ ^ Other s eci a ui ment a and model in Section E on Pa e 2 . ^ Other (s eci ui ment and model in Section E on Pa a 2). Tank 1D: 10 1 ES~~ Tank [D; In-Tank Gauging Probe. Model: ~,(b i ^ In-Tank Gauging Probe. Modcl: rLutular Space or Vault Sensor. Model: ^ Annular Space or Vault Sensor, Model: ~ Piping Sump / Trerich Sensor{s). Model: ?U i< ^Piping Sump /Trench Sensor{s). Model: ~I Fill Sump Setuor(s). Model: ^ Fill Sump Sensor(s). Model: ~~ 1~SI Mechanical Linc Lcak Detoctor. Model: ~- ^ Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ~ Ttutk Overfill /High-Level Sensor. Model: V" }~~ i ^ Tank Ctverfill /High-Level Sensor. Model: O Other (specify equipment type and model in Section E on Page Z). ^ Other (specify equipment pe and model in Section E on Pa a 2). Dispenser LU: l ' Dispenser ID: .3- `~ Dispenser Containnent Sensor(s). Model: ) '~ Dispenser Containment Sensor(s). Model: / ~ Shear Valve(s), Shear Valve(s). ^ Dis enscr Containment Floats and Chains . Dis enser Containment Floats and Chains . Uispenser ID: ,S" (Q Dispenser ID: ~-~ Dispenser Containment Sensor(s). Model: ~s~-r Dispenser Containment Sensors}. Model: ~'J ~ Shear Valve(s). _ _ Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . Uispenser IU: Dispenser IU: ^ Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model; ^ Sltear Valves}. ^ Shear Valve(s). C1Dispcnscr Containment FEoat(s and Chain s}. ^Dis enser Containment Floats and Chains . • If Use facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. CwCertlfiCatiOn - I certify that the equipment identified in this document was inspected/serviced in accordance wlth the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is . correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of ttte report; (check alt that apply): ~I'p~f System set-up ~ .history re ort "1'eciuucian Name (print): ~ ~.¢-tJ `--~}{o~ Signature: CertificationNo.:~~.~~g~ 1((~~~/.,~~- (~I~ License.No.: ~/ ~'C~g~S Testing Company Name: RICH ENVIRONMENTAL Phone No.: ~ 661 ~ 3Q2-8687 Site Address: y~_ LL-F %~2~F 5~.:/~~ (7 pate of Testing/Servicing; / l / 1 /~ ~~~~ Page I of 3 03101 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: .3~4!'a1 ~., k6.. G.11., .,.:,, .. n6n..41ict• 1~~~5 ~-- .viii .cw ~..~ wu~.., u Yes ^ o Is the audible alarm o erational? ® Yes ^ ° Is the visual alarm o erational? ~ Yes ^ ' o Were all sensors visual) ins ected, functional) tested, and confin-ned o erational? Yes ^ o Were ail sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro er o eration? ^ Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) NIA operational? ~. Yes ^ o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~ Sump/Trench Sensors; ^ Dispenser Containment Sensors. Did you confirm ositive shut-down due to leaks and sensor failure/disconnection? $1 Yes; ^ No. Yes ^ o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no CJ NJA mechanical overfill prevention valve is installed), is the ove~ll warning alarm visible and audible at the tank fill out(s) and o crating ro rly? If so, at what rcent of tank capacity does the alarm tri er? ^ es ~ N o Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. ^ es ,® No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ^ Product; ^ Water. If es, describe causes in Section E below. Yes O o Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u re orts, if a licable ® Yes ^ o Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comrrrents: Page 2 of 3 03101 1 ~(.QgS F. In-Tank Gauging /SIR Equipment 1~ Check this box if tank gauging is used only for inventory control. f~ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. ['mm~letc the foliowine checklist: ^ Yes ^ ° Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ ° Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes ^ ° Was accuracy of system product level readings tested? ^ Yes ^ ° Was accuracy of system water level readings tested? ^ Yes O ° Were all probes reinstalled properly? ^ Yes ^ ° Were all items on the equipment manufacturer's maintenance checklist completed? * T.. N.,. C.... ~.,... LT Mol..... .l..o o..a.n {....ter nn.1 mtiun It. non /t Pt•n:nn o:PC vIPrP AM u/1It t1P P(1PI'PPtPfI G. Line Leak Detectors (LLD): ^ Check this box if LLDs are not installed. r...,. .,teto rt.o rr,n„~,:.,~ ,.I.n~Ul:o*. ~. Yes ^ NO' For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? ^ N/A (Check all that apply) Simulated leak rate: ~ 3 g.p.h., ^ o. I g.p.h , O 0.2 g.p.h. Yes ^ ° Were all LLDs confirmed operational and accurate within regulatory requirements? ~ Ycs ^ ° Was the testing apparatus properly calibrated? Yes ^ ° For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A ^ Yes ^ ° For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A ^ Yes ^ ° For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~ N/A or disconnected? ^ Yes O o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfimctions fi~ N/A or fails a test? ^ Ycs ^ ° For electronic LLDs, have all accessible wiring connections been visually inspected? $1 N/A '~ Yes D ° Were all items on the equipment manufacturer's maintenance checklist completed? - to me aecaon ri, netow, aesenae now ants when these detteienctes were or will be corrected, H. Comments: Page 3 of 3 03101 L ~~ Monitoring System Certification Site Address: y }O f UST Monitoring Site Plan -- -------------------------------------------------- _:_~ ~::==~ = r==:=:~ ::::.:.::::::::::::::::~::_ -- - --- o- -- ------=-------------------------- Date map was drawn: ~/___i_/Q(~j Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page ~ of~ osioo f ~ b~sS 5643 B~i.pQRS O~ R~ERBF~FI,D,O.A.933D$ OF'L'TC,1~ (&61) 392-8687 & F.PX (661,) 392-0621 Y~~S'~tf,TS'8'i~ ti~~ ~.`mscmpR mEs4,Tr W/Q#: Fac:i.l i t.y Name ; I~Cj~~fl S `''~/'~/ l~-1.42% ~'ac:l.lit.y Address; N,~°JIj~-t-Y-'~ ~~~~t.C~+~~!~t~, ~!~- 9~~j Proc:(ue~. Tai..tze ~`~s {Pr®saure, 6uat~,azx, Cdrav~,ty} f ~-,~.S~~CJ~.~ P~(:sDUCT I,E.A.K DETECTOY2 TStPE TEST TRTQ PA.19S' s>~.ax.a.L zacTxaaa~l~ BELOW P;S I OR Sk;k2ZAx, # (~ ~ J-EFG4L~ >tA. L~7 ~v L/A TXPP~( -4~tJ/ .4C S A.S ~(L~~ 9/ __.. _ + _ T./D `]'Y'PE,_C'~~ ~-~.~.~- ~ E PASS n Sl~F2T.R.L #. 111 T~G~~ t~TO ~~ F L /~~ z./a Tx~~ ~s pASs s~~zA~, #~.___. nso ~AZ~; I c;ert:ify t.h.e above tests wexe cdnduct:ed on this dace according to Red ~_faclcat Pumps f.ie1~9 test apparatus test:i.z~g procedure an limit:at~.ons. TYv_~ Mechani.c~al. ~,ea)c Detector. Test. pass / fai]. is det:ertnined by using a .lc:~~~ £1ow th..resholri tzip rate a~ 3 ga.lZoxx pex k~.aur or lea9 at 10 PSI. T .:~ckb.owledge tk~ac a].1 data r_oJ..lected is txue 9xxd aorxect~ t:o the best of r~•y knowledge . Sigz~.e~tuxe : Date ; } ~" ~ ~ ~~ D G'• SOFTWARE REVISION LEVEL IN-TANK SETUP - - VERSION 324.01 - - - ~ T 2:DIESEL SOFTWAREp 3463'?4-100-8 T 1:REGULAR PRODUCT CODE 2 CREATED - 0.3,i1.1U,17.15 PRODUCT CODE 1 THERMAL COEFF :.000450 NO. SOFTWARE 1°1i)DOLE THERMAL COEFF :.000700 TANK DIAMETER : 113.75 TANK PR E SYSTEI~1 FEATURES: TANK DIAMETER 113.75 ~ TANK PROF'I;LE P~ VOL : 5037 FULL PERIOD 1 C 1 I'J-TAPJK TESTS ..., "'wr'~- ~ ~. ~ ~23 ~' FUL'I: Vc7I` ANIVUAL I N-TANK TESTS . FLOAT S12E: 4.0 iN. FLOAT SIZE: 4.0 IN. WATER WAR N I IVc:, 2.0 WATER WARNING 0.0 HIGH WATER LIMIT: 2.5 HIGH WATER LIMIT: 2.5 MAX OR LABEL VOL: 5037 MAX OR LABEL VOL: 15023 OVERFILL LIMIT 90i OVERFILL LIMIT 90y 13520 4533 HIGH PRODUCT 99% S`fSTErvI SETUP HIGH PRODUCT 99% 14872 4986 DELIVERY LIrI1T 1o°r. _ - - - - - PJUV 1. 2006 -3 30 Pl•1 DiLIVERY LIMIT 10'0 503 1502 LOW PRODUCT 500 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 S`fSTEIh UN[TS LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 OG TANK TILT O U S SUDDEN LOSS LIMIT: 50 00 TANK TILT 0 . PROBE OFFSET 0.00 SYSTEI°t LHNGUAGE EIVGLISH . PROBE OFFSET 0.00 SYSTEt°1 DATE%TIME FORMAT SIPHON MANIFOLDED THINKS MON DD YY`fY HH:N1r1:SS xM SIPHON MANIFOLDED TANKS TFI: NONE HOWARDS I.1IN1 !°IART N LI L1NE MANIFOLDED TANKS Tt3: NOiVE 4201 BELLE TERRACE MANIFOLDED TANKS NE HAKERSFIELD.GA 93309 TR: NONE 661-397-?600 LEAK MIN PERIODIC: 10: SHIFT 'TIME i DISABLED LEAK MIIV PERIODIC: l0% 50: SHIFT 't1hIE 2 DESHBLED 1502 LEAK MIN ANNUAL 10% SHIFT TIrv1E 3 DISABLED SH [ FI' T l l°lE 4 G 1 SABI.ED LEAK MIN ANNUAL : l03~ 50: 1502 TANK PER TST IVEEUED WRN DISABLED P)RIODIC TEST TYPE TANK ANN TST NEEDED WRN PERIODIC TEST TYPE STANDHR! DISABLED STANDARD ANNUAL TEST FAIL LINE RE-ENABLE METHOD ANNUAL TEST FAIL ALARhI DISABLE PASS LINE TEST ALARM DISABLED PERIODIC TEST FHIL LINE PER TST NEEDED WRN PERIODIC: TEST FAIL ALARM UISAHLE DISABLED ALARhI DISABLED LiIVE ANN TST NEEDED WRN DISABLED GROSS TEST FAIL GROSS TEST FAIL ALARM DISABLE ALARM DISABLED PR I IVT TC VOLUI°1E8 ANN TEST AVERAG 1 NG : OF ENABLED ANN TEST AVERAGING: OFF _ P_ER TI":ST.,AV'.LrRr~l;~lyG:__._~F PER TEST AV;RAGING: OFF TEhIP COMPENSNTIOfJ TANK TEST NOTIFY: OF VALUE (PEG F >: 60 0 TANK TEST NOTIFY: OFF . STICK HEIGHT OFFSET TNK TST SIPHON BREAK :OF DISAHI.ED TNK TST SIPHON BREAK :OFF DAYLIGHT SHVIM; TIME DELIVERY DELAY 15 M: DISABLED DELIVERY DELAY 15 MIN PUMP THRESHOLD 10.01 PUMP THRESHOLD 10.00% SYSTEhI SECURITY CODE : 000000 CUSTOM ALAR1~1 LABELS DISABLED I~ (~~~-- ___--- T '3:PRF.MIUNI LEAK TEST METHOD PRODUCT CODP 3 - - - - - - - - THERMAL GOEFF ;.000700 TEST MONTHLY ALL TANK TAfVK DIAMETER 113.75 WEEK 1 SUN TANk; PROFILE 1 PT START TIME 2:00 AM FULL VGL 10074 TEST RATE :0.20 GHLiHR DURATION 2 HOURS FLOAT S]ZE: 4.0 IN, TST EARLY STOP:DISABLED WATER WARNING 2.0 LEAK TEST REPORT FORMAT HIGH 6JATER LIMIT: 2.5 ENHANCED I°1AX OR LABEL VUL : 10074 OUERFlLL LIMIT 90 9066 H 1 GH PRODU~.T 99 9973 DELIVERY LIMIT 10% 1007 LOW FkODUCT 500 LEAK ALARf1 L I I°1I T : 99 SUDDEN LOSS LIN11T: 50 LIQUID SENSOR SETUP TANK T I LT 0.00 - - - - - - - - - - - PROBE OFFSET 0.00 L 1:8? STP TRI-STATE (SINGLE FLOAT) SIPHON h1AN I FOLDED TAN};S CATEGORY STP SUh1P Ttt : NONE LINE MAIViFULDED TANKS Ttt : NGPIE L 2:87 ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY ANNULAR SPACE LEAK hl I IV PERIODIC : l Oi . 1007 LEAK t°i1N ANNUAL IOi L 3:87 FILL 1QQ7 TRI-STATE (SINGLE FLOAT) CATEGORY OTHEk SENSORS PERIODIC TEST TYPE STAIVDARU L 4:DSL STP ANNUAL TEST FHIL TRI-STATE (SINGLE FLOAT? ALARM DISABLED CATEGORY STP SUMP P!RIODIC TEST FAIL ALARI°I DISABLED L 5:DSL ANNULAR TRI-STATE (SINGLE FLOAT) GROSS TEST PAIL CATEGORY : ANNULAR SPACE ALARI°1 D I BAWLED AVIV TEST.AVERAGING: OFF PER TEST AVERH~,ING: OFF L 6:DSL FILL TRI-STATE (SINGLE FLOAT) TAIVY, TEST NOTIFY: UFF CATEGORY OTHER SENSORS TNK TST SIPHOPJ BREAK:OFF DELIVERY UELA'Y 15 MIi'J L 7:91 STP PUI~1P THRESHOLD 10.00% TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMP OUTPUT RELAY SETUP - - - R 1:97 TYPE: STANDARD NORMALLY CLOSED L161U1D SENSUk ALMS L l :FUEL ALARM L 3:FUEL ALARM R 2:91 TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALN18 L S:FUEL ALARM L ?:FUEL ALARM L B:FUEL ALARM R 3:DSL TYPE: STANDARD NORMAL-I-Y CLOSED LIQUID SENSOR ALMS L 4:FUEL ALARM L 5:FUEL ALARM L 6:FUEL ALARM R q;OV£RFiLL TYPE: STANDARD NORMALLY OPEN, 1N-TANK ALARMS ALL:OUERFILL ALARM ALI.:MAXHPkODDUCTTALARRN L 8:91 FILL TRI-STATE {SINGLE FLOAT> CATEGORY OTHER SENSORS ~ u ~-~~ ALARM HISTORY P.EPORT ----- S'YSTEI°I ALARM ----- PAPER OUT NOV 1. 2006 12:36 PI°I PRINTER ERROk NOV 1. 2006 12:36 PM BA'P"PERM I S OFF NOV 10. 2003 8:00 AM x END HLARM H I STOR`,' REPORT ---° !N-TANK ALARI°I ----- T S:REGULAR OVERFILL ALARrt SEP 21 . 006 3:56 PM JAN 17. 2006 3:47 Prl JAIV B. 2006 12:x1 P1~1 LOW PRODUCT HLARM AUG 16. '2005 8:02 Ahl AUG 10. 2005 2:58 PNI MAY 9. 2005 10:'22 AM INVALID FUEL LEVEL AUG lti. '005 7:43 AM AUG !0. 2005 2:47 PM I°lAY 9. 2005 10:17 AP9 PRONE OUT OC;T 28. 2004 12:58 Phl DELIVERY NEEDED t°lAR 18. 2006 I l :12 AM MAR 7. 2006 5:2y PIh OCT !3. 2005 5:19 PM LOW TEI°IP WARNING OCT 26. 2004 12.:59 Ph1 ALARM HISTORY REPORT ----• IN-TANK ALARM - T 2:DIESEL OVERFILL ALARM JUL 10. 2006 8:36 PM LOW PRODUCT ALARr1 OCT 7. 2005 2:55 FM JUN 3. 2005 6:11 PM MAR 29. 2005 2:41 PM INVALID FUEL LEVEL OCT 12. 2005 6:29 AM MAR 12. 2005 3:20 PM PROBE OUT OCT 27. 2004 1:08 PM DELIVERY NEEDED OCT 7. 2005 12:35 Pr1 JUN 3. 2005 12:55 PM MAR 29. 2005 11:09 AM ~ * * * ~ END ~ x ~ ~ ~ ALARM HISTORI' REPORT ---- IN-TANK ALARM - T 3:PREMIUM OVERFILL ALARM OCT 1. 2005 7:55 AM SEP 3. 2005 9:06 Arl AUG 26. 2005 5:49 PM LOW PRODUCT ALARM FEH 4. 2006 6:40 PM NOV 28. 2005 5:49 PIH NOV 5. 2005 10:58 AM INVALID FUEL LEVEL NOV 5, 2005 12:44 PM• JUN 20. 2005 12:48 PM APR 13. 2005 5:24 PM DELIVERY NEEbEA SEP 25, 2006 4:40 PM AUG 29.' 2006 8:07 PM AUG 8. 2006 6:57 PM ALARM HISTORY REPORT ----- SENSOR ALARM ----- L t:87 STP STP SUMP FUEL ALARM NOV 1. 2006 2:22 PM FUEL ALARM oCT 27. 2004 1:57 Prl FUEL ALARM OCT 27. 2004 1:1'7 PM x * * ~ * END * ~ * ~ ALARM HiSTURY REPORT ----- SENSOR ALARM ----- L 2:87 ANNULAR ANNULAR SPACE FUEL HLARM NOV 1. 2006 2:2a Prl FUEL ALARM OCT 27. 2004 2:08 PM FUEL ALARM OCT 27. 2004 1:20 PPI ~ ~ ~ ~ ~ END :t ~ x * x lu(~~S_ ____-- ALARI°1 H [STORY REPORT ----- SEIdaOk ALARM ----- L ;3:87 FILL i7THER SENSOkti FUEL ALAR.fh fVOV I . 2006 ~ :'~4 Pf°1 FUEL ALARM OCT 27. 2004 1:58 PN1 FUEL ALARM OCT 27. 2004 1:17 PM x ~ ~ n EIVD ~ ~ ~ x ALARf°1 H 1 S"tOR`I REPORT ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 5:DSL ANIVULAR ANNULAR SPACE FUEL ALARM NOV 1. 2006 2:30 PM FUEL ALARM NOV 1. 2006 2:28 PM FUEL ALARM OCT 27, 2004 2:07 PM * * * * * END * * x * ~ ALARM HISTORY REPORT ALARM HISTORY REPURT ----° SEiVSOR ALARM ----- L 7:91 STP STP SUMP FUEL ALARM NOV 1 . 2006 2:22 Pf l FUEL ALARM OCT 27. 2004 2:01 Pr- FUEL ALARM OCT 27. 2004 1:59 PM ~ x ~ * ~ END x * ~ ~ x ----- SEfVSOR ALARf°1 ----- L 4:DSL STP STP SUI°1P FUEL ALARM NOV 1. 2006 2:27 PM FUEL HLARM OCT 27, 2004 2:01 PM FUEL ALARM OCT 27. 2004 1 :19 Pf°1 ~ * ~ ~ * END ~ x ~ ~ ~ ----- SENSOR ALARM ----- L 6:DSL FILL OTHER SENSORS FUEL ALARM oCT 27, 2004 2:02 Pr°I FUEL ALARIN OCT 27. 2004 1:i9 PM ~ * ~ x ;~ END x ~ ~ ~ ~ ALARM HISTORY REPURT -- SENSOR ALARM ----- L 8:91 FILL OTHER SENSORS FUEL ALARM NOU 1. 2006 2:23 Ph1 FUEL ALARM OCT 27. 2004 l :59 Pi°I FUEL ALARM OCT 27. 2004 1:18 PM ~ x ~ ~ x END x * ~ x i~~ ~- SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and. printouts from .tests (if applicable), should be provided to the facility.awner/operator for submittal to the local regulatory agency. F e r1R .T'TV 11VFnRMATinN Facility Name: .v - -- - - - - - Daie of Testing: ~(~ Facility Address: y},p/ ,~'L (,,. L C g3 Facility Contact: Phone: Date Local Agency Was Notified of Testing : • Name of Local Rgency Inspector (ijpresent during testtn~: 2. TESTING CONTRACTOR INFORMATION Company Name: ) )fi ~'C/ V ~ ~1~--~Z/ ~ • Technician Conducting Test: ,~~ GZJ Credentials: CSLB Contractor CC Service T SWRCB Tank Taster Other (Sped) License Number(s): ! ~ t _ v j 3. SPILL BUCKET TESTING INFORMATION Test Method Used: H drostatic Vacuum Othei Test Equipment Used: Equipment Resolution: Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 i(„ ] ~ 2 ~ t"j `l l 3 d / ~' ,~ 4 Bucket Installation Type; Direct Bury Direct Bury Direct Bury Direct $ury ntained ui ntained in S ontained in um Contained in Sum Bucket Diameter: ~ ~ / •' Bucket Depth: ~ " ~ ++ ~ '~ Wait time between applying vacuum/water and start of test: 3a w1, tiJ jp//~~ JV wt ~ -L1 ,~-)) 3C~.--, l ~,,! Test Start Time (T~: I a %,~U ,..., la ~,~ / :~Q Initial Reading {R~: ~ ~ " ~' Test End Time (TF): ; j(1 I ~;lO .~ ..-, Final Reading (RF); ~ ~~ ~ •~ Test Duration (TF - T~: ~ ~ (~ ~ ,~ Change in Reading (RF - Rt): Q ti ~ a ~ ~ Pass/Fail Threshold or „ .. ,. Criteria: Comments - (include in ormation on its made riot to tesh' nd recommended o ow-u or ailed tests' CERTIFICATION OR TECHNICL~IN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that aU the information contained in this report is true, accurate; and in fir11 compliance with legal requirements. Technician's Sigastwe: Date: _! 1--1- ~J(~_ ' State laws and regulations do n~currenfly mire testing to be performed by a qualified contractor. However, local requirements may be more stringent. v> . i r r i~ c~ rl ,~ ~Q ,~ Postage ~ s . 34 ' Q., CertHled Fee ~ Retum Receipt Fee (Endorsement Required) ~ 4 Restricted Delivery Fee Q (Endorsement Required) • ~ 7btal Postage & Fees F trt Recipient s Name EPtease P. ;o. John Kerley O Street,' A L No.; or PO Box No. ~ 82 o P Box 515_ ~ ~~ty~a~ers~ield Ca :~~ ... 2.10 1.50 3.94 93380 Posfinerk~ Here CG July 20, 2006 Mr. Steve Underwood City of Bakersfield Prevention Services (Fire 900 Truxtun Avenue Suite 210 Bakersfield, CA 93301 Subject: ELD Test Results Howard's Mini Mart #6 4201 Belle Terrace Bakersfield CA Dear: Mr. Underworld ENVIRONMENTAL • CONSTRUCTION • COMPLIANCE Enclosed are the final ELD test results performed on the above mentioned Fueling System. If you have any questions or need additional information please don't hesitate to contact me at 916-991-1100. Sincerely, CGRS, Inc. ~__-'~~- Brian Green West Coast Manager FMP/CGRS 3.0/Cwrespondence/ 31568 ~~ ~~~~ x ~ 5444 DRY CREEK ROAD ^ SACRAMENTO, CALIFORNIA 95838 PHONE: 916-991-1100 FAX: 916-991-1177 . State of Calif'omia For State Use Only State of Water Resources Control Board Division of Financial Assistance P.O. Bo!c 944212 Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. [ am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter { 8, Div. 3, Title 23, CCR: ^ 500,000 dollars per occurrence ^ t million dollars annual aggregate or AND or ~1 million dollars per occurrence ^ 2 million dollars annual aggregate B. hereby certifies that it is in compliance with the requirements of Section 2807, (Name or Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party T e Name and Address of Issuer Number Amount Period Action Com ~ct~ ~ Ihov~~® 3u~~ fly. `~' ~°~ ~ 3 33 ~- ~~r f au~11~~~ ~ FtZ~no, ~dt g37oS ~ 0~ 06 Note: !f you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance with all conditions for participation in the Fund. D. Faality Name Facility Address Facility Name Facility Address Facility Name Facility Address E. Signa of Tank Ow or Operator Date Name and Title of Tank Owner or O perator ?? ~~ C Signature of Witness or Notary Date Name of Witness or Notary CFR (Revised 04!95) FILE: Orlglna! -Local Agency Copkd- FacllltylSite(s) __ _ --- r C1T~' OF BAKERSFIELD ~r : ~ ~ OFFICE OF EiYViROIYMEIYTAL SERVICES 1715 Chester Ave., Bakersfleid, CA 93301 (661) 326-3979 • UNDERGROUND STORAGE TANKS -TANK PAGE 1 ,.,.. ~ P'y' d F AC710N ^ t. NEW lITE P>•RAaT l~Y~. AA~NDED PERMIT ^ !. CMANGE OF INfOR1NATION) ^ e,. 1'EbWORAAY SITE CLOSURE Cnacr urra ~AM+ oM'! ^ 7. PERMANENTLY CLOSED ON SITE ^ 7. RENEWAL PFRMfT (~A, ~rfon • A>, bcN uta 0 / (.SOat/y cnanga • fii bcN wa aM'1 ^~Y ^ 3, TANK AEMOvED N FAGUTY NAME a OBA • Ognq OWYfaN At) I. TANK OESdtiPTlaN TANK IU • ~ .di I ~/wn M/17NPA '~UKC~i VJ --~ /f . r COMPARTXIENTAL12E0 TANK rsa ^ No 111 ~ ~ Pi f ~~/' ~ rt n'Yee : oomaet~ ons vwe ror eaa, oompartn,alu- 4 11. TANK t~NTEIAi TANK tA1E uY MOTOR VENICLL FI.IEL PETROtFUAA TYPE ^ to REGULAR UNIFJiDED ^ L UEADEO ,~: ^ !. JET FUEL ~ (drttaAaW, oORplalr PaoeMlan T)pa) ^ 10. PREAiUU1 UNIIF.ADED ~OfESEI. 0 0. AV1ATXk/ FUEL ^ 2. IJONFUEL PETI>:OtJcVM ^ to MiDO1L1DE UNI.F.ADED ^ ~. C3ASOWOL ^ ~. OTHER ^ ~. CHEMICJtL PRODUCT ^ ,. HAzARDOUS WASTE (Inewo.. COAwgn NAME (from Heranieus 4/aANlN,t rnranfWypaya) 44t CAS d (nom rtan~ wawa 'Pa9a) ••: uaw o0 i O ss. uNKNOwN Ip. TANK CXINBTRUCTION ~ ~ ~ ~ i TYPE oP TANK ,^,, 1, vMAll ^ !. SsJOIH WALL WrTH ^ S. SfNGI.E WALL vvrrff INTERNAL BLADDER SYSTEM 443 ~ (Cnaex ona .lam oNy) l3Vf DOIJILE VYALL EXTERIOR AEII~RMIE LINER ^ AS. UMWOWN ~ ^ 4. BINDLE WALL W A VAULT ^ yy. OTHER TANK AMTERLLL. • vmwy brit t. BARD STEEL ^ ~. p~~qg r PLASTIC ^ s. CONC',RETE ^ es. UNKNOWN 44t (C+~ ona >ram onM ^ t STAddIFSS STEEL ^ 4, sTEE1 CLAD vwFiBEROLA33 ^ 0. f7iP COMPATIBLE vwi oo% MET}uwOl ^ 9si. OTHER REUrFORCEO PLASTIC 1FRP) •••••• ~••• ~ "••••• - •••",• "'°' •-,• U 1. BARE STEEL U ] F18ERCil/t33 / PU13TIC U !<. F'RP 001~PAT181.E W!t OQ% IyETHANOI ^ 9S. UNIQiONM s~.5 (G>rck ona Aam aNy) ^ 2 STANiF33 STEEL ,. , / L~4. STEEL CLAD W/FIBERGL/L4S ^ 9. f7tA NOOIBLE JACKET ^ 4O. OTHER REdrFOacED PtASTiC (~ ^ to COATED srEEl ^ !. oowf~ETe TANK INTERIOR LOrMKi ^ 1. Rl1BBER UNEO ^ !. EPOXY IYrIN10 UNgO~fOWN 4y DATE W$TALS.ED 447 ^ S. OLA88 LINING ^ 96 OR COATING ^ Z. ALKYD LE1NKt ^ 4. P,HErfol~c L1NNd3 . ,,,. / lY~ UNLINED ^ flo. OTHER cn.ur an. bm Fa bal ut~ OTHER CORROSION ^ t. MAIIUFACTURED GTMOOIC F1BERpLA 43 REWFORCED PLA DATE INSTALLED 449 STIC ^ 96 IINKf1OWN 44B PROTECTION IF APPI.IC/1BLE PROTECTgN , ^ 4, ir~RESSEO CURREM . ^ S>o. OTHER rc>..ur ~. RMn oNTJ ^ i SACR~ICIAL ANIOOE (FWbear ~. avVy) SPILL ANO OVERFILL YEAR dr9TALLEO 430 TYPE (FwbcN uaa oNy) vE 431 o RFtLL PROTECTION EQUIPMENT: YEAR INSTALLED ~z , ~t U . 9P41 CONTA7NMENf (cn.cx ,r m.r.PWyl ~ , ~ ~ C~ Y i. AURM ~,~,_ ^ ]. FILL TUBE SHUT OFF VALVE ~-- ~ ,, J L W2 DROP TUBE ~•' ~ ' ~ 1 _, , ~ / LJ 2. BALL FLOAT c~~ ^ 4. EX EMRT , ~, / 4~1. STRO~ER PLAT! q A q r ` ~ t j ~~~'~ ~'o L 'rJ (''-1 ` L ~~~' .;,I•i -:~'ii~` max. + iA:k:: 'A. ~:!.. :,lNt••TNIKLQAK . ... ,.. 4": ;. r<.v,. ; ..AI'~,.>c::>•'S:.: ~:~:r' .:••.~.~',;:. IP lINOL> WALL TANK (CAack w drat 4ppfyX 4W M OOUBLII WALL TANK OR TANK WITH BLADDlR (Cnaut ona Ran a+IYx ~ ^ t, VISUAL (L+XPOSEO PORTION ONLY) ^ S. MANUAL TANK GAUGING (MTO) ^ 1. VISUAL (SWOLE WALL tN VAULT ONLY) ^ 2. AUTOMATK; TAN( Qr1UQUJ0 (ATO) ^ d. VA009E ZANE ^ Z C~fTINUOUS INTERSTITUL MONITORING ^ 3. COKTINUOUl1 ATQ ^ 7. GROUNDWATER MANUAL MONRORINO ^ ~. lTAT19TICAL INVENTORY RECONCIL-A710N (SIR) • ^ E TANK TE9TIN0 t ~ `~ ~p r1 ~ l~1 J O ~ S S CC tl n a.p r' ~ i y !~ O t+ ; (4 G ft elENN1AL TANK TEBTINO ^ ~ GTNFR V. TANK CL0>;UIlQ INfORAAATK)N / PORMANlN1' C L03URQ iN PLAC! STIMATEO OAT! IJ1ST Utl.D (YR/6g10AY) 48A BlTIMATQO QUAKTfTY OF SUBSTAfICR REAIAINNNO 46A TAN( FIU.EO WITH INERT MATERIALS 44S °N0I~ ^ YM ^ No CF (T/99) 3:1CUPAFORMSISWRC~'~0 ~_ CITY OF 9AKER3FIEL0 OffK:E Of ENVIRONMENTAL SERVICES 171 CMst~~ Aw., 8ak~nANd, CA 9J30t (dd1) J20-J979 WT .TANK -AO! Ptt~ VL'IfINO CONSTRUCTION (CAaar r olar apply) . UNDERGROUND PIp1N0 ~ ABpyEGROUNO PIPING SYSTEM rvPE PRESSURE ^ 2. SUCTION ^ ~, GRAVITY IS6 I ^ I. PRESSURE ^ 2. SUCTION ^ ~, GRAVITY y~ I~~ E WALL ^ CONSTRUCTIOW' ^ J. LINED TRENCH ^ 98. OTHER 160 ^ I. SINGLE WALL ^ 93. UNKNOWN y6 ., ~ MANUFACTURERI LItiI. 000BLE WALL ^ 9S. UNKNOWN ^ 2. DOUBLE WALL ^'99. 07HER ' MANUFACTURER a8t MANUFACTURER yg_ ^ t. BARE STEEL ^ 6. FRP COMPATIBL! W/ tOpX I1~THANOL ^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ 100% MET}1ANpL MATERULS ANO ~ ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL ^ 2. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION PROTECTION ~ ^ 7• ELASTIC COMPATIBLE WITH CONTENTS ^ 96. UNIUIONM ^ 7. PLASTIC COMPATIBLE WITH CONTENTS ^ 8. FIEJ(IBIE (HOPE) ^ 9ti. OTHER ! 1/. FIBERGLASS ^ 8. FLEXIBLE (HOPE) ^ 99. OTHER ^ 1. FIBERGLASS ^ 9. GTHOOK; PROTECTION ~ I ^ S. STEEL wl COATING ^ 9. GTHOOK; PROTECTION 184 ^ S. STEEL wf COATING ^ 93. UNKNOWN ~~; VN. P~M~IG ItAK DETECTION (CAark r that applh ~. UNDERGROUND PIPING I ABOVEGROUND PIPING - PRESSURIZED PIPING (CMat r tltat apply): ^ t. ELECTRONIC LINE LEN( DETECTOR J.0 GPH TEST }~ AUTO PUMP 31NIT OFF FOR LEAK SYSTEM FAILURE, ANp SYSTEM CNSCOt'fIr?ECT10N • AUO~LE AND VISUAL ALARMS ^ 2. MONTHLY 02 GPN TEST ^ 7. ANNUAL 01TEGRTf TEST (0.1 GPH) I I CONVENTIONAL SUCTION SYSTEMS: ^ S. DAILY VISUAL MONROR1NCi OF PUMPING SYSTEM + TRlENiAL PIPR4G INTEGRITY TEST (O.t GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INTEGRITY TEST (0.1 GPH). SECONDARILY GOtRNNED PIPING PRESSURIZED PIPtNCi (CAaat a/ tYtaf Apply): 10. CONTINUOUS TURBINE SUMP SENSOR ~ AUDIBLE AND VISWL ALARMS ANO (~+qA ~) ~/ AUTO PUMP SHUT OFF WHEN A LEJ1K OCCURS L`J p. AUTO PV MP SHUT OFF FOR LEAK4, SYSTEM FAILURE MA SYSTEM ~~ DISCONNECTION L9 a NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR (J.0 GPH TEST) ~ FLOW SHUT OFF OR RESTRICTION 12. ANNUAL OfTEGRrtY TEST (0.1 GPH) SUCTIONlGRAVITY SYSTEM: ^ t J. CONTINUOUS SUMP SENSOR + AUOfBIE ANO VISUAL ALARMS EMERGENCY GENERATORS ONLY (CIISeR M fllp AppM EMERGENCY GENERATORS ONLY (CAscit r fast apply ^ 74. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF +ALIDIBLE AND ^ 14. C.ONTIN0003 SUMP SENSOR AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS A1.AftM3 ^ t 5. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) y~g,(~j FLOW SHUT OFF OR ^ t3. AUTOMATIC LINE LEAK DETECTOR (S.0 GPH TEST) RESTRICTION CIOt11'~t1~oJ~~e( 41\q4~e 6r• ^ t 8. ANNUAL INTEGRITY TEST (0.1 GPH) ^ 18. ANNUAL INTEGRITY TEST (0.1 GPFI) ^ 17. GAILY VISUAL CHECK ^ 17. GAILY VISUAL CHECK >.~ ~,::" .:i DISPENSER CONTAINMENT ^ 1. FLOAT MECHANISM THAT SHUTS 0FP St•IFJ1It VALVE OAT ~ fO ALLEp 468 ,^, Z,~NfIN0009 OISPENSEA PAN SEN80R +A(JD18LE ANp yISUAL ALARMS LJ~a' CONTINUOUS 019PENSER PAN SEN3pR ~ A11T0 SHUT OFF FOR DISPENSER • AUDIBLE ANO V13UA1 ALARMS ^ /, GAILY VISUAL CHECK 489 DL OYVNER/OPERATOR 910NATURE PRESSURIZED PIPING (CftacAr r Nat appy~ ~~ ••~_ • .• .•~ ^ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST III AUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ^ Z MONTHLY 02 GPH TEST ^ ~. ANNUAL IMEGRITY TEST (0.1 QPH) ^ 4. OA6_Y VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (CAsek aI that apply): ^ S. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM ^ 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPINGx ^ 7. SELF MONITORING GRAVIIY FLOW (Cfteck r fAat Apply): ^ 8. GAILY VISUAL MONRORJNG ^ 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECOf!'DARILY CONTNNED PIPING PRESSURIZED PIPING (Clleelc a! Mat apply): t 0. CONTINUOUS TURBINE SUMP SENSOR y1T iT1 AUDIBLE AND VISUAL ALARMS ANO (ctleUc ane) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ ~. AUTO PUMP SHUT OFF FOR LEAI(S, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ rw NO AUTO PUMP SHUT OFF ^ 1 t. AUTOMATK; LEAK DETECTOR ^ 12 ANNUAL INTEGRITY TEST (0.1 GPH) SUCTIONIGRAVTTY SYSTEAk ^ t~. CONTINUOUS SUMP SENSOR + AUOIBLP ANO VISUAL ALARMS 1 tartiry real IM mfortnaaon prov16W narahl 4 trw uta atxwale to tM DMt W my wWlMadps. 91GNATU F O WO _ OR GATE ~~. 471 Y ua1 JPCF (7/99) S:ICUPAFORMSI3WRC8'B.VVP~ CITE' OF B.-~KERSFIELD OFFICE OF EYVIRO~Y~tEIYTAL SERVICES . ,~..~ . ~ 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS -TANK PAGE t Psge or ~~ R ACTION ^ ~. NEw SITE PE)tlNT O +. AAIENOEO PEAMIT [] !. ClwrC.E OF iNFORAMnON1 ^ 6, tEMPORARV SITE CLOSURE '~ ^ 7. RENEWAL P1:AAaR ^ 7. PERMANENTtr CLOSED ON SITE (Boat/)' ~aaon • •b~ btal uta Jury) (BOata'y uwga • A!/ btN wa oNy) , ^ 6, TANK REMOVED 9USINES3 VAME (Serhe M FAClUTY NAMg a t]aA • Oonq 6USklass As) ] FACA)TY IO of , i I t -~~'- 'tt S~ II ^- 1. TANK 08SCRIPTiCJN ~` TANK t a A ~~ n !( COMPARTMENTAL12ED TANK ^ Yes r~ F . 1 ' ~ M ~1'a'. comdeta one psQe for ead~ camparpmerq, OA i tN ALL ( ) IN WN IVU ~. L TANK CdAEliTs /r, / - TANK USE qti ... / PETROIELJM TYPe 4_ yr ~. nwi. v...vw..c r.+c+~ ~.wa ~¢waM tma.crucu U Z LeADED ! (n "'nae, oarlo+.la PeroN~an T)ye) ^ Ib. P (gyp ^ a. DIESEL U S. JET FUEL Av1ATION FU0. ^ e . O z. NoN.a:uEL PETRa.EUM ^ to ~~ ~~ ^ .. ~~ ^ ~ oTI,EA ^ ~. cHEMI~u. Paooucr . co+~.worr wine piwn wrawoau, wawr,a )nrenk>7'oaDN ^ a. HAZaR00u9 wASTe (4i~a+ 4+t CAS r «Nasan*wt wr.~eerln+'ar+d+YPa9+1 a.. Uaoo C~ ^ ss. uNwIDwN pl. TANK CON9TRUC' T10Pt rY>~ of TANK D ~. y~e wALL O >. siNC~ wALL wRH ^ s. strxx>: wALL wml urrERNAL f3LADOER sYSiFJ~I as (c~.tr ona Arn girl ~oot]eLa wAU E)RERiOR AEMBRANE LtNt7t D >as. UNKiIOwN ^ 4. s wAU w A vALxT ^ ~ OTH~ TANK MATERIAL • pMwy tank ~.y/t. DARE STEEL ^ $. FiBEROLA93 / PLASTIC ^ S. CONCRETE ^ 43. UN)QJOWN 44+ (CAecx oM ~tavn on1yJ ^ 2. STAtNt.E3$ STEEL ^ 4. STEEL CIAO V117FtBERGYAS9 ^ 8. FRP COMPAT181E W/100% MET}iANOI ^ 4D. OT?tER REINFORCED PLASTIC (FRP) ~ TANX MATERNL - saoorWary tank ^ I. BAite 9'TE~ ^ $. FIBFROLASS /PLASTIC ^ e. FRP COAPATt81E w1100% METHANOL ^ 93. UFiQ•gWN tas (CAadI oM AMt ayY1 ^ t 9TAXi.ESE STEEL STEEL CLAD W/FIBERGLJLS3 ^ 0. FRP hqN-CpRRO0I8lE JACKET ^ 4D. OTHER REINFORCED PLASTIC (FRS ^ 1Q. COATED STEEL ^ 3. coNt~E TANK g1TER10R LN)ir(i ^ I, RLJBeER l.If+RC ^ >. EPOXY L]NIiVi) OR COATWO OATS INSTALLED 417 ^ S. OLA88 LIMNO ^ 96. UP60rIONM 416 ^ 2 ALKYD lJ>!M~KI ^ ~. P-IFJrDLJC LJP6lJO L I~0./INIIY~ED ^ pD. OTHER CtteGt one [aen For bell vsa OTHER CORROSION ^ !. T<IANUPACTi)RED GITHODIC Frer~Aee Rep~oRCr=D PW PROTECTION IF APPLJCAdIE GATE INSTAI I fn a49 TIC ^ tie. UNKNOWN 416 PROTECTION ^ ~. IMPRESSED Ci1RRENT ^ 90. OTHER cl~.t>< oM .fan «rrs D t sACR1FICtAI. ANOOe . ~r-o. aw ~, w+rr~ PILL ANO OVERFILL .YEAR INSTALLED 430 TYPE (ioibta! wa aVy) O a31 VE RFIU. PROTECTION EOUIPMEN7: YF~1ft INSTALLED a32 ,.., / Cn«k aM mat apptyl L ll/1 . SPILL CONTAWI.~NT ~ , ~ / L`7 t. A1ARM ,~,Q~_ ^ ]. FILL TUBE SHUT OFF VALVE , ~ / L~Y2. DROP TUEE ~~oo y ^ 2. BALL FLOAT ^ 4. EXEMPT ~, ~ L7'3. STRf>(LRPLATE ~~~ -'~'- ~~'V ~•:. ~n~ (L~('w 1~ 1(1;:~ .... ,•~ if SINOI./ WALT. TANK (CAeeAI aI eAaf MNY1: 18$ IR DOUOLB WALL TAHK OR TANK WRH BLADOlR (Crack ona wt~ uyYX 434 t, VISUAL (EXf''OSEO POR'T10N ONLY) ^ i MANUAI. TANK OAUli1N0 (MTO) ^ t~ VI9VAL (SWOLE WALL IN VAULT OM.Y) Z. AUTOMATIC TANK OAUOWO (ATO) ^ 6. VAD09E IANe , .,, Ly' 2. CONTINUOUS INTER9TRIA1 MONRORINO ]. CONTINUOUS ATO ^ 7. OAOUNOWATER ^ J. MANUAL MONRORINO a. STATISTICAL IM/ENTORY )tECONCIIJATgN (SIR) • ^ 6. TAM( TESTING t~`1 Co~~~In.Io~S Sccoh~u~~(y dot,, Gtr eleNNw,rAM(reaTlNO _ ^ ~. oTHeA V. TANK CLOSIIRII IN!'ORW1TKk1 / PeRMANdNT C LO»(UR>a IN PLACl~ rIMA Teo OAT! LAST USED (YR/ItA0/0AY) ~ RSTIANTIIO OUANTTTI' OR SUdeTANCQ R6AdA)NINO 466 TANK FIL.LIIO WITH INERT MATERIAL'/ ~7 aMolb ^ YM ^ No ~F iT~) S:ICUPAFORMSI3WRC~'~C CfTY OF BAKERSFIELD OfRICQ Of ENVIRONMENTAL 9ERVICE9 ~"° 1715 C1+>hh~ Aw., 8ak~nMld, CA 93J01 (041) J2a-J1179 wT • tANK rAOe ., ~ ~ Vf,'NM10 CONSTRUCTION (CIl.ctt r anet eopgq _ uNoeRGROUno P+Plrlo ~ ABOvecaouNO PIPING SvSrEM rvPE , PRESSUaE ^ 2. SUCTION ^ 7. GRAVITY 4S6 ^ ~ PRESSURE ^ 2. SUCTION ^ 7. GRAVITY a~ ^ ~ 91NG12 WALL ^ 1. LINED TRENCH O 90. OTHER 460 ^ ~. SINGLE'NALL ^ 9s. UNKNOWN CONS7RUCTIOw' +c MANUFAC7URERI~OpUBIE WAIL ^ 96. UNKNOWN ^ 2. OOUBLE'+VALL ^'99. OTHER ' MANUFACTUREA 461 MANUFACTURER ~ • [.] t. BARE STEEL ^ 6. FRP COMPATIBLB W/ 700!1 A~T'HANOI ^ t. BARE STEEL ^ 6. FRP COMPATIBLE W/ 10071 MET11ANpL MATERUIS ANO ^ 2, gTAINlE93 STEEL ^ 7. GALVANIZED STEEL ^ Z. STAINLESS STEEL ^ 7. GALVANIZED STEEL CORROSION ' PROTECTION ,,.^, 7~P1AS71C COMPATIBLE NrtTH CONTEMS ^ 96, UNIO~OWN ^ 1. PLASTIC COMPATIBLE wRH COfYTENTS ^ 8. FLEXIBLE (HOPE) ^ 9g, 07}t~ L1V4. FIBERGLA3.4 ^ 6. FLEXIBLE (HOPE) ^ 9>i. OTHER ^ 4. Fi8ERG1ASS ^ 9. CATHODIC PROTECTION ! ^ S. STEEL W/ COATING ^ 9. GTHOOIC PROTECTION 4tYl ^ S. STEEL W/ COATING ^ 95. UNKNOWN 4ti,: VN. PMIM~lO LlAK DETECTION (CMc7t M anet epW-') _ UNDERGROUND PIPING ~ ABOVEGROUND PIPING PRESSURIZED PIPING (CMek eI Mef appy): ^ t. ELECTRONIC LINE lE1K DETECTOR 7.0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LFiIK SYSTEM FAILURE. A/D SYSTEM OISCOIY~fECT10N • AUOr3LE Af~D VI$(JAL ALARMS ^ 2. MONTHLY 02 GPH TEST ^ 3. ANNUAL INTEGItI1'Y TEST (0.7 GPN) CONVENTIONAL SUCTION SYSTEI,t4: ^ S. DAILY VISUAL MONRORINCi OF PUMPING SYS'TEAA + TRIETl41AL PlP'WG NITEGRITY TEST (0. t GPH) SAFE SUCTION SYSTEMS (NO VALVES UJ BELOW GROUND PIPVXiX j ^ 7. SELF MONITORING GRAVITY FLOW: ^ 9. BIENNIAL INiEGRRY TEST (0.1 GPH) SECOIIDAWLY C0IRAINED P1IMT10 PRESSURIZED PIPING (CAeck e/ dtst 4lpp/yJ: 10. CONTINUOUS TURBINE SUMP 9ENSOR ~ AUDIBLE AAD VISUAL ALARMS AND (~9& ~) ,,~, ~ AUTO PUMP SHUT OFF WHEN A LEAK OCCURS lJ~p. AUTO PUMP SHUT OFF FOR LEAKS. 3YSTEM FAILURE AND SYSTFJ`I ,__, ~~ DISCONNECTION lK ~ NO AUTO PUMP $HU7 OFF 1 t. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ~,~j„}jT FLOW SHUT OFF OR RESTRICTION ^ 72. ANNUAL IHTEGRRY TEST (O.t GPH) SUCTIONK~RAVRY SYSTEM: ^ t J. CONTIMJOUS SUMP 3ENSOIt • ALIOIBLE ANO VIgUAL ALARMS !HERO ENC1f 0 EitlRATOR3 ONLY (CMtk e/ /IM apply) t 4. CONTIMIOUS SUMP SENSOR AUTO PUMP SHUT OFF • AL1018LE APD VISUAL A1ARM3 t 5. AUTOMATIC LINE LEAK DETECTOR (J.0 GPH TEST) ~ FLOW 911U'T OFF OR RESTRICTK)N ~ q!$~~\ t6. ANNUAL INTEGRRY TEST (0.1 GPH) u+~ Cob1~ l•.~ ot1 D(~( l`igt\t Ge PRESSURIZED PIPING (CAeck a/ tltet epply): ^ t. ELECTRONIC LINE LEAK DETECTOR ].0 GPH TEST V~,T}~ AUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE AND SYSTEM DISCONNECTION • AUDIBLE ANO VISUAL ALARMS ^ 2 MONTItLY 01 GPH TEST ^ 3. ANNUAL INTEGRITY TEST (Q 1 OPN) ^ s. GAILY VISUAL CHECK CONVEMIONAL SUCTION SYSTEMS (CAeCk of dtet apply): ^ S. DAILY VISUAL MONRORING OF PIPING ANO PUMPING SYSTEM ^ 6. TRIENNUL INTEGRITY TEST (0.1 GPt1) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PtPINGX ~ ^ 7. SELF MONRORING GRAVRY FLOW (CAsch el' at.r eppy): ^ 8. DAILY VISUAL MONROWNG ^ 9. B7EldrtAL OTEGRITY TEST (O.t GPN) SECONDARILY CONTAINED PIPING PRESSLIRQFD PIPING (CAee/c e1 Ohet+PPrY): t 0. CONTINUOUS TURBINE SUMP SENSOR WET}{ AUDIBLE AND VISUAL ALARMS ANO (dtetk one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ D. AUTO PVMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION ^ c NO AUTO PUMP SHUT OFF ^ t t. AUTOA41T1C LEAK DETECTOR ^ 12. ANNUAL INTEGRRY TEST (0.1 GFN) St1C'TION/GRAVRY SYSTEM: ^ 11. CONTUAJOU9 SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EML'ROENCY GENERATORS ONLY (CAeck d Ntet ePP~') 14. COIYTINUOU3 SUMP SENSOR AUTO PUMP SHUT OFF + AUDIBLE ANO VISUAL ALARMS 1S. AUTOMATIC LINE LEAK DETECTOR (3.0 GF7~ TEST) 16. ANNUAL INTEGRITY TEST (0.1 GPH) LJ t 7. DAILY VISUAL CHECK ^ 17. GAILY VISUAL CHECK ISPEN3ER CONTAINMENT ^ t. FLOAT MECHANISM THAT SHUTS OFF SttEAR VALVE ' ' ^ t. GAILY VISUAL CHECK GATE I 97ALLE0 t68 ,^,, 2/CON'TINVOUS 019PENSER PMI $ENBpR • AUp18l,g ANp VISUAL ALARMS ^ S. ` ~.(.r_,'. ~r~~: i ;/,i f~ I ~ it 1 ~,. UV]. CANTIrK)OU9 D19PFNSER PAN SENSOR m~(AUTO SHUT OFF fOR DISPENSER • AUOIBL.E AND VISUAL ALARAAS '~9 DL OMYlIER10PERATOR 91GNATURE I certty the! tM ~nMrtt~e6on proNded herein le fete end eotwro7e to tM Out of my IuWN{eGpe, iRLE OF WI ~CF (7/99) 4ti~ V S:ICUPAFORMSI3WRCB-B.~C ~~- _, .. ,~~ F AC710N C1T~' OF BAKERSFiELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Baker9fleld, CA 93301 (66l) 316-3979 UNDERGROUND STORAGE TANKS -TANK PAGE t O I. NEW SITE PlRA11T ~. AMENOEO PERMIT O I. AENEwAL PEAAMT (~n„~~ • ,~ axw uaa avy! 9USINESS NAAE (9anl~ w P ~nlb )kLf,~lS wmtlN a 06A • Oanq aulnaas Aa) Page d ^ I. CNAtK7! OF INFORMA i1pN) ^ 4, fEMPORAAY 91TE CLO$URg ^ t. PERMANENTLr CLOSED ON $TTE (Spec/y ~Alnpe • >a 17ta1 uae aM'1 5 ^ 4, TANK REMOV EO 1 I FAClLfTY IO ~I 1. TANK OESC:RIPTKk! - I tali ICI f SP~I . • 1 1 ~/~' /~ w I COAtPARTME 'Ya~'~oomdeu ane D~~Yead~ ccxnP+rtrnaM. I AOpITIONAL Iqa M. TANK CCKT'ENT'f TANK I1SE 434 OTOR VEHKX lE FUE PETROLPUM TYPE R ^ - _ - 4 M . L itl. EOLAAR UNLFa0E0 ^ 2 lBA0E0 ^ 3. JET FUEL (~ `~~• °~~~ ~ ~) , 13YT0. ~IJM U~'><EADEO ^ 7. OIESEI. AVIATION FUEL ^ 0 ^ 2. NON•F11EL PETROLEUM ^ la bbOitAOE LptLFADED ^ 4. QASOFIOt . ^ 99 OTHER ^ 7. CNElraf.N. PRODUCT . ~; ^ s. HAZARDOUS WASTE (4xlydar COMMOt~I NAME (Rom h4asnlbrq 4y(r•rlara lmenauvy p~1 44I CAS I (hvm xwrotxrs Atrbritr /^+*nb7 Pa9'N ~` uaa ~ ^ vs. uNlaov»t - Ip. TANK COM9'TRtJCT10N m "~ ~"''" ^ ~ . swoL$ wALL ^ s. sIN~L,E wAU wrT14 ^ s. swcL.E wAU wrn+ urTERNAt BLJIDDER sY3TEM - - - ,.~ (cn.ut one 4»m aryl , ,,,, / lRl/~ DOIIBL.E LNAL1 EXtERJOR -~aBRw~ t.S&R ^ 96. UMwOwN ^ 4. St~K)LE WALL PI A VAULT ^ ~ OTHER TANK MATERIAL • primary tsNt .BARE 9TEL~ ^ 3. FIBERGLA39! PLI3TIC O S. CONCRETE ^ 4S. UfIIUIOWN µa rclfwr eno qN,I ayg ^ Z. STAR~lE9$ STEEL O 4. Sl'EEL CLAD VWFIBERL~.A33 ^ e. FRP COMPATIBLE wnoou IeErruNOt D ~. oTHER REWFDRCED PLASTIC (FRP) ~ 7ANK MATERIAL • rrecaWary IaNt ^ L. BARE $TEEi ^ 3~IBEROLA39 / PLJ~9TiC ^ E. FRP C.OAPATIBLE YY1100% A~E"T)iANOt ^ 95. UtiOdOWN ia5 (c,»Gr ono 4tim cM', ^ t sTAwLesa STEEL , , LW4. STEEL CLAD 1N/FIBERGlAS3 ^ 0. FRP NON~RROOtBLE JACKE7 ^ 9D. DTHER REINFORCED PLASTIC (FRP) ^ 10. COATED STEEL ^ S. CONCRETE TANK INTERIOR La+rr+0 ^ T. RUBBER LR~O ^ 3. EPOXY LYiNK3 ^ s. GLJ-SB LatlHCt ^ 96. uNlv+DVtN 446 oAT>r NISTAI.LED 44T OR COATING ^ t ALJLYO Lf~6NKJ ^ 4. P11F1tpUC LR~EN() QN UMJNFA ^ »D. OTHER (CAaek aie Hwn aiA3 rr.~.-,.•.r,......u..I v r nrn wwcu~n ^ I. ~~ CAT}I00~ DATE INSTALLED 449 PROTECTION IF APPL)CAeI$ F>BfROlI449 RJ:Y~ORCED PLASTIC ^ t?6. UNKNOWN 44d PROTECTK)It ^ 4, iMPRE9SE0 CURRENT ^ 9D. OTHER Check ona .tam orry) ^ ~, SACRIFICIAL ANODE _ _ (FOrbcal usa orry) ANO OVERFILL aM rA~f aPWY) :: ~., / YEAR IN9TAt1.E0 .so TYPE (Far Beal use oNy) GJ' 1. 9i'll1 CONTAINI~Nf e/~b~ N ~,~. DROP TUBE `~~ tJ~3. STRpCLR PIATEr _ y ~~,.~y '~~.,;i:: :,k,' '"'~Y4'T ~ A~:' ~~~~ LMi•'YANK ~A1~fIQLR4 ... ... ... .~i::n: ~: ~ s ... ,O.,.VER/Fill PROTECTION EQUIPMENT: YEAR INSTALLED ~2 LW ALARM ~Ob~ii ^ 3. FILL TUBE SHUT OFF VALVE ~~- ^/~ BALL FLOAT OBI ^ ~. EXEMPT ..~.:• .. ~' r• .:A':I. IF SINOL! WALL TANK (CMck a/ tlwt apply): 463 IF OOUELQ WALL TANK OA TANK WITH BLJLDDlA (CAaek ala Rom a+rYX ~' t, VISUAL (2XP'OrlfO PORTION DW.Y) ^ S. MANUAL TANK GAUGING (MTO) ^ 1. N9UAL (S1J•KILE WALL IN VAULT ONLY) 2. AUTOMATIC TANK OAU01N0 (ATG) ^ 6. VAWSE ZONE ^ 2. NiiNU0U91NTER9TRW. MONTfORINO ~~ I. CONTINUOUS ATO ^ 1. GROUNDWATER MANUAL MONITORING i] •. 9TAT19TICAL 6fY8NTORY RECONCILIATION jSIR) ~ ^ 6. TANK TESTING ' r (.-], `~ ~011'~ In ~ 0 J S 5 CC d n ~t«.r ~.( ~ 4 tt s 4 G (r __ QSTWQ 61ENNtAL TANK T _. ^ ~. OTHER V. TANK CIOOUR!! INI'ORMATKkI / PIlRW-NlNT C LOSURe iN PLACa ~_ ~TIMATlO OAT! IAQT UEQD (YRIFIO/pAY) a66 QSTIMATIIO QUANfTTY Of 9UBETANCE REAAAM6N0 466 YANK FILLED WITH INERT MATERUI.t edT ~~ ^ Yw D NO _~- t51 :F (7/99) 3:1CUPAFORMSI3WRC~'~~ ~~.° ,~ i CTf Of BAKER9FIEL0 OffICQ Olt ENVIRONIMENTAL SERVICES 171! CMttK Aw., 8akatiANd, CA 93J01 (641) 72d-J979 wT • TAAat roe : ~ P+o~ ~ VL /MIIIQ CONST1tUCTION (CMd M tn.r ~oDh7 UNDERGROUND WPINO ABOVEGROUND PIPING SYSTEM TYPE I PRESSURE ^ 2. SUCTION ^~, GRAVITY 436 ^ ~ PRESSURE ^ Z. SUCTION ^ ~, GRAyITY ~: CONS7RUCTIOw' ^ I S LE WALL ^ J. LINED TREAICAt ^ 90. OTHER 460 ^ I. SINCIE'NALL ^ 93. UNtWOVvN ~; .MANUFACTUREAI DOUBLE WALL ^ %. UNKNONM ~ ^ 2. OOUBLE'NALL ^~99. OTHER ' MANUFACTURER 407 I MANUFACTURER ~ ^ t. BARE STEEL ^ 6. FtiP COMPATIBLE Vp 700% AET?tANOI MATERIALS ANO ^ 2. STAINLESS STEEL ^ ). GALVANIZED STEEL CORROSION PROTECTION ^ ~• PLASTIC COMPATIBLE VNTH CONTENTS ^ 96. UNKAfOVJN ' FIBERGLASS ^ 6. FLEXIBLE (MOPE) ^ 9Y. OTHER ^ t. BARE STEEL ^ 2. STAINLESS STEEL ^ J. PLASTIC COMPATIBLE WITH CONTENTS ^ 4. FIBERGLASS ! ^ S. STEEL W/ t:OATING ^ 9. GTHOOIC PROTECTION 464 I ^ S. STEEL W/ COATING ^ 6. fRP COMPATIBLE W/ t Op% METFtANOL ^ 7. GALVANIZED STEEL ^ 8. FLEXIBtP (HOPE) ^ 99. OTHER ^ 9. GTHOOIC PROTECTgN ^ 9S. UNItNOWN VN. P~M10 lEA1C DETECTION (Gnat v Intf lPPI)') UNDERGROUND PIPING I ABOVEGROUhfO PIPING _. PRESSURIZED PIPING (CnerX 4V tMf IpPly): ^ t . ELECTRONIC LJNE LEAK DETECTOR 1.0 GPN TEST ~ AUTO PUMP 3i11)T OFF FOR LEAK SYSTEM FAILURE. AND SYSTEA/ OISCOAOrECTION ~ AUDIBLE ANO VISUAL ALARMS ^ 2. MONTHLY 02 GPN TEST ^ ]. ANNUAL tNTEGRTTY TEST (0.1 OPN) CONVENTIONAL SUCTION SYSTEMS: ^ S. DAILY VISUAL MONRORINO OF PUMPING SYSTEM • TRIENNIAL PLPPJG MITEGRJTY 7EST (0.1 GPH) SAFE SUCTON SYSTEMS (AID VALVES Ur BELOW GFLOl1A~ PIPINGk j ^ 7. SELF MONRORING GRAVRY FLOW: `^ 9. 