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UNDERGROUND TANK FILE #2
J 0 B CARD Prevention Services POST CARD AT JOB SITE 900 Truxtun Ave#201 Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY N~,ME ~, [OWNER CITY BAKERSFIELD z~ CITY PHONE No. PERMIT No. INSTRUCTIONS: PLEASE CALL FOR AN INSPECTOR ONLY WHEN EACH GROUP OF INSPECTIONS WITH THE SAME NUMBER ARE READY. THEY WILL RUN IN CONSECUTIVE ORDER BEGINNING WITH NUMBER ONE. DO NOT COVER WORK FOR ANY NUMBERED GROUP UNTIL ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMI~ING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE INSPECTOR . r. ' TANKS AND BACKFILL . BACKFILL OF TANK(S) SPARK TEST CERTIFICATION OR MANUFACTURES METHOD CATHODIC PROTECTION OF TANK(S) - ~ .' , PIPING SYSTEM , ~ ' . _ TYPE OF PIPING ~ FLEX ~ FIBERGLASS CATHODIC PROTECTION SYSTEM-PIPIN~ DISPENSER PAN SECONDARY CONTAINMENT, OVERFILL PROTECTION; LEAK DETECTION CONTINUOUS VAPOR MONITORING LEVEL GAUGES OR SENSORS, FLOAT VENT VALVES ~ '~ t~ ~t[ .~L T~HT .~LL ~OX(aS) PRODUCT LINE LEAK DETECTOR(S) LEAK DETECTOR(S) FOR ANNUAL SPACE-D.W. TANK(S) MONITORING WELL(S)/SUMP(S) - H20 TEST SPILL PREVENTION BOXES MONITORING WELLS, CAPS & LOCKS -MONITORING REQUIREMENTS TYPEUre~0~LB' ~ ~ AUTHORIZATION FOR FUEL DROP 0lC ~ '0 I' * 4 , CONTRACTOR .... ~&V~ ...... ~[~_~ ..... ~ ....................................... LICENS[ No. _~_~_~_~) co~,%, __~~_ ........................................................................... ~,o~[ ~o. ___~! ~_~_~_~_:_~¢ fd ~ 743 : ~-R Postage $ ru Certified Fee i ll~ I Postmark ,~,.~ Return Rec[ept Fee Here (Endorsement Required) II Restricted Delivery Fee , e-~ (Endorsement Required) ~na Totals,, TERI NICHOLS ON ina ~ CIRCLE K STORE ~ '~ [71~n'i;'~"~'~'~s~5600 AUBURN #2 ....... l 1~ BAKERSFIELD CA 93306 ....... l -'-./- ........ ~. :...~ . Certified Mail Provides: a6%~-ao-~6g~oc m A mailing receipt (es~a,~e~l) ~00~ eu/ ~uod Sd a A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: ~, ~ [] Certified Mail may ONLY be combined with First-Class Mail® or Priority Maile [] Certified Mail is not available for any class of international mail. [] NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuabtes, please consider Insured or Registered Mail. [] For an additional fee, a Return Receigtmay be requested toprevide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Rece pt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse ma p ece "Retu..m_Fl_e~ipt Requ.ested". To r..ece, i.v.e .a.fee waive, r .fo.r a duplic,ate return receipt, a u~=® postmarK on your ueniTie(3 nnai~ receipt ~s requlreo. [] For an addit onal fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted~2elivery". [] f a postmark on t.h.e Ce. rt f ed Ma receipt is desired please pre_sent..the, arti- cle at the post onice Tor postmarking~ If a postmark on the uertifie(~ Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SWRCB, January 2002 -" Page [ of'~ Secondary Containment Testing Report Form This form is intended for u~e by contractors performing periodic testing of USTsecondary 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. FACH~ITY INFORMATION · Facility Name: (~,~I-V~C ~ I DateofTesting: q'~O"{ Facility Address: ShOO ~O{oO~d ~-dYeej,/P ~>~lcecgf~el&_ t~t, Facility Contact: /0/2k- - ' ' [ Pl~one: ~ Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): .z, ~rEsa~ CONTe,~CTOR ea*O~T~ON Technician Conducting~ ~ Test: ~-e._ 0.-,~,,JCsV~L Credentials: ~CSLB Licensed Contractor [] SWRCB Licensed Tank Tester Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS ~ Not Repairs Component Pass Fail Not Repairs ComPonent Pass Fail Tested Made Tested Made ~ o~ o o qi ~ ~ o o o To~l~~ ~ o o o o o o o ~ ' - ~ ~o o'o o oo o ~ ~ B 0 0 0 0 0 0 O DC o ~ o o o o o o ~-q ~ o ~o o oo o o 0 B 0 0 0 0 0 o If hy~os~dc test~ was pc~o~c~ describe what w~ done ~ ~e water a~e~ complcdon of tests: CERT~ICATION OF TEC~IC~ ~SPONS~LE FOR CONDUCT~G T~S TEST~G best ofmy ~owledge, ~e facts ~a~d in th~ document ~e accurate a~ in full compliance with legal requiremen~ T~ici~ s Silage: ~, ~ - ~ ~ ~- ~x Date: ~ - ~--O. ¢imle K - $2708605 5600 Auburn Street Bakersfiled, GA 93306 ~04341 - SB 989 testing ~ ~_ of~'~ SWRCB, January 2002 Page 4. TANK ANNULAR TESTING- Test Method Developed By: [] Tank Manufactm-er ~i(Industry Standard [] Professional Engineer [n Other (Specify) Test Method Used: Iq Pressure '~acuum [] Hydrostatic : t~ Other (Specify.) , Test Equipment Used: ]fJL Cb4/~"(L 0qe(~ ~'~J~ ~Qq ~ Tank# ~-~ Tank# ~ ' Tank# ~l ' Tank# Is Tank Exempt From Testing?1 · · [] Yes ~No ' [] Yes Jg No [~ Yes ~q~ [] Yes [] No Tank CapaciW: ~ ~) I O o co Ta~k Material: .. Tauk Manufa¢~are~. Product Stored: ~q Wait time between applying pressure/vacuum/water and starfin~ test: Test St~ Time: ~ ~'. ~.~ ~ 0 .. ~ O tO~.~ Test End Time: \ \., ~.~ Final Reading (Rs): [{D I~o Test Duration: ~ '~_ (1_ \ mes o d Was sensor removed for testing? []Yes FINo UlNA ~Yes []No F1NA []Yes ~No ~NA DYes F1No []NA Was sensor properly replaced and [] Yes [] No [] NA []Yes DNo []NA []Yes []No UlNA []Yes []No UlNA vefi_qed functional after testing? Comments - (include information on repairs made prior to and recommended follow-up for £ailed tests) Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing ~ Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment te~fing. {California Code of Regulations, Title 23, Section 2637(a)(6)} · SWRCB, J~uuary 2002 5. SECONDARY PIPE TESTING Test Method Developed By: [] Piping Manufacturer ~mdnstry Standard . [] Professional Engineer [] Other (Spec~) Test Method Used: ~:~essum [] Vacuum [] Hydrostatic [] Other (Specify), Test Equipment Used: ~ (~/k,(~ ~/~ ~//~ ,gf'/~ 0(~.5 [ Equipment Resolution: ~ '' . Piping Manufacturer. Piping Diameter:._ Length of Piping Run: Product Stored: Method and location of piping-run isolation: Wait time between applying . pressure/vacuum/water and starting test: Test Start Time: TestEndTime: ,/O.'l~" .,. /0 2/~ /O :/ff ' Test Duration: Cha ge ©, Pass/FailThreshold or '/v)r ~ . ~ . Comments - (include information on re~air~ made prior to te, tin~, and recommended follow-u, p for failed t~ts) Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing ? swP. c~, ~=~ary ~OQ 6. PIPING SUMP TESTING Test Me.od Developed By: ~ S~ Man~ac~ ~d~ S~d~d '~ ~ofessional En~eer ~ ~ (Spec~) Test Me.od Used: ~ Press~e ~ V~ ~Hy~s~c . · S~ Dimet~: HeiSt ~m T~ Top to Top of , Hi~e~ Pip~g Pene~fion: HeiSt ~om T~ T~ to Lowest El~ffic~ Pene~fion: Con&fion of ~p prior m tes~g~ Does ~bhe shut dom when s~nmrdemmfi~id~m- ~Yes UNo ~A ~Y~ ~No p~t ~d wat~)?* ' T~e ~mdom ~ome ~e op~o~?* W~t ~e ~ ~g p~e/~c~mt~ ~d s~g te~: T~t End W~e: { ! "3~ t I: ~3 k Z'. '~ Test ~fion: P~s~l ~shold or Cfi~fim W~s~r~ov~ for~s~g? ~Yes ~No ~NA ~ ~No ~ ~Y~ ~No ~NA ~ ~No ~NA W~ s~or properly ~l~ed ~d ~Yes UNo vexed ~cfion~ ~ ms'g? Comments - (inclu~ ~fo~n on r~ai~ ~ prior m t~ng, ~d reco~d~ follow-up for fail~ t~) Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing t If the entire depth of the sump is not tested, spec..r .ow much was t~steck If the answer to an~ of the questions indicated with asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB, January 2002 Page ~'' of 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer Xlndustry Standard [] Professional Engineer [] Other (Specify) ' Test Method Used: [] Pressure [] Vacuum ~tydrostatic IZl Other (Specify) Test Equipment Used: ~ 661vlbti_~O5j. t1"6~z~] m ~e .~L~.i p.5 ] Equipment Resolution: UDC Manufacturer: UDC Material: UDC.Depth: Height from UDC Bottom to Top of Highest Piping Penetration: .' Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Does turbine shut down when Cs=ordetec .quid¢oth OYes ONo product and water)?* Turbine shutdown response time safe shutdown?* operational?* Wait time between applying pressure/vacuum/water and starting test Test Start Time: Initial Reading (R~): Test End Time: Final Reading (Rr): Test Durafi°n: Change in Reading (Rr-R~): Pass/Fail Threshold or Criteria: 0 ,L)D'~ 0.00~. 0,0C:.~... O, co2. Was sensor removed for testing? ~Yes °No ElNA ~es [3No []NA ~fes []No []NA ~¥es []No DNA Was sensor propedy replaced and ~.Yes ,qNo [3NA ~es °No UNA ,~yes []No ONA ~,l~Yes [3No BNA verified functional after testing? F Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) [/16t/t¢[ [e~. 1< Dt Circle K - #2?08605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing ~ If the entire depth o£the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) SWrRCB, January 2002 Page ,,, 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not EqUipped With Spill/Overfill Containment Boxes Spill/Overfill Containment Boxes are Present, but were Not Tested Test Method Developed By: Spill Bucket Manufacturer [] Industry Standard Professional Engineer, Other (Specify) Test Method Used: Pressure Vacuum [] Hydrostatic Other (Specify) Test Equipment Used: see attached testing procedures [ Equipment Resolution: Bucket Depth: Wait time betWeen applying pressure/vacuum/water and 30 minutes 30 minutes 30 minutes 30 minutes starting test: Test Sm Time: TeSt End Time: Change in Reading (RrRt): Pass/Fail Threshold or 0.002 0.002 0.002 0.002 Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing SWRCB, January 2002 Page. ~7 of. 9. SPILL/OVERFILL CONTAINMENT BOXES " Facility is Not Equipped With Spill/Overfill Containment Boxes Spill/Overfill Containment Boxes are Present, but were Not Tested Test Method Developed By: Spill Bucket Manufacturer [] Industry Standard Professional Engineer Other (Specify) Test Method Used: Pressure Vacuum [] Hydrostatic Other (Specify) Test Equipment Used: see attached testing procedures [ Equipment Resolution: ~~2 Spm Box # /c} t/ [~ SpillBox#/~a [ ~/ Spill Box #/~W [ SpiliBox# Bucket Diameter & type: /~ ~/~/¢c4J ~ ~ Bucket Depth: /~ ~' ~ ~ Wait time between applying pressure/vacuum/water and 30 minutes 30 minutes 30 minutes 30 minutes starting test: Test Start Time: [0 ','~ {0:"L5 t O 2 (4q Initial Reading (R0: ["D- c~'L~'~)a ~'79, \~t~c~ [ q. 0 5 Zt~ Test End Time: [05c~( tO;~O [1 ', 0 q FinalReading (Rv): k'lr '°~'L°('q [,'~ ' I['ar~~'O Iq'0%% ~ Test Duration: /,5'-~ / j'--t~.,~, /' 5"-"-"---~ Change in Reading (Rr-Ri): 0 . 0~0~% 0 ' O0 17~. 0.0'0000 Criteria:Pass/Fail Threshold or ~;~2 0.002 0.002 0.002 Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing · Triangle Environmental, Inc. 2525 West Burbank Blvd., Burbank, CA 91505-2302 (818) 840-7020 (818) 84O-6929 US T TES TING S YS TEMS S UMMAR Y SHEET Precision Underground Storage Tank System Leak Test Client: Conoco Phillips Co. Facility# 2708605 1500 North Priest Drive Tempe, AZ 85281 Test Date: 2/16/04 Kathy Strickland (602) 728-7149 08605 Site #: 2708605 Work #: 20004374 5600 AUBURN ST County: KERN BAKERSFIELD, CA 93306 Cross Street: FAIR.FAX ROAD Tank Test System Tank Line # Product Capacity Type Rate/Results Ullage Result Rate/Result L/D Result 1 Unleaded Premium 9816 System 4000 N/A N/A N/A PASS 2 Unleaded Plus 9816 System 4000 N/A N/A N/A PASS 3 Unleaded Regular 9816 System 4000 N/A N/A N/A PASS Certified By: Technician: Ronnie Humphries State Lie. #s: 006-05-0086 2/ Comments: Compliance L/D & monitor certification, Spill bucket test. This precision tank testing system has been third party evaluated according to the guidelines of the EPA procedures for annual leak detection systems and found to exceed the criteria of detecting a leak of 0.10 gph with a Pd >95% and Pfa <5% as required by Local, State and Federal EPA UST Technical Standards Part 280 for precision testing systems. This SB-989 secondary containment testing system exceeds the criteria for detection as required by state and local agencies. Triangle Environmental, Inc. SYSTEMS TANK, LINE AND LEAK DETECTOR TEST REPORT Facility: Facility # 2708605 Tank #: 1 Test Date: 2/16/04 Product: Unleaded Premium Work#: 20004374 Test Method: System 4000 Test Method: TLDT Capacity: 9816 Manufacturer: Diameter (in): L/D Model: Product Level (in): L/D Serial #: Liquid Volume (Gals): Line Drain Back (ml): Liquid Percent (%): L/D Trip Time (sec): Specific Gravity: Holding Pressure (psi): Coef. of Expansion: Metering Pressure (psi): Water On Tank (in): L/D Test Rate (gph): Water In Tank (in): L/D Result: PASS Product Temp. (F): New leak detectoO. No Head Pressure (psi): Test Start Time: Test End Time: Test Method: TEI LT-3 Test Rate (gph): Pump Brand: Test Result: N/A System Type: Line Pressure (psi): ~ ' Line Start Time: Test Method: ULLAGE Line End Time: UllageVolume (gals.): Line Start Level: Ullage Test Time: Line End Level: Ullage Vacuum (psi): Line Test Rate (gph): Ullage Result: N/A Line Test Result: N/A WPLLD Triangle Environmental, Inc. SYSTEMS TANK, LINE AND LEAK DETECTOR TEST REPORT Facility: Facility # 2708605 Tank #: 2 Test Date: 2/16/04 Product:. Unleaded Plus Work#: 20004374 Test Method: System 4000 Test Method: TLDT Capacity: 9816 Manufacturer: Diameter (in): L/D Model: Product Level (in): L/D Serial #: Liquid Volume (Gals): Line Drain Ba~k (ml): Liquid Percent (%): L/D Trip Time (sec): Specific Gravity: Holding Pressure (psi): Coef. of Expansion: Metering Pressure (psi): Water On Tank (in): L/D Test Rate (gph): Water In Tank (in): L/D Result: PASS Product Temp. (F): New leak detector'?. No Head Pressure (psi): Test Start Time: Test End Time: Test Method: TEI LT-3 Test Rate (gph): Pump Brand: Test Result: N/A System Type: Line Pressure (psi): ~ .... Line Start Time: Test Method: ULLAGE Line End Time: UllageVolume (gals.): Line Start Level: Line End Level: Ullage Test Time: Ullage Vacuum (psi): Line Test Rate (gph): Ullage Result: N/A Line Test Result: N/A WPLLD Triangle Environmental, Inc. SYSTEMS TANK, LINE AND LEAK DETECTOR TEST REPORT Facility: Facility # 2708605 Tank#: 3 Test Date: 2/16/04 Product: Unleaded Regular Work#: 20004374 Test Method: System 4000 Test Method: TLDT Capacity: 9816 Manufacturer: Diameter (in): L/D Model: Product Level (in): L/D Serial #: Liquid Volume (Gals): Line Drain Back (ml): Liquid Percent (%): L/D Trip Time (sec): Specific Gravity: Holding Pressure (psi): Coef. of Expansion: Metering Pressure (psi): Water On Tank (in): L/D Test Rate (gph): Water In Tank (in): L/D Result: PASS Product Temp. (F): New leak detector?. No Head Pressure (psi): Test Start Time: Test End Time: Test Method: TEI LT-3 Test Rate (gph): Pump Brand: Test Result: N/A System Type: Line Pressure (psi): Line Start Time: Test Method: ULLAGE Line End Time: UllageVolume (gals.): Line Start Level: Ullage Test Time: Line End Level: Ullage Vacuum (psi): Line Test Rate (gph): Ullage Result: N/A Line Test Result: N/A .. ~ ........ WPLLD Triangle Environmental, Inc. US T MONITOR CER TIFICA TION $ UMMAR Y $HEET Client: Conoco Phillips Co. 1500 North Priest Drive Facility # 2708605 Tempe, AZ 85281 est Date: 2/16/04 Facility: 2708605 Facility # 2708605 Work#: 20004374 County: KERN 5600 AUBURN ST Cross Street: FAIRFAX ROAD BAKERSFIELD, CA 93306 Monitor model: VEEDER-ROOT TLS-350 Serial #: 80648964705001 Certification Result: PASS Sensor Type: Quantity: Result: Tank Annular: 3 Pass Annular Type: Dry Waste Oil: 0 N/A Audible Alarm? Yes Waste Oil Sump: 0 N/A Visual Alarm? Yes Vadose Wells: 0 N/A Fail Safe? Yes Line Pressure: 3 Pass Positive Shut-of~. Yes Turbine Sump: 3 Pass Gauge Only Result: Pass LineTrenchQty: 0 N/A ATG Monthly? No Fill Sump: 0 N/A ATG CSLD? No Comments: This certifies that the monitor and sensors, as listed above, are operational and calibrated per the manufacturer's specification. Inspected By: ~ ~~ Ronnie Humphrics Triangle Environmental, Inc. 2525 West Burbank Blvd., Burbank, CA 91505-2302 (818) 840-7020 (818) 840-6929 SECONDARY CONTAINMENT RES UL TS Client: Conoco Phillips Co. Facility# 2708605 1500 North Priest Drive Tempe, AZ 85281 Test Date: 2/16/04 Kathy Strickland (602) 728-7149 Facility: 2708605 Work #: 20004374 Facility # 2708605 County: KERN 5600 AUBURN ST Cross Street: FAIR.FAX ROAD BAKERSFIELD, CA 93306 Contractor's License # 673971, "A", "C-10", "HAZ" Tanks: Lines: Sumps/Spill Boxes: Product Description Test Type Result Comments Jnleaded Regular Spill Box/OPW 4 PASS LJnleaded Plus Spill Box/OPW 4 PASS IUnleaded Premium Spill Box/OPW 4 PASS Dispensers: Notes: Test Types: Type #1 is hydrostatic with water, Type #2 is pneumatic with nitrogen, Type #3 is vacuum and Type fl4 is visual inspection Environmental, inc. '-'=-'-~ ................ ' ADDREa: 5~ t4~Or~ ~, 2525W. BURBANKBLVD. mL. a18)840-7020 C~/STA~:~keO ~d~td E~' BURBAN~ ~ ~1~05-2302 FAX: (~I~) ~40-6~2Y COUN~ ~ ~ ~CH: SERVICE REOUESTED (CHECK) T^mCTI~nT~ESS TEST [--~ ~aoNrro~ CE~TrFIC^TION J~ ENVmON~VmNT^L REIVaRS J---J PRODUCT LINE TEST ~] FACILITY INSPECTION [~ OTHER [~ SER~ PE~O~D PARTS quantity Description Ou antity Description :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ............ !i:::~?: ............. ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: CUSTOMER SIGNATURE ~ DATE: SBI):. 123- WORKACKN(3/97) . TRIANGLE ENVIRONMENTAL, INC. ,SPILL BOX ANNUAL INSPECTION REPORT FORM · · 1. FACILITY INFORMATION ~' Facility Name: C~l~ ' 9(,0 Date of Testing: ¢'~_ I(,~- (Z3 ~'~ , :.,'.-~.~.. Facility Address: ~(.gOC~ ~t~~ .. ;', .'~ · .... ~,,..~..ac,,,~ Co..ac~: ~.~.~+ I""°"e: ~¢~ ~'~ %~7 I- :"' :"' Date Local Agency Was Notified of Testing: , f." 6' ' Name of Local Agency inspector (if present ~oring testing): ~ 'lt~ 2.,. TESTI'NG CoNTRacTOR IN~O~.T[ON Ronnie H~p~es Triangle Environmental, Inc.. 2525 West Burbank Blvd. Burbank, California 9~ 505 (8~8) 840-7020, (8~8) 840-6929 California .Contractor LicenSe g 67397~, A, C-~0, H~, HIC " 3. TE~T RES~LT~ - DATA. '.' . Test type Spill bo~ Size. Location Sta~ End Hydrostatic Result ' Tankg Episode Product Box Mfr (gals) Fill~apor Time Time OrVisual , , Comments: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated itt this document are accurate attd itt full compliattce with legal requirements Technician's Siglnature: ~~_ \~. ,f~. Z Date: ~"~(~- O~1 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 report must be prepared for each monitoring system control panel by the 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 lnf..ol'ma,tion Facility Contact P-erson: (~) ~/~lr~~''' ' Contact Phone No.: (~Q~-I Make/Model°f Monitoring System: '~L,~ - '~ (~ '~ Date of Testing/Servicing: B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: ~ In-Tank Gauging Probe. Model: Y~I:46, } ~ In-Tank Gauging Probe. Model: .15~gl~k ii Annular Space or Vault Sensor. Model: ~ O~ ~ Annular Space or Vault Sensor. Model: i~,'l~ing Sump / Trench Sensor(s). Model: ~. ~ ~ Piping Sump / Trench Sensor(s). Model:' I-I Fill Sump Sensor(s). Model: 1-1 Fill Sump Sensor(s): Model: l~! Mechanical Line Leak Detector. Model: x ~ Mechanical Line Leak Detector. . Model: ~ EleCt-ohio Line Leak'Detector. Model: ~'q IvLLQ ~ Elec~'onic Line Leak Detector. Model: ~ Tank Overfill / High-Level Sensor. Model: I~l Tank Overfill / High-Level Sensor. Model: I ~l Other (sp~i~¥ equipment type and model in Section E on Pa[~e 2). D Other (specif~ equipment t;ype and model in Section E on Page 2). ~ In-Tank Gauging Probe. Model: '~'¥~ ;~ D In-Tank Gauging Probe. Model: ~l. Annular Space or Vault Sensor. Model: t.I ~J~A'-'~ ' I~l Annular Space or Vault Sensor. Model: l '~Piping Sump / Trench Sensor(s). Model: e-~ I~1 Piping Sump/Trench Sensor(s). Model: ~ Fill Sump Sensor(s). Model:. - I~l Fill Sump Sensor(s). Model: ~ Mechanical Line Leak Detector. Model: . D Mechanical Line Leak Detector. Model: I~Electronic Line Leak Detector. Model: ~,~,.t"~, ~ Electronic Line Leak Detector. Model: I~l Tank Overfill / High-Level Sensor. Model: ~. ~ Tank Overfill / High-Level Sensor. Model: I~ Other (spe~ ify equipment type and model in Section E on Page 2). I-! Other (specify equipment type and model in Section E on Page 2). Dispenser : n t Sensor s Model ~ Dispens Co ' (). : ~ Dispenser Containment Sensor(s). Model: ~.Shear Valve(s). l'q Shear Valve(s). .'~ Dispenser Containment Float(s) and Chain(s). D Dispenser Containment Float(s) and Chain(s). Dispenser ID: r,)~ ~/~ Dispenser ID: Disp enser Cont~nn~ent/Sensor($). Model: l-I Dispenser Containment Sensor(s). Model: Shear Valve(s). I-I Shear Valve(s). l~ispenser Containment Float(s) and Chain(s). D Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: I"1 Dispenser Containment Sensor(s). Model: I~l Dispenser Containment Sensor(s). Model: ~1 Shear Valve(s). D Shem Valve(s). I-3Dispenser Containment Float(s) and Chain(s). D Dispenser Containment Float(s) and Chain(s). · If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - 1 certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct .and a Plot Plan showing the layout of monitoring eq.gipment. For a.ny equipment capable of generating such reports, 1 have also attached a copy of the rel~.ort; (check all th~.(apply):' __ ~'System ~e~'up ~ ~_.Marm history,report Technician Name (print)' ~{2n~,'~'~ p~ ~'~Ov'C~'O~'C~e ~-~ Signature: ' ~~ .~~ Certification No.: (~)Q)--~ \ License. No.: Page 1 of 3 03/01 Monitoring System Certification D. Results of Testing/Servicing Software Version installed: ~ (,06 O Complete the folloWing checklist: '~ Yes C3 No* 'Is the audible alarm operational? ~ Yes I-I No* Is the visual alarm operational? ~Yes .FI No* Were all sensors visually inspected, functionally tested, and confirmed operational? ~l~ Yes I~! No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Fl Yes Ul. No* If alarms are relayed to a remote monitoring station; is all communications equipment (e.g. modem) ~'4/A operational? .ff' J~ Yes Fl No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment Fl N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? '(Check all that apply) ~Sump/Trench Sensors; Fl Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~(es; uI No. I'-I Yes I"1 No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no l N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trim,er? __ % I~! Yes* Ji~ No Was any monitoring equipment replaced7 if yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts'in Section £, below. Fl Yes* ]~- No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Fl Product; Fl Water. If yes, describe causes in Section E, below.. ~_ .Yes Fl No* Was monitorinl~ system set-up reviewed to ensure proper settings? Attach set up repons, if applicable I~ Yes I~ No* is all monitoring equipment operational per manufacturer's' specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/01 F. In-Tank Gauging / SIR Equipment: C:I Check this box if tank gauging is used only for inventory control. Q Check this box if no tank gauging or SIR equ. ipmen't is installed. This section must be completed if in-tank gauging equipment is used to perform leak deteCtion monitoring. Complete the following checklist: ~ Y~s Q No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? [~ Yes [~ No* Were all tank gauging probes visually inspected for damage and residue buildup? ' ~i Yes ~[~ No* Was accuracy of system product level readings tested? I~i Yes ~ No* Was accuracy of system water ievel readings tested? [~ Yes I~ No* Were all probes reinstalled Properly? ' ~! Yes ~ 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 corrected. G. Line Leak Detectors (LLD): Cl Check this box if LLDs are not installed. Complete the following, checklist: ]j~ Yes I"l No* For equipment start-up or annual equipment certification~ was a leak simulated to verify LLD performance? t-I N/A (Check allthat apply) Simulated leak rate: ,~3 g.p.h.; ['-I 0.1 g.p.h; ,~ 0.2 g.p.h. ~l~,Yes [-I No* Were all LLDs confirmed operational .and accurate within regulatory requirements? '1~ Yes rq No* Was the testing apparatus properly calibrated? ' Q Yes ~ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ~i[ N/A ~[ Yes ~! No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ N/A ~Yes ~ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled '~ N/A or disconnected? l ~j[[ yes tq No* For electronic LLDs, does the turbine automatically shut off if. any portion of the monitoring system malfunctions l~l N/A or fails a test? ]j['~Yes D No* For electronic LLDs, have all accessible wiring connections been visually inspected? [~ N/A .~Yes ~ No* Were all items on the equipment manufacturer's maintenancechecklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. Page 3 of 3 03/01 Moniloring System Certification UST M onitoring Site Plan " Site Address: b(O{~{~ tr'J'L~)l)'rTh ~ "~ , ',' Date map was drawn: Instructions If you already have a diagram that shows all required information, you may include it, ~ather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page __ of__ 05/00 T 2 :PLUS PRODUCT CODE : 2 I N-,TANK SETUP THERMAL COEFF :. 000070 SYSTEM SETUP TANK DIAMETER : 92. O0 FEB 16, 2004 10:10 AM T I:UNLEADED TANK PROFILE : 4 PTS FULL VOL : 9816 PRODUCT CODE : 1 69.0 INCH VOL : 8058 THERMAL COEFF : .000700 46.0 INCH VOL : 4992 TANK DIAMETER : 92.00 23.0 INCH VOL : 1898 SYSTEM UN I TS TANK PROFILE : 4 PTS U.S, FULL VOL : 9816 SYSTEM LANGUAGE 69.0 INCH VOL : 8058 FLOAT SIZE: 4.0 IN. 8496 ENGLISH 46.0 INCH VOL : 4992 SYSTEM DATE/TIME FORMAT 23.0 INCH VOL : 1898 WATER WARNING : 2.0 MON DD YYYY HH:MM:SS xM HIGH WATER LIMIT: 3.0 CIRCLE K 8605 FLOAT SIZE: 4.0 IN. 8496 MAX OR LABEL VOL: 9816 5600 AUBURN L,JATER WARNINC; 2.0 OVERFILL LIMIT : 90% BAKERSF I ELI) C:A. 93306 : : 8834 661-871-7979 HIGH WATER LIMIT: 3.0 HIGH PRODUCT : 95'~.~ : 9325 SHIFT TIME I : 6:00 AM MAX OR LABEL VOL: 9816 DELIVERY LIMIT : 5~ SHIFT TIME 2 : DISABLED OVERFILL LIMIT : 905 : 490 BI-lIFT TIME 3 : DISABLED : 8834 SHIFT TIME 4 : DISABLED HIGH PRODUCT : 95~; LOW PRODUCT : 500 : 9325 LEAK ALARM LIMIT: 99 TANK PERIODIC WARNINGS DELIVERY LIMIT : 5~ SUDDEN LOSS LIMIT: 50 DISABLED : 490 TANK TILT : 3.80 TANK ANNUAL WARNINGS D I SABLED LOW PRODUCT : 500 MAN I FOLDED TANKS LINE PERIODIC: WARNINGS LEAK ALARM LIMIT: 99 Tg: NONE DISABLED SUDDEN LOSS LIMIT: 50 LINE ANNUAL WARNINGS TANK TILT : 3.48 ,, DISABLED MANIFOLDED TANKS LEAK MIN PERIODIC: 10~; PRINT TC VOLUMES T~: NONE : 981 ENABLED LEAK KIN ANNUAL : 10,% : 981 TEMP COMPENSATION LEAK MIN PERIODIC: 10~ VALUE (DEG F ): 6.0.0 : 981 STICK HEIGHT OFFSET PERIODIC TEST TYPE DISABLED LEAK MIN ANNUAL : 10~; .OUICK PRECISION TEST 1-:,ORATION : 981 HOURS: 12 ANNUAL TEST FAIL DAYL I GHT SAV I NG T I ME ALARM I) I SABLED D I SABLED PER I OD I C TEST TYPE QUICK PERIODIC TEST FAIL SYSTEM SECURITY ANNUAL TEST FAIL ALARM DISABLED CODE : 000000 ALARM DISABLED GROSS TEST FAIL PER I OD I C: TEST FA I L ALARM D I SABLED ALARM D I SABLED ANIq TEST AVERAG I NG: OFF PER TEST AVERAGIIqG: OFF GROSS TEST FAIL ALARM DISABLED TANK TEST NOTIFY: OFF ANN TEST AVERAGING: OFF' TNK TST SIPHON BREAK:OFF PER TEST AVERAGING: OFF COMMUNICATIONS SETUP TANK TEST NOTIFY: OFF DELIVER%" DELAY : '2 Mllq TNK TST SIPHON BREAK:OFF PORT SETT I NGS: DEL I VERY BELA%" : 2 M I Iq NONE FOUND RS-232 SECUR I TY C:ODE : 000000 RS-232 END OF MESSAGE D I SABLED W 3 :PLUS T B: PREM I UM LEAK TEST METHOD ~. P I PE TYPE: F I BER~LASS PRODUCT CODE : 8 LINE LENGTH: 100 FEET THERMAL ¢OEFF :.0005'00 TEST ON DATE : ALL TANK 0.20 GPH TEST: -ENABLED TANK DIAMETER : 92.00 JAN 1. 1996 O.lO GPM TEST: ENABLED TANK PROFILE : 4 PTS START TIME : DISABLED SHUTDOWN RATE: 8.0 GPH FULL VOL : 9816 TEST RATE :0.20 GAL/HR O.lO OPH TEST 69.0 INCH VOL : 8058 DURATION : 2 HOURS DATE : 999 0 46.0 INCH VOL : 4992 TANK: NONE 2B.O INCH VOL : 1898 LEAK TEST REPORT FORMAT FLOAT SIZE: 4.0 IN. B496 NORMAL WATER WARN I NG : =. 0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL 9816 OVERFILL LIMIT 90~.~ . HIGH PRODUCT 95% 9825 DELIVERY LIMIT' .5~ LINE LEAK LOCKOUT SETUP 490 WPLLD LINE LEAl..', SETUP LOC;KOUT SCHEDULE LOW PRODUCT : 500 DAILY LEAK ALARM LIMIT: 99 START TIME: DISABLED SUDDEN LOSS LIMIT: 50 STOP TIME : DIBABLED TANK T I LT : 2.50 W 1: UNLEADED MANIFOLDED TANKS PIPE TYPE: FIBERGLASS T~: NONE LINE LENGTH: 100 FEET 0.20 GPH TEST: ENABLED O. 10 GPH TEST: ENABLED LEAK MIN PERIODIC: 10% SHUTDOWN RATE: $.0 GPH 981 O.lO GPH TEST MM/DD DATE : 9~g 0 LEAK MIN ANNUAL : 10~ TANK: NONE : 981 LIQUID SEN~OR SETUP PERIODIC TEST TYPE ~UICK L i:ANNULAR ANNUAL TEST FAIL TR I -STATE < S ALARM DISABLED CATEGORY : ANNULAR SPACE PERIODIC TEST FAIL ALAR?"