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Home My WebLink AboutUNDERGROUND TANK FILE #2 (2)JOB CARD POST CARD AT JOB SITE Bakersfield Fire Dept. Prevention Services 900 Truxtun Ave #201 Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY N,AME _ OWNER PHONE 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 PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION I DATE I INSPECTOR TANKS AND BACKFILL BACKFILL OF TANK(S) SPARK TEST CERTIFICATION OR MANUFACTURES METHOD CATHODIC PROTECTION OF TANK(S) PIPING SYSTEM ' "pR MA'R ' P PIN'G'", ' SECONDARY PIPING ¢ ~ OiL. _~-~ TYPE OF PIPING [] FLEX [] FIBERGLASS CATHODIC PROTECTION SYSTEM-PIPING DISPENSER PAN SECONDARy CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION ' , CONTINuoUS vA~0R Mo"IToRi'NG ENHANCHED LEAK DETECTOR TEST LEVEL GAUGES OR SENSORS, FLOAT VENT VALVES FILL TIGHT FILL BOX(ES) 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 FINAL ..... MONI~ORING WELLIs, ~PS I ~ LOCKS FILL BOX LOCK -- AUTHORIZATION FOR FUEL DROP Ol CONTRACTOR ____(I, JA.~_{~[C_ .... _~_E~_i'_'¥ .... _~_~___¢,..'_ ....................................... LICENSE No. __'~O_O_.'~___~Z{_' ~,'~'~-.- CONTACT ____~(~__~l__~_ ................................................................... PHONE No. fd1743 ; r~ Postage $ ' FU Certified Fee r--I Postmark l i'-'1 Return Reciept Fee Hera i l'-I (Endorsement Required) ~ r-I Restricted Delivery Fee (Endorsement Required) !m Total P, TERI NICHOLSON , m CIRCLE K STORE FSent To ' ~= [ .......... 5600 AUBURN #2 ....... 'r,-[~! BAKERSFIELD CA 93306 ...... SWRCB, January 2002 " Page ~ of~? Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment ay, terns. 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 £rovided to the facility owner/operator for submittal to the local regulatory agency. - Facility Name: ~ ~ a C,~.I~- ~'x ] Date of Testing: 4' ~" O ~ Facility Address: ~'la00 ~0[oO~J c~fl~,et,.b ~>~l¢¢,~OelA_ Ca Vac~ityComct: /0& - '. [e~one: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (ifpresent during testing): · 2.. TESTING CONTRACTOR 12q'FORMATION Company Name: ~ ~ ~)'t,,~'~.~ Technician Conducting~, Test: ~redentials: ~CSLB Licensed Contractor D SWRCB Licensed Tank Tester Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Not Repairs Component Pass Fail Tested Not Repairs Made comPonent Pass Fail Tested Made o ~ o o o' ~ o~ o o ~1 ~ ~ o o o ~d~l~e~~ ~ o o o o o o o u ~o o o o oo o " ~o o o o oo o 0 OC o ~ o o o o o o 0 0 0 0 0 0 0 0 If hydrostatic testing was performed, descn'oe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this~e accurate and in full compliance with legal requirements Tectmician' s Signature: ' Date: Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing SWRCB, January 2002 Page__ ~- of~ 4. TANK ANNULAR TESTING Test Method Developed By: [] Tank Manufacturer '~..Industry Standard [] Professional Engineer [] Other (Specify) Method Used: O Pressure ~Vacuuin [] Hydrostatic Test · [] Other (Specify) ' Test Equipment Used: !Sf3~' CL4/~0-O~(~~ , 4'~)~"1 ~(~ ~,,-~t,,c) ,[ Equipme_ntRes°luti°n: . ' ....... ~ Tank# ~-~ I Tank# ~ ~ Tank// c~ t ' Tank# Is Tank: Exempt From Testing?~ , [] Yes ~aNo ~ Yes ~No [~ Yes ~ [] Yes [] No Tank CapacitY: Tank Material: Tauk Manufacturer. Product Stored: Wait time between applying pressure/vacuum/water and ..~ starting test: Test Start' Time: i' Initial Reading (RD: Final Reading (RF): Test Duration: Change ~n Reading (Rv-RO: Pass/Fail Threshold or Criteria: Was sensor r~moved for testing? DYes [3No []NA DYes DNo I-INA [3Yes UNo UNA •Yes []No DNA Was sensor properly r~placed and [] Yes [] No [] NA []Yes []No []NA []Yes UNo []NA •Yes UNo []NA verified functional after testing? Comments - (include information on repairs made prior to and recommended follow-up for failed 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 testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB, January 2002 Page 5. SECONDARY PIPE TESTING Test Method Developed By: [] Piping Manufacturer tB/ndustry Standard . [] Professional Engineer [] Other (Specify) Test Method Used: t~>ressure [] Vacuum [] Hydrostatic [] Other (Specify), Piping Run # Piping Manufacturer: Piping Diameter:._ Leng~ of Piping Run: Product Stored: Method and locution of piping-run isolation: Wait time between applying . . pres .sram/vacuum/water and ----- _.--- .... starting tes~: .... Test Start Time: Test Daration: Change in Reading (Rv-RO: C) Pass/Fail Threshold orCriteria: ~ Pass [] l~ii Comments - (include information on repairs made larior to testing, and recommended follow-u]~ for failed tests) Circle K - #2708605 5600 Auburn Street Bakersfiled, CA 93306 N04341 - SB 989 testing SWRCB, January 2002 ~ Page__ 6. PIPING SUMP TESTING Test Method Developed By: [] Sump Manufacturer' ~l(Industry Standard ' [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum ~Hydrostafic · . [] Other Test Equipment Used: ~ 6'~q~(.~J ~(;lb~ (~!~/~ }EquipmentResolufion: ' .-\ Sump# ~ -- Sump# (~e~ Sump# ~-'( Smnp# Sump Diameter. d( ~6'~~ Height from Tfink Top to Top of u '" . Highest Piping Penetration: ~'~ [ ~ ~ ~ '~ ~ , . Height from Tank Top to Lowest <~ '~ ~ n Electrical Penetration: Condition of sump prior to testingi ~)O ~ u Does turbine shut down when d -- sump sensor detects liquid (both. [] Yes [] No ~(lqA []Yes []No ~ [3Yes []No ~NA []Yes []No product and water)?' ' Turbine shutdown response time I~temprog~mm~orf~l-sa~eshu~down?. OYes OSo ~^ []¥es..O~o g~ OYes .[3~o ~^ OYes 0~o W~f~'l-~e~edtobe 0¥~ 0~o ~^ OYes 0~o ~ []~es 0~o ?~^ OYes []~o¥~ operational?* Wait time between applying pressure/vacuum/water and starting 70 t'~ t ~ ~ g test: m~ti~ ~¢~d~g tX0: t%.-'/~,tv(o Iq. ~/~'{5 lo- Test End Time: ~ ! "5c] t I: 53 k 7.~'. '7~ Final Reading (Rr): t3'95~¢ Iq,qq~°~ I0, Test Duration: % ~-,~---- [~'1.,.,,_ L '~' ~ Change in Reaciing O~R0: 0, ~) i':~_ ' ' 0 ,"OE:~(D 0 ~-' P~srrail V~sho~d or Cdt~: 0~ C~7~ 0,C~7~ ~ 0'~'X5%' ., 0,00 2.. i)~i::~e~ti:,I~:',::3,.~ .:.:'::..::(! !:.~;~i:i~i:i?:: :.!:.(.: .::.. 3_!~!~r~ii.:':.;:~,:r~?'!::::~: i:':~'~:~i?~:??? ~:~i.i!~i,i:~/i~.! Wasseusorrroperlyreplaeedand ~Yes []No nN^ ~¥es UNo []NA ~¥es []No []NA )gYes °No ONA verified functional ~ testing? Eom ments- (include information on repairs made priok to testing, and recommended follow-up for failed tests) Circle K - #2708605 5600 Auburn Street Bakersiiled, CA 93306 N04341 - SB 989 testing ~ If the entire depth of the sump is not tested, spec~,.~ ,~w much was tested. If thc 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-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer Xlndustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum ~t~/ydrostatic [] Other (Spe, cif-y) Test Equipment Used: ~ C~,qv~tl.~g_Zl~ ~L-~.} I~'t ~..~%Li't-.5 I Equipment Resolution: ~~l ~c # ~. "r I m)c # 5 -,4 [ a)c # I ~c # UDC Manufacturer: _~ ~ ~ UDC Material: ~ (.. UDC.Depth: ~ O ~ [~ ~ Height f~m UDC Bottom to Top of Highest Piping Penetration: .' Height fxom UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: ?000~ , Portion of UDC Tested1 !39c-'4¢ [~iqh~,0r fa~Iv'~ fl I( t l Does turbine shut down when d UDCsansordetectshquidCooth []Yes [3No ~NA []Yes []No ~NA ayes ENo '~NA EYes [3No product and water)?* Turbine shutdown response time Is system programmed for fail- []Yes [3No ~NA [3Yes [2No ~NA DYes [3No ~NA [3Yes [3No ~NA 'safe shutdown?' operational?*Was fail-safe verified t° be []Yes [3No ~JNA []Yes [3No ~NA [3Yes []No ~5,'NA DYes ENo ~.NA Wait time between applying pressure/vacuum/water and starting test Test Start Time: /,'/gY / :' o 2_ Initial Reading (RD: /~'. 7~¢O /} Test End Time: / .'/t' / ~ 19 ~ Test Durafi°n: t~.~ t~ Change in Reading (Rv-RO: ~ ql ] , 0 G f Z. Pass/Fail meshold or Criteria: 0,0~ 0.OC~Z- O,CC, Z. O, COZ.. Was sensor removed for testing? ~Yes UNo DNA ~Yes [3No [3NA ~es []N° DNA ~.¥es [3No [3NA Was sensor properly replaced and ~Yes ENo [2NA ~es ENo rqNA ~yes []No DNA xr~(yes ENo DNA verified functional after testing? ' Comments - finclude 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 ~ 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) ' sW~RCB, January 2002 Page. fa 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: . · ,~ ~-' ""l ¥ it Spill Box¢ # ~"~[_ Spill Box # Bucket Depth: /}A '~ ~.~ o, Wait time between applying pressure/vacuum/water and 30 minutes 30 minutes 30 minutes 30 minutes starting test: Test Start Time: I 0'-~ 'L /0:~" t !1 '.1~ Initial Reading (R0: ['7./ , 3~%C1 I'L, t~ 5-9al X%. bl)q ~, Test End Time: [{ .~ t l:0¢ [ ~ ""~ b Final Reading (RF): \% · ~)b{~''5 10_., q L, 0 { [ %. ~0~"~ Test Duration: / 3--."'"'-- / J"-'""'- / g"- ~ Change in Reading mr-RD: O- OO/'~ '7_/"~ ~)- ~ ~' I 0- 1~)O OO ~'~ Pass/Fail Threshold or 0.002 0.002 0.002 0.002 Criteria: 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 att Bucket Diameter & type: /~/'~/~/~'cnJ /~ ~t Bucket Depth: /tT~ ~' ~' ~ Wait time between applying pressure/vacuum/water and 30 minutes 30 minutes 30 minutes 30 minutes starting test: Test Start Time: tO ',~ {0~.'no~ l O J 6~q Initial Reading (R~): ['L.- ck"L,"~)~ ['79, \3t~g [~. 0 3 7..g Test End Time: [0 ~,q ( [ 0 ;OcO [[ ', 0 q Final Reading (Rv): k'~ ' °~'L~q [3 , [~e~[O It~ · O%g ~ Test Duration: /,5~.,.... / ~'--t~...~. /' ~"-'~--. Change in Reading (RF-Ri): 0.0~0~% O' C) 0 t7,,7,,- 0.0 0 0 ~10 Pass/Fail Threshold or ~--0_002~i 0.002 0.002 0.002 Criteria: ~ ~-~ ~z~ ~*~ ~ ~ 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) 840-6929 UST TESTING SYSTEMS SUMMARY SHEET Precision Underground Storage Tank System Leak Test Client: Conoco Phillips Co. 1500 North Priest Drive Tempe, AZ 85281 Kathy S~ckland (602) 728-7149 Site #: 2708605 5600 AUBURN ST BAKERSFIELD, CA 93306 Facility # 2708605 Test Date: 2/16/04 08605 Work #: 20004374 County: KERN Cross Street: FAIRFAX 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 Comments: Compliance L/D & monitor certification, Spill bucket test. State Lie. #s: 006-05-0086 2/ 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: Tank #: Product: Facility # 2708605 1 Unleaded Premium Test Method: System 4000 Capacity: 9816 Diameter (in): Product Level (in): Liquid Volume (Gals): Liquid Percent (%): Specific Gravity: Coef. of Expansion: Water On Tank (in): Water In Tank (in): Product Temp. (F): Head Pressure (psi): Test Start Time: Test End Time: Test Rate (gph): Test Result: N/A Test Method: ULLAGE UllageVolume (gals.): Ullage Test Time: Ullage Vacuum (psi): Ullage Result: N/A Test Date: 2/16/04 Work #: 20004374 Test Method: TLDT Manufacturer: L/D Model: L/D Serial #: Line Drain Back (ml): L/D Trip Time (sec): Holding Pressure (psi): Metering Pressure (psi): L/D Test Rate (gph): L/D Result: PASS New leak detector?. No Test Method: TEI LT-3 Pump Brand: System Type: Line Pressure (psi): Line Start Time: Line End Time: Line Start Level: Line End Level: Line Test Rate (gph): Line Test Result: N/A WPLLD 2 Triangle Environmental, Inc. SYSTEMS TANK, LINE AND LEAK DETECTOR TEST REPORT Facility: Tank #: Product:. Facility # 2708605 2 Unleaded Plus Test Method: System 4000 Capacity: 9816 Diameter (in): Product Level (in): Liquid Volume (Gals): Liquid Percent (%): Specific Gravity: Coef. of Expansion: Water On Tank (in): Water In Tank (in): Product Temp. (F): Head Pressure (psi): Test Start Time: Test End Time: Test Rate (gph): Test Result: N/A Test Method: ULLAGE UllageVolume (gals.): Ullage Test Time: Ullage Vacuum (psi): Ullage Result: N/A Test Date: 2/16/04 Work #: 20004374 Test Method: TLDT Manufacturer: L/D Model: L/D Serial #: Line Drain Back (ml): L/D Trip Time (sec): Holding Pressure (psi): Metering Pressure (psi): L/D Test Rate (gph): L/D Result: New leak detector? PASS No Test Method: TEI LT-3 Pump Brand: System Type: Line Pressure (psi): Line Start Time: Line End Time: Line Start Level: Line End Level: Line Test Rate (gph): Line Test Result: N/A WPLLD Triangle Environmental, Inc. SYSTEMS TANK, LINE AND LEAK DETECTOR TEST REPORT Facility: Tank #: Product: Facility # 2708605 3 Unleaded Regular Test Method: System 4000 Capacity: 9816 Diameter (in): Product Level (in): Liquid Volume (Gals): Liquid Percent (%): Specific Gravity: Coef. of Expansion: Water On Tank (in): Water In Tank (in): Product Temp. (F): Head Pressure (psi): Test Start Time: Test End Time: Test Rate (gph): Test Result: N/A Test Method: ULLAGE UllageVolume (gals.): Ullage Test Time: Ullage Vacuum (psi): Ullage Result: N/A Test Date: 2/16/04 Work #: 20004374 Test Method: TLDT Manufacturer: L/D Model: L/D Serial #: Line Drain Back (ml): L/D Trip Time (sec): Holding Pressure (psi): Metering Pressure (psi): L/D Test Rate (gph): L/D Result: PASS New leak detector?. No Test Method: TEI LT-3 Pump Brand: System Type: Line Pressure (psi): Line Start Time: Line End Time: Line Start Level: Line End Level: Line Test Rate (gph): Line Test Result: N/A WPLLD Triangle Environmental, Inc. US T MONITOR CER TIFICA TION $ UMMAR Y SHEET Client: Conoco Phillips C°. 1500 North Priest Drive Tempe, AZ 85281 Facility: 2708605 Facility # 2708605 5600 AUBURN ST BAKERSFIELD, CA 93306 Monitor model: VEEDER-ROOT TLS-350 Serial #: 80648964705001 Facility # 2708605 est Date: 2/16/04 Work #: 20004374 County: KERN Cross Street: FAIR.FAX ROAD Certification Result: PASS Sensor Type: Quantity: Tank Annular: 3 Waste Oil: 0 Waste Oil Sump: 0 Vadose Wells: 0 Line Pressure: 3 Turbine Sump: 3 LineTrenchQty: 0 Fill Sump: 0 Result: Pass Annular Type: Dry N/A Audible Alarm? Yes N/A Visual Alarm? Yes N/A Fail Safe? Yes Pass Positive Shut-off? Yes Pass Gauge Only Result: Pass N/A ATG Monthly? No 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: ~ ~~ P~onnie Humphries Triangle Environmental, Inc. 2525 West Burbank Blvd., Burbank, CA 91505-2302 (818) 840-7020 (818) 840-6929 SECONDARY CONTAINMENT RESUL TS Client: Conoco Phillips Co. 1500 North Priest Drive Tempe, AZ 85281 Kathy Strickland (602) 728-7149 Facility: 2708605 Facility # 2708605 5600 AUBURN ST BAKERSFIELD, CA Facility # 2708605 Test Date: 2/16/04 93306 Work #: 20004374 County: KERN Cross Street: FAIRFAX ROAD Contractor's License # 673971, "A", "C-10", "HAZ" Tanks: Lines: Sumps/Spill Boxes: Product Description Test Type Result Comments Unleaded Regular Spill Box/OPW 4 PASS Unleaded Plus Spill Box/OPW 4 PASS Unleaded 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 #-4 is visual inspection gle Environmental, Inc. 2525 W. BURBANK BL VD. BURBANK. CA 91505-2302 - WORK A CXNO WLEI~ME~ ( ~' C810 840- 7020 C~/STA~:, ~eO POtd ~' FAX: (818) 840-0929 COUN~ ~X~r ~ ~CH: TANK TIGHTNESS TEST PRODUCT LINE TEST LEAK DETECTOR TEST SERVICE REQUESTED (CHECK) [-~ MONITOR CERTIFICATION [~ ENVIRONMENTAL REPAIRS [-~ FACILITY INSPECTION r~ OTHER [~ VAPOR RECOVERY TEST [-~ -~ ~]>'~'L SERVICES PERFORMED PARTS CUSTOMER PRINT NAME CUSTOMER SIGNATURE SBD: 123--WORKACKN(3197) DATE: ~ - I (-.0 - oz.,} . TRIANGLE ENVIRONMENTAL, INC. .SPILL BOX ANNUAL INSPECTION REPORT FORM, 1. FACILITY INFORMATION Facility Name: CldC'~ '~"x. 1~(.,0 I Date of Testing: Facility Address: ~[.&~)O ~l~Y'~ ~. Facili~ Contact: O TM ~ ~ IPhone': ~ ~ ~ ~ Date Lo~I Agency Was Notified of Testing: Name of Local Agency in,sPecter (if present during testing): ~/~ 2. TESTING CONTRACTOR INFORMATION Ronnie Humphries Triangle Environmental, Inc. 2525 West Burbank Blvd. ~Burbank, California 91505 (818) 840-7020, (818) 840-6929 FAX. California.ContrActor' LicenSe # 673971, A, C-10, HAZ, HIC 3. TEST RESULTS- DATA Test type Spill box/ Size Location Start End Hydrostatic Result Tank# Episode prOduct Box Mfr (gals) Fill.NaporTime Time OrVisual P/F Comments: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated itt this document are accurate and in full co~npliance with legal requirements Technician's Sig.nature: ~nr,r~_ \~'~..rye. ,~/ Date: '~"~ (p- Oz"I MONITORING SYSTEM CERTIFICATION For 'Use By All Jurisdictions Within the State of California · A uthority 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 In[oyma~ion site ^daress: _tT O Bldg. No.: FaCility Contact Person: OW~..'f'~ Make/Model 0fMonitofing System: '~L~ - B. Inventory of Equipment Tested/Certified Check ',he appropriate boxes to indicate spedfic equipment inspected/serviced: TankiD: 'g,' f ~i~ In-Tank Gauging Probe. Model: Y¥1100~ I ~ Annular Space or Vault Sensor. Model: ~ I l~h~iping Sump/Trench Sensor(s). Model: O Fill Sump Sensor(s). Model: 121 Mechanical Line Leak Detector. Model: ~1 Electronic Line LeakDetector. Model: ~t O Tank Overfill / High-Level Sensor. Model: O Other (sl:~i$~ equipment type and model in Section E on Pale 2}. ~nkm:' '6'1 . ~ In-Tank Gauging Probe. Model: ~. Annular Space or Vault Sensor. Model: II l~ll;-,~.) ' ~Piping Sump / Trench Sensor(s). Model: Ci Fill Sump Sensor(s). Model: ~ Mechanical Line Leak Detector. Model: [](.Eiectronic Line Leak Detector. Model: ~ ~ Tank Overfill / High-Level Sensor. Model: . n Other (specify equipment type and model in Section E on Pa~e 2). j,Dispenser Containment Sensor(s). Model: Shear Valve(s). . Dispenser Containment.Float(s) and Chain(s). ~ Dispenser Containment'Sensor(s). Model: ,~ Shear Valve(s). ' l~l~Dispenser Containment Float(s) and Chain(s). City: ~2)~¥Nl~_.V;.~'~'~_kt'& Zip: ~ . Contact Phone No.: (~.O I ) "' Date of Testing/Servicing: In-Tank Gauging Probe. Annular Space or Vault Sensor. Piping Sump / Trench Sensor(s). Fill Sump Sensor(s): Mechanical Line Leak Detector. Model: Mode]:' Model: Model: ~ Electronic Line Leak Detector. Model: 121 Tank Overfill / High-Level Sensor. Model: 121 Other (specif~ equipment type and model in Section E on Pa~e 2). Tank ID: D In-Tank Gauging Probe. Model: Fl Annular Space or Vault Sensor. Model: Fl Piping Sump/Trench Sensor(s). Model: n Fill Sump Sensor(s). Model: Fl Mechanical Line Leak Detector. Model: CI Electronic Line Leak Detector. Model: Fl Tank Overfill / High-Level Sensor. Model: r-'l Other (specify equipment type and model in Section E on Pa~e 2). Dispenser ID: D Dispenser Containment Sensor(s). Model: I-I Shear Valve(s). [-I Dispenser Containment Float(s) and Chain(s). Dispenser ID: r-i Dispenser Containment Sensor(s). Model: iDispenser ID: Dispenser Containment Sensor(s). Model: Shear Valve(s). DDispenser Containment Float(s) and Chain(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). Dispenser ID: FI Dispenser Containment Sensor(s). Model: F! Shear Valve(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 ec~ipment. For..al3y equipment capable of generating such reports, 1 have also attached a copy of the reet~rt; (chefk all thqt. apply):" __ ~t~ System ~et'-up , l~LAJarm history,/'eport Technician Name (print): \Nlb~v'~.O_ ~lO~f~¥~'C,e.<.,~ Signature: Certification No.: O.~ Q)..~ \ License. No.: Testing Company Name: '~"1~2¥~,~L~- ~..3(~'~, '~"O W~fLPhoneNo.:(~7'~\~ _ Date of Testing/Servicing: /._~.,~/__=_[ Page I of 3 03/01 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: ~ ~,, C)'~ Complete the followinI checklist: ~ Yes I~! No* Is the audible alarm operational? ~ Yes l~l No* is the visual alarm operational? ~ Yes .D No* Were all sensors visually inspected, functionally tested, and confirmed operational? ~ ~. Yes I~l No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? ~1 Yes I~1~ No* If alarms are relayed to a remote monitoring station; is all communications equipment (e.g. modem) I~/A operational? i ~k Yes I~1 No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment I-I 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/'French Sensors; uI Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks .and sensor failure/disconnection? ~es; I~l No. I~1 Yes ~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 trigger? __% 1~! Yes* ~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. ~ Yes* ]~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) I~ Product; I~ Water. If yes, describe causes in Section E, below. ~ . ~_Yes I-I No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable ~ yes I-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. Conunents: Page 2 of 3 03/01 F. In-Tank Gauging / SIR Equipment: Izl Check this box if tank gauging is used only for inventory control. n Check this box if no tank gauging or SIR eqqipmen't is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Com ,lete the following, checklist: Yes [3' No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes 1~ No* Were all tank gauging probes visually inspected for damage and residue buildup? ' Yes ~ No* Was accuracy of system product level readings tested? Yes ~ No* Was accuracy of system water level 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): ~ Check this box if LLDs are not installed. -~ Corn flete the following, checklist: Yes ~ No* For equipment start-up or annual equipment certificationl was a leak simulated to verify LLD performance? IZI N/A (Check allthat apply) Simulated leak rate: )RI'3 g.p.h.; I-I 0.1 g.p.h; Jl~ 0.2 g.p.h. [~LYes ~ No* Were all LLDs confirmed operational and accurate within regulatory requirements? yes I~l No* Was the testing apparatus properly calibrated? ~ ' yes I~ No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? .~ 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 D N/A or disconnected? ~l~ Yes ~ No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions D N/A or fails a test? ~i~Yes D No* For electronic LLDs, have all accessible wiring connections been visually inspected? IZ! N/A '~Yes C] 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. Page 3 of 3 03/01 Monitoring System Certification Site ^d,~,-¢,,:~(,OC)~ ~O/)br'~ '~ UST~Monitoring~f. Site Plan 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 SYSTEM SETUP FEB 16, 2004 10:10 AM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGL I SH SYSTEM DATE/TIME FORMAT MOM DD YYYY HH:MM:SS xM CIRCLE K 8605 5600 AUBURN BAKERSF I ELD CA. 93306 661-871-7979 SHIFT TIME I : 6:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED TANK PERIODIC WARNINGS D I SABLED TANK ANNUAL WARNINGS D I SABLED LINE PERIODIC WARNINGS D I SABLED LINE ANNUAL WARNINGS D I SABLED PRINT TO VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET D I SABLED PRECISION TEST DURATION HOURS: 12 DAYLIGHT SAVING TIME D I SABLED SYSTEM SECURITY CODE : 000000 OOMIflUNICATIONS SETUP PORT SETTINGS: NONE FOUND RS-232 SECURITY (]ODE : 000000 IN-TANK SETUP T I:UNLEADED PRODUCT CODE : 1 THERMAL COEFF :.000700 TANK DIAMETER : 92.00 TANK PROFILE : 4 PTS FULL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 95~ : 9325 DELIVERY LIMIT : 5% : 490 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.48 MANIFOLDED TANKS T~: NONE LEAK'MIN PERIODIC: 10% : 981 LEAK MIN ANNUAL : 10% : 981 PERIODIC TEST TYPE QUICK ANNUAL TEST F~IL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 2 WIN T 2:PLUS PRODUCT CODE : 2 THERMAL COEFF :.000070 TANK DIAMETER : 92.00 TANK PROFILE : 4 PTS FULL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 95% : 9325 DELIVERY LIMIT : 5% : 490 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.80 MANIFOLDED TANKS T~: NONE LEAK MIN PERIODIC: 10% : 981 LEAK MIN ANNUAL : 10% : 981 PERIODIC TEST TYPE QUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARId DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 2 MIN RS-232 END OF MESSAGE DISABLED 3', T 3:PREMIUM PRODUCT CODE : THERMAL COEFF :.000700 TANK DIAMETER : 92.00 TANK PROFILE : 4 PTS FOLL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH MATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 9§~ : 9325 DELIVERY LIMIT' : 5~ : 490 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.50 [dANI FOLDED TANKS T;~: NONE LEAK M I N PER I OD I C: 10% 981 LEAK MIN ANNUAL : 10,% : 981 PERIODIC TEST TYPE QUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF ": DELIVERY DELAY : 2 MIN LEAK TEST METHOD TEST ON DATE : ALL TANK JAN 1, 1996 START TIME : DISABLED TEST RATE :0.20 GAL/HR DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORMAL WPLLD LINE LEAK SETUP M i:UNLEADED PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: ENABLED 0.10 GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MM/DD DATE : 97? 