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Home My WebLink AboutRISK MANAGEMENT Site Specific Time Accounting Sheet Permit # ~k~) ~'~"~ ~ Site Specific Status Changes: Employee # Employee Signature Site Name or Fede/~l) State, ;Funding (Local, of CateGory Activity Hours Date Code- Code Description (lOths) I/ " Data Entered By: Date: CONTRACT OPTIONS FOR LEAKING TANKS Site Specific Time Accounting Sheet Permit # ~"0 ~' ~ ('f~ Site Specific Status Changes: Employee # Employee Signature Site Name or AO_aress Funding (Local, State, of Federal) Category Activity Hours Date Code Code Description ( lOths ) Notes: Data Entered By: Date: LOS ANGELES P,O. Box 12359 Glendale, CA 91224 (213) 629-8080 PETER CORRICK ADJUSTERS (818) 957-1200 Casualty, Worker's Compensation FAX: (818) 249-5158 Property, Marine November 17, 1993 ORANGE COUNTY P.O. Box 19608-286 IrvJne, CA 92713 (714) 855-0469 Kern County Environmental Health Services Dept. VENTURA P.O. Box 5191 2700 "M" Street Suite 200 Ventura, CA Bakersfield CA 93301 93003 (805) 644-0444 Attention: Lydia Yon Sydow SAN BERNARDINO P.O. Box 1474 Re: Claim No. : 06500024284 Co,ton, CA 92324-0801 Insured : Diesel Electric (714) 359-8053 Claimant : Kern Co. Environmental SAN DIEGO Health Services P.O. Box 609040-137 Date of Loss : Unknown San Diego. CA Our File No. : SL-O46206-GL-RPP 92160 (619) 258-9818 Dear Ms. Von Sydow: Our firm has been retained by the insurance company of SAN LUIS OBISPO Diesel Electric, to perform an investigation into an P.O. Box357 environmental claim involving the Cullen property, your GroverBeach. CA reference number is EMO50566, located at 3315 Pierce 93483 Road in Bakersfield, CA. (805) 481-8220 SAN JOAQUIN VALLEY I have previously been in contact with Flora Darling of P.O. Boxg037 your office. A telephone call on Tuesday, November 16, Fresno, CA 1993, to Ms. Darling revealed that she believed the file 93790 (209) 225-9677 to be closed at this point. She recommended that I write to you for the final reports. We have previously received a copy of your entire file SAN FRANCISCO/ up to and including the August 19, 1993 letter from BSR BAYAREA & Associates, regarding the site. P.O. Box14144 Oakland, CA 94614-2144 I would like a copy of everything in the file past the (510)635-6200 above date and in particular, a copy of the closure FAX:(510) 635-7293 letter that the State has reportedly issued with respect SACRAMENTO to this property. P.O. Box255427 #501 Sacramento, CA Should you have any questions with regard to this 95865 request, please do not hesitate to contact my office, at (916)485-754~ (805) 481-8220. SANJOSE P.O. Box 530950 San Jose, CA 95153-535O (408) 279-4424 Kern County Environmental Health Nov. 17, 1993 Our File No. SL-O46206-GL-RPP Page 2 I am aware there will be a charge for photocopying of the remainder of the file. I request that you advise us of this cost so that we can process the payment as soon as possible. Thank you in advance for your anticipated cooperation. Thank You, Pat Parker Peter Corrick Adjusters San Luis Obispo RPP:pc cc: Royal Insurance Company Environmental Claim Unit 9140 Arrowpoint Blvd., Suite 440 Charlotte, NC 28273 Attention: Jamie Wright Re: Claim No. : 0650004284 ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE McCALLEY, R.E.H.S. (~!~~~~, ,~ 2700 'M' Street, Suite 300 DIRECTOR Bakersfield, CA 93301 (805) 861-3636 (805) 861-3429 FAX November 8, 1993 Mr. & Mrs. Alippi 5904 Cypress Point Drive Bakersfield, CA 93309 SUBJECT: CLASS V SHALLOW INJECTION WELL LOCATED AT 3315 PIERCE ROAD, BAKERSFIELD, CA Dear Mr. & Mrs. Alippi: This letter confirms the completion of site investigation at the above location. With the' "provision that the information to this agency was accurate and representative of existing conditions, it is the position of this office that no further action is required at this time. Please be advised that this letter does not relieve you of any liability under the Code of Federal Regulations or Water Code for past, present, or future operations at the site. Further, it does not relieve you of the responsibility to clean up existing, additional, or previously unidentified conditions at the site which cause or threaten to cause pollution or nuisance or otherw/se pose a threat to water quality or public health. Additionally, be advised that changes in the present or proposed use of the site may require further site characterization and mitigation activity. It is your responsibility to notify this agency of any changes in report content, future contamination findings, or site usage. If you have any questions regarding this matter, please contact Flora Darling at (805) 861-3636, Extension 549. Sincerely, Steve McCalley, Director ? By:,/' Joe Ca. fias, R.E.H.S. Interim Program Supervisor Hazardous Materials Management Program FD:cas cc: Environmental Protection Agency Regional Water Quality Control Board ~lora~alippi-h.m58 ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE McCALLEY, R.E.H.S. ~ 27o0 'M' Street, Suite 300 DIRECTOR *V Bakersfield, CA 93301 (805) 861-3636 (805) 861-3429 FAX October 19, 1993 Mr. and Mrs. Alippi 5904 Cypress Point Drive Bakersfield, CA 93309 · SUBJECT: Class V Injection Well located at 3315 Pierce Road, Bakersfield, CA EMO: 50566 Dear Mr. and Mrs. Alippi: The site assessment report prepared by BSK & Associates for the above-referenced facility has been reviewed. Based upon the laboratory report of soil analyses, no further investigative work is required at this time. Before closure of the site will be possible the underground clarifiers and leach lines must be abandoned properly. BSK and Associates has proposed filling the clarifiers with clean sand slurry to within one foot of the surface and capping with cement to grade. This office agrees with the proposal. Upon verification by this Department that abandonment procedures have been completed a closure letter will be issued. Please schedule all work forty-eight (48) hours in advance with this office in order that a hazardous materials specialist may be present. Abandonment procedures should begin within thirty (30) days of receipt of this letter. If you have any questions, you may contact me at (805) 861-3636, Ext. 549. Sincerely, Steve McCalley, Director ~., R.E.A. pecialist III Hazardous Materials Management Program FD:ch darling~alippi2.1et LOS ANGELES ....... P.O. Box 12359 Glendale, CA 91224 (213) 629-8080 PETER CORRICK ADJUSTERS (ers) 957-1200 Casualty, Worker's Compensation FAX: (818) 249-5158 Property, Marine AUGUSt 30, 1993 ORANGE COUNTY P.O. Box 19608-286 Irvine, CA 92713 (714) 855-0469 Kern County Environmental Health Services Department VENTURA P.O. Box 5191 2700 "M" Street, Suite 300 Venture, CA Bakersfield, CA 93301 93003 (805) 644-0444 Attention: Ms. Flora Darling SANRERNARDINO P·O. Box 1474 Colton, CA RE: Claim No. : 0650004284 92324-0801 Insured : DIESEL ELECTRIC PARTS & SERVICE (714)359-8053 Date of Loss : Unknown SAN DIEGO Type of Loss : Environmental P.O· aox 609040-137 Our File No. : SL-46206-RPP SanDiego. CA 92160 (619) 258-9818 Dear Ms. Darling: Our firm has been hired to investigate the above- ~~~ captioned loss for the Royal Insurance Company. They SANLU~SOmS,O have listed as an insured one Warren L. Charles, Inc., P.o. 8ox357 dba Diesel Electric Parts & Service. The site is 3315 GroverBeach, CA Pierce Road, Bakersfield, California 93308 93483 · (805) 481-8220 The present owners may be a Bernice Cullen and Betty SAN JOAOUIN VALLEY Alippi. From a ~elephone conversation with a gentlemen P.O. Box9037 in your office, we learned your file number is EMO50566. Fresno, CA 93790 (209) 225-9677 As part of our investigation, we will need a complete copy of your file with respect to the above loss. Please advise us of the cost involved and how we may ~ ~~ obtain a copy of this file. SANFRANClSCO/ BAY AREA Thank You, P.o. Box 14144 p ~(/~. /,~_.. Oakland,94614_2144CA (510) 635-6200 Pat Parker ' FAX: (510) 635-7293 Peter Corrick Adjusters SACRAMENTO San Luis Obispo P.O. eox255427 #501 Sacramento, CA RPP: ds 95865 ~ ' P.O. Box 530950 San Jose, CA 95153-5350 (408) 279-4424 Kern County Environmental Health Services Department August 30, 1993 Our File No. Sl-46206-RPP Page 2 cc: Royal Insurance Company Environmental Claim Unit 9140 Arrowpoint Blvd., Suite 440 Charlotte, NC 28273 Attention: Jaime E. Wright Re: Claim No. 0650004284 ? "V" Street Bakersfield, CA 93304 (805) 327-0671 (805) 324-421 8 FAX & Associates August 19, 1993 ..,. --~ '~:i~.~..:~..:: ...... BSK JOB B93086 Ms. Flora Darling, R.E.H.S., R.E.A. Kern County Environmental Health Services Dept. 2700 "M" Street, Suite 200 Bakersfield, California 93301 SUBJECT: Site Assessment Worlcplan Addendum Cullen Property - EMO 50566 3315 Pierce Road Bakersfield, California Dear Ms. Darling: Cte At your request, BSK & Associates (BSK) has prepared this addendum to our As essment Work'plan dated August 12, 1993 for the above-referenced site. Revisions are in accordance with our telephone discussion on August 19, 1993. Soil samples will be obtained at depths of one to two feet. and at five feet beneath the bottoms of the clarifiers and the leach line at the locations shown on Figure 3 (attached). Soil samples S-l, S-2, S-3, S-4, S-7, S-8, S-9, and S-10 will be analyzed by BSK Analytical Laboratories for soluble lead by the California Waste Extraction Method. Soil samples S-5, S-6, S-12, and S-14 will be held by the laboratory until the analytical results are received and evaluated by BSK and your department. If the laboratory analyses reveals non-detectable levels of lead no further testing will be performed. If soil samples contain concentrations of lead greater than the method detection limit than the hold samples will also be tested. In addition, soil sample S-15 will be obtained at a depth of ten feet at a location isolated from the system and analyzed for soluble lead to assess the background levels of lead at the site. Providing that you find this addendum acceptable, we would like to schedule our field investigation for Friday August 27 at 0800 hours. Please contact me if you have questions or require further information. Respectfully submitted, BSK and Associates Project Manager BMB/ds Attachment BSK JOB B93086 August 1993 /~ FiguLe'3 S-6@5' cua~ S-3@1' S-i@i' clarifiers WARHilOUSB S-7@1' 0 .._._ S-8@5' concrete slab S-9 @1' S-10@5' DRIVI~WAY ] S-12@5' 0 10 20 / Scale in Feet ~ ~ff..t/?