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Home My WebLink AboutUNDERGROUND TANK FILE #1PROVIDEk uRAWING OF PHYSIC .OUT OF FACILITY USING SPACE IDED BELOW. ALT. OF THE FOIJ_LT~ING INFORMATION MUST BE INCLUDED IN ORDER FOR APPLICATION TO BE PROCESSED: TANK(S), PIPING & DISPENSER(S), INCLUDING LK~GTHS AND DIMENSIONS __ PROPOSED SAMPLING LOCATIONS DESIGNATED BY THIS ~SYMBOL "~" NEAREST STREET OR INTERSECTION ANY WATER W~rI.q OR SURFACE WATERS WITHIN 100' RADIUS OF FACILITY NORTH ~ PROVIDE DRAWING OF PHY.c ~. f.O.U.T. OF FACILITY USING SPACE t IDED BELOW. /~Tz, OF THE FOIJ_OWING INFORMATION MUST BE INCLUDED IN ORDER FOR APPLICATION TO BE PROCESSED: TANK(S), PIPING & DISPENSER(S), INCLUDING T,K~GTHS AND DIMENSIONS __ PROPOSED SAMPLING LOCATIONS DESIGNATED BY THIS SYMBOL "~" NEAREST STREET OR INTERSECTION ANY WATER WRr.Lq OR SURFACE WATERS WITHIN 100' RADIUS OF FACILITY NORTH ARROW RICH KELLENBERGER I~KERSFIELB. OALIFORNiA g330g ...... ,DRESS (!.c~. Z~. :code) ; { INDIVIDUAL i .CORPORATION i ..j.:~.: Yea, In Buslnl~ STREET, CITY, COUNTY, STATE, ZIP CODE ~ ~' ,' J ' ........................... ~- ....... :" ................ t ....... · ......................... -~"- --'"'T"':':-T-'; } i ~ : ', -- "'" J , '- -"---- ...................................... : -~ !~:""T'~" '' ,~:':,-:' " ....................... ....... ............ ................. ..rt.' ": ": -' -:'"'- ...... : ...... :"-'.' INSURER POLICY NUMBER ProposedEff. Date{MMIODIYY) Proposed Exp. Date(MMIDO/YY) Normal Anniversary i . · Rating Date . J - ' ' : '&-/7-Y 7 ,~ -/7.-Y'8 ................., :...: ..... PREVIOUS... INSURER.' ..... r' .. IOUSP.OLICYNO. ' PARTICiPaTING:" ': Dividend. Plan/Safety... Group. RETRO. . , PLAN ..... ' :"; ': :':'" '~ ' ' ' " "' ' ':'":" .... :'"~'~' ' ' NON-PARTICIPATING ~',;~;'.';~.-"c~..?;~:dti~'!;t! ;~'-~ ....· '.; ;';.~.:J ~.;'¢IS ~J;1tlllif:li3:j q~:{L. COVERAGE A (STATES) COVERAGE B (If Nc~i PAYMENT PLAN A0~IT PERIOD AGENCY BILL '' C/~ --' OIRECT BILL ANNUAL ~ ATE,X?IRATION :SPECIAL COMPANY AND STATE INFORMATION SEM-I.ANNUAL~-~ ~EMI-"A'NNUA aUARTERLY -~' aU^RTERL~i?~Y:. ESTIMATED : '. ESTIMATED CLASS CODE CATEGORIES, DUTIES, CLASSIFICATIONS ANNUAL ..':'ANNUAL REMUNERATION ....: , ,, · ,..: . : ,.... ~_ , ~ ........ · . . , ....... ~ ....... ,.~.-::,~';. ,~: · -..~,. - .. ....... ~,.. , · . .,,). ..... .. , ,.. , ii'i; ...... -.:. ;...,' ~'!~:" 'i:' "!' ...... ................ L', 'r-, ;: ,~.;'~;(~ ~,J.t~ ~(~ : ' ' ' ,'.' '.'.{':';~; ....i, ." '"' ' "':': ...... ':" .......... ?-. ......... ! ........ ~'~ ~}~..', d.~,? ,~>~ ( ',~ iPECI~Y ADDITIONAL COVERAGES TOTAl. ........... BROAD FORM ALL STATES EXPERIENCE MODIFICATION U.S.L. & I"g MODIFIED PREMIUM $ VOLUNTARY COMPENSATI $ OTHER $ PREMIUM D LSCOUNT $ ....................... I:i .... :-:!" '"-T~> "'~'~'~' '~:"~-"'~ ..... . ....... . ,'- .,: ...... L .......: ...... .: .,,,:-? ~'..: .... :".b' TOTAL'ESTIMATED,,,w,:~,,;~ · ' '" ' ' · "." ' -') .... . .... i:,'- ' .. "' ':" /' ' ' . ' ~ANNUAL PREMIUM '"':'~:'-'(J , · :?. DEP0S,T ' ' " \" : "' ': ': PREMIUM* ". "*- . -,.., ,.. . .. .. ,", ._J.. , ... ,-. ~ .,.:.. -' .,~...:. ;*. . . . .... .. ~?oo ~o~ s~ ;ERN COUNTY HEALTH DEPA ~_~m OmCE, Bakersfield, Callfomla ~ ~ M ~, M.D. T~e (~) ~1-~ EN~RONMEN~L H~ m~Sl~ November 5, 1987 Jim Manning 2930 "A" Chester Avenue Bakersfield CA 93301 Re: Tank Abandonment - Jim Manning Auto Sales. Inc. Dear Mr. Manning: This department has reviewed the laboratory analyses for the three underground storage tank(s) at 2930 "A" Chester Avenue. Permit $A343-16. The samples indicated no significant soil contamination at this site. Based upon this information, this department considers this preliminary Site assessment complete and no further assessment is required. Sincerely, Bill Schetde Environmental Health Specialist Hazardous Materials Management Program BS/gb OISTRICT OFFICES UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/:CONTAMINATION SITE REPORT ( ) ~ U~RMIN~~ ~[L~LY ~ ~OU~A~R .