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HomeMy WebLinkAboutUNDERGROUND TANK-C-09/01/871700 Flower Street KERN COUNTY HEALTH DEPARTMENT .EALTH OmCER Bakersfield, California 93305 ' ' Leon M Hebertson, M.D. Telephone (805) 861-3636 .. ENVIRONMENTAL HEALT~ DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH : Vernon S. Reichard September 1, 1987 James M. Fogle 215 Daniels Bakersfield, California 93307 Dear Mr. Fog]e: This department has reviewed the laboratory analyses for the gasoline underground storage tank at 224 Brundage Lane, Permit #A476-20. The samples indicated no significant soil contamination at the site. Based upon this information, the department considers this preliminary site assessment complete an'd no further assessment ,is required. Since,'e]y, Bill Scheide EnvJronmenta] Health Specialist Hazardous Materials Management Program BS:aa · ,- FILE CONTENTS SUMMARY. PERMIT ~: .~dO~/~ ENV, SENSITIVITY: Activity Date · Of Tanks Comments P.O~ Box 6565 (805) 322-4566 Bakersfield, California 93386 24 Hour Service July 31,1987 Kern ~County Health Department 1700 Flower Street ~ake~sfield, California 93305 ~3UL~'~© 1687 Attention :Mr. Bill Scheide KERN ~¥~i~ ~LIH DEPI. Re: Underground Tank Abandonment Permit No.A476-20, Final Report · '~ .... BACKGROUND INFORMATION The firm of Dwight Environmental was retained as the decontamination and, preliminary assessment contractor by D & J Construction to-certify the abandonment of an underground storage tank that lies at 224 Brundage Lane in Bakersfield,California (see attached vicinity map). The Kern County Health Department issued Permit No.A476-20 on July 20,1987 following review and approval of application for abandonment. ABANDONMENT PROCEDURES Prior to the excavation of the tank. the Kern County Health Department was notified that the subject tank Was to be removed on July 24,1987 and that the size of the tank was 3000 gallons instead of 550 gallons which had been ~reported on the application. A permit for tank removal was also obtained from the Bakersfield Fire Department. Excavation of the site soils for the PurPose of ,~emoving the subject tank began at approximately' 7:00 am. The tank had been out of service for' some time and had been pumped down as far as possible. The top 1/3 of the tank was exposed so that'the tank could be decontaminated. SITE LOCATION VICINITY MAP Residual Sludge was first removed by a vacuum truck. High pressure 'cold water was then employed ~to decontaminate the interior sur.fac~s ~of the.'tank. The decontamination process took approximately one hour'. A LEL meter was used to .Verify that the tank was free of contamination. A level of 5% LEL had been achieVed and the interior of'the tank was visually insPected and found to be clean. 60lbs of dry ice was introduced into the tank for the purpose of..