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HomeMy WebLinkAboutUNDERGROUND TANK 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. IInstructions 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 address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: 7 ELEVEN #32376 Permit #015-021-001885 9600 Brimhall Rd Bakersfield, California 93312 CITY'OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326:'3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING TANK TESTING COMPANY ~ ~< ~aot,o 0 ~ NAME & PHONE NUMBER OF CONTACT PERSON 1'5-'fC~o TEST METHOD ~]e t.'T'"' ~ fa ~qo f-st.4-~cc' ~ NAME OF TESTER OR SPECIAL INSPECTOR k.~g.g CERTIFICATION # "/tt%t (, 0 (.*-t-.~d~..frt }~--~ DATE & TIME TEST IS TO BE CONDUCTED 12. / ?. o / OT , Oq 00 APPROVED BY DATE SIGNATURE OF APPLICANT · Complete items 1, 2, and 3. Also complete L iSignature item 4 if Restricted Delivery is desired. ~' ~)~..¢~.~ [] Agent ",~ · Print your name and address on the reverse ~ ~l~'~,~' J~ [] Addressee SO that we can return the card to you. ] B.~Received by (Printed Name) C. Date of Delivery · Attach this card to the back of the mailpiece, '~"! or on the front if space permits. D. Is delivery address different from item 1. [-J Yes 1. Article Addressed to: If YES, enter delivery address below: [] No 7-11 9600 BRIMHALL BAKERSFIELD CA 93312 3. Se_~ce Type I.~ Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 0860 0000 1641 7411 7002 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 ', r~ Postage $ Ce~'tifisd Fee Postmark Return Receipt Fee I'-1 (Endorsement ~uk~ H~ ~ R~H~ Delive~ F~ ~ (Endowment R~ui~ ~ To~ Pos~ge & F~ [~i~i BR~LL BA~RSF~LD CA 93312 9600 December 1, 2002 7-11 9600 Brimhall Bakersfield CA 93312 FIRE CHIEF RON FRAZE CERTIFIED MAIL ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 F^X 1661) 395-1349 FINAL REMINDER NOTICE su. PRESS,O. SE.V,CES JANUARY 1, 2003 DEADLINE 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Tank Owner/OperatOr: PREVENTION SERVICES F.,Es~ms,~;s.;.,'~.,~sE,~.s You will be receiving this letter on or about December 1, 2002. One 1715 Chester Ave. Bakers,e~a. CA 93301 month from today, January 1, 2003, your current underground VOICEFAX (661) (661) 326-0576326-3079 storage tank(s) will become illegal to operate. Current law would require that your permit be revoked for failure to perform the PUBLIC EDUCATION necessary Secondary Containment testing. 1715 Chester Av~. ~, Bakersfield, CA 93301 VOICE (661) 326-3696 In reviewing your file, I see that you have received "Reminder FAX (661) 326-0576 Notices" since April of this year. This is your last chance to comply FIRE INVESTIGATION with code requirements for Secondary Containment testing prior to 1715 Chester Ave. Bakersfield, CA 9,3,301 January 1, 2003. VOICE (661) 326-3051 FAX (661) 326-0576 Should you have any questions, please feel free to contact me at 661- TRAINING DIVISION 326-3190. 5642 Victor Ave, Bakersfield, CA 93308 VOICE (661) 3994697 Sincerely, FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc November 5, 2002 Bob DeNinno Environmental Manager 7-Eleven, Inc 3130 So. Owyhee Street Certified Mail F~RE C.~EF Boise, Idaho 83705 4768 RON FRAZE ADMINISTRATIVE SERVICES Dear Mr. DeNinno: 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 The following is a response to your letter of September 23, 2002. FAX (661) 395-1349 SUPPRESSION SERVICES The two sites left to be tested, have double wall fiberglass clad steel 2101 "H' Street tanks and are therefore subject to the SB989 testing by January 1, Bakersfield, CA 93301 VOICE (661) 326-3941 2003. However, at the time of testing, you may in fact do a visual FAX (661)395-1349 failure on the total containment sumps. PREVENTION SERVICES s~E.sE,~,s.~,~O,,~,~,~s,,~C~, Your request to defer replacement of total containment sumps by 1715 Chester Ave. Bakersfield. CA 93301 December 31.2003 is not acceptable. Our guidelines state that VOICE (661) 326-3979 FAX (661)326-0576 underground storage tank owners/operators will have 90 days (March 1, 2003) to affect repairs/upgrades to systems which have failed. Our PUBLIC EDUCATION records indicate you have two locations which have yet to be tested. 1715 Chester Av~. Bakersfield, CA 93301 Store #32241, 4101 Calloway Drive and Store #32376, 9600 Brimhall. VOICE (661) 326-3696 FAX (661) 326-0576 I hope this clarifies our regulatory requirements. Should you have F~RE INVES~aa~ON additional questions, please feel free to call me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 Sincerely, FAX (661) 326-0576 TRAINING DIVISION Ralph E. Huey 5642 Victor Ave. Bakersfield, CA 93308 Director VOICE (661) 399-4697 FAX (661) 399-5763 by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer cc: Ken Hillard 7-Eleven, Inc. September 23, 2002 City of Bakersfield Office of Environmental Services / Fire Dept. Mr. Ralph E. Huey Director of Environmental Services 1715 Chester Ave./Third Floor Bakersfield, CA 93301 Re: Proposed Petroleum Equipment Replacement Program Dear Mr. Huey: As you know, 7-Eleven, Inc. operates approximately 6 retail gasoline outlets in your jurisdiction. Pursuant to applicable regulatory requirements, 7-Eleven has conducted tests of secondary containment systems at a number of our locations in California. Based on the results of these tests and our experiences in other states, 7-Eleven has determined that certain equipment manufactured by Total Containment, Inc. ("TCI") has often been found not to meet regulatory requirements. Accordingly, 7-Eleven has decided to replace all TCI product lines that are currently in service in approximately 140 of our 7-Eleven stores in California, including 2 locations in your jurisdiction. If necessary, 7-Eleven will also replace TCI sumps and/or tanks at affected stores within your jurisdiction. For your convenience, Attachment A to this letter contains a list of affected stores located in your area. We propose to replace the subject TCI equipment at all of the affected locations by December 31, 2003. As part of this replacement program, we would ask for your authorization to accept 7- Eleven's determination that TCI secondary containment equipment is generally testing at an unacceptably high failure rate, in lieu of requiring continued site by site testing, and to defer testing of the secondary containment systems at affected locations until such time as the new equipment is installed. 7-Eleven wishes to be clear, however, that 7-Eleven will test all of its double-walled tanks by the deadline. Furthermore, the selection and installation of all replacement equipment would conform with technical standards established by the U.S. Environmental Protection Agency and other applicable codes and 7-Eleven will submit all required permit applications and obtain appropriate agency approvals to perform these upgrades. In addition, all of the affected facilities will be upgraded with Enhanced Vapor Recovery ("EVR") equipment at the time of the proposed replacements. We hope you will consider 7-Eleven's proposal to comply with the intent of the applicable regulations. 7-Eleven is prepared to discuss our proposal with you in detail and to enter into such agreements as may be appropriate. We believe that our proposed replacement program is both cost-effective and protective of public health and the environment and we are eager to discuss it with you. If you have any questions or direction, please contact Bob DeNinno, our Environmental Manager for 7-Eleven stores in your area, at 208/429-8466 or me at 214/841- 6592. Thank you for your cooperation. Sincere~,ff, / · .~Manager, Environmental Serv'ces nd Compliance Enclosure CITY OF BAKERSFIELD  i~32~2~4~1~0~1. CALLOWAY DRIVE i BAKERSFIELD ~KERN ~33'~2230~_2_~ of Bakersfield-Office of Environmental Services {Fire p_~Rartment) i.,~.~i.~.~~..,,,,~i~i ........................... [.~.~ i.~.~ ~.~.~.~i~~i~.~r~i~i~ ~;i~ ........................................................................................... · Complete items 1,2, and 3. Also complete Signature _....~. · item 4 if Restricted Delivery is desired. · Print your name and address on the reverse I J ~---"f'7 (~ ~ ; [] Addressee SO that we can return the card to you. = H'~B~d N~~te~f Delivery · Attach this card to the back of the mailpiece, I/ ~ T-' I-' 7- /- , or on the front if space permits. I v2 D. Is deli ry address different from it 1. Article Addressed to: If YES, enter delivery address below: [] No 7-11 9600 BRIMHALL BAKERSFIEI~ CA 93312 3. S_..ervice 'r~yype I~1 Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 0860 0000 1641 653/~S~- .... PS Form 3811, August 2001 Domestic ~eturn mecl~pt 102595-02-M-0835 I~ Postage $ t'~ Certified Fee Postmark Return Receipt Fee (Endorsement Required) Here =O Restricted Delivery Fee ~:3 (Endorsement Required) ILl Total Postage & Fees ~ City, State, ZiP+4 BAKERSFIELD CA 93312 Certified Mail Provides: [] A mailing receipt [] A unique identifier for your mailpiece [] A signature upon delivery [] A record of delivery kept by the Postal Service for two years Important Reminders: B Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. [] Certified Mail is not available for any class of international mail. [] NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Fol valuables, please consider Insured or Registered Mail. [] For an additional fee, a Return Receipt may be requested to provide proof ol delivery. To obtain Return Receipt service, please complete and attach a Returr Receipt (PS Form 3811) to the a~ticle and add applicable postage to cover the fee. Endorse mailpiece "Return Receipt Requested". To receive a fee waiver fo; a duplicate return receipt, a USPS postmark on your Certified Mail receipt is required. [] For an additional fee, delivery may be restricted to the addressee o~ addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". [] If a postmark on the Certified Mail receipt is~d. esired;°please present the arti- cle at the p,,~,.~t office for postmarking, lf'~ postmark on the Certified Mai, receipt is r~eded, detach and affix label with postage and mail. IMPORTANT~Ile this receipt and present it when making an inquiry. PS Form 3800, April 2002 (Reverse) 102595-02-M-1132 October 31, 2002 7-11 9600 Brimhall Bakersfield CA 93312 CERTIFIED MAIL REMINDER NOTICE FIRE CHIEF RE: Necessary secondary containment testing requirements by December 31, RON FRAZE 2002 of underground storage tank (s) located at the above stated address. ADMINISTRATIVE SERVICES 2101 'H' Street Dear Tank Owner / Operator, Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 If yOU are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment SUPPRESSION SERVICES 2101 "H" Street components for your underground storage tank (s). Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661)395-1349 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary PREVENTION SERVICES containment components upon installation and periodically thereafter, to FIRE SAFETY SERVICES · EI~NME~TAL SERVICES 1715 ChesterAve. insure that the systems are capable of containing releases from the primary Bakersfield, CA 96301 containment until they are detected and removed. VOICE (661) 326-3979 FAX (661) 3260576 Of great concern is the current failure rate of these systems that have been PUBLIC EDUCATION tested to date. Currently the average failure rate is 84%. These have been 1715 Chester Ave. Bakers~eld, CA ~301 due to the penetration boots leaking in the turbine sump area. VOICE (661) 326-3696 FAX (661) :=0o576 For the last six months, this office has continued to send you monthly FIRE INVESTIGATION reminders of this necessary testing. This is a very specialized test and very 1715 Cl'mstorAve. few contractors are licensed to perform this test. Contractors conducting this Bakersfield, CA 93301 VOICE (661) 326-3951 test are scheduling approximately 6-7 weeks out. FAX (661) 326-0576 The purpose of this letter is to advise you that under code, failure to perform TRAINING DIVISION this test~ by the necessary deadline~ December 31, 2002~ will result in the 5642 Victor Ave. Bakersfield, CA 93308 revocation of ,your permit to operate. VOICE (661) 399-4697 FAX (661) 399-5763 This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Since, Fire Inspector/Environmental Code Enfomement Officer Office of Environmental Services '?- 11:32:2'76 '_-] ii, 013 t~R I I"Iit~LL BFfl(ERf-JF I ELD, C;~, 93:3 B06~37~$75505001 ':,i>CiT 15, 2002 1 ::38 'F 2: l'iLtl.. VOI_.tJHE = ;~,2't]5 IJLL~GE ~ 6FJ23 9 Cl:i:.;; IJi. L.~,;:;E = 5820 HEIGHT = :2',4.7',~: INCHES STK HEIGHT= 34.78 INCHES [,JaTE~ VOL = i] L,daTER = O. O0 I TF''~ = 85.7 DEG F T VOLUME = 2905 G~LS 90% IJLl,~'j~= 6~ 15 G~LS HEI,gHT = :31.02 INCHES ~'.'FK HEIGHT= :31 .02 INCHES [OF~TE[' "-,',;_:,L = 0 GaLS I,.J~TER ;= 13. O0 I TEM[' = 8,1.2 [:,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 ~7- ~'{c tJ'ceX INSPECTION DATE ]~ ADDRESS q(o. O0 (~f'i~{M_[I PHONE NO. ~'~'~ ~ FACILITY CONTACT BUSINESS IDNO. 15-210- TIME NUMBER OF EMPLOYEES INSPECTION Section 1: Business Plan and Inventory Program [~i Routine ~'Combined [~} Joint Agency {~ Multi-Agency ~ Complaint [~ 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 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?: ~] Yes o Explain: Questions regarding this in.~pection? PlCas~ call us at (661) 326-3979 ~ Business S~.espons ible_Party white- Env. Svcs. Ye.ow - Station Cooy Pink - Business Copy Inspector: _~' ~~'t~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 FACILITY NAME ~/~ ~(c~.,~ INSPECTION DATE /O- [~"-O ~ Section 2: Underground Storage Tanks Program [] Routine [] Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank D tt~ ~.~ Number of Tanks Type of Monitoring c4/,.;'l,k Type of Piping OPERATION C V COMMENTS Proper tank data on file i,,, / Proper owner/operator data on file t..,/ 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 ~ .~ . Inspect°r: cJ~J ~ Office of Environmental Services (805) 326-3979 Business~e Res' ,ns. ible Party White - Env. Svcs. Pink - Business Copy September 30, 2002 7-11 9600 Bdmhall Bakersfield CA 93312 REMINDER NOTICE FIRE CHIEF RON FRAZE RE: Necessary secondary containment testing requirements by December 31, 2002 of ADMINISTRATIVE SERVICES 2101 "H" Street underground storage tank (s) located at the above stated address. Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Tank Owner / Operator, SUPPRESSION SERVICES If yOU are receiving this letter, you have no~t yet completed the necessary secondary 2101 "H' Street containment testing required for all secondary containment components for your underground Bakersfield, CA 93301 VOICE (661)326-3941 storage tank (s). FAX (661) 395-1349 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety PREVENTION SERVICES F.~ s,,m ~Es.~o,~,-,~ s~,~Es Code) of the new law mandates testing of secondary containment components upon installation 1715 Chester Ave. Bakersfield. CA 9'&301 and periodically thereafter, to insure that the systems are capable of containing releases from vOICE (661)326-3979 the primary containment until they are detected and removed. FAX (661) 326-0576 PUBLIC EDUCATION Of great concern is the current failure rate of these systems that have been tested to date. 1715 ChesterAvb. Currently the average failure rate is 84%. These have been due to the penetration boots leaking Bakersfield, CA 93301 in the turbine sump area. VOICE (661) 326-3696 FAX (661) 326-0576 For the last five months, this office has continued to send you monthly reminders of this FIRE INVESTIGATION necessary testing. This is a very specialized test and very few contractors are licensed to 1715 Chester Ave. Bakersfield, CA 9,3,301 perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. VOICE (661) 326-3951 FAX (661) 326-0576 The purpose of this letter is to advise you that under code, failure to perform this test, by the TRAINING DIVISION necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 This office does not want to be forced to take such action, which is why we continue to send FAX (661) 399-5763 monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services August 30, 2002 7-11 9600 Bfimhall Road Bakersfield, CA 93312 REMINDER NOTICE RE: Necessary secondary containment testing requirements by December 31, 2002 of underground storage tank (s) located at the above stated address. FIRE CHIEF RON FRAZE Dear Tank Owner / Operator, ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield. CA 93301 If yOU are receiving this letter, you have not yet completed the necessary secondary VOICE (661) 326-3941 FAX (661)395-1349 containment testing required for all secondary containment components for your underground storage tank (s). SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health VOICE (661) 326-3941 FAX (661)395-1349 ~ Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to insure that the systems are PREVENTION SERVICES capable of containing releases from the primary containment until they are detected 1715 Chester Ave. Bakersfield, CA 93301 and removed. VOICE (661) 326-3951 FAX (661)326-0576 Of great concern is the current failure rate of these systems that have been tested to ENVIRONMENTAL SERVICES date. Currently the average failure rate is 84%. These have been due to the 1715 Cheater Ave. Bakersfield, CA 93301 penetration boots leaking in the turbine sump area. VOICE (661)326-3979 FAX (661)326-0576 For the last four months, this office has continued to send you monthly reminders of TRAINING DIVISION this necessary testing. This is a very specialized test and very few contractors are 5642 Victor Ave. Bakersfield, CA 93308 licensed to perform this test. Contractors conducting this test are scheduling VOICE (661) 399-4697 FAX (661) 399-5763 approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, ~ . Steve Underwoo Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services L D r july 30, 2002 7-11 9600 Brimhall Bakersfield CA 93312 REMINDER NOTICE ~mE CmEF RE: Necessary Secondary Containment Testing Requirements by December RON FRAZE 31, 2002 of Underground Storage Tank ts) Located at ADMINISTRATIVE SERVICES the Above Stated Address. 21Ol "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear Tank Owner / Operator: FAX (661) 395-1349 If you are receiving this letter, you have not yet completed the necessary SUPPRESSION SERVICES 2101 "H' Street secondary containment testing required for all secondary containment Bakersfield, CA 93301 components for your underground storage tank ts). VOICE (661) 326-3941 FAX (661) 395-1349 Senate Bill 989 became effective January 1, 2002, section 25284. l (California PREVENTION SERVICES Health & Safety Code) of the new law mandates testing of secondary FIRE SAFE'Pf SERVICES · EN1/I~)NMEI~N. SERV~ES 1715 ChesterAve. containment components upon installation and periodically thereafter, to insure Bakersfield, CA 93301 that the systems are capable of containing releases from the primary VOICE (661) 326-3979 FAX (661)326-0576 containment until they are detected and removed. PUBLIC EDUCATION Of great concern is the current failure rate of these systems that have been 1715 ChesterAve. tested to date. Currently the average failure rate is 84%. These have been due Bakersfield, CA 93301 VOICE (661)326-3696 to the penetration boots leaking in the turbine sump area. FAX (661) 3260576 For the last four months, this office has continued to send you monthly FIRE INVESTIGATION 1715 Chester Ave. reminders of this necessary testing. This is a very specialized test and very few Bakemfleld, CA 93301 contractors are licensed to perform this test. Contractors conducting this test VOICE (661) 326-3951 FAX (661) 326-0576 are scheduling approximately 6-7 weeks out. TRAINING DIVISION The purpose of this letter is to advise you that under code, failure to perform 5642 Victor Ave. Bakersfield, CA 93308 this test, by the necessary deadline, December 31, 2002, will result in the VOICE (661) 399-4697 revocation of your permit to operate. FAX (661) 399-5763 This office docs not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Sine7, Steve Underwood Fire Inspector Environmental Code Enforcement Officer State ater Resources Cont?61 Board ~. ~e,.~ Division of Clean Water Programs Winston H. Hickox 1001 I Street, Sacramento, California 95814 Secretary for P.O. Box 944212, Sacramento, California 94244 Gray Davis Environmental (916) 341-5855 · FAX (916) 341-5808 · www.swrcb.ca.gov Governor Protection The energy challenge facing California is real. Every Californian needs to take immediate action to reduce energy consumption. For a list of simple ways you can reduce demand and cut your energy costs, see our website at www. swrcb, ca. gov Mr. Bob DeNinno, Owner 7-Eleven #32376 P.O. Box 711 Dallas, TX 75221-0711 Dear Mr. DeNinno: APPROVAL OF REQUEST FOR RECONSIDERATION OF ENHANCED LEAK DETECTION (ELD) TESTING, 9600 BRIMHALL ROAD, BAKERSFIELD, CA 93312 This letter is in response to your June 3, 2002 request for reconsideration of the requirement to perform ELD testing. We have reviewed your request and the supporting documents you provided and have consulted with the local permitting agency. As a result, we have determined that your underground storage tank (UST) facility is not subject to the ELD testing requirement. Based on the enclosed information, your request has been approved for the reason(s) indicated below. [~ UST system(s) does not have a single-walled component. If you have any questions, please contact Mr. Ahmad Kashkoli at (916) 341-5855. Sincerely, Elizab~eth L. Haven, Manager Underground Storage Tank Program Enclosures (basis for the decision) cc: caMrT--~I~ w---w~dT-W-i~ · City of Bakersfield fire Department 1715 Chester Avenue, Third Floor Bakersfield, CA 93301 California Environmental Protection Agency Recycled Paper ,t" (- -f-,-" "~' "J":'" From: "Howard Wines" <Hwines@ci.bakersfield.ca.us> To: <kashkola@cwp.swrcb.ca.9ov> Date: 6/21/02 11:33AM Subject: Re: 7-Eleven #32376, 9600 Brimhall Rd. Bakersfield That's right, all tanks, product lines and dispensers aie contained as required for the new installation in. 1998.' We received a copy of their request for consideration documentation as well. The only single wall components are the vapor recovery lines. State Water Resou,r Control Board Division of Clean Water Programs Winston H. Hickox 1001 I Street, Sacraraento, California 95814 Gray Davis Secretary for P.O. Box 944212, Sacramento, California 94244 Governor Environmental (916) 341-5855 · FAX (9~6)341-5808 · www. swrcb.ca.gov Protection The energy challenge facing California is real. Every Californian needs to take immediate action to reduce energy consumption. For a list of simple ways you can reduce demand and cut your energy costs, see our website at www. swrcb, ca. gov JUL 2 .... Mr. Bob DeNinno, Owner 7-Eleven #32376 P.O. Box 711 Dallas, TX 75221-0711 Dear Mr. DeNinno: APPROVAL OF REQUEST FOR RECONSIDERATION OF ENHANCED LEAK DETECTION (ELD) TESTING, 9600 BRIMHALL ROAD, BAKERSFIELD, CA 93312 This letter is in response to your June 3, 2002 request for reconsideration of the requirement to perform ELD testing. We have reviewed your request and the supporting documents you provided and have consulted with the local permitting agency. As a result, we have determined that your underground storage tank (UST) facility is not subject to the ELD testing requirement. Based on the en¢loSedinformation, your request has been approved for the reason(s) indicated below. [~ UST system(s) does not have a single-walled component. If you have any questions, please contact Mr. Ahmad Kashkoli at (916) 341-5855. Sincerely, Elizab-~th L. Haven, Manager Underground Storage Tank Program Enclosures (basis for the decision) cc: Mr. Howard Wines City of Bakersfield fire Department -- 1715 Chester Avenue, Third Floor ~, · . 'Bakersfield, CA.93301 . · California Environmental Protection Agency Recycled Paper [iAhma~l~ Kashkoli - Re: 7-Eleven #32376, 9600 Brimhall Rd. B~ersfield ' Page 1 From: "Howard Wines" <Hwines@ci.bakersfield.ca.us> To: <kash kola @ cwp.swrcb.ca.gov> Date: 6/21/02 11:33AM Subject: Re: 7-Eleven #32376, 9600'Brimhall Rd. Bakersfield That's right, all tanks, product lines and dispensers'are contained as required for the new installation in 1998. We received a copy of their request for consideration documentation as well. The only single wall components are the vapor recovery lines. D June 30, 2002 7-11 9600 Brimhall Bakersfield, CA 93312 REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 9600 Brimhall. FIRE CHIEF RON FRAZE Dear Tank Owner / Operator: ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 The purpose of this letter is to inform you about the new provisions in VOICE (661) 326-3941 FAX (661) 395-1349 California Law requiring periodic testing of the secondary containment of underground storage tank systems. SUPPRESSION SERVICES 2101 'H" Street Bakersfield. CA 93301 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California VOICE (661) 326-3941 FAX (661) 395-1349 Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, t6 closure PREVENTION SERVICES 1715 Chester Ave. that the systems are capable of containing releases from the primary Bakersfield. CA 93301 containment until they are detected and removed. VOICE (661) 326-3951 FAX (661) 326-0576 Secondary containment systems installed on or after January 1, 2001 will be tested ENVIRONMENTAL SERVICES 1715 ChesterAve. upon installation, six months after installation, and every 36 months thereafter. Bakersfield. CA 93301 Secondary containment,systems installed prior to January 1, 2001 will be tested by VOICE (661) 326-3979 FAX (661) 326-0576 January 1, 2003 and every 36 months thereafter. REMEMBER! Any component that is "double-wall" in your tank system must be tested. TRAINING DIVISION 5642 Victor Ave, Bakersfield. CA 93308 Secondary containment testing shall require a permit issued thru this office and VOICE (661) 399-4697 FAX (661) 399-5763 shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661)326-3190. Sincerel , ~ Fire Inspector/Environmental Code Enforcement Officer Environmental Services ~ _ SU/kr LEVEfl May 28, 2002 Ms. Elizabeth Haven, UST Program Manager California State Water Resources Control Board Division of Clean Water Programs, UST Program EELD Request for Reconsideration P. O. Box 944212 Sacramento, CA 94244 RE: 7-Eleven #32376 9600 Brimhall Rd., Bakersfield, CA Dear Ms. Haven: ~ The referenced site was built in 1998 as a new 7-Eleven store with a new underground gasoline storage tank (UST) system. There are no single-walled components in the UST system and this site is therefore not required to implement Enhanced Leak Detection (ELD). Enclosed for your review is: · Request for Reconsideration Form · Representative pictures of the installation of the UST system · Copies of the Double-Wall Tank Installation Checklist completed by the insta, lling contractor · Copies of the UST system tests (tanks, lines and Stage II Vapor Recovery) · Copy of City of Bakersfield Final Inspection Report completed by Steve Underwood · '* Piease feel free to.call me at (208) 429-8466 should you I~ave any questions about tn~s //~rmation. - '/ Bob DeNinno 7-Eleven, Inc. CC Steve un-~erwocd (Cit7 of Dakersfield) Enviromental Services Department / 10220 S. W. Greenburg Road / Suite 470 / Portland, Oregon 97223 Phone (503) 977-7713 ! Fax (503) 245-3438 R uest for Reconsideration F ca I. FACILITY / SITE INFORMATION H. NAME AND ADDRESS OF OWNER/OPERATOR SUBMITTING REQUEST . [ I-I 2. OPEJ~ATO~ TITLE OF APPLICANT . ' [ PHONE MAILING ADDRESS f'l (MAturinG ADD.ss SAME AS F^¢ILITY ADDRESS). CITY ' STATE ZIP CODE Please check reason(s) why you believe that the California State Water Resources Control Board (SWRCB) notification is in error. If the request for reconsideration is based on evidence that the UST system in question is greater than 1,000 feet from a Public drinking water well, include a demonstration that the center of the well head is more than 1,000 feet from the closest component of the UST system. If the request is based on evidence that the UST system does not have a single-walled component, include supporting documentation. INCLUDE ALL SUPPORTING DOCUMENTATION YOU WISH THE SWRCB TO CONSIDER WHEN REVIEWING YOUR REQUEST. REQUESTS FOR RECONSIDERATION ARE SUBJECT TO VERIFICATION. 1. ( ) I am not the owner or operator ora UST system. Check applicable reason: ( ) Change of owner or operator. ( ) No UST system(s) present. 2. ( ) UST system is permanently closed. 3. ( ) UST system is exempt from regulation, according to Section 2528 l(x) (I)(A)-(D) of the Health and Safety Code, or Section 26.21 of Title 23 of the California Code of Regulations. For example, certain farm tanks and heating oil tanks are exempt. 4. ~-~No single-walled component in UST system(s). 5. [ ) Closest componentofUST system is greater than 1,000 feet from well head of any public drinking water well. Check applicable reason(s): ( ) UST facility incorrectly located in GeoTracker database ( ) PublicDrinking Water Well(s) inco~ectly located in GcoTracker,database , 6. ( ) Other (explain) ' ' NOTE: SUBMITTAL INSTRUCTIONS ON REVERSE SIDE OF THIS FORM IH. APPLICANT SIGNATURE Certification - I certify that the information provided herein i~ tn .... ~ ....... N the best of my knowledge- Knowingly submitting · request for reconsideration based on false or misleading Bob DeNinno ~fion 25299, punishable by fine up to SS00.0. ',( . . PHONE DATE __To.be,. ~_.~mplet~d by tank manLJfao~curer I Licensed Tank Manufacturer: Delivery Date: Tank Jagket Serial e: U i_ -t.~ '~ t~" ~ vacuum gauge reading at delivery: ~ In. Hg. Steel Tank #: Street Address; . ~ ~,~) ~--'~,--' ~'~a~'~'~.'~'~'.~'~'~"' Street Address: ~t~-~-')~~--~'~-.. .... 1. ii~ual Insl3eat[on: InspecTed entire surface and found no evic~ence R~An;w~r Of damage at delivery, Y__ No .............. 2. Handling: A: Were lifting lugs used to unload the tat~k? Yes ~_. N~,,,~r. gL. . B: Was tank damaged c~u,-ing unloading? Yes _N'o~'~_._..'.. 3, Site-Storage: A: Any evidence of scrapes, hole~ Or drag marks? Yes . . . B'. WaS tank stored for over 60 days? Yes C: Wac tank covered with an opaque t~rp? yea- ............; ..... NoC~ 4. taRE-INSTALLATION TESTING CERTIFICATION: A; Vacuum gauge mon~tor,~g ,~ter.~4ht~0i SP~,~;e shows m~mu~ b.~" H~. Ye~ ~... No.. ..... B: (81temato) P?ossurized pHma~ tank ~ 5 psi, seconde~ tank to I psi, 5. Bedding aha ~Ck~t??6el A: Pea Gravo~ B: Sa~3d ......................... C: Stone ~r A5~C-33 '7, Anchori.g: ~~~~. we~ hold-down straps u6eO~ Yeu ........... Nu .................. HO~_.. Were I~old-down ~trep3 Drov~d~ bv the tank manufacturer? Ye5~ ~ No . , . 8 INaTAL~D TEST ~ERTtFICA~ON: Establish minimum vecuun~ of 15" Hg, a~er Oack-filling to top of tank A: Vacuum re. in9 at ste~ or zo~ Hg, ,~ ~ . Time ._~.~,~ B: V~cuum re.ding: aHer 12 hours for up tO 10,000 ~ltOnS Hg. _~ ............. ~me _. after ~ lluur~ for greazer ~l~an 10,OO gallons Hg ........~ .......... Time C: IS difference of abo~ readings l~s than 5" Hg.? Ye5 , No .... D~ Woo vOouum ~odin9 et end of teR.~ above I O" I I~.}' Yes No .... E: If an5~ to "C" and *'D" able ere ~s, ~nk is tight. 10, Monitoring Standpipe: Vacuum assembly wes removed and a ; ~- ~-1/2" Or 2" standpipe was ins[el[~ and is accessible f~om grade. ~ ~' "-'~'~es ~- ...:.. ' No ....... ' ' (Vac[JiJm essemoly may be reatteched to accommodate continuous vacuum moni[odng.) I I. Signaturog; Name (Plea e Print) ~~ Date Ir~p¢~or/Regule~ory O~icial .......................... 8itc O~er'~ Representative ___ 13C001 1'0~ MARKf'rING l:R~d~AIL'llA~.NT REV1096 bloomoed Tank Menufmoturer; Dellvery ~ata' . . Tank Jacket Serial ii: ~.t..,~e~ ~-- ~ Va0uum gauge reading at deliver: ~ In,Hg. To be ~mpl~ed bY Installation o~a~or 1' Date ofInstallation; Con,actor: ~.,~~__~ Location; of dam~e at deli~w, Yes~ No ....... 2. Hamdli~t A: Were li~ing lugs used to unload the ~nk? Ye~.L..;. NO R~ W~ t~nk d~m~g~ ~uring unln~ing7 Yes · No~'~ .... 3. Sit~rage: A: ~ty uvlde~uu ur ~ura~, llul~ ur dta~ llt~lk~7 Yes .......... N~ ..... B: Was tank stored for o~r O0 days? Yes ........... N~. 4. PRE-INST~TION TESTING CERTIFICA~ON: A: Vacuum gauge r~on~toring interstitial space shows minimum 5.3" H~. Yes~... No ........... B: (alternate) Pressuriz~ primew tank to 5 psi, seconda~V tank to 1 psi, and soap ~st~ all seams & fittings ~ seconde~ ~ank, Yes ........ N~ .... 5. Beddln~ and ~ck~ (In~ An~er) ' A: Pea Gravel ...~ B: San~ ,. C: S:one ~r ASTMC-33 .......................... 7. Anchoring: ~ Were hOl~-~own s~raps useo~ Yes ................. ~-~ No .... '.. _ ..._ HoTM ma~? ...... ~ . . Were h01d-down strops prodded by the tank manufecturar? Yes~, '~n .. ...... 8 INSTAL~ TEST CERTIFICATION: ~atablish ~i~i~um vacuum of 1 ~" HG. a~er ~ck-filling to lop of B: Vacuum ~adin9: a~er I 2 ho~rs for up to 10,000 gallons HG. ,'(~..~,',~, Tinle .... ~~~ ........... C; Is difference of above rea~ings le~ than ~" Hg.? Yes ~ No . D. Web va~uu.i reading et ur~d ct tuft above 10" I.{g.7 Ye~ ~ ..... N~ ....... E: If ans~ro to "C" and "D" abo~ are yes, tank is tight. 1 O. M~nitoring Standpipe: Vacuum assembly was removed eno a 1-1/2" or 2" standpipe was installed and is acceR:siOt~' from brad~. ' 'Yes~.- ';r'NO. ..... {Vacuum assembly m~y [)e reattached to accommodate conti~3uous vacuum monitoring.) I 1. ~ig~atures: Name (PI~RRR P~ln ) Rio Date - ......... [nspector/H~ulatO~ Official Site Owner's ~epresentative 31C001 TCl M&RKE*rING DE~I,I~f'M~.I~I' REV1096 To ~,eompleted by t~nk ~uf~'~urer J - ~' .' Tank Jacket 8ariel i: ~ ~ ~ ~ L - ~ Vacuum gauge r~ding a~ deliver: .,,~L In. H9.' "t" "' ~ Cd, Lo~ation.. ~ Contractor; _ 1, Visual mn~: Ina~cted entire su~0ce and founa no evi~noe of damage ~ deli~~. Yes --' ~ No .......... 2. Nmndling: A'. Were li~[ng lugs useU ~o unlosd the t~nk? Yes B: Was ~nk darn~ge~dur)ng unloading? Yam No~ .... A: A~v ~danca ~ ncra~,~, hom~n ~r dr~g m~rk~? Yo~ No~ Bt Wes ta~k stored for over 60 days? Ye~ N~ C: Was tank co, red with an opaque terD? YeS ~. ~RE-INSTA~TION TEBTIN~ CERTIFICATION: B: (alternate) Pressurized prJm~w tank to 5 psi. seconda~ tank to 1 psi, S. B~ding an~ Backfill: ~mn,,.e~ A: PeaGravel .~ 8: ~end ................. C: ~toneDerA~l~C-~ ...... 0, Ex~vation 81~e: Pet PEI RP100-g0 Yes No .. Wera hOld~nwn ~tr~p. ,~d~ Y~ ~ NO ........... W~.~, m~ny~ ~. INO~A~ TEOTCERTtFICATION. i Establish minimum vacuun~ of 15" H~. o~er beck-filling tO tOD Of tank B; Vacuum reading: ufltr 1~ hours for up to 10,000 gallons Hg. ~ ~ . , Time _.~.~ C: Is difforence of above reading5 less than 5" Hg.? Yes~ ~_:. No I ~: We5 vacuum rgedi~o at end OF te~t ,~b~ 1D" HG.7 Y~ . . . N~ ..... E: If answers to "C" and "~" a~ve ere ~s, tank i~ tight. 1 ~. Signatu~os; ~ame (PleaSe ~rlnt) . ~ 8ig~ ' Dete· 8ire Ownet'~ ~epretentativo l~C001 " ~~i~ V~' ~ ............... ' ............... ProTank, Inc. - 3~4~ ~m ~u~, Sui~ G T~, CA (310) 891~70 · (affi) 438-1111 · F~ 010) 891-~74 C~t: Site: MA~S ~O~g~AL S~VIC~, ~E. ~OUTHLAND 7-11 g~2~76 1101 ~t Sg~8 S~t 9~ B~mhall Rind P. O. ~ ~39 ~rafi~d, CA 93312 ~ng ~ch, CA 562-5954555 TANK SYSTEM INFORMATIO~ Tank Typo Typo T&nk Tnal~ P~uct . ~.ons~mc~n Overtil! Sttp~ ! Sta~ D ~ 1~ ~ 1~ U~d ~ ' 95.0 6~0 ~ 65~ DW Fg Y~ . ~ ~ Va~ ~ 10K ~9 1~7 U~ ~9 9~,0 6~0 ~7~ 65~ DW F~ Y~ Dual ~ V~ 'rF.,.q13NO RI~ULT~ Nonvolur~He Volun~ri~ Volum~ O~ ~ow ~ Und~f~ T~t Und~fi~ T~t Non~lu~e UHx~ ~l of ~e of ~c ~c ~ Including P~aun M~ni~ M~ Tank nf%nk of T~ Tank 0nly I Vast Lh~ Lbo ~t 13K a7 ~,~7 ~h P~ P~ . P~g NO ......................... Iog.89 ' o.~ ~ PA~ r~ P~ NO ~oa ~ 0.~ ~. A ~ i~ d,~ if ~C Ou~ut Of ~e m~u~em~ sysem exes this t~hdd. ~i~ Rep~fl~five T~ng ~duc~ by D~sy E, M. by. ~ · ~ ~~e~ Hendey D,,~,. c. T~hnici~ Cc~~n No: CA 98-1I~9 TANK TESTING DATA Te~t Met~.~ ,Used: VU-$000 ~ndc. rfill) , T~ pe~ ....... T~ I,SK S7 ~ 10K ~ ~ 10K ~g T~nk N~ ~: .... Unl~ 87 gal~ 9~ Unfed S9 , ....... Tank Tank Tank .... D~ of~v~ of T~ Contain P~or ~ Pr~r to ~or m T~t d.~t~n ~oum - Minute); ........ 2 h~ ~0 mia _~, h~ 03 mia 2 b~ ~ P~F~ P~ P~ P~ A ~ ~t~ < +0.~0 ~ ~ ~id~ a P~ e A ~ ~ > +0.050 gph is ~nsi~ a FAIL /~d)Ttnl~, I]lg. · 3.q43 L. omha BouJevM~l, Suil~ G · Torrame, CA *1(~0~-$0Z2 g 0 10) 691-04'/0 · (tS(X)) 43~ i I 11 · Pax O I(h 891-4)474 Site: SOUTHLAND '/.~)~/~ .............. " ..--~, ULLAGE TESTING DATA ~ D~tt~: 0.~-14-98 OS- 14 98 0514=98 ~ Vetu~ ~1~): 0756 ~78 ~78 S~ ~mv~: o.7~ o.?so o.?~ H.M ~m on T.~ ~m ~i): 1,74 1.67 2,26 A~US~C ~GE T~ T~ M~ U~: ~A-5~ ~XED PR~SURE GAS ~W ~ D~iA~N ULLAOg ~T < " T~ ~ U~: ~ ~* m T~t P~sum: 1911 1911 19i ~ ~ - Tm In~al fl: 2010 2010 N~g~ ~ (e~): o.~ o.~ o.~ Fm~ T~ - Tm l~ ~1: ~ ~. = F~I N~ ,~w (o~): 0,~ 0.~ 0.~ _~ ~ (.m): .,. o.~ o.~ a.~ U om (' : '' · 6¢.~* ~,5~ ~,~0 F~ T~ . T~ i~ ~ ~0 - ~ - ~J ~ ~,?~): ..... o.to o.~ o.~ . ~ ~.{~: ............... , ~, ~~ {'~.: ..... IL t PA~ PA.q~ P~ ~: No~. 2 Cons~u~ T~ < 0.2~5 consti~ n P~ · 3 Con~ufiv~ T~ > 0.295 co~u~ a PAll, ~Fml~ !~, · 354~ L,omita gouievard, Suite G · Tefl'anee, CA 90S0.%5022 · 01~) 891.04.70 · (800) 43g-I 111 · F-x 010) ~g1-0474 Test Site: SOUTHLAND ?,z~,,#323'/o ...-,, LIN[~ ~ DATA ~-L4-98 ~1~98 Tut D!~ .............. ~ne. Tu~inc . ~p isko{ ........... l~!~t~ , Ball Vai~ ~{I Va~e ~H Va{ye L~ MSc~]: DW ~{mflex DW ~imOex DW 50 ~0 Volume eh.n~ (ml): ' 2 0 O PA~ PA~ PA~ PA~AIL ....... LEAK Db-TrECTOR DATA -Test Method used: Red Jacket Approved PTA, (F',,qd Tc~t Apl~..ratus) in ae~o~ance with EPA 'i0CFR280,44 fa) per RI-2I .... TatDate: ., , 01{-1~-~8 ] 0~-14-9,8 [ 0S-14-98,, : Line Number: ,, TI l~K ,Pro:~'fm!, I#e. · 354~ Lomi~ 13ou~vL-'d. Su~ O · Torrumc, CA 9050.~..~22 · 010) R91.O470 · ($00) 438-1 ] l I 5ProTan~,Inc. Lomlta Boulevard, Suite G Torrance, CA 90505-5022 O10) 891--0470 · (800) 438-1111 · Fax (310) 891-0474 TEST PROCEDURE Te-201.3 / ST-30 Determln~tion of 2 Inch (WC) Static Pressure Performance of Vapor Recovery Systems of Dispensing Facilities ODF Name ~d .Adde~ GDP $OUTHI.AND ?-Il ~9-q"/6 ..... 'Bakmfldd. CA 93~12 GDF Telephone Number: ~ka ~-~ ' ' :~,~ ........ so.ce: ao.~ repot Reeov~ s;y~.m ~ ' ' oue ir " Giib~'e0 Yqx~v~c ~N~ 1 S. ~lS~~ 6. ~ ~ ~ H: O) 2.~ ~ L F~ ~u~ ~ 5 M~ ~ ~ O) ~.m PROTA~, ~C. ~ ~V T~k T~ ~: CA 98-1189 To~, ProTank, In~. 3~4~ Lomim'9oulevard~, Suite 0 Torrance, CA 9050S-5022 (310) 891-0470 · (800) 438-1111 · F~x (310) 891-0474, TEST PROCF, DUR]/TP-201.4 / $T-27 D~ATION OF DYNAMIC p_nT:_$SUR~ PERFORMANCE OF VAPOR RECOVERY SYSTEMS OF DISPENSING FACILITIES " Test Da~: 07-09-98 Loe~ien: ,, SOUTttLAND 7-1 ! STORE ' ,, Vo~ ., . ..( ( ~. .t . . . , p~' C~EffiA 0.16 , I 0.3S 0,~ TEST PROCEDURE TP-201.5 lq~_. J.n DATA S~ A/L COlv[PLIANC]~ T~TING (~ VOL~ ~ ~ ~C~ O~) 8 ~. ~.~ ~7.~ l.Ol 7.481 ~ 9.16 1 ~ 1.01 P~ I 1 ~ ~.~ ~1.~ 1,~ 7,~ ~ 9.14 11 ~ ~ ~.34 1.~ 7.~1 ~ 9.16 1.~ 1.~ P~ 12 89 ~S,~ ~,~ 1.~ 7.~1 ~ 9.16 1.~ l.~ ...................... ~~ ~ "' A~Fdd, Aec., 3S4~ It,~emb Bnak'vL*d..qulM O · Toaan~, CA ~S-tO~ · (~10) 891-0470 · ~ 43Li111 · Fax 010) 891-4M74 T~T PROCED[i~E TP-201.5 VIV. I.~ DATA SHF.,EI' A/L COMPLIANCE TF~TING (AIR VOLUh,~ ~ ~ ~~C~ O~~ ~98 ~U~D 7-11 S~ ~76 ~ V~o ~ % ~ O~ ~ O~1LV~-27 Nu~r M~ ef ~1 ~ ~1 ~1~) P~ ~ ~ ~ ~ ~ ~ V~ ~ ~ R~ Ret* l ~ O~ ~r V~ M~rV~ (~ ~,) (G~ ~) (O~ I 8~ ~.20 ~.~ 1.~ 7.4~ ~ 9,75 1 ~ ~ ~ ~ 27&.~ 1.~ 7~ 49 9.19 4 87 ~4.~ ~5.75 1,~ 7.~76 ~ 8,~ 0~ 1.13 P~ 4 6~ 2~.~ 2M.~ 1.I0 ~ $1 9.75 O. 4 ~ ~6.~ 2~.M 1.~ 7~ 4g 0.16 1.~ 1.~ P~ S ~ ~.gs 2~.~ 1,~ 7.473 47 9~ 1,m 1.~ P~ 8 ffi ~.~,. ~.ffi 1,~ 7.474 ~ 8,~ ,, l.ffi 1,~ P~ 6 ~ ~8.~ ~.~ 1.~ 7.~1 49 9.~6 6 ~ ~.~ ~.~ 1.~ ~.~ ' ~ '9.~ TC~I Technician: Hensl~ D. Bafoour CaUfomla Teste~ Lice. nM Numbe~: CA 98-1189 P~_d .,~.; ;re. · 3~45 l,ani# Boubvm*d, SuJ~ O · Tommy, ~A 90S05-50~,2 · 010) 891--0470 · (800) ~3&l ! { ! · FsE 01(~ 801-0474 ,0 - D May 29, 2002 7-11 9600 Brimhall Bakersfield, CA,93312 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 9600 Brimhall FIRE CHIEF REMINDER NOTICE RON FRAZE Dear Tank Owner/Operator: ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 The purpose of this letter is to inform you about the new provisions in California VOICE (661) 326-3941 FAX (661) 395-1349 Law requiting periodic testing of the secondary containment of underground storage tank systems. SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 Senate Bill 989 became effective January 1, 2002. section 25284.1 (California VOICE (661) 326-3941 Health & Safety Code) of the new law mandates testing of secondary containment FAX (661) 395-1349 components upon installation and periodically thereafter, to ensure that the systems PREVENTION SERVICES are capable of containing releases from the primary containment until they are 1715 Chester Ave. detected and removed. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. ENVIRONMENTAL SERVICES 1715 ChesterAve. Secondary containment systems installed prior to January 1, 2001 shall be tested by Bakersfield, CA 93301 January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component VOICE (661) 326-3979 FAX (66t) 326-0576 that is "double-wall" in your tank system must be tested. TRAINING DIVISION Secondary containment testing shall require a permit issued thru this office, and 5642 Victor Ave. Bakersfield, CA 93308 shall be performed by either a licensed tank tester or licensed tank installer. VOICE {661) 399-4697 FAX (661) 399-5763 Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. SincereLy, ~ Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures D April 17, 2002 7-11 9600 Brimhali FIRE CHIEF Bakersfield CA 93312 RON FRAZE ADMINISTRATIVE SERVICES RE: Necessary Secondary Containment Testing Required by December 31, 2002 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 REMINDER NOTICE FAX (661) 395-1349 SUPPRESSION SERVICES Dear Tank Owner/Operator: 2101 UH" Street Bakersfield, CA 93301 The purpose of this letter is to inform you about the new provisions in California law VOICE (661) 326-3941 FAX (661) 395-1349 requiring periodic testing of the secondary containment of underground storage tank systems. PREVENTION SERVICES 1715 ChesterAve. Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & Bakersfield, CA 93301 VOICE (661) 326-3951 Safety Code) of the new law mandates testing of secondary containment components FAX (661) 326-0576 upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Secondary containment systems installed on or after January l, 2001 shall be tested upon VOICE (661) 326-3979 installation, six months after installation, and every 36 months thereafter. Secondary FAX (661) 326-0576 containment systems installed prior to January 1, 2001 shall be tested by January I, 2003 and every 36 months thereafter. TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 Secondary containment testing shall require a permit issued thru this office, and shall be VOICE (661) 399-4697 performed by either a licensed tank tester or licensed tank installer. FAX (661) 399-5763 ?lease bc advised that there arc only a few contractors who specialize =nd have thc proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 02/20/2002 Date Printed and Mailed: 03/06/2002 Order Number: 3121029 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor Certification "'L'_:-~,: '.'..',,'- Sincerely, Dawn Kohlmeyer Manager, Field Reporting CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TI~-i PURPOSE: COM~LI~q'C~. TEST DATE: 02/20/02 CUSTOMER PO: wc03042366 WORKORDER NUMBER: 3121029 CLIENT: 7-ET.~-VEN, INC. SITE: 7-ET.I~.VEN #32376 10220 S.W. GIlJgE14-BIJ"RG ROJM:) 9600 BRIMH/LLL RD. SUITE 470 MARKET #2133 PORTLAND, OR 97223 BAKERSFIELD, CA 93312 BOB DENINNO MANAGER (503) 977-7713 (805) 588-4059 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 15k 1 REG UNLEAD 0. 000 P Y P Y 10k 2 PREMIUM 0. 000 P Y P Y 10k 3 MIDGRADE 0. 000 P Y P Y Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Test conducted by: KEN MINTON RICHMOND PHILLIPS ...z.:."~/' ...;,~' ...? Reviewed: Technician Certification Number: 91-1071 Printed 03/06/2002 08:35 SBOWERS INDIVIDUal. TANK INFORMATION AND"r -ST RESULTS TEST DATE: 02/20/02 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3121029 CLIENT: ?-~..T.~.V~N, TNC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: ?-~.T.~.%~N #32 3? 6 Tank ID: 15k I Tank manifolded: NO Bottom to top fill in inches: 146.0 Product: R~G ~ Vent manifolded: NO Bottom to grade in inches: 151.0 Capacity in gallons: 15,039 Vapor recovery manifolded: Ms Fill pipe length in inches: 51.0 Diameter in inches: 95.00 Overfill protection: Y~s Fill pipe diameter in inches: 4.0 Length in inches: 496 Overspill protection: ¥~s Stage I vapor recovery: DUA~ Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Start (in) End (in) II · Water Level: New/passed Failed/replaced New/passed Failed/replaced L D #1 L D #1 L D #2 L D #2D~pped Dipped Product Level: ........ Probe Water Level: Make: VAPOI~L~.SS Model: z~2000 Ingress Detected: Water Bubble Ullage Test time: S/N: ?z592 Inclinometer reading: Open time in sec: 4. oo Holding psi: 20 VacuTect Test Type: NOT Resiliency in mi: leo ~TOT VacuTect Probe Entry Point: TES'I3~.D Test leak rate mi/m: lsg. 0 TEST]~D Pressure Set Point: Metering psi: lo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: P~ss Determined by (method): Result: COMMENTS COMMENTS Material: ~.NVIROFLEX Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 60 NOT NOT NOT Start time: 12: 05 TESTED TESTED TESTED End time: 13: 05 Final gph: 0.0o0 Result: PASS Pump type: PRESSURE Pump make: ~ P~.~o COMMENTS Impact Valves Operational: Y~S Printed 03/06/2002 08:35 INDIVIDb _ TANK INFORMATION ANL ST RESULTS TEST DATE: 02/20/02 8g00 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER312102g CLIENT: ?-~.T.~.V~N, INCo AUSTIN, TEXAS 7875? (512) 45'1-8334 SITE: 7-~..T.~.V'~ #323?6 Tank ID: 10k 2 Tank manifolded: ~To BoSom to top fill in inches: 143.0 Product: p~,~,~'~Tj-~ Vent manifolded: ~TO Boffom to grade in inches: 147.0 Capacity in gallons: 10,02? Vapor recovery manifolded: ~'~s Fill pipe length in inches: 48.0 Diameter in inches: 95.00 Overfill protection: ~s Fill pipe diameter in inches: 4.0 Length in inches: 331 Overspill protection: ~J~s Stage I vapor recovery: Du2~.