~L Proposed Soil Sampling Location o S-2 S-14@5' Proposed Soil Sampling Locations 3315 Pierce Road Bakersfield, California & Associales Kern County Environmental Health Services Department August 30, 1993 Our File No. Sl-46206-RPP Page 2 cc: Royal Insurance Company Environmental Claim Unit 9140 Arrowpoint Blvd., Suite 440 Charlotte, NC 28273 Attention: Jaime E. Wr±ght Re: Claim No. 0650004284 ? "V" Street Bakersfield, CA 93304 (805) 327-0671 (805) 324-4218 FAX & Associates August 19, 1993 '" ~ .......... ,.~.. BSK .fOB B93086 ..... ~"."-) '::-~'-7.-:: Ms. Flora Darling, R.E.H.S., R.E.A. Kern County Environmental Health Services Dept. 2700 "M" Street, Suite 200 Bakersfield, California 93301 SUBJECT: Site Assessment Workplan Addendum Cullen Property - EMO 50566 3315 Pierce Road ~_~j/~ Bakersfield,California addendum our ~~itJe ~ile Dear Ms. Darling: -to At your request, BSK & Associates (BSK) has prepared this s ssment Workplan dated August 12, 1993 for the above-referenced site. Revisions are in accordance with our telephone discussion on August 19, 1993. Soil samples will be obtained at depths of one to two feet-and at five feet beneath the bottoms of the clarifiers and the leach line at the locations shown on Figure 3 (attached). Soil samples S-l, S-2, S-3, S~4, S-7, S-8, S-9, and S-10 will be analyzed by BSK Analytical Laboratories for soluble lead by the California Waste Extraction Method. Soil samples S-5, S-6, S-12, and S-14 will be held by the laboratory until the analytical results are received and evaluated by BSK and your department. If the laboratory analyses reveals non-detectable levels of lead no further testing will be performed. If soil samples contain concentrations of lead greater than the method detection limit than the hold samples will also be tested. In addition, soil sample S-15 will be obtained at a depth of ten feet at a location isolated from the system and analyzed for soluble lead to assess the background levels of lead at the site. Providing that you find this addendum acceptable, we would like to schedule our field investigation for Friday August 27 at 0800 hours. Please contact me if you have questions or require further information. Respectfully submitted, BSK and Associates BI th t~ruce . y e Project Manager BMB/ds Attachment Geotechnical Enaineerina · Enaineerina Geoloav · Environmental Services · Construction Inspection & Testing · Analytical Testing August 1993 Figur-e'3 S-5@l' , S-3@1'_ ] S4@5' S-i(~i; .._[ clarifiers WARlallOtlSB S-7@1' ~ S-8@5' concrete slab S-9 @1' S-10@5' o DRIVBWAY S-15@10' ~ S-11@1' .--~ -- ] S-12@5' 0 10 20 I / Scale in Feet ? ',.,~ / ~ i7 ~ S-13~1' Proposed Soil Sampling ~cation = S-2 ~¢~ s44~5' Proposed Soil Sampling ~catio~' 3315 Pierce Road Bakersfield, California a KERN COUNTY HAZARDOUS WASTE INCIDENT REPORT KERN CO. ENV. HEALTH SERVICES TERRY L. GRAY f805) 861-3636 LOCATION OF DiSCHArGE OR THREATENED DISCHARGE DATE AND TiHE O? [NOWLEDGE OF DISCHARGE OB THREATENED D!SCHANE STREETADDRE$6:5924 9iERC~ ~D 06/0i/9~ HOURS C[?Y: ~AKERSFfELD ZiP: 93308 SEC: ~ : --_ . ~. --- . ........ ., ___,l~ilb ............. .... bAKE/PO?~D · 17 "V" Street Bakersfield, CA 93304 (805) 327-0671 (805) 324-4218 FAX & Associates May 14, 1993 BSK JOB B93086 Mr. and Mrs. John Alippi 5904 Cypress Point Drive Bakersfield, California 93309 SUBJECT: Sampling and Testing Class V Shallow Injection Well Closure 3315 Pierce Road Bakersfield, California Dear Mr. and Mrs. Alippi: BSK & Associates (BSK) is pleased to present analytical results for the above-referenced project. This work was authorized by Mr. and Mrs. John Alippi and Ms. Bernice Cullen by written agreement dated April 2, 1993, and was conducted in conformance with the requirements of the Kern County Environmental Health Services Department (KCEHSD) and the U.S. EPA. Water and sludge samples were obtained by a BSK geologist from the clarifier on April 9, 1993, under the direction of Mr. Terry Gray of the KCEHSD. Sampling location is shown on Figure 1. Prior to sampling, the sampling equipment was decontaminated by washing in laboratory grade detergent and rinsed with deionized water. The samples were collected, stored and transported in accordance with guidelines outlined in U.S. EPA Test Methods for Evaluating Solid Waste, Physical/Chemical Methods: SW-846, Third Edition. Chain-of-Custody documentation was maintained during sample collection and transport. The water sample was analyzed