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HomeMy WebLinkAboutNOTICE OF VIOL. 7/21/2004 AT&T David Nargis EH&S Group Manager July 21, 2004 VIA FACSIMILE AND REGULAR MAIL Mr. Steve Underwood Fire Inspector / Environmental Code Enforcement Officer Bakersfield Fire Department, Office of Environmental Services 900 Truxtun~ _Suite 210 Bakersfield, CA 93301 Re: Notice of Violation & Schedule for Compliance - Failure to Perform/Submit Annual Maintenance on Leak Detection at 1520 20th Street, Bakersfield, CA 93301 Dear Mr. Underwood: This letter is in response to the Notice of Violation ("NOV") related to Section 2641 (J) of the CalifOrnia Code of Regulations, which was mailed to 1520 20th Street, Bakersfield, CA on January 28, 2004. In summary, the AT&T Environment, Health and Safety (EH&S) Organization first became aware of this NOV on April 21, 2004 through telephone conversations with a legal representative from AT&T Wireless Services. On that same day, AT&T EH&S (Gary Chimienti and David Nargis) contacted your office requesting a call-back. On April 22, we discussed the situation with you, and received the faxed copy of the NOV. Gary Chimienti initiated the process with AT&T contractors (Hanson Engineering and Tanknology) to begin the certification testing. Additionally, Lynn Ragsdale, AT&T EH&S, sent a copy of the latest Business Plan for 1520 20th Street.to your office via. overnight mail..--On June_4,_2004, you confirmed with Gary_Chimienti · _ that,you were satisfied with the certification testing results and the Business Plan, and that this certification is due again in 2005, one year from the date of the last inspection. Additionally, the secondary containment must be tested next year (anytime during the year). We believe all issues have been addressed satisfactorily. If you have any questions regarding this matter, please contact Gary Chimienti, AT&T Environment, Health & Safety Organization at 925-224-1496. Sinc.erely yours,,4 . David Nargis EH&S Group Manager FAX DATE: July 21, 2004 TO: Steve Underwood City of Bakersfield Fire Department FROM: Dave Nargis AT&T Environment, Health & Safety 630-416-6864 Fax - 281-664-9078 Steve, This fax is related to the Notice of Violation concerning Section 2641 (J) of the California Code of Regulations, which was mailed to AT&T, 1520 20th Street, Bakersfield, CA on January 28, 2004, and resolved in April-June through contact with your office. Any questions, please call me on 630-416-6864. Thanks, Dave Nargis Number of pages including this page: 2 CITY OF BAKERSFIELD 'OFFICE OF ENVIRONMRNTAL SERVI :C. ES ~ 1715 Chester Av~, Bakersfield, CA (661) 326 3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION OPERATORS NAME. ~,.~ DOES FACH.,fI~ HAVE DISP~S~ PANS? YES /.,. NO ..... MONITORING SYSTEM CERTIFICATION For U~ By All J#r~l~ct~ Mtl~n thc State of Co~fomia AurhorOy Cited: Cha~er 6.?, Health and ~afety Code; Chapter 16, Division 3, Tidg 23. Califo~ Code of Regulations This form must I~ used to do~me~ te~ng arK! se. rvi~ of monitoring oqlfipment. A.~ cz~tification or re0o_ rt mu~t be p~emm~l for each monitorin~ system control 0a~el by tbe technician who performs tbe work. A copy of this form must be provided to the tank syst~n ov~/opemtor. The owne~operator must s~bmit a copy of this form tx) the local nge~'y regulaling UST systems w~th~n 30 days of test date. Facility Name: Bldg. No.: Make/Mod~l of Monitoring Syst~n: 0~'EX~C'~ ~T' ~ ~ Da~eofTe~ting/Sexvieing: ~ I ~=~./O~ B. Inventory of ~_xluipment Tested/Certified Model: ~"'~nnularSpaeeorVaultSe~or. Mode~: ~t~.Z .. I~'~muhrStI:eorVnultSensor. . O Fill Sump Sensors). Model: UI Will Sump Sensors). Model: t~ M~cal Line Leak Detector. Mod~: Ui Mechanical Line Leak Detector. Model: I~ Tank ~ / High-LeveJ Sensor. Model: Ui Tank Overf~ / High-level ~ensor. Model: ~] O~/w~ (~ _,~p~_ ~t tyl~ ai~ _L~r~___ h ~_m~_ E O~1Pa[~2). ,l~l. Oth~ (~ez:ifyoquipn~nt ty~ 9ndmodcl h Section E on Pa~¢ 2). ~nnulnr Spa~e or Vault Sensor. ModrA: "~b~.. {~"Ann~lar Space or Yault ,~msor. Model: I~Piping Sump / Trench Sensor(s). Model:-~-~. I~l~ing Stunp/'IYench Smso~s). Model: ~/?~ Ci F'dl S~ Se~or(a). Model: CI !~!1Snmp Sensor{s). Model: I~ TankOven~/High-LevelSen~r. Model: i~l Tank~/lfigh-lxvel.~ns~. Model: I~ C~.h~ ~Xy ezp,inm,~t type and Lrn~_~l in ~on E on Pn~. 2). [ C~ Other (specify equipment type ~nd .tagde. lin .Sec~.on E o~. Page 2). .... "=' !"-" c. ont~~s). Mod~:, cfl~_ er~c~t~n~t~s). Mod~: "~/?- I~'~ltear ¥~lve(s). ' I~'~h~r ¥~dve(s). tir~spen~~tSen~ts). ~dd:=U? ~t~t~=Contai~n~tS=so~s). Mod~: I~'~hear Valve(s). ~ Valve(s). c]~__---~-.~.. ,~,~-- --- Flc~_._~ and ~i~s (3 Dispms=Co~inmea~'Fk~s) and Chain(s). attached a eepr er me report;~ nglA,~ ~PrY~ o System set-up X~J'JW, pr~ Msto~rt SitcAddren:. /-~--,-~';~ ~;~'~'~-~' ~_~,.~c., Dat~ofT~cing: P~e 1 og 3 o~1 Monitoring ~ystem C..eflmeation Ir. In, Tank Gauging I SIR Equipment: er'Check this box ffranir gauffin~_g is used only for inventory control. U Check this box if no tnnk gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. C-on?,**,* the fo!h~win ~u"Y~ a ~o* m~ ~u ~ ~,~,i,,~ ~, i~p~ for'p,~' ~.~'~d ,~.~o,,. ~,,d~ '~.,~g fo, ~.~' ~'.~?, ~'Yfs r'l No* Wexealltnnk.ga.ugingprobes..vistmlly~fordamageandre~..idu~bui.lduP? ..... ~yes 13 No. was~yof~~ ,~~ ,t~d? , . ~'es 13 No* Was accmacy of system water level readings tested? I~f~es n No. Werealipr01)es~pvolxa'ly? ......... . ~ Yes KI No* Wereallitemsontl~equipme~~'s~~c~klistcompleted? * In fl~e ,~dion H, below, describe how and when these defidendm were or will be corrected. G. Line Leak Detectors (LLD): ~'"/Chcck this box if I ~LI)s are not installed. t'-~m ~lptd~ the follawin~ ch~kli~t: C3 N/A (Check all that apply) Simulated leak t'ate: C~ .3 g.p.h-; 13 0.1 g.p.h; 1~3 0.2 g.p.h. 13 Yes O No* w~,,,,~,~.-=d"o,,,~o~=,d'~"~'~~~t.? ,, ' ..... 13 Yes 13 No. E{ Yes O No* Forn~chani,~d!.~'r~s, doeS the ,-l n restrict product'flow if i~ d~___~_-~ a leak? ON/A ....... u yes 13' No* 13N/A El N/A or disconuected? El N/A or fails a test?. 'ca yes '13 No* ~1 N/A c] Yes' 13 No* W,~ ~u it,~ns o~'~ e,pipm~t mnuf~u~*.~ m~tem~,:h~St ~omp~,~d?' . . * In the Section H, bdow, describe bow mad wben these defldendes were or wi~ be eorreete& H. Connnents: Pnge3of3 Pag~ 2 ~g3 Monitoring System Certification ..... UST Moni~ring Sit~e Plan / ~, ::::::::::::::::::::::::::::::::::::::::::::::::: . . . . . . . . . . . . . . . . ~~ ~ ~ ~ ~m ...................... ................ ~:::: :~~~~~ ::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::: ~~~ ~ ~/oy. ~ you ~y ~ve a ~ ~t sho~ ~1 ~ ~omfio~ ~u my ~c~e i~ m~r ~ ~s ~ge, M~ yo~ Moffi~g ~ ~m ~ Y~ ~ P~ ~w ~ g~ layout of ~nk~ ~d pip~g. Cl~ly id~nO~ l~fio~ of ~e fo~g ~~ ff ~: ~m~g ~ ~n~l ~els; ~m ~m~g ~ ann~ ~; ~d ~mnk H~d l~el pm~ (ff ~ f~ 1~ ~fion). ~ ~e ~ ~~ no~ ~e ~ ~s Site PI~ SYSTEM E;ETUP JUN 30. 2004 12:56 PM ES-232 SECURITY SYSTEM UNI TS CODE : O00OO0 U.S. T 2:PLUS UNLEADED SYb~ L~NGURGE PRODUCT CODE 2 ENGL I SH THERMAL COEFF .000700 TANK DIPJ~'FER 111.50 FASTRIP TANK PROFILE I PT 806 THIRTVFOIJ]~TH ST. RS-232 END OF MEE~GE FULL VOL 12062 BR](ERSF l ELD o CA, 93301 D l 661-325-0110 FLOAT SIZE: 4.0 INCHES SHIFT TIME I : DISABLED W~TER W~RNI NG : 2 SHIFT TIHE 2 : DISABLED IN--TANK SETUP ' SHIFT TIHE 3 : DIF~BLED HIGH W~TER LIMIT: 3.0 SHIFT TIME 4 : DISABLED ~ OR LABEL VOL: 12062 PERIODIC TEST WRRNINGE~ T I :REG UNLEADED OVEI~FILL LIMIT : 90~. PRODOCT CODE : I : 10866 DI.~:~BLE. D T~ COEFF : .000700 ANNUAL TEST WRRNI~ TANK DIAMETER : 111 .50 HIGH PRODUCT : : 11 ?00 DIEU~BLED TANK PROFILE : I PT DELIVERY LIMIT : SYSTEM SECURITY FULL VOL : 12062 : 120 CODE : 000000 PRINT TC VOL~ FLO~T SIZE: 4.0 INCHES LOW PRODUCT : LF,~K ~ LIMIT: 50 Ei~BLED IA~TEE MRRN]NG : 2.0 SUDDEN LOS~ LIMIT: TEMP COMPEtiTION HIGH WATER LIHIT: 3.0 TANK TILT 0.00 MRNI FOLDED TANKS VALUE (DEG F ): 60.0 PlAX OR L~BEL VOL: 12062 Tit: NONE OVF~FILL LIHIT : : 10855 PER I OD l C TI~T TYPE HIGH pRODUCT : 97~ ~UICK : t 1 ?00 DF_J. I YER¥ LIHIT : : ¥ 120 PF_~IODIC TEST FAIL ~ D I S~BLED LO~I PRODUCT : LEAK RIJ~ LIMUT: __. 50 GROSS TEST FAIL SUDDEN LOEb3 LIMIT: 99 ALARM DISABLED TANK T I LT : 2.30 PER TEST AVERAG I NG: OFF COI~UN l CAT l ONS SETUP M~N I FOLDED TANI~ TANK TEST NOT I FY: OFF Tit: NONE PORT SETTINGS: PERIODIC TEST TYPE TNK T~T SIPHON BRF_~K:OFF QU I CK DEL I VERY DF.I~¥ : 15 H I COHH BOARD : 3 (RS-232) PERIODIC TEST FAIL BAUD RATE : 9600 ~ DI.~BLED PARITY : NONE STop SIT : ~ s'ro~ G~,o~ I~TA LENGTH: 8 DATA DISABLED PER TEST AVERAG I NG: OFF AUTO TP~NSM I T SET]' l NGS: TANK TEST NOT I FY: OFF AUTO LEAK RI.ARM LIMIT TRANSMIT TNK TST SIPHON BREAK:OFF AUTO HIGH WATER LIMIT TRANSMIT DF_I. IVE.]~ DF_I~¥ : 15 MIN AUTO OVERFILL LIMIT TRANSMIT ~UTO LO~ PRODUCT TEA NSM I T AUTO THEFT LIMIT D I SABLED AUTO DE. LIVE]~¥ START TRANSMIT AUTO DELIVERY END D I SABLED AUTO EXTERNAL [NPUT ON TERN SM I T ~UTO EXTERNAL INPUT OFF AUTO SENSOR FUEL ALARM D I SRBLED AUTO SENSOR WATER ALARM D I SABLED AUTO SENSO]~ OUT ALARM D I SABLED 'I' ~3:PREI'IlLIM UNLEADED ........ PRODLI~T OODE : TH~L COiF :. 000T00 T 4: D I ~EL TNNK D{~ : 111 .