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Home My WebLink AboutBUSINESS PLAN 10/29/1986 Facility Name .-7-/~ F~'~ [~g~ Date PINAL INSPBCTION CHECKLIST / , Plot Diagram ." Plot plan notes .... Yes. No. ¥ 1. Ail new and existing tanks located on plot plan? 2. Does tank Product correspond to product labels on _. - plot plan? ¥ - ~ 3. Was there no modifications identified which were I {_{ not depicted on the plot plans? If "No" described .......................... 4. 'Are'm°n'it°rins'wel't~'-Secureand-~.E~P ~ Water. and .............. !_! .... I ...... Product in sump? - 5. Is piping system pressure, suction or gravity? ~3~e~ Ii. ,t ;, i::,?:: ~::,',: ,:, LOCATION DATA ' · : · ' ' Page 2 Ii':[~!'!;' :' :? ":' '::~,:'. - ~'." ::'..;=:.. ~;';' -': ' '*>" DATE:' . . '~ / /~:) [2-"/'~ CUSTO CITY: · . .. ~.D. ~.". :~":~'"~'~ :' ~'~'? ' :, STATE: : ~; ,.'~. WEATHER .?,'/:~"~'~, ;f::,.', ~:"""~"' `;~q.~: TiME., ,., ,,, ~ TEMPERATURE COMMENTS BEFORE TEST -' :': ':"~' ":+>"'":~'" :" :~q':; ~'~'''' ' , SCHE~T~C=.' "~:. :.:: :.:~,;:,:?'.?, ., :.:. :.:'.?;:. '.;:: :...~ . . ~ ~ ~/3 ' ~ ~' .~ .. :: ...:......, ,:.:/~,.. '~~..,. ~,, >'~.?~ .. ~ '.',. ..: '.::.' .v.;..,....,.:::'~~, ~.~. / -,~., ~ ~ ~,~., . ~ ' '-' ~' ": "'," :'-',::.:': '~:.::'h~' Z~%/: ~". ~ .. '. ' .' ~ ' . ~ ',~ .... ,..,' ; .. ,~,;' '~'.,. .,.~.~ .~..~ ~%..~ '. . . ..... ..,.. . . ~.. ,. . ~- ~ ~.,. , ~ ....... .., ............. . ... .... ~. ~ . ~ ...... .... . ........ , .... ,... ... ....... . . ~ , .. ...'.,...: .-:,.' ,,...~::~:~, ~ ~ ~ ~. · .... ~., ...',':..",.:.,.~.? ..... . .... , ~ .. . _.: . j~ ..'.. .......~., .,~:,..~.~.~=,1.~,,,. ~ ............. : : ~., ~ .' L.. ,.-.. '.:: .: .:. :::~:.:..... ::..:t '~ ..:".",>. -.. · ..' , . . ' ' . ' ' I' ': .... ,:u~ '.' ."':~ ~ ...... . ' ' :' "' ' ' ~ '"'. '"".~.' .':.~.::,.~,'.-L,~ O .: .... ."::.: "' '. . ' ' ' ' "' ' ~.: ~ ".~'- : :- ..:.....:.:,:.::.~:~,,~ ~ ':.',:., . :' ... . '...' ..... . '., ,:, ' " '. ', '.. .... ~ :.~ , "e%.' : ' ~ ' I · ' " ' ..... . . . . ~.. ,. .~ , ? · . . ':~ ' .: :."' . ..~: . ~ '.:%-; . . . ~ . . . ... ... . ... '~: ,,.~, ' ....' : ' ... ~ : ' ., ::: '.'. .. '. ....... . .:~...,: ..'.., ..:,...:.. :~ ...... .,..: . · ... ~ .. ' .-?t ~' ..: . , ' · . . . ~ , ' ~ ~ GAcc°Hs'~":'"':':'";~',>~'::'~::''':'''''~' ~o~o: ": DROP TUBE.. ~ (~.(~--( ) ' CAPACITY, GALLONS ,/O1 0 '/~ ' /0>. C~ (~' /'C:'~x~ /' ~;:) ' " DIAMETER;' INCHES., (O~. '/' ~' ' ' puMp'TypE ..... ~'.~,::,~?;: ' i~)~,~?C ,~i:~,,)~C,.~.~.;, ,,' .' : ,,..~,.,4~ ,. ,...,- ~ ..... , -:., . ~ ,'~'~'~ . ~ ,,.~.-,- ~. ~ -, ~.'~;~... TYPE oF ':~'" C:'i') i ~ ""'" '" ' "" (' ':: .... '" , - .... J~ ~*, ,- ~: , -. , , ~' ,. -,.. ~ ..:~ ~ ~., . ., AGE OF TANK , ~ . . ~;.~ ,." " ~ ~fQ. 4',,.".? ' SIPHON :' ' ':' " ~, ~4 "'" ..'.~..~,',,-~... "'~ T~N~ OP~N~NgS,"~'~ .... t "~/~' /"',~':: "'t ,)'.' ~'' -%,: -. -- . ~ , ',', ........... _ .......... ...... ~' ,.,J",'t~, ,.,.,.., ,, .... . ......... ' ' ' .. ~ ~' _,....~.. '~ ~' ~EN~-CON~IGUR-~IONp-v VENT VALVE 'TYPE ::(:'~6~: ~' : <"'"""1'~? 4~'' : f',,,'____., ' . ~'-:'' . ~j.,. ~,-.1., . ~ ~ :.. .. , ..... ,.:~..~..:..:.:..... :.. :, .-' . .,.:. ~, . · . kCEMENT PARTS: ..:~. PART ~ : ' DESCRIPTION QUANTITY ~RICE ." :.' .: .. '..'.. ,.,,:.':'. '. , . ,' *Data obtained from ~ Station ~ LL Charts ._~ Other ~ .-..~:.':. ...'..'~.,. .~L'..::, ~', " '.' " '~. ~.':..t~%.' .. . ,." ..:.,,~.:~~-. ..... . .... ,..' . ', . ...... HM808101 Account Number ACCOUNTS RECEIVABLE ADJUSTMENT February 16, 1994 , Date New Ac=ount New Address Esther Duren Close Account From Service Chanqe Other Adjustments X Fire Department- Hazardous Materials Division Department/Division 7-ELEVEN Billing Name 525 W. COLUMBUS ST. Billing Address Site Address Parcel # (If Applicable) Landlord Name & Address (If Applicable) ADJUSTMENT Last Billed Correct Billing Adjustment to Effective Date of Billing Change 264.00 0 <264.00> 1-1-94 Remarks: DUPLICATE-BILLING FOR uST's ALREADY BEING BILLED UNDER UT726001. 7-E~en Food Store #2125-16834 525~. Columbus Bakersfield, CA. 93309 ~ ~,o~ 57o 6/ ~txri P~mc~s 52.5 w, ,Sro r ~ Jcle~e,s I I 7-Eleven Food Store #2125-168~4 r ¢ :~7 ELEVEN FOOD STORE 6834 SiteID: 015-021-000806 Manager : ~.%%%%%% BusPhone: (661) 322-7879 Location: 525 W COLUMBUS ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 18D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:5541 EPA Numb: DunnBrad: 00 - 734 2 Emergency Contact / Title Emergency / Title SHASHI/VEENA KAMBOJ / FRANCHISEE DISPATCH / EMERGENCY SVCS Business Phone: (661) 322-7879x Business Pi : (800) 828-0711x 24-Hour Phone : (661) 322-7879x 24-Hour : ( ) - x Pager Phone : ( ) - x Pager : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact . Bv~ DENi~O~ Randy Martin Phone: ( .... , =~J..~ .... MailAddr: PO BOX 711 State: TX City : DALLAS Zip : 75221 Owner THE SOuin~,~ ~n~ ~, J2~¢_ ~~~ .......... ~ ...... ~T .... Phone: x Address : PO BOX 711 State: TX City : DALLAS .Zip : 75221 Period : to TotalASTs: = G~i Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: I, Martin ~ Do hereby ce~iq, thett have revi{the attached hazardo~' ,~,,,.~:~1~, m~r~age- plan f°r~~, ~/~f~r]d tlmt it alor~g with (~e ~ ~,~si~) ' ' corre~ions constitute a ~mple~e and ~rrsci man- formyfa'l . 1 06/16/2003 ~ELEVEN FOOD STORE 6834 SiteID: 015-021-000806 ~ STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE~73~t-~2~3-16834 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : D: ~ Y-Eleven, Inc. Phone: (8~ S28-~)-7-1-1-x~ Address: 4[ Gasoline Acctg. ~-~- ~. ~ / 7 ~3 City : P.O. BOX 711 State: Zip: Type : Dallas, IX 75221-0711 -ti~K ~3.wL~.~R_ INFORMATION Name : DI: I// 7-Eleven, ~n0. Phone: (~x Address: ~ Gasoline Acctg. ,~5-~- ~¢/,-.'-z,? o City : P.O. Box 711 State: Zip: Type : Dallas, IX 75221-0711 BOE UST Fee# : 002251 Financ' 1 Resp: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 ~ ~ Phone: (5~77 7713x- Name :-?OB DE~7!~?~70 Randy Matin , Ttl :ENVIRON. MGR. $~-7~-- 7/7~) State UST # : 1998 Upg Cert#: 00778 -2- 06/16/2003 July 11, 2003 Mr. Ralph Huey Bakersfield Fire Dept. Prevention Services 1715 Chester Ave. Bakersfield, CA 93301 Dear Mr. Huey: Enclosed are the updated Business Plans for the following 7-Eleven sites: 7-Eleven #16329, 1701 Pacheco Rd. 7-Eleven #16549, 4647 Wilson Rd. 7-Eleven #17721, 3601 Bakersfield '7-Eleven #16834, 525 W. Columbus St. - Please note this site has closed for gasoline operations, effective 6/16/03. Should you have any questions please feel free to call me at 253-796-7170. Sincerely, .-Randy Ma~_..~3 . Environmental Manager RM:rr 7-Eleven, Inc. Environmental Services Department / 10220 S.W. Greenburg Road, Suite 470 / Portland, Oregon 97223 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES ( 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATIOn' (CHECK) [ ]NEW FACILITY [(MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE PROPOSED COMPLETION DATE FACILITY NAME 7-L~LL--I/~-A[ ~fi/~ ~1 EXISTING FACILITY PERMIT NO. FACILITYADD~SS ~ ~- Co(~b~ CITY ~~/d~ ZIP CODE ~PE OF BUSINESS ~+~,'1 ~ ~1 s~c~ APN~ TANK O~ER ~ ~-~LL~'U~( ~, PHONE NO. ADDRESS ~0. ~ 7b~ CITY ~b[&s ~ ZIPCODE CONT~OR ~T ~'~(~5 ~ ~ CA LICENSE NO. PHONE NO. ~ ~- 7z/- ~/g 0 BA~RSFIELD CITY BUS.ESS LICENSE NO. WO~ANCOMPNO.~ o~D7 Y~ INS~ER ~ Com~$t~ BRIEFLY DESCRIBE THE WO~ TO BE DONE ~ ~-~ ~ ~t~ ~ o ~ ~ or ~. WATER TO FACILITY PROVIDED BY ~-Zc'-LL~O~/~/ DEPTH TO GROUND WATER I~{//~ SOIL TYPE EXPECTED AT SITE K0 NO. OF TANKS TO BE INSTALLED ~5' ARE THEY FOR MOTOR FUEL )<7' YES' NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ~ YES NO SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION 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 $ I 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/gM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS APPROVED BY: ~ . APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED OFFI~]~ OF ENVIRONMENTAL SER'gICES r 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 " UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page ~ ~ ~ TYPE OF ACTION I'~ 1. NEW SITE PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE (Check one item only) [] 7. PERMANENTLY CLOSED ON SITE [] 3. RENEWAL PERMIT (Spech'y reason - forlocal use only) (Specify change, forlocal use only) [] 8. TANK REMOVED 430 BUSINESS.~-~/-~-i~r~-~--//[//'NAME (Same. FACILITY NAME o~ DBA- I~ing~/~-~Busin' As)y 3I F~ILITY:: i'.~i::" M I l ..' .. .. . ':.. 1 LOCATION WITHIN SITE (Optional) 431 : · ' ' '.i .' i:,:ill~: :'.: ". 'I. TANK DESCRIPTION / ADDmONAL DESCRIPTION (For local use only) 438 E~, TANKUSE 4~S ~ RETROLEUM TYPE ~ MOTOR VEHICLE FUEL . REGULAR UNLEADED I*-I 2, LEADED [] 5, JET FUEL (If marked, complete Petmleum Type) E~lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM ~1c, MIDGRADE UNLEADED [] 4. GASOHOL [] gg. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventery page) 441 CAS ti (from Hazan~ous Mete~fals Inven~my page) 442 I--I 4. HAZARDOUS WASTE (InduCes Use~ Oil) [] 9s. UNKNOWN TYPE OF TANK [~2/SINGLE WALL~"] [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 'Check one item only) , DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 4. SINGLE WALL IN A VAULT r~ 99. OTHER TANK MATERIAL - prima~ tank F'~ 1. BARE STEEL ~31 FIBERGLASS ! PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 (Check one item only) [] 2. STAJNLESSSTEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRPCOMPATIBLEWI100%METHANOL []99. OTHER. ~,~*RE!NFORCED PLASTIC (FRP) TANK MATERIAL - se~dmy lank [-~ 1. BARE STEEL l-I 3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEWI100% METHANOL []95. UNKNOWN 445 Check one item only) [~] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER. REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] s. CONCRETE TANK INTERIOR LINING F'I 1. RUBBER MNED [] 3. EPOXY LINING [] 5. GLAS~ LINING ~95 UNKNOWN 446 DATE INSTALLED 447 OR COATING · [] ~_ ALKYD LINING [] 4. PHENOLIC LINING [] 6. UNLINED [] 99. OTHER Check one item only) ,/,~ (For local use only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 3, FIBERGLASS REINFORCED PlaSTIC [~5' UNK.NOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER Check one item only) [] 2. SACRIFICIAL ANODE (For local use only) (Check all t~etapply) SPILL CONTAINMENT ~1. ALARM I~J 3. FILL TUBE SHUTOFF VALVE DROP TUBE [~2. BALL FLOAT ~ [] 4. EXEMPT STRIKER PLATE IF SlNGLE WALL TANK (Check alI that apply)c 455 IF DOUBLE WALL TANK OR TANK WlTH I~LADDER (Check one item only): 454 [] 1, VISUAL (EXI~SED PORTION ONLY) [] 5. MANUAL TANK GAUGING (MTG) I-] xl. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 6. VADOSE ZONE [~'2, CONTINUOUS INTERSTITIAL MONITORING [] 3. CONTINUOUS ATG [] ?, GROUNDWATER [] ~. MANUAL MONITORING [] 4. STATISTICAL ~NVENTORY RECONCILIATION (SIR) * [] 8. TANK TESTING '~,.'(~ ,i, 'i:i ,i/?"i 'V.T^NKC~OSURE ~N~OR~A~ON!PEm~nEN?CLOSURE,~N ~L~CE' ' , ' ' ~ ' :" · ~,: ,'i ""' ESTIMATED DATE LAST USED (YR/MOIDAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 45? [] Y~ [~No UPCF (7/99) ' S:~CUPAFORMS~SWRCB-B.WPD CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave,, Bakersfield, CA 93301 (661) 326-3979 UST -TANK PAGE 2 Pa~e UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [~1. PRESSURE [] 2. SUCTION [] 3, GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459:, CONSTRUCTION/[]~ SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURERE~'2.. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6, FRP COMPATIBLE WI 100% METHANOL [] I. BARESTEEL [] 6. FRP COMPATIBLE WI100% METHANOL MATERIALS AND [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] ?. GALVANIZED STEEL CORROSION PROTECTION []/3; PLASTIC COMPATIBLE wrrH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE VVITH CONTENTS [] 8, FLEXIBLE (HDPE) [] 99. OTHER I j'7] 4. FIBERGLASS [] 8. FLEXlBLE(HDPE) []99. OTHER [] 4. FIBERGLASS [] 9. CATHOOICPROTECTION [] 5. STEEL WI COATING [] 9. CATHODIC PROTECTION 464 i [] 5. STEEL W/COATING [] 95. UNKNOWN 465 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WTTH AUTO PUMP SHUT'OFF FOR LEAK, LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 2, MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 3. ANNUAL INTEGRI'PfTEST(0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS: -CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY [] 5. DAILY VISUAL MONiToRiNG OF PIPING AND PUMPING SYSTEM TEST(0.1 GPH) [] 6. TRIENNIAL INTEGRITY 'lEST(0.1 GPI~I) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PiPiNG): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] ?. SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW: GRAVITY FLOW (Check all that apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAJNED PIPING SECONDARILY CONTAINED PIPING , ' PRESSURIZED PIPING (Check all that apply): PRESSURIZED PIPING (Check all that apply): . 10. CONTINUOUS TURBINE SUMP SENSOR WrTH AUDIBLE AND VISUAL ALARMS AND 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUD BLE AND V SUAL ALARMS AND (cfleck one) (CheckAuTOone) PUMP SHUT OFF WHEN A LEAK OCCURS [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [~bl AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM [] b. DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR [] 11. AUTOMATIC LEAK DETECTOR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0,1 GPH) SUCTION/GRAVITY SYSTEM: SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP S[~N~eOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALARMS [] 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 468 E~ 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER ! MONITORING 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 ~. :. .. ::: :::i: .,:!i'.,::: :: !X~ OWNER/OPERATOR SIGNATURE : ' ' I certify that the info~'maUon~ded herein Is I~ue and accurate to the best et' my knowledge. ~ OF OWNER/OPERATOR (print) 471 TITLE OF/OWNER/OPERATOR-- 472 UPCF (7/99) S:[CUPAFORMS~SWRCB'B.WPD CITV OF BAKERSFIELD OFFICE OF ENV1RON~tENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 V, T~ CLARE ~F~ON I ~E~CL~URE tN ft~ f 4~7 , CITY OF BAKeRSFiELD' OFFICE OF ENVIRONMENTAL SERVJGES 17t5 Chelter Ave., Bakersfield, CA 93301 (661) 326-3979 UST - TANK PAGa 2 ~ .............. '~'-- UNDERGROUND PIPING ABOVEGROUND PIPING ! SYSTEM TYPE ~NUFAC~E~ 2. ~U8~ WALL ~ 95. UN~ ~ 2. ~UB~ W~ ~ ~. O~ ~UFACTU~ ~t ~UFACT~R ~TER~LS AND ~ 2, STAI~SS S~EL ~ 7, ~V~D S~EL ; ~ Z STAIN~$S $~EL ~ 7. ~V~O ~EEL ~0~0~ PRO~N ~. ~~ATIB~ ~ ~ ~ ~. U~ ~ 3. P~C~A~B~ ~S ~ 8. F~(H~E} ~ ~. O~R ~ 5. S~EL W/~A~ ~ g. ~D~ ~N ~ ~ 5, S~EL WI ~A~NG ~ ~. UN~ ~VEGROUND ~IPING ~ 1, E~RO~CLINE~O~ECTOR3.0G~TEST~O~SH~OFFFOR ~ t. E~ONJCUNE~D~OR3.0~ST~AUTO~SHUTOFFFOR~ ~. SYSTEM FAILU~, AND SYSTEM DI~N~N * AUD]~ ~ VIS~ SYS~M FNLU~, ~O SYS~M OlS~NNECT~N '+ AUDIB~ A~S ~ Z ~LY 02 ~ ~ ~, ~I~E~TEST(0,1 ~) ~ 4. ~LYVI~E~ CONVENTIONAL SUCT1ON SYSTEMS: -~NAL SUCT1ON SYSTEMS ¢Cetc. k afl U~at ~): ~ 5. DALY VI~AL ~ORJ~ OF ~INO SYS~M · ~ PIPI~ i~G~ ~ 5. D~LY V~ ~N~O~ OF PlPl~ ~D ~ING SYS~M TEST (0.1 ~) ~ e. T~EN~ I~ ~ST [0,1 ~H) S~E SUCTION SYS~ (NO V~VES IN ~LOW ~ PtP~): ~E SUCT~N SYS~ (~ V~V~S IN BELOW GROUN~ PIPING): Gl~vrrY FLOW: G/~VrrY FLOW (Gae¢~ ~' ~f a~): 9. OI~N~L~~(0.1 ~H) ~ e. O~LYVI~NffORI~ SECONDLY ~N~ PI~K ~E~N~LY ~ED Pl~l~ PRESSURED PIPING (~ ~ ~t ~y~: P~D PIING ('~ a~ mat I0, ~INUOUS ~NE ~MP S~SOR ~ AU~tB~ ~D VISU~. ~ ~D 10. ~NUOUS ~NE SU~ SENSOR ~ AUDI~ ~D VIS~ A~O ~ SH~ OFF ~ A ~ 0~U~ ~ a. A~O ~ ~ ~ ~ A ~ O~URS ~S~NNE~N 11, A~O~T~LtNE~O~E~OR(3.0~H~ ~.OWSH~OFFOR ~ 11, ~ON 13. ~I~S SU~ $E~R - AUDI~ ~D Vt~ ~ ~ 13. ~NUOUS SU~ $EN~OR + AUDI~E EMERGENCY GENERATORS ONLY (~ e8 U~t epp/y) EMERGENCY GENERATORS O~LY 14, ~NUOUS SU~ ~N~R ~O~T A~O PU~ SH~ ~ + ~Ol~ ~O ~ 14. ~INUOUS SU~ ~EN~R ~ ~O PU~ SHUT OFF + AUDtB~ ~D V~S~L VISUAL ~ 15. A~O~T1CLINE~E~(3.0~H ~5~OUT~OW~FOR ~ ~S. A~O~C ~EI.~CTOR(3.0~H'~5T) RESTRICT~N 16. A~U~I~EG~TEST(04 G~) ~ 16, ~N~ ~E~ST(04 G~) 17. OAILYVlSUAL~ECK ~ 17. OAILYVI~AL~ECK 3iSPENSER~AIN~ ~ 1. FLOAT~ISM~T~OFFSH~V~ ~ 4, DAILYVI~ALCHECK ~A1~ {NST~O ~ ~ 2. ~iN~S OiS~NSER ~ S~R + AU~ ~O Vl~ ~ ~ 6. 'r~NCH LINER i ~NtTOR~ 3. ~US DIS~NSER P~ ~N~R ~ AUTO ~ O~ FOR DISP~R · AUDiB~ AN~ VlSU~ ~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 ((ifil) 326-3979 '"-'~"'-' UNDERGROUND STORAGE TANKS - TANK PAGE 1 TYi=E OF ACTION {~]'1. NEW SITE PERMIT ~ 4. AI~..NDEO PERIV, iT ~' 5. CHANGE OF INFORMATION) ]--] 8. TEMPORARY SITE CLOSURE (C~e¢l~one4emonly) [] ?. PERMANENI~.Y CLOSED ON SITE C]3. RENIEWAL PERMIT (~oe~'yreeaen-ferlncalu~ec~,y) (Spec,,fy~-for/oca/u~a,.~/,~ ~ $. TANK REMO¥'ED 430 LOCA~N V~,T/1.1IN SITE I. TANK DESCRIPTION ' ~:'~':. :::::::::::::::::::::-+~;;:?;/:::,::~:~:L.~.:: ":~ '~:'~' ~ ::':.;', ~..:~:'::~:~.:?/:.':.¥' ' . ILT~X C~N~ ':-.=~::~_::~: .~'. -~'/.. ':::.:.. ' "::'/' ' : ' ::' · '. ~ ::.:1 {ll~ ~ ~ T~) ~b, P~UM U~ ~ ~, DI~L ~ S, AV~T~N FUEL u~ ~)i D ~. u~ J (Cno~ one ~m ~) , ~UB~ WALL ~ 4. SIN~ W~L IN A V~LT ~ ~. O~ (C~ck one ~m o~y) ~ 2. 8TAI~SS STEEL ~ 4. S~ ~ W~IB~G~ ~ 9. F~ ~A~B~ W/I~ ~NOL ~ ~. O~ER_ ~'* ~0~= ~C (~) ..... ~K~R~-~~ ~ 1. E~k ~. F~R~IP~C ~ 8. ~A~B~WIt~% ~L ~. UNKNO~ ~t5 T~K I~RmR LIN~ ~ I. RUS~R UNED ~ 3. E~ UNI~ ~ 5. OR ~AT~G ~ 2. ~D UMNG ~ 4. ~UC MN~ ~ 6. UNUNED ~ ~. O~ I OTHER ~SION ~ 1. ~FA~U~D ~DIC ~ 3. F~R~S ~IHF~CED ~STIC ~. UN~ ~ ~ INST~ED ~9 PRO~CT~N IF ~ON ~ ~. !~ED CUR~ ~ ~. O~ER. ~e~ one ~ o~) ~ 2. ~FIC~ ~ ~o~ ~eE 8~R P~TE IF SING~ W~ T~ (~k ~ ~at ap~): 453 IF ~UB~ W~ T~K OR T~K ~ B~DER (~k one ~m O~y): 4~ ~ t. V~ (~D ~RTION O~ ~ 5. ~U~ T~ ~UGI~ (~G} ~ VlS~L (SlN~ W~ IN V~LT ONLY) ~ 2. A~O~TIC TANK ~ (ATG) ~ 6. V~SE ~NE ~ 4. STATJSTI~ I~Y ~L~TION (SIR) * ~ 8. T~ 81E~T~K~ING ~ ~. Q~ER : ~.: :;. · V, T~ CLOSURE INFO,ON I PER~E~ CL~URE IN P~CE ESTI~D ~TE ~ST U~D ~t~Y) 455 EST:~D QU~ OF SU~T~CE ~INING ~ T~ FI~D ~ INE~ ~TERI~? 457 OFFICE OF ENVIRONMENTAL SERVICES 17T"5 Chelter Ave., Bakersfield, CA 93301 (661) 326.3~1~' UST -TANK PAGE U~ERGROUND PIP{NO ASOVEGROUND PIPING ~ . ~SSU~E ~ 2. SU~ON ~ 3. G~W~ ~e ~ ~. PaESSU~ ~ Z SUCnO~ ~ 3. O~V~ ~. CONSmOCTIO~ SING~ WA~ ~ 3. UNED ~E~CH ~ ~, OTH~ ~ ~ ~. S~N~ WA~ ~ ~. UN~ . ~UFA~URER ~I ~FAC~R ~ ~TER~LS AND ~ 2. STAINLESS S~EL ~ 7. ~LV~ ~EL ~ 2. STAINLESS S~EL ~ 7. ~LV~D STEEL CORROS~N U~ER~OUND PIPING A~VE~OUND ~PING ~ 1. E~RONIC kINE L~ D~ECTOR 3.0 ~ TEST ~ A~O ~ SH~ OFF FOR ~ ~ 1. ~NIC UNE ~ D~OR 3.0 ~ ~ST ~ AUTO ~MP SHUT OFF FOR L~, SYST~ FNLURE, AND 8YSTEM'DIS~NEC~N + AUD]~ ~D VJS~ SYS~M FNLU~. ~D SYS~M DiS~NNE~N + AUDIBLE ~D VISUAL CONVENTIONAL SUCTION SYSTEMS: -CONVENT~NAL SUCTION 8YSTEId~ (C,.