for volatile organic compounds by EPA Method 8240, total petroleum hydrocarbons as gasoline by EPA Method 8260, total petroleum hydrocarbons as diesel by DHS approved method, and total recoverable petroleum hydrocarbons by EPA Method 418.1 by BSK Analytical Laboratories. The sludge sample was analyzed for CCR Title 22 metals and for selected soluble metals by waste extraction test (WET). Copies of the analytical results and Chain-of-Custody documentation are attached. Analytical results of the water sample indicated a concentration of 400 micrograms per liter ([tg/L) petroleum hydrocarbons (see attached TPH-D lab report) and 3 milligrams per liter (mg/L) oil and grease. Test results of the sludge sample for metals revealed detectable Soil Sampling and Testing BSK JOB B93086 Class V Shallow Injection Well Closure May 14, 1993 3315 Pierce Road Page 2 concentrations of arsenic, barium, cadmium, and lead. WET results indicated a concentration of 11 mg/L soluble lead. The reported concentration for lead exceeds the soluble threshold concentration limit (STLC) of 5 mg/L set forth under Title 22 CCR. Findings presented in this report are based on laboratory testing of a discrete soil sample obtained from the site. Reported results may not reflect actual concentrations which may exist at other locations on the site. Findings are valid as of the date of the report. Passage of time, natural processes, or human intervention on the property can cause changed conditions which can invalidate the findings and conclusions presented. We have prepared this report for the exclusive use of the client. Unauthorized use or reliance on the information contained in this report, unless given express written consent by BSK, is prohibited. This report has been prepared in accordance with generally accepted engineering practices for the area, based on guidelines of local and federal agencies. No warranties, either express or implied, are made. We appreciate the opportunity to be of service on this project. If you have questions regarding this report, please contact our Bakersfield office. ~,~¥1t~o,v,~,,~.n.. Respectfully submitted, '/'.~N~-g[ BSK & Associates . Bruce M. Blythe ~.x~-,~~_~x.~~ Project Geol9gist /J..o.h~.. B. Moore, Jr. Civil Engineer ' BMB/JBM/ds Enclosures & Associates BSK JOB B93086 MAY 1993 FIGURE 1 CURB ._~ W-1 SEPTIC TANK cL~I~ WAREHOUSE 'O 'O CANOPY SCALE: 1 INCH = 'i0 FEET DRIVEwAy sITE pLAN 3315 PIERCE ROAD BAKERSFIELD. CALIFORNIA 8, Associates I ,.\NALYII(JAL 1414 Slanislaus Stree~ Fresno, California 93706 Telephone (209) 48S-8310 LAI3ORA[ORIES FAX (209) 485-6935 II 1-800-877-83 I0 BSK-Bakersfield Date Sampled : 04/09/93 John Alippi Time Sampled : 1015 Date Received : 04/12/93 Report Issue Dates 04/22/93 Case Number ~ Ch930966 Lab ID Number : 0966-1 Sample Type: SOLID Project Number : B93086 Sample Description: S-1 bottom of clarifier California Assessment Manual {CAM) . Analyses For Total Metals Results Reported in Milligram per Kilogram (mg/kg) as Received Constituent Results DLR Antimony (Sb) .............. ND 10 Arsenic (As } ............... 4 1 Barium (Be) ................. 560 5 Ceryll£um (Be) ............ ND 1 . admium (Cd) ........... '.. 32 1 ~hromium (Cr) .............. 35 5 Cobalt (Co) ................ 14 5 ~pper (Cu) ................ 740 5 &/Lead (Pb) .................. 250 2 Mercury (Hg) ............... 0.1 0.1 ~olv_b_bdenum (Mo) ............ ? 5 ~ickel (NE) ................ 15 5 Selenium (Se) .............. ND 1 Silver (Ag) ................ 4 1 Thallium (TI) .............. ND 1 Vanadium (V) ............... 15 1 Zinc (Zn) .................. 460 5 ~cep~al a~le ~nd~io~ or m~ ~n~fere~es ~y r~ult ~ higher de--ion Non~ Det~ Not ~alyz~ ~~/ /]/~ /~or~~nics Cynthia P , QA/QC Supervisor Doug ~e~, / ~ Manager :920908 ~.T ANAI. YtlCAL 1414 Stanislaus Fresno, California 93706 Telephone (209) 485-8310 LABORAI'ORI[S FAX (209) 485-6935 1-800-877-8310 BSK-Bakersfield Date Sampled : NA John Alippi Time Sampled : 1015 Date Received : 04/12/93 Date of Analysis = 04/15/93 Report Issue Date: 04/22/93 Case Number : Ch930966 Lab ID Number = 0966-2 Sample Type= LIQUID Project Number = B93086 Sample Description= W-1 septic tank Analyses for TPH (Total Petrolenm Hydrocarbons) as Diesel by Method DHS GC/FID. Results Reported in Micrograms per Liter (ug/L) TPH(D) .......... I 400'* [ 50 Sample DLR = DLR x DLR Multiplier, DLR Multiplier = 1 DLRI Detect~on L~t for the Purposes of Reporting. Exceptional sample conditions or matrix interferences may result in h/gher dete~tion 1/mits. *-This sample contain~ lower molecular weight hydrocarbons. ee-This sample eontairm h~gher molm:ular weight h~d~.arbons. **e-This sample couta~n~ bo~h higher and lmmr molecular weigh~; hydrocarbons. Note~ Visual examination of the TPH-Diesel chromatogram suggests that Diesel is not present in any significant amount. The materials that are present do not display chromatography characteristic of Diesel. Cynthia Supervisor Jeff Creager, Organics Manager R920213 TPBDL. t ANAI_Y!IC^L 1414 Stanislaus Fresno, California 93706 Telephone (209) 485-8310 LABORA[ORIES FAX (209) 485-6935 1-800-877-8310 BSK-Bakersfield Date Sampled : NA John Alippi Time Sampled : 1015 Date Received : 04/12/93 Date of Analysis : 04/17/93 Report Issue Date: 04/22/93 Case Number : Ch930966 Lab ID Number : 0966-2 Sample Type: LIQUID Project Number : B93086 Sample Description: W-1 septic tank Volatile ,Orqanic Compounds By EPA Method 8240 Results Reported in Micrograms per Liter (ug/L) Compound Name Results DLR ~Compound Name Results DLR Chloromethane ............ ND 40.0 trane 1,3-Dichloropropene ND 20.0 Bromomethane ............ ND 40.0 Trichloroethene ......... ND 20.0 Vinyl Chloride .......... ND 40.0 Dibromochloromethane ..... ND 10.0 Chloroethane ............ ND 40.0 1,1,2-Trichloroethane ... ND 10.0 Methylene Chloride ...... ND 125.0 Benzene ................. ND 10.0 Acetone ................. ND 125.0 cie 1,3-Dlchloropropene.. ND 10.0 Carbon Disulfide ........ ND 40.0 Bromoform ................ ND 10.0 1,1-Dichloroethene ...... ND 20.0 2-Hexanone .............. ND 125.0 1,1-Dichloroethane ...... ND 20.0 14-Methyl-2-pentanone .... ND 125.0 trane 1,2-Dichloroethene. ND 20.0 Tetrachloroethene ....... ND 10.0 cie 1,2-Dichloroethene... ND 20.0 Toluene ................. ND 10.0 Chloroform ............... ND 20.0 Chlorobenzene ........... ND 10.0 1,2-Dichloroeth&ne ...... ND 20.0 .Ethyl Benzene ...; ....... ND 10.0 1,1,1-Trichloroethane ... ND 20.0 Styrene ................. ND 10.0 Carbon Tetrachloride .... ND 20.0 Total Xylenes ........... ND 10.0 Vinyl Acetate ........... ND 125.0 o-dichlorobenzene ...... ND 10.0 8romodichloromethane .... ND 20.0 m-dichlorobenzene ........ ND 10.0 1,1,2,2-Tetrachloroethane ND 20.0 p-dichlorobenzene ........ ND 10.0 1,2-Dlchloropropane ..... ND 20.0 Sample DLR = DLR x DLR Multiplier, DLR Multiplier = 1 D~: Detection Ll~t for Ge ~rpos~ of ~ptio~l sample c~tt~s or mtr~ in~rf~s ~y result in high~ det~tion l~its. ~: None De~ct~ --: Not Analyz~ Cynthia Pigman, QA/QC .Supervisor Jeff~yCreager' Organics Manager R910909 8~40~.T i ANAI. Y I 1414 Stanislaus Fresno, California 93706 Telephone (209) 485-8310 LABORAFORILS FAX (209) 485-6935 1-800-877-8310 BSK-Bakersfield Date Sampled : NA John Alippi Time Sampled : 1015 Date Received : 04/12/93 Date of Analysis : 04/12/93 Report Issue Date: 04/22/93 Case Number : Ch930966 Lab ID Number : 0966-2 Sample Type: LIQUID Project Number : B93086 Sample Description: W-1 septic tank Analyses for TPH (Total Petroleum Hydrocarbons) as Gasoline by Method DHS GC/FID. Results Reported in Micrograms per Liter (ug/L) Analyte Results DLR TPH (O) .......... ND 5 0 Sample DLR,= DLR x DLR Multiplier, DLR Multiplier = 1 ~y ~sult ~n high~ det~tion l~its. Cynthia P Supervisor Jeffr~ganics Manager R910909 III I ANALYI ICAl 1414 Stanislaus Fresno, California 93706 Telephone (209) 48S-8310 LABORAI'ORIES FAX (209) 48S-6935 1-800-877-8310 BSK-Bakersfield Date Sampled : NA John Alippi Time Sampled : 1015 Date Received : 04/12/93 Date of Analysis : 04/14/93 Report Issue Date: 04/22/93~ Case Number : Ch930966 Lab ID Number : 0966-2 Sample Type: LIQUID Project Number : B93086 Sample Description: W-1 septic tank Analyses for Hydrocarbon Oil & Grease by EPA Method 418.1 Results Reported in Milligram per Liter (mg/L) Analyte Results DLR Oil and Grease I 3 1 Hydrocarbon Sample DLR = DLR x DLR Multiplier, DLR Multiplier = 1 DLR: De~ectton Lim/t for ~he Purposes of Reporting. Exceptional sample cond~ttons or matrix Interferences may result in higher detection l:L~its. ND: None Detected --: Not Analyzed Cynthia QA/QC Supervisor Jef~~Organics Manager R920302 ~ /i~t~/-~gl~ (60Z) xed · OtEO'<Jgt, (60~) eUOtldale. L' · · esuoclxe lUe!lO · epeuJ eJ1e sluetue§ueJJe Jeqio SSalUn peuodeJ ~11~ sllnseJ Jetjl~ ~ep ~t pepJeos!p eJe Seld,,,eS 90Z£6 e!uJOJ!le~) 'ousaJ-I laaJIS snels!ue~,s t, ttq. :elON EIQLVNI~DlUO ' NNId Jeqlo-~o '"nelo~ed-~td I!os-os a§pnls-'IS snoenbv-ov /~q peqs!nbu!leEI eJnl~u§!$ pez!Joqln~ :~Ei '~ei~e~§ ~' S! le/~qO![I,~ 'OB3oq ~ ~ JO JOpJO ~10~ led 00'0~$ Jo o~ll]tto -eisqS tueJ~OJd/uoleJOqeq k3eJluoO Vcl:~ 'S'FI u! peu!llno esoqi qll~ ~ue~s!suoo ,~lleJeue~ eJa seJnpeooJd eseql ou s! eJeql leqi puc 9t~ N~S *V~'=I *STi eql u! peu!llno esoql ~ tueislsuoo ,~lleJeue~ eJa seJnpeooJd ese~ teql puelsJepun I 'seldtues e~oqe eql JOi seJnpeooJd Xpolsno-io-u!eqO leuJJod s,NS8 §u!lsenbeJ ,~qeJeq uJe I leql pue~Jepun I 'seldtues e~xia eql Jot seJnpeocud ,(Polsno-io-u!eqO letmON s,NS~ §uBsenbeJ/~qeJeq uJe I · uo!iDes s!qi u! eJnleu§!s pez!JOLllne ul] lnoqil~ pez~leUe eq II1~ SeldtUeS ON :'dOllON/N¥.U:IOdI~II eldU~S jo [e~ eeSl Peld,,,~s pelduJas uo!luelle 'lJodeEI d!z 'e$.1S '/qlO I~ s!ql u! # euoqcl sseJpl~f ANALYIICAL [ 1414 Stanislaus Fresno, California 93706 Telephone (209) 485-8310 LABORA[ORIES FAX (209) 485=6935 1-800-877-8310 BSK-Bakersfield Date Sampled : 04/09/93 John Alippi Time Sampled : 1015 Date Received : 04/12/93 Report Issue Date: 05/12/93 Case Number : Ch931114 Lab ID Number : 1114 Sample Type: SOLID Project Number : B93086 Sample Description: S-1 bottom of clarifier California Assessment Manual Analyses for Soluble Metals (WET) Results Reported in Milligrams per Liter (mg/L) in Leachate Constituent Results DLR Barium (Ba) ................ 