~ ORI~GWA~R-(CHE~LY~WA~R~HAVEA~LYGE~~ ~ ~NT~NM~TBARRIER(~ ~ ~VA~&T~T~ _: ':~ ~MP&TR~TeROUNDWA~R(G~ ~ 'IRONM£NT INC. Contractor's [.lc. #A, C-57, 500646 Jim Manning Date Received: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample Descr±ption= Center of Pad at 2' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8'020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .2 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected C~emist 4175 Lakeside Dr.. Ste. 130 Richmond, CA 94806 (415) 234-4461 CROWN ENVIRONMENTAL, INC. Contractor's Lic. #A, C-57, 500646 Jim Manning Date Received: 7-29-87 2930°Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample DeScription: Center of Pad at 6' VOLATILE ORGANICS '~ ~ ' Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND ~ 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene .1 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .4 8015 .1 ug/g T V H = Total Volatile Hydrocarbons Ail results reported in ug/g ND - None Detected C~mist 4175 Lakeside Dr., Ste. 130 Richmond. CA 94806 (415) 22't--~-4-51 5630 District Blvd., St~ 102 Bakersfield, CA 93313 (805) 397-7230 I C. · ' Conffactor'. Uc. #A, C-57, 500646 jim Manning Date Received: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30'87 Bakersfield CA 93301 Analyst: J. Johnson Sample Description: West Island at 6' VOLATILE ORGANICS Parameter Results Method Detection~Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene .1 8020 .1 ug/g p-Xylene Nb 8020 .1 ug/g m-Xylene .2 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .8 8015 .1 ug/g T V H =. Tot~al Volatile Hydrocarbons Ail results reported in ug/g ND - None Detected SUbmitted By: 4175 Lakeside Dr.. Ste. 130 Richmond. CA 94806 (415) 234-4461 5630 Dletrlct l~.~vd.. Ste. 107, B~ke~sf~eld, CA 93313 (805) 397-7230 CROWN ENVIRONMENTAL [NC. " Contractor's Lie_ #A, C-57, 500646 Jim Manmimg Date Received: .7-29-.87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 ~Analyst: J. Johnson Sample Description: East Island at 6' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .2 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: . ~//~4 ~. ~~'-' J e~C~J o%ns~n Ch~mis t ~ 4175 Lakeside Dr.. Ste. 130 Richmond, CA 94806 (415) 5630 Dlftrlct Blvd.. Ste. 102 Bakersfield. CA 93313 ~80SJ 397-7230 CROWN ENVIRONMENTAL, lNc. - ., .-Contractor'0 Uc. #A, C-57, 500646 Jim Manning Dare Received: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample'Description: East Island at 2' VOLATILE ORGANICS '" Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND '8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .3 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: /~ .~~ tt~emist 4175 Lakeside Dr.. Ste_ 130 Richmond, CA 94806 (415) 234-4461 5630 Dlstr~ct Bird,, Ste. 102 Bakersfield. CA 93313 (805) 397-7230 "' ~'- CROWN ENVIRONMENTAL INC. .... - Contractor's Llc. ~A, C-57, 500646 Jim Manning Date ReceiVed: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson' Sample Description: West Island at 2' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 '.1 ug/g Toluene .1 8020 .1 ug/g Ethyl BenZene ND 8020 .1 ug/g p-Xylene .1 8020 .1 ug/g m-Xylene .1 8020 .1 ug/g O-Xylene .1 8020 .1 ug/g T V H 1.3 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: ., ~ . o son .~emist~ 4175 Lakeside Dr.. Ste. 130 Richmond, CA 94806 (415) 234-4461 5630 Dl~t~dct Blvd.. Ste. 102 Bakersfield. CA 93313 (805) 397-7230 CRO VIRONM£NTAL, INC. ~ · " Contrnc'tor's Llc, #A, C-57, 500646 Jim Manning Date Received: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample Description: West Island at 6' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND. 8020 .1-ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene .1 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene .2 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .8 8015 .1 ug/g T V H = Total Volatile Hydrocarbons Ail results reported in ug/g ND - None Detected Submitted By: ./ 4175 Lakeside Dr., Ste. 130 Richmond. CA 94806 (415) 2344461 5630 Ols~ct Rivc~. Ste. 102 Bakersfield, CA 93313 (805) 397-7230 ..: ..... . . CROWN ENVIRONMENTAL. INc. Contractor's Lic. d,A, C-57, 500646 Jim Manning . Date Received: 7-29-87 2930 Chester Ave Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample Description: Center of Pad at 2' VOLATILE ORGANICS Parameter Results 'Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .2 8015 .1 ug/g T V H = Total Volatile Hydrocarbons Ail results reported in ug/g ND - None Detected Submitted By:J~J~l~"n~5~"-- C~emist 4175 Lakeside Dr., Ste. 130 RlChmonck CA 94806 (415) 234-4461 5630 District Blvd.. Ste. 102 Bakersfield, CA 93313 (805) 397-7230 " CnowN ENVlRONbIENTAL NC. Contr~ctor'~ lac. #A, C-$7, $00646 Jim Manning Date