~Urging any~remaining flammable vapors to the satiSfaction of the Bakersfield Fire Department Representative..The tank was then removed' from the excavation for later transport to AMR metals in Ontario, California. The vacuum truck which contained the residual sludge and the rinsate water from the decontamination of the tank was manifested for transportation to Gibson Oil and Refining in Bakersfield, California for disposal. FIELD OBSERVATIONS SAMPLING PROCEDURES Field obserVations and sampling procedures for the subject investigation consisted of the following: Visual and Olfactory observation of site soils, tank and tank bedding condition, and soil sampling utilizing stainless steel drive tubes. Casual inspection of the tank upon removal revealed some corrosion but no obvious failure points. Tank 'bedding was ~free of staining and no hydrocarbon odors were detected. Soil samples beneath .the tank were found to be a homogeneous blend of sandy silt free of rock or pebbles. Soil samples .for laboratory analysis were obtained at 2' and~'6' below the tank bottom'at two locations utilizing procedures approved by the Kern County Health Department. A backhoe was employed to excavate to the desired test depth. Representative samples were carefully t'aken from the material in the backhoe bucket at the appropriate depths by driving the stainless steel tube into the soils. ~After collection each end of the tube was covered with aluminum foil and then covered with a polyethylene lid, taped, and labeled~ Identification numbers were marked on tubes and the tubes were placed into an ice chest which ~000 GA L. -r ~N 14 .._ 6' Foo'r O~, ~' I~'FooT LCN'TH SAMPLE " FOG l E 'E O'L~ ~ P'IVl E N T contained blue ice 'for transportation to the laboratory. Chain= Of-custody. and sample'analysis request forms were completed and the ~samples were delivered the same day to SMC laboratories for the required BTX and TVH analysis. ANALYSIS Attached you will find the laboratory analYsis report Sheet from SMC Laboratories. The accompanying chain'of-custody forms have not been included but are on file at the Dwight EnvirOnmental office, and are available for review Review of the lab analysis in conjunction With field observations suggest that contaminant levels reported for samples A476-S-2, ~A476-S-6, A476-N-2 and A476-N~6 are all ~bel0w the method detection limit for BTX and TVH and no' contamination of soils exists. Please feel free to contact this office is there are any questions regarding the information herein submitted. Sincerely, Dwight Environmental JaCk D. Kash . En~ironmen~al~S ecialist JDK/ts enclosures cc; D & J Construction James M. Fogel · SMC Labo,r~atory ~ .. Analytical Chemistry 3155 Pegasus Drive P.O. Bo,,: 808.35 Bakersfield, CA 93380 ('805) 393-3597 ~Client Name: Dwight Environmental Address : P.O. BO,': 6565~, City 93308 Date sample received : ~-24-87 Da'~e analysis completed:. 7-28-87 Date of report ' : 7-28-87 Laboratory No.' : 704 throughly707 ... Teluene ' ";' <1.0 1.0 Ethyl benzene < 1.0 1.0 " ... p-Xyl ene < 1.0 1.0 ' m-Xylene ' <1.0 1. o-Xylene <1.0 1.0 ' Isopropylbenzene < 1 ~ 0 I. 0 T V H < 10 10 ~705 ID: A476-S-6 ' ugm/gm MRL, ugm/gm 'Benzene < i. 0 1.0 Toluene < 1 .. 