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UNDERGROUND TANK FILE #2
FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3911 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 852-2170 PREVENTION SERVICES filE SAfETY SERVICES' ENVIIONMfNTAI SERVICES 900 Truxtun Ave.. Suite 210 Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 852-2171 FIRE INVESTIGATION 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 10, 2004 Mr. Bob Easterday San Joaquin Hospital 2615 Eye Street Bakersfield, CA 93301 REMINDER NOTICE Re: Necessary Compliance Deadlines for UST Owners/Operators Dear Mr. Easterday: The purpose of this letter is to remind you about three compliance deadlines for UST Owners/Operators, These are as follows: 1) January 1,2005 deadline for submitting declaration statement designating: (a) Owner/Operator understands and is in compliance with all applicable UST requirements, and (b) Owner identifies the designated UST Operator for each facility owned. (c) Owner/Operator passes and submits proof of International Code Council Test. 2) EVR upgrade requirements on spill buckets are due April 1, 2005. 3) Secondary Containment Testing on all secondary systems, Code requires re-testing 36 months from date of last test which was in 2002. Should you have questions regarding these compliance deadlines, please feel free to call me at 661 - 326-3190. Sincerely, vL~ Steve Underwood Fire Prevention Officer SU:db 1f~¡r,'llÙI/11¡;(!. Y&J/IINlItI,ml;v c;j;fto'J' 01(o-lC(! cf}J;ŒII Qýf Y;?e-lttinrll JJ p1010313.jpg (1280x960x24b jpeg) CONDITION OF PIPING CITYiOF BAKERSFTELD -- OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION.. SITE ~I/Lc/.~,..l 7' L C 7' ADDRESS ZIP CODE APN FACILITYNAME /,//1c/4t./7' i-o-T' CROSSSTREET ~'7~ ~ d'/-[C.5~¢~ ~c,,~ CONTRACTOR INFORMATION INS~CE C~ER ~Tg ~ P~L~YASSESSMENT~FO~TION ': ~ ' COMP~ C"AL - ~j ~cc~ PHONENO. INS~CE C~ER ~ T~K CLE~G ~FO~TION ADD'SS ; CI~ ZIP WASTE T~SPORTEK IDENTIFICATION ~BER ~D~SsN~E OF ~NSATE DISPOSAL FACILI~ FACILITY IDENT~ICATION N~BER TANK T~SPORTER INFO~ATION COMPANY ~ ~ ~ ~L;C< ~ C.~ PHONENO. ~q~Oqq~ LICENSENO. TANK DESTINATION ~L~ T~K ~FO~TION CHEMIC~ DATES CHEMIC~ T~K NO. AGE VOL~E STOOD STOOD P~VIOUSLY STOOD For Official Use Onllt THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, L~AL AND FEDE~L ~OULAT IONS. THIS FORM"HAS BEEN COMP LETED UNDER PENALTY OF PENURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE APPROVED BY: - ' APPLICANT NAME (P~NT) ~ APPLICANT SIGNATU~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., 3,d Floor, Bakersfield, CA 93301 / FACILITY NAME~qaM_ _ ',~Oa?Otiq ~05rl,41(, INSPECTION DATE i,~{ 15 03 Section 2: Underground Storage Tanks Program I~l Routine ~ Combined [~1 Joint Agency [] Multi-Agency [] Complaint I~1 Re-inspection Type of Tank _!)[0~ Number of Tanks [ Type of Monitoring d/..IJx Type of Piping ~ OPERATION C V COMMENTS Proper tank data on file Proper owner~olT~el'ator data on file ~ Permit fees current (... Certification of Financial Responsibility L. Monitoring record adequate and current Maintenance records adequate and current c_./ Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes. Does tank have overfill/overspill protection? C=Complian;.~ ,..V=Violation. ~ Y=Yes N=NO %~ : ),~-~"~ ~ ~ I~ Inspector: ~~ ~ O~ce ofEnvironment~ Se~ic~ (661) 326-3979 Business Site Responsi~Party ~ White - Env. Svcs. Pink - Business Copy '? BSSR, Inc. - :~30 Rosedale l-i(,..I Bakersfield, CA 93308 Phone (661) 588'27: 77 Fax (661) 588-2786 MONITORING SYSTEM CERTIFICATION t This form must be used to document testing and servicing of mohitoring equipment. A separate certification or report must be prepared for each monitoring system control p.a.n, el 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 Information Facility Contact Person: ,__II [Y~ t/nC)OB IX~ ff'~lx.~ Contact Phone No.: ( ~& ~ ). Make/Model of Monitoring System: I~1'~ C Date of TestingJServicing: 1_0_/ 5/o3 B. Inventory of Equipment Tested/Certified ?Ro~rc ~r ~,~I Check the appropriate boxed to ind~¢~_~_e spec!ftc equipment !n,pected/serviced: ~ In-Tank Ga-uging Probe. Model:~tq(¥') [-~ .~[")_C~")~ FI In-Tank Gauging Probe. ~,uu : ~t {i~,,~nnular Space or Vault Sensor. Model:l~lq~_t:~o~* t. lt~o~[~ 13¥',.~nnular Space or Vault Sensor. Model: ~LL [~rPiping Sump/Trench Sensor(s). Model:~)lqO'L[q~ I'¥~t~ lC) III'Piping Sump/Trench Sensor(s). M°del:[Jt~(~7_%qg_ ~"Pill Sump Sensor(s). Model:¢ _pO_2 ~O_? O_fft'3/~10 Fl Fill Sump Sensor(s). Model: Fl Mechanical Line Leak Detector. Model: Fl Mechanical Line Leak Detector. Model: 121 Electronic Line Leak Detector. Model: 121 Electronic Line Leak Detector. Model: Fl Tank Overfill / High-Level Sensor. Model: Fl Tank Overfill / High-Level Sensor. Model: El Other (specify equipment type and model in Sec.tion E on Page 2). Fl Other (specify equipment type and model in Section E on Page 2). "iank m: Ix',,l g <,:d~ L. Tank ID: ~ In-Tank Gauging Probe. M°del:'fflqO2/~[900")_OO Fl In-Tank Gauging Probe. Model: Fl Annular Space or Vault Sensor. Model: Fl Annular Space or Vault Sensor. Model: El Piping Sump / Trench Sensor(s). Model: Gl Piping Sump / Trench Sensor(s). Model: Fl Fill Sump Sensor(s). Model: Fl Fill Sump Sensor(s). Model: Fl Mechanical Line Leak Detector. Model: Fl Mechanical Line Leak Detector. Model: El Electronic Line Leak Detector. Model: Fl Electronic Line Leak Detector. Model: FI Tank Overfill / High-Level Sensor. Model: Fl Tank Overfill / High-Level Sensor. Model: ' Fl Other (specify equipment type and model in Section E on Page 2). Fl Other (specify equipmen, t .type and model in Section E on Page 2). Dispenser ID: Dispenser ID: Fl Dispenser Containment