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Home My WebLink AboutUNDERGROUND TANK FILE #1 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE - This permit is issued for the followin_.: [] Hazardous Materials Plan r'l Underground Storage of Hazardous Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-002197 BROOKSIDE MARKET ii~i;:i;· r. oc^~io~ ~03 i~:c~,~:mo ~A~S'~U~ C^ 933~1 015-000-002197-0001 ~GULAR UNLEADED ':Y '~?~'~,'. 20,0%' . PA ~.S~SOR W/AUTO SHUTOFF 015-000-002197-0002 PREMIUM ~E.EAD~?: ... '"~ .:' 12,000 ..~,.,~.'DISP. p~Nj~ENSOR W/AUTO SHUTOFF .~, ...... ,7~ -.,~ .... , , ~., - ,, . ~., .. 015-000-002197-0003 DIESEL '~: 5.~.~.~¢' :2.~:>,.:t"..'4J¢'¢r '~.~ ~.'-~.00ff'~4~. D~i ~ SENSOR W/AUTO SHUTOFF ~' .._ ~ ~ ~ ,,. ..~: -.,,~:~: . · ~ OFFICE OF EN~R ONMENTAL SER VICES' Issue Bakersfield, CA 93301 OfficeofEv~n~S~ic~ ~ Voice (661) 326-3979 [~~~, F~ (661) 326-0576 ExpimtionDate: ~Un~ ~O~ ~00~ City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (661) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit fOr the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 22nd day of February, 2001 to: BROOKSIDE MARKET AT THE OAKS Permit #015-021-002197 8803 Camino Media Bakersfield, California 93311 ~NDERGROUN®sTORAGE r>~Ntcs ,~, ~.P~~~S~I~~,I) FI~2E I~E~. ,,~" ~..~ . ~ ~~~ tom. .~~~~ k~~ ate:, ~ tr ~ ~ ,r* ~~ ~~ ~~ `~'~>~ .=_~~ 900 Truxtun Ave.> Ste. 210 ,~~~~~~~~®~ ` ~'~ , ~':~." Bakersfield, CA 93301 TO PERFORM ELD /LINE TESTING Tel.: {661} 326-3979 / SB989 SECONDARY CONTAINMENT TESTING Fax: (661} 852-2171 ITANIC TIGHTNESS TEST AND TO PERFORM FLiEL MONITORING CERTIFICATION Page t of t (~~ ~ ~ ~ ~~~~! j~ ~ PERMIT NO - ^ ENHANCED LEAK DETECTION ^ LINE TESTING ~ SB-989 SECONDARY CONTAINMENT TESTWG ^ TANK TIGHTNESS TEST ^ TO PERFORM FUEL MONITORING CERTIFICATiOfJ - - sITE NFor~I~,~.Tior. _ -- ---- - FACILITY-D- - - - -- - ~~ .~-peo~_cl_~ _ YYl ~~,1~~-- ~ 10~~ . - NAME & PHONE NUMBER OF CONTACT PERSON I ~ S~ _ (]~1 ~ ~~~ ~ ~ l~ i - ~~ . 3a Za- ~ a ~ !OPERATOR'.~el PERI4&IT TO OPERATE NO. NUMBER OF TANKS TO BE TESTED '__-- T A !V K # __--_ -- IS PIPING GOING TO BE TESTED? --- ----- V O L U iN E _ ~ YES___ O NO _~_ ------,1'/~--------- CONTENTS ___ ~- ~ ~ I I ~ ~ ~ i 3 ~ I I I t TANKTESTING COMPANY La~nEO1~e.~inl,~ cow M~P~.a tsc.t~_ `~L. _-- INAZ~~n~i~r,:EoN:~c~r~~% ~N~3~-L923 `i '' r i 1 ~D . e~ ~lSl~1 ~o...~o.;;~„~ 'C-i4 9330- !NAME & i~ONE NUM ER OF TESTER ORi PECiAL NSPEC OR ~~CER ~ CA~fON~/a ~ -- d~~.63S~3o+~' I X0101 3 06/~Op I S 3 ~, ~ ~~ ~~ ~ ATE~ti'ME TEST TO 8E CONDUCTED ~iCC #: E T~`dr"~° "'"D 0260 ~ oo Pm I ~ ~9 a ~(o- u 1 I (SIGNATURE O PPLICANT DATE 2 ..- tS A~ =Lt.C~~tQN~ E~~~~(Vt~, a A ~E = tr~.~ ° t ~N4 B~~~F~C~tG~:~ ---------------------------~ (APPROVED BY \ ~i_ _i ..1~~ IDATE~ ;-- 1 FD2106 // . _ - - " d ~s ,~ ~~~~ ~} ~y . 'l' , ~# ~i ~;~ ~ ~~ --- - - - - - ' (UNDERGROUND STORAGE TANK) FILE # BROOKSIDE MARKET AT THE OAKS 8803 CAMINO MEDIA ._ . _ UNDERGROUND STORAGE TANKS APPLICATION TO PERFORM ELD /LINE TESTING SB989 SECONDARY CONTAINMENT TESTING /TANK TIGHTNESS TEST AND TO PERFORM FUEL MONITORING CERTIFICATION PERMIT NO. ~~~ BAK,ERSFIELD FIRE DEPT. wiR~ Prevention Services ART~I T 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 852-2171 Page 1 of 1 FD 2095 (Rev. 09/05) 1s~-f UNDERGROUND STORAGE TANKS BAKER$FIELD FIRE DEPT. fAr~ pteventioa Services 900 Truxtun Ave. Ste. 210 ~irr r , APPLICATION ~ Bakersfield, CA 93301 TO PERFORM ELD ! LINE TESTING Tel.: (661) 326-3979 / 38989 SECONDARY CONTAININENT TESTING 1^ax; (661) 852-2171 /TANK TIGHTNESS TEST AND TO PERFOf2M II FUEL MON1TORfNG CERTIFICATION p~ ~ ~ ~ PERMfT N0. ^ ENI~ANCED LEAK DETECTION ^ LINE TE IG--- ~ ^ SB-p80 SECONDARY CONTAINMENT TESTING f-1 ~..... .-..~.....-~..r vn nrocno., o, rc~ ~.v~ulTnaiur CK r~CV' r~nW , FACILITY ON NAME b P ONE MBER OF CONTACT PER AOORE5S ~ ~ ~ ~ ,_ OWNERS NAME OPERATORS NAME PERMfT TO OPERATE H0. NUMBER OF TANK5 TO BE TESTED Q ~~ d~ Q 1~..--~ ~~L - U' .:: `~ ... tn~~c T~srlNC carNPnN~r ;~ NAME OF TES G CO PANY NAME b PHONE NUM R CONTACT PERSON MAILING ADDRESS ~ 3 ,Q r O a rJ ~ l~-^~"L ~ O I~ (f j Q~ NAME b PH E NUMBER OF TESTER OR SPECIAL INSPECTOR g CERTIFICATION #: DATE b TIME T T TO BE CONDQUCTED ~ DD , ~ ICC #:. t' r ~ _ ~~ TEST AAETHOD SIGNATURE OF APPLICANT ppTE 2 .- 0 ~ QJo APPROVED BY DATE FD 2095 (Rev. 09/05) BILLING & PERMIT STATEMENT f/>Qf -- - / ~~~ BAKERSFIELD FIRE DEPT. Prevention Services ., ...._.....,., e,.a.,,,e c.,:r. 21(1 Bakersfield, CA 93301 •- ~ • LOCATION OF PROJECT ~,~ ~ ~ i'R(>pflYiY ~~ ' STARTWGGATE. COf~PL~r10!'1~~ ,~© ~~ ~' PROJECT NAME ADDRESS ~ ~!'~~~=' ."` f"' "' ~v f ~~ -~Dl/ PROJECTAODRESS - ~ p~'^ . ~~ 1 y(1ZL~G~. •- FOR ~~ CA LICENSE NO. , CfIY ~ J STATE G4 • • TYPE OF LICENSE D(PIRATION DATE ZPCOOE PHONE S CONTRACTOR ANY FAXN ~ . -a naDRess c-rY ~ zw cone • $262 50 • ~ ^ Alarms -New & Modifrc:aGons - (MiflimUiTl Charge) . 98 F » lt fee Ft 013126 = P rr S ^ > Over 20x000 Sq. ef r X . q. ~ ^ ti n NG i Ch difi i kl N & M $210 00 ~ ~ arge) ca s - ( n mlmt n o ers - ew Spr o . ^ FL 00 S O 042 = Permit fee Ft x S ver 5, q. 0 . q. ~ ^ r Modifications {< 10 heads) Minor S rinkl 00 [InspecfTon Only) S 93 ~ p e . . 98 ^ Commeririal Hoods -New & Modifications $ 398 26 . ~ ^ AddfBonat Hoods 00 336 ~ . 9ti ^ Spray Booths -New & Modifications $458 00 ~ . 98 ^ Aboveground Story a Tanks (InstBllfa6iDNinsp -1'r Time) $165.00 ~ ^ Additiona! Tanks 3 28.00 t12 ^ Aboveground Storage Tanks (Removafrlnspectton} $108.00 ~ ^ Underground Storage Tanks (/nsfa//aUovr/Inspectbn) $878.00 (pertank) 82 ^ Underground Store Tanks (iJiodtricatiwi) $878.00 (persite} 82 ^ Undergretlnd Store a Tanks (I~tulor Modification) $155.00 82 ^ Underground Storage Tanks (Remover $675.00 (pertank) 84 ^ Oilwe(1(rnstatlation) $72:00 ~ 84 Mandated Leak Detection (T ) /Fuel Monfi. ' $ 81.00 (persite) ~ ^ Tents $93.00 (per tenQ 84 ^ Afterfroursinspecttion fee 5122.00 as ^ Pyrotechnic - (Per event, Pius Insp. Fee ~ S90 per hour) S 60.00 + (Slvx min. etarW .by li3e Mapectlon) =$510.00 84 ^ RE•tNSPECTION(S) /FOLLOW-UP tNSPECTlON(S) S 93.00 {per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? M $66.00 84 ^ )=xplosive Story a $249,00 84 ^ Cop ' & File Research) (File Research Fee 533.00 per hr) 25¢ per page 84 ^ MisoeUaneoLJS ~ R 84 FD 2021 (Rev. 06K)6) t • ORfG1NAL WHrTE (to Troasury} 1-YELLOW (tp Filet ~~INK (to Customeh ~,~BI'~LtNG & PERMIT STATEMENT PERMIT NO.: BAKERSFIELD FIRE DEPT. Prevention Services PfR~ 900 Trtaxtun Avenue, Suite 210 ARTM r Bakersfield, CA 93301 TPl fF,F,tI Z7fi_~Q7Cd S Fax IFifill RS')-?171 • LOCATION OF PROJECT ^^,, ~ ~Q V ~ ~ C.Jr~ - • PROPERTY OWNER STARTWG GATE COMPLETION DATE ~ ®~ NAME PROJECT NAME ~ r ~J~~-l ADDRESS ~ ~ PHO N~ ~~~ ~~V PROJECT ADDRESS ~ ~ _ f Fl.si1.-C~G~,., CfTY ~ ~ ~ STATE /t~ G C ZIP CODE • •- CONTRACTOR NAME CA LICENSE NO. •- • TYPE OF LICENSE. EXPIRATION DATE PHONE CONTRACTOR C ANY E ~ FAX NO. -a ADDRESS ~~ CITY ~ ZIP CODE J • • ~ ^ Alarms -New & Modifications - (Minimum Charge) $262 50 ~ ~ • . 98 Over 20 000 Sq. Ft Ft x 013125 =Permit fee Sq ~ p , . . 98 ^ Sprinklers -New & Modifications - (Minimum Charge) $210 00 ~ . I gg ^ 000 Sq FL Over 5 FL x .042 = Pennif fee Sq ~ . , . 98 ^ Minor Sprinkler Modifications (< 10 heads) $ 93.00 [Inspection Only) ~ 98 ^ Commercial Moods -New & Modifications $ 398 26 ~ . ' 98 ^ Additional Hoods '~ 36 00 84 . ~ 98 . O Spray Booths -New & Mod cations $458 00 ' ~ . , 98 ^ Aboveground Storage Tanks (Installation/lnsp: 1~` Time) $165.00- ' 82 ^ Additional Tanks $ 26.00 82 ^ Aboveground Storage Tanks (Removal/Inspection) $109.00 82 O Underground Storage Tanks (Instal/ation.llnspedion) $878.00 (pertank) 82 ^ Underground Storage Tanks (Modification) $878.00 (persite). 82 ^ Underground Storage Tanks (Minor Modification) $155.00 82 ^ Underground Storage Tanks (RemovaQ $675.00 (pertank) ~ 84 ^ Oilwell (Installation) $ 72.00 ~ 84 Mandated Leak Detection (Tes ng) /Fuel Monit. Ce $ 81.00 (persite) ' 82 ^ Tents $ 93.00 (pertent) 84 ^ After hours inspection fee $122.00 84 ^ Pyrotechnic - (Per event, Ptus Insp. Fee @ $90 per hour) $ 60.00 + (5 hrs. min. stand by tee nnspedion) _ $510.00 84 ^ RE-INSPECTION(S) /FOLLOW-UP INSPECTION(S) $ 93.00 (per hour) 84 ^ Portable LPG (Propane): NO.OF CAGES? $66.00 ~ ^ Explosive Storage $249.00 84 ^ Copying & File Research (File Research Fee $33.00 per hr) 25¢ per page ~' 84 ^ Miscellaneous ; 84 FD 2021 (Rev. 09/05) 1 -ORIGINAL WHITE (to Treasury) 1-YELLOW (to Flle) 1-PINK (to Customer) i i- ~ • - ~• 5 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cite& Chapter 6 7, Health and Safety Code; Chapter !6, Division 3, Title 23, California Code ofRegulations TEiis form must be used to document testing and servicing of monitoring equipment. A seaarate certification or report mtt~ be prepare for each monitoring_system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ~~f~FF'~2E5 IZt20~ ~I/>~_ Bldg. No.: Site Address: 'R?~O~ CAtv~nb t'-1~OTA City: ~~}yc~~,~;.Tft7 _ Zip: Facility Contact Person: Gontaci Phone No.: (^!~ Make/Model of Monitoring System: 1 t--s' ;~SU Date.ofTesting/Servicing: ~/~/~ B. Inventory of Equipment Tested/Certified INSPECTOR ON-SITE: YES/ O AME: ChPrk the iennrnnriate hoses rn indicate specific eauioment insaected/serviced: Tank ID: UNr_ Tank ID: ~ Sl'L In=Pan1< Gauging obe. Model: ~ !n-Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: l~ Annular Space or Vault Sensor. Model: 0 Piping Sump /Trench Sensor(s). Model: O ~ Piping Sump /Trench Sensor(s). Model: 0,~ Fill Sump Sensor(s). Model: ®Fill Sump Sensor(s). Model: ~G$ ~ Mechanical Line Leak Detector. Model: .~ ~ T 1~ Mechanical Line Leak Detector. Model: ~ ,lA(~6f- ^Electronic Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Other (s ecif a ui ment a and model in Section E on Pa e 2 . ^ Other (s ecif a ui ment and model in Section E on Pa a 2). Tank ID: tSJ/ S '-'~ Tank ID: ~' In-Tank Gauging Probe. Model: ^ In-Tank Gauging Probe.. Model: Gil Arinular Space or Vault Sensor. Model: ~'o2C) ^ Annular Space or Vault Sensor. Model: Piping Sump /Trench Sensor(s). Model: a0 ~ ^ Piping Sump /Trench Sensor(s). Model: Fil! Sump Sensor(s). Model; ~0 g ^ Fill Sump Sensors}. Model: ® Mechanical Line Leak Detector. Model: ~F_ IA 'I/T O Mechanical Line Leak Detector. Model: ^ Electronic Line Leak Detector. Model: p Electronic Line Leak Detector. Model: ^ Tank Overfill /High-Level Sensor. Model: ^ Tank Ove~ll /High-Level Sensor. Model: ^ Other (specify equipment type and mode! in Section E on Page 2). ^ Other (specify equipment type and model in Section E on Pa a 2}. Dispenser !D: ~ ~.~ Dispenser ID: 3 ~'t{ ~ Dispenser Containment Sensor(s). Model: -__ ~ Dispenser Contaimment Sensor(s). Model: ~~ L~.Shear Valve(s). Shear Valve(s). ' ^ Dis enser Containment Floats and Chains . ^Dis enser Containment Floats and Chains . Dispenser ID: ~ Dispenser ID: 1~ Dispenser Containment Sensor(s). Model: ~~ O Dispenser Containment Sensor(s). Model: ®-Shear Valve(s). O Shear Valve(s). ^ Dispenser Containment Float(s) and Chain(s). ^Dis enser Containment Float s) and Chains . Dispenser ID: Dispenser ID: Q Dispenser Containment Sensor(s). Model: ^ Dispenser Containment Sensor(s). Model; ^ Shear Valves}. ^ Shear Valve{s). ^Dis enser Containment Float(s) and Chain(s). ^Dis enser Containment Floats and Chains . #If the licility contains mare tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. CCI"t1f CatlOil - 1 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 Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, l have also attached a copy of the report; check al! that apply): ,System set-up Alarm history report Technician Name (print): r~~w iyj~ /1')f} ~ p ~ Signature: - ~---~_ ~~ Certification No.: ~`-L~3 5 License. No. Testing Company Name: RICH ENVIRONMENTAL _ Phone No.: ~--~61-) 39~-8687 Site Address: ~ ~U '~ CA vhsvv rnEiJ~A ~f4k~s-cry-.aJ 1 eA Date of Testing/Servicing: / / y / 07 Page I of 3 03IU l Monitoring System Certification _ - ~ 5aa { D. Results of Testing/Servicing Software Version Installed: 020 • d Com lete the followin checklist: ~ Yes ^ o Is the audible alarrn o erational? Yes O o Is the visual alarm o erational? Yes ^ ° Were all sensors visual) -ins ected, functional) tested, and confin-ned o erational? ~- Yes ^ o Were al! sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their roper operation? ^ Yes ^ o If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~-NJA operational? Yes O o For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ^ N/A monitoring system detects a leak, fails to operate, or is electrically disco netted? If yes: which sensors initiate enser Containment Sensors s r /T h S ~Dis t l l ~S i i d ? Ch k ll h h . p - ec t a app y) ump renc en o s; pos t ve s u own ( a ^ No. Did ou confirm ositive shut-down due to leaks and sensor failure/disconnection? Yes; ^ Yes ^ o For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no Qi~N/A mechanical overfill prevention valve is installed), is the overfli warning alarm visible and audible at the tank fill oint(s) and operatin ro erl ? [f so, at what rcent of tank ca act does the alarm tri er? es 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 re facement arts in Section E, below. es ^ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ^ Product; ^ Water. tf es describe causes in Section E below. Yes ^ o Was monitorin s stem set-u reviewed to ensure ro er setiin s? Attach set u re orts, if a licable Yes ^ ° Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: r f .rQ t~~-t.~ .! D(L ~~--~ ` ~~ 9 ~, .~`~D ~1F_~~~'~ 7'()(t_~r-y S y ~LSQ~1~ ~ WAS ~.srM D~~ ~ ~ T~'l H~=Gr~J. Page 2 of 3 03101 ~s aa~ F. In-Tank Gauging /SIR Equipment: lS' Check this box if tank gauging is used only for inventory control. ^ Check this box if no tank gauging or S1R equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Comnlete the fallowing checklist: ^ Yes ^ ° Has al! input wiring been inspected for proper entry and termination, including testing for ground faults? ^ Yes ^ ° Were all tank gauging probes visually inspected for damage and residue buildup? ^ Yes O o Was accuracy of system product level readings tested? ^ Yes ^ o Was accuracy of system water level readings tested? ^ Yes ^ o Were alt probes reinstalled properly? O Yes ^ o Were ail items on the equipment manufacturer's maintenance checklist completed? In the 5ect~on h, netow, Uesertbe now ana wnen [nese tletJC~eneles were or wni oe correctea. G. Line Lealc Detectors (LLD): Comnlete the followinv checklist:' O Check this box if LLDs are not installed. ,>~ Yes ^ No" For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? O N/A (Check all that apply) Simulated leak rate: ~ 3 g.p.h., ^ 0. I g.p.h , O 0.2 g.p.h. ..C~~ Yes ^ o Were all LLDs confirmed operational and accurate within regulatory requirements? Yes ^ o Was the testing apparatus properly calibrated? ~, Yes ^ o For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ^ N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ N/A ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled ~ N/A or disconnected? ^ Yes ^ o For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions ')$ N/A or fails a test? ^ Yes O o For electronic LLDs, have all accessible wiring connections been visually inspected? ~'. N/A Yes ^ o Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe I[ow and when these deficiencies were or wilt be corrected. H. Comments: Page 3 of 3 63101 --------- ~~a~.~. Monitoring System Certification Site Address: UST Monitoring,Site~Plan -------------------------- -~._- - -.--- --"---~ -3 --- ------------- ----~---- - ---- - -r----------- N - - -- ---- --- c~-----------------"-------- -- - - -------- -- v------------------------------ - -~--~c ------- ~----------- - - ~---- - ~----------- - - - _- -_ ._ d----------------------"..----- - - ~-a-- --- -- --~------------------------------ - Date map was drawn: ~/~/~ Instntctions If you already have a diagram that shows ail required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection}. In the space provided, note the date this Site Plan was prepared. Page ~ of ~ osioo {~~~i 563 HRAQ~3 C~ S~:iCE$SF1$LD,~.A.933Q8 OF~`xCx (661) 392~a~67 & F.AX (661) 331g~~6~1 MX3.~8NT~8.Z ~$$;r 1}~"!'BCT~R '1'&`A7,' I W~Q#i F~e:l.lity Naxttez ;)E~r~'T~S ~ o~E~ Fac:l.~.i~y Address: 880~,~~~'`1Sivo Lr~o~j~„r,?~4~~cti~r~~c!,,~_ Pr4(~uG~ Li]Qe Tkge (pr~,saure, Suctiaz~, (3z•avity) f~irE,~Su~'E 1 1'~(:1DiJCx' LEAxC ~,IETECTObt T3t'8E 7,`EBT TRTk' $A,B~ SPRIG. ~ItJA~[ak,R A~iIiU~ Pf3~ Q$ 'g7 _ sa~xar~ # mE.~NA~t;TC.A ~ ~a a z,/D T7tP7k~ 2F~~r L/27 TY'P$ t2E {~ JAS.. ~ ~'~q ` l7.TESF~L. SPBTnr. # •L~F~HfivzcR~- ~~' fir ssaxa~z. ~ xo ~,ats~ I ::ertify the above tests were ednducted on this Bate according ~o Bed ~:~aaket Pwmps field test appaxatus testing ~oroeedure an limitatiana. Tti~=.: Mechanical Leak Aetector. Test pass /fail is determined by wing a lave flow threshgld trap rate of 3 gallon per kxour or leas at 1o P3I. i .uckmowledge tk~at a].l data ea~,lacCefl ie true and aorrecC to tale best of rry knowledge . Tech: 1~QA tin~,~ ~rtAc~.yJ ' . 31gn.f~ture:,~r' ~~""- pate= ~~ ~-~~ { i i i ~ 5~~! ~ SWRCB, January 2006 Spill Bucket Testing Report Form . This form is intended for use by contractors performing annual testing of UST spill containment structures. T7ie completed form and. printouts from.tests (tfapplicable), should beprovided to thefacility.owiier/operatorforsubmittal to the local regulatory agency. t c ~ •"~n TiRI 'f7~TL~nUM A'r'rnN ~ • - . Facility Name: F' ~ - - ------ - - -- - Date of Testing: Facility Address: p ~ . Facility Contact. Phone: Date Local Agency Was Notified of Testing : ,. _ • Name of Local Agency Inspector (if present during testingf : /1 f V ~v ~ ~ ~c~rnvr± rnl-1''i'7i A rrnu iNCf1T?MA't'~nN Company Name: E Uz M - ~' ~ , .Technician Conducting Test: B ~ N Credeatials~; CSLB Contractor CC Service Tec SWRCB Tank Tester Other (Specify) License Number(s): S'Z$~I - T ~_ SPILL RU('KFT TESTING INFORMATION Test Method Used: static Vacuum Other Test Equipment Used: V= Air. Equipment Resolution: Identify Spill Bucket (ByTank I Number, Stored Product, etc. ~ ~ - 2 ~ ~ 3 "D T~,S E~- 4 Bucket Installation Type: D' Bury Contain in Direct Bury Direct B in Direct Bury Contained in Sum Bucket Diamater: " ~ 1 '~.•~ I'~" Bucket Depth: ~ ' ` 1 ~ ` Wait time botween applying vacuuru/water and start of test: .3p r~S~ 3 p ~ ~ nib Test Start Time (T'd: ~ - ~0 P v rv~ ~ ~ 30 P rr Initial Reading (RJ:. $ ,~ ~~ ~, - ,gt f~ ~, Test End Time (T'r}; a:3O Prrt a- P o~'3v Final Reading (Rn): ~ • •1 ~ ~ ~ $ ~ ~. Test Duration (TP - T~: +{ (L f K i~ ~ ~ ~ Change in Reading (RF - Ril: t ~ ~ ~ ~ ~ ~ Pass/Fail Threshold or d ~~ - O `, Criteria: Comments - (include information on repairs made prior to testing; and recomme Q ~` nded follow-up or failed . tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTIIVG I hereby certify drat all the information contained ur this report is true, accurate; and in full compliance with 14ga1 requirement Techuiclan's Signature:,i=a~~~°- ,.~~.-~- Date: /- y ' State laws and rcgnlations do not cutreutly require toating to be performed by a qu8115Gd contractor. Howevea, local requtrgmeat8 n7Ay bC moro 6trrnganL SOFTWARE REVISION LEVEL VERSION 120.02 SOFTWARE# 346120-100-C CREATED- 00.10.16.13.28 NO SOFTIARE MODULE SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS SYSTEhi SETUP JAN 4. 2007 ~4:18 PM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATEiTIME FORMAT MON DA YYYY HN:MM:SS xM BROOKSIDE MARKET 8803 CAMINO MEDIA BAKERSFIELD CA,93308 SHIFT TIME 1 2:00 AM SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED SHIFT TIME 4 DISABLED TANK PER TST NEEDED WRN DISABLED TANK ANN TST NEEDED WRN DISABLED LINE RE-ENABLE METHOD PASS LINE TEST LINE PER TST NEEDED WRN DISABLED LINE ANN TST NEEDED WRN DISABLED PRINT TC VOLUMES ENABLED TEMP COMPENSATION VALUE ( I)EG. F > : 60.0 STICK HEIGHT OFFSET DISABLED DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK i SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM SYSTEM SECURITY CODE 000000 COMMUNICATIONS SETUP PORT SETTINGS: NONE FOUND RS-232 END OF MESSAGE DISABLED I N TANK SETUP- - - _ - - T 1:UNLEADED PRODUCT CODE 1 THERMAL COEFF :.000070 TANK DIAMETER 127,50 TANK PROFILE 1 PT FULL VOL 20082 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HJGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 20082 OVERFILL LIMIT 90i 18073 HIGH PRODUCT 95i 19078 DELIVERY LIMIT 10°r, 2008 LOW PRODUCT 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 3.25 MANIFOLDED TANKS T#: NONE Ltkuc i°i i rv rt~x t vu - ~: 1 L~ ~ 2008 LEAK MIN ANNUAL 2Q08 PERIODIC TEST TYPE QUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED AMN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 15 MIN T 2:PREMIUM 2 PRODUCT CODE . THERMAL COEFF :.000070 TANK DIAMETER 127.50 TANK PROFILE 1 PT FULL VOL 12041 FLOAT SIZE: 4.0 IN. WATER WARNING 2.0 HIGH WATER LIMIT:' 3.0 MAX OR LABEL VOL: OVERFCLL LIMIT : HIGH PRODUCT DELIVERY LIMIT LOW PRODUCT LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TANK TILT • MANIFdLDED TANKS T#: NONE 12041 90'~ 10837 95i 11439 l0i 1204 500 99 50 2.25 LEAK M[N PERIODIC: 1QX LEAK MIN PERIODIC: 1 a 1204 802 LEAK MIN ANNUAL 10: LEAK MIN ANNUAL l0i . 12oa ao2 PERIODIC TEST TYPE 61UICK PERIODIC TEST TYPE ~IUICK ANNUAL TEST FAIL y ~ ALARM DISABLED ANNUAL TEST FAIL ,. ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL i ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: PER TEST AVERAGING: OFF OFF ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANKiTEST NOTIFY: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY 1 5 MIN i i I DELIVERY DELAY 15 MIN i i T 3:AIESEL PRODUCT CODE 3 THERMAL COEFF :.000045 LEAK TEST METHOD TANK DIAMETER 127.50 _ _ TANK PROFILE 1 PT TEST ANNUALLY: ALL TANK FULL VOL 8027 DEC WEEK 2 WED START TIME 2:30 AM TEST RATE :0.20 GALiHR FLOATS SIZE: 4.0 'I N. DURATION 2 HOURS TST EARLY STOP:DISABLED WATERWARNING 2,0 HIGN WATER LIMIT: 3,D LEAK TEST REPORT FORMAT ( ENHANCED MAX OR LABEL VOL: 8027 " OVERFILL LIMIT 9Q~~ HIGH PRODUCT 7g54 DELIVERY 76p5 LIMIT • 802 LOW PRODUCT 50Q LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT 1.83 MANIFOLDED T ANKS Ttt: NONE ~~aa l LI9UID-SENSOR SETUP- - - L 1:UNLEADED ANNULAR TRI-STATE tSiNGLE FLOAT) CATEGORY ANNULAR SPACE L 2:UNLEADED STP TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMP L 3:UNLEADED F[LL TRI-STATE (SINGLE FL.OATI CATEGORY OTHER SENSORS L 4:PREMJUM ANNULAR TRi-STATE (SINGLE FLOAT? CATEGORY OTHER SENSORS L 5:PREMIUM STP TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMF L 6:PREMIUM FILL TRI-STATE (SINGLE FLOAT) CATEGORY :OTHER SENSORS. L ?:DIESEL STP TRI-STATE (SINGLE FLOAT) CATEGORY STP SUMP L B:DIESEL FILL TRI-STATE (SINGLE FLOAT) CATEGORY OTHER SENSORS L 9:DISPENSER I-2 TRI-STATE (SINGLE FLOAT) CATEGORY DISPENSER PAN L10:D[SPENSER 3-4 TRI-STATE (SINGLE FLOAT) CATEGORY DISPENSER PAN L11:DISPENSER 5-6 TRT-STATE (SINGLE FLOAT) CATEGORY DISPENSER PAN Ll2:DISPENSER 7-8 TRI-STATE tSINGLE FLOAT) CATEGORY DISPENSER PAN _- r S ~a OUTPUT RELAY SETUP ALARM HISTORY REPORT - - - - - - - - - - - - ALARM HISTORY REPORT `--- IN-TANK ALARM ---- R !:UNLEADED _ ---- IN-TANK ALARM ----- TYPE: T !:UNLEADED STANDARD T 2:PREMIUM NORMALLY CLOSED OVERFILL ALARM JAN 3. 2p07 12:05 pM „JAN 2. 2007 10:34 OVERFILL ALARM JAN 3. 2007 12:25 PM ~L19UID SENSOR ALMS AM DEC 30, 2006 12:24 pM JAN 2. 20p7 10:12 AM L !:FUEL ALARM DEC 30. 2006 12:06 PM L 2:FUEL ALARM HIGH PRODUCT ALARM L 3:FUEL ALARM AEC 30, 2006 12:26 PM LOW PRODUCT ALARM L 9:FUEL ALARM DEC 26, 2006 8:42 AM SEP 25. 2005 9:08 FM L10:FUEL ALARM OCT 27, 2006 6:43 AM L11:FUEL ALARM R0 H : L12:FUEL ALARM PROBE OUT 21 2001 HUG 15 10 AM R 2:PREMIUM MAY 3, MAY 3. 2005 12:10 PM 2005 11:56 AM INVALID FUEL LEVEL TYPE: FE8 1~ 2001 8:53 AM SEp 25. 2005 B:OL PM STANDARD NORMALLY CLOSED PROB£ OUT DELIVERY NEEDED MAY 3. 2005 11:42 AM MAY !0, 2p02. 7:04 PM DEC 22. 2003 11:05 AM LIQUID SENSOR ALMS SEP 15. 2001 6:56 pM JAN 31. 2002 1:30 PM L A:FUEL ALARM DEC 27, 2000 3:56 PM ' L 5:FUEL ALARM L b:FUEL ALARM DELIVERY NEEDED L 9:FUEL ALARM LOW TEMP WARNING SEP 25. 2005 10:08 AM L10:FUEL ALARM FED 1. 2001 8:56 AM L11:FUEL ALARM Ll2:FUEL ALARM LOW TEMP WARNING DEC 22. 2003 11:07 AM R 3:DIESEL TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 7 :FUEL ALARM " '~ Y c nm Y Y Y y Y L B:FUEL ALARM L12:FUEL ALARM *~~x~ENDx~~i~~ RECONCILIATION SETUP - - - - - - - - - - - ALARM HISTORY REPORT AUTOMATIC DAILY CLOSING ---- IN-TANK ALARM ----- TIME: 2:00 AM T 3:DIESEL PERIODIC RECONCILIATION OVERFILL ALARM MODE: MONTHLY JUN 27. 2004 5:02 AM TEMP COMPENSATION LOW PRODUCT ALARM STANDARD MAR 28. 2003 2:24 PM FEB 20, 2002 1:48 PM BUS SLOT FUEL METER TANK - - - - - TANK-MAP EMPTY HIGH PRODUCT ALARM JUN 27, 2004 5:04 AM INVALID FUEL LEVEL MAR 28. 2003 2:24 PM FEB 20. 2002 1:48 PM DELIVERY NEEDED MAR 28, 2003 2:24 PM FEB 20. 2002 l:48 PM ._ . _ ... _ .. 15 a~. ~ ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 1:UNLEADED ANNULAR ----- SENSOR ALARM ----- ----- SENSOR ALARM ----- ANNULAR SPACE L 3:UNLEADED FILL L 5:PREMIUM STP FUEL ALARM OTHER SENSORS STP SUMP JAN 4. 2007 1:10 PM FUEL ALARM FUEL ALARM wJAN 4. 2007 1:4.1 PM JAN 4. 2007 12:43 PM FUEL ALARM MAR 23. 2004 6:51 PM FUEL ALARM FUEL ALARM MAR 23. 2004 6:52 PM MAR 22. 2005 6.38 PM FUEL ALARM MAR 23. 2004 6:45 PM FUEL ALARM FUEL ALARM FEB 5. 2001 10:32 AM ~ FEB 18. 2005 5:28 AM * * * * * END * ~ x ~ * * * * END ~ ~ * * * * ~ ~ x ~ END ri ~ x ~ x ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT ---- - SENSOR ALARM ---- - L 2: UNLEADED STP ----- SENSOR ALARM ----- ----- SENSOR ALARM ----- STP SUMP L 4:PREMIUM ANNULAR. L 6:PREMIUM FILL FUEL ALARM OTHER SENSORS OTHER SENSORS JAN 4. 2007 12:46 PM FUEL ALARM FUEL ALARM JAN 4. 2007 1:07 PM JAN 4. 2007 1:00 AM FUEL ALARM MAR 12. 2006 3:22 PM FUEL ALARM FUEL HLARM MAR 23. 2004 6:44 PM FEB 5. 2001 10:33 Ahl FUEL ALARM MAR 6. 2006 11:49 AM FUEL ALARM FUEL ALARM MaR 2e. 20.03 2:40 PM JAN 30. 2001 2:54 PM ALARM. HISTORY REPORT _____ SENSOR ALARM --- L 7:DIESEL STP STP SUMP FUEL ALARM JAN 4. 2007 12:54 PM FUEL ALARM JAN 4..2007 12:54 AM FUEL ALARM MAR 23. 2004 6:38 PM ~ * x * ~ END x * * ~ ALARM HISTORY REPORT ----- SENSOR ALARM ----- L 9:DISPENSER l-2 DISPENSER PAN FUEL ALARM JAN 4. 2007 2:08 PM FUEL ALARM MAR 23, 2004 6:53 PM FUEL ALARM FEf3 20. 2002 2:52 PM x ~ * ~ x END ~saa t ALARM HISTORY REPORT ----- SENSOR ALARM ----- LII:DISPENSER 5-6 D I SPI=NSER PAN FUEL ALARM JAN 4. 2007 2:15 PM FUEL ALARM MAR 23. 2004 6:54 PM FUEL ALARM MAR 29. 2003 2:52 PM ~ * ~ ~ ~ END ~ * ~ * ~ ALARM HISTORY REPORT ALARM HISTORY REPORT ALARM HISTORY REPORT ----- SENSOR ALARNt ----- i L B:DIESEL FILL OTHER SENSORS FUEL ALARM JAN 4. 2007 f2:5t3 PM FUEL ALARM MAR 23. 2004 6:42 PM FUEL ALARM MAR 28.'2003 z:36 PM ----- SENSOR ALARM ----- ----- SENSOR ALARM ----- L1O:DISPENSER 3-4 L1.2:DISPENSER 7-8 DISPENSER PAN DISPENSER PAN FUEL ALARM FUEL ALARM JAN 4. 2007 2:19 PM JAN 4. 2007 2:10 PM FUEL ALARM FUEL ALARM MAR 23. 2004 6:53 PFl MAR 23. 2004 6:53 PM FUEL ALARM FUEL ALARM MAR 2B. 2003 2:48 PM MAR 23. 2004 6:51 PM lS~`°2-r MONITOR CERT: FAILURE REPORT SITE NAME• J ~1',Fl~~~,...~~o ~ tkE ~S DATE: /-4 ~U(~ . ADDRESS• 'S ~ 6 ~ , f' A r~~~/0 mE.~A TECHNICIAN: 7~k' 8 n1~UN m A So~/_ THE FOLLOWING COMPONENTS WEREREPLACED/REPAIRED TO COMPLETE TESTING. REPAIRS: c-rG ~ ~~ ~,J ~.s ~ou..>> ~ti r ~~ a~ , wr ; f~ N~ ~'~r.._ ~'V tZ~=.~/ Sc.1MP~,_ ~Q ~~s~ t.~~ (~E,r"a~~~l. ~`~ 7~G~~~s A~/, LABOR: ~ U ~/~ PARTS INTALLED: /V U~~ NAME: _ TITLE: SIGNATURE• _ THE ABOVE NAMED PERSON TAKES FULL RESPONSIB. ILITY OF N Il G THE APPROPRIATE PARTY TO HAVE CORRECTIVE ACTION TAKEN TO REPAIR THE ABOVE LISTED PROBLEMS AND NOTYFYIIVG RICH ENVIItONMANTAL FOR ANY NEEDED RETESTING. THIS ALSO RELEASES RICH ENVIItONMENTAL OF ANY FINES OR PENALTIES OCCURING FROM NON-COMPLIANCE, A COPY OF TffiS DOCUMENT HAS BEEN LEFT ON-SITE FOR YOUR CONVIENENCE. ~~ ~,~ B E R S F I D l~/RE A R TM T April ~ o, 2006 . Mr. Don Jeffries Brookside Market ~ PO Box 640 ' Wasco, CA 93280 RONALD J. FRAZE REMINDER NOTICE FIRE CHIEF Re: Guidelines for Unsupervised Dispensing Gary Hutton, Senior Deputy Chief Dear Mt. Jeffries: ', Administration ~ 326-3650 It has come to our attention that many convenience stores who sell gasoline, like yourselves, are closing late at night' If you are using card readers and leaving Deputy Chief Dean Clason your fuel pumps on, this is defined in the California Fire Code as: "Unsupervised Operations/Training Dispensing." 326-3652 Deputy Chief xirk Blair Unsupervised dispensing is allowed, when the owner or operator provides, and is accountable for daily site visits, regular equipment inspection and maintenance, Fire Safety/Prevention Services including any unauthorized release or spills, posted instructions for safe operation 326-3653 of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into unapproved 2101 "H" street containers and requiring vehicle engines to be stopped during fueling shall be Bakersfield, CA 93301 conspicuously posted within site of each dispenser. OFFICE: (661) 326-3941 In addition, a sign shall be posted in' a conspicuous location reading: FAX; (661) 852-2170 In case of spill or release: i RALPH E. HUEY, DIRECTOR 1) Use Emergency Pump shut-off PREVENTION SERVICES 2) Report the accident ' FIRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 3) Fire Department Telephone, Bakersfield, CA 93301 4) Facility address OFFICE: (661) 326-3979 ' FAX: (661) 852-2171 During the hours of operation; stations having unsupervised dispensing shall be David Weirather provided with a fire alarm transmitting device. A telephone not requiring a coin to operate is acceptable. The fuel IeaK detection system must have a remote or Fire Plans Examiner phone modem to insure off-site monitoring during hours of unsupervised 326-3706 dispensing. During hours of darkness, sufficient lighting must be maintained so Howard H. Wines, Ill that all signs associated with fueling operation are conspicuous and readable. A Hazardous Materials Specialist gallon container of an absorbent material used for spills must be made available 326-3649 to the public during hours of unsupervised dispensing. Afire extinguisher with a minimum 2A, 2B, and 2C rating must be located on dispenser island during hours of unsupervised dispensing. ~~~~~ ` -~ - _ = ,~ To: Mailing List of Valued Customers Reminder Notice Re: Guidance for Unsupervised Dispensing April 10, 2006 Page 2 If you are currently having hours of unsupervis~ci dispensing, you must comply with the above-mentioned requirements. . Starting April 15, 2006, this office will conduct random checks of all fueling stations within the city limits for compliance. If you shut your station down after normal business hours and are not pumping fuel, please disregard this reminder notice. Should you have any questions, please feel free to call meat 661-326-3190. Sincerely, Ralph E. Huey, Director of Prevention Services r , ~~. By: Steve Underwood, Fire Prevention Officer REH/db ~' - ~_ E R S F I F'/RE ~1 R TM RONALD J. FRAZE FIRE CHIEF Gary Hutton, Senior Deputy Chief Administration 326-3650 Deputy Chief Dean Clason Clperations/Training 326-3652 Deputy Chief Kirk Blair Fire Safety/Prevention Services 326-3653 December 1, 2005 Brookside Market PO Box 640 Wasco, CA 93280 ~A~ ~ A ~8d 3 C~1~ "-""'~- FINAL REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2005 of Underground Storage Tank (s) Located at the Above Stated Address Dear Valued Customer, Over the last six months this office has continued to send reminder notices regarding secondary containment testing. Code requires that all secondary containment systems must be tested 6 months post construction and every 36 months there after. 2101 "H" Street Senate Bi11989 became effective January 1, 2002, section 25284.1 (California Bakersfield, CA 93301 Health & Safety Code) of the new law mandates testing of secondary containment OFFICE: (661) 326-3941 components upon installation and every 36 months, thereafter, to insure that the FAX: (661)852-2170 systems are capable of containing releases from the primary containment until they are detected and removed. RALPH E. HUEY, DIRECTOR PREVENTION SERVICES flRE SAFETY SERVICES • ENVIRONMENTAL SERVICES 900 Truxtun Avenue, Suite 210 Bakersfield, CA 93301 OFFICE: (661) 326-3979 FAX: (661) 852-2171 David Weirather Fire Plans Examiner 326-3706 Howard H. Wines, III Hazardous Materials Specialist 326-3649 a Our records indicate that your facility is due prior to December 31, 2005. Those sites that have not been tested and have not pulled a permit prior to December 31, 2005, will have their permit to operate revoked. This office does not wish to take such action, which is why we will continue to send monthly reminders. Contractors are already booked several weeks in advance. I urge you to schedule your testing date as soon as possible to avoid possible revocation of your permit to operate. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerely, ItALPH~. HUEY, Director of Prevention Services f Steve Underwood Fire Prevention Officer SU:db ~.~~~5 - .f= ~ tZ3'a '. J ~Ln~ v°?~v~°~. ' i~ ~ ?34~ `c X51 St~:= 3 a~d~ ;jit: i aE=-~3SJ ~i=.'~... ,~'1?4~v ?,~ ~ ~ 'ire . a... x. ~L ^P S,JE.i; 'g s`'?*f5t < v~'H 'i sC r;sLF ~z p^tie~i ~ ^~!O ~~~~~~ -_ ~1 !1 r ..- . =_ _.,->~iC__ __,-,..~_i=~T!i:f~. ~ _;\_-_~-':~:~ ~~o-9S9.,=~Oi~~.-.. ..C~tiA!? iv=~;- ._~-.,.r '. 4 ~~1 i~-.~ ~;~`'SJ _~j~ ~ ., r -. .i-v:=Ni =_ __ ,:i'~.1,!`.:. 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Saaxp ~ ~' Su~- 2 J Su~A ~IJS L ~ninp 4 YNtisi Hit . ~ . fi~ 5-~ ~ !. .J~ ~~ ... /~. ~~ .i5-- ... ,1 ~ ~~~a ~) 55 r {'~5 tl r~tt sn~~ .. ~ ~ ~~ fines d tt Height bi water ~ ~~,~ ~ , ~~ % ,~ ! ~ r- Water Hd~ht ,,~ . ~ ~ ,~ j ;Water ~Sht ..;J-'' •~ r+ _ ~ J ~(Si~atun? r~v 2 ~7{'~ /~~~3 ---___ ,:; . ;:, ACII,T ~. FACILZ'I"Y ADZ s; -. ~, . ~~*~ ` UDC TE,S'PING s.. . ,:. ~" . r~... ,; . !: , •. yi ~`, ;~ . ;:. ;i. :s ~; ~, . N ., ~; STCOND'~R~E gYSTEM C~RTtF1CA'Z'iON FORM ~,rnt)k 5 t cue- Yvla~,~' - ~$YS?~~ ~ : DISi'~R Z DISFEENSER 3 DLSPENSER 4 START 1'IMB /.' I~1TI'IAL gT dF . ~VATd~R 'Vf-ATER ~c~r D~%~.. , 3; ~. r ~ ~~3~-~ . ~ ~~~,~.~ ~'ERTii~[CSTi+DN (SYGNA'ff3RE} S ~ .. qSS S SS , / ~ / ~ DISPE?~.::` DZSPEL~TSER S bZSFENSSR 7 . D-1S~'EN'~BR S 5'PART TflKB UVITIAL . SIGHT OF WASTER TIME tiBIGRT ,. ~'YA?Y~R ~~lRGST . ~GER2'lFLCa-'Mt)i~ cxa- 3 ~..._ l('7~1~ FIRE CHIEF ?CN ;RAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES' ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 March 10, 2004 Don Jeffries Brookside Market at the Oaks PO Box 640 Wasco, CA 93280 8t3ö3 C!.~~'- NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at the Above Stated Address. Dear Business Owner: Our records indicate that your annual maintenance certification on your leak detection system will be past due on 02-28-04. You are currently in violation of Section 2641 (1) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, April 10, 2003 to either perform or submit your annual certification to this office, Failure to comply will 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 BY:xL cUmtt{] Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBD/db ~~ CL7 " /.ß (£7 .'/. ú7 ,/4 cJ77l ""? (;CJ "1"1 ..7ePOUl;? Ute OO//l//lÆ//Uf?' ...fO/~ ,/"E"t/o/"e· ...//u:ub ../(!) 0e/l/a./~ BROOKSIDE I'~RKET 8803 CAMINO MEDIA BAKERSFIELD CA.93308 JUL 8. 20~]4 i:O8 PM SYSTEM STATUS REPORT PAPER OUT PRINTER ERROR INVENTORy REPORT T I:UNLEADED VOLUME = 10831 GALS ULLAGE = 9251 GALS 907~ ULLAGE= 7242 GALS TC VOLUME = 10808 GALS _~EIQHT .. = .67.6_9 I~CHES WATER VOL = 19 GALS -- WATER = ~.8~ iNOHES TEMP = 89.9 DEG F T 2:PREMIUM VOLUME = 5958 GALS ULLAGE = 6083 GALS 90~ ULLAGE= 4878 GALS TO VOLUME = 5944 GALS HEIGHT = 63.23 INCHES WATER VOL = 13 GALS WATER = 0.97 INCHES TEMP = 90.3; DEG F T 3:DIESEL VOLUME = 6214: GALS ULLAGE = 1813. GAL$ 90% ULLAGE= IOiOGALS TO VOLUME = 62OS, GALS HEIGHT = 92.18} INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 89,6 DEG F CITY OF BAKERSFIEI,D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CitECKLIST 1715 Chester Ave., 3rd Floor, Bakcrstield, CA 93301 FACILITY NAME ~t'oOl~-~,c[-~ ]/l//z~/~'~t ~1t~ ~,,~k-.% INSPECTION DATE: Section 2: Underground Storage 'ranks Program [] Routine ~"Combined [] Joint Agency [~ Multi-Agency 121 Complaint I~[ Re-inspection Type of Tank '~l,k) ~"P_..~ Number of Tanks Type of Monitoring 'Oc~L v~ Type of Piping ~ I,O ~ 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 dispcnsc MVF? If yes, Does tank have overfill/overspill protection'.) C=Compliance V=Violation Y=Yes N=NO Office of nv' onmental-S[nJ'ces 661) 26-3~'79 Business Copy Business Site Responsible Part~r IN EC UNIFIED PROGRAM :TION CHECKLIST Enironmental Services ~ ~~=,~'~=~,~=~~~/ 1715 Chester Ave SECTION 1 Business Plan and Inventory Program ~ Bakersfield, CA 93301 ~ Tel: (661)326-3979 FACILITY E ' ~ ' - INSPECTION DATE INSPECTION TIME FAClLITYCONTACT Business ID Number 15-021 - ~ Routine Combined i'1 Joint Agency ~ Multi-Agency [] Complaint ~1 Re-inspection C V (' C=Compliance ~ OPERATION COMMENTS \ v=Violation J~ ~ APPROPRIATE PERMIT ON HAND .{~ ~ BUSINESS PLAN CONTACT INFORMATION ACCURATE ~L ~ VISIBLE ADDRESS ~ [] CORRECT OCCUPANCY ~1~ [] ' VERIFICATION OF INVENTORY MATERIALS /~ [] VERIFICATION OF QUANTITIES ~ [] VERIFICATION OF LOCATION ~ [] PROPER SEGREGATION OF MATERIAL ~ [] VERIFICATION OF MSDS AVAILABILITYE ] [] VERIFICATION OF H/~/1AT TRAINING [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES [] EMERGENCY PROCEDURES ADEQUATE ,~ [] CONTAINERS PROPERLY LABELED ,J~ [] HOUSEKEEPING !/"[] FIRE PROTECTION .~ [] SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?; [] YES ~ NO EXPLAIN: White - Environmental Services Yellow - Station Copy Pink - Business Copy OCT 03 2003 12:27 .,~LD FIRE PREVEHTIOH (6 8S2-2172 p.1 CITY OF BAKERSFIELD O~'I~ICE OF ENVIRO~NTAL SERVI~F~. 1715 Chester Ave., Bakersfield, CA (661) 326 3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION OPERATORS NAME NAME OF MONITOR MANUFACTURER. U/,,~ 7'Z.~ ~'3-o DOBS FAaLrrYHAV~ D~SPI~S~ ?ANS? Y~ v/ ~O 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. A separate certification or report must be oreoarecl for each monitoring system control p~el 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 FacilityNamc: . ,t~c~>~;'~/)~ //i/4'~/~'Y' ~ ~ ~4-~. Bldg. No.: Site Address: ~ .~ ~g ~.c~,~O /H~z~?~ City: Z:~t<E~-T~F:S ~x Zip: ~'~' .. Facility Contact Person: ~3~:,~' ~"~f--~:~ Contact Phone No.: ( ~/ ) M k ode of ouito g System: tp e rate of esting Ser ieing: B. Inventory of Equipment Tested/Certified C~--~--'-' the oppmpriate boxes to i~_t.'~ so,~ne eg-i--.~-~ tnsp,~_ _,~d~serviced: .... I~lli-Tank aanging P~obe. Model: ~ I O%-T~k C~.ging X~be. Model: I 4~A~nular Space or Vault Sensor. Model: ~ I I~Annular Space or Vault Sensor. Model: lPling Sump / Trench Sensor(s). Model: ~/~, | I~Piping Sump / Trench Sensor(s). Model: ~ ~ I~"*F'll Sump Sensor(s). Model: be/~ [ ~ill Sump Sensor(s). Model: 12 Mechanical Line Leak Detector. Model: ~ C] Mechanical Line Leak Detector. Model: I~i Electronic Line Leak Detector. Model: [ r-n Eleclronic Line Leak Detector. Model: 1~ Tank Overfill / High-Level Sensor. Model: ] 12 Tank Overfill / High-Level Sensor. Model: 12 Other (specify equipment type and model in Section E on Pai~e 2). r-n Other (specify equipment type and model in Section E on Pgge 2). 4~l~n-Tank Ganging Probe. Model: ~ 12 ln-Ta~t~uging Probe. Model: .f~,n. nular Space or Vault Sensor. Model:~ I;i Annular Sp~0e~,~ Vault Sensor. Model: _l~ping Sump ! Trench Sensor(s). Model: 12 Piping Sump / T'tt~ Sensor(s). Model: I~ Fill Sump Sensor(s). MUd¢I: 12 Fill Sump Sensor(s).~ Model: 12 Mechanical Line Lenk Detector. Model: ~ Mechanical Line Leak Dei~s~t_.p~. Model: I~l Electronic Line Leak Detector. Model: 12 Electronic Line Leak Detectorf'~ Model: 12 Tank overfill ! High-Lewl Sensor. Model: 12 Tank Overfill / High-Level Sensor. Model: 12 Other (specify equipment type and model in Se¢~on £ on Pa~c 2,).. 12 Other (specify equipment type and model in Section E on Pa~,e 2)., ~nserm: ///2_ ", ois~rm: ~'/~'. "' ~l-~_~spenserContainmentSensor(s). Model: ~.~ll~r.~., ~****spensercontair~mentSensor(s), Model: : t~"~hear Valve(s). I;il"~hear Valve(s). ~ Dis[~_enser Co?,,,toi,nment Float(s) and Chnin(s):, ] 12 Dispenser Containment Float(s) and Chain(s). ~l~ispenser Contai'n~ent Sensor(s). Model: {~rff.., 12 Dispen~sr~ontainment Sensor(s). Model: I~hcar Valve(s). 12 Shear V~ve~ 12 Disl~nscr Com~inment Float(s) and Chnin(s). I 12 Dispenser q,onta~q~ent Fioat(s) and Chain(s). , ~r ID: c~-?~. ' ..... I Dispenser ID: nme~ ~Dispenser Containment Sensor(s). Model: . b~P~ 12 Dispenser Contai ). Model: I~$hear Valve(s). ~ Shear Valve(s). -~Dispenser Cont~inrnent Float(s) and, Chain(s). 12 Dispenser Containment Float(s) and'~;hain(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 impected/serviced in accordance with the manufacturers' guidelines. Attached to rids Cerltlicaa~n is infornmtiou (e.g. manufacturers* checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the repo.~(¢heek all that apply): ~"stem set-up ~l"~i~'~story,~~ Technician Name (print): ~ l~,~ Signature: ~ Certification No.: ~Z~i¢'~ License. No.: ~/.~ ~b Testing Company Name: ,,~C~' ,~'~,-~-y'~o/..~,.,,,t..~ ~]~n.d~c~-~ Phone No.:( ~./__.·) site ^dd s: v rate o TestinVSer icin : Page I of 3 03/01 Monitoring System Certification D. Results of Testing/Servicing Com?lete the followin~ cheekli.qt: ....... ,,, , ~Y~' ~Q No* ~s the ~,,a~ble ~arm ope%0'"al? ........ [~Y_es I~ bio* Is the visual alarm, operational? [!~Y_es I-I No* Were all sensors visuall~t in~.pected, functi.onall}' tes. ted, and confirmed operational? I~l"-Yes ~ No* Were all s~msors installed at loWest point of secondary containment and positioned so that other equipment will not interfere with their proper operati0n7 .. . If alarms arc relayed to a remote monitoring station, is all communications equipment (e.g. m~tem)' :'12 Yes Cl No* i~/A operational? i~,~ycs I-I No* For pressurized piping ;ys~ms, d°cs the turbine automatically shut down if the piping secondary containment" I~ N/A monitoring system detects a leak, ' fails to operat¢,~ or is electrically disconzBegted? If yes: which sensors initiate positive shut-down? (Check all that apply) l~umpfFrench Sensors; I~Dispenser Containment Sensors. .. Did you confirm positive shut-down due to leaks and sensor failure/disconn..ection? l;il~s; ~ No. . r~ Yes ~l No* For tank system~ that utilize the monitoring system as the primary tank overfill warning device (i.e. no [~I~/A mechanical overfill prevention valve is installed), is the overf'dl warning alarm visible and audible at the tank fill point(s) a.nd operating properly? If so, at what percent of tank capacity docs thc alarm trigger? ____% ~1 Yes* {~Nlo Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced ~nd list the manufacturer nan~ and model for all replacement parts in Section E, below.. [~ yeS. l~qo Was liquid found inside any seco~da~ containment systems designed as dry systems? (Check all that apply) Product; ~! Water. If ~es,.dc.s. cribe causes in Section E, below. ~l~;/¢s ~ No* , .Was monitofinl~'s]/stem set-up reviewed to ensure proper.settinss? Attach set up reports, if applicable I~Y~ CI No* Is all monitoring equipment operational per manufacturer's specifications? .. * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 o! 3 03/01 F. In-Tank Gauging / SIR Equipment: ~'"'Check this box if tank gauging is used only for inventory control. VI Che~k 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. Cmv....dete the followina Ci1~kligt: ........ ~ ..... , , ,. I~'~.~f~s VI No* Has all input wiring been inspected for proper entry and termination, including te~fing fo'r ground faults? I~....Y. es VI No* Were all tank gauging probes v~u,ally inspected for damage an~ residue buiidup? C~..--Yes [2 No* Was accuracy of system product level readings.tested? . . 1~ Yes VI No* Was accuracy of system water level readings tested? [~'~es vi No* Were all probes reinstalled properly? j l.Pl~Yes C] No* Were 'all items on the equipment manufacturer's maintenance checklist Completed~. * In the Section It, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ~'~eck this box if LLDs are not installed. Compete the rollowina cbeck#.~_: ............ . .... vi Yes vi No* FOr ~quipment staR-'up or annuaI equipment certification, was a leak simulated to verify LLD performance?' vi N/A (Check all that apply) Simulated leak rate: vi3g.p.h.; viO. I g.p.h; cl0.2g.p.h. vi Yes vi No* Were all LLDs confn'med ~perafional and accurate within regulatory requirements? vi Y~ vi' No* Was ~ testi.g.pP~iUs prop~r~y ~ih~.ted? " 'vi Yes vi No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? vi N/A vi Yes vi No* For electronic LLDs, does the turbine automatically shut ~ff if the i.LD detects a'leak? vi N/A vi Yes vi No* For glectronic LLDs, does'the turbine automatically shut off 'if any portion ~f the mOnitoring system is ~isabled vi N/A or disconnected7 vi Yes ~ No* For electronic LLDs, does the turbine automatically'shut off if any portion of'the monitoring 'system malfunct~on~ vi N/A or fails a test? vi Yes ca ~,*" Fo~ el~oni~ LLr~s. have ali a~cessible W~g Cnnn~tio.s b~n 4isually inSP~d? .... vi N/A vi Yes vi No* Were all items on the equi'pment manufacturer's' 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 o~o~ Monitoring System Certification UST Moni Site Plan Ins~cfions ~ you ak~y have a ~a~ ~at shows all re~ ~omfion, you my ~clude it, m~er ~ ~is page, wi~ yo~ Moffito~g Sys~m Ceffifimfion. On yo~ site pl~ show ~e general layout of ~ ~d pip~g. Cle~ly idenfi~ locatio~ of ~e follo~g e~pmen~ if ~11~: moffito~g ~s~m ~n~l p~els; sensom monim~g ~ ~ul~ space, ~s, ~em~ p~, ~i~ con.em, or o~er secon~ eonminm~t ~e~; m~h~cal or elec~o~c l~e de~cmm; ~d ~-~ ~quid level probes (if m~ for I~ de~cfion). ~ ~e ~ace pro~de~ note ~e ~te ~is Site Plan w~ pr~ared. Page ~ o~ 0~ 8803 Ceg"llNO MEDI~ BAKERSFIELD ¢A,93308 IN-TANK ~ETDP T 2~PREMIUM - - PRODUCT CODE : 2 MAR 23, 2004 7:04 PM THERHAL COEFF :.000070 T I:UNLEADED TANK DIAMETER : 127.50 PRODUCT CODE : I TANK PROFILE : I PT THERMAL COEFF :.000070 FULL VOL : 12041 SYSTEM STATUS REPORT TANK DIAMETE~ : 127.60 TANK PROFILE : I PT ALL FUNCTIONS NORMAL FULL VOL : 20082 FLOAT SIZE: 4.0 IN. !,~ATER ~ARN! NG : 2.0 FLOAT SIZE: 4.0 IN. HIGH WATER LIMIT: 3.0 · WA ~RI'4 ..... 0 MAX OR LABEL VOL: 12041 HIGH WATER LIMIT: 3.0 OVERFILL LIMIT : 90~ : 10837 MAX OR LABEL VOL: 20082 HIGH PRODUCT : 95~ OVERFILL LIMIT 90~ : 11439 18073 DELIVEE~ LIMIT : 10~ SYSTEM SETUP _ HIGH PRODUCT 95~ MAR 23. 2004 7:04 PM 19078 : 1204 DELIVERY LIMIT 10~ LOW PRODUCT : 500 2008 LE~K ALARM LIMIT: 99 SUDDEN LO.~ LIMIT: 50 SYSTEM UNITS LOW PRODUCT : 500 TANK TILT : 2.25 U.S. LEAK ALARM LIMIT: 99 SYSTEM LANGUAGE SUDDEN LOSS LIMIT: 50 MANIFOLDED TANKS ENGLISH TANK TILT : 3.25 T#: NONE SYSTEM DATE/TIME FORMAT MOM DD YYYY HH:MM:SS xM MANIFOLDED TANKS T~: NONE LEAK HIM PERIODIC: 10~ BROOKSIDE MARKET : 1204 8803 CAMINO MEDIA BAKERSFIELD 0A.93308 LEAK MIN PERIODIC: 10~ LEAK MIN ANNUAL : : 2008 : 1204 SHIFT TIME I 2:00 AM LEAK MIN ANNUAL : 1~ SHIFT TIME 2 DISABLED : 2008 PERIODIC TEST 'I-~PE SHIFT TIME 3 DISABLED ~UICK SHIFT TIME 4 DISABLED PERIODIC TEST TYPE ANNUAL TEST FAIL TANK PER TST NEEDED WAN OUICK ALARM DISABLED DISABLED TANK ANN TST NEEDED WAN ANNUAL TR.qT FAIL PERIODIC T~T FAIL DISABLED ALARM DISABLED ALARM DISABLED LINE RE-ENABLE METHOD PERIODIC TEST FAIL GROSS TEST FAIL PASS LINE TEST ALARM DISABLED ALARM DISABLED LINE PER TST NEEDED WAN GROSS TEST FAIL ANN TEST AVERAGING: OFF DISABLED ALARM DISABLED PER TEST AVERAGING: OFF LINE ANN TST NEEDED WEN DISABLED ANN TEST AVERAGING: OFF TANK TEST NOTIFY: OFF PER TESI" AVERAGING: OFF PRINT TC VOLUMES TNK TST SIPHON BREAK:OFF ENABLED TANK TEST NOTIFY: OFF DEI. IVERY DELA\' : I~ MIN TEMP COMPENSATION TNK TST SIPHON BREAK:OFF VALUE (DEG F ~: 60.0 STICK HEIGHT OFFSET DELIVERY DELAY : 15 MIN DISABLED DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN ..: END TIME 2:00 AM T ~:DIESEL pRODUCT CODE : 3 LIQUID SENSOR SETUP THERmaL COEFF :.000045 - - - TA DiASETER : 127.50 -~t'~ '~-~'~7=~ L i:UNLEADED ANNULAR OUTPUT RELAY SETUP FULL VOL : 8027 TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE R I:UNLEADED TYPE: FLOAT SIZE: 4.0 IN. STANDARD WATER WARNING : 2.0 L 2:UNLEADED STP NORMALLY CLOSED HIGH WATER LIMIT: 3.0 TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP LIQUID SENSO~ ALMS MA× OR LABEL VOL: S027 L I:FUEL ALAEM OVERFILL LIMIT 90% 7224 L 3:UNLEADED FILL L 2:FUEL HIGH PRODUCT 95% TRI-STATE (SINGLE FLOAT) L 3:FUEL ALARM 7825 CATEGORY : OTHER SENSOR~ L 9:FUEL ALARM LIO:FUEL ALARM DELIVERY LIMIT lO~ LII:FUEL ALARM 802 LI2:FUEL ALARUM LO~ PRODUCT : ~00 L ~:pREMIUM ANNUI-~AR LEAK ALARM LIMIT: 99 TRI-STATE (SINGLE FLOAT) R 2:PREMIUM SUDDEN LOSS LIMIT: 50 CATEOdOR¥ : OTHER SENSORS TYPE: STANDARD TANK TILT : l.~ NOR~4ALLY CLOSED MANIFOLDED TANKS Ta: NONE L 5:PREMIUM STP TRI-STATE (SINGLE FLOAT) LIOUID SENSOR CATEGORY : STP SUMP L 4:FOEL ALARM L 5:FUEL ALARM LEAK MIN PERIODIC: 10% L 6:FUEL ALARM : BO2 L 6:PREMIUM FILL L 9:FUEL ALARM LEAK I~IN ANNUAL : 10% TRI-STATE (SINGLE FLOAT) LIO:FUEL Od~RM : BO2 CATEGORY : OTHER SENSOR5 Lll:FUEL ALARM LI2:FUEL ALARM R 3:DIESEL PERIODIC TEST TYPE ~UICK L ?:DIESEL STP TYPE: TRI-STATE (SINGLE F~OAT) STANDARD ANNUAL TEST FAIL CATEGORY : STP SUMP NORMALLY CLO~ED AlaRM DISABLED PERIODIC TEST FAIL L 8:DIE~EL FILL LIQUID SENSOR -. ,-,,.. ...... ~2~.~ FLO~T) L 7:FUEL ALARM ALARM DISABLED CATEGORY : OTHEK ~L~',',~ L 8:FUEL G~SS TEST FAIL LI2:FUEL ALARM ALARM DISABLED ANN TEST AVERAGING: OFF L 9:DISPE~ER 1-2 TRI-STATE (SIDLE FLOAT) PER TEST AVERAGI~: OFF CATE~RY : DISPENSER PAN TANK T~T NOTIFY: OFF TNK TST SIPHON BR~K:OFF LIO;DISPE~ER 3-4 TRI-STATE (SIDLE FLOAT) DELIVERY DELAY ; i5 MIN OATE~RV : DISPE~ER PAN RECONCILIATION SETUP LII:DISPENSER 5-6 TRI-STATE (SINGLE FLOAT) AUT~TIC DAILY CLOSING OATEGORV: DISPENSER PAN TIME: 2:00 ~ PERIODIC RECONCILIATION MONTHLY LI2:DISPENSER 7-8 TRI-STATE (SIDLE FLOAT) TEMP COMPE~ATION LEAK T~T METHOD _ _ _ CATEGORY : DISPENSER PAN STANDARD TEST ANNUALLY: ALL TANK B~ SLOT FUEL METER TANK DEC WEEK 2 WED START TIME : 2:30 AM , TANK MAP EMP~ TEST RATE :0.20 GAL/HR DURATION : 2 HOO~ TST EARLY STOP:DIbBLED LEAK TEST REPORT } TANK LERK TEST HI~'IORY '- T 2:PREMIUM SOFTWARE REVISION LEVEL LAST GROSS TEST PASSED: VERSION 120.02 DEC 10, 2003 2:30 AM SOFTWARE~ 34G120-100-C STARTING VOLUPIE= 7872 CREATED - 00.10. 16.13.28 PERCENT VOLOHE = 65.4 TEST T~PE = STANDARD [tO SOFTWARE MODULE AI. aqRM HISTORY REPORT SYSTEM FEATURES: PERIODIC IN-TANK TESTS LAST ~NNUAL TEST PARSED: P~PEE OU~ ~NNU~L IN-T~NK TESTS J~N 11, 2004 3:45 NO T~T P~ED P~INTE~ EEEO~ JRN 11, 2004 3:49 PM FUL~ST ANNUAL T~T P~SS ~TTEEY IS OFF ~~ J~N 1 ~ T~T P~SSED LRST PERIODIC TEST PASS: DEC 11, 2002 2:30 ~ TEST LEaH 2 HOU~ T~NK L~K TEST HISTORY ST~TI~ VOL~E= PERCENT VOLUHE = 58.1 T i:UNLERDED TE~ ~PE = L~ST G~OSS TEST pRSSED: DEC 10, 2003 2:30 ~H ~ ~ ~ ST~RTI~ VOLU~E= 13467 FULLE~ PERIODIC ~ST pERCENT VOLUHE = 67.1 PASSED E~CH MOTH: TEST TYPE = STaNDarD DEC 11, 2002 2:30 ~ LAST ANNUL TEST pA~ED: TEST LEITH 2 ~U~ STARTING VOLUHE= 6996 ~lO TEST p~SSED PE~CE~ VOLUHE = 58.1 · T~T TYPE ~ STaNDarD FULLEST ANNUAL TEST ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ NO TEST pRSSED AL~H HISTORY ~EPOET L~ST pERIODIC TEST PA~: .... NO TEST PASSED T I:UNL~DED OVERFILL FULLEST PERIODIC TEST FEB pRSSED ~CH HONTH: NOV 12, 2003 5:3~ T~NK L~K TEST HISTORY ~T 24, 2003 11:38 ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ T 3:DIESEL HIGH PRODUCT JUL 5, 2003 4:13 LAST OEOSS TEST P~ED: FEB 5, 2003 DEC 10. 2003 2;30 AM NOV STARTING VOLUME= 1754 PERCENT VOLUME = 21.9 PROBE OUT TEST TYPE = STAN~RD FEB 1. 2001 8:53 LAST ANNUL TEST PASSED: DELIVERY NEEDED MAV 10. 2002 7:04 HO TEST PASSED SEP 15. 2001 6:56 PM DEC 27. 2000 3:56 PM FULLEST ANNUL TEST PASS NO TEST P~SED LOW TEMP WARNIN~ FEB 1, 2001 8:56 AM LAST PERIODIC TEST PASS: NO TEST P~ED FULL~ PERIODIC TEST PA~ED EACH MONTH: ALARM HISTORY REPORT ..... SEN~OR ALARM ..... ALARM HISTORY REPORT L I:UNLEADED ANNULAR ANNULAR SPACE ..... SENSOR ALARM FUEL ALARM L 3:UNLEADED FILL ALARM HISTORY REPORT MAR 25. 2004 6:51 PM FuELOTHERALARMSENSORS FUEL ALARM MAR 23, 2004 6:52 PM .... IN-TANK ALARM ..... M~R 23, 2004 6:45 PM FUEL~ALARM T 2:PREMIUM FUEL ALARM FEB 5, 200! 10:32 AM OVERFILL ALARM MAR 28, 2003 2:40 PM FEB 19, 2004 5:44 aM FUEL ALAR~J FEB 1. 2004 4:40 PM JAN 30, 2001 2:51 PM AUG 14, 2003 5:51 AM HIGH pRODUCT AIJ%RM AUG 21. 2001 10:15 AM PROBE OUT DEC 22, 200G 11:05 AM JAN 31. 2002 I:SO PM JAN 31, 2002 1:17 PM ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ END ~ * ~ ~ ~ LOW TEMP WARNING DEC 22. 2003 11:07 AM ALARM HISTORY REPORT ..... SENSOR ALABq ALARM HISTORY REPORT ~ ~ ~ ~ ~ END ~ * ~ ~ ~ L 2:UNLEADED STP STP SUMP ..... SENSOR ALARM ..... FUEL ALARM L 4:PRFJ~IUM ANNULAR M~R 23. 2004 6:51 PM OTHER SENSORS FUEL ALARM FUEL ALARM MAR 23, 2004 6:44 ~9 MAR 23, 2004 6:38 PM FUEL ALARM FUEL ALARM MAR 28. 2003 2:40 PM · APR 14, 2003 3:59 AM FUEL ALARM FEB 20. 2002 2:05 PPI ALARM HISTORY REPORT .... IN-TANK ALARM ..... T 3:DIESEL LO~ PRODUCT ALARM MAR 28, 2003 2:24 P19 ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ FEB 20. 2002 1:48 PM INVALID FUEL LEVEL ~ ~ ~ ~ ~ END ~ ~ ~ MAR 28, 2003 2:24 PM FEB 20. 2002 1:48 PM DELIVERY NEEDED MAR 28. 2003 2:24 PM .: FEB 20. 2002 1:48 PM ...... ALARM HISTORY REPORT ..... SENSOR ALARM ..... ALARM HISTORY REPORT L g:DISPENSER 1-2 ..... SENSOR ALARM .............. DISPE~SER PAN L 5:PREMIUM STP ...... ~ ....... FUEL ALARM MAR 23, 2004 6:53 PM STP SUMP ALARM HISTORY REPORT FUEL ALARM FUEL ALARM MAR 23, 2004 6:39 PM ..... SENSOR ALARM FEB 20. 2002 2:52 PM L 7:DIESEL STP FUEL ALARM STP SUMP FUEL ALARM' MAR 28. 2003 2:09 PM FUEL ALARM FEB 5, 2001 10:56 AM FUEL ALARM MAR 23. 2004 6:38 PM DEC 20, 2002 3:01 AM FUEL ALARM MAR _8, 2003 2:17 PM FUEL ALARM ~R 14, 2003 8:52 PM ALARM HISTORY REPORT SENSOR ALARM ..... ~LARM HISTORY REPORT LIO:DISPENSER 3-4 ..... SENSOR ALARM DISPENSER PAN L 6:PREMIUM FILL FUEL ALARM OTHER SENSORS MAR 23, 2004 6:53 PM FUEL ALARM ALARM HISTORY REPORT FUEL ALARM FEB 5, 2001 10:33 ~ ..... SENSOR ALARM MAR 28, 2003 2:48 PM FUEL ALARM L 8:DIESEL FILL OTHER SENSORS FUEL ALARM JAN 30. 2001 2:54 PM FUEL ALARM FEB 5, 2001 11:10 AM FUEL ALARM MAR 23, 2004 6:42 PM JAN 30, 2001 2:39 PM FUEL ALARM MAR 28, 2003 2:36 P~ FUEL ALARM FEB 20, 2002 1:36 PM ..... ,SENSOR ALARM ........ ~ENSOR ALARM ._~~ L 7:DIESEL STP LI2:DISPENSER 7-B STP SUMP D I SPENSER PAN ,'~LARI'-'I HISTORY REPORT FUEL ALARM FUEL ALARM MAR 23. 2004 6:38 PM I'I~R 23. 2004 6:51 Piti SENSOR ALARM LI 1 :DISPENSER 5-6 DISPENSER PAN FUEL ALARM MAR 23, 2004 6:54 PM FUEL AI..~RM MAR 28, 2003 2:52 FUEL ALARM SEI%..qOR ALARM ..... SENSOR AI_~RM FEB 20, 2002 1:41 PM L 2:UNLEADED STP L I:UNLEADED ANNULAR STP SUMP ANNULAR .?,PACE FUEL ALARM FUEL ALARM MAR 23, 2004 6:38 PPi MAR 2,9, 2004 6:51 PM END ~ ~ ~ x ~ ..... SENSOR ALARM ..... - .... L 5:PR~IUH STP L 2:UNLADED STP ~TP ~UMP STP S~flP FUEL ALARM FUEL ~R 2B~ 2004 6:39 PM MAR 23, 2004 6:51 PM ALARM HISTORY REPORT SENSOR ALARM ..... LI2:DISPENSER 7-8 DISPENSER PAN ..... SENSOR ALARM ..... _ .... SENSOR ALARM FUEL ALARM L 8:DIESEL FILL L ,9:UNLEADED FILL MAR 23, 2004 6:53 PM OTHER SENSORS OTHER SENSORS FUEL ALARM FUEL ALARM FUEL ALARM MAR 23, 2004 6:42 PM MAR 23. 2004 6:52 PM MAR 23. 2004 6:51 PM FUEL ALARM MAR 28. 2003 2:46 PPI i'.! ... SENSOR 'ALARM ..... - .... SENSOR ALARM ,.. - : L 4:PREMIUM ANNULAR L 9:DISPENSER .. OTHER SENSORS DISPENSER PAN ~ -- FUEL ALARM FUEL ALARM . ~ MAR 23. 2004 6:44 PM MAR 23. 2004 6:53 PM ..... SENSOR ALA~fl ..... L I:UNLEADED ANNULAR ....... SEi~SOR ALARM ANNULAR SPACE LIO:DISPENSER 3-4 DISPENSER PAN FUEL ALARM · ~ 2004 6:45 PM FUEL ALARH MAR U~'L ~L~ H~ 23. 2004 ~:53 ~H ~ROOKs I DE H~RKE? ~'IELD ¢~. 9;3300 BR,:)O}(S I [:~E I"I&RKET 88CHi CRI'-'I [ I',lO I'.'IED l F~ ~KEF:SF I ELD Ca. 9:3808 OCT 28, '2-0~ !:42 PPI SYSTEI"I STATUS REPORT T 1 :,:_'~VERF 1LL F~LF~t~tI'.'I T 1 :IJI',ILE~4[:,ED VOLUI"IE = I_.ILI. F4GE = 8899 ,3~I..S 9Oh, ULLAGE= 68913 TC VOLLIP1E = 1 I 16'7 ,:3~LS HEIGHT = 69.45 INCHES b,.IFfl"ER VOL = 18 14aTER = U. 86 INCHES TEHF:' = ?9 .ill DEC; F T 2: PREPI 1 IJl"ll VOLUME = 5415 ,3&LS ULL/e3E = 6026 C;&LS 90~.~: ULLAGE= 542l G~LS TC 'v'OLUHE = 5405 ,3&LS HEIGHT = 58.71 INCHES L,JaTER VOL = 14 GaLS I.,4ATE~ = 1 . 0[I INCHES TEI~ = 84.7 DEO F T :3:DIESEI. %,'OL UPIE = 2720 ,:3aLS ULLAGE = 5807 ,.3~LS 90% ULLAGE= 4504 Gal.S TC VOLUP1E = 2716 G~LS HEIGHT = 47.43 INCHES I...IgTER VOL = 0 (3gLS 14RTER = 0. O0 INCHES TEHP = 85.2 DEG F ~ Bakersfield Fire Dept. UNIFIED PROGRAM iNSPECTION CHECKLIST Enironmental Services , r, ,,,,,, ,, ,,, ,, _ , , , , ,,,r, , 17 15 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301.. 'Tel: (661)326-3979 tFACIt. ITY NAME I INSPECTION DATE I INSPECTION TIME Section 1: Business Plan and Inven~w P~mm ~ Routine ~Combin~ ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection C V fc=co~¢~.~ OPE~TION COMMENTS ~ V=Violation ~ APPROPRIATE PERMIT ON HAND ~ CORRECT OCCUPANCY i ~ VERIFICATION OF INVENTORY MATERIALS ~ VERIFICATION OF QUANTITIES VER~RCAT~ON O~ MSDS AW~An~U~E VEEIflOATIO~ OF ABATEMENT SUPPLIES AND PROCEDURES EMERGENCY PROCEDURES ADEQUATE ANY H~ARDOUS WASTE ON SITE?; ~ YES ~No EXPLAIN: QUESTIONS ,/~¢GARDING T~IS INSPECTION?PLEASE CALLUS AT (661)326- inspector Badge No, White - Environmental Services Yellow - Slation Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FAC1LITYNAME ~:ook~t~/t, /i,[L4 0 4k~ o~x{eA INSPECTION DATE Section 2: Underground Storage Tanks Program [21 Routine [2~ Combined [2i Joint Agency 1~ Multi-Agency ~ C. omplaint I~1 Re-inspection Type of Tank ~0Og'~6 Number of Tanks ,.~ Type of Monitoring d:t...t~4 Type of Piping ~00J~' OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data Oll file / Permit fees current Certification of Financial Responsibility x..,/' 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 A'd~quate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? Inspector:C=C°mpliance .~" J V=Violati (~1~ _/~ on Y=Yes N=NO ~~~]~%~ Office of Environmental Services (661) 326-3979 Burn'ss S~te' Respons, jl~~ l White - Env. Svcs. Pink ~ Business Copy PR~- $--0~ T HU I 55 ~ROM I~ . $ . S . R . ~lC . P . BSSR, Inc. . ,. 6630 Rozeda~e H~.~'# B, B~ers~el~ CA 93308 Phnne (66 t) 58~.2'177 Fax (6~1) 588-2786 ' MoNITO G. . SYSTEM CERTIFICATION- t TM~ [on~ mu~t b, u~ed to document t~at~g and ~icing of me'ut-ring equapm~nt. ~at~&~t~ ~ ~~o~ch moni~ri~ nvs~ c~g~'ol ~a~ by ~e ~cha~c~n who performs the work, A copy of this ~o~ .~{~..s~st~m ~waer/opciat~.' '~'e 'o~n~/o~rawr must sub~i a copy of fids fo~ to ~ local agency rc~lal~ UST . A.;:;~.:~Rueral Information _ ,~ i~.~ of Equipment T~Cerfified ' Tank ~'. Mo~=li ~n-Tank ()a~gh~ ~obo. ' Vault ge~or..' ~nnul~ Spa~ er V~ult $~sor. 'Mod~h g~r(~). ~odeh ~iping Sump / ~en~ S~0r(s). M0d~h . 5~n~s). ~ Sump Son,or(s). "Me,ct: ..... ' Line ~ Detector, Model: -.~ ........ ~ M~hani~l Line Leak Dctcclor, MD ~[l ~_ ' , ~. "' ~ 'rank ~fill / High. Level ~cn~o~, Model: ., ' ;Probe, M~el: O In-'r~k OauBing.Probe.. ,,~od~h o~ Vault ~or.' ~e[:! Q Annular Space or Vault ge~sot. '. ~;Modol: .Sump / ~ch $~sor(s). Mod~i: ~ ~ Piping ~ump / ~ch 5cn~oN~), Mod~h ..... ~Ump ~en~or(s), Mod~: ~ Fiji Sump S~naor(s). ModH: ... . _ :t ~kai. Line Leak Det~tor. Mod~: ........... · ~ O M~chanlcat Line lxak Detector. Mod~]: -- Liflo L~k Detector. M~eh .... ' ....... Q Electronic Linc Le~ D~t~tor. Model: DIs~nser ID: ..... ,, L ............ ' ~ Valve(s). ~llo~ Valve(s). er ~thir m~cnt ~r ~ Dispenser ~: "' ~s). ~jspcnser C~n~nmont 5ensorCa). Valves), ~r valw(s). , D~sp=nser ~D; ' Containment Scnso~(s). M~c[:. ~ Dispunser Conlainmcn~ ~on~o~s). '~d~h ~ ~a~ V~l'~e(s). ~ Shear Valve(s), , : facil ty ~ontains more't~ks or dl~pclisers, ~py this for~ ~clude information for cva~ lank ~d d/a~n~ at the facility, :'~ :~i,a'nuacturera' ~uid~acs. Atta~ to ~h Cc~fl~flou Is iuformaflon (e.g. m~nuacturcn ~sa) ~cc~s~ t? v~.~at~ tbl~ i 'i~ormaflon Is ~rre~t ~td a Plot Plan Showing the layout of mo~lto~g ~ulpaen~ ~or any equ~t ~e '.~ ;.~ip'SrtS, i have alsu a~ed_a copy of thc~ep~eck all tAat ~?ly): ~ S~ se??p fi ~r~ ~lsto~o~ P~e [ of 3 0~/01 ~itorJng System Certification APR-- ~-- 05 T HU I 2 : 5~ ~RO~I I~. $. $. R. I N C. P. Os. ~e. sults of Te~t~ng/Servlcmg 0 No* Is ~* vhual nla~ operational? . ~ No*' W~fe ali sensor* visually inspected, ~nc~o~'~iiy m~d, and c~n~[~d'o~cr~fi~.~!? " O N~*'" W~r~'~h le~°r~ i~ied at lowest ~t ofsecond~ conmim~nt and positioned so fiat other equipment will a No* -' if gm ar* r~[~ to a r~ot= monitoring s~atioo, is all co~c~fions e~fi~ment (e.g. modem) '~ Na o~afional? ra No* ~ pr~d plp~g ~yst~; ~os th, ~*ae automati~lly shut do~n ff ~o piping ~'~ond~ .:~ NIA moni~g s~t~ dctec~ a Ic~ f~h to operate, or ~ el~Mcally disc~ectcd? If yes: which $~son posiffw shut-do~? (Ch~k all tha~ ap~ly) ~p~n~ Sen~; ~spc~,r Cogent ' ' Did gou ~nfi~ ~$i~ve shut-floW~ ~e.~,l~a~ ~ ~r fai!prc/di$cg~,mccfioa?, ~o~; ~ ~o. '~-~0' Fo~ ~ Sy:te~ ~at uti~e file ~o~ system as ~ pfim~ ~ overfill w~n~g d~'lc= ' O NIA m¢chaM~l or.fiR prcvontign valve i$ ~$tall.d), is ~o overfill w~fl~g ~la~ vls~lo ~d audlbl~ .~.fl Ust ~o maaufac~¢~ a~ ~d m~! ~r ~!1 r~laoml~Opt ~aa$ ~ S.0~floa ~,.below.. ...... "O N~' Was ~iuid fo~d ~ide any secon~ 'coa~inment Osto~ ~i~cd ~ ~ syato~? (Cfieck aE'~at ~ply) ' ~O"No* - W~S'moaito~ sy~{6m set-up rcview~ to ca~ pm'P~ s¢t~g,?A~ch sot up re~9~, iCap~i}~,i Pug, S of 3 03~! APR-- ~--0~ THU 1 57 FROM ,. In. Tank Gauging / SIR Equipment: 0 Check ~his box ifta~ gauging i~ us,d only ~or invcntol7 con~ol. 0 Check this b~. it'no ta~ gauging or SIR equlpm,nt ~ i:~mlled. t ~s.~e~:uon must be, completed if in-~auging equipment is ~ed to pcrlb~ 1~ detection mo~toring. : .., ~ '; 0 ~o*~ ~as all hput wk~.~CCn {u,pec~d foT pro~r en~ and mr~lion, ~cluding es~ng for greed faul~? ....... . ......... : ........ ~ ~ Nos Was a~u~acy orsy$,t!~,p~d~t l~ol reading8 tested? ':;~ It ~i~ ~Oa ~ below, d~l~ ho~ and wh~ ~ese d~aencl~ we~ ~-r-~dl ~ correct, d, ' .............. .,G~...;til,~9, Leak Detectors ~LD): ~h~k this box ~s am not ~stall~d. :~o~]~l~ ~e followln~ ~ocMlst: ,~,,;~; ;~,p~}<}~ ] ~ e~i~t ~-u9 ~r arena tq~m~t ,;..~.,:,.:":~i";¢.~ ::: ,,:"~ Ho* For mcch=lcal L~s, do~s ~e ~D zcs~mt' product flow if it darers a le~? I. ,'~ ~ ~/A [ ~m~d? · ' :F~7~[:2':~re~ ~ a .... ~ ~all'i~':°~'~e ;qulpmmt ~u~-~a:~'$ m~tonan~;h~t oomPlst;d* .............. : ........... ' .~.tg~:~l'!}[.~e~on ~, below, a~l~ how and when thee deficiencies we~ or will bo eorrecte~. ' Page Ap~R-- ~-- O$ THU I ~ 8 ~ROM ~ . $ . $ . R . NC . P . O4 US~ Monitoring Site'Pian ......... . .................. ~.~ ~ ~ ..... .................... ................. ~...~ ....... ............ , '.~ ' : 0 [ns~o~tion~ have a dia~ ~t. shows all requk;d info~atton, you my include it, re.or t~ ~is page, with yo~ System C~ffica~o~. ~ your site plan, show ~e genial layout of ~nks and pipifig. Oearly identi~ in~ta~ liquid lev~ pwbes (ifu~ ~or le~ detection). ~ fl~e space pro~ded, note fl~e date ~is Site Plan ~uge of~ o~00 · Complete items 1, 2, and 3, Also complete item 4 if Restricted Delive~ is desired. Z..-..~ '" ~-E]/"'~-~;~"~"~ Agent · Print your name and address on the reverse Addressee so that we can return the card to you. 1~3Received by (PrfntedNam~) ! C. Date of Delivery · Attach this card to the back of the mailpiece, (~t~ ~ or on the front if space permits. ~" ~ ' · ' D. Is delivery address different from item 17 [] Yes 1. Article Addressed to: ,f YES, enter de,ivery'~-------'~s~rb~ [-I No BROOKSIDE NIKT . - v coP .o BOXcA64093280 , I MAI 3. Service Type'S. / ,, ~ Certified M~ __ ..~,,[] Express Mail ~{~,,~, [] Insured Mail " 4. Restricted Delivery? (Extra Fee) [] Yes 2_,. 7002 3150 0004 9985 3073 PS Form 3811, August 2001 Domestic Return Rece~F- 102595-02-M-1540 ,. ,~(~, _' . ~/' . ..~.~_ -._..__..~ '.-.__._ · Sender: Please print y~e~, address, and~ZI1:~'z~in-thi~'b'o~'~ ~ Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 · s lhh,,,lh,,lhlh,,,,,lhl,l','hh,,l!!!,,,,,,lhhhlh,,! D' Postage $ --I'" Certified Fee g Return Reclept Here Fee (Endomement Required) r-'t Restricted Delivery Fee i.r) (Endorsement Required) I'1'1 Total Postage & Fees ~ ~/,-,~o ,,~ ~.~.~.~ ........................... ~- ~'~,'Ko't:~:~ ......................................... [ormt~No. P 0 BOX 660 ,~:.~:~;~ ................................................................... . .,,.. ~.