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HomeMy WebLinkAboutUNDERGROUND TANK FILE 1Hazardous Materials/Hazardous Waste Unified 'Permit CONDITIONS :OF.-PERMIT ON REVERSE SIDE : ' ~;-:.: ' ' .-i~ ;~'~ ' ' ' i~' ~: : ' Permit ID #:: 015-000-000626 FASTR!P-FOOD STORE #633 LOCATION: 6401 S H ST -" This =ermit is i~,~ued for the followin.: E] Hazardous Materials Plan n Underground Storage of Hazardous,Materials ri Risk Management Program 'ri Hazardous Waste On-Site Treatment 015-000-000626~001 UNLADED PLUS~ASQ~E ~ 015-000-000626-0002 UNLADED GASOLINE: ~; ~...~~ 015-000-000626-0003 SUPREME UNLADED GASOLINE 015-000-000626-0004 SUPREME UUk~fiB ~S~LINE~::: . Issued by: Bakersfield, CA 93301 'Voice (661) 326-3979 :FAX(661) 326-0576 Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave.,'3rd Floor : Appr°vedby: June 30. 2003 Issue Date Permit Opera e Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ........... ?~,,?~?~,,~,,,,,~ ................ This permit is' issued for the following: ~,~??: ,,: ?~:':.:::;i ii!i! i i!?~ ii?:: ii:~ ~e[ground Storage of Hazardous Materials LOCATION 6401 T~K H~OUS S~ST~CE ' C~A~:~?._::.:,.~. ~:,G~ :;~ '~;~;~::::.. T~K T~K =(?.,. ,~T.~K PIPING PIPING PIPING '~::~:%, INST~'L:=~: ~PE MATEm~ ~(M~NITOR ~E METHOD MO~TOR 0001 Unleaded Plus G~oline 12,~0:::~)~ ff ):;~ ::~:'~:~?=~ ..... ? SW ..... ..:~3: E.C~''? ?~,J ~:::~G LPT P~SS~ ~D '%........ ':,. 0~02 Unleaded G~o]inc ]2,000 %-.-" :?.~G~]~;: ~? :~?:<:~:::::'2:~"?"', ?S~;::;.~':~::~ '~ ~,EG~¢~ ~?~' ~ ', ~.3?' ATGLPT P~SS~ ALD 0003 Supreme Unleaded G~oline 12,000 ~;~:'::~'~:.'.:: :~:::~:~:..~:~:? ~'~:......::~ ~,/?'~::.,,~'~*~..}?~' ATG LPT P~SS~ ALD 0004 Supreme Unleaded G~oline 12,000 Gal '~ ~;:~:~;:;;~;;::;~:,;~:~::;;~::::::::~:~,::';.::: ~:::~:::::,:~=,~?~'~'~'~ ATG LPT P~SS~ ALD Issu~ by: ~ B~ersfield Fke D~a~ment Approved by: ~~~' O~CE OF E~RON~AL S~ ~CES ~ 1715 Cheaer Ave., 3rd Floor ~ B~e~fiel~ CA 93301 ' ~ Voice (805)32~3979 ~ (~0~)~-057~ ~xp~t~on~at~: June 30, 2000 ICA Cert. No. 00764 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 l'bllowing information in the l-brmat of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility: facility identification number (t?om Form A): name of issuing agency; and date of issue. Other identifying intbrmation may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: FASTRIP FOOD STORE #633 Permit #015-021-000626 6401 S H ST Bakersfield, California 93307 CORRECTION N OT~i~.~ E BAKERSFIELD FIRE DEPARTMENT N° 608 Location ~/~,~ Sub Div. ~/~) ! $- /4 ~ ~ Blk Lot You are hereby required to make the following corrections at the above location: Coro Co~le~io~ aate ~or Corre~o~ ~/~/~? Inspector 326-3979 UNDERGROUND STORAGE TANK-INSPECTION Bakersfield Fire Dept. Office of Environmental Services Bakersfield, CA 9.3301 FACILITY NAME /C~5~h? BUSINESS I.D. No. 215-000 ~ FACILITY ADDRESS ~q~/ 5. *(~ ~¢ .,5~, CITY [)~r,',-~'c~[ ZIP CODE FACILITY PHONE No. ~'3( ~ ~70 ? ~D~ ~m ~D~ INSPECTION DATE .~i'/'7/~' ~ ~ Product Product Product TIME IN TIME OUT ~ df-- ,~m,~ dc- ~' ' Insl Date Inst Date Inst Dale INSPECTION TYPE: ~, ( ~o ,.~5¢-~ Size Size Size ROUTINE /./' FOLLOW-UP ~'t REQUIREMENTS yes no n/a yea no n/a yes no n/a la. Forms A & B submitted 1 b. Form C Submitted lc. Operating Fees Paid 1 d. State Surcharge Paid · le. Statement of Financial Responsibility Submitted V 1 f. Written Contract Exists between Owner & Operator to Operate UST V 2a. Valid Operating Permit 2b. Approved Written Routine Monitoring Procedure 2c. Unauthorized Release Response Plan 3a, Tank Integrity Test in Last 12 Months ~ ;-~'*~, 3b. Pressurized Piping Integrity Test in Last 12 Months ~'-i~"- ~'(:> V/' '-'- ~ 3c, Suction Piping Tightness Test in Last 3 Years V' 3d. Gravity Flow Piping Tightness Test in Last 2 Years 3e. Test Results Submitted Within 30 Days V 3f. Dally Visual Monitoring of Suction Product Piping V 4a. Manual Inventory Reconciliation Each Month 413. Annual Inventory Reconciliation Statement Submitted 4c, Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks V/ 6. Monthly Statistical Inventory Reconciliation Results V 7. Monthly Automatic Tank Gauging Results 8. Ground Water Monitoring 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Double-Walled Tanks V'" 11.. Mechanical Line Leak Detectors .12.. Electronic Line Leak Detectors ~/' 13. Continuous Piping Monitoring in Sumps 14. Automatic Pump Shut-off Capability 15. Annual Maintenance/Calibration of Leak Detection Equipment V 16. Leak Detection Equipment and Test Methods Listed in LG-113 Series 17. Written Records Maintained on Site ~)~,CO 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days 19. Reported Unauthorized Release Within 24 Hours 20, Approved UST System Repairs and Upgrades 4,// 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells u/ 23. Drop Tube INSPECTORf: .,.),(.Z, OC, ~ _ ~ OFFICE TELEPHONE No. -~0 ' _3 g?? / FD 1669 (rev. 9/95) · ~kersfield l~ire Dept. OFF!~ - OF ENVIRONMENTAL 5ER VICES 1715 Chester Ave. Bakersfield, CA 93301 Business Name: Location: · Date Completed ~,J'7/7 7 Business Identification No. 215-000 ~,3. g (Top of Business Plan) Station No. Shift__ Inspector Arrival Time: Departure Time: Inspection Time: Address Visable Correct Occupancy Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Matedal Comments: Adel~te Inadequate ri o. Verification of MSDS Availablity Number of Employees: Verification of Haz Mat Training Comments: Verification of Abbatement Supplies and Procedures Comments: Emergency Proceddres Posted Containers Propedy Labled Comments: Adequate Inadequate V~dfication of Facility Diagram Housekeeping Fire Protection Electrical Comments: UST Monitoring Program ·Comments: rl Permits Spill Control· Hold Open Device ~ I-I Hazardous Waste EPA No. Proper Waste Disposal I~ 0 Secondaq/Containment I~ 0 Secudty '[:3/ 'O Special Hazards Associated With this Facility: Violations: Busine~~anag~ ~RINT NAME SIGNATURE White-Haz Mat Div, Yellow-Station Copy All Items O.K Correction Needed Pink-Business Copy ~RRECTION N 0 jllJ!!~ E BAKERSFIELD FIRE DEPARTMENT Location ~'~'~i~'- ? Sub Div. f~[O( ~. FI ~-f Blk.. Lot You are hereby required to make the following corrections at the above location: Coro No J Completion Date fo,' Corrections //,/,.~ Inspector 326-3979 UND STORAGE ,INSPECTION , .~, , , ~, .. ~i, ........ ,' , -Bakersfield Fire Dept. Bakersfield, CA 93301 FAClLI~ NAME ~ ~,~ BUSINESS I.D. NO. 215-000 ~,~ FACILI~ADDRESS ~DI ~, ~ 5~ Cl~~~ ZIPCODE ~/~ FACILITY PHONE No. ~O~ ~O,. ~D~ INSPECTION DATE Product Product Product TIME IN TIME OUT ( )~. In~t Dat~' Inet Date ~ Inet Date INSPECTION TYPE: / ~' ~"7' /~/,q ? /~ Size Size Size // FOLLOW_UP , <~r.. × /'j2/')C,~ /~/O.O¢';, /,~;~.~ ROUTINE REQUIREMENTS yes no n/a yes no n/a yes no 1 a. Forms A & B Submitted / ~ ~.~ lb. Form C Submitted lc. Operating Fees Paid ,,'" :1 d. State Surcharge Paid la. Statement of Financial Responsibility Submitted l f. Written Contract Exists between Owner & Operator to Operate UST 2a. Valid Operating Permit / f ~-" 2b. Approved Written Routine Monitoring Procedure ~- 2c. Unauthorized Release Response Plan '~. 3a. Tank Integrity Test in Last 12 Months [;~,///~/"~'~, 3b. Pressurized Piping Integrity Test in Last 12 Months 3c. Suction Piping Tightness Test in Last 3 Years 3d. Gravity Flow Piping Tightness Test in Last 2 Years . 3e. Test Results Submitted Within 30 Days ~ ~. ~-~ 3f. DailyVisual Monitoring of Suction Product Piping 4a. Manual Inventory Reconciliation Each Month 4b. Annual Inventory Reconciliation Statement Submitted 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks 6. Monthly Statistical Inventory Reconciliation Results 7. Monthly Automatic Tank Gauging Results ' 8. Ground Water Monitoring ~)X0}~ [~.) ~"""~[(~{~J&L 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Double-Walled Tanks , u-~ 1,,/ 11. Mechanical Line Leak Detectors 12. Electronic Line Leak Detectors ~,-~1 13. Continuous Piping Monitoring in Sumps ~.,'~' 14. Automatic Pump Shut-off Capability 15. Annual Maintenance/Calibratior{ of Leak Detection Equipment 16. Leak Detection Equipment and Test Methods Listed in LG-113 Series 17. Written Records Maintained on Site . .'~_ p',~-,,~ 18. Reported Changes in Usage/Conditions to Operating/Monito'ring~ Procedures of UST System Within 30 Days ~ 19. Reported Unauthorized Release Within 24 Hours .... 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tube ,/'" RE-INSPECTION DATE, ,, ' . ,~ ,,-) RECEIVED BY:~~ FD 1669 (rev. 9/95) ~ ~BBakersfield Fire Dept. 'Off ENIJlRONMENTAL SER VICES 1715 Chester Ave. Bakersfield, CA 93301 Date Completed / 0/~,/(:~,~ Business Name: Location: Business Identification No. 215-000 ~.~,~.~ (Top of Business Plan) Station No. ~/~_'% Shift ,.~,~.