0 1.0 Ethyl benzene < 1.0 1.0 ~-Xyle~e < 1.0 1.0 m-Xylene < 1. () 1.0 o-Xyl ene < 1.0 1.0 - I sop rop y I ben zen e < 1. () 1.0 TVH < 10 10 ~706- ID: A476-N-...2' Benzene < !. 0 I. 0 Toluene < 1.0 I. 0 ' Ethylbenzene < 1.0 1.0 p-Xyl ene < 1.0 I. 0 m-Xyl ene < 1.0 1.0 o- x y i e n e < 1.0 1. () I~opropylbenzene < 1.0 _ !. 0 T V H :: 10 10 Method of Analysis: EPA ="~-u0~0/8()20 MRL = Mini mum Reporting Level TVH = Total Volat:i. le Hydrocarbons ugmYgm = microgram per gram Stan Comer SMC Laboratory AnalyticaI Chemistry 3155 Pegasus Drive ~P.O. Box 80835 Bakersfield~ CA 93380 8.~) 393-3597 Client Name: Dwight Environmental Address : P,O. Box 6565~ City 93~()8 Date ~ample received : 7-24-87 Date ~analysis completed: 7-28-87 · Date of report : 7-28-87 . Laboratory No' : 704 through 70'7 : --. .',~- RESULTS OF ANALYSIS ~707 ID: A476-N-6 ' ugm/gm MRL,ugm/gm Benzene < 1.0 I. 0 ~.~ Toluene < 1.0 1.0 Ethylbenzene < 1.0 1.0 p-Xylene < 1.0 1.0 m-Xy!ene ~' 1.0 o-Xylene < I. 0 1.0 Isopropylbenzene < I. 0 1.0 TVH ~' 10 10 Method of Analysis: EPA 5020/8020 MRL = Minimum Reporting Level TVH = Total Volatile Hydrocarbons ugm/gm = microgram per gram Stan Comer 1700 Flower ! COUNTY HEALTH DEPARTMEI ,~.TH Omc.., ~;' ": ~" '" Bakerefleld, California 93305 I..e~n M Hebertson, M.D. Telephone (805) 861-3636 ENVIRONMENTAL HEALTH DIVISION · DIRECTOR OF ENVIRONMENTAL HEALTH ' .-~"' Vernon S. Reichard PERMIT FOR P~ CLOSURE PEPJ4IT NUMBER A476-20 · OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY '"' FACILITY'~ flAME/ADDRESS: OWNER (S) NA~/ADDRESS: .. CONTRACTOR: · ...Eogle .'Equipment .. James lVl. Fogle D & J Construction "~;~i 224 Brundage Lane ,. 215 Daniels P · 0 Box: 5202="'i-~,?i'i.J:~. ,/~J."Baket'sf~.eld,. CA .... Bakersfield, CA 93307 .... Bakersfield,. :.CA~"93309 i..' LOCAT] ON; APPROVED BY ,' ' ~' . CONDITIONS AS FOLLOWS:. '1 . Permlttee must obtain a City Fire Department permit Urior to initiating .... cl o. su,ra action. -~"2:.' :,.:..;.?Tank,."~'lo'sure iactt'.v~tles must be per Kern County Hea.lth DePartment. approved '.met.hods/as, described 'in Handout #UT-30. .3. The. ',',"tank. :.ilremoval' contractor must have a qualified employee on-site ..: "suPervi.~"i~i(~the entire tank removal process. '.- · :i"~4j.. A. ~mi.ntmum~ of t.o samples, must be retrieved, beneath the cente'r'~Of the ~..: .':gaSoline..,tank at depths of approximately t~o and six feet'. .~ .' . · ~5~. ..All,.,:..(lea. ded) gasoline samples must . be analyzed for benzene, toluene, (.::~=.'~..xylene., and total petroleum hydrocarbOns · 6. Copies of' .transport.ation manifests must be submitted to the Health, '.'" .~i.'Depar:tment ~i'thin five days of ~as~e disposal. "'?:.:.':A1L,:a;ppltcable state la.s for hazardous ~aste disposal transportation 'or .. '!i-'tre'at~ment. must 'be. adhered to. 'The Kern' County Health Department. must' be · '. :? notified before moving and/or disposing Of any .contaminated·sotl. · 8.':" Permi'ttee is . responsible for making sure that "tank dispos'ttion traCk, lng record" tssbed ~th this. perm'it is properly fil~led out and returned within ..9. .