Received: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample Description: Center of Pad at 6' VOLATILE ORGANICS Parameter Results Method Detection Li'mit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene .1 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .4 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: e#f6 onnsp CB&mist kY 4175 Lakeside Dr., Ste. 130 Rlchmond~ CA 94806 (415) 234-4461 5630 District Blvd.. Ste. 102 Bakersfield, CA 93313 (805) 397-7230 CROWN ENVIRONMENTAL. [NC. ,. Con~'actor's Lic. d,A. C-57, 500646 Jim Manning Date ReceiVed: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 Analyst: J. Johnson Sample Description: East Island at 2' " VOLATILE ORGANICS Parameter ReSults Method' Detection Limit Benzene ND 8020 .1 ug/g Toluene ND '8020 .1 ug/g Ethyl Benzene' ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H .3 8015 .1 ~g/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected o~zemi s t ~ 4175 Lakeside Dr.. Ste. 130 Richmond. CA 94806 (415) 234-4461 5630 District Blvd., Ste. 102 Bakersfield, CA 93313 (805) 397-7230 CROWN ENVIRONMENTAL, iNC. .. Contractor's Lic. *'A, C-57, 500646 Jim Manning Date Received: 7-29-87 2930 Chester Ave. Date Analyzed: 7-30-87 Bakersfield CA 93301 ~ Analyst: J. Johnson Sample Description: East Island at 6' · VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H. .2 8015' .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By ~ ~. : je~'/~o n~~ Ch~mi s t ~ 4175 Lakeside Dr.. Ste. 130 Richmond, CA 94806 (415) 234'44~1 5630 District Blvd.. Ste. 102 Bakersfield, CA 93313 (805) 397-7230 Analycioal Consulting Seevioes Crowa Pacific'Eaviroame~tal ~boratory No: 11719 5630 District Blvd #10 Date Received: 7-2-87 Bakersfield, CA 93313 Date Reported: 7-10-87 Atteatioa: ~ff Johasoa Sample: Soil Sample Descriptioa: 11719-1 #9 from D&D ~'to ~50 gal. waste oil @ 3' 11719-2 #10 from DaD Auto 250 gal. waste oil @ 6' 11719C1 11719-2 mg/kg mg/kg Total Orgaai¢ Chloride, C1 2.7 3.3 Total Lead, Pb 1.4 1.7 ~il'& Grease 85 50 Total Petroleum Hydrocarboas <50 <50 Richard L. Peaaer Chief Chemist RLP/csd Doc. #292 4309 Armour Avenue Bakersfield, California 93308 J" [805) 395-0539 Contractor'~ I. ic. #A, C-57, 500646 Jim Manning Date Received: 7-1-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave. Analyst: J. Johnson Bakersfield CA 93301 Sample Description: #1, 7,500 gal, South 3" VOLATILE ORGANICS Parameter Results Method .Detection Limit Benzene ND 8020 .1 ug/g Toluene .1 8020 .1 ug/g Ethyl Benzene .1 8020 .1 ug/g p-Xylene .2 8020 .1 ug/g m-Xylene 1.4 8020 .1 ug/g O-Xylene .1 8020 .1 ug/g T V H 4.1 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND None Detected Submitted By: ~~ ~ C~Mist .... 4175 Lakeside Dr., Ste. 130 Richmond, CA 94806 (415) 22 5630 District Blvd., Ste. 102 Bakersfield, CA 93313 (805) 397-7230 Contractor's Lic. ~A, C-57, 500646 Jim Manning Date Received: 7-1-87 D & D AUto Sales Date Analyzed:'7-2-87 2930 Chester Ave. Analyst: J. Johnson Bakersfield CA 93301 Sample Description: #2, 7,500 gal, South 6' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene .ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H ND 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: ~/~ ~. ~),,w ~--.- Je~f~dhnsp~ 4175 Lakeside Dr., Ste. 130 Richmond, CA 94806 (415) 23~4461 5630 District Blvd., Ste. 102 Bakersfield, CA 93313 (805) 397-7230 Contr~ctor'~ lac. #A. C-S7, Jim Manning Date Received: 7-1-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave. Analyst: J. Johnson Bakersfield CA 93301 Sample Description: #3, 7,500 gal, North 3' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g' Toluene .1 8020 .1 ug/g Ethyl Benzene .1 8020 .1 ug/g .p-Xylene .2 8020 .1 ug/g m-Xylene .1 8020 .1 ug/g O-Xylene .1 8020 .1 ug/g T V H 2,7 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: /~~ ~'~-~-~ 4175 Lakeside Dr., St~ 130 Richmond, CA 94806 (415) 234-4461 5630 District Blvd., St~ 102 Bakersfield, CA 93313 (805) 397-7230 Contractor's Uc. #A, C-57, 500646 Jim Manning Date Received: 7-1-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave. Analyst: J. Johnson Bakersfield CA 93301 Sample Description: #4, 7,500 gal, North 6' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H ND 8015 .1 ug/g T V H = Total Volatile Hydrocarbons Ail results reported in ug/g ND - None Detected Je~ohns~n 4175 Lakeside Dr., St~ 130 Richmond, CA 