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Home My WebLink AboutUST-REPORT 10/25/1994 RECORD OF TELEPHONE CONVERSATION Location: ~_~'50 P, ~rc.~..- ID# Business Name: ~o~ ~ ~'e,~'t L~Jr Business Phone: Insp~or's N~e: ~~ Time of C~I: Date: 10/zC/~4 Time: //: ~o ~ Min: / ~ Type of C~I: Incoming ~ Outgoing [ ] Returned [ ] Time Required to Complete Activity # Min: RECORD OF TELEPHONE CONVERSATION ~a -- Location: ~g-~ ff d__.D ~g- c~ CD Busin~ N~e: ~ ~. ~-~ Conta~ N~e: ~ ~~ ~ ~ Business Phone: ~ (q / 4~ - % Insp~or's N~e: ~~ ~me of C~I: Date: ~0/~4/~ Time: Type of C~I: Incoming ~ Outgoing Content of C~I: ~~ 5 ~ ~~ Time Required to Complete Activity # Min: CITY of BAKERSFIELD . "WE CARE" 2101 H STREET FIRE DEPARTMENT February 6, 19 92 BAKERSFIELD, 93301 S. D. JOHNSON FIRE CHIEF 326-3911 Don Keith Don'Keith TrUcking 2990 Pierce Road Bakersfield, CA 93308 CLOSURE OF 1 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANKS LOCATED AT 2990 PIERCE .ROAD, IN BAKERSFIELD, CALIFORNIA. PERMIT ~ BR0024 Dear Mr. Keith, · This.is to inform you that this department has reviewed the results for the preliminary assessment associated with the closure of the tanks located at the above stated address. ~ased upon laboratory data submitted, this office is satisfied with the assessment performed and requires' no further action at this time. This letter does not relieve you- of any liability for past, present, or future operations. In addition, any future changes in site use may require further assessment or mitigation. It is the property owners responsibility to notify this department of any changes in site usage. If you have any questions regarding this matter, please contact me at (805)-.326-3797. S~ce~e.t~, //Joe A. Dunwoody ..~ / Hazardous Material Specialist Underground Tank Program Bakersfield Fire Dept. PERMIT No. HAZARDOUS MATERIALS DIVISION UNDERGROUND STORAGE TANK'PROGRAM PERMIT APPLICATION FOR REMOVAL OF AN ·UNDERGROUND STORAGE ·'TANK SITE Shop ADDRESS 3,000 Pierce ~CODE' 93308 APN FACILITY NAME Don E, Kelth Truckl~os'SSTREET Select TANK OWNER/OPERATOR' Don K, Kezth PHONE No. MAILING ADDRESS 2990 Plerce Rd, CITY BakersfleldZIP CODE 93'308 CONTRACTOR INFORMATION COMPANY Don E, Kelth Trucking PHONE NoB05Z32~5031--;[ICENSENo. ADDRESS2990 Pierce Road CITYBakersfield ZlP CODE 93308 INSURANCE CARRIERGolden Eagle Insurance Co, WORKMENS COMP No, PWC110.957 PRELIMANARY ASSEMENT INFORMATION COMPANYZalco Laboratories Inc,PHONENoB05/$95-05~9 LICENSE No. ADDRESS4309 Armour Ay CITY BakersfleidZIPCODE 93308 INSURANCECARRIERIndustrial Indemhgty WORKMENS COMP No. CP861i391 TANK CLEANING INFORMATION COMPANY Don E. Keith Trucking PHONE No. 805/322-5031 ADDRESS 2990 Pleree Road CITY BakersfleldZIPCODE 93308 WASTE TRANSPORTER IDENTIFICATION NUMBERReflnerles Service/: ~t1500 NAME OF RINSTATE DISPOSAL FACILITY Refineries Service ADDRESS 13331 N Hw¥ 33 cITY Patterson ZlPCODE 95362 FACILITY INDENTIFICATION NUMBER CAD08~ 166?28 TANK TRANSPORTER INFORMATION .... ": COMPANYDon E. Keith Trucking PHONE No805/222-~021 'LICENSE No. ADDRESS 2990 Pleree Road CITYBakersfield ZIP CODE 93308 TANK DESTINATION Golden State Metal In'c.