HomeMy WebLinkAboutBUSINESS PLAN Permit to Operate
Hazardous Materials/Hazardous Waste Unified Permit
CONDITIONS OF PERMIT ON REVERSE SIDE
lj .......... ¢??~7~?~?~,~ ..... This permit is issued for the following: ·
~:?.~, ~ ,-,.,?~..~ ............ :.. ~..,... ~.-H~ s Matenals Plan
.=~,,. ~ ,. w== ...... ,~,,:~,~. #~=~,,,, .=,,~,,, ~,,-.~:Und .~g ound Storage of H~rdous Mate~als
PERM~ ID~ 015~21000814 a~,' ~',~ ~??~'.~:~::;:Fx?.~,a;=~ ~sk Mana.ement Proaram
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LOCATION 1700
......
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~'-'.'-'-! ~ ,~:.-~~.~,":' ," ,' ,' ,' ,,' ,' "' .~:~ ~,~ a ":','-4
TAN H~RDOUSSUBSTANCE CAP~O~ ~AL (~'~,~~~ ~ T~K '~"";$~NK i PIPING PIPING PIPING PIPI
(~;-.:.:'~ ~.:,, '~LL? ~E~ERI~E ~O~15¢R '...'ONITOR TYPE TYPE METHOD ONI
~... "*~
'' 001 UNI FABED GASOLINE 10 0~O"~ GAE{'.. ' ~788~-'-~; :"RW';' S AT& /' '"1~'{' I SW S PRFRRIIRF
ALD
...... ,~ ~-i , ...' .~ ; _..~, ~, '-, ,,,,~ .........
~'~02 UNLEADED PLUS GASOLINE 10,00~;00,. GAL_:; ;;,.,. .... ~,1/80-'., ........ ;SW S ,,.d~'.ATG ~/.'"..'-: ~T SW S PRESSURE ALD
? C..~.1~8.Q.,-, SW ~;.~¢.L,,'";::?"ATG./[,.",,"~;~~ TTT SW S PRESSURE ALD
0003 SUPER UNLEADED GASOLIN 10,000:~
'~-.---
'~:. ": ..4':~~.~V ¢¢ ~'
. .%.........?. ,.,.-....-. ..... ,... ,....,... ,. .... ¢ ~ ~,'
I~ by:
O~CE OF E~R ON~L
1715 Chewer Ave., 3rd Floor
B~e~el~ CA 93301
vo~. (~o~),:~,9,9 December 22, 1998
F~ (805).32~576 Expiation Date:
7 ELEVEN FOOD STORE #2125-21 ! SiteID: 215-000-000814
MAR161998
Manager · - ' usPhone: (805) 322-8671
Locationl 1700 BRLTNDAGE LN [B~. ' ~ap : 102 CommHaz : Low
City : BAKERSFIELD /~ ' ~rid: 36D FacUnits: 1 AOV:
CommCode: BAKERSFIELD STATION 06 SIC Code: 5541
EPA Numb: DunnBrad: 00 - 734 - 7602
Emergency Contact / Title Emergency Contact / Title
SHASHI/VEENA KAMBOJ / FRANCHISEE DAVID LISUKI / FIELD CONSULTAN
Business Phone: (805) 322-8671x Business Phone: (209) 230-0711x
24-Hour Phone : (805) 322-8671x 24-Hour Phone : (209) 861-4653x
Pager Phone : ( )~37 -~St]Ox Pager Phone : ( ) - x
Hazmat Hazards: Fire ImmHlth DelHlth
Emergency Directives:
~ Hazmat Inventory One Unified List
-- MCP+DailyMax Order Ail Materials at Site
Hazmat Common Name... SpecHazlEPA HazardsI Frm DailyMax Unit MCP
UNLEADED GASOLINE F IH DH L 10000 GAL Mod
s~3NuLEADED PLUS GASOLINE F IH DH L 10000 GAL Mod
PER IINLEADED GASOLINE F IH DH L 10000 GAL Mod
-1- 03/16/1998
7 ELEVEN FOOD STORE #2125-21476 SiteID: 215-000-000814
~ Inventory Item 0001 Facility Unit: Fixed Containers on Site
~U~IU~ ~Vl~ / ~l ~/~ ~Vl~
UATLEADED GASOLINE Days On Site
365
Location within this Facility Unit Map: Grid:
UNDERGROUND FRONT PARKING CAS#
8006-61-9
Liquid Pure Ambient Ambient UNDER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum I Daily Average
10000.00 GALI 10000.00 GALI 7500.00 GAL
HAZARDOUS COMPONENTS
I
100.00 Gasoline N 8006619
HAZARD ASSESSMENTS
No No No/ Curies F IH DH / / / Mod
~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~
-- COMMON NAME / CHEMICAL NAME
UNLEADED PLUS GASOLINE Days On Site
365
Location within this Facility Unit Map: Grid:
UNDERGROUND FRONT PARKING CAS#
8006-61-9
Liquid /Pure Ambient Ambient UNDER GROUND T~NK
AMOUNTS AT THIS LOCATION
Largest Container Daily Maximum Daily Average
10000.00 GAL 10000.00 GAL 7500.00 GAL
HAZARDOUS COMPONENTS
%Wt. ~S CAS#
100.00 Gasoline N 8006619
HAZARD ASSESSMENTS I
TSecreto RS BioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP
No N No No/ Curies F IH DH / / / Mod
-2- 03/16/1998
7 ELEVEN FOOD STORE #2125-21476 \ SiteID: 215-000-000814 ~
= Inventory Item 0003 \ Facility Unit: Fixed Containers on Site
SUPER UNLEADED GASOLINE ~ Days On Site
365
Location within,this Facility Unit Map: Grid:
UNDERGROUND FRONT PARKING CAS#
8006-61-9
F STATE TYPE PRESSURE i TEMPERATURE i CONTAINER TYPE
Liquid Pure Ambient Ambient UNDER GROUND TANK
AMOUNTS AT THIS LOCATION
Largest Container I Daily Maximum I Daily Average
10000.00 GAL I 10000.00 GAL I 7500.00 GAL
HAZARDOUS COMPONENTS
I loRe
100.00 Gasoline N 8006619
HAZARD ASSESSMENTS
TSecretI oRSIBioHaz Radioactive/Amount EPA Hazards NFPA I USDOT# MCP
No N No No/ Curies F IH DH / / / Mod
-3- 0~/16/1998
~ 7 ELEVEN FOOD STORE #2125-21476 SiteID: 215-000-000814
Fast Format
= Notif./Evacuation/Medical Overall Site
--Agency Notification 01/07/1990
CALL 911
Employee Notif./Evacuation 01/07/1990
VERBAL & CALL 911 FOR RELEASE OF HAZ MAT NOTIFY BFD - HAZ MAT DIV AND
STATE O.E.S.
