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Home My WebLink AboutUNDERGROUND TANK FILE #1 Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Thl~ I~ermit is issued for the followinq: [] Hazardous Materials Plan · [] Underground Storage of HazardOus Materials [] Risk Management Program PERMIT ID # 015-021-001284 [] Hazardous Waste On-Site Treatment THIARA FOOD MART LOCATION: 3401 S CHESTER / ~' ~AKERSFIELD CA 93304 ~ ,. ii'--:{ ~ /? · ""' '? TANK DISPENSER PAN MONITORING 015-000-001284-0001 G~SOLINE ~ W/Pos Shut Off 015-000-001284-0002 GA~$OI~INE : ' 10,000 ~:,~, ..... ~:-, ,,, )ff OFFICE OF ENVIRONMENTAL SER VICES' · '~' 1715 Chester Ave., 3rd Floor Approved by: 'L. Ralpl~Huey. D~~.) . IssucDate Bakersfield, CA 93301 OfficeofEv~Services Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: · City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 · (661) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below.'The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information inthe format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 12th day of September 2002 to: THIARA FOOD MART Permit #015-021-001284 3401 S. CHESTER AVENUE Bakersfield, California 93304 05/lg/2004 13:01 661325252g OAL VALLEY PAGE 02 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326~-397 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION FACILITY '~l'~-Y~. FO~,~z~/'~w~'~, .... OP~A~RS NAME ~'~ ~oo~~. .. NA~ OF MON~R M~UFACTURER DOES FAC~Y ~VE DISPENSER .PANS? YES~' NO NAME OF TF.~TINO COMPANY' ~-~/- ~/tt~ ~,z,t~/~ff~¢t~-r, I : NA~ & PHO~ NU~ER OF CO.ACT PERSON.~e ~/~f/~ ~$t g27-~ . ,: ~ , .., : '; 85/28/2884 ~.5:1_4 661_3252529 CAL VALLEY PAGE 02 MONITORING SYSTEM CERTIFICATION For U~e ~ ~il J~rt~d~tions ~l~t~ ti~ ~tate of Cai(fo~'nia ~ ~ud~ori~ Cit~: C~pt~r 5. L lIealth and Safety C~; Cl~t~r 15, D~L~Wn 3, ~tle 2J, Cal~ornia Code of R~ut~ion$ ~ia ~ mus~ ~ umd W d~ument t~ting and so~toing of monitoring ~ui~en~ ~sep~te c~ifl~tl~ or m~ m~t,~ prcp~d for ~ m~imr~ ~y~m con~ol panel by the tochni~i~ who ~f~s t~ wo~. A,copy of~is fo~ mU~t be provided to ~e [~nk ~yste~ o~erio~at~. ~e o~n=r/oper=tor must submit s copy of fids fo~ to the loc~{ ag~cy within 30 day~ or.st date. :~ .G~e~l info~mnfion F~elii~ ~nlnct P~rs~= Coronet Phone No.: ( ). B. Invento~ of Equipment Tested/Ce~i~ed ~k the np~opriate ~xea ~ Indicate ~peclflc ~uipmcnt Inspee~l~d~ ~ Annular $pa~ or Vault S~s~. M~el: ~:, O Aflnul~ Sp~ or V~II ~en~r. ~odel: ~Pipln~ Sump /T~ch $~so~s), Mo~I: _~LJ~ ~ Pipin~ Sump /T~nch ~enso~s). O Piti Sump SerliO. M~el: ~ FiU ~ump ~e~sor(s). ~odel: ~ Me~iml Uno Le~ ~t~r, Model: ~ M~hani~l Line L~k ~tector. M~oI: Tank ID~ Tnnk ~ ~ular ~ or Vault $~sor, Model: ~ A.nuinr Spp~ or Vmtlt Senso~, ~ PJpln~ ~mp / T~ 6~s). Model: ~ P~pin$ Sump / Tmn~ Se.~r{s). Model: ~ ~ill Sump 8~s). M~el: ~ Fill Sump 8~s). Model: ~ M~h~ieal Line ~ak ~c~. Model: .... ~ Mcchanknl Line I,~ De,tot. Model: Bi,ironic Line ~nk ~eelor. Mod~: Q Rlectmnic L~,~ I.~k Dct~tor. Mndel: O Oth~ (~ci~ ~ui~ent ~ ~d model in 8eerie, E on P~e 2). ,~ ~h~r ~s~i~ cqulpment type and model i~ ~tlon D~pe~r ~ /-~ Dispenser ~ DIs~ns~ Con~inm~t S~s). M~cl: ~3- ' ' ~ DIs~n~ Con(ainment Sen~r(s). Model: ~ 8h~ VeI~s). O 8h~r Valves). _~ ~sp~r Centnl~ment,~lo~(~) ~d Chnln(~). ~ ~lsp~ser Containment l:i~e~s~ ~ Chnin(g~. DlepenJer ~: "' Dl~penaer ID: " ' ~ Olap~C~n~nt 8case,s). Mod~: ~ Di~o~er C~talnm~t Scnso~s). Model: ~ Dia~r Ce~m~t F~t(s) ~d Chal~(s~. ~ Dis~sct Co~ninm~t Fl~t(s) and ~ain(s) ~ Sh~ V~ve(s), - .... [ ~ ~h~r V~fvc(~). -- ~r Co~n~t FIo~is) ~d Chain(s). I ~ Dis~n~ Conminm~t Ffont~s) ~d ~(~. .. . , ~ ._ or I~ ..... , ~p~ ~Je form, Include Ink. etlOn ~t e~ tank nnd dlnpen~r ~ ~e ~- ~e~tJOO . ! ~fy that the equlpm~t identified in ebb document ~s iaspeet~t~ie~ In neeo~nn~ with mnOu~e(vre~ ~ldefieee. Attached ~ Ihb Cnr~ficatlon la Informn(len (e.~. mnnufac~re~' eh~k~s~) ~ee~ry to ve~fy that this Iq~r~ntloe I~ co~t and · Plot Plan slmwing the In.ut of monilorin~ equlp~nL ~or any ~vipment ~pable of ~neratlnR seek rupo~ 1 h~e n~ ntlnch~ a copy of the repo~ (cll~ ~ifkm ~): ~ System setup ~ Alarm htsto~ Page ! of 3 Monl~ng ~tem Ce~iflcnt~ 05/20/2004 15:14 6613252529 OAL VALLEY PAGE 03 D,, Rusul~ of Testh~=/Sc~,icing ~om l]~ ~e follo~ln ch~kllst: ~Yes ~ No*" We~ ali ;~;o;; i.~)l=d at ~est poJn~oFs;;o~da~ comainment and ~o;itJon~ So thai other a~ipme~t will nm fu~e~ w~th ~cJr proOF ~eratio~? . No* I~ nla~i a~ relayed to a r~otc m~nJtod~g station, is ~1 communic~ion's equipment (e.g. ~dem) ~ Yu t,,~ N/A operarlon~l? ~ Y~ O No* For p~sufiz~ p~ing sys~ms, do~ the ~i'~;ne automati~lly shut down J~ fl~' Piping seconda~ contsifl~nt ~ ~/A ~imrlng ~s~ detec;s a leak, ~aiis to o~rafe, or is cle~rjcally dJacoflnec~ed? ~Fyu: which s~sors Jnf~me Did ~u confirm ~osiCive shut-down due to ~b. ~nd s~mor ~ailu~dfsconnectfo.? ~ Yes; : ~ N/A m~hnlcal ovcrfill prevent;on valw is Jns~led), is U)e overfill wamlng ala~ visible nd audible ..... fill ~pfn~s) and o~fl.~ properly? ~so, at what ~.r oFmnk ca~c]~ ~--s the ~ tr;~e~ ~ Yes' ~' No W~ ~y mon;~flg equipment mpia~d? ...... -" Ifps, ~dentl~ specific sefls0r8, prob~, ~ o~er ~uipme.~ r~Mc~' ~d lift the mafl~a~r name and mode] ;or al] rep~ecemcnt ~ in Section E, ~low, · '. ~ ~ ~uc~ Q W~er, ]f~, describe c~scs in So.loft E w x~s --~ ~o W~omt~n s ms~-u .... ~ ~ ....... ~,,..mm~ ~m mtn[ opmttoml per m~uraomrer's sPecific~? ~fo. E bdow. d~rlbe how and when thee deflal..ei~ ~ ~. ~. k ..... ~. Comments: "' 85/28/2884 15:14 6613252529 CAL VALLEY PAGE * ', . ~ Check this box ff~o t~nk gau~i,K or ~[~ equi~cni Is ~ ~[On mUS~ ~ comp[~t~ t~ [n~t~ gauging c~u~pmeat ~ used to perform I~ detection mon~to~ng. ~e tbe Follo~n :h~kJJ~t: , :, O Y~ O ~o* ~a~ ali input wln~ been Jn;~ed for pm~ ~t~*and ~flat;on, including ~i~ f~ ~round fault? ~ ~ ~ y~ ~ ~o· Was ~cnmcy of system pr~uct lewl m~i~ga ~a~d? ..... '~ Y~ ~ No*' ~a~a~Uracy of s~tem waist'level ~ad~ mateS? ............ . .... ~ Y~ "0 ~o* W~ all it, s on ~e equipment manu~&tumr'a m~inteaa&~'chee~t~st ~ple~? * la ~e ~ion H, below, d~cribe bow and ~ken ~ese deflctenei~ were or will be corrected. " G, Line ~ak Defacers (~D): ~ Che~ this box if LLDs are not jns~lled. ~ yo ~ No* P~ equipment em~up or annual equipment c~lflcetion, w~ a leak dmulated ~ verify LLD perfo~an~ ' ~ N/A ~ka//thatapply) Simulatcdleakra~ O3g.p.h.: G0.1gp.h; O0,~g.p,h, . ~ Yes ~ No" We~ al~ LL~ ~nfi~ed op~tional ~d ~te within ~guiam~'"~qul~cnm? ~ "' ~ Y~ ~ N0* W~ m~ ~ting"appa~ ~pe/Iy Celi~d7 ~ Y~" ~ 'No~ For m~h~tcai LLDs, ~o~ih~ LLD ~blet p~c~ flow ir it de~c~ a I~k? ....... . ~ ~ Ym ~ No* 'For ele~onlc LLDs, ~oes the tu~i~'aut~ati~lly ~ut off ifthe"~LD de~ecta a , .~ ~ Y~ ~ ~o* P~ el~tronic LLDa, d~s tho turbine automat~a}ly sh~t off if anY'~i°n o~the ~on~toring system is : ~ ~ NtA ~r~s~nnected? : ~ Y~" ~ No* For elcctmnic LLDs, do~ ~' tur~n~ aut~ati~ly ~t~t off if any pofli~ ~'the~"~osiloHng sy~te~ ~ N/A mal~flct~ns or hiis a -~ Y~ ~ No* For elec~njC~LDs, have ail aCc~iblc'Wi~na coon~i~s been visually inspected? ' " ~ Yes ~ No* ~era ali I1~ on ~e equipment m~nu'~aetur~r'~ ~intenan~ ~i~eeklist ~l~tad? ...... * In the 8action H, t , , describe how and when these deficiencies we~ or will be ~r~cttd. ~ Commeu~: PAGE 81 OAL VALLEY 85/1B/200~ 13:81 66132525~9 CAL-VALLEY EQUIPMENT 3500 GILMORE AVENUE BAKERSFIELD, CA 93308 (661) 327-9341 FAX: (661) 325-2529 CONTRACTOR'S LIC.