~ 2000 E. Brunda_~e l,n.: Bakersfield, CA TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES CHEMICAL STORED STORED PREVIOUSLY STORED '1 1~ .17000 Gal. Crankcase 0il 1977-1991 None THE APPLICANT HAS RECEIVED UNDERSTANDS, A NO WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY O1'HER STATE. LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT. ' /~PR-O~"E~) B;Y: ~ APPLICANI' NAME (PRINT) APPLICANT SIGNATURE · THIS APPLICATION BECOMES A PERMIT WHEN APPROVED lot' Plan must Show the following: .1. Roads and alleys 2. buildings : N 3. location of tanks, piping, and dispensers · ' :" 5. SCALE , ~lj? -\ 6. water wells (if on site) , ~1 ,, 7. · : any other relevent information ~ "~ RECEIVED E,v,,,/Ro,w,E,w',~, NOV 1 Z 1991 LABORATORIES, INC..Ans'd ............ J. J. EGLIN, REG. CHEM. ENGR. PETROLEUM__ 4100 ATLAS CT., BAKERSFIELD, CALIFORNIA 93308 PHONE (805) 327-4911 FAX (805) 327.1918 DON KEITH TRUCKING Date Reported: 11/01/91 Page 2990 PIERCE Date Received: 10/30/91' BAKERSFIELD, CA 93308 Laboratory No.: 11717-1 Attn.: DENNIS 322-5031 Sample Description: TAi~K REMOVAL: 2990 PIERCE ROAD WASTE OIL TAi~K ® 2', 10-29-91 10:00AM SAMPLE COLLECTED BY CHRIS NICHOLS CHEMICAL ANALYSIS Method Constituents Sample Results Units P.Q.L. Method Oil and Grease 120. mg/kg 20. EPA-413.1 REFERENCES: EPA = "Methods for Chemical Analysis of Water and Wastes", EPA-600, 14-79-020. ~NVIRONM~NTAL LABORATORIES. INC'. PETROLEUM J' J' EGLIN, REG. CHEM. ENGR. 4100 ATLAS CT., BAKERSFIELD, CALIFORNIA 93308 PHONE (805) 327-4911 FAX (805) 327-1918 DON KEITH TRUCKING Date Reported: 11/01/91 Page 1 2990 PIERCE Date Received: 10/30/91 BAKERSFIELD, CA 93308 Laboratory No.: 11717-2 Attn.: DENNIS 322-5031 Sample Description: TANK REMOVAL: 2990 PIERCE ROAD WASTE OIL TANK ® 6', 10-29-91 ® 10:00AM SAMPLE COLLECTED BY CHRIS NICHOLS CHEMICAL ANALYSIS 'Method Constituents Sample Results Units P.Q.L. Method Oil and Grease 40. mg/kg 40. EPA-413.1 REFERENCES: EPA = "Methods for Chemical Analysis of Water and Wastes", EPA-600, 14-79-020. Department Supervisor ,~ Analysis Requested Report .To: J~ -T-H-'~/~ Address: ~O ~.ir~ ~ Project~: ~ ~ State: ~, Zip: q~0 ~ Other: ~ o ~ ~ L x . La~ Sample Description ~ Date & Time Sampled ~ O ~ Relinquished by:'(Si~nat~) R~v~y~¢ig~re) ~ Date: Time: S~e ~ ~¢e Relinquished by:~ignature) '~c~iv~ ~y~(~ig~ur~ Date: 'Tim~: Address City State Relinquished by: (Signature) Receiv~ by: (Signature) Date: Time: A~ention: Relinquished by: (Signature) Receiv~ by: (Signature) Date: Time: ~ ~ ~ Relinquished by: (Signature) Receiv~ by: (Signature) Date: Time: ~ Miles: ~ ~ Sample Dis~sal P.O.