~,?o ~~o ....... Certified Mail Provides: o~, · A mailing receipt (es~eAe~) c'~ 'oo~s u~O=l Sd · A unique identifier for your mailpiece · A record of delivery kept by~he_Post~ Service for two yearn Important Reminders: . , · Certified Mai! may ON[,Y be combined with First-Class Mail® or Priority Mai~®. · Certified Mail is notavallable for any class of international mail. · NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider insured or Registered Mall. · For an additional fee, a Return Receipt may be requested to provide proof of - dellvery~To~obta n-Return Receipt service, prease- ,c~n. pleteandattach a Ret.u,m Receipt (PS Form 3811) to the article and add appdcable postage to cover me fee. Endorse mailplece "Return Rece pt Requ,ested" To r..ec~.!.v.e .a.f.ee.waiver .fo.r a duplicp, te return receipt, a USPSe postmark on your c;enirieo nnai~ receipt ;s requlrea. · For ~n a.,d. ditlona fee, de very may be restricted to the addressee or addressee $ authorized a~ent. Advise the clerk or mark the mailpiece with the endorsement "Restricted-De//very". · f a postmark on the Certified Mail receipt is des red p ease present the arti- cle at the post off ce for postmarking. If a postmark on the Certified Mail 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. D ~ March 25, 2003 Beverly Eilers Brookside Market at the Oaks P.O. Box 640 Wasco, CA 93280 CERT~IED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at FIRE CHIEF RON FROZE the above stated address. ADMINISTRATIVE SERVICES Dear Business Owner: 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 Our records indicate that your annual rnaintcnance certification on your leak FAX (661) 395-1349 detection system was past due on February 20, 2003. SUPPRESSION SERVICES 2101 "H' Street You are currently in violation of Section 2641(J) of the California Code of Bakersfield, CA 93301 tx t; , u~e~u~a':ons. VOICE (661) 326-3941 FAX (~1) 395-1349 "Equipment and devices used to monitor underground storage tanks shall be PREVENTION SERVICES installed, calibrated, operated and maintained in accordance with FIRE SAFETY SERVICES* ENVIRONMENTAL SERYICE$ 1715 Chester Ave. manufacturer's instructions, including routine maintenance and service checks Bakersfield, CA 93301 VOICE (661) 326-3979 at least once per calendar year for operability and running condition." FAX (661) 326-0576 You are hereby notified that you have thirty (30) days, April 25, 2003 to either PUBLIC EDUCATION perform or submit your annual certification to this office. Failure to comply 1715 Chester Avb. Bakersfield, CA 93301 will result in revocation of your permit to operate your underground storage VOICE (661) 326-3696 system. FAX (661) 326-0576 FIRE INVESTIGATION Should you have any questions, please feel free to contact me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 328-3951 Sincerely, FAX (661) 326-0576 Ralph Huey TRAINING DIVISION 5642 Victor Ave. Director of Prevention Services Bakersfield, CA 93308 VOICE (661) 399-469Z by: . S Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc FIRE March 12, 2003 pARrM r Beverly Eilers Brookside Market at the Oaks 8803 Camino Media Bakersfield, CA 93311 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at FIRE CHIEF RON FROZE the above stated address. ADMINISTRATIVE SERVICES Dear Business Owner: 2101 'H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 Our records indicate that your annual maintenance certification on your leak FAX (661) 395-1349 detection system was past due on February 20, 2003. SUPPRESSION SERVICES 2101 "H' Street YOU are currently in violation of Section 2641(J) of the California Code of Bakersfield, CA 93301 VOICE (661) 326-3941 t~egulatlons. FAX (661) 395-1349 "Equipment and devices used to monitor underground storage tanks shall be PREVENTION SERVICES SAFmS~,~,C~S.~.,,.O.MEmA, S~.V,:. installed, calibrated, operated and maintained in accordance with 1715 ChesterAvo. manufacturer's instructions, including routine maintenance and service checks Bakersfield, CA 93301 VOICE (661) 326-3979 at least once per calendar year for operability and running condition." FAX (661) 326-0576 You are hereby notified that you have thirty (30) days, April 12, 2003 to either PUBLIC EDUCATION 1715 ChesterAvb. perform or submit your annual certification to this office. Failure to comply Bakersfield, CA 93301 will result in revocation of your permit to operate your underground storage VOICE (661) 326-3696 FAX (661) 326-0576 system. FIRE INVESTIGATION Should you have any questions, please feel free to contact me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 Sincerely, FAX (661) 326-0576 TRAINING DIVISION Ralph Huey s~42 wtor Ave. Director-of Prevention Services ....... Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc · Complete items 1, 2, and 3. Also complete A. Signature item 4 if Restricted Delivery'is desired. [] Agent · Print your name and address on the reverse X [] Addressee SO that we can return the Card to you. B. Received by (Printed Name) I C. Date of Delivery · 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 del{very ac!dress below: [] No BEVERLY EILERS ,. =' BROOKSIDE MARKET ' 8803 CAMINO MEDIA 3. servico Type BAKERSFIELD CA 93311' [] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise ......... ~_. ? [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 7002 2410 0002 1974"-9~95--~ PS Form 3811, August 2001 Domestic Return Recwib{ 102595-02-M-1540 Postage & Fees Paid USPS Permit No. G-10 · Sender: Please print your name, address, and ZIP+4 in this box ° Bakersfield Fire Department Prevention Services 715 Chester Avenue, Suite 300 Bakersfield, CA 93301 Postmark ~ ~ Return Reclept Fee | (Endorsement Required) l Here ' Restricted Delivery Fee ~ r-~ (End°rseme~~L.~ 'ILl To~aiPo~ ]~__~'V~.~I~I.~'~ ~]:L~-,~,~ ~ BRC)OK$IDE MARKET ~ ~o,~ro - '~ MEDIA ' ' I'~i'~ ~,~"F. RSFTE, gD CA 933]. ! p._ |" ' 8803 CAMINU ,, , [.o.r,,o ~,,, ...... L...I Certified Mail Provides: ,m~,69L'w'ZO'96!IZOl' =' A mailing receipt (e~e,~el~) ~,~1"0062 tmoa Sd · A unique identifier for your mailpiece · A record of delivenj kept by the Postal Service for two years Important Reminders: · Certified Mail may ONLY be core, ned with First-Class Mail® or Priority Mail; · Certified Mail is not available for any class'"l~ International mail. · NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Fop valuables, please consider Insured or Registered Mail. · For an additional fee a Return Receiptmay 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 "Retu..m_R_e..ceipt Requ.ested". To r..e~.!.v.e .a.fee. waive, r .fo.r a duplic.ate return receipt, a u~';:~ postmark on your uenmeo Mall recelp[ is requlreo. · For an additional fee delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailplece with the endorsement "Restricted-Delivery'. · If a postmark on the Cert f ed Ma race pt is desired please present the arti- cle 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. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOa and FPOs. L D March 12, 2003 ~,i,~ ~ Beverly Eilers Brookside Market at the Oaks 8803 Camino Media Bakersfield, CA 93311 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at FIRE CHIEF RON FRAZE the above stated address. ADMINISTRATIVE SERVICES Dear Business Owner: 2101 "H' Street Bakersfield, CA 93301 VOICE (661)326-3941 Our records indicate that your annual maintenance certification on your leak FAX (661) 395-1349 detection system was past duc on February 20, 2003. SUPPRESSION SERVICES 2101 "H' Street You are currently in violation of Section 2641(J) of the California Code of Bakersfield, CA 93301 VOICE (661) 326-3941 Regulations. FAX (661) 395-1349 "Equipment and devices used to monitor underground storage tanks shall be PREVENTION SERVICES .~E S~En~.~CES.aW=O~.~CES installed, calibrated, operated and maintained in accordance with 1715 Chester Ave. manufacturer's instructions, including routine maintenance and service cbecks Bakersfield, CA 93301 VOICE (661) 326-3979 at least once per calendar year for operability and running condition." FA,)((661) 326-0576 You are hereby notified that you have thirty (30) days, April 12, 2003 to either PUBLIC EDUCATION 1715 ChesterAvb. perform OF submit your annual certification to this office. Failure to comply Bakers~e~,CA ~33o~ will result in revocation of your permit to operate your underground storage VOICE (661) 326-3696 FAX (661) 326-0576 system. FIRE INVESTIGATION Should you have any questions, please feel free to contact me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 Sincerely, FAX (661) 326-0576 TRAINING DIVISION Ralph Huey 5642 Victor Ave. Director of Prevention Services Bakersfield, CA 93308 VOICE (661) 399-4697~ by: FAX (661) 399-5763 ~ Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc item 4 if Restricted Delivery is desired. · [] Addressee sO that we can return the card to you. ~1 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 fBEVERLY EILERS BROOKSIDE MARKET 8803 CAMINO MEDIA ~. Service Type BAKERSFI]ELD CA 93311 [] Certified Mail [] Express Mail } ~ _ _ _ _./, [] Registered [] Return Receipt for Merch.andise ......... t [] Insured Mail FI C.O.D. ~. Restricted Delivery? (Extra Fee) [] Yes 7002 2410 0002 1974 9558 PS Form 3811, August 2001 Domestic Return Receipt 2ACPRI-O3-Z-0985 Permit No. G-10 · Sender: Please print yeur name, address, and ZIP+4 in this box · ~A[ERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~ 7115 Chestsr Avenue, Suite 300 I''-~ Postage I $ !~r'~ Ceaified Fee II Postmark I ~ Return Reclept Fee J I: r-1 (Endomement Required) I Here '1:3 Res~cted De,ive~y Fee I (Endorsement Required) I_ m rot, BEVERLY EILERS !ru o~ BROOKSIDE MARKET 'g [~ii 8803 c^M~mo ~r~ '. .......... r,- ios~ BAKERSFIELD CA 93311 Cedified Mail Provides: · Amailing receipt · A unique identifier for your mai¥1eco · A record of delivery kept by the Postal Service for ~wo years Imp_ortant Reminders: · Certified Mail may ONLY be combined with First-Class Mail® or Priority Mail~ · Cart f ed Mail is not ava ~Able for any class of international mail. · NO INSURANCE COVERAGE IS PROVIDED with Certified Mail, For valuables, please consider Insured or Registered Mail. I For an additional fee, a Return Receipt ma), be requested to provide pr..oof of delivery. To obtain Neturn Heceipt service, p~ease complete an<3 attach a ~eturn Receipt (PS Form 3811) to the article and add applicable postage to cover the fee, E..ndorse mailpiece."Retu..m?_e_ceipt Requ.ested". To r_ece!.ve .a.fee.waiver for a duplic~, te return receipt, a U:51~® postmarK on your c;ertiT[ee Mail receipt is requlreo. · For an additional fee, delivery may be restricted to the addressee or addressee's authorized a{3ent. Advise the clerk or mark the rnailplece with the endorsement "Restdcted-De#very". · If.a postmark on t.h.e Ce. rtified Mail receipt, is desired, please pre_sen, t...the, .a. rti.~ cie at the post o~ice Tor postmarking, it a postmark on the ~ertlnee 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 mall addressed to APOs and FPOs. March 1, 2003 Beverly Eilers Brookside Market 8803 Camino Media Bakersfield, CA 93311 CERTIFIED MAlL FIRE CHIEF RON FRAZE NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE ADMINISTRATIVE SERVICES RE: Failure to Perform/Submit Annual Maintenance on Leak Detection 2101 "H' Street Bakersfield, CA 93301 System at the Above Stated Address. VOICE (661) 326-3941 FAX (661) 395.1349 Dear Business Owner: SUPPRESSION SERVICES 21Ol 'H' Street. Our records indicate that your annual maintenance certification on your leak Bakersfield, CA 93301 VOICE (661)326-3941 detection system was past duc on February 20, 2003. FAX (661) 395-1349 You arc currently in violation of Section 2641(J) of the California Code of PREVENTION SERVICES Regulations. FIRE SA/:EI~' SERVICES · ENVIRONMENT~M. SERVICES 1715 Chester Ave. 0akersfield, CA 93301 "Equipment and devices used to monitor underground storage tanks shall be VOICE (661) 320-3979 FAX (661) 326-0576 installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks PUBLIC EDUCATION 1715 ChestorAv~. at least once per calendar year for operability and running condition." Bakersfield, CA 93301 VOICE (661) 326-3696 YOU are hereby notified that you have thirty (30) days, April 1, 2003 to either FAX (661) 326-0576 perform or submit your annual certification to this office. Failure to comply FIRE INVESTIGATION will result in revocation of your permit to operate your underground storage 1715 ChesterAve. · system. 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. omccreiy, Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services January 22, 2003 . Brookside Market ;m~ C.~E~ P 0 Box 640 · ,:'~?~~~ W~co CA 93280 ' ~' ' 2101 ~'SE~I ~':c ..... vo~c~'~'~ca~ ~: Up.de Ceffificate & Fill Tag; Dc~ Owner/O~rator: SUPPRESS~N SER~ES 2101 ~' S~t Bae=~.CR~l Effective ~anu~ ], 2~3 Assembly ~iH 248] went into eff~t. ~is vo=; ~) =~ Bill deletes th~ ~qui~ment for ~ up,de ce~ificat= of comp]i~ce F~ (~1) ~1~9 (the blue sticker in your window) ~d the blue fiH tag on your fill. PR~E~ON SER~ 1715 ~terA~. YOU may. ff you whh, have ~em ~sted ot ~move them. Fuel ~0=~. cR ~ vendo~ have b~n notified of this change ~d will not deny fuel VO~E (~) ~9 F~(~)~, delive~ for missing tags or ceffificat~. ~aue EOU~N . m~ ~,,R~. Should you have any questions, ple~e feel f~e to call me at 661- ~,.~,m. c, ~ 326-3190. ~R~ ~mzs~m, Since~l~, · · - 1715 C~A~. F~ (~1) ~76 :...~ ~NING ~N ~2 ~r A~. ~emfl~, CA ~ Fire Inspector~nvironmcntal Code Enforcement Officer . , . VOICE (~) 3~ F~ (~) ~SZ~ Office of Environmental Sc~iccs SBU/dc P.,:'OO};:S 1 bE I"'IaE?:ET BP, k.'.EkSF 1 ELD CA. N~2 U 14. 2E102 I : ~6 ~-"M ALL FUNCTIOf, iS I'.IORPI~L I I'¢../EI'ITORv REr-.'ORT 'v'OL LII'.'IE = 9620 ULLAGE 90~: LILLaC;E-- 10462 GaLS Ti'-; b'OLLff'IE = I~45,3 HEIGHT = 61 .65 INCHEs L~IA'r'Ep. VOL = 19 OaLS i,,,a'rER = 0.S7 I TD.'Ip = v5 ': DEG F ~. a3 L Ot'.'lE ULLAE;E = 490~ GALS - 71 3::: '3aLS TC L~'3'LUt'.'IE = 4902 GALS HEIC;HT = 54.46 INCHES - ' C;aLS TEt"'I~ = 76.8 F T 3: 91ESEL 'COL l J/"IE = 231] 2 '3ALS ULLa,:3E = 5695 TC t"OLUHE ~ 233F~ GaLS HE/GaT - = 42.37 INCHES ~,'/ATER VOL = TEt'.Ip = 0 O0 I t,,g-,uE- = ,'?.d DEC; F CITY OF BAKERSFIELD FIRE DEPARTMENT :;'. OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME (~0~,atL ~tLd- ~-~k~.oa~ rNSPSCTION VATS il' I q FACILITY CONTACT BUSINESS ID NO. I$-210- INSPECTION TIME NUMBER OF EMPLOYEES, , Section 1: Business Plan and Inventory Program [~l Routine [~} Combined I~ Joint Agency [~ Multi-Agency ~l Complaint {~ Re-inspection OPERATION CIv COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy / Verification of inventory materials Verification of quantities L 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 Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation. Any hazardous waste on site?: ~]Yes ~No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Ins CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~m~ta/t ~nt ~ ~.~ _t'la[¢_.t, INSPECTION DATE Section 2: Underground Storage Tanks Program I~l Routine [~l~ombined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank DIO~ Number of Tanks 2> Type of Monitoring dc/gl Type of Piping i~)~' OPERATION C V COMMENTS 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 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? lfyes, Does tank have overfill/overspill protection? Inspector: Office of Environmental Services (805) 326-3979 usineSs Site Respj~)~ Party . White - Env. Svcs. Pink - Business Copy FRANZEN-HILL CORPORATION 1100 North J Street Tulare, California 93274 (559) 688-2977/FAX (559) 688-1467 LETTER OF TRANSMITTAL TO .' City of Bakersfield Date :07/10/02 Office of Environmental Services Job No : Jefferies-BrooksideOaks 1715 Chester Ave Regarding : Bakersfield, CA 93301 Approval # : Attn : Steve Underwood FAX# .' 661-326-0576 Phone : . 6~61~326~3979 ..... WE ARE SENOING YOU ATTACHED VIA: ~ U.S. Mail [] Letter []'Plans [] Contract [] Specifications [] Drawings [] Sub-Contract ~Test Results Copies Date Description 1 each 06/..05/.02 . ~e~da~_C?n.ta.inment.Te?ting Report Fo~m THESE ARE TRANSMITTED as checked below: l~For approval [] Return corrected prints v~ Focyour use [] FOR BIDS DUE ~ 2000 I~ As requested [] PRINTS RETURNED AFTER LOAN TO US [] For review [] Signature and Return Steve: If you have any questions please feel free to contact me. COPY TO.' Bob.l~ill SIGNED: · Iva Tucker Ext. 3002, Construction Secreta~ e: I of: 7 ) Franzen-Hill System Design, Construction & Maintenance Secondary Containment Testing Report Form 1. FACILITY INFORMATION Date Local Agency Was Notified of Testing: Name of Local Agency Inspector Present: .~'~u ~ d {~ ~ ~ ~0 ~ Company Name: Franzen-Hill Co~. Tulare, Technician Conducting Test: ~ Credentials: / CSLB Licensed Contractor DSWRCB Licensed Tank Tester License Type and ~: A,B, C-61/D40 H~ Lic~ 304147 ~Training by Manufacturer -- Manufacturer .... Component's) ':;; Da~e T;a~ing Expires ~nvimn, APT Piping and Tpsting /O ~ /O ;miths Filter~ EBW Piping and Testing / ~ ~ ~O~. ~otal Containment, VeederRoot Piping and T~sting E~n, Gilbarco EMC, Monitor System Piping and Testing '3. SUM~RY OF ~ST RESUL~ Number of Tanks Tested: ~ ~ ~ Number of Piping Runs Tested: Number of Submemible Pump Sumps Tested: '~ ~ Number of UDC Boxes Tested: Number of Fill Sumps Tested: _~ ....... ,~ ~ ,~ Number of Ove~ll Boxes Tested: ~nent P~ Fall ~mmn~ O O O O Technician's Signature: .¢~ ~,~U// Date: ~--[f--0 1100 No~h J Street, Tulare, California 93274/559-688-2977/800-655-3436/559~88-1467 F~ ~.franzen-hill.com / constmction~fmnzen-hill.com SWRCB Pa : of: 7 4. TANK ANNULAR TESTING IITest Method Developed By: '{~,Tank Manufacturer [] Industry Standard [] Professional Engineer / ": [] Other (Specify) [Test Method Uses: [] Pressure -~[~-Vacuum [] Hydrostatic I. [] Other (Specify) IIM~PL Used for Testing:· ITank capacity: I~ i~..r~o~,~ /,R, oo 0 IITank Material: II ]~ank Ma_nufac!urer: ]]Product Stored: IIw~me ~,,~,,n..ress,,re~. I II~a~uum/water~nd starting test I IITe~t Start Test: II "~;> ~ ,~"'" fi,~ ?° '~'"" IITeSt ~nd T"m-e!''_ II IIF',n~ Read"ng (R0: I IITest Duration: II IlCh~nge in Re~din~ (Rf-Ri): IIW~ns~o~rly replaced II Ilaffer testing? II . ~mmen~-(include information on repairs made prior to testing) SWRCB ' ,: 3 of: 7 5. SECONDARY PIPE TESTING Test Method Developed By: [] Tank Manufacturer ]~industry Standard [] Professional Engineer ,., [] Other (Specify) Test Method UseS: .~'Pressure [] Vacuum [] Hydrostatic · [] Other (Specify) Measuring Equip. Testing: Piping Run it png un I ~rest End Time: u~'5o P~",- fl¥O ~/v~ ~00 ~ ~Final Reading (R~: ' I .~ ~ ~ '~ ~ ~ ~ ~ ~ ~estDuration: [ ~ ~.~ ~ ~,~ ~0~-,-~ ' [Change in Readiqg (Rf-Ri): [ ' ~ 0 ~ ~. ~Q ~ ~ 0 ~ ~ ~mm~n~-(includo information on ropaim made prior to testino) SWRCB Page: 4 of: 7 6. SUBMERSIBLE PUMP CONTAINMENT SUMP TESTING lest Method Developed By: [] Tank Manufacturer ~-Industry Standard ~Professional Engineer rest Method Uses: ' [] Pressure [] Vacuum [] Hydrostatic I~'Other (Specify) ~,~, ~q/,t,~, ~ Sump Sump Diameter: Sump Depth: ~ ,~'~ Height from Tank Top to Highest Piping Penetration: Height from Tank Top to Highest Electri~l Penetration: Condition of sump prior to testing: ~ <~ ~ ~ ~.~ Potion of Sump Tested (1) Does turbine .shut down when sump sensor detects either )roduct or water? Turbine shutdown response time(2) /~ ~~' 1 ~ 5 ~ ~ I ~ ~ ~ ~ ,.~ Is system programmed for fail-safe shutdown? Was fail-safe verified to be Wait time applying pressure/ vacuum/water and starling test: Initial Reading (Ri): , O Final Reading (RO: ,0 Change in Reading (Rf-Ri): Pass/Fail Threshold ~~ ~~.. ~a~ sonsor roplacod a~or testin~ ~mm~n~-(include information on repairs made prior to testing) '1 If the testing method does not test the entire depth of the sump. specify how much of the sump was tested. Methods not testing the entire sump should only be used if the monitoring system provides fail-save turbine shutdown. 2 With the submersible pump running, place the sensor in product (discriminating sensors should also be placed in water). The time between placing the sensor in product and the turbine shutting down is the response time. This should be done if the secondary containment testing method used does not test the entire volume of the sump '~. SWRCB ge: 5 of: 7 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: [] Tank Manufacturer J:~lndustry Stan~lard [~professional Engineer [] Other (Specify) Test Method Uses: [] Pressure [] Vacuum [] Hydrostatic Measuring Equip. Used for Testing: ~.~ (..~ ~ ,r,.~~ ._ · ~; ii'. UDC Manufacturer: ~.0 J;/~J~ ,,, Height from UDC Bottom to Highes. t Piping Penetration: J ~ v~ j ~ ~' I ~ '~ Height from UDC Bottom to Lowest Electrical Penetration: /0 " [ ~ I ~0 / Condition of uDc prior to testing: G,~-.O ~-oo,O ~.(=o~'J .. (~ Portion of UDC Tested (1) ~ ~\ ~\ ~¥\ ~o~s ~u~ioe~'hu~ d~n when ............................ ~ . )roduct or'water? Turbine shutdown response time(2) ~-~ ,~ l~ ~ ~ i~ ~ ~ ~ Is system programmed for fail-safe .~ ~ ~ ,hutdown? ~ ~ ~ V~ Was fail-safe verified to be Wait time applying pressure/ vacuUm/water and starling test ~ G ~ ,~vr ~ ~ ~ ~ ~5 ~0 ~, ,,.-c .. Initial Reading (Ri): ,0 { , o ~ , O ~ ~ ~ ~ . Test End Time: h '~ 0 fl ~ j; ~ ~ ~>0 3 3~ Final Reading (RO: ~0 ~ , ~ ~ ~ b t , ~ x Change in Reading (Rf-Ri): ~o'~ ~U'O~'~ ~0~''~ Wassens°rrem°vedf°rtesting? II '/~) I ';*~ ~ Was sensor replaced after testing? ,/¢ ~ I¢~.