#784170 A HA7 ~:_ ~_~r~ r cc. E] Urgerll ~t-For Review (~l Please Commeltt I-J Please Reply 0 Please ReCycle Comments: 05/19/2004 15:50 6613252529 CAL VALLEY PAGE 02 MONITORING SYSTEM CERTIFICATION For Ute By dll,]urlzdictlon.~ Within the State of Callfornta Au~rt~ Ci~: Chapt~ 6. 7, H~ahh a~ ~ty C~; C~pt~ ] 6, Division 3, Tit&23, Cal~nia Code of Re~l~io~z ~ f~ mum be used to docum~t msttng ~d se~icing of m~tWring ~u~ent. A 8ep~te ~tfl~flon or .rp~ must be :~_~d for ~ m~Ror~R ~ con~ p~el by the technicl~ who ~rfv~ the work. A =o~ of fbi; · e ~k ~stem ~ner/oper~r. The owner/operator must submit a copy of this form to the local a~ency re~latin8 MST systems width 30 days oft~t date. , A. ,General Info~afion Fncili~ Conm~ Person: C~taet ~one No.: {, ), ~odel of Moni~ring System: ~/']~c. ~.C. Date ofTestln~gervicing: ~/~/~ ~. Inventp.~ of Equipment Tested/Ce~t~ed Ch~ the dp~a~ boxes lo Indlcn~ s~d~ e~ment TnnkgO: / ~ ~ TnnkIO: In-Trak O~ging ~obe. Model: ~.. ..... ~ In-Tank Gauging ~nb~. ~nul. 8p~e or Vault Sensor. Model: O A~nulsr Space or Vault ~sor. Model: Ptplng~ump/Tr~ch Senao~s). Model: ~kg ~d~___ O Piping Sump/Trench Sonar(s). Modal: Fill Sump ~m~r($). Model: ~ Fill Sump ~nso~s). M~eh ~l~nlc Li~ ~ Dete~or. Model: ~ ~leetmolc Line L~k Oe~tor, Model: ~k O~11 / Hish-Level ~nsot. Model: ~ T~k Overfill / High-Level 8enMr. ~her (s~J.[~ ~ulpment ~p~ ~d,~odc[ in Sell. Off E on Pa;e ~, O Other (;p.~ifr ~quipmcnt t~pe nfl~,modc] in S~tlofl T~ak [Dr ~ ~/~ Tank ID: I~T~k Qaug~ng ~o~ Mod~]: __~. ~ ;n-Tank Gauging Probe. Model: Annular 8p~ or Vault S~r. Model: ~ Annul~ S~e or Vault Scn~r. Model; ~iple88ump/Tr~chS~s). Model: ~A_~;~ ~ HpiagSump/T~nchSenso~s). Model: ~b~l~l Line L~ Det~tor. ~cl: ~ ~ O Mechanical Line L~ Detector, T~k Or. Oil / Hi~h-~vel 8~r. Model: O T~k Over011/Hi~-Level 9~nsor. Model: O~et (s~ir~ ~,l~ent t~ ~d model in 8ecUon E on Pag~_~).,,, O Other (~ct~y cqoipm~t ~pe and m~dd Dlsp~s~ C~i~cnt ~nso~s), Model: O Di~n~er Cofltninm~t 8en~or(s). Model: ~She~ Valve(s). ~ Shoe Valve(s). gl~n~ C~tdn~t Plo~s~ ~d Ch~ s ,, Oig~ C~ainm~t g~s). Model: ~ Din~n~ Containment ~so~}. Model: Sh~ VMv~s}. ~ Sb~ Valve(s). ~en~ Containment FIo~s~ ~d ~n(s~. G Disp~s~ ~ntninmcnt Ptoa(s~ and Chnln{a~. Dlspmser C~mln~nt Senso~n). ~odel: 0 Ois~ser Con~inment ~en~s). Model: 8he~ Vnl~(s). ~ ~h~t Valve(a). ~np~s~ ~ntain~t Floa~s~ ~d ~n(s~. ~ DJsp~r Co~mi~i Fl~t~s~ and Chni~(s). ~e~ea~on . I eer~ t~nt the ~uipment identical i, this document wn~ Inspee~/s~vleed I. nccordnn~ wJ~ the mnnu~eturers' guidelines. Affnehed ~ this Cer~fiotlen Il Information (~ manufacturers' ch~klists) In~rmntlon b cor~et nnd n Plot ~fn sho~ng the layout of monl/otln~ ~ulpmen~ For ~ny equipment capable of Ren,rntln~ 8uth ~, i hn~ also nffneh~ n eopy of the ~pofl; (~e~k ~ll rA~ nppl~)t ~ System set. up ~ ~nrm histo~ re.ri MonltorlnR System ~rtlflen0on Page ~ er~ o3~1 05/19/2004 15:50 6613252529 CAL VALLEY PAGE 83 :',!~ .: ,D' Re.quits of Testing/Servicing : ~. Yes O No* Is ~ visual ui~ o~raLioflal? .... ~ Y~' ~ No* We~ all s~s~ts v~ually in~p~d, functionally ~sMd~ an~"~firm~ ~: Y~ ~ No* W~ all s~rs installed at lowest point of~c°nda~ oontaiflm~t ~nd poSit~ed so th~t'othet eqUipme~ will . not interf~ with thelr proper ?p~Uoa? ........ ~ Yea ~ No* Ir aJ~s are relayed m a remote monit~rleg s~t~n, is all cemmualcations e~lpmenl (e.B. med~) '. ~ N/A opemtlonai9 ~ Yes ~ No* For p~u'~i~ pipln8 sys~ms, ~ the turbine aato~aUcally shut ~ i~ ihe pipins s~ond~ c~inment ~ NtA monJtorlng ~m d~ecu a lea~ rails to opemm, or is electrically dkconnec~d? If yes: which ~nsom inttlate ~sltlve shut-down? (CA~A all d~ ~pl~) ~ Sump~neh Senso~[ Q Disposer Conminmeflt D[~ you co~fltm positive ahut-down.du~ m leaks ~ e~r failure/distribution7 ~YO~; ~ No. ~ ~ ~ No*' For tank ayat~a that utili~ the reentering system as the primaw t~k overfill warning device (i.e~ n0 ~ N/A mechanical overfill prevention valve la installed), ia ~he overfill warning alarm visible and audible at lhe lank fill poin~a~d ~er~in&p~pcrly? l~so, et what ~rcent oftank capaoi~ does the ale ~ Y~* ~ No '~ Was ~y monitorin8 equi~ent replaced? frye;, Jden~l~ s~i~ senzom, ~s, ~ other equipment ~laced and Ils~ the m~ufaetumr name and m~el rot all r~l~emqnt pa~a in Section E, below. ~ Y~* ' ~ No W~ liquid ~d inside an~ a~d~ ~ialnment zystem~ dealgned a~ d~ sys~? ~h~' ~ t~m ~p~) ~ ~ ~uct; ~Waffir. if yes, d~l~ oa~m tn ~tlon E, below. ~ Y~ O Nv*' W~ mo~i~ri~g syste~' ~et~up ~vJe~ed t0 en~ ~[~r seein~.A~ch ~ up ~m, ~ 'Y~ Q Ho· Is all ~ontt~ng ~ui~t opc~tional ~ ~ufa~ter's sp~ifi~tloas? [~ ~tlon ~ bel~, aoe~ ho~ earl whoa thoe deflcieael~ were or will be eorrett~. ~; Palle 2 of 3 O3/OI s PAGE 84 05/19/2004 15:50 6613252529 CAL VALLEY .... " ack this box iftnnk Saugi~g i, u,~ onl~ for '~is s~fion must be ~mplctcd ifh-~k gauging equipment m mad to perform leak detectmn monlto~ng. ~6~ '~ So' Has ali Input wiHn8 ~en ins~md f~ p~et'~t~ and te~ination, including t~ting for ~nd ~. ~"~o~' W. acc~cy o~sysmm product I~vel m~e~l ~ted? ............ q~ a No* Wm all ii&~s on th~ ~ui~ent m~u~.'~ maiuten~ce &~klist c~mpl~ied? " below, d~crlbe how and when these defl~leacl~ were or will be corrected. Line ~eakDe~ct~ (LLD): 0 ~,ck~i~b [f~LD~are notins~ll~. y~ ~ No* For equi~enl ~ta~-up or Mnual ~ui~t ~ifl~atlon, was. ~ea~ simulated to V~ify Ya ~ No' Were all LLD~ ~nflrmed opotat[~ ~ a~U~e wiAin ~gulat~ requirement? Y~. ~ No* W~ the t~ting ap~mtus pwPetly ~li~a~9 . Y~ ' ~" ~* For ~ec~anicai LLD., doe~ ~e LDO ms.ct p~ct fl~ if i~'deteC~ a i~k* ...... Yea O No* For elee~nic 'LL~, ~b~ ~e t~lne automatically 'sh~t off if ~Le LLD de~s a y.' ~ No* For elec~nlc LL~, do~ the tur¢16e ~t~mMi~lly shut off if any portion of th~ m~it~ring System is disabled , ~ N/A or disconnected? Y~ O No' For 'el~tront~ LL~, d~ ~c turbine: autemati~lly shut off if an~ PoRi~n of ~he mon~iorinE ays~m O N/A malfunctions ~ fails a t~t7 Y~ 0 No~ ~ el~nic LL~ have .)[ac[~ibl~ ~i~i~8 ~dnectJons ~n ~iaually ins~9 " ~el 0 No* Were ail items on the cqulpmc~t manu~'s maine,anco Checkl~i completed? ~fl (he ~tio. , below, d~erlbe how end when thee de~atl~ were or will be tflrrtc~d. .;' :. .