81ENNU1 INTEGttfTY TEST (0.1 GPFQ SECONDAWLY CONTAINED PIPIAJO PRESSURIZED PIPING (CMut aI IM1ef !Apply): 10. CONTINUOUS TURBINE SUMP SENSOR ~ AU018LE AND VISUAL. ALARMS ARID (Ct+gdC aM) ~/ AUTO PUMP SHUT OFF NMEN A LEAK OCCURS D. AUTO PUMP SHUT OFF TOR LEAKS. SYSTEM FAKURE AA1D SYSTEM DISCONNECTION c NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE lF_AIC DETECTOR (3.0 GPH TEST) ~j FLOW SHUT OFF OR RESTRICTION ^ t 2. ANNUAL INTEGRRY TEST (O.t GPFt) SUCTION/GFtAVTTY SYSTEMt ^ t 3. C.ONTiMV0U3 SUMP SENSOR ~ ALA'.1fBLB RAID VLSUAI. Al/VtMB PRESSURIZED PIPING (CJNCt M t1s~f apply): ^ t. ELECTRONIC LINE LEAK DETECTOR g.0 GPH TEST V~TIiAUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE. AAlD SYSTEM DIS(aOIgJECT10N • AUDIBLE AND YLSUAI ALARMS ^ 2 MONTHLY 02 GPF1 TEST ^ ~. ANNUAL 7lTECoRTTY TEST (Q1 QPH) ^ 4. GAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Cn~ck 41/ tlwt applyJ: ^ S. DAILY VISUAL MONROWMG OF PIPING AND PUMPING SYSTEM ^ 0. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIP1fJGx ^ 7. SELF MONRORING GRAVRY FLOW (Cnsck a/ lhat epply): ^ 8. ONLY VISUAL hgNIRORiAX3 ^ 9. BIENNIAL INTEGRfT'Y TEST (O.t GPH) SECONDARILY CONTAINED PIPItIG PRE$SURI7FD PIPING (Chec/c rt/ fhsl atpp~fj•): t0. CONTINUOUS TURBINE SUMP SENSOR W~TI(AUOtBLE AND VISUAL ALARMS AND (check one) ^ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ^ D. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE ANO SYSTEM DISCONNECTION ^ c td0 AUTO PULP SHUT OFF ^ 71. AUTOMATIC LEAK DETECTOR ^ 12. ANNUAL INREGRITY TEST (0.1 GPH) SUCTIOWGRAVRY SYSTEM: ^ 1S. CONTtAAJOU3 SUMP SEJ430R ~ AUDIBLE AND VISUAL ALARMS EMERO EAICY O ENERATORB ONLY (Gnat ~f MM Kpiy) ^ t 4. CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHAT OFF ~ AUDIBLE AAfD VISUAL ALARMS ^ i5. AUTOMATIC LINE LEAK DETECTOR (J.0 GPH TES'!) ~ FLAW SAIIJT OFF OR RESTRICTION ^ t 9. ANNUAL IMEGRfTY TEST (0. t GPIs) 17. GAILY VISUAL CHECK E1/EROEIVCY 0 ENERATORB ONLY (CMCk a1 fMl apply) 14. CONTINUOUS SUMP SENSOR AU70 PUMP St7llT OFF * AUDIBLE ANO VISUAL ALARMS 1S. AUTOMATIC LINE LEAK DETECTOR (7.0 GPAI TEST 16. ANNUAL INTEGRITY TEST (O.t GPH) 77. DAILY VISUAL CHECK iSPENSER CONTAINMEAR ^ 1. FIAAT MECAtANLSM THAT SHUTS OFP SHEAR VALVE ^ 4. DAILY VISUAL CHECK DATE INST LEQ 460 ^ Z• NTINUOU9 DISPENSER PAN $EN80R ~ A(Jp(BLE ANO VISUAL AlARM3 ^ S. `.` .~.ti:r. ~; •~t,,~ u.~~c ~.l r„f ir' ll t`. /t/~~~ ~NTINUOU9 DISPENSER PAN SENSOR ~! AUTO SHUT OFF FOR 013PENSER • AUDIBLE ANO V13UAl ALARMS ~9 D(. OWNER)OPERATOR SIGNATURE ~ I cenlry Inn me mlpmatlan proNGetl fNtttkt Itl tnle arW soaxNe to tM tt.al d my kttow{edpe. pCF (7/99) S:ICUPAFORMSI3WRC8-B•~ 0 _.__ .. ..•„ ~,..,,,~,-,~,~ercc ra~,l~>: TO: Y.e~in/,klstine Dat- 1 1!'' X005 02: S8 FM Page: 2 01 ^< '~VIL?EIVCE C7F P~~~ERTY iN5~1R1•Of~~E ,PIS D~ DATE(AM1IdlD0,1^fl ~~o~o w 11/1?j05 __._~ THl5 IS E'~.~iDET~CE THAT INSURANCE AS IDENTIFIEC BELOW HAS BEEN ISSUED, IS IN FORCE, ANC CONVEYS ALL 7HE RIGHTSAND PRiViLEGESAFFORDED UNDER THE POLICY. _-_ __-,----`~ ~----- ~- PRODUCER ~MfFAY _559-2_26_-1000'559-226-180 Iw•.,a_c.,, _ ___ __ COMPANY ~- - - ThomCo i surance Assoc. Inc. Lxeense 0791289 One Beacoa Insurance 4333 N West Ave Fresno CA 93705 Jay C Diaz CODE: j SU3 CCCE: = ------- ' cusT~nnER In: HOW.~LR-4 _---- -------- - _ -- - INSURED -~------~--`--~~--.~~--~-i-^-----~---~-__- _ _ LOAN FIUMBER --TPCLIC.Y NUMBER --~----~-----_-- -- - ~_ Howard ~ 5 Mini btart __~~ FFiy16967 _ _ _-_-_.__. I{6VSII Chy Chea EFFECTIVE DATE EXPIRATION DATE 1 ` - Idrr:u~C ~r;?r 4201 Belle Terrace _ 11/01/05 11/01/06 ~'E'.r,''''!<.TE:: ~F._~~:-:;EG Bakersfield C7i 93309 ~ THIS REPLACES PRIOR EJIDENCE DATED: .. . PRL)PERTY ItJFE3~Mp;Tf!JN ,..; . LOCATION/DE S CfiIPTION 001 4201 Belle Terrace Bakersfield CA 93309 _.__ + C!7titER4iE IN FORlyIAT{UN ~ COVERAGEfPER1L5/FORMS j AMDUNTOF INSURANCE DEDUCTIBLE Building/RCjSpecial Form 51,112,100 $1000 Business Personal Property/RC/Special Form 1 $240,000 $1000 Business Income/Special Form/ 12 Months 4 AI,S t3eneral Liability I $1,000,000 Hired and Non owned Auto Liability I $1,000,000 Liquor Liability 1 $1,000,000 f ~ ~ __ _ REMARKS Ifnc'Itiding Specs ~~ ~or~diilons) C,4NC E1.LATfOH 7HE POLICl' 15 SUBJECT TO THE PREP~M1IUMS, FORiriS. APdD RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY 3E TERNiiNATED, THE CO~,SPANZ"vVILL GIVE THE F,DDIT40N?,L IhJTEREST ICENTIE(ED BELOVd _ 30 D<',YS J'JRITTEN NCiTIC:E, ANu VI+ILL 5'ENU tJOTIFIt~ATION OF ANY CHANGES' TC:' THE PULb:;Y 1"HP.1 WOULD AFFE~:T THAT INTEREST :N ACCORUANCr'JVITH THE POD CY PROVISIONS OR AS REQUIRED B'~' LAl'V. T------^^---- ----~- . A'rJGtTIONAL(hTCREST ~ . _ - NAIdE AtJU ADDRESS ~ '>Fl~. uEE ~ I :~GDi-I W. L Ifi;UF,ED . Howards Mini Mart tp;.fax v 4201 illa Terrace I AUTHORIZED REPRESENTATIVE Bakersfield CA 93309 i ACpRu.2, 13131 ~ A~OFtD CORPORHTIUN 199a UST MONITORING PROGRAM WRITTEN MONITORING PROCEDURES Page 1 of 1 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 Otfice of Environmental Services within 30 days o/ any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. ~~~~ ~Rrr ~ Bakersfield Fire Dept. Environmental Services 1? 15 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME 0 ~ ~ ~~~ 5 G~~ k~C. FACILITY ADDRESS ~~.0 t cl~ ~- if~`~C~ DESCRIBE THE FREQUENCY O++F PERFORMING THE MONITORING: TANK ~fv(~I~[f3~~~%~ PIPING ~ Ot~~~l`tL'tA° WHAT METHODDS' ANDIEQUIPMEN~T.~IDENTIFIED 8Y/pNAME AND MODEL, WILL BE USED FOR PERFORMING THE MONITORING: TANK VCC.OL~ ~r~~ T~] ~ ~.~ ~~ tt PIPING DESCRIBE THE LOCATION(S) VvHER THE MONITORING HALL BE PERFORMED (FACILITY PLOT PLAN SHOULD BE ATTACHED): LIST THE NAME(S) AND TITLE(S) OF THE PEOPLE RESPONSIBLE FOR PERFORMING THE MONITORING ANDrOR MAINTAINING THE EQUIPMENT: NA`M~E TITLE ~1 ~2.v`~~ ~ti QOM C~l.1~V~,:Q dC' REPORTING F,O(RMAT/AFOR MONITORING: TANK C•. L {/V~ PIPING _~ f/ V~~~ DESCRIBE THE PREVENTIVE MAINTENANCE SCHEDULE FOR THE MONITORING EQUIPMENT. NOTE: MAINTENANCE MUST BE IN ACCORDANCE WITH THE MANUFACTURER'S MAINTENANCE SCHEDULE 8UT NOT LESS THAN EVERY 12 MONTHS. n~ I r ( / (f Iv`ONt~QC' C`.~CGICCd '~" ~[~~~tV fc:h:~ LIG1NcdG~~~~( ~~ ~ ~'~\~j• ~OtL~C~t~6~„S DESCRIBE THE TRAINING NECESSARY FOR THE OPERATION OF UST SYSTEM, INCLUDING PIPING, AND THE MONITORING EQUIPMENT: l I'u~~[ h f ~~ ii~c~ ~s c~ ~.1 ~ ~~ C-v~~ ~r~ ~ w~cw~[x.. ( UNDERGROUND STORAGE TANK MONITORING PROGRAM EMERGENCY RESPONSE PLAN (FORM) Page 1 of 1 s axaPi n ~~Ra ARTM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 Tel.: (661)326-3979 Fax.: (661) 852-2171 This monitoring program must be kept at the UST location at al times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Prevention 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 Q ~ ~ ~~~~~ ~Kl~ FACILITY ADDRESS {{~~ rr(( ~~ d ~ I.JCII L ~ ~+t~CL IF AN UNAUTHORIZED RELEASE OCCURS, HOW W ILL 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 CONTAINMENTWZTHIN 8 HOURS OR DETE IORATE THE SECONDARY CONTAINMENT, THEN THE OFFICE OF PREVENTION SERVICES MUST BE NOTIFIED WITHIN 24 HOURS. ~' ~ ~,~ ~f`~ ~ ~~~ ~ ~S ~~~ ~,~so~~,,.~ C~~r~ Sp~11ci~ e~tt( Cat( 4't( o~ ~ i3 fi~7 DESCRIBE ~T((HE PROPOSED METHODS AND EQUIPMENT TO BE USED FOR REMOVING AND PROPERLY DISPOSING OF ANY HAZARDOUS SUBSTANC . kc the G~~~-c~. l S S~O~e~ d ~15,~.. ~- a S ~~ t(oK c°e-c~-~ac K~ ~ '~ 5 (~. v ~c~ 1G-~~t ~.~~eu~ u5e~ ~rce~ue~- cN~ Il tae. ~Po~eelY CEtS~oSce~ ~, DESCRIBE THE LOCATION AND AVAILABILITY OF THE REQUIRED CLEANUP EQUIPMENT IN ITEM ABOVE. i<<l~-y ~.~~c~' a ~( S ~'cU ~oi~c C o ~.~a~ k~ ~ ~~ ~'~!~ Q N s c c~~ a -E- U~~ flc{tu1 DESCRIBE THE MAINTENANCE SCHEDULE FOR THE CLEANUP EQUIPMENT: ~ ltckrc~ ~~1y ~. ~~s~,~e~ ~~~' LIST THE NAME(S) AND TITLE(S) OF THE PERSON(S) RESPONSIBLE FOR AUTHORIZING ANY WORK NECESSARY UNDER THE RESPONSE PLAN: NAME TITLE ,;~ .= .~ ~t~~` '~~ ~ CITY OF BAKERSFIELU FIRE DEPARTMENT ,6 ~ ~ ~~ OFFICE OF ENVIRONMENTAL. SERVICES `P .y~~ UNIFIED PROGRAM INSPECTION CHECKLIST A'w ~gti,,!'~~ 1715 Chester Ave., 3r`' Floor, 13akersfield, CA 93301 FACILITY NAME ~4a~Q~dS ~tul ~~-~' INSPECTION DATE-'~~~C~ Section 2: Underground Storage Tanks Program ^ Routine ~ombined ^ Joint Agency ^Mu1ti-Agency ^ Complaint ^ Re-inspection Type of Tank ~tV FC S Number of Tanks 3 Type of Monitoring _ Cf.ly~ Type of Piping ~~ OPERATION C V COMMENTS Proper tank data on the Proper owner/operator data on the Permit tees current Certification ot• Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No ~ 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 the with OES Adequate secondary protection Proper tank placarding/labeling [s tank used to dispense MVF? If yes, Does tank have overtill/overspill protection'? C=Compliance ~ V=Violation Y=Yes N=NO ~ - ` ~' Inspector: Office of Environmental Services (661) 6-3979 N~hitc -Env. Svcs. usiness Site Responsible Party Pink -Business C~~py E R S F I D F/RE A R TM T April 10, 2006 Mr. Jimmy Kaid Howards Mini Market 4201 Belle Terrace Bakersfield, CA 93309 RONALD J. FRAZE REMINDER NOTICE FIRE CHIEF Re: Guidelines for Unsupervised Dispensing Gary Hutton, Senior Deputy Chief Dear Mr. Kaid: Administration 326-3650 It has come to our attention that many convenience stores who sell gasoline, like yourselves, are closing late at night. If you are using card readers and leaving Deputy Chief Dean Clason your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised Operations/Training Dispensing." 326-3652 Unsupervised dispensing is allowed when the owner or operator provides, and is Deputy chief kirk slain accountable for daily site visits, regular equipment inspection and maintenance, Fire Safety/I'revention Services including any unauthorized release or spills, posted instructions for safe operation 326-3653 of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved 2101 "H" Street containers and requiring vehicle engines to be stopped during fueling shall be Bakersfield, CA 93301 conspicuously posted within site of each dispenser. OFFICE: (661) 326-3941 In addition, a sign shall be posted in a conspicuous location reading: FAX: (661) 852-2170 In case of spill or release: RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off PREVENTION SERVICES 2) Report the accident FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 3) Fire Department Telephone Bakersfield, CA 93301 4) Facility address OFFICE: (661) 326-3979 FAX: (661) 852-2171 During the hours of operation, stations having unsupervised dispensing shall be provided with a fire alarm transmitting device. A telephone not requiring a coin to David Weirather operate is acceptable. The fuel leak detection system must have a remote or Fire Plans Examiner phone modem to insure off-site monitoring during hours of unsupervised 326-3706 dispensing. During hours ofi darkness, sufficient lighting must be maintained so Howard H. Wines, 111 that all signs associated with fueling operation are conspicuous and readable. A Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available 326-3649 to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, 26, and 2C rating must be located on dispenser island during hours of unsupervised dispensing: ''- To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing `! April 10, 2006 Page 2 of 72 To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing April 10, 2006 Page 2 If you are currently having hours of unsupervised dispensing, you must comply with the above-mentioned requirements. Starting April 15, 2006, this office will conduct random checks of all fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call me at 661-326-3190. Sincerely, Ralph E. Huey, Director of Prevention Services .~~~ , ~~~~~ By: Steve Underwood, Fire Prevention Officer REH/db ~, r _ i r i~~s, n~. Technical Solutions for the Industrial World. ~./Cr l~~.r ~ a Tr~ac~r Fies®arah Corrocon CERTIFICATION OF ELDSM TRACER TIGHT®TEST RESULTS ELD TEST TYPE: Date: Prepared For: CGRS P.O. Box 1489 Fort Collins, CO 80522 Start Date: Final 09/24/04 . 9/22/2004 End Date: 9/24/2004 ORIGINAL Job # 37519NC Site Info: Howards' Mini Mart #6 4201 Belle Terrace Bakersfield, CA SYSTEM TRACER STATUS 87 Tank /Sumps A PASS 87 Primary Pipe W PASS 91 Tank /Sumps A PASS 91 Primary Pipe W PASS VR /Vent Primary Pipe W PASS Diesel Tank /Sumps A PASS Diesel Primary Pipe W PASS Diesel Vent Primary W PASS Dispenser Sumps # 4 Praxair Services Inc. certifies that the tank and product distribution lines listed in the above table have been tested by means of Enhanced Tracer TightC~. According to EPA standard test procedures for evaluating leak detection methods, the Enhanced Tracer TightC~ method is capable of detecting leaks of >0.005gallons per hour with a Probability of Detection (PD) of 0.95 and Probability of false alarm of <0.05 Tester: Alan Signature: I declare under pens State Lic. # 1619 ~/X-L,.. Date: 9/24/2004 of perjury that the information contained in this report is true and correct to the best of my knowledge. The following criteria are used for the classification of leakage based on the presence or absence of tracer. PASS FAIL Criteria: Criteria: No Tracer Detected Tracer Detected Office use only n Confirmed by: //~~,/~~~ ~~~_ Date: ~~ i~~ ,;. ~, ....f ..~, ,~ _ j~ EGEND 0 Anode ® Automatic Tank Gauge ~ Fill Riser O Sub Pump Q Vapor Return o Vent Riser ~ ~ Monitoring Well MW -w- Water Line -s- Sewer - e - Electrical -r- Telephone 0 f inch = zo ft. /1'l~nii /~'lo-~t 7~~ a~,l~er ~uc~~ Site No. ~ Date: Prepared by: CGRS Prevention Services 900 Truxtun Ave #201 POST CARD AT JOB SITE B~ersfield, CA 93301 Tel: (661)326-3979 FACILI~ NAME = ', OWN ER PHONE No. PERMIT No. INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER ONE DO NOT COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMI~ING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE INSPECTOR TANKS ~D BACKFILL PIPING SYSTEM PRIMARY PI'PING SECONDARY PIPING TYPE OF PIPING ~ FLEX ~ FIBERGLASS CATHODIC PROTECTION SYSTEM-PIPING DISPENSER PAN SECONDARY ~NTAINMENT, OVERFILL PROTECTION, LEAK DETECTI°N CONTINUOUS V~POR MONITORING ENHANCHED LEAK DETECTOR TEST LEVEL GAUGES OR 8EN8ORS, FLOAT VENT VALVES FILL TIGHT FILL BOX(ES) PRODUCT LINE LEAK DETECTOR(S) LEAK DETECTOR(S) FOR ANNUAL SPACE-D.W. TANK(S) MONITORING WELL(8)/SUMP(S) - H20 TEST SPILL PREVENTION BOXES FIlL MbNITORING WELLS, cAPS & Loc'K's ,, , FILL BOX LOCK MONITORING REQUIREMENTS TYPE AUTHORIZATION FOR FUEL DROP f0 ~ 743 PERMIT APPLICATION 'r~ONSTRUCT/MODIFY , ~ Bakersfield Fire Dept. UNDERGROUND STORAGE TANK ~ l~nvironment~ll 715 Chester AveService --,,o. I B ersfield,CA 93301 Tel: (661)326-3979 ~PE OF APPLICATION (CHECK) g NEW FACILI~ ~ MODIFICATION OF FACILI~ ~'NEW TANK INSTAL~TION AT EXISTING FACILITY FA~ ~E / . ~ISTI~ FACILI~ PERMIT ~. FACILI~ A~ESS CI~ ZIP ~DE TYPE DF BUrNErS APN ~ TANK O~ER . P~NE NO I ~E~ ~ ' c~ ~- ~CT~ ~ ~ ~ UCENSE NO. _ . ~ ~ ' ~E~ / c~ J B~IEFLY ~S~RSE THE ~ TO BE ~[ ,~ DEPTH TO ~ t SOIL WP[ EXPECTiED AT SITE ORO~NOW^TER ,-~- J .-,<';~d q NO. OF TANKS I ' ARE THY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE TOBE'NST D I . YES O,O ,ES ONO THIS SECTION IS FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION / TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO (IF KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFICIAL USE ONLY [~TIONr~'tE FACiUTY NO. j NO. OFT~.~S [ FEES$ ! The applicant has received, understands, and will comply with the attached conditions of the permit and any,oT, he state, local and federal regulations. This form has been completed under penalty of per~...~d to tJ~e~of m~_~owledge, is true and correct. - ,~ -/] AP'P~O~/ED lilY: /~PLICANT NAME (PRINT) APPUCANT SICYNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED RAISE MANHOLE--~. ~ ~2" TYP~i F-'--TRUCK VAPOR COV~R~ ~' - TYP~ · 48- OlA wEATHER-TIGHT SINGLE ~O~SERVATION CONC. SL~ ~ ~ 4" FILL R SE~ AD~PTE~ ANO CAP IN SPILL VAPOR RECOVERY BOX - . CONTAINMENT BOX ~ 4" VAPOR RisER. D~YBRE~K. ) AND CAP IN SPILL CONTAINM[NI CONTAiNM[N~ aOX (GASOLINE TANKS ONLY) · 2" DIA. CONTAiN.ENT~ NOT REQUIRED ON DIESEL T~NKS) ~ :, CONtAINMeNT VESSEL FiLL BOX PLAN EXTRACIOR 4"Xl"X4" (SHOWN FOR GASOLINE TANKS ONLY) FOR VENT. STAGE I & STAGE Il VAPOR RECOVERy FOR GASOLINE EXTRACTOR 4"XS~X4" W/PLUG REO'D FOR VENT IN D)ESEL TANKS 1/4" ~L[ED HOLE ~ ~ FLOAT ~ALL CHECK DROP TUB[ 1~,~ 42"e F,O. CONTAINMENT vESSEL 45 DEG. CUT-OFF I ;', ~ CAP FOR ANNULUS PROBE TANK GTE[L P~T[ ~ CONTAINMENT VESSEL & C~N ION ~6". FOR CONTAINED FILE BOX - ELEVATION~ HOuE RUN CONout/~ TANK '~ee~~eee~ ~ ELECTRONIC TANK LEVEL PROBE ~EL EC. J-BOX FOR INTRtNS)C WIRINO AND PROBE CORD TANK ANNULUS PLAN s,.,.,. POMECO/OPW Multi-Port Spill Containment Manholes provide spill containment for underground storage tank (us'r) fill pipes and vapo recovery risers in a completely integrated single m~nhole package. Multiports are installed over the top of tank sumps to preserve future access to the tank top and to facilitate containment of tank bung fittings. Model Descriptions POMECO/OPW offers a vast array of standard multiport configurations and options, in addition to an almost unlimited ability to provide custom solutions for virtually any spill containment application. e POMECO/OPW 311 Series - Features a flush-mounted manhole lid and raised dual dam and groove spill container ring, with P311 Buckets using POMECO 111 Style steel, slip-on 5, 10 or 15-gallon containers with external drains (piped to the fill riser) or optional hand pump (hand pump is standard with 12" riser spacing). e, POMECO/OPW 411 Series - Features a flush-mounted manhole lid and raised dual dam and groove spill container ring, with P2105 Buckets using OPW 1-2105 Style slip-on 5-gallon (standard) or 7.5-gallon containers. Base is standard 1" offset from center and can be used for 12", 14", 16" or wider riser spacing. Optional 1P-2105 Hand Pump available. ~ POMECO/OPW 500 Series ($11 1 521) EVR Multi-Port - Features a flush-mounted manhole lid and raised dual dam and groove spill container ring, with P511-EVR Buckets using OPW 1-2100 Style thread-on Spill Containers. All Fill Pods in these spill containers feature a enhanced 1DK-2100-EVR vapor tight drain valve. The Vapor return Spill Container features a permanent plug in the drain pod as per EVR requirements. EVR Multi-Port Thread -On Spill containers are available in Composite or Cast Iron bases with either 5 or 7.5 gallon buckets. Drain Valve Spill Bucket & Plug Spill bucket standard on Dual Ports, Drain Valve Spill Bucket standard on Single Pod e, Required for EVR APPLICATIONS - The FSA-400 Threaded Riser Face Seal Adaptor is installed on the fill pipe below the spill container to provide a true sealing for the drop tube flange on the 61SO-EVR overfill prevention valve. The 61SO-EVR series valve is installed in the base of the OPW EVR spill container with the patent pending 61JSK jack screw device. This configuration allows liquid in the spill container to be draine( directly into the drop tube thereby isolating the drain valve from the tank ullage, eliminating a notorious leak point in previous systems. See page 14 for ordering specifications on the FSA.400 & 61JSK 500-EVR SERIES MULTI-PORT APPLICATION Fill ,~' '~ · Spill Container OPW 6500-EVR Series Multi-Port OPW 634TT-EVR · OPW 1711T-EVR Dust Cap OPW 61SA-EVR Scries Swivcl Fill Adaptor OPW IDK-2100 OPW Drain Valve Drain Plug OPW 61VSA-EVR Series Swivel Vapor Adaptor Jack Screw Drop Tube 61SO-EVR Lock Down Device Series Overfill Prevention Valve or OPW 6IT Series- OPW FSA-400 Drop Tube ma ~,a~ ma~,~a~,~ Face Seal Adapter o~a,n ~m DPW 101BG-2100 SERIES BELOW-GRADE SPILL CONTAINERS I in. . cm. in. cm. A 209/16" 52 209.~6" 52 C* 231A6" 59 272%2" 71 * Subtract 2" from "C" dimension for Cast Iron Base Mode~s. C * I ~ CARB Certifications and Listings 101BG(S)-2100 Approval Letter 101BG(S)-2115 ~3.26 OPW 101BG-2i00, 5-Gallon OPW 1018G-2115, 15-Gallon ' Irdering Specifications Duratu~ II Base Models - Cast Iron Base Models Materials: Drain ~ Drain ~ Grade cover: fiberglass del Gal. Liter Valve lbs. kg. Model Gal. Liter Valve lbs. kg. reinforced BG.2100 5 19 Pull 60 27 101BG-2100C 5 19 Pull 72 33 composite BG-2115 15 57 Pull 65 29 101BG.2115C 15 57 Pull 77 35 (steel optional) BG.205S* 5 19 Pull 80 36 t01BG-2058C* 5 19 Pull 92 42 Lid: glass reinforced composite BG.215S* 15 57 Pull 85 38 101BG-2158C* 15 57 Pu~ 97 44 Lever, top case: polyethylene Outer shell: polyethylene, :eel grade level cover. * Steel grade level cover, powder-coated steel Containment cell: polyethylene Base: Duratuff® II or cast iron ;placement Parts/Accessories 'art No. DescdptJon Part No. Descd~on Part No. Description Price -I DK.2100 Pull Drain Valve t01BG-BUCKET 5 Gallon Replacement H11671M Steel Manhole Cover 01BG*21AR Inside Hatch He{gM Ex~ Spill Container 101GSP-0090 Gasoline-Absorbent Sock H12280M Ringseal $17.50 .I 01BC--21LA Red Lever and Crossarm Assembly D01747M Composite Manhole Cover H12620 Inside Hatch .__$32.60 J E00491 Complete Replacement Top P;I10-20UD Steel Manhole Cover w~lO '~1'~--,~I ! Assembly Tag System North America Toll Free - TELEPHONE: (800) 422-2525 + Fax: (800) 421-3297 * Email: domesticsales~opw-fc.com International- TELEPHONE: (513)870-3315 or (5t3)870-3261' Fax: (513)870-3157 ' Emai,: intlsales@opw-fc.com www. opw-fc.com © Copyright 2003, OPW Fueling Components * P.O. Box 405003 * Cincinnati, OH 45240-5003 * Pdnted in USA * 3103 PANEL "A' TYPE NEMA [ U S E L~ T,~ ~"*~ ~Y~ U S E DISPENSER -J#l CANFIPY LI~ttTIN6 DISPENSER ~2 IRBIN #3 ESD V[ILTS leo/84o vAc ! PHASE LIGHTING 9aoo FEEDER 3- 3/0 THHN COPPER/ ~' EMT RECEPT, a400 }~USS 800 AMP MOTOR A,I.C. lo.aaa AMPS HEATING TOTAL 26oo0 WATTS TOTAL 118,J8 AMPS Greg ~reen ~: o~/os/o4 Howard's Min~ Mo~ C G Electric 60364~ ~C-lO Howard's BakersfiMd. Colifornio Charl;e ~q~ ~49q]) ~LAk~ TYP, ° llq°ID B~U~L[ ~UTT LDNGI TU~INAL 48' .... ~ ..... l , ~ C~LA~ ,~ GLA~TEEL I ~D ~ II CONSTRUCTION DETAIL~ " ~ a n "T~N ~LL HAVE 30 YEAR L~/~D ~Y. : '~ 4'IFN'PTI I I 4' IFNPTI I -E J ~ j 4'IFNPTI I MODERNWELDINfi {1[CALIFORNIA,INC, ,UI 1 I 4'IFNPT{ "' I TM,S ,~ A..,v[s Ar ~ ~HE ~. v~cu~ 'Cl 11 4'IFNPTI i NORTHWEST PUMP & EQUIPMENT AN~ D~S NOT ~IR[ F~ [~E~ITY ~ST~ ~I II 4:IFNpT] I 15,0ffi GN.~N E~ D ~CKE~ ~BERGRD~ TANK IF J~II[ AIR P~ES~ TEST RE~IRED, T~ A [ i la IFNPTI ~MDNITDR PEltRY, (IN~ lANK ~Y ~E PRE'RinD ~ . A 35,~ VOL]~ ~L[,AY ~f AT T~ FAC~RY.. 115.000]01115115'188'--5'115.100" ...... SCHEDULE DF DPEN'ING~ ~_~' m ~£P~RATI ON 10,000 GALLONS 5,000 GALLONS CONSTRUCTION DETAILS ~~~ ........................ ~=~--~ .... , ............ ~]ARY ~TAI~T ~lE~ T~ ~L~ ~ ~TO~GE. ~ ONE (1) ] ~m.: ~13-115-15000 G I 2 I 4' IFNPTI ~ I el ~ I~"*l ~ MDDERN VELDING DF CAL[FB~IA, INC, ..,~ ~ ..,~ ~, ~,~ ~.,= ~.~ -~ ~L~~ : NORTHWEST PUMP & EOUIPMENT AN~ ~ NOT ~IRE FU~ ~EmI~ T~ ..... 1~8 6~.GLAST~ II ~EB U~N~ T~ PRI~, ( INN~ T~K ~Y 8[ P~SS~IZ[~ ~ %CHEDULE OF UPENINGS ~.ml I"~ ~ ~- ~ ~ ~ ~ San Joaqu n Valley Ail' Pollution Control District www.vailcyair.org Permit Application For: ~ Al ITl I{)RITY T() CONSTRUCT (ATC) - New Emission llniL [ ] At rl'l IORITY '1'~ ) (;ONS'I'RU(YI' (ATC) - Modificamm Of Emission Unii With Valid I'/'O/Valid ATC. [ ] AIITi I()RITY TO CONSTRUCT (ATC) - Renewal of Valid Amhorily lo Consnuct. ] ] PI!RMIT T() (')PI~RATI~ (PTO) - Exisling Emission Unit Now Requiring a Pcrmit m Operalc. I PI!RMFI'T(~ BI~ ISStlI!D TO: 2. MAll.lNG ADllRFiSS: ,;~ . CI'IY: ................... SrA'I'I~: ~ . ZIPCODE: 5 I.OCATION WIIERE TIII~t~QUIPMENI' WII.I. BE OPI'~RA'I'ED: Wl'l'lll~ 1,000 FTOF A 5CIK)OI.? SI.C. CODI{(~) OF I:ACII_ITY ............... /.I NI.u I ION ............I'OWNSIIII' _ ................. RANGI~ (If 4. GENERAl. NA'I'I!RI~ OF BltSlNESS: INSTAI.I. I)A'IE~ 5. TITI.E V I'EI~MIT II()I.DI'~RS ONI.Y: I)o you reques~ a COC (.EPA Review) imor lo r~ceiving your ATC? [ ] YES ~O 6. DESCRIPTION OF EQUIPMENF OR MODIFICATION FOR WtlICIt APPLICATION IS MADE (include Pcnni~ ~"s if known, and use 7. IIAVE Y()IJ liVl~l( API'I.II~D FOR AN ATC OR J,~F~YES [ ] NO Optional Section PTO IN TI I1~ I'AST? If yes, A'FC/PTO ti: ~o CltI{CK Wlllfl'llt~ll YOU AI/E A ~SPA~ PARTICIPANT IN EI'rltER OF ~,~ I'IIESE VOIAJ~'ARY PR(NiRAMS: 8. IS TIllS PROPI~RTY ZONISD PI~OPERI.Y FOR ~YES [ ] NO 9 ISTIIIS AI'PLICATI(}N SUIIMITI'ED ASTHE [ ] YES ~O [ ]Yes [ ]No [ ]Send RESUI.T OF I~II'IIER A NOTICI~ OF VIOI.ATION If yes, NOV~'I'C ~: OR A NOTICE TOCOMI'I.Y? [ ]Ycs I ]No [ ]Send int~ I I. TYPE OR PRINT NAME OF APPI.ICANT: TITI.E OF APPI.ICANT: FOR AI'CI) USE ()NI.Y: I)ATE STAMI' FII.IN(; FEE RECEIVED: S CHECK ~: I)ATE PAll): PROJECT ~: FACILITY 1l): Nollhcrn Rcgmnal Oflicc * 4230 Kiernan Avenue, Suite 130 * Modcsto, California 95356-9321 * (209) 557-6400 * FAX (209) 557-6475 Ccnlral Regional Office * 1990 East Getlysburg Avenue * Fresno. California 93726-0244 * (559) 230-5900 * FAX (559) 230-6061 Soulhcm Regional Office * 2700 M Street, Suite 275 * Bakersfield, California 93301-2370 * (661) 326-6900 * FAX (661) 326-6985 Phase I Vapor RecoverY-system CARB Executive Order. Number= , Component Manufacturer Model Number Sptll Containment Buoket (Product) F&~ )'y/~ 4:~z~ _. ~ ~'//~:,: _ 5DIII Containment Bucket (Vapor) Del~ls Bucket (Vapor} / / ~' / Additional Equipment Not Listed Above Phase II VaporRec~Very System ...... System Type,.: J~LBalance I::1, Vacuum Assist n Burner Component :.., ManMa~umr Mod~l Number Aclditienal EquiPment Not Listed Above San Joaquin Valley Unified Air Pollution Control District Supplemental Application Form GASOLINE DISPENSING , Th, is form must t~e accompanied by a complete¢l Aj~ptica#on tot Authorit~ to Construct a,n,,d Permit to O~erate form. Permit to be issued to: Location where the equipment will be operated: Current Permit to Operate number (if applicable): Instructions Complete a separate form for each tank and dispensing syetem which has a different type of Phase I or 1 i Phase II valor mcover~ system with as much informeflo~ as possible. 2 I Attach a copy of the site plan showing underground fuel and vapor lines and location of dlepen~er islands. No~e: Information on V~or I~cove~ Ezecutive Ord~'s ts avallalJl~ online at: www,.arb.ca,,qovN, apor/vapgr.htm Gasoline Storage Tanks and Nozzles Quantity of Type of Tanks Capaclty/n Gallons Typeand Grade Tanks ~c,~ o~e rot e.~ r~ ~(tr~c~ ~.~p~ ra~ ' of Fual / I~Underground F'! Aboveground' /~, ~:¥'~?P '" U/~qgg-J r'! Underground [~ Aboveground* [] Underground ,I Aboveground* Total Number of Gasoline Dispensers: ~Maxfmum number ef veh~e~ which ~a~ be'fueled at one TotaJ Number of Gasolilte Fueling Points: nc~nally ~o vehi=les pe~ di~oe~ed Total ,urnl~r of Ga.oline Di,peneing- .NOZZles':-~ ~ ,~ ;~ua~ Die,,.,; Total Number of Vapor Recovery Instruction 81gns: (s~a be c~a.~ r.a~a~ from ev~/rue/~gl~n'; *For AbovegrOun, d Ta~ ~ks: ManUfacturer: CARB Executive PLEASE CONTINUE ON REVERSE S!DE 7/01 '~D CITY OF BAKERSFIELD , O! ,CE OF ENVIRONblENTAL RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY Page FYPE OF ACTION ["'] L N~ SITE ~RMIT ~ ]. RENEWAL PERMIT E O~ ~NFOR~TION (~ c~e. ~ Z PER~NENTLY CLOSED SITE , C,~eck 3~e ,tern 0~) ~ 4. AMENDED ~RMIT local use only/ ~ 8. TANK RE~VEO ~ 6. TE~RY SITE CLOSURE I. FAClLI~ I SITE INFORMATION BUSINESS ~S STAIN ' ~ 3. F~M ~ 5. CO~ERC~L ~ 3. P~TNERSHIP ~ 7. FEDE~L AGENC~ 402. ~PE ~ 2. DISTRI~OR O 4. ~OCES~R ~ S. O~ER . RE~INING AT S~E ~? ~, ~ ~ ~ ~ ~1~ ~ U~. ~ ~ ~e ~ ~ ~ ~ ~k r~.) ,,o. i . ... PRO~R~ O~ ~ ~. IND~ ~ 4. L~ AGE~ I ~ ~ 6. STATE AGE~ 413. ~ 1. ~T~N ~ 3. P~IP O 5. ~U~A~ ~ 7. FEDE~A~ III. T~K O~EE INFO~ON ZiP ~OE 419. ~K O~ER ~ ~ 2. ~ND~I~ ~ 4. L~ AGE~ / ~T ~ 6. STA~ AGEN~ 4~. 1. ~~R~IP ~ 5, ~U~AG~ ~ 7. FEDE~A~ N. BO~ OF EQU~ON UST STOOGE FEE ACC~ ~UMBER TY (TK) HO - ~11 (916) 3~-~9 if qu~ aflse V. P~O~UM UST FINANC~L ~SPONSiBI~ INOI~TE M~S) ~-INSURED ~ '4. SUR~ ~ ~ 7. STATE FUND ~ 10. LOlL ~ ~C~ISM ~ 2, ~EE ~ 5. L~ER OF ~ED~ ~ 8. STATE FUND & ~O ~ER ~ ~. OTHER: ~ 3. INSU~NCE ~ 6. ~E~ION ~ 9. STATE FUND & ~ 422. VI. LEGAL NOTIFICATION AND MAILING ADDRE~ Ch~ ~e ~ to i~te ~i~ ~ ~ ~ ~ f~ t~ ~fl~ ~d m~. ~ 1. FACILi~ ~ 2. ~OPER~ O~ER ~K O~ER 4~. VII. ~PLICANT SIGNATURE C~ifl~: I ~i~ ~t ~e inf~ pr~d~ h~n is ~e ~d ~rate to ~e ~ ~ my 425. UPCF (7/99) S:XCUPAFORMS~cb-a.wpd · ~~ CITY OF BAKERSFIELD ' ;'. :__~.~ OFFI OF ENVIRONMENTAL $!I~tVIC£$ 1715 Chester Ave., Bakersfield, CA 93301 ~661) 326-3979 L T~K O~ ~CF (7~) 8:~CUP~O~M~~'~c , ~_..~.~. CITY OF' BAKERSFIELD , OFFI~i~ OF ENVIRONMENTAL S~VICES 17 t5 Ches~Ave., Bakersfield, CA 9330 l~i 1) 326-3979 ~noenanouno stooge r~n~s. L T~K OE~ 2. ~~~ 0 · ~ 0~. o~ U~ ~ ~ - ~. U~ · ~--~ 0~~~ ~. ~~~ 0 t ~A~~~ 0.. o~, 0 · t.'.:~" ,~*~q~'~ ':' '~,:~::,'f '~,:~":.~',T~~~' ~C~:;'h~.;':'.~.-," :.. · :~'~?"..: 4~:. ,...' :' '. ":'*~ ;=' ' '~'" "~1'~': a~= '.,': ;" '~;; ;' ' :"5'.' '.,5'~ .... ':';;'.r: '2 ........ ~. ~To~T~~~Ta) ~ L V~M~ :F (7~) 8:~CUP~ORM~~'~c :.. CiTY OF BA~FIELD ~ OFFicE OF ENVIRONMENTAL S~:VICES 1715 Che~ Ave., Bakersfield, CA 93301 ~61 ) 326-3979 J"~' ~ ~J ~ r L T~K m. I'AJ4K ~CiNI~4T~ ~ P~IC HEALTH PERMIT APPLICATIO~Ni~. ~ ':: 28,. :~."~~-~, ,~ RENEWAL FORM (~ *** DOING BI~SINESS AS / BUb,~S ADDRESS z u~ I HO!'C~.DS Y,A_~d~'T 1 ~ ~ 420i :~u'~' ~?m~' ~ n PAY BY JULY 31 TO AVOID PENALTY ~ TYPE OF BUSINESS FEE BASIS FEE ~NA~'r/,,..¥~PAY'rHISA~OUNT O- ua OWNER/S × NEW BUSINESS co ~., CHANGE OWNERSHIp - J.,.~,O O'fL T. RENEWAL ~- MAILING ADDRESS BLIND Z c~ CHARITY/TAX-SUPPORTED D 2.0. B_~:'c 180'7 ,,,Bakersfz.el% CA 00?,DZ?ZO~AL PERMIT EXPIRES 3.~7NF7 gU/ s~pt~m,~= [ PAY FEES TO COUNTY HEALTH OFFICER 1700 FLOWER STREET · BAKERSFIELD, CA. 93305 DATE FEE PAID DATE APPROVED HEALTH OFFICER LEON M, HEBERTSON. APPLICATION INSPECTION [] CONDITIONAL APPROVAL DATE 'SeDte~ber 28.. Z~8/+ DBA HO~IJ~DS [] APPROVED DATE ADDRESS .~,~20~ ]]~TJ,~, CONDITIONS AS FOLLOWS · 1.'__ ,_A_l__.!_ ~--~n1`-s-t.`~-q~`i-~-~t~-`b`~p-a-s~-pe-`r``--f~A*c~i`~y~-p~a-~np~-~pp~9y-p`~`~d-~' this department and .2. .... Pe~mitte_e.._m~s~__c.o_~t.a_.cf._.__P.__e_r_m..i~i_._r,-g.._~ .h_~i_~_...f_~r;.._.~. __ hauls_ adwanae n~o~ice. .................... i ..&._Bac~ill..ma~e~_ial....£0n..pip ~ ng .._and.._~anks._..~ o._ be.._a s ...pe:_manufa c~ur~r._,s_..spe, cif.._ica~iQns~__ ~ _6~ m "Permi¢ ~o ~era¢e" is gran¢e~ ~ Permii¢~ Au¢hori¢z.._ ......................................... l_0,___F__l_oa t__v....e._~._%___.vA_!ye S__ r_~q~..d.__o_.n__v_._e~ _~_e_s__o__~..__~_e_rgrg__uDd _~A~_~.S_._~_D~ e n~ ion ...... _t_o__o_.v_e~$%~.~_.~_._ ~ge~_~..iDSe_......~$_~._.~_sp.....~!. ~D_o_r_....~_e.Q._o_._v_.e_~..__~s~.~m..._~_._~_~, ...... Every person is req,u~d~t.o obtain o public health permit to conduct any bus paid prior to the delinquency date, in addition to such fee, the applicant shall iness, occupation or other activity provided for in this Division, and shall file pay a penalty equal to twenty-five percent (25%) of the fee. The term "delin- an application with the Health Officer on a form to be provided and pay the quency date" shall mean in case of a renewal July 31, and in the case of required fee and penalty, if any. a newly established business or activity thirty-one (3~) days after commencement of the business or activity. - 10637 or in C~rbon ~nd rat~y the Agent. ~_ Shipper'* No, ~.. Mode~ Welding Co ~ CerHer's No. ~ (N~me of CerHer} ~ R~EI~ED, subject to fhe classifications end feHffs Jn effecf on fhe dete of fhe ;ssue of th;s 8~11 of L~dine, at FRESNO, CALIFORNIA 93711 Oct 29 19 84 From MODERN WELDING COMPANY, INC. nsigned fo .]aco O!1 Co; (Mail or street address of consignee--For purposes of nofificaflon only.) u .rinafion Bakersfield State Ca. County Delivery Address ~- ~t-~,-,~.lR~,l le Terra~ (~ To be tilled in only when sh;pper desires and governing t~i~p~'~l~very thereat.) Delivering Cerrier· Car or Vehicle Initbls ' No. / ?. No. Kind of Package, Description of Articles. Special (SubJ~teWEl6HTtoClass Check appn~bteSubJ~ blllt° ~lOnoE ladle, ~ ~u thls~ndltl°n"ahlp~,' Packages Marks, and ~ceptlons Correction) or Rate Column la [o ~ dellve~ ~ the eonel~ ~ltl 2 12,000 gallon ~G Tanks, Glasteel ~,1~. ~...~, .... ~. ~-. ..... UL~ J165317 (~,~tM, ~ C ........ ) UL~J165327 '~ ~'~ "'~ "~"~"'" prepaid 2 k~ts 35,000 Volt holiday ees~ w~nessed by ~ ~Permanent ~ffi~ addr~ of rnc~,~ ~:~~~~~[ ~ MODERN WELDING COMPANY. INC. ~hJ~r P~r ' Agent mud detach and retain, this Shipping .... ~ ' ' · ~ ' -- ' ., - ~ ~Or er and must s n the ~ nal Bill of Ladln . the ^ge.t. Shipper's. No, 10638 MOdern Welding Co. Carrier's No.. (Name of Cartler) RECEIVED. subiect to the classifications and tariffs in effect on the date of the issue of this Bill of Lading, at FRESNO, CALIFORNIA 93711 Oct 29 19 84 From MODERN WELDING COMPANY, INC. nsigned fo J~-O O~ I (Mall or street address of consigne~For purpo~ of nofillcafion inafion Bakersfield State Ca. Coun~ Del;very Address ~Stine & Belle (~ To be tilled in only when shyper des;res and governing tariffs provide for delivery thereat.) Route r~-~ Deliverlnc Carrier Car or Vehicle In'Hals < ,,'~" No- No. Kind of Package Descripfion of Articles, Special .WEZO.T Class Chec~ SubJ~t ~ S~tlon I ~ Packages ~atks, an~ ~cept ohs (subject to 12 11 G 1 9 8 00g) .,. .... ~, .,. ,~. ,o,,o.,~ .~ 2 ,000 ga on UG tanks asteel exter,)r 2 kits prepaid 35,oooVolt holiday test witnessed by:i~/~_ ,~...o.~..~,~ .... .' . ~ Agent must de+ach and refaln, fhi~ Sh;ppln9 ~OOEeN W~O,.~ CO~ANV,' ,.c. Shipper, Per Order and must s,qn the ~igina) Bill o{ Lading. Permanent ~im ~dr~ of"~pp~, FRESNO. CRLI FORNIA 93711 ~ ~ S~a~re // / · Complete items 1, 2, and 3. Also complete~c item 4 if Restricted Delivery Is desired. '~ X~4/~.~-Z 9~~ r'l Agent · Pdnt your name and address on the reverse [] Addressee so that we can return the c,~rd to you, B. Recelved b~(/~ted Name). lC,. _Dat~ of Djflivery · Attach this card to the back of the mailpiece, i~],~//7 /jq_~, or on the front if space permits. D. Is daiNe~t address different fn>m Item 17 1. Article Addressed to: If YES, enter delivery address below: [] No I Howards Mini Market 201 Belle Terrace 3. Son4ceType ' akersfield, CA 93309 ~certlae~ Mall [] Expre~ Mall [] R~lstemd ~ Return Receipt for Merchandise '" [] In.~ured Mail [] C.O.D. 4. Restricted Delivery'/' (Extra Fee) [] yee 2. ArtlcieNumber 7nn~l i~EhB BBDLt 7hSE 3Bfi:l · (rransfer from service/abe0 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-a-1540 ~-"-Q Postage $ _-r' Cedlfied Fee I Postmark Return Reclept Fee I D (Endorsement Required) I Here I rm Restricted Delivery Fee I ,..IJ (Endorsement Requlred__~[ __ ; ru Total Pc ,~ ~ Howards Mini Market , m '~ir~:'~ 4201 Belle Terrace ' - ..... r~- orPOBox o~l,~a~-efiO, lr{ CA 93309 L;ffy, ~rste ................ December 12, 2003 CERTIFIED MAIL Howards Mini Market 4201 Belle Terrace Bakersfield, CA 93309 RE: Propane Exchange Program FIRE CHIEF RON r~.~zE Dear Owner/Operator: ADMINISTRATIVE SERVICES 2101 "H'Street The purpose of this letter is to advise you of current code requirements for Bakersfield, CA 93301 propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not VOICE (661) 326-3941 FAX (661)395-1349 apply to large propane tanks, only propane exchange systems. SUPPRESSION2101 'H" SfreetSERVlCES Over the past two years this office has noted a dramatic increase in the propane Bakersfield, CA 93301 exchange system in the city of Bakersfield. It has also been noted, with great VOICE (661) 326-3941 FAX(661)395-1349 concern, that many of these installations are a clear violation of the UFO (Uniform Fire Code) and represent a danger to public health and safety. PREVENTION SERVICES FIRE SAFETY SERVICES · ENVI~ONI~NI'N. SERVICES 1715 ChesterAve. Accordingly, procedures for storage of propane cylinders awaiting use, resale or Bakersfield, CA 93301 vOiCE (661)326-3979 exchange, have been adopted through BMC (Bakersfield Municipal Code) and FAX (661) 326-0576 adoption of the 2001 UFC. The procedures are as follows: PUBLIC EDUCATION 1715 ChesterAve. Storage outside of building for propane cylinders (1,000 pounds Bakersfield, CA 93301 VOICE (661) 326-3696 or less) awaiting use, re-sale, or part of a cylinder exchange point FAX (661)326-0576 shall be located at least 10 feet from any doorways or openings in FIRE INVESTIGATION a building frequented by the public, or property line that can be 1715 ChesferAve. built upon, and 20 feet from any automotive service station fuel Bakersfield, CA 93301 VOICE (661)326-3951 dispenser. (Note distance from doorways increases when FAX (661) 326-0576 cylinders are over 1,000 pounds cumulatively.) TRAINING DIVISION 5642 VictorAve. Cylinders in storage shall be located in a manner which Bakersfield, CA 93308 VOICE (661)399-4697 minimizes exposure to excessive temperature rise, physical FAX (661)399-5763 damage or tampering (Section 8212, California Fire Code, 2001 Edition). When exposed to probable vehicular damage due to proximity to alleys, driveways or parking areas, protective crash posts will be required as follows (Section 8001.11.3 and 8210, California Fire Code, 2001 Edition): 1) Constructed of steel, not less than 4 inches in diameter, and concrete filled. 2) Spaced not more than 4 feet between posts, on center. Lett o: Owner/Operators of Propane Exchange Re: Propane Exchange Program Dated: December 12, 2003 Page 2 of 2 3) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. 4) Set with the top of the posts not less than 3 feet aboveground. 5) Located not less than 5 feet from the cylinder storage area. Exceptions: Cylinders storage areas located on a sidewalk which is elevated not less than 6 inches above the alley, driveway or parking area, with not less than 10 feet of separation between the curb and the cylinder storage area. "No Smoking" signs shall be posted and clearly visible (Section 8208, California Fire Code, 2001 Edition). Resale and exchange facilities must be under permit to verify compliance. All existing facilities will be checked and when compliance is confirmed, a Permit will be issued. All new propane exchange systems must be permitted prior to installation. You will have 90 days (March 4, 2004) to comply with the procedures outlined. Once compliance has been confirmed, each exchange system will be issued a permit, which will be placed on the exchange system. Sites not conforming to current code, will be "red tagged" and must be taken out of service immediately. You should contact your Blue Rhino representative, Mr. Taylor Noland, or your local Amerigas representative. They are aware of current code requirements. If you do not have a propane exchange system, please disregard this letter. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincerel~ Steve Underwood Fire Inspector/Petroleum/ Environmental Code Enforcement Officer October 15, 2003 CERTIFIED MAIL Mr. Dave Palmer Jaco Oil P. O. Box 1807 ~.