% ~./,5' ~' ~mmen~(include information on repairs made prior to testing) ¶ If the testing method does not test the entire depth of the UDC, specify how much of the UDC was tested; Methods not testing the entire UDC should only be used if the monitoring system provides fail-save turbine shutdown. 2 With the submersible pump running, place the sensor in product (discriminating sensors should also be placed in water). The time between placing the sensor in product and the turbine shutting down is the response time. This should be done if the secondary containment testing method used does not test the entire volume of the UDC. SWRCB Page: 6 of: 7 8, FILL RISER CONTAINMENT SUMP TESTING Iii'est Method Developed 'By: ~ Tank Manufacturer [~ndustry Standard 'l~rofessional Engineer [] Other (Specify) IJTest I~leth0d Uses: .... [] Pressure [] Vacuum' [] Hydrostatic l~,Other (Specify) L FanISump# ./, J IFII~ FllISump# SumpDe'pth: ...... ~j, &v- 4' fo*' Height from Tank Top to Highest Piping penetration: Condition of sump prior'to testing ' Podion of sump Tested Vacuum/waterWait-tim~-applying-pressurel~and sta~ing test: '~ ~,~ ~O ~,~ - ~~ .... ' .... ~-~ - Final Reading (Rg: ' Jls there a'~ensor in the sump ~ II JDoes the sensor alarm whe~ II J~ectected?jeither product or water is IIII ~s sensor removed for testing?Il ' ~as Sensor replaced after II Jtesting? II c~mments-(include information on repairs made prior to testing) SWRCB '" ~ ~age: 7 of: 7 9. SPILL/OVERFILL CONTAINMENT BOXES I'est Method Developed By: [] Tank Manufacturer CI Industry Standard [] Professional Engineer I-I Other (Specify) I[Test Method Uses: · []Pressure []Vacuum []Hydrostatic II [] Other (Specify) IIMeasuring Equip. Used for Testing: Spill ~ ,ucket Diameter: r~ , ~ i~/~ Bucket Depth: h~ ~ [~"-J Wait time applying pressure/ vacuum/water and starting test Test Start Test: Initial Reading (Ri): Test End Time: Final~Reading~(Rf): Test Duration: Change in Reading (Rf-Ri): Pass/Fail Threshold Comments-(include information on repairs made prior to testing) Customer Signature: Date: SWRCB I:\MY FILES\FORMS D · May 29, 2002 Brookside Market at the Oaks P.O. Box 640 Wasco, CA,93280 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 8803 Camino Media, Bakersfield FIRI= CHIEF REMINDER NOTICE 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 California VOICE (661) 326-3941 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 the new law mandates testing of secondary containment FAX (661) 395-1349 components upon installation and periodically thereafter, to ensure that the sys. tems are capable of containing releases from the primary containment until they are PREVENTION SERVICES 1715 Chester Ave. detected 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" L~ your tap J( system must bc 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 thi~ office. Should you have any questions, please feel free to contact me at (661) 326-3190. Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures D April 17, 2002 Brookside Mkt at the Oaks P O Box 640 FIRE CHIEF WaBco CA 93280 RON FRAZE ADMINISTRATIVE SERVICES RE: Necessary Secondary Containment Testing Required by December 3 l, 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 The purpose of this letter is to inform you about thc new provisions in California law VOICE (661) 326-3941 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. I (California Health & Bakersfield, CA 93301 VOICE (661) 326-3951 Safety Code) of the new law mandates testing of secondary containment components FAX (661) 326-0576 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 l, 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 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/dm enclosures D /. April 17, 2002 Brookside Mkt P O Box 640 tIRE CHIEF Wasco CA 93280 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 The purpose of this letter is to inform you about the new provisions in California law VOICE (661) 326-3941 FAX (661) 395-1349 requiring periodic testing of the secondary containment of underground storage tank systems. PREVENTION SERVICES 1715 ChesterAve. Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & Bakersfield, CA 93301 Safety Code) of the new law mandates testing of secondary containment components VOICE (661) 326-3951 FAX (661) 326-0576 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. Bat(ersfield, 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 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. Sinc~ ,~ Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures · Print your name and address on the reverse ....... so that we can return the card to you. I | c. Signature · Attach this card to the back of the mailpiece, I I~ ~f,~~ E~Agent or on the froht if'sp~ce permits. Addressee · ' '" II D.cCs de~ver~ address different from iter~ 1'~ [] Yes 1. Article Addressed.t(~: ;: If YES, enter delivery address below: [] No BR00K~IDE MK'r C/LlqlNO I~DIA 3. Service Type BAEERSFTELD CA 93311 [3~iCertified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O,D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (C.o£y from service labe_l) 7000 1530 0006 3456 3423 PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 UNrrED STATES POSTAL SERVICE UsPsP°stageFirst-Class& Paid l Permit No. G~IO I Sender: Please print your name, address, and ZIP+4 in this box ° BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, Suite 300 Bakersf'~e~d, CA 93301 Postage $ Certified Fee 2. ].0 Postmark Return Receipt Fee ]....~0 Here (Endorsement Required) Restricted Delivery Fee (Endorsement Requ{red) ~,';i/;~; ..... :'"'~ ...................................................................... Certified Mail Provides: m 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. B 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 add tona fee delivery may be_restricted to the addressee or addressee's authorized agent. A~ise the c ;~rk or mark the mailpiece with the endorsement "Restricted Delivery". · If a postmark on the Certified Mail receipt is desired, please present the artt- c e at the post office for postmarking. If a postmark on the Certified Mail receipt is n~l~cled, detach and affix label with postage and mail. IMPORTANT: W this receipt and present it when making an inquiry. PS Form 3800, May 2000 (Reverse) 102595-00-M-2064 February 20, 2002 Beverly Eilers Brookside Mkt 8803 Camino Media Bakersfield, CA 93311 CERTIFIED MAIL FIRE CHIEF RON FRAZE NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE ADMINISTRATIVE SERVICES 2101 'H" Street RE: Failure to Submit/Perform Annual Maintenance on Leak Detection Bakersfield, CA 93301 System at Brookside Mkt., 8803 Camino Media VOICE (661) 326-3941 FAX (661) 395-1349 Dear Ms. Eilers: SUPPRESSION SERVICES 2101 ~H' Street Bakersfield, CA 93301 Our records indicate that your annual maintenance certification on your leak VOICE (661) 326-3941 detection system is past due. February 6, 2002 FAX (661) 395-1349 PREVENTION SERVICES YOU are currently in violation of Section 264 l(J) ofthe California Code of 1715 Chester Ave. Regulations. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661)326-0576 "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's ENVIRONMENTAL SERVICES 1715 Chester Ave. instructions, including routine maintenance and service checks at least once per Bakersfield, CA 93301 calendar year for operability and running condition." VOICE (661) 326-3979 FAX (661) 326-0576 You are hereby notified that you have thirty (30) days, March 22, 2002, to either TRAINING DIVISION perform or submit your annual certification to this office. Failure to comply will 5642 Victor Ave. Bakersfield, CA 93308 result in revocation of your permit to operate your underground storage system. VOICE (661) 399-4697 FAX (661) 399-5763 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 Enfomement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney BSSR, Inc. ,, ~/. ~ 6630 Rosedale Hwy., # B, Bakersfield, CA 93308 Phone (661) 588-2777 Fax (661) 588-2786 MONITORING SYSTEM CERTIFICATION' t 'This form must be used to document testing and servicing of mo~fitoring equipment. 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 owner/operator must submit a copy of this form to the local agency regulating UST system~ within 30 days of test date. A. General Information Facility Contact Person: Contact Phone No.: ( ~(3 { ) Make/Model of Monitoring System:"['L~ -3SC) P~_o~;/Og_q~_2q0-op D- Date ofTestingJServicing: 0~.. / B. Inventory of Equipment Tested/Certified-- Check the appropriate boxes to indicate specific equipment inspgcted/serviced: ,,;., TankiD: ~1 klr0U~th~E~ Tan[ID: ~$2- pl-~lErXh~O/~ ' [314'n-Tank GaUging Probe. Model: ~O1326 BI"~5i O I 00 l~4*fi-Tank Gauging Probe. Model: ~0O- t~P'Annular Space or Vault Sensor. Model: ¢RO25q I I q q OOO ~nnular Space or Vault Sensor. Model:¢flO2%q 15i145iping Sump/Trench Sensor(s).~ix?Model:O:~cl'/31~O - 2D~ ffi4vi'ping Sump/Trench Sensor(s)$1pModel:O~lqq3~O5 ~ill Sump Sensor(s). Model:t~q 'q"~t~Z) -.30~2k Ii1'~11 Sump Sensor(s). Model:o":lq'q'~O 121 Mechanical Line Leak Detector. Model: - - ~ [3 Mechanical Line Leak Detector. Model: [3 Electronic Line Leak Detector. Model: [3 Electronic Line Leak Detector. Model: ., 121 Tank Overfill / High-Level Sensor. Model: [3 Tank Overfill / High-Level Sensor. Model: 121 Other (specify equipment type and model in Sec.tion E on Page 2). [3 Other (specify equipment type and model in'Section E on Page 2). IIP'fn-Tank Gauging Probe. Model: ~..t~09_6 ~i3'),O i oO [3 In-Tank Gauging Probe. Model: ~Knnular Space or Vault Sen~or. Model: [3 Annular Space or Vault Sensor. Model: [3~iping Sump / Trench Sensor(s)~-I i~ Model: 151q q'7~O .- D. O l~ . [3 Piping Sump / Trench Sensor(s). Model: Iii'Fill Sump'Sensor(s). - Model:O~ ~-I ~10 - 2kO~ 121 Fill Sump Sensor(s). Model: ~ Mechanical Line Leak Detector. Model: 121 Mechanical Line Leak Detector. Model: FI Electronic Line Leak Detector. Model: [3 Electronic Line Leak Detector. Model: FI Tank Overfill / High-Level Sensor. Model: [3 Tank Overfill / High-Level Sensor. Model: FI Other (specify equipment type and model in Section E on Page 2). FI Other (Sp, e¢if~, equipment type and model in Section E on Page 2). Dispenser ID: [ - iX).. ~ txl ~1. Dispenser ID: '~- ~ E 1'4 '~ ~Jispenser Containment Sensor(s). Model:~O~ O.,O..OOOO %O [il'"~spenser Containment Sensor(s). Model: [~gtCY~ ~'"Shear Valve(s). [l~"hear Valve(s). 21 Dispenser Containment Float(s) and Chain(s). F! Dispenser Containment Float(s) and Chain(s). Dispenser ID: ~ - & Eq~d '~1., Dispenser ID: ':] ' t~ ~' L. [i~lSispenser Containment Sensor(s). Model: ~lqO2.~ ~2ODOOIO []~D'lspenscr Containment Sensor(s). Model: ~C12.~'~2OOOO I~(h__ ear Valve(s)._ [~S'~ear Valve(~). FI Dispenser Containment Flo~t(s~ and-Ch~ain(~. - -- 'FI DispS~nseFC0ntainment Float{s) and Chain(s): Dispenser ID: Dispenser ID: F1 Dispenser Containment Sensor(s). Model: FI Dispenser Containment Sensor(s). Model: 121 Shear Valve(s). D Shear Valve(s). FIDisPenser Containment Float(s) and Chai,n~s). [21 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 Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attach~ed a copy of the report; (check all that apply): ~-Kyst_em set-up. ~ Alarm hist?ry report Technician Name (print): 121[")[:L. C~q¢.~,t..cO . Signature: ~'('~Lfit restingCompanyName:' {'~-o~zd~'~. ,v.~". '' Phone:No::( S~D t )~? Site Address: (.~3~ 12) 17xOc~ t2~ C'~ [-~,-~ -~"W~ Date of Testing/Servicing: Page I of 3 03/01 Monitoring System Certification D~ Results of Testing/Servicing I Sof~are Version Installed: Corn )lete the followingchecklist: [~/~s t221 No* Is the audible alarm operational. [il~fes [21 No* Is the visual alarm operational? ~Yes '[221 No* Were all sensors visually inspected, functionally tested, and confirmed operational? [~l'~'es in No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper .operation? in Yes in No* If alarms are relayed to a remote monitoring station, is all communications .equipment (e.g. modem) Q N/A operational? li~es [21 No* For pressurized piping systems, does the turbine automatically shut down if tlle piping secondary containment [21 N/A monit6ring system detects a leak, fails to operate, or is electrically disconnected? If yea: which sensors initiate positive shut-down? (Check all that apply) I~}~-'~mp/Trench Sensors; ~ispenser Containment Sensors. Did you cont'um positive shut-down due to leaks and sensor failure/disconnection? [~lat'es~ in No. [~'~Yes in No* For tank systems that utilize the ~onitoring system as the primary tank overfill warning device (i.e. no __~ ~[;;I_N_ ~A_ i_mech_anicaL0.ve_rfill.prev, ention_~alv, e_is_installed),_is the~overfill_waming_alarm-visible~and.aud/ble~at-tho-tank- fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? c-tO % ~ Yes* I~ No Was any monitoring equipment replaced? If yea, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts ia Section E, below. ~l~Yes* [21 No Was liquid found imide any secondary containment systems designed as dry systems? (Check all that apply) [;;I Product; [~q~ater. If]tea, deacn'be causes in Section E~ below. ~Yes l;l No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable ~es in No* Is a.!l mon/toring equipment operational.per,manufacturer's sp.ecificafions? · In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Po.rf~'~> C)tgT Page 2 of 3 03101 E. In-Tank Gauging / SIR Equipment: Cl Check this box if tank g g is used only for inventory control. ,~ ~ Check this box if no tank gauging or SIR equipment is installed. This~¢fion must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Corn ~lete the followingchecklist: ~Y~s' ~ NO* Has all input wiring been inspected for proper entry and termination, including testing for ground faulis? Ii,Yes FI No* Were all tank gauging probes visually inspected for damage and residue buildup? ~Yes Fl No* Was accuracy of system product level readings tested? [~t/Yes Fl No* Was accuracy of system water level readings tested? Ill/Yes Fl No* i Were all probes reinstalled.properly? " · I~t~Y~s 121 No* Were.all items on the equipment manufacturer's maintenance checklist completed? ' * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): [il~Check this box if LLDs are not installed. Complete the following ,checklist: ...... [1 Yes r-I'No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? Fl N/A (Check all that apply) Simulated leak rate: Fl 3 g.p.h.; Fl 0.1 g.p.h; Fl 0.2 g.p.h. Fl Yes [J No* Were all LLDs confirmed operational and accurate within regulatory requirements? Fl Yes- ~! No* Was the testing apparatus properly cah'brated? r-1 Yes FI No* For mechanical LLDs, does the LLD reslxict product flow if it detects a leak? Fl N/A Fl Yes FI No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak? "' Fl Yes Fl No* For electronic LLDs, does the turb~e automatically shut off if any portion of the monitoring system is disabled Fl N/A 'or disconnected? ...... FI Yes Fl No* 'For electronic LLDs, does ,the. turbine automatically shut off if any portion Of the monitoring system Fl N/A malfunctions or fails a test? Fl Yes Fl No* For electronic LLDs, have all accessible wiring connections been visually inspected? Fl Yes Fl No* Were all items.°n the equipment manufacturer's 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 o3/ot Monitoring System Certification UST Monitoring Site Plan Site Address: c~O~ Cf~rn,~O i-c}~ ....... ~. ~ ....................................... ............................~ ~~<~- .~a~- · ~XP. .~ . . ............... I I ...... ~ ..... -. · ~c . . ~'~' ' ' ...................... . .............. ~.~,. Date map was drawn: ~,~ /hO / O~-. Instructions, If.you already have a diagram that. shows all required information, you may include it, rather than this page, with your Moni'toring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system.control panels; Sensors monitoring tank annular spaces, sumps, al!spenser pans, spill containers, or other secondary containment areas; mechanical or. electronic line'leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note'the date this Site Plan was prepared. Page __ of__ 05/00 BROOKS 1 DE 8:90,'3, OAr'11 NO BRF. ERSF 1 ELD CA. 9:3308 DEC 14.. 201_-Il 10:38 AI't ALL FUNOT I CH'iS i,IORI"IAL I I',IVENTOR'¥' REPORT ~ T 1 :UI',ILE~DED V,'3,LUIdE = 9'74E~: (]ALS LII.,LRGE = 10:334 GAI.B 90% ULLAGE= 8:325 ,.;;~[.S TO VOLUNE = 9714 GALS HEIGHT = 62.29 INCHES t,,JATEt~ VOL = 0 GALS I,.,I&TER = 0.00 INC:HES TEI"IP = 65.0 DEG F I' 2: PREi"I I tJl'l VOLIJI'.tE = 54:32 (_-;ALS ULLRG£ = 6609 90% ULLF~C;E= 5404 TC VOLIJI'tE = 5396 G~LS HEIGHT = 58.85 INCHES HRTE~ VOL = 15 H&TER = 1,08 TE~'IP = 69.3 T :3:DIESEL ',,/OLU?IE = 11:.?,4 G~LS ULLAGE = 68_93 E;~LS 90% ULLAGE= 6CIgKI GaLS TO VOLUP1E = i 128 GALS NEIGHT = 25.37 INCHES [4~TER VOL = 0 GaLS 14¢~TER = 0. i]l] [NCHES TENP = 71.6 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 {3Vt}~lr,~t~. lit{d' ~ ~ Ot~ INSPECTION DATE ADDRESS ~_g t~tl/~t~t,O I./Redt&'_ PHONENO. 6~6, t- FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBEROF EMPLOYEES 3 25 __, Section I: Business Plan and Inventory Program {~] Routine '~l Combined [~ Joint Agency [~ Multi-Agency ~,~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact inforraation 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 Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~] Yes [~No Questions regarding this inspection? Please call us at (66 I) 326-3979 ~ Busi ~sponsi~lefarty White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: _.LffffZ.et v [~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~ .I'O_~__~t .~d- ~ -~ ~o~S INSPECTION DATE [ ~[14t~i Section 2: Underground Storage Tanks Program I~l Routine [~l Combined ~l Joint Agency [~l Multi-Agency [21 Complaint [21 Re-inspection Type of Tank DLoFr....S Number of Tanks ~2> Type of Monitoring a/.lt, x Type of Piping Ol~F- 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 V=Violation Y=Yes N=NO Inspector: ,- . Office of Environmental Services (805) 326-3979 '~ B sible Party White - Env. Svcs. Pink - Business Copy CERTIFICATE OF INTEGRITY THE UNDERGROUND STORAGE TANKS LOCATED AT Exxon 8803 Camino Media, Bakersfield, California THE GUIDELINES OF THE STATE OF CALIFORNIA REDWINE- MANLEY TESTING SERVICES, INC. ON THIS THE 25th DAY OF January X~ 2001 ATTESTED BY ]~r~ w. Hinsle¥ For questions call Redwine Testing at 1-800-582-6368 JOB NU'~BE ~ ' ~'~'' CUSTOIIER ;( c0M~ANi:'NAME ) CUSTOMER CONTACT(LAsT,-FIRST)~ JERRY. ' ' ,. ADDRESS - LINE' 1 : - '' ADDRESS - LINE 2 CITYT. SIA,E : BAKERSFIELD~ CA, ZIP CODE .('XXXXX-XXXX) .~: .' PHONE N~MBE.R (XXX)XXX-X×XX : 201-'3707 ' *~***** C 0 M M E N T L ,I N ~'S'******* -' NSW CONSTRUCTION. , ******* ~ I T E D A T A ******** SITE'NAME (COMPANY. NAME) : EXXON . · SITE CONTACT,ILAST~ VV~ST) : '" ADDRESS - LINE 1 : 8803 CAMINO MEDIA AD.R~,~ LINE 2 CI'£Y~ S'fAT'E ' :. BAKERS~_ELD; ZIP CODE (XXXXX-XXXX) ~' 93388 PHONE NUMBER (XXX)XXX-XXXX GROUND }lATER LEVEL (PT) NU}iBER OF ?ANKS : 2 LENGTH OF PRE-TEST' (MTN) : 30 -. LENGTH OF ~ES? (MIN) : 240~ ~- -', T A N K D A T A . · ~ · "TANK N0.~ ~ TANK NO. TANK NO. TANK NO. -'' .. 1 -~ ,' 2 3 4 TANK D;[AHETER (IN 128 128 .- LENGTH (FT) '. ~ 17~, 95 29.92 , VOLUME (GAL) 12~O ~ 20000 TYPE ST .ST FUEL LEVEL (IN) 95 95. FUEL TYPE SUP UNLD REG ~'.~LD " dVOL/dy (GAL/IN .104,42 174.0'4 CALIBRATION ROD DJ:STANCE '.' 2 26,95313 : 3 41. 9375~ '" - 4 56,93750 5 74. 93750 iNV0tlCE:'tLAooo't4'7 .~ TEST DATE', O1/25/6~1 -' .-'".REDWINE TESTING SVC., I'NCo · '.. · / P.O. BOX 1567 ' BAK~R,_FIELD, CA. 93302 · TANK STATUS EVALUATION REPORT ~*~* CUSTOMER'DATA ***~* ***** 'SZTE iDATg D&J CONSTRUCTION· ~XXON ' 8803 CAM'!NO MEDIA BAKERSFIELD, CA . BAKERSPIELD, CA. ~3308 C6NTAC'T':-JERRY CONTACT: PHO'NE~ g~ 201~3707 PHONE #, COMMENT "~' cONST UCTrON. CURRENT E~A STANDARDS_ , ' THAT FoR UNDERGROUND'FUEL'.TANKS~ THE MAX~U~ ALLOWABLE LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR TANK #!: SUPER.uNLEADED TYPE~ STEEL RATE~ 023209 G.P.H,. GAiN TANK IS TIGHT. TANK'#2: REG. UNLEADED TYPE: STEEL RATE: .033699 G.P.H. LOSS TANK iS TIGHT. *'**~*** C U S O M E R '-D .A T A ****** ~ JOB.-MBER ' :: ~0~!47 " - CUSTOMSR-(COMPANY NAMEi .... : D&J CONSTRUCTION .' ' '- CUSTOME'R~.,~O~TACT(LAST FIRST): JERRY ' ' ' ' ADDRESS'--LINE 1 . . · .: :' ADDRESS - LINE '2 " : CITY, 'STATE : BAKERSFiELD~ CA. '' : ZI'P 'CODE (XXXXX-XXXX) , PHONE NUMBER (XXX)XXX-xxXx : 201-3707 · ..~**~*** .C O M M E .N T L i N E S'~**~** NEWCONSTRUCT.I'ON. ******* S I T E D'A T A SITE NAME (COMPANY NAME) : EXXON' SITE CONTACT(LAST~ FIRST) ADDRESS - LINE 1 ~' 8803 CAMiNO MEDia ADDRESS - LINE 2 : CITY~ STATE ' : BAKERSFIELD~ CA.' 'ZIP CODE (xxXxx-xxxx) ~ 93308 pHONE NUMBER (XXX)XXX-XXXX GROUND WATER LEVEL (FT) : 0 NUMBER 0F T.ANKS ~ 2 L~NGTH OF PRE-TEST (MIN) "30 LENGTH OF TEST (MIN) : 240 *~***** T A N'X D A T A ******** ThNK' ~0. T~K NO.' T~ ~0. T~K NO. .i 2 · 3 4 TANK DIAMETER (lAN) 128 128 LENGTH (FT).. 17.95 29,92 .~ VOLUME (GAL'). 120¢O 200'00 .. 'TYPE ST ST EUEL LEVEL fiN) 95 95 FUEL TYPE SUP UNLD REG UNAD dvoL/dy (GAL/IN) 104.42 174~O~ CALIBRATION ROD DISTANCE ! 10,65625 2 26.9'5313 3 41.93750 4 56,93750 5 74.93750 INVO'ICE'' ~#LA000147 ~ TEST DATE: .~.Ot/25/~ REDW~NE '~' ' SVC~ INC. _ESTING ~ P,O.. BOX 1567 . . BAKERSF~LD,.CA~ 933~2 TANK STATbS REPORT'-- ULLAGE'TEST 8803 CAMI'NO MEDIA BAKERsF~ELDr ..CA.' BAKERSF£Ei,D} CA. 93308 CONTACT: JERRY CONTACT PHONE #': 201-3707 PHONE NEW CONSTRUCTION, CURRENT EPA~ STANDARDS DICTAT~ THAT FOR UNDERGROUND FUEL TANKS THE MA ..... ~Uh ALLOWABLE LEAK/GAIN-RATE OVER THE PERIOD OF ONE HOUR~ IS .05 GALLONS. TANK #1: sgPER' UNLEADED TYPE~ STEEL SN:' -.45 TANK IS TIGHT. TANK #2: RIG UNLEADED TYPE: STEEL 'SN~ -.34 TANK IS TIGHT. JOB NUMBER .... : 000148 CUSTOMER (COMPANY NAME) : D&J CONSTRUCTION ~ CUSTOMER 'CONTACT(LAST~ FIRST): JERR'y ADDRESS - LINE I : ~ ~ ADDRESS - LiNE 2 : -' CITY, STATE : BAKERSF¢.