0 TANK: NONE W 2:PREMIUM PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: ENABLED 0.10 GPH TEST: ENABLED SHUTDOWN RATE: S.0 GPH 0.10 GPM TEST MM/DD DATE : 977 0 TANK: NONE W 3 :PLUS PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: ENABLED O.lO GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPM 0.10 GPH TEST MM×DD DATE : ~? 0 TANK: NONE LINE LEAK LOCKOUT SETUP LOCKOUT SCHEDULE DAILY START TIME: DISABLED STOP TIME : DISABLED LIQUID SENSOR SETUP L 1 :ANNULAR 87 TR I -STATE < S INGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:UNLEADED SUIdP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUIdP L 3:89 ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:89 ST[:' SUMP TRI -STATE (SI NGLE FLOAT CATEGORY : STP SUMP L 5:91 ANNULAR TRI-STATE <SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 6:91 STP SUMP TR I -STATE (S INGLE FLOAT CATEGORY : STP SUMP WPLLD LINE DISABLE SETUP W I:UNLEADED LIQUID SENSOR ALMS L I:FUEL ALARM L 2:FUEL ALARM L I:SENSOR OUT ALARM L 2:SENSOR OUT ALARM W 2:PREMIUM LIQUID SENSOR ALMS L 5:FUEL ALARM L 6:FUEL ALARM. L 5:SENSOR OUT ALARM 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 SOFTWARE REVISION LEVEL VERSION 16.02 SOFTWARE; 346016-100-C CREATED - 98.05.14,13.04 S-MODULE~ 330160-060-A SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS PLLD O.lO MANUALiO.20 CONT WPLLD 0.10 MANUAL&O.20 CONT IN-TANK DIAGNOSTIC PROBE DIAGNOSTICS T 1: PROBE TYPE MAGI SERIAL NUMBER 247316 ID CHAN = OxCO00 GRADIENT = 352.5700 NUM SAMPLES = 20 CO0 1335.0 002 16114.8 004 16114.4 C06 16127.3 C08 16127.0 Cl0 16126.7 012 21812.7 C14 21255.4 016 21182.4 018 45149.3 CO1 16114.6 C03 16114.4 005 16114,6 CO? 16127.0 C89 16126.7 Cll 45149.3 013 21117.1 C15 20992.3 C17 20915.7 SAMPLES READ =39752097 SAMPLES USED =39749219 IN-TANK DIAGNOSTIC PROBE DIAGNOSTICS T 2: PROBE TYPE MAG1 SERIAL NUMBER 249266 ID CHAN = OxCO00 GRADIENT = 351.1700 NUM SAMPLES = 20 COO 1333.1 CO1 3709.7 C02 3709.2 C03 3709.4 C04 3709.9 005 3709.8 C06 3?09.9 CO? 3?09,4 C08 3?09.9 C09 3?09.8 CIG 3?09,4 Cll 42930.1 012 18628,8 C13 17287.2 C14 17206.3 C15 17192.9 C16 17188,4 CI? 16714,8 C18 42931,6 SAMPLES READ =39748492 SAMPLES USED =39746630 IN-TANK DIAGNOSTIC PROBE DIAGNOSTICS T 3: PROBE TYPE MAG1 SERIAL NUMBER 249264 ID CHAN = OxCO00 GRADIENT = 351,1200 NUM SAMPLES = 20 CO0 1325.0 CO1 15520.0 C02 15520.0 003 15520.0 C04 15520.0 C05 15520.0 C06 15520.0 CO7 15520 0 C08 15520.0 C09 15520 0 CIG 15520.0 Cll 42773 6 C12 20308.3 C13 19216 9 C14 19150,2 C15 18967 6 C16 18901,3 CI? 18921 4 · C18 42??4.9 SAMPLES READ =39712869 SAMPLES USED =39?10817 IN-TANK LEAl( DIAGNOSTIC PROBE DIAGNOSTICS T 1: PROBE TYPE MAG1 SERIAL NUMBER 247316 GRADIENT = 352.5700 NUM SAMPLES = 19303 CO0 1334.9 CO1 16563.6 002 16563 6 003 16563.6 C04 16563 5 C05 16563.5 C06 12802 4 CO? 12802.4 C08 12802 4 C09 12802,4 ClO 12802 4 Cll 45149.8 012 21816 7 C13 21019.0 014 21201 2 C15 20982.9 C16 21109.2 Cl? 20784.5 018 45151.0 IN-TANK LEAK DIAGNOSTIC PROBE DIAGNOSTICS T 2: PROBE TYPE MAG1 SERIAL NUMBER 249266 GRADIENT = 351.1700 NUM SAIdPLES = 31820 COO 1333.5 CO1 3749.1 C02 3749.'1 C03 3749.1 C04 3749.1 C05 3749.1 C06 5399.t CO? 5399.1 C08 5399.1 C09 5399.1 CIO 5399.1 Cll 42931.8 Ct2 19168.9 Ct3 17577.0 C14 17494,6 C15 t7487,6 C16 17457.4 Cf? 17075.6 C18 42932.8 .J IN-TANK LEAK DIAGNOSTIC PROBE DIAGNOSTICS T 3: PROBE TYPE MAG1 SERIAL NUMBER 249264 GRADIENT = 351.1200 NUM SAMPLES = 61542 COO 1324.8 COl 15592.4 C02 15592.3 003 15592.3 C04 15592.3 CO5 15592.3 C06 13777.4 007 13777.4 C08 19777.3 C09 13777.4 CIG 13777.4 Cll 42774.4 C12 20468.0 O13 19265.1 C14 19192.9 C15 19065.7 C16 18934.2 C17 18957.3 C18 42775.7 WPLLD LINE LEAK DIAG FEB 16, 2004 10:12 AM W I:UNLEADED DISPENSING ENABLED DISPENSING DISPENSING PUMP ON HANDLE ON TOTAL MESSAGE:793758 CRC:28153 PARITY:59 0.10 GPH: IDLE 3.0 GPH P1:21.066 P2:20.952 PSI 0.20 GPH PI:33.890 P2:33.566 PSI MID TEST P1:20.306 P2:19.994 PSI W 2:PREMIUM DISPENSING ENABLED TEST ABORTED PENDING PUMP OFF HANDLE OFF TOTAL MESSAGE:263672 CRC:6989 PARITY:26 0.10 GPH: IDLE 3.0 GPH P1:19.034 P2:18.326 PSI 0.20 GPH P1:32.638 P2:32.444 PSI MID TEST P1:18.138 P2:17.418 PSI W 3 :PLUS DISPENSING ENABLED TEST ABORTED PENDING PUMP OFF HANDLE OFF TOTAL MESSAGE:271088 CRC:2064 PARITY:9 0.10 GPH: IDLE 3.0 GPH P1:21.542 P2:21.090 PSI 0.20 GPH P1:40.880 P2:40.070 PSI MID TEST Pl: 0.000 P2:0.000 PSI LIQUID DIAGNOSTIC L I:ANNULAR 87 SAMPLES= 5 LOW REFi= 793 HIGH REFI= 5405 VALUEI= 100079 L 2:UNLEADED ~UMP SAMPLES= 5 LOW REFI= 793 HIGH REFI= 5407 VALUEI= 100680 L 3:89 ANNULAR SAMPLES= 5 LOW REFI= 792 HIGH REFI= 5406 VALUEI= 100860 L 4:89 STP SUMP SAMPLES= 5 LOW REFI= 793 HIGH REFI= 5406 VALUEI= 95418 L 5:91 ANNULAR SAMPLES= 5 LOW REFI= 795 HIGH REFI= 5396 VALUEi= 101162 L 6:91 STP SUMP SAMPLES= 5 LOW REFI= 795 HIGH REFI= 5397 VALUEI= 98591 L 7: SAMPLES= 5 LOW REFI= 795 HIGH REFi= 5997 VALUEl=999999680 L 8: SAMPLES= 5 LOW REFI= 795 HIGH REFi= 5398 VALUEl=999999680 GROUNDTEMP DIAGNOSTIC g 1: SAMPLES= 50 LOW REF1= 793 HIGH REF1= 5396 VALUEl=999998400 ~ 2: SAMPLES= 50 LObJ REFI= 793 HIGH REFI= 5395 VALUEl=999998400 ~ 3: SAMPLES= 50 LOW REFI= 793 HIGH REFI= 5395 VALUEI=999998400 ~ 4: SAMPLES= 50 LOW REFI= ?93 HIGH REFI= 5399 VALUE1=999998400 ALARM HISTORY REPORT IN-TANK ALARM T I:UNLEADED OVERFILL ALARM JAN 22, 2004 3:58 AM DEC 16, 2003 5:59 AM SEP 21, 2003 10:49 PM INVALID FUEL LEVEL OCT 26, 2003 9:22 PM OCT 11, 2003 6:21 AM SEP 29, 2003 5:21 PM ALARM HISTORY REPORT ...... SENSOR ALARM ..... g 1: OTHER SENSORS CIRCLE K 8605 5600 AUBURN BAKERSFIELD 0A.93306 661-871-7979 FEB 16, 2004 10:12 AM LEAK TEST REPORT T I:UNLEADED PROBE SERIAL NUM 247316 NO TEST DATA AVAILABLE ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ALARM HISTORY REPORT ..... SYSTEM ALARM PAPER OUT JAN 12, 2004 4:58 AM PRINTER ERROR JAN 14, 2004 4:43 AM BATTERY IS OFF JAN 1, 1996 8:00 AM ALARM HISTORY REPORT SENSOR ALARM L I:ANNULAR 87 ANNULAR SPACE SENSOR OUT ALARM FEB 19, 2003 1:11 PM FUEL ALARM FEB 19, 2003 1:07 PM SETUP DATA WARNING NOV 26, 2002 3:05 PM ALARM HISTORY REPORT SENSOR ALARM W I:UNLEADED CONTINUOUS PUMP ALM DEC 13, 2003 8:50 PM CONTINUOUS PUMP ALM OCT 24, 2003 2:OB AM WPLLD SHUTDOWN ALM MAY 6, 2003 1:57 PM ALARM HISTORY REPORT .... I N-TANK ALARM ...... T 2 :PLUS INVALID FUEL LEVEL OCT 3. 2003 8:29 PH ALARM HISTORY REPORT SENSOR ALARM ..... W I:UNLEADED CONTINUOUS PUMP ALM DEC 13, 2003 8:50 PM CONTINUOUS PUMP ALM OCT 24, 2003 2:08 AM WPLLD SHIJTDOWN ALM MAY 6, 2003 1:57 PM ALARM HISTORY REPORT ..... SENSOR ALARM L I:ANNULAR 87 ANNULAR SPACE SENSOR OUT ALARM FEB 19, 2003 1:11 PM FUEL ALARM FEB 19, 2003 1:07 PM SETUP DATA WARNING NOV 26, 2002 3:05 PM ALARM HISTORY REPORT SENSOR ALARM ..... L I:ANNULAR 87 ANNULAR SPACE SENSOR OUT ALARM FEB 19, 2003 1:11 PM FUEL ALARM FEB 19, 2003 1:07 PM SETUP DATA WARNING NOV 26, 2002 3:05 PM ALARM HISTORY REPORT ..... SENSOR ALARM g I: OTHER SENSORS ALARM HISTORY REPORT ..... SENSOR ALARM g 1: OTHER SENSORS ALARM HISTORY REPORT I N-TANK ALARM ..... T 3:PREMIUM INVALID FUEL LEVEL AUG 3, 2003 10:57 AM ALARM HISTORY REPORT ..... SENSOR ALARM ...... W I:UNLEADED CONTINUOUS PUMP ALM DEC 13, 200~ 8:50 PM CONTINUOUS PUMP ALM CCT 24, 2003 2:0B AP1 WPLLD SHUTI)OWN ALM MAY 6, 2003 1:57 PM ..... SENSOR ALARM L 6:91 STP SUMP STP SUMP FUEL ALARM FEB 16. 2004 ll:17 AM CIRCLE K 86D5 5600 AUBURN BAKERSFIELD CA.93306 661-891-7979 FEB 16, 2004 t0:13 AM LEAK TEST REPORT T 2:PLUS PROBE SERIAL NUM 249266 NO TEST DATA AVAILABLE ..... SENSOR ALARM L I:ANNULAR 87 ANNULAR SPACE FUEL ALARM FEB 16, 2004 10:55 AM ..... SENSOR ALARM ..... L 3:89 ANNULAR ANNULAR SPAOE FUEL ALARM FEB 16, 2004 10:57 AM CIRCLE K 8605 5600 AUBURN BAKERSFIELD CA.93306 661-871-7979 FEB 16, 2004 11:30 AM SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL SENSOR ALARM L 5:91 ANNULAR ANNULAR SPACE FUEL ALARM FEB 16, 2004 10:59 AM WPLLD LINE LEAl( ALARM W 2:PREMIUM GROSS LINE FAIL FEB 16, 2004 11:36 AM CIRCLE K 8605 5600 AUBURN BAKERSFIELD 0A.93306 661-871-7979 FEB 16, 2004 10:13 AM SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL SENSOR ALARM ...... L 2:UNLEADED SUMP STP SUMP FUEL ALARM FEB 16, 2004 11:07 AM WPLLD LINE LEAK ALARM W 2:PREMIUM WPLLD SHUTDOWN ALM FEB 16, 2004 11:36 AM CIRCLE K B605 5600 AUBURN BAKERSFIELD CA.93306 661-871-7979 FEB 16, 2004 10:13 AM LEAK TEST REPORT T 3:PREMIUM PROBE SERIAL NUM 249264 NO TEST DATA AVAILABLE ..... SENSOR ALARM L 4:89 STP SUMP STP SUMP FUEL ALARM FEB 16. 2004 11:13 AM WPLLD LINE LEAK ALARM W I:UNLEADED GROSS LINE FAIL FEB 16, 2004 11:42 AI'.'I WPLLD LINE LEAK W I:UNLEADED WPLLD SHUTDOWN ALM FEB 16, 2004 11:42 AM ..... SENSOR L 4:89 STP SUMP STP SUMP SENSOR OUT ALARM FEB 16, 2004 12:27 PM WPLLD LINE LEAK ALARM W 8:PLUS GROSS LINE FAIL FEB 16. 2004 11:52 APl ..... SENSOR ALARM ..... L 5:91 ANNULAR ANNULAR SPACE SENSOR OUT ALARM FEB 16, 2'004 12:27 PM WPLLD LINE LEAK ALARM W S:PLUS WPLLD SHUTDOWN ALM FEB 16, 2004 11:52 AM SENSOR ALARM L 6:91 STP SUMP STP SUMP SENSOR OUT ALARM FEB 16, 2004 12:27. PM OIRCLE K 8605 5600 AUBURN BAKERSFIELD CA.98S06 661-871-7979 FEB 16, 2004 12:02 PP1 SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL SENSOR ALARM L I:ANNULAR 87 ANNULAR SPACE SENSOR OUT ALARM FEB 16, 2004 12:27 PM SENSOR ALARM ...... L 8:89 ANNULAR ANNULAR SPACE SENSOR OUT ALARM FEB 16, 2004 12:27 PPI SENSOR ALARM ..... L 2:UNLEADED SIJMP STP SLIMP SENSOR OUT ALARM FEB 16, 2004 12:27 PM PERMIT APPLICATION Ti~J~, ONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [] NEW FACILITY ~MODIFICATION OF FACILITY [] NEW TANK INSTALLATION AT EXISTING FACILITY Bakersfield Fire Dept. Environmental Service 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 EXISTING FACILITY PERMIT NO. FACILITY ADDRESS CITY I TM CODE 5'&0o q TYPE OF BUSINESS APN # O -'1 CITY-- / ~PCoDE I GONTRAGTOR ,. ~ ~ I GA LIGENSE NO. L,,J ~"1 ,,' e_.. t'er,r--( ._L v,,. C_. , 300 3 H S--- ADORESS I CITY~ _ ZIP CODE PHONE NO. { BAKERSFIELD CITY BUSINESS LICENSE NO. } WORKMAN COMP NO. [ INSURER BRIEFLY DESCRIBE THE WORK TO BE DONE DEPTH TO GROUND WATER ISOIL TYPE EXPECTED AT SITE NO. OF TANKS ~ ARE THEY FOR MOTOR FUEL I SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE TO BE INSTALLED ,,'~ [] YES [] NO ] [] YES [] NO THIS SECTION IS FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEl. AVIATION 2 aoo Oq, u.,,k, 3 t¢ooo 64. pre*,. THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMIC/~ STORED (NO BRAND NAME) CAS NO (IF KNOWN) CHEMICAE P_.REVlOUSLY STORED FOR OFFICIAL USE ONLY { APPLICATION DATE I FACIUTY NO. NO. OF TANKS . FEES$ The applicant has received, understands, and will comply with the attached conditions of the permit and a~y,~.~the state, local and federal regulations. This form has been completed under penalty'of perjur~nd to. t~l~, bj~, of my knowledge, is true and correct. ~ ' AI~SR(~VED BY: .... APPUCANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED MAP# 1 CALIFORNIA ANNOTATED SITE MAP BUSINESS NAME CIRCLE K STORE #2708605 DATE 03/t5/01 DRAftiNG SCALE BUSINESS ADDRESS 5600 AUBURN STREET BAKERSFIELD ZIP CODE 93306 1 "=30'--0"+ a A B C D E F G H MAP SYMBOLS VACANT LOT,' ELECTRICAL PANEL / ~ ELECTRONIC MONITORING POINTS SHUT-OFF NA~RAL GAS 1 ¢ ~ ~ ~ ANNULAR SENSOR L ~ ~ ~ ELEC~ONIC LINE LEAK DETECTOR ~ WA~R SHUT-OFF ~ ~ ~ ~%. ~ ~ AUTOMATIC TANK GAUGE~ TANKEMERGENCYsHuT-OFFMoNITORINGPUMP J - ~ '"" ~ ALARM j ~ ~LEPHONE 2 ~ ; ~ FIRST AID KIT ~ FtRE EX~NGUISHER ~ ~ ~ STORM DRAIN SANITARY SE~R ~ ' -- ~ 'l ~~ STAGING AREA ~ I ~A' J12 X 5 GALLON ~ ~ CASHIER -[PROPA.E U ~ ~ ~ ~ HMMP HMMP. AND MSDS ~ / x x FENCE ~ ~1 ~ EMERGENCY RESPONSE Z ~ EQUIPMENT/ABSORBENTS STORAGE TANK 4 z I~-~l UNDERGROUND ~ ~ ~--~ STORAGE TANK o I ~ GASOLINE (FLAMMABLE LIQUIDS) ~ ~ ~ ~ DIESEL FUEL (COMBUS~BLE LIQUIDS) ~ MOTOR OILS * LUBRICANT (CO'BUS'BCE LIQUIOS) CARBON DIOXIDE (FLAMMABLE LIQUID) I ~ 'x x~'x ~ ~ AN~FREEZE/COOLANTS (FLAMMABLE LIQUID) 6 .j..,' __~ -- ..... j/ - -- -- : :: : ~ ~~' NOR~ ~ CAR WASH PRODUCTS 7 AUBURN STREET 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 Issued by: This Dormit iS Issued for the followirt_-: -~,~~~t,~, [] Hazardous Materials Plan Permit ID #:: 015-000-001297 .... :~;~' . . ., ~i~,/~ .:-..~ [] Underground Storage of H,~--,rdous Materials -"o ~ ~. ~ ';~'? ~!:~;. :~' [] Risk Management Program ~ ~ ~'"%' -':.~.. [] Hazardous Waste On-Site Treatment CIRCLE K STORES INC *~oou..q:~ '. :~ ~ ,::.:::'n::.~.::~,.~. ,.,~,.-~ LOCATION: 5600 AUBURN ST 2I .~/~;-:~ 'BZKER~FIELD '? C,~"-:'~3~, ~'g'.: :~ , .... .....,.?. ,.-~¥ ..:~. "~' "~ ~ ~%'?-; ~ " I~", TANK HAZARDOU.~'s~B'§?AN'(:~ ..~.~:~ ' ~ ""' ~ ' .CAP~,C~ ~!%,.. DISPENSF~ 'PANS'?MONITORING 015-000-001297-0001 UNLEADED PLUS?GAS:QLINE~ ..~,?': ':'::':?:I',~O.~i"P',':Eb/~T, MECH. SHuTS~:~OF.~'!sHEAR VAL 015-000-001297-0002 MIDGRADE UNLEADED GASOLINE:".,: "::.:::~i1~[~',00 FLO'~T 'MEcH,,SHUTS OEF ~HEAR VAL. 015-000-001297-0003 REGULAR UNLEADED GASOLINE." ' '; '"' '~)~1~~FLOAT.': ,Z. ! .'.. ,~..- ,., MECH:'SHUTS. :, ,: ~FF SHEAR., VAL Bakersfield Fire Department OFFICE OF ENV1R ONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: Expiration Date: June 30. 2003 Issue Date Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ...... ~,~:~?~,~ ~ This permit is issued for the following: .... ~??i?:i~,~i~*,i~Zkii~k:?:5:~El~Hazardous Materials Plan .,?~:?~'?~?~'?:~;~}~ ~}~[ ~?~"~~,[ground Storage of H~rdous Materials ~=~, ,,,~ .... ~ ~,~= .=..-,..~..~. .... % ................... ~ ~=.~ -,Q..H~eu~ Waste PE~T ~ ~ 015-021-001297 ,.~ CIRCLE K STO~S ~:.. '...~ ~.~~.~ ~,, ~..--~ . ~"-_ '-.$ ~.~. . ~ . ~. T~K H~OUS S~T~CE PIP~G PIP~G 0001 Unleaded Plus Gasoline 0002 Unleaded Gasoline '0003 Premium Unleaded Gasoline I0,000 TYPE METHOD DWF DWF PIPING MONITOR ISSUed by: Bakersfield Fire Department' OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: DWF PRESSURE ALD PRESSURE ALD PRESSURE ALD June 30. 2000 00835 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 Nichoison Circle K Stores #8605 5600 Auburn Bakersfield, CA 93306 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE FIRE CHIEF RON ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Streel Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFE'PC SERVICES* ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIR E INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Failure to Perform/Submit Annual Maintenance on Leak Detection at the Above Stated Address. Dear Business Owner: Our records indicate that your annual maintenance certification on your leak detection system will be past due on 02-19-04. You are currently in violation of Section 2641(J) of the California Code of Regulations.. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, April 10, 2003 to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db UN D PROGRAM CONSOLIDATED F(~ TANKS UNDERGROUND STORAGE TANKS - FACILITY (one page per site) TYPE OF ACTION (Check one item only) [~1. NEW SITE PERMIT [-13. RENEWAL PERMIT F-14. AMENDED PERMIT ~]5. CHANGE OF INFORMATION (Specify change - local use only) [--~6. TEMPORARY SITE CLOSURE Page __ of r"'~7. PERMANENTLY CLOSED SITE r-~8. TANK REMOVED 400 I. FACILITY / SITE INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 FACILITY ID # Circle K Stores Inc. #2708605 BUSINESS SITE ADDRESS 401 5600 AUBURN ST BUSINESS TYPE [] 1. GAS STATION [] 3. FARM [] 5. COMMERCIAL [~2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER 4O3 TOTAL NUMBER OF TANKS ~ is facility on indian Reservation or REMAINING AT SITE I trustlands? 3 ,~o4 [] Yes [] Uo4gS FACILITY OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 3. PARTNERSHIP [] 4. LOCAL AGENCY/DISTRICT* [] 5. COUNTY AGENCY* [] 6. STATE AGENCY* I [] 7. FEDERAL AGENCY* *if owner of UST is a public agency: name of supervisor of division, section or office which operates the UST. (This is the contact person for the tank records.) 4O6 402 II. PROPERTY OWNER INFORMATION 407 PROPERTY OWNER NAME RUPERT, JAMES E. MAILING OR STREET ADDRESS 409 13104 SAN JUAN AVE CITY 410 ~ STATE 411 BAKERSFIELD I CA PROPERTY OWNER TYPE [] 1. CORPORATION [] 2, INDIVIDUAL [] 3, PARTNERSHIP [] 4. LOCAL AGENCY / DISTRICT [] 5. COUNTY AGENCY IPHONE 408 (510) 245-5219 ZIP CODE 412 93312 [] 6. STATE AGENCY 413 [] 7. FEDERAL AGENCY " IlL TANK OWNER INFORMATION TANK OWNER NAME 414 Circle K Stores Inc. MAiLiNG OR STREET ADDRESS 416 495 East Rincon Ste 150 CITY 417 Corona TANK OWNER TYPE I STATE 418 CA [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 1. CORPORATION IPHONE 415 (909) 270-5193 IZIPCODE 419 92879 [] 6, STATE AGENCY 420 [] 7. FEDERAL AGENCY TY (TK) HQ IV. BnA_ D OF EOUAL'~'~_T)ON UST STORAGE F~__~ AccomJHT NmJ~_~P. I4 )4 I 101312 017];~1 Call (O16) 322-9669 if questions arise 421 INDICATE METHOD(S) [] 1. SELF-INSURED [] 2. GUARANTEE [] 3. INSURANCE V_ PET~OLEU_M. m mql' ~m~m~m D~on~m~mm m'r¥ ' ~ 4' SURETY BOND .............. ~ - FF~A~ ~ ~ 5. LE~ER OF CREDIT ~ 8. STATE FUND &CFO LE~ER ~ 6. ~EMPTION ~ 9. STATE FUND & CD [] 10. LOCAL GOV=T MECHANISM [] 99. OTHER: 422 Check one box to indicate which address should be used for legal notifications and mailing, [] 1. FACILITY [] 2. PROPERTY OWNER Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. [] 3. TANKOWNER 423~ VII_ APPL)C,~.HT Certification: I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF APPLICANT ~ DATE (909) 270-5193 NAME OF APPLICANT (print) TITLE OF APPLICANT 426 Michelle Wilson West Coast Environmental Compliance Manager 425 STATE UST FACILITY NUMBER (For local use only) 427 I 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 428 UPCF (1/99 revised) 5 Formerly SWRCB Form A ~c ~ED PROGRAM CONSOLIDATED FoR~ FACILITY INFORMATION BUSINESS ACTIVITIES , Page 1 I. FACILITY IDENTIFICATION Ill-Il I I]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 check 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 (Formerly SWRCB Form A) 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) (Folly Form C) 3. Need to report closing a UST? [] YES [] NO 7 UST TANK (c~osure 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 g 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 perrecycler) 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE [] YES ' [] NO 11 TREATMENT - FACILITY (Formerly re'sc roms 1772) ONSITE HAZARDOUS WASTE TREATMENT - UNIT (one page per unit) (Formerly DTSC Fonra 1772 A,B,C,D and L) 4. Treatment subject to financial assurance requirements (for CERTIFICATION OF FINANCIAL Permit by Rule and Conditional Authorization)? [] YES [] NO 12 ASSURANCE (FormerlyDTSC Form 1232) 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE / CONSOLIDATION SITE [] YES [] NO 13 ANNUAL NOTIFICATION (Formerly DTSC 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 (You may also be required to prov/de additional information by your CUPA or local agency.) UPCF (1/99) 5 U~ED PROGRAM CONSOLIDATED FOR~ FACILITY INFORMATION ~ BUSINESS OWNER/OPERATOR IDENTIFICATION Page __ of__ FACILITY ID# BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) Circle K Stores Inc. #2708605 / / 08605 BUSINESS SITE ADDRESS 5600 AUBURN ST I. IDENTIFICATION 3 [ BUSINESS PHONE (661) 871-7979 CITY lO4 CA BAKERSFIELD 106 DUN & BRADSTREET '15-156-7054 1Ol lO2 1o3 ZIP CODE 1o5 93306 SIC CODE ~ digit #) 1o7 5541 COUNTY 108 BUSINESS OPERATOR NAME 1o9 [ BUSINESS OPERATOR PHONE l l0 Comvanv Ooerated [ (661) 871-7979 II. BUSINESS OWNER OWNER NAME Circle K Stores Inc. OWNER PHONE (909) 270-5193 OWNER MAILING ADDRESS 13104 SAN JUAN AVE CITY BAKERSFIELD 112 I13 114 ] STATE 115 [ ZIPCODE 116 CA 93312 III. ENVIRONMENTAL CONTACT CONTACT NAME Michelle Wilson - (ConocoPhillivs Comvanv) CONTACT MAILING ADDRESS 495 East Rincon Ste 150 117 I CONTACT PHONE H8 (909) 270-5193 119 CITY 12o [STATE 121 I ZIp CODE Corona CA 92879 122 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123 NAME 128 Comvanv Overated TITLE 124 TITLE 129 Ooerator BUSINESS PHONE 125 BUSINESS PHONE 130 (661) 871-7979 24-HOUR PHONE 126 24-HOUR PHONE 131 1-866-805-4357 PAGER # 127 PAGER # 132 ADDITIONAL LOCALLY COLLECTED INFORMATION: Certification: Based on my ir~quiry 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 submitted and believe the information is true, accurate, and complete. NAME OF SIGNER (print¥ - 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 Januaw 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 NAME: ADDRESS: CERTIFICATE OF INSURANCE SEE ATTACHED SCHEDULE SEE ATTACHED SCHEDULE POLICY NUMBER: ST8089599 ENDORSEMENT: Not applicable PERIOD OF COVERAGE: December 17, 2003 to December 17, 2004 NAME OF INSURER: ADDRESS OF INSURER: AMERICAN INTERNATIONAL SPECIALTY LINES INSURANCE COMPANY 70 PINE STREET NEW YORK, NY 10270 NAME OF INSURED: ADDRESS OF INSURED: Circle K Stores, Inc. 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): TANK# CAPACITY LOC. # ADDRESS UST/AST GALLONS INSTALL 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 81,000,000 each occurrence and 82,000,000 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 rece!ved 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 !2700010 302 E TEHACHAPI BLVD TEHACHAPI ;CA KERN 02 iU . ................................................................................................................ ? .................................................... [~ 118491 =:2700010 302 E TEHACHAPI BLVD :TEHACHAPI ~CA !KERN ~,01 !~700337 "[10597 JuRuPA r~) MIRA LOMA ......... iCA ]RIVERSIDE 01 :U 11849[ ';;700337 ' '1059~ JUI~uPA ~ .... MIRA LoMA .... ~CA RivERS'iDE ' ~o'2" "'~U ~t8~{ ~2700358 ~540 W BIG B~R BLVD ;BIG B~R CI~ ;'.CA :SAN BERNARDINO 02 '~U .......... 