¢ _ Relinquished by: (Signature) Receiv~ by: (Signature) Date: Time: ~ BC Dis~s~ ~ 5.~ ea. ~ Re~rn to client .~ · ... ,/:. .- : _ , --,: ? -... ' ' Depqrtment Of'Health SerVices '~ Toxic Substances (~ont~oI.Dlvlalon 8aeramento. California I~OFIM'"'--- ------HAZAFIDOUS: ..... ~ Js EPA ID Ne; 2..Page 1: !l~!ormatlon In the ihaded areas MANIFEST . la'not,required b~ Federal law; ~alll,g Address Tranapo,er 1 Compel 6. US EPA ID'Number Facility Name and 5lte Address - - 10. "U~ EPA ID Number OT bescrlptlon (In=ludlng P~oper 5~l~pln~ Name.'Hazard ~lass, and ID Number), Q~qtlty r:~.-:' Hand ~g InsteP,Orions and Addlllonallnformation . . ' ' ' I:hereb~ declare that'the content~ Of'this ;one~g.ment qre fu y qnd accurately des;cri~d above' b~ p~oPe~ .hlpolng name ; , ~ ~ ~p al~ respects' n proper condition for transPo~ bY h ghway acco~ding to'appljcab e nter~a~ ona and' la ge q.aMjty generator ;e~lfy'that I'have a progra~ q p ace to reduce.the volu~e and toxicity of waste ge~brated lo. the degree I have'determlq~: p '~ =tlg'able q~ ( tha~.l have ,ele~ted the prdcti~ab d mel~od'of treatment, storage, or d spo,a curr~nlly available to me which'minim Zes' the'.. t~ r; at to ~'umi r health ~hd the e~vironmen~ OR, If I a~ a sma 'quant ty generato~,'l have: made a good faith 'effod to m n mlze'~y wasi~ ' Name -~. ii* bNl:rg'~ "G.R~SS~GAI_S. NETGA[.. :*. *..' .... · COI~tMODlllY '' = ' * -- *~ g ..' -- . ~ ~;~ __~'= --~' -- __.. r ~ -::~:r. ' '. ':~-.d~ '~;~' ~'d,,.O~s:~. H,~~ 19~8-~-~--~-~' ..'..~":'-' --' ' . . ,u' '.". '-"- "- L:' /'- -; .. . '.[~..' .' . . . - ., '. ' * - -*';-" -* FINISh ',* .. · , ,,; . , .~ . - :. : . · . .; .. . .* ..*. .- ; .-' sTART: .." ~;7-"... ~:'".": '- "- : ':' .. -' "' "'. ' ~,'." " .. ~." ". . .'I3fllVER-rOAD NG ' ':- AD -'- " · ','~ - _ .. ,- . ~ .--~ ~ ~,,,,r-~.r.~,.,~. .-- -- - . . '.REMARKS:. , ?., ' ' :' -- " '' ' ' ' ' - .'.'~. :L...,· . _- . ' . '..: . . _ . _ . " ;';"':" : " ' :" ' ' ' '';' ~ ~ ' "' ' " ":' "-' " aOLDEN STATE' METALS, NC. NK DISPOSAL FORM P. O. BOx 70.158 · 2000 E. Brundage Lane Bakersfield, California 93387 ~_~ ,19 Phone (805) 327-3559 o' Fax (805) 327-5749 Scrap Metals, Processing & Recycling Contractor's - License No. DESTINATION:~ · G.S.M. · 2000 E. BRUNDAGE LANE · BAKERSFIELD, CA 93387. .. 550 .24 2000 '.97 OXYGEN CONTENT " ....................................................... 7s00 a.28 "g000 3.82 '.. ~2000 4.93 TOTAL . Ail fees ,nc,rr,d are Per Icad unless specified. Terms are ~ ~ ~~i~ ~ ~:~ represents acceptance of terms f0rpayment, and Confirms that tank removal complies with State laws. " '; ?'F-, ,,'.""'"',:';CERTIFICATE OF TANK DISPOSAL / DESTRUCTION ~TH~IS TO C~RTIFY THE RECEI~AND ACCEPTANCE OFTHE TANK(Sj'A~'~PECJFIED ..... ABOVE: ALE MAT~R .... AL SFEC'IOi'E~':WIL(~'E'"~OMPLET~LY ~ . AUTIIO~IZED ~EP.. . ' .' '. DATE ... WHITE--Con,actor Oop~ · YELLOW-- ~le Oop~ · PINK-- Perm~nt Oop~. . the f, wa~ weloh~ m~ured, or counted by a w~ter, who~e ~lon~ture ~ on · ~ce~flc~te, who (commencing wl~ ~c~on 127~) of DI~5 of *e Ca forn a Bus ne~ and Profe~ ons:.O~e, tEJ]'D~,, CA 93307 od.i'ty, · Weight [::'rJ.c[~ Anloun'b . [JeJ. ghts , : ' ' i 00% 1'; 3',[5 . 