-- Public Notif./Evacuation 01/07/1990
VERBAL AND DIAL 911
Emergency Medical Plan 01/07/1990
POLICE/FIRE DEPARTMENT: 911
NEAREST E.R. TO LOCATION IS TO BE USED IN THE EVENT OF INJURY
-4- 03/16/1998
ELEVEN FOOD STORE #2125-21476 SiteID: 215-000-000814
Fast Format
Mitigation/Prevent/Abatemt Overall Site
-- Release Prevention 01/25/1996
STANDARD GASOLINE STATION AFETY FEATURES FOR GAS PUMPS/AUTO
SHUTOFF VALVE -- COMPRESSED GASSES PROPERLY STORED IN SMALL
SAFETY CONTAINERS & WITH PROPER FITTINGS
-- Release Containment 01/25/1996
STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTO SHUT OFFS.
VAPOR SHIELDS. SHEER OFF VALVE - COMPRESSED GASSES PROPERLY STORED IN SMALL
SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN ON FILE
AT EACH STORE.
DAILY INVENTORY RECONCILIATION TO INDICATE LEAKAGE ABOVEGROUND. FIRE
DEPARTMENT AND GROUNDWATER TECHNOLOGY (800) 288-4832 *12792 CONTACTED FOR
BELOW GROUND LEAKS HEALTH DEPARTMENT CALLED ALSO BOTH INSTANCES EQUIPMENT
WILL BE SHUT DOWN FOR REPAIRS.
-- Clean Up 01/25/1996
USE ABSORBENT MATERIALS, ABSORBENT PAD (KITTY LITTER).
Other Resource Activation
-5- 03/16/1998
·
~ 7 ELEVEN FOOD STORE #2125-21476 SiteID: 215-000-000814
Fast Format
F Site Emergency Factors Overall Site
lSpecial Hazards
--Utility Shut-Offs 01/07/1990
A) GAS - NONE
B) ELECTRICAL - BACK ROOM HALLWAY
C) WATER - STORE SIDE FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO
-- Fire Protec./Avail. Water 01/07/1990
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE
FIRE HYDRANT - SOUTHWEST CORNER OF PARKING LOT
Building Occupancy Level [
-6- 03/16/1998
7 ELEVEN FOOD STORE #2125-21476 .SiteID: 215-000-000814
Fast Format
~ Training Overall Site
-- Employee Training 01/25/1996
WE HAVE 7 EMPLOYEES AT THIS FACILITY.
WE DO HAVE MATERIAL SAFETY DATA SHEETS ON FILE.
BRIEF SUMMARY OF TRAINING'PROGRAM~ SEE HAZARDOUS MATERIALS HANDLING
PROCEDURES POSTING AND EMPLOYEE AWARENESS FORM.
-- Page 2
~ Held for Future Use
--Held for Future Use
-7- 03/16/1998
~[1/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-0(
Overall Site with 1 Fac. Unit '.' JAN 2~ 5 1996
General Information
Location: 1700 BRUNDAGE LN / Map:102 Haz:2 Type: 3
City : BAKERSFIELD Grid: 36D F/U: 1 AOV: 0.0
Contact Ng~e , ' '
Contact Name ~1~
SHASHI/VEENA KAMBOJ /
Business Phone: (8~05) 322-8671x Business Phone: (209~.~ml~0711x
24-Hour Phone : (~ ~-~7! x .~; 24-Hour Phone : (:~..0¢/) ~f~/-~
Pager Phone : ( ) - x Pager Phone : ( ) - x
. ~ ......... Administrativ. e Data
Mail Addrs: ~.~90 B .... ,~u~v.~N~/~,~ ~~ ~~D&B Number: 00-734-7602
City: ~ ~ ~~37/6~ State: CA Zip:-9-3-34~4-~7~
Comm Code: 215-006 BAKERSFIELD STATION 06 SIC Code: 5541
Owner: THE~SOUTHL,.A,~N*D*CORPORATIONmo~. ~, p~~ Phone: (209) 261-0711
Address: 29~_ ....... -~ .... t~A~ ~D~~ State: CA
Summary
I, , g/... _ Do hereby certify that I have
reviewed th~ attached'_ .,, ~Thazard°us materials manage-
for_~~ that it along with
merit
plan
any corrections constitute a complete and correct man-
agement plan for my facility.
11/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 2
Hazmat Inventory List in MCP'Order
02 - Fixed Containers on Site
Pln-Ref Name/Hazards Form Max Qt¥ MCP
02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
02-001 UNLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
11/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 3
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CAS #: 8006-61-9 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: FUEL
Daily Max GAL Daily Average GAL I Annual Amount GAL
10,000 I 7,500.00 233,721.00
Storage ,~Press T Temp Location
UNDER GROUND TANK IAmbient~AmbientlUNDERGROUND FRONT PARKING
-Conc Components MCP ---TGuide
100.0% IGasoline .~ ModerateI 27
02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CAS #: 8006-61-9 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: FUEL
Daily Max GAL Daily Average GAL I Annual Amount GAL
10,000 I 7,500.00 32,675.00
Storage Press T Temp
Location
UNDER GROUND TANK IAmbientlAmbientlUNDERGROUND
FRONT PARKING
-- Conc Components MCP ---/Guide
100.0% IGasoline IModeratel 27
02-001 UNLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CAS #: 8006-61-9 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: FUEL
-- Daily Max GAL Daily Average GAL I Annual Amount GAL
10,000 I 7,500.00 187,430.00
Storage .Press~T.~Temp Location
UNDER GROUND TANK AmbientlAmbientlUNDERGROUND FRONT PARKING
-- Conc Components MCP ---TGuide
100.0% IGasoline IModeratel 27
11/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 4
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911 '~
<2> Employee Notif./Evacuation
VERBAL & CALL 911 FOR RELEASE OF HAZ MAT NOTIFY BFD - HAZ MAT DIV AND
STATE O.E.S.