=LD~ ~ ZIP CODE (XXXXX-XXXX) " : '93308 PHONE NUMBER '(XXX)-XXX-XXXX : 201-3707 NEW INSTALLATION'. .. SITE NAHE (COHPANY NAHE) : EXXON SITE CONTACT(LAST, FIRST) ADDRESS - L1NE 1 : 8803 CASINO MEDIA ADDRESS - LINE 2 CITY~ STATE : BAKERSFIELD~ CA. ZIP CODE (XXXXX-XXXX) PHONE NUMBER (XXX)XXX-XXXX GROUND 'WATER LEVEL ('FT)" : 0 NUMBER OF TANKS '' ~ 1 LENGTH OF PRE-TEST (HIN) LENGTH Of:TEST (SIN) = 180 TANK·N0. TANK N0: TANK NO '. ~TANK NO. TANK. DIAMETER. (~IN 128 LENGTH (FT) 11'97 VOLUME'.(GAL) 8000 . TYPE ST '~ FUEL LEVEL (IN) 95 FUEL TYPE DIESEL 2 dVOL/dy"(GAL/IN) '69.61 CALIBRATION ROD DISTANCE 1 10.65625 2 26.95313 3' 41.93750 : 4 . 56.93750 5 74.93'750 iNVO~CE ~LAO~Oi48 "TEST'DATE: O1f25i~l REDWiNE TESTIN~ SVC, ~ .ZNC~ . B~KERSFIBLD~ CA. 93302 ' TANK STATUS EVALUATION REPORT. D&J CONSTRUCTION EXXONTM 8803 CAMINO: HEDIA BAKERSFIELD~ CA. BAKERSFIELD, CA. 93308 CONTACT: JERRY. CONTACT: PHONE ~: 201-3'70'7 PHONY NEW INSTALLATION. CURRENT EPA STANDARDS DICTATE . THAT. FOR UNDERGROgND FUEL TANKS THE MAXIMUM ALLOWASI,~ LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR iS .05 GALLONS. TANE #i: DIESEL FUEL 2 TYPE: STEEL RATE: f$O1766 G.P.H. LOSS TANK IS TIGHT. ' '****'*** C U S T 0 M.,E R ' D A-T A ****** ' JOB "NU~BE~ ~). CUSTOMER (COHPANY NA..-i~ · :'..Da'J CoNsTRUCTION -'~ CUSTOMER CON, TAC. T(LAST, FiRsT'): JERRY ADDRESS '- LINE 2 CITY~ .S.TATE · : BAKERSF!ELD~ CA. ZIP CODE ('XXXXX-XXxx) ' .~ ,93308 PHONE NUMBER iXXX.)XXX-XXXX : 201-37~7 · ***'*** C 0 M M E N T L i'N E'S **~**** INSTA~,LATION. NEW * ~ ~**-***~ S i. T E D A T A ****~*~* SITE NAME (COMPANY NAHE) : EXXON SITE CONTAC~(LAS~ ?IRST~ : ADDRESS = LINE-1 . : 8803 CAM.iNO MEDIA ADDRESS -'LINE 2 "'" ~' ~ CA CI'£Y~. ~ATE : BAKER,~F!E.~D ZIP CODE (XXXXX-XXXX) PHONE NUMBER (XXX~vv'' GROUND.WATER LEVEL (FT) : 0 NUMBER OF TANKS : 1 LENGTH OF PRE-TEST (MIN) ~ 30 ' ' LENGTH OF TSST (I{iN) ' : 180 TANK NO. TANK NO. TANK NO, TA~K NO. i 2 3 4 TANK DIAMETER (iN-) 128 'LENGTH (FT)' ' 1'!.97 'VOLUME .(GAL) 8000 TYPE ST · FUEL .~EVELI ' (IN%,. 95 FUEL TYPE DIESEL 2 dVOn/dy (GAL/IN) 69.61 CALIBRATION ROD DISTANCE 2'0°65.625 2 26°95313 3 41.93750 4 56~93750 5 74.93750 iNVOICE '#LA000148' .. : TEST DATE: REDWIN~ TESTING SVC~ INC. BAKERSFiELD~ CA. 93302 - ' ~ TANK STATUS'REPORT -- ULLAGE TEST D&J CONSTRUCTION EXXON 8803 CAMINO MEDia' BAKERSFIELD, CA. BAKERSFIELD, ca' · 93308 CONTACT: ,,ERRY CONTACT PHONE #: 201-3707' PHONE ~: ***** COMMENT LINES NEW INSTALLATION, .CJRREN~ EPA STA!~DARDS 'D~£CTATE THAT FoR UNDERGROUND ~"~ TANKS THE 1.{AXIMUM ALLOWABLE'LEAK/GAIN RATE OVER THE PERIOD OF ONE HOUR iS .05 GALLONS, TANK #i: DIESEL FUEL 2 ' TYPE: S'TEEL ON: -.51 .TANK ~o ~TGHT. REDWINE TESTING SERVICES, INC. P.O. BOX 1567 AES PLT - 10OR' BAKERSFIELD, CA 93302 (661) 326-0446 NAME: Exxon LINE # 1: DSL TECHNICIAN: Bruce W. HInsley ADDRESS: 8803 Camlno Media LINE #2:89 UL LICENSE NUMBER: 90-1069 ' CI1Y, ST: Bakersfield, CA LINE #3:92 UL TEST DATE: 1/25/01 THE CO~'A/ERSION CONSTANT IS FOUND BY: [60 MIN/HR) / [3790/MIL/GAL) = 0.0158311 (MIN/HR) [GAL/MIN) Divide the volume dffe~entlal by the test time {15 minutes) and m,jffi'~y by 0.0158311, which will conved the volume difefenflal horn mllilffe~ r~-ar ,'ninute fo gallons pe~ hour. ]he conversion constant causes the milllffers and minutes fo car~:~ out. I:lklL~ VUL PRODUCT 11ME PSI START VOL (ML) [ML) TEST VOL DIFF. (ML) GPH GAIN/LOSS PASS FAIL DSL 10:15 50 220 115 5 -0.005 x DSL 10:30 50 115 112 3 -0.003 x COMMENTS: PRODUCT TIME PSi START VOL [ML) (ML] TEST VOL DIFF. [ML] GPH GAiN/LOSS PASS FAiL 89 UL 13:15 - 50 195 186 9 -0,009 x 89 UL 13:30 50 1 ~-~. 1 78 8 -0,008 x COMMENTS: PRODUCT TIME PSI START VOL (ML] [ML] TEST VOL DIFF. [ML] GPH GAIN/LOSS PASS FAIL 92 UL 13:50 50 190 186 4 -0.004 x 92 UL 14:05 50 186 183 3 -0.003 x COMMENTS: C February 6, 2001 Jeffries Brothers Petroleum Distributors FIRE CHIEF Hwy 46 & F RON FRAZE Wasco Ca 932g0 ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 RE: Rolling Power Outages VOICE (661) 326-3941 FAX (661) 395-1349 Dear Sirs: SUPPRESSION SERVICES 2101 "H" Slreet Bakersfield, CA 93301 With the threat in California of continued rolling power outages now, and VOICE (661) 326-3941 in the immediate furore, this office requests your assistance. FAX (661) 395-1349 PREVENTION SERVICES This office is requesting that if, "during a fuel drop," the power goes out 1715 Chester Ave. Bakersfield. CA 93301 due to rolling power outages, that you immediately stop dropping fuel voice (661) 326-3951 until power is restored. FAX (661) 326-0576 ENVIRONMENTAL SERVICES AS yOU are aware automated monitoring systems' will be off line during a 1715 Chester Ave. Bakersfield, CA 93301 power outage, which couldcompromise safeguards. VOICE (661) 326-3979 FAX (661) 326-0576 To ensure the safety of both human health, and the environment, we TRAINING DIVISION request that you make this part of your policy. 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661)399-4697 Should you have any questions, please feel free to call me at 661-326- FAX (661)399-5763 3190. Sincerely, Steve Underwood, Inspector Office of Environmental Services SBU/dm ~ CITY OF BAKERSFIELD / OFFICE OF ENVIRONMENTO SERVICES ,'~ r 1715 CheSter Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY VCPE OF ACTION ~ (Chec~ one ,1em only) .,. l. NEW SITE PERMIT [~ 3. RENEWAL P~RMIT [] 5. CHANGE OF INFORMATION (,.,~0~-,~ c/'~nge - [] ?. PERMANENTLY CLOSED SITE [] 4. AMENDED PERMIT /ocal u~e onty). [] 8. TANK REMOVED 400. [] 6. TEMPORARY srl'E CLOSURE I. FACILITY I SITE INFORMATION BUSINESS NAME (Same a~ FACILITY NAME ~' DBA - -- -- A~) 3 FAClU'~ID# I / . I I . /,, , I , / .~EsT c.oss smE~ ,o1.F^C,Lr~ ow.E. ~PE [],..oc~. [] 2. ~NDNIDU~. [] a. STA~E AGENCY'' aUS~NESS J~]'~.C_~SSTAnON [] a.F~ [] $,COMMEECUa.. [] ~. PA~TNERSHtP [] ?. FE~ERN. ACCaNC~, 4e2. TOTAL NU~ER OF TANKS ~ f~l~ ~ I~ R~ ~ T~K O~ER~ 414.J R O. g 6 Cl~ 417. j STA~ 418. ~P~ 41g. ' ' vi. LEGAL NO~FICA~ON AND MAILING ADDREss ,. :'":" r SIG~T~E OF ~1~ ~ OA~ 424. ~ ~NE 4~. UPCF (7~99) S:\CUPAFORMS~wrc~a.wpd CC' oillllltc 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 · UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page ~ of ~ TYPE OF ACTION {~ 1. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE (Check one ~tem only) [] 7. PERMANENTLY CLOSED ON SITE [] 3. RENEWAL PERMIT (Specify reason, for local use only) (Specify change - for local use only) [] 8. TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FAClUTY ID # ~ 1 LOCATION ~THIN SITE (O~tlonel) 431 I. TANK DESCRIPTION TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes ,~ No 434 DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 Au4. p..r)no Zo, o ADDITIONAL DES(~IPTION (For ~caruse only) 438 v #. TANK CONTENT$ ' : ' ' TANK uSE ~39 ,~w.O, "UM WPE ~ 4~0 ,J~l. ~TOR~HIC~ FUEL ~1". ~GU~ UN~ED D 2. L~ED D S. JET FUEL ~ 2. NON-FUEL P~RO~U~ ~ lc. ~IDG~E UN~ED ~ 4. ~HOL ~ ~. OTHER ~ ~. CHEMI~ PRODU~ COM~N ~ (~m Ha~us ~s In~n~ ~ge) ~1 ~S ~ (~m Haza~ Mate~als Inven~ pa~) ~2 ~ 4. H~US WA~E (l~s U~d ~) ~ OF T~K ~ 1. SING~ W~L D 3. SIN~ W~ ~ ~ 5. SIN~ W~ ~ I~ER~ B~DER SYSTEM 'Ch~k One ~m o~) ~ ~ ~UBLE W~L ~R ~MB~E LINER ~ ~, UN~ ~ 4. SIN~ W~L IN A VAULT ~ ~. O~ T~K~TER~-pdm~k ~ 1. ~ESTEEL ~ 3. FIB~G~SSIP~S~C D 5. ~NC~E ~95. UN~O~ Checkone~mo~) ~ 2. STAINLESS STEEL ~ 4. ~EEL~W~IBERG~ ~ 8. FRP~MPATIB~W/I~%M~OL D~. OTHER ~INFORCED ~STIC (F~) TANK ~TERIAL - ~da~ ~. ~E ~EEL ~ 3. FIB~SS / ~STIC ~ 8. FRP ~ATIB~ W/lffi% M~HA~L ~ 95. UN~ ~5 Check one ~m o~) ~ 2. STAIN~SS S~EL ~ 4. ~L ~ W~IBERG~SS 9. F~ ~ODIBLE JAC~ ' ' ~ ~. OTHER ~INFORCED ~STIC (FRP) ~ 10. ~ATED D s. ~E T~K I~ERIOR LINING ~ 1. RUBBER LINED ~ 3. E~ LINING ~ 5. ~ UNING D 95. UN~O~ ~6 DATE INSTALLED OR ~ATING ~ 2. ~D LINING ~ 4. ~MC LINING ~ 6. UNLINED ~ ~. O~ER ~ (Ch~k o~ ~m ~) (~r ~al use on~) OTHER ~OS~N ~ 1. ~NUFACTURED ~OOlC ~ 3. FI~G~ ~INFORCED ~IC ~ ~. UN~ ~8 DATE IN~ALLED ~9 PROTECT~N IF ~OTE~ION ~ 4. I~SSED CURRE~ ~ ~. OTHER 'Check One ~m o~) ~ 2. ~CRIFIC~L ~DE (For lo~l use only) SPILL AND OVERFILL Y~ INSTALLED 450 ~ (~r~cal uso only) 451 OVERFILL PROTE~ION EQUIPME~: Y~R INSTALLED 452 IF SIDLE WALL TANK (~eck all ~at apply): 453 IF ~UBLE WALL TANK OR TANK ruTH B~DDER (Check one ~em only): ~ 1, VISUAL (~SED ~N ONLY) ~ 5. ~UAL T~K ~UGING (~G) ~ 1. VISU~ (SINGLE WALL IN VAULT ONLY) ~ 2, AUTO~TIC T~K ~UGING (ATG) ~ 6, V~SE ZONE ~ 2. ~INUOUS I~ERSTITIAL ~NITORING ~ 3. CONTINUOUS ATG ~ 7. GROUNDWATER D 3, ~u~ ~NITORING ~ 4. STATISTI~L I~E~ORY RE~NCILIATION (SIR) + ~ 8. TANK TEEING BIENN~ T~K TESTING ~ ~, O~ER V. TANK CL~URE INF~MATION I PER~NENT CLOSURE IN P~CE ESTI~TED DATE ~ST USED (Y~/DAY) 455 ESTI~D QU~ OF SUBST~CE RE~INING 4~ T~K FILLED ~TH INERT ~TERIAL? 457 UPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPO CITY OF BAKERSFIELD ~ OFFICE OF ENVIRONMENTAL SERVICI 1715 ChaRter Ave., Bakersfield, CA 93301 (661) 979 us'r · TANK PAGE 2 Page o~ _ tJ UNDERGROUND PIPING ABOVEGROUND PIPING . i SYSTEM TYPE J~ 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 [~05. UNKNOWN ,j~ [] 2. DOUBLE WALL [] 99. OTHER ',~.UF^CTURER /"l' O ~:~ I'T'Yt '~Ol ~NUFACTURER [] 1. 8ARE STEEL ~ 6. FRPCOMPATleLEWI100% METHANOL [] 1, 8ARESTEEL [] 6. FRPCOMPATIBLEWlI00% METHANOL MATERIALS AND [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL r'~ 7. GALVANIZED STEEL CORROSION PROTECTION [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99, OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HOPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL WI 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 that apply): PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3, ANNUAL INTEGRITY TEST (0.1 C-.-.-.-.-.-.~fl) [] 3. ANNUAL INTEGRITY TEST (0.1 ~) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INT~GRITY [] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9. BIENNIAL INTEC-.-d:~ITY TEST (0.1 GPH) [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPf. I) SECONDARILY CONTAJNED 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 ,~ec~ one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAl_ A~,RMS AND (chec~ one) J~J' a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR · · RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 'GPH) [] 12. ANNUAL INTEGRI'I'Y TEST (0.1 GPH) SUCTiON/GRAVITY SYSTEM: ~ SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check ~J that apply) EMERGENCY GENERATORS ONLY (Check e8 that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WlTH~)I,IT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [-] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WlTHQI, JT FLOW SHUT OFF OR [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [~] 4. DALLY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR +AUOIBLE AND VISUAL ALARMS [] S. TRENCH LINER I MONITORING ~ '"" ('~ (~ ~' 3. CONTINUOUS DISPENSER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6, NONE 469 IX. OWNER/OPERATOR SIGNATURE I certify Ihat the informatl¢~ provided herein is. Ip.l,e"Amd accurate to the best of my knowledge. ( S~__~/A~R'-*~O F O~¢VNJ~ R~O PEFU~O R_ /~" DATE 470 NAI~[OF OWNE-R~'OPERA~',OR (pJ'l_nty. Z 471 TITLE OF OWNERIOPERATOR 472 · UPCF (7/99) S:\CUPAFORMS~SWRCB-B.WPD ;~~ CITY OF BAKERSFIEL~iI ~ ,,, ,.~"i' O~CE OF ENVIRONMENTAL ~ERVICES ' 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ' UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page ~ of TYPE OF ACTION ,~ 1. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE (Check one ~tem only) [] ?. PERMANENTLY CLOSED ON SITE [] 3. RENEWAL PERMIT (Sl~ecEy mason, for local uso only) (Sl~eci'ly change, for local use only) [] 8. TANK REMOVED 430 LOCATION WITHIN SITE (Optional) 431 I. TANK DESCRIPTION TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK "~Ye~ [] No 434 m~r~) I Dh '~ "~ ~ ~"~ if -Y,-. ~plete ~e page f~ ,~ ~pa~m~t. DATE INSTALLED (Y~) 435 T~K ~ACI~ IN ~ONS ~6 NUMBER OF COMP~T~NTS 437 ADDITIO~ ~ES~RI~ION (~r ~1 use on~) 438 IL TANK CONTENTS ', ' ' ' ' TANK USE 439 PETROLEUM TYPE 440 (~1. MOTOR VEHICLE FUEL la. REGULAR UNLEADED .' 2. LEADED 5. JETFUEL [] [] Ifmarked, coml~etePettoleumType) '~11~. PREMIUM UNLEADED ]2~(~00 [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT [] 4. HAZARDOUS WASTE (Includes COMMON NAME (Imm Hazat'~ous Materials Inventory page) 441 I CAS # (ft~m Hazardous Materials Inventoql page) . 442 Used 0~) [] 95. UNKNOWN TYPEOFTANK [] 1. SlNGLEWALL [] 3. SlNC_*:*:*:*:*:*:*:*:~EwALLwITH [] $. SlNGLEW, A/.C WITH INTERNAL BLADDER SYSTEM 443 fCheck one item EXTERIOR MEMBRNdE LINER E] 95. UNKNOWN DOUBLE WALL '~* ' [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL pdmary tank .~ 1. BARE STEEL [] 3. FIBERGLASS I PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBER~S [] 8. FRPCOMPATIBLEW/100%METHANOL []99. OTHER REINFORCEO PLASTIC (FRP} TANK MATERIAL'secendafytank E] 1. BARE STEEL I--1 3. FIBERGLASSlPLASTIC ,~1~'8. FRPCOMPATIBLEW/100% METHANOL 1--J95. UNKNOWN 445 'Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FRPNON-CORRODIBLEJACKET '' D99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] s. CONORE'rE TANK INTERIOR LINING r-I 1. RUBBER LINED [] 3. EPOXY LININ6 r-I 5. GLA~$ LINING [] 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING r'] 2. ALKYD LINING [] 4. PHENOUC LINING ~ 6. UNLINED [] 99. OTHER __ Check one item oniy~ (For local use only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER Check one item only) [] 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TY~E (For local use only) 451 OVERFILL PROTECTION EOUIPMENT: YEAR INSTALLED 452 ~ 2. DROPTUBE , ~'"'~0~ [)~k) ~.~"~O [] 2. BALLFLOAT []4. EXEMPT [] 1, VISUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (MTG) [] 1. VISUAL(SlNGLEWALLINVAULTONLY) [] ~. AUTOMAT,C TANK ~UG,"O ~ATGI [] ". VADOS~ ZO.E I .Ig' ~. CONT~,UOUS,NTE,ST,T,AL ~N,TOR,.~ [] ~. CONTINUOUS ATG [] ?. GROUNDWATER I [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) 4. [] 8. TANK TESTING BIENNIAL TANK TESTING [] 99. OTHER I ' V, TANK CLOSIJEE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTFrY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 45? gallo~a [] Yes [] No UPCF (7~99) S:\CU PAFORMS\SWRCB-B.WPD ~ ; OFFICE OF ENVIRONMENTAL SERVICI 5 Chester Ave., Bakersfield, CA 93301 (661) 3979 UST. TANK PAGE Page VI; PIPING CQNGTRUCTION (Check e# mat ap/y) '- UNDERGROUNDPIPING ABOVEGROUND PIPING .j~ / ~ SYSTEM TYPE [;~ 1. PRESSURE [--~. 2. SUCTION [] 3. GRAVITM 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTiOi~I[] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTUREI~!~' 2. DOUBLEWALL I~L95. UNKNOWN ,~ [] 2. DOUBLE WALL ~]99. OTHER MANUFACTURER /~ .O' 5; r~ FFI~ ~,~ MA.UFACTURER 463 [] 1. 8ARE STEEL ~r6. FRP COMPATIBLE WI100% METHANOL [] 1. BARESTEEL [] 6. FRP COMPATIBLE WI 100% METHANOL MATERIALS AND [] 2. STAINLESS STEEL r~ 7. GALVANIZED STEEL [] 2. STAINLESS STEEL r-~ 7. GALVANIZED STEEL CORROSION PROTECTION [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HOPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHO01C PROTECTION [] 5. STEEL WI COATING [] 9. CATHOOIC PROTECTION 464 [] 5. STEEL W/COATING [] 95. UNKNOWN 465 UNDERGROUND PiPiNG A~OVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check a//that app,): PRESSURIZED PIPING ('Check e//~et [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 OPH TEST WITH AUTO P~MP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL Al. ARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST I--I 3. ANNUAL INTEGRITY TEST (0.1 [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: CONVENTIONAL SUCTION SYSTEMS (Check eli t~at [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [] 6. TRIENNI~M. INTEGRITY TEST (0.1 GPI~) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING C,~L~VITY FLOW: GRAVITY FLOW (C/~ck e//~at [] 9. BIENNIAL iNTEGRITY TEST (0.1 GPH) I'""1 B. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING SECONOARILY CONTAINED PIPING PRESSURIZED PIPING (Check e//that ap.o/y): PRESSURIZED PIPING (Check e//~et ap,o/y): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (C, he~:~ one) 10. CONTINUOUS TURBINE SUMP SENSOR WITH. AUDIBLE AND VISUAL ALARMS AND (chad< 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 FOP, LF_A~S, SYSTEM FAILURE ANO SYSTEM DISCONNECTION DISCONNECTION [] c, NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR ., RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL AI.A~V~ EMERGENCY GENERATORS ONLY (Check ail Itmi ,pp~y,I EMERGENCY GENERATORS ONLY (Check ~/Ihat [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITH~¥T AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK D.~TE,,STALLED '" D ~. CONT,,UOUS D,S~.SEN PAN SENSOR · ^UO'~-E ANO VISUAL ALARMS [] S. TRENC. U.ER / ~.ITOR,"G ~ ' ~_ b ~3. CONT,.UOUS D,S~.SER PAN SENSOR W~ AUTO SHUT OFF FOR D,SPENSER · AUDIELE ANO VISUAL ~RMS [] ,. ,ONE IX. OWNER/OPERATOR SIGNATURE I ~ify_tl~aL~,~ information provided I~etn is Irue a~d accurate Io the best of my knowledge. NAME OF O~/VNER/OPERATOR (prin~Y'~ ~/'~ 471 TITLF~F OWNER/O~ TOR 472 UPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPD !_. CITY OF BAKERSFIEL~i O~CE OF ENVIRONMENTAL ~ERVICES ~ 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ' UNDERGROUND STORAGE TANKS - TANK PAGE I Page ~ of TYPE OF ACTION .~1. NEWSITE PERMIT [] 4. AMENDED PERMIT E] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE (Check one item only) [] 7. PERMANENTLY CLOSED ON SITE [] 3. RENEWAL PERMIT (Sl~ectly mason - for local uae only) (Specify chatlge - for local usa only) [] 8. TANK REMOVED 430 °''' °''''-''' .... I. TANK DESCRIPTION o9, ,,.¥... =,,,,,,,. o,,. ,,,,. ,,,- ,,,,,:,, ,,,,,,,a,-,,,,,,,. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 zo, ooo Z ADDITIONAL DESCRII~"rION (For local uae only) 438 IL TANK CONTENTS · ' TANK USE 439 PETROLEUM TYPE 440 (/~fml. MOTOR VEHICLE FUEL la. REGULAR UNLEADED 2. LEADED 5. JET FUEL [] [] [] o,*e,~, oo,,ao~. ~ou,,, r~) [] ,b. ~M~UM U,LE~ED ,E(~. D~ESEL {~O'OO [] 8. AWTION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MI•GRADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (from HazatOous Matetfals lnventory page) 441 CAS # (from Hazatdous Materials lnventoty page) 442 [] 4. HAZARDOUS WASTE (IncLudes Usea Ot) [] 9~. UNKNOWN · .. III. TANK CONSTRUCTION ,.. ' ...... ' ' TYPE OF TANK [] 1. SINGLE WALL r"l 3. SINC-:-:-:-:-:-:-:-:-~E WALL WiTH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 * EXTERIOR MEMBRANE UNER [] 95. UNKNOWN Check one item only) 2. OOUI~.LE WALL [] 4. SINGLE WALL IN A VAULT [] '99. 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. FRPCOMPATIBLEWI100%METHANOL []99. OTHER REINFORCED PLASTIC (FRP) TANK MATERIAL-Secondatytank ~ 1. I~,RE STEEL [] 3. FIBERGLASS/PLASTIC ~8. FRPCOMPATIBLEW/100% METHANOL []95. UNKNOWN 445 Check one/tern only) [] 2. STAINLESS STEEL ~. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORRODIBLE .JACKET ' ' [] 99. OTHER ! REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY' LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING [] 9. ALKYD LINING [] 4. I~..IENOLIC LINING J~ 8. UNLINED [] 99. OTHER __ 'Check one nam only) (For focal uae only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 3. FIBERGLASS REINFORCED PLASTIC [] 95.' UNKNOWN 448 DATE INSTALLED 449 PROTECTION iF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER 'Check one item only) [] 2. S4~CRIFIClALANODE .. (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 Chec,,,~,e,,~,y) ~ ,. S,',LLCONTA,,MENT ~-00 ~ 0.~ ~a [] ,. A~M ~ ~ 5. F,.LTUBES,UTOFFVALV£g" 00 ~,. DROPTUBE g"O~ 0}~0 b~S"O = ,. B'".L FLOAT __ n4.~EM,'T as. ~ZR~KER~TE g'O':' .~ m~Ih IF SINGLE WALL TANK (Check all ~at al~gly): 453 I IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 [] 1. VISUAL (EXPOSED PORTION ONLY) [] 5. MANUAL TANK GAUGING (MTG) I [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 6. VADOSE ZONE g~F 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] 7. GROUNDWATER [] 3. MANUAL MONITORING [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) ,'- [] 8. TANK TESTING BIENNIAL TANK TESTING [] 99. OTHER V. TANK CLO~URE INFONMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MOIDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457' gallon,, [] Yea [] No UPCF (7/99) S:\CUPAFORMS\SWRCB-B,WPD CiTY OF BAKERSFIELD ' ; ,~ OFFICE OF ENVIRONMENTAL SERVIC! - Chester Ave., Bakersfield, CA 93301 (661) 3979 UST Page VI; 'PIPING CONSTRUCTION (~ck ,# mf epply) UNDERGROUND PIPING ABOVEGROUND PIPING /IJ/]~. SYSTEMTYPE I~rl. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 (--I 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION/ [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462. MANUFACTURERI~ 2 DOUBLE WALL [] 95. UNKNOW~ [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER /~, ~)o ~f'~.'t ~" ¥~ 461 MANUFACTURER 463 [] I. BARE STEEL I~ 6. FRP COMPATIBLE WI100% METHANOL r-] 1. BARESTEEL [] 6. FRP COMPATIBLE WI 100% METHANOL MATERIALS AND I r~ 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL CORROSION I -- PROTECTION [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHO01C PROTECTION 5. STEEL WI 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 that al~ply): PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0~. GPH TEST [] 2. MONTHLY 0.2 GPH TEST r"] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 3. ANNUAL INTEGRrT¥ TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: .. CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM TEST (0.1 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GP~) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVFI'Y FLOW (Check all that apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 Gl=H) [] 8. DALLY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING. SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): PRESSUR. IZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND V1SUAL ALARMS AND CONTINUOUS TURBINE SUMP SENS(~R WITH AUDIBLE AND VISUAL ALARMS AND (chec~ one) (C,~ec~ o~e) 10. J~ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] i3. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR · - RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 'Gl'H) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS I-I 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATOR8 ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WTTH(~¥T AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ~MS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WrI'HOUT FLOW SHUT OFF OR I--I 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4.. DAILY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR +AUOIBLE AND VISUAL ALARMS [] $. TRENCH LINER I MONITORING ~' ~)~'~ ~ 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FO" DISPENSER + AUDIBLE AND VISUAL ALARMS [:] 6. NONE 46g IX. OWNER/OPERATOR SIGNATURE ~SIGNATURE.~FI certify mai[ the~.~nfomlatlmOWNER/OPERATORPrOVided ~l~etn i$ true and//~accurate to the best o~ my krlOW~edge. OAT~.~_ (~ -- O 470 NAME OF'OVt2N~R/OPERA'T'o~¥pn~t_) _~ // 471 TIT_J.~ OF OWNER/OPERATOR 472 UPCF (7/99) S:\CUPAFORMS\SWRCB-B.WPD 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 am conditions of the operating permit. The permit holder must notify the Office of Environmental Servic~ within 30 days of any changes to the monitoring procedures, uale~ required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCtL 1. II'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 the Office of Environmental Services must be notified within 24 hours. '~,~{ ~t:>~l//= v~[1 ~ Cttg~ed~ ~,1~ ~,~ t. ~r ,j,,t s ,o'i lls c.t, d2 q/l ~,2,,,I 'P~Fg, 2. Describe the proposed methods and equipment to be used for removing and,properly · sposins of any hamdous substance. I/~44 ? &¥e~- c~ ~b~xl,~dr /O~ $ 3. Descrii~e the loeat'.~ and availability 9fthe required cleanup eauipment in item 2 above. 4. Describe the maintenance schedule for the cleanup equipment: 5. List the name(s) and title(s) of the person(s) responsible for authorizing any work neces~sary under the response plan: Describe thp frequency of,~rf'o~g the monitoring: B. What methods and equipment, identified by name and model, will be used for perComi~ C. l~eseribe the'location(s) where the monitoring will be performed (fadlity plot plan should be attached): ~NJ ~$/ V~4~- r~e D. List the name(s) and title(s) of the people responsible for per~rming the monitoring and/or ~g the equipment: ~ ,I,.¢e~,s , ~¢~,~r ~' Pm;I r~.r4 , g,~. 8~ -m~,.,-i-,.~,..~ E. Reporting Forma~ for monito ~ring: T~ e~: ~,..,,...,+.~ ~.,.t.,.[ M- ;: OC) /9:/"/9, ~/-"~ Piping " ~' " F. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance sehednle but not le~s than every 12 months. '~-~ G. Describe the training necessa~T for the operation of LfST system, including piping, ~ ,the monitoring equipment: /~(_L. ~ff~lo~5 ,c~rg f(4,~ i~-/*aV~e '~ . . ..... :. :' :¥! ::.:[' :)':~:..?"'f~.':v" v>',.'.,':~?,.:$.~.::~:~,:~:,.:;~:,:.....:. " CERTIFICATION OF FINANCIAL RESPONSIBILI~ ~ ~ ~ '~ ~ ~byce~ ~t · ~ ~ ~mpl~ ~ ~ ~ ~n 280~ A~e 3, C~r 1~, D~n 3, TSle 23, ~l~m~ ~e of Regu~t~. ~e ~~ ~ ~ ~~~ ~1 ~i~ ~ ~uir~ b~ Sect~n 2807are ~ ~llo~: IVote: if you are truing ~e ~tate Fund a~ any part of your demonstration of financial responsibility, ~ ~ and 21,OTIIUC'2'ZONH - · · q.. ..... '.. C~OL~XOII OF F3313JICXJbZ, it~FOM~Y. BXZ,X~L~ A. W ~M ' ~k the ~f.te ~ ~ T~ ~ -Fui[ ~ of either the ~ o~r or ~he ~r~tor. C. ~i~ ~ - I~i~te ~i~ State I~ ~t~) are ~i~ r~tbfli~ either as c~t~ in ~he f~r~l ~ ~ IM - List iLL ~ ~ ~rflses of c~ifl ~or f~ivi~ts is~i~ ~r~ge. ~im ~ - List I~tf~ ~r for each ~i~ w~. ~[e: fm~e ~[IW ~r or file ~r aa i~icac~ ~ ~ or ~t. CStite F~) [ea~ bilk.) ~ ~ - l~icmte ~ Of co.rage for e8~ t~ of ~h~l~s). ~im is i~icat~, total ut mt 10~ of fi~iaL' rmtbiti~ for'e~ ~ p~IN - i~tcate the eff~cive date(s) of aLL fJ~iai Mmic(s)., (State F~ c~rage ~ld ~ c~tim as i~ es y~ mintain c~ii~e ~ rnin eLigibLe to c~ti~ ~rticiMtt~ iff the F~.) ~JW ~im - ]~i~te ~ or ~. 0~ the s~fff~ ff~fai ~mfm ~f~ c~ for corr~tJve ~tJ~? (If ~t~ State F~, i~icate ~".) ~i~ ~ - l~Jcate y, or ~. Does the s~ifiN ii--iai MMIm pr~J~ c~erage for ~tt~ thJ~ ~rty c~atiofl? (If ~i~ State F~, J~icate "~".) D. F~iil~ -. Pr~i~ eLL f~Ttity ~/or site ~s a~ /~tfm E. Sl~ B(~ - 'Pr~f~ sig~ture ~ ~te sig~ ~ ta~ ~r or ~retor; ~ title of t~ ~r or ~rator; sJg~ture of virtue or ~ta~ K ~te sJ~; ~ prJflt~ or t~ ~ of ~Jtflfls or ~t8~ (if ~ta~ si~ . Nlm, please pike ~ca~ seal next to ~Ca~'s sfg~ture). ~h4~re to N, IL Cortlf~c~flon: PLease send original to your Local agency (age~y ~o las~ y~r ~f ~mlts). ~ a c~ of the certift~ti~ at ~ fKItl~ or site [lst~ ~ the foe. If ~ ha~ ~tl~ ~ ft~iaL r.~ibiLity r~ir~ts or ~ the Certificati~ of Ff~iaL R~ibi. Lity Fora, please c~tact the State UST CLea~ N~: PeneLtie for FaiLurE to r_~__Ly with Financial IL__~r~. iblLitY Ileaulremnts: FaiLure to c~{y my rflutc fa: C1) Jm~lzf~ ciaimnc eligibility for the State UST Cte~ F~, - (2) LI~ILtW for civil ~Ltifl of ~ to S10,000 ~ttars ~r day, ~r ~rgr~ storage t~, for el~ ~y of vloiitl~ is stlt~ in ArticLe 7, S~tt~ 2S2~.T6(a) of the CaLifornia HeaLth ~ SifeW C~. ~u~-~J1 -'1K ~v. 5~12-97) PO BOX 942879 · (916,) 322-9669 STATE OF CALIFORNIA.. -'~,. i. ~'.-¢-CRAMENTO CA94279-0030 ~ .~-. -. BOARD OF EQUALIZATION UNbl~RG-'ROUN'~D STORAGE TANKI~E RETURN "i '"' BOARD USEONLY i ~uE.ON OR BEFORE 01/2,5/01 FOR OCTOBER - DECEMBER, 2000 4000 USTC RV'J'KO1 TK MT 144-OO6130 BOARD OF EQUALIZATION FUEL TAXES DIVISI01~' MAKECHANGES PO BOX 9428?9 JEFFC0 INC. IFNAMEOR SACRAMENTO CA 94279-6l$] ATTEN: JEFFRIES BROS, INC. ADDRESS P. 0. BOX 640 IS INCORRECT WASCO CA 93280 READ INSTRUCTIONS BEFORE PREPARING 75o HWY 46 GENERAL INFORMATION Every owner of an underground storage tank who is required to obtain a permit to own or operate a tank under Section 25284 of the Health and Safety Code shall pay a storage fee for each gallon of petroleum products placed in thetank. DEFINITIONS Owner is defined to include any person as well as any city. county or district or any agency, including departments thereof. Owner does not include the state government, federal government, or an operator who is not an owner. Petroleum is defined as crude oil or any fraction thereof; which is liquid at standard conditions of temperature (60 degrees Fahrenheit) and pressure (14.7.pog~.ds per squa;re inch).. Underground storage tank means any one or combination of tanks used for the storage of petroleum and located substantially or totally beneath the surface of the ground, including pipes connected to the tanks. ' The fee does not apply to petroleum products placed in underground storage tanks that 1. are located on"a farm or residence, used to store motor fuel for noncommercial purposes and have a capacity of 1,100 gallons or less~ or ...... 2. store heating oil for consumption on the premises where stored. FILING REQUIREMENTS Every owner of an underground storage tank shall file a storage fee return. Tills includes tanks that are temp0rarily empty or not in use. The return is due on or before the 25th day of the month following tl~e end of the reporting period. Late payment results in a penalty of 10% and interest at an adjusted rate established under Section 6591.5 of the Revenue and Taxat on Code. The return must be filed even though, you have no liability for the fee.. .' . .. If you have sold any of your tanks or have moved, please notify this office. If you are 'not the tank owner, .please 'in..dica~e the current owner and their mailing· address on an attachment and forward along with this return.. .'.. : .. INSTRUCTIONS: Ente~ total gallons of petroleum placed into all tanks A B - '. C owned by you in Column A; multiply by the rate in Column B; and , WHOLE ~ RATE OF FEE TOTAL FEE DUE enter that number in Column C. (DO not report on oapa.~lty.). ':'.. , '' GALLONS. . oNLY, (Column A x B) 2. Penalty[multiplyline l; ColumnC, bylO%(.lO)ifpaymentismadea~/e'r ~ , 2. ~_ ' . ~ due date shown above] . ' . . . PENALTY~ 3. Interest of 12% per annum (0.010000 per mor~,th)' -- ' '.'' -." . ' INTEREST 3. is due if payment is made after the due date. ' - -: - · . . : :. . ~hereby~ertif~thatthisreturn~nc~F~d~nganyacc~m.pany~n~schedu~esandstaternen~s~hasbeen . . . . · examinedbyrneandt~thebest~fr~ykn~w~-~qebnd~e~ief~s~a~true~c~rrdctandc~mp/etereturn~ . ' MAKE CHECK OR M(i~qEY ORDER PAYABLE TO THE STATE BOARD OF EQUALIZATION.. ' . ,Nway. s wdte your aCCgu ,nt number ~n yOU? Ch~eCk 0r:~ie~/o,'i:~er~ Ma~a ~.~ i'.h,i~' .d~..~nt for you~' rec°rds~ .,Board of.Equalization Fuel Taxes Di,~ision P.O. Box 942879 Sacramento, CA 94279-6151 Jeffco Inc. Jeffdes Bras, Inc. P.O. Box 640 Wasco, CA 93280 Acct~ 44-006130 **** 4TH QTR 2000 **** Total all Purchases: 1,493,433.00 Less direct Delivery: -310,612.00 Less Kramer Junction: -45,858.00 · 1,136,963.00 Total all Purchases: 1,593,351.00 Less direct Delivery: -310,612.00 Less Kramer Junction: -30,426.00 1,252,313.00 Total all Purchases: 1,233,227.00 Less direct Delivery: -310,612.00 Less Kramer Junction: -53,740.00 868,876.00 TOTAL GALLONS: 3,258,151.00 X.012 0.012 Total Amount Due: $39,097.81 Board of Equalization - ~uel Taxgs Division .~ P.O. Box 942879 Sacramento, CA 94279-6151 Jeffco Inc. Jeffries Bros, Inc. P.O. Box 640 Wasco, CA 93280 Acctft 44-006130 **** OCTOBER 2000 .... Units Units Units Gasoline Clear Diesel Dyed Diesel Site t 750 Hwy 46, Wasco, CA Wasco Warehouse 74,801.00 149,424.00' 45,367.00 Wasco Cardlock 28, ! 06.00 42,730.00 15,672.00 Site 2 228 E Front St, Buttonwillow, CA Buttonwillow Cardlock 29,115.00 121,390.00 0.00 C-Store , 76,357.00 13,707.00 0.00 Site 6 301 Kern ST, Taft, CA Taft Cardlock 16,044.00 4,261.00 0.00 C-Store 44,011.00 3,090.00 0.00 Site 6 102 So Beech Ave, Shafter, CA Shafter Express Cardlock 45,044.00 34,957.00 0.00 Site t0 1224 Hwy46, WASCO, CA Tigermart Cardlock 30,663.00 73,374.00 0.00 C-Store 47,130.00 4,301.00 0.00 Site 12 4700 Coffee, Bakersfield, CA Brookside Market 63,558.00 12,715.00 0.00 C-Store 100,928.00 3,893.00 0.00 Site 635 395 & 88 HWY Kramer Junction, CA Kramer Junction Cardlock 39,587.00 0.00 kramer Junction Retail 12,829.20 0.00 555,757.00 516,258.20 61,039.00 Direct Delivery 0.00 (113,235.00) (244,792.00) Sales >>>>>>>>>>> 655,767.00 403,023.20 -183,753.00 Gasoline Clear Diesel Dyed Diesel Total Purchases >>>>>>>>>>>>>>>> 0.00 112,690.00 253,194.00 535,404.00 385,898.00 206,247.00 535,404.00 498,$88.00~ 459,441.00 Total all Purchases: 1,493,433.00 Less direct Delivery: -310,612.00 Less Kramer Junction: -45,858.00 1,136,963.00 RU~-~: 8i/15,;0!,~i3:5£ z_~'ac, ie RECEIPTS TF,:A."~SACTIO~, REPORT . PAGE 1 DF2 CLEAR CAR= DIESEL -7,$28 ' A",,' ................................................................................................... 300296574 !9-14-80 D~ CLEAR CARB p~S== 7.6~ ~,c~,,Os, 1.7199 13,154.59 300206909 10-19-00 DF2 CLEAR CAP~.,.. DIESEL 7,''~'o~,7,640.09 1.6599 30{~207~7 t0-~5-00 DF2 C~AR CARB DIESEL 7,635 7.835. ~ 1. 6749 t2,788.24 300207471 10-2S-88 DF2 CLEAR CARB DIESEL 7,659 7. S50.~9 1.6899 VENDOR TOT~: 45,858.8(~ 76. 398.49 ' DESCRiPT i 0~ CATEGORY CLEAR DIESEL FUEL 8 45,858.09 ..../o, ~0.=~"~ VENDOR CATEGORY TOT~ 45, 858.88 76,398.49 ** WH 7 TOTAL: 45,858.88 7~39~.49 DESCR I P T I ON CAT EGO RY CLEAR DIE~L FUEL 8 45, 858.88 WAR~OOSE ~TEGORY TOTALS 45, 858.00 76, 39~, 49 *** GRAND TOT~: 45, 858.88 76,398.49 DESCR i PT 1 ON ~TEGORY CLEAR DIESEL FUEL 2 45, 85~. 08 76,390.49 CATEGORY ox~,D TOTALS ~ 76, JEFFRIES RROS INC - October 2000 *' KRAMER JUNCTION RETAIL DIESEL SALES , " DATE REFINERY RETAIL DSL PURCHASE HAUL JEFFRIES TOTAL DUE JEFFRIES SALES TOTAL DUE COLLECTED BY ~INS SHELL *-" 'GALL SOLD pRICE/GALL RATE .0422 PROFIT PURCH PRICE ON RTL SALES TAX JEFFRIES ANNS SHELL PROFIT 10/01/00 .TREK 507.8 $1.66490 $0.0000 $0.03 $1.6949 $860.67 ~ ~, 10/02/00 TREK 611.6. $1.66490 $0.0000 $0.03 $1.6949 $1,036.60 10/03/00' TREK 600.4 $1.66490 $0.0000 $0.03 $1.6949 $1,017.62 10/04/00 TREK 578 $1.66490 $0.0000 $0.03 .$1.6949 $979.65 10105/00 TREK 314.9 $1.62490 $0.0000 $0.03 - $1.6549 $521.13 ~ 10/06/00 TREK 478.6 $1.62490 $0.0000 $0.03 $1.6549 $792.04 10/07/00 TREK · 250.9 $1.62490 $0.0000 $0.03 $1.6549 $415.21 10/08/00 TREK 408.6 $1.62490 $0.0000 · $0.03 $1.6549 $676.19 10/09/00 TREK 350.7 $1.62490 $0.0000 $0.03 $1.6549 $580.37 ',J 10/10/00 TREK 234.1 $1.62490 $0.0000 $0.03 $1.6549 $387.41 10/11/00 TREK 458.2 $1.62490 $0.0000 $0.03 $1.6549 $758.28 10/1'2/00 TREK. 302.9 $1.62490 $0.0000 $0.03 $1.6549 $501.27 10/13/00 TREK 428.2 $1.62490 $0.0000 $0.03 $1.6549 $708.63 10/14/00 TREK 407,3 $1.71990 $0.0000 $0.03 $1.7499 $712.73 10/.15/00 TREK .260.2 $1.71990 $0.0000 $0.03 $1.7499 $455.32 10/16/00. ' . TREK .203.2 $1.71990 $0.0000 $0.03 $1.7499 $355.58 10/17/00 TREK' ~ 34712 '- $1.71990 $0.0000 $0.03 $1.7499 $607.57 ~10/18/00 'TREK.' . 762.4 ' "$1.71990 $0.0000 $0.03 $1.7499 $1,334.12 10i19/00 TREK ' 322 - '$1.65990 $0.0000 $0.03 ' $1.6899 $544.15 10/20/00 · TREK 450.4 $1.65990 $0.0000 $0.03 $1.6899 $761.13 ,'10/21/00 TREK 288.4 $1.65990 $0.0000 $0.03 $1.6899 $487.37 10/22/00 - . TREK 174.7 $'~.65990 $0.0000 $0.03 $1.6899 $295.23 10/23/00 TREK -152.2 '$1.65990 $0.0000 $0.03 $1.6899 $257.20 10/24/00 TREK 480.3 $1.65990 $0.0000 $0.03 $1.6899 $811.66 ~10/25/00 TREK 782.7 $1.67490 $0.{3000 $0.03 $1.7049 $1,334.43 - 10/26/00 TREK .527.5 $1.67490 ' $0.0000 ' $0.03 $1.7049 $899.33 $26,675.48 CASH 10/27/00 TREK 517.9 $1.67490 · .. $0.0000 $0.03 $1.7049 $882.97 ($4,621.59) ST RDTAX 62235 X. 18 10/28/00 TREK 500.9 $1.68990 $0.0000 $0.03 $1.7199 $861.50 $21,053.89 DIV BY STAX 10/29/00 TREK 383 $~.68990 $0.0000 $0.03 $1.7199 $658.72 ($19,539.57) 52235 1.0776 10~30/00 TREK 411.7 $1.68990 $0.0000 $0.03 $1.7199 $708.08 10/31/00 TREK 332.3 $1.68990 $0.0000 $0.03 $1.7199 $571.52 12829.2 $21~773,68 $1,5t4.32 $23~288.00 $25~675.48 $2,387.48 FREIGHT $0.00 CR 32000 10310 62235 PROFIT $384.88 $22,158,56 .Board of Equalization ; ..~_.~., ~ ..... Fuel Tax~s Di~sion P.O. Box 942879 Sacra~nento, CA 94279-6151 Jeffco Inc. Jeffdes Bros, Inc. ,' P.O. Box 640 Wasco, CA 93280 ~' Acct-~ 44-006130 .... NOVEMBER 2000 **** Units Units Units Gasoline Clear Diesel Dyed Diesel Site 1 750 Hwy 46, Wasco, CA Wasco Warehouse 76,400.00 133,678.00 468,267.00 Wasco Cardlock .25,113.00 49,896.00 11,650.00 Site 2 228 E Front St, Buttonwillow, CA Buttonwillow Cardlock 29,435.00 144,016.00 0.00 C-Store o 109,949.00 13,027.00 0.00 Site 5 301 Kern ST, Taft, CA Taft Cardlock 14,718.00 4,518.00 0.00 C-Store 42,732.00 2,696.00 0.00 Site 6 102 So Beech Ave, Shafter, CA Shafter Express Cardlock 41,768.00 36,111.00 0.00 Site 10 1224 Hwy 46, WASCO, CA Tigermart Cardlock 27,783.00 41,810.00 0.00 C-Store 49,584.00 4,489.00 0.00 Site 12 4700 Coffee, Bakersfield, CA Brookside Market 61,253.00 12,510.00 0.00 C-Store 95,404.00 3,648.00 0.00 Site 636 395 & 68 HWY Kramer Junction, CA Kramer Junction Cardlock 43,492.00 0.00 kramer Junction Retail 8,401.70 0.00 574,139.00 498,292.70 479,917.00 Direct Delivery (9,624.00) (110,966.00). (281,933.00) Sales >>>>>>>>>>> 664,616.00 387,326.70 197,984.00 Gasoline clear Diesel Dyed Diesel Total Purchases >>>>>>>>>>>>>>>> 9,629.00 117,985.00 300,021.00 581,836.00 395,409.00 188,471.00 691,465.00 613,394.00, 488,492.00 Total all Purchases: 1,593,351.00 Less direct Delivery: -310,612.00 Less Kramer Junction: -30,426.00 1,252,313.00 ~UN: ~ ....... '-= RECEIPTS TRANSACTION REPORT '-- ~.~oi~k 13:56 ~r. acie P~ 1 VEN~]R BOL ~ DATE PRODUCT PAK DESCRiPTiON UNITS VGtUME U COST EXT CST 8020 - TF£K PETRO~UM 300207747 11-9!-00 DF2 CLEAR CARB DIESEL 7,650 7,650.00 !.6999 13,004.62 3002080SI 1!-08-00 DF2 CLEAR CARB DIESEL 7,661 7,66!.00 t.8899 12,946.7! 3~0208200 11-10-00 DF2 CLEAR CARB DIESEL 7,674 7,674.00 1.7049 13.083.79 ................................................................................................... 300209552 Ii-29-00 DF2 CLEAR CARB DIESEL 7,44i 7,441.00 !.7149 12,760.94 ................................................................................................... ~ENDOR TOTAL: 30.486. ~0 51,796.06 DESCRIPTION CATEGORY CLEAR DIESEL FUEL 2 30,426.80 51,796.06 ..................... VENDOR CATEGORY'TOTAL 30,426.00 51,736.08 .................................................................................................................................... · ** WH 7 TOTAL: 30,426.00 51,796.06 DESCRIPTION CATEGORY CLEAR DIESEL FUEL 2 30,426.00 51,796.06 WAREHOUSE ~TEGORY TOTALS 30,426.00 51,796.06 *** GRP~iD TOTAL: 30,426.00 51,796.06 DESCRIPTION CATEGORY CLEAR DIESEL FUEL 2 30,426.00 51,796.06 CATEGORY G~ND TOTALS ~ 51,796.06 JEFFRIES BROS INC - November 2000 KRAMER JUNCTION RETAIL DIESEL SALES · DATE REFINERY RETAIL DSL PURCHASE HAUL JEFFRIES TOTAL DUE JEFFRIES SALES TOTAL DUE COLLECTED BY' ANNS SHELL GALL SOLD pRICE/GALL RATE .0422 PROFIT PURCH PRICE ON RTL SALES TAX JEFFRIES ANNS SHELL PROFIT 11/01/00 TREK 259.3 $1.69990 $0.0000 $0,03 $1.7299 $448.56 11/02/00 TREK 274.1 $1.69990 $0.0000 $0,03 $1.7299 $474.17 11/03/00 TREK :458.7 $1.69990 $0.0000 $0.03 $1.7299 $793.51 · 11/04/00 TREK 215.6 $1.69990 $0.0000 $0,03 ,$1.7299 $372.97 11/05/00 ,. TREK '270.9 · · $1.69990 $0.0000 $0,03 ' $1.7299 $468.63 11/06/00 TREK 388.9. $1.69990 $0.0000 $0,03 $1.7299 $672.76 11/07/00 _ TREK 462.9' $1.69990' $0.0000 $0,03 $1.7299 $800.77 11/08/00 TREK · 1t8.8 .. $1.68990 $0.0000 $0,03 $1.7199 $204.32 11/09/00 TREK . . 289.6 ~ ! · $1.68990 $0.0000 $0,03 $1.7199 $498.08 · ~,~. 11/10/00 ...... TREK ' 665.3.~ $1.70490 $0.0000 $0,03 $1.7349 . $1,154.23 11/11/00 TREK 154.7 $1.75490 $0.0000 $0,03 $1.7349 $285.74 11/i2/00 TREK, 359 $1.70490 $0.0000 · · ' $0,03 $1.7349 $622,83 11/13/00 TREK 320.9 · ' $1.70490 $0.0000 $0,03 $1.7349 $556.73 1i/14/00 TREK 740 $1.70490 $0.0000 $0.03 $1.7349 $1,283.83 11/15/00 ' 'TREK " 354.5'. · $1.54900 $0.0000 $0,03 $1.6790 $595.21 11/16/00, . TREK 233.8 ~ $1.54900' $0.0000 $0,03 $1.6790 $392.55 ~ 11/1,7/00 ~' TREK' -~ · .201'~8'~,. . $1.64990 $0.0000 $0,03 $1.6799 $339.00 111/18/~30 TREK. 2ti~4 ~'. $1.64990 $0.0000 $0,03 $1.6799 $355.13 11/19/00 ~ 'TREK - · 229.2'-.' · · $1.64990 $0.0000 $0.03 '$1.6799 $385.03 11/20/00 "TREK~ '- 198.2 $1.54990 $0.0000 $0.03 $1.6799 $332.96 · "11/21/00 TREK, 339.8 $1.64990 $0.0000 $0.03 $1.6799 $570.83 · 1·1/22/00, - '. TREK 167.7 ~ · · $~.65490 $0.0000 $0.03 $1.6849 $282.56 11/23/00 ·, TREK 279.1 $1.65490 · $0.0000 $0.03 $1.6849 $470.26 '.11/24/00 TREK 84 . $1.65490 $0.0000 $0.03 $1.6849 $141.53 11/25/00 TREK 109.2 $1.65490 $0.0000 $0.03 $1.6849 $183.99 · 11/26/00 TREK 221.3 -$1.65490 · $0.0000 $0.03 $1.6849 $372.87 $t6,780,04 CASH 11/27/00 TREK 167.6 ~ $1.65490 .. $0.0000 $0.03 $1.6849 $282.39 ($3,020.41) STRDTAX 62235 X. 18 11/28/00 TREK 248 ' $1~65490 $0~0000 $0.03 $1.6849 $417.86 $t3,759.63 DIV BY STAX 11/29/00 ' TREK 66:8 $1'.71490 $0.0000 $0.03 $1.7449 $116.56 ($~2,769,96) 52235 11/30/00 TREK 300.6 $1.71490 - $0.0000 $0.03 $1.7449 $524.52 ., TREK $0.0000 $0.03 $0.0300 $0.00 8401.7 $14~400,35 $989.67 $15t390.02 $16~780.04 $1,390.02 FREIGHT $0.00 CR 32000 10310 62235 PROFIT $252.05 $14,652.40 · Board of Equalization ~.. ,~--~ .? Fuel Ta~es~ D~vision .~ - il) P.O. Box 942~79 r~ Sacramento, CA 94279-6151 Jeffco Inc. Jeffries Bros, Inc. P.O. Box 640 Wasco, CA 93280 Acct~ 44-006130 .... DECEMBER 2000 .... Units Units Units Gasoline Clear Diesel D),ed Diesel Site 1 760 Hwy 46, Wesco, CA Wesco Warehouse 63,644.00 84,797.00 249,981.00 Wesco Cardlock 22,106.00 28,019.00 6,109.00 Site 2 228 E Front St, Buttonwillow, CA Buttonwillow Cardlock 26,769.00 134,218.00 0.00 C-Store · 127,868.00 11,061.00 0.00 Site $ 301 Kern ST, Taft, CA Taft Cardlock 15,558.00 4,274.00 0.00 C-Store 40,526.00 2,511.00 0.00 Site 6 t02 So Beech Ave, Shafter, CA Shaffer Express Cardlock 38,413.00 31,981.00 0.00 Site t0 1224 Hwy46, WASCO, CA Tigermart Cardlock 26,796.00 41,135.00 0.00 C-Store 52,564.00 5,215 .O0 0.00 Site 12 4700 Coffee, Bakersfield, CA Brookside Market 56,442.00 11,271.00 0.00 C-Store 99,687.00 4,196.00 0.00 Site 635 395 & 68 HWY Kramer Junction, CA Kramer Junction Cardlock 42,677.00 0.00 kramer Junction Retail 4,228.80 0.00 570,373.00 405,583.80 256,090.00 Direct Delivery 0.00 . (69,027.00/ (157,399.00I Sales >>>>>>>>>>> 670,373.00 336,556.80 98,691.00. Gasoline Clear Diesel Dyed Diesel Total Purchases >>>>>>>>>>>>>>>> 0.00 68,880.00 · 153,417.00 580,302.00 ~ 339,024.00 91,604.00 · . 680,302.00 407,904.00 245,02t.00 Total all Purchases: 1,233,227.00 Less direct Delivery: -310,612.00 Less Kramer Junction: -53,740.00 868,875.00 R~: ~.; 15/0-~. 14:~O.~?laCie EECEIPTS TRAN~CTID~ REPORT PAGE 1 W~: 7~, ~OD C~lEGDRY: 2 UE~ORS: RA~E . VENDOR BOL ~ DATE PROD~T .PAP', DE~RIPTtON UNITS VOLUI4E U COST EXT ~T G8~8 - TREK PETROLEUM ~8888%~8 18-8!-88 DF8 CLEAR CARB DIESEL ' 7,717 7,7~7.88 1.6899 1S, 8~i. ~4 300209837 !8-88-88 DF2 CLEA~ CARB DIESEL 7, 675 7~ 675.80 !. 6149 12, 394.74 30020992S 12-i0-00 DF2 C~EAR CARB DIESEL 7,672 7,672.00 1.539S !!,814.58 ~00210097 12-14-08 DF2 ~EAR CARB DIESEL 7,668 7,668.80 1.5549 11,92~.J~6 .................................................................................................... 