~. April 22, 20~)4 Thiara Food Market 340 l' S. Chester Avenue Bakersfield, CA 93304 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at :';~ ':'~"~ the Above Stated Address. ADMINISTRATIVE SERVICES Dear Business Owner: 2101 "H' Street Bakersfield, CA 9330f VOICE (661) 326-3941 Our records indicate that your annual maintenance certification on your leak vax (66t) 39s-t349 detection system will be past due on March 13, 2004. SUPPRESSION SERVICES 2101 "H' Street YOU are currently in violation of Section 2641(J) of the California Code of Bakersfield, CA 93301 Regulations. VOICE (661) 326-3941 FAX (661) 395-1349 "Equipment and devices used to monitor underground storage tanks shall be PREVENTION SERVICES installed, calibrated, operated and maintained in accordance with FIRE SAFETY SERVICES · ENVIRONMENTAL SERVICES 1715 ChesterAve. manufacturer's instructions, including routine maintenance and service checks Bakersfield, CA 93301 at least once per calendar year for operability and running condition." VOICE (661) 326-3979 FAX (661) 326-0576 You are hereby notified that you have thirty (30) days, May 22, 2004 to either PUBLIC EDUCATION "perforlTI or submit your annual certification to this office. Failure to comply 1715 ChesterAve. will result in revocation of your permit to operate your underground storage Bakersfield, CA 93301 VOICE (661) 326-3696 system. FAX (661) 326-0576 Should you have any questions, please feel free to contact me at 661-326-3190. FIRE INVESTIGATION 1715 Chester Ave, Bakersfield, CA 93301 Sincerely, VOtCE (661) 326-3951 FAX (661) 326-0576 Ralph Huey TRAINING DIVISION Director of Prevention Services 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 by: ~, Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db FACILITY NAME ' I1%10,~'o,- FOoar tJl,~r't - INSPECTION DAlb' I~1, I~"~ I M ) I Section 2: Underground Storage Tanks Program [2[ Routine [~1 Combined I~] Joint Agency [2[ Multi-Agency I~1 Complaint [2[ Re-inspection Type of Tank ,STOL. (.d,¢~ Number of Tanks Type of Monitoring d-.T'(o Type of Piping /}tO.!r: OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file k..,,' / Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current ~/ /qt_tq[ ~ ctASoth t 11~(, t' ~t Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY' Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Complian~e~ V=Violation Y=Yes N=NO Office of Environmental Services f805) 326-3979 Business Site Resp~'nsible Party White - Env. Svcs. Pink - Business Copy Bakersfield Fire Dept. UNIFIED PROGRAM INSPECTION CHECKLIST Enironment~l Se~ices ~~,,~~ 1715 .Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301. Tel: (661)326-3979 FACILITY NAME INSPI~CTION ~ATE INSPECTION TIME ADDRESS ............................................................................................. ' No, - .... N%~o~-E% pi%y-e-& ........... FACILITYCONTACT Business ID Number 15-021 - '.' ' SeCtion 1' BusineSs Plan and inventory Program ' ~ Routine ~ Combined I~ Joint Agency I~ Multi-Agency I~ Complaint I~ Re-inspection C V ~rC=C°mplianc'e~ OPERATION COMMENTS ~. v=Violation ~'/~ APPROPRIATE PERMIT ON HAND [~'~/~ BUSINESS PLAN CONTACT INFORMATION ACCURATE [~.'"' ~ VISIBLE ADDRESS ~'"/' [~ CORRECT OCCUPANCY ~"/~ ' VERIFICATION OF INVENTORY MATERIALS ~ ~ VERIFICATION OF QUANTITIES ~"~[~ VERIFICATION OF LOCATION ~/'E] PROPER SEGREGATION Ot: MATERIAL ~ [~ VERIFICATION OF MSDS AVAILABILITYE VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ............................................................................ : ............................................................. [~ ~ HOUSEKEEPING ~ [~ FIRE PROTECTION I [~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: ~ YES i'1 No EXPLAIN: QUESTIONSrlO~S ,~/G,GARDINGRT,/~rt~?PECTI(T, IS SPECTION? PLEASE CALL US AT (661) 326-3979 F~re Prevenbon 1st In/Sh~ft of S~te Business Site Responsible Party (Please Print) White - Environmental Services Yellow ~ Station Copy Pink - Business Copy 66]0.~sedale i.I~., ~ 'B, Bakersfield, CA 93308 Phon~ (661) 588-2777 Fax (66 D 588-2786 MONITO NG SYSTEM CERTIFICATION :~i~(b~'m. mt~t b~ .u~d to. document g~ti~ ~d s~ic~g of mo~ttorin$ equtp~at. ~~aRificatlqa or ~o~ mua b~".:, g~ t~g?,.:~. 'i~stem, ' ' ow~edope~r:. ~e?6~et/O~erator must sub~t a copy of ~is fo~ to ~ local agent' teguhfing ~ST s~[~ ~.~: ~: ;.Gau~in~ Pro~ ~ ModS: au~ng .: m6dcl in ~ on Pa ~d mod~l ~hcar Valve(s), DLfpenser Model: _ ' Q Dispenser Conlainmcnt Sen~ffs). Model: · '.: ',: inspired/sea,ed In accordance ~ ~p'uhc~re~' guld~ea. AKachM to ~is C~Ifl~floa la ~formatlon (~g manufacture' ch~kl~t~) utt~sa~ t6"v~ t~ ~J~ '~: · ? ~'[~a~on b ~t and a el6t Phn ~howing the layout of mo~to~lng equipm~t. For nay equlpm~t ~pnble. of Pl;~R--20--O~ THU .. · ' O Check this box it' no tank gauging or Sl~ equipment h instalted, Thi~, s~¢fion must be complctcd ifJn-tm~ gau~ equipment is u~d to pcrfom~ Io~ det~on mo~Wr~g. Complet, t~ follo~ng chemist: ' . ....... ': ~.~...~.. No*. Ha~ a~. wk~g b~ in~ctcd for pmp~t ,n~ ~d term~o~, ~clud~ ~s~ng ~r greed' f%Its?. ~' ' ' "?'" ~. ~o* Wer~ dl tank ga~gi'~g pto~s visually t~ect~d'f~} d~ge and rei~d~ b~ildup{ .......... ~:e~;~: :.g No* was a~eu~ey orszst, m product level rca~n~ e~tcd? "' ~,ai~' ~$. ., · ~S:~;}~ "O No*'. Was ~Cu~cy ofsyslcm wa~r level rcadi~ ' . -.'". " ' · ..... · Were aU !t~ on ~ ~:p~nt ~u~cm~r's mamto~c~ checkhst complc~d? ~?i~a~' ~'~i'~ ~.' :' ,~" ~ ;:~' I~ Oi~ l n ~ bel~'d~r~ ~o d~clende~ were or m~l be ~rr~ctcd. ~ ~,.~,~..~,~ ,. how'and when ',, ~,..'~Li~e Leak De~tors ~D): O Ch~k ~is box ffLLDs aro not ~mllcd. ~ ;~1 :' ,~ : ~ ~/a ............ ~, . .'[ ~ ~ ::~. No* 'For ele~alc LLD~;"~ ~ mb~, aUm~fi,ally shut off i~ LLD dct~c~ a 1,~? ' ':':'~ :,8 N/A . :.,~.: '~ N/A ~l~c~o~ ~ b~ a test? ' ' ' *: ~ fl ,n H~ ~ow, d~rl~ how'~d when tb~e defldenci~ we~ or will be corree~d, '1~:,~ ~mmen~:. .,. ~,~,,.~:..~}~: :._ ., _ ~ .:~ :." .: ' :' ' l~ ': Page 3 of 3 03~1 ~[':':~~ No* W~e ail :enso~ i~alled at lowest point of Se~ndary condiment and Positioned ao ~at ofl~,r equipment will ~:,., not ~ter~r~ with ~ek prop~ operation? ~" ~:.~ ,.' ..... ,, _ .. ' ' md Hst ~o ~ufac~ ~* ~d mode! ~o, aH rcp!~mt pa~ ~ Section ~ ~low, · ' ' ~}~,:;] [['~ i; u] ~ Prb~cg ~'wa~r:,: If yin, desm~ causes ~ So.ion E, ~low ' r,~. :~ . . .... · . .:',"'~--., : ~ .................... ' .......... ~ ~,~- ---. ...... . .... , ~'~.. ~ .... Page 2 of MAR--20--O~; THU i ~ ~'ROM ~B. S. ~. R. NC. P. UST Monitoring Site Plan ':~L2I ~.: ~ ~'~ .... t ;. ~ .......... ~ ............ ......................... ~ .~.. ~ ..~ ..................... ............. )1~' '~ .................. ..,~ ........... ~ ........ . .~ ........ ~ ............................ .,:.~,. ..... ~ .......... ~ .................. ;.':~ ...... ~ ............................ j~. " ...................................... ' '4:~.~:~..: ...... ~ *.~ ................................ '.. ,':..~r.'~ ........... -~.. , .................. , :~.~ ...... ~ ~ ~ ............. ~..~.~;;. :...., ..................... : .~?~,.~,,. .......... ~ ................................... t" ......... :) ................... ~n~uc~ons :If ~ou ~,h'~ady ~ve a dia~ ~t, ~hows all requi~d ~fo~ation. you ~y inalud~ i~ rath~ th~ this page, With your " .; ~. ..k.."" ' . , , ' ' ' . ' ' '' .M~.~r~g Sys~m C~.~a¢on...~ ~ s~ pl~, show ~c g~eral layout of ~nB and p~pmg. Clcarly ;~:~i~:':~r ~ ro~iow~s ~uipm~t, if ms~ll~, monitoring syst,m con~ol pane~; sensors monitoring ~k a~ular ~i$~:j~:i~'h~S; di~s~ V~s, :~ilI oou~ers, or oth~ se~u~ contaim~nt ~as; mechanical or elec~onic line leak a~,~c~[~rs;:~M m~nk hqmd !,vel pm~ (tfu~. for leak ~tc0t~on). In the spaoe provided, not~ th~ ~te ~ts $ttc Plan ~ge ~ of ..... 