~O P~D~ ~DE : 4 TANK P~FI~ : I PT T~ ~ : .000450 LIQUID SE~OR ~UP FU~ VOL : 12062 TR~ DI~ : 111.50 TR~ P~Fl~ : I PT FU~ ~OL : 12062 L 1 TRI-~TE (~I~E FLO~T) FL~T ~IZE: 4.0 1~ ~TER ~RNI~ : 2.0 ~T SIZE: 4.0 I~ HIGH ~TER LIHIT: ~.0 ~T~ ~RNI~ : 2.0 L 2:REG U~ED ~NNU~ ~ OR ~B~ ~OL: 12062 HIGH ~ LIMIT: ~ 0 TRI-~R~ (SIDLE FLOAT) ' CATEGORY : RNNU~ SPACE OUERF ILL LIMIT : : 10855 ~ OR ~ ~L; 12062 HIGH P~D~ : 9~ 0~I~ LIMIT : : i 1700 : 10855 DELIV~Y LIHIT ; 1~ HIGH P~D~ : 9~ L 3:PL~ UN~ED : i1700 TRI-~RTE (9I~LE FL~T) : {20 DELI ~ LIMIT : IX C~TE~ LO~ PROD~ : I : 120 L~ ~ LIHIT: 50 L 4:PL~ U~ ANNU~ SUDDEN LO~ LIMIT: 99 L~ P~D~ : 1 TANK TILT : 1.40 ~ ~ LIMIT: 50 ~~Y CLOS~ SUDDEN L~ LIHIT: 99 CRTE~RY : RNNUL~ SP~E ~N I FOLDED T~S TR~ T I LT : 0.20 T~: NO~ ~NIFO~ T~S PERIODIC ~ ~PE T~: ~NE L T~I-~aTE (~I~ FL~T> ~U{CK PERIODIC T~T ~PE CRT~ : ~P PERIODIC ~ FAIL ~LIICK R~ D I ~BLED P~IODIC T~ F~IL L 6:PR~I~ RNNU~R O~ T~ F~ ! L ~ D I ~BLED ~LLY CLO~ ~ DISHED ~~ : ~NNUL~R SP~CE O~ T~ F~I L PER T~T R~ER~ [ ~: OFF ~ D I ~BL~ TR~ T~ ~TI~: OFF P~ T~ R~I~: ~OFF L 7:DI~EL ~I-~R~ (~I~LE FL~T) TNK T~ 5IP~N BR~:O~ T~ T~ ~TIFY: OFF D~IV~' D~Y : i5 HIN T~ ~ ~IP~N B~:OFF L 8:DI~ ~NN~ D~IV~,~ DE~Y : 15 HIN L 9:DISP 1.5 TRI-b-'TATE (SINGLE FLO~T) C~TEG'OR¥ : DISPENSER LiO:DISP 3.4 TRI-STATE (SINGLE FLO~T) LE~K TE~ METHOD CATEI3;O~ : DISPENSER PAN TEST ON I~qTE : ALL TANK JAN 1. 2000 START TIHE : 2:00 {qM LII:DISP 5.6 TEST {~TE :0.20 C-~q~tHR TRI-STATE (SINGLE FLOAT) DUPaqTION : 2 HOUR~ C~TEGOR¥ : DISPENSER PAN LI2:DISP 7.8 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSE{~ PAN LI3:DI.~P 9.10 TRI-IBTATE (SINGLE FLO~T) ': ,C~T~RV : DISPENSER OUTPUT RELAY SETUP 8.02 _~OFTIA~RE# 349500-008-0 R ! :REG UN~ED CRF--aqTED - 95.04.06.09.3~ ~ HISTORY ~PE: ~AN~D ~Y CL~ ~ ~~ ~DU~ P~l OD ICI N-~ ~, L 4 :~L~ UN~D ~NNU~ LIQUID SE~R ~ aNNUL iN_T~'"~~' aNNU~ FUEL ~ L I :FU~ ~ L 2:FU~ ~ JUN 30. 2004 ~ :20 L I :SE~OR O~ ~ FU~ ~L~ L 2:SE~OR O~ ~ .- R~ lz. 2003 9:0~ L I :S~RT ~ L 2:S~ ~ FU~ ~T~N~ F~ ~Y ~ED JUN 30. 2004 I : I 0 PPI LIQUID ~E~R ~ ~"r 31. 2003 10:38 ~ L ~:FU~ ~ L ~:SE~OR O~ R~ ~ 12. 2003 8:55 ~ L 4:$E~ O~ A~ ..... SE~R ~ L 5: ~U~L 3:PR~I~ O~EO ~-r 31. 2003 10:38 ~T~RD ~L ~ ~Y CL~ A~ HI~TORY R~ ~ 12. 2003 8:58 ..... L ~:F~ R~ L S:SE~R O~ ~ dUN aO. 2004 2:08 PH L 6:~E~O~ O~ ~ L 6:~ ~ ~UN ~0. 7 ~ ~PE: ~T~N~D F~L ~Y ~LO~ ~UN ~0. 200~ I :~8 ~ LIOUID ~E~OR R~ ~ 12. 200~ ~:02 ~ ~:FU~ R~ FUEL ~ 7:SE~R O~ ~ ~ HI~O~ ~ a~ 7. 2002 7:~ ~ 8:~ R~ L g:PL~ U~ ..... ~p ~p DED FUEL ~UN aO. 2004 1:12 ~ ~L ~ ~LARM H I $~roR¥ REPORT AI~RM H 1 ~ORY ..... ~R ~ ..... FUEL ~ Di ~PE~ JUN ~0, 2004 1:15 ~ F~ ~ JUN 30. 2004 I :46 FU~ ~ FUEL RL~]~ H ISTO]~ REPOI?T SEN~OR A~M LI2:DISP 7,8 D ISPE~ PAN JUN 30. 2004 I :47 PPI ..... 8E~R A~ ...... L B: D 1 ~EL ANNU~ ANNU~ FU~ ~ JUN ~0. 2004 [:27 ~ FU~ JUN ~0. 2004 1:17 ~ FU~ ~ A~ 12. 200~ 9:01 ~ ~ HISTORY ..... SE~R ~ LI~:DI~P 9.10 D I~PE~ER PAN JUN ~0, 2004 I :49 PM FUEL A~ ~ ~1, 200~ 10:~8 ...... SE~ ~ ...... L ~:DISP 1.2 DISPE~ PAN FUEL ~ OUN 30, 2004 ~ :24 ~ F~ OCT 31. 200~ 10:~8 ~ ALARM HISTORY REPORT SENSOR ~ ..... LIO:DISP D I SPENSF_~ PAN FUEL ,.JUN 90. 2004 SWRCB, January 2002 Page SeeondalT Containment Testing Report Form This f~m i`~ intended f~ use by c~ntract~rs p¢rf~rming peri~#~c testing ~f U$T se~ndmy c~ntainment systems. Use the appropffate pages of this form to report r&~ul~ for all compon~' t~ted. The coaip!eted form, w~itten t~,t procedur~, ami printouts from t~' (~ applicablo, should be provided to the facili~ owner/o]~erator for submittal to the local regulator' agency. 1. FAC~I~ INFO~ATION ,, Facili~ Contact: { Phone'. Date Local Ag~cy Was Notified of Tes~g: Name of ~eal Agency ~peetor (~?sent during testing: ........ 2. T~ST~G CONT~CTOR IN~O~IATION Tec~ciap Conducting Test: ~ ~% . ~ed¢,tlalg: ~ CSLB Licensed Con,actor D SWRCB Licensed 'Ta~ Tester Manufacturer Training Manufac~er - component(s) Date Training Exp~t'~s 3. SUMMARY OF TEST ~SULTS [ Not Repairs Component ]Pass Fail Tested Made Component Pass Fail Tested Made , o~o~ o o ...... o o o o o~ o o o ,,o o o 0 0 0 O 0 0 0 O ~0 O 0 0 .... "0 0 O 0 0 O 0 0 ,, O' 0 0 0 ,~o~o o o If hy~osmtic tesdn~ was peffo~ed, describe what x~s done with the xvater after completion of tests: CERTIFICATION' OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated itt t/tis documettt are accurate and itt full campliattce witt~ legal require#tents Teclmician's Signature: ..~.~/~ ~ Date:_ ~; ~_~1 -O q SWRCtL Sanuary 2002 Page ~ of 9. SPILI2OVERFII~ CONTAINMENT BOXES ~acm~ is NOt ~quip~ed W~ Sp~Ove~ Con~i~e~t S!x~ ~ ........ Spil~e~ll Containment Boxes ~e Pres~L but w~e Not Tested U ........ Test Me,od Developed By: O Spill Bucket Manufac~er ~Indus~ S~l~dard ~ Professional Engineer Z~,,C o ~ C O~er (Sps~) ......... Bucket Di~em~ Wait ~me'be~e~'apply~ ' ' pres~vacuu~waer and '~as~afi ~eshold or + ,, T~t ReSult: ~ Pass'* ~ Fail a,,Pass,, ~F~[! ,. a Pass ~ F~il ~ pass, a Fail Comments - finchtde in~format£on on repairs made Frior to testin$, and recomm~nded follow~u? for failed tests} TDTAI p.aa · SWRCB, January 2002 Page_ 9. SPIIAJOVEtD'~IbL CONTAINMENT BO~S Fae~ ~ Not Equipped Wi~ SPflFoVe~ Con~i~nt Box~ SpflFQve~ll Conm~e~t Boxes,,~e Preset, but w~e Not Tesmd Test Memoa Developed By: ~ Spill BuCket Manufacturer ~In~m~ S~dard ~ ~ Prefessio~l Engineer 'T~st Me,od Used: '" ~ ~e~e ~ Vat'mm ~ Hy&ostatic ~ O~er (Spec~9 ~ Spill Box ~ ~ SpillBox Bucket Di~e~ I E" I Z" press~e/vacuu~watet and Test D~afiou: t fi' ~/~ Pas~afi ~eshold or Test Result: p Pass ~ Fail ~Pass ~ Fail{ fl Pass ~ Fail ~ Pass ~ Fail Comments - qnclude in, formation on repairs made prior to testin$, and recomm?tded f, ollow~up for failed tests) TNT~I NI ~00 NI I~8'~ ]3A3~ ON3 N! ~00'0 090NS3~Hi ~W39 W~ S0:6 3WII ON3 ~o ....... 93A39 ON3 ~00~.,'S~..'99 NW ~:8 3NIL ON3 WW 0S:8 NI 6888'~ ~839 NI938 WW 80:8 O3SSW~ NI S010'~ 93A39~ ON3 Q3SSWd t9~S3~ IS3l NI ;~00'0 090HS38Hi ~W39 WW S0:6 3Nii NI .A966'~z ~¢~39 g~4~ NI 8I~0'~ q3D3] NI938 ~00E/~L.'90 3iW~ QN3 WW Z~:8 3~1! ,3F!S NI ~66'~ ~]¢l]q NIO38 . ~00~/S~/90 ~3i~WiS iS3! NW 28:8 ,32i~WlS - 03SSWd !ql]S38 ~S31 Flci-8::K; NI ~00"0 C90HS38Hi NI 99~Z'~ 92fJ39 'QN3 0~e'~ -' 1919S3~ IS3~ ~00~'/~/90 ......... WW S0:6 3Nil ~N3 NI .....['~ 93fl39 gN3 t00..: .%;..'98 WW ,-7..- 3Nil ON3 NW 0 ..... ¢3~>~1,3 iS3i NI 6191"E 93f"G-~ NI938 WW 80:8 ' .............. 180838 iS3& ~W2-', dWRS Z8~6 W~ ~ :8 ~r30L'~s/g8 ~3 ~93I~S~2>I~8 S93~=I 39~S3qOF.IM 'NJ 29WONO88'3 00~ .,]_,F,.., V LERO ENERGY CORPORATION Post Office Box 898000 · San Antonio, Texas 78289-8000 April 27, 2004 City of Bakersfield Office of Emergency Services 1715 Chester Ave., Ste 300 Bakersfield, CA 93301 Dear Sirs: Re: Financial Responsibility - Fiscal Year 2003 - UST Facilities Enclosed are the documents for Valero Energy Corporation demonstrating financial assurance for Underground Storage Tank (UST) facilities owned bY specific subsidiaries of Valero. These documents, listed below, have been updated to include Valero Energy Corporation's financial data for fiscal year 2003. Please forward to the appropriate personnel within your agency. · Letter from CFO specifying the successful completion of the financial test of self- insurance · Guarantee by Valero Energy Corporation on behalf of the specific Valero subsidiary(s) owning the USTs. · An addendum (list) that specifies the locations and tanks at each facility covered by these financial assurance mechanisms. Should you have any questions, please contact me at (210) 592-42:35 or e-mail: j ohn.willrodt~valero.com. rodt, Director Retail Compliance JW/ss Enclosures V8159.p65 T:\CONSTRUC\O&EADMIN\REPORT- I\01CACTNY.RPT I 1 Valero Energy Corporation Fiscal Year 2003 Fi'nancial Assurance - Retail UST 412012004 i FACILITY ID # STORE # STATUS ZONE ADDRESs ClT~ STATE COUNT~ CAPACITY PRODUCT 3074 O 352 3225 BUCK OWENS BLVD BAKERSFIELD CA KERN 20068 D 00719 1O14O p 00719 1413O U O0719 ~ ~ ~I[[,E~O Michael S. Ciskowski [NtRGY CORPORATION Executive Vice President and Chief Financial Officer April 19, 2004 Certified Mail - Return Receipt Requested State of California State Water Resources Control Board Division of Clean Water Programs P. O. Box 944212 Sacramento, California 94244-2120 Attn: Scott Bac°n RE: UST Financial Responsibility - Fiscal Year 2003 Dear Mr. Bacon: I am the Chief Financial Officer of Valero Energy Corporation (Valero) located at P. O. Box 500, San Antonio, Texas 78292-0500. This letter is in support of the use of the financial test of self- insurance and guarantee to demonstrate financial responsibility for taking corrective action and/or compensating third parties for bodily injury and property damage caused by sudden accidental releases and/or non-sudden accidental releases in the amount of at least $1,000,000 per occurrence and $2,000,000 annual aggregate arising from operating underground stOrage tanks. Underground storage tanks at the following facilities are assured by this financial test or a financial test under an authorized State program by this guarantor (see attached a~ldendum). A financial test and guarantee are also used by this guarantor to demonstrate evidence of financial responsibility in the following amounts under other EPA regulations or state programs authorized by EPA under 40 CFR parts 271 and 145: EPA Regulation Closure (8§ 264.143 and 265.143) ...................... $ 7,440,302 Post-Closure Care (88 264.145 and 265.145) ...... $12,025,805 Liability Coverage (88 264.147 and 265.147) ..... $10,000,000 Corrective Action (§ 264.101(b)) ........................ $ 25,356,397 Plugging and Abandonment (8 144.63) ............... $ 979,940 Authorized State Programs Closure ............................................................. $ 547,583 Post-Closure Care ......................... .................... $ 312,489 Liability Coverage ............................................ $1,000,000 Corrective Action ............................................. N/A Plugging and Abandonment ............................. N/A Total ................................................. $ 57,662,516 One Valero Place · San Antonio, Texas 78212 Post Office Box 500 · San Antonio, Texas 78292-0500 ° Telephone (210) 370-2146 ° Facsimile (210) 370-2497 Mike.Ciskowski @valero.com UST Financial ResponsibiliTM April 19, 2004 Page 2 of 3 Valero has not received an adverse opinion, a disclaimer of opinion, or a "going concern" qualification from an independent auditor on its financial statements for the latest completed fiscal year. ALTERNATIVE I! 1. Amount of annual UST aggregate coverage being assured by a test, and/or $2,000,000 guarantee .................................................................................................................... 2. Amount of corrective action, closure and post-closure care costs, liability coverage, and plugging and abandonment costs covered by a financial test, and/or guarantee. $57,662,516 3. Sum of lines 1 and 2 ................................................................................................... $59,662,516 4. Total tangibles assets ................................................................................................. $12,942,300,000 5. Total liabilities (if any of the amount reported on line 3 is included in total liabilities, you may deduct that amount from this line and add that amount to line 6) ................................................................................................................................ $9,929,000,000 6. Tangible net worth (subtract line 5 from line 4) ........................................................ $3,013,300,000 7. Total assets in the U.S. (required only if less than 90 percent of assets are located in the U.S.) ..................................................................................................................... $13,459,500,000 Yes N~o 8. Is line 6 at least $10 million? ..................................................................................... Yes 9. Is line 6 at least 6 times line 3? .................................................................................. Yes 10. Are at least 90 percent of assets located in the U.S.? (If"No," complete line 11.) .... No 11. Is line 7 at least 6 times line 3? .................................................................................. Yes Fill in either Lines 12-15 or Lines 16-18: N/A 12. Current assets ............................................................................................................. 13. Current liabilities ....................................................................................................... N/A 14. Net working capital (subtract line 13 from 12) ..........................................................N/A 15. Is line 14 at least 6 times line 3? ................................................................................ N/A 16. Current bond rating of most recent bond issue .......................................................... BBB 17. Name of rating service ............................................................................................... Standard & Poor's 18. Date of maturity of bond ............................................................................................ 4-1-2014 19. Have financial statements for the latest fiscal year been filed with the SEC, the Energy Information Administration, or the Rural Electrification Administration? ... Yes UST Financial Responsibility April 19, 2004 Page 3 of 3 I hereby certify that the wording of this letter is identical to the wording specified in 40 CFR part 280.95 (d) as such regulations were constituted on the date shown immediately below. Michael S. Ciskowski Executive Vice President and Chief Financial Officer Date Guarantee Guarantee made this April 19, 2004 by Valero Energy Corporation, a business entity organized under the laws of the State of Delaware, herein referred to as guarantor, to the California State Water Resources Control Board (SWRCB) and to any and all third parties, and obligees, on behalf of Ultramar Inc. (UI), Valero Refining Co. - CA (VRC), Valero Refining & Marketing of CA (VRMC) and Valero Marketing & Supply Co. (VMSC) of P.O. Box 696000, San Antonio, Texas 78269-6000. Recitals (1) Guarantor meets or exceeds the financial test criteria of 40 CFR 280.95 (b) or (c) and (d) and agrees to comply with the requirements for guarantors as specified in 40 CFR 280.96(b). (2) UI, VRC, VRMC and VMSC own or operate the following underground storage tank(s) covered by this guarantee: See addendum to this guarantee. This guarantee satisfies 40 CFR part 280, subpart H requirements for' assuring funding for taking corrective action and for compensating third parties for bodily injury and property damage caused by either sudden accidental releases or non-sudden accidental releases or accidental releases, arising from operating the above-identified underground storage tank(s) in the amount of $1,000,000 per occurrence and $2,000,000 annual aggregate. (3) On behalf of our subsidiary, guarantor guarantees to SWRCB and to any and all third parties that: In the event that UI, VRC, VRMC and VMSC fail to provide alternative coverage within 60 days after receipt of a notice of cancellation of this guarantee and .the Director of the SWRCB has determined or suspects that a release has occurred at an underground storage tank covered by this guarantee, the guarantor, upon instructions from the Director, shall fund a standby trust fund in accordance with the provisions of 40 CFR 280.108, in an amount not to exceed the coverage limits specified above. In the event that the Director determines that UI, VRC, VRMC and VMSC have failed to perform corrective action for releases arising out of the operation of the above-identified tank(s) in accordance with 40 CFR part 280, subpart F, the guarantor upon written instructions from the Director shall fund a standby trust in accordance with the provisions of 40 CFR 280.108, in an amount not to exceed the coverage limits specified above. If UI, VRC, VRMC and VMSC fail to satisfy a judgment or award based on a determination of liability for bodily injury or property damage to third parties caused by sudden and/or non-sudden accidental releases arising from the operation of the above-identified tank(s), or fails to pay an amount agreed to in settlement of a claim arising from or alleged to arise from such injury or damage, the guarantor, upon written instructions from the Director, shall fund a standby trust in accordance with the provisions of 40 CFR 280.108 to satisfy such judgment(s), award(s), or settlement agreement(s) up to the limits of coverage specified above. (4) ~Guarantor agrees that if, at the end of any fiscal year before cancellation of this guarantee, the guarantor fails to meet the financial test criteria of 40 CFR 280.95 (b) or (c) and (d), guarantor shall send within 120 days of such failure, by certified mail, notice to UI, VRC, VRMC and VMSC. The guarantee will terminate 120 days from the date of receipt of the notice by UI, VRC, VRMC and VMSC, as evidenced by the return receipt. -1- (5) Guarantor agrees to notify UI, VRC, VRMC and VMSC by certified mail of a voluntary or involuntary proceeding under Title 11 (Bankruptcy), U.S. Code naming iguarantor as debtor, within 10 days after commencement of the proceeding. (6) Guarantor agrees to remain bound under this guarantee notwithstanding any modification or alteration of any obligation ofUI, VRC, VRMC and VMSC pursuant to 40 CFR part 280. (7) Guarantor agrees to remain bound under this guarantee for sO long as UI, VRC, VRMC and VMSC must comply with the applicable financial responsibility requirements of 40 CFR part 280, subpart H for the above-identified tank(s), except that guarantor may cancel this guarantee by sending notice by certified mail to UI, VRC, VRMC and VMSC, such cancellation to become effective no earlier than 120 days after receipt of such notice by UI, VRC, VRMC and VMSC, as evidenced by the return receipt. (8) The guarantor's obligation does not apply to any of the following: (a) Any obligation of UI, VRC,' VRMC and VMSC under a workers' compensation, disability benefits, or unemployment compensation law or other similar law; (b) Bodily injury to an employee ofUI, VRC, VRMC and VMSC arising from, and in the course of, employment by UI, VRC, VRMC and VMSC; (c) Bodily injury or property damage arising from the ownership, maintenance, use, or entrustment to others of any aircraft, motor vehicle, or watercraft; (d) Property damage to any property owned, rented, loaded, to, in the care, custody, or control of, or occupied by UI, VRC, VRMC and VMSC that is not the direct result of a release from a petroleum underground storage tank; (e) Bodily damage or property damage for which UI, VRC, VRMC and VMSC are obligated to pay damages by reason of the assumption of liability in a contract or agreement other than a contract or agreement entered into to meet the requirements of 40 CFR 280.93. (9) Guarantor expressly waives notice of acceptance of this guarantee by SWRCB, by any or all third parties, or by UI, VRC, VRMC and VMSC. I hereby certify that the wording of this guarantee is identical to the wording specified in 40 CFR 280.96(c) as such regulations were constituted on the effective date shown immediately below. Valero Energy Corporation Michael S. Ciskowski Executive Vice President and Chief Financial Officer Signature of witness or notary: -2- Stale of Water Resources Control Board ~ ~,"~ ~:~'~,~;~?.