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UST-REPORT 2/5/1997
/ , Env~ron~Ontal Services, inc..~.. DAVE ~IER ~ ~' ~ /'~'- :- "~ D~N"~AD' "'"..: ~'r ~" ~ ~'~'~.'~1 PROJECT MANAGER ' ' ~ ' ''/PROJECTM~'N~GER ~.''... ".'~"' :~ ~.~,,~ MPE LiC. ~ 613706 -' ~. :~' -.. .MPV LIC~'~ 5499~7 ' . -... '' '~ ~.,'..~j ~' '-~PELIC~'~_6,13706 ~. '~: ' ",~,.,.. ~. , ........................ ~RER~FIELD,,cA 9~3GSr, ~' , ~, "' ('916~'668-~316 ~3400 MANOR ST WOODLAND, CA (8°5) 393-115'1 ........ ~" ~ -',? ~dE~lX'-~ ~' BAKERSFIELD, CA 93308 ~916~ 668-9316 ]F~'(805) 393~0508" -'' ' ,.', "- ': ~' (602)'27~623'3 (805) 393-1 151 PHOENIX; AZ FAX ~805} 393-3834 ~6021 278~233 Inner Tank oo0 0 o ~,,2~e/ -'STORAGE/DISPENSING U1VIT Fuel Level Guoge Vapor ~2'1#---- Vodose Monitoring Fill Tube Concrete ~ I I I I I I I I II II I I ! I I I I I II II AGT Grondulor · Fire Insulator BAKERSFIELD FIRE DEPARTMENT February 5, 1997 Mr. Wayne Pipes FIRE CHIEF MICHAEL R. KELLY Red Lion Hotels & Inns P.O. Box 1027 ~N~VES~RV~C~S Vancouver, WA 98663 2101 'H' Street · Bakersfield, CA 93301 (805) 326-3941 FAX(805)395-1349 CLOSURE OF 1 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK LOCATED AT 3100 CAMINO DEL RIO COURT IN BAKERSFIELD, CA_ SUPPRESSION SERVICES PERMIT #BR-0156. 2101 'H' Street Bakersfield, CA 93301 C805) 326-3941 Dear Mr. Pipes: FAX (805) 39fi- 1349 PREVENTION SERVICES This is to inform you that this department has reviewed the results for the 1715 Chester Ave. preliminary assessment associated with the closure of the tanks located at the above Bakersfield, CA 93301 (805) 326-3951 stated address. FAX (805) 32643576 ENVIRONMENTAL SERVICES Based upon laboratory data submitted, this office is satisfied with the 1715 Chester Ave. assessment performed and requires no further action at this time. Bakersfield, CA 93301 (805) 326-3979 FAX (805)326-0,576 If yOU have any questions regarding this matter, please contact me at (805) TRAINING DIVISION 326-3979. 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 Sincerely, FAX (805) 399-5763 Howard H. Wines, III Hazardous Materials Technician HHW/dlm cc: Kathy Gill, RWQCB D. Johnson, Agra Earth & Environmental O A (~ ~ ~ AGRA Earth & · Environmental, Inc. Earth & Environmental 1824 Norris Road Bakersfield, CA 93308 Tel (805) 392-1344 9 December 1996 Fax (805) 392-7782 AEE Project No. 6-614-086100-2 Red Lions Hotels and Inns P.O. Box 1027 4001 Main Street Vancouver, WA 98663 Attn: Mr. Wayne Pipes, Senior Director of Corporate Engineering RE: UNDERGROUND STORAGE TANK {UST) ABANDONMENT/RESULTS OF SOIL SAMPLING RED LION INN - 3100 CAMINO DEL RIO COURT BAKERSFIELD, CALIFORNIA Dear Mr. Pipes: AGRA Earth & Environmental, Inc. (AEE) is pleased to provide the followin9 report detailing the field activities, soil sampling protocol, field observations and results of soil sample analysis for' the above referenced site (Figure 1, Site Location). The §00 gallon capacity, single walled, steel UST (used to store diesel fuel for the facility's emergency generator), was abandoned in place on 12 September, 1996; by MP Environmental Services, located in Bakersfield, California, under a direct contractual agreement with Red Lion Inns. MP Environmental Services was responsible for all necessary permitting requirements and regulatory agency notifications prior to UST abandonment. UST abandonment oversight and soil sampling was conducted by AEE personnel from our Bakersfield, California, office. The UST was regulated under the Bakersfield City Fire Department, Hazardous Materials Division. Mr. Mark Turk, Inspector-Hazard Materials, was present at the site during UST abandonment and soil sampling activities. 1.0 UST ABANDONMENT The UST was located on the east side of the inn, inside of 25' by. 35' wood/stucco enclosure, adjacent to State Highway 99, that housed .the stand-by generator and cooling tower (Figure 2, Site Plan). The UST was covered by a concrete slab approximately four inches thick. Before abandonment activities began, all product (approximately 250 gallons) in the UST was transferred into a vacuum truck, licensed to haul hazardous material. The liquid was .manifested as non-RCRA hazardous waste on a hazardous waste manifest and transported to DeMenno/Kerdoon in ComPton, California, for disposal. A copy of the waste manifest and . acceptance documentation is attached as Appendix A. UST abandonment began at approximately 12:00 p.m. on 12 September, 1996, with the Bakersfield City Fire Department's inspector (Mr. Mark Turk) verifying that the tank cavity was clear of liquids and gases. Approximately three (3) cubic yards of cement slurry was than Engineering & Environmental Services. (~ Recycleci Paper UST Closure Report l~Project No. 6-6.14-086100-2 Red Lion Hotel - Bakersfield, Ca 9 December 1996 Attn: Mr. Wayne Pipes, Jr. Page 2 pumped into the fill port of the UST to fill the evacuated tank volume. The UST's vent pipe was also filled with cement slurry and capped. The underground product supply line was cut off near slab surface and capped. 2.0 SOIL SAMPLING To comply with Bakersfield City Fire Department requirements, soil samples were collected at depths of 2 and 6 feet below the product line and the UST. The boring locations were approved by Mr. Mark Turk; Inspector. A concrete coring machine was utilized to cut a four- inch diameter core through the concrete slab at the pre-approved boring locations. One hand auger soil boring (HB-3) was advanced to an approximate depth of 13 feet below the center of the UST (Figure 2 - Site Plan and Sample Locations). Two (2) hand auger soil borings (HB-2 and HB-3) were advanced along course of the underground product line; one midway between the UST and generator, and one at the 90° turn of the pipe toward the surface. Soil samples were collected a depths of 9 and 13 feet below surface grade (bsg) in HB-1, and 4 and 8 feet bsg in HB-2 and HB-3. Samples were placed into glass jars with teflon-lined lids, and stored on ice at 4° Celsius for delivery to a state-certified testing laboratory. Sample containers were labeled in the field, and a chain-of-custody form was completed t° document delivery of the samples to appropriate laboratory personnel. The samples were transported to Zymax Laboratories, located in San Luis ObiSpo, California, for laboratory analyses. The borings were backfilled with native material to within six inches of surface grade, then capped with a quick-setting cement slurry, finished to slab grade. 3.0 ANALYTICAL RESULTS The soil samples were analyzed by Zymax Laboratories for Total Petroleum Hydrocarbons as Diesel (TPHd) per EPA Method 8015M and benzene, toluene, ethylbenzene and xylenes (BTEX) per EPA Method 8020. All soil samples reported ND (None Detected at or above the Practical Quantitatio~ Limit) for TPHd and BTEX. Certificates of Analysis and Chain-of-Custody documentation is attached as Appendix B. 4.0 CONCLUSIONS Based on field observations and results of soil sample analysis, we conclude the following: The underground storage tank and associated piping (UST system) were abandoned in accordance with practices and protocols established by the Bakersfield City Fire Department. · The soil samples collected beneath the UST system reported ND for TPHd and BTEX. Therefore no further action should be warranted for this site. ~ ~AGRA ~ RecycledPoperi ~ Earth & Environmental UST Closure Report roject No. 6-614-086100-2 Red Lion Hotel - Bakersfield, Ca 9 December 1996 Attn: Mr. Wayne Pipes, Jr. Page 3 5.0 REPORTING REQUIREMENTS A copy of this closure report should be forwarded to the Bakersfield City Fire Department at the following address to comply with permit requirements: Bakersfield City Fire Department Hazardous Material Division 1715 Chester Avenue Bakersfield, CA 93301 Attn: Mr. Mark Turk, Inspector We trust this report fulfills your Current needs for the subject site. If you have any questions or comments, or require additional information, please do not hesitate to contact us. Respectfully submitted, AGRA Earth & Environmental, Inc. Reviewed by: Dale A. Johnson, R.G. iper,'P.G. Project Manager Associate Attachments: Figure 1 - Vicinity Map Figure 2 - Site Plan and Sample Location.Map Appendix A - Hazardous Waste Manifest Appendix B - Certificate of Analysis and Chain-of-Custody Documentation ~ ~AGF~A ~ Recycled Paper Earth & Environmental Scale 1" - 2640' RED LION HOTEL 3100 Camino Del Rio Court Bakersfield, California FIGURE 1 SITE LOCATION RED LION INNS & HOTELS AGRA Earth & Environmental, Inc. FT~ZD Dt~4t7- IAPPt?OV. I Z~,f/'~- I JOB No. RE: Thomas Guide, Central Valley, 226 D-2 D ~- NoV 1996 · o~/oo- ~ ~,r-="~-~New 500 Gallon UST Al:)andoned UST & Product Line r lil Cooling Tower ~'Standby Generator SCALE 1" = 10' RED LION HOTEL 3100 Camino Del Plo Court Bakersfield, California F~GURE 2 SITE PLAN W/BORING LOCATIONS RED LION INNS & HOTELS AGRA Earth & Environmental, Inc. NOV 1996 i Form Ai~oved OMB No. 2050-0039 (E~pim 9-30-94) '~ ctions on back le 6. Department of Toxic Substance, Control I~eate ~ o, type. ~ deigned for u~e ~q e//te · . / Sacramento. Califomla · UNIFORM HAZARDOLIS t. Generator's Manifest Document No. 2. Page 1 islnf°rmati°r~not requiredin th.by shadedFederal areatlaw. WASTE MANIFEST of i 3. G~no,a*or', Name and .'6ai~.g Addms, RED LION HOT2 P.O. - VANCOUVER. WA 98666 4. C~.erator'sMane ( 36~ 696--0001 $. Transporter I Compony Name 6. US EPA ID Number 8. US EPA ID Number Designated Facility Name and Site Address 10. US EPA ID Number DEMMENO/KERDOO~ 2000 N. ALAMEDA ST 12. Containers 13. Total 1 i. US DOT Description (including Proper Shipping Name. Hazard Class, and ID Number) NON ]{CRA .HAZARDOUS ·WASTE, LIQUID b. 15. Special Handling Instructians and Add'd~nal Information WEAR PROPER PPE SITE: 3100 CAMINO DEL RIO ~NERGENCY PHONE'..-'800-458-3036 BAKERSFIELD, CA. 93308 :' 16. GL~ERATOR'S. CERTIFICA .TION: I her~y de<late that ~e con~ of ~,e comlgnment a.m. ful¥ and acc..urately de~ribed above by proper shipping name and ore classified, pocked, marked, and labeled, and are in all respects in proper canditlo~ for transport.by highway accord:ng to apphcable federal, state and international laws. If I am a la,ge quantity generator, I cestify ~hat I have a Program in place'to redUCe the volume and toxicity of waste generated to the degree I have determined to be economically practicable a~d that I have selected the practicable me~od of h'eatment, storage, or disposal currently available to me which minimizes the present' and lucre threat to human health and the emdroeme~tj OR, if I am a ~all quantity generator, I have mode a good faith effort to minlmZze my waste generation and select the best waste mana~-~.,~,: ~,~-..~ that is av~_!!~ble to me and that I can afford. 1 ~ of M~edah . ' 2 Pdated/Typed Name ... :. [ Signature t [ Month Day Year 19. Discrepancy indication Space :... s noted in Item 19. Pr,need/Typed -- ~l/'~ '"" %' Month Day Year ',' ' J ' DO NOT WRITE' '?.' ';~ ~" '~. .. . /92) ~ ' .'/i. 0,,~,,~: HAULER RFI'AIt,~'.S ": ~ ~ .' 2000 North Alameda Street, Compton, California 90222-2799 i3~'0) 537-7100 Receiving No. 105252 & Quantity & Product ,~..,:. ? ~ o Gals. O, C. ;~ [.~,. '-~ .. B.S.%W · % ( e~.~ ) · 'APl Temp. 7 ~. °F ... ' Sediments, % Flash Pt. ~F. Halides PPM ~ z ,~ '~- ' v ~ /~ ~-~ ~ '' ~ ~ '~ ~ ~C, - , ,' h ' -' ~ '- '~. ~ :. d ~ -:.'~'-~, /. ,..~ ~ ' · ~' ~ '~' -I'~. · .~,.'~.~ ?.-L~.~- ..,~ :;~ '~..~.~.," ~,..~ ~:,,,. ~,>...,~.~./:. ~ '~.'~.%~"~.'~:-~,:~:~.'~ .'? .~ ~ - ~ ~ ~'': ~.~ · ...~.~ ~'.~ .... . ~:~' ~ ..~ ~:'.. ~ ~, . r~.~,~ ~ ~ _. ~ ~ , ~., ....~..~.'~,~ ;.. ~' ~,,~ .. ~, . .... ~ -~_.~ ' ~ . '.:: ',".,', .. ', ' ..... "' · .... ~".? .4,'-~. 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Chain of Custody DATE , PAGE { OF/ PROJECT NO:~'/f~- 2_ PROJECT NAME/SITE: ^LYSIS RE TED PROJECT MANAGER: ~ec~ Lio~,- ~5~ K~'t x f ie~d' ~ / S~LE ID~CA~ON DA~ ~ ~ ~ ~ ' RELINQUI~EDBY: DATE TIME RECEIVED BY: .~ LABORATORY: , ~~~ q/{~ /~ ~ 7~X PLEASESE~RES~TSTO: 1290 No~h ltanc~k Str~ Anaheim, CA 92817 RELINQU'~O BY: ~AT~ TIME RECEIVED BY: ~ample D~sal ~ Sample R~urn (714) 779-2591 FAX <714)779~377 18~ Norr~ Road RELINQ~SHED BY: DA~ TI~ RECEIVED BY: REQ~STED T~NARO~ TI~: Bakemfield, CA 93308 (805) 392-1344 FAX (80s) 392-7782 D 2aHRS ~ a8HRS .WK ~ 2WKS B 16760 W~t Bernardo Drive R~LINQ~SHED BY: D~~ TIME RECEIPT CO~ITION: San Dido, CA 92127 /~ ~O -- (619) 48%2113 F~ (619) 487-~57 e n v i r o t e c h n o I o g y REPORT OF ANALYTICAL RESULTS I Client: Dale Johnson [Lab Number: 9571-1 M&T AGRA, Inc. Collected: 09/12/96 1824 Norris Road Received: 09/13/96 Bakersfield, CA 93308 ~Matrix: Soil I Project: Red Lion-Bakersfield ISample Descripti°n~lB-1 @ 4' Project Number: 6-61408610-2 I Analyzed: 09/18/96 Collected by: Dale Johnson I Method: EPA 8260 I CONSTITUENT PQL* RESULT** mg/kg mg/kg Benzene 0.005 ND Toluene 0.005 ND Ethyl benzene 0.005 N D Xylenes 0.005 ND Percent Surrogate Recovery 101 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Submitted by, ZymaX envirotechnology, inc. JMM/jgt/wr/wj Laboratory. Director 71 Zaca Lane : fax 805.544.8226': San Luis Obispo. California 93401 e-mail: z,/max(~callamer.com tel. 805.544.4696~ e n v i r o t e ¢ h n o I 0 g y REPORT OF ANALYTICAL RESULTS I Client: Dale ,Johnson ILab Number: 9571-1 M&T AGRA, Inc. IC°llected: 09/13/96 1824 Norris Road IReceived: 09/13/96 Bakersfield, CA 93308 iMatrix: Soil I Project: Red Lion ~ Bakersfield ISample Description~lB.1 @ 4, I Project Number: 6-61408610-2 IAnalyzed: 09/18/96 Collected by: Dale Johnson IMethod: See Below CONSTITUENT PQL* RESULT* * mg/kg mg/kg TOTAL PETROLEUM HYDROCARBONS Diesel 10. ND Percent Surrogate Recovery 56 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 · PQL - Practical Quantitation Limit · *Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 09/17/96. Note: Analytical range is C8-C40. Submitted by, ZymaX envirotechnology, inc. 9571-1t.xls acMur JMM/jgt/dzlhp/kh Laboratory Director 7i :Zaca Lane ~ fax 805.544.8226 San Luis Obispo, California 93401 e-maiJ: zymax~callamer.com " tel 80 S .544.4696 ' -Zyma'? '~-"~ e n v i r o t e c h n o I o g y REPORT OF ANALYTICAL RESULTS Client: Dale Johnson ILab Number: 9571-2 M&T AGRA, Inc. I Collected: 09/13/96 1824 Norris Road IReceived: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil I Project: Red Lion - Bakersfield ISample Description: I ' HB-1 @ 8' I Project Number: 6-61408610-2 '1 Analyzed: 09/18/96 IC°llected by: Dale Johnson I Method: See Below iCONSTITUENT mg/kgPQL* RESULT**Img/kg TOTAL PETROLEUM HYDROCARBONS Diesel 10. ND Percent Surrogate Recovery 83 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 09/17/96. Note: Analytical range is C8-C40. Submitted by, ZymaX envirotechnology, inc. 9MsS71~-;~4t .xls J olin M acMurphey~"~'~~ JMMIjgtldzlhplkh Laboratory Director 71 Zaca Lane fax 805.544,8226 San Luis Obispo, California 93401 e-mail: ~max(~callamer.com tel 805.544.4696 Zyma ~ e n v i r o t e ¢ h n o I o g ¥ REPORT OF ANALYTICAL RESULTS Client: Dale Johnson ILab Number: 9571-2 M&T AGRA, Inc. ICollected: 09/12/96 1824 Norris Road I Received: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil I Project: Red Lion - Bakersfield Sample Description: HB-1 @ 8' I Project Number: 6-61408610-2 Analyzed: 09/18/96 Collected by: Dale ~ohn~on Method: EPA 8260 ONSTITUENT PQL* RESULT** mg/kg mg/kg Benzene 0.005 ND Toluene 0.005 ND Ethylbenzene 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 101 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit ** Results listed as ND would have been reported if present at or above the listed PQL. Submitted by, ZymaX envirotechnology, inc. 9571-2.xls acMurp JMM/jgt/wr/wj Laboratory Director 71 Zaca Lane fax 805.544.8226 San Luis Obispo, California 93401 e-mail: zymax~callamer, com tel 805.54 4.4696 e n v J r o t e ¢ h n o I o g ¥ REPORT OF ANALYTICAL RESULTS Client: Dale Johnson ILab Number: 9571-3 M&T AGRA, Inc. JCollected: 09/12/96 1824 Norris Road I Received: 09/13~96 Bakersfield, CA 93308 IMatrix: Soil I Project: Red Lion - Bakersfield ISample Description: , I HB-2 @ 4 I Project N umber: 6-61408610-2 J Analyzed: 09~ 19~96 {Collected by: Dale Johnson I Method: EPA 8260 ICONST'TUENT mg/kgPQL* RESULT**Img/kg Benzene 0.005 ND Toluene 0.005 ND Ethylbenzene 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 102 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation' Limit **Results listed as ND would have been reported if present at or above the listed PQL. Submitted by, ZymaX envirotechnology, inc. 9571-3.xls JMM/jgtlwr/jk Laboratory Director 71 Zaca Lane fax 805.544.8226 San Luis Obispo. California 93401 e-mail: zymax{~callamer.com tel 805.544.4696 e n v i r o t e c h n o I o g ¥ REPORT OF ANALYTICAL RESULTS Client: Dale Johnson ILab Number: 9571-3 M&T AGRA, Inc. I Collected: 09/13~96 1824 Norris Road I Received: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil Project: Red Lion - Bakersfield ISample Descripti°n~B-2 @ 4' Project Number: 6-61408610-2 I Analyzed: 09/18/96 Collected by: Dale Johnson ~Metho6: See Below ICONSTITUENT mg/kgPQL* RESULT**mg/kg I TOTAL PETROLEUM HYDROCARBONS Diesel 10. ND Percent Surrogate Recovery 63 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQLo Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 09/17/96. Note: Analytical range is C8-C40. Submitted by, ZymaX envirotechnology, inc. 9571-3t.xls acMu Y- JMMIjgtldzlhplkh Laboratory Director · 71 Zaca Lane. fax 805.544.8226 San Luis Obispo, California 93401 e-mail: zymax@callamer, com tel 805.544.4696 e n v i r o t e c h n o I o g y REPORT OF ANALYTICAL RESULTS Client: Dale Johnson ILab Number: 9571-4 M&T AGRA, Inc. ICollected: 09/12/96 1824 Norris Road I Received: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil I Project: Red Lion-Bakersfield Isample Descripti°n~lB-2 @ 8' Project Number: 6-61408610-2 I Analyzed: 09/19/96 Collected by: Dale Johnson IMethod: EPA 8260 [CONSTITUENT mg/kgPOL* RESULT**mg/kg Benzene O.005 ND Toluene 0.005 ND Ethylbenzene 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 100 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Submitted by, ZymaX envirotechnology, inc. MSD #7 9571-4.xls JMM/jgt/wr/jk Laboratory Director 71 Zaca Lane fax 805.