11~9~ i'~s~ .... ~ ~ ,,~',~ ,L~ ,,a ,~ ~W ............... ~c, ~'~4~ ~i~ ;~¥ ' '~U .............. . ';' L. "_'Z.'_~J'~.~: ~'~'4~'~ .................. ~'~'~"~XCC~V~'C~ ......................... ";~'.;;.'.'"; .......... ;";'"~;~ ........ ;;";.~'~;~.~.~9~.~n ~'~'~ ............... [~5~' CE'i~6'~ ~T ND O ;CA RIVERSIDE 01 IU i ~i27005~ ............. ~73010 ............................................................... ~MON RD '.THOUSAND PALMS ~CA ~R VERSlDE 02 ~U · ~'f~ .............. g~'~x~'~"~'~ ................ Tx'~A ................................. T~X ................. ~'Ai9~'~'~6~ ................ ~'"'"'"~ ............ .jjj'.'j'. .................. jj. '~"~j~ ~2zoo~Y6' ................. t~g~A'A~"~C~'~"A~ ....................... ~A~55'~'~EE'~9'"'" '~ ................. ~'BERNARDINO 02 [~ ~ ~97~i [~'~'~)~ ................. ~'~5~ ~ PALMS H~ MORONGO VALLEY "~ ................ ~X~' ~A~'X~6i~6'"~b'~ ........... ~-~ ............... q-,~-v~-~"~c~'~ ................ ~'~-~[~ .......... ~x ............. ~-~['~i~ .............. ~0- ......... ~ ........................... ~ .............................. [A'+55~'5~ ..................... ~'~'~)F~6"A~ ..................................... ?~A~'~E~i~A~ '~A ~RIVERSlDE ~01 ~._ 12053 ~2700858 ~18465 ~S H~ 18 ~APPLE VALLEY ~CA ~SAN BERNARDINO ~01 ~-~ 18465 US H~ 18 ~APPLE VALLEY iCA iSAN BERNARDINO ~02 U 9816 ~'~65'~)'~ ...................... ~'5~-"~'~'~E'~ ................................. ~6A"~6~A[L'[Y iCA }RIVERSIDE ~02 ~ 14976 ~[00872 H3261 PERRIS BLVD ~MORENO VALLEY ~CA ~R VERSlDE ~01 U 1184S ~2700~2 [6940 OLD WOMAN SPRG :~YUCCA VALLEY CA '~SAN BERNARDINO ~01 U 981~ ~'~'~ .................... [~[~BA.~;~;;;;~;;~Z;;~"~}~.~;~[~;~S;~ZZ;~;;}~;j;ZZ~Z[~.~;~.~.~1~;~[.~ ]2700~2 ~6~0 OLD WOMAN SPRG ~YUCCA VALLEY :~CA ]SAN BERNARDINO ~03 U 981e ~700951 ~5809 MAN~NITA AVE ~CARMIC~EL icA' ~ {SAC~MENTO ~01 1497~ ~oo~s~ ~.o. ~,.~. ~**vE ~cA.~,c.*~ ~cA ~SAC~UE.~O ~o~--.CTj~ZZ.ZZ.TZ2ZZ!~ ........................................ 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[~"~'~'~ ................................................ ~'~E-~" ~ ~SAC~MENTO ~01 ~- .......................................................... ~'¥~'~ 1497( .... n~7 :=~ ....... ~ ~SAC~MENTO iCA SAC~MENTO 02 {U ~ 50~MRO~K RD BARSTOW ~CA SAN BERNARD{NO 01 {U 11~9 {2701156 1263 F~NKLIN AVE iYUBA C~ ~CA ~SU~ER ~01 U 1497~] ~'~i'Tf~ .................... {~'~"~'~['i~E~[~6' ' ~AVENAL ~ ~mNOS 12701178 !428 SKYLINE BLVD 12701197 ]2701197 12701197 {2701205 2701212 2701215 2701215 '6930 MORRO RD jATASCADERO iSAN LUIS OBISPO103 6930 MORRO RD ATASCADERO iSAN LUIS OBISPOi02 6930 MORRO RD iATASCADERO SAN LUIS OBISPO i01 16470 CAMBRIDGE 101 16470 CAMBRIDGE {LATHROP [SAN JOAQUIN !02 600 RIO TIERRA AVE iSACRAMENTO SACRAMENTO i02 600 RIO TIERRA AVE [01 iLOMPOC ]SANTA BARBARA i01 1421 OCEAN 1421 OCEAN iLOMPOC iSANTA BARBARA i02 9816 9816 9816 12701232 4381 EL CAMINO REAL {AT~.S..(~,.E,,~..O. ...... ~.~t SAN LUIS OBISPO 102 i~;'~'~';~'~:~ ....................... ~';~'"~2"~'~'i'~"~'~ .......................... ~C~O }CA ~SAN LUIS OBISPO ~01 ~270 56~ STINE RD jBAKERSFIELO {CA ~KERN ~01 U 1497~ J2701775 24051 JOHN F KENNEDY DR jMORENO VALLEY iCA RIVERSIDE ~01 U ~ 981( · ~'~'~ ...................... ~"~6~"~"~'~"~ .......... '~'~'6"~x~['~ ............. {~x"' '~' j~j '";.~j~ ~ ......... ' ........................................... T .............................. j2701914 L1930 ~KE BLVD ~AVIS ]'BX"' YOLO ~03 U ! 7950 [270~' 'J ~'~ ~ ~ ~LO ~ ~' [' 9816 r~i'~ ..................... {~'~'~6"~X~6[iX'Xg~ CORONA CA ....................... RIVERSIDE ................. ~01 U .................................. ~ ........... 9816 Page 1 ol 3 K Stores Inc, - Certificate of Insurance Site Listil % 2~705439 /240 N MArN ST 'SALINAs CA MONTE'~EY 02 U .... 9816 :~-5-aJ~3'9 ' 1240 N MAIN ST .............. :$AI]~X$ ......... b~A .... :~d~f~' ............. ;~Td~'~ :1240 N ~AIN Sf ~SA'E'i'~X~ ~A ~'~b~'~ ................. ~'~ ........ :2705449' ' '7647 PACIfiC AV~ ...... ;'SfOCKf6N .... 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J ........................................ ~ ~ 9 6 2~o~.~ m~9~ ALTON P~ ~W~ ~CA ~O~N~ ....... ~ ............. ~ .................................................................. ~'~'~ 2705802 ~6900 FOOTHIL~ BL~ ~FONTANA CA ~AN BERNARDINO 01' U 11783 27o~ ~ 7a~ us H~ m ~ ~U~T~ ~ .......................... ~i~'~'5~ ........................ ~'~ ........... {2705911 ~783~ US H~ 111 i~ QUINTA iCA iRIVERS DE i03 U 1497 2705911 ~783~ US H~ 111 ~ QUINTA ICA ~RIVERSIDE ~01 1497~ ~2708~5 j1161 E VALLEY P~ I ESCOND ~ ~ ~ n ~ ............................... ~ ......................... ~.~ '~a~ ..................... i'{~'~'"~"~[~"~'~ .............................. ~'~-~ .......................... ~ ................. i'~-~i'~'~6 ................... ~a~ .............................. ~ ....................~'~ ~ 2708605 15600 AUBURN ST. [ BAKERSFIELD i CA [ KERN ~ 03 ~ 981, ,'27°8~°~ L~O3O OAK ~T ...... iB~'~'~'~i~'['~ ...................... ~ ........................ [R'~'~ ....................................... ?~" ....................................... r~ ........................... '"~'i'~" 12708808 J 1030 OAK 8T J BAKERSFIELD ~ ~ ' . ~ ~KERN i270~ i ~030 OAK 8T JBAKERSF ELD ~CA KERN --~3 U 9611 ~2708~1 ~295 N WATER~N AVE ~SAN BER~RD NO ~C~ .................. [~'~"'~'~'~"T~ ........... ~ ........................................ ~ ....................... ~'6 ~270~1 ~295 N WATER~N AVE ~SAN BERNA~INO ]~ ~S~"'~'~-~5~"~ .............. ~ ................................... ~ ............................ ~'~'~ ~2708~1 ~295 N WATERMAN AVE ~SAN BERNARDINO ~SAN BERNARDINO ~03 ~C;A U i 9816 12708644 111724 AIRBASE RD iADELANTO ~CA JSAN BERNARDINO i02 ~'------i 981--~ 2708644 il 1724 AIRBASE RD {ADELANTO iCA {SAN BERNARDINO i03 ...................................... i .......................... -~'~'~ [2708644 il 1724 AIRBASE RD iADELANTO {CA iSAN BERNARDINO ]01 12708688 i10520 CAMINO RUIZ jSAN DIEGO i03 j2708688 i10520 CAMINO RUIZ SAN DIEGO i2708688 110520 CAMINO RUIZ iSAN DIEGO ~'~ ..................... i~.'f "i~"6 [/9'~'X~i~ ........................................... l'i~'i~i~5' ]270~f3~' '~I~"oLIgE AVE !FRESNO 2708734 i247 E OLigE AVE iFRESNO 2708735 !2097 MENTONE BLVD iMENTONE · 12708735 12097 MENTONE BLVD ~MENTONE~ ,~7-~ J 2~0_9__7 .._ iMENTONE ~ MENTONE BLVD iCA SAN DIEGO U j SAN DIEGO j01 i FRESNO i01 i FRESNO i02 iFRESNO i03 i02 iCA ISAN BERNARDINO 103 U {CA JSAN BERNARDINO i01 g81( 981( g81E g81( g81E 981~ [2708755 i2790 WHITSON RD iSELMA iCA jFRESNO !01 981~ 2708755 i2790 WHITSON RD !SELMA CA FRESNO , ............................................. ~ .......................................................................................... ~ .................................................. i .................... ~ ~03 U 9816 ~[2708_755 j2790 WHITSON RD ISELMA, ...... ~ ..... ,'CA ................ : ~'~ ................................ : ~ ............. [ ~ .............. ~g816 ~_ i~2 ~ sZ .......... ~KE~SFIELD L~A L~ER~ ...... [o~ [6' 9816 r2708825 ~2222 F ST BAKEA~--F~ ......... R~ ...... ~a~--~ 2708~3 ~ 1 ~0 CARPENTER RD i MODESTO ~CA I STANIS~ ' , ~&~ ......... jL~ CARP~.TER RU ]MOD~STO {CA {STAN~SUUS ~02 {U ~ Page 3 K Stores Inc. - Certificate of Insurance Site Listl. ,2~7~.9.4~ 1600 W MAIN ST '' TURLOCK ,CA .STANISLAus O1 !U 98i6! ;2701940 1600 W MAIN ST TURLOCK CA STANISLAUS 02 IU 9816~ !2~'0:~'~' : 1600 ~ ~IAIN S'~' ............ ~r~JRLOCI~ ........... ;C~ ' :~'0~ ............. :'~ '""""~ ~ .......~'~ 2701984 795 SHADOW RI'D~E O~ VISTA CA SAN 9tEGO 03 ..~U ............. 9~16~ ~2701984 795 SHADOW RID~'~ D~ VISTA ;CA SAN DIEG~ ' 02 ~U ' 98~6~ ~2701984 795 SHADOW RIDGE DR VISTA CA SAN OIEGO :01 JU 9816~ ~02964 :60 BROADWAY CHU~ VISTA ' CA SAN DIEGO 01 jU 9942~ ~2702970 '~04 MAIN ST '~MONA ;CA ~SAN DIEGO ~02 IU · 11849~ '~76~7o .... '~0~'MA ~ ~f ............... ~6~ .................... ~c~ .... ~ 6~6b~ ............ ;6~ ........ O .................; ........... }2703608 ~21998 COLO~DO SAN JOAQUIN ~CA ~FRESNO ~01 {U ' 14976~ '~'~'~ ~6'~'~'~'~b~'Sb'~6~"~6 .................. ¢~b~"'~X~6~ ........................ ~ ~b~b b~ '"'"' [b' ~ ~' 2703s~. ~03 MERCYSPR~SRO LOSSANOS ~CA ~M~RCEO ~03 ~U 9~4 ~'0~ ........... ~i'Tb4'~"fi~6 ~0~'~X~6S ~b~ ;~b'~b ~b~'"'-'"'~b ........................................... ?~'~'~ ............ ~'~'~6~' ~'~bR~b'6 :,LOS BA~OS ~CA ~b~6 ~6~ ........... 0 ~ ........................ ~ .............................. 2705008 ~1~ ....................................................................... 1424 CRIPPEN AVE ~ADE~N ................ ~;O ....................... ~CA ......................... t]SAN ......................................... BERNARDINO ~01 ............... tU~ ................................. t~ ..................... 9816: j2705008 ~11424 CR PPEN AVE ~ADE~NTO ~CA ::SAN BERNARDINO 03 ~ 981~ ~270~17 2~9 BLOSSOM ~DOS PALOS ~,CA MERCED ~01 ~U 981{ F~-~ ~6~~ ...... ~~~--'-~~' ~o2~ ~'~'~'~ ................ Fi~' ~"5~'~5~ ............................................. ~'~'~ ............................... ~'~X .................... ~X~"6'['~X~6'i~5"~55"'"-':j'~'~ .............................................................. ~'~'i [~-~ .................... {'~'~"~"~'~'~ ............................................. ~'~'~ .............................. ~x ....................... ~'~"~x~i'~'-?~"""]~" ................................... T ............................... ~'~ 2705057 18197 I ST HESPERIA CA iSAN BERNARDINO i01 U g81E [~'~'~ .................. i'~'~' i"§¥ .............................................................. i'~i~§i~'i~iX ................................. !~7~ ..................... i§X~' i~i~×i~'i~ii~6'" '~ ........... ~ ............................................................... %~i'~ [~'~§~ ..................... i~:~'~;"i"§~: ............................................................. iHESPERIA iCA iSAN BERNARDINO i03 U __ 981~ {2705063 !8190 MISSION BLVD iGLEN AVON iCA !RIVERSIDE i02 U 9816 J2705063 18190 MISSION BLVD iGLEN AVON ~ !RIVERSIDE 103 U 981E !2705063 8190 MISS ON BLVD '.GLEN AVON CA ~RIVERSIDE !01 U 981E 12705095 [4360 GENESEE AVE iSAN DIEGO iCA iSAN DIEGO 101 U 9684 i2705095 14360 GENESEE AVE iSAN DIEGO ~ .......... i.S.~_AN DIE_GO _ .~03 U 9684 t2705095 i4360 GENESEE AVE ISAN DIEGO iCA !SAN DIEGO 02 U 9684 ~2705203 j6290 MISSION !RUBIDOUX . iCA iRIVERSIDE 103 '~ .................................. '~ ....................... -~1'~ [~'~'~ .................... ~"i;;ii~i6'i~ .................................................. !'i~i~'i~i'~' ........................ ]'~X ..................... i'i('i~'i~i(§iiSi~ .................. i~ ........... ii' ........................................................ ~';i'~ i2705203 i6290 MISSION iRUBIDOUX iCA iRIVERSIDE i01 .U___ ....................... __981..~6 )2705214 765 W REDLANDS BLVD REDLANDS iCA SAN BERNARDINO 01 JU 11682 ~5214 1765 W REDLANDS BLVD iREOLANOS !CA iSAN BERNARDINO~_ i 14976 ~2705230 ~1~08 O~NGE iPA~MOUNT ~CA ~LOS ANGELES ~02 ~_ 9811 27052~ {I~OB O~NGE PA~MOUNT ~CA [LOS ANGELES ~03 U gBl~ SAN BERNAROINO ~2705245 ~6105 C~Y ~PEDL~ ~CA ~RIV~RSIDE 03 U ~2705245 ~610~ C~Y ~PEDLEY ~CA ~RIVERSIDE ~01 12705247 ~5804 MISSION BLVD ~RUBIDOUX ~ ~RIVERSIDE ~03 U . 9728 ~2Z05252 I518 W FOOTHILL ~RIALTO jGA ~SAN BERNARDINO ~01 ~ ..................................... ~ ........................ -~ [~'~§~ ................... ~'~'"~'~66~i[~ iRIALTO ICA ~SAN BERNARDINO ~03 U g728 ~270~23 ~7796 SUNRISE BLVD iClTRUS HEIGHTS ~CA !SAC~MENTO ~01 U 11682 i270~23 ~77~ SUNRISE BLVD ~ClTRUS H~IGHTS iCA ~SAC~MENTO ~03 ~. 11682 12705423 ~77~ SUNRISE BLVD ~ClTRUS HEIGHTS !CA ~SAC~MENTO ~04 U 1168' ,270~31 ,830 E ST ,MARYSVlLLE ,CA ~YU,A ,03 U , ~16 98161 Page 2 ol 3 FACILITY NAME,_ 4 i ('C__..~ ~_.. . CITY OF BAKERSFIELi) FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CitECKLIST 1715 Chester Ave., 3''a Floor, Bakersfield, CA 93301 Section 2: Underground Storage Tanks Program Routine ~'Combined l~] Joint Agency Type of Tank ]'2PO I~' Type of Monitoring Q_L_.WX [] Multi-Agency Number of Tanks Type of Piping [] .~mplaint Re-inspection OPERATION C V COMMENTS Proper tank data ou file X Proper owner/operator data on file ~, Permit fees current X Certification of Financial Responsibility ~ Monitoring record adequate and current 9~ Maintenance records adequate and current 5~, 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&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: %/~/~.ff/'~ ~ ~ White - Env. Svcs. Pink - Business Copy -4~'(.i,.ess"Site Rc~pofisible Party CfRCI..E }::[ :~:605 BAI:[ERF_;F 1EI_.D i?a. 9;]:306 6g 1 -8'71 -'/9?9 I'-IP, F:5 , 2004 9: i 6 ~M %., 'FJ"/STEM ST~'I'US ~4I.,L FLINCTI,:)NS r',J©RPiAL REPORT T 1 :l.jf'.i]. E~DED 'v'C'LI. IME = :3I~:3 (' 'S 9C1'.~':!: IJLL~GE= 5671 ')~Lh; TC VQLUME = ;3143 GALS HEIGHT = 32.9~, ]I'4CFIEG L,,.!aTEF: - -~ ' O~ 0'0'- INCttES 'FEI"I[:' = ~,:2:.~, DE~S F T 2 :PLUS W,;3, LIJM£ = :3,:149" LLLAQE = 6:1;69 ,.?e,-~ 90% LiLL/4GE= 5387 ,]~I,F_; TC VOLUME = 3443 HEIGHT = 35.05 INCHES [,,.laTER VOL ; 0 L,iaTER = O.L-IO IaCHES TEIflt:' = 7,3.8 DEC F T 3:PREMIUM ',,/©LUME = 3~ 47 G&LS ULLAGE = 6,669 G~LS 90% ULLAGE= 56:_--:17 Qt4LS TO VOLLIME = :3121 Q~LS HEIQHT = 32,84 IN,:?HES LdA"FER ',,/OL = 0 ,gaLS [.daTER = O. OO INCHES TEIflP = 71.8 DEG F SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 ADDRESS PHONE No. No. of Employees '~ c, O 0 zS ~ ~ ~ r,,~ ,~-t- oo.r t _ 7~ T rI ol ............. FACILITYCONTACT Business ID Number 15-021- ? .",'. ·/:: !:ii~ :',:.' SeCtion.. ~1' Business Plan,and I'nVentory program, Routine J~Combined I~ Joint Agency I~ Multi-Agency I~ Complaint I=1 Re-inspection ~r C=C°mpliance ~ OPERATION ~. V=Violation APPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITYE VERIFICATION OF HAT MAT TRAINING VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY LABELED HOUSEKEEPING FIRE PROTECTION I'1 SITE DIAGRAM ADEQUATE & ON HAND COMMENTS ANY HAZARDOUS WASTE ON SITE?: i"'! YES ,,l~No EXPLAIN'. e - Environ ceE Yellow - Slation Copy Pink - Business Copy 82/89/2884 15:38 81884 TRIANGLE PAGE CITY OF BAKEP. J;FIELD ,~,~a- Ave. ,~a~rerst/eM,, CA (661) 326-3979 01 APPLICATION TO PEI:~"OI~[ FUEL MONITORING CERTIFICATION OWNHR~ N .... · -- Fi-cO '- DATE " SIONA%'UR E OF APPLICANT CITY OF BAKI~FIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE Adare~s ~a~ ~ o~u td City, Zip ~ ~. q 3,,~0~ Phone No. INSTRUCTIONS: Please call tbr an inspector only when each group of inspections with the same number are ready. They will mn in consecutive order beginning with number I. DO NOT cover work for any numbered group until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce the number of required inspection visits and theretbre prevent assessment of additional fees. TANKS AND BACKFILL INSPECTION I DATE I INSPECTOR Backfill of Tank(s) Spark Test Certification or Manufactures Method Cathodic Protection of Tank(s) PIPING SYSTEM Piping & Raceway w/Collection Sump Corrosion Protection of Piping, Joints, Fill Pipe Electrical/solation of Piping From Tank(s) Cathodic Protection System-Piping Dispenser Pan SECONDARY CONTAINMENT. OVERFILL PROTECTION, LEAK DE'I'ECTION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annual Space-D.W. Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwater Spill Prevention Boxes lk 0,,k, 3k--Ceo+ · FINAL Monitoring Wells, Caps & Locks Fill Box Lock Monitor/ng Requirements Type. Authorization tbr Fuel Drop CONTRACTOR ~/' i' N/ ~ ~ e~'PO e-"~ftO~At LICENSE# q~' I~ ~'~ _ CONTACT c,~05¢~.~ PHONE# ~_ 03' ~ - PER~IT APPLICATION ~l CONSTRUCT/MODIFY TYPE OF APPLICATION (CHECK) ~] NEW FACILITY D MODIFICATION OF FACILITY STARTtNG DA3E Bakersfield Fire Dept. Environmental Service 1715 Chester Ave Bakersfield, CA 93301 Tel: {661}326-3979 NEW TANK INSTALLATION AT EXISTING FACILITY PROPOSED COMPLETtON DATE / / FACILITY NAME FACILITY ADDRESS TYPE OF BUSINESS ADDRESS -- ' CIYY I CONTRACTOR . · ,,~ CA L~N~ S ~ ~DRE~ .~ ~ ~ ~ . J CITY - ZIPCODE PHONE ~ ~ ~KERSFIELD GITY BUSINESS LICENSE NO.WORKMAN ~MP NO. INS~ER IPHONE NO ZiP CODE BRIEFLY DESCRIBE THE WORK TO BE DONE DEPTHTO . t. J SOIL TYPE EtA ;ECTED'AT sITE~''y ,/ GROUNDW^TER , 14 SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FiLE Cl YES D NO TI/IS :SECTION IS FOR/MOTOR FUEL TANK NO. VOLUME I i°l~ ~ /o/ooo ~ /o/0oo UNLEADED REGULAR PREMIUM DIESEL AVIATION THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO (iF KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFICIAL USE ONLY ~e ~plic~nt h~ receive~ underst~, and ~ill compl~ with the att~hed conditions of the pe~it ~ ~y o~ state, locM ~.fe~erM re~latio~. ~iv fo~ h~ been complete~ un~et penal¢ of perju~, ff~ to t~e~es~my ~owledge, i.~ ~e and correct. APPLIC~T N~E (PRINT) APPLIC~G~TURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED/ MAP# 1 CALIFORNIA ANNOTATED SITE MAP BUSINESS NAME CIRCLE K STORE #2708605 DATE.03/15/01 BUSINESS ADDRESS 5600 AUBURN STREET BAKERSFIELD ZIP CODE 93306 DRAWING SCALE ~< A _ B C D E F G H MAP SYMBOLS VACANT LOT ~ ELECTRONIC MONITORING POINTS QSHUT-oFFELECTRICAL PANEL ~L ~ ~ ~ ANNULAR SENSOR SHUT-OFF ~ / ~ ~ ~ AUTOMATIC TANK GAUGE ~SHUT-oFFEMERGENCY PUMP I _ ~ ~T~A ALARMTANK MONITORING ~ ~ TELEPHONE 2 ~ ~ F,RST A,D O~ ~ ~ ~ FIRE EXTINGUISHER j ~ ~ STORM BRAIN SANITARY SE~R ~ -- ~ STAGING AREA ~ I ~A' ~Jt2 X 5 GALLON EVACUATION/ ~ ~ CASHIER -JPROPANE J J ' ~ ~ M~BP HBBP, AND DSDS ~ / x x FENCE ~ ~ I ~ EQUIPMENT/ADSORBENTS z / O ~ ADD.GROUND 4 z i~- ~1 UNDERCROUND ~ ~ ~ ~--~ STORAGE TANK O J ~ GASOLINE (FLAMMABLE L1OUIDS) ~ I ~ DIESEL FUEL J ~ UOTOR OILS & LUBRICANT~ (COBBUSTIBLE UOUIDS) CARBON DIOXIDE (CO~PRESSED GAS) (FLAMMABLE LmOU)D) J ~ ANTIFREEZE/COOLANTS WASTE OIL (FLAMMABLE LIOUID) ~ ~ / ) ~ CAR WASH PRODUCTS ~ ~uc~n- (~u.) sp~ auc~-r (v~eo~) CONCRETE TANK SLAB SECTION TANK AT FILL SUMP SECTION i DROP TUBE DETAIL WV_STV_RN ,~TATE,._% [ PHASE I EVR UPGRADE - DIRECT BURY Executive Order VR-102-A Exhibit 1 Figure lA OPW Phase I Vapor Recovery System Equipment List 'i*':*'*':"i*'*"':''*:'"?:'*: i*' ":** :! "i'"':'i";*';':*~*i'*:':'*":**;:' .":"; ~'~" ~ · · ': Spill Containers and Figure 2E OPW/POMECO 1-2100 Series Covers ~ 1 C-2100 Series 1 SC-2100 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 61SA-Tool Dust Caps Figure 2K OPW 634TT-EVR (product) 1711T-EVR (vapor) Drop Tube Overfill Figure 2L OPW 61SO-EVR Series Prevention Device 2 Jack Screw Kit Figure 2M OPW 61JSK-4400-EVR Tank Bottom Figure 2N OPW 6111-1400 (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 SEINES DIRECT BURY SP!L.L .C0N. TAINME.N_T. FOR CARB/EVR The OF'W Thread-On 1-2100~EVR Series SPill ~tainers are cer[ified Tor'installmion on OFW~ Phase 1 EVE Systems, All Fill'Port ~piliC~in~ featu~e~..~=l~-~21~)~EYR vape~fight drain, vatve(DEVR M~dets). TheVaper mtum. Spill. Cer~t~iner (PEVR Models)feature a permanent plug in the drain pert as per ErR requirements. The 1-2100-EVE 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 flit pipe.below ~he .spill container to provide a..true .sealing surface for the drop tube flange on the 61SO-EVR overfill,prevention valve. The 61SO-EVR series valve is installed in the base of the OPW'EVE spilt container with the patent pending 61JSK Jack Screw device. This configuration allows liquid in the spill container to be drained directly into the drop tube thereby isolating the drain valve from the tank ullage, eliminating a notorious leak i~int· in:previous systems. EVR Multi-Pert Applicatieas ~-EYR Se, es M=,Po~ se~ p~es 2~ & 2Z OPM/~-2100-DEVR SEINES P~ODUCr R[~ 5P~ CONT~N~R OI~V 10K-2 IO0-EVR DRAIN VALVE DRAIN PLUG 61SO-400C-Lq/R SERIES OVERFILL PREVENTION VAWE 0PW Threaded Riser Adaptor IF_a?_ Seal Adap_toD ..... ' An OPW FSA~ Threaded Riser Face Seal AdaFtor is required to provide a flat, tree seating surface o~ threaded pipes where a gasket seal exisLs per EVE{ requirements, The FSA-400 is installed on the fill pipe riser below the spill container to provide m true se~llng sur~ce for the drop tube tl.~nge on the 8150-40~EVR overfill prevention wives. The F,~-400 is ~so required on tank g~ging risers and optional on vapor risers ~nd rotatable ~d~ptors. OPW FSA-400 OPW FSA-400 THREADED RISER ADAPTOR OPW 61JSK-4400-EVR JAcx SCREW (~ ~e~r~ Ordering Specifications Part No, Description List Price OPW FSA.400 4".Face. SeaI.Adapto~ ~,49.00 61JSK.4400.EVR (Jack Screw Device) Ordering Specifications p_art N,0 ..... OPW 61JSK-4400-WR OPW- .Oe~c__dpt~).~__. $39.95 1 Jack,.qcmw Assembty~ CARB 61SO Installation KIL Required on all 61SO. EVR Models North America Toll Free- TELEPHONE: (800) 422-2525 · Fmc (800) 42%3297 · Emalt: domesticsales~opw.fc..c~m International - TELEPHONE: (5t3) 870-33t5 or (5t3) 870-3251 · Fax: (513) 870-3157 · Emall: Intlsales@opw. fc.c~m www. opw-fc, com © Copyright 2003, OPW F~i~g Components .e P.O. Box 405003 ~, Cincinnati, OH 45240-5003 * Printed in USA · 3/03 OPW 1SC-2100-EVR SERIES SEALABLE COVER SPILL CONTAINERS OPW and Pomeco Spill Containment Manholes are designed to prevent spilled product from entedng the soil near the fill and vapor return riser connections on undef~mund storage tanks during normal tank filling operation, or in the event of tank overfill. The spill containers catch spillage to help prever~sofl contamination and groundwater pollution.The OPW 1SC-2100-EVR Series Sealable Cover Spill Conteiners are designed to eliminate the problems ess)dated with water entering grade level spill containers. The operation of the cover is similar to thet of a 'plumbers plug." When the lever is latched down, the plates are drawn together, expanding the seal against the machined mounting dng wall. The 1SC-2100-EVR spill containers am ideal for areas with a high water table, areas subject to tropical rain and standing water, and cold regions where melting snow and road salt can enter standard spifl contabers' 'Features: · Simple "Plumbers Plug' Operation - Seal is expanded against mounting ring waft. · Vertical Sealing Surface - Prevents gravel and debris from damaging or interfering with the seal. · Machined Sealing Surface - Ensures waterlJght seal. Teflon coated stainless steel. ,) Field Replaceable Seal - Designed for all-weather performance. · Black Anodized Aluminum Top Plate - to deter cover theft. 4. Potted Hinge Mechanism - to prevent ice and debris from Nndering lever operation. Product Identification Tags - Available for both the spill container cover and bucket to positively identify the Foduct contained in the UST with standaKJ APl symbols. (See product I.D. tag spedilcatk~ page for mom information) · Capacities. 