=If .a. ny.!: Contractors o'ther than those listed on permit and permtt apPI!.cution ' are, to.~'be. utilized ,prior.approval must be granted by the specialist"l.ts'.fied 10.' "Advi's'e:,~'thls office o.f the time and date DY the proposed sampling'.~2'th'. 24 · ' s-~'be, submitted ~'o this o~ice ~ithtn khree.' .days 'of 1-[' .':'Lab analYSis res.ults mu: .i. ,;'!: . . . '~ ~ . . . · . . . . . J k UNIFORM HAZARDOUS ,t='a us EPA iD'No. Ueatteat,¢~1 ' ~ .~.~sfield,~. 93308 I 1. US ~T Delcdplton (~cl~l~ Prop~ Shipping Nam. Hazard Ciasa, and ID Number) Quantity Unit :;:,': ~':~WEII.~O~'. ~el~se ~: 7203A 1~. GENERAT~'~ ~RTIFICATION: I here~y declare'that the contents of this conmonment are fully and accurately deacribed above by proper name and are clnanified, packed, marked, and labeled, and are in all respects in proper condition for transpo~ by hi0hway accordin0 to applicable international a~ national govern~nt reoulnlion~. If I ~m a Inrge.Guantity gener, lor, I ce~i~ lhnt I have · program in place to reduce the volume and toxicity of waste Generated to the deoree I have detained to be economically practicable and thai I have ~elected the practicable method of treatment, storage, or dispoaal cu~ently available to me which minimizea the pre~ent and future threat to human health and the environment; OR, If I am a small quantity 0eneralor. I have made a good faith elfo~ to minimize my wanle oeneralton and ~elect the best waste management method that is availnble lo me and that I can afford. ~ 18. Transpolar 2 Acknowledge~nt of Receipt of Materials ~ PrintedlTy~ed Name J Signature Month Day Yea~ I~. Diacrepan~ Ind~alt~ Space F L ~v. 9~) PreyS, ~ttl~. ere ~,~1,.. To: P.O. Box 3~0, Sacramento, CA 95812 BAKERSFIELD FIRE DEPARTMENT , ~te PERMIT In conformity with provisions of pertinent ordinances, codes and/o~ regulations, permission is hereby granted to: ~/ ' No'ne of Com~::m, Address to display, store, install, use, operate, Sell or handle materials or process involving or creating con- ditions deeme~, hazardous to life or property as follows: subject to the provisions and/or limitations as provided on the :reverse hereof. Violation of pertin- ent ordinances, codes and/or regulations shall void this permit. Fire M~rshal 1700 FIower Street N COUNTY HEALTH DEPARTM HEALTH OFFICER Bakersfield, California 93305 .,._ ,. Leon M Hebertson, M.D. '.. ' Telephone (805) 861-3636 ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH ' Vernon S. Relchard .: Foqel Equipment A476-20 Address 224 Brundage Lane . . Bakersfield, Ca.. ." ' * * UNDERGROUND TANK DISPOSITION TRACKING RECORD * * · - '~'.~This form is to be returned to' the Kern County Health DePartment within 14 · .~,'days of acceptance of tank(s) by' disposal, or recycling facility. :The · -.,-., , "holder of the permit with number noted above is responsible for insuring that this form is completed· and returned. · .... .- · "', "' Section '1 , .To be out by tank removal contractor: :'~ ......... ~ .~"~'?~'::"~;~---',"~-~¥~- ..... '" · Tard~ Removal Contractor: D,& J Construction ' ' Address 'P.O. BOX 5202 Phone # 805-327-1871 Bakersfield,California Zip 93309 . Date Tanks Removed. 