01. , 0 t Gr o s s 21.570 'I:::'[]UIxlDS. :~):-. N e't; '2630 "PEJUNDS Ad..:i,. 'Net 2630 I:::'OUNDS :DON E KEi-r'H "l"in~e: Gr'oss 11"55. ~ tX9386~ Tare ~.t.56 a.m. i.~-({~6488 We i ghlaast er '" ' Gross:L. INDA HAMMOND ' )>> > > RECEIVED BY >>>>> ~ ............... BAKERSFIELD FiRE DEPARTMENT HAZARDOUS MATERIAL. DIVISION (805) 326-3979 TANK 'REMOVAL INSPECTION FORM OWNER ~O't) W-'~/~/~ PERMIT TO OPERATe.# CO~CTOR 5~/~ CONTACT PERSON ~BO~TORY ~ ~/~.~ % OF S~PLES TEST ~THODOLOGY ~ ~ P~LI~ARY AssESSMENT CO. ~~ CO'ACT PERSON CO~ RECIEPT ~ ~ LEL% ~ O~% 'PLOT P~ CONDITION COMMENTS ' DKTE' INSPECTORS N;~ SIGNATURE BAKERSFIELD FIRE DEPARTMENT · HAZARDOUS MATERIAL D~VISION · , ,2130 G Street, Bakersfield, CA 93301 (805) 326-39?9 CERTIFICATION .STATEMENT OF TANK DECONTAMINATION ~ ' ~ ~-~ an authorized agent of name ~_~-, ~,' ~.~ here by attest ~nder penalty of , .... contracting co. perju .ry that the tank(s).loCated at 3000 '~/~/-6~--~ and address . being remoVed.under permit%~2~02 ~ has been cleaned/decontaminated properly and a LEL (lower explosive limit) reading of no greater than 5% was measured immediately following the cleaning/decontamination process. - s~gnature v ' da~e name (print) .... ' i STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD ' UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM A COMPLETETHIS FORM FOR EACH FACILITY/SITE I MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF'INFORMATION ..Z'"'7 PERMANENTLY· CLOSED SITE ONE ITEM [] 2 INTERIM PERMIT [~ 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. 'FACILITY/SITE INFORMATION & ADDRESS - (MUST BE cOMPLETED) ~ DJ~.,~.~OR FACILIT~ NAME ! ~' NAME oF OPERATOR ADDRESS ' ~ NEARESTkROSS ~TREET PARCEL # (OPTIONAL) ,/ BOX TO INDICATE ['--"] CORPORATION w~DIVIDUAL ' ~ .PARTNERSHIP I---] LOCAL-AGENCY ~ COUNTY-AGENCY ~ STATE-AGENCY ~ FEDERAL-AGENCY DISTRICTS TYPE OF BUSINESS ~ 1GAS STATION ~ 2 DISTRIBUTOR ~ v" IF INDIAN ,# OF TAN. KSATSITE, E.P.A.I.D.#(optional) r-~ 3 FARM r-~ 4 PROCESSOR "'~'--'5-OTHERoRRESERVATIONTRuST LANDS EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY)- optional DAYS: NAME (LAST. FIRST) PHONE # WITH AREA CODE I DAYS: NAME (LAST. FIRST) NIGHTS: NAME (LAST. FIRST) PHONE # WITH AREA CODE'I NIGHTS: NAME (LAST. FIRST) PHONI: # WITH ARI=A ~.~F. PHONE # WITH AREA CODE '11. PROPERTY OWNER INFORMATION- (MUST BE COMPLETED) " NAME/~ Ov/V' ~.~__~,,,./~' . CARE OF ADDRESS INFORMATION MAILING OR STREE"T ADDRESS ,/ bo;( t~ indicate . ~DUA[ ~ LOCAL-AGENCY [~ STATE-AGENCY "~9 ? O p~/~"~_..