5 and 15.gallon; spedal deep bucket 5-gallon thread-on r(x)del is available to provide additional deaf'anco for threaded-top 61TNG Over, ii Prevention Valve installations. · Fuel Compatibility- Designed to accommodate all fuels, including methanol, ethanol and MTBE. · Highway 20 Rated (H20) - AtI.OPW spill containers and manholes exceed the requirements of the Highway 20 rating. 1SC-TOOL Optiona! OpeflinO Tool Dimensions ¢ ? ........... ~...~' ~.-'~ A · ~'~:~',..'. ;. ~ ~.~ 5>. ', ..':~., B -. -v....~ tSC-2105 tSC-2155 In. cm. In. cm. ~6~- 'i!!~/;.~ ~6~ 1~,. ?!'~,3~!:':;-: ~- Tire,ad.On Mo~ls 1SC-2100 tSC-2100E' tSC-2tt$ In. cm. in. cm. in. cm. 'Subtract 2' kcm "0' dimalsk~ ~ Cut Irofl 6m ModetL "Deep Budmt Model. '0rdering' Specifications - OPW 1SC Sealable Cover EVR ~erins Thread-On Spill Containers DEVR Models - Fill Port with Drain Valve guratufl' II Base wll~ Drain Valve Models Modal GaL Liter Cow lbs. kg. Price PEVR Models - Vapor Port with Plug Duratufl' II Bas. with Plug Models 1SC-2115-P~ ~5 ~!:~ AI~n~ 47 U:::I S~45.00 I mt. dalt: Coven ~ aluminum C~ ~fi I~ ~1 Lw~ br~ Cast Iron Base with Drain Valve Models Modd tSC4115C, DEV~ GaL Uter Cover I~, kg. 1 Price J 7.5 ':/:~'i Cast Iron Base ~ Plug Models tSC-21t~ 15 ?~.~ ~m 47 ;:2~:~.~ ~a.~I Mou~ng.~g~ Td~fl pl~ma ~ ~ttmfl ~1~: high~ens~ ~lye~ytene C~m~ ~Jnl~ s~M S~ls: ~w s~ll n~le · /~ ! .':: :....'.' .oPW 15C-2100, 15-Gallon Thread-On ~ill Container Sealable Cover Operation Lid in Open Position Lid in Closed Pesitien Replacement Parts ."J_~4"_ .... ._c~_r~ ................ C04101B ~ Lwer Arm ~1874M Lower Plate C04141M Rd~erln~rt Ht2927M N~nt Hut OPW 1-2100-DEVR SERIES PRODUCT FILL SPILL CONTAINER (m. 14) OPW 1DK-2100-EVR DRAIN VALI~ (PG. 14) OVERFILL PROTECTION O OPW 61JSK-4400-EVR JACX SCREW (P~ ~encli~ (PG. 14) OPW FSA-400 THREADED RISER ADAPTOR (PG. 14) dO OPW 61S0-400C-EVR SER~F.S (~ -- SEALED PIVOT LOWER TUBE USA ~ No. 4,9~,320; 5,5~,4~; 5,174,345; 5,472,012; 5,850.~49 OPW 6111-1400 T~mc Botm~ PRO~OR (~ ~) North ~erlca Toll Free - TELEPHONE: {800) 422.252,f, · Fax: (800) 421-3297 · Email: domesticsales~opw-fc, corn Intematlona! - TELEPHONE: (513) 870-3315 or (5t3) 870-326t · Fax: (513) 870-3157 · Email: inflsales~oF~v-fc.com www. opw-fc, com © CoPYright 2003, OPW Furling Q~mlx~ents · P.O. Box 405003 · Cincinnati, OH 45240-5803 · Printed in USA · 3~3 Husky PV Vent Insta ainte~n~e Instructions Page I of 2 PRESSURENACUUM VENT MODEL 4620 AND 4885 INSTALLATION AND MAINTENANCE INSTRUCTIONS INSTALLATION The P/V Vent is designed to fit on top ora 2" vent pipe. Remove the PN Vent from the carton and visually inspect for any shipping damage. Model 4620 SHp On P/V Vent Place the PN Vent on top of ibc vent pipe and push or pull down on the PN Vent to slightly compress the seal. Tighten the 4 se~ screws £mnly. Periodic maintenance is recommended (see below). The Model 4620 can be installed on either a threaded or not threaded 2~ pipe. Hold the P/V Vent upside down and place the seal into the vent opening. Using aa Allen wrench, back the 4 set screws out so that the P/V Vent will slip over the vent pipe. Model 4885 Thread On P/V Vent Apply fuel resistant pipe sealant to the threads on the 2" vent stack. Screw thc P/V Vent onto the vent snack and tighten to a range of 20 to 50 fi-lbs with a suitable wrench. DO NOT OVER-TIGHTEN. Periodic maintenance is recommended (see below). MAINTENANCE Annually inspect the P/V Vent valve for foreign objects without removing thc P,'V Vent valve fi'om the vent I~ipe by using the followh~g l~rocedu~: 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 retaining screws. 6. Tighten the screws firmly. file:l/C:~My%20Documents~Projects~llB~Equipment%20Manual~usky%20PV%20Vent%:..i 4/25/2002 _/. ,,~/ 03/20/2003 10:20 8i88406929 TRIANGLE ' PAGE ".: ..' , MONITOI~ $¥~ CERTIHCATION 04 III ~lnkOv~fmlhi~.tl~nsof. LfAld: 3 h.:itm'ill..., ~? ,~1¢111 (.'~rlill¢.qlion 03/20/2003 i0:20 8i80406929 TRIANGLE PAGE 05 Pace2 ~f3 03/20/2003 10:20 8188406~29 F. In3Tauk Gaugi~gl SIR Equipmmt: . TRIANGLE PAGE 86 must be comp]~ ff ia-tm~ ?,;~hg equjpmcat ~s ma~d M pecR)m~ leak detec~oo mo~todl]g. ~ ~e~e.d~ were or ~H ~ correc~ H. Comments: Parc 3 0@/20/200@ 10:20 81884~ TRIANGLE PAGE O7 ................ ~.~:..¢~ ..... ~n~ . ; ' ; : : ' Z '. : Z : Z . Z : . ; ' ' :::::: :. :'::: .(?.~_.': .'%~!'f.:'t.¢.'~ i !:: i: :-: !: ::::: ::::: ! !i!. :!!!~~, ========================= :::: ::: ........... _~.~.. ............... :ZZ:ZZ:i::::: .... ii i !ii!! i i ~L~,~:::::: :2-:-:-: :-.'-:-.' :'.~:::: .:.~--,.~:: ........ 2,,~: :': Y ~."~q::: "D?.: ......................... .-.I ..... Z."'~. ' ' ' '~" .......... ~ ..... : ........... ~ ....... : r!i:::: :'".,~.- ! !.i i: ........ :..~ ....... ~ .. ..... ::::::::::::::::::::::: :,-~..:::::: :-~., :::::::::::::::::::::::::::::::::::: .... : :',',%~,e._' ' -.~ .................................... ::: :.. ::~:~ :: ::::::::::::::::::::::::::::::::::::::::::::::::::::::: :~ :::::::::::::::::::::::::::::::::::::::::::::::::: ........... ~Z::.j:: :_-::............................... ::::::::::::::::::::::::::::::::::::::::::::::::::::::. . . . . . · ==================================================== . . [nst~u~, ions ~onitodng System Certlficat~on. O~ yo~ site pl~n, Gow the general layout of tanks nnd piping. Clearly ~denti~/ Ioontic~s of ~e followin$ equipment, i~ ins~tlled: znoni~rin~ system control panels; serts~s monitortn~ tnnk nnnular Spaces, sumps, c[[~enser ?.n% spill..contn~ or other 8ccon~ contn~nment nreas~ mechanies! drCeleeOron[¢ lin~ lenk det~o~ ~nd in-tank tiqu~d level probe~ (if used t'or ]e~c ctel~-fion). In the space provided, note the date ~s SRo PI~ ~,as puaparcd. 03/20/2003 i0:20 8i88406929 ~Y~TE~ ~ETUP FEE 19. 200~ ?:~0 PM ~YBTEM UN ITB U,~. BV~TF..J,1 ENGL I ~H 9Y~M ~TI~ FOR~T MON DD CIRCL~ K 8~05 5600 ~UBU~N )A~RS~I~LD GG1 -~71 '~79 ~HIFT SH I PT T I ME 2 D t ~LED 8HIYT TI~ ~ DIALED ~HIFT TIME 4 DIALED T~NK PERIODIC D I T~ ANNU~ ~NI~S D I ~D D I LINE ~NN~L D I ~LED P~l~ TO TEHP COMpE~AT I ON V~LUE (D~ ~ ): 60.0 D l ~A PRECISION ~T DURATION D [ 8R~ED Bi~T~ BEC~ I TY CO~ : 000000 TRIANGLE COMMUNICATION~ SETUP I~ORT ~ETTINGS: NONE FOUND R$-2~ SECURITY COD~ : OODDOD R~-2~2 ~ND OF DISABLED PAGE 08 I N-TAN~ BETUP T 1: UNLEADED PRODUCT CODE · THE~L COEFF TANK D I ~/II/TER TAN~ PROF I LE FULL VOL 69.0 INCH VOL 46.0 INCH VOL 23.0 INCH VOL l 000"/00 92,00 4 PTB 9816 4992 FLOAT ~I2£: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH I~TER LIMIT: MR~ OR L~BEL UOL: OVERFILL LIMIT HIGH PRODUCT DELIV£RY LIMIT 9816 88a4 95~ 5~ 490 LOW PRODUCT ; 5DO LE~K ~I. AI~M LIMIT: 99 SUDDEN L(F~8 LIMIT; 50 TANK TILT ; 3.48 MRNI FOLDED TANKS T#: HONE LEAK MIN PERIODIC: 10% : 981 LF.~K MIN ANNUAL : 10,4 : 981 PER I OD I C TEST TYPE ~alOK ANNUAL TEST FAIL AI.~RM D 1 SABLES Pl/R 1 OD I C TE~ F~ I L ~RM D I ~B~D GROSS TEST F~I L ~RM D I ~NN T~T ~V~INO: OFF T~ TBT ~IPHON B~tOFF DEL I ~V D~Y : 2 83/28/2883 18:28 8188486929 TRIANGLE PAGE 89 T 2:PLUS PRODUCT CODE : 2 THERMAL OOEFF :.000070 TANg DIAM~TER : 92.00 TANK PROFILE ; 4 PTS FUI.~ VOL : 9$16 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 IN OH VOL : 1898 FLOAT BIZ£: 4,0 IN, 8496 k~%TER WARNING : 2,8 HIGH WATER LIMIT: MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90~ HIGH PRODUCT : DELIVERY LIMIT : : 490 LOW PRODUCT : 500 LEAK ALARM 51MIT: 99 SUDDEN LOin9 LIMIT: 50 TANK TiLT : 3.80 MANI~OLD£D TANK8 T#: NONE LE~K MIN PERIODIC; i0~ : 981 LEAK MIN ANNUAL : : 981 PERIODIC TE6'T TYPE QUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISSkgLED GROSS Tk-'qT FAIL ALARM DISABleD ANN TE~T AVER6g3ING: OFF PER TEST AVERAGING: OF} TANE TPmT NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY ; 2 HIN T 3:PREMIUM PRODUCT CODE THERMAL COEFF TANK DIAM,'fEW TANK PROFILE FULL VOL ~9.0 INCH VOL 46.0 INCH VOL 23.0 INCH VOL ,000700 92.00 4 PTS 9818 8058 4992 1898 FLOAT SIZE: 4,0 IN. 8496 WATER WARNING ; 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL %~L: 9816 OVERFILL LIMIT : 90~ : 88~4 HIGH PRODUCT : 95~ DELIVERY LIMIT : 5t4 ; 490 LOW ~RODUCT : 500 LEAK ALARUM LIMIT: 99 SUDDEN LOB8 ~IMIT: TANK TILT : ~.50 MANIFOLDED TAN{(B T#: IVON~ L~X MIN PERIODIC: 10~ : 901 LEAK MIN ANNIJ~L : I'0~ : 981 PERIODIC TEBT TYPE QUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED OR08~ TI~T FAIL ALA~ DISABLED ANN TEST ~VERAOI~: OFF TANK T~ NOTIFY: OFF T~ TST ~IP~N BRE~K:O~ D~IU~Y DELAY : 2 MIN LEAK TEST METHOD TEST ON DAT~ : ALL TANK JAN 1, 1996 START TIME : DISABLED TEST RAT]~ :0.20 OAL/HR DURATION : 2 HOURO LEAK TE~T REPORT FORMAT NORMAL WPLLD LINE L~K S~'rUP W I;UNLE~DED PIPE TYPE; FIBERGL{;~,S LINE LENOTH; 100 FEET 0.20 OPH TEST: ENABLED O,IO O{)H TEST; ENABLED ~HUTDOWN RATE: 9.0 GPH O.IO OPH TEST MM/DD DAT£ : 9'P9 0 TANK: W 2:PREMIUM PiPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 OPH TEST: ENABLED O,IO GPH TE~T: ENABLED SHUTDOWN RATE: 3.0 GPH 0,10 GPH T~BT MM/DB DATE : ?9? 0 0@/20/2003 10:20 8188486929 TRIAI'~LE PAGE 10 W ~:PLUB P I PE TYPE: F I BERGLAF~ LINE LENGTH; 100 FEET O. 20 OPH T~.BT: ENABLED O. 10 ~H TE~T: E~BL~D BHUTDOW~ R~TE: 3.00P~ O.lO ~H T~T MM/DD ~T~ : ~e 0 LINE LI~AX LOCKOUT SETUP LOCKOUT SCHEDULE I~ILY ~ART TIME: ~iSABLED STOP TIME : DISRBLED WPLLD LINE DIBBLE SETUP W t:UNLEADED LIQUID F~ENBOR ALMS L 1 :FUEL ALARM L 2 :FUEL ALP,~M L 1 :BEtISOR OUT ALARM L 2:BEN,OR OUT ALARM W 2:PREMIUM LIQUID 8RIGOR ALMS L ~:FIJ~L ALARM L $:FUEL ALARM L 5:SENSOR OUT ALARM L 6:SENSOR OUT ALARM W 8 :PLUS L I gU 1D BENMOR L 3;FUEL AL.qRM L 4:FUL~L ALARM L @:SENSOR OUT ALARM L 4 :~NBOR OUT ALARM CIRCLE K 8606 5600 AUBLI~N BAgERBFIELD CA.93306 661-871-7979 FEB 19. 2003 7:52 PM WPLLD LIN£ LEAK TEST HISTORY W 2 :PREM1UH LADT B.O GAL/HR PAi~: FEB 19, 2003 7:@4 ~ FIRST 0.20 ORL/HR PA~ EACH MONTH: FEB 19, 2003 6:27 PM FIRi~f 0.10 OAL/HR PPki~S EACH MONTH: LIQUID SENSOR SETUP L t:ANNULAR 8~ T~I-B'rATE (8INOLE FLO~T) GATEGOKS~ : RNNUt..RR SPRCE L 2:UNLEADED SUMP TRI-STATE (~INOLE FLO~T) CATEGORY : STP BUMP L 3:89 ANNULqR TRI-STATE <MINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4;89 ~TP ~UMP TRI-STATE (SINGLE FLOAT) CATEOORY; gTP BUI~ L B:Sl'ANNULAR TRI-STATE (BINOL~ FLOAT) CAT~,GOR¥ : ANNULAR SPACE CIRCLE K 8605 5600 AUBLIRN ~AKER,~FIELD CA,93306 66t-B?t-?979 FEB 19, 200g 7;52 PM WPLLD LINE LEAK T]gST HISTORY ~ i:UNL~%DED L~BT 3.0 G~L.-'HR FEB lg, 2003 7:42 PM FIREIT 0,20 OAL/HR PASS E.~CH MONTH: FEB 19, 2003 ?:B1 PM FIRST O.IO GAL/HR PRSS EAOH MONTH; CIRCLE K 8605 6600 AUBURN BAKERSFIELD CA.SB306 661-871-797~ FEB 19, 2003 7:52 ~ WPLLD LINE L£AK TEBT HIE{TORY W 3:PLUS LAST O.O GAL/HR PASS: FEB i9. 2003 ?:04 PM ~I~CH MONTH: ' FEB 19, 2003 7:15 PM FIRST 0.10 O~L/HR PA~B F.~NMONTH: L 6191 8T~ SUMP % 03/207280~ 18:28 TRIANGLE PAGE TANK LEAK TEST T I:UNLEADED LP~I' GRO~'8 TEST PR~;e, ED: NO TEST PASSF~ LAST ANNUAL T~ST NO T£BT PASSED ~L~T ANNUAL T~ NO T~T P~ED L~ P~IODIC T~T FULLEST PERIODIC TEST EACH MONTH: TANK LEAK TEST HISTORY T B:PRF~IUM LAST OROSS TEST NO TEST PASSED LAST ANNUAL TEST NO TEGT PASSED FULLEST ANNU~ T~ NO TEST P~BED L~T P~IOD[C T~T NO T~ P~S~D FULLE~ PERIODIC TEST PASSED EACH MONTH: NIBTORY R~3~ORT IN'TANK ALARM ..... 2;PLUB TANK LEAK TF..6~ HISTORY T 2:PLUS L~BT GRO~B TEST PASSED; NO TE~ PASSED LAST ANNUAL TEST PASSED; NO T~,~T PASSED FUrrieST ANNUAL TE~T PAS~ NO TE~T P~ED LAST PERIODIC TE~T PA~: ~ TEsT P~ED FULLEST PERIODIC TEST PA~D ~CH MONTH: ~LARM HI~TO~Y P~EPORT ..... SYST~ALRRM.- .... PAPER OUT FEM 19. 2003 7:50 PM PRINTE~ F~ I9, ~OD@ 7:50 PM BATT£~Y IS OFF JAN l, 1996 S:O0 AM ALA~1 HISTORY ~EPORT .... IN-TANK ALARM ..... T I;UNL£ADED OVERFILL AId~M JAN 8, 2008 2:44 AN INVALID FUEL LIBEL DEC ]g, 2002 ~:2V ~ N~%; ~ ~,,,~ , ~ ~., AI.~qRM HISTORY REPORT . .... IN-TANK At-.~6~M ..... T 3;PREMIUM 03/20/2003 18128 8~@8406929 TRIANGLE PAGE 12 ALaCtRl't HISTORY REPORT L I:ANNULRR 67 ANNULAR SPA¢£ 8£N,'~OR OUT ALRRM FEB 19, 2003 I:11 PM SETUP DaTR W~RNIN~ NOV 26, 2002 3:05 PM ..... $£N~0R ALARM ..... L 3:89 ANNUhqR ANNULR1~ SPAC£ SRN~;OR OUT ALARM FE2~ 19, 200~ 1111 PM FUI~LALRRM NOV 2&. 2002 2;0? PM ALARM HISTORY R1~PORT ..... SENSOR ALARM ..... L 5191ANNULR]~ ANNULAR SPACE g~NSO~ OUT ALARM FUEL RLAEI"{ FEB 19,'2003 12:47 PM SETUP DATA WARNING NOV 26, 2002 3:B~ PM ALRRM HISTORY REPORT ..... SEN~OR ALARM ..... L 2:UNLEADED SUMP STP SUMP SENSOR OUT ALARM FEB 19~ 2009 111[ PM FUEL ~LARM FEB 19, ~O0~ 12:~B ~ FU~L RI.RRM ~B 19, 200~ 12125 PM ALRRM HISTORY REPORT ..... ~EN~OR ALP~ ..... STP SUMP ~£NiBOR OUT ALARM FEB igo 200g 1:11 PM FEB 19, 2003 12:~ 1~ FU~L ~LaRM FEB 19, 2003 12:29 PM AI2%RM HISTORV REPORrr ..... SEN~OR ALARM ..... L ~,:91 BT~ ~1~ aTP BLIMP ~NBOR O~ ~B 19, 2003 I:11 PM FUEL aLaRM FEB 19. 2003 t2:36 PM SETUP DATA WARNING NOV 26. 2002 2:07 03/20/2083 ~8:20 8188406929 TRIANGLE PAGE 13 ALARM HISTORy REPORT OTHER 8£N~0~ ALAP, M HIE)TORY REPORT ..... 8EN[~OR ALARM ..... W I:UNLEADED WPLLD ~HUTDO~N ALM FE~ 19, 200~ ll:q7 AM ORO~,S LIN~ FAIL FEB 19~ ~00~ 1~:~ AM W~LLD 8~OWN ~M ~EO Ig, 2002 8:54 PM ALARM HI~TORY REPORT ..... 8EN~OR ALARH ..... W 9:PLU~ WPLLD BHUTDO~N ALM FEB 19, 2003 11:41 AM 0R088 LINE FAIL FEB 19. 2002 11:41 AM W~LLD 9HUTDOWN DEC 6, 2002 9:57 PM ALARM HI~TORY R. EPORT ..... 8EN~OR ALARM WPLLD ~HUTDOWN ALM FEB 19. 200~ 11:56 AM GROP~J LINE FAIL FEI~I 19, 2003 11:56 AM ~OFTWARE REVIaION LEVEL VERBION,16.D2 80FTW~:tRE# 346016-100-C CREATED - 9B.06.14.13.04 9-MODUl.~ 358160-D68-A BYBTEM F~TURE~: PERIODIC IN-TANg ANNU~ IN-TANK TE~TB ~LLD ~.[0 ~NURL~0.2O CO~ March 12, 2003 Teri Nicholgon Circle K Store 5600 Auburn//2 Bakersfield, CA 93306 CERTIFIED MAIL FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Streel Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES s~rY S~;MCES · u~aomm~r~. SERVtCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBUC EDUCATION 1715 Chester Avb. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 VIctor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Failure to Perform/Submit Annual Maintenance on Leak Detection at the Above Stated Address. Dear Business Owner: Our records indicate that your annual maintenance certification on your leak detection system was past due on March 4, 2003. You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, April 12, 2003 to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc 01/30/2003 11:56 8i8B40~S TI~IAN~L~ 2§Z5 W. BUEB.~NK gLVD., ENV'J:RON~i, ENTAL, i i iii ii TRIANGLE BUttBANK, CA 91505 PAGE 01 FAX II January 31, 2003 Number ofpag~ including cover ~e~t: 1 City of Bakersfield Fire Department To Compliance testing/inspections supervisor Steve Underwood Monitor ccrt/ficaQon Phone; ~ p~n~: 661 324 6557 CC: 661 326 0576 II I ih-om: Lorraine Soft{ Phone: 8 ! I1 840-7020 Fax phone: 818 840-6929 I II I REMARKS: [] Urseni [] Fog your review [] R~'ply ASAP [] Please corm~eat NOTI[FICATION. ! 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/are scheduled for annual Tank Monitor Certification on the following date(s); 1. Circle K 08605 5600 Auburn ST., Bakersfield. 93306 2/20/03 (~ 11:00 AM Annual Monitor Certification. (This station has three tanks 87, 89 & 91 with wireless product line leak detectors) Thank you, Lorraine Soft6 - ' II I II I II II I January 22, 2003 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 UH" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES F~RE SAFETY SERVtCE$, E~VIRONMEHTAL SERVtCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Av~. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Circle K 5600 Auburn Street Bakersfield CA 93306 RE: Upgrade Certificate & Fill Tags Dear Owner/Operator: Effective January 1, 2003 Assembly Bill 2481 went into effect. This Bill deletes the requirement for an upgrade certificate of compliance (the blue sticker in your window) and the blue fill tag on your fill. You may, if you wish, have them posted or remove them. Fuel vendors have been notified of this change and will not deny fuel delivery for missing tags or certificates. Should you have any questions, please feel free to call me at 661- 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc 01/2~/2003 1~:54 TRIANGLE PAGE Ell ENVIRONMENTAL, INC. Ill 2525 W. 8URB,~NK I:ILVD., III II I FAX JI Ill III II I I ill Date: January 21, 2003 Number of pages j~cJuding covcr shoot: 1 City of Bakersfield Fire Department III III Jill J II III I I II II To Compliance testing/inspections supervisor Steve Un4erwood Monitor certification Phone: raxpho~: 661 324 6557 CC: 661 326 0~76 ~rom: Lorraine Soft{ Fax phone: 818 840.7020 818 840-6929 I Il IIII I I II III REMARKS: [] Urgent [] For your review [] Reply ASAP [] Please commcnt NOTIFICATION! In accordance with Article 3, Section 2637 (b) ($) (48-hr notification), of California Code of Regulations Title 23, Division 3, Chapter ! 6, Underground Storage Tank 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 213103 1~ 11:00 AM Annual'Monitor "~-Certification. (This station has three tanks 87, 89 & 91. with wireless product line leak detectors) Thank you, Lorraine Soff~ .................. -~ -: - "~ ' I III I II I mill II II · I · I I CIRCLE I..{ 8605 5600 AUBUFtN BAXERSF1ELD CA. 9330F, 6~,1 -871 -7979 JaN 15. 2023 9:46 S'Y'STEI"I ',':~;'i'aT _IS ALI., FUNCT I (:,NS NF', ;' " I I'.I'v'ENTORY REP©RT -. _ T I: UI',ILEF~DED V(','L UI'.IE 5" = ._b~-I ,':~ALS LILLA~E = 4195 90:;'; ULLAGE= :321 TC VOLUPlE = 5576 GALS HEIGHT = 50.47 INCHES bJaTE~ V,:')L = 0 GaLS I.,,,I~TE~ = O. O0 I Ni?HES TEI"'lP = 71.2 E'~Ei2 F T 2 :PLIJS V©LLII"IE = 4512 GALS ULLAGE = 5'.3134 GALS 90~'; ULLAGE= 4322 ~];ALS TC V©LUI"IE = -1507 (;aLS HEIGHT = 42'. ~4 b,JRTER VOL = 0 ~. ,; baaTER = O. O0 TEI'tP = 7:3.5 bEG F T 3: PREPI I UP1 VOLUI'qE = 3139 GALS ULLAGE = 6677 GALS 90% ULLAGE= 5695 OALS Ti:; 'qOLUPtE = 2107 GALS HEIGHT = 32. ?9 1NCHES I.,J~TER VOL = 0 G~LS I,,IATER = O. 00 1NCHEi6; TEP1P = 74.3 DEG F FACILITY NAME ADDRESS ,~0© FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE ! '-'l ~-- PHONE NO. _~'~t ~ "~qT? BUSINESS IDNO. 15-210- NI3'MBER OF EMPLOYEES Section 1: Business Plan and Inventory Program Routine [~ Combined [~1 Joint Agency [~ Multi-Agency F-] 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 C Verification of Haz Mat training 'L., Verification of abatement supplies and procedures {., Emergency procedures adequate '-" " Containers properly labeled HouSekeeping o Fire Protection ,- Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~1 Yes [~ No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - S~ation Copy Pink - Business Copy Business Site,Respons~le Party Inspector: .)~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE Section 2: Underground Storage Tanks Program [] Routine [~ Combined [] Joint Agency Type of Tank .~tr~ ~- Type of Monitoring ta t. ~ [] Multi-Agency,.9 [] Complaint Number of Tanks .D Type of Piping .//'JtO I--'- [] Re-inspection 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 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 fi/V=Violation Y=Yes N=NO Inspector: ,.,.~" _~ _//.~.~a/*~) Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Site Responsible Party ConocOPhillips 1380 Lead Hill Blvd., Suite 120 Roseville, CA 95661 phone 916.774.3000 fax 916.774.3004 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.c°m All correspondences and reports should be directed to the new address as of the effective date. Sincerely, Edward C. Ralston Site Manager Conoc ' hillips December 20, 2002 Re: Financial Responsibility- 40 CFR Part 280, Subpart H Revised for: Name Change to ConocoPhillips and Coverage Period P.O. Box 52085 Phoen~,Arizona 85072-2085 1500 NoRh Pdest Ddve Tempe, Arizona 85281 Kathy Strickland Environmental Compliance 602/728-418-7149 (direct line) 602/728- 5245 (facsimile) 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 q~.u. 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: ,~ - SeCtion 280.97 ' Insumhce~overage 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 April 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. Certificate Holder: Insured: Address of The Insured: Covered Locations: Policy Term: (1) Sooner Insurance Company CERTIFICATE OF INSURANCE Certificate No. 2003-16 Date: December 20, 2002 Policy No.: S-7501A-03/04 CA State Water Resources Control Board UST Program P. O. Box 944212 Saci'amento, CA 94244 ConocoPhillips Company and its subsidiaries including Circle K Stores Inc. 600 North Dairy Ashford - ML3136 Houston, TX 77079 Per the attached list December 1, 2002 -December 1, 2004 CERTIFICATION 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 fi.om 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 8-7501A-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 600 North Dairy Ashford - ML 3136 Houston, TX 77079 TEL: (281) 293-6680 FAX: (281) 293-2941 Administrative Offices 112 Lake Street Burlington, VT 05401 TEL: (802) 658-9466 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, 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 the instrument is identical to the wording in 40 CFR 280.97Co)(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 600 North Dairy Ashford - ML 3136 Houston, TX 77079 TEL: (281) 293-6680 FAX: (281) 293-2941 Administrative Offices 112 Lake Street Burlington, VT 05401 TEL: (802) 658-9466 FAX: (802) 658-5520 !2611158 129727 STOCKDALE HWY IBAKERSFIELD KERN 93312 Bakersfield Fire Department 2708606 i1030 OAK ST BAKERSFIELD KERN i2524 OSWELL ST BAKERSFIELD KERN ! 270'1~270'"'i ~634"STI N E RD BAKERSFIELD KERN i2708825 i2222 F ST BAKERSFIELD KERN !257393 L8200-A STOCKDALE HWY. BAKERSFIELD KERN 12.7 .-0-8_ ~O- 5 'ii [~ ~i~i~iiA.' U..'. ~iI~N.'"~-':i:_~i -~i-.~-_~i ........... tBAKERSFIELD KERN 93304 Bakersfield Fire Department 93306 Bakersfield Fire Department 93313 Bakersfield Fire Department 93301 Bakersfield Fire Department 93311 Bakersfield Fire Department 93306 Bakersfield Fire Department · COmplete items 1,2, and 3. Also complete item 4 if Restricted Delivery is desired. · Pdnt your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece~ or on the front if space permits. 1. Article Addressed to: KERN COUNTY WATER AGENCY P O BOX 58 BAKERSFIELD CA 93302 7002 0860 PS Form 3811, August 2001 r-,,,, A .~( [] Agent B ' Rr~iv.ed ~.,~Pi~n ~)Name~)~',~~_el, ivery D. Is delive~ add~ diffem~ f~l. O ~ If YES. enter delive~ ad~[be~w~ ~ ~J 3. Service Type [] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 0000 1914 8435 Domestic Return Receipt 102595-02-M-0835 UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid USPS Permit No. G-10 · Sender: Please print your name, address, and ZIP+4 in this box · BAKERSFIELD FiRE DEPARTMENT OFF~CE OF ENV!RO?~,~JENTAL SERVICES 1715 ~h~ster Av~u~, Sui~ 330 ~aksmfield, ~ ~01 ' 1=3 Postage $ ,r-1 ~ r-'l Certified Fee Postmafl~ ! r'"l Return Receipt Fee Hem ,, .n (Endorsement Required) , ~1~ Restrtcte~l Delivery Fee I I--t (Endorsement Required) i rm JSeni KE~N COUNTY WATER AGENCY .-r- ............. i December 1, 2002 FIRE CHIEF RON ,:RAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SER'VtCE$ * ENVIRONMENT,M. SER~lCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Avb. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Kern County Water Agency P O Box 58 Bakersfield CA 93302 CERTIFIED MAIL FINAL REMINDER NOTICE JANUARY 1, 2003 DEADLINE Dear Tank Owner/Operator: You will be receiving this letter on or about December 1, 2002. One month from today, January 1, 2003, your current underground storage tank(s) will become illegal to operate. Current law would require that your permit be revoked for failure to perform the necessary Secondary Containment testing. In reviewing your file, I see that you have received "Reminder Notices" since April of this year. This is your last chance to comply with code requirements for Secondary Containment testing prior to January 1, 2003. Should you have any questions, please feel free to contact me at 661- 326-3190. Sincerely, Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc i I ' ! I i I Bakersfield Fire iCA 1256089 2524 OSWELL ST BAKERSFIELD IKERN__,93306 !____3 Depart__.ment i 8200-A STOCKDALE i Bakersfield Fire ~CA !257393 ..HWY' BAKERSFIELD KERN 93311 _ 3 Depart__.mept iC 29727 STOCKDALE I Bakersfield Fire A. 2611..!5~ .... HWY BAKERSFIELD. iKERN . . 93312 .... 3 DePartment Bakersfield Fire !CA .{2701270 5634 STINK.RD ...... BAKERSFIELD KERN 93313 2 Department i t . Bakersfield Fire CA 2708605 5600 AUBURN ST IBAKERSFIELD ....... KERN 93306 3 Department ....... ! Bakersfield Fire CA 2708606 1030 OAK ST BAKERSFIELD KERN 93304 3 Department ~ I Bakersfield Fire icAt2708825 2222 F ST BAKERSFIELD KERN,, 93301 ................. 3 Department .... Conoco hillips P.O. Box 52085 Phoenix, Arizona 85072-2085 1500 North Priest Ddve Tempe, Arizona 85281 Kathy Strickland Environmental Compliance 602/728-4 f8-7149 (direct line) 602/728-5245 (facsimile) December 5, 2002 Re: Financial Responsibility- Corrected (Effective 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 Phillips 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 diserepaniees between this list and your records. Please forward this information to Ye appropriate person in your agency. You may direct any questions to me at (602) 728-7149. Very truly yours, Kathy Strickland Environmental Compliance Enclosures Sooner Insurance Company 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 The Insured: 600 North Dairy Ashford - ML3136 Houston, TX 77079 Covered Locations: Per the attached list 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-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) under the policy to which this certificate applies Management Offices 600 North Dairy Ashford - ML 3136 HoustOn, TX 77079 TEL: (281) 293-6680 FAX: (281) 293-2941 Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations Administrative Offices 112 Lake Street Burlington, VT 0~01 TEL: (802) 658-9466 FAX: (802) 658-5520 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. 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 andonly 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 retroaedve 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 the instrument is identical to the wording in 40 CFR 280.97(bX2) 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 600 North Dairy Ashford - ML 3136 Houston, TX 77079 TEL: (281) 293-6680 FAX: (281) 293-2941 Administrative Offices 112 Lake Street Burlington, VT 05401 TEL: (802) 658-9466 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 financial responsibility under Subpart H of 40 CFR Part 280 is as follows: Mechanism... Issuer: Section 280.97 - Insurance Coverage 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: 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. Taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases. ~s~P~C~ January, 2002 %', ~ Page __ of __ Secondary Containment Testing Repo orm 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 test} (if applicable), should 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: 9/2712002 Facility Address: 5600 Auburn St. Bakersfield CA 93306 Facility Contact: [ 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 Vargas 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 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 knowledge, thefa, cts stated in this docu~,ment are accurate and in full compliance with legal requirements · · , · / '-~--~ 9~27~2002 Technician s Signature: / Date: ~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: I 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: 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-Ri): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Yes []NO []l~ []Yes []No []~ -lYes []No []1~ []Yes []No []l~ Was sensor properly replaced and verified functional aRer testing? [] Yes [] No [] ~ [] Yes [] No [] I~ -I Yes [] No [] ~ [] yes [] NO [] Ra, 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 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~II~ 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 Material: Piping M~ufacturer: Piping Di~eter: Len~h of Piping R~: Product Stored: Method ~d location of piping-~ isolation: Wait time between applying pressure/~cuu~water ~d st~ing test: Test St~ Time: ~itial Reading Test End Time: Final Reading (R~): Test Duration: Ch~ge in Reading (Rv-Ri): P~s/Fail ~eshold or Criteria: Test Result: ?~ ~.~ass~:~ ~ass~, ~1 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: · · ~ ~!~ · ~'~ 'Sump # 87~' ~,~v~i~,~Sump # ~'89 ®'~ ~e~~~Sump # 91 ®~~v~,~ Sump # S~p Diameter: Sump Depth: S~p Material: HeiSt from T~ Top to Top of ~est Piping Penetration: HeiSt 5om T~ Top to ~west Electrical Penetration: Condition of sump prior to testing: Potion of Sump Tested~ Does turbine shut do~ when s~p sensor detects liquid (bo~ product ~d water)?* Turbine shutdom response time Is system prowa~ed for fail-safe shutdom?* Was fail-safe verified to be . operational. Wait time between applying pressure/~cuu~water ~d st~ing 5 Mln 5 Min 5 Min test: Test St~ Time: 9:20 9:20 9:20 hitial Reading (R0: 2.5245 3.46~ 8 4.~ 892 Test End Time: 9:35 9:35 9:35 Final Reading (Rv): 2.5232 3.4509 4.~ 881 Test D~ation: Ch~ge in Reading (R~-R~): .00~ 3 .0009 .0005 Pass, ail ~eshold or Criteria: PASSED FAILED PASSED Was sensor removed for testing? Was sensor properly replaced verified ~nctional a~r testing? Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Test 2 for STP 87 oassed. Change in reading .0000 Test 2 for STP 89 failed. Change in reading .0142 Test ~ for STP 9~ f_a_i!~d- Chan~e i_n_ readin~ -0043 Tesf_ 3 for STP 89 f~_i!ed. Che.n.~e in re~_dinn~ .0006 Test 3 for STP 9~ oassed. Chan~e in readin~ .0013 t If the entire depth of the sump is not tested, specify how much was tested. If the answer to an_By of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) flWRCB:~January, 2002 Page .__ of__ 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer ' [] I~dustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: UDC Manufacturer: Bravo UDC Material: Steel printed UDC Depth: 'ir" Height from UDC Bottom to Top piping comes in of Highest Piping Penetration: thru the bottom Height from UDC Bottom to conduit from Lowest Electrical Penetration: bottom Condition of UDC prior to clean testing: Portion of UDC Tested~ I~IIA Does turbine shut down when UDC sensor detects liquid (both [] Yes [] I~o [] product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* []Yes []No []NA i-lYes []No I-INA I-lYes []No []NA []Yes []No []NA Was fail-safe verified to be [] Yes [] I~o [] operational?* Wait time between applying pressure/vacuum/water and 2 starting test Test Start Time: 11:54 Initial Reading (R~): 1.4832 Test End Time: 12:1 Final Reading (Rv): 1.4843 Test Duration: 30 Min Change in Reading (Rv-Rt): ,001 Pass/Fail Threshold or Criteria: PASSED Test Result: Was sensor removed for testing? [] Was sensor properly replaced and verified functional after testing? [] Yes [] Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the U-DC is not tested, specify how much was tested. If the answer to an'/of the questions indicated with an asterisk (*) is "NO" or "NA", the entire UDC must be tested. (See SWRCB LG-160) ~WRCB~January' 2002 R,$RI q~G Page__ of__ 8. F SER CONTAINMENT SUMP TES 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 (Rr): Test Duration: Change in Reading (RF-R0: Pass/Fail Threshold or Criteria: 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 []Yin []No []Ra, []Yas []~ []l~ []Yas []lqo I-II~ []Yas []No []l~ detected? Was sensor removed for testing? []Yin []~ []l~ []Yin []No []l~, []Y~ []No []N~ []Yas []No []l~, Was sensor properly replaced and verified functional after testing? [] Ym [] No [] I~ [] Ym [] No [] I~ [] Y~ [] No [] I~ [] Yos [] No [] I~, Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) gWRCB;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 [--IProfessional 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 Test End Time: Final Reading (R~): Test Duration: Change in Reading (Rv-R~): Pass/Fail Threshold or Criteria: Test Result: Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) t~WRa CBiJanuary, 2002 Page __ of · · Secondary Containment Testing Re rrm 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: 8/6/2002 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 Manufacturer Training Manufacturer 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 Disp 3-4 x If hydrostatic testing was performed, describe what was done with the water after completion of tests: To the b e~ of my C~nEo wSTe~dgleC,~ TedEiCn Hth~is 2culANmenR~t SarPeOacNcSurIBat55FnOd iRn ~uOllNcoDUmpCliTanINceGw~tHh IISegTaE! rSeTqu iINreLents Tec~iciansSi~a~re: '/~--~/~ Date: 81612002 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: I Equipment Resolution: Tank # Tank # Tank # Tank # Is Tank Exempt From Testing?l [] Yes [] No [] Yes [] No [] Yes [] No [] Yes [] No Tank Capacity: Unleaded Unleaded Plus Premium Tank Material: Tank Manufacturer: DW Steel DW Steel DW Steel Product Stored: Unleaded Unleaded Plus Premium 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-Ri): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Y~ []~ []1~, []Y~ []No []1~, -IY~ []No []l~, []Yea []No []Ra, Was sensor properly replaced and verified functional after testing? []Y~ []N° []l~ []Y~ []No []1~ -IY~ []No []1~ []Y~ []No []l~ Comments - (include informaa'on on repairs made 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 from periodic containment testing. {Califomia Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB~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: ~l mg Run # 91 Piping Run # 89 Piping Run # 87 Piping Run # Piping Material: Environ Environ Environ Piping Manufacturer: DW FRP DW FRP DW FRP Piping Diameter: Length of Piping Run: Product Stored: Unleaded Unleaded Plus Premium Method and location of DWIST 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 (R0: 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-R~): -.0007 -.0001 -.0055 Pass/Fail Threshold or PASSED PASSED PASSED Criteria: Test Result: ?'ii~ 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: mp # 89 Sump # Sump # Sump # Sump Diameter: Sump Depth: Sump Material: Height fxom Tank Top to Top of Highest Piping Penetration: Height f~om 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 [] product and water)?* Turbine shutdown response time Is system programmed for faiFsafe [] Y~ [] No [] shutdown?* Was fail-safe verified to be operational. Wait time between applying pressure/vacuum/water and starting 10 Min test: Test Start Time: 10:48 - 11:43 Initial Reading (R0: 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-R0: .0009 - .0004 Pass/Fail Threshold or Criteria: PASSED Test Result: Was sensor removed for testing? [] Y~ [] Was sensor properly replaced and verified functional after testing? [] Y~ [] No [] Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) Secondary. testboots had to have ULC-2000B applied to secondary, testboots. We need to return to re-te.qt Retested !!/1/_200_2- 89 pa~$ed hydrostatic_-test- ~ If the entire depth of the sump is not tested, specify how much was tested. If the answer to an_g.y of the questions indicated with an asterisk (*) is "NO" or "NA", the entire sump must be tested. (See SWRCB LG-160) SWRCBiJanuary, 2002 ill Page __ of__ 7. UNDER-DISPENSER~'ONTAINMENT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer '['~] I~dustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: /~ .... '~ UDC # '1-2 UDC # 3-4 UDC # UDC # UDC Manufacturer: UDC Material: UDC Depth: Height fiom UDC Bottom to Top of Highest Piping Penetration: Height fi'om UDC Bottom to Lowest Electrical Penetration: Condition of UDC prior to testing: Portion of UDC Tested~ Does turbine shut down when UDC sensor detects liquid (both [] TM [] No [] product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* []Yes []NO []hl~, FIYes []NO []1~ FlYes []NO []1~ []Yes []bio []1~ Was fail-safe verified to be [] Yes [] NO [] operational?* Wait time between applying pressure/vacuum/water and 5 starting test Test Start Time: '16:31 16:$~ Initial Reading (R0: ~ .20~ 4 ~ .'1464 Test End Time: ~6:46 16:46 Final Reading (RF): '1.2032 '[ .'1462 Test Duration: Change in Reading (RF-Ri): -.00'18 ,0002 Pass/Fail Threshold or Criteria: I Was sensor removed for testing? [] Yes [] No [] 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) ~ If the entire depth of the UDC 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 UDC must be tested. (See SWRCB LG-160) SWRC~,January, 2002 ~ S~ Page__ of__ 8. F 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 fi.om 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 (RF): Test Duration: Change in Reading (RF-Ri): 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~ []No []l~ []Y~ []No []l~ []Y~s []No []l~ []Y~s []No []l~ detected? Was sensor removed for testing? []Y~ []No []l~, []Y~s []No []~ []Y~ []No []hl~ []Y~ []~ []l~, Was sensor properly replaced and verified functional after testing? [] Y~s [] No [] I~ [] Y~s [] No [] I~ [] Y~s [] ~ [] I~ [] Y~s [] No [] ~ 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: ~I~ ill 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 (RE): Test Duration: Change in Reading (RE-R0: Pass/Fail Threshold or Criteria: ..... s~:~': ~Ea~t Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) SWRCB January, 2002 Page of__ ~o/ Secondary~Containment Testing Repor~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: 912712002 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 Vargas/Brett Mitchelson 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 Tested Not Repairs Made Component Pass Fail Tested 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 I 1/'15/2002 CERT~F TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING T~thebest~fmykn~w~dge~~a~edinthisd~cu~accurateandinfu~c~mp~iancewithlega~requirements(~ Technician's Signature: xN..__~ J ' o--Z.,.2t__yr ff,.J ~~/? Date: 9~27~2002 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: I 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: DW Steel DW Steel DW Steel Product Stored: Unleaded Unleaded Plus Premium 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-Ri): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []Yes []No []NA []Yes []No []NA Was sensor properly replaced and verified functional at~er 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) 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 fxom periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB January, 2002 Page __ of__ 5. SECONDARY PIPE TESTIi~ 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 OW 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 (R0: 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: '~ ,~,I( 3~ Sump It 87 Sump # 89 Sump It 91 Sump It 89 retest Sump Diameter: Sump Depth: Sump Material: Height f~om Tank Top to Top of Highest Piping Penetration: Height ~om Tank Top to Lowest Electrical PenetratiOn: Condition of sump prior to testing: Portion of Sump TestedI Does turbine shut down when sump sensor detects liquid (both [] Yes [] No [] product and water)?* Turbine shutdown response time Is system programmed for fail-safe [] Yes [] shutdown?* Was fail-safe verified to be []Yes []No []l~, -lYes []No []N~ []Yes []No []~ []Yes []No []l~, operational?' Wait time between applying pressure/vacuum/water and starting 5 Min 5 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 2.5014 Test Duration: 15 Min t5 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: 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 nassed. Change in reading .0000 Te_qt 2 for RTP 89 failed. Change in reading .0142 Test :2 for R_Tp 9~_ foiled, Change in reading ,0043 Test 3 for STP 89 .fa_i!ed. Cha__n. noe i.n. rea_di.n.no .0006 Test 3 for STP 91 nassed. Chant~e in readint~ .0013 ~ 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-DISPENSE~oNTAINMENT (UDC) 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 # ~-2 UDC # 3-4 UDC # UDC # UDC Manufacturer: Bravo Bravo UDC Material: Steel printed Steel printed UDC Depth: 7" 7" Height t~om UDC Bottom to Top piping comes in piping comes in of Highest Piping Penetration: thru the bottom from the bottorrl 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' NIA 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?* DYes •No []NA DYes •No []NA DYes []No •'NA DYes I-INo DNA 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 5 Min starting test Test Start Time: t1:54 12:t3 - 12:30 Initial Reading (RI): 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 (RF-Ri): .001 None Pass/Fail Threshold or Criteria: PASSED PASSED Test Result: i,[i!~ i~i[] 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 []NA []Y~ []No []NA []Yas []No []NA []Yas []No []NA Comments - (include information 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. Il'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. F~L RISER CONTAINMENT SUMP TElliNG 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 fxom Tank Top to Top of Highest Piping Penetration: Height bom 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 (RE): Test Duration: Change in Reading (Rv-R~): Pass/Fail Threshold or Criteria: Test Result: ~hS~~ ~ D~'~ ~: ~:'' :: 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 []NA []Yes []NO []NA []Yes []NO []~ .[]Yes []NO []NA detected? Was sensor removed for testing? []yes []NO []~ []yes []NO []Ra, []Yes []No []~ []Yes []No []~ Was sensor properly replaced and verified functional after testing? [] Yes [] No [] I~ [] Yes [] No [] ~ [] 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 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 (RE): Test Duration: Change in Reading (RE-R~): Pass/Fail Threshold or Criteria: Test Result: ~ Comments - finclude information 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 BAKERSFIELD, CA 93386 PRODUCT VOLUME %FULL WETTED (GAL) PORTION Precision Underground Storage Tank System Leak Test TES~ RESULTS ~. ..... Test Date:08-26-2002 '~ o BILLING:KERN CONSTRUCTION / SITE:CIRCLE K u605 P.O. BOX 6096 / 5600 AUBURN ST k BAKERS FI ELF'~2~ NON-WET%ED PRODUCT LE~ PORTION~ LINE DETECTOR WATER IN TANK UNL-87 9816 74% -.016-PASS PASS ~N/A 0" UNL-89 9816 71% +.022-PASS PASS -.000-PASS N/A 0" PREM-91 9816 74% +.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 factor 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 locanion 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 0 75 12KHz AMPLITUDE RATIO 15 CIRCLE K 8605 5600 AUBURN ST. BAKERSFIELD, CA 93306 98&6 GALLON UNL-87 TANK 750+ 0.75 25KHZ AMPLITUDE RATIO ~5 750+ M I N U T E S 3 5 12KHZ DETECTION RATIO = .998 M I N U T E 3 S 5 TEST RESULT = PASS 25KHZ DETECTION RATIO = .999 DATE AND TIME OF TEST: BEGINNING BOTTLE PRESSURE = 3200 BEGINNING TANK PRESSURE = 1.5 PSZG 8/;:)6/02 2' 39PM ENDING BOTTLE PRESSURE = 2700 ENOING TANK PRESSURE = ~.5 PSIS ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA 0.75 ~2KHz AMPLITUDE RATIO S5 CIRCLE K 8605 5600 AUBURN ST. BAKERSFIELD, CA 93306 98~6 GALLON UNL-89 TANK 750+ 0 75 25KHZ AMPLITUDE RATIO ~5 750+ M T N U T E S 5 M I N U T E S 3 12KHZ DETECTION RATIO = &.O0 25KHz DETECTION RATIO = ~.00 TEST RESULT = PASS DATE AND TIME OF TEST: 8/26/02 3: 1,4PM BEGINNING BOTTLE PRESSURE = 3200 BEGINNING TANK PRESSURE = &.5 PSIG ENDING BOTTLE PRESSURE = 1BO0 ENDING TANK PRESSURE = ~.5 PSIG ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA 0 75 ~2KHZ A~PLITUOE RATIO ~5 CIRCL~ K 8805 5800 AUBURN ST. 8AKEBSFIELO, CA 93308 98~6 GALLON PREM-9~ TANK 750+ 0 75 25KHz AMPLITUDE RATIO ~5 750+ ivi t N U T E S 3 5 I N U T E S 3 5 ~2KHz DETECTION RATIO = .997 TEST RESULT = PASS DATE AND TIME OF TEST: 8/26/02 BEGINNING BOTTLE PRESSURE = 3200 BEGINNING TANK PRESSURE = 1.5 PSIG 25KHZ DETECTION RATIO = .997 2: 54PM ENDING BOTTLE PRESSURE = 2200 ENDING TANK PRESSURE = 1.5 PSIG RICH ENVIRONFIENTAL 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE (661) 392-8687 & FAX (661) 392-0621 ACUI~ITE TM PIPELINE TESTEI~ WORK SHEET w/0#: Facility Name: dI~CLF~ I<. ~ o ~ Facility Address: ~OC) ~o ~O~AJ ~/~~ ~Lg), ~/~ Product Line T~e (Pressure, Suction, Gravity): ~~~ p~p Manufacturer: ~ ~K[~ Isolation Mechanism: PRODUCT START TIME E~D Ti'ME 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 Ehe 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 aC 1 1/2 times working pressure or 50 psi which ever is greater. Tech: JAbiES J. RICH Signature: ~ ~,,/~~ State License:# MFG.CERTIFICATION:~ 99-1072 601.LT SWRCB January, 2002 Page __ of__ Secondary ontainment Testing Repo; Form Zis 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: 8~6~2002 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: ~ I License Number: 798892 Manufacturer Training Manufacturer 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 Disp 3-4 x If hydrostatic testing was performed, describe what was done with the water after completion of tests: Technicians Signature'' '~,,-~--~-,_. V/ ~///~., //~._~ Date' 81612002 ~ 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 it Tank it Tank # Tank It Is Tank Exempt From Testing?l [] Yes [] bio [] Yes [] bio [] Yes [] bio [] Yes [] bio 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 (RF): Test Duration: Change in Reading (RF-Ri): Pass/Fail Threshold or Criteria: Was sensor removed for testing? []Yes []No []NA []Yes []No []NA []yes []NO []NA []Yes []No []N~ Was sensor properly replaced and verified functional af[er testing? [] Yes [] No [] I~ [] Yas [] NO [] NA [] Yas [] No [] I~, [] Y~s [] 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 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 TESTINI~ 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~;¥'~,~~~~' ~,~,, ~ ~ ....... ~,,~m,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 DW/ST 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 (Ri): 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: :::::::::::::::::::::::::::: ~" ': ~,~:~:~:I:~ ~ ~ .... I ~ ::::::: ::: 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: ~}i:'~ ~:~ Sump # Sump # Sump # Sump # Sump Diameter: Sump Depth: Sump Material: Height fi.om Tank Top to Top of Highest Piping Penetration: Height fi.om 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 [] ~ [] I~, [] Yes [] I~o [] I~ Fl Yes [] I~o [] hl~ [] Yes [] lqo [] I~, product and water)?