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Home My WebLink AboutUNDERGROUND TANK Hazardous Materials/HazardouS Waste Unified Permit CONDITIONS OF-PERMIT ON REVERSE SIDE ~'i}.i. (,i,.7 This oerrnit is issued for the followino: [] Hn~=rdous Materials Plan I~ Underground 'storage of Hm,-~dOUs Materials r-I Risk Manageme~ Program [] H,,-~dous Waste On-Site Treatment 'PERMIT ID # 0i5-021-00i808 "-" " .... · ~: ..%: :, ~.. LOCATION 430 E 93307 TANK MONITORING 015-000-001808-0001 Premium '%~ - '.. None 015-000-001808-0002 Unleaded Plus .10;01}0...<-:.?:~ - ~.. . 015-000-001808-0003 Regular Unleaded Issued by: Bakersfield F~re Department · ~" '~ ". '.. :-i,. :. ~:~'-.,!-'.? ;~i!..: :.i_~ ~i-: ' · -OFFICE OF ENVIRONMENTAL sERVIcEs': ill~ 1715 Chester Ave., 3rd Floor'; " '- 'Approvedby::"' Bakersfield, CA 93301 .Officeof£~ Date Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: ' 'Ju~l~ ~0.. 2003 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, Califomia 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in 'the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 14th day of September, 1999 to: JENNYS MINI MARKET Permit #015-021-001808 430 E. California Ave. Bakersfield, California' 93307 · ~l¢.te items !, 2, and 3. Also complete A.. Received by (Please Print Clearly) B. Date of Delivery i~jf Restricted Delivery is desired. · Print.your. name and address on, the reverse · Attach this card to the back of the mailpiece, or on the front if space permits. - D. Is delivery address different m' 1. Article Addressed to: If YES, enter delivery address b BAKERSFIELD CA 93307 *'~ 3. Service Type ~] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (Copy from service label) 70~,~ 0520 0021 9625 4562 PS ,..=~ 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 ° Sender: Please p y address,'~a'~r~zIP'+'4~in thl~""~__' '-- BAKERSFIELD FIRE DEPARTMENT ~ OFFICE OF ENVIRONMENTAL SERVICES ~ --- 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 Postage '$ ' 3/'1. 1.10 Certified Fee postmark Return Receipt Fee 1.10 (Endorsement Required) Hem Restricted Delivery Fee ~ndomement Required) · ~ ~e'~ ~ $ 2.54 Recipient'8 Name, Please Prlnt Clearly) (To.be coml~let,ed by mailer) ,--------*[..~...~.~ ....................... ~. ................ ,: .... _ ..... IStreet, Apt: No.; or PO Box No. 1201 DAI~I STRgET ~i~RSFIELD CA 93307 Certified Mail Provi~les: · A mailing receipt la A unique identifier for your mailplece · A signature upon delivery · A record of delivery kept by the Postal Service for two years Important Reminders: · Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. · Certified Mail is not available for any class of international mail. · NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail. · For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage, to cover the fee. Endorse mailpiece "Return Receipt Requested", To receive a fee waiver for a duplicate return receipt, a USPS postmark on your Certified Mail receipt is required. · For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". · If a postmark on the Certified Mai,~ rece[~t~esired, please present the arti- cle at the post office for postmarking. Iff"a postmark on the Certified Mail receipt is n~eeded, detach and affix label with postage and mail. IMPORTANIe this receipt and present it when making an inquiry. PS Form 3800, February 2000 (Reverse) 102595-00-M-1489 January26,2001 Bias Garcia 1201 Dawn Street WRE C,~Er Bakersfield Ca 93307 CERTIFIED MAIL RON FRAZE ADMINISTRATIVE SERVICES RE: Ownership of Property at 430 E. California Avenue, Bakersfield 2101 "H" Street Califomia Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Mr. Oarcia: SUPPRESSION SERVICES 2101 "H" Street This letter will recap our phone conversation of Thursday, January 25, Bakersfield, CA 93301 VOICE (661)326-3941 ' 2001. During our conversation, I explained to you that you are still the lAX (661)395-1349 legal owner of record for property located at 430 E. California Avenue. o PREVENTION SERVICES This information was supplied by Mr. Dennis Skinner, Bank of Stockdale, 1715 ChesterAve. who indicates that the loan and title remain in your name. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 With regard to your underground tanks, our paperwork will reflect that you ENVIRONMENTAL SERVICES are the legal owner of the property. Over the last 2 months, there have 1715 Chester Ave. been two operators who have operated your store. Both have complied Bakersfield, CA 93301 VOICE (661)326-3979 with the necessary documentation for operating a fuel facility. FAX (661) 326-0576 TRAINING DIVISION However, should the store close again, for a period of more than 90 days, 5642 Victor Avo. the underground fuel tanks will become illegally abandoned and require Bakersfield, CA 93308 VOICE (661) 399-4697 removal. FAX (661) 399-5763 Should you have any questions, please feel free to call me at 661-326- 3190. Sincerely, Steve Underwood, Inspector Office of Environmental Services SBU/dm cc: Pablo Bugarin Pedro Martinez '"~G'qIIFICE OF ENVIRONMENTAL~RVICES .~-~~~'~. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-~3979'' - UNDERGROUND STORAGE TANKS - UST FACILITY Page __ of __ TYPE OF ACTION ~I. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5. CHANGE OF INFORMATION (Specify change - [] 7. PERMANENTLY CLOSED SITE (Check one item only) [] 4. AMENDED PERMIT local use only) [] 8. TANK REMOVED 400. [] 6. TEMPORARY SITE CLOSURE I. FACILITY I SITE INFORMATION N~REST C,OSS STRUT ~1. FAC,',~ O~ER~PE [] 4. LO~LAGE"CY'D'STR'CT' Ti! ~.t ~ ~[] 1. coR,oRAT,O, [] ,. COU.~'AGENCY' J --~"° ~ ,. INDIVIDUAL D 6. STATE AGENCY' BUSINESS' ~. GAS STATION ~ 3. FARM ~ 5. COMMERCIAL ~PE ~ 2. DISTRIBUTOR ~ 4. PROCESSOR D 6. OTHER 403. 3. PARTNERSHIP 7. FEDE~L AGENCY* 402. TOTAL NUMBER OF TANKS Is fadli~ ~ Indian R~ti~ ~ *If ~ of UST a public agent: name of su~s~ of RE~INING AT SITE tmstlands? diesis. ~i~ ~ ~ ~i~ ~erat~ the UST. (This is the ~ta~ p~ f~ ~e tank r~.) ~ D Y~ 405. 406. PROPER~ O~ER ~ME ~7. PHONE ~08. ~ILING OR STREET ADDRESS 409, CI~ 410, STATE 411, ZIP CODE 412. PROPER~ ~PE CNDIVIDUAL ~ 4. LOCAL AGENCY / DISTRI~ ~ 6. STATE AGENCY 413. ~ 1. ~R~TION ~ 3, PARTNERSHIP ~ 5. COU~ AGENCY ~ 7. FEDE~L AGENCY ' ' ~:: ': rill. TANKO~ERINFORMA~ON'. : ": : ' ',.: .',~'~ "~ /~;~'7 : :'- , ,, . · .... . TANK O~ER ~ 414. PHONE 415. ~ILING OR STRE~ ADDRESS 416. CI~ 417. STATE 418. ZIP CODE 419. TANK O~ER ~PE ~ 2. INDNIDUAL ~ 4. LOlL AGENCY/DISTRI~ ~ 6. STATE AGENCY 420. ~ 1. ~R~TION ~ 3, PARTNERSHIP ~ 5. COUN~AGENCY ~ 7. FEDE~LAGENCY ': ~.- '" IV. BOARD OF EQUALI~TION UST 8TO,GE FEE ACCOUNT TY (TK) HQ 4 4 - Call (916) 322-9669 if questions adse 421. :'""'"'"'>" ' .... s~'-~..c,.~.'*:::-': ":u~::.,- '"::' ' INDI~TEMETHOD(S) ~ 1. SELF-INSURED ~ 4. SUR~BOND ~ 7. STATEFUND ~ 10. LO~LGOV%MECHANISM 6UA~EE ~ 5. LE~ER OF CREDIT ~ 8. ~TATE FUND & CFC LBER D gg. OTHER: INSU~NCE ~ 6. BEM~ION D 9. STATE FUND & CD 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS Ch~ one box to indi~le ~i~ addr~s sh~ld be us~ f~ I~al notifi~ti~s and mailing. D 1. FAClLI~ ~ PROPER~ OWNER ~ 3. TANK O~ER 423. L~al nolifi~ti~s and mailings ~11 be ~nt to the tank ~er unl~ b~ 1 ~ 2 is VII,' APPLICANT SIGNATURE C~ifl~don: I ~ni~ thai the inflation pro~d~ h~ein is tree and a~rate to the b~t of my kn~edge, SIGNATURE OF APPLI~NT ~ DATE 424. PHONE 425, NA~ OF APPLICANT (~0 ~ - 426.¢ TITLE 0F APPLICANT ~ 427. ISTATE UST FACILITY NUMBER (For local use only) 428. 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 429. UPCF (7~99) S:\CU PAFORMS\swrcb-a.wpd OFF OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 .... ~""*"~" UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page __ of __ TYPE OF ACTION [] 1. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE (Check one item only) ~ ~R [] 7. PERMANENTLY CLOSED ON SITE ENEWAL PERMIT (Specify reason - for local use only) (Specify change * for local use only) [] 8. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID # ~' " ' 1 LOCATION WIT~IIN SIYE (Optional) 431 H3o c:. q3507 I. TANK DESCRIPTION TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes []~o 434 ,~) U~ ~'~0~.~ ~"~ If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 438 ADDITIONAL DESCRIPTION (For local use only) ': II. TANK CONTENTS* **'* '~'' [~. MO TANK USE 439 PETROLEUM TYPE /' TORVEH~CLE FUEL ,,,fll...~a. REGULAR UNLEADED [] 2. LEADED r-] 5. JET FUEL (If marked, complete Petroleum Type) [] lb. PREMIUM UNLEADEO [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Mate#als Inventory page) 441 CAS # (from Hazardous Materfals Inventory page) 442 [] 4. HAZARDOUS WASTE (Includes Used Oil) [] 95. UNKNOWN :' ,III. TANKCONSTRUCTION ~ " : ~:'~ ' TYPE OF TANK [~1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 EXTERIOR MEMBRANE LINER [] 95. UNKNOWN (Check one item only) [] 2. DOUBLE WALL [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL - pdmary tank [] 1. BARE STEEL [[/.'~F. FIBERGLASS I PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/100% METHANOL [] 99. OTHER REINFORCED PLASTIC (FRP) 'ANK MATERIAL - secondary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 8. FRP COMPATIBLE W1100% METHANOL [] 95. UNKNOWN 445 ~Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORRODIBLE JACKET E] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE DATE INSTALLED 447 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5.,,,,GLASS LINING [] 95. UNKNOWN 446 )R COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING ~ UNLINED [] 99. OTHER __ Check one item only) (For local use only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 3, FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER (Check one item only) [] 2. SACRIFICIAL ANODE . (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 [~2. DROP TUBE ~f [] 2. BALL FLOAT -- [] 4. EXEMPT STR,KERPLATE q .,--': · :,: .,,., ~ .,~ ;: ~' ~ ~.'.,,::':, "~; :,:~:=~:: ::: ~':,. :~:: :,:i ~/.: ~/'~:~ :';:~ :.,: ::':;~r;,~:~ :: · ~ """: ~;' :'"~'" '" <" '~ ~;:~ :~:~:!:;: ;¥':'~;,~;~? :: :,~,~'[~ :i.;.,::/'/" ;!': i.~ :~;~ ~"~,· ': :~;~:~i~ -.i '*L~;,:;, ;'...,~; '..: ::: IF SINGLE WALL YANK (l~heek all that apply); 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only); 454 [] 1. ~SUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (IVrTG) [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) ~." AUTOMATIC TANK GAUGING (ATG) [] 8. VADOSE ZONE [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] 7. GROUNDWATER [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + [] 8. TANK TESTING BIENNIAL TANK TESTING [] 99. OTHER V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PI.ACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 .gallons [] Yes [] No UPCF (7/99) S:\CU PAFORMS\SWRCB-B.WPD , · -' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST - TANK PAGE 2 Page ---.