~ DISABLED L 2:UNLEADED SUMP GROSS TEST FA I L ~ 2 :PREM I UM TR I -STATE (S INGLE FLOAT) ALARM DISABLED CATEGORY : STP SUMP P I PE TYPE: F I BERGLASS ANN TEST AVERAC;INC~: OFF LINE LENGTh: 100 FEET PER TEST AVERAGING: OFF 0.20 GPM TEST: ENABLED L 3:89 ~NNULAR 0.10 GPM TEST: ENABLED TRI-STATE <SINGLE FLOAT) TANK TEST NOTIFY: OFF SHUTDOWN RATE: S.O GPM CATEGORY : ANNULAR SPACE O. 10 GPM TEST MM/DD TNK TST SIPHON BREAK:OFF '' DATE : '~'~,,, O TANK: NONE DELIVERY DELAY : 2 MIN L 4:89 STP SUMP TR I -STATE (S INGLE FLOAT C~TEGORY : STP SUMP L 5:91 ANNULAR TR I -STATE < S INGLE FLOAT) CATEGORY : ANNULAR SPACE L 6:91 STP SUMP TR I -STATE (S INGLE FLOAT CATEGORY : STP SUMP IN-TANK DIAGNOSTIC IN-TANK DIAGNOSTIC PROBE DIAGNOSTICS T 3: PROBE TYPE MAG1 PROBE DIAGNOSTICS SERIAL NUMBER 249264 T 1: PROBE TYPE MAG1 ID CHAN = OxCO00 SERIAL NUMBER 247B16 GRADIENT = 351.1200 ID CHAN = OxCO00 WPLLD LINE DISABLE SETUP GRADIENT = 352.5700 NUM SAMPLES = 20 NUM SAMPLES = 20 COO 1325.0 CO1 15520 0 W I:UNLEADED CO0 1335.0 CO1 16114.6 002 15520.0 C03 15520 0 LIQUID SENSOR ALMS 002 16114.8 C03 16114 4 004 15520.0 C05 15520 0 L I:FUEL ALARM 004 16114.4 005 16114 6 006 15520.0 007 15520 0 L 2:FUEL ALARM 006 16127.2 007 16127 0 008 15520.0 009 15520 0 L I:SENSOR OUT ALARM C08 16127.0 009 16126 7 C10 15520.0 Cll 42773 6 C12 20388.:3 013 19216 9 L 2:SENSOR OUT ALARM C10 16126.7 CI1 45149 3 C14 19150.2 C15 18967 6 01'2 21812.7 C13 21117 1 C16 18901.3 C17 18921 4 W o:PREMIUM C14 21255.4 C15 20992 3 - C16 21182.4 C17 20915 7 018 42774.9 LIQUID SENSOR ALMS 018 45149.3 SAMPLES READ =39712869 L 5:FUEL ALARM SAMPLES USED =89710817 L 6:FUEL ALARM. SAMPLES READ =39752097 L 5:SENSOR OUT ALARM SAMPLES USED =39749219 L 6:SENSOR OUT ALARM W 3:PLUS LIQUID SENSOR ALMS L 3:FUEL ALARM L 4:FUEL ALARM L 3:SENSOR OUT ALARM L 4:SENSOR OUT ALARM IN-TANK LEAK DIAGNOSTIC IN-TANK DIAGNOSTIC PROBE DIAGNOSTICS T 1: PROBE TYPE MAG1 PROBE DIAGNOSTICS SERIAL NUMBER 247316 T 2: PROBE TYPE MAG1 GRADIENT = 852.5700 SERIAL NUMBER 249266 ID CHAN = OxC000 ; NUM SAMPLES = 19303 GRADIENT = 351.1700 : ; CO0 1334 9 CO1 16563.6 NUM SAMPLES = 20 : 002 16563 6 003 16563.6 SOFTWARE REVISION LEVEL COO 1333.1 C01 3709.7 C04 16563 5 005 16563.5 VERSION 16.02 002 3709.2 003 8709.4 006 12802 4 007 12802.4 SOFTWARE~ 346016-100-C 004 3709.9 005 3709.8 008 12802 4 C09 12802.4 CREATED - 98.05 14.13.04 C06 3709.9 CO7 3709.4 OlO 12802 4 Cll 45149.8 · C08 3709.9 C;09 3709 8 012 21816.7 013 21019.0 · C14 21201.2 015 20982.9 S-MODULE~ 330160-060-A CIG 3709.4 Cll 42930.1 C16 21109.2 C17 20784.5 C12 18628.8 013 17287 2 SYSTEM FEATURES: ' 018 45151.0 PERIODIC IN-TANK TESTS C14 17206.3 015 17192.9 ANNUAL IN-TANK TESTS C16 17188.4 017 16714.8 PLLD C18 42931.6 O. 10 MANUAL&0.20 CONT WPLLD SAMPLES READ =39748492 0.10 MANUAL&0.20 CONT SAMPLES USED =39746630 IN-TANK LEAK DIAGNOSTIC PROBE DIAGNOSTICS T 2: PROBE TYPE MAG1 SERIAL NUMBER 249266 GRADIENT = 351.1700 NUM SAMPLES = 31820 COO 133:3.5 CO1 3749.1 C02 3749.'1 C03 3749.1 C04 3749.1 C05 :3749.1 006 5399.1 CO7 5399.1 COB 5399.1 C09 5~99.1 ClO 5299.1 Cll 42931.8 C12 19.168.9 C13 17577.0 C14 17494.6 C15 17487.6 C16 17457.4 C17 17075.6 C18 42932.8 t L 2:UNLEADED S'UMP : W 2:PREMIUM SAMPLES= 5 : LOW REFI= 793 ~ DISPENSING ENABLED ~ HIGH REFI= 5407 -: TEST ABORTED i VALUEI= 100680 : IN-TANK LEAK DIAGNOSTIC PENDING " PUMP OFF : PROBE DIAGNOSTICS HANDLE OFF : L 3:89 ANNULAR T 3: PROBE TYPE MAG1 TOTAL MESSAGE:263672 : SAMPLES= 5 SERIAL NUMBER 249264 CRC:6989 PARITY:26 LOW REFI= 792 GRADIENT = 3S1.1200 : HIGH REFI= 5406 0.10 GPH: IDLE : VALUEI= 100960 NUM SAMPLES = 61542 3.0 GPH CO0 1324.8 CO1 15592.4 P1:19.034 P2:18.326 PSI L 4:89 STP SUMP C02 15592.3 003 1S592.3 SAMPLES= 5 004 15592.3 005 15592.3 0.20 GPH LOW REFI= 793 006 13777 4 007 13777.4 P1:32.638 P2:32.444 PSI HIGH REFi= 5406 009 13777 3 009 13777.4 VALUEI= 95418 C10 13777 4 Cll 42774.4 MID TEST C12 20468 0 C13 19265.1 P1:18.138 P2:17,418 PSI 014 19192 9 C15 19865.7 L 5:91 ANNULAR C16 18934 2 C17 18957.3 SAMPLES= 5 C18 42775.7 LOW REFI= 795 HIGH REFI= 5396 UALUEI= 101162 L 6:91 STP SUMP SAMPLES= 5 LOW REFI= 795 HIGH REFi= 5397 VALUEI= 98591 " WPLLD LINE LEAK DIAG W J:PLUS FEB 16, 2004 10:12 AM L 7: DISPENSING ENABLED SAMPLES= 5 TEST ABORTED LOW REFI= 795 PENDING HIGH REFI= 5397 W I:UNLEADED PUMP OFF VALUEl=999999680 HANDLE OFF DISPENSING ENABLED TOTAL MESSAGE:271088 DISPENSING CR0:2064 PARITY:9 L 8: DISPENSING SAMPLES= 5 PUMP ON 0.10 GPH: IDLE LOW REF1= 795 HANDLE ON HIGH REFi= 5398 TOTAL MESSAGE:793758 3,0 GPH VALUEl=999999680 0R0:28153 PARITY:59 P1:21.542 P2:21.890 PSI 0,10 GPH: IDLE 0,20 GPH P1:40,880 P2:40.070 PSI 3.0 GPH P1:21.066 P2:20.952 PSI MID TEST Pl: 0.000 P2:0,000 PSI 0.20 GPH P1:33.890 P2:33.566 PSI MID TEST P1:20.306 P2:19.994 PSI : GROUNDTEMP DIAGNOSTIC g 1: SAMPLES= 50 LOW REFI= 793 HIGH REFI= 5396 VALUEl=999998400 LIQUID DIAGNOSTIC L I:ANNULAR 87 SAHPLES= 50 SAMPLES= 5 LOt.~ REFi= 793 kO{~J REFI= 793 HIGH REFI= 5395 HIGH REFI= 5405 VALUEl=999998400 VALUEI= 100079 ¥ 3: SAMPLES= BO LOW REFI= 793 ALARM HISTORY REPORT ALARM HISTORY REPORT HIGH REFI= 5395 i i ..... SENSOR ALARM VALUE1=999998400 i IN-TANK ALARM , ~ 1: i ! OTHER SENSORS g 4: ~ SAMPLES= 50 OVERFILL ALARM LOW REF1= ?9:3 JAN 22, 2004 :3:5@ AM HIGH REF1= 5399 DEC 16, 2005 5:59 AM VALUEl=999998400 SEP 21, 2003 10:49 PM INVALID FUEL LEVEL OCT 26, 2005 9:~2 PM OCT 11, 280:3 6:~1 AM SEP 29, 2005 5:21 PM CIRCLE K 8605 5600 AUBURN BAKERSF I ELD CA. 93:306 661-871-7979 ' ALARM HISTORY REPORT FEB 16, 2004 10:12 AM - .... SENSOR ALARM LEAK TEST REPORT W I:UNLEADED CONTINUOUS PUMP ALM T I:UNLEADED DEC 13, 2005 8:50 PM PROBE SERIAL NUM 247816 'CONTINUOUS PUMP ALM OCT 24, 2003 2:08 AM NO TEST DATA AVAILABLE WPLLD SHUTDOWN ALM ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ MAY 6, 200S 1:57 PM ALARM HISTORY REPORT ..... SENSOR ALARM L 1 :ANNULAR 87 ANNULAR SPACE SENSOR OUT ALARM FEB 19, 2003 1:11 PM FUEL ALARM FEB 19, 200~ 1:07 PM ALARM HISTORY REPORT SETUP DATA WARNING NOV 26, 2002 S:05 PM ..... SYSTEM ALARM PAPER OUT JAN 12, 2004 4:58 AM PRINTER ERROR JAN 14, 2004 4:43 AM BATTERY IS OFF ' - JAN 1, 1~96 8:00 AM ALARM HISTORY REPORT ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ I N-TANK ALARM ..... T 2 :PLUS INVALID FUEL LEVEL OCT 3. 2003 8:29 PM END ~ ~ ~ ~ ~ ALARM HISTORY REPORT ~! ~ SENSOR ALARM :i ALARM HISTORY REPORT ~ L 1 :ANNULAR 87 ANNULAR SPACE :: ..... SENSOR ALARM SENSOR OUT ALARM ' W I:UNLEADED FEB 19, 2003 l:ll PM CONTINUOUS PUMP ALM DEC 13, 200J 8:50 PM FUEL ALARM FEB 19. 200~ 1:07 PM CONTINUOUS PUMP ALM OCT 24, 2003 2:08 AM SETUP DATA WARNING NOV 26, 2002 ~:05 PM WPLLD SHUTDOWN ALM MAY 6, 200:3 1:57 PM ALARM HISTORY REPORT ..... SENSOR ALARM ..... L I:ANNULAR 87 ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ANNULAR SPACE .: SENSOR OUT ALARM FEB 19, 2003 1:11 PM FUEL RLRRM FEB 19, 2003 l:O? PM SETUP DRTR WRRNI NG NOV 26, 2002 3:05 PM RLRRM HISTORY REPORT ..... SENSOR RLRRM ..... ~ l: ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALARM HISTORY REPORT IN-TANK ALARM ..... T 3:PREMIUM INVALID FUEL LEVEL AU(] 3. 2003 10:57 AM ALARM HISTORY REPORT SENSOR ALARM ..... OTHER SENSORS ALARM HISTORY REPORT ..... SENSOR ALARM W 1:UNLEADED ' CONTINUOUS PUMP ALM ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ DEC 13, 2003 8:50 PM CONTINUOUS PUMP ALM OCT 24, 2003 2:08 AP1 ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ WPLLD SHUTDOWN ALM MAY 6. 2003 1:57 PM SENSOR ALARM L 6:91 STP SUMP STP SUMP FUEL ALARM ~ * ~ ~ * END ~ ~ ~ ~ ~ FEB 16, 2004 11:17 AH SENSOR ALARM L I:ANNULAR B? ANNULAR SPACE FUEL ALARM FEB 16, 2004 10:55 AM CIRCLE K 8605 5600 AUBURN CIRCLE K 8605 BAKERSFIELD Ca.93306 5600 AUBURN 661-871-7979 BAKERSFIELD CA.93306 661-871-7979 FEB 16, 2004 11:30 AM FEB 16, 2004 i0:13 AM ..... SENSOR ALARM LEAK TEST REPORT L g:89 ANNULAR ANNULAR SPACE SYSTEM STATUS REPORT T 2;PLUS FUEL ALARM PROBE SERIAL NUM 249266 FEB 16, 2004 10:57 AM ALL FUNCTIONS NORMAL NO TEST DATA AVAILABLE ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ; ..... SENSOR ALARM ..... WPLLD LINE LEAK ALARM L 5:91 ANNULAR W 2:PREMIUM ANNULAR SPACE GROSS LINE FAIL FUEL ALARM FEB !6. 2004 11:36 AM ~EB 16, 2004 10:59 AM CIRCLE K 8605 5600 AUBURN BAKERSFIELD CA.93J06 661-871-7979 FEB 16, 2004 10:13 AM WPLLD LINE LEAK ALARM ..... SENSOR ALARM ...... g 2:PREMIUM WPLLD SHUTDOWN ALM L 2:UNLEADED SUMP FEB 16, 2004 11:36 AM SYSTEM STATUS REPORT STP SUMP FUEL ALARM ALL FUNCTIONS NORMAL FEB 16, 2004 i1;07 AM WPLLD LINE LEAK ALARM W I:UNLEADED (',~noo LINE FAIL CIRCLE K 8605 ..... SENSOR ALARM ...... FEB 16.. 2004 11:42 AM 5600 AUBURN L 4:89 STP SUMP BAKERSFIELD CA. 93306 STP SUMP 661-871-7979 FUEL ALARM FEB 16, 2004 11:13 AM FEB 16, 2004 lO:lO AM LEAK TEST REPORT T 3:PREMIUM PROBE SERIAL NUM 249264 NO TEST DATA AVAILABLE ..... SENSOR ALA .... glPLLD LINE LEAK L 4:89 STP SUMP gl I:UNLEADED - STP SUMP glPLLD SHUTDOgllq ALM ! SENSOR OUT ALARM FEB 16, 2004 11:42 AM i FEB 16, 2004 12:27 PM I glPLLD LINE LEAK ALARM ..... SENSOR ALARM ..... gl ~3:PLUS L 5:91 ANNULAR (-;ROSS LINE FAIL ANNULAR SPACE FEB 16, 2004 11:52 AM SENSOR OUT ALARM FEB 16, 2004 12:27 PM glPLLD L I NE LEAl,'. ALARM W 3:PLUS ..... SENSOR ALARM WPLLD SHUTDOWN ALM - FEB 16 2004 11:52 AM L 6:91 STP SUMP ' STP SUMP SENSOR OUT gLgRM " FEB 16, 2004 12:27"PM CIRCLE K 8605 5600 AUBURN BAKERSFIELD CA.gSs06 ..... SENSOR ALARM ..... 661-871-7979 L 1 :ANNULAR 87 FEB 16, 2004 12:02 PM ANNULAR SPACE SENSOR OUT ALARM FEB 16, 2004 12:27 PM SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL ..... SENSOR ALARM ..... L 2:UNLEADED SUMP ........... - .... STP SUMP SENSOR OUT ALARM ..... SENSOR ALARM ...... FEB 16.. 2004 12:27 PM L S:89 ANNULAR ANNULAR SPACE SENSOR OUT ALARM FEB 16, 2004 12:27 PM PERMIT APPLICATION T~ONsTRucT/MODIFY O Bnk:ezs"e]d Fire Dept. UNDERGROUND STORAGE TANK ]~n~rironmentn] 8e~rice 1715 Chester Ave "-'"°'I B ersfield,CA93301 '~ Tel: (661)326-3979 ~ OF ~U~TlO~ (CHECK) ~ NEW FACILI~ ~MODIFIGATION OF FACILI~ ~ NEW TANK INSTAL~TION AT EXISTING FACILI~ ~ · ST~ ~ ~P CODE ~m I Cl~; ~ _ ~P C~E P~ NO. ~S~ ~ B~N~ L~EN~ NO. WOrN ~P NO. [ BRiErY DESC~BE ~E ~ TO BE D~ TO ~L ~E ~ AT S~ GROUND WATER ToNO'[OFIN~LDTANK~ ,~ ~ ~EY~ Y~F~ ~T~ NO ~ 8RLL P~N~N ~TR~ Y~D C~N~R~ NO M~U~8 P~ ~ RLE m~s sE~ION ~s Foa aoto~ FUEL T~K NO. V~U~ UNL~ ~GU~ P~MIUM DIE[L A~AT~ / gooo 64. rem, THIs SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO (IF KNOVVN) cHEMICAE P_R. EVIOUSLY STORED FOR OFFICIAL USE ONLY The applicant has received, understands, and will comply with the attached conditions of the. permit and any/~othe state, local and federal regulations. This form has been completed under penalty-of perju~d.~an_~d to ~ ~ of my knowledge, is true and correct. ~ AI~SROVED BY: .... APPLICANT 0° ) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED CALIFORNIA ANNOTATED SITE MAP BUSINESS NAME CIRCLE K STORE #2708605 DATE 03/15/01 DRA~NG SCALE BUSINESS ADDRESS 5600 AUBURN STREET BAKERSFIELD ZIP CODE 95506 1"=50'-0"~ ~ A B C D E F m H MAP SYMBOLS VACANT LOT ~ ELECTRONIC MONITORING POINTS ~ ELECmlCALsHuT_OFF PANEL SHUT-OFF I [ ~A TANK MONITORING ~ ~ ALARM ~ FIRST AID KIT 2 ~ FIRE EX~NGUISHER 0 ~ STORM DRAIN ~ ~ ~ SANITARY SE~R 0 EVACUA~ON/ ~ CASHIER PANE HMMP HMMP, AND MSDS ~ ~ x x FENCE Z / EQUIPMENT/ABSORBENTS ~ ~--~1 UNDERGROUND (FLAMMABLE LIQUIDS) (COMBUS~BLE LIQUIDS) ~. ~ MOTOR OILS ~ LUBRICANT (COMPRESSED GAS) PROPANE (FLAMMABLE LIQUID) ~-- x.~' ~ ~ ANTIFREEZE/COOLANTS (FLAMMABLE LIQUID) AUBURN STRE~ WAYNE PERRY, INC. Environmental Remediation, Construction and Consulting June 21,2004 Dear Inspector Steve Underwood, Below is a scope of work for 5600 Auburn Street in Bakersfield. While conducting the SB989 Secondary Containment Testing at the above-mentioned site, we had failures on both of the dispenser pans. We will be removing the two UDC's and installing new ones. All the penetrations on electrical, vapor and product piping will be replaced with new state approved products. A lake test will be performed on both pans after the installation is complete, but not before concrete is poured. A precision line test will be performed on the product piping and all air quality tests will be performed after the dispensers are installed. You will be contacted for a primary and secondary pressure test on the lines before any backfilling will occur. If you have any questions or concerns, please feel free to contact me. Thank you for your time. Jeff Funk Project Manager .,.. Wayne Perry Inc. (916) 834-5718 30 Main Avenue, Suite 5 Sacramento, California 95838 Phone (916) 646-9680 (800) 883-0352 Fax (916) 646-9683 Hazardous Materials/Hazardous WaSte Unified Permit ~ CONDITIONS OF PERMIT ON REVERSE SIDE i.~~. ~ This oermit Is Issued for the followinn: i ~;~~_'.',,::;~,~)% , [] HazardoUs- Materials Plan Permit ID #:: 015-000.01297 ~!i(g ~%~. LOCATION: 5600 AUBURN ST 2 ~,,,¢,: '}})~_., BAKERSFIELD "'~ !'C~"- ;'. ,~;.~,....,. ¥ ;. ,z... . ' : TANK HA/-.AHDOU$ SI~IBSTAN I N G'~' 015-000-001297-0001 UNLEADED PLusiGAS~LIN' ..~?:'i !~~ ~!~).~ 015-000-001297-0002 MIDGRADE UNLEADED GASOLINE:7.~i. .015-000-001297-0003 REGULAR UNLEADED,GASOLINE ' '. 'i ?~i~'~'~.~, ~FLOAT MECHi"SHUTS di~F SHEAR VALi "' '"" '" ,. :;?~,,,. : ...... ,.' '".-.:' ;7 ?,:' .~ '.'-~ '~ ~ .... r?~'~,...,,~z,,~.,~,~ ~,,... ~..~;'~" .. . . ,,..~' ;,,~ < ".. .., ....>, .~¥,,.::~:..~,. ~.; ~-. - '".s ~.~,. '; ~- " .~;~. .? l,"',""J · ~ ,~'~ ..,, ~ . ~ .,'., . ~... ,, ~r~ .... , .. ,.~,., ... ,,, /... ~'~, ' . ". '.'~4 "3 .' ,. ~ I-.~" ~ -' ~ '. '%.- %:.~ .~,.. ,.,~ .~ ~ .... ~,.~,. · .: .> ~, . .::,.,...,.:~ . Issued by: Bakersfield Firi Department ~ OFFICEOFENI~RONMENTALSERVICES' ~ 171, Chester Ave., 3rd Floor~, Approved by: Bakersfield, CA 93301 Voice (661) 326-3979 . FAX (661) 326-0576 Expiration Date: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ....... ~¢~?~.~,~?~??.~,~.= This permit is issued for the following: .~<~'~??7/'/~;~:~d;~;Z;:~;~;;;'d~:;~:;:;-:~Ha~rdous Materials Plan ' .~,~"~' :~, :~.:d~,~;L ~¢~, g;~$, ~g~" g~}}~ground Storage of H~rdous Materials ~ ~ '~ ~ ? ~ ':~ '~hl.~ '~C~.:="-':'~ '::~; -,~ 'r".~'~, ~.~.. ?~='"".~;:;~::h,d='~ ~:~__.._~ ....... ~:~::"~;:'.'".......::~ pE~ ~ ~ 015 -021-001297 ~.',, ~..~',~g ,.,.. ~,/ ..... .:'? ' ~.~,.: ........... ~. CIRCLE K STO~S ~.,~ ....~ ~ ~ "-] ~ -..... =n~ . ~,~,........'~ ~ ~ .~ ~.:~ . .-~ LOCA~ON 5600 ~.~... :..~ ~-.......-..~ ~-" "~ '~,, ~i~i}~ ~'"~v~::~~ ~' ,,~ ~." :' ~ ~c'~ ~:.' .. T ~ ~' T~K H~OUS S~T~CE C~AC~ ~;G~ ~i~.:: T~ ~K /¢¢ ~)=.~ PIPING PIPING PIP~G Unl~ Plus Gmoline 0~::::.~ ~G~, :~ ~.:"~..~/88 DW ~.C~F..:~,?· /, :.A~G D~ P~SS~ ~D ~02 Unlcad~ Gmolinc '0003 Premium Unl~d~ G~oline 10,000 ~.._ .......... **::,:,}!88 ~,~[~=~. ~,~, ~[ ~ ,,~ .~ ~ ~' ATG D~ P~SS~ ALD I~ by: B~emfield Fke D~ment' Approv~ by: O~CE OFE~O~L 1715 Chewer Ave., 3r~ Floor B~emfiel~ CA 9~01 Voice (805) ~979 F~ (805)326~576 Expiration Date: June 30~ 2000 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: CIRCLE K STORES INC #8605 Permit #015-021-001297 5600 Auburn St 2 Bakersfield, California 93306 March 10, 2004 Teri Nicholson Circle K Stores #8605 5600 Auburn Bakersfield, CA 93306 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE F~RE CHIEF RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at the Above ~,o,~ ~,:.z~ Stated Address. ADMINISTRATIVE SERVICES Dear Business Owner: 2101 "H' Streel Bakersfield, CA 93301 VOICE (661) 326-3941 Our records indicate that your annual maintenance certification on your leak detection FAX (661) 395-1349 system will be past due on 02-19-04. SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 You are currently in violation of Section 2641(J) of the California Code of Regulations.- FAX (661) 395-1349 "Equipment and devices used to monitor underground storage tanks shall be installed, PREVENTION SERVICES FIRE SAFETY SERVICES. ENVIRONMENTAL SERVICES calibrated, operated and maintained in accordance with manufacturer's instructions, 1715 ChesterAve. including routine maintenance and service checks at least once per calendar year for Bakersfield, CA 93301 VOICE (661) 326-3979 operability and running condition." FAX (661)326-0576 You are hereby notified that you have thirty (30) days, April 10, 2003 to either perform or PUBLIC EDUCATION 1716 ChesterAve. submit your annual certification to this office. Failure to comply will result in revocation of Bakersfield, CA 93301 your permit to operate your underground storage system. VOICE (661) 326-3696 FAX (661) 326-0576 Should you have any questions, please feel free to contact me at 661-326-3190. FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 olncerety, VOICE (661) 326-3951 FAX (661) 326-0576 Ralph Huey TRAINING DIVISION Director of Prevention Services 5642 Victor Ave. Bakersfield, CA 93308 By~ VOICE (661) 399-4697 FAX (661) 399-5763 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db 11~.' :~,~. UN :D PROGRAM CONSOLIDATED F TANKS UNDERGROUND STORAGE TANKS - FACILITY (one page per site) Page __ of __ TYPE OF ACTION ~]1. NEW SITE PERMIT El3. RENEWAL PERMIT []5. CHANGE OF INFORMATION (Specify change - [~7. PERMANENTLY CLOSED SITE (Check one item on/y) El4. AMENDED PERMIT loc, a~ use only) [--~8, TANK REMOVED 400 ~]6. TEMPORARY SITE CLOSURE .; . ' .~ L FACILI'I;Y ! SlTEINFORMATION . ,, BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 ' FACILITY ID # ~ ' }i~ , · 1 Circle K Stores Inc. #2708605 · ~!,!i~ BUSINESS SITE ADDRESS 401 FACILITY OWNER TYPE [] 4. LOCAL AGENCY/DISTRICT* La~21.' CORPORATION [] 5. COUNTY AGENCY* 5600 AUBURN ST INDIVIDUAL [] 6. STATE AGENCY* BUSINESS TYPE [] 1, GAS STATION [] 3, FARM [] 5, COMMERCIAL [] 3. PARTNERSHIP [] 7. FEDERAL AGENCY* 402 El2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER 403 TOTAL NUMBER OF TANKS Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of REMAINING AT SITE I trusUands? division, section or office which operates the UST, (This is the contact person for the tank records,) 3 404 I [] Yes [] No405 406 ,' ' ':i": :' fl' pROpERTY oWNER INFORMATION PROPERTY OWNER NAME 407 I PHONE ' 408 RUPERT, JAMES E. I (510) 245-5219 MAILING OR STREET ADDRESS 409 13104 SAN JUAN AVE CITY 410 I STATE 411 IZIP CODE 412 BAKERSFIELD } CA I93312 PROPERTY OWNER TYPE [] 2. INDIVIDUAL [] 4. LOCAL AGENCY/DISTRICT [] 6.' STATE AGENCY 413 [] 1. CORPORATION [] 3, PARTNERSHIP [] 5. COUNTY AGENCY [] 7~ FEDERAL AGENCY ' '"': ' ~ANK OWNER INFORMATION ' !: ' -,- , .' ', - III, , : ~,. TANK OWNER NAME 414 PHONE 415 Circle K Stores Inc. (909) 270-5193 MAILING OR STREET ADDRESS 416 495 East Rincon Ste 150 CITY 417 ~ STATE 418 IZIP CODE 419 Corona I CA 192879 TANK OWNER TYPE [] 2. INDIVIDUAL [] 4. LOCAL AGENCY/DISTRICT [] 6. STATE AGENCY 420 [] 1. CORPORATION [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY 4 4' - ~ ............. ' 3 II i 421 INDICATE METHoD(S). [] 1. SELF-INSURED [] 4. ~U~::r~'-~ ..... ; -: .... :---r~ =~-~'I:A~I~-F~-N-~; -- i .![7't i0: LOCAL GOV:T MECHANISM [] 2. GUARANTEE [] 5. LE'I-rEROF CREDIT [] 8. STATE FUND &CFO LETTER [] 99. OTHER: [] 3. INSURANCE [] 6. EXEMPTION [] 9. STATE FUND & CD 422 · VI_ I' ~=~_&_/ IdnTIl=l~&TIt'tM AidI't MAll Ild~.' Ann=r=_~ ':' ' ' Check one box to indicate Which address should be Used for legal notifications and mailing. [] I. FACILITY [] 2. PROPERTY OWNER ' [] 3. TANK oWNER :423 Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked· Certification: I certify that the information provided he~:ein is true and accuraie to the best of my knowledge. SIGNATURE OF APPLICANT ~ DATE [ {~ 0 q 424 PHONE(909) 270-51 93 425 NAME OF APPLICANT (pri,~) TITLE OF APPLICANT 426 Michelle Wilson West Coast Environmental Compliance Manager STATE UST FACILITY NUMBER rpor local use only) 427 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 428 UPCF (1/99 revised) 5 Formerly SWRCB Form FACILITY INFORMATION BUSINESS ACTIVITIES Page 1 of_ I. FACILITY IDENTIFICATION FACILITY ID # [ I III'!I ' { I {i'i 'i'l I I [ { 1 EPA ID # (Hazard°us Waste Only) BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) 3 Circle K Stores Inc. #2708605 / / 08605 II. ACTIVITIES DECLARATION NOTE: If you cheek YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730). Does your facility... If Yes, please complete these pages of the UPCF .... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases HAZARDOUS MATERIALS INVENTORY - (include liquids in ASTs and USTs); or the applicable Federal threshold [] YES [] NO 4 CHEMICAL DESCRIPTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355,- (This is repoerted with the HMMP.) Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Parts 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (USTs) UST FACILITY (Forn~ly SW~.CB Form ^) 1. Own or operate underground storage tanks? [] YES [] NO 5 UST TANK (one page per tank) (Formerly Form B) 2. Intend to upgrade existing or install new USTs? [] YES [] NO 6 UST FACILITY UST TANK (one per tank) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (one page per tank) (Formerly Form C) 3. Need to report closing a UST? [] YES [] NO 7 UST TANK (closure portion-one page per tank) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or [] YES [] NO 8 NO FORM REQUIRED TO CUPAs ---the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTE 1. Generate hazardous waste? [] YES [] NO 9 EPA ID NUMBER - provide at the top of this page 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT (one recyclable materials (per HSC 25143.2)? [] YES [] NO 10 perrecy¢ler) ONSITE HAZARDOUS WASTE 3. Treat hazardous waste on site? [] YES '[5~ NO 11 TREATMENT - FACILITY fformerly DTSC forms 1772) ON$ITE HAZARDOUS ~VASTE TREATMENT - UNIT (one pagc per tmit) (Formerly DTSC Forms 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (f°r CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? [] YES [] NO 12 ASSURANCE (Formerly DTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION SITE [] YES [] NO 13 ANNUAL NOTIFICATION (FormerlyDTSC Form 1196) 6. Need to report the closure/removal of a tank that was classified as [] YES [] NO 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) E. LOCAL REQUIREMENTS 15 (You may also be required ~ provide additional information by your CUPA or local agency.) UPCF (1/99) FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page __ of__ I. IDENTIFICATION FACILITY ID# I t:5f~ [iii iI [ 1 BEGINNING DATE 10o I ENDINODATE 10, BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 { BUSINESS PHONE 102 Circle K Stores Inc. #2708605 / / 08605 { (661), 871-7979 BUSINESS SITE ADDRESS 103 5600 AUBURN ST CITY " Io4 ca ZIP CODE lo5 BAKERSFIELD 93306 DUN & BRADSTREET 1o6 SIC CODE (4 digit #) lo7 15-156-7054 5541 COUNTY log BUSINESS OPERATOR NAME 1o9 I BUSINESS OPERATOR PHONE ilo Comvanv Overated (661) 871-7979 II. BUSINESS OWNER OWNER NAME ill [ OWNER PHONE H2 Circle K Stores Inc. [ (909) 270-5193 OWNER MAILING ADDRESS 113 13104 SAN JUAN AVE CITY 114 [ STATE 115 '{ ZIPCODE 116 BAKERSFIELD { CA { 93312 III. ENVIRONMENTAL CONTACT CONTACT NAME il7 [ CONTACT PHONE il8 Michelle Wilson - (ConocoPhillivs Comvanv) I (909) 270-5193 CONTACT MAILING ADDRESS il9 495 East Rincon Ste 150 CITY ,20 [ STATE 121 [ZIP CODE 122 Corona [ CA [ 92879 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME ~28 Comvan¥ O~erated TITLE 124 TITLE 129 O.l~rator BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 871-7979 24-HOUR PHONE 126 24-HOUR PHONE 131 866-805-4357 PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information ~ubmitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNE~~ATED REPRESENTATIVE D~T1 ~I,~.~ ~ I NAME OF DOCUMENT PREPARER NAME OF SIGNER (printy 136 TITLE'OF SI~NER 137 Michelle Wilson West Coast Environmental Compliance Manager UPCF (1/99 revised) OES FORM 2730 (1/99) 495 East Rincon Ste 150 Corona, CA 92879 January 16, 2004 Bakersfield - City 1715 Chester Ave, 3rd FI Bakersfield, CA 93301 ATTN: UST Compliance Department RE: Circle K Stores Inc. Certificate of Financial Responsibility Attached is the Certificate of Insurance for Circle K Stores Inc., effective December 17, 2003 through December 17, 2004. Please call me at (909) 270-5193 if you have questions. Sincerely, Michelle L. Wilson West Coast Environmental Compliance Manager attachment CERTIFICATE OF INSURANCE NAME: SEE ATTACHED SCHEDULE ADDRESS: SEE ATTACHED SCHEDULE POLICY NUMBER: ST8089599 ENDORSEMENT: Not applicable PERIOD OF COVERAGE: December 17, 2003 to December 17, 2004 NAME OF INSURER: AMERICAN INTERNATIONAL SPECIALTY LINES INSURANCE COMPANY ADDRESS OF INSURER: 70 PINE STREET NEW YORK, NY 10270 NAME OF INSURED: Circle K Stores, Inc. ADDRESS OF INSURED: 1500 N. Priest Dr. Tempe, AZ 85281 CERTIFICATION: 1. American International Specialty Lines Insurance Company, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s): TAN K# CAPACITY INSTALL LOC. # ADDRESS UST/AST GALLONS DATE SEE ATTACHED SCHEDULE For taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases, in accordance with and subject to the limits of liability, exclusions, conditions and other terms of the policy arising from operating the underground storage tank(s) identified above. The limits of liability are $1,000,000 each occurrence and $2,000,000 annual aggregate exclusive of legal defense costs which are subject to a separate limit under the policy. This coverage is provided under ST8089599. The effective date of said policy is December 17, 2003. 2. The insurer further certifies the following with respect to the insurance described in Paragraph 1: ? a. Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policy to which this certificate applies. b. The Insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or damaged third party with a right of reimbursement by the insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. c. Whenever requested by a Director of an implementing agency, the Insurer agrees to furnish to the Director a signed duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the Insurer, except for non- payment of premium or misrepresentation by the insured, will be effective only upon written notice and only after the expiration of sixty (60) days after a copy of such written notice is received by the insured. Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration of a minimum of ten (10) days after a copy of such written notice is received by the insured. e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits of liability and exclusions of the policy. I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97 (b) (2) and that the Insurer is eligible to provide insurance as an excess or surplus lines insurer in one or more states. Signature of Authorized Representative of Insurer Scott Smith Regional Manager Authorized Representative of American International Specialty Lines Insurance Company 1375 E. 9th Street, Cleveland, OH 44114 K Stores Inc. - Certificate of Insurance Site Listi~ 12700010 :302 E TEHACHAPI 8LVD -TEHACHAPI CA .KERN 02 iU 149761 !2700337 :10597 JURUPA RD MIRA LOMA 'CA ;R'iVER$1DE ' i~1 ..... !U; ........... 11849i i~7~(~33~ ' 1059~ jUi~JP~ Rc~ ........ 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[~ ........................ i~i~' [oi§"~i~i§'~'"'i'~'i ............................................................................... {2701205 {16470 CAMBRIDGE ~--~THROP iCA ------~AN JOAQUIN ~ 1-'~-~ [~'~-i'~-~ ................... ~-'~'i~'-.fi'i~'x~ ............................... i~×~ .................. ]~'x ......................... j~:~'~'~i~ ............... i'~ ................................... ~i'Fi"> ...................... i ~'~)'~"i~i6"¥i;~i~ ~"X~;i~ .............................. i'§~'~¥6 .................. }~:~' ....................... j'§;~'~'i~'-i:6 .............. ~:i' .......................................................................... .i':,i'~f~ ~ i lr~ O"6-~-~ ~OMPOC !CA ~SANTA BARBAI:~ ~ 1184.~ {2701215 i1421 OCEAN !