~,.k [] 5. ~aULY VISUAL MONITORING OF PUMPING SYSTEM + TR?ENNIAL PIPING INTEC~ITY [~] S. D~JLY VI,~JAL IdONITORING 01: PIPING AND Pt/MI=lNG SYSTEM TEST(O.1 GPH) [~] e. TRIENNIAL INTEGRITY TEST(0.1 SAFE SUCTION SYSTEM~ (NO VALVES ~N BELOW GROUND PIPING): [AFE SUCTION SYSTEMS {~0 VALVES IN BELOW GROUND PIPING): ~ 7. SELF MONITORING [~] 7, SELF MONITORING GRAVITY ROW: GRAVITY ROW (Ct*ct; [] 9. Ol~ ~ ~T (0.1 ~H) ~ a. ~LY V~ SeCOND. kY ~H~ PI~ SECONDLY CO~NED PIP~NG PRESSURED PIING (~ ~ ~at ap~): P~U~D Yl~ (~ sE ~f e~: ;' 10. ~INUOUS ~INE SUMP SENSOR ~ AUDIB~ ~D VlSU~ ~ ~D (~ ~e) ~ 10. ~UOUS ~INE SU~ SENSOR~ AUTO ~ SHUT OFF FOR ~. $YS~ F~LU~ ~D SY~M ~ b. A~O ~ SHUT O~ FOR ~S, $YS~M FNLUR~ ~D SY~M Df$~NNE~ION ~ ~ 1. A~O~TIC LiNE ~ ~OR (3.0 ~H TE8~ ~ ~OW ~ OFF OR ~ 11. AUTO~TIC ~STRI~ION ~ 12. ANNU~I~E~TEST(0.1 G~) ~ lA A~U~t~~ST(0.1 ~ t 3. ~I~US S~ SE~ + AUOI~ ~O Vl~ ~ ~ 13. ~NUOUS $U~ EMERGENCY GENERATOR8 ONLY (Check aJ' that ai~ty) EMERG ~J~CY GENERATORS ONLY (C,~eck a:t mt [] 14. CONTINUOUS SUMP ~NSOR WITHOL~_ AUTO PUMP SHUT OFF +AUOIBLE AND [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUIWP SHUT OFF + AUDIBLE AND VISUAL VISUAL ALARMS ALA~ [] 15. AUTOMATICLINELEAKDETECTOR(3.0GPHTEST')W1THOUTFLOWSHU'/'OFFOR I[~ 15. AUTOMATIC LJNE LEAK D='TECTOR(S.~GPH TEST) R~$TRICTION [] 16. ANNUAL. INTEGRITY TEST (O. l GPH) i ~ 16. ANNUAL INTEGRJ'IY TEST (0.1 ~, ~ 17, (~AILY VISUAL CHECK J'~ 17. DAILY VISUAL CHECK DIS~NSER~AIN~ ~ 1. FLOAT~ISM~T~OFFSH~V~ ~ 4. DAILYVtSUAL~ECK ~IN~US DIS~N~R P~ $EN~R W~ A~O ~ O~ FOR DIS~N~R + AUDIB~ AN~ ~SU~ A~ ~ 6, hONE =CF (7~9) S:~PAFORMS~S~C~B,~D _ CITY OF BAKEI~FIELI) 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STOOGE TANKS - INSTAL~TION CERTIFICATE OF COMPLIANCE Page BUSINE~ ~E (~e ~ FACILI~ ~E ~ D~ - ~ng BuNn~ ~) (Check all that apply) [~// The installer has been trained and certified by the tank and piping manufacturers. 478. E'/ The installation has been inspected and certified by a registered professional engineer having education and experience with underground storage tank installations. [] The installation has been inspected and approved by the Bakersfield Fire Department - Environmental Services. E:~ All work listed on the manufacturer's installation checklist has been completed. ,~. The installer has been certified or licensed by the Contractors' State License Board. -4a2. [~/ The underground storage tank, any primary piping, and secondary containment was installed according to ~3. applicable voluntary consensus standards and written manufacturer's installation procedures. Description of work being certified: I certify that the infotmaUon provided herein Is tree and accurate to the best of my knowledge. SIGNATURE~~ DATE 484. UPCF (7/99) Si~CUPAFORMS~swrcb-c.wpd CITY OF BAKERSFIELD POST CONSPICUOUSLY* *NON-TRANSFERABLE* ?--'usir..ess name .' M I T ENGINEERING ~, CONSTR~JCTI L~ca~ add~ess . · OUTSIDE CZTY issue dmtm · i2/~O/O~ E~pieation date . · ~/: Licmnsm commmnt .' GENERAL CONTRACTOR M I T ._.,4G NEE..-..!NG ~. CONST~UCTI Ou~ne~'/O~:~:ice~' IO~ ~n====,.,nnn~,, ~,,,,~u._. WAY ~UITE Q ~qlR~, JESSE W OCEAN~IDE CA BUSINESS TAX CERTIFICATE IS HEREBY GRANTED. LICENSEE IS TO COMPLY WITH ALL LAWS AND ORDINANCES. ISSUANCE OF THIS LICENSE DOES NOT CONSTITUTE AUTHORIZATION TO CONDUCT BUSINESS tF LICENSEE HAS NOT COMPLIED WITH ALL APPLICABLE LAWS AND ORDINANCES. THIS LICENSE IS ISSUED WITHOUT VERIFICATION THAT THE LICENSEE IS SUBJECT TO OR EXEMPT FROM LICENSING BY THE STATE OF CALIFORNIA. M.I.T. Engineering & Construction, Inc. 105 Copperwood Way, Suite G Oceanside, California 92054 Office: (760) 721-4120 Fax: (760) 721-4209 Contractor's License California: 723396 - A and Haz =*' t Arizona: 126949 - B1 and Tank Installation INR0108 Nevada: 0043206 - B4 and UST Handler UTH~1122 Other Certifications: International Fire Code Institute - Installation: 1036149-25 Decomissionin~: 1036149-26 Site SpeCific Health and Safety Plan Project: Address: Date: ~- GENERAL INFORMATION Subject M.I.T. Engineering & Construction, Inc. has been contracted by ~-~-~U~--/V~ to perform the following: 1. Plan Purpose and Use This Health and Safety Plan is developed to assist M.I.T. site personnel in understanding and avoiding potential Health and Safety hazards that may present itself at the site. In order to fulfill the requirements of the CAL-OSHA Hazard Communication Standard (8CCR 5194), if a subcontractor employed by M.I.T. will be present on site, the Project Manager is required to provide the subcontractor with a copy of this Health and Safety Plan pdor to the start of the project. The Health and Safety Plan will inform the subcontractor of any potential hazards associated with hazardous substances in the area in which their employees will be working, and will provide information on suggested protective measures. The subcontractor is responsible for the preparation of a Site Safety Plan for the subcontracted tasks and communicating and enforcement of Site Health and Safety requirements as it pertains to the subcontractor's agents and/or employees. The potential exists for fuels, solvents and metals to be present in the soil at the site. The potential for a flammable atmosphere is possible and should be monitored in accordance with the City or County Fire Prevention Department requirements. ~ Table 1 Emergency Assistance Information Fire Department I Paramedic I Ambulance Service: 911 Poison Information - Poison Control Center: Nearest Hospital with Emergency Room: Phone Number: Health and Safety Coordinator: Jesse Kirk Office: (760) 721-4120 Office Hours: 8:00am to 5:00pm Cell: (760) 889-3115 Project I Site Manager: John Kirk Office: (760) 721-4120 Cell: (760) 887-5184 Recommended Route from Job Site to Hospital Emergency Room: Code of Safe practices General 1. All persons shall follow these safe practice rules, render every possible aid to safe operations, and report all unsafe conditions or practices to superintendent. 2. Foremen shall insist on employees observing and obeying every rule, regulation and order as necessary to the safe conduct of the work and shall take such action as it is necessary to obtain observance. 3. All employees shall be given frequent accident prevention instructions. Instructions shall be given at least every (10) ten working days. 4. Anyone known to be under the influence of drugs or intoxicating substances which impair the employees ability to safely perform the assigned duties shall not be allowed on the job while in that condition. 5. Horseplay, scuffling and other acts which tend to have an adverse influence on the safety and well-being of the employees shall be prohibited. 6. Work shall be well planned and supervised to prevent injuries in the handling of materials . and in working together with equipment. 7. No one shall knowingly be permitted or required to work while the employee's ability or alertness is so impaired by fatigue, illness or other causes that it might unnecessarily expose the employee or others to injury. 8. Employees shall not enter manholes, underground vaults, chambers, tanks, silos or other similar places that receive little ventilation unless it has been determined safe to enter. 9. Employees shall be instructed to ensure that all guards and other protective devices are in proper places and adjusted, and shall report deficiencies Promptly to the foreman or superintendent. 10. Crowding or pushing when boarding or leaving any vehicle or other conveyance shall be prohibited. 11. Workers shall not handle or tamper with any electrical equipment machinery, or air or water lines in a manner not within the scope of their duties, unless they have received instructions from their foreman. 12. All the injuries shall be reported promptly to the foreman or superintendent so that arrangements can be made for medical or first aid treatment. 13. When lifting heavy objects, the large muscles of the leg, instead of the small muscles of the back, shall be used. 14. Inappropriate footwear or shoes with thin or badly worn soles shall not be worn. 15. Materials, tools or other objects shall not be thrown from buildings or structures until proper precautions are taken to protect others from the falling objects~ Heat Stress There is a potential for heat stress from the use of protective clothing and climate conditions. One or more of the following procedures may be employed to alleviate potential heat stress problems in the event that site conditions warrant the use of personal protective equipment (PPE), or ambient temperatures 85 degrees F. Provide plenty of liquids. To replace body fluids (water and electrolytes) lost because of sweating, use a 0.1% saltwater solution, more heavily salted foods, or commercial drink mixes; The commercial mixes may be preferable for those employees on a Iow-sodium diet. Noise There is a potential for noise levels to exceed 85 DBA during site activities involving excavation equipment. ^11 personnel are required to wear hearing protection while drilling equipment is in operation. Health Effects There is potential for chemical compounds in the form of solids, liquids, gases, mists, dusts, and vapors to cause both acute and chronic health problems resulting from inhalation (breathing), absorption (through direct contact with skin), or ingestion (eating or drinking). The routes of exposure of chemicals potentially encountered at the site include: * Absorption through direct contact with the impacted soil and groundwater and bare skin, or potentially through the eyes and membranes. * Inhalation of vapors or dusts released from site activities. * Ingestion through 1.) Contamination of hands and hand-to-mouth contact 2.) Contamination of food or liquid brought on-site 3.) Contamination of smoking materials or chewing gum Monitorin.q Equipment (For tank removal) Monitoring equipment utilized on site during all activities shaft be one of the following types at a minimum: * Flame Ionization Detector (FID) * Photoionization Detector (PID) in conjunction with a Combustible Gas Indicator (CCI) / Oxygen Monitor In addition, a direct reading calorimetric tube indicator system may be used. All air monitoring equipment shall be inspected and tested prior to the commencement of site activities. Risk Assessment .Summary Anticipated exposure to chemicals on-site include gasoline, diesel, and benzene, toluene, and xylene (BTX). These chemicals represent a hazard because they are moderately to extremely toxic and most are highly flammable. Threshold limit values (TLV's), Shore Term Exposure (STEL's), and toxicity levels (LD50, Oral Rat), all in mglkg (PPM), are listed below: Compound TLV STEL Toxicity Gasoline 200 300 Diesel 50 75 Benzene 10 25 4894 Toluene 100 150 5000 Xylene 100 150 4300 Benzene is considered an extreme cancer hazard. Applicable MSDS Forms are attached. Hydrocarbon Vapor Criteria and Responses Hydrocarbon Concentrations Response 30 PPMV TVH Limited hazard, no special action. 