'No. of Tanks ~ect~on 2 - To be filled out by contractor "decontamtnatin~ tank(s): Tank "Decontamination" Contractor Dwight Environmental Address P.O. BOX 6565 Phone # 805-322-4556 Bakersfield,California Zip 93386 Authorized representative of contractor certifies by si~nJng belOw that tank(s) have been decontaminated in accordance with Ke~n County Eealth Department requirements. Signature Title Section 3 -To be filled out and siKned by a__qn authorized representative o__f the treatment., storaEe, or disposal facility acceDtln~ tank(s): Facility Name American Metal Rec¥clin~ Address 2202 South Milliken Phone #714-947-2888 Ontario, California' Zip 91761 . Date Tanks Received No. of Tanks Signature ~ ~ ,,r~-~ Title .~.~,~/-~- (Authorized Representative) · * * MAILING INSTRUCTIONS: Fold in half and staple. Postage a~d m~iling label have alread'~ be~' affixed to outside for yOur convenience. (Form #H~/P-150) DISTRICT OFFICES Delano . Lamont . L~ke lamb,lis . M '~ve . RIdQecrest . ~hafter . Taft [? ::.. ~?ooeo~e, s~.. .~" .:..KERN COUNTY HEALTH DEPARTMLSNT ' . .. aE~Lm OF~CE, : "': Te~h~e (~5) ~1-3~6 -' ' ' EN~flONMEN~L-H~ DIVISION .. '. ' · ' :" :'.:~'-,-'. .' . .... . ' . : . :. . :... ' "' ' ': DIRE~R OFEN~RONMEN~H~L~ ' ?P~IT ~ A4 6-20 '"~ .:~.::S~T~CBS STOOGE FACILI~' ":' -: ~' ' . :!'.::~-:~. Lane -;?'::::::.:;..:~: a~:~:.::::?~ No'. ?': ..-::':':'~.:,::2::~f:".'~:'~. :?':'~:: ',-~ , /~:~ .:', "."::': ' ?:~-:,;~.,.' . ".- '.:? ..: ':'.-/,"~::-""i..,''~' :. '. ...... '.. : ........ ' .... POST 0N PREMISES. ': : : ;,... =..;..: ;..-~:;.'. '"::::'. .... . ..... v ..... ". CONDITIONS AS FOLLOWS: ..- ... .... '1 Permittee must obtain a City Fire Department permit :Prior' 't.o "'initiating closure ac~io~ '~-: '. ~':' . . _::?..~:-, .-.. 2 .Tank closure activities must be pen' Kern county Health Department approved 'methods as described.In Handout =UT-30. 3 The tank removal contractor must have a qualified employee ..on-site supervising the entire tank removal process. 4 A minimum of two samples must be retrieved beneath the center.'.'.=0f':::t:he. gasoline tank at depths of approximately two and six. feet., 5 All (leaded) gasoline samplei must be analyzed for benzene,. ::-.tOluene., xylene, and total petroleum hydrocarbons :. 6 :-Copies of transportation manifests must be submitted to :the Health Department within five days of waste disposal. . ' ' ' 7 Ail applicable State laws for hazardous .waste disposal, ..':. treatment must be adhered to. The Kern County Health Department. m.ust'::'be notified before moving and/or disposing of any contaminated, soll.'"';:'~-?~.::,:::::?~-::-?/~. ., .:. 8. Permittee ts respons'ible for making sure that tank dtsposttlon,.::'~:~J~:~ki'ng record" issued with this permit fs properly' filled out and 'r.'et'ur'~'~:~::~/~i.{~.i:n = -14 days of tank removal. ' . . ' .... ';:.--:~'~--' · :~?-.'9.: If an~. contractors other than .those.':l'lsted on.'Permit and: Pernit;:i~applI'c,:a'~ion :/'" :are to be utt:ltzed,:' prior approval': n'uSt'"be':grante8 · .