~ Material: D~7 S~'~.T. Installed: A~G Stage II vapor recovery: ~,sszs~ CPinstalled on: / / COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L,D. #:2 Probe Water Level: Make: V~,~O~,L~.SS Model: ~.,D2000 Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. oo Holding psi: VacuTect Test Type: uo~ Resiliency in mi: z?o No~ VacuTect Probe Entry Point: TESTED Test leak rate mi/m: [ag.o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: Determined by (method): Result: COMMENTS COMMENTS Material: ~,NVI ROFLEX Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 60 ~TOT ~TO~ Start time: 12: 05 T][S'I~D 'i'ESTED TEST]ID End time: [3: 05 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: ~J~ P~'.~'RO COMMENTS Impact Valves Operational: ~s Printed 03/06/2002 08:35 INDIVIDU v.. TANK INFORMATION AND"r ST RESULTs TEST DATE:02/20/02 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3121029 CLIENT: 7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ELEVEN #32 37 6 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 145.0 Product: MIDGRADE Vent manifolded: No Bottom to grade in inches: 150.0 Capacity in gallons: 10,027 Vapor recovery manifolded: YES Fill pipe length in inches: 50.0 Diameter in inches: 95.00 Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 331 Overspill protection: YEs Stage I vapor recovery: DUAL Material: DW STEEL Installed: ATe Stage II vapor recovery: ASSTST CP installed on: ! / COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VAPORLESS RED JACKET Model: LD2000 FX2V Ingress Detected: Water Bubble Ullage Test time: S/N: 121282 60701-4993 Inclinometer reading: Open time in sec: 4. oo Holding psi: 22 VacuTect Test Type: NOT Resiliency in mi: zgo NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zag. 0 TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo 3. oo Water table depth in inches: Results: mASS PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (ft): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 60 NOT NO~ NOT Start time: 12: 05 TESTED TESTED TESTED End time: 13: 05 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YEs Printed 03/06/2002 08:35 ~:~ii~l~ ~ MONITORING SYSTEM CERTIFICATION ~lgr Use By All Jurisdictions Within the State of Calife~k Authotfty Cited: Chapter 6.7~alth and Safety Code; Chapter 16, Division 3 Title ~alifornia Cede of Regulab'ons This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring system 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: 7-ELEVEN #32376 City: BAKERSFIELD CA Zip: 93312 Site Address: 9600 BRIMHALL RD. Contact Phone No:588-4059 MARKET #2133 Date of Testing/Service: 02/20/2002 Facility Contact Person: MANAGER Make/Model of Monitoring System: TLS-350 Work Order Number: 3121029 B, Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced  nk ID: 1 Tank ID: 2 In-Tank Gauging Probe. Model: MAG-1 ~ In-Tank Gauging Probe. Model: MAG-1 Annular Space or Vault Sensor, Model: 420 ~ Annular Space or Vault Sensor. Model: 420 Piping Sump/Trench Sensor(s). Model: 352 [] Piping Sump/Trench Sensor(s). Model: 352  Fill Sump Sensor(s). Model: [] Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: LDo2000 [] Mechanical Line Leak Detector. Model: LD-2000 Electronic Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: ] Tank Overfill/High-Level Sensor, Model: MAG-1 [] Tank Overfill/High-Level Sensor. Model: MAG-1 [] Other (specify equipment type and model in Section E on page 2). [] Other (specify equipment type and model in Section E on page 2). lank IU: 3 lank IU: [] In-Tank Gauging Probe. Model: MAG-1 [] In-Tank Gauging Probe. Model: [] Annular Space or Vault Sensor. Model: 4?0 [] Annular Space orVault Sensor. Model: [] Piping Sump/Trench Sensor(s). Model: 352 [] Piping Sump/Trench Sensor(s). Model: [] FilISump Sensor(s). Model: [] FilISump Sensor(s). Model: [] Mechanical Line Leak Detector. Model: LD-2000 [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill/High-Level Sensor. Model: MAG-1 [] Tank Overfill/High-Level Sensor. Model: ] Other (specify equipment type and model in Section E on page 2). other and model in Section E (specify equipment type on page 2). E~i~pen~er ID: llZ Dispenser IU: [] Dispenser Containment Sensor(s) Model: 352 [] Dispenser Containment Sensor(s) Model: 352 [] Shear Valve(s). ~] Shear Valve(s) [] Dispenser Containment Float(s) and Chain(s). --1 Dispenser Containment Float(s) and Chain(s). Lhspenser IL): Dispenser ID: ~/1u Model: 352 '~1 Dispenser Containment Sensor(s). Model: 352 Dispenser Containment Sensor(s) [] Shear Valve(s). "~ Shear Valve(s). [] Dispenser Containment Float(s) and Chain(s). ~ Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5/6 Dispenser ID: 11/12 [] Dispenser Containment Sensor(s) Model: 352 -X-] Dispenser Containment Sensor(s). Model: 352 [] Shear Valve(s). -X'1 Shear Valve(s). [] Dispenser Containment Float(s) and Chain(s). '~ Dispenser Containment Float(s) and Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C, Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): System set-up report; r~ Alarm history report COMPANY: Tanknology PHONE NO: (800) 800-4633 page 1 of 3 Based on CA form dated 03101 onitoring System Certification Site Address: 9600 BRIMHALL RD. Date of Testing/Service: 02/20/2002 MARKET #2133 D. Results of Testing/Servicing Software Version Installed: 121.00 Complete the following checklist: [] Yes [] No * Is the audible alarm operational? [] Yes [] No* Is the visual alarm operational? [] Yes [] No * Were all sensors visually inspected, functionally tested, and confirmed operational? Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not [] Yes [] No * interfere with their proper operation? [] Yes [] No * [] N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment [] Yes [] No* i[] 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 positive shut-down due to leaks and sensor failure/disconnection? [] Yes [] No [] Yes [] No * [] N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger?. % [] Yes* [] No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. [] Yes* [] No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) [] Product; [] Water. If yes, describe causes in Section E, below. [] Yes [] No* Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. [] Yes [] No * ts all monitoring equipment operational per manufacturers' specifications? · In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: page 2 of 3 Oonitoring System Certification Site Address: 9600 BRIMHALL RD. Date of Testing/Service: 02/20/2002 MARKET #2133 F. In-Tank Gauging ! SIR Equipment [] Check this box if tank gauging is used only for inventory control. [] 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. Complete the following checklist: [] Yes i [] No * Has all input wiring been inspected for proper entry and termination, including testing for ground faults? [] Yes [] No* Were all tank gauging probes visually inspected for damage and residue buildup? [] Yes []No* Was accuracy of system product level readings tested? []Yes []No* Was accuracy of system water level readings tested? []Yes []No* Were all probes reinstalled properly? [] Yes [] No * Were all items on the equipment manufacturers' maintenance checklist completed? · In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) ' [] Check this box if LLDs are not installed. Complete the following checklist: [] Yes [] No * [] N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? (Check all that apply) Simulated leak rate: [] 3 g.p.h [] 0.1 g.p.h {-"J0.2 g.p.h [] Yes [] No * Were all LLDs confirmed operational and accurate within regulatory requirements? [] Yes i [] No* Was the testing apparatus properly calibrated? [] Yes [] No* [] N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? [] Yes []No * [] N/A For electronic L~_Ds, does the turbine automatically shut off if the LLD detects a leak? [] Yes []No * [] N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? []Yes []No* [] N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? [] Yes []No * [] N/A For electronic LLDs, have all accessible wiring connections been visually inspected? [~J Yes []No * Were all items on the equipment manufacturers' maintenance checklist completed? · In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: page 3 of 3 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 02/20/02 WORK ORDER NUMBER3121029 CLIENT:7-EL]ZVEN, INC. SITE: 7-ELEVEN #32376 BRIMHALL RD 9600 BRIMHALL RD ~ ~o~ ,,~ A ~ BAKERSFIELD, CA PREMIUM (~ (~ ~~ L ~. L ~o~ (~ 0 ~LUS ~ ® @ ~ C-STORE Printed 03/06/2002 08:35 SBOWERS Work Order: 3121029 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3121029 ':FULL VOl.:. : 9526 DEL ~ VE~'9 L~¢~i 'i: : l 8% ~NK TiLT Tanknology-NDE 8900 Shoal-Creek, Building 200 Austin, Texas 78757 Work Order: 3:1.21029 ':~i:.~~':' .... . ~.~ :i :: ~ ~:~ g~:::~':-!:~::,:; [ 1.:. ~ ?.2":[ {~:i ..... .::~.., .~ ..~: ::~ ~:,~.-.~..~ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3121029 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3121029 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3121029 :~..:.'d~3 :! ' "..- ,. '~;~-"~ ;:':~:~:, ?::t~i.2 .:5 ~:.~h'~'l.:':~: ~-t : ~}.) :.--:,-- . i.:~i. ]~-- [....::~ .; ~.. T~olo~-~ 8900 Shoal Creek, Bulldog 200 Austb, Texas 78757 e3/04/2002 i5:30 5i238e72i5 TANKNOLOGy P~G~ ~2 CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING 8900 SHOAL CREEK, BUILDfNG 200 , AUSTIN. TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TESTTYPE: TLD-1 PURPOSE: COMPLIANCE TE.~I 13^'I'F;: 02/20/02 CUSTOMER PO; wc //'~"'- WOR~*~-D-~'N~ .R.ER: 33.21029 PO~r~, OR 97223 [ B~RSFI[~, CA 93322 / ' % Line and Leak Detector Tests 'n~J<nolo~,y .~pprcciatc$ fltc oppor~unJ[y [,~ ~crvc y(~u..~d looks lo--rd [o working wi[h y~u in thc ~uturc. P]casc call rely timc. d~y ~r ni~llt. ~,I~C~ yOU I~¢C(] Tanknology representative: Se~ices conduced by: MINTON RiC~ PHILLIPS Reviewed: Technician Certification Number. 91-1071 Draft 03/04/2002 15:22 MFRISK ~ 03/84/2002 15:38 5123887215 TANKNOLOGY PAGE ~ Use By AIl Ju~sd~cfions Within the Sta~ of Cafifor~ Authority Cited; Cha~r 6. % Health end S~ty Code; Chap~r 16, Divi~'on 3 Title 23. California Code of Regulations This form must be used to ~ocument tearing and se~ldng O~ mont~rlng equlpmenL I~ more than ~ne monl~dng system co.roi panel is ins~lted at the fad~lty a ~ific~tion or re~ must be ~re~ared r~r e~h ~o~o~_s~stem_~ntrol ~anal by the t~hniclsn who periods 1he wo~. A ~py ~ this form must be provi~e~ ~ the ~nk system ~nerlopemt~r, The ownerlopem~or must submit a co~y of t~is ~ ~ the Ioce~ agency ~ulat~g U~ s~leme within 30 days of teS~ A. General Information Facility Name: 7-El. EVEN ~32376 City: BAKERSFIELD CA Zip; 93312 Site Address; 9600 BRIMHALL RD, Contact Phone NO: 588-4059 MARKET ~2133 Facility Contact Person: MANAGER Date of Testing/So.ice, 02/20/2002 Make/Model of Monitoring System: TLS~50 Work O~er NumDer; 3121029 B. Invento~ of Equipment T~tedlCe~ifled Che~ the appropriate boxes to indicate s~edflc ~uiDment inspected/se~i~d [Tank ID' ..1 Tank ID: 2 ~k Garaging ProDe. Model: MAG-1 ~ In-Tank Gauging Pro~. Model: ~ Annut~rSpeceorVaultSens~r. M~el: ~ Annular Sp~ce or Vault Sen~or. Model 420 420  Piping Sump~r~nch Sens~r(s~, M0del: 352 ~ Piping Sump~'en~ Sensor(s), Mo~e~: 352 ~ rll~ Sump Sensor(s}, Model: Sump MDdel:  Mechanical Line Leak Detector, ~lodel: LD-2000 M~anical Line Leak De~r, Mo~el, LD-2000  Electronic Ltn~ Leak D~ec~or. Mo~el: El~tronic Uno I.eak Dot. tot.  Tank Ore. Il/High. Level Sen~t. Modet: ~G-1 ~ Tnnk Or. Il/High-LeVer Sensor. M~el; MAG-1 ~ O~her (sp~cl~ equipment ~pe an~ model In Se~lon E on p~ge 2). ~ O~er (s~l~ e~ui~men{ ~pe and m~el in Section E on page 2). Tank ~D: 3 Tank ID; ~ In-Tank Gauging Probe, Moael: MAG-1 ~ In. Tan~ Gauging Pm~  Annular Space ~r Vault Sensor, M~el: 420 ~ ~nular S~sce or Vault Sen~r, Mode~: ~ Pl~lng Sump/Trench Sensor(s~. Model; 352 ~ Piping Sump~ren~ Sensor(n). Mod~l.  Fill Sum~ Sensor(s). Mode~: ~ Fill Sump Sensor{s) Model: Mechani~l Line Leak Detec~r. Model; LD-2000 ~ M~hant~l Line Leak De~t~r, Model Elect.onto Uno Leak Data.or. Moael: Electronic Uno LE8k D~or, M~el  Tank Ovedll/Hig~-Leve Sen~r. Model: MAG-1 ~ Tank Ore.ill/High. Level Sensor. Model: Otl~er (specl~ eaLlipment type and ~del in Se~i~n E on page Z). ~ Other (sDed~ e0ulpment ~e and model in SecUon E on page ~. Dispenser ID: ~/2 Dispenser ID:~/D ~ Dispe~ser Con~inment~nsor(s) Motel: 352 ~ Dispenser Containment Sensor(s) Moaeh 352 ~ Shear Valve(s}, ~ ShearVal~(s) ~ Dispenser Containment Float(e) end Cheln(s}. ~ Dlsp~s~ Con. inmont Float(s) end Chain(s). ;Dispenser ID; Dispenser ID: 9/1D ~ Dispenser Conta~nmentSensor(s) Mo~el: 352 ~ Dispenser ~n~lnmentSensor(a). Mo~l: 352 ~ Sneer Val~[~) ~ ~r Valve(s). ~ D~spenser C~ntatnment float[s] an~ Chain(s), ~ Di~nser Co~lnment Float(s) an~ Chain(s). Dispenser ID; 5i6 Dispenser ID; 11/12 Containment Sensors) Model: 35~ ~ Dispenser Containment Model: 352 ~ S~ear Valve(s). ~ Sneer Valve(s]. ~ Dt~enser Containment Float(s) and Chain(s), ~ Disposer Con~inm~t Fioa{(~) end Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include Information for eve~ tank and dispenser ~ the facility, _.I ce~i~ that the equ~pmem identified in this document was Inspected/so.iced in ac~rdan~ wEh the manu~urers' guidelines, A~a~ed to this ce~i~cation is information (et manufa~urem' checklist) ne~ssa~ to veri~ that t~is in~rmatlon is correct and e Site Plan show, ag the layout of monitoring equipment, For any equipment ~pable ~ generating such repo~s, I have also a~ached a copy ortho (Check all ~hat apply): System set-up repo~: ~ Alarm hlsto~ repo~ PRINTED NAME:RICHMOND PHILLIPS SIGNATURE: "~' ~' COMPANY, ~anknolo~y PHONE NO: (80~) 800~633 page 1 of 3 Base~ on CA fo~ dated 03/01 8:3/84/2882 15:38 51238072].5 TANKNOLOGY PAGE 25 t~onltoring System Cerlification Site Address; 9600 BRIMHALL RD. Date of Testlng/Service: 02120/2002 MARKET #2133 D. Result~ of Tesling/Servicing So[lw.nre Vcrnlm~ ln,~tsltcd: 121.00 cnmplctc thc fi)llnwing chccltlist: [] Y~, [] N,, ' Is the audible alarm operational? [] Ye,, [~ No, Is the visual alarm operational? ,.~ Yes [] Na ' Were all sensors visually inspected, functionally tested, and oo~rmed operational? [] Ye~ [] N~ · Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? [] Yes [] N,~ - ~ N/^ If alarms are relayed to a remote monitoring station. Is eli communications equipment (e.g. modem) operationaF7 For pressurized piping systems, does the turbine automatically shut down if the pilling secondary containment [] Y,,, [] No · [] N/^ monitoring system detects a leek, fails to operate, or is electrically disconnected? If yes; which sensors Initiate shut-down~ (check all that apply) [] Sump/Trench Sensors; [] Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? [] Ye, C~ No [] Y~, [] No * [] :,4/^ For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical · overfill prevention valve Is Installed), Is the overfill warning alarm visible and audible st the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trl§~ler? [] v¢.~ [] Ne Was any monitoring equipment replaced? If yes. identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement l~arts in Section E, below. [] Ye.~' [] No WaS liquid found inside any secondary containment systems designed as dry systems? (check all'that apply) [] Product; [] Water. If yes, describe ca~ses in Section E, below. [] ¥¢~ [] N,, · Was monitoring system set-up reviewed to ensure I=roper settings? Attach set-up reports, if aPl~llcable. [] Yc~ [] ~e ' ts all monitoring equipment operational per manufacturers' specifi~tions? · In .qccti~m F; bclow, dcscribc how ~n(I whcn th~e dcGcicnccs wcrc i)r will bc corr=c~cd. E. Comments: 83/84/2882 i5:38 5i238872i5 TANKNOLOGY pAGE ' ~onitoring System Certification Site Address: 9600 BRIMHALL RD. Date of Testing/Servioe: 02/20/2002 MARKET #2133 F. In-Tank Gauging / SIR Equipment [] Check this l~ox if tank geugin9 is used only for inventory contrc~l. [] 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. Complete the followin~ checklist: [~] Yc.~ [] No ' Has all input wtrlng been inspected for proper entry and termination, including testing for !around faults? r~ Ye.~ .j-~;~,. Were ali t~nk gauging probes vtsually Inspected for damage and residue [] Yc~ []~(~. Was accuracy of system product level readings tested? ["~']¥~. ~'"]No - Was accuracy of system water level readings tested? [] Y~ []N,,' Were all probes reinstalled properly? [] Ye, [] N,~ ' i Were ell items on the equipment manufacturers' mairrtenance checklist completed? ' In the Section H, below, descriOe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LED): [] Check this box if LEDs ars ~ot Installed. Complete the '['ollnwlng checklist: For equipment start-up or annual equipment certification, was a leak simulated to verify LED performance? [] Y~., [] ~o* ~"~/'^ (Check all that apply) Simulated leak rate: [] 3 g.p.h [] 0.1 gp.h [--']0,2 g,p,h [~ Yc~ : [] N~ · Were all LEDs confirmed operational and accurate within regulatory requirements? [] Y:~ [] N,, · Was the testing apparatus properly calibrated? ~ ¥~ []No' [] ~,'/A For mechanical LEDs, does the LED restrict product flow if it detects a leak? [~','~ []No' [] N/^ For electronic LEDs, does the turbine automatically shut off if the LED detects a leak? [] Ye.< ~-']N~, [] ~/^ For electronic LEDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? [] Y~. [---]N~ · [] N/^ For electronic LEDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? [] Yc~ I'""}~'o * [] N;^ For electronic LEDs, have all accessible wiring connections been visually inspected? [--"] y¢.~[~No · Were all items on the equipment manufacturers' maintenance checklist comloleted9 · ~n t~e Section H, below, describe how and when these deficiencies ware or will be corrected. H. Comments: February 20, 2002 Bob Deninno 7-11 POBox 711 Dallas, TX 95221-0711 CERTIFIED MAIL FIRE CHIEF NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RON FRAZE · RE: Failure to Submit/Perform Annual Maintenance on Leak Detection ADMINISTRATIVE SERVICES 2101 'H" S~'eet System at 7-1 l, 525 W. Columbus, Ba~kersfield, CA., 7-11, 3601 Bakersfield. CA 93301 Stockdale Hwy, Bakersfield, CA., 7-11, 4101 Calloway, Bakersfield, CA VOICE (661) 326-3941 FAX (661) 395-1349 7-11, 9600 Brimhall, Bakersfield, CA SUPPRESSION SERVICES Dear Mr. Deninno: 2101 *H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 Our records indicate that your annual maintenance certification on your leak FAX (661) 395-1349 detection system is past due. February 1, 2002, February 19, 2002, February 23, PREVENTION SERVICES 2002, February 23, 2002. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 You are currently in violation of Section 2641(J) of the California Code of FAX (661) 326-o5?6 Regulations. ENVIRONMENTAL SERVICES "Equipment and devices used to monitor underground storage tanks shall be 1715 Chester Ave. Bakersfield, CA 93301 installed, calibrated, operated and maintained in accordance with manufacturer's VOICE (661) 326-3979 FAX (661) 326-0576 instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." TRAINING DIVISION 5642 V~tor Ave. Bakersfield, CA 93308 You are hereby notified that you have thirty (30) days, March 22, 2002, to eithe; VOICE (661) 399-4697 perform or submit your annual certification to this office. Failure to comply will FAX (661) 399-5763 result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney u'l Postage $ .3/4. m Certified Fee 2. ]. 0 ,j] Return Receipt Fee ., .A Postmark C23 (Endorsement Required) J-. ~)U Here Restricted Delivery Fee .... . . . · ~ (Endorsement Required) · . ,., ,.,.; .~".~.,:.',.< .:=, :,.:,,.....-,. .... ',..~ .,,. , ., ........ . · "" C~I t' 0 ]lOX 71! ................................................................. =' · ':' *'; ,':-:~,"" '.'"'~' J"'"."*:'-.: "- ;*:"..":*;':"'*: :~* ' Compi~ 1, 2, and 3. Also complete A. Received b~/(Please Print B. Date of Delive?y -~z;~~~ item 4 if?~l~stricted Delivery is desired. · ;,~."~~ · Print you? name and address on the reverse ,'.'.:';~~ C. Signature !~~~. ~'::~'*';~'~~~ so that we can return the card to you. ~ Agent ,.~:.~;;%~.~~ · A~ach this card to the back of the mailpiece, X . , -, ~~?.~,.,. or on the front if space permits. ~ Addre~ee D. Is deliv~ different ~m ~em 17 ~ Yes 1. Adicle A~ress~ to: .;.If YES, ' address below: ~ No .' sos ( ~-11'~ P O BOX 7il 3. 8omico Typo D~, ~ 95221 -0711 ~ Codified Mail ~ Expre~ Mail ~: 525 ~ CO[~OS~ 3601 D Registered ~ Return R~eiptforUemh~dise 0~ ~, 4101 C[~W4Ym ~ Insured Mail D C.O.D. O0 B}~AT.T. (9600) 4. Restricted Delivew? (Extra Fee) D Yes PS Form 3811, July 1999 Domestic R~urn Receipt ' 102595-~-M-1789 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ ~,{¢OtOX INSPECTION DATE Section 2: Underground Storage Tanks Program [] Routine [~(Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type o£Tank ,l'lO~ltcrC..-~ Number of Tanks Type o£ Monitoring C/-- 14A Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current L,/' Certification of Financial Responsibility ~/' Monitoring record adequate and current Maintenance records adequate and current L,/ 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 Business Site Responsible Party White - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 9 ~{C~ . ~SPECTION DATE ! 0/I FACILITY NAME ADDRESS qG~ ~ ~ PHONE NO. ~g~' q0.~ FACILITY CONTACT BUSINESS IDNO. 15-210- NUMBER OF EMPLOYEES ~SPECTION TIME Section 1: Business Plan and Inventory Program I~l Routine ~ Combined [~ Joint Agency [~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate L/ / Visible address k.,, Correct occupancy L, / Verification of inventory materials Verification of quantities ~ .... 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 L~ / Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: a Yes ~No ~ ~ Explain: ~ , Questions regarding this inspection? Please call us at (661) 326-3979 Business Site,Responsi. ble Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: :,~M~ ~ 8900 Shoal Creek Bivd, Building 200 Austin, Texas 78757 KERN CTY- ENVIROMENTAL HEALTH 2700 M STREET SUITE 300 BAKERSFIELD, CA. 93301 Test Date: 02/23/2001 Date Printed and Mailed: 03/08/2001 Order Number: 3115700 /' Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN#32376 ~ 9600 BRIMHALL RD. k MARKET #2133 ~ BAKERSFIELD, CA. 93~ ~. Testing performed:// E~ne t~sts Monitor certifications Stage II A/L tests Stage II pressure decay tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TLD-1 PURPOSE: CO~LIANCE TEST DATE: 02/23/01 CUSIOMER PO: W-B03050847 WORK ORDER NUMBER: 3115700 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 10220 S.W. GREENBURG ROAD 9600 BRIMHALL RD. SUITE 470 MARKET #2133 PORTLAND, OR 97223 BAKERSFIELD, CA 93312 BOB DENINNO MANAGER (503) 977-7713 (805) 588-4059 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 15k 1 REG UNLEAD 0. 000 P Y P Y 10k 2 PI:IF_~IU~ 0 . 000 P Y P Y 10k 3 MIDGRADE 0 . 000 P Y P Y Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: KEN MINTON RICHMOND PHILLIPS Cf' .: ;~:i::~¢~''.~-,i ..... /:':~?.. ~;: );'~'!~ Reviewed: Technician Certification Number: 91-1071 Printed 03/08/2001 08:51 KOHLMEYER INDIVID . L TANK INFORMATION ANo, i EST RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115?00 CLIENT: 7-ELEVEN , INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ELEVEN #32 37 6 Tank ID: 15k 1 Tank manifolded: NO Bottom to top fill in inches: 146.0 Product: REG ONLEAD Vent manifolded: No Bottom to grade in inches: 151.0 Capacity in gallons: 15,039 Vapor recovery manifolded: YEs Fill pipe length in inches: 51.0 Diameter in inches: 95.00 Overfill protection: YEs Fill pipe diameter in inches: 4.0 Length in inches: 496 Overspill protection: YEs Stage I vapor recovery: DUA.L Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS r Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VAPO~,L~.SS Model: LD2000 Ingress Detected: Water Bubble Ullage Test time: S/N: n/a Inclinometer reading: Open time in sec: 3. oo Holding psi: z? VacuTect Test Type: NOT Resiliency cc: z45 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zsg. o TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 1.50.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 08: 30 TESTED TESTED TESTED End time: 09:00 Final gph: o. ooo Result: PASS Pump type: PRESSURE Pump make: ~ PETRO COMMENTS Impact Valves Operational: YEs Printed 03/08/2001 08:51 INDIVII ,L TANK INFORMATION A ST RESULTS TEST DATE: 02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115?00 CLIENT: ? -]~T.~.~N, TNC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: '7 -~.T.~.VJ[N #32 3'7 6 Tank ID: 10k 2 Tank manifolded: NO Bottom to top filJ in inches: 143.0 Product: P~Ct4Tt~t~ Vent manifolded: No Bottom to grade in inches: 147.0 Capacity in gallons: 10,02.7 Vapor recovery manifolded: ~s Fill pipe length in inches: 48.0 Diameter in inches: 95.00 Overfill protection: 'z~s Fill pipe diameter in inches: 4.0 Length in inches: 33.t Overspill protection: 3r~s Stage I vapor recovery: Material: DJ ST~E~, Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / ! COMMENTS Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: v~,~o~Lzss Model: z~2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: n/a Inclinometer reading: Open time in sec: 4. oo Holding psi: z~ VacuTect Test Type: NOT Resiliency cc: z75 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zeg. o TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: a. oo Water table depth in inches: Results: PAss Determined by (method): Result: COMMENTS COMMENTS Material: Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 ~OT NOT Start time: 08: 30 TE, STED TESTF. D TEST~,D End time: 09: 00 Final gph: 0. 000 Result: PASS Pump type: PR~.S Sb-R~. Pump make: ~ P~.~Ro COMMENTS Impact Valves Operational: Printed 03/08/2001 08:51 INDIVID° L TANK INFORMATION Ahcr TEST RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115?00 CLIENT: 7-~.LEVEN , TNC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-~..LEVEN #32 37 6 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 145.0 Product: HIDC-RADE Vent manifolded: NO Bottom to grade in inches: 150.0 Capacity in gallons: 10,027 Vapor recovery manifolded: YES Fill pipe length in inches: 50.0 Diameter in inches: 95.00 Overfill protection: YEs Fill pipe diameter in inches: 4.0 Length in inches: 331 Overspill protection: YEs Stage I vapor recovery: DUAL Material: DW STEEL Installed: ATe Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~O~LESS Model: LD2000 Ingress Detected: Water Bubble Ullage Test time: S/N: n/, Inclinometer reading: Open time in sec: 4. oo Holding psi: l? VacuTect Test Type: NOT Resiliency cc: 165 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zsg. o TESTED Pressure Set Point: Metering psi: ~o Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (it): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 09: 10 TESTED TESTED TESTED End time: 09:40 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 03/08/2001 08:51 SITE DIAGRAM 8900 SHOAL CREEK. BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 02/23/01 WORK ORDER NUMBER3115700 CLIENT:7-ET.~.V~N, INC. SITE: 7-ELEVEN #32376 BRIMHALL RD REG ~.j!~ i 9600 BRIMHALL RD ~, :~o~ (~ A BAKERSFIELD, CA PREMIUM (~ (~) ~) L E L (~ 0 W PLUS ~ (~ ~ yA C-STORE Printed 03/08/2001 08:51 KOHLMEYER MONITOR CERTIFICATION FORM CUSTOMER: 7-ELEVEN, INC. SITE I.D.: 7-ELEVEN ~,32376 DATE: 02/23/200`1 ADDRESS: 9600 BRIMHALL RD. MARKET #2`133 WORK ORDER: 3`1`15700 BAKERSFIELD, CA 933'12 1) IN TANK PROBES MANUFACTURER: tidel MODEL NUMBER: 3500 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): NO LAST TEST DATE: I I PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( Y/N ): NO TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( Y/N ): YES COMMENTS: 2) OTHER PROBES: MANUFACTURER: tidel MODEL: 3500 NUMBER OF LIQUID, FLOAT. SW POSITIVE SHUT FAIL SAFE ( Y/N ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOR DOWN (Y/N) (Y/N) ANNULAR PROBE 3 LIQUID NO NO YES TURBINE SUMP 3 FLOAT NO NO YES FILL SUMP FIBERTRENCH MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 MONITOR CERTIFICATION FORM (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL · NUMBER OF SENSORS: MECH. LEAK DETECTOR ( YIN ): YES MECH. LEAK DETECTOR OPERATIONAL ( YIN ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WITH THE SIMULATED LEAK TEST ( YIN ): POSITIVE SHUT DOWN (Y/N):. OPERATIONAL ( YIN ): 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( Y/N ): NO ( YIN ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES ........ i:.i~-i'"' .... ....~,..-~" ....... :.:.!::: ..... RICHMOND PHILLIPS TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 02/23/2001 Date Printed and Mailed: 03/08/2001 Order Number: 3115700 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor certifications Sincerely, Dawn Kohlmeyer Manager, Field Reporting CERTIFICATE'-'OF UNDERGROUND~STORAGE T~NK SYSTEM TESTING ~ · Tankno/ogy 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TT.~-I PURPOSE: CO[v~,LTA_NCi~. TEST DATE: 02/23/01 CUSTOMER PO: WB03050847 WORK ORDER NUMBER: 3115700 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 10220 S.W. GREENBURG ROAD 9600 BRIMHALL RD. SUITE 470 MARKET #2133 PORTLAND, OR 97223 BAKERSFIELD, CA 93312 BOB DENINNO MANAGER (503) 977-7713 (805) 588-4059 The folloxving test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests ~5k ~ a~G ~ 0. 000 ~, ~ok 2 Pas~IUM o. ooo ~ ~0k ~ ~~ o. ooo ~ Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: KEN MINTON RICHMOND PHILLIPS Reviewed: Technician Certification Number: 91-1071 Printed 03/08/2001 08:45 KOHLMEYER ,L TANK INFORMATION RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115700 CLIENT: 7-ET,~.V~N, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ET.~.V~N #32 37 6 Tank ID: 15k i Tank manifolded: NO Bottom to top fill in inches: 146.0 Product: R~G ~ Vent manifolded: NO Bottom to grade in inches: 151.0 Capacity in gallons: 15,039 Vapor recovery manifolded: ~"gs Fill pipe length in inches: 51.0 Diameter in inches: 95.00 Overfill protection: Y]~S Fill pipe diameter in inches: 4.0 Length in inches: 496 Overspill protection: Y'~s Stage I vapor recovery: DUA.L Material: Dw S~g~.L Installed: AT~ Stage II vapor recovery: ASSZST CP installed on: / / COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level; L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: vA~ol~.ss Model: ~.n2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: n/a Inclinometer reading: Open time in sec: a. oo Holding psi: z? VacuTect Test Type: NOT Resiliency cc: z45 NOT VacuTect Probe Entry Point: 'i~STE, D Test leak rate mi/m: zsg. o 'I~ST~D Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: a. oo Water table depth in inches: Results: PAss Determined by (method): Result: COMMENTS COMMENTS Material: F. NVIROFLEX Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 08: 30 ~s~D ~Es~_J~ End time: 09: 00 Final gph: 0. 000 Result: PAss Pump type: Pump make: ~ P]~o COMMENTS Impact Valves Operational: Printed 03/08/2001 08:45 TEST DATE: 02/23/01. 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115?00 CLIENT: 7-~.LEVEN, 'rNC. AUSTIN. TEXAS 78757 (512) 451-6334 SITE:7-~.LEVEN #32376 Tank ID: 10k 2 Tank manifolded: NO Bottom to top fill in inches: 1.43.0 Product: pRF_~TU~ Vent manifolded: NO Bottom to grade in inches: 147.0 Capacity in gallons: 1.0,027 Vapor recovery manifolded: ~s Fill pipe length in inches: 48.0 Diameter in inches: 95.00 Overfill protection: ~"gs Fill pipe diameter in inches: 4.0 Length in inches: 331. Overspill protection: Y~s Stage I vapor recovery: DUAL Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSTST CP installed on: / / COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: V~ORLESS Model: Lb2000 Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. oo Holding psi: VacuTect Test Type: NOT Resiliency cc: z75 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zsg.o TESTED Pressure Set Point: Metering psi: ~o Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 1.50.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 08: 30 TESTED TESTED TESTED End time: 09:00 Final gph: 0o 000 Result: PASS Pump type: P~SSUR~. Pump make: ~ PETRO COMMENTS Impact Valves Operational: YES Printed 03/08/2001 08:45 ,L TANK INFORMATION A ST RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115?00 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-ELEVEN #32376 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 145.0 Product: MTDGZ~,DE Vent manifolded: NO Bottom to grade in inches: 150.0 Capacity in gallons: 10,027 Vapor recovery manifolded: Y~s Fill pipe length in inches: 50.0 Diameter in inches: 95.00 Overfill protection: Y~s Fill pipe diameter in inches: 4.0 Length in inches: 331 Overspill protection: 'z~s Stage I vapor recovery: DO~ Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSTST CP installed on: / / COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~O~LESS Model: LD2000 Ingress Detected: Water Bubble Ullage Test time: S/N: n/. Inclinometer reading: Open time in sec: 4. oo Holding psi: z7 VacuTect Test Type: NOT Resiliency cc: [65 NOT VacuTect Probe Entry Point: '~ESTED Test leak rate mi/m: lag. o '~ESTED Pressure Set Point: Metering psi: ~o Tank water level in inches: Calib. leak in gph: 3. OD Water table depth in inches: Results: P~,ss Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 09: 10 TESTED TESTED TESTED End time: 09:40 Final gph: 0. 000 Result: PASS Pump type: PRESSUR~ Pump make: F~ P~.~'~O COMMENTS Impact Valves Operational: Y~S Printed 03/08/2001 08:45 MONITOR CERTIFICATION FORM CUSTOMER: 7-ELEVEN, INC. SITE I.D.: 7-ELEVEN ~L32376 DATE: 02/2312001 ADDRESS: 9600 BRIMHALL RD. MARKET #2133 WORK ORDER: 3115700 BAKERSFIELD, CA 93312 1) IN TANK PROBES MANUFACTURER: tidel MODEL NUMBER: 3500 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): NO LAST TEST DATE: / I PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( Y/N ): NO TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( Y/N ): YES COMMENTS: 2) OTHER PROBES: MANUFACTURER: tidel MODEL: 3500 NUMBER OF LIQUID, FLOAT. SW POSITIVE SHUT FAIL SAFE ( Y/N ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOR DOWN (Y/N) (Y/N) ANNULAR PROBE 3 LIQUID NO NO YES TURBINE SUMP 3 FLOAT NO NO YES FILL SUMP FIBERTRENCH ' MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 MONITOR CERTIFICATION FORM (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL ' NUMBER OF SENSORS: MECH. LEAK DETECTOR ( Y/N ): YES MECH. LEAK DETECTOR OPERATIONAL ( YIN ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WITH THE SIMULATED LEAK TEST ( YIN ): POSITIVE SHUT DOWN (Y/N): OPERATIONAL ( YIN ): 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( Y/N ): NO ( Y/N ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES ,,,¢.-.":;:' '~.'::: ;;:-"'" S:.:~°~ /":'.: :.':::'i:?' RICHMOND PHILLIPS ;:';,*: ........ . ......... / ,~.~;,.4..,-::/:... TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 02/23/01 WORK ORDER NUMBER3115700 CLIENT:7-ET.~.V~N, INC. SITE: 7-ELEVEN #32376 BRIMHALL RD 9600 BRIMHALL RD ~ ~o~ ,].:., A ~ BAKERSFIELD, CA PREMIUM (~ (~ (~~ LE L ~o~ ~ 0 ~us ~ ® @ ~ C-STORE Printed 03/08/2001 08:45 KOHLMEYER items 1,2, and 3. Aisc complete B. Date of Deliver~ Restricted Delivery is desired. . Print your name and address on the reverse that so we can return the card to you. C~ . · Attach this card to the back of the mailpiece, [] Agent . [] Addresse( or on the front if space permits. D. I'~,ery address different from it~l? [] Yes 1. Article Addressed to: ,~,. If YES, enter delivery address belo~-. [] No BOB DENTNNO 7 EL~ INC P 0 BOX 711 DALLAS TEXAS 75221 0711 3. Service Type ~] Certified Mail [] Express Mail ~¢.~ (-~OO"'~r;~r'~,e~l ~," ~ Registered B Return Receipt for Merchandis~ 4. Restricted Delivew? (Extra Fee) ~ Yes 2. A~icle Number (Copy from se~ice label) ~t0 286 963 PS F~381 1, July 1999 Domestic Return Receipt 102595-99-M-1789 Permit No. G-lO I · Sender: Please print your name, address, and ZIP+4 in this box · Z 410 2~6 963 US Postal Service~ ..~Receipt for Certified Mail No Insurance Cover~i~ Prov~l. Do not use for International Mail (See revers~ Sent to BOB DI~III~IO Street & Number P 0 BOX 711 P~t~,~ate'~ede7 S 2 21 0 7 ]- ]- Postage Certified Fee l. 10 Spedal Delivery Fee Restricted Deliven/Fee Return Receipt Showing to Whom & Date Delivered 1.10 Return Receipt S~owing to Whom Date, & Azldressee's Address TOTAL Postage & Fees $ 2.53 Postman~ or Date Stick postage stamps to article to cover First-Class postage, certified mail fee, and charges for any selected optional services (See front). 1. If you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural cartier (no extra charge). 2. If you do not want this receipt postmarked, stick the gummed stub to the d~3t of the retum address of the article, date, detach, and retain the receipt, and mail the articT~.~[ 3. If youwant aretumreceipt, write the certified mail number and your name and ~lress/ ~ on a return receipt card Form 3811 and attach it to the tront of the article by meanl~'of th,~ gummed ends ~f space permits. Otherwise, affix to back of article. Endorse front ol ~Liclt~ RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter tees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested, check the applicable blocks in item 1 o4 Form 3811. 6. Save this receipt and present it if you make an inquiry. 102595-95-1~-0548 December 8, 2000 FIRE CHIEF RON FRAZE Bob DeNinno 7-Eleven, Inc. ADMINISTRATIVE SERVICES P.O. Box 711 CERTIFIED MAIL 2101 'H" Street Bakersfield, CA 93301 Dallas, Texas 75221-071 1 vOiCE (66~) 326-3941 FAX (661) 395-1349 RE: Compliance Inspections at (2) 7-11 Facilities: 9600 BrimhalI, Store SUPPRESSION SERVICES //32376 & 4101 Calloway Road, Store 32241. 2101 ~H" Street Bakersfield, CA 93301 VOICE (661)326-3941 FAX(661)395-1349 NOTICE OF VIOLATION & .REVENTIO. SERVlC SCHEDULE FOR COMPLIANCE 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 Dear Mr. DeNinno: FAX (661) 326-0576 ENVIRONMENTAL SERVICES Per our conversation, I am relaying my observations and violations noted 1715 Chester Ave. during my facility inspections at the above mentioned address on Tuesday, Bakersfield, CA 93301 VOICE (661) 326-3979 December 5, 2000. FAX (661) 326-0576 TRAINING OIVJSION 9600 Brimhall Facility #32376: 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 1. No Pehhit to Operate found on site (Permit needs to be posted). FAX (661) 399-5763 2. The cover to the Emergency Shut-off Switch has been taped shut with no way to access it. 3. No fuel monitoring records. Noted tape on floor going back to October 31, 2000. Very obvious no one is checking or maintaining records. 4. No Hazard Communication Program found onsite (M.S.D.S., Site Diagram, Emergency Response, Training Records). 5. No operator data, new operator has taken over in the last year. 4101 Calloway, Facility #32241' 1. No operator data for new operator. 2. No Hazard Communication Program in place (M.S.D.S., Emergency Response Procedures, Training Records, Site Diagram).' 3. No evidence fire extinguishers have been serviced. (No tags). 4. Boxes blocking emergency exits and electrical breaker panels must have 30" clearance. It was also noted at both facilities that the employees did not know anything about the hazard communication program, or proper monitoring record retention. Please have the above mentioned corrections made within 30 days. (January 5, 2001.) Failure to comply will result in further enforcement action. Your help is greatly appreciated. Sincerely, Ralph E. Huey, Director Office of Emergency Services by: Steve Underwood, Inspector Office of Environmental Services SBU/dm C~RRECTION N O TjJjC E BAKERSFIELD FII:JE DEPAI:ITMENT N°_ 'J 0 2 ~ Location Sub g~,,. %0o ~t,~,,il~ ~,~. Lot You are hereby required to make the following corrections at the above location: Cot. No Completion Date for Corrections/7,/I ~''/0~) /~ Date !,.~/~'"/~) ~_~-/_L ff~~ ~ · I~ctOr 326-3979 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME -] ~/t"OC~'x INSPECTION DATE Io3[~fO0 Section 2: Underground Storage Tanks Program [] Routine [~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank l0 OJlg'C.-q Number of Tanks 3 Type of Monitoring ~ t- ~ Type of Piping D_ cO ~ OPERATION C V COMMENTS Proper tank data on file %,/ Proper owner/operator data on file ~// Permit fees current ~ Certification of Financial Responsibility ~ Monitoring record adequate and current ~[~ k/ /q~ 0X.¢ 0 t'C{$ Maintenance records adequate and current ~ Failure to correct prior UST violations ~ Has there been an unauthorized release? Yes No k/ 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: Office of Environmental Services (805) 326-3979 Business Si{e Responsible Party White - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME '-'] (;~lCttCeX INSPECTION DATE ADDRESS '~(oOO ~r,~/n~{{ I~c~. PHONENO..o~1~'~O' FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine [~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand ~d ~ ~ t4t- '~ O ~ t~ Business plan contact information accurate ~ff /~0 144,af ~- · Visible address L/ ~ Correct occupancy Verification of inventory materials 'x/~ Verification of quantities ! Verification of location Proper segregation of material Verification of MSDS availability V' t'l~. ,~-.~xt~ Verification of Haz Mat training b,~/' ~,~ Verification of abatement supplies and procedures ~J /" tr. ~ Emergency procedures adequate V ' t~ t Containers properly labeled Housekeeping b/ ! Fire Protection Site Diagram Adequate & On Hand b/ C=Compliance V=Violation/ Any hazardous waste on site?: [] Yes Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business ~i~es~on/~ Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: -;~~ CITY OF BAKERSFIELD Imc 171~ Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STOOGE TANKS -UST FACILI~ ~PE O~ ACTION ~ 1. NEW ~IT~ ~MIT . ~ENEWAL PERMIT ~ 5, CH~GE OF IN,ORaTION ~ec~ ~ - ~ 7. PER~NE~LY CLOSED .~ ~ 4. A~NDED ~MIT ~c~/~ o~ ~ 8 TANK RE~VED ~ ~. TEM~RY SITE CLOSURE I. ~AClL~ / S~ INfOrMATION N~REST CRO~S STREET ~ ~1. ~IL~ O~E~ ~ ~ 4. LO~L AGENCY/DIS~IC~ ~ ~ 2. INDIVlDU~ ~ 6. STATE AGENCY' BUSINESS ~I. ~S STATION ~ 3. FARM ~ 5. ~RC~ ~ 3. PARTNERSHIP ~ 7. FEDE~AGENCY* ~2. ~PE ~ 2. DISTRIBUTOR ~ 4. ~ES~R ~ 6. O~ER ~' I RE~INING AT $~E ~fl~? ~. ~ ~ ~m ~ ~ ~ UST. ~=m~~ f~k ~.) IL PR~ O~ER INFO~N I ~ILINGOR $~ ~RE~ 410. ~A~ 411. ZIP ~DE 412. ~OPER~ O~ER ~ ~ D 2. I~ ~ 4. L~ A~ / DIS~I~ ~ 6. STA~ AG~ 413. lie T~K ~ER INFOR~ T~K O~ER~ 7-Eleven, I~C, x 414. ~NE 415. Gasoline Accounting ~ILING OR ST~ ~ 416. P. O. Box 711 :c,~ Dallas, TX75221-0711 417. ~ STA~ 418. ~ ZIP~DE 419. TANK O~ER ~ ~ ~ 2. I~ ~ 4. L~A~ I Dl~l~ ~ 6. ~A~ AG~Y 4~. 1. ~T~N D 3. P~P ~ 5. ~U~A~N~ ~ 7. FE~AGE~ W. BO~ ~ EQ~~N ~T 8TO.GE F~ ACCOU~ NUMBER VII. ~PLICANT SIGNA~RE ..E OF A. ~NT ..,) ~Ni~ 42.. T,T~O" 'l[~EnvironmentalE~a- q 77- 7 ,=.Manager ISTATEUSTFAClLITYNUMBER(FoftocI/uIIortly) .';' 428.11998UPGRADE~RTIFICATENUIVIBER(For/o~Iu..eeOfffy) UPCF (7/99) S:\CU PAFORMS~swrcb-a.wl3d :_~. c~v o~ 1715 Chester Ave., Bakersflel~ CA 93301 (661) 326-3979 UNDERGROUND STOOGE TANKS - TANK PAGE ' ~~ (~~'~ ~) (~~'~ ~) L T~K I ~~ ~,'~t i CITY OF BAKERSFIELD ~ -- ~ OFFICE OF ENVIRONMENTAL SERVICES d~i ' ~' I Chafer Ave., Bikerlfleld, CA ~1 (M1) 32~ SYSTEM 4 ~NUF~C~U~E~ 2. ~U~ W~ ~ ~. U~ ~ Z ~U~E W~ ~ ~. OT~ ~ ~F~RER ~1 ~FA~R 4 ~E~S~ '~ 2. ~~ ~ 7. ~v~~ ~ z ~~E~ ~ T. ~v~E~ ~ s. ~ ~C~N ~ '~ S. S~Lw/~ ~. U~ ~ 1. ELE~~~3~~OW~F~ ~ 1. ~ z ~YO=~ TEST(0.1 G,J~I) r"l 6. TRIENNIAL. [NTEGRJTY TEST (0.1 ~J~l) Ill 7. sa..,= MON~ I-1 r-I 9. mENN~NTEMmYTEST(0.1 ~ I'J 8. DAJLYV~J~LMONrrO~Ne l'J e. M. NNW.~TEST(OJ (~H) UPCF (7/99) S:~.CUPAFORM,.R~RWRCB~'WPC vmo T^tegavlc s 1715 Chester Ave., Bakersflel~ CA 93301 (661) 326-3979 UNDERGROUND STOOGE TANKS - TANK PAGE 1 ~ OF ~ ~ ~. ~ ~ ~ ~ 4. ~O ~ ~ S. ~ ~ ~~) ~ e. ~mY ~E ~O~ ' ~~ (~~.~M~) (~~.~~) ~ ~. T~~D L T~K ~~~) 0~ I~ 0 ~ ~ 0 · A~~ 0 2. ~~ ~c ~~ 0 ~. ~ OM. o~ ~T~~ ~~(~ Os.~ Oz~~ 0~~~ OLi ~ ,, ',-,,' 'h' ," '~ ',r ' ,,' .......... nrc, ~'~;'~:'~":;': ..... '' :':'"'" ~*~","::"~ ~ ~. ~(~~~ ~ ~ ~T~~(~) ~!. ~(~w~v~T~ ~ 0TM Om OPCF (7~) S:~COP~O~~~'~° i CITY OF BAKERSFIELD ~ -- ~ OFFICE OF ENVIRONMENTAL SERVICES i~ ' ~" t~l/Chl4ter Av~.. Blker~fleld, CA ~1 (~1) 32~ I ~F~RER ~1 ;~ 1.~S~ ~ e. ~A~I~~L ~ 1. ~E~EL ~ e. F~A~WII~~ ~TECT~N ~ 3. ~~A~~ ~. U~ ~ 3. ~~AT~~S ~ 8. ~(H~) ~. O~ r ~E~D ~ (~ M ~ ~-~ · ~R~D ~ (~ M ~ ~ TEST(O.t GPH) i'1 6. T~ENNW.~rE(g~rYTEST(0.1 Cd=H) C]T. Sa.~MONn'O4~NG O 7. I~ 9. BIENNIAL IC'tC-GI~'TY TEST (0.1 ~ r"l e. DAILY VISUAL. MONITO~NG [ri e. mENN~L~TES'r(oJ (~=~) 14. ~~~~~~~*~~ ~ 14. ~~~~~~~+~~ RESTR~ ~e. ~U~ ~~(0.~ ~) ~e. ~~(o.~ ~) ~7. ~LY~E~ ~ 17. ~LY~E~ ..:,.... -.: '~;:~'~:~"~ .~,~ ............... ,,~ .... ~ ............... , .... ~ ~,~ ,,.. Di~H~~ ~ 1. ~T~~T~WV~ ~ ~ ~Y~~ SI~TU~ OF O~~TOR ~(/~//D DATE 470 472 ~o~o~~To~ ~ ~ ~ ~ ~. T~O~O~TO~ Environmental Manage~ UPCF (7/9g) $:~,CUPAFORM~WRCB.~.WP{~ _~. CITY OF BAKERSFIELD 1715 Chester Ave., Bakersflel~ CA 93301(661) 326-3979 . UNDERGROUND STO~OE TANKS - TANK L T~K UPCF (7~) SACUP~M~~.~O ~R-~' OF BAKERSFIELD k OFFICE OF ENVIRONMENTAL , ~ONSTRUCT~M' ' TEST(0.10i~) I--I 6. T~ENN~LWTEOR/TYTEST(0.1 (a~) [] Z. SEU:UOMTOmN~ 0 c~vrrY FU~Vt. ORAvrrY FLOW (CMOk M O~ W~/~ [] o. O~,M,P, AL ~ TE~ (O.S Gf~ 0 e. D*LYV~U*L MoMroR~O [:] e. e~g~L wrEomTY T~T (O. S O~4 (Check one) .~& AUTO PUMP ~,nJT OFF WHEN A LEAK ~ I'1 a. AUTOI~JMPS,qUI'OFFWHENAL.E,~OO~R$ ~,~ 0 ~ NO ~JJTO PUMP S~UT OFF [] c ~O AUTO PUt~ SHUT O~ RESTmCT'ION ~ s2. ~.~L WTEMUTY T~r (o.~ OF~) [] sz A~NU~ ~ TEsr (o.