=-- of ~ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ~I.,,,PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION/ [~' SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL [] 1. BARESTEEL [] 6. FRP COMPATIBLE W/100% METHANOL MATERIALS AND [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL CORROSION PROTECTION [] 3/1,,,PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER ~4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL WI COATING [] 9. CATHODIC PROTECTION 464 [] 5. STEEL W/ COATING [] 95. UNKNOVVN 465 UNDERGROUND P,..NG ABOVEGROUND P.P,NG SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 RIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ~ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GP~) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) [] 8. DALLY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chec~ one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (cflec~ one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17, DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER I MONITORING l~O [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate ID the best of my knowledge. SI_~GN~TURE OF OWNER/OPERATOR DATE / 470 NA-~rE O~ OWNER/OPLd'I:~A'Iq~R (prtnt) -- 4;'1 I TITLE OF OWNE~OP~:RAtOR 472 IPermitNumber(Forlocaluseonty) 473 PermitApprovedtForlocaluseonly) 474 PermitExpirationDate(Forlocaluseonly) 475 UPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPD CITY OF BAKERSFIELD ~./.:" ':'-'O' OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page ~ of TYPE OF ACTION ~1. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 8. TEMPORARY SITE CLOSURE (Check one ~tem only) [] 7. PERMANENTLY CLOSED ON SITE [] 3. RENEWAL PERMIT (~oecify reason, for local use only) (Specify change, for local use only) [] 8. TANK REMOVED 430 BUSINESS --E (S~m., FACIUTY --E Ge DBA - Dong Bu,n, AS)e'~{~"~ ~, X~ g'l ~/[ ' ~1~ ' ~/'J/~ ~-,-'~"' 3 FACIUTYID'I ! J I 1 LOCATION WITHIN SITE (O~lfonel) 431 I. TANK DESCRIPTION TANK ID # 432 TANK MANUFACTURER 433 / COMPARTMENTALIZED TANK [] Ye~ ~ 434 DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 ADOITIONAL OESCRIPTION (For I0~1 use only) 438 II. TANK CONTENT~ "':' - TANK USE 439 PETROLEUM TYPE 440 ~. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (ffmat~ed, complete Pelrofeum Ty~e) [~. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc, MIDGRADE UNLEADED [] 4. GA$OHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT COMMON NAM~ (f~m Hazardous Materfals Inven$oty page) 441 CAS # (f~om Hazardous Mate~fal~ Inventoqt page) 442 [] 4. HAZARDOUS WA~ (It~clt~do$ Used 0#) I-1 ss. UNKNOWN III. TANK CONS[RUCTION ... :' ' TYPE OF TANK ~1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) [] 2. DOUBLE WALL EXTERIOR MEMBRANE MNER [] 95, UNKNOWIq [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL - I~ma~ ta~k [] 1. BARE STEEL ~3. FIBERP--;-;-;-;-;-;-;-;-~ASS I PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FISERGLA$$ [] 8. FRPCOMPATIBLEWI100%METHANOL []99. OTHER REINFORCED PLASTIC (FRP} TANKMATERIAL-SeO~daryta~k [] 1. 13ARE STEEL [] 3. FIBERGLASS/PlASTIC [] 8. FRPCOMPATIBLEWI100% METHANOL []95. UNKNOWN 445 'Check one item only) [] 2. STAINLE~ STEEL [] 4. STEEL CLAD W/FIBERC-d. AS8 [] 9. FRP NON.CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] s. CO.C.~E TANK INTERIOR LINING [] 1. RUBBER MNED [] 3. EPOXY LINING [~ 5. GLASS UNING [] 95. UNKNOWN 440 DATE INSTALLED 447 OR COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING ~ UNLINED [] 09. OTHER __ Check one item only) (For local use only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 3. FIBERC,.~.AS$ REINFORCED PI.A$TIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF ~ FROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER Check one ~tem only) [] 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local uso only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 D,O, TUBE q f [] 2. -LFLOAT -- [] ,. XEM" IF SINOLE WALL TANK (Ch~',k i# ~f~I II~oly): 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 [~2.. VISUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (M'FG) [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) AUTOMATIC TANK GAUGING (ATG) [] 8. VADOSE ZONE [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] 7. GROUNDWATER [] $. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) ',. [] 8. TANK TESTING BIENNIAL TANK TESTING [] 99. OTHER V. TANK CLO~URE INFORMATION I PERMANENT CLO~URE IN PLACE ESTIMATED DATE LAST U~D (YR/MO/DAY) 4~S ESTIMATED QUANTITY OF SUBSTANCE REMAINING 45~ TANK FILLED WITH INERT MATERIAL? 457 [] Ye~ [] No UPCF (7~99) S:\CUPAFORMS\SWRCB-B.WPO i:.~. · ~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 5 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST - TANK PAGE 2 t Page __ of · ': ' ::: Vi; PIPING CONSTRUCTION'i'Cnec~ all,at appg')' : '; ' ':'' , · A.,/ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ,L-¥~ESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 ~"'1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 CONSTRUCTION/ MANUFACTURER I-I 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER 461 MANUFACTURER 463 [] I. BARE STEEL [] 6. FRP COMPATIBLE WI 100%METHANOL [] 1. BARESTEEL [] 6. FRP COMPATIBLE W/100% METHANOL MATERIALS AND [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL CORROSlONpRoTECTiON [] 3//15LASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER {[Y4. FIBERGLASS [] 8, FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 5. STEEL W/COATING [] 95. UNKNOWN 465 :.: . ' ":':":i ':: "' ::?~!',~i:::: :~!'iil. "::: ''~ ''! '''~ ::i.' '!:::'. ::??~?,:::~:~i?:: :~i::'PIPING ~KDETECTlON~Ckallth/~ta~p!y):.i~::' :i:..':'.: ::: i?!:.~: !:i/::il :: .'.:i ::?ii'¥':!,:' ' :'... "'. :"::'~::'iiii:-iiI: .': UNDERGROUND PIPING ABOVEGROUND PIPING /' SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRES~RIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): "~. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.I GPH) [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1GP~I) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check o~e) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (chec~ o~e) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRiCTiON [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHO!dT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR VVlTHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4, DAILY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS OISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS r'"l 5/ TRENCH LINER / MONITORING MI__/') [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS '~.. NONE 469 IX. OWNER/OPERATOR SIGNATURE I ceffify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF OWNER/OPERATOR DATE / //,~ 470 NAME O¥~)WNE¥~'OI::tEI~ATOR (p~'t~t) ' v 471 TITLE OF OV~'NERTOI~ERATO~ 472 Permit Number (For local use only) 473 Permit Approved (For local use only) 474 Permit Expiration Date (For local use only) 475 UPCF (7/99) S:\CU PAFORMS\SWRCB-B.WPD ' r 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ' UNDERGROUND STOOGE TANKS- TANK PAGE ~ - ~PE OF ACTION NEW SITE ~RMIT ~ 4. ~ENOEO PERMIT ~ 5. CHANGE OF INFOR~TION) ~ 6, TEM~RY SITE CLOSURE (Chock one ~m only) ~ 7, PER~NENTLY CLOSED ON SITE ~ 3. RENTAL PERMIT (~ ~a~ * ~r ~al use only) (~ c~a~ - ~r ~al u~ on~) ~ 8. TANK RE~VED 430 LO~TION ~THIN ~TE (~naO 43~ I. TANK DE~CEIP~ TANK I0 ~· 432 T~K ~NUFAC~RER ~3 COMP~TMENTALIZEO TANK ~ Y~ ~o 4~ DATE INST~LED (Y~) ~5 T~K ~ACI~ IN ~LLONS ~ NUMBER OF CO~TMENTS ~7 II. TANK GOl~l-r~n~ 1. TANK USE 439 PETROLEUM TYPE 440 MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (Ifmarked, complete PeS~leum Type) [] lb. PREMIUM UNLEADED ~ DIESEL [] 6. AVIATION FUEL [] 2. NON-FUELPETROLEUM [] lc. MIDGRADE UNLEADED [] 4. ~HOL [] 99. OTHER [] 3. CHEt~C~,L PRODUCT [] 4. HAZARDOUS WA~TE (Inc~udes COMMON NAME (ft°m Haza~°u~ Mate~als lnventn~y page) 441 I CAS # (from Hazardous Matelfate lnvento~y page) 442 Use~ O~) [] 9s. UNKNOV~ · III. TANK CONSTRUCTION . ~r. '. TYPE OF TANK ~'1. SINGLEWALL [] 3. SINGLE WALL WITH r'l s. $1NGLE WALL WITH INTERNAL. BLADDER SYb'~'EM 443 (Chock one/tern only) [] 2. DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 4. SINGLE WALL IN A VAULT [] g9. OTHER TANK MATERIAL - i~tmm'y lattk [] 1. BARE STEEL ~3. FIBERGLASS I PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLAS~ [] 8. FRPCOMPATIBLEWlI00%METHANOL []g~. OTHER REINFORCED PLASTIC [FRP) TANKMATERIAL-sec~ndarytanI~ [] 1. BARESTEEL [~. FIBERGLASSIPI.ASTIC [] 8. FRPCOMPATIBLEWI100% METHANOL []95. UNKNOWN 445 ~Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGI.A~S [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] s. CO.CRETE TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5.. GI,.AS8 LINING [] 95. UNKNOWN 448 DATE INSTALLED 447 OR COATING (Check one item only) (For locel use only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 3. FIBERGLASS REINFORCED PI.A~FIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] gg. OTHER 'Check one item only) [] 2. SACRIFICIAL ANOOE (For local use only) SPILL AND OVERFILL . YEAR INSTALLED 450 TYPE (Fork)cai uso only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 · ;..'::~;~-'.':~::~'. :~:~.~.:~:';.;~h::~t'~"G "':a': i:~(~;h':~ ....... :;'>'- ........ ' ........... :i:;x~z~,,.'.~:' '/,4~::~::-~'~::;:,,,,' '.:' :' ,"~..':: ~;:~; ;::.:),~:.' ',' '.. .'..."','.. IF ~INGLE WAU. TANK (Chock all tl~t a~aly): 453 I IF DOUBLE WALL TANK OR TANK IhlTN BLADDER (Check one item only): 454 32. , VISUAL iEXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (MTG) I [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) AUTOMATIC TANK GAUGING (ATG) [] 6. VADOSE ZONE J [] 2. CONTINUOUS INTERSTITIAL MONITORING · CONTINUOUS ATG [] 7. GROUNDWATER I [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION {SIR) · [] 8. TANK TESTING fllENNIAL TANK TESTING [] 99, OTHER I V. TANK CLO~URE INFORMATION I PERMANENT CLO~URE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 4.~B ESTIMATED QUANTITY OF SUBSTANCE REMAINING 4~ TANK FILLED WITH INERT MATERIAL? 457 UPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPD OFFICE OF ENVIRONMENTAL SERVICES 5 Chester Ave., Bakersfield, CA 9330'1 (661) 326-3979 UST - TANK PAGE 2 Page __ of __ . '... i~ w~,i,wNe CONST~UC~O. ~Ch~,ll~.~0PP~.... . . · UNDERGROUND PIPING ABOVEGROUND PIPING ~I.,,,PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 SYSTEM TYPE CONSTRUCTION/~f['[/l' SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] ~9. OTHER MANUFACTURER 461 MANUFACTURER 463 [] I. BARE STEEL [] 6. FRPCOMPATIBLEW1100% METHANOL [] 1. BARESTEEL [] 6. FRP COMPATIBLE W/100% METHANOL MATERIALS AND [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL PROTECTIoNCORROSION [] 3.,;/PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER []~. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 5, STEEL W/ COATING [] 95. UNKNOWN 465 ', * .... ,?:.~,~..'./;,,/.~.'i ...... il ~, ~ '" ....ii¥¥~;~??~,!i~i%!?~V~i~!PIPINGLEAKDETECTION(~eckeiI~a~ppIY)':ii'ii~i?~ii' i:;..: ~. ii!i~ ,: '~!?ii:~;.!!! ii'?.7 *i''* i..'.'~... '/'.'"' *i', i!i.:i:I*' UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 ~1. EF~IZEO PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): ECTRONIC LINE LEAK OETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRI'i~ [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GP~) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (chec~ one) [] a. AUTO P~MP SHUT OFF WHEN A LEAK OCCURS I'"] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING /~O [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein is true and accurate to the I~est of my knowledge. SIGNATURE OF OWNER/OPERATOR DATE ,/ ~ 470 ~,--].,~_..