-' · ' . .... ' · "-,: .'- , · :' ' ':'.. =.9'c, ':'?~::::,:::~,:,~.~:~;~-:~5~'~ ',- : .... i' - : , · : . ". "._ -' '?::: 7.'" ':.:. ~ .-...-~i---,-.~..~.,~- '-!.::lO-. :~ tdvlse'/this 'office :.:of the .time: and ..:d"at'e'~:.Of.' Lthe :: ..... hours advance notice-. ............ .... .: :,~,. .................. =.~..-.~.~ .... · ...... .~-~::,¥,...??:~ ?~1 ~. "Lab anal~s is. "resui~s-; m:u~ be 'submitted .'tO 'this:' 'bff:l:ceJ:;'wtthtn:'.::ith:~ee :~:~:ays ~:,of '- " '"' .... O~lano ~mont .. Lake l~bella' Moiav~ Ridqecrest . shaff~ ~f~ .... ~ ........ "-: ..... 17~ Flower Street I~ERN COUNTY HEALTH DEPARTML~I' . H~L~OFFICER Bakersfield, California 93305 Leon M Hebe~on, M.D. ~lephone (~5) 861-3636 .. ENVIRONMEN~L HEAL~ DIVISION DIRECTOR OF EN~RONMENTAL HEAL~ ~rnon ~ Reichard PER~IT FOR PER/4ANENT CLOSURE PERMIT NIB4BER A476-20 OF UNDERGROUND F~kZARDOUS SUBSTANCES STORAGE FACILITY · FACILITY NA~/ADDRESS: OWNER(S) N/Ib~IE/ADDRESS: CONTRACTOR: Fogle Equipment' James MJ Fogle D & J Construction . 224 Brundage Lane 215 Daniels P. 0.' Box 5202 'Bakersfield, CA Bakersfield,.CA 93307 Bakersfield, CA 93309 · .Phone # (805) 393-7720 Phone # (805.) 327~1871 License No. 474331 PERMIT FOR CLOSURE OF PERMIT EXPIRES October 20, 1987 I TANK AT ABOVE APPROVAL DATE July 2~ 1987 LOCATION.' APPROVED BY fill Sch~/d~ ..................... POST 'ON PREmiSES .................. ' . . CONDITIONS AS FOLLOWS: 1. Permittee must obtain a City Fire Department permit prior to ~n~tJatJng closure action. 2 Tank closure activities must 'be per Kern County Health Department approved 'methods as described in,Handout #UT-30. 3 The tank removal contractor must have a qualified employee on-site supervising the' entire tank removal process. · 4 A minimum of two samples must be retrieved beneath the center of the gasoline tank at depths of approximately two and Six feet. 5 All (leaded) gasoline samples must be analyzed for benzene,~ toluene, xylene, and total petroleum hydrocarbons. 6 Copies of transportation manifests must be submitted to 'the Health Department within five days of waste disposal. 7 All applicable state laws for hazardous waste disposal, transportation, or treatment must be adhered to. The Kern County Health Dep~rtment must.be notified before moving and/or disposing of any contaminated soil. .8. Permittee is responsible for making sure that "tank disposition tracking record" issued with this permit is properly filled out and returned within 14 days of tank removal. 9. If any contractors other than those listed on permit and permit application ~are to be utilized, prior approval must be granted by the specialist listed on permit. 10. Advise this office of the time and date of the proposed sampling with 24 hours advance notice. 11. Lab analysis results must be submitted to this office within three days .of analysis completion. ACCEPTED BY' DATE DISTRICT OFFICES . Delano . [amont . Lake Isabella Moiave Ridgecrest Shafter' . Taft P.O. Box 6565 (805) 322-4566 Bakersfield, California 93386 24 Hour Service July 16, 1987 . - Kern County Health Department Division of Environmental Health 1700 Flower Street Bakersfield, California 93305 Attention:Ms. Amy Green i.