94806 (415) 2344461 5630 District BlvcL, Ste. 102 Bakersfield, CA 93313 (805) 397-7230 Contzactoz'~ Ur.. ~A, C-57, 500646 Jim Manning Date Received: 7-1'-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave' Analyst: J. Johnson Bakersfield CA 93301 Sample Description: #5, 5,000 gal, South 3' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene .1 8020 .1 ug/g Ethyl Benzene .1 8020 .1 ug/g p-Xylene .1 8020 .1 ug/g m-Xylene .1 8020 .1 ug/g O-Xylene .1 8020 .1 ug/g T V H 2.6 8015 .1 ug/g T V H = Total Volatile Hydrocarbons Ail results reported in ug/g ND -None Detected Submitted By: ~~ '~~ Jeff/p~hnsb~' Chen~t ~ 4175 l~keolde Dr., St~ 130. Richmond, CA 94806 (415) 234-4461 5630 District Biv(L, Ste. 102 Bakersfield, CA 93313 (805) 397-7230 Conira~or's Lic. d~A. C-57. s0o646 Jim Manning Date Received: 7-1-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave. Analyst: J. Johnson. Bakersfield CA 93301 Sample Description: #6, 5,000 gal, South 6' · " VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020 .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H ND 8015 .1 ug/g T V H = Total Volatile Hydrocarbons Ail results reported in ug/g ND - None Detected Submitted By: ~/q e nson// Chemist 4175 Lakeside Dr.. St~ 130 Richmond, CA 94806 (415) 5630 District Blvd., Ste~ 102 Bakersfield, CA 93313 (805) 397-7230 Contractor's Ifc. #A, C-57. 500646 Jim Manning Date Received: 7-1-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave. Analyst: J. Johnson Bakersfield CA 93301 Sample'Description: #7, 5,000 g~l, North 3' VOLATILE ORGANICS Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene .1 8020 .1 ug/g Ethyl Benzene .1 8020 .1 ug/g p-Xylene .1 8020 .1 ug/g m-Xylene .1 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H 2.0 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted ~ By: Je~(~o ns Christ 4175 Lakeside Dr.. Ste. 130 Richmond. CA 94806 (415) 234-4461 5630 District Blvd.. Ste. 102 Bakersfield. CA 93313 (805) 397-7230 ..OWN ENVIRONMENT _NC. Contractor's Uc. *'A, C-57, 500646 Jim Manning Date Received: 7-1-87 D & D Auto Sales Date Analyzed: 7-2-87 2930 Chester Ave. Analyst: J. Johnson · Bakersfield CA 93301 Sample Description: #8, 5,000 gal, North 6' VOLATILE ORGANICS : Parameter Results Method Detection Limit Benzene ND 8020 .1 ug/g Toluene ND 8020' .1 ug/g Ethyl Benzene ND 8020 .1 ug/g p-Xylene ND 8020 .1 ug/g m-Xylene ND 8020 .1 ug/g O-Xylene ND 8020 .1 ug/g T V H ND 8015 .1 ug/g T V H = Total Volatile Hydrocarbons All results reported in ug/g ND - None Detected Submitted By: Je f ~.6h~son 4175 Lakeside Dr., St~ 130 Richmond, CA 94806 (415) 234-4461 5630 District BlvcL, Ste. 102 Bakersfield, CA 93313 (805) 397-7230 ~allfo[,nla--Health and. Welfare Agency .-~ ~;:~:~!:i~i~::~A~,~ . ~ ~:,~,','i.~i-~ "Dep~ment of. Health Se~lce .~.' '.-"- ."' ~: ..... .: ~'~:~:~~~~?:~xl~ Substances Control Dlvlalod print or type. (Form des~gnarl for use on e//te (12.p/tch) ........ ~'" ......... ~'"~-- .......... ~"~'-' " ' ' typewdter.) · .... . · ~' · ' · ~ Sacramento, California:, ~"__,. ~'~UNIFORM~. WASTE HAZARDOUSMANiFEST .' 1. GeneratoCs US EPA ID No,. ~-' ;::~: DocumentManlfe~ No:~. :~..Informatlon.~ Is ~'~ In the~8had~ law: '~.' 3..~'~Genemto~a Mailing Addresa~ ..~ ~ ~ ~ ~- 'c._ · .... 4.*Generators Phone (~) ~~ /~ ~ ' '::;'*'~:~ .~ . .. ~,.T~s~ 1 Company Name -..: ~. · : ' ~,. US EPA ID. Numar :7~:~:T~er 2 Company N~e · - ..:,~.~, ~;..: .... .: .: · . .:. , nat~ F~lllty ~e and Site Add~aa ~ ~ 10..~ .~ :'.: , ID,Numar · De~Hptlon (Inc/ud/ng Pm~r Sh/pp/ng Name, H~ C/ae~ Instructions and Additional Information:-~',:'~.~. .G~TOR'S C~TIFICATION: I hereby decl~e that the contents of this ~nalgnment' am'fully' and accumtely~deacrl~ above Unless I am a small quantity generator who has ~n exempted ~:a~tUte~o~[~gulatlon~fmm'~the~'dut~'~o make a waste mlnlml~tlon ce~lflcatlon .: under' Section 3~2(b) of RCRA; I also ce~l~ that I have a p~ramJ~Place'=tb'~ce"the .v01Ume:and'~;t0XlCl~ of-.w~ie genemt~ to the degree I'~'[~. ~ve?dete~lned to ~ economl~lly pm~tl~ble and I have ael~t~=the meth~-~of'~,tr~tme~h~atomge~o~dlsposal::..cu~tly' av~lable~to me.:whlchr~[; 17~ I Acknowledgement of.Receipt of Materials :....., .. .. ~. Facility Owner or Operatoc Ce~lflcatlon of receipt of h~oua mat~ala cove~.b~, this manifest exce~'~s'noted.., . In. Item 19. ' A (i 1/85) ,' Blue: GENE~TOR SENDS