~., Inspector'~-'T'~-~k, Arrival Time: Departure Time: Inspection Time: Address Visable Correct Occupancy Verification of Inventory Materials Verification of Quantities verification of Location Proper Segregation of Matedal Comments: Adequ/ate Inadequate 131- Verification of MSDS Availablity Number of Employees: Verification of Haz Mat Training Comments: Verification of Abbatement Supplies and Procedures Comments: Emergency Procedures Posted Containers Propedy Labled Comments: Adequate Inadequate I~/ [] Verification of Facility Diagram I'~'/ I'1 '" Housekeeping [3/''' ri Fire Protection Electrical Comments: UST Monitoring Program Comments: Permits Spill Control Hold Open Device Hazardous Waste EPA No. Proper Waste Disposal Secondary Containment Secudty [] 0 [] [] Special Hazards Associated with this Facility: Violations: Business Owner/Manager PRINT NAME 'SI/GNATURE White-Haz Mat Div. Yellow-Station Copy All Items O.K Correction Needed Pink-Business Copy CONTINUED (See 2na File) F'ASTRIP 633 6401SO.H ST. BAKERSFIELD CA. 661-831-4709 DEC; 8, :2000 10:34 AM SYSTEM STATUS REPORT ALL FUNC;TIONS N©RMAL INVENTOR, Y F,'EI::'OP, T T 1: ]::'REM. VOLUME = 3729 GALS ULLAGE = 8271 GALS 90% ULLAGE= ?071 GALS TC VOLUME = 3691 (]ALS HEIC~HT = 39.51 INCHES WATER VOL = 0 G~ WATER = O. O0 TEMP · = 74.6 DEG F T '2: UNL. 2 VOLUME = 2049 (3ALS _ lO..,:, ULLAGE= 0751 GALS TO VOLUME = 202~ G~L~ HEIGHT = 21.~1 INCHES W~TER VOL = WaTeR = 0.90 II TEMP ,. -' = ?~. T 3 :PLUS VOLUME = 2993 GALS ULLAGE = 9007 GALS 90% ULLAGE= 78137 GALS TO (/OLUME '= 2971 (.]ALS HEIGHT.., = 28.56 INCHES WATER ~"~L = 17 GALS WATER "~" TEMP ~ 0.87 IN.~HE~ .:70.1 DEG F T 4 :UNL. ~ . . VOLUPIE ...... = 2612 (]RL~ ULLAGE = 9388 GALS 90.% ULLAGE= 8188 (]ALS TC VOLUME = 2594 GALS HEIGHT = 25.91 INCHES WATER VOL = 0 GALS WATER = 0.00 ~HES TEMP = 69.7 F C IRRECTION NOTI . E BAKERSFIELD FIRE DEPARTMENT N° - - 1 0 4 0 Location ["~1.5{~'1,/) ~(~ /'_~ ~ ~ Sub Div. 6 (/~[ 5 ~" . Blk. . Lot You are hereby required to make the following corrections atthe above location: Completion Date for Corrections ~ Date l ~]~)0 c~' Inspector 326-3979 FACILITY NAME ~,.~4r,~3 ADDRESS (~ ¢./0 I FACILITY CONTACT ~SPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 PHONE NO. ~3{-q ?0 BUSINESS IDNO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program Routine [~1 Combined [] Joint Agency [] Multi-Agency '[21-Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate'permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training r 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 Busi{aess Site/Besponsjble Party Inspector: .M~_, d~_P~6_ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3'd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE Section 2: Underground Storage Tanks Program Routine [~ Combined ~1 Joint Agency Type of Tank ,50J~L.S Type of Monitoring fi'V(,, [21 Multi-Agency [] Complaint Number of Tanks Type of Piping [] Re-inspection OPERATION C V coMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current %/' Certification of Financial Responsibility 1/ 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 (805) 326-3979 White - Env. Svcs. ~usi~ess Site Respohsible Party Pink - Business Copy 06.'0';'.'00 0?:49 25 0576 CITY OF BAKgI~FIELD OFFICE OF ENVIRON.~[ENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS- UST FACILITY r~ ~. ~ SI'rE OE_RMrr ~ ~ REN~,'Va4. P~.RMIT I. FACILITY i SITE INFORMAl'ION N. BoA.q~ OF EQ~JJZATION UST STORAGE FE~ ACCOUNT NUMBE~ - Call (910) 3Z2-9569 if ~,oc.ar~_ ~,~-rho~$) ~ D 4~. r'l ,). STXTErU~&CC) LEGAL NOTIFICATION AND MAJUNG ADDRESS / VT/. APPUCANT SIGNATURE UPCF (7/cj9) S:~U PAFOP. MS~wtcO'-a.w~a 06:0?.'00 OT:$O .0 "g~'661~.6 0576 BFg) ItAZ ~T DIV CITY OF BAKERSFIELD OFFICF. OF F.~'IROL~G~IZNTAL SgRVIC£S 1715 Chester Ave., Bakersfielck CA 93301 (661) 326-3979 UNDERGROUNO STORAGE TANKS - TANK PAGE 1 OO3 43O ' L T,A,',,I~ DESCR]I~"ION 43.4 TAll( USE la' tr~d~eJ:~ ~ ~ [] 2. NO.FUEL PE'r~;JOLEuM ~] 3. c:~euIC.,~-,a'm:XX~C'r IL TANK ¢ONTENI~ ~caa~ ~o 0 z ~ [] s. JET mom. l--lin. ~wu~.~u,,Jz~,~o I-1 3. mJ~S~. O & AV~'nO~ ~. · m .T_Am< .c~£ ..m~no~. _ i ?'fI~OFT,Uql( IJ~ 1. ~NCa,.E WALL [] 3. ~NI:3LF. WALLWrfI'I · (c~., ~,~ .~,.~ un,y) ~1,-/- OOUBLE W)U. I~ 4. Ufos. u~ec~c;w ISIs. F1 ~ or~r~ r-J 95. UNKNOWN r-I se. o'n-~m ,4,45 TANK ;I',?J'ER~)R UNING OTHER ~.SX~N ~2 06,'07.'00 07:$0 26 0576 BFD H.{Z ~{T DD CITY OF-BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 171 ~ Chualar Ave., Bakeraf~d. CA 93301 (681) 32~-3979 004 U3T - T&.NK I=AGE 2 PRE.S.S U Nu~D PmPfN~ ~ M ~ ~ , ~ a. ~~O~A~C~ ~ A~ ~ s~ OFF F~ ~s. ~S~M F~_~ A~ SYS~M OI~O~N ~ 11. ~uTC~C LI~ ~ ~ (3.0 ~ ~ ~" ~W ~ OFF OR E~Y G~ O~Y (~ M ~) AS(~rEG~O~JNO [] ,$. ~N~eC"~T'E~T(0.1GPH) -- uPCF (7,~9) S'~CU PAFORM~S~C~'B'V~= D 06,'07'00 07:$[ ~66 6 05?6 BFD ~L~Z .w._kT D CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 17t5 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 - ~ 005 · UNDERGROUND STOf:L~GE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE I. FACILITY IDENTIFICATION One form per tank IL INSTALLATION The installer has been cer~ed by the tank and piping manufacturers. The installation has been inspec*~:J and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. ALI work tinted on the manufactu~s installation checJdist has been completed. The installation contractor has been certified or licensed by the Cona-actors Slate License Baa~d. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. ~enUfy ~thod: IlL TANK OWNERJAGENT SIGNATURE ~ i ¢~ ~ ~,e ~e~maee~ ~4e~t ~ ~ ~ & aeC~l~e ~3 ~ ~ :~ ~' t~c~ge ....................... 06'0?'00 07:50 "~ Br'-D H.~Z ~--~T DJ',' 003 LOC~.ON wrr~n~ ~ (~ CITY OF BAKERSFIELD OFFICE OF E~N%'IRON~IENTAL SERV'ICES 1715 Chester Ave., Bakersfield~ CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 t TANK 'N'T'ERIOR UPCF S .\CU pA FO RJG$~S~/I~C B-B .'~C m o6 o7 00 07:30 :5'~ oo4 . cormcsx:- i f'l OTH~ .... ...~.:~-.. ViL'PfI~LF.~CiETE_CTiC)~,,N~'~a~a~a;,I:~/) .... : !' '":.." . -.... .... ~ ,5. ~'~N ,LUXL ~'~EC.,~eFY TEST, (oJ C4TM) UPCF (L~9) S '~'CU PA FOi~MS%SWI~C ~'B'WP 0 06 O' 00 ~'~$ 05?6 BF'D ~L~Z M_kT DJ",' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 17i 5 Chester Ave., Bakersfield, CA 9330i (66i) 326-3979 ~ 005 UNDERGROUND ~'9'O~G1= TANKS - IN~?ALLA19ON CERTIFICATE OF COMPLIANCE - I. FACILITY IDENTIFICATION One form per tank II. INSTALLATION The instal}er has ~n ~ by ~ ~nk a~ pi~ manu~. The i~l~fion has Deen ins~ and ~fi~ by a ~te~ pmf~ional engineer. ~e i~lla~n has ~en ~s~ a~ appmv~ by ~e Ci~ of Bak~field ~ of Environmen~l Se~s. ~ ~m rm~ ~ ~ man~s insertion ~t has ~n ~mp~. ~e ins~lla~ ~n~ ~s ~n ~ or li~n~ by ~e ~om S~ Li~ Boa~. ~o~r ~ ~s us~ as al~ by ~e Ci~ of Bake~field ~ of En~nmen~l Se~ces. IlL TANK OWNEI;JAGENT SIGNATURE 06'0? O0 BF'D ~IAZ ~T OO3 CITY OF BAKERSFIELD OFFICE OF EN'VIROLN~IENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE rANKS - TANK PAGE 1 435 L TJkNI( m. TANK CO~flTr~4T$ ,-~P~OFT~I< r-J 1. ~NC~.~ WAJ-L ~ 4. SIh<:L~W,U.L tNAVALILT T,a~K 'NT'[RIOR UINING I--I ~. ~ UNED [-] 2. S~::Rlrl CI~. AI~OCE Fly~ 0 ~o 4S7 S .\CU PAFORMSLSWRCB-i~ .WPC ~00~ j ~ UI=~F (7,~J9) S~CUPAFORM'S"SVV~C~'B'WI=O 06 O? O0 ~'-~ $ ~ ; 0576 BF'D CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 17i 5 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ~ 005 UNDERGROUND ~'TOP. AGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE I. FACILITY IDENTIFICATION One form per tank The installer has been cert~ed by ~ tank and piplr~j manufacturem. The installation has been inspec'~ and certified by a registered professional engineer. The installaUon has been inspec:ed and approved by the City of Bakersfield Office of Environmenl~l Services. Au w~r~ rm~ on ~e manufactu~s installation checldlst has been completed. The installation contractor has been certified or licensed by the Contractors Slate License Beard. Az~other method was used as al~,ved by the City of Bakersfield Office of Environmental Services. L~ent~x mesh _od: IlL TANK OWNEPJAGENT SIGNATURE April 4, 2000 FIRE CHIEF RON FRAZE ADMINISTRA11VE SERVICE8 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRE~ION SERVICE8 2101 'H° Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION 8ERVICE~ 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 3263951 FAX (805) 326-0576 ENVIRONMENTAl. SERVI~ 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 3263979 FAX (805) 326-0576 TRAJNING OM;ION 5642 Victor Ave. Bakersfield, CA, 93308 VOICE (805) 399-4697 FAX (aOS) 3~-S?S3 Jaco Oil Mr. John Kefley P O Box 1807 Bakersfield CA 93303 1807 Dear Mr. Kerley: You have been identified as the compliance coordinator for the facility/facilities referenced in the attachment. The permits to operate this facility/facilities will expire on June 30, 2000. However, in order for this office to renew your permit, updated forms A, B, & C must be filled out and returned prior to the issuance of a new permit. Please make sure that yOu are sending the updated forms which are indicated by the date 7/99 in the lower left hand comer. Please complete and remm to this office by May 15, 2000. Failure to comply, will result in a delay of issuance of your new permit to operate. Should you have any questions, please feel free to call me at 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment Facility Farrells Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip W~nole,~e Fuels Chris Liquors Howards Howards Howards Address 6401 White Lane, .Bakersfield, .Ca 93309 8001 White Lane, Bakersfield, Ca 93309 1200 Coffee Road, Bakersfield, Ca 93308 4901 S. Union Ave., Bakersfield, Ca 93307 2698 Oswell Street, Bakersfield, Ca 93306 1640 S. Chester Ave., Bakersfield, Ca 93304 805 34t~ Street, Bakersfield, Ca 93301 12851 Rosedale Hwy, Bakersfield, Ca 93312 4013 S. "H" Street, Bakersfield, Ca 93304 ~~I"Street,~Bhl~ersfield, Ca 93304 2200 E. Brundage Ln., Bakersfield, Ca 93307 2732 Bmndage Ln.; Bakersfield, Ca 93304 3200 Panama Lane, Bakersfield, Ca 93312 4201 Belle Terrace, Bakersfield, Ca 93309 3300 Planz Rd., Bakersfield, Ca 93309 . . 