$44.8226 San Luis Obispo, California 93401 e-mail: zymax(~callamer.com tel 8 0 5.5 4 4.46 9 6 e n v i r o t e c h n o I o g y REPORT OF ANALYTICAL RESULTS IClient: Dale Johnson ILab Number: 9571-4 M&T AGRA, Inc. l Collected: 09/13/96 1824 Norris Road I Received: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil Project: ~ Red Lion - Bakersfield Sample Description: HB-2 @ 8' Project Number: 6-61408610-2 Analyzed: 09/18/96 Collected by: Dale Johnson Method: See Below CONSTITUENT mg/kgPQL' RESULT*'Img/kg TOTAL PETROLEUM HYDROCARBONS Diesel 10. ND Percent Surrogate Recovery 63 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL- Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 09/17/96. Note: Analytical range is C8-C40. Submitted by, ZymaX envirotechnology, inc. MSD #4 J~nn M~~ 9571-4t.xls acMur JMMIjgtldzlhplkh Laboratory Director 71 Zaca Lane : ~ fax 805.544.8226 San Luis Obispo. California 93401 e-mail: zymax(~callamer, com ; tel 805.544.4696 e n v, r o t e c h n o I 0 g y REPORT OF ANALYTICAL RESULTS I Client: Dale Johnson ILab Number: 9571-5 M&T AGRA, Inc. ICollected:' 09/12/96 1824 Norris Road I Received: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil I Project: Red Lion - Bakersfield Sample Description: HB-3 @ 9' Project Number: 6-61408610-2 Analyzed: 09/19/96 ~Collected by: Dale Johnson Method: EPA 8260 I CONSTITUENT PQL*' RESULT** · mg/kg mg/kg ~ Benzene 0.005 ND Toluene 0.005 ND Ethylbenzene 0.005 ND Xylenes 0.005 ND Percent Surrogate Recovery 101 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Submitted by, ZymaX envirotechnology, inc. MSD#7 j~n M~'~--~ 9571-5.xls acMu JMM/jgt/wr/jk Laboratory Director 71 Zaca Lane : i fax 805.544.8226 · San Luis Obispo, California 93401 e~mail: zymax(~callamer.com : tel 805.544.4696 ~'~ O g ¥ REPORT OF ANALYTICAL RESULTS Client: Dale ,Johnson ILab Number: 9571-,5 M&T AGRA, Inc. ] Collected: 09/13/96 1824 Norris Road Received: 09/13/96 Bakersfield, CA 93308 I Matrix: Soil Project: Red Lion-Bakersfield ISample Descripti°n~B-3 @ 9' Project Number: 6-61408610-2 IAnalyzed: 09/18/96 Collected by: Dale Johnson IMeth°d: See Below ICONSTITUENT mg/kgPQL' RESULT**Img/kg TOTAL PETROLEUM HYDROCARBONS Diesel 10. ND Percent Surrogate Recovery 64 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 09/17/96. Note: Analytical range is C8-C40. Submitted by, ZymaX envirotechnology, inc. 9571-5t.xls JMMIjgtldzlhplkh Laboratory Director '71 Zaca Lane fax 805.544.8226 San Luis Obispo, California 93401 e-mail: zymax~callamer.com · tel 805.544.4696 Client: Dale Johnson ILab Number: 9571-6 M&T AGRA, Inc. ICollected: 09/12/96 1824 Norris Road IReceived: 09/13/96 Bakersfield, CA 93308 [Matrix: Soil I Project: Red Lion - Bakersfield Sample Description: HB-3 @ 13' Project Number: 6-61408610-2 Analyzed: 09/19~96 ~Collected by: Dale Johnson Method: EPA 8260 CONSTITUENT mg/kgPQL* RESULT** Benzene 0.005 ND Toluene 0.005 ND Ethyl benze ne 0.005 N D Xylenes 0.005 ND Percent Surrogate Recovery 100 ZymaX enVirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL. Submitted by, ZymaX envirotechnology, inc. 9571-6.xls cMurp JMM/jgt/wr/jk Laboratory Director 71 Zaca Lane ; fax 805.544.8226 San Luis Obispo. California 93401 ~; e-mail: zymax(~callamer.com - tel 805.544.4696 '~ o g ¥ REPORT OF ANALYTICAL RESULTS I Client: Dale Johnson ILab Number: 9571-6 M&T AGRA, Inc. ICollected: 09/13/96 1824 Norris Road I Received: 09/13/96 Bakersfield, CA 93308 IMatrix: Soil I Project: Red Lion - Bakersfield .. Sample Description: HB-3 @ 13' I Project Number: 6-61408610-2 Analyzed: 09/18/96 iCollected by: Dale Johnson Method: See Below ICONSTITUENT mg/kgPQL* RESULT**Img/kg TOTAL PETROLEUM HYDROCARBONS Diesel 10. ND Percent Surrogate Recovery 68 ZymaX envirotechnology, inc. is certified by CA Department of Health Services: Laboratory #1717 *PQL - Practical Quantitation Limit **Results listed as ND would have been reported if present at or above the listed PQL.~ Note: Analyzed by GC/MS Combination. Note: Extracted by EPA 3550 on 09/17/96. Note: Analytical range is C8-C40. Submitted by, ZymaX envirotechnology, inc. 9571-6t.xls acMur JMMIjgtldzlhplkh Laboratory Director 71 Zaca Lane fax 805.544.8226 San Luis Obispo. California 93401 e-mail: zymax(~callamer.com tel 805.544.4696 _BAKERSFIELD FIRE DEPARTMENT %Z~S MATERIAL DIVISII - 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM FACILITY ~e~ ~, ADDRESS ~'~[~0 ("~b-,~ ~ O~R PE~T TO CO~CTOR ~.~, ~c~ ~ ~O~ACT PERSON ~ ~BO~TORY ~~ ~Lo~,.~ ~ OF S~PLES TEST ME~ODO~OGY ~ ~%~( ~ ~D ~ ~ PRELI~ARY ASSESSMENT CO. ~ CO.ACT PERSON~.~e~ CO~ RECIEPT ~ LEL% ~ 0:% PLOT P~N' CONDITION OF PIPING CONDITION OF SOIL INS~E~ N~ RECORD OF TELEPHONE CONVERSATION Type of Cai: Incoming [ ] Outgoing [ ~ Return~ [ ] Time Required to Complete Activity # Min: ~ ~ ~ ~ .~ . 0~ , m 2 RED LION HOTEL 3100 CAMINO DEL RIO CT. NOT TO SCALE BAKERSFIELD CA UST SITE P~N AGRA Earth & Environmental, Inc. I I I I I GENERAL CONDITIONS PART I GENERAL The standard contract that shall govern the work detailed in the attached specification and attachments as shown in Attachment 1. The below General Conditions should be considered supplemental to the General Conditions provided in Attachment 1. In the case of a conflict between the General Conditions provided below and those in Attachment 1; the term~ and conditions of Attachment 1 shall prevail to those listed below: · "Owner": The term Owner shall refer to Red Lion Hotels & Inn (Red Lion). The Contractor shall enter into a contract with the Owner to perform the scope of work defined in these documents. · "Engineer": Shall refer to AGRA Earth & Environmental, Inc. (AEE), for work under this scope. AEE shall provide construction observation services for the Owner to monitor the Contractors compliance with the construction specifications and drawings. AEE does not have any contract agreement with the Contractor and will not assist the Contractor of the methods or materials used to complete the specified work. -' "Contractor": An individual, partnership, firm, or any acceptable combination thereof, or joint venture, contracting with Red Lion for performance of all or a portion of the work specified in these documents. 1.01 INDEMNIFICATION The Contractor shall indemnify, defend, and hold harmless Red Lion Hotels & Inns and AGRA Earth & Environmental (AEE), Inc. from any claim of liability arising out of the Contractor's torts during performance under this agreement. The liability of the Contractor shall continue after the termination of the contract with respect to any liability, loss, expense or damage, resulting from acts or omissions occurring prior to termination, except as liability may be limited by law. The extent of the Contractors obligations for damages under this agreement shall not be limited by the extent or amount of performance bond or insurance coverage provided in the agreement. 1.02 INCONSISTENCIES AND OMISSIONS The specification and drawings included in the contract are intended to be explanatory of each other, but should any discrepancies appear, the terms and conditions in the specification, shall prevail over the notes and details shown on the drawings. The specifications and drawings are intended to require and to include all labor, materi~ls, equipment, permits, tools, and the like necessary and proper for the work. The Contractor shall exercise proper precautions t°. verify the figures shown on the drawings before layout of work, and will be held responsible for any error resulting from failure to exercise such precautions. For existing work the Contractor shall verify existing conditions to insure that the new work will fit to the existing structure in the manner intended and shown on the drawings. Should any condition exist that are contrary to the intent of the specifications or those shown on the drawings, the Contractor shall notify the Owner or the Engineer prior to fabrication or performing any work in the area involving differences. Notification shall be in the form of a drawing or sketch indicating field measurements and notes related to the area. Red Lion Hotels & Inn 6-614-086100 SUMMARY OF WORK PART I GENERAL 1.01 WORK UNDER THIS CONTRACT A. The work includes the furnishing of all labor, materials, tools, equipment, services and incidentals for the excavation and underground storage tank decommissioning, installation of replacement above ground storage tank, and all associated work at the Red Lion facility located at 3100 Camino Del Rio Court, Bakersfield, California (See Attachment 2). B. Contract forms shall be signed by both the Contractor and the Owner, before any work begins. A copy of the contract is attached for your review. Please address any items to which Contractor takes exception to in our bid response. C. Final invoice must include a mechanics lien waiver or similar affidavit showing clear evidence that all the Contractor's suppliers and/or subcontractors have been paid for the work. D. The work includes, but is not limited to the following: 1. Provide, set-up, and remove all necessary fencing and barriers required to safely complete work under this scope. All work shall be performed such that their is no interruption to surrounding businesses and operations. The Contractor shall maintain all necessary safety equipment and barriers for the entire duration of work under this contract. 2. Disconnection of any electrical service to the Underground Storage Tank (UST) system at the subject site. 3. Measure and record the level of any liquids within each tank. Provide methods, equipment, and labor to remove all liquids from the UST. Provide and maintain temporary storage for the fuel removed from the UST. Removed fuel shall be placed into the installed AST when installation has been completed and approved. Properly dispose of any sludges removed from the UST off-site. Proper disposal shall include submittal of proper documentation of sludge disposal to the Engineer. 4. Provide and maintain temporary fuel service to the emergency generator. Temporary fuel service shall be installed and maintained during UST removal activities and until the AST is fully operational. 5. Decommission, excavate, remove, and properly dispose of the UST, and all associated piping. If sold, the UST shall be sold only as scrap. Disposal of the tanks shall include proper documentation. 6. Excavation, transport, and disposal of soils and debris generated from the UST decommissioning activities as detailed in the bidding documents and as directed by the Engineer. Red Lion Hotels & Inn 6-614-086100 7. Provide, place, and compact backfill material into the former tank cavity excavation per applicable local building codes. Final surfaces grades and elevations shall match existing grade and elevation prior to work under this scope. 8. Furnish and install a new, Owner approved, Above-ground Storage Tank (AST) to a fuel source to the existing emergency generator. Installation shall include proper installation of the tank, connection of the tank to the generator, and testing the tank and fuel piping system. Installation of the AST shall include construction of a concrete slab per manufactures specifications, and steel guard post to protect the AST, if required. 9. The Contractor shall locate, mark and use extreme care when excavating near or around utilities. The Contractor shall be responsible for any and all damage that occurs under this scope. The Contractor shall be responsible for protection of all monitoring wells, located on the property during tank decommissioning activities. Any wells damaged during tank decommissioning and excavation activities will be replaced by the Owner at the Contractors expense. 10. All required permits and payment of permit fees shall be the responsibility of the Contractor unless otherwise specified in this section. Coordination and scheduling of work with utilities, governmental agencies, inspectors, sub- Contractors, AGRA Earth & Environmental (AEE), Inc. and the Owner is the responsibility of the Contractor. The Contractor shall schedule all necessary inspections and notifications for tank removal activities with the Bakersfield Fire Department Hazardous Materials Division. 1 1. The Contractor shall clean up and dispose of all rubbish, scrap, debris, and unused materials of any kind resulting from the work. The Contractor shall be responsible for removal of soils, dirt, mud, and debris from the surface of areas effected by work under this scope. The Contractor shall be responsible for cleanliness of the site during and at the conclusion of this scope of work. 12. The Contractor is responsible for permits and fees for disposal of possible hydrocarbon impacted water placed in the water storage tank that was removed from the excavation under this contract. 1.02 CONTRACTOR INSURANCE REQUIREMENTS The insurance requirements for the Contractor, for work under this contract, are stated in general conditions. The Contractor shall submit certificates of insurance to the Owner and the Engineer prior to any work under this contract. 1.03 SCHEDULE OF WORK The Contractor shall: Proceed with performance under the contract immediately upon receipt of the notice to proceed executed by the Owner. The Contractor shall continuously and diligently prosecute the work to complete on or before the time set forth in this section. Complete All Work: 21 Calendar Days following regulatory approval. Red Lion Hotels & Inn 6-614-086100 Red Lion Hotels & Inn 6-614-086100 1.04 INSPECTION The Contractor shall be responsible for requesting and 'obtaining any and all inspections by all jurisdictional authorities which may be required. 1.05 TESTING A. The Engineer, at his discretion, may direct where and when tests are to be performed and may also call for additional tests if in his opinion conditions warrant additional testing. B. The Contractor is responsible at all times for quality control of the work and for ensuring that all applicable provisions of the specifications are met. C. The Engineer may perform tests at any time to check compliance with the specifications. D. The Contractor shall be responsible for all tests by suppliers to ensure quality control of materials delivered to the project. 1;06 ORGANIZATIONS, SPECIFICATIONS, CODES (ABBREVIATIONS) A. The following standard plans and specifications may be referred to herein: American Public Works Association Standard Specifications (APWA) American Society for Testing of Materials (ASTM) National Fire Protection Association (NFPA) Uniform Building Code (UBC) Uniform Fire Code (UFC) Underwriters Laboratories (UL) Uniform Mechanical code (UMC) Uniform Plumbing Code (UPC) B. When reference is made to any of the above standard specifications and standard plans, reference is made to the current edition of the noted specifications, unless otherwise noted. C. Where applicable, the work of this contract shall meet the requirements of any of the above codes, standards, and specifications. All appropriate local codes and ordinances by governing agencies will be obeyed. Required fee will be paid by the Contractor unless otherwise noted. Red Lion Hotels & Inn 6-614-086100 1.07 SAFETY A. The Contractor shall be responsible for safety. The Contractor shall provide adequate safeguards, safety devices and protective equipment and take any other needed actions, or as the" Engineer may determine reasonably necessary to protect the life, health and safety of the public and to protect property in connection with the performance of the work covered by this contract. The Contractor is notified that there is a possibility that hazardous materials may be encountered at this site. If a hazardous condition is detected during this project, the Contractor shall immediately cease operations until the Contractor is in full compliance with 29 CFR 1910.120, and .other appropriate regulations. The Contractor shall immediately notify The Owner and AEE, Inc. to evaluate site conditions and to determine appropriate modifications to the scope of the work. B. Contractor understands that work consists of excavation and handling of possible hydrocarbon impacted soils, and will be required to have workers trained in accordance with OSHA 29 CFR 1910.120 (2) and all other federal, state, and local guidelines. The Contractor shall submit, to the Owner, a copy of the Contractor's employees OSHA 40 hour training certificates prior to the start of any work at the site. Red Lion Hotels & Inn 6-614-086100 UST DECOMMISSIONING PART 1 GENERAL 1.01 DESCRIPTION This section covers decommissioning of Underground Storage Tank (UST). Associated piping and other superfluous materials from the tanks and lines shall be removed, and tanks and other materials shall be properly disposed. The UST system is located within the walled enclosure located in the southeast corner of the parking area immediately southeast of the hotel building (See Attachment 2). The installation specifications and UST orientation is unknown. Construction plans and construction as-built plans for the UST installation are not available. The UST is an approximately 500-gallon diesel fuel tank used to provide fuel to the emergency generator. Anticipated subsurface conditions include fill material within the top two feet, the soil type surrounding the tank cavatity is sands and silty sands. Groundwater fluctuates in this area, but is anticipated to be encountered at approximately below 85 feet as measured from the ground surface in the area of the UST. Areas of perched groundwater may be encountered. The Contractor shall possess a current California State Contractor's license (A, C-36, C- 61/D40), State Hazardous Substance Removal Certificate, and -if required by local jurisdiction- Busines Lincense. PART 2 EXECUTION 2.01 PREPARATION A. OBSERVE STATE REGULATIONS The Contractor shall observe all State of California and Bakersfield City Fire Department regulations, and meet or exceed all applicable guidelines associated with the permanent decommissioning of underground storage tanks. State regulations that are applicable to the permanent decommissioning of underground storage tanks include the Uniform Guidelines for Adoption of California Underground Storage Tank Regulations. B. TANK REMOVAL/ABANDONMENT-IN-PLACE GUIDELINES The City of Bakersfield Fire Department published guidelines for the permanent decommissioning of underground storage tanks are detailed in Attachment), and shall be followed by the Contractor where appropriate. C. .FIRE PROTECTION GUIDELINES The Contractor shall follow the guidelines set forth in document NFPA 30, ~ and Combustible Li~_uids Code (1987 Edition), of the National Fire Protection Association. The document NFPA 329 Underground Leakage of Flammable and Comb~lstible Liouids (1987) outlines the recommended practice for handling underground leaks, Red Lion Hotels & Inn 6-614-086100 GENERAL CONDITIONS PART I GENERAL The standard contract that shall govern the work detailed in the attached specification and attachments as shown in Attachment 1. The below General Conditions should be considered supplemental to the General Conditions provided in Attachment 1. In the case of a conflict between the General Conditions provided below and those in Attachment 1; the term= and conditions of Attachment I shall prevail to those listed below: "Owner": The term Owner shall refer to Red Lion Hotels & Inn (Red Lion). The Contractor shall enter into a contract with the Owner to perform the scope of work defined in these documents. "Engineer": Shall refer to AGRA Earth & Environmental, Inc. (AEE), for work under this scope. AEE shall provide construction observation services for the Owner to monitor the Contractors compliance with the construction specifications and drawings. AEE does not have any contract agreement with the Contractor and will not assist the Contractor of the methods or materials used to complete the specified work. "Contractor": An individual, partnership, firm, or any acceptable combination thereof, or joint venture, contracting with Red Lion for performance of all or a portion of the work specified in these documents. 1.01 INDEMNIFICATION The Contractor shall indemnify, defend, and hold harmless Red Lion Hotels & Inns and AGRA Earth & Environmental (AEE), Inc. from any claim of liability arising out of the Contractor's torts during performance under this agreement. The liability of the Contractor shall continue after the termination of the contract with respect to any liability, loss, expense or damage, resulting from acts or omissions occurring prior to termination, except as liability may be limited by law. The extent of the Contractors obligations for damages under this agreement shall not be limited by the extent or amount of performance bond or insurance coverage provided in the agreement. 