~ 0~) ~) ~ OF O~~T~ ~) ~ / ~ 471 I T~E 0F O~TOR 47~ Bob DeNinno I ~Environm~ntal Manager _ UPCF (7/gg) S:~CUPAFORMS~gwRC~-~.WP C 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 45%6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 03/24/2000 Order Number: 3111697 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor certifications Stage II A/L tests Stage II pressure decay tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting " CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING ~ · Tankno/ogy 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TLD-1 PURPOSE: COMPLIANCE TEST DATE: 03/24/00 CUSIOMER PO: WA04071372 WORK ORDER NUMBER: 3111697 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 10220 S.W. GREEN-BURG ROAD 9600 BRIMHALL RD. SUITE 470 MARKET #2133 PORTLAND, OR 97223 BAFd~RSFII~.LD, CA 93312 BOB DENINNO MANAGER (503) 977-7713 (805) 588-4059 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 15k i REC~ UNT.~..]~D 0. 000 P Y P Y 10k 2 PREMIUM 0. 000 P Y P Y 10k 3 MIDGRADE 0. 000 P Y P Y Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the fnture. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: KEN MINTON RICHMOND PHILLIPS '.:?~:': ':" ~' ·-~ :" ," ~"~'.~--:: ;~i:~;':~.::i!:.!i:~ ..... Reviewed: Technician Certification Number: 91-1071 Printed 04/10/2000 08:28 CCHAPA TEST DATE:03/24/00 8900 SHOAL CREEK, BUiLDiNG 200 WORK ORDER NUMBER3111697 CLIENT: ?-ET.~.V~N, TNC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: ?-E~.~.VEN #323?6 Tank iD: 15k i Tank manifolded: No Bottom to top fill in inches: 146.0 Product: ~G ~ Vent manifolded: No Bottom to grade in inches: 151.0 Capacity in gallons: 15,039 Vapor recovery manifolded: Y-~s Fill pipe length in inches: 51.0 Diameter in inches: 95.00 Overfill protection: 'z-~s Fill'pipe diameter in inches: 4.0 Length in inches: 496 Overspill protection: Y~s Stage I vapor recovery: DULL Material: DW S~J~.T, Installed: ATG Stage II vapor recovery: ASSTST CP installed on: / / COMMENTS Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: Model: Lo2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. co Holding psi: VacuTect Test Type: NOT Resiliency cc: zso NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zsg. o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib, leak in gph: 3. co Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 05:15 TF_,ST~D TESTED TESTED End time: 05: 45 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: ~ PETRO COMMENTS Impact Valves Operational: YES Printed 04/10/2000 08:28 TEST DATE: 03/24/00 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER311169? CLIENT:7-ET.~.~'EN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-ET.~.V~N #32376 Tank ID: 10k 2 Tank manifolded: NO Bottom to top fill in inches: 143.0 Product: PAgHTT. Tt,/ Vent manifolded: NO Bottom to grade in inches: 147.0 Capacity in gallons: 10,027 Vapor recovery manifolded: ms Fill pipe length in inches: 48.0 Diameter in inches: 95.00 Overfill protection: Y'gS Fill pipe diameter in inches: 4.0 Length in inches: 331 Overspill protection: ~gs Stage I vapor recovery: DUA.L Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~O~.L~.SS Model: ~.n2000 Ingress Detected: Water Bubble Ullage Test time: S/N: n/a Inclinometer reading: Open time in sec: 4. oo Holding psi: 16 VacuTect Test Type: ~TOT Resiliency cc: 15o NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: leg. o TESTED Pressure Set Point: Metering psi: lo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PAss Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 150.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 ~TOT NOT NOT Start time: 05: 15 ~S~gD TES~D TES~D End time: 05: 45 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: ~'~ PET~O COMMENTS Impact Valves Operational: Y-gS Printed 04/10/2000 08:28 TEST DATE: 03/24/00 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER311169? CLIENT: 7-ET,~.VEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ET,~.VEN #3237 6 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 145.0 Product: MTDel~AOE Vent manifolded: NO Bottom to grade in inches: 150.0 Capacity in gallons: 10, O27 Vapor recovery manifolded: YEs Fill pipe length in inches: 50.0 Diameter in inches: 95.00 Overfill protection: 3r~s Fill pipe diameter in inches: ' 4.0 Length in inches: 331 Overspill protection: ~Es Stage I vapor recovery: DUkL Material: DW S~t~.T. Installed: AT~ Stage II vapor recovery: ASSTST CP installed on: / / COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VAPO~.~.SS Model: u)2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: 7~9~ Inclinometer reading: Open time in sec: ,~. oo Holding psi: ~6 VacuTect Test Type: NOT Resiliency cc: z55 NOT VacuTect Probe Entry Point: ~'~ST~D Test leak rate mi/m: zsg. o TES~i~D Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: P~.ss Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 3-50.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 05: 3.5 ~S~gD T]~S~gD TES~SD End time: 05: 45 Final gph: 0. 000 Result: PASS Pump type: ~RESSURE Pump make: ~ PETRO COMMENTS Impact Valves Operational: Printed 04/10/2000 08:28 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 03/24/00 WORK ORDER NUMBER3111697 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #32376 BRIMHALL RD <d--P> ~ <d---i> 9600 BRIMHALL RD BAKERSFIELD, CA PREMIUM ~o~ (~ 0 PLUS ~ (~) ~ Y C-STORE Printed 04/10/2000 08:28 CCHAPA MONITOR CERTIFICATION FORM CUSTOMER: ?-ELFVEN, INC. SITE I.D.: ?-ELEVEN ~L32376 DATE: 03~24~2000 ADDRESS: 9600 BRIMHALL RD. MARKET #2133 WORK ORDER: 3111697' BAKERSFIELD, CA 93312 1) IN TANK PROBES MANUFACTURER: tidel MODEL NUMBER: 3500 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): NO LAST TEST DATE: I I PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( YIN ): YES COMMENTS: 2) OTHER PROBES: MANUFACTURER: tidel MODEL: 3500 NUMBER OF LIQUID, FLOAT. SV~ POSITIVE SHUT FAIL SAFE ( YIN ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOF DOWN (Y/N) (Y/N) ANNULAR PROBE 3 LIQUID NO YES YES TURBINE SUMP $ FLOAT YES YES YES FILL SUMP FIBERTRENCH MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 MONITOR CERTIFICATION FORM (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL · NUMBER OF SENSORS: MECH. LEAK DETECTOR YIN ): YES MECH. LEAK DETECTOR OPERATIONAL ( YIN ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): N/A TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WITH THE SIMULATED LEAK TEST ( YIN ): POSITIVE SHUT DOWN (Y/N): OPERATIONAL ( YIN ): YES 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( YIN ): YES ( YIN ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES RICHMOND PHILLIPS ~.":~:~::::./ ...~'~': TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 D April 4, 2000 7-11 FIRE CHIEF Ro~ F~Z~ Mr. Bob Deninno 10220 SW Greenberg Rd #470 ADMINISTRATIVE SERVICES Portland OR 97223 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 Dear Mr. Deninno: SUPPRESSION SERVICES 210~ 'H' Strut You have been identified as the compliance coordinator for the Bakersfield, CA 93301 facility/facilities referenced in the attachment. VOICE (805) 326-3941 FAX (805)395-1349 The permits to operate this facility/facilities will expire on June 30, 2000. PREVENTION SERVICES 1715 c~,~t,,r ^v,,. However, in order for this office to renew your permit, updated forms A, Bakersfield, CA 93301 VOICE (805) 326-3951 B, & C must be filled out and returned prior to the issuance of a new FAX (805) 326-0578 permit. ENVIRONMENTAL SERVICES 1715 chest,,r ^v,,. Please make sure that you are sending the updated forms which are Bakersfield, CA 93301 VOICE (805) 326-3979 indicated by the date 7/99 in the lower left hand comer. Please complete FAX (805) 326-0576 and return to this office by May 15, 2000. Failure to comply, will result in TRNNING DIVISION a delay of issuance of your new permit to operate. 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 Should you have any questions, please feel free to call me at FAX (005) 399-5763 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment Facility_ Address 7-11 1701 Pacheco Road, Bakersfield, Ca 93304 7-11 4647 Wilson Road, Bakersfield, Ca 93309 7-11 3601 Stockdale Hwy, Bakersfield, Ca 93309 7-11 960 Brimhall Road, Bakersfield, Ca 93312 7-11 525 West Columbus, Bakersfield, Ca 93301 7-11 4101 Calloway, Bakersfield, Ca 93312 ~ER OF T~S TO BE TESTED ~ I~'o PIPING ~ING TO BE TESTED~ .:, T~ vOL~E"., CONTE~S 27576 Comerce Center Or. IlO: T~TESTING CO~ TANKNOLOGY-NDE CORP. ~DRESS.Temecula' CA 92590 N~ O* TESTER ~;Ck P/,;ll p CERTIFICATION ~ /aT/ STATE REGIST~TION 3_ _. &71 .. DATE & TIME TEST IS TO BE CONDUCTED 7-z~C ~/ ~i~0 B~ ' XP~OVED~: DATE .. glGNATURE 0F~APPL~C~Tx C~RRECTION N OTlJi~ E BAKERSFIELD FIRE DEPARTMENT N° 0 2 3 5 Location 7- ~lc u'e Ox You are hereby required to make the following corrections at the above l~ation: Cor. No Inspector CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME -~-~'lctJc~ INSPECTION DATE 14/itt/~'~ Section 2: Underground Storage Tanks Program [2i Routine [~ombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank ~0CO fi-C_% Number of Tanks 3 Type of Monitoring CL./tX Type of Piping Oodl= OPERATION C V COMMENTS Proper tank data on file .~/' Proper owner/operator data on file Pennit tees current [/r Certification of Financial Responsibility V/ Monitoring record adequate and current Maintenance records adequate and current ~/' Failure to correct prior CST violations t,// Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY' Type of Tank Number, ,f Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OCS 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 Business Site Responsible Party White - Env. Svcs. Pink - Business Copy C CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME '"! ~ ~(coc~ INSPECTION DATE ADDRESS qOu0t~ {g~-,~t~o~{ PHONE NO. ~g~- FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine [~]/Combined [] Joint Agency [] Multi-Agency [] Complaint [] 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 Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training L~~ Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping x,J~t/-/~oc~ {3[~_/ec( ~, Fire Protection Site Diagram Adequate & On Hand ~ ~ C=Compliance V=Violation Any hazardous waste on site?: [] Yes [] No Questions regarding this inspection? Please call' us at (805)326-3979 Business Sitez]~espon~b~ Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: GF:O::;S GqLLO;'iS 61 t 2 L!L! 3;;SE 3915 F_:LOSEOUT ~..EF L ~. T TE';'iPERRTLIRE 102 .':'F PRODUCT GRRDE UNL C:UR~:SHT !H-Ti:INK CURRENT STRTUS AUERAGE TD~F'ERRTI RE 69 .',:',':' F SHIFT :-_]RL. ES t589 TRNK.:, PRO[:,UCT GF.:RDE SUL LRST [.'EL IUER'.? , ,p..~. CURRENT STRTUS LEUEL CURRENT IN-TANK GROSS GF:LLONS 7208 ULLRGE 2819 NONE RVEEAGE I.,JFiR N I N6 S F'R.W.~CT GF'.R[:,E ULF' ,qL~kM:_:; NONE CURRENT iN-TR?!K HONE F:Je. 1 -UNL H?mz! -ULP .... ~ -'SUL lr:tersti rial-Pr El'lC, OF F:EPOF.:T (-E~!6R'.:, CERTIFICAT UNDERGROUND STORAGE K SYSTEM TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST DATE: 04/26/99 CUSTOMER PO;wg04281381 WORK ORDER NUMBER3205276 CLIENT: THE SOUTHLAND CORPORATION SITE: 7-ELEVEN #32376 10220 S.W. GREENBURG ROAD 9600 BRINHALL RD. SUITE 470 BAKERSFIELD, CA 93312 PORTLAND, OR 97223 BOB DENINNO MANAGER (503) 977-7713 (805) 588-4059 1-he followLng test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local ~egulations Line and Leak Detector Tests ...................................... :': ................. ::::::::::::::::::::::::::::: i?:ii!i!::iiii::i '~i~:: .~' 15k i REG IJNLEAD 0. 000 P Y P 10k 2 PREMIUM 0. 000 P Y P 10k 3 PLUS 0.000 P Y P Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: TODD PARKER RICHMOND PHILLIPS .~ 'j..:~ ' .:? * . ...-~' ., ;' ~.::h/ .%,.o,.:..~:,/ ~." ~/" ?". ?~::..' Reviewed: Technician Certification Number: 91-1071 Printed 04/30/1999 12:42 KOHLMEYER MONITOR CERTIFICATION FORM CUSTOMER: THE SOUTHLAND CORPORATION SITE I.D.: 7-ELEVEN ~L32376 DATE: 04126/99 ADDRESS: 9600 BRINHALL RD. WORK ORDER: 3205276 BAKERSFIELD, CA 93312 1) IN TANK PROBES MANUFACTURER: TIDEL MODEL NUMBER: 3000 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): LAST TEST DATE: I I PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( YIN ): YES COMMENTS: ATG CHECK 2) OTHER PROBES: MANUFACTURER: TIDEL MODEL: 3000 NUMBER OF LIQUID, FLOAT. SW, POSITIVE SHUT FAIL SAFE ( Y/N ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOR DOWN (Y/N) (Y/N) ANNULAR PROBE :3 LIQUID NO YES TURBINE SUMP 3 FLOAT NO YES FILL SUMP FIBERTRENCH MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL' NUMBER OF SENSORS: MECH. LEAK DETECTOR ( YIN ): YES MECH, LEAK DETECTOR OPERATIONAL ( Y/N ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WITH THE SIMULATED LEAK TEST ( YIN ): POSITIVE SHUT DOWN (Y/N): NO OPERATIONAL ( YIN ): YES 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( Y/N ): ( Y/N ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES .... ........:' RICHMOND PHILLIPS ,-:::~".-::~.."~: ........ .~' ,,-~.~.':,'~-~.~ ..... TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 1715 CHESTER(805)AVE.,326_3979BAKERSFIELD , ~A 93304 .~PLICATZON TO PERFO~ A TIGHTNESS TES~ PERMIT TO OPERATE ~ , NUMBER OF ~ TO BE TESTED~ IS PIPING GOING TO BE TESTED .,~ TANK~ VOLUME CONTENTS $ 27576 Commerce Center Dr. //109 TANK TESTING COMPANY TANKNOLOGY-NDE CORP. ADDRESS Temecula, CA 92590 ~TEST 'METHOD Ap~~Y: ' DATE ' ~IGNXTURE 0F~APPLIC~T D February 9, 1999 FIRE CHIEF 7 Eleven RON FRAZE 9600 Brimhall Rd ADMINISTRATWE SERVICES Bakersfield, CA 93312 2101 'H' Street Bakersfield, CA 93301 VOICE {~05} 326-3941 RE: Compliance Inspection ~ (~o5) 395-1~9 SU..aESS~O~ SER.CeS 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 SERVICES 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 ENVlRONMENTN. 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 thc necessary requirements to VOICE (805) 326-3979 FAX (805) 326-0576 be in compliance. TRAINING OMSION Should you have any questions, please'feel fi'ee to contact me at 5642 Victor Ave. Bakersfield, CA 93308 805-326-3979. VOICE (805) 399-4697 Sincere~ Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure LERK TEST [:,ISRBLE REPORT i~ 0 ID # 0 16,50 ..~ 1 85.-" 14.-'"98 Ft~7.R OFF --- TANK 3 08:.31:06 05/1._,..' .... PRODUCT GRADE SUL = 'q'2 LEAK TEST OFF POWER ON --- ~,o, :31:30 ~- ,~ = 'q- LEAK TEST ENDED .. AUTOM.ATIC.ALL? END OF REFORT .... LEUEL ~F: GROSS G.ALLO~; 6380.3 NET GALLONS F ~.-..-' 1.0 TEMPERATURE 7'3. ?~"'F ~, ATEF,'. LEUEL 0,000 DUF.:.AT I ON 02: 02 LEUEL CH.ANGE-0,002 TEMP CH.ANGE-O.H~ F LEAK RATE -~;i, 1457 LE~,,' RATE BY' HOUR fx /'5<0D><0~> ID;Il 0 -0,0015 -0.~,'"~A., POWER OFF --- -0.14._,' 08:39:15 05,"1.5/98 [:,lAG-DATA POWER ON--- ..r.~ q496 0,0000 0,00~Z~ 08:.3,9:34 E~/15,'98 -x~_;£~ 1 ~-ll. END OF REPORT (-016R) 0.'.'~ GALLON/HOLIR TEST ALT TEST COMF'LETE .ATTEMPT ING TO UERi END OF REPORT (-016R) ID~'O POWER OFF --- 0? :08:08 05.x 15,'98 POWER ON --- 0g:08:14 05..,. ~.S 'EP~' OF REPORT (-016R) IO#O POWER'. OFF --- 09:54:52 05/15/98 POWER ON --- 11:05:18 05x15z'98 ~k~O OF REPORT (-016R) 6-38-1998 7:.52AM FROM RHL DESTGN GROUP 916 646 ,'1679 P. 2 STATE Ol~ CALIFORNIA STATE WATER RESOURCES CONTROL U,,~Gi.,~;-~OUND STORAGE TANK PERMIT AFFLiCATION - FORM A COMPLETE ~tS FOR~ FO~ EACH FACILI~I$IT~ I. FAClLE~/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) CIW'~E .~ATE .... I Z~P CODE SITS PN~E a WITH ~ ~ ~X ~¢O~PO~TION ~ INOIVJ~ ~ P~IP ~ L~,AG~ ~ COUNW-AG~CY' ~ 3TATE-AG~CY* ~ T~ ~ICATE EMERGENCY CONTACT PERSON (PRIMARY) E~ERGENCY CONTA~ PERSON (SECONDARY) - N1GHT$: N~E (~ST. FIR~ PHONE ~ Wt~ ~ ~ NIGHT~: NN~ (~ST. FiR$~ PHONE e WI~ ~ II. PROPER~ OWNER INFORMATION- (MUST EE COMPLETED) NA~E CARE O~ ADDRESS I~ORMATiON IlL TANK OWNER INFORMATION - (MUST BE COMPLETED) N~ OF OWNER CARE OF ADDRESS IV. BOARB OF EOUALIIATION US? STORAGE FEE ACCOUNT NUUBER- Cill (916) 322-9669 if quostfons V. P~ROLEUM UST FINANCIAL RESPONSIDILI~ - (MU~ BE COMPLETED) - IDENTI~ THE ~ETHOD(S) USED ~ 8 STATE~ND&CHI~FFIN~CI~OFH~R~ ~ ~ ~TA~&C~R~F~OFDEPO~IT ~ ~0 L~GO~f, vECH~,S~ ~ ,~ O~R I VI. LEGAL NO~FICATION AND BILLING ADDRESS Legal noUfication and billing wile be sent to the tank owner unless box I or 11 is checked. ) C~CK ON~ 8OX ,NOICA~NG WHICH ~OVE ~OR~SS SHOULD BE USED FOR ~GA~ NO. FICATIONS AND .,~ING; I.= ,,.~ I(I.~ ~ FORM HA~ BEEN COMPLieD ~NO~R ~ENAL ~ OF PERJURY, AND TO TH~ 8EST OF MY KNOWLEDGE, ~ tRUE AND LOCAL AGENCY USE ONLY COUN~ ~ JURISDICTION ¢ FAQILI~ ¢ I 6-38-] 998 7:52AM FROM RHL DESIGN GROUP 916 6A6 4679 P. 3 STATE OF CAUFORNIA STATE WATER RE$oI.rRC;$ CONTROL BOARD UNDErGrOUND ST0~AGE COMPLETE A SEPARATE FOR~ F0~ EACH TAN~ SYSTE~. ONE ~EM ~ 2 INTERIM PERMIT ~ 4 AMENDED PERMIT~_J~ 5 TSMPO~A~Y TANK CLOSURE ~ 8 TANK DBAOR FAClLJ~ NAMEWHERE TANK IS INSTALLED: ~t '~ ~, ~ }~ ~ ~ ~ C. DATE INSTALLED (MOmAY~/AR) ~ ~ ~ O,IANK CAPAC~ tN GALLONS: I 0, ~ IL TANK CONTENTS ,. A.1 is MA~KED, COM~LDE ITEM C. A ~ 1 MOTOR V~HICL~ ~UtL g 4 OiL B.C. la REGU~ UNLADED 3 DI[8~L ~ 6 AVIATION GAS ~b PREMIUM UNL~ 4 GASANOL ~ 7 METHANOL ~ ~ P~ROLEUM ~ ~ EMP~ ~ I PROOUCT ~ ,¢ ,i~E U~0~O ~ 5 JETFUE: D. IF ~.1) I$ NOT MARKED. EN~R NAME OF ~U~STANCE STO~ED C. A, S. ~: IlL TANK CONSTRUCTION ~,nK ONE ITEM ONLY IN BOXSS A. ~. AND C. AND ALL ~AT APP%IES IN BOX D AND E SYSTEM ~ 2 SlNG~ WALL ~ 4 SINGLE WALL IN A VAULT ~ 9e OTHER UA~R~L ~ 5 CONCR~T~ ~ 6 ~LWINYL CHLORIDE ~ ? ALUMINUM ~ S 10~ M~THANOL COATING ~S L~NING MA~RIAL COMPATIBLE WITH I~0% ME~ANOL ? YES ~ D.~RIOR ~ 1 POLY~NYLENE WRAp ~ 2 COA~NG ~ 3 VINYL WRAP ~ · FIBERG~$S RE~NFORCED P~STIC CORROSION S~i~ CONTAINMENT INSTALLED [Y~R} --~ OVE~¢tLL~VENTION ~OUIPMENT INSTALLED (Y~R~ E. SPILL AND OVERFILL, etc. DROP TMe; YES ~ NO STRI~ER P~T~ YES ~ NO ~ISPENSER CONTAINMENT YES ~ NO __ IV. PIPING INFORMATION c,ec~ A i~ ABOve ~ROUNO 0~ U IF UNDER~ROUND. eOTH I~ B. CONS~UCTION A U 1 StNGC~ WALL ~2 ~USL~ WALL A U 3 MN~ ~NCH A ~ ~S UNKNOWN A U 99 C. UA~RIALAND A U ~ BARE STEEL A U 2 STAINLESS STEEL A U 3 POL~tNYL CHLORIDE (PvC)A~ FIBERG~SS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCR~E A U 7 S~ELW/COA~NG A U 8 1~% METHANOL V. TANK LEAK D~ECT]ON RECONCILIATION MONITORIN8 GAUGING MONITORING MON~ORING TANK GAUG,,~¢ TESTING VL TANK CLOSURE INFORMATION (PERMANENT CLOSURE THIS FO~M HAS BEEN COMP~ED UNDER PENAL ~ OF PERJURE AND TO THE 8EST OF MY KNOWLEDG~ IS TRUE AND CORRECT LOCAL AGENCY USE O~LY ~ESTA~LD, NUM~ERISCO~POSEDOFT~EFOURNUMBERSSELOW COU~ = JURISDIC~O~; FAClL]~ · TANK = ~IS FOR~ MUST BE ACCOMPANIED BY A PERMIT APPLICATION · FORM A, UNLESS A CURRENT FOR~ A HAS BEEN RLED. FORM C MUST BE COMPLIED S0R INSTALLATION~ TH~S FORM 6-38-1998 '7:S3AM FROH RHL DESIGN GROUP 916 6z26 ¢16'79 p. ~TATE ~F C~MFQR~I~ STATE ........ O~RC_S CONTROL ~0~RD UNDERGROUND STORAGE TA~K PERMIT APPLmaTION - FORM B CO~PLET~ A $~PAEATE ~0RM FOE EACH TANK ONE ITEM ~ 2 INTERIM PE~3~T ~ a A~SNDED PERMIT ~ 6 TEMPORARY TA'NK CLOSURE ~ 8 TANK L TANK DESCRIPTION CO~PL~T~ *~L ~T~S - SPaC~ ~ II. TANK CONTENTS ,~ A.~ ts ~RK~, co~.~Te ~f~ c. kV[ATION ~ SYSTEM ~ Z SlNG~ WALL ~ a SINGLE WALL IN A VAULT ~ 9S O~H~R ~A~fl~L ~ 5 C~C~ETE ~ e POLWINYL C~LOmOE ~ 7 ALUMINUM ~ 8 10C% M~TH~OL COMPATI~g~WIFRP COATING ~s LINING MA~RIAL COMPATIB~ WI~ I~% k~E~ANOL? Y~S- NO~ CORROSION SP;LL CGNTA(NL' [~T :~TALL~O tY~) ~ ~ QVERF~REVENTtON EQUIPMENT INSTALLED (YEAR) ~ ~,~ E. SPILL AND OVERFILL, etc. DROP TUB~ Y~S'._ ~_ NO STRIKER P~TE YES ~ NO , DISPENSER CONTAINMENT YES ,, ', NO IV. PIPING INFORMATION c~.cc~ A IF ASOVE GROUND O~ U IF UNDERGROUND, ~OTH IF ~PLIC~LE ~ SYS~M~PE A U 1 SUCTION ~ 2 PRESSURE A U 3 GRAVI~ ~ U 4 FLEXI~L~PIPJNG A U ~ OTHER ~ MA~RIALAN0 ~ U I ~A~E~TEEL A U 2 STAINLESS S~EL A U 3 POLWINYL CHLOR[DE(PVC)A~4 FI~RG~SS P[PE PROTEC~0N A U 9 GALVANIZED STEEL A U I0 CA~ODICPROTECTJON A U ~5 UNKNOWN A U g~ OTHER V. TANK LEAK DETECTION ' WEEKLY MANUAL ~ 10 MONTHLY TANK ~ 95 UN~OWN VI. TANK CLOSURE INFORMATION (P~u,~r CLOSU~ THIS FORM HAS BEEN COMPLIED UNDER PENAL~ OF PERJUR% AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY ~E STATE LD. HUMBER IS COMPOSED OF THE ¢OUR NUMBERS BELOW THI~ FORM MUST BE ACCOMPANIE~ BY l PERMIT APPLICATION' - FORM A, UNLESS l CURRENT FORM A HAS 8~N FILED, FORM C ~UST 8E COMPLIED FOR ~$~ALLATION$, THIS FORM 6-38-1998 7: SxlAM FROM RHL DESIGN GROUP 9] 6 64.6 z[679 P- STATE WA/ER' RESOURCES CONTROL BOARD UNDERGROUND STORAGE TAN~ PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. IlL TANK CONSTRUCTION SYSTE~I ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT ~ gg OTHER MA~RIAL ~ 5 CONCRETE ~ 6 POLWINYL CMLORiOE ~ ? ALUMINUM ~ 8 100% METMANO~ COMPATIBLEW/F~P C. INTERIOR ~ 1 ~UBBER ~INEO ~ 2 AL~D LINJNG ~ 3 EPOXY UNING ~ 4 PHENOLIC CORROSION PRO~C~ON ~ 5 CATHODIC PRO.ChON ~ 91 NON~ ~ S5 UN~OWN ~ ~ OTHER E, SPILL AND OVERFILL, ate. D~OP TU E YES NO , _ S~nlK~R P~TE YES ~ NO , D:$PENSER CONTAINMENT YES IV. PiPiNG INFORMATION c:~L~ A ,~ ~ov~ s~ouNo OR U :~ u,o~ou~. SO~ :~ B. CONS~U~ON A U 1 SINGLE WALL ~2 ~USLE WALL A U 3 LINED ~ENCH A U g5 UNKNOWN A U ~g OTHER C. MATERIAL AND A U I ~RE STEEL A U 2 STAINLESS S~EL A U 3 POL~INYL CHLORID~ (PvC)~ 4 FJBE~G~SS PIPE CORROSION A U 5 ALUMINUM A U ~ C~CR~ A U 7 5TEELWI~ATING A U 8 1~% METHANOL COMPATIBLEWm~P PROTECTION A U g ~LV~IZED STEEL A U ~O CA~ODICPROTEC~ON A U a~ UNKNOWN A U gg OTHER V. TANK LEAK DETECTION ~ 7 C~NUOUSINTE.STITIAL ~ 8 S]R ~ g WE~KLY MANUAL ~ 10 M~THLY TANK ~ 95 UN.NOW. ~ ~90~ER VL TANK CLOSURE INFORMATION (.~ c~osu.[ THIS FO~M HAS BEEN COMPLIED UNDE~ PENAL~ OF PERJU~Y. A~D TO THE BEST OF MY KNOWLEDGE, IS T~UE AND CORRECT I i LOCAL AGENCY USE ONLY ~EST~TELD. NU~aE~SCO~POSE~OF~,EFOUR.U~SE~S~E[OW COUN~ ~ JURISDICTION e FAC~LI~ ~ TANK 06/~0/98 TIlE 11:59 FAX GROUNDWATER ~002 ST,~TE OF CAUFORM& CERTIFICA~ON OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLA~ON FORM C COMPL~E A SEPARATE FORM ~R EACH TANK SYSTEM SITE LOOATION II. INSTALLATION (mark all that apply): E~h ' e installer has been certified by the tank and piping manufacturers. [~The installation has been inspected and certified by a registered professional engineer, C~'~,T, he installation has been inspected and approved by the implementing agency. , All work listed on the mp,m.~'3~'~rer's installation checklist has been completed. ' ~ The installation Contractor has been cedified or licensed by the Contractors State License Board. [] Another method was used as allowed by the implementing agency. (Please specify.) III. OATH I certify that t~~rovided is true to the best el my belief and knowledge. Tank Owner/Agent '-Ft4g~ Print Name - /Phone ( Bob DeNi~o ' En~ronmen~ ~er LOCAL AGENCY USE ONLY STATE COUN~ ~ JURISDICTION FORM C {7~11 THIS FORM MUST 8E ACCOMPANIED BY PERMIT APPLICATION FOR~ A & State Water Resour~ontrol Board Division of Clean Water Programs P.O. Box 944212 Sacramento, CA 94244-2120 (Instructions on reverse) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required mounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ~ 500,000 dollars per occurrence r--] i million dollars annual aggregate or AND~ or [ I million dollars per occurrence P~ 2 million dollars annual aggregate B. The Southland Corporation hereby certifies that it is in compliance with the requirements of Section 2807, INama of Tank Owner or Operator) Article 3, Chapter 18, D/vision 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: Irrevocable Banker~ Trust Company Standby' · 1,000,000 per Annual Yes Yes Standby One Bankers Trust Plaz~ Letter of occurrence & Letter of New,York, NY 10006 Credit No. 2,000,000 Credit S-08219 Annual Aggregate Note: If 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. gzZT[, F.i,ityA .,e.s C /O0 Facility Name Facility Address Facility ~ Facility Address / ,-,t E. s~ Bob DeN/ann CFR {Revised 04/95l -~ FILE: Original - L~ lency Copies - Facility/S/reis) / · MAIU~ ADDRESS; 'LOA~ DIVISION RO. BOX 318- CHURCH S1 STANDBY LETTER OF CREDIT N~w YORK, N.~ 14TH FLOO~ ON~ BANKERS T~UST PLAZA II:~EVOCABLE STANDBY LETTER DECEMBER Z0, lS~! OF CREDIT NO. S-082~ BENEFICIAR¥~ UNITED STATES ENVIRONMENTA~ PROTECTION AGENCY AND 28 OTHER BENEFICIARIES AS PER ATTACHED LIST GENTLEMEN: WE HEREBY ESTABLISH OUR IRREVOCABLE STANDBY LETTER OF CREDIT NO. S-08219 IN YOUR FAVOR, AT THE REQUEST AND FOR THE ACCOUNT OF THE SOUTHLAND CORPORATION OF 27~1 NORTH HASKELL AVENUE, DALLAS, TEXAS 75221, UP TO THE AGGREGATE AMOUNT OF TWO MILLION U.S. DOLLARS (U.S. $2,000,000.00) AVAILABLE UPON PRESENTATION BY AN~ ONE OF YOU OF: 1.YOUR SIGHT DRAFT, BEARING REFERENCE TO THIS LETTER OF CREDIT NO. AND 2. YOUR SIGNED STATEMENT READING AS FOLLOWS= "I CERTIFY THAT THE AMOUNT OF THE DRAFT IS PAYABLE PURSUANT TO REGULATIONS ISSUED UNDER AUTHORITY OF SUBTITLE I OF THE RESOURCE CONSERVATION AND RECOVERY ACT OF 1976, AS AMENDED." THIS LETTER OF CREDIT MAY BE DRAWN ON TO COVER TAKING CORRECTIVE. ACTION AND/OR COMPENSATING THIRD PARTIES FOR BODILY INJURY AND PROPERTY DAMAGE CAUSED BY ACCIDENTAL RELEASES ARISING FROM OPERATING THE UNDERGROUND STORAGE TANK(S) IDENTIFIED BELOW IN THE AMOUNT OF ONE MILLION U.S. DOLLARS (U.S.$~,000,000.00} PER OCCURENCE AND TWO MILLION U.S. DOLLARS (U.S. SZ,000,000.O0) ANNUAL AGGREGATE: SEE EXHIBIT A, THE LETTER OF CREDIT MAY NOT BE DP. AWN ON TO COVER ANY OF THE FOLLOWING: A) ANY OBLIGATION OF THE SOUTHLAND CORPORATION UNDER A WORKERS' COMPENSATION, DISABILITY BENEFITS, OR UNEM~'LOYMENT COMPENSATION LAW OR OTHER SIMILAR LAW; B) BODILY INJURY TO AN EMPLOYEE OF THE SOUTHLAND COR['ORATION ARISING FROM, .AND IN THE COURSE OF, EMPLOYMENT BY THE SOUTHLAND CORPORATION; C) BODILY INJURY OR PROPERTY DAMAGE ARISING FROM THE OWNERSHIP, MAINTENANCE, USE, OR ENTRUSTMENT TO OTHERS OF ANY AIRCRAFT, MOTOR VEHICLE, OR WATERCRAFT; 85580 (1~o) · §Bankers Trust Compa UAILI AOORES$; LOAN DIVISION co. BOX 318- CHURCH ST. ~ STANDBY LETTER OF CREDIT .Ew YORK, N.~ 40008 14TH FLOOR ONE BANKERSTRUST PLeA NEWYORK, NY10~6 D) PROPERTY DAMAGE TO ANY PROPERTY OWNED, RENTED, LOANED TO, IN THE CARE, CUSTODY, OR CONTROL OF, OR OCCUPIED BY THE SOUTHLAND CORPORATION THAT IS NOT THE DIRECT RESULT OF A RELEASE FROM A PETROLEUM UNDERGROUND STORAGE TANK; E) BODILY INJURY OR PROPERTY DAHAGE FOR WHICH THE SOUTHLAND CORPORATION IS OBLIGATED TO PAY DAMAGES BY REASON OF THE ASSUMPTION OF LIABILITY IN A CONTRACT OR AGREEMENT OTHER THAN A CONTRACT OR AGREEMENT ENTERED INTO TO MEET THE REQUIREMENTS OF 40 CFR 280.93. THIS LETTER OF CREDIT IS EFFECTIVE AS OF DECEMBER 20, 1991 AND SHALL EXPIRE ON DECEMBER 20, 1992, BUT SUCH EXPIRATION DATE SHALL BE AUTOMATICALLY EXTENDED FOR A PERIOD OF ONE YEAR ON DECEMBER 20, 1992 AND ON EACH SUCCESSIVE EXPIRATION DATE, UNLESS, AT LEAST X20 DAYS BEFORE THE CURRENT EXPIRATION DATE, WE NOTIFY THE SOUTHLAND CORPORATION BY CERTIFIED MAIL THAT WE HAVE DECIDED NOT TO EXTEND THIS LETTER OF CREDIT BEYOND THE CURRENT EXPIRATION DATE. IN THE EVENT THAT THE SOUTHLAND CORPORATION IS SO NOTIFIED, ANY UNUSED PORTION OF THE CREDIT SHALL BE AVAILABLE UPON PRESENTATION OF YOUR SIGHT DRAFT FOR 120 DAYS AFTER THE DATE OF RECEIPT BY THE SOUTHLAND CORPORATION, AS SHOWN ON THE SIGNED RETURN RECEIPT. WHENEVER THIS LETTER OF CREDIT IS DRAWN ON UNDER AND IN COMPLIANCE WITH THE TERMS OF THIS CREDIT, WE SHALL DULY HONOR SUCH DRAFT UPON PRESENTATION TO US, AND WE SHALL DEPOSIT THE AMOUNT OF THE DRAFT DIRECTLY INTO THE STANDBY TRUST FUND OF THE SOUTHLAND CORPORATION IN ACCORDANCE WITH YOUR INSTRUCTIONS. WE CERTIFY THAT THE WORDING OF THIS LETTER OF CREDIT IS IDENTICAL TO THE WORDING SPECIFIED IN 40 CFR 280.99 (b) AS SUCH REGULATIONS WERE CONSTITUTED ON THE DATE SHOWN IMMEDIATELY BELOW. THIS CREDIT IS SUBJECT TO THE MOST RECENT EDITION OF THE UNIFORM CUSTOMS AND PRACTICE FOR DOCUMENTARY CREDITS, PUBLISHED BY THE INTERNATIONAL CHAMBER OF COMMERCE. VERY TRULY YOURS, BANKERS TRUST COMPANY (AUTHORIZED SIGNATURE) TITLE: ASSISTANT VICE PR~S IDE~T I : CITY OF BAKER~IELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (SOS) 326-3979 IN${'EC'TION RECORD ~ (ZARD AT/OB SFi'E .... PIPING ~EM  - Piping ~ ~s) for ~ Sp~D.~. T~s) FIN~ 09/03/97 L$:L4 ~805 32fl 0576 BFD IL~,Z .~AT DIV ~004 CITY OF BA F LD OFFICE OF E ON AI, SER CES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF AP~IC^TIO~ [ ]lqEWFACIL1TY [ ]MODIFICATION OF FACILrl'Y [ ]NEW TANK INSTALLATION AT EXISTING FACIL1TY S'rARTINGDATE. ~ov.. I c.~c~-~ PROPOSED COMPLETION DATE .~:~,~ FACILfTYNAME '1- I '~ ._~-}-~,,~ EXISTINOFACIL1TYPERMITNO. FAc~.rrYADDP. ESS M~ ~-,-,. C:.a. ll~-.,~-¥ ~crre ~~6,'.e..i ,a. ZIPCODE TYPE OF BUSINESS ¢- ..~-)-~.e.- ,,,' ,~].~ ,. d~r-';,,,-, k.,,~ 1 ! APN # TANK OWl, a~ ...~o,-'+~ h:~-,,.d' ~ _,~C - PHONE N'O. coKrI~CTOR ~ ~ J~__..~ r-,,-. CA LICENSE NO. ADDRESS I)o~ ~. ,~..~.,~,-,,a. &.-[-. CITY PHONE NO. ( ,~ ~,'z") ~.~ q ,--3 - ~ ~ ~ ~ BAKERSFIELD Ch'Y BUSINF_.SS LICEI~E NO. WORKMAN COMP NO.'vv d. ~ ~c, 3~ lN~ BRIEFLY DESCRIBE THE WORK TO BE DONE ,~ r-~.~-~.-.~ ~ ~ T , G- ~a.-e.,-"~. WATER 1'O FACILITY PROVIDED BY ? cx ~ DEPTH TO OROUND WATER ~o~./~. SOILI'YPEEXPECTEDATSlTE.gil-h., .~,:~,-~ /-~,-~:i,,r-,.~'}'/- · ~0. OF TANK~ TO BE II~T~ ~ ARE THEY FOR MOTOR FUEL ~,-' SPILL PKEVENTION CONTROL AND COU1CIER MEASURES PLAN ON FK.E YES NO SI/CTION FOR MOTOR FUZL ~ ~o -/4~z,~O~ (,'Mt.-. TANK NO. VOLUME UNLEADED REGULAR PRI/1VI1UM DIESEL AVIATION SZCT~ON FO~ ~_O~ MOTOR F~ZL STOI~Z T~aS'KS TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO B~X~D N~,~) OF KNOW~ FOR OFFICIAL USE ONLY - , ' ":.":;:::;:ii :i:{::.: !.:.. ~id;.:T:'::!: '. -. .~: .:. ...... :..-.:..:.;:~.~.~:. .............. _:.:.:.:..:::.: ...... ~....~:~:,:~::~:.~ ........ ~!:~..:~,;:...-,..::..-.:::~ T~ ~"eLiC, q~r ~ ~C~, r.r~D,~,I~ST~S, ~ WiLL COM~L ¥ wrm T~ AT'rAc~nm co~,i~mom or THIS PERMIT AND ANY ~ STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PEPJURY, AND TO THE BEST OF MY KNOWLEDGE, -'--"T~$ APPLICATION BECOMES A PERMIT WHEN APPROVED GI~OLrP INC. ARCHITECTURE · ENGINEERING · ENVIRONMENTAL SERVICES 650 Howe Ave., Suite 504, Sacramento, CA 95825-4732 · Telephone: (916) 646-4003 Facsimile: (916) 646-4679 LETTER OF TRANSMITTAL Date November 21, 1997 Job # 3468.10 To: Inspector Steve Underwood City of Bakersfield Office of Environmental Services 1715 Chester Ave. Bakersfield, CA 93301 From: Lou Hollman RHL Design Group, Inc, RE: Southland Store #32241 9600 Brimhall @ Calloway Bakersfield, CA 1 11/21/97 State Forms "A" & "B" REMARKS: Thanks for waiting, Steve. We finally got the address assigned. M. E-0ouUHollman, Job Captain IF ENCLOSURES ARE NOT AS NOTED, KINDLY NOTIFY US! THANK YOU BELLEVUE, WA LA HABRA, CA PETALUMA, CA SCOTTSDALE, AZ F:\PROJECT\SOUTHLND\3468-10\frmab-su.doc STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE I MARK ONLY ~ I NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED. SITE ONE ITEM [] 2 INTERIM PERMIT ~ 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I, FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FACILITY NAME NAME OF OPERATOR ADDRESS NEAREST CROSS STREET PARCEL it (OPTIONAL) CITY NAME STATE ZIP CODE SITE PHONE # WITH AREA CODE I~,,Z~. ~..~ ~ ~ ~ CA v' BOX ~' CORPORATION [---1 INDIVIDUAL {--"] PARTNERSHIP [~1 LOCAL-AGENCY ~ COUNTY-AGENCY' [~ STATE-AGENCY* I-'-J FEDERAL-AGENCY' TO II~ICATE DISTRICTS · If owner of MST is a public agency, complete the following: name of supervisor of division, seclion or office whicfl operates the UST TYPE OF BUSINESS ' I GAS STAT'ON K--] 2 DISTRIBUTOR~ 3 FARM r'~ 4 PROCESSOR [-'--I 5 OTHER I[-'-']~/'FINDIAN'#OFTANKSATSITEIE'P'A'"D'#(°pti°nal)~oRRESERVATIONTRuST LANDS ,' EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional DAYS: NAME (LAST, FIRST') PHONE # WITH AREA CODE DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ~ ~/ box lo indicate ~ INDIVIDUAL i---J LOCAL-AGENCY [---] STATE-AGENCY ~2~o _~_l~-~&~ M~- ~=~-~ ~0 ~CORPORAT,O. r-~.^R~E.S.,P ~COUm-AOENCY TraPEZE.AL-AGENCY CITY NAME STATE ZIP CODE PHONE # WITH AREA CODE III. TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ~ box to hdicete [~ INDIVIDUAL (~ LOCAL-AGENCY ~ STATE-AGENCY ~ ~ . 1~:~y...'~ ~ ) ~ CORPORATION E~] PARTNERSHIP E~ COUNTY-AGENCY ~ FEDERAL-AGENCY CITY NAME STATE ZIP CODE P~.ONE it WITH AREA CODE I¥, BOARD OF EQUALIZATION LIST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise. v. us, F-] 8 STATEFUNO&CHIEFFINANCIALOFFICERLETTER [---] 9 STATE FUNO & CERTIFICATE OF DEPOSIT E~ 10 LOCALGOV'T. MECNANISM ~ 99 OTHER. VI, LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. i CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY COUNTY ft JURISDICTION # FACILITY # LOCATION CODE o OPTIONAL CENSUS TRACT # - OPTIONAL SUPVISOR- DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY, OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A (6-95) INSTRUCT[©NS FOR COMPLETI~NG FORM "A" GENERAL INSTRUCTIONS: '~ 5~ 9 ' 2528-~ ()F CH APTER SECTION 2711 OF TITLE 23, CHAPTER 16, CALIFORNIA CODE OF REGULATIONS AND SECTIONS 6.7, DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATING PERMIT. t, One FORM "A" shall be completed for all NEW PERMIT CHANGES or any FACILITY/SITE INFORMATION CHANGES. 2. SUBMIT ONLY ONE (I) FORM "A" for a Facility/Site, regardless of the number of tanks located at the sile. 3. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR. 4. Please type or print cle~ly all requested information. 5, Use a hard point writing instrument, you are making 3 copies, 6, Tank owner must submit a facility plot plan to the local agency a:~ par~ of the application showing buildings and landmarks [Section 2711 (a)(8), CCR]~ 7, Tank owner must submit documantation showing compliance with state financial responsibility requirements to lhe Iocal agency as part of the application for petroleum USTs [Secfitm 2711 (a)(l I ), CCR]~ TOP OF FORM: "MARK ONLY ONE ITEM" Mark an (X) in the box next to ~be item that best describes the mason the ibrm is being comple!ed. L FACILITY/SITE INFORMATION & ADDRESS (MUST BE COMPLETED) t, Record name and address (physioai location)of tire undergroand tomsk(s) NOTE: Address MUST have a valid physical location including city, state, and zip code, P.O. BOX NUMBERS ARE NOT ACCEPTABLE. Include neasest cross street and name of the opermor. 2. }>hone number must have m~ area code. If the night nnmber is the smm~, write "SAME" in proper location. 3. Check the appropriate box for TYPE OF BUSINESS OWNERS~tlP (ex. CORPORATION, INDIVIDUAL, etc.). 4. Check the appropriate box for TYPE OF BUSINESS. 5. If Facility/Site is located within an Indian reservation or other Indian trust lands, check the box mm'ked "YES", ~ . . 6, Indicate the NUMBER of TANKS at this SITE. 7. Record the E.P.A. ID # or write "NONE" in the space provide& II. PROPERTY OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete all items in this section, unless all items are the same as SECTION t; If{he same, write "SAME AS S1TE' across this section, Be sure to check PROPERTY OWNERSHIP TYPE box. tlL TANK OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete all items in this section, unless all items are lhe same :ks SECTION I; if the same, wrile "SAME AS SITE" across this section. Be sure to check TANTK OWNERS TYPE box. tV. BOARD OF EQUALIZATION UST STORAGE FF~ ACCOUNT NUMBER (MUST BE COMPLE'IT~D. SEE ARTICLE 5, CHAFI'ER 6.75, DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE.) Enter your Board of Equalization (BOE) UST storage f~ account number which is required before your permit application can be processe& Registration with the HOE will ensure that you will receive a qum'terty stora=e fe~ retain ~n reporting the per gallon fee due on the number of gallons placed in your USTs. The BOE will code persons exemtJl'-Oom paying the storage fee so returns will not be sent. If you do not have an account number with the BOE or if you have any questions regarding the fee or exemptions, please call the BOE at 916-322~9669 or write to the BOE at the following address Board of Equalization, Fuel Taxes Division, P.O. Box 942879, Sacmmento, CA 9427%0001. V. PETROLEUM UST FINANCIAL RESPONSIBILITY (MUST BE COMPLETED FOR PETROLEUM USTs ONLY. SEE SECTIONS 27t 1 (a)(11) OF TtTLE 23, CHAPTER 16, CALIFORNIA CODE OF REGULATIONS0 Identify the method(s) used by the owner and/or operator, in meeting the Federal 0J~d State financial responsibility req{firements. USTs owned by any Federal or State agency as welt as non-petroleum USTs are exempt from this requirement, VI, LEGAL NOTIFICATION AND BILLING ADDRESS Check ONE BOX for the address that will be used for'rB1OTH LEGAL AND BILLING NOTIFICATIONS. TANK OWNER OR AUTHORIZED REPRESENTAtiVE MUST SIGN AND DATE THE FOgM AS INDICATED. [SEE SECTIONS 271 t (a)(13) OF TITLE 23 CHAtYI'ER 16, CALIFORNIA CODE OF REGULATIONS.] INSTRUCTION FOR THE LOCAL AGENCIES ---lrhe county and jurisdiction numbers am predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number may '-':-abe assigned by the local agency; however, this number must be nmnefical and cannot contain any alphabetical characters. If the local agency prefers the Stale Board 1o assign the facility numlx:r, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCURACY OF TttE INFORMATION. THIS APPLICATION CANNOT BE PROCESSED IF THE HOE ACCOUNT NUMBER IS NOT FILLED IN. THE LOCAL AGENCY 1S RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW CO?lES. THE PINK COPY' SltOULD BE RETAINED BY THE TANK OWNER. ': STATE OF CALIFORNIA ~ STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE ONE ITEM [] 2 INTERIM PERMIT F-~ 4 AMENDED PERMIT [] 6 TEMPORARY SITE ,CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR F_~.ClLITY NAME NAME.OF OPERATOR ADDRESS NEAREST CROSS STREET PARCEL # (OPTIONAL) CITY NAME STATE ZIP CODE SITE PHONE # WITH AREA CODE ~,~k, ~""-"~-~ ~ ~ ~ CA v' BOX ~ CORPORATION [~ INDIVIDUAL F~} PARTNERSHIP [~ LOCAL-AGENCY ~ COUNTY-AGENCY ° ~ STATE-AGENCY * [~ FEDERAL-AGENCY * TO INDICATE DISTRICTS ° If owner o! UST is a public agency, complete the foliowing: name of supervisor of division, section or office which operates the UST EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST} PHONE #,WITH AREA CODE NIGHTS: NAME (LAST, FIRST} PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION-(MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS i~)~..~-lt'-'~ ~' box to indicate [~ INDIVIDUAL [~ LOCAL-AGENCY r~ STATE-AGENCY ~=.~ GO '-"~4~ &~--. J~ ~l(~ ~ CORPORATION F-") PARTNERSHIP m'~ COUNTY-AGENCY ; I'--") FEDERAL-AGENCY ~ I PHONE # WITH AREA CODE III. TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER CARE OF ADDRESS NFORMAT ON I MAILING OR STREET ADDRESS ~ box to iod~te ~'~ INDIVIDUAL r~ LOCAL-AGENCY ~] STATE-AGENCY I CORPORATION [~) PARTNERSHIP r--m OOUN'P/-AGENCY [~ FEDERAL-AGENCY I CITY NAME ) 8TATF~ ) ZIP CODE . I PI-JONE # WITH AREA CODE IV. BOARD OF EOUAL)ZATION UST STORAGE FEE ACCOUNT NUMBER - C~fl/910) $22-9609 ii questions ~dse. [~ 8 STATE FUND & CHIEF FINANCIAL OFFICER LETTER ~ 9 STATE FUND & CERTIFICATE OF DEPOSIT [~ 10 LOCALGOV"F. MECHANISM [--") 99 OTHER VI. LEGAL NOTIFICATION 'AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. I CHECK ONE BOX INDICATING WHICH A, BOVE. ADDRESS SHOULD BE USE. D FOR LEGAL NOllFICATIONS AND BILLING: I.[] II. ~-1 II1.~ THIS FORM HAS BEEN ~)MPLET£D UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, 18 TRUE AND ¢ORREGT [TAN OWNER'SNAME*RINTED&SIGNA R* , } I DATE MONTH,DAY. EAR LOCAL AGENCY USE ONLY I COUNTY tt JURISDICTION # FACILITY It LOCATION CODE - OPTIONAt I CENSUS TRACT # - O~TIONAt SU~¥1SOR - DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY.: OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A (6-95) INSTRUCTIONS FOR COMPLETI[NG FO~M "A" GENERAL INSTRUCTIONS: SECTION 27t 1 OF TITLE 23. CHAPTER 16, CALIFORNIA CODE OF REGULATIONS AND SECTIONS 25286, 25287. AND 25289 OF CHAPTER 6.7, DIVISION 20, CALIFORNIA HEALTII AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATING PERMIT. I, One FORM "A" shall be completed for all NEW PERMIT CHANGES or any FACILITY/SITE INFORMATION CHANGES, 2. SUBMIT ONLY ONE (I) FORM "A" for a Facility/Site, regardless of the uumber of tanks located at the site. 3. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR. 4. Please type or print clea'iy all requested information. 5. Use a hard point writing instrument, you are mi~ng 3 copies. 6. Tank owner must submit a facility plot plan to the local agency a~ part of the application showing the location of tt~e USTs wilh respect to buildings and landmarks [Section 2711 (al(8), CCR]. 7. Tank owner must submit documentation showing compliance with state financial responsibility requirements to lhe local agency as part of the application for petroleum USTs [Section 2711 (alii 1 TOP OF FORM: "MARK ONLY ONE ITEM" Mark an tX) in the box next to the ~tem that best describes the mason the form is being completed. I. t:;,~,CILITY/SITE INFORMATION & ADDRESS (MUST BE COMPLETED) I. Record name and address (physical location) of the underground tank(s). NOTE: Address MUST have a 'valid physical location including city, stme, an(l zip code, P.O, BOX NUMBERS ARE NOT ACCEPTABLE. hlclude nearest cross street and name of the operator. 2. Phone number must have oa~ area code. lfthe night number is the same, write "SAME" in proper toca_tion. 3. Check the appropriate box for TYPE OF BUSINESS OWNERSHIP (ex. CORPORATION~ IND1VIDUAL~ etc.~. 4. Check the appropriate box for TYPE OF BUSINESS. 5. If Facility/Site is located within an Indian reservation or other Indian trust lands, check the box marked 6. Indicate the NUMBER of TANKS at this SITE. 7. Record the E.P.A. ID # or write "NONE" in the space provided. II. PROPERTY OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete ail items in this section, unless ail items ,'u,e the same as SECTION I; If the same, write *'SAME AS SITE" across this section. Be sure to check PROPERTY OWNERSHIP TYPE box. ['-, IlL TANK OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete altjtems in this section, unless all items are the same as SECTION I; If the stone, write "SAME AS SITE" across this section. Be st~re to check TANK OWNERS TYPE box. IV, BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER (MUST BE COMPLETED. SEE ARTICLE 5. CHAPTER 6,75, DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE.) Enter your Board of Equalization (BOE) UST storage fee account number which is required before your permit application can be processed. Registration with the BOE will ensure that yon will receive a quagterly storage fee return in reporting the per gallon fee due on the number of gallons placed m your USTs. The BOE w~ll code persons exemp~from paying he storage fee so returns will not be sent. If you do not have an account number with the BOE or if you have any questions regarding thc fee or exemptions, please call the BOE at 916-322-9669 or write to the BOE at the £~Iowing ad_dross Board of Equalization, Fuel Taxes Division, P.O. Box 942879, Sacramento, CA 94279-0001. V. PETROLEUM US'[' FINANCIAL RESPONSIBILITY (MUST BE COMPLETED FOR PETROLEUM USTs ONLY. SEE SECTIONS 2711 (alii I) OF TIlLE 23, CHAI~fER 16, CALIFORNIA CODE OF REGULATIONS.) Identify the method(s) used by the owner and/or operator, in meeting the Federal and State financial responsibility req~imment.q. USTs owned by any Federal or State agency as well as non-petroleum USTs are exempt from this requirement, VI. LEGAL NOTIFiCATION AND BILLING ADDRESS Check ONE BOX for the address that w~ll be. used fo~B_B_-OTH LEGAL AND BILLING NOTIFICATIONS. TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SiGN AND DATE THE FORM AS INDICATED. [SEE SECTIONS 27l 1 (al(13) OF TITLE 23 CHAPTER 16, CALIFORNIA CODE OF REGULATIONS.t INSTRUCTION FOR THE LOCAL AGENCIES [~he county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number may be assigned by the local agency; however, tiffs number must be numerical and cannot contain any alphabetical ch,'u:acters, If the local agency prefers the State Board )o assign the facility number, plense leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCURACY OF TIlE INFORMATION. THIS APPLICATION CANNOT BE PROCESSED IF THE BOE ACCOUNT NUMBER tS NOT FILLED IN. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLO~ COPIES. THE PINK COPY'SIIOULD BE RETAINED BY THE TANK OWNER. g,'95 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE I ' MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED. SITE ONE ITEM [] 2 INTERIM PERMIT ~ 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATIO~N & ADDRESS - (MUST BE COMPLETED) DBA OR FACILITY NAME NAME OF OPERATOR "ADDRESS NEAREST CROSS STREET PARCEL ff {OPTIONAL) CITY NAME STATE ZIP CODE SITE PHONE # WITH AREA CODE v' BOX ~[~ CORPORATION ~ INDIVIDUAL [---] PARTNERSHIP r--] LOCAL-AGENCY [~] COUNTY-AGENCY* ~ STATE-AGENCY * ~ FEDERAL-AGENCY' TO INDICATE DISTRICTS · If owner of UST is a public agency, mmplete the following: name o! supervisor of division, section or office which operates the UST TYPE OF BUSINESS ~ 1 GASSTATION ~ 2 DISTRIBUTOR ~ v'IFINDIAN I# OF TANKS AT SITE I E.P.A. I.D.#(optional) ~ RESERVA'nON I ~ 3 FARM ~--~ 4 PROCESSOR r'~ 5 OTHER OR TRUST L~NDS I I EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional I DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ,~.~_.__~...j~,~;~. V' box tO hdc. ate r--I INDIVIDUAL ~ LOCAL-AGENCY ~ STATE-AGENCY ~ 2> ~'O .-~"O ~ ~--'~[{~' ~'~ ~ ~'"~/~ ~[*'~' ~ {~ ~ CORPORATION [~ PARTNERSHIP [~ COUNTY-AGENCY [~ FEDERAL-AGENCY CITY NAME STATE ZIP CODE PHONE # WITH AREA CODE III. TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS V' box to indicate J---i INDIVIDUAL [~] LOCAL-AGENCY ~ STATE-AGENCY ~,~.. ~ . ~,~'~. ~'~ ) ) ~ CORPORATION [~ PARTNERSHIP ~ COUNTY-AGENCY r--] FEDERAL-AGENCY CITY NAME STATE I ZIP CODE PHONE # WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise. (TK) HO V. PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED) - IDENTIFY THE METHOD(S) USED I v' box to indicate [~ 1 SELF-INSURED ~ 2 GUARANTEE r~] 3 INSURANCE ~ 4 SURETY BOND ~] 5 LETTER OF CREDIT r-~ 6 EXEMPTION ~ 7 STATE FUND r--'l 8 STATEFUND&CHIEFFINANCIALOFFICERLETTER ~ 9 STATE FUNO & CERTIFICATE OF DEPOSIT [~] 10 LOCALGOV'T. MECHANISM [--) 99 OTNER. VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. I CHECK ONE BOX INDICATING WHICH ADDRESS SHOULD BE USED FOR LEGAL NO'nFICATIONS AND BILLING: I. II. III. ABOVE THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ITANK OWNER'S NAME (PRINTED & SIGNATURE) % '~ 'L.~~,~,.(~'~ ~ ,~'~,.,, ,~.~,.....~ ~,,~ ,.~-~ ?.~5,~ ~- ~.-~'¢'~'"~'"~" ~"' '""~ ' ~'~ '] TANK OWNER'S TITLE/.~.