'F ':,~'TECFCAL!FORNIA :UNDERGa~ND sTORAGE TANK'EERMIT ApPLIC/tqqON - FORM A ~ ~.' 'COMPLETE THIS FORM FOR EACHFACIUTY~ITE ~ERM~ IMARK ONLY ~ 1 'NEW~ PERMIT · .?. ONE ITEM :-:. ~ ;~ I~TERI. M PERMIT I. FACILITY/SITE INFORMAIION & ADDRESS; (MusT BE COMPLETED)' ACDRESS ' ' - ,' : . . NAME OF OPERATOR · · ' NEAREST CROSS STREET. /' pARCEL I (OPTIONAL) STATE ; ZIP CODE -~ LOCAL-AGENCY ~ COUNTY~GENCY . DE~TRiCTS C; TY NAME · " SITE PHONE I WITH AREA CODE TO INDICATE . ~-~'ORPORAllON ~ INDIVIOUAL ~ PARTNEP, SH!P .1~] STATE-AC~ I--1 FEDERAL4~GENCY ~ ~ · ~ RESERVATION I ~ 3 FARM F~". ',t PROCESSOR 7-"' 5 0T'-;EB ' on TRUST LA~ t EMERGENCY CONTACT pERSON '(PRIMARy) EMERGENCY CONTACT PERSON (SECONDARY). optimal · , · I N'°"'rs: NAME, 'r; ~A~E ' MA,~.ING OR-S FREET ADDRESS ¢;~ NA~E 'TANK OWNER INFORMATION- (MUST BE COMPLETED) ·I" ~ box I~e~ ~ INeiVIOBI~ ' ¢--] L()CN.-AG~Y. I'--'] STATE~k6C..NCY II, pROPERTY OWNER INFORMATION. (MUST BE COMPLETED) CARE OF AOORESS INF--O~MATION ,/ ~, ~om~ica,· , --': INOmViOUl([ 'Fi LOCAL-A~ICY F'~ STATE-AGENCY ~-~ISORATION* ~ PARTNERSHIP" I--~ COUNTY-~GF~ICY ~ FEDERU.4kGENCy ST.,T.,T.,T.,T.,T.,~ ' i ZiP CODE PFK~E, WITH AREA CODI~ - · .i WAME OI= OWNER .- J ,MA~L'ING OR STREET ADDRESS IV. BOARD OF EQUALIZATION UST STORAGE'FEE ACCOUNT NUMBER. Call (916) 739-2582 if quesl~ons arise.. TY(TK)-HO i~---~-~::~/ l~ ~'~'13" " ', '' V: LEGAL NOTIFICATION. AND BILLING ADDREss Leaa, n~:,:!calion and billing will be s~nl ~o lbo lank owner unless box I or Ii is checl~ed. iCHECK ONE BOX LNDICATING WH'ICH ABOVE ADDRESS SHOULD BE USED FOR LE3A_ XOT)FIcATioNS AND BILL~IG: THIS FORM HAS BEEN A~PLICANF'S NAME (PRINTED & Si( LOCAL AGEN( COUNTy # LOCATION CODE - OPTIONAL- ' UNDER PENAL TY OF PE:WJUA Y. AND TO THE BES~F OF'M~ KNOWLEDGE, IS TRUE AND CORRECT . i ;=PLICANT'S TITLE I'DATE MONTH/DAY/YEAR ",' JuRISDICT;ON #. I · ' CENSUS TR'ACT · - OPTIONAL - FACILr~' # . -' : SUPVISOR -OtSTRICT CODE - OPTIONAL -THIs FoRM MUST BE ACCOMPANIED 'BY AT LEAST (1) OF) IViORE.PEF~MIT APPLICATION. FORM B, UNLESS THIS IS A CHANGE OF SITE..NFORMAT ON'ONLY" F~A~2 :ORM, A (¢-~)' :.- . .% _ .: : . . - ::, .. . ~ :~. . , .;. ,.;~ - ~ . .~..~ -' ,. .. . .' .. DE'RG · . . ON UN ROUND STORAGE TANK' PERMIT APPLICAI1 -. FORM · COMPLETE.A SEPMIATE FORM'FOR EACH TANF, $~STEM. ' .. I MARK ONLY [] I NEW PERMIl':' '' .(~ .,,,,3 :RENE"WA[.'PERMI~' :. ~ $ CHANGE OF INFORMATION ONE ['rEM .. [] 2 INTERIM PERMI~ -(~ 4 :~dENDE[~ PER'MIT ' ' [] § T~MPORARY ~rANK CLO~uRE · OBA OR FAclUTY'NAME WHERE TANK IS lNSTALLED: ~'~-..,~.~ :p.~)~' I. TANK DESCRIPTION - COMPETE Au.rn~s- specl~ IF UNKNOW~ A..OWNER'S TANK I. O. t ///~../.~///)/,~.~ ) C. DATE INSTALLED'(MO~'OAY/YEAR)("~f¥'/~' '" v~- w II. TANK C0.NTENTs ,FA., ISMARKIED. COJdPLETEITEM C. : D. TANK CAPACITY IN GALLONS: · , · C. ~ UNLEADED : ' [] Ib PREMIUM UNLEADED .~__j~ 3 CHEMICAL PROOt. JCT ~F'-q" 95 UNKNOWN' · ~ 2 WASTE 9g oTRER r~--.R~ ~N ~ O. m~.¢~I c.~s.': ' O. IF (~.4) mS NOT MARKED. ENTER NAME OF SUBSTANCE STORED III,'TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, a. AND C. AND ALL THAT'APPLIES IN 8OX O A. TYpE OF [] ~ DOUBLE WAu. SYSTEM ~ '2 ~iNGLE WALL. TANK - MATERIAL ~Ptim~ Ta~k) [~ sINGLE WALL wITH EXTERIOR LINER ~-I' 4. SECONDAry CONTAINMENT (VAULI~ED TA~IK) · ~ ~ BARE STEEL ~ ~ ~R~ 9 BRONZE [] 2 STAINLESS STEEL [] ,o c,~-vAN~D ] 7 ALUMINUM ] 95 UNKNOWN ] 95 UNK2~IOWN ~ ] 9~ oTHER [~ STEEL CLAD W/FEIERGI'As~ REINFORCED PtJLS'FlC [] 8 100% METHAJ~L COMPAT'~LEW/FRP · [] 9g OTHER C. INTERIOR UNING ~ ' RUBBER LINED , [] 2 ALKYD LINING IS LINiN~ MATERIAL COMPATIBLE W1TH lOo~e METHAN(N. F--J 3 ~po~ LIN~ ] 95 UI~ga~OWN YES__ NO__ ] 4 PHENOLIC LINING [] ~ oTHER 0. CORROSION '--I ! POLYETHYLENE WR~.P I'--~ 2 COATING ~'~ 3 VINYL WRAP PcIOTECTION --~ 5 C,~THODIC PROTECTION I~ 9! NONE ' ~ 95 UNKNOWN ~ FIBERGLASS REINFORCED PLASTIC ] ~ OTHER IV. PIPING INFORMATION ORC,~ A IF'ABOVEGR(~UNOOR. U IF uNDERGROUNO. BOTH IF AF~'LICABLE A. SYSTEM TYPE A U I SUCTION A~,~2 PRESSURE A U 3 GRAVITY B. CONSTRUCTION A ~ SINGLE WALL A U 200UBLE WALL 3 LINED TRENCH A U 99 OTHER ' A U 95 UNKNOWN- A U 99 OTHER c. MATERIAL AND CORROSION, PROTECTION A U 1 BARE STEEL A U.. 2 STAINLESS STEEL 'A U 3 POLY'VlNYL CHLORIDE (PV~A(~4 FIBERGI''A~'s PIPE A U 5 A~UMINUM A U 6 CONCRETE A U 7 STEEL WI COATIN~ A U 8 1~ ~ ~MPA~B~W~ · A U 9 ~LVANI~D S~' "A U 10 C'ATHOO~CPROTECTION A U 95 UN~WN A U. ~ O~ER ~"AUTOMAT~LINELEAKOETECTOR ~ 2 LJNET~H~ESSTESn~ ~NffOR~ ~ ~ O~R D. LEAK DETECTION V. TANK LEAK DETECTION ' ' , . . 6 TANK TESTING t INTERSTITIAL MONITORING '~ ,91 NONE ~---~, 95 UNKNOWN ' [] ~ Diner VI. TANK CLOSURE INFORMATION ' . , ~.E~T,MAT~DOUANT,T~O~ ~.WASTAN'<F,u.EDW,TH YE,'[] .o [] ~. E.':;TIMATE0 DATE LAST USED {MO/DAW'YR) · f SUBSTANCE REMAINING GALLONS INERT MATERIAL ? . L._ THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND '7'0 THE BEST OF MY KNOWLEDGE, IS TRUE AND CORR, ECT LOCAL AGENCY US .~:),,NLY- THESTATEI. O. NUMBER IS C~T~'~6§~b"OF THE FOUR NUMBERS'RELOW ' '- - r PERMIT APPROVED BY/DATE · . i PERMIT EXPIRATION DATE THIS 'FORM MUST 'liE/[CCOMPANIED BY A PERMIT :APPucATI~I~ - EORM -~'UNLESS A CURRENT' FORM A HAS BEEN RLED. C~)MPLETE A SEPARATE FORM FOR EACH TAM( SYSTEM.. I MARK oNLY· f--']-I NEW PERMIT" -.,~ [~ 3·RENEWA~- PERMIT [] $ CHANGE OF INFO, RMATION .ONE ITEM; E~. 2 NTER M PERMIT,. '' [~ AMENDED' P~RMIT.. ' r~ 8 TEMPORARY TANK CLO~URE DBA OR FAclUTY NAME WHERETANK I~ ~ISTALLED:- ~.~/~.~" ~1~.-~ ' I. TANK DESCRIPTION co~P~E-~ AL/. rrEM.Q -. S?EClFY IE UNKNOWN ' ' ...... · ' '; ' "I ,. ,.~,,u~:,,c~RED sv: :.-- A. OWNE~ TANK ~ O.'., J~'~/~'.;U"/~. i~:, )" ' ' ' · · J/~-~,~/,//).~ ) C. DATE INSTALLED (MO/DAY/YEAR! . ' D' .TANK CAPAC ,1~...IN (~M.LONS: -:STATE WATER RE$OURCF..~CONTROL BOARD" UNDERGROUND.STORAGE TANK PERMIT AppLICATION, FORM II. TANK CONTENTS I A. ,~--'~., I .MOTOR VEHICLE FUEL' ~ ~ 2 P~TROLI=UM O. IF (A.I) IS N~T MARKED. ENTER NAME '~ ~8ST~ sToR~'.' UNLEADED UNt. EADED JET'FUEL C.A. ~.w: Ill: TAN K' CONSTRUCTION ' 'MARK ONE ~TEU ONL9 ,N BOXES ~. ~. AND C. AND ALL THAT APPLIES IN I~OX O A. TYPE OF' F--1 I DOUBLE WALL .-[~3 SINGLE WALL wITH EXTERIOR LINER, . "~ ~ 95 UNKNOWN SYSTEM~ ~ 2 SIN~LEWALL [] 4 'S~CONDA~Y'CONTAINM,.E. NT (VAULTEDTA.NK). [] 99'OT}'IER MATERIAL '~P~imarf ' ~"---I ~ BARE STEEL ;---]. s ~:~ ~ 9 a~ON~ ' [] 2 STAINLESS STEEL ' [] 8 POLYVINYL cHLORIDE [] 'o GA"VAN'~D STE~- ] 3 FIBERC_~ASS I:--] _ T 'ALUM~UM. [] 95 uNIO~3wN ~ STEEL CLAD WI FII~ERGI.A~ REINFORCED PLA~T1C [] 8 100% METHANOL COMPATIGLEw/FRP [] ~· Oll~ER C. INTERIOR ~iiNING. · ,r----] ! RUGBER LINED 'r~ 2 A~.KYO LINING ,. J 5 GLJ~.S$ LININQ ' ',; INED. IS LININ(~ MATERL~L COMPATIBLE WlTH 100%' METHAN(N. ? "~-~! ~OLYETI-IYI:.ENE WRAP F'~ 2 COATING O. CORROSION -- -- PqOTECTION . --'m 5 CATHODIC PRoTECTIoN IT-T- "9! NONE IV. PIPINGINFORMATiON :C~RcLE .~ IFAROVEGROUNDOR U ,FUN{:)ERGROUND. GOeT~iFAP~LICABLE ' ' A. SYSTEM TYPE = A U 1 SUCTION ' A~,~)2 PRESSURE A 'U 3 GRAVITY A U 99 OTHER . ,~ ', 8~ CONSTRUCTION AU~. SINGLE WALL .'A U' 2 COUSLE WALL A~)3.. LINED TRENCH A U 95 UNKNOWN ~A U ' '9g oTHER .C. MATERIAL AND .' A U 1 BARE STI~EL.' ' A .U 2 STAINLESS STEEL A U' 3 POLYVINYL.~:HLORIOE (PVC)A(~)4 FIBEP, GJ_~,~S PI~E CORROSION PROTECTION A U 5 ALUMINUM A U $ cONcRETE A"U 7 sTEEL'W/coA'TINQ 'A' U' 8 100% ~ COMPAT1BLEW/FRp A U 9 GALVANIZED STEEL A U-10 CATHOOIC PROTECTION A U 95 .UNKNOWN A U 99 OTHER' , · O. LEAK DETECTION ~AUTOMAT,IC LINE LEAK DETECTOR ~ 2 LINE TIGHTNESS TEST1NG ~INTERSTrrlAL . L-~J MONffORIN~ 'E~ ~g OT~R ., V: TANK LEAK.DETECTION V~SUAL CHECK rANK "rESTING ~ ~NvENToRY RECONCILmATION ~ 3 VAPOR MONITORING J~-'"'~'~4' AUTOMATIC TAN~ GAUGING [] 5 G~C)UNDWATER MONITORING ~1'~ INTERSTI1;IALMoNITORING ~ 91 NONE r--~. 95 UNKNOWN . [] 9~, O~ER VI. TA'NK CLOSURE INFORMATION : ,.'.. I ,. ~_.A n~A:r~o O.~TE.LAST USeD i~O,OA¥,R~ : ~. EST,MATEO OUANT,TY O~ '' J ' 3' w~ TANK F'LLED W'~ ' ~ [] I ' · ' ' SUGSTANCE.REMAINING GALLONS ' INERT MATERIAL ?" YES NO [] .LoCaL AGENCY USE ~/~H;-S~ ~BER IScoMPosED ;~;HE FOUR NUMBERS BELOW ': .' ."' ".' STATE D ': PERM r NUMBER - ": ' · ' PERMIT-APPROVED BY DATE · ' ': PERM T EXPI~T~N ~TE " ~:~o~ a '(~ ,t THI~ FORM ~ BE AC~'~IED BY A PER~ ~PUCA~ON- F~RM & UN~ A CURRE~ FORM A HA~ B~R~D. ' ' -'- . "STATE WATER RESOURCES coNTROL BOA~D UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B . " 'COMPLETE A:SEPARATE FORM FOR EACH TMa( SYSTEM. MARK ONLY [] t .NEW PERMIT - · [::::::~3 RENEW~ PERUIT. [] S ~ C~: ~FORMAT~:3N ONE ITEM [] 2 INTERIM PERMIT. ~::] 4 AMENDED PERMIT . [] 8: TEMpORARY' TANK ~LO~URE I. TANK DESCRIPTION 'CO~P~E~EALLrn~s- SPEC~Y~FUNKNOV~ - · ~--]. 8 TAM( REMOVED A. OWNER's TANK I.D. C. DATE INSTALLED (MO/DAY/YEAR) B. MANUFACTURED BY: O. TANK CAPACr1Y:IN GN.LONS: I1: TANK CONTENTS ~PA-~ ISMARKI~D. COUPLETE ITEM C. A. ~ MOT. OR vEHIcLE FUEL [] 4 oil ~ 2 PETROLEUM [] 80' EMPTY ,-'-TI .~ CHEMICAL PROOUCT ~ 95' UNKNOWN D. iF (A.I) IS NOT MARKED. ENTER NAME DE S~JBSTANC~ sTORED [] 2 WASTE J--'-1 la REGULAR C.