4.9 0.2 Cadmium (Cd) ............... 0.86 0.05 Copper (Cu) ................ 0.8 0.2 Lead (Pb) .................. 11 0.2 ND: None Detected DLR: Detection L]LmJt for thd Purposes of Reporting. --: Not Analyzed Exceptional sample conditions or matrix Interferences may result in higher detection limits. Leachate: 0.45Urn filtrate of WET as per DOM Waste Extraction Test Cynthia Pigman, QA/QC Supervisor Doug ~eas~, ~nor~anics Manager R920729 CAMWET ~!i .:T~ :~}.y:::~::: Sampled Sampled Sample Descfiptio~cation S~tion Code :.{ ,. Signature Print Name Company Date ~me R~qu~t~ / R}~q~ b~ R E C E ! P T , PAGE I 05/11/93 Invoice Nbr. 1 94506 12:24 am KERN CO RESOURCE MANAGEMENT AGENCY 2700 'N' Stl~ee.t Bakersfie]d, CA 93301 Type of Order (S05) 861-3.502 - .- i 'CASH REGISTER CULLEN/ALIPPI Cus:omer P.O.~ I Nth By Order Date i Ship Oa:e ! '~ Via Terms 5097IN t RAR 05/t!/93 ! 05/'1i/93 !20-CULLENI NT .ine Oescrip%ion Quantity Price Unit Disc Total i 4751 HAZ MATS WORK ORDERS ! 41.80 E 41.80 MWO001 2 REF: EM50566 -- Order' Total 41.~0 Amount Due 41.80 Payment. Made Ey Check 41 .50 · --, ;'4AY 2 1993 KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT HAZARDOUS MATERIALS MANAGEMENT PROGRAM UIC SHALLOW INJECTION WELL CHECKLIST 3/93 FACILITY NAME: CULLEN PROPERTY DATE OF INSPECTION: 03/17/93 TIME: 11:00 AM INSPECTORIS): TERRY GRAY ADDITIONAL PARTICIPANTS: I. GENERAL INFORMATION A. INTRODUCE YOURSELF AND ALL OTHERS (SHOW CREDENTIALS) B. EXPLAIN WHY YOU ARE THERE. C. (LEGAL INFO) OWNERS NAME: J.J. & BETTY ALIPPI & BERNICE CULLEN ADDRESS: 5904 CYPRESS CIRCLE POINT CITY: BAKERSFIELD STATE: CA ZIP: 93308 PHONE NUMBER: D. OPERATOR'S NAME: SAME AS ABOVE ADDRESS: 3315 PIERCE RD. CITY: BAKERSFIELD STATE: CA ZIP: 93308 APN: PHONE NUMBER: (SWAP BUSINESS CARDS, ALSO ASK FOR BUSINESS LICENSE) E. PARENT COMPANY: ADDRESS: CITY: STATE: ZIP: ARE THEY A SUBSIDIARY OF A CORPORATION: NO ARE THEY INCORPORATED IN THE STATE: NO F. CONTACT PERSON: J.J. ALIPPI PHONE NUMBER: PAGE 1 UIC SHALLOW INJECTION WELL CHECKLIST II. INTERVIEW THE OPERATOR/NATURE OF BUSINESS A. HOW LONG IN BUSINESS: B. ARE THEY A MEMBER OF AN ASSOCIATION: UNKNOWN C. ARE THEY AWARE OF ANY WATER SUPPLY WELL LOCATION AND/OR OWNERSHIP: MUNICIPAL WATER D. SITE HISTORY YEARS OF OCCUPATION: PREVIOUS OWNERS: PREVIOUS OPERATORS: WARREN CHARLES PREVIOUS USES OF FACILITY: ELECTRICAL WIRING E. PRODUCTS OR SERVICES OFFERED: F. BRIEF DESCRIPTION OF ANY PROCESS, OPERATION, OR MAINTENANCE THAT PRODUCES WASTE: G. WHAT CHEMICALS ARE STORED ON SITE: H. DO THEY HAVE MATERIAL SAFETY DATA SHEETS: .N/A I. DESCRIBE THE WASTE DISPOSAL PRACTICES: J. SOLVENT HAULER: N/A VERIFICATION RECEIPTS: N/A HOW OFTEN: N/A K. WASTE OIL HAULER: N/A VERIFICATION RECEIPTS: N/A HOW OFTEN: N/A L. WASTE ANTIFREEZE HAULER: N/A VERIFICATION RECEIPTS: N/A HOW OFTEN: N/A M. WASTE SLUDGE HAULER: N/A VERIFICATION RECEIPTS: N/A HOW OFTEN: N/A N. OTHER WASTES: N/A VERIFICATION RECEIPTS: N/A HOW OFTEN: N/A 0. ASK FOR SITE MAPS OF FACILITY AND AS-BUILTS, PLUMBING PLANS FOR THE DISPOSAL SYSTEM: PAGE 2 UIC SHALLOW INJECTION WELL CHECKLIST III. INSPECT THE FACILITY GENERAL SITE CONDITIONS HOUSEKEEPING: GOOD EASE OF ENTRY: GOOD COOPERATION: GOOD SURROUNDING LAND USE: COMMERCIAL A. GENERAL APPEARANCE OF THE WELL(S): NONE B. SUSCEPTIBILITY TO SPILLS: YES C. CLASS V WELL(S~): NONE STATUS: YEARS OF OPERATION: D. OIL/WATER SEPARATOR OR GREASE TRAP USED: NO E. ARE THE WELLS PUMPED OUT: N/A HOW OFTEN: F. DO THE WELLS EVER GET PLUGGED UP: UNKNOWN G. CONSTRUCTION DETAILS (MEASURE) TOTAL DEPTH: DIAMETER: CASING: H. ARE THE INJECTION WELLS REGULATED BY A STATE OR LOCAL PROGRAM: RWQCB I. PERMIT: NO J. HOW ARE SPILLS OR ACCIDENTS HANDLED: UNKNOWN K. WHERE DOES THE FLOOR/LOT DRAINAGE WATER GO: YARD L. CAR WASH: NO HOW IS THE EFFLUENT DISPOSED: CLEANERS USED: M. HOW MANY AUTOS ARE SERVICED DAILY: DOCUMENTS TO REQUEST 1 MAP OF FACILITY 2 AS-BUILT DIAGRAMS~ PLUMBING PLANS 3 DRILLERS LOGS 4 MONITORING WELL DATA 5 FLOW DIAGRAM OF PROCESSES, WASTE GENERATION, AND DISPOSAL 6 MANIFESTS FOR WASTE DISPOSAL 7 MATERIAL SAFETY DATA SHEETS PAGE 3 KERN COUNTY UNDERGROUND INJECTION CONTROL PROGRAM INSPECTION REPORT AGENCY: KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT INSPECTOR: TERRY GRAY FACILITY INFORMATION FACILITY NAME: CULLEN PROPERTY PARENT COMPANY: ADDRESS: 3315 PIERCE RD CITY: BAKERSFIELD STATE: CA ZIP: 93308 CONTACT NAME: J.J. ALIPPI POSITION: CO-OWNER DESCRIPTION OF WASTE STREAM: DESCRIPTION OF INJECTION WELL: CLARIFIER DESCRIPTION OF ACTIVITY THAT MAY ENDANGER GROUND WATER BUT NOT RELATED TO INJECTION WELLS OR TANKS (e.g. PONDS, SPILLS): INSPECTION