~_~'M---~-C" {CA iSANTA BARBARA i02 1184~. i~;~;~"i'~;~'~; ..................... i';;,~'~':i'"i~C~'ii~"i~'£ ......................... ij~¥~§'~i~i~ ...................... !~'~'"'""~'""_~'"'"~i~fi[0'i'~-~i~'i~""i'~'i .......... !0 .............................................................................. 1497~ [2701270 15634 STINE RD iBAKERSFIELD ICA IKERN 101 U 1497_6l 2701270 5634 STINE RD iBAKERSF ELD [CA KERN t02 -0 .......... ~'~'~'~ ...................... ~':~'~"~"~×'~"~ ................................................. ~¥~'~'~ ................ ~x ........................ i~'~'~'~'x~: ...................... i'~ .......... o ........................................ ~':~-~ ...................... i':i'~'i~"~'Xi'i;i"§¥ ................................................... ~i~§~i~'~'i~ ................ ]'~;~ ...................... ti'i~i~A'i;~'i" ......................... t~'~ .......... ~i' 'Ii'I "~ 'i' I "I'-~'~ · ~------ F, .......... i ~' .... ~ ~ ?23 E MAIN ST iWESTMORLAND iCA lIMPER AL 103 U i 96.8_4.~ }~701527 i685 PARKER RD iFAIRFIELD iCA IS--dijON'-6 ....... ~'0-~--' i0' }2701775 124051 JOHN F KENNEDY DR iMORENO VALLEY iCA i~,RIVERSlDE !01 U 981~ i2701775 24051 JOHN F KENNEDY DR iMORENO VALLEY CA !RIVERSIDE 102 U 981E {2701914 i1930 LAKE BLVD iDAVIS i'~ .......................... {'~;~'i~6 .................................... i~ ......... U 7951: 12701914 '{ ~'6-~'~E~/-~ .......... ~ iC~, {YOLO ~02 ~ 2701914 1930 LAKE BLVD iDAVIS CA ~YOLO i01 U 981~ 9 9.22 ~13120 MAGNOLIA AVE iCORONA ICA ~RIVERSIDE 102 !U 98t~ Page 1 of 3 Stores Inc. - Certificate of Insurance Site Listi ~'705439 1240 N MAIN ST iSALIN~ :CA !MONTEREY" ~:02 ~0 ........... 9816! ;270~39 ~ 1240 N MAIN ST TSA'~i'~ .... ;CA ~'~'~ ~ ......... ;270~49 7647 PACIklC A~ ~Sf0CKfdN CA ~SAN JOAQUIN ~01 [U 11~9i ;~705449 :7647 PACIFICAVE .......... ~sT~ck~N ;CA " ~'~"~A~Ui~ ~ ~0 : 1 ~'~9~ '2705617 ,8600 AVIATION BLVD ~INGLEWOOD ~GA :.02 [U ~ 1202~ :27056 7 ~8600 AV AT ON BLVO qNGLEWO00 ~GA :01 ~U : 12023~ '2705659 8451 S~USON AVE P CO R VE~ ~CA LOS ANGELES 03 iU 10369 ~2705659 ~8451 S~USON AVE ~PICO RIVE~ ~ ;LOS ANGELES 02 ~U 11863 {2705670 ~.1425 E 4TH ST ONTARIO CA SAN BERNARDINO ~01 [U 12032 2705684 {27180 MCCALL BLVD ~SUN CI~ ~CA ~RIVERSIDE 01 lU ~'~ ~:,'~'~b'~ ................. ............. ~'~'~'~'~[['~'[~6 ................................................ .......................... ?~O~"~i~ Z~ ............ ........................ ~'~'i~'~i'5~ .......... ........................ ~-__~Z'"'""~'O 12023 ~ 2705684 27180 MCCALL BLVD ~SUN CI~ ~CA ~ RIVERSIDE ~03 500~ ~2705705 ~304 S MAIN ST ~CORONA ~CA RIVERSIDE ~01 151~ ~5'~b'~ ........... ~b~ ~ ~Xi~"~Y ~CORONA ~CA ~i~iS~ ...................... ~ ........... lU '57'~ ............. ~'~'~6~i~"~5 ............................................ .~ ~'~ ............... iCA ~SAN ~O [0~ ................................................................ ~2705708 {98 BONITA RD ~CHU~ VISTA iCA SAN DIEGO ~02 ' ' 15~ ~2705728 ~=4200 CHINO HILLS P~ ~CHINO HILLS ~ SAN BERNARDINO J02 '~5'~ ................... r~"E~i'~5 '~i[[-~"F~ ................... ~E~i~'6"~'i'[[~ .......................... jb-~ ..................... ~'~"~ [~5i~5"~'~ ~ ............ ~ 203~ . _ 2705731 H501 E MAIN ST jBARSTOW ~CA __[~N BERNARDINO ~01 15~ ~2705731 H501 E MAIN ST JBARSTOW iCA SAN BERNARDINO ~02 1515a 2705733 J998 SUNRISE BLVD ROS~ILLE iCA ~P~CER 02 151~ ~27057~ ~981 F~NCISCO BLVD [SAN ~FAEL ~CA ~MARIN ~01 1005E ~27057~ ~981 F~NCISCO BLVD ~ SAN ~FAEL ~CA ~MARIN ~02 1005E ~2705786 ~5793 ALTON PK~ ~IRVINE ~CA ~O~NGE ~01 ~U 1497( 2705786 ~5793 ALTON P~ IRVINE ~ ~O~NGE ~02 1497~ ~2705802 ~16900 FOOTHILL BLVD ~FONTANA ~CA ~SAN 8ERNARDINO ~01 11783 ;2705802 16900 FOOTHILL BLVD ~ FONTANA ~CA ~SAN 8ERNARDINO ~ 02 1178~ '5'~b'~'~ ~ .............. ~'~'"~"~'"~'~"~ ...................................... [G"6O'i~'~ ............................... T~X' ..................... ~'i~i-5[ ......................... ~ ......................................................................... ~'~'~'~ [2705911 {783~ US H~ 111 ~ QUINTA ~CA ~RIVERSlDE ~03 14976 2705911 ~783~ US H~ 111 ~ QUINTA iCA _~IVERSlD~ ..... ~01 1497E 2708~5 1161 E VALLEY P~ jESCONDI~ iCA {~N DIEGO 01 . 981E 12708~5 j1~6~ ~LLEY P~ ~ESCONDI~ ~CA iSAN DIEGO [03 ......................................... ~'~"~ ~7708605 _ . ~5600 AUBURN ST ...... ~BAKERSFIEED-- ~CA ~KERN ~03 9816 12Z08605 ~_--~5600.AUBURN.S~ ~ {BAKERSFIELD · [CA [KERN ~01 [~ ...................~'~"~'~ ..................................... jBAKERSFIELD ~'~ ........................ ~'~'~'~. ...................................... ~ ........ ,~ ...................................................................... 9816 ~ ~1030 OAK ST .[BAKERSFIELD ~[ ~KERN ~01 U 9816 ~270~6 {1030 OAK ST iBAKERSF ELD ~CA ~KERN ~03 U 9816 ~2708~1 ~295 N WATER~N AVE ~SAN BER~RDINO ~CA {SAN BERNARDINO {02 ~270~I ~295 N WATER~N AVE SAN BERNARDINO ~ .{SAN BERNARDINO ~01 ~U 9816 ~2~8~ ....... ~295 N WATERMAN AVE ~SAN BERNARDINO iCA ~SAN BERNARDINO ~03 ~U 9816 ~2708~4 ~11724 AIRBASE RD ~ADE~NTO ~CA ~SAN BERNARDINO ~02 ~ 9816 2708644 ~11724 AIRBASE RD ~ADE~NTO ~CA ~SAN BERNARDINO ~03 U 981E 2708688 ~10520 CAMINO RUIZ j~N DIEGO ?CA ~AN DIEGO ~03 U ~ 9816 2708688 {10520 ~MINO RUIZ SAN DIEGO ~CA ~N DIEGO ~02 U ~ 9816 ~ 247 E OL VE AVE FRESNO .~CA ~ FRESNO ~02 U 9816 27087~ ~247 E OLIVE AVE ~FRESNO ~CA ~FRESNO ~03 U 9816 2708735 .~2097 MENTONE BLVD ~MENTONE ~CA ~SAN BERNARDINO ~01 ~_ ~ 9816 2708755 ~27~ WHITSON RD ~SELMA ~CA ~FRESNO ~01 U .~ 9816 2708825 i~22 F ST IBAKERSFIELD ~CA ~KERN ~01 2708825 ~2222 F ST ~BAKERSFIELD ~CA ~KERN ~03 U 2708~3 ~1~0 CARPENTER RD ~MODESTO ~CA .~STANIS~US ~2 U ~ 98'~ Page 3 of 3 C~K Stores Inc. - Certificate of Insurance Site Listi~ iS?0{940 1800 W MAIN ST TURLocK ,CA ~STANISU~U'~ ' ;`2~0!984 795 SHADOW RIDGE DR VISTA 'CA ,.SAN.?IE~30 .... '03 ..jU .............. 9816: ~2701984 795 SHADOW RIDGE DR VISTA iCA ~SAN DIEGO 02 iU 9816! f:~i'~ .... 795 'SHA'~0W'Ri'~' ~ ....... ~1~:~ ....................... :CA .....SAN DIEGO 01 iU ~ 9816t ~'2702964. ....... !60 BROADWAY CHULA VISTA ' CA SAN DIEGO !01 J.L~ 9942~ i2702970 1704 MA~N ST RAMONA i~;A .....~S~I 6~6 2703608 :21998 COLORADO SAN JOAQUIN iCA FRESNO i02 U 11849I i:~'~;'"~ !'i'~' ~ 't~,~:1~'~ ~ ~ :~LOS BANDS ~CA MERGED J01 jU 968z ~705017 i2549 BLOSSOM DOS PALOS iCA MERGED ]01 JU 981~ 270501-7 i2549 BLOSSOM ;iDOS PALOS iCA iMERCED !03 U 981( !2705018 [,1021 SHAFFER RD !ATWATER iCA MERGED i01 U 981( i2705018 _~ 1021 SHAFFER RD iATWATER CA iMERCED 02 'U 981E 2705020 11598 N ORANGE REDLANDS iCA SAN BERNARDINO i02 U 981(~ 12705020 11598 N ORANGE REDLANDS iCA iSAN BERNARDINOi03 U 981E 2705020 ~598 N ORANGE !REDLANDS iCA SAN BERNARDINO i01 U 9816 i2705057 8197I ST HESPERIA iCA SAN BERNARDINO 01 U 9811~ 2705057 8197 I ST iHESPERIA !CA iSAN BERNARDINO102 981E 2705057 i8197 I ST 'HESPERIA iCA iSAN BERNARDINOi03 U 981E 2~7050~6_3- ....... .L8, .1.~90_ _M. I__S S__I O_N_ _B L~V. D GLEN AVON iCA iRIVERSIDE 102 U 981~ 2705063 i8190 MISSION BLVD GLEN AVON iCA ~RIVERSlDE [01 U 9816 12705095 i4360 GENESEE AVE SAN DIEGO iCA iSAN DIEGO i01 U 9684 !2705095 i4360 GENESEE AVE [SAN DIEGO iCA iSAN DIEGO 103 9684 '2705095 !4360 GENESEE AVE SAN DIEGO iCA !SAN DIEGO i02 ,U .............................................................. _~9~_~,8~.. 2705203 16290 MISSION __ RUBIDOUX iCA iRIVERSIDE 101 .U_ 981~ 2705214 765 W REDL~,NDS BLVD REDLANDS !CA SAN BERNARDINO 101 U 11682 [2705214 [765 W REDLANDS BLVO REDLANOS [CA SAN BERNARDINO i02 [U 11682 12705221 i8609 GARVEY AVE ,ROSEMEAD iCA iLOS ANGELES ~ ! 10316 12705230 i 16408 ORANGE i PARAMOUNT iCA iLOS ANGELES ~02 [~ 9816 ?05238 i765 W HARVARD BLVD ISANTA PAULA iCA iVENTURA i03 IU 9816 2705239 i2734 DEL ROSA SAN BERNARDINO iCA ~SAN BERNARDINO~.3~lU 11849 2705239 i2734 DEL ROSA SAN BERNARDINO CA iSAN BERNARDINO 02 JU 11849 i2705245 ~6105 CLAY iPEDLEY ICA JRIVERSlDE 103---[U i 9816 2705247 j5804 MISSION BLVD RUBIDOUX ICA !RIVERSIDE i03 _U~ ....................... =__97_.2_8. 2705247 !5804 MISSION BLVD RUBIDOUX CA [RIVERSIDE i02 U 9728 2705252 J518 W FOOTHILL RIALTO ICA JSAN BERNARDINO i02 2705423 17796 SUNRISE BLVD JClTRUS HEIGHTS iCA SACRAMENTO i01 .........2705423 i7796 SUNRISE BLVD iCITRUS HEIGHTS iCA ~iSACRAMENTO j03 _.U 11682 2705423 j7796 SUNRISE BLVD CITRUS HEIGHTS ~ iSACRAMENTO 104 U 11682 2705431 i830 E ST MARYSVILLE iCA [YUBA 03 U 9816 '~'~'~'~i .................... i~"~"~ .................................................................. ~i~'~;§~iEE'~ ........................ iCA iYUBA i01 U 9816 ~ r:-_ ~.2._Z_0_'~_~. ............. ;.~_ ?A.H.~_ ,~...H..~.R_N.,~_S_T_ ................ _~_0..N. ZE_R__E.~__ ................ .C* .................. ~.O_N,.T,~ .R.E..Y_ __ ~ ~! .......... .U.-_ ........................................... _~,~._~ 2705432 i899 HAWTHORNE ST MONTEREY CA MONTEREY 03 U 9816 ~2705439 ~1240 N MA N ST ~SAL NAS CA jMONTEREY i03 |U 9816 Page 2 of 3 CIRCLE t::[ 8605 5600 AUBURI;~ E:AF:ERSF I EI_.D C:~. 9:3306 'E, 61 -871 --',."97':-~ MAR 5. 2004 9:16 AH SYS"I'EI'"I STATUS REP':iRT AI_,L FUNCTIONS N':}RI'"iAL 1 N~,.,'E NTC:'F:Y F:E F'C:'FN' ]" 1 :IJNI. EADED ',/!3',/_,I.!HE = :3 | F_',;3 IJLLAGE =, 6E, 5:5', 90:~'.-; ULLAGE= 5G71 ]"C VOLLIME = 21 HEIGHT : 32.96 INCHES hATER VOL = 0 ,::;AL::-; ~. --I.,,.I~TEF~ ' - I]: I]O--I FICHES -' TEMP = F.,R. E, DEG 'F 2: F:'LLIE; VC. LIJME = ;3447 C LI.L~(;E = 6:369 La.O:?-.:: ULLAC;E= 5'3',37 GAL::_: TC 'v'OLLIME = :2444:21 GgLS HEIGHT = :35.0% INCHES WATEF.' VC:'L = 0 W~A'I'ER = 0. O0 I NCHE£: TEMI::' = 7:3.C-: DEG F T :3; :-:'REM 1 IJM ',,,,'OLIJHE = 3147 (]ALS ULLAC;E = 6,669 90% ULLAC;E= 5687 '::;ALS TO VC:,LLIME = 3121 GALS HEIGHT = :32.84 II'.IC:HEg W~TER VOL = 0 C;~LS I..d~TER = 0.0El I TEMP = 71.8 DEC; F CITY OF BAKERSFIEI,D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CitECKLIST 1715 Chester Ave., 3rd Floor, Bakerstield, CA 93301 Section 2: Underground Storage Tanks Program [~ Routine ~fCombined {~! Joint Agency ~l Multi-Agency ~ C~omplaint ~l Re-inspection Type of Tank Ii)faO ~' Number of Tanks Type of Monitoring ('i~L..I/V~ Type of Piping i~)lAJ ~' OPERATION C V COMMENTS Proper tank data on file Proper owner,~operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No , Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES A'd~quate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: %~/~~'_/'~.~__ x)~ ~t~. ,t~q~L%~.~, Office o n~mental Serv~res (~61} ~,..~3979 ' ~iae~s-S'ite-lk~sible Party ~ White - Env. Svcs. Pink - Business Copy ~'--CTION CHECKLIST_ ~- Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave SECTION 1 Business Plan and Inventory Program Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NA~='~ INSPECTION DATE INSPECTION TIME PHONE No. No. of Employees ADO.ESS ' oOO OOV!-- 79 ..... ___q ............ FACILITYCONTACT Business ID Number 15-021- : ~;~ .:! .:..!'/~i?!'~.i~ ;':/<'" ~i,~' ~:-~ ~ ',i''~'''- ,Section '.1 :'Business plan and InVentorY Pi. ogmm · ri Routine ,~Combined [] Joint Agency ~'! Multi-Agency [] Complaint [] Re-inspection C V (' C=Compliance '~ OPERATION COMMENTS ~, v=violation ~ ~] APPROPRIATE PERMIT ON HAND ,i~ [] BUS,NESS PLAN CONTACT INFORMATION ACCURATE J~J"' [] VISIBLE ADDRESS [~ [] CORRECT OCCUPANCY ,~ [] VERIFICATION OF INVENTORY MATERIALS ~ [] VERIFICATION OF QUANTITIES J~L [] VERIFICATION OF LOCATION ,~ [] PROPER SEGREGATION OF MATERIAL ~' [] VERIFICATION OF MSDS AVAILABILITYE ~ [] VERIFICATION OF HAT MAT TRAINING ~' [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES J~' [] EMERGENCY PROCEDURES ADEQUATE ,~ [] CONTA,.ERS PROPERL~ LA~ELED ~l~ [] HOUSEKEEPING t ~-,~.-_.~ ~d>_ ..t~3 .~__~_~__~J_ _,~-t-~ J~t ~! ............ /~ [] FIRE PROTECTION . ~ [] SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?; [] YES ~No EXPLAIN: CALL US (661) ~/ ~ Badg~oo~- ..... Inspector Party Whi - Environmental Services Yellow - Station Copy Pink - Business Copy .--~' . PAGE 81 I TR I ANGLE 02/0~/2004 15:38 81884 9-.,-. ,~ , ~= r~=v~ll~M (~1105~-~1~ P,~ CITY OF BiKEI~FIELD OFFICE OF ENVIRONM~[TAL SERVICI~ 1715 Chester Ave~ Bakersfield~, CA (~1) APPLICATION TO PERFORi~,[ ~ MONITORING CERTIFICAIION O~ N~ ........... __ :~: ........_ (" T~ _ vo~ CITY OF BAK~FIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JO~ srrE Phone No. Pe~it ~ I~STR~CTIO~S: Please call lbr an inspector onl~ ~hen e~ch 8~up of i.sp~fio~s with the same number a~ ~ady. They ~ill ~. in eonse~mive o~er beginning with number I. DO NOT ~over work tbr ~ny numbe~d ~up umil all ilems in ~hat ~up a~ signed offby th~ Pe~iuin~ Authority. Following ~hese instructions will ~duce the number of ~qui~d inspection visits ~nd the~tb~ p~vem ~sessmem of a~ditional fees. TA~KS A~D BACKFILL gackfill of T~k(s) Spa~ Test Ce~ification or M~ufactu~s Method Cathodic Protection of Tank(s) PIPING SYSTEM Piping & Raceway w/Collation Sump Co.sion Proration of Piping, Join~, Fill Electdcal Isolation of Piping From T~k(s) Cathodic Proration System-Piping Dispenser P~ SECONDARY CO~AI~ME~, OVE~ILL PROTE~ION, LEAK DETE~ION Liner Installation - T~k(~) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sen~o~, Float Vent Valve~ Product Compatible Fill Box(es) Product Line Leak Detectors) Leak Detectors) for Annual Space-D.W. lank(s) Monitoring Well(s)/Sump(s) - H20 lest Leak Detection Device(s) for Vadose/Gmundwater . FINAL Monitodng Wells, Caps & L~ks Fill Box Lock Monitoring Requirements Type Authorization tbr Fuel Drop PERMIT APPLICATION ~ CONSTRUCT/MODIFY ~ ~. Bakersfield Fire Dept.' ,,~-~UND. ERGROUND STOR~E TANK ~ ~ Environmental Semite B~ersfield, CA 93301, ~PE OF APPLICATION (CHECK) D NEW FAClLI~ ~ MODIFICATION OF FAClLI~ D NEW TANK INSTAL~TION AT EXISTING FACILI~ FACILI~ ~DRESS ~CIT~ [ ZIP ~DE TYPE OF BUSINESS ~ TANK OWNER ~ PHONE NO ~DRESS C TY ZIP CODE [ CONT~CTOR I I ~ / ~LI~NSE NO. ~HON5 ~. [ ~K5RSF~5k0 C;~ 8US~NESS UC~NS5 NO, WORKMAN ~M~ NO. ~NSURE~ BR~5~LY DSS~SE THS WORK TO 8~ WATER TO FA~LI~ PROVIDED BY / ~ ' DEP~ TO . j. J ~P/~ ~EC ED~TSWE ,/ NO. OF 'rANKS - / J ~E THEY FOR MOTOR FU~L SPILL PR~ENTtON ~NTROL AND COUNTER M~SURES PL~ ~ FILE TO ~ INSTALLED ~ ] a YES m NO a YES a NO ~IS SECTION IS FO~MOTOR FUEL TANK NO. VOLUME UNLE~ED REGUL~ PREMIUM DIESEL AVIATION / /ol~o~ /%00o THI~ SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STOP, ED (NO BRAND NAME) CAS NO (IF KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFICIAL USE ONLY J' ~'~t~N'. d~:e'.:-:,": .:'. :::.>:. ': '-:.:':::...:.::' The applicant has received, understands, and will comply with the attached conditions of the permit and any o~Te state, local and federal regulatior~. Thiv form ha~ been completed under penalty perjury, /~ to th. e/est~my knowledge, is true and correct.~ AP~VE O BY: APPLICANT NAME (PRINT) APPLICAN~GNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED~/ MAP// I CALIFORNIA ANNOTATED SITE MAP PRE.ARED"Y: BUSINESS NAME CIRCLE K STORE //2708605 DATE 03/1.5/01 BUSINESS ADDRESS 5600 AUBURN STREET BAKERSFIELD ZIP CODE 93306 DRAWING SCALE ~"= ~o'-o"_+ ': X A _ B C D E F G H MAP SYMBOLS VACANT LOT ~ ELECTRONIC MONITORIN~G POINTS GSHUT-oFFELECTRICAL PANEL 1 / / ~ SENSOR -- G NATURAL GAS ~ ANNULAR SENSOR ~ WATER SHUI-OFF ~ ~ ~ ~ ~ AUTOMATIC TANK GAUGE ~A EMERGENCYTANKSHUT-OFFMoNiiORiNGPUMP I TMA [ ~ ~ ALARM ] ~ TELEPHONE ' 0 ~ STORM DRAIN ~ ~ ~ SANITARY SE~R ~ I ~ ~ ~ I ~ ~ STA~IN~ AREA ~ I CASHIER J ~ ~PROPANE II ' ~ ~ HMMP HMMP, AND MSOS ~ ~ ~ ~ ~ ~ ~ a .s~s ~oc,~,o~ ~ ~ ~ x >< FENCE ~ ~l I ~ EUERGENCY RESPONSE Z / EQUIPMENT/ABSORBENTS ~ ~ ABO~GROUNO STORAGE TANK Z } UNDERGROUND 4 ~ ~--~ STORAGE TANK 0 J ~ GASOLINE (FLAMMABLE LIQUIDS) ~ J ~ ~ ~ DIESEL FUEL (COMBUSTIBLE LIQUIDS) MOTOR OILS · LUBRICANT~ (COMBUSTIBLE LIQUIDS) CARBON DIOXIDE (COMPRESSED GAS) (FLAMMABLE LIQUID) J ~ ANTIFREEZE/COOLANTS WASTE OIL (FLAMMABLE LIQUID) 6 j' ~ / ~ CAR WASH PRODUCTS I AUBURN S~E~ TANK AT FILL SUMP SECTION -- CONCRETE TANK SLAB SECTION__ DROP TUBE DETAIL I PHASE I EVR UPGRADE - DIRECT BURY '~~ WT_.STT_tKN ~TATZ.,5 [ Executive Order VR-102.A Exhibit 1 Figure lA OPW Phase I Vapor Recovery System Equipment List ::i.~,oihe~[?i.~ei:'.:..i.'i~i,!?:..i~i'ii:~'!.i:'.?.':i.i:"~.i.i.i'':''''':M'an,~fa~t?re~.:~.i.':~:'''~':' ':~'"'"': "::""~"':' ':~"~": '~....~? Mbd:et~: ~ Spill Containers and Figure 2E OPW/POMECO 1-2100 Series Covers ~ lC-2100 Series 1SC-21'00 Series Replacement Drain Figure 2F OPW 1DK-2100 Valve Kit Gasket Seal Adaptor Figure 2G OPW FSA-400 Rotatable Phase I Figure 2H OPW 61SALP-EVR (product) Adaptors Figure 21 61VSA~EVR (vapor) Installation Tool Figure 2J OPW 61 SA-Tool Dust Caps Figure 2K OPW 634TT.EVR (product) 1711T~EVR (vapor) Drop Tube Overfill Figure 2L OPW 61SO-EVR Series Prevention Device ~ Jack ScrewKit Figure 2M OPW 61JSK-4400-EVR Tank Bottom Figure 2N OPW 6111-1,400 (optional) Protector Tank Gauge Port Figure 20 Morrison Brothers 305XPA Series Tank Monitoring Components Cap and Ring Kit Pressure/Vacuum Figure 2P Husky Model 4885, 2-Inch Threaded Vent Valve ~ The OPW/Pomeco 511 sedes covers include the 1-2100, 1C-2100 or 1SC-2100 spill containers. 2 Ball float vent valves are not certified for installation of this system in new facilities (including those undergoing major modifications). OPW Fueling Components - Phase I Vapor Recovery System - VR-102-A ~OPW 1-2100.EVR'SERIES DIRECT BURY StiLL CONTAINMENT FOR CARB/EVR The OPWThread-On 1-2100-EVR Series SPill Containers are cerf~ed'for'installation on OF'W Phase 1 EVR Systems, All Fill Port Spilt.~irtem feafl~e a~..e~..tOK-.21~0-EYR vapor.tight drain, valve (DL=VR Mode~s}.. The Vaper return. Spill. Ce~t~i~ex (PEVR Models}feature a permanent plug In the drain pert as per ErR requirements. The 1-2100.EVR Series Thread-On Spill Containers are available in Composite or Cast Iron bases with either 5, 7:5 or 15 gallon buckets. The FSA-400 Threaded Riser Face Seal Adaptor is installed on the fill pipe.below.the.spill container to provide a.true.sealing surface for the drop tube flange on the 61SO-EVR overfill.prevenlJon valve. The 61SO-EVR series valve is installed in the base of the OPW EVR spill container with the patent pending 61:JSK Jack Sc,rev~, device. This co,nfig, umt.,ion all,o.w? li,q, uid in the ,sp~t container to be drained directly imo the drop tube thereby isolating the dram valve from the rank u.age, e~rmnat~ng a nozorK)us leak paint, in:previeus systems. EVP. Multi-Port Applications 500.EVR S~ Uu~,P~t ~ ~ 21 & 23. OF~ 1-2tO(~PEVR 5~.; ~ ~2tO0-DEVR SERIES OPW 1DK,21OO-EVR OFM/F~,-400 THREADED RISER ilILDAPTOR " . SERIES OVERFILL ~ ,~:~;:;i!!:i;.i~:.:::;.!!~i:~; PREVENTION VALVE OPW Threaded Riser Adaptor ~:ace Seal Adaptor) , ~"" An OPW FSA.400 Threaded Riser Face Seal Adaptor is required to p. rovide EVE requirements. The FSA-400 is installed on the fill pipe riser below the sp~ container to provide a true sealing surface for the drop tube flange on the 61S'O-400C-EVR overfill prevention valves. The FSA-400 is also required on tank gauging risers and optional on vapor risers and rotatable OPW 6] JSK-4400-EVR adaptors. 0PW FSA-400 JACK .~'J~EW (Pa~t Ordering Specificadons ~,.~,~ ~ · Part No. Description List Pflce 0PW FSA.400 4".FaceSmdAdapto~ ~19.00] , ;~;~,~ · 61JSK-4400-EVR (Jack Screw Device) Eart No, _l)e~.~.0. ......... ~_ _.L.~_t P_rj.~__. OPW61J.~<-4400-EVR JackScrewAssembly~CARB61SOinstallatlon / $39.95 Kit. Required on all 61SO.EVR Models No~h America Toll Free- TELEPHONE: (801)) 422-2525 · Fax: (BOO) 421-3297 · EmaJl: domestk~ales@opw-fc, com www, opw-fc, com .~'~ ,~-~co.,,~. © C, opydght 2003, OPW Fueling Components · P.O. Box 405003 · Cincinnati, OH 45240-5003 * Printed in USA + 3/03 oPW.1sc.21OO.EVR SERIES SEA BLE,COVER SPILL CONTAINERS OPW and Pomeco Spill Containment Manholes are designed to prevent spilled product from entering the soil near the fill and vapor return riser connections on underground storage tanks during normal tank filling operation, or in the event of tank ovedtli. The spill containem catch spillage to help-prevent-so~l contamlna~on and groundwater pollution. The OPW 1SC-2100-EVR Series Sealable Cover Spill Containers are designed to eliminate the problems assodated ~th water entering .grade level spi~l containers. The operation of the cover is similar to that of a 'plumbem plug." When the lever is latched down, the plates are drawn together, expanding the seal against the machined mounting ring wall. The 1SC.2100-EVR spill containers are ideal for areas with a high water table, ames subject to tropical rah and standing water, and cold regions where melting snow and road salt can enter standard spill contai~eE 'Features: · Simple "PlumbersPlug? Operation - Seal is · Product Identification Tags - Available for expanded against mounting ring wall. both the spill container cover and bucket to · Vertical Sealing Surface - Prevents gravel pasitively identify the product contained in the and debds from damaging or interfering with UST with standarfl APl symlxils. (See product the seal. I.D. tag spedrncation page for more information) · Mechlned <jeallng Surface .Ensures · Capacities. 5and 15-gallon; spedat deep watertight seal. Teflon coated stainless steel,bucket. 5-gallon thread-on model is available e. Field Replaceable.Seal - Designed for to provide addr~3ral clearance for threaded-top ~.....i: ::':.'~.... all-weather performance. 61TNG Overfill Prevention Valve installations. ~::~:...,:~ . :~.... · Black Anodized Numlnum Top Plate - · Fuel Compatibility - Designed to accommodate all fuels, including OPW 15C-2100, 15~albn to deter cover theft, methanol, ethanol and MTBE. Thread-On Spill Container · Potted Hinge Mechanism - to prevent ice and debris from hindering lever operation. ·'Highway 20 Rated (H20) - AIIOPW spill containers and manholes exceed the requirements of the Highway 20 rating. Sealable Cover Operation Dimensions C~'.'.'.'-. '~ · "'.'"-: a -..,.'-.~' '.'.' '~.'~ C..;~..,..~ .,..~..~......,.,. A ~:,.....::....~ ~:,..~ [. ~ '... i....~.:, ........ '..' .... i..; ............... 'ii ................. , opt~nst up.iq · P: ........~.. 8 · ...'-'. *.'.~ SllpOn aocl~ Tin, ad.On tSC-2~05 ~SC-2t55 ISC.2~00 tSC-21~£" tSC-2t~5 In. cm. In. cra. in. cra. in. cra. in. s ~4' ;ii'i.~?:' 2r ,::':j.~:'i!! d' ii' .:!i!!~?i.;;j:~2~/r '::.~;Ui:i!!; ~- :::.;;i:~!1:i:!.!i .~., ,SulWmct 2' t'om"O" dlmm~ ~ Cut Iro~ Bm Models. ,*0e~p ~cbt taxid. OPW 1SC Sealable Cover EVE Series Thread-On Spill Containers Lid In Open Position DEVR Models - Fill Port with Drain Valve DuratufP ]1 Base with Drain Valve Models Cast mn Base wJth Drain Valve Models Modd GaL LJter Cover lbs, kg.i r-,~ i UOdd GaL Liter Cov~ b.,kg,i ,,~. i PEVR Models - Vapor Port wf~h Plug Replace~ Parts OuratufP II Base wt~ Plu~l Models Cast Iron Base with PluQ Models Fflcs Modei GaL :I;.~ Cove' ~sc.2~5.P~~5 ::i~.. ~Jum~ 47 i2'~;:l ~5:°°1 ~SC.2~C~'EV, ~5 ?~?. A~r~m 47 !2!:il S650.0~1 ~O1874U ' C04141M Rubber In~rt $14.101 Materials: Mounttng ring: Teflon plasma coned cast iron 'q.~,~.~..~ 'i Corec cast aluminum Bellows: high-density polyethylene H~2927M AEluslment Nd Cowr seat: Iow sw~t nih'il~ Bese: OuratufPll ~ cast tron tscrooL Levee bronze Clamps: stainless steel II~-ZIOi~EVR Drain Valve Kit I ~15~0 Seals: Iow swell nltrlle OVERFILL PROTECTION OPW 1-2100-DEVR SERIFS OPW 1DK-2100-EVR O OPW 61JSK-4400-EVR PRODUCT FILL SPILL CONTAINER DRAIN VALVE (PG, 14) JACK SCREW ~ ~lh'~l~ (PG. 14) (FG. 14) OPW FSA-400 O OPW 61S0-400C-EVR THREADED RISER ADAPTOR SERIES (F'G. 51) .... ~ 61SO-4OOC-EVR · :':: .... LOWER "' North America Toll Free -TELEPHONE: (800) 422-2525 4. F~x: (800) 42.1-32~7 ~, F:mail: domeslicsale,,~opw-fc.com 'W"~ International - TEI~,PHON£: (513) 870-33'15 or (515) 870.32~ ~* Fax: (§~3) 870-3157 · www.opw-~.com A [~-~-----'~'c~,~,~ © Cop~i9ht 2003, OPW Fueiin0 Cc~oner~ ~' P.O. Box 405003 · Ctncinr~ti. OH 45240-5003 Husky PV Vent Instal~on/Maintc~n~e l~st~ctions Page I of 2 PRESSURENACUUM VENT MODEL 4620 AND 4885 INSTALLATION AND MAINTENANCE INSTRUCTIONS INSTALLATION Thc P/V Vent is designed to fit on top ora 2" vent pipe. Remove the PS Vent from the carton and visually inspect for any shipping damage. si'*,,~-e-~z- .--,~.,.:...~ Model 4620 Slip On P/V Vent c;,-T.'~~v ] .7: .... ~.... ~r~ '~ ' ~ The Model 4620 can be installed on cithex a threaded . ~~/)~.. or not threaded 2~ pipe. Hold the PR Vent upside ..{.,~:./g.~.~ ,~ . ,?~:..~r~ down end place the seal into,the vent opening. Using · ~. ,~' an Allen wrench, back the 4 set screws out ~ that Place the p/V Vent on top oftbe vent pipe and push o~ pull down on the P/V Vent to slightly compres~ the seal. Tighten the 4 set screws firmly. Periodic maintenance is recommended (see below). ~ Model 4885 Thread On P/V Vent Apply fuel resistant pipe sealant to the threada on the 2' vent stack. Screw the P/V Vent ohm the veto ~ack and tighten to a rengn of 20 to 50 ft-lb~ with a suitable wrench. DO NOT OVER-TIGHTEN. Periodic maintenance i~ recommended {see below). ~ '~.... ;,-.,;7~ · .......... MAINTENANCE Annually inspect the P/V Vent valvc for foreign objects without removing thc P/V Vent valve from the vent pipe by u.sh~g the fotlowhtg procedure: I. Remove the screws that holds the top cover on. 2. Remove any debris that might be sitting inside the lower cover. 3. Check the drain holes in the lower cover for blockage. 4. The two (2) screens should not be removed. 5. Reinstall the top cover and retainin~ screws. 6. Tishten the screws firmly. flle://C:Wly% 20Documents~Projects~JiB~Equipment%20Manual~lusky%20PV%20Vent%L2 4/25/2002 Z , ' 03/20120.03 10:20 8i88406929 TRIANGLE ' PAGE 04 :,~ ,"" . , MONITORING SYSTJ~ CF. RTIFICATION ~ ~ ~o~n _._ , _ - I ~~~~ ~, ~,. I n ~~:~~ ~~_~ I · i~ ~~/~~ ~~ in ~~/~~ ~_~ ' ! ~ ~ ~.. ~ ~ s~ ~ ~ I ~m; . ,~~ . O Di~~~s~. ~ O ~~~~s~ M~d: , ,'. --- . ~ ~ -~ :.. , - . 2883 i0:28 Bi88486929 TRIANGLE PAGE 85 c.4mtuete me. rono~ ~~ , . ,, P, al~2 of 3 ~L~t I 03/20/2003 i0.' 20 81884 9 TRIANGLE PAGE 06 F. I~?.TaakGaugiag/$IREquipmeat:. m ~ N/A H. Co~en~: 03/20/2003 ).0:20 81884 9 TRIANGLE PAGE 07 ...., ~ ~ ........................~ .~,,~ .... . ................. :::::::::::::::::::::::::::::::::::::::::::: ...:::::::::'::~,~:~ .... : ........... : ...... ~.::. [::: :~ ~ =======================::: ~ ::: :: ,::: :::::::' - :~:: .... 2:' ............ ~; ........ ,,' _ .~ ............................................ ~.. .... I] ............................................. , Insidious :; 03/20/2003 i0:20 8i88406929 TRIANGLE PAGE 08 I N-TANg 8ETIIp 8Y~TEH gETUP T 1:UNLEADED .... ~ - PRODUCt' CODE '?5 COMMUNICATION~ SETUP TAN~ DIAM~T£R : ~2.00 ....... TA~ ~ROFIL~ FULL VOL ~YSTEH UNITB 69.0 I~H ~L : U,S. ~RT S~TTING8: 46,0 INCH VOL B~T~ ~NGURGE 2~.0 INCH VOL : 1898 EN~H NON~ FOUND 8YBTEM ~TE/TI~ FOR~T MON DD VYVy HH:~;~ ~ R~-23~ S~U~ITY FLOAT SIZe: 4.0 IN. 8496 COD~ : OOO80O CIRCL~ ~ 8605 WATER WARNING ; 2.0 5600 ~UBURN HIGH ~RTER LINIT: 3,9 BA~FI~ 0~.93~06 661-871-~979 ~ OR LA~L VOL: galG O~RFILL LIMIT gO~ 8HIFT TrHE I : 6:00 ~ R8-2~2 END OF ME~E 8834 SHIFT TIME 2 : DIBBLED DISABLED HIGH P~OD~T 95X 8HIPT TI~ 8 : DIALED 9825 BSIFT TIME 4 : DIALED DELIVERY LIMIT . 490 DIBABL~ L~ PROD~T : 500 TA~ ANNU~ ~RNI~9 ~K ~R~ LIMIT: gg DISheD B~DEN L~8 LIMIT; 50 LI~ ~IODIC W~NI~8 T6N~ TILT : 3.48 DIbBLeD LINE ~NN~L ~RNINO~ ~NIFOLDED TANK8 DI~ED T~: ~NE PRI~ TO VOL~ES E~D L~K MIN PEEIODIC: : 981 T~HP COMpE~ATION V~LUE (D~ ~ ): 6~.0 L~RK MIN ANNUAL : I~W ~ICK HEIGHT O~F~T : 9~1 DI~AB~ PRECISION ~BT DURATION ~: 12 P~IODIC TEST ~YLIGHT SAVING TIME GUIOK DISABLED RNNURL T~BT FAIL ~I~TEM BEC~ITY A~M DISAB~D CODE : 000000 ~RM DI~D~D ~ARM DIBA~ ANN T~a? AVOWINg: O~F T~ TBT SIPHON B~O~ DELI~ DE~Y : ~ MIN 03/20/2003 10:20 8188406929 TRIANGLE PAGE 09 T 2;PLUS ...... P]~ODUCT CODE. : 2 T 3:PREMIIJM THERMAL C, Ok'~F :.000070 PRODUCT CODE TaNK DI~-IL:TER : 92.00 TI-~RHRL COP_FF .000700 TANK pROFiLE · ; d PTS TaNK DI~ILr~E~ 92.00 FULL VOL : 9816 TAN~ PROFILE 4 69.0 INCH VOL : 8058 PULL VOL 9816 46.0 INCH VOL ; 4992 69.0 INCH VOL 8058 23.0 INCH VOL ; 1898 46,0 INCH VOL 4992 L.EAK TNT METHOD 28.0 INCH VOL 1898 TE~T ON DATE : ALL TANK FLOAT SIZE: 4.0 IN, 8496 JaN 1, 1996 FL~XqT SIZE: 4,0 IN, 8496 START TII~ : DISABLED k~TER WARNING : 2.0 TEST RA~ :0.20 HIgH I~qTER LIMIT: 3.0 WATER WARNINO ; 2.0 DURATION : 2 HOURS HIgH WATER LIMIT: MAX OR L~qB~EL VOL: 9816 OV£R~ILL LIMIT : 90~ ~ OR LABEL vOL: 9816 : 8834 OVERFILL LIMIT : 90~ LEAK TF~T REPORT FORMAT HIGH PRODUCT : 95~ : 08~4 NORMAL : 9325 HIGH PRODUCT : 95~ DELIVERV LIMIT : 5~ ; 9325 : 490 D~LIVERY LIMIT : : 49~ LOW PRODUCT : 500 LEaK aLARM LIMIT: 99 LO~ PRODUCT : ~UDDEN LO~ LIMIT~ SO LEAK ALARM LIMIT: 99 TANK T~LT : ~.80 SUDDEN LO~S LIMIT: TaNK TILT : ~,~0 MAN~FOLDED T~NK8 T#~ NON£ MANIFOLDED T#: NON~ ~PLLD L~N~ L£AK SETUP LEAK MIN P~RIODI¢: I~ : 981 L~E MIN PERIODIC: 10~ : 981 ~ 1:UNLEADED : 981 LEAK MIN ANNLI~L : I, OX PIPE TYPE~ FIBERGL~ckq : 991 LINE L~NOT~: 1~ D.2~6PH TEST: ~NRBL£D PERIODIC TEb--I' TYPE 0,10 G~H TEb'T; ENABLED QUICK PERIODIC TEST TYPE SHUTDOWN RATE: ANNUAL T~ FAIL QUICg 0,10 OPH TF..