~'~.~ ~ ~ ~?.~e~'~ ~,~,~,~ ~?~?~.~'~.~ Division of Cle~ Water Pro~ams ~' ~¢~" :~ *:; ? ~ ~? Sac~ento, CA 942~-2120 0ns~ctions on ~ve~e side) .......... '~-~:':~: ~ ~':'~" ,~,?.>a:~:,~?~ ?",~"'-': ............. ' ~t'. ~:~;:'~?~:v ........ CERTIFICATION OF FINANCI.A[ RfiSPOINSIBILITY FOR ~DERG~O~D STOOGE T~ CONT~N~G PET~OLE~ A. I am required to demons~ale Financial Res~nsibili~ in the Requir~ amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: 500,000 dollars per occu~ence I million doll.s annual ag~cgale ~ or AND ~ or I million doll,s per o~unenee 2 million dollam annual aggre8ate B. Valero Ener~ Comoration ~oro~y con~os t~at ~t is in compliance ~it~ the ~quiromonts of Section 2807, (Name of y,ng o~ner ~ o~mt~) A~ict* ~, Chapter ~8, Division 3, Tit~ 2~, California C~o of Roffula~ons. T~e mechanisms used to demonstrate financiol responsibility as required ~y Section 2807 are as State UST Fund State UST Cleanup Fund N/A $995,000 per 'Continuous Yes Yes P.O. Box 944212 occunence and Sac~mento, CA annual ag~egate 94244-2120 Chief Financial Valero Energy Coworation N/A $1,000,000 per Annual Yes Yes Officer Leuer P.O. Box 500 occmence md San ~tono, TX $2,000,000 78292-0500 annual aggregate Guarantee Valero Energy Co~oration N/A $1,000,000 per Annual Yes Yes P.O. Box 5~ occurence and San Antono, TX $2,000,000 78292-0500 annual aggregate Note: It you are usin~ t~o Stato Fund as ony pa~ ot your demonstration of ~nan~al responsi~it~y, your execution and su~mission of t~is ceai~cation atso cea/ties that you aro in compliance with oil condiions for po~icip~tion in tho Fund. See attached list. Fa~li~ Name F~cili~ Ad~ress F~ciI~ Nam~ Fa~li~ Address E. Si~mlure of Tank Owner or Operator Date N,me and Ti~ of Tonk Owner or O~m~r ~~' C~' ~ / ' ~ ~ 0 ~ Micha,lS. Ciskow,ki-Ex~ufiv, Vi~Presid~nt~dChi,fFinancial Officer 81~nture of Wimess or Nom~ D,te Name of Wimoss or No~ CFR ('Reviaed ~5} FILE: Original - ~cal Ag~n~ Copiea - Fa~ili~lSite(,) 07/16/2004 04:20 PM TInkno I o(~, eoe$754061 I/2 .... TANKNOLOGY-SO. CALIFORNIA 3 4 1 6 PH, (909) 308-1210 27fi76 COMMERCE CTR. DR. STE, 109 TEMECULA, CA 92590 1'~-2a, . Wells Fargo Bank, r'~lifornia www. welhf~.r§o.conl "' ' NOT NEGOTIABLE ~^crn,T¥ 0c,fr2/,. Wt'm '~'(;q.q- ! PERMIT TO OPERATE # L, b-t']Qa/~[,.~'(~.-. / ! OPERATORS NAME I OWNERS NAME N'UMBEK OF TANKS TO BE TESTED. IS PIPING GOING TO BE TESTED TANK # VOLUME CONTENTS 5::I tqozD O.e '"'" "' ..-_...-...,. ....... . _.?-..--__ MAiLrNOA.DDRESS (t'TBG ~'~ "' ..... N~ & PHONE ~ER OF CONTACT PERSON , , TEST mTHOD '-['[-1 ) '" I N,~E OF TESTER ~Q,[&~ CERTIFICATION ~ 0~" Ih, DATE & T~ TEST IS TO BE CO~UCTED . APPROVED BY DATE MRY 12 2004 10:32 BKsFLD FI~E P~EVEMTIOM {~G1~8~2-2172 ~.1 PERMIT APPLICATION T ONSTRUCT/MODIFY Bake~fteld F~e Dept. UNDERGROUND STOOGE TANK I En~onmen~al ~ce ..... ~,_ - .......... 1715 Chester Ave i ~ 2 B~ersfield, CA93301 ~ -'~= '~'"~'-~-,-,~.. Teh (661)326-3979 ~PE OF APPLICATION (CHECK) ~MODIFICATION OF FAC[Li~ ~ NEW' ~ANK INS~AL~TiON AY EXISTING FAClLI~ NEW FACILI~ F~LI~ ~ESSn ~ ~P ' ' ' " Id >, NO. ~ TANKS [ ~E TH~ F~ MOT~ FUEL TANK ~ ~UME U~D R~U~ P~I~ ~ES~ A~AT~ J ~1S BE~ · FOR N~ ~OT~ FUEL 5TO.GE TA~ ~, VOLUME ~E~l~ ~ED l~ 5~D ~ME) ~S ~ (IF ~} ~1~ PRE~O~V STORED FOR OFFICIAL U~E ONLY The ~plicant h~ received, ~erst~m] ~d will comply with the ~tached ~nditiom of the permit and a~t~ stata, local a~ federal rega!atiom. This fom h~ been completed u~der penal~ of , perju~a~ tq ~ ~t of my ~ow;l~e~e', j:; ~ue a~ corrqc].- :Il 1'( ' ~ THIS APPLiCAT~N BECOME8 A PE~ WHEN APPROVED SCOPE OF WORK 1. INSTALL NEW EVR (VR-IOI-D) EQUIPMENT AT EACH TANK: A. BREAK CONORETE AT FILL & VAPOR, INSTALL NEW SPILL BUOKETS (PHIL-TITE 85000-0S FILL & 85001-NV-OS VAPOR) B. TOP SEAL CAP (MORRISON BROS. 525C) C. TOP SEAL ADAPTOR (PHIL-TITE SWF-IOO-B) D. VAPOR CAP (MORRISON BROS. 305C) E. VAPOR ADAPTOR (PHIL-TITE SWV-IO1-B) F. POSITIVE SHUT-OFF DROP TUBES.IN FILL (PHIL-TITE 61SO-PT) G. RISER ADAPTORS AT FILL, VAPOR & TLM (PHIL-TITE M/F4X4) H. TLM CAP & ADAPTOR (EVER-TITE 4097AGBR & 4097MBR) I. P/V VENT VALVES (HUSKY 4885) -MANIFOLD VENT RISERS ~ r/G X~XE~ r~KS J. EXTRACTOR FI~ING (UNWERSAL V~21) ...... ~ 1~~ K. DROP TUBE AT VAPOR (OPW 61-T) ~1 ( ...... o I ........ 0 ) ~ ~ ~/,~/o,~ ~o.~ ~ GROUND & GRADE PLAN S[RWC~ ST~T~ON ~20-~S76 nZS CO~[ ROAD e Bm~ALL RO*D ...... · i Chevron COFFEE ROAD ........ FILL & vaPOR RISERS ~ TANK L~VEL MONITOR RISER EVR UPGRADE DETAILS i Chevron Material - Equipment List F'~l'cility N~umber: '" 203576 Address: "' 1125,COFFEE ROAD BAKERSFIELD '"' State: '"" California Surveyor Petro Builders Inc. Name: SCOtty EVR Package Require QTY of Packa.cm I 1 31 2 I 3 I 4 I 5 ~ Addition Equipment: QTY 1 2 DEBRI BUCKETS FILL 3 3 DEBRI BUCKETS VAPOR 3 4 ,HUS ~KY VENT VALVES 3 5 PHIL-TITE EVR. OVER FILL DROP TUBES (FLAPPER) 3 6 3" BALL FLOAT FOR UNIVER, SAL HOUSING IF REQUIRED BY AGENCY 3 PHIL-TITE TANK BOTTOM PROTECTOR 8 9 10 11 12 Scope of Work: Cost 1 INSTALLATION OF THREE EVR #1 RETRO FIT KITS, AND ADDITIONAL EQUIPMENT 2 FOR DIRECT BURIAL 3 TLM RISERS IN SEPARATE MANWAY CENTER OF TANKS 5 6 7 8 9 10 PHIL TITE DIRECT BURY TO DIRECT BURY $ 7,885.0~0 11 EXCAVATION $ 3,888.00 12 Safety Fence $ 75.00 13 Paintin.q 14 Test n.as $ 262.00 15 Permit Process $ 112.00 16 General Conditions/SURVEY $ 2,612.00 17 Fee & Profit $ 1,483.00 I Total Cost $ 16,3171'00 Number of Dates to Perform Work I 51 Signture / Date: Phas.e I Equipment Facility_.Nu~nber 203576 ~ I Address: 1125,COFFEE City ~-, BAKERSFIELLP~'I r State: California I Surveyor Contractor:. Petro Builders Inc. ~ Name: Scotty, ,, General Information: NO HIGH LEVEL ALARM Total N_o.. of Tanks 3 Tank No. (example: 1 of 5) Fill / Vapor Configuration 1. Sump 2. Direct Tank Manufacturer JOOR Bury 2 Tank Type ,STEEL FIBREGLASS COATED DW. Equipment List ~R-101-C (Phil-Tire) Existing vR-to2-c (oPw) Mfg Model Number Mfg IModel Number Mfg Model Number Spill Bucket - Fill Phil-Tire 85~0~-F OPW I? OPW 1SC-2100-DEVR 85000-S 85000-GS 85000-EXT 85100-15 Spill Bucket: Vapor Phil-Tire 85101-NV PHIL TITE ? OPW 1SC-2100-PEVR 85001 -NV-S 85001 -NV-GS 85001-NV-EXT Replacement Drain VIv Kit nla OPW 1DK-2100 Debris Bucket ' fill ' r Phil-Tire PP 1005 TB . None Debris Bucket - vapor Phil-Tire PP 1005 TBP (optional) None R~3tatable Adaptor- fill PhiI-Tite SWF-100-B Dover ? OPW 61SALP-EVR Rotatable Adaptor - vapor Phil-Tire SWV-101-B Dover ? OPW 61VSA-EVR Vapor Riser Offset PhiI-Tite M-6050 (optional) None n/a Riser Adaptor Phil-Tire M/F4x4 None n/a Face SealAdaptor n/a None oPw FSA-400 or FSA-400-S Spill Container Cast Lid Phil-Tire 85011 OPW ? Dust Cap - fitl M°rrision 305C OPW 634T OPW 634TT-EVR or 634LPC Bros. Dust Cap- vapor Morrision 323C OPW 1711T OPW 1711T~EVR or 1711LPC Bros. Tank Gage Port Ever-Tite 4097AGBR Evertite ? Morrision 305XPA1100AKEVR (threaded adaptor) Brothers (cap & adapt) 305-0200AAEVR (repl adapt) 305XP-110ACEVR (repl cap) Ever-Tite !40g7MBR (double handle Evertite ? Ever-'l~te 4097AGBR (adaptor) cap) 4097GMBRNL (adaptor) 4097MBR (cap) Veeder Root 312020-952 (cap & adapt) P/V Vent Valve Husky 4885 ? See Photo Husky 4885 or opW623V ExtractorFitfing Universal !Univ. V-421 orOPW233 Universal ? OPW OPW233 Ball Float Vent Valve 'Universal Univ. 37 or OPW 53VML Universal ~" OPW OPW 53VML or OPW 30MV Drop Tube OPW 61-T (straight tube) or OPW 61S0-PT OPW 61-T (straight tube) or 81 SO-PT 61SO-xxxC-EVR Tank Bottom Protector Phil Tite TBP-3516 OPW OPWI 6111-1400-EVR Pomeco Jack Screw Kit n/a OPW 61JSK-4400-EVR Tool kit for Rotatable PhiI-Tite T-7043 n/a Adaptors Additional Equipment Not Listed Above: Phase II Equipment :Facility Number 203576 Address 1125,COFFEE ROAD City BAKERSFIELD State California ontractor: Petro Builders Inc. Surveyor Name: Scotty General Information: NO