1.02 INCONSISTENCIES AND OMISSIONS The specification and drawings included in the contract are intended to be explanatory of each other, but should any discrepancies appear, the terms and conditions in the specification shall prevail over the notes and details shown on the drawings. The specifications and drawings are intended to require and to include all labor, materials, equipment, permits, tools, and the like necessary and proper for the work. The Contractor shall exercise proper precautions to verify the figures shown on the drawings before layout of work, and will be held responsible for any error resulting from failure to exercise such precautions. For existing: work the Contractor shall verify existing conditions to insure that the new work will fit to the existing structure in the manner intended and shown on the drawings. Should any condition exist that are contrary to the intent of the specifications or those shown on the drawings, the Contractor shall notify the Owner or the Engineer prior to fabrication or performing any work in the area involving differences. Notification shall be in the form of a drawing or sketch indicating field measurements and notes related to the area. Red Lion Hotels & Inn 6-614-086100 SUMMARY OF WORK PART I GENERAL 1.01 WORK UNDER THIS CONTRACT A. The work includes the furnishing of all labor, materials, tools, equipment, services and incidentals for the excavation and underground storage tank decommissioning, installation of replacement above ground storage tank, and all associated work at the Red Lion facility located at 3100 Camino Del Rio Court, Bakersfield, California (See Attachment 2). B. Contract forms shall be signed by both the Contractor and the Owner, before any work begins. A copy of the contract is attached for your review. Please address any items to which Contractor takes exception to in our bid response. C. Final invoice must include a mechanics lien waiver or similar affidavit showing clear evidence that all the Contractor's suppliers and/or subcontractors have been paid for the work. D. The work includes, but is not limited to the following: 1. Provide, set-up, and remove all necessary fencing and barriers required to safely complete work under this scope. All work shall be performed such that their is no interruption to surrounding businesses and operations. The Contractor shall maintain all necessary safety equipment and barriers for the entire duration of work under this contract. 2. Disconnection of any electrical service to the Underground Storage Tank (UST) system at the subject site. 3. Measure and record the level of any liquids within each tank. Provide methods, equipment, and labor to remove all liquids from the UST. Provide and maintain temporary storage for the fuel removed from the UST. Removed fuel shall be placed into the installed AST when installation has been completed and approved. Properly dispose of any sludges removed from the UST off-site. Proper disposal shall include submittal of proper documentation of sludge disposal to the Engineer. 4. Provide and maintain temporary fuel service to the emergency generator. Temporary fuel service shall be installed and maintained during UST removal activities and until the AST is fully operational. 5. Decommission, excavate, remove, and properly dispose of the UST, and all associated piping. If sold, the UST shall be sold only as scrap. Disposal of the tanks shall include proper documentation. 6. Excavation, transport, and disposal of soils and debris generated from the UST decommissioning activities as detailed in the bidding documents and as directed by the Engineer. Red Lion Hotels & Inn 6-614-086100 7. Provide, place, and compact backfill material into the former tank cavity excavation per applicable local building codes. Final surfaces grades and elevations shall match existing grade and elevation prior to work under this scope. 8. Furnish and install a new, Owner approved, Above-ground Storage Tank (AST) to a fuel source to the existing emergency generator. Installation shall include proper installation of the tank, connection of the tank to the generator, and testing the tank and fuel piping system. Installation of the AST shall include construction of a concrete slab per manufactures specifications, and steel guard post to protect the AST, if required. 9. The Contractor shall locate, mark and use extreme care when excavating near or around utilities. The Contractor shall be responsible for any and all damage that occurs under this scope. The Contractor shall be responsible for protection of all monitoring wells, located on the property during tank decommissioning activities. Any wells damaged during tank decommissioning and excavation activities will be replaced by the Owner at the Contractors expense. 10. All required permits and payment of permit fees shall be the responsibility of the Contractor unless otherwise specified in this section. Coordination and scheduling of work with utilities, governmental agencies, inspectors, sub- Contractors, AGRA Earth & Environmental (AEE), Inc. and the Owner is the responsibility of the Contractor. The Contractor shall schedule all necessary inspections and notifications for tank removal activities with the Bakersfield Fire 'Department Hazardous Materials Division. 11. The Contractor shall clean up and dispose of all rubbish, scrap, debris, and unused materials of any kind resulting from the work. The Contractor shall be responsible for removal of soils, dirt, mud, and debris from the surface of areas effected by work under this scope. The Contractor shall be responsible for cleanliness of the site during and at the conclusion of this scope of work. 12. The Contractor is responsible for permits and fees for disposal of possible hydrocarbon impacted water placed in the water storage tank that was removed from the excavation under this contract. 1.02 CONTRACTOR INSURANCE REQUIREMENTS The insurance requirements for the Contractor, for work under this contract, are stated in general conditions. The Contractor shall submit certificates of insurance to the Owner and the Engineer prior to any work under this contract. 1.03 SCHEDULE OF WORK The Contractor shall: Proceed with performance under the contract immediately upon receipt of the notice to proceed executed by the Owner. The Contractor shall continuously and diligently prosecute the work to complete on or before the time set forth in this section, Complete All Work: 21 Calendar Days following regulatory approval. Red Lion Hotels & Inn 6-614-086100 ~.~. ~Q ~c~ .... ny Paoe 3 of 14 Red Lion Hotels & Inn 6-614-086100 1.04 INSPECTION The Contractor shall be responsible for requesting and 'obtaining any and all inspections by all jurisdictional authorities which may be required. 1.05 TESTING A. The Engineer, at his discretion, may direct where and when tests are to be performed and may also call for additional tests if in his opinion conditions warrant additional testing. B. The Contractor is responsible at all times for quality control of the work and for ensuring that all applicable provisions of the specifications are met. C. The Engineer may perform tests at any time to check compliance with the specifications. D. The Contractor shall be responsible for all tests by suppliers to ensure quality control of materials delivered to the project. 1~06 ORGANIZATIONS, SPECIFICATIONS, CODES (ABBREVIATIONS) A. The following standard plans and specifications may be referred to herein: American Public Works Association Standard Specifications (APWA) American Society for Testing of Materials (ASTM) National Fire Protection Association (NFPA) Uniform Building Code (UBC) Uniform Fire Code (UFC) Underwriters Laboratories (UL) Uniform Mechanical code (UMC) Uniform Plumbing Code (UPC) B. When reference is made to any of the above standard specifications and standard plans, reference is made to the current edition of the noted specifications, unless otherwise noted. C. Where applicable, the work of this contract shall meet the requirements of any of the above codes, standards, and specifications. All appropriate local codes and ordinances by governing agencies will be obeyed. Required fee will be paid by the Contractor unless otherwise noted. Red Lion Hotels & Inn 6-614-086100 1.07 SAFETY A. The Contractor shall be responsible for safety. The Contractor shall provide adequate safeguards, safety devices and protective equipment and take any other needed actions, or as the Engineer may determine reasonably necessary to protect the life, health and safety of the public and to protect property in connection with the performance of the work covered by this contract. The Contractor is notified that there is a possibility that hazardous materials may be encountered at this site. If a hazardous condition is detected during this project, the Contractor shall immediately cease operations until the Contractor is in full compliance with 29 CFR 1910.120, and other appropriate regulations. The Contractor shall immediately notify The Owner'and AEE, Inc. to evaluate site conditions and to determine appropriate modifications to the scope of the work. B. Contractor understands that work consists of excavation and handling of possible hydrocarbon impacted soils, and will be required to have workers trained in accordance with OSHA 29 CFR 1910.120 (2) and all other federal, state, and local guidelines. The Contractor shall submit, to the Owner, a copy of the Contractor's employees OSHA 40 hour training certificates prior to the start of any work at the site. Red Lion Hotels & Inn 6-614-086100 ~.,.,,~, ")~ .~aa~ .... n') P~n~.6 nfl4 UST DECOMMISSIONING PART 1 GENERAL 1.01 DESCRIPTION This section covers decommissioning of Underground Storage Tank (UST). Associated piping and other superfluous materials from the tanks and lines shall be removed, and tanks and other materials shall be properly disposed. The UST system is located within the walled enclosure located in the southeast corner of the parking area immediately southeast of the hotel building (See Attachment 2). The installation specifications and UST orientation is unknown. Construction plans and construction as-built plans for the UST installation are not available. The UST is an approximately 500-gallon diesel fuel tank used to provide fuel to the emergency generator. Anticipated subsurface conditions include fill material within the top two feet, the soil type surrounding the tank cavatity is sands and silty sands. Groundwater fluctuates in this area, but is anticipated to be encountered at approximately below 85 feet as measured from the ground surface in the area of the UST. Areas of perched groundwater may be encountered. The Contractor shall possess a current California State Contractor's license (A, C-36, C- 61/D40), State Hazardous Substance Removal Certificate, and -if required by local jurisdiction- Busines Lincense. PART 2 EXECUTION 2.01 PREPARATION A. OBSERVE STATE REGULATIONS The Contractor shall observe all State of California and Bakersfield City Fire Department regulations, and meet or exceed all applicable guidelines associated with the permanent decommissioning of underground storage tanks. State regulations that are applicable to the permanent decommissioning of underground storage tanks include the Uniform Guidelines for Adoption of California Underground Storage Tank Regulations. B. TANK REMOVAL/ABANDONMENT-IN-PLACE GUIDELINES The City of Bakersfield Fire Department published guidelines for the permanent decommissioning of underground storage tanks are detailed in Attachment), and shall be followed by the Contractor where appropriate. C. .FIRE PROTECTION GUIDELINES The Contractor shall follow the guidelines set forth in document NFPA 30, Flammable and Combustible Liauids Code (1987 Edition), of the National Fire Protection Association. The document NFPA 329 Underground Leakage of Flammable and Combustible Liauids (1987) outlines the recommended practice for handling underground leaks. Red Lion Hotels & Inn 6-614-086100 D. SAFETY PROCEDURES The Contractor shall follow adequate safety procedures, and' provide for a well- ventilated work place during tank decommissioning. The Contractor alone shall be responsible for job site safety. Compliance shall include, but not necessarily be limited to, OSHA mandated training of employees, use of personal protective equipment, air monitoring, decontamination procedures, and related items. The cost of compliance with hazardous waste regulations shall be included in the Contractor's bid, and no additional compensation shall be made for this condition. E. UTILITY LOCATES Arranging for the location of all utilities shall be the responsibility of the Contractor. The locations of utilities near the work site shall be known to the Contractor before tank decommissioning commences. It is the responsibility of the Contractor to know the location of all utilities on-site in the area of the UST. Any electric lines leading to the underground tanks shall be disconnected by the Contractor. PART 3 EXECUTION 3.01 TANK DECOMMISSIONING/ABANDONMENT IN PLACE A. The proposal for abandonment-in-place of this UST has been discussed with City of Bakersfield Fire Department Hazardous Materials Division representatives. The Hazardous Materials Division verbally aquired to this decommissioning procedure, therefore the Contractor shall abandon the UST and associated piping per guidelines set forth by the City of Bakersfield Fire Department (See Attachment 3). The Contractor shall be responsible for providing dewatering services during the tank decommissioning. Any residual sludge or rinsate generated during tank removal will be pumped by the Contractor from and properly disposed of off-site by the Contractor, The disposal of liquid waste removed from the UST by the Contractor shall include proper documentation. All documentation of disposal shall be submitted to the Engineer. B. Site Security: The Contractor shall be responsible for controlling access to the work site during all work under this contract. In order to minimize any possible physical hazards associated with the excavation, temporary fence shall be installed around the excavation area(s). C. Drain Pipes: The Contractor shall drain, cap and remove all piping into the tanks, being careful to avoid spilling. D. Empty Tanks: Remove all liquid from the tanks, even liquids whose removal requires hand pumping. Fuel existing in the UST shall be temporarily stored by the Contractor, and placed in the AST once the AST installation has been.completed and approved. Sludge shall be removed from the tanks and disposed of off-site by the Contractor. Proper disposal of liquids from the UST shall mean off-site disposal or recycling of liquids by a subcontractor permitted for liquid recycling or disposal activities. Any liquids that can not be recycled must be disposed of in accordance with applicable federal and state regulations. Red lion Hotels & Inn 6-614-086100 E. Tank Removal (if applicable): The tank shall be removed for off-site disposal. The Contractor shall take all necessary and appropriate measure to ensure no damage occurs to surrounding structures or utilities as a results of these operations. The Contractor shall provide any dewatering necessary for tank removal, soil sample collection, and backfilling of the cavity. Dewatering includes the disposal of recovered water with possible hydrocarbons. F. Soil Testing: The Engineer or Owner's Representative will collect soil samples from the soil surrounding the tank at various stages of the excavations, and the Contractor shall make time, labor, and equipment provisions for this soil sampling. F. Destroy Tanks (if applicable): Destroy each of the tanks on-site by cutting a large hole (not less than two feet by two feet) in each tank before that tank is removed from the site. A CERTIFICATE OF DESTRUCTION will be provided by the Contractor to the Owner for the tank removed. G. Remove Tank Off-Site (if applicable): After the tank has been destroyed, it shall be removed off-site. Disposal of the tanks in the responsibility of the Contractor. The tank shall not be resold for other than scrap metal. Red Lion Hotels & Inn 6-614-086100 EARTHWORK PART I GENERAL 1.01 DESCRIPTION This section covers all grading, leveling, excavation, backfilling, and other earth moving work required for returning excavation to existing grade and/or as specified herein. Finish grading and surfaces of excavations will be the same as the existing grade at the site prior to this scope of work unless otherwise specified in the contract documents. PART 2 PRODUCTS 2.01 APPLICABLE CODES AND STANDARDS SPONSOR NUMBER SUBJECT ASTM D 75 Methods of Sampling Coarse and Fine Soil and Aggregate. ASTM D 422 Particle-size Analysis of Soils. ASTM D 2922 Tests for Density of Soil and Soil-Aggregate In-Place by Nuclear Methods(shallow depth). PART 3 EXECUTION 3.01 EXCAVATION A. Excavation shall be unclassified, and shall include the removal of all material of whatever nature, including pavements, regardless of the manner in which they are removed. Excavation may be performed beyond the limit lines shown to suit construction methods, subject to approval by the Engineer. B. All pavement removed shall be separated from other materials and disposed of by the Contractor. All removed pavement shall be disposed of in an appropriate manner and documented accordingly. C. Materials determined by the Engineer to be satisfactory for backfill shall be protected from contamination with unsatisfactory material and stock piled in areas selected by the Contractor, D. The Contractor is responsible for damage resulting from his activities and shall repair or replace any damage at no expense to the Owner. Red Lion Hotels & Inn 6-614-086100 3.02 TESTING The Contractor is responsible for compliance with the requirements of this specification. Tests shall be performed to monitor compliance with this specifications, and shall include the following: A. Density of soil in-place shall be determined in accordance with ASTM D-2922 or ASTM D-1556. Structural fill or granular fill shall be used and fill material below roadways, walkway, piping systems, and any area indicated on the site sketch as requiring structural fill. Fill material requirements are provided below. B. Laboratory Maximum Density and Optimum Moisture Content: ASTM D-1557. C. Sampling method to be used shall be in accordance with ASTM D-75. D. Any work not meeting specifications shall be redone and retested by the Contractor at his expense. Red Lion Hotels & Inn 6-614-086100 SOIL TRANSPORTATION AND DISPOSAL PART I GENERAL 1.01 DESCRIPTION This section covers transportation and disposal of soils not suitable of backfill material or soil that have hydrocarbon impacted. Soils found to have hydrocarbon impacted, as quantified by representative sample analysis in an Owner approved laboratory, shall be excavated be excavated by the Contractor under the direction of the Engineer. Excavated soil found to have hydrocarbon impacted shall be disposed of off-site and a facility permitted to handle such soils. Actual quantity of soil, if any, that are impacted with fuel is unknown, and shall be determined during field activities. PART 2 EXECUTION 2.01 GENERAL A. Soils under this section include soils excavated from the tank removal activities. Asphalt and concrete pavements removed during UST decommissioning or soil excavation activities shall be separated from excavated soils and disposed of properly. B. Hydrocarbon impacted soils are not expected to be encountered during excavation activities, however, the Engineer will be observing and screening excavated soils. Any soils determined by the Engineer to be impacted shall be properly disposed at a disposal facility permitted for such impacted materials. C. Non-impacted are defined as soils contain no detectable concentrations of hydrocarbon or with hydrocarbon concentrations below jurisdictional guidelines concentrations for leaving soils to remain at the site. Non-impacted soils, not suitable for backfill, shall be disposed of by the Contractor off-site. D. The Contractor shall conform to all applicable laws, codes, and regulations regarding transporting, loading, safety, and use of any and all vehicles associated with the work under this scope. This shall include local and state vehicle loading requirements. Red Lion Hotels & Inn 6-614-086100 EXCAVATION AND BACKFILL PART I GENERAL 1.01 DESCRIPTION This section covers excavation and backfill for tank decommissioning and piping removal. Tank cavity backfill material shall be placed in lifts and compacted. PART 2 PRODUCTS 2.0 MATERIALS A. Prior to the delivery of material to be used in the work, the Contractor shall advise the Engineer of the material source, shall furnish samples for testing if requested by the Engineer, and shall receive the Engineer's approval before using the material from that source. B. Native, non-organic, on-site soils may be suitable for reuse as structural fill if properly moisture conditioned and compacted as summarized below. Moisture contents may be significantly higher or lower than the optimum range needed for soil compaction at the time of this work. Structural fills should be compacted to the following based on maximum dry density determined by ASTM Test method D-1 557. Granular Fill- 95% Top eight inches of road or walkway subgrade - 95% Native silts or fine-grained dill material - 92% C. Temporary cut slopes may be made at 1H:IV up to four feet in height provided groundwater seepage is not encountered. OSHA approved shoring is recommended in excavation that are not sloped, or for those in which subsurface water is encountered. All excavation shall be performed in accordance with Cai OSHA regulations and guidelines. D. Excavated materials that are impacted with hydrocarbons (as defined above or determined by the Engineer) shall not be used for backfill or other fill material. PART 3 EXECUTION 3.01 GENERAL A, Excavation is unclassified and includes the removal of all materials encountered, regardless of their nature or of the manner in which they are removed. Red Lion Hotels & Inn 6-614-086100 B. Shoring, sheeting and bulkheading required to prevent caving, to restrict widths of slopes or to prevent disturbance detrimental to adjacent areas or to other parts of the contract work shall be furnished, placed and later removed by the Contractor. Shoring should conform to specifications of Cai OSHA. C. The method of excavation shall not weaken surrounding areas or damage structures that are completed or under construction. Existing structures and utilities adjacent to excavations shall be protected and supported to prevent settlement. 