Sensor(s). Model: D Dispenser Containment Sensor(s). Model: D Shear Valve(s). Fl Shear Valve(s). Fl Dispenser Containment Float(s) and C..hain(s). Fl Dispenser Containment Float(s) and Chain(s). Dispenser ID: Dispenser ID: CI Dispenser Containment Sensor(s). Model: Fl Dispenser Containment Sensor(s). Model: Fl Shear Valve(s). I-1 Shear Valve(s). El Dispenser Containment Float(s) and Chain(s). Fl Dispenser Containment Float(s) and Chain(s). . Dispenser ID: Dispenser ID: Fl Dispenser Containment Sensor(s). Model: I-I Dispenser Containment Sensor(s). Model: Fl Shear Valve(s).' [3 Shear Valve(s). FIDispenser Containment Float(s) and Chain(s). Fl 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 - I 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 equipment. For any equipment capable of generating such reports, lhavealsoattac_~hdacopyofthereport;_(,~heekallthatapply): UI Syst~t~mset-pp ^ ~! ~l,arm histor~'re, port Technician Name (print): -~ I I'~'~ L ~_ b~..~.'i~.[.._[(~ Signature: ---~e~_,,_(~,,~_~,_. Certification No.: [ ~ ! ~ License. No.: (~"~ 9_ ~ Testing Company Name: ['~ ,' ,' ,' ,' ,' ,' ,' ,' ,' ,~>~, I _k.~,, Phone No.:(__~D_~) Page I of 3 03/01 Monitoring System Certification D; Results of Testing/Servicing Software Version Installed: ~ ~ O ~ -,, "~ ~--~., Complete the following eheeldist: 151~s Fl No* Is the auth'ble alarm operatmnal. [3~.Yes ~1 No* Is the visual alarm operational.9 ~¥es r'l No* Were all sensors visually inspected, funcfionall7 tested, and confirmed operational? fi~"~Yes ~ No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will .~ not interfere with their proper operation? ~Yes FI No* If alarms are relayed to a remote monitoring station, is ali commun/cations equipment (e.g. modem) Fl N/A operational?. Fl Yes ~ No* For pressurized piping .systems, does the turbine automatically shut down if the piping secondary containment ~ 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) Fl Sump/Trench Sensors; FI Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? Fl Yes; FI No. ~l~Yes ~ No* For tank systems that utilize the rtionitoring system as the primary tank overfill warning device (i.e. no Fl N/A mechanical overfill prevent, ion valye is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly~ If s°, at what percen(of tank capacity does th6 a!arm trigger? % Fl Yes* Iii No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for ail replacement parts in Section. E, below. Fl Yes* Iii No Was liquid foUnd inside any secondary containment systems designed as dry systems? (Check all that apply) 121 Product; rq Water. Ifyes~ desen'be muses in Section E~ below. [~'~Yes I~! No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable [iiFYes /21 No* Is all monitoring equipment ,operational.per manufacturer's sp.ecificafions? * 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/.. [] Check this box ifta uging is used only for inventory control. ~ .. 121 Check this box if no tank gauging or SIR equipment is installed. Th~s'~ect~on fiaust be completed if in-tank gauging equipment is used to perform leak detection monitoring· Com ~lete the following checklist: ~t~Y~s' {3 No* Has all input wiring been inspected for proper entry and termination, including t'esting for"ground faults?' I~Yes.. ~ No* W~re all tank gauging probes visually inspected for damage and residue buildup? ~ Yes {321 No*. Was accuracy of system product level readings tested'.* . · {~'Yes 121 No* Was accuracy of system water level readings tested? ' 13~res FI No* Were all probes reinstalledproperly? [~Yes Fl 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): [~heck this box if LLDs are not installed. Comple.te the following checklist: 121 Yes 121 No* For 'equipment start-up or annual 'equipment certification, was a leak simulated to verify LLD performance? ~ N/A (Check all that apply) Simulated leak rate: rq3g.p.h.; Fl0.1g.p.h; 1210.2 g.p.h. ~ Yes Fl NO* Were all LLDs c~nfi.rmed operational and accurate within regUlatory requirements? Fl Yes- Fl No* Was the testing apparatus properly cah'brated? 121 Yes 121 N~* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Fl N/A 021 Yes Fl No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak? {3 N/A Fl 'Yes Fl No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled 121 N/A or disconnected? ~ Yes [J No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system Fl N/A malfunctions or fails a test? Fi Yes Fl NJ'* For electronic LLDs, have all accessible wiring connections been visually .inspected? Fl N/A 121 Yes {3 No* Were all items.on the equipment manufacturer's maintenance checklist completed7 · In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03/01 MOnitoring System Certification ., -'- · usT Monitoring Site Plan ~' ~ Site Address: ............... ~ ~iaoOt~' ~D .................... ' ...... · . . ~'{~,.,~,.',-: ......................................... ........... . ................ m~t o~,. ................. ........... . i. i .............. (~e,~,~,~T~ ................ ''0 .~,.~i~i~i i i i i i i i i .................................. Date map was drawn: ~__/ ~ ~/ O~ 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 controI 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__ o5/oo ' 6'6m ~ " CITY O~ 'OFFICE OF E~ON~NTAL ,1715 C~s~r Ave., Bake.r~fle~, CA (661) ~2~-3979 APPLI~ON TO ' FUEL MO~TO~G CER~FICATi0N . ,. '. : ,: ' _.~ D /. January 22, 2003 san Joaquin Hospital FIRE CHIEF R©N FRAZE 2615 Eye Street Bakersfield CA 93301 ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 RE; Upgrade Certificate & Fill Tags VOICE (661) 326-3941 FAX (661) 395-1349 ])car Owner/Operator: SUPPRESSION SERVICES 2101 "H' Street 8akers~e~d. c^ 900o1 Effective January 1, 2003 Assembly Bill 2481 went into effect. This VOICE (661) 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 FIRE SM:E'W SER~ICE$ · EII1/tRO~tEENTN~ SEFN~CE$ 1715 ChesterAve. 