~f lJ~'~' ~1 ~;~' O/"V~'~ [ DATE MONTHIDAY/YEAR LOCAL AGENCY USE ONLY I COUNTY # JURISDICTION # FACILITY # LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL SUPVISOR- DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF S~rE INFORMATION ONLY. OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A (6-95) ! .. XNSTRUCTX©NS FOR COMPLET][NG F©RM 'A" GENERAL INSTRUCTIONS: SECTION 2'/1 l OF TITLE 23,. CHAPTER 16~ CALIFORNIA CODE OF REGULATIONS AND SECTIONS 25286, 2528?. AND 25289 OF CHAPTER 6,?, DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATING PERMIT. I, One FORM 'A" shaIl be completed for alt NEW PERMIT CHANGES or any FACILITY/SITE INFORMATION CHANGES. 2. SUBMIT ONLY ONE (1) FORM "A" for a Facility/Site, regardless of tl~e numar of tanks toca~ed m the si~e. 3. This form should ~ completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK ~NSPECTOR. 4. Ple~se type or print clec~[y all requested infon[mtiom 5. Use a hard point writing instalment, you nm m~ing 3 copies. 6. Tank owner must submit a facility plot plan to the local agency as pm~ of the application showing lhe location of the USTs wilh respect to buildings and landm~ks [Section 271 ~ (a)(8), CCRi. 7. T~k owner must submit documentation showing compliance with state financial msponsibiiity requirements to lhe local agency as par of the application for petmlet~m USTs [Section 2711 (a)(1 I), CCR]. TOP OF FORM: "MARK ONLY ONE ITEM" M~k an (X) in the box next to d~e item that ~s~ describes the ~eason d~e form is being completed. 1. FACILITY/SITE INFORMATION & ADDRESS (MUST BE COMPLETED) I. Record nmne and address (physical Iocadon) of the underground lank(s). NO~: Address MUST have a vat~d physical location including c~ty, stme, and zip code~ P.O. BOX NUMBERS ARE NOT ACCEPTABLE~ Include nemst cross street and Bame of the operator. 2, Phone number must have m~ a~a code. if the negbt m~mber is the same, write "SAME'~ ~n proper 3. Check the appropda~e box for TYPE OF BUSINESS OWNERS/tIP (ex, CORPORATION~ INDIVIDUAL, otc,), 4. Check the appropriate box for TYPE OF BUSINESS, 5. If Fadlity/Site is Iocmed w~thin an Indian msmw'ation or other tn&an trust l~nds, check ~he box m~ked "YES", 6, Indicate the NUMBER of TANKS at thb 7. Record the E.P,A. ID 8 or w~te "NONE*~ ~n the spac~ provkb& IL PROPERTY OWNER tN~ORMATION & ADDRESS (MUST BE COMPLETED) Complete all items in this section, unless ~1 items ~e the same as SECTION 1; lf~he same, write "SAME AS SI~E" across t~tis section. Be sum to check PROPERTY OWNERSHIP TYt~ box. llI. TANK OWNER INFORMATION & ADDRESS (MUST BE COMPUETED) Complem all items in ~his section, unless ali i~ems ~e the same mg SECTION i; ff the saone, whte "SAME AS SITE*' across this section. Be sure to cheek TANK OWNERS TYPE box. tV. BOARD OF EQUALIZATION UST STORAGE F~ ACCOUNT NUMBER (MUST BE COMPLE'I~D. SEE ARTICLE 5, CHAPTER 6.75, DIVISION 20, CALIFORNIA HEALTH AND SALTY CODE) Enter your Bo~d of Fqualization (BCE) UST storage f~e account number which is required bdbre your ~rmi~ application can be processed. Registration with the BCE will ensure that you will receive a qumxerly storage ftm mmm in reporting the per gallon fee due o~ the numL~r of g~lons placed in your USTs. The BCE will code persons exempt from paying the storage fee so returns will not be sent. ffyou account number with the BCE or if you have any questions regarding the fee or exemptions, please call the BCE at 916-322-9669 or write to the BOE at the following address Board of ~uatization, Fuel T~es Division, P.O. Box 942879, Sacramento, CA 94279-0001. V. PETROLEUM UST FINANCIAL RESPONSJBILITY (MUST BE COMPLETED FOR PETROLEUM USTs ONLY. SEE SECTIONS 27t 1 (a)(l 1) OF TIT~ 23, CHAPTER I6, CALIFORNIA CODE OF REGULATIONS.} Identify the method(s) used by tt~e owner and/or operator, in meeting the Federal m~d State financial responsibility requirements, USTs owned by any Federal or State agency as we[I as non-petrolemn USTs are exempt from this requirement, VI. LEGAL NOTIFICATION AND BILLING ADDRESS Check ONE BOX R)r the address that wilt be ~sed for BOTH LEGAL AND BILLtNG NOTt~ICATK)NS. TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDICATED. [S~ SECTIONS 2711 (a)(13) OF TITLE 23 CHAFI~R 16, CALIFORNIA CODE OF REGULATIONS..} INSTRUCWION FOR THE LOCAL AGENCIES The county and ju~diction numbem m predetermined and can be obtained by calling the State Board (916) 227-4303. The facility numar may be assigned by the local agency: however, tiffs numar must ~ numerical and cannot contain any alphabetical ch~wactem, ff the local agency prefers the Stale Bomrd Io assign the facility numar, plmse leave it blank~ IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY TttE ACCURACY OF TIlE INFORMATION. THIS APPLIC,~FiON CANNOT BE PROCESSED IF THE BCE ACCOUNT NUMBER 1S NOT FI~ED IN. THE LOCAL AGENCY 1S RESPONSIBLE FOR THE COMPLETION OF THE *'LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE P1NK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED BBA OR FACILITY NAME WHERE TANK IS INSTALLED: ~ '~[:~::> I~-, ~ )--1~3 L-- ~ ~ ~ I ~ I. TANK DESCRIPTION COMPL~E ALL ITEMS - SPECI~ IF UNKNOWN C. DATE INSTALLED (MO~AY~EAR) i ~ ~ D. TANK CAPACI~ IN GALLONS: I O t ~ ~ II, TANK CONTENTS IF A-1 IS MARKED, COMPL~E I~M C. ~ ~ I MOTOR VEHICLE FUEL ~ 4 OIL B. C. ~ la REGU~R UNL~ED ~ 3 DIESEL ~ 6 AVIATION GAS 1c MmDGR~E UNLADED ~ 5 JETFUEL ~ B U85 ~ 3 CHEMIC~PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER(DESCRIBE~NITEMD. B~0~ III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS ~ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTallk) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING OR [] S GLASS LINING {~ 6 UNLINED [] 95 UNKNOWN [] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES ~ NO__ D. EXTERIOR [] I POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION [] 5 CATHODIC PROTECT]ON [] 91 NONE [] 95 UNKNOWN [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) ~/ - OVERFILL P~EVENTION EQUIPMENT INSTALLED (YEAR) E. SPILL AND OVERFILL, etco DROP TUBE YES ~ NO STRIKER PLATE YES ~ NO DISPENSER CONTAINMENT YES ~- NO IV, PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A, SYSTEMTYPE A U 1 SUCTION ~)2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A(~2 DOUBLE WALL A U 3 LINED TRENCH A IJ 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A(~)4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 1 I~ECP~NiCAL UNE LEAK [] 2 LiNE TIG~i'fN~.SS m 3 CONTINUOUS INTER$'~flAL [] 4 ELEGmO~IIC tINE ~ 5 AU30/~TIC PUMP DETECTOR TESTING ~ MONITORING LEAK DETECTOR .~ SHUTDOWN [] g9 OTHER V. TANK LEAK DETECTION [] 1 v,su^L C.ECK [] ~ MA.UAL INVENTORY [] ~ VADOZE []. AUTOMATIC T^N~ [] ~ GROU.D WATER [] B ANNUALTAN~ I VI. TANK CLOSURE INFORMATION (P~RUAN~.T CLOSUR~ 1. ESTIMATED DATE ~ST USED (MO/DAY, R) 2. ESTIMATED QUANTI~ OF 3. WAS TANK FILLED WITH YES SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STA~ I.D. NUMBER IS COMPOSED OF THE F UR NUMBERS BELOW COUN~ ~ JURISDICTION ~ FAClLI~ ~ TANK ~ m STATE I.D:~ ~ I ) II II ) I )))I II1 ) I PERMIT NUMBER PERMIT APPROVED BY.ATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT P~N. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS FORM B INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for alt NEW PERMITS, PERMIT CHANGES:i REMOV- ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3.Please type or print cIearly ail requested information. 4,Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. Tank owners must submit documentation showing compliance with state financial responsibility require- ments to the local agency for petroleum USTs [2711 (a)(l 1) CCR]. TOP OF FORM: MARK ONLY ONE ITEM L 1. Mark an (X) in the box next to tl~.~;ttem that best de.s~_ribes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. t. TANK DESCRIPTION - COMPLETE ALL ITEMS ~ IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.), II. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. tf not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & Check the appropriate box. C.Check the type of MOTOR VEHICLE FUEL (if box t is checked in rA)~ D. Print the chemical name of the hazardous substance stored in the .fACnk and the C.A.S.#. (Chemical Abstract Service number), if box 1 is NOT checked in A. 111. TANK CONSTRUCTION ~ MARK ONE ITEM ONLY IN BOX A, ,B~-,.C & D 1, - -Check only one item in TYPE OF SYSTEM, TAN*-MATERIAL tN~IOR LINING and CORROSION PROTECTION. 2. If OTHER, print in the space provided. IV. PIPING INFORMATION ', 1. Circle"A" if above ground circle "U" if underground, and circle both if applicable. 2. tf UNKNOWN circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requ!rement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to comply with the.monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE · 1, ESTIMATED DATE LAST USED ~ MONTH/YEAR (January, 1988 or'01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). L_ 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 27i I (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state t~qderground storage tank identification nu~.ber is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the. six digit tank number. The county and jurisdiction numbers ~ire predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A'L The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank, tT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGE~ICY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK O¥¥NER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B ~ COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. '- MARK ONLY .~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM[~ 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ~-] 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS lNSTALLED: ~ ~.¢~(~;::> ~,, ~"~ ~.-~/~ ~ ~ ~ I. TANK DESCRIPTION COMPLETE ALL ITEMS - SP~CI~ IF UNKNOWN I ~ OWNER'S TANKI'D'' ~ '. B' MANUFACTURED BY: ~+') ~~1~~ [ C. DATE INSTALLED (MO~AY~EAR). I ~ ~ D. TANK CAPACI~ IN GALLONS: ~ ~ ~ ~ ~ II, TANK CONTENTS ~F A-1 IS MARKED, COMPL~E ITEM C. ' ~ ~ I MOTOR VEHICLE FUEL ~ 4 OIL B. C. ~ la REGU~R UNLADED ~ 3 DIESEL ~ 6 AVIATION GAS ~ 2 P~ROLEUM' ~ 80 EMP~ ~ 1 PRODUCT ~ lb PREMIUM UNL~ ~ 4 GASAHOL ~ 7 ME~ANOL lC ~ UNLADED ~ 5 JETFUEL ~ 8 M85 ~ ~ c.~,c~..oouc~ ~ ~s u.~.owN ~ ~ w~sTE ~ ~ ~D~D ~ ~ O~.~O~SC.~,~,~O.~0~ O. ,~.~,S.O~.~D. ~.TE..~ O~SU~S~.C~ S~O.~O C.~. S..: III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] . 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL .,..i. [] 4 SINGLE WALL IN A VAULT [] 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 [] S 100% METHANOL COMPATIBLE W/FRP (PrilllaryTallk) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [] 1 RUBBER UNED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING OR [] 5 GLASS LINING g 6 UNLINED [] 95 UNKNOWN . [] 99 OTHER 'COATING ~s LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES~ NO__ D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC CORROSION ~'~' [] 95 UNKNOWN OTHER PROTECTION [] 5 CATHODIC PROTECTION'"m 91 NONE [] 99 SPILL CONTAINMENT INSTALLED (YEAR) E. SPILL AND OVERFILL, etc. DROP TUBE YES V NO , STR KKR PLATE YES ~' NO DISPENSER CONTAINMENT .YES ~ NO IV. PIPING INFORMATION C~RCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 sucTION ~2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U' 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL 2 DOUBLE WALL A U 3 LINED TRENCH ALI 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLOR~E(P~C)A{~4 FIBERGLASS PIPE CORROSION A U' 5;~ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING ' A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9"~ALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [~' aECHR,ICAL UNE LEAK r--12 uNE ~GmNESS ~3 CONT,NUOUS ,NTERSTmAL I----I4 ~LECTRON,C L,NE [~5 AUTO~T,C PUMP DETECTOR TESTING MONITORING ~ LEAK OETECTOR SHUTDOWN [] 99 OTHER V. TANK LEAK DETECTION J 6 ANNUAL TANK [] 1 VISUAL CHECK [] ~ MANUAL INVENTORY [] 3 VADOZE [] 4 AUTOMATIC TANK [] 5 GROUND WATEI~ [] TESTING j 7 CONTINUOUSMoNiTORiNG INTERSTITIAL [] B. SIR [] 9 TANKWEEKLYGAuGINGMANUAL [] 10 TESTINGMONTHLY TANK [] ~ UNKNOWN [] ~ OTHER VI. TANK CLOSURE INFORMATION ('PERMANENT CLOSURE ~N-PLACE) J 1. ESTIMATED DATE LAST USED (Mo/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES[] NOJ-~ SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER 'PENAL TY OF'PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND cORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW JCOUNTY # JURISDICTION # FACILITY # TANK # STATE I.D:# SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS [FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (6-95) INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety' Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGER REMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3. Please type or print dearly all requested information. Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. Tank owners must submit documentation showing compliance with state financial responsibility require- ments to the local agency for petroleum USTs [27I 1 (a)(11) CCR]. TOP OF FORM: MARK ONLY ONE ITEM' 1. Mark an (X) in the box next to the'--~tem that best desc~iibes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is instaIIed. TANK DESCRIPTION - COMPLETE ALL ITEMS - tF UNKNOWN - SO SPECIFY A. indicate owners tank tD # - tf there is a tank number that is used by the owner to identify the tank (ex. AB70789). B, Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). --~ C. Indicate the year the tank was installed (ex. t987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). II. TANK CONTENTS 1. IF MOTOR VEHICLE FUEL, check box t and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. Check the appropriate box. C.Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box I is NOT checked in A. II1. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, ELm C & D t. --Cq-~eck only one item in TYPE OF SYSTEM, TANK.MATERIAL, INTERIOR LINING and CORROSION PROTECTION. 2. tf OTHER, print in the space provided. PIPING INFORMATION 1. Circle' "A" if above ground circle "U" if underground, and circle both if applicable. 2. If UNKNOWN ~:ircle; or if OTHER, print in space provided, 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V, TANK LEAK DETECTION , I 1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED ~ MONTFt£YEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank lin Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 27tt (a)(t3) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and tlie six digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form 'W'. The tank number may be assigned by the local agency, however, this number: must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. tT IS TRE RESPONSIBILITY'OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION, THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" .INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY '~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ONSITE1 ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS INSTALLED: ~"t '/..~,~ ~.~ 1 ,~) ~.~/~ ~,~.~ ~¢'~ ~'~. I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. #~::Jo,~.~,_,,~. t B. MANUFACTURED BY: C. DATE INSTALLED (MO/DAY/YEAR) I ~ t z""i~ D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. A. [] 1 MOTOR VEHICLE FUEL [] 4 OIL B. C. ~ la REGULAR UNLEADED [] 3 DIESEL [] 6 AVIATION GAS lb PREMIUM UNLEADED [] 4 GASAHOL [] 7 METHANOL [] 2 PETROLEUM [] 80 EMPTY ~ I PRODUCT [] lc MIDGRADE UNLEADED [] 5 JET FUEL [] 8 M85 [] 3 CREMICALPRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. BELOW) O. IF(A, 1) IS NOT MARKE9, ENTER NAME OF SUBSTANCE STORED C.A.S.#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXDANDE A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT [] 99 OTHER ri. TANK [] I BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS ~ 4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrJmaryTallk) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [] I RUBBER UNED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING OR [] 5 GLASS LINING ~ 6 UNLINED [] 95 UNKNOWN [] 99 OTHER COATING is LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES~..~.. NO__ D. EXTERIOR [] 1 POLYETHYLENE WRAP '[] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION [] 5 CATHODIC PR(~TECT1ON ~ 91 NONE . [] 95 UNKNOWN [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) ~ ~ OVERFILL~EVENTiON EQUIPMENT INST~,LLED (YEAR) E. SPILL AND OVERFILL, etc. DROP TUBE YES ~ NO__ STRIKER PLATE YES ~ NO DISPENSER CONTAINMENT YES ~ NO IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION ~2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~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 COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 1DETECToRMECHANICAL UNE LEAK ~r-"-m 2 TESTINGLINE TiGHTNESS 0~ 3 MONITORINGCONTINUOUS INTERSTITIAL [] 4 t. EAKELECTRONICDETECToRLINE [] 5 AUTO~,TICsHuTDowN PUMP [] 99 OTHER ¥. TANK LEAK DETECTION [] 1 v,SUAL C.ECK [] ~ MANUAL ,NVENTORY [] ~ VADOZE []. AUTOMAT,C TANK []~ GROUND WATER [] ~ ANNUALTANKI RECONClL,AT,ON MONITOR,.G GAUG,NG MON.TOR,NG TEST, NG [] ~ CONTIN~O~SINTERS~TIAL [] ~ S,R [] ~ WEEKL~ MANUAL [] 10 MONTHLY TANK [] ~ UNKNOWN [] ~ OTHER I MONITORING TANK GAUGING TESTING VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) I 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OFsuBSTANCE REMAINING GALLONS ) 3. WAS TANK FILLED WITRiNERT MATERIAL ? YES[] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY', AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS riELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D:# ~-~I I I I I I I I I '1 I II I I / PERMIT NUMBER I PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD SE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES, REMOV-' ALS and/or any other TANK INFORMATfON CHANGE. 2. This form should be completed by eitiqer the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. Please type or print clearly a~ requested information. Use a hard point writing instrument, you ara making 3 copies, 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buiIdings and landmarks [2711 (a)(8) OCR], Tank owners must submit documentation showing compliance with state financial responsibility require- ments to the local agency for petroleum USTts [27I 1 (a)(l 1) CCR]. TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to the item that best describes the reason tile form is being completed. 2. Indicate the DBA or Facility name where the tank is instaIIed. I. TANK DESCRIPTION ~ COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank iD # ~ If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the 'tank (ex. ACME TANK MFG). C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). TANK CONTENTS 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B.Check the appropriate box. CoCheck the type of MOTOR VEHICLE FUEL (if box 1 is checked in A). D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box 1 is NOT checked in Ac III. TANK CONSTRUCTION-MARK ONE ITEM ONLY tN BOX A, B, C & D 1, Check only one item in TYPE OF SYSTEM, TANK ivIATERIAL, INTERIOR LINING and CORROSION PROTEGTION. 2. tf OTHER, print in the space provided. lV. PIPING INFORMATION 1. Circle "A" ff above ground circle ~'U" ii underground, and circle both if applicable. 2. If UNKNOWN circle; or if OTHER, print in space provided, 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION I. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1, ESTIMATED DATE LAST USED - MONTH/fEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digk jurisdiction number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY {~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBAOR FACiLITY NAME WHERE TANK IS INSTALLED: ~/~=,~ ~'~__--~t ~ ~ ~ ~--1 t~ I. TANK DESCRIPTION COMPLETE ALL ~TEMS - SPEC~ ~F U,KNOWN C. DATE INSTALLED (MO~AY~EAR) l ~ ~ D. TANK CAPACI~ IN GALLONS: j~[ ~ II. TANK CONTENTS ~ A-1 IS MARKED, COMPL~E I~M C. ~ 3 CHEMIC~PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER(DESCRIBEIN~MD. BEL0~ D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: III. TANK CONSTRUCTION MA.K O"~ ~T~M ONLY ~" BOXSS A. B. AND C, AND ALL ~AT APPUES ~N aOX ~ ANO ~ A. ~PE 0F ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WI~ E~ERIOR UNER ~ 5 I~L B~DDER SY~M ~ 95 UNKNOWN SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER B. TANK ~ 1 BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERG~SS ~ 4 STEELC~D W/FIBERG~SS REINFORCED P~STIC MATERIAL ~ 5 CONCRETE ~ 6 POLWINYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% METHANOL COMPATIBLEW~.P (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER C. INTERIOR ~ 1 RUBBER UNED ~ 2 AL~D LINING ~ 3 EPOXY UNING ~ 4 PHENOLIC LINING LINING OR ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING IS LINING MA~RIAL COMPATIBLE WI~ 100% ME~ANOL ? YES ~ O. E~RIOR ~ ~ POLY~HYLENE W.AP ~ 2 COA~NG ~ 3 WNYL WRAP ~ 4 F~BERG~SS RE~NFORCED P~ST~C CORROSION PROTEC~ON ~ 5 CA~OOICPROTEC~ON ~ 91 NONE ~ 9S UNKNOWN ~ 99 OTHER SPI~ CONTAINMENT~I~STALLED (Y~R) ~ OVERFI~PREVENTION EQUIPMENT INSTALLED (YEAR) E. SPILL AND OVERFILL, etc. DROP TUBE YES ~ NO STRIKER P~TE YES ~ NO DISPENSER CONTA NMENT YES IV. PIPING INFORMATION C~.CLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM ~PE A U I SUCTION ~ 2 PRESSURE A U 3 GRAVI~ A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A~2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND A U 1 BARE S~EL A ~ 2 STAINLESS S~EL A U 3 POLWINYL CHLORIDE (PVC)A~4 FIBERG~SS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CA~ODICPROTEC~ON A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~DE~0RMEC~I~L UNE L~K ~ 2 TES~NGLINE TIGmNESS ~ 3 CONTINUOUSMoNiTORiNG INTERS~AL ~4 L~KELE~ONICDE~CToRUNE ~5 A~O~TICsHu~ PUMP ~ 99 O~ER V, TANK LEAK DETECTION ~ ' VISUAL CHECK ~ 2 MANUAL INVENTORY ~ 3 VADOZE ~ 4 AUTOMATIC TANK ~ 5 GROUND WATER ~ 6 ANNUAL TANK I ~ 7 CON~NUOUSINTERS~TIAL ~ 8 SIR ~ 9 WEEKLY MANUAL ~ 10 MONTHLY TANK ~ 95 UNKNOWN ~ 99 OTHER I ~ON,TOR'N~ TA,K ~AUG,NG TESTING VI. TANK CLOSURE INFORMATION (P~RUAN~.T CLOSUR~ I 1. ESTIMATED DATE ~ST USED (MO~AY~R) 2. ESTIMATED QUANTI~ OF 3. WAS TANK FILLED WITH YES ~ NO~ SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENAL ~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I I LOCAL AGENCY USE ONLY THE STA~ I.D. NUMBER IS COMPOSED OF THE ~UR NUMBERS BELOW COUN~ ~ JURISDICTION ~ FAClLI~ ~ TANK ~ PERMIT NUMBER PERMIT APPROVED BY.ATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE ACOOMPANIED BY A PLOT P~N. FILE THIS FORM WITH THE LO~AL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS FO~M B INSTRUCTIONS FOR COMPLETING FORM GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safeb, Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shalt be completed for each tank for ali NEW PERMITS, PERMIT CHANGES. ,: REMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. PleaSe type d~'print clearly all requested information. Use a hard point writing instrument, you are making 3 copies. 5. Tank owner's must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]~ Tank owners must submit documentation showing compliance with state financial responsibility require- ments to {he local agency for petroleum USTs [27I 1 (a)(1 t) CCR]. TOP OF FORM: MARK ONLY ONE 1. Mark an (X) in the box next to the.item that best de~bes the reason the form is being completed. 2. Indicate the DBA or Facility nar~-, 'where the tank is installed. I. TANK DESCRIPTION - COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - if there is a tank number that is used by the owner to identify the tank (ex. AB70789). B, Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the yea~ the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). 11. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and compIete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name of the hazardous substance stored in the~flk and the C.A.S.#. (Chemical Abstract Service number), if box I is NOT checked in A. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B,,C & D I. ~- Check only one item in TYPE OF SYSTEM, TANK-MA~TERIAL, IN'~IOR LINING and CORROSION ' ' 'PROTECTION. 2. tf OTHER, print in the space provided. PIPING INFORMATION 1. Circle "A" if above ground circle 'U" if underground, end circ!e b-otb if applicable. 2. If UNKNOWN-Circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to compL~y with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED ~ MONTH/YEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of th~ two .digit county number, the three digit jurisdiction number, the six digit facility number and th~ ~ix digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet, tf the local agency prefers the State Board to assign the tank number, please leave it blank. tT tS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY"-INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE' RETAINED BY' THE TANK OWNER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION·- FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~' 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] '~ PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK ~EMOVED 0 AOR FAO,L NAMEW.ERETA.K,S,.STALLED: I. TANK DESCRIPTION COMPLETE ALL ~TEMS - SPEC=FY ~F UNKNOWN C. DATE 'NSTALLED (MO/DAY. EAR) I '~ ~ o. TANK CAPACI~ ,N GALLONS: ~--~ ~ I1. TANK CONTENTS m A-1 ~s MARKED, COMPLETE ITEM C. A. ~ 1 MOTOR VEHICLE FUEL [] 40IL~.i B. C. ' '~' la REGULAR UNLEADED [] 3 DIESEL [] 6 AVIATION GAS [] ~ P~ROLEUM [] ~o EMP~ ~., PRODUCTL_J 1,~ ~.~..~. ~.~ [] , GASA.O'- [] , METHANOL  lc IViiDGRADE UNLEADED [] 5 JETFUEL [] B MBS [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE 2 LEADED [] 99 OTHER(DESCR)BEINITE. D. BEL0W} D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. #: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ~ 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL ",.~:. · [] 4 SINGLE WALL IN A VAULT [] '99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS' ~'4 STEEL CLAD W/ FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] S 100% METHANOL COMPATIBLE W/FRP (PriaaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OT~ER C. INTERIOR "[~ 1 RUBBER UNED [] 2 ALKYD LINING [] 3 EPOXY UNIN~' [] 4 PHENOLIC LINING LINING OR [] S GLASS LINING I 6 UNLINED [] 95 UNKNOWN. []' 99 OTHER COATING IS LINING MATERIAL COMPATIBLE Wi~.l.100% METHANOL? YES__ NO__ D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COAT1NG [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC . CORROSION PROTECTION [] 5 CATHODIC'PROTECTION i~ 91 NONE [] 95 UNKNOWN [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) ""1~ OVERFIL~PREVENTION EQUIPMENT INSTALLED (YEAR) ~ ~ E. SPILL AND OVERFILL, etc. DROP TUBE YES .~. NO STRIKER PLATE YES ~ NO DISPENSER CONTAINMENT YES ~ NO IV. PIPING INFORMATION C~RCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~) 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A(~2 DOUBLE WALL A U 3 LINED TRENCH A, U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARESTEEL A U 2 STAINLESS STE~EL A U 3 POLYVINYL CHLORiDE(PVC)A~4 FIBERGLASS PIPE CORROSION A U' 5 ALUMINUM A U 6 CONCRETE ,~' A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION 'A U 9' GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 1 UECHANI~L UNE LF~K [] 2 UNE TIGHT,ESS ~ 3 CON'rl,uous IHTERS?mAL ~ 4 ELECTRONIC UNE ~ 5 AUTOmaC PUMP OETECTOR TESTING ~ MONITOR~IG ~J LEAK DETECTOR ~ SHUT[X3WN [] 99 OTHER V. TANK LEAK DETECTION ' , [] , v,SUAL C.ECK [] ~ MANUAL ,NVENTORY[] ~ VADO~E [], AUTOM~T,C TANK[] ~ ~ROUND wATER [] ~ ANNUALTANK I t~ ~MONITOR.NGCONT'NUOUS'NTERSTITIAL [] ~, S,R [] ~ TANKWEEKLYGAuG.NGMANUAL [] ,0 TEST. NGMONT"LY TANK' [] .~ UNKNOWN [] ~ OT.ER. I VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) ' 1. ESTIMATED DATE LAST USED (MOFOAY/YR) 2. ESTIMATED QUANTITY OF } 3. WAS TANK FILLED WITH vEs I ' SUBSTANCE REMAINING GALLONSINERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND cORRECT TANK OWNER'S NAME ' . ~' ' '" LOCAL AGENCY USE ONLY THE sTATE I.D. NUMBER IS COMPOSED OF TflE F~O"UR NUMBERS BELOW " I COUNTY # JURISDICTION # ,FACILITY # TANK # . I PERMIT NUMBER I PERMIT APPROVED BY/DATE PERM!T EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUNO STORAGE TANK REGULATIONS ~ORMB INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety' Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES__~,', REMOV- ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3. Plea-se type drprint clearly all requested information. 4. Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the loca~ agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. 6. Tank owners must submit documentation showing compliance with state financial responsibility require- ments to :(he local agency for petroleum USTs [2711 (a)(l 1) CCR], TOP OF FORM: MARK ONLY ONE tTE~,I 1. Mark an (X) in the box next to the item that best desc~bes the reason the form is being completed. 2. Indicate the DBA or Facility nar~teZ'where the tank is installed. I. TANK DESCRIPTION - COMPLETE ALL ITEMS ~ IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # ~ If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). .'___i C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). Il. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box t and complete items B & Co 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. Check the appropriate box. C.Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in iA)~ D. Print the chemical name of the hazardous substance stored in the t-~'nk and the C.A.S.#. (Chemical Abstract Service number), if box I is NOT checked in A. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B, C & D 1. - Check only one item in TYPE OF SYSTEM, TANK-.MA.TERIAL IN]~IOR LINING and CORROSION ' ' PROTECTION. 2. If OTHER, print in the space provided. IV. PIPING INFORMATION Circle' 'W' if above ground circle "U" if underground, and circle both if applicable. 2. if UNKNOWN~ircte; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring require, merit for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to compL--~y with the monitorin9 requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED - MONTHtYEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). I_~ 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 27tt (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility n~mber and thc-six digit tank numbe}. The'county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facilit,/number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If tf~e local agency prefers the State Board to assign the tank number, please leave it blank. tT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B' COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK ,REMOVED DBAOR FAClLITY NAME WHERE TANK IS lNSTALLED: ~ ~/.~ ~-~3 ~t~;~ ~.~ ~ ~..~ ( ~__ ] ~ ~ I. TANK DESCRIPTION COM~T~ ~ ~T~S - SP~C~ ~F UN~NOW~ C. DATE INSTALLED (MO~AY~EAR) J ,~ ~ D. TANK CAPACI~ IN GALLONS: j~i ~ I II. TANK CONTENTS ~F A-1 IS MARKED, COMPL~E ~TEM C. ~ ~ 1 MOTOR VEHICLE FUEL ~ 4 01~ B. C. ~ la REGU~R UNLADED ~ 3 DIESEL ~ 6 AVIATION GAS ~ 2 P~.OLEUM ~ 80 EMP~ ~ 1 PRODUCT ~ lb PREMIUM UNL~ ~ 4 GASAHOL ~ 7 METHANOL  lC MIDGR~E UNLADED ~ 5 JETFUEL ~ 8 M85 ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE 2 LEADED ~ 99 O~ER(DESCRIBEINffEMD. BEL0~ D. IF (A. 1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B, AND C. AND ALL THAT APPLIES IN BOX D AND E A. ~PE 0F ~ ~ DOUBLE WALL ~ 3 SINGLE WALL WI~ EXTERIOR LINER ~ 5 ~N~RNAL B~OER SYS~M ~ 95 UNKNOWN SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER B. TANK ~ 1 BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERG~SS ~ 4 STEEL C~O W/FIBERG~SS RE{NFORCED P~ST[C MATERIAL ~ 5 CONCRETE ~ 6 POL~INYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% METHANOL COMPATIBLEW/FRP (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER C. INTERIOR ~ 1 RUBBER MNED ~ 2 AL~D LINING ~ 3 EPOXY MNING ~ 4 PHENOLIC LINING LININGOR ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING ~S LINING MA~RIAL COMPATIBLE Wl~ 100% METHANOL? ~S~ NO~ D. E~RIOR ~ 1 POLY~YLENE WRAP ~ 2 COA~NG ~ 3 VINYL WRAP ~ 4 FIBERG~SS REINFORCED P~STIC :' CORROSION PROTEC~0N ~ 5 CA~ODICPRO~C~ON ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER OVERFI~ PREVENTION EQUIPMENT INSTALLED (YEAR) ~ ~ , SPILL CONTAINMEN~INSTALLED (Y~R) ~ ~ E. SPILL AND OVERFILL, etc. DROP TUBE YES ~ NO STRIKER P~TE YES ~ NO DISPENSER CONTAINMENT YES ~ NO IV. PIPING INFORMATION C,RCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM~PE A U I SUCTION A~2 PRESSURE A U 3 GRAVI~ A U 4 FL~IBLEPIPING A U 99 OTHER , B, CONSTRUCTION A U 1 SING~ WALL A 2 ~UBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE S~EL A U 2 STAINLESS S~EL A U 3 POL~INYL CHLORIDE(PV~)A~4 FIBERG~SS ~IPE C0RROSION A U 5, ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U .' 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U ~':~GALVANIZED STEEL A U 10 CATHODIC PROTEC~ON A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1O~T~CToRMEC~I~ LINE L~K ~ 2 ~S~NGMNE T~G~NESS ~3 CONTINUOUSMo~ORING I~ERSTmAL ~ 4 ~KE~C~ONIC~cToRUNE ~ 5 A~O~C~u~ PUMP ~ 9~ V. TANK LEAK DETECTION ~ 1 VISUAL CHECK ~ 2 MANUAL INVENTORY ~ 3 VADOZE ~ 4 AUTOMATIC TANK ~ 5 GROUND WATER RECONCILIATION MONITORING GAUGING MONITORING TESTING ~ 7 CON~NUOUSINTERS~TIAL ~ 8 SIR ~ 9 WEEKLY MANUAL ~ 10 MONTHLY TANK ~ 95 UNKNOWN ~ 99 OTHER I MONITORING TANK GAUGING TESTING VI. TANK CLOSURE INFORMATION (P~R~AN~NT CLOSUR~ ~N-P~C~) ~ 1. ESTIMATED DATE ~ST USED (MO/DAY~R) 2. ESTIMATED QUANTI~ OFsuBSTANCE REMAINING GALLONS 3. WAS TANK FILLED WlTHiNERT MATERIAL ? YES ~ THIS FORM HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY ~E STA~ I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW'  COUN~ ~ JURISDICTION ~ FACtLI~ ~ TANK ~ STATE ,D: I I J I I I IJ PERMIT APPROVED BY/DATE  PERMIT NUMBER PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS SEEN FILED. FORM C MUST BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT P~N. FILE ~IS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS FORM B (6-95} INSTRUCTIONS FOR COMPLETING FORM GENERAL INSTRUCTIONS Section' 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for al~ NEW PERMITS, PERMIT CHANGES, REMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2. This form shouId be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3. Please type or print dearly all requested information. 4 Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit ~ plot ptan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. 6, Tank owners must submit documentation showing compliance with state financiat responsibility require- ments to the local agency for petroleum USTs [27I 1 (a)(1 t) CCR], TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or Facitity name whom the tank is instatIed. 1. TANK DESCRIPTION ~ COMPLETE ALL ITEMS * IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 28,000 or 10,000 etc.). 11. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Sera, ice number), ii: box I is NOT checked in A. I11. TANK CONSTRUCTION-MARK ONE ITEIVl ONLY IN BOX A, B, C & D 1, Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTECTION. 2. If OTHER, print in tt~e space provided. IV. PIPING INFORMATION 1. Circle "A" if above ground circle "U" if underground, and circle both if applicable. 2. tf UNKNOWN circle; or if OTHER~ print in space provided, 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION I. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. Vl. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAS'T USED ~ MONTH/YEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by,galling the State Board (916) 227~4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank, IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION, THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE1 ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS INSTALLED: c~ ~,~ t~i~----, V)~'It~-I~ I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECI~ IF UNKNOWN C. DATE INSTALLED (MO~AY~EAR) ~ ~ ~ E D. TANK CAPACIW IN GALLONS: II. TANK CONTENTS ~ A-1 IS MARKED, COMPL~E ITEM C. lc UIDGR~E UNLADED ~ 5 JETFUEL ~ 8 M85 ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER(DESCRIBEINI~MD. BEL0~ D. IF(A. 1) IS NOT MARKE9, ENTER NAME OF SUBSTANCE STORED C.A. III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL ~AT APPLIES IN BOX D AND E A. WPE OF ~ 1 DOUBLE WA~ ~ 3 SINGLE WALL WI~ E~ERIOR LINER ~ 5 IN~RNAL B~D~R ~S~M ~ 95 UNKNOWN SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER a, TANK ~ 1 BARE STEEL ~ 2 STAINLESS S~EL ~ 3 FIBERG~SS ~ 4 STEELC~9 W/FIBERG~SS REINFORCED P~STIC MATERIAL ~ 5 CONCRETE ~ 6 POLWlNYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% METHANOL COMPATIBLEW/FRP (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER C. INTERIOR ~ 1 RUBBER UNED ~ 2 AL~D LINING ~ 3 EPOXY UNING ~ 4 PHENOLIC LINING LINING 0R ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING IS LINING MA~RIAL COMPATIBLE WI~ ~00% METHANOL ? YES ~ NO~ D. E~ERIOR ~ 1 POLY~HYLENE WRAP ~ 2 COA~NG ~ 3 VINYL WRAP ~ 4 FIBERG~SS REINFORCED P~STIC CORROSION PROTECTION ~ 5 CA~ODIC PRO~C~ON ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER SPILL CONTAINMENTJNSTALLED (Y~R) ~ ~ OVERFI~REVENTION EQUIPMENT INSTALLED (Y~R) ~ ~ , E. SPILL AND OVERFILL, etc. DROP TUBE YES ~ NO STRIKER P~TE YES ~ NO DISPENSER CONTAINMENT YES IV, PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM ~PE A U I SUCTION ~2 PRESSURE A U 3 GRAVI~ A U 4 FLEXIBLE PIPING A ~ 99 OTHER B. CONSTRUCTION A U 1 SING~ WALL A~ 2 DOUBLE WALL A U 3 LINED ~ENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARES~EL A U 2 STAINLESS S~EL A U 3 POLWlNYL CHLORIDE(PVC)~4 FIBERG~SS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCR~E A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A ~ 10 CA~ODICPROTEC~ON A U 95 UNKNOWN A U 99 OTHER B. LEAK DETECTION ~ 1 MEC~I~ UNE L~K ~ 2 UNE ~G~NESS ~ 3 CONTINUOUS IN~RSTmAL ~ 4 ELEC~ONIC LINE ~ 5 A~O~TIC PUMP 0E~OR TES~NG MONITORING ~ [~K DE~CTOR ~ SH~ ~ 99 OTHER V, TANK LEAK DETECTION m MONITORING TANK GAUGING TEST)NG VI. TANK CLOSURE INFORMATION m~nu~.~.~ c~osun~ 1. ESTIMATED DATE ~ST USED (MO~AY~R) I2' ESTIMATED QUANTI~ OFSUBSTANCE REMAINING GALLONS THIS FORM HAS BEEN COMPLETED UNDER PENAL ~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I TANK OWNER'S NAME ~ DATE I LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW STATE I.D:~ ~ I I l I I} Illl ) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMP~IED BY A PLOT P~N. FILE THIS FORM WI~ THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS FORM B INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTION'S Section 2711 of Title 23; Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for alt NEW PERMITS, PERMIT CHANGES;~ REMOV-' ALS and/or any other TANK iNFORMATION CHANGE. 2.. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR 3.'Please type'or print clearly all requested information. Use a hard point writing instrument, you are making 3 copies. 5.Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. Tank owners must submit documentation showing compliance with state financial responsibility require- ments td the local agency for petroleum USTs [271 t (a)(11) CCR], TOP OF FORM: MARK ONLY ONE ITEf~:, 1. Mark an (X) in the box next to the item that best de~bes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed 1. TANK DESCRIPTION - COMPLETE ALL ITEMS ~ IF UNKNOWN ~ SO SPECIFY A. Indicate owners tank ID # - if there is a tank number that is used by the owner to identi~¢ the tank (ex. AB70789)~ B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the year the tank was instaIled (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). TANK CON'FENTS A, 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in ~A-~, D. Print the chemical name of the hazardous substance stored in the t~nk and the C.A.S.#. (Chemical Abstract Service number), ff box I is NOT checked in A. 1II. TANK CONSTRUCTION ~ MARK ONE ITEM ONLY IN BOX A, ~ C & D t. ---Check only one item in TYPE OF SYSTEM, TANK MATERIAL ~NTERIOR LINING and CORROSION ' ' 'PROTECTION. 2. If OTHER, print in the space provided. IV. PiPiNG INFORMATION 1. Circle "A" if above ground circle "U" if underground, and circle b~)th if applicable. 2. If UNKNOWN air, cie; or if OTHER, print in space provided. 3. Indicate the L~AK DETECTION system(s) used to comply with the monitoring requir?ment for the piping. V. TANK LEAK DETECTION I. Indicate the LEAK DETECTION system(s) used to comply w~th the monitoring requirements for the tank. Vt. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED - MONTH?FEAR (January, 1988 or 0t/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). '~"-', 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(t3) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facitity number and thg §ix digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. tT tS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGEtz~CY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. '"' STATE oF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICA. TION - FDRM''B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 .TANK REMOVED · I, TANK DESCRIPTION COMPLETE ALL ITEMS- SPECI~ IF UNKNOWN C. DATE INST~LED (MO~AY~EAR) I ~ ~ ~ D. TANK CAPACI~ IN GALLONS: .. ~ ~ J ~ II, TANK CONTENTS ~F A-1 IS MARKED, COMPLETE I~M C. , ~ I MOTOR VEHICLE FUEL ~ 4 O1~, .. B. C. ~ la REGU~R UNL~ED ~ 3 DIESEL ~ 6 AVIATION GAS lc MIDGR~E UNLADED ~ 5 JETFUEL ~ 3 CHEMICAL PROOUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER(OESCRIBEINI~MD. BEL0~ D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: IlL TANK CONSTRUCTION MARK ONe ~T~M ONLY ~N BOXES A, B, AND C, AND ALL T. AT AP.U~S ~N ~OX D AND E A. ~PE OF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL wm~ EXTERIOR UNER ~ 5 ~RNAL B~DDER SYS~M ~ 9S UNKNOWN SYSTEM ~ 2 SING~ WALL ':,,~,~" , ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER MATERIAL ~ 5 CONCRETE ~ 6 POLWINYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% METHANOL COMPATIBLE W~RP (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 U~KNOW, ~ 99 OTHER C. INTERIOR ~ 1 RUBBER LINED '- ~ 2 AL~D LINING ~ 3 EPOXY UNING * ~ 4 PHENOLIC LINING LININGOR ~ S a~SS UNING. ~.6 UNLINED ~ 9S uNKNowN': ~ 99 OTHER COATING ~s LINING MA~RIAL COMPATIBLE WI~ 100% METHANOL? YES~ NO~ D, E~RIOR ~ 1 POLY~HYLENE WRAP ~ 2 COA~NG ~ 3 VINYL WRAP ~ 4 FIBERG~SS REINFORCED P~STIC CORR0Sl0N PROTECTION ~ 5 CA~OD~CPRO~O~ON ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER SPILL CONTAINMENT~STALLED (Y~R) ~ ~ OVERFI~PREVENTION EQUIP E. SPILL AND OVERFILL, etc, DROP TUBE YES ~ NO STRIKER P~TE YES ~ NO ~;~~NT ~ NO IV, PIPING INFORMATION C~RCL~ A IF ABOVE GROUND OR U iF UNDERGROUND. BOTH IF APPLICABLE A, SYSTEM~PE A U 1 SUCTION ~2 PRESSURE A U 3 G~VI~ A U 4 FL~IBLEPIPING. A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A~ 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A. U 99 OTHER 'C, MATERIAL AND A U I BARE S~EL A U 2 STAINLESS STEEL A U 3 POLWINYL CHLORIDE (PVC)~ 4 FIBERG~ss PIPE CORROSION A U. 5~ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTEC~ON A U 95 UNKNO~ A U 99 OTHER D. LEAK D~ECTION ~ 1 .EC~,~ UNE ~K ~ 2 U,~ ~,G~,~SS ~ 3 C0,T,,UOUS ,~RS~ ~ 4 ~L~CmO,,C U,E ~ S ~O~,,C DE~CTOR ' TES~NG ~ MONITOR~NG L~K DE~CTOR SHUT~ ~ 99 O~ER V. TANK LEAK DETECTION ~ I VISUAL CHECK ~ 2 MANUAL INVENTORY ~ 3 VADOZE ~ 4 AUTOMATIC'TANK ~5 GROUND WATER ~6 ANNUALTANK~ RECONCILIATION MONITORING GAUGING . MONITORING TESTING ~ 7 CON~NUOUSINTERS~TIAL ~ 8 SIR ~ 9 WEEKLY MANUAL ~ 10 MONTHLY TANK ~ 95 UNKNOWN' ~ 99 OTHER MONITORING TANK GAUGING TESTING ' VI; TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-P~CE) I 1. ESTIMATED DATE ~ST USED (MO/DAY~R). 2. ESTIMATED QUA~IW OF~...SUBSTANCE REMAINING GALLONS ~ 3. WAS TANK FILLED WlTHINERT MA~RIAL ? YES ~ NO~ THIS FORM HAS BEEN COMPLETED UNDER P~NAL~ OF PERJUR~ AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ITANK OWNER'S NAME ~~~ I LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED 0FTHE FOUR NUMBERS BELOW' ~ COUN~ ~ JURISDICTION ~ FAClLI~ ~ TANK PERMIT NUMBER PERMIT APPROVED BY,ATE ) PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICA~ON - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE AC~0MPANIEO BY A PLOT P~N. FILE THIS FORM WiTH ~E LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS FORM B (6-95) INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for alt NEW PERMITS, PERMIT CHANGb-S3,, REMOV- ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3. Please type'or print clearly all requested information. 4. Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the logation of the USTs with respect to buildings and ~andmarks [2711 (a)(8) CCR]. 6. Tank owners must submit documentation showing compliance with state financial responsibility require- ments td the local agency for petroleum USTs [2711 (a)(11) CCR]. TOP OF FORM: MARK ONLY ONE ITEf'7~3 1. Mark an (X) in the box next to the item that best des-~,ibes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. I. TANK DESCRIPTION ~ COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank tD # - tf there is a tank number that is used by the owner to identify the tank (ex. AB70789)~ B, indicate the name of the company that manufactured the tank (ex. ACME TANK MFG), ---t C. Indicate the year the tank was installed (ex, 1987), D. Indicate the tank capaci.~ in gallons (ex. 25,000 or 103000 etc.). 11. TANK CONTENTS A, 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C~ 2. if not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box, C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chem ca name of the hazardous substance stored in the t~nk and the C,A,S..