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HomeMy WebLinkAboutUNDERGROUND TANK-C-11/01/90 KERN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT · ' INVESTIGATION RECORD ADDRESS ASSESSORS' PARCEL ~ CT /,SOO 2uP- CHRONOLOGICAL RECORD OF INVESTIGATION ', I I I I i - I I I I I ! ! I I I I I MC:cd F7 OAT ACTIVITY INITIALS .TIME .. _ ,~3 ..... · F> r~lI TTI NG AND SPECTI ~ 't ,' A(DTI VI TY SHEET DATE I ACTIVITY INITIALS TIME ' " ~' .- - -- ' '~;.~ ~'~'.~I ~ . ~'. ' ~ - ~'~ BAKERSFIELD FIRE DEPARTMENT 12 November 1980 BUREAU OF FIRE PREVENTION X 64 Date APPLICATION Application No.. In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made by: Bakersfield ~ell and Pump Co, 1600 E, CaLt£ornia Avenue. Name. of Company Address to display, store, install, use, operate, sell or handle materials or processes involving or creating con- ditions deemed hazardous to life or propertv as follows: P~rm~Ssiou to install ! - 10,000 ~al underground. ~asoline storage tluk~ Aleo~ installation o£ Vauor Recovery, ~ys~em Ptmee 1 ami 11. One pump to be in. tailed. Permit:ee is ~rle ~odeen, _ ~uthorized ~ ,~,,~,- ~ ~9 ~ ....... ~.~...~.~ ................ Permit ~ ..... ~.~::a4 .... 1..1~. ...................... Date Fire Marshal  :~?':~?:""' ' ' ' ' ' ~ ~: ~ ~ : ~ :' ' ~" " ~ ~i '' -'~ f~7'~c.-- : E~ ' "= 1'- . '- .... -' :. ~-~-~ ..... -' ~ ?:~7~2, ', "~":-~: ~ '" ' '-7.: , . ' -. - .. ! ~-: : "-. , ~ ~. ~C~ ~ 77k..,. . . .:, .. FILE CONTE:ITS SUMMARY PERMIT ~: /~~7 ENV. SENSITIVITY:, Activity Date # Of Tanks Comments R LuURCE MANAGEMENT G£NCY · ' ~ Environmental Health Services Department RANDALL L. ABBOTT ~ STEVE McCAL!-EY, REHS, DIRECTOR DIRECTOR DAVID PRICE HI WILUAM J. RODDY, APCO ASSISTANT DIRECTOR I~annin~ & Deve~o~mem $er~ces De~ar~ent TED JAMES, AlCP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT November Elwood Champness 1600 E. California Ave. Bakersfield, CA 93301 CLOSURE OF ~ UNDERGROUND HAZARDOUS SUB~.ANC~ STORAG~ TANK LOCATED AT 1600 E. CALIFORNIA AVENUE IN BAKERSFIELD, CALIFORNIA. PERMIT # A1298-15/"150027 This is to advise you that this Department has reviewed the project results for the preliminary assessment associated with the closure of the tank noted above. Based upon the sample results submitted, this Department is satisfied that the assessment is complete. Based on current requirements and policies, no further action is indicated ar. this time. It is important to note thar. this letter does not relieve you of further responsibilities mandated under the California Health and Safety Code and California Water Code if additional or previously unident!~ied contamination at the subjec~ site causes or threatens to cause pollution or nuisance or is found to pose a significant threat to public health. Thank you fo;~ your cooperation in this matter. ~ ~ ~ T CARRIE GEORGI HAZARDOUS MATERIALS SP,~C~AL~ST cc: B.S. Construcr.ion ' ~ 0 Box 26~' Lake isaDeiia, CA 9S2~0 2700 "M" ·STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 KERN COUNTY ENVIRONMENTAL HEALTH SE ARTMENT ~,,,~,,o~, ........... _~.~...,_~~ ..... C.~.~.~.~.;:.~ ...... ~.~ ......................................................... ~ ............ ~e~ortln~ Person ~ress ' Phone ......................... , .................... ~O~ress ~ho~e ..................... "~ ~ ~ ~"~ ~`~k~..~.~=.~.~: ~.~:-~.e..`....~ ~..~ ~.~:.~~~ · ~__~~.~.~_..: ..... ~..~l~._~%~...., ...... ~-~~E~h--~--~-~- l.{'lh ,,._,..r.j~,.~,~ 'KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT ' SERVICE AND COMPLAINT FORM ~ 6a~'e:...;~..';-.-.; .:. ._ Time:. ..................... ~ · , ' .~'1~ ~ z v,* ~ ' . .. " .1 ~ ,- './ ~.~, / ,, /, '-7/ ., /.~ /.., ~ / ~ Serwce Re.uest ~ Complaint CT No. ,~ ~,:~./ 1Ass gned to -/ . .. ........................ , .. .... ~;; ..........m~-~ ......... r~ ................................................ ~"_ ,~ ~,, ~ / . , .." I., . ~ /> N /~, . .~ "-~," ~-..~.~=~z.~, ...... ........... ~..,.-~.-~ ......... .............................................................................. Directions ........................................................................................................................................................................................................ Reoortlng Person ........................... = ................................ Address ...................................................................... Phone " - ~o~erty Owner .................................................. A~dress ................................................................. Phone ....................... ........................................... ...................................... ..... .......................................................... Complainant notified of results ...................... Investlgate(~ by ........................................................ Date Environmental Health 580 41.13 2029 (Rev. Nat. ional ,' ...s,,o..,.,,,,,,,.o. [1 1[ i, !i,I . Laboratory Director  Thomas C. Sheath, B.S. loxlcology = m ,, o,,,,,.,-o~,=,o~,,~, Laboratories ~c. 11 O0 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 BENZENE, TOLUENE, ETHYLBENZENE, XYLENES B. S. Construction Date of P.O. Box 2624 Report: 19-0ct-90 · Lake Isabella, CA 93240 Lab #: 100190E-7 Attention: Nick Silicz Sample Description: Bakersfield Nell & Pump . Sample #1 - Tank N 2 Test Method: .EPA Method 802Q Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Received @ Lab: Completed: 28-Sep-90 Ol-Oct-90 'lg-Oct-90 Minimum Reporting Analysis Reporting Constituent Units Results Level Benzene ug/g N.D. 0.05 Toluene ug/g N.D. 0.05 Ethylbenzene ug/g N.D. 0.05 Total Xylenes ug/g N.D. 0.05 Comments: California D.O.H.S. -Cert. #225 N.D. = None Detected. .- Labo~alow logy Thomas C. Sneath, B.S. IOXICO ,, Chief Toxicologis! Laborat orles 110O California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 BENZENE, TOLUENE, ETHYL. BENZENE, XYL. ENE$ 'B. S. Construction Date of P.O. Box 2624 Report: 19-Oct-90 Lake. Isabella, CA 93240 Lab #: 100190E-8 Attention: Nick Silicz Sample Description: Bakersfield We].]. & Pump Sample ~2 - Tank N 6' Test Method: EPA Method 8020 Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Received @ Lab: Completed: 28-Sep-90 Ol-Oct-90 19-0ct-90 Minimum Reporting Analysis Reporting Constituent Units Results Level Benzene ug/g N.D. 0.05 Toluene ug/g N.D. 0.05 Ethylbenzene ug/g N.D. 0.05 Total Xylenes ug/g N.D. 0.05 Comments: California D.O.H.S. Cert. #225 N..D. = None Detected Dat. a Release Authorized: ~.~5~,,~~, I~ t) ~l Naresh C. Jai., Ph.D. a o I1 a I .:11[ [ ![I11. Laboratory Director loxlcology i.m, Thomas C. Sneath, B.S. Laboratories 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 BENZENE, TOLUENE, ETHYLBENZENE, XYL. ENES -. ,.... -.__ ___ .. ~, ......................... B. S. Construction Date of P.O. Box 2624 Report: 19-0ct-90 Lake Isabella, CA 93240 Lab #: 100190E-9 Attention:- Nick Si].icz Sample Description: Bakersfield Well & Pump Sample ~,~ - Tank S 2' Test. Method: EPA Method 8020 Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Rece.ived @ Lab: Completed: 28-Sep-90 Ol-Oct-90 19-00t-90 Minimum Reporting ' Analysis. Reporting Constituent Uni t.s Resul t.s L. evel Benzene ug/g N.P. O. 05 Toluene ug/g N.D. 0.05 Ethylbenzene ug/g N. D, O. 0.5 Total Xylenes ug/g N.D. 0.05 Comments: California D.O.H.S. Cert.. #225 N.D. = None Detected ti rl~' Naresh C. Jain, Ph.D. ~Na o al ,' .. [1 !~ ', !i[ll . Laboratory Director Thomas C. Sneath, B.S. loxlcology s~ sm ., c~,~,~ox,co,o~,. Laboratories ,.c. 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 BENZENE, TOt. UENE, ETHYL. BENZENE, XYLENES B. S. Const. ruct.~on Date of P.O. Box 2624 Report: 19-00t-90 Lake Isabella, C~ 9,52.40 Lab #: lOOlgOE-lO, ~t. tention: Nick Si 1.icz .Sample Description: .Bakersfield Nell & Pump ....... Sample #4 - Tank S 6' Test. Method: EP~ Method 8020 Type of Sample: Soil Date Sample Date Sample Date ~nalysis Collected: Received @ Lab: Completed: 28-Sep-90 Ol-Oct-90 19-Oct-90 ; Mi nimum R epo r t ing A ma 1 ys i s Repor t.i ng Cons ti tuent Uni t.s Resu ]. t.s Level Benzene ug/g N.D. 0.05 Toluene ug/g N.D. 0.05 Ethyl. benzene ug/g N.D. O. 05 Total Xylenes' ug/g N.O. 0.05 Comments: California D.O.H.S. Cert. #225 N.D. = None Detected Data Release Authorized: . Laboratory Director Thomas C. Sheath, B,S, Laboratories 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 BENZENE, TOLUENE, ETHYLBENZENE, XYLENES B~ S. Construction Date of P.O. Box 2624 Report: 19-0ct-90 Lake Isabella, CA 93240 Lab #: 100190E-11 Attention: Nick Silicz , Sample Description: Bakersfield Well & Pump .... .Sample #5 - Dispenser 2' Test Method: EPA Method 8020 Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Received @ t. ab: Completed: 28-Sep-90 Ol-Oct-90 19-0ct-90 Minimum Reporting Analysis Reporting Constituent Units Results Level Benzene ug/g N.D. 0.05 Toluene ug/g N.D. 0.05 Ethylbenzene ug/g N.D. 0.05 Total Xylenes' ug/g N.D. 0.05 Comments: California D.O.H.S. Cart. #225 N.B. = None Detected Data Release Authorized: '~, ~,] ,*'a"ona' ' I_al~ratory Diroctor Ghiot Toxicologist Labo ralorles' 11 O0 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 BENZENE, TOLUENE, ETHYl_BENZENE, XYLENES B. S. Const. ruct. ion Date of P.O. Box 2624 Report.: 19-Oct.-gO Lake Isabella, CA 9,3240 I_ab #: ].00190E-12 Attention: Nick Si].icz Sample Desoript. ion: Bakersfield We].]. & Pump Sample #6 - Dispenser 6' Test. Method: EPA Method 8020 Type of Sample: Soil Date Sample Date Sample Date Analysis Collec..ted: Received @ Lab: Completed: 28-8ep-90 Ol-Oct.-90 19-00t-90 Minimum Reporting Analysis Reporting Const. i tuent Uni t.s Resul t.s . Level Benzene ug/g N.D. 0.05 Toluene t.lg/g N.D. O. 0.5 Ethylbenzene ug/g ' N .D. 0.05 Total Xylenes ug/g N·D. 0..05 Comments: California D.O.H.S. Cert. #225 N.D. = None Detected · I t Naresh C. Jain, Ph.D. Laboratortes 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322. Total Petroleum Hydrooarbons Gasoline B. S., Construction Date of P.O. Bo× 2624 Report.: .19-0c.t.