~. Subject:.Permit Numbers A477-15 and A476-20 We request.to amend the above listed permi'ts. The proposed changes are as follows: Dwight Environmental shall decontaminate the tanks. 2) The rinsate generated shall be transported by MP Vacuum Service to Gibson Refining for disposal. 3) The tanks shall be disposed of at A.M.R. in Ontario. 4) Dwight Environmental shall perform the preliminary site assessment. We hope the above information is sufficient. Both clients are quite anxious to complete these projects. Any efforts on your part to expedite the approvals would be most appreciated. Environmental Specialist Dwight Environmental JDK/ts enclosures 2) INTERNAL US~ ONLY.: KEt',~ CouNTY HEALTH DEPARTMENT PTO ~- PTA IT00 PLOWER STREET, BAKERSPIELD, cA. 93305 { oF T~KS TO BE A~DONED ~ (80'9)' 881-8836 LENOTll OF PIPING ~ A~NDON APPLICATION FOR PERMIT FOR PER~NENT ' ' ' '/ * ' CLOSURE/ABANDONMENT OF UNDERGROUND . ~ '?, ' ~ HAZARDOUS SUBST~CES STORAGE FACILITY THIS APPLICATION I8 FOR ~ REMOVAL. 0R ~ AEAND0~MENT IN PLACE (FILL 0~ 0N~ APPLICATION PER FACILITY) ~ROJECT CONTACT [PHONE ~ [SEC/T/R (RU~ LOCATIONS 0N~Y) ' FOGLE ~EQUIPMENT 224 .BRUNDAGE LN.' ~ ' UNION A~' OMNER {~DRESS {"H0"S (805 ) 39 ~ 7720 ~K R~OVAL CO~CTOR ]ADDRE~ ~PHONE D&J coNSTRUCTION· .O. BOX 5202 93309 ( 80~ 32~'~871 PROPOSED PROJECT STARTING DATE {CALIF0~IA LICENSE ~ {WORKER'S COMPENSATION ~ {INSURER A.S.A.P. {'428493 { 66WCI-110066 J PAUL ;YB~NDT INS. P~LXMXN~Y SITE.ASSESSMENT CONT~CTOR ADDRESS PHONE ~ B.C.I. 3021 ANTONIO ~' (805 ) 32¢18~ ~ORKER'9 COMPENSATION ~ INSURER PHONE , ( ) -- ON FILE ~BO~TORY T~T WILL ~ALYZE S~PLES ~DRESS PHONE CHEMICAL COMPOSITION OP MATERIALS STORED TANK it VOLUME CHEMICAL STORED (NON-coMMERcIAL NAME) DATES STORED CHEMiC'AL PREVIOUSLY STORE! 1 550 GAL. REG. GASOLINE UNK. TO 8/86 TO TO WATER TO PACILI~ PROVIDED BY JDEPTH TO GROUNDWATER CALIFORNIA WATER SERVICE I UNK. ~BAREST WATER WELL - GIVE OlsT~CEAND DE$CR£BE ~PE IP WITHIN 500 PEET SOIL ~PE AT PACILITY ~ B~IS POR SOIL TYPE AND GROUNDWATER DEPTH DETEEMINATION · TOTAL NUMBER OF SAMPLES TO BE ANALYZED ]SANPLES WILL-BE ANALYZED FOR: ~ 2 { BEZENE, TOLUENE, XYLENE TOTAL VOLATIVE HYDRO-CARBO~ { DESDRIBR HOW RESIDUE IN TANK~)ANO PIPINO IS TO BE REMOVED AND DISPOSED 0P (INCLUDE T~NSPORTATION AND DISPOSAL COMPANIES): SHIPPED TO CROSBY AND OV~RTON ' 0EgCRIBE BOTH THE DISPOSAL METIIOD *~D DIEP08AL LO~TION PORt T~RiS) CROSBY AND OVERTON · PIPINO 'm · PLEASE PROVIDE INPOR~TION REQUESTED O._N REVERSE SIDE OP THIS SHEET BEPORE SUBMI~ING APPLICATION POR REVIEW ~ $' THIS poRM'Ms 'BEEN COMPLETED UNDER PENAL~ 0P PENURY AND ~ THE BEST OP ~ KNOWLEDGE IS ~UE ~D CORRECT· .. (form {HMMP-140) " HY~'-i~-_ FACILITY USING SPACE'~-7"'9 BEI/DW. · · PROViD__E. DRAWING O__F P . · ALL'OF THE FOLLOWING INFO'ION MUST BE INCLUDED IN ORDER F~R APPLICATION TO BE PROCESSED:. , .