308810499 !2-19-00 DF2 C~AR CA~ DIESEL 7,664 7,664.~ 1.5599 !1,955.46 ................................................................................................. 300810740 18-83-8~ DF2 CLEAR CARB DIESEL 7,670 7,670.80 1.5099 ii,5~L 38 ..................................................... ~ ............................................. 38021It6i 12-30-80 DF2 CLEAR CARB DIESEL 7.674 7,674.88 1.467~ Ii,280.4'Z~ .................................................................................................. VEN~R TOTAL: 5~, 748.80 8~. 99 I. 18 ' DESCRIPTION CATEGORY CLEAR DIESEL FUEL 2 53, 74~. 8~ 83, 991.18 ..................... VE~OR CATEGORY TOT~ 53, 74~. 00 83, 991. !2 .................................................................................................................................. ** WH 7 ~OTAL: 53~740.00 83,99I. 12 DESCRIPTION CATE~RY CLEAR DIESEL FUEL 2 53,740.08 83, 991.12 WA~H~ CATE~RY TOTALS 53,74~.00 ~ 83,991.'12 " *** G~ND TOTAL: 53, 740.80 ~, 99!. 12 DESCRIPTION CATE~RY ~EAR DIESEL F~L 2 53,740. 00 ~, 991.18 CATEGORY GRA~ TOT~S ~ ~, 991.1~ JEFFRIES BROS INC - December 2000 KRAMER JUNCTION RETAIL DIESEL SALES DATE REFINERY RETAIL DSL PURCHASE HAUL JEFFRIES TOTAL DUE JEFFRIES SALES TOTAL DUE COLLECTED BY ANNS SHELL GALL SOLD PRICE/GALL RATE .0422 PROFIT PURCH PRICE ON RTL SALES TAX JEFFRIES ANNS SHELL PROFIT 12/01/00 TREK 575.5 . . $1.68990 $O.0000 $0.03 $1.7199 $989.80 12/02/00 TREK '-335.4-. $1.68990 $0.0000 $0.03 $1.7199 $576.85 12/03/00 TREK 53.2 ~ $1.68990 $0.0000 $0.03 $1.7199 $91.50 12/04/00 TREK ' 87.9~ $1.68990 $0.0000 $0.03 "$1.7199 $151.18 12/05/00 TREK . 106.1 , . $1.68990 $0.0000 $0.03 $1.7199 $182.48 - 12/06/00 TREK '140~8 $1.61490 $0.0000 $0.03 $1.6449 $231.60 12/07/00 TREK 105.2 -$1.61490 ! $0,0000 $0.03 $1.6449 $173.04 12/08/00 TREK 88.2 $1.61490 $0.0000 $0.03 $1.6449 $145.08 12/09/00 TREK 57.1 $1.61490 $0.0000 $0.03 $1.6449 $93.92 12/10/00 TREK 70.5 ' :~ $1.53990 $0,0000 $0.03 $1.5699 $110.68 12/11/00 - TREK 47.7 ' $1.53990 $0.0000 $0.03 $1.5699 $74.88 '12/12/00 TREK' 39.4 ~ . ' $1.53990 $0,0000 $0.03 $1.5699 $61.85 , 12/13/00 TREK 122.5 $1.53990 $0.0000 $0.03 $1.5699 $192.31 12/14/00 TREK 96~2 $1.55490 $0.0000 $0.03 $1.5849 $152.47 12/15/00 TREK, 61;3 $1.55490 $0,0000 $0.03 $1.5849 $97.15 12/16/00 ., ', TREK '0 $1,55490 $0.0000 $0.03 $1.5849 $0.00 12/17/00 ' TREK ~ '318.3' $1.55490 $0.0000 $0.03 $1.5849 $504.47 ,12/;18/00 ~-TREK' :' ' .~ ;151.4." $1.55490 $0.0000 $0.03 $1.5849 $239.95 ~'12/19/00 :~'TREK. :'" 259.6' $1.55990 $0.0000 $0.03 $1.5899 $412.74 12/20/00 '' TREK " 205.8 · $1.55990 $0.0000 $0.03 $1.5899 $327.20 12/21/00 TREK' . ~ 282.7 $1.55990 $0.0000 $0.03 $1.5899 $449.46 12/22/00. 'TREK 31.3 $1.55990 $0.0000 $0.03 $1.5899 $49.76 12/23/00 TREK - - 71.2-. $1.50990 $0.0000 $0.03. $1.5399 $109.64 · 12/24/00 ' TREK 26.3 ~ ' . $1.50990 $0.0000 $0.03 $1.5399 $40.50 12/25/00 TREK 0 $1;50990 $0.0000 $0.03 $1.5399 $0.00 12/26/00 TREK 161.2 ' $1.50990 '- $0.0000 $0.03 ' $1.5399 $248.23 $8,230.78 CASH 12/27/00 TREK 299.6 ' '$1;50990 :' $0.0000' $0.03 $1.5399 $461.35 ($1,481,54) STRDTAX 62235 X. 18 12/28/00 TREK 82.6 $1.50990 $0.0000 $0.03 $1.5399 $127.20 $6,749.24 DIV BY STAX 12/29100 TREK 211.6 $1.50990 : $0.0000 $0.03 $1.5399 $325.64 ($6,263.80) 52235 1.o77s 12/30/00 TREK . 5912 $1.46990. $0.0000 $0.03 $1.4999 $88.79 12/31/00 TREK 81 $1.46990 $0.0000 $0.03 $1.4999 $121.49 4228.8 $6r831.46 $485.44 $7,316.90 $8r230.78 $913.88 FREIGHT $0.00 CR 32000 10310 62235 PROFIT $126.86 $6,958.33 O~riginal , DECLARATIONS COMMERCIAL PROPERTY COVERAGE PART ' PE'I=ROLEUM PRODUCTS DISTRIBUTORS COVERAGE FORM (PETRO PAC)® INSUR,~NCE APPLIES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN OR COVERAGE IS INDICATED. Limit of Insurance Coverage $ (Limits Shown on Supplemental Declaration) A. Designated Locations $ 250,000 Each Location B. Newly Acquired Locations $ 150,000 Each Location C. Temporary Locations OPTIONAL PROPERTY COVERAGES See Supplemental Declarations 1. Replacement Cost ~ ,5 0,0 0 0 2. Terminal Access Card ($25,000 included in Coverage Extension 6. i.) 3. Surface Water Contamination of Gas and Oil ($25,000 included in Coverage Extension 6. j.) 4. Erroneous Delivery ($25,000 included in Coverage Extension 6. k.) MORTGAGE HOLDERS Location No. Bldg. No. Name and Mailing Address r~ Loss Payable Certificate [X--~ Mortgage Holders Interest Certificate · · ~ Contract of Sale Clause DEDUCTIBI I: $1,000 Unless otherwise specified in the attached forms or endorsements in the Commercial Property Coverage Part. See attached sChedule` of Form~' and Endorsements and s~PPlemental Declarations. , Includes copyrighted mater, iai of insuranceSer~ices, 0ffiCe, inc. With its permission. CP-F-2 (08-98) Policy Number: 0784390 :'" ..: . Transaction Effective Date:. 09-15-2000 .! Original SCHEDULE OF FORMS AND ENDORSEMENTS Title as on Form or Endorsement Form Edition Supplemental Declarations Commercial Property CP-F-21 (07-95) Coverage Part Loss Payable Certificate CP-F-10 (07-95) Mortgage Holders Interest Certificate CP-F-11 (07-95) Lenders Loss Payable Endorsement 438BFU (05-42) Petroleum Products Distributors Coverage Form CP-F-15 (06-99) (Petro Pac) Business Income-Special Form CP-F-36 (06-99) Causes of Loss-Special Form (Petro Pac) CP-F-16 (08-98) Commercial Property Conditions CP 00 90 (07-88) Pollutant Cleanup & Removal (Petro Pac) CP-F-83 (08-98) Blanket Location Extension Endorsement CP-F-84 (08-98) Disaster Deductible Extension CP-F-27 (12-99) Business Computer Form IM-F-9 (10-95) Business Computer Extension Endorsement IM-F-10 (10-95) C~ncellation ChangeS CP 02 99 (11-85) Property Amendment Clause CP-F-79 (07-95) California Standard Fire Policy Provisions IL-F-28 (09-94) WF-50 ((~8-78) Policy Number: 0784390 : ,. "~... Tran~aCti°n.Effective Date: 09-15-2000 Original ..~ SUPPLEMENTAL DECLARATIONS · ~ COMMERCIAL PROPERTY COVERAGE PART' .~ prom. Bldg. Designated Premises and.occupancy Subjed of -" Forms Deductible Repla~T~ cr Agreed Value Limit of No. No. (Address, City,. State) Insurance Applicable % Cost I~fx]a~g ~ (Expiration Date) Insurance 12 8803 CANINO' MEDIA BLV]) ..... : .... BAKERSFIELD;CA'. 8803 CAMINO~NEDIA Petro Pac CP-F-15 YES NONE ~1,800,000 r', BLVI)/ CONVENIENCE CP--F--16 STDRE Business Income CP-F-36 CP-F-16 cP-F-21 (07-95) Policy Number: 0784390 Transaction Effective Date: 09-15-2000 Original , ~ LOSS PAYABLE CERTIFICATE Place of ISsue - FEDERATED MUTUAL INSURANCE COMPANY 2400 W. Dunlap Ave., Suite 250 Phoenix, AZ 85021 Phone: 602-944-5566 Home Office: Owatonna, MN 55060 TO: TRI COUNTIES BANK 5201 CALIFORNIA AVE STE 102 BAKERSFIELD CA 93305 We certify that you are named as Loss Payee in the below numbered policy which has been issued to: JEFFRIES BROS INC JEFFCO INC PO BOX 640 WASCO CA 93280 to cover the personal property as designated below: Loc. Bldg. No. No. Location Deductible · Limit 12 1 8803 CAMINO MEDIA BLVD/ CONVENIENCE STORE ~1,000 ~1,800,000 BAKERSFIELD CA 93311 ~-~ Special coverage [] Named peril coverage The policy contains the provisions that loss, if any, will be adjusted only with the Named Insured and Payable to the Named Insured and the Loss Payee listed above as their respective interests may appear, subject to all the terms and conditions of the policy. We certify that the policy is effective from 09-15-2000 to 09-15-2001 12:01 .A.M.,. (Or 12 Noon) Standard Time, as stated in the policy, at the address of the Named Insured as stated in the policy. ' ..... " If we cancel the policy we will provide at least ten days advance written notice or more aS~maYlbe allowed by the Cancellation Provision of the' CommOn Policy Conditions. ' Special provisions,' if any: .. "*~ " This Certificate' is'furnished as evidenc~ of a policy.as it stands at the date of issue, and is given as a matter of information 0nly. 'Except as specified herein, this Certificate cOnfers no 'rights on the holder and imposes no - -.'SECRETARY ' : ' PRESIDENT CP-F-10 (07-95) Policy Number: 0784390 02/IG/2001 1~;11~- GG132GB453 REDWINE TESTING PAGE 01 Facsimile Cover Sheet To: InsPector Steve Underwood '"',., Company: Bakersfield Fire Department -' Phone: (661) 326-3190 "i-' Fax:' (6611) 326-0576 ' ::'.'.' FROM: Kathy Fritts Company: REDWINE TESTING SERVlGE$, 'Phone:, (661:) 326-0446 Fax: (661:) 326-0453 ,",", Date: Febmry 16, 2001 ,, Pages including this, Cover page: 14 Comments: 02/16/2001 13:11 6613268453 REDWINE TESTING PAGE 13 .~:NVOICE #LAOOO148 TEST DATE, O1/25/O1 .'~ .RB. DWINE TESTING SVC,, INC, .?. * BAKg. RS~!E'LD, CA.' 93302 ...... '"' TANK STATUS REPORT -- ULLAGE TEST ,]g'&J CONSTRUCTION EXXON ,? 8see CAH NO :y~. i:i~ONTACT, JERRY CONTACT~ i:~:HO'N~ #, 10~-3707 PHONE #, .,'...' N~W INSTALLATION. ,. ..".:: CURRENT EPA STANDARDS DICTATE :.i!i! ..... THAT ~OR UND~RSROUND FUEL'TANK. S,. THE HAXIMUM ALLOWABLE LBAK/GAI~ RAT~ ,'.!i' OVER ,T~E PERIOD OF ONE HO~R IS .05 GALLONS. i,i~ANK #1: DIESEL F~L 2 ,TYPE', STEEL SN, -.51 i}'"' TANK IS TIGHT. ~?,., 02/15/2001 13:11 S~13260453 REDWINE TESTING PAGE 12 ',[::i",' .TANK NO TANK NO TANK NO TANK NO. ?' VOLUME (GAL) 8000 ":;" '" TYPg ,' ST ~;..,.'. ' :~[~,VOL/d~ (GAL/IN) 69.61 ',j~.'..,. '~'~' 1 10 ~5625 ?':, 4 S'~. 9~75° ,~. 5 74 ,'9'3750 ~,~ ,". 02/16/2001 13:11 ~13260453 REDWINE TESTING PAGE 11 /'"" JOB NUMBER ~ 000148 ~':":' CUSTOMER (COMPANY NAME) D&J coNsTRUCTION '~;.:. CUSTOMER CONTACT'( LAST, ~IRST) ":":"'~';.. ZIP CODE (XXXXX-XXXX) 93308 .i.':~:: ******* C .0 M M g N T L I N E S ,.~ SITE NAME (COMPANY NAME) , EXXON ~:~..~,.'.?' 8ITB CONTACT { LAST, FIRST) ,.:!:'..ADDRESS - LINE 1 , 8803 CAMINO MEDIA .'~."' ADDRESS - LINE 2 , ::"' CiTY ~TATg ?.:,:.? , ~ BAKERSFIELD, CA. ',~ .... ZiP CODE (XXXXX*XXXX) .:.s,. PHONE NUMBER (XXX)XXX-XXXX , :},': NuMBeR OF TANKS .;.~./ LENGTH OF TEST (MIN) , 180 .'~':.': ?. ,~,, 02/16/2001 13:11 6613268453 REDWINE TESTING PAGE 10 i:N'VOICE #LA000118 TEST DATE: 01/251~I '?'~. ' R.EDWIN~ TESTING SVC., INC. <'.'.. BAKZRSFI~D, CA. 93302 <' . TANK STATUS ZVaLUATION REPORT ":.' ***'' CUSTOMBR DATA ***** ''*** SITZ DATA "~&J CONSTRUCTION EXXON ~:". 8803 CAMINO MgDIA :'32.', ..' }:'~O]TACT, J~RRY CONTACT, ~H'ONE %, 201-37~7 PHON~ $, ,,?,'. "."," ***** .COMMENT LINES ..: ..... N~W INSTALLATION. '":; CURRENT'~PA STANDARDS DICTATE '...~?:.~. THAT ~OR UNDERGROUND FUgL TANKS, THE MAXIMUM ALLOWABLB L~AK/GAIN RATE ,", OVER THE PBRIOD OF ON~ HOUR IS .05 GALLONS. .::"~.hNK $1~ DI~L ~UgL ~ TYPB~ STEEL RATE~ .~O1766 G.P.H. LOSS :~,:,'.". TANK IS TIGHT. .",.[. :, ~': ~ :',~..',_ . ,,:: - 02/16/2081 13:11 6613268453 RED~4INE TESTIN6 P~6E 89 TANK NO TANK NO TANK NO. TANK NO. :::~ANK DIAMgT~R (IN) 128 VOLUME (GAL} 80'00 ~j~VOL/'dy (GAL/IN) 69.61 .?.aALiBRATION ROD DISTANC~ 4 56 ,..93 7 5~ 5 74. 93750 02/16/2801 13:11 6513260453 REDWINE TESTING PAGE 88 *****'' C U S T. ':')"::';' JOB NUMBER , 000148 :":?~ ' CUSTOMER (COMPANY NAME } = D&J CONSTRUCTION ':~"~ CUSTOMER CO~TACT'(LAST~ FIRST.), JERRY ";Q'" ADDRESS - LINE ~ ~;~, CITY, STATE , BAKERSFIELD, CA. (.:. ZIP COD~ (XXXXX'-XXXX) ', 93308 :'.~t" P~ON~ NUMBER (XXX)'XXX-XXXX , 201-3707 *~*'***-C O M'M N~W INSTALLATION. ,,,j}~.~: ' ':/", ''*****' S I' T"~ D A T A ...~:./.:'. '~:~?~" SIT~ · NAME ( COMPANY NAME ) , ZXXON ":'~?.' .... SI~ CO~ACl (haS~, FIRST)' .:.:':,. AD'D~$S - LINE 1 , 8803 ~AMINO MEDIA ;:,,~:',::,' CITY, STATE , BAKERSFIELD, CA, ':""' ZIP CODg (XXXXX-XXXX) ..;,.:...PHONE NUMBER. {XXX)XXX-XXXX .(:,.~ ,[(':.: NUMBER OF TANKS ,'I :.'~:~..'LENGTH OF. PRE-TEST (HIN) , 30 ';~:(' LENGTH OF T~ST (MIll .~ 180 :':.[',. ,.,¢j:.,' ' .:~.:..:.:. '.[' :;. .'?~' j,, :' 82/16/2881 13:11 6613268453 REDWINE TESTINS P',O. 'BOX 1567 "~'"" BAKBRSFI~LD CA 93302 '?::::,.:. .:::'"' '.TANK sTATU:8 REPORT -- ULLAGE TEST ' *~.''* CUSTOMER DATA ****" **'"' SlT~ DATA CO S UCT O. XXON "~',:', 8803 CAMINO M~DIA ,,, '.?/,': ,'.?~[HONZ $, 2OI-3707 PHONE $ ~ ".,~3 ,.' "",' ' '~"'* COMMENT LIN~S d: ', ' '.'.7 ~". fi, · ~' ,. ::~'.], . ,~.'", cuRR~.N.T EPA STANDARDS DICTATg ..'~"~'~"THAT FOR UNDERGROUND.'FUEL TANKS, THE MAXIMUM ALLOWABLE LEAK/GAIN RATE ":'~'~'", OVBR THE PBRIOD OF ONE HOUR IS .05 GALLONS' ,[~ANK ~1, ~UPER UNLEADED TYPE', STEEL SN, ,?,, "?. !AN.~'IS TIGHT. .;'~,[~NK $2, R~G UNL~ADED TY~.B, ST~L SN, -. 3~ .<~?:,,:. TANK IS TIGHT. ,, %;, ,, ,~:,~: ',V : '?~',. 02/1~/20B1 13:11 S5132~0453 REDWINE TESTING PAGE % 'T'ANK NO. TANK NO. TANK NO. TANK NO. ~NK DIAMETER (IN) 128 128 ?:' LENGTH (FT} 17.95' 29,92 /.' VOLUME (GAL) 12000 20000 'f":. TYPE ST ST i~UEL.'TYPE ,SUP UNLD REG UNLD i'!~VOL/d¥' (GAL/IN) ,104.42 174,O4 'i:~ALI'BRATION ROD DISTgN~E :?:' '1 10,65625 2 26.95'313 3 41.9.3750 4 56,93750 :.,,j 5 7~.93750 02/16/2001 13:11 6613260453 REDWINE TESTING PAGE 05 i'~'. JOB NUMBER. - .000147 .':' CUSTOMER (COMPANY'NAMB)' , D&J CONSTRUCTION ,]~',,,'CUSTOMER CONTACT(LAST, FIRST)~ J~RRY :?~' CITY, STATE '" , BAKERSFIELD, CA. '.' ZIP. CODE (XXXXX-XXXX') ,ii:'- PHONE NUMBER (X'XXl'XXX-XXXx' , 20~-~707 i.":'.'.' NBW CONSTRUCTION. '.. '. ,.." SITm. NAME (COMPANY.NAME). , EXXON '~.?' SITE CONTACT(LAST, .FIR'ST) '."? ADDRESS - LINE i ~ 8803 CAMIN0.MEDIA ~.'.. ADDRESS - LINB 2 " CITY, STATE , BAKERSFIELD, CA. :'!':ii", z~P CODm (XXXXX-XXXX), .....:,. PHONE NUMBER (XX'X)XXX-XXXX , i,. OROUND WATER LEVEL {FT}' ~ 0 · '.:.:..LENGTH OF PRE-TEST (MIN) , 30 .% LENGTM OF TEST (HI'N) , 240 82/16/2001 13:11 6613260453 REDWINE TESTING PAGE 04 ~N'VOICE #LAOOO147 TEST DATEz O1/25/O! '.'.' REDWINE TESTING SVC,, INC. 'h. P,O. BOX 1567 ..::.., BAKERSFIELD, CA. 93302 .....: TANK STATUS ~VALUATION REPORT ..' .,t~, CUSTOMER DATA *"*** ***** ~ITE DATA *'~** ':' 88*3 CAMINO H~DIA .:~AK~SFI~LD, CA. BAKgRSFIgLD, CA. '~O.~TACT, J~RRY CONTACT ~ '"~'~ CURRENT EPA STANDARDS DICTATE ' THAT FOR UNDERGRO'U~D' FU~L 'TANKS, T~ MAXIMUM ALLOWABLE LEAK/GAIN RATE '. OV~'~"TH~ ~IOD.'OF ONB HOHR IS .~$ GALLONS. "~,~A~K 'S1~ SUPgR UNLEADED TYPB,. STBBL ~ATE~ .O23209 G.~.H. GAIN .: .... TANK I.S TIGHT. .:;TANK $2 ~ REG UNLEADED TYPE ~ STBBL RATE ~ . 033699 G.P.H. LOSS TAN} IS TIGHT 82/16/2881 13:11 6613268453 REDWINE TESTING PAGE 83 ~'" TANK NO. TANK NO. TANK NO. TANK NO. :,~,ANK. DIAHETER (IN) ~2a 128 ,'i." LENGTH '(FT), i'7,95 29.92 · :i:. VOLUME (GAL) 12000 20000 :/,'. TYPE ST ST !.~'UEL TYPE sUP"'UNLD REG UNLD (~VOL/dy (GAL/IN) ,. 10.4,42 174,O4 ,~ALIBRATION ROD DISTANCE .... , 2 26,9.5'3'1'3 3 41:, 93750 :'::'""' $ 74'.93750' :[." 02/16/2001 13:ii 6613260453 REDWINE TESTING PAGE 02 ~:, JOB NUMBER , 000147 CUSTOMER (COMPANY NAME)' D&J CONSTRUCTION " CUSTOMER CONTACT(LAST, FIRST) JERRY ADDRESS -.LINE ADDRESS - LINE 2 ~' CITY, STATE BAKERSFIELD, CA. "" ZIP CODE (XXXXX-XXXX) ~ PHONE NUMBER '(XXX)XXX~XXXX 201-3707 NEW CONSTRUCTION ,',> SITE NAME (COMPANY NAME) , EXXON .: SITE CONTACT(LAST, FIRST) , "¥ ADDRESS - LINE 1 , 8803 CAMINO MEDIA ,~::' ADDRESS - LINE 2 , .i.. CITY, STATE : BAKERSFIELD, CA. .:"' ZIP CODE (XXXXX-xxxx). j 93308 ..' PHONE NUH~ER (xxx)XXx-xxxx GROUND WATER LEVEL (FT) , O' :..... NUMBER OF TANKS ~ 2 ':,'. LENGTH OF PRE- ST (MIN.) , 30 ..::.. LENGTH OF TEST (MIN). : 2¢0 C(~.~ RECTION NOTICE BAKERSFIELD FIRE DEPARTMENT N°_ 1 0 7 7 Location ~03 Sub Div.. Blk.. Lot ...... You are hereby required to make the following corrections at the above location: Cot. No Completion. Date for Corrections Date ~/~/~1 Inspector 326-3979 C(~ ~'I:CTIO N NOTICE -BAKERSFIELD FIRE DEPARTMENT Sub Div, Blk. . ~t You are hereby required to make the following cormetio~ at the above l~ation: Co~, ~o Completion Date for Corrections *//~-.~1 · . Inspector 326-3979 E f"IAREET 8803 OAHINO MEDIA BAEEF:SF I ELD GA, 92:308 FEB 5. 2001 10:23 AM ,Si\"STEI'I 7STATUS REPORT ALL FUNCT [ON~: NORMAL ..... SENSOR ALARM L 1 :UNLEADED ANNIJLAR ANNULAR SPACE FUEL ALARM FEB 5. 2001 10:31 AM ...... ~:ENSOR ALARM ...... L 2: UNLE~I',ED STP STP SUMP FUEL ALARPI FEB 5. 2001 10::31 AH ...... SE ['.I',SOR ALARM L S:UNLE&DED F1LL OTHER SENSORS: FIJEL ALARIfl FEB 5.. 2001 10:32 AM EiENSOR ALARM EMIUM RIqNULAR OTHER SENSOR',S FdEL ALARM ['EE~ 5.. 2001 10:32 AM ..... SE I',If5OR Al.ARM L 6:PREMIUM FILL OTHER SENSORS FUEL ~LARM FEB 5.. 2001 10:32 AM ...... SENSOR ALARP1 L 5: PP.,EM I UM s'rP STP SUMP FUEL, ALARM FEB 5.. 2001 t0:33 AM ..... SEI'.IBOR AL.AI;~I'I Il ESEL STi::' MP FUEL ALAR!"I FEB 5, 2001 10::34 AP1 ..... SENSOR ~LARM ....... L ,_q:DIESEL FILL OTHER SENSORS FUEL, ALARM FEB 5.. 2001 10::2',4 AM ...... BEN;X_;OR i:iL/.~ R l'.ll ........ L10: [::I,C2;I::'ENSER :3-4 [,ISPENSER I:"~N Fi_lEI_. F~ L AF.q'.'I FEB 5. 2001 10:S5 APl ...... SENSOR Al. ARM ....... L12:DISPENSER 7-8 ~D I SPENSER -Pa N - - FUEL gLARH FEB 6, 2001 tO:S6 AM ....... SENSOR ~I,,ARP1 ...... L 9:[,ISPENSE~ I-2 DIS?ENSER PAN FUEL ALARM FEB 5. 2001 10:S6 ~I"1 ..... S E I,l,.c.;,:_-:, ~ ALARI':I ........ L1 l :[,ISPENSER 5-6 DISPENSER PAN FIJEL ALhRI'I FEB 5. 2001 1D:ST AM D I '.:_;PENSEJ~ PRN FUEL ALARM FE£; 5. 2001 10:56 F~Pl ..... SENSOR L 10: f',I SPENSEP: 3-4 SPENSER PAN 5, 2001 11:10 cAN EROOV. S I DE '-,3803 *--:Af'-'iI 1'40 PIEDI~ BAKERSF I ELD C:¢'~. 93308 FEB 5, 2001 11:15 SYSTEPI STchTUS REI>ORT L 1 :FUEL L 2:FUEL ~LRRI"I L :.3:FUEL RLRRI,'I L 4: FUEL ~:'~LRRPi L 5:FUEL RLRRt"I L 6 :FUEL L ? :FUEL L ,'33: FUEL RLRRP1 L 9 :FUEL L 1 0: FUEI., L 'LiEL ~L~RPI L 12: FUEL I N'dENTO~Y REPORT T 1 :UI'4LEADED 'v'OLUP1E = 1651 i GALS ULLAGE = 3571 C;ALS qFi;'.r, ULLAGE= ~ 562 ._,RI .... HEIGHT = 97.69 INCHES t,.JATER VC, L = 0 6RLS ~i&TER = O. O0 INCHES TEr'.'IP = 65.2 bEG F T 2 :PREPII UP1 \.,'OL IJPlE = 962:3 ,'_';ALS Ulal~;E = 24 t 8 '~ L~II'JLLFK-:E-- 1213 HEIGHT = 95.01 INCHES t.,IRTER = O. O0 INCHES TEPIP = 65.5 BEG F T 3 :DIESEL VOLUP1E = 6502 GRLS ULDqC;E = 1525 ,3¢ALS 90:~;; LILLAGE= 722 ORLS TC VOLUME = 6485 GALS HE[E-;HT = 96.26 1NC:HES faRTER VOL = 0 [3&LS t~gTE~ = O. O0 INCHES TEPlP = 65.6 DEG F BROC.,KS I DE R~A}(EF',SF 1 ELD C~. 9:]:20:3 FEB 5. 2001 11:15 AH ':3YSTEP1 ~I'&TLJg REPORT ~1_1. FUNCTI£:,NS NC, RId~L ....... SENSOR ALARI"I ..... Lll:UiSPENSER 5--6 D I SPEI'.ISER PAN FUEL FEB ~:;. 2001 11:16 ~M NAR}:::ET 880:3 '::RI'IlNO I"IEDIA B(:I;:EF:5;F I ELD CA. 93308 FEB 5. 2001 S\'",_:.:TEH g'F~TUS REI::'ORT ALL FUNCT I OI',IS Iq,DRI,'IAL L12:DISPENSER '7--8 DISPENSER PAN FUEL aLARI','I FEB 5. 2001 11:23 aP1 FEE: 5, 2C31 t ,I k;Ti.YI'mJ:J F~E [-'0 RT ALL FI.I',ICT iON',_-: I',K:.RI'.'laL ..... SENSOR ~ [_,~::~RI'-'I ....... L 1 2: D 1 £~PENSER ?' -8 D l SF-:'EI',IF_~E~ PAN FIJEL AL,~:~RI"I FEB 5, 2001 1:55 t:f'1 [-:F?:Z;":]'KS I I]'E I'qe:d.d:.;ET 81313:3 CaHII'.I,:~ I'-'IEDIe~ E~}.i Eli:5_;[-' 1 El_i, C~. q- '~, .,.;, U,.,'-' - ':' FEE; 5.. 2001 PI'-'I' E:'¥',C:;TEH FJT~-~TU;5: F.'EF',:_;'RT ~L.L F II'.l,:]"l"I';~:,l',l,c:-: NC, F:I"IAL CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-;;979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY [ ]MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTINODATE &- /--e'~ . PROPOSED COMPLETION DATE FACILITY NAME A:~~~" ,/t'/~. EXISTING FACIL1TY PERNffr NO. FACmlTYADDRESS ~f~e~5 ~/~,~.,',,~ ~/f[e~,'o CITY ,~.~:ZC) ZIPCODE TYPE OF BUSINESS ~"~,z~/~"z,,e~ .z'~,Z,z~.~- Z ,~_.,'~/v'~ · APN # TANK OWNEg .,...)~:f-~-,~;~:z_~ ~g~'~. PHONENO. ADDRESS /-':.e~. ~ ~ crrY ~/,,~v zm CODE co~vn~ACTOa ~-'Z~, / .. c'~ z-~u'c*z-z~/ -- c^ LIcm~sE NO. ADDRESS ~'-'M~-~-c~-e-'"~f'",,~ ~---~/%-. < CITY ~-~--~"'~;' ZIPCODE ~HONE ~0. ~ - ~ 7OeV BAr, m~smn) crrY Busmmss ~ICm,~SE ~0. WORKlVLa. NCO~NO. ~.Z~-~/~,~-~--',ev INSURER ~',~-E' BRm_~zY nESCRmE Trm woe, I( zo BE DONE /x/~'~/-~zc WATER TO FACILrrY PROVIDED BY .~,~Z- /ZP~z'~'~--- DEPTH TO GROUND WATER ~',/fx",,,~---- SOIL TYPE EXPECTED AT srrE No. OFTA~CSTO~En~ST~ ~ ARSU-mYFOgMOTOammI. ' C~S~ ~0 SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE YES NO SECTION FOR MOTOR FIlL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION SECTION FOR NON MOTOR FIJEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (~O Bm~VO NAME) OF KNOWN) FOR OFFICIAL USE ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATrACHED CONDmONS OS THIS PERMrr AND ~NY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. ~-f/-)l. 5-]07 u-ns som~ HAS sn~-~ co~v~m.nTm) u~)~ Pm~A~TY OS PnmnmY, Am) TO Trm BSST OS ~ mWO~S, m TRUE AND CORRECT. T[II$ APPLICATION BECOMES A PERMIT WHEN APPROVED CITY OF BAF~ SFIELD ~FFICE OF ENVIRONMI~TAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE Address $~'O3 ~,-~O /~GO,~. Address. ~ City, Zip City, Zip I Phone No. Permit # "~ '~' ~-- O t"~6 INSTRUCTIONS: Please call t'or an inspector only when each group of inspections with the same number are ready. They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered group until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. TANKS AND BACKFILL Backfill of Tank(s) *C~x- GII.~v'C...-~ Spark Test Certification or Manufactures Method Cathodic Protection of Tank(s) ~ PIPING SYSTEM ........... Piping & Raceway w/C°llecti°n Sump ~./7/~_.~ · ~2'~ ~'-h/~ Corrosion Protection of Pi-ping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) Cathodic Protection System-Piping Dispenser Pan '~x'~ .-~.~e~ O/~ SECONDARY CONTAINMENT, OVERFILL PROTECTION, Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Fl~.oat .Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) ~O'1,,~ ~. Leak Detector(s) for Annual Space-D.W. Tank(s) ' M°nit°ring Well(s)/Sump(s) ' H20 Test Leak Detection Device(s) for Vadose/Groundwater Spill Prevention Boxes e"'-"- ~ '~/%"'~fO ! Monitoring Wells, Caps & Locks Fi, BoxLock ' Monitoring Requirements Type'"'~ <o -- "~ ~ Authorization for Fuel Drop Z/~'~t~ ! CONTRACTOR ~ 3 LICENSE# 741o~-~ CONTACT i3/~ 3~.X~_,~ PHONE # ~'~'~ - O'~-~ 33~- 7z4~-