-90 Lake Isabella, CA .95240 I_ab~- 1.00190E-7 Arrant. ion: -Nick Silicz Sample Description: Bakersfield Well & Pump Sample #1 - Tank N 2' Test. ~e~hod: Ca.l.if. DOHS Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Rec'd @ Lab: Completed: 28-Sep-90 O].-Oot-90 19-0ct-90 Minimum Repo r ti ng Anal ysi s Repo rt.i ng Consti rue nt Uni t.s Resu ]. t.s I... eve 1 Total Petroleum HydroL carbon as Gasoline ug/g None Detected .5.00 Comments: California D.O.H.S. Cert,. ~225 Data Release Authorized ']~a. o n a I ,' ~--~' ~"'Lab°rat°ry Dire~torPh'D' " ',l tI, i !i~!l . loxlcology nm, mtn Tl~orrla$ O. $1~eatl~, ,.$. Ghiof Toxi¢olo§ist a oratories 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 Total Petroleum Hydrocarbons Gasoline B. S. Construction Date of P.O. Box 2624 Report: 19-Oct-g0 Lake Isabella, CA 9S240 Lab#: 100190E-8 Attention: Nick Silioz Sample Description: Bakersfield Hell & Pump Sample #2 - Tank N Test Method: Calif' DOHS Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Rec'd @ Lab: Completed: 28-Sep'-90 O].-Oct-90 19-Oct-90 Minimum Reporting Analysis Reporting Constituent Units Results Level Total Petroleum Hydro- carbon as Gasoline ug/g None Detected 5.00 Comments: California D,,O.H.S. Cert. #225 Data Release Authorized 1~ ti I Naresh C. Jain, Ph.D.* a cna Laboratory Director ~, 0 X .0 g y Thomas C. Sneath, B.S. Chief Toxicologist orator es ,.c. 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 Total Petroleum Hydrocarbons Gasoiine ~ ............................. fl. S. Construction Date of P.O. Box 2624 Report: lg-Oct.-gO Lake IsabelIa, CA 95240 Lab#: iO01gOE-9 Attention: Nick Silicz Sample Description: BakersfJ. eid Well & Pump Sampie #5 - Tank S 2' Test Method: Cai&f. DOHS Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Rec'd @ Lab: Completed: 28-Sep-90 Ol-Oct-90 19-Oct-90 Minimum Reporting Analysis Reporting Constituent tJnits Results Level Total Petroieum Hydro- carbon as Gaso].ine ug/g None Detected 5.00 Comments: California D.O.H.S. Cert. #225 Data Release Authorized LaboratormS 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 Total Petroleum Hydrocarbons Gasollne B. S. Construction Date of P.O. Box 2624 Report: 19-0ct-90 Lake Isabella, CA 93240 ' Lab#: lO0190E-lO AttentioD: Nick .Silicz Sample Description: Bakersfield Ne].]. & Pump Sample ~4 - Tank S 6' Test Method: Calif. DOHS Type of Sample: Soil Date Sample Date Sample Date Analysis Collected: Rec'd ~ Lab: Completed: 28-Sep-90 Ol-Oct-90 19-0ct-90 Minimum Reporting Analysis Reporting Cons t.i t. uen t Uni t.s Resu 1 t.s Level Total Petro].eum Hydro- carbon as Gasoline ug/g None Detected 5.00 Comments: California D.O.H.S. Cert.. #225 . ~ll.., Laboratory Director 10 ~r~'[%O~ cO ~a~r~OI~1iI~~' i e s' INC." Thomas C. Sneath, B.S.chief Toxicologist 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 Total Petroleum Hydrocarbons Gasoline ~~~~~ .... ~~~ ...................... B. S. Construction Date of P.O ' Bo× 2824 Report: 'lg-Oct-90 Lake Isabella, C~ 93240 Lab#: lOOlgO/-ll Rttention: Nick .Silicz .-- ............ Sample Description: Bakersfield Well & PUmp Sample ~5 - Dispenser 2' Test Method: Calif. DOHS Type of Samp].e: Soil Date Sample Date Sample Date ~nalysis Collected: Rec'd e Lab: Completed: 28-Sap-90 Ol-Oot-gO 19-Oct-90 Minimum Reporting ~na].ysis Reporting Constituent Units Results Level Total PetroleUm Hydro- carbon as Gasoline ug/g None Detected 5.00 Comments: California D.O.H.S. Cert,, #225 ti Naresh C. Jain, Ph.D. ,~a onal ~, 1~ ~!~.~ ~o~o~ o.c~o~ loxlcolog¥' s~, Thomas C. Sneatll, B.$. Chief Toxicologist I.aborator~es ~.c. ,, 1100 California Ave. Bakersfield, California 93304 805 / 322-4250 800 / 350-3515 FAX 805 / 322-4322 Total Petroleum Hydrocarbons Gasoline B. S. Construction Date of P.O. Box 2624 Report.: 1,9-0ct.-90 Lake isabella, CA 9,3240 Lab#: 1.001.90E-12 Attention: Nick Silicz ' Sample Description: Bakersfield Well & Pump Sample #6 - Dispenser 6' Test.. Method: Calif. DOHS Type of Sample: Soil Date Sample Date Sample Date ~nalysis Collected: Rec'd @ Lab: Completed: 28-Sep-90 Ol-Oct-90 19-00t-90 Minimum Reporting ~nalysis Reporting Constituent Uni t.s Resu 1 ts Level Tot. al Petroleum Hydro- carbon as Gasoline ug/g None Detected 5.00 Comments: California D.O.H.S. Cert.. #225 GIBSON OIL & REFINING CO., INC. 3300 TRUXTUN AVE. , SU]:TE 200 BAKERSFT ELD, CALZ FORNI:A 93301 (SO5) 327--0413 ..................... FAX NO.-'"805--S61' 0229 FA..'~ TRANSM]:TTAL C_O._V.__ER SHEET DATE= ,//~- ~ 4- ~/f) ....... To= © .~.~_.~ ~ .. ..... ~- / ........ NUMBER DIALED= ~-~_~ FROH: ~~ SENT BY: ~~ ......... COMMENTS: NOTE: IF YOU DO NOT RECEIVE ALL OF THE PAGES ]:NOZC~TED ABOVE, PLEASE CALL THE FOLLOWING NUMBER (~05) 327-0413 :',. TOTAL P.02 GIBSON OIL & REFINING CO,, INC. 3300 TRUX?UN AVE. , SUITE 200 BAKERSFIELD, CALIFORNIA 93301 (805) 327--0413 .............................. FAX NO. '805--861'--0229 ......... ' ........................... FA~ TRANSMITTAL C_O~.__ER SHEET NOTE.' IF YOU DO NOT RECEZVE ALL OF THE PAGES ZNDZCATED ABOVE~ PLEASE CALL THE FOLLOWZNQ NUNBER (805) 327-0413 F~ ~ ~ ~. ~o ~x~. ~ and Front of Tox~ ~bSla~l ~ ~ ..: .