3.02 BEDDING, BACKFILLING, AND RESURFACING A. Backfill shall be constructed to return the finish surface to original grade and elevation. Grading shall conform to the original surface grade and slope or as otherwise directed by the Engineer. B. Ground surface shall be returned to the elevation and grade that existed prior to the start of work under this contract. Surface restoration shall include replacement of all landscaping, bushes, trees, surface cover, asphalt or concrete paving of the to match existing (prior to start of work under this contract). Asphalt and / or concrete pavement shall be replaced to original thicknesses. In all cases, the minimum asphalt thickness shall be no less than three inches. C. The Owner does not guarantee sufficient backfill material exists on-site to satisfactorily complete the work. Imported or selected backfill material that is required to make up any shortage will be supplied by the Contractor at no additional expense to the Owner. 3.03 TESTING Tests shall be performed to monitor compliance with the specifications. The Contractor is responsible for compliance with these specifications. Red Lion Hotels & Inn 6-614-086100 ABOVE-GROUND FUEL STORAGE TANK FURNISH AND INSTALLATION PART I GENERAL 1.01 DESCRIPTION This section covers the furnish and installation of a 1,000 gallon above-ground diesel fuel storage tank as a replacement for the removed USTs. The Contractor shall furnish and install an fuel storage above-ground storage tank (AST) that meets the requirements of Attachment 4. Possible AST vendors, as provided by Red Lion, are listed in Attachment 5. A possible location for the AST is adjacent to the emergency standby generator within the block-walled area adjacent to the hotel building. Its preferred location will need to be verified with the hotel's Director of Engineering. PART 2 PRODUCTS 2.0 MATERIALS The Contractor furnished fuel AST with a fuel storage capacity of 500 gallon that meets the requirement of the Uniform Fire Code Standard 79-7,'.(Attachment 4)~ pipe, pipe fitting and all necessary equipment and materials to provide a fully functional generator fuel supply system. As a minimum, all piping and pipe fitting shall meet the requirements of the Uniform Plumbing Code (UPC), National Fire Protection Association (NFPA) 30, the AST manufacturers recommendations, and all local regulations that govern such activities. The AST, piping, and pipe fittings shall be inspected and approved by jurisdictional agency prior to acceptance by the Owner. PART 3 EXECUTION The Contractor shall coordinate with the Director of Engineering for the Red Lion Inn facility to verify the placement location of the fuel AST. Furnish and installation shall include supply and installation of all necessary pipe, pipe fittings, labor, materials, and the like to provide a fully functional fuel supply to the emergency generator. The Contractor shall request inspection and obtain approval for the AST installation of the jurisdiction agency. As-built plans shall be provided with the final invoice for services. /The as-built plans, at a minimum, shall be prepared on 8.5 inch by 11 inch paper, drawn to scale, and shown the location of the AST, generator, and major features in the area. Major features include: walls, columns, trees over 3 inches in diameter, utilities and piping, stairways, and the like. The as- builds shall also document the manufacture and model number of the AST installed, the piping material piping size used, and the location of the piping. Safety shut-off valves shall also be shown on the as-built plans. Each page of the as-built plans shall include the facility address, the title "AST Installation As-Built Plans", the Contractors name and address, and the date of AST installation. Red Lion Hotels & Inn 6-614-086100 ~o,,-h '~ ~ aa~ r,,v n~ Paoe I of I ATTACHMENT I RED LIO.N HOTELS & INNS STANDARD AGREEMENT THE AMERICAN INSTITUTE OF' ARCHITECTS AIA Document A107 Abbreviated Form of Agreement Between Owner and Contractor For CONSTRUCTION PROJECTS OF LIMITED SCOPE where the Basis of Payment is a STIPULATED SUM 1978 EDITION THIS DOCUM£NT HAS IMPORTANT LEGAL CONSEQUENCES; CONSULTATION WITH AN AITORNEY IS [NCOURAG£D WITH RESPECT TO ITS COMPL£TION OR MODIFICATION This document includes abbreviated General Conditions and should not be used with other General Conditions. It has been approved and endorsed by The Associated General Contractors of America. AGREEMENT made as of the day of in the year of Nineteen Hundred and BETWEEN the Owner: and the Contractor: the Project: The Owner and the Contractor agree as set forth below. Copyright 1936, 1951, 19S8, 1961, 1963, 1966, 1974. © 1978 by the Americ.~n Init.lute oi Afch~leclt, 1735 Nuw York Av,.nue. N ~V.. Washington. O.C 2~. ~nd wdl be ~Ubl~'Cl lO I~.[al p~u~ecul~un. AIA DOCUMENT A107 · AU~R[VIAT[O O~VNER-CONT~OR AGREEMENT · [ICH[H [DillON · APRIL 1'J78 · AIAe ~ 1~78 * THE ~[RICAN INSTITU[E OF ARCHITECTS, 173S ~EW YORK AVENUE, N.W., WASHINGTON, D.C. ~ A107-1978 I ARTICLE 1 THE WORK 1.1 The Contractor shall perform all the Work required by the Contract Documents for ~Here m~e~'! lhe caption de:,c,*~pt~ve ol ~he Work as used on other Contract Documenls.) ARTICLE 2 TIME OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 2.1 Tile Work to be performed under this Contract shall be commenced and, subject to authorized adjustments, Substantial Completion shall be achieved not later than ti'fete inle~t .tn~,. ~peciat prow~on:i lot I~qu~d.~led damages ~rela. t~ng to I~,dute (o complete on timeJ ARTICLE 3 CONTRACT SUM 3.1 Tile Owner shall pay the Contractor in current [unds for the performance o[ the Work, subject to additions and deductions by Change Order as provided in the Contract Documents, the Contract Sum of 3.2 The Contract Sum is determined as follows: ~$late here Ihe Oase b,d or o~her lump ~um amount, accel:)~ed alte~nate~, and unit prices, as applicable.) AIA I.)OCUMENT Al0? * ,~.I~.L¥'IATEI.) OWNER*C()NERACTOR AGREEMENT" EIGHIIt EDIIION *. APRIL 1978 · ,,',, I')?~ ,. htF A.".ii'RI(J.-~N h'~Sl'llbrE O~ .:~RCtlIIEC]s, 1.*,.I] NEW ~'ORK AVENUE, N.V¢., ~.VA:)HINGI(JN, D.C. 2tX,~6 A107-1978 2 ARTICLE 4 PROGRESS PAYMENTS 4.1 (Here insert pa!,'ment procedures and provision lot ~etalnage. ii any.j (Here insert any tare ol intete~l agreed ul:x~l.) ~Usut). laws and tcou~rement~ under the [~e~al Truth in tend~ng ACt. similar state and I~al consumer ct~,t laws and other regular;ohs at the ~vner's and Contractor's pr,nopal places ol business, the I~a~on ol Ih. P~oj~ a~ el~vhete ~y all.ce ~he vahd~ty ol ~h;s provision. ~pec~hc legal advice should be obtained wnh re~c( ~o delel~. ~d~cauon. or other r~u~remenls such a~ wry.eh d, sclosure or ~a~ers ) ARTICLE 5 FINAL PAYMENT Final payment-, constituting the entire unpaid balance of the Con- tract Sum, shall be paid by the Owner to the Contractor within thirty (30) days after the Work has been completed, the Contract fully performed and all liens, encumbrances or unsettled liens with respect to the Work have been satisfied by the Contractor and the Owner has accepted the work. ARTICLE 6 ENUMERATION OF CONTRACT DOCUMENTS 6.1 The Contract Documents, which constitute the entire agreement between the Owner and the Contractor, are listed in Article 7 and, except for Modifications issued after execution of this Agreement, are enumerated as follows: (L,s! below the A~teement. the Cond~hon$ ol the Co~lt~ct, [(~ene~,ll. ~pplementa~, 4nd olher Condo(ions/. the Draw~s. (he $~e~dtcdl~o~s. any Addend-~ and acce/:~ed dltem~tes, showin$ pale o~' shee( nunVaers in ail c~ses and dale/ where In the event of any conflict in the Contract Documents, they shall be determined according to the following priority: 1. General Contract - Articles 1-6. 2. Supplementary General Conditions. 3. General Conditions. 4. Drawings and Specifications. AIA DOCUMENT A107 · ABflREVI~,TEO O~.VNER-CONTR. ACTOR AC, R[E.N~[NT · [IGHIH [OITION · APRIL 1978 · AIA~ 1978 · TH[ A.~ERICAN INSTITUT£ O~ ARCHIT[CJS, 1735 N£%V YORK AV£NU[, N.%V., %¥~HINGTON, C.C..~3006 A107-1978 3 GENERAL CONDITIONS ARTICLE 7 t~R.n_o..f_the Contractor's Applications for Payment. the ~ltJddJi~ wdl determine the amounts owing to the Con- CONTRACT DOCUMENTS tractor and will'issue Certificates for Pa~,ment in accord- 7.1 The Contract Documents cons,st of this Agreement ance with Article 15. with General Condor OhS. Supplementary and other Condo- 8.5 tions, the Drawings. the Specificahons. all Addenda issued ments of the Contract Documents. He wtll prior to the execution of this Agreement. and all Modifi- on all claims, disputes or other matters ~n be- cations i:;_:_J L~__ .L_ '--~:'--'t atter execution of the tv.'een the Contractor and the Owner. w,II not be Contract such as Change Orders. v. ntten ,nterpretations I~able for the results of anvinter ordec~sion ren- and ,,..'ntten orders for minor chan~.es in the Work. The dered m good fa th The Al decisions in matters ;ntent of the Contract Documents ,s to tnclude all items relahng to artistic final if consistent w~th the necessary for the proper execution and completion of the intent of the Cont All other decisions of L%'ork. The Contract Oo~:uments are complementary and the Architect those which have been waived by what is required by an',, one shall be as binding as if re- the mak acceptance of final payment, shall be sub- quired by all. Work not covered m the Contract Docu- upon the written demand of either ments ~,~.'ill not be required unless ~t ~s consmstent therewith and reasonably referable therefrom as being necessa~' to 8.6 The .0~Tt.er... ....... will have authority to reiect Work produce the ,ntended results· which does not conform to the Contract Documents. 7.2 Noih,ng contained in the Contract Documents shall R 7 ....... ' create any contractual relationship bets~,een the Owner ~ ........ '-~ qlJemlmeimlm~ and any Subcontractor or Sub-subcontractor. appropriate action upon lh-~~ch · as Shop Drawings, Prod~.~jJ,~'ff~mples, but only for 7.3 Bvexecuting the Contract, the Contractor represents confor~g concept of the Work and that h~ has visited the site and familiarized himself with . 1 .... ~._ L.f ......t:_.. o: .... ' ti.~ C~,,t,.J. D ......... I,. the local conditions under which the Work is to be performed. ARTICLE 9 7.4 The ¥¥ork comprises the completed construction re- OWNER quired by the Contract Documents and includes all labor necessary to produce such construction, and all materials 9.1 The Owner shall furnish all. surveys and a legal de- and equipment incorporated or to be incorporated in scription of the site. ' 9.2 Except as provided in Paragraph 10·5, the Owner such construction, shall secure and pay for necessary approvals, easements, assessments and charges required for the construction, use ARTICLE 8 or occupancy of permanent structures or permanent ARCHITECT changes in existing facilities. ....... 9.3 The Owner shall fonvard all instructions to the Con- 8.1 T!..t,.i.._'..tt__t..72.,~._ ' ·- ' "" ' "' tractort] '..__; _..'2 __~' ;_ t-~: ? .... " - ........... -' - '- · - 9.4 If the Contractor fails to correct defective Work or 8.2 The ~shall at all times have access to the persistently fails to carry out the Work in accordance with Work wherever it is in preparation and progress, the Contract Documents, the Owner, by a written order, may order the Contractor to stop the Work, or any pot- 8.3 The ~lil~,~Z'will visit the site at intervals appropri- tion thereof, until the cause for such order has been ate to the stage of construction to familiarize himself gen- eliminated; however, this right of the Owner to stop the erally with the progress and quality of the Work and to Work shall not give rise to any duty on the part of the determine in general if the Work is proceeding in ance with the Contract Documents. However, the ~ Owner to exercise this right for the benefit of the Con- tractor or any other person or entity. ~ will not be required to make exhaustive or continu- ous on-site inspections to check the quality or quantity of ARTICLE 10 the Work. C:. ............ ....... ' ............ ' ............... CONTRACTOR ,r~ -' '~- ...... ,- ---~ .. :. ---J ........ ~ ..... 10.1 The Contractor shall supervise and direct the Work, ~9~inrr d-~ ..... ~--~ -~;: ........ ' .......... ........... : .... using his best skill and attention and he shall be solely ' - The .~t.~...~_":: will not have control or charge of responsible for all construction means, methods, tech- and will not be responsible for construction means, meth- niques, sequences and procedures and for coordinating ods. techniques, sequences or procedures, or for safety all portions of the YVork under the Contract· precautions and programs in connection with the Work, 10.2 Unless othe~¥ise specifically provided in the Con- and he will not be responsible for the Contractor's failure tract Documents, the Contractor shall provide and pay for to carr~ out the Work in accordance with the Contract all labor, materials, equipment, tools, construction equip- Documents· ment and machiner',', water, heat. utihties, transportation, . Ol.~er ' s, . 8.4 Based on the ........ ooser~.at~ons and an evalua- and other facilities and services necessary for the proper AIA OOCL'.~4ENT Al0:' · *'BBRE~.i~,T~.D C',',N~R.-CO',TR.-~CTOR -xGR;,.E',~E'",T * E!CHT~'l ~CDITIO% · · ~,~..:c,. ;tis ~_'.~ ~.o~.~xL-:. ~',~ ',~*~H~C:~"- ~C :~ A107-1978 4 ' V'-3 rr~£ ~.~,;.RtC~,', ,N_;T:TLTE C'.: ~ .... ~' 12.3 .&nv r'oqs caused hv defech'.e r~r all-timed work 15.2 Pa',menl.; ma'. be v~dhheldon account of tl~ defec- shal t~e borne b~. the party re,pons,hie therefor, h,.e ~.,.ork not remedied. 2' claim`; filed. ~31 fadure of the Contractor to make pa~,ment~ properly to Subcontractors ARTICLE 13 or for labor, mater,als, or equipment. ~4~ damage to the MISCELLANEOUS PROVISIONS O,.vner or another conlractor, or '5! pers,~tent fadure to carry out the Work m accordance with the Contract 13.1 The Contract shall' t:~ governed bv the law of the Documents. place where the Proiect is located. 15.3 ........... 13.2 ................ the Owner arising out of. or relahng to. the Conh "'- .I~11 '- Documents or the breach thereof ,;ha be decide '-' arbitrahon in accordance with the Conqruction ,tn,' 15.4 Final pa~,ment shall not be due until the Contractor &rbitration Rules of the American Arb~trat,on A; has deh~.ered to the O~.ner a complete release of all liens then obtainm~ unless the part,es mutuaIl,~ a, other- ar,s,ng out of th,s Contract or rece,pts in full covering ail v~'ise. Notice of the demand for arb,tratlon be flied labor, mater a s and equ,pment for ~'hich a lien could be :n v, rmng ,.,.~th the other part~, to the iontractor filed or a bond sat,sfac:or', to the Owner indemn,f~.ing Agreement and ,.~,lth the Amer,can Arbor As~ooat,on h~m aga,nst any hen. If any lien rema,ns unsatisfied after and shall be made ~,ithin a reasonable after the dis- all payments are made. the Contractor shall refund to the pure has arisen. The award the arbitrators O~ner all moneys the latter may be compelled to pay in shall be final, and judgment ma,.' eniered upon ~t in dischar~.mg such lien, including all costs and reasonable accordance ~.,th applicable la~.v court having ]uris- attorne,,s' fees. diction thereof. E~cept bv ~r,t consent of the person 15.5 The making of fina! payments shall constitute' a or enhtv sought to be arbitration aqsme out v,'a¢.er of all claims by the Owner except those arising of or relating to the Coat Documents shall include, from ~1~ unsettled liens. ~2i faulty or defective VVork ap- by consolidation, in an,.' other manner, any pearmg after Substantial Completion. ~31 failure of the person or entity nora to the agreement under which ~,¥ork to comply with the requirements of the Contract such arbitration arise niess it is shown at the time the Documents, or (41 terms of any special warranties re- demand for arbitr~ n is filed that tl~ such person or quired by the Contract Documents. The acceptance of entitv is substant involved in a common question of final payment shall constitute a waiver of all claims by the fact or law. (21 presence of such person or entity is Contractor except those previously made in writing and required if o )lete relief is to be accorded in the arbi- identified by the Contractor as unsettled at the time of the tration. (31 interest or responsibility of such person or final Application for Payment. entity in matter is not insubstantial, and [4) such per- son or is not the Architect or any of his employees ARTICLE 16 or co Jttants. The agreement herein among the parties PROTECTION OF PERSONS AND PROPERTY to Agreement and any other written agreement to 16.1 The Contractor shall be responsible for initiating, a referred to herein shall be specifically enforce- maintaining, and supervising all safety precautions and programs in connection with the Work. He shall take all reasonable precautions for the safety of, and shall provide ARTICLE 14 all reasonable protection to prevent damage, injury or TIME loss to (1~ alt employees on the Work and other persons 14.1 All time limits stated in the Contract Documents who may be affected thereby, (2) all the Work and ail are ot the essence of the Contract. The Contractor shall materials and equipment to be incorporated therein, and expedite the Work and achieve Substantial Completion* (3) other property at the site or adjacent thereto. He shall within the Contract Time.