INFORMATION INSPECTION DATE: 03/17/93 NUMBER OF WELLS: 1 WELL TYPE AUTO SERVICE: INDUSTRIAL WASTE: X AGRICULTURAL WASTE: STORM WATER: OTHER: STATUS OF WELLS ACTIVE: X ABANDONED: UNDER CONSTRUCTION: OTHER: INJECTATE SAMPLED: NO VIOLATION FOUND: YES FOLLOW-UP NEEDED: YES RCRA FACILITY: UNKNOWN COMMENTS: ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE McCALLEY, R.E.H.S. ~ 2700 "M" Street, Suite 300 DIRECTOR ~!I Bakersfield, CA 93301 (805) 861-3636 (805) 861-3429 FAX · March 23, 1993 Bernice Cullen J.J & Betty Alippi 5904 Cypress Pt. Dr. Bakersfield, CA 93309 SUBJECT: CLASS V SHALLOW INJECTION WELL LOCATED AT 3315 PIERCE ROAD, BAKERSFIELD, CA Ladies And Gentlemen: Tiffs letter is an' official notice to inform you that the property noted above has been determined by Kern County Environmental Health Services Department (KCEHSD) to be the site of a class V shallow injection well. The well has been identified as a wash rack that discharges to the ground. This notice is being sent to you because you have been identified as the owners of the property listed above. Pursuant to Code of Federal Regulations 40 (40 CFR), Section 144.12(a), "no owner or operator shall.., operate [an injection well].., in a manner that allows the movement of fluid containing any contaminant into underground sources of drinking water, if the presence of that contaminant may cause a violation of any primary drinking water regulation.., or may otherwise adversely affect the health of persons." Within thirty (30) days of receipt of this notice, compliance must be initiated with the guidelines cited in the enclosed copy of EPA-REGION 9 GUIDELINES FOR CLOSURE OF SHALLOW DISPOSAL WELLS. The booklet cites the minimum requirements for site work plan activities, contractor requirements, example illustrations of well designs, and sampling methods and procedures. Be advised that KCEHSD may have additional requirements not listed in the EPA Closure Guideline Booklet. In accordance with Kern County Ordinance Code G-5541, Section 8.04.100 the Department is authorized to charge for inspections, review of reports, and laboratory service costs incurred in the process of obtaining compliance with any violations noted. Be advised that you will be billed at the rate of $20.00 per hour for administrative oversight during the abatement of violations. Cullen/Alippi Property Subject: Class V Shallow Injection Well March 23, 1993 Page 2 If we may be of any further assistance, please contact this Department at (805) 861-3636, Extension 582. Sincerely, Steve McCalley, Director By: Terry L. Gray Hazardous Materials Inspector Hazardous Materials Management Program TLG:cas cc: U.S. Environmental Protection Agency (EPA) ATTN: Martin Zeleznik Regional Water Quality Control Board - Fresno ATI'N: Dale Essary ~ra~cullemuic KERN COUNTY ENVIRONMENTAL HEALTH SERVICES' DEPARTMENT SERVICE .AND COMPLAINT FORM Date :.~ .'/,;: ;' '~ Reporting Person ................................................................................. Address .................................................................................. Phone ................................ h~ Information .... ~.~'~ RESULTS OF .... I NV ESTIGATION . Complainant notified by ,..,' .,.-'~ ,.~..~'"""- -.~ of results ................................ Investigated .r.:. .......... ~ -~-.,.-. ............................................................................ Date Environmental Health 580 4113 2029 (Rev. 9/1~9) UIC PAPERWORK CHECKLIST PAGE (INITIALS) 1. BEGIN UIC PAPERWORK CHECKLIST ~/FILE 2. COMPLETE COMPLAINT FORM [.~ FILE 3. ASSIGN A TP OKING NUMBER (LIST ON COMPLAINT FORM) 4. ~E~N ~ F~nS FOnnS~ FO~ C~SS [~ (IF NECESSARY) ~. ~ESS~C~ ~O~E~ ~SCO~n FO~ [~ F~E [~1 O~ERSHIP (IF NEEDED) ( 1 PER EACH RESPONSIBLE PARTY) [~ ACCOUNTING 8. COMPLETE SHALLOW INJECTION WELL [~ EPA DISK CHECKLIST & UIC PROG~M FORM ~ FILE HARD FILE [ ] RWQCB 9. PROP 65 REPORT (mF NEEDED) '[/[ FmLE [~ JANET (REVIEWED BY JOE CANAS) 11. NOTIFICATION LETTER(S) [~ OWNER [ ] OPE~TOR [ ] [ ] ~WQCB [ICC'S 12. SECOND NOT~CE (~F NECESSARY) [ ] OWNER [ ] [ ] OPE~TOR [ ] F~LE 13. HEARING NOTICE (IF NECESSARY) [ ] OWNER [ ] [~] OPE~TO~ [ ] F~LE 14. REFER~L TO E.P.A. (IF NECESSARY) [ ] [ ] UIC PAPERWORK CHECKLIST PAGE 2 (INITIALS) 16(a). RECOMMEND CLOSURE WITHOUT SITE [ ] [ ] CHARACTERIZATION 16(a)(1). REQUEST DETAILS AND DOCUMENTATION [ ] [ ] FOR CLOSURE OF UIC 16(a)(2). ISSUE CLOSURE LETTER FOR SITES [ ] FILE [ ] WITHOUT CHARACTERIZATION [ ] EPa [ ] RWQCB 16(a)(3). COMPLETE WORK ORDER CLOSURE FORM [ ] FILE [ ] [ ] ACCOUNTING 16(a)(4). PUT ABATE DATE AND ABATEMENT [ ] [ ] ACTION IN COMPUTER FILE 16(a)(5). LOG FILE INTO FACILITIES FILES [ ] [ ] 16(a)(6). TAKE FILE TO FILE ROOM [ ] [ ] 16(b) RECOMMEND ADDITIONAL SITE [/~ CHARACTERIZATION 16(b)(1) INPUT DATA TO REFLECT CASE [ ] [ ] REASSIGNMENT 17. MAIL LETTER REQUESTING SITE [ ] FILE [ ] CHARACTERIZATION 18. REVIEW & APPROVAL OF WORKPLAN [ ] [ ] 19. SITE CHARACTERIZATION & FIELDWORK [ ] [ ] 20. REVIEW SITE CHARACTERIZATION [ ] [ ] REPORT 21. REMEDIATION (IF NECESSARY) [ ] [ ] 22. CLOSURE LETTER [ ] FILE [ ] 23. ISSUE WORK ORDER CLOSURE SHEET [ ] FILE [ ] [ ] ACCOUNTING 24. PUT ABATE DATE AND ABATEMENT [ ] [ ] ACTION INTO COMPUTER FILE 25. LOG FILE INTO FACILITIES FILES [ ] [ ] 26. TAKE COMPLETED FILE TO FILE ROOM [ ] [ ] UIC PAPERWORK CHECKLIST PAGE 1 (INITIALS) 1. BEGIN UIC PAPERWORK CHECKLIST [f~"FILE 2. COMPLETE COMPLAINT FORM [~'"FILE WHITE COPY TO FILE ROOM 3. ASSIGN A TRACKING NUMBER ~ ILIST ON COMPLAINT FORM) 4. ASSEMBLE CASE FILE FOLDER [./]" [~' (IF NECESSARY) 5. RESEARCH PROPERTY RECORD FOR ,[,-'~'FILE OWNERSHIP (IF NEEDED) 6. ATTACH APN MAP TO FILE (IF NEEDED) [/] FILE 7. COMPLETE WORK ORDER LOG SHEET [~/FILE [/'~ 1 PER EACH RESPONSIBLE PARTY) '.~,'J ACCOUNTING ( 8. COMPLETE SHALLOW INJECTION WELL [ ] EPA DISK [ ] CHECKLIST & UIC PROGRAM FORM [ ] FILE [ ] HARD FILE [ ] RWQCB 9. PROP 65 REPORT (IF NEEDED) [ ] FILE [ ] [ ] JANET 10. DRAFT NOTIFICATION LETTER(S) [ ] [ ] (REVIEWED BY JOE CANAS) 11. NOTIFICATION LETTER(S) [ ] OWNER [ ] [ ] OPERATOR [ ] FILE [ ] RWQCB [ ] cc's 12. SECOND NOTICE (IF NECESSARY) [ ] OWNER [ ] [ ] OPERATOR [ ] FILE 1'3. HEARING NOTICE (IF NECESSARY) [ ] OWNER [ ] [ ] OPERATOR [ ] FInE 14. REFERRAL TO E.P.A. (IF NECESSARY) [ ] [ ] 15. WITNESS INITIAL SAMPLING [ ] [ ] UIC PAPERWORK CHECKLIST PAGE 2 (INITIALS) 16(a). RECOMMEND CLOSURE WITHOUT SITE [ ] [ ] CHARACTERIZATION 16(a)(1). REQUEST DETAILS AND DOCUMENTATION [ ] [ ] FOR CLOSURE OF UIC 16(a)(2). ISSUE CLOSURE LETTER FOR'SITES [ ] FILE [ ] WITHOUT CHARACTERIZATION [ ] EPA [ ] RWQCB 16(a)(3). COMPLETE WORK ORDER CLOSURE FORM [ ] FILE [ ] [ ] ACCOUNTING 16(a)(4). PUT ABATE DATE AND ABATEMENT [ ] [ ] ACTION IN COMPUTER FILE 16(a)(5). LOG FILE INTO FACILITIES FILES [ ] [ ] 16(a)(6). TAKE FILE TO FILE ROOM [ ] [ ] 16(b) RECOMMEND ADDITIONAL SITE [ ] [ ] CHARACTERIZATION 16(b)(1) INPUT DATA TO REFLECT CASE [ ] [ ] REASSIGNMENT 17. MAIL LETTER REQUESTING SITE [ ] FILE [ ] CHARACTERIZATION 18. REVIEW & APPROVAL OF WORKPLAN [ ] [ ] 19. SITE CHARACTERIZATION & FIELDWORK [ ] [ ] 20. REVIEW SITE CHARACTERIZATION [ ] [ ] REPORT 21. REMEDIATION (IF NECESSARY) [ ] [ ] 22. CLOSURE LETTER [ ] FILE [ ] 23. ISSUE WORK ORDER CLOSURE SHEET [ ] FILE [ ] [ ] ACCOUNTING 24. PUT ABATE DATE AND ABATEMENT [ ] [ ] ACTION INTO COMPUTER FILE 25. LOG FILE INTO FACILITIES FILES [ ] [ ] 26. TAKE COMPLETED FILE TO FILE ROOM [ ] [ ] l¢OITJr OI OEI LOG Date: 3-/)-~ ~ ~ork O~er ~: ~0 .~0,~'~ Tracking ~: ~0 Catego~: ~N: '~.~% - /~/ -~- ~ -.~ WO T~e: Heimb.: Y ~ N ~ Code: WORK ORDER NAME: ..?_r~_ .~3 /.~ ~,~r~c RESPONSIBLE PARTY' (RP) NAME: RP CONTACT: RP ADDRESS: -5~o Y C~P~,5 p~ D~' ~P CITY: ~ ~//g/~ STATE: ~P PHONE NOS.: ( ) ( INSPECTOR: /~ PROG~: ~H~P-Enforcement DESCRIPTION: ~ ~ FACILITY NAME: REPORTING PERSON: PHONE NO. COMMENTS: MH:For mobilehome A.P.N. see page 41 ASSESSORS MAP 332-161-03-00-3 Roll 1 FILE BEING PREPARED 93 STATUS - ACTIVE Area Code 001-017 Name CULLEN BERNICE D TR & TRS Deed 06746-0123 10/13/92 801 cd SD 3 &ALIPPI J J & BETTY TR & TRS ET AL DEED 05431-0651 Use 22000 CV 81030 Notf 5904 CYPRESS PT DR KTX BAKERSFIELD CA 93309 Census Bill 5904 CYPRESS PT DR Coord BAKERSFIELD CA 93309 Zoning Site 3315 PIERCE RD BAKERSFIELD S-CD L/S 2 B/TP TR/RG CLVER Acres CP *** VALUES **~ Mineral Land Imprvmnts Other Imps Pers/Prop Exemptions Market 31,329 26,611 NET ASSESSED VALUE 57,940 VALUES CHANGED 01/30/81 * *** NO SUPPLEMENTAL RECORDS TO DISPLAY *** * * PF1 TAX INFORMATION PF3 CHANGE ROLL TYPE PF4 PARCEL HISTORY * * PF5/8 NXT/PRE SUPPL PF6 SUPPL. INFO PF7 PEC.SUPPL. EVENT * * PF9/IO NXT/PRE PARCL PF23/24 PRINT WO/W FEED PF17 PRINT LATER IN BATCH * Enter parcel number 332 161 03 O0 3 File - P EVENT- 24-22 SA MW KS IH II S1 KB RANDALL L. ABBOTT ~~ Environmental Health Services Department ~'~ ~~ STEVE McCALLEY. REHS, DIRECTOR DIRECTOR l~]J~le~J~l Air Pollution Control District ~~/ Planning & Development Services Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 ,O-Wheeler'. KERN BROS. TRUCKING !iii 720 Semi End Dumps 3920 MERCURY Bottom Dumps BAKERSFIELD, CA 93308 Skip Loaders (805) 323-1261 P.U.C. CAL-T-84262 CONSIGNOR (Owner): ~*, "~'"[ . f'' } ' . '_ ; 2[}~O ~ ~E LOT AT CUSTOM~;~ CONSIGNEE (Receiver): ~ ~. ~.." i~;t'~ ~ / .r~y' ~ ' ~ '~ [ ~ !~ ' { ~ ~ONLY AND ACCEPT NO RESPON-SIBILI~ " ' " ~ ; '.' {WHAT. EVER FOR O~GE ~LTNG POINT OF ORIGIN: /"" ~' ( ,'~' , f"~l ~ "~; ,,'~ .... . , , DESTINATION: .:~'~- .-' . . ;~ ~,.;. . ~ . ~ ~ . = ~ . LOCATION DRIVER REPORTED ,.:', , ;, =-- EQUIPMENT ~ ' ~.F " CAPACITY J, AXLES "~'" 7. TOTAL ~ : , ,HAS ,(,.. .'(;'.~ : :. :: .................... - ,, : ~ . , } CHARG~ DUE ' . colleclion or delinquent accounts and legal ra~e el HOURLY ' ' ' ' ;"~jl ' MILEAGE MILEAGE , USED ~ ~ " SIGNATURE OF CONSIGNEE ,or agent) ~, . PUBLIC UTIL~IES COMMISSION REQUIRES PAYMENT FOR T~ESE CHARGES NOT LATER THAN THE EI~EE~ OF THE MONTH FOLLOWING DATE OF THIS BILL