% .Z~--~'~,~*~J' c~ ~/;~'loC~ NA'J~E OF OWNBf~[/'OP~RA'I"Of~'~h~ - - 471 TITLE O~ OWNER/OF~EI~&,TO/R 472 I Permit Numher (For locel use only) 473 Permit Approved (For local use only) 47 4 Permit Exp'ration Dale (For local use only) 475 UPCF (7/99) $:\CUPAFORMS\SWRCB-B,WPD '~ CITY OF BAKERSFIELD OFFIiL~E OF ENVIRONMENTAL SER~VlCES 17t5 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE One form per tank Page ~ of I. FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME ot DBA - Doing BuMness As) IL INSTAM~TION Check all that apply The installer has been certified by the tank and piping manufacturers. [] The installation has been inspecfed and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. [] All work listed on the manufacturer's installation checklist has been completed. [] The installation contractor has been certified or licensed by the Contractors State License Board. [] Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify_ method: III. TANK OWNER/AGENT SIGNATURE I ce~ify ttmt the information provided he~ I~ ~ & ~ ~ ~ b~ of ~ ~e SIGNORE OF TANK O~E~AGE~ ~TE ....... 4~ ~-~E ~K O~E~A~ (~nt) 488 'T~E OF TAN~'O~E~AGE~ ........................ From C ....... LINE LEAl<, REPORT ~ED HAR 17~99 1:55:44 P;q ~T~TION N~HE: BANK OF STOCKDALE 5555 CALIFORNIA AUE BAKERSFIELD CA PREM UNLEflD CURRENT STATUS: 3 GPH LEflK ....... LI),IE LEAK REPORT ....... (~ED ~RR 17,99 18:58:38 STATION ? BANK.OF STOCKDALE .JSdJ CALiFORNI~ ~KERoFIELD UI'ILEADED 2 CLiRREt~T STATLiS~ 3 GPH LEAK ....... LINE LEI~K REPORT ....... I:JED MAR 17,99 11:35:~4 AH STATION NAHE: BANK OF STOCKDALE 5555 CALIFORNIA AUE BAKERSFIELD CA 9~i09 UNLEADED CURRENT STATUS: DID NOT HOLD PSI ...... STATUS REPORT TUE PlP~ 11,~9 9:32:88 STATION NAME: BANK OF STOCKDALE 438 E CALIFORNIA AUE BP. KERSFIELD CA 93389 TANK 1 PRODUCT: UNLEADED CURRENT STATUS: GROSS: 484.586 gal NET: 479.969 gal FUEL LEVEL: 8.?~f:~m~mm~ WATER LEUEL: 8.808W TEI,tP: 74.658 ~ GRTJSS UTF: II142.414I GROSS ULLAGE: 95~,=18561,864~ml TANK 2 PRODUCT: UNLEADED CI~RENT STATUS: GROSS: 5~.267 gal NET: 588.177 gal FUEL LEVEL: 8,4917 in WATER LEUEL:' --0.0000 in TEHP: 75.497 mF GROSS VTF: 11121,732 gal GROSS ULLAGE: 95%=18548.382 gal TANK 3 PRODUCT: UNLEAD PREH C'URRENT STATUS: GROSS: 462.45I NET: 457. FUEL LEVEL: b.}RTER LEVEL: 0,00I TEHP: 74.98t'mF GROSS UTF: 11164,547 gal GROSS ULLAGE: 95k,=lOS&),197 gal ....... LINE LEAK REPORT ....... TUE HAY 11,99 9:41:53 AH STATION NAHE: BANK OF STOCKDALE 438 E CALIFORNIA AUE -I BAKERSFIELD CA PRE~ UNLEAD CURRENT STATUS: DID NOT HOLD PSI ___m LI~E LEAK REPORT ....... TUE M~V 11,99 10:21:12 STATION NAHE: BR~K OF STOCK~LE 430 E CALIFORHIR BAKERSFIELD CA UhiLE~qDED R CURRENT STATUS: DID NOT HOLD PSI -~-- LINE LEi~K REPORT TUE IIAV 11,99 10:27:51 STI%TIOt~ 8F1ltK OF STOCKD~LE 4,30 E C~LIFORIIiI% AUE 8FIKERSFIELD C~ 93389 U~_E~DED CL~J~ENT STATUS: DID NOT HOLD PSI D May 20, 1999 Mr. Dennis Skinner FIRE CHIEF Bank of Stockdale ~ON ~RAZE 5555 California Avenue #105 Bakersfield, CA 93309 ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 RE: 430 East California Avenue VOICE (805) 326-3941 FAX (805) 395-1349 Dear Mr. Skinner: SUPPRESSION SERVICES 2101 'H' Street A final, inspection on thc fueling system at the above stated address was Bakersfield, CA 93301 VOICE (805) 326-3941 completed on May 11, 1999. However, several correctipns must be completed prior FAX (805) 395-1349 'to opening this facility. They are as follows: PREVENTION SERVICES 1715 Chester Ave. l. The hose and nozzles must be replaced prior to opening. Bakersfield, CA 93301 2. The "No Smoking .... Tum off Engine" signs must be replaced on VOICE (805) 326-3951 FAX (805) 3260576 the dispenser islands. 3. The emergency shut-off switch signs must b.e replaced. ENVIRONMENTAL SERVICES 4. The address numbers must be replaced (2"x 6" contrasting 1715 Chester Ave. Bakersfield, CA 93301 background). vOICE (805) 326-3979 ' 5. Two fire extinguishers (min. 2A-20 BC) must be on site. FAX (805) 326-0576 6. All loose wires on dispenser island and store front must be capped TRAINING DM$1ON with outlet covers. 