~.,~. ~' I'--'1 CORPORATION [~ PARTNERSHIP r'~ COUNTY-AGENCY r--1 FEDERAL-AGENCY ,~. PHONE # WITH AREA CODE III. TANK OWNER. INFORMATION . (MUST BE COMPLETED) NAME OF OWNER I CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ./ box to indicale ~ INDIVIDUAL · ~ LOCAL-AGENCY ~ STATE-AGENCY [~ CORPORATION ~ PARTNERSHIP ~ COUNTY-AGENCY ~ FEDERAL-AGENCY CITY NAME STATE ZIP CODE PHONE # WITH AREA CODE IV, BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER,- Call (916) 323-9555 if questions arise. TY(TK) HQIXl -I I I I I I V. PETROLEUM UST FINANOIAL RESPONSIBILITY - (MUST BE OOMPLETED)- IDENTIFY THE METHOD(S) USED I .." box loindicate ["--] 1 SELF-INSURED ~ 2 GUARANTEE E~ 3 INSURANCE [---] 4 SURETY BOND ~ 5 LET~'ER OF CREDIT ~ 6 EXEMPTION ~R VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank'owner unless box I or II is checked. ICHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: !.[~ I~~ . . THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND ~ro THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT A,PPLICANT.~ NAME (PRINTED & SIGNATURE) ~ ~. "~ J APPLICANT'S TITLE / DATE MONTH/DAY/YEAR.. ~ COUNTY# JURISDICTION # FACILITY ct · I . DCA ION CODE - OPTIONAL cENSus TRACT.# - OPTZONAL 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. FORM A (5-91) ;. FOR0033A-5 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 I I NEW PERMIT [] 3 RENEWAL PERMIT [] 5 cHANGE OF INFORMATION · [] 7 PERMANENTLY CLOSED ON SITE ONEiTEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT , [] .6 TEMPORARY TANK CLOSURE ~ TANK REMOVED ...,, o,, .s .,s,-,,..,.. I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S' TANK I. D. # / ' B. MANUFACTURED BY: "~,, .c. DATE ,NSTALLED,MO,OAY,YEAR, / ¢ ?'7 O. TANK C AO,','Y ,N GALLONS: / II. TANK CONTENTS IF A-1 IS MARKED, COMPL,E,TE ITEM C . .. [] 2 P~rROLEUM [] ~0 EMPTY . [] , PRODUCT,. ,bPREM,UM 4. GAS~OL . ~1~ ' METHANOL I [] 3 CHEMICAL PRODUCT[] 9S UNKNOWN~ WASTE .- 2 LE^DED [] 99 OTHER IDESCR~BE ~N I~EM D. BELOW)I D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. #: IlL TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B.'ANDC, ANDALLTHATAPPi. IESINBOXDANDE A. TYPE OF [] 1 DOUBLE WALL b~ 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM ~SlNGLE WALL -- [] 4 SECONDARY CONTAINMENt (VAULTED TANK) [] 99 OTHER B. TANK ~,~RE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS . [] 4 STEEL CLAD W/FIBERGLASS RE~NFORCED PLAST,C MATERIAL [] S CONCRETE [] S POLYVlNYL CHLORIDE [] 7 ALUM~NUa [] e lOm/o METHANOL COMPAT~BLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] '99 OTHER ' [~ I RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR ~LINED [] 95 UNKNOWN [] 99 OTHER . LINING [] 5 GLASS LINING IS LINING MATERIAL COMPATIBLE WITH lOm/o METHANOL ? YES__ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 C...