30-100 PPMV TVI-I General Work Areas Benzene detector tube measurements taken each 30 minutes. 100-1400 PPMV TVH General Work Areas Half mask OV Respirators worn by all in work area. Benzene detector tube measurements taken each 30 minutes. 1400 PPMV TVH Well Head Emissions Flush downhole with nitrogen gas. (near bore hole or auger flights ~,, t 1400 PPMV TVH General Work Areas Work Stops. Procedures taken to subdue excessive vapor levels. I PPMB Benzene in General Work Areas Half mask OV Respirators wom in work area. Benzene detector tube and measurements taken every 15 minutes until levels are well below I PPMV. 10 PPMV Benzene in General Work Areas Work Stops. Procedures taken to subdue excessive vapor levels. Benzene detector tube measurements taken each 15 minutes until concentrations are below 1 PPMV. PPMV - Pads per million vapor TVH - Total Volatile Hydrocarbons ..~ OV - Organic Vapor Personal Protective Equipment Hard hats, If overhead hazard is present Hearing protection while drilling equipment is operating Safety glasses or goggles Safety Shoes Steel. toe and shank, chemically resistant (PVC or rubber) or PVC overboot as necessary to prevent skin contact or leather absorption of contaminants. Polyethylene Tyvek Yellow or white coated Tyvek as necessary to prevent skin and clothing contact with contaminated soil.. Nitrile gloves (neoprene as alternate) Respiratory Protection: * Half Face APR: Combined organic vapor / dust cartridge respirator required if wind conditions are creating airborne dust and/or airborne concentrations exceed 2 PPM on the PID/FID when measurements are collected in the breathing 'zone. * Full Face APR: Required when consistent 20 PPM readings are taken in breathing zone of site personnel. Site Control Appropriated safeguards will be taken to prevent fire and/or explosion during this project. Non-sparking tools and equipment shall be utilized at the site. Sources of ignition and spark shall be prohibited within 100 feet fo the excavation site. Dust and vapor suppression controls shall be impleted if dust and/or volatile organic compounds exceed recommended levels. These controls may include covering dust sources, spraying water onto the source (if practice will not spread contaminated soil to on-site areas), or temporarily stopping work. Acceptable methods for vapor suppression include covering and/or backfilling contaminated stockpiles, backfilling or covering off- gassing excavations, locating stockpiles away from and/or downwind from nearest public receptor and stopping work. Access to the project site shall be limited to authorized personnel who have read and signed the site specific Health and Safety Plan. ^ site perimeter fence is presently in place for site control. Excavation and/or construction zones will be established with barricades, cones and flagging tape to prevent unauthorized access during the project. MapQuest Yellow Pages - Baker~jld Memorial. Hospital Page 1 of 2 '"~!~'~ ..... ~: ~ · ................................... ~,,: where to go, how to get there! Back to Searct~ Results * ~ew Search Baker~ield Memorial Hospital Advertise your ~ke~fi~ Memor~l Hospi~l Main Phone: 661~327-4647 business on the 420 34th St Fax: 661-326-0706 ~ ~x 1888 Mapquest ~kersfield, ~ 9330~ Yellow Pages Usted Under · ~ospitals Nutritionists . Find More... · Bi~h centerA · Search by Phone ~ · Emergency medical ~ surgical service · Mapsb Directions · White Pages · E-mail the Page to a frien~ · Places nearby · Local Guide · ~t driving directions Get business-class I1~ services & support on AOL for Small Business Add or update_y_our business listing in the ~1 Yellow Paqes. ~i:~l~li~lG~ONfW~/I/i[~ ~ Zoom In ~' Re-center All riqhts reserved. Use Subject to License/Copyright; Ts the information for this listing incorrect? Click here to update. Overview Help I Feedback I Advertise With Us I Add/Update a Listing © 2003 Digital City, [nc. All Rights Reserved. Site Inde~x J About MapQuest J Partners J MapStore_ [ Help Center International Web Sites I Mobile MapQuest ~ Advertise With .Us I Business Solutions http ://yp.mapquest.com/mmn.adp. _d]rskip=O&_dtrlette~-&_&rexpand=&_dmnap=O&_dac=... 2/7/2003 MapQuest Yellov~;:Pages - Drivir~irections to Bakersfield Memorial Hospital Page 1 of 1 where to go, how :l~ ~oet there! ~':j~.,~ONLINEI~ Back to Search Results · New Search ~'~ '~ NO D~. DATES :.::~.} Cli~Here :~ Driving Dire~ions S~ing Point: DestinaUon Point: 525 W COLUMNS ST Bakersfield Memrial Hospital Adve~ise your BAKERS~E~, ~ 9330~ 420 34th St Bakersfield~ ~ 93301 business on the ~-327-~47 Mapquest Yellow Pa~es t: s~ out going East on W ~LUMBUS ST towa~s [S~ 0.2 Miles VERDE ST by ~rning right. (0.39 Km) ~ind ~ore.,. 2: Turn ~GHT onto UN[ON AVE. 0.5 Miles · Search by Phone~ (0.78 Km) · Maps ~ Dire~ions 3: Turn R[G~ onto 34TH ST. 0.2 Miles · White Pages (0.34 Km) · Local Guide Total Dis~nce: 0.9 miles ([.5~ Km) Estimated Time: 1 minute. Get business-class ~ing Poi~: se~ices ~ support pn AOL for Small Address: j525 ~UH~.U.S...S~ Business business listinq in the Yellow Paqes. Save Timel If you log in ~ YellOw Pages, you ~n save ~monal addresses for ~ster searching. · Loqin to AOL Yellow Paqe~ ~i~tion Poi~: Bakersfie~ ~emorial Hospital 420 34th St Bakemfield, CA 9330[ Get directions from this business Help_ [ Feedback [ Adve~ise With Us [ Add/Update a Listing ~ 2003 Digi~l CiW, Inc. All Rights R~erved. Site. Index I About MapQue_st_ I Partners [ Ma~J~ I Help Center international Web Sites I Mobile MapQuest I Advertise With Us I Business Solutions Privacy Policy & Legal Notices ©2003 MapQuest.com, Inc. All rights reserved. © 2003 Digital City, Inc. All Rights Reserved. Privacy Polic_y_ 8~ Leqat Notices http://yp~mapquest~c~m/main~adp?qa-d=42~+34th+St&qc-d=Bakers~e~d&qs-d=CA&qz-d=~~~ 2/7/2003 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 Manager : -"-~ BusPhone: (661) 322-7879 Location: 525"-W COL~IBUS ST Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 18D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code:5541 EPA Numb: DunnBrad:00-734-7602 Emergency Contact / Title Emergency Contact / Title SHASHI/VEENA KAMBOJ / FRANCHISEE DAVID LISUKI / FIELD CONSULTAN Business Phone: (805) 322-7879x Business Phone: (209) 230-0711x 24-Hour Phone : (805) 322-7879x 24-Hour Phone : (209) 861-4653x Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact : Phone: (214) 841-6718x MailAddr: PO BOX 711 State: TX City : DALLAS Zip : 75221 Owner THE SOUTHLAND CORPORATION Phone: (214) 841-6718x Address : PO BOX 711 State: TX City : DALLAS Zip : 75221 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: Bob D~ Environmental Manager I, L)O hereby certify that I have (Type or print name) reviewed the attached hazardous materials manage- ment plan for '~l'~..,.tr~~ ~ and that it along with (Name of Business) any corrections constitute a complete and correct man- agement plan f~. Signature Date -1- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE 32125-16834 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : r ~ Phone: (~)' 7-Eleven Inc. Address: ' ~f City : Gasoline Acctg. State: Dallas, TX 75221-0711 Type : P.O. Box 711 TANK OWNER INFORMATION ............. Name : ~ Y-Eleven, Inc. Phone: Address: Gasoline Acctg. ,¢2~,~¢- City : State: Type : P.O. Box 711 Dallas, TX 75221-0711 BCE UST Fee# : 002251 Financ' 1 Reap: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/11/2000 Phone: (~v ' Name :BOB DENINNO Ttl :ENVIRON. MGR. State UST # : 1998 Upg Cert#: 00778 = Hazmat Inventory One Unified List --As Designated Order Ail Materials at Site Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax lUnitlMCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod UNLEADED PLUS GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod -2- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers on Site -- COMMON NAME / CHEMICAL NAME UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 F STATE ~ TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid /Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS 100.00 ~asoline N 8006619 HAZARD ASSESSMENTS ITsecretI RSIBioHazI Radioactive/Amount [ EPA Hazards NFPA I USDOT# MOP No No No No/ Curies F IH DH / / / Mod ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 r STATE -- TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecret' RS,BioHaz' Radioactive/Amount ' EPA Hazards NFPA USDOT# MCP NoIIIN° { No No/ Curies F IH DH / / / Mod -3- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site ~ -- COMMON NAME / CHEMICAL NAME SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 F STATE T TYPE . i PRESSURE i TEMPERATURE I CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 10000.00 GAL 10000.00 GAL I 7500.00 GAL HAZARDOUS COMPONENTS %Wt. Gasoline I ~S CAS# 100.00 N 8006619 HAZARD ASSESSMENTS ITsecretl RSIBioHaz Radioactive/Amount EPA Hazards I NFPA I USDOT# MCP No No No No/ Curies F IH DH / / / Mod 4 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 ii588~8/5i~i~8i5~i5~88~/58~8~8~88~8~~8~88888~ Fast Format Notif./Evacuatio~Medical 888888888888888888888888888888888888 Overall Site i i88 Agency Notification 8888888888888888888888888888888888888888888 05/20/1999 CALL-911. O i888 Employee Notif./Evacuation O VENAL AND CALL 911. FOR RELEASE OF ~Z ~T NOTIFY BFD HAZ MAT DIV AND o STATE O.E.S. o o i8888 ~blic Notif./Evacuation O VENAL AND DIAL 911. o O i88888 Emergency Medical Plan O FIRE/POLICE DEPT - 911 o NEAREST EMERGENCY ROOM TO THE LOCATION IS TO BE USED IN THE EVENT OF INJURY. o o -5- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 i~ Site Emergency Factors i/~ Special Hazards ~/~/~/~~/~/~/~/~/5~/~ 05/20/1999 i O CALL 911. ° o i~i~i~ Utility Shut-Offs O A) GAS - NONE B) ELECTRICAL - BACK ROOM HALLWAY o C) WATER - STORE FRONT/SIDE o D) SPECIAL - NONE o E) LOCK BOX - NO o O i~E~ Fire Protec./Avail. Water o PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE. o O O O FIRE HYDRANT - ????????? o o i/~i~i~ Building Occupancy Level o O -7- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 Training ~~~~~~~~ Overall Site i~ Employee Training ~/5~~/~/~~/~/~/~/~~~ 05/20/1999 o WE HAVE 7 EMPLOYEES AT THIS FACILITY. o O WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. o O BRIEF SUMMARY OF TRAINING PROGRAM: SEE HAZARDOUS MATERIALS HANDLING o PROCEDURES POSTING AND EMPLOYEE AWARENESS FORM. ° O O i~ Held for Fumre Use o O ii~i~i~ Held for Fumre Use O O 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 Manager : BusPhone: (661) 322-7879 Location: 525 W COLUMBUS ST ~ Map : 103 CommHaz : Low ~ ' Grid: 18D FacUnits: 1 AOV: City : BAKERSFIELD / CommCode: BAKERSFIELD STATION 04 SIC Code:5541 EPA Numb: / DunnBrad:00-734-7602 Emergency Contact / Title _Emerqency Contact / Title SHASHI/VEENAKAMBOJ / FRANCHISEE ,'~-~--~ ii /~~~~ Business Phone:~ ~ 322-7879x Business Phone: i~oO- ~~- 24-Hour Phone : ~ ~ ~322-7879x 24-Hour Phone : ~00i ~-071~..~ Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards:~ ~ ~%%~e~_ Im~lth DelHlth Contact : Bob DeNin~0 Phone:~ ~ ~ ~~ ~ l' U '~ [ ~ ' MailAddr: PO BOX 711 ~ ~ %~ State: TX Omer 7rEleven, Inc. ,, ~g~0~%' Phone: ~03- q 7 ~ ' ~ ~ 1B .: Address : PO BOX 711 State: TX City : D~S Zip : 75221 Period : to Total~Ts: = Gal Preparer: TotalUSTs: : Gal Certif'd: RSs: No Emergency Directives: l, _1,~ ~/_-~/Jmo Do hereby certify that l have (Type or print name) reviewed the attached hazardous materials manage- ment plan for '"~'--~/-E.~J C~l and that it along with (Name of Busine~) any corrections constitute a complete and correct man- agement pla~ Date / 1 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 STORAGE CONTAINER DATA (UST FORM A) Last Action Type: FACILITY/SITE INFORMATION Business Name: 7 ELEVEN FOOD STORE 32125-16834 Cross Street : Business Type: Org Type: Total Tanks : 3 IndnRes/Trust: No PA Contact: PROPERTY OWNER INFORMATION Name : i~4,~, ~ ~ ~' n3 ' Phone: AddresS: i l l l OO uoOo~ ~3-[ ~& i ,.. City -~ '~~c~ State:O__~ Zip: 93311 Type : TANK OWNER INFORMATION Name : 7-Eleven, Inc. ~ Phone: : ~O5 977- U q ~ 5' Address: Gasoline Acctg. \ city : P.O. Box 711% State: Zip: Type : Dallas, TX 75221-0711 ", BOE UST Fee# : 002251 Financ' 1 Resp: INSURANCE Legal Notif : Tank Owner Mailing Address Date:04/ll/2000 Phone: (503) 977-7713x Name :BOB DENINNO Ttl: ENVIRON. MGR. State UST # : 1998 Upg Cert#: 00778 = Hazmat Inventory One Unified List -- As Designated Order Ail Materials at Site Hazmat Common Name... ISpecHazlEPA HazardsI Frm I DailyMax Iunit MCP UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod UNLEADED PLUS GASOLINE F IH DH L 10000.00 GAL Mod SUPER UNLEADED GASOLINE F IH DH L 10000.00 GAL Mod -2- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 = Inventory Item 0001 Facility Unit: Fixed Containers on Site UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 Liquid /Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 10000.00 GAL 10000.00 GAL 7500.00 GAL 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS TSecretl~slBioHaz Radioactive/Amount EPAHazards NFPA IUSDOT# MCP No N No No/ Curies F IH DH / / / Mod = Inventory Item 0002 Facility Unit: Fixed Containers on Site ~ UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 F STATE TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline 8006619 TSecretI RS'Bi°Hazl HAZARD ~SESSMENTS I Radioactive/Amount EPA Hazards NFPA USDOT~ MCP No I No No No/ · Curies F IH DH / / / Mod 3 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 SiteID: 015-021-000806 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 Liquid /Pure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 10000.00 GALI 10000.00 GALI 7500.00 GAL HAZARDOUS COMPONENTS %Wt. RNo~ CAS# 100.00 Gasoline 8006619 HAZARD ASSESSMENTS TSecretl~SIBioHaz Radioactive/Amount EPAHazards NFPA lUSDOT# MCP No N No No/ Curies F IH DH / / / Mod -4- 10/31/2000 i 7 ELEVEN FOOD STORE 32125-16834 ~~~ SiteID: 015-021-000806 i i~ Notif./Evacuation/Medical ~~~~~~ Overall Site i i~ Agency Notification ~~~~~~~ 05/20/1999 i O O o CALL 911. ° o o iEEE Employee Notif./Evacuation ~EEE~EEE~EEEE~EEE~ 01/07/1990 i O O o VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFD HAZ MAT DIV AND ° ° STATE O.E.S. ° o o i~E Public Notif./Evacuation ~E/~/~/~E/~EE~/~/~EE/~/~EEE~g~E 05/20/1999 i O O o VERBAL AND DIAL 911. o o O i~ Emergency Medical Plan ~6~6~6~6~~6~~6~6~ 05/20/1999 i O O o FIRE/POLICE DEPT - 911 o o NEAREST EMERGENCY ROOM TO THE LOCATION IS TO BE USED IN THE EVENT OF INJURY. ° O o -5- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 Mitigation/Prevent/Abatemt ~~~~~ Overall Site i~ Release Prevention ~~~~~~~ 05/20/1999 O STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTOMATIC SHUT-OFFS, o VAPOR SHIELDS, SHEER OFF VALVE. COMPRESSED GASSES PROPERLY STORED IN SMALL ° SAFETY CONTAINERS AND WITH PROPER FITTINGS. ° O i~ Release Containment ~~¢~~~~~ 05/20/1999 O STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTO SHUT OFFS. ° VAPOR SHIELDS. SHEER OFF VALVE - COMPRESSED GASSES PROPERLY STORED IN SMALL ° SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN ON FILE o AT EACH STORE. o o DAILY INVENTORY RECONCILIATION TO INDICATE LEAKAGE ABOVEGROUND. FIRE DEPT o AND IT CORPORATION CONTACTED FOR BELOW GROUND LEAKS HEALTH DEPT CALLED ALSO ° BOTH INSTANCES EQUIPMENT WILL BE SHUT DOWN FOR REPAIRS. ° O i~ Clean Up ~~~~~~~~ 01/25/1996 O USE ABSORBENT MATERIALS, ABSORBENT PAD (KITTY LITTER). o O ~ Other Resource Activation o o -6- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834/~5/~/~/~/~/~/~/~5 SiteID: 015-021-000806 Site Emergency Factors ~~~~~~ Overall Site i~ Special H~ards ~~~~~~~ 05/20/1999 O CALL 911. O i~g Utility Shut-Offs ~E~E~E~E~E~~~ 05/20/1999 O A) GAS - NONE o B) ELECT~CAL - BACK ROOM HALLWAY C) WATER - STORE FRONT/SIDE D) SPECIAL - NONE o E) LOCK BOX - NO O iEE~ Fire Protec./Avail. Water ~EE~EE~EEEEE~E~E~~EE 05/20/1999 O P~VATE FI~ PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE. o O o o FIRE HYD~NT - ????????? o i~ Building Occupancy Level o o -7- 10/31/2000 7 ELEVEN FOOD STORE 32125-16834 Training ~~~~~~~~ Overall Site i~ Employee Training ~~~~~~~ 05/20/1999 O WE ~VE 7 EMPLOYEES AT THIS FACILITY. o o WE HAVE MATE~AL SAFETY DATA SHEETS ON FILE. o O B~EF SUMMARY OF T~INING PROG~M: SEE ~ZA~OUS ~TE~ALS HANDLING o PROCEDURES POSTING AND EMPLOYEE AWARENESS FO~. o O o O i~ Held for Fumre Use 0 o i~ Held for Fumre Use o 0 7 ELEVEN FOOD STORE 82125-16834 SiteID: 215-000-000806 Manager : ~ ~f 9 BusPhone: (805) 322-7879 Location: 525 W COLUMBUS ST ~ -- Map : 103 CommHaz : Low City : BAKERSFIELD Grid: 18D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 04 SIC Code: 5541 EPA N~u~~_~/.~ V~m~6- ~cz.~ ~ DunnBrad:00-734-7602 ,/ ~F~' I~Emergency Contact /~/ Title Emergency Contact // Title X72~ ~nny ~~F~CHISEE (~% DAVID LISU~ // FIELD CONS~T~ Business Phone: (~)'~322-7879x g~f-~ Business Phone:~9) 230-0711x 24-Hour Phone : ( ....... -~ ~ 24-Hour Phone : ( .... ' · Pager Phone : ( ) - x Pager Phone : (~~ Hazmat Hazards: Fire Im~lth DelHlth Contact : Phone: ( ) - x ~ ......... ~.~ .... ann ~ ~ 7// State: MailAddr: ~ ~=~..~-:r ~,r~ ~ City : .- D~-.