0~/00 RIGHTS AND PRIVILEGES ~FORDED UN0~E PO~CY. , L~$~ ~0100644 Dave Everett x6328 PO Box 10269 P.O. ~x 8~9 ~kersfield ~ 933~9-0269 S~ R~sa ~ 95402 Nick Ellis CODE: I SUB COD~ iara, In= PLP ~03-735-400 ~ACP780112~601 ~ Thiara FOO~ ~t ~ ~DA~ J ~ONDA~ ~I~EDU~IL ~ 3401 Sou~ C~es~ Ave ~ 05/01/02 ~ 05/01/03 ~ Bakersfield ~ 93304 ~ ~iS~C~O~~A~ L~TIO~DESCRIPTION 001 3401 Sou~ C~este= Ave ~t wi~ gas ~s- Bakersfield ~ 9330~ Buil~in~ 225,000 1000 Canapis/P~ps/T~ks 200,000 1000 All coverages special fo= ~ re~la~en~ cost endors~ent ~neral Li~ility 1,000,000 ~nder~ Loss Pay~le En~r~t ~'~ ~SL 8~ ~ ~0~ ~6 ~a P~E~[U~$, FORMS, ~D RU~S IN EFFE~ FOR ~CH POUCY PERIOD. SHOULD THE POLICY ~E ~INAT~D, THE COMP~ ~ ~J~ THE ADDI~O~ I~EST IDENTIFIED BELOW 30 DAYS WRI~N NOTICE, AND ~LL SEND NOTIFICATION OF ~T C~ES TO ~E POLICY T~T WOULD AFFECT THAT INTER~$T. IN ACCORDANCE WiTH ~E PQLICY PROVISIONS O~ ~ ~EQU[RED aY ~W. ~a ~m ADDRESS X ] MO~G~ ~ ~ ~D~T~ ~u~ T~ecula Valley B~k, N.A. L0~ GP535~81400 27710 Jefferson Avmue A-100 ~om~E~ AR-- 18--05 MON I 6 : ~ ~ROM B $ . $ . R . ~ I NC . P . 0 ! OCT ~S ~00~ 8:39 BKSFL~ FIRE PREVEHTIOH 15~11~5~-~17~ .,~1 '~ 1715 C~r Ave., Bakersfield, CA (~1) 3~-3979 AePLi~ON TO PE~O~ FUEL MO~TO~NG ,. ?, DO~ FA~Y ~ DBP~SER PANS? ~~ NO__ ';:'.,. N~ & PHO~ ~~ OF ~A~ PBRSON . ~ ~,/' 7-10-2003 5: O.SPM I~R~]M CALVALLEY EQU Ii P 166132525 P. 2 CAL VALLEY EQUIPMENT 3500 Gilmore Ava Bakerstield, Ca 93308 eel-327.9341 Fax 661-325-2629 IMPRF~SED CURRENT CATHODIC PROTECTION CERTIFICATION 8bu¢l~l ~ 8oil PotenlJal Read; ings For Previously Installed Systems (8¥stem Off ) Tahk ...... Tank "F01i Iprodu I ve~-I Sore ce. ler ~rO~'~' ~ Number , Size , ..... T,¥pe .I Uno I Line ]End of Tank~ .el'Tank Endo1.T.an.k C_ondult 8trugture te 8oll Pol~ntia! Readings For Previously Installed 8ystams ( 8 ,stern On ) · T~I~- Tank ' Fuel Product I ~- Ve~t""' I" $ or E" Center N or W : Electronic . Number Size .. Type Lille I L!!te lEnd 0f Tank .._o..~ Tank End 0! Tank Conduit ". I I~ef~by oefllfy that the minimum syStem potential requirements fat Impressed Current Cathodic . ~ Have Been Met i. ' :':',ii: J ..ye Not seen uet for the systems referenoed above: taken in ac~rdance with the minimum standards of the National Assuoiatlofl of Corrosion Engineers, and as done to comply wllh EPA and Stale Directives i, r-3 ~ Postage $ f rt.I Certified Fee I r-1 ~ Postmark R~rn Reciept Fee Here I r-'l (Endorsement Required) I r~l Restricted Delivery Fee l ~l?J' (Endorsement Required) , . Total Postage & Fees I ii ~ inn I fl · Complete items 1, 2, and 3. Also complete A. Sign~t~· item 4 .if. Restricted Delivery is desired. X/'~~ I-I Agent · Print your name and address on the reverse ~ ~ ~~ [] Addressee so that we can return the.card to you. lB. Received by (Printed Na~e) / ~ C.~ o,,f Delivery' · Attach this card to the back of the mailpiece, or on the front if space permits. ~'~'~/...,~l/_.A /'~ )~[r~Y~.~:7~~~Y~5 - D.~S deiiv~ ~ddress different fro)~ern~d J~ Yes 1. Article Addressed to: If YES, enter delivery address beJt3~: I-I No , SATRAM SINGH , THIERA FOOD MART ' 3401 SOUTH CHESTER 3. Service Type 'BAKERSFIELD CA 93307 [] Certified Mail [] Express Mail ~. r, [] Registered [] Return Receipt for Merchandise ' ......... J [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number 7002 2410 0002 1974 9701 (Transfer from service label) PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540 D FIIIE June 20, 2003 CERTIFIED MAIL Satram Singh Thiera Food Mart 3401 South Chester Bakersfield, CA 93307 Re: Failure to Perform or Submit Three Year Cathodic Protection Certification FIRE CHIEF ~,ON ~AZE NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 Dear Customer VOICE (661) 326-3941 FAX (661) 395-1349 According to our records, your three year Cathodic Protection Certification is past duc at Thicra Food Mart. 'You arc in violation of section 2635 2(a) Failure to SUPPRESSION SERVICES 2101 "H" Street Perform/Submit Cathodic Protection Testing results. Bakersfield, CA 93301 VOICE (661) 326-3941 Section 2635 2(a) is as follows: FAX (661) 395-1349 PREVENTION SERVICES "Field-installed cathodic protection systems shall be designed and certified as 1715 Chester Ave. adequate by a corrosion specialist. The cathodic protection systems shall be tested Bakersfield, CA 93301 by a cathodic protection tester within six months of installation and at least every VOICE (661) 326-3951 three years thereafter." FAX (661) 326-0576 ENVIRONMENTAL SERVICES The cathodic protection is part of your leak detection system and is a condition of 1715 Chester Ave. your Permit to Operate. Therefore, prior to August 30, 2002, you shall either Bakersfield, CA 93301 perform or submit evidence of cathode protection testing. Failure to comply will VOICE (661) 326-3979 FAX (661) 326-0576 result in revocation of your Permit to Operate. TRAINING DIVISION Should you have any questions, please feel free to contact me at 661-326-3190. 5642 Victor Ave. Bakersfield, CA 93308 Sincerely, VOICE (661) 399-4697 FAX (661) 399-5763 Ralph E. Huey Director of Prevention Services By: -,~ Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services REH/SU/db ern County Construction, Inc. P.O. Box 6096, Bakersfield, CA 93386 Contractors License # 481053 (661) 634-9950 Fax (661) 634-9233 Febmary25,2003 City of Bakersfield Dept. Of Fire Prevention 1715 Chester Ave. Baker~---~ A~T.~T;I~: Mr. Steve 13ad~ood ~ RE: SB989 Test Results / / Mobil ~ ~ 3401 S. Chester ~ ~ Bakersfiel~ ' Atta-a'~-,~~e SB989 test results for the above referenced gas station. If you have any questions please contact Josh Simmons at (661)634-9950. SxORCB, January 2002 Page Secondary Containment Testing Report Form This form is intended for use by contraCtors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: //b"Lo/~t,~/] I Date of Testing: "' Facility Address: '~ H 0 I ~ ~ ~ f~~]Ph°tncc~7''' (fl/je (. 0~ Facility Contact: ' Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): · OR o AT,o Company Name: ~-~'~ ~..~-~.~/1~ ~o~ Technician Conducting Test: d os L- ~/~,~v~-o~-<~ Credentials: ~,CSLB Licensed Contractor SWRCB Licensed Tank Tester Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Not Repairs Not Repairs Component Pass Fail Tested Made Component Pass Fail Tested Made Ifhy~ostatic testing was perfo~ed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To',e best of my knowle,~~ta,d , ,is document are accurate and ,full compliance wi, ,al requ,emen. . Tec~ician s Si~amre: ~ ~ Date: SWRCB, January 2002 Page 22. of_t~__ 6. PIPING SUMP TESTING Test Method Developed By:. Sump Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: ] Equipment Resolution: Sump #~ ~ I Sump #'~'~'7 I Sump # I Sump # Sump Diameter: Sump Depth: Sump Material: Height from Tank Top to Top of , Highest Piping Penetration: Height fxom Tank Top to Lowest · Electrical Penetration: Condition of sump prior to testing: ~.-7o o q~ ~-'700t} Portion of Sump Tested1 Does turbine shut down when sump sensor detects liquid (both product and water)?* Turbine shutdown response time / 0 Is system programmed for fail-safe shutdown?*~ No NA (~s No NA Yes No NA Yes No NA Was fail-safe verified to be /~s vt-42-. No NA ~ No NA Yes No NA Yes No NA operational?