HIGH LEVEL ALARM Dispenser Number I 2 3 4 5 6 7 8 N~). of dispensers 1&2 3&4 5&6 7&8 9&10 11&12 Serial number 660714 660717 660715 660713 660716 660718 Type of dispenser 1. Balance' 2. Vac Assist 1 I 1 I 1 1 Manufacturer 1. Dresser Wayne 2. Gilbarco 1 I I I I 1 3. Other No. of hoses/dispenser 6 6 6 6 6 6 Hose length 12' 12' 12' 12' 12' 12' Nozzle Mfg. 1. Husky 2. Emco Wheaton 3. VST 2&4 2&4 2&4 2&4 2&4 2&4 4. Other Nozzle Model No. I Breakaway ALL HUSKY Probe Type 1. Veeder Root !321 geaudreau Other 2 2 2 2 2 2 Monitoring System 1. Veeder Root !TLS 350 2. APl Ronan 1 1 I 1 1 !3. Other May 12, 2004 To Whom It May Concern: The following people are authorized to obtain permits on behalf of Petro Builders, Inc. for various Chevron locations for the EVR Upgrade Program. * Monica Velasco, Petroleum Business Systems * George Johns, Petroleum Business Systems If you have any questions regarding this information, please do not hesitate to contact the undersigned. Sincerely, PETRO BUILDERS, INC. R. L. Girard President ~ ~ State of Californ,a :" CONTRACTORS STAT2 LICENSE BOARD Xc,~v~ ucENsE. STATE LICENSE NO. 241905 c~=i,d~,,(s)A B C61tD40 HAZ C21 BOB GIRARD OFFICE: (562) 946-2285 FAX: (562) 946-5395 10609 PAINTER AVENUE, SANTA FE SPRINGS, CA 90670 HTTP:/~WW.PETROBUILDERS.COM ~i~aa~a~ 0 9 / 3 0 / 2 0.0 A ACORD CERTIFICAT;- OF LIABILITY INSURANCE DATEIMM,DD ~ ~ 01/05/2004 ~ODUC~ (949)622-$517 FAX L~.)622-S518 THIS CERTIFICATE .__.~SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GSM' Insurance Services HOLDER. ·THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Li c. #0D15612 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 19200 Von Karman Ave. #400 Irvine, CA 92612 INSURERS AFFORDING COVERAGE NAIC # INSURED Petro Builders, Inc. INSURERA: American Int'l Specialty Lines 26883 10609 Painter Ave. ~NSURERB: Commerce & Industry Ins. Co. 19410 Santa Fe Springs, CA 90670 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TQ THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ~NDICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [NSF[ ADD'L POLICY EFFECTIVE POLICY EXPIP. ATIOt~' LTl=. NSR[ · TYPE OF INSURANCE . POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY PROP 417 77 94 01/01/2004 01/01/2005' EACH OCCURRENCE $ 1,000,00C X' COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES (La occurence) 100 , 00(] .) CLAIMS MADE~]XI OCCUR · MED EXP {Any one person) $ 10,00C A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3 , 000,00G GEN'L AGGF[EGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 3 ~ 000,0.0C I POLICY~ PRO' JECT [~] LOC AUTOMOBILE LIABILITY CA 8'08 71 43 01/01/2004 01/01/200g COMBINED SINGLE LIMIT $ ANYAUTO (La accident) I 000,00C ALL OWNED AUTOS : BODILY INJURY SCHEDULED AUTOS (Per person) $ B ~IiRED']~U'FOS ............... : ....................... " BODILY iNJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO oNLY: EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ ' EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ '1 OCCUR ~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE . RETENTION $ $ · WC $1A1 U- O J H- WORKERS COMPENSAT]ON AND WC 328 22 92 01/01/2004 01/01/2005 X TORYLMTS ER EMPLOYERS' LIABILITY B ANY PROPRIETORJPARTNEPJEXECUTIVE E.L. EACH ACCIDENT $ i ~ 000 ~ 000 OFFICER/MEMBER EXCLUDED? E.L DISEASE- EA EMPLOYEE $ ~, 000,000 If yes, describe under SPECIAL PROVISIONS below E.L DISEASE- POLICY LIMIT $ i, 000,000 OTHER PROP 417 77 94 01/01/2004 01/01/2005 $1 000,000 each loss Zontractor' s Pol 1 ution ' A Liability $3,000,000 total all losses DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS '?E×cept 10 days notice for nonpayment of premium, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ~ BUT FAILURE TO MAiL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Sample Certi fi cate oP ANY KIND UPON THE INSURER,~ITS AGENTS OR REPRESENTATIVES. For Bid P~rposes Only A UTHORIZEDREPRESENTATIVE.~/'~ ACORD 25 (2001/08) ©AC ~D CORPORATION 1988 SITE SAFETY PLAN JOB LOCATION: Chevron #20-3576 1125 Coffee Rd. Bakersfield, CA PETRO BUILDERS, INC. 10609 Painter Ave. Santa Fe Springs, CA 90670 PREPARED BY: ~ Michael eltz. Petro Builders, Inc. Health & Safety Officer DATE PREPARED: May 7,'2004 SITE' DESCRIPTION JOB TITLE: Chevron #20-3576 SITE DESCRIPTION: X Operation X Gas station X U.S.T. Non-Operating Terminal Former U.S.T. Undeveloped Refinery MWs Remediation Landfill Hoists Building Borings Factory Soil samPles Lot Drums Field Pits Oil/Gas Product Oil/Gas Wells PROJECT INFORMATION: EVR- Repairs ACTIVITIES AND DURATION: Upon arrival Petro Builders, Inc. personnel will perform an initial site reconnaissance with air monitoring equipment and observe any physical hazards that may be present. The air monitoring results and physical hazards must be recorded in this document. After a safe work environment has been established, Petro Builders, Inc. will conduct a site screening'survey.. If at this time a member of the Petro Builders, Inc. field team considers personal health and safety, to be at risk, operations on the site will cease and the safety concern will be addressed. If the safety concern requires consultation, contact the Petro Builders, Inc. Health and Safety Department for further instructions. In the event the work plan becomes altered the Petro Builders, Inc. Health and Safety Officer must be notified immediately and appraised of the alterations so that an addendum to this plan can be prepared. SITE .SAFETY PLAN SIGN OFF SHEET The following persons have read, understand and will comply with this Site Safety Plan. This plan was established for Petro Builders, Inc. personnel who are trained in the compliance with OSHA 29 CRF 1910.120 (Waste Site Worker Protection) exclusively for the work performed on the site listed above. This plan is provided to others solely for information purposes or contractual requirements. Any other use of this document is done without the authorization of Petro Builders, Inc. NAME COMPANY SIGNATURE (See attached additional signature sheet if required) All site personnel have read the Site Safety Plan and are familiar with its provisions. TITLE NAME ~_G~G~URE · Health & Safety Officer Michael W. Peltz Project H & S Officer Bill Day ~ ~t~'~~ Site Safety Officer Michael W. Peltz SITE HEALTH AND SAFETY RISK HAZARD LEVEL A ( ) B ( ) C ( ) D (X) (Requested by site environmental personnel) AIR MONITORING ACTION LEVELS Level D < 100 PPM sustained readings Level C > 100 PPM sustained readi.ngs ' ' If at any time air monitoring levels read over 100 PPM or a member of the Petro Builders, Inc. Field Team considers personal health and safety to be a risk, operations on the site will cease and the safety concern will be addressed. If the safety concern requires consultation, contact the Petro Builders, Inc. Health and Safety Department for further instructions. In the event the work plan becomes altered the Petro Builders, Inc. Health and Safety Officer must be notified immediately and appraised of the alterations so that an addendum to this plan can be prepared. Please note: Air monitoring will t~ke place continuously every 15 minutes during excavation and at any time deemed required by the Site Safety Officer and Consultant. POTENTIALHAZARDS CHEMICAL HAZARDS: TYPE: PHYSICAL HAZARDS: DESCRIPTION: ' Temperature (X) Heat or cold exposure Noise (x) Equipment (x) Topography ( ) Confined Spaces ( ) Other ( ) Excavation WHEN VEHICULAR TRAFFIC POSES A POTENTIAL PHYSICAL HAZARD, SAFETY VESTS AND SAFETY CONES ARE REQUIRED ON-SITE. BIOLOGICAL HAZARDS: RADIATION HAZARDS: EQUIPMENT MONITORING EQUIPMENT: Hnu (PID) 11.7ev bulb ( ) .OVA(FID) (x) LEL/02 Meter ( ) Line Finder ( ) Colometric Tubes ( ) HCN Detector ( ) H2S Detector ( ) . Other ( ) PERSONAL PROTECTIVE EQUIP. DECONTAMINATION EQUIP. Eye Protection (x) Plastic Trays ( ) Ear Protection ( ) Plastic Bags ( ) Protective Gloves (x) Sprayers ( ) Steel Toe Shoes ( ) Contrad Wash Solution ( ) Protective Footwear (X) Rinse Water ( ) Hard Hat (x) Scrub Brash ( ) Chemical Suit ( ) Waste Solution Holder ( ) Type: PVC/Nylon ( ) Other: ( ) ON SITE EMERGENCY EQUIPMENT WILL INCLUDE: (2) ABC Rated Fire Extinguishers Visquin to place soil on and cover stockpiles Water hose and water availability for vapor suppression All emergency exists posted EMERGENCY CARE THE NEAREST EMERGENCY MEDICAL FACILITY: San Joaquin Hospital ADDRESS: 2615 Eye St., Bakersfield TELEPHONE NUMBER: 661-385-3000 DIRECTIONS FROM SITE: See attached map and directions. LOCATION OF PRIMARY TELEPHONE: 562-946-2285 LOCATION OF ALTERNATE TELEPHONE: 562-946-2285 EMERGENCY TELEPHONE NUMBERS: 562-946-2285 POLICE: 661-327-7111 FIRE: 661-324-6551 AMBULANCE: 911 PETRO BUILDERS, INC: (562) 946-2285 HAZ MAT UNIT: 911/661-324-6551 PURPOSE STATEMENT This Site Safety Plan has been established to comPly with Occupational Safety and Health Administration (OSHA) and the Environmental Protection Agency (EPA) standards and regulations. The main focus of this plan is to protect the health and safety of our personnel and the community. The plan also assigns duties and