~ MM/DD DATE : r'~ 0 ALARM DI~BL£D ANNUAL T~ST FAIL TANK: NONE PERIODIC T£ST PAIL ALgRM DISABLED aLaRM DISABLED ~ERIODIC TEST FAIL GROSS TI~gT FAIL ALAPJ~ DISABLED Ab%aM DISABLED CRO~ TI~T FAIL aLARM DIbBLeD ANN 'r~--~T A%q~RAGING: O~F P~R T£ST aVERAO1NG: OF~ ANN TEST AVERAGING: P~R 'Z'~T AVI~RAOINGI OF~ TaNK TI~T NOTIFY: OFF TANK TF_~IT NOTIFY: OFF TNK TBT SIPHON BR£AK:OFP ~ 2:PRI~'IIUM TNK TST ~IPHON BREAK:OFF DELIV£R¥ DELAY : 2 MIN PIPE TYPZ: FIBERGLASS DELIVERY DELAY : 2 MIN LINE LENGTHI ~00 F~ET 0,20 GPH TEST: ENABLED O.lO GPH TF.~IT: ENABLED GHUTDO~N RATE: S,O GPH O,lO GPH TEST DAT£ : ?9? O 0@/28/208@ 18:28 8188486929 TRIANGLE PAGE lB CIRCLE K 8605 W 9:PLUS [~PLLD LINE DISABLE ~ETUP 5600 AUBURN I~KERSFIELD CA.93306 PIPE TYPE: FIBERGLA~ 661-871-7979 LINE LENGTH: 1~ F~ W I:~NL~DED 0,~0 ~H T~BT~ ~N~BLED FEB 1~, 2flfl~ O.lO ~H TEST: Et~BLED LIGU[D ~N~OR ALMS SHUTDOWN RATE: 3.0 GPH L I:F~L A~RH WP~D LIN~ LEAK 0.10 ~H T~T MM/DD L 2:F~L ~ T~BT HI~TORY ~T~ : ~9 0 L l:~OR OUT ALARM TA~: NONE L 2:SE~OR OUT N 2:PR~IU~ ~ 2:~REM]~ LIeUID gEnOA R~ ~DT 3.0 GAL/HR L ~:F~L ALA~ F~B 19, 2003 L ~:F~L ALARM L 5:~0~ OU~ ALARM L 6:~OR O~T ~ FIRST 0.20 ~AL~HR ~CH MONTH: W FEB 1~, 2003 LIQUID 8~NBOR AL~ LINE L~ LOC~O~ ~TUP L ~:F~ ~ FI~BT 0.10 OALyHR L ~:SEN80~ OUT A~RM EACH MOTH: LOC~O~ 8C~UL~ L 4:~N80~ OUT ~ILY ~ART TIME; DlflA~ED ~ ~ ~ ~ ~ END ~TOP TIME : D~B~LED CII~I. JE K 8605 ~600 AUBURN BAKEP,,~FIF, LD C~,93306 C]~LE K 8605 66t-~1-7979 ~600 ~UBURN LleU1D B~O~ SETUP B~K~R~IELD 0~.93306 - - ' F~ 19, 2~03 7;52 PM 661-871-797~ L t :ANNULAR 87 ~LLD LINE LE~K T~I-~AT~ (BIN~ FL~T) T~T HI~TO~ CRT~ : ANNU~ ~P~E WP~D LINE L~RK TE~ H [BTORY W I: UNLE~ED L 2: UNLERD~ TRI-STATE (~INGLE FL~T) ~T 3.0 GR~HR P~; W 3~PLUB CRT~ORY :BTP ~UMP ~B l~, 2003 7:42 LAST 3.0 O~/HE FEB t 9 L 3:89 RNNU~E FI~T 0.20 GAL/HR TRI-BTAT[ (~I~LE FLOAT) ~CH ~NTH: CATEGORY : ~NNUL~E ~CE F FEB 1~. 2003 ~:31 PH E~H HO~H: L 4:89 STP ~P FIRST O.iO TRI ~TATE (El NGLE FLOAT) EACH MOtH ~ C~TEOORY : ~TP gU~ FI~T ~ ~ a a ~ END L B:9l 'ANNU~R ~I-~RT~ (8I~ FL~T) C~T~RY ; RNN~R L 6t91 ~TP SUMP 03/20/2003 18:20 8188406929 TRIANGLE PAGE TANK L~AK TE~T HISTORY T 3:PR~IUM LAST ~ROSS TEST PF~SF.,D: TANK L£AK TF.~T HISTORY NO TF, BT PA,.~SED T I:UNLEADED LA~ ANNUL TE~ P~B~: ~ ~ ~ ~ ~ ~ND ~ ~ ~ ~ ~ L~ ~R~ TEST P~ED: NO T~T PA~D ~0 TE~T P~B~ FUL~BT RNNU~ T~ ~T RNNURL T~T P~BGED: NO TEgT P~SED NO T~T P~ED L~T P~RIODIC T~T FULLEST ~NNURL TE~ PR~S NO T~ P~SED NO T~T P~ED FULLE~ P~IODIC TE~ ~RH HIBTO~ L~T PERIODIC T~T PRB~: ~SSED ERCH HONTH~ ~ TEST P~ .... IN-TRNK ~LRRH ..... ~ ~ ~ ~ ~ END ~ ~ ~ N ~ T 2=PLUB FULL,BT PERIODIC TEST P~ED ~CH HONTH~ ALARM HISTORY REPORT ..... SYSTEM ALRRM.- .... ~ ~ ~ ~ ~ END ~ ~ ~ w ~ PAP£R OUT F£B 19. 2003 7:50 PM TANK LEAK TF. ST HISTORY PRINTER ERROR F~3 19. ~00~ 7:50 PM T 2:PL~ ~TT~RY IS OFF JAN ~ TE~ PASSED LAST P~RIODIC TEST ~ TEsT P~ED FULLEST PERIODIC TEST PA~ED EACH MONTH: ALARM NI6~TORV REPORT .... I N-TANK ALRPJ9 ..... T i ~ UNL~RDE~ OV£RFILL AI.~RH J~N 8, 206~ 2:44 ~ INVALID FUEL LEVEL FEB 15. ~003 a:lo ~ D£¢ Is, 2002 ~:~? PM N~%~ ~ ~n,.,~ . ~ ~., 83/28/2883 10:20 8188406929 TRIANGLE PAGE AL~t HISTORY REPORT ..... SENSOR ALARM ..... Al.ARM HISTORYREpORT L I:ANNUIj~R 87 ..... SEN~0R ALARM ..... RI.ARM HISTORY R£PORT ANNULAR 8PACE L 3:89 ANNULAR 8£N?~OR OUT ALARM ANNULAR 8PACE ..... SENSOR ALARM ..... FEB 19, 2003 I:ll PM SENSOR OUT ALARm1 L 5:91 ANNULAR FUEL ALARM FEB 19, 2003 1:It PM ANNULAR 8PACE S~NSOR OUT R~RM FEB 1~. 200~ t:O? PM FUEL R~M FEB 19, 20~ 1:1[ P~ FUEL RLR~ NOV 26, 2002 3:85 PM ~TUP DRTR ~aRNI~ F~ 19, 2003 [2:47 PM ~V 26. 2002 ~:07 PM 8~UP DRTR MRRNiNG NOV 26. 20~2 ~:S6 ~ ALARM HIBTORY REPORT ..... BEI~OR ALARM ..... ALARM HIBTORy RF,.,PORT L 2:UNLEADED SUMP ..... SENSOR ALARM' AL.~RM HISTORY REPORT STP SUMP L 4:89 B~P SUMP SENSOR OUT AI~ STP SUMP ..... SENBOR ALARM ..... FEB 19, 2003 l:lI PM SENgOR OUT ALARM L 6:91 BTP BUMP FUF, L ALARM F~B 19. 2009 I :~1 PM ~TP BUMP ~ENBOR OUT ALARM FEB 19. 2003 t2:~6 P~ FU£L ALRJ~M FI~B 19, 2003 1:1! PM FUEL ALARM FEB 19, 2003 12:3B PM FU~ ~M ~EB 19, 2003 12{25 PM ~UEL ~ARH FEB 19. 2003 12:36 PM F~ 19, 2OOG 12:29 PM NOV 26, 2002 2:07 ~ 03/20/2009 10:20 81@8406929 TRIANGLE PAGE i3 HI~TORY i~PO~T ..... ~EN~OR ALARM ..... ~ ?: OTHER B£N~OR~ ALARM HISTORY RE~:~ORT ..... SENSOR AL~M ..... w AL~P.M HIEtTORY REI>OR"r WPLLD 8H~D~N ~M FEB 19, 2003 11:41 AM ..... ~E~R ALARM ..... W~LLD ~H~DOWN ~ FEB 1~, 200~ 11:41 Al4 ~B 19,.~008 11:47 AM W~L~D ~H~WN ~M ~0~ LIN~'F~IL DEO 6, 2002 8:57 PM F~ 19, 200~ lI:4~ AM WPLLD 8HD~OWN ~ DEC 19, 2002 8:54 ~M ~OFTW~6~ REVISION LEVEL VERBIONo16.fl~ 80FTWARE~ 346016-100-C 6~EATED - 98.05.14.13.04 ~i.A~ HI~TO~Y ~0RT ..... ~N~OR ~L~RM ..... BYBT~ F~TURE~: W ~:~R~I~ PERIODIC 1N-TANX T~S WPg~gHUTDOWN ALN ANNU~ IN-TANK TE~TB FEB 19. 200~ 11:56 AM PLLD 0,10 ~N~L~0.20 0~0~ LINE FAIL WPLLD F~ 19, 200~ I1:5~ AM 0,10 ~NU~fl.20 March 12, 2003 Teri Nichoig0n Circle K Store 5600 Auburn #2 Bakersfield, CA 93306 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Perform/Submit Annual Maintenance on Leak Detection at FIRE CHIEF ~ON ~F~ZE the Above Stated Address. ADMINISTRATIVE SERVICES Dear Business Owner: 2101 'H' Street Bakersfield. CA 93301 VOICE (661) 326-3941 Our records indicate that your annual maintenance certification on your leak FAX (66t) 395-1949 detection system was past due on March 4, 2003. SUPPRESSION SERVICES 2101 "H' Street You are currently in violation of Section 2641(J) of the California Code of Bakersfield, CA 93301 "~ · ,,Oe"ula*;ons' VOICE (661) 326-3941 FAX (661) 395-1349 "Equipment and devices used to monitor underground storage tanks shall be PREVENTION SERVICES installed, calibrated, operated and maintained in accordance with F~E SAFET~ SER~lCES · FANIROI~IL~N. SERVICE8 1715 Chester Ave. manufacturer's instructions, including routine maintenance and service checks Bakersfield, C^ 93301 at least once per calendar year for operability and running condition." VOICE (661) 326-3979 FAX (661) 326-0576 You are hereby notified that you have thirty (30) days, April 12, 2003 to either PUl)MC EDUCATION p~rform or submit your annual certification to this office. Failure to comply 1715 Chester Av~. Bakemfleld, CA 93301 will result in revocation of your permit to operate your underground storage VOICE (~1) 326-3696 system. FAX (661) 326-0576 FlEE INVESTIGATION Should you have any questions, please feel free to contact me at 661-326-3190. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 ~ncere~y, FAX (001) 326-0~76 Ralph Huey TRAININa OIVlSION Director of Prevention Services 5642 Victor Ave. Bakersfield, CA 93308 FAX (661) 399-5763 / Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc ~./ 01/30/2003 11:56 81@E TRIANGLE PAGE 01 ill II ~11 IIIII FAX Date: January 31, :1003 Number of pages including c, ov~r ~heet; 1 City of Bakersfield Fire Department . I Il I III I I I To Compliance testing/inspections supervisor From** Lorraine Sofft Steve Underwood Monitor certification Phone: 818 840-7020 Phor~e; Fax p. honc: 818 840-6929 ~'ax ~one: 661 324 6557 CC: 661...326 0576 I I ' REMARKS: [] Urgcnl [] Fox your r~view [] Reply ASAP [] Please cormnent NOTiFICATIONI In accordance with Article 3, Section 2637 Co) (5) (48-hr notification), of California Code of Regn!ations Title 23, Division 3, Chapter 16, Underground Storage Tax~k Regulations (Secondary Testing and Annual Maintenance Certification). This is to notify you that the following Tosco gasoline service station(s) is/are scheduled for annual Tank Monitor Certification on the following date(s); 1. Circle K 08605 5600 Auburn ST., Bakersfield. 93306 2f20/03 (~ 11:00 AM Annual Monitor Certification. (This station has three tanks 87, 89 & 91 with wireless product line leak detectors) Thank you, Lorraine Soff~ D /. January 22, 2003 Circle K FIRE CHIEF RON FRAZE 5600 Auburn Street Bakersfield CA 93306 ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield. CA 93301 RE.' Upgrade Certificate & Fill Tags VOICE (661) 326-3941 FAX (661) 395-1349 Dear Owner/Operator: SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA93,301 Effective January 1, 2003 Assembly Bill 248 went into effect. This VOICE (66t) 326-3941 FAX (661) 395-1349 Bill deletes the requirement for an upgrade certificate of compliance (the blue sticker in your window) and the blue fill tag on your fill. PREVENTION SERVICES FI~E SAFETY SERVICES · ENVIRONMEHt'AL SERYlCES 1715 Chester Ave. You may, if you wish, have them posted or remove them. Fuel Bakersfield, CA 93301 VOICE (661) 326-3979 vendors have been notified of this change and will not deny fuel FAX (661) 326-0576 delivery for missing tags or certificates. PUBLIC EDUCATION 1715 Ch~,sterA,,~. Should you have any questions, please feel free to call me at 66t- Bakersfield, CA 93301 vOiCE (6Ol) 326-3~ 326-3190. FAX (661) 326-0576 FIRE INVESTIGATION Bakersfield, CA 93301 VOICE (661) 326;3951 FAX (661) 3260576 /' ' TRAINING DIVISION 5642 Victor Ave. Steve Underwood Bakers~eu, CA ~a30S Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-4697 FAX (661) 399-5763 Office of Environmental Services SBU/dc TI~]:AKIGLE 2§~5 W. BURBANK BLVb., BURBANK, (:A 91§O5 ENV~RONN~t~NTAL, TN~. III ~11 _ II I I III I I III I III I JI I I III II FAX Number of pages includ/ng cover shoot: 1 City of Bakersfield Fire Department TO Compliance trstlng/inspeetions svpervisor From: Lorraine Soft{ Steve Underwood Monitor c~q. fication Phone: 81 $ 840-7020 Phone: Fax phone: 818 840-6929 Fax phone: 661 324 6557 CC: 661 326 0576 I I~ t , -- - mi I II II I Ill - I I I JI I I J I III J I JII JII I II REMARKS: [] Urgent [~ For your review [] Reply ASAP [] Please comment NOTIFICATION.,! In accordance with Article 3, Section 2637 (b) (5) (48-hr notification), of California Code of Regulations Title 23, Division 3, Chapter 16, Underground Storage Tank Regulations (Secondary Testing and Annual Maintenance Certification). This is to notify you that the following Tosco gasoline service station(s) is/arc scheduled for annual Tank Monitor Cerfifi.cation on.the following-date(s); ......................... -" '---~ 1i Circle K 08605 5600 Auburn ST., Bakersfield 93306 2/3/03 {~ 11:00 AM Annual'Monitor \ ~NCertification. (This station has three tanks 87, 89 & 91. with wireless product line leak detectors) Thank you, Lorraine Soff~ ............................................ ' "' "~" I I _ I ! IIIIIII _ II I I CIRCLE F. 8605 5600 aUBUR:N BA};::ERSFI ELD Ca. 9:3:306 661-871-7979 OH~',] 15. 2003 9:46 ~'"1 SYSTEM STATUS F<EI::'OF,'T ALI. FUI'.I(:T IONS INVENTORy F..EiC~OF.:T ~---. T 1 :UNLEADED VOLUME = 56,21 GaLS ULLA,3E - 4195 ':]ALS 90.'-.~: ULLAC;E~ o,; q o~_ 1 ,_ GALS; TC VOLUME = 5576, C;ALS HEIGHT = 50.47 INCHES WATER VOi,= 0 '.]aLS WATER = 0. C 0 l N,:Z:HES TEMI:, = ?1. :3 DEO F T 2: I::'L V©LUP1E 451 '2 GALS LILLA[3E - 5:304 (];ALS 90;'.a ULLa,:3E=- 4322 TC VOLUME = 4507 ':--;aLS HEIGHT = 42.64 !/ES WATER VOL = 0 WATER = O, O0 TEMP = 7:3.5 DEC; F T 3: P"REM I UM VOLUME = :3139 OaLS ULLAGE - 66'77 [3AI_S '-q 0Y4 ULLA,3EQ 5695 TC V©LUME = :3107 HEI~3HT = :32.79 1NCHES [.dATER VOL = 0 (-':ALS WATER = O. O0 I NCHEf-] TEPII:' = 74 .:3 DEG F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME 6~.I'c~¢..~ .~'~'o~'t_, INSPECTION DATE J -1 ~"' (} 3 ADDRESS ,-~0~ .~.O~t_IFek PHONE NO. ~'l[- '~qT? FACILITY CONTACT BUSINESS IDNO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES c~ Section 1: Busfiness Plan and Inventory Program [~ Routine ~[] Combined 1~ Joint Agency [~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials L Verification of quantities Verification of location Proper segregation of material ~.. Verification of MSDS availability V~rification of Haz Mat training Verification of abatement supplies and procedures Emergency procedUres adequate Containers properly labeled Hou'sekeeping o / , Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Explain: Questions regarding this inspection? Please call us at (661) 326-3979 Business Site)~. espons~le Party White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector:. CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME O,.,[tl'c,(C ~.. ,,~"{'OPC INSPECTION DATE 1-[~"'03 Section 2: Underground Storage Tanks Program [] Routine [~ Combined [] Joint Agency [] Multi-Agency _ [] Complaint [] Re-inspection Type of Tank .tOil) ~" Number of Tanks Type of Monitoring ct/~//}q Type of Piping OPERATION C V COMMENTS tank data on file Proper Proper owner/operator data on file ~ / Permit fees current Certification of Financial Responsibility I, 4 Monitoring record adequate and current Maintenance records adequate and current / Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? i~ s~~i t~il: i a ~~: V i~ _~_~,~~~s N=NO ~~ ~ Office of Environmental Services (805) 326-3979 Business Site Responsible Party White - Env. Sves. Pink - Business Copy 1380 Lead Hill Blvd., Suite 120 Roseville, CA 95661 · · phone 916.774.3000 ConocoPh ll ps December 18, 2002 Steve Underwood Bakersfield Fire Department 1715 Chester Avenue Bakersfield, California 93301 RE: New Office Location Dear Mr. Underwood: Effective December 23, 2002, my new address will be. Edward C. Ralston ConocoPhillips 76 Broadway Sacramento, CA 95812 (916) 558-7633 -Phone (916) 558-7639 - Fax E-mail - Ed.C. Ralston~_.ConocoPhillips.cOm All correspondences and reports should b® directed to the new address as of the effective date. Sincerely, Edward C. Ralston Site Manager ConocoPhillips P.O. Box 52085 Phoenix, Arizona 85072-2085 1500 North Priest Drive Tempe, Arizona 85281 "' Kathy Strickland Environmental Compliance 602/728-418-7149 (direct line) 6022728-5245 (facsimile) December 20, 2002 Re: Financial Responsibility- 40 CFR Part 280, Subpart H Revised for: Name Change to ConocoPhillips and Coverage Period I am enclosing information relating to ConocoPhillips and its subsidiaries including Circle K Stores Inc. requirement to provide financial responsibility for the ownership and operation of underground storage tanks by its operating entities pursuant to 40 CFR Part 280, Subpart H and similar state regulations. ConocoPhillips Company meets the insurance coverage requirements set forth under 40 CFR § 280.97. It is intended that this financial responsibility likewise satisfy the requirements of authorized state programs. ConocoPhillips provides this financial responsibility for all underground storage tanks at retail locations, terminals and bulk plants which are owned and/or operated by all ConocoPhillips entities including Circle K Stores Inc. The information enclosed consists of a Certificate of Insurance and a Certification of Financial Responsibility in the form prescribed by the federal regulations. I am attaching site list for you r jurisdiction, according to our database. Please let me know if there are discrepanices'between this list and your records. Please forward this information to the appropriate person in your agency. You may direct any c~.estions to me at (602) 728-7149. Very truly yours, Kathy Strickland Environmental Compliance Enclosures December 20, 2002 CA State Water Resources Control Board UST Program P. O. Box 944212 Sacramento, CA 94244 CERTIFICATION OF FINANCIAL RESPONSIBILITY ConocoPhillips Company and all of its subsidiaries, including Circle K Stores Inc., hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR Part 280. The financial assurance mechanism used to demonstrate financial responsibility under Subpart H of 40 CFR Part 280 is as follows: Mechanism: ,:' ~ Section280.97 ~ InsUi-ahce~:°ver~i'ge ' ~ ~':'~ ' Issuer: Sooner Insurance Cor~pany ~ ~' Certificate of Insurance No. 2003-16 Amount of . ,,.:.: ..: Coverage: $1,000,000 per occurrence $2,000,000 annual aggregate Effective Period Of Coverage: From January 1, 2003 until Apdl 30, 2004, unless eadier Revoked or replaced by written notice to the Implementing Agencies listed on the attached Exhibit A. Coverage: Taking corrective action and compensating third parties for bodily injury and. property damage caused by accidental releases. Sooner Insurance Company CERTIFICATE OF INSURANCE Certificate No. 2003-16 Date: December 20, 2002 Policy No.: S-7501A-03/04 Certificate Holder: CA State Water Resources Control Board UST Program P. O. Box 944212 Saci'amento, CA 94244 Insured: ConocoPhillips Company and its subsidiaries including Circle K Stores Inc. Address of 600 North Dairy Ashford - ML3136 The Insured: Houston, TX 77079 Covered Per the attached list Locations: Policy Term: December 1, 2002 - December 1, 2004 CERTIFICATION (1) Sooner Insurance Company, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tanks: [See attached list] '- for taking corrective action and/or compensating third parties for bodily injury and property damage caused by accidental releases in accordance with and subject, to the limits of liability, exclusions, conditions, and other terms of the policy arising from operating the underground storage tanks identified above. The limits of liability are $1,000,000 each occurrence and $2,000,000 annual aggregate, exclusive of legal defense costs, which are subject to a separate limit~under the policy. The coverage is provided under policy S-7501A-03/04. The effective date of said policy is December 1, 2002. (2) The Insurer further certifies the following with respect to the insurance described in Paragraph 1: (a) Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policY to which this certificate applies Management Offices Administrative Offices 600 North Dairy Ashford - ML 3136 112 Lake Street Houston, TX 77079 Burlington, VT 05401 TEL: (281) 293-6680 TEL: (802) 658-9466 FAX: (281) 293-2941 FAX: (802) 658-5520 (b) The Insurer is liable for payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third-party, with a right of reimbursement by the insured for any such payment made by the Insurer. This provision shall not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. (c) Wherever requested by a Director of an implementing agency, the Insurer agrees to furnish to the Director a signed duplicate original of the policy and all endorsements. (d) Cancellation or any other termination of insurance by the Insurer except, for non-payment of premium or misrepresentation by the insured, will be effective only upon written notice and only after expiration of 60 days after a copy of such written notice is received by the insured. Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured. (e) The insurance covers claims otherwise covered by the policy :that are reported to the Insurer within six months of the effective date of cancellation or non-renewal of the policy except where the new orrenewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applic, able, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions limits, including limits of liability and exclusions of the policy. I hereby certify that the wording of the instrument is identical to the wording in 40 CFR 280.97(1>)(2) and that the Insurer is licensed to transact the business of insurance, or eligible to provide insurance as an excess or surplus lines insurer, in one or more states. Scott W. Irwin Vice President Authorized Representative of Sooner Insurance Company 600 North Dairy Ashford - ML 3136 Houston, TX 77079 Management Offices Administrative Offices 600 North Dairy Ashford - ML 3136 112 Lake Street Houston, TX 77079 Burlington, VT 05401 TEL: (281) 293-6680 TEL: (802) 658-9466 FAX: (281) 293-2941 FAX: (802) 658-5520 · COmplete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ¥ ~'"',c'~ ~, . . '~,.~ M _ . .~ [] Agent · Print your name and address on the reverse "~ '~ Y,,C/ '-' ~°' _ _Ac~ressee so that we can return the card to you. · , . . ,~- , m~J~_~.._ ..B. R~eE'Name),~F'~,~.w.J~Et~J,)elivery · Attach this card to the back of the' mailpiece? _. ~ or on the front if space permits. 1. Article Addressed to: if YES, enter delivery adt~u,~.~,beKow'. ~? KERN COUNTY WATER AGENCY . P O BOX 58 3. Service Type ' BAKERSFIELD CA 93302 [] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise ;: [] Insured Mail [] C.O.D. 4, Restricted Delivery? (Extra Fee) [] Yes 7002'!0'&60 0000 1914 8435 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 UNITED STATES POSTAL SERVICE UsPsP°stageFirst'Class& Fees PaidI Permit No. G-10 I · Sender: Please print your name, address, and ZIP+4 in this box · B,,-~J~ERSFUELD FIRE DEPARTi~ENT OFFICE OF ENV~RO~'~MF_.NTAL SERVICES 1715 dh~ster Avenue, Sui'~ 3,00 Bakersfield, CA 03301 Certified Fee P~t~ Return R~ipt Fee ~ ~nd~mem R~uim~ ~do~m~t R~ul~ ~ CO~Y WAT~g AGENCY o BOX 58 'i ............ ZI~I.I.-IM-ZO-G66ZOi. (8SJOAOII) ZOO7- I!Jdv '008S mJO:i Sd · Aqnbu! ue fiugqem uoqA~ 1' luosoJd pue ldlogOJ s!ql O~NVJ.LIOdlMI 'lte~ pue e6eTsod q~,,~ leq~l x,,u.~ pue LIO~Tep 'p~peel~R3u s, I~ pe!.~!Peo etlT uo ~Je,,,Tsod e ,~1 '6ui~J~mTsod JoJ eo!J~o 3sod eqT Tg elO 2!lJS eql lueseJd eseeld 'pe3!sep s. ~,d!e~J I~e~ pe~J~l~eO eql uo ~Jem~sod ',,~e~!leO pe~o~seE,, luemesJopue eql qll~ eoe[dl!em eql ~J~m ~o ~lo. eql ~PV 'lue6e pez!Joqlne s, eesseJpps ~o eesse~ppe eq~ ol pe~oi~lse~ eq ~m ~eA.lep 'eej leuo~1~ppe ue ~o~ 'pe~nbe~ s~ 3dJ~J IJe~ perjUreD ~n~ uo ~em~s~ SdS~ e ldJe~J uJnleJ eTeoJldnp J~ JeA]e~ ea~ ~ aA~e~J ol '.pelsenbea ~d/aoe~ u~n~e~,, e~!dlmem esJopu~ eq~ ~eAOO O~ e6e~sod elqeO!ldde ppe pus ~lO~e aql o~ (~8~ ~oJ Sd) ld~eoe~ uJnlea e qoe~e pue e~e dmoo essa d 'eom~es ldme~a uJn3e~ umelqo ol '~eA!lep Jo jomd ep.AoJd o~ pelsen~J eq Aero l~ eoe~ O~nlea e '~t I~uomlmppe 'lle~ peJe~s!Ba~ Jo peJ~Ul ~ep~suoo eseeld 'selqsnleA 'l~e~ leUO~leu~elu~ Jo ss~lo Xue Joj elqeH~Ae lou s~ l!~ Pa~J~eO m '1 ~ AlUOUd ~o I e~ SSelO-~s~mj ql~ peu!q~oo eq AqNO ~ Ile~ Pa!J!WeO s~eei o~ ~o~ eo~eS lelSOd eql iq lde~ ~eA]lep ~o p~ooe~ V ~eAilep uodn e]n3~u6!s V m eoe]dl!e~ ~noX ~o~ Je~t~uepi enb!un V m ld~eoe~ 6u~Hem V :SOpgAOJd HeW December 1, 2002 Kern County Water Agency P O Box 58 Bakersfield CA 93302 RON FRAZE ADMINISTRATIVE2101 "H ' StreetSERVICES '~ ~ CERTIFIED MAIL Bakemfield, CA 93301 VOICE (661) 326-3941 (661)3, t 9 FINAL REMINDER NOTICE sup. RES=O. SERV,CES JANUARY 1, 2003 DEADLINE 2101 "H' Street Bakersfield, CA 93301 VOICE (660 326-3941 F^X (66t) 3,6-1349 Dear Tank Owner/Operator: PREVENTION SERVICES sAF~.s~s.E,~o~.,~,~s~,,V~ YOU will be receiving this letter on or about December 1 2002. One 1715 Chester Ave. · ea~e,s,e,a, CA rS.a01 month from today, January 1, 2003, your current underground VOICE (661) 326-3970 storage tank(s) will become illegal to operate., Current law would FAX (661) 326-0576 require that your permit be revoked for failure to perform the PUBLIC EDUCATION necessary Secondary Containment testing. 1715 Chester Avi~. Bakersfield, CA 93301 VOICE (c~O 326-36~ In reviewing your file, I see that you have received "Reminder FAX (661) 326-O576 Notices'· since April of this year. This is your last chance to comply nRE INVESTIGATION with code requirements for Secondary Containment testing prior to 1715 Chester Ave. Bakemfleld, CA 93301 January 1, 2003. VOICE (661) 326-3951 FAX (661) 326-0576 Should you have any questions, please feel free to contact me at 661- TRAINING DIVISION 326-3190. 5642 Victor Ave. Bal<emfleld, C^ 93308 vOiCE (66~) 3~-46~7 S i ncerel y, FAX (661) 39~-$7~3 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc i J I 'l J Bakersfield Fire iCA 1256089 12524 OSWELL ST BAKERSFIELD !KERN 193306 } 3 Department ~ .... i ....... T~2--0~.A STOCKD~-~LE ' ~_ j ~ ; -I--Bakersfield Fire CA !257393 i HWY'. BAKERSFIELD IKERN ' 93311 3JDepartment i~ ....... i29~27 S'TOC-~DALE ....... 1 Bakersfield Fire " - ICA 12611158 ',HWY BAKERSFIELD i KERN 93312 3 Department ................. i ................................................... Bakersfield Fire !CA J2701270 15634 STINE RD ..... BAKERSFIELD iKERN,, 93313 2 Department I Bakersfield Fire CA 2708605 5600AUBUR ST IBAKERSFIELD KERN 93306 3 Department CA Bakersfield Fire 2708606 1030 OAK ST BAKERSFIELD KERN 93304 , 31 Department ! Bakersfield Fire ICA 2708825 2222 F ST BAKERSFIELD =KERN ..... 9330~1 ..... 3!Department Conoc hillips P.O. Box 52085 Phoenix, Arizona 85072-2085 1500 North Priest Drive Tempe, Arizona 85281 Kathy Strickland Environmental Compliance 602/728-418-7149 (direct line) 602/728-5245 (facsimile) December 5, 2002 Re: Financial Responsibility- CorreeCed 0gffeetive Period of Coverage) - discard previous one sent 40 CFR Part 280, Subpart H I am enclosing information relating to Phillips Petroleum Company and its subsidiaries including Tosco Corporation requirement to provide financial responsibility for the ownership and operation of underground storage tanks by its operating entities pursuant to 40 CFR Part 280, Subpart H and similar state regulations. Phillips Petroleum Company meets the insurance coverage requirements set forth under 40 CFR § 280.97. It is intended that this financial responsibility likewise satisfy the requirements of authorized state programs. Phillips provides this financial responsibility for all underground storage tanks at retail locations, terminals and bulk plants which are owned and/or operated by all Phil~lips entities including Tosco Corporation and Circle K Stores Inc. The information enclosed consists of a Certificate of Insurance and a Certification of Financial Responsibility in the form prescribed by the federal regulations. I am attaching site list for you r jurisdiction, according to our database. Please let me know if there are discrepanices between this list and your records. Please forward this information to 'the appropriate person in your agency. You may direct any questions to me at (602) 728-7149. Very truly yours, Kathy Strickland Environmental Compliance Enclosures · CERTIFICATE OF INSURANCE Certificate No. 2003-16 Date: November 20, 2002 Policy No.: S-7501A-03/04 Certificate Holder: CA State Water Resources Control Board UST Program P. O. Box 944212 Sacramento, CA 94244 Insured: Phillips Petroleum Company and its subsidiaries including Tosco Corporation and Circle K Stores Inc. Address of 600 North Dairy Ashford - ML3136 The Insured: Houston, TX 77079 Covered Per the attached list Locations: Policy Term: December 1, 2002 - December 1, 2004 CERTIFICATION (1) Sooner Insur~ce Company, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tanks: [See attached list] for taking corrective action and/or compensating third parties for bodily injury and property damage caused by accidental releases in accordance with and subject to the limits of liability, exclusions, conditions, and other terms of the policy arising from operating the underground storage tanks identified above. The limits of liability are $1,000,000 each occurrence and $2,000,000 annual aggregate, exclusive of legal defense costs, which are subject to a separate limit under the policy. The coverage is provided under policy S-7501 A-03/04. The effective date of said policy is December 1, 2002. (2) The Insurer further certifies the following with respect to the insurance described in Paragraph 1: (a) Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policy to which this certificate applies Management Offices Administrative Offices 600 North Dairy Ashford - ML 3136 112 Lake Street HoustOn, TX 77079 Burlington, VT 05401 TEL: (281) 293-6680 TEL: (802) 658-9466 FAX: (281) 293-2941 FAX: (802) 658-5520 (b) The Insurer is liable for payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third-party, with a right of reimbursement by the insured for any such payment made by the Insurer. This provision shall not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. (c) Wherever requested by a Director of an implementing agency, the Insurer agrees to furnish to the Director a signed duplicate original of the policy and-all endorsements. (d) Cancellation or any other termination of insurance by the Insurer except, for non-payment of premium or misrepresentation by the insured, will be effective only upon written notice and' only after expiration of 60 days after a copy of such written notice is received by the insured. Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured. (e) The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior Policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, ffapplicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions limits, including limits of liability' and exclusions of the policy. I hereby certify that the wording of the instrument is identical to the wording in 40 CFR 280.97COX2) and that the Insurer is licensed to transact the business of insurance, or eligible to provide insurance as an excess or surplus lines insurer, in one or more states. Scott W. Irwin Vice President Authorized Representative of Sooner Insurance Company 600 North Dairy Ashford - ML 3136 Houston, TX 77079- Management Offices Administrative Offices 600 North Dairy Ashford - ML 3136 112 Lake Street Houston, TX 77079 Burlington, VT 05401 TEL: (281) 293-6680 TEL: (802) 658-9466 FAX: (281) 293-2941 FAX: (802) 658-5520 December 5, 2002 CA State Water Resources Control Board UST Program P. O. Box 944212 Sacramento, CA 94244 CERTIFICATION OF FINANCIAL RESPONSIBILITY Tosco Corporation, a wholly owned subsidiary of Phillips Petroleum Company, hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR Part 280. The financial assurance mechanism uSed to demonstrate finaacial responsibility under Subpart H of 40 CFR Part 280 is as follows: · . Mech~a~isin: Section 280.97 - Insurance Coverage .. :. ~ ' ~ - ," ~ Issuer: Sooner Insurance Company Certificate of Insurance No. 2003-16 Amount of Coverage: $1,000,000 per occurrence $2,000,000 annual aggregate Effective Period of Coverage: From December 1, 2002 until April 30, 2003, unless earlier revoked or replaced by written notice to the Implementing Agencies listed on the attached Exhibit A. Coverage: Taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases. '~s~c~ anuar , //( Page __ of Se on ont ,n e t This form is intend~ for use by contractors performing pedodic tes~'ng of UST seconda~ containment systems. Use the appropriate pages of this form to repon resul~ for all components test~. The complet~ form, written test procedures, and printou~ from test~ (~applicable), shouM be provid~ to the facili~ owner~operator for submittal to the local regulato~ agency. 1. FACILI~ ~O~ATION Facili~ Na~: Bakersfield 76 2608605 IDate of Testing: 9/27/2002 FaciliWAd~ess: 5600 Auburn St. Bakersfield CA 93306 Facili~ Comact: [ Phone: Date ~cal Agency Was Notified of Testing: 9-27-2002 Na~ of ~cal Agency ~spector (if present during testing: 2. ~S~NG CO~CTOR ~O~TION Co~y Name: Shirley Environmental Testing Tec~ici~ Conducting Test: Robe~ Vargas Credentials: ~ CSLB Licensed Contractor ~ S~CB Licensed T~ Tester Manufacturer Training M~ufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Not Repairs Component Pass FailNot Repairs Component Pass Fail Tested Made Tested Made STP 87 x STP 89 x STP 91 x Disp 1-2 x If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my I~nowledge, the. fa. cts stated in this document are accurate and in full compliance with legal requirements ~.// ,/ ~-- Technician's Signature: ~~.// J/,~... , ,__ ~-/'"'--~ Date:- 9127/2002 ~SWRCB January, 2002 Page __ of__ 4. TANK ANNULAR TESTING Test Method Developed By: [] Tank Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: 1 Tank # Tank # Tank # Tank # ls Tank Exempt From Testing?~ I-lYes J-]No I-lYes I-~No I-JYes J-lNo I-lYes I-JNo Tank Capacity: Tank Material: Tank Manufacturer: Product Stored: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R~): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: ~a:i:l: ~ Was sensor removed for testing? [] Y~s [] No [] I~, [] Yes [] No [] I~, [] Yes [] No [] I~, [] Yes [] No [] ~ Was sensor properly replaced and verified functional atter testing? []Yes []No []l~ []Yes []~ []1~ []Yes []~ []N~ []Yes []No []1~ Comments - (include inforrnat~'on on repairs rnade prior to testing, and recommended follow-up for failed tests) ~ Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such systems that are hydrostatically monitored or under constant vacuum, are exempt fzomperiodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} ~WRCB*January, 2002 Page __ of__ 5. SECONDARY PIPE TESTIN~ll~ Test Method Developed By: [] Piping Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~ · ~ ~~®~®~®~Piping Run # ~®~®~ Piping" Run- # ~ *~ ~®®~~t®~-~ Piping Run # -- Piping Run' :~®~m~# Piping Material: Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: Method and location of piping-mn isolation: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R~): Test End Time: Final Reading (RF): Test Duration: Change in Reading (Rv-Ri): Pass/Fail Threshold or Criteria: Test Result: Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~WRCB~January, 2002 Page __ of__ 6. PIPING SUMP TESTING Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ,'~ gl Sump # 87 Sump # 89 Sump # 91 Sump # Sump Diameter: Sump Depth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested~ Does turbine shut down when sump sensor detects liquid (both []Yes []No []NA []Y~ []No []1~ []Y~ []No []1~. []Y~ [] product and water)?* Turbine shutdown response time Is system programmed for fail-safe []Yes []NO []l~ []Yes []NO []l~ []Yes []NO'[]I~ []yes []NO [] shutdown?* Was fail-safe verified to be [] Yes [] No [] I~ operational?* Wait time between applying pressure/vacuum/water and starting 5 Min 5 blin 5 test: Test Start Time: 9:20 9:20 9:20 Initial Reading (R0: 2.5245 3.4618 4.1892 Test End Time: 9:35 9:35 9:35 Final Reading (RF): 2.5232 3.4509 4.1887 Test Duration: 15 Min 15 Min 115 Min Change in Reading (Rr-Rx): .0013 .0009 .0005 Pass/Fail Threshold or Criteria: PASSED FAILED PASSED Test Result: I~:PO ~:Pfi~ IRl~all : ::: ~: ~r-l,;: ~'~[~ass~ Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA Was sensor properly replaced and verified functional after testing? [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] NO [] NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Test 2 for STP 87 passed. Change in reading .0000 Test 2 f~r ~TP 89 failed. Chan~e in readin~ .0~42 Test_ _2 for STP 9! failed_ Cha~0e in madin~ :0043 Test 3 for STP 89 failed_ Chan~e in readi.n.~ .0006 Test 3 for STP 91 nassed. Chanoe in readino .0013 ~ If thc entire depth of thc sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) ~WRCB~January, 2002 Page __ of__ 7. UNDER-DISPENSER CONTAINMENT 0.TDC) TESTING Test Method Developed By: [] UDC Manufacturer 'l-~ I~dustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: UDC # 1-2 UDC # UDC # UDC # UDC Manufacturer: Bravo UDC Material: Steel printed UDC Depth: 7" Height 15om UDC Bottom to Top piping comes in of Highest Piping Penetration: thru the bottom Height bom UDC Bottom to conduit from Lowest Electrical Penetration: bottom Condition of U DC prior to clean testing: Portion of UDC Tested~ N/A Does turbine shut down when UDC sensor detects liquid (both []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* []Yes []No []NA []Yes I-INo DNA DYes []No DNA DYes •NO I-INA Was fail-safe verified to be []yes []NO []NA []yes []NO []NA []yes []NO []NA []yes []No []NA operational?* Wait time between applying pressure/vacuum/water and 2 Min starting test Test Start Time: 11:54 Initial Reading (R~): 1.4852 Test End Time: 12:11 Final Reading (RF): 1.4843 Test Duration: 30 Min Change in Reading (RF-Ri): .001 Pass/Fail Threshold or Criteria: PASSED Test Result: Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []!No []NA []Yes []No []NA Was sensor properly replaced and verified functional after testing? [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA Comments - (include infi)rmation on repairs made prior to testing, and recommended follow-up for failed tests) I If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any'of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) gWRCB~January, 2002i~1 ~ Page of Facility is Not Equipped With Fill Riser Containment Sumps [] Fill Riser Containment Sumps are Present, but were Not Tested [] Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~ Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R0: Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R0: Pass/Fail Threshold or Criteria: ~ ~ass ~ml:,: ~: ,~ ~:ass~l Test Result: Is there a sensor in the sump? [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Does the sensor alarm when either product or water is F1Y~ FINO F1R~ F1Y~ FINO FI~ F1Y~ [-1NO Fll~ F1Y~ F1NO Fll~ detected? Was sensor removed for testing? [] Y~ [] No [] Was sensor properly replaced and verified functional after testing? [] Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB~January, 2002 Page __ of__ 9. SPII.L/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes [] Spill/Overfill Containment Boxes are Present, but were Not Tested [] Test Method Developed By: [] Spill Bucket Manufacturer [] Industry Standard F'lProfessional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum []Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~ Spill Box # Spill Box # Spill Box # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R~): Test End Time: Final Reading (Rv): Test Duration: Change in Reading (Rv-R0: Pass/Fail Threshold or Criteria: Test Result: Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ?~WRCB~anuary, 2002 Page of ' -- ko ' ' ~o ~ Secondary Containment Testing Ret ,rm ~/ This f~rm is intended f~r use by c~ntract~rs perf~rming peri~dic testing ~f UST sec~ndary c~ntainment 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), shouM be provided to the facility owner~operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Bakersfield 76 2608605 I Date of Testing: 8/6/2002 Facility Address: 5600 Auburn St. Bakersfield CA 93306 ' Facility Contact: I Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Shirley Environmental Testing Technician Conducting Test: Robert Vargas Credentials: [] CSLB Licensed Contractor [] SWRCB Licensed Tank Tester License Type: A HIC HAZ License Number: 798892 Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Not Repairs Component Pass FailTested Not Repairs Made Component Pass Fail Tested Made STP 87 x STP 89 x STP 91 x Disp 1-2 x Disp 3-4 x If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFIC~ TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge,/fhe facts sta~ed in this document are accurate and in full compliance with legal requirements Technician s Signature:' [ ~~/ ~'e'x--~r-~- / /~-'3 Date' 8~6~2002 SWRCB~anuary, 2002 Page __ of __ 4. TANK ANNULAR TESTING Test Method Developed By: [] Tank Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: [ Equipment Resolution: " ~' ' · Tank # Tank # Tank # Tank# Is Tank Exempt From Testing?I [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Tank Capacity: Unleaded Unleaded Plus Premium Tank Material: Tank Manufacturer: OW Steel DW Steel OW Steel Product Stored: Unleaded Unleaded Plus Premium Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R~): Test End Time: Final Reading (Rv): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: Was sensor removed for testing? [] Y~ [] No [] ~ [] Y~ [] No [] I~, [] Y~ [] No [] N~ [] Yos [] No [] I~ Was sensor properly replaced and verified functional after testing? [] Y~ [] No [] fa. [] Y~ [] No [] I~ [] Y~ [] No [] I~ [] Yos [] No [] I~ Comments - (include informaa'on on repairs made prior to testing, and recommended follow-up for failed tests) s Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} 8WRCB~January, 2002 Page__ of __ 5. SECONDARY PIPE TESTIN~I~ Test Method Developed By: [] Piping Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~ Piping Run # 91 Piping Run # 89 Piping Run # 87 Piping Run # Piping Material: Environ Environ Environ Piping Manufacturer: DW FRP OW FRP DW FRP Piping Diameter: Length of Piping Run: Product Stored: Unleaded Unleaded Plus Premium Method and location of DW/ST DWIST DWIST piping-mn isolation: Wait time between applying pressure/vacuum/water and 5 Min 5 Min 5 Min starting test: Test Start Time: 11:14 11:14 111:14 Initial Reading (R0: 4.7343 3.2577 4.1206 Test End Time: 11:29 11:29 11::29 Final Reading (RF): 4.7350 3.2578 4.1!261 Test Duration: 15 Min 15 Min 15 Min Change in Reading (RF-Ri): -.0007 -.0001 -.0055 Pass/Fail Threshold or PASSED PASSED PASSED Criteria: Test Result: ! '! ~ ~ Comments - (include in./brmation on repairs made prior to testing, and recommended follow-up for failed tests) SWRCBlJanuary, 2002 Page __ of__ 6. PIPING SUMP TESTING Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: Sump # 89 Sump # Sump # Sump # Sump Diameter: Sump Depth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Good Portion of Sump Tested~ 2" above product Does turbine shut down when sump sensor detects liquid (both []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA product and water)?* Turbine shutdown response time Is system programmed for tail-safe []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA shutdown?* Was fail-safe verified to be [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA operational?* Wait time between applying pressure/vacuum/water and starting 10 Min test: Test Start Time: 10:48 - 11:43 Initial Reading (Ri): 1.1263 - 1.1106 Test End Time: 11:03 - 11:58 Final Reading (RF): 1.1252 - 1.1102 Test Duration: 15 Min Change in Reading (RF-R~): .0009 - .0004 Pass/Fail Threshold or Criteria: PASSED Was sensor removed for testing? [] Yes [] No [] NA [] Yes [] No [] NA ~ [] Yes [] No [] NA [] Yes [] No [] NA Was sensor properly replaced and verified functional after testing? [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Secondary. tostboots had to haw ULC-2000B applied to socondary tostboots. We need to return to re-test. Retest_ed 4'!!'!!2002:89 passed hydrostatic test- ~ If the entire depth of the stunp is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB~January, 2002 -~ Page __ of__ 7. UNDER-DISPENSERn"~ONTAINMENT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer '['~ ~dustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: UDC # 1-2 UDC # 3-4 UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height from UDC Bottom to Top of Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Testedl Does turbine shut down when UDC sensor detects liquid (both []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* []Yes Was fail-safe verified to be []Yes []No []NA []Yes []No []NA []Yes []'No []NA []Yes []No []NA operational?* Wait time between applying pressure/vacuum/water and 5 Min 5 IdJn starting test Test Start Time: 16:31 16:31 Initial Reading (Ri): 1.2014 1.1464 Test End Time: 16:46 16:46 Final Reading (RF): 1.2032 1.1462 Test Duration: 15 Min 15 Min Change in Reading (RF-Ri): -.0018 ,0002 Pass/Fail Threshold or Criteria: Test Result: [] P~ Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []NO []NA Was sensor properly replaced and verified functional after testing? [] Yes [] No [] Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) t If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) $WRC~,January, 2002 ,i~l~_ ~ ~l~ Page __of__ 8. F RISER CONTAINMENT SUMP TES G Facility is Not Equipped With Fill Riser Containment Sumps [] Fill Riser Containment Sumps are Present, but were Not Tested [] Test Method Developed By: [] Sump Manufacturer []Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: .... ~ "~ Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Ri): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-Ri): Pass/Fail Threshold or Criteria: Test Result,:: ' ' ': .................. ~ ..... ~'"' "~'~: ~ ~i'"~:~ .............. ~,~ ~a$~:, :D~al ;,~'~[$~!:~[11 Is there a sensor in the sump? [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Does the sensor alarm when either product or water is []Y~s []~ []1~ []Y~s []~ []1~ F3Y~s []~ []~ []Y~s []No []1~ detected? Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA Was sensor properly replaced and verified functional after testing? []Y~s []No []l~ []Y~s []No []~ []Y~ []No []l~ []Y~s []No []~ Comments - (include injbrmation on repairs made prior to testing, and recommended follow-up for failed tests) S-WRCB~January, 2002 Page __ of 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes [] Spill/Overfill Containment Boxes are Present, but were Not Tested [] Test Method Developed By: [] Spill Bucket Manufacturer [] Industry Standard []Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum []Hydrostatic [] Other (Specify) Test Equipment Used: [ Equipment Resolution: Spill Box # Spill Box # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Ri): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: Test Result: !~ Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) sWRCB January, 2002 Page __ of Repor Form Secondary Containment Testing 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), shouM be provided to the facility owner~operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Bakersfield 76 2608605 I Date of Testing: 9~27~2002 Facility Address: 5600 Auburn St. Bakersfield CA 93306 Facility Contact: I Phone: Date Local Agency Was Notified of Testing: 9-27-2002 Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Shirley Environmental Testing Technician Conducting Test: Robert VargaslBrett Mitchelson Credentials: [] CSLB Licensed Contractor [] SWRCB Licensed Tank Tester Lice~se T~e~ ....... A HIC H~~. ....... ~5~ Number~ : .............. 798 ~2~ ............ Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Not !Repairs Component Pass FailTested Not Repairs Made Component Pass FailTested Made STP 87 x Retest STP 89 x STP 89 x Retest Dispener 3-4 x STP 91 x Disp 1-2 x If hydrostatic testing was performed, describe what was done with the water after completion of tests: Retested '11/15/2002 CER~F TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING T~thebest~fmykn~w~dge~~tedinthisd~cu~?~tr~accurateandinfu~c~mp~iatt~ewithlegalrequirements Technician'sSignature:X,~..__~// {o~/,..,~L-;/' 7/a--..~.. //a~.~ Date: 912712002 SWRCB January, 2002 Page __ of__ 4. TANK ANNULAR TESTING Test Method Developed By: [] Tank Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: Tank # Tank # Tank # Tank # Is Tank Exempt From Testing?~ [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Tank Capacity: Tank Material: Tank Manufacturer: OW Steel OW Steel OW Steel Product Stored: Unleaded Unleaded Plus Premium Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Ri): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Yes []No []N~ []Yes []No []l~ []Yes []No []N~ ,[]Yes []No []hta, Was sensor properly replaced and verified functional after testing? []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ Secondary containment systems where the continuous monitoring automatically monitors both thc primary and secondary containment, such systems that are hydrostatically monitored or under constant vacuum, are exempt fxom periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB January, 2002 .Page __ of 5. SECONDARY PIPE TEsTIN~ Test Method Developed By: [] Piping Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: Piping Run # Piping Run # Piping Run # Piping Run # Piping Material: Piping Manufacturer: DW FRP DW FRP DW FRP Piping Diameter: Length of Piping Run; Product Stored: Unleaded Unleaded Plus Premium Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Ri): Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R0: Pass/Fail Threshold or Criteria: Test Result: Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB January, 2002 Page of__ 6. PIPING sUMp TESTING Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: Sump # 87 Sump # 89 Sump # 91 Sump # 89 retest Sump Diameter: Sump Depth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Testedl Does turbine shut down when sump sensor detects liquid (both []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA product and water)?* Turbine shutdown response time Is system programmed for fail-safe []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA shutdown?' Was fail-safe verified to be []Yes []No []NA -lYes []No []NA []Yes []NO []NA []yes []No []NA operational?' Wait time between applying pressure/vacuum/water and starting 5 Min 5 Min 5 Min 5 Min test: Test Start Time: 9:20 9:20 9:20 12:48 Initial Reading (R0: 2.5245 3.4618 4,1892 215042 Test End Time: 9:35 9:35 9:35 1:23 Final Reading (RF): 2.5232 3.4509 4.1887 2.50t4 Test Duration: 15 Min 15 Min 15 Min 30 Min Change in Reading (RF-R~): .0013 .0009 .0005 .0004 Pass/Fail Threshold or Criteria: PASSED FAILED PASSED PASSED Test Result:' :"' .... ' .':'" ~'*::' ,~g ~,Fil!!,::~ ~ .................................. []~a{i:~,~ Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []NO []NA []Yes []No []NA Was sensor properly replaced and verified functional after testing? [] Yes [] No [] I~ [] Yes [] No [] I~ [] Yes [] No [] I~ [] Yes [] No [] Ra, Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Test 2 for STP 87 nassed. Change in reading .0000 Te~t 2 for STP 89 failed. Change in reading .0~42 Te-qt_ :2 for STP 9~_ f_a_!!ed_- Chanfle in readin~ _0fl45 Test 3 for STP 89 failed. Change in reading 1000~_ Test 3 for STP 91 nassed. Chanae in readina .0013 i If the entire depth of the sump is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCB January, 2002 . Page · of__ 7. UNDER-DISPENSEI~I~oNTAINMENT [III}C) TESTING Test Method Developed By: [] UDC Manufacturer '1'~ I~dustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: UDC # 1-2 UDC # 3-4 UDC it UDC # UDC Manufacturer: Bravo Bravo UDC Material: Steel printed Steel printed UDC Depth: 7" 7" Height from UDC Bottom to Top piping comes in piping comes in of Highest Piping Penetration: thru the bottom from the bottom Height from UDC Bottom to conduit from conduit from Lowest Electrical Penetration: bottom bottom Condition of UDC prior to testing: clean clean Portion of UDC Tested~ N/A N/A Does turbine shut down when UDC sensor detects liquid (both []Yes []No'[StINA []Yes []No []NA []Yes []No []NA []Yes []No []NA product and water)?* Turbine shutdown response time ls system programmed for fail- safe shutdoWn?* []Yes []No []NA []Yes []No []NA []Yes []No I-INA I-lYes I-INo I-INA Was fail-safe verified to be · 9* []Yes []No []NA []Yes []No []NA []Yes []NO I-INA []Yes •NO DNA operahonal. Wait time between applying pressure/vacuum/water and 2 Min 5 Min starting test Test Start Time: 11:84 12:13 - 12:30 Initial Reading (R0: 1.4832 1.6142 -1.6141 Test End Time: 12:11 12:28 - 12:45 Final Reading (RF): 1.4843' 1.6142 -1.6140 Test Duration: 30 Min 15 Min Change in Reading (R~-R0: .001 None Pass/Fail Threshold or Criteria: ~ PASSED ~ PASSED · Was sensor removed for testing? l[]Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA Was sensor properly replaced and verified functional after testing? [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] No [] NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) 8. RISER CONTAINMENT SUMP TE G Facility is Not Equipped With Fill Riser Containment Sumps [] Fill Riser Containment Sumps are Present, but were Not Tested [] Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~ Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R0: Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R0: Pass/Fail Threshold or Criteria: Is there a sensor in the sump? [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Does the sensor alarm when either product or water is []Y~ []~ []N~ []Y~ []~ []NA []Y~ []No []~ ,[]Y~ []No []l~ detected? Was sensor removed for testing? [] Y~ [] No [] Ra, [] Y~ [] No [] I~ [] Y~ [] No [] R~, [] Y~ [] No [] I~ Was sensor properly replaced and verified functional after testing? [] Y~ [] No [] I~ [] Y~ [] No [] I~ [] Yas [] No [] I~ [] Y~ [] No [] I~ Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB January, 2002 Page of__ 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes [] Spill/Overfill Containment Boxes are Present, but were Not Tested [] Test Method Developed By: [] Spill Bucket Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum []Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~t Spill Box # Spill Box # Spill Box # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R0: Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: Comments - finclude inJbrmation on repairs made prior to testing, and recommended follow-up for failed tests) RICH ENVIRONMENTAL 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE(661)392-8687 & FAX(661)392-0621 ALERT 1000 UNDERFILL AND ALERT 1050X ULLAGE SYSTEM Precision Underground Storage Tank SystEm Leak Test TEST RESULTS .- ..... BILLING:KERN CONSTRUCTION / SITE:CIRCLE K 8605 P.O. BOX 6096 ~ 5600 AUBURN ST / BAKERSFIELD, CA 93386 k BAKERSFIELD, C~ PRODUCT VOLUME %FULL WETTED NON-WET%ED PRODUCT LE~ WATER IN (GAL) PORTION PORTION~ LINE DETECTOR TANK UNL-87 9816 74% -.016-PASS PASS -.0~=~K~SN/A 0" UNL-89 9816 71% +.022-PASS PASS -.000-PASS N/A 0" PREM-91 9816 749 +.015-PASS PASS -.002-PASS N/A 0" WATER BALANCE Measurements showed that water in the backfill area at the time of testing was below tank bottom, and therefore not a facter in test determination. A monitoring well or a well point was driven in the backfill area to determine that there is no water in the backfill at tank bottom. A precision test was performed on tanks at the above, location using the Alert 1000 underfill system and the Alert 1050 ullage system. I have reviewed the data produced in conjunction with this test for purpose of verifying the results and certifying the tank systems. The testing was performed in acorrdance with Alert protocol, and therefore satisfies all requirements for such testing as set forth by NFPA 329-92 and USEPA 40 CFR part 280. The results of testing are shown on the following page, and indicate whether the wetted and non-wetted portion passed or failed. Included with the report are reproduction of data compiled during the test which formed.the basis for these conclusion. This information is stored in a permanent file if future verification of test results is needed. ALkNC 040 Test Certified By: rt#99-1072 ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA CIRCLE K 8605 5600 AUBURN ST. BAKERSFIELD, CA 93306 9816 GALLON UNL-87 TANK ~2KHz AMPLITUDE RATIO 25KHz AMPLITUDE RATIO 0.75 ~ 5 750+ 0 75 ~ 5 750+ M M I I N N U U T T E 3 E 3 S S 5 5 12KHz DETECTTON RATIO = .998 25KHz DETECTION RATIO = .999 TEST RESULT = PASS DATE AND TIME OF TEST' 8/26/02 2: 39PM BEGINNING BOTTLE PRESSURE = 3200 ENDING BOTTLE PRESSURE = 2700 BEGINNING TANK PRESSURE = 1.5 PSZG ENDING TANK PRESSURE = 1.5 PSZG ALERT TECHNOL OGLES PLO T OF ULLA GE TEST DA TA CIRCLE K 8605 5600 AUBURN ST. BAKERSFIELD, CA 93306 9816 GALLON UNL-89 TANK ~2KHz AMPLITUDE RATIO 25KHz AMPLITUDE RATIO 0 75 ~ 5 750+ 0.75 ~ 5 750+ M M N N U U T T E 3 E 3 S S 5. t 5 12KHZ DETECTION RATIO = 1.O0 25KHZ DETECTION RATIO = 1.00 TEST RESULT = PASS DATE AND.TIME OF TEST: 8/26/02 3: &4PM BEGINNING BOTTLE PRESSURE = 3200 ENDING BOTTLE PRESSURE = ~800 BEGINNING TANK PRESSURE = &.5 PSIG ENDING TANK PRESSURE = ¢.5 PSIG ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA CIRCLE K 8605 5600 AUBURN ST. BAKERSFIELD, CA 93306 9816 GALLON PREM-9~ TANK ¢2KHZ AMPLITUDE RATIO 25KHZ AMPLITUDE RATIO 0 75 1 5 750+ 0 75 ~ 5 750+ M M I I N N U U T T E 3 E 3 S S ~2KHz OETECTION RATIO = .997 25KHz DETECTION RATIO = .997 TEST RESULT = PASS DATE AND TIME OF TEST: 8/26/02 2: 54PM BEGINNING BOTTLE PRESSURE = 3200 ENDING BOTTLE PRESSURE = 2200 BEGINNING TANK PRESSURE = ~.5 PSZG ENDING TANK PRESSURE = ~.5 PSIG RICH ENVIRO~NTAL 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE (661) 392-8687 & FAX (661) 392-0621 ACURITE TM PIPELINE TESTER WORK SHEET DATE: ~'~-O~ W/0#: Facility Name: d.l~d.L~ 14. ~(~ o ~ Facility Address: ~-"C~©O ~O~O~/kJ ~/~~~LD,~/~ Pump Man'ufacturer: ~f~ ~f~--- Isolation Mechanism: PRODUCT START TIME END TIME TEST VOLUME RESULT /READING /READING PRESSURE RATE PASS/ 00: 00/GPH 00: 00/GPH (PSI) (GPH) FAIL I certify that the above line tests were conducted according to the equipment manufacturer's procedures. The results as listed are to my knowledge true and correct. The test pass/fail is determined using a threshold of 190 ml per hour (0.05 GPH) rate at 1 1/2 times working pressure or 50 psi which ever is greater. Tech: JAMES J. RICH State License:# 99-1072 Slgnatur MFG. CERTI FtCATION: # 601.LT SWKCi!I January, 2002 . Page __ of __ SecondarY ontainment Testing Repo 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), shouM be provided to the facility owner~operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Bakersfield 76 2608605 I Date of Testing: 8/612002 Facility Address: 5600 Auburn St. Bakersfield CA 93306 Facility Contact: I Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Shirley Environmental Testing Technician Conducting Test: Robert Vargas Credentials: [] CSLB Licensed Contractor [] SWRCB Licensed Tank Tester License Type: [ License Number: 7988112 Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Not Repairs Component Pass Fail Not Repairs: Component Pass Fail Tested Made Tested Made STP 87 X STP 89 x STP 91 X Disp 1-2 X Disp 3-4 x If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFIC~T_I~ OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING ~ the best ~f my ~n~wle~ 5f~7tated in this ~c~e ac~urate and in fu~l c~mp~iance wit~ lega~ requirements Technician's Signature:~- ~-~/~e--,.