THIS COPY'TO 1700 Flower Street KeRN COUNTY HEALTH DEPARTMEN] .EA,~, OFFICER Bakemfleld, California 93305 . Leon M Hebertsofl, M.D. Telephone (805) 861-3636 . ENVIRONMENTAL HEALTH DIVISION . " DIRECTOR OF ENVIRONMENTAL HEALTH ' Vernon S. Reft=hard · Name Facility C. ' Kern County Permit ~ .... * * UNDF. RGROUND TANK DISPOSITION TRACKING RECORD * * ' - ....... · Thi~ form is to be returned to the Kern County Health Department'-Within 14 days of acceptance of tank(s) by disposal or recycling facility.. The " holder of the permit with number noted above is responsible for insuring that this form is completed and returned. ,. ~.. ~:::: ~... .... ' ~, .. ...... Zip Date Tanks Eenoved ~/--F7 No. of Tanks ,~ ~cZ~oa 2 - To be fllled out ~ con,racier "decoa~amlnattn~ ~ank(s).: Authorized represeatative or coatrac~or cer~ifies by si~nin~ below that ~a~{s) have been ~c~t~inated in accordance wi~h ~ern Count~ HeMth Signature ~ Title Section 3 -T~ b~ filled out and slEned ~ a~ authorized representative of the .treatment, storaffe, or disposal facility acceptlnff tank(s): Date Tanks Eec~veh ~" ~ ~X~'~ ,No. o, ~anks { Author ized~epresenta[lve ) * * *' ~ILING INSTRUCTIONS: Fold in half and staple. Postage and mailing . label have already been affixed to outside for your convenience. (Forn ~P-150) . ~ o~ o~c~s ~[~no . L~mont . I_ake I~h~ll~ M~[nv~ Rldq~r~t ~h~[fer Taft INTERNAL .USE ONLY: KERN COUN'I~Y HEALTH DEPAR.TMENT PrO PTA ~'-~' DIVISION OF' ENVIRONMH~rTAL HEALTH APPLICATION DATE ~' 1700 FLONER STREET, BAKERSFIELD. CA 93305 · OF TANKS TO BE ABANDONED (805) 881~3636 LENGT~ 0F PIPING TO ABANDON APPLZ CATTON FOR P~.I~MZT FOI~ CT.,OSUI~/ABANDONM~N~ OF UND~-I~(31:tOUND HA~.AI~DOUS ~UB~TA~C~-S S'rOI~A~3~- FAC 'r T., T TEIS APPLiCATION IS ~0R [~ R~0VAL. OR 0 ~ IN P~CE (FILL OUT 0N_..~ APPLICA?ION PER FACILITY) I ~ATER TO PACILITY PROVIDED BY ~ [DEPTH TO GROUNDMAT~R . ,qEAREST ~ATER NELL - GIVE DISTANCE AND DESCRIBE TYPE IF t~ITHIN 500 FEET ~SOIL TYPE AT FACILITY 1tOTAL NUMBER OF SAMPf~EB TO BE ANALYZED SAMPLES MILL BE ANALYZED FOR: ~ESCRIEE BO~ EESIDUg IN ~ANN~S~ ~ V~PII~ IS TO B~'~MOV~-D ~ DISFOSED OF ~INCLDDE "I~S~oR*rA?ION AN~ DISPOBAL CO~PANIES~: i BESCEI~EE ~O"~! 'I~E DISI~L ~OD ~ ~IS~O~ML L~?ION FON: - / ~ PZPING "' PLEBE PROVID~ IN~R~TION RB~D ON RB~ ~ID~ OF ~IS ~ BB~R8 ~MI~ING ~PLICATION ~R R~IgM * ' ~S FORM ~S BEEN C~PL~ ~ER P~L~ OF PE~ ~ ~ ~ B~ OF ~ ~O~E IS ~ ~ ~RR8~. 1700 Flower Street KERN COUNTY HEALTH DEPARTMENT ,EA-TH OFF'ICER Bakersfield, California 93305 / Leon M Hebertson, M.D. Telephone (805) 861-3636 .. · · ENVIRONMENTAL HEALTH DIVISION ..* ' ' DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Reichard · _.. .. . ... :-.. :.....:.: ~.:..,.~. :~ --..' ' :::?:~.:..-.',: .. PERI, IT FOR PEE~ANENT CLOSURE PER,~IT NIJ74BER A343-16 ',;-' :-'.,:. 'OF lr~II)ERGROIA~I) IIAZAPJ)OUS . , : ~.:,:" :::'.'::-!:· . : i~,~:. :, SUBSTANCES STORAGE FACILITY -':' .... ~.::.'., '~.:.. :..:.::~.,?¥:~¥'.:...,~;~.'~':i~.: · , :...{-;: :'..,:? :~"..:..~,. '- ... -..,·. ~ : : ':FACII'ITY NAIVE/ADDRESS: ::;: !:'Ok'NER($) ~/AI)I)RESS: ..':j" .';:.."~.':::~CONTP, ACTOR: -.· . .1 .. :3~::,' - . ' ' ::':" ':': ::..'i,;:::/'..,:~:.:, :'~:':~.i"; '.'·: -:' ':':: ::": :;. · :'-D & D Au, to Sales, Inc. -." ..: _Jim l~anning ':::':,.~:~i:::;:-:v.,,.:.::...~: :. :..'~ '.i::'%. J~m ~ann~ng -.:-j"':"~".q...-:'::.,: :~:~:' · · :'.';'~,,:':';' .-2930 ,~ :~dhester Avenue .... · .:.'. ?'. :.'~'~9~0~ Cor~ Oak coU~'t-:~iF~?.:!.-;::!::::.~:~:~!~'.970~ Cork Oak' .~:.:;:;:!-:.,/:/-?Bake~'field, CA :- .... :-,,-'::!..:~-'::!'.:Bakers~ieId, CA '::9~3lI i~':.'?i~;~i:'~!:Bakersfield,/'CA ~'933'ii -;:,. ': ::;':: ~'"""::".-~:.c-:..';~:~.:, :? :.~ ,~-,;..'. - "' .' :~ ' ' '~.":'· ~'''~ !'~ :.:Phone ~(~0~) ~34:'3a6 ~ ::.'~ '~ :·'??:i!::Phone # (a05)' 3aa-~oo ,~'~;". ' · ~,?~'c,~,,.::~'.-n.~..~ .~o ~,~e~o~~2 ' :: ::.?.~.'~ ~c.~,.'...:.~% ::-~ PER,~[IT ~PIRES '"""~' ~",~'"~: September 19, 1987 - -¢...~.~ ::, "-~:-.-'~,.~ : .',: , ~ 7, -' . ' -' ...... : .... ' . .,' . :' .; ':' ' 'g"?:: --~ ~ L ~' ¢., '" '* ' ' · ' .~-, ¢?',-.~' ~ ?...z','~ - ...... ,': - ' ' '-' '" '. ' 3 T~KS AT ABOVE :' '". ''-.,.:APPROVAL DATE, "' ....- .... June 19, 1987 .-. ....~ . '"-.-. -:_ " ,. BAll ~cheide ......... : ........... POST O~ PREmiSES ' · COnDiTiOnS AS ~OggO~: '1. It is the responsibili, ty of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work. 2. Permittee must obtain a City Fire Department permit prior to initiating closure action. 