~ATING [] 3 VINYL wRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION ,,~I NONE : ''"~ ["---~95 UNKNOWN [] 99 OTHER E. SPILL AND OVERFILL SPILL CONTA!NMENT INSTALLED (YEAR) '""-' OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) '---'""--- IV. PIPING INFORMATION CIRCLE A IFABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A IJ 1 SUCTION A U 2 PRESSURE ~ GRAVITY A IJ 99 OTHER B. CONSTRUCTION .1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A [J 99 OTHER C. MATERIAL AND A~l BAREST~..~-L A U 2 STAINLESS sTEEL A U 3 POLYVlNYL CHLORIDE(PVC)A U 4 FIBERGLASS PiPE CORROSION A'O' 5 ALUMINUM A I.I 6 CONCRETE A [J '7 STEEL W/ COATING A IJ 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A IJ 9 GALVANIZED STEEL A IJ 10 CATHODIC PROTECTION A [J 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [~k 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE T~HTNESS TESTING [] 3 INTERSTITIAL ,~.~'~THER~~ MONITORING Vl TANK LEAK DETECTION I[] 1 v,SUAL CHECK [] ~ ,NVENTORY RECONC,',AT,ON [] ~ V..V..V..V..V..V..~",TOR,NG [] ~ AUTOMAT,C TANK GAUG,NG []~ GROUND WATER MON,TOR,NG []~ TANK TEST,NG [] ~ INTERST,TIALMONITOR,NG ~, NONE [] 9~ UNKNOW, [] ~ OTHER VI. TANK CLOSURE INFORMATION ,. ESTIMATED DATE. LAST USED (~O,DAY~R) 2. EST,MATED QUANT~TYOF 3. WAS TANK F,LLED w,TH YES · /~/.2..'~/'~ / · SUBSTANCE REMA,N,NG GALLONS ,NERT MATER,AL? [] ' THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICANT'S NAME ~ | DATE COUNTY # JURISDICTION # FACILITY # TANK # PERMIT NUMBER .' PERMIT APPROVED B~/DATE ~ PERMIT, EXPIRATION DATE· FORM a (7-91) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROOO4~-R5 o.--d m m ~ FILE CONTENTS= DPe[mit to per~te t D~O~ ~ Date ~Constructton Permit ~ Date ~' ~ ~Permit to abandonl No. of'Tanks ..Date ~ended Permit Conditions Permit Application Form, '. / ' Tank Sheets, Pbf P~'" ~ ~AppIicatio~ to Abandon tanks(s) Date ~Annual Report Fo[ms ~Copy o[ Written Contract Between Owner & Operator ' ~[nspectton Report~ ~C'orrea~ndence - Received ....... ., . ..... Da te " " ,, .. ~te ~Corres~ndence - Nailed ..... .......... Da ~e .... ~e ...... Unauthorised Release Reports Abandonnent/Cloau;e 'Repot te ...... OSampling/Lab Re~;ts .... ~_ ~MV~ C~pliance Check {'New Cona'truCtion CheckliSt) ' ~STD C~plianoe Check (New Construction Checklist) ~MVF Plan Check (Mew Construction) ~STD ~lan Check (Mew Construction) ~MVF Plan Check (Ewisting-,~aci O'lncomplete. Application, Porn ty). OPermit Application Checklist. ~onito~/~ Hell Constru~tl'on. Data/PermitS _ Date ,, ~Enviro~ental Sensi[t'~ity Data: ' Groundvater Drilling, Borinq Logs Location o~ Hater Hells ~Statement o~ Underground Conduits ~Plot Plan Keaturinq A~I Enviro~entally Sensitive Data ~Pho~os ~Cons[ruction Dravings Location: ~flalf sheet shoving date received and tally of inspection ~Hiscel laneous l?OOFIowerStreet KERN COUNTY HEALTH DEPARTMENT HEALTH OFFICER Bakersfield, California 93305 Leon M Hebertson, M.D. ENVIRONMENTAL