*ar~d ~':j. rta! col~].etJ, ort give all notices and comply with all applicable laws, ordi- 14.2 The Date of Substantial Completion of the Work is nances, rules, regulations and orders of any public author- the date __.',:f~__~ ~_, ;' _ ' _ .... when construction is it,,, bearing on the safety of persons and property and their ~ .... ' ....;- complete so that the Owner can occupy or protection from damage, injury or loss. The Contractor utilize the Work for the use for which it is intended, shall promptly remedy all damage or loss to any property caused in whole or in part by the Contractor. any Sub- 14.3 If the Contractor is delayed at any time in the contractor, any Sub-subcontractor, or anyone directly or progress of the Work by changes ordered in the Work, indirectly employed by any of them, or by anyone for by labor disputes, fire, unusual delay in transportation, whose acts any of them may be liable, except damage or adverse weather conditions not reasonably anticipatable, loss attributable to the acts or omissions of the Owner unavoidable casualties, or any causes beyond the Con- tractor's control, - ~ ............... ~_. _L .L .... L: ~ or by am. one for whose acts ! -- ~ ..... ' ...... : ~-- ~-'- then the Contract may be liable, and not attributable to the fault or negli- Time shall be extended by'Change Order for such reason- gence of the Contractor. The foregoing obligations of the able time as the ~ ,,i'~ ..... ' ~'oTk as 2. Contractor are in addition to his obligations under Para- ~vhote J.s de~tayedA. RTICLE 15 graph 10.11. PAYMENTS AND COMPLETION ARTICLE 17 INSURANCE 15.1 Payments shall be made as provided in Article 4 and Article 5 of this Agreement. 17.1 Contractor'.-; liability insurance .;hall be purchased AIA DOCU.',,4£NT A107 o ~,.~E',I~,TED C,'.',%E~-CO'-TR'~CTOR ~.CRE£',~E",T o 't~'5~ ;-.22 - '?", · ~.:t . '""3 · ~,!'~ :"-6- T~E .~,'.~-:R!C-~', ,~.ST TL.".E C.F ~RC~::ECT~ 173~ '-,£'.', ,~,~,,, ~..-:-,:~ x .'. ~..,~:--' --, -'c 2:_.:.:,~ A107-1978 6 ARTICLE 21 OTHER CONDITIONS OR PROVISIONS 1. Ail alterations or work performed on the property directly affecting normal vehicular or foot traffic patterns shall be barricaded to insure public safety, convenience and co- ordinated with the property's General Manager. 2. Contractor shall coordinate all schedules and work with property General Manager so as not to interfere with prop- erty operations. 3. Contractor shall keep area clean and free of clutter and debris at all times and upon completion shall clean up all excess material and remove debris to the satisfaction of the Owner. 4. Contractor shall not effect any changes, substitutions and/or additions to the project unless authorized in writin9 by the Corporate Engineerin9 Department. 5. Contractor, personally or' through an authorized and competent representative, shall supervise the work constantly, and shall as far as possible keep 5he same -' foreman and workmen on the job from commencement co completion. The workmanship of the entire job must in .every way be first class, and only experienced and competent.workmen will be allowed on the job. 6. Anything to the contrary contained herein or elsewhere not- withstanding, Contractor hereby agrees that (i) neither the general partners of Owner, any successor general partner of the Owner, nor any of the limited partners of Owner shall have any personal liability for the performance of any of Owner's obligations hereunder, and, (ii) any liability or obligation of Owner arising hereunder shall be limited to and satisfied only out of the property of Owner. This Agreement entered into as of the day and year first written above. OWNER CONTRACTOR AIA OOCLJ/~i:NT ,.107 * ^i38R£¥1ATED O¥S,N£R.COINTRACTOR AC, R££t..,,[NT · £1(]HTH EDITION · APRIL 1978 · AIAe .- ~) .;J').';~, · l'rl£ .~.%~.£KIC^"~ I.',.STITUT£ OE ,ARCHITECTS, 1715 5,£W YORK AV£r~L;£, N.W., WASHINGTON, D.C. 20006 A107-1978 8 EXHIBIT A SUPPLEMENTARY .GENERAL CONDITIONS 2.2 In the event the work is not finally completed as provided herein, it is agreed that Owner will suffer certain damages which are difficult to ascertain. As a result, in the event the work is not finally completed on the date specified herein, together with any extensions of the contract time, Owner will be entitled, as a reasonable estimate of such damages, to the amount of Two Hundred Dollars and No One Hundred ($200.00) per calendar day in liquidated damages for each calendar day of such delay until the work is finally completed. 7.15 It is specifically understood that all work provided for in either the plans or the specifications, regardless of whether it is provided in both, is to be performed by Contractor for the contract price. 8.7 Any review and approval by Owner of. any shop Drawing, Product Data, or Samples is only for conformance with consideration of structural integrity, safety, compliance with the Contract Documents, or any other Obligation of the Contractor. The Contractor is responsible for confirming and correlating all dimensions, fabricating and construction techniques, coordinating his work with that of all other trades, and the satisfactory performance of the entire work in accordance with the Contract Documents. 10.12 Contractor is responsible for ensuring that the construction site is neat and orderly during the construction period, and that streets are free of dirt and debris from con- struction site. 13. Unless otherwise provided herein, the Contractor shall carry on and proceed with the work during the litigation. 14.4 Contractor will make requests for extensions of time in writing within 25 days of the date of the claimed delay and, if such requests are not made,the request for extension shall be deemed waived. 14.5 No extension of time for completion will be allowed for delays or suspensions caused by or contributed to by the fault or negligence of Contractor or anyone for whose acts Contractor is responsible. 14.6 Contractor will be entitled to no delay damages, wage escalation, material escalation, extended overhead, or addi- tional compensation of any kind of any delay except for such delays as may be caused solely by a default of Owner. EXHIBIT A SUPPLEMENTARY GENERAL CONDITIONS Page 2 16.2 Until acceptance of the Contract work by Owner, Contractor will be responsible for any loss or damage in the work, materials, equipment or supplies, due to any cause, except when, by the terms of this Contract, Owner bears the risk. 17.2 All the liability insurance Certificates shall name Owner as an additional insured and the certificates will provide that the coverage shall not be canceled or reduced without 30 days prior written notice to the Owner. The amounts of all such insurance shall not be less than the following: One Million Dollars ($1,000,000.00). 17.3.1 Contractor will be responsible for all losses within exclusions and deductibles for the property insur.ance. 18.4 In the event the parties cannot agree to the cost or credit to the Owner from a change in the work, the Owner may direct the Contractor to proceed in accordance with such change and the cost or credit shall be determined by arbitration. 21.2 In the event of any suit or action, including any appeals therefrom, brought by either party against the other to enforce any of the obligations hereunder or arising out of any dispute concerning this Agreement, or to enforce or collect any judgment or decree of any court, the losing party shall pay the prevailing party such a reasonable amount for investigation costs, attorney fees and expert witness fees, as may be set by the court. 21.3 Should any provision of this Agreement at any time be in conflict with any law, ruling or regulation or be unenforce- able for any reason, then such provision shall continue in effect only to the extent that it remains valid. In the event any provision of this Agreement becomes less than operative, the remaining provisions of this Agreement shall, nevertheless, remain in full force and effect. ATTACHMENT 2 UST LOCATION SITE SKETCH AND LOCATION MAP CHESTER · STOCKDALE ~ JOAGE RED LION HOTEL 3100 CAMINO DEL RIO CT. BAKERSFIELD CA SITE LOCATION AGRA Earth & Environmental, Inc. ZTt'~ D DA T~- JOB . RED LION HOTEL 3100 CAMINO DEL RIO CT. NOT TO SCALE BAKERSFIELD CA UST SITE P~N AGRA Earth & Environmental, Inc. FI~D ~ JO~ ~0, ATTACHMENT 3 · UNDERGROUND STORAGE TANK REMOVAL/CLOSURE PROCEDURES CITY of BAKERSFIELD FIRE DEPARTMENT FIRE SAFETY SERVICES & OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE. · BAKERSFIELD, CA ° 93301 BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES ~'~E CONDITIONS FOR ABANDONMENT OF UNDERGROUND STORAGE TANKS ** Contractors must have the following information on file in order to obtain a permit: 1. Copy of Contractors license 2. General liability policy 3. Workmans compensation policy 4. Site safety plan ** Site assessment/sample collection contractor must have a soil sampling and quality control/quality assurance protocol on file. GENERAL 1. A permit application for an UST abandonment shall be filed and applicable fees paid 5 working days prior to the commencement of work. This permit shall remain on-site during the entire removal process. A. Permit is valid for 90 days. 2. Forty-eight hour advance notice shall be given to the Bakersfield City Fire Department Hazardous Materials Specialist to arrange an inspection appointment. 3. It is the responsibility of the Permittee to obtain any permit required by other regulatory agencies (i.e. Building department and Department of Public Works). 4. Tank Closure activities must follow the Uniform Fire Code and ali Federal and Cai-Osha regulations. 5. It is the Contractors responsibility to know and adhere to all applicable laws and regulations regarding the handling, transportation or treatment of hazardous materials. 6. If any contractors other than those listed on permit and permit application are to be utilized, prior approval must be granted by the Bakersfield City Fire Department Hazardous Materials Specialist. Deviation from the submitted application is not allowed. TANK EXCAVATION, REMOVAL AND DISPOSAL 1. Abandonment of tanks in place will only be allowed if removal would pose undue risk to an existing structure. Proof of risk and a work plan/proposal shall be submitted to the Bakersfield City Fire Department Hazardous Materials Division for review and approval prior to the commencement of any work activity. 2. Excavation of enough material to expose the top of the tank, removal of contents, high pressure rinsing, and inerting may be done prior to the arrival of the inspector. TANKS MAY NOT BE REMOVED WITHOUT AN INSPECTOR PRESENT. 3. Job site safety and assuring all CAL-OSHA regulations are followed is the contractors responsibility. 4. Excavations, holes, pits, trenches etc. shall be back filled immediately. Any excavations not back filled shall be properly secured as to ensure public safety (i.e. fenced off). 5. Any excavated material from the tank pit, piping runs, etc. not used as back fill will be properly disposed of, or if left on location will be either containerized or covered with suitable material to prevent the emission of hazardous, noxious or unpleasant vapors and/or odors. In addition the material will be properly secured as to ensure public safety (i.e. fenced off). 6. Tanks shall be either decontaminated or transported as hazardous waste. 7. A Hazardous Waste manifest will accompany either the rinsate or the tank and shall be present on site and presentable upon request. 8. The interior of tanks being transported not as hazardous waste (decontaminated) shall have a lower explosive limit (LEL) of no greater than 5% immediately following cleaning and prior to the introduction of CO~ A. The contractor shall certify on the inspection form that the cleaning process was properly conducted and the LEL results did not exceed 5%. 9. The decontaminated tank shall be inerted with the introduction of CO2, in the form of dry ice or from canisters. A. A rate of 20 pounds of dry ice to 1000 gallons of tanks capacity, or the corresponding weight of Carbon Dioxide (CO=). B. If canisters are used they shall be bonded to the tank(s). C. A receipt for the CO2 shall~remaln on site and presentable upon request. 10. Prior to the removal of a decontaminated tank the LEL level will be no greater than 5% and the oxygen level will be no greater than 12%. SOIL SAMPLING/PRELIMINARY SITE ASSESSMENT 1. Soil samples shall be obtained under the direction of a professional engineer, geologist, or authorized representative of a state-approved laboratory and in the presence of an inspector from this office, unless previously approved. 2. Samples shall be collected, at a minimum, from depths of 2 and 6 feet below the tank bottom, dispensers, and product lines and from the following locations: A. Tanks less than 1000 gallons - from the center of the tank. Tanks 1000 - 10,000 gallons - 1/3 of the way in from each end. C. Tanks greater than 10,000 gallons - from the center and 1/4 of the way in the end of the tank. D. Below all dispensers. E. Piping - every 15 feet and/or at connections, joints, bends, etc. 3. Any area of obvious contamination or likely areas of contamination may be required to be sampled. 4. All 'samples shall be analyzed by a state certified laboratory. 5. Soil samples shall be analyzed for all known and suspected substances to have been stored in the tank. 6. All samples will be accompanied by a Chain-Of-Custody sheet. 7. A soil sample report/preliminary assessment shall be submitted to the Hazardous Materials Division with five days after results have been received and shall contain at a minimum the following information. A. Name and location of where the tanks were disposed of. B. Name and location of where the rinsate was disposed of. C. A signed copy of the Hazardous Waste Manifest. D. A tank disposal receipt from the scraping facility. E. Copies of ail lab data sheets and Chain-Of-Custody documentation. F. A plot plan showing the locations of the buildings, tanks, piping runs, dispensers, and ALL SAMPLE LOCATIONS WITH CORRESPONDING I.D. NUMBERS AND DEPTHS. BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIALS DIVISION GUIDELINES FOR PERMIT TO INSTALL AN ABOVEGROUND STORAGE TANK FOR FLAMMABLE OR COMBUSTIBLE LIQUIDS A. Any aboveground storage tank installed within the City of Bakersfield, for the purpose of storing flammable or combustible must meet the requirements of article 79 of the 1991 Uniform Fire Code. B. Within Fire Zones 1 and 2 and the closely built commercial and residential areas of Fire Zone 3 the requirements of section 15.64.410 of the Bakersfield City Municipal Code also apply. These requirements are as follows: 1. Aboveground tanks containing Class I, II or IlI-A liquids shall not exceed a capacity of 2,000 gallons individual or 4,000 gallons aggregate. 2. A tank vault shall completely enclose the tank. 3. The tank vault shall be constructed of reinforced concrete at least six inches thick (equal to a two-hour wall). 4. The tank vault shall be liquid tight. 5. All vaulted tanks/tank vaults shall have an enclosed space between the tank and the tank vault and will be called secondary containment. 6. The only openings permitted in the tank vault shall be for inspection, filling, dispensing, venting, emergency venting, and they shall be installed through the top only. Anti- siphon devices shall be installed on discharge lines. 7. Tank connections shall be so piped or closed that neither vapors or .liquid can escape into the enclosed space between the tank and the tank vault (the secondary containment area). 8. Means shall be provided to ventilate each vault to dilute, disperse and remove vapors. 9. Means shall be provided to recover liquids from the secondary containment area. If a pump is used to meet this requirement, the pump shall be of an approved type, and not permanently installed in the secondary containment area. 10. Tanks should be UL listed for above-ground use. 11. Emergency venting is required as per Uniform Fire Code. 12. Vent 'pipe provided for normal tank venting shall terminate at least twelve feet above ground level. 13. Permits shall be required from the Building Department for all reinforced concrete such as pad, sides, ends and top. 14. Permits shall be required from the Building Department for all electrical through Building Department. 15~ The tank vault shall be protected against accidental dislodgement by the use of crash posts which are a minimum of six inches in diameter, six feet long, two feet of which shall be below grade and encased in concrete. Encasement in concrete shall be minimum of twelve inches wide. 'Bottom of posts, suspended in concrete minimum of three inches from bottom. The crash posts shall be set four feet on center and three feet from the vault. 16. The tank vault shall be protected against dislodgement during seismic activity as per the Building Code. 17. Tank vault should be at least 25 feet from any opening in a building, any property line or any street, alley, or public way; one hundred feet from I, R-1 and R-,3 occupancies; and one hundred fifty feet from all A and E occupancies (see Uniform Building Code). 18. Vaults shall have warning and identification sign installed to clearly identify hazards. 19. Vapor recovery methods must be approved by air pollution laws. 20. All vaulted tanks shall be inspected for vapor and/or liquid leaks every six months. Records of the inspection shall be kept on premises and signed by responsible party. 21. Vaults shall have capability of being physically monitored. 22. Dispensing nozzles with auto shut off required. 23. No hold-open devices are allowed with Class I flammable liquids. 24. Maximum life of aboveground tanks: 25 years. C. Application Process 1. Provide two sets of a plot plan for the facility. This plan must include location of property lines, all buildings and openings to each building (such as windows, doom, vents, etc.), nearest road or intersection, all tanks piping, any fixed source of ignition (ie. water heaters forced air AC units, etc.) all foundations and equipment to be installed. 2.' Construction details of tank pad seismic straps or fixtures and crash posts. 3. Certification by the manufacture that the tank meets the applicable codes. 4. Identification of the materials to be stored in the aboveground storage tank. 5. Building permits for all reinforced concrete and electrical work must be obtained at the Bakersfield City Building Department. Construction cannot begin without their approved permit. 6. · Complete any necessary application for the air pollution control district for any storage or dispensing of gasoline or aviation fuel. 7. Applications must be fully completed or they will be returned; no exceptions. 8. Permit fee must be submitted with the application or the application will not be processed. 1 .~JNIFORM FIRE CODE 7902.1.3.2-7902.1.7.2.4 EXCEPTIONS: I. Tanks of 300 gallons ( l 135,5 L) capacity or less located on private property and used for heating and cooking fuels in single-family dwellings. 2. Tanks located underground. 7902.1.4 Sources of ignition. Smoking and open flames are prohibited in storage areas. See also Section 7901.10. 7902.1.5 Explosion control. Explosion control, equivalent protection devices or suppression systems, or a barricade shall be provided in accordance with the 1~ uilding Code when Class I liquids are stored inside buildings in excess of the exempt amounts, or where explosive vapor-air mixtures could develop under normal operating conditions. EXCEPTION: Class I-B and I-C liquids when provided with continuous ventilation at the rate set forth in Section 8003.1.8. See also Sections 7902.5.11.7, 7902.5.12.7, 7903.2.3.4,3 and 7903.2.3.5.3. 7902.1.6 Separation from incompatible materials and accumulation of combustibles. Stor- age of flammable and combustible liquids shall be separated from incompatible hazardous mated- als in accordance with Section 8001.9.8. Grass: weeds: combustible materials: and waste Class I, II and III-A liquids shall not be accumu- lated in an unsafe manner at a storage site. 7902.1.7 Abandonment and status of tanks. 7902.1.7,1 General. Tanks taken out of service as a result of a property's being abandoned or its use being changed shall be removed or abandoned in place in accordance with Section 7902.1.7.2.3 or 7902.1.7.3.3. The time schedules stipulated shall not apply. In other cases, tanks taken out of service shall be safeguarded or removed in accordance with Section 7902.1.7. 