~E CHIEF Bakersfield, CA 93308 ~ON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 REMINDER NOTICE VOICE (661) 326-3941 FAX (661 ) 395-1349 Re: Deadline for Dispenser Pan Requirements December 31, 2003 SUPPRESSION SERVICES 2101 "H' Street For - Fastrip' s @: 420:I-BelLTerra~, 8001 & 1200 Cofee Road, Bakersfield, ca 93301 805 34th Street, 3701 Ming Ave., and 1702 Union Avenue VOICE (661) 326-3941 FAX (661) 395-1349 /~ ;'{ Dear Underground Storage Tank Owner/Operator: PREVENTION SERVICES FIRE SAFETY SERVICES · E. 7~RONI~NTAI. SERVICES 1715~hesier Ave. A review of our files, indicate that you have not completed the retrofit of your Bakersfield, CA 93301 ..... vOiCE (661)326-0979 underground storage tank system. Current code requires that you install under FAX (661) 326-0576 dispenser containment pans prior to December 31, 2003. PUBLIC EDUCATION 1715 ChesterAvi~. Further file review, indicates that you have been receiving Reminder Notices Bakersfield, CA 93301 VOICE (661) 326-3696 since April of 2002. With time growing short (2.5 months) this office is very FAX (661) 326-0576 concerned that insufficient time is left for you to hire a licensed contractor and FIRE INVESTIGATION complete the necessary retrofit. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 32~-3951 Currently, contractors are scheduling 8-10 weeks out. I strongly urge you to FAX (661) 326-0576 complete the repairs as soon as possible. Failure to comply with the state TRAINING DIVISION requirement could result in revocation of your permit to operate your 5642 VlctorAve. underground storage tank system. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 If I can be of any further assistance, please feel free to contact me at 661-326-3190. Sincerely~ yours, Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db ~--------~- 'v'OL IJPllq = 2540 ~ '3 El::.~; LILL~GE= 82~,0 ! TC VOL LII'"IE = 24 q 3 HEIGHT = 25.26 INCHES 4201 BELLE TE~R~CE . ' : ~'~ BKFLD. Cg. 93:339 805-397-780Ei T 3:UNLE~DE[. 2 t/C,L UP.'IE = 9884 OCT 13.. 2003 10:23 ~;'-'1 90~ ULLAGE= 916 TC VOI.UP1E = 9?'00 (;ALS HE I G HT = ,;,,-, - , .:,. 313 INCHES S'Y'STEP.I ST~V[IJS F:E$:',:i:,~tT t.,d~TER VOL = 0 ....· ................. [,'dATER' = O. O0 I NC:HES aLL FLINOTIONS NOF~HFiL TEPlP = 86.6 DEl F I N".."}] NTOE'y' REPORT T 4: PRE["I 1 U['I N/OLUHE = 44?6 ,3~'~LS t;LLF~GE T 1 :UNL[-Fw,rq-, 1 - ?524 GALS " 90~:.; ULLROE~ 6:324 GALS VOLUME = ?E, gQ OALS TC VOLUME = 4394 ,';;ALS ULLAGE - 43 ','-' - HEIGHT = 38.1~ INCHES qO% ULLgGE~ 31L~ G~L',[; t.',.I~TER VOL = 0 GRLS TE; VOLUHE = ,'7'562 G~r % ~'dgTE~ HEI(;HT = 58.45 I' ':o = 0.00 INCHES -, /"~ TEPIP /.',JRTER VOL = 0 ,L;~ = 85.8 D TEPlP = 85.2 DEE; F ~ ~ ~ ~ ~ END ~ ~ ~ CO ,~~ECTION NI~TiCE 0/~898 BAKERSFIELD FIRE DEPARTMENT~ Name ~0 ~ ~c{[ ~ T~ ~ ~(L co~cctJo~s at ~c abovc location: Cor. No. I - /_ Completion Date for Corrections i l~ .5 {~ ~;., Date Inspector FD 1950 326-3951 .~ Bakersfield Fire Dept. UNIFIED PROGRAM[i~_"~2ECTION CHECKLIST Enironmental Services ,',,' ' ,,, ,,' , , ,, ,,,,,,',,,,, - " 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME IINSPECTION DATE I INSPECTION TIME FACILITYCONTACT- II' / 15-021- Section 1: Business Plan and Inven~ P~mm ~ Routine ~ Combin~ ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection C V fC=~om.~.~ OPE~TION COMMENTS % V=Violation APPROPRIATE PERMIT ON HAND BUSINESS P~N CONTACT INFORMATION ACCU~TE VISIBLE ADDRESS VERIFICATION OF QUANTITIES VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL ~ERIFICATION OF HAT MAT TRAINING ~VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~EMERGENCY PROCEDURES ADEQUATE ~ CONTAINERS PROPERLY ~BELED ...................................................................................................................................................... ~ F~.E P.mECnO. ~ S~E D~aG.~M ADEQUatE & O. H~.D ANY HAZARDOUS WASTE ON SITE?: ~J YES ~ No EXPLAIN: Inspector Badge No., White. Environmental Services Yellow. Sletion Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVIC. ES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME /~o)flr_~ I~ta, fl~t4' INSPECTION DATE Section 2: Underground Storage Tanks Program [21 Routine ~ Combined [~ Joint Agency [2i Multi-Agency 1~ Complaint [21 Re-inspection Type of Tank $olg Number of Tanks q Type of Monitoring pt'T6, Type of Piping/ql)T OPERATION C V COMMENTS Proper tank data on file k,~ Proper oxvner/operator data on file / Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current ~ / Failure to correct prior UST violations 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? C=Compliance/~ V=Violation Y=Yes N=NO Office ofEnvironmentM Semic= (661)326-3979 ~&inds~i[e Respo~ib~ ~;'ty White - Env. Svcs. Pink - Business Copy · Complete items 1, 2, and 3. Aisc complete ~~~~sseeA'S'ignature .. item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card ,o you. ~j~l~e~ by ~Prigte~e~ ~ ., C. Date of Demive~ m Attach this card to the back of the mailpiece, ~ m~ ~~ ~ [ ~ or on the f~ont if space permits. --/1 ~ D. ms demiv~-- adJres~ diffe~nt from item 1 ? Yes 1. A~le Addressed to: mf YES, enter deiive~ address beldw: ~ No ~OWARDS ~INI ~AR~ 4201 B~LL~ ~RRAC~ BA~RSFIELD CA 93309 3~e~ice Type ~e~ified Mail ~ Express Mail ~ Registered ~ Return Receipt for Merchandise ~ .......... ~ ~ Insured Mail ~ C.O.D. 4. Restricted Deliver? (Ext~ Fee) ~ Yes 2. A~icleNumber 7~ ~5~ ~ ~5 ~ ~ransfer from se~ice label) 3 PS For 81 1, gust 2001 Domestic Return Receipt . 102595-02-M-1~0 _-F ,; Certified Fee Return RecJept Fee [:3 (Endorsement RbquJred) Here rl I~es'~tcted Delivery Fee u3 ( .Endorsement Required) ITl } Tot~ Po~a~o ~ -- -- FU [Sent To r~ HOWARDS MINI MARKET r,- [~'~,'~m:F 4201 BELLE TERRACE [.o[.£.o...~...~.o.._ BAKERSFIELD CA 93309 September 8, 2003 CERTIFIED MAIL Howards Mini Market 4201 Belle Terrace Bakersfield, CA 93309 FIRE CHIEF RON FR,AZE ADMINISTRATIVE SERVICES 2101 "H' Sffeet REMINDER NOTICE Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1949 Re: . Deadline for Dispenser Pan Requirements December 31, 2003 SUPPRESSION SERVICES 2101 "H' Street Dear Underground Storage Tank Owner/Operator: Bakersfield, CA 93301 VOICE (661) 326.3941 FAX (661) 395-1349 A review of our files indicate that you have been receiving quarterly reminders from April of 2002 to December 2002. Our files further show that since January PREVENTION SERVICES F.,~s~.sE~s.~.,,.o.,~.,~.sE~s of this year you have been receiving monthly reminders. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326.3979 The purpose of this letter is to remind you of the necessary retrofit of your FAX (661)326-0576 /~ fueling system. Current code requires that you install under dispenser PUBLIC;EDUCATION containment pans prior to December 31, 2003. You will not be allowed to pump 1715 ChesterAve. fuel after December 31, 2003 unless you have completed the upgrade Bakersl~eld, CA 93301 . VOICE (661) 326.3696 reouirements. FAX (661) 326-0570 FIRE INVESTIGATION Contractors are already scheduling g-10 weeks in advance. I urge you to retrofit 1715 Chester Ave. your facility as soon as possible. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 Should you have any questions, please feel frcc to contact mc at 661-326-319.~ TRAINING DIVISION 5642 victor Ave. '-" ,,~q~ncere~, yours, Bakersfield, CA 93308 VOICE (661) 3994697 FAX (661) 399-5763 \ ~x/~, · Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db S'YSTEM SETUP AUG 13, 200:3 6:5:3 AM SYSTEM UNITS SYSTEM LANGUAGE · c, ENGL I SH ~YBTEM DATE..."T I ME FORMAT COMP1U~q I C~T I ObIS SETUP MON DD 'YYYY HH :l"lPl: B~ xM .......... HOWARD~ 6 _4201 BE~,LE TERRACE PORT BETTI NOS BKFLD.- OA' 93309 805<397--9600 COMM BOARD : 1 (RS-232) BAUD RATE : ~600 ~HIFT TIME 1 : 6:00 AP1 PARITY : NONE SHIFT TIP1E 2 : DISABLED STOP BIT : 1 ~TOP SHIFT 'rltqE S : DISABLED D~Tg LENGTH: S D~Tg SHIFT TIME 4 : DISABLED TANK PERIODIC: WARNINGS AUTO TRANSMIT SETTINGS: D I SABLED T~NK ~NNU~L W~NING~ ~UTO LEaK aLaRM LIMIT D I SgBLED D I SgBLED LINE PERIODIC WARNINGS AUTO HIGH WATER LIMIT D I S~BLED D I SgBLED LINE ANN~JRL WARNINO~ AUTO OVERFILL LIMIT D I BgBLED B I SRBLED AUTO LOW PRODUCT PR I NT TC VOLUME~ D IBABLED AUTO THEFT LIMIT ENABLED D I 8ABLED TEMP COMPENSaTI ON ~UTO DEL I VERY START VALUE (DEG F ): 60.0 DISABLED STICK HEIGHT OFFSET AUTO DELIVERY ENB D I SABLED D I BABLED ~UTO EXTERNAL INPUT ON H-PROTOCOL DATA FORMAT D IBABLED HEIGHT AUTO E>~TERNAL INPUT OFF D~YLIGHT fiAVI~qG TIME DISABLED ENABLED AUTO SENSOR FUEL ALARM START DATE DISABLED APR WEEK I SUN AUTO SENSOR [,lATER ALARM START T I ME DI B~BLED 2:00 AM AUTO SENSOR OUT ALARM END DATE DISABLED OCT WEEK 6 ~UN END TIME RE-DIRECT LOCgL PRINTOUT D I SgBLED RS-232 SECURITY CODE : 000000 LOW PRODUCT : 1 RS-232 END OF MESSAGE LEAK ALARM LIMIT: 99 DISABLED SUDDEN LOSS LIMIT: 50 TANK TILT : 6.20 MANIFOLDED TANKS TI~: NONE LEAK MIR PERIODIC: 10% : 1200 LEAK MIN ANNUAL : 10% : 1200 PERIODIC TEST TYPE I N-TANK SETUP OUICK ANNUAL TEST FAIL T i:UNLEADED 1 ALARM DISABLED PRODUCT CODE : 1 THERMAL COEFF :.000700 PERIODIC TEST FAIL TANK DIAMETER : 95.50 ALARM DISABLED TANK PROFILE : 1 PT FULL VOL : 12000 GROSS TEST FAIL ALARM DISABLED FLOAT SIZE: 4.0 IN. 8496 ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF WATER WARNING : 2.0 HIGH WATER LIMIT; S.O TANK TEST NOTIFY: OFF MA× OR LABEL VOL: 12000 TNK TST SIPHON BREAK:OFF OVERFILL LIMIT : 95~ : 11400 DEL-I VERY DELAY : 15 MIN HIGH PRODUCT : 95~ ~ : 11400' DELIVERY LIMIT : 1% : 120 PER I OD I C TEST TYPE 0 U I ¢ K ANNUAL TEST FAIL ALARM DISABLED PER I OD I C; TE~T FR I L T 2: PLUS ~L~RI"I D I S~BLED PRODUCT C;ODE 2 THERMAL COEFF .000700 GROSS TEST FAIL TANK DIAMETER 95.50 ALARM DISABLED TRAK PROFILE 1 PT FOLL VOL 12000 ANN TE~T ~VERRGI NG: OFF PER TEST RVERAGI NO: OFF FLO~T $I2E: 4.0 IN. 849g T~NK TEST NOTIFY: OFF W~TE~ b~NING : 2.0 TNK TET SIPHON ~E~K:OFF HIGH ~ATER LIMIT: 3,0 DELIVERV DEL&V : IS MIN M&X OR L~EL VOL: 12000 OVERF ILL L I Pl I T : 95% : 11400 HIGH PRODUCT : 95% : 11400 DELIVERY LIMIT : : 120 LO~ PRODUCT : 1 ~ LE~K ~L~RM LIMIT: 99 : SUDDEN LOS$ LIMIT: 60 T~NK TILT : 7.OD T 3:UNLEADED 2 PRODUCT CODE : 3 MAN:FOLDED TANKS THERMAL OOEFF :,000700 T~: NONE TANK DIAMETER TANK PROFILE : 1 PT FULL VOL : 12000 LEAK MIN PERIODIG: 10% : 1200 FLOAT $IZE: 4.0 IN. 8496 LEAK MIR ANNUAL : 10% : 1200 b,JRTER ~RRN I big : 2. O ~ HIGH ~RTER LIMIT: 3.0 ~ MAX OR LABEL VOL: 12000 i OVERFILL LIMIT : : 11400 HIGH PRODUCT : 11400 DELIVERY LIMIT : : 120 LOW PRODUCT : 1 LEaK ~LaRI"I LINIT: 99 SUDDEN LOSS LIi"IIT: 50 TaNK TILT : ?.50 T 4: PREI"I I UI"I I'IRNIFOLDED TFtNKS PRODUCT CODE : 4 TI~: NONE THERPI~L COEFF : .000700 TaNK D I a[~IETER : 95.50 TaNK PROFILE : 1 PT LEak' NIN PERIODIC: 10~'; FULL VOL : 12000 : 1200 LEaK NIN ~NNU~L : lO~ FLO~T SIZE: 4.0 IN. 8496 : 1200 9J~TER gaR[,l I NG : 2.0 HIGH gaTER LINIT: ~.0 PER I OD I C TEST TYPE aUICK NaX OR La9EL VOL: 12gOg OVERFILL LINIT : aNNUAL TEST FAIL : 11400 aLaRH DIS,~BLED HIGH PRODUCT : : 11400 PERLODIC TEST FAIL DELIVERY LIPIlT : 1~ .aLaRI"] DISABLED : 120 GROSS TEST FaIL LO~ PRODDOT : 1 aLaRN D I SaBLED - -LEAK- ALARP1 L I P11T: 99 SUDDEN LOSS LINIT: 50 ANN TEST AVERAGING: OFF TaNK TILT : 4.70 PER TEST aVERaOI NO: OFF PIaNIFOLDED TANKS TaNK~ TEST 'NOTIFY: OFF T~: NONE TNK TST SIPHON BREAK:OFF LEaK NIN PERIODIC DELIVERY DELAY : 15 I~IN : 1200 LE~K NIN ~NNU~L : 10% : 1200 ............ PE~ I OD IC TE~T TYPE OIJ I CK ANNUAL TEST FAIL ALARM DISABLES LIOUID SENSOR SETUP PERIODIC TEST FAIL ALARM DISABLED L 1 :NORTH NORMALLY CLOSED GROSS TEST F~IL ~L~RM DI$~BI,ED C~TEGORY : MONITOR ~ELL fiNN TEST ~VER~GING: OFF PER TEST ~VERAGING: OFF L 2;SOIJTH NORMALLY CLOSED T~NK TE~T NOTIFY: OFF C~TEGORY ; MONITOR WELL NORMALLY CLO~ED DELIVERY DELAY : 1S MIN , CATEGORY : ANNULAR SPACE ° L 4 :PLLJS NORMALLY CLOSED CATEGORY : ANNULAR SPACE , L 5:UNLEADED 2 ~ NORMALLY CLOSED CATEGORY : ANNULAR SPACE LEAK TEST METHOD TEST ON DATE : ALL TANK JAN 1, 2000 L 6:PREMIUM START TIME : 2:00 AM NORMALLY C, LOSED TEST RATE :0,20 GAL.,'HR CATEGORY : ANNULAR SPACE DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORMAL OUTPUT RELAY SETUP R I:POSITF\/E SHUT-OFF TYPE: STANDARD _; --- NORMAIzEY-CLOSED-- '- LIOUID SERSOR ALMS ALg:FUEL ALARM ALL:SENSOR OUT ALARM ALL:SHORT ALARM p2EVIS I 0f'4 LEk]EL aLaRl"l H I STORS" REPORT ~,ERfS i ON.lb ,_ ...~ c.c~1~ ~,~01 5-100-B I N-TaNK ~LaRPl SOFTklA~ '~7~,' oft 08.56 CREATED ~ 9~.~ .... T I~UNLEApED 1 S-~09ULE~ SSOi 6,0--0l -' , .... S: OVERF ILL ALaRN ~'wSTEM FEaT~..,.,,n.' TESTS SEP 4.. 3000 4:37 Pl'q '~ PERIODIG l~-~.C"~fi N~Y S, 1999 3:52 n~., ...... , - JUL 1:3., 1998 1:06 PPi pRECISION FLL9 HIGH PRODUCT SEP. 4 ~uu 4:37 PH HaY S, 1999 :3:52 JUL 13, 1998 1:06 PPI INVALID FUEL LEVEL JUL 4, 200S 6:1'2 PP1 -* -- JUN 23. 2003 J:55 PPl .... ~' JUN 14. 200:3 6:3G PI"1 aL~R~ ~ISTORY REPORT PROBE OUT ..... S,~STEI"I aLaRM ..... JaN 12, 199S 10: 02 paPER OUT JUN 14, 200~ 6:00 apl LOW TEMP WARNING PRINTER ERROR J~N 1~, 199B 10:0~ ~M JUN 14, 2003 6:00 APl BaTTER'W I~ OFF JAN 1. t996 fi:O0 AP1 ALARM HISTORY REPORT I bi-TANK ALRRI't T 2 :PLUB INVALID FUEL LEVEL NOV 27, 2002 3:39 PM MAR 31, onFl9~¢~ 10:31 AM DEC 3, 2001 7:40 Aid ALARM HISTORY REPORT .... IN-TANK ALARM ...... T 4:PREMIUM INVALID FUEL LEVEL DEC 17, 2ggl 3:17 PM NOV 27, 1998 2:53 PM ALARM HISTORY REPORT .... I N-TONK ALARM T a:UNLEADED~_ '? I NV~LIB FUEL LEVEL SEP 30.. 2002 4:49 PM ~UG 17, 2002 8:~ PM MAY 18. 2002 3:54 PM ALARM HISTORY REPORT ..... SENSOR ALARM L 1: NORTH MONITOR ~ELL FUEL FEB 2~.. 2003 7:57 Nfl FUEL ALARM RUG 5, 2002 4:22 PM FUEL ALARM OCT.15, 2001 11:51 ALARM H1STORY REPORT ...... SENSOR ALARM ..... L 3:UNLEADED 1 ANNULAR SPACE FUEL ALARM END ~ ~ ~ ~ ~ AUG 5, '~00'?~ ~ 4:11 PM FUEL RLRRM OOT. 15, 2001 6: 43 ~I"1 FUEL RLRRM OCT 20. 2000 8:44 Piti ALARM HISTORY REPORT ...... SENSOR ALARM ..... L 2:SOUTH MONITOR WELL FUEL ALARM AUG 5, 2002 4:16 PM FUEL ALARM OCT 20, 2000 4:22 PM FUEL ALARM OCT 20, 2000 4:20 PM ALARM HISTORY REPORT ..... SENSOR ALARM ..... L 4:PLUS ANNULAR SPACE FUEL ALARM AUG 5, 2002 4:10 PM _ FUEL ALARM OCT 15, 2001 6:44 AM FUEL ALARM OCT 20, 2000 3:45 PPI ALARM HISTORY REPORT SENSOR ALARM L 6:PREMIUM ANNULAR SPACE FUEL ALARM AUg; 5, 2002 4:13 PM FUEL ALARM OCT 15.. 2001 6,:41 AM FUEL ALARM Otl;T 20, 2000 3:48 PM ALARM HISTORY REPORT ..... SENSOR ALARM - L 5:UNLEADED 2 ANNULAR SPACE FUEL ALARM AUG. 5. 2~02 4:09 PM FUEL ALARM OCT 15, 2001 6:44 AM FUEL ALARM OCT 20, 2000 3:46 PM HI~'FORY REPORT ..... ~ENSOR ~L~RM ..... L 7: OTHER SENSORS ~L~RM HI~TOR¥ REPORT ~L~RM HISTORY REPORT ...... ~EN~OR ~L~RM ..... ..... SEN~OR ~L~RM ...... 9 '2: L 8: OTHER SENSORS OTHER SENSORS HISTORY REPORT ..... SENSOR ~L~RP1 ...... ~ 1: OTHER sE~sORS ~L~RM HISTORY REPORT ..... SENSOR ~L~R~'] ..... OTHER SENSORS ALARM HISTORY REPORT ..... SENSOR ~L~RM ..... OTHER SENSORS ..... CdENSOR ALARM ..... SENSOR ALARM ..... L 2:SOUTH L 4:PLUS MONITOR [dELL ANNULAR SPA~:_-:..E FUEL ALARM FUEL ALARM AUG 13, 2003 7:10 AM AUG l~, 2003 7:12 AM ...... SENSOR ALARM ...... . ...... SENSOR aLARM ..... L I:NORTH L 5:UNLEADED 2 MONITOR WELL ANNULAR SPACE FUEL ALARM FUEL ALARM A~G 13, 2003 7:10 AM AUG 19. 2003 7:12 AM ...... SENSOR ALARM ..... SENSOR ALARM ..... L 3:UNLEADED 1 L 6:PREMIUM ANNULAR SPACE ANNULAR SPACE FUEL ALARM FUEL ALAR~I AUG 18, 2003 7:11 AM AUG 13. 2003 7:12 AM · ~ 09'/25./'01 '.'.D~:45 0576 BFD HAZ 3L~T DIVI ' ~002 .. MONITORING. SYSTEM CERTIFICATION For LJ~'e By All Juri.~'dit:tttms Wilhi~ the State o/¢'~llifort~ia Attthorit.~::~ited: Cht~pter 6. 7. Health attt] Safety Code: Ch~tpter 16. DivisiO~ ). Title 23. C~diJbrniu Code of Reg,lations This t'orm must be used to document testing and se~icing of monitoring equipment. A ~¢parate 9ertification or report must b'e prepared for eac~g.nitoring system control ~ by the technician who performs the work. A copy of this t'orm must be provided to the tank system owner/operator. The owner/operator mast submit a copy of this t'o~ to the local agency regulating UST systems will, in 30 days of tes~ da~e. A.. General Information Facility Name: ~i ~ ~ ~&~ ( ' '~' ~' __ ............. ~.,~.,~,~ ~..bDa'~' ~,~T ~ Bldg. No.: Site Address: ~j_~L/_g~"~.~ C~ City: [{t~41~ Zip: Facility- Coneact Person: ~ ~-t~ ~e.~L Contact Phone ~o.: ( ~; )~ ~q ?5- Mak~odel of Monitoring System: ~fi~;~ ~:, ~,...~, ~fi~ Date ofTesting/Se~icing: ~/ B. Inventory o~ Equipment 'resteWCertified Check thc appropriate boxes to indicate specific eqmpment ~specte~se~iced: Tank~: ~ ~ ~ .... ~: '~ ~n-lank Gauging Probe. Model: ~ ~g { ...... ~[n-Tank Gauging Probe. ' Model: ~.G ~nul~Sp~ceorVaultSen,or. Model: ~1~.~. ~4~7 ~nnul~ Space or Vault Sen,or. Model: [/~ ~Piping Sump / Trench Sensors). Model: ~ '~ ,~ ~ ¥ X~ ~iping Sump / Trench Sensors). Model: ~J ff -- R'<~ e~ _ ~fill Sump Sensor(s). M~el: ~ Fill Sump Sens, or(s). Model: ~ Mechanical Line Le~ Detector. Model: ~ ~;~T" ~Mech~ical Line Le~k Detector. Model:' ~4~ ~ Etec~onic Line Leak Detector. Model: ~ Elec~onic Line ~ Deiector. Model: ~ Tan~ Ove~ll i High-Level SenSor. Model: Q T~k Ove~ill / High-Level Sensor. Model: Q Other (speci,f7 equipment t~e md model in Section E on Page 2). ,Q Other (s~cify equipment t~e ~d model in Section E on Pa~e 2). ~n-'rank Gauging Probe. Model: ~.~ ( ~[n-T~k Gauging ~obe. Model: i~. ~-~' '~mulw Space or Vault Sffnsor. Model: {~ ~ ~"-- · -~ ~-~_~_ ~Annul~ Space or Vault Sensor, Model: ~-'- ~Piping Sump / Trench Sensors). Model: ~(~" ,~3:$ ~ "~ ~P~ping Sump / Trench Sensor(s). Model: ~~ ~ Fill Sump Sensor(s). M~el: ~ Fill Sump Sensor(s). Model: ~Mechanical Line Le~ Detector. Model: ~,~C o~-~4,~ , ~lechanical Line Le~ ~tector. bi,el: ~ ~ Elec~onic Line Le~ Detector, Model: ~ ~ E~ec~onJc Line &~ Detector. Model: ~ Ta~k Ove~ll / High-Level Sensor. 'Model: ~ Tan~ Ove~ll / High-Level Sensor. Model: ~ Other (s~cify equipment type and model n Section E on Pa~c 2). ~ Other (speci& equipment tFpe and madel in Section E on P~C 2). Dlspemer ID: ~ ~' ~ Dis~nser ID: ~ ~ ~. O Dispenser Contfinment Sensor(s). Model: ~ Dispenser Containment Sensor(s). Model: ~ Dispenser Containment ~oat(s) and Chain(s). ~ Dispenser C~nt~nment Float(s) md Chain(s). Dis~nser ID ~ ~ Dispenser ID: ~ ¥/~ ~ DispenserContaihment Sensor(sL Mod~l: ~ Dispenser Containment Sensor(s). Modek ~qhear Valve(s). . ~hear Valve(s). ~' ~ Dispenser Containment ~oat(s) and Chain(s). ~ Dispenser Containment Float(s) and Chain(s), Dispenser ID: ~"~' ~ .... D'ls~nser ID: _// ( ~ Dispenser Contaifiment Sensor(s), ~odel:. ~ Dispenser Contfin~ent Sensor(s). Model: ~Shear Valve(s). ~hear Valve(s). ~DJspenser Co~tainmcm Float,s) and Chain(s). ~. Dis?riser Contfinment 61oat(s) and Chain(s). .-If the facili~ contains more tanks or dispensers, copy this fo~. include infommtlon for ever}' t~k and dispenser at the facility. C. Certification · I ce~ that the ~uipment lden~ in t~s document w~ l~pect~se~leed in accordance with the g~fidelin~. Attached to this Ce~ficntion is I~o~fion (e.g. ~nufacmro~' checMIsm) necessa~ to vefi~ that t~s l~ommtion is correct and a Plot Plan Showing the layout of mo~tofing ~ment. For any eq~pment ~pable or generating such report, I have.also a,ached a copy of the repo~: (ehec~ all that appO): ~ystem scl.up ' ~lavm history report Technician N~e (print): ~G~ ~,~. .,-~" Signature: _ ~~~. Certification No,: '~q~;g . License. No.: ~:~ ~'~?, ~ Testing Company Name: ~x~ ~' ~ ~'Cvl g~ ~' ~ Phone No.:(4~ ~ _) 5q~2 ~- ' Site Aedress: ~.~'~ ~f~~ Date ofTesdng/Scrvicing:~G~/~/g.D;~ Pa~e Io[ 3 03/01 Monitoring System Certification 09/28/01 07:46 '~661 6 0576 BFI) HAZ MAT DII ' 1~003 D. Results of'resting/Servicing Software Version l'nstalled: Corn flete the following checklist: , ~Y~s i [3 No* ] Is the audible alarm operational?' la"Yes r3 No* Is the visual alarm operational'J_ . ~, ' ' " iil~es O No"' Were all sensors zisually inspected., functionally teste,d.,and confirmed operational? - ',,WYes ra No* Were ail sensors installed at lowest point of secondary containment and positioned so that other equipment wild- not interfere with their_proper opera;on'? [3 Yes _~,)Wo* / If alarms ar'e relayed to a remote monitoring station, is all communications eqt~ipment (e.g. modem)' (Iff N/AJ operational? ~'Yes ~ No* For pressurized '-~i-'~-g s~'te-ms.--~oes the turbine automatically shut down if the piping secondary containment ~ N/A monitoring system detecis a leak, tails to opera_~.e, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check ail that apply) lift Sump/Trench Sensors; ~ Dispenser Containment Sensors. Did you confirm vositive shut-down due to leaks and sensor t'aiture/disconnection'~ CI Yes' CI No ~ Yes ~ No* I ........ ' ' ' ' For tank systems that utilize the monitoring system as the primary tank overfill warning device (i e nO (9'/N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the' tank fill point(s) and operating prope!'ly'?. If so, at what. percent of tank capacity does the alarm trigger? . .~.O % ~ Yes* ~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced i and list the manufacturer name and model for all replac, ement parts in Section E. below. ~ Yes* Ci~/No Was liquid found inside any secondary, containment systems designed as dry systems? (~heck all that apply) Product..; ~ Water. If ye.s, describe causes in.S.'ection E, below'. -~li!~ Yes .~ No* Was monitoring system s_et-up reviewed to ensure proper settings? Attach. set up reports, if applicable ia/Yes. ~ No'" I Is all monitori,ng equipment operational ..... per manufactu.r&s~ specifications? .... . * In Section E below, describe how and when these deficiencies were or will be corrected, Page 2 of 3 ca/ct 09/28/01 07:47 "~'661 6 0576 BFD HAZ NAT DI' ' ' ~ 004 F. In-Tank Gauging / SIR Equipment: ~ Check this box if tank gauging is used only tbr inventory control. ~ Check this box if no tank gauging or SIR equipment is installed. · This section must be completed if ia-tank gauging equipment is used to perform leak detection monitoring. Com,)lete the foilowin[l checklist: . , , ...... , . , ~ Yes Q No:) I H~s ali inp.u.t wiring been_~i.nspected for proper entry and termin¢[i~.n2 including testing for ground I"aults? .. [W~es = 121 No* 'Were ail tank gauging probes visually inspected for damage and residue buildup*. ii'Yes t~ No* Was accuracy of system product level reading~ tested'? (~W'Yes ~ No" 'l Was accuracy ,~i' system water level readings, tested? 2.' ..... (~Yes U..l No* Were all probes reinstalled properly'? ~Yes ~ NO* Were all items on the equipmen'i"manufacturer's maintenance ch~cl~[ist complet'ed? '" · In the Section H, below, describe how'and when these deficlem:ies were or will be corrected. G, Line Leak Detectors (LLD): ~ Check this box it'LLDs are not installed. Cpm )lete the following checklist: [] Yes ~ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LI.D performance? 121 N/A (Check all that apply) Simulated leak rate: ~! 3 g.p.h.: ~ 0.1 g.p.h '. ~ 0.2 g.p.h. .. ~ Yes [] No* Were all LLDs confirmed operational and accurate within regulatory requirements? ~1 Yes [] No* Was the testihg apparatUS properly calibrated? .... 1~ Yes ~ No* For mechanical LLDs, does the LLD restrict p~'oduct flow if it detects a leak'? '~ N/A O Yes [] No* For electronic [J..Ds, does the turbine automatically shut Off if the LLD detects a leak? ~ N/A '~ Yes [] No* For electr~riic LLDs, does the turbine'automatically shut off if any portion of'~-he monit0fi'ng system is disabled ~ N/A or disconnected? [] Yes i~l No* For electronic LLDs, does the turbine a'utom,4dcallY shut off if any portion of the monitoring system malfunctions C} N/A or failsa te~t'? ~ Yes (~ No'.* For electronic LLDs, have all accessible wiring connections been visually inspected? ZI N/A '~,~ Yes .ZI No* Were all items on the equipment manufacturer's maintenance checklist completec~? · In the Section H, below, describe how and when. these deficiencies were or.will be corrected. H. Conm~ents: [,age 3 o1'3 0~/0~ Monitoring System Certification UST Monitoring Site Plan : Site Address: ' ..... . ...... · .... . .... ' ' ' ~ .':'.' ' ' ' ~ I~' '. .... ,'.";.' ' ~ .' : ' .... ..' ' · ' ~ ~ ~ ~~~ ~ ~ ~~ ~ ~ ~ ~ ~ ..... .... ,.... :........ ...... ...........~.--~---~: ...... ........r, ................. ' ' · .... ~o~" '~'' ...... ~ ~''' '~ Dat~ map ',vas dr~wn: 0___~I ~ I0~'. ' ............ '-. Instruction~ If you already have a diagra~ that shows all re~lUired information;'.yo'u miy'(ifi'e!ude"it,, raiMr' th0.n'this page, ~th your MonitOring Sy~i~l~iC'~tifi~'~'~i'~?i'~':On 'y°~ locations, of th~ 'f°ii0~ng equiP~&~it, if installedi3(;:~hii0fir/~;"s3tem' ~3*fi~'3i:'3';~i~?i~i~b3~"~$~'~t~'~ annular spaces, sumpS, disPefis~r' pans; sPiil containers, or'o'ther ~¢0ndar~ ¢6ht~i~'-'h'~ ~eaS~"'~cha'hi~al' 3i2':~le~t*~fiie line leak detectors; and in-tank liquid level probes (if used for leak detection); In th~ SPace prOvided, note the date this site Plan · .. ..... .. · ??:.~ · . .....¢.,..:..:.. :.~ . . ;.. :.. · .... !, ..... was prepared. '. '.. ' · ~. ":.':-:~.~.:!/ ',:.'..7:1::i,~iii.~4:~i:: :. }: ..'.': 12.:,: :..:: ,... -' .'. · . - -- ..~ ' "~ ": .i"-:fe:......'.;:'-"-~';~: .. r ' ... . . .. : . . ::; . !';i.:.:'.'' ,'.5 "3'..?::'5.'k:~.[" · · :":~ , ..... · e. · ":~.,.,'-~;;i~.F",-,',~;.'~;,.-'~'.:~'~.'3~.'..: ~ .~ : '' · '? · '.'. ::..'~."..'... ...' .. · ?... '.. ~..'~. '..'~;...~::..,.':-;:.~ %~..:'z ~:.-., ' ,, !'~: '...; . ...;.. ' : · : ' "'."~';:z' TRACER TIGHT® TEST RESULTS Prepared for: 7/17/2002 Shirley Environmental LLC Job No: 860009 1928 Tyler Avenue, Suite K Jaco #355 - Howard's Market South E1 Monte, CA 91733 4201 Belle Terrace Testers St Lic. No: N/A Bakersfield, CA 93309 SYSTEM STATUS SYSTEM # PRODUCT SIZE TRACER TRACER DETECTED? 1 Unleaded 12,000 A NO 2 Plus 12,000 B NO 3 Unleaded 12,000 R NO 4 Premium 12,000 W NO Soil permeability is ~reater than 26.1 darcys. GROUND WATER INFO SYSTEM # DEPTH / GROUND WATER DEPTH / TOP OF TANK DEPTH / BOTTOM OF TANK (Inch) (Inch) (Inch) Tank 1 >150 43 139 Tank 2 >150 44 140 Tank 3 >150 51 147 Tank 4 > 150 52 148 SITE COMMENTS Back fill in tank pits consists of tight packed sand. Backfill in piping trench is tight packed sand. Ground cover over tanks and pipeing trench consists of fractured asphalt. TEST EVENTS INSTALLATION INOCULATION SAMPLING ANALYSIS 6/11/02 6/11/02 6/20/02 6/24/02 FILL RISER- SPILL BUCKET TEST TANK # PASS/FAlL Tank 1 PASS Tank 2 PASS Tank 3 PASS Tank 4 PASS Submitted by: TEST COMMENTS General Tanks I through 4 are single walled lined steel. Product distribution, vent, vapor recovery piping and stage II vapor recovery piping is single walled steel. Tanks 1 Through 4 No detectable Tracer's in the tank excavation zone. There were very light TVHC (Total Volatile Hydrocarbons) detections in samples from the tank excavation zone. Product Distribution Lines, Stage 1 and 2 Vapor Recovery Lines and Tank Vent lines No detectable Tracer in line excavation zone. There w6re no TVHC (Total Volatile Hydrocarbons) detections in samples from the piping excavation zones. Conclusion Tank and line components are Enhanced Tracer Tight® at the time of testing. Submitted by: Jimmy Humphfies Tracer Research Corporation Tracer Research Job No. 860009 Page 3 of 5 Sample Date: 06/24/02 CONDENSED DATA Location Compound Concentration(mg/L) 001 A 0.00000 001 B 0.00000 001 R 0.00000 001 W 0.00000 001 TVHC 0.00000 002 A 0.00000 002 B 0.00000 002 R 0.00000 002 W 0.00000 002 TVHC 0.00000 003 A 0.00000 003 B 0.00000 003 R 0.00000 003 W 0.00000 003 TVHC · 0.00000 004 A 0.00000 004 B 0.00000 004 R 0.00000 004 W 0.00000 004 TVHC 0.00000 005 A 0.00000 005 B 0.00000 005 R 0.00000 005 W 0.00000 005 TVHC 0.00000 006 A 0.00000 006 B 0.00000 006 R 0.00000 006 W 0.00000 006 TVHC 0.00000 007 A 0.00000 007 B 0.00000 007 R 0.00000 007 W 0.00000 TVHC (Total Vola~e Hydrocarbons) values repoaed ~ milligramMiter (rog/L). Tracer v~ues reposed ~ mi~igramMiZr (rog/L). 0.0000 = Not Detected -999999.9999 = No sample Tracer Research Job No. 860009 Page 4 of 5 Sample Date: 06/24/02 CONDENSED DATA Location Compound Concentrafion(mg/L) 007 TVHC 0.00000 008 A 0.00000 008 B 0.00000 008 R 0.00000 008 W 0.00000 008 TVHC 0.11100 009 A 0.00003 009 B 0.00000 009 R 0.00000 009 W 0.00000 009 TVHC 0.00000 010 A 0.00000 010 B 0.00000 010 R 0.00000 010 W 0.00000 010 TVHC 0.00000 011' A 0.00004 011 B 0.00000 011 R 0.00000 011 W 0.00000 011 TVHC 0.00000 012 A 0.00000 012 B 0.00000 012 R 0.00000 · 012 W 0.00000 012 TVHC 0.00000 013 A 0.00000 013 B 0.00000 013 R 0.00000 013 W 0.00000 013 TVHC 0.00000 014 A 0.00001 014 B 0.00000 TVHC (Total Vo~file Hydrocarbons) values reported h milligrams~iter (rog/L). Tracer v~ues ~po~ed ~ mi~igrams~i~r (rog/L). 0.0000 = Not Detected -999999.9999 = No sample Tracer Research Job No. 860009 Page 5 of 5 Sample Date: 06/24/02 CONDENSED DATA Location Compound Concenffafion(mg/L) 014 R 0.00000 014 W 0.00000 014 TVHC 0.00000 015 A 0.00000 015 B 0.00000 015 R 0.00000 015 W 0.00000 015 TVHC 0.00000 016 A 0.00008 016 B 0.00000 016 R 0.00000 016 W 0.00000 016 TVHC 0.00000 017 A 0.00000 017 B 0.00000 017 R 0.00000 017 W 0.00000 017 TVHC 0.00000 018 A 0.00000 018 B 0.00000 018 R 0.00000 018 W 0.00000 018 TVHC 0.00000 TVHC (Total Volatile Hydrocarbons) values reported in milligrams/liter (mg/L). Tracer values reported in milligrams/liter (reg./L). 0.0000 = Not Detected -999999.9999 = No sample Tracer Renearch Corporation Tank 2 Tank 3 Tank 4 12,000 gal 12,000 gal 12,000 gal Plus Unleaded Premium Tracer [B] Tracer [R] Tracer [W] vapor .- ...... .- ................... .- ......... q 10 0 7 0 6 O 3 _oC~ 16 15 13 [ ...... -e- ..... ~ .......~ ...... "2 (Typical) 14 12 11 "l // 17 Dispensers / 9 8 5 4 ,,: 0 0 0 18 ~an~ 1 12,000 gal Unleaded Tracer [Al o Concrete Asphalt vents 0 Building S£oz'e 860009 Jaco #355 Howards Market E X P LA NA T I ON m · ! Sampling Probe__ .-L°cati°n 0~6 12 [ ......... SAMPLING LOCATIONS ] Approximate ~lpe±lne Location f e e t · Complete items I 2, and 3. Aisc complete item 4 if Restricted Delivery is desired. ., ,~,-. ~ / ! ,/,///~/'~ I//~,/~ [] Agent · Print your name and address on the reverse ~'~Z~J~/~/~ ~'~./~/' ?' / ~ Addressee so that we can return the card to you. ~ ~c~v~lby (~iOt~a~) ~ C. Date of Delive~ B A~ach this card to the back of the mailpieCe,or on the front if space permits. D. Is delive~ a~dm~ differ~t from it~ 17 ~ Yes 1. AAicle Addressed to: If YES, enter delive~ address below: ~ No HOW~DS M~I M~T 4201 BELLE TE~ACE BA~RSF~LD CA 93309 3. Se~ice Type ~ Ce~ified Mail ~ Express Mail ~ Registered ~ Return Receipt for Merchandise ........................ ~ ~ Insured Mail ~ C.O.D. 4. Restricted Deliver? (Extra F~) ~ Yes 2, A~icle Number ~nsferfromse~icela~l) 7002 3150 0004 9985 3448 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1~0 OF ,tC AL USE Postage ~ r-1 Return Reclept Fee Pos'mla~ r'~ (Endorsement Required) Here r-~ Resalcted Delivery Fee Ltl (Endorsement Required) IT} Total Postage & Fee~ ;~ July 8, 2003' CERTIFIED MAIL F!RE CHIEF Howards Mini Market ~:C,N FR,AZE 4201 Belle Terrace ADMINISTRATIVE SERVICES Bakersfield, CA 93309 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 REMINDER NOTICE SUPPRESSION SERVICES ° 2101 "H' Street Re: Deadline for Dispenser Pan Requirements December 31, 2003 Bakersfield, CA 9,~301 VOICE (661) 326-3941 FAX (661) 395-1~,49 Dear Underground Storage Tank Owner/Operator: PREVENTION SERVICES ~715 Ch.sterAve. A review of our files indicate that you have been receiving quarterly mmindcm Bakersfield, CA 93301 from April of 2002 to December 2002. Our files further show that since January VOICE (661) 326-3951 FAX (661)326-0576 of this year you have been receiving monthly reminders. ENVIRONMENTAL SERVICES 1715 Chester Ave. The purpose of this letter is to remind you of the necessary retrofit of your fueling Bakersfield. CA 93301 SYstem. Current code requires that you install under dispenser containment pans VOICE (661) 326-3979 FAX~661) 326-0576 prior to December 31, 2003. You will not be allowed to pump fuel after December 3 I, 2003 unless you have completed the upgrade requirements. TR/~,NING DIVISION 5,~{2 Victor Ave. Bakersfield, CA 93308 Contractors are already scheduling 8-10 weeks in advance. I urge you to retrofit VOICE (661)309-4697 FAX (661) 399-5763 your facility as soon as possible. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, Ralph Huey Director of PreVention Services By: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SU:db D July 1, 2002 Howards Mini Market 4201 Belle Terrace Bakersfield, CA, 93309 RE: Deadline for Dispenser Pan Requirement December 31, 2003 for Site Location at 4201 Belle Terrace, Bakersfield. FIRE CHIEF FR E REMINDER NOTICE ADMINISTRATIVE SERVICES 2101 "H" Street Dear Underground Storage Tank Owner, Bakersfield, CA 93301 VOICE (661)326-3941 FAX (661) 395-1349 You will be receiving updates from this office with regard to Senate Bill 989 which went into effect January 1, 2000. SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 This bill requires dispenser pans under fuel pump dispensers. On December VOICE (661) 326-3941 FAX (661)395-1349 3 1, 2003, which is the deadline for compliance, this office will be forced to revoke your Permit to Operate, for failure to comply with the regulations. PREVENTION SERVICES 1715 Chester Ave. Bakersfield. CA93301 It is the hope of this office, that we do not have to pursue such action, which VOICE (661)326-3951 FAX (661) 326-0576 is why this office plans to update you. I urge you to start planning to retro-fit your facilities. ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 If your facility has been upgraded already, please disregard this notice. VOICE (661) 326-3979 FAX (661)326-0576 Should you have any questions, please feel free to contact me at (661)326- 3190. TRAINING DIVISION 5642 Victor Ave. VOICE (661) 399-4697 ., FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services FIRE W June 5, 2003 ~P A R T M J~ T~ ~~ Howard's Mini M~ket 4201 Belle Te~ace Bakersfield CA 93309 REMINDER NOTICE ;~s c~_F RE: Deadline for Dispenser Pan Requirements December 31, 2003 F~OH FRgZE ADMINISTRATIVE SERVICES 2101 "H' Street Dear Underground Storage Tank Owner: Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 A review of our files indicate that you have been receiving quarterly SUPPRESSION sERVICES reminder notices since April of 2002. Effective January 2003, you can 2101 "H' Street expect them monthly. Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 The purpose of this letter is to remind 'you of the necessary retrofit of your fueling system. Current code requires that you install dispenser PREVENTION SERVICES F,.ESAFmS~.~S......O..~..~SE.~:ES pans prior to December 31, 2003. You will not be allowed to remain 1715 Chester Ave. Bakersfield, CA 93301 open after December 31, 2003 unless you have completed the upgrade VOICE (661)326-3979 requirement. Contractors are already scheduling work 6-8 weeks out. FAX (661) 3264)576 I urge you to start planning to retrofit your facility as soon as possible. PUBLIC EDUCATION 1715 Chester Ave. oJ ,.ve;ncerel", Bakersfield, CA 93301 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 Steve Underwood FAX (661)326-0576 Fire Inspector/Environmental Services TRAINING DIVISION Office of Environmental Services 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 SBU/rs May 7, 2003 Howard Mini Market 4201 Belle Terrace Bakersfield CA 93309 FIRE CHIEF REMINDER NOTICE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 RE: Deadline for Dispenser Pan Requirements December 31 2003 FAX (661) 395-1349 ~ SUPPRESSION SERVICES Dear Underground Storage Tank Owner: 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 A Review of our files indicate that you have been receiving quarterly FAX (661) 395-1349 reminder notices since April of 2002. Effective January 2003, you can PREVENTION SERVICES expect them monthly. RRE SAFETY SERVICES. ENVlRONM~NT,M. SERVICES 1715 Chester Ave. Bakersfield, CA 93301 The purpose of this letter is to remind you of the necessary retrofit of VOICE (661) 326-3979 FAX (661) 326-0576 your fueling system. Current code requires that you install dispenser pans prior to December 31, 2003. You will not be allowed to remain PUBLIC EDUCATION after December 31, 2003 unless you have completed the upgrade open 1715 Chester Ave. Bakersfield, CA 93301 requirement. Contractors are already scheduling work 6-8 weeks out. VOICE (661) 326-3696 FAX (661) 326-0576 I urge you to start planning to retrofit your facility as soon as possible. FIRE InVESTIGATIOn Sincerely, Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 Steve Underwood VOICE (661) 399-4697 FAX (661) 399-5763 Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc TRACER TIGHT® TEST RESULTS Prepared for: 7/17/2002 Shirley Environmental LLC Job No: 860009 1928 Tyler Avenue, Suite K Jaco #355 - Howard's Market South El Monte, CA 91733 4201 Belle Terrace Testers St Lic. No: N/A Bakersfield, CA 93309 SYSTEM STATUS SYSTEM # PRODUCT SIZE TRACER TRACER DETECTED? 1 Unleaded 12,000 A NO 2 Plus 12,000 B NO 3 Unleaded 12,000 R NO 4 Premium 12,000 W NO Soil permeability is ~reater than 26.1 darcys. GROUND WATER INFO SYSTEM # DEPTH / GROUND WATER DEPTH / TOP OF TANK DEPTH / BOTYOM OF TANK (Inch) (Inch) (Inch) Tank 1 >150 43 139 Tank 2 >150 44 140 Tank 3 >150 51 147 Tank 4 >150 52 148 SITE COMMENTS Back fill in tank pits consists of tight packed sand. Backfill in piping trench is tight packed sand. Ground cover over tanks and pipeing trench consists of fractured asphalt. TEST EVENTS INSTALLATION INOCULATION SAMPLING ANALYSIS 6/11/02 6/11/02 6/20/02 6/24/02 FILL RISER- SPILL BUCKET TEST TANK # PASS/FAIL Tank 1 PASS Tank 2 PASS Tank 3 PASS Tank 4 PA S S Submitted by: TEST COMMENTS General Tanks 1 through 4 are single walled lined steel. Product distribution, vent, vapor recovery piping and stage II vapor recovery piping is single walled steel. Tanks 1 Through 4 No detectable Tracer's in the tank excavation zone. There were very light TVHC (Total Volatile Hydrocarbons) detections in samples from the tank excavation zone. Product Distribution Lines, Stage 1 and 2 Vapor Recovery Lines and Tank Vent lines No detectable Tracer in line excavation zone. There were no TVHC (Total Volatile Hydrocarbons) detections in samples from the piping excavation zones. Conclusion Tank and line components are Enhanced Tracer Tight® at the time of testing. Submitted by: Jimmy Humphries Tracer Research Corporation oldtugs ON = 6666'666666- po~ooloG lON= 0000'0 · (-ld'&u) a~.q/smv~..