* Wait time between applying test: Test Start Time: Initial Reading (R0: Test End Time: / "fi'g' Z' 34. Final Reading (Rv): Test Duration: Change in Reading (Ri:-Ri): --g~- Pass/Fail Threshold or Criteria: Test Result: ~ Pass [] Fail [] Pass ~'l~il [] Pass [] Fail [3 Pass [] Fail Was sensor removed for testing? Yes No NA ~ No NA Yes No NA Yes No NA Was sensor properly replaced and verified functional after testing? Yes No NA No NA Yes · No NA Yes No NA Comments - (include ~de prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB, January 200~ ' '"'. Page ...~ of~ 5. SECONDARY PIPE TESTING Test Method Developed By: ~~ Industry Standard Professional Engineer Test Method Used: ~?ss~e~_~e~./~ rrro ,9 C Q Vacuum Hydrostatic Test Equipment Used: ] Equipment Resolution: Piping Ran # ¢'7~ I?zl Piping Rnn# g ?.~/$ I Piping Run # ~/- 112_ I Piping Run tl Piping Material: ~rlyt?~; ~-[.e~ ~.~4'y't'go ~(4~)t -C~./,~o ~ k >~ eipingManufacturer: To'cai ¢, 4~t:t~Oi,~C - ~ Piping Diameter: ]'_L i! ._. Length of Piping Run: '~'0 1 ~0 / "~o ~ ~o / ProductStored: L?q$o{,~.e ~7 '(_'705o/,'e~( ~7 ~vc6o/'~( ~1[ [ga~o/~;qq Method and location of '"~l/b,'~qe Sulm~ T~l/ia;o,e ~'ut~f i'~Vb,'~a %1~i'~ T4 0'b,'r~ piping-nm isolation: Wait time between applying pressure/vacuum/water and starting test: Test Start Tim~: [ 0 .' q~;" /0; q/~'~ [0. q~"' /0 ,'q~'~ Initial Reading (Ri): ~. [ ~ O ~-, O ~, I Test End Time: II ; q5''' [! ; qx--" ti ; qx'~ I t ;,4 Fml Reading (R~): · ~. a ~ 0 9--' 0 5.0 Test Duration: I ~ ~'~ l I/~/. [ 1,.~r. [ ~,x Change in Reading (RF-R0:: ---, I ftj; ,~ .,th,_ ---- · Pass/Fail Threshold or .t~ , · Test ResUlt: "~ xJ~Pass [] Fail ¢~.eass [3 Fail ~Pass [] Fail ~/Pass :[] Comments - (include. information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 Page __~ of__~__ 5. SECONDARY PIPE TESTING Test Method Developed By: Piping Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: { Equipment Resolution: Piping Run # ~7 Piping Material: ~/I t/~'o ~'/~' }/ ' ~ --"----~ Piping Manufacturer: Piping Diameter: { Length of Piping Run: Product Stored: (.Ta~o[tt~ ff"l G*Sof,'~e C7 0a~ol,'/t~ C4! (4aSo/,~t.~ ?tt Method and location of piping-runisolation: ~I')C ~/q '~U 0~.., 7/g ~V(_.. 7/~t (.JVC 7/le Wait time between applying pressure/vacuum/waterand //t~ /W! ~ /0 ~/,~q /~/lOt// /~/4,4! t,t · starting test: Test Start Time: ('2.: 0 '7 I'~ ;07' [,Z: {b7 {,,~: ~ 7 Initial Reading (Ri): Test End Time: ] :07 / .' 07 /,'0 7 / ' o 7 Final Reading (RE): Test Duration: Change in Reading (RrRO: Criteria:Pass/Fail Threshold or .T~stlResUlt: ~-Pass [3Fail ~g~ Pass [3Fail ~f Pass []Fail [] PaSs ~oil! .... Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 Page ~' of_t~__ 5. SECONDARY PIPE TESTING Test Method Developed By: Piping Manufacturer Industry Standard PriSt~essional Engineer Other (Specify) : Test Method Used: Pressure- V~cuum Hydrostati~c Other (Specify) Test Equipment Used: [ Equipment Resolution: Piping Material: l~ D.[/t~ fc, ~/e ~ ,." Piping Manufacturer: I T~W /~-~ f,1 r~ C~t" :.' Piping Diameter: { ~, ~! Length of Piping Run: '~ O / Product Stored: ~/ ~7~ 3o?~h-~- Method and location of piping-run isolation: [40~ Wait time between applying pressure/vacuum/water and ~'--~f'O starting test: Test Start Time: / Initial Reading (RO: ~. ,9 Test End Time: 2_~- L/0 Final Reading (RF): ~. o Test Duration: [ ~0 (' Change in Reading (RF-Ri): Pass/Fail Threshold or ~t . ~ [ Criteria: ;~St:ReSd!t: ,~Pass [] Fail [] Pass [] Fail Cl Pass [] Fail ' [1 PaSs.:, rl.F,~iii '. .... Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB, January 2002 Page ~ of __~__ 7. UNDER-DISPENSER CONTAINMENT (U-DC) TESTING Test Method Developed By: UDC Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method. Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: I Equipment Resolution: UDC Material: Ic'~ p F~0 f::IZ4° UDC Depth: .-~ [. ?~/ ~e.~_~t Height from UDC Bottom to Top It //~// of Highest Piping Penetration: [ lq [ ~ Ir / ~ /t Height from UDC Bottom to ~ ~ t! Lowest Electrical Penetration: c[ It ~t a Condition of UDC prior to testing: '~ O 0 0 d (7? ootJ ~_r> ~>o4 Portion ofUDC'Tested~ Igoy~ /~[( {~o~l~ (~' ~t~ fa~/~ Does turbine shut down when UDC sensor detects liquid (both Yes No ~ Yes No ~ Yes No ~_~ -Yes No product and water)?' Turbine shutdown response time Is system programmed for fail- safe shutdown?* Yes No NA Yes No NA Yes No NA Yes No NA Was fail-safe verified to be Yes No · NA Yes No NA Yes No NA Yes No N~ operational?* ".'~, Wait time between applying pressure/v~cuum/water and //9 ~ tr 1%. ,~ ~; ~t /t~/'/~fP~ /~/0~ starting test Test Start Time: I t: 7~ g 1 l: ~r~ / Z_;/~' /2: Initial Reading (R0: ~. '~ ~ ~ 7 ,a/~ i *,/o6 q ~. Test End Time: //: ~t/ / F J a ~/ [ 2-: :go / 2-: gO Final Reading (R~): ~- 3 $' ? °~ ~) 3' , ~ ~,~' '-/, Test Duration: I ~- r~ i rl 1~' nmt~''x' [ 5'-~,,¥x Change in Reading (RF-R0: ,~ ' ,-- · O0 / ~ , 005/ ~, OtO Pass/Fail Threshold or Criteria: 4~ ,' ~o 2. ~.~', o~ ~ ~ , o o9_ :t, o Test Result: .~.Pass [] Pail__.~_~, ll~Pass fl Pail [] Pass .j21vaii [] 'Pass 4~l'Faii Was sensorremovedfor[esting? Yes No ~'A~ Yes No ~ Yes No NA Yes No NA Was sensor properly replaced and Yes No ~) Yes . No I~ Yes No NA Yes No NA verified functional after testing? Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the uDC is not tested, specify how much was ~sted. If the answer to an__y of the questions indicated with asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWRCB, January 2002 Page '7 'of__~_ 7. UNDER-DISPENSER CONTAINMENT (U-DC) TESTING Test Method Developed By: U-DC Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic Other (Specify) Test Equipment Used: ] Equipment Resolution: # 3?¥ I UDC # I # I # UDC Manufacturer: //~/~'~7~ ~ bY, s ~e ~.~ UDC Material: ~ t° ~'7~{~' UDC Depth: ~ 7- ~ ~ ' Height from UDC Bottom to Top l/ of Highest Piping Penetration:. [ L[ [ ~ t / Height fxom UDC Bottom to Lowest Electrical Penetration: Lpg/ ~ It ... Condition of UDC prior to (.,.700 ,19 ~?O o J testing: Portion of UDC Tested~ DolCv~ ~/~ I¢o ~u,~ b/r ~ Does turbine shut down when UDC sensor detects liquid (both Yes No ~A~ Yes No A~ Yes No NA Yes No NA produqt ag.d water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* Yes No t.13liY Yes No ~ Yes No NA Yes No NA Was fail-safe verified to be ~.~ operation,al?*, Yes No Yes No Yes No NA Yes No Wait time between applying .. pressure/vacuum/water and / h If' I (~ starting test Test Start Time: ! ' ht'~ '2' i I Initial Reading (~R0: fi,/.t~ ~/~ ~-'- Test End Time: / ' ~ ~' '2 ' Zb Final Reading (RI:): ~ /&/4~ ~'-, I ,~. Test Duration: /5-'"~/~ [ ~-~ ~x Change in Reading (RF-R0: ~ ----, 0 o a] Pass/Fail Threshold or Criteria: ~::, oo 2_ _---e, Och -L ::Test Result: ~-Pass [] Fail [3 Pass ~[3~Faii [] Pass [] Fail [], Pass [3~Fail Was sensor removed for testing? Yes No ~ Yes No ~/~ Yes No. NA Yes No NA Was sensor properly replaced and Yes No ~ Yes No (~ Yes No NA Yes No NA verified functional after testing? Comments - (include information on repairs made prior to testing, 'and recommended follow-up for failed tests) ~ If the entire depth of the UDC is not tested, specify how much was tested. If the answer to .any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) 'SWRCB, January 2002 Page 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes Spill/Overfill Containment Boxes are Present, but were Not Tested Test Method Developed By: Spill Bucket Manufacturer Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum Hydrostatic' Other (Specify) Test Equipment Used: I Equipment Resolution: Spill BOX # ~ 7 I Spill BOX # ~! I Spill BOX # I Spill BOX # Bucket Diameter: / 2- l! Bucket DePth: ~ ~ t/ Wait time between applying and /O /~t'a. pressure/vacuum/water starting test: b Test Start Time: I tQ Initial Reading (R~): .