~. (Chemical Abstract Service number), if box 1 is NOT checked in A. TANK CONSTRUCTION ~ MARK ONE ITEM ONLY IN BOX A, B,q C & D 1, - -Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION ' ' PROTECTION. ' ' 2. tf OTHER, print in the space provided. IV, PIPING INFORMATION Circle "A" if above ground circle "U" if underground, and circle b~)th if applicable., 2. if UNKNOWN ~ir, cle; or if OTHER, print in space provided, 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requi?ment for the piping. V. TANK LEAK DETECTION 1. indicate the LEAK DETECTION system(s) used to comply with the. monitoring requirements for the tank. Vi. INFORMATION ON TANK PERMANENTLY CLOSED tN PLACE 1. ESTIMATED DATE LAST USED ~ MONTH/YEAR (Januaw, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and th~ six digit tank number. The county and iurisdiction numbers are predetermined and can be obtained by calling the State Board (9t6) 227~4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank, IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. ~ STATE OF CAUFORNIA ~* STATE WATER RESOURCES CONTROL ROARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - F, ORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. I MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] ? PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPEaFY IF UNKNOWN . OWNER'S TANK ,. o., B. MANUFACT. RED BY: C. DATE INSTALLED (MO/DAY/YEAR) I '~"~ ~'-"1, ~ D. TANK CAPACITY IN GALLONS: ~ ~ t II, TANK CONTENTS IFA-1 ISMARKED, OOMPLETEITEMC. A. ~ ' MOTOR VEHICLE FUEL [] 40'~,. B. C. ~ la REGULAR UNLEADED [] 3 DIESEL [] 6 AVIATION GAS [] lb PREMIUM UNLEADED [] 4 GASAHOL [] 7 METHANOL [] 2 PETROLEUM [] 80 EMPTY [] I PRODUCT [] ~c M~DGR~E U,'E~ED [] S ~ETFUEL [] ~ U~ [] 3 C.EM~CALPRODUCT [] ~5 UNKNOWN [] ~ WASTE [] ~ L~ADED [] SS 0T"ER(~ESC,~N~TEMD.~EL0V~ D. IF (A. 1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S. #: III. TANK CONSTRUCTION MARK ONE ~TEM ONLY ~N BOXES A, S, ANDC, ANDALLTHATAPPLIES~NBOXDANDE A. TYPE OF [] ~ DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 5 ~NTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL '" [] 4 SINGLE WALL IN A VAULT [] 99 OTHER B. TANK [] ~ BARE STEEL [] 2 STAINLESS STEEL [] 3 F~BERGLASS ~ 4 STEEL CLAD W/ F~BERGLASS REINFORCED PLASTIC MATERIAL [] ,5 CONCRETE [] 6 POLYWNYL CHLORIDE [] 7 ALUMINUM []'8 ~00°/o METHANOL COMPATIBLEW/FRP (P~ir~ryT~.~) [] ~ SRONZE [] ~0 GALVAN,ZED STEEL [] ~ UNKNOWN [] ~ OTHER C. INTERIOR [] 1 RUBBER UNED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LININGOR [] 5 GLASS UN~NG [] 6 UNUNED [] 95 UNKNOWN [] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES__ NO__ D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION [] 5 CATHODIC PROTECTION ~ 91 NONE [] 95 UNKNOWN [] 99 OTHER' SPILL CONTAINMENT 1313~NSTALLED (YEAR) ~ ~ OVERFII~REVENTION EQUIPMENT INSTALLED (YEAR) ~'~ E, SPILL AND OVERFILL, etc. DROPTUBE YES ~ NO STRIKER PLATE YES NO DISPENSER CONTAINMENT YES ~,~ NO IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM'PfPE A U 1 SUCTION A,~ 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B, CONSTRUCTION A U 1 SINGLE WALL 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)~[~ 4 FIBERGLASS PiPE CORROSION A U .5~.ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL~COMP,~TIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D.. LEAK DETECTION [] ~ ,~c.,,.,~,,.,..~ ~ r--~ ~ u., ~,~.,.~, ~ ~ co.~.,o., ,.,~,~.,, [] ~ ~,~o~o.,o,.~ [] ~ ,~ro~,,o V. TANK LEAK DETECTION [] I VISUAL CHECK [] 2 MANUAL INVENTORY [] 3 VADOZE [] 4 AUTOMATIC TANK r~ 5' GROUND WATER [] 6 ANNUAL TANK J RECONCILIATION MON,TORING GAUGING ~ ~ MONITORING T~STING [] ~ CONTINUOUS,NTERSTITI*L [] ~ S,R [] ~ WEEKLY MANUAL [] ~0 MONTHLY TANK [] ~,5 UNKNOWN [] ~ OTHER I MONITORING TANK GAUGING TESTING VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE ~N-PLACE) [ 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OFSUBSTANCE REMAINING GALLONS [ 3. WAS TANK FILLED WITHiNERT MATERIAL ? YES[] NO[] THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE ~.D. NUMRER IS COMPOSED OF THE FOUR NUMRERS BELOW~ PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE i , , THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A. UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS, THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM 8 (6-95) INSTRUCTIONS FOR COMPLETING FORM '~B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B~' shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES, REMOVe' ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3.Please type or print clearly all requested information. Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) OCR]. 8. Tank owners must submit documentation showing compliance with state financial responsibility require- ments to the tocat agency for petroleum USTs [2711 (a)(11) OCR], TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an tX) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or FaciIity name where the tank is installed. TANK DESCRIPTION ~ COMPLETE ALL ITEMS ~ tF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # ~ tf there is a tank number that is used by the owner to identify the tank (ex, AB70789). Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG), Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or I0,000 etc.). tl. TANK CONTENTS A, 1, IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. tf not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate bom C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name of the hazardous substance stored in the tank and the C.A.8.#. (Chemical Abstract Service number), if box 1 is NOT checked in A. tlt. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B, C & D t, Check only one item in TY'PE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTECTION. 2. If OTHER, print in the space provided. lV. PIPING INFORMATION Circle' 'W' if above ground circle "U" if underground, and circle both if applicable. If UNKNOWN circle; or' if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. Vt. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1, ESTIMATED DATE LAST USED ~ MONTH£¢EAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) COR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and iurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A", The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. ~ ~ f q e e ,.., Tanlcnology 890G Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 07/28/2004 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/17/2004 Order Number: 3135559 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7 -ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment-Tank Interstitial Sincerely, :D~K~ Dawn Kohlmeyer Manager, Field Reporting .o¡c't.w.:; . 58-989- CONDARY CONTAINMENT SU t-" Tanknology RY RESULTS TEST DATE:07/J.7/2004 KENT RANDY MARTIN 253-796-7170 WA 98032 WORK ORDER NO.: 3135559 SITE: 7-ELEVEN #3-2376 9600 BRIMHALL RD, MARKET #2133 BAKERSFIELD CA 933J.2 CLIENT: 7-ELEVEN, INC, 208J.9 72ND AVE, SOUTH SUITE 206 Tank Interstital Tests Piping Interstital Tests REGULAR PREMIUM Total Containment PASS Tanknology representative: JERRY BELLOLl Services conducted by: STEPHEN COULTER ~ c_~~ SITE NAME: 7-ELEVEN #32376 32376 IDATE:107/17/2004 IWORK ORDERj 3135559 SITE ADDRESS: 9600 BRIMHALL RD, MARKET #2133 BAKERSFIELD CA 93312 REASON FOR TEST: Groundwater Level(1I from grade): SECONDARY CONTAINMENT TEST RESULTS e e Final Pass! ~ Fail .......- - ~ 14. "Hg PASS - - - - ~ - - - ...---.- - - - - - - - - Final Pass! Result Fai Initial Finish level Time .......--- --.- ~ - -15 "HgI11O-=-- - ~ - - - ~ - ~ - - ~ - - - - - - Initial Finish level Time Start Time 1005 Start Time TANK INFORMATION AND INTERSTITIAL TESTS Tan Product Tank Size Dia. Material Manufacturer Depth Test Method (n) ( ) 1 REGULAR 10028 96 TOTAL CONT I TOTA~ CONT Irotal Containment - 2 PREMIUM 10022 96 150 Vacuum 3 0 0 . 4 5 6 7 8 Comments: LINE INFORMATION AND INTERSTITIAL TESTS - - - Tan Product Dia. len. Material Manufacturer Volume Test Method (.. ) (feet) (gallons) 1 2 3 4 5 6 7 8 Comments: -i ~ ¡ Work Order: 3135559 e e Secondary Contaill.ment Testing Report Form l1tbfori1t tllntendedfor TISft hy C011Þ'ar:lcr~ ~rfcimiRg [If!I1od1c .Wttng lY/7AT 8eC01lÓal'y t:01'dainmenl ~$_, U.œ In. Øpþ1vprlate pagu 0/ thi8form to'nptJIt rvw/ú fo,r-all cmtÍþø;,entJ tested; 71ss compietedfOl'm. . writÌlm tsØproc~, arid pritirWt3 from iæu (tJaþp1lcuhle), ·:rhould be pnwlded t( the fitclltty OWnw/oþf:xJIOI' foriJJlllittDl In the local ,..gWQ/fRY Q~. Page .L of';:¿ pacilityNrune: paçiJitY.A.ddrcsIl: pllGility. Coritad: Datè J.:.oçà1A~WaàNo of'Thsting: .~ameofLocal Ag,élicy Inspector f'n seut: 1.FACILlTYINFoRMATION 2. TESTJNQ'~OJIi'I'RACTORJNFORMATION CSWRCBLicc:nxdTant Tc.sIa' ..Man )~. 'lramlq.b)'··Man~ CoDí;Xmcn1(l) I'Jat.e Trainin &pm '. ... .}fumberofTàDks,Tested: I . .... t"µm~ dfpjpiDgRDusTeStectO ~oI8ub~iblePa:mp.:ßIIIIPI Lested: ('t').... .. .. NmnbCrofJJI)C BoxeI,TesœcS: ð wmba:9f.Pi.U SPaIPI Te!I.~:O NuáI1DCD'. ~:, "'i . . .. ... N NM ~::' .. Not KCplI!rt COlDpoacat . 'rÌiSÎed ComPIHLCII.t l"ÌUI J'.ø "ettcd r.c.. - Þi_: ú'Ú ........ L A L..-:.. Jô .' . . "t" .. ....--. -~- .---.-.-.. -..,. '. . : ., " .'H." .. ... ...... '.--' "'-'~;.,..-- .... , ~. --- ~......"-~ . ~.",.",..-"." .- -' .- -.......... '--- ~--- ',., " - .. .' ~ 'J"'" ~ . '~ -17~dI Tecluf 'W B~" i ~\ '.. . ~ C~ DD¢:ð ~. .... lCIIILlI.. . '. TJ"\,. -:. . . '--" SWRCB Øecembèt2001 3. SUMM:ARYOFTE8T~TS Tanknology-NDE 8900 Shoal Creek. Building200 Austin, Texas 78757 ,¡ I~ " W órk Order: 3135559 TestMethQdDevelapcÜ By: TestMethod Used: Test Eqllipm~:nIU ¡è4: e e PIIgC ::::? uf __.~ - . 4. TANf{~~TES'1'INn ~aJ\k. Mèln\¡[achlTcr tndu~tI): S~andard 9_~~:': (S'J1_~~iJj) Prc~surc Other (Specify) l'''piÌ::~iulÌ.ál EIl~UÜ1~f Ilýdro$latic -.---¡ )ðaCµÜI11 "Eql1Ïpn~t R,esolutiol1: · Is TánkE.JI.cilrpl:¡;rom'Testing'l~ · '1:Drik Cap~citY: Tal1kMåtedål: ~'. TnflkMá11ufuê~: · ~röªücfSlOrèd,:. ,ow ilittimebetwe:ériapþlyir¡g þressurelvacu~¡nifwalC3:>?1J ct startiI;,gté¡,i: , re5t··'St~irim~:; IiiitiaLRea4ing;(R.}; T\:~If:rldTilTîe:. -. . ._. Fin~l;Rca~"iTlgfR.~);; Test'D(I:rn-Hon;- { ^,^ -- . Ghang~inJ~eac1ïnK(~I'-~~: . Pëlb-g/F2iJ'11íì-ê:SholdorCritëriå:- ^ . :- "," ". ,~,., '-."' ,-' ," " '- " . I':~;":.:'~'.:~. Wtî.Š j~lJS~·rero()ve. , .lc.'í1.ifl¡,:1· : \v~$ ;,5t11SQ(pro¡:lerlYircp1äéédlµld 'V~íit'ied,unëíioDaJ),ncr~t.i~lii g?, Yos No TaDk# Yi:1I :1'B'oI<# I' r-;o Nò ye:i Ii u ---..... .. ~ ....;..... . .. --- ....-. , ..---- .' '- ." C, ;'-'.?; :::.~Ëf·:~'::.~Ò,~k .: Yès No NA .-- No.NA Ye.s.NóNA Yt:¡¡ No iliA YeilNo .NA çomœeD*~...,;(ili~!l';({r¡nf(Jf'rrìåtinn··on r:epail'-snradèp'tÜirto, t.csfm~ ·~··re.r:oml~~~d~4fol/Qr~~1fP..L(j;¡;liIl'.tJ.ll'.fl,~) . " ' , ." - --- - 'h)';i, --~., . ..-.- -- ·.;;__-...,;.:.n......;~_' ~. ., ......... ..... ..... "-.-,,. --."-'-" -.--. -. .'. -..--...- .. I. Sec::~ndaT)' contáinmL'I\tsy¡¡tcJrJ:t whcrctbc: continuous .inQJ1ilor~iI\ltomatica11Y ~onitors both. ~he pritÍìåry a.II.d5C\CC\ndà~ containment, such as systeros thatarehydm~bitica\1y mnnil.tlrc~ ur wllkr COlL~IIlDt VIlCllWll, lire exelUpt rrolUpèriQdiC è6Ðtamm.eí:lt testing. (California ÇodeçfRegùìations..T¡t¡eCn~Scction 2ó37(à)(.6)} '. . Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 , .>- -~ DJnknology 8900 SHOAL CREEK. BUILDING 200 AUSTIN, TEXAS 78751 (512) 451-6334 FAX (512) 459-1459 TEST DATE:07 /17 /04 CLIENT: 7 -ELEVEN, INC. WORK ORDER NUMBER313 555"9 SITE:7-ELEVEN #32376 COMMENTS Arrived on site at 8:00 A,M. for Premium Tank Interstitial retest. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 07/28/2004 07:25 SBOWERS Â-" "- r e SITE DIAGRAM 1-" »Jnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 e TEST DATE: 07/17/04 CLIENT: 7 - ELEVEN I INC. WORK ORDER NUMBER3135559 SITE:7-ELEVEN #32376 (IT'Î 7= ~ }M:' ø CD ® ® ø ø ~ REG PREM (IT'J p) 0 @ ::::c::: 10 =It ..- § w...... § 1\:)1 w~ ......~ 0> ~ (IT'J p) w T Printed 07/28/2004 07:25 SBOWERS 7-11 82:376 9600 BRIMHALL RD. BAKERSF I ELD, CA. 98312 B0687875505001 MAY 11· 2004 10'-40 AM SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL INVENTORY - REPORT T '2: RUL VOLUME = 4244 GALS ULLAGE = 5784 GALS 90% ULLAGE= 4781 GALS HEIGHT = 42.73 INCHES ST},', HEIGHT= 42.73 INCHES WATER VOL = 0 GALS WATER = O. O0 INCHES TEMP = 71.5 DEG T 3:PUL VOLUME = 2474 GALS ULLAGE = 7548 GALS 90% ULLAGE= 6546 GALS HEIGHT = 27.52 INCHES STK HEIGHT= 27.52 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 72.9 DEG F ~ ~ ~ ~ ~ END ~ ~ ~'~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3~a Floor, Bakersfield, CA 93301 ACIm'¥ NAME 7- z,z_.76, NSPECnON DA*E Section 2: Underground Storage Tanks Program [2i Routine [~Combined ,.._[21 Joint Agency 121 Multi-Agency [21 Complaint [~1 Re-inspection Type of Tar-Xnk I~)[~D ['"-~> Number of Tanks Type of Monitoring ~.L.- Bq Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees cu,'rent 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 ~~ ~ Inspector: ~J~~ ~ ~ ¢ -' Office of~ment~ Se{~s (66~326-3979 Business ~e Party · While - Env. Svcs. Pink - Business Copy ~ IN ECTION Enironmental Services UNIFIED PROGRAM ~ECKLIST ~~.~~~~,~*~:~ 1715 Chester Ave ~/an~/n~o~~ ] Bakersfield, CA 93301 · Tel: (661)326-3979 FACILI~ NAME · · t ' INS~C~JON DATE INSPECTION TIME PHONE No. No. of Employees FACILI~ CO~TACT Business ID Numar 15-021 - SeCtion i: Business Plan and inventory Program [] Routine ~,Combined [] Joint Agency [] Multi-Agency i-I Complaint [] Re-inspection C V ~'C=Compliance) OPERATION COMMENTS ~. V=Violation _ I'1 APPROPRIATE PERMIT ON HAND  r=l BUSINESS PLAN CONTACT INFORMATION ACCURATE ,,~ i'"] VISIBLE ADDRESS ~ [] ' VERIFICATION OF INVENTORY MATERIALS  [] VERIFICATION OF QUANTITIES ~ [] VERIFICATION OF LOCATION ~_~ [] PROPER SEGREGATION OF MATERIAL  [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ [] EMERGENCY PROCEDURES ADEQUATE  [] CONTAINERS PROPERLY LABELED ~ [] HOUSEKEEPING  [] FIRE PROTECTION  % ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: [] YES /~No EXPLAIN: White - Environmental Services Yellow - Station Copy Pink ~ Business Copy R D December 19, 2003 Mr. John Whiting Regional Water Quality Control Board ~IRE CHIEF 1685 E Street ~OlXl FF~AZE Fresno, CA 93706-2020 ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 '~F__..,: MTBE VOICE (661) 326-3941 FAX (661) 395-1349 Dear Mr. Whiting: SUPPRESSION SERVICES 2101 Street Preliminary site assessment results from 7-11 Store #32376 site Bakersfield, CA 93301 - located a~t-9600;BYi'niha~il-.~0a-d~-~/ield MTBE concentrations in one sample VOICE (661)326-3941 FAX (661) 395-1349 at 0.13 mg/kg. The remainder of the test results are below levels that we PREVENTION SERVICES would normally require a full site assessment. FIRE SAFETY SERVICES * ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 I have enclosed the closure report, including this preliminary VOICE (661) 326-3979 FAX (661) 326-0578 assessment for your review. Per LG letter 153, any closure involving MTBE must be reported to the Regional Water Quality Control Board PUBLIC EDUCATION prior to closure. I am requesting concurrence that this site can be closed 1715 Chester Ave. Bakersfield, CA 93301 with no further action required. VOICE (661) 326-3696 FAX (661) 326-0576 Please notify me at your earliest convenience, on your FIRE INVESTIGATION concurrence, or reasons to require further action. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ~lncerely, TRAINING DIVISION Ralph E. Huey, Director 5642 Victor Ave. Bakersfield, CA 93308 Office of Environmental Services VOICE (661) 399-4697 FAX (661) 399-5763 Howard H. Wines, III Hazardous Materials Specialist Registered Geologist #7239 Office of Environmental Services REH/db enclosure Tankno ogy 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757* Phone: (5'12) 451-6334 Fax: (5'12)459-1459 Date Printed and Mailed: 01/06/2004 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER.AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 11/24/2003 Order Number: 3132046 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET'.#2133 BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting 4~Lp TANKNOLOGY CERTIFICATE OF TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: POSTCONST TEST RESULT SUMMARY REPORT TEST DATE: 11/24/03 WORK ORDER NUMBER: 3132046 CUSTOMER PO: 32376-06 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 20819 72ND AVE. SOUTH 9600 BRIMHALL RD. SUITE 206 MARKET #2t 33 KENT, WA 98032 BAKERSFIELD, CA 93312 RANDY MARTIN MANAGER (253)796-7t 70 (661)588-4059 TEST TYPE: TLD-I Product Pipe Tightness Test Results ~,,~:~? ~:.,,~ ~:,,,~ ~;~, ,,'~,, ~,.~ ,~:::~ ~ :~ ;,,~ ~,~ ~::::: ~, :.~,:~ ~ ~: :~ ::::::~ : :: : :: = IMPACT 10k 2 REG~ E~IROFLEX PRESS~E 10k 3 ma~ E~IROFLEX PRESS~E ~%! .....~ ..... ~M~UFACmRER ~:~>~:~:MODEE#~ '~::SER~¢~ ~SULT :M~U RER :: SER~#:~? ~SULT 10k 3 FE PETRO FZIY NA P ~ew ~eg~s~e~e~ Moe ~es~ De~e=~o~ Ies~ ~CTOR:~::::;:~ ~- ::: ': ~ ~ ~: R~P~GED LE~ DET .CTOR ~ :, :: ~SERI~: ;RESUET~ ~'M~UFA~RER~ :~:~?MODEE#~::~~ ~ ~SER~# ~:::::: :RESULT For o~ de~iied r~o~ info~ation, visit ~.~n~olo~.com and select ~-Line E~o~s-W~, or con,ct your local Tan~o]o~ o~ce. Tester Name: RHOME DESBIENS Technician Ce~ifi~tion Number: ~rintod 0~/0~/2004 08:32 SBOWERS TEST DATE:Il/24/03 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3132046 CLIENT:7-ET.~.V~N, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-ET.~.VEN #32376 Tank ID: 10k 2 Tank manifolded: NO Bottom to top fill in inches: 144.0 Product: ~GT.~_,AR Vent manifolded: NO Bottom to grade in inches: 147.0 Capacity in gallons: 10, O26 Vapor recovery manifolded: ¥~s Fill pipe length in inches: 48.0 Diameter in inches: 96.00 Overfill protection: ~q~s Fill pipe diameter in inches: 4.0 Length in inches: 324 Overspill protection: ~Es Stage I vapor recovery: DU~T., Material: TOTAL CO~ Installed: ATG Stage II vapor recovery: ~CE CP installed on: / / COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 LD. #2 Probe Water Level: Make: ~ P-.TRO Model: ~'"~lv Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 3. oo Holding psi: 29 VacuTect Test Type: NOT Resiliency cc: 150 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: ~.89.0 TESTED Pressure Set Point: Metering psi: 2o Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PAss Determined by (method): Result: COMMENTS COMMENTS Material: ENVTRO~T.EX Diameter (in): 1.5 Length (ft): 260.0 Test psi: Bleedback cc: Test time (min): NOT ~'OT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: Pump make: ~ PETRO COMMENTS Impact Valves Operational: O'Nm~OWN Printed 01/06/2004 10:18 INDIVIDtJ -L TANK INFORMATION AND EST RESULTS TEST DATE: 11/24/03 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3132046 CLIENT: 7-ELEVEN , INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7 -EI~V~N #3237 6 Tank ID: 1Ok 3 Tank manifolded: NO Bottom to top fill in inches: 146.0 Product: P~MTOH Vent manifolded: NO Bottom to grade in inches: 150.0 Capacity in gallons: 10,022 Vapor recovery manifolded: YES Fill pipe length in inches: 50.0 Diameter in inches: 96.00 Overfill protection: Y~.S Fill pipe diameter in inches: 4.0 Length in inches: 324 Overspill protection: ~s Stage I vapor recovery: DOA.~ Material: TOT~ COt,~' Installed: ATG Stage II vapor recovery: CP installed on: / / COMMENTS I/ Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: ~ PSTRO Model: yx3-v Ingress Detected: Water Bubble Ullage Test time: S/N: ,~ Inclinometer reading: Open time in sec: 4. oo Holding psi: 30 VacuTect Test Type: ROT Resiliency cc: 3.oo ROT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: 3.89. o TESTED Pressure Set Point: Metering psi: 3.9 Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PAss Determined by (method): Result: COMMENTS COMMENTS Material: ENVT~O~T.EX Diameter (in): ~.. 5 Length (ft): 280.0 Test psi: Bleedback cc: Test time (min): ROT ~OT ROT ROT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: ~'~ ~E~O COMMENTS Impact Valves Operational: Printed 01/06/2004 10:18 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 11/2a,/03 WORK ORDER NUMBER3132046 CLIENT:7-:~'r.]~t/*~, I~Co SITE: 7-]~T.:A'*'v'*B~ #32376 (~(~VENTS REG PREM Printed 01/06/2004 08:32 SBOWERS INTERNATIONAL www. secor, com 3017 Kilgore Road, Suite 100 S E C O [~ INCORPORATED Rancho Cordova, CA 95670 916-861-0400 TEL 916-861-0430 FAX November 3, 2003 Mr. Steve Un0erwood BakersfieM Fire Department Office of Environmental Services 1715 Chester Avenue, Suite 300 Bakersfield, California 93301 RE: Fuel Line Upgrade and lIST Flemoval Fleport 7-Eleven Store Number 323-?6 9600 Brimhall Road Bakersfield, California SECOR Proiect No.: 77EL.32376.23.0521 Dear Mr. Underwood: SECOR International Incorporated (SECOR) has prepared this letter on behalf of 7-Eleven, Inc, to document soil sampling associated with the removal of one underground storage tank (UST), and the removal and replacement of the fuel lines, at the site referenced above (Figure 1). INTRODUCTION This report documents removal and replacement of product lines and the removal of one UST from the 7-Eleven Store No. 32376 located at 9600 Brimhall Road, Bakersfield, California (Figure 1). All work was conducted in accordance with the requirements of the Bakersfield Fire Department Office of Environmental Services (BFDOES). SECOR provided oversight during UST and product line removal activities at the facility. Glacier Environmental (Glacier) was subcontracted by 7-Eleven to perform the product line removal activities, and Kern Construction (Kern) was subcontracted by 7- Eleven to conduct the UST removal activities. The purpose of SECOR's project involvement was to observe and document the removal of the product lines and UST and collect soil samples to assess subsurface conditions beneath the former USTs and product piping. SECOR's scope of work consisted of the following tasks: · Prepare a site-specific Health and Safety Plan; · Observe and document the removal and disposal of the UST rinsate, UST, and product piping; · Collect soil samples beneath the UST and product lines under the direction of the BFDOES specialist; · Analyze soil samples collected from beneath the UST and product piping; · Prepare a summary report documenting the product line and UST removal, waste disposal, soil sampling activities, and soil sample results. UST Facility Removal Report 7-Eleven Store Number 32376 November 3, 2003 Page 2 SITE BACKGROUND The site is located at the intersection of Brimhall Road and Calloway Drive in a commercial/residential area of Bakersfield, California. The site is operating as a retail gasoline service station and convenience store. Two 10,000-gallon gasoline USTs and associated facilities remain at the site (Figure 1). No background information related to any previous environmental work performed at this site is currently available in SECOR's files. FIELD ACTIVITIES 7-Eleven conducted a scheduled upgrade of the product lines for this site during the week of July 21, 2003. Following the completion of this upgrade, the secondary containment on the 12,000-gallon capacity double-walled fiberglass UST failed a pressure test. No leak was expected, but the decision was made to remove the tank and convert the current, three-UST fuel system into a two UST, blended fuel system. The UST was removed on August 22, 2003. Permitting Kern obtained the permits to remove one 12,000-gallon capacity, double-walled fiberglass gasoline UST from the BFDOES (Attachment A). Fuel Line Sample Collection and Analysis On July 25, 2003, SECOR's field technician collected a total of four soil samples from native soil under the fuel dispensers. Due to an excessive amount of pea gravel, samples were not collected beneath two of the dispensers, marked as D-1 and D-3 on Figure 1. All samples were collected under the direction of a BFDOES representative. Each soil sample was screened for hydrocarbon vapors using a portable photoionization detector (PID). Soil samples were collected in clean, 2-inch diameter by 6-inch-long brass sample tubes. A hand auger was used to extract soil, which was then placed into a sample tube. The sample tube was filled completely with soil to minimize headspace and sealed using Teflon® sheets and plastic end caps. Each soil sample was labeled and placed in a cooler on ice for delivery to Kiff Analytical in Davis, California. All soil sampling equipment was cleaned with a non-phosphate detergent solution and rinsed with tap water followed by a distilled water rinse to reduce the possibility of cross-contamination between sample locations. Copies of the field notes are included in Attachment B and the soil sample locations are shown on Figure 1. The soil samples were analyzed for total petroleum hydrocarbons as gasoline (TPHg), benzene, toluene, ethylbenzene, and total xylenes (BTEX), and methyl tert-butyl ether (MtBE) using Environmental Protection Agency (EPA) Method 8260B. UST Removal, Sample Collection and Analysis In order to maintain the integrity of the dispenser slab during UST removal, Kern set shoring on the eastern, western, and southern side of the UST basin. On August 28, 2003, the 12,000-gallon UST was thoroughly rinsed and evacuated to remove any petroleum residue remaining in the tank. Approximately 100 gallons of rinsate water, generated during the tank cleaning operation, was transported under Uniform Hazardous Waste Manifest as File: 7-Eleven/Store 32376/Reports/32376 Tank Pull and Line Upgrade Report.doc SECOR International Incorporated UST Facility Removal Report 7-Eleven Store Number 32376 November 3, 2003 Page 3 Non-RCRA Hazardous Waste Liquid to Demenno-Kerdoon, Compton, California for proper disposal (Attachment C). On August 22, 2003, Kern exposed and inerted the USTs with dry ice. After confirmation by BFDOES that the UST was properly inerted, Kern removed the UST from the excavation for inspection. The UST appeared to be in good condition, with no apparent holes or cracks visually observed. The UST was disposed of as non-hazardous waste at Golden State Metals, Inc., Bakersfield, California. Mr. Steve Underwood, Hazardous Materials Specialist for the BFDOES, observed the UST removal and soil sample collection activities. Soil Sample Collection - UST Cavity On August 28, 2003, a total of six UST confirmation soil samples were collected in native soil underneath the UST (Figure 1). Two soil samples were collected from each end and from the middle of the excavation. The samples labeled as T3-1 were collected at two and six feet below the eastern end of the tank, the samples labeled as T3-2 were collected at two and six feet under the center of the tank, and the samples labeled as T3-3 were collected at two and six feet beneath the west end of the tanks. The bottom of the tank was located approximately 12-feet bgs, therefore these samples were actually collected at 14-feet and 18-feet bgs, which corresponds to 2-feet and 6-feet beneath the tank. Samples were collected with a slide hammer equipped with a bullet sampler loaded with clean 2-inch diameter brass sleeve. No soil discoloration was observed in soil within the tank pit or under the dispenser islands. No gasoline odors were noted during collection of the soil samples. All soil samples collected for chemical analysis were retained in the brass liners, labeled, and capped with Teflon sheets and plastic end caps. The samples were then sealed in zip-lock bags, placed on ice, and transported to the laboratory accompanied by the appropriate chain-of-custody documentation. The soil samples collected under the UST .were analyzed for TPHg, BTEX, and MtBE using EPA Method 8260B. Soil Sample Analytical Results - Fuel Lines and USTs The soil sample results are summarized in Table 1 and presented in Figure 1. No concentrations of TPHg or BTEX were reported above laboratory detection limits in any of the dispenser or UST soil samples. Concentrations of MtBE were detected in one soil sample, collected at 18-feet bgs underlying the west end of the UST cavity, at 0.13 milligrams per kilogram (mg/Kg). No MtBE concentrations were detected above the laboratory detection limit in the other five tank pit samples, nor in the four soil samples collected under the dispenser islands (Table 1 and Figure 1). Copies of the certified analytical laboratory reports and chain-of-custody documentation are presented in Attachment D. SUMMARY OF FINDINGS Kern successfully removed and disposed of one 12,000-gallon, double-walled fiberglass UST from the site. No holes or cracks were observed in the UST. The tank removal and collection of soil samples was completed under the direction of Mr. Steve Underwood, Hazardous Materials Specialist with the BFDOES. MtBE was detected in one soil sample collected at 18-feet bgs under the western end of the UST, at a concentration of 0.13 mg/kg. TPHg, BTEX, MtBE were not detected above laboratory detection limits in any of the soil samples collected from under the dispensers (Table 1). File: 7-Eleven/Store 32376/Reports/32376 Tank Pull and Line Upgrade Report.doc SECOR Intemational Incorporated UST Facility Removal Report 7-Eleven Store Number 32376 November 3, 2003 Page 4 If you have any questions or comments regarding this letter, please call us at (916) 861-0400. Sincerely, SECOR International Incorporated Jaff Auchterlonie M. Gavan Heinrich, R.G. Senior Geologist Associate Geologist JA/dh Attachments: Figure 1 - Site Plan Table 1 - Soil Analytical Data Attachment A - UST Removal Permits Attachment B- Field Notes Attachment C - Waste Disposal Documentation Attachment D - Certified Analytical Reports and Chain-of-Custody cc: John Wainwright, SECOR / Randy Martin, 7-Eleven Inc. File: 7-Eleven/Store 32376/Reports/32376 Tank Pull and Line Upgrade Report.doc SECOR Intemational Incorporated FIGURE LEGEND: Z~ SOIL SAMPLE LOIATION - JULY & AUGUST 2003 CHEMICAL ANALYTICAL RESULTS: ANALYTE ID3'4'° I~_SAMF 'E ID <0.0050 CONCENTRATION (mg/kg) I MtBE <0.0050 ANALYTES: DEPTH DEPTH IN FEET (B6 S) ~1 T3-1 -2 -6 -*RASH TPHg TOTAL PETROLEUI~ HYDROCARBONS ~ J I DEPTH 14' 1E \ AS GASOLINE (mg/1 g) I ;PHg <1.0 <1.0 ( B ~BENZENE (mg/kg) <0.0050 <0.0050 ! 7-ELEVEN I MtBE <0.0050 <0.0050 STORE MtBE METHYL TERTIARY BUTYL ETHER (mg/kg) APPROACH I NO. 32376 T3-2 -2 -6 DEPTH 14' 18' TPHg <1.0 <1.0  MtBE <0.0050 <0.0050 D5 4.0 DEPTH 4.0' [ ) ~ ITPHg <1.0 ~ I <0.0050 T3-3 -2 -6 ~ IMtBE 4°'°°5° I TPHg <1.0 <1.0 \ B <0.0050 <0.0050 A MtBE <0.0050 0.13 \~.~ ~ ~'~t,t ID4.4.0 ~' IDEPTH 4.0' = ,TPHg <1.o D2- 4.0 <0.0050 IDEPTH 4,0' IMtBE <0.0050 I;PHg<I.O , <0.0050 ~ IMtBE <0.0050 =~ o 4o so I I  APPROXIMATE SCALE FEET ~REPARED BY: PREPARED FOR: i APPROACH DRAWNBY: DWR O ~"; 7-ELEVEN \ CHECKED: DC I FIGURE 1 El APPROVED: JA ilSTORE #32376 r- REV. DATE: · 11/4/03 PR BRIMHALL JOB NO.: 77EL.32376.43.0520 S E C O R 9.600 BRIMHALL ROAD SITE PLAN 3017 KILGORE ROAD, SUITE '100 BAI~!ERSFIELD, CALIFORNIA CAD FILE: SITE PLAN.DWG RANCHO CORDOVA. CA 95670 ' TABLE TABLE 1 Dispenser and UST Pit Soil Sample Analytical Results 7-Eleven Store #32376 9600 Brimhall Road Bakersfield, California Sample Ethyl Sample Date Depth Benzene Toluene Benzene Xylenes TPHg MtBE Notes I.D, Sampled (ft bgs) (mg/kg) (mg/kg) (mg/kg) (rog/kg) (mg/kg) (mg/kg) Dispenser Samples D2o4' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 D4-4' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 D5-4' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 D6-4' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 UST Pit Samples T3-1-2 08/28/03 14.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 T3-1-6 08/28/03 18.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 T3-2-2 08/28/03 14.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 T3-2-6 08/28/03 18.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 T3-3-2 08/28/03 14.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 T3-3-6 08/28/03 18.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 0.13 Explanation: BTEX, TPHg and MtBE via 8260B TPHg = Total petroleum hydrocarbons-as-gasoline ft bgs = Feet below ground surface MtBE = Methyl-ted-butyl ether mg/kg = milligrams per kilogram or parts-per-million < = Not detected above laboratory reporting limit Ranch Market-Riverbank\Tables\32376_Line Upgrade Soil Table.xls Page 1 of 1 ~ECOIR ATTACHMENT A UST REMOVAL PERMITS UST Facility Removal Report 7-Eleven Store Number 32376 9600 Brimhall Road Bakersfield, California SECOR Project No.: 77EL.32376.23.0521 lO-09-OB09'54AM FROM KJ~]~CONSTRUCTION PO2 CITY OF BA~RS~ IELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 32~3979 PE~T ~PLICATION FOR REMOVAI, OF AN ~'DERGROUND STORAGE TANK ~tTg IN~O~TION ....... ~ ~' ~ ~ .-.2~ ~ ....... CO~CTOR ~FO~TIO~. ~o~ss'~..~._.~J7 ' cr~ ~~ ~o~ ~-' . .-._ ........ ~o~ NO.(~~C~SE NO. ~.s~c~ c~g wo~u~Ns co~ ~o, T~NK ~S~RT~ ~FO~ON CO~ ~~ ~-,' PHO~ NO. ~'~ LIC~SE NO, ~o~ss.~ ~,,, ~, ....... ~~,. .... z~~? C~C~ DATES ~MICAL TA~ NO, AGE VOL~E STOOD STOOD P~OUSLY STOOD ' ~ F~ 0~ial U~ 0~ .............. THE APPLIC~T NAS ~[IVSD, ~D~TANDS, ~D W]~L COMPLY W[TN THE A~ACHEO COND[T[0NS OF P[~T AND ANY OTHEE STAT[ L~AL AND FED~L ~ULATiONS. THIS FO~ HAS BE~N C~P LETED ~DEE PENALTY OF PENURY, AND TO THE BE~T OF ~Y KNOWLE~E IS T~ APPROVED B~ ..... ~ .... APPLICANT NA~E ffmNI) ' ' ~L~CA~T THIS ~rLICA~ON ~L BECOMg A.~E~IT ~EN ~PROVED 10-09-03 09'54AM FROM KER ONSTRUCTION ?05 · 8~2~ FAX 861393~645 T&T BAI(ERSFI£LD ~00~ ,~' ..... ~ CITY OF HAKERSFIELD ~-~ / ~f, ~ -~, O[,. .CE OF ENVIRONMENTAL S. .(VICES ~,t~r 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDEROROUND 8TO~OE T&NK~ C[.O~UR~ CERTIfiCaTION i. FAC~L. ITY IDENTIFICA?ION BU$1NE~iS NAME (,g~m~ ,',s FACILITY NAME or Dl~'.~ing ~u~ines~ A~) ~ ."~'/~1'/1 #-- .... .......... , ..... TANK O~ER NAM~ ~ANK OWN~ ADDRESS ..... ~~E~ Cl~' ~a STAT5 ~3 Zl~ COOE II, TANK CLOeU~E INFORMATION -'~ Tan~ ID# ~ ~nffa~o~f Flamma~Vap~ ~ Concenira~i~ of Oxygen INTERIOR ~; C-.. g ,, I ~EADINGS I ~ -~ ,. .,., ,- ...... ", .... ~ :'~"~'-'~-~'~' ~ .,.;,.~ .,~~ ~,,,,;~,~ ..,.,, ~,',, ,,:,~.,~,~t%,,r ~,,,,,.: ' ~;.~, ,,,,,~ ,~z~ ~'~"~ ~' '~ERTIE[~A~ION,~,?:,.:~'.,~:~,;¢~?.,'~:~'~:';"/:'~" ® :' '"' '~' ?'' ......... ":"' ..... "'~' '"" ":' ' .... " ":" ~.,,r~,~..~l~,..~q,~p~.,~....~e,~,,~m~~~, ~3.~9~R'~,g,~,;.~.,?~.~',~ ", ',,.~'~ .. ',..:,{',.,~r???, ..... , '.....~_ ,', ,'.~ On e~mln~Uon of~e ~nk, I ~ ~e ank I~ v~ually ~e ~m pf~o[, slu~, ~{e (~ln, flaky reai~ual ef tank watents), rln~ea[e end debns, I ce~ ~at~ In~aUon pm~ed heroin I~ ~ue ~ aggumte M th~ beat o~ my kn~edge, , ~er I$ ~ re;resen~tive of ~e CUPA, auto.ed agency, or LIA: ' ~ Yes ~ No F 1715 Chester Av~, '~ ~ b. Ce~fied $afe~ Pmfe~ional'(CSP) CI~' ' ~- D ~, Ce~lfled Marine Chem~s[ (CMC) Bake,sfieJd. CA 93~01 t~ ~ d, Registered anvlronme~l Health Speolalist (REH~) PHONE ~ e, Pro~a~sianal En~Inee~(PE) (661) 326-3979 ~m U f, Cla,$ II Registe~d Environmen~l U g. CO~actor~' state License Boerd ~icenead contractor (~ff~ ?ttye~, th~ [e~k I~te~ ~m~e~ ~hall Oe ~heoked MIh a ~us~e ~e~ Indlca~r ~ tO ~r~ being cunduc(~ on th~ ATTACHMENT B FIELD NOTES UST Facility Removal Report 7-Eleven Store Number 32376 9600 Brimhall Road Bakersfield, California SECOR Project No.: 77EL.32376.23.0521 JOB NAME: 7-Eleven Store #32376 JOB NUMBER: 77EL.32376.23.0806 CONTACT: Travis Simmons (Kern Construction) DATE PREPARED: 08/22~03 ADDRESS: 9600 Brimhall Road OVER SITE BY: Barry Miller Bakersfield, CA DATE: Thursday, 08/28/03 "After arriving on-site, review work order and SSP, then call Jaff Auchterlonie in Sacramento" 1) Check in with Kern Construction's Aaron or Travis Simmons. Tarvis Cell ph - (661) 203-3096. 2) Review Site Health & Safety Plan, address site hazards. Note potential hazards in field notes below. Review today's scope of work. 3) Please note quantity of drums on-site (if any) and what type of lid in the drum inventory section. 4) City of Bakersfield Fire Marshall, Steve Underwood is the inspector. He will be meetincj you on-site at 1 pm. Steve Underwood ph: (661) 326-3190 - Office (661) 496-0405 - Cell 5) Record those present for today's event and their affiliation. (Business cards) Ask Kern Construction when they plan to backfill and the timeline on the blended system construction. Will stockpile samples be taken, requested TAT and what is the timeline for stockpile removal? 6) Note the presence of any staining or damage to the tank surface. Any tank pit staining? Record the ID number on the UST. Document where the UST is being disposed, who is hauling it and the manifest #. 7) Add to existing site plan show the location of any stockpiles, tank pit, dispensers, any visable lines and other features. Take a roll of photos showing the site, cross street and any utilities or potential hazards..etc. 8) The excavation is shored, making sidewall sampling in the tank pit impossible. You will NOT be going inside the excavation. and the contractor does not have a backhoe onsite. You will have to bring several extensions and hand auger/impact sample a sample from the top of the excavation. Record tank pit sample location in field notes and on your site map. Record sample name on map. (Refer to Jaff's table for naming sequences.) Verify desired analyses for tank pit soil samples. 9) For each sample collected, measure PID readings at same location. 10) If contamination present, we would like to install a vault]well box for later drilling in the location of the former tank. Please keep this in mind and call Jaff in Sacramento before you leave the site. 11) Make a copy of ori~linals for yourself and mail ori~linal field notes and COC's to Danielle Catlin-Wri~lht in Sacramento. Health & Safety Site Plan: Hand Auger, Impact Sampler (with extensions), Post Hole digger and a shovel. Brass Sleeves (6X2"), Caps, tephlon tape. FID or PID to measure soil headspace and to monitor breathing zone. COCs and one Cooler with Ice Rolly Wheel, graph paper and a pencil. 1/2", 9/16', and 15/16" sockets, and other misc. tools Camera, film, zip locks & sharpie pens. Direct all questions to Jaff (916) 8254607 or (916) 861-0400 ext 223 -office PROJECT MANAGER, JAFF AUCHTERL ONIE AUTHORIZATION JOB NAME: 7-Eleven Store ~L32376 JOB NUMBER: 77EL.32376.23.0806 CONTACT: Travis Simmons (Kern Construction) DATE PREPARED: 08/22/03 ADDRESS:. 9600 Brimhall Road OVER SITE BY: Barry Miller Bakersfield, CA DATE: Thursday, 08/28/03 SITE VISITATION REPORT Arrival Time: i ~' ~(~ Departure Time: ._L~I ~ DRUM INVENTORY /~-Jc3 J~]~' WATER CARBON TOTAL OPEN TOP SOIL EMPTY TOTAL BUNG TOP HEALTH AND SAFETY ASSESSMENT DESCRIPTION OF ACTIVITIES ONSITE AND NOTES JOB NAME: 7-Eleven Store #32376 JOB NUMBER: 77EL.32376.23.0806 CONTACT: Travis Simmons (Kern Construction) DATE PREPARED: 08/22/03 ADDRESS: 9600 Brimhall Road OVER SITE BY: Barry Miller Bakersfield, CA DATE: Thursday, 08/28~03 DESCRIPTION OF ACTIVITIES ON SITE AND NOTES (cont) Field Work Conducted By: Barry Miller Date: Au~lust 28, 2003 I / ' / Chain of Custody Number: SECOR Chain-of Custody Record Field Office: 077 Sacramento I--I1 Additional documents are attached, and are part of this Record. Address: 3017 Kilgore Road, Suite 100 Job Name: 7-Eleven Store #32376 Rancho Cordova, CA Location: 9600 Brimhall Road Bakersfield, California Project # 77EL.32376.23 Task # 0410 Analysis Request Project Manager JaffAuchterlonie Laboratory Kiff Analytical ~ Tumaround Time ~ ,/11~ ,/3~';~ ~ _~_ ~ ~ ~ ~ ~ ~ Sampler's Name Barry Miller ,,x,~ ~ ~ '~ .~_~o ~o Sampler's Signature ~ ~ ~:~i5~° .~ .~O~o~ '~o~ ~ [~''~<-~!,~ Comments/ Sample ID Date Time Matrix ~ ~- ~-~~ ~ ~.~ o~.~o~.,,,,o~ >~-~ o~'~ ~-~1, Instructions z T3-1-2 08/28/03 Soil x x 1 T3-1-6 08/28/03 Soil x x 1 T3-2-2 08/28/03 Soil x x 1 T3-2-6 08/28/03 Soil x x 1 T3-3-2 08/28/03 Soil x x 1 T3-3-6 08~28/03 Soil x x 1 Special Instructions/C~m'~ Relinq~~ Received by: Fed Ex Sample Receipt ~e~m~e~:~, Mt. BE., ~'~.", TD,,:,,-~H~- Sign "~/~'~--- Sign Total no. of containers: email results to jaucl~teHe~,~secor, com Print · Barry Miller Print Chain of custody seals: CC results to: dacatlin@secor, com Company SECOR ! f Company Rec'd in good condition/cold: Time ~:~)~ Date~ Time Date Conformsto record: Relinquished by: Received by: Sign Sign Client: SECOR Print Print Client Contact: Jaff Auchterlonle Company Company Kiff Analytical Client Phone: (916) 861-0430 Time Date Time Date ext. 223 Date: 8/28/03 Page I of I LEGEND: Z~D2 DISPENSER SOIL SAMPLE LOCATION CHEMICAL ANALYTICAL RESULTS: ANALYTE TBPHg <1.0 <o.00,50 CONCENTRATION (mgJkg) MtBE <0.0050 ANALYTES: DEPTH--DEPTH IN FEET (BGS) TPHg --TOTAL PETROLEUM HYDROCARBONS B AS GASOUNE (mg/l(g) BENZENE (mg/kg) MtBE -- METHYL TERTIARY BLrTYI. ETHER (mg/l(g) 0 40 80 · PPROXIMATE SCALE CHECKFJ~. ~C~ FIGURE 1 APPROVED: JA 7-ELEVEN STORE ff32376 DATF~ e/~ 9600 BRIMHALL ROAD SITE PL,a~N TABLE 1 UST Removal Soil' & Water Sample Field Collection 7-Eleven Store #32376 9600 Brimhall Road i Bakersfield, CA Soil Sample FID or PID ', Soil ANALYSES REQUESTED Sample Sample Depth Reading i Type TPHg/BTEX/MtBE LEAD Number Date (feet bgs) (ppm) ~ 8260 Total I I Tank Pit Samples . . Label samples as: T1-1-13' (T=Tank 1= Tank #1 1= Sample # 13'= sample depth) T~- l- ~ ' T T T T Line 5oil Samples ~e/~/e~ L L L L L L L L L Dispenser Samples ~/~/~ D D D , D D D D Other Samples ~e/~/e~ File: UST and Line Sample Field Table.xls Page 1 of 2 JOB NAME: 7-Eleven Store #32376 JOB NUMBER: 77EL.32376.43.0806 CONTACT: Brad (Glacier Environmental) DATE PREPARED: 07/24/03 ADDRESS: 9600 Brimhall Road OVER SITE BY: Barry Miller Bakersfield, CA DATE: 07/25/03 "After arriving on-site, review work order and SSP, then call Jaff Auchterlonie in Sacramento" 1) Check in with Glacier Environmental, Brad Cell ph - (425) 471-1844. 2) Review Site Health & Safety Plan, address site hazards. Note potential hazards in field notes below. Please note quantity of drums on-site (if any) and what type of lid in the drum inventory section. Are there any outlets outside this store? Where are they located? Please note in field notes. 3) Bakersfield City Fire Marshall (Steven Underwood) will be your inspector. He may or may not be meeting you on-site. He has quite a few inspections on Friday. Steven's phone number (661) 326-3979. 4) Make sure you have the inspector's card and email address. This way the analytical results could be sent them as soon as it is received. Please verif~ which analyses they would like us to run. 5) There is not an existing site plan. Please add the following: Include: the store building, USTs (dimensions and gallonage), dispensers, any visible product lines/piping, canopy, stockpiles and sample locations. Add any tank pit observation wells, utilities (overhead/underground), storm drains, asphalt areas? Please note any adjacent businesses. If residences close-by, note addresses. 6) Take a roll of photos showing the site (N,E, S, W), cross street, sample locations, any utilities, potential hazards, noteable items..etc. 7) Record sample location in field notes and on your site map. Record sample name on map Refer to Jaff's table for naming sequences (attached). Lab # Samples Container TAT Analyses Soil Samples Kiff >6 Brass Sleeve Standard TPH~/, BTEX and Ox~Is EPA 6260; Total Lead, EPA 6010) Lab Contact: Kiff Analytical Mr. Joel Kiff Phone: 530-297-4800 2795 2nd Street, Suite 300 FAX: 530-297-4802 Davis CA 95616 Please contact sample receiving (ext. 125) to let them know what to expect. Especially on rush samples. 8) For each sample collected, measure PID readings at sample location. Record reading. 6) Call Jaff in Sacramento before you leave the site. Cell (916) 825-,4607 or (916) 861-0400 ext 223 -office Or Danielle (field phone) at (916) 826-3778 7) Be sure to fax the COCs to Danielle and copy your field notes before mailing them. (Incase of questions) Mail originals of all notes and COC's to Danielle Catlin-Wright in Sacramento, Health & Safety Site Plan Hand Auger, Impact Sampler, Post Hole digger and a shovel. Rolly Wheel, graph paper and a pencil (create &/or modify Fig) Brass Sleeves (6X2"), Caps, tephlon tape. Camera, film, zip locks & sharpie pens. FID or PID to measure soil headspace and to monitor breathing zone. ZipIocks: sandwich size for PID readings & gallon to place samples in, then to cooler. COCs and one Cooler with Ice PPE: steel toe boots, hard hat, ear protection & gloves. 1/2", 9/16', and 15/16" sockets, and other misc. tools (plastic mallet is handy) Direct all questions to Jaff (916) 825-4607 or (916) 861-0400 ext 223 -office ~ PROJECT MANAGER, JAFF AUCHTERLONIE AUTHORIZATION ~_~ ~ JOB NAME: 7-Eleven Store#32376 JOB NUMBER: 77EL.32376.43.0806 CONTACT: Brad (Glacier Environmental) DATE PREPARED: 07/24/03 ADDRESS: 9600 Brimhall Road OVER SITE BY: Barry Miller Bakersfield, CA DATE: 07/25/03 SITE VISITATION REPORT Arrival Time: Departure Time: Il 60 DRUM INVENTORY WATER CARBON TOTAL OPEN TOP SOIL EMPTY TOTAL BUNG TOP HEALTH AND SAFETY ASSESSMENT '7+__2,~ ~ .... 1 ,,j - ~w~k. - - ' ' DESCRIPTION OF ACTIVITIES ONSITE AND NOTES ~= ~.o JOB NAME: 7-Eleven Store#32376 JOB NUMBER: 77EL.32376.43.0806 CONTACT: Brad (Glacier Environmental) DATE PREPARED: 07~24~03 ADDRESS: 9600 Brimhall Road OVER SITE BY: Barry Miller Bakersfield, CA DATE: 07/25/03 DESCRIPTION OF ACTIVITIES ON SITE AND NOTES (cont) Field Work Conducted B)/: Barr~ Miller Date: Jul}/25, 2003 SECOR dOB NO. CALCULATED BY. DATE International Incorporated CHECKED BY DATE SHEET OF 'A'I-I'ACHMENT C WASTE DISPOSAL DOCUMENTATION UST Facility Removal Report 7-Eleven Store Number 32376 9600 Brimhall Road Bakersfield, California SECOR Project No.: 77EL.32376.23.0521 10-09-03 09'54AM FROM KE', CONSTRUCTION P03 ~,ilgle ~f (;all~emla--E~vironmental Protection Agwncy ~:arm Approv~ OM~ No. 20S0~03g (g.pjrel ~'30.~el See Instructions on back of page 6. 5: Tranepa~lar 1 C~pany Nam~ ...... ' 6. u~ EPA ID Number "' 7. Tr~n~p~fl~r 2 'C~pany N~e B, U~ EPA ID Number ~ E, ~iat~'~ran,por~r'~ ID [Re~e~,] ' ' ..... ~ I I. US DOT Dnseelpllen [lneludMe Pre,er S~tpa;ne Name, Hazard claes, and ID Number) Nm T~? ...... ~llly WI/Vol Wasm Number N b, " E T ~ ............ II I If I I EpA/O~e~ ~P~Other ' 15, Special Handling In~lructl~ and Addlti~al In~orm~lta~ 16, OENIKMOB'S CfBTIHCATION: I hereby declare that the contents al Ibis coniignmenl are fully 0nd accuralely described above by proper ihippin9 name and are Cio.sifted, packed, If I am a large quanll~ gSn,ru~e, I Certify Ihal ~ have a proaram in place ia reduce the volume and I~xicily ef waite general.d le lhe degree I have dalermin~ ta be .canomicollF precllcabl* and Ihal I~ave lelected the p/aciieable malhad o~ frealmenL storage, or di~al currently available Io me bhlch minimizes I~preaant and ~luCe Ihreat ~o human health  ava ab e ia me and thai can at,rd . ,., I 7. ~ani~rter 1 Acknowledg~ni o~ ~ecllpt ct Mater,ah .