~tu m. pa~od~ sOn~A ~O0RI~ '(2/~tu) ~m.ri/stu~..qlgU ~ pa~odoa sOn~A (suoq, re~ap~H Olt3UlOA l~O~) DHA,L 00000'0 A~ LO0 00000'0 ~ LO0 00000'0 ~ LO0 00000'0 ¥ LO0 00000'0 DI-IA~ 900 00000'0 AX 900 00000'0 ~ 900 00000'0 ~ 900 00000'0 ¥ 900 00000'0 DI-IAJ. ~00 00000'0 A~ ~00 00000'0 ~ ~00 00000'0 fl ~00 00000'0 V ~00 00000'0 DHAJ~ ~00 00000'0 A~ ~00 00000'0 ~ ~00 00000'0 ~ ~00 00000'0 V ~00 00000'0 DHAJ. ~00 00000'0 A~ ~00 00000'0 ~ ~00 00000'0 ~ £00 00000'0 V £00 00000'0 DHA~L ~00 00000'0 A~ ~00 00000'0 ~ ~00 00000'0 ~ ~00 00000'0 V ~00 00000'0 9HAJ. I00 00000'0 A~ lO0 00000'0 ~ I00 00000'0 ~ I00 00000'0 V I00 ("I/'dm)uo.~.~ua:~uoD punodmoD uoo~o'-I V,I.V(I (I~ISN~(INOD i~0/~,U90 :o~e(I aldmgs ~ Jo ~ a~d 600098 'oN qof qoI~OSO~/Iool~iJ~ Tracer Research Job No. 860009 Page 4 of 5 Sample Date: 06/24/02 CONDENSED DATA Location Compound Concentrafion(mg/L) 007 TVHC .0.00000 008 A 0.00000 008 B 0.00000 008 R 0.00000 008 W 0.00000 008 TVHC 0.11100 009 A 0.00003 009 B 0.00000 009 R 0.00000 009 W 0.00000 009 TVHC 0.00000 010 A 0.00000 010 B 0.00000 010 R 0.00000 010 W 0.00000 010 TVHC 0.00000 011 A 0.00004 011 B 0.00000 011 R 0.00000 011 W 0.00000 011 TVHC 0.00000 012 A 0.00000 012 B 0.00000 012 R 0.00000 012 W 0.00000 012 TVHC 0.00000 013 A 0.00000 013 B 0.00000 013 R 0.00000 013 W 0.00000 013 TVHC 0.00000 014 A 0.00001 014 B 0.00000 TVHC (Total Volatile Hydrocarbons) v~ues reported in milh'grams/liter (mg/L). Tracer vflues reported in milligrams/liar (mg/L). 0.0000 = Not De~c~d -999999.9999 = No sample Tracer Research Job No. 860009 Page 5 of 5 Sample Date: 06/24/02 CONDENSED DATA Location Compound Concentration(mg/L) 014 R 0.00000 014 W 0.00000 014 TVHC 0.00000 015 A 0.00000 015 B 0.00000 015 R 0.00000 015 W 0.00000 015 TVHC 0.00000 016 A 0.00008 016 B 0.00000 016 R 0.00000 016 W 0.00000 016 TVHC 0.00000 017 A 0.00000 017 B 0.00000 017 R 0.00000 017 W 0.00000 017 TVHC 0.00000 018 A 0.00000 018 B 0.00000 018 R 0.00000 018 W 0.00000 018 TVHC 0.00000 TVHC (Total Volatile Hydrocarbons) values reported in milligrams/liter (mg/L). Tracer values reported in milligrams/liter (mg/L). 0.0000 = Not Detected -999999.9999 = No sample Tracer Research Corporatio~ Tank 2 Tank 3 Tank 4 12,000 gal 12,000 gal 12,000 gal Plus Unleaded Premium Tracer [B] Tracer [R] Tracer [WI vapor Disp ...... Disp ...... R y ...... J ...... ~- ................... ~- ......... n z0 o ~ (Typical) /! 17 Dispensers Dispensers ;/ 9 8 5 4 ,' 0 O O O / ° Tank 1 o o o o 12,000 gal Unleaded Tracer [A] Vents Concrete Asphalt o Building Store 860009 % Jaco #355 Howards Market EXPLANATION N iAKERSF I ELD , CALl FORNIi 'Z Sampling Probe Location 0 8 ~2 .......... SAMPLING LOCATIONS ...... Approximate Pipeline Location f e e t D April l0,2003 Howard Mini Market 4201 Belle Terrace Bakersfield CA 93309 REMINDER NOTICE RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakorsfleld, CA 93301 RE: Deadline for Dispenser Pan Requirements December 31, 2003 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Underground Storage Tank Owner: SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93,301 A Review of our files indicate that you have been receiving quarterly VOICE (66t) 326-3941 reminder notices since April of 2002. Effective January 2003, you can FAX (661) 395-1349 expect them monthly. PREVENTION SERVICES FIRE SAFEW SERVICES · ~MF.~TJU. SER~ICE8 1715 ChesterAve. Thc purpose of this letter is to remind you of the necessary retrofit of Bakersfield, CA 93301 your fueling system. Current code requires that you install dispenser VOICE (661) 3263079 FAX (661)326-0576 pans prior to December 31, 2003. You will not be allowed to remain open after December 31, 2003 unless you have completed the upgrade PUBLIC EDUCATION 1715 ChestorAv~. requirement. Contractors are already scheduling work 6-8 weeks out. Bakersfield, CA 93301 I urge you to start planning to retrofit your facility as soon as possible. VOICE (661) 326-3696 FAX (661) 326-0576 1715 Chester Ave. ::' BakersfleM, CA 93301 VOICE (661) 326-3951 FAX (661) 3260576 TRAINING DIVISION Steve Underwood 5642 Victor Ave. Bakersfield, CA 93308 Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-4697 . FAX (661) 399-5763 Office of Environmental Services SBU/dc CONTINUED (See 2na File) UN T Construction & MECHANICAL (661) 871-1788 Continuous Monitorinc Device Certification TEST DATE t ~ ~' ,~ '~ O~')('~,~ FACILITY NUMBER 355 ADDRESS F20~ O~://~ 7~rr~ TELEPHONE~t- ~. 7~0 Cl~ ~~~/~/ ~, ZIP CODE ~ 3 ~ 0 ff MA.. ~N. Mo... o. MON,~O.,N~ S~S~.~ ~. } ~'0 TANK 1 TANK 2 TANK 3 TANK 4 Contents of Tank ~ ~/u ~ {/N/~ G~ Capacity of Tank ~ ~) ~ ~ Type of Product Line' (Gravity, Suction, Pressure) ~~ ~., ~ ................. ~' INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OR NO IN THE APPLICABLE BOX: Annular Space Sensor Sump Sensor Dispenser Containment Sensor /t~/L"2 "~ Electronic Overfill/Level ~ /FO .~ Electronic In-Line Leak Detector ..... Mechanical Line Leak Detector In-Tank Gauging Device ~ .... INDICATE THE FOLLOWING BY PLACING A YES OR No IN APPLICABLE BOX: Does the Monitoring System have audible and visual alarms? ! Does the turbine automatically shut down if the system detects a leak, fails to operate or is electronically disconnected? Is the monitoring system installed to prevent unauthorized tampering? /'C' Is the monitoring system operable as per the manufacturer's specifications? Which continuous monitoring devices Initiate positive shut down of the turbine? CERTIFIED TESTER'S ID#~,~'~C~<'/~. /-, ~.,~/" ~ SIGNATURE OF CERTIFIED TECHNICIAN , .....¢7c~4:.:..~,.,.'2."( .A,v,. o. TESTING COMPANY NAME & TELEPHONE CERTIFICATION DATA CC~RECTION NOT Ijl~, BAKERSFIELD FIRE DEPARTMENT N_° 1 0 0 2 Location .J-J~t~Y~ a2J.5 Sub Div. ~e i ~e[[c ~ r,~Blk. . ~t You are hereby required to make the following cor~etions at the above location: Cot. ~o Compl~'oon Date fo,' Correetions#J (/g)~.~) Date !0/2~J/~fi) ..~ ~f~ ' '~ ~nspect0r 326-3979 OL L~:~(;E ~;':,.'- .; "' = ._ ..., o .;. HEIGHT ~ 51,74 INC:HES HOL,J~DS E, bJ~TER VOL = 0 GALS 42F~1 EIELLE 'I'ERR~,.i;E b..I~TER = 0, OCt IN(:HES ~ 7.~. (?f%. q::i:'~rtq TEMP = 82.6 DEl F OOT 27. 20F) 8:40 ~l'"l T :3:IJNLE~DED 2 V'8, LLIME = 4904 UL ~' '""~;E = 7096 C;~LS 9t JLLa,3E= 5896 GaLS ~ ~h"STEPI ST~TUS'-RF;pO~?T- T(~)LIJI'.'IE = 4792 G~LS ............. HEIGHI = 40.88 INC;HES b. JATER = iii, I)0 I NE;RES I I'.ru'ENT,3,F:y REPORT TEMP = 92,4 DEC; F T: JNI,E&DE[', 1 ~_-l:- 4: PREP1 :f I:IH ........ b"(~°li'lE = 10OK5 ~2~LS WOLIjPIE: = 44'72 GaLS ULL~t3E = 1995 C~f~L.S IJLLf¥3E :~ 752z 90'S: ULL~E;E= 795 C~LS 90:'-.;:; II.i.~.3E= 6:32E C4f~LS TC 'v'OLLIPIE = 9~46 t3RLS TO V&LLIME 4..:,,. _, (3~LS HEIGHT = 74.21 INCHES HEI,3HT = 38.14 INCITES I.,,.I~TER VOL = 0 '-'" o t,,~&TER = O, 00 INCHES I.-J~TER = 0,71 1NC:HES TEMP = 82.6 DE3 F TF' = 9C.? [,EG F ; CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME /4ot~ar, dfi ~unt IIAtr{ ~ INSPECTION DATE it~[J ADDRESS O9.OI -' _13e. llt' '-Get'ate_ PHONENO. ~qT' 76~(9 ' FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~ Routine [~Combined [~l Joint Agency [~ Multi-Agency [~ Complaint l~ Re-inspection OPERATION C: V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities L, ' Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~l Yes [~l No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 White-Env. Svcs. Yellow - Station Copy Pink-Business Copy Ins pectorl CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME..~0UJttfd~ ]h. lvx, ~l/l(tx~ *(o INSPECTION DATE Section 2: Underground Storage Tanks Program [~[ Routine [~ombined [] Joint Agency [] Multi-Agency ,t//[] Complaint [] Re-inspection Type of Tank .a--t0{:: Number of Tanks Type of Monitoring ,art¢ Type of Piping OPERATION C V COMMENTS Proper tank data on file %,/ Proper owner/operator data on file kd/ Permit tees current ~ ) /~0 Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations 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? C=Compliance V=Violation Y=Yes N=NO Office of Environmental Services (805) 326-3979 ~u3:,i~C$s oi~c ..os~:tsi lehl~a, rty White - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD '- r 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STOOGE TANKS - UST FACILI~ (Check~ OFoneACTION/~m on~) ~ 1. NEW SITE ~RMIT ~ 3. RENTAL PERMIT ~ 5. CHANGE OF INFOR~TION (~ec~ c~a~ - ~ 7. PER~NENTLY CLOSED SI~ ~. local use only) ~ 8. TANK RE~VED AMENOEO ~RMIT ~ 6. TEM~Y S~E CLOSURE I. FAClL~ I SITE INFORMATION N~REST CRO~ STREET ~1. FACIL~ O~ER ~ ~ 4. LO~ AGENCY~IS~IC~ 6. STATE AGENCY' ~SUSINESS . ~ STA~ON ~ 3. F~ ~ 5. ~ERC~ ~ ~ ,, ~ ~TNERSHIP ~ 2. DISTRIBUTOR ~ 4. ~CES~R ~ 8. O~ER ~. ~' 7. FEDE~ AGENCY* TOTAL NU~ER OF T~KS J ~ f~li~ ~ In~ ~ ¢ · ~ ~ UST a public ~ ~e ~ su~ ¢ (~ ~ ~e ~ p~ f~ ~ ~ r~.) II. PR~ O~ER INFO~N ~O~R~ O~R~ ~7. J ~NE ~O~R~ O~ER~E ~ Z I~1~ ~ 4. L~AGEN~/DISTRI~ ~ 6. STA~AGENCY 41). 1, ~TION ~. P~SHIP ~ 5. ~U~ A~N~ ~ 7. F~E~ AGENCY .. m.T~~ER~FoR~ :' - T~K O~ER ~ 414. ~ 415. ~ 1. ~T~N ~3. P~ER~IP ~ 5. ~U~AGEN~ ~ ~. FEDE~AGE~Y ~. BO~D OF EQU~TDN ~T 8TO.GE FEE ACCOU~ NUMBER INDI~TE M~S) ~1, SE~-INSURED ~ 4. SUR~ ~NO ~ 7. STA~ FUND ~ 10. LOlL ~ ME--ISM ~ 2, ~A~E ~ 5. ~i iEROFCREDff ~ 8. STATE FUNO&CFO LEi I~ ~ ~. OTHER: ~ 3. INSU~CE ~ 6, ~E~N ~ 9. STATE FUND & CD 4~. VI. LEGAL NOTIFICA~ON AND MAILING ADDRESS 2. ~R~ O~ER TANK O~ER VII. ~PLICANT SIGNA~RE UPCF (7/~) S:~CUPAFORMS~a.~O ;~ ~ CITY OF BAKERSFIELD :; OPIUE OF ENVIRONMENTAL t~RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNOEnGROONO STORAGE YANKS - YANK PAGi: ./ rvP~ OF ACTK}N 0 ~. NEW ~TE ~ ~4. M~I~O PERMIT rls. ~ ~ ~OM~N) ~ ~. ~Y ~E ~0~ OI~FICE OF E~IRONMENTAL .ERVICE. ~ SYSTEM ~ ~t ~E~URE ~ 2. ~uCT~ ~ 3. ~ 4M ~ t ~E~RE ~ 2. ~N ~ 3. ~ i ~FAC~RE~ ~f 17. DAJLY~CHE~ ~ 17. O~LY~E~ UPCF (7~) S:~CUPAFORMS~8.~C ;_.~._ _ c~¥ o~ o~~n~.~.D 171~ Chester Ave., Bakersflel~ CA 93301 (661) 326-3979 ~ o~ ~N ~ t. ~ ~E ~ ~~o ~ ~ S. ~ ~ ~0~) ~ 4. ~Y ~E ~0~ OFFICE OF ENVIRONMENTAL SERVICES -' Cheerer Av~.. B4kellfleld, CA 93301 (~1) $28-3~7g ~ - ?ANK PA~f ~ UHOEJ~4~NO PIliNG I ASOYEGI~uNO PtPIHG TYPE j~ ~. PRESSURE CONSTRUCT~,~ 1. SI~eWA~ ~3. UN~T~ ~. Q~ER ~ ~ t. Si~Ew~ ~. U~ ~NUFAC~RERI~ 2. ~U~ W~ ~ ~. U~ ~ 2. ~U~E W~ ~ ~. OTH~ J ~FA~URE~ ' ~TECT~N ~ 3. ~~A~~ ~. U~ TEST(0.1 C.d:~) r'l e. TRI~IHTECd~rYTEST(0.1 C~ [] ~. s~ ~ [] ?. SF.J..F JvK::)Hrro~ 0 o. mFje~.KrEc.,mTYT~.s'r(o.s ~ I:~.JMPS~fUTOFFVVt. FJdA ~CX~.J~ ~ a. AUTO J:~,JMPSHtrroFF WHENALF. AKOC.,C~JRS UTO PUMP SHUT OFF FOR ~ sY~rF.M FA&UI~ ~ SY~'EM [] I). AUTO PUMP SHUT OFF FOR LEAJ~. ~'YSTEM FAILURE ~l c NO AUTO PUMP SHUT OFF I--1 c HO AUTO J:~JMP ~a.nJ'r OFF l-1 ~s. AUTO~LE~C~rECTO~(3.0OPHTES'T)W~THFLOWSHUTO~OR C] 11. ~UJTOI~T~CLF_AXD~'TEGTOR I--1 ~2. ~HU~.u'~rE(~"T~'TE~r(0.10F~-O [~ 12. N~.I~TE~'T'(0.1 · 13. CONTIFAJOU~UMPS~480R*AUOI~L1~A~IDVTSU/~IL~a~4~ 0 13. C~NTIHUO~SS~4~SEN$OR'"ALK)ISLE/d'iOVI,~J,~.N.ARM8 14. CONT1NU~JSSUI~SEN~ORWrI'H(~T~~$AUOiOLEANO 0 14. C:oFmh%IOU.~tJI~4~EN~ORW~rH(Xr~AUTOPUMPaI'flJI'(:~'F*~,~'iC)VlSU,~,L iS. AUI'OI~'rtcuNE ~C)~rrE~roR(3.0(~Fq4 TEST)wm'K~trT~SHUTOFFOR [] 1~. AUT01~I'K:LINELE,~0ETECTOR(3.0(3FHTESl'} ICI~e. ~Nu~ (o.~ (~) ~e. ~u~ ~EC~l~ (o.~ G~) ~ST ~ST I 17. OAJLY VISUAL CHECK I r-1 17. ONLYVI~UALCHEC~ · ':'-..". DISPEN~ERCONTAJNMENT ~1 1. Ft,OATMECHAf~SMTHAT~HUT~OFFSHP. ARVALV~ ~,,,4~DAJLYVI~JAI. G~,K OA?EINSTN. LEO 448 0 2. COtfTIMJO~GISPE/,~ERPAH~EN~O~$AUOI~.EANOVISUALAL~qMS '~L~. ~UNE~IMON~ [] 3. CGHTII~KJO4J8 ~ PAN ~ WITH AUTO ~.IUT OFF FOR OISPEN~.R NAME~WNERa3 PERATO I~i(P~ ~ ~ / 4}'1 TITLEpF,~W~F~._PERATOR Ipwm~Num~'(Fo?~ocalu~eoely) 473 ~ ~ (r~/~d~ 474 pem~Oet~(Fe~logelu~eo,'t~) UPCF (7/9g) $:~CUPAFORM$t,.qVVRC~.WP£ o~:g o~ ~vmo~~T,~~vlc~s 1715 Chester Ave., Bakersfleld~ CA 9330T'(661) 326-3979 UNDERGROUND STOOGE TANK~ - TANK ~AGE 1 ~r~N ~ ~ ~ L TANK DE$CRg~ION "rANK mO m 432 / TEST (0.1CIPH) SAFE SUCT~N SYSTE~4S (NO VALV~.~ ~N ~.OW GROUND P~ SAFE SUCTION SYSTEMS (NO VN.V~$ ~ 8~.OW G~OUNO I~G~ I-i 7. SELF MO~aTO~NG n 7. G.c~A~ FLO~. GRAVITY FU3w (C~4c~ M ~at C] ~. mEN~W.~TE~(O.~(~) 0 & UPCF (7/99) S:\CUPAFORM,.%'~WIRCB~.WP £ c,Tv aa asns , OF~i?E OF ENVIRONMENTAL ~RVICES 1715 Chester Ave., Bakersfield, CA 933~(661) 326-3979 UNDERGROUNO STOOGE TANKS - TANK PAGE 1 ~ 0¢ ~N ~ ~' ~ ~ ~ · ~0 ~R~ ~ ~. ~ ~ ~0~) ~ ~- ~Y ~ ~O~ (~~'~ ~ ~) (~~'~~) ~ 8. IL ?~LqK ~ 0,~~~ 04.~ 0~.o~ ~T~~ ~~1 ~ ~ ~a,~ ~ 4. ~~~ 0 · ~A~I~~ 0~. O~ Os.~ 0~~ 0,.~~ 0~ 0~.o~ ' T,'.:~'~S~'R,~ ':' ~.~i~,~ >..,'F ~%'.'&: ~ .~l ..... ~,:~ ~'X*~=.?'.,;:,.'. ..... .q~:....." '"~;" .7' }' ~(~~~ ~ s. ~T~~(~O} ~ 1. ~(~w~v~r~ V. T~ ~U~ ~~ I PIR~ ~U~ IN ~ CF (7~) 8ACUP~ORM~~'~c CITY OF eAKER~IFIEI. D ~ OFFIGE OF ENVIRONWIENT~L. ~ERVICE~ ~ (:heater Ave.. Bakemtl~ld. CA 93301 (6~1) ,n UIT ' ?~NK P4qr svsr~ rvp~ .,l~. P~Essu~ I~.~. ~UCTCN a ~. (:l~AvrrY 4M I-1 ,. P~ssu~E [] 2. ~T~ON a ~. GAAVTTY UPCF (7,,.99) S:\CU PAFORM.,%%SWRCB-B.WP £ ~ CITY OF BAKERSFIELD OF~::E OF ENVIRONMENTAL Si~I~VICES ~ '1715 Chester Ave., Ba:k. ersfleld, CA 9330'1 (661) 326 3979 UNDERGROUND STORAGE TANKS-INSTALLATION CERTIFICATE OF COMPLIANCE One form per tank Page - I. FACILITY IDENTIFICATION BUSINESS. NAME (Same a~, FA~rLITY N~ME et C)~A. I~ ~ A~) __ ~ [ ................................... II. INSTALLATION " Check a/I that eppty · ~"~* The Installer has been certified by lhe tank and piping manufacturers. 13 The installation has been inspec*~l and certified by a registered professional engineer. ~ The installation has been Inspected and approved by the City of Bakersfield Office of Environmental Services. '~ All work listed on the manufacturer's installation checklist has been completed. 13 The installation contractor has been certified or licensed by the Contractom 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 .... .................. _ CITY OF BAKERSFIELD I'~. OFIR~E OF ENVIRONMENTAL S~VICES 1715 Chester Ave., Bakersfield, CA 93301 ,r (661) 326-3979 UNr~E;O;OUNO STO~OE T^NKS- CERTIFICATE OF COMPLIANCE One fo~ per tank - I. FACILI~ IDENTIFICATION II. INSTALLATION " Check all lhat apply · ;~ The installer has been certified by the tank and piping manufacturers. [] The installation has been insped,~:l and certified by a registered professional engineer. ~ The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. ~]~ Ail work listed on the manufacturer's installation checklist has been completed. [] The installation contractor has been certified or licensed by the Contractors State License Board. [] Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify method: IlL TANK OWNER/AGENT SIGNATURE S-~T~-" ~ .... ~I~/~'C~ .............. 0ATE ~_~/F~ ~_.~ ~ ' ...................... ~ CITY OF BAKERSFIELD ~ O~E OF ENVIRONMENTAL S~VICES * ~ 1715 Chester Ave,, Bakersfield, CA 93301 · (661) 326-3979 o UNDERGROUND STORAGE TANKS-INSTALLATION CERTIFICATE OF COMPLIANCE One form per tank · -~ -- -"l"- I. FACILITY IDENTIFICATION FJ~ClU'rYID_.L I i III :-I ~ I i i I I I I TA/,eCID# ~ , :~..~s,, ii: m l~ IIII I ~-.~ _v~L-~___~ ~,~'~/~~&"~~~' II. INSTALLATION Check ~/I ~at a/~/y ~ The Installer has been certified by the bink and piping manufacturers. l-I The installation has been insped~d and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. [3 The installation contractor has been certified 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 CITY OF BAKERSFIELD ~. OF'E OF ENVIRONMENTAL,VICES ~ 1715 Chester Ave., Bakersfield, CA 93301 r (661) 326-3979 UNDERGROUND STORAGE TANKS-INSTALLATION CERTIFICATE OF COMPLIANCE One form per tank Page ~ o~ - I. FACILITY IDENTIFICATION 8U,~,~ES3 NAME (Same~a~ ;ACII.ITY NAME or OOA. Oo~a Ou~,ne~ ~) r, ~ . ! t ................................... II. INSTALLATION Check a/I ghet epp/y ~ C] The Installer has been certified by the tank and piping manufacturers. ID The installation has been insped~l and certified by a registered professional engineer. C] The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. [] All work listed on the manufacturer's installation checklist has been completed. 0 The installation contractor has been certified or licensed by the Contractors State License Board. C] Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify_ method: III. TANK OWNER/AGENT SIGNATURE , _~,__~ ~.' _,~...~. ~__~L~_ _.~._,~, a._,~. ,, 0~..~_,, ~ ~ ~ Bakersfield Fire Dept.e HAZARDOUS MATERI.ALS DIVISION " 2130 G Street, Bakersfield, CA 93301 (805) 326-3970 UNDERGROUND TANK QUESTIONNAIRE I. FACILITY/SITE No. OF TANKS ' F FO I/~Wc~ ~ ttlB'd ............ PARCEL ~.(O~ONA L) ~ ~OX TO INDICATE ~ CORPORATION ~IVIDUA[ ~ PAR~ERSHIP ~ lOCAL AGENCy DIS~IC~ ~COUN~ AGENCY ~ S~ATE AGENCY ~FEDE~L AGENCY ~PE OF BUSINE~ ~S STATION ~ 2 DISTRIBUTOR I KERN COUN~ PERMIT . - ~ ' EMERGENCY CONTACT PERSON (PRIMAR~ . _ EMERGENCY CONTACT PERSON (SECONDAR~ optional DAYS: NAME (~ST. FIRS~ PHONE ~. WITH ARC. P* - .', . DAYS: NAME (~ST, FI~ PHONE ~. WITH AR~ CODE NIGHTS: NAME (~ST, FIES~ PHONE ~. WI~ A~ CODE ~ N G ~: NAME (~. FI~ PHONE ~. WITH AE~ CODE II. PROPER~ OWNER INFORMATION (MUST BE COMPLETED) NAME CARE OF ADDEE~ INFORMATION MAILING OR ST~E~ ADD~ESS ~ 6OX ~ I~UAL ~ LOCAL AGENCY' ~ STATE AGENCY ~-- ~ Z C~~ ~~ TO INDICATE ~ARTNE,SHIP 0 COU,~ A~ENCY 0 FED,~L A~ENCY III. TANKOWNER INFORMATION (MUST BE OOMPLETED) NAME ~ CA~E OF ADD~E~ INFORMATION MAILING O~ STREET ADD~ESS ~ SOX ~IDUAL ~ LOCAL AGENCY ~ STA~E AGENCY CI~ NAME ~ ZIP CODE ~ PHONE No. WITH AREA CODE OWNER'S DATE VOLUME PRODUCT IN TANK No. INSTALLED STORED SERVICE YIN YIN DO YOU HAVE FINANCIAL RESPONSIBILITY? Y~ TYPE CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ./-]da/attd5 ~;~ai /tlt:1c ~fo INSPECTION DATE Section 2: Underground Storage Tanks Program [~outine [] Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank AtO~ Number of Tanks Type of Monitoring ,qT'6, Type of' Piping /. OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file V/ Permit tees current l/ Certification of Financial R'esponsibility Monitoring record adequate and current V' Maintenance records adequate and current V 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? C=Compliance V=Violation Y=Yes N=NO // Inspector: ;~, Omce of Environmental Services (805)326-3979 'Business Site Responsible ~'arty White - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME //o~a,~.l_q i~,m, lltl~4[ ~& INSPECTION DATE ADDRESS ~~ qOol ~{[cT~NE NO. ~7- FACILITY CONTACT BUSINESS ID NO. I5-210- NSPECT ON Tree UM ER OF EMPLOVE S Section 1: Business Plan and Inventory Program [~]"Routine I~] Combined 1~1 Joint Agency 1~ Multi-Agency 1~1 Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand V Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location V Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate L~/ Containers properly labeled V / Housekeeping Fire Protection Site Diagram Adequate & On Hand V C=Compliance V=Violation Any hazardous waste on site?: I~l Yes [~No Explain: Questions regarding this inspection? Please call us at (805) 326-3979 While - Env. Svcs. Yellow - Station Cop), Pink - Business Copy BAKERSFIELD FIRE DEPARTMENT February 13, 1998 FIRE CHIEF MIGHAELR. KElly Howards Mini Market 4201 Belle Terrace ADMINIgTiOdlVESERVICE$ Bakersfield, CA 93309 2101 'H' Street Bake~eld, CA 93,~1 (805) 326-3941 FAX (806) 395-1349 $Ulqq~[SSlON S[II'VK~U RE: "Hold Open Devices" on Fuel Dispensers 2101 'H' Street Bakersfield, CA 9330 I (805) 326-3941 Dear Underground Storage Tank Owner: FAX (805) 395-1349 PUWNnON s~av~-~s The Bakersfield City Fire Department will commence with our annual 1715 Chester Ave. Underground Storage Tank Inspection Program within the next 2 weeks. Bakersfield, CA 93301 (805) 326-3951 FAX (805)326-0576 The Bakersfield City Fire Department recently changed its City Ordinance ENVIIB3NMENTAI.$ERVICES concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire 1715Chester Ave. Department now requires that "hold open devices" be installed on all fuel Bakersfield, CA93301 dispensers. The new ordinance conforms to the State of California guidelines. (80,5) 326-3979 FAX (8O,5) 326-0576 The Bakersfield Fire Department apologies for any inconvenience this 1RAINING DIVISION 5642 Victor Street may cause you. 8~kersfield, CA 93308 (805) 399-4697 vAx c~)3,~.57,5,3 Shoul.d you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey NUMBER OF TANKS TO BE TESTED IS PI~ING ~I~G TO BE T~ VOL~ -. co~z~s ~akersfield ¥ire Dept. OFf, OF ENVIRONMENTAL SER VICES 1715 Chester Ave. Bakersfield, CA 93301 Date Completed BusinessName: I-(,~rva~c(~ ihl~. , Location: q~lo [ [.g~.t(~_ Business Identification No. 215-000 ~ ~ ~ Cop of Business Plan) Station No. Shiff~ Inspector ~val Time: Depa~ure Time: Inspec~on Time: Adeq_,u/~te Inadequate Adeq_.~ate Inadequate Address Visable LV' [3 Emergency Procedures Posted Correct Occupancy ~ [] Containers Propedy Labled ~ I"1 Verification of Inventory Materials ~ [] Comments: Verification of Quantities ~,1~. Verification of Location I~,// r'l Verification of Facility Diagram Proper Segregation of Matedal 133/ [] Housekeeping 13'__/ i-I , Fire Protection 131// [] Comments: Electrical Comments: / Verification of MSDS Availablity ~ [] Number of Employees: ~' UST Monitoring Program ~// [] Comments: Verification of Haz Mat Training E3j/ [] Permits ~' [] Comments: Spill Control [] Hold Open Device I~ [] Verification of / Hazardous Waste EPA No. Abbatement Supplies and Procedures [;3/ [] / Proper Waste Disposal ~ [] Comments: Secondary Containment I:~/'/ [] Secudty Di/ [] Special Hazards Associated with this Facility: Violations: ....... / All Items O.K Busings O~anag~ PRINT NAME White-H~ Mat Div. Yello~Station C~y Pink-Business Copy UNDERGROUND STORAGETAN JSPECTION Bakersfield Fire Dept. FACILITY NAME ,/-~uJec~_(~ )ht~ ,' /~,'iac~- BUSINESS I.D. No. 215-000 ~( FACILI~ADDRESS ~0 I F~(~ ~r~t~ Cl~ ~ ZIP CODE ~ FACILI~ PHONE NO. ~ 7" ~O0 ~ ~ [q l INSPECTION DATE .q,.~1~ ~ Pr~uct Pr~uct Pr~u~ TIME IN TIME OUT d~ ~lo~ .~,~ ~t Insl ~te Inst Date Insl ~le INSPECTION ~PE: ( q ~ ~[ / ~ f ~ Size Size S~e ROUTINE FOLLOW-UP ~ ~ ~ ~ [~,~ O i~ ~0~ REQUIREMENTS yes no n/a yes no ~a yes no la. Forms A & B Submiff~ 1 b. Form C Submiff~ lc. O~rating F~s Paid ld. State Surcharge Paid le. Statement of Financial Res~nsibili~ Submiff~ lf. Wri~en Contract Exists ~een Owner & O~rator to O~rate UST 2a. Valid O~mting Permit 2b. Approved Wriffen Routine Mon~oring Pr~edure 2c. Unauthoriz~ Release Res~nse Plan 3a. Tank Integrity Test in Last 12 Months ~ 37/~ ~ ~ 3b. Pressur~ Piping Integrity Test in Last 12 Months V ~ ~. Suction Piping ~ghtness Test in Last 3 Years ~ ~ ~. Gravi~ Flow Piping Tightness Test in Last 2 Years ~ ~ ~. Test Results Submi~ed Within 30 Days ~ ~ 3f. Daily ~sual Mon~oring of Suction Pr~uct Piping~ ~ ~. Manual Invento~ R~onciliation Each Month ~ ~ ~ ~. Annual Invento~ R~onciliation Statement Submiff~ ~. Meters Calibrat~ Annually 5. Weekly Manual Tank Gauging R~ords for Small Tanks 6. Monthly Statistical Invento~ Reconciliation Results 7. Monthly Automatic Tank Gauging Results 8. Ground Water Monitoring 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Double-Walled Tanks 11. M~hanical Line Leak Detectors 12. El~tronic Line Leak Det~tors 13. Continuous Piping Monitoring in Sumps 14. Automatic Pump Shutoff Capabili~ 15. Annual Maintenance/Calibration of Leak Detection Equipment 16. Leak Det~tion Equipment and Test Meth~s Listed in LG-113 Series 17. Wriffen Records Maintained on Site ~ O 18. Re~ Changes in Usage/Conditions to Operating/Monitoring Pr~edures of UST System Within ~ Da~ 19. RepoSed Unauthorized Release Within 24 Houm 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tu~ INSPECTOR: ~ OFFICE TELEPHONE NO. FD 1~9 (rev. 9/~) -- - ~AYMENT TRANSFER REQUESTED BY ,,~--~7~'~',"- ~)m,~: ~ DATE ,/- J/-~ 7 DEPARTMENT ~ ~. ,.~c_s. PHONE ~,--~'- ,_~?'7~' PAYMENT TRANSFERRED FROM: CUSTOMER TYPE AND NUMBER CUSTOMER NAME PAYMENT DATE PAYMENT AMOUNT PAYMENT TRANSFERRED TO: CUSTOMER TYPE AND NUMBER CUSTOMER NAME PAYMENT AMOUNT APPROVED BY: ~-- SUBMIT TO ACCOUNTS'RECEIVABLE FOR PROCESSING BAKERSFIELD FIRE DEPARTMENT December 4, 1996 FIRE C,~EF JACO Oil MICHAEL R. KELLY P.O. Box 1807 ~MlnlSmnVE SE~CES Bakersfield, CA 93 3 03-1807 2101 'H' Street Bakersfield, CA 93301 (80,5) 326-3941 RE: Underground Storage Tanks located at Howards Mini Market #6, 4201 FAX (~) 395-13~9 Belle Terrace in Bakersfield. SUPPI~SSION SERVICES 2101 'H' Street Dear JACO Oil: Bakersfield, CA 93301 (805) 326-3941 FAX (805)395-1349 A~ I am sure you are aware, all existing single walled steel tanks that do not meet the current code requirements must be removed, replaced or upgraded to PREVENTION SERVICES 1715 Chester Ave. meet the code by December 22, 1998. Your tanks do not currently meet the new Bakersfield, CA 93301 code requirements and therefore fall into the remove, replace or upgrade category. (8O5) 326-3951 FAX (~35) 32643576 Your current operating permit expires on or before that date and of course will not be renewed until appropriate upgrade of your tank system is accomplished. ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield, CA 93301 In order to assist you and this office in meeting this fast approaching (805) 326.3979 FAX (805) 326-0576 deadline, I have attached a brief questionnaire addressing your plans to upgrade these tanks. Please complete this questionnaire and return it to this office by TRAINING DIVISION Thursday, December 1 9, 1 996. 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 If yOU have any questions concerning your tanks or if we can be of any [AX (805) 399-5763 assistance, please do not hesitate to contact this office. Sincerely, Ralph E. Huey Hazardous Materials Coordinator Office of Environmental Services REH/dlm attachment BAKERSFIELD FIRE DEPARTMENT May 15, 1 998 Mr. John Kerley JACO Oil Company RI~ CHIEF MICHAI~L R. KELLY P.O. Box 82515 Bakersfield, CA 93380-2515 ADMINISTRA11VE SERVICF~ 2101 'H' Street ~ok~-n~,Cfi~0~ RE: Howard, 4201 Belle Terrace (805) 326-3941 FAX (805) 395-1,149 Dear Mr. Kerley: 2~01 'H' ~t Last summer, you answered a survey concerning your underground storage tanks, 8~e~'fletcl, CA 9,3,301 (8~5) 326-394l stating that your tanks would be replaced by April 1'998. - ..... You did not meet FAXes) 3~-m9 that target date! ...... We are concerned! ~71s Ch~te~Ave. On December 22, 1998, your current underground storage tanks will become (805) 326-3951 illegal to operate. Current laws and code requirements would require that if your tanks FAX(~) ~-(~76 are not removed or upgraded by that date, your permit to operate would be revoked, - - it will be illegal for any fuel distributer to deliver fuel to your tanks, - - and your tanks ENVIRONMt:NT~L'~iI'VICE$ would then be considered illegally abandoned and require that action be taken within 1715 Chesto~ five. ~,~,cAv,~0~ ninety (90) days to remove the tanks. (805) 326-,3979 FAX (~05) 326-0576 Of course, we have no interest in pursuing this route. We would, like to have your t~,l~ ~nS~ON tanks properly handled prior to this December 22,1998 deadline. Please review your 564~ V~or Street ~ak~a. cA 9~,~ situation and reply within two weeks as to the current (realistic) plans for your existing (805) 399-4697 tanks. FAX (805) 399-5763 As we get closer to the December 22, 1998 deadline, I would expect construction costs, as well as lead times to increase considerably. If there is anything this office can do to assist you in your planning, do not hesitate to call. Sincerely, Office of Environmental Services REH/dm BAKERSFIELD FIRE DEPARTMENT February 24, 1998 Mr. John Kerley JACO Oil Co P.O. Box 1807 n~ c,1~ Bakersfield, Ca 93303-1807 MICHAEL R, KELLY RE: Howards, 4201 Belle Terrace ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93~1 (805) 326-3941 UNDERGROUND STORAGE TANK UPDATE SUPPRESSION SERVICES Dear Underground Storage Tank Owner: 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 The City of Bakersfield has some exciting news regarding loan monies, which has just FAX (805)395-1349 become available through the Small Business Loan Association (SBA). PREVEN110N SERVICES 1715 Chester Ave. Pollution Control loans, thru the SBA, are intended to provide loan quarantees to eligible Bakersfield, CA93801 small businesses for the financing of planning, design, or installation of pollution prevention (805) 326-3951 FAX (805) 326-0576 controls, which includes underground storage tank facilities. ENVIRONMENTAL SERVICES The vast majority of businesses are eligible for financial assistance fi.om the SBA. The ]715 ChestorAve. SBA defines an eligible small business as one that is independently owned and operated and not Bakorsfiold, CA 93301 (805) 326-3979 dominant in its field of operation. For those applicants that meet the SBA's credit eligibility FAX (805)326-0576 standards, the agency can quaranty up to eighty percent (80%) of loans of $100,000. Seventy five percent (75%) of loans above $100,000. Lynn Knutson, Chief of Finance for the SBA says, "If TRAINING DIVISION customers apply immediately, and meet the requirements, funding is available". 5642 Victor Street Bake~'fleld, CA 93308 (805) 399-4697 The City of Bakersfield hopes all of our underground Storage tank owners take advantage FAX (805)399-5763 of this opportunity. For more information on SBA, Pollution Control Loans, please call or write to: Lynn Knutson, Chief Financial Officer Small Business Loan Association 2719 North Air Fresno Drive, Suite 200 Fresno, CA 93727 Phone # (209) 487-5785, Ext 130 Don't delay, start today!!! Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services ,0 D February9,1999 F~RE C,~EF Howards Mini Market #6 RON FRAZE 4201 Belle Terrace ADMINISTRATIVE SERVICES Bakersfield, CA 93309 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 P-~E: Compliance Inspection SUPPRESSION SERVICES Dear Underground Storage Tank Owner: 2101 'H' Street Bakersfield. CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 The city will start compliance inspections on all fueling stations within the city limits. This inspection will include business plans, PREVENTION SERVICE8 underground storage tanks and monitoring systems, and hazardous 1715 Chester Ave. Bakersfield, CA 93301 materials inspection. VOICE (805) 326-3951 FAX (805) 326-0576 To assist you in preparing for this inspection, this office is ENVIRONMENTAL SERVICES enclosing a checklist for your convenience. Please take time to read this 1715 Chester Ave. Bakersfield, CA 93301 list, and verify that your facility has met all the necessary requirements to VOICE (805) 326-3979 FAX (805) 326-0576 be in compliance. TRAINING DIVISION Should you have any questions, please feel free to contact me at 5642 Victor Ave. Bakersfield, CA 93308 805-326-3979. VOICE (805) 399-4697 FAX (805) 399-5763 Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure SUNSET MECHANICAL 3812 PANORAMA DR. BAKERSFIELD CA. [SCS] 322-06~0 Continuous Monitoring Devic Certification MAK~ AND MODEL OF MONITO.ING SYSTEM~~ Contents of Tank ~.~. Capad~ of Tank Type of Produot Line: (GraviS, Suction, Pressure). ~ ~h u~ ~NDI~TE LOCA~ON OF THE MONITORING SENSORS TESTED 8Y P~CING A YES OR NO IN APPLt~B~ BOX: Annular space Sensor Sump Sensor Dispenser Containment Sensor ' Elec~onic In-Line Leak Detecto~ Mec~nl~l Line Leak Detecto~ In Tank Gauging Devi~ . INOICATE THE F~L~NG 8Y P~CING A YES OR NO IN APPLI~LE BOX: poes the monitoring ~y~tom have audible and visual Does the turbine automatically shut-down if the system'detects · a leak, fails [o operate °r i$ electroni~lly dis~nn~ted? Is the monito6ng system Installed to prevent unautho~ed lampefing? Is the monitoring system operable as per the manu[acturee~ specifications? the turbine? ~ich continuous monitoring devices lni~i~t~ positive shut-down of ' CERTIFIED TESTER'S I~ USTMAN SIR SYSTEM Yearly Statistical Inventory Reconciliation '(SIR) Report 1995 STATION NAME: HOWARD'S #6 STATION #: 3355 COMPANY NAME: JACO 0I~5 ADDRESS: 4201 BELLE TERRACE CITY: BAKERSFIELD ZIP: 93309 STATE: CA PHONE: COUNTY: KERN DATE OF REPORT: 02/09/96 MONITORING THRESHOLD: 0.05 GPH LEGEND --> T - TIGHT/PASS * I * - INVESTIGATE~FAIL I IP - IN PROCESS/INCONCLUSIVE ND - NO DATA SUBMITTED TANKID CAP JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 33551 12K T T T T T T T T T T T T 33552 12K T T T T T T T T T T T T 3355M 12K T T T T T T T T T T T T 3355P 12K T T T T T T T T T T T T SIR PROVIDER: USTMAN INDUSTRIES, INC. 12265 W. BAYAUD AVE. SUITE 110 LAKEWOOD, CO 80228 PH: 303/986-8011 FAX: 303/986-8227 SIR VERSION: 91.1 I certify under penalty of per~,ury that all SIR results listed above are as calcul~ted~ ~ ~ Fill one segment_~ for each tank, unless al~anks and piping are ~ constructed of t~same materials, style and~pe, then only fill one segment out. please identify tanks by owner ID #. I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN IA' OWNER'S TANK I' D' # ' B'MANUFACTUREDBY:~'/4f2'F-'t"II"J//~'/F'/J(~/'v~3 I c. ! 0 J '" I III, TANK CONSTRUCTION MARK ONE ITEM ONLY tN ROXES A, B, ANDC,~DALLTHATAPPLIESINBOXD A. WPEOF ~ 1 DOUBLE WALL ~ 3 SINGLE WA~ WI~ E~ERIOR LINER ~ 95 UNKNOWN SYSTEM ~ 2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAUL~DTAN~ ~ 99 O~ER 8. T~K ~ 1 BARE STEEL ~ 2 STAINLESS S~EL ~ 3 FIBERG~SS ~ 4 STEELC~D W/FIBERG~SS REINFORCED P~STiC MATERI~ ~ 5 CONCRETE ~ 6 ~LWlNYL CHLORIDE ~ 7 ~UMINUM ~ 8 1~. ME~ANOL ~MPATIBLEW/FRP (PrimaryTa~k) ~ 9 BRON~ ~ 10 ~LVANI~D S~EL ~ 95 UNKNOWN ~ ~ O~ER ~ 1 RUBBER LINED ~ 2 ~O L.ING ~ 3 EPO~ LINING ~ 4 PHENOL~ LINING C. INTERIOR / LINING ~ 5 G~SS L,N,NG ~ S UNLINED ~ 9S UNKNOWN ~ ~ O~ER ~'~ IS LINING MATERIAL ~MPATIBLE WITH 1~ ME~ANOL ? YES~ NO~ D. CORROSION ~ 1 ~LYE~YLENE WRAP ~ 2 ~ATING .... ~ 3 VI~L WR~ ~ 4 FlaERG~S REINFORCED P~STIC PROTEC~0N ~ 5 CATHODIC PROTECTION ~ 91 ~NE ~ 95 UN~OWN ~ ~ O~ER IV. PIPING INFORMATION C~RC~ A IF ABOVE GROUND OR U IF UNDERGROUND, BO~ IF APPUCAaLE A. SYSTEMTYPE A U 1 SUCTION . A~2 PRESSURE A U 3 G~VI~ A U ~ O~ER B, CONSTRUCTION A U 1 SINGLE WALL A U 2 ~UBLE WALL A~ 3 LINED TRENCH A U 95 UNKNOWN A U ~ O~ER C. MATERIAL AND A U 1 ~RE STEEL A U 2 STAINLESS S~EL A U 3 ~LWINYL CHLORIDE(PVC)A~ 4 FI~ERG~S PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 1~. ME~ANOL COMPATIBLEW~RP PROTECTION A U 9 ~LVANI~D S~EL A U 10 CATNODIC PROTECTION A U 95 UNKNOWN A U ~ OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DE~CTOR ~ 2 LINE T~HTNESS TESTING ~ 3 INT~S~L ~NffOR~NG ~ 99 O~ER V, TANK LEAK D~ECTION _ I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN tA. OWNER'S TANK L D.# B. MANUFACTURED BY: C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACI'rY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100°/. METHANOL COMPATIBLEW/FRP (.rimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. CORROSION [] t POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRA,o [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN [] 99 OTHER ,. IV. PIPING INFORMATION C~RCLE A IFABOVEGROUNOOR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMP~ATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION E~ 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION ~__' 1 VISUAL CHECK [~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING i_."~_~ 6 TANK TESTING ~ 7 INTE"STITI/ALMONITORING [~ 91 NONE [] 95 UNKNOWN [] 99 OTHER rmit Underground Hazardous Materials Storage Facility State I.D. No. 280001 ..... ,::.::?~,:??,-?.~,ii~.'.~:.;}! ;.:i]i?::?iiiii?:ii]i'.'i?!?.%Permit No. 621 CONDITIONS ~ P~!~i~ ~ih REVERSE' SIDE Tank Hazardous G~i~ii?!iiii::~?:i?.?; ..... ..y~i~i~?~iii::i.~:~::.. ??.~.~i'ank "~:';::-;~:~ :~ J. :~:~ ;~:I: ~ ~ ~:~::;::; Piping Piping Piping Method ~%::??~??.:?' .... ~:~ ............. :~:::..:~ .................................... ~.":~ Monitoring Number Substance C~::~.~%-:? I n'~ {'~ii~a;;~::-;.'::::.. ~ ~.~T y p e U o hi{]6~ ~:::~::~;.:~'~, Type 01 UNLADED ~::2:~~;:~:~ ;';]]: 71.98~:~:~:: ~ ~ ~L .... SIR~:::::~].~;~?~LPT PRESSURE ALD 02 UNLADED PLUS ?~1::~[O00 ~:.? ::*-:::;;];;;'.'.~:;~;~;;;?~;?~;;[. ??' SWE:}'['?%:.:~~~:~:~.-.:' ?::~..::;~LPT PRESSURE ALD 03 UNLADED ::~i':2~OQ0 ~;:'~ .~??'.':':I.98~ '~":":.~::;:.;~?:~?;;~']:~:.:;:~;~::;~:.~;:~.?~T ~'....:::;;~?~ LPT PRESSURE ALD ;. '..?::.. ?;: ~ .:".;:" ~ .' ~X~. -,¥.: : :'.'. :.?: .... ,.~?:<:.:: ....... ".......: .; ?..:' ~{ ~..:. Bakersfield Fire Dept. ==========================...:::..... :...7.:::::::-:.:..:-.-:::--.-:??.?-;.7./?' L.~:.:.::~:::~:~ ........ JACO-HI LL OIL CO. HAZARDOUS MATERIALS DIVISION ........... ;'::':%:::;';:~:;:];;;;~:';];:;;]~;:;'~:::?:;;:'~;'?':"~ ............. HOWARD'S MINI MART 1715 Chester Ave., 3rd Floor 4201 BELLE TERRACE Bakersfield, CA 93301 (805) 326-3979 BAKERSFIELD, CA 93309 ~alph fi. Huo~, Ha~ardou~torial~ Coordinator Valid Irom: 12-22-03 to: 12-22-08 EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at thc UST localion at all nines. The informauon on this monitoring program are coedilions of the operming perllxit. The permit holder must notify the Office of Environmental S~ViC~ within 30 days of al:ly Chillings tO the monitoring procedures, ualess required to ob,mn approval before making the change. Required by. Sections 2632(d) and 2641(h) CCR. Facility Address ~Ja~ ! l~cl/6 ?-crr'r~c~ I. 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, containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notified wjthin24hours. D¢ocaA%,~ or% ft~on3t. /~vs~ ~,~ri{~ ~c,~/I ~r 2. Describe the proposed methods and equipment to be used for removing and properly disposing of'any hazardous substance. ./~fa ,,~ t{ 3. Describe the location and availability of the required cleanup equipment in item 2 above. 4. Describe the maintenance schedule for the cleanup equipment: List the name(s) and title(s) ofthe person(s) responsible for authorizing any work necessary under the response plan: · :~(~,!, //-,,(/a.~ ~ ,~*~ r UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must I~ k~ at tl~ UST lo~on at all ~ TI~/nformation on thi_~ ~ program am conditions of th~ Ol~ra~g p~rmic Th~ permit holder must notify tl~ Offic~ of Eav~onmm~ ,~C~ w~thin 30 d,~ or'ally cimn? tO [h~ mommrmg procodur~ unlem required to O~t~in ~ ~ making tl~ clumg~. ~ by Se~iom 2632(d) and_ 2641Cn) COL B. What methods and equipment, identified by name and model, will be used for perfuming the monitoring: 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: .-gE,b ltd, II~,,~ E. Reporting Format for monitoring: Tank Piping F. Describe the prevemive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintemmee schedule but not less than every 12 months. G. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: !~r r I~ 4( ~, ¢ ~ ~ c t (rca'l/~'°~) ~ I SO# ! ~er: ~..~A.d_~ o£/_ C_O, Site# ~ UONITOR WELLS WelINumberl I 2 3 4 5 6 7 8 9 10 11 12 Well Depth /~ '~ De~h to Water )~ P~uct Det~d AMOUNT in inches ~ Standard Symbols for diagram below: ~Fill T ~ Vapor Recove~ ~ V.R. w/Ball Float ~ Monitor Well ~ Obse~ation Well (Outside Tank Bed Area) (Inside Tank Bed Area) ~ Ball Float ~ Tank Gauge 0 Vent ~ Manway ~ Iron Cross ~ Turbine Location DiagramTin;lude ~he. Va~)o~ R~coyery Syst?m: , I ~~ · t~ · ., · Vapor Recovery System & Vents were tested with which tank? ~~D ~~ Pa~s and Labor used General Comments ~~ ~e~.