~, , ~UNLEADED · UNLEADED [----] 2 LEADED ill. TANK 'cONSTRUCTION MARK ONE ITEM ONLYINBOxESk B. AND C. AND ALL THAT APPllES IN BOX D A. TYISE.OF I:---] 1 DOUBLE WALL ~ SINGLE WALL WITH EXTERIOR LINER. [] g5 UNKNOwN SYSTEM ~ 2' SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 9g OTHER 8. TANK . · ~' MATERIAL ',Prime'y Tank) BARE STEEL CONCRETE BRONZE [] 2' STAINLESS'STEEL [] 3 FIBERGLA.S~ · [] ii pOLYV~YL CHLORIO~ [] 7 ALUM~U~ ~ STEEL CLAD WI FI~ REI~RcED I~TIC [] 8 100~ METHANOL COMPATJBLEW/I:RP ] 99 OTHER C' INTERIOR UNING D. CORROSION P~0T, ECT10N ?--] $ RI:lageR LINED [] '2 'ALKYD L~ING IS LININ~ MATER[AL C~PATII~_E WITH 100~ METHANOL ? EPOXY LINING UNKNOWN __ NO__ ] 4 PHENOLIC LINING ] 9~ OTHER --~ ! POLYETHYLENE WRAP i--'-~ 2 COATING ~ 3 VINYL WRAP ~ FIBERGLASS REINFORcED PL~TIC ~ 5 CATHODIC. PROTECTION t'--"' gl 'ND.NE --g5 UNKNOWN [] 9~ OTHER ', ~. IV. PIpING?FORMATION oracLE' A.,F ABOVEGROUNdOR U iF UNOERGROUNO. BOTH IF APPLICABLE A. SYSTEM TYPE A U'?, SUCTION A U~.2'PRE$SURE 'A U 3 GRAVI'PI B. CONSTRUCTION' A U gg OTHER A U~i' SINGLE W~,LL A U 2 .DouBLE WALL r. ~3 LINED TRENCH A U g5 UNKNOWN A U '!ag OTHER A U I BARE STEEL A :U 2 STAINLESS STEEL A U -3 PQLYVINYL CHLORiOE(PVC}A~_~ FIBERGI.AS~ PiPE C. A U 5 ALUMINUM -' A 'U ii CONCRETE A U 7 STEE[W/COATINO A U 8 100% METHANOL'COMPAT]BLEW/FRP A U 9'GA~LVANI71:D STEEL A U 10 CATI~O, oICP~OTECTION -'A U 95 UNKNOWN A U ~ OTHER O. LEAK DETECTION ~. AUTOMATIC LINE LEAK DETECTOR '~'-'~, ;~ 2 LINE TIGHTNESS .TEST]NO' ~-~-~ k~ONrI'ORING~t~fERsTTriAL [] 99 OTHER V. TANK LEAK DETECTION ~ "': ' __= ~ v,SUAL CaECa< ~-"~.' ::'NVENTO,¥ ~ECONC,UAT!ON 3 VAPOR MO.~TOR,NG I~'"'~, AUTOMATIC TANK ~UG~NG [] 5 G~UND WATER Mo~rromNG 6 TANK TESTING I 7 INTERSTiTIAL MONIT~ORING ----; 91 NONE [] 9~ OTHER MATERIAL AND CORROSION PROTECTION F-~ 95 UNKNOWN VI. TANK CLOSURE INFORMATioN -' ' . x. ESTIMA TED DATE LAST USED {MO~OAY/YR) : SUBSTANCE REMAINING 3. WAS TANK EILLED WITH YES [] NO [] GALLONS !NERT MATERIAL ? THIS. ' :'l FORM AP~Lp ,NrED& S~' CAN ~SNN~Az uMRE!< HAS '~'~'~~ BEN'COMPLETED u ~! . UNDER ' ....... PENAL T¥ "'. OF PERJURY. AND . TO '', ~_ E BEST OF '. MY '.'. KNOWLEDGE, . I,/,~/~ DATE ~' ~/' IS TRUE ~ AND ? CORTECT , LOCAL AGENCY U~ '~HE ~MBEfl IS COMPdSEO OFTEN FOUR NUMBERS BELOW I -, ?:: :...., /l:.O:#' -. I..: :STATE COUNTY'# ::'~'~dRISDICTION #.' . PERMIT APPROVED. BY/DATE. " FACILITY # TANK J. J PERMIT EXPIRATION OATIE THIS FO'RM'.MUST BE AccoMPANIED BY A PERMff APPI ICAliON. FORM A, UNLESS A CURRENT. NORM A HAS.BEEN RLED. ~oRu B-{9-9°~ COMPLETE A sEPARATE FORM FOR EACH rANI( SYSll~M.. ' : ' .' ':' ' · 08AOR FAcIUTYNAMEWHERETANKI~ISTAItI:D: ~'~"~: ~.~_ '.' . . . I.. TANK DESCRIPTION C(~Pt.L~ ALL rr~s -' :~,Ecuw ,= UNKNOWN" A. owNER'S TANK I. D. ~ -'' . . · '- .. C. DATE INSTALLED (MO/DAY/YEAR~'~ . ". D. TANK CAPACITY IN GALLoNs: ~m~m"'W~'~ ..... -- II. TANK CONTENTS 'IF A-I' I$ MARKED. COMPLETE ITEM C. 'A. ~ MOTOR VEHICLE FUEL "'---] 2 PETROLEUM''~ !'-'-], 3 CHEMICAL PROOiJCT ] 4 OIL' ] 80 EMPTY · [] 95 UNI~K:)WN 8.¸ C 2 w&s. TN- C~.' [] IRREGULAR · . UNLEADED ] lb PREMIUM UNLEADED [] 2 LF,.~D · [:::::::] 3 DIESEL [] $ AVtATiONi3ASI C.,A. S. w: - ~ I11. TANK CONSTRUCTION L uARK ONE ~TEU ONLY ~N aOX~S A. rt.,NC) C. ANO'XLL mAT AP.,..~ES IN aOX O A. TYPE OF I--1 1 'DOUBLE WALL - SYSTEM'. . ~ 2 SINGLE wALL  SINGLE WALL wITH' EXTERIOR LINER · [] . 4 SECONDARY CONTAINMENT (VAULTED TANK) S. TANK '1'--1 I ~ARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGI'ASS · MATERIAL'-;.. ;-'J 5 CONCRETE , [] s POLYVINYL C,LORIDE I---] 7 AU~UINUM ',PrimarfTu~l ~ 9 BRONZE ' [] !0,GALVANIZED STEEL* [] eS UNKNOWN · J--q. 95 'UNKNOWN [] 9~ OTHER J~' STEEL CLAD WI F18ERGI-As~ R~INF-ORCED PLASTIC [] 8 t00% METHANOL COMPAl'ISLE W/FRP ' r--'~ gg OTHER C. INTERIOR UNING F---'1 ! RUB, BEn LINED [] 2 ALKYD LINING . [] IS LININ(J MATERIAL CoMpATIBLE W1TH 100~, METHAN(X. ? - YES 'O. CORRosION ----]~ , , POLyETHYLENE WRAP I--'-'J 2 COAT1NG I'-"~ PqOTECT10N --~ 5 CATHODIC PROTECTION I----' cji NONE "~ EPOXY LIN,INI3 [] 4 PHENOLIC LINING u.,o,,owN [] ...oTHER. VINYL WRAp FIBERGLASS REINFOFICED pLAsTIC UNX~OWM [] ~ DINER IV. PIPING INFORMATION cmcLE A IF ABOVE GROUNO OR U ,F UNOERGROUNO. BOTH IF APPLICABLE A. SYSTEM TYPE · : A U t SUCTION A~,,,)2 PRESSURE A U 3 GRAVITY 8, CONSTRUCTION A~J~I-SINGLE WALL A U 2 DOUBLE WALL ~ LINED TRENCH ' A U sag OTHER A U 95 UNKNOWN A U gg'OTHER C. MATERIAL AND CORROSION PROTECTION A U 1 BARESTEEL A U 2 STAINLESS STEEL AU 3 POLYVINYL CHLORIDE.(PVC~A U~_~ FIBE~ PIPE A'U 5 ALUMINUM A U 8 CONCRETE .A U 7 STEEL wI COATING, A U 8 100'% METHANOL COMPATIBLE W/FRP A U-90. ALVANI7FD STEEL A U 10 CATHoOIC PROTECTION A ru 9,5 UNKNOWN, A U 9g OTHER O. LEAK DETECTION. ~ AUTOMATIC LINE LEAK DETECTOR ~ 2 LINE TIGNTNESS TESTING ' .~T~N[I.ORI,,iGERSTITIAL J'-"-J .gg O'I'H~R . V. TANK LEAK DETECTION. , , ' :-'-"~ ! ',/'SL~AL CHE(~K :.~_/,.,,"~2 :NVENTOR'Y RECONCILIATION Z 3 VAPOR MONITORING~I~/'~AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING --- 6 rANK rES·TING ,' 7 ,NTERSTiTIALMONITORING ~ 9! NONE ' ~ 95 uNKNOwN [] ~g DINER VI. TANK CLOSURE INFORMATION' " ' J L E~TIMATED DATE LAST. USED IMOiOAy/YR) QUANTITY OF ' 3. WAS TANK FILLED WITH YES [] ~ [] SUSSTANCE REMAINING GALLONS INERT ~ATEHIAL ?' THIS FORM HAS BEEN COMPL~T~D UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS TRuE AND CORRECT · J APPLICANT'S NAME /,~/ . ' DAm NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW , ~RU, (~-~O~'. ,:, THIS FORM MUST BE ACCOlt/~ANIED BY A PERMIT APPUCATION · FORM ~'UNLESS A:CURRENT FORM A HAS BEEN RLED. ' ,, ~'' ' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REOULAR PREMIUM DIESEL AVIATION TANK NO. ,'. VOLUME SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STOKED CAS NO. CHEMICAL PREVIO:JSLY STOKED (NO BRAND NAME) (IF KNOWN) FOR OFFICIAL USE ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY wrrH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. State of Califom,a ,State Water Re$oumes Control Board Division of Clean Wile, Programs P.Q. Box 0,44212 $_~,-_-amento. CA 94244.2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY " FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A I ~m required to demonsWate Financial Respoasibili~ in ~ mq~ ~o~u u s~iR~ in ~tlon 2807. ~ I ~, Div. 3. Tine 23. C~: [ ~5~,~ ~11~ ~ ~e ~ I million ~11~ ~1 a~pte ~ or ~ or ~ ~ I million ~11~ ~ ~cu~e ~2 million doll~ ~ a~tc Jaco Oi 1 Company hereby certifies that it is in compfiance with the requirements of Section 2807, Art;cie 3, Chapter 18, Division 3, Tit;e 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required bY Section 2807 are as follows: C. Mechanism State Fund Self Insurance Name and Address of Issuer State of Calif. Mechanism Jaco Oil Company P.O. Box 82515 Bakersfield, CA 93380-2515 · Number '":' .Covemge · 'Amount $990,000 $10,000 Coverage period Cont Corrective Action'--- Yes Third Part7 · CO~p. Yes Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance v~th all conditions for participation in the Fund. Ficfl0e/N~m4 . . F~dt~ Fast.ri~ ~633 6401 S. H Street, Bakersfield F~,i,~ N~ J F~I,~ A~ '' F~d,w N~ F~ A~ 7/5/99 7/,q/gq FILE: Original - Local Agency T,J2-_JamDeson;~. Brian Busacca Copies - Facility/S~te(s) SUNSET MECHANICAL 3812 PANORAMA DR, BAKERSFIELD CA. Continuous-Monitoring Devic~ Certification TEST DA'I'E ' ~'?- 7--Yf FACILI]~Y NUMBER ' " * ~ CONTACT PERSON ~-'~---~-C)Cu,,~ FACILI~ NAME ~ ~~ ~ , ' '~ I c,.7 z,.co . ,, , ~Z. ~.~ MAKE AND MODEL OF MONITORING ~YSTEM / .... J ~7 .,--- --'- ... contents of Tank ~ i~,~,l,~- W~.~[~,. ~q,~ ~ Capaci~ of Tank , , / 2,~0 /~ ~0 .{~ ~o ~tD, ~ 'Type of Product Line: (GraviS. Suction. Pressure). ~3~ ~A~ A YEs OR NO IN APPLICABLE BOX: INDICATE LOCATION OF TH~ MONITORING Annular Space Sensor ",Electronic In-Line Leak Detector Mechanical Line Leak Detector In Tank Gauging Device IN APPLICA§LE BOX: poes the monitoring' system have audible and visual alarms? shut-down the Does the turbine automatically . if system detects a leak. fails to operate or i~ e!ec!romcally disconnected? -i; the monitorin9 system Installed to prevent unauthorized tampering? Is the monitoring system,operable es per the manufacture? spscifications? Which continuous monitoring devices lniti~t~ positive shut-down of the turbine? CERTIFIED TESTER'$ ID~ 81GNATUR-~ OF CERTIFIED TECH."IICIAN ~ P 0~4 ~6~ 60~ Receipt for Certified Mail No Insurance Coverage Provided ,~o,~, Do not use for International Mail (See Reverse) st'~l~Ou°O'l'L COI'fPAh-Y Po~ge Certified Fee Special Delivery Fee Re~k~ied Delivery Fee '~eturn Receipt Showing to Whom & Date Delivered 'Return Receipt Showing to Whom, i Date, and Addressee'$ Address TOTAL Postage & Fees Postmark or Date D June 8, 1999 FIRE CHIEF RON ERAZE ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-394-1 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENvIRoNMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326--0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 John Kerley JACO Oil Company P.O. Box 1807 Bakersfield, CA 93303-1807 CERTIFIED MAIL RE: Failure to Make Corrections SECOND NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE Dear Mr. Kerley: This office is very concerned with the lack of response from your company with regard