<3> Public Notif./Evacuation
VERBAL AND DIAL 911
<4> Emergency Medical Plan
POLICE/FIRE DEPARTMENT: 911
NEAREST E.R. TO LOCATION IS TO BE USED IN THE EVENT OF INJURY
11/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 5
00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
STANDARD GASOLINE STATION AFETY FEATURES FOR GAS PUMPS/AUTO
SHUTOFF VALVE -- COMPRESSED GASSES PROPERLY STORED IN SMALL
SAFETY CONTAINERS & WITH PROPER FITTINGS
<2> Release Containment
STANDARD GASOLINE STATION SAFETY FEATURES ~RGAs'PUMPS/AUTO SHUT OFFS.
VAPOR SHIELDS. SHEER OFF VALVE - COMPRESSED GASSES PROPERLY STORED IN SMALL
SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN ON FILE
AT EACH STORE.
DAILY INVENTORY RECONCILIATION TO INDICATE LEAKAGE ABOVEGROUND. FIRE
DEPARTMENT AND m~-T-~-' ::_~n~_-n ,, 2 ~ ~ ~ ~ ~ ~- ~ ? ~ CONTACTED FOR BELOW GROUND LEAKS
HEALTH DEPART~-~CALLED ALSO BOTH INSTANCES EQUIPMENT WILL BE SHUT DOWN FOR
REPAIRS.
<3> Clean Up ~ ~0'0~ .--~-~~ ~ / ~7~
<4> Other Resource Activation
11/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 6
00 - Overall Site
<F> Site Emergency Factors
<l>~Special Hazards
<2> Utility Shut-Offs
A) GAS - NONE
B) ELECTRICAL - BACK ROOM HALLWAY
C) WATER - STORE SIDE FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE
FIRE HYDRANT - SOUTHWEST CORNER OF PARKING LOT
<4> Building Occupancy Level
11/01/95 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 7
00 - Overall Site
<G>.~raining
<1> Employee Training
WE HAVE 7 EMPLOYEES AT THIS FACILITY>
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
SEE HAZARDOUS MATERIALS HANDLING PROCEDURES POSTING~AND EMPLOYEE AWARENESS
FORM
<2> Page 2
<3> Held for Future Use
<4> Held for Future Use
06/25/93 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 1
Overall Site with 1 Fac. Unit
General Information
Location: 1700 BRUNDAGE LN Map: 102 Hazard: Low
Community: BAKERSFIELD STATION 06 Grid: 36D F/U: 1 AOV: 0.0
-- Contact Name Title Business Phone 24-Hour Phone
'TCDD & '~-RE~DA ~~~;'J~en~ ~3 1(805) 322-8671 x~ JONES (~4]~) ~34--2-7q-t--~. (() - 1)
Administrative Data
Mail Addrs: 1700 BRUNDAGE LN D&B Number: 00-734-7602
City: BAKERSFIELD State: CA Zip: 93304-
Comm Code: 215-006 BAKERSFIELD STATION 06 SIC Code: 5541
Owner: THE SOUTHLAND CORPORATION Phone: (~o~) ~! -oTff
Address:-3~"~. F'T~T T ~%T&?,,~--~.. ...~" SU--30 I--3~ ~ ~.~o~4~~State: CA
City: FRESNO ""---~ -- Zip: -8-3f~--Z= ~'~71/'
Summary
RECEIVED
JUL I 9.1993.
HAZ. I~,I~T. ~lV.
I, '~-~f~ ~"~D'~m,-~~''''' Do hereby certify that I have
"0.~/~o,~
reviewed the attached hazardous materials manage-
ment plan for ?-E/~,~,~. ~,.~/.,/7~ and that it along with
(Name of Business)
any corrections constitute a complete and correct man-
agement plan for my facility.
06/25/93 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 00 - Overall Site
<E> Mitigation/Prevent/Abatemt
<1> Release Prevention
STANDARD GASOLINE STATION AFETY FEATURES FOR GAS PUMPS/AUTO
SHUTOFF VALVE -- COMPRESSED GASSES PROPERLY STORED IN SMALL
SAFETY CONTAINERS & WITH PROPER FITTINGS
<2> Release Containment
<3> Clean Up
<4> Other Resource Activation
06/25/93 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page 6
00 - Overall Site
<F> Site Emergency Factors
<1> Special Hazards
<2> Utility Shut-Offs
A) GAS - NONE
B) ELECTRICAL - BACK ROOM HALLWAY
C) WATER - STORE SIDE FRONT
D) SPECIAL - NONE
E) LOCK BOX - NO
<3> Fire Protec./Avail. Water ~
PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE
FIRE HYDRANT - SOUTHWEST CORNER OF PARKING LOT
<4> Building Occupancy LeVel
06/25/93 7 ELEVEN FOOD STORE #2125~21476 215-000-000814 Page 7
00 - Overall Site
<G> Training
<1> Page 1
WE HAVE 7 EMPLOYEES AT THIS FACILITY>
DO YOU HAVE MATERIAL SAFETY DATA SHEETS ON FILE?
SEE HAZARDOUS MATERIALS HANDLING PROCEDURES POSTING AND EMPLOYEE AWARENESS
FORM
<2> Page 2 as needed
<3> Held for Future Use
<4> Held for Future Use
06/25/93 7 ELEVEN FOOD STORE #2125-21476 215-000-00081'4 Page 4
00 - Overall Site
<D> Notif./Evacuation/Medical
<1> Agency Notification
CALL 911
<2> Employee Notif./Evacuation
VERBAL & CALL 911 FOR RELEASE OF HAZ MAT NOTIFY BFD - HAZ MAT DIV AND
STATE O.E.S.