- g/ ~/'/~---~ - ,5 ~ Date: 8/6/2002 ? SWRC~3 January, 2002 Page __ of __ 4. TANK ANNULAR TESTING Test Method Developed By: [] Tank Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: I Equipment Resolution: Tank # Tank # Tank # Is Tank Exempt From Testing?~ [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Tank Capacity: Tank Material: Tank Manufacturer: Product Stored: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R0: Test End Time: Final Reading (Rr): Test Duration: Change in Reading (R~-R~): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Yes []No []1~ []Yes []No []1~ -lYes []INO []1~ []Yes []NO []NI~ Was sensor properly replaced and verified functional after testing? [] Yes [] No [] I~ [] Yes [] NO [] I~ "! Yes [] No [] I~ [] Yes [] No [] I~ Comments - (include in~forrnation on repairs rnade prior to testing, and recommended follow-up for failed tests) t Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB January, 2002 Page __ of__ 5. SECONDARY PIPE TESTIN~ Test Method Developed By: [] Piping Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~1~~ Piping Run # 91 Piping Run # 89 Piping Run # 87 Piping Run # Piping Material: Environ Environ Environ Piping Manufacturer: Piping Diameter: Length of Piping Run: Product Stored: Premium Plus Unleaded Method and location of DW/ST DWIST DW/ST piping-mn isolation: Wait time between applying pressure/vacuum/water and 5 Min 5 Min 5 'Min starting test: Test Start Time: 11:14 11:14 11:14 Initial Reading (R~): 4.7343 3.2577 4.1206 Test End Time: 11:29 11:29 11:29 Final Reading (RF): 4.7350 3.2578 4.1261 Test Duration: 15 Min 15 Min 15 Min Change in Reading (RF-R0: -.0007 -.0001 -.0055 Pass/Fail Threshold or PASSED PASSED PASSED Criteria: Test Result: Comments - (include information on repairs made prior to testing, and recomrnended follow-up for failed tests) SWRCB January, 2002 Page __ of__ 6. PIPING SUMP TESTING Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: Sump # Sump # Sump # Sump # Sump Diameter: Sump Depth: Sump Material: Height from Tank Top to Top of Highest Piping Penetration: Height fxom Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Testedt Does turbine shut down when sump sensor detects liquid (both []Yes []NO []~ []Yes []NO []1~ []Yes []NO []l~ []Yes []No []l~ product and water)?* Turbine shutdown response time Is system programmed for fail-safe []Yes []NO []!~ []Yes []NO []I~, []Yes []NO []l~ []Yes []NO []l~ shutdown?* Was fail-safe verified to be · 9' DYes •NO []NA operational. Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (Ri): Test End Time: Final Reading (R~): Test Duration: Change in Reading (R~-R~): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Yes []NO []NA []Yes []NO []~ []Yes []NO []~ []Yes []NO []NA Was sensor properly replaced and verified functional after testing? []Yes [] No []NA []Yes []NO []NA []yes []NO []NA []yes []NO []NA Comments - (include in~)rrnafion on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the sump is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) · SWKCB January, 2002 ~ Page __ of __ 7. UNDER-DISPENSER'I2ONT~NT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer ' [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: t~"¢ ,~ ,~! .... ~l~: UDC # 1-2 UDC # 3-4 UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height fi-om UDC Bottom to Top of Highest Piping Penetration: Height fi-om UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested~ Does turbine shut down when UDC sensor detects liquid (both [] Yes [] bio [] ~ [] Yes [] I~o [] ~ [] Yes I-Ii [qo [] ~ [] Yes [] I~o [] product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* t-lYes []l~o []lq~ I-lYes []l~o []lq~, []Yes []l~o []lq~ []Yes []lqo []lq~ Was fail-safe verified to be []Yes [-II~o []lq~ []Yes [-II~o []l~, I-lYes []bio []Ra, []Yes I-ll~o []l~, operational?* Wait time between applying pressure/vacuum/water and 5 I~lin 5 ~lin starting test Test Start Time: 115:3~ Initial Reading (R0: 1.2014 ~.~ 464 Test End Time: '115:415 ~15:415 Final Reading (RE): '1.2032 1.14t52 Test Duration: ~$ Min ~$ I~lin Change in Reading (RF-Ri): -.00~ 8 ,0002 Pass/Fail Threshold or Criteria: ~ ~ , ~'"~ Was sensor removed for testing? [] Yes [] ~ [] I~ [] Yes [] I~o [] Ra, [] Yes [] I~o [] I~ [] Yes [] Was sensor properly replaced and verified functional after testing? [] Yes [] I~o [] ~ [] Yes [] [4o [] ~ [] Yes [] [4o [] [q~ [] Yes [] Comments - (include infi>rmation on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the UDC is not tested, specify how much was tested. If the answer to any of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) · SWRCB January, 2002 Page __ of__ 8. RISER CONTAINMENT SUMP TEStinG Facility is Not Equipped With Fill Riser Containment Sumps [] Fill Riser Containment Sumps are Present, but were Not Tested [] Test Method Developed By: [] Sump Manufacturer [] Industry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: [ Equipment Resolution: , ~ ~.~'~ Fill Sump # Fill Sump # Fill Sump # Fill Sump # Sump Diameter: Sump Depth: Height from Tank Top to Top of Highest Piping Penetration: Height from Tank Top to Lowest Electrical Penetration: Condition of sump prior to testing: Portion of Sump Tested Sump Material: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R~): Test End Time: Final Reading (RE): Test Duration: Change in Reading (RF-Rt): Pass/Fail Threshold or Criteria: Test Result: []~ss~ .......... : ""~'~ []~all~"~'~'~"~:~' ~-~' :~ ~ass ~:,~a i , ~ "'""~::"'~"~%¢ []:~:::~'~'~::': ~ ~ ~a,,,'.S.~ ~ ..... ~"~ Is there a sensor in the sump? [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Does the sensor alarm when either product or water is []Yes []No []Nt~ []Yes []No []NA []Yes []No []l~ []Yes []No []1~ detected? Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []1~, Was sensor properly replaced and verified functional after testing? [] Yes [] No [] NA [] Yes [] No [] NA [] Yes [] NO [] NA [] Yes [] No [] NA Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ SWRCB January, 2002 Page __ of__ 9. SPILL/OVERFILL CONTAINMENT BOXES Facility is Not Equipped With Spill/Overfill Containment Boxes [] Spill/Overfill Containment Boxes are Present, but were Not Tested [] Test Method Developed By: [] Spill Bucket Manufacturer [] Industry Standard [-]Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: Spill Box Spill Spill Hi Box # Box # Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R0: Test End Time: Final Reading (RE): Test Duration: Change in Reading (RE-R~): Pass/Fail Threshold or Criteria: ~',~ass ~,~, Test Result: Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 07/24/2002 23:32 8185674273 OPM PAGE 02/02 (~~ O~Ct E~O~ENTAL SER~CES OF 1715 Chester' Ave.;.Bake~fi~'CA (661)32~3979':.., "~ PERMIT APPIACATION TO CONSTRU~OD~ UNDERGROUND STORAGE [ ~ ~~ ~~r~ ~ ~o~x. { 1~ T~ ~~~ ~T ~T~.~~ ~~0._ T~ CfF:CL~ K 8605 BE, FiLl ~LIBLIRN BAt(EF:::_;FIELD C'~ 9330E, 661 --871 -7979 ALk~ 26, 2002 2:24 PPI SYSTEP1 S]'W?IJS P, EI:"OIFT FIJNCT I ¢_'iNS NOP-.I"'IGL T 1: Lff',ILE&DED VOLUME = 7401 LILI.,GOE = 2415 90~!.;; ULLAGE= 14'3:3 TC VOLUP1E = 7253 HEIGHT = 63.65 II',iC;14ES WATER VOL--= 0 GALS W~'TEP. = O. O0 [NCHES TEMI::' = 88.5 I-)EL; F T 2 :PLUS VOLLiNE = 7141 (;aLS ULLA{]E = 2675 GaLS 90::'..;:: IJLLAGE= 169:3 '.]ALS TC VOLUI'.'IE = ?126 GaLS ~T = 61.E,:] INCHES = 0,00 1NCHES TEPlP = 88.8 DEGF T :3 ;PREMI UP1 VOLUME = 7435 GALS ULLAGE = 2;381 GALS; 90;',:: ULLAGE= 1,'399 GALE; TC VOLUME = 7279 GALF.', HEIGHT = E,:2:.91 1NCHE~;; WATER VOL = I:,ihTER = O. O0 I N'C:HES TEHP = 89.9 DEGF ..... SENSOR ALARM ......... L 2: UI',gLE~DED--:-S'UMP STP SUMP FUEL aUG :36. "-:.LL~.-'-' ..... ,'SENSOR aLaRM L 4 :I:"LuS-SUPlt:' STP SUMP FUEl. au,.; 3E,, 2oo':.' 3: '.2a PM .......... SENSC>R aI..aRI',l ......... L F~: I:'REPII UM-S;iJMP STI::' SUMP FUEL aLaRM aUG 26. 2002 2:30 PPI CITY OF BAK~SFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661)326-3979 I. NSPE(;'TION RE(;ORD POST CARD AT JOB SITE INSTRU~IONS{ Ple~e call for m ins~tor only whm ~h ~up o~i~tions ~th ~he ~ numar ~ ~y. They will mn in cons~utive o~er be~nning numar 1. ~ NOT cover work for my num~ ~up ~til all it~ in t~ ~up ~ si~ offby t~ Pe~iuing Authofi~. Follo~ng th~ instructions will ~uce the ~SPE~ON J DATE J ~SPE~OR ~kfiil of T~(s) Sp~ T~ Cenifica6on or M~uf~/u~ M~ Cambric Proration o~T~k(s) I El~cal l~laaon ofPip~g F~ Ca~ic Pmt~6on S~-Piplng SECONDARY CO~AIN~, O~ILL PR~ION, LEAK DETE~ION Liner l~mll~ion - T~k(.S) Liner [ns~llation - Piping Vault With ~uct Com~le ~1~ ~el Oaug~ ot S~n, ~t V~t P~uct Compmible Fill P~uct Line Leak ~t~to~s) L~ ~tect~s) for Annual Sp~c-D.W. T~k(s) Monito~n8 Wcll(s~Sum~s) - H20 Test Leak ~tion ~vic~s) ~or V~o~Omund~tcr P~vcntion Boxes Monitodng Wells, Caps & ~ks ~ .... Fill Box L~k Authofi~tion for Fuel Drop plOlOlO6.jpg (1280xg60x24bjpeg) 08/81/2882 23:45 8185674273 QPM PAGE 82/82 o~c~ o~ ~o~~~ 171$ Ch~' A~--B~~~'C~' (~1)' 32~9~',, -- I / 07/24/2882 23:32 8185674273 {~PH PAGE 02/02 CI~' O~ Bg~'HEL~*' t OmCE OF E~O~ENTAL SERmCES , . (661) 1715 hester A~,;,Bake~fid~'cA 32~3979'" ," /- ''~ PERM/T APPliCATION TO CONSTRUCT/MODiFY UNDKRGROUND ~TOI~GE LLC Quality Project Management, L.L.C. 2109 S748th. :., Suite 101 85282 Phone: ~175 Fax: (602) 4~ 6 LETTER OF TRA .L ARE SE~ING YOU: ~ A~ch~ ~ Under ' v~ ~e foQow~ i~: Bid ~~ Field Re~ Co~ies Date ~sc~tion ~SE ARE T~SM~D AS C~ED BELOW: ~ For appmv~ ~ Approv~ ~ su~ ~ Re~t copies for approv~ ~For yo~ ~ ~ App~v~ as nord ~ ~t copi~ for ~on ~ ~ r~ues~ ~ Re~ for ~viiom ~ For ~view ~d co--mt ~ For r~iew ~d si~ ~ FO~ m~ R~: CC: Si~ed: 10:14 ~'661 326 0576 BFD BAZ ~T DIV ~]001 CITY OF BAKERSFIELD '"~A.. ~'" ~-~ o~ ~'~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYpE OF APPLICATION (CI-IECK) [ ]NEW FACILITY [~0MODIFICATION OF FACILITY [ INE~ TANK INSTALLATION AT ~XI~I'tNO FACILITY PROPOSED COMPLWI]ON DATI~ , 'PERMIT NO- 'rvP~ o~ susu~ss A~N # TANK OW'NF~ PHONE NO. 7/~. BAK{mS~UELO crrv Busu~I~S UCI~E ~O~ · -_~y.~,~.~ wo~ COMP ~O. nvsumm DElrtHTOOROUI~WATER /7<' ..- sOu. rn,£ma,~moATsrr£ ~~ ~r ' NO. OFTANESTOEIEINSTALLED~[- ~ ,ARETI-IEYFORMOTORPUEL--~ YF_~- ~NO SPILL PREVENTION CONTROL AND GOUNTERMEA$URF~ PLAN Obi FILE _ TANK NO. VOLUME UNLEADED P~OULAR PREMIUM DIESEL AVIATION $~'T~flN sOR NON ,M OTOR~ STO~GZ TANKS 0~o SRA~ ~ ~ g~OW~ FOR OFFICIAL U~R ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE A~ACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULAT IONS. f / THis FDRM HAS BEEN COMP LETED UNDEK PENALT¥ OF PERJURY, AND TO T~ BF. ST~O~MY KNOWLEDGE, IS ' APPROV~ nV': "-'" API'LICANT ~AM£ 0'R.UVTi ' ~e~C~NT SiON^'ruRE THIS APPLICATION BECOMES A PIXEMIT V~m,~ APPROVED ~, . ~07/0S/2002 12:00 310~7999S4 PETC~N TECH INC PAGE 82 PETCON TECHNOLOGIES IgC. July 9, 2002 To Whom It May Concern: I, Oytun Turumtay, Treasurer of Petcon Technologies lnG., give ;authorization to Mr. Anthony Elliott to obtain any permits, licenses or any other necessary documentation on our behalf for any Phillips Petroleum/Tosco/Phillips 66 Company service station located in California. I4118 8, Inglewo0d Avanu~ Hm~ta~e. CA ~2S0 · CA Contractor License #675998 A, C10, Haz · Workers Compensation Insurance policy ~K}46-02, unit 0006359, T ~'~0 eT~ ~ expires 1103 r 31067~ ~ · City of Bakersfield Business License fK)2-58725 (as of yet, have not received hard copy) If you have any questions or need any additional information, please do not rena~~.c~ hesitate to contact me at (310) 679-9991. ~w~.oom Thank O~un Turuml~y, Tin,suer ~.~ ~;07/09/2002 12:00 3106799994 PETCON TEOH INC CERTIFICATE ~ A~N" HORKERS' CORPENSATION DEPARTHENT / '" : ~' u:o..: ~u~.~ · ~, P 0 Box 26000 ' SACRAMENTO CA, .: ~s i$ tO e~y ~ we ~e i~ued a vMid Wo~ers' C~p~On tns~ee policy in a form appraised by the C~lfornia Ins~ce Commlsslone~ to ~ ~ploy~ n~ed below for ~e policy period indieate~ ~is policy iS ~t subject to ~ellati~ by ~e Fund except ~on aOd~S' advance wr~en fleti~e to t~e employer. We will aisc give you, g~;~a~' ~ance notice sh~ld ~is policy ~ c~celled prior t~ '~s. no~l. &xpiratie~ . ~ : · ~. , This ~ii~e ~f ~ins~r~ce is n~t ~ in's~a~e .policy a~ does ~t a~n~. ex, fid' of altar ~e .covenlge ~fforded polici~ des~ibed herein is subject to all ~e ~s, exclusions ana conap!ohs e~ SUCh ~llcles. :. ~ .~ '~ :, ~., . ~. , . ~ ~ · ~ · ..... 't E~OYER'~ LZABZL~T~ 'L 't EN~E,E~'"a2e~. ' ~...,~ . : ........ ~ ;~.'..., .,.. ~,...,, :~. ........ ~. .............. ~ ~ :., : · ..~. ~..... ~.~..- . . . . , .. .,. .... . ~ .¢ ...... - =- , . .... ,..-..:.... .. ,:. .,~ ........ , U,~.~ ...... --"- : . " ' ' ' · . '.' ",'..:: .". :; ". "' ~. -',:. :~:'..:,.":~RI~:. '1~-~1, P04'~0 State of California CONIRA¢IOR$ SLATE UCEN$~ BOARD ACTIVE UCENSE 07/17/2082 12:85 3186799994 PETCOH TECH IHC PAGE 82 PROJECT SPECIFICS 'TOSCO SITE/12708605 5600 AUBURN ST. BAKERSFIELD, CA TI-IIS PLAN ADDRESSES WORKER AND COMMUNITY HEALTH AND SAFETY CONCERNS AND ACTIVITIES ASSOCIATED WITH THE ARCO SERVICE STATION #2708605 AT $600 AUBURN, BAKERSFIELD, CALIFORNIA. TI-IE PLAN WILL BE IMPLEMENTED DURING ALL PHASES OF THE ON SITE WORK. ALL PETCON TECHNOLOGIES INC. PERSONNEL, SUB-CO~CTOR AND/OR THIRD PARTIES V~TIICH MAY ENTER THE SITE ARE REQUIRED TO COMPLY WITH ELA. S.P. AT ALL TIMES. SITE MANAGER:. THE SITE MANAGER HAS OVER-ALL PROJECT RESPONSIBILITY FOR THE DEVELOPME2XIT, COORDINATION', AND IMPLEMENTATION OF 2TIE TOSCO SERVICE STATIOI~[ #2708605 WORK PLAN IN A SAFE MANNER. THE S1TE MANAGER IS ALSO RESPONSIBLE FOR TI-IE IMPLEMENTING OF AS WELL AS SUPERVISING THE FIELD TEAM MEMBERS. THE SITE MANAGER FOR THIS SITE IS JESSIE ORNELAS OF PETCON TECHNOLOGIES INC. 07/17/2002 12:05 31067gSSS4 PETCON TECH INO PAGE 03 E,MERGENCY ASSISTANCE INFORMA,, TION NEAREST FIRE DEPARTMENT AND PARAMEDIC LOCATION: FIRE STATION 911 2213 UNIVERSITY AVE. BAKERSFIELD, CA GEN. NON-EMERGENCY #: (661) 631-8421 NEAREST HOSPITAL WITH EMERGENCY ROOM: KERN MEDICAL CENTER (661) 326-2000 1830 FLOWER BAKERSFIELD, CA SITE MANAGER: JESSIE ORNELAS OFFICE HOURS 7:00 AM TO 3:30 PM (310) 679-9991 FIELD HOURS 7:00 AM TO 3:30 PM (213) 761-2091 AFTER OFFICE HOURS (213) 761-2091 87/:1.7/2882 ~.2:05 3106799994 PETCON TECH ZNC PAGE 04 MapQuesI: Driving Directio~: North America Page 1 of 2 Iqetscape Presents Home 114e~ ~iI driving directions · Europe r~0 Auburn ~t 22t3 University Ave · ~yed R~ut~ Ehakersfield, CA I~immfleld, CA ~ U8 US Tolal DI~IUt~: ~.00 miles Tat=! Eefinmted Time: ~ mlnul~s Whats ~: ~ out gOl~ ESst on AUBURN 8T ~ FAIRF~ RD 0.05 2: Turn RIG~ onto FNRF~ RD, 0.~ miles 3: T~e ~-178, 1,94 miles 4: Ta~ ~e ~ ~RNON A~NUE ~t. 0.19 mil~ ~ 6: Turn RIOHT on~ MT ~RN~ A~. 0.68 6: Turn LEFT Mto UNI~RSI~ A~. 0.~ miles D~nce; B minu~ 3,00 mile~ Yellow ~ RO~ O~R~: http:llwww.mapquest.comldirectionslmain.adp?lg=cR9JOorrUaUAbShXO2valAO/;25... 7/17/02 07/i7/2882 12:85 3186799994 PETCOH TECH :[NC PAGE 85 ~-~ ~ , iviapc, luest: Driving Directi~i: North America Page 2 of 2 DESTI~TION: 2~ ~n~m~ Ave ~ , ..=.:j ~-;,~= ~"~.~.~==:~, [i,~.~~ ....... ~ ~M~T~ ~ T~ ~ ~-~-TUmlM~T~ ~ ~$imcttona ore ~ only. No repreaemal~n Is m~ or warrml[y glvan as M tl~Oir contm~ mad om~ditlorm or route ~81~i~1~ or e~dl'douafle~s, U~t aSsumea all ~ ~ ~e, ~t ~ ~ ~e I~ I ~ Ma~ I Pam~ J MapS~ J H~ ~ P~ Poli~ & ~6( Notre ~ 2~ MapQu~t.~m, Inc. All ~hffi ~e~. http:llwww, mapquest, com/directionslmain.adp ?l g=cR9JOorrUaUAbShXO2valA%25... 7/17/02 07/17/2002 12:05 3106799994 PETCON TECH INC , PAGE 06 :. Map~uest: Driving Directio~North America Page I of 2 INetscape Presents Home I Ha~ ~ driving directions · .o,~A..r,~ MOM: m~ t~,,x~ ~'~-~. · E~ ~09 Auburn ~t 1~ F~r 8t , ~ved Ro~s* ~ke~ld, CA ~eM, ~ ~ ~ US To~I O~: 3.51 mll~ Tebl ~6~ Time: 6 minums ~=~ mil~ ~r: . ~-- ~REC~QN8 D~TANGE ~: Sm~ outgoing East ~ ~UBU~ ST t~ F~RF~ RD, 0.~ miles ~ 2: Turn RIGHT onto FAIRF~ RD, 0.09 3: T~e ~-178. 1,94 miles 4: Take t~ ~ ~RNON A~NUE ~t. 0.19 ~ 6: S~y s~ight ~ go 0~o HEIGHT ST, 0.01 mil~ 6: Turn LE~ on~ MT ~RN~ A~, 0.97 7: Turn RIGHT 0~o FLOR ST, 0.28 miles Dis~n~: 6 minu~ 3.Et Yellow ~ re. ir RO~ ~ ':' ....~' ~ ~ ~ ~b ~ Zoom In ~ Ro-~n~r http://www, mapquest,comldirec=tions/main.adp?1g=cR9JOorrUaUAbShX02valA%25... 7/17/02 87/17/2882 12:85 3186799994 PETCONTECH 7'NC PAGE 87 ~apuuesz: unwng Directio~ North America Page 2 of 2 http :l/www.mapquest. comldimctionslmain,adp ?1g=cR9JOorrUaUAbShX O2valA %25.. . 7/17/02 May 29, 2002 Circle K 5600 Auburn Street Bakersfield, CA,93306 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 5600 Auburn Street FIRE CHIEF REMINDER NOTICE RON FR~E Dear Tank Owner/Operator: ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 The purpose of this letter is to inform you about the new provisions in California VOICE (661) 326-3941 FAX (661) 395-1349 Law requiring periodic testing of the secondary containment of underground storage tank systems. SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 Senate Bill 989 became effective January 1, 2002. section 25284.1 (California VOICE (661) 326-3941 Health & Safety Code) of the new law mandates testing of secondary containment FAX (661) 395-1349 components upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are PREVENTION SERVICES 1715 CheslerAve. detected and removed. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 Secondary containment systems installed on or after January 1,2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. ENVIRONMENTAL SERVICES Secondary containment systems installed prior to January 1,2001 shall be tested by 1715 Chester Ave. Bakersfield, CA 93301 January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component VOICE (661) 326-3979 that is "double-wall" in your tank system must be tested. FAX (661) 326-0576 TRAINING DIVISION Secondary containment testing shall require a permit issued thru this office, and 5642 victor Ave. shall be performed by either a licensed tank tester or licensed tank installer. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Please bc advised that there are only a few contractors who specialize and have thc proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures 05/01/2002 18:18 3106799994 PETCON TECH INC PAGE 03 ..................................... ~-,"'.~ :.~"~`~.~.~`"...~`~.~r"~;.~`.~:~¢"~n~;~;~`~ -'*"'" i '-'f~' "'~,'c~2~f""".~'~'~':~:"~'".';~'?"~;~ 04/2g/02 15:15 ~8811 0578 B~ ~Z ~T DIV ~0o5 OffiCE OF E~O~~~ SER3;~C~ 1715 C~~~ter Ave.,. B~e~~, CA (661) 3.26-3979 ~LI~ON TO PE~O~ A T~ ~G~~SS TEST/ SECO~RY CO~A~NT ~T~G FAX~rransmittal COVER SHEET FIRE DEPARTMENT PREVENTION SERVICES 1715 Chester Avenue · Bakersfield, CA 93301 Business Phone (661) 326-3979 · FAX (661) 326-0576 COMPANY: '"'"~'~--'~ CO~ ~i~'~-~,.,~~.~--- FAX NO.: ~ lb -' ~'~q"q~f FROM: ~t~ L~~~~ ~ II II COMMENTS: 05/02/02 08:54 '~661 326 0576 BFD HAZ MAT DIV ~001 *** ACTIVITY REPORT *** TRANSMISSION OK TX/RX NO. 4058 CONNECTION TEL 13106799994 CONNECTION ID START TIME 05/02 08:51 USAGE TIME 02'46 PAGES 3 RESULT OK D FIRE April 17, 2002 Circle K 5600 Auburn F~RE CHIEF Bakersfield CA 93306 RON FRAZE ADMINISTRATIVE SERVICES RE: Necessary Secondary Containment Testing Required by December 31, 2002 2101 "H" Street Bakersfield, CA 93301 VOICE (661)326-3941 REMINDER NOTICE FAX (661) 395-1349 SUPPRESSION SERVICES Dear Tank Owner/Operator: 2101 'H" Street Bakersfield, CA 93301 Thc purpose of this letter is to inform you about the new provisions in California law VOICE (661) 326-3941 FAX (661) 395-1349 requiring periodic testing of the secondary containment of underground storage tank systems. PREVENTION SERVICES 1715 ChesterAve. Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & Bakersfield, CA 93301 VOICE (661) 326-3951 Safety Code) of thc new law mandates testing of secondary containment components FAX (661) 326-0576 upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Secondary containment systems installed on or after January 1,2001 shall be tested upon VOICE (661)326-3979 installation, six months after installation, and every 36 months thereafter. Secondary FAX (661) 326-0576 containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every 36 months thereafter. TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 Secondary containment testing shall require a permit issued thru this office, and shall be VOICE (661) 399-4697 performed by either a licensed tank tester or licensed tank installer. FAX (661) 399-5763 Please be advised that there are only a few contractors who specialize ahd have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures ' gle Environmental, Inc. Date: ~I {~OZl Attn: Steve Underwood City Of Bakersfield Fire Department 1715 Chester Avenue, Third Floor Bakersfield, CA 93301 Re: UST System Test Results Please find attached the tank/line/leak detector test and/or monitor certification results for Tosco Marketing Company facility(les) in your jurisdiction. If you have any questions regarding the attached please call (818) 840-7020. Triangle Eiqvironmental, Inc. For Tosco Marketing Company Attachments cc: Tosco Deale~ - Please file the attached test results in your Tosco Compliance binder. Thank you for your cooperation. Site# Test Date Site# Test Date 2525 W. BURBANK BLVD., BURBANK, CA 91505-2302 . TEL:(818) 840-7020 ° FAX:(818) 840-6929 Triangle Environmental,' Inc. 2525 West Burbank Blvd., Burbank, CA 91505-2302 (818) 840-7020 (818) 840-6929 US T TESTING SYSTEMS SUMMARY SHEET Precision Underground Storage Tank System Leak Test Client: :: Phillips 66 Company Phillips Facility # 08605 1500 North Priest Drive Tempe, AZ 85281 Test Date: 3/4/02 Kathy StdckLand (602) 728-7149 Facility:. 2708605 Work #: 302363 Phillips Facility # 08605 County: KERN 5600 AUBURN ST Cross Street: FAIR.FAX ROAD BAKERSFIELD, CA 93306 Tank Test System Tank Line # Product Capacity Type Rate/Results Ullage Result Rate/Result L/D Result Certified By: Technician: Ed Justice State Lic. Os: CA-1624 Comments: Monitor certification This precision tank testing system has been third party evaluated according to the guidelines of the EPA procedures for annual leak detection systems and found to exceed the criteria of detecting a leak of 0.10 gph with a Pd >95% and Pfa <5% as required by Local, State and Federal EPA UST Technical Standards Part 280 for precision testing systems. This SB-989 secondary containment testing system exceeds the criteria for detection as required by state and local agencies. Triangle Environmental, Inc. US T MONITOR CER T!FICA TION S UMMAR Y SHEE T Client: Phillips 66 Company 1500 North Priest Drive Phillips Facility # 08605 Tempe, AZ 85281 :: Test Date: 3/4/02 Facility: Phillips Facility # 08605 Work#: 30?363 County: KERN 5600 AUBURN ST Cross Street: FAIRFAX ROAD BAKERSFIELD,, CA 93306 Monitor model: VEEDER-ROOT TLS-350 Serial #: 80648964705001 Certification Result: PASS Sensor Type: Quantity: Result: Tank Annular : 3 PASS Annular Type: DRY Waste Oil Annular: 0 N/A Audible Alarm? Yes Waste Oil Sump: 0 N/A Visual Alarm? Yes VadoSe Wells :~' 0 N/A Fail Safe? Yes Line Pressure: 3 PASS Positive Shut-off? Yes Turbine Sump: 3 PASS Gauge Only Result: PASS Line Trench: 0 N/A ATG Monthly? No Fill Sump: 0 N/A ATG CSLD? 'No Comments: This certifies that the monitor and sensors, as listed above, are operational and calibrated per the manufacturer's specification. Inspected By: ~~.~ Ed Justice Triangle Environmental, Inc. UST FA CILITY INSPECTION/A UDIT SHEET Facility: Test Date: 3/4/02 Phillips Facility # 08605 5600 AUBURN ST BAKERSFIELD, CA 93306 County: KERN Cross Street: FAIRFAX ROAD Work #: 302363 -- Status -- Type 'Number of N= Not Present or Observed C= Coaxial P= Pressure F = Flex Disp. Hoses S= Satisfactory D= I~ual A= Angle Cl~eck M= Metalic U= Unsatisfactory N= No Sage I W Vertical Ch~ Regular: 4 4 Fill Cover: S Plus: 4 4 Fill Cap: S Fill Type: D Premium: 4 4 Fill Cap Seal: S Product Line Type: P Diesel: Drop Tube: S Tank Swing Joint Type: F Kerosene: Strike Plate: G Dispenser Swing Joint Type: F Total # of Gas Nozzles: 4 V/R Cover: S ~ Status N=Not Present ~ Stage II V/R Cap: S s=satisactory U= Unsaelsfaetory B= Balance V/R Seal: ' S Impact Valve: S A=A~ V/R Dry Break: S Vertical Check Valve: N System Type: A Sub Pump: S Fill Spill Containment: S Assist Mfgr: GILBARCO Sub Pump Cover: S Fill Spill Mfgr: OPW Overfill: S Dispenser Containment: U Overfill Mfgr: OPW Sub Pump Containment: S Comments: Compliance Detail: (List items that need immediate attention.) - ALARM D I SABLED ============================= : :.:::: SYBTEM $ETU~ · PORT SETTINGS: PERIODIO TEBT FAIL · :': :::::?::. :::::...::::. MAR 4. 2002 12~17 PM NONE FOUND GROSS TEST FAIL RS-232 SECURITY ~YSTE;~ UNITS ~ ANN TEST AVERAGING: OFF U.S. PER TE~T AVERAGING; OFF SYSTE~ LANGUAGE ENGLISH TA~K TEST NOTIFY; OFF ~0~ DD YYYy HH;~X;~8 x~ RS-232 END OF MESSAOE TNK TST SIPHON BREAK;OFF D I SABLED .. ' : ..... :::.:~::.. CIRCLE K 8605 '~ DELIVERY DELAY ; 2 ~IN 5600 AUBURN : 661-871-7979 : ~ SHIFT TIME 1 ; 6;00 AM SHIFT TIME 3 ; DISABLED SHIFT TIME 4 ; DISABLED " TANK PERIODIC WARNINGS D I SABLED I N-TANK SETUP ~ ' T 2:PLUS T~NK ~NNU~L WARNINGS ; PRODUCT CODE : 2 LINE PERIODIC ~RNING$ ~ T I:UNLE~DED THERMAL COEFF :.000070 · : LINE ~NNU~L WARNINGS THERMAL COEFF :.000700 T~NK PROFILE : 4 PT$ J ~ TANK PROFILE : 4 PTS 69.0 INCH VOL : : ::::' PRINT TC VOLUMES FULL VOL : 9816 46.0 INCH VOL : 4992 46.0 INCH VOL : STICK NEI~NT OFFSET ' ~ " PRECISION TEST DURATION ' NIGH ~ATER LIMIT: 3.0 NOU~S: 12 W~TER ~RNING : 2.0 ~ DAYLIGHT SAVING TIME HIGH MATER LIJ~IT: 3.0 ':"' MAX OR L~EL VOL: 9816 ;: EN~LED OVERFILL LI~IT : 90% ' . ' : $T~T D~TE M~X OR L~BEL VOL: 9816 ~ : ': ..... : .... ' ~PR ~EEK 1 SUI~ OVERFILL LIMIT : ~0% HIGH PRODUCT : 2:00 ~M HIGH PRODUCT : 95% ,,~,,DELIVERY LIMIT : END D~TE : 932~ : OCT WEEK 6 SUN DELIVERY LIMIT : END TIME :::: : 490 LO~ PRODUCT : 500 2:00 ~M LEAK ALARM LIMIT: LEAK MIN ANNUAL : 10~ -':.zez.-~'~-- :~ '- ',,:' ~:, :,'.: ;':,,~' :. ,: -',- :. :': ................... :.: ,:.. '- .