~ ~ ~-~. - -When OWNER-or local regulafions-requireimmediate~reperts of system failure-Complete, the-following: REPORTE9 NAaE':' DATE TInE TO: Phone~ OWNER or R~ulato~ qenw FI~ NUMBER Pdnt C~fi~ Tears Nme V~u~ ~a~n Numar VacuTectTMTEST REPORT · S.O. # 160389 Date 03 / 27 / 9i6 Owner JACO OIL COMPANY Site# 355 Phone <800> 2!53-8054 InvoiceName/Address USTMAN INDUSTRIES, INC. 12265 W. BAYAND AVE. #110 LAKEWOOD, CO 80228 Attn: BRUCE McDUFFY SiteName/Address JACO OIL COMPANY HOWARD'S #6 4201 BELLE TERRACE BAKERSFIELD, CA 93309 TANKS LINES Leak Det Ullage TANKS and LINES Tested to CFR-40 Pads See Tank Dipped Dipped Probe Water Rubble Air Line Final Exist 280-281 & NFPA 329 Speo's. Diag, Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW For Material Level Level Level Detected Detected Detected · Material Syst Type TEST TEST Rate · Pass/ LD(s) Loc. ST/ · · · · · · Tight · · · · · TightFail/ TestedOther: FRP¢-- START START START or ~ ST/ START END or or & Tank - Tank Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail NONE PASS Product Capacity 1 N~~~ 30.000 012.00 00.000 N N N' T lA ST PS · 9:14 9:44 '0.:000 7F P - Ex'stLDSN/MDbM~G: 31284--9060 XLD LEAD 95 30.000 012.00 00.0Q0 Pump RED JACKET '*' "'; ' 50 00 PLUS MaterialStartTime: 8 : 23 Percent of Fill at 7 0 Mfg.: :i. '" ~i.~ / UNETESTPSIi . Time of Test: · . ,! , · S T End Time: i 1:20 TestTankps.: --2· 00Entry:Pr°be F I L L Deqrees:lnclin°meter- · 400 OperateDiSp ..... I~'es/n°lShea' Valves y I .oo N NI PS. 9': 5.9~ 1'0.: 29 0;009~,T P - 2 SUPR 12000 Diameter 00 000 038.00 00 N T · 2A ST .. ......... . E,,s, LDS,/M~L/MFG: 20491--9481 XLD UNL 9500.000 038.00 00 00 I Pump "~ ' '' · UNE TEST PSI Material StartTime: 8 : 23 Percent of Fitl at 37 0 Mfg.: RED JACKET ' ' ': 50 . 00 Time of Test: · ' . ,:' ~ :, ' S T End Time: 1 1 : 2 0 Tank Probe Inclinometer_ Oisp ..... Shear{Valves Test PSI: -- 2 0 0 F I L L 3 0 0 Operate Iyes/no) Y · Entry: Deqrees: · 3 REG 12000 Diameter 00 , 000 037,.00 00.00 UNL 9500.000 037.00 00.0 -. ' SN/MDL/MFG: ~aterialStart Time: '! i : 54 Percent of Fill at 36 0 Pump ,~ , ' Time of Test: · , . ., i : ' ~, , : ' · ' Mfg.: RED JACKET L,NE~EST,S' 50 00 ST End Time: 14 : 29 Tank Probe Inclinometer_ ' ' ' Disp .....ShearVafves Te~t PSI: -- 2. 00 Entry: F I L L Oeclrees: · 300 Operate/¥es/nol Y 4 PEG 12000 Diameter O0 ,.~000 1044 · 00 00 · 0'00 N N NIT '4AST PS 13': 12 1~ ;74.2 0..000'T ' P - E'i"LDSN/~'d'/~O: 40 693-- 9777 XLD UNL 9500. ooo1 044. OD OD. oooI Pump ' ,~ "' ~": ',, ', Material StarlTime: 11 : 54 Percent of Fill at 45 0 Mfg.: RED JACKET ' i 50 00 '~ S T End Time: i 4 : 2 9 Tank Probe Inclinometer_ Disp ..... Shea/,Valves Tvst PSI: -- 2· 00 En ry: F I L L Deqrees: · 500 op~,~t, qres/.ol, Y New/2nd LD SN/MDL/MFG: Percent of Fill at Pump ~aterialStart Time: Time of Test: Mfg.: ' '~ ' · ' '. , , , . ',... LINE TEST PSI: Tank Probe Inclinometer ...... " Dispenser Sheaf Valves End Time: T~st P~I: Entry: O~(:lre~: Operate I,t, esmo~ I I I New/2nd LB SN/NIDL/MFG: Percent of Fill at Pump :, i ' 'i: LiNE TEST PSI; -Material Start Time: Time of Test: Mfg.: · .' ~ .; . Tank I Probe I Inclinometer Dispenser ShearlValves End Time: Test PSI: ~ Entry: D~qr~s: Operate Tanknology Corporation International WESTERN REG I ON Unit # 015 State Lic. # 15 67 State: CA 5225 Holli~ter St., Houston, TX 77040 TANKNOLOGY Region: NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800) 888-8563 · FAX (713) 690-2255 TAK-01 BAKERSFIELD FIRE DEPARTMENT December 18, 1997 FIRE CHIEF MICHAEL R. KELLY Mr. John Kerley JACO Oil ADMINI~RAnVE~I~qCE$ P.O. Box 1807 2101 'H' Street ~ko~el~, c^ 9~Ol Bakersfield, CA 93 303-1807 (SEkS) 326-3941 FAX (805) 395-1349 RE: Howards Mini Market #6, 4201 Belle Terrace SUPPRE.~ION SERVICES 2101 'H" Street ~ok~, C^ 9X~Ol Dear Mr. Kerley: (80,5) 326-3941 FAX (8~5) 395-1349 You will be receiving this letter on or about December 22, 1997. One PmaNnON SE~CES year from today, December 22, 1998, your current underground storage tanks will mSCh~^w, become illegal to operate. Current law would require that your permit be revoked Bake~field, CA 93301 (805) 326-3951 and, would make it illegal for any fuel distributer to deliver to any non upgraded lAX (805) 3264~76 tanks. ENVIRONMENTAL SE[NlCES 1715 Chester Ave. However, in reviewing your file I see that you do plan to replace your Bakersfield, GA 93301 (805) 326-3979 tanks by April, 1998. We congratulate you on your decision to replace your tanks FAX (805)326-0576 and simply want to offer any assistance we can in meeting your target date. Please remember to contact this office for permits well in advance of your Ti~JNING DIVISION 56~2VIctor~t anticipated start date. As we get closer to the December 22, 1998 date, I would B~kersfielO, CA 93308 expect construction lead times to become extended, as well as costs for tank (80.5) 399-4697 FAX (8G5) 3~9-$763 replacements. Sincerely, Ralph E. Huey Hazardous Materials Coordinator REH/dm cc: Kirk Blair, Assistant Chief BAKERSFIELD FIRE DEPARTMENT January 27, 1998 Mr. John Kerley JACO Oil FIRE CHIEF MICHAEL R. KELLY P.O. Box 1807 Bakersfield, CA 93303-1807 ADMINI$~E SERVICES 2101 'H' Street Bakersfleld, CA93,.,X]l RE: Howard Mini Market #6, 4201 Belle Terrace (805) 326-3941 FAX (805) 395-1349 UNDERGROUND STORAGE TANK UPDATE SUPPRESSION 2101 'H" Street Bokemfleld, CA 93301 Dear Mr. Kerley: (805) 326-3941 FAX (805) 395-1349 The City of Bakersfield wishes to congratulate those tank owners who PREVENTION SER~/ICE$ have upgraded, removed or replaced their tanks in the month of January. During 1715 Chester Ave. ~kersfietd, CA 93301 the month of January, our office had six sites (14 tanks) which are now in (805) 326-3951 compliance. This is a very big "first step". FAX (805) 326-0576 EN¥1RONMENTAI.$ERVICE$ For those who have not yet upgraded, I would like to share some thoughts 1715 Chester Ave. Bokersfleld, CA93301 on why it is so important to act right away: (805) 326-3979 FAX (805)326-0676 1. Licensed contractors are booking up fast, in some cases, up TIMdNING DIVISION to three months in advance. 56a2 Victor Slreet 2. Supplies (pumps, dispensers, leak detection equipment) Bakersfield, CA 93308 (805) 3994697 may be scarce. FAX C805)399-$763 3. The cost for upgrading or removing could go up as demand increases. 4. Assembly Bill 1491 will ban fuel deliveries after January 1999 to non-upgraded owners. The good news, is there is still time!!! If there is anything this office can do to assist you in your planning, do not hesitate to call. Sincerely, Ralph E. Huey Hazardous Materials Coordinator Office of Environmental Services cc: Kirk Blair, Assistant Chief BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST i 'APR. By_..__ FACILITY ~~1~. ~ ADDRESS V~,{ PE~IT TO OPE~TE ~ OPE~TORS N~E ~CO ~' OWNERS N~E ~BER OF TA~S TO BE TESTED ~ IS PIPING GOING TO'BE TESTED T~ VOL~E CONTENTS / ~ 00~ T~ TESTING CO~Y ~A~KNO~ ~DRESS TEST METHOD N~E OF TESTER ,. ~rdU~ C~_~ CERTIFICATION ~ STATE REGIST~TION ~. /~m ~ D~T~ ~ TIM~ T~ST ZS TO B~ C0~DUCT~D ~N , Z7 ~R~~Y: DATE SIGNATURE OF APPLIC~T ' DEP~ CI ~ .~ o f BAKERSFIELD FIRE T_/1,'.[ENT . FIRE SA FETY SERVICES O OFFICE OF ENIqRONMENTAL SERVICES 1715 CHESTER AVE. · BAKERSFIELD, CA · 93301 R.E. HUEY R.B. TOBIAS, HAZ-MAT COORDINATOP~ FIRE MARSHAL (805) 326-397¢ (805) 326-3951 TANK INTEGRITY TESTING INSPECTION FORM THIS FORM MUST BE COMPLETED AT TIME OF INTEGRITY TEST BY THE TECHNICIAN ON SITE AND SUBMITTED WITH THE TANK INTEGRITY TEST Faciliw Permit to Operate Number Facility Permit to Tightness Test Numb'er ' Facilitv Name Facility, Address Facility Telephone Numoer ~(SX--,m-%:? 7-7/~0'"~ Have you complied with the follovdng sat'ew requirements YES/NO Y~::~ The area within 25 feet of any underground storage tank opening is free of smoking, open flames, and any other source of ignition. }/~-_~ Legible signs with the words "NO SMOKING" are posted in conspicuous locations around the testing area. ~/~ The general public is restricted from the testing area bv rope, flags, cones, and "if dark" a fluorescent hamer. ~(:xS::, Fire protection in the form of a 2A/20BC fire extinguisher is located within the restricted area. ,,,V~ Vehicles utilized dunng the testing period, or within 25 feet of the underground storage tank opening, have adequate ventilation, and the tester has equipment which can be utilized to monitor the concentration of flammable vapors within the vehicle. ~/~ Personal protective equipment, an eve wash and gloves, and a site safety plan are within the testing area. ~;5~ Equipment/materials is available to absorb and contain any small release of testing liquid which is discharged as a result of the test, (Examples include DOT-acceptable containers for storage of the absorbent and an adequate supply of absorbent). If the answer to any of the above questions is NO, stop the testing procedure IMMEDIATELY until compliance is obtained. COMPLETE REVERSE SIDE TANK INTEGRITY TESTING INSPI~CTION FORM continued Is the following data consistent with the information submitted on the apphcation for Permit To Perform Integrity Testing (PTT)? vEs~o y~<:~ The number of tanks being tested }""~--~') Testing company , k/~ Test method used ~"~,~ State Licensed Technician on site ~/"~---f..~ State Licensed Technician's # ~'~ Is the site lavout consistent with the application plot plan? State exceptions for any NO answers to the above questions: I CERTIFY THATTHE AFOREMENTIONED FACTS ARE TRUE AND CORRECT UNDER PENALTY OF PERJURY. (Not valid if not signed and dated,) dale month city..nd state (SIGNATURE) - State Licensed Tcchnictaa o~'~te (PRINT3 . State l~ccmed Technician on Site TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Certificate of Tightness Service Order #: 160389 Test Date: 03/27/96 Underground storage tank system(s) tested and found tight for: Tank Owner: 3ACO OIL COMPANY Test Site No.: 3 5 5 Test Site Address: JACO OIL COMPANY HOWARD' S ~6 BAKERSFIELD, CA 93309 4Tank(s) only, 4 Line(s) only, 4 Leak Detector(s) only. Tanksizes & productstested: 1 12000 NO LEAD PLUS 2 12000 SUPR UNL ¢3 12000 REG UNL 4 12000 REG UNL Lines Tested: lA NO , 2A SUP, 3A REG, 4A REG Leak Detectors Tested: 31284-9060 XLD 20491-9481 XLD 20889-2811 XLD 40693-9777 XLD · Valid only with , Corporate Seal UnitMgr. Certificate Number & Name 296 STEVEN R. COLBY 07/97 1567 STEVEN R. COLBY 10/96 U.S. Patent #4462249, Canadian Patent #1185693, European Patent AppL #169283 TANKNOLOGY & VacuTect Are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank identification & site location drawing. ..... SENSOR ALAR'H L 2 :SOUTtt HOIq I TOR I,dELL FUEL ~L~R["'J ,JAN 14, 1998 8:27 AP1 ........ SENSOR L 1 :NORTH NONI TOR [,JELL FUEL dAN 14.. 1998 8:28 AP1 - ..... SENSOR ALARI'.'I L 3:UNLEADE[', 1 FUEL JAN 14. 199E', S:29 AI'.'I ..... SENSOR ~LARI"I L 4 :PLUS ANNULAR FUEL ALARH JAN 14. 1998 8 ..... SENSOF: aL/h F.,'F'I ...... L 5:UNLEADED 2 JAN 14. 199:~I 8:31 ~"1 ..... SEi',iSO~ aLaR'I"I L 6: t>~2Ei"l 1 Ul'.'l FUEL aL~RI"I JaN 14. 1998 8:32 aid HObJARDS 6 4201 BELLE TERRACE BKFLD. F',;, 93309 s 97 MAR 18.. 19q8 ~ 0 I::'M SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL INVENTORy REPORT T I:UNLEADED 1 VOLUME = 2470 C ..... ULLAGE -,~L,~ - 95:30 GALS 90~LLAGE--- 8:330 GALS TCI~UME = 2457 GALS HElt~'~J'~T = 24.77 INCHES bJATER VOL = 0 GAL~ ~ATER = O. O0 INCHES TEMP = 67.3 DEG F _3 2_: 'v'L;'l. LIME -J~ 4505 LILL~GE = ?495 G~LS 90~.~; LILL~GE= 6295 G~LS TC VOLUME = q478 HEIGHT = 38.35 INCHES WATER VOL = 0 = 0.00 INCHES = 68.6 DEG F T 3:UNLEADED 2 VOLUME = 3402 G~LS ULLAGE - 8598 C;~LS 90::~ LILL~{~E~ ?398 G~LS TC VOLUME = 3358 G~LS HEIGHT = 31.17 1NCHES ~J~TER VOL = 0 G~LS ~TER = 0.00 INCHES TEMP = 78. I DEG F T 4:PREMIUM VOLUME = 3051 G~LS ULLAGE - 8949 G~LS 90f,~ LILL~(~E: ??49 G~LS TC VOLUME = 3029 G~LS HEIGHT = 28.81 INCHES bJATER VOL = 0 GALS = 0.00 INCHES = 70.2 DEC F ~ ~ ~ ~ ~ END ~ ~ ~ ~ BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST FACILITY ~)I~3~Pi~. ~(~ ADDRESS qZO{ ~_~' ~~ PE~IT TO OPE~TE ~ OPE~TORS N~E ~ DI U' OWNERS N~E ~(O ~1 L ~ER OF TA~S TO BE TESTED ~ IS PIPING GOING TO'BE TESTED~ T~ V0L~E CONTRAS T~ TESTING CO~Y ~A~KNO~ ~DRESS ffE~e~, ~ ~Z~I TmST ZmTHOD STATE REGIST~TION ~ ~O ~R~~Y: DATE SIGNATURE OF APPLIC~T CORREC ON NOTICE Bakersfield Fire Dept. Office. of Environmental Services You are hereby required to make the following corrections ~[ ~}~ ,, ~>~ , at the above location:., I '~/~- ~~~Z'--~ '~ ~ /~,~, ~~, m C~ ~ __ . ~~/~ ~~ ~a yes no ~a yes no ~a : ._- // -- Completion Date for Cor;ections 4~/r~ . Date /~/~(~ _ _ _ ~ / ' Inspector ~ 326-3979 16. Leak Det~tion Equipment and Test Methods Listed in L~-I 13 Sories 17. Wri~en Records ~aintained on Site ~ ~ 6. Re~ed Changes in Usage/Conditions to Opsmting/Monitodng Procedures ol UST System Within ~0 1 ~. RepoSed Unautho'~ed Rolease Within 24 ~ours 20. Approved UST System Repairs and Upgrades 2i. Records Showing Cathodic Protection fns~ection 22. Secured Monitoring Well~ ~ ~ ~ ~ "" 23. Drop Tu~ RE-INSPECTION D~TE ~ ~ RECEIVED BY: I~8~ClOR: ....... OFFICE I~kfi~O~[ ~o. TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Certificate of Tightness Service Order ~: 146240 Test Date: 05/11/95 Underground storage tank system(s) tested and found tight for: Tank Owner: JACO OIL COMPANY Test Site No.: 3 5 5 Test Site Address: JACO OIL COMPANY HOWARD' S # 6 BAKERSFIELD, CA 93309 Tank(s) only, 4 Line(s) only, 4 Leak Detector(s) only. Tank sizes & products tested: Lines Tested: lA REG, 2A REG, 3A PLU, 4A PUN ,_ Leak Detectors Tested: 40693-9777 XLD 20889-2811 DLD '-' 31784-9064 20491-9281 DLD Valid onlywith Corporate Seal UnitMgr. Certificate Number & Name 083 STEVEN E. HAWKINS 06/96 95-1525 STEVEN E. HAWKINS 04/95 U.S. Patent #4462249, Canadian Patent # 1185693, European Patent Appl. # 169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank Identification & site location drawing. "1, KNOLO, " . VacuTect T" TEST REPORT s.o. # 14 6 2 4 0 Date 05/11/95 Owner JACO OIL COMPANY Site~ 355 ', Phone <800> 253-8054 InvoiceName/Address USTMAN INDUSTRIES, INC. 12265 W. BAYAND AVE. ~110 LAKEWOOD, CO 80228 Attn: BRUCE McDUFFY SiteName/Address JACO OIL COMPANY HOWARD'S ~6 4201 BELLE TERRACE BAKERSFIELD, CA 93309 TANKS I LINES Leak Det Ullage ~ TANKS and LINES Tested to CFR-40 PaAs ~ Tank Dipped Dipped Probe Water Bubble Air Line Final ~ Exist 280-281 & NFPA 329 Spec's. Diag. Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW For Material Level Level Level Det~ted Det~ted Det~ted B Material Syst. Type TEST TEST Rate B ~ss/ LD(s) Loc. ST/ ~ ~ ~ ~ ~ · Tight ~ ~ ~ ~ ~ Tighl Fail/ Tested Other: Tank Tank Tank FRP/ START START START or ST/ START END or or & ~ Product Ca~ci~ Lined END END END Yes/No Yes/No Yes/No Fail Line~; FRP PS/SS/GS TIME TIME GPH ~Fail NONE PASS ! · . T ~p - ~.~,~s.~o~: 40693-9777 XLD 1 REG Diameter ; ' lA ST. .PS i0:05 10:35 0.000 ~rcent of Fill at Pump ' ' - · ' '* - ' ~' Materi~ Sta~ ~me: Time of Test: Mf~.: · . ..... '4 LINE TEST PSI 5 0 · 0 0 Tank I ProDe Inclinometer ~ Dis~s~ Shear Val~s End ~me: Test PSI: I Ent~: O~rws: RU~ l TAN 1 o~,a,e~.s~,o~ 2 REG D,.~.,e, I -I 2A ST PS i0:10 10:40 0.000, ~. P - ~.~"os"~u"~: 20889-2811 DLD ~rcent of Fill at Pump ....... ' ....... ~ ~' Material Sta~ ~me: Time of T~t: Mf~.: .~ 2~ I LINE TEST PSI 5 0 · 0 0 End ~me: Test ~1: Ent~: Deqr~s: ~U~ ~F ~ O~rate {~./no) 3 PLUS Diameter ~1} ' I~ . .'3A ST ..... PS~ ..... /!:00.. 1!..:-30 .0.000.., T/:t. p - ~.,,,os,~ou,~: 31784-9064 DLD UNL ../=.~ LD SN/MDUMFG: Mated~ ~rc~t of Fill at Pump ~':'37~ ' ~ - ": ....... ~ ~ · "''~" ~" .. :, .... L'NE TEST PSI 5 0 · 0 0 Stad ~me: ~me of Test: Mf~.: . ~; ....... ,,, ~,o; ......... . End ~me: Te~ PSI: Ent~: D~r~s: operate ~es/no) 4 PUN Diameter ':L ";J '"' ~ ':'>J'- .4~A ST,.:~ PS L.i:.!0~ 11.1.49 0.'Q0Oc T.::. p - ~.~,,DS.~.U.~: 20491--9281 .DLD I I N~12nd LD SN/MD~MFG: ~ent of Fill at Pump '- ~ ~-~'-. ~:~:: .... . f~/~-:~' '-.:.~.: ' ,-,,r, ~ -~-,: ~;-- -, ... "-- ,~ :c?~,5 ' Material Stad ~me: Time of Test: Mfg.: "'''~ .... , , MNE TEST ~1 5 0 0 0 t End ~m~: Test ~1: Ent~ D~r~s: O~rate (~es/not . "~--' , ~-., ';' LINE TEST PSI: Maten~ Stad ~me: ~me of Test: Mfg.: ,~,., ~:-~ .~_~., ~c~.,,.,' ..... ;' ..... ~.~ w.,f.: ~.,:~' .~ . ;; ..~ .~:;~:~, End ~me: Test ~: ~ Ent~ D~r~: Diameter ;,.. ~..: ~ ~ N~/2nd LD SN/MD~MFG: ~ment of Fill at Pump Tank I Pro~ Inclinometer O~ S~a, ' EDd ~m~: T~{t P~I: I ~nt~: ~ D~qr~ O~rate Tanknology Corporation International TANKNOLOGY Region: WESTERN REGION Unit ~ 023 State Lic. ~ 95-1525 State: CA 5225 Hollister St., Houston, TX 77040 NOTE: Original VacuT~ Data r~ordings are review~ byT~knology's Audit Control Depa~ment and maintained on file. (800) 888-8563 · FAX (713) 690-2255 ' ~Site# MONITOR wELLs .......... Well Number I 2 3 4 5 6 7 8 9 10 1 1 12 Well Depth ,, Depth to Water ,,, Pr~uct Det~d AMOUNT in lnches l .... Standard Symbols for diagram below: ~Fili ~ Vapor Recove~ ~ V.R. w / Ball Float ~ Monitor Wail ~ Obse~atiOn Well (Out~lde T~nk Bed Area) (Inside Tank Bed Area) ~ Ball Float ~ Tank Gauge O Vent ~ Manway ~ Iron Cross ~ Turbine Location ,Di~gramT~nCu~e~he. Vapo[ R~coyery Syst~m~ .~. Vapor Recovery System & Vents were tested with which tank? Pa~s and Labor used General Comments ~_ ~o~ ~e~x P ~ .... ~~~ When OWNER or local regulations require immediate reports of system failure-Complete the following: RE~ORTED NAME DATE TiME TO: Phone~ ' ' OWNER or R~Ul~to~ ~ency FI~ NUMBER PHnL C~fi~ Tes~rs N~e V~u~ Ce~n Num r ~Ce~s~rs Sigm~m~ ~~ ..... De~ ~//~Tes~ng c°mple~ ~ORRECTION NC~.~ lC E BAKERSFIELD FIRE DEPARTMENT Location Sub Div. 4/~ ~ ~//~ ~Z~B~- ~t, , You are hereby required to make the following cor~ctions at the above location: Cor. No / i ': Completion Date fo,' Corrections_ ~. , //~ .~//~5'//Y& .? .,~/ ' Date. /~~ ~~~~_~~ / Inspector ~ - '" 326-3979 ~ UNDERGROUN[ STORAGE TA{III INSPECIION '.'/.;Baker'sfield Fire Dept. ' ':~i Bakersfield, CA 93301 ~?.~.?~,-,1> BUSINESS I.D. No. 215-000 FACILITY NAME FAClLITYADDRESS ~//~! L~/~ ~.~?_ .~r~.,,~.__.CITY ~.. ~,~I~. ZlPCODE~--~' -~.~>.~ FACILITY PHONE No. :~'?~ ?~4~ ~C~ ~D~ ~D~ ~D~ INSPECTION DATE Product : Product ,,~ Productt,,. TIME IN TIME OUT Insl Date Insl Date Inst Date INSPECTION TYPE: Size Size Size ROUTINE ~ FOLLOW-UP REQUIREMENTS yes no n/a yes no n/a yes no n/a la. Forms A & B Submitted 1 b. Form C Submitted lc. Operating Fees Paid ld. State Surcharge Paid le. Statement of Financial Responsibility,Submitted lf. Written Contract Exists between Owner & Operator to Operate UST 2a. Valid Operating Permit 2b. Approved Written Routine Monitoring Procedure '.~ 2c. Unauthorized Release Response Plan.' / 3a. Tank Integrity Test in Last 12 Months 7/~/(~ C'] //C~Vi ~, 3b. Pressurized Piping Integrity Test in Last 12 Mo~th~.s ( 4~'~c~ 3c. Suction Piping Tightness Test in Last 3 Years ¥""~~ -/ t,~ ~ /.~ 3d. Gravity Flow Piping Tightness Test in Last 2 Years ,L'PT ~/~ 3e. Test Results Submitted Within 30 Days td 3f. Daily Visual Monitoring of Suction Product Piping -~ ~,,.~ 4a. Manual Inventory Reconciliation Each Month 4b. Annual Inventory Reconcd~abon Statement Submitted 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging R~cords for Small Tanks ~,' 6. Monthly Statistical Inventory Reconciliation Results, 7. Monthly Automatic Tank Gauging Results 8. Ground Water Monitoring ~" 9. Vapor Monitoring ~/'PT'~' ,~',~ 10. Continuous Interstitial .Monitoring for D(~Ubl'~-Walled Tanks 11. Mechanical Line Leal~ Detectors 12. Electronic Line Leak Detectors . >.- ~ , .- -.,, ~,' 13. Continuous Piping Monitoring in Sumps 14. Automatic Pump Shut-off Capability 15. Annual Maintenance/Calibration of Leak Detection Equipment 16. Leak Detection Equipment and Test Methods l~isted in LG-113 Series 17. Written Records Maintained on Site ~.-~(2(~ ' 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days 19. Reported Unauthorized Release Within 24 Hours 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tube REqNSPECTION DATE ,,, RECEIVED BY: II~PECTOR: '-'.~.~-/~.~ ff'~:~.~,.. ~------~.,~ x'd~--~ OFFICE TELEPHONE No. FD 1669 (rev. 9~95) USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: HOWARD'S #6 STATION #: 355 COMPANY NAME: JACO OIL ADDRESS: 4201 BELLE TERP~ACE CITY: BAKERSFIELD ZIP: 93309 STATE: CA ~ PHONE: PERIOD ANALYZED: APRIL, 1995 DATE OF REPORT: 05/15/95 PART A: Data Tank ID: Tank and Lines Status: Product: Quality: Dels: Sales: 00 ITIGHT 00-FS PRE GOOD 10873 10770 02 ITIGHT 02-UNL #1 GOOD 31638 30743 03 ITIGHT 03-UNL #2 GOOD 5972 5896 05 ITIGHT 05-FS MID GOOD 20119 16061 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 00 No comments. 02 {4/9/1995:DEL 198} {4/10/1995: -109} {4/26/1995: 205} 03 {4/30/1995.: -139} 05 {4~26~1995:DEL -158} {4/27/1995: -146} {4/30/1995: 349} For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: HOWARD'S #6 STATION #: 355 COMPANY NAME: JACO OIL ADDRESS: 4201 BELLE TERRACE CITY: BAKERSFIELD ZIP: 93309 STATE: CA PHONE: PERIOD ANALYZED: MAY, 1995 DATE OF REPORT:~06/14/95 o PART A: Data Tank ID: Tank and Lines Status: Product: Quality: Dels: Sales: 02 TIGHT 02-UNL #1 FAIR 36080 31434 03 TIGHT 03-UNL #2 GOOD 5916 5876 05 TIGHT 05-FS MID GOOD 12669 16521 00 TIGHT 00-FS PRE GOOD 10620 9924 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitorin~ are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 02 {5/10/1995:DEL 827} {.5/11/1995: -699} {5/26/1995: -11549[ {5/29/1995: 11712} 03 No comments. 05 No comments. 00 No comments. o USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: HOWARD'S #6 STATION #: 355 COMPANY NAME: JACO OIL ADDRESS: 4201 BELLE TERRACE CITY: ZIP: 93309 STATE: CA PHONE: PERIOD ANALYZED: MARCH, 1995 DATE OF REPORT: 04/17/95 PART A: Data Tank ID: Tank and Lines Status: Product: Quality: Dels: Sales: 00 TIGHT 00-FS PRE GOOD 9888 11607 02 TIGHT 02-UNL #1 GOOD 25956 31135 03 TIGHT 03-UNL #2 POOR 3999 6371 05 TIGHT 05-FS MID POOR 13752 15580 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detectiOn vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: Tank ID: Comments and Recommendations: 00 No comments. 02 (3/19/1995: - 58) o3 {3/5/ 995: -117} 05 No comments. For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR m~onthly monitoring. Jaco Oil Company 3101StateRoad Bakersfield, CaJifomia93308 ~'~ PO. Boxl807 Bakersfield, Califomia 93303-1807 · Phone: 805 393-7000 · Fax: 805 393-8738 August 1, 1994 LETTER FROM CHIEF FINANCIAL OFFICER I am the chief financial officer for Jaco Oil Company, general partner of Jaco Hill Co.. This letter is in support of the Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective action and/or compensating third parties for bodily injury and property damage caused by an unauthorized' release of petroleum in the amount of at least $10,000 per occurrence, and $10,000 annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter. Hbward's #6, 4201 Belle Terrace, Bakersfield, CA 93309 1. Amount of annual aggregate coverage being assured by this letter: $10,000 2. Total tangible assets: $5,869,372 3. Total liabilities: $1,737,100 4. Tangible net worth $4,132,272 I hereby certify that the wording of this letter is identical to the wording specified by subsection 2801.1(d)(1), Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief. Executed at Bakersfield, California on Date Signature Name: Brian Busacca Title: Chief Financial Officer BB:jlc CORRECt. ON NOTICE BAKERSFIELD FIRE DEPARTMENT (/ Location //,;:~,-),'>.q /~,'. ,,' /')0~I2;[''. Sub Div..z/~.~/ :,.%//~. 4.~,i~.~Blk. . Lot You are hereby required to make the following corrections at the above location: Cor. No Completion Date fo,' Corrections Inspector 326-3979 UNDERGROUND $,~ .RAGE tl~IK!INS~EC~ION ~?.~:::i~,::~'.~i;*~Oiiii?~;¥,.. ;'~ Fire Dept. . .,~ ' ', ~ : ~ Bakersfield, CA ~3301 FACILI~ NAME t6~L~ BUSINESS I.D. No. 215-000 FACILI~ADDRESS ~O~ ~ ~~ CI~ ~5~ ZIP CODE FACILI~ PHONE NO'. ~ ~ INSPECTION DATE t 0 / ~ ~/~ I / ~ % ~.~ TIME IN I ~ ,o~ TIME OUT ()~ I~ ~, INSPECTION ~PE: IO/~ ~/~ S~e S~e S~e ~.~ ROUTINE ~' FOLLOW-UP ~,~0 I 2./O~ ~ REQUIREMENTS ~ no ~a ~ ~ ~a la. F~s A & B 8ubm~ ~ ~ lb. F~ C Su~ 1c. O~mting F~ Pa~ ~ ~ · ;' Id. ' State Sum~rge Paid ~ ~ le. State~nt of Fi~l R~si~l~ Su~ ~ lf. Wr~en Cont~ E~sts ~n ~er & O~mt~ to O~e UST~ ~ ~' ~. ~lid O~mting Pe~ ~ ~ ~ 2b. Ap~ov~ Wr~en Ro~ine MonRofing Pr~ure ~ ~ ~ 2c. Una~ho~ Relea~ Res~n~ P~n ~ ~ ~ ~ ~. Tank Int~ T~t In Last 12 Months /~ / 3b. Pre~ur~ Piping Int~ri~ Test in Last 12 Months ~.~ -~ ([~ ~ ~ ~. Suction Piping ~ghtness T~t in Last 3 Y~rs ~ ~ ~. Gmv~ FI~ Piping ~ght~ T~ in Last 2 Yearn V / ~. T~t R~uEs Subm~ Within ~ Da~ v ~ / 3f. Dai~ ~s~l MonRoring of Suct~n Pr~ Piping // ~. Manual Invent~ R~cil~tion Each M~th //' ~. Annual Invento~ R~nciliati~ Statement Su~ ~ ~/ / ~. Metem Calibmt~ Annual~ / ~/ ~ 5. W~ Manual Tank Gauging R~ds f~ Small Tan~ ~ 6. Mont~iy' Statisti~l Invento~ R~nciliation R~uRs ~ ~/~ ~ 7. Mo~hN A~atic Tank Gauging R~uRs ~ ~ 8. Ground Water ~nRoHng /~ 9. ~r MonAoHng ~ ~ 10. Continuous IntemtRial Mon~oHng f~ Doubl~Wall~ Tan~ .- , ~/ 11. M~hani~l Li~ Leak Det~ ~/ ~ 12. El~tmnic Li~ Leak Det~tom /~ 13. Continuous Piping MonRoHng in Sum~ ~/ 14. A~omatic Pump Shrift Ca~bil~ '*"' ' " ~ ~ 15. Annual Maintenan~Calibmtion of Leak ~t~ Equi~ I; ~e 3 ~ ~ / 16. Leak Det~tion Equipment and T~ Metes List~ in LG-113 Se~ d ~ 17. Wr~en R~rds Maintain~ ~ SRe ~ ~ C ~ ~'~' ~ 18, Re~ Changes in U~g~CondR~s to O~mti~R~ng Pr~ur~ of UST S~tem WRhin ~ Da~ ~/ 19. Re~A~ Una~h~ Relea~ W~hin 24 Houm / ~. Approv~ UST S~tem Re,irs a~ U~m~ ~ ~ / 21. R~rds S~ng Cath~ Pr~ Ins~t~ ~ / ~. Dr~ Tu~ t ~ ~ ~ ; RE-INSPECTION DATE RECEIVED BY: INSPECTOR: ~/~ ~,, ';,~--- OFFICE TELEPHONE NO. TANKNOLOGY CORPORATION INTERNATIONAL · - 5225 Hollister, Houston. Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 "'Certificate of Tightness Service Order #: 122524 TestD/a~e: 07/28/9-~ · Underground storage tank system(s) tested and found tight for: · 'Tank Owner: JACO OIL COMPANY INC. ."' Test Site Address: JACO OIL COMPANY INC. HOWARDS $6 ': BAKERSFIELD, CA 93309 .'. 1· Tank(s) only, 1 ,Line(s) only, 1 Leak Detector(s) only. Tank sizes & products tested: '..-:' 1 12000 SUPR UNL :c,. Line's Tested: '~. Detectors Tested: .. .'t~.'.. ~ ' ?'~UnltMgr. Ce~ifi~teNumber&Name 336 3S~ ~. ~OOC~S [[/95 Valid only with ~ Corporate Seal '.;:;;};'U:S. Pato~[ ¢4462249, Canadian Patent ¢1185693, Eulexin ~tent Appl. ¢169283 ' :-...' ..TANKNOLOGY & VacuT~t are trademarks of TANKNOLOGY CORPORAT ON NTERNATIONAL Note: S~ VacuT~t Repoff for tank Identification & site '~' ;: :.~ ': ,. ' .., ' I~atlon drawing. VacuTectTM TEST REPORT 12252~ Owner JACO OIL COMPANY INC, Site# 355 Date 07/28/94 Phone <800> 253-8054~ Invoice Name/Address USTMAN INDUSTRIES, INC. 12265 W o BAYAND AVE. #110 LAKEWOOD, CO 80228'- Attn: BRUCE McDUFFY SiteNarne/Address iJACO OIL COMPANY INC. HOWARDS #6 4201 BELLE TERRACE BAKERSFIELD, CA 93309 ! TANKS LINES Leak Det See Ullage TANKS and LINES Tested to CFR-40 Parts Tank Dipped Dipped Probe Water E3ubble Air Line Final Exist 280-281 & NFPA 329 Spec's. Diag. Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LiNE LD(s) NEW For Material Level Level Level Detected Detected Detected · Material' Syst. Type TEST TEST Rate · Pass/ LD(s) Loc. ST/ · · · · · · Tight · · · · · Tighl Fail/ Tested Other: ' FRP/ START START START or ST/ START END or or & 'k Tank Tank Lined END END END Yes/No ' Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH FailNONE PASS Product Capacity ' ~ t~ '* --~¢ Exist Lb SN/MDL/MFG: 2t)8~J. ~ ~2t¢3. DI,D rJNL 963u.uuu u~/.uu New/2nd LD SN/MDL/MFG: Material StartTime: 3L..~ [ 4'.~ Percent of Fill at ~J U M(~.; LtNETESTPSl TimeofTest ' Pump (J~D JACKET ' 50 . 00 ~T End Time: ~ '~ Z~ Tes~TankpsI:--JfLo U~) Entry:Pr°be ~'.j.I./= D~gr~:lnclin°meter' j~ o ~,.~ U O OperateOispenser Shear ValveSlyes/nol New/2nd LD SN/MDL/MFG: Percent of Fill at Pump MaterialStart Time: Time of Test: Mfg.: LINE TEST PSI Tank Probe Inclinometer Dispenser Shear Valves End Time: Test PSI: Ent~: De~rees: Operate lyes/not Diameter I I I Exist LD SN/MDL/MFG: New/2nd LD SN/MDL/MFG: Percent of Fill at Pump MaterialStart Time: Time of Test: Mfg.: LINE TESTPSI Tank I Probe Inclinometer Dispenser Shear Valves End Time: T~st PSI: ~ I Entry: Dgqree~: oF)erate tyes/nol Diameter I ] Exist LD SN/MDL/MFG:, New/2nd LD SN/MDL/MFG: l~ Percent of Fill at Pump MaterialStart Time: Time of Test: Mfg.: LINE TEST PSI ~ Tank I Probe Inclinometer Dispense, Shear Val~es End Timg: T~st PSI: I Entr~: D~qr~s: , Operate lyes/not Diameter I I , Exist LD SN/MDL/MFG: Percenl of Fill at Pump MaterialStart Time: Time of Test: Mf~l.: LINE TEST PSI: E~r~d Time: Test P~I: Eq~ryi Deoree~: Operate Iyes/no~ New/2nd LD SN/MDL/MFG: Percent of Fill at Pump MaterialStart Time: Time of Test: Mfg.: LINE TEST PSI: Ep¢ Time: T~ P~I: Entry: Deorees: Operate I),es/nol Tanknology CorPoration International TANKNOLOGY Region: ' WESTERN REGION Unit # 0 23 State Lic. # State: CA 5225 Hollister St., Houston, TX 77040 NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800) 888-8563 · FAX (713) 690-2255 TAK-01 ~;~.~,. . , ~ Monitor'Well(outside Tank Bed Area) '~ (Inside Tank, Bed Ar~a), ~{ "::'' ,*,. . , ~.~,.... ,:_~,Va~or_,_ _ ~_ :Rece~e.~.System & vents were tested with which tank? ..... , ~ ':, "'sT':'~ ' ~ ':" ' failure-Oomplete t~e following:;:t Wfi~n O~NER 6r I°dal regulations require immediate repo~s of system ' ' '~' APPLICATION TO BXRFORMA TICHTNES~ TEST o~£~,~*o~ t~,~,~m ............... ow~-~s t~m~ ~ D~L,, T~S VOL~ /~ , __~n _._ /z~ ........ ~ _ · ..~ DATE' OF ~PLIC~ APPLICATION TO PERFORM A TICRTNESS TEST NU34BER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED ~-~ TANKNOLOGY CORPORATION INTERNATI 11994 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 By Certificate of Tightness Service Order #: 115 6 51 Test Date:0 ? / 2'1/9.4 ',. r Underground storage tank system(s) tested and found tight for: '...' ~'.~. Tank Owner: JACO OIL COMPANY INC. . !.' 3 5 5 . ..~,~ Test Site Address: 'JACO OIL COMPANY INC. HOWARDS #6 · BAKERSFIELD, CA 93309 ; -~..'~. ? :.~'. "- 3Tank(s) only, 3 Line(s) only, 3 Leak Detector(s)·only.;..- Tank Sizes & products teSted: .' · 1 '12000 REG UNL 2 12000 NO LEAD PLUS 3 12000. 'i' t-; ~ ,.. '.,r ,' · , -,~ ... :?{ :. lA RE(], 2A NO 3A REG . ~" ', : ...... .', ' . · '.. - ' ~. '/;;, ;.' ~,, · '~.' ,·'. ~," - Leak Detectors Tested:, 20889'2811 DLD 31284-9064 DLD 40694-9777 XLD -~':'U'nit Mgr; certificate NUmber & Name3i2 DAVID TOHIR 10/95 . · '-' Valid:ohlywith~.:;~ ;..' .~.~ :' 1315 ,DAVID TOHIR 12/96 Cor~oi!~te.S~a:'? 'i U.S.'Patent ;94462249, Can'adian Patent #1185693, European Patent Appl. #169283 , TANKNOLOGY&¥acuToetaretrademarksofT^NKNOLOGYCORPOR~IIONINTERN^IIONAL Note: SeeYacuT~CtRepo~fortankldentlfi¢~tl~slte? I??~, ~ ", ' ' . , Ioe~flon dra~ln~._ .':.~t-~. , ~ ~. '~ . ... · % ,.,.,;t,,~ &..:~.. :;. ?,: .'- · . t,.'.,, ,.,..,J VacuTect " TEST REPORT s.o.# 115651 Date 07 / 21/9~ [Owner JACO OIL COMPANY INC. Site# 355~ Phone <800> 253-805~ llnvoiceName/Address USTMAN INDUSTRY'ES, INC. 12265 W. 5AYA~D AVE, ~110 LAKEWOOD, CO 80225 !i BRUCE HcDUPFY ~ . Attn: ~iteN~me/Address JACO OIL COMPANY ]:NC. HOWARDS f~6 4201 BELLE TERRACE BAKE:RSFIELD, CA 93309 TANKS LINES Leak Det See Ullage TANKS and LINES Tested to CFR-40 Parts Tank Dipped Dipped Probe Water Rubble Air Line Final Exist 280-281 & NFPA 329 SpeCs. Diag. Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW For Material Level Level Level Detected Detected Detected · Material Syst. Type TEST TEST Rate · Pass/ LD(s) Loc. ST/ · · · · · · Tight · · · · · Tight Fail/ Tested Other: FRP/ START START START or ST/ START END or or & k Tank Tank Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail NONE i PASS Product Capacity I ~I~G 12000 °~amete'~)OoOOO 05j~50 00.150 N N N T iA S%.~ -PS 9:27 9~57 ? 000. [~ P - E~istLDS"~OL,M~:20'389--281t DLD ~3NL 95~;0".000 059~00 00.160] New/2nd LO SN/MDL/MFG: Pump RED JACKET UNET~ST"S, 50 O0 MaterialStart Time: 8: 59 Perce.t pt Fi. at 62 0 Mfg.: Time of Test: · o ~. T End Time: l J-: ~ D Tank -- 2 , O 0 I Probe F I L L Inclinometer. '1 0 0 0 I Disp ..... Shear Valves Test PSi: I Entry: Deorees: ~ o ,,, Operate Iyes/no~ 2 NO 12000 Diameteri){~,OO0 pGg~50 00o1501 N N N ] T 2A ,ST ~S .0:CID .,~'-':39 0,00.9 [' P .- Exist'DSN~D~,U~:31284--9064 DLD LEAD 951)0 000' 1070.00 00'1601I ~ ' PLUS MaterialStartTime: 8: 59 TimePercent°f~FillatofTest: 73 · 0 M,g.:Pump P, ED JACKET ......... LINE TEST PSI 5C~ . 00 .~T End Time: 11.° 49 TemTankpsl:-- 2 . O0 Probe Inclinometer. o Dispense, ShearVaives Entry: ~'~ [ L L De~rees: 8 0 0 Operate (yes/noI 3 REG 12000 Diameterl;O.O00 135'~,0(J ;00~150I ~ N N I T 3A ST P~ ,2:~0 3;~.[? *~00 ~ P - ExistLDSN/IVtDL/MFG; 40694--9777 XLD gNL 95~)'0.000 p64. po oo'. 160JJ Material Start Time: 1 2: 12 Percent of Fill at 6 7 0 Pump Time of Test: · o Mfg.: RED &ACKE? '..E TEST .S, 50 00 ~ T En~ Tim~: .'L 4: 3 5 T~tTankp~l:-- 2~ 0 0II Entw:Pr°be ~'~ T ~ L Inclinometer.g~re~: 1, · 0 0 0 OperateDiSp ..... I~'es/"°~Shear Valves Diameter I I "' ~'7" I Exist LD SN/MDL/MFG: New~/2nd LD SN/MDL/MFG: Percent of Fill at Pump ~ - Material Start Time: Time of Test: Mfg.: LINE TEST PSI Tank ! Probe Inclinometer .... Dispenser Shear Valves End Time: I T~ P~I; I Entr~: De~re~,~: ,, operate/~es/no/ Diameter [ Exist LD SN/MDL/MFG: New/2nd LD SN/MDL/MFG: Percent of Fill at Pump Material Start Time: Time of Test: Mfg.: LINE TEST PSi: Tank I Probe Inclinometer Dispenser Shear Valves En~J Time: T~t PSI: ~ EntrY: D~qr%'~s: Dp?re Diameter ~ Exist LD SN/MDL/MFG: New/2nd LD SN/MDL/MFG: Material Percent of Fill at Pump ' Start Time: Time of Test: Mfg.: L NE TEST PSt: Tank I Probe Inclinometer ................ Dispenser Shear Valves End Time: T~,~t P~I: ~Entrv: I D~r~: Operatelyes/no~ , Tanknology Corporation International ?rAN~NOLOGY Region: -WESTERN REOZON Unit # 037 State Lic. #1315 State: CA 5225 Hollister St., Houston, TX 77040 NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800) 888-8563 · FAX (713) 690-2255 MONITOR WELLS ' .Well Number ,1 2 3 4 5 6 7 8 9 10 11 Depth, to Water ~- ~ ~ P~uct Det~d Standard Symbols for diagram beloW: .Q~,II ',:= ~ Vapor Recove~ ~'V.R. w / Ball Float ~ Monitor Well ~ obse~ation Well ~ · (Outside Tank Bed Area) (Inside Tank Bed Area), ~: Ball Float ~ Tank GaUge ~ Vent. ~'Manway · ~ Iron Cross ffi Turbine Location Diagram- nc ude ~he. Vapo[ Recove~ Sys, t~m. "~' Vapor Recove~ System & Vents were tested with which tank? / Pa~s and Labor used General Comments REPORTED' NAME'" DATE TiME ~'~'~ :. TO:~ Phone~ OWNER or R~ulato~ ~en~ FI~ NUMBER · P~ ~ Tears N~e V~u~ ~~n Num~ AP~L!CATION TO PERFOP~ A T!~ETNES$ TEST PERMIT TO OPEPJ~TE # NI.~ER 0F ~ANXS TO ~E TESTED IS RIPING GOING TO BE TESTED T~ vOL~ /~ _ ....... F~ ~,~. ........ .. N~ OF TESTER .... CERTiFI~TION g STATE REGIST~TYON ~ ......... ---.,~,_ DA~E & TI~ TEST IS TO RE CONDUCTED Jaco-Hill Company 3101 State Road Telephone (805) 393-7000 Post Office Box 1807 Bakersfield, California 93308 Bakersfield, California 93303-1807 January 20, 1994 Mr. Ralph Huey RECEIVED CITY OF BAKERSFIELD UNDERGROUND TANK PROGRAM JAN 2 4 1994 2101 "H" STREET BAKERSFIELD, CA 93301 HAZ. MAT. DIV. Subject: HOWARDS MINI MARKET 4201 BELLE TERRACE BAKERSFIELD, CA Dear Mr Huey: To comply with the monitoring program requirements outlined in the State Underground Storage Tank Regulations, Jaco-Hill Company utilizes Statistical Inventory Reconciliation (SIR) with tank integrity testing as a release detection method at the above referenced facility. Current regulations require Jaco-Hill Company to (1) submit a summary to the local agency which indicates the results from the statistical inventory reconciliation reports for the previous 12 months, (2) perform tank integrity tests bi-annually and (3) perform integrity tests on the piping and line leak detectors annually. Attached for your review is the following: The annual sununary of the SIR reports for this facility prepared by our SIR vendor, Ustman Industries Inc. Copies of the results of the line and leak detector tests which were performed November 17, 1993, by Tanlmology Corporation International. Review of the results indicate the product lines are tight and the leak detectors are functioning properly. Jaco-Hill Company strives to maintain compliance with all state and local regulations at our facilities. Should you have any questions or require additional information, do not hesitate to contact me at (805) 393-7000. P spectfull .,. / Operations Manager JK/jk attachments USTMAN SIR SYSTEM-- Monthly Monitoring Rep~~.'