to several correction notices issued at Fastrip's, located within the city, the are as follows: Fastrip at 6401 "H" Street was issued a correction notice on April 20, 1998 for the following: Failure to provide annUal maintenance on leak detection system, per Section 2641 (J) of the California Code of Regulations Title 23, Division 3, Chapter 16, underground storage tank regulations & failure to service fire extinguishers per UFC (1994 Edition). Fastrip at 4013 South "H" Street was issued a correction notice on April 20, 1998 for the following: Failure to provide statement of Financial Responsibility, per title 23, CCR. Copies of form A,B&C, replace missing "No Smoking" "Turn off Engine" sign on dispenser island. Additionally, you were given personally, a business plan and related underground storage tank forms on March 2, 1999 for the Fastrip at 12851 Rosedale Hwy, which still has not been 100% completed. You are hereby requested to appear at a hearing on this matter. The hearing will be held at 10:00 a.m. on Thursday, July 6, .1999 at: City of Bakersfield Fire Department Office of Environmental Services 1715 Chester Avenue, Suite 300 (3a Floor) Bakersfield, CA 93301 At this hearing, you may present your plans for compliance. In the event that you are unable to attend this hearing as scheduled, you may reschedule to a later date, by calling this office as soon as possible. Failure to appear, will result in additional enforcement action. If you have any questions, please feel free to call me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm cc: Walt H. Porr, Jr., Assistant City Attorney. CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 ADDRESS ~ t./O [ FACILITY CONTACT INSPECTION TIME INSPECTION DATE ~ ~0~ ~'~ PHONE NO. ~',31 ~, BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES [ Section 1: Business Plan and Inventory Program [~Routine [2i Combined [21 Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures bt/ Emergency procedures adequate Containers proPerly labeled Housekeeping Fire Protection L/ '/~¢'~., ~¥{¢tne, tJt.5~ct-c t~cc~x/ ~Cl'dtc.c' Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Questions regarding this inspection? Please call us at (805) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Business Site Responsible Party Inspector: d_, d~J"O C, RRECTION NOTJj E BAKERSFIELD FIRE DEPARTMENT N° 6 6 9 Location 6- q~t~? Sub Div. (~ ? ~) I ~''j-j'' .. Blk. ~o? ~31' Cl You are hereby required to make the following corrections at the above location: Cot. NO I Completion Date fo,' Corrections/'~0{ 0 ~ 7 ~ - - spect0r 326-3979 FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE q~-,-)0~ ~,~r - Section 2: Underground Storage Tanks Program [] Routine [~ Combined Type of Tank ~'tO Type of Monitoring [21 Joint Agency [] Multi-Agency [] Complaint Number of Tanks /4' Type of Piping /= C h 0T ) [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current V" Certification of Financial Responsibility Monitoring record adequate and current t// 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 (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Site Responsible Party D February 9, 1999 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICE8 2101 'H' Street BakerSfield, CA 93301 · VOICE (805) 326-3941 - FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield. CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave, Bakersfield, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAJNING DMSION 5642 Wctor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Fastrip Food Store 6401 South "H" Street. Bakersfield; CA 93307 RE: Compliance Inspection · Dear Underground Storage Tank Owner: The city will start compliance inspections on all fueling stations within the city limits. This inspection will include business plans, underground storage tanks and monitoring systems, and hazardous materials inspection. To assist you in preparing for this inspection, this office is enclosing a checklist for your convenience. Please take time to read this list, and verify that your facility has met all the necessary requirements to be in compliance. Should you have any questions, please feel free to contact me at 805-326-3979. Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure ELI) C~. ]' 2: UI"IL.E/4[,I~I).--2 '~O17 UP;1E' *~-~-=--~ 2: E~ 6~-ff~m L ','3 , L.mI..,L~GE = '8496 90;:;~ LJLLiSt(:;E= %292 (;aLS TC ',;'('.,LUP1E ;= 35:33 HEiOIqT =: :32..~,'7. INCHES I.. a'r'EF: VOL = .28 t,.J~TER . = 0 .'91' I'NCHES k/C, LUME ~ = 20:3 l ULL.RE;E "' = 10001 90h ULi_A,3E= ~3'79'?' OALS 'I'C V<)LUPI~j,= 2029 ,;;;ALS HEIGHT 21.83 1 IaFiT'ER "30I, = 17 Gi4LS t,,,J~,7'EF~ = 0.88 [NCHES TEMP = 69.2 DEC; F T 4: UNI_.E~E,EI)-. 1 VC, LUME = 5945 i_JL, LAf.-iE = ~,!_-) ~l ,'7 91-!:i:.; I_ILL,~(;E= ,4883 :;;aLS TC V©LLIME = ~:.i93S "](~LS HEIGHT =: 47.55 INCHES I,'.I&'irER VOl.. = 0 ~3aLS t4RTER = 0. O0 I I,ICHES TEMP = ?4.6 DE BAKERSFIELD FIRE DEPARTMENT February 13, 1998 FIRE CHIEF MICHAEL R. KELLY AI)MINIS~ATIVE SEWlCES 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 ~tll~l~.,~lON ~EEVICI~ 2101 "H" Street Bakersfield, CA 93,301 (805) 3263941 FAX (805) 395-1349 PEEVENIION SERVlCF, S 1715 Chest~ Ave. Bakersfield, CA 93,301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAl. SEWIC~ · 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93,. *.*.*.*.*.*.*.*~ ~ (805) 399-4697 FAX (805) 399-5763 Fastrip Food Store 6401 South "H" Street Bakersfield, CA 93304 RE: "Hold Open Devices" on Fuel Dispensers Dear Underground Storage Tank O.wner: The Bakersfield City Fire Department will commence with our annual Underground Storage Tank Inspection Program within the next 2 weeks. The Bakersfield City Fire Department recently changed its City Ordinance concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire Department now requires that "hold open devices" be installed on all fuel dispensers. The new ordinance conforms to the State of California guidelines. The Bakersfield Fire Department apologies for any inconvenience this may cause yo.u. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey JUN-09-199?· 11:10 FROM~ONKNOLOGY-SO.CAL TO 91~12~91712 BA.KEKMFIP-LD FI~E DE~RTMENT HAZARDOUS MATERIAL DIVISION 1715 CHESTER AVE., BAKERSFIELD, 'CA {805) 326-3979 93304 FACILITY_~ PERMIT TO OPERATE NUMBER OF TA/TK$ TO BE TESTED__ IS PIPING GOING TO BE TESTED DATE / SIGNATURE Os APPLI~N-T TOTAL P.04 EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring pwgram must be keprat the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Servi~es wilhin 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 2641(h) CCIL FaeilityAddress bqo [ f;. "i~" .6T _P,k.(¢t, dO q33~'7 If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion baTard, are not cleaned up fi.om the secondary containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notified within24hours, d,.~c, nh~,,,,tbe~r /aa~rta/ I&gv h,'~ ,~' /~t~c Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substance. Describe the location and availability of the required cleanup equipment in item 2 above. Describe the maintenance schedule for the cleanup equipment: List the name(s) and ~title(s) of the person(s) responsible for authorizing any work necessary under the response plan: fN. at/a_ ~a ~ /~.~, x~ ~)~n fctl~ ,/ ~hm~ dat~ o,'1 WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all time~. Tim information on thia monitming program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtnin ~ beforo making tho change. Required by Sections 2632(d) and 2641(h) CCtL Facility Name lc~ .~m~ Facility Address 0~'t0/ ~, x.//n ~-~ .fi~c{J. dv~ c[33o7 Ao Describe the frequency of performing the monitoring: Tank ~¢& dc,~r, t2,.,d- ~?_~..~o da,l? Piping Bo What methods and equipment, idemified by name and model, will be used for perfoming the monitoring: Tank Piping ~n,~,. Describe the location(s) where the monitoring will be performed (facility plot plan should be attached): Eo' List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: Reporting Format for monitoring: Tank dL/r' Piping Describe the preventive maintenance schedule tbr the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Go Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: I~qt. ~' A~, ~c/r. Jqaoc toc~t, ~ t[~[ '~Ca~e, tcf RECORD'~F TELEPHONE CONVERSATIO Location: Business Name: Contact Name: Business Phone: Inspector's Name: Time of Call: Date: 5!'~(~7 Time: Type of Call: Incoming ID# # Min: Returned [ ] Actions Reauirea: -ime Reauirea to Comsiete ActiviTy ~ Min: -~KEE'FJF IELD C~. ,- U..~-u~, 1 -4709 P1A'y' ~?, 1 997 2: 18 I::'H SYSTEP1 ~T~TIJ~ REPORT ALL FUNCTIONS I N'UEI'ff'ORy REPORT T I: F:'REI"I I UP1 VOLUPtE = 2899 LILL,q,'3E = 813.3 90:% ULLAGE= 6929 P.', TC VOLUHE = 3893 GaLS HEi~:]HT = 34.55 INCHE~ ~..,.I~'ER VOL = ~TE~ = I-I 8v I N'"HE 'l" 2 :IJNI..Ea[iE[:, : ",/':]LI_II"IE = RR':'c' '~A] o /ILLF¥2E = E, 4,15 'g-~! II/I..AQE= 524l '];ALS TC 'v'OLLIPiE = 557'3 ~ HE] GHT d~ .~ · -, .... 1 k,i~TE~ "./OL 1 9 ~ TEP~F: = 7a 3 PEG F'. ' 0 V'OL UPiE~ = 409~ .... ,'-.~,o ':~8:~-:; II/.L~(3F2= 6734 Q4LS TC 'v'OLUI'iE = qEIi~8 HEIQHT = :35.a2 INCHES (,'..I~TER ".."C'L = 1 7 = d_ INCHES 'r'EP1F' = 79.5 DEC; F T q: UNLEFflDE[~ ULL~kQE = 819g 'FC b'OL UP1E = 8189 HEIGHT = gl '-'~' /.