//~ Zip : _9567~- 7f2i/ O~er THE~SO~H~D CORPO~TION Phone: (~ ~,~- Address : ~COLD C~4P D~ ~O ~joZ ~// State: City : ~.C~~A ~ //~ [ Zip : Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif 'd: RSs: No Emergency Directives: ~ Hazmat Inventory One Unified List --Alphabetical Order Ail Materials at Hazmat Common Name... ISpecHazlEPA HazardsI Frm DailyMax Unit MCP SUPER UNLEADED GASOLINE F IH DH L 10000 GAL Mod UNLEADED GASOLINE F IH DH L 10000 GAL Mod UNLEADED PLUS GASOLINE F IH DH L 10000 GAL Mod (Type or pent ns. me) reviewed ~he ~ched ~z~rd~us -,-~. merit plan for ~-~~J~/~ and that it alon~ any c0r[ec~i0ns c0~]s~ilu~e a c0mple~e and c0~re~ man- a~eme~]t plan ~0~ my ~cili~y, ~,~- ~%:~ 04 / 20 / 1999 7 ELEVEN FOOD STORE 32125-16834 SiteID: 215-000-000806 ~ Inventory Item 0003 Facility Unit: Fixed Containers on Site SUPER UNLEADED GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 Liquid JPure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 10000.00 GALI 10000.00 GAL[ 7500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS iTSecretI ~S BioHazI Radioactive/Amount EPA Hazards NFPA USDOT~ MCP No N No No/ Curies F IH DH / / / Mod ~ Inventory Item 0001 Facility Unit: Fixed,Containers on Site ... L..iL3LVlIV.I.U/%I /%JZ-~LV/I'', / L.--L'II~,LVL-LL,.,:Z-%--~ UNLEADED GASOLINE .. Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 ~ STATE ~ TYPE PRESSURE i TEMPERATURE CONTAINER TYPE Liquid JPure Ambient Ambient UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum Daily Average 10000.00 GALI 10000.00 GAL 7500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 TSecret HAZARD ASSESSMENTS oRS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod -2- 04/20/1999 f 7 ELEVEN FOOD STORE 32125-16834 SiteID: 215-000-000806 ~ Inventory Item 0002 Facility Unit: Fixed Containers on Site UNLEADED PLUS GASOLINE Days On Site 365 Location within this Facility Unit Map: Grid: UNDERGROUND FRONT PARKING CAS# 8006-61-9 F STATE ~ TYPE PRESSURE TEMPERATURE CONTAINER TYPE Liquid /Pure ]Ambient I ambient I UNDER GROUND TANK AMOUNTS AT THIS LOCATION Largest Container I Daily Maximum I Daily Average 10000.00 GALI 10000.00 GALI 7500.00 GAL HAZARDOUS COMPONENTS 100.00 Gasoline N 8006619 HAZARD ASSESSMENTS ITsecretl ~SIBioHaz Radioactive~Amount I EPA Hazards NFPA USDOT# MCP No N No No/ Curies F IH DH / / / Mod -3- 04/20/1999 F 7 ELEVEN FOOD STORE 32125-16834 SiteID: 215-000-000806 Fast Format = Notif./Evacuation/Medical Overall Site --Agency Notification 01/07/1990 CALL 911 -- Employee Notif./Evacuation 01/07/1990 VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFD HAZ MAT DIV AND STATE O.E.S. Public Notif./Evacuation 01/07/1990 VERBAL AND DIAL 911 Emergency Medical Plan 01/07/1990 FIRE/POLICE DEPT - 911 NEAREST EMERGENCY ROOM TO THE LOCATION IS TO BE USED IN THE EVENT OF INJURY. -4- 04/20/1999 7 ELEVEN FOOD STORE 32125-16834 SiteID: 215-000-000806 Fast Format ~ Mitigation/Prevent/Abatemt Overall Site -- Release Prevention 01/25/1996 STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTOMATIC SHUT-OFFS, VAPOR SHIELDS, SHEER OFF VALVE. COMPRESSED GASSES PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. -- Release Containment 01/25/1996 STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTO SHUT OFFS. VAPOR SHIELDS. SHEER OFF VALVE - COMPRESSED GASSES PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN ON FILE AT EACH STORE. ~.,,._ DAILY INVENTORY RE~NCILIATION TO INDICATE LEAKAGE ABOVEGROUND. FIRE ....... - ........ ~-~ .................... ~vvv, 288-4832 *12792 CONTACTED FOR BELOW GROUND LEAKS HEALTH DEPARTMENT CALLED ALSO BOTH INSTANCES EQUIPMENT WILL BE SHUT DOWN FOR REPAIRS. Clean Up 01/25/1996 USE ABSORBENT MATERIALS, ABSORBENT PAD (KITTY LITTER). Other Resource Activation -5- 7 ELEVEN FOOD STORE 32125-16834 SiteID: 215-000-000806 Fast Format ~ Site Emergency Factors Overall Site -- Special Hazards 01/07/1990 CALL 911 --Utility Shut-Offs 01/07/1990 A) GAS - NONE B) ELECTRICAL - BACK ROOM HALLWAY C) WATER - STORE C) WATER - STORE FRONT/SIDE D) SPECIAL - NONE E) LOCK BOX - NO -- Fire Protec./Avail. Water 01/07/1990 PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE FIRE HYDRANT - ? Building Occupancy Level -6- 04/20/1999 7 ELEVEN FOOD STORE 32125-16834 SiteID: 215-000-000806 Fast Format ~ Training Overall Site -- Employee Training 01/25/1996 WE HAVE 7 EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: SEE HAZARDOUS MATERIALS HANDLING PROCEDURES POSTING AND EMPLOYEE AWARENESS FORM. Page 2 -- Held for Future Use Held for Future Use -7- 04/20/1999 P' ~ 7 ELEVEN FOOD STORE 32 2 - 6834 , Overall Site with 1 Fac. Unit General Information i~v '~i Location: 525 W COLUMBUS ST /~ Map:103 Haz:2 Type: 3 City : BAKERSFIELD~ Grid: lSD F/U: 1 AOV: 0.0 Contact Name ~~ Contac~ Name ~'~ ~ .~i~le .~ Sus~ness Phone: (805)322-7879x Business Phone: (20~~-0711x 24:Hour Phone :~ ~-7~79x 24-Hour Phone : (~hV) ~ I -~ Pager Phone : ( ) - x Pager Phone : ( ) - x Administrative _Data Mail addrs: ~/~~~ ~ D&B Nu~er. 00-734-7602 City: ~ ~~~~-- '~ '~' State: CA Zip: ~-~~ Co~ Code: 215-004 BAKERSFIELD STATION 04 SIC Code: 5541 Owner: THE SOUTHLAND CORPO~TION - Phone: (209) 261-0711 ~ v~ ~ ~T T I ~ Address: .=~ , ~,,0 .......... ~ ~D~~~~ State: CA - Sugary O'¥pe er P~nt name) reviewed th~ attached hazardous materials manage- merit plan for q~-t~£c4ttS~and that it along with --- (Name of Busi-nes~) any corrections constitute a complete and correct man- agement ~ 11/01/95 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hl~h GAL 02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL 02-001 UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL 11/01/95 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL I Daily Average GAL I Annual Amount GAL 10,000 ~ 7,500.00 713,930.00 Storage ~~Press T Temp Location UNDER GROUND TANK IAmbientlAmbientlUNDERGROUND FRONT PARKING -- Conc~ Components MCP ---~Guide 100.0% IGasoline ModerateI 27 02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL 10,000 ~ 7,500.00 37,116.00 Storage~~Press T Temp Location UNDER GROUND TANK IAmbientlAmbientlUNDERGROUND FRONT PARKING -- Conc ~ Components. ~ MCP ----~uide 100.0%IGasoline ~ IModeratel 27 02-001 UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL 10,000 ~ 7,500.00 98,000.00 StorageIIPress T Temp Location UNDER GROUND TANK IAmbientlAmbientlUNDERGROUND FRONT PARKING -- ConcI Components ~ MCP ---~uide 100.0% IGasoline IModeratel 27 11/01/95 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFD HAZ MAT DIV AND STATE O.E.S. <3> Public Notif./Evacuation VERBAL AND DIAL 911 <4> Emergency Medical Plan FIRE/POLICE DEPT - 911 NEAREST EMERGENCY ROOM TO THE LOCATION IS TO BE USED IN THE EVENT OF INJURY. 11/01/95 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 5 00 - Overall Site <E> Mitigati0n/Prevent/Abatemt <1> Release Prevention STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTOMATIC SHUT-OFFS, VAPOR SHIELDS, SHEER OFF VALVE. COMPRESSED GASSES PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. <2> Release Containment STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS'PUMPS/AUTO SHUT OFFS. VAPOR SHIELDS. SHEER OFF VALVE - COMPRESSED GASSES PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. BUSINESS EMERGENCY PLAN ON FILE AT EACH STORE. DAILY INVENTORY RECONCILIATION TO INDICATE LEAKAGE ABOVEGROUND. FIRE DEPARTMENT AND ~_~.~FE~2~CONTACTED FOR BELOW GROUND LEAKS HEALTH DEPART~CALLED ALSO BOTH INSTANCES EQUIPMENT WILL BE SHUT DOWN <3>Clean--' Up ' ~S~O) ~C:~'~-4~'~ 1~7~ <4> Other Resource Activation 11/01/95 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards CALL 911 <2> Utility Shut-Offs A) GAS - NONE B) ELECTRICAL - BACK ROOM HALLWAY C) WATER - STORE C) WATER - STORE FRONT/SIDE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS LOCATED IN STORE PER FIRE CODE FIRE HYDRANT - ? <4> Building Occupancy Level ,11/01/95 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 7 00 - Overall Site <G> Training <1> Employee Training WE HAVE ? EMPLOYEES AT THIS FACILITY. '/ WE HAVE MATERIAL SAFETY DATA SHEETS ON FILE SEE HAZARDOUS MATERIALS HANDLING PROCEDURES POSTING AND EMPLOYEE AWARENESS FORM. <2> Page 2 <3> Held for Future Use <4> Held for Future Use HM808101 Account Number ACCOUNTS RECEIVABLE ADJUSTMENT February 16~ 1994 I!I Date New Account New Address Esther Duran Close Account From . . Service Change Other Adjustments X Fire Department. Hazardous Materials Division Department/Division 7-ELEVEN Billing Name 625 W. COLUMBUS ST. Billing Address Site Address Parcel # (if Applicable) Landlord Name & Address (If Applicable) ADJUSTMENT Last Billed Correct Billing Adjustment to Effectlv® Date of Billing Change 264.00 0 <264.00> 1.1-94 Approved By: Remarks: DUPLICATE BILLING FOR uST'S ALREADY BEING BILLED UNDER UT726001. RETURN PAYMENTS TO; (~0 PLEASE MAKE CHECKS PAYABLE TO: CITY OF BAKERSFIELD .~.- . ~ ~ ~~,; C~TY O~ BAKERSFIELD P.O. BOX 2057' BAKERSFIELD, CA 93303-2057 AC~~S ~AT/Ri ALS O [ V IS ION " ;TATE ~ANDAT:E9 PROGRAN.,'AD~, ,, ",' ". -" ." .'=,';~ ".':".. , ERG~oO~D :. · . . . .... : '?' ELEVEN - ,., "' M~ST RETURN THIS COPY=WITH PAYMENT "RETURN PAYMENTS TO: ..... ~ 'e , '~: '"J I P~I~,S'E.-M~,i~i~'~J"iE'CKS PAYABLE TO: " E.O. BOX 20,~7 ' ~"':':: ~ " CITY, OF BAKERSFIELD' , BAKERSFIELD, CA 93.303-2057 ACOO. ~(D~,,~ ~,~A~E.~I A~S DI ~' X5 ION ~ · '-' ':. , .. ,' '.. ....... ~ ~ { · , ........ .. ..................... .... .. 