<3> Public Notif./Evacuation
VERBAL AND DIAL 911
<4> Emergency Medical Plan
POLICE/FIRE DEPARTMENT: 911
NEAREST E.R. TO LOCATION IS TO BE USED IN THE EVENT OF INJURY
06/25/93 7 ELEVEN FOOD STORE #2125-21476 215-000-000814 Page '3
02 - Fixed Containers on Site
Hazmat Inventory Detail in MCP Order
02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CAS #: 8006-61-9 Trade Secret: No
Form: Liquid· Type: Pure Days: 365 Use: FUEL
Daily Max GALI Daily Average GAL ] Annual Amount GAL
10,000 ~ 7,500.00 233,721.00
Storage~lPress-T Temp Location
UNDER GROUND TANK IAmbient/ambientlUNDERGROUND FRONT PARKING
-- Conc Components MCP --TGuide
100.0% IGasoline IModeratel 27
02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CAS #: 8006-61-9 Trade Secret: No
Form: Liquid· Type: Pure Days: 365 Use: FUEL
Daily Max GALI Daily Average GAL I Annual Amount GAL
10,000 ~ 7,500.00 32,675.00
Storage Press T Temp~ Location
UNDER GROUND TANK Ambient~AmbientlUNDERGROUND FRONT PARKING
-- Conc Components MCP -~Guide
100.0% IGasoline IModeratel 27
02-001 UVLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CAS #:~8006-61-9 Trade Secret: No
Form: Liquid Type: Pure Days: 365 Use: FUEL
Daily Max GALI Daily Average GAL I Annual Amount GAL
10,000 ~ 7,500.00 187,430.00
StorageI~Press T Temp Location
UNDER GROUND TANK IAmbient~ambientlUNDERGROUND FRONT PARKING
-- Conc~ Components MCP ---/Guide
100.0% IGasoline ModerateI 27
06/25/93 7 ELEVEN FOOD STORE ~2125-21476 215-000-000814 Page 2
Hazmat Inventory List in MCP Order
02 - Fixed Containers on Site
'Pln-Ref Name/Hazards 'Form Max Qty MCP
02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
~02-001 UVLEADED GASOLINE Liquid 10000 Moderate
· Fire, Immed Hlth, Delay Hlth GAL
CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING
NDE ENVIRONMENTAL CORPORATION
20000 Mariner Avenue, Suite 500
Torrance, California 90503
(310) 542~2
Test Date~ 13 May 19 9 3 Work Order~: 9 6 0 9 0 2
Client: THE SOUTHLAND CORPORATION Site: 7-11 #960902
/
295 W. CROMWELL, #105 1700 BRUNDAOE LN. ~/
FRESNO , CA 93711 BAKERSFIELD , CA 93305
Attn: JEFF SIMONSON
The following tests were conducted a~ ~he site described above in accordance with all applicable portious of Federal, NFPA, and Local regulations.
TANK SYSTEM INFORMATION
Tank Tank Product Vapor Recovery
Tank Capacity Diameter Level Tank
No. Gallons Inches Product Inches Material Stage I Stage II
I 9,980 95 PREMIUM 52.00 STEEL COAX BALANCE
2 9,980 95 MIDORADE 56.50 STEEL COAX BALANCE
3 9,980 95 UNLEAD 58.00 STEEL COAX BALANCE
TEST~GRESULTS
VPLT Wetted Vent & Leak Leak
Volume Portion Ullage Vapor Product Detector Detector
Tank Change of Tank Test Lines Lines Present? Results
No. (gph) Pass/fail Pass/Fail. Pass/Fail Pass/Fail Yes/no Pass/Fail
I 0.013 PASS PASS PASS PASS YES PASS
2 -0.001 PASS PASS PASS PASS YES PASS
3 0.025 PASS PASS PASS PASS YES PASS
NDE 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.
NDE CUStomer Service Representative Testing conducted by
F. MILLER~ ~~, M. LEVESQUE
Reviewed by~ ~ Technician certification no.:
Benjamin/. Alicea 14 05
T~tDa~: 13 May 1993 WorkOrde~: 960902
TANK TESTING DATA
Tank 1 Tank 2 Tank 3 Tank 4 Tank 5 Tank 6
Product: PREMIUM~MIDGRADE/UNLEAD~
True Capacity-gal: 9,980 9,980 9,980
Manifolded tanks: NO NO NO
Manifolded Vents: NO NO NO
Tank Bottom
to top of fill-in: 135 125 122
Fill pipe length-in: '40 30 27
Tank diameter'in: 95 95 95
Tank Bottom
to top of grade-in: 142 134 131
Fill pipe diameter-in 4 4
Fluid Level-in: 52.00 56.50 58.00
Fluid Volume-gal: 5,591 6,187 6,383
Water in tank-in: 0 0 0
Specific Gravity: 0.748 0.746 0.743
Tank Construction: STEEL STEEL STEEL
OFT/UFT: UFT UFT UFT
No. thermistor: 5 5 5
Ground Water level-in
How determined: NO WELL NO WELL NO WELL
Test start time: 19:17 19:20 19:25 : : :
Test finish time:- 21:30 21:23 21:25 : : :
Total temperature
change (degrees F): 0.059 0.038 0.000
Total fluid level
change (inches): 0.001 0.001 0.000
Leak Rate (GPH): 0.013 -0.001 0.025
I] PASS PASS PASS
Pass/Fail:
NDE Environmental Corporation - 20000 Mariner Avenue Ste 500 - Torrance, CA. 90503 - 010) 542-4342 Page I
T~tDa~: 13 May 1993 WorkOrde~: 950902
ULLAGE TEST~G DATA
II Tank 1 Tank 2 Tank 3 Tank 4 Tank 5 Tank 6
Product: PREMIUM MIDGRADE UNLEAD