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 ChesterAvb. Should you have any questions, please feel free to call me at 661- Bakersfield,CA 93301 326-3190. VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 ChesterAve. Sin~ ~ Bakersfield, CA 93301 VOICE (661) 326-3951 ,; FAX (661) 326-0576 TRAINING DIVISION 5642 VlctorAve. Steve Underwood 8akers,ol,~. C^ 93.30a Fire Inspector/Environmental Code Enforcement Officer VOICE (661) 399-4697 FAX (661) 399-5763 Office of Environmental Services SBU/dc CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME .5ttl/I ~aaqtl,& dOgtlt4~}~,(',,t t'{O~tJr[tt INSPECTION DATE il' k -~ t Section 2: Underground Storage Tanks Program [] Routine 1~ Combined [] Joint Agency [] Multi-Agency [] Complaint [~l Re-inspection Type of Tank 00O{~ Number of Tanks { Type of Monitoring (~g_,/31 Type of Piping ~t~!= 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) :.1~ {,oo0 rd'} 50n ~,., 'Ta,,k_ 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=C°mpliance ,d V=Violation Y=Yes N=NO Office of Environmental Services (805) 326-3979 o, Business Site Responsible Party While - Env. Svcs. Pink - Business Copy -~.~&dventist 261s Eye Street Health P.o. Box 2615 Bakersfield, CA 93303-2615 San Joaquin 805-395-3000 Community Hospital November 4, 2002 City of Bakersfield Fire Dept. Att: Ralph Huey Prevention Services 1715 Chester Ave Bakersfield, CA 93301 RE: Under Ground Storage Tank Dear Mr. Huey, You will find enclosed the paper work needed to show proof that we are maintaining our underground tank properly to your certifications. Enclosed is our Preventative Maintenance Schedule, the Requisition for the test and certification of tank monitor system, and paperwork from BSSR, Inc for the service and repairs they did on underground tank. If you have any questions please call our office at 661-326-4140 and ask for Bob Easterday, Director of Plant Operations or myself, Keri Patterson, Department Assistant of Plant Operations. Sincerely, Keri Patterson, Dept. Assist. Enc. 3 · ' :: ''., ..: :... , .... ' :SERVICES / REPAIRS PERFORMED ' ;'Q~;: . ';; ~:..~OUN~,'~ ..,. .... ... .,. :":' :.....::: ,. '.' :: ,":. ..'L.'" ~ '. · .' ,,' ': ": .:.::' ;...., >..-;.:::.:...:.._: ;-.~..:-._-. '. '. - ..... ~ .,'"'-L.L-' .. :'.'., ,.::: ::. ~,.:;. ": . .... .... :........., 7:,,: :'~:~. ,':. ~..;-',.: -. :,, · : , :':¢"~""::: :: ": :':;" ;'"'> ". "~OTAuZ~R REA~INGS- P~N~ER- SERIAL NUMBER ~.~ co..s ":""'-":~'~'" i~u~p,l,s~~ ,~-,-.' :,:: :. o I' I ' ' '-'"- ~i~s:A¢¢~' ' ' ': : TOTAL LA~OR C~ARGE '. .READINGS'BEFORE.. . TOTAL T~VEL TIME~ i: · . . .... , ..~, .: ...... .:..~. PM' ....". ~ · · -. CAUSE DEPAR~URETIME ~- . .-:. '-' ' .. . ':: · .... ~.. . - ..... . . ~ ~ . .. - .., .-~..... . · .~.... ..... .. : . . . . , , . ~ ~ .... :... -. . : ...:..:. -,'..-'. .'_ , .,..,, :. . . . . ..... · . ~ , : · -.:":. · . . . · . . ,... SERV CE P~ASON (PR NT N~E). . ' SERV CE PERSON (~RINT N~E) . AUTHOR ZED PERSON (PRINT NAME) - . - .. ' ._,.~ .~: ,,..:.. .... · . ., . · . ., ..-:. ;fi/ :' > ' S~VICE. PER~'S SIGNATURE'. ' - : · SERV CE PERSON'~ S ~NATURE AUTR'OR ZED P{RSO~ SIGN~URE ' 0ATE '":';¢;-:? ,':":':. SALESAGREEM T:lt" agreedthat~i~c~ecti~nismadeb~sut~r~the~se'~eagreet~payaF~NANcE~HA~TT~ExCEEDTHEM~MUMLEGAL~TE ~m utedafle " .... :' ;..- de'duc nC cu~¢nt payments and/or ~edits 8ntil f~lly pa d ~e a so agree to pay all co lections ~s s and including attome s' fees as ma be adud ed b he ) ' ~ r 20 d~ys from the due ~ate on . .... , ,, .,, t risrwrtten . ~e · ~ . · . . .... Y Y J g . y coud andwaweallnghts ata~y cla~ms exempted under Stats E~s¢and wi . .~.,.~ ~ , 2ropedy wlthoq~ p con nt of B~SR, Inc. from orlg~nal place of se~l~s provldedldehve~hnstallat~on of pa~s. MerCandise not returnable unless approved by BSSR' nc (SFI I FR) :.,. , ~ ,~ .¢' . ..... ',~ TOTALAMOUNT ~uyor ~ ~. ~ato ~dministration Si~naturo ~ate Type g~4 PM PL~ ~RK' ORDER Location: B1 ENG OFFICE "'DePt: "? ' UO Issue Date: 09/03/02 Controt #: 0E02151 il Property: Ctient: WO Issue Time: 15:10:13 -.,~= .GIL~R~a -- Lq%l P. Guide: ~o98 Last Status/.c: //,/ Model: Schedute Code: A Descript: ALARM, UNDERGROUND TANK Last ~0 #: 0 Serial: 506]438000500 Schedule Pri: Category: L ALARM SYSTEMS, FIRE, SMOKE, OTHER & Warranty Date: 00/00/00 Company Code: Vendor: Crew: ENG Trade: ENG Emp: JG Acquis. Date: 00/00/00 Notes/Specs: Last Performed: 09/12/01 Comments: JCN#: Next Schedule: 09/12/02 Installed Date: 00/00/00 Contract PO: Type Contract Work: Serv Contr. S/Date: Serv Contr. E/Date: Stock #(NSN) Manufacturer Part Number Standard Part # (E[A) Qty Required Description Type UNDERGROUND TANK CERTIFICATION CALL COMPANY TO CERTIFY UNDERGROUND 'TANK. BAKERSFIELD SERVICE STATION REPAIR, INC PHONE #588-2777 NO# 4098 UPDATED 9/26/97 Completed By /~~Y~'~-~ Date ~'-~ Time · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. [] Agent · Print your name and address on the reverse [] Addressee so that we can return the card to you. ~ (Printed Name) } C. Date of Delivery · Attach this card to the back of the mail or on the front if space permits. delivery address different from item 17 [] Yes 1. Article Addressed to: enter delivery address below: [] No SAN JOAqUTN }{OSPI~AL 2615 EYE S~REE~ BAKERSFIELD CA 93301 3. Service Type ~] Certified Mai] [] ~:xpress Mai{ [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes · 7002 0860 0000 1641 7244 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 