7902.1.7.2 Underground tanks. 7902.1.7.2.1 Temporarily out of service. Underground tanks temporarily out of service shall have the fill line. gage opening, vapor return and pump connection secure against tampering. Vent lines shall remain open and be maintained in accordance with Sections 7902.1.10 and 7902.2.6. 7902.1.7.2.2 Out of service 90 days. Underground tanks not used for a period of 90 days shall be safeguarded in accordance with the following or removed in accordance with Section 7902.1.7.4: I, Flammable or combustible liquids shall be removed from the tank. 2. All piping, including fill line, gage opening, vapor return and pump connection, shall be capped or plugged and secured from tampering, and 3. Vent lines shall remain open and be maintained in accordance with Sections 7902.1.10 and 7902,2,6. 7902,1.7.2.3 Underground tanks out of service for one year. Underground tanks which have been out of service for a period of one year shall be removed from the ground in accordance with Section 7902.1.7.4 and the site shall be restored in an approved manner. When the chief determines that the removal of the tank is not necessary., abandonment in place is allowed. 7902.1,7.2.4 Tanks abandoned in place. Tanks abandoned in place shall be abandoned as fol- lows: 1. Flammable and combustible liquids shall be removed from the tank and connected piping, 2. The suction, inlet, gage. vapor return and vapor lines shall be disconnected. 3. The tank shall be filled completely with an inert solid material approved by the chief. 4. Remaining underground piping shall be capped or plugged, and 5. A record of tank size, location and date of abandonment shall be retained. 1-245 A'i-I'ACHMENT 4 ~. ABOVE GROUND STORAGE TANK REQUIREMENTS UNIFORM FIRE CODE STANDARD 79-7 Proposed Testing Requirements for Protected Motor Vehicle Fuel Stbrage Tanks '-Used Within the Scope of Uniform Fire Code Appendix II-F DIVISION I General .Sec. 79.711 Scope. Aboveground atmospheric motor vehicle fuel storage tanks intended for use in conjunction with dispensing motor fuels into vehicles shall be in accordance with this standard. This standard includes requirements for test tanks, test tank conditioning, fire testing, post-fire testing, physical testing and pass-fail criteria. This standard also establishes performance criteria for thermal.and physical testing of protected aboveground atmospheric motor vehicle fuel storage tanks and requires an evaluation of applicable environmental exposure factors. The purpose of this test is to evaluate protected aboveground atmospheric motor vehicle fuel storage tanks which are intended to provide a level of thermal and physical protection similar to that achieved with underground tank installations. DIVISION II Testing Procedures Sec. 79.721 Pre-fire Test Tank Condition and Configuration. (a) Size of Test Tank. When test results are to be applied to multiple tank sizes, the tank to be tested shall be that tank with the greatest ratio of fire exposed surface to tank volume. This may not be the smallest tank. One tank size test shall satisfy the testing need for all similarly designed tanks in a product line which have an equal or smaller ratio of fire exposed surface area to tank volume. (b) Dryness. When the tank protective materials contain moisture (i.e., water or solvents, etc.), the materials shall be conditioned such that the dampest portion of the material has achieved a moisture content corresponding to drying to equilibrium with air in the range of 50% to 75% relative humidity at 73+/-5 degree F. (c) Temperature. The ambient air temperature at the beginning of the test shall be within the range of 50 degree F to 90 degree F. (d) Materials. The tank and all protective materials shall be in their normal operating condition. (e) Venting. Venting devices for normal and emergency operation shall be installed, (f) Appurtenances and External Equipment. Non-ferrous external aPpurtenances which are intended to be installed in the tank openings shall be installed during the test to determine the potential for such appurtenances to melt and allow an explosive condition to occur. All equipment external to the tank not installed during the test shall be represented by an uninsulated capped schedule 40 iron pipe nipple a minimum of 6 inches in exposed length. The pipe diameter shall be consistent with the opening but shall not be less than 1-1/2 inches.. Sec. 79.722 Type of Fire Test. (a) General. The tests shall be two-hour full-scale tests. Either a pool fire, or a furnace test is acceptable as long as the required heat flux is provided. The temperature of the environment that generates the heat flux shall be between 1850 degree F and 2150 degree F at all times after the first five minutes of the test. The empty test Specimen shall be exposed to heat flux and temperature conditions representative of total engulfment in the luminous flame regime of a large free-burning fluid~l:iydrocarbon- fueled pool fire. (b) Furnace Test. The furnace shall be capable of maintaining a total heat flux of 65,000 BTU/exposed sq. ft. per hour +/- 5,000 BTU. (c) Pool Fire Test. An average total cold wall heat flux of 50,000 BTU/exposed sq. ft. per hour +/- 2,500 BTU averaged over the duration of the test on all exposed surfaces shall be maintained. Sec. 79,723 Thermocouples (a) Placement. Thermocouples shall be placed uniformly on the interior surface of the primary tank with no more than nine square feet per thermocouple and no less than one thermocouple per segment and face or end. Thermocouples shall be placed no closer than 12 inches to any tank opening. (b) Recording. The Thermocouple readings shall be recorded at intervals not to exceed 5 minutes for the duration of the fire test. Sec, 79.724 Fire Test Pass/Fail, A tank shall be considered to be acceptable under Section 79.222 provided that: (a) The thermocouple readings shall not exceed an average temperature rise of 260 degree F, and maximum temperature of any single therm0couple of 400 degree F. (b) The structural integrity of the primary tank and its supports is maintained. (c) The required emergency venting remains operational. Sec. 79.725 Post Fire Testing. (a) Hose Stream Test. Immediately after the fire test, the protected tank shall be subjected to a hose stream test.in accordance with the procedures established by the Uniform Building Code Standard 43-1, Section 43.108, for testing of wall assemblies. (b) Leakage Test. 1. A leakage test shall be conducted on each primary tank tested using the production pressure test required in the manufacturer's listing procedure; or, 2. A 24 hour leakage test shall be conducted on each primary tank tasted maintaining the tank completely full of Water. Sec. 79.726 Post Fire Testing Pass/Fail. The tank shall be considered to be acceptable Under Section 79.725, provided that the primary tank shall remain leak tight. Sec. 79.727 Physical Testing. (a) General. This phase of testing may be conduCted on either a tested tank or a tank not subjected to the tests described in Section 79.722. (b) Projectile Protection. The protected tank shall be tested in accordance with the requirements for bullet resistance as specified in U.F.C. Section 77.203(d)2. (c) Impact Protection. When impact protection is not provided by guard posts the tank shall be tested, when anchored according to the manufacturer's recommendation, for resistance to heavy vehicle impact by resisting an impact of 12,000 lbs. at 10 mph. The load shall be applied over a one square foot area' at a height of 18 inches above the bottom of the protected tank. Sec. 79.728 Physical Testing Pass/Fail. The'tank shall be considered acceptable under Section 79.725 provided that the primary tank shall remain leak tight. Sec. 79.729 Climatic/Environmental Testing. The evaluation of all climatic and environmental exposures to which a protected tank may be exposed during its anticipated service life shall be made of the test tank to assess the ability of the protective characteristics of the test tank to perform as intended to meet the requirements of this standard for thermal and physical protection. DIVISION Iil Reporting of Results Sec. 79.731 Report of Test. The report of the test shall contain the following: 1. Description of the test tank to include; drawings showing structural design, plan, elevation, principle cross-section, and other sections as needed for clarity. 2. Location of thermocouples. 3. General ambient conditions at test time. 4. Information on the actual moisture content of the test tank protective material obtained within 72 hours prior to the test. 5. Average and individual temperature data measured in the fire environment. 6. Visual observation made during the test. 7. Photographs of the following: a. Test tank prior to test. b. Test in progress. c. Test tank exterior-post test. 8. Performance for the protected tank with respect to any damage. 9. Pass/Fail criteria results. 10. Results of the evaluation of environmental exposures conducted to assess the ability of the protective characteristics of the tank to pedorm as intended to meet the requirements of this standard for thermal and physical protection for the service life of the tank. 11. Manufacturer's statement on the expected service life of the tank and any limitations on the types of climates or environments to which the tank may be exposed during its service life. Sec. 79.732 Labeling. A protected tank and all other tanks in the same line of tanks manufactured to the specification of the tanks that qualify as meeting the pedormance criterion of this standard are eligible for labeling. Each tank shall be labeled in the factory prior to installation. The label shall indicate compliance with Uniform Fire Code Standard 79-7 including any limitations. It shall be permanently attached to the exterior of the protected tank in a location which is readily visible after the tank is installed in the field. Reason. Appendix II-F was established in a proactive effort to provide guidance to the fire service, fueling facility operators, and manufacturers of aboveground, motor fuel storage tanks (AS7'), on safe alternatives to the historic requirement of the Uniform Fire Code (UFC) which mandated storage of fuels for dispensing into motor vehicles to be in underground storage tanks (UST). From a fire protection standpoint, underground storage of motor fuels remains the preferred and proven fuel storage method. The economic impacts resulting from environmental regulations on UST installations created the demand for an alternative fuel storage method using AST's. Aboveground storage tanks create and are subject to thermal and physical risks unlike UST's. The goal of Appendix II-F was to create an AST system that mitigates the thermal and physical risk exposures of an AST to a level similar to that of an UST. It was accepted that the field erected special enclosure using six inches of concrete and installed inside a building, as provided historically in UFC Section 79.902 (c) for use where it was impractical to use-USTs or because of building limitations, provided an appropriate degree of thermal and physical protection for ASTs. The Uniform Building Code (UBC) Chapter 43 details the fire resistive qualities of materials. UBC Table 43-B, item number 6-1.1, indicates that five inches of siliceous (normal) aggregate concrete has a fire-resistive rating of two hours. In order to accommodate alternate and improved protection technologies an alternative to the traditional special enclosure construction method is the option of installing ASTs in listed and approved tank enclosures or materials providing fire protection of not less than two hours was included in Appendix II-F. It was recognized at the time Appendix II-F was added to the UFC that no nationally recognized test procedure for testing ASTs in a simulated or actual hydrocarbon pool fire environment existed. The absence of a test standard has left fire officials with only the option of using UFC Sec. 2.301, Alternate Materials and Methods when presented with an AST not protected in a special enclosure. This prevented AST manufacturers from marketing listed alternatives to special enclosure designs. Two national standards for fire testing ASTs in a rapid rate-of-rise fire condition are close to being available. This standard will assure that whatever test method is used by any nationally recognized testing laboratory, the label will indicate test results achieving objectives intended by Appendix II-F. Sec. 79.721 (a) requires the tank which has the greatest ratio of fire exposed surface area to tank volume in a product model line to be tested as a representative sample since this tank provides the greatest challenge to the insulating system because the heat sink factor of the liquid is minimized to the greatest extent. This adds a margin of conservatism in the listing of larger tanks of similar construction in a product line. Sec. 79.721 (b) & (c) requirements assure standardization of test conditions and reproducible results. The requirement for dryness is based on the American Society for Testing and Materials (ASTM) E-119 test method for conducting fire tests of building construction and materials as set forth in UBC Standard 43-1 Sec. 43.109. Sec. 79.721 (e) would show if the tank design or protective materials have the potential to adversely affect the operation of the vent devices. This must be determined during the post-fire test evaluation since such vent devices are an integral part of the tank safety system. Sec. 79.721 (f) assures standardization of test conditions and allows for reproduction of results. Sec. 79.722 (a-c) requires specific temperature and heat flux changes based on the rapid rate-of-rise fire conditions referenced by ASTM and UL. The main difference between conventional fire tests and hydrocarbon pool fire test conditions is the rate of temperature rise. These test methods "get hotter faster" than in UL 263 or ASTM Method E-119 (UBC Std. 43-1), which consequently subjects the specimens to a strong thermal shock. In this standard, the specified "fire" temperature (that is, the temperature of the environment that generates the total heat flux) is from 1850 degrees F to 2150 degree F. Temperature can be thought of as the driving force for heat flux. The specified total heat flux is the summation of the radiative plus convective components, with the radiative component being very dominant. P~s/Fail temperatures are based upon a typical starting temperature of 60 degree F with a goal of limiting tank wall temperatures below the ignition temperature of motor fuels'. As the primary constituent of gasoline, heptane is the reference material. The ignition temperature of heptane is listed in NFPA 325M as 399 degree F. This established the maximum temperature of any single thermocouple at 400 degree F. The average limit was established as 20% under the maximum. 20% of 400 degree F = 320 degree F and 320 degree F - 60 degree F (the average starting temperature) = 32 degree F. ATTACHMENT 5 POSSIBLE ABOVE GROUND STORAGE TANK VENDQRS I N D 'U $ T R I E $ Dave Huchins Redline Hotel & Inns 4001 Main St. Vancoover, WA 98633 Dear Mr. Huchins: Thank you for calling'Hallmark Industries to request information on our new Hallmark TankVault II aboveground vaulted tank. The Hallmark TankVault was designed for the safe storage and dispencing of flammable or hazardous liquids. We are very excited about the new TankVault II, which has obtained the new Underwriters Laboratories (U.L.) Subject 2085 Listing for Insulated (vaulted) tanks. The TankVault II meets the requirements of N.F.P.A. 30, N.F.P.A. 30A, N.F.P.A. 31, U.F.C. Appendix IIF, and the new U.F.C. Standard 79-7. We have spent several years in research and development to design what many believe to be the best abovegroUndtank on the market. If you are comparing vaulted tank costs please insist on verification of the U.L. Subject 2085 Listing and Fire Code compliance. This will assure you that your tank will not become obsolete. Enclosed is the literature you requested on the Hallmark TankVault II. Since 1978 Hallmark has been the leader in the above ground tank industry. We have several manufacturing facilities throughout the U.S. that manufacture a wide variety of storage tanks. If you require any information on our other products or have any questions, please contact us at: (800) 872-2270. Sincerely, William Y. Hall President !-800-872-2270 Fax: 13 ;0) 217-9873 · ~: ~,'~,' -- ,~': · I~' ~ - · ' ' The A vantages of Hallmark Tanl ults m A new lightweight design that is shipped as a complete unit. · Virtual elimination of any potential soil contamination · Tested in accordance with the U.L. requirements for · Meets requirements of NFPA 30 for above ground tanks insulated tanks and the U.F.C. testing criteria for and the 1991 Uniform Fire Code protected tanks. · Designed to withstand natural disasters · Secondary Containment with a leak detection monitoring · The 6" concrete vault provides thermal protection to tube is standard on all models flammable liquids · It sits on 2" supports to allow complete visual leak · Hallmark TankVaults are available in 250-12,000 gallon sizes. inspection Outer steel tank which protects and contains the concrete insulation lO' Primary U.L. 142 'Tank · .. ~. ~ 1/4' annular space ~- "- ~ between the primary and ' '; '(~'. 2'o '(~ ~' 'secondary containment ~- T,o~ 6" of lightweight . C, 6'o . f~_., j ~o~,o, T,~o~ reinforced concrete which O- 2"0 , ! Concrete ~ provides the tank with a 2- Fill 4 'o Vent Emergency Vent ':' hour fire wall rating · ', U.L 2085 2'0 2"0 .':. A 2" leak detector tube to , o~ '~ ' ~ monitor the secondary ... ~ containment ~ o' - ~ O' ~ The secondary · TYPICAL TOP PLAN containment is a sealed · '.':" . (Custom Designs A va#able) and pressure tested . geomembrane ' "' . .~ DIMENSIONS SIZE WIDTH LENGTH HEIGHT WEIGHT 250 GALLON 3'6" 7'8" 3'3" 2,900 lb. 500 GALLON 4'1" 11 '0" 3'4" 4,400 lb. 1000 GALLON 4'10" 11 '0" 4'8" 6,~0 lb. 2000 GALLON 7'3" 12'0" 5'1" 9,400 lb. 4000 GALLON 7'3" 17'1" 6'6" 18,000 lb. 5000 GALLON 7'3" 21 '1" 6'6" 21,000 lb. 6000 GALLON 7'4" 21 '1" 7'6" 23,000 lb. 8000 GALLON 7'10" 24'0" 8'0" 37,000 lb. 10000 GALLON 7'10" 29'8" 8'0" 41,000 lb. 12000 GALLON 7'10" 36'0" 8'0" 45,000 lb. Dual compartment tanks are available for ali sizes Tank height includes 2" bottom support channel ,PEI Contact your local distributor: LISTED I N D U S T I'~ I E S N D U S T R E S For Immediate Release: Company Contact: David Hall (310) 323-7708 THE HALLMARK TANKVAULT II Hallmark Industries, Inc., is pleased to announce the release of the New Hallmark TankVault il. The Hallmark TankVault II is the result of several years of research and development by Hallmark Industries, Inc. This new product has been tested in accordance to the new Underwriters Laboratories (U.L.) 2085 test for Insulated Tanks and the Uniform Fire Code (U.F.C.) Appendix IIF Proposed Test Criteria. This new generation of aboveground tanks utilizes a revolutionary new lightweight concrete technology. Research has revealed that standard 3,000 psi concrete used in the majority of aboveground tanks today may not pass the new strict testing requirements for vaulted tanks. Fire Department specifications for aboveground vaulted tanks are becoming more stringent. When vaulted tanks were first accepted in the industry, six inches of structural 3,000 psi concrete was accept- ed as a two hour fire wall. The original purpose of enclosing an aboveground tank with concrete was to provide insulation and fire I N El U $ T R I E $ proteCtion. There was no structural necessity for the concrete. The proposed vaulted tank test specifications developed by the U.F;.C. Appendix IIF Test Criteria Committee requires that the internal tank temperature shall "not exceed an average temperature rise of 260 F." (Copies of the testing criteria are available from Hallmark). Outside Laboratories have demonstrated that the normal 3,000 psi concrete with gravel aggregate used in the majority of aboveground tanks on the market today, may not prevent this temperature rise. Hallmark Industries has replaced the old gravel concrete with a new lightweight insulating concrete technology. This new patent pending lightweight design also allows us to ship a complete unit without the weight of concrete saving both shipping and off-loading costs. The new testing requirements for vaulted tanks may force current stan- dard concrete vaulted tanks to become obsolete. Hallmark is aware that this change may take time and that many existing public specifi- cations may already include requirements for 3,000 psi tanks. For this reason, we will utilize the 3,000 psi Concrete in the Hallmark TankVault II upon request. The standard Hallmark TankVault pour-in- place vaulted tank is also still available. I N D U S T R I E $ With over 15 years of tank experience, Hallmark'Industries was the first to design and market aboveground "pour-in-place" vaulted tanks and once again we are the leader in an exciting new aboveground tank technology. Attached, please find the new color brochure and specifications for the Hallmark TankVault II. If you require additional information or sUbmittal drawings, please contact Hallmark at (310) 323-7708. South Hamilton ,~,ve.. Gar~lena. C~ 90248 jua-19-iga5 13:29 FRC~i. T. IZH.