-~ ~ ~ Final Reading (RE): . 'go° ~ Test Duration:. [ ~5-10,q t'/q ~ W t- Change in Reading (RF-R0: ~ · O O / Pass/Fail Threshold or ~ 00 7~ Criteria: .-- · ~' ' ~?est,Reaal~:~ , g'Pass [] eail[] Pass ~ail [] ~'ass [].eail ~,ass ~il Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ' ~ Postage $ , ~ Certified Fee , r'-I Pos'an;utc Return Reciept Fee Here , r-I (Endorsement Required) , r-I Restricted Delivery Fee ~ (Endorsement Required) ,ru 'rotan., THIARA FOOD MART :ru ~ 3401 SOUTH CHESTER I r2 t~ BAKERSFIELD, CA 93304 ........ 1 · Complete items 1, 2, and 3. Also complete ____/...----~nature · Print your name and address on the reverseil X so that we can return the card to you. B. Receivqd_ by (Printed Name) C Date of De ivery · Attach this card to the back of the mailpiece, or on the front if space permits. ..~ D. Is delive~ addre~ di~e~t ~om ~em 1~ Yes ¢. A~icle Addre~ed to: if YES, enter delive~ addre~ below: ~ No T~A FOOD M~T 3401 SOUTH C~STER BA~RS~LD, CA 93304 [3 Se~Typo .]4 ~ Ceffified Mail ~ Express Mail D Registered ~ Return Receipt for Merch~dise, . Restri~ed Deliver? (~ F~) ~ Yes' PS Form 3811, August 2001 DomesUc Return Re~ipt February 5, 200;3~ . ~: Satnam Singh Thiara Food Mart 3401 South Chester Ave Bakersfield, CA 93304 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Frae C.~EF RE: Failure to Perform/Submit Annual Maintenance on Leak Detection RON FRAZE System at the Above Stated Address. ADMINISTRATIVE SERVICES 2101 "H" Street Dear Business Owner: Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 Our records indicate that your annual maintenance certification on your leak detection system was past due on January 8, 2003. SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 You are currently in violation of Section 26410) of the California Code of VOICE (661) 326-3941 "~, · -Oeou~at;ons. FAX (661) 395-1349 PREVENTION SERVICES "Equipment and devices used to monitor underground storage tanks shall be ,...,~sE,~,s.t.~.,.~s~.w.. installed, calibrated, operated and maintained in accordance with 1715 Chester Ave. ~a~ers~e~d, CA 933O1 manufacturer's instructions, including routine maintenance and service checks VOICE (661)326-3979 at least once per calendar year for operability and running condition." FAX (661) 326-0576 PUBLIC EDUCATION You are hereby notified that you have thirty (30) days, March 7, 2003, to either 1715 ChesterAv~. perform or submit your annual certification to this office. Failure to comply Bakersfield, CA 93301 VOICE (661) 326-3696 will result in revocation of your permit to operate your underground storage FAX (661) 326-0576 system. FIRE INVESTIGATION Should you have any questions, please feel free to contact me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 o,ncere, j, TRAININa OIV~SION Ralph Huey 5642 Victor Ave. Director of Prevention Services Bakerslield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 bye ~ Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc D January 22, 2003 Thiara Food Mart ~RE C.~EF 3401 South Chester Ave RON FRAZE Bakersfield CA 93304 ADMINISTRATIVE SERVICES 2101 "H' Street B~l~e~. cA 933o1 RE: Upgrade Certificate & Fill Tags VOICE (661) 326,3941 FAX (661) 395-1349 Dear Owner/Operator: SUPPRESSION SERVICES 2101 "H' Street Bakorsfiold, CA 93301 Effective January 1, 2003 Assembly Bill 2481 went into effect. This vOiCE (661)326-3341 Bill deletes the requirement for an upgrade certificate of compliance FAX (661) 305-1349 (the blue sticker in your window) and the blue fill tag on your fill. PREVENTION SERVICES FIRE SAFETY SERVICES · ENltlRONM~J~TAL SERVICES 1715 ChesterAvo. You may, if you wish, have them posted or remove them. Fuel Bakersfield, CA 93301 vendors have been notified of this change and will not deny fuel VOICE (661) 326,3979 FAX (661) 326-0576 delivery for missing tags or certificates. PUBLIC EDUCATION 171SChesterAv~. L Should you have any questions, please feel free to call me at 661- Bakorsfield, CA 93301 326-3190. VOICE 1661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Sincere~ VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION S 5642 Victor Ave. Bakersfield, CA 93308 Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-4697 FAX (661) 399-5763 Office of Environmental Services SBU/dc 10-02-03 O§'40^M FROM K CONSTltUCTION ?02 SWRCB, January 2002 Page of Secondary Containment Testing Report Form This form i$ lntendtd for ute by contractort lntrformlng ln~rlodl¢ t,Mting of U~r z~Gondary vontalnment ~t~rn~. U~ the appropriate pag~ of this form to report re~ult~ for all components tested. The completed form, written t~t proc~tdur~, and prlntout~ from t~t$t~ (if al~pticablz)o $hould be provid~l to th~ fa~lllty owne. r/ol~rator for ~ubmlttal to th~ local rzgulator~ agcnay. 1. FACILITY INFOI;t3~TION Facility Name: l~t~ ~ v~/ ..................... 'gaiiity Contact: - t [ Phone: 't Date Lomtl nsanoy Was ~lotifi~d _o_fT,K~I$: ~.'?._./I ~ ~.~L" I Name of Local A$cnc¥ Instructor (~r~ent durlq~,t,,~t~tg): ,,, 2. TESTING CONTRACTOR INFORMATION 3. SUMMARY OF TEST RESULTS Not Repairs Component Peas FallTeit~dN°t RepalraMade Componsflt Pall PallTested~ Mad~ ........ Ifh~ ~fin8 ~ ~rfo~d, d~H~ wh~ w~ don~ with th, CERTIFICATION OF TECHNIC[AN RESPONSIBLE FOR CONDUCTING THIS TESTING To the bat of my imowled~#, tbe ~d ia thi~ document are accurate end Itt full comflllanc~ wltit htgal r~quirem~nt$ T~chni~iafl'. $1.at~.:_., ~ Da~; ~'~ ~ ! 10-02-03 09:40AM I ROM K CONSTRUCTION P03 SWRCB, January 2002 Pa~e_ of__ 6. PIPING SUMP TESTING Test Method Devclopcd By: Sump Manufacturer Irtd~try Standard Professional gnglnCer ... Tmgt Me'hod UIK~d: Pressure V'~cuum Hydr~tatic Test Equipmmt used: F, quipm=nt' Resolution: Sump it Sump # Sump # Sump Diameter. ltei~h! ~'om Tank Top to Top of Hi~_~t PIpins Penetration: Height f~mm Tank Top to Lowest Etectricat Penetration: Condition of sump p, rl,'or to testing: Portion of Sump Tested* Does turbin~ shut down when sump soarer deteots liquid (both ~1~ No NA Yes No NA Yes No NA Yes No NA Is sy~tem p.ro~ammed for fail-safe ~k~ No NA Yes No NA Yes No NA Yes No NA shutdown?' Was fail-safe verified to be - oper~ona[?' ~ No NA Yes No NA Yes No NA Yes No NA Wait time between applyin~ pressure/v~uunVwat~r ~ui stmi~S *.