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Home My WebLink AboutUNDERGROUND TANKD T FIRE CHIEF ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93,.~1 VOICE (661) 326-3941 FAX (661) 852-2170 PREVENTION SERVICES 900 Truxtun Ave., Suite 210 Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 852-2171 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661 ) 399-4697 FAX (661) 399-5763 August4,2004 Mr. Brandon Neal, Director of Plant Operations HealthSouth Bakersfield Rehabilitation Hospital 5001 Commerce Drive Bakersfield, CA 93309 CLOSURE OF 1 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK LOCATED AT 5001 COMMERCE DRIVE PERMIT # BR-0282 Dear Mr. Neal: This is to inform you that this department has reviewed the results for the preliminary assessment associated with the closure of the tanks located at the above stated address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. Accordingly, no unauthorized release reporting is necessary for this closu re. If you have any questions regarding this matter, please contact me at (661) 326-3979. Sincerely, Howard H. Wines, III Hazardous Materials Specialist Registered Geologist No. 7239 Office of Environmental Services HHW/dlc cc: J. Whiting, RWQCB HEALTHSOUTH Bakersfield Rehabilitation Hospital (03-089) TO: Howard Wines FROM: Brandon Neal Area Director of Plant Operations DATE: 6/7/04 Howard, Please accept the attached Closure Report for issuance of Final Clean Closure of the Underground Fuel Storage Tank located at or facility. Please contact me if you have any questions. Brandon Neal Bakersfield Office (661) 323-5500 EXT 4077 Direct (661) 633-3780 Fax (661) 633-5253 5001 Commerce Drive, Bakersfield CA 93309 UST HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL BAKERSFIELD, CALIFORNIA Prepared For: HealthSouth Corporation One HealthSouth Parkway Birmingham, Alabama 35243 Janua~ 2004 Bhate Project No.: 9030082 Prepared By: BHATE ENVIRONMENTAL ASSOCIATES, INC. 1608 13TH AVENUE SOUTH, SUITE 300 BIRMINGHAM, ALABAMA 35205 Fort Walton Beach, FL · Jacksonville, FL · Tampa, FL Alamogordo, NM · Nashville, TN · Norfolk, VA 1-800-806-4001 www.bhate.com HEM,TItSouTn BAKERSFIELD REHABILITATION HOSPrrAL LIS'I' CLOSURE REPORT This page intentionally blank. Revision Date: January 2004 Revision No. O0 HEALTHSOUTH' BAKEP~SFIELD REHABILITATION HOSPITA.L UST CLosta~ I I I I I HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL UST CLOSURE REPORT BAKERSFIELD, CALIFORNIA Prepared For HealthSouth Corporation One HealthSouth Parkway Birmingham, Alabama 35243 Prepared Bhate Environmental Associates, Inc. 1608 13th Avenue South, Suite 300 Birmingham, Alabama 35205 Bhate Project No. 9030082 January 2004 Revision Date: January 2004 RevisiOn No. 00 ' l .HY-ALTHSOUTH BAKEIL~FIELD REHABILITATION HOSPITAL UST CLOSURE .REPORT I I I I I I 1 HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL UST CLOSURE" REPORT REVIEW SHEET Please sign and date This report has been reviewed and approved by: (:~'cott Dof-vi'n, P.G. Senior ~ Diane Lazarus, QEP Senior Project Manager Louis M. Montgomery, P.E. Regulatory Compliance Director Signature Signature t / ' ~D~ate blte Date Revision Date: January 2004 Revision No. O0 HEALTHSOIYFH B~kKERSFIELD REItABILITATION HOSPITAL UST CLost~ R~vo~ This page intentionally blank. Revision Date: January 2004 Revision No. 00 HEALTHSOUTH BAKERSFIELD ]~EHABILITATION HOSPITAL 'UST CLOSURE REPORT i I I I I I I , I I I I ! I I I I DISTRIBUTION LIST HealthSouth Corporation Attn: Jim Moxley One HealthSouth Parkway 3 Birmingham, Alabama 35243 (205) 970 - 5951 HealthSouth Bakersfield Attn: Brandon Neal Bakersfield Rehabilitation Facility 2 5001 Commerce Drive Bakersfield, California 93309 (661) 323 ~ 5500 Revision Date: January 2004 Revision No. O0 HEALTHSOUT}~ .BAKERSFIELD REHABILITATION HOSPITAL 'UST CLOSURE REPORT This page imentionally blank. Revision Date: January 2004 Revision No. O0 ,HEALTHSOUTU .B.~KERSFIELO ]~EHABIL1TATION 'HOSPITAL UST CLOSURE REPORT HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL '1 I 1 I UST CLOSURE REPORT BAKERSFIELD, CALIFORNIA TABLE OF CONTENTS 1 2 3 4 5 Introduction ..................................................................................... 1-1 Project Background ........................................................................ 2-1 Closure Assessment and Field Observations ................................. 3-1 3.1 AST Installation ....................................................................................... 3-1 3.2 UST Excavation ...................................................................................... 3-1 3.3 Tank Inspection ....................................................................................... 3-2 3.4 Sampling ................................................................................................. 3-3 Disposal .......................................................................................... 4-1 4.1 Tank ........................................................................................................ 4-1 4.2 Soil .......................................................................................................... 4-1 4.3 Rinsate .................................................................................................... 4-1 Closing Remarks ............................................................................ 