5542 Wctor Ave. 7. Need APC to do vapor testing. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Once these items are completed, and visually verified by this office, the facility may open. A business plan and several underground storage tank documents must be filed out by the new owner. If I can be of further assistance, please do not hesitate to call me at 326.3979. Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm ........ STATUS REPORT TUE NOV 58:99 11:01:20 AH STATION NAI'IE: BANK OF STOCKDALE 450 E CALiFORNiA AVE BAKERSFIELD CA 9~09 TANK 1 PRODUCT: UNLEADED CURRENT STATUS: GROSS: 586.474 g.~l NET: ~81.~26 gal FUEL LEVEL: , .0%., in WATER LEVEL: 0.8080 in TEMP: 8.~'3.493 ~F GROSS VTF: 11248.526 gal GROSS ULLAGE: 95~.=10659.176 TANK 2 PRODUCT: UNLEADED GROSS: 6250.164 gal NET: 6178.419 gal FUEL LEVEL: 48.5903 in WATER LEUEL: 0.8088 in TEHP: 79.629 ~F GROSS VTF: GROSS ULLAGE: 95~=4795.486 ga] TANK 3 PRODUCT: UNLEAD PREH CURRENT STATUS: GROSS: 4426.686 gal NET: 4369.211 gal FUEL LEVEL: 37.6792 in WATER LEVEL: 0.0080 in TEMP: 79.g75 ~F UR05~ UTF: 7200.. 14 ga! GROSS ULLAGE: 95)~=6618.964 gal CITY OF BAKER~IELD OFFICE OF ENVIRONMENTAL SERVICES 171~ Chester Ave., Bakersfield, CA (805)326-3979 INSi~CTION POST CARD AT $O8 SITE City, Zip TANKS AND BACKIm~ INSPECTION DATE INS1~"'TOR 13~ck~ll of T~k(s) Spark Te=~ ~ ~r Mamfacmr~ Method Cad~dic Pr~_,~'*~ J~ of Tank, s) ; PIPING SYSTEM Electrical Isolation ofPiFin~ From Tank(s) Cathodic Protection Sy3~.m-Piping Dispevts~ Pan SECONDARY CONTAIN.'ME.¥r. OVERFILL PROTECTION. ~ D~:i-]~.C~iON Liner tnsuiluion - Trak(s) L~er lfls~llalion - Piping Vault With Product Con~atible Seller L~vel Gauges oe Senseef. Float Vent Vxlves Produc~ Corr~ble Fill Box(es) L~k Z~-~'mtO) for Anru~ Sp~co.D.W. Talc(s) ~on~tor4fl~ ~cll(s)/$um~s) - H20 Tes~ FINAL MOmtofllig Wells. Caps & Fill Box L~k WRI~EN MONITORING PROC~D~S UNDERGROUND STORAGE TANK MONITORING PROGRAM B. What methods and equipment, identified by name and model, will be used for perfoming the monitoring: Piping (~ ~t C. Describe the location(s) where the monitoring will be performed (facility plot plan should be attached): D. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining ~e equipment: E. Reporting Format for monitoring: Tank Pipins F. Describe the pr~,,entive maintenance schedule for the monitorins equipment. No~e: Maintenance m~st be in accordance with the m~ufat~rer~s but not less than every 12 months. S ¢ ~cc~ x/e~ r(x!. G. Describe the training necessary for the ol~eration of UST system, including piping, and the monitoring equipment: EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM Th/s monitoring program must be kept at the UST location at all times. The information on this momtofing program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the momtormg procedures, unless reqmred to obtnin approval before ranking the change. Requ/red by. Sections 2632(d) and 2641(h) CCR. Facility Address q..~ ~, t%.{,~. /~uv~_ Ok(c{, C~ 1. If an unauthorized release occurs, how will the hazardous substance be cleahed up? Note: If released hazardous substances reach the environment, increase the fire or explosion bz=ard, are not cleaned up from the secondary, comainment within 8 hours, or deteriorate the secondary containment,~then the Office of Environmental Services must be notified within24hours. J~¢Oc~tno ~ ~ Mtt~(d~r- t-d(~tlt/~- iq(- , , ~.~,,,,,/: ,;/-,,/,,, ~ ' ~ I 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substance. (}6~_ e~ ~,~-~ /~,-~r ~ ag~c~,¥-_ 3. Describe the location and availability of the required cleanup equipment in item 2 above. 4. Describe the maintenance schedule for the cleanup equipment: 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work neces, sary under the response plan: