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Home My WebLink AboutFMC RESULTS 2008JOB CARD POST. CARD AT JOB SITE INSPECTION RECORD-USTs s axarr a ~-~s - w11rTM t BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FACILITY NAME ~ ~ OWNER n ADDRESS ~ ~ © p ~ ~ 1 ADDRESS o ~ ~ 1 ~ . tl ~ CITY BAKERSFIELD STATE CA ZIP 9 3 3 i a, CITY (0~5 STATE ZIP 15 PHONE NO. ~ ~ ~~ ~ - ~ ~ ~ PERMIT NO. ~ ~ ' O ~ ~~ INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER 1. DODO NOT COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE INSPECTOR TANKS AND BACKF,ILL BACKFILL OF TANK(S) ~~ ~~ SPARK TEST CERTIFICATION OR MANUFACTURES METHOD ~.~~ 1 O ~ ~ C ATHODIC PROTECTION OF TANK(S) n 4J ,i I~( -- PIPING SYSTEM ~ S PIPING &~A AY W/COLLECTION SUMP .• ~ ~ I ~ m`1S ''1 ` ~ CORROSION PROTECTION OF PIPING, JOINTS, FILL PIPE ^ ref ELECTRICAL ISOLATION OF PIPING FROM TANK(S) CATHODIC PROTECTION SYSTEM-PIPING ~~ .~ DISPENSER PAN r - _ - SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION ., LINER INSTALLATION -TANK(S) LINER INSTALLATION -PIPING VAULT WITH PRODUCT COMPATIBLE SEALER LEVEL GAUGES OR SENSORS, FLOAT VENT VALVES (~ ~ ~ - PRODUCT COMPATIBLE FILL BOX(ES) . PRODUCT LINE LEAK DETECTOR(S) ~ ~ - ^ LEAK DETECTOR(S) FOR ANNUAL SPACE-D.W. TANK(S) ~. MONITORING WELL(S)/SUMP(S) - H2O TEST LEAK DETECTION DEVICE(S) FOR VADOSE/GROUNDWATER SPILL PREVENTION BOXES l FINAL MONITORING WELLS, CAPS & LOCKS FILL BOX LOCK ~. br-~ MONITORING REQUIREMENTS TYPE ~'-" . ~S- ~ ( L ©•~ , AUTHORIZATION FOR FUEL DROP ~ ~, ( CONTRACTOR IIG , ~ ~V ~lS LICENSE NO. ~ 9 ~ ~ © O- 14 • N~1 Z CONTACT i 1 f1A , I PHONE NO. ~oS "' '^I QQ - o ya g FD 2097 (Rev. 09/05) ~~~ uc~~o c (.~ ~~c~ r ~ ~ f s ~ ~ ~~ C~c ~.'~ ~ ~ i~ s , 7 ~ LAS ~ ~ ~ ~ , o ,~ ,~ ~~C.J ~~ cL,l r ~~c~~ ~~ ~~e~ 'P`O eG~, ~'~1J ~S J --~-~ i~-~-- '~'~-'~ C ~. l1 e ~, X01 ~'1 ~ ^- S ~ ~~~d~ ~d f ~f'~`~~ 09-07-'07 12:36 FROM-QPM,LLC 8185674273 A,+ CERTIFICATE CAF ~.IASi~.l1"Y 1111a1.IFtAWr:~ +xwuc~ 8 CEfi 18 fSS11ED !IS A G~vlanler~t t 1,1 ~~~Y aao Cotats~s pa WAS ~A e rreo A9D tnaural~ce 6 Finrnctat $siviOSs 2160 He+a-B-ome Bfvel.. Sake Bb0 tC-f9113,yf>, CA 9bd49-41tb NSttR® FC.L. 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PJdDOffSpIIENT /200t! lliT3TLQD C!t[YIIIGTd HDLPaR'f' KQ1Z4~ ~1'-lCfIV~ '1Q-Of-tOba LS ATTAt~4 1'O /WD iM~gFS A pAftT D>ti YitYg (+Oi.YCY. ~~~ K E CIiRTtg CQli3TfkUCTIt>ri t701i~Afi1' SMC ANt?!OR CAEI[r701er i1QBERT {stfp plD tipilSJO 1m T~Mg<JfR PAf~fC G titSA51 ~g19,N PR1t4Tf?0 ~d»Otl-Y (RCY.P~OR ~+ w m ~~ m _ m m a. m 4 I~~~~.~~T~~~~L ~o~~ ~~~vc11 .~ H ~ -•,.~~... IJS~' IPISfiAL1~'~IQ~~~ETR.~}~I`~T`I~TG gam. t~sis dca~r Qf I?~c~~r~ ~8, 20a4 U .~ a o~ w cn M N N ti m ~I m I 07 .P ~~ r. xodge ~_. t'r~tidezz[. ICC~Haard of punect~s ~~ James L. Witt ]~(.' Ct~tef r'•Y~E[tlISS'IG DfFicer 5222437-UL Cesti4~Ca~e 1~urnber {~D[}E CaUN~IL~ 09-87-'87 12:36 FF30M-QPM,LLC ggp41v9tl~ t',Z'/28/04 10:24AM, 8b~a~Jap~6b(3 iZ/~fl/2Q04 11:28 FIIx 8oS4'J495g6 Y 61i IKY AlJY NSNTIGIII U~ ~n I:,rrtrs~s~t. promissc ly_arne; • Address .. y ; Cvn9r~' " will btl 1 (S CUfrO It ia° ~ poss~bi 9TT-78 . .te-i5~U '~ 'r 'ii . 8185674273 .s. OOy Fp~6 ~ ~O~^NtvO pip T.~E PROMIS'SOA I~GD WITY1 ~INGFA. RV IRL' raw ~r....~.... , ~~~'' ~ UST•lristatlatiof~lRetrofittin~" ... .~ ~~~ ,~.~ ~~ 001 v.~Y...V.• A9.~W. ~~ss,•i~i:. M r..7 tQ; XX4141014Q98 •,,,,, Ey~~3 NIDTHV OEVU5$~ft .Date' r;,µ :~ 1211BIa00 .; ,. i~lrth pat®::~„~ ~4l0311953 ~~,~;<J,T r 588~E~IZAt3>rtH GT ... •~.a. s;'~„~~`dr ... i''^•f a I °°'~"' ~~~~, TI:MPI_ETQN GA 93465 `,~.:r ~;.;.r~'Z5;'~?KZ~~3+~'~ . _ d I; EXpMI{rIATIQN Rf=SUt~T~ pi$c9~ '~~ ,~~' • . s. 5'~'". ~~~~. ° ~ ~pUr'INettQt card and oertifll~t6'°'- p Y~rr~~ atios~51 Yau have pa65ed N+0 tJ8T InS~~lalionrReVOi}tilrrg e~dmia9Yap: 7T,i0 40 ; ~ ~ ~' p~u'~ w9rderi to you by, ICC wilhln six weeks fmm me cast dey of +ne rnenth in which you leafed. ~,,~.s ~~~~ .6.~„ ~f.~'i~ for eddre~ la avoid 4~ib•.`~`', .".+'," rngty Ir ~p.~nant Ihat you r+ar+Ty Prprrtlssor and ICC of any change9 In.~~,~~ ~ ~~~!}„ y a1 your•:CrGficBt@ nvt beln~ reGelvcd. Please ooAtaCi Pfomis80~d1 8 Tb 3 artid ICC at ~~~~#;. " 3s28 wlm changes to your name and addrl~S. Thsra may be an_ atltlltlpn8l fes`fcstlit~etl°n is ;;~; ;-~ :•; tlua to a missaelled name or ht¢orrecr address. '~,° ^'i' :~a."~ ~'~ sy'f;,, g~~~~' ~:. r ~. ' }a~' p~c' ':7 ~' ,~~,. vs..ci~''.Ka~ '' ~u '+V.. ;,7+x• nq fit- y,.~. ri.: yea' ~u ~a •kN~~ ~ 4 9 J ~ i • p,^ •b' 'O.'•"Iry ' ~'" ~p C ~ Y' „, ~w` " 1 P~ , s, yy ~~ { \ .fie+ ' r • 1 , ~ Lui L, ~iw. ,1.i'.~ ., tif" •,'~°^~ ., . ~. ~ ,.z.~ .. x.54_ .._ J.°.c T-3~9 P008/02~ F-884 ~~ ~'"~ ^~;~` • I• • f~~.. yid,., 'S ,:. ~.ay C W'•~~' Y~ 15101U UFid li3'1 N109 4V]_ v n3N11v0 ~Iti~ An:7~101, xn'/~ A~vaA_~~ 6vM0 a0'1O7 S3pN tl•t'J ~VMJ ONr10d911 M9 OJ~QIOJ U~nw 09-87-'87 12:37 FROM-QPM,LLC 8185674273 T-3~9 P009/020 F-884 Site Specific Health & Safety Plan Site Information: 7-Eleven Bakersfield, CA Customer Information: 7-Eleven Scope of Work; Contractor Information: K E Curtis Construction Co., Inc 1400 ~Id Conejo Rd Newbury Park, Ca 9132Q Project Supervisor: Bob Cannon 8fl5-402-2172 Site Safety Cover Prepared 9!8!2007 Plan Form RaviSed 8/2007 09-07-'07 12;37 FROM-QPM,LLC 8185674273 T-309 P010/020 F-884 JSA (Job Safety Analysis) Contractor Site Address KEC Project Superintendent K.E. Curfis Construction Co. 7-11 13vb Gannon 1400 Old Conejo Road 805-402-2172 Newbury Park, CA 91320 Bakersfield CoP Project Coordinator Safety Officer Bob Dippell 714-815-77Q9 PERSONAL PROTECTIVE EQUIPMENT REQUIRED ON SITE Wark boats, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVED RECOMMENDATIONS FOR SAFE WORK Mark for Underground Physical injury from being ^ Maintain increased level of awareness Service Alert. Make notes struck by moving , Use appropriate traffic control measures on any other possible vehicles. safety hazards. Notify Under-ground Service Alert 48 hours prior to any invasive activities. Perform on site safety Discussion of possible ^ Discuss potential safety concerns before meeting (Day of job start hazards for daily tasks commencing work up) Inform management personnel of scope of work and discuss potential hazards involved during work activities including exposure to heat, noise and chemical contaminates ^ Perform Tailgate safety meeting reviewing site specific hlealth and Safety Plan, JSA, Safety Ghecklists and sign off sheets. 09-@7-'@7 12:38 FF~ONJ-QPM,LLC 8185674273 T-309 P011I@2@ F-884 JSA (Jab Safety Analysis) Contractor Site Address KEC Project Superintendent K.E. Curtis Construction Co, 7-11 Bob Cannon 1400 Old Conejo Road 805-402-2172 Newbury Park, CA 91320 Bakersfield GaP Project Goordinator Safety Officer Bob Dippell . _ _ 714-$15-7709 PERSONAL PROTECTIVE EQUIPMENT REQUIREb ON SI~'E Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVED RECOMMENDATIONS FOR SAFE WORK Lockout / Tagvut Electrocution ^ Notify all affected personnel that a lack Electrical shock aut/tag out system will be in place for the duration of the project ^ All lock out/tag out procedures must be followed ^ Isolate all energy sources ^ Verify that all affected circutis are de- anergized ^ Upon completion of electrical work activities remove lock aut/tag out and test equipment for normal and safe operation. 09-07-'07 12:38 FF30M-QPM,LLC 8185674273 T-309 P0121020 F-884 JSA (Job Safety Analysis) Contractor Site Address KEC Project Superintendent K.E. Curtis Construction Co. 7-11 Bob Cannon 1400 Qld Conejo Road 805-402-2172 Newbury Park, CA 91320 Bakersfield CoP Project Coordinator Safety Officer Bob Dippell 714-815-7709 PERSONAL PROTIwCTIVE EQUIPMENT aEQUIRED ON SITE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS WVOLVED R>~CQMMENDATIONS FOR SAFE WORK Set up cons#ruction zone Physical injury from ^ Maiintain increased level of awareness moving vehicles. , Wear proper PPE for job tasks as Physical injury from lifting determined by SSb and carrying mat®rial. interterence from ^ Always use appropriate traffic control pedestrian traffic. measures. Utilize fencing /delineators Physical injury from falling cones/ flags and Caution tape to rope off area or flying objects. Identify potential hazards of work ^ Maintain a safe working distance form the public ^ Use proper lifting) carrying techniques Use air-monitoring equipment to verify no hazardous atmospheres on a continuous basis 09-87-'~7 12:38 FROM-QPM,LLC $185674273 T-3~9 P013f020 F-884 JSA (Job Safal:y Analysis) Contractor Site Addr®ss KEC Project Superint®ndent K.E. Curtis Construction Go. 7-11 Bob Cannon 1400 Old Canejo Road 805-402-2172 Newbury Park, CA 91321) Bakersfield CoP Project Coordinator Safety Officer bob Dippell 714-815-7709 PERSONAL PROTECTIVE EQl11PMENT REQUIREIp ON $ITE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVED RECOMMENQATIONS FOR SAFE WORK Lay out, saw cut and Possible exposure to V(JC's. ^ Maintain increased level of awareness concrete/asphalt remove! Physical injury from moving Perform air monitoring as n®ed®d vehicles. Physical injury due to saw ^ Keep fire eXtinguishers in immediate area cutting and concrete breaker ^ During saw cutting operations; ensure personnel Slippery conditions due tb wear hard hats, eye, ear, hand 2nd foot water cooling of saw blade. protection Possible flying obj®cts. Possible ear and eye injury. ^ During saw Cutting utilize caution when Heavy loads. walking through slurry mixture coming Pram Backhoe, saw blade. ^ Glean up slurry mixture immediately ^ During backhoe and Concrete breaker operations, ensure personnel wear hard hats, eye, ear, hand and foot protection ^ MakB sure all electrical cords are properly grounded, free from frays, and are kept dry and protected. ^ Utilize any other PPE 2s directed by the SSO ^ Maintain constant communication with all field personnel when vehicles are being utilized. ^ Vehicles shall use backup 2larms ^ When possible, all personnel shall remain a safe distance from saw cutter, trucks and backhoe (esp. when using breaker). r Use saw cutter, breaker, jackhammer, pry bar and other tools in a safe and proper manner ^ Use proper lifting Techniques only trained personnel shall operate machinery and small tools. r Fill out "Hot Work" permit 89-87-'87 12:38 FROM-QPM,LLC 8185674273 T-389 P014/828 F-884 JSA (Job Safety Analysis) Contractor Site Address KEC Project Superintendent Yf.E. Curtis Construction Co. 7-11 Bob Cannon 1400 Old Cone}o Road $D5-4D2-2172 Newbury Park, CA 91320 Bakersfield CoP Project Coordinator Safety Officer Bob Dipped 714-815-7709 PERSONAL PROTECTIVE EQUIPMENT REQUIRED ON SITE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVED RECOMMENDATIONS FCyl2 SAFE WORK t=xcavating Moving equipment ^ Identify potential hazards Utilities Work area must be inspected daily by a Access "Competent Person" Peform air monitoring as needed ^ During backhoe/excavator operations, ensure personnel wear hard hats, ey®, ear, hand and foot protection. Utilize any other PPE as directed by the SSO Check equipment before use to confirm proper operaiion Do not operate equipment outside of its designated capacity ^ Ail machinery must have back-up alarms ~ All soils and equipment should be at least 2' from edge of excavation. ^ Any contaminated material generated will be stockpiled on plastic Sheeting and covered. The material will then be characterized and disposed of in a proper manner. ^ Confirm that all underground utilities have been identified. ^ Ensure that all proper work permits have been filled out ^ Ladders shall be located every 25' in trenches and excavations deeper than 4' tJ9-87-'87 12:38 Ff30M-QPM,LLC 8185674273 T-389 P015/020 F-884 JSA (Job Safety Analysis) Contractor Site Address KEC Project Superintendent K.E. Curtis Construction Co. 7-11 Bob Cannon 1400 Old Conejo Road 805-402-2172 Newbury Park, CA 91320 Bakersfiel d CoP Project Coordinator Safety Officor Bob Dippell ... 714-815-7709 PERSONAL PROTECTIVE EQUIPMENT REQUIRED ON 51TE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVED RECOMMENDATIONS FOR SAFE WORK Removal of piping Back injury . Wear hard hats, proper eye, ear, hand, foot including sumps, pumps Small Tools protection at al# times. Grinders sensors, dispensers, etc. Electrical Cards ^ Keep fire extinguishers in immediate area Air Compressor ^ Use proper liftinglcarrying techniques. Eye and Ear Hazards . Use safety glasses, gloves, and proper technique Forklift when using small hand tools, grinders, etc. ^ Make sure all electrical cords are properly grounded, free from frays, and are kept dry and protected. ^ Oniy trained personnel are to operate forklift ~ #f grinders or torches are to be utilized, me proper "Hot Work" permit must b® completed. 1~9-87-'87 12:39 FROM-QPM,LLC 8185674273 T-389 P016/02t] F-884 JSA (Job Safety Anafysis) Contractor Site Address KEG project Superintendent K.E. Curtis Construction Co. 7-11 Bob Cannon 1400 Old Conejo Road 805-402-2172 Newbury Park, CA 91320 Bakersfield CoP Project Coordinator Safety Officer Bob Dippell _ 714-$15-7709 PERSONAS PROTECTIVE EQUIPMENT REQUIRED ON SITE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZ4RDS INVOLVED RECOMMENDATIONS FOR SAFE WORK Working in excavations Physical injury from Continuously monitor tank excavation and moving vehicles trenches for hazards. Uneven ground in trench bottom ^ Keep fire extinguishers in immediate area Back injury ^ Complete proper work permit ladders shall be located every 25' in trenches and excavations deeper than 4' ^ Perform Confined Space Assessment 09-07-'07 12;39 FF30M-QPM,LLC 8185674273 T-309 P017/020 F-884 JSA (Job Safety Analysis) Contractor Site Address KEC Project Superintendent It.E. Curtis Construction Co. 7-11 Bob Cannon 1400 Old Conejo Road $05-402-2172 N®wbury Park, CA 91320 Bakersfield CoP PrQjeCt Cggrdinatr~r Safety Officer Bob Dippell 714-815-7709 PERSONAL PROTECTIVE EQUIPMENT REQUIRED ON SITE Work boats, hard hats, safety glasses, gloves, hearing protection Task HAZARDS tNVOLVEI] RECOMMENDATIONS FOR SAFE WORK Tank Removal Equipment identify potential hazards Hazardous atmospheres ~ Check equipment before us® to confirm proper Fire & explosion hazards operation. ^ Do not operate equipment qutside of its designated capacity. Do not enter confined spaces without proper procedures and permits. ^ Monitor the air prior to entry ~ Ensure company "No smoking" policy is enforced on site. ^ Test the explosion level of each tank prior to removal. ^ Continuously monitor the tank and excavation for hazardous atmospheres Make sure a 20#, ABC rated fire extinguisher is available in the immediate area ^ Remove or limit all possible sources of ignition ^ All soils and equipment should be at feast 2' from edge of excavation 89-87-'8? 12:39 FROM-QPM,LLC 81856'14273 T-389 Pt718/02t~ F-884 JSA (Job Safety Analysis) Contractor Site Address KEC Project Superintendent K.E. Curtis Construction Co. 7-11 Bab Cannon 1400 Old Conejo Road 805-402-2172 Newbury park, CA 91320 Bakersfield CoP Project Caardinatar Safety Officer Bob Dippell 714-815-7709 PERSONAL PR4~'1=CTIVE EQUIPMENT REQUIRED ON SITE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVED RECOMMENDATIONS F012 SAI=E WORK Backfilling and compactinn dye and ear injury. ^ Prior to any backfilling activities, ensure no Physical injury due to use personnel are located within the excavation of heavy equipment. Backhoe/Bobcat ~or trench to be backfilled Open Excavation ^ Maintain increased level of awareness ^ During backhoe operations, ensure personnel in the vicinity utilize proper PPE for job tasks a During compacting operations, ensure personnel in the vicinity utilize hard hats, eye ear, hand and foot protec#ion ^ Additionally, utilize any other PPE as directed by the SSO r Use equipment and tools in a safe and proper manner 09-87-'87 12:39 FF30h1-QPM,LLC 8185674273 T-309 P019~'1~20 F-884 JSA (Job Safety Analysis) Contractor Slte Address KEC Project Superintend®nt K.E. Curtis Construction Co. 711 Bob Cannon 1400 ald Conejo Road 805-402-2172 Newbury Park, CA 91320 Bakersfield CaP Project Coordinator Safety Officer Bob Dippell . 714815-7709 PERSONAi_ PROTECTIVE EQUIPMENT REQUIRED ON SITE Work boots, hard hats, safety glasses, gloves, hearing protection Task HAZARDS INVOLVI=D RECOMMENDATIONS FOR SAFE WORK Paving and concrete Vehicular traffic ^ Inspect area to identify potential hazards placement and finishing Physical injury due to use ~ Always use appropriate traffic control of heavy equipment Eye and ear injury measures. Utilize fencing (delineators / cones/ flags and caution tape to rope off area of work ^ Wear proper PPE for job tasks as determined by SSO prior to work ^ Use proper tools and in a safe manner ^ Beware of concrete and/or asphalt trucks to assure safe routing. a 09-87-'87 12:39 FROM-QPM,LLC 8185674273 T-389 P020/020 F-884 ~~ERC~N~Y RESPC~N~~ LOCATION: 7-11 Bakersfield IF A PHYSICAL INJURY OCCURS, FIRST AID SHALL BE ADMINISTERED ANb THE WORKER SHALL BE TRANSPORTED TO THE NEAREST EMERGENCY MEDICAL FACILITY. IN THE EVENT OF AN EMERGECNY FOLLOW INGIDENT REPGRTlNG PROGEDURESI IMMEDIATELY NOTIFY THE CORRECT CONTACT PERSON BASED ON THE INCIDENT ALWAYS NOTIFY KE CURTIS CONTACT KE Curtis -Ivan Morales Office: (805) 499-0428 x 316 (24 Hour) Dell: (805) 368-5011(24 Hour) (805] 402-2172 7-Eleven Office: Cell: 7-Eleven Emergency Phone (24 Hours] Fire Department 911 Arr~bulance 911 Police 911 Poison Control (800) 876-4766 HOSPITAL SEE MAP & DRIVING DIRECTIQNS ATTACHED EMERGENCY RE$PQNSE 9IE~I2OO7 KEC Job #: 1695 ,~ . , _a ~~ .; -.~, ~ t ~- _( _~~" 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/23/2007 Order Number: 3153860 Date Printed and Mailed: 07/31/2007 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241, MKT 2133 4101 GALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Monitor Certification Sincerely, ~ Oar ~a~,~m~tys~ Dawn Kohlmeyer v Manager, Field Reporting ,., ~~.~-:;~ ,t,. ~ ~A~070~0 TANKNOLOGY CERTIFICATE OF TESTING 9y 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: RE-TEST TEST RESULT SUMMARY REPORT TEST DATE: 07!23!07 WORK ORDER NUMBER: 3153860 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241, MKT 2133 P.O. BOX 711 4101 GALLOWAY DRIVE DALLAS, TX 75221 BAKERSFIELD, CA 93312 . MANAGER (972)828-7908 (661)587-8826 TEST TYPE: TLD-1 Product Pine Tightness Test Results IMPACT LINE LINE LINE DELIVERY TEST RESULT FINAL LEAK RATE (gph) VALVE ID PRODUCT MATERIAL TYPE A B C D A B C D w FUNCTIO l 1 REG UNLEAD ENVIROFLEX PRESSURE 2 2 MIDGRADE ENVIROFLEX PRESSURE 3 3 PREMIUM ENVIROFLEX PRESSURE F~ric+inn I ina 1 oak Ila4ar+nr Toe4 EXISTING LEAK DETECTOR #1 EXIST IN LEAK DC70R LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESULT 1 1 RSD JACRST MLD 8857 P 2 2 VAPORLESS LD2000 ? P 3 3 VAPORLESS LD2000 03121686 P Now Ranlar_aman4 1 ina 1 aalc Ilo4or4nr Toc+ REP LA ED L K DETECT R # R ED LEAK DET E T R #2 LINE ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL # SERIAL # RESUL rte, ~wuc~ ucmncu ~cyvu u,ivuua~~un, visa www.~amvwiugy.cum gnu sciec~ vn-Lme nepores-wicHr, or conuict your wcai iammoiogy omce. Tester Name: ROBERT ALLEN Technician Certification Number: Ruiz C~~ Printed 07/31/2007 08:21 ACRAMER INDIVIDUAL TANK INFORMATION AND TEST RESULTS - Tanlv~olbgy TEST DATE:07/23/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153860 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32241, rIItT 2133 TANK INFORMATION Tank ID: 1 1 Tank manifolded: No Bottom to top fill in inches: 158. o Product: REC UNLEAD Vent manifolded: No Bottom to grade in inches: 161.0 Capacity in gallons: 10, o2s Vapor recovery manifolded: YES Fill pipe length in inches: 62.0 Diameter in inches: 96.00 Overfill protection: YES Fill pipe diameter in inches: 4. o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL corm Installed: ATC Stage II vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Method:VacuTect LEAK DETECTOR TEST RESULTS ' Test method: LT-1 Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: RED JACKET Ingress Detected: Water Bubble Ullage Model: MLD Test time: S/N: sass Open time in sec: a . 00 Inclinometer reading: Holding psi: 9 VacuTect Test Type: NoT Resiliency cc: zoo NoT VacuTect Probe Entry Point: T ESTED Test leak rate ml/m: 189 . o TESTED Pressure Set Point: Metering psi: 2s Tank water level in inches: Calib. leak in gph: a.oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLn-i LINE A B C D Material: ENVIROFLEX Diameter (in): 1.5 Length (ft): 175.0 Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE ' Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 07/31/2007 08:21 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ,i Tan TEST DATE:07/23/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3153860 CLIENT:7 -ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7 -ELEVEN #32241, MKT 2133 TANK INFORMATION Tank ID: 2 2 Tank manifolded: No Bottom to top fill in inches: 160. o Product: MIDCRADE Vent manifolded: No Bottom to grade in inches: 163. o Capacity in gallons: 10, 028 Vapor recovery manifolded: YES Fill pipe length in inches: 64. o Diameter in inches: 96 . oo Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL coNT Installed: ATE Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test MethOd:VacuTect LEAK DETECTOR TEST RESULTS Tes#`method: LT-1 Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VAPORLESs Ingress Detected: Water Bubble Ullage Model: r~zooo Test time: S/N' Open time in sec: a . 00 Inclinometer reading: Holding psi: 17 VacuTect Test Type: NoT NoT Resiliency cc: 190 T VacuTect Probe Entry Point: ESTED Test leak rate ml/m: 1a9. o TESTED Pressure Set Point: Metering psi: 2a Tank water level in inches: Calib. leak in gph: s . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TE5T RESULTS Test type: TLD-i LINE A B C D Material: ENVIROFLEX Diameter (in): i . 5 Length (ft): 175. o Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Staff time: TESTED TESTED TESTED TESTED End time: Final gph: Result: Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 07/31/2007 08:21 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan/v~o%gy TEST DATE:07/23/07 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER9153860 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32241, MKT 2133 TANK INFORMATION Tank ID: 3 3 Tank manifolded: No Bottom to top fill in inches: 157. o Product: PREMxUM Vent manifolded: No Bottom to grade in inches: 160. o Capacity in gallons: 10, o2s Vapor recovery manifolded: YES Fill pipe length in inches: 61. o Diameter in inches: 96.00 Overfill protection: YES Fill pipe diameter in inches: 4 . o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL corm Installed: ATG Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test Meth~d:~7acuTect LEAK DETECTOR TEST RESULTS Test n~ethad: LT-1 Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VAPOxLESs Ingress Detected: Water Bubble Ullage Model: LDZOOo Test time: S/N: osisieae Open time in sec: 4.00 Inclinometer reading:. Holding psi: 16 VacuTect Test Type: NOT Resiliency cc: lao NOT T VacuTect Probe Entry Point: ESTED Test leak rate ml/m: 1a9. o TESTED Pressure Set Point: Metering psi: 16 Tank water level in inches: Calib. leak in gph: a . 00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLa-i LINE R B C D Material: ENVIROFLEX Diameter (in): 1.5 Length (ft): 175. o Test psi: Bleedback cc: Test time (min): NOT NOT NOT NOT Start time: TESTED TESTED TESTED TESTED End time: Final gph: Result: PUmp type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: UNKNOWN Printed 07/31/2007 08:21 MONITORING SYSTEM CERTIFICATION ' For Use By Alt Jurisdictions Within the State of Califomia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, Califomia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The ownerloperator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #32241, MKT 2133 Site Address: 4101 GALLOWAY DRIVE Facility Contact Person: MANAGER Make/Model of Monitoring System:TLS350 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced TanklD: 87 TanklD: 89 X In-Tank Gauging Probe. Model: MAG PROBE X In-Tank Gauging Probe. Model: MAG PROBE X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: 420 X Piping Sump/Trench Sensor(s). Model: 352 Piping Sumplfrench Sensor(s). Model: 352 ~( Fill Sump Sensor(s). Model: 352 Fill Sump Sensor(s). 352 Model: X Mechanical Line Leak Detector. FX1V Model: X Mechanical Line Leak Detector. Model: LD2000 Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: X Tank OverfilllHigh-Level Sensor. Model: FLAPPER Tank Overfill/High-Level Sensor. Model: FLAPPER Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Tank ID: Tank ID: In-Tank Gauging Probe. Model: MAG PROBE In-Tank Gauging Probe. Model: X Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: X Piping SumplTrench Sensor(s). Model: 352 Piping Sumplrrench Sensor(s). Model: ~( Fill Sump Sensor(s). Model: 352 Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: LD2000 Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank OverfilllHigh-Level Sensor. Model: FLAPPER Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Ispenser 1/2 Dispenser ID: 3/4 O Dispenser Containment Sensor(s) Model: 352 X Dispenser Containment Sensor(s) Model: 352 Shear Valve(s). X Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: 5/6 DispenserlD: 7/8 0 Dispenser Containment Sensor(s) Model: 352 X Dispenser Containment Sensor(s). Model: 352 X^ Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: Dispenser Gontainment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~ System set-up X^ Alarm history report Technician Name (print): ROBERT ALLEN Certification No.: A20125 City: BAKERSFIELD CA Zip: 93312 Contact Phone No: 587-8826 Date of Testing/Service: 07/23/2007 Work Order Number: 3153860 Signature: _ License. No.: I~,iz Testing Company Name:Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 07/23/2007 Page 1 of 3 Based on CA form dated 03101 Monitoring System Certification Monitoring System Certification Site Address: 4101 GALLOWAY DRIVE Date of Testing/Service: 07/23/2007 D. Results of Testing/Servicing Software Version Installed: 121.00 Complete the following checklist: x Yes No * Is the audible alarm operational? Q Yes ^ No * Is the visual alarm operational? 0 Yes No * Were all sensors visually inspected, functionally tested, and confirmed operational? Q Yes ^ No Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No * x N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? Yes ^ No' ^ N/A For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^X SumplTrench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks dnd sensor failure/disconnection? ^x Yes ^ No Yes ^ No * ^ NIA For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ss ^ Yes' ^x No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ^ Yes* ^x No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. Q Yes ^ No * Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ^x Yes ^ No * Is all monitoring equipment operational per manufacturers' specifications? * In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: Page 2 of 3 Based on CA form dated 03/01 t' ' Site Address: 4101 GALLOWAY DRIVE F. In-Tank Gauging /SIR Equipment Monitoring System Certification Date of Testing/Service: 07/23/2007 Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SiR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Q Yes ^ No * Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^Yes ^ No • Were all tank gauging probes visually inspected for damage and residue buildup? ^Yes ^ No' Was accuracy of system product level readings tested? ^Yes ^No • Was accuracy of system water level readings tested? X Yes ^No' Were all probes reinstalled properly? ^X Yes ^ No • Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD) Complete the following checklist: Check this box if LLDs are not installed. ^x Yes ^ No' ^N/A For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: Q 3 g.p.h ~ 0.1 g.p.h ~0.2 g.p.h ^X Yes ^ No' Were all LLDs confirmed operational and accurate within regulatory requirements? X Yes ~No' Was the testing apparatus properly calibrated? X^ Yes ~ No • ^ N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^Yes ^No " ~ NiA For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes ^No' 0 N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes ^No' 0 NiA For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? ves ^No • ^X N/A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No • Were all items on the equipment manufacturers' maintenance checklist completed? ' In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 SWRC$, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #32241, MKT 2133 Date of Testing: 07/23/2007 Facility Address: 4101 GALLOWAY DRIVE BAKERSFIELD, CA, 93312 Facility Contact: MANAGER Phone: (6 61) 5 8 7- 8 8 2 6 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC . Technician Conducting Test: ROBERT ALLEN Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: License Number: Manufacturer Manufacturer Training Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Tank Annular 1 REG ^ ~ , ^ ^ ^ ^ ^ ^ Tank Annular 2 MID ^ ~ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts s/t~ated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~~~=~~2~"-~'I/~ ~~~-~~ Date: 0 7/ 2 3/ 2 0 0 7 SWRCB, January 2002 4. TANK ANNULAR TESTING Page 2 Test Method Developed By: ~ Tank Manufacturer ~X Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Sped) Test Equipment Used: 4 " Dial Gauge . Equipment Resolution: '~ ~' ~ '': ~,lr REG ~_ 2~MID ~: ..~~~,: ,. ,. ~, , _ , Tank # Tank # Tank # T ~ ~~ ~.~. , : ank # `f :r'~~hnt~ ~ .. ~ ' Is Tank Exempt From Testing? 1 Yes X No Yes ~ No Yes No Yes ~ No Tank Capacity: 10 K 10 K Tank Material: TOTAL CONT TOTAL CONT Tank Manufacturer: TC TC Product Stored: REG UNLEAD MIDGRADE Wait time between applying pressure/vacuum/water and starting test: ihr lhr Test Start Time: 11:2 0 am 11:2 0 am Initial Reading (R1 ): -lOhg -lOhg Test End Time: 12 : 2 Opm 12 : 2 Opm Final Reading (RF ): 0 0 Test Duration: lhr lhr Change in Reading (RF - RI ): 10 10 Pass/Fail Threshold or Criteria: 0 0 Test Result: ~ Puss ~ Fail ~ Yass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Was sensor removed for testing? X Yes N NA X Yes N NA Yes N NA Yes N NA Was sensor properly replaced and verified functional after testing? ~ ~ ~ Ye N NA ~ ~ ~ Ye N NA ^ ~ ~ Ye N NA ^ Ye N NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Vacuum would not stabilize on the 87 and 89 tank annulars. 1 Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SITE DIAGRAM . ~n 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 07/23/07 CLIENT:7-ELEVEN, INC. WORK ORDER NUMBER3153860 SITE:7-ELEVEN #32241, MKT 2133 ~~ VENTS OO L O ~ N~ O ~O d ~ ~O< O Q ~ GN O O N N~ ~O G-o O AIR/ Nj, H2O ' ICE ,o 7-eleven # 32241 N 4101 Calloway @ hageman E bakersfield, ca, 93312 Printed 07/31/2007 08:21 ACRAMER •' Work Order: 3153860 _:15421 '1-11 32241 •1101 GALLOWAY DR SaKERSFIELD,%A 93312 5u384118305Lu1 JUL 23. 8007 12:13 PM SYSTEM STHTUS' REY~RT ALL FUNCTIONS NDRIHA)_ ALARM HISTORY REPORT ---- I N-TANK .1Lr1RM T t:RUL HLAFCM H[STORY REFt~kT ---- 1 Fi-TANK ALAkI•i - T 3:MUL SOFTWARE REVISION LEVEL VERS14l~ 1'?1.00 SOFTWr+kE# 346121-t00-H GREwTFU - U0.11.15.13.29 w-I54C~ULE# 330161}-100-a SYS3~cM FEATURES: F'1:R[ODIC IN-THNK TESTES AP~NUAL I N-TANI: TESTS BiR ALFfiT9 HISTOR',' P.EPORT -••--- SYSTEM i-+LiiRM --- ~-- PAYI:k Ot1T JUN 2 . 'd007 6: G9 PM PRINTER EkROR JUN 1. 2007 6:09 PM BATTI:R'i I8 OFF JAN !. 1956 6:00 AM * * s x END „ ~ * 3t s( htGH WATER tiLARM JaL 23. 2007 10:54 AI.1 JU1. 13. 20116 l1 :15 AM HUG 12. 2UU5 9:00 AM OVERFILL ALARM JUL 23. 2007 10:58 tiM JUL 21. 2007 6:06 AM JUL 10. 2007 10:58 AM LGu,~ PRODUCT ALARf'I JUL 23. 2007 11:01 AM JUL 18. 2007 4:52 PM JUL 16. 200'7 7:34 NM H y r;,{ pRODUCT HLARM JUL 23. 2007 {0:57 flM JAtC 4. 2007 8:14 PM NOV ?, 2006 9:23 AM INVALID FUEL LEVEL JUL 23. 2007 11:01 HM JUL 18. 2007 4:39 PM JUL 16. 2007 ?:22 AM PRGSE DUT JUI, 23, 2007 t'::12 PI'1 JUL 23. 2007 10:48 NM .JUL 13. ?OQo 12:03 PM HIGH WATER WARNING JLIL ~3. 2007 10:54 AM J[.fL 13, ?006 11 :15 Aft HUG 1F. 2005 9:00 AM L>=L 1 VERY N1:£1~ED JUL 23. 2007 It:01 AM JUL 18. 2007 t0:5;? AM JUL 17. 20ti7 8 : UB AM MAX PRODUCT HLARM JUL l3. 2006 11:55 AM H[GH WATER HLARM JUL 23, 2007 10:56 AIN JUL 13. 2006 11:13 AM ALI; l2. 2005 8:55 AM Dv1=RF I LL RLRkw JUL. 23. 2007 10:59 AM MAY 3G. 2007 7:~1 AM APR 4. 2007 7:s7 AM LOW PRL~DUCT AI.r~RM JUL 23. 2007 11:GI Hhl JUL 13. 2006 12:04 PM AUG 12. 2405 10:14 AM +tiuH PRODUCT ALHRM JUL 23. 2007 10:59 W'1 JUL 13. 2006 11:32 AM JUN 22. 2006 e:fD AM INVALID FUEL LEVEL JUL 23. '007 11:01 AM JUL 13. 2006 12:00 PM AUG 12. 2005 10:15 W'. PROB£ ,!UT JUL 23. 2007 12:11 Phl JUL 2s. 2007 10:5J AM JUL 13. 2006 12:U; PM HIGH WATER WARNING JUL 23. 2007 10:56 AM JUL 13. 2006 71:13 tiM AUi; 12. 20u5 8:55 AIh DELIVERY NEEDED JUL 23, 2007 11:01 Hft APR 20. 2007 8:02 PI.1 OCT 29. 006 11:25 P1~1 MAX PRODUCT ALARM JUL 13. 2006 11 55 AM LOW T£IkP WARNING JUL 23. ?0 U7 12:11 PM Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 - Work Order: 3153860 t i ALHRI'1 HISTt)RY REPORT ---- lr~-TANK ALARM - T 3:SUL H 1 GH WATER ALARI'1 JUL '23. 20Ct7 10:54 AM JUL 13. 2001 11:16 AM n!h3 12. 2005 9:03 AM c]V ERF I LL FiLARM JUI. 23. 2007 10:5f3 kM JUL 13. 2006 11:30 HM AUG 12. 2005 10:17 HM LOW PRODUCT H1.kRM JUL 23. 2007 1l:Ol AM MAY 6. 2007 :r:2~i PM APk 30. 2007 11:2a AM H1~H FROpUCT ALARM •lUL 23. 2DD7 10:58 AM JUL 13. 2D06 11 :32 AI-I JUN 22. 2D06 8:11 AM iNVALIC~ FUEL LEVEL JUL 2's. 2007 11:a1 AM MAY 1. 2D07 7:15 HM MAY 1. 2067 t t : 53 AI~I FROBE OUT JU:. 23. 2DD7 12:11 PM JUL ~3. 2DD7 10:49 AM JUL 13. 2D06 11:50 AM NIGH WATER WARNING JUL 23. 2007 1:54 AM JUL !3. 20Dfi 11:16 AM AUG !2. 2Dp5 Q:03 AM DELIVERY NEEDED JUL 23. 2007 11:01 HM MHY 10. 2007 11:12 AM ~1i~Y 4. 200? 9:18 PIN h1HX PRODUCT ALARM JUL 13. 2D06 11:32 AM LOW TEIHF WARNING AUG 12. 2005 10:5.3 HM ALfiFtM HISTORY kEPORT ---- SENSOR HLARM ----~• L I:RUL ANNULAR ANNULAR FPRCE SEN80R OUT ALARM JUL 23. 2007 10:4: HM FUEL ALARM JUL 23, 2007 9:29 AM FUEL ALA1~1N JUL 23, 2l3u7 9:12 Ali Ic. ~~*END~~**~ ALARM HISTORY kEPGRT ----- SENSOR ALARM -- -- L 2:RUL TURBINI+ 3TP BUMP SENSOR OUT ALARM JUL 23. 2007 1D:42 rfM SENSOR OUT ALARM JUL 23. 2DG7 lD:D3 AM FUEL ALt~RM JUL 23. 2007 9:10 AM ~e Jf * if * E14L1 w if * * it HLHRM HISTORY REPORT -----~ SE1~IO0R ALARM ----- L 3:MUL ANNULAR ANNULAR SPACIr SENSOR OUT ALARhI JUL 23, 2007 lQ:43 AM FUEL ALARM JUL 23. 20U7 9:U5 HM SETUI/ DATA WARN1Nl; MAR 2Q. 20U7 3:14 PM ALARM HIBTJ~iY REPORT ----- SEIV~LR ALARM ----- L ~1:MUL TURBINE S7f SUMP SEN~]R OUT ALARM JUL 23. 2D07 1U:43 AM SEN°GR OUT ALARhI JUL ?3. 2007 10;1'2 AM FurrL ALARM JUL 23. 2007 9:Ofi AM iF ie 3i * END 3E IE iE k # HLARM HIS7QRY REPORT ----- SENSOR ALARM ----- L 5:SUL ANNULAR ANNULAR 5P~1CE SENSOR OUT ALARM JUL 23. %uu7 10:43 hr'. FULL f1LF'+r~Tt JUL 23. 2Ut3? 9:08 AM SETUP DATA WARN[NU MAR 20. 2007 2:113 PM * sr ^ ~ >F END ~ ~ * ~ ALARM HISTORY REPvkT ----- SEN60R ALARM --"°- L 6:3UL TURBINE STP SUMP SENSOR OUT ALARM JUL 23. ?007 10:43 wM SENSOR OUT ALARM JUL 23. 2007 10:12 AM I.IraU1D 14ARNING JUL 23. 2007 9:09 AM Tarlknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ' VJoikOrder: 3153860 _t ALARM HISTORY REPORT ----- S1~NSOk ALARM ~- L 7:D1SP t-2 DISPENSER PAN SENSOR OUT H[.HRM JUL 23. 2007 1G:43 W'9 HIGH LI~dUIL ALARM JUL 23, 2007 10:37 HM SENSOR OUT ALARM JUL 13. 3006 12:26 Pri * * * * ~ END ~ : ALARM ~l[STORY REPORT ----- 6&NSOR ALARM -- L B:DISP 3-4 D[SPI±NSER PNN SENSOR OU7 ALARM JuI. 23. 2UU7 IO:a2 tiM HIGH LI6rUID ALARM JUL 2's. 2007 10:3 AM wSNSOR DUT ALARM JUL 13. 2006 l2:28 PM * * * ~ x END * n x ~ ~ ALARM Hi9TOR`[ REPORT ----- SEN6Uf2 aI.ARih ----- L 9:I•!SF 5-6 DISPENSER PAN SENSOR OUT ALARM JUL 2?. 2007 1U:43 AM KIGH LI~aU[U ALARM JUL '23. 2007 10:29 AM L I6t1I D WARN ] Mi JUL 23. 2QG7 9:45 AM riLARM HISTuR'! REPORT ----- SENSOR ALARM -- L1G:DISP 7-B D I SPEN,'3SR PAN SENSOk t7UT ALARM ,ruL z:~. 2oa7 lo:4s ~,rl HIGH L I ~at1 f U ALARM JUL 23. 20117 10:34 rift SENSOR OUT HLi+RM JUL 13. 200E f2:28 PM ~~ ~x~EfVD~l~tx~it Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ,, ;: ~ `y~ r 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 06/11 /2007 Order Number: 3152958 Date Printed and Mailed: 06/29/2007 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241, MKT 2133 4101 GALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment Tank Interstitial Tank Interstitial Sincerely, ~ oar ~a~! Dawn Kohlmeyer Manager, Field Reporting ~. SWRCB, January 2002 Page 1. '= Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (af applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #32241, MKT 2133 Date of Testing: 06/11/2007 Facility Address: 4101 GALLOWAY DRIVE BAKERSFIELD, CA, 93312 Facility Contact: MANAGER Phone: (6 61) 5 8 7- 8 8 2 6 Date Local Agency Was Notified of Testing : 0 6 / 0 5 / 2 0 0 7 Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY , INC . Technician Conducting Test: ROBERT ALLEN Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: License Number: Manufacturer Manufacturer Training Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair e Tank Annular 1 REG ^ ~ ^ ^ ^ ^ ^ ^ Tank Annular 2 MID ^ ~ ^ ^ ^ ^ ^ ^ Tank Annular 3 PRE ~ ~ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, th(eq~fa~cts~ stated in this d~oc/u~m~ent are accurate and in full compliance with legal requirements Technician's Signature: f `-~'l'~ ~~a~ L Date: 0 6/ 11 / 2 0 0 7 SWRCB, January 2002 Page 2 4. TANK ANNULAR TESTING Test Method Developed By: ~ Tank Manufacturer ~X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure a Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: 4 ' Dial Gauge Equipment Resolution: _ Tank # 1 REG .. ~,. Tank # 2 MID Tank # 3 PRE Tank # Is Tank Exempt From Testing? 1 ~ Yes X No Yes x No Yes ~ No Yes No Tank Capacity: 10 K 10 K 10 K Tank Material: TOTAL CONT TOTAL CONT TOTAL CONT Tank Manufacturer: TC TC TC Product Stored: REG UNLEAD MIDGRADE PREMIUM Wait time between applying pressure/vacuum/water and starting test: lhr ihr ihr Test Start Time: 10:3 5 am 10:3 5 am 10:3 5 am Initial Reading (Ri ): -lOhg -lOhg -lOhg Test End Time: 11:3 5 am 1 l : 3 5 am 11:3 5 am Final Reading (Rp ): 2 .5hg lhg -lOhg Test Duration: ihr lhr lhr Change in Reading (RF - R~ ): 7.5 9 0 Pass/Fail Threshold or Criteria: 0 0 0 Tetit F2esult: ~ Pass ~ Fail ~ Yass ~ Fail ~ Nass ~ Fail ~ Yass ~ Fail Was sensor removed for testing? X Yes^N NA Yes N NA X Yes~N NA Yes N NA Was sensor properly replaced and verified functional after testing? ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ ~ ~ X Ye N NA ^ Ye N NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} ~ Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:06/11/07 WORK ORDER NUMBER3152958 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32241, MKT 2133 COMMENTS Retest SB-989 of all tank interstitials. The 87 and 89 tank annulars failed vacuum test. But, we need more time on testing both tank annulars due to flexing problems. Will return to retest. The 91 tank annular passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 06/29/2007 08:05 ACRAMER ' ,. TEST DATE: 06/11/07 CLIENT:7-ELEVEN, INC. SITE DIAGRAM - Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 WORK ORDER NUMBER3152958 SITE:7-ELEVEN #32241, MKT 2133 ~Q VENTS OO L O ~ N~ O ~ O a Q! ~ O OO Q ~ GN O O N N~ OO G-o O AIR/ Nj, H2O ' ICE ,~ 7-eleven # 32241 N 4101 Calloway @ hageman E Bakersfield, ca, 93312 Printed 06/29/2007 08:05 ACRAMER UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~ l ~~vCJ ^ ENHANCED LEAK DETECTION ^ LINE TESTING ,~'~~~° _.~~___~.~ _.~,~,. BAKERSFIELD FIRE DEPT. ~SB-989 SECONDARY CONTAINMENT TESTING B B R 9 F I A ~~Ra Prevention Services ARTM T 1600 Truxtun Ave., Ste. 401 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ TANK TIGHTNESS TEST ~TO PERFORM FUEL MONITORING CERTIFICATION `SITE~INFORMATION FACILITY ~~ E ~evely ~ 3 2241 NAM ~ ~~E~N~uMBE ~O~ (COST~A~ PER S2~ ADDRESS yl~~ ~Olitowa j>R. Bakersfield ~ a33~2 OWNERS NAME _ _ OPERATORS NAME PERMIT TO OPERATE NO. 1 1ooZ8 ~7-Re u~lar 2 1ooz8 gq - Midgrade 3 1002$ °I t - ~rem~um TANK TESTING GOMPANY NAME OF TESTING COMPANY Tanknolo Incv NAME & PHONE NUMBER OF Anthony Cheeks (951) 676-4U6U gyp CONTACT PERSON MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF YdrIl RDgQ!"s CERTIFICATION #: TESTER OR SPECIAL INSPECTOR: gG~I~T7'L" ~ S'S CONDUCTED;TEST TO BE ~24/O~ ~ ~d ~ ICC #: ~~C ~ ~ ~ /~ ~ ' A'i' METHOD SIGNATURE OAF AP L~~ ICANT_ ~~ ~1 DATE: 02~~ /O7 APPROVED BY 0~- ! //g~~~ p ,r~ I DATE c~' ' G, ~~7 t V GVJJ ~tICY. V.7l V:J) UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD/LINE TESTING f S8989 SECONDARY CONTAINMENT TESTING ... /'rAN K TIGHTNE55 TEST AND TO PERFORM FUEL [iAONITORING CERT{F{CATION H~AKER3h'IELD FIRE DEPT. e Pl'EV~II~OII $elV~CCS 'rss w~ 1600 Truxtun Ave., Ste. 401 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fa7~ (661) 852-21 ? 1 Page 1 of 1 PERMIT NO.. '""' ~~~ ^ ENHANCED LEAK OE7ECT{ON ^ LINE TESTING ~SB-8B9 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~O PERFORM FUEL MONITOAING CERTIFICATION SIT I' _.. ~,NI~N..:. FACILITY ? ~ teYer~ ~ 3 22'~ t NAM ~ ~~ NRUIUtBER{~O~F`C05 A~ PERSON ADDRESS ~jol ~al~oWa DR. B~ilCer'sfietd Gol °13312 1 OWNERSNAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE ESTEO? YES NO TANK# VOL CONTE TS 1 100 24~ ~S7 - Re ,~-ar 2 100$ g~! - Midgrade __ 3 1 DOZ$ R t - ~ew~um ' .. _ .. TATIK TESi'INB~OIJAIRAHY; .. NAME OF TESTING COMPANY Tanknolo ~nC, gyp NAME 8 PHONE NUMBER OF Anthony Cheeks {951) 676-4080 CONTAGTPERSON MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 j kAME fc PHONE NUMBER OF Wf~~ KQ9Q'"S TESTER OR SPECIAL INSPECTOR: q0 '~ ,,. '~ CERTIFICATION fl: CONDUCTED TEST TO BE 2`/47 r 71-N1 f `f/ ICC Y: ~~~'t ~ ~ `' ,~ ~T I f METIiOD SIGNATURE OF AP LICANT DATE: e~ ~ ~ ~O ~ APPROVED BY DATE > FD 2095 (Rev. 09!05) 4/£ 1901r9L9606 RBolou~ua1 Nd Z£~t0 LOOZ/90/ZO BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 02/21 /2007 Order Number: 3151148 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 GALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: 989 Turbine Sump Test Line Interstitial Secondary Containment Line Interstitial Secondary Containment Tank Interstitial Secondary Containment-Dispenser Pan\Sump Secondary Containment-Spill Container Tank Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting SWRC13, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (af applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #32241 Date of Testing: 02/21/2007 Facility Address: MARKET # 2133 4101 GALLOWAY DRIVE, BAKERSFIELD, CA, 93312 Facility Contact: MANAGER Phone: (6 61) 5 8 7- 8 8 2 6 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: TANK TESTER License Number: 3 -1647 Manufacturer Trainins Manufacturer Component(s) Date Trainin g Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Tank Annular 1 REG ^ ~ ^ ^ Piping Sump 2 MID ~ ^ ^ ^ Tank Annular 2 MID ^ ~ ^ ^ Piping Sump 3 PRE ~ ^ ^ ^ Tank Annular 3 PRE ^ ~ ^ ^ Piping Sump 3 PRE ~ ^ ^ ^ Secondary Pipe 1 REG A ~ ^ ^ ^ UDC 1/2 ~ ^ ^ ^ Secondary Pipe 1 REG B ~ ^ ^ ^ UDC 1/2 ~ ^ ^ ^ Secondary Pipe 2 MID A ~ ^ ^ ^ UDC 3/4 ~ ^ ^ ^ Secondary Pipe 2 MID B ~ ^ ^ ^ UDC 3/4 ~ ^ ^ ^ Secondary Pipe 3 PRE A ~ ^ ^ ~ UDC 5/6 ~ ^ ^ ^ Secondary Pipe 3 PRE B ~ ^ ~ ^ UDC 5/6 ~ ^ ^ ^ Piping Sump 1 REG ~ ^ ^ ^ UDC 7/8 ~ ^ ^ ^ Piping Sump 1 REG ~ ^ ^ ^ UDC 7/8 ~ ^ ^ ^ Piping Sump 2 MID ~ ^ ^ ^ Spill Box 1 REG FILL ~ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~~~ ~ Date: 0 2 / 21 / 2 0 0 7 ;SWRCFs, January 2002 Page 2 . Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: 7-ELEVEN #32241 Date of Testing: 02/21/2007 Facility Address: MARKET # 2133 4101 GALLOWAY DRIVE, BAKERSFIELD, CA, 93312 Facility Contact: MANAGER Phone: (6 61) 5 8 7- 8 8 2 6 Date Local Agency Was Notified of Testing : / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC . Technician Conducting Test: WILLIAM ROGERS Credentials: ~ CSLB Licensed Contractor ~ SWRCB Licensed Tank Tester License Type: TANK TESTER License Number: 3 -1647 Manufacturer Training Manufacturer Component(s) Date Training Expires / / / / / / / / 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair ad Spill Box 1 REG FZLL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 1 REG VAPOR ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 1 REG VAPOR ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 2 MID FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 2 MID FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 2 MID VAPOR ~ ^ ^ ^ ^ ^ ^ Spill Box 2 MID VAPOR ~ ^ ^ ^ ~ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ^ ^ ^ ^ ^ ^ Spill Box 3 PRE FILL ~ ^ ~ ^ ^ ^ ^ ^ Spill Box 3 PRE VAPOR ~ ^ ^ ^ ^ ^ ~ ^ Spill Box 3 PRE VAPOR ~ ^ ^ ^ ^ ^ ^ ^ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~~~ ~ Date: 0 2 / 21 / 2 0 0 7 ~~ SWRCB, January 2002 4. TANK ANNULAR TESTING Page 3 . Test Method Developed By: ~ Tank Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: > .,.~. .:, .~ . Equipment Resolution: , ..x=,. ~~ ~' Tank # i REG Tank # 2 MID Tank # 3 PRE Tank # . ~... __ Is Tank Exempt From Testing? 1 Yes X No Yes ~ No Yes ~ No ~ Yes ~ No Tank Capacity: 10 0 2 8 10 0 2 8 10 0 2 8 Tank Material: TOTAL CONT TOTAL CONT TOTAL CONT Tank Manufacturer: TCI TCI TCI Product Stored: REG UNLEAD MIDGRADE PREMIUM Wait time between applying pressure/vacuum/water and starting test: 0 0 0 Test Start Time: 8: 0 0 8: 0 0 8: 0 0 Initial Reading (Ri ): 0 0 0 Test End Time: 10:3 0 10:3 0 10:3 0 Final Reading (RF ): 0 0 0 Test Duration: 2 . 5 HOUR 2 . 5 HOUR 2 . 5 HOUR Change in Reading (Rp - RI ): 0 0 0 Pass/Fail Threshold or Criteria: 0 0 0 1'esl Result: ~ Pass ~ hail ~ Pass ~ Fail ~ Pass ~ bail ~ Pass ~ l~~ail Was sensor removed for testing? Yes N NA ~Yes~No^NA X Yes N NA Yes N NA l l d d an Was sensor proper y rep ace verified functional after testing? ~ Ye ~ N ~ NA ^ X Ye ~ N ~ NA ^ x Ye ~ N ~ NA ^ Ye N NA COIrilnentS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) All 3 tanks would not hold vacuum. I Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB, January 2002 5. SECONDARY PIPE TESTING Page 4 - Test Method Developed By: ~ Tank Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: .?. ~+..+... w..-~>.... .'~T ~1~' ti!_< < - `f.'.1 .3- ~sri k." .~rn'n ~ w • ~ °`~ Piping Run # 1 REG A Piping Bun # 1 REG B ~~ ~ Equipment Resolution: L..-..~, .... ~. ~.~: .~,~1 .ti7i:.. Piping Run # 2 MID A Piping Run # 2 MID B Piping Material: GEOFLEX GEOFLEX GEOFLEX GEOFLEX Piping Manufacturer: ENVIRON ENVIRON ENVIRON ENVIRON Piping Diameter: 2 2 2 2 Length of Piping Run: 5 0 5 0 5 0 5 0 Product Stored: REG UNLEAD REG UNLEAD MIDGRADE MIDGRADE Method and location of piping-run isolation: REG UNLEAD REG UNLEAD MIDGRADE MIDGRADE Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 9: 4 0 9: 4 0 9: 4 0 9: 4 0 Initial Reading (RI ): 5 5 5 5 Test End Time: 10:4 0 10:4 0 10:4 0 10:4 0 Final Reading (Rp ): 5 5 5 5 Test Duration: 1 HOUR 1 HOUR 1 HOUR 1 HOUR Change in Reading (RF - RI ): 0 0 0 0 Pass/Fail Threshold or (Criteria: 0 0 0 0 'l'est Kesult: ~ Pats ...Fail.. ~ Yass ~ Fail ~ Pass ~ Fail ~ Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 5. SECONDARY PIPE TESTING Page 5 - Test Method Developed By: ~ Tank Manufacturer ~X Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~X pressure ~ Vacuum ~ Hydrostatic Other (Sped) Test Equipment Used: Equipment Resolution: """"'"'""" ' .,... Piping Run # 3 PRE A Piping Run # 3 PRE B Piping Run # Piping Run # Piping Material: GEOFLEX GEOFLEX Piping Manufacturer: ENVIRON ENVIRON Piping Diameter: 2 2 Length of Piping Run: 5 0 5 0 Product Stored: PREMIUM PREMIUM Method and location of piping-run isolation: PREMIUM PREMIUM Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS Test Start Time: 9: 4 0 9: 4 0 Initial Reading (RI ): 5 5 Test End Time: 10:4 0 10:4 0 Final Reading (RF ): 5 5 Test Duration: 1 HOUR 1 HOUR Change in Reading (Rp - RI ): 0 0 Pass/Fail Threshold or Criteria: 0 0 'Test Result: Pass ~ Fail ~ Pass ~ ('ail ~ Yass ~ Fail ~ Pass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 6. PIPING SUMP TESTING Page 6 Test Method Developed By: ~ Sump Manufacturer ^X Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~ Pressure ~ Vacuum ~X Hydrostatic Other (Sped) Test Equipment Used: VPLT Equipment Resolution: __ a ;..,~. ~' j ~ ~r~__ __.___ _. . _ . _ Sump # 1 REG Sump # 1 REG Sump # 2 MID Sump # 2 MID _ Sump Diameter: 4 2 4 2 4 2 4 2 Sump Depth: 4 5 4 5 4 3 4 3 Sump Material: PLASTIC PLASTIC PLASTIC PLASTIC Height from Tank Top to Top of Highest Piping Pentration: 1 o i o 10 10 Height from Tank Top to Lowest Electrical Pentration: 14 14 12 12 Condition of sump prior to testing: OK OK OK OK Portion of Sump Tested: r 2 " ABOVE SAME SAME SAME Does turbine shut down when sump sensor detects liquid (both product and water)?* ^yes ~No~N Yes ~No~N Yes ~No^N ~ Yes ^No~T Turbine shutdown response time: Is system programmed for fail-safe shutdown?* ^ ~ ~ Yes N N ^ ^ ~ Yes N N ^ ^ ~ Yes N N ^ ^ Yes No Was fail-safe verified to be operational?* ^ ^ ~ Yes N N ^ ^ ~ Yes N N ~ ^ ~ Yes N N ^ ^ Yes No Wait tune between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 11:0 5 11:3 8 11:2 0 11:3 7 Initial Reading (RI ): 12 12 12 12 Test End Time: 11:2 0 11:5 3 11:3 5 11:5 2 Final Reading (Rg ): 12 12 12 12 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading(Rp-RI ): .00008 .00010 .00001 .00001 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 .0 0 2 0 0 . 0 0 2 0 0 .0 0 2 0 0 r<~~t K~,~ir: 0 r~d~ ~ 1~.i~~ ~ Pass ~ r:,~~ 0 F~:~S~ [~ H~:~i1 ~ Pass ~ Fait Was sensor removed for testing? Yes^No^NA ~Yes~No^NA Yes^No^NA Yes ^No~T Was sensor properly replaced and verified functional after testing? ~ ~ ~ Ye N NA ~ ~ ~ Ye N NA ^ ~ ~ X Ye N NA ^ ^ X yes N COmmelltS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) r If the entire depth of the sump is not tested, specify how much was tested. If the answer to anv of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB, January 2002 Page 7 . 6. PIPING SUMP TESTING Test Method Developed By: ~ Sump Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Sped) Test Equipment Used: VPLT Equipment Resolution: ~ ~ ~' t ~~~~~ ~ ~,~ Sump # 3 PRE 3 PRE Sump # Sump # Sump # Sump Diameter: 4 2 4 2 Sump Depth: 4 7 4 7 Sump Material: PLASTIC PLASTIC Height from Tank Top to Top of 11 11 Highest Piping Pentration: Height from Tank Top to Lowest 14 14 Electrical Pentration: Condition of sump prior to testing: OK OK Portion of Sump Tested: 1 SAME SAME Does turbine shut down when sump sensor detects liquid (both ^yes ^No^N ^yes ^No^N Yes ^No^N ~ Yes ^No~1 product and water)?* Turbine shutdown response time: Is system programmed for fail-safe * ^ ^ ~ Yes N N ^ ^ ~ Yes N N ^ ^ ~ Yes N N ^ ^ Yes No shutdown? Was fail-safe verified to be ^ Yes ~ N ~ N ^ Yes ^ N ~ N ~ Yes ^ N ~ N ^ Yes ^ No operational?* Wait time between applying pressure/vacuum/water and starting test: 15 MINS Test Start Time: 12:07 Initial Reading (RI ): 13 Test End Time: 12:22 Final Reading (RF ): 13 Test Duration: 15 MINS Change in Reading (R p - RI ): . 0 0 0 0 2 Pass/Fail Threshold or Criteria: . 0 0 2 0 0 Test kesult: ~ Pass ~ Fail Was sensor removed for testing? ayes^No^NA Was sensor properly replaced and verified functional after testing? aYes~N~NA 15 MINS 12:25 13 12:40 13 15 MINS .00001 .00200 Pass ~ Fail ~ Yass ~ Fail ~ Pass ~ Fail esnNonNA nYes~Na~NA Yes ~~No~ e~ N~NA I ^Yes~ N~NA I^ Yes Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the sump is not tested, specify how much was tested. If the answer to anv of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160} SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Page 8 Test Method Developed By: ~ UDC Manufacturer ^x Industry Standard ~ Professional Engineer Other (Sped) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT Equipment Resolution: ' ~ »~r-r,~ ~~~ . ~.~ UDC# 1/2 UDC# 1/2 UDC# 3/4 UDC# 3/4 UDC Manufacturer: ENVIRON ENVIRON ENVIRON ENVIRON UDC Material: PLASTIC PLASTIC PLASTIC PLASTIC UDC Depth: 3 0 3 0 3 0 3 0 Height from UDC Top to Top of Highest Piping Pentration: 12 12 12 12 Height from UDCTop to Lowest Electrical Pentration: 8 8 8 8 Condition of UDC prior to testing: OK OK OK OK Portion of UDC Tested: t 2'~ ABOVE SAME SAME SAME Does turbine shut down when sump sensor detects liquid (both product and water)?* yes ^No~N Yes ~No~N Yes ~No~N ~ Yes ^NoL~~ Turbine shutdown response time: Is system programmed for fail-safe shutdown?* ^ ^ ~ Yes N x N ^ ^ ~ Yes N x N ^ ^ ~ Yes N x N ~ ^ Yes No x Was fail-safe verified to be operational? Yes ^No~N Yes ~No~N Yes ^No~N Yes ~No~T Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 12:5 6 1:16 1: 3 6 1: 5 3 Initial Reading (RI ): 14 14 14 14 Test End Time: 1:11 1:31 1:51 2 : 0 8 Final Reading (Rg ): 14 14 14 14 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading(Rp-Rt ): ~ .00009 .00029 .00002 .00020 P ass/Fail Threshold or Criteria: . 0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 .0 0 2 0 0 'lest Result: ~ Pass ~ Fail ~ YasS ~ Fail ~ Pass ~ Fail ~ Yass ~ Fai! Was sensor removed for testing? ~yes~No^NA aYes~No~NA aYes~No~NA Yes ~No~ l Was sensor properly rep aced and verified functional after testing: ^ x Ye ~ N ~ NA ^ x Ye ~ N ~ NA ^ x Ye ~ _ N`t f~ _J NA x yes ~ No ~ i Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) t If the entire depth of the UDC is not tested, specify how much was tested. If the answer to anv of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWRCB, January 2002 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Page 9 - Test Method Developed By: ~ UDC Manufacturer ^X Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic n Other (Specify) Test Equipment Used: VPLT 1Equipment Resolution: , ~ ``` ~ 1~,' ~ UDC# 5/6 UDC# 5/6 UDC# 7/8 UDC# 7/S UDC Manufacturer: ENVIRON ENVIRON ENVIRON ENVIRON UDC Material: PLASTIC PLASTIC PLASTIC PLASTIC UDC Depth: 3 0 ~ 3 0 3 0 3 0 Height from UDC Top to Top of 12 12 12 12 Highest Piping Pentration: Height from UDCTop to Lowest 8 8 8 8 Electrical Pentration: Condition of UDC prior to testing: OK OK OK OK Portion of UDC Tested: t SAME SAME SAME SAME Does turbine shut down when sump sensor detects liquid (both yes ^No~N ^Yes ^No~N Yes ^No~N Yes ^No~i product and water}?* Turbine shutdown response time: Is system programmed for fail-safe * ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ ^ Yes No X shutdown? Was fail-safe verified to be * ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ ^ ~ Yes N X N ^ Yes No X operational? Wait time between applying pressure/vacuum/water and starting 15 MINS 15 MINS 15 MINS 15 MINS test: Test Start Time: 12:0 7 12:2 5 12:5 6 1:16 Initial Reading (Rt ): 14 14 14 14 Test End Time: 12:2 2 12:4 0 1 :11 1:31 Final Reading (RF ): 14 14 14 14 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading(Rg-RI ): .00000 .00000 -.00000 -.00001 Pass/Fail Threshold or Criteria: - 0 0 2 0 0 . 0 0 2 0 0 . 0 0 2 0 0 . 0 0 2 0 0 'Kest Result- -_ ~ Pass ~ Fail ~ Pass ~ Fail ~ Pass ~ fail ~ Yass ~ Fail Was sensor removed for testing? Yes^No~NA Yes^No^NA Yes^No^NA Yes ~No~i Was sensor properly replaced and if d f i l ft i ? ^ X Ye ~ N ~ NA ^ X Ye ~ N ~ NA ^ X Ye ~ N ~ NA ^ ^ X Yes N ver ie unct ona a er test ng COmmeIIts - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any_of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWRC.B, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 10 Facility is Not Equipped With SpilUOve~ll Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer Other (Specify) ~ Industry Standard ~ Professional Engineer Test Method Used: ~ Pressure Other (Specify) ~ Vacuum ~ Hydrostatic Test Equipment Used: VPLT ~~~""'`' ~' ,~ Equipment Resolution: S III Box # 1 REG FI S X11 Box # 1 REG FILL LL S X11 Box # 1 REG VAPOR P P P pill Box # 1 REG VAPOR Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 12:5 6 1:16 12:5 9 1:16 Initial Reading (Rt ): 8 8 9 9 Test End Time: 1:11 1:31 1:14 1:31 Final Reading (Rp ): 8 8 9 9 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R g - Rl ) • 00006 .00004 .00020 .00003 Pass/FailThresholdor Criteria: .00200 .00200 .00200 .00200 7 est Result: ~ Pass ~ Fail ~ Yass U Fail ~ Pass ~ Faii ~ Pass ~ Fail COmment5 - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRGB, January 2002 9. SPILL/OVERFILL CONTAINMENT BOXES Page 11 Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer ~ Industry Standard ~ Professional Engineer Other (Specify) Test Method Used: ~ Pressure ~ Vacuum ~ Hydrostatic Other (Specify) Test Equipment Used: VPLT Equipment Resolution: ~' ~' Spill Box # 2 MID FILL Spill Box # 2 MID FI LL Spill Box # 2 MID VAPOR Spill Box # 2 MID VAPOR Bucket Diameter: it 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and 15 MINS 15 MINS 15 MINS 15 MINS starting test: Test Start Time: 11:0 6 11:3 7 11:0 7 11:3 7 Initial Reading (Rt ): 9 9 9 9 Test End Time: 11:21 11:5 2 11:2 2 11:5 2 Final Reading (RF ): 9 9 9 9 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R p - RI) • 00004 .00001 - .00001 - .00001 Pass/FailThresholdor .00200 .00200 .00200 .00200 Criteria: I'cst Result: ~ Pass ~ Fail ~ Pass ~ Fail ~ P:I1.S ~ Fail ~{ P:ISS Fail COmmCntS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRC~, January 2002 SPILL/OVERFILL CONTAINMENT BOXES Page 12 Facility is Not Equipped With SpilUOverfill Containment Boxes: SpilUOverfill Containment Boxes are Present, but were Not Tested: Test Method Developed By: ~ Spill Bucket Manufacturer Other (Specify) ~ Industry Standard ~ Professional Engineer Test Method Used: ~ Pressure Other (Specify) ~ Vacuum ~ Hydrostatic Test Equipment Used: VPLT Equipment Resolution: ___ ,,,~ r,.r. ~~ _ ---.-z--rn ,~-_ -- w. `"' ~~ S S X11 Box # 3 PRE VAPOR ~ , ,,,,.,~., . , w pill Box # 3 PRE FILL Spill Box # 3 PRE FILL p' ,w ~ Spill Box # 3 PRE VAPOR Bucket Diameter: 11 11 11 11 Bucket Depth: 12 12 12 12 Wait time between applying pressure/vacuum/water and starting test: 15 MINS 15 MINS 15 MINS 15 MINS Test Start Time: 12:07 12:25 12:06 12:24 Initial Reading (RI ): $ 8 9 9 Test End Time: 12:2 2 12:4 0 12:21 12:3 9 Final Reading (Rp ): $ B 9 9 Test Duration: 15 MINS 15 MINS 15 MINS 15 MINS Change in Reading (R p - RI) - .00000 - .00002 .00005 .00003 Pass/Fail Threshold or Criteria: , 00200 .00200 .00200 .00200 Test Result: ~ Yass ~ Fail ~ Yass ~ Fail ~ Yasti ~ Fail ~ Yass ~ Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Jj ~ Tanlv~obgy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:02/21/07 WORK ORDER NUMBER3151148 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32241 COMMENTS Syr SB-989 testing on all components. All Tank Annulars Failed. All other components passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT LEAK TEST RESULTS Printed 03/14/2007 08:18 ACRAMER -rt ;' SITE DIAGRAM i Tan 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 02/21/07 CLIENT:7-ELEVEN, INC. WORK ORDER NUMBER9151148 SITE:7-ELEVEN #32241 Q~Q VENTS O N `~O E N~ o ~ o ~~ ~ ~ o0 o ~ GN O O N N~ ~O G~ • O AIR/ ICE Nj~ H2O ' 7-eleven # 32241 4101 Calloway @ hageman bakersfield, ca, 93312 Printed 03/14/2007 08:18 ACRAMER 4~ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements Facility Name: 7-ELEVEN #32241 Facility ID #: 235421 Facility Address: 4101 GALLOWAY DRIVE. BAICERSFIELD, CA 93312 Reason for Submitting this Form (Check One) ©Change of Designated Operator Facility Phone #: 661-587-8826 ^ Update ICC # and/or Expiration Date Designated UST Operator(s) for this Facility Primary (Optional) Designated Operator's Name: John Ablakat Relation to UST Facility (Check One) Business Name (Ifd~erent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician [~ Third-Party International Code Council Certification #: 5279288-UC Expiration Date: 03/09/2008 ALTERNATE 1 (Optional) Designated Operator's Name: Tony Mensour Relation to UST Facility (Check One) Business Name (If di, fJerent from above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician © Third-Party International Code Council Certification #: 5269136-UC Expiration Date: 11/17/2007 ALTERNATE 2 (Optional) Designated Operator's Name: Sarkis Z.oumalan Relation to UST Facility (Check One) Business Name (If di„8`erentfrom above): ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 818-992-8981 ^ Service Technician ®Third-Party International Code Council Certification #:5238439-UC Expiration Date: 07/09/2008 I certify that, for the facility indicated at the top of this page, the individual(s) listed above will serve as Designated UST Operator(s). The individual(s) will conduct and document monthly facility inspections and annual facility employee training, in accordance with California Code of Regulations, title 23, section 2715(c) - (f). Furthermore, I understand and am in compli lie~with th equirements (statutes, regulations, and local ordinances} applicable`to,~under unsh~torage tanks. NAME OF TANK OWNER (Please Print): 7~ ~ Y MARTIN SIGNATURE OF TANK OWNER: DATE: 2/15/2007 OWNER'S PHONE #: (253) 796-7170 November 2004 -~ Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of and Compliance with UST Requirements -continued ALTERNATE 3 (Optional) Designated Operator's Name: Kevin Watermolen Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 916-212-7973 ^ Service Technician ^O Third-Party International Code Council Certification #: 5250470-UC Expiration Date: 12-21-2008 ALTERNATE 4 (Ootionall Designated Operator's Name: Jessica Tuttle Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-537-7663 ^ Service Technician x^ Third-Party International Code Council Certification #: 5286530-UC Expiration Date: 07-03-2008 ALTERNATE 5 (Optional) Designated Operator's Name: Jim Palmer Relation to UST Facility (Check One) Business Name (If different from above): Gilbm~co Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 831-840-5235 ^ Service Technician D Third-Party International Code Council Certification #: 5254109-UC Expiration Date: 2-21-2007 ALTERNATE 6 (Optional) Designated Operator's Name: Brian Ellsworth Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 707-815-2511 ^ Service Technician ~ Third-Party International Code Council Certification #: 5263224-UC Expiration Date: 7-7-2007 ALTERNATE 7 (Optional) Designated Operator's Name: Aaron Celaya Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 510-364-0385 ^ Service Technician O Third-Party International Code Council Certification #: 5246905-UC Expiration Date: 01-20-2007 ALTERNATE 8 (Optional) Designated Operator's Name: Darrell Riley Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 619-206-8379 ^ Service Technician ^D Third-Party International Code Council Certification #: 5248975-UC Expiration Date: 11-29-2008 ALTERNATE 9 (Optional) Designated Operator's Name: Darren Austin Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 858-699-2751 ^ Service Technician ~ Third-Party International Code Council Certification #: 5250436-UC Expiration Date: 1 1-11-2008 ALTERNATE 10 (Optional) Designated Operator's Name: Eric Banghart Relation to UST Facility (Check One) Business Name (If different from above): Gilbarco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 310-467-2529 ^ Service Technician ^D Third-Party International Code Council Certification #: 5250118-UC Expiration Date: 11-9-2008 ALTERNATE 11 (Optional) Designated Operator's Name: Blake Herness Relation to UST Facility (Check One) Business Name ([f different from above): Cilbmco Veeder-Root ^ Owner ^ Operator ^ Employee Designated Operator's Phone #: 951-288-1519 ^ Service Technician ~ Third-Party International Code Council Certification #: 5249180-UC Expiration Date: 12-12-2008 February 15, 2007 BAKERSFIELD FIRE DEPARTMENT 900 TRUXTUN AVENUE, SUITE 210 BAKERSFIELD, CA 93301 RE: Statement of Compliance and Designated Operator Dear Sir or Madam: Gilbarco/Veeder-Root, acting as the authorized agent of Safeway/Vons is submitting on behalf of the company, the attached Owner Statements of Designated Underground Storage Tank (UST) Operator and Understanding of Compliance with UST Regulations for the subject fuel facility to register this site and Designated Operators with the county. The owner understands that with the submission of this document, Gilbarco/Veeder-Root is stating, on behalf of Safeway/Vons that each location is in compliance with all applicable UST regulations. Further, as specified in regulations Title 23, Section 2715 (c)-(f), the individuals listed as designated operators for the location will complete and document a monthly inspection to be maintained in accordance with the applicable requirements. Each statement of compliance being submitted herein is based on: (1) Gilbarco/Veeder- Root reasonable and good faith review of facility operations to evaluate compliance with applicable UST regulations, as well as information provided by facility operations as of the date the statement of compliance is made, and (2) Gilbarco/Veeder-Root's understanding of the applicable UST regulations and requirements as of the date the statement of compliance is made. Should you have any questions or require further information please do not hesitate to contact me at (303) 986-8011. Sincerel ~~ .~;,~~' Sherry Peczka Designated Operator Program Manager Gilb arco/V eeder-Root Enclosures 10/i2/2008 01:28 PN UNDERGROUND STORAGE TAN K$ APPLICATION To PERFORM ELD r uNE TESTINf3 15NB/9 8ECONDARY CONTAINMENT TESTSr(i !TANK TIGHTN>::S$ TEST AND TO PERFORM FUEL MONITORING CERTIFICATION Tanknologv 8088784081 i/1 BAICERBP'IELD FIRE DEPT. : ~ r ' >d Praveation Serv?ces w~~t ~rtT 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: {661) 326-3979 Fax: {661) 852-2171 Page 1 of 1 PERMR NO. ~D ENHANCED LEAK DETECTION © UNE TESTING ^ SB-084 SECONDARY CONTAINMENT TESTING 1 1 TAYIC T1f:MTYFCC TFCT ~ TA PFRFAf]RA F11F1 MC1NITfIREN1: C`FRTIFI[:/STI(]N 517E INFOR TKN4 FACILITY ~T_ll#32241 NAME 8 PHONE NUMBER OF CONTACT PERSON Manager- (b61 587-8826 ADDRESS 4101 Calloway Dr. Bakersfieid, 93312 O1""~$'r^"''E Sou~land Corporation OPERATORS NAME Southland Corporation PERMIT TO OPERATE NO. NUMBER OF TANKS Tp BE TESTED 0 ` ^ . YES __ __ __ __ _ ~ NO. _ _ _~~ IS PI NO OOINO TO BE TESTED9 TANK ~ _ _ YOL E CONTENTS 1 10028 87 Unleaded Gas -- TANK TESTMIB Coi1PaNY - NAM! OF TESTINO COMPANY Tanknolo v I11C. 9Y. NAME 8 PHONE NUMBER OF Wes~By COUtter 800.6BB~21TB CONTACT PERSON MAILINOADDRESS 41786 Enterprise Circle S. Suite D Temecula, CA 92590 NAME 8 PHONE NUMBER OF Steven Gallardo TEBTlR OR SPECML INSPECTOR: CERTIFICATION ~: i i DATE a TIME TEST To Be Tuasday,l0l47/06, 9.00 AM coNDUCTED: Icc ~~ 5259843-UT TEST METTioD slow-TURE of APPLICANT DATE: 10!12106 APPROVED BY DATE FD 2095 (Rev. OB105) ,~-~ _ ~ / BELSHIRE ~ ~- ~ ENVIRQNMENIAL ~,~ ._ _~- ,: - - SERVlCE.S, lNf_: 25971 Towne Centre Drive Lake Forest, GA 92610 (949)460-5200 Fax (949) 460-5210 ' Date: September 11, 2006 TO: Steve Underwood City of Bakersfield Fire Dept. 900 Truxton Ave., Ste. 210 Bakersfield, CA 93301 FROM: Jim Brown Sent Via: FedEx Ground Ref# 358673110011200 RE: Spill Bucket Test 7-Eleven Site# 32241 4101 Calloway Dr. Bakersfield, CA 93312 Transmittal ^ As Requested ^ For Review ^ Sign & Return ^ For Your Use ®For Your Files Quantity Description 1 Spill Bucket test performed on 9/712006. Comments: Please do not hesitate to call me at (949) 460-5200 if you have any questions or concerns regarding this work. Jim Brown Project Manager ~_ . ~s :;:- SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors perfot'ming annual testing of UST spill containment structures. The completed fo. rm and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACTT,TTY TNFnRMATT(~N Facility Name:. ~~ 3 Z 2 Date of Testing: '~--a.-~ Facility Address: fa C ~~ urn / FacilityContact:`j Phone: ~ ~ ~~7 ~ 2~ Date Local Agency Was Notified of Testin` Name of Local Agency Inspector (if present during testing): 2. TESTING CnNTRACTOR TNFnRMATTnN Company Name: ~ ,9 TZ, Technician Conducting Test: `1.~q~G-~ (jG~~ Credentialsl: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 3, SPILL BUCKET TESTING INFnRMATI~N Test Method Used: y osta ' Vacuum Other Test Equipment Used: Equipment Resolution: - --- -- - - - Identify Spill Bucket (By Tank 1 ~' 7Cy ~~ 2 ~/ ~~ 3 4 Number, Stored Product, etc.) Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury Contained in Sum Contained in Sum Contained in Sum Contained in Sum Bucket Diameter: ~~ .Bucket Depth: ly ~ f ~' Wait time between applying vacuum water and start of test: ~ °~`~ - 6 'ti'p Test Stazt Time (T~: /p .~6 Y yr2gs~ ~6: 3 D4*. t~:SZ'`~+. Initial Reading (RI): t f• ~2 t(. (2~~ / 3 Se /!. /3 ~8' Test End Time (TF): l0~ ~.r ' ~~~ v7 g'''' /a: 4S9 //~a ~ 9'"`' Final Reading (RF): Y / 277 ~(, ! Z 7S / 35'0 j 3 ~ Test Duration (TF - T~: /S,y, y~ ~ S ~, ~S „w'7 ~ 1 „y~~ Change in Reading (RF - RI): Pass/Fail Threshold or Criteria: ~~ ,a , b m2 .~e-~._ a , 6 o T-- ~, ,r~~ ~ . COmIlleritS - (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING .I hereby certify that all the information contained in this report is trace, accurate, and in full compliance with.legal requirements. Technician's Signature: ~L~~ (.~~'%~"' Date: / ~ ~ ~ ~ t State laws and regulations do not currently iequire testing to be performed by a qualified contractor. However, local requirements maybe more stringent. ~'~~L UNDERGROUND STORAGE TANK 4'~ I,; PERMIT APPLICATION TO s s u s P I D P/R!f CONSTRUCT /MODIFY /MINOR ~> ~R~e~ r MODIFICATION OF AN UST PERMIT NO. ~ 7 TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY n Mnf]IFICATIAN nF FACILITY Bakersfield Fire Dept. Environmental Service 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^/NEW TANK INSTALLATION AT EXISTING FACILITY X~ MINnR MnDIFICATInN ~F FACILITY TARTING DATE ROPOSED COMPLETION DATE AGILIzTY NAME // (STING FACILITY PERMIT NO. FACILITY ADDRESS r ~~ .~.~ ITY ~ ~ ' IP CO E ~ ~ PE OF BUSINESS PN # ANK OWNER ~ /~ PHONE NO DDRE r~ ~7~ / / / y ~ ~ / /' FAO /~+ /~A/,//~~ /~/'////°l f ~ ALL j IP I ~~ ONTRACT A LICENSE NO. ICC NO. ~ C/ HONE NO. r ~ AKERSFIEL~ I~ USINESS LICENSE NO.® (~/' v/"'~^ ORKM S COMP NO. ~ ~ ~ NSURE BRIEFLY DESCRIB THE WORK T BE DONE r C ~. WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO ~ nw acs. ~ TANK NO. THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME UNLEADED REGULAR REMIUM DIESEL VIATION FOR OFFICIAL USE ONLY The applic has received, understands, and will comply with the attached conditions of the permit and any other state, local regulations its form s en completed under penalty of perjury, and to the best o my knowledge, is true and correct. APPROVED BY: APPLICwKNT NAME (PRINT) `/ THIS APPLICATION BECOMES A PERMIT WHEN APPROVED 0 n f -- CERTHOLDER COPY SG ,- S~":~'7`~ P.O. BOX 420807, SAN FRANCfSCO,CA 94142-0807 -"COMPSi1SATION - ' FhF-S" [~ R-A N-G E - CERTIFICATE OF WORKERS' CO[VtPENSAT[ON INSURANCE ~, ISSUE DATE: 04=Oi-2006 GROUP:-. 000426. - POLICY NUMBER: 0000276-2006 CERTIFICATE ID: 304 - CERTIFICATE EXPIRES: 04-01-2007 04-01-2006/04-01=2007 PE200F OF EVIDENCE ONLY 2597•i T04tNE CENTRE DRIVE LAKE FOREST CA 92610 SG JOB: '41AIVER OF SUBROGATION AVAILABLE UPON REQUEST This is to certify that we have issued a valid Workers'.Compensation insurance policy in a form approved by the California Insurance Commissioner 'to the employer named below for the policy period indicated:.; This policy is not subject to cancellation by the Fund except upon 3O days advance written notice to the employer We will a{so give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurancs is not an insurance policy and does not amend, extend or alter the coverage affilrcied by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance may •be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, -exclusions, and conditions, of such policy. r• THORIZED REPRESENTATI PRESIDENT - ".EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES - EXCLUDED. ENDORSEMENT #1600 -LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 I5 ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER ~._ BELSHIRE ENVIRONMENTAL SERVICES, INC. SG :25971 .T.OI~I[VE CENTRE DR . JFOOTHILL RANCH CA •52610 " • - M9408 .z-os! PRINTED' : 03-18-2006 r ~} - ~; `~` g g~'~ _ PxoDtICER. (~49~55~-4~QQ -4800 M•i~i~ailT7um Risk Managa~ien~ & Insurance Seruices 'S~3t3 Trabuca Road _ ~rntine, CA °ZfiZQ IFISIlRED HeTshz i"ir Entl'1 ronm.¢...n~a7 Sere i ct=s Y Irtc. THIS CERTIFICATE f3 IS5 UI D AS !L f; rATTF~Z (~F II~lF4RZ~IATit~~ b13LYRKD CC}I~FF~2s N£3 RIGHTS UPQT~ THE cERTEFICATI; ffQLi?ER_ THIS CF.RTIF[CATE BQ~S Nt3TAf~tEh'D, EXTERi[] (3I~ ALTER THE CfJVETtA~E AI-•Fat213E€7 SY THE Pt~LICIES BELOyy_ . • INSUi~ERS AFFOROII~IG C(~1F'ERAGE :t cME.RA:. ~urZCh R~~eric~n ~ • `--- 25g7I Toame Centre ©r-;ve ttasotxr~s_ Steadfast Insurance Faa~h-i1i Ranch, CA 9Z6ZQ IusoaEiz~ . -. IH3thZ£-t2 D. - t~rsthzaz E: G.QVERAGES THE POUGES of INSURANCE LiSTEI} l3ELOVY HAVE BEEN ISSUED TO THE I}!St]RED td/~D e~SOVE FOf2T1-IE POUCY PEf2lOD Ifid[CAZED IdOTVSF1i'IiSTA2~lpiHG ~~ANYREQLIItz.S~NTTERIidORCDNDf170NO~ANYCONTRACTOIZDTHERDOGUIUIEI~ITVVITHRESP£CTTOWHICHTHISCERTIFK'.Al-EkIAYBElSSUIDOR •`h•.AYPERT/UN,THE INSLIRANCEAFFORDED HYTHE POLICIES OESCRISED HEREIN tS SUSIECTTO ALL THEl IIi[viS, EXCLUSIONS AND COTiD17TONS OF SUCH "POLICIES. /IGC~ZEC.FtTJ= LIM[TS SHAWN MAY HAVE BEEN REDtICiz1 xY PAID CLAIMS- i' ~~ ~'t7PE OFiFI.StIRAIdCE FOLtClPIU6St3EA ~ PODGY EF<~CIZKE PODGY EXFiR.0.TIOCI DATE DATE hTIDD f~[Ts ' GFNF~re i LI46IUTY - -, - .. .. t+ (:ACH OCCURR€NCE 5 I r ©04, I - X COt~+5H2CIALGEKEAALItA$1tSIY 9~6f}~g-Q3 ~{Tfx6r/~QQ7 ~`7~~/~QQ~7 flREDRFd4GE[l4lyonefire} $ ' ~ c[Att~ts taADE ^X occuR ram DCP (Any a~ perici7) a 5 A F>~soturt K Aov Ix~uRir s 1, OQf3, - GEttERALAT~REGATE ffi I„OflO,C GENZ AGGREGATE UMtTAPPUES t'EIZ PRODUCTS-COMP/OP AGG S ~~(~}Q~[ PRD- POUCr ~cr toc AUT'04SOStLE t3AHIU7Y ~ ~ CDli81f9H7 SlNGI,E IJG9'I' X AT(YAtICO .. 9I5042-d3; OS/I4/20Q?~ o6/I4/Z~6Q& ~'~ S I,(IO4),~oe RLLOWNEDN-rTOS ~ SOOJ£.Yd`tIVRY SCt-IEDtlLEp AU70S - - ~O~ '~ S ~ X HIRED AUTOS . Y OPtL X uori-owrr~ wras ~F s ) FRO?EFfTY DAMAGE S (PeC acadu#} GRRAGE UABtU'TY ~ AUTD OFILY-EA ACCIDENT S ANY RUTD ~ OTHII2.THAR! EAACC S AUrQ ONLY. AGG S F~CCESS ~ rarr~'[y EACH OCC(/RRENCE S ~ ~ OQ~ ~ OAO X occuR ~IX1lIMSGMDE ED 5337678-UI. •06/I4/2QU5 Q5/14/Z006 AGGREGATE r S,OE?O,Q00- a g S DEO[ICT[8[~ S ' REIEMION 5 S 41tOR:KERS CORSPEHSXTiOFt AND - TORY UhEITS '? . ' ER ~ F3iA1'LL7YE32S LIA[3lLI]Y E.LEACtiACCtDEN7 F E.LDISEASE-FAfaAPLOY S £.L DISEAS>_- ["oUCY LIMIT S oTIIER QE}O ~I OOQ Lrttirit on~ractors Po171t:tion ' , , 6 Liahi7ity 916039-Q3 05/I4/Z405 06/I4-/2t}~~ OESCRIFFKJN OF 6~F~'cAl7QNS20C1iTICtFGSNHiICtEShxL'L.USIOt1s ADDED $Y ENOpRSEfQE'h'iTSFEGtAL PftOYtsiOits -- ~ ' t _. R>/: Prom Evidznee t31:1y - • =I.!} day notice of cancelTat-ioi~ in ttee e`t+rti~ of Ftvi~-gaynten~ a'~ prelllium. ~ERTIF(CATE H(7LDF=R aDDniolrAl.-,us-oat=D• IrL~I~az c~I~ clfr~cELt..aTloht - SHOULB{;HYOF'FHEASOYE-ESCFtIHEDP0t~6SBEEANCELL.FITBI=FOR6THE EYPIRATiON IIATETREREOF TKE[SSUAtLG GO.iTPj{i~fYFFfd.LENDEA~fO~ZTQF6Qt1- • DaYSn~lrcF~ttsoTlcarcr~et~xT~iexoLDezuAr~eD-tart-t>={~; HifTFISILURE T01rtAlLSIIGx tlOitCESE{ALL ffi4FOSE I10 o3LIGATiON 1IR LVLSiJTY DFA>•IY IE2<^ttI UPDN'LEiE CO[SP hGEi,£IS OFt gEFl~SEISfATt+tES • -. =°-=1=roaf~E~dence >7EiIy~~=== AunsQUS~nx~rt~FSQUTR r 1 ~ .- . ~' ~ ~ - . .~ •, ~ _ - '$tate•.~:`California R,,,,,, G ~, CONTRACTQRS:.$TATE.LICENSE BOARD ~ , :,I. 'z`~°'""""" ~ ~.ACTIV~.LIGENSE ~ ^' . :Condumnr - ~' '~:r Affairs', r ~ Lbenaal~Lmber~H~O~H~V~~~V '~ EMdy CO:RP ~~ ~. ~ ~ e~:m.orsm..EELSHLRE'~.ENV~IRONME.NTAL ~ I ~~ ~. F r ~E.~VIC~S .INC - , . _ ~ , - ~• ~~.~..i~ . r~,~.~o~o~.. 05/31-/2008 , ~ ~.:~ ~~ . ,' ~ \ -b. ... .. 1.... ~ •\ ~ C' r' y ' ~~ ~ UNDERGROUND STORAGE TANK PERMIT~APPLICATION TO CONSTRUCT /MODIFY /MINOR MODIFICATION OF AN UST PERMIT NO. B S R S P D ~~~~ ~~ r Bakersfield Fire Dept. Environmental Service 900 Trt.ixtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY ^ NEW TANK INSTALLATION AT EXISTING FACILITY ^ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY TARTING DATE ROPOSED COMPLETION DATE A~ILIzTY NAME / ~/ ,/ ~~ S` EXISTING FACILITY PERMIT NO. AGILITY ADDRES C~L`'~ ~ ~ ITY [~ L'' IP CO E PE OF BUSINESS PN # ANK OWNERr ~/ PHONE NO g°~ /'/~ DDRE r~ ,/Y?J~ ~/ / /~/l //y/y/A~- ~~~///7 J ~ ~L1Cj(~~ fa IP / J ~ cs ONTRACT / A LICENSE NO. ICC NO. DDR S ITY IP ~~A,/ PHONE NO. KERSFIEL~ ITY BUSINESS LI~ E NO.~ ORKM S COMP NO. ~ ~ ~ INSURE ' BRIEFLY DESCRIB THE WORK T BE DONE f WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED qRE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO TANK NO. THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED EGULAR REMIUM IESEL VIATION FOR OFFICIAL USE ONLY The applicant has received, understands, and will comply with the attached conditions of the permit and any other state, local regulations. This form has been completed under penalty of perjury, and to the best o,~my latowledge, is true and correct. _ APPROVED BY: APPLIGtNT NAME (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ a n f -- CERTHOLDER COPY ~ SG ~~~~~ P.O. BOX 420807, SAIV I=RANCISCO,CA 94142-0807 --cor~~srisRrroN ~-rt s- u ~-A ri -e e - • '~ ~ ~ ~ GERTIFICAi'E OF 1tVORKERS' COMPEt1FSATIOItI INSUR.AIIIGE ~' - j ~4 ~ISSl1E DATE: Q4=01-2006 GROUP:. 000426, - POLICY NUMBER: 0000276-2006- CERTIFICATE ID; 304 - - CERTIFICATE EXF?IRES: 04-0i-2007 ~ 04-01-2006/04-01;2007 Pk200F OF .EVIDENCE ONLY 5G c1O6: WAIVER OF SUBROGATION AVAILABLE 259.'71 TOWNS CENTRE-DRIVE UPON REQUEST ' LAKE FOREST CA 9261Q - • This is to certify that we have issues! a valid Workers',Compensation insurance policy in a form approded by the California Insurance Commissioner 'to the employer named belovV for the policy period indicated,.; This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. r We will also give you 30 days advance notice should this po[icjr be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage affil"riled ' by the policy listed herein. Notwithstanding any requirement, term ar condition of any contract or other document with respect to which this certificate of insurance may .be issued or to which it may pertain; the insurance afforded by the policy described herein is subject to all the terms,exclusions, and conditions, of such policy. • !ice , HORIZED REPRESENTATI PRESIDENT '.EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES -EXCLUDED. . ENDORSEMENT #1600 -LARRY MOOTHART, SEC, TRES - EXCLUDED. ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER BELSHIRE ENVIRONMENTAL SERVICES, ING. SG , 25971 T:OWNE CEIITRE DR . FOQTH2LL RANCH.GA.•92610--~ - ~ - ~ ost - PRINTED': 03-18-200E ~to~os r - s /'~ - ~~~ ` ~~~~ ~~~ , ~ Viz t}Sf~6~Zi70 $ PRQDUCER ~~49~r~5~-:4~€tQ - -~.$Q(l -. ~ Tt~fS CERTfFfCI~TE F~ ISSU~,~LS t~ f:ATTFR OF II~tFE~fZ2L~A'l'[c~i~F . , r~I~[.YA[an cat~F~RS xa RI,,~HTS ulsa~t TxE cEIZTeFIeATE M~ilern~fia~•Rzs[e F~3atfaga~`nt & ~ti5tit~at~ce Sa?.r~Ees ~ F ' RTiFiCAT~Dfl~S~[{7 FiC~f~Eft~IISC T~i€hD,.OR L~ cer~sa `~ X34&€I ALT€R THE CL}t~EFZLtGE dF1=aRL)E€t SY.TI~ I=e~ttCtz=s BEt~~y - .- 5~'3Q ~"rabuca Road _ ~ - INSURERS AFFORI~ItiCx Ct3Y~tAGE T'rntPr-Le, CA °2-bZt3 - - FusuxED geTshi i~ . Enu"i rrsnr~...Lr~a7 Serve ces ~ Inc ~ It•ISLT2E.R A: ZuF'-t EII ~Y?C`T t~ti Z5g71~ Ta~afe CEnt~re ar-ive !lisuR~s_ S~eadfas~ Insurance ' Foc~~hz~7 Ranch= C~. ~ 9.~6ZQ tusuRai~ . ~IFtst~si o- ' Z `~ r ~ G.~YLI~V~ - .. " THE POUCIES OF (AISfIRA(VCE LfSFED F3f30V{l I#A~fE BEEEf fSSLtE!] TO ZHE R1Sf.IRED NAk'~ EtSO~ FOR7HE P~(1CY PEf2fOD ItiD[CA'fED HO'iV$fTFiSTA1~ID(HG _ ,~;ghiy KEC~LtIFL"gatEflT, TERi4L OR COf+@CTK)N 0~ 1SbtY CONTRAL`T OR OTHEH DQCUEvIENIf 1+1tFfEl RESPECTTO WHICH THES CEl2TJFICAI-E EefAY BE lSSl3ID DR THE Q`fSURAtdCE AFFDRDC~7 9YTf-t1= POUCfES LlESGRlSED fiF12EIN IS SUB.tECTTD ALLTHl=TERMS, IXCLUSIOHS AFLQ CQAiDFTIONS Qf= SUCFf ~ '`-ft3AY PERT.4IIY . POL[CIES_•lI~GREGATE tkUFITS SHCIWN TJL4Y HAttE BEEF! KEDEICELI SY PAID CLAIMS ~ ~ IfFSR °~i'FR ~ j'2YPEOFVZSitRAPICE." .. POLIGYNEttO'8ER ~ - .. -PODGY Efl~_ E(YE PbLICY E7CFiR.47iOCI D,gTE DfETE kVbD I..kd[TS. ~Entt~uL.I~sIUtY ~ ~ I,aQ~~~Qo - X coc~szcrEU"t~tExaL.uAS¢m 9Y643fi-Q3 Q6/14~ZUQ5 06/14f~I7U6 flREOAFdAGE(AttyonefireJ s ZQO Q(}Q ' ~ ctAi6AS t~iDE a OCCLiR T ~ IUD ~ (My me pecsal, 5 S, U€}CI Q ~ - l'ER50NAE K IiDV tNJUEty S ~ s I)UIx, QQQ G~ERALAI~RREC,.ATE s ~r~QTQCId GEDCL AGGREGATE Uhi1TAPPUES PEFr PROOUGTS- GO'kA'!OE' AGG S ~ ~ (~(~ ~ QQ - T'OLICY ~ , ECT LOC . Alt[O&4081LE LIABICFFY COEAHtHEO 51t3GLE Lx~itT s x ASyYAIliD sl6o4z-a3,. f~5/I~£~2QaS c~/i~•~z'oo6 c~~~~n I,fl~,t~E1 ALI.OWNEDAUI'OS ~ 60DIf.YbWViZY s SCHEt'7LiLE{7 A[IfOS - - ~'~ ~~ S X ?!0[Q-OVYf1F1~ AUl"QS . ' FROI'ERTYDAMAGE S [PsF accidclf,} ' GgRpGE L~{gg17y ~ - - RUTU O[dLY- FISACCIDEN7' S ANYRUt"O OTHERTHAIY EAACC s 4 A(JTOOKI.Y: AGG S ,' FYCFS.S IJABYI]Y - F1lCH OCC(lRt2EFlCE S ~" x QQQ ~ QHO Jf occuK ~ ctAltusanADe EI? 5337678-QI. •E36/14/ZQaS Q6/14/ZUd~ acctzESn~ r 'S„O€](}, QOQ ~ s 6E000)"tBLE S ' RtTEMTION 5 ~ S - kVORKER5 CQFCPI=KSATTON Al`tU TORY UKFtI"S ? . ER f . ~ . >=1utPintc~:RS' LI~iHFLFTY E.L EACH ACCIOEN't S - E!_ DISEASE-FAEMPLO s .E,E_bISEASr= - OLICYLSIFIT S P OTFFE2Z ~ ff ~~{( --'~1 -?"CyQ~~/t~~Q L~tmt-~ ~ atff>v~acto~s Po17LttYVL~ 9~5t139-Q3 Q~/I4/~4(~S Ub/I4~/20t~6 i_Y ah-i7 ity bESCCngF7oNOFOgEFcqJiQNS20~aT[c~'lSntH_Ifct.ESrFxCL.tlsioNSAnb®BYENDPRSELtEri'TTSPECtALPfrOStfstOtts . - - -~ , ifT day notice of cancel~at~o€L 7n the e~rt=rit of Ltczt-~-~Saynten~ v~ prellf-~um. =ERTIF[CAFE HF3LI3ER aDwz-lofusLtrtsulz~n;-tasulz~R;~iT~ .. CAT~CELLA.TIOFI - .. - , SHOULIIAI'lYDFTHEABOYE QFSCKI8E0 POLICIES SE CJSIVC1=f T Ffs BFFOIZE'FI-FE ' ' - ~ ~fE~et1'FONDAFETfiFt2H7F.7TiE1~4t3EFlGCOhfP'RfFYY~tII1EFfDEAYCkZI"iDFfE[2t . - ~ .. DRYSYf~iFFTENbI07JCESDZHEC82FF3cATi:HOLDfi2AL41dEDTO12'_ELErT,.. H'Jf'l=itSLU12ETQ7hRlCS[ICFf I~IOIiCES!{kLt ~CiPOSE I10 03LIGifT[Of~f IIR UA?ftF11~ E~XLI'fIfFtFFULT{]t;I?FiEt<oSiPRb`l~S7i0£tFtF3R~'~TATKEs -• = ~Froof~~~'Fc~erfte tlz~~== ~rrrc~a~ .~& UNDERGROUND STORAGE TANK PERMIT APPLICATION TO CONSTRUCT /MODIFY /MINOR MODIFICATION OF AN UST 8 BRSPI D F//~~ ~Arer r PERMIT NO. TYPE OF APPLICATION: (Check one item only) ^ NEW FAGILITY ^ MODIFICATION OF FACILITY Bakersfield Fire Dept. Environmental Service 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ NEW TANK INSTALLATION AT EXISTING FACILITY MINOR MODIFICATION OF FACILITY TARTING DATE ROPOSED COMPLETION DATE AGILITY N/AME ~/ / EXISTING FACILITY PERMIT NO. FACILITY ADDRESS ITY IP CO E ` PE OF BUSINESS ~~>>~~ e PN # ANK OWNER ~~ HONE NO ¢~ /~ DDRE `~ ,/S/1~/ ~~( FAO/, ' ~~~~~~ l ~ I P~~~ NTRACT A LICENSE NO. ICC NO. DDR s ~....- ITY ~/ id ~,~ HONE NO. f- rT~bl`~ ~ KER~ D CI~ USINESS LI~ E NO.~ (ff~~ ORKM S COMP NO. ~ ~ ~ INSURE BRIEFLY DESCRIB THE WORK T BE DONE i" f WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED qRE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO THIS SECTION IS FOR MOTOR FUEL TANK NO. 1-HIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED EGULAR REMIUM IESEL VIATION The applicant has received,. understands, and will comply with the attached conditions of the permit and any other state, local and regulations. This form has been completed under penalty of perjury, and to the best o my loiowledge, is true and correct. ~~/'~~ n_ APPROVED BY: APPLICRNT NAME (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ n n - CERTHOLDER COPY - ~~~~~ _ P.D. BOX 420807, SAf\t [=t~ANCISCO,CA 94142-0807 --GClMPEi`ISATIQN - . ' ~ - ~ - EhF;.~s,- E~ R-A N-G H . ~_ ~ CERTIFICATE OF 1~(ORKERS' Ct?M~E[1FSATION tt~SlJ[~ANGE `4 ISSUE DATE; Q4=~01-2006 GROUP:. 000426 - POLICY NUMBI=R: OOOf3278-2Q0B CERTIFICATE !D: 304: - CERTIFICATE EXPIRES: 04=01-2007 04-01-2008/04-Ot=2007 PROOF OF EVIDENCE ONLY 5G JOS: HtAIVER OF SUBROGATIQId AVAILABLE 259.'71 'i'OI~IHE CENTRE FIRIVE UPON IZE4UEST •LAKE FOREST CA 92610 - - This is to certify that we have issued a -valid Workers'.Compensation insurance policy in a form approved by the California Insurance Commissioner 'to the employer named below for the policy period indicated,;- This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 80 days advance notice should this policy be cancelled prior to its nflrmal expiration: This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded ' by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may •be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, .=exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT '.EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE C05T.S: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 -KAREN CASS, PRES -EXCLUDED. , ENDORSEMENT #1600 -LARRY MOOTHART, SEC, 7RES - EXCLUDED. ..ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-0i-2004 I5 ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER- BELSHZiFE ENVIRONMENTAL SERVICES, INC. 2597'1 -T_01'INE CEIITRE DR F0t1THTLL RANCH cA ~S2fi10 .. . os) - - - Stz l~to~os _ ~ g g _ 9 - ~JI ~6 ~ ~ ~ ~ ~ ~~~ ~= c _ _ ... i~ - - - ~ _ - ~ CYtS ~ ~ . s`~L ~~ ~~~~.~~ZQQ~ 1?xoottcFJt _ (~49~ 85~-:45f~Q -•4$tf(I THIS CERTfEICATE fS ISSCEEI? AS ti. F~i"1-ER QF 1I~IFt~Ritf~i7'IC~~ " HE~ERTEFIC.ATE• ~1~7F~iItJ•R7S~: Managa~~ & ~FiSiti`altce S~t~tiEttiS ~~LYtiH€1GCII~FEI2SNtiR1GFiFS€SPt3Pf7 ~T F N1 7 ~ ~ H ' E 7 fS C 1Z I~ICI~TE t~t3E5 r~t~TAf=gEh Ift~ER T D, EXTE1~tD.c~R _ L'L C~LS~ 's~ CC33!~8Q t~LT~t THE C_ Q~IER1t.GE dFi=t3R13E€3 BY I~IE Pf3l~CIES BEL£)T~( _ • 5530 ~`t-abuca Road _ • [ttSLIRERS AFFORI~IFiG GOIEERFiGE ~r`~tirte, CA °Zfi2t3 . - IrssuRr=D Be~'shir`e Envira~tiF~...t~~a3 Se~Ces, inc. tNSt1RE-RA ZLFF~TEIF ~?T`TCdti Z5~7I Tatvrse 4=ert~re Dr~i~re ttsstltztsts_ S-~e3dfas~ Tncutzat~ce - ~ ~00~~22-I~ RarlCh, ~ ' g.~ETZQ IfiSItR£dZ~ ~ . INSItfz82 E ' G.QVERA6ES 7HE PQLIClES ©t= Jt~iSttRANGE LfSTEt~ BIZOVY HAVE $EEFt tSSUi=Q TO TH E ltiSF]RED NAkiID tt80SfE FOR THE P(3tICY PERIOD lFiOfG4TED FIOTiNlFEiSTANDf1,FG H~`IT, TE}ZM OR CONDI[IC)N OF AI~fX COKTRAC i' OR OTI-iEfZ DOCU~'it1A~F1T~ RE~PECTTD W(itCH THtS CE~ZTJFiCATE kfAY:BE ISSUED OR- +• :4NY REL2EIIR , ~`hx.AY PERT/VFI. TFT!_ 1bIS(fRAt1CE AFFOftI3C~t 6YTE[E POLICIES QESCRIBED HF2tIIN IS SU6.tECTTO ALL THETEFtMS, IXCLCJSIOHS A!`FD CE?t•2RFTfDNS OP SUCt~ i~ f'QLtC[ES_~At;GRE6.4TE L1MlTS SHOWN IJIAY HAttE BEEN REDUCt7] 6Y i',4It3 C.tJS11vfS .. INSFZ ~ ~ POCIGYT1UNt8[3t 'TYPE OF7KSttItAPFCE ~ POGfGYL~_ L-i~iilE Pt3UG'i'EXPiKRTlOiti . [.!NETS DATE GATE kVgO . i_ Lt72 . . ~ .. .. _ _ ~ ! GENF.~uiLtlKStcr[Y ~ ~ F1[CH OCCURR€NCF S I, QQQ, (1t}t1 X ccxtifiaezctaLC.at~uLLU+stu3Y 9I6f}35--03 Q6j~~,f2U05 U~~'I4/~~O4y6 FIIxEwtrvtAG~~~s~y a IQ(1 E3{!Q • cu~tsns fdADE XI~I occltR , ~ F~ t~sr «,~ ~a,y s 5: UQQ . PEr;sot~rRt. t: Aov ix~tl~r s I s OQO, Q00 G$iEILiLAGGREG4TE S _ Y,OflO,Qty4 GENT AGGRECiAT'E [tC~6[TA?PLI6 PEFC ~ PRODUCTS-CO;tiPIOP AGG S ~Y(}QQ~Q[y '~ ppLtCy ~ ¢ LOC - AUOOw+nan F LJABIESEY COR18lfJ87 SINGLE [1WYT - s X At,LYAUTO 9I604Z-03; 0&/X4/2005 OSj~4~Ot16 ~'~~"~ I, 0041,00 ALL OWNED gU'fOS ` BODILY tiVJUtZY S sCHEDttt-EL7 AU705 _ ~~ ~~ ~ X i-pRt~ AUTOS BOOttY tfiUURY s X NONF-0WNED AUTOS tp~ ~ [ R~OP.~ OAI~MGE 5 (3l4Rt1GE URHtUTY AUTD ONLY- [AACCIDENY S - ANYRUTD ~ OTHERTI1Ah! EAACC S 4 AUTO ONLY: AGG S F7CCES5 UAeat'IY 64CH OCCGRREt•[CE i 5 , 004? ~ 09t7 • X accux ~ctAintsauir~E 1=Q 5337675-QX •U6/I~€/ZD05 Ofi/I~X/Z006 Acr,.IZEG~tTE r 5,0€I€},000- S S 6EWCflBLE S RE'TEMIDN S ~ ,i S . 1K0{t[CE>•ZS GOFIPEHSJITtOFI AND TORY t~[ffS ','~'_ EIt ~ F1NPt~s' UAHFLiIY ~ EL EACH ACCiOEStT S E.C..DIStASE-F1iFaAPfA 5 - F_L OtSEAS1=- ["O[1CY Lkd[T S ~x,QtFt1,Q€li3 Litui~ an~t~acto~s Pollrx~ion g Liability 915039-Q3 (~6/I4j244)5 U6f~4j20Q6 OESClZip'TtpN OF CgEt2A?I¢KS(LOC~i'I1<111SN8{1CLEStE'XCLl1SIOFIS ADh® $Y ENOpfLSt3dElV'TTSYEGtIiL [ RDYIStOttS . - . .~ ~ . ~: Pt`oof ~viden~e E)n3y - iE~ day notice of cance~f7a~-ioa~ in tF~e e`reri~ of ttc~'4-~Sayiiten~ a~ p~ettr[E~tu. =ERTIF[CIkTE Hf7Lt3ER AotuTtoKat.uasurzt=is-tt~ttzs=xt~~ ... C~.i~CE2[ATICPI - ~ ~ ~ - SRQULIIRIQYc7FTHEAHOYERESCRSH[~POLk:t6SSEeANcELL~I3EFORETFtE~. psf.~'F(ONBATE'IIiEI2ELSF.THEISSf3tt16WM?RPFYt~fttlEtmEAtf[7RTaFfAtL - ~ ~ ~ - .. t?AYSYYRIFTE<•I 3~IOTICt=Tt}THE C$i.2'1EiCA7EfiOLDt=.4FiA6iED177'FF?E LE~-F, Ft'JCEiYSLU~ZETO&FIi1LSUCFITt077CESE~kLLlh4POSEFF00?3L1GA'FiOt~aRE.tA~-BY - ~ - ~ ~ ~ ~ Or jIFtYIFl~c1Ff [ts'~t.1TiEGOtSPA fLG ORFCEPRESEKfA'FN1TT '• -`~'PT'DO'~~~1C7€~eTtCE T1e`€~yx•-z~:..=' AuTfFagi~RII'ttGSEN"E'A _ . ~ ~ ...e <_ _- .? - ~- --_ _ ~ r~'~' jS"1 i`f's - O ~ LillitE-li ViT~ ISJQ CCfRD Z~ 5 (713] .~..~ UNDERGROUND STORAGE TANK PERMIT APPLICATION TO ~ & s p i D F/Ral~ CONSTRUCT /MODIFY /MINOR ~~'~~' ~' MODIFICATION OF AN UST r~? _~ _. PERMIT NO. TYPE OF APPLICATION: (Check one item only) ^ NEW FACILITY n M[ll']IFICATIl1N l~F FACII ITY Bakersfield Fire Dept. Environmental Service 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel: (661)326-3979 Fax: (661) 852-2171 Page 1 of 1 ^JNEW TANK INSTALLATION AT EXISTING FACILITY .P~ MINnR MnnIFICATInN AF FACILITY TARTING DATE ROPOSED COMPLETION DATE AGILITY NAME ~~/ EXISTING FACILITY PERMIT NO. AGILITY ADDRESS / ~~' ~ ~ ITY l ~' e IP CO E ~ ~ PE OF BUSINESS ..!i~~n% i ' ~ w PN # ANK OWNER ~~ PHONE NO DDRE ~~ ~ .~/ / /~~//rr l ~ I P~~~S NTRACT ~~~,~~ ~~ ~~~~ ~ A LICENSE NO. /' CC NO. z~ys~ z-vi DDR S /~ ~-- t~yy pp nY IP 77i.~ppl~~~~~/~ HON .,~ ~ BAKERSFIEL~ I~ USINESS LI~ E NO. ~ ORKM S COMP NO. ~ e ~ INSURE ' BRIEFLY DESCR{B THE WORK T BE DONE f i WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO.OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL ^ YES ^ NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ^ YES ^ NO TANK NO. w PHIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. OLUME NLEADED EGULAR REMIUM IESEL VIATION Y The applicant has received, understands, and will comply with the attached conditions of the permit and any other state, local regulations. This form has been completed under penalty of perjury, and to the best o,~'my knowledge, is true and correct. APPROVED BY: APPLIGtNT NAME (PRINT) THIS APPLICATION BECOMES A PERMIT WHEN APPROVED ~ a n f - CERTHOLDER COPY SG _ _ ~~~~~ _ P.O. BOX 420807, SAN ~RANCISCO,CA 94142-0807 -•GQMPENSATIQN ' . ~ ~ - EAE-S Ci R-A N-~ E . • "'~ ~ ~ GERT[~[GATE OP WORKERS' CC}M~EtVSATIOt1t titi[SIJRAiiiCE `ISSUE DATE: 04'01-2006 GROUP:. 000426_ - POLICY NUMBER: 0004276-2006 CERTIFICATE ID: 304 - CERTIFICATE EXPIRES: 04-01-2007 04-01-2008/04-Ot=2007 PE200F OF EVIDENCE ONLY SG JOB: WAIVER OF SUBROGA'PIOH AVAILABLE 259.71 7'OYtNE CENTRE DRIVE L4PQN REQUEST LAKE FOREST CA 52610 This is to certify that we have issued a valid Workers'.COmpensation insurance policy in a forth approved by the California Insurance Commissioner'fo the employer named below for the policy period indicated;.;- This policy is not subject to cancellation by the Fund except upon 30 days advance written notice #o the employer. r We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the .policy Listed herein. Notwithstanding any requirement; term or condition of any contract or other document with respect to which this certificate of insurance may •be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, ,exclusions, and conditions, of such policy. HORIZED REPRESENTAT PRESIDENT r '.EMPLOYERS LIABILITY LIMIT INCLU!]ING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, ENDORSEMENT >y1600 -KAREN CASS, PRES - EXCLUDED. ENDORSEMENT #1600 -LARRY MOOTHART, SEC, TRES -EXCLUDED. ENDORSEMENT 1€2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. . - s - __ - ~~~~ ~~ ~~~~ ~ E}6fZ6,/ZE~O~ _e PRODFJCER ~949~85Z-4SQt? -~8I}0 TE~tseE~T~~teATEISISSUEBASA~4TTF~OFIPlF-t3RiL~fATIt1AI - J.. i3T<tLYAN€~ G(ItdFERS t~i4 REGFiTS UPQt1 THE t:E1~7iFICRTE I~I~~Tern~riln R~sfe ~Iat~aga~`rF-~ & ItiSUt~~tce S~r~r'iEeS - F ~(~L~Et~THISC ~zTIFICA7E[~43=Sttt~T~~€c:a,F,ttFgtg.ai~ Li cue i Qr~•~4&fT AL7€R THE C_ €2~E AFFQRt3EB f~Y T i~ Ff3LtefES I~EL~~y_ . .- 5~3t7 Trabtzca Road _ ~I~Y ine, Ct~ °Z6Zt3 - - FZ~~URERS AFFQR~if~G C1~yERF~GE - fElsulzr;a geTsb~ i`G . Envi rCTIIrI-~._IT~aI Set v~ cis ~ mac. tNSUR~.RA ZIFI"''IEIF AII~F`T CITE ~ - Z~~7~.To~IITe Centre Drive ItisIJP.~a: S~ead~'as~ Insurance - ~~€~~h-e~1 R~ttcb, C~. ~ 9ZEIQ rrasuRazt~ - - ~utslJ~ Ir_ G~IStslz€IZ ~ G.GT~lEFZAG€.S - - THE PQETGES tQE= lt1SfSRANCE LFSTEB HEZQVY HAVE BZ~Ff [SStIET] TO'THE IPLSI]RED NA1:St=D ASOftE FARTIIE PaLFCY PF=F2lOt7lISD[CATED_ Ho7V1FlTtiSTANDF{IG ,t yyldY REQEIIK-gh>=f!-f, TFRM OR CONBRION OF 1SbIY CONTRACT OR OTI-It~t DQGUINFI IC~A~ETH R1=SPECTTOF VJF{ICH THtS CERTJFI~-ATE kiAY BE ISSUID OFT' ~IsSAY~PERT.4tel,THER~FSC![~AAICEAI~dFti?EF7BYT~POLIGESOE5CRI8FBHERIIN-SSUBJECTTi3ALITHETE-~t[~s,IXCLUSIOHsANDGONDtTiOJ~fSOf=sLIeH •," ~OLIC[ES_-A~C~ZEG4•?T= L><1~flTS SHOWN TJl.4Y KAtfE BEEi~E REDLFCED SY F'AIB CLItl1~dS -.II?sR >_Y'Ft ~"tYPEOFIFI5i7RAHCE .. POLfCYNIJ6ATiHi eotlcY~_ rlvE eauc~roci=[RaT[orI DATE GATE D [~NFTS _ j GF1V~R/LL FJRFSIt1TY FACH DCCUf2R€NCF S ~ x (}QQ i QQQ - X COGfilazcrALGENERALLlA$tLITY 9I6t~38-03 Q6f~.~€/ZQQS Q6114fZ€tQ6 Ftlz~wuaAGe~~r~E a I.QO,EtfID - aAr>uts iv~AF?E X~ Occult - r~ F~ tA~Ir «xt P~«ta s S, 4QQ ~_ A PnzsorraLKADYUIJIIEty s I,QOf},QQQ G131EluLLALX}REGA7"E ffi - Y y (3fl0, Q(}Q GEKLAGGRE6ATEt]&tffAPPtt_FSYEFt PROtWGTS-I:0.'lfP/OPAGG S ~~(}~(]~QQ PfJC.IGY ,~ ~ L¢C AIITOb408tL.E LIABtEIEY CO(.ialHE7) SINC~.E U'&f[T S JC ASyYkUCO '3I6U4Z_p3_ Q6fX~~00~ QGfI4/~.`OQ6 ~ ~~^~ I, (3(M2, QQ AIL OWNED AUIDS ~ _ ~ ~ 130DILY INJURY 9 SCHE~LILEP AF]T03 - . ~°~~~ ~` X rilREa Auros - t30F JltY tfiFJ[1RY X TIOPi-ONTIi~ AUT'US , S (P`~ ~ ' ~ PROP. 6fTY DAMfIGE S (PeF accidaw`} GARAGE Ll4BIliTY AlIYO ONLY- EAACCIDEN7 S ANYAITi'O OTHERT~iMI EaACC S G aura QNLY AGG S L7CCES5 UAHILICY ~ EACH OC WRRQICT= S ~ y QQR} t (IH(l X occult QaAic~nsan+we E(2 5337678-QZ -06/1.4/ZQQS 06/I4/ZO06 AccR>=~.aTe r 5,0(}Gt,dOQ- ~ s 6EEHICTIHI..E S REFEP1TlON S - ~ S 1RDt2ICERS W AIPEtISXTtOt! AND - TORY ~g ~`_ ~ ~ EAIPLDYERS LIA8U.i1Y EI_F1iCFiACCtOENT S E.L.DLSFASE-FAI7~7PCA S .EE- otsFA~- ['Ol~CY Lta1SIT s Q~'I;i`dCfiOF'`S POITCI'~TOit .~Z,Q(3DsE3€ltT L'Eti[-!'~ B L~ahiyity 9I5Q~9-43 D6fI4/Z4US Q6f~4/2QQ6 DESCRlYI>QN bF G'FFF~It~IQNS20~ATiC~'lsl~lHjlCt~S[FXCLUSfoFIS ADbl3T $Y 1=tI~ORSEkIETGtTSF'ECfAL. YIZDSt[slQtts '" .~ €: PC`OQ~ EYideF[C0 [ltT~~t - 7.Q cF~y notice of C~rtCe7Ta~1o€t in #1'te etiterit of Ettlc'7-j33y17ten~ o'~ ~it`e3Fi-tCIIII. ERTIF[CA-fEEfE7LBER tWtxTlettrat..ttasvtzm-tlasuR>=RtFi~~ •~ C~GE€-EA•FTCbf - - ~ ~ 58QULBRHYOFTHEA80YEDESCRft3EDPOLlCtE5SEC7SNCELi~lT13EFO[Z6TFfE - ~ ~ EXI"FizATTQNRATE1Ii5=c287F 7KE[SSt1T~1GCO:1IPIlNYY~Ft.t-EtIDEASEE7RTOrkf~tlL - ~ - .. BAYSTiYRIFTE~'IAiOTIC~T'OT-r{ECH2TIFZCISTEFiOLDE.FAtAFdEI)T7]'Ff:HL'F'-, • _ ~ ~ g'JT'FRILEIRETQ"kfRiLSFICFFId6TtCESHW~tIe(FOSEFIf203LIGA7TOt~EIIRII~=IFY .- ~ ~ - - DFBFFfIflc~fIIIJ2OFITF{ECO~fPA !LG>=.FtTSORF~FRESf=NTATFYES. . -- =~ Praaf~E=~ic~err~e (Q~€~y~==-- ~urHO~nx~Ir~IrR - - _ -- -- - ..._ ; -_., _ .- 'r - - - - +~ - _ .~, _ - _= mss--~-t-'- _ _ - - - - GQRI~ Z~S {71st} O 4D CC?~ZPQ QF~F ~s3& ,_._ '° - - UNIFIED PROGRAM CONSOLIDATED FORM TANKS UNDERGROUND STORAGE TANKS -FACILITY (one page per site) Page _ of _ TYPE OF ACTION ^ 1. NEW SITE PERMIT ^ 3. RENEWAL PERMIT ®5.CHANGE OF INFORMATION ^ 7.PERMANENTLY CLOSED SITE (Check one item only) ^ 4. AMENDED PERMIT specify change local use only ^ 8. TANK REMOVED ^ 6.TEMPORARY SITE CLOSURE 400 1. FACILITY /`SITE INFORMATION -..~ _ , _ _ BUSINESSNAME(Same as FACILITY NAME or DBA-Doing Business As) 3 FACILITY ID#:. 7-Eleven #32241 1 NEAREST CROSS STREET aot FACILITY OWNER TYPE ^ 4. LOCAL GENCY/DISTRICT* 4101 Calloway Dr ® 1. CORPORATION ^ 5. COUNTY AGENCY* BUSINESS ®1. GAS STATION ^ 3. FARM ^ 5. COMMERCIAL ^ 2. INDIVIDUAL ^ 6. STATE AGENCY* TYPE ^ 2. DISTRIBUTOR ^ 4. PROCESSOR ^ 6. OTHER ao3 ^ 3. PARTNERSHIP ^ 7. FEDERAL AGENCY* ao2 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 aoa ^ Yes ®No aos aos " ll. PROPERTY`OWNER INFORMATION `- PROPERTY OWNER NAME 407 PHONE aoe WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS 4os 15601 Dallas Parkwa ,Suite 40 CITY 410 STATE 41t ZIP CODE atz Dallas TX 75001 PROPERTY OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL afs _ III. TANK OWNER INFORMATION TANK OWNER NAME aia PHONE ats 7-Eleven Inc. 253-796-7170 MAILING OR STREET ADDRESS ats P.O. Box 711 Attn: Gasoline Acct CITY ate STATE 416 ZIP CODE ats Dallas TX 75221-0711 TANK OWNER TYPE ®1. CORPORATION ^ 2. INDIVIDUAL ^ 4. LOCAL AGENCY /DISTRICT ^ 6. STATE AGENCY ago ^ 3. PARTNERSHIP ^ 5. COUNTY AGENCY ^ 7. FEDERAL AGENCY °` 1V. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY TK HQ 44- 3 1 8 9 6 Call 916 322-9669 if uestions arise 421 V. PETROLEUM.UST FINANCIAL RESPONSIBILITY INDICATE ^ 1.SELF-INSURED ^ 4. SURETY BOND ^ 7. STATE FUND ^ 10. LOCAL GOVT MECHANISM METHOD(S) ^ 2. GUARANTEE ^ 5. LETTER OF CREDIT ^ 8. STATE FUND & CFO LETTER ^ 99. OTHER: ® 3. INSURANCE ^ 6. EXEMPTION ^ 9. STATE FUND & CD az2 VI. LEGAL'NOTiFICATION AND_MAILING'ADDRESS ,. r. Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. ^ 1. FACILITY ^ 2. PROPERTY OWNER ®3. TANK OWNER a23 ~~ ~ .VII. APPLICANT SIGNATURE ~ ~~ ~ `' ~ ~ ~ ` '~~~ Certificati - I c ion provided herein is true and accurate to the best of my knowledge. SIGN U OF APP T DATE aza PHONE azs ' 7/28/06 702-270-7160 NA OF APPLI ANT (print) azs TITLE OF APPLICANT a2~ Randy Martin Gasoline & Environmental Compliance Manager STATE UST FACILITY NUMBER (For local use only) 428 1998 UPGRADE CERTIFICATE NUMBER (For local use only) azs UPCF (1/99 revised) Formerly SWRCB Form A UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMAT ION BUSINESS OWNER/OPERATOR IDENTIFICATION Page _ of _ i I.IRENTIFICATfON __ FACILITY ID# ~ G DATE tau ENDING DATE ~ I ~ 101 ~ F A', OOQ 8/1/20O6 12/31 /2007 BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 BUSINESS PHONE 102 7-Eleven #32241 661-587-8826 BUSINESS SITE ADDRESS 103 4101 Calloway Dr. CITY 104 ZIP CODE 1os CA Bakersfield 93312 DUN & BRADSTREET 106 SIC CODE (4 digit #) 107 00-734-7602 5541 COUNTY ~ 0e Kern BUSINESS OPERATOR NAME 109 BUSINESS OPERATOR PHONE 110 Shinda & Paramjeet Upple 661-587-8826 tl. BUSINESS OWNER.... __ -- _ - - - UWNEK NAME _ _ _ - 111 OWNER PRUNE - ~ 12 7-Eleven, Inc. 253-796-7170 OWNER MAILING ADDRESS 113 P.O. Box 711 Attn: Gasoline Acctg CITY 114 STATE 115 ZIP CODE 116 Dallas TX 75221-0711 III. - ENVIRONMENTAL CONTACT _ CONTACT NAME _ - _ - 117 ---- CUNTACT PRUNE - ? ,~ Randy Martin 253-796-7170 CONTACT MAILING ADDRESS 119 P.O. Box 711 Attn: Gasoline Acctg CITY tzo STATE 121 ZIP CODE 12z Dallas TX 75221-0711 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- - ---- - -_ NAME 1z3 - ...NAME. - - __ i ze Shinda Upple 7-Eleven Emergency Dispatch I TITLE tza TITLE tzs Franchisee Emergency Service BUSINESS PHONE 125 BUSINESS PHONE 130 1800-828-0711 800-828-0711 24-HOUR PHONE 126 24-HOUR PHONE 131 1-800-828-0711 800-828-0711 PAGER # 127 PAGER # 13z ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: se on my i uiry oft bse individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined a a familiar ith the' ormation submitted and believe the information is true, accurate, and complete. SIGNAT E F O R OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 - - 7/28/06 Rachel Rodriguez NAM F SIGNER (print) 136 TITLE OF SIGNER 137 Randy Martin Gasoline & Environmental Compliance Manager UPCF (1/99 revised) HMP 2 (Back) Instructions OES FORM 2730 (1/99) EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify LOCAL AGENCY within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641 (h) CCR. Facility Name: 7- Eleven Store #32241 Facility Address 4101 Calloway Dr., Bakersfield 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then LOCAL AGENCY must be notified within 24 hours. In case of a gasoline spill- Small gasoline spills will be picked up with absorbent material by employees using safety equipment. Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. Employees will be notified to evacuate if deemed necessary. A contractor will be contacted to remove the spill as necessary. In case of a small carbon dioxide release- the tank will be visually inspected for obvious signs of the release point. If possible the control valve will be shut off. In the case of a large release of carbon dioxide, employees will be notified to evacuate and Contact 911 and 7-Eleven Dispatch. In case of fire- the alarm will be sounded by shouting "Fire" and the building will be evacuated. Employees will contact 911 and assemble at the designated assembly area as depicted on the site map. If safe, employees will shut off power and control fire using fire extinguishers. 2. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances. Small gasoline spills will be picked up with absorbent material by employees using safety equipment, Waste will be placed in a drum for proper disposal. For large spills Employees will activate the emergency shut-off ,Contact 911 and 7-Eleven Dispatch, and, if safe, will attempt to prevent the spill from entering storm drains or migrating off-site by placing absorbent material in front of the leading edge of the spill. A contractor will be contacted to remove the spill as necessary. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent is located inside the store in the backroom. 4. Describe the maintenance schedule for the cleanup equipment. Inventory of absorbent is periodically checked. List the name(s) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan. Randy Martin, Gasoline & Environmental Compliance Manager 253-796-7170 Date 7/2A/~f UNDERGROUND STORAGE TANK MONITORING PLAN For use by Unidocs Member Agencies or where approved by your Local Jurisdiction Authority Cited: Title 23 CCR, Sections 2632(d)(1), 2634(d)(2), and 2641 (h) TYPE OF ACTION ^ 1. NEW PLAN ®2. CHANGE OF INFORMATION Mol. PLAN TYPE ®MONITORING IS IDENTICAL FOR ALL USTs AT THIS FACILITY. Moz. (Check one item only) ^ THIS PLAN COVERS ONLY THE FOLLOWING UST SYSTEM(S): I. FACILITY INFORMATION FACILITY ID # (Agency Use Only) _ FACILITY NAME 7-Eleven #32241 M03. FACILITY SITE ADDRESS 4101 Calloway Dr. M04' CITY Bakersfield Mos. II. EQUIPMENT TESTING AND PREVENTIVE MAINTENANCE State law requires that testing, preventive maintenance, and calibration of monitoring equipment (e.g., sensors, probes, line leak detectors, etc.) be performed in M06. accordance with the equipment manufacturers' instructions, or annually, whichever is more frequent. Such work must be performed by qualified personnel. MONITORING EQUIPMENT IS SERVICED ® 1. ANNUALLY ^ 99. OTHER (Specify): Mop. TII. MONITORING LOCATIONS This monitoring plan must include a Site Plan showing the general tank and piping layouts and the locations where monitoring is performed (i.e., location of each sensor, line leak detector, monitoring system control panel, etc.). [f you already have a diagram (e.g., current UST Monitoring Site Plan from a Monitoring System Certification form, Hazardous Materials Business Plan map, etc. which shows all re uired information, include it with this Ian. IV. `TANK MONITORING MONITORING IS PERFORMED USING THE FOLLOWING METHOD(S): (Check all that apply) MI°' ® 1. CONTINUOUS ELECTRONIC MONITORING OF TANK ANNULAR (INTERSTITIAL) SPACE(S) OR SECONDARY CONTAINMENT VAULT(S) SECONDARY CONTAINMENT IS: ^ a. DRY ®b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM MI l PANEL MANUFACTURER: VeederROOt Mtz. MODEL #: TLS35O M13. LEAK SENSOR MANUFACTURER: VeederROOt Mta. MODEL #(S): H4739O-420 Mts. ^ 2. AUTOMATIC TANK GAUGING (ATG) SYSTEM USED TO MONITOR SINGLE WALL TANK(S) PANEL MANUFACTURER: MI6' MODEL#: Mt7. IN-TANK PROBE MANUFACTURER: Mls. MODEL #(S): M19. LEAK TEST FREQUENCY: ^ a. CONTINUOUS ^ b. DAILY/NIGHTLY ^ c. WEEKLY Mzo. ^ d. MONTHLY ^ e. OTHER (Specify): Mzl . PROGRAMMED TESTS: a. 0.1 h. ^ b. 0.2 h. ^ c. OTHER S ecif M22 ^ g~P~ S•P (P Y)~ . M23. ^ 3. INVENTORY RECONCILIATION ^ a. MANUAL PER 23 CCR §2646 ^ b. STATISTICAL PER 23 CCR §2646.1 Mza. ^ 4. WEEKLY MANUAL TANK GAUGING (MTG) PER 23 CCR §2645 TESTING PERIOD: ^ a. 36 HOURS ^ b. 60 HOURS Mzs. ^ 5. INTEGRITY TESTING PER 23 CCR §2643.1 TEST FREQUENCY: ^ a. ANNUALLY ^ b. BIENNIALLY ^ c. OTHER (Specify): Mz6 . Mn. ^ 6.VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approval) ^ 99. OTHER (Specify): Mzg. V. FIFE 1VIONITORING MONITORING [S PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mao. ® 1. CONTINUOUS ELECTRONIC MONITORING OF PIPING SUMP(S)/TRENCH(ES) AND OTHER SECONDARY CONTAINMENT SECONDARY CONTAINMENT IS: ®a. DRY ^ b. LIQUID FILLED ^ c. UNDER PRESSURE ^ d. UNDER VACUUM M31. PANEL MANUFACTURER: VeederROOt M32. MODEL #: TLS3SO M33. LEAK SENSOR MANUFACTURER: VeederROOt M3a. MODEL #(S): 794380-352 M35. WILL A PIPING LEAK ALARM TRIGGER AUTOMATIC PUMP (i.e., TURBINE) SHUTDOWN? ®a. YES ^ b. NO M36. WILL FAILURE/DISCONNECTION OF THE MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M37. ® 2. MECHANICAL LINE LEAK DETECTOR (MELD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS AND RESTRICTS OR SHUTS OFF PRODUCT FLOW WHEN A LEAK IS DETECTED MELD MANUFACTURER(s): VapOrIeSS & Red Jacket M38' MODEL #(S): LD2000 8t FX1 V M39. ^ 3. ELECTRONIC LINE LEAK DETECTOR (ELLD) THAT ROUTINELY PERFORMS 3.0 g.p.h. LEAK TESTS ELLD MANUFACTURER: M40' MODEL #: Mal. PROGRAMMED LINE INTEGRITY TESTS: ^ a. MINIMUM MONTHLY 0.2 g.p.h. ^ b. MINIMUM ANNUAL 0.1 g.p.h. Mae. WILL ELLD DETECTION OF A PIPING LEAK TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO M43. WILL ELLD FAILURE/DISCONNECTION TRIGGER AUTOMATIC PUMP SHUTDOWN? ^ a. YES ^ b. NO Maa. ® 4. INTEGRITY TESTING TEST FREQUENCY: ®a. ANNUALLY ^ b. EVERY 3 YEARS ^ c. OTHER (Specify) M45. M46: ^ 5. VISUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY* ^ o, MIN. MONTHLY & EACH TIME SYSTEM OPERATED** Mai. * Requires agency approval *" Allowed for monitoring of unburied emergency generator fuel piping only per HSC §25281.5(b)(3) ^ 6. PIPING IS SUCTION PIPING MEETING ALL REQUIREMENTS FOR EXEMPTION FROM MONITORING PER 23 CCR §2636(a)(3) ^ 7. NO PRODUCT OR REMOTE FILL PIPING IS CONNECTED TO THE UST(s) ^ 99. OTHER (Specify) M48. UN-022A -1/3 www.unidocs.org Rev. 10/14/03 1 ~, s - i5 Underground Storage Tank Monitoring Plan -Page 2 of 2 VI. DISPENSER 1VIONITORING MONITORING OF AREAS BENEATH DISPENSER(S) IS PERFORMED USING THE FOLLOWING METHOD(S) (Check all that apply) Mso. ® 1. CONTINUOUS ELECTRONIC MONITORING OF UNDER DISPENSER CONTAINMENT (UDC) PANEL MANUFACTURER: V@@flefROOt Msg. MODEL #: TLS35O Msz. LEAK SENSOR MANUFACTURER: V@@d@rROOt Mss. MODEL #(S): T943HO-352 Msa. WILL DETECTION OF A LEAK INTO THE UDC TRIGGER AUDIBLE AND VISUAL ALARMS? ®a. YES ^ b. NO M55. WILL A UDC LEAK ALARM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M56. WILL FAILURE/DISCONNECTION OF UDC MONITORING SYSTEM TRIGGER AUTOMATIC PUMP SHUTDOWN? ®a. YES ^ b. NO M57. ^ 2. MECHANICAL ASSEMBLY (e.g., FLOAT AND CHAIN ASSEMBLY) IN UDC TRIPS SHEAR VALVE IN CASE OF LEAK ASSEMBLY MANUFACTURER: Mss. MODEL #(S): Msg. ^ 3.V[SUAL MONITORING DONE: ^ a. DAILY ^ b. WEEKLY (Requires agency approvaq M60. ^ 4. NO DISPENSERS ^ 99. OTHER (Specify) M61. VII. ENHANCED LEAK DETECTION ^ 1. WE HAVE BEEN NOTIFIED BY THE STATE WATER RESOURCES CONTROL BOARD THAT WE MUST IMPLEMENT ENHANCED LEAK Mso. DETECTION (ELD) FOR THE UST(S) COVERED BY THIS PLAN. PER 23 CCR §2644.1, ELD IS PERFORMED EVERY 36 MONTHS AS REQUIRED VIIL; TRAINING REFERENCE DOCUMENTS MAINTAINED AT FACILITY (Check all that apply) Mso. 1. ® THIS UNDERGROUND STORAGE TANK MONITORING PLAN (Required) , 2. ® OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) 3. ® THE FACILITY'S BEST MANAGEMENT PRACTICES (Required as of January 1, 2005) 4. ^ CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS 5. ^ CALIFORNIA UNDERGROUND STORAGE TANK LAW 6. ^ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: "HANDBOOK FOR TANK OWNERS -MANUAL AND STATISTICAL INVENTORY RECONCILIATION" 7. ^ SWRCB PUBLICATION: "WEEKLY MANUAL TANK GAUGING FOR SMALL UNDERGROUND STORAGE TANKS" 99. ^ OTHER (Specify): M81 Personnel with UST monitoring responsibilities are familiar with all of the above documents relevant to their job duties and can access those documents when needed. By January 1, 2005, this facility will have a "Designated UST Operator" who has passed the California UST Sytem Operator Exam administered by the International Code Council (ICC). By July 1, 2005, and annually thereafter, the "Designated UST Operator" will train facility employees in the proper operation and maintenance of the UST systems. This training will include, but is not limited to, the following: - Operation of the UST systems in a manner consistent with the facility's best management practices. - The facility employee's role with regard to the leak detection equipment. - The facility employee's role with regard to spills and overfills. - Whom to contact for emergencies and leak detection alarms. For facility employees hired on or after July 1, 2005, the initial training will be conducted within 30 days of the date of hire. TX. COMMENTS/ADDIT-IONAL INFORMATION Please use this section to include any additional UST system monitoring-related information (e.g., additional information required by your local agency): Mss. Note regarding Section X. Pending certification of a Designated UST Operator, the following person has authority for performing the monitoring activities and maintaining leak detection equipment covered by this plan. NAME: JOB TITLE: X. PERSONNEL RESPONSIBILITIES AS OF JANUARY 1, 2005, THE "DESIGNATED UST OPERATOR" IDENTIFIED IN SECTION III OF THE CURRENT UST OPERATING PERMIT APPLICATION -FACILITY FORM WILL HAVE ULTIMATE AUTHORITY FOR PERFORMING THE MONITORING ACTIVITIES AND MAINTAINING LEAK DETECTION EQUIPMENT COVERED BY THIS PLAN, AND WILL PERFORM AND DOCUMENT MINIMUM MONTHLY VISUAL INSPECTIONS OF THE FACILITY'S U YSTEMS IN ACCORDANCE WITH 23 CCR § 2715 ). XI. OWNER/OPERATOR SIGNATURE CERTIFICA O .Ice fy that a information provided herein is true and accurate to the best of my knowledge. OWNER/O REPRESENTING DATE: M91. ® Owner M9o. ® operator 7/28/06 OWN R/OPERATOR NAME (print): M9z. OWNER/OPERATOR TITLE: M93. Randy Martin Gasoline & Environmental Compliance Mgr (Agency Use Only) This plan has been reviewed and: ^ Approved ^ Approved With Conditions ^ Disapproved Local Agency Signature: Date: Comments/Special Conditions: UN-022A - 2/3 www.unidocs.org Rev. 10/14/03 l~~ WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #32241 Facility Address: 4101 Calloway Dr., Bakersfield, CA Date: July 28, 2006 A. Describe the frequency of performing the monitoring: Tank The site consists of three 10,000 gallon double walled fiberglass clad steel tanks (1-Regular Unleaded, 1-Midgrade, 1-Premium) and are monitored monthly with a VeederRoot TLS350 Piping Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensors activates audio/visual alarms and provided positive shutdown of the turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank The method of leak detection for the tanks is Interstitial Monitoring using the Veeder-Root TLS350 Tank Gauge. VeederRoot model 794380-420 probes are used for the monitoring. Hiah level alarms activate audio/visual and external alarms. Piping The piping is monitored continuously by VeederRoot liquid sensors model #794380-352 located in the turbine sump of each tank. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. The piping is precision tested annually at a threshold of .1gph. Vaporless Mechancial Line Leak Detectors (LD2000) are used to detect 3 gph release. C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator. The operator will contact 7-Eleven Dispatch 1 800-828-0711 for any alarm conditions on the VeedeRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Randy Martin D. Reporting format for monitoring: Tank Current status reports are available from the Veeder-Root TLS-350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office location. Piping Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Third party annual test results will be submitted to the agency. Written Monitor Procedures 7-Eleven #32241 Page 2, July 2006 E. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Tanks and product lines are continuous~r monitored and alarmed. Alarm histories are printed each month and investigated for corrective actions by the Designated Operator. Equipment repairs; replacements are performed as needed F. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: Employees are trained on the operation of the UST in a manner consistent with "Best Management Practices", Emergency Contact information, Spill/Overfill response procedures, Hazardous Waste Procedures, and Monitoring equipment operation and alarm response procedures. Training is conducted annually, or within 30 days for new employees, by the designated operator. L,` ~ -. 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 07/13/2006 Order Number: 3147502 Dear Regulator, Date Printed and Mailed: 07/26/2006 Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 GALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: ~~ Leak detector tests ~ a Line tests t1 Monitor Certification Q~ Secondary Containment-Spill Container Sincerely, ~~ ~a~~~rr~s~. Dawn Kohlmeyer Manager, Field Reporting TANKNOLOGY CERTIFICATE OF TESTING ~ ~n 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 TELEPHONE (512) 451-6334 FAX (512) 459-1459 PURPOSE: COMPLIANCE TEST RESULT SUMMARY REPORT TEST DATE: 07/13/06 WORK ORDER NUMBER: 3147502 CUSTOMER PO: CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 P.O. BOX 711 MARKET # 2133 DALLAS, TX 75221 4101 GALLOWAY DRIVE BAKERSFIELD, CA 93312 • MANAGER (214)841-6714 (661)587-8826 TEST TYPE: TLD-1 Prndur_t Pine Tinhtnncc Tact Rpcultc LINE LINE LINE DELIVERY IMPACT ' TEST RESULT FINAL LEAK RATE (gph} VALVE ID ' PRODUCT MATERIAL TYPE ' A B C D A B C D FUNCTION 1 1 REG UNLEAD ENVIROFLEX PRESSIIRE P P 0.000 0.000 Y 2 2 MIDGRADE ENVIROFLEX PRESSIIRE P P 0.000 0.000 Y 3 3 PREMIIIM ENVIROFLEX PRESSIIRE P P 0.000 0.000 Y Fxictinn 1 ina 1 Halt rlc+nr4nr Tuc+ EXI STING LEAK DET ECTOR #1 EXIST ING LEAK DETE CTOR #2 LINE --- ID MANUFACTURER MODEL # SERIAL # RESULT MANUFACTURER MODEL# SERIAL # RESULT 1 1 RED JACKET FX1V 8167 P 2 2 VAPORLESS LD2000 03121684 P 3 3 VAPORLESS LD2000 03121686 P Now Fa ntllarmm~nt 1 inn 1 n~4 fln•nr4r~r Tnc4 EP L CE E' " DET ECTOR#1 . ___ REPL" ACED LEAK DET EC ~ LINE ID ____ MANUFACTURER MODEL # __ SERIAL # RESULT MANUFACTURER MODEL # ~ _ SERIAL # RESUL ..,~ ~w~~~~ ~~~a~~~~ ~~N.,~ ~ ~~~,.,~~~~a~~~~~, visas www.ianK~wwgy.wm anu seicci vas-Lme Icepons-wttHr, or comacl your local IanKnoiogy otr~ce. Tester Name: WILLIAM ROGERS ~~~~ Technician Certification Number:1647 Printed 07/26/2006 07:24 SBOWERS INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan/v~o/ogy TEST DATE:07/13/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147502 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32241 TANK~,INFORMATION Tank ID: 1 1 Tank manifolded: No Bottom to top fill in inches: 15a. o Product: REG UNLEAD Vent manifolded: No Bottom to grade in inches: 161. o Capacity in gallons: l0, 028 Vapor recovery manifolded: YES Fill pipe length in inches: 62. o Diameter in inches: 96.00 Overfill protection: YES Fill pipe diameter in inches: 4 • o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL coNT Installed: ATC Stage 11 vapor recovery: BALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Test ivlethod: VacuTec t LEAK DETECTOR TEST RESULTS best-method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: RED JACKET Ingress Detected: Water Bubble Ullage Model: FxiV Test time: S/N: 816' Open time in sec: a.oo Inclinometer reading: Holding psi: as VacuTect Test Type: NOT Resiliency cc: 210 NOT T VacuTect Probe Entry Point: ESTED Test leak rate ml/m: 1s9. o TESTED Pressure Set Point: Metering psi: 12 Tank water level in inches: Calib. leak in gph: 3.00 Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type:' TLS- i LINE.. - ~. E3 C D Material: ENVIROFLEX Diameter (in): 1.5 Length (ft): 175.0 Test psi: 50 50 Bleedback cc: 0 0 Test time {min): 60 60 NOT NOT Start time: 12:25 12 :25 TESTED TESTED End time: 13:25 13:25 Final gph: 0.000 0.000 ReSUIt: PASS PASS Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:24 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~~ ~ 7an/ax~bgy TEST DATE:07/13/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147502 CLIENT:7-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32241 TANK INFORMATION. ,, Tank ID: 2 2 Tank manifolded: No Bottom to top fill in inches: 160. o Product: MIneRADE Vent manifolded: No Bottom to grade in inches: i63 . o Capacity in gallons: lo, o2a Vapor recovery manifolded: YES Fill pipe length in inches: 64. o Diameter in inches: 96. oo Overfill protection: YES Fill pipe diameter in inches: 4 . o Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL corm Installed: ATG Stage II vapor recovery: sALANCE CP installed on: / / COMMENTS TANK TEST RESULTS Tesf Method:VacuTect LEAK DETECTOR TEST RESULTS lest method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vAPOxLESs Ingress Detected: Water Bubble Ullage Model: LD20o0 Test time: S/N: o3iaicsa Open time in sec: 4.00 Inclinometer reading: Holding psi: 2s VacuTect Test Type: NoT Resiliency cc: l9o NoT VacuTect Probe Entry Point: T ESTED TESTED Test Peak rate m1/m: is9. o Pressure Set Point: Metering psi: 22 Tank water level in inches: Calib. leak in gph: a.oo Water table depth in inches: Results: PASS Determined by {method): Result: COMMENTS COMMENTS LINE TEST RESULTS Test type: TLn-i .:,:,LINE.. A R C D Material: ENVIROFLEX Diameter {in): 1.5 Length {ft}: 175. o Test psi: 50 50 Bleedback cc: 0 0 Test time (min): 60 6o NoT NoT Start time: 12:25 12:25 TESTED TESTED End time: 13:25 13 :25 Final gph: 0.000 0. o00 ReSUIt: PASS PASS Pump type: PRESStrRE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:24 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ Tan TEST DATE:07/13/06 8501 N MOPAC EXPRESSWAY, SUITE 400 WORK ORDER NUMBER3147502 CLIENT:T-ELEVEN, INC. AUSTIN, TEXAS 78759 (512) 451-6334 SITE:7-ELEVEN #32241 TANK INFORMATION Tank ID: 3 3 Tank manifolded: No Bottom to top fill in inches: 157.0 Product: PREMIUM Vent manifolded: No Bottom to grade in inches: 160. o Capacity in gallons: 10, 028 Vapor recovery manifolded: YES FiII pipe length in inches: 61. o Diameter in inches: 96. oo Overfill protection: YES Fill pipe diameter in inches: 4.0 Length in inches: 324 Overspill protection: YES Stage I vapor recovery: DUAL Material: TOTAL coNT Installed: ATG Stage II vapor recovery: BALANCE GP installed on: / / COMMENTS TANK TEST RESULTS Test Method: VacuTec t .. LEAK,DETECTOR TEST RESULTS -- Test method: FTA Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: vAPORLSSs Ingress Detected: Water Bubble Ullage Model: LD2ooo Test time: S/N: osiaisae Open time in sec: a.oo Inclinometer reading: Holding psi: 2a VacuTect Test Type: NoT Resiliency cc: lso NOT T VacuTect Probe Entry Point: ESTED Test leak rate ml(m: 1a9. o TESTED Pressure Set Point: Metering psi: 23 Tank water level in inches: Calib. leak in gph: s.oo Water table depth in inches: Results: PASs Determined by (method): Result: COMMENTS COMMENTS LINE TEST RESULTS:. Jest type: -TLD-i .....LINE.. A B C ~ Material: ENVIROFLEX Diameter (in): 1.5 Length {ft): 175. o Test psi: 50 50 Bleedback cc: 0 0 Test time (min): 60 60 NoT NoT Start time: 12:25 12:25 TESTED TESTED End time: 13:25 13:25 Final gph: 0.000 0.000 ReSUIt: PASS PASS Pump type: PRESSURE Pump make: FE PETRO COMMENTS Impact Valves Operational: YES Printed 07/26/2006 07:24 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3 Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring svstem control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #32241 Site Address: MARKET # 2133 City: BAKERSFIELD CA ~ip:93312 4101 GALLOWAY DRIVE Facility Contact Person: MANAGER Make/Model of Monitoring System:TLS350R B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced Tank ID: 87 Tank ID: 89 X In-Tank Gauging Probe. Model: MAG 2 X In-Tank Gauging Probe. Model: MAG 2 X Annular Space or Vault Sensor. Model: 420 X Annular Space or Vault Sensor. Model: 420 X Piping Sump/Trench Sensor(s). Model: 208 Piping Sump/Trench Sensor(s). Model: 208 Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: FX1 V X Mechanical Line Leak Detector. LD2000 Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill/High-Level Sensor. Model: ATG X Tank Overfill/High-Level Sensor. Model: ATG Other (specify equipment type and model in Section E on page 2). Other (specify equipment type and model in Section E on page 2). Tank ID: Tank ID: X In-Tank Gauging Probe. Model: MAG 2 In-Tank Gauging Probe. Model: )( Annular Space or Vault Sensor. Model: 420 Annular Space or Vault Sensor. Model: X Piping Sump/Trench Sensor(s). Model: 208 ~ Piping Sump/Trench Sensor(s). Model: Fill Sump Sensor(s). Model: ~ Fill Sump Sensor(s). Model: X Mechanical Line Leak Detector. Model: LD2000 Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: X Tank Overfill/High-Level Sensor. Model: ATG Tank Overfill/High-Level Sensor. Model: Other (specify equipment type and model in Section E on page 2). ~ Other (specify equipment type and model in Section E on page 2). ispenser 1/2 DispenserlD: 3/4 Dispenser Containment Sensor(s) Model: 352 .Dispenser Containment Sensor(s) Model: 352 X^ Shear Valve(s). X Shear Valve(s) Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: 5/6 DispenserlD: 7/8 Dispenser Containment Sensor(s) Model: 352 Dispenser Containment Sensor(s). Model: 352 X^ Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). DispenserlD: DispenserlD: Dispenser Containment Sensor(s) Model: ~ Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser Containment Float(s) and Chain(s). - It the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): ~ System set-up ~ Alarm history report Technician Name (print): WILLIAM ROGERS Certification No.: 8520 Date of Testing/Service: 07/13/2006 Work Order Number: 3147502 Signature: ~~"' J~~~i~~ License. No. : Testing Company Name:Tanknology Phone No.: (800) 800-4633 Site Address: 8501 N. MoPac Expressway, suite 400, Austin, TX 78759 Date of Testing/Servicing: 07/13/2006 Contact Phone No: 587-8826 Page 1 of 3 Based on CA form dated 03/01 Monitoring System Certification Monitoring System Certification Site Address: MARKET # 2133 4101 GALLOWAY DRIVE D. Results of Testing/Servicing Software Version Installed: Complete the following checklist: 121.00 Date of Testing/Service: 07/13/2006 ^ Yes ^ No " Is the audible alarm operational? ^x Yes ^ No * Is the visual alarm operational? 0 Yes ^ No * Were all sensors visually inspected, functionally tested, and confirmed operational? 0 Yes ^ No " Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ^ Yes ^ No * X N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? 0 Yes ~ No * ~ NrA For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) ^X Sumplfrench Sensors; ^x Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ^X Yes ^ No ^X Yes ^ No * ~ NtA For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? 90 ^ Yes* ^x No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* Qx No Was liquid found inside any secondary containment systems designed as dry systems? (check all that apply) ^ Product; ^ Water. If yes, describe causes in Section E, below. ^X Yes ^ No * Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable. ^X Yes ^ No * Is all monitoring equipment operational per manufacturers' specifications? * In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: Page 2 of 3 Based on CA form dated 03/01 Monitoring System Certification Site Address: MARKET # 2133 Date of Testing/Service: 07/13/2006 -4101 GALLOWAY DRIVE F. In-Tank Gauging /SIR Equipment Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes ^ No' Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ No • Were all tank gauging probes visually inspected for damage and residue buildup? ^X Yes ^No • Was accuracy of system product level readings tested? ^Yes ^No' Was accuracy of system water level readings tested? x^ Yes ^No • Were all probes reinstalled properly? Q Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? In the Section H, below, describe how and when these defciencies were or will be corrected. G. Line Leak Detectors (LLD) : ~ Check this box if LLDs are not installed. Complete the following checklist: Q Yes ^ No' ^NiA For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Check all that apply) Simulated leak rate: Q 3 g.p.h ^ 0.1 g.p.h ~02 g.p.h ^X Yes ^ No' Were all LLDs confirmed operational and accurate within regulatory requirements? ~X Yes ^No' Was the testing apparatus properly calibrated? ^X Yes ^No' ^ NtA For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^Yes ^No' ^Q NIA For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? Yes ^No' ~ N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? Yes ^No' 0 NiA For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? Yes ^No' Q N;A For electronic LLDs, have all accessible wiring connections been visually inspected? Yes ^No' Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 Based on CA form dated 03/01 SB-989 SECONDARY CONTAINMENT SUMMARY RESULTS i• ?~~ ol~o-gy TEST DATE:07/13/2006 CLIENT: 7-ELEVEN, INC. P.O. HOX 711 DALLAS TX 75221 214-841-6714 Tank Interstital Tests WORK ORDER NO.: 3147502 SITE: 7-ELEVEN #32241 MARKET # 2133 4101 GALLOWAY DRIVE BARERSFIELD CA 93312 Piping Interstital Tests TANK ' LINE PRODUCT MANUFACTURER RESULTS PRODUCT MANUFACTURER RESULTS' REG UNLEAD MI DGRADE PREMIUM Sump & Under-Dispenser Containment Tests Sumpl DISP.# MANUFACTURER P/F 187 FILL OPW Fail 289 FILL OPW Pass 289 FILL OPW Pass 391 FILL OPW Pass 391 FILL OPW Pass Tanknology representative: BRIAN DERGE Services conducted by: WILLIAM ROGERS ~~~~~~~ UMP TESTS ,}~ ~ ` SECONDARY CONTAINMENT TEST RESULTS Test Date: Work Order: 07(1312006 3147502 Type Tank or Disp # Manufacturer Model or Material Diam.NVidth/Length (") Depth (") Test Method Start Time Initial Level Level Change Finish Time Final Result Pass/ Fail Spill Container 187 FILL OPW Plastic 11 12 Hydrostatic-24Hr 10:40 6 -1 10:45 5 Fail Spill Container 289 FILL OPW Plastic 11 12 VPLT 11:14 7 -.00000 11:29 7 Pass Spill Container 289 FILL OPW Plastic 11 12 VPLT 11;32 7 .00001 11:47 7 Pass Spill Container 391 FILL OPW Plastic 11 12 VPLT 11:16 6 -.00003 11:31 6 Pass Spill Container 391 FILL OPW Plastic 11 12 VPLT 11:36 6 .00002 11:51 6 Pass Comments: ~~ ~ Tanlv~o/ogy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE:07/13/06 WORK ORDER NUMBER3147502 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32241 COMMENTS Lines, lds, EEO, and monitor passed. 87 fill bucket failed, the remaining buckets passed. PARTS REPLACED QUANTITY DESCRIPTION HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ITEMS TESTED HELIUM PINPOINT'LEAK TEST RESULTS Printed 07/26/2006 07:24 SBOWERS ITE DIAGRAM ~ Tanla~o/ogy 8501 N MOPAC EXPRESSWAY, SUITE 400 AUSTIN, TEXAS 78759 (512)451-6334 FAX (512) 459-1459 TEST DATE: 0 7 / 13 / 0 6 CLIENT:7-ELEVEN, INC. WORK ORDER NUMBER3147502 SITE: 7 -ELEVEN #32241 N ~ VENTS E ~ ~ 0 0 0 0 0 0 ~N O O O Y Y Y r ~M ~ ~ M O O O N C O r r r M ~ (~ ~ ~ U T ~ 3 ~ STP STP STP ~ o ti ~ Y ~ ~ ~ PLUS SUP UL O ~ ~- Printed 07/26/2006 07:24 SBOWERS Work Order: 3147502 . ,_ . ~ , . ... .~_ w .. . r. ~, n~ ... ~ p - Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 1 ~ Work Order: 3147502 Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 ,. m Work Order: 314 7 5 0 2 ~ `~ _ Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 F ~~ ._ _° Work Order: 3147502 .S ,.~._ ~ ~.^ Tanknology Inc. 8501 N. MoPac Expressway, Suite 400, Austin, Texas 78759 r`'~r.~`1 ,1i UNDERGROUND STORAGE TANKS ,~ 'r , „„ ,, ~„ B E 'r. 9 F I~L D ~~r~ r APPLICATION ~"~ TO PERFORM ELD /LINE TESTING / SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~ ~'~ BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 ^ ENHANCED LEAK DETECTION ^ LINE TESTING ^ SB-989 SECONDARY CONTAINMENT TESTING ^ TANK TIGHTNESS TEST ~ TO PERFORM FUEL MONITORING CERTIFICATION -~ ___ _ SITE<INFORMATION FACILITY '~_EICVCri #3ZZ41 NAME & PHONE NUMBER OF CONTACT PERSON Manager - (661) 587-8826 ADDRESS 4101 Calloway Dr., Bakersfield, Ca 93312 OWNERS NAME OPERATORS NAME PERMIT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED? YES ^ NO TANK# VOLUME CONTENTS __ -- _. - - TANK TESTING COMPANY NAME OF TESTING COMPANY Tanknolo It1C. gyp NAME & PHONE NUMBER OF Anthony Cheeks (951) 676-4060 CONTACT PERSON MAILING ADDRESS 41785 Enterprise Circle S. Suite D Temecula, CA 92590 NAME & PHONE NUMBER OF Will Rogers (909) 772-9853 TESTER OR SPECIAL INSPECTOR: CERTIFICATION #: DATE & TIME TEST TO BE ']/~ $/06 - ~ ~ :30AM CONDUCTED: '~~ #~ 5251926 - UT TEST METHOD SIGNATURE OF APPLICANT DATE: ~/•L O~ APPROVED BY DATE FD 2095 (Rev. 09/05) ~-~~ 3~a ~ t- F ~ 6f yY~°' >,, State of California ,For,-State Use Only °~ State of Water Resources Control Board ;: ' o Division of Clean Water Programs ~,; P.O. Box 944212 ~~4FOPN~P Sacramento, CA 94244-2120 ~ _ (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or ® 1 million dollars per occurrence ® 2 million dollars annual aggregate .rB.. _ _7-Eleven.- InC... _ _ _ _hereby_certibes that it is,in compliance_wifh the requirements of Section-2807, - - (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism ~ ~ ° =Mechanism °" ~~ ~ ~ Coverage~~~ ~ ;Cove,rage Corrective Third Party T e~ ~ .Name:and Address,of.lssuec~ ,__ ~~ Numler Amount ~~ Period. Action Com Liability Insurance Illinois Union Insurance Co. $2,000,000 per c/o ACE Environmental Risk UST G2379486A Occurrence & 4/30/2007 436 Walnut Street 002 $2,000,000 to Yes Yes Philadelphia, PA 19106 Annual 4/30/2008 Aggregate Note: If you are using the State Fund as any part of your demonstration of irnancial responsibility, your execution and submission of this certification also certifies that you are_in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address 7-Eleven #32241 4101 Calloway Dr., Bakersfield, CA Facility Name Facility Address 7-Eleven #32376 9600 Brimhall Rd., Bakersfield, CA Facility Name Facility Address E. Signatur of Tank Ow r or orator Date Name and Title of Tank Owner or Operator Randy Martin-Gasoline & Environmental Compliance Mgr. ~ z 3 ~-j Signature of Witness or Notary Date Name of Witness or Notary ~~ 3-07 Rachel Rodriguez CFR (Revised 04/95) v ~ BILE: Original -Local Agency Copies -Facility/Site(s) n~ - jv CERTIFICATION OF FINANCIAL RESPONSIBILITY 7-Eleven, Inc.. (formerly known as The Southland Corporation) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR part 280. The financial assurance mechanisms used to demonstrate financial responsibility under 40 CFR part 280 aze as follows: Storage Tank Liability Insurance Policy No. UST G2379486A 002 issued by Illinois Union Insurance Company, effective Apri130, 2007, through Apri130, 2008, with a retroactive date of November 24, 2005, and covering underground storage tanks for taking corrective action-andlor-compersatiug~third parties-for bodily injury-and-property damage caused by accidental releases in the amount of TWO MILLION DOLLARS ($2,000,000) "per occurrence" and TWO MILLION DOLLARS ($2,000,000) "annual aggregate" as specified by 40 CFR §280.93; and To the extent of its eligibility, participation in various State funds and State assurance programs as set forth in 40 CFR §280.101. 7-E By: N Title: Vice President Date: Apxi,l 9, 2007 STATE OF TEXAS COUNTY OF DALLAS SUBSCRIBED-AND-SVVORItiT TO }3EFORE ivlE this - ~ ~ -day of--- ~ ` / --- 2007. ~~ ~ Notary Public,~f an~iFor,$"/aid Coufity and State. vv ~ ~/ My Commission Expires: iG.UI- Q ~ ~ y,,, DOROTHY J. JOHNS ROTARY iU8L1C STA1E OF iF~ ~ COMMiSS40R EX~iRFE: ~"ra~ gUGUST 10. 2009 LEV N INC. am Ga C. Lockhart 516202.3/sP/76088/0465/040907 - I r' 09-87-'67 12:34 FROM-QPM,LLC UNt7~FiCd~bU{VO 5~"00'~fiGr` TA9VFt ~~~B~B'~° d~~~l..lOAT6C7N ~OFt R~iUlOHAL OF AID UND~RGROUfVt7 ~7'bRACE 'TANK Perrttit No: 8185674273 T-369 P002I020 F-884 s, ~'' ~-~-~ ~-~'~ 900 T,-uxzun Ave., Ste. 210 ~~~~ ~~~~ ;~ 13akersfield, CA 93301 ~4 ~ ~ 1"eL: (661) 3~6-397'9 Fax; (661) 552-2171 Page 1 of t ! -~_ _.~ SITE INF~SI~fl11ATIC~IN SITE ~AdDRESS ~IV ` /j+~ /~ ~ ~ W _I V I I { ziP CODE FACILITY NAME i'?w p ;' ROSS STR E T C E iTANKOWNER/OPERATOR ' /~ PHONE NO .T~~ tpL~+ ,,,, ~'~ ( APN MAILING ADdRE55 , n ~ ~ ! CITY I/~ 7 J / ZIP CODE ~C~ `J ~' C°~7NT9~ACTQR t NFOFaMAT 1 0 N Y . COMPANY 6 ~•~!"J / ~ ~ J~~ PHONE NO. (~~~-', ~ N/~ Vj LIC -~ ADflRESS ~ CITY ~ ZIP CODE 3 INSURt4NCE RRIER ~C~/-ys~~ ~ J ~~ ~J~l WORK ENS COMP O. / ~/ r~ , 7( D v PRELEMINARY ASSESS N MENT INFORMATI0 COMPANY ~ ~~ PHONE NG1C~/~ C~ ~, ~~ C'~ / `J LICENSE NO. ADDRESS ~ ~ ~ ~ CITY ) ~ r~~1~ ZIP CODE ~~ INSURANCECARRIER WORKMENS COMP NO. TANI~C CLEANING INFORMATION COMPANY S ~v,.J~ /i . t~ c--G PWOtvE N O~ / ~ G~73~ // ~~ J~ 7 LICENSE NO. ~ /' APPRESS / /a ~ ~ ref IJYIG( Y ~ ~ /~ j~ ITY ~-~ ~ l7 Yn~ zI~,,CC E INSURANCEC ARRIER WORKMENS COMP No. WASTE TRANSPORTER 1DENT!FIGAT!pN NUMBER FACIttTY IDENTIFtCAT10N NUMBER NAME pF R!N$ATE DISPOSAL FACILITY ADDRESS CITY ZIP CODE TANK TRANSPORTER INFORMATION COMPANY ~ ~- ~ ~ PHONE NO.~~Q ~~ ~9 ~ 7 r LICENSE NO, ADORFwSS Q ~ CITY /1'~n ~J YIP CODE ~ 7// `7 7 A~ ~~~ ~ TANK DESTINATION ~ vO~ ~ a0 ~~ ~ LJ7' TANK INFORMATION CHEMICAL GATES CHEMICAL TANK NO. AGE VOLUME STORED STORED PREVIOUSLY STORED oCJO S -~ --- ~ ~ --~ ~'or Qfficlel USa dory APPLICATION PATE FACILITY No. Na. OF TANKS FEE $ THE APALfCANT kaS kE'CE'NEO. UNDERSTANDS, AND WILL COMPL V WITH THE A TTACHED CDND17fON5 OF THIS PERMlT aNp ANY OTHER STATE, LOCAL AND FEDEFul4 REODU17lpn~$. // --THIS fORM rrAS BEHY CpMPCETEO UNpER PENALTY OR PERJURY, ANO TOT 8ES T OF MY KNDW E~fQGE !S TRUE ANO COR9EC T Lt /-} .~ , T- nr,.,r,.-.,.ter, .,.. ,.....-...-i I •oci irotir tieu: ioninir, ~ no' o9'i~,n'T Cinr,inn iodl ~ YWi~ A4~E~i,1CA1'If~N t/11l1.1. Ei~GCJ~/!~ A~1'~~fV117' W~9>~N ,4i~~~i.1V~~J FD 2088 {aav o?roll 09-87-'07 12:35 FROM-QPM,LLC 8185674273 T-309 P004/020 F-884 •';i'li~ii~!rIIN(!1!ICfI!tlimllll[1!I;IflilhnhAilf!I111l111J1;1II11I11;iIpU~1!!11!1141IIIUIIIIII1111;III!IIE!!!I;IIIC!IIIIIII1Qllill!III!1!1!1i111t1111!N1111111111illlllp!I((IIJIIIUIN!!tpIIII!III:NI I!!!l ~!! ~I!illlllJ!I!!t!111i1!llll;Illllilrlilll!: ' - •-"" ':`.'~" .;,E,.;<' CO'~t'1`R,•~CTOR5 ST?,TI/ LICENSE $QARr7 ~~~ ~ Y ~~,~:~.. ,~,~Q ~~~~ H.-~Z.~R~C~LTS S'UPS7'ANCES ~N~O~~.~ ~I~Y~ I~1E~~L ~~TZO~sA,~~~~s+~,~~c~o~T ~ , ~.- ?VrsUSns to the pcvYisions of ~Secti4n 703$:;7%of the Bi~in~ess a~,d Pt•ofesstorts Code, '-.- F.z~:srvar of Contractors does hereby certify th~t,tlnta•`following qualt{yin person -. ---:~<-Dui<<. t:ompleted the hazardous substances rernoval.artd remedia~ actions ~ =? f",f,~• ,, :. •. ~ ~' Qualifier; RQ~ERT CANNON i~:~; A ~ ' ~ ~ . _~~ ~ / LicenseNo,: Z9~700 ` t~ ~ `'`~+,~~~;~..-~`' Business tiame: K.E. GURTYS• CCNST~tUCTION COMPANY, INC. • .. ~~are~.r r;~i-~1 Isar ~1.~ ~~a ~: r e b T t! 2 : _ ~ 19 9 2 Thls eeriiife~uen is eke prepecty of the f _ . ; , COntr3alara. is not Re><Istro. o r ~._~ K (~~~ tr'<naEcralalwend rha!I be returned 1o the RcgUtruupohdsr~ndwhenbuipGKd¢d. • ••-.:•t:7.-' t71.•~N{1~;91! r>9vokesd, or invatldated for am rcaaon. • ••::•:ali:'.II;I..::!:.,;;;!!:'dql:;Il;i!;tl!ttlt;IlNHII(;I(fIIIII(IIiINI(Ill!;llklllllllglll!Itllq!IIINllltlll!pfllhl!tIIII!I!1!Il~lllillllpllligl;111111111p1!111,,;{IIIIIIIII11iIIIIlI111111111Illlll~!fll lllr!IplllllOlltllllgllllll~111I gq M t Stat® QI Caiitomiz ~ ' ~,,,,,,.5`bN~l'RACTOA$ STATE LICEhtSE BOARD ' i „ntim~ ACTIVI:l,IC1tiNAE , nftn,n ~~~7~~ COr'•if j ~ ~. CONTRACTARS ST1tTE UCEIVSE BOARD ,~.~:. ~~« K E GU RT45 GtON3TRlJCT1CN i ~~-- Ac~tv*= t.ICEr~E COMPANY lNC ~ ~',`;e°' //_'~{{~~7 r~ ln~... WMbi ~~Y J oo F,~y `..'O rl~ c„~.M~.~•1 ~ B c-s MaZ Cap K E CURTIS CONSTRUCTION •~...».. COMPANY 1NC c•~~°". 12!31!2006 b"` ~ ~~'..,e•• 12/31/2008 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3911 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 852-2170 PREVENTION SERVICES fiRE SAfElY SERVICES. ENVIRONMENIAl SERVICES 900 Truxtun Ave.. Suite 210 Bakersfield. CA 93301 VOICE (661) 326-3979 FAX (66J) 852-2171 FIRE INVESTIGATION 1715 Chester Ave.. 3'd Floor Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661) 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield. CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 10, 2004 Store Manager 7-11 4101 Calloway Drive Bakersfield, CA 93312 REMINDER NOTICE Re: Necessary Compliance Deadlines for UST Owners/Operators Dear Valued Customer: I The purpose of this letter is to remind you about three compliance deadlines for UST Owners/Operators. These are as follows: 1) January 1,2005 deadline for submitting declaration statement designating: (a) Owner/Operator understands and is in compliance with all applicable UST requirements, and (b) Owner identifies the designated UST Operator for each facility owned. (c) Owner/Operator passes and submits proof of International Code Council Test. 2) EVR upgrade requirements on spill buckets are due April 1, 2005. 3) Secondary Containment Testing on all secondary systems. Code requires re-testing 36 months from date of last test which was in 2002. Should you have questions regarding these compliance deadlines, please feel free to call me at 661 - 326-3190. Sincerely, ~ éØiLt(J Steve Underwood Fire Prevention Officer SU:db "cfj;:rllÙI/I!he Yf;;)4I1WUNU~1f OJt(l.jt 0;' l{o/j({j cfllCMI Qr;/9f;~'llûw¿¡ II ~ - - ~PR 23 2004 9:28 BKSFLD FIRE PREVEMTIOM (661)852-2172 p.1 04/22/2~04 1,4:06 ~S13!i20E~2~. PAGe 01/01 ~'&X( 661 ) 392-062 1715 Ch~mr'A~ Bak~fi~d, C~ (661) ~3~9 ~LI~TION TO ~~ ~ MO~TO~G CRR~I~TIO~ o~~_~ ........ ,, .:.. ' ............. ,. TANK#. ¥OLUI~ CO~ 9, ... ,.. -- MONITORING SYSTEM CERTIFICATION For Use By All durixdictions ~Yithin the State of California .-lm'horiO, Cited; Chaprer 6. 7, Health and Sc~e~ Code; Chapter 16, Division 3, Title 23, Cal~brnia Code of Regulations This ~orn~ mast be used ro doe~ent tesr~g ~d servicing ofmonkor~g equipment. A separate ce~ifica~/on 0r repros mus~ be ~repa -ed for each monixorine system con~ol panel by ~e reclmici~ w~ performs ~ work. A copy ofthi~ fbrm must be provide~ to the tank system owner/operator. The o~er/operator must submit a copy of fl~is form to ~e local agency regulating UST systems within 30 days of rest dare. A. Generallnformation ---- . Facilir). Contact Person: Contact Phone No.: (.) Mal~c, M0delofMonicoringSys~em: ~~<.~T ~ '~ DateofTesth~Setwicing: g. Inventory of Equipment Tested/Certified _~jx?~c.gj~s_;, ~ ~ropria[e Doxes to indicate specific equipment inspeeted/service~: ~",mk Gauging Probe.. Model: ~ ~'&W ~-T~k Oa~e~ Model: ~~ ~mtar Space or Vault. Sensor. Model: ~ ~ul~ Space or Vault Sensor. Model: ~o .............. ~ ~ipina Sump/'n'6nch Sensor(s). Mod& ~ ~ ~Piping Sump / Trench Sensor(s). Model: ~ ......... 11 Smnp Sensorks). Model: ~ ~ill Sump Sensor(s). Model: cchm6cal Line t.e~ Detector. Model: ~ ~~ ~ech~ical Line Leflc Detector. Model: ~ ..... ~ [.:tccn'onic Line Letd{ Detector.. Model: ~ Elec~onic Line Le~ Detector. Model: ~ 't'ank Overfill / High-Level Sensor. Model: ~ ~ Tm~k Overfill / High-Level Sensor. Model: ~ Other kspeciI}' equipment type ~d model in Secdon E on Pa~e 2}. ~ O~er qspeci~, equipment type and model in Section E on Pa~e ~ l'm~k Gauging Probe. Model: ~& - [ D In-T~k Gauging Probe. Model: ~nular Space or Vauk Sensor. Model: a[~.O D ~nui~ Space or Vault Sensor. Model: ~ Piping Sump / Trench Sensor(s). Model: · '~ ~ ~ Piping Sump / Trench Sensor(s). Model: Q~ill Sump Sensor(s). Model: ~ Fill Sump Sensor(s). Model: ~Mechmlical Line ke~ De;ector. Model: ~ O -~o ~ Mech~ical Line Le~ Detector. Model: ~ Electronic Line Le~ Detector. Model: ~ ~ Electronic Line Le~ Detector. Model: ~ T;mk Overfill / High-Level Sensor. Model: ~' T~k Oveffill / Hi~-Level Sensor. Model: ~ Other tspeci~' equipment type ~d model, in Section E on Page 2~. ~ Other (speci~ equipment B, pe ~d model in Section E o~ Pa~e 2). enser Coar~menr Sensor(s). Model: ~ ~ ~-- ~enser Containment Sensor(s). Model: ~hear V alveks). ~he~ Valve(s). .~.t~)ispcgser Con[~nmen[ Float,s) ~d Chain(s}. ~ Dispenser Containment Float(s) and Chain(s). Dislenser ID:. ~ ~ q~ Dispenser ID: ~enser Containment sensor(s). Model: ~ ~ Dispe~er Containment Sensor(s). Model: ~Shear Valveks). . ~ She~ Valve(s). ~ Dj59enser Contaimnent Float(s) m~d Chain(s). ~ Dispenser Containment Flora{s) m~d Chain(s). a.ser ID: ~ ~.~ ~ Dispenser ID: enser Containment Sensor(s). Model: ~ ~ ~ Dispenser Containment Sensor(s). Modek Valve(s), 0 She~ V~ve(s). .~}ispenser Conr~nmenr Float{s) ~d Chain(s). . ~ Dispenser Containment Float(s} ~d Ch~n(s). :qf the fitcili[y contains more tm~ks or dispensers, copy [his form. Inolude information for every t~k ~d dispenser at the faeili~. C. Certification - t certify that the ~quipm~nt identified in this document was inspected/serviced in aeeordanc~ with the manut~ctnrers' guidelines. Attached to this Certification is inI~rmadon (e.g. maaulhcturers' checklists) necessary to verify that th~ information cocrec[ and a Plot Plan showing the layout of monitoring eq~men;. For any eq~t capable of generating such reports, I have also attached a copy of ~he report; ~ehec~ aa #tat apply): ~System set-up ~~ry rep~ ~ 8~9850 'I'esringCompm~y~mne: RICH ENVIRONMENTAL PhoaeNo.:(p61 ) 392-8687 Page 1 of 3 03/Ol Monitoring System Certification ,D. i~csuit~s of Testing/Servicing Soft,, :,'e 'Version Installed: t e~ Coml)iel'e tile following ehecldist: -'Cff~\'es I [3 No* Is dxe audible alarm operational? '~'~)7..es I El No* Is the visual alarm °perationat9 - [~Yes [ ~ No* Were all'sensors visually inspected, ftm~tionally tested, and confirmed operational? -- tY_q'~yes [ El No* Were all sensors h~stalled at lowesx point of secondary containment and positioned so that other equipment nor interfere with their proper operafio.a.? Yes If alarms are relayed to a remote monitorh~g station, is all conmmnications equipment (e.g. modem) operational? ~s ~ No* For pressurized piping systems, does the turbine atttomatically shut down if the piping secondary coarainm-~n--~- I-I N/A monitoring system detects a leak, faits to op~ate~,,~ov-.is elecn'ically discomxe~i/~d? If yes: which sensors hfiriate positive shut-down? (Check all d'tat apply) I~hl'Sump/Trench Sensors; lit'Dispenser Con?~xi+mlenr Sensors. Did >,ou confirm positive shut-down du.e to leaks ~ sensor failure/discom~ection? [BTYes; [] No. _ Yes CI ]>kY~' For rank systems that utilize the monitoring system as the prhnary tm~ overfill warning device (i.e. no mechanical overfill prevention valve is installed), is fl~e overfill warning alarm visible and audible at the rank ..._ fill point(s) and operating properly? I~so, at what percent of tank capacity does the al'a,'m n'igger? -'~'-es* [.W~'o Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced m~d list the manufactm'er name and model tbr all replacement pans in Section E, below. Yes,~ [ L.q'~i~''-' Was liquid fotmd inside any secondary containment systems designed as dry systems? (Checl' all thoz apply) _~.1 Product; {Zl Water. Ifyes, describecausesinSectionE, below. ~ No* Was mmfitoring System set-up reviewe,d to ensm'e proper settings? Attach set up reports, if applicable .... [3 No* Is all monitoring equip, recur operations! per mmm~actur, er's specifications? tn Section £ below, describe how and when these deficiencies were or will be corrected. commems: Page 2 of 3 03/0 in-rl'~mk Gauging f SIR Equipment: ~C~eek this box i~t~ gauging ls used only for inventory control. ~ Check ~is box if no t~c gaug~g or SIR equipment is installed, Th'l~ section mus~ be complemd if ln-~lc g~uging e~uipme'nt is nsed to perform le~ de~ection monitoring. Complete the following ~hecklist: Yes { ~ No* Were all taNc gauging probes visuatly inspected for d~mge and residue buildup? ~Yes} ~ No* W~ acc~acy of system product levelr~adNgs tested9 Yes ~ D No* Was ace~aey of system water levelreadNgs tested.9 X'es ~ ~ No* Were all probes reinstalled property9 Yes [ ~ No* Were all items on the equipment nmnuthe~er's maNten~ee checklist completed? tn thc Section H, below, describe how and when these d~fieieneies were or will be corrected. Line Leak Detectors' (LLD): ~ ~,ec~ this box if LLDs ~e not inst~led. Corn ple~e the following eheeldist: ~"es Q No* ~or equipment stm-up or mmual eq~pmeut certification, was ~'teak simdated to Veri~ L~D pertbrmance? ~ N/A (Check all thar apply) Shnulatedleflcrate: ~3g.p.h.; ~0.1g.p.h; ~0.2g.p.h. =~s ~ No* Were alt LLDs confirmed operational ~d acetate within re~larory requirements? ~ ~ No* "~as ~e testing ap.~ratus properly calibrmed? - ~Yes Q No* For mech~ical LLDs, does the LLD re~=ict product flow if it detects a leak? ' ~ N/A Yes ~ ~ For elec=onic LLDs, does the turbhe autonmtic~ly shut off if the LLD detects a le~? .... For elec=onic LLDs, does the turbine ~ut°mtically shut off if any poffion of the monitor,s system is disabled Yes ~N/A or disco~ected9 yes [ ~ For elec=onic LLDs, does the turbine a~tomalically shu~ offifany pmgion of~e monitoring system malfimctions or hils a test? Yes ~'e~''s ~'~ For elec~onic LLDs, have all accessibl~ ~h~g co~ecfions been visually inspected? ~ No* Were all items on ~e equipment m~uf~cmr~r's nm~tenance checklist completed? tn ti~e Section H, below, describe how and when these deficiencies were or will be corrected. Page 3 of 3 03/o Monitoring System Certification UST Monitorin~ Site Plan -,,' ............. ting- E ~,~rO ........................ ............................... ~~:::: ~ :~:~. :::::::::::::: :::::-[~::::~-~; :::::./'::::::¢:::: ..... . .......... :::: .~...:::: ~,~.~ "'::,.:::::'~::::: ...................................... X..o.o ~ !!!ii!!i!iii ~ ................................... D~ map wa~ ~a,~: q/..%/~f". Instructions ]f 5. ou ah'eady have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site pimp, show the general layout of tanks and piping. Clearly identil\' locations of the following equipment, if installed: monitoring system control pane[s; sensors monitoring tank annular spaces, sumps, dispenser pm~s, spill containers, or other secondary containment areas; mechanical or electronic tine ~eak detectors; trod in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan wa,~ prepared. Page MONITOR CERT. FAILURE REPORT THE FOLLOWING COMPONENTS WERE REPLACED/REPAIRED TO COMPLETE THE MONITOR CERTIFICATION TESTING. LIST OF PARTS '~EPLACED/REPAIRED: ~ RICH ENVIRONI NTAL 5643 BROOKS CT BA/(E~$FIELD, CA.93308 OFFICm- (661) 392-8687 & FAX (661)392-0621 MRCPLA-NICAL LRAK D~TECTOR TEST W/0#: PRODUCT LE~,- DETECTOR TYPE ..... TEST '" ~RIp PASS SERIAL ~ER BELOW ' PSI 0R 3 GPH .. ~AIL - . I ceruify the above tests were conducted on this date according to Red Jacke= pump~ field ~esg appar&~s gesting procedure an limitations. The Mechanical Leak Detecgor Test. pass / fail is determined by using a-low flow threshold ~rip rage of'3 gallon per hour or less ag 10 PSI. I acknowledge thag all data collecgad is true and correct ~o the besg of my knowledge. : SYSTEM SETUP .i ............ IN-TANK SETUP 7~11 32241 ........... 4~01CALLOWAY DR APR 26, 2004 9:36 AM BAKERSFIELD,CA 93312 PORT SETTINGS: T I:RUL BOBB4118BO5001 PRODUCT CODE ¢OMM BOARD : 1 (EDIM) THERMAL OOEFF .000600 APR 26, 2004 9:36 AM SYSTEM UNITS R8-282 SECURITY TANK DIAMETER 96.00 U.S. CODE : DISABLED TANK PROFILE I PT SYSTEM LANGUAGE FULL VOL 10028 ENGLISH COMM BOARD : 2 (EDIM) METER DATA NO SYSTEM STATUS REPORT SYSTEM DATE/TIME FORMAT, RS-202 SECURITY ALL FUNCTIONS NORMAL SON DD YYYY HH:MM:SS xM~ CODE : DISABLED FLOAT SIZE: 4.0 IN. ?-11 82241 4101CALLOWAY DR RECEIVER SETUP: WATER WARNING : 1.5 BAKERSFIELD,CA 93812 HIGH WATER LIMIT: 2.0 B0884118305001 NONE MA~ OR LABEL VOL: 10028 SHIFT TIME ! : 7:00',AM .:.,~,~OVERFILL LIMIT : 90M SHIFT TIME 2 : DISABLEDi : 9025 SHIFT TIME S : DISABLEDi HIGH PRODUCT : 95g : 9526 SOFTW6RE REVISION LEVEL SHIFT TIME 4 : DISABLED DELIVERY LIMIT : VERSION 121,00 ' 1002 SOFTWARE# 346121-100-A SHIFT.BIR PRINTOUTS " CREATED - 00.11.15.lS.2~ DISABLED DAILYBIR PRINTOUTS LOW PRODUCT : 500 ENABLiED LEAK ALARM LIMIT: 99 S-MODULE# 380160-100-a TICKETED DELIVERY SUDDEN LOSS LIMIT: 99 SYSTEM FEATURES: DISABLED AUTO DIAL TIME SETUP: TANK TILT : 0.00 PERIODIC IN-TANK TESTS TANK PER TST NEEDED WAN ANNUAL IN-TANK TESTS DISABLED NONE MANIFOLDED TANKS BIR TANK ANN TST NEEDED WRNi T~: NONE DISABLED i LINE RE-ENABLE METHOD LEAK SIN PERIODIC: · 50~ PASS LINE TEST"- : 5014 LINE PER TST NEEDED WRN LEAK SIN ANNUAL': DISABLED : 2507 LINE ANN TST NEEDED WAN DISABLED PERIODIC TEST TYPE PRINT ,TC VOLUMES STANDARD ENABLED ANNUAL TEST FAIL TEMP COMPENSATION RS-232 END OF MESSAGE ALARM DISABLED VALUE (DEG F ): 60,0 DISABLED STICK HEIGHT OFFSET PERIODIC TEST FAIL DISABLED AUTO DIAL ALARM SETUP ALARM DISABLED H-PROTOCOL DATA FORMAT GROSS TEST FAIL HEIGHT ALARM DISABLED DAYLIGHT SAVING TIME ENABLED ANN TEST AVERAGING: OFF START DATE PER TEST AVERAGING: OFF APR WEEK 1 SUN START TIME TANK TEST NOTIFY: OFF 2:00 AM END DATE TNK TST SIPHON BREAK:OFF OCT MEEK 6 SUN - DELIVERY DELAY : 1 SIN END TIME ......... 2:00 AM REfDIRECT LOCAL PRINTOUT DISABLED \ , EURO PROTOCOL PREFIX S SYSTEM SECURITY CODE : 000000 ; '~ T B:SUL ' ALARM HISTORY REPORT I ALARM HISTORY REPORT T 2:MUL PRODUCT CODE : 3i SYSTEM ALARM --Ii .... IN-TANK ALARM PRODUCT CODE : 2 THERMAL COEFF :'000600~ PAPER OUT THERMAL COEFF :.000600 TANK DIAMETER : 96.00! APR 13, 2004 11:53 AMi T 2:MUL TANK DIAMETER : 96.00' TANK PROFILE : I PT PRINTER ERROR TANK PROFILE : 1 PT FULL VOL : 100281 APR 13, 2004 11:53 AM. OVERFILL ALARM FULL VOL : 10028 METER DATA : NO BATTERY IS OFF FEB 20, 2002 8:50 AM METER DATA : NO JAN 1o 1996 8:00 AM LOW PRODUCT ALARM FLOAT SIZE: 4.0 IN. NOV FLOAT SIZE: 4.0 IN. WATER WARNING : 1.5 HIGH PRODUCT ALARM WATER WARNING : 1.5 HIGH WATER LIMIT: 2.0 FEB 20, 2002 8:50 AM HIGH WATER LIMIT: 2.0 MAX OR LABEL vOL: 10028 INVALID FUEL LEVEL MAX OR LABEL VOL: 10028~ OVERFILL LIMIT : 90~ NOV 2, 2003 6:41 AM OVERFILL LIMIT : 90~! : 9025 FEE : 9025~ HIGH PRODUCT : HIGH PRODUCT : 95~i : 9526 ~ ~ ~ ~ ~ END ~ ~ ~ ~ PROBE OUT : 9526i DELIVERY LIMIT : 10~i FEB 20° 2002 8:54 AM DELIVERY LIMIT : 10~! : 1002! FEB 20, 2002 8:43 AM : 1002i LOW PRODUCT : 500~' LOW PRODUCT : 500 LEAK ALARM LIMIT: 99' DELIVERY NEEDED LEAK ALARM LIMIT: 99~ SUDDEN LOSS LIHIT: 99 NOV SUDDEN LOSS LIMIT: 99: TANK TILT : 0.00 TANK TILT : 0.00 MANIFOLDED TANKS MANIFOLDED TANKS T#: NONE T#: NONE ALARM HISTORY REPORT LEAK MIN PERIODIC: LEAK MIN PERIODIC: 50% : 5014i IN-TANK ALARM --- : 5014 LEAK MIN ANNUAL : '25~ T I:RUL LEAK MIN ANNUAL : 25~ : 2507 : 250? ~ OVERFILL ALARM ! MAR 19, 2004 6:57 AH PERIODIC TEST TYPE PERIODIC TEST TYPE FEB 20, 2004 12:24 PM STANDARD!," FEB 15, 2004 6:51 AM STANDARD: ANNUAL TEST FAIL LOW PRODUCT ALARM ANNUAL TEST FAIL , ALARH DISABLED JUN 18, 2001 9:55 PM ALARH DISABLED MAY 6, 2001 12:32 PM PERIODIC TEST FAIL PERIODIC TEST FAIL ALARM DISABLED HIGH PRODUCT'ALARM ALARM DISABLED DEC 26, 2003 7:38 AM GROSS TEST FAIL : SEP 26, 2003 7:~6 AM GROSS TEST FAIL ALAR~ DISABLED ALARM HISTORY REPORT ALARM DISABLED INV~L'ID FUEL LEVEL ANN TEST AVERAGING: OFF'i FEB 20, 2002 8:53 AM IN-TANK ALARM A'NN TEST AVERAGING: OFF PER TEST AVERAGINg: OFF' FEB 20, 2002 8:41 AM PER TEST AVERAGING: OFF: JUN 18, 2001 10:10 PM T 3:SUL TANK TEST NOTIFY: OFF! TANK TEST NOTIFY: OFF PROBE OUT HIGH WATER ALARM TNK TST SIPHON BREAK:OFF! FEB 20, 2002 8:52 AM FEB 20, 2002 9:00 AM TNK TST SIPHON BREAK:OFF. FEB 20, 2002 8:40 AM DELIVERY DELAY : 1 MINi OVERFILL ALARM DELIVERY DELAY : 1MIN ~ FEB i. DELIVERY NEEDED AUG 18, 2003 8:39 PM HIGH PRODUCT ALARM MAY 28, 2003 8:42 PM FEB 20, 2002 8:50 AWl HAR 22, 2003 5:28 PM PROBE OUT ~: FE~ 20, 2002 9:57 AM FEB 20, 2002 8:53 AM FEB 20, 2002 8:42 AM HIGH WATER W~RNING LEA~ TEST METHOD FEB 20, 2002 9:00 AM TEST MONTHLY : ALL TANK ~ DELIVERY NEEDED WEEK I MON '~' · ' FEB 20, 2002 9:56 AM .START TIME : DISABLED ~ ~ ~ ~ ~ ~[~_ ~ ~ ~ ~ ~ TEST RATE :0.20 GAL/HR .~ DURATION : 2 HOURS TST EARLY STOP:DISABLED LEAK TEST REPORT FORMAT .' NORMAL T 4: ANNULAR SPACE L 6:SUL TURBINE L 9:DISP FUEL ALARm" STP'SUMP DIBPENBER~P~N APR 26. 2004 9:22 A, FUEL ALAR, HIGH FUEL ALARM APR 26. 20O4 9:23 ~ APR 26. 2004 AUG 12, 2003 2:38 PPI FUEL ALARM HIGH LIQUID eOT 23, 2003 5:48 AM AUO' 12, 2003.!;2.!28 FUEL ALARM AUG 11, 2003 12:31 PM HIGH LIQUID ALARM . HIGH · AUG 12o 2003 2:.25 PM AUG 11, 2003 HISTORY REPORT~ SENSOR ALARM --. L I:RUL ANNULAR ANNULAR SPACE FUEL ALARM APR 26, 2004 9:22 AM . ALARM HISTORY REPORT FUEL ALARM AL~,RM HISTORY REPORT ALARM HISTORY REPORT AUG 12, '2003 2:38 PMi ..... SENSOR ALARM -- L 4:MUL TURBINE --~-- SENSOR ALARM .......... SENSOR:ALaRM FUEL ALARM STP SUmP I L 7:DISP 1,2 LIO:DISP.7-8 AUO 11, 2003 12:22 PH FUELRLARM DISPENSER PAN DISPENSER APR 26~ 2004 9:22. AM ' 5IgDID WARNING LIgUID WARNING ~P~i 26°'2004 9:15 AM APR FUEL ALARM HIOH L.IOUID ALARM ~IGH LIOUID ALARM JAN ?~ 2004 .6:30 PM · "AU~, 12,:2003 2:01 PM AUG 12, ~003 2,;:~2 PM HIGH LIQUID ALARM AUO 12, 2003 '2:32 PM 'LI~DID ~ARNING HIOH LIQUID ALARM ~U~ 1'2~ 2003 11:28 AM AUG 11, 2003 12:16 PM ALARM H I STORY REPORT ..... SENSOR ALARM L 2."RUL TURBINE . STP SUMP ' FUEL ALARM 'i:, . APR 26, 2004 9:2~ AM' : RL~RM HISTORY:: REPORT .i!i::,:~L~RM HISTORY REPORT . i ALARM HlSTOR~ REPORT FUEL .ALARM ..... SENSOR ALARM,--~:::' ~ ': '~' SENBOR..AL~RM J~N 14, 2004 3:56 PM ~. K'SU~ aN ~R ~:: ' .... SENSOR ~L~RM ..... ~ .......... . . , NUL FUEL FUEL ~LARH ~LARM-HISTORy REPORT ..... q OUTPUT RELAY SETUP RECONCILIATION SETUP ALARM .HISTORY REPORT i ............ SENSOR ALARM .... L12: ..... SENSOR ALARM ..... R I:RUL PSD EDIM 1: OTHER SENSORS LI6: TYPE: EDIM 2: OTHER SENSORS STANDARD NORMALLY CLOSED AUTOMATIC DALLY CLOSING TIME: 2:00 aM LIQUID SENSOR ALMS ~UTO SHIFT #l CLOSING L I:FUEL ALARM TIME: DISABLED L 2:FUEL ALARM L 2:HIOH LIQUID ALARM AUTO SHIFT #Z CLOSING L 7:HIGH LIQUID ALARM TIME: DISABLED ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~! L B:HIGH LIQUID ALARM ~ ~ ~ ~ ~ END ~ ~ ~.W~ L 9:HIGH LIQUID ALARM AUTO SHIFT #3 CLOSING : LIO:HIGH LIQUID ALARM TIME:. DISABLED R 2:MUL PSD AUTO SHIFT #.4 CLOSING TYPE: TIME: 7:00 AM t STANDARD ,I NORMALLY CLOSED PERIODIC RECONCILIATION ~. MODE: MONTHLY LIQUID SENSOR ALMS ALARM: DISABLED L 3:FUEL. ALARM ALARM HISTORY REPORT L 4:FUEL ALARM TEMP COMPENSATION LIQUID SENSOR SETUP L 4:HIGH LIQUID ALARM STANDARD SENSOR ALARM .... L:?:HIGH LIQUID ALARM METER CALIBRATION L13: L B:HIGH LIQUID .ALARM OFFSET: 0.000~ OTHER SENSORS L I:RUL ANNULAR L 9:HIGH LIQUID ALARM TRI-STATE (SINGLE FLOAT) CATEOORY ; ANNULAR SPROE L10:HIGH LIQUIDALARM BUS SLOT FUEL METER TANK , : R '3.:~UL PSD TANK MAP EMPTY ~' TYPE: ' i BTANDARD L 2:RUL TURBINE ~ ' ' NORMALLY CLOSED ' DUAL FLT, HIGH VAPO~ii CATEGORY : STP' SUMP:t? !. :] :' ':::::: i.{ LI,QUID SENSOR ALMS ~ ~ ~ ~ ~ END ~'~ ~ ~ ~i L 3:MUL AN~ULAR ! ~ 'iL'5:FUEL ALARM TRI-STATE (.SINGLE FLoAT)I ':L 6:FUEL'ALARM .6:HIGH LIQUID ~LARM CATEGORY :IANNULAR vY.:HIGHLIQUID.ALARM '8:HIGH,'LIQUID'ALARM i .9:H:IGH LIGU.ID ALARM L 4:MUL ~:H'IGH,.:LIQUID:,~L~M, . . 4101CALLOWAY DR DUAL FLT. HIGH :~ BAKERSFIELD'CA~93312 CATEGORY ' ": .BOBB4118BO5001.: '. APR 26, 2004 9:37 ALARM HISTORY REPORT L 5:.SUL AN~ULAR::, i:'!:? ' '" SENSOR ALARM - - CATEGORY : :.:,? · · OTHER SENSORS :::::::~.::.:~ = · : ALL FUNCTtONS NORMAL DUAL FLT. HIGH VAPORf · . CATEGORY : STP SUMP. :{:.:..':.'DUAL FLT. DISCRIMINATING :,,!::.:CATEGORY : DISPENS R:.PA · i!.' 'DUAL FLT. DISCRI:MIN~TING Tankn¢ olo 8900 Shoal Creek Bird, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 05/21/2004 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 04/26t2004 Order Number: 3134783 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Leak detectorIests. /"} . Sincerely, Dawn Kohlmeyer Manager, Field Reporting Subcontracted Services TOPS Data' Entry Form Site Name & ID # 7-ELEVEN #32241 Subcontractor Name JAMES Address: MARKET # 2133 Address: 5643 BROOKS CT City, State, Zip: BAKERSFIELD, CA 93312 City, State, Zip: BAKERSFIELD, CA 9330 Phone # (661) 587-8826 Phone # 661-392-8687 WO# 3134783 Tanknology Contact: CP Testdate 04/26/2004 Site Information Tank# 1 Tank# 2 Tank# 3 Tank# 4 Tank# 5 Tank# 6 Tank# 7 Tank# 8 Product REG UNLEAD MIDGRADE PREMIUM Tank Size 10028 10028 10028 Tank Tightness Test Line Tightness Test Leak Detector Test P P P Tank Cathodic Protection Line Cathodic Protection Flex Cathodic Protection 60 Day Inspection ; ATG Certification P Pressure Decay NL Liquid Removal Dry DBP Wet DBP AZ Leak Test Section 52 Insp. Intersticial Insp. Rule 461 Insp. 05/21/2004 Work Order: 3134783 , ~ FIPR 2,3 ~004. ~:~8 BK~FLD F!~E PREVEMTIOIt tHBI)85;~-~.l"/;3 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134783 LIMITED WARRANTY VAPORLESS MANUFACTURmNG MECHANICAL ~ROOUCTS ALL LEAK DETECTORs MU~I' BE TEATED &FTER INSTALLATION TO ENSURE LEA K DETECTtON OF 3 GPH A1r i o pSI BE FORE S~'E IS RETURNED TO OPERATION. See Leal( Oel~tor Te'ete~ {LDT-agO) teat irmtruetlnns. Vaporte~s~ MamdaClurjfl§, I~qc~'warrants ilo p;odblc~ [o be Ir~e from ~e~e¢l$ iii nnaletialS, end WO~manship for the Iollowin9 period;: k0-2000 and LO-22~) sodas of leak daleG'[om ate c:ov~re~ tot 24'mo~thG after the dale of FnalaFlafion; ell olhef Llmlt~! We~lm~ I~r Eleet~i~.al t Electronic I~¢~luet~) are cowrecl e'er 18 morlttqs &f~er i~tarlal~r~ dele. I his wartan[ywin be ;on$ide~ed YOlO if the pr4x~uet iS k~ui~l 1'O r~a~,,a beel~ improperly insta e~l, m s'used, abused or disessemDlad. T~s '~an~ is yali~ or~ly il the a¢COrn,~nyin~ WARRANTY REGIb'TRA'TJON CwldqD i~; COMPLETED AND RETURNED TO VAPORLE~.S M&NUFACTURINQ, INC~ wi'/NIN FOURTEEN (14) DAYS FROM I~E DATE IT IS PUT INTO Beloee request 01 warranty repair o~ leek del~ctors, follow the b~sta~latien instruction; I~r the appr~wiat= leak delectm and lea, k clelecf0r testing pr010c01 es explained with,the LDT. a90 leek delector tester, Tomqflef4wai?a~1~o0flsidmatiO~l:Ca Vap~rJess Manu~acruring~ ~c. al ~) 367~18S Up~n m~`e~vtn~ ~n R~A [Re~u ~ed Gu~ -~1~t~zati~ )~~ ship Ilrle producl pref~id cbrecth~ to Vaporlef~ ManulecflJneD.,Jnc.. 8700 gaaE L0dl§ Mesa D~.. P~escern'Valloy. Ari:r01~a,86314. Relutn tho leak deteclO~, prepa~l Wita· ~oPlr o! the Warranty Cheek I,i~t (loak dete~orlast Dealers and wholesale oullet~ fe~ Vaporle~.s ~n;xkucts me:not requared m author;zed to pedorr~ wana~ty repairs :or exchanges on behalf of Yap~'Pess, nor ere'they aulh~¢,ad'[o modify thio wa[rarely in am~, way. ~waf~a~ties~m~d~`f~w.in~udk~wa~mn~ie~m~rc~Aae~i~yand~itrmssf~rpa¢~¢uiarptJrpese~axe~1edt~4mo~hs~r~f~aate roduel is ptrt pnto so,vice tED-20(]0 end LDo2200); )8 rnorpths'~mm date produc~ ia P~I into ServiCe lot ~ll el'her VMJ mechanical and teal equlp m~Pn~r (see ,satiable Lim~l~eCl. Wartanl¥ luf. Ele0tr~cat / E.J, ectr~li~ p~cl~Jcts). In no ev~mt P~a~ Vapor ess Manulacluting. In¢, be I~eld ~ia~e lot inci0~.ntal :or CO~equerdi~l damages due TO breach o~ this"wa~raety er elher watt'aflhes implied.arir~ng i~l ¢0nne~0n will1 this prcxluct 'incFu(li~qg without habltilybrni!ali0n'cnntrpct;ort'°ra'5 of ,,qlored0~herealleliCl~els or ~amage I'0 Iht grou. nd ende~grou nd or e~vironment, wh;ether at s ng pneler Iheo6es,0/~nrl. ne¢~je4~oe.. 'saict ~. ~ _m.e,state~do ?1 a~ .k~. ti.~ ,' .~,ti..o? ?. c~.: h~w,!0~)~ a-n implied wan'amy tast$~ I~or. Oo they allOW ~ e0~lu$ion o~ mciden al or consequential damages Vaporless Ma~UfactuTing. Inc. a 8700 EaSt'L~h§ Me1~aO;k~e - Fresco11 Vailey; AZ 8631,1 1-800-367'.01 8~ CUSTOMER COPY -KEEP THIS POFrI?ION FOR YOUR RECORDS. IIUIPORTANT:! WA'RRANTY REGISTRATION Return thls portion to Yaporless Manufacturing Products, (Please TyPk or Print) ReqCreqd. POst Inalallehon Te~t Flesulls Reeistered Owner: .... [-~ - l: i i IAstall#?g Organ~tJan: Location of Producl ~s_~llati_~ ...... Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134783 LIMITED WARRANTY' VAPORLESS MANUFACTURING MECHANICAL PRODUCTS &LL LF_&K DETECTORS MUST BE TESTED AFTER INSTALLATION 1'0 EI~SURE LEAK DETECTION OF 3 GPH ATIg PSI BE FORE SITE IS RETURHEOTO OPERATION. See Leak Delector Teste~ CLOT-agO)teat instru=fio~s. LC)-~00 series O1 leak Del,aCtors ars covered ~r 24 murll,hs after Ihe ~.te nt in.~talJaticm: ell ether mechanical YM113t'~dacts (~e~, m~perate IJmit~l Wen'an~ a3r Eleetri=al 1 Electronic predut'l~) am c~A~ere, d for 18 }1~ontlls a~ter i~lstallMion date. 'r'~is warts, lily w,l/be, cnnsidere,0 VOID if the product ~s [ou~cl to h~ve been irnDr0perty installed, misused, abused or T~ s watraely is valid only il~ ;he ar,~:nrnpanyirtg WARRANTY REGISTRATN3N CARD I$ COMlaLETED ~O RETURNED TO VAPOBLESS MANUFACTURING. INC. WITHIN FOURIEEN (141 DAYS FROI~I'[HE DATE IT I$ PUT INTO SERVICE. Belom reque$1 ul wa~'rardy ralJair Ulr l,eak deteClO~, l,o[tow Ihe imsllallalion inslructiotts to( Itta appmpriale leak detectoi and leak Ue~ector. testm9 I:~'oloc~ a~. e~lOlained with the Ll.)'r-8.q~ l,eek detector tester. TD*requetAwa?rantycoflsideralion: ce~l yapofl~sManufa{~lufing. Inc. at IBD0) 357-0185 Upon receiving an RGA (Returned Goods'Autho~zala)n). ship the 0rGUur,1 prepa~cl diroclly lo Vaporles-~ Idanulaclurm~}. Inc.. 8700 East Long Mesa iDr.'. Presco11 Vail,ay, Aritona 66;314. Retur'n'the leak deeCt°r prepaid a~1113 a copy d Ihe Warran~r Check List (l~ak detectm lest results). Dealers arld,whole'~ale Dui;lets, tor,.Vaj;x)tless products are nol requi~'ccl or ael,horized tn Derro~m warrarll,y rapture-Dr exchanges OR Maporless, nor ara 1hay authcxized to nrodily this warranty in any wa~. Ail war rarities ~mplied by law, i~cl~cli~a ~Warr~nl,i'es st me rcfla~lal~il!!y .e,nd Illness for pen icul,ar p~rPo~es a~a limited I,o 24 ~r~op th~ horn datepr~3uCt ~s I~1 i flt~ ~,e~ce i L1~-20{30 a.~Kt L0.22~00~'.-18 monlh~ I~m da~a ~nx~uCt ~5 ~)ut into sorvice fo~ ~i,I other YM! mechanical-a~d test equipment separale L imited WAntAnty for Emclrical / Electronic products)..' It~ no e~aanl shah ValOOrle~s Menufactunng. Inc. be held liable for .ncidental ~r ~equenhal .~amecjes clue.to breach of this wa~Al)ty or ctber walrraniiOS.im~hed ansin~ in ¢Onnecti0~l with g~qls pn3dt~l includi~lg iimitAtion, luSS o! store0 Ik3uids'o~ damage l,o the gr~und, uflde~gn~ed or a~l~ron~mnl, wherner arising under theorms of ~nrs. neg}igence. tiabrlily ~ohtraclL o; otherwise · Some staleS do nol allow limitations tm how 1¢3n§ an implied warraa~ last-5, nor do they allow the exclusion of i~cidental or consequent&al damages. The'~el6re. ~he eb¢~utlpul,al ed h mltarion$ and I or ex¢lus;o~ may esl aPPly'to yoi[. This waC'rant). 9ives you s~eeilic legal dght~, and y6u may also ha,~e olher ~Lgh.l~. va't~ch may vary from slate lo ,~t~te. Fo( [urther queStionS conce~meg lmm: w~a~ty, Vepo;tess ManiJfactunng. Inc, * 8?0D East L0~g Mesa Drive ~-Prescotl Valley, AZ 86314 1-8OO-367'-O1.85 IMPORTANTI WARR:ANTY REGI.$TFIATIO'N Return this. portiOn tb vaporless Manufactui, ing 'pr°dbcts ~umha~dF~om: ~o~ ~*'1 ~.~ tnsmiti~., o~an~tton: Company:. InStallert ~ L~tion.,of. P~duct fns~l~on: ' Station ID;' Ci~: ~.A~E~ State: Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134783 MONITORING ,S¥$"FEI~I CER.TI}.,'ICA"I'ION .';I,;,;;o, .":.,- ,'.';r:~;/: Ch:,pze:'.d. ~. Y~.~o,~:J:.o.'~d '~;'~-9' C'ode: Cii;q.,ter 16. D:;'~Jt'n :~.' ~;d; 21. cTahl;2.m.? £'ode. :';~'[i;.'~ CO.Lll,C: Pcr'.:.:,,I ....... CoJ~'ii'.e,r Phone .Nc,.: i ~. I,*vea~o,':,' ofEquipmcn[ 'I'esi'ed/Ct. rfifii~d : -'. :.,,,I. i:.:cclii!, Hih~.-{.~v~l.q~-~ur. M~?.L:. ' ~ .. {.O 'Fas,~('!vertUl/Pagl~.L,:,,¢lSens,)r..M~,;C'..' . _ ' ..... ~ ._~,:,z~,,,g.,~.m~' ' ' .~0~.~:. ~,4'~,.:'~ c~::,,.v~,~: ' -- -~:~.~,..:'W- ....... ;,~.":i:' ,,.~'.~tri~:~? I,'~ch l:;~:$6r~J.. Model' ~. __ O~Piph'~gq. umo',"£r¢o,:i;.'qe:,sfirl,.x). M'u~:L: ~- --,--v"-- · : :fi ' ;.l '~hfil~:"~.~F.~);44j. M~¢I: O ']~ill SUmp Srn~0vL%',..Mo~=::' ; .......... ~; ~.;:l~.,·, g~rill;'[Jgh-l.ev.-[-'i¢~g'~r. {Vlod¢]: :1 '[',~,k;~,efffll/Ri~h4~ve,:~m:ior. k4mleL " . ~"---"~'~ ~ ~ ~. ~- ..... _.. ~ .,-I' Ofl~¢~:131gei~ cqU-lp a;i~ l~'lg and re.d,:: in ~¢C- oq £ t., ~,~.;.~':' :. · r,,~,=,,.;,,.~ ' ~' ~' - ' .... ' ·.v~.~ ,:....:: ,.' .,L*. :l.:i. I ? .':*he,a vamu) ' :~9y!",~.L~-'P,':'.--i",_*Y~t'l::u.u4.'.)tntJCl!ai'~(~:'. ._ .._ [ ~:l~ispe*n-~rCOOc;~i,.*~,"r/er~l**~ioa;("J],u:[dCh~i~ . ': '~;37"" m. 5-.-4- t~ oi~p.,,, re: .. ', -~'xc::w..~ &et.;;. ' I ~ sh,:.~ Vn~..o'.O.' ' ' ' ........ ; ...... :.'.:., ,.~a,',~ t,(.,,n,):~ ~.~r..~'g~'*-) ' g',~e.,'~ -. -.. e. iglb~.~,rer~, - . .. v'.u.:;:2', ,.:_ ' ,~. . . .~{c,cr~.',e.N~..: L.'..b..l.y.LdO:- ~,B~O .8§0 J'~g~ J 0[:3 ',,) 0.: 3,,:.,,',:,,,' u,.~" Sysrg. rm C.e ri'if{cation Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134783 fi. i~ut~s of T~th~/Servici~g ~:~'~] 0 ~* ~' ~ .~ r~iayed ~a ~mom 'mo~tor~ stnfion, is all con~unkaibas cquipmc~ {g~g: modem} 'positive shvt-d~n? (Chackatt Iha~ app~) ~umP~r~ch SensOrs; ~Pc~ Co--ear posigve shut-down d~ m le~ ~ s~naor'~ilu~discO~ecti°n~ ~es~ ~ / D~=¥ou Confirm ' {.~N?A { mc~kd ov~rfiU preV~o~ Valve is ~mMcd), a ~e overfil! w~nlng at'arm v~tble and aodihl~ L/'{ ['P~O~{~(~. U ~ater. Ifyes, d~fibc ca~S iaSectiOn,E~ below.' ' ' , " *.lb'i~ciioU E,below, d~gbe how and when these deftciene~ were or will-be eorrec~d. Tanknology-NDE 8900 Shoal Creek, Building, 200 Austin, Texas 78757 Work Order: 3134783 ~ Check ~ ~x ~no ~ ~u~g or SIR'eq~pmem is ~st~llct[ ~ctiOn must ~ complemd if in-~ ~ugi~ ~uip~nt is u~g ~o perform [e~ deletion mo~toring. Q '~o* ~ ~tl ~put w~g ~enim~ f~ ~op~ ~n~.~ mrm~rion,,inel~g tes~ig ~} ~ No' W~,acc~cy o~sysr~m product ~vVl roafl~ ~,No' ~erc a~probcs r~d pr~erLY? ~ ~o* W~all. i~ on ~e equipmen[~g~'sm~ce'che~ist completed'? ......... Leak Det~tor$ (~D): ~ ~,:cct m~ box ~.LLDs me no[ m~le6, O .N0* "For m~ea! ~Ds, ~s d~e LLD r~Zt ~od uet fl0W it a' ~tec~ a leak? ' ~ "For el~o~c'.LL~;.'does ~e0r d~c0~e&e~? ~75i~ ~ticallY ~ut :off if. any po~. 0[~e moni~ring s~rem' ~'. dis~b!ed ~ For eteC~oM: ~, does ~'t0rbine.~aUy.~aI 6ff if ~y.p~iOa. 0f ~ momtonng, sys~m'~!funcno:ls ~ NO~ W,~.~ Seetbn'~ below, d~erib~.bow an& when (b~e fieflei~c~ were or Will be eOrr~te4.. I-'1. CommentS:, .... ' 3ot :3 0~ l Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3~.34783 UST Monitofine Site Plan ................................ ................. .... .m,,--~ . ........................ . ............... Imtruetion~ If ~ ou already bsv.e a .dia~ ~at shows ~IOnitor~ng.'Sy~em Ce~ifiC~tiOn. On your ,toca~i6i~,ot' ~c foUow~g equipmeuq, if (n~ail~: monitoring ay~em cmxtrol p~e~; ~onsors monitoring ~nk · spaces, sua~Ps, disP. en~rP~, spill .cont~0rs, or d~ecr9~; t~Od:'&-t~ liquid lo,el.' prob~.(if Used for w~s prepped, Tan~ology-~E 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134783 MONITOR CERT. FAILURE REPORT Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 7875? Work Order: 3134783 PRODUCT .~: D~TgCTOR TYPK. 'TEST ' TRZP S~R~ ~R BELow PSI OR " ~I~ ~_ . : , ~s I ~e. rc:i, fy, the ~oVe ~aca,:we~e ~nduoted on this' ~te accordl~ i ac~°W!e~e C~c all ~Ca' Collecce~ i~ crue .and CO~r=ce tO Of .mY .knowle~a. . Tech: ~;. ~-~ Dace limim ' I Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:04/26/04 WORK ORDER NUMBER3134?83 CLIENT:7-ELEV~N, INC. SITE:7-ELEVEN #32241 COMMENTS Monitor certification results scanned in PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Pdnted 05/21/2004 08:58 SBOWERS SITE DIAGRAM ~ ~ T'an~ 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 04/26/04 WORK ORDER NUMBER3134783 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #32241 W~ ~ VENTS E Em ,-°'~'- m <~ <~ PLUS SUP UL Printed 05/21/2004 08:58 SBOWERS Work Order: 3134783 B0~841'] 8~05001 ~RT p~D~ ~DE : ~R 26, 2004 9:~ ~ ~M UNI~ ~292 ~iTY T~ Dl~i'~ ; 96' ~ ~T ~L FU~o~ 4101 C~L~Y,DR ~EIU~ ~: ~ ~RNI~, t 1 ~oso4~laaosool NO~ ~ OR ~ VOL: ~oO ~HI~ T]~ 8OF~ ~lglON L~V~ V~ION 121.00 BHI~ ~Rga 34612t-lflO~ DI~ ~TED - BO. 1 [, [5.13.2~ ~ILY 'B[,~ PRI~B ~ L~ :PROD~ : 5 P~IODIC i N~TA~. B1R T~ ANN ~ N~ ~N~ T~: '~, T~ ~E~TiON ~-23~ E~ OF ~ ~ D[~ V~UE (~ F. ): 60,D DI~ P~IODIC T~ F~iL ~1~ ~IG~ :0~ H-P~T~h. mT~ ~O~T ~YLIO~. ~V.]~ T[~. ,g~ · ANN ~ AV~: OF '~R' ~- t ~n ~A~ '~ ~T,]~: oF ~ ~ .T~ a!~n ~.;,or D F-J~ I~CUE I fly £ ~ 0ooooo . ., Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3134783 I T 3:~UL RLRRtt HIf3TORY REPOI~T !. ALRI~ HIEITORY T 2:MUL P, RODUCT COD£ : ,3 ..... E~STEH AI.~qRM --I .... IN-TAm RL~ PRODUCT CODE : 2' THEib'~L COEL:T :.000600' lhqPER' OUT ' ' THEM'%~ COEFF :.000600 TANK :HRMt£TER. : 9&.00 APR L$. 2004 [1:53 Al~f T 2:HUL TANK DIETER : 96.00 TaNK PROFILE t '1' PT PRZNT1~ ERROR T~NK PROFILE : I PT FULL VOL : ~0028 ~qPR 13o 2004 11:53'~1 OVERFILL RLARM ' ' FULL vol: 10'02B FI~TF-'R ORT~ : NO - · ~TTER~ Is 'OFF F;a 20, 2002 8,:50 t. tETEE D~.TR ; '~' JAN 1, t996 '8:00 ~ ~ P~O~ ~ HiGH ~TER' LI~IT;' 2.0' '' ~ OR ~ V~L; 10028: O~[gL LIHIT : 9~ ~ ..2, 2003' ; 9025' HiGH P~D~ : 9~ .... D~[VER¥,LIM]T : l~: : 1002 F~20, 2002 B:43 L~ PROD~ : 500- ~.. LO~ P~D~T : 500 ~ ~ L~M~T; 99 D~i~ N~D, L~ ~.LIMIT: 99 SO.EH ~ LIMIT,: S9 ~ 2,.~003 ~DEN ~ ~{HIT: 99 T~ TILT : T~ TiLT : 0.00 ~NIFO~D L~ MIN ~NN~ : 2~ : 2507' PERIODIC T~T ~ ~5~ 2004 5:51 ~ ANN~ T~T PAIL L~ P~D~ ~ - P~[ODlC T~.FRIL ~ T~ F~ ~'26. 200a 7:as ~ ~ ~ST BIP~N ~:OFF~ P~ 20', 2002 8:B2 ~, F~ 20-'20~2~'9:00 ~Y'2s, 2ooa e:42 ~ .F~. 20. 2~0~ F~ 20, 2002 8; LE~ T~ ~O FES ~. ~02 ~9:00 ~ t ~ F~ 20.'20D2,' D~T[ON : 2 ~ T~ REPORT Ta~o]ogy-~ 8900 Shoal C~cek, Building 200 Austin, Texas 78757 Work Order: 3134783 F~ n~ F~ ~. HIgH LIQUID ~i ~R' 26. 2004 9:~ ~ ~R 26. 2004 ~R 2S, 2004 9;28 ~ ~ · ~ n~ p~ :~ HiGH ~I~tD ~ FU~L ~ fllOH L]~ID ~ ti, 2003 12:31 ~ HIGH L'Ig~lD ~ '~ 12. 2003 2:25 ~ ~ II, 2~3 'L. ItRUL ANNLII~a~ ~R 26. 2004 e:~ ~, JAN .7. 2004 6:~ : ~ 1:2~ 2003 2:0} ~ A~ t2;"2003 A~ 12. 2003 '2:32:P I' ~p '~ .. Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 31347 $3 ~ a!ff~O~¥ REPORT ~ .ttll~oRY ~ORT : ~ ..... z ........ . ....... -~=-- ~R~ ..... -. LI2: ..... ~R ~ .... ~ R I:RUL ~ ~1~ OT~ 9E~~ ~ ~T~ ' L.I:P~,~ TI~: Dt~ED L 2~HI~ LIQUID ~ '~UTO' L ?;H[O~ LIgUiD ~ . L B:~IGH LIQUID = ' · ~ ~ ~ ~ ~ E~ ~ ~ ~ ~'~:~ 'L,.gIHIGHLI'~DID ~ ~0 ~Hl~ ~3 ¢L~l ~ R 2:M~'~D ~o~BHI~ 84 CL~t L 3:FO~. ~ L 4:HIG~ LI~ID LI3: L ItR~ ~NN~ , L 9:HlOfl LIG~I:D'~ ~ : :RNN~ ~ ' .... ' ,' . '.~ ~I'V ' ' . ;-.:~,., ~'., ,~ ~ ! ' Ta~ology-~E 8900 Shoal Creek, Beilding 200 Austin, Texas 78757 www. secor, com INTERNATIONAL 3017 Kilgore Road, Suite 100 ,NCORPO"*TEO Ra.oho Co,dova, C^ 0 670 916-861-0400 TEL '916'861-0430 FAX Mr. Steve Underwood City of Bakersfield Fire Department 1715 Chester Avenue Bakersfield, CA 93301 RE: Fuel Line Upgrade Soil Sampling Report 7-Eleven Store Number 32241 4101 Calloway Drlve Bakersfield, California SECOR Project No.: 77EL.32241.43.0520 Dear Mr. Underwood: SECOR International IncOrporated (SECOR) has prepared this letter on behalf of 7-Eleven, Inc. (7- Eleven) to document the soil sample results obtained during the fuel line upgrade activities conducted at 7-Eleven Siore No. 32241 located at 4101 Calloway in Bakersfield, California. This work was conducted in accordance with the requirements of the City of Bakersfield Fire Department (CBFD). The soil samplb collection was performed by SECOR. Glacier Environmental Services, Inc. was subcontracted bY 7-Eleven to complete the fuel line upgrade activities. INTRODUCTION The purpose of SECOR's project involvement was to collect soil samples to assess subsurface conditions beneath the dispenser islands. Specifically, SECOR's scope of work consisted of the following tasks: · Preparation of a site-specific Health and Safety Plan; · Collection of soil samples beneath the dispenser islands and product piping at the direction of the CBFD specialist; · Laboratory analySis of soil samples collected from beneath the dispensers; and · Preparation of thiS report documenting the fuel system upgrade and soil sampling activities. SITE BACKGROUND No reports related to any previous environmental work performed at this site were found in SECOR's 7-Eleven files. SITE LOCATION AND FACILITY DESCRIPTION The site is located at the southwest corner of the intersection of Hageman Road and Calloway Drive in Bakersfield, California. Access to the property is provided by Hageman Road to the north and Calloway Drive to the east. The site is located in a mixed residential and commercial area. The site is occupied by an operating 7-Eleven convenience store, which is located on the south eastern portion of the property. Three 10,000-gallon underground storage tanks (USTs) are located SECOR 7-Eleven Store Number 32241 Fuel Line Upgrade Soil Sampling Report January 15, 2003 Page 2 in the northeast portion of the property between the dispensers and the intersection of Hageman Road and Calloway Drive approach (Figure 1). The concrete drive slab and four dispensers are located adjacent to and southwest of the USTs, The dispenser islands and UST areas are paved with concrete and the remainder of the site is surfaced with asphalt. Portions of the dispenser islands and UST concrete pads were removed and replaced during the fuel line upgrade activities, FIELD ACTIVITES Dispenser and Fuel Line Sample Collection and Analyses On July 25, 2003, a SECOR scientist collected one soil (D4) and three pea gravel (D1 through D3) samples beneath the dispensers at 4 feet below ground surface (bgs). All samples were collected under the direction of a CBFD representative. Each soil sample was screened for hydrocarbon vapors using a portable photoionization detector (PID). Soil samples were collected in clean, 2-inch diameter by 6-inch-long brass sample tubes. A SECOR scientist used a hand auger to extract soil then pounded a sample tube into the soil in the center of the auger. The sample tube was filled completely w~th so~l to m~mm~ze headspace and sealed using Teflon sheets and plastic end caps. Each soil sample was lab, eled and placed in a cooler on ice for delivery to Kiff Analytical in Davis, California. All soil sampl!ng equipment was cleaned with a non-phosphate detergent solution and rinsed with tap water followed by a distilled water rinse to reduce the possibility of cross- contamination between sample locations. Copies of the field notes are included in Attachment A and the soil sample locations are shown on Figure 1. The soil samples were analyzed for total petroleum hydrocarbons as gasoline (TPHg), benzene, toluene, ethyl benzene and xylenes (BTEX), and methyl-tert-butyl ether (MtBE) using Environmental Protection Agency (EPA) Method 8260B. RESULTS Soil Sample Analytical Results None of the samples were collected from beneath the dispensers contained concentrations of TPHg, BTEX or MtBE above the laboratory detection limits. The soil sample analytical results are presented in Figure 1 and are summarized in Table 1. Copies of the analytical reports and chain-of- custody documentation a~e included in Attachment B. SUMMARY AND CONCLUSIONS Four samples (D1 through D4) were obtained beneath the dispenser islands. Concentrations of TPHg, BTEX and MtBE were not detected above the laboratory reporting limits in any of the samples. File: 7-Eleven/Store 32241/Reports/32241 Fuel Line Upgrade Report.doc SECOR International Incorporated SECOR 7-Eleven Store Number 32241 Fuel Line Upgrade Soil Sampling Report January 15, 2003 Page 3 LIMITATIONS This report has been prepared for the exclusive use of 7-Eleven, Inc., their agents, and other authorized parties as it Pertains to 7-Eleven store No. 32241 located at 4101 Calloway Drive in Bakersfield, California. The findings and conclusions documented in this report have been prepared for specific application to this project. They have been developed in a manner consistent with the level of care and skill normally exercised by members of the environmental science profession currently practicing under similar conditions in the area. No warranty, expressed or implied, is made. The potential for the presence of unknown, unidentified, or unforeseen subsurface contamination always remains. Furthe¢ evidence to determine such potential site contamination would require additional subsurface exploration and testing. If you have any questions or comments regarding this letter, please call us at (916) 861-0400. Sincerely, SECOR International Indorporated Jaff Auchterlonie M. Gavan Heinrich, R.G. Senior Geologist Associate Geologist JA/dc Attachment: Figure 1 - Site Plan Table 1 - Dispenser Soil Sample Analytical Results Attachment A - Field Notes Attachme'nt B - Certified Analytical Reports and Chain-of-Custody cc: File/7-Eleven, Inc. File: 7-Eleven/Store 32241/Reports/32241 Fuel Line Upgrade Report.doc SECOR International Incorporated SECOR FIGURE - ~ LEGEND: A DISPENSER SOIL SAMPLE LOCATION - HAGEMAN ROAD / JULY 25, 2003 CHEMICAL ANALYTICAL RESULTS: " ANALYTE <0.0050 CONCENTRATION (rog/kg) ! IDEPTH 4.0FEET I USTs Mt. BE <0.0050 FE.CE \- I P'g <0.0050<"0 I 5 ANALYTES: "% I°EPTH 4'OFEETI<0.o050 /'/ D4%~XZ~~CAN(°/// ~ DEPTH DEPTH IN FEET(BGS) . ITBPHg <1.0 .~/ u)O TPHg TOTAL PETROLEUM HYDROCARBONS · -- D , z AS GASOLINE (rog/kg) CURB ) I t~tt~E <0.0050 ~ OP¥ 'q e ~ BENZENE (mg/kg) /~ / ~,, MtBE METHYL TERTIARY BUTYL ETHER (rog/kg) DEPTH 4.0FEET r-I PHONE / rP~g <1.o ~ ~B£ <0.0050 PARKING / / / / ~ OPEN FIELD ~.,,,,%~ / DEPTH 4.0 FEET / r~PH~ <1.0 ~.. <0.0050 ~ MtB£ <0. O050 .~: STORE #32241 O O 13_ FENCE OPEN FIELD 0 40 80 I I APPROXIMATE SCALE FEET PREPARED BY: PREPARED FOR: DRAWN BY: DWR CHECKED: DRAWN BY: ~ FIGURE 1 REFERENCE: THIS FIGURE IS BASED ON FIELD MEASUREMENTS, 7-EL VEN FACILITY #32241 AND IS INTENDED FOR ILLUSTRATION ONLY. APPROVED: DRAWN BY: 4~101 CALLOWAY DRIVE SITE PLAN DATE: 8/5/03 JOB NO.: 77EL.32636.43.0520 E C O R B ERFIELD, CALIFORNIA 3017 KILGORE ROAD, SUITE 100 CAD FILE: SITE PLAN.DWG RANCHO CORDOVA, CA 95670 SECOR TABLE TABLE 1 Dispenser Soil Sample Analytical Results 7~Eleven Store #32241 4101 Calloway Drive Bakersfield, California Sample Ethyl Sample Date Depth Benzene Toluene Benzene Xylenes TPHg MtBE Notes I.D. Sampled (ft bgs) (mg/kg) (mg/kg) (mg/kg) (mg/kg) (mg/kg) (mg/kg) Dispenser Samples D1-4.0' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 D2-4.0' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 D3-4.0' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 D4-4.0' 07/25/03 4.0 <0.0050 <0.0050 <0.0050 <0.0050 <1.0 <0.0050 Explanation: BTEX, TPHg and MtBE via 8260B TPHg = Total petroleum hydrocarbons-as-gasoline ft bgs = Feet below ground surface MtBE = Methyl-tert-butyl ether rog/kg = milligrams per kilogram or parts-per-million < = Not detected above laboratory reporting limit 7-Eleven Store #32241\32241 Line Upgrade Soil Table.xls Page 1 of 1 ATTACHMENT A FIELD NOTES Fuel Line Upgrade Soil Report 7-Eleven Store Number 32241 4101 Calloway Drive Bakersfield, California SECOR Project No.: 77EL.32241.43.0520 JOB NAME: 7-Eleven Store #32241 JOB NUMBER: 77EL.32241.43.0806 CONTACT: Ed Foster (Glacier Environmental) DATE PREPARED: 07/24/03 ADDRESS: 4101 Callowa¥ Drive OVER SITE BY: Barr~ Miller Bakersfield, CA DATE: 07/25/03 "After arriving on-site, review work order and SSP, then call Jaff Auchterlonie in Sacramento" 1) Check in with Glacier Environmental, Ed Foster Cell ph - (2061 396-5466. 2) Review Site Health & Safety Plan, address site hazards. Note potential hazards in field notes below. Please note quantity of drums on-site (if any) and what type of lid in the drum inventor~ section. Are there any outlets outside this store? Where are they located? Please note in field notes. 3) Bakersfield City Fire Marshall (Steven Underwood) will be your inspector. He will be meeting you on-site at 7 am. He has quite a few inspections on Friday. Steven's phone number (661) 326-3979. Make sure you have the inspector's card and email address. This way the analytical results could be sent them as soon as it is received. Please verify which analyses they would like us to run. 5) There is not an existing site plan. Please add the following: Include: the store buildihg, USTs (dimensions and gallonagel, dispensers, any visible product lines/piping, canopy, stockpiles and sample locations. Add any tank pit observation wells, utilities (overhead/under~lround), storm drains, asphalt areas? Please note any adjacent businesses. If residences close-by, note addresses. 6) Take a roll of photos sh(~wing the site (N,E, S, W), cross street, sample locations, any utilities, potential hazards, noteable items..etc. 7) Record sample location in field notes and on your site map. Record sample name on map Refer to Jaff's table for naming sequences (attached). Lab # Samples Container TAT Analyses Soil Samples Kiff >6 Brass Sleeve Standard TPHg, BTEX and Oxys EPA 8260; Total Lead~ EPA 60fO) Lab Contact: Kiff Analytical Mr. Joel Kiff Phone: 530-297-4800 2795 2nd Street, Suite 300 FAX: 530-297-4802 Davis CA 95616 Please Contact sample receiving (ext. 125) to let them know what to expect. Especially on rush samples. 8) For each sample collected, measure PID readings at sample location. Record reading. 6)Call Jaff in Sacramento I~efore you leave the site. Cell (916) 825-4607 or (916) 861-0400 ext 223 -office Or Danielle at (916) 826-3778 7) Be sure to fax the COCs to Danielle and copy your field notes before mailing them. (Incase of questions) Mail originals of all notes and COC°s to Danielle Catlin-Wright in Sacramento. Health & Safety Site Plan Hand Auger, Impact Sampler, Post Hole digger and a shovel. Rolly Wheel, graph paper and a pencil (create &/or modify Fig) Brass Sleeves (6X2"), Caps, tephlon tape. Camera, film, zip locks & sharpie pens. FID or PID to measure soil headspace a'nd to monitor breathing zone. ZipIocks: sandwich size for PID readin~¢ & gallon to place samples in, then to cooler. COCs and one Cooler with Ice PPE: steel toe boots, hard hat, ear protection & gloves. 1/2"~ 9/16', and 15/16" sockets, and other misc. tools (plastic mallet is handy) Direct all ~luestions to Jaff (9167 825-4607 or (916) 861-0400 ext 223 -office PROJECT MANAGER, JAFF AUCHTERLONIE AUTHORIZATION ~,~/ ~ JOB NAME: 7-Eleven Store #322~" JOB NUMBER: 77EL.32241.43.0806 CONTACT: Ed Foster (Glacier Environmental) DATE PREPARED: 07/24/03 ADDRESS: 4101 Calloway Drive OVER SITE BY: Barry Miller Bakersfield, CA DATE: 07/25/03 SITE VISITATION REPORT Arrival Time: (__~('13 ~ ~ Departure Time:~,~, '~ ~ DRUM INVENTORY WATER CARBON TOTAL OPEN TOP SOIL EMPTY TOTAL BUNG TOP HEALTH AND SAFETY ASSESSMENT DESCRIPTION OF ACTIVITIES ONSITE AND NOTES / JOB NAME: 7-Eleven Store #32241- JOB NUMBER: 77EL.32241.43.0806 CONTACT: Ed Foster {Glacier Environmental) DATE PREPARED: 07/24/03 ADDRESS: 4101 Calloway Drive OVER SITE BY: Barry Miller Bakersfield, CA DATE: 07/25/03 DESCRIPTION OF ACTIVITIES ON SITE AND NOTES (cont) Field Work Conducted By: Barn/Miller Date: Jul)/25, 2003 -F/CRT- ~ z4J/~_ ~ )^ ~A~-- T~ ~-~---~(L,.-i-/~-5-~_//_. ,. SECOI NAM CALCULATED BY. DATE CHECKED BY. DATE International Incorporated L~k5I SHEET OF ..; {::'~:~'i;:'~'5'~,55~'~~5~~(:~.->~ ========================= ::,5::-7 ".' ::.'.'? '.':-...'.' :: :.': '::?: ':':~ ?~'::.?:::::~:,:"":~-~.~ :?~:, :~' ~' : ',:-'.~:,'~,-:'~',,.~:_.~-.?'-~-' .,. ~: ,'~.:': :': :: :: ....... ~.". ' .:'..- ':-:5..:". ~:' "' '.~- ;.o" :'~;,:'~; ' '~'i~~¢ .... :'~ ~;~: ;7 '"' '~:5'. ~;~'" " ~ h"' ' .-. ' -.. .. .,,'.; , .' ,, ':;~ :~:~i~;~".~'~-~ '?.'?~l~:~:l'~i~.~?..,'~*~ ?.:?: ?.~'.':.~ ~.~'~:: )~:~ '-.:~':'5 .;~:::,;~ ?.~-~: ~::, ~:~ ~. ':5: ~'~ ,': '.: ~:::':, '5':~: :. t.~¥ 5.' :.;~. ' :' '?'"~'::"~:':<'".,,Sam. ~ "~'"~":?;<:~":'~'ers~..~ gna~ure.."'?~:':z~'~:~:" .~:':'~":?: ':: ....... "' ='''', ....." ': ...' "' .... ,.~": .'~:.:~,; ": ;.,x~: ~'m "e ;.~.-'"~' '~"'<, ~:" :'-=~: = m: ,. ~ ...... = '=:" ~"~'?,~ "--o= ~ '*~" ' ":~ '-.~ ': ~*'.-' .... ' t~.' ' ~..: :' ":~ ,.,~v..~ .. ........ ,..;..~: ........ .5~ . . ::' : ','::":7'. ........ ,?, ..... ,~,. ~,~'..~ .~.:,o:~,5~.~,~'~-E,~: ~m~:~ ~o~. :~: ~ :?5:L ~.:: ~?~le:~.~D,:~ :,t:?-~ ...y~:: .~ .: Date,.i ,.~:T~me~:.~, Mat~ .~:= :m.. ?~; ~ ~ ~....~.~.~ ?~ m.~ -. ,;,. : · ,~ ~~ ~ ~ :::'~i~i~ ~!i~e~i~n~'~i~~~ ~':j.~ ~?~t;. :;:i~z~.~ :~:~:,:~:??~:~/?.'t~:,;:.-t. ~: :5:: :;L.~F..). '[:' 0~mJe~ Date. ~,~;~' :.~i~'e, :'. -.::;' ,. :: :, D~t~':L:'~ ~{~:: ~.: ~~..:.....:.: ",: .~ ~~~?~?~.. ~';. ~ ::b-::5"~.~ ~:;O'~fi~:: :~:'%.::,"~'-': ';~'. ~'. '-'..':'::"....:7:' :;- SECOR ATTACHMENT B CERTIFIED ANALYTICAL REPORTS AND CHAIN-OF- CUSTODY DOCUMENTATION Fuel Line Upgrade Soil Report 7-Eleven Store Number 32241 4101 Calloway Drive Bakersfield, California SECOR Project No.: 77EL.32241.43.0520 J~FF Report Number: 34259 Date · 8/1/2003 ANALYTICAL u.c Jaff Auchterlonie SECOR International, Inc. 3017 Kilgore Road, Suite 100 Rancho Cordova, CA 95670 Subject: 4 Soil Samples Project Name · 7-ELEVEN STORE #32241 Project Number · 77EL.32241.43 Dear Mr. Auchterlonie, Chemical analysis of the samples referenced above has been completed. Summaries Of the data are contained on the following pages. Sample(s) were received under documented chain-of-custody. US EPA protocols for sample storage and preservation were followed. Kiff Analytical is certified by the State of California (# 2236). If you have any questions regarding procedures or results, please call me at 530-297-4800. Sincerely, 2795 2nd St., Suite 300 Davis, CA 95616 530-297-4800 Date · 8/1/2003 ANALYTICAl. Project Name' 7-ELEVEN STORE #32241 Project Number' 77EL.32241.43 Sample: D1-4 Matrix: Soil Lab Number: 34259-01 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7~30~2003 TPH as Gasoline < 1,0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 96.2 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 96.9 % Recovery EPA 8260B 7/30/2003 Sample: D2-4 Matrix: Soil Lab Number: 34259-02 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Metlsod Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 97.1 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 97.4 % Recovery EPA 8260B 7/30/2003 2795 2nd St., Suite 300 Davis, CA 95616 530-29~?~800 ~'~Fr Report Number: 34259 Date · 8/1/2003 .ANAL YTICAL /./.c Project Name' 7-ELEVEN STORE #32241 Project Number' 77EL.32241.43 Sample: D3-4 Matrix: Soil Lab Number: 34259-03 Sample Date :7/25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 98.0 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 96.4 % Recovery EPA 8260B 7/30/2003 Sample: D4-4 Matrix: Soil Lab Number: 34259-04 Sample Date :7/25/2003 Method Measured Reporting Analysis Date ' Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Total Xylenes < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 8260B 7/30/2003 Toluene - d8 (Surr) 98.2 % Recovery EPA 8260B 7/30/2003 4-Bromofluorobenzene (Surr) 95.3 % Recovery EPA 8260B 7/30/2003 Approved By: J~'".e,I Kiff 2795 2nd St., Suite 300 Davis, CA 95616 530-29~800 Report Number: 34259 QC Report: Method Blank Data Date: 8/1/2003 Project Name: 7-ELEVEN STORE #32241 · ' Project Number: 77EL,32241.43 Method Method Measured Reporting Analysis Date Measured Reporting Analysis Date Parameter Value Limit Units Method Analyzed Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 713112003 Toluene < 0.0050 0.0050 rag/Kg EPA8260B 713112003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 713112003 Total Xylenes < 0.0050 0.0050 rog/Kg EPA 8260B 713112003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 rog/Kg EPA 8260B 7/31/2003 TPH as Gasoline < 1.0 1.0 rog/Kg EPA 8260B 7/31/2003 Toluene- d8 (Surf) 97.7 % EPA 8260B 7/31/2003 4-Bromofluorobenzene (Sun') 100 % EPA 8260B 713112003 Approved By: J~,' Ki" KIFF ANALYTICAL, LLC 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 Report Number' 34259 QC Report: Matrix Spike/Matrix Spike Duplicate Date ' 8/1/2003 Project Name- 7-ELEVEN STORE#32241 Project Number- 77EL.32241.43 ~DuD, lic,ate Spiked ~Du,plic,ate Spiked ~p~Kea -,. Sample Relative Spike Spiked ~p~(ea Sample Sample IRe~ative Percent Percent Spiked Sample Spike Dup. Sample Sample Analysis Date Percent Percent Percent Recov. Diff. Parameter Sample Value Level Level Value Value Units Metl~od Analy[~d Recpv. Recov. Diff. Limit Limit Benzene 34260-01 <0.0050 0.0387 0.0400 0.0367 0.0380 mg/Kg EPA 8260B 7/31/03 94.9 95.0 0.105 70-130 25 Toluene 34260-01 <0.0050 0.0387 0.0400 0.0370 0.0380 mg/Kg EPA 8260B 7/31/03 95.6 95.1 0.524 70-130 25 Tert-Butanol 34260-01 <0.0050 0.193 0.200 0.170 0.177 mg/Kg EPA 8260B 7/31/03 87.7 88.6 1.05 70-130 25 Methyl-t-Butyl Ether34260-01 <0.0050 0.0387 0.0400 0.0374 0.0392 mg/Kg EPA 8260B 7/31/03 96.6 98.0 1.39 70-130 25 Approved By: J~l Kiff KIFF ANALYTICAL, LLC ~ ~ 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 ~ Report Number' 34259 QC Report: Laboratory Control Sample (LCS) Date * 8/1/2003 Project Name- 7-ELEVEN STORE #32241 Project Number' 77EL.32241.43 LCS LCS Percent Spike Analysis Date Percent Recov. Parameter Level Units Meffiod Analyzed Recov. Limit Benzene 0.0396 mg/Kg EPA 8260B 7/31/03 94.2 70-130 Toluene 0.0396 rog/Kg EPA 8260B 7/31/03 94.3 70-130 Tert-Butanol 0.198 mg/Kg EPA 8260B 7/31/03 90.2 70-130 Methyl-t-Butyl Ether 0.0396 mg/Kg EPA 8260B 7/31/03 96.6 70-130 KIFF ANALYTICAL, LLC Approved By: ~el Ki 2795 2nd St, Suite 300 Davis, CA 95616 530-297-4800 ~,J Chain-of Custody Number: SECOR Chain-of Custody Record Field Office: ~ _.~,~'A- jt4.~"J~T~ [] Additional documents am affached, and am a pa~ of this Record. Address: ~~ Job Name: ~--~~ ,, __ L~ation: ~ Analysis Request Proj~t ~ .~ ~[,~ Task ~~ Project Manag~r~A~-~ ~ ~~ Turnaround Tim; ~E~ ~ =' ~1~ '~ Sampler s Name ~ ~ ~ ~ ~ ~ g o ~ Sampler'sSignatum~ a ~ ~ ~ ~ ~'~ - -{ ~ ~mment~ =E ~mple ID Dae Time Matrix ~ ~ o ~ ~ 3 ~ z ~ m ~ Instructions Special Instmction~Comments: Reli~ b~ Received by:~ Sample R~eipt ~L ~~ ~ ~~e~e~ Sign ~ Sign Total no. of containe~: ~. ~ Print --~~ ~;~ PHnt ~~ Chain of cust~y seals: Company ~ - ~~ Rec'd in good conditio~cold: ~ ~~ ~: T?e ~~ate~~'., Date Confo~s to ~o~: ~~ ~~~,~ Relinquish~by: ~ R~eiv~b~' Client: / uS,~ ~~ /~'~ ~eZ~'~ Company ~ Ti~ Date Time ~ql~_ Oate~ Client Ph°ne'~)~/'d'~. SE~R ~EC R~, ~ Date: .. 7-11 32241 4101CALLOWAY DR BAKERSFIELD,CA 93312 B0384118305001 MAY 11, 2004 11:05 AM SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL INVENTORY REPORT T I:RUL VOLUME = 3615 GALS ULLAGE = 6418 GALS 90~ ULLAGE= 5410 GALS TO VOLUME = 3593 GALS HEIGHT = 37.39 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 70.0 DEG F T 2:MUL VOLUME = 4087 GALS ULLAGE = 5941 GALS 90~ ULLAGE= 4938 GALS TC VOLUME = 4056 GALS HEIGHT = 41.01 INCHES WATER VOL = 0 GALS WATER = O.OO INCHES TEMP = 72.4 DEG F T 3:SUL VOLUME = 4383 GALS ULLAGE = 5645 GALS 90~ ULLAGE= 4642 GALS TO VOLUME = 4351 GALS HEIGHT = 43.25 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 72.2 DEG F ~ ~ ~ ~ Bakersfield Fire Dept. ECTiON Enironmental Services UNIFIED PROGRAM IN ~ CHECKLIST ~=~ ~.~,~'~'~:~~~ 1715 Chester Ave SECTION I Business Plan and Inventory Program ] Bakersfield, CA 93301 Tel: (66])326-3979 FACILITY NAME __ ' INSPE~:TIO~I DATE INSPECTION TIME ADDRESS PHONE No. No. of Employees FAC~UTYCO~5~-- ........................... ! ...................................................................... .~si~es--~ ~-0~m--~ ! 5-021 - ~ Routine ombined L'3 Joint Agency I~ Multi-Agency I~ Complaint I~! Re-inspection C V ~' C=Compliance ~ OPERATION COMMENTS ~, v=violation '~ [~ APPROPRIATE PERMIT ON HAND ~ [~ BUSINESS PLAN CONTACT INFORMATION ACCURATE ~ ~ VISIBLE ADDRESS - ~ VERIFICATION OF QUANTITIES ~ [~ VERIFICATION OF LOCATION [.,_ PROPER SEGRE_GAT_ION OF MATERIAL k-~' ~ VERIFICATION OF MSDS AVAILABILITYE ,1~ ~ VERIFICATION OF ,~'MAT TRAINING ~ ~ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ ~ EMERGENCY PROCEDURES ADEQUATE ~ CONTAINERS PROPERLY LABELED ~. [~ HOUSEKEEPING ANY HAZARDOUS WASTE ON SITE?: ~ YES /I;~l-No EXPLAIN: QUESTIONS R,~ARDI~ THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 "---~~"[/~!(~'-~ ..... ~-~ -~ ~o~-Y~ ~i~-o~ iT~ ............. ~~~ White - Environmental Se~i~s Yellow - ~ation Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 Section 2: Underground Storage Tanks Program [~l Routine Ii'Combined [21 Joint Agency ~ Multi-Agency 1~ Complaint [~21 Re-inspection ~ Type of ~ank~ -Di_A) ~ O.~ Number of Tanks "~ Type of Monitoring ~. I... ~ Type of Piping ~ ~ ? OPERATION C V COMMENTS Proper tank data on file Proper ow,~er/operator data on tile Permit tees current Certification of Financial Responsibility ~. Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO -"'~usiness Sit~ Responsible Party Omce oe ;henna/ie;vi, s(jS6 )06-3979 While - Env. Svcs. Pink - Business Copy ~ /04/22/2004 14:05 661392~1 PAGE 01/01 *COPY REQU]~STED PLEASE FAX ( 56.t ) 392-0621 'CITY OF BAKERSFIELD OFFICE' OF ENVIRONMENTAL SERVICES 1715 Chester'Age., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION NAME OFT~$TINO COMPANY R~C~ ~VZ_~0NMZ~;~L . N~ &'PHO~ ~~.OP CO.ACT P~SON_ JAMES ._R.!CB __ ~(_66.1.) 39_2-8687 ,. , MRR 08 2004 15:18 BKSFL]] FIRE PREVE~ITIOrt (661)852-2172 p.2 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING/TRACER TESTING FACILITY 7-{l ~ ~ZZ~ ADDRESS %1Ol C.4u_o.,,VA,/ c>o-- - %~_e~$r~ ,~ ,c~ PERMIT TO OPERATE ~. OPERATORS NAME "7-~ I OWN~S ~AM~ ~-~} NUMBER OF TANKS TO BE TESTED ~ .__ IS PIPING C~INO TO BP. TESTED V TANK # VOLUME CONTENTS I IbP 08/06/2003 09:10 91E,06 0 SECOR PAGE 82/88 Report Number: 34259 Date: 811/2003 ~ ANALY7'ICAi- Jaff Auchtedonie SECOR IntamaUonel, 3017 Kilgom Road, Suite 100 Rancho Cordova, CA 95670 Subject: 4 Soil Samples Prelect Name' 7-ELEVEN STORE #32241 Project Number: 77EL.32241.43 Dear Mr. Auchterlonle, Chemical analysis of the samples referenced above has been completed. Summaries of the data are contained on the following pages, Sample(e) were received under ciocumented chain-of-custody. US EPA protocols for sample storage and preservation were followed. Kiff Analytical Is certified by the State of Califomia (# 2236). If you have any questions regarding procedures or results, please call me at 530-297-4800. Sincerely, 2796 2nd St., Suite 300 Davis, CA 95616 530-297-4800 08/06/2003 09:18 91686 0 SEOOR PAGE 03/08 J~FF Report Number : 34259 Date; 8/1/2003 I ANAL YTICAL .Lc Project Name: 7-ELEVEN STORE f~32241 Project Number: 77EL32241.43 Sample: D¶-4 Matrix: Soil Lab Number: 34259-01 Sample Date .~i25/2003 Method Measured Reporting Analysis Date Parameter Value Limit Units Methyl Analyzed Benzene < 0.0050 0.0050 rog/Kg EPA 8260B 7~30~2003 Toluene < 0.0050 0.0050 rog/Kg EPA 8260B 7t3012003 Ethylhenzene < 0.0050 0.0050 mglKg EPA 8260B 7130/2003 Total Xylene~ < 0.0050 0.0050 mglKg EPA 8260B 7/30/2003 Methyld~butyi e~er (MTBE) < 0.0050 0.0050 mg/Kg EPA 8260B 7t30/2003 TPH as Gasoline < 1.0 1.0 mglKg EPA 8260B 7/30/2003 Toluene - d8 ($urr) 98.2 % Recovery EPA 8260B 7/30/2003 4-Bmmofluorobenzene (Sun-) 96.9 % Recovery EPA a260B 7130/2003 Sample: D2-4 Matrix: Soil Lab Number: 34259-02 Sample Date :7/2512003 Method Measured .R, ap.orUng Analysl.$ Date Parameter Value Limit Units Method Analyzed Benzene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Toluene < 0.0060 0.0050 rog/Kg EPA 8260B 7/30/2003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 7/30/2003 Total Xylenes ¢ 0.00S0 0.0050 mglKg EPA 8260B 7130/2003 Methyl-t-butyl ether (MTBE) < 0.0OS0 0.0050 mg/Kg EPA 8260B 7t30/2003 TPH ae Gasoline < 1.0 t .0 mg/Kg EPA 8260B 7/3012003 Toluene - ct8 (Sun-) 97.1 % Recovery EPA 8250B 7~30~2003 4-Bromofluorobenzene (SUIT) 97.4 % Recovery EPA 8250B 7~30~2003 27g$ 2nd St., Suite 300 Davis. CA gS&'l& ,~0-2g~,-~800 08/06/2809 09:18 9168E SEOOR PAGE 04/08 ~F~i~ RaportNumber: 34259 Date: 8tl/2003 I ANALYTICAL L .c Project Name: 7'ELEVEN STORE ~2241 Project Number: 77EL,32241.43 Sample: D3-4 Matrix: Soil Lab Number: 34259-03 Sample Date :7/25/200G Method Measured Rep. orting Analysis Date Parameter Value Limit Units Method Analyzed Benzene ¢ 0.0050 0.0050' mgJKg EPA 8260B 7~30~2003 Toluene < 0.0050 0.0050 mg/Kg EPA 8260B 7/30/2003 Eth¥1ber~ene < 0.0050 0.0050 mg/Kg EPA 8260B 7130/2003 Total Xylenes ¢ 0.0050 0.0050 rog/Kg EPA 8260B 7t3012003 Methyl-~tyt ether (MTBE) < 0.0060 0.0050 mg/Kg EPA 8260B ?130/2003 TPH as Gasoline < 1.0 1.0 rog/Kg EPA 8260B 7130/2003 Toluene - d8 (Surf) 98.0 % Recovery EPA 8260B 7130/2003 4,-Bromofluorobenzene (Surf) 96.4 % Recovery EPA 8260Et 7130/2003 Sample: D4-4 Matrix: Soil Lab Number; 34259-04 Sample Date :7/25/2003 Melhod Measured .R.e~orting Analysis Date Parameter Value Lim~[ Units Me, od Analyz__~__ Benzene < 0.0050 0.0050 mglKg EPA 8260B 7130/2003 Toluene < 0.0DS0 0.0050 mg/Kg EPA 8260B 7/3012003 Ethylbenzene < 0.0050 0.0050 rog/Kg EPA 8260B 7/30/2003 Total Xylenes < 0,00S0 0.0050 mg/Kg ' EPA 8260B 713012003 Methyl-t-butyl ether (MTBE) < 0.0050 0.0050 rog/Kg EPA 8260B 7/3012003 TPH as Gasoline < 1.0 1.0 mg/Kg EPA 82.60B 7/3012003 Toluene - d8 (Surf) 98.2 % Recovery EPA 8260B 7/3012003 4.Bromofluorobenzene (Sun') 95.3 % Recovery EPA 8260B 7/30/2003 Approved By: J~, 2795 2nd St., Suite 300 Davis, CA 95616 Report Number: 34259 QC Report: Method Blank Data Date: 8/~1120D3 Project Name' 7-ELEVEN STORE #32241 Project Number' 77EL.32241.43 Method Mel~ed ~e~ured R.l~tinll Anal),.Is Date Measured Reper'd~ Analy~ts Date ParamM~r ~-~1~ ,~, ~ I.Mils Me~od A~alyzed Pa~mll~r Vplue L/mit Units Meli~od ~,nafv'ze~ Ber, zene < RDD50 0.0050 m~Kg EPA 82509 7/3t/2003 cO To,erie < 0.0050 O. OOSO rr~Kg EPA 82E~B 7.'31/2003 Total Xylenes < O.0OSO O. OOSO rog/Kg EPA82.~B ?,'~1~2'003 Cn Meth~-t-bu~)l ettm (MI~E) ¢O.0~O o.aaao mg~lql EPA8260B 7t$1~Z003 TPH a~ Oasel~.e < 1.0 1.O m~ EPA ~6DB 7~1~0~ Toluene- ~8 (~ 97.7 ~ EPA 826~B 7~1~0~ ~emben~ (~u~ 100 ~ ~A 828flB ~) 0 m Approved By: J~,~l KIFF ANALYTICAL, LLC 2795 2nd St, Sure 3~ Dav~ CA 95616 53~2974800 m Report Number: 34259 CIC Report: Matrix Spike/Matrix Spit(e Duplh;ate Date: 8/1/2003 Project Name- 7-ELEVEN STORE #32241 Project Number' 77EL.32241.43 _Du ,plic.ate _Spike.d _Dup, lic~ate S_pike.d ~piKe~. ,. ~ample Relative S_pike S_pike~. ~plKe~. ~amp~ ~amp~e _RelafivePercent Pement _Spike~. Sample Spike- pup.. .~.a.mple ~ample Analysis Date Percent i~ercent Percent Recov. Diff. Parameter ~ampme Value Level Level va~ue Value Units Metl'iod A~lYzedR~6v. RecOV. D[tf. Limit Limit Benzene 34260-01 <0.0050 0.0387 0.0400 0.0367 0.0380 mg/K~ EPA 8260B 7/31J03 94.9 95,0 0.105 70-130 25 Toluene 34260-01 <0.0050 0.0387 0.0400 0.0370 0.0380 mg/Kg EPA 6260B 7t31103 95.6 95.1 0.524 70-130 25 Tert-B~anol 34260-01 <0.0050 0.193 0.200 0.170 0.177 roG/Kg EPA8260B 7/31/03 87.7 88.6 1.05 70-130 25 Methyl-t-Butyl Ether34260-01 <0.0050 0.0387 0.0400 0,0374 0.0392 mg~Kg EPA8260B 7/31103 96,6 98.0 1.39 70-130 25 ~) 0 m App,ov.d K[FF ANALYTICAL, LLC 2~5 2nd St, Su~ 300 Devis, CA 95616 53~2fl7~800 Report Number' 34259 OC Report: Labom~,ory Control Sample (LCS) Date: 6/1/2003 (JO Project Name: 7-ELEVEN STORE #32241 UD Project Nuntber- 77EL.32241.43 LCS LOS Percent .Spike. Analysis Date Percent Reeov. Parameter Level Units MethOd Analyzed Recov. Limit Benzene 0.03~6 mg,~g EPA 6250B 7131/03 9,t.2 70-130 Toluene 0.0396 rng/Kg EPA 8260B 7/31103 94.3 70-130 Tort-Butanol 0.198 rng/Kg EPA 8260B 7131103 90.2 70-130 Methyl-t-Butyl Ether 0.0396 n~tKg EPA 8260B 7131f03 96.6 70-130 0 K]FF ANN.YTICAL, LLC Approved By: i ~ ~ 2795 2ncl St, Suite 300 Dav~$, CA 95616 530-297-4800 m Chain-of Custody Number: Chain-of C tod I:l ord Field Office: ~ ~R~'.4-~t~uT[r~ I~ AdditionaJ documents are attached, and me a part of thrs Record. Special Instructions/Comments: Rali~ by_', , ReceNed by:~~-~ Sample Print ~ Prrnt / Chain of custody seals ~' ~ Company. Compan~.~--~__ - -- Rec'ci lngood condilion/c~: 'Relinquished / [Flecalved~ Client: ~ Sign Ctient Conta~t:'~~~ prlnt-m~c~r u.~,~J ~,,~~ l,e.-& ,,~A~..,mzfoarso Time~']'i'.!7 '.. oa~~ ClientFhone:~&)~'~/-a~:) Time,"' Date_ , ~ro~- Date: ~ / 7-- ~' / O~ Pas...L. of Tanknology 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512)459-1459 Date Printed and Mailed: 09/05/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 08/12/2003 Order Number: 3130480 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment-Dispenser Pan\Sump Secondary Containment-Line Interstitial Secondary Containment-Spill Container Secondary Containment-Sumps\Under Dispenser Secondary Containment-Tank Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting TEST DATE:08/12/2003 WORK ORDER NO.: 3130480 CLIENT: ?-ELEVEN, INC. SITE: 7-ELEVEN #32241 20819 72ND AVE. SOUTH MARKET # 2133 SUITE 206 4101 CALLOWAY DRIVE KENT WA 98032 BAKERSFIELD CA 93312 P.~/~DY MARTIN 206-849-3685 Tank interstital Tests Piping Interstital Tests REG UNLEAD Total Containment PASS REG A Environ PASS MIDGRADE Total Containment PASS REG B Environ PASS PREMIUM Total Containment PASS PLUS A Environ PASS PLUS B Environ PASS PREM A Environ PASS PREM B Environ PASS Sum & Under-Di,, Containment Tests ........ '~ :?~ ' ii~::: ~¢:::' i~:~' ~ ....... ~::~'~: ~ :~ ~ ........ ~, 87 Total Containment Pass 87 Total Containment Pass 89 Total Containment Pass 89 Total Containment Pass 91 Total Containment Pass 91 Total Containment Pass 87 FILL OPW Pass 87 FILL OPW Pass 87 VAPOR OPW Pass 87 VAPOR OPW Pass 89 FILL OPW Pass 89 FILL OPW Pass 89 VAPOR OPW Pass 89 VAPOR OPW Pass 91 FILL OPW Pass 91 FILL OPW Pass 91 VAPOR OPW Pass 91 VAPOR OPW Pass 1/2 Environ Pass 1/2 Environ Pass ranknology representative: KEN MINTON Services conducted by: WILLIAM ROGERS SU l^.¥ ~, Tankno~ TEST DATE:08/z2/2003 WORK ORDER NO.: 3130480 CLIENT: 7-~, ZNC. SITE: 7-~L~ ~32241 20819 72~ AVE. SO~E ~ET ~ 2~33 SUITE 206 4[0~ C~LOWAY DRi~ ~ WA 98032 B~ERSFIE~ CA 933~2 ~Y ~TIN 206-849-3685 Sump & Under-Dispenser Containment Tests Continued 87 Total Con~inment Pass 87 Total Containment Pass 89 Total Containment Pass 89 To~l Containment Pass 91 To~l Containment Pass 91 To~l Containment Pass 87 FILL OPW Pass 87 FILL OPW Pass 87 OPW Pass 87 OPW Pass 89 FILL OPW Pass 89 FILL OPW Pass 89 OPW Pass 89 OPW Pass 91 FILL OPW Pass 91 FILL OPW Pass 91 OPW Pass 91 OPW Pass 1/2 Environ Pass 1/2 Environ Pass 3/4 Environ Pass 3/4 Environ Pass 5/6 Environ Pass 5/6 Environ Pass 7/8 Environ Pass 7/8 Environ Pass SECONDARY CONTAINMENT TEST RESULTS SITE NAME: 7-ELEVEN #32241 32241 08/12/2003 WORK ORDER 3130480 SITE ADDRESS: MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD CA 93312 REASON FOR TEST: SB-989 Installation IGroundwater Level(" from grade): TANK INFORMATION AND INTERSTITIAL TESTS I~p~h Start Initial Finish Final Pass/ Dia. Material Manufacturer e Test Method Tanl Product Tank Size (" ) " Time Level Time Result Fail 1 REG UNLEAD 10028 96 TOTAL CONT Total Containment Vacuum 10:25 -10 "Hg 11:25 -10 "Hg PASS 2 MIDGRADE 10028 96 TOTAL CONT Total Containment Vacuum 10:15 -10 "Hg 11:15 -10 "Hg PASS 3 PREMIUM 10028 96 TOTAL CONT Total Containment Vacuum 23:41 -10 "Hg 00:41 -9.3 "Hg PASS 4 5 6 7 8 Comments: LINE INFORMATION AND INTERSTITIAL TESTS Volume Start Initial Finish Final Pass/ Dia. Len. Matedal Manufacturer Test Method Tan~ Product (" ) (feet) (gallons) Time Level Time Result Fail 1 REG A 2.00 75 GEOFLEX Environ Pressure 9:29 5 psi 10:29 5 psi PASS P, EG B 2.00 75 GEOFLEX Environ Pressure 9:30 5 psi 10:30 5 psi PASS ;~LUS A 2.00 75 GEOFLEX Environ Pressure 9:25 5 psi 10:25 5 psi PASS ;~LUS B 2.00 75 GEOFLEX Environ Pressure 9:23 5 psi 10:23 5 psi PASS PREM A 2.00 75 GEOFLEX Environ Pressure 10:46 5 psi 11:46 5 psi PASS PREM B 2.00 75 I GEOFLEX Environ Pressure 9:27 5 psi 10:27 5 psi PASS 7 8 Comments: SECONDARY CONTAINMENT TEST RESULTS SUMP TESTS Type ITank °r Disp# I Manufacturer I Model or Material I Diam'A~'i(~th/Length I" DepthI( ,, ) Test Method I Time Start I InitialLevel I Change Level I Finish Time I Result Final I Pass/ Fail STP Sump 87 Total Containment Plastic 48 45 VPLT 12:28 16 -.00001 12:44 -.013 Pass STP Sump 87 Total Containment Plastic 48 45 VPLT 12:49 16 -.00000 1:04 -.006 Pass STP Sump 89 Total Containment Plastic 48 43 VPLT 12:50 18 .00015 1:05 -.003 Pass STP Sump 89 Total Containment Plastic 48 43 VPLT 1:16 18 .00002 1:32 -.007 Pass STP Sump 91 Total Containment Plastic 48 45 VPLT 12:30 16 -.00092 12:46 .046 Pass STP Sump 91 Total Containment Plastic 48 45 VPLT 12:51 16 -.00036 1:06 .016 Pass Spill Container 87 FILL OPW Plastic 11 11 VPLT 12:31 5 -.00002 12:47 .001 Pass Spill Container 87 FILL OPW Plastic 11 11 VPLT 12:52 5 -,00012 1:07 .001 Pass Spill Container 87 VAPOR OPW Plastic 11 11 VPLT . 1:15 6 -.00002 1:31 .000 Pass Spill Container 87 VAPOR OPW Plastic 11 11 VPLT 1:34 6 .00001 1:48 .000 Pass Spill Container 89 FILL OPW Plastic 11 11 VPLT 2:08 5 -.00096 2:23 .002 Pass Spill Container 89 FILL OPW Plastic 11 11 VPLT 2:26 5 -,00128 2:42 .002 Pass Spill Container 89 VAPOR OPW Plastic 11 11 VPLT 1:18 5 ,00001 1:34 .000 Pass Spill Container 89 VAPOR OPW Plastic 11 11 VPLT 1:35 5 -.00017 1:49 .001 Pass Spill Container 91 FILL OPW Plastic 11 11 VPLT 2:07 5 .00002 2:22 .001 Pass Spill Container 91 FILL OPW Plastic 11 11 VPLT 2:25 5 -.00001 2:40 .000 Pass Spill Container 91 VAPOR OPW Plastic 11 11 VPLT 2:09 6 -.00005 2:24 -.000 Pass Spill Container 91 VAPOR OPW Plastic 11 11 VPLT 2:27 6 -.00038 2:43 .000 Pass Dispenser Sump 1/2 Environ Plastic 23 X 44 30 VPLT 10:38 11 .00006 10:54 -.006 Pass Dispenser Sump 1/2 Environ Plastic 23 X 44 30 VPLT 11:01 11 .00002 11:16 -.003 Pass Dispenser Sump 3/4 Environ Plastic 23 X 44 30 VPLT 10;40 15 .00006 10:56 -.003 Pass Dispenser Sump 3/4 Environ Plastic 23 × 44 30 VPLT 11:02 15 -.00166 11:17 .040 Pass Dispenser Sump 5/6 Environ Plastic 23 X 44 30 VPLT 10:43 13 -.00005 10:59 -.002 Pass Dispenser Sump 5/6 Environ Plastic 23 X 44 30 VPLT 11:03 13 -.00005 11:18 -.002 Pass Dispenser Sump 7/8 Environ Plastic 23 X 44 30 VPLT 10:45 16 .00001 11:00 -.005 Pass Dispenser Sump 7/8 Environ Plastic 23 X 44 30 VPLT 11:04 16 -.00001 11:19 -.002 Pass Comments: Work Order: 3130480 3. SUMMARy OF TEST RESULTS ~poaeni ~ Fail[ Com~ T~cim's Si~: S~ ~ 2~1 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ,Work Older: 3:1.30480 Me~g Eq~t'U~ f~ T~ SWRCB Decembe~ 2001 Tmflcnology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 .Work Order: 3130480 M~a.~g Eq~ U~d f~ T~E; ~ of~g ~; - · ........ ~ ~ ~t4' , .............. W~it ~e ~e~ ~ly~g Comments - (include infor~on One. irs m~e prior sw~te_~ t~rat~2~ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ,Work Order: 31.30480 ,~p~ ......... ~ . ~ ~~: ,,, ~X .... . He~t ~m T~ Top ~w~t ~p ~d~ e~r~t Commen~- ~ind~e i~o~aon on repair~ ~e prior to t~t~ ~ If the t~sting m~hod docs not test the cflti~ d~ of ~e ~p, ~ci~ how mu~ of ~e ~p w~ t~ M~ nm t~ ~ ~t~ s~p ~td ~ ~ ~ed if~e mo~or~g ~ ~d~ ~e ~ shu~owm : Wi~ ~e ~bm~ible ~p :~, p~ ~e s~r ~ ~ct (~~ ~ ~ ~ be p~d ~ ~er). ~e ~e c~t ~g m~ us~ d~s not ~[t &o ~ volvo of,~o ~ S~CB ~ 2~1 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ~Work O/der: 3130480 -T~ Method ~s~l~ ........ Pre.ute V~u~ Hy~os~gc ........ ............ ~ ~ t~ ~ ~ :H~ ~om ~'gOUom ~ T~ ~ of~ ~to po~~ Of~GT~ ~ ~l~ ~] ~ ~ ~r ~liq~' Yes No, Y~ No ~' Y~ N0 y~ NO ~on,?' Yes No ~ Y~ No ~ Y~ No ~ Y, NO ~ ~ ~t P~ail ~ld or Co~ - (include ~f~atio~ qn,,~aim m~e p~or to ~g, ~ ~ ~r~ t~) Ta]xknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Orfler: 3130480 SpiWOv~rfill Conta/mn~t,BOxes are Present, but w~'~ot T~st~J ................. Test Method Developed By: Spill Bucket Maaufact~w~ Industry Standard Professional Engineer Other Test MethodUs~t: Pressure Vaout~ Hydrostatic O thor Test Equipment Us _ell: F4uipment Rcs°iuti~n: wa/t time between .... applying Cilia: Comments-(in~e,t~or~aon on ~ mapper ~,t~a~, ~ r~~ foU~ for f~ t~) __ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Offier: 3130480 ~S,p!ll/Overfill C~ent Boxes are Present, but"~ Not Tes~ Test M~aod D~,~elo.t~l By: Spill Bu~ltet Manuf~t,~r Industry Standard pfofe~o~'Engin~ Oth~, Test Method Used: Pre~xe Vacuum Hydrosta~e Oth~ rs~,m~) ......... Bucket Diameter:. Bucket Depth: , Wait time between applying ~d startS, g tes~ Test Start Time: ........ 2,0-} g!~ g:~? ~ :~2 '7. ....................... Initial Reading (PO: Final Readiag OR,): ......... Chanse ia Reading Pass/Fail Threshold or Criteria: ' ~ . c,e, xoo ~k oo~oo u Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:0 8 / 12 / 0 3 WORK ORDER NUMBER33.3 0 4 8 0 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32241 COMMENTS Performed post construction SB 989 testing on all components. The 91 tank annular took 6 additional hours to pull down the vacuum to achieve passing results per Bakersfield FD protocol. Testing witnessed by Steve Underwood of Bakersfield FD. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) ,...~:', ~ ..... ~;,~,~ : : ,' ~,~ ~: ~-~, :~:: :::: HELIUM PINPOINT L~EST RESULTS Printed 09/05/2003 09:00 KOHLMEYER SITE DIAGRAM 8900 SHOAl_ GREEK, BUll_DING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 08/12/03 WORK ORDER NUMBER3130480 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #32241 W~ ~ VENTS E ~-- _O~cO 0 0 ~ PLUS SUP UL Printed 09/05/2003 09:00 KOHLMEYER Tanknology 8900 Shoal Creek Bird, Building 200 Austin, Texas 787§7 Phone: (512) 451-6334 Fax: (512)459-145g Date Printed and Mailed: 08/27/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 08/02/2003 Order Number: 3130347 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment Tank Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting SB 989 RY RESULTS TEST DATE: 08/02/.2003 WORK ORDER NO.: 3130347 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 20819 72ND AVE. SOUTH MARKET # 2133 SUITE 206 4101 CALLOWAY DRIVE KENT WA 98032 BAKERSFIELD CA 93312 RANDY MARTIN 206-849-3685 Tank Interstital Tests REG UNLEAD MIDGRADE PREMIUM Total Containment PASS Piping Interstital Tests I sump & Under-Dispenser Containment Tests Tenknolo~y representetive: Se~ices conducted by: KEN ~INTON DAVID SECONDARY CONTAINMENT TEST RESULTS NAME: 7-ELEVEN #32241 32241 08/02/2003 WORK ORDER: 3130347 SITE ADDRESS: MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD CA 93312 REASON FOR TEST: SB-989 Re-Test ]Groundwater Level(" from grade): TANK INFORMATION AND INTERSTITIAL TESTS [~e,p~ start Initial Finish Final Pass/ Dia. Matadal Manufacturer h Test Method Tank Product Tank Size (" ) Time Level Time Result Fail 1 REG UNLEAD 10028 96 i TOTAL CONT 2 MIDGRADE 10028 96 TOTAL CONT 3 PREMIUM 10028 96 TOTALCONT TotaIContainment 50 Vacuum 2113 -10.02 "Hg 2213 -8.74 "Hg PASS 4 5 6 7 8 Comments: FOUND WATER iN SECONDARY OF TANK. PUMPED OUT. LINE INFORMATION AND INTERSTITIAL TESTS Dia. Len. Volume Start Initial Finish Final Pass/ Tanl Product Matedal Manufacturer Test Method (" I (feet) (~lallons) Time Level Time Result Fail 1 2 3 4 5 6 7 8 Comments: 8900 SHOAL CREEK. BUILDING 200 AUSTIN. TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:0 8 / 0 2 / 0 3 WORK ORDER NUMBER3 ;13 0 3 4 ? CLIENT:7-ELEVEN, INC. SITE:"/-ELEVEN #32241 COMMENTS Performed re-test on 91 tank annular with passing results. Pulled tank down several times to discover water in secondary of tank. Pumped approx. 1" water from tank. Pulled vacuum again several times to get tank to stabalize at -10.02". Ran test and dropped to -8.74" which is OK per Bakersfield F.D. regs. DON LANT WAS ON SITE WITH ME. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 08/27/2003 08:40 KOHLMEYER SITE DIAGRAM 8~00 SHOAl_ GREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 08/02/03 WORK ORDER NUMBER3130347 CLIENT:7-]~LEVEN, IATC. SITE: 7-EL]~VEI~' #32241 W~ (~ VENTS E Cq' ~- ~" PLUS SUP UL Printed 08/27/2003 08:40 KOHLMEYER CITY OF BAI~FIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE Address q{~.) t tc~_,ttlotl.,'&~ Address City, Zip E&~ r~l ~ q~ City, Zip ~ q37oq Phone No. Pe~it, INSTRUCTIONS: Please call for an inspector only when each g~up of inspections with the same number a~ ~ady. They will mn in consecutive order beginning with number I. DO NOT cover work for any numbe~d group until all items in that group am si~ed offby the Pe~itting Authority. Following these instructions will reduce the number of ~qui~d inspection visits and theretb~ prevent assessment of additional fees. TANKSANDBACKFILL INSPECTION I DATE I INSPECTOR Backfill of Tank(s) Spark Test Ce~ification or Manuhctu~s Method Cathodic Protection of T~k(s) ~IPING SYSTEM Piping & Raceway w/C°llecti°n Sump ~l~t~O~ ~r~ ~t Co.sion Protection of Piping, Joints, Fill Pipe . Electheal Isolation of Piping From Tank(s) Cathodic Protection System-Piping Dispenser P~ ~ ~ ~ ~' S~CONDAR~ CO~AINME~, OVE~ILL PROTECTION, LEAK BETE~ION Liner l~stallatio~ - Tank(s) Liner Installation - Piping Vault With P~duct Compatible Sealer Level ~auges or Sensom, Float Vent Valves PFodNct Compatible Fill Box(es) P~duct Line Leak Detectors) Leak Detectors) For Annual Space-D.W. Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/G~undwater FINAL Monitoring Wells, Caps & Locks Fill Box Lock I Monitoring Requirements Typ~ Authorization for Fuel Drop CONTRACTOR &fn,tet F~Ot~fl~ LICENSE ~ ~qq 73g CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING O~RaTO~S Nam .~//w~8 U/~ C~ ow~ss~ ~-// /~6 ~ER OF TANKS TO BE ~D ~ ,, ISP2~GGO~GTOBE~~ ~ vo[m co s TANK TF_..3TINO COMPANY ,R~10~n.//,n~6" 7L~'7~/A/6 NA~ & PHO~ NUMBER OF CONTA~ PERSON ~ oF ~~ o~ sPec~ ~sP~O~ CERT~CATION #~~ APPRO~ BY DA~ Tanknology 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 06/05/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 05/30/2003 Order Number: 3129244 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Stage II A/L tests Stage II blockage tests Stage II pressure decay tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting CERTIFICATE OF STAGE II VAPOR RECOVERY TESTING 8000 SHOAl. CREEK. BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 0 5 / 3 0 ! 0 3 WORK ORDER NUMBER: 3 12 9 2 4 4 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 10220 S.W. GREENBURG ROAD MARKET # 2133 SUITE 470 4101 CALLOWAY DRIVE PORTLAND, OR 97223 BAKERSFIELD, CA 93312 ATTN: BOB DENINNO CONTACT: MANAGER UNLEADED emco 1/2 0.15 PASS UNLEADED emco 3/4 0.1% PAS S UNLEADED emco 5/6 0.15 PASS UNLEADED emco 7 / 8 0.07 PAS S PRESSURE DECAY TEST 10k i 2.00 1.98 1.98 1.97 1.96 1.96 1.92 12772 PASS passed gz:oas t. est. and system manifolded. Tanknology appreciates thc opportunity to sc~vc you, and looks toward to working with you in thc t'uturc. Please cai! any time, day or night, whc~ you nccd us. Tanknology representative: Test conducted by: CLIFF PORTER RICHMOND PHILLIPS Reviewed: Technician Certification Number:91-1071 i A/L VACUSMART Stage II Vapor Recovery Testing Results Facility Name: 7-ELEVEN #32241 Testing Using Facility Address: MARKET # 2133, BAKERSFIELD, CA. Hasstech Vacusmart Test Date: 05/30/2003 Alternative to TP-201.5 Test Unit S#: vs-0594 Work Order: 3129244 Testing Tech: Richmond Phillips Representative: Richie P. System Type: VAPORVAC Disp # Grade A/L GPM P/F Comments 1 87 0.95 6.05 P all nozzles emco 4505 1 91 0.92 9.14 P 1 89 0.93 9.23 P 2 87 1.04 6.39 P 2 91 1.00 7.80 P 2 89 1.02 8.20 P 3 87 1.04 6.44 P 3 91 1.02 8.80 P 3 89 1.02 8.88 P 4 87 0.96 6.57 P 4 91 0.99 8.80 P 4 89 0.99 9.05 P 5 87 1.04 8.97 P 5 91 1.00 9.05 P 5 89 1.01 8.7'2 P 6 87 0.98 7.50 P 6 91 1.01 9.05 P 6 89 0.99 9.14 P 7 87 0.99 8.87 P 7 91 1.04 9.05 P 7 89 1.05 9.05 P 8 87 0,96 7.80 P 8 91 . 0.98 8.42 P 8 89 0.99 7.86 P Page 1 Form 1 Source Test Results Static Leak Test Date: 05/30/2003 Time: 08:25 Application No. GDF Name and address: 32241 MARKET # 2133 Stage II system (check one): Vapor Balance [ ] Single Hose M.P.D. [ ] Vacuum Assist [X ] Type: VAPORVAC Stage I type (check one): Two point [ X ] Manifolded? Yes [ X ] Coaxial [ ] No [ ] Tank # 1 2 3 Product grade 87 89 91 Actual tank capacity (gallons) 10028 10028 10028 30084 Gasoline volume (gallons) 6006 5465 5841 17312 Ullage (gallons) 4022 4563 4187 12772 Initial pressure of UST, inches H20 2 2 Number of nozzles served by tank 8 8 Test location: (A) Stage I vapor coupler of (B) Stage II riser b b b b Initial Pressure, inches H20 (2.0) 2.00 Pressure after 1 min. (inches H20) 1.98 Pressure after 2 min. (inches H20) 1.98 Pressure after 3 min. (inches H20) 1.97 Pressure after 4 min. (inches H20) 1.96 Final Pressure after 5 min. (inches H20) 1.96 Allowable Final Pressure: Table lA, Table lB, Equations 9.1, 9.2 1.92 Test Status [Pass or Fail] Pass Tests Conducted By: RPHILLIPS Test Company: TANKNOLOGY Date of Tests: 05/30/2003 Tests Witnessed By: GENSII - Rev 8/7/2002 Work Order #: 3129244 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:0 5 / 3 0 / 0 3 WORK ORDER NUMBEI~ 12 9 CLIENT:7-ELEVE~, I~C. SITE:7-ELEVE~ #32241 COMMENTS witness PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 06/05/2003 10:28 KOHLMEYER SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 05/30/03 WORK ORDER NUMBER33.29244 CLIENT:7-EL~.¥'~, I~TC. SITE: 7-ET.]~v'~T #32243. W~ ~ VENTS E c' " PLUS SUP UL Printed 06/05/2003 10:28 KOHLMEYER 7-11 :]12241 4101 GALLOWAY DR B~}(ERSFIELD,CA 93312 BO384118305001 JUN 13.. 2003 10:26 AP1 ~3¥STEPl CGTATUS REPORT ALI_ FUNCTIOI',IS N©RHAL I IWENTC, RY REPORT T 1 :RUL VOLUME = 4507 GALS ULLAGE = 55'21 GALS 90.':.'.~ ULLAGE= 4518 GALS TC VOLUI'IE = 445CI GALS HEIGHT = 44.18 INCHES WATER VOL = 0 GRL~ ~RTER = 0.00 l NCRE~ TEP1P = 80,6- DE~- F T 2:MUL VOLUI'IE = 1961 GALS ULLAGE = 8069 GALS 90~ ULLAGE= 7064 GALS TC VOLUP1E = 1939 GALS HEIGHT = 24.00 INCHES WATER VOL = 0 GALS WATER = 0.00 INCH: TEMP = 77,6 T 3:SUL VOLUME = 2974 GALS ULLAGE = 7054 GALS 90~ ULLAGE= 6051 GALS TC VOLUME = 2941 GALS HEIGHT = 32.38 INCHE~ WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 78,4 DEG F .- Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services .=. ? ,, ,,, ,,,,,,,, ,,,,,,, , - 1715 Chester.Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 t FACILITY NAME IINSPECTION DATE INSPECTION TIME ~-~ ......................... RHONE No. NO. o~yees 1 5-02 l- Section 1: Business Plan and Inventory Program ~1 RoUtine ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint i'1 Re-inspection C V (C=Com.,i~.o~ OPERATION COMMENTS k V=Violation ~'/'{~ APPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCU~TE ......................................................................................................................................................... CORRECT OCCUPANCY ~a VERIFICATION OF MSDS AVAILABILI~E ............................................................................................... ~.'~ .... ~t~._~.~.e ...... .~,~..._.(_~ _.~. ~ ~ SITE DIAGRAM ADEQUATE & ON HAND ANY H~ARDOUS WASTE ON SITE?: ~ YES ~No EXPLAIN: QUESTIO~t~EGARDI~ T~NSPECTION? PLEASE CALL US AT (661)326-3979 //~ ............ .......... ..... While - Environmental Services Yellow - S~alion Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., Ya Floor, Bakersfield, CA 93301 FACILITY NAME "~ ~lCt)IL/d INSPECTION DATE ~* Section 2: Underground Storage Tanks Program [~1 Routine [~j Combined [221 Joint Agency ~ Multi-Agency []]]l Complaint [~ Re-inspection Type of Tank ~tOImC~ Number of Tanks --~ Type of Monitoring ~t t_tt4 Type of Piping /]ILO ff"' OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on tile Pennit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No I,..2/' Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES A&quate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtill/overspill protection? ~eCto°~:En al 79 Business ~ite Resp~- c~n~ible Party White - Ear. Svcs, Pink - [lusiness Copy May 8, 2003 7-11 Bob DeNinno P.O. Box 711 Dallas, Texas 75221-0711 CERTIFIED MAIL RE: Failure to Complete SB 989 Secondary Containment Repairs & Retest at the following locations in Bakersfield, CA: 7-11, 1701 Pacheco Rd., 7-11, 4647 Wilson Rd., 7-11 9600 Brimhall Rd., 7-11, 3601 Stockdale, 7-11, 4101 -'~ ':~': Calloway, 7-11 525 W. Columbus. AO.,.IS.RA. VE SERV,CEB FINAL REMINDER NOTICE 2101 "H' Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661)395-1349 Dear Underground Storage Tank Owner & Operator: SUPPRESSION SERVICES 2101 'H' Street Since January 1, 2003, this office has sent you monthly reminders Bakersfield, CA 93301 advising you of a failed SB 989 test. In that letter, this office also VOICE (661) 326-3941 FAX (661) 395-1349 requested an update with regard to repairs of your system. PREVENTION SERVICES . ,,.,,.~,,,~,,.,.,,.o..,.,.~,~.~,, This office further explained that repairs of your system are a 1715 ChesterAve. condition of your permit to operate. Please be advised that yOu must Bakersfield. CA 93301 VOICE (681)326-3979 have your system repaired and retested by June 15, 2003. Failure to FAX (661) 321~-0576 comply may result in further enforcement action up to, and including PUBLIC EDUCATION revocation of your permit to operate. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3690 This office has extended every courtesy with regard to sending FAX (681) 320-0576 contractor information as well as one on one visit's FIRE INVESTIGATION 1715 Chester^ye. Should you have any questions, please feel free to call me at 661-326- Bakersfield. CA 93301 VOICE (681) 328-3951 3190. FAX (661) 326-0576 TRAINING DIVISION Sincerely, 5642 Vlctor Ave. Bakersfield, CA 93308 VOICE (681) 3994697 Ralph E. Huey FAX (681) 399-5763 Director of Prevention Services by: ,.,~ Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc · Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. , address different from item 17 [] Yes · 1. Article Addressed to: if YES, enter delivery address below: [] No ~ · .- -.. · .... '... - ..:..i~',:L':.~' ,~.L':"":i.~...~. .. ..... ..-,,,~. ~-~ .,~ ................ ~-<~-, ~. ~-~" BOB DENINNO ...... ' "~'"' .... ""'"'"='""~'~ .... ~ .... "~ 7-11 .... >....~~J;:~ D~LAS TEXAS 75221 0711 D ~fled M~l D ~pre~ Mail ~ Register~ ~ Remm Re~ipt for Me~di~ ~ I~ured Mail ~ C.O.D. 4. Re~fl~ Del~e~ ~m F~) D Yes 7002 3150 0004 9985 3837 ~ PS Fo~ 3811, August 2001 ~me~c Return R~ipt ~CPRI~Z~ i'n Ream R~e~ Fee Here ~ ~ndo~ment R~ui~ Re~ OelWe~ Fee (Endomement R~uir~) m ~o~,o~ BOBDEN~NO ~ro .... 7-11 . po ox* t ...1 m [~'~ ~ ~ ~ TEXAS 75221 0711 MRY OB 2003 ?:19 BKSFLD FIRE PREVEMTIOM (661)B52-2172 p.2 ClT~r OF BAKERSFIELD "~a~--)..... OFFICE OF ENVIRONMENTAL SERVICES · · 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT A~PLICATION TO CONSTRUCTIMODIgY UI~DF.,RGROUND STOOGE T~NK ~PE OF ~PUCATION (~CK) [ ]NEW FACILiW ( ]MOD~ICATION OF FACIb~ [ ]NEWTANKINSTALLAT10N AT ~IST1NO FACILI~ PHONE ~O,.~&' ~ ~ BA~[~DC~ aUS~ESS UCeNSE ~0. D~a TO ORO~D WASA ~[L ~PE ~PE~ED Ar SPILL P~ION CO~R~ AND C0~ MEAS~S P~N O~ m~ V~ N0 TANKNO. VOLUME ~L~D~ REGU~ P~MIUM DI~EL AV~TION TA~ ~O. VOL~E CH~ICAL storm ~s No. CHEMICAL P~VIOUSLY STORED (NO B~ND N~E) ~ ~O~) FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO, NO. OF TANK~ , FEES $ THE APPLICANT HAS RECEIVED, UNDERffrANDS, AND WK,L COMPLY WiTH THE ATTACHED CONDIT[ON$ OF' THIS PEKMIT AND ANY OTHER IgI'AT~ LOCAL AND FEDERAL REGULATIONS. TItI$ APPLICATION BECOMlg$ A PEP~MIT WHEN API'ROYED · ! L D M~rch 12. 2003 Bob Deninno 7-1! P.O. Bo~ 71 ! Dallas, Texas 95221-0711 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection FIRE CHIEF RON ~'aAZE System at 7-11,525 West Columbus, 7-11, 4101 Calloway, 7-11, 9600 Brimhail in Bakersfield, CA ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 Dear Business Owner: VOICE (661) 326-3941 FAX (661) 395-1349 Our records indicate that your annual maintenance certification on your leak SUPPRESSION SERVICES detectiOn system was past due on February 19, 2003 (525 West Columbus) and 2101 'H' Street February 20, 2003 (4101 Calloway & 9600 Brimhall). Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 You are currently in violation of Section 2641(J) of the California Code of Regulations. PREVENTION SERVICES FIRE SA/:E3Y SER~CE$ · ENVlRONII~I~'N. SEI~lCE$ 1715 ChesterAve. · "Equipment and devices used to monitor underground storage tanks shall be Bakersfield, CA 93301 ~ VOICE (661) 326-3979 installed, calibrated, operated and maintained in accordance with FAX (661)326-0576 manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." PUBLIC EDUCATION 1715 Chester AVe. Bakersfield, CA 93301 You are hereby notified that you have thirty (30) days, April 12, 2003 to either VOICE (661) 326-3696 FAX (661) 326-0576 perforn'l or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage FIRE INVESTIGATION system. 1715 Chester Ave. Bakersfield, CA 93301 vOiCE (sS~)326-3.~S~ Should you have any questions, please feel free to contact me at 661-326-3190. FAX (661) 326-0576 TRAINING DIVISION Sincerely, 5642 Victor Ave. Bakersfield, CA 93308 Ralph Huey VOICE (661) 399-4697 FAX (661) 399-5763 Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc April 21, 2003 Mr. Steve Underwood Bakersfield Fire Department 1715 Chester Avenue Bakersfield, CA 93301 RE: 7-Eleven #32241, 4101 Calloway, Bakersfield, CA - - Dear-Mr.-Underwood: As per the referenced Notice, 7-Eleven has hired Glacier Environmental to complete the piping upgrade at thisl site as well as the other stores in the Bakersfield area. In regard to this site, Glacier intends to submit for permit applications the week of April 28, 2003. Once permits are acquired, the work at this site will be scheduled to commence in mid June, 2003. The submission of this information by 7-Eleven, Inc. shall not constitute, nor be deemed to constitute, an admission of liability or responsibility with respect to the alleged violations and, in addition, evidence of this submission may not.. be used in any administrative or judicial proceeding or otherwise. ~ Please feel free to contact me at (208) 429-8466 should you have andy questions. CC Market Manager Judy Soper Jeff Simonson Joe Jordan 7-Eleven, Inc. Environmental Services Department / 10220 S.W. Greenburg Road, Suite 470 Portland, Oregon 97223 · Complete items 1, 2, and 3. Als0 complete · item 4 if Restricted Delivery is desired, [] Agent , Print your name and address on the reverse 'il Addressee SO that we can return the card to you. by (Printed Name) C. Date of Delivery · Attach this card to the back of the mai!piece, or on the front if space permits. D. Is delivery address different from item 17 [] Yes 1, .Article Addressed to: if YES, enter delivery address below: il No BOB DENINNO 7-11 P O BOX 711 DALLAS TEXAS 95221 0711 [ il Certified Mail [] Express Mail ] ~ [] Registered [] Return Receipt for Merchandise J ~-~ il Insured Mail [] C.O.D. .~ 4. Restricted Delivery? (Extra Fee) F'J Yes ,.~ 7002 3150 0004 9985 3103 , JPS Form 3811, August 2001 Domestic Retur~ Receipt .- 2ACPRI-Oa-Z-0985 Bakersfield Fire Dep~rtment Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 Postage I $ Certified Fee I Return Reclept Fee I Postmark (Endorsement Required) I Here r--I Restricted D.eLivew. Feg, I LI3 (Endorsem?~''~''~,~ m To. Po= BOB DENINNo t ........... 1' o ~ox 7~ ...... fu~;-~ .... ~ 1 0711 ...... Certified Mail Provides: m A mailing receipt · A unique identifier for your rnailpiece · A record of delivery kept by the Postal Service for two years Important Reminders: · Certified Mall may ONLY be coml~ned wlth¥irst-Class Mail~ or Priority Mails. · Certified Mall 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 sarvice,,piease c~,.mplete and attach a Ret.u. rn t~eceipt (PS Form 3811) to the article an(3 add applicable postage to cover me fee. Endorse mai piece "Return Receipt Requested". To receive a fee waiver for a duplica, ta return receipt, a USPSe postmark on your Certified Mail receipt is requlrea. · For an additional fee, delivery may be restricted to the addressee or addressee's authorized a~ent. Advise the clerk or mark the mailpiece with the endorsement "Restricted'Delivery". · f,a postmark on t.h.e Cart fled Ma ,receipt s desired please pre~sent..the..a.rtl- cie at the post o~ice for postmarking. If a postmart( on the [;ertitie(~ Mall receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. April 11, 2003 Bob DeNinno 7-11 P.O. Box 711 Dallas, Texas 95221-0711 CERTIFIED MAIL FIRE CHIEF RON FRAZE RE: Recent SB 989 Secondary Containment Testing ADMINISTRATIVE SERVICES 2101 'H* Street 7-1 l, 4101 Calloway, Bakersfield CA 93312 Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 FOURTH REMINDER NOTICE SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear Owner/Operator: FAX (661) 395-1349 PREVENTION SERVICES Our records indicate that you completed your secondary containment 1715 ChosterAvo. testing on December 19, 2002. Our records further show a failed test. Bakersfield, CA 93301 VOICE (661) 326-3951 Therefore you are required to have your system repaired and re-tested FAX (66t) 326-0576 as soon as possible. ENVIRONMENTAL SERVICES 1715 Chester^ve. This office requests an update with regard to repairs of your system. Bakersfield. CA 93301 VOICE (661) 326-3979 Please be advised that repairs involving the replacing of components FAX (66 t) 326-0576 must be under permit from this office. The repairs of your system are TaAInInO DiViSIOn a condition of your permit to operate. Failure to repair and re-test will 5642 Victor Ave. result in the revocation of your permit to operate. Bakersfield. CA 93308 voice (661) 399-4697 lAX (661) 399-5763 Should you have any questions, please feel free to contact me at 661- 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc MONITOR.lNG SYSTEM CERTIFICATION A, Gcoeral , - ........ ~.i ~]d~, N~.: .............. B. iavenm~ of ~uipmeht atuliu'~3~ er V~It S.,~C MOdel. ~ ~chasT~ Lin~ t ~ ~. Moat. ~ Q Mv~ L;ne ~ ~l~cmr. Ma~ei; -~ ............... ~ T~le~qrm',c L,nc L~ D~Iov, M~el: " 0 E~]c l~ Lc~ ~tor, M~ei. __. ~ S~ Va&~O. , ............. fl~atJo. N ....... D, R '~.Jis _~lm{~ m~ ¢~w~ ~r'~?~, , , ,,, ,,, ,,,, .......... -~ Y~ ~ 0 ~0" I~ ~ ~} Mann ~t~L? ......... . ~ ~r int~r~ ~{ tJyk ~upem ope~{~nT , , , --- [~ '~{m~ ~ relayed to a e~n~ ~ni~nrhx~ ~iq.. ts all ~ti~5 cq~,pm~t ~ Y~' { ~'~o W~s liquid ~d inside ~y ~uon~ ~n~mcnc ~ems d~si~cd a~ d~ s~ten~q ~'A~c~ all I!1~. ,~}~ ' h, Section ~ bzlaw, descd~ ~ and whc~ (kesedeflclenel~ we~ Or will be eurr~te~, 03/2?/2003 12:54 512380721S TANKNOLOGY PAGE 07 Ma~'-~?-03 0~; 19A TANKN~Y 909 1239 P. 1~ L~k De~ecto~ (LID): 0 0~ d~is ~ ~f LLDs ~r~ ,~au ins~l~. No' Far ~ukmen~ MIA ~b~k nll tA~ a~) No' ~cm __ c,~-~U~$T Monit. oring Si~ Plan S,,:A,,~,~: ~f~I ~ ~ .~~~~_~_ ~$~. ....... .......... ,~.'' :;~... ............~-- ~. ~.~ ~ ~ ........... ;~ ..................,~ ~~ ,¢. ,x~ ~ ~.~' . .~2',.22~.J ''',2 ............ . ._~-' ::::~' , . , ~ ~ ~: ~. . . ..". ~r~:~, ::' ~~~:~ ~::. ' ' ~:~. ~ '' '...2~.. ' ..... .''' .. 0~/27/2003 12:54 512380721~1k TANKNOLOGY PAGE 02 M~LrJ27-03 09: 17A TANKNC~DGY 909 239 P. 07 Mar 2S 03 04:30p M~G. Cerc2 Elco C ~on: N6 Ol, LT ,' 03~27/2003 12:54 51238072 TANKNOLOGY PAGE 03 Ma~-Z7-03 og: iSA TANK gOg 123g P. 08 RICH ~NV. IRONM~NTAL w/od: a~L ~ e~cL~y c~ ~o~e %~sC~ were c~n~ucce~ oft ch)~ ~Ce accord'l~g :o O~ thy knowte~m. Teeh~ · Complete items 1; 2, and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. I . ~ "-. [] Agent *~ Print your name and address on the reverse ! ~~a,..,~tf¥--"), D0~0~.A r'lAddressee so that we can return the card to you. 0._ Received by (Pri~m~) - -I C. Date of Delivery · Attach this card to the back of the mailpiece, ._e::>~ or on the front if space permits. D. Is delivery address different from item 17 [] Yes 1. Article Address?d to: if YES, enter delivery address below: [] No 4101 CALLOWAY BAKERSFIELD CA 93312 la. Service Type [] Certified Malt [] Express Mail ~ _ [] Registered [] Return Receipt for Merchandise i [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2.~ 7002 3150 0004 9985 2908 PS.Form 3811, August 2001 Domestic Return Receipt - 2ACPRI-O3-Z-0985 Sender: Please print y.our r~d~lress, and-ZlP~4~h'this box * BAKERSFIELD FiRE DEP^RT~ENT OFF~CE OF ENV~RON~¥~NTAL SERVICES 174 5 Chestar Avenue, Suits 300 ~ga~er~a~d, CA ~3301 Postage $ Ce~ied Fee Return Reclept Fee (Endorsement Required) Here Restricted Delivenj Fee (Endorsement Required) a-om. 7-11 [~! BAI~RSFIELD CA. 93312 Certified Mail Provides: resJ~Aea~ ~oo~ eu.~,~ll,~o-~ sd · A mailing receipt · A unique identifier for your mailpiece · A record of delivery kept by the Pogtal Service for two years Important Reminders: ~ s Certified Mail may ONLY be combined with First-Class Maile 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. , · F. or an additio.nal fee,. a Return Receipt ma)' be reque.sted to pr.o. vid, e pr_oo.f of oelivery, JO obtain HeTum Hecoipt ssrvJce, pleass ~mplete eno attach a HeTum Receipt (PS Form 3811) to the article and add applicable postage to cover the fee.. Endorse mailplece."Retu, r.n_P,_e_~ipt R. equ.ested". To r..e~..ive .a.f.ee.,waive, r.fo, r a ouplicpte return receipt, a uuP~ postmark on your uertnieo Ma, receipt ~s reqmree. · For an additional fee, delivery may be restricted to the addressee or addressee's authorized a,g.~n,t.. Advise the clerk or mark the mailpiece with the endorsement "Restricteoue/ivery: · If.a postmark on t.h.e Ce. rtified Mail .receipt is desired, please pre_sent.the..a.rtl- cie at the post onice TOr postmarking. If a postmark on the c;ertiTieo Mail receipt is not needed, detach and affix label with postage end mail, IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. D 0 March 5, 2003 7-11 4101 Calloway Bakersfield CA 93312 CERTIFIED MAIL FIRE CHIEF RON FR~E RE: Recent SB 989 Secondary Containment Testing ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfiold. CA 93301 THIRD REMINDER NOTICE VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES Dear Owner/Operator: 2101 "1-1' Street Bakersfield, CA 93301 VOICE (661)326-3941 Our records indicate that you completed your secondary containment FAX (661) 395-1349 testing on December 19, 2002. Our records further show a failed test. PREVENTION SERVICES Therefore you are required to have your system repaired and re-tested as soon as possible. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 tax 1661) 3~e-os?a This office requests an update with regard to repairs of your system. Please be advised that repairs involving the replacing of components PUBLIC EDUCATION must be under permit from this office. The repairs of your system are 1715 Chester Av~. Bakersfield, CA 93301 a condition of your permit to operate. Failure to repair and re-test will VOICE (661) 326-3696 FAX (661)326-0576 result in the revocation of your permit to operate. FIRE INVESTIGATION Should you have any questions, please feel free to contact me at 661- 1715 Chester Ave. Bake~s,eU, C^ 933m 326-3190. VOICE (661) 326-3951 FAX (661) 326-0576 __ 5642 Victor Ave. . Bakersfield, CA 93308 VOICE (661) 399-469'7 FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc Tankn ology 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512)459-1459 Date Printed and Mailed: 03/07/2003 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 12/19/2002 Order Number: 3126764 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Secondary Containment Spill Container Secondary Containment Tank Interstitial Sincerely, Dawn Kohlmeyer Manager, Field Reporting SS- MARY RESULTS TEST DATE: 12/19/2002 WORK ORDER NO.: 3126764 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 10220 S.W. GREENBURG ROAD MARKET # 2133 SUITE 470 4101 CALLOWAY DRIVE PORTLAND OR 97223 BAKERSFIELD CA 93312 BOB DENINNO 503-977-7713 Tank Interstital Tests :REG UNLEAD Total Containment PASS MIDGRADE Total Containment PASS PREMIUM Total Containment FAIL Piping Interstital Tests Sump & Under. Dispenser Containment Tests PR~ ,Pass MID Fail MID Pass Tanknology representative: Se~ices conducted by: KEN MINTON WESLEY COULTER SECONDARY CONTAINMENT TEST RESULTS NAME: 7-ELEVEN #32241 32241 12/19/2002 WORK ORDER 3126764 HTE ADDRESS: MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD CA 93312 REASON FOR TEST: SB-989 Compliance Groundwater Level(" from grade): TANK INFORM~ ,~,r~ ~,~,v ..,, =r~TITIAL TESTS Deot Start Initial Finish Final Pass/ Dia. Material Manufacturer(~,~) h Test Method Tan~ Product Tank Size ( - ) Time Level Time Result Fail 1 REG UNLEAD 10028 96 TOTAL CONT TotaIContainment 65 Vacuum 0938 -10 "Hg 1038 -10 "Hg PASS 2 MIDGRADE 10028 96 TOTAL CONT Tota~ Containment 67 Vacuum 0936 -10 "Hg 1036 -10 "Hg PASS 3 PREMIUM 10028 96 TOTAL CONT Total Containment 64 Vacuum -10 "Hg 0 "Hg FAIL 4 5 6 7 8 Comments: The premium tank was dropping very rapidly, It lost all vacuum in approx. 25 minutes. ,.,,~ ,,,r~RMATION AND INTERSTITIAL TESTS Dia. Len. Material Manufacturer Volume Start Initial Finish Final Pass/ Tank Product (" ) (feet) (gallons) Test Method Time Level Time Result Fail 1 2 3 4 5 6 7 8 Comments: No tests performed on lines. LINES FAILED VISUALLY. PATTERN OF FAILURES OBSERVED AT OTHER FACILITIES. SECONDARY CONTAINMENT TEST RESULTS wo~ Order: 3126764 T~pe Tank or Disp Manufacturer Model or Diam./WidttgLenDth Depth Start Initial Level Finish Final Pass/ # Material ( ,, ) ( ,, ) Test Method Time Level Chan,qe Time Result Fail Spill Container REG FILL Plastic 13 12 0915 4 -0.25 0939 3.75 Fail Spill Container REG VAPOR Plastic 13 12 VPLT 1003 4.25 -.00563 1015 +.020 gph Fail Spill Container PREM FILL Plastic 13 12 0914 4.25 -0.5 0925 3.75 Fail Spill Container PREM Plastic 13 12 VPLT 1002 4.25 +.00024 1014 +.022 gph Pass Spill Container MID FILL Plastic 13 12 0912 4 -0.5 0924 3.5 Fail Spill Container MID VAPOR Plastic 13 12 VPLT 1000 4 -.00032 1012 -.002 gph Pass Comments: All spill containers are made by Emco/Wheaton. This manufacturer does not appear in the drop-down menu. Each of the "fill" buckets failed by visual measurements. Water measurements were taken from the bottom of the bucket to the top of the water level. Work Order: 3126764 SECONDARY SYSTEM CERTIFICATION FOP_M Line i Line 3 Line 3 Line 4 S~rt Time Certit'~fion Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3126764 SECONDARY SYSTEM CERTIFICATION FORM Turbine Sumps Sump! Sump2 Sump 3 Sump ~H~t Time W~~ T~ P~ 2 of_ Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:12 / 19 / 0 2 WORK ORDER NUMBER3 12 6 ? 6 4 CLIENT:7-ELEVEN, INC. SITE:7-ELEVEN #32241 COMMENTS Arrived on site at 8:30 A.M. for CA reg SB-989 secondary containment testing. Three tank annulars tested - 87 and 89 passed, 91 failed. Six spill buckets tested - 87 fill and vapor failed, 91 fill failed, and 89 fill failed. 91 vapor and 89 vapor buckets passed. LINE INTERSTITIALS FAILED VISUALLY. PATTERN OF FAILURES OBSERVED AT OTHER FACILITIES. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 03/07/2003 14:02 SBOWERS SITE DIAGRAM 8900 SHOAl_ GREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 12 / 19 / 02 WORK ORDER NUMBER33.2676 4 CLIENT:7-'~LEVEN, IN(:. SITE: ?-ELEVEN #32241 W~ ~ VENTS E · -o'~'- ~ ~ ~ PLUS SUP UL Printed 03/07/2003 14:02 SBOWERS · Complete items 1; 2, and 3. Also complete item 4 if Restricted Delivery is desired· .· Print your name and address on the reverse so that we can return the card to you. I C. · Attach this card to the back of the Tailpiece, I or on the front if space permits. -5',/7,ff ~ 1..Article Addressed to: l! YES, enter delivery address below: [] No 7-11 4101 CALLOWAY BAKERSFIELD CA.93312 , Service Type [] Certified Mail [] Express Mail -~'~- [] Registered [] Return Receipt for Merchandise ']~ ~l Insured Mail [] C.O.D. · ' ~[ed Delivery? (Extra Fee) [] Yes 7002 0860 0000 1641 6117 j PS Form 3811, August 2001 Domestlc Return Receipt 2ACPRI-O3-Z-0985 ;-~:Ot +~?- tO lhh,,,Ih,,ll, lh,,,,, ll, hh,,hh,,lllh,,,,,Ihhhlh,,I ~,~ ~ C I ¢~ L USE Return Receipt Fee I Here c~ Restricte~ r--I (Endorse!' c~~ ,' ~,---__4101 CALLOWA¥ r'*[~i~' eI~KERSFtELD CA 93-312 ' ........... or po'Box*~,,..~ ............. [ii$i;'$ilg';/ .................. ~ ~ . Certified Mail Provides: · A mailing receipt a A unique identifier for your mailpiece · 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 Me[I receipt is required. ~11 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 Mail rl~caipt is d~tsired, please present the arti- cle at the post office for postmarkFtrg, If a p~Sstmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail, IMPORTANOe this receipt and present it when making an inquiry. PS Form 3800, April 2002 (Reveme) 102595.02-M-1132 February 13, 2003 7-.11 4101 Calloway Bakersfield CA 93312 FIRE CHIEF RON FROZE Certified Mail ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 RE: Recent SB 989 Secondary Containment Testing FAX (661) 395-1349 ~ SUPPRESS,O. SERV,CES SECOND REMINDER NOTI CE 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear FAX (661) 395-1349 Iotwner/[.)pera[or.' PREVENTION SERVICES Our records indicate that you completed your secondary containment FIRE SAFETY SERVICES * ENVIRONMENTAL SERVICES 1715 ChesterAve. testing on December 19, 2002. Our records further show a failed test. Bakersfield, CA 93301 VOICE (661)326-3979 Therefore you are required to have your system repaired and re-tested FAX (661) 326-0576 as soon as possible. PUBLIC EDUCATION 1715 ChesterAv~. This office requests an update with regard to repairs of your system. Bakersfield, CA 93301 vOiCE (~1)326-36s0 Please be advised that repairs involving the replacing of components FAX (661) 326-0576 mUst be under permit from this office. The repairs of your system are FlaE tNVESTIOnTIO, a Condition of your permit to operate. Failure to repair and re-test will 1715 ChesterAve. ., result in the revocation of your permit to operate. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661)326-0576 Should you have any questions, please feel free to contact me at 661- 326-3190. TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 ~1~ ~ VOICE (661) 3994697 Si FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc ~,,~ Sacramento, CA 94244-2120 ~ (Ins~ctions on reverse side) CERTI~IC~TIO~ O~ ~1~;1~ RESPONSIBILITY FOR UNDERGROUND STOOGE TANKS CONTAINING PETROLEUM A. I ~ required to demons~te Fin~cial Responsibili~ in ~e Requi~d ~oun~ ~ specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ~ 500,000 doll.s per occu~ence ~ 1 million doll.s ~nual aggregate or ~D or I million per occu~ence ~ 2 million doll.s ~nual aggregate d°ll~s e. 7-Eleven, Inc. · hereby ~ifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Opemtod A~icle 3, Chapter 18, Division 3, TiUe 23, California Code of Regulations. The mechanisms used to demopstmte financial msponsibili~ as required by Section 2807 am as follows: A~a~n International ...... ~i ,0~0,000 Specialty Lines PLS Occurrence & Annual Yes Yes Insuran~ Insuran~ Company 2674022 $2,000,000 Annual Aggregate Note: If you am using the State Fund as any pa~ of your demonstmtion of financial msponsibili~, your execution and submission of this ce~ification also ce~ifies that you am in compliance with all conditions for pa~icipation in the Fund. D. Facility Name Facility Address 7-Eleven ~17721 3601 Stockdale Rd., Bakersfield, CA Facili~ Name Facility Address 7-Eleven ~32241 4101 Calloway Dr., Bakersfield, CA Facili~ Na~. Facility Address 7-EI~ ~32376 ~/~~~ 9600 Brimhall Rd., Bakersfield, CA E. S~gna~b ~.~ ;~n~r'o, Op.rato, ' .~. ..m. an, Ti~ o~ T..~ Own.r or O,.r.to, -~~~ Bob DeNinno, Environmental Manager Si u e of WRness o Nota~ ~ Date Name of Witness or Nota~ ~~~. ~/~/~ ~ Rachel Rodriguez ~FE (Eevised 04/~5) FI~E: Original - L~ :al A~enc~ ~opies - Facility/Site(s) CERTIFICATION OF ,FINANCIAL RESPONSIBILITY 7-Eleven, Inc. (formerly known as The Southland Corporation) hereby certifies that it is in compliance with the underground storage tank ("US'i'") financial responsibility requirements of Subpart H of 40 CFR Part 280 and applicable.requirements under State law. The financial assurance mechanism used to demonstrate financial responsibility is third party insurance, more particularly described as follows: Storage Tank Third Party Liability Corrective Action and Cleanup Policy No. PLS6191639, issued by American Intemational Specialty Lines Insurance Company effective from November 24, 2001 tO November 24, 2004, pursuant to 40 CFR {}280.97, providing coverage for underground storage tanks with respect to the taking of corrective action and/or compensating of third parties for bodily injury and property damage caused by accidental releases. The limits of liability are those "per occurrence" and "annual aggregate" limits specified by 40 CFR {}280.93 and/or appliCable State law. This Certification supercedes all previous such Certifications issued with respect to financial i responsibility for UST's owned or operated by 7-Eleven, Inc. or its predecessor The Southland Corporation. To the extent required by applicable law, Certificates of Insurance have been filed with appropriate State authorities. 7-ELEVEN, INC. By: ~ Name: Edward J. Herman Date: STATE OF TEXAS COUNTY OF DALLAS My Commission Expires: ' ' - .,..-. / / <~,., ,.. ~. ,: ' .,.~', ,~'.~,,.. ~,. ...... ~.";, 102394vl January 22, 2003 7-I1 FIRE CHIEF 4101 Calloway RON FRAZE Bakersfield CA 93312 ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 RE: Upgrade Certificate & Fill Tags VOICE (661) 326-3941 FAX (661) 395-1349 Dear Owner/Operator: SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93.301 Effective January 1, 2003 Assembly Bill 2481 went into effect. This VOICE (601)325-3941 Bill deletes the requirement for an upgrade certificate of compliance FAX (661) 395-1349 (the blue sticker in your window) and the blue fill tag on your fill. PREVENTION SERVICES FIRE SAFETY SERV1CE$ * ~MENTN. SER~CE8 1715 ChestorAvo. You may, if you wish, have them posted or remove them. Fuel Bakersfield, CA 93301 vendors have been notified of this change and will not deny fuel VOICE (661) 32~-3979 FAX (661) 326-0576 delivery for missing tags or certificates. PUBLIC EDUCATION 1715 ChestorAv~. Should you have any questions, please feel free to call me at 661- Bakersfield, CA 93301 326-3 190. VOICE (681) 328-3898 FAX (661) 32~0576 FIRE INVESTIGATION Sincerel~; 1715 Chester Ave. , Bakersfield, CA 93301 ./.. ,/~ /, VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION Steve Underwood 5642 Victor Ave. Bakersfield, CA 93308 Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-469'~ FAX (661) 399-5763 Office of Environmental Services SBU/dc · Complete items 1,2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. B. Received by · Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 17 [] Yes 1. Article Addressed to: If YES, enter delivery address below: [] No I 4101 CALLOWAY [ 3. Service Type I BAKERSFIELD CA. 93312 I []Certified Mail [] Express Mail ' [] Registered [] Return Receipt for Merchandise "-- - ~ ~" [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2 A~ir~l~ klHmh~r [ 7002 0860 0000. 1641 5691 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 Permit No. G-10 I · Sender: Please print your name, address, and ZIP+4 in this box · , ....... ~ ..... ~ FIRE D.EPART~ENT (}FF~CE OF ENVIRONMENTAL SERVICES 1715 Ch~st:;r Avenue, Suii~e C,~;(~mfield, CA ©~F C~AL , ~ Postage $ r~ Certified Fee Postmarl~ R~um R~elpt F~ Hem ~ (E~do~ent R~uir~ [(~A~RSF~LD CA 93312 ................... Certified Mail Provides: · A mailing receipt · A unique identifier for your mailpiece · 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 · NO INSURANCE COVERAGE IS PROVIDED w[th Certified Mail. For valuables, p)ease 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 Ma{I receipt is required. · For an additional fee, delivery may be restricted to the addressee or eddressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery", · If a postmark on the Certified Maid receipt is desired, please present the arti- cle at the post office for postmarkings:If a post_mark on the Certified Mail receipt is detach and affix i~ibel with ~-_g~ stage and mail. IMPORTANT: receipt and present it when making an inquiry. PS Form 3800, April 2062 (Reveme) 162595-62-M-1132 January 13, 2003 4101 Calloway Bakei'sfield CA 93312 FIRE CHIEF RON FRAZE Certified Mail ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 RE: Recent SB 989 Secondary Containment Testing FAX (661) 395-1349 SUPPRESSION SERVICES REMINDER N OTI CE 2101 'H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dca' Owner/Operator: PREVENTION SERVICES ,.~s,,~,~,~s.,,,~.,..,~.,,~s Our records indicate that you completed your secondary containment 1715 ChestorAve. testing on December 19, 2002. Our records further show a failed test. Bakersfield, CA 93301 VOICE (661) 326-3979 Therefore you are required to have your system repaired and re-tested FAX (661) 326-0576 as soon as possible. PUBLIC EDUCATION 1715 ChesterAv~. This office requests an update with regard to repairs of your system. Bakersfield, CA 93301 VOICE (661)326-3696 Please be advised that repairs involving the replacing of components FAX (661) 326-0576 must be under permit from this office. The repairs of your system are FIRE INVESTIGATION a condition of your permit to operate. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661)326-3951 Should you have any questions, please feel free to contact me at 661- FAX (661) 326-0576 326-3190. TRAINING DIVISION 5642 Victor Ave. Siacer~,f Bakersfield, CA 93308 ' FAX (661) 399-S763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING FACILITY ADDRESS PERMIT TO OPERATE # NUMBER OF TANKS TO BE TESTED-~ ~£S IS PIPING GOING TO BE TESTED ~£~' TANK # VOLUME CONTENTS TANK TESTING COMPANY NAME & PHONE NUMBER OF CONTACT PERSON ~"~ ~t~tg.~4' cfi ~ qoq-'~ 06'-I2.10 TEST METHOD ~ OLT-. e,tx~4o~,l~,-'~a~,35 ~ PO~7~o w~ S NAN~ OF TESTER OR SPECIAL INSPECTOR cm~zn~CA~ON# q~5~ ~0 ~ 6~ ~ DATE & Tm~ TEST ~S TO BE CONDUCTED APPROVIqD BY DATE SIGNATURE OF APPLICANT · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. [] Agent · Print your name and address on the reverse [] Addressee so that we can return the card to you. by Name) · Attach this card to the back of the mailpiecel or on the front if space permits, delivery address different from item 17 [] Yes 1. Article Addressed to: If YES, enter delivery address below: [] No !7-11 4101 CALLOWAY BAKERSFIELD CA 93312 3. ~e Type [~ Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise '~"~-~-~-- - .......... ~ [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes ~ 7002 0860 0000 1641 7428 ~ PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 · Sender: Please ~j~Q~'ham/~,'address, ataCZ~+._4~i~m-is-b-ox=~, ~! ~., , f ~A~-f~ERSFt~ELD FIRE DEPAF~T~NT OFF~CE OF ENVIRONMENTAL SERVOCES 1715 Chast~r Avenua, Suj~ 30.0 r"'l Postage $ r--I Certified Fee Postmmk Return Receipt Fee ~ (Endorsement Required) Hem ~ Restricted Delivery Fee r-~ (Endorsement Required) r,-[~ 4101 CALLOWAY ................... tBAKERSFIELD CA 93312 ! Certified Mail Provides: · A mailing receipt · A unique identifier for your mailpiece · 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 I~ 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 Mail receipt ~desired,~lease present the ertl~ cie at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANOe this receipt and present it when making an inquiry. PS Form 3800, April 2002 (Reverse) December 1, 2002 7-11 4101 Calloway Bakersfield CA 93312 FIRE CHIEF RON FRAZE CERTIFIED MAIL ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 F^x 166t)39s-1349 FINAL REMINDER NOTICE s,.,PRESSiO. RVICES JANUARY 1, 2003 DEADLINE 2101 "H" Street Bakersfield, CA 93.301 VOICE (661) 326-3941 FAX (661)395-1349 Dear Tank Owner/Operator: PREVENTION SERVICES ~,~.~E~.~.v.~.~,,.~,~. You will be receiving this letter on or about December 1, 2002. One 1715 Chester Ave. Bakersfield, CA 93301 month from today, January 1, 2003, your current underground VOICE (661) 326-3979 FAX (661) 326-0576 storage tank(s) will become illegal to operate. Current law would require that your permit be revoked for failure to perform the PUBLIC EDUCATION necessary Secondary Containment testing. 1715 Chester Avi~. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 In reviewing your file, I see that you have received "Reminder Notices" since April of this year. This is your last chance to comply FIRE'NVES~T~ON with code requirements for Secondary Containment testing prior to 1715 Chester Ave. Bakersfield, CA 93301 January 1, 2003. FAX (661) 326-0576 Should you have any questions, please feel free to contact me at 661- TRAINING DIVISION 326-3190. 5642 Victor Ave. Bakersfield. CA 93308 VOICE (661) 399-469'/ -- -.,'qlncerelv, FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc November 5, 2002 Bob DeNinno Environmental Manager 7-Eleven, Inc 3130 So. Owyhee Street Certified Mail ~RE C.~EF Boise, Idaho 83705 4768 RON FRAZE ADMINISTRATIVE SERVICES Dear Mr. DeNinno: 2101 "H' Street Bakersfield, CA 93301 VOICE (661)326-3941 The following is a response to your letter of September 23, 2002. FAX (6el) 39~-1949 SUPPRESSION SERVICES The two sites left to be tested, have double wall fiberglass clad steel 2101 "H' Street tanks and are therefore subject to the SB989 testing by January 1, Bakersfield, CA 93301 r vOiCE (e6t) 326-394~ 2003. However, at the time of testing, you may in fact do a visual FAX (661)395-1349 failure on the total containment sumps. PREVENTION SERVICES ,,,~ ~. s,,~s.,,,,,~,.,.~..~,~, Your request to defer replacement of total containment sumps by 1715 Chester Ave. Bakersfield. CA 93301 December 31, 2003 is not acceptable. Our guidelines state that VOICE (661)326-3979 FAX (661) 326-0576 underground storage tank owners/operators will have 90 days (March 1, 2003) to affect repairs/upgrades to systems which have failed. Our PUBLic EDUCATION records indicate you have two locations which have yet to be tested. 1715 Chester Av~. Bakersfield, CA 93301 Store #32241, 4101 Calloway Drive and Store #32376, 9600 Brimhall. VOICE (661) 326-3696 FAX (661) 326-0576 I hope this clarifies our regulatory requirements, Should you have FIRE INVESTIGATION additional questions, please feel free to call me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (651) 326-3951 Sincerely, FAX 1061) 326-0576 TRAINING DIVISION Ralph E. Huey 5642 Victor Ave. Bakersfield, CA 93308 Director VOICE (661) 399-469~ FAX (661) 399-5763 by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer cc: Ken Hillard /tcmer 7-Eleven, Inc. 23, 2002 City of Bakersfield Office of Environmental Services / Fire Dept. Mr. Ralph E. Huey Director of Environmental Services 1715 Chester Ave. / Third Floor Bakersfield, CA 93301 Re: Proposed Petroleum Equipment Replacement Program Dear Mr. Huey: As you know, 7-Eleven, Inc. operates approximately. 6 retail gasoline outlets in your jurisdiction. Pursuant to applicable regulatory requirements, 7-Eleven has conducted tests of secondary containment systems at a number of our locations in California. Based on the results of these tests and our experiences in other states, 7-Eleven has determined that certain equipment manufactured by Total Containment, Inc. ("TCI") has often been found not to meet regulatory requirements. Accordingly, 7-Eleven has decided to replace all TCI product lines that are currently in service in approximately 140 of our 7-Eleven stores in California, including 2 locations in your jurisdiction. If necessary, 7-Eleven will also replace TCI sumps and/or tanks at affected stores within your jurisdiction. For your convenience, Attachment A to this letter contains a list of affected stores located in your area. We propose to replace the subject TCI equipment at ali of the affected locations by December 31, 2003. As part of this replacement program, we would ask for your authorization to accept 7- Eleven's determination that TCI secondary containment equipment is generally testing at an unacceptably high failure rate, in lieu of requiring continued site by site testing, and to defer testing of the secondary containment systems at affected locations until such time as the new equipment is installed. 7-Eleven wishes to be clear, however, that 7-Eleven will test all of its double-walled tanks by the deadline. Furthermore, the selection and installation of all replacement equipment would conform with technical standards established by the U.S. Environmental Protection Agency and other applicable codes and 7-Eleven will submit all required permit applications and obtain appropriate agency approvals to perform these upgrades. In addition, all of the affected facilities will be upgraded with Enhanced Vapor Recovery ("EVR") equipment at the time of the proposed replacements. We hope you will consider 7-Eleven's proposal to comply with the intent of the applicable regulations. 7-Eleven is prepared to discuss our proposal with you in detail and to enter into such agreements as may be appropriate. We believe that our proposed replacement program is both cost-effective and protective of public health and the environment and we are eager to discuss it with you. If you have any questions or direction, please contact Bob DeNinno, our Environmental Manager for 7-Eleven stores in your area, at 208/429-8466 or me at 214/841- 6592. Thank you for your cooperation. ~~Sincere , ,~lanager, Environmental Services and Compliance Enclosure CITY Of BAKERSFIELD ~':-.-~=-:~i~_;: =' I_ --- ............. ~ ......... ~'~*~:- ~-' ................... ._..;_ .l!il 2133[ 32241.i4101CALLOWAYDRIYF. iBAKERSFIELD ~.'KERN 1933122302 .C~.~ofJaker~etd-OfficeofEnvtmnmentatSew~es.~_allm..~e.n_t). ·Complete items 1, 2, and 3. Also complete item4 if Restricted Delivery is desired. ·Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpie~ce, . or on the front if space permits. 1. Article Addressed to: If YES, enter delivery address below: [] No 7-11 4101 CALLO~AY BAKERSFIELD CA 93312 3. Service Type I~ Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 0860 0000-1641 6520 ' PS Form 3811, Auc~ust 2001 Domestic Return Receipt 102595-02-M-0835 BA~JERSF~ELD FIRE D~PARTMENT OFF'IC~ OF ~NVI~RON.%~NTAL SERvIc~s 1715 Chester Ave,nu~, Suite 3~ ~kersF~M, CA 93301 I r"t Postage $ gr"l I E:3 Certified Fee , r-1 Postmark Return Receipt Fee Here j ~ [Endorsement Required) J ~ ' Restricted Delivery Fee: (Endorsement Required): ~ I'U Total Postage & Fees c~lsentTo r,-[ 7-~! ~ ~i/~;i;;G;'/~:; ............................................................................. [.o~.o..~.o~...~: ........... .?.L..c.~?.....~ ..................................... Certified Mail Provides: · A mailing receipt · A unique identifier for your mailpiece · A signature upon delivery · A record of delivery kept by the Postal Service for two years Important Reminders: la Certified Mail may ONLY be combined with First-Class Mail or Priority Mall. al 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 Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a p~stmark on the Certified Mail receipt is not~ded, detach and affix label with postage and mail IMPORTANT: ~his receipt and present it when making an inquiry. PS Form 3800,,April 2002 (Reverse) 102595-02-M-113~ October 3 l, 2002 7-11 4101 Calloway Bakersfield CA 93312 CERTIFIED MAIL REMINDER NOTICE FIRE CHIEF RE: Necessary secondary containment testing requirements by December 31, ~c,~ ~z~ 2002 of underground storage tank (s) located at the above stated address. ADMINISTRATIVE SERVICES 2101 "H' Street Dear Tank Owner / Operator, Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 If you are receiving this letter, you have no..._[ yet completed the necessary secondary containment testing required for all secondary containment SUPPRESSION SERVICES components for your underground storage tank (s). 2101 'H' Street Bakersfield, CA 93301 VOICE (661)326-3941 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California FAX (661) 395-1349 Health & Safety Code) of the new law mandates testing of secondary PREVENTION SERVICES containment components upon installation and periodically thereafter, to ~ s~m s~.~c,,s.,=..~.,~.sE..,c,;s insure that the systems are capable of containing releases from the primary 1715 Chester Ave. Bakersfield, CA 93301 containment until they are detected and removed. VOICE (661) 326-3979 FAX (661) 326-0576 Of great concern is the current failure rate of these systems that have been PUBLIC EDUCATION tested to date. Currently the average failure rate is 84%. These have been 1715 Chester Av~. I Bakersfield, CA 93301 due to the penetration boots leaking in the turbine sump area. VOICE (661) 326-3696 FAX (661) 326-0576 For the last six months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very FIRE INVESTIGATION 1715 ChesterAve. few contractors are licensed to perform this test. Contractors conducting this Bakersfield, CA 93301 VOICE (661) 326-3951 test are scheduling approximately 6-7 weeks out. FAX (661) 3~-0576 The purpose of this letter is to advise you that under code, failure to perform TRAINING DIViSIOn this test~ by the necessary deadline~ December 31~ 2002~ will result in the 5642 Victor Ave. Bakersfield, CA 93308 revocation of your permit to operate. VOICE (661) 399-4697 FAX (661) 399-5763 This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerer, Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME "7' ~'[CtJt.~ INSPECTION DATE ,[~) 't _q-' t) '~ ADDRESS ql$ I (16_((O0_hx t[ PHONE NO..~ff'/~ ~g~ FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Lo Section 1: Business Plan and Inventory Program [~] Routine ~ Combined [~ Joint Agency [~ Multi-Agency [.~ Complaint [~ Re-inspection OPERATION C V COMMENTS / Appropriate permit on hand / Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ..~ [. .... ,/ Verification of quantities Verification of location / Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled e/ Housekeeping '/.- Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~] Yes ~Io Questions regarding this inspection? Please call us at (661 ) 326-3979 Business Sitre~esponsible Party White - Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: C~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ']- ~ / e ~l[~ INSPECTION DATE I0- Section 2: Underground Storage Tanks Program [21 Routine ~i/~ombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank OID~_q Number of Tanks ~ Type of Monitoring ~ L./4~ Type of Piping _//](/J~' OPERATION C V COMMENTS Proper tank data on file / Proper owner/operator data on file Permit fees current Certification of Financial Responsibility ~ Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance~/~-Violation,,,~Y=Yes N=NO ~~'0~0~A Inspector: c,- Omce of Environmental Services (805) 326-3979 'Business Si{0 Responsible Party White - Env. Svcs. Pink - Business Copy September 30, 2002 7-11 4101 Calloway Bakersfield CA 93312 REMINDER NOTICE FIRE CHIEF RON FRAZE RE: Necessary secondary containment testing requirements by December 31, 2002 of ADMINISTRATIVE SERVICES 2101 "H' Street underground storage tank (s) located at the above stated address. Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Dear Tank Owner / Operator, SUPPRESSION SERVICES If yOU are receiving this letter, you have not yet completed the necessary secondary 2101 "H' Street BakersfieM, CA 93301 containment testing required for all secondary containment components for your underground VOICE (661) 326-3941 storage tank (s). FAX (661) 395-1349 PREVENTION SERVICES Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety s,~m sE~Es.~,~,~,~ ~ne~s Code) of the new law mandates testing of secondary containment components upon installation 1715 Chester Ave. Bakersfield, CA 93301 and periodically thereafter, to insure that the systems are capable of Containing releases from VOICE (661) 326-3979 the primary containment until they are detected and removed. FAX (661) 326-0576 PUBLIC EDUCATION Of great concern is the current failure rate of these systems that have been tested to date. 1715 ChesterAve. Currently the average failure rate is 84%. These have been due to the penetration boots leaking Bakersfield, CA 93301 VOICE (661) 326-3696 in the turbine sump area. FAX (661) 326-0576 For the last five months, this office has continued to send you monthly reminders of this FIRE INVESTIGATION necessary testing. This is a very specialized test and very few contractors are licensed to 1715 Chester Ave. Bakersfield, CA 93301 perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. VOICE (661) 326-3951 FAX (661) 326-0576 The purpose of this letter is to advise you that under code, failure to perform this test, by the T~AINING DIVISION necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 This office does not want to be forced to take such action, which is why we continue to send FAX (661) 399-5763 monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Sincere . Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services August 30, 2002 7-11 4101 Calloway Bakersfield, CA 93312 REMINDER NOTICE RE: Necessary secondary containment testing requirements by December 31, 2002 of underground storage tank (s) located at the above stated address. FIRE CHIEF RON FRAZE Dear Tank Owner / Operator, ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 If you are receiving this letter, you have not yet completed the necessary secondary VOICE (661) 326-3941 FAX (661)395-1349 containment testing required for all secondary containment components for your underground storage tank (s). SUPPRESSION SERVICES 2101 'H" Street Bakers1~e~d, CA93301 Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health VOICE (661) 326-3941 FAX (661) 395-1349 & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to insure that the systems are PREVENTION SERVICES capable of containing releases fi.om the primary containment until they are detected 1715 Chester Ave. Bakersfield, CA 93301 and removed. VOICE (661) 326-3951 FAX (661) 326-0576 Of great concern is the current failure rate of these systems that have been tested to ENVIRONMENTAL SERVICES date. Currently the average failure rate is 84%. These have been due to the 1715 Chester Ave. Bakersfield, CA 93301 penetration boots leaking in the turbine sump area. VOICE (661)326-3979 FAX (661) 326-0576 For the last four months, this office has continued to send you monthly reminders of TRAINING DIVISION this necessary testing. This is a very specialized test and very few contractors are 5642 Victor Ave. Bakersfield, CA 93300 licensed to perform this test. Contractors conducting this test are scheduling VOICE (661) 399-4697 FAX (661) 399-5763 approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel fi.ce to call me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services July 30, 2002 7-11 4101 Calloway Bakersfield CA 93312 REMINDER NOTICE FIRE CHIEF RE: Necessary Secondary Containment Testing Requirements by December RON FRAZE 3 I, 2002 of Underground Storage Tank (s) Located at ADMINISTRATIVE SERVICES the Above Stated Address. 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Dear Tank Owner / Operator: FAX (661) 395-1349 SUPPRESSION SERVICES If you are receiving this letter, you have not yet completed the necessary 210t "H" Street secondary containment testing required for all secondary containment Bakersfield. CA 93301 components for your underground storage tank (s). VOICE (661) 326-3941 FAX (661) 395-1349 Senate Bill 989 became effective January I, 2002, section 25284.1 (California PREVENTION SERVICES Health & Safety Code) of the new law mandates testing of secondary FIRE SAFETY SERgICE$ · ENVIRONMENTAL SERI~CES 1715 Chester Ave. containment components upon installation and periodically thereafter, to insure Bakersfield, CA 93301 that the systems are capable of containing releases from the primary VOICE (661) 326-3979 FAX (661)326-0576 containment until they are detected and removed. PUBLIC EDUCATION Of great concern is the current failure rate of these systems that have been 1715 Chester Ave. Bakersfield, CA 93301 tested to date. Currently the average failure rate is 84%. These have been due VOICE (661) 326-3696 to the penetration boots leaking in the turbine sump area. FAX (661) 326-0576 FIRE INVESTIGATION For the last four months, this office has continued to send you monthly 1715 CheslerAve. reminders of this necessary testing. This is a very specialized test and very few Bakersfield, CA 9,3,301 vOiCE (ee~) 326-395~ contractors are licensed to perform this test. Contractors conducting this test FAX (661)326-0576 are scheduling approximately 6-7 weeks out. TRAINING DIVISION The purpose of this letter is to advise you that under code, failure to perform 5642 Vlctor Ave. Bakersfield, CA 9.3.308 this test, by the necessary deadline, December 31, 2002, will result in the VOICE (661) 399-4697 revocation of your permit to operate. FAX (661) 399-5763 This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Since~ Steve Underwood Fire Inspector Environmental Code Enforcement Officer D June 30, 2002 7-11 4101 Calloway Bakersfield, CA 93312 REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 4101 Calloway. FIRE CHIEF RON FRAZE Dear Tank Owner / Operator: ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield. CA 93301 The purpose of this letter is to inform you about the new provisions in VOICE (661)326-3941 FAX (661)395-1349 California Law requiring periodic testing of the secondary containment of underground storage tank systems. SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 Senate Bill 989 became effective January l, 2002, section 25284. l (California VOICE (661) 326-3941 FAX (661) 395-1349 Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, io ensure PREVENTION SERVICES 1715 ChosterAve. that the systems are capable of containing releases from the primary Bakersfield, CA 93301 containment until they are detected and removed. VOICE (661) 326-3951 FAX (661) 326-0576 Secondary containment systems installed on or after January 1, 2001 will be tested ENVIRONMENTAL SERVICES 1715 ChoslerAve. upon installation, six months after installation, and every 36 months thereafter. Bakersfield, CA 93301 Secondary containment systems installed prior to January 1, 2001 will be tested by VOICE (661) 326-3979 FAX (661) 326-0576 Janual'~J l, 2003 and every 36 months thereafter. REMEMBER! Any component that is "double-wall" in your tank system must be tested. TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 Secondary containment testing shall require a permit issued thru this office and VOICE (661) 399-4697 FAX (661)399-5763 shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661)326-3190. Sf6ve Underwood Fire Inspector/Environmental Code Enforcement Officer '-' " Environmental Services ~ _ SU/kr R D May 29, 2002 7-11 4101 Calloway Bakersfield, CA ,93312 RE: NecesSary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 4101 Calloway nRE C.~EF REMINDER NOTICE RON FR~E )ear Tank Owner/Operator: ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 'he purpose of this letter is to inform you about the new provisions in California VOICE (661) 326-3041 FAX (661) 395-1349 Law requiring periodic testing of the secondary containment of underground storage tank systems. SUPPRESSION SERVICES 2101 "H" Street Senate Bill 989 became effective January 1, 2002. section 25284.1 (California Bakersfield, CA 93301 VOICE (661) 326-3941 Health & Safety Code) of thc new law mandates testing of secondary containment FAX (661) 395-1349 components upon installation and periodically thereafter, to ensure that the systems PREVENTION SERVICES are capable of containing releases from the primary containment until they are .. 1715 ChesterAve. [erected and removed. Bakersfield, CA 93301 { VOICE (661) 326-3951 ~ FAX (661) 326-0576 Secondary containment systems installed on or after January 1,2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. ENVIRONMENTAL SERVICES Secondary containment systems installed prior to January 1,2001 shall be tested by 1715 Chester Ave. Bakersfield, CA 93301 January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component VOICE (661) 326-3979 FAX (661) 326-0576 that is "double-wall" in your tank system must be tested. TRAINING DIVISION Secondary containment testing shall require a permit issued thru this office, and 5642 Victor Ave. shall be performed by either a licensed tank tester or licensed tank installer. Bakersfield. CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures D April 17, 2002 7-11 4101 Calloway FIRE CHIEF Bakersfield CA 93312 RON FRAZE ADMINISTRATIVE SERVICES RE.' Necessary Secondary Containment Testing Required by December 31, 2002 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 REMINDER NOTICE FAX (661 ) 395-1349 SUPPRESSION SERVICES Dear Tank Owner/Operator: 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 The purpose of this letter is to inform you about thc new provisions in California law FAX (661) 395-1349 requiring periodic testing of the secondary containment of underground storage tank systems. PREVENTION SERVICES 1715 Chester Ave. Senate Bill 989 became effective January I, 2002. Section 25284.1 (California Health & Bakersfield, CA 93301 VOICE (661) 326-3951 Safety Code) of the new law mandates testing of secondary containment components FAX (661) 326-0570 upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Secondary containment systems installed on or after January 1, 2001 shall be tested upon VOICE (661) 326-3979 installation, six months after installation, and every 36 months thereafter. Secondary FAX (661) 326-0576 containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every 36 months thereafter. TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 Secondary containment testing shall require a permit issued thru this office, and shall be VOICE (661) 399-4697 performed by either a licensed tank tester or licensed tank installer. FAX (661) 399-5763 Please be advised that there are only a few contractors who specialize ahd have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 02/20/2002 Date Printed and Mailed: 03/06/2002 Order Number: 3121028 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 SWC CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor Certification _ -- .... ,, , -~ [., _ II ,- ....... J_ __, Sincerely, Dawn Kohlmeyer Manager, Field Reporting 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TLD-1 PURPOSE: COMPLIANCE TEST DATE: 02/20/02 CUSTOMER PO: wc03051663 WORK ORDER NUMBER: 3121028 CLIENT: 7-ET.~.VEN, INC. SITE: 7-ELEVEN #32241 10220 ~... ~-..~oa~ ~o~ ~T # ~ ~o~ 4~o ~lO~ ~ c~ow~ ~ PORT~, OR 97223 ~RSFIE~, CA 93312 BOB DENI~O ~AGER (503) 977-7713 (805) 555-1212 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 10k 1 REG UNT.~.AD 0. 000 P Y P 10k 2 PREMIUM 0. 000 P Y P Y 10k 3 IIDGRADE 0. 000 P Y P Y Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any iime, day or night, when you need us. Tanknology representative: Test conducted by: CLIFF PORTER RICHMOND PHILLIPS Reviewed: Technician Certification Number: 91-1o71 Printed 03/06/2002 08:34 SBOWERS J INDIVIDUi TANK INFORMATION ANDLST RESULTS TEST DATE:02/20/02 8g00 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3121028 CLIENT:?-~.I~'v-~N, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-~.I~VEN #32241 Tank ID: 10k i Tank manifolded: No Bottom to top fill in inches: 157.0 Product: REG tn, rL,V, AD Vent manifolded: No Bottom to grade in inches: 161.0 Capacity in gallons: 10,000 Vapor recovery manifolded: Y~s Fill pipe length in inches: 62.0 Diameter in inches: 95. oo Overfill protection: Y~s Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: Y~s Stage I vapor recovery: DUAL Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: ! ! COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: w~t~o~.ss Model: LD2000 Ingress Detected: Water Bubble Ullage Test time: S/N: 013097 Inclinometer reading: Open time in sec: 4. oo Holding psi: VacuTect Test Type: NOT Resiliency in mi: 175 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: z89.0 TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: a. oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVI:ROFT.~.X Diameter (in): 2.0 Length (fi): 200.0 Test psi: 50 Bleedback cc: 0 Test time (rain): 60 NOT NOT NOT Start time: 07: 45 TESTED TESTED TESTED End time: 08: 45 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: F~ P~.TRO COMMENTS Impact Valves Operational: tn~o~ Printed 03/06/2002 08:34 TEST DATE:02/20/02 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3121028 AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-~..T.~.V~N #32241 CLIENT: 7-~,T.~..VEN, INC. Tank ID: 1Ok 2 Tank manifolded: NO Bottom to top fill in inches: 159.0 Product: pzuT_~4It~ Vent manifolded: No Bottom to grade in inches: 163.0 Capacity in gallons: 10,02"/ Vapor recovery manifolded: ,z-~s Fill pipe length in inches: 64.0 Diameter in inches: 95.00 Overfill protection: 3rss Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: ¥'~s Stage I vapor recovery: DOA.L Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VA~OR~'~SS Model: Lb2000 Ingress Detected: Water Bubble Ullage S/N: ~9793 Test time: Open time in sec: 4. oo Inclinometer reading: Holding psi: 2o VacuTect Test Type: NOT Resiliency in mi: 165 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: leg.0 TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3.oo Water table depth in inches: Results: p~,ss Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (ft): 200.0 Test psi: 50 Bleedback cc: 0 Test time (rain): 60 NOT NOT NOT Start time: 07: 45 TESTED TESTED TESTED End time: 08: 45 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: FE PET~O COMMENTS Impact Valves Operational: YEs Printed 03/06/2002 08:34 INDIVIDu -,_ TANK INFORMATION ANO"r,-ST RESULTS TEST DATE:02/20/02 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3121028 CLIENT: 7-ELEVEN, TNC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ELEVEN #32241 Tank ID: 1Ok 3 Tank manifolded: No Bottom to top fill in inches: 156.0 Product: MTDGRADE Vent manifolded: NO Bottom to grade in inches: 160.0 Capacity in gallons: 10,027 Vapor recovery manifolded: YEs Fill pipe length in inches: 61.0 Diameter in inches: 95.00 Overfill protection: YEs Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: ~s Stage I vapor recovery: DUA~ Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Start (in) End (in) I Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~O~LW. SS Model: ~.n2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: 5~94 Inclinometer reading: Open time in sec: 4. oo Holding psi: 3.8 VacuTect Test Type: NOT Resiliency in mi: 3.?0 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: 3.89. o TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PAss Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (ft): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 60 NOT NOT NOT Start time: o7: 45 TESTED TESTED TESTED End time: 08: 45 Final gph: 0. 000 Result: PASS Pump type: PR~SSU~ Pump make: ~ ]?~.TEo COMMENTS Impact Valves Operational: 3rss Printed 03/06/2002 08:34 ' ~:i-~' ~ MONITORING SYSTEM CERTIFICATION i~lir Use By All Jurisdictions Within the State of Cafif~ Authority Cited: Chapter 6. ~alth and Safety Code; Chapter 16, Division 3 Title ~llafifornia Code of Regulations This form must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The ownefloperator must submit a copy of this form to lhe local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: 7-ELEVEN #32241 City: BAKERSFIELD CA Zip.' 93312 Site Address: MARKET # 2133 Contact Phone No:555-1212 SWC CALLOWAY DRIVE Date of Testing/Service: 02/20/2002 Facility Contact Person: MANAGER Make/Model of Monitoring System: TLS-350 Work Order Number: 3121028 B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced nkID: 1 Tank ID: 2 In-Tank Gauging Probe. Model: MAG-1 'X] In-Tank Gauging Probe. Model: MAG-1 Annular Space orVault Sensor. Model: 420 ~ Annular Space or Vault Sensor. Model: 420 ~'~ Piping Sump/Trench Sensor(s). Model: 352 ~ Piping Sump/Trench Sensor(s). Model: 352 ] FilISump Sensor(s). Model: '~] FillSump Sensor(s). Model: ~] Mechanical Line Leak Detector. Model: LD-2000 X---] Mechanical Line Leak Detector. Model: LD-2000 Eleclronic Line Leak Detector. Model: -"] Electronic Line Leak Detector. Model: Tank Overfill/High-LeveI Sensor. Model: MAG-I [] Tank Overfill/High-LeveI Sensor. Model: MAG-1 ~] Other (specify equipment type and model in Section E on page 2). [] Other (specify equipment type and model in Section E on page 2). tanK IU: 3 lank lU: '~ In-Tank Gauging Probe. Model: MAG-1 [] In-Tank Gauging Probe. Model: Annular Space orVault Sensor. Model: 420 [] Annular Space orVault Sensor. Model: Piping Sump/Trench Sensor(s). Model: 352 [] Piping Sump/trench Sensor(s). Model: [] FilISump Sensor(s). Model: [] FilISump Sensor(s). Model: [] Mechanical Line Leak Detector. Model: LD-2000 [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill/High-Level Sensor. Model: MAG-1 [] Tank Overfill/High-Level Sensor. Model: ] Other (specify equipment type and model in Section E on page 2). [] Other (specify equipment type and model in Section E on page 2). ~,ispenser iD. 1/z L)lspenser IL): //0 r'x'] Dispenser Containment Sensor(s) Model: 352 [] Dispenser Containment Sensor(s) Model: 352 I[] ShearValve(s). ~ ShearValve(s) [] Dispenser Containment Float(s) and Chain(s). '~ Dispenser Containment Float(s) and Chain(s). ulspenser IL): ~/4 Dispenser IL): '~q Dispenser Containment Sensor(s) Model:352 ~] Dispenser Containment Sensor(s). Model: '~ ShearValve(s). '~ ShearValve(s). ~] Dispenser Containment Float(s) and Chain(s). ~ Dispenser Containment Float(s) and Chain(s). Dispenser ID: 5/6 Dispenser ID: ~ Dispenser Containment Sensor(s) Model:352 ~] Dispenser Containment Sensor(s). Model: '~ ShearValve(s). '--] ShearValve(s). r~ Dispenser Containment Float(s) and Chain(s). ~] Dispenser Containment Float(s) and Chain(s). * If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this certification is information (e.g manufacturers' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): System set-up report; r~ Alarm history report p~ PRINTED NAME:RICHMOND PHILLIPS SIGNATURE: ":~;~"';:""'":':" '~''' '""~':"~'?' COMPANY: Tanknology PHONE NO: (800) 800-4633 page 1 of 3 Based on CA form dated 03/01 onitoring System Certification Site Address: MARKET # 2133 Date of Testing/Sewice: 02/20/2002 SWC CALLOWAY DRIVE D. Results of Testing/Servicing softWare Version Installed: 121.00 Complete the following checklist: [] Yes [] No * Is the audible alarm operational? [] Yes [] No* is the visual alarm operational? [] Yes [] No * Were all sensors visually inspected, functionally tested, and confirmed operational? ]Yes Were all sensors installed at lowest point of secondary containment and positiOned so that other equipment will not No interfere with their proper operation? [] Yes [] No * [] N/A If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment [] Yes [] No * [] N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (check all that apply) [] Sump/Trench Sensors; [] Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? [] Yes [] No [] Yes [] No * [] N/A For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e.: no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill points(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger?. % [] Yes*' [] No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the ~ manufacturer name and model for all replacement parts in Section E, below. [] Yes* [] No Was liquid found:inside any secondary containment systems designed as dry systems? (check all that apply) [] Product; ~ [] Water. If yes, describe causes in Section E, below. [] 'Yes [] No ..... Was monitoring System set-up reviewed to ensure proper settings? Attach set-up reports, if ap'pli~:able.' [] Yes [] No * Is all monitoring equipment operational per manufacturers' specifications? · In Section E below, describe how and when these deficiences were or will be corrected. E. Comments: page 2 of 3 i~)nitoring System Certification Site Address: MARKET # 2133 Date of Testing/Service: 02/20/2002 SWC CALLOWAY DRIVE F. In-Tank Gauging I SIR Equipment [] Check this box if tank gauging is used only for inventory control. [] Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: [] Yes []No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? [] Yes [] No * Were all tank gauging probes visually inspected for damage and residue buildup? [] Yes []No* Was accuracy of system product level readings tested? []Yes []No* Was accuracy of system water level readings tested? [] Yes [] No * Were all probes reinstalled properly? [] Yes [] No * Were all items on the equipment manufacturers' maintenance checklist completed? · In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): [] Check this box if LLDs are not installed. Complete the following checklist: For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [] Yes [] No* [--']N/A (Check all that apply) Simulated leak rate: [] 3 g.p.h [] 0.1 g.p.h []0.2 g.p.h [] Yes [] No * Were all LLDs confirmed operational and accurate within regulatory requirements? [] Yes [] No * Was the testing apparatus properly calibrated? [] Yes [] No * [] N/A For mechanical LLDs, does the LLD restrict product flow if it detects a leak? [] Yes r--]No * [] N/A For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? [] Yes []No * [] N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled or disconnected? [] Yes []No * [] N/A For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions or fails a test? [] Yes []No * [] N/A For electronic LLDs, have all accessible wiring connections been visually inspected? r--'] Yes E~No * Were all items on the equipment manufacturers' maintenance checklist completed? · In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: page 3 of 3 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 02/20/02 WORK ORDER NUMBER3121028 CLIENT:7-ET.'mV-~N, INC. SITE: 7-ELEVEN #32241 C3C~ VENTS o o o SUP Ul Printed 03/06/2002 08:34 SBOWERS ' W~'ork Order: 3121028 .:.::DI S¥~E~:!.~: BEC UR I P~ CODE:..: OOOOOO T~olo~-~E 8900 Shoal Creek, Build~g 200 Aust~, Texas 78757 " W~rk Order: 3121028 STP:: Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ~ W~)rk Order: 3121028 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 ~ W~)rk Order: 3121028 :.:::: 5:,::0 i..i..i~'.'~E Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 3121028 :: · · ~"~'Y'~:Ii'!. '"!' !J:!~'i~::i'. !::.¢(7i.:;i? .~,~%Ri:lI'!,i(;; ............ L 7;::'ii:!?.' I--':i ~ H:.?~i'si'rC;.~?? ;:~::, ..,,,~,...ii. ~,:. ~ .:.-;:.. ~ .............. .. i'.KI (.~.i: L.'..' :'X.i :~ TSi':Ji:; :':< *:'::i :': OE(;' ~':: i ::: :i :::1':.¥ :::" :~(.':'L.L:!%:' = 4:0:1 i:]: ::;ii;il:i:::: ::'::::B ':.::~'.': .. ?:.'.? Tanknology-NDE 8900 Shoal Creek, Building 200 Austin, Texas 78757 Work Order: 31.2 ....... l ¢~'-"l't:~K. [~[~'1 ......... T I FEB ~ '? :, t,~,T'2 6, 200! 9~C:18 ~M 'f'.~"~:;h[~L ........... !!,4'.~,r. AI-4:,~ ALA'.;f~4 ..... . ......... ~..,~.~.,¢~.~ ~.~,~r' ~ [-[, ~:..~u~:~: ....... T~olo~-~E 8900 Shoal Creek, BuildMg 200 AustM, Texas 78757 Work Order: .312:1.028 :~.~ U~i.~ L~: ..; ~. <.,,-,~ &L~f~i~ ........... ~Z', T~olo~-~E 8900 Shoal Creek, Bulldog 200 Aust~, Texas 83/04/2002 15:22 5i238072i5 TANKNOLOGY PAGE 82 8900 SHOAL CREEK. BUILDING 200 AUSTIN, TEXAS 78?57 (512) 451-6334 FAX (512) 459.145g TEST RESULT SITE SUMMARY REPORT TESTTYPE: TLD-1 PURPOSE: COM3~T.IANCE TF,,%T DATF,.'. 02/20/02 CUSTOMER PO'. wc WORK ORDER NUMBER: 3121028 CLIENT: 7-~.L~.VEN, INC. SITE: 7-~.L~VEN #32241 10220 S.W. G~E~G RO~ ~T" 2~33 t PORT~, OR 97223 ~RSFIE~, ~ 93312 BOB DENI~O ~AGER (503) 977-7713 (805) 555-1212 The 'i%11ow{ng test(s) were canducmd at thc site above in ~,ccordanc¢ with all ~plicabl¢ portinns o'E Federal, NFPA and local resulation$ Line and Leak Detector Tests 10k 1 PEG UNLEAD 0.000 10k 2 PP.~MIUM 0.000 P Y P Y 10k 3 MIDGRADE 0. 000 P Y P Y Tnnknolo~:y apprcci,'tte,~ thc oppnrttmlt'y to sc~¢ you. ~d looks ~o~td ~ w~i.F wtfl~ you ill the future, Pl~lsc call any tim~, 8~y or nigl~t, when you nc~d us. Tanknology representative: Se~ices conducted by: .... ~N M2~ON RZC~ Reviewed: Technician Cedifi~tion Number: Draft 03/04/2002 15:11 MFRISK 03/04/2002 15:22 5i23807215 TANKNOLOGY PAGE 13 ~ii~lm lr"arl~ Or MONITORING SYSTEM CERTIFICATION Use By Al~ Jun'sdic~ions Within the S~te of Califo~ AutlTodt~ Ci~d: ~epter 6, 7, Nealth and Salty Code: Chap~r 16. Division 3 Title 23, Call.mia Code of Regulations T~is ~rm m~t be used to documEnl lasting and ~e~clng O~ monl~rlng equJ~ent. If mo~ than one monitorl~ s~em ~ntrol p~net is instal~ at the taclll~, ee~ir~on or repod mua~ be prepared for each m0~lRq s~te~Qt~i~3~el_by t~e te~ni~an whD ~edo~s Ihs ~, A COpy ~f {~is ~rm must ~e ~rovlded ~ t~e ~nk system ~nedoperstor. The ownEr/operator must Subml[ 3 ~py 0[ t~iS f0~ lO t~e 1o~1 ageney regulating UST ~ems wlt~i~ 30 Oa~ ~ ~st d~ A. General In[ormatlon Facility Name: 7-ELEVEN ~32241 Ci~; ~KERSFIELD CA Zip: 93312 Si[e Add ~ss: MARKET ~ 2133 Conta~ Phone No: 555.121~ SWC ~LLOWAY DRIVE Date ofTestlng/Se~ice: 02~0/2002 Facility Contact P~rson: MANAGER MakelModel of Monitoring System: TLS-350 Work Order Number: 3121028 B. Invento~ of Equipment. TestedlCe~lfled Check ~e appropriate boxes to Indicia spedflc ~ulpment inspectedlse~i~d nk ID: 1 Tank ID: 2 in-Tank Gauging Probe Model: MAG-1 .~ In.Tan~ Gauging Pmk. Model; MAG-1 }~ Annular Space or Vault Sensor, Annular Space orVault Sensor. Moael: 4~0 Mode~: 420 Piping Sump~rench Sensor(s) Model: 352 ~ Piping Sump~ren~ Sensor(s), Model 352 FJ~J Sum0~ensor(s~' - ' M~el: ~'F~II $um~ Sen~r(sJ. ~ Mechanical Line Leak D~{ector. M~el: LO-2000 ~ Mechanical Line ~ak Dete~or, M~del: LD-2O00 EJ~[ronic Line Leak Detect~r Model; ~ Electronic Line ~ak De[scar. M~del: ~ Tank Ove~ll/Hlgh-l.evelSensor. Model: MAG-1 ~ Tank Ove~lFHig~LevelSenaor Model: MAG-1 ~ Other (specl[y ~ulpme~t ~pe ant moael in ~c~on E on ~e 2). ~ Other [s~eciN ~ulpmeflt ~De and model In SecUon E on ~ge 2), Tank ID: 3 Tank ~ in-Tank Gouging P~be, Mo~el: MAG-1 ~ In-TankGauging Pr~e, Model; ~ Annular Space or Vault Sensor. Model: 420 ~ Annular Space orVauit Sensor, MoOel: Piping Sump~rench Sensor[~) Model; 352 ~ Piping $ump~rench Sen~r(s). Modal: RIt Sump Sensor(s) M0~eh ~ Fill Sump Sensor(s). Model: Mec~ani~l Line Lesl( Defacer. Model: L~2DOD ~ Meeani~l Line I.eak De~ctor, Ele~[mnic L~ne Leak Detector. Model: ~ Electronic Line Le~ D~tor. Model: T3~k Ovediit/Hlgh-Level Sensor Modek MAG-1 ~ Tank ~effilllHIg~-Level Sen~r. M~el: ~her (sp~l~ equipment b/po and m~el In Se=Ion E on ~age 2), ~ ~ner (sp~l~ g~uipment ty~ an0 model in S~ion E an page 2). Dispenser ID: .J.(2 Dispenser ID: 7/{ ~ Dispenser ContainmentSenaDr(e) Model: 352 ~ Dispenser Conlalnm~tSensor(s) Mo~el'. 352 ~ SheerVarve(s) ~ Shearval~(s) ~ Dispenser Containment Float(s) an~ Chain(s). ~ Dispenser Conlatnmenl Float(s) and Chg)n(s), Dispenser ID: 3/4 D~penser ID: ~ Dispenser ComalnmentSenscr(s) Model: 352 ~ Dispenser Con~inment Sensor{s), Medal: ~ Sne3r valve(s). ~ Shear Valve(s). ~ Dispenser Con.inmont Float(s) and Chain(s). ~ Dlsaenser ~n~tnment Float(s) and Chain(s) Dispenser ID: 5/6 Dispenser ~ Dispenser Con~inment Sensor(s) Modek 352 ~ DIspenserCon~lnm~t Sense(s). MOael: ~ ShearValve(s), ~ SnearValve(s), ~ Dis~enaer, Containment Float(s) and Chain[s), ~ DIs0enser Con.inmont R~l(s) an~ ' I~ the facility contains more tanks or disgensem, ~py this form. Include info.etlon for eve~ ~nk and dispenser at the facility. C; Codification "~_I ce~i~ that the e~uipment identified in this document was Ins~ected/sewlced in accaraan~ with the manu~u~m' guidelines. Attached to this codification Is Information (e.g menufa~urem' checklists) necesea~ to veri~ that this in~rmation is correct. and a Sl~ Plan showing the layout of monitoring equipment, For any equipment capable of generating such repo~s, I have also affe~ed '- a copy of the (Check all that a~ply): Sy~em set-up repo~; ~ Alarm h~to~ repo~ .,.. ~." ~-~' , PRINTED NAME:RICHMOND PHILLIPS SIGNATURE: '~:' ' ' .... COMPANY; Tenknology PHONE NO: (800) 80¢4633 p3ge 1 of 3 Bas~ on CA form dated 03/01 83/84/2882 15:22 5123887215 TANKNOLOGy PAGE. 14 ~[onitoring System Certification Site Address: MARKET # 2133 Date of Testing/Service: 02/20/2002 SWC CALLOWAY DRIVE D. Results of TestinR/Servicing $ofl'~rcVersion Installed'. 121.00 Complete tile I'ollowln[ checldisr: J~Ycs [~ No ' Is the audible alarm operational? [] Ye., [~ No* IS the visual alarm °peratlona~? [] Yc.~ [] N,, · Were ell sensors visually inspected, functiona!ly, tested, and confirmed operational? [] ¥~ [] No* Were all sensors installed at lowest point of secondary containment and positioned so that oi~er equipment will not interfere with their proper operation? [] 'r'c., [] N~ · ~ N/^ If alarms are relayed to e remote monitoring station, is all communications equipment. [e.g. modem] operational? For pressurized piping systems, does the turbine automaiically shut down if the piping secondary containment [] ¥~... [] ~,, · [] N/^ monitoring system detects a leak, fails to__operate, or is elec-[rlcally disconnected? If yes: which sensor~ Inltiate positive shut-down? (check all that apply) [] Sump/Trench Sensors: IxI Dispenser Containment Sensors. Did you confirm Positive shut-down due to leaks and sensor failure/disconnection? [] Yc~ [~ No [] Yc.~ [] N(~ · [] Wf^ For tank systems that utilize the mon~orlng system as the primary tank overfill warning device (I.e.; no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible et the tank fill points(s) and operating properly?. If so. at what percent of tank capacity does the alarm trigger? % [] Ye..* [] Ne Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and Fist the manufacturer name end model for all replacemerrt parts in Section E, below. [] Yc.~' [] N,, Was liquid found inside any secondary containment systems designed asdry systems? (check all that apply) [] Product: [] Water. If yes, describe causes in Section E. below. [] ¥¢.~ [] ~, * Was monitoring system set-up reviewe<f to ensure proper settings? Atfach set-up reports, if applicable. [] Yc~ [] No ' Is all monitoring equipment operational per manufscturel'S' specifications? "[n Section E b¢]o~. (Icscrih¢ how ~nd. when these dcficicncc~; wcrc or will bc corrected. Comments: 83/84/2882 15:22 5123887215 TANKNOLOGY PAGE 15 ? ~onitorin~ System Certification Site Address: MARKET # 2133 Date of Testing/Service; 02120/2002 SWC CALLOWAY DRIVE F. In-Tank Gauging / SIR Equipment [] Chec~ this box If tank gauging is used only for Inventory control. [] Check this box if no tank gauging or SiP, equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leek detection monitoring. Complete tile ¢ollowi~tE ~:heckIisl: [] ¥c~ [] ~- Has all input wiring been tnspe~d for proper ent~ and termination, including testing for ground fault? ~ Y~: ~o - Were afl rank gauging probes visually inspe~ed for damage and ~si~ue buildup~ ~ y~, ~ No · Was accuracy of system product level readings msted~ ~ v~, ~ N,, ~ Was ac~racy of system wamr level readings tested? ~ y~, ~,,, We~ all probes rein~mtl~ properlyq ~ v~ ~,. Were all items on the equipment manu~urers' main~nance checklis[ comple~d~ ' In the Se~ion H, below, describe how and wl~en these deflclen¢~ were or will ~e corrected. G. Line ~eak Detectors (~D): ~ Check this box if LLDs a~ not installed. Complete the followin~ check~l¢l: ~ ~, ~ ~ * ~N/A For eauipment sta~-up or annual equipment ~lflcatlon. was a leak simulated to veri~ LLD pedormance? (Check all th~ apply) Simulated leak ~[e: ~ 3 g.p.h ~ 0.1 g,p.h ~0.2 g.p.h ~ Ycs ~ No ' Were all LLD~ ~nfirmed o~eretlonal snd accurate w~hin.., r~ulato~ requiremen~ ~ V~ ~,," Was the testin~e.ppa~tus ~ropedy calibrate? ~ Y~s ~N~' ~ N/A For meaantcal LLDs. does the LLD restrict product flow if it deters a leak? :~ Ye~ ~No" ~ N/k For electronic LLDs. does the turbine automatically shut off if the LLD detec~ a leak? ~ ~, ~N,* ~ ~/,~. For electronic [.LBs, does the tu~ine automati~lly shut off if any podlon of the monitoring s~tem is disabled or disconnected? ~ Yes ~o · ~ N/A For elect~nic LLDs, does the turbine automatically shut off if any po~ion of the man,taring system malfunctions or ~ils a tes~ ~ v~, ~o' ~ ~/A For ele~ronlc LLDs, have all a~essi~le wiring connections Oeen visually Inspected? ~ ve~ ~go · Were sll items on the' equipment manu~umrs' maintenance aeckllst ~mpleted? ' In t~e Section H. below, des¢ibe how and when these deflaencles ~re or will be core,ed H. Comments: page 3 or3 D February 20, 2002 Bob Deninno 7-11. P O Box 711 Dallas, TX 95221-0711 CERTIFIED MAIL FIRE CHIEF NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RON FRAZE RE: Failure to Submit/Perform Annual Maintenance on Leak Detection ADMINISTRATIVE SERVICES System at 7-11,525 W. Columbus, B~tkersfield, CA., 7-11, 3601 2101 "H' Street Bakersfield, CA 93301 Stockdale Hwy, Bakersfield, CA., 7-11, 410l Calloway, Bakersfield, CA VOICE (661) 326-3941 FAX (661) 395-1349 7-11, 9600 Brimhall, Bakersfield, CA SUPPRESSION SERVICES Dear Mr. Deninno: 210t 'H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Our records indicate that y6ur annual maintenance certification on your leak FAX (661) 395.1349 detection system is past due. February 1, 2002, February 19, 2002, February 23, PREVENTION SERVICES 2002, February 23, 2002. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661)326-3951 YOU are currently in violation of Section 26410) of the California Code of FAX (661) 326-0576 Regulations. ENVIRONMENTAL SERVICES "Equipment and devices used to monitor underground storage tanks shall be 1715 Chester Ave. Bakersfield, CA 93301 installed, calibrated, operated and maintained in accordance with manufacturer's VOICE (661) 326-3979 FAX (661)326-0576 instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 YOU are hereby notified that you have thirty (30) days, March 22, 2002, to eithe~ VOICE (661) 399-4697 pcrform or submit your annual certification to this office. Failure to comply will FAX (661) 399:5763 result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Port Jr., Assistant City Attorney ..13 Postage 13'1 Certified Fee J3 Return Receipt Fee Postmark ~ (Endorsement Required) Here 3. [~r~~~:~: ........................................................... ... '&~;::..~:':: .,~,,'?. :'-' ;4 '.:~.~' "'::';.,g";:,:~;;~-:.'{,';'..-'~'.:~i:'ii-:.-:"-.",: · Compl~' 1, 2, and 3. Also complete -~~~ item 4 if:i~stricted Delivery is desired. .i · Print youi' name and address on the reverse C. Signature // , ~:_~ ~ -"~ ,~' so that we can return the card to you. ~~~ I A~tach this card to the back of tho mailpiece, X ~_~j ~., T.. ~1.~ gent ~'~.. or on the front if space permits. Addressee ~C~,.. D. Is delivery ad~ different from item 17 [] Yes · ".';;' ':i "'7 ' 1. Article Addressed to: .... ~'~1~I1~1-~O ;.,.If YES,~delivery address below: [] No BOB /, P 0 BOX 7i 1 3. Service Type ])ALLA.q, '1~ 95221 -0711 [] Certified Mail [] Express Mail P.E: 525 ~ COLOHBOS, 3601 [] Registered [] Return Receipt for Merchandise OCI~.~T.~ a'tv-Y, 4101 CAI,LO'JAY, [] Insured Mail [] C.O.D. O0 ~R'T~AT.T. (9600) 4. Restricted Delivery? (Extra Fee) [] Yes A~tic~(~r~be~(.~'~str~)r~)~wc~)~)--- ---- ----"" 7714 2. PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 8900 Shoal Creek Bird, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 10/2212001 Date Printed and Mailed: 10/25/2001 Order Number: 3119274 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 SWC CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Stage II A/L tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting A/L VACUSMART - Stage II Vapor Recovery Testing Results Facility Name: 7-ELEVEN #32241 Testing Using Facility Address: MARKET # 2133, BAKERSFIELD, CA. Hasstech Vacusmart Test Date: 10/22/2001 Alternative to TP-201.5 Work Order: 3119274 Test Unit S#: vs-0029 Testing Tech: Richmond Phillips Air District: SCAQMD Representative: System Type: V^PORVAC Disp# Grade A/L GPM P/F Comments i 87 '1.'12 6.35' P emco a4500 "' 1 91 1.07 8.35 P I 89 1.08 8.34 P 2 87 1.02 6.40 P 2 91 1.03 7.80 P 2 89 1.03 8.13 P 3 87 0.98 7.50 F adjusted pump 3 87 1.15 7.27 P 3 91 1.10 8.27 P 3 89 1.12 8,00 P 4 87 1.10 7.50 P 4 91 1.07 8.27 P 4 89 1.07 8~34 P 5 87 1.05 9.05 P 5 91 1.09 8.34 P 5 89 1.08 8.20 P 6 87 1.03 8.88 P : 6 91 1.08 8.20 P 6 89 1.06 8.06 P 7 87 0.98 9.14 F adjusted pump 7 87 1.06 9.23 P 7 91 1.14 9.64 P 7 89 1.17 8.34 P 8 87 1.09 9.19 P 8 91 1.09 8.49 P 8 89 1.11 8.27 P Page 1 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 10/22/01 WORK ORDER NUMBER3119274 CLIENT:7-ET.'~.'v'~N, INC. SITE: 7-ET.~:V"E,N #32241' N CCO VENTS ~o~'~ ~O.a,_,_ (~ ~ ~ PLUs SUP UL Printed 10/25/2001 07:27 SBOWERS 7-11 32'-241 4101 PAI_.LC.[,.IAY BA}..iERSF l ELD · C,'q 93312 B03:~:411 ~205001 ,:3CT 19. 2001 10:06 AM S"~"S'FEPi S"Fe-fl']_i~ REP" ALI_ FdI',K.':T1Cq'.E3 I {,I',.,,'E NTO F:V F:EPORT T 1 :RUL ',,/OLUHE = 5405 ULLAGE = 4625: GALS 9f3'.~.;i: I..IL[.A,]E= 362t') GALS TC ',,,,'OLtJHE = 5340 GALS HEIGHT = 50.94 INCHES ~,,,WI'EF~ ',,,~,'.)L = 0 GALS b~'i'ER : 0. O0 I I'.ICHES TEMP = 00,0 DEG F T 2:HdL ',,,,'0 L I_IME = 4258 GALS ULLAGE = 5770 OALS 90~:',. UL.[.A'i;E= ;~,767 ,'.'_-;ALS T(; ',,/OL_UI"IE = 4200 HEIGHT = 42.30 WATER 'v',',) L = 0 I.,..{eYTER = 0. O0 1NCHES TEi'"IP = 82.5 DEG F T :3 :SUL ',/OLUNE = 40'79 (];ALS ULLAC-;E = 5949 (]ALS 00% ULLA'.]E= 4946 GALS TC 'v":I','L,LIP1E = 4025 GRLS HEIGHT = 40.94 I.I',ICHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEI"ll:.' = St. 8 DEG F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ? ~[¢~lz\ INSPECTION DATE i Section 2: Underground Storage Tanks Program ~l Routine ~ Combined [] Joint Agency [] Multi-Agency [21 Complaint [] Re-inspection Type of Tank 13C0~-C.~ ~ Number of Tanks ~ Type of Monitoring ~'Lt4't Type of Piping _lq¢o .I~ OPERATION C V COMMENTS Proper tank data on file / Proper owner/operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current ~ ~/ Failure to correct prior UST violations"~('"'// Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank' Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=CompliancTq~V=Violation Y=Yes N=NO Inspector: ,/}d.~_.~t~ ~ _/~-'~'} ~S Office of Environmental Services (805) 326-3979 ible Party . White - Env. Svcs. Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME "7. ~'.lel~e' iA INsPEcTION DATE I'~)/I q/Ot ADDRESS qlrJ! Ottflow,t, PHONE NO. ~'g9" 8~¢,',',qg ' "' FACILITY CONTACT t BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES ~,~ Section 1: Business Plan and Inventory Program [~ Routine ~ Combined [~ Joint Agency [~ Multi-Agency ~ Complaint ~} Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy ~, / Verification of inventory materials / Verification of quantities Verification of location L, / Proper segregation of material Verification of MSDS availability Verification of Haz Mat training / Verification of abatement supplies and procedures Emergency procedures adequate ~,. / Containers properly labeled [.~ / Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes X~No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site3Responsible Party wn~te- E,,. S,~s. W,ow - Statio, Co~,y Austin, Texas 78757 ~('K' '~'~ ( Phone: (512)451-6334 Fax: (512) 459-1459 KEF~N/O"'~.:.~L~I ROMENTAL HEALTH 2700 M STREET SUITE 300 BAKERSFIELD, CA. 93301 Test Date: 02/23/2001 Date Printed and Mailed: 03/08/2001 Order Number: 3115701 Dear Regulator, osed are the r,~sults of recent testing performed at the following facility: // 7-ELEVEN #32241 MARKET # 2133 . BAKERSFIELD, CA. 93312 '~t. ing performed: be~ector test~~- Line test~- - Monitor certifications -- IIII II Sincerely, Dawn Kohlmeyer Manager, Field Reporting CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING ~ · Tank~o/ogy 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TLD-1 PURPOSE: COMPLIANCE TEST DATE: 02/23/01 CUSTOMER PO: WB03050843 WORK ORDER NUMBER: 3115701 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 10220 S.W. GREENBURG ROAD MARKET # 2133 SUITE 470 SWC CALLOWAY DRIVE PORTLAND, OR 97223 BAKERSFIELD, CA 93312 BOB DENINNO MANAGER (503) 977-7713 (805) 555-1212 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 10k 1 REG UNLEAD 0. 000 P Y P Y 10k 2 PREMIUM 0. 000 P Y P Y 10k 3 MIDGRADE 0. 000 P Y P Y Tanknology appreciates the opportunity to serve you, and looks for~vard to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: KEN MINTON RICt~qOND PHILLIPS Cf. ...?. .......... .,~:.:.,:.-.'.>,:- ?..... ,: ....... ,....~.....~:}~.:~ Reviewed: Technician Certification Number: 91-1071 Printed 03/08/2001 08:51 KOHLMEYER [ INDIVIDc . L TANK INFORMATION Ahcr, EST RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115?01 CLIENT:7-ET.~.VEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-ET.~.~N #32241 Tank ID: [Ok 1 Tank manifolded: NO Bottom to top fill in inches: 157.0 Product: Ms trz~7_J~ Vent manifolded: No Bottom to grade in inches: 161.0 Capacity in gallons: 10,000 Vapor recovery manifolded: ~css Fill pipe length in inches: 62.0 Diameter in inches: 95.00 Overfill protection: ~s Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: Y~S Stage I vapor recovery: DUJ~L Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #t L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~O~.L~.SS Model: ~2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: ,/, Inclinometer reading: Open time in sec: 4. oo Holding psi: 12 VacuTect Test Type: NOT Resiliency cc: 18o NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: 189.0 TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 12: 30 TESTED TESTED TESTED End time: 13: 00 Final gph: o. 000 Result: PASS Pump type: PRESSURE Pump make: F~ PETRO COMMENTS Impact Valves Operational: YEs Printed 03/08/2001 08:51 INDIVIDo' L TANK INFORMATION EST RESULTS TEST DATE: 02/23/01 8900 SHOAL CREEK. BUILDING 200 WORK ORDER NUMBER3115?01 CLIENT: 7-ET.'~.V~N, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-~..T.'~.~v~N #32241 Tank ID: 10k 2 Tank manifolded: NO Bottom to top fill in inches: 159.0 Product: PI~MIOM Vent manifolded: NO Bottom to grade in inches: 163.0 Capacity in gallons: 10,027 Vapor recovery manifolded: ~'~s Fill pipe length in inches: 64.0 Diameter in inches: 95.00 Overfill protection: Y~s Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: 'z-ss Stage I vapor recovery: DU~.L Material: DW STEEL Installed: ATe Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~O~.SS Model: z,o2ooo Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. oo Holding psi: VacuTect Test Type: NOT Resiliency cc: z?o NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: leg. o TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: P~ss Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi:): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 12: 30 TESTED TESTED TESTED End time: 13: 00 Final gph: 0.00o Result: PASS Pump type: P~s so-z~ Pump make: ~ P~.T~O COMMENTS Impact Valves Operational: ~s Printed 03/08/2001 08:51 INDIVIDO'AL TANK INFORMATION AND' -EST RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK. BUILDING 200 WORK ORDER NUMBER3115701 CLIENT: 7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ELEVEN #32241 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 156.0 Product: MIDC-RAD~.. Vent manifolded: No Bottom to grade in inches: 160.0 Capacity in gallons: 10,027 Vapor recovery manifolded: YEs Fill pipe length in inches: 61.0 Diameter in inches: 95.00 Overfill protection: YEs Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: YEs Stage I vapor recovery: DUAL Material: DW STEEL Installed: ATe Stage II vapor recovery: ASSIST CP installed on: ! ! COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~ORL~.SS Model: LD2000 Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. oo Holding psi: VacuTect Test Type: NOT Resiliency cc: z65 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: zeg. o TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: mASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 12: 30 TESTED TESTED TESTED End time: 13: 00 Final gph: 0. 000 Result: PASS Pump type: PRE S Sb-~E Pump make: ~s PETRO COMMENTS Impact Valves Operational: YEs Printed 03/08/2001 08:51 SITE DIAGRAM ~1~ 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 02/23/01 WORK ORDER NUMBER3115701 CLIENT:7-ELEVEN, INC. SITE: 7-ELEVEN #32241 N © VENTS ~ o · PLU ,., SUP UL ,'- (~ S Printed 03/08/2001 08:51 KOHLMEYER MONITOR CERTIFICATION FORM CUSTOMER: 7-ELEVEN, INC. SITE I.D.: 7-ELEVEN #32241 DATE: 0212312001 ADDRESS: MARKET #2133 SWC CALLOWAY DRIVE WORK ORDER: 3115701 BAKERSFIELD, CA 93312 1) IN TANK PROBES MANUFACTURER: tidel MODEL NUMBER: 3500 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): NO LAST TEST DATE: / / PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( YIN ): YES COMMENTS: 2) OTHER PROBES: MANUFACTURER: tidel MODEL: 3500 NUMBER OF LIQUID, FLOAT. SW POSITIVE SHUT FAIL SAFE ( YIN ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOR DOWN (Y/N) (Y/N) ANNULAR PROBE 3 LIQUID NO NO YES TURBINE~ SUMP 3 FLOAT NO NO YES FILL SUMP FIBERTRENCH MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 MONITOR CERTIFICATION FORM (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL · NUMBER OF SENSORS: MECH. LEAK DETECTOR ( YIN ): YES MECH. LEAK DETECTOR OPERATIONAL ( YIN ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WITH THE SIMULATED LEAK TEST ( YIN ): NO POSITIVE SHUT DOWN (Y/N):. NO OPERATIONAL ( YIN ): YES 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( Y/N ): NO ( YIN ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES ...~:."::.-. :/ . :': ...... .~:, ~,..,':. RICHMOND PHILLIPS :? .......... , .......... / ~.~'.,~.:.;:~:~, ',-.. ...... TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 ,,ii Tan o#ogy 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 02/23/2001 Date Printed and Mailed: 03/08/2001 Order Number: 3115701 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 SWC CALLOWAY DRIVE ,:,J { 0 ~ ~x-([euo~-~I BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor certifications · I Sincerely, Dawn Kohlmeyer Manager, Field Reporting CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TLD-1 PURPOSE: COMPLIANCE TEST DATE: 02/23/01 CUSTOMER PO: WB03050843 WORKORDER NUMBER: 3115701 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 10220 S.W. GREENBURG ROAD MARKET # 2133 SUITE 470 SWC CALLOWAY DRIVE PORTLAND, OR 97223 BAKERSFIELD, CA 93312 BOB DENINNO MANAGER (503) 977-7713 (805) 555-1212 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests iOk 2 ~I~ 0,000 ~ lOk 3 HIDG~g O, 000 ~ Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: KEN MINTON RIC~OND PHILLIPS Reviewed: Technician Certification Number: 91-1071 Printed 03/08/2001 08:45 KOHLMEYER INDIVIDOmL TANK INFORMATION ANo--J EST RESULTS TEST DATE:02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115701 CLIENT: 7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ELEVEN #322 41 Tank ID: 10k i Tank manifolded: NO Bottom to top fill in inches: 157.0 Product: REG UNLEAO Vent manifolded: NO Bottom to grade in inches: 161.0 Capacity in gallons: 10,000 Vapor recovery manifolded: YEs Fill pipe length in inches: 62.0 Diameter in inches: 95.00 Overfill protection: YEs Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: YEs Stage I vapor recovery: DUAL Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: ! ! COMMENTS Start (in) End (in) II Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VA~ORL~.SS Model: LD2000 Ingress Detected: Water Bubble Ullage Test time: S/N: n/a Inclinometer reading: Open time in sec: 4. oo Holding psi: 12 VacuTect Test Type: NOT Resiliency cc: 18o NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: 189.0 TESTED Pressure Set Point: Metering psi: 10 Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: ' Results: mASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVTROFLEX Diameter (in): 2.0 Length (ft): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 12: 30 TESTED TESTED TESTED End time: 13: 00 Final gph: 0. 000 Result: PASS Pump type: PRESSURE Pump make: ~1~ PETRO COMMENTS Impact Valves Operational: YEs Printed 03/08/2001 08:45 TEST DATE: 02/23/01 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115"/O]. CLIENT: ?-~.:L~V~i~', II~'C. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: Tank ID: ].Ok 2 Tank manifolded: No Bottom to top fill in inches: ].59.0 Product: P~I~m! Vent manifolded: No Bottom to grade in inches: ].63.0 Capacity in gallons: ].0, o2? Vapor recovery manifolded: Y~s Fill pipe length in inches: 64.0 Diameter in inches: 95.00 Overfill protection: ~J~s Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: us Stage I vapor recovery: DUkT~ Material: DW S'Z~,L Installed: ATG Stage II vapor recovery: ASSIST CP installed on: COMMENTS Dipped Water Level: Start (in) End (in) II New/passed Failed/replaced New/passed Failed/replaced' Dipped Product Level: L.D. #1 L,D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: w~a~o~.ss Model: L~2000 Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. oo Holding psi: 3.6 VacuTect Test Type: NOT Resiliency cc: VacuTect Probe Entry Point: T~ST~D Test leak rate mi/m: zeg.o TESTED Pressure Set Point: Metering psi: Tank water level in inches: Calib. beak in gph: 3. oo Water table depth in inches: Results: pass Determined by (method): Result: COMMENTS COMMENTS Material: ~.z,~'I ROF:r_~X Diameter (in): 2.0 Length (ft): 2O0.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: ].2: 30 TESTED TESTED TESTED End time: 13: 00 Final gph: 0. ooo Result: PASS Pump type: P~ s so1~, Pump make: COMMENTS Impact Valves Operational: Printed 03/08/2001 08:45 INDIVIDUAL TANK INFORMATION ANLr I EST RESULTS TEST DATE:02/23/0'I 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3115701 CLIENT: 7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE:7-ELEVEN #32241 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 156.0 Product: MTDGZ~J:)E Vent manifolded: NO Bottom to grade in inches: 160.0 Capacity in gallons: 10,02 7 Vapor recovery manifolded: ~s Fill pipe length in inches: 61.0 Diameter in inches: 95.00 Overfill protection: HZ'SS Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: Y~S Stage I vapor recovery: DUAL Material: DW STE~.~. Installed: ATG Stage II vapor recovery: ASSr'ST CP installed on: / / COMMENTS Start (in) End (in) Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced Dipped Product Level; L.D. #1 L.D. #1 L.D. #2 L.D. #2 Probe Water Level: Make: VAPOR~ESS Model: Lb2000 Ingress Detected: Water Bubble Ullage Test time: S/N: Inclinometer reading: Open time in sec: 4. oo Holding psi: VacuTect Test Type: NOT Resiliency cc: z6s NOT VacuTect Probe Entry Point: T'~S'[3~D Test leak rate mi/m: les. o Pressure Set Point: Metering psi: ~o Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: pass Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (ft): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 12: 30 TESTED TESTED TESTED End time: 13: 00 Final gph: 0. o00 Result: PASS Pump type: PRES Sb-tU~ Pump make: FE P~.TRO COMMENTS Impact Valves Operational: YEs Printed 03/08/2001 08:45 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 02/23/01 WORK ORDER NUMBER.31].5'701 CLIENT:7-~..T.~.~'BN, INC. SITE: 7-ELEVEN #32241 ~ VENTS E SU~ UL Printed 03/08/2001 08:45 KOHLMEYER MONITOR CERTIFICATION FORM CUSTOMER: 7-ELEVEN, INC. SITE I.D.: 7-ELEVEN ~L32241 DATE: 0212312001 ADDRESS: MARKET # 2133 SWC CALLOWAY DRIVE WORK ORDER: 3115701 BAKERSFIELD, CA 93312 1) IN TANK PROBES MANUFACTURER: tidel MODEL NUMBER: 3500 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): NO LAST TEST DATE: I / PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( YIN ): YES COMMENTS: 2) OTHER PROBES: MANUFACTURER: tidel MODEL: 3500 NUMBER OF LIQUID, FLOAT. SW POSITIVE SHUT FAIL SAFE ( YiN ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOF DOWN (Y/N) (Y/N) ANNULAR PROBE 3 LIQUID NO NO YES TURBINE SUMP 3 FLOAT NO NO YES FILL SUMP FIBERTRENCH MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 MONITOR CERTIFICATION FORM (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL' NUMBER OF SENSORS: MECH. LEAK DETECTOR ( YIN ): YES MECH. LEAK DETECTOR OPERATIONAL ( YIN ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): NO TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WlTHNo THE SIMULATED LEAK TEST ( yIN ): POSITIVE SHUT DOWN (Y/N): NO OPERATIONAL ( Y/N ): YES 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( YIN ): NO ( YIN ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES ........ i~?" ....... .,,' . ..... ?:::: .... RICHMOND PHILLIPS TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE COMMENTS: PAGE 2 OF 2 December 8, 2000 FIRE CHIEF RO, FV.~ZE Bob DeNinno 7-Eleven, Inc. ADMINISTRATWE SERVICES P.O. Box 711 CERTIFIED MAIL 2101 'H' Street Bakers,eld, CA 933m Dallas, Texas 75221-0711 VOICE (661) 326-3941 FAX (661) 395-1349 RE: Compliance Inspections at (2) 7-11 Facilities: 9600 Brimhall, Store SUPPRESSION SEat/ICES #32376 & 4101 Calloway Road, Store 32241. 2101 'H" Street Bakersfield, CA 93301 vo,cE (661) FAX (561) 5954349 NOTICE OF VIOLATION & PUEVE.nO. SEUV, SCHEDULE FOR COMPLIANCE 1715 Chester Ave. Bakerslleld, CA 93301 VOICE (661) 326-3951 Dear Mr. DeNinno: r~x (661) ENVIRONMENTAL SERVICES Per our conversation, I am relaying my observations and violations noted 1z15 Chester^ye. during my facility inspections at the abox~e mentioned address on Tuesday, Bakersfield, CA 93301 VOICE (661) 326-3979 December 5, 2000. FAX (661) 326-0576 TRAINING DIVISION 9600 Bfimhall Facility #32376: 5642 Victor Ave. - .. Bakersfield, CA 93308 vOICE (ee~) 390-~6~7 1. No Pex~it to Operate found on site (Permit needs to be posted). FAX (661) 390-5703 2. The cover to the Emergency Shut-off Switch has been taped shut with no way to access it. 3. No fuel monitoring records. Noted tape on floor going back to October 31, 2000.- Very obvious no one is checking or maintaining records. 4. No Hazard Communication Program found onsite (M.S.D.S., Site Diagram, Emergency Response, Training Records). 5. No operator data, new operator has taken over in the last year. 4101 Calloway, Facility #32241: 1. No operator data for new operator. 2. No Hazard Communication Program in place (M.S.D.S., Emergency ResPonse Procedures, Training Records, Site Diagram).' 3. No evidence fire extinguishers have been serviced. (No tags). 4. Boxes blocking emergency exits and electrical breaker panels must have 30" clearance. It was also noted at both facilities that the employees did not know anything about the hazard communication program, or proper monitoring record retention. Please have the above mentioned corrections made within 30 days. (January 5, 2001.) Failure to comply will result in further enforcement action. Your help is greatly appreciated. Sincerely, Ralph E. Huey, Director Office of Emergency Services by: Steve Underwood, Inspector Office of Environmental Services SBU/dm ~. RRECTION NO~!C E BAKERSFIELD FIRE DEPARTMENT N° 1025 Location ~7 ' ~{ eOtV~. Sub Div. L~ I/) i ~_d I (/~ ~q . Blk. ~t You are hereby required to make the following corrections at the above l~ation: ~or. ~o I Completion Date for Corre-tion~// i/_C/dl',~ (;'~0-~5~ Date ,al,!oo ' - - ~pector 326-3979 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE t a { ~'{ 0 0 FACILITY NAME 7 [::7.1corex ADDRESS /dll9 t~ct {{~u/'eq PHONE NO.S'~ ? '~'~o3 {0 FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES (~ Section 1: Business Plan and Inventory Program [21 Routine '~! Combined [] Joint Agency [~l Multi-Agency [] Complaint [22} Re-inspection OPERATION C V COMMENTS Appropriate permit on hand .V /~O~C 'fvOO~{[ Business plan contact information accurate ~/ b{OAJ 01) {rl:l-l~lc IM % Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability W ' MI0tqc Verification of Haz Mat training ~/ " t~- Verification of abatement supplies and procedures ~ / tc Emergency procedures adequate ~/ ~ ti,- Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand L,t' tc C=Compliance V--Violation Any hazardous waste on site?: [21 Yes [21 No Questions regarding this inspection? Please call us at (661) 326-3979 Business Site,Responsible Party White- Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: O · CITY OF BAKERSFIELD FIRE DEPARTMENT ' OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME '"/ &"'fCk/r.~ INSPECTION DATE Section 2: Underground Storage Tanks Program [] Routine ~ Combined [21 Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank ~0~ I~':L~ Number of Tanks Type of Monitoring ~'/.- ~ Type of Piping /)cO ~ OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on tile Pennit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violatious Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY' Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Office of Environmental Services (805) 326-3979 Business Site Responsible Party White - Env. Svcs. Pink - Business Copy 8900 Shoal Creek Blvd, Building 200 Austin, Texas 78757 Phone: (512) 451-6334 Fax: (512) 459-1459 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 1715 CHESTER AVE., 3RD FLOOR BAKERSFIELD, CA. 93301 Test Date: 04/03/2000 Order Number: 3111882 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7-ELEVEN #32241 MARKET # 2133 BAKERSFIELD, CA. 93312 Testing performed: Leak detector tests Line tests Monitor certifications Stage II A/L tests Stage II pressure decay tests Sincerely, Dawn Kohlmeyer Manager, Field Reporting ~. ~ · CERTIFICATE OF UNDERGROUND STORAGE TANK SYSTEM TESTING Tankno/o y 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST TYPE: TLD-1 PURPOSE: COMPLIANCE TEST DATE: 04/03/00 CUSTOMER PO: wa05051562 WORKORDER NUMBER: 3111882 CLIENT: 7-ELEVEN, INC. SITE: 7-ELEVEN #32241 10220 S.W. GREENBURG ROAD MARKET # 2133 SUITE 470 SWC CALLOWAY DRIVE PORTLAND, OR 97223 BAKERSFIELD, CA 93312 BOB DENINNO MANAGW. R (503) 977-7713 (805) 555-1212 The following test(s) were conducted at the site above in accordance with all applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 10k 1 REG UNLEAD 0. 000 P Y P Y 10k 2 PREMIUM 0. 000 P Y P Y 10k 3 ,MIDGRADE 0 . 000 P Y P Y Tanknology appreciates the opportunity to serve you, and looks forward to working with you in the future. Please call any time, day or night, when you need us. Tanknology representative: Services conducted by: KEN MINTON RICHMOND PHILLIPS Reviewed: Technician Certification Number: 91-1071 Printed 05/08/2000 08:58 CCHAPA TEST DATE: 04/03/00 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3111882 CLIENT: 7-ELEVEN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-ELEVEN #32241 Tank ID: 10k 1 Tank manifolded: NO Bottom to top fill in inches: 157.0 Product: MS ~ Vent manifolded: NO Bottom to grade in inches: 161.0 Capacity in gallons: 10,000 Vapor recovery manifolded: ~"~s Fill pipe length in inches: 62.0 Diameter in inches: 95.00 Overfill protection: ~'-gs Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: ~s Stage I vapor recovery: DUA~ Material: DW sTE~.~. Installed: ATe Stage II vapor recovery: ASSZST CP installed on: / / COMMENTS .............................................................................................................................................. ~'i~'ili:i'i .................................. E'~a"('i~i') ........... , Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced J Dipped Product Level: L.D. #1 L.D. #1 L.D. #2 L.D. ~2 Probe Water Level: Make: v~o~ss Model: ~2000 Ingress Detected: Water Bubble Ullage Test time: S/N: Open time in sec: 4. oo Inclinometer reading: Holding psi: VacuTect Test Type: ~0~ Resiliency cc: z60 ~0~ VacuTect Probe Ent~ Point: ~S~D Test leak rate mi/m: ~89.0 ~S~D Pressure Set Point: Metering psi: Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: Determined by (method): Result: COMMENTS COMMENTS ~ Material: ENVIROFLEX Diameter (in): 2.0 Length (fi): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 3o NOT NOT NOT Start time: 10: 00 TESTED TESTED TESTED End time: 10: 30 Final gph: 0. 000 Result: PASS Pump type: PRE S SUl~E Pump make: ~ P~.TAO COMMENTS Impact Valves Operational: Printed 05/08/2000 08:58 TANK INFORMATION iT RESULTS TEST DATE:04/03/00 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3111882 AUSTIN, TEXAS 78757 (512) 451-6334 SITE: ?-ET,~.V~N #32241 CLIENT: 7-~.LEVEN, INC. Tank ID: 10k 2 Tank manifolded: No Bottom to top fill in inches: 159.0 Product: p~TUM Vent manifolded: No Bottom to grade in inches: 163.0 Capacity in gallons: 10,027 Vapor recovery manifolded: ~gs Fill pipe length in inches: 64.0 Diameter in inches: 95.00 Overfill protection: ~t-gs Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: ~s Stage I vapor recovery: DUA~ Material: DW STEEL Installed: ATG Stage II vapor recovery: ASSIST CP installed on: / / COMMENTS Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #'1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VAmORLESS Model: Lb2000 Ingress Detected: Water Bubble Ullage S/N: 69?93 Test time: Open time in sec: 4. oo Inclinometer reading: Holding psi: 15 VacuTect Test Type: NOT Resiliency cc: 155 NOT VacuTect Probe Entry Point: TESTED Test leak rate mi/m: 189.0 TESTED Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: a. oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (ft): 200.0 Test psi: 5O Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 10: 00 TESTED TESTED TESTED End time: 10: 30 Final gph: o. 000 Result: PASS Pump type: PR~ S SURE Pump make: ~ P~.~Ro COMMENTS Impact Valves Operational: ~s Printed 05/08/2000 08:58 EST RESULTS TEST DATE: 04/03/00 8900 SHOAL CREEK, BUILDING 200 WORK ORDER NUMBER3111882 CLIENT: 7-ET.~.~EN, INC. AUSTIN, TEXAS 78757 (512) 451-6334 SITE: 7-~.T.~.VEN #32241 Tank ID: 10k 3 Tank manifolded: NO Bottom to top fill in inches: 156.0 Product: MIDGi~J%DE Vent manifolded: NO Bottom to grade in inches: 160.0 Capacity in gallons: 10,027 Vapor recovery manifolded: 3rss Fill pipe length in inches: 61.0 Diameter in inches: 95. oo Overfill protection: 3rss Fill pipe diameter in inches: 4.0 Length in inches: 330 Overspill protection: ~"~s Stage I vapor recovery: DU~.L Material: DW STE~.T. Installed: ATG Stage II vapor recovery: ASSTST CP installed on: / COMMENTS ................................................................................. §'~"iiii') .......................... E'n'd"('i~ ....I Dipped Water Level: New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Dipped Product Level: Probe Water Level: Make: VA~Om. ESS Model: ~.~2000 Ingress Detected: Water Bubble Ullage Test time: S/N: 6~794 Inclinometer reading: Open time in sec: 4. oo Holding psi: 14 VacuTect Test Type: NOT Resiliency cc: 155 NOT VacuTect Probe Entry Point: 'Z~S~J~D Test leak rate mi/m: 189.0 'Z3i[S~L~J~D Pressure Set Point: Metering psi: zo Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: PASS Determined by (method): Result: COMMENTS COMMENTS Material: ENVIROFLEX Diameter (in): 2.0 Length (ft): 200.0 Test psi: 50 Bleedback cc: 0 Test time (min): 30 NOT NOT NOT Start time: 10: 00 TESTED TESTED TESTED End time: 10: 30 Final gph: O. 000 Result: PASS Pump type: PRESSURE Pump make: ~ PETRO COMMENTS Impact Valves Operational: ¥"~s Printed 05/08/2000 08:58 SITE DIAGRAM 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 04/03/00 WORK ORDER NUMBER3].1].882 CLIENT:7-ELEV~N, INC. SITE: 7-ELEVEN #32241 ~VENTS ~ ~ PLUS SUP UL C-STORE Printed 05/08/2000 08:58 CCHAPA MONITOR CERTIFICATION FORM CUSTOMER: 7-ELEVEN, INC. SITE I.D.: 7-ELEVEN #32241 DATE: 04103/2000 ADDRESS: MARKET # 2133 SWC CALLOWAY DRIVE WORK ORDER: 3111882 BAKERSFIELD, CA 93312 1) IN TANK PROBES MANUFACTURER: tidel MODEL NUMBER: 3500 SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N,): N/A LAST TEST DATE: I / PASSED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): N/A TYPE (DISPLAY OR PRINT OUT): OPERATIONAL ( Y/N ): YES COMMENTS: 2) OTHER PROBES: MANUFACTURER: tidel MODEL: 3500 NUMBER OF LIQUID, FLOAT. SW POSITIVE SHUT FAIL SAFE ( Y/N ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOF DOWN (Y/N) (Y/N) ANNULAR PROBE 3 LIQUID NO YES YES TURBINE SUMP 3 FLOAT YES YES YES FILL SUMP FIBERTRENCH MONITORING WELL DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? DRY COMMENTS: PAGE 1 OF 2 MONITOR CERTIFICATION FORM (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL ' NUMBER OF SENSORS: MECH. LEAK DETECTOR ( Y/N ): YES MECH. LEAK DETECTOR OPERATIONAL ( YIN ): YES DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( YIN ): N/A TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM GO INTO ALARM WITH THE SIMULATED LEAK TEST ( YIN ): POSITIVE SHUT DOWN (Y/N):. OPERATIONAL ( YIN ): YES 4 ) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( YIN ): YES ( YIN ) ( FAIL SAFE ) THE MONITORING SYSTEM IS CERTIFIED OPERATIONAL ( YIN ): YES ........ ~ii~iii~?'" ....~?" ....... RICHMOND PHILLIPS ~';,' ........ /' ~-' ~,-'''' TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 _. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENT/~SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STO~GE TANKS - UST FACILI~ ~PE OF ACTION ~ 1. NEW SITE ~RMff ~:. RENEWAL ~RMIT ~ 5. CHANGE OF INFOR~TION (~ ~ - ~ 7. ~R~NE~LY CLOSED SI~ (Check one ~m o~ly) . ~NDED ~RMIT ~al uae o~y) ~ 8. TANK RE~VED ~ 6. TEM~RY SITE CLOSURE I. FAClL~ I S~ INFORMA~ON N~REST CROSS STRE~ ~1. ~IL~ O~ER ~ ~ 4. LO~L AGENCY~IS~IC~ ~ 2, INDIVIDUAL ~ 6. STATE AGENCY' BUSINESS ~1. ~S STATION ~ 3. FARM ~ 5. ~ERC~ ~ 3. PARTNERSHIP ~PE ~ 7. FEDE~ AGENCY' ~2. ~ 2. DISTRIBUTOR ~ 4. ~OCES~R ~ 6. O~ER RE~INING AT SffE ~? ~, ~ ~ ~ ~ ~ U~. IL PR~ O~ER INFO~ PRO~R~ O~ ~7. '1 ~NE ~ILING OR ST~ ~ ~OPER~ O~ER~ ~ ~ Z I~ ~ 4. L~A~N~/DI~I~ ~ 6. STA~AGEN~ 413, . ~TION ~ 3. P~HIP ~ 5. ~ A~ ~ 7. F~E~ AG~ IlL T~K ~ER INFO~ T~K O~ER~ 414.~~NE 415. ~ILIN~ OE STYE ~[~ 4~. I 7) CI~ 417, STA~ 418. ZIP ~OE 419. 1. ~T~N ~ 3. P~IP ~ 5, ~ A~NCY ~ 1. FE~ AGE~ ~. BO~ ~ EQ~~N ~T 8TO.GE F~ ACCOU~ NUMBER V. P~OLEUM ~ ~NC~L RES~NSIBI~ INDI~TE M~S) D 1. SE~-I~U~D ~ 4. ~ ~ D 7. STA~ ~ND ~ 10. LO~ ~ ~1~ ~ 2. ~E ~ 5. ~ROFC~Dff D 8. STA~ND&CFO~i~ ~ ~. O~ER:. NSU~E ~ 6. ~ION ~ 9. STATE ~ND & CD 4~. VI. LE~ NO~FICA~ON AND MAILING ~DRESS ~e~toin~te~~~f~~m~llng. ~ 1. FAClLI~ ~-E~veR, IRc.- Bob ~NiRno ~ 3. T~O~ 4~. ~ n~mm~s ~ ma~l.~ ~ ~ ~t ~ ~k ~ ~ ~ ~ ~ 2 ~ ~. ; 10220 SW Greeburg Rd ~70 /' / I ' Podland OR 97223 // VII. ~PMCANT SIGNA~RE I~ ' __ 4~. ~E o~ ~~0 Bob DeNinno ~ ', Environmental Manager STATE UST FACILITY NUMBER (For/or, al use on/y) 428. 1998 UPGRADE CERTIFICATE NUId~ER (For Io~al uae only) 429. UPCF (7199) S:\CU PAFORMS~Swrgd~a.wpd 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGnOUNO .STORAGE TANKS - TANK PAGE 1 , rY~ OF ~N ~ ~. ~ ~ ~ 0 4. ~O ~ ~ S. ~ ~ ~~) ~ ~. ~Y ~E ~0~ L T~K CITY OF BAKERSFIELD ~ e OFFICE OF ENVIRONMENTAL ~ERVICE8 ~ ' '~ Ch~tir Ave.. Bakerlfleld, CA 93301 (~1) 3264~11 SYSTEM ~ ~TECT~N ~ 15. ,~o~~~~~~~oR ~ 15. RES~ ~ ~ ~. ~N~~(0.~ ~) ~ ~, ~NU~;~~(0.~ ~) ~ 17. DAILY~E~ ~ 17. O~LY~E~ ~ ~¥-~ ~. ~ ~,~- ..... ,=_~ .......,_~ ..~ .,~ . ~.,~:,~..~./'.; ~.~: ~:~,~,.%~,,,~= ~.,, ..,'~:~"~;::'~'".';'~:~,~ ~. ....~;~- ~ -~., ";'"' "' ' '" ""'~' - '~------ ~ ..~-'r' w~':~-~~- -, I ~'~--- = =~;~: -- '~ ~"Y~:':"~'~':~ ~-~ ~: ~'~' ~ .... ~' ' WBWE~T~ 81O~RE ML gI~TU~ OF O~~TOR ~ ~ ~OFO~~T~.~ Bob DeNinno ~ 471 o~o~ ',Environmental Manager ~ p~,~t~~) m ~~(~~) 474 ;..,~~(~.~; UPCF(7199) ~ S:~CUPAFORMS~WRC, B'~.WPC 1715 Chester Ave., Bakersflel~ CA 93301 (661) 326-3979 UNDERGROUND STOOGE TANKS- TANK PAGE 1 ~ OF ~N ~ ~. ~ ~E ~ ~ 4. ~D ~ ~ ~. ~ ~ ~W~) ~ ~. ~Y ~E.~O~ CiTY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES Cheltlr Avl., Blkerlfleld, CA g3301 (~1) 3211-1~11t /1~ t. PRESSURE I"1 2. SUCTION r-~ 2. QRAV~'Y 458 [] h PRESSURE [] 2. SUCTION [] 3, GRAVITY SYSTEM tYPE CONSTRUCTK3N/,[]~ ~. SINGLE WALL ~ 3. LINED ?RENC~ [] 9~. OTHER 4~0 [] ;. SINGLE WALL [] 9~. UNKNOWN MANUFACTUeEJq[J~ 2. OOUBLE WALL [] ~. uNKNOWN [] 2. OOueLE WAU. [] 9~. OTHER f "~.* ~FACTURER 4~1 MANUFACTURER MATERIALSANO '1--1 2. gTAJNLE~.I SI'EEL ri ?. (3ALVANQ:ED~rEEL r-~ 2. STJUNLES-gSTEEL [] ?. GALvANIZED sTEEL CORROSION · $. ~'EEL W/COA'FING I-I g. cATHO01C PI~OTECTION 464 ' [] 5. STEEL W/COATING [] 95. UNKNOWN 4~. PRESSUniZED ~NG (C/mc~ M ~mt m~Y): I~ESSURIZED P~NG (C,,/~ M ~1 [] 1. ELECTRON~IJNELEAKOETECTO~3.0QI~I~W~THA~TOP~MP~HUTOFFFOR ~ 1. ELEC'tl~OMCUNELEAKOETECTOR3.0GI~I~WITHAUTOlaqJMP~UTOFFFORLEAK. [] 3. AN~J~.Wt'EanS~TES~(0J m=,) [] 4. OA~LYVtSU~.C~EC~ CONVENTtONAL SUCTION SYSTEM0: CONVENTIONAL SUCTION S',raieM8 (Caedf dF Mt s~o/y): . [] 5. DAJLYVI~UALM0NITORINGO~IqJMPINQ~YSTEMe''rRIE~Plla~I"K~ 0 5. ~LY~~~~~~ TEST(0.1 ~) 0 6. ~~~(0.1 ~) s,~-E SUCTION ~ (NO V~V~.S W ~a. OW (mOUe> ~): S/.FF. SUCn~SYSTEMS(NOVALVES~NaeOWC. aOUNOPa'e~O~ [] 7. seu~ MoNrrom,~ [] C. RA'A'r'Y FLC~. C.~YTT'Y FtOW (c.~dr dF ~ I'1 9. B~,,n'C-(~'rEST(0.S aPH) ne. DALYV~MONrr~ [] o. ~F..NW4. BnC-~TEST(O.1 (C~ck one) ~]/& AUTO PUMPS~JI'OIq=V~I~NALE/g<OCCUI~ C] & AUTOPUMPSHUTOIq:wt~,NALEN<OCCURS [] c NO AUTO PUMP SHUT OFF [] c NO AUTO PUI49 SHUT OFF ~ESTR~'~ION [] ~2, ANNU~.U~EC, mTYTEST(0.1GPH) s2. ANNU~. ~TE~r(0.t M=H) 13. CONT1NUOU~UMP~I~OR*A~ANDVtSUAL~LN~I~ r"i 13. CONTINUOU~ SUMP~ENSOR +WN~IDVLq~.N.Af~e~ ~II~ROB, dCY (aeNBIATQdll ONLY MMMN~IM)~ EI~B4GY OEN~RA~ ~Y MM 14. ~S~~~~~*~~ ~ 14. ~~~~~~+~~ ~STR~ la. ~NU~~(0.1 ~) 0 16. ~l~~(0.1 ~) ?7. DAJLY~E~ ~ ~7. ~LY~E~ ~ OFO~mroa~ ~ Bob DeNinno 4, T~OFO~~TOR 472 , ~ ~Environmental Manager , UPCF (7/gg) S:~CU PAFORM..q~qWRCB,,~.WP C ~ "." OffICE OF ENVIRON~NTA~RVICES 1715 Chester Ave., Bakersflel~ CA 93301 (661) 326-3979 ~ UNDERGROUND STOOGE TANKS - TANK PAGE ~ OF ~N ~ ~. ~ ~ ~ ~ 4. ~O ~ ~ S. ~ ~ ~W~) , ~T~N~~ L T~K TANKIOl ~ T~W~R ~ J ~~DT~ crI'Y OF BAKERSFIELD ,,~.. e o~FIcE OF ENVIRONMENTAL SERVICE9 ~ Choler Ave., Bakemlleld, CA g3301 (M1) UIT. I'ANK PAGE ,,~ ~. P~qESSURE ~ :~. ~UCTK~ ~ 3. ~V1TY 4g r'J ~. I:~ESSURE I'I :2. SUCTION CONSTRUCT]ON/ I. ~)IN~II WALL. [] 3. LINED ~"I~NC~ [] g~. OT~R 4~0 [] I. SING~E WALL [] ~. UNK,NO~ I~ANUFACTURERI,~ 2 0OUB~.EWAU.. []96. UNKNOWN [] 2. 0OU~LEWAU. []99. OTHER r M~.~FACTURER 4~1 --u*- -~- JFACTUR~R i1"'~ 1.&~RESTEE~ I""l e. FRPCOMPATI~L~'d~ 1O0eA I~'I'IANOL [] 1. BARE,rEEL [] 6. FRPCOMPATI~W/100%ME~ MATERIALSANO :r""~ 2. ~TAU'A~T'EKL [] ?. (3A}..VANIZ~D~TF.~. I-1 2. ~TAiNLE~SSTEEL [] ?. GALVANIZ~.D~TEEL CORROSION ~3~¢'r~N i/-1 3. ~=LA~'nCCOM'ATIm.~W~"HCONTEN?~ I'lm. UNXNOVVN r-I 3. P~"nccoMPA'rlm.~Wn'HCONTENT$ r'"! e.n..EXmLE(H~ee) r"'lee, o'n.,~ . s. STEEL W/COATING [] g. CATHOOIC I=~OT~C'TION 444 ' I'"1 S. STEEL W/COATING [] ~. UNKNOWN 4~ VlL I~1~1~ LEAK DETECTION (c~mc* M m~ mae/) PRESSURIZED PIliNG (C/~ck M ~l' ~): PI~ESSURIZED FHI~NG (Check M ~lt~t !1--1 1. ELECT1113N~UNELEAKOL=TECTOR~.OGI=HTESI'WITHTIL/TOI"~MP SHUT OFF FOR r'! t. EI.ECTRONICUNELEAKDETECTOR3.0GI~I~'hTII~AUTOP~,IP~HLJTOFFFORLEA~ AL~ [] 2. M~Y0.2GI~ITEST [] 3. ANNUAL ~ ~ (0,1(]la'N) r-I 4.. DAiLYV~U~.CNEC~ TEST(0.1Gla94) r'] e. T~IN'TEG~TYTE~F(0.1 GPH) [] 7. SEU~~ I'1 GRAVITY ~ GRAVITY FLOW (CM~ M tMt aI~Iy): [] g. 81F~ I,~ TEST (O.S QPI. I) I-1 8. DAI~YVI~L,~ ~ [] ~. mEN~a~. ~ TF. SI' (O. S ~ ~ECOtIDAF&I.yCONT/UNE~IVdV4~ ~COII~JI~.YCONTAINEDIV4RNG p~E SSURt~D FIFI~ (Ched~ M M 4W~I~' (~ ~) ~N ,2. ~~~(o., ~ - 0 ,z ~~~(o., ~) t3. ~~~eW~~ ~ 13. ~M~+~~~ se. ~U~~(O.t ~) ~ Se. ~l~~(O.S ~) rT. O~LY~E~ ~ S7. ~LY~E~ ; ~'....;~.~ ~ ~ '..,. ~~:~,.;~'~'~/~~': .' ~o~o~~o,~ ~ Bob DeNinno ~ Environmental Manager _ UPCF (7~1 S:~cUPAFOR~~'~c D FIIIE April 4, 2000 7-11 F,RE CH~E~ Mr. Bob Deninno RON gRAZE 10220 SW Greenberg Rd g470 ~.~smanv~ s~wees Portland OR 97223 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 Dear Mr. Deninno: SUPPRESSION SERVICE8 2101 'H' Street '~OU have been identified as the compliance coordinator for the ~,~o=r~. c^ 933o1 faCility/facilities referenced in the attachment. vo~c; (~os) ~,~4~ FAX (805) 39~-1349 PASO. s~wc~ The permits to operate this facility/facilities will expire on June 30, 2000. 1745 c~,to, ^v.. However, in order for this office to renew your permit, updated forms A, Baker~f~:l, ~ 93~01 vOiCE (~os) 3am~s~ B, & C must be filled out and returned prior to the issuance of a new ~ax cos) 3z,~-0~76 permit. E~aossem'~ sEmnc~ ms c~.t~ ^~. Please make sure that you are sending the updated forms which are Bakemf~ld, CA 9~301 voice ~os) ~2~-aa?~ indicated by the date 7/99 in the lower left hand comer. Please complete FAX (805)326-05?6 and return to this office by May 15, 2000. Failure to comply, will result in TRA{NING DM${ON a delay of issuance of your new permit to operate. 5642 Vleto~ ^v~. Bakmt~f~d, C~ vo,ct {~os) a~9? Should you have any questions, please feel free to call me at 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment Facility_ .Address 7-11 1701 Pacheco Road, Bakersfield, Ca 93304 7-11 4647 Wilson Road, Bakersfield, Ca 93309 7-11 3601 Stockdale Hwy, Bakersfield, Ca 93309 7-11 960 Brimhall Road, Bakersfield, Ca 93312 7-11 525 West Columbus, Bakersfield, Ca 93301 7-11 4101 Calloway, Bakersfield, Ca 93312 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME '7' a{t'OC~ INSPECTION DATE t~{~q( q ~, ADDRESS qiO I daliO~a'~ PHONENO. ~,6,/'- ~',q?' ,q'~'~2~ FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES ~-V Section 1: Business Plan and Inventory Program [] Routine [~ffCombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address / Correct occupancy Verification of inventory materials v/ Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures D/ Emergency procedures adequate Containers properly labeled Housekeeping 12t ' ~{cdtttd ~a~,,.l~, Fire Protection cJ ,~(e~, 4to ~/~tyt- q~0~q Site Diagram Adequate & On Hand C=Compliance V=Violation Explain:Any hazardous waste on site?: []Yes []No. Questions regarding this inspection? Please call' us at (805) 326-3979 Busine~ S~te~esponsible Party White- Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: ~ C CITY OF BAKERSFIELD FIRE DEPAiiTMENT OFFICE OF ENVIRONMENTAL SER~rICES UNIFIED PROGRAM INSPECTION C~IECKLIST 1715 Chester Ave., 3'd Floor, Bakersfield CA 93301 FACILITY NAME 'l' ~'/c0'c~'x -4 30%2. q/ INSPECTION DATE Section 2: Underground Storage Tanks Program ~ Routine [~ombined [~1 Joint Agency [21 Multi-Agency I~1C(,mplaint 1~ Re-inspection Type of Tank iflt01=e-5 Number of Tanks Type of Monitoring C} t. t44 Type of Piping OW F' OPERATION C V ~'OMMENTS Proper tank data on file . Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current I 1¥1 Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACI'FY Type of Tank Number of Tanks Y N OPERATION COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Omce of Environmental Services (805) 326-3979 Bqsine~s' -"'-~esponsible Party Whhe - Env. Svcs. Pink - Business Copy , ~ RPR-28-1999 12:$8 FROM TRNKNOLOGY TO 9-15032453438 8900 SHOAL CREEK, BUILDINO 200 AUSTIN, TEXAS 7875'/ (51 ;2) 451-6334 FAX (512) 459-1459 TEST RESULT SITE SUMMARY REPORT TEST DATE: 04/19/99 CUSTOMER POi,90420J, 401 WORK ORDER NUMBERa205236 CLIENT: TBE SOUTHLAND CORPORATION $FrE: 7-ELEVEN #32241 Zo22o s.w. G~EN~ORS ROAD MARKET I1 2133 SUITE 470 SWC CALLOWAY DRIVE PORTLAND, OR 97223 BAKEP~FIELD, CA 93312 BOB DENINNO MANAGER (503) 977-77~3 (805) 555-1212 The follo~iag tea(s)were conducted at the site above in accordance with all .applicable portions of Federal, NFPA and local regulations Line and Leak Detector Tests 10): I REG UNLEAD 0. 000 P Y P 10): 2 PREMIUM 0. 000 P Y P 10~: 3 ;ELUS 0 . 000 ~' ¥ F Tanlmolo$7 apl~ciate,~ thc Oi~l~ortunlty to e~c y~, ~d loo~ f~ ~ w~g wi~ you ~ ~c f~. ~lc~c ~ ~y gmc, d~ ~ ~ whm you nc~d u~ Tanknology mpmse~afive: Se~ces ~ndu~ by: R®viewed: Technician Ce~ific~fion Number: 91-1071 Pd~d ~2~1~ 13:01 KOH~EYER , RPR-28-1999 12:59 FROM TRNKNOLOGY TO : EST RESULTS TEST DATE: 04/[9/99 8~0 SHOAL CREEK, BUILDING 2DO WORK ORDER NUMBER32052~6 CLIENT:~ ~~ AUSTIN. T~AS 78757 (512) 451~ ~lTE:7 ..~ Tank ID: 10~ ~ Tnnk mnnifalded: ~ BoSom to to~ fill in inch.: Produ~ ~ ~ Vent mani~lded: ~ BoOm to grade in inches: Capec~ in gallons: ~o, oo0 Vapor recove~ manifolded: ~s Fill pipe len~ in inches: Diameter in inche~: 9S. oo ~e~ll pr~ion: ~s Fi~ pipe diameter ~n inches: Len~h in inch.: 33O Ovemp~l pr~e~on: ~s S~ge I vapor recover: Material: o~ s~ Installed: A~ S~ge II vapor rec~: cP in.ailed on: / / COMMENTS New/pa~sed Failedlrepl~ced New/passed Fail~dlrepleced Dipped Water Level: L.D. #1 L.il. #1 L.O. fl2 .L.D. #2 u~ppe~ I~roauct Level; Make: Probe Water Level: Model: Ingress Detected: Water Bubble Ullag~ SIN; Test time: Open time in sec: ~. oo Inclinometer reading: Holding psi: VacuTect Test Tyl)e: ~,Io~ Resiliency cc: [6o ~o~ VacuTect Probe E~ry Point: ~r~s~J[o l'est leak rate mi/m; ~e~.o 'zl~s~'l~ ..: Pressure Set Poi~: Metering psi: Tank water level in inches: Calib. leak in .qph: 3. oo Water table depth in inches: Results: Determined by (method): Result:. COMMENTS COMMENTS II. ~ ~- 2.0 Length (f~): 200.0 COMMENTS Test psi: ,50 Bleedback cc: 0 Test time (mtn): 30 Test 1: Start time: Finish psi: -2 ~O~ ~O~ Vol change cc: Test 2: Staff time: Finish psi: Vol change ac: o Tes~ 3: Start time: zz:~s Finish p~l: Vol change cc: o Final gph: o. ooo Result: ~.~ Pump type: Pump make: ~'~ ~-~z~.o ~'_i .... IIII III _ I IIIIII III I I I ' * 'il * '1 III Printed 04/28/1999 13:01' APR-28-1999 13:00 FROM TRNKNOLOGY TO 9-15032453438 P. TEST DATE:04/19/99 8900 SHOAL CREE~ BUILDING 200 WORK ORDER NUMBE~205Z36 AUSTtN. T~AS 787~ (512) 451~ 91TE:3 -.~ ff3224[ Tank ID: lo~ 2 Tan~ m~n~folded: ~o BoSom to top fill in inches: lsg. 0 Produ~: ~ Vent ma~i~lded: ~0 8~om to grade in inches: i63.0 Capaci~ in gall~s: i0,000 Vapor re~ve~ manifolded: ~s Fill pipe len~h in inches: 64.0 ' Diameter In inehe¢: g5. oo ~e~ll pr~ion: ~¢ Fill pip~ distorter in in~s; 4.0 - Len~h in inches: 330 Ovempill protection: ~s Stage I ~por r~e~ Material: DW S'~= In~l,led; ~e S~ge II vapor recover: CP installed on: / / *COMMENTS start (In) End (in) ! New/passed Failed/replaced New/passed Failed/replaced Dipped Water Level; L.D. #1 LD. #1 L,O. #2 L,D. #2 :Dipped Proauct Level: Make: Probe Water Level: Model: z,D2ooo Ingress Detected: Water Bubble Ullage SZN: Test time: Open time in sec: 3. oo Inclinometer reading: Holding psi: V~,uTec~ Test Type: ~OT Resiliency cc: VacuTect Probe Ent~ Point: '~,s-~-~_,u Test leak rate mi/m: ~sg.o Pressure Set Point: Metering psi: Tank water lave! in inches: Callb. leak in gph: 3. oo Water table depth in inches: Results: ~,A,~e : Determined by (method): Renu It; COMMENTS COMMENTS Material; Impact Valves Operational: 3tBs Diameter (in): 2.0 Length (f~): 2 oo, 0 COMMENTS Test psi: .50 Bleedback cc: o Test t~me (mm): 30 Test 1; Start time: Finish psi: -2 NOT NOT NOT Vol change cc: -2 Test 2: Slant time: ~rss~z~o 3'zs'z'x.o .3'~,s~ Finish pal: Vol change cc: Test 3: Sladtlme: Vol change cc: o Final gph: O. ooo Pump type: Pu~ make: ~ ~0 Pdnmd ~1999 13:01 APR-28-1999 13:00 FROM TANKNOLOGY TO 9-150~245~438 TE,ST DATE:04/.1. g/99 8900 SHOAL CRBEK, BUILDING 200 WORK ORDER NUMBER3205236 CLIENT: ~'la~ soo'z'~,l'z,41t3133 AUSTIN, TEXA.~ 7R7.~7 (.~1~.) 451-6334 ~,ITE: '/-~X.~i'V]3~ #322&1 Tank ID: 10~ 3 Tank manifolded: two Bottom to top fill in inches: 3-s6.0 Product: z=z,t~s Vent manifolded: Z,l'o Bottom to grade in inches: 3.60.0 Capacity in gallons: 3.0,000 Vapor recovery manifolded'. 3'~s Fill pipe length in inches: 61.0 Dialyzer. er in inches: ~. 00 Overfill proteotion; ~Jss Fill pipe diameter irt inching' 4. o Length in inches: 530 Overspill protection: ~'ss Stage I vapor recovery: Material: Da' s.l..,s~L Installed: A~"~ Stage [I vapor recovery: ASSIST CP in~talhsd oil: / / COMMENTS ' Start lin) End Lin) ~ New/passed Failed/replaced New/passed Failed/replaced Dipped Water Level: L.D. #1 LD. #I L,D. ;Z L.B, fi2 Dipped Product Level: Make: vA~o~ss Probe Water Level: Model: Ingress Detected'. Water Bubble Ullage S/N; Test time; Open time in sec: 3. oo Inclinometer reading: Holding psi; VacuTect Test Type: ~ Resiliency cc: 3. eo ZqOT VacuTect Probe EL~try Point: ~E,~'zm~ 1'est leak rate mi/m: zs~.o 'Z"SST~ Pressure Set Point: Metedng psi; Tank water level in inches: Calib. leak in gph: 3. oo Water table depth in inches: Results: Determined by (method): ~esul~ COMMEN'r~ ~1 Impact Valves Operational: ~-~S Diameter (in): 2 0 II Length (R): 2o01 .~J. COMMENTS Test psi: 5o ~' Bleedback oct 0 · 1] Test time (mia): 3 0 It Test 3: Start time: ~z:so II Flnl~ psi: -4 Z~oT ~/o'~ I/ vol change cc: " ~J Tes~.2: Start time: .J.~-.~-a.u .... .~=,o ~.~, I/ Finish psi: -2 J~ Vol change cc: o I/ Test 3: Star time: ~=: 20 I/ Finish ps~ !/ Vol cha~ge c~c: IJ Final gph: o. o00 IJ Pump type: ~sstY~: Il Pump make: I .......... ,',',= ,,,, r ,,,,, ~ ,,,, ~PrintedO~Wlgggl~3;01 ,, .... ~PR-28-1999 13:01 ~ROM T~MKNOhOG¥ TO 9-150~2453438 P.l~ MONITOR CERTIFICATION FORM CUSTOMER: THE SOUTHLAND CORPORATION SITE I.D.: 7-ELEVEN ~32241 DATE: 04/19/99 ADDRESS: MARKET # 2133 SWC CALLOWAY DRIVE WORK ORDER: 3205236 BAKERSFIELD, CA 033~2 1) IN TANK PROBES MANUFACTURER: tldel MODEL NUMBER: 3O0O SERIAL NUMBER: NUMBER OF TANKS MONITORED: 3 SET UP FOR MONTHLY TEST (Y/N): LAST TEST DATE: I I PA$3ED/FAILED: DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RE3ULT$ ( YIN ): TYPE (D/SPLAY OR PRINT OUT): OPERATIONAL ( YIN ): YES COMMENTS: 2;) OTHER PROBES: MANUFACTURER: tidel MODEL: 3000 NUMBER OF LIQUID, FLOAT. SW POSITIVE SHUT FAIL SAFE ( YiN ) OPERATIONAL PROBE LOCATION PROBES OR VAPOR SENSOI~ DOWN (Y/N) (Y/N) ANNULAR PROBE 3 U~UlD NO YEti, TURBINE SUMP '3 FLOAT NO YES FILL SUMP FtBERTRENCH MONITORING WES. I DISPENSER PAN OTHER ANNULAR SPACE FILLED WITH MONITORING FLUID? COMMENTS: PAGE1 OF2 ~ . ~. · APR-28-1999 13:01 FROM TANKNOLOGY TO 9-15032453438 P. 14 (CONT.) 3 ) PRODUCT LINE PRESSURE MONITOR MANUFACTURER: MODEL: NUMBER OF SENSORS: MECH. LEAK DETECTOR ( Y/N ): YES MECH, LEAK DETECTOR OPERATIONAL ( YIN ): DOES THE SYSTEM DISPLAY OR PRINT OUT MONTHLY TEST RESULTS ( Y/N ): TYPE (DISPLAY OR PRINT OUT): DOES THE SYSTEM. GO INTO ALARM WITH THE SIMULATED LEAK TEST ( Y/N ): POSITIVE SHUT DOWN (Y/N): OPERATIONAL ( Y/N ): 4) OVERALL SYSTEM PERFORMANCE DOES THE FUEL SYSTEM SHUT DOWN DO ALL ALARMS INCLUDE BOTH WHEN POWER IS SHUT OFF TO AUDIBLE AND VISUAL ALARMS: YES THE MONITORING PANEL ( YIN ). YES ( Y/N ) ( FAIL SAFE ) THE MONITORING SYSTEM I$ CERTIFIED OPERATIONAL ( YIN ): YES ,<?:. ' , .,, ,/ ~,, ~,//'. RICHMONO PHILLIPS, ; ....... ."' fr;-,,,.~'~-~'.,,'-, · TECHNICIAN ( PRINT ) TECHNICIAN ( SIGNATURE ) COMMENTS: PAGE 2 OF 2 TOTAL P.14 FIII E February 9, 1999 FIRE CHIEF 7 Eleven RON FRAZE 4101 Calloway Dr ~M'N'ST~nV~ SEaviCES Bakersfield, CA 93312 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (so5) 39,~1a~9 RE: Compliance Inspection SUPPRESSION SERVICES Dear Underground Storage Tank Owner: 2101 'H' Street Bakersfield, CA 93301 vO.CE (sos) 326-3941 The city will start compliance inspections on all fueling stations FAX (805) ~9~-1a~9 within the city limits. This inspection will include business plans, PREVENTION SEI1VICES underground storage tanks and monitoring systems, and hazardous 1715 Chester Ave. materials Bakersfield, CA 93301 lnsp¢c[lon. VOICE (805) 326-3951 FAX (805) 326-0576 To assist you in preparing for this inspection, this office is ENVIRONMENTAl. SERVICES enclosing a checklist for your convenience. Please take time to read this 1715 Chester Ave. Bakersfield, CA 93301 list, and verify that your facility has met all the necessary requirements to VOICE (805) 326-3979 be in FAX (805) 326-0576 comF-ance. TmU.'NG Dn~S'ON Should you have any questions, please feel free to contact me at 5642 Victor Ave. Bakersfield, CA 93308 805-326-3979. VOICE (805) 399-4697 FAX (805) 399-5763 Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure Permit No. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENT,&_[, SERVIC. E$ .... ' 1715 Chester Ave., Bakersfield, CA (805) 326 3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF A~PLICATIQN (CHECK) ~']NEWFAClLITY [ ]MODIFICATION OF FACII/I'Y [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE ~/~ Z'~ .- '["~ PROPOSED COMPLETION DATE I FACILITY NAME '1- ~ ~ ~-ooo /~u,~- EXISTINGFACIL1TYPERM/TNO. FACILITY ADDRESS *-*~o, ~,~uc.z~ ~"~-'r' CITY ~x~z-~qm.,-r~l TANK OWNER --~ o~1'~ ~,.~.~..I ~ ~.,or~-~. PHONE NO. ADDRESS,~2-o -%ToO~J-~oL~'m~u-6~.lTY f~u~'~z~.oa'r~,,,,] ZIPCODE CONTRACTOR ~.!laa~-~ /~,,"e,~.41,~% CA LICENSE NO. ADDRESS ~t01 c., Ant,a, ~ _ CITY /mn. lt-~{,, ~./$ ZIPCODE_~ PHONE NO. n~ - .~ ~- 4~'~'~ ' BAKFASF~.CD cn'Y BUSINF. SS UCENSE NO. WORKMAN COMP NO. %~)~91! 7qO ~1 (,~ INSURER BRIEFLY DESCRIBE THE woRK TO BE IJONE M~w' -~-! WATER TO F^CIIXI'T PROVIDED BY' ~ DEPTH TO G~O~qD WATER $O1~ TYPE EXPECTED ^T S1TE NO. OF TiN'i~ TO BE INSTA~.t~n ~ ~ THEY FOR MOTOR lrUEL X ~ NO ~.~' S?ILL ?~VEN~ON COl~i~OL ~ COUNTER i~,~_.,~$ ~ ON ~ ~YE~ NO SZCTION FOR MOTOR FU~L TANK NO. VOLUME UNLEADED REOLEAR PREMIUM DIESEL AVIATION SECTION FOR N'ON MOTOR FU]gL STOI~GE TAiNK~ TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) (IF KNOWN) FOR OFFICIAL USE ONLY I THE APPLICANT HAS RECEIVED, UNDEI~TAND5, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTI-{ER STATE. LOCAL AND FEDERAL REGULA/IONS. THIS FORM HAS BEEN COMPLETED UNDER PENALIY OF PERJURY, AND TO THE BEST OF MY KNOWLFRX}E, I~ APPLICANT NAME (PRINT) APPLICANT SIGNATURE PPLICATION BECOMES A PERMIT WHEN APPROVED Permit No. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES .-..' 1715 Chester Ave., Bakersfield, CA (805) 326;-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF ApPLICATION (CHECK) D<]NEW FACILITY [ ]MODIfICATiON OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARLING DATE ~ - Z~ .- '7'~ PROPOSED COMPLETION DATE I ) - ~ ~ ~ FAClIlTYNAME '~- , ~ i~-~c~ /ff,~.,~:~.. EXISTINOFACIL1TYPERM1TNO. FAClLITYADDRES$ t-~o, ~At.~a w,~T' CITY =~x~3~.a.c~! ~_ c:~ Z/PCODE TANK OWNER ..5, o~1 H ~A~ ~ ~,o c~..-t~. PHONE NO. ADDRESS .~g;o .~T~,Ja'2-~o~ t~.~.~-~.ITY ~'tx,..~a.~Tp~. Z~PCODE CONTRACTOR lla,~e~ ('~t,.~-[u~; CA LICENSE ADDRESS I tOt ~, ~nrm' '~. _ CITY /~fla ~,~. ~.0, ZIPCODE_~[~Z~...~_ PHONE NO. _~a - ,mm,~- d~K_q' BAKEt~SFIt[LD crrY B~ LICENSE NO. WORKMAN COMP NO. I,~J ~_ ~ ~ 7 qo ~/~ INSURER ~,~.[ .K~dr,~,,,,,_. (~m~4~/ - WATER TO FACffATY PROVIDED BY ~ DEFTH TO GROUND WATER SOIL TYPE EXPECIED Al' SITE NO. OF TANKS TO BE INSTA{~{.~-r) ~ ARE THEY FOR MOTOR FUEL X YES. ~.' SPiLL PRE--ON CONTROL AND COUNTER MEA$~$ FLAN ON FILE YF~ NO SECTION FOR MOTOR I~L TANK NO. VOLUME UNLEADED KEOULAR ~ DIESEL AVIATION I I O~ ooo SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED CAS NO. CHF_/~CAL PREVIOUSLY STORED (~o BP, AND NAME) OF K~OW~ FOR OFFICIAL USE ONLY o.' i':i:ii{ , : -:." ' , ':'~.:.,;'~:~': ~: '.: ':'::~::~:F~ ~ ~':'~ ~:.:~ L:,':'CPU~:~:::::::':: ::.:: :: :::. ::: ~:~: ~ ~PLIC~ ~S ~C~, ~T~S, ~ ~L C0~LY ~ ~ AGAC~ CO~ON8 OF ~ PE~ ~ ~ O~ STA~, L~ ~ ~ ~G~ONS, ~ FO~ ~ BEEN CO~LE~ ~ P~Y OF P~Y, ~ TO ~ BEST OF ~ ~O~E, ~ ~ ~ II- ~P~C~ N~ (P~ ~PLIC~ SIONA~ PPLICA~ON BECOMES A PE~T WHEN APPRO~D STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE I MARKONLY .~ 1 NEW PERM'T [~ 3 RENEWAL PERMIT ~--'-~ 5 CHANGE OF INFORMATION ~] 7 PERMANENTLY CLOSEQ SITE ONE ITEM [] 2 INTERIM PERMIT ~] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FACILITY NAME NAME OF OPERATOR ADDRESS NEAREST CROSS STREET PARCEL # (OPTIONAL) CITY NAME STATE I ZIP CODE SITE PHONE # WITH AREA CODE ~ ~. ~..~c-~.-~ ~ -~.---z... ~c::) CA v' BOX *'~ CORPORATION [--"t INDIVIDUAL [~] PARTNERSHIP r-] LOCAL-AGENCY [-"-] COUNTY-AGENCY* [~ STATE-AGENCY* ['"'-] FEDERAL-AGENCY * TO INDICATE DISTRICTS · It owner of UST is a public agency, complete the following: name of supervisor of division, section or office which operates the UST. · oo o I EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE I DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODEI NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ~/ box ID indicate ~ INDIVIDUAL [~ LOCAL-AGENCY I'---1 STATE-AGENCY ~ ~ ~--O .---~"~.'t ~1~) ~ (~,,"'[/-~ L..~L,.,- 1¢'2_..'1~ · [~CORPORATION ~ PARTNERSHIP [~ COUNTY-AGENCY r"--} FEDERAL-AGENCY CITY NAME STATE I ZIP CODE I PHONE # WITH AREA CODE III. TANK OWNER INFORMATION- (MUST BE COMPLETED) NAME OF OWNER I CARE OF ADDRESS INFORMATION I MAILING OR STREET ADDRESS I V' box to indicate [~ INDIVIDUAL [~ LOCAL-AGENCY I---I STATE-AGENCY CITY NAME t STATE [ ZIP CODE PHONE ft WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise. TY(TK) HQ ~--~-° (~ ~, ~_ i,~ . · V. PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED)- IDENTIFY THE METHOD(S) USED Iv box t°indicate ''~=~'''1 SELF'INSURED r-'] 2 GUARANTEE [--[ 3 INSURANCE I~'] 4 SURETY BOND r--I 5 LE'FrER OFcREDIT ['~] 6 EXEMPTION [--I 7 STATE FUND I r--i 8 STATE FUND & CHIEF FINANClAL OFFICER LETTER r-'-] 9 STATE FUND & CERTIFICATE OF DEPOSlT ~ 10 LOCALGOV'T. MECHANISM ~ 99 OTHER VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ITANK OWNER'S NAME (PRINTED & SIGNATURE) I TANK OWNER'S TITLE I DATE MONTHfDAY/YEAR I I LOCAIJ AGENCY USE ONLY COUNTY # JURISDICTION # FACILITY # LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL SUPVISOR - DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION ~ FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A (6-95) NST UGTi{ONS C©MPB T NG F©RM 'A GENERAk :x s,rxu-c oxs: . SECTION 271 I'OFTiTLE 23, CHAFFER {6, CALIFORN~A CODF OF REGULATIONS AND.SECTIONS 252~6,.25287..AND 25289 OF CHAPTER .... 6 7, DiViSION-20, CALIFORNIA HEALTH AND SAFETY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATING pErMIT. h Oue FORM ~*A" shall be completed fix aB NEW PERMIT CHANGES or m~y FACILtTY/S~TE INFORMATION CHANGES.. 2~ SOBMIT ONLY ONE (t} FORM "A~' fora ~:acilffy/Si~e, regardR:ss of the number of tanks located at tlx~ site, , 3, This form should be eompleted by eit}~sr tI,e PERMIT APPLICANT ol the LOCAl. AGENCY UNDERGROUND Tt{N~iNSPECTf5R. 5. Use a hard poin~ wdfi~g instn, tment, yes am m~2<ing 3 copies. 6, Tank owner mus~ sobn~t a facility pto~ plan ~o tho !octal agency as pa~ oftI~e applicado~ showing the tocatio~ of ~he USTs with respect to Nlildings and landma'ks [Section 27 t t (a)(8) CCR]. 7. Tank owner must submit d6cmnentation showing compliance with state financial responsibility requirements Io the local agency as part of the applicalion for ~mimleum USTs [Sec/ion 271I (a)(lt), CCRj. TOP OF FORM: "MARK ONLY ONE ITEM" ; ' Mark an (X) ia the box next to the item that be. st desNiioes the l~ason the form is beb~g co~{~pleted. I. FACILiTY/SFt~ IN}ORMATION & ADDRESS (MUST BE COMP~STED} . ' ' .. I. Record name ~d agdress (pt~ysieal location) of the tmdergrotmd tank(st. ' NOTE: Address Mt ST have a valid physical locaffon including city state, and zip code~ P.O. BOX NUMBERS ARE NOT ACCEPTABLE. . Include newest cross.stayer and amine of the o~mtor. · ., .. 2. Phone m~mber nmst have an area code. If the night number is the same, write "SAME" in proper lf~ca{ioa. . . . "3. Check the appropriate box tbr TYPE OF BUSINESS OWNERSHP (ex, CORPORATION, INDIVIDUAL, etc.). ' 4, Check th~ apErcpr~gm )ox for TYPE OF BUS[NESS. : . 5, If Facility/Site is Ideated within an indian resers'adoa or other tadiar~ [~st Iands~ check {he box markd(~;YES'i o.' . .. 6. indicate the NUMBER of TANKS at this SITE. ' 7~ Record the E.P.M ID'~ or ware '*NONE" in tho space pro¥idezt: ........... IL PROPERTY OWNER INFORMATION & ADDRESS (MUST BE COMPLETED} Cmnple[= all iIen~ in this sectiom uuiess all items ~ ~he same as SE~ION h [f the gamE, write "SAME AS S1TE" across this section. Be to check PROPERTY O%~ERSftlP TYPE box. ill TANK OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete all items in this swXkm, re{less ail kerns are the same ~s SECT1ON 1; If the same, write "SAME AS S[TF across this section. Be sum to check TANK'OWNERS TYPE box. IV, BOARD OF EO~AL1ZAq'ION UST STORAGE FEE ACCOUNT NUMBER (MUSt BE COMPLETED. sEE ARTICLE 3 CItA~F~R 6~70.'" DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE,) ' Enter your Board of ~ualization (BOE) UST storage fee accoum number which is ~4uired before your permit application c~n ~ processe~[. Registration with ~he BOE will cast,re that yon will receive a quarterly storage fee return i~ repmting the ~r gallon fee due on the number of gallons placed i*~ your USTs, The BOE will code persons exeinpt'frol~ paying the storage fee so ~tums will nor be sent. lfyuu do not have account number wiih the BOE or if.you have any qtxes~io~s ~egm'ding the fee or exemptions, please call the BOE at 916-322-9669 or w~te to the ' BOE at the fi~[lowing adeess Board of' Equalization, Fuel Tszxgs N~ision, P O,.Box 942879, Sac~'amesto, CA V,PETROLEUM UST FINANCIAL RESPONSIBILITY (MUST BE COM~ LETED FOR PE[ NC LEUM USFs ONLY, SEE SECTIONS 271 l (a)( 1 t) OF TITLE 23, CNAF['ER~ 6', CALIFORNIA CODE OF REGU~AT[ONS$ ~'i ...... ldenlil? lhe method(s) used by the owaer.m~d/or ope. reCur, in mcetin~ the Fede~%t.'and Sfk,e financial re~punsibilit9 re'qniremeats, USTs o,Mied by any Federal or S~ate age~cy as we~I as non-,petroleum USTs are exempt from ff~is requirement, ,. ' ' VI. LEGAL NOTIFICATION AND BILLING ADDRESS Check ONE BOX for the address that x~itt be used ik>r BOTN LEGAL AND BtLL1NG NOTiETCATIQNS. TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST S'tGN ,~ND DATE TH.E PORM AS INDICATED, '[~EE SECTIQNS ~7I'1" (a)(l 3~ DF TITLE 23 ~HAFi'ER 16 CALIFORNI~ CODE OF REGULATIONSq INS l ReC FiON FOR IHE LOCAL AGENCIES The co~fi~y rind jufisdictior~ numbers am predetermined and can be obtai~ed by c~Jing d~e State Board (9 J 6) 227-4303, The facility nmn~r m~y be assigned by the local agency; however, this number m~lst be numerical and cammt contain any alphabetical characters.. If the local agency. . ~mik~ the State Bom'd to assign ihs fhcility numk~r, pleas¢ leave it blanb IT IS THE RESPONSiBILtTY OF THE LOCAL~A~3ENCY TIiAT INSPECT~ )lie FAC1LITY TO VERIF~ THE ACCURACY OF THE INFORMATION.' TH~S APPLICATK)N CANNOT BE PROCESSED tF THE BOE ACCOUNT NUMBER IS NOT FILLED IN.' Tile LOCAL 'AGENCY tS RESPONSIBLE FOR THE COMPLETION OF TttE "LOCAl, AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE OKIGINAL AND YELLOW COI:?~ES, THE FINK COPY SHOULD BE RETA1NED BY THE TANK ~' ' ':' ' ' ' ~ .' " STATE OF CALIFORNIA . , ' , ' i ..,~ ,i .... ' ....... .,:~ , .' STATEWATER REsoURCES CONTROL BOARD' · 'RM~ ' : ~ ' /.i, .,.~ . :UNDERGROUND'STORAGE'TANK PERMIT APPLICATION- FO ~ .... ,.," ' COMPLETE THIS FORM FOR EACH FACILITY/SITE . MARK oNLY'." ~ "' ~W pERM,T [] 3 R~ENEWAL PERMIT.. [] 5 CHANGE OF INFORMATION '[---] 7 :"~I~'~:~Y' CLoSeD. SiTE ONE I~M- ~ 2 INTERIM PERMIT · ~ 4',"AMENDED PERMIT. ~. 6 TEMPORARY SITE CLOSURE' I. FACILI~/SITE INFOR. MATION & ADDRESS- (MO'ST BE cOMPLETED) ' ~ DBA OR FACILI~ NAME ~A ~ NAME OF OPERATOR' ADDRESS :~ N~REST CROSS STREET ' PARC~ ~ (OP~ONAL) CI~NAME~~ ~ ~ ~' STA~cA .' ZIP CODE~~ ~. SITE PHONE ~ WITH AR~ CODE ,. ~ BOX ,~ CORPORATION . ~: INDIVIDUAL ~ PAR~ERSHIP : ~'LOCAL-AGENCY' ~ COUN~-AG~CY* ~ STA~-AG~CY* ~ FEDEX-AGENCy' ~0 iNDiCATE ' ' .... . . DISTR~CTS . . , ,. , ,., ~.;~ ' ~ ~er of US~ ~ a publ~ age~. ~mplete the fol~whg: ~e of supewisor ~ dMs~n, s~ or office wh~ ope~tes the UST ~ ~ "; . . ': .EMEflGENCY CONTACT PERSON (PRIMARY): ' ' EMERGENCY CO~TACT PERSON (sEcONDARY)- optional ' "/ NIGHTS: NAME (~ST FIRS~~ ~'' 1~ ' "'~'~ ~;~ ~ONE # WITH AR~ CODE ' t~I~T~ '~E (~? ~iRS~ ~r. ; ~' "~H~ ~ WI~ AR~ CODE . ~, ~,~' ?,r~'~~ '. . . , ... ~. ~..,~ ~.. : ." . ~.~ II. PROPER~ OWNER INFORMATION -.(MUST BE CO'MPLETED) ' ,.~. .' '~2'?' "::.. .~,~ ~.~ ,. . .:~., ~' ~'.,~ ~:~, ~.,' '~"~ . MAILING OR SMELT ADDRESS .... I V ~x Io h~te ~' I~dlV[DbAL ~. ~OC~-AGENCY ?' ~ ~TA~.AGENCY ~ ~0~)~ ~' ~~ ~ , ,~CO~PORA~ION ~A~RS~.IP ~ CO~,~-AGENCY~ ~ FEDERAL-AGENCY , CI~ NAME · STATE ZIP CODE~ ~' PHONE ~ WITH AREA CODE TION-,(MuST BE~COMP~E "':"'. ,,., ' ~" "~ .' B' '~ ........ " {. III. TANK'owNER INFORMA ........ ~ .... ..~. ~.ED) -. -'...L~" '~,~' /Il NAME OF OWNER ".~ '~ ..... "' ~,~,' / CARE OF ADDRESS NFORMAT,. ~ , ,~N ' MAILING OR STREET~DDRESS" . ' ' ,~,': / ~ ~xto~d~te "~ ND V DU~ ~ ,LOCAl-AGENcY ~ STA~-AGEhCY . ~ ~ COUNW-AG~CY '~ FEDERAL-AG~CY CI~ NAME ..... ' ' , ;~i~.,' ;~ 'T~.;~ ~1 STATE J ZIP CODE . PHONE ~ WI~ AREA CODE ;, '. IV. BOARD OF~EQUALIZATION UST STO~AGE FEE AccOUNT NUMBER - Call' (91.6)~2'2:9669 if. questions arise. '. TY(TK) HQ ,~ O · ,..'., ~::' ~...:, . V: PETRoLEuM UST FINANCIAL R.ESPONSiBILI~- (MUST BE cOMPLETED) -'IDEN~i~ TH~ ~ETHOD(S) USED ~ ~ox~oi~ ~ s~[~.~su~ ~ t ouam~~ ~ a ~sum~cfi ~ ~ su~o~ ~ k~o~cS[~,{ ~ o ~u~o~ ~ ~ ~'8 S~ATE~ND&CHIEFFIN~CI~OFRCERL~R. ~ 9 ~A~ND&cER~RCA~OFDEPOSI~ ~ 10 LOCA~GO~'.ME~HANIS~ ' ~ 99 O~ER VL. LE~AL'NOTiFICATI'pN AND BILLING ADDRESS' Lo,al notific;tion and billing wil'l be ~ent t6 the '~a"nk owne:r' unle~ box I or II is Checked. ',~.1_ ' ' ' ." , · ' : , f :" ,.~'. , ~. ' %s ~o.M H~S ~ COmPLEtED'UNDE" ~E~ O~.~E~jU.y, ~D TO ~ ~S~O~ ~'~ K~oWLED~E, /S ~"UE ~D CO.~EC~ '. ' . , .. . . '[ · ~ ~' . ~' .... , ~:,.,';. '~ ; .. ~ .~;-, "TANK OWNER'S NAME (PRIN,ED &, SIGNATURE) .' . ' ' ~,," IT~NKOWNER'S TIT~E ~ ' I DATE MONTH/D~EAR "~ LOCALIAGENCY USE ONLY ' ' · .. ' "; ~ .... ' ' '" I . '.~"'~'~'; ...... .., ~ .......... g"~'""' JURISDICTION"-'~ ..... t~ ~ ',,,'.. ,,~ .... ~'~'"'~ ........... · ~lS FORM MUST'BE'ACCOMPANIED BY AT LEAST {1) OR MORE PERMIT APPLICATION'- FORM B, UNLESS ~lS IS A CHANGE OF SffE INFORMATION ONLY. owNER MUST FILE TH S FORM WI~:THE LOCAL AGENCY IMPLEMENT NG THE UNDERGROUND STORAGE TANK REGULATIONS FORM A(6-95) - ". ' . ".. ' ~. : NSI RUCTIONS F©} l C©MPBE 2. ING FORM GENERAL INSTRUCTIONS: SECTION 27 t t OF TITLE 23. CHAPTER 16, CALIFORNIA CODE OF REGULATIONS AND 8ECTIONS 25286, 25287. AND 25299 OF CHAPTER 6,7, DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE REQUIRE OWNERS FO APPLY.FOR AN UST OPERATING PEI~M]T~ t. One FORM "A' shah be completed lbr all NEW PERM[T C[.tANGES or anF FACILITY/SITE ~NEORMA'NON CHANGES~ 2, SUBMFP ONLY ONE ( ~ ) FORM "A" for a Facility/Si{e, regardlnss of {be mm}~s~' of tanks located at 1t~¢ site ..... A This form should be comp[<~ed by citijet ~ie PERM!T APPLICANT or {he LOCAL AGENCY UNDERGROUND TANK ~NSPECTOR. 4. Please ~ype or prin~ clearly a/~ r{~qncs~ed informatiom 5. Use a hard point writing instn~mer~t, yos am making 3 c~}pies. 6. Tank owner must s~brrfit a facility plot plan to thc loc:d agency as part of the application showing the location of the US% wi~h respect to buildings and tandmza'ks [Section 27tl (a)(g), CCR}. 7. Tank owner muat submit docnm~mtation showing compli~mce with stnte t5nancial msponsibility requirements to the local agency as pa~t of the applicaIion for [mtroleum USTs [Section 27t I (a)(1 i), CCR1, TOP OF FORM; "MARK ONLY ONE ITEM" Mark an (X) in the box next to the item that best describes the ~eason tt~e for'm is beii~g complete& - - I. FACILITY/Sf'~ INFORMATION & ADDRESS (MUST BE COMMUTED) 1. Record name a~d address (pi~ysical location) of fhe unde~'gronnd tank(s). NO~: Address MUST have a valid physical location including city, stale, and zip code~ P.O. BOX NUMBERS ARE NOT ACCEPTABLE. Inclnde neamst cross st~t and nme of the operator. 2. Phone nnmber must have an ama code. If the uight number is the same, write "SAME" in proper location. 3. CMck tM appropriate boa for TYPE OF BUSINNSS OWNERSHIP (ex. CORPORATION, INDIVIDUAL, 4. Check the appropriate box for TYPE OF BUSINESS. 5, If Facility/Site is located within an Indian i~sewation or other Ia&aa mist lands, check d~e box marke(~ "YES" 6. Indicate the NUMBER of TANKS at tlxis 7. Record tM E.P.A. ID 0 or write "NONE" in the space provided. IL PROPERTY OWNER iNFORMATiON & ADDRESS (MUST BE COMPLETED) Complcm all items i2 this section, unless all items axe the same as S~?52NON 1~ i~ }he smudge, wdlo %AME AS S[TF across this section, Be sum 1o check PROPER~FY OV,~ERSHP TYPE box, ill TANK OWNER INFORMATION & ADDR~S (MUST BE COMPLETED) Complete all items in this section, unless ali items are the same ~$ SECTION 1; ff the same, write "SAME AS SFFF across this section, ge sum to cheek TANK OWNERS TYPE box. IV, BOARD OF EQOALIZA~'I(JN UST STORAGE FEE ACCOUNT NUMBER (MUST BE COMPLETED. SEE ARTICLE 3, CHAlYFER 6.J5. DIVISION 20, CALIFORNIA HEALTH AND SAFETY CODE.} Enter your Bom'd of ~ualization (BOE) UST storage fee account number which is requited before your pored* application can be pmcesse& Registmtlon with the BOE will ensu~ that you will receive a quarterly storage fee return in reporting the per gallon fie due on the nmnber of gallons placed it~ your USTs, The BOE will code persons exempt from paying the storage fee so returns will not be sent. If you account number with Ihs BOE or if you have any questions regarding the fee or exemptions, please call the BOE at 916-322-9669 or write to the BOE at tM fc~ttowing address Board of ~lnalizatiotx, Fue[ Taxes Division, P.O~ Box. 942879, Sacramet~o, CA 94279-0001. V. PETROLEUM UST FINANCIAL RESPONSiBiLiTY (MUS1 BE COMPLETED FOR PETROLEUM USTs ONLY, SEE SECTIONS 271 OF TITLE 23, CHAPTER'I 6, CALIFORNIA CODE OF REGULATIONS.) ~7 . Identify the mettmd(s) used by the owner crud/or operator, in meeti,}g the Federat and Sram financi=t responsibility ~quirernent& USTs owned by' any Federal or State agency ~<4 well as nowpetroteum USTs m~e exempt from II,is requirement, V L LEGAL NOTIFICATION AN D B iLL1NG ADDRESS Check ONE BOX for the address that wilt be used R>r BOTH LEGAL AND BILLING NOTiNCATIONS, TANK OWNER OR AUTHORIZED REPRESENI%TtVE MUST SIGN AND DATE FHE FORM AS INDICATED, [SEE SECTIONS 27I'1 (a)(13) OF TITLE 23 CHAPTER I6, CALIFORNIA CODE OF REGULATIONS,} iNSTRUCTION FOR THE LOCAL AGENCIES The county mad juNsdiclion n~mbet~s are predem~'mi~ed and can he obtair~ed by calling the State Board (916) 227-4303, The facility nnmker may - be assigned by the local agency; however, ~his nnmbei' must be tmme~ic~t and cannot contain any alphabetical chamctem if the local agency pmle~ the State Be~'d to assign the facility nnmt:er, please leave it blank IT IS THE REsPONSiBiLiTY OF THE LOCAL AGENCY TttAT INSPECTS THE FACILITY TO VERIFY THE ACCURACY OF THE INFORMATION. THIS APPLICATION CANNOT BE PROCESSED iF'ritE BOE ACCOUNT NUMBER IS NOT FILLED IN. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE %OCAL AGENCY USE ONLY" fNFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGtNAL AND YELLOW C(3PIES~ Tile PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. · ' STATE OF CALIFORNIA . -% . .... .' ~ .... . ........ - "' :STATE. WATER RESOURCES CONTROL BOARD .~ ..... UNBERG~OUND, STORAGE TANK PERMIT APPLICATION - FORM A ' COMPLETE THIS FORM FOR EACH FACILITY/SITE MARKONLY .~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED SITE ONE ITEM [] 2 INTERIM PERMIT E~ 4-'~AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE f I. FACILITY/SITE INFORMATION & ADDRESS - (MU~T BE COMPLETED) DBA OR FACILITY NAME NAME OF OPERATOR ~ ~.~1I ADDRESS NEAREST CROSS STREET PARCEL # (OPTIONAL) CITY NAME STATE I ZIP CODE ' ' SITE PHONE it WITH AREA CODE I ~' BOX ~ CORPORATION [] INDIVIDUAL , r~l PARTNERSHIP ~ LOCAL-AGENCY [] COUNTY-AGENCY" [] STATE-AGENCY* ~Z] FEDERAL-AGENCY' TO. INDICATE DISTRICTS · I! owner of UST is a public agency, complete the following: name o! supervisor of division, section or office which operates the UST "~" EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional DAYS: NAME(LAST, FIRST'/. PHONE # WITH .~REA CODE DAYS: NAME (LAST, FIRST) PHONE .it WITH AREA CODE N~GHTS: NAME (LAST, FIRST/ ' ''~ ~ PHONE it W~TH AREA CODE "N~GHTS: NAME (LAST, F~RST) '"' PHONE' #:w~TH AREA CODE I1. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS V' box to indite r--~I'IND~VIDUAL E~ LOCAL-AGENCY ', ['-'1 §TATE-AGENCY CITY NAME STATE ZIP CODE PHONE # WITH AREA CODE IlL TANK OWNER INFORMATION - (MUST BE COMPLETED) ,. " '-~-:'" ' " I NAME OF OWNER t',i CARE OF ADDRESS INFOR, MA'[I.ON MAILING OR STREET ADDRESS I v" boxto indicate [] INDIVIDUAL E~] LOCAL-AGENCY E~] STATE-AGENCY ~,3 ~,'2..~ ~-~'T<::~ ~ ~.,~ ~:) ,:-~-'~ ~.t, [A~.~..-, -*~ [ ~ CORPORATION [] PARTNERSHIP [~ COUNTY-AGENCY [] FEDERAL-AGENCY crrY NAME STATE ZIP CODE I PHONE it WITH AREA CODE . IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-0660 if quostions arise. V, PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED) - IDENTIFY THE METHOD(S) USED I, box t° indicate ~1 SELF'INSURED I~] 2 GUARANTEE r--] 3 INSURANCE [-''~ 4 SURETYBONo I--'~ 5 LETrER OF CREDIT I'~i 6 EXEMPTION [::::~ 7 STATE FUND [] 8 STATE FUND & CHIEF FINANCIAL OFFICER LETrER [] 9 STATE FUND & CERTIFICATE OF DEPOSIT [] 10 LOCALGOV'T. MECNANISM [:~ 99 OTHER. VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing wilt be sent to the tank owner unless box I or II is checked. " ' THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF My KNOWLEDGE, IS TRUE AND CORRECT TANK OWNER'S NAME (PRINTED & SIGNATURE) I TANK OWNER'S TITLE ~ DATE MONTH/DAY/YEAR LOCALI/[GENCY USE ONLY COUNTY # JURI~DIC'I"ION ~' ' ' ! FACILI'T~.~ it LOCATION CODER - OPTIONAL CENSUS II, ACT # - OPTIONAL ' ' . .; SUPVISOR - DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY, OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNBERGROUND STORAGE TANK REGULATIONS FORM A (6-95) G:NE'P. AL iNSTRUCTiONS: SECTION 2711 OF TITLE 2)~ CHAPTER i6.. CALiPORNiA CO~i OP 'REGULATIONS AND SECTIONS 25286~ :B:~?~ ~Gq'D lBl~9 OF' CHAPTER 6.1, D~ViS~ON 20~ CALP'O~N~A HI!ALTM AND SAFETY CODI: ~EQUiR}: OWNERS TO APPI.Y POR AN UST OPNRA'NNG I. One FORM %~' sllaJi be completed for alt NEW PERMJT CHANGES or :my }~RCILITY/S?I~E tNFORMAT!ON CHANGES, 2. SUBMIT ONLY ONE ( {} 'FO~{M "A for a F::cility/She, r~T' dh:ss of the number of tanks iocatgd at {he sic, 3, TMs farr:~ should be completed by ei{her the PERMIT A?PL:(.iANT or the LOCAL AGENCY UNDERGROUND 'rANK INSPECTOR. 6. Tank owner must <:~b:~ a fadl~:y ~/et pla~ to the }oecd agei:cy ~:5 p;i~t of lira application showiug the toca~ios of :hie USTc wi~h ~aspect to buildings and tandmm"ks [Section 2711 (a)(8), CCR], application for petrol=mn USTc [S~ctio~ 27t i (a)(l l), CCR]~ TOP OF FORMi "MARK (}NRY ONE ~TEM' L FACILITY/SITE INFORMATION & ADDRESS (MUST BE COMPLETED) l. Record namo m}d address (pivsioal location) of the u~dergrotmd ::ank(s)~ NOTE: Address MUST have a valid physic~] location i~:cluding city, s{ale~ :md ~ip code. P,O. BOX NDMBERS ARE NOT ACCEPTABLE. 3. Check thc appropriate box i:c,r TYPE OF BUSINESS OWNERS:liP (ex, CORPORATION tNDIVIDUA!, 4. Check the appropria¢ l~ox 9~r FYPE OF BUSINESS fi, :n<ficl:$ the NUMBER o6TANKS a: :his 7. Record the EihA. tD ~ or wri:e "NONE" in th~: space provid,s& Ii. P}~OPE}t'FY OWNER INFORMAT:ON& ADDRESS (MUST BE COMPLETED) Complete all i~ems :s :his sect:on, unless :ti floras ars ti~e same as SECtiON 1: If {he same. walls "SAME AS SFFE' across this section, Be sttre 1o check PROPERTY OWNERSHIP TYPE box. IlL TANK OWNER iNFORMATiON & ADDRESS (MUST BE COMPLEI ED) to cheek TANK OWNERS TYPE box, iV. BOARD OF EQUALIZATKIN UST STORAGE Kf~E ACCOUNT NUMBER (MUST BE COMPLETED, SEE ARTicLE 5, CHAPSD~:R 6.75. DIVISION 20, CALIPORNIA HEAETH AND SAPETY CODE.) Enmr your Board of ~lUalizafion (BCE) UST storage fee accou~ nunfmx' which is required before your permit application can be pmcesse& Registration with the BCE will ensure thai yott wilt receive a qua~qcrly storage fl~e iemm m rapturing the per gallon fee due on the am~her gallons placed in your USTc, The BCE e'itl code persons exempt from paying tim serage fee so returns will mx Be sem. [fyo~ do not have an accmmt number with :he B(}E or if you have any questions mgs:db:g the f%e or exemptions, please call the BCE at 916.322-9669 or write re the BCE at the fi~llowing address Board of Eq~alizatloa, Fuel Taxes DNisioa, P.O. Box 942879, Sacramento, CA 942794)001. V. PETROLEUM UST FINANCIAL RESPONSIBILITY (MUST BE COMPLETED FOR PETROI.EUM USTc ONLY, SEE SECTIONS 271 OF TITLE 23, CHAFFER 16, CAf. IFORN[A CODE OF REGULATIONS.) identify the method(s) used by thc owner asd/or operator, in meedng the Fo{ie~i and Stare fimmcial msponsibiiity requirements, USTc owned by arly Federal or 8iate agtmcy as well as non.~pet~eiem:: USTc are exemp? from fftis rnquiremcn~, V ~. LEGAL NOTINCATiON AN D B ILLtNG ADDRESS Cf'reck ONE BOX for the address tl,a~ wilt be used for BOTH LEGAL a ND BILLING NOTIE~CATfONS, TANK OWNER OR AUTbRIRIZED REPRESEN'I%TI'VE }4USt SIGN AND DAiE t'I~E PORM AS INDtCA FED. {SEE SECTIONS 27i (a)(13) OF T[I'LE 23 CHAPTER 16, CALiFORNiA CODE OF REGULAIiONS~I INSTRUCTION FOR THE LOCAL AGENCIES Tim ceunly and }u:isdicfion :mmbets are predetnrmN:ed and cm~ be obta ned by calling the State Board {916) 227-4303, The facility ntm~r may be assig~ed by the local agency; however, ti~ig number m~xst t~ tlumericril and canltot con~ain any alphabetical ch~ac~em. If the local agency tT IS T}iE RESPONSiBiLITY OF THE LOCAL AGENCY THAT ~NSPECTS THE FAC1LFFY TO VERIFY THE ACCURACY OF 1NFORMAT~ONL TH~S APPLICATION CANNOT BE PROCESSND tF THE BOB ACCOUNT NUMBER tS NOT FILLED IN. THE LOCAl. AGENCY tS RESPONSIBLE FOR THE COMPLETION OF THE %OCAL AGNNCY USE ONLY" iNFORMATION BOX~ THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COMES, THE P~NK COPY SHOULD BE RETAINED BY THE TANK OWNER, STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY Z 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ONSITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS lNSTALLED: ~ t.~'T-~-t i.-J~).--~ ~'~- I I ~. I. TANK DESCRIPTION COMPL~E ALL ~T~MS - SPEC~ ~F UNKNOWN ~ OWNER'S TANK I. D. ~ ~ ~~ B. MANUFACTURED BY: ~J~ C. DATE INSTALLED {MO~AY~EAR) ~ ~ ~ ~ D. TANK CAPACI~ IN GALLONS: I II, TANK CONTENTS ,F A-1 IS MARKED, COMPL~E ITEM C. ~ ~ ~ ~OTO~ VE.,C~ ~ ~ ~ O,~ ~. C. ~ ~ ~" U~ ~ ~ ~SEL ~ ~ AV,*~O~ ~S ~ lc M~DGR~E UNLADED ~ 5 JET FUEL ~ 8 M85 ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER(DESCR~BEINITEMD. BEL0~ D. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: II1. TANK CONSTRUCTION MARKONE,TEUONLY.NSOXESA.~.ANOC. ANOALLTHATAPPL.~S.N~OXDAN9E A. ~PE OF -~ 1 DOUBLE WALL ~ 3 S~NGLE WALL Wl~ E~ER~OR UNER ~ 5 ~N~RNAL 8~DDER SYS~M ~ ~5 UNKNOWN SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER B. TANK ~ I SARESTEEL ~ 2 STAINLESS S~EL ~ 3 FISERG~SS ~ 4 STEEL C~D W/FISERG~SSREINFORCEDP~STIC MATERIAL ~ 5 CONCR~E ~ S POLW~NYL CHLORIDE ~ 7 ALUMINUM ~ e ~00% METHANOL COMPATISLEWmRP (P~i=~T~.k) ~ ~ B.ONZE ~ ~0 ~ALV*.~ZEO STE~L ~ ~ UNKNOWN ~ ~ OT.E. C. INTERIOR ~ ~ RUBBER UNED ~ 2 AL~D UNPEG ~ 3 EPOXY UN~NG ~ 4 PHENOUC UN~NG LININGOR ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING ~S L~N~NG MA~R~AL COMPATIBLE W~ 100% METHANOL? YES~ NO~ D. E~ERIOR ~ ~ POLY~.YLENE WRAP ~ 2 COA~NG ~ 3 WNYL WRAP ~ 4 F~SERG~SS RE~NFORC~O P~S~C CORROSION PROTEC~ON ~ 5 CA~ODICPROTEC~ON ~ 9~ NONE ~ 95 UNKNOWN ~ 99 OTHER SPILL CONTAINMENT INSTALLED (Y~R) ~ ~ I ~ ~ OVERF~REVENTION EQUIPMENTINS~ALLED (Y~R) E. SPILL AND OVERFILL, etc. DROP TUBE YES ~ NO~ STRIKER P~TE YES ~ NO DISPENSER CONTAINMENT YES ~ NO IV. PIPING INFORMATION C,RCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM~PE A U I SUCTION ~2 PRESSURE A U 3 GRAVI~ A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SING~ WALL A~ DOUBLE WALL A U 3 LINED ~ENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS S~EL A U 3 POL~INYL CHLORIDE (PVC)A~ 4 FIBERG~SS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1 aEC~I~L LINE L~K ~ 2 UNE ~IG~NESS~ 3 C~TINUOUS [NTERSTmAL ~ 4 ELECmONlC LINE ~ 5 A~O~TIC PUaP 0E~OR TES~NG ~ MONITOR~NG ~ [~K DE~CTOR ~ SHU~ ~ 99 OTHER V. TANK LEAK DETECTION 7 CONTINUOUSINTERS~TIAL ~ 8 SIR ~ 9 WEEKLY MANUAL ~ 10 MONTHLY TANK ~ 95 UNKNOWN ~ 99 OTHER MONITORING TANK GAUGING TES~NG VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-P~CE) 1. ESTIMATED DATE ~ST USED (MO~AY~R) 2. ESTIMATED QUANT'~ OF ~ 3. WAS TANK FILLED WITH YES ~ NO~ SUBSTANC~ REMA3NING GALLONS ~NERT MATERtAL THIS FORM HAS BEEN COMPLETED UNDER PENAL ~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I TANK OWNER'S NAME ~I DATE LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUN~ ~ JURISDICTION ~ FAClLI~ ~ TANK STATE I.D.'~ ~ I II I II I'1 PERMIT NUMBER PERMIT APPROVED BY.ATE ~ PERMIT EXPIRATION DATE T ~IS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A~ UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MU~T BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT P~N, FILE THIS FORM WITH THE LOCAL AGENGY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TION~ FORM B (6-95) INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS "' Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES,. R. EMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3.Please type or print clearly alt requested information. Use a hard point writing instrument, you ara making 3 copies. 5.Tank owners must submit a plot plan to the local agency showing the location of the USTs with.respect .to buildings and landmarks [2711 (a)(8) CCR]o 6. Tank owners must submit documentation showing compliance with state financial responsibility require- ments t5 the local agency for petroleum USTs [271 t (a)(l t) CCR]. ,TOP. OF FORM: MARK ONLY ONE ITEM .-. 1. Mark an (X) in the box next to the,item that best describes the reason the form is being completed. 2. Indicate the DBA or Facitity name ~Nhere the tank is installed. 1. TANK DESCRIPTION ~ COMPLETE ALL ITEMS ~ IF UNKNOWN - SO SPECIFY .. A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. .. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). -. C. Indicate the year-the tank was installed (ex. t987). D. Indicate the tank capacity, in gallons (ex. 25,000 or 10,000 etc.). II. TANK CONTENTS A. 1. IF MOTOR .VEHICLE FUEL, check box 1 and complete items B & 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name df the hazardous substance stored in the tank and the C.A.S.#. (Chemical'.. Abstract Service number), if box I is NOT checked in A. Ill. TANK CONSTRUCTION-I~ARK ONE ITEM ONLY IN BOX A, B, C & D 1-: --.CJ'}~ck only one item in TYPE OF SYSTEM, TANK-MATERIAL INTERIOR LINING and CORROSION · ' PROTECTION. ' 2. if OTHER, print in the space provided. IV. PIPING INFORMATION ' Circle "A" if above ground circIe 'U" if underground, and circle,'t~)th if applicable. 2.If UNKNOWN'~:~rqle; or if OTHER, prir,~t in space provided. 3.Ind!c.ate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate th~ LEAK DETECTION system(s) used to comply with the.monitoring requirements for the tank. Vl. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE ESTIMATED DATE LAST USED ~ MONTH/YEAR (January, 1988 or 0t/88) 2.ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank/in Gallons). 3.WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)f13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state 'underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and'jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facilib, z number must be the same as shown in form "A". The tank number may be assigned by the local agency~ however, thi. s number must be numerical and cannot contain an alphabet, tf the local a.gency prefers the State Board to assign the tank· number, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- .RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY~' INFORMATION BOX. THE LOCAI.~ AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW (~OPIES. THE PINK COPY SHOULD BE 'RETAINED BY. THE 'TANK OWNER. ? ~ ...... SI~TE OF CALIFORNIA ~~.~ ~' STATE WATER RESOURCES coNTROL BOARD '' ~@(~[~ t~l~,~,. UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM a.'~ . ,~,-.. COUPLE~ A SEPARATE FORM FOR EACH TANK sYs~M. MARK ONLY ~ NEW PERMIT ~ 3 RENEWAL PERMIT . ~ 5 CHANGE OF INFORMATION ~ 7 PERMANENTLY CLOSED ON SITE ONE ITEM ~ 2,1N. TERIM PERMIT ~ 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE ~ 8 TANK'REMOVED DBAOR FAC L ~ NAME WHERE TANK IS INSTALLED: ~~ ~~ ~' I } ~' ~ ~'~H I. TANK DESCRIPTION ~QMPLETE ALL ITEMS - SPECI~ IF UNKNOWN I ~ OWNER'S TANK I. D.' ~' ~~~ B. MANUFACTURED BY: ~~ ~T~,~ ~T'[ c. DATE INSTALLED (MO/DAY. EAR) [ ~ ~'~ D. TANK CAPACI~ IN GALLoNs: II. TANK CONTENTS ~F A-1 IS MARKED, COMPLAN I~M C. ~ ~ 1 MOTOR VEHICLE FUEL ~ 4 OIL B. C, ~: la REGU~R UNLADED: ~ 3 DIESEL ~ 6 AVIATION~G~S ~ 2 P~ROLEUM ~ 80 EMP~' ~ 1 PRODUCT ~ lb PREM~U~ UNLADED ~ 4 GASAHOL ~ 7 METHANd~ ,~ lc MIDGR~E UNLADED ~ 5 JET FUEL ~ S M85' ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~ 2 WASTE ~ 2 ~ADED . ~ 99 O~ER(DESCRIBEINtTEMD. BE~0~ D. IF(A. 1) IS NOT M~KED, ENTER NAME OF SUBSTANCE STORED C.A.S.~: · ' . . ~ IlL TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B ANDC, AND ALL THAT APPLIES IN BOX D AND E ::~';. :.~' .... A. ~PE OF ~ 1 DOUBLE ~ALL . ~ 3 SINGLE WALL Wl~ EXTERIOR LINCh ,~ 5':IN~R~AL B~DDER SYS~M ~'95 UNKNO~ SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT . ?, ~ ,Dg 0~HER '~ '''~ B. TANK ~., BARESTEEL ~" ~' S~AINLESS S~ ~ 3 F,SERG~SS ~:4 S~ELC~O W/FIBERG~SSREINFORCEDP~STIC MA~RIAL ~ 5 CONCRETE ~ 6 POLWINYL CHLORIDE ~ 7 ALUMINUM ~ ~ 100% METHANOL COMPATIBLEW/F~P (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN '~ 99 OTHER ~,,: C. INTERIOR ~ I RUBBER LINED ~ 2 AL~D LINING ~ ~3' EPOXY MNING' 4 PHENOLIC LINING-' .... 6 UNLINED ~ g5 UNKNOWN ' :~ '99 OTHER ~,~,,',*~, LINING OR ~ 5 G~S LINING '~ COATING · IS LINING MA~RIAL COMPATIBLE Wl~ 100% METHANOL? YES~ NO~ D. EXTERIOR ~ 1.0LY~HYLENE WRAP ~2 COA~NG., ~ 3 V.NYL WRAP ?,.~::4. FIBERG~SS REINFORCED P~STIC CORROSION ..... PROTEC~ON ~. 5 CA~ODIC}PROTEC~ON ~ 9~ NONE ' ~ 95 ~NKNOWN ': '.~ 99 OTHER SPILL CONTAINMEN~STALLEO (Y~R) I I - '~ _ ' OVERF~REVENT!ON EQUIPMENT INSTALLED (YEAR) I · ' E. SPILL AND OVERFILL, etc. DROPTUBE YES ~ NO STRIKERP~TE YES % NO · DISPENSER CONTAINMENT YES NO IV. PIPING INFORMATION . ';~IRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE~ A. SYSTEM~PE A U '1 SUCTION ~2 PRESSURE A ~ 3 GRAVI~ 'A U 4 FL~IBLEPIPING~ A U 99 OTHER B. CONSTRUCTION A U'I SINGLE WALL' A~ DOUBLE WALL A U 3 LINED ~ENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARES~EL A U 2 STAINLESS S~EL A U 3 POL~INYL CHLORIDE(PVC)A~ 4 FIBERG~SS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 'STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTEC~ON A U 9 GALVANIZED STEEL, A U 10 CAT~DICPROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ ~c~,~ u.~ ~K ~ 2 LINE TIG~NESS~ 3 CONTINUOUS INTERS~AL ~4 ELEC~ONIC'UNE ~ 5 A~0~TIC PUMP DE~OR TESTING ~ MONITORING '~K DE~CTOR SHUT~ ~ 9~ OTHER ~TANK LEAK DETECTION ' ' · ] ~'~ I VISUAL CHECK ~ 2 MANUAL INVENTORY ~ 3 VADOZE ~ 4 AUTOMATIC TANK ~ 5 GROUND WATER ~ 6 ANNUALTANK . RECONCILIATION MONITORING GAUGING' ~ MONITORING ~ TESTING I~ 7 CONTINUOUSINTERS~TI~ ~ 9 WEEKLY MANUAL 10 MONTHLY TANK ~ 95 UNKNOWN ~ 99 OTHER ~ ~ MONITORING 8 SIR TANK GAUGING TES~NG VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-P~CE) "~ESTIMATED DATE ~ST USED (MO/DAY'R) 2. ESTIMATED QUANTI~ OF 3. WAS TANK FILLED WITH" YES SUBSTANCE REMAINING GALLONS INERT MATERIAL ? ', · THIS FORM HAS BEE~O~LETED UNDER PENA~ ~ OF PERJURY; AND TO ~HE BEST OF MY KNOWLEDGE,/S TRUE AND CORRECT TANK OWNER'S NAME ~ ~ ~ ~ ~- (PRINTED & SIGNATURe. LOOAL AGENOY USE ONLY -THE STA~ ~.D. NUaBER ~S COaPOSEDOFTHE FOUR NUMBERS BELOW ; ~', '' ' ' .COU'N~ ~ JURISDICTION ~ F~CILI~ ~ "/ , TANK f .~. STATE I:D.'~: :~, t I' I '' I I. I I I' t,I t. PERMI~'NUMBER .~ . ~ PEfl~IT APPROVED BY/DATE PERMIT EXPIRATION DATE .~ ~IS FORM MUST BE ACCOMPANIED' BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BE~ FI~ED. FORM C MUST BECOMPL~ED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPAN ED BY A PLOT P~N FILE THIS FoRM WITH THE LOCAL AGENCY IMPLEMENTIN~'THE UNDERGROUND STORAGE TANK flEGU~TIONS FORM B (6-9~) . , INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL. INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES; REMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2.. This form should be completed by either the PERMIT APPLICANT or tile LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument, you are making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. 6. Tank owners must submit documentation showing compliance with state financial responsibility require- ments t6 the local agency for petroleum USTs [2711 (a)(11) CCR]. TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to theJtem that best descC:.ibes the reason the form is being completed. : 2. Indicate the DBA or Facility name'where the tank is installed. I. TANK DESCRIPTION - COMPLETE ALL ITEMS ~ IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - tf there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex, ACME TANK MFG). -' C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity_ in gallons (ex. 25,000 or 10,000 etc.). II. TANK cONTENTS A. 1. tF MOTOR VEHICLE FUEL, check box 1 and complete items B & 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box t is checked in-AI. D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box t is NOT checked in A. Ill. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B, C & D 1.7 ' .Check only one item in TYPE OF S¥_S, TEM, TANK-MATERIAL INTERIOR LINING and CORROSION ' ' PROTECTION. 2. If OTHER, print in the space provided. IV. PIPING INFORMATION 1. Circle"'W' if above ground circle "U" if underground, and circle' both if applicable. 2. If UNKNOWNCi'rcte; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank, VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED - MONTH,YEAR (Januap?, 1988 or 01/88) . _ 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit ~aciiity number and the six digit tank number. The county an~t'judsdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an a!phabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY T'HE TANK OWNER. STATE WATER RESOURCES CO.TROL ~. UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLE~ A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ ~ NEW PERMIT ~ 3 RENEWAL PERMIT ~ 5 CHANGE OF ~NFORMAT[ON ~ 7 PERMANENTLY CLOSED ONS~TE~ ONE ITEM ~ 2 INTERIM PERMIT ~ 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED DBAOR FACILI~ NAME WHERE TANK IS INSTALLED: ~> .... ~*~.-~ ~,:~ ~* ~ t ~/~' ~ ~H C. DATE INSTALLED (MO~AY~EAR) ~ ~'~ ~ ~ D. TANK CAPACI~ IN GALLONS: )~ ~ II. TANK CONTENTS ,F A-1 IS MARKED. COMPL~E ITEM C. . ~ 1 MOTOR VEHICLE FUEL ~ 4 OIL B. C. ~ la REGU~R UNLADED ~ 3 DIESEL ~ 6 AVIATION GAS 2 P~ROLEUM 80 EMP~ ~ lc MDGR~E UNLADED ~ 5 JETFUEL ~ 8 M85 ~ 3 CHEMICAL PRODUCT ~ g6 UNKNOWN ~ 2 WASTE ~ 2 LEADED ~ 99 O~ER (DESCRIBE IN ITEM D. BEL0~ D. IF (kl) 18 NOT M~KED, ENTER N~E OF SUBSTANCE STORED C.A.S. ~; mira, TANK CONSTRUCTION UAR~ ONE ITEM ONLY IN BOXES A. B, ANDC, A,D ALL ~AT APPLIES mN BOX D AND E A. ~PE OF ~ I D~BL~ WALL ~ 3 SINGLE WALL WI~ EXTERIOR DNER ~ 5 IN~RNAL B~DDER ~S~M ~ 95 UNKNO~ SYSTE~ ~ 2 SINGLE WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER B. TANK ~ 1 BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERG~SS 4 STEEL C~D W/FIBERG~SS REINFORCED P~STlC ~ATERIAL ~ 5 CONCRETE ~ 6 POL~mNYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% UETHANOL COMPATIBLEW/FRP (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 9g OTHER C. INTERIO~ ~ 1 RUBBER LINED ~ 2 AL~D LININ~ ~ '3 EPOXY UNING ~ 4 PHENOLIC LINING LINING OR ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING IS LINING MA~RIAL COMPATIBLE Wire 100% MEmANOL ? YES__ NO__ D, E~ERIOR ~ 1 POLY~HYLENE WRAP ~ 2 COA~NG ~ 3 VINYL WRAP ~ 4 FIBERG~SS REINFORCED P~STIC CORROSION '-~ROTECTION ~ 5 CA~ODIC,PRO~C~ON ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER SPILL CONTAINMEN~STALLED (Y~R} ~ ~ ~ ~ OVERF~PREVENTION EQUIPMENT INSTALLED (YEAR) E, SPIL~ AND OVERFILL, etc, DROPTUBE YES ~. ,. NO STRIKER P~TE YES -~ NO DISPENSE~ CONTAINMENT YES ~ NO IV. PIPING INFORMATION '~IRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM~PE A U 1 SUCTION ~2 PRESSURE A U 3 GRAVIW A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SING~ WALL A~ DOUBLE WALL A ~ 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MA~RIALAND I U 1 BARE SmEL A U 2 STAINLESS SmEL A U 3 POLWINYL CHLORIDE (PVC) 4 FIBERG~SS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW~RP PROTEC~ON A U 9 GALVANIZED STEEL A U 10 CA~ODICPROTECTION A U 95 UNKNOWN A U 99 OTHER O. LEAK DETECTION ~ 1 MEC~I~L LINE L~K ~ 2 UNE ~G~NESS ~ 3 CONTINUOUS INTERSTI~AL ~ 4 ELECmONIC UNE ~ 5 A~O~TIC PUMP DETECTOR TES~NG ~ MONITORING LEAK OE~CTOR ~ SHUT~ ~ 99 OTHER V. TANK LEAK DETECTION ' CONTINUOUSINTERSTmTmAL ~ 8 SIR ~ 9 WEEKLY MANUAL ~ 10 MONTHLY TANK ~ 95 UNKNOWN ~ 99 OTHER MONITORING TANK GAUGING TESTING VI. TAN~ CLOSURE INFORUATmON (P~RUANSNT CLOSURE ~N-P~CE) 1. ESTIMA~D DATE ~ST USED (MO~AYER) 2. ESTIUATED QUANTI~ OF 3. WAS TANK FILLED WITH YES SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS 8EEN~PLETED UNDER PENAL ~ OF PERJURY, AND TO ~HE 8EST OF MY KNOWLEDGE, IS TRUE ANO CORRECT LOCAL AGENC~ USE ONLY ~HE STA~ I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW r , COUN~ ~ JURISDICTION ~ FACILI~ ~ TANK ~ PERMIT NUMBE~ ~ PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLIGATIOH - ~ORM A, UN~SS A CU~REH~ FO~M A HAS BEEN FILED, ~O~M C MUST BE COMPLIED FO~ IN~ALLATIONS, THIS FORM SHOULD,BE~CCOMPANIED BY A PLOT P~H. FILE ~IS FO~M WITH THE LOCAl AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS FORM B (6-95) INSTRUCTIONS FOR COMPLETING FORM GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code cf Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, D. ivision 20, Health and Safety Code require tank: owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for alt NEW PERMITS, PERMIT CHANGES, REMOV- ALS and/or any other TANK INFOFtMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER~ GROUND TANK INSPECTOR. : 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument, you are making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs: with respect to buildings and landmarks [2711 (a)(8) CCR]. , 6. Tank owners must submit documentation showing compliance with state financial respons,'ibitity require- ments to the local agency for petroleum USTs [2711 (a)(11) CCR]. TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to the item tt~at best describes the reason the form is being co'mpleted. 2, Indicate the DBA or Facility name where the tank is installed. I. TANK DESCRIPTION ~ COMPLETE ALL ITEMS ~ IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - tf there is a tank number that is used by the owner to identify the tank, (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 11. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete itenis B B~ Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in A). of the hazardous substance stored in the tank and the C.A.S.#. (Chemical D. Print the chemical name Abstract Service number), if box I is NOT checked in A. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B, C & D 1. Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION i PROTECTION. 2. If OTHER, print in the space provided. lV. PIPING INFORMATION Circle "A" if above ground circle "U" if underground, and circle both if applicable. If UNKNOWN circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requiremeat for the piping. V. TANK LEAK DETECTION ; 1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE : 1. ESTIMATED DATE LAST USED - MONTH/YEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallon's). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 27tl (a)(t3) CCR] ' INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, ihe three digit jurisdiction number, tl~e six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must he'numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please 'leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] e TANK REMOVED I I. TANK DESCRIPTION COMPLETE ALL ~TEMS - SPECIFY ~F UNKNOWN I C. DATE INSTALLED (MO/DAY/YEAR) ~ ~1 ~ D. TANK CAPACITY IN GALLONS: ~(~'I II. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. lb PREMIUM UNLEADED [] 4 GASAHOL [] 7 METHANOL [] 2 PETROLEUM [] 60 EMPTY ~. PRODUCT [] 10 M,0G~E U.L~0ED [] ~ ~ETFUEL [] B M~ [] ~ C.EM,C^LPRODUCT [] 9S UNKNOW" [] 2 WASTE [] ~ LEADED [] 99 D. IF (A. 1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S. #: III. TANK CONSTRUCTION MA.KONE~TEMONLY~NBOXESA. B, ANDC, ANDALLTHATAPPUES~NBOXDANDE A. TYPE OF .~' 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS ~ 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (Primary Tank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING OR [] 5 GLASS LINING ~ 6 UNLINED [] 95 UNKNOWN [] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES__ NO__ D. EXTERIOR [] ~ POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP ~ 4 FIBERGLASS RE~NFORCED PLASTIC CORROSION PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) I C-'l ~ -~ OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) t z.~ ~ -"~ E. SPILL AND OVERFILL, etc. DROP TUBE YES .~ NO ' STRIKEF~PLATE YES ~ NO DISPENSER CONTAINMEN~ YES~ NO IV. PIPING INFORMATION C,RCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION O PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~ DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U i BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U~ FIBERGLASS PIPE CORROSION A IJ 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 10ET~CToRUECH~CAL U,S LEAK ~F----i 2 ~ES~NGU"E ~N~SS ~ CONT~NUOUSa0N~m,,N~ ,NTERSTmAL [] 4 LEAKELECTRON~C0ET~CToRUN~ [] $ AU~0~CsHuTOowN PUaP [] 99 OTHER V. TANK LEAK DETECTION I [] 1 VISUAL CHECK [] 2 MANUAL INVENTORY [] 3 VADOZE [] 4 AUTOMATIC TANK [] 5 GROUND WATER [] 6 ANNUALTANKI RECONCILIATION MONITORING GAUGING MONITORING TESTING ~ 7 CONTINUOUS INTERSTITIAL [] 8 SIR [] 9 WEEKLY MANUAL [] 10 MONTHLY TANK [] 95 UNKNOWN [] 99 OTHER MONITORING TANK GAUGING TESTING VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) I 1, ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OFsuBSTANCE REMAINING GALLONS [ 3, WAS TANK FILLED WITHiNERT MATERIAL ? YES[] NO[] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT TANK OWNER'S NAME DATE LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW I! COUNTY # JURISDICTION # FACILITY # TANK # PERMIT NUMBER I PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (6-95) INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL, .INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES;, REMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3.Please type or print clearly all requested information. 4.Use a hard point writing instrument, you are making 3 copies. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) OCR]. 6. Tank owners must submit documentation shewing compliance with state financial responsibility require- ments to the local agency for petroleum USTs [271 t (a)(l t) CCR]. TOP OF FORM: MARK ONLY ONE ITEM , 1, Mark an (X) in the box next to tl~e Item that best de¢cdbes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. 1. TANK DESCRIPTION ~ COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B, Indicate the name of the 0ompany that manufactured the tank (ex. ACME TANK MFG). '. , C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.), 11. TANK CONTENTS A~ 1. tF MOTOR VEHICLE FUEL, check box t and complete items B & C. . 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name of the hazardous substance stored in the tank and the CoA.S.#. (Chemical Abstract Service number), if box 1 is NOT checked in A. III. TANK CONSTRUCTION-M~RK ONE ITEM ONLY IN BOX A, B, C & D 1 .- Q:eck only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION ' ' PROTECTION. 2. If OTHER, print in the space provided .. IV. PIPING INFORMATION ~ 1. Circle "A" if above ground circle "U" if underground, and circle' ~oti~ if applicable. 2. If UNKNOW,N-.drde; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate. the LEAK DETECTION system(s) used to core'pie with the.monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED tN PLACE 1. ESTIMATED DATE LA, ST USED - MONTH/YEAR (JanuaW, 1988 or 0t/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INtri- CATED [see section 2711 (a)(t3) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground ~torage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facitity number and the six digit tank number. The county &hd jurisdiction numbers are . predetermined and can be obtained by calling the State Board (916) 227~4303. The facility number must be the same as shown in form'"A". The tank number may be assigned by the local agency, however, this' number must be numerical and ' cannot contain an alphabet. If the local agency prefers the Stat.? Board to assign the tank number, please leave it blank. IT tS THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY .THE TANK OWNER. :.,.~;~;:%, UNDERGROUND STORAGE TANK,. PERMIT APPLICATION - FORM B ~~, '~';~' ' · :=;., ,COMPLETE A SEPARATE FORM FOR EACH TANK SYS~a. MARK ONLY ~ 1 NEW PERMIT ~ 3 RENEWAL PERMIT ~ 5 CHANGE OF INFORMATION ~ 7 PERMANENCY CLOSED ON SI~E ONE EEC ~' ~'.INTERIM PERMIT ~ 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED DBAOR FACILIW NAME WHERE TANK IS lNSTALLED: ~~"~~ ~ -~ ~ ~ ~ ~, I. TANK DESCRIPTION COUPLETS ALL ~TS~S - SPEC~ ~F UNKNOW. C. DATE INSTALLED (MO~AY~EAR) ~ ~ ~ D. TANK CAPACI~ IN GALLONS: ~ ~ ~ ' II. TANK CONTENTS ~F A-1 ~s MARESO, COMPL~E ~TSU C. ' lb PREMIUM UNL~D~ ~. 4 GASAHOL ~ 7 ME~ANOL D. IF (A.1) IS NOT M~RKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: IlL TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D AND E .' A. ~PE OF ~ ~' DOU~ WALL ~ 3 S,NGLE WALL' W,~ EXTER,OR UNER './~ S ,N~RNAL S~DDER sYS~M SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A vAuLT / ~ ~99 OTHER B. TANK ~ 1 MARE STEEL ~ ~ STAINLESS S~EL ~ 3 FIBERG~SS ~. 4' STEEL C~D W/FiBERG~SS REINFORCED P~STiC. MATERIAL ~ 5 CONCRETE ~ 6 POLWlNYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% METHANOL COMPATIBLEW/FRP (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 'OTHER' C. INTERIOR ~ 1 RUBBER LINED ~ 2 AL~D LINING ~ 3 EPOXY UNING ~ 4 PHENOLIC LINING. LINING OR ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING IS LINING MATERIAL COMPATIBLE Wl~ 100% METHANOL? YES~ NO~. D. E~ERIOR ~ 1. POLY~HYLENE WRAP ~ 2 COA~NG ~ 3 VINYL WRAP ~ 4 FIBERG~SS REINFORCED P~STIC CORROSION . PROTECTION ~ 5 CA~ODI~PRO~C~ON ~ 91 NONE ~ 95 UNKNOWN, .'. ~ 99 OTHER SPILL CONTAINMEN~STALLED (Y~R) i ~ ~ ~ OVERFI~REVENTION EQUIPMENT INSTALLED (YEAR) E. SPILL AND OVERFILL, etc. DROP TUBE YES ' ' NO STRIKER P~TE YES N0 DISPENSER CONTAINMENT YES ~ NO IV. PIPING INFORMATION ~nCL~ A IF ABOVE GROUND OR O IF UNDERGROUND, BOTH IF A~PLICABLE A. SYSTEM.~PE '. A U 1 SUCTION . ~ PRESSURE A U 3. GRAVI~ A U~ 4 FL~IBLE PIPING. A 'U. 99 OTHER B. CONS~UCTION A U I SINGLE WALL.~ DOUBLE WALL A U 3 LINED ~ENCH A U, 95 UNKNOWN A 'U 99 OTHER C, UATERIALAND A U 1 BARESTEEL A U 2 STAINLESS S~EL A U 3 POLWINYL CHLORIDE(PVC)A FIBERG~SS PIPE ,CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7, STEELW/COATING ' A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER O. LEAK DETECTION ~ u~c.~,~ U.E ~a~ ~ 2 U.E ~ESS ~ CO.T,.UOUS ,.T~nSTmA~ ~4 E~.CmO.,C U.. ~ 5 A~O~C PUMP V. TANK LEAK :DETECTION MONITORING TANK GAUGING TESTING VI. TANK CLOSURE INFORMATION(PERMANENT CLOSURE IN-P~CE) I 1. ESTIMATED DATE ~ST USED (MO/DA~R) 2. ESTIMATED QUANTI~ OF 3. WAS TAN'K FILLED WITH YES ~ NO~ SUBSTANCE REMAINING GALLONs INERT MATERIAL ? THIS FORM HAS BEEN:~LETED UNDER PENAL ~ O~.~ERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY- ~E STA~ I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW ~, , . COON~ ~ JURISDICTION ~ FACILI~ ~ PERMIT NUMBER . '? "' 'PERMIT APPROVED BY.ATE PERMIT'EXPIRATION DATE THIS FORM MUST BE AccoM~AN~E'D BY A PERMIT APPLICATION- FORM A, UNLESS A CURRENT FORM A HAS BEEN'FILED. FORM C MUST BE COMPLIED FOR INSTALLATIONS. THIS FORM SHOULD BE,ACCOMPANIED BY A PLOT P~N. FILE THIS FORM WITH'THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safeb~' Code require tank owners to apply for an UST operating permit, 1. One FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGESi, REMOV- ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. Please type or print clearly all requested information. 4. Use a hard point writing instrument, you are making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [2711 (a)(8) CCR]. Tank owners must submit documentation showing compliance with state financial responsibility require- ments to the local agency for petroleum USTs [27t 1 (a)(l I) CCR]. TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to t~e item that best descr.'ibes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. 1. TANK DESCRIPTION - COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B, Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the year the tank was installed (ex. t987). D. Indicate the tank capacity in gallons (ex, 25,000 or 10,000 etc.). II. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2, If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. ~ B. Check the appropriate box, C. Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in.A). D. Print the chemical name of the hazardous substance stored in the tank and the C.A,S.#. (Chemical Abstract Service number), if box I is NOT checked in A. II1. TANK CONSTRUCTION-MARK ,.ONE ITEM ONLY IN BOX A, B, C & D 1,- Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTECTION. 2. tf OTHER, print in the space provided. IV. PiPiNG INFORMATION ~ ' Circle' "A" if above ground circle "U" if underground, and circle bot~ if applicable, 2. tf UNKNOWN-~ircIe; or if OTHE'R, print in space provided. .3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION I. Indicate the LEAK DETECTION system(s) used ~:o com'pl¢ with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED - MONTH/YEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). ' 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2~11 (a)(13) CCR] INSTRUCTION 'FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit cou.n.ty number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and can be ~obtained by calling the State Board (9t6) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an alphabet, tf the local agency prefers the State Board to assign the tank number, please leave it blank. tT tS THE RESPONSIBILITY OF 'THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL .AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. :~ STATE OF CALIFORNIA '[[.g~J~ ~'~-~_~ STATE WATER RESOURCES CONTROL BOARD , ' :' ~' UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B '~=~ ~ ~ COMPLE~ A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT ~ 3 RENEWAL PERMIT ~ 5 CHANGE OF INFORMATION ~ 7 PERMANENTLY CLOSED ON SITE ONE ITEM ~ 2,,INTERIM PERMIT ~ 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE ~ 8 TANK REMOVED I. TANK DESCRIPTION C. DATE INSTALLED (MO~AY~EAR) II, TANK CONTENTS ,F A-1 IS MARKED, COMPL~E ITEM C. ~ 2 P~ROLEUM ~ 80 EMPW ~: , PRODUCT lb PREMIUM UNL~ED ~ 4 GASAHOL ~ 7 ME~ANOL F ~ lc MIDGR~E UNLADED ~ 5 JETFUEL ~ 8 M85 ~ 3 CHEMICAL PRODUCT ~ 95 UNKNOWN ~2 WASTE ~ 2 LEADED ~ 99 O~ER (DESCRIBE IN ITEM D. BEL0~ D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. ~: III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXDANDE A. ~PE OF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WI~ EXTERIOR LINER . ~ 5 I~RNAL B~DDER SYS~M ~ 95 UNKNOWN SYSTEM ~ 2 SING~ WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER B. TANK ~ I BARE STEEL ~ 2 STAINLESS S~EL ~ 3 FIBERG~SS ~ 4 STEEL C~D W/FIBERG~SS REINFORCED P~STIC MATERIAL ~ 5 CONCRETE ~ 6 POLWlNYL CHLORIDE ~ 7 ALUMINUM ~ 8 100% METHANOL COMPATIBLE W/FRP (Prima~Tank) ~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER C, INTERIOR ~ 1 RUBBER LINED ~ 2 AL~D LINING ~ 3 EPOXY UNING ~ 4 PHENOLIC LINING LINING OR ~ 5 G~SS LINING ~ 6 UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING IS LINING MA~RIAL COMPATIBLE WI~ 100% METHANOL? YES~ NO~ D. EXTERIOR ~ 1 POLY~HYLENE WRAP ~ 2 COA~NG ~ 3 VINYL WRAP ~ 4 FIBERG~SS REINFORCED P~STIC CORROSION PROTEC~ON ~ 5 CA~ODI~PROTEC~ON ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER SPILL CONTAINMENT INSTALLED (Y~R) E. SPILL AND OVERFILL, etc. DROPTUBE YES ~ NO STRIKER P~TE YES ~ NO DISPENSER CONTAINMENT YES ~ NO IV, PIPING INFORMATION ~IRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM ~PE A U 1 SUCTION ~ PRESSURE A U 3 GRAVI~ A U 4 FLEXIBLE PIPING A U 99 OTHER B. CONSTRUCTION A U 1 SING~ WALL~ DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND A U I BARES~EL A U 2 STAINLESS S~EL A U 3 POL~INYL CHLORIDE(PVC)A~ FIBERG~SS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER B. LEAK DETECTION ~ 1 MEC~ UNE L~K ~ 2 LINE ~IG~NESS CONTINUOUS INTERS~AL ~ 99 O~ER ~0R TESTING ~ MONITORING ~ 4L~KELEC~ONICDE~CToRUNE ~ 5 A~O~T]CsHU~ PUMP I V. TANK LEAK DETECTION VI, TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-P~CE) I 1. ESTIMATED DATE ~ST USED (MO~AY~R) 2. ESTIMATED QUANTI~ OF I3' WAS TANK FILLED WITH YES ~ NO~ SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN;~LETED UNDER PENAL ~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STA~ I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW ... COUN~ PERMIT NUMBER ~ PERMIT APPROVED BY.ATE PERMIT EXPIRATION DATE THIS FOHM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CUHRENT FORM A HAS DEEN FILED. FORM C MU~T BE COMPLIED FOR IHSTALLATIONS. THIS FOR~ SHOULD BE ACCOMPANIED BY A PLOT P~N. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STOHAGE TANK REGU~TIONS FOH~ 8 (6-95) INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permit. 1. One FORM "B" shall be completed for each tank for a!t NEW PERMITS, PERMIT CHANGES, REMOV- ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3.Please type or print clearly all requested information. Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [27t 1 (a)(8) CCR]. 6. Tank owners must submit documentation showing compIiance with state financiat responsibility require- ments to the local agency for petroleum USTs [27I 1 (a)(t 1) CCR]. TOP OF FORM: MARK ONLY ONE ITEM 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. indicate the DBA or Facility name where the tank is installed. TANK DESCRIPTION ~ COMPLETE ALL ITEMS - IF UNKNOWN ~ SO SPECIFY A. indicate owners tank tD # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B.Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). Indicate the year the tank was installed (ex. 1987). D.Indicate the tank capacity in gallons (ex~ 25,000 or 10,000 etc.). tl. TANK CONTENTS 1. IF MOTOR VEHICLE FUEL, check box 1 and complete items B & C. 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. Check the appropriate box. C.Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in A). D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box 1 is NOT checked in A. III. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B, C & D 1. Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINING and CORROSION PROTECTION. 2. If OTHER, print in the space provided. IV. PIPING INFORMATION Circle' "A" if above ground circle "U" if underground, and circle both if applicable. If UNKNOWN circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to comply with the.monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIMATED DATE LAST USED - MONTH/YEAR (January, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 27tl (a)(t3) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency, however, this number must be numerical and cannot contain an a!phabet, tf the local agency prefers the State Board to assign the tank number, please leave it blank. IT 1S THE RESPONSIBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY .OF THE INFORMATION. THE LOCAL AGENCY 1S RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE OF CALIFORNIA ,Z..*,~' '"'t" ~ STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] e TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ~D~>'~ t.-J~i,~O ~'~ -- i I ~'~-/--- . ~ I. TANK DESCRIPTION COMPLETE ALL ~TEMS - SPECIFY ~F UNKNOWN A. OWNER'S TANK I. D. # i.~ ~ ~----.~.-~ D~.--'--~/,J B. MANUFACTURED BY: 'T~'"~/~' ~ ~-~'~ '"~-~ ~[ ~ ~'~ 'T c. DATE INSTALLED (MO/DAY/YEAR) J ~"1' ~ ~ D. TANK CAPACITY IN GALLONS: J~)~ O(~(~ II. TANK CONTENTS IF A-1 IS MARKED. COMPLETE ITEM C. ~'~, MOTOR VEH,CLE FUEL [] 40,L B. ~,a .EGU~. UNL~O [] ~ D,ESEL [] ~ AV,AT,ON GAS ~ ~ PRODUCT [] ~ ,.~,U~ U.~ [] ~ G^SA.OL [] ~ METHANOL 2 PETROLEUM 80 EMPTY -~'L_._J lc MIDGRADE UNLEADED [] 5 JET FUEL [] 8 M85 [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. #: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D AND E A. TYPE OF ~ 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR UNER [] 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS ~ 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLE W/FRP (Primary Tank) [] 9 BRONZE' [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING OR [] 5 GLASS LINING .~ 6 UNLINED [] 95 UNKNOWN [] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES__ NO__ D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [~¢'4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) ~" 4'~1'~"~ '~ OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) E. SPILL AND OVERFILL, GtC, DROP TUBE YES ,? NO__ STRIKER PLATE YES ~ NO DISPENSER CONTAINMENT YES ~ NO__ IV, PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A(~2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B, CONSTRUCTION A U 1 SINGLE WALL At~2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A(~)4 FIBERGLASS PIPE CORROSION A U § ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER O, LEAK DETECTION [] 1 MECHANICAL LINE LEAK [~ 2 UNE 'i3GHTNESS ~,'3 CONTINUOUS INTERSTITIAL [] 4 ELECTRONIC LINE [] 5 AUTOMATIC PUMP [] 99 OTHER DETECTOR ~J TESTING ~ MONITORING LEAK 0ETECTOR SHUTDOWN V. TANK LEAK DETECTION [] , v,su^L CHECK [] ~ MANUAL ,NVENTORY [] ~ VADOZE [] 4 AUTOMATIC TANK [] ~ GROUND WATER [] ~ ANNUALTANKI RECONCILIATION MONITORING GAUGING MONITORING TESTING ~ 7 CONTINUOUS INTERSTITIAL [] 8 SIR [] g WEEKLY MANUAL [] 10 MONTHLY TANK [] 95 UNKNOWN [] 99 OTHER I MONITORING TANK GAUGING TESTING VI, TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) '. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF I3' WAS TANK FILLED WITH YES[] NO[] SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I TANKOWNER'S NAME I) DATE LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.'# ~ I I I I I I I I I I I I I I I PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (6-95) ..';~... STATE WATER RESOURCES CONTROL BOARD i~.~,~,~ UNDERGROUND STORAGE'TANK PERMIT APPLICATION FORM B '.~,~'...~. ~ . " COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, MARK ONLY "~"i~ NEW PERMIT ~---]':'3 RENEWAL PERMIT [] 5 CHANGE OF 'INFORMATION [] 7 PERMANENTLY CLOSED ONE ITEM []' ~%!I~TERIM PERMIT '~-1 4 AMENDED PERMIT. [] 6 TEMPORARY TANK CLOSURE . [] . 8 TANK REMOVED I DBAOR FACILITY NAME WHERE TANK IS INSTALLED: .~{:3-'L.P'~'-~.-~ ~._A.~,Jv'"_~ ~- I I ~,~"~.~;.= o ~,..~ · I. TANK DESCRIPTION., COMPLETE ALL ~TEMS- SPEC~' ~F UNKNOWN · ' ~. · A. OWNER'S TANK L D. # · t.,...'~J ~ =,-,.-,.~/,,..I B. MANUFACTURED BY: "F~TA )... /-:'~""r'~ C. DATE INSTALLED (MO/DAY/YEAR) I ~ ~:~ ~ '. O. TANK CAPACITY IN GALLONS: 'l~} O(::~ ' II. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. [----')' lb PREMIUM UNLEADED [] 4 GASAHOL [] 7 METHANOL [] ~ PETROLEUM [] 60' EMP~ .~ ~ PRODUCT [] ~c M,0~ UNL~OED [] ~ UET~UEL [] 6 M~ [] 3 ~?HEMICALPRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED . [] 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A. 1) IS NOT MARKED, ENTER NAME OF SUBSTANCE 'STORED C.A.S. #: III. TANK CONSTRUCTION ' MARK ONE ITEM ONLY IN ~OXES A, B, ANDC, AND ALL THAT APPLIES IN BOX D AND E A. 'PfPEOF ~ DOUBLE WALL' , [] 3 SINGLE WALL WITH. EXTERIOR LINER [] 5 ~INTERNAL BLADDER SYSTEM [] 95 uNKNOWN SYSTEM [] 2 sINGLE WALL [] 4 SINGLE WALL IN A VAULT' [] '99 OTHER MATERIAL [] 5 CONCRETE '[~ 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP ' .;~ (PrimaryTaltk) [] 9 BRONZE" [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99~OTHER~, C. INTERIOR [] :1 RUBBER LINED [] 2 ALKYD LINING ', [] 3 EPOXY UNING [] 4 PHENOLIC,LINING . LINING OR ' [] 5 GLASS LINING .~ ,6, UNLINED [] 95 UNKNOWN [] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES '~ NO__ '~;~" i [~4 FIBERGLASS REINFORCED' PLASTIC D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP CORROSION . '- ', PROTECTION '[] 5 CATHOD~C~PROTEC~ON [-~' '91 NONE ..... [] 9S UNKNOW~'~'' [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) ~ 4~1C'~ '~ OVERFIL,,~REVENTION EQUIPMENT INSTALLED (YEAR) 'E, SPILL AND OVERFILL, etc. DROP TUBE YES, '~ NO STRIKER PLATE YES NO DISPENSER CONTAINMEI~I' YES ~ NO ' ' . IF APPLICABLE .' · IV. PIPING INFORMATION r'.CIRCLE A IFABOVE'~ROUNDOR' U 'IFuN[~RGROUND. BDTH A, SYSTEM TYPE A U 1 SUCTION A(~2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPINGf A U 99 OTHER. B, CONSTRUCTION' A U I SINGLE WALL A(~)2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARESTEEL ; A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A(~4 FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL w/ cOATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION . A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN : A U 99 OTHER D. LEAK DETECTION [] ~ MECH.~,CA~. UNE LEAK [] 2 L,NE T~Gm'NESS i~..3 COm'~NUOUS ,NTERSTmAL [] 4 ELECmON,C UNE [] 5 AUTO~T,C PUMP DETECTOR TESTING ~ MONITORING LEAK DETECTOR SHUTOOWN [] 99 OTHER V. TANK LEAK DETECTION I [] 1 VISUAL CHECK [] 2 MANUAL INVENTORY '[] 3 VADOZE [] 4 AUTOMATIC TANK []'5 GROUND WATER []6 ANNUALTANK RECONCILIATION. MONITORING GAUGING MONITORING TESTING ~ 7 CONTINUOUS INTERSTITIAL [] 6 SIR [] 9 WEEKLY MANU~:L [] 10 MONTHLY TANK [] 95 U'~KNOWN [] 99 OTHER MONITORING TANK GAUGING TESTING VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) I 1. ESTIMATED DATE LAST USED (MO/DAY/YR) I 2. ESTIMATED QUANTITY OF · 3. WAS TANK FILLED WITH ,,, , SUBSTANCE REMAINING GALLONS NERT MATERIAL ? , THIS FORM HAS BEE~"~,IV~LE'FED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I .TANK OWNER'S NAME ' . '~, . . ~, . ' IDATE I PRINTED&SIGNATURE)~ ~ il, ~ '~," / 't LoCA~ AGENCY USE ONL?" ~HE STATE I.D. NUMBER IS COMPOSED OF THE F(~i~ NUMBERS BELOW .. 'i~ STATE I.'D:# ~ I I I I I I I I'1 I I : .1 PERMIT NUMBER ~. i.: I 15ERMIT APPROVED BY/DATE. . PERMIT EXPIRATION DATE THIS FORM MUST BE'ACCOMPANIED BY A PERMIT APPLICATION ;. FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM. SHOULD BEiACCOMPANIED BY A PLOT PLAN. F LE TH S FORMWITH THE LOCAL AGENCY, IMpLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (6-95) '.: ..... :.': INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23, Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287, and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank owners to apply for an UST operating permiL 1. One FORM "B" shall be completed for each tank for alt NEW PERMITS, PERMIT CHANGES, REMOV-' ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. · ' 3. Please ¢/pe or print clearly all requested information. 4. Use a hard point writing instrument, you are making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect ...... to buildings and landmarks [2711 (a)(8) CCR]. Tank owners must submit documentation showing compliance with state financial responsibility require- ments t~ {t~ local agency for petroleum USTs [2711 (a)(11) CCR]. TOP OF FORM: MARK ONLY ONE ITEM' 1. Mark an (X) in the box next to the item that best describes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. I. TANK DESCRIPTION - COMPLETE ALL ITEMS - tF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - tf there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). II. TANK CONTENTS A. 1. IF MOTOR VEHICLE FUEL, check box I and complete items B & 2. tf not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FUEL (if box t is checked in .A). D. Print the chemical name of the hazardous substance stored in the 'tar~k and the C.A.S.#. (Chemical Abstract Service number), if box I is NOT checked in A. I11. TANK CONSTRDCTtON-~RK ~NE ITEM ONLY IN BOX A, B~ C & D 1 .- Check only one item in TYPE OF SYSTEM, TANK MATERIAL, INTERIOR LINII~G and CORROSION PR'OTECTION. 2. If OTHER, print in the space pr?vided. IV. PIPING INFORMATION 1. Circle' "A" if above ground circle "U" if underground, and circle both if applicable. tf UNKNOWN circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to com~51¢ with the monitoring requirements for the tank. VI, INFORMATION ON TANK PERMANENTLY CLOSED tN PLACE ESTIMATED DATE LAST USED - MONTH/YEAR (January, 1988 or 01/88) '2.ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3.WAS TANK FILLED WITH INERT MATERIAL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(t3) CCR] INSTRUCTION FOR THE LOCAL AGENCIES -~. The state underground storage tank identification, number is composed of the two digit cou. oty nqmber, the three digit jurisdiction number, the six digit facility number and tl~e six digit tank number. The county and ju'risdiction numbers are predetermined and can be obtained by calling the State Board (916) 227-4303. :The faci shown in form "A". The tank number may be assigned by the local agency, however, tt~is number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. tT IS THE RESPONSIBILITY OF THE .LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY 1S RESPONSIBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. ., STATE WATER RESOURCES CONTROL BOARD ?;?i' UNDERGROUND STORAGE TANK PERMIT APPLICATION- . ~,.' ,~ '~' COMPLE~ A SEPARATE FOR~ FOR EACH TANK SYS~M. ~MARK ONLY ~' 1 NEW PERMIT ~ 3 RENEWAL PERMIT ~ 5 CHANGE OF INFORMATION ~ 7 PERMANENTLY CLOSED ON SiTE ~, ONE ITEM ~ ~.INTERIM.~%, PERMIT, ~ 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE ~ e TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECI~ IF UNKNOWN ~ I C. DATE 'I~STALLED (M~AY~EAR) ~ ~ ~ ~ D. TANK CAPACIW IN GALLONS: ~; II. TANK CONTENTS IF A-1 IS MARKED, COMPLAN ITEM C. ' r~la REGU~R UNLADED ~ 3 DIESEL ~ 6 AVIATION GAS ~ ~1 MOTOR.VEHICLE FUEL ~ 4 OIL B.~ ·~ ~ lb PREMIUM UNL~ ~ 4 GASAHOL ~ 7 METHANOL ~ P~.OLEU~ ~ 80 E~P~~.1 PRODUCT g lC MtOGR~E U.L~OEO ~ ~ JET FUEL ~ 8 ~85 ~ 3 CHEMICAL PRODUCT ~ 95'.UNKNOWN ~ '2 WASTE ~ 2 LEADED ~ 99 O~ER (DESCRIBE IN ITEM O. BEL0~ D. IF (~.1) IS NOT MARKED, ENTER NAME OF SUBSTANC~'~STORED C.A.S. ~: III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, AND ALL ~AT APPLIES IN BOX D AND E,. A. WPE OF 1 DOUBLE WALL ~ 3 SINGLE WALL Wl~ EXTERIOR UNER ~ 5 I~RNAL B~DDER SYS~M ~ 95 UNKNOWN SYSTEM~ 2 SINGLE WALL ~ 4 SINGLE WALL IN A VAULT ~ 99 OTHER B, TANK ~ 1 BARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIBERG~SS 4 STEEL C~D W/FIBERG~SSREINFORCEDP~STIC MATERIAL ~ 5 CONCRETE ~ 6 POL~INYL CHLORIDE ~ 7 ALUMINUM 8 100% METHANOL COMPATIBLEW/FRP (Prima~Tank) ~ 9 BRONZE ~ 10 G~LVANIZED STEEL ~ 95 UNKNOWN ~ 99 OTHER C. INTERIOR ~ ~, RUSaER LINED ~ 2 AL~D LiNiNG ~ ~ 3 EPOXY UN,NC ~ 4 PHENOUC UN,NC LININGOR ~ 5 G~SS LINING ~ S UNLINED ~ 95 UNKNOWN ~ 99 OTHER COATING IS LINING MA~RIAL COMPATIBLE,WI~ 100% ME~ANOL ? YES ~ NO~ : D. EXTERIOR ~ ~ POLY~HYLENE W~P ~ 2 COA~NG ~ 3 WNYL WRAP ~4 FlaERG~SS REINFORCED P~STIC CORROSION PROTECTION ~ 5 CA~ODI~PRO~C~ON-~~,NO~E ........ ~ 9~--0~ ~ 99 OTHER SPI~ CONTAINMENT INSTALLED (Y~R) i ~ ~ ~ OVERFILL PREVENTION EQUIPMENT INSTALLED (Y~R) I ~ E. SPILL AND OVERFILL, etc; DROP TdBE YES ~ NO S~RI~ER P~TE YES ~ NO D/SPENSER*CONTAiNME~ YES , ~ NO .. IV, PiPiNG INFORMATION ,¢~.C[E' A-i~VE GROUND OR U IF UNDERGROUND, BOTH F ~L CABLE A. SYSTEM~PE A U I SUCTION A~2 PRESSURE A U 3 GRAVI~ A U 4 FLEXlBLEPIP~NG A U 99 OTHER B. CONSTRUCTION A U 1 SING~ WALL A~2 ~OUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND A U 1 BARE S~EL A U 2 STAINLESS S~EL A U 3 POL~INYL CHLORIDE(PVC)A~ FiBERG~SS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCR~E A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER ~0R ~ TESTING MONITORING [~K DE~CTOR SHUT~ V. TANK LEAK DETECTION J ~ 1 VISUAL CHECK ~ 2 MANUAL INVENTORY ~ 3VADOZE ~ 4 AUTOMATIC TANK ~ 5 GROgNDWATER 6 ANNUALTANKj UO.~TORIN~ TAN~ ~AUGING TESTIN~ VI. TANK CLOSURE INFORMATION (P~.UAN~NT CLOSU.E IN-P~C~) J 1. ESTIMATED DATE ~ST USED (MO/DAY'R) I2' ESTIMATED QUANTI~ OFSUBSTANCE REMAINING , GALLONS j 3. WAS TANK FILLED WlTHiNERT MATERIAL ? YES ~ NO~ TH~S F~RM HAS BEE~L~ED ~NDER PENAL~ ~F PERJURY~ AN~ T~ THE BEST ~F MY KN~LEDGE~ ~S TRUE AND C~RRECT I TANK OWNER'S NAME'' ,, ~.' J DATE I (PRINTED&SIGNATUR~ ~ J ~ ~: ~ ...... ~ .J , l LOCA~ AGENCY USE ONL~ ~HE STATE I.D. UUa~ER IS COMPOSED OFTHE FOUR UU~BERS BELOW PER~IT NUMBER ~' ~ PERUlT APPROVED BY/DATE ~ , PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FO~M A, UNLESS A CURRENT FORM A HAS BE~ FILED. FORM C MUST BE COMPLIED FO~ INSTALLATIONS. THIS FORM SHOULD BE ~CCOMPANIED BY A PLOT P~N. RLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGU~TIONS INSTRUCTIONS FOR COMPLETING FORM "B" GENERAL INSTRUCTIONS Section 2711 of Title 23; Division 3, Chapter 16, California Code of Regulations and sections 25286, 25287 and 25289 of Chapter 6.7, Division 20, Health and Safety Code require tank o~¥ners to apply for an UST operating permit. 1. Or;e"FORM "B" shall be completed for each tank for all NEW PERMITS, PERMIT CHANGES, REMOV- ALS and/or any other TANK INFORMATION CHANGE. 2. This form should be completed by either the PERMIT APPLICANT or the LOCAL AGENCY UNDER- GROUND TANK INSPECTOR. 3. Please type or print clearly all requested information. 4. Use a hard point writing instrument, you ara making 3 copies. 5. Tank owners must submit a plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [271 t (a)(8) CCR]. Tank owners must submit documentation showing compliance with state financial responsibility require- ments to the local agency for petroleum USTs [2711 (a)(t 1) CCR]. TOP OF FORM: MARK ONLY ONE ITEM t. Mark an (X) in the box next to the item that best describes the reason the form is being completed. Indicate the DBA or Facility name where the tank is installed. TANK DESCRIPTION ~ COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to identify the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the year the tank was installed (ex, 1987). D. Indicate the tank capacity in gallons (ex. 25,000 or 10,000 etc.). TANK CONTENTS 1. IF MOTOR VEHICLE FUEL, check box t and complete items B & 2. If not MOTOR VEHICLE FUEL, check the appropriate box in section A and complete items B & B.Check the appropriate box. C.Check the type of MOTOR VEHICLE FUEL (if box 1 is checked in D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box I is NOT checked in A. III. TANK CONSTRUCTION-MARK ONE ITEM ONLY IN BOX A, B, C & D 1. Check only one item in TYPE OF SYSTEM, TANK MATERIAL INTERIOR LINING and CORROSION PROTECTION. 2. tf OTHER, print in tt~e space provided. IV. PIPING INFORMATION 1. Circle "A'' if above ground circle "U" if underground, and circle both if applicable. 2. tf UNKNOWN circle; or if OTHER, print in space provided. 3. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requirements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED tN PLACE 1. ESTIMATED DATE LAST USED - MONTH/YEAR (Januapy, 1988 or 01/88) 2. ESTIMATED QUANTITY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT N'~ATER1AL? Check "Yes" or "No". TANK OWNER OR AUTHORIZED REPRESENTATIVE MUST SIGN AND DATE THE FORM AS INDI- CATED [see section 2711 (a)(13) CCR] INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identification number is composed of the two digit county number, the three digit jurisdiction number, the six digit facility number and the six digit tank number. The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916) 227~4303. The facility number must be the same as shown in form "A". The tank number may be assigned by the local agency', however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. tT IS THE RESPONSfBILITY OF THE LOCAL AGENCY THAT INSPECTS THE FACILITY TO VERIFY THE ACCU- RACY OF THE INFORMATION. THE LOCAL AGENCY IS F~ESPONSlBLE FOR THE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX. THE LOCAL AGENCY SHOULD RETAIN THE ORIGINAL AND YELLOW COPIES. THE PINK COPY SHOULD BE RETAINED BY THE TANK OWNER. STATE WATER RESOURCES CONTROL BOARD . UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A ., COMPLETE THIS FORM FOR EACH FACIlITY/SITE MARK 0NLY :~:~' NEW PER"T [:'~ 3 RENE'WAL PERMIT [::] S CHANG'I= OF INFORMATION [:"~ 7 PERMANENTI"Y CLOSED SITE ONE ITEM 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY SITIE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS-(MUST BE COMPLETED) DE~A OR FACIL)~I~' NAME ~'/'~ )k I " ~RESS J , ~EASES? CROSS STRE~ ~;TY :~ME /// , , S TA:I:~ I ZIP COOE ~J-TE PlaNE # WITH ARF_A CODE/, TO iNDICATE RPORAllON ~ INDIVIDUAL F--J P~RTNERSHiP ~ LOCAL-AGENCY ~ COUNTY4~GENCY [--1 STATE-AGeNCY [---] FEDERAL-AGENCY O~TRICTS EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONOARY). optional OAY~. NAM, E (LAST. FIRST) ,,~ ,~ .... -*--- PHONE # WITH AREA C~DE DAYS.' NAME .(I.~T. FIRST) -~GHT$: NAMEIL~ST, R~ST)~ ', ~ PR'ONE ~ WITH AREA COOE N~GHTS: NAME ([XST. FIRST) ~ PHO~-E · wrrH AREA COOE. II. PROPERTY OWNER INFORMATION-(MUST BE COMPLETED) · i STATE Z~P COOE /~,IONE · ~ITH AREA COOE CiTY NAME -- IlL TANK OWNER INFORMATION r (MUST BE COMPLETED) .MAILING OR STREET ADDRE$$ ~ ~J/ . _ / ~' ~,, ~,m~ticam ~ INOIVIOUA[ I I LOCN.-AGIglCY I'--'] STATI-'.,I, GF. NCY ~ITY N~E ~ ' ,4 . ' ' / r I'STATE ' (ZIPCOOE I P)~ONEeY~HAREACOO~ ' ~v. BOARD OF EQUALIZATION UST STORAGE FEE AccOuNT NUMBE~ Call (9~6) 739-2582 if questions a~ise. TY(TK) HQ IT[ -lolol I=! I V. LEGAL NOTIFICATION AND BILLING ADDRESS Legal n=:':!cation and billing will be sent to the tank owner unless box I or II is checked. CHECK ONE aOX INDICATING WHICH AgOVE ADDRESS SHOULD BE USED FOR LEG,t, NOTIFICATIONS AND BILL'lO: L [] II. [] II THIS FORM HAS SEEN COMPLETED UNDER PENAL TY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I,..,PLICANT'SNA. ME(PRINTEO&$1~RE)__ .~,=~LICAN'PS TITLE I DATE MONTH/DAY/YEAR LOCAL AGENCY USE ONLY I COUNq'Y # JURISDICT;ON # FACILITY # LOCATION CODE . OPTIONAL CENSUS TRACT # - OPTIONAL SUPVISOR -OISTRICT CODE - OPT/ON, M. THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION- FORM B, UNLESS THIS I$ A CHANGE OF SITE INFORMATION ONLY. FORM A (9.90) STATE WA~ RE~UR~S ~ROL UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPL~E A SEP~ATE FORM FOR ~CH TANK SYSTE~ MARK ONLY ~ t N~ PERMIT ~ 3 REN~ PERMIT ~ 5 CHAN~ OF INFORMAT~N ~ 7 PERMANENTLY ~OS;O ON ONE ITEM ~' 2 INTERIM PERMIT ~ 4 ~ENDED PERMIT ~ e ~M~RY TANK CLOSURE ~ 8 TANK REMOVED ~ j I. TANK DESCRIPTION c~Em ALL ITEMS - SPECI~ IF UNK~ II. TANK CO~E~S t;A.~ IS MAR~O.~PLEm ITEM C. " _ ~ la REGU~R ~ 3 'OIESEL PE~OL~M ~ m ~P~ P~T '~ lb PREMIUM 4 ~OL ~ 7 M~L ~ UNLOAD 5 JET FUEL ~ 3 CHEM~LPR~T ~ ~ UN~ W~ ~ 2 L~O ~ O~ER ~SCRI~ IN ~M D. BEL~ II1. TANK CONSTRUCTION A. ~PE OF ~ ! ~8LE W~ ~ 3 S~LE W~ W~ E~Efl~R L~ER ~ g5 UN~WN SYSTEM/~ 2 S~LE W~L ~ 4 ~N~Y ~T~ME~ ~A~DT~ ~ ~ O~ER ~ ~ ~ STEEL ~ 2 ST~NLESS S~ ~ 3 ;~BE~S ~ STEELC~D W/~S~R~ R;~N~ORC;D B. MATERI~T~K ~ 5 C~CRE~ ~ 6 ~LWI~L ~ORI~ ~ 7 ~UM~M/~ 8 1~ MEdrOL ~MPATIBLEW~ O. CORROSION ~ 1 ~L~ENE W~; ~. 2 ~A~ ~ 3 ~ ~ ~ 4 F~aE~S REINFO~D PROTE~ON' IV. PIPING INFORMATION c~ A IF~O~GR~OR U ~UN~ND,~L~A~ A. SYSTEM TYPE A U I ~T~ A ~ 2 PRESSU~ A U 3 G~V~ A U ~ O~ER B. CONSTRU~ION A. U I SIDLE W~L A~ 2 ~SLE W~L A U 3 L~ED T~H A U ~ UN~OWN _ A U ~ O~ER C. MATERIAL AND A U ! ~RE STOL A U 2 ~NNLESS S~EL' A U 3 ~LW~L CHLORIDE (PV~ 4 FISERG~S CORROSION A U 5 ~UMINUM A U 6 ~RE~ A U 7 STEEL W/ ~ATI~ A U 8 1~ ME'~OL ~MPATIBLEW~ PROTE~ION A U g ~v~o s~ A U I0 CAT~ PROTECT~ A U ~ UN~OWN A U ~ O~ER D. LEAK D~E~N V. TANK LEAK D~ECTION , VI. TANK CLOSURE INFORMA~ON ! 1. ESTIMATED DATE ~T USED (~AY~R, ~ 2. ESTIMATED ~1~ OF~BST~E REMAINI~ ~3 I3' WAS TANK FI~ED WI~INERT MA~R.L ? YES ~ .0~ THIS FORM HAS SEEN COMPLE~D UNDER PENAL~ OF PERJURY. AND TO ~E BEST OF ~ KNOWLEDGE. IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE LD. NUMBER ~ COMPOSED OF THE FOUR NUMBERS BELOW COUN~ = JURISDICTION ~ FACIL~ ~ TANK = PERMIT NUMBER } PERMIT ~PROVED BY'ATE I PERMIT EXPt~TION ~TE ;oRu a (~ T~S ~RM ~ST BE ACne,lED BY A PER~ ~PUCA~ON · FORM ~ ~LESS A CURRE~ FORM A HAS BEEN FI~D. STATE OF CAUFORI4A STATE WATER RESOURCES CONTROL 80ARO UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. · ' ~ 7 PERMANENTLY CLOSED ON SITE MARK ONLY ~, NEW PERMIT [:~ 3 RENEWAL PERMIT [] $ CHANGE OF INFORMATION [] S TANK REMOVED ' ONE ITEM ~ 2 INTERIM PERMIT [] 4 AMENDED PERMIT j~ 6 TEMPORARY TANK CLOSURE I I. TANKDESCRIPTION . CO~.~TEALLITEMS-SPEC,~',;UNKNGWN . ' '" ~//--~/CiP C; DATE INS TALLE, (MO/gAY/YEAR, 0. TANK CAPACITY IN GALLONS: /e,~O0 " II. TANK CONTENTS i;^.11~MARKEO. COMPLETE ITEM C. '........ ~a REGULARr 3 OlE~EL [] MOTOR HICLE FUEL [] 4 OIL B. C. UNLEADED 4 GA~AHOL L__~2PETROLEUM [].EMPTY ~:"12 PRODUCT lbPREMIUMuNLEAOEO ~ $ JETFUEL r-"-J 7 IdEI'HANOL [] 3 CHEMICAL PRODUCT [] 9,5 UNKNOWN [] WASTE [] 2 LF.~D 9~ O~HER (DESCRIBE IN ITEM O. BELOW IlL TANK CONSTRUCTION UA~KOaEm~MONLY~aOX~B~.B. ANDC. ANOAU. THATA~PUES~NBOXO A, SYSTEM/{-'-1 2 SINGLE WALL [] 4 ~CONOARY CONTAINMENT (VAULTEOTANK) [] 99 OTHER ~ ! BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS :~ 4 STEEL CLAD W/FISERGLA~ REINFORCED PtJLSTIC TANK MATERIAL ~-I $ CONCRETE [] 6 POLYVINYL CHLORID~ [] 7 ALUMINUM'['--] 8 100% METHANOL COMPATISLEW/FRP :P,i=,,~) I--1 , ~.o.z~ [] lo ~vAN~o sTEEL [] ~ u"KN°WN [] ~ OTHER . C. INTERIORuNING ["-'-I S ~ LINING /~a UNLINEO [] ~ UNi<NOWN [] 99 OTHER I~ LINING MATERIAL COMPATIBLE WITH 100% METHA~ ? YES_ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP ~ 2 COATING [] 3 VINYL WRAP ~ 4 FIBERGLASS REINFORCED PLASTIC PROTECTION ~ 5 CATHO01C PRoTECTICI~ 91 N~E [] g~ UNKNOWN I----I 99 OTHER IV. PIPING INFORMATION C~Rc~ A. IFABOVEGROUNOOR U IFUNOERGROUNO. BOTH IF APPLICASLE A. SYSTEM TYPE A U I SUCTION A ~ 2 PRESSURE A U 3 GRAVITY & U 99 OTHER 8, CONSTRUCTION A-U ! SINGLE WALL &(~) 200UBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN _ A U 99 OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIOE(PVC}A~ 4 FIBERGIJLSS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW~RP PROTECTION A U ~ GALVANIZED STEEL A U ~o CATHO0~ PROTECTK)N A U ~S UNKNOWN A U ~ OTHER D. LEAK DETECTION '~'~ AUTO~ATICLINELEAKO~TECTOR Z L~ETr3HTNESSTESTING ~--~. uo~rroRaG [] ~ OTHER V. TANK LEAK DETECTION ~,,~8 TANK TESTING /~7 ,NTERSTITIALMONITORLIN(] [] 91 NONE [] 95 UNKNOWN [] g9 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATEO OATE LAST USEO ,MO~OAY/YR) 2. ESTIMATED QUANTITY OF~USSTANCE REMAINING GALLONS I3' wAS TANK FILLED wiTHINERT MATERIAL THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE 8EST OF MY KNOWLEDGE. IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # ~ORM S (~ot THIS FORM MUST BE ACCOIV~ANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAs 8EEH FILED. s'rATE WA~R RESOUR~ ~ROL BO~D UNDErGrOUND STO~AGE TANK PERMIT APPLICATION - FO~M B COMP~E A SEP~ATE FORM FOR EACH TANK SYSTE~ MARK ONLY ~ I N~ PERMIT ~ 3 REN~ RERMIT ~ 5 CHLOE OF INFORMAT~N ~ I. TANK DESCRIPTION c~ ~L ~s - S. SC~ ~ UNX~ c. II. TANK CO~E~S ~A-~ ~2 P[TROL[U~ ~ ~ mP~ 1 ~ UNLOAD ~ 5 ~ 3 CHEMI~LPR~T ~ ~ U~ ~ 2 W~ ~ 2 L~O~ ~ O~ER ~RI~ IN ~M D. BELOW A. ~PE OF ~ I ~BLE W~ ~ 3 ~E W~ ~ E~ER~R L~ER ~ g5 UN~OWN SYSTEM/~ 2 S~LE W~ ~ 4 ~N~Y ~T~ME~ ~A~DT~ ~ ~ OmER ~ 1 ~ STEEL ~ 2 ST~LES8 S~ ~ 3 FIBERG~S ~ 4 8TEELC~D WI FIBER~ REINFORCED P~ B. MATERI~T~K ~ 5 C~RE~ ~ 6 ~LWI~L CHLORI~ ~ 7 ~UUINUM' ~ a ~ MEaL ~MPATIBLEW~RP UNINO · O. CORROSION ~ 1 ~L~NE W~ ~ 2 ~ ~ 3 ~ ~ ~ 4 FleECeS RE~FO~D PROTE~ON ~ 5 CA~ P~TECT~91 ~E ~ ~ UN~ ~ ~ O~ER IV. PIPING INFORMATION c~ 4 ~O~O~OR U ~UN~NO.~;~L~A~ A. SYSTEM TYPE A U I ~T~ A ~ 2 PRESSURE A U 3 G~V~ A U ~ O~ER B. CONSTRU~N A, U I SIDLE W~L A~ 2 ~BLE W~ A U 3 LINED TR~H A U 95 UN~WN _ A U ~ O~ER C. MATERIAL AND A U ! ~REST~L A U 2 STNN~SS S~EL A U 3 ~LW~L CHLORIDE(P~ 4 FIBERG~S CORROSION A U ~ ~MiNUM A U 6 ~RE~ A U 7 8T~LWI~ATi~ A U 8 1~ ME~O~ ~MPA~BLEW~ PROTE~ION A U g ~V~D S~~ A U IO ~T~PROTECT~ A U ~ UN~WN A U ~ O~ER V. T~K LEAK D~ECTION VI. TANK CLOSURE INFORMA~ON I i. ESTIMATEO OA~ ~T USED (~AY~R) 2. ESTIMATEO ~TI~ OF~BST~E REMAIN-- ~--S I3' was TANK FI~ED wI~INERT MA~R~L THIS FORM HAS BEEN ~OMPLE~D UNDER PENAL~ O~JURY, AND TO ~E BEST OF ~ KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER ~ COMPOSED OF THE FOUR NUMBE~ BELOW COUN~ ~ JURISDICTION; FACIL~ ~ TANK ~oRu a 1~ TffiS ~RM ~ST BE AC~IEO BY A PER~ ~PUCA~ON · FORM ~ ~LES$ A CURRE~ FORM A HAS BEEN FI~D. 06/30/98 TUE 12:00 FAX GROUNDWATER ~004 ~'TATE OF CAUFORNIA ~ ' . STATE WATER RESOURCES CONTROL BOARD ~ CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION I1. INSTALLATION (mark ali that apply): ~he installer has been certified by the tank and piping manufacturers. ~The installation has been inspected and certified by a registered professional engineer. [~The installation has been inspected and approved by the implementing agency. Il work listed on the manufacturer's installation checklist has been completed. ~ The installation Contrac{or has been certified or licensed by the Contractors State License Board. [] Another method was used as allowed by the implementing agency. (Please specify,) II1. OATH I certify that the ovided is true to the best of,my belief and knowledge. ! Print Name ~ ( ) .q77- lJ En~rommtM M~er LOCAL AGENCY USE ONLY COUN~ ~ JURISDICIION ~ FAClLI~ ~ TANK ~ STATE FORM C (Tm~l THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FOR~ A & B UNLESS ~EY HAVE BEEN FILED P, . LY f~' ~'.~ State of California ~ Foite Usc Only State Water Resourcll~rontrol Board Division of Clean Water Programs P.O. Box 944212 Sacramento, CA 94244-2120 (Instructions on reverse) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ~ 5(}0,000 dollars per occurrence ['--'l I million dollars annual aggregate or AND~ or ] I million dollars per occurrence [KXI~ 2 million dollars annual aggregate B. The Southland Corporation hereby certifies that it is in compliance with the requirements of Section 2807, [Name of Tank Owner or OperatorJ Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial respons/bilRy as required by Section 2807 are as follows: Irrevocable Bankerg Trust Company Standby :. 1,000,000 per Annual Yes Yes Standby One Bankers Trust Plaz Letter of occurrence & Letter of New;York, NY 10006 Credit No. 2,000,000 Credit S-08219 Annual Aggregate Note:' If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance w/th all conditions for participation fn the Fund. Facility Name Facility Address Facility Name Facility Address ~,h~/f~ Bob DeNinno i Environmental Manager , CFR (Revised 04/95) FILE: Original - I Agency Copies - Facility/Site(s) []l ar l rs Trust Comp 'LOA~ DIVISION ~.o. BOX 318- CHURCH ST STANDBY LETTER OF CA£DIT 14TH FLOO~ ONE B^NKE~S T~UST PLAZA NEWYO~K. NYI~ IRREVOCABLE STANDBY LETTER DECEMBER 20, 1991 OF CREDIT NO. S-08219 ~ENEFICIARY. UNITED STATES ENVIRONMENTAL PROTECTION AGENCY AND 28 OTHER BENEFICIARIES AS PER ATTACHED LIST GENTLEMEN: ~E HEREBY ESTABLISH OUR IRREVOCABLE STANDBY LETTER OF CREDIT NO. S-08219 IN YOUR FAVOR, AT THE REQUEST AND FOR THE ACCOUNT OF THE SOUTHLAND CORPORATION OF 271~ .NORTH HASKELL AVENUE~ DALLAS, TEXAS 7522~, UP TO THE AGGREGATE AMOUNT OF T~O MILLION ~.S. DOLLARS (U.S. $2,000,000.00] AVAILABLE UPON PRESENTATION BY ANY ONE OF YOU OF: 1.YOUR SIGHT DRAFT, BEARING REFERENCE TO THIS LETTER OF CREDIT NO. 5-08219, AND 2. YOUR SIGNED STATEMENT READING AS FOLLOWS: "I CERTIFY THAT THE flJdOUNT OF THE DRAFT IS PAYABLE PURSUANT TO REGULATIONS ISSUED UNDER AUTHORITY OF SUBTITLE I OF THE RESOURCE CONSERVATION AND RECOVERY ACT OF 1976, AS AMENDED." THIS LETTER OF CREDIT HAY BE DRA~N ON TO COVER TAKING CORRECTIVE ACTION AND/OR COMPENSATING THIRD PARTIES FOR BODILY INJURY AND PROPERTY DAMAGE CAUSED BY ACCIDENTAL RELEASES ARISING FROM OPERATING THE UNDERGROUND STORAGE TANK(S) IDENTIFIED BELO~ IN THE AMOUNT OF ONE MILLION U.S. DOLLARS (U.S.$1,000,000.00) PER OCCURENCE AND TWO MILLION U.S. DOLLARS (U.S. SZ,000,000.00) ANNUAL AGGREGATE: SEE EXHIBIT A. THE LETTER OF CREDIT MAY NOT BE DRAWN ON TO COVER ANY OF THE FOLLOWING: A) ANY OBLIGATION OF THE SOUTHLAND CORPORATION UNDER A WORKERS' COMPENSATION, DISABILITY BENEFITS, OR UNEMPLOYMENT COMPENSATION LA~ OR OTHER SIMILAR LAW; B) BODILY INJURY TO AN EMPLOYEE OF THE SOUTHLAND CORPORATION ARISING FROM, AND IN THE COURSE OF, EMPLOYMENT BY THE SOUTHLAND CORPORATION; C) BODILY INJURY OR PROPERTY DAMAGE ARISING FROM THE OWNERSHIP, MAINTENANCE, USE, OR ENTRUSTMENT TO OTHERS OF ANY AIRCRAFT, MOTOR VEHICLE, OR ~ATERCRAFT; 85580 (1 ~0) · []Bankers Trust Compa LOAN DIVISION ~o. sox STANDBY LETTER OF CREDIT NEw YORK, N.~ 1 aTN FLOOR ONE BANKERS TRUST PLeA NEW YORK, NY I0~6 D) PROPERTY DAMAGE TO ANY PROPERTY OWNED, RENTED, LOANED TO, IN THE CARE, CUSTODY, OR CONTROL OF, OR OCCUPIED BY THE SOUTHLAND CORPORATION THAT IS NOT THE DIRECT RESULT OF A RELEASE FROM A PETROLEUM UNDERGROUND STORAGE TANK; E) BODILY INJURY OR PROPERTY DAMAGE FOR WHICH THE SOUTHLAND CORPORATION IS OBLIGATED TO PAY DAMAGES BY REASON OF THE ASSUMPTION OF LIABILITY IN A CONTRACT OR AGREEMENT OTHER THAN A CONTRACT OR AGREEMENT ENTERED INTO TO MEET THE REQUIREMENTS OF ~0 CFR 280.93. THIS LETTER OF CREDIT IS EFFECTIVE AS OF DECEMBER 20, 1991 AND SHALL EXPIRE ON DECEMBER 20, 1992, BUT SUCH EXPIRATION DATE SHALL BE AUTOMATICALLY EXTENDED FOR A PERIOD OF ONE YEAR ON DECEMBER 20, 1992 AND ON EACH SUCCESSIVE EXPIRATION DATE, UNLESS, AT LEAST 120 DAYS BEFORE THE CURRENT EXPIRATION DATE, WE NOTIFY THE SOUTHLAND CORPORATION BY CERTIFIED MAIL THAT WE HAVE DECIDED NOT TO EXTEND THIS LETTER OF CREDIT BEYOND THE CURRENT EXPIRATION DATE· IN THE EVENT THAT THE SOUTHLAND CORPORATION IS SO NOTIFIED, ANY UNUSED I- PORTION OF THE CREDIT SHALL BE AVAILABLE UPON PRESENTATION OF YOUR SIGHT DRAFT FOR 120 DAYS AFTER THE DATE OF RECEIPT BY THE SOUTHLAND CORPORATION, AS SHOWN ON THE SIGNED RETURN RECEIPT. WHENEVER THIS LETTER OF CREDIT IS DRAWN ON UNDER AND IN COMPLIANCE WITH THE TERMS OF THIS CREDIT, WE SHALL DULY HONOR SUCH DRAFT UPON PRESENTATION TO US, AND WE SHALL DEPOSIT THE AMOUNT OF THE DRAFT DIRECTLY INTO THE STANDBY TRUST FUND OF THE SOUTHLAND CORPORATION IN ACCORDANCE WITH. YOUR INSTRUCTIONS. WE CERTIFY THAT THE WORDING OF THIS LETTER OF CREDIT IS IDENTICAL TO THE WORDING SPECIFIED IN 40 CFR 280.99 (b) AS SUCH REGULATIONS WERE CONSTITUTED ON THE DATE SHOWN IMMEDIATELY BELOW. THIS CREDIT IS SUBJECT TO THE MOST RECENT EDITION OF THE UNIFORM CUSTOMS AND PRACTICE FOR DOCUMENTARY CREDITS, PUBLISHED BY THE INTERNATIONAL CHAMBER OF COMMERCE. VERY TRULY YOURS, BANKERS TRUST COMPANY (AUTHORIZED SIGNATURE) TITLE: ASSISTANT VICE P SIDEFr .]un 28 98 O9:OOp CHEf TER BEMMETT 915-363-0861 Construction blanagemenl Services Mr. Ch~ter P.O. ~x 684 Rancho Cordo~a, ~ 95741-0684 phone (916) :168-2023 3un 28 98 09:0Op CHESTER BEMMETT 916-363-0861 p.2 Construction Management Services Mr. Chester Bennett P.O. Box 684 l~ncho Cordova, C_~ 9574 i-0684 June 23rd, 1998 DLB Construction Inc. 190 Dillon Ave, Suite 'F' Campbell, Ca. 95008 Attn: Derails Ball Re: Southlm~d Facility # 32241 Hageman ~ Galloway Bakersfield Subject: Punchlist follow-up Dear Dennis, Please complete the items on the punchlist dated 6/17 and notify me vd~en the site is ready for re-inspection. My intent Would be to finalize this location's punchlist items on or about July 15th. The attached sketches are for the shelving at both sites as discusse~ Please use the 1 lx17 drawing I provided you on site last week for the specifications and spacing, these sketches layout the locations. If you have any questions or concerns regarding these items, please call me to discuss. Sincerely, Chester Bennett cc: Bill Borgh, Southlm~d Roy Pedro, RI-IL phone (916) 368-2023 Jun 28 98,. 09:00p CHEi~iiER BENMETT 916-363-0861~ p.3 I BAKER~IELD CITY OF OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 fNSPECTION RECORD POST CARD AT JOB SITE City, Zip Pho~ No. Permit # iN~TRU~rloNs: Plea~ ~il for an ~mmlywhm~dm sroupofinspe~i~swithtl~ mmo nmnl~a~ur~ady. Tl~ywill runinonm~m~anturb~imin~wilhnumt~ T~ AND BACKFIX~ I INSPECTION 1, DATE, ~R , PIPING SYSTEM I Vault Wi~ ~ Co~bk ~ M~t~g Well(sYS~s) - H20 T~ FIN~ STATUS REPORT Tn#O TANK ....... i -- - -- 'PRODUCT-GRADE.~ JNL CURRENT STATUS LEVEL 79 GROSS GALLONS 8922 NET GALLONS 8857 ULLAGE 1105 AVERAGE TEMPERATURE 78.4°F WATER 0.00 IN LAST DELIVERY NONE CURRENT IN-TANK ALARMS NONE CURRENT 'IN-TANK WARNINGS NONE TANK 2 PRODUCT GRADE ULP CURRENT STATUS LEVEL 57.53 GROSS GALLONS 6273 NET GALLONS 6110 ULLAGE 3754 AVERAGE TEMPERATURE 95. I°F WATER 8.88 IN LAST DELIVERY NONE CURRENT IN-TANK ALARMS NONE CURRENT IN-TANK WARNINGS NONE TANK 3 PRODUCT GRADE SUL CURRENT STATUS LEVEL 74.28 GROSS GALLONS 8317 NET GALLONS 8238 ULLAGE 1710 AVERAGE TEMPERATURE 74.8°F WATER 8.88 IN LAST DELIVERY NONE CURRENT IN-TANK ALARMS NONE CURRENT IN-TANK- WARNINGS NONE ...EXTERNAL pROBES... Channel 1 Interstitial-.Pr:81 Normal -UNL Sump . -Pr:82 Normal -UNL Interstitial-Pr:83 Normal -ULP Sump -Pr:84 .... Nor~al--=-UL]B_ . Interstitial~~ Normal -SUL Sump . Normal -SUL-Pr:06 END OF REPORT (-816R) STATUS REPORT ID # 0 11:38:11 06YO4Y98 TANK 1 ...... --'PRODUCT'~R~E.-~_UNL CURRENT STATUS LEVEL 79.93 GROSS GALLONS 8922 NET GALLONS 8857 ULLAGE 1185 AVERAGE TEMPERATURE 78.4°F WATER 0.00 IN LAST DELIVERY NONE CURRENT IN-TANK ALARMS NONE CURRENT IN-TANK WARNINGS NONE TANK 2 PRODUCT GRADE ULP CURRENT STATUS LEVEL 57.53 GROSS GALLONS 6273 NET GALLONS 6118 ULLAGE 3754 AVERAGE TEMPERATURE 95.1°F WATER 8.88 IN LAST DELIVERY.' NONE CURRENT IN-TANK ALARMS NONE CURRENT IN-TANK WARNINGS NONE TANK 3 PRODUCT GRADE SUL CURRENT STATUS LEVEL 74.20 GROSS GALLONS 8317 NET GALLONS 8238 ULLAGE 1718 AVERAGE TEMPERATURE 74.0OF WATER 0.08 IN LAST DELIVERY NONE CURRENT IN-TANK ALARMS NONE CURRENT IN-TANK-' WARNINGS NONE · ..EXTERNAL PROBES... Channel 1 Interstitial-Pr:81 Normal -UNL Sump -Pr:02 Normal -UNL Interstitial-Pr:83 Normal -ULP Sump -Pr:04 ..... ;Normal_=ULP - l~terstitiai~~ 'ormal -SUL . Sump ~ -Pr.86 Normal -~UL END OF REPORT (-816R) i' ., If'Tanlcnolo 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 10/07/2004 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 08/06/2004 Order Number: 3135945 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7 -ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Line tests Sincerely, :D~K~ Dawn Kohlmeyer Manager, Field Reporting rW/Þ Dlnknology PURPOSE: COMPLIANCE TEST DATE: 08/06/04 CLIENT: 7-ELEVEN,INC. 20819 72ND AVE. SOUTH SUITE 206 KENT, WA 98032 RANDY MARTIN (253)796-7170 TANKNOLOGY CERTIFICATE OF TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 TELEPHONE (512) 451-6334 FAX (512) 459-1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3135945 CUSTOMER PO: SITE: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA 93312 MANAGER (661 )587-8826 TEST TYPE: TLD-1 10k 10k 10k 1 REG UNLEAD 2 MIDGRADE 3 PREMIUM ENVIROFLEX ENVIROFLEX ENVIROFLEX PRESSURE PRESSURE PRESSURE 0.000 0.000 0.000 IMPACT . ,., ,'j'. , VALVE, fUNCtlÓ y y y P P P 10k 1 10k 2 10k 3 For owner detailed report information, visit www.tanknology.com and select On-Line Reports-WRAP, or contact your local Tanknology office. Tester Name: WESLEY COULTER /I~ ~ Technician Certification Number: 10004 Printed 10/07/200406:57 SBOWERS INDIVIDUAL TANK INFORMATION AND TEST RESULTS -~ DJnlcnology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLIENT: 7 -ELEVEN, INC. Tank 10: 10k 1 Product: REG UNLEAD Capacity in gallons: 10,028 Diameter in inches: 96 . 00 length in inches: 324 Material: TOTAL CONT COMMENTS '~rl!2;';;'·,!IANKkIN~~BriII~111!i!'r<!i;K Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 158.0 161. 0 62.0 4.0 DUAL ASSIST ',,'JiÄNKf~s;r;RESUifst~ßtlN1_at,,¿~ç:JiTèçbl~'!I!·.;!;;;;i(:i!!ßEiK1ÐËmE~1rëR;ffiES'tRESUßTSÍ',' . ^ _^_~'"'-__t .--,_co____' _ __1'-}~;i",*:iJ!$>\I~'""k>I,¡;:w"<~'''''" 0 ,,-',' __"-.c",,, - - <. -- .--¡ -::__,_,_"__,/jf,-,_,_,_",,,, - ..< 4 'N"^ .-_' >-m_ .CO.. -_}~ ¿fføMiWiw& k"'i>% '»,0"",^-"~,--__, - '--"___00 _'^_ .'·mnn _"-'>_ y,_,,,_,~ ,,*,)¡& i~.",il1o'Y,' "'''',,,«.,,,,,,,",",, -, _-~;_ ,n - ,C_ __.-'F-- '",,'-,,___,-co-, '" Start (in) End (in) Dipped Water level: Dipped Product level: Probe Water level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS New/passed L.D. #1 Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate mllm: Metering psi: Calib. leak in gph: Results: Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #2 L.D. #2 NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 280 60 17 :38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/200406:57 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~., DJnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. Tank ID: 10k 2 Product: MIDGRADE Capacity in gallons: 10,028 Diameter in inches: 96.00 Length in inches: 324 Material: TOTAL CONT COMMENTS Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 160.0 163.0 64.0 4.0 DUAL ASSIST Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS F't:~~':,,:,: , New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Bubble Make: Model: SIN: Open time in see: Holding psi: Resiliency cc: Test leak rate mllm: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 194 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/2004 06:57 · INDIVIDUAL TANK INFORMATION AND TEST RESULTS r~ Dlnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. Tank ID: 10k 3 Product: PREMIUM Capacity in gallons: 10,028 Diameter in inches: 96 . 00 Length in inches: 324 Material: TOTAL CONT COMMENTS Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 157.0 160.0 61.0 4.0 DUAL ASSIST fu·','¡1,n;,m=_~",k ',",' ""',"'WiW'ôWií ' _' iiI:''''At'''''''' <,.,.'t,.. :;r~JœI]J:,'$rrjt~§$~I1:r$':If"é$hv,!~,~ '~~Ÿ¡~S,1:J;:'¡;'¡;':',:ó:", Start (in) End (in) .~~~~fíiEg¡rfóß,~~sf'fŒšØí!",ª,;tJ:.'k. ~!I~~f~~#tod; F'1;.ä:'[~ Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS Bubble Ullage New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate mllm: Metering psi: Calib. leak in gph: Results: COMMENTS NOT TESTED NOT TESTED NOT TESTED Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 182 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/200406:57 r" DJnlmology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:08/06/04 CLIENT: 7 - ELEVEN, INC. WORK ORDER NUMBER3135945 SITE:7 -ELEVEN #32241 COMMENTS Arrived on site at 5:00 P.M. for primary piping testing. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 10/07/200406:57 SBOWERS SITE DIAGRAM -., Dlnlmology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 08/06/04 CLIENT: 7 - ELEVEN, INC. WORK ORDER NUMBER3135945 SITE: 7 -ELEVEN #32241 viE CJ:X) VENTS 0 0 0 ø ø ø c ro ~ 0 0 EN ff Jf Q)"- ..- C> C") ~ ~ '<:troC") 0 0 0 N..cO> ..- ..- ..- ~@)ai :tt: U § § § >. - cro-c Q):;:ã> >o¡;:: ~=(/) Jf Jf Q) ro ... I U Q) PLUS SUP UL ........ ~ ..-ro 0.0 ..- '<:t Printed 10/07/200406:57 SBOWERS Letter of Transmittal Date: September 3, 2003 Attention: Bakersfield Fire Dept. Company: Environmental Services Address: 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 RE: 7-Eleven #32241 4101 Galloway Dr. Bakersfield, CA Enclosed are: I~ Business Plan [] Emergency Response Plan [] Business.Activities [] Written Monitoring Procedures [] Business Owner/Operator Identification [] Site Map [] Hazardous Materials Chemical Inventory [] Owner/OperatorAgreement [] Underground Storage Tank- Facility [] Test Results - [] Underground Storage Tank-Tank [] Other: Comments: Updated forms Randy Martin t~acnel Roariguez ~ Environmental Manager Sr. Administrative Assistant 253-796-7170 503-977-7745 7-Eleven, Inc. Environmental Services Department / 10220 S.W. Greenburg Road, Suite 470 / Portland, Oregon 97223 UNIFIED PROGRAM CONSOLIDATED FCRM UNDEn=nOUND STORAGE TANKS ,ClLITY -- (one page per site) Page __ of __ TYPE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEVVAL PERMIT [] 5.CHANGE OF INFORMATION [] 7.PERMANENTLY CLOSED SITE (Check one item only) [] 4. AMENDED PERMIT specify change local use only I-I 8. TANK REMOVED [] 6.TEMPORARY SITE CLOSURE 400 BUSINESS NAME (Same as FAC g TY NAME or DBA - Doihg Bus ness As) 3 ~:IEACIEIT¥'ID~ 7-Eleven #32241 NEAREST CROSS STREET 4Ol FACILITY OWNER TYPE [] 4. LOCAL GENCY/DISTRICT* 4101 Calloway Dr [] 1. CORPORATION [] 5. COUNTY AGENCY* BUSINESS [] 1. GAS STATION [] 3. FARM [] 5. COMMERCIAL [] 2. INDIVIDUAL [] 6. STATE AGENCY* TYPE [] 2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER 403 [] 3. PARTNERSHIP [] 7. FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office REMAINING AT SITE trustlands? which operates the UST (This is the contact person for the tank records.) 3 4o4 [] Yes [] No 4o5 4o6 PROPERTY OWNER NAME 407 PHONE 4o8 WECI - 99 -3LLC 972-361-5000 MAILING OR STREET ADDRESS 409 15601 Dallas Parkway, Suite 40 CITY 41o I STATE 411 I Zip CODE 412 Dallas TX 75001 PROPERTY OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL 413 TANK OWNER NAME 414 PHONE 4~5 7-Eleven Inc. 253-796-7170 MAILING OR STREET ADDRESS 416 P.O. Box 711 Attn: Gasoline Acctg CITY 417 I STATE 418 ZIP CODE 419 Dallas I TX 75221-0711 TANK OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY 420 [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY TY(TK) HQ 44- I 3 I 1 I 8 19 16 I Call (916) 322-9669 if questions arise INDICATE [] 1. SELF-INSURED [] 4. SURETY BOND [] 7. STATE FUND [] 10. LOCAL GOVT MECHANISM METHOD(s) [] 2. GUARANTEE [] 5, LETTER OF CREDIT [] 8. STATE FUND & CFO LETTER [] 99. OTHER: [] 3. INSURANCE [] 6. EXEMPTION [] 9. STATE FUND & CD 422 Check one box to indicate which address should bb used for legal notifications and mailing. Legal notifications and mailin be sent to the tank owner unless box 1 or 2 is checked. [] 1. FACILITY [] 2. PROPERTY OWNER [] 3. TANK OWNER 423 UPCF (1/99 revised) Formerly SWRCB Form A ~IIFIED PROGRAM CONSOLIDATED FOR UNDER , UND STORAGE TANKS- NKPAGE 1 (two pages per tank) Page__ of ~ TYPE OF ACTION [] I NEW SITE PERMIT [] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Check one item only) [] 7 PERMANENTLY CLOSED ON SITE [] 3 RENEWAL PERMIT (Specify reason- for local use only) (Specify reason- for local use only) [] 8 TANK REMOVED 430 ;U-;I'~/SeSRN;;;;~n~e as FACILITY NAME °r DBA- D°ing Business As)I 3[ FAC'L'TY'D: I II I I I 1 LOCATION WITHIN SITE (Optional) 431 4101 Calloway Dr., Bakersfield, CA ~ii~, I,~ TANK~ESCRIPTI~,N (~al~d!~!~'~ ,P,.la~:~w thth~ 0Cat!~b¥0f t~US~,~y,s,t~fii~ h~ bdin§:: bUd d~a'~d~ [ihd~tl~§ :~h~i bei:§:db~ tt~cl~t~th~10ca TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 1 Bakersfield If "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1998 10,000 ADDITIONAL DESCRIPTION (For local use only) 438 TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED r-'J 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. pREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER ~ [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4. HAZARDOUS WASTE Gasoline (Includes Used Oil) [] 95. UNKNOWN TYPEOFTANK []1. SlNGLEWALL [] 3. SINGLEWALLWITH []5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Checkone item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 2. DOUBLE WALL [] 4. SlGNLE WALL IN VAULT [] 99. OTHER ~ TANK MATERIAL - primary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5, CONCRETE [] 95. UNKNOWN 444 (Checkone item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL - secondary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check oneitem only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] 1 MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN 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 (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Checkall [] I SPILL CONTAINMENT 2003 OPW that apply) [] I ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2003 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 1998 ~: :;:i ~! :~:: :~ ~,: !~!~:~,, :i'~i~,iV,~i~ANK~:EEAK~DETEC~ION :[A~d6~i~tioh 0f:~6:~m'&'~ ~ring p~:~Sh:~ ::b~'~u'~'{6d:~b~'{h~~ 5ca ~&:~cy ) :~.':~ ":~ ::::', ::"::::,,[~;~::~': ~ IF SINGLE WALL TANK (Check alt that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [] 99 OTHER ESTIMATED DATE LAST USED (YPJMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE 456 457 REMAINING TANK FILLED WITH INERT MATERIAL? gallons [] Yes [] No UPCF (1/99 revised) Formerly SWP, CB Form B Page __ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION / [] 1. 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 Environ 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL [] 2, STAINLESS STEEL [] 7, GALVANIZED STEEL [] UKNOWN [] 2, STAINLESS STEEL [] 7, GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 8, FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5, STEEL W/COATING [] 9, CATHO01C PROTECTION 464 [] 5. STEEL W/COATING [] 95. UNKNOWN 465 ....... ~,~,,,: :~,. ~:~:~ = =: ~::::: ::~ ~11 ;:~ E I~IN GtE E A K D E TE CT! O N ~, (Check all th at: apply)= (A d escr~ pt!o n:of; th e=m on UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED 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. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL LEAK, 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 (0.1GPH) [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DALLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Check all that apply) 1-15. DAILYVISUALMONITORINGOFPUMPINGSYSTEM+TRIENNIALPIPINGINTEGRITY 1-15. DAILYVISUALMONITORINGOFPIPINGANDPUMPINGSYSTEM TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) [] 7. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [] 7. SELF MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9, BIENNIAL INTEGRITY TEST (0,1 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 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) (Check 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 r-lc. NO AUTO PUMP 8HUT OFF Dc NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF 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. CONTINUOU88UMPSENSOR+AUDIBLEANDVISUALALARM8 [] 13. CONTINUOUSSUMPSENSOR+AUDIBLE ANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUSSUMPSENSORWlTHOUTAUTOPUMPSHUTOFF+AUDIBLE AND [] 14. CONTINUOUS SUMP SENSORWlTHOUTAUTOPUMPSHUTOFF+AUDIBLE AND VISUAL ALARMS VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 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 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 1998 [] 3. WITH AUTO SHUT OFF FOR DISPENSER + [] 6. NONE 469 ~ is true and accurate to the best of my knowledge. 470 DF OWNER/OPRATOR (print) 472 Martin Environmental Mana¢ler Permit Number (For local use only) 473 Permit Approved (For local use only) Permit Expiration Date (For local use only) 475 UPCF (1/99 revised) Formerly SWRCB Form B UNDER ;,'OUND STORAGE TANKS - T, PAGE 1 (two pages per tank) Page of ~ TYPE OF ACTION [] I NEW SITE PERMIT [] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Checkone item only) [] 7 PERMANENTLY CLOSED ON SITE [] 3 RENEWAL PERMIT (Specify reason - for local use only) (Specify reason - for local use only) [] 8 TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 7-Eleven #32241 LOCATION WITHIN SITE (Optional) 431 4101 Calloway Dr., Bakersfield, CA : : i; ~AN~!IOESC~!~lON~(A::§:~16~l~:~l~t::~lan,with~:the!lS~-ati~n;of the U~T~y~t~:~:: i~10~li~ bbildih~§~:~dJa'ndma~k~ :~h:~ll:b~iS~bmitted:t0'~th~6qS~l:::~?~ TANK ID# 432 ,TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 2 Bakersfield If "Yes". complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1998 10,000 ADDITIONAL DESCRIPTION (For local use only) 438 ;::::;': ':: '~;~i:i~ ~?'; ::::~::: I~:~ANK CONTEN~S ::;:::::::: ::::?~i ~ :~~:': :: ~, ,, ,,,' ,' "~ .... ,~' ,~' ~ :: ,~ ~.~,~-~': '~:~"' ,,:~::~ ~ '::'-, ~ ', ~:::' ....... -~,, TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3, DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER__ [] 3, CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4, HAZARDOUS WASTE Gasoline (Includes Used Oil) [] 95, UNKNOWN TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN I~2, DOUBLEWALL []4. SIGNLE WALL IN VAULT 1-199. OTHER__ TANK MATERIAL- primary tank [] 1. BARE STEEL [] 3. FIBERGLASS/PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 (Check one item only) [] 2, STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANKMATERIAL-sece~d~taak [] 1. BARESTEEL [] 3. FIBERGLASS/PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check oneitem only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95, UNKNOWN 446 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] 1 MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN 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 (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Checkall [] I SPILL CONTAINMENT 2003 OPW that apply) [] I ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2003 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 1998 IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] I VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [] 99 OTHER ESTIMATED DATE LAST USED (YR/MO/DAY) 455 I ESTIMATED QUANTITY OF SUBSTANCE 456 457 REMAINING TANK FILLED WITH INERT MATERIAL? I gallons [] Yes [] No UPCF (1/99 revised) Formerly SWRCB Form B IFIED PROGRAM CONSOLIDATED " TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 ::: ~,~ '~ :,,~;~,:: :~;~l ,,:~ I; PIPING,C~,C~ION (Checkall that::a ;,:::,::; ::I ~,,,,,: ,.: :::~i~::;; .:': ~¢~:~. Page __ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION I [] 1. 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 Environ 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100%UETHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99, OTHER [] 3, PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 9. CATHODIC PROTE,CTION 464 [] 5. STEEL W/COATING [] 95. UNKNOWN 465 ~i~'~'.~':.' ~,VII:~EIEING:EEAK~,DE~ECTION :i~A~aiiiih~ii!~r~i~i :(Ade'~i~r~: ~f ih~ ~on~i~ ~r~rn ~l~'~ii~iitedlt~ i~l:'~?r~:~:::: UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING PRESSURIZED 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 [] I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS, ALARMS, [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPHTEST [] 3, ANNUAL INTEGRITY TEST (0.1GPH) [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS (Check ell that apply) [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5, DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPtNG): [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) [] 7, SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [] 7. SELF MONITORING [-19, BIENNIAL INTEGRITY TEST (0.1GPH) GRAVITY FLOW (Check all ~at apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 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 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) (Check 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 I-lc. NO AUTO PUMP SHUT OFF I-lc NO AUTO PUMP SHUT OFF ~ 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION ~3 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAViTY SYSTEM [] 13, CONTINUOUS SUMPSENSOR+AUDIBLEANDVISUALALARMS [] 13. CONTINUOUSSUMPSENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMPSENSORWlTHOUTAUTOPUMPSHUTOFF+AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WlTHOUT AUTO PUMP SHUT OFF*AUDIBLE AND VISUAL ALARMS VISUAL 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 [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK CONTAINMENT DATE INSTALLED 468 [] 2. CONTINU~)US DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 1998 [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 provided to the best of my knowledge. 470 F OWNER/OPRATOR (pdnt) IPERATOR 472 Martin Environmental Mana¢ler Permit Number (For local use only) 473 Permit Approved (For local use only) Permit Expiration Date (For local use only) 475 UPCF (1/99 revised) Formerly SWRCB Form B ~"- ~IIFIED PROGRAM CONSOLIDATED F ' UNDER UND STORAGE TANKS - K PAGE 1 >¢' (two pages per tank) Page ~ of ~ ~PE OF ACTION ~ I N~ SITE PERMIT ~ 4 AMENDED PERMIT ~ 5 CHANGE OF INFOR~TION ~ 6 TEMPO~RY SITE CLOSURE Che~ one item only) ~ 7 PERMANENTLY CLOSED ON SITE ~ 3 RENTAL PERMIT (Spec~ reason- for Io~1 use only) (Sped~ reason- for Io~1 use only) ~ 8 TANK REMOVED 430 ~ll~S~e as FACILI~ N~E °r DBA- D°ing Business ~)~1 FAC'L'TY'D: I I I III LOCATION WITHIN SITE (Optionat) 431 4101 Calloway Dr., Bakersfield, CA ,,~:?~.:~I~:TAN K~DESC~I~TION~?(A ~l~d pt~t: ~ahs~h~.[~e~l~tipn ~f: th~ S~t~.i~pg b~ildj~.~ a~h~ks~ll b?~ 0.~i~t~d~th:~:~d~: :~ TANKID~ 432 TANK~NUFACTURER 433 COMPARTMENTALIZED TANK ~ Yes ~ No 434 3 Bakersfield . "Yes", ~mplete one page for ea~ compa~ent. DATE INSTALLED (YEA~MO) 435 TANK CAPACI~ IN GALLONS 436 NUMBER OF COMPARTMENTS 437 4/1998 10,000 ADDITIONAL DESCRIPTION (For Io~1 use only) 438 TANK USE 439 PETROLEUM ~PE 440 ~ 1. MOTOR VEHICLE FUEL ~ la. REGU~R UNLADED ~ 2. L~DED ~ 5. JET FUEL if ma~ed~mplete Petroleum Type) ~ lb. PREMIUM UNLADED ~ 3. DIESEL ~ 6. AVIATION FUEL ~ 2. NON-FUEL PETROLEUM ~ lc. MIDG~DE UNLADED ~ 4. GASOHOL ~ 99. OTHER ~ ~ 3. CHEMICAL PRODUCT COMMO~ NAME (from Hazardous Materials Invento~ page) 441 CAS~ (from Hazardous Materials Invento~ page ) 442 ~ 4. HA~RDOUS WASTE Gasoline (Includes Used Oil) ~ 95. UNKNOWN ~PE OF TANK ~ 1. SINGLE WALL ~ 3. SINGLE WALLWlTH ~ 5. SINGLE WALLWlTH INTERNAL B~DDER SYSTEM 443 (Che~ one item only) EXTERIOR MEMB~NE LINER ~ 95. UNKNOWN ~ 2. DOUBLE WALL ~ 4. SlGNLE WALL IN VAULT ~ 99. OTHER ~ TANK MATER~L- pdma~ tank ~ 1. BARE STEEL ~ 3. FIBERG~SS/P~STIC ~ 5. CONCRETE ~ 95. UNKNOWN 444 (Che~ one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL C~D W/FIBERG~SS ~ 8. FRP COMPATIBLE W/ ~ 99. OTHER REINFORCED P~STIC (FRP) 100% METHANOL TANK ~TER~L-s~0nd~nk ~ 1. BARE STEEL ~ 3. FIBERG~SS / P~STIC ~ 5. CONCRETE ~ 95. UNKNOWN 445 (Che~ one item only) ~ 2. STAINLESS STEEL ~ 4. STEEL C~D W/FIBERG~SS ~ 8. FRP COMPATIBLE ~ 99. OTHER REINFORCED P~STIC (FRP) W/100% METHANOL ~ 5. CONCRETE ~ 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING ~ 1. RUBBER LINED ~ 3. EPOXY LINING ~ 5. G~SS LINING ~ 95. UNKNOWN 446 OR COATING ~ 2 ALKYD LINING ~ 4 PHENOLIC LINING ~ 6 UNLINED ~ 99 OTHER (Check one item only) (For Io~1 use only) ~8 DATE INSTALLED 449 OTHER CORROSION ~ 1 MANUFACTURED CATHODIC ~ 3 FIBERG~SS REINFORCED P~STIC ~ 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION ~ 4 IMPRESSED CURRENT ~ 99 OTHER (Che~ one item only) ~ 2 SACRIFIC~L ANODE (For Io~1 use only) SPILL AND OVERFILL Y~R INSTALLED 450 ~PE (Io~1 use only) 451 OVERFILL PROTECTION EQUIPMENT:Y~R INSTALLED 452 (Che~all ~ 1 SPILL CONTAINMENT 200~ OPW ~ 1 A~RM ~ 3 FILLTUBE SHUTOFF VALVE that apply) ~ 2 DROP TUBE 2003 ~ 2 BALL FLOAT ~ 4 EXEMPT ~ 3 STRIKER P~TE 1 998 ~ ~IV;: ~AN KgEEAK~DE~EC~ION:'(A~des~ptlon :d~:the~mon~tonng pr~ramshatl be submitted to the':lo~l agent,) ~:' ~,~'..'~' ~: ~ IF SINGLE WALL TANK (Che~ a~ that apply) 453 IF DOUBLE WALL TANK OR TANK WITH B~DDER 454 (Che~ one item only) ~ 1 VISUAL (EXPOSED PORTION ONL~ ~ 5 ~NUAL TANK GAUGING (MTG) ~ 1 VISUAL (SINGLE WALL IN VAULT ONL~ ~ 2 AUTO~TIC TANK GAUGING (ATG) ~ 6 VADOSE ZONE ~ 2 CONTINUOUS INTERSTIT~L MONITORING ~ 3 CONTINUOUS ATG ~ 7 GROUNDWATER ~ 3 ~NUAL MONITORING ~ 4 STATISTICAL INVENTORY RECONCIL~TION ~ 8 TANK TESTING + (SIR) BIENN~L TANK TESTING ~ 99 OTHER ESTI~TED DATE ~ST USED (Y~MO/DAY) 455 ESTI~TED QUANTI~ OF SUBSTANCE 456 457 RE~INING TANK FILLED WITH INERT ~TER~L? gallons ~ Yes ~ No i UPCF (1/99 revised) Formerly SWRCB Form B IFIED PROGRAM CONSOLIDATED TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 Page __ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1, PRESSURE [] 2. SUCTION [] 3, GRAVITY 458 [] 1. PRESSURE [] 2, SUCTION [] 3. GRAVITY 459 CONSTRUCTION / [] 1. 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 Environ 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3, PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HDPE) [] 99, OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 5. STEEL W/COATING [] 95. UNKNOWN 465 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all thatapply): 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, SYSTEM FAILURE, AND SYSTEM DISCONNECTION * AUDIBLE AND VISUAL LEAK, 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 (0.1GPH) [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 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 PIPINGAND PUMPING SYSTEM TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) [] 7. SELF MONITORING SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): GRAVITY FLOW [] 7. SELF MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) GRAVITY FLOW (Check allthat apply); [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 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 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) (Check 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 I-lc NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF 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. CONTINUOUSSUMPSENSOR+AUDIBLEANDVISUALALARMS [] 13. CONTINUOUSSUMPSENSOR+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 SHUTOFF+AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WlTHOUT AUTO PUMP SHUT OFF+AUDIBLE AND VISUAL ALARMS VISUAL 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 [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK CONTAINMENT DATE INSTALLED [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 1998 [] 3. CONTINUOUS DISPENSER PAN SENSOR WIT.__~H AUTO SHUT OFF FOR DISPENSER + [] 6. NONE 469 IAL ALARMS y knowledge. / /' 470 OAT (pdnt) TITLE OF OWNER/OPERATOR 472 Martin Environmental Mana er Permit Number (For local use only) 473 Permit Approved (For Iocat use only) Permit Expiration Date (For local use only) 475 UPCF (1/99 revised) Formerly SWRCB Form B WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The informatioo oo this monitoring program are conditions of the operating permit. The permit holder must notify local agency within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name: 7-Eleven Store #32241 Facility Address: 4101 Calloway Dr., Bakersfield, CA Date: Au,qust, 2003 A. Describe the frequency of performing the monitoring: The site consists of three 10,000 gallon double walled fiberglass clad steel tanks ( 1-Regular Tank Unleaded, 1-Midgrade, 1-Premium) and are monitored monthly with a VeederRoot TLS350 Product lines are double wall Enviroflex and are monitored continuously with a VeederRoot TLS350. The turbine sump sensor activates audio/visual alarms and provides positive Piping shutdown of the turbines. B. What methods and equipment, identified by name and model, will be used for performing the monitoring: The method of leak detection for the tanks is Interstitial Monitoring using the Veeder-Root TLS350 Tank Gauge. VeederRoot model 794380-420 probes are used for the monitoring. Tank High level alarms activate audio/visual and external alarms. The piping is monitored continuously by VeederRoot liquid sensors model #794380-208 located in the turbine sump of each tank. The turbine sump sensors provide positive shutoff and activate audio/visual alarms. The piping is precision tested annually at a threshold of .lgph. Vaporless Mechanical Line Leak Detectors (LD2000) are used to detect 3 gph Piping release. C. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: The individual responsible for the monitoring equipment is the store operator. The operator will contact 7-Eleven Dispatch I (800/828-0711) for any alarm conditions on the VeederRoot. The local maintenance contractor will be dispatched. 7-Eleven, Inc. is responsible for maintaining the equipment. The Environmental Manager is Randy Martin D. Reporting format for monitoring: Current status reports are available from the Veeder-Root TLS-350 as a print out and from the display screen. Monitoring records will be kept at the location and at a central office Tank location. Current status reports are available from the Veeder-Root TLS 350 as a print out and from the display screen. Piping Third party annual test results will be submitted to the agency. 'Writte, n Monito[ ,P..rocedures .7-Eleven ~32241 'Page 2, D. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. The tanks and product piping system are checked every 120 days. Any equipment repairs and replacement are as needed. In accordance with the manufacturer's instruction, the monitoring equipment is tested annually to certify that it is functioning properly. E. Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: 7-Eleven trains the store operator in the operation of the equipment. The monitoring plan is reviewed with the operator. Training is provided for new employees. Training refreshers are offered as needed. The operations manual for the equipment was provided to the store operator when the equipment was installed. i :¡ .., Tanlcnology 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 10/07/2004 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES INSPECTOR STEVE UNDERWOOD 900 TRUXTUN AVE., STE. 210 BAKERSFIELD, CA. 93301 Test Date: 08/06/2004 Order Number: 3135945 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7 -ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Line tests Sincerely, :D~K~ Dawn Kohlmeyer Manager, Field Reporting r 1-~ Dlnknology PURPOSE: COMPLIANCE TEST DATE: 08/06/04 CLIENT: 7-ELEVEN, INC. 20819 72ND AVE. SOUTH SUITE 206 KENT, WA 98032 RANDY MARTIN (253)796-7170 TANKNOLOGY CERTIFICATE OF TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 TELEPHONE (512) 451-6334 FAX (512) 459-1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3135945 CUSTOMER PO: SITE: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA 93312 MANAGER (661 )587 -8826 TEST TYPE: TLD-1 10k 10k 10k 1 REG UNLEAD 2 MIDGRADE 3 PREMIUM ENVIROFLEX ENVIROFLEX ENVIROFLEX PRESSURE PRESSURE PRESSURE y y y 0.000 0.000 0.000 P P P 10k 1 10k 2 10k 3 For owner detailed report information, visit www.tanknology.comand select On-Line Reports-WRAP, or contact your local Tanknology office. Tester Name: WESLEY COULTER ~ Technician Certification Number: 10004 Printed 10/07/200406:57 SBOWERS ? INDIVIDUAL TANK INFORMATION AND TEST RESULTS t-~ 7l:Jnlmology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. Tank 10: 10k 1 Product: REG UNLEAD Capacity in gallons: 10,028 Diameter in inches: 96.00 Length in inches: 324 Material: TOTAL CONT COMMENTS !fAN"';,I!~illWA:n~Bllttii;;f:t:~\j' Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 158.0 161.0 62.0 4.0 DUAL ASSIST Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: est leak rate ml/m: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 280 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/200406:57 INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~~ DJnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Tank ID: 10k 2 Product: MIDGRADE Capacity in gallons: 10,028 Diameter in inches: 96.00 Length in inches: 324 Material: TOTAL CONT COMMENTS Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 160.0 163.0 64.0 4.0 DUAL ASSIST Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Bubble Make: Model: SIN: Open time in see: Holding psi: Resiliency cc: Test leak rate ml/m: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 194 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/200406:57 c, INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~ 41 ~ Dlnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Tank ID: 10k 3 Product: PREMIUM Capacity in gallons: 10,028 Diameter in inches: 96.00 Length in inches: 324 Material: TOTAL CONT COMMENTS Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 157.0 160.0 61.0 4.0 DUAL ASSIST Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate ml/m: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 182 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10107/200406:57 -..- r, -~ Dlnlmology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:08/06/04 CLIENT: 7 - ELEVEN, INC. WORK ORDER NUMBER3135945 SITE:7 -ELEVEN #32241 COMMENTS Arrived on site at 5:00 P.M. for primary piping testing. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 10/07/200406:57 SBOWERS J; ,'i SITE DIAGRAM -., Dlnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 08/06/04 CLlENT:7-ELEVEN, INC. WORK ORDER NUMBER3135945 SITE: 7 -ELEVEN #32241 vfE CJ:X) VENTS ® ® ® ø ø ø c ro ~ 0 ~ EN Jf Jf a.>"- ..- C) ('f) ~ "<tro('f) 0 0 0 N~(j) ..- ..- ..- N _ ('f)@)ro =It U 8 8 8 >- - Cro-c a.>:¡:ã5 >otö= ..!Q=(/) Jf Jf a.> ro ..... I U a.> PLUS SUP UL 1'--' ~ ..-ro 0.0 ..- "<t Printed 10/07/200406:57 SBOWERS -,' ~ ~ 'i ~ Tanlcnology 8501 N. MoPac Expressway, Suite 400 Austin, Texas 78759 Phone: (512) 451-6334 Fax: (512) 459-1459 Date Printed and Mailed: 10/07/2004 KERN CTY - ENVIROMENTAL HEALTH 2700 M STREET SU ITE 300 BAKERSFIELD, CA. 93301 Test Date: 08/06/2004 Order Number: 3135945 Dear Regulator, Enclosed are the results of recent testing performed at the following facility: 7 -ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA. 93312 Testing performed: Line tests Sincerely, :D~K~ Dawn Kohlmeyer Manager, Field Reporting Co r~ Dlnlmology CLIENT: 7-ELEVEN, INC. 20819 72ND AVE. SOUTH SUITE 206 KENT, WA 98032 RANDY MARTIN (253)796-7170 TANKNOLOGY CERTIFICATE OF TESTING 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 TELEPHONE (512) 451-6334 FAX (512) 459-1459 TEST RESULT SUMMARY REPORT WORK ORDER NUMBER: 3135945 CUSTOMER PO: SITE: 7-ELEVEN #32241 MARKET # 2133 4101 CALLOWAY DRIVE BAKERSFIELD, CA 93312 MANAGER (661)587-8826 PURPOSE: COMPLIANCE TEST DATE: 08/06/04 TEST TYPE: TLD-1 10k 10k 10k 1 REG UNLEAD 2 MIDGRADE 3 PREMIUM ENVIROFLEX ENVIROFLEX ENVIROFLEX PRESSURE PRESSURE PRESSURE P P P 0.000 0.000 0.000 y y y 10k 1 10k 2 10k 3 'I For owner detailed report information, visit www.tanknology.com and select On-Line Reports-WRAP, or contact your local Tanknology office. Tester Name: WESLEY COULTER Technician Certification Number: 10004 Printed 10/07/200407:14 SBOWERS ';? INDIVIDUAL TANK INFORMATION AND TEST RESULTS 1-~ Dlnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Tank 10: 10k 1 Product: REG UNLEAD Capacity in gallons: 10,028 Diameter in inches: 96 . 00 Length in inches: 324 Material: TOTAL CONT COMMENTS Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTectTestType: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 158.0 161. 0 62.0 4.0 DUAL ASSIST . ",I.1~~rQ§ï~1 ENVIROFLEX 1.5 175.0 50 280 60 17 :38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate mllm: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/200407:14 ~ INDIVIDUAL TANK INFORMATION AND TEST RESULTS ~., DJnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLIENT: 7 - ELEVEN, INC. Tank ID: 10k 2 Product: MIDGRADE Capacity in gallons: 10,028 Diameter in inches: 96.00 Length in inches: 324 Material: TOTAL CONT COMMENTS Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / ~.~B; Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage II vapor recovery: 160.0 163.0 64.0 4.0 DUAL ASSIST New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 ENVIROFLEX 1.5 175.0 50 194 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Bubble Make: Model: SIN: Open time in sec: Holding psi: Resiliency cc: Test leak rate mllm: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10107/200407:14 ~ INDIVIDUAL TANK INFORMATION AND TEST RESULTS -., DJnlcnology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 TEST DATE:08/06/04 CLlENT:7-ELEVEN, INC. Tank ID: 10k 3 Product: PREMIUM Capacity in gallons: 10,028 Diameter in inches: 96.00 Length in inches: 324 Material: TOTAL CONT COMMENTS WORK ORDER NUMBER3135945 SITE: 7 -ELEVEN #32241 ·i!';itl~If1!¡;Ø.RM~1fIØ Tank manifolded: NO Vent manifolded: NO Vapor recovery manifolded: YES Overfill protection: YES Overspill protection: YES Installed: ATG CP installed on: / / Bottom to top fill in inches: Bottom to grade in inches: Fill pipe length in inches: Fill pipe diameter in inches: Stage I vapor recovery: Stage \I vapor recovery: 157.0 160.0 61. 0 4.0 DUAL ASSIST Dipped Water Level: Dipped Product Level: Probe Water Level: Ingress Detected: Water Test time: Inclinometer reading: VacuTect Test Type: VacuTect Probe Entry Point: Pressure Set Point: Tank water level in inches: Water table depth in inches: Determined by (method): Result: COMMENTS New/passed Failed/replaced New/passed Failed/replaced L.D. #1 L.D. #1 L.D. #2 L.D. #2 Bubble Make: Model: SIN: Open time in see: Holding psi: Resiliency cc: Test leak rate ml/m: Metering psi: Calib. leak in gph: Results: NOT TESTED NOT TESTED Ullage NOT TESTED COMMENTS Material: Diameter (in): Length (ft): Test psi: Bleedback cc: Test time (min): Start time: End time: Final gph: Result: Pump type: Pump make: COMMENTS ENVIROFLEX 1.5 175.0 50 182 60 17:38 18:38 0.000 PASS PRESSURE FE PETRO NOT TESTED Impact Valves Operational: YES NOT TESTED NOT TESTED Printed 10/07/200407:14 .... ~~ DJnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE:08/06/04 CLIENT: 7 - ELEVEN, INC. WORK ORDER NUMBER3135945 SITE:7-ELEVEN #32241 COMMENTS Arrived on site at 5:00 P.M. for primary piping testing. PARTS REPLACED HELIUM PINPOINT TEST RESULTS (IF APPLICABLE) Printed 10/07/200407:14 SBOWERS ..." . - 4 ;- . SITE DIAGRAM r~ Dlnknology 8900 SHOAL CREEK, BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 FAX (512) 459-1459 TEST DATE: 08/06/04 CLlENT:7-ELEVEN, INC. WORK ORDER NUMBER3135945 SITE: 7 -ELEVEN #32241 viE (XX) VENTS ® ® ® ø ø ø c ro 0 0 ~ EN Jf Jf Q)~ ~ ~ ~ e>C") 0 0 0 '<troC") N.!:(J) ~ ~ ~ N _ C")@)ro ~ () § § § >- - cro-o Q)3:(i) >o¡¡:: Æ=(/) Jf Jf Q) ro .... ~()~ PLUS SUP UL ~ ro 0.0 ~ '<t Printed 10/07/200407:14 SBOWERS e 1Jr- o/ft,ç- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES , 1715 Chester Ave., Bakersfield, CA (805) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST FACILITY '7 -II it:3 22-Ll} ADDRESS 416-., CJtuÀW~ 1)fbtÙé - ~fl~r~ PERMIT TO OPERATE # OPERATORS NAME I OWNERS NAME NUMBER OF TANKS TO BE TESTED T ANI< # VOLUME (- LL-l j.JÚ 7--/1 ,~ IS PIPING GOING TO BE TESTED 3 CONTENTS utJ'C . mf' 6f'Jv~ T ANI< TESTING COMPANY MAILING ADDRESS~ß? -1l(fJil~ Ø0tØW~æ- Q,rj(lf;{,e þ- ~~ CflfAOJ- ThtJ l.A1J'r f(OO--{dk-1J.¡)1 NAME & PHONE NUMBER OF CONTACT PERSON TEST METHOD 1lJ)- l NAME OF TESTER wes (OÙ(;1122- CERTIFICATION # ð~lLtæ DATE & TIME TEST IS TO BE CONDUCTED ~~ @. 321Ú "~ d~LKIÛ ~ APPROVED BY DATE J~N-01-2001 11:05 FROM THE SOUTHLAND CORP. 2191 TO 915032453438 P.08 STORAGE TANK AGREEMENT THIS AGREEMENT is made and.entered Lab as of ~his ~ day of ~ ,-.J,~' ,19~ by and between THE SOUTHL~ CORPORATION, a Texas corporation ("Southland" ,--)-~11 North H~kell Ave~,,ue, Dallas, Texas 75204, and Shinda Upple and Paramjeet Kaur Upple (' Franchisee ). WHEKEAS, Southland is the owner of and Franchisee is an operator of underground storage tanks at a retail motor fuels outlet located at 4101 Calloway Drive,-Bakersfield, CA 93312-2302 (the "outlet"); and WI-t~KEAS, Franchisee sells gasoline at the outlet on consignment from Southland pursuant to a Consigned Gasoline Amendment dated ~ 1~7[q ~ ; and WHEREAS, Southland and Franchisee are subject to certain Federal, state and local require- ments governing the operation of underground storage tanks at the outlet including, but not limited to, those se~ forth in Chapter 6.7 of Division 20 of the California Health and Safety Code (the "Act") and regulations promulgated thereunder and codified in Subchapter 16 of Chapter 3, Tide 23, California Administrative Code (the "Regulations"); and WHEREAS, Section 25923 of the Act and Section 2610Co) of the Regulations provide that if there is an operator of underground tanks at a facility who is not the owner of said tanks, the owner shall enter into a written ..contract with that operator to perform certain responsibilities under the Act and the Regulations. NOW TI-IF_J~FOKE, in consideration of the premises and of the mutual promises and covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: 1. This Agreement shall commence on ~7'~ .7 ,19 ~oc , and shall continue until expiration or termination of the Consigned Gasoline Addendum between the parties. 2. Franchisee shall monitor the underground storage tanks at the outlet in accordance with Section 2644 of the Regulations and any applicable permit, rule or order issued pursuant to the Regulations or any other applicable Federal, state or local authorities. 3. Franchisee shall maintain appropriate records in accordance with Section 2712 of the Regulations and any applicable permit, rule or order issued pursuant to the Regulations or any other applicable Federal, state and local authorities. 4. Franchisee shall implement reporting procedures as required by any permit, rule or order issued pursuant to the Regulations or any other applicable Federal, state and local authorities. 5. At its expense, Southland agrees to train Franchisee in the monitoring of the underground storage tanks, the maintenance of appropriate records ahd the implementation of reporting proce- dures as set forth in paragraphs 2, 3 and 4 of this Agreement, and Franchisee agrees to attend such training. 6. Southland shall properly close the underground tanks at the outlet as required by any permit, rule or order issued pursuant to the Regulations. 7. Southland shall indemnify Franchisee against any liability for civil penalties assessed as a result of Franchisee's failure to comply with the Act or the Regulations or Southland's failure to Form 4400288 4/95 (California only) }'~o_e 1 of 2 JAN-O1-2001 11:06 FROM THE SOUTHLAND CORP. 2191 TO 91503245~438 P.Og comply with the Act or Regulations, excep! that no indem,~nification shall be provided where the' noncompliance is caused in whole or in part by Franchisee s negligence or willful misconduct. 8, This Agreement shall not be modified, altered, amended or revoked except in writing duly executed by the parties. 9. A breach of this Agreement by Franchisee shall not constitute a ground for termination or /mnrenewal ofthe'/-Eleven Store Franchisee Agreement by and between Franchisee and Southland, unless the breach is otherwise a breach of the ?-Eleven Store Franchise Agreement. 10. In the event of a dispute o~r. controversy arising out of this Agreement oi' the breach thereof, the arbitration provisions of the ? Eleven Store Franchise Agreement shall apply. ' IN WITNESS WI-12EKEOF, the parties have executed this Agreement as of the day and year first above written. 7-ELEVEN: THE SOUTHLAND CORPORATION David Wheeler Jerry A. Hook Market Manager A~sistant ~ecretary Full Name (Typed) Full Name (Typed) 7-ELEVENOfficdSmrcNo. 2237-:t2241 A 5151 N. Palm Avenue, Suite 711 Address ot OffiCe street Fresl~ CA 93704-22011 'City State Ztp FRANCHISEE(S) Stg~~ Shinda Upple Paramjeet Kaur Upple l-ull Name ('typed) l, utl Name (1 ypecl') Witness: Witness o! AlCOve b!gnature wimess df A~ove signature 4101 Calloway Drive Store ^dciress street Bakersfield C A 93312- 2302 tZ~ty State /ip Form 4400288 4/95 (California only) ?~g¢ 2 of 2