HEALTH DIVISION Telephone (805) 861-3636 ~' DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Reichard ~ I NTER1- M PERMIT PERMI T-~eO 500 4 9 (2: TO OPE RAT F-.: ISSUED= JULY 1, 1986 Exr~'rREs: JULY 1, 1989 UNDERGROUND HAZARDOUS SUBSTANCES : STORAGE FACILITY NUMBER 0F TANKS-- 1 'FACILITY: I 0NNER: DON KEITH TRUCKING I KEITH, DON E. 2990 PIERCE ROAD I 2990 PIERCE ROAD BAKERS~'IELD, CA I BAKERSFIELD, CA 93308 TANK # AGE(IN YRS}, SUBSTANCE CODE PREssuRIZED PIPING? i 9 NO 2 NO NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT NON--TRANSFERABLE * * * PosT ON PREMISES """';' J"' =' '=' DATE PER.MIT MAILED: ~?R'2 9 198'/ DATE PERMIT CHECK LIST RETURNED: Kern County Health Departme, Permit. Division or Environmental Application~t, 1700 Flower Street, Bakersfield, CA 93305 APPLICATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE ~FACILITY Type of Application (check): ~New FaCility ~lModification of Facility [~Existing Facility [']Transfer of Ownership Type of Business -(Check):' [2]Gasolfn4 stat-i~ /~Other (deSCribe) Is Tank(s) Located on an Agricultural Farm? [2]Yes r~No dY Is Tank(s) Used Primaril~ for ~gcultural Purposes? ~Yes Facility Address ~??Q ~~..,~ Nearest Cross St. T. R SEC (Rural Locations ~ly) ,/ .owner Do,v /fz,' l . Con gct Persc- Operator Contact Person Soil Characteristics' at Facility-(~ C. Contractor CA Contractor's Llcenae Addr ess Zlp Telephone propos~ Start'i~ Date proposed' Cc~pl~tio~ Worker's Ccmpensation .Certificatio~ ! ' Insurer D. If This Permit Is For Modification Of An Existing .Facility, Briefly Describe Modifications Proposed E. Tank(s) Store (check all that apply): Tank ~ Waste Product .Motor Vehicle Unleaded Regular Premium Diesel Waste F. Chemical Caapositton of Materials Stored (not necessary for ~otor vehicle fuels) Tank ! Chemical Stored (,non-cce~ercial, name) CAS ! (if kno~} Ch~ical previous, ly stored G. Transfer of Ownershi~ Date o-~-ansfer Previous Owner r vious ;acillt Na e , I, Lt)r~/ff~.~ %~.//~ acce~c fu'll'y all 061'fgati'ons 'o'f permif I~. issued to ~)~[ /~z~{ '.7"~ : . I understand that the Pemitting Authority may review and mddify' 'or- 'te-~miriate/ the fransfer of the Permit to Operate this ~rqro~%d storage facility upon receiving this completed form. This form has been completed under penalty of perjury and to the best of my knowledge is true and correct. ~UT HEPARATE FORM F~.~,~ TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: [qVaulted' [-]Non-Vaulted [qDouble-Wall ~Single-Wall . 