3. Tank closure activities .must be per Kern County Health and Fire Department approved methods as described in Handout ~UT-30. 4. A minimum of t~o samples must be retrieved beneath the center of the waste oil tank at depths of approximately two and six feet. S. The two gasoline tanks must have samples retrieved one-third from each end of the tanks at two and six foot depths. These samples must be sampled for benzene, toluene, xylene, and total volatile hydrocarbons. 6. The waste oil tank and waste piping samples must be analyzed for oil and grease and total halogenated hydrocarbons. ~. If any contractors other than those listed on permit and permit application are to be utilized, prior approval must be granted by the specialist listed on the permit. 8. A minimum of two samples must be retrieved at depths of approximately .two and six feet for every 15 linear feet of pipe run and also near the dispenser area(s). 9. All gasoline samples must be analyzed ~or benzene, toluene, xylene, and total petroleum hydrocarbons. 10. All waste oil samples must be analyzed for total organic halides, oil and grease 'and lead. 11. Copies o~ transportation manifests must be submitted to the Health Department within .five days of waste disposal. DISTRICT OFFICES PERNIT FO1~. P~.RNANENT CLOSURE OF UNDERGltOUND HAZARDOUS SUBSTANCES STORAGE FACILITY ~.~:~12.: :AIl'~.'.'.~p'PIicable'' 's'tate ':laWs. ,for ~,(haz.a~dous waste ~.~disPosal .transpor "~;.: .... -.~eatment mus't'".'be 'adhered to. :'?~The Ke~n 'County ·.Health ?~DePa~t~ent~(~st'' be 15. Results ~ust be submitted to .this office ~ithin three days of ,analysis completion. INTERNAL USE oNLy: DIVISION OF E~IRO~AL ~L~ ~PLI~TION · 1~00 ~LOHER STREET. ~R~FIELD. ~ 93305 · O~ T~S ~ BE A~N~D (805) ~1-3636 . ~H 0F PIPI~ ~PLZ CATZON FOR PKRMZT FO.R PER~E~ CLOSURE/U~DOWE~ OF ~DERGROUND H~DOUS SUBST~CES STOOGE FACZ LI TY )~ER ~S PHO~ ~RK~'S ~P~TION · ZN~R P~ Cfl~I~L C~SITION OF ~T~I~ I ~ATER TO PACILITY PROVIDED BY JDEPTH I JNEAR~T WATER NKL~ - GIVE DIST~CE ~ DgSCRIBE ~[ IF WI~IN 5~ P~ JSOIL ~E AT PACIL[~ I~IS FOR ~IL ~E ~ OROU~AT~ DE~ D~I~TION ~S~ZBg ~ RgSZDU~ IN T~K(S) ~D PIPING IS ~ Bg R~ ~ DISPOSED OF (INCL~E ~S~ATION PIPING / / " ~IS FORE ~S ~ ~PL~D ~ P~L~ O~ PE~ ~ ~ ~ B~ O~ ~ ~E IS ~UE ~.-. &..' (~o~ e~-l~O) ~?oo;o~,,,st~,t 'KERN COUNTY HEALTH DEPARTMEN ~ ,EALTH OmCER Bakersfield, California 93305 ~ . Leon M *l-lebertson, M.D. Telephone (805) 861-3636 .. ENVIRONMENTAL HEALTH DIVISION ... '*. . ~ )IRE~'[~3R OF ENVIRONMENTAL HEALTH . · ' ..' ~--~/-/-~~-<~ ' Vernon S. Reichard PERMIT FOR PERMANENT CLOSURE . ..'-.',:::if -.' . PERMIT. NUMBER A343-16 .:'i::.::. , .:/:' '::. ;:~ FACILITY N~E/ADDRESS: :".': !; :?.~::OWNER(S) NAME/ADDI~ESS: :'!i.f-!;':~:::'!'.:':':~::".CONTRACT~R:' ::i:,:-"?::~:'.'"?:::::.~.:~,:~-!'~!~'~!!.i':.' ":' :-':D, &' Auto Sales, Inc. :' . an i'ng ":i?? , anning' ::":.~ :' ri(~'2930 A :Chester Avenue ::::' :'i::~.:-:i':i!: i,i::.i79701 Cork Oak Court '" ::.:?~;,,?.~(i?i~i:':::~.:.:i?!i:(:' 9?0 l .Co ~k Oak Cou~t ::':~ ?!":-i~i: ~':!.?i:::i~ Bakersfield, CA .-?~:::~i',::-:-,::-:?:~':':'!:i~ii/:'i:~:Bakersfield, '--CA '~'93311 :::~.::i?.~?!:~:~??::Bakersfie!d, :':'CA :..93311.~:,.::!. ~.~.,:.? ~::.~?~.,.~.,.~::~?~ ,~.:~: ~-~?~.~., ,. ...... ...:,,.-,:~'-:~.~k~ .::..,,..::<?:'~::.: ~ :,::Phone ~# (.805) .. 8.34.38. 1 .:~:~.;?:,.~.~,~..~. ~!~: .~.~. , .... :..(, -,. .... ...=. , .. :. :~::.~ ~:~ . ,.~.'.,.-~' ,.~, ~;~,'.~ ............. --.' ......... ,~<.~ PERlVXIT EXPIRES .-...- -.,Se tember 19, 19 ,?.,,~.. ,~.: .... :.::::..~.~:~. ?.PERMIT FOR CLOSURE OF ..,:?~..~,~?,.~:2~.:~?~:~:~.:.,:?,,.,.. . : ....... P ............ :".'~:: '"'-:~'"3 T~KS 'AT ABOVE -':..'~:" -::.7::(~::,:.~::.:?~i:;.~5?:::?i~c:~PROVAL DATE ~ .... ~':". .... ~'June 19, 1987 ......... :,~-~7~:~,~:~;: .... . . - . - .. · ,. .. .. :.. .- · ~ .... .- ~ .. ....~ ~r' L0~ATION.. ' . .... ~ ..i : . .:APPROVED BY .(:'.'-.~' ...? '.... . -.......':.':.,..: .. ....."::".':, -.: .... .~.-', Bill Sch~lde ..... : -..?/::':.' ?-", ................ ' .... ' .... POST 0N PREMISES. . · :';-":' "..' '.'":':":::' .'.. ;' -' :":::-.:' ~:: ?;~'.- CONDITIONS AS FOLLOW: 1. It ts the responsibility of the Permittee to obtain permits 'which .may be required by othe~ regulatory agencies prior to .beginnlng work. 2. Permittee must obtain a City Fire Department permit prior to initiating closure action. 