True Capacity-gal: 9,980. 9,980 9,980
Ullage volume-gal: 4,389 3,793 3,597
Fluid pressure
on tank bottom(psi): 1.41 1.52 1.56
Ullage test pressure: 2.59 2.48 2.44
Stabilization time: 20 20 20
Fill start time: 21:35 21:35 21:35 : : :
Time to i PSI: 2 2 2
Time to test pressure: 4 4
Start time - test 1: 22:00 22:00 22:00 : : :
Nitrogen flow (cfh): 0.20 0.20 0.20
Ullage temperature-F: 78.5 77.1 77.7
Finish time - test 1: 22:10 22:10 22:10 : : ~ :
Nitrogen flow (cfh): 0.20 0.20 0.20
Start time - test 2: 22:10 22:10 22:10 : : :
Nitrogen flow (cfh): 0.20 0.20 0.20
Ullage temperature: 78.6 77.2 77.8
Finish time - test 2: 22:20 22:20 22:20 : : :
Nitrogen flow (cfh): 0.20 0.20 0.20
Start time - test 3: 22:20 22:20 22:20 : : :
Nitrogen flow (cfh): 0.20 0.20 0.20
Ullage temperature-F: 78.6 77.3 77.9
Finish time - test 3: 22:30 22:30 22:30 : : :
Nitrogen Flow (cfh): 0.20 0.20 0.20
Pass/Fail: II PASS PASS PASS
'l ULLAGE TEST COMMENTS:
NO~: [ 2 ~ecu~ve ~t @ < 0.275 ~nstim~ n P~S ] [ 3 ~nsecu~ve ~ @ > 0.275 ~nztim~ a FAIL ]
NDE ~ronmen~ Corpo~on - 20000 Mariner Avenue S~ 5~ - Torran~, CA. ~503 - ~10) 542~342 P~e 2
T~tDa~: 13 May 1993 Wo~O~e~: 960902
LINE TEST DATA
I Tank 1 Tank 2 Tank 3 Tank 4' Tank 5 Tank 6
Product: PREMIUM MIDGRADE UNLEAD
Pump type: PRESSURE PRESSURE PRESSURE
Pump Make: REDJACKET REDJACKET REDJACKET
Isolator: ELEMENT ELEMENT ELEMENT
Line Material: STEEL STEEL STEEL
Line Length (ft): 15 15 15
Line Diameter (in): 2 2 2
Test pressure (psi) 50 50 50
Bleed Back (cc): 20 15 15
Test start time: 20:00 20:00 20:35 : : :
Time* (1): 20:10 20:10 20:45 : : :
Finish PSI: 49 49 49
Vol Change (cc): 10 5 10 ~
Time (2): 20:20 20:20 20:55 : : :
Finish PSI: 49 48 48
Vol Change (cc): 0 10 10
Time (3): 20:30 20:30 21:05 : : :
Finish PSI: 49 48 48
Vol Change (cc): 0 0 0
Volume change-GPH:[[0.005 0.008 0.011
NDE Environmental Corporation - 20000 Mariner Avenue S~ ~00 - Torrance, CA. 90503 - (310) ~42-4342 Page 3
T~t Da~: 13 May 19 9 3 Work O~er0: 9 6 0 9 0 2
LEAK DETECTOR DATA
Tank 1 Tank 2 Tank 3 Tank 4 Tank 5 Tank 6
Serial number: I 2 3
Product: PREMIUM MIDGRADE UNLEAD
Leak Detector
manufacturer: REDJACKET REDJACKET REDJACKET
Leak detector model: D.L.D. D.L.D. D.L.D.
Leak detector
serial number: iN/R N/R 411886337
Open time - sec: 5 5 5
Element holding-psi: 13 12 12
Resiliency - cc: 100 100 100
Leak calibration-cc: 252 252 252
Leak Rate - GPH: 4.00 4.00 4.00
Metering PSI: 10 10 10
Detected Leak (Y/N): YES YES YES
Pass/Fail: IPASS PASS PASS
FA~ED LEAK DETECTORS
I Tank 1 Tank 2 Tank 3 Tank 4 Tank 5 Tank 6
Leak Detector
manufacturer:
Leak detector model:
Leak detector
serial number:
Leak Rate~-
Pass/Fail:
i LEAK DETECTOR TEST COMMENTS:
NDE Environmental Corporation - 20000 Mariner Avenue Ste 500 - Torrance, CA. 90503 - (310) 542-4342 Page 4
TestDate: 13 May 1993 WorkOrder~: 960902
COMMENTS
SITE CONDITIONS, NECESSARY REPAIRS:
ADDITIONAL WORK PERFORMED:
PARTS/EQUIPMENT PROVIDED:
Was lock-out/tag-out procedure used?: YES
Was location fully operational upon leaving site?: YES
Was a visual inspection of all submersible pumps, leak detectors, dispensers,
etc. conducted while on-site?: YES
Was station manager or attendant present during final inspection?: YES
NDE Environmental Corporation - 20000 Mariner Avenue Ste 500 - Torrance, CA. 90503 - ('310) 542-4342 Page 5
,- Steven S. Jones
(uy~e or ~rinu name
Do hereby certify that I have reviewed the /gE'CEI~D
FEB I4 19~J9,
attached Hazardous .Materials business *ola~fA.~.MAT. DiV.
for 7-El,,e, veB FO,~ Store
{name of business)
and that it alon~ with the attached additions
er corrections constitute a com~!ete and correct
Business Plan for my facility.
. nhre _ : .... 2/918.~ ....
BUSINESS NAME ? ELEVEN FOOD STORE ~:ZlZS-Zi4?G i0 NUMBER Z15--0~;~}-00.~814
t. OCRTION 17~N~ BRUNDRGE LN HIGH HAZARD RATING Z
1. OVERVIEW
LAST'CHANGE 1Z/tZ/88 BY VAL
JURIS CODE ZlS-OOB JURiS BAKERSFIELD STATION
MAP PAGE 10Z GRID 36O FACILITY UNITS 1 HAZARD RATING Z
RESPONSE SUMMARY ZR SEC 4)
EMERGENCY COOROINATOR (PRE-OETERMINEO) SHALL NOTIFY ALL. AGENCIES ANO INTER-
COMPANY PERSONS IN THE EVENT OF INCIOENT. EMERGENCY COORDINATOR SHALL
IMPLEMENT At.L NECESSARY MEASURES IN REGARD TO EMPL. OYEE/ENVIRONMENTRL SAFETY
AS INSTRUCTED BY TRAINING RECEIVED.