-, aTEN' = l"j GAL;3 I'E'PIP = O. O0 [ : 83.9 DEQ F F'A~'rRIP ~.:,d ~40I SOU?H t~ 805-881-4709 ,', !qq? 2:1° PH - TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hotlister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (7!3) 690-2255 Certificate of Tightness 180027 Service Order #: Underground storage tank system(s) tested and found tight for: #633 Tank Owner: oACO OIL COMPANY TestSite No.: 362- TestSite Address: OACO OiL COMPANY FASTRIP BAKERSFIELD, CA '93313 4Tank(s)only, 4Line(s)only, ~stDate: 08/01/96 Leak Detector(~) Oh~rg. Tank sizes & products tested: i 10000 REG UNL 4 10000 NO LEAD PLUS 2 10000 REG UNL 3 10000 SUPR UNL Lines Tested: lA REG, 2A REG, 3A SUP, 4A NO Leak Detectors Tested: 50883-0991DLD 50192-0234XLD 21384-7394DLD 30790-2764DLD Unit Mgr. Certificate Number & Name 312 DAVID TOHIR 10/:97 1315 DAVID TOHIR 12/96 Corporate Seal U.S. Patent #4462249, Canadian Patent # 1185693, European Patent Appl. # 169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank identification & site location drawing. .... VacuTectTM TEST REPORT S.O. # 180027j " Date 08 / 01,/~ 6 Owner JACO OIL COMPANY Site# 362 Phone <805> '831-4709 InvoiceNarne/Address USTMAN INDUSTRIES, INC. 12265 W. BAYAND AVE.' #110 LAKEWOOD, CO 80228 Attn: BRUCE McDUFFY Site Name/Address JACO OIL COMPANY FASTRIP #633 6401 S. "H" STREET BAKERSFIELD, CA 93313 TANKS LINES ~Leak Det Ullage TANKS a~nd LINES T~sted to CFR-~,O Parts See Tank Dipped Dipped Probe Water Bubble Air Line Final Exist ~280-281 I& NFPA 329 Spec's. Diag· Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak ~LINE LD(s) NEW For Material Level ' Level Level Detected Detected Detected · Material Syst. Type TEST TEST Rate [] Pass/ Lb(s) Loc. ST/ · · · · · · Tight [] [] · · · Tighl Fail/ Tested Other: FRP/ START START START or ST/ START END or or & , Ti Tank Tank Lined END END END Yes/No Yes/No Yes/No Fail Line# FRP PS/SS/GS TIME TIME GPH Fail NONE PASS Product Capacity 1 REG 10000 Diameter 00:/0~0'0~; '0'3~9~:00[ ~'[0;0~?~b[:l;~ N N N T ~;1A; ~[~S'~:,? ([ ~(~:P~'[:(:;: '9 :;j40?~ tiO~i:;~0~:, ~'.%0 ~:(~0'" ...... 00J:~' ~.;~ p -- Exist LO SN/~OL/MFG: 50883--0991DLD UNL 9500.000 039.00 00.0DS Time of Test: 39 0 Uf~.: F E PETRO ST EndTime: 11:25 Tank Probe Inclinometer :~;~37~'~.;:~. j?~;~; : ';; ?~ ~?~ ~?:%% :~ ~.~ ;~:f.~?-~;? LINE TEST PSI 50 00 T~t PSI: -- 8 ~ F I L L Deqr998: . Operate ~es~no) Y · Enid: -- 3 0 0 O~sp ..... Shear V .... T:-':: P - s.~ou~: 21384-7394DLD U~L 9~ 00 . 0001044. 00 o0.O0'flI ' ....... ~ ............... ' ~teri~l 81a~ Time: 9: 2 4 Percen~°~ Fill 8I Pump S T ~d Ti~e: 11 : 25 ~n~ ~.obe ,n~ino~ete. ~' ~ TestPSI:--, 8]-- Ent~: FILL Deqrees: - . 600 O~,,,,Disp ..... ~y~Z.o~S"'"Va'~' y 3 SUPR 10000 DiameterO0 ::::::::::::::::::::::::::: N ~ N T ~73:'~: ~::'~T;?~:::' ::C ;s?~.;.:~: [.2:?~1'~1~2'~;':;3!:;:~:~:~.0.~:~0~0:07~'~'?~;~ p Exist LO SN~DL/MFG: 30790-2764DLD UNL 9~30.500 1018,00 00.00~ Matedal~ New/2nd LD SN/MDL/MFG: Sta~ Time: 1 1 : 5 ~ Percent of Fill at Pump ;~/~,~, ~/; S ~ End Time:' ~ ~: 0 5 Tank _ Probe Inclinometer Tt~, PSI: 80 FILL 1 000 O~,p ..... Shear Va,yes · Entry: Degree: -- · Operate ~e~/no~ Y 4 NO 10000 D,a~t.~ 0,0~000~J.0257~O0 DOjf:O0/g N N N ~ T ;ff;.:~<A~ 3~ST'~:~;:~j 9500.~'~2='.'KX.UvulU = uu 00.01gI .... ......... ~ ........ ............. ~0{~;~0:0~0?~T~{>~{~ ..... P - E.,,,~OS~,~U~:~ 50192-0234XLD LEAS New/2nd ~D SN/MDL/MFG: PLUS Material eta, Time: 11: 5] Percent°f Fillet Pump >~::~?~?:?¥:~:. .~::?-~..~'~:~t'-.:/;. ~ ST EnaTime: 14: 05 Tank IProbe Inclinometer T~tP~I: --· 80 IEntry: FILL Deer, s:-~. 000: Operate°isp ..... ~es/no~Shea¢Va'ves y Demeter' ~ Percent of Fill at Pump ~ ~;~i~'~;' :~?~,:~ Material Sta~ Time: Time of Test: Mfg.: ~ ~ ..... ; >~.;t' ~.~: :17~¥: ,~'~ 7.:~. ~;:~;~' ..~.u ~ r~ ,:~:~.: End Time: Test PSI: Ent~: DeQr~s: O~erate ~es/no~ · Material Percent of Fill at Deqrees: Operate ~es/no~ Tanknolog~y Corporation International · TANKNOLOGY Region: WESTERN REGION Unit # 089 State Lic. # 1315 State: CA 5225 Hollister St., Houston, TX 77040 NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800) 888-~8563 · FAX (713) 690-2255 TAK-O1 SO- [~20 0 ~ '""7 d~er: ~./6~ o Site- 2' ¢ '-'z..._ MONITOR WELLS Well Number I 2 3 4 5 6 7 8 g 10 1 1 ~1 2 ~Well Depth Depth to Water, ~G ' Product Detected ~ AMOUNT in inches Standard Symbols for diagram below: eFill Vapor Recovery e V.R. w/Ball Float e Monitor Well e Observation Well (Outside Tank Bed Area) (Inside Tank Bed Area) e Ball Float e Tank Gauge 0 Vent ~ Manway FT~ Iron Cross ~ Turbine Location Diag.ram= n.c uce t. he. Vapor. Re. ce.very Syst.em.. Vapor Recovery System & Vents were tested with which tank? Parts and Labor used General Comments when OWNER or local regulations require immediate reports of system failure-Complete the'f-ollo~ing: REPORTED NAME DATE TIME TO: Phone# OWNER or Regulatory Agency FILE NUMBER Print: Certified Testers Name Vacutect~ Certification Number ,1~¢?.~ .5A ~T}' ~5~.~'ICE..~. ~.- Ot:FA~E OF .IfA:"v'I>~O,.~5'd£~%TAL 5~:/i' VI C2~5' '~?,~'SCI-IE~,I'ER AVE o BAKEreSFiELD, CA ~, 935C. q ~N~P~C ~ON '~ %" - ./ iecatiorm around the testing area. ~e g'cn'~rai'pi~!k is restricted r.. ' . ~... :om ti'm ;esti.n~j are;:~ ~Jy rope, fia~s, ,.o~es, and 'ff dark" a, fi'uoresccnr barrier. Fire protec;ion ~n the % - - ~ m ~.m, of a ~&/.0~C fi~e .... "~" ~"- ,c~.a~m. wk~m the .. restricted .~ea .... Vetnclcs utilized du::in~ the resting pe~od, or w'ithin 25 ~'' : .... 'r, ', storage tank opem~lg? have adeouate .........,,.,..,~,,~o+~-,~,,,o.., a~.d the tester h.;.~ equipment which car, be utiti:z, ed :,:> rncmitor rbc conccr~tratioa ,:'~f' flamma::g~: vapor'~ the ve~le. ... . · P,:r~m~J. 0,reject:ire. eau.ipmcm.,. . a~'~ eve. wash and g~ovcs.:' ""sm~' ~ a she ~,~..~ ~ . plan are Mr[~ the testing area, Equipmcnffmaterials is ava~.~abm to ab.serb .~.nd co~'aix:~ 'az t~sting liquid which is u~sd,,~rg~ as a result o'f' the test,, DOT*accePtable ..... '~"' for ~" - of t~m ..... . ~.,mtm,,~.,s ~to, ag,. absorbem ~.,~ an adequate supply of aL~orbent). If the answer re any :of the'above'questions is N~Q, stop theu.,,~,,.,g procedure until .... ' · '~ .... ~,.mpioam. e ..... 'COMPLETE FtEVIERSE BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST FACILITY ADDRESS PERMIT TO OPERATE OPERATORS NAME ~CO O, L NIR4BER OF TAN-KS TO BE TESTED OWNERS NAME ~O ~1 L Is PIPING GOING TO'BE TESTED~r.~ TANK VOLUME TANK TESTING COMPANY CONTENTS TEST METHOD ~CD ~C~- STATE REGISTRATION cERTIFICATION cA DATE & TIME TEST IS TO BE CONDUCTED_ ~.~)aT-- DATE SIGNATURE OF APPLICANT USTMAN SIR SYSTEM Yearly Statistical Inventory Reconciliation (SIR) Report 1995 STATION NAME: FASTRIP STORE #633 STATION #: 3362 COMPANY NAME: JACO OIL ADDRESS: 64 O1 SOUTH H STREET CITY: BAKERSFIELD STATE: CA COUNTY: KERN ZIP: 93307 PHONE: DATE OF REPORT: 02/09/96 MONITORING THRESHOLD: 0.05 GPH LEGEND --> T - TIGHT/PASS *I* - INVESTIGATE~FAIL IP - IN PROCESS/INCONCLUSIVE ND - NO DATA SUBMITTED TANKID CAP JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 33621 12K T T T T T T T T T T T 33622 12K T T T T T T T T T T T 3362M 12K T T T *I* T T T T T T T 3362P 12K T T T T T T T T T T T SIR PROVIDER: USTMAN INDUSTRIES, INC. 12265 W. BAYAUD AVE. SUITE 110 LAKEWOOD , CO 80228 PH: 303/986-8011 FAX: 303/986-8227 SIR VERSION: 91.1 I certify u~nder penaltyp,~/p~Ury that all are as cal~ul~ed. Signat./~/of Tank Owner/Operator of Agent SIR results listed above Date USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report · STATION NAME: FASTRIP STORE #633 STATION #: 362 COMPANY NAME: JACO OIL ADDRESS: 6401 SOUTH H STREET CITY: ZIP: STATE: CA PHONE: PERIOD ANALYZED: MAY, 1995 DATE OF REPORT: 06/14/95 PART A: Data Tank ID: Tank and Lines Status: Product: Quality: Dels: Sales: 02 03 05 00 IN PROCESS IN PROCESS IN PROCESS TIGHT 02 -UNL #1 03-UNL #2 05-FS MID 00-FS PRE POOR POOR POOR POOR 51695 7750 26510 14566 44851 12152 26593 12980 USTMAN INDUSTRIES INC. is~a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or deliverY discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: O2 Daily variance too high - review sticking procedures; delivery data distorted or inaccurate review delivery procedures 03 Daily variance too high review sticking procedures 05 00 Same comment as the above system #03 5/2/1995: 281} I5/3/1995:-1031 I5/5/1995:-194,6} 5/7/1995 :DEL 2163} 5/9/1995: 188 5/18/1995: 121} 5/31/1995: 144} USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: FASTRIP STORE #633 STATION 0: 362 COMPANY NAME: JACO OIL ADDRESS: 6401 SOUTH H STREET CITY: STATE: CA ~ ZIP: PHONE: PERIOD ANALYZED: APRIL, 1995 DATE OF REPORT: 05/15/95 PART A: Tank ID: Tank and Lines Status: Product: Data Quality: Dels: Sales: 00 02 O3 O5 TIGHT TIGHT TIGHT TIGHT 00-FS PRE 02-UNL MI 03-UNL #2 05-FS MID FAIR POOR POOR POOR 11543 23596 20123 19739 14356 31359 16008 24608 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, 'additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 00 {4/3/1995: 208} {4/23/1995:DEL 311} {4/27/1995: -149} O2 Data adjusted for tilted tank; Delivery data distorted or inaccurate review delivery procedures {4/2/1995: -1119} I4/9/1995:DEL -246} {4/16/1995: 100} {4/25/1995: 4043 4/30/1995:DEL -118} O3 O5 Majority of o/s exceed +/-100 -> review sticking procedures {4/2/1995: 293} {4/23/1995: 6125} {4/25/1995:DEL -4125} 4/2/1995: 1142{ 4/17/1995: 430 4/20/1995: 4677} I4/9/1995:DEL -1349} (4/10/1995: 1277} 4/18/1995: -4244} {4/19/1995:DEL -629} For regulatory compliance in California, a Piping integrity test every 12 months and a tank integrity test every 24 months are required in as .a~ion with SIR monthly monitoring. USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: FASTRIP STORE #633 STATION #: 362 COMPANY NAME: JACO OIL ADDRESS: 6401 SOUTH H STREET CITY: STATE: CA ZIP: PHONE: PERIOD ANALYZED: MARCH, 1995 DATE OF REPORT: 04/17/95 PART A: Tank ID: Tank and Lines Status: Product: Data Quality: Dels: Sales: 00 03 05 TIGHT TIGHT TIGHT TIGHT 00-FS PRE 02-UNL #1 03-UNL #2 05-FS MID FAIR POOR POOR POOR 17190.I 15190 27734I 23473 24151 21947 29286 25394 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 00 Status assumes tank is gauged daily {3/2/1995: 1971} {3/30/1995: 506} {3/31/1995: -597} 02 I3/2/1995: 105} i I3/5/1995:-2105} I3/6/1995: 2228} 3/26/1995: -145 3/29/1995 :DEL 222} 3/30/1995: 1319} 3/31/1995: -501 03 ~{3/2/1995: 3309} {3/5/1995:DEL -152} {3/12/1995:DEL 128} { 3/16/1995:DEL 115} 05 3/23/1995: 136 3/29/1995: -787} 3/31/1995: -2413 For regulatory compliance in California~ a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. R.E. HUEY HAZ-MAT COORDINATOR (805) 326-3979 CITY of BAKERSFIELD FIRE DEPARTMENT FIRE SAFETY CONTROL & HAZARDOUS MATERIALS DIVISIONS 1715 CHESTER AVE. ' BAKERSFIELD, CA · 99301 May30,1995 R.B. TOBIAS, FIRE MARSHAL (805) 326-3951 FASTRIP FOOD STORE #633 6401 S H ST BAKERSFIELD, CA 93313 Dear Business Owner: NOTICE OF VIOLATION STATE REGISTRATION REQUIREMENT Owners of underground storage tanks must register those underground storage tanks with the State of California Water Resources Control Board and renew that registration every five years. Our records indicate five years have passed since your last State registration pursuant to Section 25287 of the California Health and Safety Code. This means that for state registration renewal you must submit a state surcharge of $56.00 for each tank. Please make your check payable to the City of Bakersfield. You have 30 days from the date of this letter return these the state surcharge to 1715 Chester Ave., Bakersfield, Ca. 93301. If you have any questions or if we can be of any further assistance please don't hesitate to call 326-3979. Failure t° renew your state registration is a violation of Section 25287, California Health and Safety Code, and will result in your Permit to Operate the underground tank(s) being revoked. Sincerely Yours, Hazardous Materials Coordinator REH/ed TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, '[exas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 · Certificate of Tightness Service Order #: 142144 Test Date: 04/20/95 Underground storage tank system(s) tested and found tight for: Tank Owner: JACO OIL COMPANY Test Site No.: .362 Test Site Address: JACO OIL COMPANY FASTRIP BAKERSFIELD, CA 93313 'Tank(s) only, 4Line(s) only, Tank sizes & products tested: Lines Tested: lA REG, 2A REG, 3A PLU, #633 4 Leak Detector(s) only. 4A SUP Leak Detectors Tested: 30590-3901 DLD 30590-2764 DLD Unit Mgr. Certificate Number & Name 31284-7357 DLD 231 TODD L. PARKER 04/96 1487 TODD L. PARKER 10/96 50192-0234 XLD Valid only with Corporate Seal U.S. Patent #4462249, Canadian Patent # 1185693, European Patent Appl. # 169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank identification & site location drawing. VacuTectTM TEST REPORT .................... Date 04/20/95 Owner JACO OIL COMPANY Site:i/: 362 Phone <800> 12'53-8054 Invoice Name/Address USTMAN INDUSTRIES, liNC. 12265 W. BAYAND AVE. #110 LAKEWOOD, CO 80228 Attn: BRUCE ,MCDUFFY SiteNarne/Address JACO OIL. COMPANY 'FASTRIP #633 6401 S. "H" STREET BAKERSFIELD, CA 93313 TANKS LINES Leak Det TANKS and.LINES Tested to CFR-40 Parts Ullage Tank Dipped Dipped Probe Water Rubble Air .Line Final Exist 280-281 & NFPA 329 SpeCs. For Dia. & Water Product VVater Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW Material Level Level Level Detected Detecled Detected m Material Syst Type TEST TEST Rate · Pass/ LD(s) loc,~ · ST/ m · · · m · Tight · m · m m Tighl Fail/ rested Other: ' :' lar'l pI FRP/ START START START or ST/ START END or or & fal,k 'lank # Product Capacity Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/CS TIME TIME GPH Fail ',,lONE PASS i j~ ~ [4¢, (. .; Diameter lA ST PS 14:55 15:35 0.000 ,,il p -- ExistLDSN/MDI./MFGt 30590--3901 DLD U ~ L rt..z2,,. LO sN/MDL/MFG: Percent of Fill at Pump Material Slart Time: Time of test: Mt%: L,Ne test ~¢, 5 0 . 0 0 End ti~: t~), PST: EntrY: D,,q,ees: , RU ~AN ~ 2 ,, °l ...... '~'~:"~ ~ .... [.I fl L N~/2nd LD SN/MDL/MFG: ~rcenl of Fill at Pump Material-' Sla~ Tm.e: Time el Test: MI~.: LINE TEST ~SI 5 0 · 0 0 . Tank Probe Inclinometer Dispense~ S~ea~ Valves End Tim~: , Test PSI: Entry: Oeqrees: RU TAN ~ ~ ,, , Operale ~eg/no) ~ , , Percent of Fill at Pump Matedal Stad Time: Time of Test: Mfg: tine TESt PSI 5 0 . 0 0 ~n(,~ lime: T~l PSI: J Entry: Deqrees: 4 SL]PRii N L Diamei", ' "] I I 4A ST ..... ~'S L7:05 17:35 0 000 T. p - e.i~ UDSn/'.'ou~e~: 30590-- 2764 DLD n..,~., ~'LD) SN/MDL/MFG:  ' Percenl of Film at Pump Material Start Time: Time el Test: Mfg.: LINE test Psi 5 0 . 0 0 End Time: Test ~1: Entr~: D~rees: O})erale ~es/no) Material Percent of Fill al Pump I.It4~ TEST psi: Slafl Time: Time of fesl: MI~.: End Time: T~t PS~ J gn]ry: m O?qtees: O~e,ate ~uw/2~}d L~) 5~MDL/MFG: ~rcent of Fill at Pump Material Stad Time: Timeof Test: Mfg.: lINE fESF PSh End Time: T¢~t PSI: J Entr~: iANKN(,'~LOGYRegion: WESTERN REGION Unit# 089 StateLic.#1487 ~(')t E: OHginal VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. Tanknology ,Corporation International State: CA 5225 HoliiSter St., Houston, TX 77040 (800) 888-8563 · FAX (713) 690-2255 MO'N1TOR WELLS '" Well Number 1~ 2 3 4 5 6 7 8 9 10 11 12 Well Depth )/(,;~" i Depth to Water,;?/~--~. Product Detected AMOUNT in inches= Standard Symbols for diagram below: OFill Q Vapor Recovery Q V.R. w/Ball Float (~ Monitor Well (~) Observation Well (Outside Tank Bed Area) (inside Tank Bed Area) (~) Ball Float (~) Tank Gauge O Vent F'M"I Manway rtl Iron Cross ~ Turbine Location DiagramT~n.c~u.de .the. Vapor. Re, co.very Syst.em.. Vapor Recovery.System & Vents were tested with which tank? Parts and Labor used General Comments When OWNER o.r Ioca/regulations require immediate reports of system failure-Complete'the following: REPORTED NAME DATE TIME TO: Phone# OWNER or Regulatory/Ngency FILE NUMBER PI~ C.,~"'~_=~:J, '['es,rEts Naive Vac-.ul~ctTM C, ert~catior~ Number .,, ~~~ .round HazardoUs Materials St°rage Fa'¢ility '"'"St' ' '":'::'?::?::':":'"""'"'""'"'"'"'""'"' ........... ,~ ' ' ,~.Tank HaZardous G~ii:~?~%:~?;::? .... Y~:a~?:.~:~:. :~ ~'.~ank 'X?.;~:~:~;~.~:~?~%: Piping Piping Piping Number Substance Ca~p:~.~i{~:%.::.::?' I~'~'E,~&~?.'::::, ~ :?'.?Type M o~ii:~i~?;:':~;:~:.~?:: Type Uethod' Monitoring ......... :.: ,.,., :-'.' .?...:.:.??:::?, ,...;.;~??:~:::~:,.~....,. .::' .:,: .?.':.... · . ~p~ u~ ~t,~ ~:~ ...::::~:::,. ~'......,.; ~c ..:...::.:.-:" ~1~.,.,'.:.:?:? ~ .. ,. ...:::~;.:.;:.;.. ?&.. :~?....:~?~:.~;~?::,..;~..;.: ...... ..: . :.-'.:.~:::::::~ ...... .?.. ,.~:':: ":.":::.;~? '~, :.~- . ..... ~;;~.;::....;:?:::.::?~::.~[? .~:::' ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ~[~;::::%?,..:::::?:'~. :~ ::~.:::::~ .... ' Iss,ed. y: '::~:;~:~?'?::? .:~:~L ..::~? ::?::.::~:~:: ;:;;;;;L"'::.;:::;;[h.':~::~::;~: '?:::~:.. ~:?.::...::.::::~' ~ ~ j~,::::: ....... ' ' ~ · · "::~;;;L;::.:::'::.::::.:.:'~::;;;;:.~:.:.? .:?: ~' ':~[: ~J~:~:.. :::::::::::::::::::::: . .:.:.: ;:?:' :?' ~ .?:'Issued To: ~ · Bak~sh~ld ~ D~pt. ===================================================================================================================================================================================== ~¢~_ ~~{ '~ HAZARDOUS MATERIALS DiViSiON. ..~.:`:.:~.::.::::.:.:~.::;~;~:~:;:~:;;::~:~:~:~;~C~:~:~:::::~.~C~C.:~.:.:~ ............. ~ ~-, ~__ z ~}o~ · ~~~ ~/ Bakersfield, CA93301 ~1 ~ I~ -~ Approved by: .=,p~ ~..u~, .==.~.ou. ~=~,,~,. coo..,.~,o, ~,,. ,rom: CITY of BAKERSFIELD :/ '"WE CARE" FIRE DEPARTMENT M. R. KELLY FIRE CHIEF FASTRIP FOOD STORE #633 6401 S H ST BAKERSFIELD, CA 93313 October 20, 1994 1715 CHESTER AVENUE BAKERSFIELD, 93301 · 326-3911 Dear Business Owner: This notice serves as a reminder that owners of underground storage tanks must be registered with the State of California Water Resources Control Board and renew that registration every five years. Our records indicate five years have passed since your last State registration pursuant to Section 25287 of the California Health and Safety Code. This means that for state registration renewal you must submit an Underground Storage Tank renewal application form, Forms A. B and C completed for each tank at this facility (forms included) and a state surcharge of $56.00 for each tank. please make your check payable to the City of Bakersfield. You have 30 days from the date of this letter to complete and return these forms 'along with the state surcharge to 1715 Chester Ave., Bakersfield, Ca. 93301. If you have any qUestions or if we can be of any further assistance please don't hesitate to call 326-3979. Sincerely Yours, REH/ed Ralph E. Huey Hazardous Materials Coordinator C 0 R R E C'i:ijlp N NOTICE BAKERSFIELD FIRE 'DEPARTMENT ~ocat~o. Sub Div.