~ ,~ :;-:>',:, d .;<,,,~ ...:::~-, 4 ~-, <,_.::4.-.<---,,,-~%'~-¢.. ~;~. ~.c ;~.":~,~',:-~,: ~ ..... ::"::':::'::¥:: ANNUAL TEST FAIL · ALARM DISABLED · :'. ' ' "~:~-R~'~i'~ ~VEST TYpE : "': : : ALARM DISABLED ' ::::::" ' GROSS TEST FAIL : ' .::- ALARM DISABLED ':' :: :::::: i ..... ALARM DISABLED " ':: ~.::....: : PERIODIC TEST FAIL · "::': : ANN TEST AVERAGING: OFF -' ALARM BISABLED W 2:PLUS PER TEST AVERAG I NG: OFF ~ . GROSS TEST FA I L P I PE 'D/PE; F I BERGLASS TANK TEST NOTIFY: OFF ALARM DISABLED LINE ·LENGTH: 100 FEET 0.20 GPH TEST: DISABLED .... .:::~'.,:?:.:....... TNK TST SIPHON BREAK:OFF ANN TEST AVERAGING: OFF ~!~::l O-.IO-'-OPI4-TE-S-T}" E'~'I~'LI~D i DELIVERY DELAY : 2 MIN ~: 0.10 GPH TEST MM/DD ..... . TANK TEST NOTIFY: OFF DATE : ?o..o 0 T 2:PLUS ":i.i .,::':.. ' !:.. :: . STANDARD <::'~":':': i DELIVERY DELAY : 2 MIN . ::::.'::{i::: ' ', :i::i:. :' :'~:': ..: T 3:PREMIUM !' PRODUCT CODE : 3 ::::?::.:::.,.~ ,. THERMAL COEFF :. 000700 TANK DIAMETER : 92. O0 .:!,~ '. i:i!:':-' TANK PROFILE : 4 PTS --'. -'.::-:5:':.':}:':". FULL VOL : 9816 W 3:PREMIUM i::;''::':: -:" 69.0 INCH VOL : 8058 ' LEAK TEST METHOD .: . 46.0 INCH VOL : 4992 PIPE TYPE: FIBERGLASS 2~.0 INCH VOL : 1898 TEST ON DATE : ALL TANK LINE LENGTH: 100 FEET : ' JAN 1, 2000 0.20 GPH TEST: DISABLED' · START TIME : 12:00 AM 0.10 GPH TEST: ENABLED ' . :- FLOAT SIZE:', 4.0 IN. 8496 ~ TEST RATE :0.20 GAL/HR )':i.i~:SHUTDOWN RATE: 3.0 GPH DURATION : 2 HOURS 0.10 GPH TEST MM/DD WATER WARN1NG : 2.0 DATE : ~?? 0 ' : HIGH WATER LIMIT: ~.0 : T J:PREMIUM :" DISPENSE MODE: ~ MAX OR LABEL VOL: 9816 LEAK TE~T REPORT FORMAT ::::: STANDARD OVERFILL LIMIT : 90~ NORMAL : 8834 ' ' HIGH PRODUCT : · :,::':.~ .~:. ?.-:. : 9325 DEL I VERY L I M I T : S~; ..~.:.:... ,.:.~~ : 490 :J'"i"' LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: SO ', .... · ::: .. ..:.~.:. '~ .: :: TA~: T:LT : ~ :0 .... · :: ~::: ' ~ :~:::: , T~: NONE LI NE LEAK LOCKOUT SETUP : ::: ' _ ........... ': ::::.j ========================== ':: ~ · : · :~:.~::~ :i ~ooeOUT SO~EDO:Z ?'-::)j) - LEAK MIN PERIODIO: 10~ ~ -:.. W I:UNLEADED ::::::::'j DAILY ~ : ..... ::::: PIPE TYPE: FIBERGLASS :::::::.:.:.j STOP TIME : DISABLED LEAK M~ ~OAL : ~0~ [:::::::¢~::': L~E LE~T~: ~00 FEET "' ::~::::"" .... "'~ : 9~ ~:?::"::::: 0.20 ~P~ TE~Z: DmA~LED ":::: ............ ':' ~ .......... ~.: :.:::::::':: ::~ O. 10 ~PH TE~T: ENABLED ~::~'~::: ~::::~%:'.~ :<': J ..... .---:::: :7" ::':5~::(:::~~:, :'. ~:':::<." )~: :':~:::~-~: SHUTDOWN RATE: ~. 0 ~PH }(::~::!~5{:: :::::::::::::::::::::::::::::::::::::::: L :: 8V-ANNULAR :.!!i:i>' i: :!::i: :::! CATEGORY : ANNULAR SPACE LAST .(:;ROSS TEST PASSED: PERCENT VOLUME = P3.0 ..... SOl~WAREIREVI s ION- ~V~L~ .... ~,ll~[ T~ST TY~ = STANDARD ~ L 2 : UNL~AD~D--~UMP V~RSION 16. 02 ~{l~l:, ....' ::: l' I' I Il: l: · ~ TEl-STATE (SINGLE FLOAT) SOFTWARE~ 346016-100-0 CATEGORY · STP SUMP OREATED - S-MODULE~ ~$0160-060-A NO TEST PASSED L J:PLUB-ANNULAR SYSTEM FEATURES: TRI-8TATE (SINOLE FLOAT) .:::,~::'~ PERIODIO IN-TANK TESTS ::::::::::::::::::::::::::::::::::::::::::::::: OATECORY : ANNULAR SPAOE' ':?, ANNUAL IN-TANK TESTS FULLEST ANNUAL TEST PASS .:::~..:.:::~?:,:':. :::.:: . :.'. ~ :.::t ============================': ' j PLLD · ': O. lO MANUAL~O;20 CONT NO TEST PASSED :~' "~"':':':: ' ~ L 4:PLU~-SUMP 0.10 MANUAL~0.20 OONT LAST PERIODIO TEST PASS: , WPLLD ~ TR I -~TATE (~ I NOLE FLOAT ) I :l:::~":::~::. .::..:..:¥;. ::::::~::.::~.~ OATEOORy : STP ~UMP ....[ NO TEST PASSED ~ .: · ===================================== :','~j~::.!:::i::}~]~:~:.::~-~::~:::, L S ;PREM I UM-ANNULAR FULLEST PER I OD I C TEST T~:-ST~Z: <S:NCLE VLOAT> [~:.j:: PASSED EAC~ ~O~T~: OATE~ORY : ANNULAR SPACE L 6:PREMIUM-~UMP '. TANK LEAK TEST HISTORY TR I -~TATE (S I NOLE FLOAT ) ,. :::::::::::::::::::::::::::::::::::::::::::: '::.-:~-:9:. "<::" ':: :~: ::' ~ . :: ,:::.:,~., .... ,:. ~ LAST CROSS TEST PASSED:' :. . ...:.. ~ ~ STARTI NO VOLUME= 4789 .: '-'. '::. i j PEROENT VOLUME = 48.8 ~ LAST ANNUL TE~T PASSED: :. .... :,~ LAST OROSS TEST PASSED: :. ~ j NO TEST PA~SED JAN 1, 2000 12:00 AM STARTI N~ VOLUME= 2828 WPLLD LINE DISABLE ~ETUP FULLEST ANNUAL TE~T PASS PEROENT VOLUME = 28.8 ............ TEST TYPE = STANDARD "' ' W I:UNLEADED NO TE~T P~ED : - ;~.:;:.,~ ..... ::.:..:.: · .:..:{ .... '.::.,: · LAST PERIODIC TEST PASS: :::::':':': LAST ANNUAL TEST PASSED. , L I:FUEL ALARM NO TEST PfiSSED ~v ~ NO TE~T P~SED L 2:FUEL ALARM L I:~EN~OR OUT ALARM ::}~ FULLEST ANNUAL TEST PAS: · :.:.: ...... ; ::: ':: LAST PERIODIC TEST PASS :::.: :.::. ..-:::: .... ..: L 8;FUEL ~L~RH : NO TE~T P~S~ED · ,::~::: ?',.":.::: . : L ~ ~EN~O~ O~ ~L~H %'. : ...... ' ..... : :;~: :F~:'~:<:.:; ?::.':: ~ff~;K~Y;:'::" L 6 :FUEL ~L&~H ~:"':::~:~":;:: L 5:SENSOR O~ ALARM L 6:SE~OR O~ RLRRM . - :::::::::::::::::::::::::::::: :.:.:-<.:,..:.:.:+:<,.>.,::::.:..: ;:.:,:.:::,:. ::.:::~,,::::;: q:;.:+'<:: :::~:~j~:::~:~::~ ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ..... SYSTEi~i ALF4RI~i .... IN-TANK ALRR~'I PAPER OUT T 2:PLus · ~ ~ ~ ~ ~ END ~ ~ ~ ================================ ~N 1, 1996 ~:~0 ~t~ ~EP 6. 2001 6:~0 P[~ '- ........ ~EP 6, 2000 4:00 P~ DEL I VERY ~EEDED ~L~R~ H I ~TORY REPORT "~ ~ 8~N 7. 2~02 4:26 P~ [ NO~ 16. 2001 9:06 P~ ..... ~EN~OR'~L~R~ SENSOR OUT :m ~ f'IAR 4, 2002 1 I: 28 Aid , sENSOR OUT ALARId MAR 4, 2002 11:03 Aid ALARfd HISTORY REPORT ~.. .... I N-TANK ALARII '-: HIOH PRODUCT ALARM ~ ALARld NISTORY REPORT OCT 25, 2000 3:33 ..... :... _ ~ SEP 14, 1999 4:16 Rid .... IN-TANK ALA~ld ..... INVALID EUEL LEVEL ¢ T 3:PRE~IU~ :::':'~' : FEB 14, 2002 ~0:44 Ptd ~ SUDDEN LOSS ALARfd ': :-:': FEB 9, 2002 7:23 P~ ~ OCT 13; 2000 3:33 Pld MAR 4, 2002 11:28 AM ~ ' INVALID FUEL LEVEL ..... ~ENSOR ALAR" 8EP 6, 2000 4;08 PR OCT 18,. 2001 8:22 PR L 2:UNLEADED-SURP JUN 28, 2001 ~;01 PR STP SUMP JUN 1, 2001 8;54 PR SENSOR OUT ALARI~ DELIVERY NEEDED ~ :::'. J:: RAR 4, 2002 11;28 JAN 2~, 2002 7;00 PR : PROBE OUT ~ ::::' DEC 12, 2001 8;26 PR : I~AR 4, 2002 11;28 A~ ::.~ FUEL ALARBI OCT 19,-2001 I0:02 AM : SEP 6, 2000 3:53 PM ~:~::::: MAR '4, 2002 10:51 AM J~ 20. 2002 8:30 PM OCT 31, 2001 4:20 PR ...... ........ ':' .......... ALARM HISTORY REPORT ..... SENsoR ALARM ..... 'ANNULAR SPACE ..... SENSO~ ALARM --- ~NNUL~R SPRCE MRR SENSOR OUT ALARM MAR 4, 2002 10:37 AM M~R 4. 2002 11:28 RH 'FUEL MRR 4, 2002 11:19 ~H GROSS LINE FRIL FUEL RL~RH :: HRR ~, 2002 11:11 AM FUEL RL~RM SENSOR OUT ~RM '. M~R 4, 2002~11:28 ~M FUEL ~L~RM H~R 4, 2002 10:48 ~M ~PR 20, 2001 9:01 ~M "': ~L~M H I STO~Y. REPORT ...... SENSOR ~L~M ..... : ..... SENSOR ~L~M ..... W S:P~EMIUM ..: : L 4:PLUS-SUMP · ' :' .... : STP SUMP ~ MAR 4- 2002 10:12 AM ============================ '::: SENSOR OUT ALARM MAR ~- 2002 11:28 AM '~::'"': GROBB LINE FAIL FUEL ALARM ~ MAR 4- 2002 10:12 AM MAR 4, 2002 lO:4G AM · .::: OONTINUOUS PUMP ALM FUEL ALARM JUN 23, 2001 4:04 PM .::'W 1 :UNLEADED ........................... WPLLD SHUTDOWN ALM .j.. · MAR 4, 2002 10:21 :':: ?' ~.. GROSS LINE FAIL :;: : CONTINUOUS PUMP ALM CIRCLE K 8605 5600 ~UBURN B$%KERSFIELD C¢% 93306 i v~iil'>:~ ''~?~/~}~ '/~".~.~iii:?i~:,~.,:>'?:?'c:?~!i''':-.', ".L':"4' ~i" ~ MAR 4 2002 12 20 PM sYSTE. STATUS REPORT ~LL FUNCTIONS NO~MRL INVENTORY REPORT :::::::::::::::::::::::::::: ':~?:'~'?::~ ::?: ":'..'::':'"":'"::::~:' ' "::::' :::: ':: :::::::::'::':::::~' ::::::' ':' T 1 :UNLEADED · ' ::::::::::::::::::::::::::::::::::::::::::: ::" ' . . · .' . :: :...':.:'"'. ~ VOLUblE = 4~66 ~L~ ::::::::::::::::::::::::::::::::::::::::::::: :.'~':-' :::::.. -. · . ":.:?: ULLagE = ~8~0 ~L~ ':- '::.' :.."'- ' ..':' 90% ULLAGE= 3868 G~LS ================================================================ ~: ...,.::': . · : .... Tc VOLUM: = ~S~: S~LS .... .- .. ':'..::' :'.:::'. : : .: .. ' HEIGHT = 45.82 INCHES ~TER VOL = 0 G~LS ?:::..'.' ~ :/.. :..~:.,' .~-,,....... ~...~;':. :.. . · . :.:. : ..... TEMP ~ 64.4 DEG F ~:~:~:' . . . ~'~:':::'.:~:'.:' . . '. -. ..: '......:-...:::C..':.~ -. .~..:: .:: 'T 2 :PLUS VOLUME = 2070 G~LS ULLAGE = 7746 G~LS ::5::::::::::: 90~ ULLAGE= 6764 G~LS :::::::::::::::::::::: . '.':.. .: . : {. :...:::.:: : U~TER VOL = 0 G~LS .::: . :. ::: : :::::::::: .. :,.:~:.~ :,,::;~::-::?::: ::. :-: · ..... . . · "~.'.; ',-,-', ' · ':' v,',:, :<~,'~.,:,;,~- ::::::::::::::::::::::::::::::::":::::::::::::::::?::<c::::::::::::::::::::::::::: ::::::::: TEMP = 70.6 DEG F T 3: PREM I UM VOLUME = 2847 G~LB~~' ULLAGE = 6969 G~LS '' ' .: TG VOL~E ~ 2828 GgL8 . HEIGHT = 30.'59 INCHES ~TER VOL = 0 G&LS SOFTI~J~RE REVISION LEt/EL VER~ ION . 16,02 ORERTED - 98,~5,14,1~,~4 ~-I~ODULE~ ~01 ~Y~TER FERTURE~: PERIODIC IN-TRNK TE~T8 RI~NURL IN-TRNK TE~T~ PLLD O,lO RRNURL&0,20 CONT ~PLLD O. 10 MANUAL&O. 20 COI~T ::::::::::::::::::::::::::: For Use By Ail Jurisdictions grtthin the State of California Authority Cite&' Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, ~stle 2~o C~!;_fornia Code of Regulations This form must i~ usexl to ~loom~zt t~ting atzd sex'vicing of monitoring equator. ~A separate c~fification or ~po~t, must be prepared ~for each monitoring ~-~.em control panel by the technician who performs ~he wodc. ,~ copy of this form must be provided to the tank system ownedoperator. The owner/operator must ~ubmit a copy of ~ form to the local ~mcy regulafi~ Ub~I' ~jstems within 30 days of ~est date. A. General Information ,~ F~y~ 7~ 0~,0~ m,~.~o.:~ Make/ModelofMoaitodagSystem: 'fS<~- ~:~0 ~t~O_o/~ 0 ~ DateofTesting/~:s~ing: B. Invento~ of Equipment Tested/~ed :: "' In-Tank Gauging Probe. Model: In-Tank Gauging Probe,. Model: Annular Space or Vault Sensor. Model: Annular Since or Vault ,~nsor. Model: P/pingSumplTrench.~mso~s). Model: PipingSump~Treuch~s). Model: ~l ~11 Sump &msc~s). Mod& TankOve~filllHigh-Lc~cl,~asoc Mede. l: TankOvc~lllIfsgh-Lcvcl,~oSor. Model: O.~L,O . E! in ,~aion E on Tank ID: In-Tank Gauging Probe. ModeI:----~ ~) ~ "~ t · C! In-Tank Gauging ~ Model: Annular Space or Yanl~ Sensor. Model: ~ f~.~ E! Annular Space or Yaul~ ,Sensor. Modd: Piping Sump / Trench Scnso~$). Model: c~7 0~"' ~l PipingSump/TrcnchSeasor(s). Model: Fill Sump Sensor(s). Mode]: CI Fill Smnp .Se~,offs). Modd: Line Leak ~r. Model: · ' El Mechanical ~ Leak Do. cctor. Model: Electronic Line Leak Detector. Modal: .... ~d ~{_~,~ O Electronic Line Leak Detector. Modal: D~m: / . ~ D~.~m: 12 Dispenser Conminmem Sensor(s). Model: 12 Dispenser Containment Sensor(s). Model: Shear Valve(s). C! Shear Valve(s). and Chain(s). Chain(s). ~-m: ~ -~ ~ D~ m: 121 Dispenser Containrnem Sensor(s). Model: CI Dispes~ser Containment S~nsor(sL Model: Shear Valve(s). El Shear Valve(s). ~1 Dispenser Containment Float(s) anti Chain(s). [ Q Dispenser Containment Float(s) and Chain(s). Dispenser ID: [ Dispenser ID: ~ DispenserContainmem Sensor(s). Model: I~! DispeaserContuinment Sensor(s). Model: O Shear Valve(s). El Shear Valve(s). ODispenser .Containrnent Flo~g(s) and Chain(s). ~ Dispeaset Containment Float(s) and Chain(s). -' · If the facilit~ con,ns more tanks or dispensers, copy this form. Include information for every rank and dispenser at Se facility. C. Certification. I certify t~t the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is i~rmation (e.g. manufacturers' checklists) necessary, to verify that this information is correct and a Plot Plan showing the layout of mom'l~g equipment. For ~ equipment eatable of generating Technician Name (print): ~Vo~o~-'---k O~-'~' e~_. Signature: Testing Company Name:'-V'c,e~ ~n\s~ ~_~-~0 ~r'~c~m~.c~3vc ~x Phone No.:(~::~._) ... - _ . ,,~ .., ..... -.-.:~.-....~>'- ... . - . Site Address:Z~ Z.<7 ~._D, t.'~C~'~.,-,~.- '~J A__-', ~i)c~e_,-,k etx ehfof Date of Testing/Servicing: ,~[ D. Results of Testing/Servicing Software Version Installed: '" '~1 Yes ~ No* I.~ the a~libI¢ alarm opaational? 4~ Yes ~ No* Is the visual alarm operational? 4a Yes ~ No* Were all sensors visually inspected, functionally ~ and confirmed operational'/ ~ Yes Ca No* Wexe all sensors installed at lowest l~oint of ~econdary cov~inme~lt a/Id positioned so that other equipment will not interfere with their proper operation? Ca Yes Ca No* If alarms are relaycd to a remote monitoring station, is all communications equipment (e.g. modem) '"' -~! N/A operational?' '"' 4~! Y~' Ca No* For pressurized piping systcms, does the tu~oine automatically shut down if the piping secondary containmcnt Ca N/A monitoring system detccts a lcak, fails.~_o~te, or is eleclrically disconnected? If yes: which sensors initiate positive shut-down? (C-.beck a//that app/y-')'~! Sump/Trench Sensors; I~)ispenscr Containment $cnsor~. Did you confirm positive shut-down duc to leaks ~ scnsor faihrg/, disconnection'?-gl Yea; Ca No. El Yes El No* For tank systems that utilize thc monitoring system as the primary ~nk overfill warning device (i.c. no """- -1~ N/A mechanical overfill prevention valve is installed), is the ovcrfi~ warning alarm vis~le and audible at the ~l poiat(s)'and ol~rating Prolixly? If so, at what i~xccat of tank .capacity does thc alarm trig2cr? ~.% El. YL-~'' -~1 No Was any monitoring equipmcnt rcplaccd? If yes, idcntify specific scnsors, probes, or other equipment replaced · ~. and list the manufactm~ name and model for all replacement l~arts in Section E, below. Ca yes~t-- ~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all,hat apply) El Product; Ca Water. If yes, describe caases in Section B, below. '~] Yes El No* Was monitorinl~ system sci-up r~vicwed to cnsufc proper scttin~s? Attach sct up reports, if applicablc ~ Yes El No* Is all monitoring equipment operational per manufacturer's specifications? · In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/01 F, In-Tank Gauging / SIR Equipment: Check this box if tank gauging is used only for inventory control. El Check this box if no tank gauging or SIR equipment is installed. This section must be completed if h-tank gauging equipment is used to perform leak detection monitoring. C. omr Ilete the foliowin{$ checklist: lq Yes lq ]No* Hasa~iaputwiringbeeninsp~ctedf~rpro~r~ntryandterminati~n,inc~udingte~tingf~rgr~undfau~ts? vi yes vi lXlo* Wexe all tank ganging probes visually inspecaM for damage and reaidue buildup? lq Yes lq No* Was accuracy of sYStem product level readings tested? Iq yes lq No* Was accuracy of system water level readings tested? '" lq Yes lq No* Were all probes reinstalled properly? lq Yes lq 'No* Were all items on the equipmeat manufacturex's maintenance checklist completed?' * In the Section Iq, below, describe how and when these deficiencies were or will be correcfed. G. Line Leak Detectors (LLD): lq Check this box ifl~ Bs are not installed. ~omplete following the checklist: '~1 Yes ~1 No* For equipment staR-up or annual eqUXtl~x.ment certification, was a leak simulated to verify LLD performance? El N/A (Check all that apply) Simulatedleak'rate:"~13g.p.h.; lq0.1g.p.h; 1~10.2g.p.h. 'l Yes lq No* Were all LI ~Ds confLrmed operational and accurate within regulatory requirements? ~ Yes El No* Was the testing apparatus properly calibrated? vi Ye, o,,, El No* For mechanical IJl~Ds, does the LLD restrict Product flow if it detects a leak? 4~1 N/A ~ Yes El No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? El N/A '~i Yes E! No* For electronic I.I~Ds, does the turbine automatically shut off ff any portion of the monitoring system is disabled El N/A or disconnected? '~ Yes El No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions El N/A or fails a test? : '~! Yes ~1 No* For electronic LLDs, have all accessible wiring connections been visually inspected? E! N/A -RI Yes El 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 corrected. H. Comments: Monitoring System Certification UST o!lR~ring Site Plan ., ......... ........................ ~...~ ................. Date map was drawn: .~/ Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks' and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spil! ..c. onta_i_n_.e?, or other secondary containment areas; mechanical df electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. l'~me ~ ol'~j' WORK A CKNO Environmental, Inc ADDRESS: ~"~:>0 0 2525 W. BURBANK BL VD. TEL.'C818)840-7020 CITY/STATE: BURBANK, CA 91505-2.*02FAX: (818) 840-6929 COUNTY SERVICE m!Qtmm p_ -m ) P~oou~ Lmn ~ST ~ FAC~L~ msPn~o~ ~AK DE~OR ~ST ~ VAPOR RECO~RY ~ST SER~ PE~O~D Qu ~fi~ De~fiption , ~ ~fi~ De~fiption CU~OMER PRI~ CUSTOMER SIGNATURE DA~: BT~4T UB REPORT - T 3:DELI'v'ER'f'-blEEDED OR'z' REPORT " 1857 IJLLf¥~E = - qO% ULLAGE= B75 TC VOLUPiE = BO21 HEIGHT = 69.17 1NCNEB kilTER '~,~OL = 0. O0 't I',ICHE~, [,,,I~TER -'= 4g. 8 DEG F- T EPIP ..... T 2 :M.MS ULLAGE '30% UL'L&GE= 6016 %31 ~ G~LB HE l/3HTvoL = 0 ,3~LB ,3&TER = O. ¥3 = 6B.'3 DEG F T S: pREPl I UI"I ',?OLUt'tE = 29'21 GfhLB 90% ULLAGE= 5913 GALS TG3JOL-~i"IE : '2~42 ~:IGNT = 21 , t 5 I NC.:H:S FJ bI~TE'R VOL = ). -0 [NCHES .&.I~TER 4q. 5 [,E) F NEE[~ED 2002 9: 54 AI'.'I T 1 :UNLEADED I IIVENTORY INCREaSE INCREASE START JRN 30.. 2002 '3:2'7' AM 'v'©LUME : 1098 GaLS HEIGHT = 15.E,:3 INCHES WATER = 0.00 I I',IC;HES 1 I',IC:REaSE END JAI',I 30. ~]32 10:10 AM VOLUME = ?994 C/ALS HEIGHT = 68, d~L 1' ?~CHES TgJATER ..... = i3.00 I NC:HES TEHP = 49. I I',ICREaSE: 690E, I I',ICREASE: 6, 9 ? 0 T 3: PREM I UP1 INVENTORY I I',ICRE~:~SE I NCREAS£ START JaN 9L].. 2002 9:55 AM VOLIJP1E = 9B6 GaLS HEIGHT = 14,62 INCHES W&TER = 0.00 INCHES TE = 72.0 DEC; F I I',JL-:}-? £ A f=_tE JAN 30. 2002 1 '] 1'-',:, AM \/,:)LIJHE =., _';4 '_:i ';:4'~:: HE][C~HT = 31 . IF, II',I(2HES WATER = O. ]0 11',,ICHES TEPll::' = 60.6 DEG F ' INCREASE= 19:36 I I',iC:REASE= 1943 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME dt~'C{~ ~-,~'['OPC INSPECTION DATE Section 2: Underground Storage Tanks Program [21 Routine '~l Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank ~0,J ~ Number of Tanks Type of Monitoring d_l. ~ Type of Piping 0(.O b-" OPERATION C V COMMENTS / Proper tank data on file ~ / Proper owner/operator data on file ~ ,/ Permit tees current '~ / Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current / Failure to correct prior UST violations / Has there been an unauthorized release? Yes No ~ Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? Office of Environmental Services (805)326-3979 White- Env. Svcs. Pink - Business Copy'~..~' CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r" Floor, Bakersfield, CA 93301 FACILITY NAME 0.,~'c{c,~--.~'¥OC'c_. INSPECTION DATE ADDRESS ~0c'3 ~aOt'~x PHONE NO. ~'~1 ~ "~q ? FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [21 Routine [~ Combined [~ Joint Agency [21 Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand L Business plan contact information accurate Visible address Correct occupancy , k. / Verification of inventory materials Verification of quantities Verification of location Proper segregation of' material L~ / Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping / Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: ~] Yes ~o Explain: '" Y Questions regarding this inspection? Please call us at (661 ) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy ,/ Tosco Marketing Company P.O. Box 52085 Phoenix, Arizona 85072-2085 TO S C O 1500 North Priest Drive M a r k e t i n g Tempe, Arizona 85281 C 0 m p a n Y David A. Waldschmidt Assistant General Counsel 602_/728-7470 (direct line) 602/728-5277 (facsimile) April 23,200 l Re: Financial Responsibility 40 CFR Part 280, Subpart H To Agencies Listed on the Attached Exhibit A: I am enclosing information relating to Tosco Corporation's requirement to provide financial responsibility for the ownership and operation of underground storage tanks by its operating entities pursuant to 40 CFR Part 280, Subpar.t H and similar state regulations. Tosco Corporation meets the financial test of self-insurance set forth under 40 CFR § 280.95. It is intended that this financial responsibility likewise satisfy the requirements of authorized state programs. Tosco provides this financial responsibility for all underground storage' tanks at retail locations, terminals and bulk plants which are owned and/or operated by all Tosco entities including Circle K Stores Inc., Tosco Operating Company, Inc., Tosco Refining L.P., Bayway Refining Company, Tosco Terminal Corporation and Tosco Corporation. For your information, Tosco's ' retail operations are collectively referred to as "Tosco Marketing Company". The information enclosed consists of a Certification of Financial Responsibility, a letter from Tosco's Chief Financial Officer in the form prescribed by the federal regulations and a facility address list for your state or region. Please forward this information to the appropriate person in your agency. You may direct any questions to me at (602) 728-7470. Very truly yours, David A. Waldschmidt Assistant General Counsel DAW/cs 8220C$ I.DOC Tosco Corporation 1700 East Putnam Avenue Suite 500 Old Greenwich, CT 06870 Telephone: 203-698-7575 · Facsimile: 203-698-7910 T O S C O c;~g .. De.sy Vice President Treasurer CERTIFICATION OF FINANCIAL RESPONSIBILITY Tosco Corporation hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR Part 280. The financial assurance mechanism used to demonstrate financial responsibility under Subpart H of 40 CFR Part' 280 is as follows: Mechanism: Section 280.95 - Financial Test of Self Insurance' Amount of Coverage: $2,000,000 in the ag~egate Effective Period of Coverage: From January 1, 2001 until April 30, 2002, unless earlier revoked or replaced by written notice to the Implementing Agencies listed on the attached Exhibit A. Coverage: Corrective action and third-party compensation .for bodily injury and property damage caused by sudden and nonsudden accidental releases arising from the operation of underground storage tanks. By: Craig 1~. Deasy Its: Vice President and Treasurer Date: April/_~, 2001 County of ) he foregoing instrument was acknowledged before me this r~day of by Craig R. Deasy, personally knOwn to me as Vice President and Treasurer of Tosco Corporation, who executed the same on behalf of the corporation. Notary Public My Commission Expires~~~h DENISE G. MECIL! Notary Public, State of Connecticut No. 0111489 Qualified in Fairfield County Commission Expires March 31,2006 Tosco Corporation 1700 East Putnam Avenue Suite 500 Old Greenwich, Connecticut 06870 Telephone: 203-698-7506 Facsimile: 203-698-7903 Jefferson F, Allen President April 16, 2001 Underground Storage Tank (UST) Financial ResPonsibility Letter fi.om Chief Financial Officer I am the chief financial officer of Tosco Corporation, 1500 Putnam Avenue, Old Greenwich, CT 06870. This letter is in support of the use of the financial test of self-insurance to demonstrate financial responsibility for taking corrective action and compensating third parties for bodily injury and property damage caused by sudden accidental releases and nonsudden 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 owner or operator: (See Attached Listings) A financial test is also used by this owner or operator 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: Amount EPA Regulations: Closure (§§ 264.143 and 265.143)' $ None Post-Closure Care (§§ 264.145 and 265.145) $ None Liability Coverage (§§ 264.147 and 265.147) $ None Corrective Action (§§ 264.101(b)) $ None Plugging and Abandonment (§ 144.63) $ None Authorized state programs: Closure $ 28,509,000 Post-Closure Care $ 17,138,000 Liability COverage $ 49,000,000 Corrective Action $ 5,997,000 Plugging and Abandonment $ None Total $ 100,644,000 This owner or operator has not received an adverse opinion, a disclaimer of' opinion, or a "going concern" qualification from an independent auditor on his financial statements for the latest completed fiscal year. Alternative H 1. Amount of annual UST aggregate coverage being assured by a financial test, and/or guarantee $ 2,000,000 2. Amount of corrective ~ction, closure and post-closure care costs, liability coverage, and plugging and abandonment costs covered by a financial test, and/or guarantee $ 100,644,000 3. Sum of lines 1 and 2 $ 102,644,000 4. Total tangible assets $ 8,407,200,000 5. Total liabilities $ 6,394,100,000 6. Tangible net worth $ 2,013,100,000 Yes No 7. Total assets in the U.S. (reqUired only if less than 90 percent of assets are located in the U.S.) $ N/A 8. Is line 6 at least $10 million? X 9. Is line 6 at least 6 times line 3 ? X 10. Are at least 90 percent of assets located in the U.S.? X 11. Is line 7 at least 6 times line 3? N/A · 16. Current bond rating of most recent bond issue Baa2 BBB 17. Name of rating service Moody's Standard Investor & Poors .. Service 18. Date of maturity of bond January 1, 2047 Yes No 19. Have financial statements for the latest fiscal year been filed with the: SEC X. Energy Information Administration X Rural Electrification Administration X I hereby certify that the wording of this letter is identical to the wording specified in 40 CFR part 280.95(d) and/or WAC 173-380-470 as such regulations were constituted on the date shown immediately below. ~~erson F. Allen Chief Financial Officer April 16, 2001 ATTACHMENT TO LETTER FROM CHIEF FINANCIAL OFFICER All under~ound storage tanks (UST's) owned and/or operated by Tosco Corporation and its affiliates and subsidiaries are covered by this financial test of self-insurance. These entities include Circle K Stores Inc., Tosco Operating Company, Inc., Tosco Refining, L.P. (collectively referred to as "Tosco Marketing Company"), Bayway Refining Company, Tosco Corporation, and Tosco Terminal Corporation. UST's are located at the following refineries, terminals, carbon plant, and bulk plants: REFINERIES & TERMINALS: Bayway Refinery Los Angeles Refinery (Wilmington) Sacramento Terminal 1400 Park Avenue P.O. Box 758 76 Broadway Linden, NJ 07036 Wilmington, CA 90748 Sacramento, CA 95818 Baltimore Terminal Los Angeles Terminal San Francisco Refinery-Rodeo 2155 Northbridge 13707 S. Broadway 1380 San Pablo Avenue Baltimore, MD 21226 Los Angeles, CA 90061 Rodeo, CA 94572 Colton Terminal Portland Terminal San Francisco Refinery- 2301 S. Riverside 5528 NW Doane Avenue Carbon Plant Rialto, CA 92316 Portland, OR 97210 2101 Franklin Canyon Rodeo, CA 94572 Ferndale Refinery Renton Terminal 3901 Unick Road 2423 Lind Ave SW Tacoma Terminal Ferndale, WA 98248 Renton, WA 98055 520 East D Street Tacoma, WA 98421 Honolulu Terminal Richmond Terminal 411 Pacific Street 1300 Canal Boulevard Honolulu, HI 96817 Richmond, CA 94804 Los Angeles Refinery (Carson) Riverhead Terminal 1520 East Sepulveda Boulevard 213 Sound Shore Rd. Carson, CA 90745 Riverhead, NY 11901 BULK PLANTS: 845 Walnut Ave. Greenfield, CA 93927 100 Lee Rd. Watsonville, CA 95076 SUPPLEN[ENTAL ATTACHMENT TO LETTER FROM CHIEF F~'ANCIAL OFFICER FACILITY LIST A list of facilities covered by this financial responsibility mechanism has been filed with: California State Water Resources Control Board UST Program P.O. Box 944212 Sacramento, CA 94244 It may also be obtain'ed from: Tosco Marketing Company 2000 Crow Canyon Place, Suite 400 San Ramon, CA 94583 Attention: David Camille (925) 277°2335 or Tosco Marketing Company 3525 Hyland Avenue Costa Mesa. CA 92626 Attention: Michael Bryan (714) 428-7606 8222CS4.DOC EXHIBIT A US ENVIRONMENTAL PROTECTION AGENCY ARIEL RIOS BUILDING 1200 PENNSYLVANIA AVENUE NW WASHINGTON DC 20460 EPA REGION 1 1 CONGRESS ST SUITE 1100 BOSTON MA 02114-2023 EPA REGION 2 290 BROADWAY NEW YORK NY 10007-1866 EPA REGION 3 1650 ARCH STREET PHILADELPHIA PA 19103-2029 EPA REGION 4 ATLANTA FEDERAL CENTER ' 61 FORSY'TH STREET SW ATLANTA GA 30303-3104 EPA REGION 5 77 W JACKSON BLVD .,. CHICAGO IL 60604 I ':: ~ EPA REGION 6 i . FOUNTAIN PLACE SUITE 1200 1445 ROSS AVE DALLAS TX 75202-2733 EPA REGION 9 75 HAWTHORNE ST · - SAN FRANCISCO CA 94105 EPA REGION 10 1200 SIXTH AVENUE SEATTLE WA 98101 ALABAMA DEPT OF ENVIRONMENTAL MGMT UST COMPLIANCE SECTION P O BOX 301~463 MONTGOMERY AL .36130 AZ DEPT OF ENVIRONMENTAL QUALITY UST SECTION 3033 N CENTRAL AVE #4T PHOENIX AZ 85012 CA STATE WATER RESOURCES CONTROL BOARD UST PROGRAM P O BOX 944212 SACRAMENTO CA 94244 DE DEPT OF NATURAL RESOURCES UST BRANCH 391 LUKENS DR. NEW CASTLE DE 19720 DC ENVIRONMENTAL HEALTH ADMIN UST DIVISION 51 N STREET NE RM 3019 WASHINGTON DC 20002 FLORIDA DEPT OF ENVIRON PROTECTION STORAGE TANK REGULATION SECTION 2600 BLAIR STONE RD. TALLAHASSEE FL 32399 GEORGIA DEPT OF NATURAL RESOURCES UST MANAGEMENT PROGRAM 4244 INTERNATIONAL PKVVY STE 104 ATLANTA GA 30354 HI DEPT OF HEALTH SOLID & HAZARDOUS WASTE BRANCH 919 AL& MOANA BLVD RM 212 HONOLULU HI' 96814 LA DEPT OF ENVIRONMENTAL QUALITY UST DIVISION P O BOX 82231 BATON ROUGE LA 70884 MD DEPT OF ENVIRONMENT OIL CONTROL PROGRAM 2500 BROENING HIGHWAY BALTIMORE MD 21224 BUREAU OF WASTE SiTE CLEANUP DEPT OF ENVIRONMENTAL PROTECTION 1 WINTER STREET BOSTON MA 02108 MI DEPARTMENT OF ENVIRONMENTAL QUALITY STORAGE TANK DIVISION P O BOX 30157 LANSING MI 48909 DEPT OF ENVIRONMENTAL QUALITY UST SECTION OFFICE OF POLLUTION CONTROL P O BOX 10385 JACKSON MS 39289 NEVADA DIVISION OF ENVIRON PROTECTION BUREAU OF CORRECTIVE ACTION 333 W NYE LANE NUMBER 138 CARSON CITY NV 89710 NH DEPT OF ENVIRONMENTAL SERVICES ... OIL REMEDIATION AND COMPLIANCE BUREAU PO BOX 95, 6 HAZEN DR CONCORD NH 03302' NJ DEPT OF ENVIRONMENTAL PROTECTION BUREAU OF USTS P O BOX 433 TRENTON NJ 08625 NM ENVIRONMENT DEPT UST BUREAU HAROLD RUNNELS BLDG ROOM N-2510 1190 ST FRANCIS DRIVE SANTA FE NM 87502 NY DEPT OF ENVIRONMENTAL CONSERVATION BULK STORAGE SECTION 50 WOLF ROAD ROOM 360 ALBANY NY 12233 NORTH CAROLINA DIV OF ENVIRON MGMT UST/LUST PROGRAM P O BOX 29578 RALEIGH NC 27626 DEPT OF ENV QUALITY UST PROGRAM 811 SW 6TH AVE 7TH FLR PORTLAND OR 97204 PA DEPT OF ENVIRONMENTAL PROTECTION DIVISION OF STORAGE TANKS . 