3. Tank closure aqtivities must be pe'r Kern County Health and Fire Department approved methods as described in Handout ~UT-30. '4. A minimum of two samples, must be retrieved beneath the center of the waste oil tank at depths of approximately t~o and six feet. " 5. The two gasoline tanks must have samples retrieved one-third from each end of the tanks at t~o and six foot depths. These samples must be sampled benzene, toluene, xylene, and total volatile hydrocarbons. 6. The waste oll tank and waste piping samples must be analyzed for oi'l and grease and total halogenated hydrocarbons. 7. If any contractors other than those l~sted on permit' and permit-application are to be utilized, prio~ approval must be granted by the specialist listed on the permit. 8. A .minimum of two samples must be retrieved at depths of approximately two and six feet for every 15 linear feet of pipe .Pun and also near the dispense~ area(s). .. 9. All gasoline samples must be analyzed for 'benzene, toluene, xylene, and total petroleum hydrocarbons. '. 10. All waste oil samples must be analyzed fo~ total ovganic halides, ~iI and grease and lead. ~. Copies o~ transportation manifests must be submitted to the Health Department ~ithin five days of ~aste disposal. DISTRICT OFFICES Delano Lamont . Lake Isabella Mojave Ridcjecrest . Shaffer . Taft SUBSTANCES STORAGE FACILITY , ...... ~ .. ....... .... ..- ...... .;~ ,. ~ ~?~i2..:'~}Ai '~i'pplicable'.~state'''-laws .for :!hazardous ~aste disposal,<~,:transportatlon.:°::-.or ~,-, .~:.:~tr~atment '~ust ~bo .adhered :to.'~',";;;The· Kern .County Health'DePartment'}~u'st ~be ~.-')¢~;'?;{'notified before moving and/or disposing o.f..any .contaminated soil. ~}:~i'~Pernit:ee ~.!s ,.responsible .~for ~:nakin~ ,sure'~,tha'-;:c~tank :~lsp°st ....... ' ' ~ sued '~ith 'this''~;'' era'it '}}is '-p~pe~.I~"?fi'i'ied .'ou't?and ?re'turn'~-d"~ithin '~}i4'.'~4ldvtse this office 'of 'the 'time~'and 'date .~of proposed':.sampling'~th :24".[ours · advance notice.' -" - ~-'. -".t ~:" -' '.- .... '"' ,-' ' '-' ~¥q :.~:'?:'~"/. '". '~''t[-[~l "" .15.. ~esults ~ust be submitted to this office ~ithln three days of ::,analysis 170OFIowerStreet r~ERN COUNTY HEALTH DEPARTME~"~. HEALTH OFhCER Bakersfield, California 93305 Leon M Hebertson, M.D. Telephone.(805) 861-3636 ENVIRONMENTAL HEALTH DIVISION '*. ~ DIRECTOR OF ENVIRONMENTAL HEALTH "* ~,a~~~ ' Vernon S. Relchard OF UNDERGROUND I~ZARDOUS , '. '' . . . · .................. POST ON PREMISES 1. Per'mittee must obtain~ a Fire Department permit prior to Initiating abandonment action. 2. All p~ocedu~es used must be in accordance ~lth requirements of the standards and guidelines developed for the tmplementatto, n of Kern County Ordinance Code. I ~lnimu~ of ~o samples must be ~etrieved beneath the center o~ the ~aste oil tank at depths of approximately t~o and six 4. The 7,500 gallon and 5,000 gallon tanks must have samples ~et~leved one- third from 'each end of the tanks at t~o and six .foot depths. These .samples must be sampled fo~ benzene, toluene, xylene, and total volatile . hydrocarbons. 5. The ~aste otl tank and ~aste piping samples must be analyzed for oil and grease and total halogenated hydrocarbons. . : 6. A minimum of two samples must be ~et~ieved at depths of approximately' t~o .and six feet for every 15 iineav feet off pipe ~un. 7. Fo~ all fuel product piping, every 1~ linear fee~ of pipe run must be sampled at t~o and six feet depths for benzene, toluene, xylene, and -total volatile, hydrocarbons. One se~ of the samples must be taken underneath each dlspense~ at the p~escvibed depths. 8. Advise this office of the time and da~e of p~oposed sampling ~ith 24 hours advance notice. 9. This departmen~ mus~ receive lab .analyses results no later than' 5' days a~tev their Completion. 10. .The holder of this permit is responsible fo~ insuring ~ha~ the ~ank disposition tracking ~ecord ts completed and ~e~uvned to this department ~ithin 14 days of acceptance of tank by a disposal or recycling facility. ACCEPTED BY DATE ~[STRJCT OFFICES Oe~a~o ~mo~t Lake ~sa~eJ~a Molars . ~lg~ecrest . Shader . Taft ~i!'