Postage $ Certified Fee Postmark Return Recelpt Fee Here r"'l (Endorsement Required) cO Restricted Delivery Fee r--I (Endorsement Required) FLJ TQtal Postage & Fees ~ r~ I Sent To ["-[ SAN JOAQUIN HOSPITAL ¢#~ $~"~' ~/~gRSFIELD C~ 93301 Postage & Fees Paid USPS Permit No. G-lO · Sender: Please print your name, address, and ZIP+4 in this box · ~AKERSF~ELD FiRE DEPARTMENT CFF~CE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, Sui'~e 300 Bskers2~eh:[, CA t;~301 ~~D ~ ~ October 21, 2002 San Joaquin Hospital 2615 Eye Street Bakersfield, CA 93301 CERTIFIED MAIL FIRE CHIEF NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street RE: Failure to Submit/Perform Annual Maintenance on Leak Detection System Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES Dear Underground Storage Tank Owner: 2101 "H" Street Bakersfield, CA 93301 Our records indicate that your annual maintenance certification on your leak detection VOICE (661) 326-3941 FAX (66t) 3954349 system was past due on September 7, 2002. PREVENTION SERVICES YOU are currently in violation of Section 2641(J) of the California Code of ~RE S~E~ SE.VtC£S.ENraON~an~ SEmnCES 1715 Chester Ave. Rc;ulations. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, PUBLIC EDUCATION including routine maintenance and service checks at least once per calendar year for 1715 Chester AVb. Bakersfield, CA 93301 operability and running condition." VOICE (661) 326-3696 FAX (661) 326-0576 You are hereby notified that you have thirty (30) days, November 21, 2002, to either FIRE INVESTIGATION perform or submit your annual certification to this office. Failure to comply will result 1715 Chester Ave. in revocation of your permit to operate your underground storage system. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661)326-0576 Should you have any questiOns, please feel free to contact me at 661-326-3190. TRAINING DIWSION 5642 Victor Ave. lncerely, Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney BSSR, Inc. , 6630 ~os~dale H~., ~ B, Bake~ficld, CA 93308 Phone (661) ~8g-2777 Fax (661) $88-2786 MONITOR G SYSTEM CERTIFICATION . 'H~t~ fo~ m~t ~ u~d to dormant tc~t~$ and s~icing of ~itorin$ equipment. ~ara~.r~fieation or _renan "~'~ '~ed for ~ch ~omtorme svs~ con~ol~ by ~¢ ~:cmn who pcrfo~ ~e work.: A ~ of~h fd~ must ...:~;~'Geueral Informa~on , r Of Equipment T~ted/CerfiflCd ' ) I ~ch ~nsor(~). ~ipi~ Sump / Trench $~s), Mod~ O~ ~ q~ ~6- Line L~ ~t~r. Mo~cl: = Q Meeh~{~l Line Le~ D~t~tor. Model: i B model in S~ion :" ~ In-Tank O~gin8 Pr$be. ' ' M~el: V~lt 8~f~ . .' M~del: .... ~ Annul~ $paee or V~lt ~sor. ~ak ~e~r. Mod~l: ~ M~hanlcal Line L~k Det~tot. M~ol$ ' Sense. Model:, ~ T~k O~1~ / High-Level Sonic Modal; ~d m~el In S~tion B on ] ~d m~cl ia Section B on S~so~s). M~I:' ~ Dis~nser C~tain~nt S~n~r(s), M~tI: ~:"- .... S~r(s), Model: ~ D,~s~ :ontanm=nt $eh$0~S). Sh~ DBpenser ID: ..... ~.epnmifis mo~ or dispen~,% ~PF ~i$ form. ~cl~e inflation f~ ~v¢~ ~k ~d db~n~t:~ the · 'C;:; :Cer~caflea - I ~t~ ~at ~e ~ulpment identified in tb~ document ~ ias~t~/s~ieed In .. ~'~6{a~' gul~ A~ch~ to ~is Co,la,Uae 1s info--tiaa (e.8. manufactures' ch~klt$~} ae~ to v~l~ · '~fo~tlaa h co~t and a Plot' Plan ~owhg thc layout or monitorial ~ulpment. For any ~uipmmt ~p~le of ~e~bave~a~edacopyoftber~;(ch~Aa~&~dpp~): ~ Sy~ ~p D ~arm'lds~ort Page ! of 3 ,.M~torlng System CertiBcadon N0¥--2~--02 lION 1 0 : ~$ FROH 1~ . $ . $ . R . I tiC . P . 07 F. ln-:,Tank Gauging / SIR Equipment: Q Chock this box ii' tastk gaugin~ is us=d only for invcnto~ control. "' / "' :' =' '" ' ' ~ Check this box it' no tank lau$irtg or $I~ equipmont is installed. .Ih.~',e~tion mu~t bo ,omplcted if in-t~nk gauging ~quipment i~ u~d to p~rform 1~ dot~tion monitoring. -'~::~ :':~ W~ all ~n~ gaug~ pm~ visu~lly ~c~d for ~mese and ro~ buffdup? ,, ........ · Q No* Was ~ocuracy of ~ystcm p~oduct level madlngs tested? ~:'~' ~ ~:" '~n ~ below, d~flbe .... ' ........ deficiencies or how nnd wh~ tb~ were ~H be ~acted. i.,:.O~.~,t~[~e L~k De~ctors ~LD): ~ck ~ box ~ LLDs ~o ~t ~sta~ed. .; ,.:C~ ~e folle~n chee~st~ ~., .~ .... .... ~ .... · ' , .' .~ ~' ,~; ~ m* For el~nlc ~s;'~o~ ~e ~b~ automatlcd~ shut off if tim :" .... ' '" , ~ ;~'X~ I :0 'No* Were aa R;~.on ~c m~pm~t m~'~es toaSt--ce checklist ~le~? ..... ~i:~$~iflon H, ~ow, de.ibc how, and when thee defl~encl~ w~ or will bc correct~. Page 3 of 3 I10N 10 : 54 FROM l~. $. $. R. I Nmi;. P. 08 O~ .:R,osu:l, ts of Testing/Servicing ~,w. ~ .... ~ ........ chec~st: ~ ~ . . ~;:;~ '~ NOS:' Wei&"all ~m°rs vtg~l~ ~P~, ~nctional~ted, and con~med opcraaonal?_ ............ ~' . '~ No* Were all senso~ ~stallcd at lowest ~mt of sccon~ contal~ent and posl~oned so ; ~ ~ter~ wi~ thck p~pcr op~tlon? Did you co~m ~ifi~ shut-d¢~, ~e ~ !*~ ~d ~nsor ~m~d~sm~tlm* 0 YeS:' O .Nd. '?'..~. No*. 'For ~ syste~ ~t ufil~ ~e ~oni~g ~st~ ~ ~e ~ ~ ~ezfffi W~ng ~cvi~e (i.e. no . . ~nI whm t~'deflci~a~ were or ~a be eo~t~. : .,.~ ..~ ,. , · .~, ~ ....................................... NOV--25--02 ~ON 1~ :~ FROH ~. $. $. R. NC. P. 09 Certification UST Monitoring Site Plan - //'/././. .. ~ ................ ........ ~ ::: ..... ~ ~:~::::::::::::::: .......... ~.o~.Ta~ ....... Ins~fion~ ~ve a diag~ ~t. sh.ows eH ~uk~ ~fomafi~, you my inolu~ it, ra~ ~ ~is ~ge, wi~ y~ur $ymm ~fi~fio~. ~ yo~ si~ pl~, s~ow ~c gcn~! layout of tan~ ~d p~pm~. ,Cl~ly identify inimbk liquid le~l probe~ (if reed for leak dc~ction), m mc space promac~, nora me ~e m~s ~m rm Page .... of ....... 0~00 BSSR, Inc. 7 6630 Rosedale Hwy., # ~akersfield, CA 93308 Phone (661 ) Fax (661 ) 588-2786 MONITORING SYSTEM CERTIFICATION . t This form must be used to document testing and servicing of mohitoring 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 Information Facility Name: ~t~ ,,] C) }cS (~. t) t .t,, i I-4~ .