* Turbine shutdown response time Is system programmed for fail-safe []Yes []~ []!~ []Yes []~ []1~ []Yes []bio []1~ []Yes []~ []1~ shutdown?* Was fail-safe verified to be · 9* []Yes I-I1~1o I-I1~ 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 (RF-Ri): Pass/Fail Threshold or Criteria: Test Result: Was sensor removed for testing? []Yes []l~o []1~ []Yes []l~o []~ []Yes []l~o []l~ []Yes []1~o []l~ Was sensor properly replaced and verified functional after testing? [] Yes [] I~o [] I~, [] Yes [] I~o [] hl~ [] Yes [] bio [] ~ [] Yes [] lqo [] ~ Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) 1 If the entire depth of the sump is not tested, specify how much was tested. If the answer to an_gy 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~ONTAINMENT (UDC) TESTING Test Method Developed By: [] UDC Manufacturer ' [] I~dustry Standard [] Professional Engineer [] Other (Specify) Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: UDC it 1-2 UDC it 3-4 UDC it UDC it 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 Testedj Does turbine shut down when UDC sensor detects liquid (both [] Yes []N° []1~ []Yes []NO []1~, []Yes []No []1~, []yes [] product and water)?* Turbine shutdown response time Is system programmed for fail- safe shutdown?* []Yes •No []NA DYes •NO []NA []Yes []NO []NA I-lYes []NO []NA Was fail-safe verified to be []Yes []NO []l~. []Yes []NO []~ []Yes []NO []1~. []Yes []No []l~, operational?* Wait time between applying pressure/vacuum/water and 5 Min 5 starting test Test Start Time: 16:3'1 '16:3~ Initial Reading (R0: ~1.20'14 '1.1464 Test End Time: '16:45 16:46 Final Reading (RF): 1.2032 1 Test Duration: 15 Min 15 Min Change in Reading (RF-Ri): -.00'18 .0002 Pass/Fail Threshold or Criteria: Test Result: ~O}~:i!~ :,::, :ii:i}l ~F~ was sensor removed for testing? []Yes []NO []NA []Yes []NO []NA []Yes []NO []NA []Yes []NO []NA Was sensor properly replaced and verified tunctional after testing? []Yes []NO []NA []Yes []NO []NA []Yes []NO []NA []Yes []NO []NA Comments - finclude information on re_pairs 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) · SWRCB January, 2002 Page of __ 8. RISER CONTAINMENT SUMP TE~IqG 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: ~33~,~,,~~!~':~'~?,~1~1 ,~" ~ "il~,,, ,~t~ 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 (RE): Test Duration: Change in Reading (RE-RO: Pass/Fail Threshold or Criteria: Test Result: i~ ~ F1 ~::~g, ~ ~;i 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~ []No []1~ []Yos []No []1~ []Yos []No []1~ []Yos []No []1~ detected? Was sensor removed for testing? []Y~ []No []1~ []Y~ []~ []1~ []Yos []No []1~ []Y~ []No []1~ Was sensor properly replaced and verified functional after testing? []Y~s []~ []1~ []Yos []No []1~ []Yos []No []1~ []Y~ []~ []1~ 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 I-]Professional Engineer [] Other (Specify). Test Method Used: [] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Test Equipment Used: Equipment Resolution: ~i',~l~!~ii~il~t~ll~ 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 (Ri): Test End Time: Final Reading (Rv): Test Duration: Change in Reading (RF-Ri): Pass/Fail Threshold or Criteria: Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) L 2: UNLEADED-i~iLIHP :E;TP SUMP FUEL AI. JL] 2E,, '.:~C ]2 2: 26 .... = SEN~;OR ALAD.'I ...... L 4 :PLuS-E;UPI]:', EH't:, B UMF-' FUEl., ~i.,ARH AUG 2'*_',. 2002 2:28 PM .......... E;E r,,llsoR ~I.,ARI'-'I L 6 :I:'REPII UM-BUMP STP SUPIP FUEL F~LARIvl AijG 26., 2002 2:30 PPI C;ID:;;LE K 8E, 05 5E, O f.3 F~LIB LIRN ,~}'.ER,~F I ELD L';F~ '3:330E, 681 --EWI -7979 ALii] 2E,. 2[]CI2 2: 2q .Pl'i S',"STEI'.'I S]'AT!.IS PEF'Of.-Z.T ~ FUNCTIONS NORI"'IAL ! N',,,,'EI',iTC, R,~.' REPORT T 1 :UNLEADED VOLUHE = '74i] 1 GALE; ULLAOE -' 2415 "'A '3 CJ~;~ LILLAC;E ~ 14'3;3 TO VOLUP1E ~ ?253 HEIGHT = g3.65 INC:HES WATER VOL = 0 GALS (,d~TE~ :: o. O0 TEPlP = 88.5 DEU F IJLLAGE = 2875 GALE; 90>;:; ULLAC~E= 169:3 -..,., TC.: VOLLIME = 7126 *}ALS HF'-'HT = 61.62 INCHEE; I"~R = O. O0 I TEMP = 88.8 DEC; F T 3: I:'REM I UPI VOLUME = 7435 GaLS UL L~¥:_-;E = 2381 (]ALE; -'J-',, ULLAGE= 1:399 OALS TO VOLUME = 727'3 GALE; HE 1GHT = 6:2.91 l NCHE:-.'(; I/,!ATEF: = O. OCII NC;HE'3 TEPiP = 89.9 DEL:; F 87/24/2882 23:32 8185674273 ,. ... , P~mit [qo- CIT~ OF BAKERSFIELD PAGE 82/132 q~ooJ. OFFICE OF E~TRONMENTAL SERVICES 1715 Chester' Ave.;,Bakersfi~ld,.CA (661)' 326-3979';' TANK CITY OF BAK~SFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661)326-3979 I.NS PEC~'TION RE(~ORD POST CARD AT JOB SITE Facility Phone 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 I. DO NOT cover work for any numbered ~'oup until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. TANI~ AND BACKFILL I INSPECTION DATE [ INSPECTOR Backfill of Tank(s) Spark Test Certification or Manufactures Method Cathodic Protection of Tank(s) f~PIPING SYSTEM Corrosion Ptotoction of Piping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) Cathodic Protection System-Piping Dispenser Pan SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETE~ .'TION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compat~le Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak D~tector(s) Leak Detector(s) for Annual Space-D.W. Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwater Spill Prevention Boxes ,....-~'- -~'- -~'- -~ ~. ~ ~,, , Monitoring Wells, Caps & Locks k...._ ~ .... Fill Box Lock Authod~tion for Fuel Drop L p1010106.jpg (1280x960x24b jpeg) PaGE 82/82 07/24/200'223:32 81.85674273 I]PM PAGE 02/02 ~i,~.. 0F BAi~RS i~i~~i~;'-.' ~~~'' :' OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester' Av~,;Bakersfield,'CA (661) 326-3979';' PERMIT APPliCATION TO CONSI1~,UCl:'./MODIKY UN~ERGROUIt'D sTORAGE [ ]N'B'W FAC{MI'W {)~MO{i~FICATION OF FACILITY. [ ]iNTifW TANK, INSTALLAT!ON AT ~'XISTIN(i, FACII~ LLC Quality Project Management, L.L.C. 2109 Suite 101 85282 Phone: H75 Fax:(602)41 LETTER OF .L Attention: WE ARE SENDING YOU: ~fl Attached [] [] Bid Documents [] Contracts [] Field Report [] Change Order the following items: [] [-] Photographs [] Plans [] Addendum [] Other Copies Date Description THESE ARE TRANSMITTED AS CHECKED BELOW: [] For approval ~For your use [] As requested [] For review and signature [--] FOR BIDS DUE [] Approved as submitted [] Approved as noted [] Return for revisions [] Resubmit copies for approval [] Submit .copies for distribution [] For review and comment [] Other Remarks: CC: Signed: u'//l~/oz 1U:14 8661 326 0576 BFb HAZ RAT DIV ~001 CITY OF BAIOtRSFIELD "~i. {~--~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFtr UNDERGROUND STORAGE TANK TY~ OF APPLICATION (CHECK) [ ]NEW FACILITY [~MODIFICATION OF FACILITY [ 1NEW TANK INSTALLATION AT EXISTING FACILITY STARTINO DATE '7~~" PROPOSED COMP LETION DATE ~ - ~ 1'--e~,.,~- FACILITY NAME ' IC4~ F.~dSTING FACILITY PERMIT NO.~ _ .. ~ACn.rr~AOO~----~:-_ _ _. TANK O~ ' ~" ~,..~ Pt~ONE NO,~ CONTRACTOR c~ T ' ~, CA L~CIiNSE NO._~ ADDRESS · 'crrY PRONE NO., wo~ COMP ~O. - -'~' n~'SURER , BIUEFLY DESCRIBE THE WORK TO BE DONE . ~ UA/ ~d~ ,. TANK. NO. VOLUME / SECTION FOR .MOTOR _FU .KL, DIF~EL AVIATION TANK, NO. VOLUME $~'nqN FOe NON l~ OTOR~ STOR~OZ TANKS CHEMICAL STORED CAS NO, CHEMICAL PREVIOUSLY STORED (NO mbU~ NAM~ (n: ~OWN) FOR OFFICIAL L~E ONLY !APPtiCAIIO~ D. ATE, FACILtT¥ NO. ": NO. OF TANKS .... .FI~ S_ I THE APPLICANT HAg RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE AT~ACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULAT IONS./ / THIS FORM HAS EIEEN COMP LETED UNDER. PENALT¥ OF PEIUURY, AND TO ~ BEST_~F. MY KNOWLEDGE. IS '" APPROVED BY: APPLICANT NAME (PRINT) ~_____..~P~CANT SIGNASFURE Ti~$ APPLICATION BECOMES A PERMIT ~ API~ROVED .~, ~87/09/2082 12:08 3188799994 PETCON TECH INC__ PAGE 02 PETCON TECHNOLOGIES INC, I4116 $, If~glewmd ^Ve~m Ha~wihome, ~ 6O25O T 310 679 999t July 9, 2002 To Whom It May Concert: i, Oytun Turumtay, Treasurer of Petcon Technologies Inc., give ;authorization to Mr. Anthony Elliott to obtain any permits, licenses or any other necessary documentation on our behalf for any Phillips Petroleum/rosco/Phillips 66 Company service station located in California. , CA Contractor License ~675998 A, C10, Haz · Workers Compensation Insurance policy #046-02, unit 0006359, expires 1103 , City of Bakersfield Business License #02-58725 (as of yet, have not received hard copy) If you have any questions or need any additional information, pl,aase do not hesitate to contact me at (310) 679-9991. Oytun Turumtay, Treasurer Petcon Technologies Inc. ~87/89/2082 12:88 3186799994 PETCON TECH INC STATE · P.O. B~X 807. SAN FRANCISCO.CA 8~;~101-.0807 COMla~NSATION ': .. CERTIFICATE OF WORKERS" .COMPENSATION .IN,,I~dJRANClE 155L~ DATE: 01-O1-02 POLICY NUMBER: 041t-02 CERTIFICATE EXPIRFr~: GONTRACToR~ STA~E LICENSE BOARD ATTN" NORKER$' CORPENSATION DEPARTHENT. .." ': P 0 B0X 26000 ' · SACRAMENTO CA, PAGE 83 [INIT UOB: L. ZC #6759.8 : :' O:O.:: SOUTH, :' .~ i:' This is tO ce~ify that we have issued a valid Worker~' Compensation insurance policy in a form appro,ed by the CaIWornla Insurance Commissioner to the employer named below for the policy period indicated, This policy ts nat subject to c~ancellatiOn by the Fund except upon 30days' advance written notloe to t~e employer, We will also give you, g~.db~* ~ence notice sh~ld ~is policy be c~celled prior t~ 'its, n0~l, &xpira6o~ ~h~s ~f~ate .~f fln~ur~ce ~s ~et ~n ~ns~a~e .pohcy ~ d~s ~t a~n~. ex~n~ or a~r ~e .coverture ~ff~ded polici~ des~ibed h~ein is subject to ~1t ~e ~s, e~El~ns and cond~ b~ ~f such ~licies. ' "'" ~ ¥..~ .:.:. .' ,.. ITl 07/17/2002 12:05 310B799994 PETOON TEOH INC PAGE 82 PROJECT SPECIFICS 'TOSCO SITE #2708605 5600 AUBURN ST. BAKERSFIELD, CA THIS PLAN ADDRESSES WORKER AND COMMUNITY HEALTH AND SAFETY CONCERNS AND ACTIVITIES ASSOCIATED WITH TH~ ARCO SERVICE STATION #2708605 AT 5600 AUBURN, BAKERSFIELD, CALIFORNIA. THE PLAN WILL BE IMPLEMENTED DURING ALL PHASES OF THE ON SITE WORK. ALL PETCON TECHNOLOGIES INC. PERSONNEL, SUB~CONTRACTOR AND/OR TH1RD PARTIES V~HICH MAY ENTER THE SITE ARE REQUIRED TO COMPLY WITH H.A.S.P. AT ALL TIMES. THE SITE MANAGER HAS OVER~ALL PROJECT RESPONSIBILITY FOR THE DEVELOPMENT, COORDINATION', AND IMPLE~ATION OF THE TOSCO SERVICE STATION #2708605 WORK PLAN IN A SAFE MANNER. THE SITE MANAGER IS ALSO RESPONSIBLE FOR THE IMPLEMENTING OF THE H.A,S.P. AS WELL AS SUPERVISING TIlE FIELD TEAM MEMBERS. THE SITE MANAGER FOR THIS SITE IS JESSIE ORNELAS OF PETCON TECHNOLOGIES iNC. 07/i7/2002 i2:05 3106799994 PETCON TECH INC PAGE 83 EMERGENCY ASSISTANCE INF, ORMA,, TION NEAREST FIRE DEPARTMENT AND PARAMEDIC LOCATION: FIRE STATION 22 I3 UNIVERSITY AVE. BAKERSFIELD, CA GEN. NON-EMERGENCY #: (661) 631-8421 911 NEAREST HOSPITAL WITH EMERGENCY ROOM: KERN MEDICAL CENTER 1830 FLOWER BAKERSFIELD, CA (661) 326-2000 SITE MANAGER: JESSIE ORNELAS OFFICE HOURS 7:00 AM TO 3:30 PM FIELD HOURS 7:00 AM TO 3:30 PM AFTER OFFICE HOURS (310) 679-9991 (213) 761-2091 (213) 761-2091 07/i7/2002 12:05 3106799994 MapQuest: Driving Directi~j: North America PETCOH TECH PAGE 04 Page 1 of 2 Home Iqetscape Presents driving directions · North America FROM: · Europe 6600 Auburn 8t · ~ R~u~ Babrsrmld, Total Dbtaflce: 3.00 What's Nesrt~ Seemh ~ miles fi3~ Yellow Pagee Search Bakersfield for. ]Auk) repair" 22t3 Unlvemity Ave Ba~amfleld, CA Total Ee'dmatetl Tlma: 5 mlnul~a by turning left. 2: Turn RIGHT onto FAIRFAX RD, 3: Take CA-178. 4: Take the MTVERNON AVENUE exit. 6.' Turn RIGHT onto MTVERNON AVE. 6: Turn LEFT onto UNIVERSITY AVE, Total Estimated Time: 6 rFlinutl~ DIRECTION8 DISTANCE I: Start out going East on AUBURN ST towards FAIRFAX RD 0.05 miles 0.09 miles 1.94 miles 0.1g mil'es 0.68 miles 0.06 miles Total Distanoe; 3.00 miles ROUTE OVERVIEW: Zoom In ~') Re-center http://www.mapquest.com/directions/main.adp?lg=cR9jOorrUaUAbShX02valA%25... 7/17/02 07/i7/2002 12:05 3106799994 , MapUuest: Driving Directi~li: North America PETCOH TECH IHC DF-~TINATION: 2213 Univer~lty AYe Bakemfleld, CA US C-~ TeattOn~y ~ T~lr~l~Y-TumMapawlthTe~ PAGE 05 Page 2 of 2 TIrade dimm are In~a',~3rnat only. No repmesnta~on ~ ml~e or warranty gm u M ~eir contatlt, mad ~xmditlone m ~ usal~lr~, or expedMousnaea, U~r aSsumes all ~k of uae, Mal~Quest end tls uul0P~ums essm no r~spoesf~J~ ~r any IM.~ at' 4~ muulling from auc~ use, ~ite Index I About M,,,O~_~ I pa~em I ~ I Help Center International VVe.~, Sites I Mobi~ Ma~Ou~ I Advel~ W~ffi us I R_~iO~L_~Luti_'_o_n_s Privacy Policy & Lei3al Notices 2002 MapQuest.com, Inc. All righte reaen~cl. http://www, mapquest.com/directions/main.ad p? lg=cR9JOorrUaUAbShX02valA%25... 7/17/02 07/17/2002 12:05 3106799994 :~ r~apL, iuest: Driving DirecfioQ~,' North America PETC~ TECH P~GE OG P~ge 1 of 2 Home I Help ~1~ Netscape Presents driving directions · Nort~ America · Europe · ~ved Routes What'o Nearby ~ miles for: Yellow Pege~ Semmh Bakersfield for: MOO Auburn St t830 Flewer St Bakefl~eld, CA h~eM, ~ ~ us To~I Diskfit: 3.51 mil~ To~! ~6~ Time: 6 mlnu~s , DIRECTION8 I: Start out 9ol¢~1 East on ^UBURN ST towards FAIRFAX RD by turning lefL 2: ?urn RIGHT Onto FAIRFAX RD, 3: Take CA-178. 4: Tske the MT VERNON AVENUE exit. 8: Stay straight to go onto HEIGHT ST, 8: Turn LEFT onto MT VERNON AVE, 7: Turn RIGHT onto FLOWER ST, Total Estimated Time: 6 minut~ DISTANGE miles 0.09 miles 1,94 miles 0.19 miles 0.01 miles 0.97 mila~ 0.26 miles Total DiStanco: ~.st mffea ROUTE OVERVP~N: ~ OM ~ WI[L~ ~ Zoom I~ ~ Re. center http://www, mapquest, oom/directions/main.adp?1g=cR9JOorrUaUAbShX02valA%25,,. 7/17/02 87/17/2082 12:05 3106799994 =,- ~ap~ues~: ur[wng Directio6 North America PETCOH TECH IHC P,~GE 87 Page 2 of 2 L!cense/Oo~ovrio ht DESTINATION: ~830 Flowor Bt Baker~old, GA ,'?~:: · , ""Gi',F ,~ " Ro-dleplay Dlreetlons wfth: ~ Ow~~uap~T~ O T~0~, 0 Tum-by-Tum Mapa ~ Text ~ dim~orlS am Inf'onr~tional only, NO mpmaell~tion ia made Or warranty given aa to ~eir content, road conmUorm or mute ~e~l~y ~ expm~ouane~. Ua,ar aasum~ alt ~lc c~ ~8~ UapOue~t end ~ aupp~_~ anume no maponalmlib, for any/e~ or de/ay ras~llJflg from SUCh uae. Site Incl~ I About MapQue~ I Partners I MaoStom J Help Cen~e_r ~ema"on~LWeb si~,~ I I~o~~t I bdwr~a With U='I au=~n~~s P~ P~ & ~al Nou~ O 2~2 ~~, Inc NI ~h~ ~, http:l/www.mapquest, com/directionslmain.adp?1g=oR9JOorrUaUAbShXO2valA%25 7/17/02 D May 29, 2002 Circle K 5600 Auburn Street Bakersfield, CA,93306 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661 ) 326-3941 FAX {661) 395-1349 SUPPRESSION SERVICES 2101 UH" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326o3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Necessary Secondary Containment Testing Requirement by December 3 I, 2002 of Underground Storage Tank located at 5600 Auburn Street REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002. section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components 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. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1,2001 shall be tested by January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office, and shall be 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, 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~Iff enclosures 05/01/2002 04/29/02 10:10 3106799994 PETCON TECH INC PAGE 03 15:15 ~66~t 0576 ~ ~Z ~T ~V ~005 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SER'~;q[CES 1715 C, e~~ter Ave.,. Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING PA~ ADDRESS PEtLM1T TO OPEl:LATE # OPERATORS NAME. O~S NAME ......... N'tJM~EROFTA..NWKSTOBETES'I'E~_.~. .I5PII:ql~GC~INGTOBETES'I'ED . T~ ~ VOL~ CO~TS ' N~ & ~O~u~ mn~ o~ CO.ACT P~sON_ NAME OF TESTER OR SPECIAL INSPECTOR ~,Kr~ICATION # APPROVED BY DATE SIGNATURE O1:; APP]:JCANT qo~ BAKERSFIELD FAX~Irransmittal COVER SHEET FIRE DEPARTMENT PREVENTION SERVICES 1715 Chester Avenue · Bakersfield, CA 93301 Business Phone (661) 326-3979 ® FAX (661) 326-0576 FAX NO.: II Il COMMENTS: 05/02/02 08:54 "~"66! 326 0576 BFD HAZ MAT DIV ~00! *************************** *** ACTIVITY REPORT *************************** TRANSMISSION OK TX/RX NO. CONNECTION TEL CONNECTION ID START TIME USAGE TIME PAGES RESULT 4O58 13106799994 05/02 08:51 02'46 3 OK D April 17, 2002 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ~H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave, Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Circle K 5600 Auburn Bakersfield CA 93306 RE: Necessary Secondary Containment Testing Required by December 31, 2002 REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components 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. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every 36 months thereafter. Secondary containment testing shall require a permit issued thru this office, and shall be 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, 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 Environmental, Inc. gle Date: 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 E'nvironmental, Inc. For Tosco Marketing Company Attachments cc: Tosco Dealer - 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 UST TESTING SYSTEMS SUMMARY SHEET Precision Underground Storage Tank System Leak Test Client: Phillips 66 Company 1500 North Priest Drive Tempe, AZ 85281 Kathy StrickLand (602) 728-7149 Facility: 2708605 Phillips Facility # 08605 5600 AUBURN ST BAKERSFIELD, CA 93306 Tank # Product Capacity Phillips Facility # 08605 Test Date: 3/'4/02 Work #: 302363 County: KERN Cross Street: FAIRFAX ROAD Test System Type Tank Rate/Results Ullage Result Line Rate/Result L/D Result Certified By: Comment~: Monitor certification Technician: Ed Justice Mfgr's #: TEI-046 State Lic. #s: CA-1624 AQMD 1430 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 Pla <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. UST MONITOR CERTIFICATION SUMMAR Y SHEET Client: Phillips 66 Company 1500 North Priest Drive Tempe, AZ 85281 Facility: Phillips Facility # 08605 5600 AUBURN ST BAKERSFIELD, CA 93306 Phillips Facility # 08605 Test Date: 3/4/02 Work #: 302363 County: KERN Cross Street: FAIRFAX ROAD 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 FACILITY INSPECTION/A UDIT SHEET Facility: Phillips Facility # 08605 5600 AUBURN ST BAKERSFIELD, CA 93306 County: KERN Cross Street: FAIRFAX ROAD Test Date: 3/4/02 Work #: 302363 ~ Status N= Not Present or Observcd S= Satisfactory U= Unsatisfactory Fill Cover: S Fill Cap: S Fill Cap Seal: S Drop Tube: S Strike Plate: G V/R Cover: S V/R Cap: S V/R Seal: S V/R Dry Break: S Sub Pump: S Sub Pump Cover: S Overfill: S Overfill Mfgr: OPW -- Type C= Coaxial P= Pressure D= Dual A= Angle Check N= No Stage I V= Vertical Ch~k F = Flex M= Metalic Fill Type: D Product Line Type: P Tank Swing Joint Type: F Dispenser Swing Joint Type: F Status N= Not Present S= Satisfactory U~ Unsatisfactory Impact Valve: S Vertical Check Valve: N Fill Spill Containment: S Fill Spill Mfgr: OPW Dispenser Containment: U Sub Pump Containment: S i Number of' Disp. Hoses Regular: 4 4 Plus: 4 4 Premium: 4 4 Diesel: Kerosene: Total # of Gas Nozzles: 4 --- Stage H I~ Balance A= Azlst System Type: A Assist Mfgr: GILBARCO Comments: Compliance Detail: (List items that need immediate attention.) COMMUNICATIONS SETUP SYSTEM SETUP: MAR 4, 2002 12!IT'PM SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH SYSTEM DATE/TIME FORMAT MON DD YYyy HH:MM:SS ×M CIRCLE'K 8605 5600 AUBURN BAKERSFIELD CA 93306 661-871-7979 SHIFT TIME 1 : 6:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED TANK PERIODIC WARNINGS DISABLED TANK ANNUAL WARNINGS DISABLED LINE PERIODIC WARNINGS DISABLED LINE ANNUAL WARNINGS DISABLED PRINT TO VOLUMES ENABLED TEMP COMPENSATION VALUE (DEC F ): 60.0 STICK HEIGHT OFFSET DISABLED PRECISION TEST DURATION HOURS: 12 DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM PORT SETTINGS: NONE FOUND RS-232 SECURITY CODE : 000000 RS-232 END OF MESSAGE DISABLED I N-TANK SETUP T I:UNLEADED PRODUCT CODE : 1 THERMAL COEFF :.000700 TANK DIAMETER : 92.00 TANK PROFILE : 4 PTS FULL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: OVERFILL LIMIT HIGH PRODUCT DELIVERY LIMIT !:! PERIODIC TEST TYPE QUICK ANNUAL TEST FAIL ALARM DISABLED PER I OD I C TEST FA I L ALARM DISABLED ::i: GROSS TEST FA I L ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF "~?ii.i TNK TST SIPHON BREAK:OFF ':~'!'I DELIVERY DELAY : 2 MIN LOW PRODUCT : 500 9816 :- 90% 8834 -~ 95% "~e' 9325 490 i:::!: ::i T 2:PLUS PRODUCT CODE : 2 THERMAL COEFF :.000070 TANK DIAMETER : 92.00 TANK PROFILE : 4 PTS FULL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 95% : 9325 DELIVERY LIMIT : 5% : 490 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 LEAK ALARM LIMIT: 99 f:::'.:'" TANK TILT : 3.80 ...~.:: . ':i::. : · , . '::':: :: ::.:.; .;: ::: ::;.?:::: :::: j:.:. ~ :::::::::::::::::::::::::::::: : I? ~ LEAK MIN PERIODIC: 10% ~4~ ;~;::;~:~::~: .................... ;-.: "-: ...... :..~_::: ~ ::: :.:::. -.:: ....... .. :'.::,: · ~ ~:I · : 981 ~ i'~:::r~::~:?,,f':i-.::~:':::.:::,:~:::::.',.::,: :,::;:?':':' :~:Oi:~:"~ :'..:::.' ':::- . ,.:.-::~: ' LE~ Ml N ANNUAL : 10~ ~:::J~ ~.~ ........ ::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::: ~~ .................. ...... ...... ::;:::::c:¥:.: ANNUAL TEST FAIL ALARM DISABLE[) !ii:i .... :.: PERIODIC TEST FAIL ' ':;::i GROSS TEST F~IL : ~L~R~ DIe,BLED PER TE~T ~VER~OINO: OFF T~NK TE~T NOT I FY: OFF T 3:PREMIUM PRODUCT CODE : 3 THERMAL COEFF :.000700 TANK DIAMETER : 92.00 TANK PROFILE : 4 PTS FULL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 95~ : 9325 DELIVERY LIIdlT : 5% : 490 LOW pRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.50 MANIFOLDED TANKS T~: NONE .' ....... ~:~ ..... '"'-~-%>~ ..... '~'- '<-':'~-'~ ..... ""'"< "<':'"'~":'-":,~'"'"<>..:~--- .. PER I OD I C TEST TYPE QUICK ANNUAL TEST FAIL ALARM D I SABLED PER I OD I ~ TEST FA I L (~LARM D I SABLED 'GRO~S TEST FA I L ALARM D I SABLED ANN TEST AVERAG I NG: OFF PER TE~gT AVERAG I NG: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DEL I VERY DELAY : 2 M I N P I PE TYPE: F I BERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: DISABLED .... 0-. 