~-', .. ,:. · ... ..'.:...;.: '...:..'.. :... ..'.'.. ~ , . . . .: .~'¥~.~ ...,.,~.':~.~.~ ~..';';.' .~ . ,.... · ......;.... ........; .....' ..: ~ '.?..~ ~' j, ,: .~ .: '-.:'., ,' .:..-.-.., .'~.. ~;', · .;.'... '... ,'. '.',,.,~'~' '~-.../.'~ .-- , ..... . .: .... ............. . ...... . -:... ~.~,...... ~:~.. ~..~,.... ~.~: .:...~ ~ ~.~;~.~',. ~.~. ~ ~~~. ,..: '..'x '.'~,..~ ....~. ....... :'.'. .,.,. ,~..~'. .. .... , ....... ,,~ ,,.., ~ .... .- .; ...~ ~,.~ ,. ~.. ../.,. T~CKIN~ ~ ',.~ accel of tank(a) · /~-: ~' section'2 "'-~To be filled out 'by ':cont~aciOr""de~on~s'~'tnattnE , ' ' ~ ' "' "<. -' ' .,... "':' ~' '?' · :: -.': ~' ;'.'~' "" '; ', " -:~: ' ".. · ..... .:.-?-:>:. -...:i-:..'AUthorized ""' ':' "" ....... ~ representative"of ':fiontractor certt fies ~by" Signing' 7belo~' :::"':~:'::~.:":'>':?;i:'tank(s)'" '':> .'bare been decontaminated In accordance with Kern ~Count7 ?::-:~.'.:~C~?~,-.:..::- ' Department ~'requlrements. -: ~.., c .: ~ .!-~ :::*,' -;:. ?:- : ,- ~ ~- - ~,:~:.~.~..- - . ;~:~. "~. .....::. Sl~nat~r :.-, ,',~ :. ~ .'.. . :- .... - ..... ..... -Tltie . ~.' ,;-. ~ -.-' - ..~ . .~ ~.. ~,~ '~ -~. ~ . xa.~ , . .... .'::.:,..?.:~eetton 3':z"'To ~be' filled 'ou~ and ~sl~ne~ ~ an -authorized :.:C'~ ":-.:".~ - ' ' ~ ' ~' : _ / ..%~:.~t,-,.,' .... Da~e Tanks. Recet~d v'. ...... ~ / .a~ '..,?..-,;~ ''.~ :. . of .... ',-:~:~:::.- . Signature ~'~ ~~ .'Title · * * ~AI~ING INSTRUCTIONS: 'of tx~ e~ .. :. Fol:~ In half and staple. Fosta~e and -- :"~ '-::.'::" - "label have &Iready been f ~ outside rbr your .convenlence;"*~<:-j:_:~(~/: :~" . .: ;.. ,:. ?.... .... "- (Form ~III, I~IP-150) : · '~ "- '" " "' "".' ": :": .:~:';~'~;-.- -. '" ':~:.:~::,' ... .,D~STm~. . orates ,'.,' -' :., , ,.TM:: ,:,..,. .::?:? -.:.-. CHAIN OF CUSTODY FORM Shtpped ~ro~ _~. ~-~_~_~_~_~_ '~ ~-~ Addressl _ Phone~ __~_~_:~2. ~ / To: ~ational 'T. oxicology Laboratories, Inc. Addressm 5101 l&th Street, Suite 107 Bakers{ield~ CA 95~01 Phmne~ '(805) 322-4250 Sample In~orma~.~on Number o~ Samples:___~-___ Sample Collector: Sample Description, _~Z~ .... D.O.T. Shipping Class HazardOus Class: ........ phaln o~ Possession Shipping In~ormatian ..... 2. Company. Name Inclusive Dates Signature Shipping In~ormation ~. National Toxicology Labs, In~ Received. By: A~~ ~~ Date: ~eceived By: Date: Ti me: Purpose:. Received By: Date: Time: Purpose: Received By~ '- Date: Ti me: Purpose: " CHAIN OF CUSTODY FORM ~ig Tot ~ational 'ToxicoloGy Laboratories~ Inc. Add~essm ~101 lSth Street~ Suite 107 Bakers{ield~ CA Phonet '(805) 522-4250 Sample In~orma~i on ... D.O.T. Shipping Class Hazardous Class: _-- I I Anal ysi s Requested III Chain ~ Possession · Shipping In~orma[ion ...... 2. Company Name Inclusive Dates Signa[u~e ..... Shipping Information National Toxicology ~abs~_In~ Received By: Date: Ti me: Purpose:. Received By: Date:' Ti me~ Purpose: Received By~ '- Date: ....... Time: Purpose: RANDALL L. ABBOTt 2700 M Street, Su/te 300 Agency Director Bakersfield, CA 93301 (805) 861-3502 e Telephone (805) 861-3636 · ' ..... * · ~ Telecopier (805) 861-3429 STEVE Mc CAM. EY · Oi,-e,=or RESOURCE MANAGEMENT AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH SERVICES PERMIT FOR PERMANENT CLOSURE PERMIT NUMBER A 1298=15 OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY '"-FACILITY-NAME/ADDRESS: .......... ' .... OWNER(S) NAME/ADDRESS: ..... CONTRACTOR:: - ................"-~" '- '= .... - Bakersfield Well & Pump Elwood Champness B.S. Construction 1600 E. California Ave. 1600 E. California Ave. P.O. Box 2624 Bakersfield, CA 93301 Bakersfield, CA 93301 Lake Isabella, CA 93240 License #518528-A Phone: 805-324-6026 Phone: 619-379-4003 PERMIT FOR CLOSURE OF PERMIT EXPIRES November 20~ 1990 _1 TANK(S) AT ABOVE APPROVAL DATE . /~ August ~.0bx1990' Hazardous Materials Sl~/cl~list ............................................................................... POST ON PREMISES ................................................................................ CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work (i.e., City Fire and Building Departments). 2. Permittee must notify thc Hazardous Materials Management Program at (805) 861-3636 two working days prior to lank removal or abandonment in place to arrange for required inspections(s). 3. Tank closure activities must be per Kern County Environmental Health and Fire Department approved methods as described in Handbook UT-30. 4. It is 'the contractor's responsibility to know and adhere to all applicable laws regarding the handling, transportation or treatment of hazardous materials. $. The tank removal contractor must have a qualified company employee on site supervising the tank removal. The employee must have {auk r~moval experience prior to working unsupervised. 6. If any contractors other than those listed on permit and permit application are to be utilized, prior approval must be granted by the'specialist listed on the permit. Deviation from the submitted application is not allowed. 7. Soil Sampling: a. Tank size less than or equal to 1,000 gallons - a minimum of two samples must be retrieved from beneath the center of the tank at depths of approximately two feet and six feet. b. Tank size greater than 1,000 to 10,000 gallons - a minimum of four samples must be retrieved one-th{rd of the way in from the ends of each tank at depths of approximately two feet and six feet. c. Tank size greater than 10,000 gallons - a minimum of six samples must be retrieved one-fourth of the way in from the ends of each tank and beneath the center of each tank at depths of approximately two feet and six feet. 8. Soil Sampling (piping area): ...... A minimum oI two samples.must be retrieved at depths of approximately two feet and six f_ee_t for. every 15 linear feet of pipe run and under the dispenser area. PERMIT FOR PERMANENT CI~)SURE PERMIT NUMBER A 1298-15 OF UNDERGROUND HAZARDOUS ADDENDUM SUBSTANCES STORAGE FACILITY 9. Soil Sample analysis: a. All soil samples retrieved from beneath gasoline (leaded/unleaded) tanks and appurtenances must be analyzed for benze'ne, toluene, xylene, and total petroleum hydrocarbons (for gasoline). b. Ail soil samples retrieved from beneath die, el tanks and appurtenances must be analyzed for total petroleum hydrocarbons (for diesel) and benzene. c. '- Ail soil samples retrieved from beneath waste oil tanks and appurtenances must be analyzed for t'otal organic halid~s, lead, ~[I a~-~::~k~. d. All soil samples retrieved from beneath crude oil tanks and appurtenances must be analyzed for oil and grease. e. All soil samples retrieved from beneath tanks and appurtenances that contain unknown substances must be analyzed for a full range of substances that may have been stored within the tank. f. Ail soil samples retrieved from beneath tanks and appurtenances that contained furfuryl alcohol resin must be analyzed for phenols, formaldehyde and furfuryl alcohol. 10. Thc following timclablc lists pre- and post-tank removal requirements: ACTIVITy ' · ' ' . DEADLINE ....... Complete permit application submitted At least two weeks prior to closure to Hazardous Materials Management Pro,ram Notification to inspector listed on permit of date Two working days ' and time of closure and soil sampling Transportation and tracking forms sent to Hazardous No later lhan $ working days for transportation and 14 worting Materials Management Program. Ail hazardous waste days for the tracking form after tank removal manifests must be signed by the reCeiver of the hazardous waste Sample analysis to Hazardous Materials Management No later than 3 working days after completion o~ analysis Pro,ram 11. Purging/lnerting Conditions: a. Liquid shall be pumped from tank prior to purging such that less than 8 gallons of liquid remain in tank. (CSH&SC 41700) b. Tank shall be purged through vent pipe discharging at least 10 feet above ground level. (CSH&SC 41'/00) c. No emission shall result in odors detectable at or beyond property line. (Rule 419) d. No emission shall endanger the health, safety, comfort or repose of any person. (CSH&SC 41700) e. Vent lines shall remain attached to tank until the inspector arrives to authorize removal. RECOMMEHDATIONS/GUIDELINES FOR REMOVAL OF UNDERGROUND STORAGE TANKS This department is responsible for enforcing the Kern County Ordinance Code, Division 8 and state regulations pertaining to underground storage tanks. Representatives from this department respond to job sites during tank removals to ensure that the tanks are safe to remove/close and that the overall · job performance is consistent with permit requirements, applicable laws and safety standards. The following guidelines are offered to clarify the inlerests and expectations.for this department. 1. .lob site safety is one of our primary concerns. Excavations are inherently dangerous. It is the contractor's responsibility to know and abide by CAL-OSHA regulations. The job foreman is responsible for the crew and any subcontractors on the job. As a general rule, workers are not permitted in improperly sloped excavations or when unsafe conditions exist in the hole. Tools and equipment are to be used only for their designed function. For example, backhoe buckets are never substituted for ladders. 2. Properly licensed contractors are assumed to understand the requirements of the permit issued. The job foreman is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit COnditions may result in a stop-work order. .3. Individual contractors will be held responsible for their post-removal paperwork. Tracking forms, hazardous waste manifests and analyses documcntation are necessary for each site in order to close a case file or move it into mitigation. When contractors do not follow through on necessary paperwork, an unmanageable backlog of incomplete cases results. If this continues, processing time for completing new closures will increase. Accepaed By: OWNER OR AGENT DATE MD:ch driggs\ 1298-15.pta KERN COUNTY REE.C.c.c.c.c.c.c.c~URCE MANA~T ACENCY INTEI:~L USE Cf',ILY:.~/_/ ~ ENVIR(3"IMENTAL HEALTH SEI:~ICES DEPARTNENT APPLICATION DATE: '~-/'/-/~-~.~Z~- PTA: ,/~'/~.-/.~" 2700 'M' STREET, SUITE 300 ...... BAKERSFIELD. CA 93301 ~ OF TANKS TO' ABANDON: (805)861-3636 (F~LL OUT ONE. APPLICATZON PER FACZL~TY) ..... APPL~CATIC~ FOR PEI:~T FOR PERNANENT CLOGLJRE?ABANDONMENT OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FAC]'LZTY THiS APPLICATION IS FOR ~ RENOVAL, OR [] ABANDCiNNENT ZN PLACE F~ILlTYl~,~:Dakfld. Well & ~ump I~]L600 ~ California Ave. ~1:(805) 324-6026 CITY:Bakersfield- ZiP: 93301 I'$T~'l':WJ'~liams St 01~: Eiwood Characters l~a~'SSl600 P... California Ave. ISTATE:CA I ~i:-(805) 324-6026 ClW: Bakersfield CA ZIP:93301 [~: P.O. Box 2624 JSTATE:CA T~K~8(N~LCa~T~:B S Construction ~._ ' CJU:Lake Isabella ZIP:93240 ~1:(619) 379-4003 Ca~R~Tffi~qRI~I~5~L~:B S Construction ~.- ~X~: P.O. Box 2624 [S~IE: CA ~:(619) 379-4003 CfR: Lake Isabella IZI~: 93240 ~'$~N~T]~I: 1011675-89 ~-- [~:State Comp. Ins. Fund L~A~TN~LL~L~£5~U~:Nan'i Toxicology Lab ~:1100 California Ave ~:1805) 322-4250 ~ C]W: Bakersfield ~Z[P: 93304 ~ICAL ~TI~ OF ~TER[ALS STORED: T~K ~ VOLU~E ~]CAL STO~ED OAT~ STO~ED ~~L FO~ERLY STOREC TO ..... TO TO a Wa t e r t. ~ ~ ~ D]~ ]~ N]~IN ~ ~: None ~ ~]L ~ ~[ F~]L]U: Sand, Gravel&Clay ~]$~]L~~~~]~]~:Bakersfield, Well' & Pump John Woodard-Mgr. ~ ~l~l~Q~~anks triple rinsed w/cold water,Rinsate hauled to Gibson Ref ~,[~T]~T~:B ~0~onstruction ~l~~Tlffi~Rl~TE: bi Q~al. Va ~ ~: (619) 379-4 ~Gibson Refinery by Qual. Vacuum ~ D]~ ~[~($): hauled to AMR b~Q~ity ~ ~]~ ~ I~($): AHR, Ontario CA .~]~~pipl~:hauled to AMR by Q~al~ty ~]~~T[~P]P[~:/ AMR, Ontario, CA ~ vacuum ~~ ~~E ~E R~ SI~ ~ ~IS ~I~TI~ BEF~ ~l~l~ F~ ~I~ ~IS FO~ H~ BE~ ~LETEO UNOER P~AL~ OF PENURY ~O TO ~E B~T OF ~ ~LE~E R E C E I P T P~.GE i. 08/I?/90 ~nvoffce Nbn. 1 38530 9:27 am KERN COUNTY PLANNING & DEVELOPI~ENT 2700 'M' S'treet 8akers¢ffe]d, CA 93301 Tyoe :f Order ~ (805) 861-2615 CASH--REGISTER ................. - .... ' .......... ' .... BS-'"CONSTRUCT~ON ........ CusTomer P.O.% ~Cn ~y Order Oa~ Ship DaTe Via , Terms t4.08179.01 RAR 08/17./90 08/!7/90 iDD NT t Line Oescrffp~fion ~ Quan~ffty Prfice Unit Dffsc To~a] 1 PER~IT TO CLOSE/A8ANDON 1 250.00 E 250.00 I?0G Order T,:ta~ 250.00 Amount Due 250.00 P~%/men~ ?4ade By Check 250_00 THANK YOU! RANDALL L. ABBOTT 2700 M Street, Suite 300 Agency Director Bakersfield, CA 93301 (805) 861-3502 . Telephone (805) 861-3636 ~-~- ~ · ~ '.~ Telecopier (805) 861-3429 STEVE Mc CALLEY ' "~°"~'~ ' ~ ...... ~- "'"" Dire~or RESOURCE MA;N'AGEMENT AGENCY DEPARTMENT+OF ENVIRONMENTAL HEALTH SERVICES August 9, 1990 Bakersfield Pump Company 1600 East California Ave. Bakersfield, CA 93307 ATTN: Mr. Elwood Champnes ........ -'" Re: Underground Storage Tank -Permit #150027 Dear Mr. Champnes: On June 8, 1990, you advised'me in person that an application would be submitted to either remove or abandon-in-place the underground storage tank at your facility. Numerous requests have been made of Bakersfield Pump Company to submit the necessary information to be in compliance with the laws. As of this date, August 9, 1990, neither the transfer of ownership (permit to operate) or an application to abandon the tank have been received. You are, therefore, in violation of the following laws: 1. California Health & Safety Code, Division 20, Chapter 6.7. 2. Kern County Ordinance Title 8, Section 8.48.100 (A) (B); Section 8.48.140; and Section 8.48.150. It is necessary for this office to request that you appear for a hearing to show cause why a complaint should not be filed against you. Please appear at the Kern County Environmental Health Services Department~ 2700 "M" Street, Suite 300, Bakersfield, California 93301, on: DATE: August 16, 1990 TIME: 9:00 a.m. At that time you, or your legal representative may present information to the Hearing Officer and discuss with our staff the laws violated. Failure to appear at this administrative hearing may forfeit your right to further appeals prior to court acti. on. We hope that you will appear for the hearing so'this problem can be resolved. ~_~_C~c~F~ Mibhael D~iggsJ ~E.H.S. ~"~'~ ~e_f~n ~J.~ Hazardous )tate~i/a~s Specialist ~]~- ~-~ Hazardous MateYfa~s Management Program MD:ch drigg$\bakpump, let GARY J. WICKS 2700 M Slreet, Suite 300 .Agency Director t Bekerlfleld, CA 93301 (805) 861-3502 ~,.'~.-??'~"~-~-c~ 'Telephone (805) 861-3636 ;f,r,,, -.?:_ Telecopier (805} 861-3429 STEVE McCALLEY Director RESOURCE ~.EN'T AGENCY DEPART~~MENTAL Hay 30, [990 Bakersfield Pump Company 1600 East California Avenue Bakersfield, CA 9SS07 ATTN: Mr. Elwood Champnes RE: Underground Storage Tank - Permit #15002? Dear Mr. Champnes: On October 6, 1989, a routine inspection of an underground storage tank was conducted at 1600 East California Avenue, Bakersfield, California. At that time, the permit to operate (#150027) had the facllit$ listed as Layne-Western Company, Inc. Mr. Joe Lopez, employee of Bakersfield Pump Company, 'was advised the County (permitting authority) must be contacted within S0 days of any change in ownership. Mr. Lopez was also advised if the new owner wished to abandon the tank, an application would have to be submitted and a permit obtained. The necessary forms and information were Given to Mr. Lopez at that time. Since that time, numerous requests have been made of .Bakersfield Pump Company~to submit the necessary information to be in compliance with the laws. On May 4, 1990, this inspector contacted Mr. Joe Lopez and Mr. Champnes (son) at the facility at 1600 East California Avenue and again advised them of the owner/operator's'responsibility, under law, of the necessary conditions to operate or abandon an underground storage tank. All the necessary forms and information were Given to them. As of this date, May 30, 1990, neither the transfer of ownership (permit to operate) or an application to abandon the tank have been received. You are, therefore, in violation of the following laws: Elwood Champnes Page Two May 30, 1990 1. California Health and safety Code, Division 20, Chapter 6.7. 2. Kern County Ordinance Code Title 8, Section 8.48.100(A)(B); Section 8.48.140; and Section 8.48.150. It is necessary for this office to request that you appear for a'hearing to show cause why a complaint should not be filed against you. please appear at'the Kern County Environmental Health Services Department, 2700 "M" Street, Suite 300, Bakersfield California 93301 on: DATE: June 6, 1990 TIME: 10:00 a.m. At that time you, or your legal representative, may present information to the HearinG Officer and discuss with our staff the laws violated. Failure to appear at this administrative hearing may forfeit your right to further appeals prior to court action. We hope that you will appear for this hearing so this problem can be resolved. Sincerely, Hazardous Materials Specialist Hazardous Materials Management Program MD:iq Permit ~ · , Environmental Sensitivity .ion Time '-' . ~ UNDERGR~IUND HAZAROOUS SUBSTANCE STORAGE FACILITY * INSPECTION REPORT * ~-" '~-~ ' ''" ' """" Address ~ *" ' ',~ ' Facility Name .. ~_~,~_... ~ . ~_ . .... No. of Tanks .~[ ;~ Is Information on, Permit/Application Correct? Yes ,~'N'~.'?~' Permit Posted? Yes __ No Type of Inspection: *, Routine ,' ~, Complaint Reinspection. Comments: ." ' ' ' ~ ' '; ' ~ ' ~.~-.. -~ , . ~ .~-,; ~, · ~ . . L,' ", ~i, TEM' ~ VIOLATIONS NOTED 1. Primary Containment Monitoring: < , , ',~-? "~.'?" ' ~""' ~' '~;' -~ .~-~ ----~-' i; '"- ~-~ a. Intercepting and Directing System "~ ~ . ,-, ~.. ~ ..~, .._~: ~._~ ~-_.. , .....-~'.~ .-.: _. [ .~ ~'-~-' ~.~ ,' b. Standard Inventory Control Monitoring ........ "~'~" '~'~' - c. Modified Inventory Control Monitoring ' '~ -" ' ' d. In*Tank Level Sensing Device 'e. Groundwater Monitoring .......... ~ f. Vadose Zone Monitoring ~t~k ~.~ 2. Secondary Containment Monitoring: a. ~Liner b. Double-Walled Tank 3. Piping Monitoring: a, Pressurized b. Suction c. Gravity 4. Overfill Protection 5. Tightness Testing ..~. 6. New Construction/Modification 7. Closure/Abandonment. ,.. 8. Unauthorized Release 9. Maintenance, General Safety, and Operating Condition of Facility ~- Comments/Recommendations: .... ?", '~ ~ - - ,---~, ~ . -' ~ ..... ..£~ ;,;:', ~ Reinspectio~ .~cheduled? Yes No Approximate Reinspection Date INSPECTOR: ~ "~ ~ REPORT RECEIVED BY: Health 580 4113 170 (7-87) (805) 36i-3682 .. . ~:.,,~ ~,~'~ ~E ! VA~R RE.VERY INSPEC'T!~ FO~ . ~ , ~ ~ A ' ._ ........... ' .............. x .......... . ...................................... . ~, '~-;?" ~-~'""~' 1. PRODUCT (UL,, ~JL, 9, on R) ' " _.. .... TAN~uA .... N RcF,RENC= 5. B~K~-C~ LOCK ON VAPOR CAP 'x. B. F~LL CA~ NOT P~PERLY S~TED ?. VAPOR CAPS NOT PROPERLY SEATED --- . ..,: ...... ~ F~ FILL CAP 9. GASKET ~ISSING FRO~ VAPOR CAP .. - 10. FILL ADAPTOR NOT TI~T !1. VAPOR ADAPTOR NOT TIGHT !2 GASKET ~ .... ......i~_~w mx, ADAPTOR ~ ~rH TUBE ;~ISSING ,/ !NP~PERLY SEATED !3. ORY BREAK ~SK~S DETERIORATED ~ T* 14. ~C~a, ¢E VERTICAL PL.&Y ~N ~AXIAL (rl~ .... ~ , ,,, v FILL ~lt~: "~ " ~RNED ;N THE 1.4RONG OZRECT;ON MECH~ ISM DEFECTIVE , ·. ~',,., 4 ..... U.,E. ,_NT 18. TUBE LENGTH MEASUREM~4T ..... ........ =:~.,= ('SHOULD .~- 0.~ LESS) NOTE: A ,%'2HECK ABOVE INDICATES A VICL~TZON OF KCAPCD RULE 209. RECEPT OF GASOL!NE PRIOR TO CORRECTION ~,Y (JRTHER CC~STI'FOTE A VIOLAT!CN OF KCAPCD RULES 209 & 412. ~a~,.ers, ,ai . CA. 93301 " ~ASE II VA~R RE.VERY INSPECTI~ FO~ - . h '"t ~ ........................................ .aA.-. GRADE ~' 2. CHECK VALVE Z 4. RING, RIVET I ~ 5. SELLCNS ] I , I ' ' ? ~. S~VEL(S) ! i ~ ~ I I ' I Ii ~ff' FLOW __!M~TER~~(~} ' 1. HOSE CONDITION . : A P LENG~ t ~ 0 3. C~FIGURATION .. , , I t ~ ' 4. SWIVEL ' ~ I , I E 8.~ POWERX,.P~LOT C'N OTHER I I I I t t I .. ~ :_ ' ~ ~, ~ ,, ~ I I I ~ i , ; SA=Sa] arise RE~eaqe~ RJ=Red Jacke% GH=Gu']¢ i,asseqmann :':= sro.. ; ~=., =~ :,g ec, .,= kffnked. FR= frayed >*~ iNSPECTION RESULTS KeV ..".o inspect-;on results: C'nec:k= OK, ?= Repaffr with,- C~ENTS: X%%¢: ....... ~ NOTE: C~L!FO~IIA,~L~- &-SA~ ,~DE SECTI~4 41960.2, RE~!RE¢ ~AT ~E A~VE LISTED 7-DAY 3:FiC,ulCi:= $E.~REC~cD N.