~.~3~'-['1~ [_. Bids. No.: Site Address: '~J2. ~ I ~ '1~ ~ '~ ~:,.'"WI'Z.E ~ 'T City: ~:~lZ...~ i:~.~"-~(~L_~ Zip: Facility Contact Person: 3 1 rW'X Contact Phone No.: ( (~ ~ ~ ) Make/Model of Monitoring System: ~::rr'f/_~ /¢f~02 ~0 i0C)OO (~ Date of Testing/Servicing: B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific ec~uipment Inspected/serviced: , Tank ID: ~ I'~ ~'~ ~.. · Tank ID: [~'l'~-Tank Gauging Probe. lllwztaS~zaoaxModcl: ~.~,,;/'7-~.-: ;'?~ ~,. 7~: C~n-Tank Gauging Probe. Model: ~lq':l ~Knnular Space or Vault Sensor. Model: o~. ~'~oa-~ u,loa~'r~'r~ [i}"'Annular Space or Vault Sensor. Model: O':lq q ~, qO - q.20 [~"l~iping Sump / Trench Sensor(s). Model: D~Cr~ .~¢420~o ~ ~ C3 Ci~Piping Sump / Trench Sensor(s). Model: O-q'q q CiL..~l Sump Sensor(s). Model:CS-./'cl q~ ~cq O - '2. O~ [1 Fill Sump Sensor(s). Model: Cl Mechanical Line Leak Detector. Model: ~ Mechanical Line Leak Detector. Model: Cl Electronic Line Leak Detector. Model: ~ Electronic Line Leak Detector. Model: ~ Tank Overfill / High-Level Sensor. Model: FI Tank Overfill / High-Level Sensor. Model: [l Other (specify equipment type and model in Sec!ion E on Page 2). Cl Other (specify equipment tTpe ~d model in Section E on Page 2). Tank ID: ["Sia, CIL L)? ~E:tO~: IZ ~-ir'O ~ Tank ID: I~'l'~-Tank Gauging Probe. Model: ~lql3'2~,~thq riO'LO O Cl In-Tank Gauging Probe. Model: CI Annular Space or Vault Sensor. Model: Cl Annular Space or Vault Sensor. Model: CI Piping Sump / Trench Sensor(s). Model: Cl Piping Sump / Trench Sensor(s). Model: Cl Fill Sump Sensor(s). Model: CI Fill Sump Sensor(s). Model: C! Mechanical Line Leak Detector. Model: CI Mechanical Line Leak Detector. Model: Cl Electronic Line Leak Detector. Model: C! Electronic Line Leak Detector. Model: Cl Tank Overfill / High-Level Sensor. Model: Cl Tank Overfill / High-Level Sensor. Model: Cl Other Ispecif~, ~uipment type and model in Section E on Parle 2). Fl Other (specify equipment t~pe and model in Section E on Page 2). Dispenser ID: Dispenser ID: [l Dispenser Containment Sensor(s). Model: Cl Dispenser Containment Sensor(s). Model: FI Shear Valve(s). ~ Shear Valve(s). Cl Dispenser Containment Float(s} and Chain(s}. ~ Dispenser Containment Float(s/ and Chain(s}. Dispenser ID: Dispenser ID: ~ Dispenser Containment Sensor(s). Model: Cl Dispenser Containment Sensor(s). Model: FI Shear Valve(s). Q Shear Valve(s). I Cl Dispenser Containment Float(s} and Chain(s~. VI Dispenser Containment Float(s} and Chain(s}. Dispenser ID: Dispenser ID: Cl Dispenser Containment Sensor(s). Model: Cl Dispenser Containment Sensor(s). Model: Cl Shear Valve(s). Cl Shear Valve(s). ClDispenser Comainment Float(s/ and Chai,n(sI. C! Dispenser Containment Float(sI 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 - ~ 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) necessar7 to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, i have also attached a copy of the report; (check all that apply): El System setTpp n CI.A,larm history report Technician Name (print): ..... 'l~ t D 1[~. ~. C"~ I~l?, I~t(2~ Signature: ~ (qJ~'~)( (.~-~[ Certification No.: [ OO 'Zo q. License. No.: (3 ~ ~ [g~ ~ ~Z Testing Company Name: ~?-~.~ I ~ C. Phone No.:( 6 0 [') S~-~.) Site Address: 663C3 I~O~'1~- ~L_E [q, t3J~( ~. _~ Date of Testing/Servicing: CD{ /~ /CDc,Q.. Page I of 3 03/01 Monitoring System Certification D; Results of Testing/Servicing ~ Software Version Installed: ~. 0 ~. Co. mplete the followingchecklist: ~'s C} No* Is th~ auch'ble'alarm operational? ~es Cl No* Is the visual alarm operational? I~es Q No* Were all sensors visually inspected, functionally tested, and confirmed operational? [21,'~es Q No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? C} Yes [~ No* If alarms are relayed to. a remote monitoring station, is all communications equipment (e.g. modem) C} N/A operational? C~ Yes ~'No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment ~ 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) ~1 Sump/Trench Sensors; ~ Dispenser Containment Sensors. Did you eonfu-m positive shut-down due to leaks {mo sensor failure/disconnection? Cl Yes; C] No. [ia,~?:es Q No* For tank systems that utilize the monitoring system as the primary tanlc overfill warning device (i.e. no [~ 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 a!arm trigger? q ~ % Er"Yes* ci No Was any monitoring equipment replaced? If ye~, identify specific sensors, probes, or. other equipment replaced and list the manufacturer ~ame and model for all replacement parts in Section, E~ below. Cl Yes* {ii No Was liquid found inside any seeondaD, containment systems designed as dry systems? (Check all that apply) Q Product; ~ Water. Ifyes~ desen'be causes in Section E~ below.. I~Yes E! No* Was monitorinll system set-up reviewed to ensure proper settinlls? ARach set up reports, if applicable ~s [2 No* Is,a.ll monitoring e.qm,'p.ment operational,per manufacturer's spe.¢ifi, cations? ,. * In Section E below describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/01 In-Tank Gauging / SIR Equip~l~nt: Cl Check this box if tank~J~ging is used only for inventory control. ~ ~ Check this box if no tank gauging or SIR equipment is installed. ! This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following, checklist: '[~Yes' Fl No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ~es Fl No* Were all tank gauging probes visually inspected for damage and residue buildup? [~t/Yes ~1 No* Was accuracy of system product level readings tested? Iii/Yes Fl No* Was accuracy of system water"ievel readings tested? [~/Yes Fl No* Were all probes reinstalledproperly? 