2. ~ Material Carbon Steel [] Stainless Steel [-]Polyvinyl Chloride I-]Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [] Concrete [] Altm~in~ [] Bronze [-]UnknOw~ [] Other (describe) / 3. Primary Containment / Date Installed Thickness (Inches) Capacity (Gallons) ~ Manufa~ctu~er 4. Tank Secondary Containment []Double-Wall ~Synthetic Liner []Lined Vault ~None []-]unknown [] Other (describe): Manufacturer: rlMaterial ThickneSs. (Inches) Capacity (Gals.) 5. Tank Interior Linin~ ---~Rubber []']Alkyd [][]Epoxy []Phenolic [-]Glass []Clay ~unlined []Unknown [~Other (describe): 6. Tank Corrosion Protection '---~Galvanfzed -~~[ass-Clad []Polyethylene Wrap. []Vinyl ~Tar or Asphalt []Unknown [-]None. [-]Other (describe): Cathodic Protection: []None []Impressed Current System []sacrlfib"l'al 9e%ode System ~--~ribe System & Equipment: 7. Leak Detection, Monitoring, and Interception a. Tank: nvisual (vaulted 7tanks only) rqGroundwater Monitoring' Well rlvadose Zone Monitoring Well(s) [~U-Tube WithOut Liner ~rlU-Tube with C~mpatible Liner Directing Flow to Monitoring We.II(s)* Vapor Detector* rlLiquid Level SenSOr* []CondUCtivit~ Sensor' ri Pressure Sensor in Annular Space of Double Wall Tank ' [] Liquid Betrieval & Inspection From U-Tube,_Monitoring Well or A~hular Space []Daily~u~ir~ & Imventory Reconciliation ~]Periodic Tightness ~estin~ ~] None ~.~ Unknown [] Other b. Piping: · Plow-Restricting Leak Detector(s) for Pressurized Piping~w [] Monitoring S~p with Race~y [] Sealed Concrete Race~y []Half-Cut Compatible Pipe Race~ay rlSynthetic Liner Race,my [] Unknown [] Other · Describe Make & Model: 8. ~en Tightness Tested? []Yes r~No ~unknown 'Date of Last Tightness Test Results of Test Test Name Testing Company 9. Tank ~ ~ Repaired? []Yes ~No []unknown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection '~Operator F~, Controls, & Visually Monitors Level [2]Tape Float Gau~e []Float Vent Valves [] Auto Shut- Off Controls '[-]Capacitance Sensor []Sealed Fill Box []None []unknown Other: List Make & M~del For Above Devices a. Underground Piping: ~Yes [']No []Unknown Material Thickness (inches) Diameter Manufacturer' []Pressure []Suct'i'on ~Gravity App~.oximate Length of Pipe ~ b. ._ Underground Piping Corrosion Protection .. ~alvanized []Fiberglass-Clad F]Imp~essed Current []Sacrificial Anode []Polyethylene Wrap []Electrical Isolation [-]Vinyl Wrap []Tar or Asphalt []Unknown .[]None []Other (descri,be): .c. Underground Piping, Secondary Containment: []DoUble-Wall []Synthetic Liner System [~None []Unkno~ -[']Other (describe): Permit Questionnaire Normally, permits are sent to facility Owners but since many Owners live outside Kern County, they may choose to have the permits sent to the Operators 'of the facility where they are to be posted. Please fill in Permit # and check one of the following before - returning this form with payment: _~ 1. Send all Information to Owner at the address listed on invoice (if Owner is different than Operator, it will be Owner's responsibility to provide Operator with pertinent information). 2. Send all information to~ Owner at the following corrected address: 3. Send all information to Operator: Name: Address:~ (Operator can make copy of permit for Owner).