~. ' 19~ Dl~crepan¢~ I~dl~all~fi DO NOT WRITE ~ELOW THIS LINE. DTSC B022A (I/99) Green; TRAHSPORTER RETAINS I~PA 8700--22 ' - PO4 & BA ~ I D WEIGHfiD PHONE ~7-3559 Batch :1~3~ PAY BY~ TZ.T TRUC~ ~. O~ANE Oar','ter': .,DE COMMODITY GROSS TARE N~'?' PRI~E AMOUNT ~v of~'l$ ~erUtlc~t'""-'"""'~h~ll~l~ ...... lhe t~nk Io the re~:¥oltng t dl~po~l f~illb and be prOviaeo ~CF (7~) ~:2~ FA~ 001393804~ T~T B~ERSFIE~ GOLDEN STATE METALS, iNC. TANK .'r P. o, 60~ 701ss , 20~ E. "fund.ge Lane [- te ~ ~ ~/~-'~ . ~ Phon~ (BO~) 327-35~ , Fax {80~) 3~7-574~ ~;;~,,~ ............................ ~ ~ontra=t~'a .... ' ..... __ . ...................... l.:phone No,, ................ ~ .............. "" ~ .................. ~ ................... I ' ..... WEIGHT OERT, NO: EH~D PERMIT NO; ~0 ,14 550 ,24 ~ RESIDUALS PRE8ENT (R~EC~ ;=o 1,~2 , ,,' ',; , ~ ',,'",,,','~, ~ ..~ , ~.~,~ ~ ~ . ,~,;~:~:~ _ , OXY~BN OONTB~T ...... Z,oo ~.~ ._ '.. DISPOSAL FEE ,m .......... ~ ........... ,,[**..,:*,m...,.,,.,,.;.::;:;,:**..,>~*,,.,*..,/;,~-~ ..................... ,,,;,r*'; .................... ,,; ..... ~ , 170o ...... ~....~ ,~.~ ......... All fees Incurred ara per Icad unless Ipecllled. Terme lire net 30 days from receipt of tank. Cofltraetor's sign.tut. represent, acoeptan~ of ter~ for payment, and ;onflrm~ that tank removal ~ompllea with 5tat. law~. 1 ~, TE OF TANK DISPOSAL / Di;.-$'I~I~.ICTION ' F ATI'ACHMENT D CERTIFIED ANALYTICAL REPORTS AND CHAIN-OF- CUSTODY DOCUMENTATION UST Facility Removal Report 7-Eleven Store Number 32376 9600 Brimhall Road Bakersfield, California SECOR Project No.: 77EL.32376.23.0521 ~FF Report Number: 34260 Date ' 8/1/2003 ANALYTICAL Jaff Auchterlonie SECOR International, Inc. 3017 Kilgore Road, Suite 100 Rancho Cordova, CA 95670 Subject: 4 Soil Samples Project Name: 7-ELEVEN STORE #32376 Project Number: 77EL.32376.43 Dear Mr. Auchterlonie, Chemical analysis of the samples referenced above has been completed. Summaries of the data are contained on the following pages. Sample(s) were received under documented chain-of-custody. US EPA protocols for sample storage and preservation were followed. Kiff Analytical is certified by the State of California (# 2236). If you have any questions regarding procedures or results, please call me at 530-297-4800. Sincerely, 2795 2nd St., Suite 300 Davis, CA 95616 530-297-4800 J~FF Report Number · 34260 Date · 8/1/2003 I ANALYTICAL Project Name' . 7-ELEVEN STORE #32376 Project Number' 77EL.32376.43 Sample: D2-4 Matrix: Soil Lab Number: 34260-01 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/31/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/31/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/3'1/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/31/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/31/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/31/2003 Toluene - d8 (Surf) 97.6 % Recovery EPA 8260B 7/31/2003 4-Bromofluorobenzene (Surr) 101 % Recovery EPA 8260B 7/31/2003 Sample: D4-4 Matrix: Soil Lab Number: 34260-02 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Metl'iod Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 97.2 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 94.5 % Recovery EPA 8260B 7/30/2003 Approved By: J~l Kiff II 2795 2nd St., Suite 300 Davis, CA 95616 530-29~-~800 ~FF Report Number · 34260 Date · 8/1/2003 I ANAL YTICAL LLC Project Name ' 7-ELEVEN STORE #32376 Proiect Number' 77EL.32376.43 Sample: D5-4 Matrix: Soil Lab Number: 34260-03 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 97.8 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 94.3 % Recovery EPA 8260B 7/30/2003 Sample: D6-4 Matrix: Soil Lab Number: 34260-04 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Mettiod Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 97.0 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 94.5 % Recovery EPA 8260B 7/30/2003 Approved By: J6~l Kiff 1~ 2795 2nd St., Suite 300 Davis, CA 95616 530-297~800 Report Number' 34260 QC Report: Method Blank Data Date · 8/1/2003 Project Name- 7-ELEVEN STORE #32376 Project Number' 77EL.32376.43 Method Method Measured Reporting Analysis Date Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 7/31/2003 Toluene < 0.0050 0.0050 rog/Kg EPA 8260B 7/3112003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 7131/2003 TotaIXylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/31/2003 Methyl-t-butyl ether(MTBE) < 0.0050 0.0050 rng/Kg EPA 8260B 7/31/2003 TPH as Gasoline < 1.0 1.0 rog/Kg EPA 8260B 7/31/2003 Toluene- d8 (Surr) 97.7 % EPA 8260B 7/31/2003 4-Bromofluorobenzene (Surr) 100 % EPA 8260B 7/31/2003 KIFF ANALYTICAL, LLC Approved By: J~l Kiff 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 ij Report Number: 34260 QC Report: Matrix Spike/Matrix Spike Duplicate Date' 8/1/2003 Project Name: 7-ELEVEN STORE #32376 Project Number: 77EL.32376.43 ~Dup, lic,ate Spiked ~Du,plic,ate Spiked ;3p~KeCl Sample Relative Spike Spiked SpiKe(] Sample Sample _Relative Percent Percent Spiked Sample Spike Dup. Sample Sample Analysis Date Percent Percent Percent Recov. Diff. Parameter Sample Value Level Level Value Value Units Metl'iod Analyzed Recov. Recov. Diff. Limit Limit Benzene 34260-01 <0.0050 0.0387 0.0400 0.0367 0.0380 rog/Kg EPA 8260B 7/31/03 94.9 95.0 0.105 70-130 25 Toluene 34260-01 <0.0050 0.0387 0.0400 0.0370 0.0380 rog/Kg EPA 8260B 7/31/03 95.6 95.1 0.524 70-130 25 Tert-Butanol 34260-01 <0.0050 0.193 0.200 0.170 0.177 mg/Kg EPA 8260B 7/31/03 87.7 88.6 1.05 70-130 25 Methyl-t-Butyl Ether34260-01 <0.0050 0.0387 0.0400 0.0374 0.0392 mg/Kg EPA 8260B 7/31/03 96.6 98.0 1.39 70-130 25 KIFF ANALYTICAL, LLC 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 Report Number' 34260 QC Report: Laboratory Control Sample (LCS) Date' 8/1/2003 Project Name' 7-ELEVEN STORE #32376 Project Number' 77EL.32376.43 LCS LCS Percent Spike Analysis Date Percent Recov. Parameter Level Units Metl'iod Analyzed Recov. Limit Benzene 0.0396 mg/Kg EPA 8260B 7/31/03 94.2 70-130 Toluene 0.0396 mg/Kg EPA 8260B 7/31/03 .94.3 70-130 Tert-Butanol 0.198 mg/Kg EPA 8260B 7/31/03 90.2 70-130 Methyl-t-Butyl Ether 0.0396 mg/Kg EPA 8260B 7/31/03 96.6 70-130 KIFF ANALYTICAL, LLC Approved By: ~'~el Ki 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 ~/ Chain-of Custody Number: ~ECOR Chain-of Custody Record Field Office: ~ [] Additional documents are attached, and are a part of this Record. Location: ' Project ~ ~..3Z~, ~ Task ~ ~/~ Analysis R~uest Turnamun~Time~~- ~o ~ 8 .~ Sampler's o o o o ~ o ~ o Sampler's ~ ~.~ ~1 ~ ~ ~ Comment~ E SamplelD Date ~me Uatdx ~ ~o ~ ~ ~ ~ ~ E= ~ ~ Instructions z Sp~ial In~uotion~Gomment~: Reline_by: Re~iv~ by: /' 8ample R~eipt ~[[ ~O~ ~ - Sign ~ ~ ~ Sign ~ To~l no. of containem: ~ . Date Time O1~ Date ~z~e3 Client Phon Date: ~~FF Report Number ' 34711 Date · 9/2/2003 ANALYTICAL m.c Jaff Auchterlonie SECOR International, Inc. 3017 Kilgore Road, Suite 100 Rancho Cordova, CA 95670 Subject' 6 Soil Samples Project Name · 7-Eleven Store #32376 Project Number' 77EL.32376.23 Dear Mr. Auchterlonie, Chemical analysis of the samples referenced above has been completed. Summaries of the data are contained on the following pages. Sample(s) were received under documented chain-of-custody. US EPA protocols for sample storage and preservation were followed. Kiff Analytical is certified by the State of California (# 2236). If you have any questions regarding procedures or results, please call me at 530-297-4800. Sincer.ely, 2795 2nd St., Suite 300 Davis, CA 95616 530-297-4800 ~FF R eportNumber' 34711 Date · 9/2/2003 t ANAL YTICAL ,, z.c Project Name' 7-Eleven Store #32376 Project Number: 77EL.32376.23 Sample: T3-1-2 Matrix: Soil Lab Number: 34711-01 Sample Date :8/28/2003 Method Measured .Reporting Analysis Date Parameter Value Limit Units Metl-iod Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 98.1 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 99.8 % Recovery EPA 8260B 8/30/2003 Sample: T3-1-6 Matrix: Soil Lab Number: 34711-02 Sample Date :8/28/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 96.7 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 107 % Recovery EPA 8260B 8/30/2003 AP P roved By: /J~)~'~/ 2795 2nd St., Suite 300 Davis, CA 95616 530-:~97~...~0 ~FF Report Number · 34711 Date · 9/2/2003 I ANAL YTICAL Project Name' 7-Eleven Store #32376 ProJect Number: 77EL.32376.23 Sample: T3-2-2 Matrix: Soil Lab Number: 34711-03 Sample Date :8/28/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 94.2 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 108 % Recovery EPA 8260B 8/30/2003 Sample: '1'3-2-6 Matrix: Soil Lab Number: 34711-04 Sample Date :8/28/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Metkiod Analyzed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 96.8 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 106 % Recovery EPA 8260B 8/30/2003 2795 2nd St., Suite 300 Davis, CA 95616 530-297~,/8~0 ~FF R eportNumber' 34711 Date ' 9/2/2003 I ANALY'rlCAL /./.c Project Name' 7-Eleven Store #32376 Project Number' 77EL.32376.23 Sample: T3-3-2 Matrix: Soil Lab Number: 34711-05 Sample Date :8/28/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 96.6 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 106 % Recovery EPA 8260B 8/30/2003 Sample: T3-3-6 Matrix: Soil Lab Number: 34711-06 Sample Date :8/28/2003 Method Measured .R. ep.orting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260R 8/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260R 8/30/2003 Methyl-t-butyl ether (MTBE) 0.13 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 97.3 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 106 % Recovery EPA 8260B 8/30/2003 2795 2nd St., Suite 300 Davis, CA 95616 530-:~97~/8~0 ' Report Number: 34711 QC Report: Method Blank Data Date: 9/2/2003 Project Name: 7-Eleven Store #32375 Project Number: 77FL.32376.23 Method Method Measured Reporting Analysis Date Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Toluene <:0.0050 0.0050 rng/Kg EPA 8260B 8/30/2003 Ethylbenzene <: 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0.0050 rog/Kg EPA 8260B 8/3012003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 rng/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 rog/Kg EPA 8260B 8/30/2003 Toluene- d8 (Surr) 104 % EPA 8260B 8/30/2003 4-Bromofluombenzene (Sun') 96.2 % EPA 8260B 8/30/2003 KIFF ANALYTICAL, LLC 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 Report Number' 34711 QC Report: Matrix Spike/Matrix Spike Duplicate Date · 9/2/2003 Project Name: 7-Eleven Store #32376 Project Number: 77EL.32376.23 Duplicate Spiked DuD. lic,ate Spiked Spiked Sample Relative Spike Spiked Sp~kea Sample Sample Relative Percent Percent Spiked Sample Spike Dup. Sample Sample Analysis Date Percent Percent Percent Recov. Diff. Parameter Sample Value Level Level Value Value Units Metl'iod Analyzed Recov. Recov. Diff. Limit Limit Benzene 34711-01 <0.0050 0.0395 0.0401 0.0374 0.0380 mg/Kg EPA8260B 8/30/03 94.6 94.7 0.185 70-130 25 Toluene 34711-01 <0.0050 0.0395 0.0401 0.0317 0.0324 mg/Kg EPA8260B 8/30/03 80.1 80.8 0.870 70-130 25 Tert-Butanol 34711-01 <0.0050 0.198 0.200 0.186 0.198 mg/Kg EPA8260B 8/30/03 94.1 99.0 5.04 70-130 25 Methyl-t-Butyl Ether34711-01 <0.0050 0.0395 0.0401 0.0366 0.0366 mg/Kg EPA8260B 8/30/03 92.7 91.4 1.49 70-130 25 Approved By: J~f~a~ ~.~'/ 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 Report Number · 34711 QC Report: Laboratory Control Sample (LCS) Date · 9/2/2003 Project Name' 7-Eleven Store #32376 Project Number' 77EL.32376.23 LCS LCS Percent Spike Analysis Date Percent Recov. Parameter Level Units Method Analyzed Recov. Limit Benzene 0.0395 mg/Kg EPA 8260B 8/30/03 97.0 70-130 Toluene 0.0395 mg/Kg EPA8260B 8/30/03 97.6 70-130 Tert-Butanol 0.198 mg/Kg EPA 8260B 8~30~03 96.9 70-130 Methyl-t-Butyl Ether 0.0395 mg/Kg EPA 8260B 8/30/03 93.4 70-130 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 ~ ,~/t [ ' Chain of Custody Number: ~ ~L SECOR Chain-of Custody Record Field Office: 077 Sacramento r-'il Additional documents are attached, and are part of this Record. Address: 3017 Kil~lore Road, Suite 100 Job Name: 7-Eleven Store #32376 Rancho Cordova, CA Location: 9600 Brimhall Road Bakersfield, California Project # 77EL32376.23 Task # 0410 Analysis Request Project Manager Jeff AuchteHonie Laboratory Kiff Analytical ~~ ; ~ _ ~ _~ TumaroundTime Standard ~ ~)~. ~ ~= ~.> ~ . ~ Sampler,sSampler'sNamesignatureBarryMiller [~ '~'-= ~ ~."--~ ~ >-~ ==~!i°=~.~o _~°.~- .._~'~'~ !i~,~=--' Comments/ Sample ID Date Time Matrix O= ~ ~- o r- = ~- ~ Instructions z T3-1-2 08/28103 Soil x x 1 T3-1-6 08/28/03 Soil x x 1 T3-2-2 08/28/03 Soil x x 1 T3-2-6 08/28/03 Soil x x I ,,~. T3-3-2 08/28/03 Soil x x 1 T3-3-6 08/28/03 Soil x x 1 Special Instruct~,~ Relinq~_~. Received by: Fed Ex Sample Receipt ~a~/~e~l~e~le¢~, Mt. BE., ..~C-" .... , _ =.:, _ Sign '"'-~ Sign Total no. of containers: email results to jaucl~edef~ secor.com Print Ba~-ry Miller Pdnt Chain of custody seals: !CC results to: dacatlin@secor, com Company SECOR Company Rec'd in good condition/cold: ?"~g Sxlm/,,~ ,'~ t't'/vdO/ ~,,V ~,~l/' / ~¢. V/,'I ~ Time ~<~:~ Date .,~'//~, r Time ~Date Conformstorecord: I,,~¢J ~'x ~. o~ z.g'. 1",,~¢. "'""~'v°~/"~v/'z-el&el,~'~':~ Relinquished by: ~ Received by: . ~,F ~,~4. ~',e,,w,~,~.~ ,,~ ;,~./~z. c~,~=*.~-- o~z~ Sign ,../,..--'" Sign ~J~ ,~z/ Client: SECOR ~,~ 2.*c. · ~',~ -/~zy',,.v,,,~.~¢/'-,~- Print Print ' ,~],e,~,V .~.,1~'~. Client Contact: Jaff Auchterlonie '~°/~v~"'~z"~'~"v' /'~ //4° ~",~"~1~/z~/,3,o ~2.~ ~' me,~'al3y'"~ Date TimeC°mpany~z(,,Kiff AnalyticalDate 9/?.f/o~, Client Phone: ext.(916)861'O430223 Date: 8/28/03 Page 1 of I ....,, ~n,~ Custody Numba': ..... SECOR Chain-of Custody Record ~Md Ofr~ce: 077 ~.cfamento ~ .4d:ld~tionaJ documents are attached, and am part of ftts Record. Addre, s: 301;' KIIgore R. oed~ Suite 100 Job Nm~ 7-Ele~m~ Stere ,~, 2,~6 , _, ,,Rmleho ~ CA Locally: g~O0 Brimball Rc~d B4Lkerdleld~ C.Ilfom, la Pro]ec! if 77EL32376.23 Task g 04i 0 Anal' rais Request SampleV8 Signature ' ~ 13-1-2 08/28/03 Soil x x ..... 1'3-1-6 Oa/2.&a~ Sdl x x 1'3-2.2 08/28A)3 SoB x x .S~.~.~al Instruot Relinq~ Received by:Fed Ex .......... Sign "~ .... Sign ' ' Total no. oleontak~ra: .mall ~e~ult. ~ae "-~~:~':~n~ .... Print Ba~ ruler Print Chain ~ ce~0dy sea, s:, cc resultsto: dacatlln~secor, com Company SECOR Company Reddln goodconditkat~c0U: Time ~~~ Trna ~Oate ..Conforms to ,con::l: R~ru:lubhed by: R~ceived by:. Sign - Sign Client 8ECOR Print Pri~ C:l~ent Contact: Jeff A, ur~_tertonle Company Omnpany K'iff,~J'm.l~tlcai Cllerd' Prmna: (~)lq 861-043.0 T~me Oa~e Time Date ext. 223 ~~.w Dale: 8/28a)3 Page,, . 1 of I ' Tanknol eogy 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512)459-1459 Date Printed and Mailed: 11/17/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 10/09/2003 Order Number: 3131246 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Line tests Tank tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting tl~' 'r~rl~lo~r~ I TANKNOLOGY ~FRTIFICATI: OF TI:~IIG ~89oo SHO^L CREEK, BUILDING 200 ^USTIN, TEXA~7'7~757 TELEF:)HONE (512) 451-$334 FAX (§1~) 4§~145~ PURPOSE: POST CONST TEST RESULT SUMMARY REPORT TEST DATE: 10/09/03 WORK ORDER NUMBER: 313'1246 CUSTOMER PO: 32376-005 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 20819 72ND AVE. SOUTH 9600 BRIMHALL RD. SUITE 206 MARKET/12133 KENT, WA 98032 BAKERSFIELD, CA 93312 RANDY MARTIN MANAGER (253)796-7170 (661)588-4059 Tank Tightness Tests Results TEST TYPE: VacuTect ~EX~E~4AL* ~i'~S~RESULT TEST;RESUL~: 10k 2 REGULAR 10,028 96. O0 TOTAL CONT 60.00 180.00 PASS PASS 10k 3 PREMIUM 10,022 96.00 TOTAL CONT 71.00 180.00 PASS PASS *Where regulations require, for VacuTect external water level may be depth of dry well or water is assumed at lowest point that can be confirmed dry. Product Pipe Tightness Test Results ! ': ? TEST RESULT '. '~ ' .F!N~L~EAK RATE~ (gp) uc.rur, n VALVE 10];. 2 1;:['~v~TROFL1~Z pRESSO"R~ P 0. 000 TLD-1 Y 10k 3 ENVIROFLEX PRESSUR~E P 0. 000 TLD-1 Existing Line Leak Detector Test ~ ~ ~ ~',EXtST~NG4~E~K DETE¢;OR~ · ~i ~E~!STING LEAK DETECTOR~/ .......... ~ ~, .... ~: :~: ::~j.,~,::,~ : ,, ~; ~__ SERIAL# __RESULT 10k 2 VAPOAL~-SS LD2000 10k 3 VAPOAL~-BS T.D2000 New Replacement Line Leak Detector Test : :: : REPLACEDL~ DE~ECTOR:~I!: ~,~,, : , REPLACED LEAK,~DE~ECTOR #2 :: LLNE i~:MANUFACTURER MODEL~,,:: SERi~/:: RESULT M~UFA~URER MODEL~; SERIAL# RESULT! For owner detailed report in£ormatio~, visit www.tanI~o]o~y.com and select On-Linc Reports-WI~?, or contact your local Tank~olog7 of~cc. Tester Name: ALBERT J. QUEIROS Te/c~nic'~n Certification Number: 91-1448 - ^.. TEST DATE:10/09/03 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER313124,6 CLIENT: 7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-:ELEV]~ #32376 Tank ID: 3-0k 2 Tank manifolded: NO Bottom to top fill in inches: 3-4,4,. 0 Product: aEGOLAR Vent manifolded: NO Bottom to grade in inches: 147.0 Capacity in gallons: 3-O, O28 Vapor recovery manifolded: YEs Fill pipe length in inches: 4,8.0 Diameter in inches: 96.00 Overfill protection: YEs Fill pipe diameter in inches: 4,. 0 Length in inches: 324, Overspill protection: YEs Stage I vapor recovery: DOAL Material: TOTAL CONT Installed: &T~ Stage II vapor recovery: aALANC~. CP installed on: / / COMMENTS Start lin) End (in) II Dipped Water Level: 0.00 0.00 New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. ~2 L.D. #2 Dipped Product Level: 60.00 60.00 Probe Water Level: -0. 035 -0. O35 Make: Model: Ingress Detected: Water N Bubble N Ullage:N S/N: Test time: 08: 23-3.0: 35 Open time in sec: Inclinometer reading: 0.00 Holding psi: VacuTect Test Type: F~ltiple tanks Resiliency cc: NOT NOT VacuTect Probe Entry Point: Fill Test leak rate mi/m: Ti~STED - TESTED Pressure Set Point: -1.0o Metering psi: Tank water level in inches: 0. o0 Calib. leak in gph: Water table depth in inches: 180.00 Results: Determined by (method): MON~ Wi~LL Result: PASS COMMENTS COMMENTS TANK DIPPED AT FILL AND ATG I~ESULTING IN SAME LEVELS. Material: ~Nvzz~o~m~x Diameter (in): 3-. 5 Length (ft): 260.0 Test psi: 50 Bleedback cc: 3-90 Test time (min): 60 NOT NOT NOT Start time: 09:15 TESTED TESTED TESTED End time: 10: 15 Final gph: o. ooo Result: ~ass Pump type: ~RE S SO-R~ Pump make: FE P~.TaO COMMENTS Impact VaNes Operational: YEs Printed 11/17/2003 14:51 , su, s TEST DATE: 10/09/03 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3131246 CLIENT: ?-~.T.~.~]i2~', 'r~TC. AUSTIN, TEXAS 78757 (512)451-6334 SITE:?-~.T,~.~-EN #323?6 Tank ID: 10k 3 Tank manifolded: ao Bottom to top fill in inches: 146.0 Product: P]~EMI~ Vent manifolded: NO Bottom to grade in inches: 150.0 Capacity in gallons: 10,022 Vapor recovery manifolded: ~s Fill pipe length in inches: 50.0 Diameter in inches: 96.00 Overfill protection: ~'~s Fill pipe diameter in inches: 4.0 Length in inches: 324 Overspill protection: 3rzs Stage I vapor recovery: DU~ Material: TOT~L CONT Installed: ATC, Stage II vapor recovery: CP installed on: ! ! COMMENTS Start (in) End (in) Dipped Water Level: 0.00 0.00 New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: 71. O0 31.00 Probe Water Level: -0. 003 -0. 003 Make: Model: Ingress Detected: Water N Bubble N UllageN S/N: Test time: 08: 23-10: 35 Open time in sec: Inclinometer reading: 0.00 Holding psi: VacuTect Test Type: Mt~.t~.~31e tanks Resiliency CC: NOT NOT VacuTect Probe Entry Point: Fill Test leak rate mi/m: TESTED TESTED Pressure Set Point: -1.00 Metering psi: Tank water level in inches: 0.00 Calib. leak in gph: Water table depth in inches: 180.00 Results: Determined by (method): MONTR Result: PASS COMMENTS COMMENTS TANK DIPPED AT FILL AND ATG RESULTING IN SAME LEVELS o Material: ENV~ROFLEZ Diameter (in): 1.5 Length (ft): 280.0 Test psi: 50 Bleedback cc: 190 Test time (rain): 60 NOT NOT NOT Start time: 09: 15 '~_~S'['~D '['~,S'[~E,D TESTED End time: 10:15 Final gph: 0. 000 Result: PASS Pump type: PZ~ s so-z~ Pump make: ~'~ P~.~o COMMENTS Impact Valves Operational: ¥gs Printed 11/17/2003 14:51 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:3. 0 / 0 9 / 0 3 WORK ORDER NUMBER33.3 3.2 4 6 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN %32376 COMMENTS post .... unable to test ldfs due to dispensers off-line and site closed...all 4 torque test failed test (fill and vapor)...no blockage results to agency ..... A. Heath notified PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) :ITEMS ~STED i: ~: · : : Printed 11/17/2003 08:27 SBOWERS SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 10 / 09 / 03 WORK ORDER NUMBER3131246 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #32376 (~VENTS Pdnted 11/17/2003 08:27 SBOWERS ~900 Shoal Creek Bird, ~uildin~ 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512)459-1459 Date Printed and Mailed: 10/20/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 10/06/2003 Order Number: 3131287 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment-Dispenser Pan\Sump Secondary Containment-Line Interstitial Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Secondary Containment-Tank Interstitial SincerelY, Dawn Kohlmeyer Manager, Field Reporting ~r%, Tanknolocjy TEST DATE:lO/06/2003 WORK ORDER NO.: 313128'7 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32376 20819 72ND AVE. SOUTH 9600 BRIMHALL RD. SUITE 206 MARKET #2133 KENT WA 98032 BAKERSFI ELD CA 93312 RANDY MARTIN 253 -796-7170 Tank Interstital Tests Piping Interstital Tests --,-- ,~?,~ ~ : ,:' LINE ';? ~ PR:ODUCT~ ';,~,~ ~ M~<~RER RESULTS REGULAR Total Containment PASS REGULAR "A" Environ PASS PREMIUM Total Containment FAIL REGULAR "B" Environ PASS PREMIUM "A" Environ PASS PREMIUM "B" Environ PASS Sum & Under-Dispenser Containment Tests Sum~'~ ~ ~ ........ ~ ~ ........ : ' : ....:::::;: :: ;'": : ........ : ~*'::::: ; :::~;~/~ ~ ' < ~ · : :: ~: ~,: : ' '~==~;:'~ '~ '~'~ .~:::;:;~ ~ ':~ ~ ~ : REGU~R To~l Containment Pass REGU~R Total Con~inment Pass PREMIUM To~l Containment Pass PREMIUM To~l Con~inment Pass 1/2 Environ Pass 3/4 Environ Pass 5/6 Environ Pass 7/8 Environ Pass 9/10 Environ Pass 11/12 Environ Pass REG FILL OPW Pass REG VAPOR OPW Pass PREM FILL OPW Pass PREM VAPOR OPW Pass ]'anknology representative: KEN MINTON Services conducted by: WESLEY COULTER 'ran/ no/ogy SECONDARY CONTAINMENT TEST RESULTS " NAME: 7-ELEVEN #32376 32376 10/06/2003 WORK ORDER: 3131287 SITE ADDRESS: 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD CA 93312 -' REASON FOR TEST: SB-989 Installation Groundwater Level(" from grade): TANK INFORMATION AND INTERSTITIAL TESTS Dia. Material Manufacturer I~e.p~h Test Method Start Initial Finish Final Pass/ Tank Product Tank Size (" ) Time Level Time Result Fail 1 REGULAR 10028 96 TOTAL CONT Total Containment 57 Vacuum 1541 -10 "Hg 1641 -9.9 "Hg PASS 2 PREMIUM 10028 96 TOTAL CONT Total Containment 56 Vacuum 0224 ~10 "Hg 0324 -1.5 "Hg FAIL 3 0 0 4 5 6 7 8 Comments: 11 hours labor spent pulling vacuum and retesting premium tank interstitial to verify failure. LINE INFORMATION AND INTERSTITIAL TESTS Tank Product Dia. Lan. Material Manufacturer Volume Start Initial Finish Final Pass/ (" ) (feet) (~la ons/ Test Method Time Level Time Result Fail 1 REGULAR"A" 1.50 140 DW FLEX Environ Pressure 1535 5 psi 1635 5 psi PASS 2 REGULAR"B" 1.50 120 DW FLEX Environ Pressure 1535 5 psi 1635 5 psi PASS 3 PREMIUM"A" 1.50 150 DW FLEX Environ Pressure 1536 5 psi 1636 5 psi PASS 4 PREMIUM"B" 1.50 130 DW FLEX Environ Pressure 1536 5 psi 1636 5 psi PASS 5 6 7 8 Comments: All piping labelling can be found on the top-hats of each STP sump. ~ Test Date: 10/06/2003 ~ ~ Work Order: 3131287 SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS TypeI# Manufacturer J ModelOrMaterial J Diam"~'i~th/Lengthl Depth [TestMeth°d('') J Start I 'nitia' I Lave' J Finish I Final J Pass/Time Level Change Time Result Fail STP Sump REGULAR Total Containment Plastic 46 57 VPLT 1614 9.75 -.00039 1632 +.010 Pass STP Sump REGULAR Total Containment Plastic 46 57 VPLT 1639 9.75 +.00001 1656 -.002 Pass STP Sump'" ~REMIUM Total Containment Plastic 46 56 VPLT 1618 9 -.00046 1635 +.021 Pass STP Sump PREMIUM Total Containment Plastic 46 56 VPLT 1641 9 -.00156 1705 +.135 Pass Dispenser Sump 1/2 Environ Plastic 23 x 43 29 VPLT 1451 15 +.00035 1507 -.002 Pass Dispenser Sump 3/4 Environ Plastic 23 x 43 29 VPLT 1454 15,5 +.00001 1509 -.001 Pass Dispenser Sump 5/6 Environ Plastic 23 x 43 29 VPLT 1552 12,75 -.00000 1607 +.001 Pass Dispenser Sump 7/8 Environ Plastic 23 x 43 29 VPLT 1458 15,75 -.00017 1514 +.007 Pass Dispenser Sump 9/10 Environ Plastic 23 x 43 29 VPLT 1554 12.25 -.00017 1609 +.002 Pass ..... Dispenser Sump 11/12 Environ Plastic 23 x 43 29 VPLT 1503 14.75 -.00041 1520 +.003 Pass Spill Container PEG FILL OPW Plastic 13 13 Vacuum 1400 30 0 1401 30 Pass Spill Container PEG VAPOR OPW Plastic 13 17 Vacuum 1355 30 -0,~ "' 135~" 291~ Pass Spill Container PREM FILL OPW Plastic 13 18 Vacuum 1417 30 0 1418 30 Pass Spill Container PREM OPW Plastic 13 16 Vacuum 1425 30 0 1426 30 Pass Comments: We performed a 15 minute confirmation test on each STP sump to complete the 30 minute test cycle required. Water measurements in the STP sumps were taken from the highest point of the tank crown to the top of the water level, Water measurements in the dispenser sumps were taken from the bottom of the sump to the top of the water level. Work Or~er: 3131287 : ' Seconda~ Con~mment Testing Report Form Ta~ology-~E 8900 Shoal Creek, Build~g 200 Austin, Texas 78757 Work Order: 31.31287 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Ord, er: 31312 8 7 Ta~ology-~E 8900 Shoal Creek, Building 200 Austin, Texas 78757 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 W, ork Or,der: 3131287 ?. o~ ~) ii Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 W, ork Ord, er: 3131287 omer~pe~y) Ta~ology-~E 8900 Shoal Creek, Build~g 200 Aust~, Texas 78757 ; Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Tankno/ogy 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:lO/06/03 WORK ORDER NUMBER3131287 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Arrived on site at 1:30 P.M. for CA reg SB-989 secondary containment post-construction testing. Performed secondary containment testing as follows: 2 tank interstitials, regular passed, premium failed. 4 piping secondaries, all passed. 2 STP sumps, both passed. 6 dispenser sumps, all passed. 4 spill containers, all passed. We logged 11 hours of labor on the premium tank interstitial verifying the failing results. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINTiLEAK TEST RESULTS Printed 10/20/2003 08:11 SBOWERS SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 3.0/06/03 WORK ORDER NUMBER3133.287 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN $32376 (~OVENTS REG PREM Printed 10/20/2003 08:11 SBOWERS · 08/06/2003 09:14 9168( SECOR PAGE 82/08 D~te: 8/1/2003 ANYIL Y77 I L Jaff Auchte~lonle SECOR International, Inc. 3017 KIIgore Road, Suite 100 Rancho Cordova, CA 95670 Subject: 4 Soil Samples Projeot Name: Z-ELEVEN STORE ~2370 '-'7(~'~' Project Number: 77EL.32376.43 Dear Mr. Auohterlonie, Chemical analysis of'the samples referenced above has been completed. Summaries of the data are contained on the following pages. Sample(s) were received under documented chain-of.custody. US EPA protocols for sample storage and preservation were followed. Klff Analytical ia oertlfled by the State of California (# 2236). If you have any questions regarding proc, edures or results, please call me at 530-297-4800. Sincerely, 2795 2nd St., Suite 300 Davis, CA 95616 530-297.4800 09:14 916@61 SECDR PAGE 83/88 j~I~FF R eportNumber: 34260 Date: 8/1/2003 ANA£ Y77CAL Project Name: . 7-ELEVEN STORE #32376 Project Number: 77EL.32376,43 Sample: D2-4 Matrix: Soil Lab Number i 34280-01 Sample Date :7125/2003 Method Measured .R, ep..orting .A. na. lysi.s Date Parameter Value Liroit Units Method Analy~ecl Benzene < 0,0050 0,0050 rog/Kg EPA 8260B 7131/2003 Toluene < 0.00S0 0,0050 rog/Kg EPA 8260B 7131/2003 Ethylbenzene < 0,0050 0,0050 rog/Kg EPA 8260B 7/31/2003 Total Xylenes < 0.0050 0,0050 mg/Kg EPA 8260B 7/3112003 Methyl. t-butyl ether (MTBE) < 0.0050 0.0050 mgAKg EPA 8260B 7/3112003 TPH aa Gasoline < t.0 1,0 mg/Kg · EPA 8260B 7/3112003 Toluene - d8 (Sun') 97.6 % Recovery EPA 8260B 7131/2003 4-Bromofluorobenzene (Surr) 10t % Recovery EPA 8260B 713112003 Sample: D4-4 Matrix: Soil Lab Number: 34260-02 Sarople Data :7/25/2003 Method Measured Reporting .A. nalysis Date Parameter Value Li~it Units MeffiOd Analyzed Benzene < 0,0050 0.0050 mg/Kg EPA 8260R 7/30/2003 Toluene ,; 0.0050 0.0050 rog/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 7/30/2003 Totat Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 rog/Kg EPA 6260B 7/30/2003 'FPH a~ 13a$oline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene. cl8 (Surr) 97,2 % Recovery EPA 8260B 7~30~2003 4-Broroo~uombenzene (Sun-) 94,5 % Recovery EPA 8260B 7130/2003 2795 2nd St., Suite 300 Davis, CA 95816 530-29~-~800 0@/06/2003 09:14 91606 0 SECOR PAGE 04/08 ~l~j~lrF Re portNumber: 34260 Date: 8/1/2003 t ANA/..YTiCAL Project Name: 7-ELEVEN STORE #32376 Project Number: ??£L.32376.43 Sample: 05-4 Matrlx: Soil Lab Number: 34260-03 Saml~le Date :712512003 Method Measured Rep, orting .A, nalysis Date Parameter Value Llmrt Units n,lettiOd Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7130/2003 Toluene < 0.0050 0.0050 rog/Kg EPA 8260B 7130/2003 Ethytbenzene < 0.0050 0.0050 mg/Kg EPA 82608 7130t2003 Total Xylenes < 0.0050 0,0050 mg/Kg EPA 8260B 7~30~2003 Methyl4-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 713012003 TPH as Gasoline < 1.0 1.0 mglKg EPA 8260B 7/3012003 Toluene - d8 (Sun') 97.8 % Recovery EPA 8260B 713012003 4-Bromofluombenzene (Sun') 94.3 % Recovery EPA 82.60B 7/3012003 Sample: 06-4 Matrix: Soil Lab Number: 34260-04 Sample Date :7/25/2003 Method Measured Rep.erring ,A.n~, lysis Date Parameter Value Umk Units ~ettiod Analyzed Benzene < 0.0050 0.0050 mg/K0 EPA 8260B 7130/2003 Tetuene < 0,0050 0.0050 rog/Kg EPA 8260B 7/30/2003 Ethylbenzena < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xytene$ < 0.0050 0.0050 mglKg EPA 8260B 7130/2003 Methyl-t-butyl ether (MTBE) < 0,0050 0,0050 mg/Kg EPA 8260B 7130/2003 TPH as Gasoline < 1.0 1.0 rog/Kg EPA 8260B 7/30/2003 Toluene - d8 (Sun') 97.0 % Recovery EPA 8260B 7130/2003 4-Brornofluorobenzene ($urr) 94.5 % Recovery EPA 8260B 7/30/2003 Approved By: J~ff~f 2795 2nd St., Suite 300 Davis, CA 95616 530-297~/4800 Report Number: 34260 --. (;lC Report: Method'Blank Data Date' 8/1/2003 --. Project Name- 7-ELEVEN STORE #32376 Project Number: 77EL.32376.43 Meltmd Melhod Measum~ Repmllng Analysis Dale Messured Repnrl[ng Aflolya[s Dafa Parp. meter · Value Umff Units I~e~ed Analyzed Pammeler VaMe Umil Units Method A~abrzed ~e~{ene, < 0.0050 0.C050 m~'l~ EPA B26Q8 7/S112~]O'J, cD Toluene < n. nn6n 0.~'~0 rn~ EPA 82~08 ?~I/200~, cn E~4tm~ < n. ODS0 n.~ mg/~ EPA, B2eCB Total benes < 0.0050 0.~050 mg/K9 EPA 8260B .Met..~14.-butyI .et^tot 0V,1E~E') < {).DDSO n.eeso rog/Kg EPA $2~0B TPH aa Gasoline < 1 .O t.0 m~l;g EPA 8260B 7t$1J'2,G03, Toluerte- d8 (Sun') 97.7 % EPA a260B 1t31i2,a~, 4-1~o~flaflmbmtzene (Suer) I~O % EPA 8260B 7151.,'9,~03, M 2795 ~ ~, S~te 300 Oa~s, CA 95616 530-2974800 m Repmt Number: 34260 QC Repofl: ~t~x Spike/~ 8pike Duplic~ D~e: ~11~03 Pr~t ~me: 7-ELAN STORE ~23~6 Pr~t ~mber' 77EL32376.~ Dupficats ~i~d ~u~l~c~e ~pi~ ~Aed ~mple Relative ~pike Spied ap~ ~mp~ ~p[e ~t~v~eme~ Pement Spik~ Sample ~ ~ ~ple Sample Amlpis Date Pement ~ Pement ~. D~. Pamme~r Samp~ Value vame ~lue Un~ ~thod An~zed ~cov. Rec~. ~. Limit ~mit Be~ene 34~0-~ <0.0~0 0.0387 0.0400 0.0~7 0.03~ m~Kg EPAS~0B 7/31~3 94.9 ~.0 0.105 ~-130 25 Toluene 34~0-ffi <0.0~0 0,03~ 0.0400 0.0370- 0.03~ mgtKg EPA S~0B 7t31~3 95.6 ~.1 0.524 70-~30 25 Ted~anol 34260-~ <0.0~0 0.193 0.200 0.~70 0.177 mg~g EPA 8~0B 7~1~3 87.7 ~.6 1.05 70-130 25 M~hyM-~l Eth~3426~01 <0.0~0 0.0387 0.0~0 0.0~4 0.03~ mg~g EPA 8~0B 7~1~3 fl6.6 ~.0 1.39 7~130 25 Approved By:. J~l Kiff I! (= KIFF ANALYTICAL, LLC m 2795 2nd St, Suite 300 Davis, CA 95616 530-297-,1500 m Report Number: 34260 -.. qc Report: Laboratory Control Sample (LCS) Date: 8tl/2003 Project Name: 7-ELEVEN STORE #32376 Project Number: 77EL,32376A3 LC$ LCS Percent .Spik~ Analys~ Date Percent Recov. Parameter Leve~ Units MetYioo Anal)rzed Recov. Limit Benzene 0.0396 rng/Kg EPA 8260B 7131103 94.2 70-130 Toluene 0,0336 rng/K§ EPA 82608 7131103 94.3 70-130 Tert-Butanol 0,198 rng.q(g EPA 8260B 7/31103 90~. 70-130 Methyl-t-Butyl Ether 0,0336 rncj/Kg EPA 82608 7/31103 96.6 70-130 U~ m 0 KIFF ANALYTICAL, LLC Approved By: el Kiff 2795 2nd SI, Suite 300 Davis, CA 956'16 530~297-4800 : Chain-of Custody Number:.. ,' S~__.,C~ Chain-of Custody Record "~ti ?...~ 0 Field Off[ce: O Additional ctocuments a~e attached, and are a part of this Record. · Pmle~ #..'"~'~_ ._~Z,-~_ ,~_ ras~ # ~ Ana~ neq,est Sample ID ~.,~, Time Matrix g-)l~_q ¥' ~ ~' X ~-.~ _.o~! 1 [ . IT1 I. Special InLtrucflons/Oomments: Ralinqul~_~: Received by: ,.-'""~'i Sample Receipt ~[~, ~U~'~ ~ ~ S~gn w ~ Sign~ Total 110. ~f c~ntairmra: Company :"~3~ . . C Redctin good con~tlen/oeld: · -i~ ~-6k~.~'/i~ i~ ~._,O~f~, ~0 W~ Relinquished by: ~ Re~' : ; ~.~iw,~t~ r~c¢¢~'& ~-~' &¢~*c ck,~, '~g ~% Print / Print ~le I.,~,,~,¢,,,~'t''''-' CliemContact'.~A1~..~;~.~ -o ~,~ ~',~O~r~.~' [/Z' Z- ,~e-.,~zqe!.'ellb C°m~/ Company ~-;~'~-~t-,~ ~ ~~ Date Time ~1~3 Date:ozz't 0'3 Client Ph~n m User: RightFAXUser ~ost: FAX Class: Fax Job: !Q_HAZl p1010124.jpg ( 1280x960x24b jpeg) p 1010122.jpg (1280x960x24b jpeg) p1010121 .jpg (1280x960x24b jpeg) p1010120.jpg ( 1280x960x24b jpeg) p1010119.jpg (1280x960x24b jpeg) p1010128.jpg (1280x960x24b jpeg) p1010125.jpg ( 1280x960x24b jpeg) p1010126.jpg (1280x960x24b jpeg) p1010065.jpg (1280x960x24b jpeg) 7-11 32:376 9600 BRIMHALL RD. BAKER~F I ELD .. tiaA. 9.'3312 B0687875505001 OOT 7, 2003 1:43 PM ......... IN-TANK ALARM ...... ~""::TEM STATUS FtEPORT T 2 :MIjL .pROBE OLIT ~Ls~ ........... ' FUNCTIONS NORMAL · Oc' '- 7, 2003 1:40 PP1 i :"7--1 I ;32S76 .......... SEI,ISOR AL~RI'.'I ...... 9600 BRIMHALL RE). L i:RUL STP SUMP '~ BAK'ERSFIELrl..C:A.93812 BT[:' SLIMP HIGH LIOIJID ALARM ~, B0687075505001 OCT 7, 200'3 1:42 PM OCT 7.. 200~ 1:43 PM SYSTEM STATUS REPORT /--.-Z FUNCTIC, NS NORMAL ...... SENSOR ALARM L :3:PUL STP SUMP STP SUMP HIGH LIOUID ALARM 7.. 2003 1:43 PM ..... SENSOR ALARM ..... L 9:DISP. 5-6 ir) I ,cJt:>ENSEFf I::'AN H-I(~H LIOUID ALARP1 OCT 7.. 2003 1:43 PM SENSOR ALARM LIO:DISP. ?-8 ........ SENSOR ALARM ...... I'~I,Or"~-NSER PAN Li2:gISP. 11-12 ,L. IC4.U_,Ig ALARM glSDENSER PAN 0C'~'"~7. 2003 1:44 PM HIC~H LlglUIg ALARM OCT 7.. 2003 I :45 PM ........ SENSOR aLaRM L ~:DISP. 3-4 7. , .'_32276 91 SPENSER PAN 9'~,...,~ t4IC4H LlcaUID aLARM BA~:'~ERSFIELI-~..Ca. OCT '7, 200S 1:44 PM B0687875505001 OCT 7, 2009 1:45 PM SYSTEM STATUS REPORT aLL FUNCTI©NS NORMAL ......... SENSOR ALARM L 7:DISP. 1--2 DISPENSER PAN HIGH LI(~UID ~LaRM OCT ?, 200:3 1:44 PM ........ SENSOR ALARM ..... Lll:DISP. 9-10 gl.SPENSER PaN H' LIQUID ALARM Ob,-,~' 7, 2003 1:45 PM SENSOR ALARM ....... Lll:DISP. 9-10 DISPENSER PAN HIGH LIQUID ALARM OCT ?. 2003 1:45 PIN 7-11 32376 9600 BRIMHALL RD. BAKERSF I ELD .. CA. 9t3912 B0687875505001 ........ SENSOR ALARM ' OC.T 7, 2003 1:46 PM L 9:DISP. 5-6 DISPENSER PAN HIGH LIQUID ALARM OC:T ~- 2008 1:47 PM SYSTEM STATUS REPORT ~: FUNCTIONS NORMAl- ...... SENSOR aLaRM ...... L ?:DISP. 1-'2 DISPENSER PaN .......... SENSOR ALARM ...... HIGH LIQUID aLaRM Lll :DISP, 9-10 OCT 7., 2008 1:48 PM DISPENSER PaN HIGH LIQUID ALARM OCT 7, 2003 1:46 PM ..... SENSOR aLARM ...... L 8:DISP, 3-4 DISPENSER PAN ...... SENSOR ALARM ..... HI(SM LIQUID aLaRM LI' ISP. 11-12 OCT ?, 200:3 1:48 PM D I ~,-~ '~SER PAN HIGN LIQUID ALARM OCT 7 ...... = SENSOR ALARM ..... LI', iISI:". 7-8 D I~NSER PaN ....... SENSOR ALARM ...... ttlC;H LIQIJII-:, ALARM LIO:DISP. 7-8 OCT 7, 2003 1:48 PM DISPENSER PAN HIC;H LIQUID ALARM OCT 7, 2002 1:47 PM ........ SENSOR ALARM L 2:kUL AbINULAR ANNULAR SPACE FUEL, ~L~RM OCT 7. 200~ 1:49 PM ......... SENSOR ALARI"I ...... L 4:PUL ANNULAR ANNULAR SPF~CE FUEL ~L~RM OCT 7. 200~ 1:49 PPI 9600 BRIP1HALL R[]. BAKERSF ! ELI]), CA, 93312 B0687875505001 C,"-'T 7, '-' - zOLl,o 1:5~ PPI SYSTEPI ST~TU~ REPORT L '2: FUEL ALARM L 4:FUEL ~L~RM 89/83/2883 3.8:33 91 SECOR PAGE 83./18 O SECOR INTERNATIONAL INCORPOI~'rED 3017 KIIDore Ro~(J~ Suite 100 www'~;ecor, com 915-~t1.0400 la. / 918.01~1.~430 r.~ company: date/time: from: no. of pages (including cover): message: . . Disclaimer: The information transmitted herein Is Intended only for the person or entity fo which it is addressed and may contain confidential and/or p~v'deged material. If you am not the Intended recJplent of this rear. age. you are hereby nottlied that any use, review, ,=b.namlsslon, dissemination, distribution, reproduction or any a~tion taken In reliange upon this m_,~.,~ege is prohibited. If you reoelved this oommuni~ation In error, please notify the sender immediately and delete the orll;l!nal messajle and all attachments fTom ),our electronic files. 09/03/2003 i0:33 9i6061~0 SECOR PAGE 02/i0 Date: 9/2/2003 .4NAI.. YTICA ; Jaff Auchterlonie SECOR International, Inc, 3017 Kilgore Road, Suite 100 Rancho Cordova, CA 95670 Sul3ject: 6 Soil Samples Project Name: 7-Eleven Store #32376 Project Number: 77EL.$2376.23 Dear Mr. Auchterlonie, Chemical analysis of the samples referenced above has been completed. Summaries of the data are contained on the following pages. Sample(s) were received under documented chain-of-custody. US EPA protocols for sample storage and preservation were followed. KlffAnalytical Is certiorari by the State of California (# 223~), If you have any questions regarding procedures or results, please call me at 530-297-4800. Sincer ~ly, 2795 2nd St., Suite 300 Davis, CA 95616 530-297-4800 0S/03/2003 10:33 Si6861~0 SECOR PAGE 03/i0 Date: 9/2/2003 i ANALY77CAL .cc ProJect Name: ?-Eleven Store #32376 Project Number: 77EL.32376.23 sample: T3-1-2 Matrix' Soil Lab Number: 34711-01 Sample Date ;8/28/2003 Method Measured Rep. orting .Analysis Date Parameter Value Limit Units MetHod A. naa/zed Benzene < 0.00S0 0.0060 rog/Kg EPA 8260B 8/30/2003 Toluene ¢ 0.0050 0.0050 rog/Kg EPA 8260B 5/30/2003 Ethylbenzene < 0,0050 0.0050 mg/Kg EPA 8260B 5/30/2003 Total Xylanea < 0.00S0 0.0050 rog/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (I~'rBE) < 0,0050 0.0050 mg/'Kg EPA 8260B 8/3012(303 TPH as Gasoline < 1.0 1.0 mgtKg 'EPA 8260B 8/30/2003 Toluene - d8 ($urr) 98.1 % Recovery EPA 8260B 5/30/2003 4-Bromofluombenzene (Surr) 99.8 % Recovery EPA 8260B 8/30/2003 Sample: T3,1-6 Matrix: Soil Lab Number: 34711-02 Sample Date :5/28/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units MetHod Analyzed Benzene < 0.O0S0 0.0050 mg/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0.0050 mg/K4] EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 8130/'~003 Total Xylenes < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0,0050 0.0050 rog/Kg EPA $280B 8/30/2003 TPH aa Gasoline < 1.0 1.0 mg/Kg EPA 8260B 8/30/201)3 Toluene - d8 (Surf) 96.7 % Recovery EPA 8260B 8/30/2003 4-Bmmofluorobenzene (Surf) 107 % Recovery EPA 8260B 8t30/2003 2795 2nd St., Suite 300 Davis, CA 95616 530-~-97.L4~0 09/09/2809 10:33 916861~0 SECDR PAGE 04/10 ~C~~J~P'~/~IIII~P'~/TCAL LLC DateRep°rt Number :: 9/2/2003 34711 Project Name' 7-Eleven Store #32376 Project Number: 77EL.32376,23 Sample: 'r3-2.2 Matrix: Soil Lab Number: 34711-03 Sample Date ;8/28/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units MetHod Analyzed Benzene < 0.O0SO 0,0060 mg/Kg EPA 8260B 8/30/2003 Toluene < 0.0050 0,0050 mg/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0,0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Total Xylenea < 0.00S0 0.0050 rog/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mglKg EPA 8260B 313012003 TPH as Gasoline < 1.0 1,0 rog/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 94.2 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Sun') 108 % Recovery EPA 8260B 8t30/2003 Sample: T3-2-6 Matrix; Soil Lab Number: 34711-04 Sample Date :8/~-8/2003 Method Measurecl .R. ep..orting _Analysis Date Parameter Value um~ Units MetHod Analyzed Benzene < 0,0060 0.0050 rog/Kg EPA 8260B 8/30/2003 Toluene < 0,0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Total Xylenes < 0,0050 0.0050 rog/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < 0,0050 0.0050 rog/Kg EPA 82608 8/30/2003 TPH ae Gasoline < 1.0 1.0 rog/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 96.8 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Sun-) 106 % Recovery EPA 8260B 8/30/2003 2795 2nd St,,'Suite 300 Davis, CA 95616 89/83/2883 i0:33 9i686i~0 SECOR PAGE 85/10 Date' 9/2/2003 ANAL Y'rlCAL Project Name: T-Eleven Store #32576 Project Number: 77EL.32376.2:~ Sample; 1'3.3.2 Matrix; Soil Lab Number: 34711-05 Sample Date :8/2812003 Method Measured .R. ep.orting Analysis Date Parameter Value uml~ Units MetHod An,a!yzed Benzene < 0,0050 0,0050 mg/Kg EPA 8260B 8/30/2003 Toluene < 0.D0SO 0.0050 rog/Kg EPA $260B 8130/2003 Ethylbenzene < 0.00-~0 0,0050 mgtKg EPA 8260B 813012003 Total Xylenes < 0,0050 0.0050 mgtKg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) < O.O0S0 0.0050 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1,0 1.0 mgtKg EPA 6260B 8/30/2003 Toluene - d8 (Sun') 96,6 % Recovery EPA 8260B 8/30/2003 4-Bromofiuorobenzene (Surr) 106 % Recovery EPA 8260B 8/30/2003 Sample: 'r3,.3.6 Matrix: Soil Lab Number: 34711-06 Sample Date :8/28/2003 , Method Measured .R, ep. prtlng Analysis Date Parameter Value [.im~[ Units MetHon Analy~ed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 8130/2003 Toluene < 0.0011O 0.0050 rog/Kg EPA 8260B 8/30/2003 Ethylbenzene < 0.OOS0 0,0050 mcj/Kg EPA 8260B 8/30/2003 Total Xylenes < 0.0050 0,0050 rog/Kg EPA 8260B 8/30/2003 Methyl-t-butyl ether (MTBE) 0.t 3 0,0060 mg/Kg EPA 8260B 8/30/2003 TPH as Gasoline < 1.0 1.0 rog/Kg EPA 8260B 8/30/2003 Toluene - d8 (Surr) 97.3 % Recovery EPA 8260B 8/30/2003 4-Bromofluorobenzene (Surr) 106 % Recovery EPA 8260B 8t30/2003 Approved Ely: 2795 2nd St., Suite 300 Davis, CA 95616 530-;J97~J(~0''' Report Number: 34711 QC Report: Method Blank Data Date .Pr°ject Name: 7-Eleven Stem #32376 Project Number: 77EL.32376.23 Me,had MaUmd Measured Repealing Analysis Date Measured Reportin Parameter V;;,~ Umlt Unj[s Method Apayzed Parameter Va!,~ Limit Units Method ,amaJvzed Ber,,mno < 0.01~50 0.{X)50 n~l(O EPA 8260B 8/30/2J~O3 Toluene < O. OOSe 0.¢050 m~Y.g EPA. 8260B Eth~ax~-z e n e < 0.00RQ, 0.O0~0 m~(g EPA 8260B Total3¥eaes < 0.0050 0.0050 fagR(g EPA8260B 8/30/2003 Molty~-t~u~d et.J3e~(MTBE) '< 0.0050 0,0050 m~Kg 15oA8260B 8,i30~2003 'rPH as ease~rae < 1.0 l.O rog/Kg EPA 8260B Te~u~ee - eib (Sen) 104 % EPA 8260B 4-Bmm~lluombenzene (Surf} g82 % EPA 8,?.6q)B B~3O/2on3 0 2795 2r~l St. Suite 300 Davis. CA,5616 530-297-4800 Report Num~er: 34711 QC Report: Matrix Spike/Matrix Spike Duplicate Date* 9/2/2003 CO Project Name: 7-Eleven Store #32376 Project Number: 77EL32376.23 Dupticale Spiked ~Du~.tic~.te Spiked Spiked . _Sample Relative Spike Spiked =plKe~ Sample S_ample _Reladv,ePercent Percent ~n Spiked .S.a.mple Spike Dup. ~ .a~ple Sample .Ap..Mysi,s Date Percent ~'ercent Percent Recov. Oiff. Parameter Sarape value Level Level Value Value Units Metl~oe Analyzed Recov. Recov. Diff. Limit Limit cn Benzene 34711-01 <0.0050 0.0395 0.0401 0.0374 0.0380 rog/Kg EPA8260B 8130/03 94.6 94.7 0.185 70-'130 25 Toluene 3471'1-01 <0.0050 0.0395 0.0401 0.0317 0.0324 mg/'Kg EPA8260B 8/30/03 80.1 80.8 0.870 70-130 25 Ted-Butanol 34711-01 <0.0050 0.198 0.200 0.186 0.198 rog/Kg EPA8260B 8/30/03 9¢.1 99.0 5.04 70-'130 25 Methyl-t-ButylE~er34711-01 <0.0050 0,0395 0.O401 0.0366 0.0366 mg~g EPA8260B 8f30/03 92.7 91.~. 1.49 ?0-~130 25 2795 2nd St, Suite 300 Davis, CA 956'16 530-2974800 Report Number: 34711 OC Report: Laboratory Control Sample (LCS) Date: 9/2/2003 Project Name: 7-Eleven Store #32376 co Project Number: 77EL.32376.23 P. LCS LCS Percent Spike Analys/s Date Pement Recov. Parameler Level Units Mel~od Analyzed Re,or. Limit Benzene 0.0395 m§~g EPA 8260B 8/30/03 97.D 7D-13l) Toluene 0.0395 mg,~g EPA 8260B 8/30/03 97.6 70-130 Tert-Butanol 0.198 mg/Kg EPA 8260B 8/30/03 96.9 70-130 Methyl-t-Butyl Ether 0.0395 rog/Kg EPA $260B 8/30/03 93.4 70-130 m 0 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 Commenls/ Instruc~orts CITY OF BAKI~.SFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE City, Zip ~ ~33{ Z City, Zip ~O q3)o~ INSTRUCTIONS: Please call tbr an inspector only when each group of inspections with the same number are ready. They will run in consecutive order beginning with number I. DO NOT cover work tbr any numbered group until all items in that group are signed off by the Permitting Authority. Following these instructions will reduce the number of required inspection visits and there/ore prevent assessment of additional fees. TANKS AND BACKFILL N[~ Backfill of Tank(s) ~ Spark Test Certification or Manufactures Method I,~k' Cathodic Protection of Tank(s) PIPING SYSTEM ~"~ ~',... 6J / /t~) ' Piping& Raceway w/Collection Sump '~o7~-,g,,-~? ~l = g:~5'.~ e~r; '-(~, ~ ~ ' Corrosion Protection of' Piping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) ~(~( Cathodic Protection System-Piping SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s)for Annual Space-D.W. Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwater Spill Prevention Boxes /~C~'" '7 FINAL Monitoring Wells, Caps & Locks j Fill Box Lock Monitoring Requirements Type ~t'~",~ ~[ ( Authorization for Fuel Drop CONTRACTOR c '- * )'C~ K~t~/ ~0'~ ~"'i LICENSE// CONTACT ~c~ J~~ PHONE# BAKERSFZELD FZRE DEPARTKENT 171§ Chester Ave., BakersfXeld, CA 93301 "- (805) 326-3979 TANK REXOV~ ZNS~CTZON FOR~ OWNER_ - .-- PERMIT TO OPERATE9 CONTRACTOR CONTACT PERSON ' PRELIMANAR¥ ~SSESSI~RT CO.