~- - DECEMBER, 1993 Report Date: 01/11/94 Company name :JACO OIL Station Name: HOWARDS'S #6 Station # : 355 Address: 4201 BELLE TERRACE City: State: CA CUMULATIVE MONTHLY REPORT - JACO OIL- 1993 LEGEND --> T - TIGHT IL - INVESTIGATIVE LOSS ?? - INCONCLUSIVE ND - NO DATA SUBMITTED TANK JAN FEB MAR APR MAY' JUN JUL AUG SEP OCT NOV DEC 355-00 T T T T T T T T T T 355-02 T T T T T T T T T T T' T 355-03 T T T T T T T ~/~ T T T'~ T 355-05 T T T T T T T~/ ~ T T T' T Tank ID: Product: 00 00-FS PRE 02 02-UNL #1 03 03-UNL #2 05 05-FS MID USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. d f TEST SITE ADDRESS: ~co o~ co~ ~c. ~ uow~s 4201 BELLE TERRACE BAKERSFIELD, CA TANK SIZES g PRODUCTS TESTED LINES TESTED 2A, 3A, 4A LEAK DETECTORS TESTED UnitMor. Ce~ificateNumber&Name 083 ~TEVE~ g. ~A~I~8 06/9A Valid only with U.6. ~lem ~62249, C~dian ~mm ~ 1185693, ~uropean ~tem AppL ~ 169283 Corpor~ S~] TAN~NOLOGY & ~cuT~I are trademarks ot TANKNOLOGY CO~PO~ATION I~T~NATIONAL Note: ~ VacuTect Test fle~ for tank I~ent~tlon ~nd TANKNOLOGY" VacuTectTMTEST REPORT Owner 3ACe OIL ¢ONPA~¥ INc. site# i6 ~ Phone <800> 253-8054 InvoiceName/Address USTHA~ TNDUSTRIE$, T~C. 12265 ~. RAYA~D AVE. #110 ~AK~..WOOD, CO 80228 ! Attn: BRUCE McDUFFY Site Name/Address JACO OIL COMPANY INC. 355 HOWARDS 4201 BELLE TERRACE BAKERSFIELD, CA TANKS LINES Leak Det~ " Ullage TANKS and LINES Tested to CFR-40 Pads See Tank Dipped Dipped ~:)robe Water Bubble Air Line Final Exist ;)80-281 & NFPA 329 Spec's. Diag. For Dia. & Water Product'Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW Material Level Level Level Detected Detected Detected · Material Syst. Type TEST TEST Rate · Piss/ LD(s) Loc. ST/ ~ · · · · · Tight · · · · · Tight Fail/ rested Other: O FRP/ START START TART or ST/ START END or or & , Tank Tank Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail qONE PASS Product Capacity i RE(3 Diameter ~ .i.A ST , · PS 10:05 10 ;15 0.000 R - N ExislLDSN/MDL/MFG: U N L :' , New/2nd ED SN/MDL/MFG: Malarial Percent of Fill at Pump ~ Start Time: Time of Test: Mf~.: LINE TEST PSt 5 0 · 0 0 Tank I Probe Inclinometer Dispenser Shear Valves End Time: Test PS1: I Entry; Peqrg'~8; ~ operate Ii'es/riel y Percent of Fill at Pump Material Start Time: Time of Test: Mf~l.: LINE TEST PSI 5 0 0 0 Tank Probe Inclinometer ~ J)isl~enser Shear Valves · End Tim~: T~II I:~1: Entry: D~jrees: Operate lyes/noI y 3 uNPLUSL /' Diamele~' ' I I 3A ST pS' 11'05 I1:35 0.000 T ,p, ['~ ExistLDSN/MDL/MFG:New/2nd~os.,~ou~:31284-9064 DLD Percent of Fill at Pump Material I Start Time: Time of Test: Mf~l.: LINE TEST PSI 5 0 · 0 0 Tank Probe Inclinometer Dispenser Shear Valves I~r~ Tim~; Twt J~J; I~rllrY; D~qr~{~: Operate Ij'es/nol Y 4 SUPR UN L ~ Diameter . ,J' .: J J 4A ST PS 11'~45 12:15 0'000 T P N Exi"LOS"~DUu~G: 20491--9281 DLD New/2nd LD SN/MDL/MFG: g/ Material Pement of Fill at Pump O~,tart Time: Time of Test: Mfs.: L NE TEST PS 5 0 · 0 0 Tank ! Probe Inclinometer End Time: Test PSI: I Entry: Deorees: Operate (yes/no) y Diameter', .... ~ ~' '; : '~ ~?. ' ' ' ' Exist LO SN/MDL/MFG: New/2nd LD SN/MDL/MFG: Percent of Fill at Pump LINE TEST PSi: MaterialStart Time: Time of Test: Mf~l.: .... :,, . · .... Tank. · I Probe Inclinomeler Dispenser Shear Valves End Time: Test PSI: I EntrY: Deorees; Operate {yes/no) ' '~.', , { .... i Exist LD SNfMDL/MFG: New/2nd LD SN/MDL/MFG: Percent of Fill at Pump i LINE TEST PSI: Material Start Time: Time of Test: Mfg.: Tank I ProbeI Inclinometer Dispenser Shear Valves End Tim~: 'lrij~I J~l: J I~nlryi JIp~r~: Operate Iyes/nol Tanknology Corporation International TANKNOLOGY Region: WESTERN REGION Unit # 416 State Lic. # State: CA 5225 Hollister St., Houston, TX 77040 NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Depadment and maintained on file. (800)888-8563· FAX(713)690-2255 TAK-01 . er" Site#, [ ~ MONITOR WELLS ' · Well Number 1 2 3 4 5 6 7 8 g 10 1 1 1,2 Well Depth Depth to Water P~uct Det~d ~MOUNT in inches standard Symbols for diagram below: ~Fill ~ V~por Recov~, ~ V.R. W / Ball Float ~ Monitor Well ~ Obse~ation..Well (Inside Tank Bed 'A~ea) (Outside-lank Bed Area) ~ Ball Float ~ Tank Gauge" O Vent . .' ~ Manway ~ Iron. Cross ~ Turbine' ~,~.' ,~-~ ~ Location _DiagramTin lu e ~he~Vapo[ R~coyery'Syst~m: :. '~ ~ .. ...... ~. Vapor Recove~ System & Vents were tested with which tank? .,. Pa~s and Labor used General Comments, ~-- ~,~oc p ~ ~ ~ d~. ~ When OWNE~ or local regulations require immediate reports of system failure-Oomplete the REPORTED, NAME DATE TlUE TO: Phone~ OWNER or R~utsto~ ~en~ FI~ NUMBER Print C~fi~ Tesmrs Nme V~u~ ~m~n Numar Ce~ Tes~rs Sig~m Da~ Testing Compte~ TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Certificate of Tightness Service Order # 030711 TestDate 11/22/93 Underground storage tank system(s) tested and found tight for: TANKOWNER: JACO OIL COMPANY INC. 16 TEST SITE ADDRESS: JACO OIL COMPANY INC. 355 HOWARDS 4201 BELLE TERRACE BAKERSFIELD, CA [ ] .^.~(s)o..~, [ ~].,.~(s)o.~, [ ~],~,~c~o.(s~ o..~. TANK SIZES & PRODUCTS TESTED .,.: ~.??~t~'~ t'NES TESTED lA ~ = LEAK DETECTORS TESTED 40693 - 9777 X L D ~/~A WA~~ '~tltlllllllt~~' UnitMgr. Ce~ificateNumber&Name 083 STEVEN E. HAWKINS 06/94 Valid only with U.S. ~tent e~2249, ~dian ~tent ~1185693, European ~tent ADDI. ~169283 Corporate Seal TANKNOLOGY & ~cuT~ are trade~rks of TANKNOLOGY CORPORATION INTERNATIONAL Note: ~ VacuTect Test ReDo~ for tank IdentE~tl~ and site ~t~n d~wlng. · VacuTectTM TEST REPORT S.O. # 030711 [ ,~ Date 11/22/93 Owner JACO OIL COMPANY INC, Site# 16 Phone <800> 253-8054 InvoiceName/Address USTNA~ I~DUSTRIE$, ,I~. 12265 W. BAYARD AVE. #110 I',AKE~OOD, CO 80228 ~ Attn: BRUCE McDUFFY $1teName/Address JACO OIL COMPANY INC. 355 HOWARDS 4201 BELLE TERRACE BAKERSFIELD, CA TANKS LINES Leak Det " Ullage :l TANKS and LINES Tested to CFR-40 Pads See Tank Dipped Dipped ~Probe Water Bubble Air Line Final ExiSt 280-281 & NFPA 329 Spec's. Diag.. For Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW Loc. Material Level Level Level Detected Detected Detected · Material Syst. Type TEST TEST Rate · Pass/ LD(s) ST/ · · · · · · Tight · · · · · Tight Fail/ Tested Other: O Tank Tank FRP/ START START TART or ST/ START END or or & : Product Capacity Lined END ENO END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail qONE PASS 1 RE(] Diameter lA ST pS [3:45 14:25 0.000 T P N ,~i~,u~s.,~o~,~: 40693-9777 XLD UN L New/2nd ED SN/MOL/MFG: Percent of Fill at Pump Material Start Time: Time of Test: Mf~l.: LINE TEST PSi 5 0 . 0 0 Tank ! Probe Inclinometer Dispenser Shear Valves 1~9~1 mjp~: TIJ~Jl ~Ji j Entry: Dearees: , Operate I'(es/no~ y Material Percent of Fill at Pump Start Time: 'rim of Test: Mf~l,: ! LINE TEST PSI Tank I Probe Inclinometer~ Dispenser Shear Valves End Time; TIJ~ P~l: I Entry: Deorees: Ojoerate Iyes/no~ Diameter I J J Exist LD SN/MDL/MFG New/2nd LD SN/MDL/MFG: Material Percent of Fill at Pump ', Slart Time: Time of Test: Mf~l.: LINE TEST PSI Tank ! Probe Inclinometer Dispenser Shear Valves ~Ep~ 'll'im~~ . Test PSI: I Entry: De~rees: Operate I~,es/nol New/2nd LD SN/MDL/MFG: Percent of Fill at Pump O Material Start Time: Time of Test: Mfg.: LINE TEST PSI ' Tank ! Probe Inclinometer Dispenser Shear Valves End Time; TJJJ ~Ji j I~ptry; DjSj-~,~; Operate ~J/es/no~ New/2nd LD SN/MDLIMFG: Percent of Fill al Pump Material Start Time: Time of Test: Mf~l.: · , LINE TEST PSI: Tank I Probe Inclinometer Dispenser Shear Valves J~n~ TJ~; TS§~ J~J; J I~n~p/: Dearees: Operate lyes/riel · New/2nd LD SN/MDL/MFG: Percent of Fill at Pump Mai~rial Starl Time: Time of Test: Mf~.: · I LINE TEST PSi: Tank I ProbeI Inclinometer Dispenser Shear Valves Ep(~ Tim~: TIjjJ I~:~1~ J Enlry: I Dearees: Tanknology Corporation International TANKNOLOGY Region: WBSTgRN REGTO~ Unit ~ 416 State Lic. # State: CA 5225 Hollister St., Houston, TX 77040 NOTE: ?riginal VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800) 888-8563 · FAX (713) 690-2255 TAK-01 SO# ~-~ t l ner-- Site#==i MONITOR WELLS' Well Number I 2 3 4 5 6 7 8 9 10 1 1 Well Depth Depth to Water (Outside Tank Bed Area) ~ Ball Float ~ Tank Gauge .i O Vent :]~ Manway. Iron Cross .' Tur ne LocatiOn DiagramT 9~ ~e",h R~ Sy n u e. Vapo[ coye~ stem. :,., ,-*, .~ . . '~' ' ' Z'- ' ' Vapor Recove~ System & Vents were tested with which tank? Pa~s and Labor used : ~ General Comments ~~ ~ ~ &~m ~ ~ oc~. When OWNER or local regulations require immediate repo~s of system failure-CompJete the following: RE~ORTED NAME DATE TIME '::- -. TO: .... -.. Phone~ OWNE~ or R~ulato~ ~en~ ~1~ NUMBER ~ - Print C~fi~ Tes~m Nme V~u~ ~~n Numar Ce~ Tes~rs Sig~m De~ Tesfi~ Com~ 03/11/94 ]:r'~vo~c~ ;'45¢. 1~:28~ am KERN CO RESOURu~ .......~,IA,~~.ME,~'- AGENCY 2?00 '~' Scree~ Bakersf-ie7 d CA 9 , ..oui Type of Or'der ~.,~m REu[STER JACO OIL CO?4PANY 8049]'N RAR t 03/11/94 ! 03/I 1/94 20-JACO~t'" NT 2 RE~ DT4. N_~~AL~~ FEE EH 1 800.00 E 500.00 Amount Due 500.00 Payment: r4ade By Check 500.00 THANK YOU .,' R E C E I P T PAGE 1 11/23/93 Invoice Nbr. 1 109566 3:54 pm KERN CO RESOURCE MANAGEMENT AGENCY 2700 'M' Street Bakersfie]d, CA 93301 Type cf Order W (805) 861-3502 CASH REGISTER JACO OIL COMPANY Customer P.O,# I Wtn By IOrder Date I Ship Date I Via I Terms 7220-IN I GLR I 11/23/93 t 11/23/93 120-JACO4 I NT Line Oescrtptton Quantity Price Unit Disc Total 1 100 00 E 100.00 3398 UNDE~_~T.~KS A~NNUAL FEE EH 1 , Order Total 100.00 - Amount Due 100.00 Payment Made By Check 100.00 THANK YOU! COUNTY OF KERN · '. ENVIRONMENTAL HEALTH SERVICES BILLING DATE 2700 "M" STREET, SUITE 300 11/05/93 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 AMOUNT DUE PERMIT/INVOICE #280001c-g4 I00.00 t AMOUNT ENCLOSED CHARGES PAST DUE ARE SUBJECT TO PENALTY HOWARD' S MARK/~T ' ~/ P.O. BOX 180~~--- DUE DATE BAKERSFIELD, CA~3303 12/05/93 2700 '[~' St:r'c~eL: (805) 861--3502 · ~A,:>~' ....... REG.,.GTER .JACO O:(L COMPANY 280001C93 I BAG !1/'t6/g2 I 1/16/92 J J NT L.'i:~e ,~et,~;ript:'fon Qu~ntffty P~"ice Unit; Dffsc Tot:~a'l t 339I~ LJNDERG~OUND TANKS ANNUAl. FEE 4 100.00 E 400.00 ,~STO01 Orde¢ 'rot~'l 400. oo Amount Due 400.00 Pm._vment. N~de B.y Check ¢00.00 TflANK YOLJ! RESPONSE CHECKLIST Specialist reviewing the. information term-ned: Date questionnaire was ret'm-ned: ..... ~ ' Facility Permit Nm=be= Tanks located at the facility: Was a reply received for each zubstance code assigned to the facility? Does the facility need to provide additional inform-don in...order for the monitor/rig alternative to be acceptable?. Yes ~ No Descn'~e what information is required: The monitoring alternative p/c~d by the facility reprezentative is acceptable for the fac/Ii .ty (The monitoring alternative will be viewed as unacceptable if the alternative was not appropriate for the-type of tank descri"bed on the facility profile or within the facility file. Example: The facility may w/sh to use the visual alternative for a tank :ha: is not vaulted, or the tank size is not appropriate for the type of inventory monitoring chosen.) Additional Commenm: Information has been reviewed and placed within the ciambase: Date entered within the databaze: Entered by (name): "ENCLOSURE-CHECKLIST Facility .H01{ARD'S HINI HARKET Permit # 280001c This checklist is provided to ensure that all necessary packet enclosures were received. Please complete this form and return it to the Kern County En~ironmental Health Services Department, along with the Monitoring Alternatives Questionnaire~ within 30 days of receipt. CITI~.CK yI~S NO The packet I received contained: x 1. Cover letter. ×. ,, 2. Facility Profile Sheet (provides Facility Permit Number and information on the underground storage tanlm and piping, as provided on the application). The substance code in Column #1! should be referenced when reviewin_~ the Monitorin~ Alternatives Fact Sheets and Ouestionnaires. x __ 3. A Monitoring Alternatives and Upgrade Requirements Fact Sheet for each substance code referenced on the Facility Profile Sheet. x 4. A Momtoring Alternatives Questionnaire for each substance code referenced on thc Facility PrOfile Fact Sheet. Signature of Person Title CC - ~ Date January 22< 1992 MONITORING ALTERNATIVES QUESTIONNAIRE FOR MVF 5 FACILITY TANKS Facility Name: HOWARD' S MINI NARKET Facility Address: 4201 Belle Terrace ~ Bakersfield, Ca.. 93309 Owner's Name: JAC 0 HI LL Owner's Address: P.O.Box 1807, Bakersfield~ Ca. 93302 Operator's Name: Elliott Williams Permit Number (obtained from the facility profile sheet): 2 8 0 0 01 C Number of Tanks which have been assigned the MVF5 Code: 4 All information has~ been received and reviewed and the following summarizes the monitoring alternative which I have picked for the MVF 5 tanica at this facility. I realize that the monitoring alternative must be approved by the local agency before implementation. In addition to 'the alternatives listed below any leak interception and detection system must be monitored utilizing a continuous monitoring device. (Place an X next to the alternative picked). __ 1. VISUAL MONITORING will be utilized. (I can inspect the exterior of all tanks, without using extraordinary personnel protective equipment). __ 2. IN-TANK LEVEL SENSOR will be installed in each tank, which are capable of detecting a leak of 0.2 gallons per hour. The sensor will be used to test the tank monthly. The facility will ALSO COM]PLEYE A TANK INTEGRITY TEST EVERy THREE YEARS. utili~ing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. __ 3. IN-TANK LEVEL SENSOR has been installed in each tank, which is capable of detecting a leak of 0.2 gallons per hour. The sensor will be used to test the tank monthly. The facility will ALSO COMPLETE A TANK INTEGRITY TEST EVERY THREE YEARS, utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. Provide the following information on the system installed:' System Manufacturer: System Model No.: Date Installed: -- SEE PAGE 2 FOR ADDITIONAL ALTERNATIVES -- MONITORING ALTERNATIVES QUESTIONNAIRE -FOR MVF 5 FACILITY TANKS Permit No.: 280001C 4. VADOSE ZONE MONITORING will be utilized ALONG WITH ANNUAL TANK INTEGRITY TESTING. The facility will submit a proposal to the department for approval of the number, locations and design of monitoring wells which will be utilized to monitor the underground storage tank systerm. Each monitoring well will be equipped with a continuous monitoring device. __ 5. VADOSE ZONE MONITORING will be utilized ALONG WIT[t ANNUAI:. TANK INTEGRITY TESTING. The facility has already installed monitoring wells, and would like to utilize them. A plot plan of their locations and a drawing showing their construction are enclosed. The facility does/does not have continuous monitoring equipment installed within each well. Provide information on the monitor which has been installed within each well: System Manufacturer: System Model No.: Date Installed: __ 6. MODIFIED INVENTORY CONTROL MONITORING (tank gauging 2 days per week) for underground storage tanks which have a total tank capacity of 2,000 gallons or less, that do not have metered dispensers; ALONG WITIt AN ANNUAL TANK INTEGRITY TEST utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. XX 7. STANDARD INVENTORY CONTROL MONITORING (tank gauging 5-7 days per week) for underground storage tanks which dispense product from metered dispensers; ALONG WlTtl AN ANNUAL TANK INTEGRITY TEST utilizing a licensed tester who's method has been certified to detect a leak of 0.1 gallons per hour. Name of person completing this form: John Kerley Title: ~~ Date: 'January 22, 1992 AEG:ch green~ueation FACILITY PROFILE SHEET BAi<£R$~. ! ELD CA PERMIT # 280001C Substance Tank Tank Year Is piping Tank # Code Contents Capacity Installed Pressurized? 1 MVF 5 REGULAR 12,000 1984 YES 2 MVF 5 UNLEADED 12,000 1984 YES 3 MVF 5 PREMIUM 12,000 1984 YES 4 MVF 5 PREM-UNLEADED 12,000 1984 YES 3aco Oil Company 3101 $~te Road Telephone: ($05) 39~-7000 Po~ O~flce Box 1807 Bskers~ield, California 95308 Facsimile: .(805) 39~-8738 Bal~ers~iel~l, (~alifornla 9330:~-1807 May 19, 1992 Bill Scheide, R.E.H.S. Environmental Health Services Department 2700 M Street Bakersfield, CA 93301 RE: Green Acres Market 9629 Rosedale Hwy. Permit %380009 Dear Mr. Scheide: Enclosed is the information requeSted in your May 4, 1992 letter. The diesel at Green Acres Market is tank #3. Als© enclosed is the corrected copy. of our May 26, 1987 over/short calculations sheet as requested. Please place this in your file, we will begin using this for all our stations. We will also begin using your Trend Analysis Sheet, since it more accurately meets state and county requirements. I am reaffirming your commitment made at our April 29, 1992 meeting to change over to "low throughput" any of the diesel or premium tanks at our locations that meet county requirements. If you need assistance in determining those tanks, please send specific qualifications and I would be happy to make a list for you. Thank you for your consideration. Sincerely, Ke¥in Mullikin Gasoline Operations Manager KM:sh TREND ANALYSX ~ wo~l~.a~t~'l / IANK # ~ CAPACITY /~O,:5/J PRODUCT ;/~~ YEAR/PERIOD INSTRUCTION'S: 'ART A : OVER~0E/SHORTAGE FIll in all information at top of form. In the space for year/ 1 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY 1 ~-~'~ +[~ being conducted (from 1 throug~ DAY 2 ~'['~7~ 12 only). Transfer the date and DAY 3 ~, ~ the sign from columns i and 16 of DAY 4 -~ Reconciliation Sheet to columns DAY 5 ~]~,~ at left. Use the table belo~ tc DAY 6 ~1,~ determine the action number for DAY 7 ~.~' the period being analyzed. OAY S -l~.~ DAY 9 -~.~ ~C~l~5~)~ ~i~ ACTI ON NUNBER DAY 10 ~1~,~ ~'i~l TABLE DAY 12 '~.~-- 30-DAY I ' ACTION DAY 13 ~_ PERIOD NUMBER[ NUMBER DAY 14 __~~ .... I = 20 DAY 15 ~[~~ 2 = 37 DAY 16 3 = 54 DAY I7 -~[.~ 4 = 69 DAY 18 -I~.[ 5 = 85 DAY 19 ~.~ 6 = 101 DAY 20~/ 7 = 117 DAY 21 ,~,/ 8 = 133 DAY ~2 ~ff 9 = 149 DAY 23 --~V. 3 : 10 = 165 DAY 24~ ~ { 11 = 180 DAY 25 ~/~.~ ~ 12 = I96 DAY 26 +[~,~ DAY 27 __~ Circle appropriate period and DAY 28 ]~--~ action number. A full cycle DAY 29[ -~.~ ~ade up of periods 1'12, after DAY 30 ~ --~,~ ~hich a new cycle begins. Use TOTAL ~INUSE$ /~ information to complete Part B. PART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-part A ............ Line 2. Cu~ulative minuses from previous periods in this cycle. Line 3. Total minuses (add lines 1 & 2) ............. Line 4. Action number for this period (from table above) .... Line 5. Is line 3 greater than line 4~ ~Yes ~No I~ Yes, you have ~ reportable loss and must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK tUT-10 "STANDARD INVENTORY CONTROL ~ONITORING'. KER'N COUNTY TREND ANALYSI ~ "'AC I L I TY >5/)/ '~ ~ · _ . -.--' - PERMIT # ANK # '~- CAPACITY /-~~ PRODUCT ~J~>:'" /I'F]- Y~AR/PgRIOD I NSTRUCTI ON'S : ART A : OVERAOE/SHORTAOE Fill In all information at top form. In the space for year/ I 16 period indicate the year and th~ DAY DATB (+/-) consecutive period pi analysi~ DAY I ~-~~ ~,~ being conducted (from I throug~ DAY 2 ~/-~ ~,/ ,,, 12 ,only). Transfer the date and DAY 3--~.~' the sign from columns i and 16 DAY 4 -~.~ Reconciliation 9heet to columns DAY 5 ~.~ at left. Use the table below DAY 6 4~.~ determine the action number fo~ DAY 7 -~.~ the per!od being analyzed. DAY 9 -3~.~ ACTI ON NUMBER DAY 10 ~7~ TABLE DAY 11 -10~.~ OAr ~2 ~.~ ~O-~AY t ACT~OS ......... I ~ 20 DAY 16 ~,~ 3 = 54. DAY 17 - -/~,~ i 4 = 69 DAY 18 ~-~ ; 5 = 85 ~AY ~9 ~.~ 6 = ~0~ DAY 20 ~ ~ i 7 = 117 DAY 21 ~, ~ 8 = 133 DAY 22 ~/~-~ 9 = 149 ~ 11 = 180 DAY 24 DAY 25 ~//~ 12 = 196 DAY 26 ~ [~q, ~ DAY 27 ~'~ Circle appropriate period and DAY 28 ~~ action number. A full cycle DAY 29 ~' -~.'~ made up of periods 1-12, after DAY ~0 ~-~ f~,~ which a new cycle begins. Use FOTAL MINUSES /~ information te complete Part B. PART B: ACTIO~ NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Uumulative minuses from previous periods in this cycle. ,.. Line 3. Total minuses (add lines 1 { 2) ............. Line 4. Action number for this period (from table above) .... , Line 5. Is line 3 greater than line 47 ~Yes ~No I~ Yes, ~ have A reportable loss and must begin notification and investigation procedures as described in Kern County Health Depautme'nt HANDBOOK *UT-lO "STANDARD INVENTORY CONTROL MONITORING". Env. Healt~ 880 4113 101~ (6/86l KERN COUNtrY It 1:. A ~. -i- It u .-. r alx'l' MI/N ~l TREND ANALYSI ::~ w t.~ ~ 1~. ~ ~t ~. ~ 'l ANK # / CAPACITY ./,~O(~ PRODUCT ~/(/~..~ ~/ YEAR/PERIOD I NSTRUCTI ON'S ~ ART A : OVERAGE/SHORTAGE Fill in ail informatiOn at top of form. In the space for year/ I 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY I ~,/ being conducted (from 1 through DAY 2 -~2- 12 onI¥). Transfer the date and DAY 3 --~ the sign from columns 1 and 16 of DAY 4 ~,/ Reconciliation Sheet to columns DAY 5 ~{~,~ at left. Use the table below to DAY 6 ~ -~0.~ determine the action number for DAY ? ~ e/~,~ the period being analyzed. DAY 8 - DAY 9 ACTI ON NUMBER DAY 10 ~ TABLE DAY DAY 12 ~'~ 30-DAY I ACTION DAY 13 ~ PERIOD NUMBERI NUMBER DAY 14 I = 20 DAY 15 - 2 = 37 DAY 16 --~-~ 3 = 54 DAY 1~ -3~ 4 = 69 DAY 18 / ~/,~ 5 = 85 DAY 19 - 6 = DAY 20 ~-~ 7 = 117 ~AY 22 --/~,~ 9 = 149 DAY 23 ~ ~//.~ 10 = 165 DAY 24 1'1 = 180 DAY 25 ~ /' 12 = 196 DAY 26 DAY 27 . ~/~ Circle appropriate period and DAY 28 ~ :1~ action number. A full cycle Is DAY 29 ,~ made up of periods 1-12, after DAY 30 ~-~-Q~ ~.~ ~hi'ch a new cycle begins. Use IOTAL ~INUSES /~ information te complete Part B. ?ART B: ACTION NUMBER CALCULATION htne 1. Total minuses this period-Part A ............ ~lne 2. Cuaulative minuses from previous periods in this cycle. ~lne 3. Total minuses (add lines 1 & 2) ............. ~ine 4. Action number for this period {from table above) .... ~lae 5. Is line 3 greater 'than line 47 ~Yes I~ Yes, you have ~ reportable loss and must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK ~UT-10 "STANDARD INVENTORY CONTROL ~ONITORING" Env. Health 880 4113 1010 (6/86) KERN COUNTY H~A~'i'~ TREND ANALYSX ~ I NSTRUCTI ON'S : 'ART A : OVERAGE/SHOrTAGE Fill in all Information at top for~. In the Space for year/ I 16 period indicate the year and th~ DAY DATE {+/-) consecutive period of analysi~ DAY I ~-~~ -~.~ be!n~ conducted (fro~ i throuz~ DAY 2 ~/~ . ~ 12 only). Transfer the date DAY 3 ~~.~ the sign fro~ columns i and 16 DAY 4~' -7~,'~ Reconciliation Sheet to colu~n~ DAY 5 -~.~ at left. Use the table belo~ DAY 6 +1~.~ determine the action number fo~ DAY 7 ~.~ the period bein~ analyzed. DAY 8 DAY 9 ~/~ ACTI ON NUHBER DAY 10 ~,~ TABLE DAY 12 -~/,q 30-DAY I ACTION DAY 13 ~ PERIOD NUMBER[ NUMBER I DAY ~5 ~ 2 = DAY 16 _~ . 3 = 54 DAY 18 -,(~ 5 = 85 DAY 21~f ~,~ 8 = 133 DAY 23~ - ff~.~ 10 = 165 DAY 24 ¢/~,¢ 11 = 180 DAY 25 ~ 12 = 196 DAY 26 DAY 27 ~¢~ Circle appropriate period DAY 28 action number. A fuji cycle DAY 29 ~.~ made up of period~ 1 '12, after DAY 30 .~-~-~ ~,~ which a new cycle begins. Use TOTAL ~INUSES ./~ information to complete Part B. PART B: ACTION NUNBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. Line 3. Total minuses (add lines i & 2) ....... ' ...... Line 4. Action number for this period (from table above) .... Line 5. Is line 3 Rreater than line 47 ~Yes ~No If Yes, you have a reportable loss and must begin notification and investi~ation procedures as described in Kern County Health Department HANDBOOK ~UT-IO "STANDARD INVENTORY CONTROL SONITORING" ~flv. Healt~ SSO 4113 ~0~ (6/86~ KERN COUNI'Y TREND ANALYSX ~NK ~ ~ CAPACITY~.~ '~ ~'~ .... PRODUCT ~./,~t~/~,'~'/ _ YEAR/P~RXOD I NSTRUCTI ON'S : ART A : OVERAGE/SHORTAGE Fill tn all information at top of form. In the space for year/ 1 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY 1 ~-~/-~ --~'7 being conducted (from 1 through lAY 2 ~--[--~- ~,~ 12 only). Transfer the date and DAY ~ , f/.~ the sign from columns 1 and 16 of ]AY 4 ~/~ Re~onctliatton Sheet to columns OAY 5 ~,~ at left. Use the table below ]AY 6 -~,~ determine the action number for DAY 7 + ~ the period being analyzed. )AY s ~,~ AC · o N NU ~AY 10 TABLE )AY m~ +3~3 SO-DAY { AC~0N ~AY 16 ~,~ 3 ~ 54 DAY 17 - }l~.~ . 4 = 69 ~AY 18 _~,~ 5 ' 85 ~AY 19 ~ ~?.~. 6 - 101 ]AY 20 ~ y~ ? 7 = 1 3AY 21 ~ ],7 8 = 133 22 9 - 149 3AY 23 ~ 10 = 165 ~AY 24 11 = 180 DAY 25 -~,~ 12 = 196 DAY 26 ~/~ DAY 27 -' ]~],/ Circle appropriate period and DAY 28 +~. ~ action number. A full cycle DAY 29 --~ made up of periods 1-12, after 9AY 30 ~-kg-?~ ~/~f which a new Cycle begins. Use tOTAL MINUgES // information to' complete Part B. :ART B: ACTION NUMBER CALCULATION ;ine 1. Total minuses this period-Part A ............ // Line 2.' Cumulative minuses from previous periods in this cycle. ;tne~. Total minuses (add lines 1 t 2) ............. Line 4. Action number for this period (from table above) .... Line 5. Is line 3 greater than line 47 ~Yes ~No If Yes, ~ou have a reportable loss and must begin notification and investigation procedures as describe~Ow~dsMi~iMa[{~ 4201 ~k in Kern County Health Department HANDBOOK ~UT-10 B~9~ ~.~ "STANDARD INVENTORY CONTROL MONITORING" ~nv. Healt~ 580 4113 1018 (6/86) KERN COUNI'Y TREND ANALYSI u "AC I L I TY //~O//J~,~//".~ ~ PERMIT ~ ~ ANK ~ .~ CAPACITY /~g.?~/3~3 PRODUCT /-~> ~/~- YEAR/PERIOD I NSTRUCTI ON'S : ART A : OVERAGE/SHORTAGE Fill In all information at top of form. In the space for year/ 1 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY 1 ~-~/-~ ~,~ being conducted (from 1 through DAY 2 ~-[~ ~ 1~ only). Transfer the date and DAY 3 -~6~ the sign from columns 1 and 16 of DAY 4 ¢/~/' Reconciliation Sheet to columns DAY 5'~,/ at left. Use the table below to DAY 6 --~/,[ determine the action number for DAY 7 ~3~,~ the period betn~ analyzed. DAY 8 ~,~ DAY 9 ~,~ ACTI ON NUMBER DAY 10 ~/ TABLE DAY ll -~ DAY 12 ~ /y~ '30-DAY { ACTION DAY ~ _z~/~ {PERIOD NUMBERI NUMBER DAY 14 __ ~ ~9, I... I = 20 DAY le ~ 3 = 54 DAY 17 -~.~ ~ 4 = 69 18 = 8s DAY [9 --/~E.7 6 ~ [0[ DAY ~[ ~$,/ 8 ~ ~33 DAY 22__ ~/,~ 9 = 149 DAY 23 ~ ~/g~ ~0 = ~6~ DAY 24/ ~//~,~ 11 = 180 , = DAY 26 DAY 27 -- ~ Circle appropriate period and .DAY 28 ~l~O,~ action number. A full cycle DAY 29 ~,~ made up of periods 1-12. after DAY 30 ~-~~ ~,/ which a new cycle .begins. Use TOTAL ~!NUSES /~ information to complete Pert B. PART B: ACTION NUMBER CALCULATION Line 1, Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. Line 3. Total minuses (add lines 1 ~ 2) ............. · Line 4. Action number for this period (from table above) .... Line 5. Is line 3 greater than line 47 ~Yes ~No If ye~, you have a reportable loss and must be~tn notification and investigation procedures as described ~0wards Mini Mat~ ~6 in Kern County Health Department HANDBOOK ~UT-IO 4201Be{~l~ "STANDARD INVENTORY CONTROL MONITORING" ~f~.,~ KERN COUNI'Y TREND ANALYSX :~ ~ o i~ i~, ~ it ~-~ t~ 'J~ AC I L I TY *. ~ ~ PERMIT ANK # / CAPACITY /~-~r) ~ PRODUCT ~ /~:~ YEAR/PERIOD ~?~-~-~ NSTRUCTI ON'8 : ART A : OVERAGE/SHORTAGE Fill in all information at top of form. In the space for year/ 1 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY 1 ~/,~ being conducted (from 1 through DAY 2 . ~47~ 12 only). Transfer the date and DAY 3 ~ the sign from columns 1 and 16 of DAY 4 --/~,~ Reconciliation Sheet to columns ~AY 5 ~/~,'1 at left. Use the table below to DAY 6 --~7~.~ determine the action number for DAY 7 ~.~. the period being analyzed. DAY 8 DAY 9 ~/ ACTI ON NUMBER DAY 10 /~ TABLE DAY 11 DAY 12 +?,~.- SO-DAY { ACTION DAY 13 - PERIOD NUMBER{ NUMBER DAY 14 ~ ~ ~ 20 DAY 15 ~ = 37 DAY 16 3 = 54 DAY 17 -/~.~-- 4 = 69 DAY 18 ~,?,~ 5 = 85 DAY 19 .10.~- 6 = 101 DAY 20 7 = 117 DAY 21 47~~ 8 = 133 DAY 22 9 = 149 DAY 23 10 = 165 DAY 24 .~7,~ 11 = 180 DAY 25 - 12 = 196 DAY 26 DAY 27 +il Circle appropriate period and DAY 28 action number. A full cycle is DAY 29 ~, made up of periods 1-12, after DAY 30 --~(/ which a new cycle begins. Use TOTAL MINUSES y information to complete Part B. PART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. Line 3. Total minuses (add lines 1 & 2) .............. Line 4. Action number for this period (from table above) . . .'. Line 5. Is line 3 greater than line 4? [-]Yes ~No If yes, you have a reportable loss and must begin notification and investigation procedures as described ~owardsMiniMark~ #6 in Kern County Health Department HANDBOOK #UT-10 4201Be{~ "STANDARD INVENTORY CONTROL MONITORING" ~nv. Health 580 4113 1016 (6/86) KERN C O UN'i' Y TREND ANALYST INSTRUCTION'S: ART A : OVERAGE/SHORTAGE Fill in all information at top o! form. In the space for year/ 1 16 period indicate the year and thm .DAY DATE (+/-) .consecutive period of analysis DAY 1 ~-~/~Y~-' ~.~ being conducted (from 1 througk DAY 2 ~[--~ ~ 12 on~y). Transfer the date a~d DAY 3 the sign from columns 1 and 16 of DAY 4 ~ Reconciliation Sheet to column~ DAY 5 ~/~ at left. Use the table below DAY 6 -~.~ determine the action number DAY 7 ~f[,~ the period being analyzed. DAY 9 ~,~ ACTI ON NUMBER DAY 10 ~} ~ ~.~ TABLE DAY 12 -~, ~ 30-DAY { ACTION DAY 13 _.~ PERIOD NUMBER{ NUMBER DAY 14 __ ~31,~_.. 1 = 20 DAY 15 ~7~ ~ = 37 DAY 16 ~~ 3 = 54 DAY 17 -[~.~ .... 4 = 69 DAY 18 +~ 5 = 85 oar ~9 -9,~ 6 ~ ~o~ ~AY 20 -~,~ 7 = 117 DAY 21 ~/[,~ 8 = 133 DAY 22 --~,/ 9 = 149 DAY 23 ~/~,~ 10 = 165 DAY 25 -~0~ 12 = 196 DAY 27 ~/E0,.~ Circ[e appropriate period and DAY 28 ~-3 action number. A full cycle pAY 29 ~/~ made up of periods 1-12, after DAY 30' ~-~~ ~,~ which a new cycle begins. Use TOTAL ~INUSES /~ information to complete Part B. PART B: ACTION.NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this 'cycle. ... Line 3. Total minuses (add lines 1 a 2) ............. Line 4. Action number for this period (from table above) .... ... Line 5. Is line 3 greater than line 47 ~Yes ~No I~ Yes, you have ~ reportable loss and must begi~ow~[~Mi~iMa~[~_ ~6 notification and investigation procedures as described 4201Belk~e~e in Kern County Health Department HANDBOOK ~UT-10 ~f~.,~9~ "STANDARD INVENTORY CONTROL RONITORING". Cnv. He~lth 580 4113 {0~ (6/86) KI~RN C O UN'I' Y TREND ANALYSX INSTRUCTION-S: ~RT A : OVERAGE/SHORTAGE. Fill tn all information at top of form. In the space for year/ 1 16 period indicate the year and the ~A~ DATE (+/-) consecutive period of analysts DAY 1 ~/-~ --~,q bein~ conducted (from 1 throug~ DAY 2 ~ 12 onl. y). Transfer the date and DAY 3 ~,q the sign from columns 1 and 16 of DAY 4--~'~ Reconciliation Sheet to columns DAY 5 ~,~ at left. Use the table below tc DAY 6 --~,~ determine the action number foz DAY 7 -A~ the period bein~ analyzed. 9 ...... ACTXON NU ER 0AY 12 ~;{,~ . . 30-DAY ~ ACTION 0AY ~S _.~,~ PE~IO0 NU~BER[ NU~BER 0AY 15 ____~ 2' 0~Y 16 ~'f .. 3 = 54 DAY 19. ) 6 = 101 5AY 24 -~,/ ' 11 = 180 DAY 25 --~,? 12 = 196 2e DAY 2? '1~./ Circle appropriate period and DAY 28 ~ ~,~ action number. A full cycle DAy 29 ~ ]], ~ made up of periods 1-12, after DAY ~0 ~ ~. ~ which a new cycle begins, Use TOTAL ~INUS]~S /~ information to complete Part B. ?ART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. 5tne 3. Total minuses (add lines 1 ~ 2) ............. Line 4. Action number for this period (from table above) .... 5the 5. Is line 3 greater than line 47 ~Yes ~No I~ Ye~, yOU have ~ reportable loss and must begin notification and investigation procedures as described in Kern Count~ Health Department HANDBOOK ~UT-10 "STANDARD INVENTORY CONTROL MONITORING" KERN C O UN'I' Y ti ~. ~, · - '" ti TREND ANALYSI ~AC I L ITY /~//~~ ~z~ FERMI T #2~,~-~ ANK # ~ CAPACITY /'~Y--~) PRODUCT ,,. ~,~~ yEAR/PERIOD INSTRUCTION'S: ART A : OVERAGE/SHORTAGE Fill in all information at top of form. In the space for year/ I 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY I ~ being conducted (from I through DAY 2 ~, 12 only). Transfer the date and DAY 3 the sign from columns 1 and 16 of .DAY 4 -'~ Reconciliation Sheet to columns DAY 5 at left. Use the table below to DAY 6 /~'~, determine the action number for DAY 7 ~ the period being analyzed. DAY 8 DAY 9 ~ ACTI ON NUMBER DAY 10 ~ TAB L E DAY 11 DAY 12 ~,~ 30-DAY { ACTION DAY 13 .~.~:~_ PERIOD NUMBER{ NUMBER DAY 14 -~ ~ 1 = 20 DAY 15 {,O 2 = 37 DAY 16 -~ 3 = 54 DAY 17 4 = 69 DAY 18 5 = 85 DAY 19 --~'V' 6 = 101 DAY 20 -~' 7 = 117 DAY 21 ~,~ 8 = 133 DAY 22 ~,~ 9 = 149 DAY 23 ~,~ 10 = 165 DAY 24 11 = 180 DAY 25 12 = 196 DAY 27 + Circle appropriate period and DAY 28 ~ action number. A full cycle is DAY 29 -/~,/ made up of periods 1-12. after DAY 30 - ~ which a new cycle begins. Use TOTAL MINUSES /~ information to complete Part B. PART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. ~ Line 3. Total minuses (add'~tnes 1 & 2) ' ~ Line 4. Action number for this period (from table above) ~ Line 5. Is line 3 greater than line 4? ~]yes ~No If Yes, you have ~ reportable loss and.must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK #UT-lC "STANDARD INVENTORY CONTROL MONITORING". Env. Healt~ ~80 4113 101~ (6/86) KERN C O UN'I' Y TREND ANALYSI ANK # /' CAPACITY /~OO O PRODUCT ~?~l, ~ YEAR/PERIOD INSTRUCTION'S: ART A : OVERAGE/SHORTAGE Fill in all Information at top of form. In the space for year/ 1 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY 1 ~/o being conducted (from 1 through 0AY 2- -~'~ 12 only). Transfer the date and DAY 3 %/Y~,( the sign from columns 1 and 16 of DAY 4 -~q,7 Reconciliation Sheet to columns DAY 5 -~ at left. Use the table below to DAY 6 ~/~ determine, the action nUmber for DAY 7 -~ the period being analyzed. DAY 8 DAY 9 ~ ACTI ON NUMBER DAY 10 *~.~ TABLE 0AY 12 30-DAY { ACTION DAY 13 -9/-~- PERIOD NUMBER{ NUMBER DAY 14 --' 1 = 20 NAY 15 ~q~ 2 = 37 DAY 16 -/~,~ 3. = 54 DAY 17 ~o~,~ 4 = 69 DAY '19 ~( 6 = 101 DAY 21 --~/ 8 = 133 3AY 22 9 = 149 OAY 23 ~-~F 10 = DAY 24 . -~g,/ 11 = 180 DAY 35 -~9'~ 12 = 196 DAY 26 ~/~ ~ 0AY 27 Circle appropriate period and DAY 28 ~/~,~ action nueber. A full cycle DAY 29 ~./ eade up of periods l-l~, after OAY 30 ~ which a new cycle begins. Use ~OTAL MINUSES lnforaation to coaplete Part B. ~ART B: ACTION NUMBBR CALCULATION ~ine ~. Total sinuses this period-Part A ............ ~lne 2. Cueulative einuses froa previous periods in this cycle. ~L ~ine 3. Total sinuses (add lines ~ & 2) .......... . .~.~ ~ine 4. Action nuaber for this period (froa table above) ~ ~lne 5. Is ~ine 3 greater than line 4~ ~Yes ~No If 'Yea, you have a reportable loss and aust begin notification and investigation procedures as described In Kern County Health Oeparteent ~ANOB00K ~UT-10 "STANDARD INVENTORY CONTROL MONITORING'. Env. Health 580 4213 1018 (6/86~ KERN COUNq_'Y TREND ANALYSX 'AC I L [ TY . ,/./4 ./ PERMIT ~ ~(]/ ~NK # ~.~ CAPACITY ~,'~-~:->O(~ PR0r~UCT /c.;f_~/.~ ~/,F'~, YEAR/PERiOD T NSTRUCTT om~s : ~RT A : OVERAGE/SHORTAGE Pill in all information at top of form. In the space for year/ 1 16 period indicate the year and th~ DAY DATE. (+/-) consecutive period of analysis :3AY 1 ~-~/-~- --/Zf,~' being conducted (from 1 throug~ 3AY 2 ?~.~- 12 only). Transfer the date and ,DAY 3 ~/, ~ the sign from columns' 1 and 16 of JAY 4 ~//~,0 Reconciliation Sheet to columns ~AY 5 -~.~ at left.. Use the table below 3AY 6 ~,~ determine the action number for DAY 7 --~,~ the period being analyzed. ~AY 9 -~/,~ ACTI ON NUMBER DAY 10 ~-~ TABLE ~AY ~ 1 ~9, o . )AY 12 ~'~ ~0-DAY [ ACTION 3AY 13 --/~O,~ PERIOD NUMBER{ NUMBER )AY 14 ~/~{ 1 ~ 20 3AY 16 ~/~?, $ 3 - 54 DAY 17 -99 ~ 4 = 69 = 85 { lAY 19 Y/~-~ 6 = 101 ~AY 20 ~,? 7 = 117 3AY 21 ~? 8 = 133 )AY 22 --/~ ~'~ 9 = 149 DAY 24 --/~ 11 = 180 DAY 26 DAY 27 ~ ~.~ Circle appropriate period and DAY 28 -~0~.~ action nuaber. A full cycle DAY 29 -7.~ aade up of periods i-l~, after OAY 30 / V ~/.~ ~hich a ne~ cycle begins. Use ~0TAL ~INUSES /~ information to complete Part B. ~ART B: ACTION NUMBER CALCULATION ~ine 1. Total atnuses this period-Part A ............ btne 2. Cuaulattve atnuses froa previous periods in this cycle. ~ . Line 3. Total minUses (add lines 1 & 2) ............ 5~ Line 4. Action number for this period (from table above) ~ .20 Line 5. Is line 3 greater than line 47 ~Yes ~No If Yes, you have a ueportable loss and must begin notification and investigation procedures as described In Kern County Health Department HANDBOOK ~UT-IO "STANDARD INVENTORY CONTROL MONITORING'' COUNTY RESOURCE MANAGEMENT AGENC' KERN ENVIRONMEN''fAL EALTH SERVICES DEPARTMENT 2?00 "M" STREET; SUITE 300, BAKERSFIELD, CA..,.3301 (805)861-3636 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY ~ INSPECTION REPORT * MI 28uuu,~ ~ T~ME IN TIME OUT NUMBER M I T%oOSTED? ) YES ' ...... 1~'8 ...... /¢ .................... ?~SPECT ION COMP L~ ~"~'~ ................................. I L [ TY NAME: ~.~.~.~.~.~,,'...~.,.,,~,~.~,~.~.~ ......................................................................................................................................................................................... ~L~TY ADDRESS:4201 BELLE TERRACE BAKERSFIELD, CA ~ ~ s N A ~ E:,~,,~,q.9...,q,LL,,.qg_~.~5~Z_.~.~,~ ................................................................................................................................................................. R A T 0 R S N A M E:..~,6 ~,~_.~..LL....qg~.~,~,~Z.....~ ................................................................................................................................................................. ~ENTS: TEN V I OLAT I ON S/OB,SE RVAT IONS !MARY CONTAINMENT MONITORING: ~Standard Inventory Control I Modified Inventory ControlI In-tank Level Sensing Device Groundwater Monitoring Vadose Zone Monitoring DARY 'CONTAINMENT MONITORING: :tton - ;OITION OF FACILITY ' · ': '~ KERN TY AIR POLLUTION CONTRO _,I:IICT 2700 "M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR RECOVERY INSPECTION FORM Station'Name F~.~,~3 ~ /3'~]~f4w, ct"T"~ocation 424D/ _/~'"//_.~"_ ?~.~--~.~/~ .w~/~'~ P/O # ~mpany MailingAddress t~ ~ ~ ~ ~ ~otico ~ec'd BY TANK · 1 TANK ~2 T~K ~3 TANK ~4 1. PRODUCT (UL PUL, P, or R) 2. TANK LOCA~ON REFERENCE 3. BROKEN OR MISSING VAPOR CAP 4. BROKEN OR MI~ING FILL CAP 5. BROKEN CAM LOCK ON VAPOR CAP 6. FI~ CAPS NOT PROPERLY SEATED 7. VAPOR CAPS NOT PROPERLY SEATED " 8, GASKET MISSING FROM FILL CAP .. 9. ~SKET MISSING FROM VAPOR CAP 10, R~ ADAPTOR NOT TIGHT 11. VAPOR ADAPTOR NOT TIGHT 12. GASKET BE~EN ADAPTOR & FI~ ~BE MISSING / IMPROPERLY SEATED 13. DRY BR~K GASKE~ DETERIO~TED 14. EXCESSIVE VE~ICAL P~Y IN CO~IAL FI~ TUBE 15. COAX~L FILL TUBE SPRING ..' MECHANISM DEFE~IVE / 16. TANK DEPTH M~SUREME~ 17. TUBE LENGTH MEASUREMENT ' 18. DIFFERENCE (SHOULD BE 6" OR LESS) 19. OTHER 20. COMMENTS: /_~._),~",~_.,~.'7'"'._% ;~, ~X~~ / WARNING: SY~MS MARKED WI~ A CHECK ABOVE ARE IN VlO~ON OF KERN COUN~ AIR PO~U~ON CONSOL DIS~I~ RU~(S) 2~, 412 AND/OR 412.1. THE CALIFORNIA H~L~ & SA~ CODE SPECIFIES PENAL~ES OF UP ~ $1,~.~ PER DAY FOR EACH VIOLATION. ~PHONE (~5) ~1-3~2 CONCERNING FINAL RESOLU- ~-~o~ APCD FILE ' ~.: ~" 2700 "M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 PHASE II VAPOR RECOVERY INSPECTION FORM Station Location ~,~/?¢"~ / ~--~._~/,/,.~_~ ~.~/:~ ~' P/O# Company Address ~.'O, ~'~-'~X ! ~4'? ~ City ~_'A. A~-~ ~-~ ~'"'./~//~ Zip Contact Phone System Type: BA RJ HI HE GH. HA Inspector ..¢'-~; ~ *-¢'.¢'~7., ~ ,~>..--'7 Date -~ - 2 ~ ~ ?..~ Notice Rec'd By NOZZLE cf GAS GRADE NOZZLE TYPE 1. CERT. NOZZLE 2. CHECK VALVE N O 3. FACE SEAL Z Z 4. RING, RIVET L E 5. BELLOWS 6. SWIVEL(S) 7. FLOW LIMITER (EW) 1. HOSE CONDITION V A 2. LENGTH ~ P 0 3. CONFIGURATION R 4. SWIVEL H 0 5. OVERHEAD RETRACTOR S E 6. POWER/PILOT ON 7. SIGNS POSTED Key to system types: Key to deficiencies: NC= not certified, B= broken BA=Balance HE =Healey M= missing, TO= torn, F= flat, TN= tangled RJ =Red Jacket GH=Gulf Hasselmann AD= needs adjustment, L= long, LOTM loose, HI =Hirt HA =Hasstech S= short MA= misaligned, K= kinked, FR= frayed, =~< INSPECTION RESULTS Key to inspection results: Blank= OK, 7= Repair within seven days, T= Tagged (nozzle tagged out-of-order until repaired) U= Taggable violation but left in use. COMMENTS: '/~,_~,~;Z~,,,z-/.'~ ' VIOLATIONS: SYSTEMS MARKED Wl~ A' "T OR U" CODE IN INSPECTION RESULt, ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 412 AND/OR 412.1. THE CALIFORNIA HEAL~ & SAFETY CODE SPECIFIES PENAL~ES OF UP TO $1,~.~ PER DAY FOR EACH DAY OF VlOLA~ON. ~LEPHONE (805) 861-3682 CONCERNING FINAL RESOLU~ON OF ~E VIOLATION. NOTE: CALIFORNIA HEAL~ & SAFETY CODE SECTION 41960.2, REQUIRES THAT ~E ABO~ LIS~D 7-DAY DEFICIENCIES. BE CORREC~D WITHIN 7 DAYS. FAILURE TO COMPLY MAY RESULT IN LEGAL AC~ON 9149-10 ~5 APCD FILE TREND ANALYSX ~ ANK # ~7 CAPACITY /2-'*~ PR0VUCT (,~Z, ~ .... ' ' . . INSTRUCTION'S: ART ~ : OVERAGE/SHORTAOE Fill in all Information at top o! form. In the space for year/ 1 16 period indicate the year and th{ DAY DATE I+/-) consecutive period of analysi~ DAY I ~--~'~"~- -,~ beinR conducted (from 1 throug~ DAY 2 '~-'~-~'~ ~8.~'- 12 only). Transfer the date and DAY 3 ~/.-~ +~.~- the sign from columns 1 and 16 of DAY 5 at left. Use the table below DAY 0 I '~7~ determine the action number fo~ DAY ? the period being analyzed, DAY 9 +~,~ ACTI ON NUMBER DAY 10 - ~.f~ TABLE DAY 12 ~ ; 30-DAY { ACTION DAY 14 __ , I = 20 DAY 15 ~ ; 2 = 37 DAY 16 .