~I._LI'I~RI,', T~NKU~IJLT TO 'I i~607~0419i P. Oi T.T.I. , To~n~ ~1~. ~5 TeK 31~1~402 Wa~e Pi~ Lion ~1 / ', 1 ~n S~ / V~cr, WA 9S6~3 ~o~ ~H9~19 Dear Mr. Pipe, Wc axe plca~l to makc thc following quotation for the I-lallmark Tank, I-Iallmar[~ ranks provide safe econamical abovegrouad slomgc for flammable liquids. We know you'll be pleased ~vith our quality and competitN'e prices. Quaati~ Stock #. Description 6 HII-1000 1000 Gal Rectangular Hallmark T_a_n_kvault 6 TTP-A Venting Accessories w/Tank Gauge 6 OPT-F 7 Cranon Internal Overspm 6 OPT-V Double Tap Bushing w/Suction Tube 6 405-10 1" Single Poppet Foot Vah,e 5 HH-500 500 Gal Rectangular I-la,mark Tankvault 5 TTP-A Venting Accessories w/Tank Gauge 5 OPT-F 7 Gallon l. nlctllal Overspill. Container 5 OPT-V Double Tap Bushing w/Suction Tube 5 405-10 1" Single Poppet Foot valve Standard lead time is six weeks, fly, ur delivery ~_ate is critical please inform us when ordering. Freight is F.O.B. Origin Freight Collect. The freight quoted is an estimate only. Payment ternm to b~ negotiated upon receipt of the order. This proposal is valid for 60 days. Standard tank equipment accessories will be' installed at the factory prior to delivery. Thank you for the opportunity to provide you with this quotation If you have any questions please call me at 800-872-2270. SincereSt] · D~e Hall Vi~e President of Sales JuIq-l.~-l~q~5 1_3: 2'~ T. l/HRLLI'.'I~ TRIqKURLILT TO 13E,075,341~1 P. 02 SPEC/F/CA TiONS HALLMARK TANKVAUL T Iir'" RECTANGULAR VAULTED TANK WITH SINGLE-WALL STEEL INTERNAL TANK 1. CERTIFiGA TIONS Thc entire vaulted tank shall have: 1.1 Underwriters Laboratories (U.L.) 2085 Protected Type Lisdnff, which meets the requirements of the 1994 Uniform Fire Code Appendix II-F and Standard 79-7 for Protected Tanks. 1.2 Underwriters Laboratories (U.L.) 2085 Fire Resistive T)l~e Listing;, which meets the requirements of the 1994 NFPA 30, NFPA 30A and NFPA 31. 113 The Underwriters Laboratories 2085 Listing must include the vehicle impact ~_nd ballistics protection 1.4 California Air Resource~ Board (C.A.R.B.) Phase I and II Vapor Recover/Certified. 1.5 The internal tank to be constructed in accordance with U.L. 142. 2. INSULATiON SPECIFICATIONS 2.1 The internal steel tank shall be encased in 6: of LIGHT WEIGHT INSULATING CONCRETE which is capable of preventing the internal tank temperature from rising not more than 145°F. DURING A 2000°F FIRE TEST FOR 2 HOUR.S, as tested by Underwriters Laboratories. 2.2 Thc insulation shall not contain any aggregates that may act as heat sinks. 2.3 The insulation shall be a mono]id'ftc (seamless) pour and contain no cold joints. 2.4 The insulation shall be one piece construction with no multiple concrete sections. 3. PAINTING SPEC/F/CATIONS 3.1 INTERNAL TANK - The outer shell shall be coated with 2-part coal tar epoxy - 12 to 14 IvffL ciD.' thickness to prcvent corrosion. 3.20LrI'ER TANK - The ironer shell shall be coated same spc~cific:adons as noted above. 3.3 FINISH COAT - The entire exterior finish coating shall be petroleum resistant 2-part white epox-y with 8 to 10 MIL dry thickness. 4. CONSTRUCTION SPECIFICATIONS PROTECTED TANK SIZES: 250 TO 6,000 gallon FIRE RESISTIVE TA=NK SIZES: 250 to 6,000 gallon 4.1 The internal tank shall be rectangular in shape, listed and constructed in accordance with Underwriters Laboratov/142 Standard for Above,Ground Tartly. 4.2 The internal and outer steel tank shall be constructed of minimum 3/16" thick. A-36 Hot Rolled Steel. 4.3 The tank shall meet seismic zone standards and prosride thc capability to be anchored as required by local codes for earthquake and/or flood. 4.4 The internal tank shall be pressure tested at the factory, as 5 psi for twenty-four (24) hours. 4.5 The tank shall be designed for an internal over-spill containment where required. (Optional) and shall have 2" interstitial test monitoring pipe. 4.6 The tank shall include atmospheric and emergent3' venting nozzles. Manways shall be installed on tanks of 5000 gallons cr more. 4.7 The tank shall have an exterior attached U.L. label showing U.L. 2085 Protected Tank and Fire Resistive Tank Listing and manufacturing location. 4.8 The unit shall be supported by a minimum 2" channel on the bottom that is an integral part of the ~'stem. The bottom of the channels shall be coated with a cold tar epox3' to prevent corrosion from occurring benVeen the concrete and steel. 4.9 The tank shall have signs to include: Labels to meet applicable codes; flammable, no-smoking, product content, and capacity.. Each. nozzle of th.e tank shall be identified for its intended use. ' THE ENTIRE TANKVAUL T IS COVERS BY A MANUFACTURERS 30 YEAR WARRANTY THIS DRAN,/ING IS THE PROPERTY DF T.T.I. & IS CONSIDERED lrlP P R[IPR 1 E'_ T L-1R Y. RIGHTS ARE RESERV[D. T.T.I, IS A MANUFACIURER OF ttALLMARK TANKS, 2 4" FILL PORT 3 4 5 2" PORT (2" X 8L~. VENT RISER t ~ ~,/ITH VENT CAP) 6 2" PUMP SUCTION PORT 7 2" HrlNII'OR TUDE 8 GROUND CLIP ! '-~ l~ INNrR TANK ]JLL ~ ~ ' - .. 500 GALLON ~ g'-m' OuTsI~C ~'J SIDE SECTION i/4'=1' DAT[: 07/08/93 TItIS DRA~/ING IS THE PROPERTY OF T,T,I, & IS CONSIDERED TOP PRE1PRIETFIRY. THE TANK IS A PATENTED PRODUCT & ALL 'RIGHTS ARE RESERVED, T.T.I. IS A MANUFACTURER DF HALl_HARK TANKS. '" ----- ! 4" VAPOR VENT PORF ............. . 2 4" FILL PORT 3 2" GAUGE PORT 4 6" EMERGEI',ICY VENT PORT -- ' 4' JO' 5 2" PORT (2" X 8'LG, VENT RISER WITH VENT CAP) ? 6 2"' PUMP SUCTION.PORT. 7 2°. MONITOR TUBE · 8 GROUND CLIP ~ I LJi I ~ 910 C6FiUTER TX 8.2 ANKSUPPORT LEG (:3 REQ"D,) -.I- ;I, · SIDE SECTIEIN' A-A ' HAL[_HARI< HII"lO00 I DRAWING NO.: HII-004 ~LE: 1/4"=1' DATE, 07/09/93 DWN. BY, C. TENNISON CK. BY, SHEET NB: 1 REV.: 10/24/94 : ' (OilAIll'~tllltlLi rll'e Uepl, ,i FICE OF ENVII:IONMENT ItSERVICE$ '~B'NDERGROUND STORAGE TANi~'PROGRAM PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE ~'['~F_.LO L..to~ ~--~E-L ADDRESS ._~ ~rm~o D~I ~lP CODE q.~ APN FACILITY NAME CROSS STREET fl4~o~g'O,qLE' TANK OWNER/OPERATOR ~J_~O--~"~¥Ad~'~L~ PHONE NO. ('~'~ (~c-~_~O MAILING ADDRESS "~?-~,.~× jcl"7 CITY V'A~--~o~.'c--~,/X,'AZIPCODE CONTRACTOR INFORMATION COMPANY (~l~J) P__-t~UIRDNnq~ ~..~l/CL PHONE No. (~,.}~.~3-fl5i LICENSE No. ADDRESS ~,'~./J~-CT~o'~, '~TF CITY ~IP CODE INSURANCE CARRIER ~-'~'kd'~FP__~[_ ~'~.ne-'nn~ rTV' WORKMENS COMP No. PRELIMANARY ASSEMEHT INFORMATION COMPANY~I~ l~ ~'. P-r~,~,,~. PHONE No.~)~J,~q-j~-~ LICENSE No. AODRESS I~ KJd~S ~'~ CI~ ~E~-&F~L~ ZIP CODE INSURANCE CARRIER WORKMENS COMP NO. TANK CLEANING INFORMATION COMPANY ~) ~l~~U ~b'i~ PHONE No. ~)~- ADDRESS ~ C~;,~g .~-I~ CI~"~ ZIP CODE WASTE TRANSPORTER IDENTIFICATION NUMBER C./~ l~ZeZ-l~i"~ / NAME OF RINSTATE DISPOSAL FACILI~ .~ r~'~[ '~i~F~ ~[ ADDRESS~ ~. Au~m~ 5~ c~ ~r~ Z~PCODE FACILI~ INDENTIFICATION NUMBER ~.A-~~ TANK ~ANSPORTER INFORMATION COMPANY ~ JA - AB~.~)~ ~ ~cb~PHONE No. LICENSE No. ADDRESS Cl~ Z~P CODE TANK DESTINAT;ON TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES CHEMICAL STORED STORED PREVIOUSLY STORED THE APPLICANT HAS RECEIVED. UNDERSTANDS, AND WILL COMPLY WITH THE AI'rACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE. LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDEP PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. APPLICANT NAME (PRINT') APPLICANT 'SIGNATURE THIS APPLICATION BECOMES._A PERMIT WHEN APPR__OVED. ................. · ,~ r~, r- -,"/"~ -r'u~' .~"~l"r~ ~'"t~' D AI[CI3I~I='I;I ri. ~ . / ~"'""5 '* ' ~ I~ ?.t RED LION HOTEL 3100 CAMINO DEL RIO CT, NOT TO SCALE BAKERSFIELD CA UST SITE P~N ~arth ~ ~nvlronmontat, thc. CITY of BAKERSFIELD FIRE DEPARTMENT ~ FIRE SAFETY SERVICES & OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE. · BAKERSFIELD, CA · 93301 R.E. HUEY R.B. TOBIAS, HAZ-MAT COORDINATOR FIRE MARSHAL (805) 326-3979 (805) 326-3951 Septer~ber 28, 1995 Dear Underground Storage Tank Owner: Enclosed is your updated Permit to Operate for the underground storage tank(s) located at the referenced place of business. Please take a moment to review the information printed on the permit to make sure everything is correct. If any corrections need to be made, please call the discrepancies to our attention immediately. Your Permit to Operate is a legal document and its accuracy determines whether you are in compliance with the law, If you are the tank owner and not necessarily the tank operator at the site, please make a copy of this permit for your own files. Forward the original permit to the tank location so that it may be conspicuously posted on site. If you have any questions regarding the Permit to Operate or your responsibilities as an underground storage tank owner, please call the Office of Environmental Services at (805) 326-3979, or write to us at the letterhead address. Sincerely, / Ra,~ HJahrdE(:;uHsUl~lYaterialsCoordinator Enclosure P it Op Underground Hazardous Materials Storage Facility CONDITIONs ~ Pi~!~i~ ~i~ REVERSE SIDE RED LION HOTELS & INNS 1715 Chester Ave., 3rd Floor 3100 CAMINO DEL RIO COURT Bakersfield, CA 93301 BAKERSFIELD, CA 93308 (805) 326-3979 STATE OF CAUFORN]A STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COUPLETETHIS FORM FOR EACH FACILITY/SITE [ MARKONLY ~ 1 NEWPERMIT [---] 3 RENEWAL PERMIT ' [~] 5 CHANGE OF INFORMATION E'-'~ 7 PERMANENTLY CLOSED SITE ONE ITEM 2 INTERIM PERMIT ~ 4 AMENDED PERMIT [] 6 TEMPORARY S[TE CLOSURE ADDRESS NEAREST CROSS STREET PARCEL # (OFTIONAL) STATE [ ZIP CODE SITE PHONE # WITH AREA CODE · / BOX TO INDICATE ~ CORPORATION [~] INDIVIDUAL ARTNERSHIP r--1 LOCAL-AGENCY I---I COUNTY-AGENCY' E~ STATE-AGENCY' E~ FEDERAL-AGENCY' DISTRICTS' ° If owner of MST is a public agency, complete the following: name of Supervisor of division, section, or office which operates the UST RESERVATION [~] 3 FARM E~ 4 PROCESSOR 5 OTHERI OR TRUSTLANDS EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) · optional I ~O~TH AREA CODE NIGHTS: NAME (LAST. FIRST) PHONE # WITH AREA CODE NIGHTS: ~a.('CAS'F. FIRST) II. PROPERTY OWNER INFORMATION- (MUST BE COMPLETED) [ CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ./ box to indicate r---] INDIVIDUAL ~ LOCAL*AGENCY E~ STATE-AGENCY I .'~00~ tv~ o.~u s"f' r~ CO"PORAT,ON ~PARTNE"S"'". ~ COU"~Y-AGENCV ~ FEDERAL-AGENCY i O'~NAME STATE I ZiP CODE I PHONE # WITH AREA CODE IlL TANK OWNER INFORMATION- (MUST BE COMPLETED) NAME OF OWNER ~ CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS / ,f" box to indicate E~ INDIVIDUAL [~ LOCAL-AGENCY E~ STATE*AGENCY '~'00/ I~'~ ~'""' / r~ CORPORAT,ON ~ PART.£"S.,P ~ COUNTY-AGE.CY © FEDERAl*AGENCY CITY NAME~ ~} Vg.4f.~V~~(''/~ [/ STATE~/i~¢.. 'ZIP CODEq ~;~ ~ ~ >[I PHONE # WITH360 -7~oAREA CODE IV. BOARD OF EQUALIZATION MST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise. TY O'K) HQ [~-~-I0~.~1.71/I¥1 !1 V. PETROLEUM MST FINANCIAL RESPONSIBILITY- (MUST BE COMPLETED) - IDENTIFY THE METHOD(S) USED ~/box tolndicate [~1 SELF-INSURED ~ 2 GUARANTEE I-~ 3 INSURANCE '~ 4 SURETY BOND E~ 5 LETi'EROFCREDIT ~ 6 EXEMPTION I-'-I 99 OTHER VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. I~HECK~NE~~~~ND~~AT~NGWH~~HA~~vEADDRESSSH~ULDBEUsEDF~RLEGALN~T~F~~A~~~NSANDB~LL~NG: 1'~ '"E~ '"'~'] THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ~ OWNER'S NA (PRJ~ITED & SIGNED) . ~ / ~ ~ OWNER'S TITLE ~ DATE MONTH/DAY/YEAR LOCALAGE.CfUSEO.LY I IT ' -- COUNTY # JURISDICTION # FACILITY # LOCATION CODE . OPTIONAL CENSUS TRACT # - OPTIONAL 8UPVISOR -OISTRICT CODE - OPT/ONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMff APPMCATION- FORM B~ UNLESS THIS IS A CHANGE OF SiTE INFORMATION ONLY. OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A (3/99) r-ORO~M-R? INSTRL~I©NS FOR ~©MPLET~NG " GENERAL INSTRUCTIONS: SECTION 2711 GE 'IITLE 23, CI.tAPTER 16, CALIFORNIA CODE OF REGUI~TIONS AND SEC'I2ONS 252~6, 252~7, AND ~289 OF CHAPTER 6.7, DIVISION 20, CAI..IFOi~NIA HEALTIt AND SAI~ CODE ~QU~E OWNERS TO APPLY FOR AN UST OPERA'I~NG PE~IT. 1. (~e FOIl4 "A" shall ~ ~ompl~t~d for all NEW PEI~T CHANGES or ~ny FACILITY/S~E ~FO~MA~ON CHANGES. ~ 2. SUBMIT ONLY ONE (1) FO~M "A" for a Facflity~im, regardless of ~e numar of t~ks located at ~e site. 3, This fo~ shoukt be completed by eider tim PERMIT APP~CANT or the LOCAl. AG~CY UNDERGROUND TANK INSPE~'OR. 4. Please ty~ or print clearly a~ request~ info~ation. 5. Use a hard point writh~g inst~uent, you are making 3 copies. 6. T~k owner must submit a facilltj plo~ plan to ~e locfl ag~ey as pan of fl~e application show~g ~e k~ation of ~e USTs with ms,ct to build~gs md landmass [Section 2711 (a)(8), CCR]. 7. T~k owner muir submit documentafi~ showing c~mplian~ wi~ state fin~ciM res~nsib~ity mquimm~ts m ~e lo~ agency as ~n of ~e application for ~ttoleum USTs ~Secfion 271 ! (a)(11), CCR], TOP OF FORM: "MARK ONI.Y ONE iTEM" Ma~ ~ (X) h~ the ~x next to the item that ~st descries fl~e reas~ the fo~ is ~g completed. L FACIIJTY/SN'E ~FORMA'I2ON & ADDRESS (MUST BE COMPLEq~D) 1. Record name and address (physical l(~afion) of the underground tank(s). NOTE: Address MUST have a wdkl physical la:ation including city, state, and zip code. P.O, BOX NUMBERS ARE NOT ACCEPTABLE. Include nearest cross street ~d name of the operator. 2. Phone number must have an area c~e. If the night numar is the ~ame, write "SAME" ~ proper locati.m. 3. Check O~e appropriate ~x for T~'Pg OF BUSINESS D~ERSItIP (ex. CORPORA'HON, ~DIVIDUAL, etc.). 4. Check the appropriate ~)x for TYPE OF BUSINESS. 5. ~ FacilitylS[te is l~ated within an Indian resemation or other Indian trust lm~ds, check the box marked "YES". 6. Indicate ~he NUMBER of TANKS at this SITE. 7, Record the E,P.A. ID ~ or wrim "NONE" h the space provided. . IL PROPERTY OWNER LNFORMATION & ADDRESS (MUST B E COMPLEIED) Complete all imms in this section, unless all imms are the same as SECT[ON 1; ff tl~e same, write "SAME AS SITE" across tiffs sectim. Be sum to check PROI~EI~TY OWNERSIIiP TYP1)~ ~x. llL TANK OWNER [NFORMATIO~ & Al)DRESS (MUST BE COMPLETED) Complete all [tams in this section, unless all items are ~e same as SECIION 1: If th~ ~ame, writ~ "SAME AS SITE" across this sectkm. Be sure to check TANK OWNI~RS TYPE box. IV. BOARt) OF EQU6k!ZATION LJST S'I"ORAGE FEE ACCOUNT NUMBER (MUST BE COMPLET[~D. SEE ARTICI.I'~ 5, CtlAlq'ER 6.75, DIVISION 20, CAI.II:ORNIA llEAI..T[t AND SAFETY CODE.) Enler your ISoard of l~clualizalion (BOE) UST storage fcc account number which is rcqtfirzd ~ft~re your F~mnit application carl be processed. per g.dton Icc (k c on the I4% ~siratRm with ~he t~OE wNl ensme th.~t you will recent a quarterly slorage fee rett~m in reponNg thc 50,0n(3 0re'rills) ' ' number ~;1 g:'dk, ns phccd in.your US'['s. 'ire BOE will code ~rsons excmpl from ,~.tv~r'~. [,> 'he ~tc)r,~oe .... fee ~o ~c~t r'ns ,xili not hc R:nl. If you do not have, an acc,mm rorer>er whh Irc BOil,;~ ~,'c you have any questions regardh~g the fcc ot exemptions, please call thc BoIL al 910-322 9609 or write to t}~<: BOE at thc iol.l,.)wing address Board of EqtmNxxttion. l':uc'l Taxes Division, ILO. Box 942879, Sacrmnento, CA 94279..(~001, V. PETROIiXJM UST FINANCIAl., RIiSPONSIItIIITY (MUST BE COMPi.ETED FOR PIi'IROIJ(L:M USTs ONLY, SEE SEC'I tONS 2711 OF TITLE 23, CHAPTER 16, CAI.II'ORNIA CODE OF RIXRJI.ATK)NS.) ldcnt{fy l.hc nmthkx[(s) used by thc owner and/or operalor, in meeting lhe Federal and Stale financial rcspon~i})iiity ~cquiremeats. USTs (~wucd by auy Federal ot State agent5' as well as hon..petroleum USTs a~c exempt horn this rexlui~cmcnt. VI. LEGAl. NO'I"IFICAT1Ok' AND B1LI ING ADDRESS Check ONE BOX R>r the address that will be used for BOTII LEGAl. AND BILLING NOTIFICATIONS, TANK OWNER OR AUTI K)R!ZED REPRESENTATIVE MI ST S1GN AND DATE TIlE FORM AS iNDiCATI(D. [SEE S],;CI'IONS 2711 (a)(13) OF TITLE 23 CIIAPTEI{ 16, CAI.2FORNIA CODE Or REGULATIONS.] INS"IRUCT1ON FOR Tile I.OCAL AGENCIES The counly an jurisdiclion lltirn~rs ate prcdctemfined and eau }ce obtahmd by caller O~e State 'Board (916) 227-4303.' ]tm [acilily number may be assigngd by the local agency ho~t ever this nmnber must be numerical m~d cannot contain any alphabetical Omracters..lf the local agency prefers · e State Board to assign O~e facility number, please leave it blank. IT IS Tile RESPONSIBitlt'Y OF TIlE I.OCAL AGENCY TItAT 1NSPECTS TIIE FAC1LITY T() VERIFY TIIE ACCURACY OF THE LNFORMAT1ON. TiIIS APPI.SCAT1ON CANWOT BE PROCESSED IF THE BOE ACCOUNT NUMBER 1S NOT FILLED IN. TIlE IX~AL AGENCY 1S RESPONSIBI.E FOR TIlE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX AND FOR FORWARDING ONE FORM 'A' AND ASSOCIATED FORM "B"(s) TO TflE FOLLOWENG ADDRESS. THE LOCAL AGENCY SHOULD RETAIN TIlE ORIGiNAl5 AND FORWARD THE YELLOW COPIES TO THE FOLLOW~G ADDRESS. TIlE PINK COPY SHOULD BE RETAINED BY TllE TANK OWNER. STATE OF CALII':ORNIA STATE WATER RESOURCES CONTROL BOARD C/O S.W.E.E.P,S. DATA PROCESSLNG CENTER P.O. BOX 527 PARAMOUNT. CA 90723 3!93 FORO12OR1 ?'. ~r : ~" STATE OF CAUFORNIA ~,,/.~-~ UNDERGROUND, STORAGE TANK PERMIT APPLICATION - FORM 'A '~' COMPLETE THIS FORM FOR EACH FACILITY/SITE / MARK ONLY [~ I NEW PER'lIT. [] 3 RENEW/AL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED SITE ONE ITEM[~ 2 INTERIM PERMIT [::'-~, 4 /~ENDED PERMIT [] 6 tEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION,&~,ADDRESS- (MUSTBE COMPLETED) CI~ NAME STA~ . ZIP CODE SI~ PHONE t WI~ AREA ~DE TO IN~CA~ ~ COR~RA~ON ~ INDIVIDUAL ~TN~SHIP ~ L~AL-AG~CY ~ COU~Y-AGE~Y' ~ STATE-AGENCY' ~ F~E~L-AGE~Y D~TRICTS' * If ~ner ~ MST is a public agency, m~lae the ~ollowing: n~ of Su~w~or of db~n, ~n, or oflim whEh ~ates the MST 'PEOF BUSINESS ~ 1 GASSTATION ~ 20ISTR[~TOR~ 3 FARM ~ 4 PROCESSOR ~5 ~ER I~IFINDIAN"OFT~KSATSITEIE'P'A*I*D''(~ti*al)ORRESERVATION'TRUST,~DS , ' ~ ~ ~ ~ ";TE~E~ENCY ~A~ ~ERSON (PRIMARY) ...~ ~' · ~ EMERGENCY~ACT'PERSON (~COND~)-'.~tlonal. ~1] DAYS:~~~NAME (LAST. FIRS~' ~ ~0~--PHONE · WITH~_ ~/[/AREA CODE DAYS: NAME (LAST. FIRS~ PHONE ~ WITH AREA CODE ' N~T,~ FIRS~ NtGHTS: NAME (LAST, FIRS~ PHONE e WITH ~EA CODE NIGHTS: TH AREA CODE ,,1[ PROPERTY OWNER INFORMATION- (MUST BE COMPLETED) } CARE OF ADDRESS INFORMATION MAILING OR STREET ~DRESS ~ ~x ~i~ate ~ INDIVIDUAL ~ L~AL-AGENCY - ~ STATE-AGENCY I ~O~ ~ ~.,~s~ ~co.~...,o. ~.~.~.~.,. ~ co~..~.c~ ~ ~o~.*.~.c~ ,I ~'~ "*~" ~ ~'~ ~ ~ .... STA~ ZIP CODE~ ~& ~ ~ . P"ONE "3.