~_~.~u/___~__CONTACT PERSON cos ~SCZSPT [4~L~ ~0 ~ r.~nt ~-- o2t PLOT PLAN I ,, CO~ZTZO~ os PZ;Z~ CO~TZON os, SOXL COMMENTS DATE INLIECTOIt8 NNIE 8/flfmTURf air No. cJ ,.30 ~ CITY OF BAKERSFIELD '~:T,_.- O9..(,:, OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PER~T ,aPPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY [ ]MODIFICATION OF FACILITY [ INEWTANK INSTALLATION AT EXISTING FACILITY STARTING DATE /~off ~ PROPOSED COMPLETION DATE FACILITY NAME 9-// .-~ ~9~ EXISTING FACILITY PERMIT NO. FACILITY ADDRESSq~ ~'~qA/,n~.~ ~. CITY ~~ ZIP CODE TYPE OF BUSINESS ~ ~/~ ~ APN ~ TANK O~ER ~-//~ PHONE NO.~'~'~ ADDRESS ~/~1 ~, '~ ~1/ CI~ ~~ ZIP CODE ~ CO~~R ~ ~ ~ ~Z. CA LICENSE NO. ~ ADD.SS ~. ~ ~ Cl~ ~ ~. ZIP CODE ~6 PHONE NO~I~ ~-~ BA~RSFIELD CITY BUSINESS LICENSE NO. ~1~ ~r[v D~scm~ z.~ wo~ TO ~ON~ ~~ ~ ~ ~~ WATER TO FACILITY PROVIDED BY DEPTH TO GRO~D WATER SOre ~PE EXPE~ED AT SITE NO. OF TANKS TO BE ~STALLED ARE THEY FOR MOTOR FUEL YES NO StaLL P~VE~[ON CO~ROL AND CO~ER M~S~S PLAN ON HLE YES NO S~CT~ON FOR MOTOR FU~L TANK NO. VOL~E ~LEADED ~GULAR P~MIUM DIESEL AVIATION I I~,~ ~ SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) (IF KNOWN) FoR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. NO. OF TANKS FEES $ I THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS ~ APPROVED BY: . APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED Permit No. ~,,..--0:~] CITY OF BAKERS ~.ELD ~;" OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE '7-// ADDRESS ~ '~;1~",*'//-~ ZIP CODE APN FACILITY NAME 7-// ~r'e~e: ~ CROSS STILEET TANK OWNER/OPERATOR ~7-H .2';~'d.. PHONE NO. MAILING ADDRESS .~'_--P~ _'_'_'_'_'_'_'_'_'_~,,-~z/.~_ .=~7~'l ~ r/~/*t~ CITY ~2 ~, ZI~q.~ CONTRACTOI~ INFORMATION, COMPANY /C'e~./ ~~ ~ PHONE NO(F~/.~ ~q'-'~/--~> LICENSE NO. ,6/8/ INSURANCE CARRIER ,~?'FqP'/~ ft.,~/A WORKMENS COMP NO. tY-./qb/,~eT' PRELIMINARY ASSESSMENT INFORMATION COMPANY ~,~Z . PHONE NO.L'/tr~.) ~g-- qd,~7 LICENSE N©. ADDRESS 2T,~/¢ ,¢~2~r,.~ ~g. ~ /,~o CtTY ~t, ro~t,.~ ih,, INSURANCE CARRIER WORKMENS COMP NO. TANK CLEANING INFORMATION COMPANY ,~ '~r~ ..2"A/~ PHONE NO.(_.~/&.) ~D~SS ~~ ~ C~ ~~ Zm WASTE ~SPOR~R ~E~ICA~ON'~ER N~E OF ~SA~ DI~PO}~ FACm~ ~~ / ~~ ~D~SS ~ ~, ~~ ~ CI~ ~~ FACILI~ ~E~ICA~ON ~ER ~~ TANK TRANSPORTER INFORMATION COMPANY '~7'Zr-~,~ PHONE SO. :~e_e- &~e~" LICENSE NO. ADDRESS /'~O .,~,~,t~r,$' ~_~. CITY ~,c~'~__~. ff,~. Z~ ~ T~ DES~A~ON ~ T~K ~FO~TION V.T S c.m c T~ NO. AGE VOL~E STOOD STOOD P~OUSLY STOOD For Official Use Onb/ I THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY.WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULAT IONS. THIS FO~p4 HAS BEEN CO~4P LETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TR.~J~ AND COI~RECT. ,~ / / AP~[OVED B~.'.' - APPLICANT NAME (PRINT) "AP'PLICP~NT SIGNATURE THIS APPLICATION WILL BECOME A.PERMIT WHEN APPROVED RECORD OF TELEPHONE CONVERSATION Location: .... ~FO, ID#.___ InspeCtor's Name: Type of Call: InCOming ~(] Outgoing [ ] Returned [ ] Time Required to Complete Activity # Mln: RECORD OF TELEPHONE CONVERSATION Location: tk~-"~ ID# Businee~ Name:~ "~'* I{ , ~,c. Contact N~e: ~ ~~ ~ Busin~ Phone: ~'~ ~ ~ f~ - ~ ~O F~: ~meofC~l: D~e: ,~'~ ~me: I',~~ ~Min: .... ~ T~e ~ C~I: In~ing ~] O~oing [ ] R~m~ [ ] Time Required to Complete Activity # Min: JUN ':~'~I~ ~'2 b ........... SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL INVENTORY REPORT T I:RUL VOLUME = 10450 GALS ULLAGE = 4590 GALS 90% ULLAGE= 3066 GALS HEIGHT = 60.25 IP~'~ES STK HEIGHT= 60,23 K~ES WATER VOL = 0G~'"L-~;" .... WATER = 0.00 INCHES TEMP = 76.5 DE~" T 2:MUL VOLUME = $682 GAI.¢ ULLAGE = .6846 GAL 90~ ULLAGE=' 5545 GAL ~x HEIGHT = 38.46 INC.,~ STK HEIGHT= S8.48 IN¢ WATER VOL = 0 GALl: WATER = 0.00 IN¢~ ~ TEMP = 85,5 DEG T 3:PUL VOLUME = 3243 GALS ULLAGE = 6779 GAL$ 90% ULLAGE= 5777 GALS HEIGHT = $3.69 IF 'ES STK HEIGHT= 35.69 WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 83.0 DEG F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CitECKLIST 1715 Chester Ave., 3"t Floor, Bakersfield, CA 93301 FACILITY NAME 7~ [[ INSPECTION DATE (~ Section 2: Underground Storage Tanks Program [2i Routine [~Combined 121 Joint Agency [~l Multi-Agency l~l Complaint I~l Re-inspection Type of Tank {DoJ.lc'e ~ Number of l'anks Type of Monitoring d_ctlA Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owneffoperator data on file ~, Permit fees current Certification of Financial Responsibility ~ Monitoring record adequate and current k., 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? yes, Does tank have overtill/overspill protection? If C=Cornpliance V=Violation Y=Yes N=NO Inspector: Office ofEn~ironmental-Serv-~ce~(661) 3"~6-3979 /"/' Business Veq~esponsible Party White - Env. Svcs. Pink - Business Copy Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironmental Ser'e'tces ~a r ,,,, ..........: ',',, '" , ..... ' ", " 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME IINSPECTION DATE I INSPECTION TIME .... ~ ~£ ........................................................................ i ............................ "~ ~~.:~*o_..._~__.._1 ........................ ADDRESS _ j . ,,..,If: ONE'No. ~No. of Employees FACIL~T¥CONT~.C~' [Bus~ness ID Number /' ls-o2~- Section 1: Business Plan and InventoB/Program FI Routine I~:ombined [] Joint Agency [] Multi-Agency I~ Complaint FI Re-inspection l C=C°mpliance ) OPERATION COMMENTS ~, V=Violation APPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCURATE VERIFICATION OF LOCATION ~.;~;~;o:;;~;~;:;L-22,;~ ........................ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES CONTAINERS PROPERLY ~BELED SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE.'?; FI YES ~ No EXPLAfN: Inspector Badge No., j' Business Site Resp~lnsllSle Party While - Environmental Sen/ices Yellow - Station Copy Pink. Business Copy May 8, 2003 7-llB°b DeNinno P.O. Box 711 Dallas, Texas 75221-0711 CERTIFIED MAIL RE: Failure to Complete SB 989 Secondary Containment Repairs & Retest at the following locations in Bakersfield, CA: 7-11, 1701 Pacheco Rd., 7-11, 4647 Wilson Rd., 7-11 9600 Brimhall Rd., 7-11, 3601 Stockdale, 7-11, 4101 ~ ':~ Calloway, 7-11,525 W. Columbus. ADMINISTRATIVE SERVICES 2101'H' Street FINAL REMINDER NOTICE Bakersfield, CA 93301 VOICE (661) 326-3941 F^x (eo~) 395-13~9 Dear Underground Storage Tank Owner & Operator: SUPPRESSION SERVICES 2101 'H' Street Since January 1, 2003, this office has sent you monthly reminders Bakerslield. CA 93301 advising you of a failed SB 989 test. In that letter, this office also VOICE (661) 326-3941 FAX (661) 395-1349 requested an update with regard to repairs of your system. PaEVEnTION SERVICES F,,Es,,m~,.t,,~,,a~.~u This office further explained that repairs of your system are a 1715 Chesterave. condition of your permit to operate. Please be advised that you must Bakersfield, CA 93301 VOICE (661)326-3979 have your system repaired and retested by June 15, 2003. Failure to FAX (661) 326-0576 comply may result in further enforcement action up to, and including PUBLIC EDUCATION revocation of your permit to operate. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661)326-36911 This office has extended every courtesy with regard to sending FAX (661) 326-0576 contractor information as well as one on one visit's mE ~NVESTI~ON 1715 Chester^,,e. Should you have any questions, please feel free to call me at 661-326- Bakersfield. CA 93..'.'~ 1 vOiCE (c~) ~e-~s~ 3190. FAX (661) 320-0576 TRAINING DIVIStON Sincerely, 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 Ralph E. Huey VAX (661) 399-5763 Director of Prevention Services by: ,;t Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc · Complete items 1, 2, and 3. Aisc complete A. Signat~e ,~ o ** · item 4 if Restricted Delivery is desired .... L ./J/ , ) /~ I~ Agent · Print your name and address on the reverse ~(~)~(d/"J/'~ y,/~~ [] Addressee :- sothatwe can return the card to you. B. Re~ivedby(Pn~ted. Name) lC. Dat, eof~elivery · Attach this card to the back of the mailpiece, I,~,/ 1,4~ ,~ oronthe f ont, space perm.s. -,. ,- .'J,Sm D. IsJdelivery address different from item 17 [] Yes 1. Article Addressed to: if YES, enter delivery address below: [] No · .: . , - . .., Z,.:..:,-..,,.~'?¥ .~.:¥.,-!,;L.: ,... ..... ,..'.,,':~ ........ ~'.",,~-.,~. '~-~,~A~,-~ BOB DEN[NNO · ": "'~:,,.:'; j?~'::7,:~ej~~~ DALLAS TEXAS 75221 0711 a. []Sen/iCecortifledTypeMall [] E~press Mail [] Registered r-I Return Receipt for Merchandise " [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7DBE 3],5D DDDL~ =~=J65 3~37 PS Form 3811, August 2001 Domestic Return Receipt 2ACPRI-03-Z-0985 ITl · ~ fl-' Postage $ ".: ;~:.-,,,,,~' '-r,~?,5:~ ~,<f;, ' ~;~;~ ~B~ Certified Fee ~~'~,: ' t-~ Rotum Reclept Feo Hem ~ ':' [:i (Endorsement Roqulmd) . t-1 Restricted Delivery Fee {Endorsement Roquimd) rn Tot~.o= BOBDENINNO m %11 MRY 08 2003 ?:19 BKSFLn FIRE PREYEHTIOH (661)852-2172 p.2 CITY OF BAKERSFIELD ' '~cL,-~' ~'50~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERIVIIT APPLICATION TO CONSTRUCTJMODIFY UI~FDERGROI~'ND STORAGE T~NK ~E OF ~P~CATION (C~CK) [ ]NEW FACILi~ ( ]MODUlaTION OF FACIL~ [ ]NEWTANKIN3TALLATION AT ~IST~O FACIL~ ~AR~DATE ~ O) PR~SEDCOMP~TIONDA~ ~d~' O~ ,, FACIL~YADD~SS q~ ~t~ll ~ c~v ~,~,~t~ .... z~P CODE CO~~a~/~te,~ ~,~e~l 5e~otte. ~c CA LICENSE NO.~ PHONE NO.~Zff- WO~A~ W, re~ ro O~a TO ~o. o~ t~ TO SE ~ST~SO ~S~ ~OR M~O~ ru~ VSS, ~O SPILL P~ION CO~ROL AND CO~ MEAS~S P~N O~ ~ Y~ ~0 ~ION FOR MOTOR FUEL TANK NO. VOL~E UNL~D~ REGU~ P~MIUM DI~EL AV~TION SECTION FOR NON MOTOR FLr~L STORAGir TANIC5 TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND N~E) .(IF KNOWN) FOR OFFICIAL USE ONLY I APPLICATION DATE FACILITY NO, NO. OF TANKS ~~ FE$S $ ' I Tile APPLICANT ("lAS RECFAV~D, UNnERSTAND8, AND ~'[LL COMPLY WITH TH£ ATTACHED coNnITIONS OF THIS PEILMIT AND ANY OTHER :5-rA'r~ LOCAL AND FF_,r~EIL~L REOULATION$. THrS F0~, HAS BEEN CDMI~LETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF Mr KNOWLEDGE, IS TRUE A~,' CC2RI.~E.~ ,~,fL // ~, Oh,'/ AentOV~O By: . .,~,~,L,C^~ ~e cP~tsn A~,e~.~vr s~,~S^TUt S / TI~I~ APPLICATION BECO~S A e~MIT W~N ~MROVED ELEVEn April 11, 2003 Mr. Steve Underwood Bakersfield Fire Department 1715 Chester Avenue Bakersfield, CA 93301 RE: 7-Eleven #32376, 9600 Brimhall, Bakersfield, Ca Notice of Violation Dated March 12, 2003 Dear Mr. Underwood: As per the referenced Notice, attached please find a copy of the Annual Monitor Certification. The Certification was completed on March 17, 2003. The submission of this information by 7-Eleven, Inc. shall not constitute, nor be deemed to constitute, an admission of liability or responsibility with respect to the alleged violations and, in addition, evidence of this submission may not be used in any administrative or judicial proceeding or otherwise. Plea/~e feel free to contact me at (208) 429-8466 should you have any questions. // Bob DeNinno 7-Eleven, Inc. CC Market Manager Judy Soper Enviromental Services Depar_tm_e_nt __10220 S. W. Gree~nburg Road / Suke. 470 / Portland, Oregon 97223 Work Order: 3128493 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3128493 TanknologyoNDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3128493 Tan~olo~-~ 8900 Shoal Creek, Buildin~ 200 Austin, Texas ?8757 Work Order: 3128493 ~k~olo~-~E 8900 S~oat Cree~, Buildi~8 200 Austin, ~exas 787~? Work Order: 3128493 :: :;, ,~* ::: ;::::~"~':~: ':?,,,~:'.; ~*,:~:::: ;r:~: ~?~'5 ~,~;~*wS;?~;~T ,:,,~::: ! :,:::::: :::: ,: ,.~:.~ ::, ::: .:~.~ ~ ~ :-,: :::~<.~;::::~:: ::~:~,:~¢:~,~:~:: :::::::::::::::::::::::: ~7.~):::::~:,:: :::::::::::::::::::::::: :::;::::2: : :: :::~;: :?:~::,;:: ::::::~%g[:;: :~? :~::: :~ Tan~olo~-~E 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3128493 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 L D March 12. 2003 Bob Deninno 7-ll P.O. Box 711 Dallas, Texas 95221-0711 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection FIRE CHIEF RON FRAZE System at 7-11,525 West Columbus, 7-11, 4101 Calloway, 7-1 l, 9600 Brimhall in Bakersfield, CA ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 Dear Business Owner: VOICE (661) 326-3941 FAX (661) 395-1349 Our records indicate that your annual maintenance certification on your leak SUPPRESSION SERVICES detection system was past due on February 19, 2003 (525 West Columbus) and 2101 'H' Street February 20, 2003 (4101 Calloway & 9600 Brimhall). Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661)395-1349 You are currently in violation of Section 2641(J) of the California Code of Regulations. PREVENTION SERVICES FIRE SAFETY SERVICES · ENltllK~I~.rHTN. SERVICES 1715 Chester Ave. "Equipment and devices used to monitor underground storage tanks shall be Bakersfield, CA 93301 VOICE (661) 326-3979 install~l, calibrated, operated and maintained in accordance with FAX (661) 3260576 manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." PUBLIC EDUCATION 1715 Chester Ave. Bakomfleld. CA 93301 · You are hereby notified that you have thirty (30) days, April 12, 2003 to either VOICE (661) 326-3696 FAX (661) 326-0576 perform or subnfit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage FIRE INVESTIGATION system. 1715 Chester Ave. Bakersfield, CA 93301 vOiCE (~1)326-39s~ Should you have any questions, please feel free to contact me at 661-326-3190. FAX (661) 326-0576 TRAINING DIVISION Sincerely, 5642 Vlctor Ave. Bakersfield, CA 93308 Ralph Huey VOICE {661) 399-4697 FAX (661) 399-5763 Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer · Office of Environmental Services SBU/dc , i!i .,' T'anAno ogy 8900 Shoal Cree'k Bird, Building 200 Austin, Texas 78757 Phone: (512)451-6334 Fax: (512)459-1459 Date Printed and Mailed: 03/07/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 12/19/2002 Order Number: 3126767 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment Spill Container Secondary Containment Tank Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting ~ s~-~ s~co.~^.~ co.~^,.~.~ ~1~^.~ .~su.~s TEST DATE: 12/19/2002 WORK ORDER NO.: 3~26767 CLIENT: 7-~, ~C. SITE: 7-~ ~32376 10220 S.W. GREE~G RO~ 9600 BRI~LL RD. SUITE ~70 ~ET ~2133 PORTL~ OR 97223 B~ERSFIELD CA 93312 BOB DENISe 503-977-7713 Tank Interstital Tests REG ~E~ Total Contai~ent FAIL PR~I~ Total Contai~ent PASS MIDG~E Total Contai~ent PASS Piping Interstital Tests I I Sump & Under-Dispenser Containment Tests REG Fail REG Fail PR~ Fail PR~ Fail MID Fail MID Fail lenknolo~y ~e~esentetive: Semites co~ucte~ KEN MINTON WESLEY COULTER SECONDARY CONTAINMENT TEST RESULTS NAME: 7-ELEVEN #32376 32376 12/19/2002 W( 3126767 SITE ADDRESS: 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD CA 93312 REASON FOR TEST: SB-989 Compliance IGroundwater Level(" from grade): TANK INFORMATION AND INTERSTITIAL TESTS I~p~ start Initial Finish Final Pass/ Dia. Material Manufacturer e, h Test Method TanF Product Tank Size (" ) Time Level Time Result Fail 1 REG UNLEAD 15040 96 TOTAL CONT Total Containment 55 Vacuum - -10 "Hg - -0 "Hg FAIL 2 PREMIUM 10028 96 TOTAL CONT Total Containment 51 Vacuum 1553 -10 "Hg 1653 -8.3 "Hg PASS 3 MIDGRADE 10028 96 TOTAL CONT Total Containment 54 Vacuum 1545 -10 "Hg 1645 -9.7 "Hg PASS 4 5 6 7 8 Comments: The regular tank annular dropped to 0 in approximately 30 minutes. We pulled vacuum on this tank several times over the course of approx. 45 minutes. LINE INFORMATION AND INTERSTITIAL TESTS Dia. Lan. Volume Start Initial Finish Final Pass/ Tanl Product Material Manufacturer Test Method (" ) (feet) (gallons) Time Level Time Result Fail 1 2 3 4 5 6 7 8 Comments: No tests performed on lines. LINE INTERSTITIALS FAILED VISUALLY. PATTERN OF FAILURES OBSERVED AT OTHER FACILITIES. ~r~jl~l~y Test Date: 12/19/2002 SECONDARY CONTAINMENT TEST RESULTS Work Order: 3126767 SUMP TESTS Type Tank or Disp Manufacturer Model or Diam./Width/Length Depth Test Method Start Initial Level Finish Final Pass/ # Matedal (" ) (" ) Time Level Chan,qe Time Result Fail Spill Container REG FiLL Plastic 13 13 1537 5.5 -0.75 1542 4.75 Fail Spill Container REG VAPOR Plastic 13 12 VPLT 1622 4.75 -,03281 1628 *.188 gph Fail Spill Container PREM FILL Plastic 13 13 VPLT 1642 6.25 -.00870 1654 +.028 gph Fail Spill Container PREM Plastic 13 12 1532 4.75 -0.5 1559 4.25 Fail Spill Container MID FILL Plastic 13 11 1539 5 -1.25 1600 3.75 Fait Spill Container MID VAPOR Plastic 13 12 1533 5.25 -0.75 1559 4.5 Fail Comments: All spill buckets are made by Emco/Wheaton. This manufacturer does not appear in the drop-down menu. The reg fill, prem. vapor, and plus fill & vapor buckets all failed by visual measurements. Water measurements were taken from the bottom of the bucket to the top of the water level. · Work Order: 3:1.2 67 67 ' '' SECONDAR¥SYSTEM C CATION FORM Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 'Work (~rder: 3126767 SECONDARY SYSTEM CERTIFICATION FORbt Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:12 / 3.9 / 0:2 WORK ORDER NUMBER3 3.2 6 ? 6 '7 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Arrived on site at 2=45 P.M. for CA reg SBT989 secondary containment testing. Three tank annulars tested - 87, 89, and 91 failed. All six spill buckets failed. LINE INTERSTITIALS FAILED VISUALLY. PATTERN OF FAILURES OBSERVED AT OTHER FACILITIES. PARTS REPLACED HELIUM PINPOINT TEST RESULTS ilF APPLICABLE) Printed 03/07/2003 14:02 SBOWERS SITE DIAGRAM ~ ,, Tankr~ 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 12 / 19 / 02 WORK ORDER NUMBER3126767 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #32376 BRIMHALL RD 960~SRIMHALL~D O ~) ~~ Cv <~ ~o~ ~^~ B,~RSFIELD,<~_~A PREMIUM ~ ~ ~ I ~ L ~o~ ~ 0 ~us ~ ~ ~ ~ C-STORE Printed 03/07/2003 14:02 SBOWERS · Complete items 1, 2, and 3. Also complete . item 4 if Restricted Delivery is desired. .la _Print your name and address on the reverse so that we can return the card to you. BY'Receiv"~-I~(~ · Attach this card to the back of the mai!piece, ': ' ry or on the front if space permits. D. Is delivery address different from item 17 [] Y~'s- 1..Article Addressed to: if YES, enter delivery address below: [] No SHASHI KAMBJO 17 ELEVEN [9600 BRIMHALL [] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 2410 0002 1974 9565 F'S Form 3811, August 2001 Domestic Return Receipt 2ACPRI-03-Z-0985 P~fle $ Ce~ified Fee Postmark Return Reciept Fee ~ (E~o~ment R~u[red) Hem Re~~ ~ S~SHI K~BJO 7 ELEVEN 9600 BR~L BA~RS~LD CA 93312 .............. s~a~e, z~+4 ............... March 1, 2003 Shashi Kambjo 7-Eleven 9600 Bfimhall Bakersfield, CA 93312 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE FIRE CHIEF RON FROZE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection System at the Above Stated Address. ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield. CA 93301 Dcar Business Owner: VOICE (661) 326-3941 FAX (661) 395-1349 Our records indicate that your annual maintenance certification on your leak SUPPRESSION SERVICES detection system was past due on February 20, 2003. 2101 "H' Street Bakersfield, CA 93301 You are currently in violation of Section 2641(J) of the California Code of VOICE (661) 326-3941 FAX (661) 395-1349 Regulations. PREVENTION SERVICES. "Equipment and devices used to monitor underground storage tanks shall be FIRE SAFETY SERVICEI~ * ENVlRONMleNTAL SERVICES 1715 ChesterAve. installed, calibrated, operated and maintained in accordance with Bakersfield, CA 93301 VOICE (661) 326-3979 , manufacturer's instructions, including routine maintenance and service checks FAX (661) 326-0576 : at least once per calendar year for operability and running condition." PUBLIC EDUCATION ; YOU are hereby notified that you have thirty (30) days, April 1, 2003 to either 1715 Chester Av~. :, Bakersfield, CA 93301 perform or submit your annual certification to this office. Failure to comply VOICE (661)326-3696 will result in revocation of your permit to operate your underground storage FAX (661) 326-0576 system. FIRE INVESTIGATION 1715 ChesterAve. · Should you have any questions, please feel free to contact me at 661-326-3190. Bakersfield, CA 93301 VOICE (661) 326-3951 .FAX (661) 326-0576 Sincerely, TRAINING DIVISION 5642 Victor Ave. Ralph Huey Bakersfield, CA 93300 Director of Prevention Services VOICE (661) 399-4697 FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc · Complete items 1, 2, and 3. Also complete .item 4 if Restricted Delivery is desired. [] Agent · Print your name and address on the reverse so that we can return the card to you. B. Receiv,,'7,d by (Pr[ntedName) · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1 ? if YES, enter delivery address below: [] No 7-11 9600 BRIMHALL BAKERSFIELD CA 93312 [] Certified Mail [] Express Mail ~ [] Registered [] Return Receipt for Merchandise [] insured Mail [] C.O.D. Restricted Delivery? (Extra Fee) [] Yes 2._Article Number }i~S August zuu, ~, ...................... 2ACPRI-(]3-Z-098o Form 1, Postage ~ $ [ Ce~ified Fee Postma~ Return R~iept Fee (Endomement Required) I Hem Restri~ Delive~ F~ ~ 9600 BR~LL [~? BA~RS~LD CA 93312 ..... 1 ;'~ February 13, 2003 7-11 9600 Brimhall Bakersfield CA 93312 FIRE CHIEF ~orq m*ZE Certified Mail ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661)$26-3941 RE: Recent SB 989 Secondary Containment Testing FAX (661) 395-1349 su.P.ESS,O. SERV,CES SE C OND REMINDER N OTI CE 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear FAX (661) 395-1349 'Jwneu'JFerator: PREVENTION SERVICES Our records indicate that you completed your secondary containment FIRE SAFER' SERVICES · ENVlRONIIENT~L SER',flCES 1715 ChesterAve. testing on December 20, 2002. Our records further show a failed test. Bakersfiold, CA 90301 VOICE (661) 320-3979 Therefore you are required to have your system repaired and re-tested FAX (661) 326-0576 as soon as possible. PUBLIC EDUCATION 1715 ChestorAvb. This office requests an update with regard to repairs of your system. Bakersflold, CA 93301 VOICE (661) 326-3696 Please be advised that repairs involving the replacing of components FAx (001) 3~0-0676 must be under permit from this office. The repairs of your system are a condition of your permit to operate. Failure to repair and re-test will FInE INVESTIGATION 1716 C,estorAve. result in the revocation of your permit to operate. Bakersfield, CA 93301 VOICE (661) 32~-3961 FAX (661)326-0576 Should you have any questions, please feel free to contact me at 661- : 326-3190. TRAINING DIVISION 5642 Victor Ave. sin2 VOICE (661) 399-4697 FAX (661) 399-5763 Steve Underwood . Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc 268-~ 800/£00'~ 828-~ £6£6 ~£ 80~ g0~£8 dl 'esgog ~g~ed HT~-~oJ~ 6£:~i ~68-~ 800/600'd 8~9-~ £6£6 ~£ 90~ 60~£9 dl 'esgo9 ~glg~d X1~-moJ~ ~:~1 £0-1~-~d¥ %Vork Ot~. 3128493 ''~' ~ ] I ........ I " ''. ......... ".,l~l ~ ~" '~...' ~ ~.. '-' · ' . '. ', ' .......... ."'.'"" ' , ' ........ ~ ..... '*,'' ' ," . ~'~, "' ~ ....... /~'~ '' '~;'.:;'i'""' '~::~ L:: '_"'_ .:. ' ..... ' :' ~ ..... : ..... ' '"'~_.~:: ...... ~'_ '~, . ~:_' "'::':' '.'"" '.' ' ... ~'_~" '~ ' ~, ~ , · . ,, ................ ~ ..... ...,.,,,.. ....... ;.,.,,~ ............. ~,, , ~.~ .... , ~ ,,-~ .... ~~-... .. ~ .... . .... ~ ..... , ....................... '~~'~.~,, CITY OF BAKERSFIELD '-~C~,._~ OFFICE OF ENVIRONMENTAL SERVICES ( 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATIO~ (CHECK) [INEW FACILITY [I,(MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE c/~/0 2> PROPOSED COMPLETION DATE r--.-~tgo ~ FACILITY NAME 7-~-~ff~ ~9~ EXISTING FACILITY PE~IT NO. FACILITYADD~SS ~a ~c/~/[ ~. CITY ~~ ZIPCODE ~/~ TYPEOFBUSINESS ~e~t' / ~ ~ ~/ ~ APN~ TANK O~ER ~- &-~/ PHONE NO. ~a~- ~ ~ ~ff$~ ADDRESS ~- ~d~ ~// ' CI~ ~ 5-~ ZIP CODE ~g~/~ 0~/~ CO~CTOR ~ ~c,~r/~5 ~ ~,~ CA LICENSE NO. ~9~ ADD~SS/~ C~?<-~d~F_ ~i~ ~ CITY ~t~ ZIPCODE ~ PHONE NO. 7~ - 2Z/- ~/ZD BA~RSFIELD CITY BUSINESSUICENSE NO. WO~AN COMP NO. ~7 ~ ~S~ER ~< ~g~~/)m ~- ~ BRIEFLY DESCRIBE THE WO~ TO BE DONE ~ ~c c~ ~ ~ ~c ~ WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER /{////~ SOIL TYPE EXPECTED AT SITE h/o . NO. OF TANKS TO BE INSTALLED .,,', ' ~ ARE THEY FOR MOTOR FUEL · )d YES .... NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ~, YES NO SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) (IF KNOWN) FoR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. NO. OF TANKS FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM~HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE A~p~E~./7 - AP--PR(~)'¥~E-D BY: . APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED stawc s 1715 Che ter Ay,., '~~" UNDERGROUND STOOGE TANKS (C~e~ ~e ~m o~y) ~ 7. PER~E,~ C~SEO ON SITE ~ 3. RE~ · . . 1. T~K DE~RIP~ON MOTOR VE.~CL~ Ft;¢L . P..EC.,ULAR U~.F..,*,OF.O ~ · ~O ~ ~. ,l~ (e~, m~e~ ~um T~) ~. ~::UM U~ED ~ 3. DIESEL ~ 5, AViaN FUEL r .,=== ====================== .:~::,;.:: .: · :;]:::'"' :2.: ;..;:":/ :~ ;)? '. - "~ILT~AC~STRU~::: ~ ~:--...;"'.-..:. :. :.':J . ,: ' '" ~(C¢~one ~mo~) ~UB~WN~ ~ 4, Si~EWA~INAVAUL~ ~ ~3, ~INFOR~D ~T~C (F~) ~ 10. ~A~ OR f~AT~ ~ 2. ~O LINING ~ 4, ~UC L~Nt~ ~ 6. UNU~EO ~ ~. OTHER ~C,~e~ o~ ~ ~ __ ..~ ~r ~t use SPILL AN00VE~I~ / Y~ t~T~D ~ ~ (~r~ u~ o~) ~1 0~t~ ~.OTE~'ION EQU~P~R INST~O ~2 ~RJ~R P~TE ~ 2, AUTOMATIC T~K ~U~ING {ATG} ~ ~. V~SE ZONE j~2. ~NUOU~ INTER~TR~ ~NIT~ING ~ 3. ~.~EATG ~ 7. ~OUNDWA~R ~ ~ 3, ~UAL ~NffORlNO :" ' · V, TANK CL~URE INFORM~W~ t PE~ANENI' CL~2URE IN F- C:11~ OI~ BAKER$1:IELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Che~ler Ave., 8akertfleld, CA g3301 (661) 326-3979 UST / UNDERGROUND PIPING A~VEG~UND PiPiNG CONSmUCTtO~ . SINOL~ WA~ ~ 3. LINED TREN~ ~ ~. OrH~ ~ ~ 1. S*N~ W~ ~ ~. ~N~ ~TER~LS AND ~ 2. STAI~ESS S~EL ~ 7. ~LVAN~ ~EEL ~ 2. STAI~SS S~EL ~ 7. ~LV~DSTEEL CORROSION UNDERGROUND PIPIN~ A~VE~O~ND PIPING · NGLE W~ ~Pi~ ~ 81~LE W~ ~PING ~7 PRESSURED PIPING (~k ~1 ~at a~): P~SS~R~ P;Pi~ (Ch~ ali ~at ~ 1. E~RONIC MNE L~ ~CTOR 3,0 ~ T~=T ~ A~O ~ SH~ OFF FO~ ~ ~. E~C~[C L~E ~ D~OR 3.0 ~ ~ST ~ 5, DAILY VISU~ ~NITOR~O ~ PU~ING SYSTEM + ~I~N~ PIPI~ I~E~ ~ 5. D~LY ViS~ ~N~ORI~ OF PIPING ~D ~[NG ~YS~M TEST (0.1 ~H) ~ 6. TR~L I~oRr~ ~ST (04 S~E S,UCTION SYS~ (~ V~VES iN ~LOW GROU~ ~P}~): ~E SUC~N SYS~ (~ V~VES IN BELOW ~UND PIPIt): 3~V~ FLOW: 0~ FLOW (~ ~ ~t ~ g. BiENN~L I~ ~ST(0.1 ~) I ~ SECOND~LY CO~N~ Pi~ t S[~ND~LY ~NNED 10.(~I~OUS~) ~l~ ~ ~ENsc~ ..... %~ ,~D[~ ~D VI~L ~ ~ND t0. CONTIN~U~ TU~INE SU~ ~EN~OR~ AUDIB~ ~ ~ ~ OFF ~ A LEI~ O~URS a. A~O ~ ~UT O~ ~EN A ~K O~URS ~ D. AUTO PU~ SHUT OFF FOR ~. SYSTEM FNLU~ ~ SYSTEM ~ ~. A~O ~ SH~ 0~' FOR ~S, SYS~M FN~ ~0 SYS~M OlS~NNECTION ~ 11. A~O~C LINE ~ O~CTOR (3.0 ~H ~j ~ ~OW SH~ OFF OR ~ 11, A~O~TIC ~ ~R ~ 13. ~INU~S ~U~ SEN~R * AUDI~ ~D Vi~ ~ ~ t3. ~NUOUS SU~ ~EN~R * AUDIBLE ~D VtSU~ E~RGENCY G EN~RS ONLY (~ a~ ~f a~) E~RGE~Y GENE~TOR8 ONLY (Cha~ ~ 14. ~I~US SU~ SEN~R ~ AUTO PU~ SH~ O~ + AUO~ AND ~ 14..~tNUOU5 ~ SEN~R ~ A~O PU~ ~UT OFF + AUDIBLE AND VISUAL VI~AL ~ ~ 1 & A~T[C UNE ~ D~EOT~ (3.0 ~H ~ST) ~Q~ PLOW SHUT OFF OR ~ ~ 5. AU~TIC LINE ~ ~OR (3.0 ~H ~ ~7, DAILY VISUAL~ECK ~ t7. OA~INST~O ~ ~ 2. ~{N~USOIS~NSERP~R+AUDIB~DVIS~ ~ 5. TREN~LI~RI~NITORING F // 472 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES r 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 · ' UNDERGROUND STORAGE TANKS - TANK PAGE 1 4, Page __ of 7¥PE OF ACTION [] 1. NEW SITE PERMIT AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE (Check one item only) [] 7. PERMANENTLY CLOSED ON SITE [] 3. RENEWAL PERMIT (Specffymason-forlocaluseonly) (Spact[ychange-forlocaluseonly) E] 8. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME ot DBA - Doing Business As) 3 FACILITY I,#. i /I 1 · ' ' ' ' . i:!: ::': I. TANK DESCRIPTION J TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COIVlPARTMENTS 437 ADDITIONAL DESCRIPTION (For local use only) 438 ~ TANK USE 439 ~11bI PETROLEUM TYPE 440 MOTOR VEHICUE FUEL REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked, complet~ Petroleum Type) PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM ~/~c. MIDGRADE UNLEAOED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Mate~fals Invenloty page) 441 CAS ti (from Hazardous Mate~als Inventory page) 442 [] 4. HAZARDOUS WASTE (Includes Used O~) [] 9S. UNKNOWN TYPE OF TANK [~/1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one/tern On/y) d2. DOUBLE WALL EXTERIOR MEMBRANE UNER [] 95. UNKNOWN [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL o primary tank [] 1. BARE STEEL [~3. FIBERGLASS I PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRPDOMPATIBLEWI100%METHANOL []99. OTHER / REINFORCED PLASTIC (FRP) TANKMATERUU.-seoond~ymnk ~ 1. BARE STEEL [~3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEW/100% METHANOL ~95. UNKNOWN 445 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL ClAD W/FIBERGLASS [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] s. CONC~TE [] 1. RUBBER UNED [] 3. EPOXY UNING [] 5. GLASS LINING [~95. UNKNOWN 446 TANK INTERIOR UNING INSTALLED 447 OR COATING [] 2. ALKYD UNING r-J 4. PHENOLIC LINING [] 6. UNLINED [] 99. OTHER __ Check one item only) ~ (For local use only) ~)THER CORROSION [] 1. MANUFACTURED CATHODIC [] 3. FIBERGLASS REINFORCED PLASTIC E~95. L!NKHOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT E] 99. OTHER Check one item only) [] 2. SACRIFICIAL ANODE (Forlocal use only) SPILL AND OVERFILL ~/. YEAR INSTALLED 450 TYPE (Forlocal use on/y) 451 .~,ERFILL PROTECTION EQUIP~=AR INSTALLED 452 Check o, ~e~a~) L~. SP,LL CONTA~N~ D/' AU~M ~r ~. F~LL TUBE S,UT OFF VALVE 31 DROP TUBE U 2. BALL FLOAT [] 4. EXEMPT STRIKER PLATE IF SINGLE WALL TANK (Check elI ~iI epply): 4[3 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 [] 1, VISUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (MTG) []/$( VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 8. VADOSE ZONE ~L~ 2. CONTINUOUS INTERSTffiAL MONITORING [] 3. CONTINUOUS ATG E] 1, GROUNDWATER [] 3. MANUAL MONITORING I-] 4. STATISTIC~d. INVENTORY RECONCILIATION (SIR) + [] B, TANK TESTING 81ENNIAL TANK TESTING [] 99. OTHER · · ~::::::' .'.'i:. ::?i .'V. TANK~m. OSURE~NFORMAT~ON~PERM~NEN?c[OsURE~NpL~cE' · 'i. ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 45~ TANK FILLED WITH INERT MATERIAL? .gallons [] Yes [] No UPCF (7/99) S:~CUPAFORMS~SWRCE~B.WPD CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST - TANK PAGE 2 Page of : / UNDERGROUND PIPING ABOVEGROUND PIPING SYS~M~PE . P~SSURE ~ 2. SU~ON ~ 3. O~Vl~ 458 ~ 1. PRES~RE ~NS~UCTIO~ ~' SINGLE WALL ~ 3. LINED ~ENCH ~ ~. OTHER 4~ ~ 1. SING~ WA~ ~ ~. UN~ ~2 ~UFA~RER~2. ~UB~ WA~ ~ 95. UNK~ ~ 2. ~UBLEWA~ D ~. O~ ~UFACTURER ~1 ~UFACTURER ~ I. BARE STEEL D 6. F~A~BLEWlI~% ~NOL ~ 1. BA~STEEL ~ 6. FRP~ATIBLEWlI~% ~L PROLCON ~ 4. FIBER~SS ~ 8. F~IB~ (HDPE) O ~. O~ER O 4. FIBERG~SS O 9. ~DIC P~C~ON , ~ 5. S~EL WI ~A~NG 0 9. ~ODIC PRO~ION ~ ~ 0 5. S~EL W/~ATING 0 SINGLE W~ HPIffi ~ SlNO~ WA~ HPlffi PRESSURED PIPING (~eck a8 ~at ap~y}: P~SSUR~D PIPING (Check all ~t app~): ~ 1. E~RONICLINE~D~ECTOR3.0~T~AUTO~SH~OFFFOR ~ 1. ELEC~ONICLINEL~D~E~OR3.0GPH~ST~O~SH~'OFFFOR~ ~, SYSTEM FAILU~, AND SYSTEM DI~NNEC~N + AUDIB~ ~D VlSU~ SY~M FNLU~, ~D SYS~M DIS~NNECT~N + ~DIB~ ~D VISU~ A~ A~ ~ Z ~LY 0~ ~ TEST D 2. ~LY 0.2 G~ ~ST D 3. ~u~ I~ ~ST (0.1 ~ 3. ~NU~ I~EG~TEST(0.1 GPH) ~ 4. ~ILYVISUAL CHECK ~ 5. DAILYVISUAL~NITORINGOFPU~INGSYSTEMe~IENN~PIPINGI~EGRI~ ~ 5. DAILYVISUAL~N~oRINGOFPIPING~D~INGSYS~M TEST (0.1 G~) ~ 6. TRIENN~L I~GR~ ~ST (0.1 GPH) ~E SUCTION SYS~ (~ V~VES IN BELOW GROUND PIPING): ~E SUC~ON SYS~ (~ V~VES IN BELOW ~OUND PIPING): ~ 7. SE~ ~N~O~NG ~ 7. S~ ~N~ORING G~V~ ~OW: G~V~ FLOW (~e~ a~ ~t D 9. BI~N~L I~ ~ST (0.1 ~H) ~ 8. DAILY VI~ ~N~ORING ~ 9. BIENN~LI~G~ST(O.1 ~H) 8ECOND~LY ~NED PIPI~ ~ECOND~LY CO~NED PI~NO PRESSUR~ED PIPING (~ aa ~at ap~): P~SSURI~D PIPING (C~ ag ~at ap~): 10. ~INUOUS ~RBINE SUMP ~ENSOR ~ AUDIB~ ~D VISUAL ~ ~D 10. ~INUOUS ~INE SUMP SENSOR UTC PU~ ~H~ OFF ~ A ~ O~URS ~ a. A~O PU~ ~HUT O~ ~EN A ~ O~URS UTC ~ SHUT OFF FOR ~, SYS~M FNLURE ~D SYSTEM ~ b. A~O ~ SHUT OFF FOR ~S, SYS~M FAILU~ ~D SYS~M DIS~NNE~N DIS~NNE~ION ~ c. ~ A~ ~ SHUT O~ ~ ~ NO A~O PUW SH~ OFF D 11. A~O~TIC LINE ~ D~OR (3.0 ~H ~ ~ ~OW SH~ OFF OR ~ 11. AUTO~TIC ~ D~CTOR ~STRI~ION ~ 12. ANNU~ IffiE~ TEST (0.1 G~) ~ 12. ANNU~ I~EGR~ TEST (0.1 G~) ~ 13. ~INUOUS SU~ SEN~R + AUDI~ ~D VISUAL ~ ~ 13. ~INUOUS SU~ SEN~R + AUDIBLE ~D VISU~ EMERGENCY OENE~RS ONLY (~e~ a8 ~at ap~) EMERGE~Y GENE~TOR~ ONLY (Che~ a8 ~at ap~ D 14. ~INUOUS SU~ ~EN~R ~OUT A~O PU~ SH~ OFF + AUDIB~ AND D 14. ~INUOU~ SU~ SEN~R ~OUT A~O PUW SH~ O~ + AUDIB~ ~D VISU~ VISUAL ~ A~MS ~ 15. AUTO~TICUNE~D~E~OR(3.0GPH~ST)~THO~FLOWSH~OFFOR ~ 15. AUTO~TICLINE~D~OR(3.0~H~ST) ~ 10, ~NU~ I~EOR~ TEST [0.1 O~) ~ 16. ~U~ I~EORI~ TEST (0.1 ~ 17. DAILY VISUAL ~ECK ~ 17. DAILY VISUAL ~ECK DISPENSER ~AIN~ ~LOAT ~C~ISM T~T SHUTS OFF SH~R VAL~ ~ 4. DAILY VISUAL CHE~ DA~ INkeD ~ ~ 2. ~IN~US DIS~NSER P~ SEN~R + AUDIB~ ~D VISU~ ~ ~ 5. ~NCH LINER I ~NffO~ ~ 3. ~IN~US DIS~NSER P~ SEN~R ~TH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL A~ I ~i~ ~at the inf~a~ ~d~ h~n Is ~e ~d ~rate to the b~t ~ my ~ge. UPCF (7/99) 8ACUPAFOEMS~S~C~8.~D  CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 '""~~'"' UNDERGROUND STORAGE TANKS - TANK PAGE 1 Y~PE OF ACT[ON r'] 1. NEW ~fTE PERMIT [2~'4. AMENDED PEFIKUT ~ 5. CHANGE OF INFORMATI~N> ~ 6. TEMPORARY SITE CLOSURE (Check one item ordy) [] ?. PERMANENTLY CLOSED ON SITE r~3. RENEWAL PERMIT (Sper.~y~.t~rlo~lusaot~y) (E~r.i~t~e. Jt~iocalu~eonty) ~'] S, TANK REMOVED 430 BUSINESS NA~E (Same a~ FACILITY NA~E or DBA - Doing Bu.~ne~ As} 3 FACIlJTY ID # 1 [ LOC-.XnON WrmlW SITE (O;~on~t) ' ' I. TANK DESCRIPTION ' (~, ~ ~e~ T~) ~b' P~IUM UN~ED ~ 3. D~ESEL ~ 6. A~ON FUEL (Ch~ one ~m 0~) . ~US~ W~ ~ 4. SIN~ W~ IN A VAULT ~ ~, O~ER I ' Checkone~mo~) ~ 2, STAIN~S~S~EL ~ 4. S~EL~W~B~ ~ 9. F~ ~N~ODIB~ JA~ ~. O~ER OR PRO~C~ON iF (~ck ~e ~m o~y) ~ 2, SA~FiC~ ~OE (~t ~1 use 0~) S~tLL AND OVE~ Y~ I~T~D ~ ~E (~1 ese oaly) ~1 OV~I~ ~CT~N EQUIP~: ~R INSTALLEO ~2 $~1~ P~TE IF ~LE WALL T~K (C~ck ~ ~t ~): 4~ tF ~UB~ W~ T~K OR T~K ~ B~DER (C~eck one ~m onty): ~ 2. A~O~TICTA~U~(ATG) ~ 6. V~SE~NE '~2. ~ 4. STATIS~~ORY~NCIL~T!ON(SIR)e ~ 8. T~K~INO 8t~L TA~ TES~ ~ffi. O~ER · = .... ': V, T~K CL~U~ INF~MA~ f PE~ENT CLOSURE IN P~CE ESTI~TED DATE ~ST U~D ~/DAY) 455 ESTI~D QU~ OF SU~TANCE RE~INI~ ~6 T~K Ft~D ~ INERT ~TERI~? 457 JPCF (7/99) SACUP~ORMS~S~C~8.~D OFFICE OF ENVIRONMENTAL SERViCE,~ 8~ENN~L t~ ~Sr(O,t ~) ~t~tJ8 S~ ~A ~ ~tr~ ~U~ ~ O~ + ~,'J~6~ ~ ~ ~. ~:~VS ~ S~ ~ A~O aU~ ~vl' OFF + AUOi~LE ANO Vl,S~A~ DAILY VI,~ ~"::~"" '~ ' 'r~ ~ '~' '~:~ ~ ,' - ~"~" ~ . · - .... ~ ~ ~JS~E[~ ~i,~'AiN~ ~ ~FLOAY ~I~M ~ ~ ~;~ SH~ '/~VE ~ 4. DRILY ~"~AL __~..~" ~.:.'~.~ ~_,~,~, ~,~ ~ ............. ~__ ~~~ ::: ~.~ ........ ~ . 1 j 474 F--~t ~,, .......  CITY OF BAKERSFIELD ~ ~ B r OFFICE OF ENVIRONMENTAL SEI~gICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE Page ~ of __ I. FACILITY IDENTIFICATION': : BUSINESS NAME (Same a~ FACILITY NAME or DBA - D<~ing Business As) 3 ADDRESS (For local use only) 476. (Check all that apply) D"/ The installer has been trained and certified by the tank and piping manufacturers. 47s. :f/ The installation has been inspected and certified by a registered professional engineer having education and 479. experience with underground storage tank installations. [] The installation has been inspected and approved by the Bakersfield Fire Department - Environmental Services. 4~0. ~ All work listed on the manufacturer's installation checklist has been completed. ,~. Et/ The installer has been certified or licensed by the Contractors' State License Board. ~. [3/ The underground storage tank, any primary piping, and secondary containment was installed according to ~3. applicable voluntary consensus standards and written manufacturer's installation procedures. Description of work being certified: I certify that Ihe infan~a,~n provtcl~ I~ tree and acoJ..~.rate to the best o~ my knowledge. DATE 484. NAME OF TANK OWNE~GENT~ (p/fnO 485. TITLE OF TANK OWNE~AGE~ ~ 486. UPCF (7~99) Si&CUPAFORMS~swrcb-c.wpd CITY OF BAKERSFIELD POST CONSPICUOUSLY* *NON-TRANSFERABLE* Business name . · M I T ~N~INEERING ~ CONSTRUCTI Location mdd~ess . : OUT~IDE CiTY Lic Nb~/Ci=ss .: O~ 57~& CONTRACTOR~, BUILDING .s~'- Oate .... : i~/~O/O~ ~xpi~mtion date . : ~/~0~0~ License comment ' GENERAL CONTRACTOR .~?','~'% ~:j:~:~,~,:~::?~?,, ., OCEAN~IDE CA ~0~ BUSINESS TAX CERTIFICATE IS HEREBY GRANTED. LICENSEE IS TO COMPLY WITH ALL LAWS AND ORDINANCES. ISSUANCE OF THIS LICENSE DOES NOT CONSTITUTE AUTHORIZATION TO CONDUCT BUSINESS IF LICENSEE HAS NOT COMPLIED WITH ALL APPLICABLE LAWS AND ORDINANCES. THIS LICENSE IS ISSUED WITHOUT VERIFICATION THAT THE LICENSEE IS SUBJECT TO OR EXEMPT FROM LICENSING BY THE STATE OF CALIFORNIA. M.I.T. Engineering & Construction, Inc. 105 Copperwood Way, Suite G Oceanside, California 92054 Office: (760) 721-4120 Fax: (760) 721-4209 Contractor's License ,California: 723396 - A and Haz ~' ~ iArizona: 126949- B1 and Tank Installation INR0108 ~Nevada: 0043206 - B4 and UST Handler UTH-1122 Other Certifications: International Fire Code Institute -Installation: 1036149-25 Decomissionin~l: 1036149-26 Site Specific Health and Safety Plan Project: Address: Date: ~ ~-~ GENERAL INFORMATION Sublect M.I.T. Engineering & Construction, Inc. has been contracted by ~-£~-~2-f./~-/t(' ._~'-~, to perform the following: 1. Plan Purpose and Use This Health and Safety Plan is developed to assist M.I.T. site personnel in understanding and avoiding potential Health and Safety hazards that may present itself at the site. In order to fulfill the requirements of the CAL-OSHA Hazard Communication Standard (SCCR 5194), if a subcontractor employed by M.I.T. will be present on site, the Project Manager is required to provide the subcontractor with a copy of this Health and Safety Plan prior to the start of the project. The Health and Safety Plan will inform the subcontractor of any potential hazards associated with hazardous substances in the area in which their employees will be working, and will provide information on suggested protective measures. The subcontractor is responsible for the preparation of a Site Safety Plan for the subcontracted tasks and communicating and enforcement of Site Health and Safety requirements as it pertains to the subcontractor's agents and/or employees. . - The potential exists for fuels, solvents and metals to be present in the soil at the site. The potential for a flammable atmosphere is possible and should be monitored in accordance with the City or County Fire Prevention Department requirements. Table 1 Emergency Assistance Information Fire Department / Paramedic / Ambulance Service: 911 Poison Information - Poison Control Center: Nearest Hospital with Emergency Room: ~ . Phone Number: Health and Safety Coordinator: Jesse Kirk Office: (760) 721-4120 Office Hours: 8:00am to 5:00pm Cell: (760) 889-3115 Project I Site Manager: John Kirk Office: (760) 721-4120 Cell: (760) 887-5184 Recommended Route from Job Site to Hospital Emergency Room: Code of Safe Practices General 1. All persons shall follow these safe practice rules, render every possible aid to safe operations, and report all unsafe conditions or practices to superintendent. 2. Foremen shall insist on employees observing and obeying every rule, regulation and order as necessary to the safe conduct of the work and shall take such action as it is necessary to obtain observance. 3. All employees shall be given frequent accident prevention instructions. Instructions shall be given at least every (10) ten working days. 4. Anyone known to be under the influence of drugs or intoxicating substances which impair the employees ability to safely perform the assigned duties shall not be allowed on the job while in that condition. 5. Horseplay, scuffling and other acts which tend to have an adverse influence on the safety and well-being of the employees shall be prohibited. 6. Work shall be well planned and supervised to prevent injuries in the handling of materials and in working together with equipment. 7. No one shall knowingly be permitted or required to work while the employee's ability or alertness is so impaired by fatigue, illness or other causes that it might unnecessarily expose the employee or others to injury. 8. Employees shall not enter manholes, underground vaults, chambers, tanks, silos or other similar places that receive little ventilation unless it has been determined safe to enter. 9. Employees shall be instructed to ensure that all guards and other protective devices are in proper places and adjusted, and shall report deficiencies promptly to the foreman or superintendent. 10. Crowding or pushing when boarding or leaving any vehicle or other conveyance shall be prohibited. 11. Workers shall not handle or tamper with any electrical equipment machinery, or air or water lines in a manner not within the scope of their duties, unless they have received instructions from their foreman. 12. All the injuries shall be reported promptly to the foreman or superintendent so that arrangements can be made for medical or first aid treatment. 13. When lifting heavy objects, the large muscles of the leg, instead of the small muscles of the back, shall be used. 14. In;,ppropriate footwear or shoes with thin or badly worn soles shall not be worn. 15. Materials, tools or other objects shall not be thrown from buildings or structures until proper precautions are taken to protect others from the falling objects~ Heat Stress, There is a potential for heat stress from the use of protective clothing and climate conditions. One or more of the following procedures may be employed to alleviate potential heat stress problems in the event that site conditions warrant the use of personal protective equipment (PPE), or ambient temperatures 85 degrees F. Provide plenty of liquids. To replace body fluids (water and electrolytes) lost because of sweating, use a 0.1% saltwater solution, more heavily salted foods, or commercial drink mixes,- The commercial mixes may be preferable for those employees on a Iow-sodium diet. Noise .~ There is a potential for noise levels to exceed 85 DB^ during si,~e activities involving excavation equipment, mi personnel are required to wear hearing protection while drilling equipment is in operation. Health Effects There is potential for chemical compounds in the form of solids, liquids, gases, mists, dusts, and vapors to cause both acute and chronic health problems resulting from inhalation (breathing), absorption (through direct contact with skin), or ingestion (eating or drinking). The routes of exposure of chemicals potentially encountered at the site include: * Absorption through direct contact with the impacted soil and groundwater and bare skin, or potentially through the eyes and membranes. * Inhalation of vapors or dusts released from site activities. * Ingestion through. 1.) Contamination of hands and hand-to-mouth contact 2.) Contamination of food or liquid brought on-site 3.) Contamination of smoking materials or chewing gum Monitoring Equipment (For tank removal) Monitoring equipment utilized on site during all activities shall be one of the following types at a minimum: * Flame Ionization Detector (FID) * Photoionization Detector (PID) in conjunction with a Combustible Gas Indicator (CCI) / Oxygen Monitor In addition, a direct reading calorimetric tube indicator system may be used. All air monitoring equipment shall be inspected and tested prior to the commencement of site activities. Risk Assessment Summary Anticipated exposure to chemicals on-site include gasoline, diesel, and benzene, toluene, and xylene (BTX). These chemicals represent a hazard because they are moderately to extremely toxic and most are highly flammable. Threshold limit values (TLr's), Shore Term Exposure (STEL's), and toxicity levels (LD50, Oral Rat), all in mg/kg (PPM), are listed below: Compound TLV STEL Toxicity Gasoline 200 300 Diesel 50 75 - Benzene 10 25 4894 Toluene 100 150 5000 Xylene 100 150 4300 Benzene is considered an extreme cancer hazard. Applicable MSDS Forms are attached. Hydrocarbon Vapor Criteria and ResPonses H)fdrocarbon Concentrations Response 30 PPMV TVH Limited hazard, no special action. 30-100 PPMV 1%/I-I General Work Areas Benzene detector tube measurements taken each 30 minutes. 100-1400 PPMV TVH General Work Areas Half mask OV Respirators worn by all in work area. Benzene detector tube measurements taken each 30 minutes. 1400 PPMV TVH Well Head Emissions Flush downhole with nitrogen gas. (near bore hole or auger flights :., t 1400 PPMV TVH General Work Areas Work Stops. Procedures taken to subdue excessive vapor: levels. I PPMB Benzene in General Work Areas Half mask OV ReSPirators worn in ~ area. Benzene detector tube and measurements taken every 15minutes until levels are well below I PPMV. 10 PPMV Benzene in General Work Areas Work Stops. Procedures taken to subdue excessive vapor levels. Benzene detector tube measurements.taken each 15 minutes until concentrations!are below I PPMV. PPMV - Parts per million vapor TVH - Total Volatile Hydrocarbons OV - Organic Vapor Persona,I Protective Equipment Hard hats, If overhead hazard is present Hearing protection while drilling equipment is operating Safety glasses or goggles Safety Shoes Steel. toe and shank, chemically resistant (PVC or rubber) or PVC overboot as necessary to prevent skin contact or leather absorption of contaminants. Polyethylene Twek Yellow or white coated Tyvek as necessary to prevent skin and .clothing contact with contaminated soil.. Nitrile gloves (neoprene as alternate) Respiratory Protection: * Half Face APR: Combined organic vapor / dust cartridge respirator required if wind conditions are creating airborne dust and/or airborne concentrations exceed 2 PPM On the PID/FID when measurements are collected in the breathing zone. * Full Face APR: Required when consistent 20 PPM readings are taken in bre~.thing zone of site personnel. Site Control Appropriated safeguards will be taken to prevent fire and/or explosion during this project. Non-sparking tools and equipment shall be utilized at the site. Sources of ignition and spark shall be prohibited within 100 feet fo the excavation site. Dust and vapor suppression controls shall be impleted if dust and/or volatile organic compounds exceed recommended levels. These controls may include covering dust sources, spraying water onto the source (if practice will not spread contaminated soil to on-site areas), or temporarily stopping work. Acceptable methods for vapor suppression include covering and/or backfilling contaminated stockpiles, backfilling or covering off- gassing excavations, locating stockpiles away from and/or doWnwind from nearest public receptor and stopping work. Access to the project site shall be limited to authorized personnel who have read and signed the site specific Health and Safety Plan. A site perimeter fence is presently in place for site control. Excavation and/or construction zones will be established with barricades, cones and flagging tape to prevent unauthorized access during the project. MapQuest Yellow Pages - Bak .