13/Yes C! No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section FI, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): [~Check this box ffLLDs are not installed. Com ,lete the followin checklist: 121 Yes [2 No* For equipment st~t-up or'a~'~l equipm~ c~cation, was a leak simulated to verify LLD performance? Fl N/A (¢heck all that apply) Simulated leak rate: Fl3g.p.h.; Fl0.1g.p.h; [J 0.2 g.p.h. ~1 Yes Fl No* Were'all LLDs c~qrmed operational and accurate within regulatory requirements? .. Fl Yes- Fl No* Was the testing apparatus properly cah'brated? Q Yes Fl No* For mechanical LLDs, does the LLD restriCt'product flow if it detects a leak? FI N/A ~1 Yes [2 No* For electronic LLDs, does the turbine automatically shut ~ff if the LLD detects a leak? Fl Yes' Fl No* For electronic LLDs, does the turbine automatically shut off if any po~on oi~ the monitoring system is disabled Fl N/A or disconnected? ~i Yes Fl No* For electron/c LLDs, does the turbine automatically shut off if any portion of the monitoring system FI N/A malfunctions or fails a test? Fl Yes Fl No* For 'electronic LLDs, have all accessible wiring connections been visually inspected? Fl N/A Fl Yes Fl 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: Page 3 of 3 oato~ Monitoring System Certification UST Monitoring 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 MoniWring 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 liqu/d level probes (if used for leak detection). In the space provided, note the date this Site Plan ,vas prepared. Page __ of__ os/oo B D May 29, 2002 San Joaquin Hospital 2615 Eye Street Bakersfield, CA,93301 RE: Necessary Secondary Containment Testing Requirement by December 3 l, 2002 of Underground Storage Tank located at 2615 Eye Street FIRE CHIEF REMINDER NOTICE RON FRAZE 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-~:~9 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 PREVENTION SERVICES are capable of containing releases from the primary containment until they are 1715 Chester Ave. detect ed 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 be advised that there are only a few contractors who specialize and 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/kr enclosures D April 17. 2002 San Joaquin Hospit~al 2615 Eye Street FIRE CHIEF Bakersfield CA 93301 RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street RE: Necessary Secondary Containment Testing Required by December 31, 2002 Bakersfield, CA 93301 vo,cE (661)326-3941 FAX (661)395-1349 REMINDER NOTICE SUPPRESSION SERVICES Dear Tank Owner/Operator: 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 Thc purpose of this letter is to inform you about the new provisions in California law FAX (661) 395-1349 requiring periodic testing of thc secondary containment of underground storage tank systems. PREVENTION SERVICES ' 1715 Chester Ave. Bakersfield, CA 93301 Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & vOICE (661) 326.3951 Safety Code) of the 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 fi-om 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 I, 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 l, 2001 shall be tested by January 1, 2003 TRAINING DIVISION and every 36 months thereafter. 5642 Victor Ave. Bakersfield, CA 93308 Secondary containment testing shall require a permit issued thru this office, and shall be VOICE (661) 399-4697 FAX (661) 399-5763 performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, [ 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 .~ 6630 Rosedal~ -Hwy., #~, Bakersfield, CA 93308 Phone (661) 58 7 Fax (661) 588-2786 " MONITORING SYSTEM CERTIFICATION- t This form must be used to document testing and servicing of mo~toring equipment. A~_sep_ state certificat/on or report must. prepared for each mouitorine Systera contl-ol pan~l by the technician who performs the work. A copy of th/s form must be pmvlded to the tank system owner/operator. The owner/operator must submit a copy of this form to fixe local agency regulating UST systems with/n 30 days of test date. A. General Information Facility Name: <---~t,,J JOA ,(D~J I~J ' ~0~..~ T~L- Bldg. No.: SiteAddmss: ,~).6l 5 ~"(1~ ~TR~'Y City: I~A ,~'~.~'~'~ Li~ Zip: Facility Contact Person: Jie~ 60OCaC~r~rO Contact Phone No.: ( ~l ) "~cI Make/Model of Moniwring System: ]~/v( C / ?Icl0~O ~OC"}(~) Date of Testing/Serviclng: B, Inventory of Equipment Tested/CertiOed Cheek the aporooriate boxes m Indicate sl)eciflc equipment insoected/serviced: I ? ltl I'lIl ' n' [ I I'l' rl I' I II ,,, i ' '1 ....' ' qr fl ' , rI .~n-Tank Gauging Probe.' Model: -- I~n-Tank Gauging Prbbe. Model: I~'"Annular Space or Vault Sensor. Model:t~O'~.g c~ ~, once i O 13h'~nnular Space or Vault Sensor, Model: :? El Piping Sump / Trench Sensor(s). Model: El ~Piping Sump / Trench Sensor(s). Model: ~ Sensor(s).t~le~-rofl-t,~61/.Modeh ~ q~0~'~_~' ' ' ~Sensor(s)~l~T, it t~gLt, Model: ~:]c~(/?j~t/~i - ~O~ E! Mechanical Line Leak Detector. Model: El Mechanical Line Leak Detector. Model: 12 Electronic Line Leak Detector. Model: 12 Electronic Line Leak Detector. Model: 12 Tank Overfill / High-Level Sensor. Model: 12 Tank Overfill /High-Level Sensor. Model: 12 Other (Specify .equ_ip~..e~..~ type and model in Sec.tion R on Page 2)._. 12 Other (specify equipment type a~..d model in'Section E on Page 2)... Tank ID: ~ ~ ~C'I/., O[~ ~ffl~J~'lTPiTCf/?, Tank ID: II,In-Tank Gauging Probe. Model: 12 In-Tank Gauging Probe. Model:' El Annular Space or Vault sensor. Model: 12 Annular Space or Vault Sensor. Model: J ~F4i.