5-1 List of Figures Figure 1 Site Location Map Figure 2 Site Map List of Appendices A B C D E F G H ! Franzen-Hill Corporation UST Integrity Test (October 28, 2002) BSSR Monitoring System Test (December 23, 2002) BSK Associates Concrete Cylinders Test - AST Pad (November 26, 2003) Site Photographs - UST Excavation and Removal Receipt for Dry Ice City of Bakersfield, UST Atmosphere Test (September 8, 2003) Tulare Iron and Metal Works, UST Recycling Receipt (September 11, 2003) Vulcan Materials Company, Aggregate Quality Certification (December 3, 2003) Liquid Waste and Rinsate Disposal Manifest Revision Date: January 2004 Revision No. O0 HEALTH$OUTH BAKEI~FIELD REHABIL~ATION HOSPITAL 'US'F CLOSURE REPORT AST Bh~e BSK BSSR LEL PVC USGS UST ACRONYMS Aboveground storage tank Bhate Environmental Associates, Inc. BSK Associates Bakersfield Service Station Repair, Inc. Lower Explosive Limit Polyvinyl chloride U. S. Geological Survey Underground storage tank Revision Date: January 2004 Revision No. 00 ~ALTHSOUTH ]~AKERSF~LD REItAB~TATION HOSPITAL UST CLOSURE [~EPORT This page intentionally blank. Revision Date: January 2004 Revision No. 00 ii HEALTHSOUTH B.~RSFIELD REHABILITATION IglOSP1TAL CLOSURE REPORT This page intentionally blank. Revision Date: January 2004 Revision No. 00 iv HEALTHSOUTH.]~AKERSFIELD REHABILITATION HOSPITAL UST CLOSURE REPORT I I I I I I I I I 1 1 1 INTRODUCTION This document contains the Underground Storage Tank (UST) Closure Report at the HealthSouth Bakersfield Rehabilitation Facility and was prepared by Bhate Environmental Associates, Inc. (Bhate) for HealthSouth Corporation, Birmingham, Alabama. This UST Closure Report documents the UST closure performed in accordance with the State of California Code of Regulations, Title 24, Part 9; the California Health and Safety Code; the of City of Bakersfield Office of Environmental Services requirements; and the Bhate proposal dated March 5, 2003. Revision Date: January 2004 Revision No. 00 1-1 T,ION HOSPITAL 'UST CLOSURE REPORT This page intentionally blank. Revision Date: January 2004 Revision No. 00 1-2 HEALTHSOUTH rBAKERSFIELD REHABILITATION HOSHTAL UST CLOSURE REPORT 2 PROJECT BACKGROUND The UST closure site is located at the HealthSouth Rehabilitation Facility at 5001 Commerce Drive, Bakersfield, California (Figure 1). The site is on property managed by the HealthSouth Corporation and utilized by the HealthSouth Rehabilitation Facility. The closure site is geographically located in the northeast comer of Section 34, Township 29 South, Range 27 East, on the U.S. Geological Survey (USGS) 7.5 minute Gosford Quadrangle. The 1,000 gallon UST removed has solely been utilized for storage of diesel fuel that supports the back-up generator to the facility. The secondary tank's annular space integrity was last tested by Franzen-Hill Corporation, Tulare, California, on October 28, 2002 (Appendix A). The 30- minute pressure test indicated that the tank's annular space was not compromised (i.e., no viable means for pressure loss due to holes or cracks). At the time of the test, there was product within the sump area around the fill pipe. Most likely this accumulated during filling of the tank. On December 23, 2002, the tank's leak monitoring system was tested by Bakersfield Service Station Repair, Inc. (BSSR), Bakersfield, California (Appendix B). During the testing and inspection, approximately 17 inches of a product was present within the annular space of the tank's secondary contaiment, approximately 150 gallons. The leak detection system for the primary tank and lines had not indicated a leak. I! !! Revision Date: January 2004 ReviSion No. 00 2-1 HEALTH$OUTH .BAKERSFIELD REHABILrYATION 'HOSPITAL UST CLOSURE REPORT This page intentionally blank. Revision Date: January 2004 Revision No. 00 2-2 I I i: HigALTHSOUTH BAKEIRSFIELD REHABILITATION HOSPITAL 'UST CLOSURE 'REPORT 3 CLOSURE ASSESSMENT AND FIELD OBSERVATIONS 3.1 AST Installation Initial site activities included the preparation of the site for the new aboveground storage tank (AST), pouring of the AST concrete spill containment pad, and installation of the AST within the back-up generator area (Figure 2). The AST concrete pad was poured on August 29, 2003. Testing cylinders were poured concurrent to the AST pad for subsequent testing. Seven and 28- day testing were completed by BSK Associates. The 28 day compressive test meets the 2,500 psi requirements per the project design specifications. The testing data are attached as Appendix C. Photographs of the installed AST are provided in Appendix D, Photographs 1 and 2. 3.2 UST Excavation Bhate mobilized to the site on Sunday, September 7, 2003. Activities began on September 8, 2003, by Franzen-Hill Corporation, a contractor to HealthSouth, to remove the one 1,000-gallon diesel fuel UST. The following personnel were also present during the UST removal: · Steven Underwood, Fire Inspector, City of Bakersfield, Office of Environmental Services · Brandon Neal, Regional Director of Plant Operations, HealthSouth Bakersfield Rehabilitation Hospital · Scott Dolvin, Project Geologist/Field Manager, Bhate Environmental Associates I,? Initially, the tank contained approximately 200 gallons of residual fuel in the primary tank and about 175 gallons of a liquid in the annulus. The fuel inside of the tank was removed with a pneumatic pump and transferred directly to the newly installed AST. The residual fuel in the annular space was removed and placed in 55-gallon drums for disposal (Appendix D, Photograph 3). I 1 1 The piping from the generator to the UST was thoroughly rinsed with water and detergent, Biosolve®, flushing the rinse water into the UST for subsequent removal. (Biosolve®, is an emulsifier that solubilizes, emulsifies, and separates the hydrocarbons into exceptionally small micro-emulsions while surrounding them into the water based solution.) The tank and annulus were also triple rinsed with clean water and detergent. The piping and tank rinsate were then removed and placed in 55-gallon drams for later transportation and disposal. Approximately 15 pounds of dry ice was placed into the empty clean tank for evacuating the tank to inert status. The dry ice displaced the oxygen and potentially