EMERGENCY CONTACTS ZR SEC 2)
TOOO ~ FREDA RAWLES - 3ZZ-8GT1
RA~x~ - 834-Z711 - Steve Jones
UTILITY SHUTOFFS ZA SEC ~)
R) GAS - NONE 8)ELECTRICAL - 8ACK ROOM HALLWAY C) WATER - STORE SIDE/FRONT
D) SPECIAl. - NONE E) LOCK BOX - NO
Z. NOTIFICATION / PUBLIC EVACUATION
LAST CHRNOE / / BY
Verbal and dial 911.
< NO INFORMATION RECORDED FOR THIS SECTION >
PAGE 1 01/19189 1'6':~"
MATERIAL SAFETY DATA SYSTEMS, INC. (805) G48-GS~
BUSINESS NAME 7 ELEVEN FO00 STORE ~2125-Z14?G ID NUMBER Z15-(a~.-O$OB14
LOCATION 17~ BRUNDAGE LN HIGH HAZARD RATING
3. HAZ MAT TRAINING SUMMARY
L, RSTC'RRNGE' /' / BY
See Hazardous Materials Handling Procedures Posting and Employee Awareness
form (attached).
< NO INFORMATION RECORDED FOR THIS SECTION >
LOCAL EMERGENCY MEOIC~L ASSISTANCE
LAST CHANGE lZ/lZ/S8 BY VAL
SEC S) POLICE/FIRE DEPARTMENT: 911
NEAREST E.R. TO LOCATION IS TO BE USED IN THE EVENT OF INJURY
PAGE Z 01/19/8B 1G:4B
MATERIAL SAFETY DATA SYSTEMS, I'NC. (805> G48-6800
BUSINESS NAME ? ELEVEN FOOD STOR~ ~ZIZS-Z14'?G tO NUMBER Z15-000-000814
LOCATION 1"70~) BRUNOAGE LN HIGH HAZARD RATING Z
FACILITY UNIT 01
OVERALL HAZARDOUS MATERIALS INVENTORY
LAST CHANGE 1Z/tZ/88 BY VAL
ID TYPE NAME M~X AMT UNIT HAZARD
LOCATION CONTAINMENT USE
1 PURE UNLEADED GASOLINE 18000 GAL HIGH
H ST SIDE OF STORE UNDERGROUND'TANKS FUEL
ID PERCENT COMPONENTS HAZARD LIST
118Z.00 100.0 GASOLINE HIGH
Z PURE REGULAR GASOLINE 10000 GAL. HIGH
H ST S10E OF STORE UNDERGROUND TANKS FUEL
ID PERCENT COMPONENTS HAZARD LIST
t18Z.00 100.0 GASOLINE HIGH
3 PURE SUPER UNLEADED GASOLINE t0008 GAl_ HIGH
H ST SIDE OF STORE UNDERGROUND THNI<S FUEL
ID PERCENT COMPONENI'S HAZARD LIST
118Z~00 100.0 GASOLINE HIGH
B. FIRE PROTECTION / WATER SUPPLIES
· LAST 'CHANGE t'2'7-IZ/88'BY VAL
SEC 4) NO PRIVATE FIRE PROTECTION
3R SEC S) FIRE HYDRANT "- ? Located in southwest corner of parking lot.
Fire extinguishers located in store per fire code.
PAGE 3 01/19/89 16:49
MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648'-0800
BUSINESS NAME 7 ELEVEN FOOD STORE ~21ZS-Z14.T6 IO NUMBER Z15-0~-000814
LOCATION 17~ BRUNDRGE LN HIGH HAZARD RATING Z
O. EMPLOYEE NOTIFICATION / EVACURTION
[P1ST'CHANGE iZ/12/88 BY Vt-ll_
3R SEC Z) VERBAL. & CRI_L 911
FOR RELERSE OF HAZ MAT NOTIFY BFD - HAZ MAT AND STRI'E OES
Call Tom Carmichael, Development Manager at 1-800-541-1334 for removal of
cleanup materials.
MITIGATION / PREVENTION / ABATEMENT
LEST CHRNG£'1'Z/'lZ/88 BY VEL.
3A SEC 1) STANDARD GASOLINE STATION AFETY FEATURES FOR GAS PUMPS/AUTO
SHUTOFF VALVE-- .'C-~OH?RESSED G~SSES r'r~ur.~-,,~_, ~,~,~[D IN ~,-,n~. ......
See Hazardous Materials Handling Procedures Posting and Employee Awareness
form (attached).
PAGE 4 0t/t9/89 16:49
MATERIAL SAFETY OR'fA SYSTEMS, INC, (805> 848-6800
CITY of BAKERS cTELD
Loc~1o~: ~ Brundage Lane ~PPRESS: 4008 White Lane 5r~C,:~RO I~. C~gSS CO~54 11 55 41 29
C~TY. ZIP: Bakersfield 93304 CitY, Z~P: Bakersfield ~29 Ou~ AND
PHONE ~: 805/322-8671 ~ONg ~: ~5) 834~12 .....
~J ' ' ' ' I Underground/Front PK~
~ ........ t.l.$.~.' 8006619 ~ ~1 ~.~.~.~ ~ular Gasoline ~_19
r-~ ~t ~! ~C.~.s.r~ Unleaded Gasoline 8006619
~t T~ ~ % C.~.$. ~ er Unleaded
,,
Health of Prflsure H~lth ~t S~ ~ ~ C.A.S. ~P
~arke t Ma~O~ 805 / 66~
', Steven S. Jones, Market Man~x~K .................. , .......... I~-.-~--~--:~--}~ .............
Form Ai:~:~ovld OK48 No. ~350-0072
Facility Identil~lcatJort. :!':::~ . . -:: Owner/Opera(or Name : ' :'" ' ""
Tier Two ": 7-E~EVEN STORE NO: 21476 ~-- .~ ~e ~ut~d Co.ration ~ , 214, 522-4790
EMERGENCy s,,.,.~ BRUN~AG~ ~ H ST ~ .~.~.. 2828 N. H~kell-.~las, ~ 75204
AND BAKERSFIELD CA 93304/ '_ _'_ ........ . :.'
HAZARDOUS C 0 UN T Y: K E ~ ~ Emergency Contact ..