responsibilities, along with establishing safety procedures and contingency plans for those involved with this project. RESPONSIBILITIES PROJECT HEALTH AND SAFETY OFFICER Design, implement and maintain project Site Safety Plan(s) to comply with Federal standards and regulations. Instructs Site Safety Officer (SSO) on potential site hazards. Checks cOnformity, consults on changes, develops alternative procedures to'the plan and resolves Safety issues. SITE SAFETY OFFICER Has knowledge and authority to carry out specifications of the Site Safety Plan. Coordinates on-site activities regarding health and safety and has authority to stop work if significant safety hazards arise. Supervises air monitoring, decontamination, and documentation reqUirements. Oversees usage of personal protective equipment and maintains compliance with the Site Safety Plan. SITE WORKERS To use knowledge obtained through 40-hour Waste Sit Worker Protections course, Standard Operating Procedures, and common sense, to safely perform site duties. TRAINING All Petro Builders, Inc. field members receive corporation 40 hour Waste Site Worker Protection training that meets or exceeds the requirements of OSHA 29 CFR 1910.120. This training is supplemented annually with an 8-hour update course. MEDICAL SURVEILLANCE All petro Builders, Inc. field team members are enrolled in a medical surveillance program, which includes: initial employment physical, annual physical and termination physical. Petro Builders, Inc. also maintains a personal exposure field that documents air-monitoring results and sampling results 'from each site that employee works. All Petro Builders, Inc. field team members will establish on site medical surveillance (performed by trained Petro Builders, Inc. personnel) when the 'temperature exceeds 80 degrees F. along with establishing cold weather working procedures. PERSONAL PROTECTION EQUIPMENT LEVEL D: Coveralls (Optional) Hard Hat (Site specific) Inner Gloves (Optional) Outer Gloves (Optional) Safety Glasses (Site Specific) LEVEL C: Full face air purifying respirator Hooded chemical resistant coveralls Hard hat (site specific) Inner gloves Outer gloves Chemical resistant outer boots Steel toe boots LEVEL B: SCBA Hooded chemical resistant coveralls Hard hat (site specific) Inner gloves Outer gloves Chemical resistant outer boots Steel toe boots LEVEL A: SCBA Encapsulated chemical resistant suit Inner gloves Outer gloves Chemical resistant boots Steel toe boots SITE CONTROL The Petro Builders, Inc. field team shall locate any areas that contain elevated air monitoring results, or confined spaces, and record these areas on the map. All exclusion zones shall be marked off and secured. Only authorized personnel who have read and signed tlfis Site Safety Plan §hall be allowed in the exclusion zone. These people must also be able to demonstrate that they have the proper medical and training requirements. All site work shall employ the buddy system. Do not lose visual contact with the decontamination area with a line of site person. Site decontamination problems and emergency response must be addressed prior to daily operations during the tailgate meetings. Any entrance into unidentified confined spaces without prior consent of the Project Health and Safety Officer is prohibited. DEFINITION OF A CONFINED SPACE According to NIOSH, a confined space "refers to a space that by design has limited openings for entry and exists: unfavorable natural ventilation, which could contain or produce dangerous air, contaminates, and which is not intended for continuous employee occupancy". DECONTAMINATION Decontamination personnel shall wear personal protective equipment at most one level lower than the workers entering the exclusion zone. All persons leaving the site must complete a decontamination process, which includes'at least the following stations: 1. Equipment drop 2. Outer glove removal 3. Inner glove removal Upon completion of site personnel decontamination, all site personnel should wash hands and face prior to leaving the site. EMERGENCY PROCEDURES On-site personnel will use the following emergency procedures. The Project Safety Officer shall be notified Of any on-site emergencies and will be responsible for ensuring that the appropriate procedures are followed: PERSONAL INJURY IN THE EXCLUSION ZONE: Upon notification of any injury in the Exclusion Zone, the designated emergency signal (a continuous vehicle horn blast) shall be sounded. All site personnel shall assemble at the decontamination line. The rescue team will enter the Exclusion Zone (if required) to remove the injured person to the hot line. The Site Safety Officer and Project Team Leader should be decontaminated to the extent possible prior to movement to the Support Zone. The on- site EMP shall initiate the appropriate first aid, and contact should be made for an ambulance and with the designated medial facility (if required). No person shall re-enter the Exclusion Zone until the cause of the injury or symptoms are determined. PERSONAL' INJURY IN THE SUPPORT ZONE: Upon notification of an injury in -the Support Zone, the Project Team Leader and Site Safety Officer will assess the nature of the injury. If the cause of the injury or loss of the injured person does not affect the performance of the site personnel, operations may continue. The on-site EMP shall initiate the appropriate first aid and follow up as stated above. If the injury increases the risk to others, the designated emergency signal (a continuous vehicle horn blast) shall be sounded and all site personnel shall move to the decontamination line for further instructions. Activitieson site will stop.until the added risk is removed or minimized. FIRE/EXPLOSION: Upon notification of fire or explosion on site, the designated emergency signal (a continuous vehicle horn blast) shall be sounded and all site personnel moved to a safe distance from the involved area. FIRST AID: If the site of the accident is safe to enter, field crew members should perform first aid if trained in RED CROSS STANDARD FIRST AID AND ADULT CPR. PERSONAL PROTECTION EQUIPMENT FAILURE: If any Site worker experiences a failure or alteration of protective equipment that affects'the protection sector, that person and his/her buddy shall immediately leave the Exclusion Zone. Reentry shall not be permitted until the equipment has been repaired or replaced. OTHER EQUIPMENT FAILURE: If any other equipment on site fails to operate properly, the Project Team Leader and Project Safety Officer shall be notified and then determine the effect of the failure on the continuing operations on site. If the failure affects the safety of personnel or prevents completion of the Work Plan Tasks, all personnel shall leave the. Exclusion zone until the situation is evaluated an appropriate actions taken. EMERGENCY ESCAPE ROUTES: The following emergency escape routes are designated for use in those situations where egress from the Exclusion Zone cannot occur through the contamination lines: IN ALL SITUATIONS, WHEN AN ON-SITE EMERGENCY RESULTS IN THE EVACUATION OF THE EXCLUSION ZONE PERSONNEL SHALL NOT RE- ENTER UNTIL: 1. Petro Builders, Inc. Health and Safety officer allows. 2. The conditions resulting in the emergency have been corrected. 3. The hazards have been reassessed. 4. The Site Safety Plan has been reviewed. 5. Site personnel have been briefed on any changes in the Site Safety Plan. APPENDIX I - SITE SAFETY PRACTICES 1. Any activities such as making, eating, drinking, chewing gum or tobacco, or any activity that increases the risk of hand to mouth Contact shall be prohibited within the contamination zones. 2. Field crewmembers are encouraged to shower as soon as possible upon leaving the site. 3. Check all personal protective equipment prior to use to identify any faulty equipment. Report defects to the Site Safety Officer. 4. Avoid contact with any unknown sources on the site. Avoid kneeling, walking in puddles, leaning or sitting on drums or containers, and do not pick anything up and smell it. 5. Levels of protection that have been set in the he Site Safety Plan must be followed unless the project health and Safety Officer have granted permission. 6. 