~t: Test Sta~ Time; lnil. inl Readina (R4): ~.., ~ ~'~ Test ,T, tme: Test Duration: ,, Clumse in Readhl~ (Rr.l~): '_ - 0 ~ ~ ..... , .... '"' Pass/Fail Throshold or Criteria: , ":rest Rmult2 ,,q~'P~ I~ Fall B 'P~ss B Fall 13 Pass B Fall r~ Pass B Pall Was smuor removed for testing? ,, ~ No N^ Y~ No NA Yes No NA Yes No N_A_. Was sensor properly repla~ed and ~ No NA Yes No NA Yes No NA verifiemt t'~m,~o,,n, at alter testing? Yes No NA Conl~ellU - On~iud~ i~.ormatlon on r~pairs rnade i~rior to testi#$, and recommend~d fotlow, ut~ ~for failed t~t~) * Ifthe entitm depth ofthe sump is not tested, specify how much was tested, if thc answer to any of the questions indicated w~ au astarlsk (*) Is "NO" or "NA'*, the entire sump must be tested, (~ee SWR, CB L(]-160) 10-02-03 09:40AM ]~ROM K OONSTI~UCTION P04 SWKCB, J~u~ 20~ P~e. of 7. ~DER-DISPENSE~ CO~AINME~,,,, (UDC). ~ST~G T~ Me~°d U~: Pm~re ~'acuum ~ ~u~rer: Height ~m U~ BoSom m T~ ofHi~t Pip~ ~e~on: t~ O He~ eom ~ B~om to Condition o~ ~ ~ior to ~ ~ ~ ~b~e ~ut dow. Wben ' ' ~ s~et dead?quid ~ Yes ~o ~ Y~ Ho ~A Yes o~tloa~?' Yea Mo NA Y~ ~o NA Y~ P~Pail ~hold or Cri~ri~ ' ~ o ~ W~ s~ mmo~ f~ ~i~? Yea No ~ Y~ No NA Y~ No NA Y~ No NA ~fl~io~l~n~ Y~ No NA Y~ No NA Ym No NA Y~ No NA I if the entlru depth ofthe UDC is not tested, specify how much wu tested. If the nnswer to'~ of the questions indicated with mterbk (*) is "NO" or "NA", the ent|m UDC must be tested. (See SWRCB LG-160) 10-'02-03 09:40AM BROM K CONSTRUCTION P05 SWRCB, ~anuar~ 2002 Page of 9. SPILL/OVERFrLL CONTAINMENT BOXES FaCility Is Not F~uipped With Spill/Overfill Containment Boxes Spill/Overfill Cofltain~ nt Boxes are Present, but were Not Tested Test M~tod Developed By: Spill Bucket l~nufitctur~ Industry St~dard Professional ~Sinccr To~'Methed ',Js~: Pre~ Vacuum Hyd~ostatl~ Test Equipment Used: ~-quipment Resolution: ~ sPliS._.~~x # spin nox~ sum so~# Wait time between applyln~ .... Test Stm't Time: ~,** ~ Te~ ~ Time:~_~.~ chn~ m badl~ (l~l~: .~,~ .... Test X~eult: d~Pass [~ Fall r~ Pass m Fall G Pass G Fail .,, l:1 Puss f'l Fall Comments - (Incls~_de _Information on repa~r~ made pHo~ ~o t~r~r~, and re~ommv, nde~t ~'olIow-up · CITY OF BAKERSFIELD _ ( OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY /~MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY FACILITY NAME/"k"l./o ~, ~ ! EXISTING FACILITY PERMIT NO. FACILITY ADDRESS ~c~O / ~-.E.b.~ CItY/~v ~, ~-c~x/~s~ j~ ZIP CODE TYPE OF BUSINESS '/q/9 1 ~i r'~ ~/~,/~% ~d~ APN g TANK O~ER ~'~ ~ b ~,~ ~ PHONE NO. ADDRESS Z~o ~,~ ~d. CITY ~~~ ZIP CODE %31~ CONT~QR ~<~ ~a ~d~cd a ~ CA LICENSE NO. ~/o~ ADD,SS ~'~0, ~oX ~Oq~ CITY ~,sC~{~ ZIP CODE q~6 PHONE NO. ~/~3~q ~c} BA~RSFIELD CITY BUSINESS LICENSE NO. WOMAN COMP NO. INSURER BRIEFLY DESCRIBE THE WQ~ TO BE DONE ~ ~ m~ ~ ~,~ a~ b/~6'S. ~~ ~o~'I]~_J$/C WATER TO FACILITY PROVIDED BY E ~ I ~~ DEPTH TO GRO~D WATER l ~o ~ SOIL TYPE EXPECTED AT SITE ~ ~ ~ i ~ ~ NO. OF TANKS TO BE INSTALLED /~ ARE THEY FOR MOTOR FUEL ~E NO SPILL PREVENTION CONTROL AND CO~ER MEASLES PLAN ON FILE ~: YES NO SECTION FOR MOTOR FUEL TANK NO. VOL~E ~LEADED REGULAR P~MIUM DIESEL AVIATION [ i~.Ooo ~ / SECTION FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) (IF KNOWN) FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. NO. OF TANKS FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FO~ HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEDE, IS TRU~ ~1~ CORP~2T// · APPROVED BY: . APPLICANT NAME (PRINT) ~(PI~ANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING FACILITY PERMIT TO OPERA~ OPERATORS NAME, · ~ ~ VOL~ CO~S TANK TESTING COMPANY ~/~/'l,/" CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r" Floor, Bakersfield, CA 93301 FACILITY NAME /-'}xl~'o,- ~:~ta~ ~4tt?t" INSPECTION DATE ADDRESS ~q'O ( ..~. ~t'.~¢~ PHONE NO. FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program I~ Routine ~Combined [~l Joint Agency {~ Multi-Agency ~,~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate ' Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material ~.. Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Explain:Any hazardous Waste on site?: [~Yes ~(No Questions regarding this inspection? Please call us at (661) 326-3979 Busines~ Site ~ponsible Party White - Env. Svcs. Yellow- Station Copy Pink- Business Copy Inspector: THIAR~ FOOD MART ~401 SO CHE~TER BAKERSFIELD C~ 661-8~32-5900 DEC 3, 2002 ii:iS PM SYSTEM STATU~ REPORT L 1 :SETUP D~TA WARNING L 2:SETUP D~TA WARNING INVENTORY REPORT VOLUME :'~ 3834 GALS ULLAOE ~- 6166' OAL~ TO VOLUME = ~791 HEIOHT = 39.16 INCHES ~ATER VOL = 0 I,,J~TER = O. O0 INCHES TEMP : 75,9 DEO F T ~EMI UM VOLUME = 1334 ULLAOE = ~66~ OAL~ 90~ ULLAGE= 7666 GALS TC VOLUME = 1319 GALS HEIOHT = 18.',35 INCHES WATER VOL = 0 GALS ~ATER = 0.00 INCHES TEMP = 75.5 DEG F CITY 61~B~KERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ' I'~ta.q'k ~OOd ~]40~'qL INSPECTION DATE ['2.' Section 2: Underground Storage Tanks Program ~l Routine ~l/Combined [~ Joint Agency [] Multi-Agency [] Complaint ~ Re-inspect/on Type of Tank ,~00 t.. [E. tg. ] Number of Tanks Type of Monitoring ~ Type of Piping .Dc0 V/' ¢'~ OPERATION C V COMMENTS tank data on file Proper Proper owner/operator data on file Permit tees current L,/ Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY' Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO ~fl~ J0C.{ Office of Environmental Services (805) 326-3979 Business Site R Party White - Env. Svcs. Pink - Business Copy APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ '"~ SECONDARY CONTAINMENT TESTING .. pERMIT TO OPERATE #, , , ,, OP~_~TOaS ~A~m ~~ NUMB~ OF TANKS TO BE TES~,, ~ IS PIPING GOING TO BE TES~ TANK # VOLUME CONTENTS TANK TESTING COMPANY ~;'5,~FI-- NAMfl & PHONE NUMBF.,R OF CONTACT PERSON c~ t~ NAME OF TESTER OR SPECIAL INSPECTOR CmTn~C,~tON # ,OZo~?W*/o t , DATE.~.TIME TEST IS TO BE CONDUCTED APPROVED BY DATE SIONATURE OF APPLtC,~,IT CITY OF BAKERSFIELD_. C ICE OF ENVIRONMENTAL RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY P3ge __ of FYPE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT '[~ 5. CHANGE OF INFOR~TION (S~eci~ change - ~ 7. PER~NENTLY CLOSED SITE (Check one ytem only) ~ 4. AMENDED PERMIT local use only) ~ 8. TANK REMOVED 400. ~ 6. TEMPO~RY SITE CLOSURE I. FAClLI~ I SI~E INFORMATION N~REST CROSS STREET 401. FACIL}~ O~ER ~PE ~ 4. LOCAL AGENCY/DISTRICT' BUSINESS ~ ~ 6. STATE AGENCY' ~PE -- ]. GAS STATION ~ 3. FARM ~ 5. COMMERCIAL ~ 3. PARTNERSHIP ~ 7. FEDE~LAGENCY' 402. ~ 2. DISTRIBUTOR ~ 4. PROCESSOR ~ 6. OTHER 403. TOTAL NUMBER OF ~ANKS Is fa~lity ~ indian R~ati~ ~ ~ 'If ~et ~ DST a public agen~: name ~ suD~sor of RE~INING AT SITE 1ms~lands? [ divisi~, s~i~ ~ offi~ ~i~ ~at~ the UST. (This is the ~ta~ pe~ f~ the tank r~.) ~ 4~. ~Y~ ~No ~5. 4~. II, PROPER~ O~ER INFORMATION ~IklNG Da STREET ADDRESS CI~ 410. STATE 411. ZIP CODE 412. PROPER~ O~ER~PE D 2. INDIVIDUAL ~ 4. LO~LAGENCY/DISTRICT ~ 6. STATE AGENCY 413. ~I. ~ 3. PARTNERSHIP ~ 5. COUN~AGENCY ~ 7. FEDE~LAGENCY COR~TION III, TANK O~ER INFORMATION TANK O~ER ~ME 414, PHONE 415. ~ILING OR STRE~ aDdRESS CI~ ~ 417, STATE~ 418. . ZIP ~OE~q 419. TANK O~ER ~PE ~ 2. INDIVIDUAL ~ 4. LOCAL AGENCY/DISTRICT ~ 6. STATE AGENCY 420. ~1. ~ 3. PARTNERSHIP ~ 5. COUN~AGENCY ~ 7. FEDE~LAGENCY COR~TION IV. BOARD OF EQUALI~TION UST STOOGE FEE ACCOUNT NUMBER TY (TK) HQ 4 4 - Call (916) 322-9669 if questions arise 42~. . V. P~ROLEUMUST FINANCIAL RESPONSIBILI~ INDICATE METHOD(S) ~. SELF-INSURED ~ 4. SUR~BOND ~7. STATEFUND ~ 10. LO~L~MECHANISM ~ 2. GUA~NTEE ~ 5. LE~ER Off CREDIT ~ 8. STATE FUND & CFO L~ER ~ ~. OTHER: ~ 3. INSU~NCE ~ 6. ~EMPTION ~ 9. STATE FUND & CD 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS Ch~ ~e box to {ndi~te ~i~ addr~ sh~id be us~ f~ I~al n~ifi~ti~s and mailing. L~al notifi~ti~s and mailings ~11 be sent to the tank ~ units box 1 ~ 2 is ~. 