~iping'Sump / Trench Sensor(s),' Model: 12f/ping Sump / Trench Sensor(s). Model: Sensor(s)~o~r,~o- kog~c Model: . I~' ~ Sensor(s).' Model: 12 Mechanical Line Leak Detector. Model: 12 Mechanical Line Leak Detector. Model: El ElectTonic Line Leak.Detector. Model: 12 Blectronic Line Leak Detector. Model: El Tank Overfill ! High-Level Sensor. Model: El Tank Overfill / High-Level Sensor, Model: 12 Other (Sl~ecify equipment t~pe and. model in Sech'on ]~ on Page~ 2.).. .. ,~ O..~ther (specify eXluipment type. and re. ode! in Section H on Page 2). Dispenser ID: ' ~ Dispenser ID: 12 Dispenser Containment Sensor(s). Model: El Dispenser Containment Sensor(s). Model: 121 Shear Valve(s). 12 Shear Valve(s). El Dis.~p~.nser Contai,nment Float(s) and C..hain(s). ....~__ Dispenser Conta. inme~t'Flqat(s~ ~d Chain(s). ., , , . Dispenser ID: ......... Dispenser ID: 12 Dispenser Containment Sensor(s). Model: 12 Dispenser Containment Sensor(s). Model: 12 Shear Valve(s). El Shear Valve(s). Cl Disp~ns~r C,ontainm,e~t ~lo,,at(s,) and Chain(s~. , El Disl~ns~,r Conta. i,n?nt Flo, at(,s) and chai~/s). ,., , Dispenser ID: Dispenser ID: 12 Dispenser Containment Sensor(s). Model: 12 Dispenser Containment Sensor(s). Model: El Shear Valve(s). 12 Shear Valve(s), C~Dispenser Contai,,nment r~oa,~,(s~, and,~ai.n(0. , ..... El, Dispe,,nsar Containment ~loat(s) au,d Chai~(s). . ,, *if the facility contains more tanks or dispenser~ COpy this form. Lqciude information for every tank and d/spenser at the facility. C. Certification - I carttfy that the eqnlpment identified in this document was inspected/serviced in accordance with tile manufacturers' guidelines. Attached to this Certification is information (e.g. manafaemrers' chegldists) necessary tn verify that this information is correct and a Plot Plan showing the layout of mnnitori~g equipment, leer any equipment capable of generathg reperts~ I have also attached a copy of the report~ (e,~e2 ~/h~ t~pl2): ~ystem set-up I~l Alarm history report Tec~nician~ame(p~t): ~,C~g ~. cAr~. ~ L-LO Signa~e: Certification No.: i On ~ t-I .. License. No.: ...6,..6'50 ROSeO D teofr t S, i g: Page I of 3 03/0~ Monitoring System Certification Results of Testing~Serviding Sot~varo Versio~ Installoc~. ~ ,0 ~- ~es ~ No* Is ~e visual ~,op~fio~? ,,, ~ ~ No* W~ all sensors visually ~s~c~, ~fio~y [~pt~d~ ~d co~d O~emfio~al? . ~es ~ No* W~e all se~ors ~lled at lowest po~t of se~n~ con~ent ~d posi~on~ so ~at 0~er equipmen~ not ~terfere wi& ~e~ pw~r ~ ~ "~o* If a~s ~e rehyed W a r~o~ mo~g s~fion, is ~l 'com~cafio~ 'eq~pment (e.g. modem) ~ N/A ~erafional? '%~ ~ ~o* ~o~ ~%~a pip~ ~, ~ ~ ~'~uiom~ ~ut ao~ ~ pi~ ~on~ ~o?~nt ~ N/A mo~g syst~ ~ a 1~ ~h to opiate, or is elec~ca~y ~o~ect~? If y~: w~ch sensors positive shut-do~? (C~dc~ ~ t~ ~pp~) ~ S~~ch Se~o~; ~ ~p~er Con~ent Sensors. Did ~ou.confi~ posi~ve ~ut-do~ d~ W leaks ~d se~or ~d~co~e~on? ~ Yes; ~ No. ~es ~ No* For ~ sys~s ~at u~ ~e ~o~to~g system as ~e p~ ~k ove~ w~ing de~ce (i.e. no ~ N/A mecha~cal ov~ll preven~on valve is ~s~lled), is ~e ore. Il w~g a~ v~le ~d audible at ~e an~ ~st ~e m~ui~c~ ~e ~d model for ~I r~hc~t.p~ .~ Se~ ~ below. ~ ~oduc~ ~ Wa~r. If ~, d~cn~ ~es ~ S~cto~ ~ below. ~Yes ~ 'No* W~ monit~= s s~m set-u ~view~d to e~e. prope~ se~s? A~h ~et up r~o~, if aw~ca~le y~ ~ No* h aH mo~Wdu~ eq~pm~t op~fio~ ~r ~ac~er's ~dficafio~? S~flon E below, d~cribe how and when ~e deflden~ were or ~ be ~rre~. E. Comments: Page 2 of 3 03/01 E !nYl'nnk Gauging,/SIR.Equ nt: ~ Cheek this box if tan~g~ is used only for inventory control. ;~ ~ Check this box if no tar~ gauging or SIR equipment is installed, . This section must bo completed if in-tank gauging equiPment is used to perform leak detection monitoring. Corn ~lete the following chec, klis/: ~ ,,, {~'Yes El No* Were all tank gauging probes visually inspected eo~,damage .,and r,esidue buildup? ... "." . . . {~/Yes El No* Was a~¢uracy of system product level readings tested? ~"Yes El No* Was accuracy of system water level rea ,d~n, gs tested? "' . ....... '['.[ ....... ~"Yes t ,El No* Were all items on the exluipment manufacturer's maint~ance checklist ~ompleted? ' In the Section H below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ~"/check this box ffLLDs are not installed. ' Complete the folio ,wi.'n~ checklist: ra N/A (¢Aeelc all tt~t at~tdy) $~ leak rate: ~] 3 g.p.h.; El 0.1 g.p.h; El 0.2 g.p.h. ~'Yes El No* For m~ehanieal LLDs, docs the LLD'r~strict Pr°du&'flow if it det~ a leak~ ...... El N/A ta y~; ~' No* For e~ect~o~¢ LLm, does'the t~bin; E! N/A , a Yes El No* For"~iectro~e LLDs, aoes the t~bi~ a~toma~ly'mut off ~f a~ pon~on of ~ monito~i~ ~/st~'~ d~abied El N/A or disconnected? dl ye~ El ~o* Fo~ '~ec~o~ 'L~_.D~,"'aoe~ t~ ~in~ 'autom~tican¥'';h,,t of/~f any pomon of the monito~ ~stem El N/A malfunctions or fails a test? ~ 'Yes El No* For electronic LLDs, have all acCeSsible wiring connections been visuall~ inspected? El N/A * In the Section B below, describe how and when these deficiencies were or will be correc[ed. H. Comments: Page 3 of 3 o3;o1 Monitoring Syst~em Certification UST Monitoring Site Plan · ........................................ ...... 0 ..................... If you alre~y have a dia~m ~t shows ~1 mq~ed ~fomation, you ~y include it, m~er th~ ~s page, wi~ yo~ Monitoring Sys~m Co~fioafion. ~ yo~ si~ pl~, show ~e g~l layout of ~ ~d pip~g. Cle~ly idmfi~ loeafion~ of the following equipmen~ if ~mlled: moni~o~ng ~ys~m consol p~el~; sensor~ monitoring ta~ a~ular spaces, s~p~, d~,pen~er p~, ~ilI deteom~; ~d ~-mnk liquid level probes (if u~ for le~ detection). ~ ~e ~a~e ~ded, note ~e dato ~is 8ire Plan was prepped. Page ~ of ~ ~ o~o SAN JOAC~U I N HOSP ! TAt 2615 EYE STREET BAKERSFI ELD,. CA. 805-395-3000 " NOV 529.. 