7-Eleven St'ores 3146 Gold Camp Drive / Suite Rancho Cordova, CA 95670 06/25/93 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 2 Hazmat Inventory List in MCP Order £ 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL 02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL 02-001 UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL 06/25/93 7 ELEVEN~FOOD STORE 32125-16834 215-000-000806 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-002 UNLEADED PLUS GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL I Daily Average GAL 1 Annual Amount GAL 10,000 ~ 7,500.00 713,930.00 Storage ~~Press T Temp Location UNDER GROUND TANK IAmbient~AmbientlUNDERGROUND FRONT PARKING -- Conc Components MCP ---~Guide 100.0% IGasoline IModeratel 27 02-003 SUPER UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GALI Daily Average GAL I Annual Amount GAL 10,000 ~ 7,500.00 · 37,116.00 Storage~[Press T Temp Location UNDER GROUND TANK IAmbientlAmbientlUNDERGROUND FRONT PARKING -- Conc Components MCP ---~uide 100.0% IGasoline IModeratel 27 02-001 UNLEADED GASOLINE Liquid 10000 Moderate · Fire, Immed Hlth, Delay Hlth GAL CAS #: 8006-61-9 Trade Secret: No Form: Liquid Type: Pure Days: 365 Use: FUEL Daily Max GAL~ Daily Average GAL Annual Amount GAL 10,000 I 7,500.00 98,000.00 Storage~lpress T Temp Location UNDER GROUND TANK Iambient~AmbientlUNDERGROUND FRONT PARKING -- Conc Components MCP ---TGuide 100.0% IGasoline IModeratel 27 06/25/93 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 page 4 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification CALL 911 <2> Employee Notif./Evacuation VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFD HAZ MAT DIV AND STATE O.E.S. <3> Public Notif./Evacuation VERBAL AND DIAL 911 <4> Emergency Medical Plan FIRE/POLICE DEPT - 911 NEAREST EMERGENCY ROOM TO THE LOCATION IS TO BE USED IN THE EVENT OF INJURY. 06/25/93 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 5 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention STANDARD GASOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTOMATIC SHUT-OFFS, VAPOR SHIELDS, SHEER OFF VALVE. COMPRESSED GASSES, PROPERLY STORED IN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. <2> Release Containment <3> Clean Up <4> Other Resource Activation 06/25/93 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 6 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards CALL 911 <2> Utility Shut-Offs A) GAS - NONE 'B) ELECTRICAL - BACK ROOM HALLWAY C) WATER - STORE C) WATER - STORE FRONT/SIDE D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS'LOCATED IN STORE PER FIRE CODE FIRE HYDRANT - ? <4> Building Occupancy Level 06/25/93 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 7 00 - Overall Site <G> Training <1> Page 1 WE HAVE ? EMPLOYEES AT THIS FACILITY. WE HAVE MATERIAL SAFETY DATA SHEETS oN FILE SEE HAZARDOUS MATERIALS HANDLING PROCEDURES POSTING AND EMPLOYEE AWARENESS FORM. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use 06/25/93 7 ELEVEN FOOD STORE 32125-16834 215-000-000806 Page 1 Overall Site with 1 Fac. Unit General Information Location: 525 W COLUMBUS ST Map: 103 Hazard: Low Community: BAKERSFIELD STATION 04 Grid: 18D F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- , JONES ( ) - Administrative Data Mail Addrs: 525 W COLUMBUS ST D&B Number: 00-734-7602 City: BAKERSFIELD State: CA Zip: 93309- Comm Code: 215-004 BAKERSFIELD STATION 04 SIC Code: 5541 Owner: THE SOUTHLAND CORPORATION Phone: Address: 3139 WILLOW AV SU 3~~ C~# ~/~ State: CA City: FRESNO Zip: ~~7// Summary I,_ ,~T'e~'~'//,.,~ Do hereby certify that I have ' <TYpe~ p,.~ mu~e) reviewed the attached hazardous materials manage. ment plan for. ?:~/~co. '~/4~and that it along with (Name of t~usine~s) any corrections constitute a complete and correct man- agement plan for my facility. HAZARDOUS MATERIALS HANDLING PROCEDURES FUEL SPILLAGE EMERGENCIES 1) In case of large fuel spill, (50 square feet or larger or any- thing that looks potentially hazardous) CALL THE FIRE DEPARTMENT. 2) In case of small fuel spill 50 square feet or smaller, de~ermine poten~ia! hazard. Use absorbent material (kitty litter or sand), absorbent pad, or for very small spills, let evaporate. UNDER NO CIRCUMSTANCES HOSE OFF WITH WATER. THIS WOULD CAUSE UNDER- GROUND CONTAMINATION A~D WE COULD BE FACED WITH A VERY LARGE CLEAN-UP BILL. Keep used clean-up material in a metal container with metal lid. 3) For removal of clean-up material for #1 or #2, call Tom Carmichael at 1-800-541-0334. 4) Know where the fire extinguisher is and how and when to use it. If you have to use a fire extinguisher, ALWAYS CALL THE FIRE DEPARTMENT FIRST. In our store the fire extinguishers are located: . 5). Know where and how to shut off power to gasoline equipment. Every store is different; have someone show you. In our store the gaso- line power shut-off is located: . C02 TANK HANDLING 1) Ail C02 tanks are to be stored with metal cap in place (except when in use). Replace metal cap on tank after use (empty). 2) ~,1,1 C02 tanks are to be chained up tightly 3/4 way up at all times. Signed: Witness: Employee Franchisee/Store Manager Complete and file in each employee file. Bakersfield Fire Dept. Hazardous Materials Inspection Date Completed /_rS-q- REG~J¥~.D Location: .ff~_C' o0, C.6/un~.~0g .... OCT Plan ID # 215-000 90~o (Top right comer Business Plan) ~.7. ~g,&T. !..')..iV. Station eo. ~ shi~ /? tnspector Adequate Inadequate Verification of [nvento~ Materials ~ Verification of Quantities ~ Verification of Location ~ ~oper Se~egafion of Matefi~ ~ Comments: Verifi_..cation of MSDS Availability ~ [--] O~ Number of Employees Verification of Haz Mat Training [~ ~ Col'nmoJ'l.ts: Verification of Abatement Supplies & Procedures [~ [-~ Com.ine~ts: Emergency Procedures Posted [--] Containers Properly Labeled Con'u'ne_~Es: Verification of Facility Diagram Special Hazards Associated with this Facility: Violations: FO 1652 (Rev. 3-89) White-Haz Mat Div.. Yellow-Station Copy Pink-Business Office CITY of BAKERc,,. 7ELD NOI~--TR/~%) E S EC RETS ~usIN£SS NAH£: 7-Eleven Store 2720- 1_!~.. OWNER ~:A,'<E: 7-Eleven MarkE.~ 27~Q.. ~m:~ oF T~ F~.CILi~Y: 7-E].e,v~_~I_~!.~83z I,OCATION: 525 West Columh.~ _ ADDRgSS: 4008 White Lane STANDARD Itlu.~iS~O~ 54 11 CITY. ZIP: Bakersfield 93301 CITY, ZIP: Bakersfield ~ DO~: aaO BRADSTREgT NUMBER P.O~ ~:__ 8~322-78~9 PMO~ c:_ (805~~L~ ....... O0 - 734 - ~ of P~ ~lth ~.~: H ~C.~.S. ~ Su~er Unleaded Ga~l.i~e ~9 .... Lil I I [_ I /"- ]2 ~ I , L _i of P~r~ :,(aGt,CYC~tACIS "R,. Karen McG%ll fllli~&EChiS.¢~ ...... ~/~=787.9 ~Z Steve Jones Market Man~e~ 805/6647~L~ Fo.n AC~'ovm:l OM8 No. 2050-0072 Facility Identification ': !';:':' · ':: Owner/Operator Name ' ': ' :'" Tier Two ."' 7-ELEVEN STORE NO: 16~34 % N~ The Southland Corporation ~ ( 214, 522-4790 EMERGENCY StreetA~d SEC COLUMBUS S SAN DIMAS l uai,~.,, 2828 N. Haskell-.Dallas, Texas 75204 AND BAKERSFIELD CA ~3301 'i , HAZARDOUS ' COUNTY: KERN Emergency ContaCt i ::!: ....:.... - ' ' : CHEMICAL ~ T C: 5 5 ~, 1 Store Ma~acjer S T O INVENTORY i' - Nam t~i A I,~ ~ .' ~/o.~/~¢ s,cc~ ~ ~ I , ' TITLe: STORE MANAGER ~yCh~m~¢aZ :.':=: :.FOR .I,~ PHON:: (~05) 322-7879 ::.::i::.OFFICIA~;I ~ I ' .~ ~n~a C~qh~ 2~-HOU~: (805) 3Z2-7~79 ::f?aUSE (;io.,.R~,~ I ' ~ (214) 5~-47go Important: Read all instructio~ before completing form RepoSing Period Fr~ Ja~a~ t to ~ 31. 19 : ent.o~ .:': ": ':'.:. .. .:L:: : ::/ Storage Codes and Lo .:: '. ': - :":: .: :: ~.: ::'.::.:~.:.:::?::.-~.:'::::~:~:?.f:~:':.:~,:)?.::::::::::::::::::::: ..>.Physical -:':7 .. ':::'"':.~: 'l~v cationS . . .:..: ':' ..:Chem~Cal:De~rip~i~.n?.:~::~:.::~:~?~?::~:?~:.: :.'and Health" ~ax. '.:~vg...:.. No. of : :.;.: :'.'.:.:¥.::'-, ..... .' . .... :.:--....,: -." ::' :~..V: ' : Dally: '::Dally -::'-' Days . :." .::'. "'.::::::.::.:: -¥ (Non-Confidential):,:.'..':'~: . .. . . .?:.:. :::-:.: ,:':.:..... ..-.:...... -:::..:::~...:.....:~:.:..,:.:....:.. Hazards. ':'.::- 'Amount Amount' On-site : ~. i:' .'.~:'~:~:.': ': '. '.. : :~:: :':':':~ :::::~:'.':':?: '-':': :).:..' :':' '.::~':.:.::~ ' ? '.~: ...:.'. (~ all ~at a~y}.: '(code) :. (code) (days) - ~-torage Lose - .-~'tora8e~catio~ cAsl I I I I I I~~ '"'~ -- · ' :.5 ~ ~~[o~~ S~et ~ ~ Fire S~ Remase · :. .' .~ .' ,.: i ' Chem. N~e. ~ et ~es~e thai apply: ~e Mix ~ ~ Gal "" "' ' "' cAs l I I I I I I~~ ~"~ -.' Chem. Name ~ of Pr~ U~ea~ ~oline R.~,,.,,y ~ ~ 131615 I m ~ ~"~ (~) ...':.:... ~ .... J that apply: ~e M~ ~ ~ Ga~ . S~et ,, - S~ Relea~ J " Chem. N~e ot ~ess~e ~ialo (~te) : X ~lay~ (~) that apply: ~. ~ ~ ~id Gas Certlflcatlofl ' ' (Read ~nd ~itn afttr (ompittin8 all ltctJo~i) -: Optional Attachments (Check one) i c~tl~ ~ ~lty of ~w l~t i ha~ ~s~ally tx~l~ a~ am familia~ wilh t~ inl~mali~ s~ilt~ In this a~ all attac~ ~umenls. a~ that ~ my ~u~ of ~e ~all res~lble f~ obtainl~ the inf~mati~, I ~li~o that J~ su~tt~ Inlum~im is lt~. ~ccurate. a~ c~plele. ~ I have attach~ a lite plan Pa~e ~) . of ~ pages F~m Al~;xoved OMB ~. ~72 Facl ty Identification : Owner/Operator Name · "' :' :" ..... ' ....... ':'.: Tier Two ..~ ~ ~ge 1 N~ ~ ~uthl~d' Co--ration ~ ( 214, 522-4790 EMERGENCY Str.tA~res, M~il~ess 2828 N. H~kell -.~llas, Texas 75204 HAZARDOUS EmerGe~cW Contact · :.. · ... INVENTORY N~ Titl. Information Numar 24 ~. ~ ( :'.:>'ONLY: ~ (214 ~ 522-4790 Chem. N~e ~ of ~ess~e that apply: ~re Mix ~1~ Ll~id Gas Chem. N~o ~ Re~a~ __ ot Press~e , ~iate t~at apply: ~e ' ' ~ret ~ -- Fire S~den Release Chem. N~e ~ ct Press~e ; Reactivity ~~ I I I I -- ~iate (acute) I" I Certification (Rtad and ~ign afttr ¢ompltting all ~ction~) Optional Attachmenta (C~eck one) BUSINESS NAME 7 ELEVEN FO.OD ~,'.