CHEMICAL ..... · .......... _
INVENTORY S ~ C: 5541 S~o~e H~age~ S T 0 R ~ ~ 0: 2147 6
~ NAME:
s~,~i/~c ~c~ ~ ~ ( ~ TITLE: STORE MANAGER
Information '
...... PHONE: (805) 3~2-8671
byChemical :r"::"~::.OFFiCmAE':'FOR .1~, J ..... .~ Linde C~t~iqht Z4-HOUR: (805) 3~2-~671
Important: Read all instructio~ before co~ ~letin~ form RepoSing Period Fr~ Ja~a~ I ~ ~ 31. 19
s~.,~ -. ~ ~ P~no lot ne~ n~
isl~.
~.,~ ~ F~. '- 3 1 4 P~ng lot ne~ D~ isl~
S~ Re~a~
Chem. Name __ o; ~e ,
Pr~ Unlead~ ~oline Re~,,.,,y ~ ~ 13~6 I~"1 ~
t~at apply: ~m M~ ~ ~ Gas .... ' ....
/
Chem. Name __ of Press~e
X ~lay~ (~) I m
that apply: ~o ~ ~ ~ Gas
Certification ' ' (Read and tign after ¢ompittin8 all ~ection~) ' Optional AtZachmanta (~eCk
Fc~m Al~'oved OMB No. 2050-0072
Tier Two .~ ~ ~ge 1 ~ ~ ~uthl~d Co--ration ~ , 214, 522-4790
E~ERGENCY S,,.,A~,... .., ~.,. 2828 N. H~kell - ~llas, Texas 75204
AND City State Zip · ... · v" .
CHEMICAL
INVENTORY N~ Title
Information
':::.?:USE 'l I 522-4790
.... ~ortant: Read all instructions ,,~] ........ ~leting form Reporting Period From January t to December 3t. 19 . ,,,
Sudde~ Rele&s~ :.
Chem. Name of Pressure ~ .
Delayed (c.~onicl '. '
that apply; Pu~a Mix ~ollcl Liquid Gas '
Sudcle~ Release
Chem. Name ot
Irnn'~Kliat e (acute)
Delayed (clvonlc }
that app!y: Pure Mix Solid Liquid Gas
Sudden Release
Chem. Name ol Pressu, e ~
Reactivity
-- ~iate (acute) i
~ Delayed (chronic)
that apply: Pure Mix Solid Uquid Gas
Certification (Read and ~i&n after ,ompicting all sections) Optional Attachments (Check one)
SEE FRONT PAGEl I'"a*'a"acn~aU"olsi"
HAZARDOUS MATERIALS HANDLING PROCEDURES
FUEL SPILLAGE EMERGENCIES
1) In case of large fuel spill, (50 square feet or larger or any-
thing that looks potentially hazardous) CALL THE FIRE DEPARTMENT. ..
2) In case of small fuel spill 50 square feet or smaller, determine
potential hazard. Use absorbent material. (kitty litter or sand),
absorbent pad, or for very small spills, let evaporate. UNDER
NO CIRCUMSTANCES HOSE OFF WITH WATER. THIS WOULD CAUSE UNDER-
GROUND CONTAMINATION AND WE COULD BE FACED WITH A VERY LARGE
CLEAN-UP BILL. Keep used clean-up material in a metal container
with metal lid.
3) For removal of clean-up material for #1 or #2, call Tom Carmichael
at 1-800-541-0334.
4) Know where the fire extinguisher is and how and when to use it.
If you have to use a fire extinguisher, ALWAYS CALL THE FIRE
DEPARTMENT FIRST. In our store the fire extinguishers are
located:
5) Know where and how to shut off power to Raso!ine equipment. Every
store is different; have someone show you. In our store the gaso-
line power shut-off is located:
CO2 TANK HANDLING
1) ~ CO2 tanks are to be stored with metal cap in place (except
when in use). Replace metal cap on tank after use (empty).
2) ~1! CO2 tanks are to be chained up tightly 3/4 way up at all times.
Signed: Witness:
Employee Franchisee/Store Manager
Complete and file in each employee file.
~ZARDOUS ~TERIALS HANDLING PROCEDURES
FUEL SPILLAGE EMERGENCIES
1) In case of large fuel spill, (50 square feet or larger or any-
thing that looks potentially hazardous) CALL THE FIRE DEPARTMENT.
2) In case of small fuel spill 50 square feet or smaller, determine
potential hazard. Use absorbent material (kitty litter or sand),
absorbent pad, or for very small spills, let evaporate. UNDER
NO CIRCL~ISTANCES HOSE OFF WITH WATER. THIS WOULD CAUSE UNDER-
GROUND CONTAMINATION AND WE COULD BE FACED WITH A VERY LARGE
CLEAN-UP BILL. Keep used clean-up material in a metal container
with metal lid.
3) For removal of clean-up material for ~1 or #2, call Tom Carmiehael
at 1-800-541-0334.
4) Know where the fire extinguisher is and how and when to use it.
If you have to use a fire extinguisher, ALWAYS CALL THE FIRE
DEPARTMENT F1RST. In our store the fire extinguishers are
located:
5) Know where and how to shut off power to gasoline equipment. Every
store is different; have someone show you. In our store the gaso-
line power shut-off £s located:
CO2 TANK HANDLING
1) All CO2 tanks are to be stored w£th metal cap in place (except
when in use). Replace metal cap on' tank after use (empty).
2) All CO2 tanks are to be chained up tightly 3/4 way up at all times.
PLEASE POST IN STORE
SAK~RSFIELD ciTY FIRE DEPART~.~ R ~ ~ ~ ~ V ~ 0
~ 2~30 "O" S~EET "
B~RSFIELD, CA 93301 J~[ ~3 1987
(805) 326-3979 ~O~ Ans'd ...... .....
OFFICIAL ~SE O~LY
USINESS N~E
~AZA~DOUS ~TE~ALS
BU~NE~ P~ AS A WHOL~
FOR~ ~A
INSTRUCTIONS:
1. To avoid further action, return this focm by
2. TYPE/PRINT ANSWERS IN ENGLISH.
3. Answer the questions below for the business as a whole.
4. Be as brief and conctse as posstble.
SECTION 1: BUSINESS IDENTIFICATION DATA
A. BUSINESS NA~E: 7-Eleven Food Store #2125-21476
B. LOCATION / STREET ADDRESS: 1700 Brundage Lane
CITY: ~kersfield ZIP: 93304 BUS.PHONE: (805) 322-8671
SECTION 2: EMERGENCY NOTIFICATIONS
In case of an emergency involving the release or threatened release of a
hazardous material, call 911 and 1-800-852-7550 or 1-916-427-4341. This will aoti~
~our loca! ~re departmen~ and the State 0ff~ce of Eser~enc¥ Services as requ~:ed h~
law.
EMPLOYEES TO NOTIFY IN CASE OF EMERGENCY:
NARE AND TITLE DURING BUS. HRS. AFTER BUS. HRS.
A. Todd & Freda Rawles, Franchisees Ph~ (805) 322-8671 Ph~ same
B. Kathy MeJia. District Manager 2125 Phe (805~ 834,2711 Ph# same
SECTION 3: LOCATION OF UTIL~TYSilUT-OI~S FOR BUSINESS AS A~IOLE
A. NAT. GAS/PROPANE: None
B. ELECTRICAL: Back room hallway
¢. WATER: Store side/front
D. SPECIAL:
E. LOCK BOX: YES /(NO) IF YES~ LOCATION:
IF YES, DOES IT CONTAIN SITE PLANS? (/YE~ / NO MSDSS? (yES)./ NO
FLOOR PL~S? YES / NO KEYS? YES / NO
- 2A -
SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE
Emergency Coordinator(pre-determined) shall notify all agencies and inter-company
7~?~ i ~?i '~] · uersons in the event of incident. Emergency Coordinator shall implement all ~ ~}~ecessary measures in regard to employee/environmental safety as instructed
by trainings'received.
SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE
Police/Fire Department: 911
Nearest E.R. to location is to be used inuthe event of injury.,
SECTION 6: ,ENPLOYEE TRAINING
EMPLOYERS ARE REQUIRED TO HAVE A PROGRA~ WHICH PROVIDES E)~PLOYEES WITH INITIAL A~
REFRESHER TRAINING IN THE FOLLOWING AREAS.
CIRCLE YES OR NO INITIAL REFRESHER
A. ~ETHODS FOR SAFE HANDLING OF HAZARDOUS
.~ATER[ALS: ....................................... YES NO YES NO
B. PROCEDURES FOR COORDINATING ACTIVITIES
WITH RESPONSE AGENCIES: .......................... YES NO YES NO
C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO
D. E~ERGENCY EVACUATION PROCEDL~ES: ................. YES NO YES NO
E. DO .YOU ~AINTAIN E~PLOYEE TRAINING RECORDS: ....... YES NO YES NO
SECTION ?:
CIRCLE YES OR NO
DOES YOUR BUSINESS F~a~DLE HAZARDOUS ~ATERIAL IN QUANTITIES LESS TF~N $00 POL~DS OF A
SOLID,
I, Todd ~aWq'a~ , certify that the above information is accurate.
I understand that this information will be used to fulfill my firm's obligations under
the new ~allfornla Health and Safety code on Hazardous Materials {Div. ~0 Chapter 6.95
Sec. 25500 Et Al.) and that inaccurate information constitutes perjury.
SIGNATURE, ~ ,~~ TITLE Franchisee' DATE
- 2B -
BAKERSFIELD CITY FIRE DEPARTMENT
2130 "G" STREET
BAKERSFIELD, CA 93301
/· OFFiCiAL USE ONLY ID#---.---
BUSINESS N~%ME: . .
BUSI NESS PLAN
SINGLE FACILITY UNIT
FORM 3A
INSTRUCTIONS
1. To avoid further action, this form must be returned by:
2. TYPE/PRINT YOUR ANSWERS IN ENGLISH.
3. Answer the questions below for THE FACILITY UNIT LISTED BELOW
4. Be as BRIEF and CONCISE as possible.' ...... ~' ........................ .-' ....
FACILITY UNIT~ FACILITY UNIT N~ME:
SECTION 1: MITIGATION, PREVENTION~ ABATEMEN~F PROCEDURES
SECTION 2: NOTIFICATION .%\q] EVACUATION PROCEDURES AT THIS U/IT 05~LY
BAKERSFIELD CITY FIRE DEPARTMENT
I.D. ~ FORM 4A-1 Pa~e ! . o~ 1
NoN--TRADE SECRETS
HAZARDOUS MATERI ALS INVENTORY
BUSINESS NAME: 7-Eleven Food Store #2125-21476 OWNER NAME: The Southland Corporation FACILITY UNIT #': 100
ADDRESS: 1700 Brundage Ln. @ "H" Street ADORESS:1240 S. State College Bi. FACILITY UNIT NAME:
CITY, ZIP: Bakersfield~ CA 93304 CITY,ZIP: Anaheim~ CA 92806
PHONE ~:. (805)322-8671 PHONE #: (714)635-7711 [OFFICIAL USE CFIRS CODE
{ ONLY ,,
I 2 3 4 5 6 7 8 9 lO
TYPE MAX ANNUAl, CONT USE LOCATION IN THIS · BY HAZARD D.O.T
CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE OUIDE
M 0 10,000 est. "H"
· 187',4~0 GAL O1 19 St:.: .side of store 100 Gasoline/Unleaded \\~-~/' FLLQ 1203
M~.~ 10,000 233,721 GAL 01 1.9 "· 100 Gasoline/Regular FLLQ 1203
M ~ 10,000 32,675 GAL 01; 19 " 100 Gasoline/Super Unleaded FLLQ
1203
M ~ GAL 4 99 near Sales Counter 100 CO2/Carbon Dioxide ~ NFLG 1013
NAME: Jack Doolittle TITLE: Gasoline Manager SIGNATURE: ~ -~ c~ DATE: 6/8/87
EMERGENCY :CONTACT: Todd & Freda Rawles TITLE: Franchisees~ PHONE # BUS HOURS: (805)322-8671
AFTER BUS HRS: (805)322-8671
EMERGENCY CONTACT: Kathy Mejia TITLE: District Manager, 2125. PHONE # BUS HOURS: (805)83~82711
PRINCIPAL BUSINESS ACTIVITY: Convenience store with self-serve gasoline AFTER .BUS HRS: (805)834-2711
- 4A-1 -