10-' ~P R--TE'S-T'f' SHUTDOWN RATE: 3.0 GDH O. 10 GPH TE~T MM/DD DATE : 999 0 T 2:PLUS D I SPENSE MODE: LEAK TEST METHOD TEST ON DATE : ALL TANK JAN 1, 2000 START TIME : 12:00 AM TEST RATE :0.20 GAL/HR DURATION : 2 HOURS LEAK TEST REPORT FORMAT NORIdAL WPLLD LINE LEAK SETUP W 3:PREMIUM PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: DISABLED' 0.10 GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MId×DD DATE : 999 0 T 3:PREMIUM DISPENSE MODE: STANDARD :::::::::::::::::::::::::: :::i i :::. ::.'.,,'..-:::: · LEAK MIN PERIODIC"- 10~ -:. W I :UNLEADED · ,:::.' :'.:.:'~ - I : 9si .'. : ., :::ii:.'.'"::::.:::,".' · PIPE TYPE' FIBERGL · ,:-:..: ........ , . · ASS :":!: ':::::-:' ..j LEAK [diN ANNUAL : 10~ : :u: ' LINE LENGTH: lO0 FEET :'-iiii'i::i~!'i':i:':. ,: ~ : 981 J!;{:::.!:!":::~, 0.20 GPH TEST: DISABLED ?:;:~?f;>;, . i ....... :.:' ':: '::: O. 10 GPH TEST' ENA ;~;;~,:: ': :'::,:.. ', ......... ,--,:-'., ' : -' : ..... BLED ~/,~::;~<<.,:' .;. t .... .~., .-:::-:c:::;::'":..::~i:?k:;-;' :.... ~:::::,,:i~:: :::::::-.'ii;:.J SHUTDOWN RATE: 3.0 GPH ~" ~%:::i O. 10 GPH TEST MM/DD ~ I:~qTE : .~. 0 T I: UNLEADED DISPENSE MODE:. ~ BTAN~RD ;~ 'c::f:'~.;<~;b;.;.';<;.:.:-.:-b;:::.;':;::;. ;.;-:-:~ ::::::::::::::::::::::::::::::::::::::::: ::: .~.1,:.': .:-c.:::-:4: J ~ ~:,. :? :: ~::;~:} ::::..:~ ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::: LINE LEAK LOCKOUT SETUP LOCKOUT SCHEDULE DAILY START TIME: DISABLED STOP TIME : DISABLED LIQUID SENSOR SE' L l:87-ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORy : ANNULAR SPACE L 2:UNLEADED-SUMP TRI-STATE <SINGLE FLOAT) CATEGORy :. STP SUMP L 3:PLUS-ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:PLUS-SUMp TRI-STATE (SINGLE FLOATi CATEGORy : STP SUMP L 5:PREMIUM-ANNULAR TRI-STATE <SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 6:PREMIUM-SUMP TRI-STATE (SINGLE FLOAT) CATEGORy : STP SUMP WPLLD LINE DISABLE SETUP UNLEADED : FUEL ALARM 2 :FUEL ALARM 1 :SENSOR OUT ALARM :SENSO~ OUT : FUEL ALARM 3:SENSOR O~ ALARM 5:SENSOR O~ aLARM ,i 'i ..... ~OFTt~IRRE'"REVISION-LEVEL-- ...... VERSION 16.02 SOFTWARE~ 346016-100-C CREATED - S-MODULE~ ~80'160-060-A SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS PLLD "0.10 MANUAL&O;20 CONT ~PLLD 0.10 MANUAL&0.20 CONT TANK LEAK TEST HISTORY T 1 :UNLEADED LAST GROSS TEST PASSED: DEC 25, 1999 6:36 AM STARTING VOLUME= 4789 PERCENT VOLUME = 48.8 TEST TYPE = STANDARD LAST ANNUAL TEST PASSED: NO TEST PASSED FULLEST ANNUAL TEST PASS NO TEST PASSED LAST PERIODIC TEST NO TEST PAS~ED FULLEST PERIODIC TEST PASSED EACH MONTH: I' TANK LEAK TEST HISTORY il LAST .GROSS TEST PASSED: ,JAN 1, 2000 12:IICI AM STARTING VOLUME= 22G0 ...... PERCENT VOLUME = 23.0 :i!.jl, TEST TYPE : STANDARD LAST ANNUAL TEST PASSED: NO TEST PASSED FULLEST ANNUAL TEST PASS NO TEST PASSED LAST PER I OD I C TEST PASS: NO TEST PASSED FULLEST PERIODIC TEST PASSED EACH MONTH: TANK LEAK TEST HISTORY T 3 :PRk-]~JI UM LAST GROSS TEST PASSED: JAN 1, 2000 12:00 AM STARTING VOLUME= 2828 PERCENT VOLUME = 28.8 TEST TYPE = STANDARD LAST ANNUAL TEST PASSED. NO TEST PASSED FULLEST ANNUAL TEST PAS: NO TEST PASSED LAST PERIODIC TEST PASS NO TEST PASSED FULLEST PERIODIC TEST PASSED EACH MONTH: ALARM HISTORY RE ..... SYSTEM ALARM ..... PAPER OUT FEB 5, 2002 10:17 AM PRINTER ERROR FEB 5, 2002 10:'17 AP1 BATTERy IS OFF JAN 1, 1996 8':00 AM ALARM HISTORY REPORT .... IN=TANK ALARM T I:UNLEADED OVERFILL ~LARM JUN 15, 2001 9:36 PM JUN 2, 2001 2:25 PM MAY 27, 2001 1:07 PM HIGH PRODUCT ALARM OCT 25. 2000 3:33 AM SEP 14, 1999 4:16 AM INVALID FUEL LEVEL FEB 20, 2002 1:56 PM FEB 14, 2002 10:44 PM FEB 9, 2002 7:23 PM PROBE OUT MAR 4, 2002 11:28 AM SEP 6, 2000 4:08 PM DEL l VERY NEEDED JAN 23, 2002 7:00 PM =============================== ..: ALARM HISTORY REPORT .... IN-TANK ALARM ..... T 2:PLus INVALID FUEL'LEVEL JAN 9. 2002 4:38 APl NOV 17, 200i 1:21 PM SEP 6. 2001 6:30 PM PROBE OUT MAR. 4, 2002 11:28. AM SEP 6. 2000 4:00 PM DELIVERY NEEDED JAN 7. 2002 4:26 PM NOV 16, 2001 9:06 PM OCT 13, 2001 8:33 AM ....... :~ ALARM HISTORY 'REPORT i .... IN-TANK ALARM ..... 'i T 3:PREMIUM ! SUDDEN LOSS ALARM ~ OCT 13; 2000 3:33 PM . SEP 6, 2000 3:52 PM ' INVALID FUEL LEVEL ~i OCT 18. 2001 8:22 PM ..... OUN 28. 2001 .2:01 PM . OUN 1, 2001 3:54 PM ALARM HISTORY REPORT SENSORALARM ..... L l:87-ANNULAR ANNULAR SPACE FUEL ALARM MAR 4, 2002 12:16 PM SENSOR OUT ALARM MAR 4, 2002 11:28 AM sENsoR'OUT ALARM MAR 4, 2002 11:03 AM ALARM HISTORY REPORT ..... SENSOR ALARM L 2:UNLEADED-SUMP STP SUMP 'SENSOR OUT ALARM ~.: .... MAR 4, 2002 11:28 AM : PROBE OUT [:' ' j.::.,':::. FUEL ALARM : MAR 4, 2002 11:28 AM I::::':::: MAR '4, 2002 10:51 AM ! SEP 6, 2000 3:53 PM i: : .: ' .::::~ ! · DELIVEry NEEDED . "!:.tilt!~, APR 20, 2001 8:58 AM ':' JAN 30, 2002 9:54 AM t JAN 20. 2002 8:30 PM ALARM HISTORY REPORT ..... SENsoR ALARM ..... L O;PLUS-ANNULAR ANNULAR SPAOE SENSOR OUT ALARM MAR 4, 2002 11:28 AM FUEL ALARM MAR 4. 2002 ll:ll AM FUEL.ALARM APR 20, 2001 9:18 AM ALARM HISTORY REPORT ..... SENSOR ALARM ..... L 4:PLUS-SUMP STP SUMP SENSOR OUT ALARM MAR 4. 2002 11:28 AM FUEL ALARM MAR 4. 2002 10:46 AM FUEL ALARM APR ·20. 2001 8:56 AM .I ALARM HISTORY REPORT SENSOR ALARM L 5:PRBqlUM-ANNULAR 'ANNULAR SPACE SENSOR OUT ALARM MAR 4, 2002 11:28 AM FUEL ALARM MAR 4, 2002 11:19 AM FUEL ALARM MAR 4, 2002 11:17 AM ALARM HISTORY RE~ SENSOR ~LARM - L 6:PREMIUM-S~MP STP SUMP 1 SENSOR OUT AI~ARM MAR 4. 2002~11:28 AM FUEL ALARM MAR 4. 2002 10:48 AM FUEL ALARM APR 20. 2001 9:01 AM ALARM HISTORY REPORT SENSOR ALARM ..... W I:UNLEADED WPLLD SHUTDOWN ALM . MAR 4, 2002 10:21 AM GROSS LINE FAIL MAR 4, 2002 10:21 AM CONTINUOUS PUMP ALM JUN 23. 2001 4:04 PM ALARM HISTORY REPORT ..... SEN~OR ALARM --- W 2:PLUS WPLLD SHUTDOWN ALM MAR 4. 2002 10:37 AM GROSS LINE FAIL MAR 4. 2002 10:37 AM HIGH PRESSURE WARN FEB 18. 2002 3:22 PM ALARM HISTORYREPORT ...... SENSOR ALARM ..... W 3:PREMIUM WPLLD SHUTDOWN ALM MAR 4. 2002 10:12 AM GROSS LINE FAIL MAR 4. 2002 10:12 AM CONTINUOUS PUMP ALM JUN 23, 2001 4:04 PM I NVENTORV REPORT T 1 :UNLEADED VOLUME = 49~6 G~LS ULLAGE = 4850 90% ULLAGE= 38~8 GALS TC VOLUHE = 4951 G~LS HEIGHT = 45.82 INCHES /. ~ . .:' TE~P = 64.4 DEG F ': ULLAGE = 7746 HEIGHT = 24.45 INCHES WATER VOL = 0 GALS j T 3: PREH I UH · . .... :.:j~ ] ~OLUHE = z847 SOFTWARE REVISION'LEVEL VERSION 16.02 SOFTWARE~ 346016-100-0 OREATED - 98.05,14.13.04 S-MODULE~ 330160-060-A 'SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS PLLD 0.10 MANUAL&0.20 CONT WPLLD 0.10 MANUAL&O.2O CONT For Use By All Jurisdictions grtthin the State of California Authority CitexL' Chapter6.7, Hca!th and Safety Code: Chapter 16, Division $, Tide 25, California Code of Regulations This form must be used to ~locumcat testing and sexvicing of monitoring equlpmeat. A~parat~ certification or report must be prep_areal for each monitoring system control panel by the techni~ who performs ~h¢ work. A copy of tl~ form must be provided to the tank system ownerloperator. The owner/operator must ~ubmit a copy of this form to the local ~ regulating UST a3tst~ns within 30 days of test date.. A. General Information ,... Facility Name: , 7~':~ O~ ~o 0~ Facility Contact Pcrson: ~..~ of o to g 3 ;o B. Inventor~ of Equipment Tested/Certified Tankm: '~ -~ m-Tank Gauging Prob~ MOd~ Ann~ar Space or Vault Sensor. Mod& Piping Sump !Trench S~so~s). Modd: Fill Sump Season(s). Model: Mochauical ~ L~ak Da~:lor. MOd& Electronic L~c Leak D~ctot. Model: Tank Ova'flU I High-level $ensoc. Mod~l: md model in ,%cfion E on In-Tank Gauging Probe. Model: ~/~ t~ -- I Annular Space or Vault Sensor. Modd: ~ ~l "~ ' PipingSump/Trcnch$casor(s). Model: c~ 0~"' Sensor(s). Model: Linc ~ Detecior. Model:' Electronic Linc Leak Detector. Model: Ir,,l t9 Tank Overfill / High-Level Sensor. Model: (-~' [1 Other (s Dispenser ID: [ ~ 12 DispenserCon~t S~nsor(s). Model: Shear Valve(s). and C~ain(s). I'~ Dispenser Containment $~nsor(s). Model: Shear Valve(s). ~ Dispense~ Containment Float(s) and Chain(s). Dispenser ID: ~ Disg~nser Containment S~xsot(s). Model: ~ Shear Val~(s). ODispenser Containment Flo~(s) and Chain(s). Taak ID: h-Tank Gauging Pro~ Mod& Annular Space or Vault $~nsor. Modd: Piping Sump/Tr~:~,S~asor(s). MOd~ Tank ID: C! In-Tank Gauging ~ Modd: {2 Annular Space or Vault Sensor. Modd: Q Piping Sump / Tmnch,%asor(s). Model: O FilISump .Segsor(s). Modal: 0 Mechanical LT~ Leak Dct~or. Modal: Elccuonic Line Leak D~caor. Modal: Tank Overfill I ~-~vd S~. M~: D~r ~: Dis~n~t ~s). M~d: Sh~ V~v~s). :~n~t ~oat(s) ~d ~s). D~ ~: Di~n~t ~s). M~d: Sh~ V~v~s). ~ ~d ~a(s). D~~: Sh~ V~vc(s). · ~n~n~t ~t(s) ~d ~s). E on *If thc facility contains more tanks or disposers, copy this form. Include information for every tank and disl~nset at trw. facility. Co Certificatioll. I certify that the equipment identified in this document was inspected/serviccd in accordance with the manufacturers' guidelines. Attached to this Certificatiou is i~rmafion (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of mom'te~ equipment. For a~ equipment capable of generating ~gt~eport~, I have also attached a copy of the report; (check a//that3/dZp~: ~ System set-up ~ Al~mJ~tory rqport//" Technician Name (print): 'I5~O ~ oo -' ,.-k O-k-~; e,_~q. Signature: Testing Company Name:'"Wr-,a ma\ v ~_~,t/troo~ca'a. ex~,- k,. Phone No.:(~L~:a_) D. Results of Testing/Servicing So ftware Version Insmlled: /'~ 'K! Yes el" No* I~' the audible alarm operga. 'onal? " '" -I~ Yes I~ No* Is the visual alarm operational? ~ Yes 12 No* Were all sensors visually inspected, functionally tested, and'confirmed operational? 4~ Yes 12 No* Were ali sensom installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their p~uper operation? 12 Yes 12 No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. ns~dem) "" -gil N/A operational?- '"' ~ Yes 12 No* For pressurized piping systems, does the tudoine automatically shut down if the piping secondary containment 12 N/A monitoring system detects a leak, faiis4O._operate, or is elecuically disconnected? If yes: which sensors initiate positive shut-down? (Check a//that app/y"/'~ Sump/Trench Sensors; I~Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks ~ sensor failure/disconnection-"/'~ Yes; 12 No. 12 Yes 12 No* For tank systems that utilize the monitoring system as the primary tank ovexfill warning device (i.e. no ~ =gl N/A mechanical overfill prevention valve is installed), is the ovexfill warning alarm vis'lc and audible at the tank _ fill Point(s)'and operating properly?, ffso, at what pax:ent of tank capacity does tbe alarm trigger? .~% 12 yeS.-~..R! No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment repiaced ~ and list the manufacturer name and model for all replacement pa~s in Section E, below. 12 Yeses' ~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all,hat apply) 12 Product; 12 Water. If yes, describe causes in Section E, below. ~ ~ffes 12 No* Was monitoring system set-up reviewed to ensure proper set~in~s? Attach set up reports, if applicable 4a- Yes 12 No* Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiendes were or will be correcte& E. Comments: Page 2 of 3 03/01 F. In-Tank Gauging / SIR Equipment: '~'1~ Check this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be co'mpleted if M-tank gaUging equiPment is used to perform leak detection monitoring. Com dete the followln~ checklist: ~! Yes I~! No* Has all input wiring been inspected for proper en~o, and termimtion~ including testing for ground faults? I~ Yes vi No* Wcre all mnk gauging probes visually inspccted for damage and residue buildup? Cl Yes Cl No* Was accuracy of system product level readings tes~cl? ~! Yes I-I No* Was accuracy of system ~ter level readings tested? I~! Yes r-I No* Were all probes reinstalled properly? El Yes I~! No* Were all items on ~ equipment manufacturer's main~ncc checklist completed?' * In the Section II, below, describe how and when these deficiencies were or will be correcfed. G. Line Leak Detectors (ELD): Cl Chcck this box if!:l Y~s are not instslled. Complete the following checklist: '~1 Yes Cl No* For equipment start-up or annual eqUXtl~ent certification, was a leak simulated to verify LLD performance7 I~1 N/A (Check all that apply) $imulatedle. ak'rate.'x~13g.p.h.; VI0.1g.p.h; IZl0.2g.p.h. '~1 Yes I~l No* Were all I.lJ')s confLrmed operational and accurate within regulatory requirements? 4~ Yes ~ No* Was the testing apparatus properly calibrated? I~! Ye&,, Cl No* For mechanical l.Ll~s, does the LLD restrict Product flow if it detects a leak7 ~ N/A q~l Yes Cl No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? ~ N/A '1~ Yes ~ No* For electronic LLDs, does the turbine automatically shut iff if any portion of the monitoring system is disabled C] N/A or disconnected? ~ Yes I~l No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions E] N/A or fails a test? q~l Yes I~1 No* For electronic LLDs, have all accessible wiring connections been visuall~ inspected? 121 N/A ~ Yes. I~l 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: MouRoring System Certification U ST Mo!lit ring Site Plan Date map was drawn: .~/ L~/. Oh 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 6r~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~ gle Environmental, Inc. 2525 W. BURBANK BL VD. BURBANK, CA 91505-2302 TANK TIGHTNESS TEST PRODUCT LINE TEST LEAK DETECTOR TEST MAR 0 8 ZOOZ TEL: (818) 840- 7020 FAX: (818) 840- 6929 WORK A CKNO WLEDGMENT DATE: ._9-~--.,- ocgs AUVH#: FACILITY#: 7~_~ ~ ~ ~gO~ Ch'Y/STATE: g~,k.~-*sS~ .4'~- q3~og co ,N TE -: =O SERVICE REQ~I2 (CH~) FACILITY INSPECTION ~ VAPOR RECOVERY TEST [-~ ENVIRONlVIENTAL REPAIRS OTHER SERVICES PERFORMED Quantigt Description Ouantit~ Description CUSTOMER PRINT NAME~6~~ ~_.~. CUSTOMER SIGNATURE DATE: ~nz m-wo~.,tca~a~ CIRCLE K 8605 5600 B~KERSFIELD (;~:~ 99306 66,1 -'871 -7979 JAN qFi.. 2002 10:45 APl ['EPi t3'I'f~TU~ t;:EP,:3RT T :3 :DEL I VERY- NEEDE[~ [',?,,R'~" REPORT T 1 :IJI',ILEFg-.~ED 90% ULLAGE= ':dtT5 GALS TO ~,/OLUPiE = 8021 G~L,gJ HEIGHT = 68.17 1NF_;HE~ b,j~TER t/OL = 0 TEMP .... = a8.8 DEG F T 2 :PLUS V©LUPlE = 2818 G~LS IJLL~GE = 6998 GALS 90% ULLAGE= 6016 ,2-;~LS TO ~,.,,'OLUI'"IE = 2816 GaLS HEIGHT = '30,:37 INOHES WI~TER V©L = 0 GaLS = 13,130 1 I',IOHE~-2, V,2:,LUI'IE .= 2921 G~LS IJLL~GE = 6:E:'35 _~LF_, 913~;:; ULL&GE= 5913 GALS T(-: 330LklI"IE ': 7-.!942 : F'REM I UM T l I I'&,,'ENT,;DRY I I',IC,:RE~?,E I I'&'.:REASE START JAN 3L3.. 2FI02 9:2? AI,'I I I',I(.:RE~SE El'ID ,J~l',l 30. 2C102 113:10 al"'1 VOLUME = ?994 OaLS HEIGHT = 68.46 ~I~JATER = 0. O0 I TEMt::' = 4"_4.5 DEC-; F F,L;Jt'~; I I',I(:RE~SE= 6906 p - ,",,' .... 697CI I N T 3: I::'REI'.'I I UM I NVENT'.,'R. I I I,,ICREF~SE START ,JFq'4:30 .. 2002 '3: 55 ~:~I'"1 ~/OLIJ"IE = 9Fj E ..... HEIGHT = 14 '-'-' INCHES t,,,IF~TER = Cl. CIO INCHES '"-' - DEG F = ,, =.LI I l'IOREat-'~tE END L 'dOLIJl'lE = 'T.~' '~ ? '[:J HE-'~GH'I~-- = ~-l. 15 t.4F~TER = O. O0 I 1'4CHES TEMP = 80.6 DEG F lili 1 i..i,:'::REaSE = 19:36 T I I'.ICR. EASE= 1 _ 4 ._, CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME dlll'~.{r~ ~.. ,~P(~ Section 2: Underground Storage Tanks Program [~l Routine '~ Combined [~l Joint Agency Type of Tank Or0 ~ Type of Monitoring eli, ~ INSPECTION DATE !! ~q/O [~l Multi-Agency l~l Complaint Number of Tanks .~ Type of Piping 003 t'""" [21 Re-inspection 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 Maintenance records adequate and current Failure to correct prior UST violations ~'~ Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SpCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violafion Y=Yes N=NO Inspector: ~ {~D Office of Environmental Services (805) 326-3979 White - Env. Svcs. k ---B/si~ess Site R~onsible ~ Pink - Business Copy ~ ~....~. ' FACILITY NAME ADDRESS FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3~d Floor, Bakersfield, CA 93301 INSPECTION DATE ~/~/0 PHONE NO. ~'~l ~ "~q 'l BUSINESS IDNO. 15-210- NUMBER OF EMPLOYEES L Section 1: Business Plan and Inventory Program [~l Routine [~ Combined [~ Joint Agency {~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand L,'/' Business plan contact information accurate L,,' Visible address Correct occupancy , Verification of inventory materials Verification of quantities Verification of location L/ Proper segregation of material Verification of MSDS availability L / Verification of Haz Mat training L, 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?: Explain: Yes Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Y Marketing Company Tosco Marketing Company P.O. Box 52085 Phoenix, Arizona 85072-2085 1500 North Priest Drive Tempe, Arizona 85281 David A. Waldschmidt Assistant General Counsel 602/728-7470 (direct line) 602/728-5277 (facsimile) April 23,200 [ 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[ 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 under~ound 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 8220CS I.DOC Tosco Corporation 1700 East Putnam Avenue Suite 500 Old Greenwich, CT 06870 Telephone: 203-698-7575 Facsimile: 203-698-7910 Craig R. Oeasy 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: Its: Date: Craig ff. Deasy Vice President and Treasurer April ~_~, 2001 County of ) by Craig R. Deasy, personally known to me as Vice President and T~asurer of Tosco Corporation, who executed the same on behalf of the corporation. Notary Public //,~ My Commission Expires: DENISE G. MECILI Notary Public, State of Connecticut No. 0111489 Qualified in Fairfield County Commission Expires March $1,2006 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 from 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)' Post-Closure Care (§§ 264.145 and 265.145) Liability Coverage (§§ 264.147 and 265.147) Corrective Action (§§ 264.101 (b)) Plugging and Abandonment (§ 144.63) $ None $ None $ None $ None $ None Authorized state programs: Closure Post-Closure Care Liability C°verage Corrective Action Plugging and Abandonment Total $ 28,509,000 $ 17,138,000 $ 49,000,000 $ 5,997,000 $ None $ 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 Amount of annual UST aggregate coverage being assured by a financial test, and/or guarantee Amount of corrective hction, closure and post-closure care costs, liability coverage, and plugging and abandonment costs covered by a financial test, and/or guarantee 3. Sum of lines 1 and 2 4. Total tangible assets 5. Total liabilities 6. Tangible net worth Total assets in the U.S. (required only if less than 90 percent of assets are located in the U.S.) 8. Is line 6 at least $10 million? 9. Is line 6 at least 6 times line 37 10. Are at least 90 percent of assets located in the U.S.? 11. Is line 7 at least 6 times line 3? $ 2,000,000 $ 100,644,000 $ 102,644,000 $ 8,407,200,000 $ 6,394,100,000 $ 2,013,100,000 Yes No $ N/A X X X N/A 16. 17. Current bond rating 0fmost recent bond issue Name of rating service Baa2 BBB Moody's Standard Investor & Poors Service 18. Date of maturity of bond January 1, 2047 19. Have financial statements for the latest fiscal year been filed with the: SEC Energy Information Administration Rural Electrification Administration Yes No X X 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, 2OO 1 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 1400 Park Avenue Linden, NJ 07036 Los Angeles Refinery (Wilmington) P.O. Box 758 Wilmington, CA 90748 Sacramento Terminal 76 Broadway Sacramento, CA 95818 Baltimore Terminal 2155 Northbridge Baltimore, MD 21226 Los Angeles Terminal 13707 S. Broadway Los Angeles, CA 90061 San Francisco Refinery-Rodeo 1380 San Pablo Avenue Rodeo, CA 94572 Colton Terminal 2301 S. Riverside Rialto, CA 92316 Femdale Refinery 3901 Unick Road Ferndale, WA 98248 Honolulu Terminal 411 Pacific Street Honolulu, HI 96817 Portland Terminal 5528 NW Doane Avenue Portland, OR 97210 Renton Terminal 2423 Lind Ave SW Renton, WA 98055 Richmond Terminal 1300 Canal Boulevard Richmond, CA 94804 San Francisco Refinery- Carbon Plant 2101 Franklin Canyon Rodeo, CA 94572 Tacoma Terminal 520 East D Street Tacoma, WA 98421 Los Angeles Refinery (Carson) 1520 East Sepulveda Boulevard Carson, CA 90745 Riverhead Terminal 213 Sound Shore Rd. Riverhead, NY 11901 BULK PLANTS: 845 Walnut Ave. Greenfield, CA 93927 100 Lee Rd. Watsonville, CA 95076 SUPPLEMENTAL ATTACHMENT TO LETTER FROM CHIEF Fff4ANCIAi. 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 I CONGRESS ST SUITE 1100 BOSTON MA 02114-2023 EPA REGION 2 29O BROADWAY NEW YORK NY 10007-1866 EPA REGION 3 1650 ARCH STREET PHILADELPHIA PA 19103-2029 EPA REGION 4 ATLANTA FEDERAL CENTER 61 FORSYTH STREET SW ATLANTA GA 30303-3104 EPA REGION 5 77 W JACKSON BLVD CHICAGO IL 60604 EPA REGION 6 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 PKWY STE 104 ATLANTA GA 30354 HI DEPT OF HEALTH SOLID & HAZARDOUS WASTE BRANCH 919 ALA 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 9O20 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. 1500 North Priest Drive Tempe, AZ 85281 Kathy StrickLand (602) 728-7149 Tosco Facility # 08605 Test Date: 4/20/2001 Facility: 2708605 Tosco Facility # 08605 5600 AUBURN ST Work #: 10300955 County: KERN 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 Mfgr's #: State Lic. #s: CA-1393 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 P~fa <5% as required by Local, State and Federal EPA UST Technical Standards Part 280 for precision~esting systems. This SB-989 secondary containment testing system exceeds the criteria for detection as required by state and local agencies. Environmental, loc. 2525 IV. BURBANK BL VD. TEL: (818) 840- 7020 BURBANK, CA 91505-2302 FAX: (818) 840-6929 WORK A CKNO DATE: FACILITY#: ADDRESS: CITY/STATE: COUNTY TANK TIGHTNESS TEST PRODUCT LINE TEST LEAK DETECTOR TEST SERVICE REQUESTED (CHECK) MONITOR CERTIFICATION [] FACILITY INSPECTION ~ VAPOR RECOVERY TEST [] ENVIRONMENTAL REPAIRS [~] OTHER [] SERVICES PERFORMED PARTS Quantity Description Quantity Description CUSTOMER SIGNATURE DATE: ~)~. ~-0. ~1-0 > SBD:. 123 -- WORKACI.,,'~(3?77) Triangle Environmental Inc US T MONITOR CERTIFICATION SUMMARY SHEET Client: Tosco Marketing Co. 1500 North Priest Drive Tempe, AZ 85281 Facility: Tosco Facility # 08605 5600 AUBURN ST BAKERSFIELD, CA 93306 Monitor model: VEEDER-ROOT TLS-350 Serial #: 80648964705001 Tosco Facility # 08605 Test Date: 4/20/2001 Work #: 10300955 County: KERN Cross Street: FAIRFAX ROAD Certification Result: PASS Sensor Type: Quantity: Tank Annular: 3 Waste Oil: 0 Waste Oil'Sump: 0 Vadose Wells: 0 Line Pressure: 3 Turbine Sump: 3 LineTrenchQty: 0 Fill Sump: 0 Result: PASS N/A N/A N/A PASS PASS N/A N/A Annular Type: DRY Audible Alarm? Yes Visual Alarm? Yes Fail Safe? Yes Positive Shut-off? Yes Gauge Only Result: PASS ATG Monthly? No 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 CER CA ON For Use By ~All Jurisdictions Within the State of California ".. ~luthorit~ Cited: Clmpte~ 6.7, Health and &~fety Code; CAapter 16, Division 3o Title 23, .C_xdifornia Code of Regul~ions This form must be used to dOCUment· testing and servicing of. monitoring equipment. If more than one- monitorin, g system eo. ntroi pane! is .installed at the facility,' ~i- separate certification' dr mpg. rt niust'be pmlbated for. ' .' each morfitofin~ ~stem control panel by the tectmiCiafl'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 rdgulating UST systems within 30 days of test .date. Instructions are printed on the .back of this page. General Infomation Facility Name:': '(~ O.~ MakedModel ofMonitoring Systm.: V w~-~--~__R,. Bldg. No_' Cit~.. ['~O P¢~£ f~ ~ t~l~ ~- ~ Zip: : B.' Inveatory 0f~xtuipment Tested/Certified Check the appropriate boxes to indicatespecific'~Iuipmeat inspected/serviced~ .- . ~ . . . ~1 Arm .ular Space or Vault Scm;or. Modch. .sa ~.' .ins s~r t T.m~ch.Sms~O.. ~.o~ ,i [~.rm .smp..Smso,:s),.. }~od~ . I~ BlcCtrodclincI, cak Detector... Modch . ~r Shear Valve(s).. ~ ShcarValve(O: Other (specify equipment type snd model in'Section E on Pgg.¢2).. ' · , KI Other (spec~ equip'm~nt.~ .nnd moddin .%ctio~ i2-.Oo Pag~ 2).:.: ~ul~ S~ ~ Vault ~r. M~ · .~ o ~' ' . ~'~ S~ or Vault ~ ...M~d: -. .... - Pip~gSump/Tm~s). · MM~ . · ~. .' '.~ Pip~Smp'/Tm~s). M~. .- ' ' ' ' Fill Stop ~0- M~d: ~ Fill Stop ~s). M~d: ' ' ~.~~~~c M~ .... ~ M~.~c~.~r.. M~ . . . - . D~ ~n~mt ~gs~' MM~ - -' - · O'D~ ~mt ~s~. M~ , . . . ' . Sh~ V~v~s). 0 ~h~ VMvgs). - ' . 0 ~(~~~.~h~E~2~ ',"- . · .. C. Certification - I certify'that the ~lUipm'e~t identified in-th~ document wa~ inspectca/st/viecxl.in'acco .raauce-with the ' manufaeturer~' guidelinec~ Attached to'thi$.~cation is information (e4~. manufacturer$~ checklisfs~ n.~t-y to. · . verify that this infomation is correct and a.Site plan showing the layout of monitoring .equipment...Fgr any'0tuipmemt' ' capable of genera'fing such reports, I.havealsoattachedacopyofthe(dz~-all&at~ply): -~tSystemset-up report; - .- gl Alav, his~qry report. .... , . . Technician Name (print): ~ .., , ~-tt~_~e..~ Cert.tLic. Nc,.: - ' Sig~_~,_re: -... D. Res~ults ofTesfing/Servicirig.' . Software Version Installed: ,. Complete the following checklist: I!~ Y.s El No.* Is the auch-bl¢ -'~ ¥~ - a ~o~ ~i~mo~on~.~, ,' ~ Y~ ~ ~9' W~~-~~~o~y~dm~o~2 ~ ~ - ~ No* W~~~l~w~tOf~n~v~inm~t~d~on~o~i~t~] .-,, not ht~ ~ ~ek pm~ o~on?, .- · - · ~ ~A o~o~?- - ~.Y~ . ONo* For~p~g . ''Did~u ~~ifivc~at4om dud m 1~ ~d~r~~~on? ~Y~;~ No. .. .' '.'. " ... ~.~h'~)md~g~.~,~w~.~of~~.~c~~ : ...... ~d ~ ~c~~~6.~d m~cl for ~ ~mt~ h ~oa ~ ~ow: .... · .... . .. · ~ '~ :.~...-'.9~aw~.:.~~~~~~o,~.. . · .... * . . ..' - ,.~'~Y~"' -a ~o*- wam~g~~m~&~m~m~¢~. ':'.,'-,' "' '- ~-~. ~ . ~.a-~o.. .. ~~~~~~~~~~o~,..~ · · · .. - · .... -'-" -'"" * In Section E belo~z. ...." E.. Comments: des/x/be hob-and when these ilefidendcz were or will t~e corrected. $itiAddress: Date of Testing/Sen, icing: F. J'n-Tank Gauging/S~REquipment' ..- '~ Cheek this box iftank gauging is used onlY forinventory controL .. , i-! Check this box if no tank gauging or SIR equipment is installed. -.. This.segti.' 'on must be completed gin-tank gauging equipment is used to perform leak detee, tion monitoring. ..- Comple. te the following checklist: El Yes Cl' No* Were all tank gauging probes visually inspex:ted for.clam~ge and residue btfildup? ' VI Yes U! No* Was accuracy of system water level readings tested? Il Yes El No* Wen: all pml~s.~installed properly?. .- . -- .' ~ .Yes' IZ! No* Wercallitemsonthdequipmen'tmanufa~fi~. gmaintea~uce, r,,hecklisteomp, l~ted? " .- ~' la the Section H~ below, describe how~nd when the~e deficiencies were or will be con'ed& · - G. LineLeakDeteCtor~(f,LD): .. -. gl Check this boxifLLDs are not installed. -' - .." ' ...- . -.. Complete the following checklist: . I~1. Yei cl N6* For equipment start-up or atmualr equipment' certifieatioa~ was a leak'~imulated to verify LLD ,p~. o~? ' . .... Cl. NIA (CheclcMlthatz~pply) Simulated leak rate: ~! 3-g~p.b);. E! 0.I '~p~a-, 121 0.2 g~p.h.= , . .,.Notes:. I. RequiredforequiPme~tstart-upe=tifieatioa.andatmuatcerfificatiom ' '.. ,. ': ' ' -2.' Unless mandat_~d by local agency, c~. ' cation, required only for eteetronic LLD start-up.. Yes' Cl No.'.were~ll_UlnseonfirmeitoPer~onalandaeem-atewit~in.~ryrequirements?. Ye~ O-No, Was~¢testingapp~o_,_,sp~pertyca~ratea~ .. .-- .: " Yes 13 No* 'Fofincch~ni~alLLl)s, do~s.tl~LLDrestri~imxluctflowifkd~ects~leak~' ..... ' .. CIN/A ~.Ycs 121 No* I'F°r¢lec~r°nie~d°~s~eim-binemst°matk~llyshut°ffifthcLLDde~'~" 'atcal~ yes'. ~l No* F~re~ectr~ie~L~.d~sth¢imbin¢~ut~m~ti~t~y.shut~if~yp~i~"6fth~m~ni~ring~isdisab~t~ IZl N/A ordiscormec~ed? Yes' Cl"No*!l For ele~0nie LLDs, ~ioe~ the. turloine ~,,tomatically shut' off if my-portion of.the -monitoring system IzI N/A malfunctions or fails a te~2 .... Yes. Cl 'No*. For electronic LLDs, have all access~le wiring connections ~ visually inspe~.ed? .... CIN/A .,. Yes: gl No* .Wereallitems.ontheequiprneatmanufaetureffsm~inteaan~eehecklist.completed? ... the Section H, b~low, describe how. and when these deficiencies were or will be.corrected. I:L Comments: · - ' ~ouE~r~.gSy~em CeraacaaO" UST Monitoring Site Plan Instructions · If' you already.have a diagram lhat shows all x~quixed infonn~on, you may include it, rather than thi.~ page, with,yom: Monitoring.System Certification- Oa.yo~7. ~ plan, .show-the general hy6ut of ~nks and piping. : '..-: .Clearly identify locations of the following.equipment, if installed: monitoring system control panels;, ~asors · ' '- .' monitorin~t~nk annular'spaee~ ~wnp% ~ pan%.apill, eo~inerg or other ~condaty eon~alnment areas;.- '..mechanical or elee~nie line lea~k deteeto~ aad in-tank liquid level probe~ Cfi-used fo~ leak detection).- In the-. · . -. - .space prO. vided,.note ~e.date this 8ire Plan Was prepared. Page- ~ of '~ Hnst~9 T I:UNLEADED PRODUCT:CODE:' THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL 69.0 'INCH VOL 46.0 INCH VOL 23.0 INCH VOL : 1 :~000700 92.00 4 PTS 9816 8058 4992 1898 FLOAT SIZE: 4,0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 PlAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90~ : 8834 HIGH PRODUCT : 95N : 9325 DELIVERY LIMIT : 10% : 981 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.48 MANIFOLDED TANKS T~: NONE LEAK MIN PERIODIC: 10N : 981 LEAK MIN ANNUAL : 10~ : 981 PERIODIC TEST TYPE OUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED SYSTEM SETUP APR 20, 2001 8:07 '('.'l" ..... .; ,,, <~:: ,,,,_ ~(;;.. -. _: GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF [. DELIVERY DELAY : 15 MIN SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGL I SH SYSTEM DATE/TIME FORMAT MON DD Yyyy HH:MM:SS xM CIRCLE K 8605 5600 AUBURN BAKERSFIELD CA 93306 661-871-7979 SHIFT TIME 1 : 6:00 AP1 SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED TANK PERIODIC WARNINGS DISABLED TANK ANNUAL WARNINGS DISABLED LINE PERIODIC WARNINGS DISABLED LINE ANNUAL WARNINGS DISABLED PRINT TO VOLUMES .:,,;?} ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 · STICK HEIGHT OFFSET D I SABLED PRECISION TEST DURATION , HOURS: 12 ~ DAYLIGHT SAVING TIME . · i' ENABLED 1'~ "i'~ APR WEEK 1 SUN j ?';, START TIME · ~ 2:00 RM END DATE OCT WEEK 6 SUN ' END TIME 2:0o AP1 " "::"::] SYSTEM SECURITY ';'::/ CODE : 000000 RCLE CI K 8~05' 5600 AUBURN B~}',ER,--,FIELD CA 93306 · 661.-871-797.9' APR 20, 2001' 8:07 SYSTEM STATUS ALL FUNC~I. ONS NORMAL. INVENTORy REPORT l' i :UNLEADED "./OLUME = 1 2! 3 GAI.~ ULLAGE - 8603 (:;ALS 90:~ ULLAGE- 762i TC VOLUME = 1203 GALS HEIGHT = 16.~5 II',IC,~ES WATER VOL = 0 G6LS WATER = O. O0 I NC~;ES TEMP = ?0.9 DEC: F T 2:PLUS VOLUME = 4029 GALS ULLAGE - 5787 (;ALS 90% ULLAGE~ 4805 GALS TO VOLUME = 4025 GALS HEIGHT = 39.23 INCIEES WATER VOL = 0 GALS WATER = 0,00 INC~S TEMP = 72.8 DEG F T 3: PREM I UP1 VOLUME = 1 959 GALS ULLAGE = 7857 (,";ALS 90~ ULLAGE= 6875 GALS TC VOLUME = 1936 GALS .- HEIGHT = 23.52 INC~'-'-S WATER VOL = 0 GALS WATER = O. O0 I NCH-'-o-S TEMP = 76.5 DEG ? COMMUN I CAT IONS SETUP RS-232 E ..... OF D I SABLED ai, MESSAGE PORT SETTINGS: NONE FOUND RS-'232 SECURITY CODE : 000000 L 'K TEST METHOD ' . ' JAN l, 2000 START T I PIE : 12: OB ~ [~j~ DURATION : 2 HOURS LERK TEST REPORT FORM~T WPLL1] L I NE LEAK ,SETUP W 1 :UNLEADED PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: DISABLED 0.10 GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MM/DD DATE : 797 0 T I:UNLEADED DISPENSE MODE: STANDARD W 2 :PLUS PIPE TYPE: FIBERGLASS LINE LENGTH: lOO FEET 0,20 GPH TEST: DISABLED 0.10 GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MM/DD DATE : ??? 0 T 2:PLUS DISPENSE MODE: STANDARD W 3:PREMIUM PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: DISABLED 0.10 GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPH O,lO GPH TEST ~M/DD DATE : ??? 0 T 3:PREMIUM DISPENSE MODE: STANDARD T 3: PREM I ElM I~ - THERI"IAI.. L:<:,EFF :.000700 " ' R'" ' ' :~'~ 69.0 INCH VOL : ~05~ 46.0 I/ICH VOL : 4992 2~.0 INCH VOL : 1898 ~ATER ~RN ING : 2.0 ~:-, :,', ,'-~ HIGH WATER LIMIT: O.O M~X OR L~BEL VOL: 9818 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 95X : 9325 DELIVERY LIMIT : 10~ : 981 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.50 MANI FOLDED TANKS T~: NONE LEAK MIN PERIODIC: 10~ : 981 LEAK MIN ANNUAL : 10~ : 981 PERI OD IC TEST TYPE ~ U'I OK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF "" i DEL I VERY DELAY TNK TST SIPHON BREAK:OFF : 15 MIN T 2:PLUS PRODUCT CODE : 2 THERMAL COEFF :.00007£ TANK DIAMETER : 92.0C TANK PROFILE : 4 PTS FULL VOL : 981E 69.0 INCH VOL : 805~ 46.0 INCH VOL : 4992 23.0 INCH VOL : t898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9'816 OVERFILL LIMIT : 90~ : ~834 HIGH PRODUCT : 95~ ; 9325 DELIVERY LIMIT : lO~ : 981 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : :i.80 MANIFOLDED TANKS T~: NONE LEAK MIN PERIODIC: ~0~ : 'gB1 LEAK MIN ANNUAL : :0~; : 981 PER I OD I C TEST TYPE ~U ANNUAL TEST FAiL ALARM DISAELED PER I OD I O TEST FA I L ALARM D I GROSS TEST FAIL ALAR/t D I SABLED ANN TEST ~!..'ERAG ING: PER TEST AVERAGING: OFF TANK TEST NOTI ~': O~F i TNK TST SIPHON BREAK:O?F ' b~.Li'~E~:~ VELA"," : l~ ~:N .... 5600 AUBURN .' BAKERSFIELD ~A 9830t 661-871-7979 ..- 'APR 20, 2001-i0:08 AM SYSTEM STATUS REPORT T 2 :PLUS · .: ' VOLUP1E ' LILLAGE = ',:, : ':,.."7... , 90~; ULLAGE= .<':'.,:r,:? ' :...,:::.': TC VOLUIdE = ALL FUNcTIONSNORMAL INVENTORY RE,OR'¥ T I:UNLEADED VOLUME ~.' 1166 GALS ULLAGE '= 8650 GALS ,-90% ULLAGE= 7668 GALS TC VOLUIdE = 1156 GALS HEIGHT = 16.40 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEIdP = 71.4 DEG F 4028 GALS 5788 GALS 4806 GALS 4023 GALS HEIGHT = 39.22 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 72.9 DEG F T 3:PREMIUM ' ::'. ": ' VOLUME = 1957 GALS ,-':, .,: ' ':'.'): ULLAGE = 7859 GALS 90% ULLAGE= 68?? GALS , TC VOLUME = 1934 GALS ~ HEIGHT = 23.50 INCHES : t WATER VOL = 0 GALS .:: ::.;-'....':,....:; .' :,i WATER = 0 O0 INCHES ::-' .......... ,:.,,- ....... :-..~ TEMP = 76.6 DEG F ~i~i:[ WPLLD LI NE r,~ SABLE :~i~l -.--:-' -- :-::- ~m. ~;~i ." w ~='u~L~:,s~:', -' .. ~¢;,~:':~ ' L [ ~U ~ D SENSOR ::~:.:'.] L 2:FUEL AL~RI"I ::.".'(-J.L l C,:~: I, >:<ENSOR ALMS :':.:/ L :3:1 ['t.:L ALARM '::~ :'/ L 4: FUEL ALARM bJ :3; PREH I UM L I (IU I D SENSOR RL["IS L 5:FUEL ALARM :i L 6:FUEL ~L~RP1 SOFTWARE REVISION LEVEL VERSION 16.02 SOFTWARE; 346016-100-C CREATED - 98.05.14.13.04 S-MODULE~ 330160-060-A SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS PLLD O.lO MANUAL&0.20 CONT WPLLD 0.10 HANUAL&0.20 CONT LOCKOUT SCHEDULE DA I LY START TIME: DISABLED STOP TIME : DISABLED LI(~UID SENSOR SETUP L 1:87-ANNULAR TRI -STATE (S INGLE FLOAT~ CATEGORy : ANNULAR S "c~-' ~ ,-. UNLEADED-SUMP ti{! TRI-STATE (SIN,,LE FLOAT~. o : .., CATEGORy : STP SUMP L 3 :PLUS-ANNULAR TRI-STATE (SINGLE FLOAT), CATEGORy : ANNULAR SPACE L 4 :PLUS-SUMP TRI-STATE (SI NGLE FLOAT) CATEGORy : STP SUP1P L 5:PREMIUM-ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORy : ANNULAR SPACE ...... ": TRI-STATE (SINGLE FLOAT) t . ': :;'1:" ::":':';':':::":::':'~::'::'.' ': ........ :.:."': .... .:":::-:',3:,';':' ": .......... : ........ :', . ....................... .... ::':' ' :: ..... :':: '" :':':" : :::::::":::"":7 .... - ': .' ," ' CATEGORY · S . '-: .-;'. ...... :....... :...: .. .... :." , ." ·. - ·: . :,' ...... .: :.,,' ....... - :.'.~ ,: ...,,.'...,;..,.~',., ,.~:, :, .: :. .. , · TP SUMP ~ · '~:Z,:;,;:,::, ,' ', ':,:::..,'::::: :.1 :~::-:'.:'::'.~'::':? i'::::'-:Z :i::,.:L::':.:'..: :",. :.-,:1',::,, '-.:':'"'::' ::: :-'::.::::::. '~ "..":,, ..... :':' ":"' '.': :' :: ., '- · :: : "' ":'. ' .... : ::' ':."- ".:::::'-" '" ': :...": ':':. '.':'::vi..:::.:' ' ' _ ' ' ' .... :i:...:::: 'i..,,:.', ::' - ::.: :.. -:_ .. ::- ................. I N-TANK SETUP T I:UNLEADED . PRODUCT CODE''. THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL 69.0 INCH VOL 46.0 INCH VOL 23.0 INCH VOL :.000700 92.00 4 PTS, 9816 8058 4992 1898 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT : 90% : 8834 HIGH PRODUCT : 95~ : 9325 DELIVERY LIMIT : 10~ : 981 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.48 MANIFOLDED TANKS T~: NONE COMMON I CAT IONS SETUP -- -- --, -- T' T' -- -- 'r -- PORT 'SETTINGS: . NONE FOUND RS-232 SEC:uR I TY CODE : 000000 'sYsTEM.SETUP' "';-': ' .., . APR 20, 2001 lO:O8.AM SYSTEM UN I TS U.S. SYSTEM LANGUAGE ENGL I SM ' SYSTEM DATE~TIME FORMAT MON DD YYYY HH:MM:SS xM CIRCLE K 8605 5600 AUBURN BAKERSFIELD CA 93306 661-871-7979 SHIFT TIME 1 : 6:00 AM SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED T~NK PER I OD I C WARN I NGS D I SABLED TANK ANNUAL WARNINGS D I SABLED LINE PERIODIC WARNINGS D I SABLED LINE ANNUAL WARNINGS D I SABLED PRIlIT TO VOLUMES ENABLED LEAK MIN PERIODIC: 10% : 981 LEAK MIN ANNUAL : 10% : 981 PER I OD I C TEST TYPE ANNUAL TEST FAIL QUICK ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MIN TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED PRECISION TEST DURATION HOURS: 12 DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK 1 SUN START TIME'''''~''''~ ': 2:00 AM END DATE OCT WEEK 6 SUN END TIME 2:00 AM -- :;:..::-:-.:::.::: . .::. WPLLD LINE LEAK SETUP W 1 :UNLEADED PIPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPH TEST: DISABLED 0.10 GPH TEST: ENABLED SHUTDOWN RATE: 3.0 GPH 0.10 GPH TEST MM/DD DATE : 797 0 T I:UNLEADED DISPENSE MODE: STANDARD T 3:PREMIUM THERMAL COEFF .0 TANK DIAMETER : TANK PROFILE' ~ 4 PTS FULL VOL : 9816 69.0 INCH VOL : 8058 46.0 INCH VOL : 4992 23.0 INCH VOL : 1898 T 2:PLUS · PRODUCT CODE : 2 THERMAL COEFF :,000070 TANK DIAMETER : .92,00 TANK PROFILE .: 4 PTS FULL VOL': 9816 69,0 INCH VOL : 8058 46,0 INCH VOL : 4992 23,0 INCH VOL : 1898 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 9816 OVERFILL LIMIT 90% 8834 HIGH PRODUCT : 95~ : 9325 DELIVERY LIMIT : 10% : 981 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.50 MANIFOLDED TANKS T~: NONE LEAK MIN PERIODIC: 10% : 981 LEAK MIN ANNUAL : 10~; : 981 PERIODIC TEST TYPE aUICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MIN t i FLOAT SIZE: 4.0 IN. 8496 WATER WARNING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL OVERFILL LIMIT HIGH PRODUCT DELIVERY LIMIT 9816 90% 8834 95% 9325 10% 981 LOW PRODUCT : 500 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : 3.80 MANIFOLDED TANKS T¢: NONE LEAK MIN PERIODIC: 10% : 981 LEAK MIN ANNUAL : 10% : 981 PERIODIC TEST TYPE ~UICK ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 ['lIN WPLLD L I NE D I SABL W I:UNLEADED' LIQUID SENSOR ALMS L I:FUEL ALARM L 2:FUEL ALARM L I:SENSOR OUT ALARM L 2:SENSOR OUT ALARM W 2 :PLUS LIQUID SENSOR ALMS L 8:FUEL ALARM L 4:FUEL ALARM L 3:SENSOR OUT ALARM L 4:SENSOR OUT ALARM W 3: iF'REM I UM LIQUID SENSOR ALMS L 5:FUEL ALARM L 6:FUEL ALARM L 5:SENSOR OUT ALARM L 6:SENSOR OUT ALARM SOFTWARE REVISION LEVEL VERSION 16.02 SOFTWARE; 846016-100-0 CREATED - 98.05.14.13.04 S-MODULE¢ S30160-060-A SYSTEM FEATURES: PZRIODIC IN-TAN: rESTS ANNUAL I N-TANK TESTS PLLD O. 10 MANUAL&O. 20 ¢ONT ~PLLD ~ '8: ~j >¢3: ,: .:4~.t :.. I: . LIQUID SENSOR SETUP START TIME:' DISABLED STOP TIME : n ISA~LED L 1: 87-ANNULAR TR I -STATE (S INGLE FLOAT) CATEGORY : ANNULAR SPACE L 2:UNLEADED-SUMP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 8:PLUS-ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 4:PLUS-SUMP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 5:PREMIUM-ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE ~ 2: PL US PiPE TYPE: FIBERGLASS LINE LENGTH: 100 FEET 0.20 GPM TEST: DISABLED 0.10 OPM TEST:, ENABLED ~TDOWN RATE:, 3.0 GPH 0 GPH TEST MM/DD DATE : 797 0 T 2:PLUS DISPENSE MODE: STANDARD W 3: PREM I UM -' P I PE TYPE: F I BERGLASS LINE LENGTN: 100 FEET 0.20 GPH TEST: DISABLED 0.10 GPH TEST; ENASLED HUTDOWN RATE: 3.0 QPH · 10 QPH TEST MM.×DD DATE : ?,7,? 0 -.':"i T 3: PREM I UR J: i DISPENSE B1ODE: i O. 10 MANUAL&0.20 CONT ! ,. L 6:PREMIUM-SUMP .~ TR I -STATE (S I NOLE FLOAT) ':'::.; ........ "]' ' CATEGORY : STP SUMP . ' . .': .::;..,... ..... '. '7 ........ ."., '"'".'";:i ';:':: ,- . ......t:";:.':::,: · ,-.,,.,.:'...,.: :..'..:..: ..... ... :; .... ' .... ', :::::::::::::::::::::::::::::::::::::: ::;:':':'::.:.:: .:: ,<.'. :',::.. :.:.:.....:'::..:::.: ...':::,:.': ::,:.~. :::::::::::::::::::::::::::::::::., :,..,., ....... ~ ................ ,'...: :..:.,: .:,:..:':!' :,,~. ::... ,'....' .:::..,: ¢.,';:~::(j.:,',,-::':¢:' ~:>?':,.;::.,%'< ?"5:.:',:<'::':::::::;,:,W.~::':;?'P::'::?.-;::;& ', ~2<::~;~:~:~.;:%:%~%~:¢~``:~[(~>```~:~;~4~;~`C-:;(:::`::;::: ,: ..... ~.. , :, .' .': .... ~. ? .... .' ' Y:~,"' :'?: ;'{ '?"' '":2':' ~ : .... ,:' ' ' · '?',',, ',-¢.","Y-X~' ~~`~`~;~`"`¢¢~`:~:`~c~`,<~:.~:'f~`:~,~r~.~:?~<.~:~`:.:`~>`:~:,:~:~:~ ~',:'" ,:'.,'::<,, ->~-',,}: i<, -,:::', ,-.,, .,,'.:,' ' : ,',','::: ',"' :':.':"';"' :.,,' "' ' :' ":: ,',,:'~ ',:- ALARM H!STORY REPO; ...... SENSOR ALARM l': 5 :PREMI UM-ANNULAR ANNULAR SPACE FUEL ALARM APR 20, 2001 9:06 AM FUEL ALARPI MAY 8, 2000 lO:iS AM FUEL ALARM MAY 8, 2000 !0:13 AM ,,:::. <.. :' .... ~ ALARM HISTORY REPORT ';;':" .... :' :'; STP SUMP l ~ FU~L A~ARM ~ APR 20~ '2001 9:0i AM MAY 8 2000 10:00 AM FUEL ALARM MAY 8, 2000 9:48 AM ALARM HISTORY REPORT ~I~ .· I ii?::J ALARPI H ! STORY REPORT' ..... SENSOR ALARM _____~r~. ~ii~i~i~ ..... SENSOR ALARM L S:PLUS-~NNUL~R ' ~ L 1:8?-~NNUL~R ANNULAR SPACE ,,- 4;~ , ,.;~..~., ANNULAR SPACE FUEL ALARM ~o:-:~j FUEL ALARM APR 20, 2001 9:18 AM ".:::JlJ APR 20, 2001 9:23 AM FUEL RLRRM I ::::,:: ' FUEL ALARM MAY 8, 2000 10:24 AM I',::~ MAY 8, 2000 10:31 AM FUEL ALARM /' Ii.y:,.. FUEL ALARM OCT 26, ~Sss 2:~0 PM ~7,::'~'~'~'~NOV ~5, ]99~ 9:~e ~M ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ END ALARM HISTORY REPORT ALARM HISTORY REPORT SENSOR ALARM ..... SENSOR ALARM L 4 ;PLU~-SUMP L 2 ;UNLEADED-SUMP ~' FUEL ALARM FUEL ALARM ~ .i APR 20, 2001 8;58 ~M APR 20, 2001 8;58 J.:;';',",~ FUEL ALARM FUEL ALARM :~-,m....:::MAY 8, 2000 9:47 AM MAY 8, 2000 10:39 AM ....' FUEL ALARM . ~ FUEL ALARM · O~T 18, 1999 2:lB PM ,, M~Y e, 2000 10:~ ~M ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ : "~ ~ ~ ~ ~ ~ END ~ . :. .. _.: .. ::::-::..:/.::.::'" . , .' . . , : : · . .... ~:::'..: :.::' ' ....,-- .: .. :.:. :,..... -. :. · . . .. ...:. :: :::.: ::::::::::::::::::::::::::::::::: . : .. .:,....-: ::. ..... .. .. ,~..:.: ..':..-.:. ===================== ...:..: ...::..:.; ::..:.:.',.:':.:<:..: .. ':::::: .:: :,...,::.::~.,:: :::.: :, ::, ...,.....,: :: ::: '::....:/,.:.~ :.: :. :::, -:: '. : :.. ~. ' :~-,........: ..-, .. ,:,::. ..... :., -:- '- -' ':" ;.'-.:::, ::-' ' ::':,:.'-:;::";: . '" '" .' (' -' ',"' . ': ':: 't~ ': ::~.: ,", :..... .:.' ::.:;'.:,. :'::.: ~,:: :-:'.::: :.. : : . - ::,':, :, :':... '. . : . ' .,. .;: ,. ::::.';: .~-,.,-..,..:::..- :.. ::. ,":'.': . :- . :..::.'. W']S :PREM I UM WPLLD SHUTDOWN ALM ~;s~ APR 20, 2001 9:$9 AP1 GROSS LINE FAIL .APR 20, 2001 9:$9 AM MPLLD SHUTDOMN ~LM DEC ~0, 1999 9:27 ~M ~LRRM HISTORY REPORT'.. ----- SENSO~ AL~RN ..... W I:UNLERDED WPLLD SHUTDOWN RLR APR 20, '2001 9:56 AM GROSS LINE FAiL APR 20, 2001 9:56 AM WPLLD SHUTDOWN ALM FEB 15, 2001 6:14 PM ALARM HISTORy REPORT ..... SENSOR ALARM W 2:PLUS WPLLD SHUTDOWN ALM APR 20, 2001 10:03 AM GROSS LINE FAIL APR 20, 2001 10:03 Af"l WPLLD SHUTDOWN ALM OCT 25, 1999 6:06 PM 5600 ~UBURN ERS_:FI£LO (?a 99806 -871 -'7979 JaN 2. 200i 8:53 aM SYS'['EM ;3TAT JS aLL FLIblCTIONS I,I.;}F:HAI.. *]'iRCL-E }:.l 8605 ,)~lq 2h 21]01 i0:i2 al'-'l T 1: UIILEA£',ED VOLUME = 7362 I,.IA'I-'ER = i'3.1]0 I fiCHES TEHi::' = 53,4 £)EG F T 2: 'v'C, LUNE =: 2528 I.ILLAt_]E = 72~18 GaLS 9 0'.'..,:, I_II..LR,2E = ~,;)0E, TC VOL, LIME := 25'~'~:, ,S~LS HEfGHT = :28.1:3 INCHES t,aeq"gR = 0.0O 1NCHES TEk'IF' = (~5.~, 9EG f:' 1' 8: I:'REI"I 1 IJM ",," ",_',"JL. L II"1E = 2059 I.JI..LA(.;iE = '?"7 5'7' '305;!; [..ILLA,.2E= fi,??5 (-:ALS ,IGHT = 9.4.95 I I,ICI4E[5 TER V,OL = O G~L.S b,i~¥I'ER = 0. O0 INCHES; TEMP = E, 4.8 DEG F D January 22, 2001 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 ~H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 396-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Circle K 5600 Auburn Street Bakersfield Ca 93306 RE: Dispenser Pan Requirement December 31, 2003 Underground Storage Tank Dispenser Pan Update Dear Underground Storage Tank Owner: You will be receiving updates from this office now, and in the future with. regard to the Senate Bill 989, which went into effect January 1, 2000. This bill requires dispenser pans under fuel pump dispensers. On December 3 l, 2003, which is the deadline for compliance, this office will be forced to revoke your permit to operate, effectively shutting down your fueling operation. It is the hope of this office, that we do not have to pursue such action, which is why this office plans to update you. I urge you. to 'start planning now to retro-fit your facilities. 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 t't.t~_ ADDRESS 5{o00 FACILITY CONTACT INSPECTION TIME INSPECTION DATE tlo}{O PHONENO. ~7(' ~777~ BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine [~Combined [] Joint Agency [] Multi-Agency ~1 Complaint [21 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 k,, / Verification of Haz Mat training k./ 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?: Explain: [] Yes [] No Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Business Site.l~espons~ble Party Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME err,cie Section 2: Underground Storage Tanks Program [~l Routine ~ Combined [] Joint Agency Type of Tank ~/[Lh~'' Type of Monitoring INSPECTION DATE ff~./~./ [] Multi-Agency [] Complaint Number of Tanks ~ Type of Piping .f)OJ.~' [] Re-inspection 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? C=Compliance . V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (80)~6-3979 White- Env. Svcs. Pink - Business Copy Business Site Responsible Party