'If unexpected hazardous situations occur work shall be halted until the information is discussed and remedied by the Project Health and Safety Officer. PLEASE RETURN TO THE PETRO BUILDERS, INC. HEALTH & SAFETY OFFICER PLAN FEED BACK FORM JOB NAME: Chevron #20-3576 DATE: May 7, 2004 CLIENT: Chevron Products Company PROBLEMS WITH PLAN REQUIREMENTS: UNEXPECTED SITUATIONS: 1125 Coffee Rd, Bakersfield, CA 93308 to San Joaquin Community Hospital 0 mi 0.5 1 1.5 2 Copyright © 1988-2003 Microsoft Corp. and/or its suppliers. All rights reserved, http://ww,#.microsoft.com/streets © Copyright 2002 by Geographic Data Technology, Inc. All rights reserved. © 2002 Navigation Technologies. All rights reserved. This data includes information taken with permission from Canadian authorities © 1991-2002 Government of Canada (Statistics Canada and/or Geornatics Canada), all rights reserved. "9':00 AM 0.0 mi ~ Depart 1125 ee Rd, Bakersfield, CA 93308 [1125 Coffee Rd, Bakersfield, CA 93308] on · Coffee Rd (South) for 0.3 mi 9:01 AM 0.3 mi Turn LEFT (East) onto Truxtun Ave, then immediately turn LEFT (North) onto Coffee Rd for 1.5 mi 9:04'AM 1.8 mi. Turn RIGHT (East) onto SR-58 [Rosedale Hwy] for 2.6 mi 9:09 AM 4.4 mi Road name changes to SR-178 [SR-58] for 0.2 mi 9:10 AM 4.6 mi . Keep STRAIGHT onto SR-178 [24th St] for 0.9 mi 9:12 AM 5.5 mi Keep STRAIGHT onto SR-178 [23rd St] for 0.5 mi' 9:13 AM 6.0 mi Turn LEFT (North) onto Eye St for 0.2 mi 9:14 AM 6.2 mi ~ Arrive San Joaquin Community Hospital Copyright © 1988-2003 Microsoft Corp. and/or its suppliers. All rights reserved, http:llwww, microsoft.comlstreets © Copyright 2002 by Geographic Data Technology Inc. All rights reserved. © 2002 Navigation Technologies. All rights reserved. This data includes information taken with permission fromPage 2 Canadian authorities © 1991-2002 Government of C~nada (Statistics Canada and/or Geomatics Canada) all rights reserved. WAYNE PERRY, INC. Environmental Remediation, Construction and Consulting March 2, 2004 Inspector Steve Underwood City of Bakersfield Fire Dept. 1715 Chester Ave. Third Floor Bakersfield, CA. 93301 SUBJECT: SB 989 COMPLIANCE TESTING AT CHEVRON STATION # 20-3576 LOCATED AT 1125 COFFEE RD. & BRIMHALL RD. IN THE CITY OF BAKERSFIELD, CA. 93306 Dear Inspector Underwood, Below please find the secondary containment testing results for the above-referenced site. These results are being sent to you per the requirement of SB 989. Included with this submittal are the following: CONTRACTOR: Wayne Perry, Inc.; License No: 300345 TECHNICIAN: Jose M. Dethier · SB 989 Testing Results & Procedures Components Tested Component Date Tested Type of Test Pass / Fail Manufacturer Performed Reg~lar (87') Fill Bucket - OPW- Pomeco 02/04/04 Hydrostatic Pass If you have any questions regarding the attached results please contact the undersigned at (714) 826-0352. Sincerely, Rodolfo_ V~. Rubio Project Manager Attachments - SB 989 Testing Results & Procedures CC: Judy Bowe- Chevron Products Company Sam Stevenson- Chevron Products Company Dealer- Station Manager 8281 Commonwealth Ave. Buena Park, California 90621 Phone (714) 826-0352 Fax (714) 523-7880 SWRCB, January 2002 Page [' of._~ 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 Contact: ~13c t Phone: Date Local AgencY Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: ~q{~0M~_.. 0~_~?~¢.~ , /fXjC- Teclmician Conducting Test: ,A ~ /'~._ ~>. ~ Credentials: t}~g'CSLB Licensed Contractor [] SWRCB Licensed Tank Tester Manufacturer Trainin~ Manufacturer Component(s) Date Training Expires : 3. SUMMARY OF TEST RESULTS Pass Not Repairs Cmnponent Pass Fail Not Repairs Component Fail Tested Made Tested Made [] [] [] [] [] [] [] [] [] [] []- [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] ~ [3! [] [] [] [] [] [] If hydrostatic testing was performed, describe what was done with the water after completion of tests; CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING TillS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Teclmician's Signature: ~/~~ Date: ~,~ SWRCB, January 2002 - Page -2-- 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes [] Spill/Overfill Containment Boxes are Present, but were Not Tested 72 Test Method Developed By: [] Spill Bucket Manufacturer '~Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum ~ydrostatic [] 9ther (Specify)~ Test Equipment Used: Afl_~ ~J(/.[ ('~'kPd -~4q¢~3 ~'~1)~ CJAx,q ~,-~- I Equipment Resolution: Box Bucket Depth: /-.~ t~ Wait time between applying pressure/vacuum/water and ¢0 /hq ~ Y~ starting test: Test Start Time: /[~' B~ Initial Reading (R~): /~'. ~ Test End Time: //,' ~'- FinalReading CRF): / ~. 525 Test Dmfion: [?_ Change in Reading (RF-R~): ~52. aaoo '~7 Pass/Fail Thresho]d or 0 k)q~'"~ , Criteria: Comments - (include information on repairs made prior to testing, and recommended folIow-up for failed tests) Secohdary Containnlnt Test Panel Test Parameters Test Status Function Menu Test Site, Sta~t~s ~ [ 1 Chevron [Saving..: Pass/Fail,. Restart ' 1125 Coffee Rd. Change 'PASS ~ I I Bakersfield, CA 99999 t~:~0~2~-~ --~;~ Save Return ~roduct ,, Test Results i87 Fill Bucket Type 15.95~- 11:38:54 AM 11:42:00 AM 11:45:00 AM 11:48:00 AM 11:50:54 AM 02/0412004 02/0412004 02104/2004 02/04/20~ 02/04/2004 Test Time ,H 2~8 2004 9:20 BKSFLD FIRE PREVEHTIOrt (661)852-2172 p 1 ERMIT APPLICATION TO CONSTRUCTtMOOI~ ~ ~et~leld ~ De~t. ~ NE'~ FACtL]~ . ~MO~IFI~ON OF FAC]LI~ ~ N~ TANK [~TAL~T]ON AT ~I~TING FACIU~ mm m TH~ 8EC~ I~ F~ ~ FUEL FOR OFFICIAL USE ONI. Y l'he applicant I~ received, w~ders/m'~Jz, and w/Il comply wit~ fha attachwtl e~ndltion~ of the permit and any, otl~e ~tate, Io~al and f~deral regulationz. Thi~ form ha~ been completed under per/,a/O~ of p~rjt~ and tO ~ ~t of my Imow/edge, U true and correct. /I /~ THI~ APPUCATION'BE¢OME8 A PERkU? WHEN APPROVED CITY OF BAKERSF~.I.D OFFICE OF ENVIRONMENTAL SERVICF~ · 1715 Chester Av~, Bakersfield, CA (661) 326-3979 APPLICATION TO P~,FORM FUEL MONITORING CERTIFICATION ~ APPROVI~D BY DATE APPLICANT MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or r~port must be prepared for each monitoring system control panel by ~he technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Conlact Person: ~ ~ Contact Phonc No.: ( ~! )~ Make/Mod¢lofMonitoringSys~m: ~~ ~l~'~ ~ ~3-~ Date of Testing/Scrvicing: ~ B. Inventory of Equipment Tested/Certified ~n-Tank Gauging Probe. Model: ~ -I~l~-Tank Gauging Probe. Model: ~" ~Annular Spa~ or Vault S~nsor. Model: ~/ ~i'~'-Annular Space or Vault Sensor. Model: ~J~ z. - ~uin§ Sump I Trench Sensor(s). Model: L~0- ~'~i~ing Sump ! Trench Sensor(s). Model: d~-F'fll Sump Sensor(s). Model:~it~ ~"Fill Snmp Sensor(s). Mod~l: ~) ~ M~chanical Line Leak Dgt~ctor. Model: I~ Mechanical Line Leak Detector. Model: ~] El~tonic Line l~ntk De~r. Mod~l: ~] Eloclronic Line Leak De~ctor. Model: I~i Tank Overfill ! High-Level Sensor. Model: I-~ Tank Ov~tfll ! High-Level Sensor. Model: vi Other (spec~f~ equilm~'nt t~ and model in Section E on Pa~ 2). . . I-I Other (specif~ equipment t3q~ and model in Section E on Page 2). ~p-Tank Gauging Probe. Model: ~ t-i ~ Gauging Probe. Model: ~lllular Spa~ or Yault Sensor. Mod~]:~ ~] Ann~ or Yault Sensor. Model: ~ping Sump ! Trench S~nsot(s). Model: ~l Piping Sump/'Tn~ Sensors). Model: .~'dl Sump S~mso~s). Model: ~ l~lll Sump Sensor(s).~ Model: ~Mechanical Line ~ Detector. Mod~l: ~ ~ ~ ~l Mechanical Line L~k Det~c~,~ Mod~l: ~ Elec~onic Line ~ D~or. Mod~l: -~l El~cmmic ~ Leak D~ctor. ~l~o~l: r~ Tank Overfill ! High-Level Sense. Model: ~ Tank Overfill ! High-Level S~nsor. Moo~l~ I-! Other (specify equipment tl~ and modelin Section E on Page 2). FI Otl~ (specify equipment typ~ and model in ~tion E on Page 2). ~ Shear Valve(s). I~Shear Valve(s). ~ mSl~aS~ Co.~t ~oat~s~ ~d Cha~(0. ~ mSl~ Con~anm~t ~oa~s~ a~a Containm~t S~nsor(s). Model: ~ ~ Disp~on~ainm~lt S~nsor(s). Model: ~hear v~ve(s). Cl Shear I-I Dispenser Containment Float~s~ and Chain(s). [~l Dispenser Con~t Float~s~ and Chain~s~. Containment Sensor(s). Model: ~0~ ~ I~ Dispens~ Containment Senso~Model: v~ve(s). Cl Shear valve(s). FIDispenser Containment Float(s) and Chain,s). ~] Dispgnser Containment Float(s~ and Chain~ *ff th~ facility contains more tanks or disp~nsm-s, copy this form. luelud~ information for every tank and dispenser at the facili~ C. Certlfkafion - I ~ ~at ~e eq~mmt kimtl~d in this doma~m was .~,ea~i/~ in an~mlan~ with me Technician Name (print): ~ /~:~ Signature: ~ ,e., ~ Certification No.: ~7'~/a License. No.: d~/J~' ~ Page l~f3 03~1 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: /~/~.,~. e.~ 2_. Com~dete the followin;~ ~yes I-I No* Is thc ~libl¢ alarm Oj~ratlonal?  12 No* Is the v~.q!la! a~l~a_rlll opeA'fltiol~ll? , , 12 No* Were all seaL'°rs vi_s,_al~iy inspected, functionall]t tested, and confirmed operational? I~'~¥ns 12 No* Were all sensors insf~led at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? If alarms arc relayed to a remo~ monitoring station, is all communications equipment (e.g. modem) 12 * 12Yes ~N/~ operational? r~es 12 No* For pressurized piping systems, does the tuffoine automatically shut down if the piping secondary containment 12 N/A monitoring system detects a leak, fails to operate, or is electrically disconnectS? If yes: which sensors initiate positive shut-down? (Check all that apply) I~l~'ump/Trench Sensors; I~i~l~spenser Containment Sensors. Did ~tou confirm positive shut-down due to leaks and sensor failure/disconnection? I~es; 12 No. 12 Yes 12 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no I~I~NIA mechanical overfill prevention valve is installed), is the overffdl warning alarm visible and audible at the tank fill point(s) and opemfinff properly? If so, at what percent of tank capacity does the alarm trigger? __% 12 Yes* ~Ko Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the n~nufa~turer name and model for all replacement parts in Section E, below. 