~ eld Memorial Hospital Page 1 of 2 ~'~ii~':' ~,~': _ . ....... .. ' ~ : ~ .............................. ;,, where to go, how to get there[ I Back to Search Results · New Search Bakersfield Memorial Hospital Advertise your Sakemrmld Hemorial Hospital Main Phone: 661-327-4647 business on the 420 34th St Fax: 661-326-0706 PO Box 1888 Mapquest Bakersfield, CA 93301 Yellow Pages Usted Under · Hospitals Find More... · Nutritionists · Birth centers · Search by Phone # · Emerqency medical IA surqical service · Maps & Directions · White Pages · E-mail the Page to a frieJ~dd · Places nearb~ · Local Guide · Get; driving direction5 Get business-class ~ '-' ~.":::' ' .'.'-~: ~,: "~:'t:-t:'. ' :': "":::':" '.~ ~ :"~-'-'.~ ':' ":':"~ ' on AOL for Small Business ":~ :.: ~;:~e'~:"::"'" ~':'"'~:':':~...~ ~ :" ·' ':."~ ~':' '~ ~....'. ........... ': ~:'.t...~ ':.:.:.'..'.:.:....'~ th:~J2:: ::. : :: :":~ . :'":'"':":'~.. ": .~: ";::.': ....:::::~:.:~,.~:: .-.~ :.: ::~. :.:~ ..:.~t ..... .... .:..'.:: .f ~ ..'.. :: Add update your business listing Jn the .:.:~.;:. :.;,..-:.:.~ :~::~::. ..:....:.::~..:.:::..:,~:. ~ ,:~A~: ~.~ .~ .{::.~f~. ~ ~:~. Yellow Pages. .... · '~':5~::::.':': '~ .'~---. ~' ~-' .":'.~-::~: ~;,~'~'"' ~..~::]~ ~'..:~ :~..~: :.:.: .... .~ ::,:~ ~........:....:....:...~::.:::: ~ . ~'~-~:~:~.: .. ...... ~. ........ ;.'.':~f::.~¢' '7.'~M::.:.::' ~.:: : ~ .. r :: : ' ;~'~:': ::': I (~NG~~E~ ~ Zoom In ~ Re-enter All rights rese~ed. Use Subject to License/Copyright Is the in~rmatlon for this listing inco~e~? Click herp to update. Overview Help I Feedback_ I Advertise With US I Add/Update a Listinq © 2003 Digital City, ~nc. All Rights Reserved. Site Index I About MapQuest I Partners I MapStore I Help Center International Web Sites I Mobile MapQuest I Advertise With Us I Business Solutions http://yp~mapquest~c~rn/maln~adp?-dirskip=~&-dir~ett~r=&-direxpand~&-dirmap=~&-dac~~~~ 2/7/2003 MapQuest Yellow Pages'- ~. Directions to Bakersfield Memorial ~pital Page 1 of 2 where to go, how to get there[ Rent DVDs Back to Search Results o New Search_ Online T~ Netflix for FREE! Driving Directions Starting Point: Destination Point: 9600 BRIMHALL RD Bakersfield Memorial Hospital Advertise your BAKERSFIELD, CA 93312 420 34th St Bakersfield, CA 93301 business on the 661-327-4647 Mapquest Yellow Pages 1: Start out going East on BRIMHALL RD towards 1.0 Miles WOODMONT DR by turning left. (1.53 Kin) Find More.,. 2: Turn R~GHT onto COFFEE RD. 0.5 Miles · Search by Phone # (0.77 Km) · Maps & Directions 3: Turn LEFT onto TEUXTUN AVE. 4.4 Miles · White Paqes (7.04 Km) * Local Guide 4: Turn LEFT onto CHESTER AVE. Pass through I 1.2 Miles roundabout. (1.94 Km) 5: Turn I~[GHT onto 34TH ST. 0.7 Miles G_et business-class (1.08 Km) services & support Total Distance: 7.7 miles on AOL for Small (I2.35 Km) Business Estimated Time: 15 minutes. Starting Point: Add or update your b__usine$$ listing in the Address: I?~00 ~m~U~_.~ ................................. Yellow Paqes. State: ~ ZIP code: ~ ~ Save Time! If you log in to Yellow Pages, you can save personal addresses for faster searching. · Login to AOL Yellow Pages Destination Point: Bakersfield Memorial Hos_Dital 420 34th St Bakersfield, CA 93301 Get directions from this business ejde]~ I eE~dback I Advertise With Us I Add/Update a Listi_~g © 2003 Digital City, Inc. All Rights Reserved, 8]te Index I About MapQuest I partners t MapStore I Help Center International Web Sites I Mobile MapQuest I Advertise With Us I Business Solutions Privacy Policy. & Legal Notices 02003 MapQuest.com, Inc. All rights resewed. http://yp.mapquest.com/main.adp?qa_d=420+34th+St&qc_d=Bakersfield&qs_d=CA&qz_d:... 2/7/2003 January 29,2o03 Mr. Steve Underwood Bakersfield Fire Department 1715 Cllester Avenue Bakersfield, CA 93301 RE: 7-Eleven #32376, 9600 Bdmhall, Bakersfield Secondary Containment Repairs Dear Mr. Underwood: 7-Eleven is in receipt of your memo dated January 13, 2003, 7-Eleven has contracted with MIT Engineering to make the necessary repairs to tl'le components tllat failed the Secondary Containment Testing. MIT Engineering is preparing permit applications for submittal in early February. Once repairs are complete, the system will be tested by 7- Eleven's testing contractor, Tanknology, Inc. 7-Eleven hopes this information satisfies the Agency's request. Please feel free to tact me at (208) 429-8466 slaould you have any questions. Bo~ DeNinno 7-Eleven, Market Manager Judy Soper Jason Ward Jesse Kirk (MIT) Env[romenr. zl Serviccs D~aru'ae~l~ / 10220 S. W. Greenbu~g Road / Suite 470 / Portland, Oregon 9722,~ Phone (505) 977-7713 / Fax (~0~) 245-3438 State of California t g .. State of Water Resources el Bo~d ~.~-'~ ~: ..~:?~ -< ,: -. ~:'~.~:~':~;~:~..;.~,;~:;~'~ ~r~ ~.~.~ . Sacrmento, CA 94244-2120 (Ins~ctions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STOOGE TANKS CONTAINING PETROLEUM A. I m required to demonsmte Fin~cial ResponsibiIi~ in ~e Required mounu ~ specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ~ 500,000 doll.s per occu~ence ~ I million doll~s ~nual aggregate or ~D or  ! million doll.s per occu~ence ~ 2 million doll.s ~nual aggregate B. 7-Eleven, Inc. , hereby ce~ifies that it is in compliance with the requirements of Section 280L (Name of Tank Owner or O~mtod A~icle 3, Chapter 18, Division 3, Ti~e 23, California Code of Regulations. The mechanisms used to demonstmte financial msponsibili~ as mquimd by Section 2807 am as follows: Amedmn International $1,000,000 per Special~ Lines PLS Occu~ence & Annual Yes Yes Insuran~ Insumn~ Company 2674022 $2,000,000 Annual Aggregate Note: If you a~ using the State Fund as any pa~ of your demonstration of financial ~sponsibili~, your execution and submission of this ce~i~cation also cerises that you am in compliance with all conditions for pa~icipation in the Fund. D. Facility Name Facili~ Address 7-Eleven g17721 3601 Stockdale Rd., Bakersfield, CA Facility Name Facili~ Address 7-Eleven ~32241 4101 Calloway Dr., Bakersfield, CA Facili~ Na~. Facility Address ::5~ ~[/~~ 0600 Brimha,I Rd., Bakersfield, CA E. S 3 ~ Name and Title of Tank Owner or Operator Bob DeNinno, Environmental Manager Si ature of~tness or Nota~ g Date Name of Witness or Nota~  ~~ Rachel Roddguez CFR (Revised 04/95) FILE: Original - L~ :al Agency. Copies - Facility/Site(s) CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly known as The Southland Corporation) hereby certifies that it is in compliance with the underground storage tank ("us'r") financial responsibility requirements of Subpart H of 40 CFR Part 280 and applicable, requirements under State law. The financial assurance mechanism used to demonstrate financial responsibility is third party insurance, more particularly described as follows: Storage Tank 'Third Party Liability Corrective Action and Cleanup Policy No. PLS6191639, issued by American International Specialty Lines Insurance Company effective from November 24, 2001 to November 24, 2004, pursuant to 40 CFR §280.97, providing coverage for underground storage tanks with respect to the taking of corrective action and/or compensating of third parties for bodily injury and property damage caused by accidental releases. The limits of liability are those "per occurrence" and "annual aggregate" limits specified by 40 CFR §280.93 and/or applicable State law. This Certification supercedes all previous such Certifications issued with respect to financial i responsibility for UST's owned or operated by 7-Eleven, Inc. or its predecessor The Southland Corporation. To the extent required by applicable law, Certificates of Insurance have been filed with appropriate State authorities. 7-ELEVEN, INC. By: ~ Name: Edward J. Herman STATE OF TEXAS COUNTY OF DALLAS SUBSCRIBED AND SWORN TO BEFORE M this o~ __~.-t, 2001. Notary Public In ~[d For Said County and State My Commission Expires: - 102394vl , ELEVEn January 29,2003 Mr. Steve Underwood Bakersfield Fire Department 1715 Chester Avenue Bakersfield, CA 93301 RE: 7-Eleven #32376, 9600 Brimhall, Baker_sfield _ Secondary Containment Repairs Dear Mr. Underwood: 7-Eleven is in receipt of your memo dated January 13, 2003. 7-Eleven has contracted with MIT Engineering to make the necessary repairs to the components that failed the Secondary Containment Testing. MIT Engineering is preparing permit applications for submittal in early February. Once repairs are complete, the system will be tested by 7- Eleven's testing contractor, Tanknology, Inc. 7-Eleven hopes this information satisfies the Agency's request. Please feel free to tact me at (208) 429-8466 should you have any questions. CC Market Manager Judy Soper ...... Jason Ward Jesse Kirk (MIT) Enviromental Services Department / 10220 S. W. Greenburg Road / Suite 470 / Portland, Oregon 97223 Phone (503) 977-7713 / Fax (503) 245-3438 January 22, 2003 7-il F~RE C..EF 9600 Brimhall RON FRAZE Bakersfield CA 93312 ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield. CA 93301 RE: Upgrade Certificate & Fill Tags VOICE (661) 326-3941 FAX (661) 395-1349 Dear Owner/Operator: SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 Effective January 1, 2003 Assembly Bill 2481 went into effect. This VOICE (661)326-3941 Bill deletes the requirement for an upgrade certificate of compliance FAX (661) 395-1349 (the blue sticker in your window) and the blue fill tag on your fill. PREVENTION SERVICES FIRE SAFETY SERVICES · ENVIROffMENT~L SERVICES 1715 ChestorAve. You may, if you wish, have them posted or remove them. Fuel 0akorsfleld, CA ~301 vendors have been notified of this change and will not deny fuel VOICE (661)320-3979 FAX (661) 328-0576 delivery for missing tags or certificates. PUBLIC EDUCATION . ~715 c~oste~^v~,. Should you have any questions, please feel free to call me at 661- Bakersfield. CA 93301 326-3190. VOICE (601) 326-3696 FAX (661) 320-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 vOICE (c~l) 32~-3~51 FAX (661) 326-0576 i' ' .."" " TRAINING DIVISION Steve Underwood 5642 Victor Av~. Bakersfield, CA 93308 Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-4697 FAX (661) 399-5763 Office of Environmental Services SBU/dc -I · Complete items 1,2, and 3. Also complete ~ jnat.u~'e . .. ~,_. ~ item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1 ol ,~res~ different from item1 .~ ¢"1 '~s 1. Article Addressed to: If YES, enter delivery address below: [] No , I ' '7- ! ]- 3. Service Type 't. ~)600 BR~[~J~']~.~,]-- [] Certified Mail [] Express Mail BAE~ERS]~[EID CA 9331 :~ [] Register~ed [] Return Receipt for Merchandise · ' ' [] Insured ~ail [] C.O.D. 4. Restricted Deliver~? (Extra Fee) [] Yes ~'7002 0860 00'00 1641 5660 -'l PS Form 381 1, August 2001 Domestic Heturn Necempt I02595-02-M-0835 1~3 Postage $ r"l Certified Fee postmark Return Receipt Fee rt. (Endorsement Requiree') Here =[3 Restricted Delivery Fee (Endorsement Required) I'tJ T~ ,tm r,- 7-11 ................. [os~', 9600 BRIMHALL . January 13, 2003 7-11 9600 Brimhall Bakersfield CA 93312 FIRE CHIEF RON FRAZE Certified Mail ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 RE: Recent SB 989 Secondary Containment Testing F,x (661) suP..Ess,o. SE.viCES REMINDER NOTI CE 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Owner/Operator: PREVENTION SERVICES ,~,~..E~,~.t,~r,~'~Es Our records indicate that you completed your secondary containment 1715 ChesterAve. testing on December 20, 2002. Our records further show a failed test. Bakersfield, CA 93301 VOICE (661) 326-3979 Therefore you are required to have your system repaired and re-tested FAX (660 326-0576 as soon as possible. PUBLIC EDUCATION 1715 ChesterAv~. This office requests an update with regard to repairs of your system. Bakersfield, CA 93301 VOICE (661) 326-3696 Please be advised that repairs involving the replacing of components FAX (661) 326-0576 must be under permit from this office. The repairs of your system are FIRE INVESnaAT~ON a condition of your permit to operate. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661)st, s-aus~ Should you have any questions, please feel free to contact mc at 661- FAX (661) 326-6676 326-3190. TRAINING DIVISION Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 /" Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc MONITORING SYSTEM CERTIFICATION For Use B), A l/J'nrisdictions W)'thin the State of Ccdifom~ic~ ~t'/a;ri(v Cite,t: Ch,tpter 6. 7, Heed/th crud S:~k~ Code; Cha~ter ] 6, Divixion 3, Title 23, CcH~brnin Code of Reg~dutions ~ot'm must be used to doc~xent tesrh~g ~d servicing of monkoring equipment. ~ separate certification or repmx must be monixoc[n~system conn'ol panel by the reclmician who pertBrms t~e work. A copy of this tBrm must be provided to the tank oxvt~er/operator. The o~er/opermor must submit a copy of this form to the local agency regulating UST systems within 30 Comae[ Person: Contact Phone No.: ( _) ~vml.:e M,~det of Monkoring System: T~5 ~D Date of Testh~g/Servicing: ~ /_~./~.~_ .:~vem'oO' of Equipment Tested/Certified }'I~)L 3. ~lJl'O..~Jl'i;ifq .... boxes t0 indicate specific equipment~ ........................ insl)eetcd/serviced .... m-f:,m~ dau~in&Probe. Model: Z ~ 't-' m ' ; g' g Probe. Model: ~~ ..... ;,mrmlm' SpLtcd or Vauk Set,sot. Model: ~nul~ Space or Vault Sensor. Model: ~~ ............ Sump .; 'french SensorCs). Model: Piping Sump / Trench Sensor(s). Model: ~ ........... 5m~p 5ensorts). Model: 6 ~'?~ ~ Fill Sump Sensor(s). Model:M°del:~'~ ~]<c[ro~fic Lmc Lc~d; Detector. Model: ~ Electronic Linc Le~( Dctcctor, Modeh OvcrBtl / Hish-L~vel Sensor. Model: ~ Tm~k Ovm'Htl / High-Level Sensor. Model: ~d>e; ~;t~E?.~j~))~nr type m~d model in Section ~.A~l~age 2). Q Other (specie, equipment type and model in Section E on.,?agc 2). ~'m~i~ Gauging Probe. ModeL: __ ~ in-Tank Gauging Probe. Model: _-u,~uk~f 5pace or Vault Sensor. Model: ~ .~nular Space or Vault Sensor. Model: 5m'np / french Sensor(s). Model: __ ~ Piping Sump / Trench Sensor(s). ModeL: Smnp Sensorts). Model:__ ~ Fill Sump Sensor(s). Model: ix.~ccmmic:~d Lmc Le~ Detector. Model: ~ Mech~ica[ Line Leak Detector. Modeh ~ l.:iecrroxfic Line L.e~fl( Detector. Model: ~ Electronic Line Leak Detector. Model: O¥'crfill/High-f_evel Sensor. Modeh ~ ~ T~k Overfill / High-Level Sensor. M'odel: [,:pccirY c~uipmenr t¥~ rmd model in Section E on Pa~e 2). _ =~__pther (spcci~ equipment D, pe ~d model in Section E l,t~pc-n>cr uontmmn~nt ~cnso,(~). Model. ~ ] ~Dispenser Containment Sensor(s). Mo~et:-~7 V;dvcts. ~ She~ Valve(s). ~)i-:,:,c,~sct- Con 'ainmcnt Float[s) ~d Cbam(s). 0 Di~onminmenr Float(s} m~d Chain(s)} l..%,pcns~v Containment Sensor(s). Model: ~7 ~ Dispenser Containment Sensor(s). blodel: ~ Vahe(s). ~ Shem' Valve(s). ' ............. Db..0c~xsm' Ccmtuimnenr Float(s) m~d Chain(s). ~ Dispenser Containment FloaRs) and Chain(s). ,'xspmt~m-Coataimnenr Sensor(s). Model:~J ~ Dispenser Containment Sensor(s). Model: ~~ 'X :al'vets). ~ Shem Valve(s). GDi>Sm)?; ~.pj>[3~xj/j}m~t Float(s) mad Chain(s). ~ Dispense[ Containment Float(s) ~d Chain(s). &xcili[) contains more [m'~ks or dispensers, copy [his form. Include information tbr every t~k ~d dispenser'a[ the ~'Crf}i~O~iOi't - t cer[il~ [hat the equipment ideutified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Al[ached [o ~his Cerdticadon is infm'ma[ion (e.g. manufacturers' checklists) necessary to veril~ ~hat this information coercer ;tltd ~ Plot Plan showing II~e layoul of moni[oriug equipmenI. For any equipmenl capable of generatin¢ such reports, t have :,trothed ~ copy of the report; (check' MIH~ttt apply): ~ System set-up ~[~ history r~ort '[l-cmfician Nmne (print): ~ ~ ~~~ Sigfiature: .~ Cc}'~i~}Cm'Jo~iNO,: ~~ License. No.: C~/D40- ~,~9850 i'csrh~gCompmxyNmne: RICH ENVIRONMENTAL PhoneNo.:(661 ). 392-8687 Page 1 of 3 05/0~ x~.~-.s'~ii~s oi' Testing/Servicing Version installed: ..2C~.35!.~Actc the i'otlowhig checklist: ] G No,~ is the audible alann °Perariortal? ,l~___~. ~_iI-~"T.;~' 'i ~ No¥ ls the visual alarm operational'? {~"~ "'""~-[ ~ lqo" Were all sensors visually h,spected, functionally tested, m,d confirmed operational'? ~ No* Were all seasors hxstalled at lowest point of secondary containment m~d positioned so that other equipmem will not interfere with their proper operation? ~ No='' if alarms ~e relayed to a remote monitorhxg station, is ali conmmnications equipment (e.g. modem) ~N~5 operational? '~-[~-- ~ No¥ For pressm'ized piping systems, does the turbine automatically shut down if the piping secondmy conrainmem ~ 'N,.A monitoring system detects a teak, fails to oper3te, or is elecn'ically discmmected? If yes: which sensors positive Shut-down? (ChecX ct//rhc~r c~p13J ~Smnp/Trench Sensors; ~ Dispenser Contaimuenr Sensors. Did ?otl confirm l~ositive shut-down due to leaks and sensor failure/discomaection'> Yes; ~ No ......... ~--"No;~ For r~ systems that utilize the monitorNg system as the primary tm~c overfill warning device (i.e. no ~ N/A mechanical overfill prevention valve is installed), N the overfill warning alarm visible and audible at the tanlc fill point(s) m~cl o~erating [3roperly? if so, ar what percent of taint eapaci~ does fl~e.alm'm trig¢er? ~',, ~ ~ No Was any monkorh~g equipmem replaced9 If yes, idenri~ specific sensors, probes, or other equipment replaced and list the manuGctm'er name and model lbr all replacement pans ia Section E, below. No Was liqtfid fotmd ~side any secondary comaimnenr systems designed as d~y systems? (Check all that a/p~.',) Product; ~ Water. If yes, describe cruises in Section E, below. t G No:" Was monkoring system set-up reviewed [o ensure proper seaings? Aaach set up repo,xs, if applicable '-~'"~' G No'~ Is all monitorNg equipment operational per manuhcturer's specifications? >Jccfion ~ belo,v, describe how and when these deficiencies were or will be corrected. Page 2 of 3 03/01 :~- :~'aid~. G;'~uging / SIR lgquipmenl': ~ Ct~eck this box if ta~ gauging is used only for inventory control. Check flxis box if no t~ gaugNg or SIR equipmen~ is iasmtled. '5"i't~s ~oc don must be completed if in-tank gauging equipment is used to perfbrm leak detection monitoring. 5' ~-s ~ ~ No:~ ~ Has ali input wiring been inspected for proper entry and termination, including testh~g for ground ":~s [, G No* I 'Were all tat~ gauging probes visually inspected for damage and residue buildup? '~,:s ~ O No* ~ Was accm'acy of system product level readNgs tested? Tes [ ~ No* ~ Was acct~acy of system water level readNgs tested? 'Tc-s } ~ 'No* ] Were allprobes reinstalled properb,? "~s { ~ No* ~ Were all items on the equipmem manul:acrm'er's mah~tenm~ce checklist completed? 5, ~i'~c5co,ion H, Below, describe how and when these deficiencies were or will be corrected. :_ine .Leat~ De~ectors (LLD): ~ Check. this box ifLLDs m'e nor installed. Yc-s O No* F~r equipment start-up or ammal equipment certification, was a leak simulated to verify LLD perlBrmance? ~ N/A (~hec.k r#l rha~ %'y139 Simulated leak rare: ~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 requh'ements? X cs ~ No:~ Was the resting apparatus properly calibrated? 'Y ~.s G No~ For mecMnical LLDs, does the LLD restrict product flow if it detects a leal<? 'l es ~ No* For elec=onic LLDs, does the turbine automatically shut offifrhe LLD detects a leak? ~ N/A 5 es ~ NOv For electronic LLDs, does d~e turbine automatically shut off if any poaion of the monkoring system is disabled ~ N/A or discmmecred? '~ es ~ No* { For elecuonic LLDs, does the [tlrbine automatically shtll offifany potXion of~e monitoring system n~alfuncrio~s j ~ N/AI or t:aits a ~esr? Tes } ~ No*N/A For elecn'onic LLDs, have att accessible wMng co~ectioas been visually inspected? Yes ~ No`~' ~ Were alt items on the equipment manuhcmrer's maintenance checklist completed9 i~x ~'t~c Section H, below, describe how and when these deficiencies were or will be corrected. Page 3 of 3 03/or 5k,,.ito:qiig ~.~ stem Certification UST Monitoring Site Plan. Date map w~s *awn: Instructions :ii;early have ~ diagr~ flint shows all 'req~ired information, you may include it, rather than this page, with yot~i- ~Xlol~itot'i~xg System Certification. On your site pimp, show the general layout of tanks and piping. Clearly idem'il? of t-l~e Ibllowing equipment, if installed: monitoring system control panels; sensors monitoring tank annular stmxps, dispenser pm~s, spill containers, or other secondm'y containment areas; mechanical or electronic liae leak and in-tank liquid level probes (if t~sed tbr leak fl~tection). In the space provided, note the date this Site Page ~of g os/o0 . RICH ENVIRO1V ENTAL 5643 BROOKS CT BAK~.RSFIELD~CA.93308 OFFIC~, (661) 392-8687 & FAX (661)392-0621 MEC~LA/gICAL LEAK DETECTOR TEST w/0~: Produce Line Type {Pr~ssurej Suction. Gravity) PRODUCT LEAK DETECTOR TYPE TEST' TRIP PASS SERIAL NUMSER BELOW PSI OR $ GP~ FAIL L/D TYPE YES SERIAL ~ NO FAIL L/D TYPE YES PASS SERIAL # NO' FAIL ! certify the above tests were conducted on this date according to Red Jack, et Pumps field test app&raEus testing procedure an limitations. The Mechanical Leak Detector Test pass / fail is determined by using a-low flow threshold trip rate of 3 gallon per hour or less aE 10 PSI. I acknowledge tha~ all dana. collecLad is ~rue and correct to ~he bose of my knowledge. Signature Da~e: ~~ COMMUNIC,qTIONB SETUP' ":~' ~ ':~: ~ ~ ..... :<'~"~ "~, SOFT RE' REVISION .... . - _ VERSION 121 .DO ' ~ I'N-T~ /, T ~:PUL ''".~ '7'. CRERTED - ~0.11.15.13.23 PO~T SETTINGS: T 2:E~L j P~OD~CT CODE ~-MODULE~ '330160-100-~ COMH BO~D : 1 (EDIM PRODUCT CODE : 1: THERMAL COEFF :.000700 SYSTEM FEATURES: RS-232 SECURITY THERMAL COEFF :~000700: T~NK DIAMETER : 96.00 PERIODIC IN-T~NK TESTS~ CODE : DISABLED T~NK DIAMETER : 96.00~ T~NK PROFILE : 1 PT ~NNU~L IN-T~NK TESTS T~NK PROFILE : 1 PT. FULL VOL : 10028 FULL VOL : 10028 METE~'D~T~ : BIR COMM BOARD : 2 (EDIM METER D~T~ : YES EN~. FRCTOR: ' NONE RS-2S2 SECU~] TY SYSTEM SETUP CODE : DZSaBLED CRL UPDATE: ZMMED~aTE :' FLOAT SIZe: : . ~PR 26. 2~04 8:~8 ~M RECEIVER SETOP: FLO~T SIZE: 4.0 .IN. ~TER"~RNiN~ ' NONE ~TER ~aRNI NO :I .5 HIGH' ~TER' LIMIT SYSTEM OMITS U.8. HIOH ~TER LIMIT: 2.0 M~X OR L~BEL VOL: 1~28 S~STEM L~NG~aGE M~X OR L~BEL VOL: 10028 OVERFILL LIMIT : 9~ ENGLISH SYSTEM D~TE/TIME FO~Tj OVERFILL LIMIT 90~ : 9~25 ~ 9025: HIgH PRODUCT : 9S~ MOM DD Y~YY HH:MM:SS xM:, 8IGH PRODUCT 95~: ~.. : 9526 7-11 32376 .' 9526. DELIVERY LIMIT : 9600 BRI~H~LL RD. DELIVERY L~MIT 10~ : 1002 B~KERBF I ELD ~ C~. 93~ 12 1002 LOW PRODUCT : 500 ' B0687875505001 - LOw PRODUCT : 500 LE~K ~L~RM LIMIT: 15 ~UTO DI~L TIME SETUP: ' . LE~K ~L~RM LIMIT: 1~ MOD~N LOMB LIMIT: 40 SHIFT TIME 1 : 7:00 ~M T~NK TILT ' · 0.00 BHIFT~'TIME 2 : DISABLED NONE SUDDEN LOSS LIMIT: 40 · . ~N~' TILT : '0. O0 M~NIFOLD~ T~NKM. SHIFT TIME 8 : DISABLED ~M iFOLDED T~NKM SHIFT TIME 4 : DISABLED ~::.'~: ~N T~: ;NONE' ' SHIFT MIR PRINTOUTS ~ ::~:' : ~: ::N~NE DI S~BLED ~ .:~ "~ ' : , ~' ~" : LE&K ~IN~P~RIODIC: ::25g ~N~BLEDD~ILV BIR PRINTOUTS :~' ~: ~,'~K'.?~:N~ ~' : ' PERLQ~:I~:',. 25~.::~ "' .: :, : 2507 TIOKETED DELIVERY.. :.. ::~: ::,:.,... :: ::~ ~'~ ' D I SaBLED ~::'~aK .:'~ N '~NNU~L. ' .'50~:" . '~ ' ' T~NK PER TST 'NEEDED ~RN ~":~ .... '~ " D{S~BLED : :~: .:': ' . :~ ~ ] :~ :<; PE~I:ODIC TEBT TYPE TST NEEDED ~RN ..: :.PEEI:oDic B j TEST TYPE LINE RE-ENgBLE METHOD RS-232 END 0F HEBBgO ' BT~NDgRD ~NNU~L T~T.F~IL[ PaSS LINE TEST DISABLED ~ &NNU~L TEST FaIL RL~RM DISABLED LINE PER TMT NEEDED URN ~WTO DI~L ~L~RM ~ETWP ~ ~L&RM DISABLED PERIODIC TEST F&IL D I B~BLED ~. PER I OD I C TEST F~ I L ~L~ D I M~BLED LINE ~NN TST NEEDED URN: D ] S~BLED , ~L~RM D I 8~BLED ; GROSS TEST F~ IL PRINT TC VOLUMES ~ :GROSS TEST F&IL ~L~RM DISABLED D I S~BLED ~L&RM D I 8~BLED aNN TEST ~UER~G I NG: 'OFF TEMP COMPENSATION ~ .~NN TEST ~VER~GING: OFF PER T~ST &V~R&GING: OFF V~LUE (DEC F ): 60.0 ~ P~R TEST ~WER~GING: OFF STICK HEIGHT OFFSET ~ T~NK TEST NOTIFY: OFF ENABLED -'~-~ .......... ; T&NK TEST NOT I FY: OFF ~ TNK .TST SIPHON BRE~K:OFF · '"' : . ~NK TBT SIPHON BREaK:OFF H-PROTOCOL D~T~' FORMAT ' ' :. : : ~ D~ I VERY DEL~Y : 3 M I N HEIGHT ' ~: :':' i" : ~LIVERV DEL~Y : S MIN STICK OFFSET : 0.00 EN~BLEDD~YLIGHT SAVING TIME ~ 3. .::~ .:': . ~CK~ :. OFFSET : 0.00 START D~TE " ~PR MEEK 'i SUN - ' .:' ." : ~:-" START TIME . :.. ~ .: ,, .. 2:00 ~M ~ : END D~TE , :: ;~:. ~ ' · OCT "'~EEK 6 '~UN' ~ ':" :: :' j ':: ~': .::~" END TIME i ' ; '~ t '' ' ~E-DI~ECT LOCAL PRINTOUT'~ ' :i '. ~ ::. ""; : ........ '. :j . . EURO PROTOCOL PREFIX ~ ' ~,,~ LEA~-'TESY--METPIo~ .... ~ OUTPUT RELAY SETUP TEST ON DATE : ALL T~NK .IN-T~NK ALARHB :-::.'~:~ ........ :'~'' '~):~"~:~ ~ ::.~[.:,. ~AN 1, 1996 R I:RUL P.B.D. T'I:LEAK ALARM ~:':. START TIME : DISABLED TYPE: T 3:LE~K ~L~RM RECONCILIATION ~ET~p TE~T R~TE :0.20 G~L/~E ST~NDMRD T S:LO~ PRODOCT ~L~RM _ . s._ ....... ~_ ~' DURATION : 2 HO~RS NORMALLY CLOSED T 8:GRO8S TEST FRIL .- TST EMRLY BTOP:DIS~LED LIQUID SENSOR ~LM8 EDIM 2: IN-T~NK ~L~RMS L 1 :FUEL ~L~RM LE~K TEST REPORT FORMAT T 1 :LOW PRODUCT ~L~RM L ~:FUEL ~L~RM ~OTOM~TIC D~ILY CL~SI~ NORMAL T I :GROSS TEST F~IL L 7:FUEL ~L~RM TIME: 2:00 ~M : L 8:FUEL ~L~RM ~ .... ' LI~OID ~ENBOR ~LMS L 9:FUEL ALARM ~UTO SHIFT ~1 CLOSING. 'L I :FOEL ~L~RM ~ LIO:FUEL ~L~RM TIME: DISABLED L 2:FUEL ALARM ~ Lll :FOEL ~L~RM > L 3:FOEL ALARM ~ LI2:FOEL ~L~RM ~OTO SHIFT ~2 CLOSING ~' ~ L 7:FOEL ~LARM ~ RLL:HIOH Li~OID RL~M TIMEr DISABLED ~ L 8:FUEL ALARM ~ L B:LI~UID W~RNIN~ L ~:FUEL ~L~RM L 7:LIQUID W~RNING AUTO SHIFT ~ CLOSING LIO:FUEL ALARM L 8:LIQUID W~RNING TIME: DISABLED Lll:FUEL ALARM L 9:LIQUID W~RNING ~.~ LI2:FUEL ALARM LIO:LI~UID W~RNING AUTO SHIFT ~4 CLO8ING.' ~.~ LIQUID SENSOR SETUP J L 1:HIGH L!~UID ALARM Lll:LI~UID WARNING TIME: 7:00 ~ L ~:HIGH L~I~UID ALA~ LI2:LI~UID WARNING L 7:MIGH L.I~UID AL~M L-I:RUL STP~-SUMP L B:HIOH LIQUID AL~RM~ PERIODIC RECONCILIATION DUAL FLT. HIGH VAPOR L 9:HIGH LIQUID ALARM MODE: MONTHLY C~TEGORY : 8TP SUMP L I 0: H I GH L I ~U I D ALARM ALARM: ENABLED Lll :HIGH LIQUID ALARM ALARM THRESHOLD: 1.00M LI2:HIGH LIQUID ALARM ~ ~LA~M OFFSET: L 2:RUL ~NNULA~ TRI-STATE (SINGLE FLOAT) R 2:RUL P.S.D. ~ TEM~ COMPENSATION C~TEGORY : 6NNUL~R 8PAC~ TYPE: --- ~ STANDARD , BT~ND~RD .... METE~ C~L IBR~TION NORMALLY CLOSED OFFSET: O. 000~ L 8:POL STP SOMP BOS SLOT F~EL METER T~NK D~L FLT. HIGH V~POR I N-T~NK C~TEGORY : STP SOMP T I :LE~K ~L~RM 8 2 1 .0 T 2:LE~K ~L~RM ~ 2 I I T 3 :LEAK ~L~RM S 2 I 2 2 L 4:POL ~NNOL~R T 2:LOW PRODOCT ALARM ~ 2 2 0 TRI-STATE (SINGLE FLO~T) T 2:IN~LID FUEL LEVEL 3- 2 2 1 C~TEGORV : ANNULAR SP~CE T 2:OROSS~ TEST F~I.L 9 2 2 2 2 3 2 3 0 R LIGUID SENSOR ALMS 3 2 3 1 3 L 1 :FUEL ALARM 3 2 3 2 2 L 7:DISP. 1-2 L 3:FUEL RLRRH 3 2 4 0 D~L FLT. DISCRIMINATING L ?:FUEL ~LRRM 3 2 .4 1 CRTEGORV : DISPENSER. PAN L 8:FOEL ALARM / 3 2 4 2 2 L 9 :FUEL RLRRH ~ 3 2 5 0 3 L 10: FUEL 'ALARM ' [ ~ 3 2 5 I LI' 1 :FUEL ~LRRH ~ . 3 2 5 2 2 L 8:DISP. 3-4 L12:FUEL :ALARM ,~.. 3 2 6 0 3 DU~L FLT. DISCRI, MINRTING L I :HIGH ~LIGUID ALARM~~~.: ~~. 3 2 6 1 CRTEGORV : DISPENSER PAN LLL 8:HIGHT:HIGH3:HIGH :LI~U~D~LlgUlDLIGUID ~RRMR~MRMRLRRM · :'~ ' 333 222 776 012 ~32 L 9:DISP. 5-6 L S:HIGH;LIgUID ~RRM 3 2 7 2 2 LIO:HIGH ~LIGUID R~RRM 3 2 8 0 DUAL FLT. D[SCRIHINRTING Lll:HIGH LIGUID ~LRRH 3 2 8 1 CATEGORY : DISPE~ER PAN L12:HIOH~LIgUID ~R~ 3 2 8 2: 2 L I:LI~UID ~RRNI~' ~ 3 2 9 0 L 2:LIGUiD ~RRNI. NG = 3 2 9 l L.3:LIGUID NRRNINO .~', '- 3 2 9 2 2 LIO:DISP. 7-8 " L 5:LIGUID WARNING, 3 2 10 0 3 DUAL FLT. DISCRIMIN~TI~ L ?:LIQUID MRRNIN~ 3 2 10 1 CATEGORY : DISPENSER PAN L 8:LIGU[D ~RRNING 3 2 10 2 2 L 9:LIGU.ID ~RRNING 3 2 Il 0 , LIO:LIGUID MRRN I NG 3 2 Il 1.' 3 2 11 2' 2 Lll:DISP. 9-10 Lll':LI~UID W~RNI:NO 3 ' 2 ~.20~ DUAL FLT. DISCRIMINATING L12:LI~U'ID WARNI~ ,. · , , 3. 2., 12 ' 1 CATEGOR~ : D I SPENS[R PAN ., :::. · .... :< .::- ~ 3 2 12 2 2 L12:DI~P. 11-12 ~ NO~LL~ ~CLOSED ~,. : :;::=.::~::.?¥::~ .~:....'.::.,.. ¥::...::. . .: .... :.: ~.:< . . , ALARM HI STORY REPORT ALARM HIBTORY REPORT S'TOR¥ H I REPORT .... IN-TANK ALARH ---~ ALA~H HI~TORY ~EPO~T ..... ~EN80~ ALA~H SYSTEM ALARM .... " L 2:~UL ANNULA~ PRPER OUT T 2:RUL .... I N-TRNK RLRRM RNNULRR ~PRCE PRINTER ERROR OVERFILL RLRR~ ~ ~:PUL OCT APR 18, 2004 7:23 AM AP~ 19, 2004 7:59 AM · BATTE~V I8 OFF ~ 18, 2004 6:55 AH OVERFILL ALA~H F~EL AL~H ~.. 5AN 1, 1996 B:O0 AH MAR-29, 2004 6:45 RM FEB 20, 2002 I :10 PM ~T CLOSE DRILY ~ENDING ' OCT 17, 2003 2:00 AM LOW PRODUCT RLRRM L~ PRODUCT ALRRM MAR 12, 2004 8:09 ~M NOV- 6, 2003 3:16 PM ~T ", OCT 30, 2003 10:27 PM ~ 20; 2002 I :05 PN RPR 1~, 2004 8:05 RM NOV' 6; 2003 3:16 PH HRR 3, 2004 7:I1 RM FE~ 20. 2002 1:14 PH ~ ... FEB 15, 2004 7:05 RR FEB.::.20,. 2002 1:05 PR ~ INVALID FUEL LEVEL PRQBE OUT , ~:' FEB 20. 2002 .1:12 PH :NO~: 6~':2003 3:16 PH ~ ~ ~ ~ ~ END ~ ~ ~ ~ j :00~:' ~, 2003 7~3~ RH PROBE OUT 00~: 7.'~.2003 7:47 ~ OCT 13. 2003 :1.:00 PH OOT 7, 2003 .1:~0' PM ~ OCT 7, 2003 7:47 RH DEL:IVE~V NEEDED . NO~=.,IO. 2003 10: -' NO~: 6, 2003 DEL I VERY NEEDED RpR:'. 16, 2002 ~ 12, 2004 5:26 ~ :-: g~N 29, 2004 :2:56 P~ O~N 22, 2004 10:50 R~. LO~:':TE~ ~P~ 1.9,' 2004 :~:1~ ~/ "i': :' .... IN-TRNK ~L~R~ --- D~C 14, 2003:4:23i ~HJ . . T 1 :RUL " ...:~ ~ :; :?- ~ .?::.~: OVERFILL RLRR~ : .?, .:::: .. FEB 20, 2002 ' 1: 1 O':PM:,' ":' :...?~ :;:~ ,. . ,. {;~ :~ JUL 18. 2001 ?:32:::RM::': : :::':::':<~: ::'~.'~'::k': .: HIGH PRODUCT RL~RM::' ' ~::::: ~ FEB 20, 2002 1:1 INVRLID FUEL LEVEL :~ ', ' :' · :':"" OCT 7, 2003 11:56 RN ~:::~..~ PROBE OUT : OCT 9, 2003 7:39 RH .':~'., - OCT 7, 2003 11:56 ~M ' ;:: ' OCT 7, 2003 11:55 RM :.:: DEL I VERY NEEDED ' ~ : :: ~; 7' % "' : '" i : 8UHP OCT 9, 2003 11;04 RM :. ~ ::.:; 04 1 ~52 · ':' ALARM :.. : ':2003 2:40 :'" . , L3,:::200a I " ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ~,,2::: :: . · ~LA~"I .............. HISTORY~ ......................... REPORT I:ALARM HISTORY REPORT ALARM HISTORY REPORT .... ALARM ,HI~TOR¥,~RE~ORT:i., :~ii ..... SEN~OR ALARM --- DISPENSER ALARM --~- i ..... SENSOR ~LARM .... LII:DISP. 9-10 E 1: ..... SENSOR ALARM ---t L 5:MUL STP SUMP L 8:DISP. 3-4 DISPENSER PAN STP SUMP DISPENSER PAN FUEL. ALARM SENSOR OUT ~LARM HIGH LIQUID ALARM NOV 13, 2003 11:28 AM SEP 15, 2003 2:26 PM OCT 13, 2003 2:21 PM HIGH LIQUID ALARM LIQUID WARNING HIGH LIQUID ALARM OCT 13, 2003 2:21 PM MAR 17, 2003 2:21 PM OCT lS, 2003 2:05 PM HIGH LIQUID ALARM LIQUID WARNING FUEL ALARM OCT 8, 2003 8:24 AM FEB 20, 2002 12:22 PM OCT 13, 2003 2:03 PM ~ ~ ~ ~ ~ END ~ ~ . ~ ~ ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ~ ~ ~ ~ END ~ ~ ~ ~ : ALARM HISTORY REPORT .... PRODUCT ALARM F I:RUL PROD THRESHOLD ALM. JUN 1, 2002' 2:01 AM ' PROD THRESHOLD ALH : MAR 1, 2002 2:00 AM ALARM HISTORY REPORT ALARM HISTORY REPORT ALAR~ HISTORY REPORT .... ? SENSOR ALARM ..... SENSOR ALARM --- - .... SENSOR aLARM --- L12:DISP. 11-12 L 6:MUL ANNULAR L 9:DISP. 5-6 DIBP~NSER:PA~ ANNULAR SPACE' DISPENSER PAN HIGH~LIQU.ID ALARM : SENSOR OUT ALARM HIGH LIQUID ALARM OCT 13, 2003 2:30 PM SEP 15, 2003 2:26 PM OCT 17o 2003 12:!01 PM . HIGH:.LIGUID ALARM :, FUEL ALARM HIGH LIQUID ALARM OCT L3o 2003 2:20 PM ~ ~ ~ ~ ~ END ~ ~ ~i~ MAR 17, 2003 2:20'PM OCT 17o 2003 12~00 PM ' ' i H~GH LIQUID ALARM FUEL ALARM LIQUID WARNING .i OCT 7, 20.03 1:46 PM FEB 20, 2002 12:32 PM OCT 17, 2003 12.~00 PM ' ALARM HISTORV REPORT ~ ~: ~ ~ ~ END ~ ~ ~ ~ ~ .... PRODUCT ALARM .... ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ~ ~ ~ ~ END ~ ~ ~ ~ F 2:PUL pROD THRESHOLD ALH JUN 1, 2002 2:01 ALARM HISTORY REPORT ALARM H I STORY REPORT .... ..... SENSOR ~L~RM ---~ ..... SENSOR ALARM --- :~ 1.:: ':' ~ ' LIO:DISP. 7-8 OTH~~ s~NsoRs L 7:DISP. 1-2 '":': DISPENSER P~N DI SPENSE~ P~N HIGH LIQUID' ALARM HIOH LIQUID ALARM ........ . OCT 13, 2003 2.22 PM OCT 13, 2003 2:19 PM : . ... HIGH LI~UID ~LaRM HIGH LIQUID aLARM ::.:: OCT 13, 2003 2:09 PH OCT 13, 2003 1:30 PM ' ~ · OCT 1~, 2~03 2:87 PM OCT 1~, 2003 I:06 PM- .:...: ..' -:,;.~'.,L ,.-'..'i ', . ,?,.':... ., ,.~.~:::..Li. t .... · ,.: :. ,:. ! ~i?i':.. ..L.,:L'.L~ ~:_-: ....... !-~': ':: ~- .. . - t ' f.i. ' ..... S£NSOR ,,::,,L,,:,,RN ..... · "'i " '::v --~-' SENSOR'~LaRM ..... L 7:DISP. 1-2, ....... ' L 1 :RUL STR.:.~ DISPENSEE PAN "~LaRH HISTORY REEORT ~T~ ~OHP ". ~' ~ ~. HIgH LIQUID ~L~RH ~ FUEL ~L~RM ~PR 2G, 2004 8:58 ' APR 26, ~00~' 8~47 ~M ' '  .... PRODUOT ~LARM .... ~. F ~:RUL PROD THRESHOLD ~ JUN l, 2002 ~:01 AM "':~: "~ -'-i- SENSOR A%aRM ..... : 8:DISP.~ ,::~ STP SUMP "' ~" HIgH LIQUID FUEL ~L~RM . ~PR 26, 2004 9:00 ::'. ~.~.~ ~ ~ ~ ~ END ~ ~ ~ ~'~ aPR ~6, 2004 8:48 aM , · ~ · .... ~ ::: ,'~..:t.. ~ .... B~NBOR aLaRM ..... LIO:DIBP. ?-B I ~ 2 :RUL ~NNUL~R ' DI SPENSER PaN ~LaDfl HISTORY REPORT ~L~¢E': ' HIGH' LIQUID ~LaRM .... PRODUCT ~L~RM .... aPR 26, :'~004: B: 4B aM ::. F 4:RUL : '~[ '. :~' ..: · . ;~ ' . , : ::: : .-: · ~ ' . SENSOR ~L~RM .-i~- ~NS('R:~aLaRM ..... ? 'L12:DISP. ~1~ ' ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ L 4:PU~:''aNll~aR::: 'DISPENSER P~N ~ . .:. ANNULA~:BP~t3~ : ~ HIGH LIQUID aL~RN , .... i "~ APR: :26:~?~0: 8 ;49 AM ' · : ........... ::. · ~ :. .::. :. .:. .. :,:~ .... .:., ~:. ::: ::::::::::::::::::::: ::j:: , ::'J~:' ~, , ~, ~::', :':.: :'.,'~:~:::':'::: ': :'::: .i:?::~. :,:: ";:: LI:I ;DISP:..:: 9'10 : - ..::. :,.:: .;, :, .: ...... :,':' :':.:::.,:'.: ,:' :' :~ ::i..:.~,: .'? HIGH LIQUID ~L~R~ : ~:,. : : ~.~ :.: ~PR: 26, :2~ ~':~ ~:: .'... :.~:-~:~ · :.:":,, :.'F ,:'. ':'.?: .... '"' :':'": ~ :'' '" ~ .: ,...:::'" .. ::': J.' . :. ... . . ~ .. . .. APR 23 2004 9:28 BKSFLD FIRE PREVEMTIOM (661)852-2172 p.4 APPLICATION TO PERFORM FUEL MONITORIN-G CIERTIFICAT[ON T~. V~ ~N~ .,~ , ~ ~~,~ ...... . Tanknology 8900Shoal Greek Bird, Building 200 Austin, Texas 78757 Phone: (,512) 4,51-6334 Fax: (§12) 459-1459 Date Printed and Mailed: 05/13/2004 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 04/27/2004 Order Number: 3134778 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32376 9600 BRIMHALL RD. MARKET #2133 BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests /1 Sincerely, Dawn Kohlmeyer Manager, Field Reporting Work Order: 3134778 MONITORING SYSTE;M CERTIlqCATION ,FoJ- Ua',e ~h, ..1# .l~erLc,licliOns }Yithi. lhe ~tute of Cat~ornh~ =l:.~,or~IV C;~& Ch,~p~e~ 6 7; Heah]~ am~ S;~b~ Code; Choprer 16. Division3 T#te ~3 Ca?~jbrait~ C~e oJ'Regulatio~. ~:;,> of.reit ddt&. F..:;~.;) Ca,a=cl Pm-son: Contact Phon~ No.:( ).__ ,¢...,~cmu,'y of.Equipmeal Tested/Ccciilled . g [:.---,~,~-m,~ m~. ........................ m~,: ~~ __ I ~:r-k'*mm ~m~" ' ~ ~~'-i .... .'~ ~:,,,~,~.,' .Spar,- ar Vault S=,um'.~a~:~ I ~ ~nala'gpa~eo~ Vaatt~a~or. M~lz .~ ._ ~ .... ~-~ ~,, 'St..,;p ~¢~,~L.~j. M0dch I O Fill Sump.~a~0~)~ · k. lO~tel:" ~' S~ .:[,.cri'[,:~ic t.;t~. L~ ~teclo~,.Model: ........ ~ ........ ~ F~cce0ni~ Liac Le~ Detector. Mod~k .... ~i ~ L_Z, OvcifilD Hi~-14vel'Set~ot'. Mo~[: ~ 'l~k;Overli[li High-Level Sen~rl M0d6 _. . :' ~ :~.~.,t. lar Sp;~dC ~'¥~[1 ~'l}~Of. MOdel; ~ ~nular Sp~ or Wit ~e ~r. .'~dC'l~ ; :~ ;-¥.ti~ ~:tJP · l'rcaCh Se~}~o~'s). Mo~et: ........... ~ Piping Sump /T~ch ~m~s). Model: '~' 3i:Ct~.,elc~d Lin~ Lc~ D'¢k~10t, Modch ~ Mech~i~al Linc L~ak Detector. M0~;l: ' ;i ~ ..... ~, [,,&~fiJt;,Hi~-Lcx. cl. Sensor, Model: .... ~ :I~kOve~X~[l/ili~)-LevcI,Sen~ot ii'el: 3 DiSpenser Cdn~inm¢a~ Fl*aKs'} mid Chablis}. 3z~_;[r~ i~,g S) a~cal CertificaliO, Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ~ Wprk Order: 3134778 Were all se, asors visually in~peeted, fuactionaliy res~ea; ired coafirmed operatimml? ...... po~itive~medown? (~J~e~lall/bat~ph~ ~Sump~renchgunsors;~Di~pen~er'~oami~m~e.r Sen~ors. Did 3oa Con'ti,~l ~oshive Shal-do~n da~ [o 'leaks m~6 scn~or Iht!re'e/disco' fil~oh~r(~) ~td o~ing 9ropcr¥? If so. ac w~r pcrccni Ofcm~ ca~aci¢ and list rh~ mtmuhctmer na~ ~d m~l iht all replacement parts ia Se~ioa E. Product; D Water. l fica, describe causes ia Seclioa E. below. Is t~l'monitorh~ cquipmem opcrutiOnal per-ummifaCrm'cr's describe'how u~id:whe~{ lhcscdefieicucie~ ~e,'e or will be corrected, Page 2~t~3 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ~ Wgrk Order: 3134778 (.'hc;'k this box if no rs.air, gauging or SIR' ~:quiPmeni is iitsialk, d Yz;'.:; ,;c,:.d.,,n rnu~.t be completed if in-rubriC gaugip_g equipmcnl is used to Perform teak detectioa monitor/ag; ii ~...; ..< ; ..q lqo* k as ail input Wrong been mSl:)ectedtm,. proper enky' ~ncl termination; tn¢lod;ng i;'* ',-.i ,. '.,; I O' No'* 1 Was afcuracY °£ aYiaem produc~ level r~adiags .':--' ; e'~ ! ~ No* J Were all probosrein~ulied properly? i; '-~77.--~,_,, ., ,['C-t No'~ j Were'all itePxs o~ I~e equip,itea~ manufaerm'er's maizitenanee ~ec. kl~sr comPlemd?. ' ". ..... ~: 5ecJ;,;,t, D., betoW,.deScribe' hOW iilld When ihese aefieiem;ie,J: were'Ur Will. ~ ~.~' ~ .,-;,ti D,c~e¢~.ors~(:LLD); El 'Chark ~P. ks box it'tLOs ~,re not in,tailed: Ji ' -'~. i t_q NO" l;'of equipment' stoa-up m'.amtaal equi~mem.cer[itlcatian,, wac. a leak simulated m verit~ ELD perfot'mal~c¢ ii. ~.' 'L .~' I ~ NO* .Were ill kl~I~ coiltii'med oPe,'afio,tal and accurate Within regulamryrequirements? :!1 ! o was:*e iesiing apparatus p,'opeHy calibrated?. ~ '~,..~. :." ~J 'Nos Fo,'m~chanica! kLDs,.does thc LI Drest'ri0t product Oowifit dexeets a' '!r.~,=~-: ~ No~ Fro. elecn.oaiC 'I.:LDs; do~sdi~ mrbiae aa;omadc~lly shat off if any paaian at' the montlOr[ng system is disubJe ? ' ] ~lf N/A ~r discomiec[ed'? ' ' ..... · ' -'; ', c-~ : O No* Far eJ¢cn'anic.LLJ.~, dOe~ tlx¢ tt,rbiae aummaficaliy Sht/;offifaayport[oa of[he moaimring system malt'uncriot, i..' ,~r H;'A Or titila a :, .', x..-s { ~ 'NO;' 'Forelecwoaic LkD%.have all accossib[e wiring COhnections.bcen,visualty inspeca:d? '*'Ja t'liC Sdcti0u H, b~!oW, des°'ib~ hOW and whoa these deficicacieS were 0r wi!l b~:corr¢c3ed. Page 3 of 3 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 4 7 7 8 RPR 23 2004 8:28 BKSFLD FIRE PREVENTION (SGI)SS2-~.I?2 p.4 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 313 4 7 7 8 . RICH ENVIRO~ENTA r, PRODUCT LE~ DETECTOR TYPR TEST" TRiP PASS SE~ ~R BELOW PSI OR L/D Tlr1' ,l~a P~S' I L/D TYP~ · Y=S ' i cer~i/~ ~he above Cascs ~re,con~u~ted' on ~his ,da~a according Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 " 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 0 4 / 2 ? / 0 ,~ WORK ORDER NUMB EI~ 13 4 '7 '7 8 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32376 COMMENTS Monitor certification results scanned in PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 05/13/2004 08:22 SBOWERS SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 04/27/04 WORK ORDER NUMBER3134778 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEI~ #32376 (~(~)VENTS REG PREM Printed 05/13/2004 08:22 SBOWERS Work Order: 3134778 UST Monitoring Site Plan~ ~ _~ ,.. . ~;.. : : ...... . : ......... ..... :'~'.~2~. 71. :~.~.: .... : ............ 2... ~ ...... ..'.., ~2: ........... I~t ructions 1~ ~[. atreadv ha~.e a diagr~ ~hat shows all required intBrmation~ yoU.~7 inelu~ ir. rather ~Ma thi~ ~ge. ~l~:,~ari~&a'~s[cnJ. Cet~ificafioa, Onyour: 5i~e plan, ~ow ll~e general [aTout u['~mlks and piping. Clearly i~mix i,'<.tti'a~ts ,'h' ri,e following equipment, if in,tailed: monitoring Lvstem Control panels; seo~s monimriag ta~k ~p:,ccS. ~t~mps. dispenser pros, spirt container's, or o~her ~eouda~ containm~t areas; meet~nical or e~mronic Ii,re oe,,.ctm'.q: :md il~-ra~ liquid, level.p.'obhg 0f tiSed Ibr~ del%itoh), in,the space pr,yided, note the date tiffs Ta~ology-~E 8900 Shoal Creek, Bulldog 200 Austin, Texas 78757 ,, Wprk Order: 313477 8 eo~.£ ,~,o, Level ---'- ....... ~.l.-~,,, ~-,.~' , ~-~..~ ~ ~ION l~t.O0 - -' ' '"Y"i ~E~ 346~21'100~ -; T S~DULE~ 33D160-lOO-a ~ ~D : / (~lM PROD~ CODE : 1~ T~ T~L CO~ :.ODD?Do T~N~ ~]~ : 96. ~TUR~; ~-2~2 ~URI~ Ta~ Di~ : ~6.00 PERIODIC /N-TR~ ~ Co~ : D[~B~ TR~ P~FILE : I ~ RNN~' IN-T~ TE~TS ' FULL ~L : tO'O2a ~.~T~ : Y~ ~IR ~~ : 2 (EDI~ ~ ~T~ : ~ ~PR 26. 2004 8:39 ~ ~Ei~ SET~: FL~T ~[~: 4.0 IN. ~ UNITS HigH' ~ LIMIT: 2;0 ~ ~ ~ OR ~ ~L: 10028 g~L'I ~H O~ILL LIHIT' 9~' ~ ~T~T'I~ ~O~T ~25 HIGH P~D~ ': '' : ' · 9526 7.11 32976 ~LIU~: LICIT t~ 96~ ~IH~LL~ RD* : '1002 BO68787~DODOOI ~0 :DI~ T~ ~: ~'~' LIMIT: 15' 8HI~ T.I~: I : 7:00 ~ ' 8~N L~ LI~IT: '40: T~TILT ~ . 0 BBI~T[~ 2 :'DI~D ~ :T~ TILT :~ '0.00: B~I FT BIR .PR i NTO~ ~ T~'PER ~T'~ ~N5~. ' :.4 D~D '~ P~I.ODIC Ol~ ; ', ~. Li~ p~ TaT ~ ~N .~0 DI~ ~~UP~ ~ DI~ p~IODIC T~ F~IL LI~ RNN ~ ~ ~N , ~ DI~ ~ T~.,F~i,L, DI~ ,. ~ RN~ T~RVE~i~: OFF'~ T~ C~E~TIOfl t P~ T~T A~I~:' O~ ~tCK ~IGHT OFFS~ T~ T~T, N~I~': OFF T~ TBT DIP~N ~T~L .~TA .FO~T= [, ~': D~'I ~ .D~Y 1:3 ~EIGHT ; ~ ~ ~YEfGHT ~VI~ T[~E t : : ~ICK OF~ ; O',~ i ' · ~ TI~ I 2:00, ~ E~ ~TE i '., ~':oo ~ ~ E~ p~L P~]X <:. , ! . ~ .. .... ; I~' · .. .:, :.~.~.;. . . : [ ' , :.:~., ).~., . , ~ BEC~]~ [ 'q · Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134778 D~TION ; '2 ~ ~LY CL~D .EDIH LIGUID.BE~R g 1 :P~ ~RM L T.:F~L ~ ; D~L ~Tj, HIGH ~R L: 9;HIGH LIQUID ~ LI0~HIGH LIQUID ~ ~ T~LD: { ~O( L 2:R~ nHNU~ T~ ~E~T[ON B~ ~OT D~ FLT; HIGH V~, IN-T~.~ 3 2 1 O, 9 T 3;L~ ~ 3 2 2 0 3 TRI~A~ (Sl~ ~T) T 2~{~)O FUEL ~ 3; ; 2 2 2 ' 3 LIQUID ~OR ~ L t :F~. ~ Lt O:F~ ~ ~ { 9 2 5 L S:D]~. 3-4 I D~L ~T., DI~IMI~TI~. L leHIGH LIQUID ~ L 8:HiOH LIQUID ~ [ L 9:HIGH C]~U]D ~ 3 2' 8 0 L 9~D]~. 5-6 ' LID;HIGH ~IQUID-~. L'2:LIgU~D~NI~ ' 3 2: 9 2 2 L 3;LlaOlO ~NI~ ~ 3 2 lO 0 9 L10:D]~. ?-e " L 5:LiOU{D ~NI~ '3 2 l0 I R 3 ',;' .'.~. : · ~ ,;.. .~ , · :. ~,'~ . '. ' .~'.' .' .. Ta~ology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 W.ork Order: 313 4 7 7 8 ..... ~Y~T~ ~ .... L 2:RUL ~NN~ PaPE~ O~ T 2:RUL .... IN-TR~ ~ ..... ~ aNNO~R ~E APR 18, 2004 ?:23 ~ ~R' 19, 2004 7:59 ~ ~ 17, 2OO~ 2:00~ L~ PROD~ ~ L~ P~D~ ~ ~ 20~ 2002 i:t2.~ ~ 6, 200~ 9:!6 ~ ~ ~ ~ ~ ~,.~ END ~:~ K K ~ 9[ 2003 ?:99 ~ ORN'29, 20aa 2:56':~ JAN: 22. 2D04 t0:50 ~ Ta~ology-~E 8900 Shoal Creek, Building 200 Aust~, Texas 78757 Work Order: 313 4 7 715 ..... ~ 8E~O~ O~ ~ , H~OH LIQUID ~ [5, 2003 2:26 ~ ~ ~ 13, 2003 HiGH LIGO1D ~RNING * HIGH LIGUID LIQuiD. ~N[NO FUEL ~ F~ 20, 2002 12;22 ~ ~ 13. 2003 '2;03 PH .... PJ~DJ. JCT F I:RUL PROD JUN 1, 2002 '~:01~. ~ 1, ,2002; 2:DO~ ~ HI~ORY R~RT /~ Hi~To~ REpOrT ~ H[BTO~, RE~~r ..... ~;:~a~ ..... 6:H~ ~NN~ L 9:OlSP.::5~6 DI~ ~ AHN~ BPOE ' .DIVE,ER ~N. HIOHL[QUID ~ ~R'O~..~' HIGN:~LI~ID A~ '~T 1:9', :2OO~ ~2:.3~ ~ 15,-2003 2:26 ~ ~ l?. 2003 12:01 ~ ........ .. F~~ . . , ~. t.a;:2003 2:20 ~ "~ n ~ ~E~ ~ a ~:~ ~:~ 17, 2003 2:~.~ ~' l?;.. 2003 12:DD ~ .... · , · ~.A~ ~LIQUID ~NI~ ' ~ ?, 20.03 I :,46 ~ P,L~RH HII~TORY PJ~OET ~ Hi~TOE~ R~.PORT ~ NiBTO~ R~O~ ~ t3, 2003' 2:09 ~ ~T 13. 2003 l:3O ~ .. HI~CH LIQUID ~ HIGH LIGUID ~RM. i Ta~o]ogy-NDE 8900 Shoal Creek, Bui]d~g 200 Aust~, Texas 78757 ,Work Order: 3134778 .... . .(.. .... :]2.. ~ ..... ~ . -- ......... ;: . *"- .... 8~ DiBPE~ ~N : ~: ' HIGH LIGUID : ~ HI~ORY: ~? ....... ~. . ~R 26. 2~04 815~ ~ ' F ~:RUL STP 8~ HIGH LIOUID ~-.' ~; ! ~'~ ' ~N N N ~ ~E~ a ~ N ~ ~ ~R ~, 2004' 8:48 ,-~'- ~ 26, ~l 8:49 ~ ..,:~ I /';?' ":~ '.,..~. . L :, . .., .:.... I~.. :. ~: ' ..';': ..ti.':;," . ,~... ~::::. ~:,..:,~;, ~~, .~:, ~ ~.: Ii[ ' *:'" ~ :'"' "":':' {';: "/ ...~ · . .' :' ~ ;.;'; e- '1 ~:t~~N::~ . HIGH LIGU'ID ~ ' ~' :'-:'. ~'~:;~ .... t ~;.~-~~ , ~e'~s. e~4 ~4~ ,'~, ~, ~ .'.. ~ t' ':' ;; '1 ~ AI~'.~- ' ~ .:?. I!~: :' ' , :' ~ .~' : .' ~, ":.:~C'~ ,."~ ,~?~'. '-: - '~ .';T..~?. i - · ....... ~'~ r;.. "' .' -~. .'. :. Y'~ .2'~.~ ~,.~.~q~ :~ :-. ~ :~:'~ Ta~ologg-NDE 8900 Shoal Creek, Bulldog 200 Aust~, Texas 78757 84/22/2884 14:02 661392062! PAGE 0Z/01 *C0~¥ REQUeSteD PLEASE FAX(661)392-0~21 CITY, OF BAKERSF~LD OFFICE OF ENVIRONMF..~NTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326'3979 FAX C661) APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION OWNERS NAME NAM~ OF MONrroa MANUTACr~ DOES PA .C]I/I~ HAVR DISPF~. SP.,R PA.NS? TANK #. VOLUM~ CON~ UNDERGROUND STORAGE TANK Bakersfield Fire Dept. Environmental Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST ¡SECONDARY CONTAINMENT TESTING PERMIT NO. I ~T - Olb9 I TANK TIGHTNESS TEST (ELl:» D LINE TESTING D SECONDARY CONTAINMENT TESTING FACILITY 7 - E/e.vQy-¡ (Our ~cb :tt:- 377L/S EL): DDRESS ß 9~oo ßrimha/I Rei. a.ke.rsf;aJd CA 933? ~ OPERATORS NAME ..JJ- ERMIT TO OPERATE NO. . . .--j--. --7=-E/~VÔ1 - Sforti.. ~ 3?.3V~- - .s:"'329:L-/~-X ~-~ WNERSNAME 7 - ¡;1r¿vQy¡-- ----. - NUMBER OF TANKS TO BE TESTED 2- IS PIPING GOING TO BE TESTED )<YES o NO TANK NO. CONTENTS VOLUME I R u la.r LJf)I~ .l 01 00(:) Q) :;L P r~m" ().!'11 ()n{~ /01000 0..1 ANK TESTING COMPANY Pro..xair Saru¡'c.e.J1 Tnc-. MAILING ADDRESS 375S N. ßu<s¡n~..s.s Ca.nffl/ Or. 7üC:SOI7 Az- ?S70S- )..9YY NAME & PHONE NUMBER OF CONTACT PERSON J Mi·c.ho:.~i-Kra:wtma ·(S2.D}-SYS';.. O;l3~' - ðR.-- u.{¡'fL,-GLLi1+hu-·fS-z.C)5lf5-02.<O . ~-.< ESTMETHOD EnhOJ1c..o..d Le.o.l: DlLfur/ðl? NAME OF TESTER OR SPECIAL INSPECTOR Do..riY OffL DATE & TIME TEST IS TO BE CONDUCTED /{-//- 0 Y &:OOAM IGNATURE OF APPLlCA CERTIFICATION NO. 03 - / ~ ~ PPROVED BY DATE /(-;¿-CJ'/ DATE FItX{ f,fr;I) ~Sd- - ;J.../? / fd2063 11-9'-OY: liS pr OUr- phont¿ d;JCu....rs/i)Y¡ Gi7 N(),/ 3n:(} -fhfL ðr/jl>tc..j) or -rhiV' 'Y,PIICa.f¡(y¡ w,!( b.€.. 3(../"11 ~'j r/iA.11 /ncltld')L) Q.... c.hwk {Dr +~ fJJlrr',,/-f f'~LS. Th(L.. eJ.ædc shtJUtd a,r/VL. //J my e1f-{¡CfL Noy ¡()ft,. II? -I-ha- rJ?a..a.nfin1L / WfL u:anfl.d you.. To K;¡ow a...boCA-+ -/-J.,¡S Ú)?CðWlI'':j -t-e..J-I fl.,ven-r. r