400 MARKET ST PO BOX 8762 HARRISBURG PA 17105 SC DEPT OF HEALTH & ENVIRON CONTROL DIVISION OF UST MANAGEMENT 2600 BULL STREET COLUMBIA SC 29201 DEPT OF ENVIRONMENT AND CONSERVATION UST DIVISION 4TH FLOOR L&C TOWER 401 CHURCH STREET NASHVILLE TN 37243 TX. NATURAL RESOURCE CONSERVATION COMM PETROLEUM STORAGE TANK DIVISION P O BOX 13087 AUSTIN TX 78711 VA DEPT OF ENVIRONMENTAL QUALITY OFFICE OF SPILL RESPONSE AND REMEDIATION P O BOX 10009 RICHMOND VA 23240 TOXICS CLEANUP PROGRAM WASHINGTON DEPT OF ECOLOGY P O BOX 47655 OLYMPIA WA 98504 WASHINGTON DEPARTMENT OF LICENSING UST SECTION PO BOX 9020 OLYMPIA WA 98507-9020 ... Triangle Environmental Inc 2525 West Burbank Blvd., Burbank, CA 91505-2302 (818) 840-7020 (818) 840-6929 US T TESTING SYSTEMS S UMMAR Y SHEE T Precision Underground Storage Tank System Leak Test Client: Tosco Marketing Co. TOSCOFacility # 08605 1500 North Priest Drive Tempe, AZ 85281 Test Date: 4/20/2001 Kathy StrickLand (602) 728-7149 Facility: 2708605 Work#: 10300955 Tosco Facility # 08605 County: KERN 5600 AUBURN ST Cross Street: FAIRFAX ROAD BAKERSFIELD, CA 93306 Tank Test System Tank Line # Product Capacity Type Rate/Results Ullage Result Rate/Result L/D Result Certified By: Technician: Dan Marinescu State Lic. #s: CA-1393 Mfgr's #: Comments: Monitor certification This precision tank testing system has been third party evaluated according :to the guidelines of the EPA procedures for annual leak detection systems and found to exceed the criteria of detecting a leak of 0.10 gph with a Pd >95% and Pfa <5% as required by Local, State and Federal EPA UST Technical Standards Part 280 for precisi~ng systems. This SB-989 secondary containment testing system exceeds the criteria for detection as required by state and local agencies. 2525 W. BURBANK BL VD. TEL: (818) 840-7020 C~Y/STA~: BURBAN~ CA 91505-2302 FAX: (S18) 840-6929 COUNTY s~amce ~O~mD (C~) TANK TIGH~ESS ~ST ~ MONITOR CERTIFICATION SER~C~ PE~O~D PARTS Quantity Description Quantity Description SBD:.123--WOILKAC~'N(3F//) Triangle Environmental Inc ":, US T MONITOR CERTIFICATION SUMMARY SHEET Client: Tosco Marketing Co. ~500 No~h Priest Drive Tosco Facility # 08605 Tempe, AZ 85281 Test Date: 4/20/2001 Facility: Tosco Facility # 08605 Work~: 10300955 County: KERN 5600 AUBURN ST Cross Street: FAIRFAX ROAD BAKERSFIELD, CA 93306 Monitor model: VEEDER-ROOT TLS-350 Serial #: 80648964705001 Certification Result: PASS Sensor Type: Quantity: Result: Tank Annular: 3 PASS Annular Type: DRY Waste Oil: 0 N/A Audible Alarm? Yes Waste Oil'Sump: 0 N/A Visual Alarm? Yes Vadose Wells: 0 N/A Fail Safe? Yes Line Pressure: 3 PASS Positive Shut-off? Yes Turbine Sump: 3 PASS Gauge Only Result: PASS LineTrenchQty: 0 N/A ATG Monthly? No Fill Sump: 0 N/A ATG CSLD? No Comments: This certifies that the monitor and sensors, as listed above, are operational and calibrated per the manufacturer's specification. InsPected By: Dan Marinescu · : - -- MONITORING SYSTEM CERTI CATION. ,: For Use By All Jurisdictions Within the State of California ' "'.. >luthorit~ Cited: C. hapter d. 7,' ttealth and Sa:fety Code; Chapter 16, Division3, Tit. le 23,.California Code of Regulationx .... "This form must be used to doCUment. testing and servicing of. monitoring equipment. If more than one' ' monitoring system control panel is installed at the .facqlity,' a-separate certification'6r report hiust'be pmoaied for. each mo~tof-in~ ~stem control panel by the techni¢iaffwho perforais the work. A co~y of this form must be provided to the tank system.owner/operator. The owner/operator must submit a copy of this form to the loml agency r~gulating UST system within 30 days of test .date. Insm~ctions are printed on the .back of this page. A- General Information racility. Nam¢:-~ '(~) 0.8 ~.~' - Bldg. No.: · B.' Invetttory Of'Equipment Tested/Certified " Check the appropriate boxe~ to indicate specific'equipment h~s ~:ted/serviced~. - . ; . . : .. .. .. ' '- ~ Ann .ular Space or Vault S~mor. Model:... ct-o ~.. .lil'..2am~larsPaoe'orV..aul. tScmor. Model:.." -.~ 'ca .tm .su~..Smsor(s),.. ' ~odd: .... : o:Fm-~ scmo,O:~ -." Modce'. ' [l. Dispetm~ContainmcntSen=qor(s). .Model:- ~D.' ,t.qp~s~r.Cq.n~;nmmtSenso~s). Model: "'. ..... ' ..... ~ Shear Valve(s).. ii) Shear Valve(s): _ El Othcr(spcc!fycquipmc~ttypcandmodctia'SccfioaE0nPPgc. 2)-'' ' El Od~cr(spcc~cquipincat. typc.~dmodcliaScctior/£.OaPagc.2).'..'. -*.:~. Tank ID: . t~ q ~ t... Tank ID: -- '. . ' ' ... I~t Annular Spac~ or Vault Seasor. Model: .,t4t}'~' .CI-AnnularSpadeorVault .Sen.nor.....Model: -. ': '- ~! PipingSumpiTnmchSeasor(s). Model: . . ?..o.[". .' .El PipiagSump'/Treach.S~as0. t($). Model:. .- ' ' El Fill Sump Sensor(s). Model: C! Fill Sump $~msor(s). Model: ' ' Cl. MochaaicalLiaelxakDetector.. Model: ., ..' El MecharficalLiacLeak-Detoctor,. Model: . -.-. - .~. Tank Overfill / High-Level .,g.~t.qor. Model: 'Ol~o6t ... .El Tank,Overt'dI/ltil~a-L?dSeag~. Model: . ..' .... El Dizpeag~ Containment ~msor($).' Model: - · -' - -' gl'Di.~xa~r Coatainm. mt.S~a~or(s).. Mod.el: , . . · ' Ii~ Shear Valve(s). 121 ~hear Valve(s). ' ' ~t Dispen.~a-ContainmeatFloa~(0aodChs~j). .... .El Di.qtga~Cofi~inmmtFloa~s)aod -C~al~($). -. -': --.-.. -: . : · .. C. ~.er-tificaffon ~ I ~-tify'that the ~Iuipm~t identified in-thi~ document ~ im-pe~ted/s~vieed.in'aecordanee:With thc ' :- · manufactnrer~' guideline,. Attached to'thi~.Ce_qific~tion is infOmation (e.g. manufaetnrers' ,Aiecklh~j verify that this infomation is correct ~nd a.Site Plan showing the layout of monitoring.equipmeut~ .Fpr any.'~luipment' '- ' ' capabl~ of genera'ting ~uch reports~ I'lmv¢ also attached ~ copy of the (check' all ti, at ~ply): . - I~ ~ystem set-up report; - .- Ikl Alar~nl\ h~qry report- D. ~gl~ of T~fin~Se~cifig.' . . So~e Ve~ion Ins~l~ '- ~ ~ ' ~ ~ ~mplde ~e folloMng ~ ~A. o~o~?- - -' . ~ ~ monkd~g ~ d~ a l~.~.m o~-or ~ eI~y ~~ ~ ~hi~ ~ ~6ate ' . -' " ~five~huMo~? (~t~ly).~$~~~ aD~~nm~m~t~. · .. :'Did~u~~ifive~ut~omdueml~d~r~~~oa7 ~Y~;~No. ..~ . . '~ 'Y~ ~"No*- F~.~ ~ ~at ~l~e' mofiim~g ~ 'm. ~e. p~ ~ 'ov~ ~g g~ Cu~ ~o .... ': "' ~: ~A , m~i~'o~ p~mfim-~-~ ~, ~ ~e ov~ ~ing ~.~le ~d au~le a ~e ~. : ...... md ~e ~~m~.~d m~el for ~ ~mt~ h ~oa ~ ~ow; .... · .... ' -. "-2 '~ :.. .. .a~ aW~.:.~y~~~~~~ow.. ..-. ' ' i ' :2 ~-Y~ <~-a-~o, '~m~~~o~~~~~~o~, .. ;,.' ...- '. -.' ' ..... . ~ .-.... .., . . ~ . . · ..... ...." ~ ~o~ena: . .- C~ ?.~-r~ Pav_e 2.of3 11/I5/99 - Site'Address: -'5"~ ~ ~ men F. in-Tank Gaug~g/S~nipment: '. ' ffi ~~xff~~g~m~oflYfor'~vmto~n~oL _. ~ ~ ~ ~x ffno ~ ~ughg or S~ ~uipmmt ~ ~l~ ,. ~.~on mm ~ ~mpla~ ffh~ ga~n'g m~pment ~ ~ to ~om 1~ det~on mommy. . .. Complete ~e follo~ng ~ D Y~ ~' No* W~ ~ ~------ -- --~u~g pm~ ~ly ~ for ~ge ~d ~idue ~dup? ' D Y~ ~ No* W~ a~ of~ p~ 1~ ~ ~ Y~ ~ No* W~am~of~mmt~level~d~t~? ~ Y~ .l ~ No* W~lpm~.~~p~.-. -- - . ~.Y~' ~ No* W~~on~i~m~t~~ffm~m~'~l~? " .. - ~ In the ~tion ~, ~low, d~be how~nd ~on ~ defici~d~ we~ or ~!! ~ co~ -- G. L~e~kDet~om~J,D): .. :" ~ ~~x'ff~not~ -: .." ' .. . -. ~mplete the following ch~ ' ' ~. Y~ ~ N6* For ~mt ~p or ~'~dpmmt' ~fi~ m a l~'~u~ m v~ ~ ~o~? ' ' · .... ~-~A (~~~) 8~1~ ~3-~p~; O0.1~p~ O0~p~) ' . " .No~ 1. R~ for ~Pm~t ~ ~fi~on ~d ~ ~om ' ' .. .. '" ,I ': -Z' Unl~ m~d~t~ ~ 1~ gmS, ~on.~ ody f~dm~c ~ ~.- . i-.~ Y~' ~. Not W~~~~o~dm~in-~~m~?- . .. · ~ Y~ O.No* W~e~~mqpm~y~~ .. .~. : -' ~. y~ ~ ~o* -Fofm~i~d~~~~flow~d~al~' .... · "- ~.Y~ ~ No* O ~A ord~m~? O ~A mal~o~ or fdh a t~? ~ Y~. ~ 'No~ For clinic ~ have ~ ~le ~ mm~o~ ~ ~ly ~? .... ~ ~A -,- ~ In ~e S~on H, ~low~ d~ how. and wh~ ~ defi~ were or~ll H_ Comments: ;. - .. UST Monitoring Site Plan ....... · -~ ~s~cfions Page' '~ of ~ 11/15,99 INsTANK SETUP SYSTEM SETUP CIRCLE K 8g05"'. APR 20, 2001 . 8:07 BAKERSFIELD' CA 9:3306 THERMAL COEFF : '::000700 APR 20, 2001 8:07 A~;~i:" TANK DIAMETER' : 92.00 SYSTEM UNITS ~-: ,, .- --,, TANK PROFILE : 4 PTS U.S. .' FULL VOL : 9816 SYSTEM LANGUAGE ' :',, ' 69.0 'INCH VOL : 8058 ENGLISH i,~ ~YSTEM STATUS 46.0 INCH VOL : 4992 SYSTEM DATE/TIME FORMAT - - '~' 28.0 INCH VOL : 1898 MON DD YYYY HH:MM:S$ xM t':' ALL FUNCTIONS NORMAL CIRCLE K 8605 :i - INVENTORy REPORT WATER WARNING : 2,0 661-871-7979 - T 1;UNLEADED '' ''"" SHIFT TIME 1 : 6;00 AM I ULLAGE = 8603 C;AL:B '" : .... MAX OR LABEL VOL; 9816 SHIFT TIME 2 : DISABLED J 90:;~ ULLAGE= 76,21 · .'' :::': ~ OVERFILL LIMIT ; 90% .:: SHIFT TIME J ; DISABLED : TC VOLUP1E = ' ' "I ; 8834 :.: SHIFT TIME 4 ; DISABLED ~ HEIGHT 16,851203 GALSiN_.nE~ ' ~ HIGH PRODUCT ; 95~ j WATER VOL = 0 GALS .... ,.: TANK PERIODIC WARNINGS j WATER = 0.00 INC'~ES .' .: DELIVERY LIMIT : 10~ DISABLED j TEMP = 70.9 DE~: F · . ' ' : 981 TANK ANNUAL WARNINGS ~ ' -' :,'.':, · LOW PRODUCT : 500 LINE PERIODIC WARNINGS ~.'.-.'.'.~ T '2:PI, US ':'::' :" LEAK ALARM LIMIT: 99 DISABLED VOLUME = 4029 GAL~ ........ :.:<?,-':;::::,:?'~:.--:: SUDDEN LOSS LIMIT: 50 LINE ANNUAL WARNINGS ULLAGE = 5767 GALA: ..~:,~ ....... ~ ......... TC VOLUME 4025 GAL~ :":';~'>>'~'~<':"";':~:' M~NIFOLDED TANKS PRINT TC VOLUMES HEIGHT = 3.9.z3~ INC~S ·~"??::"::':::~;"'J:??:' T~: NONE ENABLED W~TER VOL = 0 LEAK MIN PERIODIC;: 10~ V~LUE (DEG F ): 60.0 : 981 STICK HEIGHT OFFSET D I S~BLED T 3: PREM I UM LE~K MIN ANNUAL :' iOA PRECISION TEST DURATION VOLU~E = 1959 ~ DAYLIGHT SAVING TIME 90~ ULLAGE= 6875 GAL~ . :.,: : :- .'~::'/ ENABLED TO VOLUME = 1936 GALS .:.' ' PERIODIO TEST TYPE START DATE F':.~:::'. HEIGHT 29 5': ? APR WEEK 1 SUN WATER VOL = 0 CAL~ : START TIME WATER = O. O0 I NC ANNUAL 'TEST FAIL 2:00 AM j TEMP = 76.5 DEG F "'" - ....:' -- ALARM DISABLED END DATE : OCT WEEK 6 SUN :, . ~ .... ' PERIODIC TEST F~IL END TIME J ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ '; ALARM DISABLED 2:00 AM C ========================================= ANN TEST AVERAGING: OFF J:~:?~ .::?...:~:./ _ _ _ ~ N~ ~aTUP ~ONE FOUND ~¢:~4~:::~&,;9,.¢ . TEST ON D~TE : ALL TANK': TANK Dii:.:METER : · 92.'00 ; 4 PTS :';:t;!.~i::::r::%7'-:'~:~:.:~::: TEST RATE :0.20 GAL/HR [~? 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 .... <:~,:t~::,'.'.:.:<:~: ....... ' DURATION : 2 HOURS [;~:~:~ 46 0 INCH VOL : 23.0 INCH VOL : 1898 NORMAL [~:<:: ~TER ~RNINO : 2.0 MAX OR LABEL VOL; 981~ : 7.'. ./:. .::' HIGH. PRODUCT : 95% . . : 9:325 " ):. : 9325 ¢ DELIVERY LIMIT ..,.'- .' -.....: DELIVERY LIMIT : 10~ .' : 981 '."':':' : WPLLD LINE LEAK SETUP LO~ PI,:ODUCT : 500 ' . LEAK ALARM LIMIT~ 99 :' - ' " LEAK ALARM LIMIT: 99 . SUDDEN LOSS LIPIIT: 50 .'.'.:>':: ...... SUDDEN LOSS LIMIT: 50 TANK TILT : ..:.~:: ." ...,-':.'.- ~'.. --' TANK TILT : 3.50 ,..,:., ':<:.:. ~ NRNIFOLDED TANKS 0.10 GPH TEST: ENABLED LEAK PIlN PERIODIC: 10% : 981 SHUTDOWN RATE: 3.0 GPH : .... .:- ,., ' · DISPENSE MODE; PERIODIC TEST TYPE ' ~ STANDARD PERIODIC TEST TYPE :~'~'~~'~t~ W2:PLtJS ~ ANNUAL TEST FAIL ~ ALARM DISAB:ED ALARIfl D I SABLED PIPE TYPE; FIBERGLASS IT:''~ PERIODIC TEST FAIL LINE LENGTH; 100 FEET I'" J PERIODIC TEST FAIL ALARM DI~Aer~D . 0,20 GPH TEST; DISABLED ALARM DISABLED GROSS TEST FAIL 0.10 OPH TEST; ENABLED ~ GROSS TEST FAIL ALARH DISA~D ~ SHUTDOWN RATE; ~,0 GPH ALARM DISABLED . : : T 2;PLUS ANN TEST AVERAGING= OFF PER TEST &VERRGING: ] .~ TNK TMT SIPHON BRERK:<:~F ., ........ -. ~ :::,::':: TNK TST SIPHON BREAK:OFF j.: DELiV:RY DELA,, : iS.~:N .: O. 10 GPH TEST MM/'DD }: :.'; .~ /'::: .:' · 5600 AUBURN :,..'.. BAKERSFIELD CA' ~SO, :wPLLD, . .. 661-871-7979 · "- ~INE DISABLE ' . ' ' ~. .... ~: ".-.~: .' L I ~E LEAK. LOOKOUT':~E~': ,'~PR 20, 2oo1'.,1.~.~o8.~M ' :.: · ."' "· . " ....... .- - - :" · .... ' ':." ~ 'i":"ONL:~::~'::'~::': ' ' "'," LOOKOUT ~OHEDULE - .... ' Da I LY · ' . ' - . LIeU'ID BE'~'.IS(:,R A~MB START TIME~ DISABLED BYBT~P1 STATUS REPORT L 1 ~FUEL AL~-:RM - STOP TIME ~ DISABLED ............ L 2~FUEL aLaRM ALL FONCTIONS' NORMAL ' . : .. ::.. W 2.PLU,_ l NVENTORY REPORT . ' ::~. L S:i :.:tSL ALARM ~..I ._'; :>REM I UP1 .. "'.::- 90~ ULL~C:E= 766~ ' TO VOLUME = 115~ GALS ~I(IUID SENSOR ALMS '~' :' ":" ~ HEIGHT 16.~0 INCHES L 5:FUEL ALARM LI(~UID SENSOR SETUP L 6:FUEL ALARM · . WATER VOL = 00ALS :....: · " WATER = 0.00 INCHES · - ........... . TEMP = ?1 .'~ DEG F '::l t. :.'~: ..-' T 2:PLUS "i OaTEOORV : ANNULAR ' "":: ULLAOE = 5788 OALS "j .... "" ~0~ U~LAGE= ~B06 OALS L 2~UNLEADED_BUMP TO VOLUME = ~02S OALB ~':~' TRI-STATE (SlNOLE FLOAT.:. HEIGHT = ~S.22 INOHES : ~:] OATEOORy ~ STP ~UMP W~TER VOL = 00~LS ~ATER = 0.00 INCHES SOFTM~RE REVISION LEVEL TEMP = 72.9 DE~ F VERSION 16.02 L 3:PLUS-~NNUL~R SOFTMARE~ ~46016-100-C TRI-STATE (SI HOLE FLO~T)~ : T ~:PREMIUM VOLUME = 1~57 G~L$ $-MODULE~ ~0160-0~0-~ 90~ ULLR~E= 6877 GRL~ PERIODIC IN-T~NK TE~T~ L 4~PLU~-~UMp , TC VOLUME = 19~4 G~L~ ~NNURL IN-TRNK TE~T~ TRI-~TRTE (~INGLE FLO~T) .... : '.: HEIGHT = 23.50 INOHE~ j PLLD , '- C~TEGORY ; ~TP ~UMP , ~TER VOL = 0 G~L~ --J ~ .::~..::-,;:",>..~',..:'...:<:.:J ~RTER 0,00 INCHE~ ~~ L,~PLLD TEMP 76.6 DEG F 0.10 RRNURL&O 20 SONT ....... . ....... '.',~' ............. ~, = · L 5~PREMiUM-~NNULRR . ~',. TRI-STRTE (SI HOLE FLORT) .... ~ CRTEGORY ~ RNNUL~R SPRCE :'" ": ":' '": ~ ~ ~ ~'~ :I,ID ~ ~ ~ ~ ~ ................... , . ::'. .................. I,>....:. '.,.: ' ' · '.:' : ' . . .- y--: ...... ~ . : . · . , ' ' :"": .... " '" ' ' " ' ' ' ' ' ' ~ TRI-STATE (~INGLE FLORT) :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ,,':),.::':::':..:':::::"::.:'::'--.. SRTEGORY ; STP SUMP .:.~.?~.:::::::::::::::::::::::::::::======================.~::~:::==========================:.:... ::': :":: ... :,::::,:..:~ ::::::::::::::::::::::::::::::: :~ ' ::.':.,' ':.: ::.",,'.:_' ::'' .:: '-::~-J .... . .... . - .... . ~::..: . : .. ........ ..-.. ..;..?-::.':::::..: : ...... . . . , ::: - . : .- ... ':.. :....:?:'::. ,.. -:.:. _. :... :.:,.:,::':'. ..... - ::?:..:.. :-.- "- ~ ' .... . . - '.- .<4::- .::,.: '.'::: .: , ,, .:,.;:: ::, - .. ,..- . .,.. .. ... ,... · ~ .... ,,. . - , , -.- .,.,,..-: :.,'":'-.::~::',-, . .- . . - : .':." . ...... . ': .... : :':: ...:...:- .- .,..::: :'.... :: THERMAL COEFF :.000700 ' NONE FOUND '" UNITS ."..'. ' · TANK DIAMETER- : 92.00 · ' "U.S.' - :' ::-:' ' SYSTEM LgN¢U~¢E'' F~LL VOL : ~816 c, · ~S-2~2 SECURITY · . ' 69.0' INCH VOL : 8058 CODE : 000000 ENGLISH ' ' :' ' SYSTEM DATE2TIME FORMAT 46.0 INCH VOL : 4992 , · ' · - 23.0 INCH VOL : 1898 :,J ' ~' MON DD YYYY HH:MM:SS xM CIRCLE K 8605 5600 AUBURN FLOAT SIZE: 4.0 IN. 8496 R$-232 END OF MESSAGE BAKERSFIELD CA 93306 - ~>' SHIFT TIME o : DIS~LED ~HIFT TIME $ : DISABLED .. .' HIgH PRODUCT : 95~ "' T~NK PERIODIC ~RNINGS .............. ~ DISABLED LE~K MIN ~NNU~L : 10~ HOUR~: 12 I D~YL I ~HT 8~V I N6 T I ME . ~NNU~L TE~T F~IL END D~TE ALARM DISABLED OCT WEEK 6 SUN ,,, .. .. ,. '.:.: ',:.'. =============================== ........t ' PRODUCT CODE PRODUCT CODE ..' : 2 TEST ON DATE : ALi2""'TA~K- THERMAL COEFF ' · THERMAL COEFF ::000070 JAN 1', 2000 TANK DIAMETER .92:'00 TANK DIAMETER '. :- .92.00 ,START TIME ; 12:00 AM TANK PROFILE ' " 4 PTS TANK PROFILE, :~ :,::'. 4 PTS TEST RATE :0.20 GAL/HR FULL VOL 9816 FULL VOL,': 9816 · DURATION : 2 HOURS 69.0 INCH VOL 8058 69.0 INCH VOL :' 8058 46.0 INCH VOL 4992 46.0 INCH VOL': 4992 :..:'~, .,. -.,.-,. 23.0 INCH VOL 1898 23.0 INCH VOL : 1898 '.-i:~ ~:'* ', ~:~if-;:'. .., .':-:b'.,-:,;..., ,. LEAK TEST REPORT FORMAT " :~.:::,4~:.'- :.:': ,.. NORMAL FLOAT SIZE: 4.0 IN. 8496 FLOAT SIZE: 4.0 IN. 8496 i ? WATER WARNING : ..0 WATER WARNING : 2,0 i:: i .: HIGH WATER LIMIT: 3.0 HIGH WATER LIMIT: 3.0 ' ::{i::-_:."..,',: :.::,z::,:.::~ .: ':-~:'":':":; ':Y./:'?:.¥:. MA× OR LABEL VOL: 98:16 MA× OR LABEL VOL: ':3816 , OVERFILL LIMIT : 90~',; OVERFILL LIMIT : : 88:.34 : : 88,34 ': I HIGH t::'RODLICT : 95~ J HIGH PRODUCT : '.'' : 9325 i : 9325 ' ' : DELIVERY LIMIT : 10~ i DELIVERY LIMIT : 10~'~ : 981 i. : 9131 WPLLD LINE LEA}( SETUP .~ ............ ".t LOW PRODUCT : 500 ' LOW PRODUCT : SO0 .J LEAK ALARM LIMIT: 99 LEAK ALARM LIMIT: 99 · ' '"" '"" :" i SUDDEN LOSS LIMIT: SO , SUDDEN LOSS LIMIT: 50 · ' '-~' : ":-::. ! W 1;UNLEADED :,~ TANk: TILT : 3.50 i-" TANK TILT : 3.80 ~'~'!,~'~'-~-:x.~,'~W"/::~!,~tl LINE LENGTH: 100 FEET .~¢~S:. TI~: NONE T¢: NONE ~,~,,,,: ,. <-,, ................. ,v.,': .... 0.20 GPH TEST: DISABLED :: :'. i(::i :?'&j.;:-:;i:!:i:':.~,~t! O. 10 GPH TEST: ENABLED ' SHUTDOWN RATE; O,O GPH i:!}!..} LEAK MIN PERIODIC;: 10~'; LEAK MIN PERIODIC: 10~4 DATE : 999 0 : T l:UNLEADED LEAK MIN ANNUAL ; 10~ :'.'~:'!:"1 LEAK MIN ANNUAL : 10~ DISPENSE MODE: : 981 J' "'i ; 981 :.:::".~... ....... ,, ,., .:,~:-: '.:.. j.. STANDARD · .': ,---. _ PERIODIC TEST TYPE PERIOr~IC TEST TYPE · ' - ..................... ~ ~LIICK . . ~UICK '.. ~......' .... i' ....... .', ..:.?:...' ~4:-'.?':':~t:'.L':>: .'.:' ANNUAL TEST FAIL ANNIJAL TEST FAIL :~~!!~!~i~t,~,t~~~~~.~-:..?,:-',, ,:.: .:-:, ;:.,:, :-.,~ .,'--::~<,:. ,,--.:::--..,,,':.,,,::'::,,,-,, :.:,'~<-<~,:;,: ,·-i-.., :,,;~..-:...,,,.~:,,-,.-:.~:,.::~,:;~.,,,~¢ ALARM D I SABLED ~J~..,..~ ALARM l]I SABLED : PER I OD I ¢ TEST FA I L .. . .. :..,...:,:::, PERIODIC TEST FAIL ' . ALARM D I SABLED j ALARM D I SABLEI] ....... GROSS TEST FAIL ': i GROSS TEST FAIL · :.,:.: ,.. ALARM DISABLED { ALARM D I SABLED · .-.':' · ..... · - ' - . ~NN TEST AVERAGING: OFF : ANN TEST AVERAGING: OFF :;:""":':':':':'~':": '"::'"':'".."> · ' "":':.,.... ...... ' ':':'>~"" '::..-,, , . ...... :::¥ ........ .. :::::::::::::::::::::::::::. .,, . . PER TEST AVERAGING: OFF 7Y::':"::::' PER TEST AVERAGING: OFF :f':: '~:.":-..'. ;...T.:':'. ': :-:. , .... :.7,, .?. ,.' %.: :.:. ~.:: /e: - ~ , ~.f.~:*...',:,,.-, '. -,'~ '*; ;;,::, :.~. ~:.}:: ... :.:, :f; .,:,~,., ~-:: ~ .. c:.:~ .":':'.:':, ,.. :..'..-;.*~%',, ;;':. :.'.~' :: I ' .:',,,.,, :: .......... <,'-:: ............ ,;,, '.,..,',.., .......................... :;.z ..... 'x..-.'<',::; TANK TEST NOTIFY: OFF ..... .,<,::,,:.~?.,.,,.:,~,,,>,.:::,:..,.,,,,?::~.~;:,~:~:~;>:.~:.::<,!:..: :,~:::!:~,',~,, TANK TEST NOT I FY: OFF TNK TST SIPHON BREAK:OFF ::::' t TNK T~T SIPHON BREAK:OFF "' ~ 'i':"I DELIVERY DELAY : 15 MIN . .'" ~ DELIVERY DELAY : 15 MINi · - ......... ". .. ,. -/:7 :.; ?~7~7::;::: '.~ · · :'. ;~",:!'-:L' · ,: .:,:- . : : : . .... ' "" ..... :. ......... ., ..... :i: :::::..:" ": · .....'... .... :.........::....:..- .... ..., ~...:..'..:',:./-:~. :. : . ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: · ..,.:'... .: :...::.:;: ::::::::::::::::::::::::::: :·. ·.:'·...,.. ::: :..·: ...:. :.·. ·.-. ...... . .;.. ,.,::-. ·... ,,:....·...:.:·:;:.,...:: ======================================================== . .. :",. .... .::, ,. ~' ;:::..: ::7 . ;.-t':.;.' '- -:-7-:,;':.: ': '.,~: :,,>.~:?: ~.:.:-, ! :.:': :--.','_,. ,-.. ·~ · :' 7::::'* ":-:": :.' "5": ' ':::'- ':~4":::-: ,4 :';: '":" '~1' ~'~:" ":t:i~<-:,'t:,.?="..~:;::(;g?7::'3 .-. .... :.:. :,:... ::::::::::::::::::::::::::::::::::::::: , . .. , . . :" :,,; . .:' D I SABL]I~'F{Jp' ... . WPLLD ' ~:~;,~:J LINE LENGTH: IO0'FEET' ~:~:¥~j ~T~RT TIME: DISABLED . j::::::.] 0.20 QPH'TE~T: DISABK~ LI~UID SENBOR ~LMS ::j STOP TIME : DISABLED I?::'"l O.lO GPH TEST:-ENRBLED L 2:FUEL'ALARM ~:,: , SHUTDOWN RATE:. 3.0 GPH L 1 :SE~SO~ O~T gL~M T '2:PLUS L 2:SENSOR OUT gLgRP1 DISPENSE MODE: ~ 2 :PLUS _ ST~ND~RD L J:FUEL ALARM : L ~:SENSOR OUT ALARM -: ~ LIQUID SENSOR SETUP ': ' L 1:87-ANNULAR ' L 5:FUEL ALARM TRI-STATE (SINGLE FLOAT) , ...' .---.': L 6:FUEL fiL&RP1 .: C~TEGORY : &NNUL~R SPfiC:E · ... L 5:SENSOR OUT ~LARM ~ W ~:PREMiUM-' , . ,. L 6:SENSOR OUT ~L~RM ,:' ~ PIPE TYPE: ~ L '2:UNLEADED-SUMP : LINE LENGTH: 100 FEET ' ....,,...-0::::. ",...~ TRI-STgTE (SI NGLE FLOgT) ~. 20 GPH TEST: DIBBLED ~HUTDO~N R~TE: 8.0 ~PH :'.: :':::::'.'? CATEGORY:ANNULAR SPACE 'DISPENSE MODE: . ~T~ND~RD VERSION 16.02 L Q:PLUS-SUMP ~- ::::-~.. ,. SOFTW~RE~ 346016-100-C TRI-STATE (SINGLE FLO~T) ' CREATED - 98.05.14.1~.04 C~TEGORY : STP SUMP ~ SYSTEM FEATURES: L 5 :PREMI UM-ANNULAR PERIODIC I N-TANK TESTS TRI-STATE (SI NGLE FLOAT) : ANNUAL IN-TANK TESTS CATEGORY : ANNULAR SPACE . :, ....:.. '] 0.10 MANUAL&0.20 CONT " ~ 0.10 MANUAL&0.20 OONT [ .:. L 6:PREMIUM-SUMP ' ' , TRI'STATE (SINGLE FLOAT') AL~Ri."i i'-J::ToR',.' RELY'OR: ' ALARM N:STOR¥ REPORT ..... SENSOR ALARM-:--.-. - .... ·SENSOR ALARM -- - .... SENSOR ALARM · BZ 5:PREMIUM-ANNULAR .... :' L 3:PLUS_ANNULAR. ' - L.l:ST-ANNULAR . ANNULAR SPACE ' . ANNULAR SPACE . 'ANNULAR SPACE FUEL ALARM " FUEL ALARM ' FUEL ALARM · APR 20, 2001 · 9:06 AP1 ' APR 20, 2001 9:18 APt APR 20, 2001 9:23 AM FUEL ALARM FUEL ALARM FUEL ALARM MAY 8, 2000 10:15 AP1 MAY 8, 2000 iO:24'AM If,AY 8, 2000 10:31 AM FUEL ALARM FUEL ALARM /' FUEL ALARM MAY 8, 2000 IO:I:3'AM OCT 26, 1999 2:50 PM NOV 15, 1999 9:58 AM , ..: :-'.: ,': :.!: ,, .::..:- :..",:,.El ALARM HISTORY REI::'ORT ALARM HISTORY REPORT : ..:.,.. ,. :,: :::::."~':":": ...... SENSOR ALARM ..... SENSOR ALARM ..... SENSOR ALARM ..... ':': :"'":"";"' L 6:PREMIUM-SUMP L 4:PLUS-SUMP L 2:UNLEADED-SUMP ~::"' ..... '"'':' STP SUMP ?.~. STP SUMP ST::' SUMP ' .... FUEL ALARM I FUEL ALARM FUEL ALARM · APR 20, 2001 9:01 AM ~ ' APR 20, 2OD1 E¢:56 AM ~ii ,APR 20, 2~01 8:58 ,:.::.,' , ::..', "::U:,.i -~.r-.::.:':,:~?. '-'FUEL ALARM ~:~ FUEL ALARM , FUEL ALARM ~},~i~3~ PlAY 8, 2000 10:00 AM 'flAY 8, 2000 9:47 AM MAY 8 2000 10:39 AM FUEL ALARP1 FUEL ALARM MAY 8, 2000 9:48 AP1 . ' OCT 18, 1999 2:16 PM "' i FUEL ALARM : PlAY 8, 2000 10:34 AM .i i : '. ' .................... ":.' ?':'.i-';::'3:'.::"::':': ................. ~. ....... .:'."': -:-:--::- ..... -- : 7' ' :': ,:: : ..... -. · .--: . . .. :.. ,:::..' ,: :: .::::.-.,:-: ., . · . :: :..: :. .'...~ :: · · .::: ...' , ;.:'. .,i"' '," :-.' ' . ':::':,.:', ...... ::.:: :..i-?..'!ii'::/' :.-'-' .,.,:.:- :::. . . . ::-' -- _ ' .. . : : .... : ,. :,. ,. - .,.:...-,: .,:..:' ....... . . .., .' .. : ::::::::::::::::::::::::::: .. :, - :.. :::':.., : ..... ,., _ . .: , . .,,', , .... , .... . ·., , , .,. , :. ,,:.; -.. , ..:': ,.::?,,,:?./,:qr:.,,,,,;:.,;:,, ,,..., ,..,. :, : -: '" . ::.·.::.,..:.,::'?':iL: :..,.::::::::?' 1: ' -<:: :.: ",:,' · '. - . :::. :~ :,. .:'-' ',-,"::-: ,::::.:.:,~,·',? .' ', ..: . .,·: ::. ,-.,{.: ,: ::;:,: :.. ..: ...... . : : ? ::'.::' :,:: .:..,..: :: ::,,::. ::.... -.' -, ¥'.':... ';' ':: -- ' , ''- ::¢'..: :-. ' ,..:-::·. 4:'.:,-: .;: '",i- *';:'~ ¢':': .JS':..-::: ~r.,;.:,.: :¢~: ~,,,:~: , ' · · .. , - .' . ,:.,':: , ·: ,- . ' ' .4':: :::,;! <: ' , aL*:-, ': -', ¥C L-:::·5::':¢ ·: -,-. :' ' .':. , ..:, ,;'"3,, '"'-.:',~ ."., '; r . : :~ ..,::: ':::':,:.'. :. .: . :. '.:_::.:::, :,..:',:...':'.:' . .:: '. .: ,. : :., .... -:........ · :... .:.. :.::' ,..,:::;:....:-:::,: :::-::-:,?::.'::' ....:.: . ": .. . . , · ' ' """,': '" '" '" .... "' ' '..' .:':"?" ':i" ';:i::: '.:::'-::'.:'.::::i": · :, :!-: ,- ALARM HI:3TORY REPORT 9 --.--:,BENSOR ALARM ..... W 1 :UNLEADED . SEN~OR ALARM -- ~.7. WPLLD ~HUTDOWN ~LM 'W::3~PREMIUM . '' '" APR 20, 2001 9:56 AM WPLLD SHUTDOWN ALM 1ApR 20, 2001 9:39 AM GROS~ LINE FA'IL APR 20, 2001. 9:56 AM . GROSS LINE FAIL .APR 20, 2001 9:39 AM WPLLD ~HUTDOWN ALM FEB 1S, 2001 6:14 PM ~PLLD SHUTDOWN ALM DEC ~0, 1999 9:27 AP1 S'¥'S'[EI"i STATUS F:EFT;'F:T i~l.,!_. FLff,]CT IONS N,:3FJ'i&L C l }b?:L.E }( F: ( '~ 6 "~ x, S"~"S'f'EPI Z/Pal'US F:EPOFtT c4..4 9']:L: I,L&C~E= 1472 G~LS '3Er;.,:, LiLLa,?E: E;]n]6 ,:5;AL~; {....i~'I'ER = (]. Z Zt l NCHES TEI'iP = (:5.6 BEG F T 3: PREI'.I 1 LID VOLLII'iE = 2'059 L.II..L~:~,.-.;E = 775',? GALS : 'v'OkOl'.'tg = '2 ('J FJ?Z'. ;'[GHT 2'.4. :35 I NC;lIES ~'I'EF: ',,/OL = 0 GALS I,,t~TI'ER = 0. O0 l I'.ICHE?) TEI"IP = E, 4.8 DEG F January 22, 2001 FIRE CHIEF RON FRAZE Circle K 5600 Auburn Street ADMINISTRATIVE SERVICES Bakersfield Ca 93306 2101 'H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 RE: Dispenser Pan Requirement December 31, 2003 Underground Storage Tank Dispenser Pan Update SUPPRESSION SERVICES 2101 'H" Street ' Bakersfield, CA 93301 Dear Underground Storage Tank Owner: VOICE (661) 326-3941 FAX (661) 395-1349 You will be receiving updates from this office now, and in the future with. PREVENTION SERVICES regard to the Senate Bill 989, which went into effect January 1, 2000. 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 This bill requires dispenser pans under fuel pump dispensers. On December 31, 2003, which is the deadline for compliance, this office will ENVIRONMENTAL SERVICES be forced to revoke your permit to operate, effectively shutting down your 1715 Chester Ave. Bakersfield, CA 93301 fueling operation. VOICE (661) 326-3979 FAX (661) 326-0576 It is the hope of this office, that we do not have ,to pursue such action, TRAINING DIVISION which is why this office plans to update you. I urge you. to start planning 5642 Victor Ave. Bakersfield, CA 93308 now to retro-fit your facilities. VOICE (661) 399-4697 FAX (661) 399-5763 If your facility has upgraded already, please disregard this notice. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Steve Underwood, Inspector Office of Environmental Services SBU/dm CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME (I,t~c~ L ,t~'~Ct c, INSPECTION DATE II~[o ADDRESS ,5'(~OO j~O~Orw, PHONENO. ~.71' 77~.~ FACILITY CONTACT BUSINESS ID NO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program I~ Routine [~Combined I~ Joint Agency [~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate ~,, Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material / Verification of MSDS availability Verification of Haz Mat training / Verification of abatement supplies and procedures / Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes [~ No Questions regarding this inspection? Please call us at (661) 326-3979 Business Site~espons~ble Party white- ~.,~. S,,cs. ye,ow - station Copy }'ink - ~smess Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME (~t. lP¢l¢ ~.~ ~'~C5 INSPECTION DATE Section 2: Underground Storage Tanks Program ~l Routine [~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection Type of Tank ~[//~" Number of Tanks Type of Monitoring d~./IA Type of Piping OPERATION C V COMMENTS Proper tank data on file / Proper owner/operator data on file Permit tees current Certification of Financial Responsibility I,,,' / // Monitoring record adequate and current / Maintenance records adequate and current Failure to correct prior UST violations L,, /' Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance .,V=Violation _ Y=Yes N=NO Office of E~vir~)nr~ent~l Servicers (80)~6-3979 Business Site Responsible Party White - Env. Svcs. Pink - Business Copy