~ COUNTY IIBALTII DEPARTHENT PTO ' PTA _ 'DIVI310N OF BNVlRONSE~TA[ IISA~TII APPLICATION DATE IT00 ~L~SR STREET, B~ISFIBLD, CA ~3308 ~ O~ T~KS.T0 DB AB~DONBD (806) 801-3030 LEHGTII OF PIPING TO ABANDON ~PLICATZON FOR PERMIT FOR PERCENT C~OSU~/A~DO~T O~ UHD~ROU~D THIS ~P~ICAT~0N IS FOR. ' '~REHOVAb, 0R ~An~D0~M~NT IN P~CE (FILL OUT 0~ APPLICATI0~ PER I DAYS . C8~I~ COMPOSITION OF ~TERIAL$ STOR~ Y~ ~ VOLUHB Cii~I~ STORED {NON-CO~SRC~ N~) DAZES STORED CilSMICAL PREVIOUSLY STORED MAT~ TO FACILITY PROVIDED BY ]DSPTJI TO OROUNDNAT~ ~ ~IDBScRIBB BO~U' T~ 'D/sPOSAL HETIiOU ~D DISPOSAL LOCATION ~l / / TZT~B DATg 7 PROVIDE DRAWING OF PHYSICAL LAYOUT OF FACILITY USING SPACE PROVIDED BELOW. ALL OF THE FOLLOW'ING INFORMATION MUST BE INCLUDED IN ORDER FOR APPLICATION TO BE ' PROCESSED: '~'~'TANK(S), PIPING & DISPENSER(S), INCLUDING LENGTHS AND DIMENSIONS PROPOSED SAMPLING LOCATIONS DESIGNATED BY THIS SYMBOL "(~)" · NEAREST STREET OR INTERSECTION . .. :'::..'. ANY WATER NGRTH ..... ~" ,~ . ,~...: ~.:.: · '.. '-) F :~?. . . ...' / : ' , '?~ .,~. ', -: ,.~ ., ,.. '~' '" '.':'" :~,;.'... .... ~ :t::~:~.,~. '...: :',~.~ ."~ :..,',::.' ' . !'~:'::~:: :." ':-: ~:'?~ ~' ,:?.~, ;~:v,',:;,:~ ".':~ ~': ".~.~-~'~ 'T~?~,~;~.~-:~::>'', ~"~.'.:":?:"~>*r'.,', ,.>.-;:. .'>.'- :'~': ...... Division of Environmental Health Application Date- 1700 Flower Street, Bakersfield, CA 9]305 No. of Taqks to ~e Abandoned A~PLICATIGN FOR PERMIT FOR TEMPORARY OR PERMANENT ~L%ZARDOUS SUBSTANCe- SlII93~E FA~ILI~ T_~ of A_~.lication (Fill Out One Application Per Facility) ~T~porary Closure/Abandonmen~ ..... [] Permanent Ciosur~e/Abando .nment. A. Project Contact {rk3me, ~ phone): Day~V/-/ 7~ ~ Nights Facility Na~ ~ ~~!~9~ ~"~ J~ ~ ' .. ' .~7/ ~/~O Facility ~dress ~ ~ ~ ~ ~~~M~ . Neares~ Cross R .... SEC - - T ~Rural ~ca~io~ ~ly) ~rator ~ ~ Tele~one ~dress Zip B. ~ter to Facilit~ Provid~ by ~/~ , ~ ~p~ Soil Characteris=ics at Facility /~; ;/F.~ .C~~ ~. · . ' .~sis for ~il ~ and Gro~d~ter ~6h' ~tam~atio~ ~,~ - C. Ta~ Re,vel Contractor ~ ~ ~dress ~ ~ ~; r ~ ~ Zip~ Tele~one Pro~s~ Starti~ ~te ~ ~, ~'6 Pro~~letion ~ta - ~rker's C~nsation Cartificatio~ ~ ~l~7~ Insurer Enviromental Assas~ent Contractor ~ ~' License No. ~dress' Zip Telephone P~o~s~ Starti~ ~tm Pro~s~ Cmpletion Date ~rker's Cm~ation C~rtification ~ Insurer D. Ch~ical Cm~sition of Materials Stor~ Tank ~ Chemical Stored (non-co~rcial name) Dates Stor~ Chemical Previously Stored (if different) J to to F. This application for: .~removal or ~a~qndo~ent in place , · * PL~SE ~IDE INFO~TION REQUESTED ~ ~E SiDE OF ~IS SHE~ B~ORE SU~4I~I~ APPLICATI~ ~R ~. This lot's has been completed under penalty o~ pe['jury and to the best o5 my knowledBe is tru~ arzJ " p[o'~'idc ~c~ i.[.'.Ci~.~:~ ol ' sical Layout of Facility Us[ . pace Provided Below; Include Ail ~e Followi~ _ ~cation of Tank(s), Piping-& Dis~nse~(s) ~ Pro~s~ S~pl.~ Location' Indicati~ Approximate Dep~ of Samples ' -- Nearest Street or I~tersection ~UO ~y Water ~lls or Surface W~ters Wi~in 100' Facility " ' ~" . / , -..,",. - ' '~e~ ' -., . ' ~ '~ , . App~cved · ~y ?C~:.'~ 1 ,:. _ F!TR CONTENTS INVENTORY ~ ~l..Permit t~7 Operate ~ U Date [] Permit to Operate Application %Tanks Plot Plan ~-~ Date [~] Construction Permit % -- Date []'Construction Permit Application Date [] Permit to Abandon % No. of Tanks Date ~ Application to Abandon ~ tank(s) Date' / ~//~/~ Amended Permit Conditions Modification [] Annual Report Forms [] Copy of Written Contract Between Owner & Operator [] Inspection Reports [] Correspondence - Received Date ~. Date Date .. Date [] Correspondence - Mailed Date Date Date Date [] Unauthorized Release Reports [] Abandonment/Closure Reports [] Sampling/Lab Reports '[~ MVF Compliance Check (New Construction Checklist) [] STD Compliance Check (New Construction Checklist) ................ [] MVF Plan Check (New Construction) [] STD Plan Check (New Construction) [] MVF Plan Check (Existing Facility) [] STD Plan Check (Existing Facility) ~' [] "Incomplete Application" Form [] Permit Application Checklist [] Permit Instructions [] Discarded [] Tightness Test Results Date .. Date Date [] Monitoring Well Construction Data/Permits [] Environmental Sensitivity Data: [] Groundwater Drilling, Boring Logs [] Location of Water Wells [] Statement of Underground Conduits [] Plot Plan Featuring All Environmentally Sensitive Data [] Photos [] Construction Drawings Location: [] Half sheet showing date received and tally of inspection time~, etc ~]· Miscellaneous ~