- TANK(S)', PIPING & DIspENsER(S), INCLUDING LENGTHS AND DIMENSIONS PROPOSED SAMPr~ING LOCATIONS DESIGNATED BY THIS 'SYMBOL "~" ~ST S~ OR INTF_I~TION . ~ WATER r~m'z.q OR SUI~ACE WATERS wITHIN 100' RADIUS OF FACILITY · iNTERNAL USE ONLY: KERN COUNTY HEALTH DEPARTMENT PT0 -- PTA i700 FLOWER STREET, BAKERSFIELD.' 'CA 93305 ~ OF TANKS TO BE ABANDONED (805) 861-3636 LENGTH OF PIPING TO ABANDON CLOSUR~./ABANDONMENT OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FAC][ LT TY ~'~ REMOVAL. OR ABANDONMENT IN PLACE (FILL OUT ONE APPLICATION PER FACILITY) ..... :. · THIS APPLICATION IS FOR L~ PROJECT CONTACT · PHONE # {SEC/T/R (RURAL LOCATIONS ONLY) ', ~'§ JIM FOGLE DAYS- 323~835~{ ........ ~ NIGHTS- " ~ ~ FOGLE EQUIPMENT 224 BRUND'AGE LN. ' UNION AVE. . '-' IADDRESS - [PHONE(805 ) 393_ 7720 · UWNER %?'' Ji%MES M. ~FOGLE 215 DANIELS ANK REMOVAL CONTRACTOR {ADDRE~ . [PHONE - D&J CONSTRUCTION' .O. BOX 5202 93309 ( 80~ 327-1871 PROPOSED PROJECT STARTING DATE [CALIFORNIA LICENSE .# {WORKER'S COMPENSATION ~ [INSURER · ~o~ A S.A P ',". , , { 428493' '{ 66WCI-110066 ", { PAUL ;YBRANDT INS." ~ ~ ' ' ' PHONE ~~ PRELIMINARY SITE ASSESSMENT CONTRACTOR ~DDRESS · ~-o 302,1 ANTONIO ' (805) 324-185~ ~O ~ ~;ORKER'S COMPENSATION · INSURER PHONE ~ ON FILE ( ) - LABORATORY THAT WILL ANALYZE SAMPLES ADDRESS PHONE CHEMICAL COMPOSITION OF MATERIALS STORED TANK # VOLUME CHEMICAL STORED (NON-COMMERCIAL NAME) DATES STORED CHEMICAL PREVIOUSLY STOREi TO TO TO TO WATER TO FACILITYPROVIDED BY ]DEPTH TO GROUNDWATER ~ CALIFORNIA WATER SERVICE { UNK. ~ o , {SOIL ~PE AT FACILITY ~ ~ NRAREST WATER WELL - GIVE DISTAN~ AND DESCRIBE ~PE IF WITHIN 500 FEET ~ ~ IASIS FOR SOIL TYPE ~D ·GROUNDWATER DEPTH DETENMINATION ~ OTAL NUMBER OF S~PLES TO BE ANALYZED SAMPLES WILL BE ANALYZED FOR: 2 BEZENE, TOLUENE, XYLENE TOTAL VOLATIVE HYDRO-CARBC~ )ESCRIBE HOW RESIDUE IN TANK.)AND PIPING IST0 BE ~MOVED AND DISPOSED OF (INCLUDE TRANSPORTATION AND DISPOSAL COMPANIES): z SHIPPED TO CROSBY AND OVERTON )BSCRIBE BOTH THE DISPOSAL METHOD AND DISPOSAL LOCATION FOR: TANK(S) ~ ~ CROSBY AND OVERTON PIPING · ' PLEA·SE PROVIDE INFORMATION REQUESTED ON REVERSE, SIDE OP THIS SHEET BEFORE SUBMITTING APPLICATIO~ FOR REVIEW ' ~ THIS FORM HAS 'BEEN COMPLETED UNDER PENALTY OF PERJURY AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. (Form ~HMMP~140)~ PROVIDE DRAWING OF PHYs :YOUT OF FACILITY USING ..'-[DED BEIfY~. ~LL OF THE FOILOWING INFORMATION MUST BE INCLUDED IN ORDER FOR APPLICATION TO pROSESSED: TANKiS) , PIPING & DISPENSER(S) , INCLUDING .LENGTHS AND .DIMENSIONS __ PROPOSED SgaMPLING LCCATIONS DESIGNATED BY THIS SYMBOL "{~ ".' NF_AREST STREET OR I~ECTION'' '"' .... ' ""' ' gNY WATER WEt,Lq OR SURFACE hrATERS ~ITHIN 100' RADIUS O~ F~ClI,ITY · - -. . .... , ".'i~ .~· i: ':" · i"~.~ '~ "i' ~,,~.~:':~..~.~ ~'"'"'.~ _ -i ..... i' . '.i :~-~Y ' '-';,~ ,.i'~.~i '' .~:.i,.,,,,m~ ~0~'' ':'~.'Z ~ · ~/'~4"'. · .. ~ ... ~ . ,, .... l, '~7~' ~:,.~:..-.'.'.~::.;::ii:~ ........ :::7''''l'~': ...... :'~' ....... . . .. . . . ::\~,- . ........... : ....... """ .... . "iaC'-' "" - ..... .'~':?- · ":' .... '. ~. ~ '. IBRUNDAG. E "LANE