explosive vapors from the tank. The receipt for the purchase of the dry ice is included as Appendix E. Atmospheric levels for oxygen and lower explosive limit (LEL) were monitored by Bhate and were measured and verified by the City of Bakersfield Office of Environmental Services Inspector. These readings Revision Date: January 2004 Revision No. O0 3-1 Z;-[ O0 'oN uo!sp, o}I ~OOZ: Lmntm£ :m~(I uo!s.t~}I uo!loedsul iUel S'S oq ol poqlooms pm po[iddu SUA'~ duo lluqdsu luomoouldox V 'suo.tloo~.p old[llnm m. somB l~JOAos uocu~xuoxo POiiu oql sso:tou ~oq-4ouq oql 3u!,x.up ~q poAo.tqou S~aX m!S oql JO uo!loudmoo I~I · POllW4Ouq SUA'~ 1! s~ ootppuq oqljo lO>lonq oql 3u[sn possmdmoo ,(II~o!po.uod oJoax si!os poouldaa oql 'uOBUAUOXO oql jo soqouoJ ~axoI oql uI '(LI - 9I sqdu-t~oloqd 'O x!puodd¥) uo.q!sodmoo x~i.nm.s jo iu.uolum ii[Piouq iuuo.tl[ppu tll!A,~ 3UOl~ oiOq oql OlU! poouId s~ax uop. mqsaAO po,xoma}I · doop looj 8 XIolum!xo-tddg pm looj 0£ Xq looj 0i[ ,qolem!xo~ddu po.ms,om lid >Iml oqljo suo[suom!p leUg OtLL 'ponu!luoos.tp oq plnoqs uo.tl~Auoxo lmll 'omq[l pm poo~opufl ':tin ,~q poo:~u sug 1.t pm ponu!luoo sit. os op!s jo omI.mJ odolS · ssou-4o!ql u! soqou! 8 ol 9 ptm '3uoI looj 8 [ 'aP!,V' looj 0 [ Xlolum!xo:ddu S~A~ pud oououns Ot[L '[I!H-uozm&t ,~q Iusods!p soj al.ts oql moxj poAomoa su,~ s.uqop OtkL '(9 - ¢' sqdu~oloqd '(I x!puoddv) 0uoqo8) aools ppis IFms u ol poxgju ~ouramq ~IOU[ o!Inmp,~q u tll!A', dn-uo>Io:q s~ax pud oloaouoo ~u.ffFOAO otLI. · poddua ptm po33nld s~ gm.d!d reals.Ks £SFI OtLL 'fl x!puoddv sa punoj soo.~uo8 iuluourao .~Vm~t jo aa!!tO pio[ts:to>l~fl jo KI[D oql mo~ uo!l~o~t!UOD oanSOlD ZSfl oql uo pop:too~:t o:m xao a'd mmsoT) &Sfl 5'Vlld$OH NOIlV&YIIIIVH:I}[ Oq~lglt:t->lVfl' HlflOSHI"IWIH ,HEAJ~THSOUTH BAKERS,FIELD REHABILITATION 'HOSHTAL U'ST CLOSURE 'REPORT I' I' I'! 1 1 t ! loss, or product leakage were observed by Mr. Underwood or Bhate (Appendix D, Photographs 18 - 20). The interior tank was not able to be inspected. 3.4 Sampling Typical soil sampling required by the State of California for the closure of a UST is one soil sample from each end of the tank, 2 feet below the tank. There is no requirement for side wall or groundwater samples. Due to failed attempts to expose and remove the dead-man pad, and concern for site safety, soil samples were not collected as directed by Mr. Underwood. No discoloration or staining of the soils was visually observed by Mr. Underwood or Bhate. The tank coments (diesel fuel) were removed for re-use in the new AST. Annulus waste liquids and residual rinse from the tank and ancillary piping were removed and placed in drams on-site for disposal. Because all liquids removed were verified at the site or were classified as petroleum contact, analysis was not necessary to determine the contents for either the tank contents or the rinsate. Revision Date: January 2004 Revision No. 00 3-3 HEALTHSOUTH ]~AKERSFIELD REHABILITATION HOSPITAL UST CLOSURE REPORT This page intentionally blank. Revision Date: January 2004 Revision No. 00 34 ,H~ALTHSov~i B~Et~S~t~t~ REHABILITATION HOSPITAL UST CLOSUR~ REPORT 4 DISPOSAL 4.1 Tank After excavation, Franzen-Hill Corporation transported the tank to Tulare Iron and Metal Works in Tulare, California, for recycling. The receiving manifest associated with the tank is located in Appendix G. 4.2 Soil All soil was backfilled into the original excavation. No soil was removed from the site. As needed, additional soil from Vulcan Materials Company, Western Division, Bakersfield, California, was used for backfilling. This material meets the requirements of the California Standard Specifications for aggregate, Section 90-2.02 (Appendix H). 4.3 Rinsate Rinse water from the tank and piping was considered to be petroleum-contact water and was containerized in 55-gallon drams for later disposal by the contractor. The disposal manifest associated with the rinsate is located in Appendix I. Revision Date: January 2004 Revision NO. O0 4-1 HEALTHSOUTH .]~.a~ERSF~LD REHABIL~ATION HOSPITAL U'ST C~osva~ R~Poa~ This page intentionally blank. Revision Date: January 2004 Revision No. 00 4-2 i i i i HEAL~rnSotrrta BAK~RS~mLD REHABILITATION HOSPITAL UST CLosmu~ PmPoa~ 5 CLOSING REMARKS This report has been prepared for HealthSouth Corporation for specific application to the subject site. Information provided in this report is based on information obtained during the field activities performed by Bhate and subsequent.communications with involved project personnel and contractors. Future environmental conditions at the subject site can change due to future changes in operations and land usage. The opinions and findings of this report represent those conditions apparent at the times and dates, the work was performed. New regulations, changes in surrounding land use, altered geologic conditions, and other factors may also result in different future Conditions. The work described in this report has been prepared in accordance with current State of California, Kern County, City of Bakersfield UST regulations, and industry practice. No other warranty is implied or expressed. l; 1 Revision Date: January 2004 Revision No. 00 5-1 HEALTHSOUTH iBAKERSFIELD REHABILITATION HOSPITAL USTC. rosv~ 'R~vol~ This page intentionally blank. Revision Date: January 2004 Revision No. 00 5-2 ]~AKERSFIELD 'HOSPITAL 'UST CLOSURE iREPORT I IZ I I I I I I I I FIGURES I Revision Date: January 2004 Revision No. O0 Oregon P f \ x, ~. a¢,,c -x,h X.,B~akersfiel d z-,,~,x ~' ~ 2oo M,,e$ Ocean ~. '~$._~._~ .../- ~ ...... f"" .... ! ....... ': ............ ~~, ! ~" .... ~~~ ...... ~"7'?F ........ ~-~~~~~ 0 I 1 Mile ~ eZ~ Figure 1 ~ ~l~J~S.~ ---- SITE LOCATION "~ .EALTHSOUTH I. ~.AW. ~: Rehabilitation Hospital PROJECT NO,:I SCALE: DATE: E/zvJro~me~t~l ~bz~ers [l~g 5cJe/zlJ~ts F~LE: SSD Bakersfield, CA 9030082~ SHOWN 12/15/03 9030082-01.01 '_j ///////////////////// MAIN FACILITY )NCRETE WA ABOVEGROUND STORAGE TANK ir AST PAD CONCRETE SURFACE STORAGE SHED ~--- BACK-UP GENERATOR ~X X ~X ~X X FORMER UST CONCRETE UST PAD ASPHALT DRIVE AND PARKING NOTE: ThI~ Informoflon Is depl~ed 1o provide visu,I old wlfhln tho oontoxt of this mpor~ and should nor be u#d om a sole ~fe~noe In p~lme dlmonMonlng of feature= Indlo~ed. Pleas verify ~ Iooaflon of all fJ~umJ. Inoludln~ undJ~mund and abow~mund ~lllfl~. prior any ~ubJu~a~ ~pIo~lon. LEGEND FACILITY WALL FENCE SITE MAP UST LOCATION AND AST AREA PROdECT NO. J SCALE 9030082J NTS j~ JD~ ~: SSD J %oo82-o .o -o HEALTHSOUTH REHABILITATION HOSPITAL SITE LAYOUT BAKERSFIELD, CALIFORNIA FIGURE 2 I I HEALTHSOUTH BAKERSFIELD I~_~!tABILITATION HOSPITAL 'us'r CLOSURE REPORT 1 I I .I 1 .1 I I APPENDIX A FRANZEN-HILL CORPORATION UST INTEGRITY TEST (OCTOBER 28, 2002) Revision Date: January 2004 Revision No. O0 Appendix A I r:l~ranz~n.,l'llll Corporation,'"'. '~ 1!00 NORTH J 8TREET TUI_~.RE, CA 93274-t939 (559) 688-2977 Fax (569) 688.1467 BILL TO: HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL 5001 COMMERCE DRIVE BAKERSFIELD, CA 93309 CUS'~'~'MER it: 35306 INVOICE it: 82467 INVOICE DATE: 10/29/02 DUE DATE: 11/28/02 LOCATION: HEALTHSOUTH BAKERSFIELD 5001 COMMERCE DRIVE BAKERSFIELD, CA WORK ORDER NUMBER: ~110760 YOUR REFERENCE NUMBER: PO#2479374 SB-989 Testing. 690.00 N TOTAL QUOTE: 690.00 '~" TOTAL: 690.00 ,I REQUEST: SB-989 TESTING TURBINE ANNULAR SPACE SECONDARY PRODUCT LINEHAzARD DRUM FILL SUMP CITY OF BAKERSFIELD FIRE PERMIT iUOTED PRICE $690.00 'm~ESOLUTION: Did SB-989 Testing: AnnUlar passed. Secondary not tested-no test boots, metal Sump, ~etal coupl'er. Sump not tested-free standing productTno secondary boots. Metal sump needs to be replaced per Steve inderwoo~ City of Bakersfield Fire Dept. Tested 10/28/02 ,I RECOMMENDATION: Metal sump needs to be replaced, needs boots. mill write up work plan and quote for customer. i" i i De~. 05 02 08:37a Franzen-Hill Page: 1 of:, 7 Consfl'uction, Maintenance & Testing for Fueling Facilities & Lubricating Systems Secondary Containment Testing Report Form '.liFac,ity Name: · HealthSouth JlFacllity Address: 621 Golden State J F~cility Contact: ! D~D-ate Local Agency Was Notified of Testing: I[Name of Local Agency Inspector Present: FACILITY INFORMATION I Date of Ir~1-323-s500 Bakersfield we# 10/28/02 2:00PM 110760 2. TESTING CONTRACTOR INFORMATION Company Name: Franzen/,HilloCorp. Tulare, Ca. Technician Conducting Test: Credentials: v' CSLB Licensed Contractor DSWRCB Licensed Tank Tester License Type and #: A,B, C-611D40 HAZ Lic# 304147 . Training by Manufacturer Manufacturer Component's) Date Training Expires Environ, APT Piping and Testing smith Fiberglass, EBW Piping and Testing Total Containment, VeederRoot Piping and Tesling .Econ, Gilbarco EMC, Monitor System Piping and Testing 3. SUMMARY OF TEST RESULTS Num[3-er of Tanks Tested:` ! Number of Piping Runs Tested: f '" Number of Submersible Pump Sumps Tested: / Number of UDC Boxes Tested: ~U_?..b?. o_f._,F.i!l_..S_u.m_P_S_S Tes~?.,d.! ...... .~.. ' .................... Number of Overfill_Box, es Tested: __~ ........................ c°mponant Pass Fall Commen'm .... o n [] [] 0 [] [] [] ....... [] 0 n [] 0 - [] [] .I .I .I Technician's Signature: · Customer Signature: 2080 South Union Ave, Bakersfield, Ca. 93307-4154 PH. 661-834-1100 FAX 661-834-4216 www.franzen-hill.com :1 Page: 2 of: 7 p.3 i i 4. TANK ANNULAR TESTING ye.st Method Developed By: m~ Tank IMarlu[aotuifll~r ~lndustr~ Standard F3 F~ue-~lonal Engineer 1'3 Other (Specify) .... 1'est Method Uses: "' [] Pressure ~,~acuum F'i Hydrostatic [] O~her (Specify) Tank Capacity: I~) 0~,' Tank Material: Tank ManUfacturer: Product Stored: D,,'~' ~ Wait time applying pressure/ vacuum/water and starting test I -]~.. ?~ ,- Test Start Time: Test End Time: =inal Reading (Rf): I~ _ rest Duration: iChange in Reading (Rf-Ri): ,~ ~ 0 fVas sensor removed for testing? /v'~ .. ~Vas sens°r properly replaced ~fter testin, g? ..... i i i i i i Ce~_ m_e .__n~-(include information on repairs made prior to testing) i SWRCB I I Page: 3 of;. 7 5. SECONDARY PIPE TESTING Test Method Deveioped By: [] Tank Manufacturer [] Indust~J Standard I-I Professional Engineer i-i Other (Specify) Test Method Uses:" [] Pressure I'3 Vacuum [] Hydro~a[;c [] Other (Specify) Measuring Equip. Used for Testing: Piping Material:: Piping Manufacturer: PiPing Diameter, i .... Length of Piping ,.R. un: Product Stored: Method and location of piping-run isolation: ~/ait time applying pressure/ ......... vacuum/water and starting test ' ~'est Start Time: ... i~iUa~ Reading (..Ri,): .... Test End Time: Final Reading (Rf): .......... T~st Duration: , , Change in Readir{g (Rf-Ri): ,,, Pass/Fall Threshold I I I I I I information on repairs made prior to testing) I I i I I I SWRCB I. ,I]ec, 05 02 OS:38a Fra~}..~en Hill 55S6R81467 p.5 Page: 4 of: 7 6. SU_RMI::RSIBLE PUMP CONTAINMENT SUMP TESTING Test Method Developed By: [] Tank Manufacturer []'i'ndustl3/Stan~ai~ [] ProfesSional Engineer CI Other (Specify) :est Method Uses: [] Pressure CI Vacuum [] Hyd'ros[a[Ic [] Other (Specify) ~leas~ring Equip. Used f~r Testing: Sump Diameter:. ~u.m, _P Depth: ..... Sump Material: Height from Tank Top to Highest Piping Penetration: Height from Tank Top to Highest Electrical Penetration: Conditi0 ,n of ,sump prior to testing: Portion of Sump Tested (¶) DOes turbine shut down when sump sensor detects either 3roduct or water? ]'urbine shutdown response time(2) Is system programmed for fail-safe ~hutdown? b~as fail-safe verified to be 3perational? ~ait time applying pr~sure/ ~um/water and starting test: __ Te ,s_LStart ~.est: /' .... Initial Readim~ (Ri):' / ,. Test End Time: ........ /' ,. Final Reading (Rf): / Test Duration: //' Cha, nge in Reading (R~-Ri): Pass/Fail Threshold W~ sensor removed for testing?'' Ii-/ I "I .......... Wa..,s sensor replaced"after testing? ~1 / ' , .... I- .I ,I. Comments-(include Information on repairs made prior to testing) t t~ang ~e ~[ire sump s~uld only ~ ~ E ~ ~ng s~t~ provides Aa~ve ~ne ~u~. 2~ ~e submemlble p~p mnn~, pA~ ~e s~ In ~duct (~s~mlna~ng ~m s~M al~ ~ pla~ In ~ter). ~e ~e helen placing ~e s~ in pm~ and ~ ~J~ shuffing d~ is ~e ~ ~e. ~ ~uld be done If · e s~nda~ ~n~inment ~ang me~ ~d d~ not ~ the ~are vol~e of me sump SWRCB ,Dec~ 05 02 09:3Ba Fr-a~,en Hill 559688146? p.6 Page: 5 of:, 7 T. UNDER-DISPENSER CONTAINMENT (UDC) TESTING *rest Method Developed By: [] Tank Manufacturer [] Industry Standard [] Professional Engineer I-1 Other (Specify) Test Method Uses: [] Pressure [] Vacuum r-I Hydrostatic [] Other (Specifij) Measuring Equip. Used for Testing: __ ~ UDC # LJDC Manufacturer: LJDC Material LIDC Depth: ........ Height from UDC Bottom to Highest Piping Penetration: Height from UDC Bottom to Lowest Electrical, Penetration: Condition of UDC prior to testing: · ,,,, Portion of UDC Tested (.,t.) Does turbine shut down when UDC sensor detects either 3roduct or water? Turbine shutdown response time(2) Is system programmed for fail-safe shutdown? Was fail-safe verified to; be operational? Wait time applying pressure/ vacaum/water and starting test Test Start Test: Initi~-I Rea'ding (Ri):~ Test End Time: Final Reading (Rf): Test Duration: Change in Reading (Rf-Ri): Pass/Fail Threshold Was sensor removed fo~'testing? · I Commenls~include information on repairs made prior to testing) .I '1 If the testing method does not test the entire depth of the UDC, specify how much of the UDC Was tested. Methods not testing the entire UDC should only be used if the monitoring system provides fall-save lurblne shutdown. 2 With lhe submersible pump running, place the sensor In product (discriminating sensom should also be placed In water). The lime between placing the sensor in product and the turbine shuffing down is the response time. This should be done if the secondary containment testing method used does not test the entire volume of the UDC. SWRCB i i i · Deo 0'50~ 0~): 3Ba Fr~.~?!~.en Hi 11 55.~:~,~Bi~67 Page: 6 of: 7 8. R__LI- RISER CONTAINMENT SUMP TESTING Test Method Developed By: [] Tank Manufacturer r-1 Indu'~try' Standard [] Ffoi'essional Engineer [] Other (Specify) Test' Method Uses: [] Pressure [] Vacuum I"] Hydrostatic [3 Other (Specify) Sump Diameter:: .... Sump D~pth: ' Height from Tank Top to Highest Piping Penetration: Condition of sump prior-to testing: ..... Portion of Sump Tested ' ~ump Material: ,, ,Wait time applying pressure/ vacuum/water and starting test: .... ITest Start Test: Initial Reading (Ri): ..... I'est End Time: Final Reading (Rf): .......... Yest Duration: C,,,hange in Reading ,(R~-Ri): . , Pass/Fail Threshold Is tl~re a.sen, sor in ihe sump ...... Does the sensor alarm when either product or water is dectected? Was sensor removed for testing? ,. Nas sensor replaced ~fter testing? ..... p.? I I I I C~.mrne~tflF(include information on repairs made prior to testing) t I - 1 SWRCB · I)~C' 05 02 0S:39a :::::::::::::::::::::::: Hill 559~.?~.B1467 p.8 Page: 7 of: 7 9. SPILL/OVERFILL CONTAINMENT BOXES T-est Method' Developed By: [] Tank Man'ufactumr I-I IndUstry Stand';rd a Professional Engin'e~' ~' [] Other (Specify) Test Method Uses: C] Pressure [] Vacuum [] Hydrostatic [] Other (Specify) Bucket Diameter: Bucket Depth: , .... Wait Ume applying pressure/ vacuUm/water and starting test Test Start Test: Initial Reading (Ri): .... Test End Time: .,. Final Reading (Rf): T~est Duratior~: ' ,Change ir~ Reading (Rf-R~: F~ass/Fail Threshold Cemments-(include information on repairs made prior to testing) .I SWRCB I:~Y FILES~FORMS HEALTH$OUTH ]~AKERSF~LD REItABILITATION HOSPITAL 'UST C~os~ bI I I PI I APPENDIX B BSSR MONITORING SYSTEM TEST (DECEMBER 23, 2002) Revision Date: January 2004 Revision No. 00 Appendix B I BSSR, Inc ' 6630 Rose. dale Hw::.:fi(:g 13, Bakersfield, ,CA 93308 Phone (661) 2.'~,~-2777 Fax (661) 588-2786 " MONITOR G SYSTEM CERTIFICATION Thi~ form m~t be used to document testing and servicing of monitoring equipment. A s~arate c~rtification or reoor~ _~re0ared for each monitorine swaern control._~el by the technician who performs the work. A copy of this folm must be provided the tank system owner/operator. The owner/operator must submit a copy' of ~ form m lbo local agency regulat~ UST ~'lm witMn30 days ofte~ date .... . ... I . A. General Information Maim/Model of Monito 'TLS-,~ 50 7oqo- O211 Date of Tcel/n~el~icin~: B. InventOry of, E.qu/pment Tested/Certified, . . ' - · -, ~ .. . _....~ '- ,.=-=?;.. . II~in-TankOa~ingProbe. - ' ~ ln;TankOa~.Probc. -- '. M0dch ' ':, '-r:,' ~ ;Annulm; Space or Vault Sensor. I:i'An~uhr $1~ce of Ya~it Sansor. Modch.. '; "-:'~,,: · t.; · ~ .l~Piping Sump I Tr~noh Se~. s), Model: " ~ Piping Semp/~ Sanson(s). -Model:' ' ' ' C. :- ! ~i ' ~ Fill Sump Se~sof(,).' Model: '' ~ l~ll $~-np ,~msof(,~ Model: - ' '.-:" - "',-,:7'.~ I~' ~ Blecironic Line Leak Delecim'. Model: ' I:l F.,lecimnlc ~ Leg¢ Detector.' Model: -. -..- n Tmtk Ovedill t ltigh-l. Kw. d .%mo~-. Modd: . rt Tm~ ~ 1ltlsh-~' Semor. Model: .... ': Tank ID: '-' .Ta~. ID£; ' .-. ' ' ............ "'~"' ....~:"-~..~'~' " CI h~-T~k Oa~ing Probe. Model: ~ In-Tank Oa~ins l~be. · Model: -. - '- "- .' ';-'-.. O A~nular Space or Vault Sen,sot. Model: "'. 12 A~n~lar SliCe of Va~ll,%nSOr.'. Model: ~ Mechanical Linc Leak Detector. M~xlel: O Mechanical LineLeal~Detector.' ' Model: ...... ...'. O Eleclmni~ Line Leak Defacer. Model:. I:! Bte,~-oalcL~cLeak D~_.-,~_-~. Model: ' ~[[ Cl Tan~..erfili ./.Hig~el Sensor. Model: I:! Tank Overfill I I-!Ij~eh-Le~"Scnsor[ Model:" i[[ O Other(s~clfg-t~uipgentt,~eandmoddhSectiouBonPagc2~., ,O Othcr~sl~gfycqui{mtagtyp~andmodalin,Sgcttoa'liouPaga2). . ~ ! CI Dispenser Containment S~r(s). Model:' U3 Dispenser Cot~_~t Sensor(s). Model: ' , O Shenr Valve(s). ' .O Sl~ar Veivc(s). Dispenser ID: · , ,Diqastser. i~ , * : ~ O Dispenser Conteinment $~nsor(s). Model: . O D~ Ccotainmmt S~s0r(s). Model: . I .O Sheer ¥~v~(s). * ' ' O. ~h~ 1:3 Dist, e~d ~ .Co.ntainment l~,o,a~s) and C~, (,). . 1:3'~ ContainS, i Float(,) and Chain(.}. . ~ ~ Dispeaser ID: .. Dispenser ID: i i:3 Dispenser Containment Sensor(e). MOdel: C3 Dispenser Containmeht Sensor(s). Model: . , . C)'Shear Valvgts). ' O Shear Valve(s). ' . rlOis~.ser Coniainment Float(si and Chainfs). ' ' · Cl, Dispenser Containn]~n, t Floats) and, Chain(s):, ,, - '' · ff the f~cility con'tain~ mole t~G or ~fi~ copy this form. Include information for evct~ tank and dispansof st the facility. C. Certification - I certify ~at tae equipment Ideatifled in tha document was inspected/servked In accordance with the. manufacturers' guldeffnes. Attached to thb ~ou is Information (e~ manufacturers' checkli~) necessary to veri~ thst fids ·, Information is correct and t Plot Phn showing the layout of m.oultoring equipment. For any equlpmeut capable af gcoer~thtg tach I ,ports, I have also a~ed a ~!~ ~f the r~por~ (e./,~ _~ ~ ,v,p0'): ' .12 Sl!Lem .sei-~p,., Ci~Usrm histgrY report . -' ~ · ' ' · 't. . Ceni. 'ficagon No.: 0C)O '" 0.~ ! ._~ ~"~ ' License. No.! I - · ' Page I of 3 02/01 Monitoring System CertificatiOn '1 ag/Servicing s .the_ n,;~le s!.a. nn o~er~oual? .s. the y. isual alarm operational? ~ere all sensors visually in~ectK1, f~cti.onally tes. ted~ end ¢ontlrm~ Opera.tional? ~ere all sensors installed at lowest point ofsecondery conteinment'and positioned so thai other cquipm .ent will ~ot interrcr~ with their prier.operation? - alarms ar~ relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~pl,n'ational? l~or preaa'tuized piping s~tams, does the ttubine automatically shut down ff the piping secondary containment monitoring system d~-t3 a leak, fails to operate, or is electrically disconnect~l? If yes: which sensors, initiate Imsitive shut-down? (Clt~ all that apply) ~ Smag/Tr~ S~nsor~; .Did YOu confirm positive shut-down due .M. leaks and sensor failure/disconneciioa? C] Ye~ ~! No. For tank systc, ms that utilize thc ni.'(mimring ~ 'as the prin~y.. ~ over, il wam~n~ device (i.e. no mechanical ovcrfin prevention valve is installed), is the overfill wam,n~ alton visible and auch'ole at. the tank fill~in,(s) ~nd op~re~ ~opal~ Itsn, _at what percent,of tank capacft~ does th~ alarm trigger? % Was_liquid found tnsida a~ secmula~ co~_~t~mnnt ~ deaign~ as dry ~? (Oreck all t/tat ai~ly) · Was m_m,'.,~_~rlng ~ s~t-up tmiawed to emur~ proper settings7 Altach set up t~rts, if applicable . . Is all mnn~tnrlna eo,~in,r~,,t ~rm*! l~r niannfacan~'S specificalions? ~ deserll~ how and wh~m Oaese deficlen, des wer~ or will be eo~ .: Page2 of 3 ~ ., 'E. ~Y)-Tank Gauging / SIR Eqmg..ent.' '"'"'"' ' O Check this box if.taal?':'iii!aging is used only for inventory control. '~. O Check this box if no tar~ gauging or SIR equipment is installed. iTl'tis section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the foHowing checklist: ' Cia'Yes ~ No* Has all input wiring been inspected for proper entry and termination, including testing for ground faul~s? - ~l/Yes [2 No* Were an tank gauging probes visually inspected for damage and residue buildup? - [W'Yes ~ No* Was accuracy of system product level readings tested? - [~]~t'es ~1 No~ Was accu/.acy of system water level readings tested? '" I~,~es ~! No* Wore all probes r~installectprop~rly? ' _ {]~l~/'es [~ No* Wer~ all items on the equipment manufacturer's mainteaance checldist ¢ompl~ted? · "~i G. LhleLeak Detectors (LLD): [a~'~this boxffLLDs m-o not installed., *- checklist: ~ N/A (Clieck all that apply) $imulatedleakrat~:'[2 [2 Yes [2 No* We~ all LIDs confirmed operational and ac, oura~ [2 Yes- I~1 No* Was the testing apparatus properly cah'bramd? [2 Ye~ [2 No* FormechsnloalLLD~,doestheLLDrestrictproduotflowifit&,it.'¢tsaleak? ~ N/A [2. Y~ [2 No* Forelecironicr.r.r~s, doestheturbineautomatc.~llyshuto~if~'eLLDd~t~leak? ~ NIA · [2 Yes a No* For elecfroni¢ LLDs, dues th~ turbine antomafically ~hut off if any p~rtio~ of tl~ moai~ sy~em is.disabled. " ,~l N/A or discom¢cted? .. ~] Y~ ~ No* For electronic LLDs, does the' tarbine automafic.~lly shut eft if' any portion of ~ monito~ ~'stem '---~ N/A malfun~dom or fails a test? [2 Yes '[2 No* For electronic LLDs, have all a¢cesa'ble wiring ¢mme~t/ens besa v/sually inspe~ed? '[2 Yes [2 No* Were all items.on the equ/pment manufacturer's mahtenanco ch~ldlnt completed? ....... ,.. '..' .,.: ....... . describe how and when these deficiencies were or will be corrected. · H. Comments: 'l ' t 'l Page 3 of 3 03/01 Monitor/rig System Cert/flcaflon UST Mo~toring Site Plan Site Ad&~s: ~ ~ ~ ~0 ~,D~ ~ ~f ~ ~,xo~ ..... - ........ '...' . ~ . ."...' .': · · .' .... '.' - ' ....... '-". · · '- .................. ~~.,~-~~~. . .......... . ........... .......... -.. ...... ~. .... ~,~c~ ..................... ~.~.~ w., ~ ~_.,~___/~/o'~ .. If You 'alread~ have a diagram that. shows all required information, You may inolude it, rather than this page, with your Monitoring System Certifioation. ' On your site plan, show the general layout of tanks and piping. Clearly identify lbcat/or~ of the following equipment, if installed: monitoring system oontrol panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill.containers, or other secondary containment areas; mechanical or electronic linc leak' detectors; and/n-tank liqu/d level probes (/fused for leak detection). In thc space prov/ded,.notc the date this Site Plan was prepared. 05100 Page __ of__ :1 HEALTHSOUTH BAKERSFIELD REHABILITATION 'HOSPITAL UST CLOStmE 'REPORT APPENDIX C BSK ASSOCIATES CONCRETE CYLINDERS TEST- AST PAD (NOVEMBER 26, 2003) Revision Date: January 2004 Revision No. 00 Appendix C I ;i :/ ! I I I I I Dec 11 03 08:40a BRANDOM NEAL 6616335253 Contact: School District; Address: 11 7 "V" Street Bakersfield, CA 93304 Mr. Brandon Neal Health South Rehabilitation 5001 Commerce Drive Bakersfield, California 93309 OSHPD #: F, eport Date: BSK Project No.: $s031341-1,5 11/26/2003 c0349860B SUBJECT: Project: Structure: Date of Pour: Area of Pour: Concrete Cylinders Set No. CB203285 Health ~uth Rehabilitation Hospital Fuel tank; slab and curb August 29. 2003 Center of stab S~r~ (pa) Smg~h (pa) (pounds) 09/05/0~ 7 1,72~. CM 6 28,27 48,500 " 09/26/03 28_ 2,830 2,$00 CM 6 28.27 0g/26/03 28 3,040 2..§,00 CM 6 98 97 86.00O Hold Time ,~mpled' 9:4E, AM Sampled by; K. Wall Date Delivered: Delivered by: K. Wall Materials were; Mix No.: 3425054 Cement Content~ Supplier;. Vulcan Invoico No.: 941009 __x_ Sampled and tested Not sampled and tested Slump: ~ /Ur Content; N/A Concrete Temp: 84° Air Trap; 80 Name: Signature: Results ~f Ihe t~st~ were; __X_ In f. ompllance Not in compliance Project Inspector. Enforcement Agency: Date: 11/26/2003 Don $hetters Offers. r~ Rtate. wlde He,flth Planning & Development Geotechnical Engineering · Engineering Geolo~, Environmental .~vlces · Conslrudion Inspec~n & Testing, A~alyttcal YesUng 12/11/2003 TI]U 10:37 [TX/RI NO 8308] .HEALTItSOUTEI BAKERSFIELD REHABILITATION HOSPITAL UST CLOSURE REPORT I I I I I I I I I I :l I APPENDIX D SITE PHOTOGRAPHS - UST EXCAVATION AND REMOVAL I Revision Date: January 2004 Revision No. O0 Appendix D !~EALTHSOUTH BAKERSFIELD REHABILITATION I~'OSPITAL UST CLOSURE REPORT I I I I I I I I I I I I I Photograph 1. Side view of newly installed AST Photograph 2. Side view of newly installed AST with generator Revision Date: January 2004 Revision No. 00 ~-][EALTHSOuTH ~AKERSFIELD ~EHA3ILITATION ~'OSPITAL UST CLOSURE REPORT I I I I I I I I I I I' I I Photograph 3. Removal of residual fuel Photograph 4. Initial breaking of concrete pad Revision Date: January 2004 Revision No. O0 I 1 EIE~LTUSouT~-I BAKERSIFIELD REH:~m~T:~T~ON HOSP~T:~L I[JST CLOSURE REPORT I I I I I I I I I I I I I I I I Photograph 5. Breaking up and size reduction of concrete pad Photograph 6. Stockpiling of concrete pad for disposal Revision Date: January 2004 Revision No. O0 1 [-[EALTHSOUTH BAKERSFIELD lt{EHABILITATION I[q[OSPITAL lUST CLOSURE REPORT I :l Photograph 7. South sidewall of UST excavation Photograph 8. North and east sidewalls of UST excavation Revision Date: January 2004 Revision No. O0 HEAL't H$OUTH BAKERSFIELD REHABILITATION HOSPITAL REPORT I: I: I I I I I I I I i I I I I Photograph 9. Side excavation showing caving and exposure of sewer line Photograph 10. Side excavation showing caving of sidewalls Revision Date: January 2004 Revision No. 00 HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL CLOSURE REPORT I I I Ii I I ! I 11 I Photograph 11. Side view of UST with strap cut Photograph 12. Side view of UST with straps cut Revision Date: January 2004 Revision No. 00 t[-][EALTHSOUTH BAKERSFIELD REHABILITATION ~OSPtTAL I[JST CLOSURE REPORT I I' I I I I I I I I I I I I Photograph 13. Excavation of side wall overburden Photograph 14. UST removed from overburden Revision Date: January 2004 Revision No. 00 I; [-[EALTHSOUTH BAKERSFIELD REHABILITATION ~IoSPITAL UST CLOSURE REPORT I I I I I I ! I I I I I I I I Photograph 15. UST removed from excavation o Photograph 16. Overburden stockpiled Revision Date: January 2004 Revision No. 00 ! I I~IEALTH~OiUTH ~AKERSFIELD ~EHABILtTATION ]~-~OSPITAL CLOSURE I I I I I I I I I ! I I I I Photograph 17. Overburden stockpiled Photograph 18. UST sidewall visual inspection Revision Date: January 2004 Revision No. 00 I[q[EALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL lUST CLOSURE REPORT I I I I I I ! Photograph 19. UST sidewall visual inspection Photograph 20. UST sidewall visual inspection Revision Date: January 2004 Revision No. 00 HEALTH$OUTH BAKERSFIELD REHABILEFATION HoserrAL U'ST CLOSURE REI~RT ,I .I .I APPENDIX E RECEIPT FOR DRY ICE Revision Date: January 2004 Revision No. O0 Appendix E [IIRR O~ 'X]~l/Y~] ZU:ZI II~lz[ }OOZ/9I/IO :1 ILINE FRANZEN-HILL CORPORATION 1100 NORTH J STREET TULARE, CA 93274-1939 (559) 688-2977 Fax (559) 688-1467 VENDOR: JACK FROST ICE SERVICE INC. Al-TN: TIRACY P.O. BOX 843 MODESTO, CA 95353 PURCHASE ORDER P.O. #: 1223945 P.O. DATE: 09/10/03 VENDOR #: 0678 JOB #: 030111 PHONE: (209) 264-7615 FAX: (209) 264-0868 SHIP TO: HEALTH SOUTH ATTN: HEALTH SOUTH 5001 COMMERCE DRIVE BAKERSFIELD, CA 93309 P.O. NOTE: HEALTH SO. SHIPPING INSTRUCTIONS: WILL CALL DATE REQUIRED: 09/10/03 F.O.B. POINT: Tulare, California PURCHASER: KEN IMOTO PAYMENT TERMS:" COD ITEM # DESCRIPTION QUAN UNIT PRICE/UNIT AMOUNT3 m i ! ! ! ! ! ! 1. GRDDRYICE DRY ICE 09/11/03 (KEN IMOTO) - MARK FOR 030111 HEALTH SOUTH ~.9i~ 18896~qq 30.00 LB 0.950/LB TOTAL: Il TH uazueJ-i eB~, :OI 28,50 28,50 ue[' I I I I tOOg/9I/IO FROsT ~V,c~-~-- P^'rE o ?'-/~-~ ADDRESS .300~ BLOCK BLOCK 7# BAGS 20# BAGS 40~ BAGS TERMS: Net loth Prox. A finance c~large of 1-1t2% per month (Annual Rate 1B%) will De charged on all balances not paid by 1~1e 25th of the rno~lth. Minimum finance charge CUSTOMER COPY I I I I Lgi~, 18896c;c~ Il.tH uezue-'=l e6t, :OI ~0 '9 1 ue~ 1 ~ALTHSOUTH BAKERSFIELD I~EHABILITATION HOSPITAL UST CLOSURE REPORT ,I ,I I I i APPENDIX F CITY OF BAKERSFIELD UST ATMOSPHERE TEST (SEPTEMBER 8,~2003) Revision Date: January 2004 Revision No. 00 Appendix F Nov 06 o3 01:50I° ...... Fr-anz~n Hi1! 5596881~B? .. _. CITY OF BAKERSFIELD-.., OFi . £E OF ENVIRONMENTAL SL ..VICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS CLOSURE CERTIFICATION p.3 I.FACILIT~ IDENTIFICATION TANK OWNER NA~IE ' TANK OWNER ADDRESS Page or 7~0 74.1 TANK OWNER CITY 742 · STATE 743 ZIP CODE 7,~ II.~TANK CLOSURE INFORMATION i Tank ID # Concentration of Flammable Vapor I Concentration of Oxygen (Attae~ addlO4~ g=~ll~ of ~/spage ' 745 7468I ]746b 746~ ; 7418 747b 747c ..... 7~8 ?4ga }'49b : 749c , 750a 7~ 750c 2 ~ ]51 ! 752aI 7521~ I 752.c ! '753a 753~ 753c. ; 3 : I I. '.' . . . . :-.?/.~.:..;~.~,...~.~,:-;~.%?:~,:~...~&:~¥~.~:~?J~;~.~:~`:~c~-:~J-~[~..~G.`E~J~77~."~::~:;-~:.~:~:J~`~:~TM ";,;'...' .... Un examinaUon of the tank, I cerlffy the tank Is visually free fram product, sludge, scale (lhin, flaky residual of tank contents), dnseato and debris. I fudher certify that ~ informa~on provided herein Is lrue and accurate to the best of my knowledge. S,~NATU~aO~'CER~,r~..__ ------ ~ , STATUSO.~.,^T,O. O~ CE.T, PY~N~ PERSON ~,~j~,~. ([/./~~/. Certifier is a representative of Ihe CUPA, ,u[hodzed agency, or UA: NAME-~gCERTIFli:A~P~0 Z~4 V' Yes CI No TANK INTERIOR ATMOSPHERE READINGS Name of CUPA. authorized agency, or LIA: I/ City of Bakemfleld~ Flee Department - Office of Eaviromnenial Services If certifier Is other than CUPA / LIA check appropriate box below:. I-1 a. Certified I~lusbtal Hygienist (ClH) Bakersfield, CA 93301 ~-~ PHONE (661) 326-3979 ~ss DATE ?s~ I CERTIFICATION TIME FLAMMABLE OR COMBUSTIBLE MATERIALS TANK PREVIOUSLY HE LD '" (ff yea, the ~ank In~rior atmosphere ~hell be re.d~ec, ked v4~h a ¢omb~ble gas k~cEca~ prio~ to work being ~mductod on the tank.) Ob. Dc. Od. Oe. Of. Certified Safety Pmfesslenal (CSP) Cedlflad Marine Chemist (CMC) Registered Environmental Health Specialist (REHS) Professional Engineer (PE) C~ass I! Registered Environmental Assessor Contractors' State License Board ficensed conlrac/or (with hazardous substance removal certification) CERTIFIER'S TANK MANAGEMENT INSTRUCTIONS FOR SCRAP DEALER, DISPOSA,., ,',CILITY. ETC. 761 762 '~Yes 1'3 No 763 A copy of this ced/flcata shall accompany Ihe lank to the recycling I disposal facility and be IXovlded to the CUPA. If there is no CUPA, 764 ~ ! [ copies shall be subrntffed to the LIA and authorized agency;, owner I operator of Ihe tank system; removal contmct~, and the recycling I disposal facility. PCF (7/99) 11/06/2003 THU 15:53 S:~CUPAFORMS~dtS¢1249.doc {TX/RI NO 77641 HEALTH$OUTH BAKERSFIELD REHABILITATION HOSPITAL UST CLOSURE REPORT APPENDIX G i TULARE IRON AND METAL WORKS UST RECYCLING RECEIPT i (SEPTEMBER 11, 2003) Revision Date: January 2004 Revision No. 00 Appendix G i ~ ov06 03 Ol:50p Franzen Hill 5596881467 Franzen-Hill Fueling Facilities System Design, Construction & Maintenance California Licensed Contractor No. 304147 September 10, 2003 Tulare Iron and Metal Works 3615 south "K" Street Tulare, CA 93274 The following gasoline tanks have been taken to Tulare Iron and Metal for recycling and disposal: Job No. 03-1111 1 '! I I .I HealthSouth 5001 Commerice Drive Bakersfield, CA 93309 (1) 1,000 Gallon Tank Tulare Iron and Metal have accepted the above listed tanks from Franzen-Hill Corporation. 'Tu~ I;~;n and Meta~ works eh-Hill ~.,or13o ration Date: September 11, 2003 1 ,! 't ,I I -! 1100 Nortl~ J Street. 'l'ulare, California 93274 / 559-688-2977 / 800-655-3436 / 559-688-1467 FAX ~,-ww. franhilLcom / franhill@lightspeed.net 1110612003 THU 15:53 [TX./RX NO 7764] HEALTHSOUTH BAKERSFIELD REHABILITATION HOSPITAL UST CLOSURE ~EPORT -I ,I APPENDIX H VULCAN MATERIALS COMPANY AGGREGATE QUALITY CERTIFICATION (DECEMBER 3, 2003) Revision Date: January 2004 Revision No. O0 Appendix H '1 - ; .I ,I 03 11:42a Franzen Hill 5596881487 From: unknown Pa_.ge: 2/2 Date: 12/3/2003 3:30:33 PM gui[an Materials Company Western Division ContracLor; Project: Date of Project: Franzen Hill Co. Health South Truxtun Ext. ' September 8, 2003 Date: December 3, 2003 To Whom It May Conoem: This letter is to certify that we supplied material to the above-mentioned project that conforms to the specifications as set out in section 90-2.02 of the California Standard Specifications. This section states that aggregate must be free of deleterious coatings, clay balls, root;s, bark, sticks, rags and other extraneous material. If you have any questions, or if I can be of additional assistance, please do not hesitate to call. Respectfully submitted, Don Thomason Quality Control Representative 661 835.4800 ext. 2254 BOX 22800 e BAKERSFIELD, CALIFOR N IA 93390 - TELEPHONE 661 835-4800 'i This fax was received by GFI FAXmaker fax server. For more informaUon, visit: http://www, gfi.com 12/04/2003 THU 13:45 [TX/RX NO 8184] HEALTHSOUTH BAKE~F~ REHABILITATION HOSPITAL ~UST Ccos~P~ P~vo~ .! r I APPENDIX I LIQUID WASTE AND RINSATE DISPOSAL MANIFEST Revision Date: January 2004 Revision No. 00 Appendix I -! GGIG335253 27 O~ 07:2Ea BRAMDOM NEAL FROM : COLE' S SEt;~,J ICES ! NC FN~X NO, : 661-322-8883 ~u~ ~ ~ I~'~""~*~''~' ' ~ ~"~"~ c ,~' ' ~ % '~i~[ z "~' ;,; ........................... · I ' ' ~1 ~'q~e' "'f": "':' : "· '~"" ~~'~' ~''''''' ~1 ~ /":'".. .'.' ~':;::'?' ~',~ .:',': . :' :. ': ::i'~-?:' ~. :¥: ~ . :.' . ':~,?'"'>:.:..,,,, ~ ',0.;~.:4,~'::,~.~,~/;~ ~ ~;~:~',~:~,:fi}:,:.'~ ', '. :. ', :,, .. 0 ........ :... ' .'.L · ...... "~ - zI ' I'i'c'4 ,.. I . '/ ' ~1i~lb..:~:~-',"/, ;~/~C~/~. I ' ~' c~t)Ul~, tntJi~utlun I L .... '' ' tt~ ................... ~ ......... ~ , .... , , ., '. ;~ , ~':~ ,.:' , I ~. Tatal 16. G~NCtI,n.~ 0~"-~ CC(¢TIrlC~'SlONs t ~ d~lm. I~(d ti,. c~14m! c~ iki. c,~n.ln.m~ml c.e (ullv (md m~curOtely daKr ~ ohO~e ~y ¢~ro~ar sltil~4'~l noma a~d ~,t$ c~,,ll'i.d, Ipock,,(~. , n~gl'~([, c,~w~ Icl~lud, ~ cIr~ tn a~ rm~fi T/~ DTO~It e(~l~dJl~l for IfCilll~or~'~Ir h¥1~wo¥ O~.Mdil~ K) ODI)~CII~I~ Jnfarnoii0~l ol~J nfl?,ona{ GlOVefnm~?! r~ulullu.* DO NOT WRITE BELOW THIS LINE, Monll~ DGy Year v,:ll..w ¢ ,t:'l,lt! N ..'x 'I Oit 05/27/2004 TI-IU 09:17 [TX/RX NO 6135] Bhate Environmental Associates, Inc. Environmental Engineers & Scientists I I I I I I I I, I I I I I I