~O WITH. 7~oAREA CODE.. III. TANKOWNER INFORMATION ~ (MUST BE COMPLETED) .. ' ' NAME OF OWNER CARE OF ADDRESS INFORMATION MAILING OR STREET ~DRESS ~ ~x ~ i~ate ~ INDiViDUAL ~ L~AL-AGENCY ~ STATE:AGENCY ~O~ ~ ~' ~ S~ " ~ CDR<RATION ~ P~TN~SHIP ~ COO'Y-AGENCY . ~ FEDE~L~G~NCY __ IV. BOARD OF EQUALIZATION MST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise.~ ._ v..ET.o~EUM UST ~.~.C~ .~S.O.S~alUTV-(MUST SE COU.~ET~)-IDENT~V TH~ MgT~O~(S) ..USE~ ~ I ,, 9 ~'~ 6 EXEM~ION~ ~ :~ ~ ~ ~ OTH~R;~"2 . ~ .~ ~5 L~E~0FCR~ ~: ? ~ ~ ' ' ' [ ': '<' ~ '~ ~' ~:"~ - VI. LEGAL ~TIFICATION AND BILLING ADDRESS ~Leg~ not~h~t~on ~d bll~ng w~ll be sent to the t~.owner unless box I or II ~s checked. CHECK ONE ~X INDICATING WHICH ABOVE ADDRESS SHOU~ 8E USED FOR LEGAL NOTIFIGATI~ AND Bl'Lk~O: I. ~ II. ~ IlL ~ ::::::::::::::::::::::: ,,,," :::: LOCAL AGENC~ USE ONLY ' - .../~.:?~' ~;~ ' ' ~ ~ / . .. ~. ~'~ "~;:~ :~'~ [~ I CENSUS -., T~C~I ~ ~. ~T/O~L ' [ 8UPVISOR - DISTR~T' ~DE ~ ~ ~ - ~,~ . THIS FORM M~T BE AC~IEDBY'~ LEAST (1) OR ~RE PERMff ~PUCATION- FORM:~,:U~ESS THB ~ A CrinGE OF ~ I~OR~O~ O~. OWNER MUST E~ THB FORM W~ ~E L~ AGENC~ I~1~ THE ~GROUNO ~ORAGE T~K REGU~ FORM A (~) '~,; ~' · ; ~ '~ ~7 ~NSTRL~I©NS FOR ~©MPLETING 'A" GENERAL INSTRUCTIONS: SE(nON 2711 OF Trri.r~, 23, CItAPTER 16, CALIFORNIA CODE OF REGULATIONS AND SEC'nONS 25286, 25287, AND 25289 OF CHAPTER 6.7, DIVISION 20, CALIFOi~N'IA ItEALTIt AND SAI~ CODE REQU~E OWNERS TO APPLY FOR AN UST OPERAI~NG PERMIT. I. (~e FOt~f 'A" shall ~ completed for all NEW PEI~T CHANGES or any FACILrFWSlTE ~FOKMA'I2ON CHANGES. . 2. SUBMIT ONLY ONE (t) EO~M "A" for a Facflity~im, regardless of ~e numar of tanks located at ~e site. 3. This fo~ shoukl be cmnpIeted by ei~r tim PEI~M1T APP[JCANT or the LOCAL AGENCY UNDERGROUND TANK tNSPE~'OR. 4. Please ty~ or prh~I clearly all requestcd ink>nnat[on~ 5. Use a hard poim writh~g instrmnem, you are making 3 copies. 6. T~k owner must submit a facility plot plan to the local agency as pa~ of ~he application show~g hhe kmaIion of ~e UST8 with ms,ct to build~gs and lan.~arks [Se~ion 2711 (a)(8), CCR]. 7. T~k owner mu~t submit documentation showing c~mpl[an~ wi~ sram finemci~ res~nsib~ity mquimmmts m ~e loc~ agency as ~ of ~e application for [~troleum USTs ISeclR)n 271 [ (a)(11), CCR]. TOP OF FORM: "MARK ONLY ONE ITEM" Ma~ ~ (X) h~ th¢ ~x next to the item that ~st describes ~e reas~ the fo~ is ~g completed. I. FACII..[TY/SITE ~FORMAIlON & ADDRESS (MUST BE COMPLETED) 1, Record name and address (physical l<~adon) of the underground tank(O. NOTE: Address MUST have a valkl physical kx:ation including city, state, and zip code. P.O. BOX NUMBERS ARE NOT ACCEIrFABLE. Include ~learest cross street ~d name of the operator. 2. Phone nnmber must have an area c~te. If the nlghl numar is ~e same, write "SAME" in proper location. 3. Check Ihe appropriate ~x for 'FYP~ OE BUSINESS OWNERSHIP (ex. CORPORA'~ON, ~D1V1DUAL, etc.). 4. Check the appropriate ~)x for TYI>E OF BUS[NESS. 5. If Facillty/Stte is l~atcd within an Indian resemation or olher Indian trust lm~ds, ched~ the box marked "YES". 6. Indicate fl~e NUMBER of TANKS at this srI'E. 7. Record the E.P.A. ID ~ or wrh.e "NONE" ~ the space provided. IL t~ROPERTY OWNER ~FORMAT1ON & ADDRESS (MUST BE COMPLETED) Complete all items in this section, mdess alt hems are the same as SEC'IION 1; If the same. write "SAME AS SITE" across ~is section. Be sum to check PROPERTY OWNERS}lIP TYPE ~x. I.ii. TANK OWNER INFORMATION & ADDRESS (MUST BE COMPLETED) Complete all items in this section, unless ail items are the same as SECIION 1; If the same. write "SAME AS SITE" across this sect[on. Be sure to check TANK OWNI~RS TYPE hex. IV. BOARD OF EQUAUIZATION UST STORACE FEE ACCOUNT NUMBER (MUST BE COMPLETED. SEE ARTICLIi 5, Cft AIq'ER 6.75, DIVISION 20. CAL, iFORNIA IIEALTIt AND SAFETY CODE.) Emcr your Board of llqu,dizaliam (BOll) UST storage fee account number which is rc,lulrcd bef~;rc your pcm~ii applicalion cnn'be processed. 14eg:{str:~fi,m with ~hc tN)Il will c~sme thai you will recent a quarterly slo~age fca remm in reponmg thc 5{A0n6 (i,millq) f~:~ l;,dlon fca duc on the manbcr of gallons phccd in }ot~r US l's. 'Ibc BeE '~ill code l~rsons 'exempl from p;,ying the storage fee so rets:m< will nd bc <chi, If you do to thc BOI~ al thc 1'ollo~ [ng :~d&c~s Bt,ard of Equalization, Fuel Taxes Division. PI), 8,)x 94D;79, Sttcrar~lento, (2A V. PETROIitJM UST FINANCIAl, RESI ONS1BHIfY (MUST BE COMPI.liTED FOR l'l.l'l ROLEUM US l's ONI.Y, SNIi SECt IONS 2/11 OF TITLE 23, CtlAPTER 16, (:AI.II'ORNIA CODE OF REGULATIONS.) Identify thc mcdx<xt(s) tlqcd by the owner and/eT opcra~or, in mtmting the Federal ired Static financial rcspon=ibi!i~y lgqltholticntil. L;ST:~ ,,,,, ned by any Federal or Shit( agency as well as non petroleum USTs a~c exempt from this requirement. VI. LEGAl, NOTII:ICATION AND BIiJ,iNG ADDRESS Check ONE BOX for the address that wilt b,: used for BOTH LEGAL AND BII_LtNG NOTIFICA'I IONS. TANK OWNHR OR AUTttORIZED REPRESENTATIVE MIST SIGN AND DATE TIlE FORM AS INDICATED. [SIZE SECTIONS 2'711 (a)(13) OF TfI'LE'23 CIIAPTiiR 16. CAI.JFORNIA CODE Or REGULATIONS,] INS'IRUCI'ION I'OR TIlE I,OCAL AGENCIES The cotmly an jurisdiclion nurntxrs are prcdcten~dned and can be obta~ed by callNg the State Board (9/6) 227-4303. 'I he facdily number may assigngd by Ihe local agency; however, this ntm~ber must be numerical mid cannot contain any alphabellca} d~aractcrs. If the local agency prefers lhe State Board to assign ~e facility number, please leave it blank. IT iS TIIE RIiSPONS1Bitli'Y OF TIIE I.OCAL AGENCY TifAT INSPECTS TIIE FAC1L1TY TO VIjRIFY TIIE ACCURACY OF 'DiE LNFORMATION, Tills APPIJCATtON CAN%'OT BE PROCESSED IF TIlE BeE ACCOUNT NUMBER 1S NOT FILLED IN. TIlE t~CAL AGENCY 1S RESi'ONSItli,E FOR TlfE COMPLETION OF THE "LOCAL AGENCY USE ONLY" INFORMATION BOX AND FOR FORWARDING ONE FORM "A" AND ASSOCIATED FORM "B"(s) TO THE FOLLOWING ADDRESS. TIlE LOCAL AGENCY SttOULD RETAIN TIIE OR.IG1NA[5 AND FORWARD THE YELLOW COP1ES TO THE FOLLOW~G ADDRESS. ~ttE RINK COPY SHOULI) BE RETAINED BY TIlE TANK O%~ER. STATE OF CALIFORNIA STATE WATER RESOURCES CONInROL BOARD (JO S.W.E.E.P,S. DATA PROCESSLNG CENTER P.O. BOX 527 PARAMOUNI', CA 90723 FOROt20R1 / . Y STATE WATER RESOURCES CONTROL BOARD i UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A '"'~"-~ .. '~ COMPLETE THIS FORM FOR EACH FACILITY/SITE [ MARKONLY ~ 1 NEW PER~tIT ['~ 3 RENEWAL PERMIT E'~ 5 CHANGE OF INFORMATION ~] 7 PERMANENTLY CLOSED SITE ONE ITEM 2 INTERIM PERMIT E~ 4 ~ENDED PERMIT ~ 6 ~M~RARY SITE CLOSURE I. FACIL~Y/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) ." I ,P~ OR FACILIW NAME ~.~ NAME OF OPERATOR ADDRESS / NEAREST CRO~ STREET P~CEL ~ (O~NA~ CI~ NAME STA~ ZIP CODE SITE PHONE ~ WI~ AREA AGE~Y ~ STATE-AGENCY' ~ FEDE~L-AGE~Y * If Is a pu e th I of ~n, n ~PEOFBUS'NESS ~ I~SSTATiON ~ 2DiSTRiBU,OR I ~ ~ IF INOIAN [M OF T~KS AT SiTE I E. P. A. '. O, ' (.ti'al) RESERVATION ~ ~ 3 FARM ~ 4 PROCESSOR 50~ER.; , ORTRUST,~DS.m =;.., ,,,,. ~E~E~NCY ~ACT ~ERS~N (PR~R~) ~[ '[, ~ :~' ~' EMERGENCY'~ACT PERSON (SECOND~Y)- ~tlonal DAYS: NAME (LAST, FIRS~ PHONE * WITH AREA CODE DAYS: NAME (LAST, FIRS~ PHONE ~ WITH AREA CODE PHONE e WITH AREA CODE NIGHTS: N~FIRS~ ~fH AREA CODE NIGHTS: NAME (LAST, FIRS~ ,. PROPERTY OWNER I~FO"~IIIO~- {~UST nfl I - ~ CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS ~ ~x ~i~ate ~ INDIVIDUAL ~ L~AL-AGENCY ~ STATE-A~NCY . STATE [ ZIP CODE ~ PHONE ~ WITH AREA CODE III. TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER CARE OF ADDRESS INFORMATION MAILING OR STREET ~DRESS ~ ~x ~ i~ate ~ INDIVIDUAL ~ L~AL-AGENCY ~ STATE.A~NCY CI~ NAME ~ STATE ZIP CODE PHONE ~ WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise. V. PETROLEUM MST FINANCIAL RESPONSIBILITY-(MUST BE COMPLETED) - IDENTIFY THE M~THOD(S) USED /, m ..~.~x el~am ~ 1 SELF-INSURED ~ 2 GU~ANTEE ~ 3 I~UR~E .?~ .~ 4 ~R~ ~ND m VI. LEG~L flOTIFICATION ~ND BILLING A~DRESS 'Leg~ notifi~tion ~d billiOg W]I be sent lo the t~ owfie? unless ~x I or Il is checked. CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFIGATIO~ AND BILLING: I. II. ~ III. ~ LOCALAGENC~ USE ONLY'( .- '; m '; . ' JURISDICTION ~ FACIL~ e ,'"' '' u~at~on CODE -~r;ON~ ' CENSUS t~c,r~[. ~t~o~ nuPwsor - OmTR~CT ~DE- ~' THI~ FORM M~T BE AC~MP~I~D.BY ~T ~ST (1) OR ~HE PERMff ~PUCATION- FORM. B,.u~s THB B ~ OH~GE OF ~ I~OR~ON OWNER MUST FI~ ~B FORM W~ ~E L~ AGENCY IMP~I~ THE UNDERGROUND ~ORAGE T~K REGU~ FORM A (~) :~,. · ~ INSTRL~'IONS FOR COMPLETING 'A" GENERAL INSTRUCTIONS: SECI'ION 2711 OF TITLE 23, CItAPTER 16, CALIFORNb\ CODE OF REGULA'IIONS AND SECI'IONS 25286, 25287, AND 25289 OF CHAPTER 6.7, DIVISION 20, CAI..Ii:OtO4J/A HEALTIt AND SAI~i;.TY CODE REQUIRE OWNERS TO APPLY FOR AN UST OPERATLNG PERMIT. 1, One FOIhM "A" shall }x'. completed for all NEW PERMIT CHANG ~'~$ or any FACtLrFY/S1TE INFORMATION CHANGES. 2. SUBMIT ONLY ONE (1) FORM "A" for a Facility/Site, regardless of ~e number of ranks heated at ~e ske. 3. This form should be cmnpleted by eid~er the PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPEC~I'OR. 4. Please ty~ or print clearly atl requested information. 5, Use a hard point wdth~g instalment, you are making 3 coplcs. 6, T~k owner must submit a facility plot plan to the loc~ ~ 2 e~ cy as pan of fl~e spplicm[on showing ~e k~atlon of tim USTs with re, spect to buildMgs and lau ~marks [Seclion 27t 1 0)(8), CCR]~ 7. T~k owner mu,,, submit documentadrm showing mmplian~ wi~ sram fNmmiM res~nsib~ity requimmmts to ~e loc~ agency as ~an of ~e application for [~t roleum USTs [Sect ion 27 t I (a)(t 1), CURl. TOP OF FORM: "MARK ONLY ONE ITEM" Ma~ ~ (X) in the ~x next, to the item that ~st describes ~e reasm the fo~ is berg completed. FACILITY/SITE ~FORMATION & ADDRESS (MUST BE COMPLE~D) 1. Record name and address (physical l<mation) of the underground tank(s). NOTE: Address MUST have a valid physical !(x:adon including city, state, and zip code. P.O. BOX NUMBERS ARE NOT ACCEPTABLE. include nearest cross street ~d name of the operator. 2. Phone number must have an area c~e. ff the night number is the same. write "SAME" in proper Iocatim. 3. Check the appropriate trax for 'I'YP~ OF BUSINESS OWNERSHIP ex. CORPORA'~ON, D~DIV1DUAL, etc.). 4. Check the appropriate N)x for TYPE OF BUSINESS. 5. ~ Facility/Site is l~atcd within an Indian rcse~'ation or other Indian trust lm~ds, check the box marked "YES". 6. Indicate thc NUMBER of TANKS at this SITE. 7. Record the E.P.A. iD ~ or wrim "NONE" h~ dm space provided, H. PROPERTY OWNER fiNFORMAT1ON & ADDRESS (MUST BE COMPLETED) Complete alt i~erns in this secdon, mdcss all imms are the same as SEC'lION 1; If d~e same, write "SAME AS SITE" across ~is section. Be sum to check PROPERTY OWNERStIiP TYPE box. III. TANK OWNER INFORMATION & ADDRESS (MUST BE COMPLE'i ED) Complete all items in this secdon, unless all items are tim same as SEC'I1ON !; if the same, write "SAME AS SITE" across this section. Be sure to chcck TANK OWNERS TYPE box. IV. BOARI) OF EQUAL~IZATION USi' S'iORAGE FEE ACCOUNT NUMBER (MUST BE COMPLETED. SHE AR'IICI.E 5, CIIAI~TER 6.75, DIVISION 20, CALIFORNIA IlIiAI.Tit AND SAFETY COl)Ii) Emer yum' Board of l~quallz.nim~ (ItOE) UST ston~ge fcc accmmt mm~ber xt hich is rcquirud before your [xx'mit aplqicalion can be processed. Registration with thc B()E wi.il ch:mm th,~t )Gu will receive a quaaerly sto~age fca return in repom~g thc SO.Ot~5 ({.u.ill<) per !t,dlon fee duc ~,n Ihe numbc~ Gl g.dlc'ns placed in >'ot, r l'5'l's. 'i]x: BOE will code ~rsons exempl from t,ayin~ thc ster,~ge ft~c go rchm~< will not b,: <cra. If y<,u da nat have. an accomlt number v, idl thc BOil t;r if you h~,vo any questions regarding thc thc or t:x. cmpli~,~s, please t, it]l Ibc B(;I.. al 910-322 9609 or ~ritc to Ibc B()E al thc to!l,)v, b,g ,~dthc~,s Board of Equalization, Fuel Taxes Division. P,O. i¢ox 9.128'79. Sacimncnt(~, CA 9,12'i9 t;OOl. V. PE'[1<OI.hUM L;ST I'INAN(r[AL RES['()NStgH.fTY (MUST BI{ COMPLETI~D [TiN I>E'I ROI,EL'M USf~ ()NI 3'. NiJE NEC liONS 2 OF TITLE 23, C}iAPTHR 16, CAI J1 QRNIA CODE OF REGU1,ATff)NS,) ]dcutffy ibc mcd~,xt(s) used by thc owner and/o~ opcralor, in meeting the Federal and State fin,racial [csptm~}Ality rcquizemcn/i. LJS'[':; ov,~:cd by any Federal o~ St,itc agency as well as non.pcholcum USTs a~c exempt from this rcxluitcmcnt. VL LEGAL NOTIFICATION AND BIiJ.iNG ADDRESS Check ONE B()X for the address that will be used for BO]'lt LEGAL AND BH.LiNG NOTIf:i('ATIONS. TANK OWNER OR AUTttORIZED REPRESENTATIVE MI ST SIGN AND DATE TIlE FORM AS [NI)KTA~I !.;13. [NEE SEC'fI()NN O)(t3) OF 'ITl L.E 23 CI!APTER 16, CAIAI:ORNIA CODE or REGULAT[ONS.] INSTRUCTION FOR 'FILE I..OCAI, AGENCIIiS Thc counly an jurisdiction mm~tmrs arc predetermined and can he obtained hy calling the State Board (916) 227.4303. 'I he facd,ly number may assigned by Ibc local agency; hm~ cvcr, this number must be numerical *md cannot colltahl uny alphabetical characters. If the local agem'y · e State Board to assign ~e facility number, please leave it blank. IT 1S TtfE RIiSI>ONSiBtlATY OF ]'lie I.OCAL AGENCY TitAT INSPECTS TIlE FACILFI'Y TO VERH;Y TIlE ACCURACY OF TIlE ENFORMATION. TflIS APPLICATION CANWOT BE PROCESSED iF THE BOE ACCOUNT NUMBER 1S NOT FILLED IN. TIlE IX)UAL AGENCY IS RIiSPONS1BLE FOR THE COMPLETION OF TIlE "LOCAL AGENCY USE ONLY" INFORMATION BOX AND FOR FORWARDING ONE FORM "A" AND ASSOCIATED FORM "B"(s) TO THE FOLLOWING ADDRESS. THE LOCAL AGENCY SttOUIJ) RETAIN TIlE ORIGiNAteS AND FORWARD THE YELLOW COPIES '1~ TtIE I:OLI.OWhNG ADDRESS. TIlE PINK COPY SItOULI) BE RETA1NEI) BY TIlE TANK O~'~ER. STATE OF CALIFORNIA STATF. WATER RESOURCES CONTROL BOARD CJO S.W.E.E.P.S. DATA PROCESS.lNG CENTER P.O. BOX 527 PARAMOUN-F, CA 90723 3;93 FORO12OR1 STATE WATER RESOURCES CONTROL BOARD ~. UNDEROROUND STORAOE TANK PERMIT APPLICATION - FORM B OOMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ONE ITEM [] 2 INTERIM PERMIT E~ 4 AMENDED PERMIT [] ~ I~MPORARY TANK CLOSURE E:::] ' TANK REMOVED - I DBA OR FACILITY NM/E WHERE TANK IS INSTALLED: ~ [. ~. O~ ~ I.. TANK DESCRIPTION COUPLETE A'' rrEus - SPECifY ~F UNKNOWN A. ~NE~S TANK i.D., I B. M~U;AC~RED C. ~ ~ST~UED ~MOrOA,n'EAR~ Iq g~' O. TANK C~AD,~ II. TANK CONTENTS iF A-~ ~S MAR~D. CO~PLET~ rrEM C. ,~ [] , MOTOR V~.ICLE ;UEL [] , O,L ". C. [] ,.,EGULAR UNLEADEDI I 4 GASAHOL [] 2 PETROLEUM [] 80 EMPI~' [] I PRODUCT [] lbPREMIUM ,~-~ [] 7 METHN~OL UNLEADED 5 JET FUEL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED~=i 99 OTHER (DESCRIBE IN ITEM D. BELOW) D. IF (A.t) IS NOT MARKED, ENTER NAME O~ SUBSTANCE STORED C.A.S. II: III. TANK CONSTRUCTION MARK ONE n~M ONLY ~N BOXES A, B, AND C, AND ALL THAT APPLES ~N SOX D AND E ~L TYPE OF [] 1 DOUSLE WALL [] :3 SINGLE WA~ WITH EXTERIOR LINER [] ~ UN,~IOWN SYSTEM ~ 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK} [] 99 OTHER B. TANK [~ 1 BARE STEEL [] 2 STAINLESS STEEL [] :3 FIBERGLASS [] 4 STEEL CLAD W/I=IBERC, d. ASS REINFORCED PLAST~ MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] . 100% METHANOL COMPATIBLE W/FRP ~,~-.~.~) [] , SRONZ~ [] lo GALVAN=D STEEL [] ~ UN~OWN [] ,, OTHER [] 1 RUBBER LINED [] 2 ALKYD LINIqG [] :3 EPOXY LINING [] a, PHENOLIC LINING C. INTERIOI~ [] ~ GLASS LINING [] S UNUNED~ ~ 95 UNKNOWN [] *. OTHER UNING IS LINtNG MATERIAL COMPATIBLE VVITH 10~ METHANOL ? YES ~ NO~ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4. FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ~[ ~5 UNKNOWN [] ~9 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) ~ OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR). IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U~ 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U~ 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A(~'~)~ BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE c. MATERIAL AND CORROSION A U 5 ALUMINUM A U ; CONCRETE A U 7 STEELWICOATING A U Ii l(x~, METHANOL COMPATIBLEW/FRP PROTECTION A U Ii GALVANIZED STEEL A U 10 C, ATHCO~PROTECT~SN A U 95 UNKNOWN A U ~9 OTHER D. LEAK DETECTION [] 1 AUTOMATIC LiNE LEAK DETECTOR [] 2 LINE T~HTNESS TESTING [] MONrrO~ING 99 OTHER V. TANK LEAK DETECTION [] 6 TANK TESTING ? INTERSTITIAL MONITORING [] B1 NONE [] 95 UNKNOWN [] ~ OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) I2. ESTIMATED QUANTITY OF I3'wAs TANK ;'u-ED W'TH YES[] NO[] ..... SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORMHAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, j~ID TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT [ APPLICAN'I'S NAME . , /~ ~ \ J I ~ v -I* II-/' LOCAL AGENCY USE ONLY THE STATE I.D, NUMBER S COMPOSED*OF THI[ F~)UR NUMBERS BELOW COUNTY ~ JURISDICTION # FACILITY PERMIT NUMBER I PERMIT APPROVED BY/DATE I PERMIT EXPIRATION DATE I THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (12-91} r~l. RI INSTRUCTIONS FOR COMPLETjI~ FORM "B" ' GENERAL INSTRUCTIONS: "' 1. One FORM "B" shall be completed for each tank l~or all NEW PERMITS, PERMIT CHANGES, REMOVALS and/or any' other TANK INFORMATION CHANGE. 2. Th~s form should be completed by e~ther tile PERMIT APPLICANT or the LOCAL AGENCY UNDERGROUND TANK INSPECTOR. 3. Please type or print clearly all requested information. 4. Use a hard point Writing instrument, you are making 2 copies. TOP OF FORM: 'MARK ONLY ONE ITEM" ' '~ 1. Mark an (X) in the box next to the 'item that best describes the reason the form is being completed. 2. Indicate the DBA or Facility name where the tank is installed. I. TANK DESCRIPTION - COMPLETE ALL ITEMS - IF UNKNOWN - SO SPECIFY A. Indicate owners tank ID # - If there is a tank number that is used by the owner to ident'~fy the tank (ex. AB70789). B. Indicate the name of the company that manufactured the tank (ex. ACME TANK MFG). C. Indicate the year the tank was installed (ex. 1987). D. Indicate the tank capacity in gallons (ex. 25.000 or 10.000 etc.) I I. TANK CONTENTS A. 1. iF MOTOR VEHICLE FUEL. check box I and complete items B & C. 2. If not MOTOR VEHICLE FUEL. check the appropriate box in section A and complete items B & D. B. Check the appropriate box. C. Check the type of MOTOR VEHICLE FLIEL (if bo~. 1 is checked in A). D. Print the chemical name of the hazardous substance stored in the tank and the C.A.S.#. (Chemical Abstract Service number), if box 1 is NOI checked in A. III'. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOX A,' B, C & D 1. Check only one item 'in TYPE OF SYSTEM. TANK MATERIAL. INTERIOR LINING and CORROSION PROTECTION. 2. If OTHER. print in the space provided. IV. PIPING INFORMATION . 1. Circle A if above ground circle U 'if underground, and circle both if applicable. 2. If IJNKNOWN c~rcle: or ~f OTHER. print ~n s~ace.provided 3. Indicate the LEAK DEIECTION system(s) used to comply with the monitoring requirement for the piping. V. TANK LEAK DETECTION 1. Indicate the LEAK DETECTION system(s) used to comply with the monitoring requ'irements for the tank. VI. INFORMATION ON TANK PERMANENTLY CLOSED IN PLACE 1. ESTIFtATED DATE LAST USED - MONTH/YEAR (January. 1988 or 01/88) 2. ESIIMATED QUANT1TY of HAZARDOUS SUBSTANCE remaining in the tank (in Gallons). 3. WAS TANK FILLED WITH INERT MATERIAL? Check 'Yes' or 'NO' APPLICAI~iI: MUST SIGN AND DATE THE FORM AS INDICATED. INSTRUCTION FOR THE LOCAL AGENCIES The state underground storage tank identi, fication number is composed of the two digit county number, the three di.g~t'jurisdiction number, the six digit facility number and the six digit tank number. The county 'and jurisdiction numbers are predetermined and can be ob,t. ained by calling the State Board (916) 227-4303. The facili't~t number must be the same as shown in form "A'. The tank number may be assigned by tile local agency. however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to assign the tank number, please leave it blank. IT IS THE RESPONSIBILITY OF THE LOCAL AGENCY ll¢~T INSPECTS THE FACILII~f TO VERIFY THE ACCURACY OF THE INFI~RFIATION. THE LOCAL AGENCY IS RESPONSIBLE FOR THE COMPLETION OF THE 'LOCAL AGENCY USE ONLY' INFORJ~ATION BOX AND FOR FORWARDING ONE FORM 'A' AND ASSOCIATED FORM 'B'(s) TO THE FOLLOWING ADDRESS.