~_ORE 3Z1ZS-1B834 ID NUMBER ZlS-0f~O-~OBOB LOCATION SZS W COLUMBUS ~T HIGH HAZARD RATING O. EMPLOYEE NOTIFICATION / EVRCUATI'ON" :! LA'ST CFft°iNGE' fl/10/88 BY VFIL SEC Z) VERBAL AND CALL 911. FOR RELEASE OF HAZ MAT NOTIFY BFD HAZ MAT DIV AND STATE O,E~S, Call Tom Carmichael, Development Manager at 1-800-541-1334 for removal of cleanup materials'. E. MITIGATION / PREVENTION / ~BATEMENT LAST CHANGE 11/10/88 BY VRL SEC 1) STANDARD G~SOLINE STATION SAFETY FEATURES FOR GAS PUMPS/AUTOMATIC SHUT-OFFS VAPOR SHzELD~, SHEER OFFV~LVE. COMPRESSED GASSES PROPERLY STORED iN SMALL SAFETY CONTAINERS AND WITH PROPER FITTINGS. See Hazardous Materials Handling Procedures Posting and Employee Awareness form (attached). PAGE 4 01/19189 1B:41 M~TERIAL SAFETY DATA SYSTEMS, ]:NC. (80S) BUSINESS NAME ? ELEVEN FOOD STORE 3ZIZS-1B8~4 I0 NUMBER Z1S-000-000806 LOCATION SZS W COLUMBUS ST HIGH H~ZRRD R~TiNG FBCILITY UNiT ~,, OVERALL HAZAROOUS HATERI~L9 INVENTORY LAST CHANGE 1t/18/88 BY V~I_ ID TYPE NAHE MAX 8MT UNIT HAZARD LOCRTI ON CONTAt NHENT USE 1 PURE UNLEADED G~SOLINE ~ GAL HIGH STORE FRONT UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LIST 118Z.~ 188.,8 GASOLINE HIGH Z MIXTURE REGULAR GASOLINE 1~ GAL HIGH STORE FRONT UNDERGROUNO TANKS FUEL I0 PERCENT COMPONENTS HRZARO LIST I18Z.~ 1~0.0 GASOLINE HIGH 3 PURE StJPER UNLEADED G~SOLINE 1~0~ GAL HIGH STORE FRONT UNDERGROUND TANKS FUEL ID PERCENT COMPONENTS HAZARD LIST 118Z.~ 18~.8 GASOLINE HIGH 8. FIRE PROTECTION / WATER SUPPLIES LAST CHANGE / / BY Fire extinguishers located in store per fire code. NO INFORMATION RECORDED FOR THIo SECTION > PAGE 3 .... 01 / t E;7 8g'"TG'~ z~ I'- MATERIAl_ SAFETY D~TA SYSTEMS, INC. (805) G48-GB~)O BUSINESS NAME 7 ELEVEN FOOD STORE 3Z12S-16834 !O NUMBER Z1S-~-OOO80B LOCATION S25 W COLUMBUS ST HIGH HAZARD RATING Z 3. HAZ MAT TRAINING SUMMARY L~ST'CH~NGE / / BY See Hazardous Materials Handling Procedures Posting and Employee Awareness form (attached). < NO INFORMATION RECORDED FOR'THIS SECTION > 4,. LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE tl/10/88 BY VAL SEC S) FIRE/POLICE DEPT - NEAREST EMERGENCY ROOM TO THE LOC~TtON IS TO BE USED IN THE EVENT OF INJURY. PAGE Z 01/t9/89 16:41 MATERIAL SAFETY DATA SYSTEMS, INC, (805) B48-6800 BUSINESS NAME ? ELEVEN FOOD STORE 3Z1ZS-1GB~4 tO NUMBER Z1S-OOO-OOO80G LOCATION SZS W COLUMBUS ST' HIGH HAZARD RATING 1, OVERVIEW LAST CHANGE 11/10/88 BY VAL JURIS CODE ZlS-0~4 JURIS BAKERSFIELD STATION 04 MAP PAGE 103 GRIO 180 FACILITY UNITS 1 HAZARO RATING Z RESPONSE SUMMARY ZA SEC 4) EMERGENCY COORDINATOR (PRE-OETERMINEO) SHALL NOTIFY ALL AGENCIES AND iNTERCOMPANY PERSONS IN 'THE EVENT OF INCIDENT. EMERGENCY COORDINATOR SHALL IMPLEMENT ALL THE NECESSARY MEASURES IN REGARD TO EMPLOYEE ANO ENVIRONMENTAL SAFETY AS INSTRUCTED BY TRAINING RECEIVED. EMERGENCY CONTECTS JERRY & KAREN MCGILL - R~i~J~x~E~E~ - 834-Z711 - Steve Jones UTILITY SHUTOFFS A) GAS NONE 8) ELECTRICAL - BACK ROOM HALLWAY C) WATER - STORE FRONT/SIDE D) SPECIAL - NONE E) LOCK 80X - NO Z. NOTIFICATION / PUBLIC EVACUATION LAST CHANGE / / BY Verbal and dial 911. < NO INFORMATION RECORDED FOR THIS SECTION > PAGE 1 Oi/IB/8B tG:41 MATERIAL SAFETY DATA SYSTEMS, INC. (80S) G48-G800 CITY of &.--1A'TRSFIELD ~,i' .-...~, .,t ., , .~.. ,~ ., " I ~ ' E CARE ".32.:..%~:," .' ./ v Steven S. Jones REC;EIYED Do hereby cer:ifT' that I have reviewed :,~AT_.MAT. DtV. "ii attached Hazardous Materials business ~lan for __ ?-E]e¥_en Food Store _. (name of business;. and that it alon.~ with the attached additions er corrections constitute a comp!ere and correct Business Plan for my facility. ' 2 R9 ~{ZARDOUS btATERIALS HANDLING PROCEDURES FUEL SPILLAGE EMERGENCIES 1) In case of large fuel spill, (50 square feet or larger or any- thing that looks potentially hazardous) CALL THE FIRE DEPARTMENT. 2) In case of small fuel spill 50 square f~et or smaller, determine potential hazard. U~e absorbent material (kitty litter or sand), absorbent pad, or for very small spills, let evaporate. UNDER NO CIRC~ISTANCES HOSE OFF WITH WATER. THIS WOULD CAUSE UNDER- GROUND CONTAMINATION AND WE COULD BE FACED WITH A VERY LARGE CLEAN-UP BILL. Keep used clean-up material in a metal container with metal lid. 3) For removal of clean-up material for #! or ~2, call Tom Carmichael at 1-800-541-0334. 4) Know where the fire extinguisher is and how and when to use it. If you have to use a fire extinguisher, ALWAYS CALL THE FIRE DEPARTMENT FIRST. In our store the fire extinguishers are located: . 5) Know where and how to shut off power to gasoline equipment. Every store is different; have someone show you. In our store the gaso- line power shut-off is located: CO2 TANK HANDLING 1) All CO2 tanks are to be stored with metal cap in place (except when in use). Replace metal cap on tank after use (empty). 2) All CO2 tank~ are to be chained up tightly 3/4 way up at all times. PLEASE POST IN STORE ~ I~RSFIELD CITY FIRE DEPART~NT R E C [ ! V ~.,0. ~. 2130 "G" S~EET B~RSFIELD, CA 93301 JUL 13 1987 ........... OFFICIAL USE ONLY ~US INESS h'~E ~Z~RDOU~ ~TERI~LS ~U~I~E~ P~ ~ ~ ~OLE ~OR~ ~ INSTRUCTIONS: 1. To avoid further action, return this form by 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. SECTION 1: BUSINESS IDI~qTIFICATION DATA A. BUSINESS NAME: 7-Eleven Food Store #2125-16834. B. LOCATION / STREET ADDRESS: 525 W. Columbus CITY: Bakersfield ZIP: 93309 BUS.PHONE: (805 } 322-7879 SECTION 2: EMERGENCY NOTIFICATIONS In case of an elergency involvin$ the release or threatened release of a hazardous laterlal, call 911 and 1-800-852-7550 or 1-916-427-4341. This will notify your local fire departsent and the State Office of Emergency Services as required by law, E~/PLOVEES TO NOTIPY IN CASE OF F.~ERGENCY: NAME AND TITLE DURING BUS. HRS. AFTER BUS. HRS. A. Jerry &'Karen McGill, Franchisees Ph~ (805) 322-7879 ph~ same B. Kathy Mejia, District Hanager 2125 Ph* (805) 83~-2711 Ph~ same SECTION $: LOCATION OF UTtLITY SHUT-OI~$ FOR BUSINESS AS A#HOLE A. NAT. GAS/PROPANE: None B. ELECTRICAL: back r6om hallway C. WATER: store front/side D. SPECIAL: E. LOCK BOX: YES /"~0) IF YES, LOCATION: IF YES, DOES IT CONTAIN SITE PLANS? ((YE~ / NO MSDSS? ('YES)./ NO FLOOR PLANS? YES / NO KEYS? YES / NO - 2A - SECTION 4: PRIVATE RESPONSE TEA~ FOR BUSINESS AS A WHOLE Emergency Coordinator(pre-determined) sh~ll notify all agencies and inter-company persons in the event of incident. Emergency Coordinator s~.all implement all ,,~'p~f~';f!necessary measures in regar~ to employee and envirnmental safety as instructed by training received. SECTION 5: LOCAL EMERGENCY MEDICAL ASSISTANCE FOR YOUR BUSINESS AS A WHOLE Fire/Police Depa=tment: 911 Nearest E.R. to the location is to be used in the event of injury. SECTION 6: EMPLOYEE TRAINING EMPLOYERS ARE REQUIRED TO HAVE A PROGRAM WHICH PROVIDES E~PLOYEES WITH INITIAL AN~ REFRESHER TRAINING IN THE FOLLOWING AREAS. CIRCLE YES OR NO INITIAL REFRESHER A. METHODS FOR SAFE HANDLING OF HAZARDOUS .~TERIALS: ....................................... YES NO YES NO B. PROCEDURES FOR COORDINATING ACTIVITIES WITH RESPONSE AGENCIES: .......................... YES ~0 YES NO C. PROPER USE OF SAFETY EQUIPMENT: .................. YES NO YES NO D. EMERGENCY EVACUATION PROCEDURES: ................. YES NO YES NO E. DO YOU MAINTAIN EMPLOYEE TRAINING RECORDS: ....... YES NO YES NO SECTION 7: HAZARDOUS MATERIAL CIRCLE YES OR NO DOES YOUR BUSINESS I~NDLE HAZARDOUS )IATERIAL IN QUanTITIES LESS TRAN 500 POUNDS OF A SOLID, 55 GALLONS OF A LIQUID, OR 200 CUBIC FEET OF A COMPRESSED OAS: ...... YES NO I, Jerry McGil~ , certify that the above lnformationts accurate. · I understand that this information will be used to fulfill my firm's obligations under the new California Health and SafetF code on Hazardous Materials (Div. 20 Chapter 6.95 sec. 25500 Et Al.) and that inaccurate information constitutes perjury. SIGNATURE ITLE Franchisee DAT~ - 2B - .BAKERSFIEI, D CITY FIRE DEPARTMENT - I.D. ~ FORM 4A-1 Page 1 of NON--TRADE SECRETS HAZARDOUS ~IATER I ALS INVENTORY BUSINE,~S NAME: 7-Eleven Store #2125-16834 OWNER NAME: The Southland Corporation FACILITY UNIT #: ADDRESS: 525 W. Columbus @ San Dimas ADDRESS :1240 S. State College B1. FACILITY UNIT NAME: Ste. 100 CITY, ZIP: Bakersfield~ CA 93309 CITY,ZIP:Anaheim~ CA 92806 P,ON~ ~:, ,(805)322-7879 PHONE ~: (714)635-7711 ~OFFICIAL USE CFIRS [ ONLY ] 2 3 4 5 6 7 8 9 10 TYPE MAX ANNUAL CONT USE LOCATION IN THIS · BY HAZARD D.O.T CODE AMOUNT AMOUNT UNIT CODE CODE FACILITY UNIT WT. CHEMICAL OR COMMON NAME CODE 6UIDE M 10,000 Est,-~ GAL 01 19 Store front/Columbus 100 Gasoline/Unleaded I[~'~ FLLQ 1203 98.063 ~)M 10,000 37,116 GAL 01 19 " 100 Gasoline/Super Unleaded Jt~ FLLQ 1203 M ~ ~ Ft3 04 99 " 100 CO2/Carbon Dioxide NFLG 1013 NAME: Tfl,~L- u~ttle TITLE:Gasoline bfanager S ONATURE: ~ f ~ DATE: 6/8/87 EMERGE-N-C~-~-O~N-~ACT: Jerry McGill TITLE: Franchisee f PHONE # BUS HOURS: (805)322-7879 AFTER BUS HRS: (805)322-7879 EMERGENCY CONTACT: Kathy Me, ia TITLE: District Manager, 2125 PHONE # BUS HOURS: (805)834-2711 PRINCIPAL BUSINESS ACTIVITY: Convenience store wroth se±£-serve gasolzne AFTER BUS HRS: (805)834-2711 ~ BAKERSFIELD CITY FIRE DEPARTMENT · 2130 "G" STREET BAKERSFIELD, CA 93301 OFFICIAL USE ONLY ID# BUSINESS NA~IE: BUSI NESS PLAN SINGLE FACILITY UNIT FORM 3A INSTRUCTIONS 1. To avoid further action, this form must be returned by: 2. TYPE/PRINT YOUR ANSWERS IN ENGLISH. 3. Answer the questions below for THE FACI'LITY UNIT LISTED BELOW ..j3f~'-.~.iii_ 4. Be as BRIEF and CONCISE as .possible.' ........ FACILITY UNIT~ FACILITY UNIT NAME: SECTION 1: MITIGATION, PREVENTION, ABATEMEN'r PROCEDOq{ES · SECTION 2: NOT!F!CATION' .%%~D EVACUATION PROCEDL'RES AT TI{IS ~'IT ONLY