~ ~ , 3 = 54 DAY 17 ~. · : 4 = 69 DAY 18~~- { 5 = 85 DAY 19 ' 6 = 101 DAY 20 ~ 7 = 117 DAY 21 ~g~,~ : 8 = 133 DAY 22 ~/ 9 = 149 DAY 24 } +~2./ : 11 = 180 DAY 25 ~ ~,~ 12 = 196 DAY Z6 { DAY 27 - ~ Circle appropriate period and DAY ~8 , ~ action number. A full cycle DAY 29 { -~[,~-- made up of periods 1-12, after DAY 30 ~-~/~ -~.~ which a new cycle begins. Use TOTAL MINUSES /~ information to complete Part B. PART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. Line 3. Total minuses (add lines 1 a 2) ........ - ..... Line 4. Action number for this period (fro~ table above) .... Line 5. Is line a ~reater than line 47 ~Yes ~No I~ Yes, you have a reportable loss and ~ust begin notification and tnvesttlatton procedUres as described In ~ern Coant~ lealth Oepart~nt ~l~OBOO~ ~I-10 "STANDARD INVENTORY CONTROL ~O~IIORI~" Env. Health 580 4113 1019 (6/86) KERN COUNTY TREND ANALYS ~' ANK { /' CAPACITY /,~(~D~ PRODUCT ~j..>VJ,~/~/~/ YEAR/PERIOD ~-~/ INSTRUCTION'S: ART A : OVERAOE/SHORTAOE Fill in all Information at top of form. In the space for year/ 1 { 16 period indicate the year and the DAY DATE{ (+/-) consecutive period of analysis DAY 1 ~-3;o-='/~-- { -,~ 'being conducted (from 1 through DAY 2 ~-~./-./,,,--- { -03 ~- 12 only) Transfer the date and DAY 3 ~-.i'-"~'.~l -~q ~ the sign from columns 1 and 16 of DAY 4 Reconciliation Sheet to columns DAY 5 ~ at left. Use the table below to DAY 6 determine the action number for DAY 7 -/0~'~- the period being analyzed. DAY 8 ~c~, ~ DAY 9 -~.-~- ACTI ON NUMBER DAY I0 t~,~c- TABLE DAY 1 1 DAY 12 30-DAY { ACTION DAY 13 _- PERIOD NUMBER[ NUMBER DAY 14 -3l. 1 = 20 DAY 15 2 = 37 DAY - q,__s_ 3 - 54 DAY 17 · -~ . ' ' 4 = 69 DAY 19 6 = 101 DAY 20 _',~-~,~/.~.~ 7 = 117 DAY 21 8 = 133 DAY 22 9 = 149 DAY 23 10 = 165 DAY 24 11 = 180 DAY 25 ~ 12 = 196 DAY 26 DAY 27 Circle appropriate period and DAY 28 ~,~ action number. A full cycle is DAY 29 , --I,~ made up of periods 1-12, after DAY 30 ~,~ which a new cycle begins. Use TOTAL MINUSES /~ information to complete Part B. PART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-Part A ............ Line 2. Cumulative minuses from previous periods in this cycle. .~ Line 3. Total minuses (add lines 1 & 2) ............. Line 4. Action number for this period (from table above) .... ~d/ Line 5. Is line 3 greater than line 47 ~]Yes C~No If Yes, you have ~ reportable loss and must begin notification and investigation procedures as described in Kern County Health Department HANDBOOK #UT-10 "STANDARD INVENTORY CONTROL MONITORING". Env. Health 580 4113 1018 (6186) KERN COUNTY ~A~i'~ u~rAR'I'M~N~ TREND ANALYSX ~ ~u~~'l ANK # -" CAPACITY /~_ >~9 PRODUCT <hT/ ~,'ff. YEAR/PERIOD ~ ' " I N~TRUCTI ON'S : ~RT A : OVERAOE/SHORTAO~ Fill tn all information at top oi form. In the space for year/ I 16 period indicate the year and th~ DAY DATE, {+/-) consecutive period of analysis DAY I > ~? ';~' ~, ~ being conducted (from I throug~ ''' ' ' /r +~7 12 only) Transfer the date and ~' ~/, [ the si~n from columns i and 16 of DAY 4 t ~//~t~ Reconciliation Sheet to columns DAY 5/ ~~ at left. Use the table below kc DAY 6 ~ determine the action number fox DAY 7 ] -~,~ the period being analyzed. DAY 9 ' +~.~ ACTI ON NUMBER DAY 10 -~,~ TABLE DAY 12 --/~ 30-DAY { ACTION DAY 13 { ~.~. PERIOD NUMBER{ NUMBER ~ DAY lB ~ ~V.~ 3 = U4 DAY lV ', --q~,3 4 = 69 { DAY 19 ;~~ 6 = 101 { DAY 21 ~ ~.~ 8 = 133 DAY 22 ~ ~. ~ 9 = ~49 DAY 23 ' -~.~ 10 = 165 i DAY 24 ~ +~,1 ~1 = ~80 ~ I DAY 25 ~ ~.~ 12 = 196 DAY 26 i ~'9 DAY 27 ; ~ff.~ Circle appropriate period and DAY 28 ~ ~ action number. A full cycle ts DAY 29 i -~.~ made up of periods 1-12, after DAY 30 /~-'/~b ~{~ which a new cycle begins. Use TOTAL MINUSES /~ information to complete Part B. PART B: ACTION NUNBER CALCULATION Line 1. Total ~inuses this period-Part A ............ /~ Line 2. Cumulative ~inuses from previous periods in this cycle. ~ Line 3. Total minuses (add lines 1 & 2) . .- ........... ~ Line 4 Action number for this period (from table above) .... ~/~ · / a~'. Line 5. Is line 3 greater than line 47 ~Yes ~No I~ Yes, you have a reportable loss and must begin notification and investigation procedures as described tn Kern Count~ Health Department HANDBOOK tUT-10 "STANDARD INVENTORY CONTROL MONITORING". Env. Health ~80 ~113 ]O~ (6/86) KERN COUNTY TRE'ND ANALYSI ~ I NSTRUCTI ON'S : ART A : OVERAOE/SHORTAGE Fill in all information at top of form. In the space for year/ 1 16 period indicate the year and the DAY DATE (+/-) consecutive period of analysis DAY 1 ,q "7"'~,,,~- -~'~-- being conducted (from 1 throug~ DAY 2 ~ "~/-'~1-- + 0-,~ 12 only). Transfer the date and DAY 3 ~-/'-'~ 7~ ~/, / the sign from columns 1 and 16 of DAY 4 i ~,~ Reconciliation Sheet to cOlumns DAY 5 ~ -~,O at left. Use the table below tc DAY 6 ~ ~.~ determine the action number for DAY 7 ~ -~ the period being analyzed. DAY 8{ '~'~ DAY 9 i --&.? ACTI ON NUHBER DAY 10 { ~/~0.~ TABLE DAY 12 ' ~__~ 30-DAYI ACTZ0N DAY 13 +~ PERIOD NUMBER NUMBER DAY 14 __ 1 ~ 20 DAY 15 { ~/~ 2 = 37 DAY 16 ~ '--I.~ 8 = 54 OAY 1~ i - ~.~ 4 = 69 DAY 18 ~ ~0 5 = 85 DAY 20 ~ -~ 7 = 11 DAY 21 ~ +~.~ 8 = 133 DAY 22 { ~.~ 9 = 149 DAY 23 DAY 25 ~ ~ ~ : 12 = 196 0AY 26 ~ DAY 27 / Circle appropriate period and DAY 28 / ~,~ action number. A full cycle DAY 29 -[3.~ made up of periods 1-1~, after DAY 30 ~'?'~ + ~/~ 3 which a new cycle begins. Use tOTAL MINUSES /~ information to complete Part B. PART B: ACTION NUMBER CALCULATION Line 1. Total minuses this period-Part A ' Line 2. Cumulative minuses from previous periods tn this cycle. Line' 3. Total minuses (add lines 1 t 2) ~ Line 4. Action number for this period (from table above) .... ~tne 5. Is line 3 ~reater than line 47 ~Yes ~No I~ Yes, you have a reportable lOSS and must begin notification and investilatton procedures as described in Kern County Health Department HANDBOOK tUT-lO "STANDARD INVENTORY CONTROL MONITORING". inv. Health ~80 41i3 1016 (6/86) Jaco Oil Company 3101 State Road Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93308 Facsimile: (805) 393-8738 Bakersfield, California 93303-1807 June 27, 1990 JUN Kern County Environmental Health Department .. .... . .....;~'.',./" 2700 "M" Street, Suite 300 Bakersfield, Ca. 93301 Ms. Amy Green: Please be advised that the attached forms are those forms that we have requested that all of our operators in Kern County utilize in completing underground tank monitoring. Please advise us if you have any problem with these forms. La%.r£ence, Henson Gasoline Operations LJV 1Si</5ilL)H'l'b CALCULATIONS PDRMIT Locat i on ·, Month PRODUCT' Gal:,. over/sho~t PRODUCT DAYS GALLONS SOLD OVER SHORT _~ DAYS GAI, LONS J. .. TOTAL Gals. sold 2 x 100% Variation 2 3 B. iX'es amt. over/short exceed 350 gals? I 3 4 __ No - c~tin~ ~{itoriwj ~ , Ye~ - ~'~rt within 24 hfs o~i~overy 4 6 i ~5 t~ va~iatl~ exceed TOTALS ] ~_ Yes - Re~t to ~mitting ~t~[ity 8 ~a ~ ~ithin ~ h~s o[ qia~ve~y, TOTALS 9 A. Ga}a ove~/sho~t .... ~ 9 l0 TOTAL Gals. sold 10 11 13 1 4 ' ___ yes - Retort within 24 hfs o~i~o~r~ 1 3 TOTALS ~s t~ vartatl~ ex~d 5~? ~4 __ ~ - ~tin~ r~ti~ ~itoring TOTALS 1 5 Yes - ~rt to ~mitti~ Aut~ity : -- within 24 hzs of direly 1 5 1~ ~%~{ '"" ' 16 ~ 7 A. Gals over/aho~t 1 8 -' ~ + ~o~u oais. sold 1 7 19 ' J X 100i Variation 19 2 0 { e. ~s ~t. o~/s~t e~ ]50 gala? ..... ' ~ __ ~ - ~tin~ ~itozing 2 0 2 1 -- Yes - Re~t within 24 hr~ o~i~ove TOTALS ~ the va~iati~ exceed 5~? TOTALS 2 3 __ gea - ~t to ~mitti~ ~t~ity 2 2 within 24 hfs cf di~very 2 25 a. Gals over/sho~t 24 = 25 ) 26 TOTAL Gals. sold . .,. ,, - , 27 '. B. ~s ~t. ovef/s~rt e~ed 350 gal~? ' ID - Continue ~itocimj . 2 --~ 9' ~ ~s the va[iati~ exc~d 517 3 0 -__ I~ - Contin~ ~mtine .onitocin9 · " j [ ..... __ ges - ~e~ct to ~mltti~ Aut~ctty ]0 ,, within 24 hcs of dis~ve~y ToTaLs MONTHLY " ~OaT. ~.O , ' ' TOTALS ~. ~ ovet/a~ort MONTHLY GRAND .,, · TOTALS (TOTAL SHC RTABSS __~o~ sa~s. so~d GRAND TOTALS (TOTAL X 100% Vat iai Have you: sho[tages exceeded chart amount? u. ~ vatiati~ exce~ 1.5%2 Ilave your shortages ex Yea No ~ - O~ntln~ ~tine ~itotin9 If Yes, ~eport to Kern County __~ Ye~- ~e~tt to Petmitti~ ~tl~tity If ~s, repott to Ke:n If NO, continue monito[ing within 24 bra of di~,vety If NO, continue monito )RNIA 93303, {B05) 393-7000 Monlh Day ,19 NO LEAD @ UNLEAOEO PREMIUM ~ DIESEL Money Gallons Money Gallons Money I I I I ~ t I I I I ~ ~ I I I I I I I I I I I I I ~ I ~ I I I I I ! I I I I I I I I I ~ I I I ~ I I I I I I I ~ I I ~ ~ I I I I I I I I i I i I I I I I i I i I I I I f I I i I ~ I I I I I I I ! I i I I I I I I I I I I I I I t I I I I I I Rcpls. Sub. Sales Book Inv. Inches Gallons + or - PRODUCT . CASH SALES l To!,, I · " I ,.... c,. I~''': ! ~.ii~.E~~_ o~. ,,_,,. ,.'~.i, ._ .NK ~ ~., CAPACITY 120~O PR0~UCT U~&- ~P~£~ YEAR/PERIOD "' I NsTRucTI ON'S : RT A : OVERAGe/SHORTAGE Pill in all information at top of form. In the space for year/ I 16 period indicate the year and the DAY DATB (+/-) consecutive period of analysis AY I ~-~7-~ -- Y~.,/ being conducted (from I through AY 2-, +~/,~ 12 only). Transfer the date and AY 3 -~3,~ -- the sign from columns 1 and 16 of AY 4 -~f~, Reoonctltation Sheet to columns AY 5 +~..Q. at left. Use the table below tc AY 6 ~ f~.~ determine the action number for Ay 7 4-~ ~, ~ the period being analyzed. AY 9 ACTZON NUmBeR AY., 10 41~.~ T. AB L E Ay 12 ~0-DAY ] ACTION AY 13.]-_~.~__ ,PERIOD NU~BERI NUMBER AY 15 ~__ 2 = 37 AY 16 3 = 54 AY 18 .. a-~ ~ ~/ 5 = 85 ~Y 22 , ~AY 26 ~AY 27 Circle appropriate period ~Ay 28 action number. A full cycle ~AY 29 ~ade up of periods 1-~2, after iRT B: ACTION NUmBeR CALCULATION lne 2. Cu~ulative ~tnuses fro~ previous periods in this c~cIe. ~ l~e 4. A~tion ~u~ber for this period (fro~ table above) .... In Kern County He~Ith Department HANDBOOK ~UT-IO "STANDARD INVENTORY CONTROL ~ONITORIN6". v. ~e~{th 680 4113 1018 (6/86) , KERN COUNTY TREND ANALYSI~ .NK # I CAPACITY iIOC~ PRODUCT [~/J/. ~-/' YEAR/PERIOD I NSTRUCTI oN's ~ .RT A : OVERAGE/SHORTAGE Fill in all information at top of form. In the space for year/ 1 16 period indicate the year and th~ DAY DATE (+/-) consecutive period of analysis AY 1 -/,-~-, - , -- -~/,~Y being conducted ( from 1 througk AY 2 -~.~- 12 onl,y.). Transfer the date and AY 3 -~5~.5~ - the sign from columns 1 and 16 of AY 4 -/,~,.~ Reconciliation Sheet to columns AY 5 ~//,~- at left. Use the table below AY 6' 'ele2.,P..- determine the action number for AY 7 ... -,~, ~ the period being analyzed, AY 8 ~ ~L~,} AY 9., 4~.~'~ ACTI ON NUMBER AY 10 ~'~,7 TABLE AY 12, -/0~:~ 30-DAY { ACTION AY 1~ +g~.~ PERIOD NUMBER{ NUMBER AY 14~"~Y- 1 = 20 AY 18~ $ = 54 AY 18 5 = 85 ~Y 20 7 = 117 AY 21 8 = 133 ~y 22 { 9 = 149 { AY 23 10 = 165 ~Y 24 11 = 180 ~AY 25 12 = 196 3AY 26 DAY 27 Circle appropriate period and 3AY 28 action number. A full cycle is OAY 29 made up of periods 1-12, after '~Y 30 /O-.f,~-c].2. which a new cycl.e begins. Use ]TAL MINUSES .. information to complete Part B. iRT B: ACTION NUMBER CALCULATION the 1. Total minuse~ ibis period-Part A ............ [ne 2. Cumulative minuses from previous periods in this cycle. '7~) [ne'3. Total.minuses (add lines I & 2) ............. [ne 4. Action number for this period (from table above) .... [ne 5. Is line 3 greater than line 47 ~]¥es ~No I_[ Ye,s, you have a reportable loss and must begin notification and inveatigation procedures as described in Kern County Health Department HANDBOOK #UT-10 "STANDARD INVENTORY CONTROL MONITORINO". /. /-lea/th 580 4313 $O?e ¢6/86) KERN C OUN'rY TREND ANALYSI 'AC I L I T.Y ~0tc~D5 '~ PERMIT ANK # '~ CAPACITY iZ0~U PRODUCT _~£/L'~.! YEAR/PERIOD ~3-~ ART 6 : OVERAGE/SHORTAGE Fill in all information at top form. In the space for year/ 1 16 period indicate the year and th~ pAY DATE (+/-) consecutive period of analysis DAY,,,1 ~'~'?-~ -~- $~/.~ being conducted (from 1 throug~ DAY 2.: · -- ~L43--" .., 12 only). Transfer the date and D~Y 3 / +~0.! the sign from columns 1 and 16 of DAY 4 ,,-/~ Reconciliation Sheet to columns DAY 5 ~,~ at left. Use the table below t, DAY 6--~/~, determine the action number roi DAY 7 ~ ~ the period being analyzed. DAY 8 - ~ .. DAY 9. +zoo. 7 - ACTI ON NUMBER DAY 10 .. -),7 TABLE DAY 12 ~.~ 30-DAY { ACTION DAY 1~- -IL.~___ PERIqD NUMBER{ NUMBER' DAY 15 '~;~ a = DAY 18/ 5 = 85 DAy 19 ',. 6 = 101 DAY20 -'. 7 = 117 DAY 21 .8 = 138 I DAY 22' 9.. = 149 DAY 23 10 k. = 165 DAY 24 j 11. ',,, = 180 DAY 25/ 12 " = 196 DAY 26' DAY 2~' Circle appropriate period and DAY 28 actlon number. A full cycle DAY ~9- made up of periods 1-12, after DAY 30' ~'~J-~ which a new cycle begins. Use TO~AL MINUSES informa,tiOn to complete P~rt PART B: ACTION NUMBER CALCULATION bine 1. Total ml~uses this period-Part A .... ~ ....... nine 2. Cumulative minuses from previous periods in thi~ cycle. ~ , 5t~e 8. Total minuses (add lines 1 & 2) ............. Line 4. Action number for this period (from table above) .... /0 / 5tne 5. I9 line 8 greater than line 41 ~Ye~ ~No If Yes, you have a reporta.~le, loss and must begin notification and invegtlgatlon p~ocedures as described in Kern County Health Department HANDBOOK ~UT-IO "STANDARD INVENTORY CONTROL MONITORING.". ~NSTRUCT~ ON'S : ~RT A : 0VERAG~/,SHORT&GE Fill in all information at top oJ form. In the space for year/ 1 16 period indicate the year and th~ 'DAy DATE ~(+/-) consecutive period of analysit 9AY I ~'~?-~ ~ ~ being conducted (from I througl ~AY 2 .- .-~-~4,~ 12 0nly). Transfer the date an( O__AY 3., ~,~ the sign from columns 1 and 16 JAY 4 ~ ~[,~ Reconciliation Sheet to columnf DAY 5 ~,.~ , at left. Use the table below t( ~AY 6 . -,~?.~ ,, determine the action number fo) 9AY ? ~/.,.~ the period being analyzed. DAY 9 ~2,3 ACTI ON NUMBER ~AY 12 ~.~ 30-DAY I ACTION OAY 13 -~.~ PERIOD .NUMBERI NUMBER 9AY 19 6 = '101 3AY 2i 8 = 133 )AY 22 .... 9 = 149 9AY 23 10 = 165 3AY 24 11 = 180 DAy 25 ., ~2 = 196 ,DAY 26 .pAY 27 Circle appropriate period and DAY 28 ,. action number. A full cycle ,DA.Y 29 , made up of periods 1-12, after OAY 30 /~-~ , , ~hich a ne~ c~cle begins. Use [OTAL MINUSES : ., information to complete Part B. ?ART B: ACTION NUMBER CALCULATION ~ine 1. Total minuses this period-Part A ............ Clne 2.- Cumulative minuses from previous periods in this c~cle. Cine 3. Tot.ai minuses (add lines 1 & 2) ............. ~ine 4. Action number for this period (from table above) .... /~/ ~ine 5. Is line 3 greater than line 47 ~Yes I~ Yes, you have ~ reportable loss and must begin ,, notification and investigation procedures as described in Kern Count~ Health Department HANDBOOK ~UT-10 "STANDARD INVENTORY CONTROL SONITORIN6', ;nv. Health 580 4113 1016 (6/86) Location i'~OcO~,~b50~ ~ Month DC 7- Lacs PRODUCT' 13/%'/- R~(~ eh - q, ~/ cal~. over/.hort PRf PRODUCT: DAYS GALLONS SOLD OVER SHORT ~ DAYS GAL DAYS GALLONS SOLD 7 g?3' /" -f,q ~ m - C~tinue routine mnitorin9 6 - ~ 7 . lq3[. ~ · 9 5 9 11' 3/( ~ ~/Z~04- ' X 100. Variation ' 11 '' ' '-- __Yes - Re~rt within 24 hfs o~i~ry} 13 14 1 4 /~'~ ~the variatl~ exc~ 5{1 1 4 ~OTALS /O ~ '~ ~IG Q -~U, ~ / ~ - c~ntlnue ,~ti.. ~l,o~i.~ TOTALS -- within 24 hfs of dl~ 15 ..... 16 i 6 ... "~ ~ " ' 1 6 : 1 7 19 i x 100% Variation 19 20 i, O. ~ms ~t. owL/short exce~ 3509als? 20 __ Yes - Re~rt within 24 firs o~i~owr 21 TOTALS +OTA LS .... ~s the variatim~ exc~ 51? TOTALS ..... within 24 hfs of di~ry 2 3 : 24 24 'k~:~:. ~ " ~ 25 a. c.l~ o~er/sho~t 24 25 · ~ 25 26 }. 26 ~TO*~C ~.l~. sola 26 27 27 ~ X 100~ Varimtion 2~ ~ 28 2 ~ ~ B. ~s ~t. over/~rt e~eed 350 9als? · oTALs ' } __ m - c~tinue ~itorin9 2 8 TOTALS · ,. i ~ Yes - Re.rE within 24 hfs o~i~ver ~OTALS 2 9 29 { ~s the variation exceed 5~? 2 9 ~ 0 ..... ~ m - Continue routine .onltorin9 3 0 3~ ~- Yes - .c~rt to Permittin~ Aut~rity 3 0 __. ~ithin 24 hfs of dism~ry 3 1 ~ALs TOTALS ,, TOTALS , MONTHLYJ MONTHLY, %r;uT. A. Gals over/short MONTHLY GRAND GRAND ' ~ GRAND TOTALS TOTALS (TOTAL SH( RTAOES] TOT~t, ~. ~ol~ TOTALS X 100% Variat ~o~ Have your shortages exceeded chart, amount? B. ~s variatic, n cxceed 1.5%? Have your sh~ Mare your shortages exceeded chart Yes i No · t ~ - Continue Routine ~itozi~ Yes ] Yes No If Yes, report t~ Kern County --Yes- ~e~rt to Permitti~ ~t~rity If Yes, repo: If Yes, report~Kern County If No, continue ~onitoring -- within 24 hfs o['di~very If NO, Contil If NO, contioue 1807, --LD, CALIFORNIA 93303, (805)393-7000 /~ onth /\ I, ('~ ~OX REGUI_AR NO LEAD ~t UNLEADED PREMIUM ,I.; DIESEL ,/Ioney Gallr,ns Money Gallons Money Gallons Money Gallons Money cPc_ 7 q/- q I ' I I I I I I I I J I I I i I i I I I . I I I I '-'" ¢ I I I I ., ............... I . [ I I ~%,:~z=.: :".'--~.'.~?.,,~,~.~ :~:' . "; .... :.'.';~:.. -.....~::.:- . ..~.:: :_<:--:~ :.'' '~' · ~'~" ~*: ...... .. :::'~:, I I I i I -' I I I I I I I . I i I I i I I i I i I I t_.,' w,t I I I i I I ~ I I .,~ I i I I Beg. Add Rcpts. E + or - Reg. NO Lead .,L / Diesel ~' REMARKS: Total ES 11 u,,, pmcE ,~OUNTII ~~~ ~ ~ ~ I ~ Less Less Cr. Cards Pump Test BAKERSFIELD, CALIF. 93307 INC. / / DATE __ (1105) 327-4~00 Truck #~ ACCT # __ SOLD TO: SHIPPED TO: F O. ~"~.~1'~ )? PO.# " ~UGE UNI~ PRICE" ~AL ' PRODU~ BE~RE A~ER GAUL8S PER UNiT PRICE 02 ~ ..S~C' 0 Lead G~I,, - Fla.~able Liquid UNi20O '0 ~ ~ ~ 'em. N0 Lea~ Gasoline- Flammable Liquid UN1203 0 Premium Q~ine - Flammable Uquid UN1203 04 ' Die~f Fuel ~2- CombustiVe Liquid NAI~3 PC ~ P~ P~ ~M~R · P~ODU~ D~CRI~]ON Com~u~fibl~ kiquid ~ Sub Flammable Liquid ~ Nel Orums Sales Tax 80i Drams Oelivered ( ) Return~ ( ) ~ $20 i~1 Brutus Delivered ( ) Returned ( ) (e $25 This In. Ice Includes California and federal taxes If a~ll~ble, Terms: Net by the l~h of the follow- Freight/Deli~w Differential lng month. A 1~ Interest will ~ a~e~e~ on past due amounts, which is an annual percentage O~ 18~. In the ~ent an scion Je brought by wholesale ~uela Inco~mled ~or Ihe ~ll~lon o~ sums In.ice Total due. reasonable aEomev'a f~a and eo~ shall ~ eald In addition to Ihe sum due. I I Chergl__Chlok Che~k # C.o.D. (Caah)~ WHITE OFFICe: I Oellvered by ~ Received by X BLUE NUMERIC GREEN OE[tV~R~ Jaco Oil Company OVER/SHORT CALCULATIONS 1) Fill in Permit #, Location, Month and Year. 2) Identify each product you are keeping the recap on. 3) Enter the total sales by product from Line 10 of the Daily Report to the appropriate date line. 4) In the Plus and Minus columns enter the amount over or short for each day from Line 16 of your Daily Report. 5) The weekly total on this form will be the figure you will use as your gallons over or short for th~ week you are working with. 6) To determine the gallons over or short, you take the gallons over. less the gallons short, to arrive at a net number. This number can be a negative nmnber. 7) The monthly recap will be the total gallons over less the total gallons short. Again, this can be a negative number. This is the total mnount over or short for the month. INVENTORY CALCULATION l) To complete this portion, you need two numbers: a) The net amount over and short from recap of overs and shorts for the week; b) Total weekly sales by the meter reading also is on the recap. 2) SECTION A: Enter the net gallons over or short for the week on the first line and total sales for the week on the second line. By dividing the gallons short or over by the gallons sold you will have a fraction. By multiplying this fraction by 100 you will have a percentage of variation. SECTION B: Simply answer the two questions based on the information you have gathered. At th~ end of the month a recap of the month (28-31 day period) shall be calculated using the same format. 3101 State Road Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93308 Bakersfield, California 93303 Jaco Oil Company 3101 State Road Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93308 Bakersfield, California 93303 ACTION NUMBER CHART In an effort to detect leaks, an "action number" has been developed. For each month you will coun~ the number of total shortages by product. If a product comes up short more than the action number, it indicates a possible leak and is to be reported at once. 'This recap will be totaled at the end of each month. At the bottom of the over/short calculation. ACTION NUMBERS JANUARY 17 FEBRUARY 15 MARCH 17 APRIL 16 MAY 16 JUNE 16 JULY 16 AUGUST 16 SEPTEMBER 16 OCTOBER 17 NOVEMBER 16 DECEMBER 17 · ., ()VI':R/SItORTS CALCUI,ATT©NS # 1 ~ '7'I <-~: ''? ~ PRODUCT: ...... cat::. ~ ..... %[~] C 'r, ':,',: aa:~. u,L~ I),'~YS GALLONS SOI,D OVER SHORT _ ~ 2. D:zo~ a~t..:'--r/oh rt -xee~i 350 gala? ] ~ X 10O% Var:au~on ~ ~ B. ~es amt. ,':var/short exceed ~ M '~ ~es the variation exceed 5~? -, ~ ~ - Continue routine ~nitoring 6 ~es thc variation exceed 5%? kra -- ~ ~ Yes - RP~rt to Permitting Authority 7 -- l~ - Continue routine rgnitoring w~th~n 24 hr~ 'of discovery Yes - Re~rt to Permitting Authority __~ . within 24 hfs of dJ~cover~ A -- --~ Gals over/short 8 m'~L~ z ' -- )~ } +_.%1~ ~ TOTAL Gals. sold } 9 A. Gals over/short ~ O X 100% Variation 10 ¢ TOTAL Gals. sold -- ~.~ u. roes ~t. o,er/s~rt exce~ as0 ~azs? 11 x lOO~ 'Variation -- ~ ~ ~ ~ - Caatinue ~.~nitoring .. 1 2 { B. ~es sat. over/short exceed 250 gals? -- Yes - ~rt wi~in 24 hrs O~iscovery~ ~ ~ ~es ~e variation exce~ 5%~ ~ 1 3 ~ -- ~ - ~ntinue ~.bnitoring ~ ~ ~ ~ - ~ntinue routine ~nitoring 1 4 ~ Yes - Re~rt within 24 hrs o~iscover ~ Yes - ~rt to Pe~itting Aut~rity ~ TOTALS ~ ~es the variation exceed 5%? ~ - ~ntinue routine r~nitoring wi~in 24 ~s of die,very 1 5 -- Yes - Re~rt to Pe~itting Aut~rity %VEEI< 3 . -- within 24 hrs of discovery " WEEK 3 + ~7 ] { TOTAL Gals. sold 17 a- Ga~s over/snort ~/~O~) X 100% Variation 18 ~ TOTAL Gals sold B. ~s ~t. over/short exce~ 350 gals? 19 x 100% Variation ~ ~ - ~ntinue ~nitor~g 2 0 B. ~es ~t. over/short exceed 350 gals? ~ Yes - ~rt wi~in 24 hfs O~is~very 2 1 ~ ~ - continue E.bnitoring s~e v~iation ex~ 5%? __ Yes - ~rt within 24 hrs o~iscover~ - ~ntinue rout~e ~nitoring . TOTALS ~s the variation exceed 5%? ~ Yes - ~rt to Pe~tting Au~ority 2 2 ~ , ~ntinue routine ~nitoring within 24 hfs cf die,very 2 3 -- Yes - ~rt to Pe~itting Authority A. __ -- { 0 ~ Gals over/short 2 4 ¥,~ 4 within 24 hfs of discovery ' ~]9~ TOTAL Gals. sold 2 5 A. Gals over/short {, ~ x 100% variation 2 6 ~ TOTAL Gals. sold B. ~es ~t. over/s~rt e~e~ 350 gals? 2 7 { X 1002 Variation ~ ~ - ~ntinue ~nitoring 2 8 B.. ~es ~t. over/short exceed 350 ga~? ~ Yes - Re~rt wi~in 24 hfs o~iscovery TOTALS ~ - ~ntinue ~.~nitoring ~ the variation exce~ 5%? -- Yes - ~rt within 24 hrs o~iscover ~b - ~ntinue routine ~itoring 2 9 ' -- Yes - Re~rt to Pe~itting Authority 3 0 : ~ - Does the variation exceed 5%? ~ ' __ ~ - Continue routine r~nitoring within 24 brs of discovery 3 1 ~ __ Yes - Re~rt to Permitting Authority ) / within 24 hfs of diucovery TOTALS ~]%{ ~ ~__TOTAL Gals. sold GRAND ' A. Gals over/short ~ ~ ~ j X 100% Variatio, TOTALS (TOTAL SH [~TAGES ~o:;~z c~l=. ~ozo s x 100% var iatic: amount? Variation exceed 1.5%? Have your shortages exceeded chart amount~ u ~es va:'iaticn e::c:ed ~ F~ ~ - Continue Poutine b~itoring Yes No · ' - --- }~ - Continue Eoutine :tn!toting Yes E~rt to Permitting Authoritv If Yes, report-to-Kern County Ye:: - R~f~t to P3rm:tt'.:q Authority ovt';t</b~lU.N't'b CALCULATIONS PERMIT ~ Loca t ion Man th Yea r PRODUCT: Gal:'. ov¢r/zh¢,rt PRODUCT: DAYS GALLONS SOLD OVER SHORT = DAYS GA],i,ONS SOI,D OVER SHORT ~ TOT;d, Gals. sold --- 2 × 100% variation 2 3 B. Does ~n.t. ov,:,r./short ¢:xcced 350 gals? ~ - 3 ~ __ NO - Continue .~bn~torin9 4 5 __ YeJ - Rcix~.-t withi~ 24 hrso~scovery. 5 6 Does the variation exceed 5%? 6 ~ __ No - Continue routine monitoring - Rel:ort to Permittin~ Authority 7 TOTALS8 ~--i Yes ~/th~. 2i hfs o~ di~over¥., ,. , TOTALS 9 A. Gals over/short 8 9 1 0 ~ TOTAL Gals. sold 1 0 11 x 100% variation 11 1 2 B. Does amt. over/short exceed 350 gals? __ ~tp - Continue ~nitoring .. I 12 1 3 Yes - Report within 24 hrs o~i GayeTyI 1 3 1 4 ooe---~ the variation exceed 5%? s ~ 1 4 TOTALS __ No - Continue routine monitoring ~ Yes - Report to Permitting Authority ~ TOTALS 1 5 -- within 24 hfs of discovery ~ 1 5 1 7 A. Gals over/short 1 8 ~ TOTAL Gals. sold 1 8 1 9 ! I X 100% Variation 1 9 2 0 t B. Does amt. over/short exceed 356 ~als? ~ No - Continue Monitoring 2 0 t : 2 1 I ~ __-- Yes - Report within 24 hfs odfiscover 2 1 TOTALS I Does the variation exceed 5%? TOTALS 2 2 I No - Continue routine monitoring -- Yes - Report to Permitting Authority 2 2 2 3 -- within 24 hr~ of discovery 2 3 2 5 A. Gals over/short 2 4 --' 25 2 6 ... TOTAL Gals. sold 2 6 27 x 100% variation 27 2 8 B. Does amt. over/short exceed 350 gals? TOTALS -- NO - Continue Monitoring 2 8 Yes - Report within 24 hrs o~iscover TOTALS 2 9 oo~s the variation exceed 5%? 2 9 3 0 __ NO - Continue routine ~nitoring 3 1 __ Yes - Report to Permitting Authority 3 0 within 24 hrs of discovery 3 1 TOTALS ] ................ TOTALS | MONTHLY i %~i7~'~'~ '~N0 ......... A. Gals over/short. MONTHLYI GRAND i -' GRAND TOTALS (TOTAL SHORTAGES) ~ TOTAL Gals. sold (TOTAL SHO TAGES) TOTALS Have your shortages exceeded chart amount? x 100% Variatio, Have your shortages exceeded ch amount? Ye No B. Does Varioticn 1.5%? ~b - utile ~nitori~.g Yes __ No report to Kern County --.~..~_ ~ ........................ If YeB, rSr~r~--~n ~r.~' KERN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT INVESTIGATION RECORD DBA OWNER ADDRESS ADDRESS ,ASSESSORS * PARCEl. % CT CHRONOLOGICAL RECORD OF INVESTIGATION DATE FACILITY: CERTIFICATION OF FINANCIAL RESPONSIBILITY ' FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM I A. ! am requtred to demonsl~zm FinanCaal l~esponsib~ty in the required amounts as spec~ied in Section 2~07. ChapWt i~. Div. 3, Tide 2.3. CC~: ~ $00.000 dollars per o(~urrence ~ t miiio~ doflars mud a~ate or ,*d~D ~' ~-~ t minion doUars per occurrenc~ ~=~ 2 million dollars annual a~ B. ,l~cq--H ;, 11 £:~-'~ny hereby certifies that tt is in compliance with ff~ requiremer~ of ~ection 2807, (~'~e o~ T~k O~e~ ~ Article 3, Chapter 18, Division 3, T'[Ee 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility es required by Section 280?ere as follov~: Sta~e F.~d State of gallfom~a $ 990,000.0( ~Yc Y~_~ Yes Bakersfield, CA 93303-1807 Note: If you are using the b~ate Fund as any part of your demonstration of financial responsibility, your execution and subm/~/on of ~s cergficat/on also certifies thet you are in compliance with all conditions for participation in the Fund. D . F~iirf Nam. F~W /~ammmm Fastr~p Fo:>'J Store ~m?.l 805 34.th St.~ Bakersfield ' Fastr[~ Food Store ~ 26~8 0~11 St.~ Bakersfield Fm:i.lit? ~ame r-,mem~qm~m~lmmm ~Ninii-. ~'~'-m 843 E. Ridoecre_.~c Blvd.. Ri _dgecre~ ~ Unw~,rd'S ~ipi ,~4~r't ~ ' 3200 Panama In.. Bakersfield"~ / I~rfl'S Mini Mart ~ le Terrace. USTMAN SIR SYSTEM Monthly Monitoring Report SEPTEMBER, 1993 Report Date: 10/07/93 Company name :JACO OIL Station Name: HOWARD'S #6 Station # : 355 Address: 4201 BELLE TERRACE City: State: CA PART A: Data Tank ID: System Status: Product: Quality: Dels: Sales: 00 TIGHT 00-FS PRE FAIR 6518 7455 02 TIGHT 02-UNL #1 POOR 30229 40762 03 TIGHT 03-UNL #2 FAIR 3976 8071 05 TIGHT 05-FS,MID FAIR 12667 17228 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: Comments and Recommendations O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. oo {9/6/1993: 2139} {9/30/1993:DEL 119} 02 This system showed several unrecorded deliveries. Ensure that deliveries are entered and on the day they occur; verify accuracy of deliveries with before and after tank measurement to the nearest 1/8" {9/15/1993: 8783~ 9/21/1993: 2014} 9/26/1993: 3413} {9/27/1993: 2813} o3 {9/16/1993: 4387} {9/19/1993: -183} 05 {9/1/1993:DEL 195} '{9/6/1993: 4986} {9/26/1993: 4769} { 9/28/1993:DEL 268} For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. Apl::l ication ~ttached Plot Plan (3 sets)~ Con:~t~ction ~awi~'~s (3 sets) Completion Card Plans Check~.' ~: ' ' ~L HO~: x $35.~ Total Plan Check/Inspection Fee KERN 'COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT . s~v,~ ~,,,,. co~,..,,,,,,-~ ~o.~ ~ .°,,,.~..--_/~..-._.~O...'~,~e... ...... ~ .............. ,, ,,, , o~, ........... .y.. .~ ~./_ ..... ~/n__,_..._ .... ..~:~.~ ~ &....~...~_m~t~....~..... , , .~ ........................................ ~eportlng Pe son '" " . Address Ph .--~,., -h-.~--~ ~o_..z.. 2 d,/.. ........................ , ................................................ - ........... 0~.. '.q-.~.-..9.~7 ProperlY Owner Phone ......................... Reason for aken by ~ RESULTS OF \ .... INVESTIGATION ' Complaina Investigated by Oate .,, ". ~, ' KERN COUNTY HEALTH ..: DEPARTMENT . _?~./¢~/.r'.. . "· :'. ~ ' D01N~ BUSINESS / BUSINESS ADD~ESS~..;'. ;"~.~... ', '. '" ~; . "~ ,'~' it(:,;,~It~S :'~J~ ' ~ ' '. '..:. : .'. ::.' .... '] . . '. ' ' ' , · , ' . , .' .PAY BY JULY 3.1. TO,AVOID'PENALT, Y TYPE OF BUSINESS "FEE BASIS ~' FEE ~.~,~.~, ~A~-T~OUNT o : ~ o w N E~ ?'S" ,, ..:.. ... x .NEw.' suS~N~SS'~:'..,",~'-. J;~C~:. ~' - ....'. CHANGE OWNER~HJP:.:~.' ~. ,: '-~ '"'.: .. :, . ' ? " RENEWAL. ' ". "'. ...' ".'".', MAILING ADDRESS .. . .. .BLIND . ~,C, ~t~... ~.1;(~7 CHARITY/TAX 3,0/' ' '" ~".,'~,~]~'~("~'~-u, PERMIT' EXPIRES· ' s~e~' '~,' DATE FEE PAID DATE AppROvED.. , HEALTH~ oF~IcER',~ ~..""':" LEON ~ H~S~RTSON,'~:::~:.~ ~,.;~,' :.' ~ i ,, TIGHTNESS TESTING REPOk EVALUATION FORM Specialist reviewing the tightness test report: [0~/~'~' A)t'~K"X ~' . . Date tightness test repons were submitted: ~. - ~- ~Z Date tightness tests'were completed: [ .- ~ - ~ ~ Facility Permit Number: 2. ~°O~ / Number of Tanks Tested at the site: L/t (list the tanks by the/r tank nUmbers ff provided). Was the method a test of the entire tank system, piping alone, or just the facility tanks? (describe) ~_~-r~'~ :srx~: ~'~".~. Did the facility pass all tests: !,,,'"" Yes No (if no, provide the leak rate and a description of the tank(s) that failed the test) (failure is > 0.1 gal per hour). The facility will do the following to investigate the failed test: The test method certification that is submitted to the state specifies that each test method -. be completed in a certain manner. Is there anything within the results which woatdsuggest" that the tank test was improperly completed? Yes /~' No (describe). InfOrmation has been reviewed and placed within the database: .YES NO Date entered within the database: Entered bv (name) RESOURCE MANAGEMENT AGENCY ~. RANDALL L. ABBOTT ~ '"~' s~-v~ . ;.~ ':.~DiRECTOR .~.i ' '" : ' .i ~ . Air Polluiior~ .... " *DAVID PRICE !11 ' Vat.UA~.'J,:RODDY, · .. .. · ,.. ~',' .: :...,-' · " :*'*:~' ~VIRONMENTAL H~L~ SERVICES DEPONENT" 'PE~.FOR ~E PERFOR~CE OF :A T~ ~GR~. ~ST ON :' ....~ERGROUND. STOOGE,. T~ 'LOCA~D AT T~' LISTED FAC~I~ vncm o n (s) Howard's. Market Jaco Off :' T~olo 4201 Belle Te~ace 3101 State ROad 107~ Bake~fleld, CA 93309 Bake~fleld, CA 93308 R~cho.~ong~.~ :'Phone: (805) 397-7606 Phone: (805) 393-7~0 Phone: (714) :' '[ - STA~-CER~D.~S~G ~OD E~LO~D Vacutect s n - icn sn · - ' ' STA~-LICENSED 'S ~1444 .... -PER~T FOR'~E P~O~CE PE~ E~S April 6, 1~ " OF A T~K ~G~ .~T ONe.' ' '"' ~PROV~ DA~ Janua~ 6, 19 4 T~ SYS~M(S) ~PRO~D AT ~ ~O~ LOCA~ON . .'....' .............. 2 ~ ~ ..... ; . . .POST ON PREMISES .... ........... ....... COND~ONS ~ FO~OWS: - 1. It h the,r~pomibffi~, of the Per~tt~ to obtain perm~ w~ch may be r~uR~ by other re · - to beg~ng work (i.e., Ci~ Fire. and Building Departmen~)~ .. 2.' 'Pemitt~ mint noti~ the Hamrdom Matefiah Management pm~m at '(~5) ~1-3~6 . ta~ integfi~ t~t to allow tho H~rdom Material Sp~al~t the option of peffomg a spot 3. Tank ~tegfi~ t~t mint be per Kern ~un~ En~omenml H~lm- ~a Fke Dep~tment-appr~v~"/me~6 a~cfib~ in Hana~ook ~-20. · · .~ :" '-:'.-/./~::~/.?"~:?;.':?"':':~ '[':; · 4. It ~ the state-li~m~ t~teVs r~pomibfli, to ~ow md adhere to all'apPli~blo la~ hamrdom matefiah.. . ,. . ' , · .: 5. ~e ta~ integfi,'t~ting companY: mint have the state-li~m,~:t~ter ~t~ on. the pemit · . .... · . . . .', .%-,.. ,..-,.; .-.. ?,.~ [,:.~,~i.~;~,~,'~,,!~5~:~,~¢~ : · .' . ' ' , . ' . · . ~ . · . · , . . , . . - . , .-: : .:,....:..,, .""~"-':;~:'~: INTEGRITY TEST ON UNDERGROUND STORAGE 6:. :' .' 'If any tester other than the one listed on the permit and permit application.is to be utilized, p~0!7:,app[0.V.~!.':,.~,i~:.:?. be granted by the speCialist li~ted on the permit. Deviation from the submitted application is not: 7. ^ modification permit must be obtained from the department prior 'to exposing the tank to retest ~r'.ini~iigili~n~:~?~¢, a release or failed integrity test. 8. The following timetable lists pre- and post-tank integrity test requirements: DEADL:INE ' ' Complete permit application submitted to At lea~t on0. week prior., to tank. the Hazardous Material Management Program integrity lest , ..~' . :.::: '..' ' -- Notification to the specialist listed on permit· 24 hours. · of date and time of. the tank integrity test. : ' '~ Send written results of a test t° the No later than 30 days specialist listed On the permit is completed.'-~ i :ii:,; .:::. '.:., .. "' :Notification to the Specialist listed on the -.. No later than 2;4 hours -.., ' 'permit of the results ora failed/inconclusive test . 'completiOn of · ' m coMM D^ ONS/GUmE NES FOR PEm:O CE oF ^,'r :This:. department is responsible for enforcing the state Iaws pertaining to underground:stora this department Perform spot check inspections to ensure'that the job performance:is ., :.:,.~ .......... applicable laws, and safety standards. The following guidelines are offered to' Clari~ tile interests' .~: L::i :..~' '.:,Job site 'safety is0ne of our. PrimarY' concerto.', Tank integrity` tests are inherently ::3 :" responsibility, to know and abide by'¢AL-osHA regulations~i?iTh.,ei~tate:!iCensed tester ~.~' testing company employees on the,job site.'. To°l~ and equipment are to be used only ~ 2:,~ , properly, state' liCens~:l, testers.are ~issumed' to understand:the,,irequirements iof the:i .... ? ..,.,~ .......... responsible' fei: Iai°wing and abiding by the conditions of the peru!it: Deviation'Rom .the"1 .. 3.~ ·The testing' Compan~ Will be' held responsible for. the post-test paperWork. Analyses: documenia[i0n~;.is~ · :~,. "~ ~each' siie. in order to,close a casefile or move it,into mitigation;. When t~t. ers do,.~.t Pap~rW~rk, an unmanageable'backlog of incompie~e ca~es results. If thi~ continue,~; process~g KNOLOG" -~/~ Tanknology Region: ~/estern 992 VACUTECTTM TANK TESTING REPORT Tester: Tony Hinsley Unit # 56 Lic. # 1444 Customer Howard's Market #6 (Kern County) Gust. Ref.# S.O.# 50318 Date: 1-9-92 Billing Address: Jaco 0il, 3101 State Rd., Bakersfield, CA 93303 Phone' (805) 393-7000 Service Address: 42ol Belle Terrace~ Bakersfield, CA 93309 Attention: Jackie TANK TEST LINE TEST Vent, TANKS and LINES TESTED TO CFR# 40, Parts 280-281 Tank: Risers, & NFPA329 Specifications. Others: Dipped Dipped Rec. Ullage TIGHT Vapor Rec: TIGHT Type Water Prod. Water Water Bubble Air (T) TIGHT (T) (T) ~' of Tank Tank Level Level Level Ingress Ingress Ingress FAIL FAIL LINE FAlL SUCTION (SS) or PRES. SYSTEM (PS) FIBERGLASS Date/Tank# Prod. Dia. Gal. START START START Detected Detected Detected (F) (F) A, B, C (F) (FG) or STEEL (ST) LEAK DETECTORS Installed? (LDI) 1-9-92 SUPR 92 12K 0.00 89 .16 NO NO NO T T lA T PS, FG, LDI' TEST PRESSURE: 50 #1 STARTED: 07:12 FINISHED: 07:42 I. START: 06: 30 FINISH: 08: 00 TEST PSh -. 80 LEAK RATE: 0.00 GPH ' 1-9-92 SUPR 92 12K 0.00 89 .16 NO NO NO T T 2A T PSt FG~ LDI TEST PRESSURE: 50 #2 STARTED: 08:00 FINISHED: 08:30 START: 06:30 FINISH: 08:00 TEST PSh -.80 LEAK RATE: 0.00 GPH 1-9-92 UNLD 92 12K 0.00 69 .16 NO NO NO T T 3A T PS, FG, LDI TEST PRESSURE: 50 #3 STARTED: 09:37 FINISHED: 10:07 START: 08:20 FINISH: 10:45 TEST PSh -o80 LEAK RATE: 0.00 GPH I-9-92 UNLD 92 12K 0.00 72' .16 NO NO NO T T 4A T PS, FG, LDI TEST PRESSURE: 50 #4 PLUS STARTED: 10:30 FINISHED: 11:00 START: 08:20 FINISH: 10:h5 TESTPSh '-.80 LEAKRATE: 0.00 GPH TEST PRESSURE: STARTED: FINISHED: START: FINISH: TEST PSh LEAK RATE: COMMENTS: SITE CONTACT: SITE PHONE: TANK TEST' INCLUDES TESTING OF RISERS, VENT AND VAPOR RECOVERY LINES. TRnknolnnv ~nrnnr~tion IntprnRtionRI · 1~70r) ,l~.m~.v Rnld~v~rd I Init ~17{3 · R~nc-hn c~,~-=monga, Californi~ (~7.~n /-~ ~ n~. ~n~ ~.~/-~ ~ n~ :-/o-~ s.o.# ?o MONITOR WELLS Number 1 2 3 4 .5 6 7 8 9 10 11 12' Depth Water Prod. Detected NOT Det. LOcation Diagram .~'~}1~ ' ~'e/f~ ,~ · 1 Parts and Labor used General Comments When local regulations require immediate reporting of a System leak--Complete the following: Reported to: Name Date Time Phone Number Regulatory Agency File Number . C:_-,./'~ ,._._ KNOLOG ~b LINE TEST LOG S.O.# 3o7/~ Customer ~v,l'~ ~L Date }~Taak No. ~ I Line No. I,~ Product !1 ilPipiag ~t~rial T~st Pr~ww~r~ f~ p~i Calib.Maltipli~r ~ICOMP~SSIO~ Zero Pres. Level Test Prea~Level ]~TEST I LEVELA Volume A , LINE TEST '~Mil. Ti~e ~g~g tl Level I LevelA lVolumeA Projected G.P.H. [7.'~ t 2 i ~.~ t,~ I ,~o~' ~ I II I ~ I I I ~FINAL LINE TIGHTNESS ~TE: ~ , FAIL [ ] or PASS '1 ~ Comments: Tank No. 2 Line No. ~2d Product Piping Material Test Pressure ~' O psi Calib.Multiplier , COMPm~SSIO~l Zero Pres. Level Test Pres. Level TEST Il LEVELA ' Volume A LINE TEST Mil. Time}Reading #1 Level i L?_v_e!.A .I~1 Proj_ected_G.p:H._A ~;oo Start 2_0, ,z- ! ....... ' ---', _ ............... , ~,,'~oI i'2o, o i. ? ,os II , o./~ 1 FINAL LINE TIGHTNESS RATE: ~ , FAIL [ ] or PASS Comments: PORM No.: Li,,eT~tLo~-l/89 TANKNOLQGY CORPORATION INTERNATIONAL 4601 $outl~ Pinemont Drive, Suite 100 * Houston, TX 77041 · (713) 890.TANK ,, Fax: (713) 890.225,5 Tank No. '~ ,, Line No. '~,/~ Product '[Piping Material Test Pressure ~'O psi Calib.Multiplier COMPRESSION Zero Pres.Level' Test Pres.Level 'TEST LEVELA , Volume A LINE TEST IMil.Time ~teadina #] Level I LevelA VolumeA i Projected G.P.H. A FINAL LINE TIGHTNESS RATE: C~ , FAIL [ ] or PASS Comments: TankNo. cl LineNo. f'"¢~' Product t,l~}~'~/~ad ~J,,,,,r Piping Material Test Pressure ~ 'psi Calib.Multiplier ,¢ ~/~ COMPRESSIO~ Zero Pres. Level Test Pres. Level TEST' 31 LEVELA Volume A .. LINE TEST Mil. Time !Readia8 # Level LevelA VolumeA I Projected G.P.H. A FINAL LINE TIGHTNESS RATE: c~ , FAIL [ ] or PASS [ Comments: Technician Ilo , ~'~.nY .. ~'~'~ )~'~' , ~~ VacaTe-ct Ctrtif · PRINT ~IAM~ -nlGNATURR FORM No.: LiacTcatLog-l/89 RESuURCE MANAGEMENT A G.:NCY Environmental Health Seduces Department RANDALL L ABBOTT STEVE McCP,[I FY, REHS, DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE I!i wnddA~ J. RODDY, APCO ASSISTANT D~RECTOR Planning & Deveiopmem Setvic~ Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT TANK INTEGRITY TESTING INSPECTION FORM Date /~- ~- ~2_ Facility Permit to Operate Number H Facility Permit to Tightness Test Number Facility Name b/~v~A~h'~ /1~.~.