1. FACtLI~ ~ 2. PROPER~ O~ER ~ 3. TANK O~ER 4~. VII, APPLICANT SIGNATURE Ce~ifi~ti~: I c~i~ that the inf~mati~ pmvid~ h~n is true and a~rate to the ~t of my kno~edge. NAM~ ~PPLICANT (pdnt) V 426. TITJE OF APPLICANT 427'. STATE UST FACILITY NUMBER (For local use only) 428. 1998 uPGRADE CERTIFICATE NUMBER (For local use only) 429. J UPCF (7/99) S:\CUPAFORMS\swrcD-a.wpd OF~E OF ENVIRONMENTAL ~)RVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNOERGROUND STOOGE TANKS- TANK PAGE cO~T~ON ~IN ~ ~ L TANK CITY OF ~AKERSFIELD -- · ~ OFFTCE OF ENVIRONMENTAL .ERVICES ~i~ ~ C~r A~,. ~ke~fleld, CA 9~1 (~1) 3~79 SYSTEM ~ ~ I ~ESSURE ~ 2. ~T~N ~ 3. ~ ~ ~ t. ~ESSURE ~ 2. SUCTION ~ 3. ~ 4~ ~NUFACTURER~ Z ~U~E WALL ~ ~, U~ ~ 2. ~U~E WALL ~ ~. OTHER ~1 ~FAC~RER ~ ~TER~S A~ ~ 2. STA~ ~ ~ 7. ~V~ ~ ~ 2. STAIN~ STEEL ~ 7. ~V~D ~EEL ~RROSION c,~AvrrY ~ow~. c,~AvrrY ~.ow (c~c~ ~ ~ ~m/y).- J"'] g. mENMALINTEC~TEST(0.1(3PI. I) I""1 8. OAILYVtSUALMONITOt~NO l"'1 e. mENNT~.~TEST(O.S ~=H) FJ~RGENCY 0 ~)I~..R~ ONLY (Chggk M M allll/y) I~ERO~ G~ld~R~TOIi~ O~Y (~ M M ~ RESTRICT~N 17. O~LY~ECK ~ 17. ~LY~ECK ~ O~~TOR (p~ 471 T~E OF~E~T~ 472 UPCF (7/99) S:~,CU PAFORMS~SWRCB-B.WPD :O _ CITY OF BAKERSFIELD OFI~E OF ENVIRONMENTAL ~ktVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 · UNDERGROUND STORAGE TANKS- TANK PAGE 1 L TANK .. : "'~" e5 CITY OF IIAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICE8 · /'~ Che~ter Ave., Bakemfl®ld, CA 9~01 (~1) 3~79 II I UNOER~UNO ~ A~VEG~UND SYSTEM ~PE ~ ~. ~ESSURE ~ 2. ~TION ~ 3. ~ 4~ ~ ~. ~ESSURE ~ 2. SUCTION CONSTRUCTiO~j~ I. SINGLEWALL ~ 3. UNEDT~ ~. O~ER ~ ~ t. SIN~EW~L . ~'~. UN~ ~NUFACTURE~ 2. ~UBLE WALL ~ ~. UN~ ~ 2. ~U~E W~L ~ ~. OTHER ~ ~FA~RER ~1 ~UFACTURER ~ I.~S~EL ~ ~. F~A~Wlt~~L ~ I. ~E~EEL ~ 6. FRP~ATI~EWII~~~ j ~TER~S AND ~ 2. STAI~ ~EL ~ ~. ~V~ ~ ~ 2. STAINLE~ STEEL ~ Z. ~V~D ~EEL ~RROSION j~ 3. ~IC~A~~ ~. U~ ~ 3. ~TIC~MPATI~TH~S ~ 8. ~I~(H~) ~. O~ ~OTECT ON ~ S. S~EL WI COA~M 9. ~O~ ~N ~ ~ 5. S~EL WI ~A~NG ~ ~. UN~ ~5 U~E~U~ ~.~ '~UND PI~ · ~ ~ ~ ~ ~LE W~L ~ ~ ~. E~C~~OR3.0~~~~FOR ~ 1. ~C~~R3.0~~O~O~FOR~ ~ 2. ~Y0~ ~ 3. ~~(~ ~ ~ 3. ~N~~(O.~ ~) ~ 4. ~~E~ CONVENTIONAL SUCTION SYSTEM~: CONVENTIONAl SUCTION SYSTEM~ (Check al that apply): r-I 5. DAJLY VISUA~ MONITORING OF PUMPfNG SYSTEM + TRIENNIAL PIPING INTEGRITY r-I 5. DAILY VISUAL MONITORING OF Pti=lNG AND PUMPING SYSTEM TEST (0.1 Cd=H) [] 6. TRIENNIAL INTEGRITY TEST (0.1 OPt4) SAFE SUCTION SYSTEMS (NO VALVES iN BELOW GROUND PII~NG~ SAFE StJCT~N SYSTEMS (NO VALVES ;N BELOW GROUND ~PING~ [-I ?. SELF MONrrOmNG [] 7. SELF ~ION~OmNG GRAVr/Y FLO~. GRAVITY FLOW (C/',e~ al tl~at apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) [] S. DAILY VISUAL MONITORING [] 9. mEN~AL ~TEC, RrP~ ~ESY (O.1 SECONDARILY CONTNHED PIPIHG ~=CONDARJLY CONTNNED ~PING PRESSURIZED ~ (Check al ~tat apply): PRESSURIZED PIPING (Check al that aPpty): ~0. CONT;NUOUS 11JRBINE SUMP SENSOR WITH AUOE)LE ANO VISUAL ALARMS AND (C..~e~ ~ne) 10. CONTINUOUS TURBINE SUMP E~,,ISOR vll~TrlJ AUDIBLE AND VISUAL ALARMS AND (ctmc:k ~ne) '~a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS D. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] I). AUTO PUMP SHUT OFF FOR LEAK~, SYSTEM FAJLURE AND ~YSTEM DISCONNECTION DISCONNECTION [] c. ND AUTO PUMP SHUT OFF [] c. ND AUTO PUMP ~ OFF [] 12. ANNUAL ~rEG~rrY TEST (0.1 Ca=H) (-] 12_ A~UAL~NTEGR~YTEST(O.t G~) EMERGENCY OENERATOR8 ONLY (C. Je~ al ff~ aR~,) EMERGENCY GENERATOI~ ONLY (Che~ al mat [] 14. CONTINUOUS SUMP SEN$OR WITHOUT AUTO PUMP ~ILIT OFF + AUI3I~I.E ANO [] 14. CONTINUOUS SUMP ~R WITHOUT AUTO PUMP SHUT OFF + AUOIBLE ANO VISUAL VISUAL AblJ~MS ALARMS [] 15. AUTOMATIC LINE LEAK OETECTOR (3.0 GPH TEST) WTTHOUT Ft.OW ~HUT OFF OR [] 15. AUTOMATICLINELEAKOETECTOR($.OGPHTEST) RESTRICTION [] 18. ANNUAL INTEGRITY TEST (0.1 GPH) I--I 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. · , '~'~ ...... J ,., j [] 17. DAILY VISUAL CHECK DAILY VISUAL CHECK . OlSPENSERCONTAINklENT I"'1 1. FLOAT MECHANISM THAT ~HUT~ OFF ~HF. ARVALVE [] 4. DAILY VISUAL CHECK OATEIN~JTAiLL_E.0/ 4~8 ["1 2. CONTINUOU$OISPF. N~ERPAN~NSOR+AUOIBLEANDVISUALALARMS [] 5. TRENCHUNER/MONITORING I/~.~ I~ ~' I"] 3. CONT'INUOU~ DISPENSER PAN ~ WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VI$1JAL ALARM~ r'"] 6. NONE 4~9 IX, OWNER/OPERATOR ~IGNATURE ~ c~'tify mat me into~mam~ 0mvtded ~'eln i= ~ ane .ecumte to me I~t d my $10NATUI~E'~)F O~/NERJOPE~TOR~ ~ ~ i ~///i~ . I DATE ~/0~1'1 ~,~10~,.._,~ 470 NAME OF OWNER/OPERATOR (pr/nt~_, 471 TITLE OF ~)VVNER/OP~RATOR 472 UPCF (7/99) S:\CUPAFORMS~SWRCB-B,WPO WRI~EN MONITORING PRO,ED--S UNDERGROUND STORAGE TANK MONITORING PROGRAM ,at. Describe the fi- ,equency of performing the monitoring: Piping (l~w~ ~x.~_~ , - B. What methods and equipmeat, idemiffed by name and model, will be used for perroagn& the monitoring: C. Descr/be the location(s) where the monitoring will be performed (facility plot plan should be attached):. D. List the name(s) and fide(s) of the people responsible for performing the monitorin& and/or . ' .main!aining the,equip,merit: I ~ E. Reporting Format for monitoring: AT Piping .AT¢ F. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance sehednle . but not less than every 12 months. ..... ~-- --- .-- .... ---- .....~ - ,~.c- ~..~e !t~ O. Describe the training neces.~.sary for the operation of UST s/stem, including pipins, and the EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kepi at the UST location at all times. The information on this monitoring program arc conditions of the operating' permit. Thc pcrmi! holder mus~ notify the Office of Environmental Scrvices within 30 days of any changes to thc monitoring procedures, unless required to obtain approval before making thc change. R~quired by Sections 2632(d) and 2641(h) CCR. Facility Addressg~t ~. C~,t&q'er ,L-~. . ._..~ 1. If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the enviroment, increase the fire or explosion ba--,'cl, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notified 2. Describe the proposed methods and equipment to be used for removing and properly aispos .s otany hazaraous substance. SeJ aa , .6ee Otc. k~o~- 3. Describe the location, and,availability of~e required cleanup equipment in item 2 above. 4. Describe themaintenance schedule for the cleanup equipment: 5. List the name(s) and title(s) of the person(§) responsible for authorizing any work necessary under the response plan: ~.~c~tsai~,. ~t~,~ 4- ~'f:~.~c ~ " CERTIFICATION OF FINANCIAL RESPONSIBILITY If you are u~ir~ the 8taw Fund a~ any part ol your r' The mechan~ umed lo ~ fil~anc~l reSl~on~ibil~ a~ ~ b~ S~t~n 2807 are ~ i