~I,I , DA,~.' FAILURE TO CC~P~'f ~AY R~LT IN LEaL ACTI~ ' 1700 Flower Street KERN COUNTY HEALTH DEPARTME HEALTH OFFICER Bakersfield, California 93305 Leon M Hebertson, M.D. Telephone (805} 861-3636 ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Reichard INTERIM PERMIT ~% PERMIT~15OO2 7C TO OPERATE '- ISSUED: JULY 1, 1986 EXP I RE S: JULY 1, 1989 UNDERGROUND HAZARDOUS SUBSTANCES STORASE FACILITY NUMBER. OF TANKS= ! ...... FACILITY: I OWNER: LAYNE-WESTERN COMPANY, INC. I LAYNE-WESTERN COMPANY, INC. 1600 EAST CALIFORNIA AVE. I 1600 EAST CALIFORNIA AVE. BAKERSFIELD, GA ~ BAKERSFIELD, GA 93307 TANK # AGE(IN YRS) SUBSTANCE CODE PRESSURIZED PIPING? 1 5 MVF 3 UNK NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT NON--TRANSFERABLE ~ ~ ~ POST ON PREMISES DATE PERMIT MAILED: AUG 2, 5 1986 DATE PERMIT CHECK LIST RETURNED: . Division ol: Environmental He~ch ApplicationWte 1700 Flower Street, Bakersfield, CA 93305 '~PLI~TION FOR PE~IT ~ OPE~TE ~E~R~ ~~US SUBST~CES S~E FACILI~ T~ o~ Application (ch~k): ~New FaCility ~ification of Facility ~isti~ Facility ~ansfer of ~ershtp Osc~ Ma~ A. ~ergen~ 24-Hour Contact (n~e, area c~e, ~one): ~ (805) 324-6026 .Nigh~80.5 ~ 83~- 8043 Facility ~ LAYNE-WESTE~ COMPANY. INC. ~ of B~iness (check): ~line 'S~t~on ~er (de~ri~)W~ W~, D~nq Co~. Is Tank(s) ~cat~ on ~ Agricultural Fa~? ~Y~ Is Tank(s) Us~ Pri~rily for ~ricultural ~r~ses? ~Yes Facility Addre~ 1600 F~s~ C~3~3~ ~u~ ~0~ Nearest Cro~ St. W~~ St. T 29S R 28E SEC S~ ~28 (R~al ~atio~ ~ly) B. ~r ~ ~acili~ Provid~ by C~o~a W~er Service ~p~ ~' Gro~~r Unknown ~il ~aracter~stics at ~acility U.b~r~w~ , ~sis for Soil ~ a~ Gro~ter ~p~ '~te~inati°~ Unknown , , C. Contractor ~ ~ntractor's ~ce~e Pro~s~ S~rti~ ~ Pro~s~ C~pleti~ ~rker's C~~ti~ Certi~f6atf~ ~ In~rm~ Pro~ E. T~k(s) Store (~eck all ~t a~ly): Tank ~ ~s~ Pr~uct ~tor Vehicle Unlead~ R~ular Pr~i~ Die~l ~ste Tank ~ Ch~i~l Stor~ (no~c~rcial ~e) G. Transfer of Ownership Date of ~--ansfer Previous Owner Previous Facility Name I, accept fU-~i'y all o61'{gations of 'permit' N~. issued'to . I understand that the Permitting Authority m--~-~eview and ~x~ify or terminate th~ transfer of the Permit to Operate this %~dergro~a%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. - TANK ~ (FILL OUT SEPADJVFE FORM F. .! TANK) FOR EACH SECTION, CHECK i~J~L APPROPRIATE BOXES H. 1. Tank is: []]Vaulted [-]Non-Vaulted []Double-Wall [~Single-qWall 2. ~ Material [] Carbon Steel [] Stainless Steel [] Polyvinyl Chloride [] Fiberglass-Clad Steel L-] Fiberglass-Reinforced Plastic [] Concrete [] Al~ninu~n ~ Bronze []Unknown []Other (describe) 3. Primary Containment Date Installed Thickness (Inches) ~Capacity (Gallons) Manufacturer 1 I- I - 80 i" I O, 000 Modern Welding 4. Tank Secondary containment I-]Double-Wall D Synthetic Liner []Lined Vault ~None ~jUnknown [-]Other (describe): Manufacturer: ~Material Thickness (Inches) Capacity (Gals.) 5. Tank Interior Lining DRubber []Alkyd [']Ep~x¥ ~Phenolic []Glass []Clay [qt~lined [~]L~known []Other (describe): 6. Tank Corrosion Protection " ---~GalvanfZed ~ass-Clad [-]Polyethylene Wrap []Vinyl Wrapping ~'TTar or Asphalt []Unknown []None []Other (describe): Cathodic Protection: ~one ~]Impressed Current System ['lSacrfficfal ~ode System Describe System & Egui~ent: 7. Leak. Detection, Monitqring, .and Int~ a. Tank: []Visual (vaulted tanks only) [-]Groundwater Monitoring' Well(s) []Vadose Zone Monitoring Well(s) [-]U-Tube Without Liner []U-Tube with C~patible Liner Directing Flow to Monitoring Well(s)* [] Vapor Detector* [] Liquid Level Sensor* [] Conductivit~ Sensor* [] Pressure Sensor in Annular Space of Double Wall Tank [] Liquid Retrieval & Inspection From U-Tube, Monitoring Well or Annular Space [] Daily Gauging & Inventory Reconciliation []Periodic Tightness Testing []None []Unknown []Other b. Piping: Flow-Restricting Leak Detector(s) for Pressurized Piping' [] Monitoring S~m~p with Raceway [] Sealed Concrete Raceway []Half-Cut C~mpatible Pipe Raceway ~Synthetic Liner Race~ay []None [] Unknown [] Other *Describe Make & Model: 8. Tank Tightness l~is Tank Been Tightness Tested? []Yes []No ~]Unknown Date of Last Tightness Test Results of Test Test Name Testing fl~mpany 9. Tank Repa i r Tank Repa~ed? []Yes ~No ~Unknown Date(s) of Repair(s) Describe Repairs 10. Overfill Protection ~Operator Fills, Controls, & Visually Monitors Level [-]Tape Float Gauge []Float Vent Valves [] Auto Shut- Off Controls ~Capaci~ance Sensor []Sealed Fill Box []None ~Unknown []Other: List Make & Model For Above Devices 11. Piping a. Underground Piping: [qYes [-]No []]unknown Material (~_-~~.~ Thickness (inches) Diameter Manufacturer []Pressure []Suction '~Gravity Approximate Length of 'Pipe R~ b. Underground Piping Corrosion Protection : Gal'vanized []Fiberglass-Clad [-]Impressed Current ~Sacrificial Anode Polyethylene Wrap ~Electrical Isolati~'. ~Vinyl Wrap ~]Tar or Asphalt [JUnknown []None [-]Other (describe'.,: c. Underground Piping, Secondary Co~.~.a[~nent: ~Double-Wall [']Synthetic Liner' '-:,,'stem ~e ~]Unknown [-]Other (describe):