~7-~ Facility Address ~-c~/ /~//~ Facility Telephone Number ~ ? ~- ~ ~ Has the tester complied with the following safety requirements stated in UT-20, Section 25? YES/NO ¥~ The area within 25 feet of any underground storage tank opening is free of ~ smoking, open flames, and any other source of ignition. ~/~% Legible signs with the words "NO SMOKING" are posted in conspicuous locations around the testing area. ,~ f~,~ The general public is restricted from the testing area by rope, flags, cones, and "if dark" a fluorescent barrier. ~,] ~ ~ Fire protection in the form of a 2A/20BC fire extinguisher is located within the restricted area. ~/~?~ Vehicles utilized during the testing period, or within 25 feet of the underground storage tank opening, have adequate ventilation, and the tester has equipment which can be utilized to monitor the concentration of flammable vapors within the vehicle. Y~ Personal protective equipment, an eye wash and' gloves, and a site safety plan are within the testing area. ~/~ Equipment/materials available to contain any small release of is absorb testing liquid which is discharged as a result of the test. (Examples include DOT-acceptable containers for storage of the absorbent and an adequate supply of absorbent). If the answer to any of the above questions is NO, stop the testing procedure IMMEDIATELY until compliance is obtained. 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861.3636 FAX: (805) 861-3429 T.,ANK INTEGRITY TESTING INSPECTION FORM continued Is the following data consistent with the information submitted on the application for Permit To Perform Integrity Testing(PTT)? YES/NO c/. The number being of tanks tested ~-~'/oc~/of~iV Testing company LJPr~cfT'7~cz~7~ Test method used T~o,~)/ ]~,'~/~/~ State Licensed Technician on site I ~ z4 ~ State Licensed Technician's # ~/~ Is the site layout consistent with the application plot plan? State exceptions for any NO answers to the above questions: State Licensed Technician on site ~a~ardous Mate~als Specialist Inspection Date HM35 · RES J. URCE MANAGEMENT AL. dNCY Environmental Health Services Department RANDALL L. ABBOTT STEVE McCAI ! Fy, REHS, DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE !II VaLLL4M J. RODDY, APCO ASSISTANT DIRECTOR Planning & Development Services Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PERMIT FOR THE PERFORMANCE PERMIT NUMBER: T0104 OF A TANK INTEGRITY TEST ON UNDERGROUND STORAGE TANKS LOCATED AT THE LISTED FACILITY FACILITY NAME/ADDRESS: OWNER(S) NAME/ADDRESS: TESTING COMPANY: Howard's Market Jaco Oil Tanknology Corporation 4201 Belle Terrace 3101 State Road 10700 Jersey, #170 Bakersfield, CA 93309 Bakersfield, CA 93308 Rancho Cucamonga, CA 91730 Phone: (805) 397-7606 Phone:~ (805) 393-7000 Phone: (714)941-4491 STATE-CERTIFIED TESTING METHOD EMPLOYED Vacutect STATE-LICENSED TESTER Tony Himley STATE-LICENSED TESTER'S #1~.~.~. PERMIT FOR THE PERFORMANCE PERMIT EXPIRES April 6, 1992 OF A TANK INTEGRITY TEST ON APPROVAL DATE January 6, 1992 4 TANK SYSTEM(S) APPROVED BY _.~.__ _.~J~_ _~ AT THE ABOVE LOCATION' ~US MATERJALS SPECIALIST ................................ POST ON PREMISES ................................ CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City F~re and Building Departments). - 2. Permittee must notify the Hazardous Materials Management Program at (805) 861-3636 twenty-four hours prior to tank integrity test to allow the Hazardous Material Specialist the option of performing a spot check inspection. 3. Tank integrity test must be per Kern County Environmental Health- and Fire Department-approved methods as described in Handbook UT-20. 4. It is the state-licensed tester's responsibility to know and adhere to all app!icable laws regarding the handling of hazardous materials. 5. The tank integrity testing company mt~t have the state-licensed tester listed on the permit on site performing the test. 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (R05'~ RRl-~a:~q PERMIT FOR THE PERFORMANCE OF A TANK PERMIT NUMBER T0104 INTEGRITY TEST ON UNDERGROUND STORAGE ADDENDUM TANKS LOCATED AT THE LISTED FACILITY 6. ff any tester other than the one listed on the permit and permit application is to be utilized, prior approval must be granted by the specialist listed on the permit. Deviation from the submitted application is not allowed. 7. A modification permit must be obtained from the department prior to exposing the tank to retest or investigating a release or failed integrity test. 8. The fOllowing timetable lists pre- and post-tank integrity test requirements: ACTIVITY · DEADLINE Complete permit application submitted to At least one week prior to tank the Hazardous Material Management Program integrity test Notification to the specialist listed on' permit 24 hours of date and time of the tank integrity test Send written results of a test to the No later than 30 days after testing specialist listed on the permit is completed Notification to the specialist listed on the No later than 24 hours after permit of the results of a failed/inconclusive test completion of analysis RECOMMENDATIONS/GUIDELINES FOR THE PERFORMANCE OF A TANK INTEGRITY TEST ON UNDER- GROUND STORAGE TANKS This department is responsible for enforcing the state laws pertaining to underground storage tanks. Representatives from this department perform spot check inspections to ensure that the job performance is consistent with permit requirements, applicable laws, and safety standards. The following guidelines are offered to clarify the interests and expectations of this department. 1. Job site safety is one of our primary concerns. Tank integrity tests are inherently dangerous. It is the tester's responsibility to know and abide by CAL-OSHA regulations. The state-licensed tester is responsible for any other testing company employees on the job site. Tools and equipment are to be used only for their designed function. 2. Properly state-licensed testers are assumed to understand the requirements of the permit issued. The tester is responsible for knowing and abiding by the conditions of the permit.' Deviation from the permit conditions may result in a stop-work order. 3. The testing company will be held responsible for the post-test paperwork. Analyses documentation is necessary for each site in order to close a case file or move it into mitigation. When testers do not follow through on necessary paperwork, an unmanageable backlog of incomplete cases results, ff this continues, processing time for completing new tank integrity tests will increase. OWNER OR AGENT DATE WGN:cas (t0104-h.m34) Kern County Use Only :7/ Environmental Health. vices Dept. p. No.~/77,?/ # Tanks to Test__ '. -'" 2700 M Street, Suite 3~,~ T¢~, to include: Tank only. -' :.. Bakersfield, CA 93301 '. ':.. -.. Tank/Piping Piping only · .... (805) 861-3636 ..::.. · . PTO No.£'~'~.:'(.~'.'/ Appl. Date/? - ~/-~:~/ ' .'.7.~ . 7.' ' ..... APPLICATION FOR "PERMIT TO TEST UNDERGROUND ItAZARDOUS SUBSTANCES STORAGE TANK A. Kern County Environmental Health Services Dept. Permit to Operate #- '~ <-~ ''~ '" ' "' (If there is no permit number, an application for a permit to operate must be submitted and approved before the permit to test can be processed.) B. Facili _ty Information ·" '~' ...... " TANK # SIZE PRODUCT AGE OF TANK COMMENTS Contact person Day Phone (~) Night Phone (~) C. Tank Owner Information Owner Name '~' P~-F_C) D. Testing Company Information Company Name "T-fi-nl.E~qDL6~,,/ Contact Person Day b'v't,r~,,.'.~ Pell,%L~--r- Phone ( Worker's Compensation Insurance # IA.~/a.,'-7"7 q - Liability Insurance # ~'L~7_- I qq~le._,q Test Method Used V I~cC1)~'-j-' State Licensed Technician's # [~ ~ ~ ~ / ~ t/ ':....". E. If.plot plan information is not available before the. test,.it must be submitted with the test :. ...... - results. If the. information is available before, the test, provide a plot plan of the facillty: · ..-.: showing all important points (including but.not limited to): · tank location and number/designation, pump location, all buildings and roads, vapor, .... vent and product lines, fill boxes, et~2) · Proposed tanks to be tested designated by this symbol" 0 ". · Nearest street or intersection · Any water wells or surface waters within 100' radius ot[ facility · North Arrow F. This form has been completed under penalty of perjury and to the best of my knowledge is true and correct. DATE CG:ch geoi'gi\ut-20 R E C,..F Z P T P..'-.GE I i :57 piT~ KEr~.N ......... 2?00 ouS) 801-35~''' ...... t ....... Vi .............. I 4751 uND 55 O0 E 41"~ O0 Or, der' Total 4125.00 Amount: Due 4 '~25. O0 r'~¥1'l~t:: ~lC~U.~ ~y Check 41~u.00 f"lV~ Z ~.~ ~'~ -'~ 2,,'."}4/9'I [n¥oi.;;e Nb[' . '1 !!:12 ~¢, KE~'N CO RESOURCE ~ANAGEMENT ~.GENCY 2?00 '~!' B~ker~fie!d, C~ g~301 Type o¢ Ocder (805.) C.:SH REGISTER JACO OIL COMPANY I SMK I 12/04/91 i 12/04/91 J I NT ' U~OERO~OUaD T~JKS ~NNLIAL FEE 'I 200.00 e 200. UST001 . Order To~] 200_00:,_ 'Amoun~ Due 200. THANK YOU AND HAVE ,~ NICE OAY! RESOURCE MANAGEMENT AGENCY Envitomnental Health Se~,,icea Department RANDALL L. ABBOTT STEVE McCALLEY, REHS, DIRECTOR DIRECTOR Air Pollution Control District DAVID PRICE I11 W~!!!~.M J. ReeDY, APCO ASSISTANT DIRECTOR Ptanning & Devebpment Set. cea Department TED JAMES, AICP, DIRECTOR 'ENVIRONMENTAL HEALTH SERVICES DEPARTMENT PERMIT TO OPERA~ UNDERGROUND IiAZARDOUS STORAGE FACILI'IT Permit No.: 280001C State ID No.: 280001 Issued to: HOWARD'S MARKET No. of Tanks: 4 Location: 4201 BELLE TERRACE BAKERSF[ELD, CA Ovmer: JACO OIL COMPANY #355 P.O. BOX 1807 BAKERSFIELD, CA 93303 Operator: SACO OIL COMPANY P.O. BOX 1807 BAKERSFIELD, CA 93303 Faellity ProRle: Substance Tank Tank Year Is piping Tank No. Code Contents Capacity_ Installed Pl'essurized? 1 MVF 5 REG~ 12000 1984 YES 2 MVF 5 UNLI=ADED 12,000 1984 YES 3 MVF $ PREMIUM 12,000 1984 YES 4 MVF 5 PREM-U~.~ADED 12,000 1984 YES This permit is graated subject to the conditiom aad prohibitiom listed on the attached summary of conditiom/l~rohibitiom ~ Ste~e McCalley ./r ( -- ' Issuo ......Date: November 29, 1991 - -' ...... Title: Director. Environmen[a.~ '~'~ ~;~~ent F_xpiration.Date; November 29, 1~36 -- POST ON PREMISES .- NONTRANSFERABLE 2700 '?vi" STREET, SUITE 300 BAKERSFn:[ r), CALIFORNIA 93301 (805) 861-3636 FAX: (805) HAZARDOUS UNDERGROUND STORAGE FACILITY PERMIT SUMMARY OF CONDITIONS/PROHIBITIONS CONDITIONS/PROHIBITIONS: 1. The facility owner and operator must be familiar with all conditions specified within this permit and must meet any additional requirements to monitor, upgrade, or close the tanks and associated piping imposed by the permitting authority. 2. If the operator of the underground storage tank is not the owner, then the owner shall enter into a written contract with the operator, requiring the operator to monitor the underground storage tank; maintain appropriate records; and implement reporting procedures as required by the Department. 3. The facility owner and operator shall ensure that the facility has adequate financial responsibility insurance coverage, as mandated for all underground storage tanks containing petroleum, and supply proof of such coverage when requested by the permitting authority. 4. The facility owner must ensure that the annual permit fee is paid within 30 days of the invoice date. 5. The facility Will be considered in violation and operating without a permit if annual permit fees are not received within 60 days of the invoice date. 6. The facility owner and/or operator shall review the leak detection requirements provided within this permit. The monitoring alternative shall be implemented within 60 days of the permit issue date. 7. The facility underground storage tanks must be monitored, utilizing the option approved by the permitting authority, until the tank is closed under a valid, unexpired permit for closure. 8. Any inactive underground storage tank which is not being monitored, as approved by the permitting authority, is considered improperly closed. Proper closure is required and must be completed under a permit issued by the permitting authority. 9. The facility owner/operator must obtain a modification permit before: a. Uncovering any underground storage tank after failure of a tank integrity test. h. Replacement of piping. c. Lining the interior of the underground storage tank. 10. The tank owner must advise the Environmental Health Services Department within 10 days of transfer of ownership. 11. Any change in state law or local ordinance may necessitate a change in permit conditions. The owner/operator will be required to meet new conditions within 60 days of notification. 12. The owner and/or operator shall keep a copy of all monitoring recor~ at the facility for a minimum of three years, or as specified by the permitting authority. They may be kept off site if they can be obtained within 24 hours of a request made by the local authority. 13. The owner/operator must report any unauthorized release which escapes from the secondary containment, or from the primary containment if no secondary containment exists, which increases the hazard of fire or explosion or causes any deterioration of the secondary containment within 24 hours of discovery. AEG:jrw (green~oermit.p2) 2 MONITORING REQUIREMENTS:(~t=~Spr) 1. .All underground storage tanks designated as MVF $ within Page 1 of this permit shall be monitored utilizing the following methods: a. The U Tubes shall be monitored manually, utilizing a gauging stick or electronic- ally, by installation of monitoring devices connected to an audible and visual alarm system within 60 days of the issue date on Page 1 of this permit. b. All piping sumps shall be monitored manually or by utilizing an elearonic monitoring device; ALONG WITH c. Each tank shall be monitored utilt~.ing Standard Inventory Control Monitoring (tank gauging five to seven days per week). Kern County Environmental Health Services Department forms shall be utilized unless a facility form can provide the same information and has been reviewed and approved by the Environmental Health Services Department. (Monitoring shall be completed in accordance with require- merits summarized in Handbook UT-10.) AND d. All tanks shall be tested every three years utilizing a tank integrity test which has been certffied as being capable of detecting a leak of 0.1 gallon per hour with a probability of detection of 95 percent and a probability of false alarm of 5 percent. The first test shall be completed before December 31, 1992, and a subsequent test completed before December 31, 1995. All tank integrity tests completed after September 16, 1991, shall be completed under a valid, unexpired Permit to Test issued by the Environmental Health Services Department. 2. All pressurized piping systems shall install pressurized piping leak detection systems and ensure that they are capable of functioning as specified by the manufacturer. The mechanical leak detection systems must be capable of alerting the owner/operator of a leak by restricting or shutting off the flow of hazardous substances through the piping, or by triggering an audible or visual alarm, detecting three gaUons or more per hour, per square inch, line pressure within one hour. 3. AU pressurized piping systems shall be tested annually unless the facility has instaUed the following: a. A continuous monitoring system within secondary containment. b. The continuous monitor is connected to an audible and visual alarm system and the pumping system. c. The continuous monitor shuts down the pump and activates the alarm system when a release is detected. d. The pumping system shuts down automatically if the continuous monitor fails or is disconnected. The first test shall be completed before December 31, 1991, and subsequent tests completed each calendar year thereafter. 4. AU underground storage tanks shall be retrofitted with oversplll containers which have a minimum capacity of 5 gallons; be protected from galvanic corrosion, if made of metal; and be equipped with a drain valve to allow the drainage of liquid back into the tank by December 1998, or as specified by the Environmental Health Services Department. 5. All equipment installed for leak detection shall be operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks (at least once per year) for operability or running condition. 6. An annual report shall be submitted to the Kern County Environmental Health Services Department each year after monitoring has been initiated. The owner/operator shall use the form provided within the Handbook UT-10. PERMIT NUMBER .o, ~/~r~ i~- TYPE OF INSTALLATION ( ) 1. In-Tank Level Sensor (v)' 2. Leak Detector (<3. Fill Box · ' t .... ' ~ ' ~'" ~. IN TANK LEVEL SENSORS Number of Tanks L~st By Tank ID Name of System Manufacturer & Model Number Contractor/Installer 2. LEAK DETECTORS Number of Tanks ~i List By Tank ID Manufacturer a ~od~l ~Nu~6er Contractor/Installer 3. FILL BOXES Number of Tanks L't List By Tank ID Manufacturer & Model Number Contractor / Instal let OPERATO ' DATE ENVZRONMENTAL HEALTH :SERVICES DEPARTMENT ;2~30 ":~" STREET :~UiT~ 300 KERN C~dNTY AIR POLLUTION CONTROL'~.~TRICT 2700 "M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 .- PHASE II VAPOR RECOVERY INSPECTION FORM Station Location %.Z~'.~/~/ ._.?.~...//'~/~. ~.?.:_~?z?.,~/~ P/O ~ ~ ~/~ --/~ Company Address ~ - ,~- ~_~ ,2 ~ City ~,~/~/~ Zip ~~ ..... BA ~ ~ .~E '~H, ~HA Contact ~/~ ~/~-Phone ~ ~-.~ System Type: ~~.,~ / ~,. Inspector ~ ~ Date ~: ~ ~ / Notice Rec'd By NO~LETYPE , ~ ~t~/~ ~ ~/~,~ ~,'~ ~ ~ ~ 1. CERT. NOZZLE 2. CHECK VALVE N O 3. FACE SEAL Z Z 4. RING, RIVET L J E 5. BELLOWS 6. SWIVEL(S) 7. FLOW LIMITER (EW) 1. HOSE CONDITION j ~/// V A 2. LENGTH P O 3. CONFIGURATION R 4. SWIVEL H O 5. OVERHEAD RETRACTOR .~.-- . S .... E 6. POWER/PILOT ON 7. SIGNS POSTED Key to system types: Key to defi(~]encies: NC= not certified, B= broken BA:Balance HE =Healey M= missing/' TO= torn, F= flat, TN= tangled RJ =Red Jacket CH=Gulf Hasselmann AD= ne~l§ adjustment, L= long, LO= loose, HI =Hirt HA =Hasstech S= short MA= misaligned, K= kinked, FR= frayed. INSPECTION RESULTS Key to ir~sPec'~'n results: B"l~'nk= OK, ~ 7= Repair within seven days, T= Tagged (nozzle tagged out-of:order until repaired) U= Taggabte violation but left in use. VIOLATIONS: SYSTEMS MARKED WITH A "T OR U" CODE IN INSPECTION RESULTS, ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH DAY OF VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLUTION OF THE VIOLATION. NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, REQUIRES THAT THE ABOVE LISTED 7-DAY DEFICIENCIES ' BE CORRECTED WITHIN 7 DAYS. FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION .......... KERN COUNTY'AIR POLLUTION (~DNTROL DISTRICT 2700 "M" Street, Suite 275 ,. Bakersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR RECOVERY INspEcTION FORM .. Company Mailing Address ~ ~ _~, ~ ~ City Inspector ...... No~e Rec'd By ~~ 1. PRODUCT (UL PUL, P, Or R) ~ / ~ ~ ~ 2. TANK LOCATION REFERENCE ~ ~/~]~/~ ~ 3. BROKEN OR MISSING VAPOR CAP .. BROKEN OR M SS NG F LL CAP 5. BROKEN CAM LOCK ON VAPOR CAP ' 6. FI~ CAPS NOT PROPERLY SEATED 7. VAPOR CAPS NOT PROPERLY SEATED 8. GASKET MISSING FROM FILL CAP 9. GASKET MISSING FROM VAPOR CAP 10. FILL ADAPTOR NOT TIGHT 11. VAPOR ADAPTOR NOT TIGHT 12. GASKET BETWEEN ADAPTOR & FILL TUBE MISSING / IMPROPERLY SEATED 13. 'DRY BREAK GASKETS DETERIORATED 14.ExcESsIvE VERTICAL PLAY IN COAXIAL FILL TUBE 15. COAXIAL FILL TUBE SPRING MEC~NISM DEFECTIVE 17." TUBE LENG~ MEASUREMENT /~Z /Z¢- ~ /Z~' / ~ // '" 19. OTHER 20. COMMENTS: WARNING: SYSTEMS MARKED WITH A CHECK ABOVE ARE IN VIOLATION OF KERN COUNTY AIR' POLLUTION CONTROL DISTRICT..BULE(S) 209, 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES . OF UP TO $1,000.00 PER DAY FOR EACH VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLU- *'~** TION OF THE VIOLATION(S) 44444444444,444444444444.444444.4.4,4***4**44*44**4 Environmental Sensitivity Inspection Time ,:.~ ,~ ?~/~ ~_ /~/~ U~DERGROUND HAZARDOUS SUBSTANCE STORAGE F AClLI~ to. of Tanks :/{. Is Information on Permit/Application Correct~ Y, ~ No__ Permit Po~ YI~ ~'. No__ ryp, of Inspection: ~outine ~ Complaint ' ~,in~ion ;omments: ITEM VIOLATIONS NOTED I. ~Primary Containment Monitoring: "~...a' Intercepting and Directing System '~' Standard Invento~ Control Monitoring c. Modifi~ Invento~ Control Monitoring ' d. In-Tank Level ~nsing Device e. Groundwater Monitoring f. V~ Zone Monitoring ~ ~ondary Containment Monitoring: a. Liner Double-Walled Tank c. Vault Piping Monitoring: b. Suction c. Gravity 6.} N~ Con~ru~ion/Modifi~tion 7. CIo~re/Abandonment t. Maintenance. ~en;ral ~f,~. a.d Operating Condition Facility :omment~Recommendations:.J'- ~~ Reinspection ~hedut~? Yes / .... '"'No Approx,m~e Re,n~,on Date ,'~ . . 4ealth 580 4113 170 (7-87) KERN' COUNTY 'AIR POLLUTION'CONTROL:DISTRICT 2700 "M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR RECOVERY INSPECTION FORM _ Notice Rec'd By ~ TANK · 1 T~K ~ T~ ~3 TANK ~4 1. PR~UCT(ULPULP, or'R) ~L . ~k ~ ~ ~ 2. TANK LOCA~ON REFERENCE ~ ~ -- ~ ~$F 7. VAPOR CAPS NOT PROPERLY S~TED 8. ~SKET MI~ING FROM FILL CAP '~. 9. GASKET MISSING FROM VAPOR CAP L 10. FI~ ADAPTOR NOT TIGHT ~ 11. VAPOR ~APTOR NOT TIGHT 12~ ~SKET BE~EEN ADAPTOR & FI~ TUBE MISSING / IMPROPERLY SEATED 1~ DRY BRaE ~SKE~ DETERIO~TED .~.EXCE~IVE VE~ICAL PLAY IN COAX~L FI~ TUBE 15. CO~L FI~ T~BE SPRING MEC~ISM DEFECTIVE ~ 17. ~BE ~NG~ M~SUREMENT q' ~ 18- DIFFERENCE (SHOULD BE 6" OR LESS) ¢ t, ~1, ~/, D'' 19. OTHER . . 20. COMMENTS: '~ / '~r WARNING: SYSTEMS MARKED WITH A CHECK ABOVE ARE IN VIOLATION OF KERN'COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 209, 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLU- AO("~I'~ ~11 [~ :"-,? KERI~ DUNTY AIR POLLUTION CONTR(',' ISTRICT 2700 "M" Street, Suite 275 ... Bakersfield, CA. 93301 (805) 861-3682 --'t-- ------:;~-z'--~7~"' ~ ,., PHASE II VAPOR RECOVERY INSPECTION FORM Station Location ~20/ ~ '/'~t~¢:~--__/,~~2~/~ //~, Contact ¢'/9/mdrm Phone ¢~3 7W~' System Type: ~ Inspector -~, >~~ Date ~--~'~--~ Notice Roc'dBY 1. CERT. NOZZLE 2. CHECK VALVE 'N O 3. FACE SEAL Z Z 4. RING, RIVET L E 5. BELLOWS 6. SWIVEL(S) -/ 7. FLOW LIMITER/" (EW) ; 1. HOSE CONDITION V ~ A 2. LENGTH.- O 3. CONFIGURATION R 4. sWIVEL O 5. OVERHEAD RETRACTOR S E 6. POWER/PILOT ON 7. SIGNS POSTED Key to system types: Key to deficiencies: NC= not certified, B= broken BA=Balance HE=Healey M= missing, TO= torn, . F= flat;' TN= tangled RJ =Red Jacket GH=Gulf Hasselmann AD= needs adjustment, L= long, LO= loose, HI =Hirt HA =Hasstech S= short MA= misaligne.d, K= kinked, FR= frayed. ** ** 11 . I I I I Key to inspection results: Blank= OK, 7= Repair within seven /j~/,~ days, T= Tagged (nozzle tagged out-of-order Until repaired) .~ U= Taggabl.e violation but left in use. COMM N S VIOLATIONS: SYSTEMS MARKED WITH A "T OR U" CODE IN INSPECTION RESULTS, ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH DAY OF VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLUTION OF THE VIOLATION. NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, REQUIRES THAT THE ABOVE LISTED 7-DAY DEFICIENCIES BE CORRECTED WITHIN 7 DAY,,S. FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION Sta,on ~dreg1~ °1 ge. I/,V '7--0' '~,~ C~... Station ~dres/4:2t)l Major Cross StreeL ~ ! t'4 ~ ~ t.~ Major Cross Street Ze'ephone No >'~' 7 - 7~ c~ Telephone No '3 ~'ota,i,er 'Reading W. en ~'a~d q 'Y e / .~ 5 ~ota,izer Read,rig ~. ~.~ ~ q e z ~ ~ W~ W~ING Use of this d~ce is prohibited ~ ~ate law and un- Use of this de~ce is prohibited by state la~ and un- authofized remo~l of this tag or use of this equipment authorized removal of this t~g or use of this equipment ~11 constitute a ~olation of the law punishable ~ a ~11 constitute a ~olation of the law punishable ~ a ~mum d~l fine of $1,~ ~r day or a ma~mum magnum d~ fine of $1,~ ~r day or a magnum c~minal fine of $~ ~r day and/or six months in jail. c~minal fine of $5~ ~r day and/or six months in jail. I declare under ~nal~ of ~u~ that the de~ce ta~d I declare under ~nalty of ~u~ that the de~ce raged ~s not used, nor ~s the tag removed, until the required was not used. nor was the tag removed, until the required re~im ~re effe~ed and the dist~a noticed, re~im ~re efle~ed and the dist~ noticed. Re~ired ~ ~fle Re~ired ~ i ~tle (Plea~ p~nt) (Please print) Si~ature., Signature Date T~me . . Date .~me Total~er Reading at ~me o{ Re.ir Total~er Reading at ~me of Re.ir Re~im ~de Re.in ~de BEFORE USING ~lS D~el~pho~ ~ air BEFORE USING ~15 D~ ~elepho~u~l air ' i fi~ at ~ ~~ ~ ~llution control dis~ at ~ ~ / ~ ~ ~ · ~llut~on control d st ~ . . If re~im ~re ~de to the no~ ~y ~u must noti~ if re.irs ~re made to the~ ~Y ~u must nou~ the CounW DepOnent of Weighm and Measures. the ~unty Decrement of Weights and Measures. 66249 66249 DOING BUSINESS AS / BUsj'NEss ADDRESS ' ' PAY BY TYPE OF BUSINESS FEE BASIS FEE PENAL~ (IF ANY) PAY THIS OWNER/S X NEW BUSINESS CHANGE OWNERSHIP ~ RENEWAL MAILING ADDRESS BLIND 2,C, ~:c i~ CHARITY/TAX SUPPORTED ~ke~f ieL4, CA 1700 [[OW[~ SI~[[I · BAK[~SF~[[D, CA. 93305 DATE F E PAID DATE APPROVED, HEALTH OFFICER · ~ LEON M. HEBERTSON, M.D. APPLICATION INSPECTION ~ CONDITIONAL APPROVAL DATE Sept~er 28, 1984 DBA HO~'~S ~A~T ~APPEOVED DATE ADDRESS ~ ~LL~ ~.~ CONDITIONS AS FOLLOWS OWNER JACO 0~ i. All co~t~ction to be as per fac~ity p!a~ approved ~ this de~ment a~ retried ~ ~spection by Permitt~ Aut~rity. ~, Pe~Eittee ~t co,act Pe~itti~g Authority for o~site ~Dection(s) uith ho~s ad~nce notice. .~ ~e Derfo~tions to be aDp~tely .028". A~ ~c~i].! ~ter~l for pip~ ~ ~s to be as p~ ~n~act~er's spec~icatio~. ~ ~ ~te inm~eet~ons ~ Pe~itt~ A,~thority ~ ] ~ b~de of C. A~j other ~spection P~itt~ Authority deems neces~ A,.,. Underground stooge faculty ~t to be p~ ~to operation ~ f~l aDp~val "Pe~it to Se~te" is g~ed ~ Pe~itt~ Authority. 7. S~rk test~ (~,~ volts) required at site prior ~ ~l~tion of Test ~st be ce~ied ~ ~act~er. 8. ~e ass~b~es to ~ le~-proof caps at ~de a~ below s~p a~ access point to be sec~ed ~ sealed watertight ~ ?. }~tor~ requ~ents for t~s facility w~ be descried on f~l "Pe~t 'to ~erate". ~!oat vent ~lves req~ed on vent ~s of ~erg~ ~s as a pr~e~ion to overf~.~ c~tible ~th p~se II ~r recove~ ~st~ l!. F~ml "Pe~it to ~e~te" wi~ ~t be issu~ ~ Pe~tt~ Authority is pr~ed with ~ ho~ co.ct a~ telep~ne ~ber. RECEIVED BY ~ SECTION 3503 FI'LIN'~/OF APPLICA'TION FOR PUBLIC HEALTH PER/~A T O.FI_ER ./ , . . SECTION 3807. PENALTIES. If any fee required by thi~ Division is not Every person is requ, i'~'~d to obtain a public health permit to conduct any bus- paid prior to the delinquency date, in addition to such fee, the applicant shall iness, occupation or~other activity provided for in this Division, and shall file pay a penalty eq?ol, to twenty-five percent (25%) of the fee. The term "delin- an application with the Heohh Officer on a form to be provided and pay thequency date" shall mean in'case of e renewal July 31, and in the case of required fee and penalty, if any. a newly established business or activity thirty-one (3!) days after commencement of the business or activity. ~akcrsfield, CA Application For Permit To Operate U~rgmu~ ~5) 861-3636 Appl,cation Date ~.// H~a~d~ Materiali Stor~e F~iliw 'yDe of Application (check): Jew Facility Construction _~ .. _ Modification of Ex~slin9 Facil~y . Existing F~cility ..... Transfer of Ownership ~ Emergency 24-Hour Contact & Telephone Numar ~ ~/ _~_~%~.D.C~{~ ~ "~ ~~ ~ ....... · .......................... ~sessor's Parcel Num~r.~ ,. Water to F~ility Rrovided By ( C~ ) ~ c~.~ ~ -- - Depth to Groundwater I Soil CharacteristiCs at Facility_.~ ~ c,1 c~ Basis for ~il Ty~ and Groundwater Depth Determinations _ E--CJ-~--~ ~ ~ . Contractor ..... ~ ~ J ~ " - .............................. ~A. ~ntr~tor's Li~n, No Address .................................. .Telephone_~ Proposed Starting Date_~ / j / S,V ............................. ~roposed Completion gate~/_ .-Briefly De~ribe Modifications Pro.sad . 1) Prima~ Containment: Tank Date Cap. Sty MFR/ Type Coatings Mat'l Prev. Mat'l No. Installed Thickness (Gals) Model (FRP, E~c) Int/Ext Stored Stored 2) ~condary Containment Tan k Cap,Sty No. Material Thickness (6al~) / ~ ,, Construction Details 24 HQUR RiEPORT~BLE VARI ATI ON/LOSS NOTIFI CATION County Department. 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section · REGARDING: Name Of Person Filing Report: /~-//~-~ (date and time) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank ~ Daily Weekly Monthly Line 8 of /_~ Variation/Loss Variation/Loss Variation/Loss Trend Analysis I have stopped dispensing product and begun investigation procedures required by the Permitting Authority. This notification' is in addition to the phone call I previously placed. Signature ~-4 HO. UR, REPORT.~LE VARIATION/LOSS NOTI FI CATI ON TO: Kern County Health Department. 1700 Flower Street Bakersfield, California 93305 Attn: Underground Tank Section I~EC~ING: Name 0f Person FilinM Report: ~/~~/4,.. /~..".". ,'/~:Xm~/'~ ~~ 0n ~:'L/~'-:'~ · ~://:' , the above facility had an (date and time) inventory variation/loss that exceeded reportable limits as described below: Amount of Amount of Amount of Total Minuses Tank # Daily Weekly Monthly Line 3 of Variation/Loss Variation/Loss Variation/Loss Trend Analysis · x: , .q I/.x:: / ! have stopped dispensing product and begun investigation procedures required by the Permitting Authority. This notification is in addition to the phone call I previously placed. Jaco Oil Company 3101 State Road Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93308 Bakersfield, California 93303-1 May 26, 1987 Kern County Health Department 1700 Flower St. Bakersfield, Ca. ATTN: Ann Boyce Dear Ann: Enclosed please find a copy of our revised forms. These forms and procedures will be implemented system wide as of June 1, 1987. We will be holding meetings in our office on May 28, 1987 at 9:00 a.m. and 11:00 a.m. should you wish to send anyone from your office. Sinc. erely, Roy F. Saunders RFS: j s encl REPORTING PROCEDURES FOR INVENTORY SHORTS/OVERS Any loss that is reportable under the guidelines must be reported to the Health Department and Jaco's office. The guidelines for reporting are as follows: 1) Any shortage or overage on any tank over 200 gallons on a daily basis must be reported to the 'Health Deparmtent and our office. 2) Any shortage or overage over 350 gallons or above 5% by the weekly calculation must be reported to the Health Department and our office. 3) On a monthly basis, any shortage or overage over 1½% of monthly throughput must be reported to the Health Department and our office. 4) On a monthly basis, if your total number of shortages exceeds the action number chart it needs to be reported to the Health Department at once. The Health Department reporting number is: 805-861-3636, 24 hours a day Jaco Oil's office number is: 805-393-7000 The Health Department will need your location and permit number for reporting purposes. Jaco Oil Company DAILY REPORT INSTRUCTIONS A) Fill in the month, day and'year at the top as well as the location at the bottom of the page. B')' In Area #1, write down the pump number, total gallons and total money reading from the console, or the dispenser as the case :nay be. C) Line #2, is the total of all pump readings. D) Line #17 is the.start figure, or totals carried forward from the previous day. E) Line #8' is: Line 2 less Line 17 for a total sales figure. F) Line #9 is for deducting pump tests that were returned to the underground tanks. G) Line #15 is the net total sales after adjustments. I{) Line #10 is the total sales in gallons for the day. This should be taken from Line #15. I) Line #11 is the total sales in mOney, by grade, less pump tests and credit cards, if any, to determine your deposit. J) Line #4 is the beginning inventory by the prior days gauging (Line #5 of prior days report). K) Line #12~ receipts are gross gallons received for inventory. These gallons are not to---6~temperature.corrected. L) Line #14, these numbers are in section 10 which came from Line 15 of the report. (Total gallons sold by grade of product). M) Line #5 is the sum of Line 4 plus Line 12 minus Line 14 to determine Book inventory. N) Line #3 is the inches you gauged the tank at the close of the report. O) Line #15 is the gallons those inches represent from the tank chart. P) Line #16 is the difference between Line 5 and Line l~. Q) Line #15 is your beginning number for Line 4 for the next day. Line #2 becomes Line 17 for the next day. SM.ecial Notes: 1) Daily tank gauging must take place at the same time that the final shift is cut off for the.day. It is imperative that this be done to have accurate paperwork. 2) It is recommended that the gauging be performed by the same people as much as possible. 3101 State Road Telephone: (805) 393-7000 Post Office Box 1807 I~=l~.r.~i.lcl P.~lifnrnia 93308 Bakersfield, California 93303 · Permits # c,){~'O 0 0/ Inspector · l~'"t Facility Name ,,z/o~;.~,'~t3 ]~ ~eIF Date {.J?o PIN~ INSPECTI~ C~C~ISl ~ce~}S ~ (:' ." :: . > / ~ ~o~ ~o ~ / / Plot Diagram Plot plan notes ~ . l '' - ) o~: : ,/J ~ ,~ ' , ~ p Yes No 1. Ali new and existing tanks located on plot plan? 2. Does tank product correspond to product labels on IZ {~} plot plan? / 3. Was,there no modifications identified which were t.~/ not depicted on the plot plans? If "No" described / 4. Are monitoring wells secure and free of water and l~" ~I product in sump? 5. Is piping system pressure, suction or gravity? '~ Yes No 6. Are Red Jacket subpumps and ail line leak detector I ~ accessible? Type of line leak detector if any ~/o-',~ ~u~C, 7. Overfill containment box as specified on application? If "No", what type and model number: a) Is fill box tightly sealed around fill tube? b) Is access over water tight? {~{~ c) Is product present in fill box? I_~{ 8. Identify type of monitoring: /'t~c,~o~/~'~6 ~£ / a) Are manual monitor,lng instruments, product and water finding paste on premises? b) Is the fluid level in Owens-Corning liquid level -{ monitoring reservoir and alarm panel in proper operating condition? c) Does the annular space or secondary containment {_-{ i~/ liner leak detection system have self diagnostic capabi I t ties? It' 'Wes", ts It functional _! If "~o", how is It tested fo~ proper operating condition? 9. Notes on any abnormal conditions: L~NL~ER(;RoLIND STORAGE FACLI.ITY PI.AN CHECK LIST ~t~pLICABILITY/EXEHP't'IONS (Facllitics in any of folio,wing categories are exempt) Facility has Hazardous Waste Facilities Permlt or ISD from DOHS Not storing hazardous substances Tanks not substantially underground Control of external parasites on cattle Farm tanks storing ~DiF's used to propel vehicles for ag purposes Storing HVF's for ag pest control by licensed pest control operator within one mile of farm Sumps, separators, storm drains, catch basins, ollfield gathering lines, refinery pipelines, lagoons~ evaporation ponds, and well ceilars APPLICATION COHPLETION Identification of responsible parties (24 hour) -.-' ~. Facility location adequately described '/ Workers' Compensation certificate or waiver /~c.5.~.,~'~ -;c~' '/ ~pplicant desires exemption from secondary containment fo£ M V~s ' (If "YES", the following subsectiqn must be completed with all "YES" answers in order for exemption to apply) ,/ Highest groundwater not within 50 feet of ground surface 7 Nearest surface Water is not within 75 feet of tank excavation ~ Nearest ag or domestic well is not within 50 feeC of tank excavation /~ Facility is not located in an aquifer recharge area ~--' Facility is not located in a unique wildlife habitat area, GENERAL DESIGN STANDARDS (asterisked items are N/A if ~/F exemption permitted) * Provides primary and secondary containment Primary containment product-tight / Approval by nationally recognized testing agency of tanks and equipment * Secondary containment compatible with product Secondary containment volume at least 100% volume of primary tank * If sec. cont. for more than one tank, must contain 150% of volume of largest primary tank placed in it, or 10% of aggregate volume, whichever is greater. If open to rainlSall, set'. cont. must also accomodate 2fi hr. rainfall Monitoring system within secondary containment, approved, and compatible Water intrusion into sec. cont.--monitoring and're~vtng Corrosion Protection-- Tanks Corrosion Protection-- Piping ?- % ~rrosion Protection-- Isolation of piping and tanks Overfill Protection (device ~/th alarm system) Pog~n~ial intermixing of ineo~a~lble substances prevented by separation ~ater and sewage lines no closer than 10 feet from tanks~ pipes~ fi wnitorir systems Approved backfill and bedding for tanks and piping Ca~hodtcally Protected Steel, Fiberglass' Reinforced Plastic, or Fiberglass Steel Tanks Leak Intercepting and Directing System PVC or better ,05~-, o~. ~ .... ~ ~orizontal and Vertical Sections half-slotted (typ, . ~ Sloped 1/4 inch per foot to ~ell 2 foot mnitoring sump or greater / ~ps at grade and belo~ sump sealed to be leak proof or~N, Vault, gan, or Trough ~-~/ Synche~ic Hembrane Liner or Sealed Concrete ' ~ '' Sloped 1/~ inch per foot to mnltoring ~ell .... ~ Under each tank and of size. to intercep~ leak from anywhere on Can .' ' '~tnimum 2~ ~nitoring veil or sump Leak ~Cectton/Honitorin8 Pr~surized Product Piping . ~ Leak: interception and direction system co ~nitortng ~e[1 .~/ Red 3acker (cannot be used alone) -, Overfill Protect ion Fill Box sealed leak-proof Visually ~nitored by facility operator l?0O Flower Streel K~-RN COUNTY HEALTH DEPARTMEI~ r HEALTH OFFICER Baker,,fie;d, Calilornia 93305 Leon M Hebertson, M.D. Telephone {805) 861-3636 ENVlRONMEI,ITAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH .,~;..~; Vernon S. Retchard NOTICE To: Applicants for Permit to Operate Underground Storage Facilities Section 3800 of Article 3 of the California Labor Code reqtutres that every county or city requiring issuance of a permit as a condition for construction of ar~ b,,tld~ug or structure have on file: 1. A certification consent to self-insure issued ~y the Director of Ir~ustrial Relations, or 2. A certificate of worker's compensation insurance issued by an admitted ~-~urert or An exact copy or duplicate thereof certified by the d~ector or the ~r~urero Permit applications w~ not be processed un~ess th~s department is provided .or Bas on file one off the certificates listed above, or app]~[ca~t Bas sig~ed statement of exe~ption be~OWo The cert~ficate ~u~t show the ex~ration date of the po]~cyo These requirements shali Mt apply ~f the fol~o~ statement is read and signed by applicant: "I certify that ~n the perfornmme o.£ the work for wh£ch this permit ~ issued I shall not e~ploy ar~ person ~ ar~f ~ar~er so as to become subject to the worker's co~ensatio~ laws of C~l~forr~." DISTRICT OFFICES