12 Yes* I~1~I~o Was liquid found inside any seconda~ containment systems designed as dry systems? (Check all that apply) 12 Product; 12 Water. If ~es, describe causes in Section E, below. I~s 12 No* Was monitoring system set-up reviewed to ensure proper setting? Attach set up reports, if applicable I~'Yes 12 No* Is all monitoring equipment operational per manufacturer's specific~ions? .... · In Secti, ~n E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page2 of 3 0:5/01 F. In-Tank Gauging / SIR Equipment: Or'Check this box if tank gauging is used only for inventory control. ca Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. '~Yes ~ No* Hasa~inputwiringbeeninspectedf~rpr~perantryandterminati~n~inc~udingtestingf~rg~undfau~ts? ~ Yes ca No* Were all tank gauging probes visually inspected for damage and residue buildup? ~'~es vi No* Was accuracy of system product level readings tested? ~Yes ca No* Was accuracy of system water level readings tested? ~'~,~Yes cl No* Were aH probes reinstalled properly? ~ Yes ca No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be con~u~i. G. Line Leak Detectors (LLD): Ca Check this box if LLDs are not instaHed. Co~-?ete the followi~ eh_~eidi~t: ~ Yes ca No* For'equipment s~art-up or annual equipment c~ification, was a leak simulated to verify LLD p~rformance? ca N/A (Check all that apply) Simulated leak rate: ~g.p.h.; caO. l g.p.h; ca 0.2 g.p.h. ~es ca No* Were aH LLDs confirmed operational and accurate within reg~llatory requirements? dYes ca No* Was the testing apparatus properly calibrated? ~Yes ca No* For mechanical l.lJDs, does the LLD restrict product flow if it detects a leak? ca N/A ca Yes ~o* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ N/A cl Yes I'~ No* For electronic I.LDs, does the turbine automatically "shut off if any portion of the monitoring system is disabled ~lA or disconnected? I-I yes ca ,~o* For electronic I.I JI~s, does the turbine automatically shut off if any portion of the monitoring system malfunctions {~f N/A or falls a test? ca Yes _~ ~1o* For electronic I.LDs, have all accessible wiring connections been visually inspected? ~]~ N/A ~yes cl No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Seclion H, below, describe how and when these dellciendes were or will be corrected. Page 3 of 3 0.v0~ Monitoring System Certilieatton UST Mo fitori g Site Plan Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System C~tifi~tion. On yom' site plan, show the geno'~l layout of ~ and piping. Clearly identify locations of the following equipment, if install~l: monitoring system control panels; semors monitoring tank annular spaee~, sumps, di~n,~r pan~, spill containers, or otber ~,ondary containment are~; n~:hanical or electronic line leak detector~; and in-tank liquid level probes (if ~ for l~tk det~fion). In the spaco provided, note the date this Site Plan was prq~arexl. ~-~'TEM SETUP 1N-TANK SETUP · JUN 30. 2004 8:55 ~ COI'{flUN I CRT I ONi~ I~ET UP T I: U~ED ?~D~ ~DE : 1 'r~ ~F :. ~ST~ UNI~ ~ ~I~: TR~ DI~ : 111.00 U.S. TR~ P~FI~ : I PT S~ ~~ C~ ~ : I (~-232) F~ VOL : 12032 E~LISH b~ ~1~ FO~T ~ ~ : 9600 ~N DD ~ HH;~:~ ~ P~I~ : ~ ~OP BIT : I ~OP YL~T SI~: 4.0 IN. 8496 ~I P ~TR ~H: 8 ~T~ ~NI~ : 3.0 1200, CO~E RD 4IGH ~ LIMIT: 4.0 ~FI~ ~.93308 R~O ~IT ~I~: 561-589-6305 ~ OR ~ VOL: 12032 SHI~ TI~ 1 : 11:00 ~ a~O ~ ~ LIMIT O~I~ LIMIT : 9~ DI~ : 11430 SHI~ TI~ 2 : DI~ ~HI~ TI~ 3 ' DI~ ~0 HIOH ~ LIMIT 4IOH P~D~ ' DI~ : 11671 ~HI~ TI~ 4 : DI~BL~ a~O 0~I~ LIMIT D~I~ LIMIT : ~I~ : 120 T~ P~IODIC ~NI~ ~0 L~ DI~L~ DI~-~ L~ P~D~ : 500 T~ RNN~ ~NI~ ~0 T~ LIMIT ~ ~ LIMIT: 99 ~I~B~D ~I~ ~DEN L~ LIMIT: 99 LI~ P~IODIG ~NI~ a~O D~I~ ~ Ta~ TILT : ~I~ RNN~ ~NI~ ~0 D~IV~ E~ ~NIFO~ DI~L~ DI~ Ta: ~ YRI~ TC VOL~ ~0 ~~ I ~ ON ~BI Pn a~O ~~ I~ ~FF ~ MIN ~IODIC: T~ ~E~TION DI~ : t20 'J~ (DEG F ): 60.0 ~0 ~R F~ ~ DIgR~ " ~ MI N RNN~ : ~ICK ~IO~ OF~ ~0 ~R ~T~ ~ : 120 DI~ DI~ 4-P~T~L ~TR FO~T a~O ~R O~ tEIG~ DI~ ~ERIODIC T~ ~PE ' STRN~D ~~ ~VI~ TI~ ~T~ ~TE ,WNN~ ~ FRIL ,~R ~ I BUN ~ DI ~ TI~ ~-232 8~I~ YERIODIC ~ FRIL 2:00 ~ CODE : 000000 ~ DI~BL~ .~ ~ 6 SUN O~ T~T FRIL ~ TI~ ~ DIBBLED 2:00 ~ aNN ~T RV~I~: OFF :~E-DI~ L~ PRI~O~ ~-232 E~ OF ~ y~ ~ R~I~: OFF ~ ~I~ TR~ ~ MOTIf: OFF ,~DE : 000000 T~ ~ SIP~N B~:OFF D~I~Y D~Y : 15 MIN T 3 :Dli~EL ._ T 2:PREHIUH ?RODUCT CODE : 3 L. IGUID SEN~OR SETUP L~RODIJCT CODE : 2 THERPIRL COEFF : .000450 THE~HRL COEFF : .000700 TANK DIRHETI~ : 111.00 TANK DIRHETER : 111.00 TANK PROFILE : I PT "- I :UNL STP TANK PROFILE : I PT FULL VOL : 12032 TRI-STATE (SINGLE FLOAT) FULL VOL : 12032 ~tTEGOR¥ : STP SUPIP _--'LO~T SIZE: 4.0 IN. 8496 7LORT SIZE: 4.0 IN. 8496 L 2:UNL ANNUIJ~E k~tTER IdRRNING : 3.0 TEI-b-'TATE (SINGLE FLOAT) t,3RTER bJ~RNING : 3.0 -IIGH 14RTER LIHIT: 4.0 CRTEGO]~t : ANN~ SI:~CE 'tlGH klRTEE LIHIT: 4.0 I'tR,X OR LABEL VOL: 12032 PIRX OR L~d~EL VOL: 12032 OVERFILL LIHIT : OVERFILL LIHIT : 95~ : 11430 L 3:UNL FILL : 11430 -iIGH PRODi.lCT : 9?*,4 TRI-STATE (SINGLE FLO~T) -iIGH PRODUCT : 9?*4 : 11671 ,.~TEGORY : OTHER SENSOES -' 11671 DELIVERY LIHIT : DELIVERY LIHIT : tO~ : 1203 : 1203 -~Obl PRODUCT : 500 L 4 :PREH STP LOt4 PRODUCT : 500 ~ RLRI~ LIHIT: 99 TRI-STATE (SINGLE FLOAT) ~ R[.REH LIHIT: 99 ~LIDDEN LO~l~ LIHIT: 99 ,~TEGOEY : STP SUHP SUDDEN LOt3~ LINIT: 99 TANK TILT : O.OO 'rANK TILT : 0.00 HRNIFOLDED TANKS Z. 5:PREH ANNULAR HRNIFOLDED TANKS Tit: NONE TRI-STATE (SINGLE FLOAT) Tit: NONE --- C4~TEGORY : ANNULAR .~PRCE Z~7.RK NIN PERIODIC: ZERK HIN PERIODIC: 10~ : 1203 : 1203 '- 6:PREH FILL Z~J~K HIN ANNLIRL : 10~ TRI-b-'TATE (i31NGLE FLOAT) .-.ERK HIN ANNLIRL : tot4 : 120~1 ,~TEGORY : OTHE~ SENSORS : 1203 ?ER IODI C TEST TYPE _~ERIODIC TEST TYPE r='TANI~Od~D L 7:DIEBEL STP STANDARD TEl-STATE (SINGLE FLOAT) ANNUAL ~ FAIL ~.~tTEGO~ : 13TP SUHP ~NNURL TF.~T FAIL RLREH DISABLED RLAI~I D I ~BLED ~ERIODIC TEE~T FAIL .". 8:DIll'EL ANNULAR L~EEIODIC TEST FAIL P&.RRH DISABLED TEl--STATE (SINGLE FLOAT) ~ DISAB~_i~ ~.~tTEGORY : ANNIJLRR SPACE GRO~ TEST FAIL *~RO~ TEST FAIL ~RH DI~RI-I~ RLAEH D I~BLED ~NN TEST AVERAGING: OFF aNN TEST AVERAGING: OFF ?ER Tl~-~r AVERAGING: OFF TRI--~TATE (SINGLE FLOAT) ?ER TEST AVERRGING: OFF ~TEGORY : OTHER TANK TEST NOTIFY: OFF 'lANK TEST NOTIFY: OFF TNK TC~T SIPHON BREAK:OFF TNK T~T SIPHON BREAK:OFF LIO:DISP 1-2 DELIVERY DEL~¥ : 15 HIN TRI-STATE (SINGLE FLOAT) DELIVERY DEL~¥ : 15 HIN -.. C4~TEGORY : DISPENSER PAN LEAK TEST HETHOD 'I'EE~ ON DATE : ALL TANK --11 :DIBP 3-4 .~AN 1. 2005 TRI-STATE (SINGLE FLOAT) STRET TIHE : 2:00 RH ~TEGORY : DISPENSER PAN TEST RATE : 0.20 DLIRRTION : 2 HOUR~ .-. --12:DI~P 5-6 TRI-STATE (SINGLE FLO~T) ~ TEST REPORT FORHRT C4~TEGORY : DISPEIq~ER PAN NORH~L LI3:DISP 7-8 ~L,F~H H!IB'I'O~' REPORT '~ION 11G.02 ~~~ G4~l l~-lO0~ C~ - 08.05.14.15-05 T 2:P~I~ O~P~ ~Y ~ ~ ~~E ~D~ '~IODIC T~T ...... ~ ~T~: I~Y 20, 2004 12: O0 P~IODIC IN-T~ T~TS ~ t :U~-PR~ ~NN~ IN-T~ ~ D~IODIC ~T · ~PE: .JUN 6, 2004 12: -~Y CL~ JUN 5, 2004 ~Y 25, 2004 ~IQUID ~E~R ~ L I :FU~ ~ L 2:F~L L 3:F~ ~ L 4:F~ ~ L 5:F~ ~' L 6:F~ ~ ~ HI~TORY LIO:F~ ~ ..... ~ ~ ..... LI 1 :F~ ~ LI2:F~ ~ ~~ I~ OFF LI3:F~L ~ .]~N 1, 1996 8:00 ~ ~ ~ ~ ~ ~ E~ '~PE: ST~D ~y CLUED L ~:F~ ~ L 8:F~ ~ L 9:F~ ~ ~ ~ ~ ~ ~ Et~ ~ ~ ~ ~ ~ LIO:F~ ~ ~ Hl~O~ R~ORT LI2:FU~ ~ .... IN-TRNK ~ LIa:F~ ~ T 3:DI~EL ~lODIC T~ ~V 20, 2004 ~ERIODIC T~ ~ HI~O~ R~ .]UN S, 2004 12:~0 · JUN 5, 2004 .... 1N-T~ ~ ..... ~y 25. 2Q04 ~ECO~ILIRTION ~UP R~TIC ~ILY CL~I~ ~V IQ, 2004 6:12 ~ TI~: 2:80 ~ RPR 24, 2004 2:48 ~ ~IODIC R~IL~y 4IGH P~D~ ~ - ~R 2~, 200~ 8:25 ~ HODE: pE~TION I~ID F~ ~ ~ lO, 2004 ~:16 ~ ~ ~ ~ ~ ~ ~R 2S. 2004 5:36 DH ~R 26, 2004 t2:19 ~ ~ p~D~ ~ ~R 27. 2004 8:25 ~ ~IODIC T~ ~N ~Y 2Q. 2004 12:00 ~ ~LRRM HISTOR'Y REPORT ~ HIS'TORY REPORT BENBOR RI..qRH ..... ~ HISTORY REPORT L. I :UNL STP ..... BENErOR RI. aqRM ..... STP GI.IHP ..... ISENtSOR ~ ..... '*. 5:PP-,EH ANNULP. R ,'3ENISOR OUT ~ .'L 3:UNL FILL r~NNUI, aqR ~3PRCE -.1UN 30, 2004 9:56 F~ OTHER I~ENSORS ?UI~ *=UEL ~ .3UN ?UEL RLRRH .]UN :30,. 2004 9: JUN 30° 2004 9:53 P~ L~ETLLo D~T~q ~3ETUP DRTR bJRRNING APR 23,. 2004 SENSOR OUT ~ r.q~R 2:3, 2004 8:46 Sat -.1UN 30,. 2004 9: 52 r~LAI~ HII3TORY REPORT ,~bNV, H HI~TOR¥ REPORT ~I. ARM HI~O~ ~ ..... ~E~R ~ ..... ..... ~R ~ ..... ' 6:P~ FI~ ~E~R ~ ' 4 :PR~ ~ OT~ ~E~ "2:U~ RNN~R ~p ~ ?~ ~ ANNU~ ~E ?~ ~ .JUN 30. 2004 9:34 ~ ~ R~ .3UN 30, 2004 9:31 ~ JUN 30. 2004 9:38 ~ ~ ~TR ~RNI~ ~ ~ ~R 23. 2004 8:46 ~ :3~ ~T~ ~NI~ JUN 30, 2004 9:31 ~ aPR 23. 2004 8:4G ~ ~ ~TR ~NI~ ~R 23. 2004 8:46 ~ ~ HI~TORY REPORT END ~ ~ ~ ~ ~ LI~:DI~ ?-8 D I SPE~ PAN · ]UN 30. 2004 9:44 ~ ~ ~TR ~NI~ ~R 23, 2004 8:46 ~ F~L~RH HISTOI~! REPORT ~ HIb-'TORY REPORT SE~R ~ ..... ;. 8:DI~ ~NN~ ..... ~R ~ ---~- ~NNU~R ~E ~11 :DI~P 3-4 ?U~ ~ DISPE~ PRN · ~UN 30, 2004 9:42 ~ 7~ ~ .JUN 30, 2004 9:48 ~ ~L A~ aPR 23. 2004 10:08 ~ ~ ~TA ~NI~ ~R 2~, 2004 8:46 ~ ~R 2~, 2004 10:05 ~ -" ,:~L~ HIBTOR~Z REPORT r.~z~RH HIb-~TORY R~ORT ..... ~EN~OR ~ ..... ZI2:DI~31) 5-6 ..... SENSOR ~ ..... DIEfl)£N~BI~ PRN ~ 9:DIEBEL FILL _---~L ~ OTHER S£NF~ORf3 .3UN BOo 2004 9: 45 RM ..1UN 30, 2004 9:42 RM ~;ETLIP DRTR IARRNING APR 2:3,. 2004 8:46 RH SETUP DRTR 14RRNING 4700 Coffee Rd. Brookside Mkt. 07/08/04 Diesel Dis Leak