2000 ~;TEI'.'I S'I'ATLIS REPORT I NVENTORV REPORT T I :DIESEL VOLUME = IS561 GaLS ULLAGE = 1439 GALS 90~'~; ULLAGE= 0 TC VOLUNE= 1:3485 F'",~aL,_, HEIGHT =lEI1 .76 I NCHEE¢ [.dATE~' 'v'OL = 0 GALS WATER = O. O0 I NG;HES TEMP = 72.5 DEG F T '2: DECONTAI"I I NAT I VOLUME = 59 ~'" o ULLAGE = 485 GaLS 90% ULLAE;E= 413 GALS TC ,~?LUHE = ~'~ TB~ = 61 ,1 DEG F T '3: BAE }:;LIP GENER'ATOR VOLUME = 90% ULLAGE= 111 TO VOL~JME = '793 ~aI - -" .... ~: ~ .... HEIGHT = 26,51 INCHES L,JATER 'v'OL = 0 GALS WATE~ = 0.00 INCHES TEI'4P = 47.? 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 ,.~t~ ~"0a.o.O,~, tal~l, at&ti~,v /4~','~ INSPECTION DATE !~(a't[~30 Section 2: Underground Storage Tanks Program [~l Routine [~1 Combined [~1 Joint Agency [21 Multi-Agency [] Complaint [] Re-inspection Type of Tank tirO(z Number of Tanks ~ Type of Monitoring da.l~a Type of Piping 15~ ~' OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current ~/ ~ I ,7/ 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) ~,: 0OO {Diego ~ AGGREGATE CAPACITY' Type of Tank t~O.z ma t-( 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 Environmental Services (~05) 326-3979 //' J~'~ess Sit~'Responsible Party ' White - Env. Svcs. Pink - Business Copy -~,~ ~.~.~/~ #1 Page: 207 pe WO: PM PLANNED WORK ORDER Location: 81ENG OFFICE Dept: WO Issue Date: 09/01/00 Control #: 0E02151 Property: Client: WO Issue Time: 10:30:44 Mfgr: GILBRACO PM Guide: 4098 Last Status/MC: //3/ Modet: schedule Code: A Descript: ALARM, UNDERGROUND TAI~q( Last WO #: 0 Serial: 5063438000500 Schedule Pri: Category: L ALARM SYSTEMS, FIRE, SMOKE, OTHER & Warranty Date: 00/00/00 Con~oany Code: Vendor: Crew: ENG Trade: ENG Emp: JG Acquis. Date: 00/00/00 Notes/Specs: Last Performed: 09/20/99 Comments: JCN#: Next Schedule: 09/19/00 Instatted Date: 00/00/00 Contract PO: Type Contract Work: Serv Contr. S/Date: Serv Contr. E/Date: Stock #(NSN) Manufacturer Part Nun~aer Standard Part # (EIA) Qty Required Description Type UNDERGROUND TANK CERTIFICATION CALL COMPANY TO CERTIFY UNDERGROUND TANK. BAKERSFIELD SERVICE STATION REPAIR, PHONE ~588-2777 WO# 4098 UPDATED 9/26/97 Complet'ed By _,~~~- -- Date ¢' ~'"' Time ! '~'~. 'CONTRACTOR" " SERVICE STATION ADDRESS ,, ' i ~ I PAGE REPORTED PR'OBLEM .... , - · -.';,:-"~ I , I , MILEAGE TO SITE SUBTOTAL ' , ~ ,~ ~ ~, 'u~:"' .'" ~ ' '. .... , ....... -":~' ' ' : ' "-" ffEM [- TIME RATE SOB- MARK 'l '-AMouNT ' ENDING ODOMETER READING TOTAL'. ...... ' - · . I 'l' TOTAL. MILEAGE TO SffE' '' ' · ' "~'<:' '" '~" '~" ' '" '"" -" ~" "' '"' '" ' CO~RACTOR ~ONFIRMED'SERVI~E CALL ' ' : ' ' ' /TRAVEL:TlUE : , ' ' ' . :' .. "' ' .''- ' ~ ~ '" ' '.'~ "; .... -r SERVICE.~RSON (PRI~ NAME) ' ' ' ~ ' · SERVICE PERSON:{~IN~'NAME) ', ' .; , SERVICE'PERSON'S SiGNAl. RE: · ... -. .- . . . SERV~E PER~'S ~IGNATURE .. DEPARTURE TIME AND. AUTHORIZED PEaSeS.SIGnATURE · - . . DA~ ..' .. :. · :..-...,,:; . , 1715 Chesler Ave., B~kersfleld, CA UNDERGROUND STO~GE TANKS- UST FACILI~ 4t~ UPOF (7~) 5:~CUPAFORM~-~ Chafer AVe. Bake~flel~ CA 93301 (661) 32~3979 UNDERGROUND sToOGE T~KS. TANK PAGE 1 L T~K DE~i~ __ CITYOF BAKERSFIELD ~.~~,~. OFFI~ OF ENVIRONMENTAL SE~/ICES 171 $ Cheater Ave.,' Bakersfield, CA93301 (661) 326-3979 UNDERGROUND STORAGE TANKS-INSTALLATION CERTIFICATE OF COMPLIANCE .' One form per tank I III I - I. FACILITY IDENTIFICATION 8U$1NES,~ ~ (~am~ ~ FACK~TY HAME ~ ~A - ~ ~ M) 14, i4 1 ..... . ................ ii.' INSTALLATION Check afl Umt apply * ~ The installer ha~ been certilled by the tank and piping manufacturers. The installation has been inspe~;gl and certified by a registered professional engineer. The installation has been Inspected and approved by the City of' Bakersfield Office of Environmental Services. All work listed on the man~s installation checldist has been completed. The installation contractor has been certified or licensed by the Contractors State License Board. (3 Another method was used as allowed by the City of Bakersfield Office of Environmental Services. *-. . _ III. TANK OWNER/AGENT SIGNATURE March 29, 2000 San Joaquin Hospital 2615 Eye Street Bakersfield, CA 93301 Dear Underground Tank Owner: Your permit to operate the above mentioned fueling facility will expire on June 30, 2000. However, in order for this office to renew your permit, updated forms A, B & C must be filled out and returned prior to the issuance of a new permit. Please make arrangements to have the new forms A, B & C completed and returned to this office by May 15, 2000. For your convenience, I am enclosing all three forms which you may make copies of. Remember, forms B & C need to be filled out for each tank at your facility. Should you have any questions, please feel free to contact me at (661) 326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental SerVices SU/dlm Enclosure CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME .~a ,.~{]atmJc& taOltill, O~,'('",I [4~SlMta.( INSPECTION DATE L2' Section 2: Underground Storage Tanks Program [] Routine [] Combined [~Joint Agency [] Multi-Agency [] Complaint 1~1 Re-inspection Type of Tank ,Or_0 ~- Number of Tanks Type of Monitoring c~/4~i4 Type of Piping 0c0 F OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current k,// Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current V/ Failure to correct prior UST violations k// Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S)l,e..,~a ~.,I Type of Tank ~4B.'d t .k- Number of Tanks '2'., 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? V C=Compliance V=Violation Y=Yes N=NO Inspector:;. _~ _Z~~ Omce of Environmental Services (805) 326-3979 ~BUs-i'ness Site Responsible Party--. ' White - Env. Svcs. Pink - Business Copy