~Z/O/ ~73, "Il" S''/t' Blk Lot You are hereby required to make the following corrections at the above location: Completion Date for Corrections /~.L./~.~ ,,,~ ~at~ /~/= ,~ ~,~~~. Inspector 326-3979 UNDERGROUND'$TORAG IilK INSPECTIqN !, ' ' ' .... Ba ersfield Fire Dept. ~'J~,~ -Tc~,~ ~ ~,; ~o~v~cL /~' Bakersfield, CA 93301 FACILITY NAME' ~'~.5'~; ~ BUSINESS I.D. No. 215-000 FACILITY ADDRESS _~r~ct 0 [ 5 ~' ~;'{ CITY ZIP CODE FACILITY PHONE No. INSPECTION DATE I ~//2-~ TIME IN TIME OUT INSPECTION ~PE: ROUTINE /' FOLLOW-UP REQUIREMENTS la. F~s A & B lb. F~ C Su~ lc. O~mtingF~ Pa~ ld. State SUrcharge Pa~ le. State~ of Fi~al R~si~l~ Su~ lf. W~en Contm~ E~s~ ~n ~er & O~mt~ ~. ~lid O~mting Pete 2b. Ap~ov~ Wr~en Ro~ine Mon~oHng Pr~ure 2c. Una~ho~ Relea~ Res~n~ Plan ....... ~ ...... Tank Int~ T~t in Last 12 M~ths 3b. Pre~u~ Piping Int~r~ Test in Last 12 M~ths ~. Suction Piping ~ghtn~s T~t in Last 3 Yearn ~. Gmvi~ F~ Piping T~htn~ T~ in Last 2 Yearn ~. T~t R~uEs Subm~ Within ~ Da~ 3f. Dai~ ~sual Mon~odng of Su~i~ Pr~ Piping ~. Manual Invento~ R~ncil~tion Each ~th ~. Annual Invento~ R~iliation Statement Subm~ ~. Mete~ Calibmt~ Annually 5. W~y Manual Tank Gauging R~rds f~ S~II 6. Monthly Statisti~l Invento~ R~nciliation R~uRs 7. M~th~ A~atic Tank Gauging R~uEs 8. Ground Water Mon~ng ~. ~ Mon~oring 10. Continuous Intemtitial MonRo~ng f~ D~bl~Wall~ 11. M~hani~l Line Leak Det~tom 12. El~tmnic Li~ Leak Det~tom 13. Continuous Piping MonEoHng in Sum~ 14. A~omatic Pump ShUtoff Ca~bil~ 15. Annual Maintenan~Calibmtion of Leak Det~ 16. Leak Det~tion Equipment and T~ Meth~s L~t~ 17. Wr~en R~rds Main~in~ on S~e . 18. Re~ Chang~ in U~ggCondRi~s to O~mti~R~ Pr~ur~ of UST S~tem Within 19. Re~ Una~hor~ Relea~ W~hin 24 Houm ~. Appmv~ UST S~tem Re.irs and U~md~ 21. R~rds Sh~ng Cat~ Pmt~i~ Ins~ ~. ~dr~ Mon~ori~ Wells ~. Dr~ Tu~ RE-INSPECTION DATE .,, / 2.~--~/~ RECEIVED BY:' ~' INSPECTOR: '~/~_/~_~~~~ OFFICE TELEPHONE No. ~'~,,~,~.- 3~' 7 ~ FD 1~9 Jaco 0il Company 3101 State Road Bakersfield, Califomia 93308 m p O. Box 1807 Bakersfield, California 93303-1807 ~ · Phone: 805 393-7000 · Fax: 805 393-8738 August 1, 1994 LETTER FROM CHIEF FINANCIAL OFFICER I am the chief financial officer for Jaco Oil Company, general partner of Jaco Hill Co.. This letter is in support of the Underground Storage Tank Cleanup 'Fund to demonstrate financial responsibility for taking corrective action and/or cdmpensating third parties for bodily injury and property damage caused by an unauthorized release of petroleum in the amount of at least $10,000 per occurrence, and $10,000 annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter. Fastdp #633, 6401 So. H St., Bakersfield, CA 93313 1. Amount of annual aggregate coverage being assured by this letter: $10,000 2. Total tangible assets: $5,869,372 3. Total liabilities: $1,737,100 4. Tangible net worth $4,132,272 I hereby certify that the wording of this letter is identical to the wording specified by subsection 2801.1(d)(1), Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief. AUG'01 Executed at Bakersfield, California on Date Name: Brian Busacca Title: Chief Financial Officer BB:jlc certificate of Tightness Service Order #: 126017 Test Date: 08/03/94 Underground storage tank system(s) tested and found tight for: Tank Owner: JACO OIL CO. 362 Test Site Address: JACO OIL CO. FASTRIP BAKERSFIELD, CA 93308 Tank(s) only, '~ Line(s) only, Tank sizes & products tested: 4 Leak Detector(s) only. Lines Tested: li~" SO'P, 2A ?LU, ' i',",, '~' ;'; . i' 3.A REG, "4A RE:G Leak Detectors Tested: 30590-2?64 DLD 30590-3901 DLD Unit Mgr. Certificate Number & Name 50192-0234 XLD 31284-7367 338 CHARLES T. BUONANNO 01/96 Validonlywith 1577 CHARLES T. BUONANNO 04/97 CorporateSeal U.S. Patent #4462249, Canadian Patent #1185693, European Patent Appl. #169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank identification & site location drawing. Owde[ JACO 0IL CO. invoice Name,/Address JACOi OIL CO, Site Name/Address VacuTectTM TEST REPORT Site# 362 3101 STAT~; RD. BAKERSFIELD, CA 93308 iJACO~OIL COL. FASTRIP '6401 S. "H" STREET BAKERSFIELD, CA 9'3308 S.O. # Date Phone Attn: 126017 08/03/94 <805> 393-7( A4COUNT PAY~ 00. BLES : JACKIE : " TANKS : · ,. !. LINES Leak Met Ullage TANKS· and LINES Tested to CFR-40 Parts See Tank Dipped· Di~)ped , P~'obe Water Bubble Air Eine Final Exist 280-281 & NFPA 329 ,Spec's. Diag. Dia. & Water ~ Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW For MaterialLevel Level Level · Detected Detected Detected · Material Syst. Type TEST TEST· Rate, · Pass/ LD(s) Loc. ~ ST/ · · , · · · · Tight · ' · · · · TightFail/ restedOther: l k Tank -i'an k FRP/ ·, START START STAR~ or ST/ START END or or & Product Capacity Lined END END 'END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail qONE PASS, Tank I Probe Inclinometer Dispenser Shear Valves y T~ PSI: I En~: Deor~9: Operate E9¢ Tim~: UN L : New/2nd LD SN/MDL/MF&: Material Percent of Fill at Pump ~:~ ~;,~;; , ;~ 7~?; ~ ::''~>' ' Sta~ Time: Time of Test: Mfg.: '~'' ~'~-, ~':~ ~ ~ : 7'7~?~;~:~T~3~ . . . (;~', UUE T~S~ PS, " End Time: Test PSI: Ent~: Dear~s: Operate ~es/no~ . End Time: T~st P~I:' Entw: Dg~r~s: Operate ~es/no~  . New/2~d LD SN/MDL/~FG: ' Tank I Probe Inclinometer O~erate ~es/no~ ~ ~ End Time: T~ P~I: } Entw: D~r~s: -- Diameter I I End Tim~ T~s~Tank P~I: ~1 Ent~:Pr°be D~r~:lnclin°meter Operate ~es/no~ ,.. ~ ' New/2nd LD SN/MD~MFG: ~rcent of Fill at Pump ~:~ "~:" * ~ ~/~ ~'~Z¢'~'~;c: '~ %~:~ ~"~'~ ': ~ )~' LINE TEST ~Sl: Material Stud Time: Time of Test: Mfg.: j~ ...... ;. ~.~ .~. ~. ;. ,~,~.~ ~,;~L[~7~,~,::~; ~ Tank Probe Inclinomeler End Time: Tg~t P~I:' En~: ~ Dgqr~s: Operate ~es/no~ TANKNOLOGY Region: WESTERN REGION Unit :~ 416 State Lic. #1577 NOTE: Original VacuTect Data ['ecordings are reviewed by Tanknoiogy's Audit Control Department and maintained on file. TAK-01 State: CA Tanknology Corporation International 5225 Hollister'St., Houston, TX 77040 .(800) 888-8563 * FAX.(713) 690-2255 SO~ ) ~.&C~* -7 ~ner: _,~~ Site# MONITOR WELLS Well Number I 2 3 4 5' 6 7 8 9 10 1 1 12: Well Depth .Depth to Water Product Detected: AMOUNT in inches Standard Symbols for diagram below: OFill Vapor Recovery v~ V.R. w / Ball Float ~ MOnitor Well ,~,(~ ObserVation Well (Outside Tank Bed Area) (Inside Tank Bed Area) (~) Ball Float (~ Tank Gauge O Vent ~ Manway r'~ Iron Cross r'~ Turbine Location Diagram .-In.cia.de .the. Vapor. Re. coyery Syst.em.. , Vapor Recovery System & Vents were tested with which tank? Parts and Labor used General Comments When OWNER or local regulations require immediate reports of system failure-Complete the following: REiSORTED NAME DATE TIME TO: Phone# OWNER or Regulatory Agency FILE NUMBER Print Certified Testers Name Vacutectm~ Certification Number C ' ' ' Date Testing Completed 17!5 CHESTER AVE., BAKERSFIELD 'CA 93304 (Bom) 3~6-3~79 APgLICAT!oN TO PERFORM A TIGHTNESS TEST DATE & TIME TEST iS TO BE CONDUCTED SATE i BAEZRSFIELD FIRE DEPARTMENT 1715 CHESTER AVE., BAKERSFIELD, 'CA '93304 (BOB) 326-39'79 APPLICATION TO PERFORM A TIGETN~SS TEST OPERATORS NAME NUMBER OF TANKS TO BE TEsTED..,~__ IS TANKS VOLUME  _ )~- ,, DATE. DATE & TI5rE TEST IS TO BE CONDUCTED OWNERS NAME PIPING GOING TO BE. TESTED~__i. STATE REGISTR3kTION $ /~77 BAKERSFIELD FIRE DEPARTMENT HAzARDouS·MATERIAL DMSION PERMIT TO OPERATE UNDERGROUND HAZARDOUS STORAGE FACILITY permit No.: IssUed to: 310056 FASTRIP FOOD STORE #362 State ID N°.: 310056 Location: 6401 SOUTH H STREET BAKERSFIELD, CA 93313 Owner: \ JACO HILL P.~ O. BOX 1807 BAKERSFIELD, CA 93302· Operator:. JACO HILL P. O. BOX 1807 BAKERSFIELD, CA 93302 Facility Profile: · Tank No. . Substance Capaci .ty 1 GASOLINE 12,OOO GAL 1987 2 GASOLINE 12,OOO GAL 1987 3 GASOLINE 12,OOO GAL 1987 4. GASOLINE 12,OOO GAL ' 1987 Year Installed YES YES YES YES This permit i~s granted subject to the conditions listed on the attached summary of conditions and may be revoked for failure to adhere to the stated conditions and/or violations of any other State or Federal regulations. Issued by: Ralph E. Huey Title: Hazardous MateriaI Coordinator Issue Date: JULY 1, 1991 Expiration Date: JULY 1, 1994 POST ON PREMISES NONTRANSFERABLE DBA OR FACILITY NAME ~ BOX ~0 INDICATE TYPE OF BUSINESS HAZARDOUS MATERIALS DIVISION 2130 G Street, Bakersfield, CA 93301- .. i (805) 326.3970 ~ ' - AU6 2 .~ 1991. Ans'd CORPORATION IGAS O 2 DISTRIBUTOR KERN COUNTY PERMIT STATION IU 3 FARM [~ 4 PROCESSOR [~ 5 OTHER TO OPERATE No. ZIP~,~DE %55 i '.,~ ' ~INDIVIDUAL I~PARTNERSHIP [~ LOCAL AGENCY DISTRICTS [~ICOUNTY AGENCY [~ STATE AGENCY [~FEDERALAGENCY EMERGENCY CONTACT PERSON (PRIMARY) DAYS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE NIGH¥S: NAME~L~ST, ~'RS--T) -- PHONE NO. WITH AREA CODE ' I1. PROPERTY OWNER INFORMATION (MUST BE COMPLETED) EMERGENCY CONTACT PERSON (SECONDARY) optional DAYS: NAME (LAST, FIRST) PHONE No; WITH AREA CODE NIGHTS: NAME (LAST. FIRST) PHONE NO. WITH AREA CODE NAME MAILING OR STREET ADDRESS CARE OF ADDRESS INFORMATION ~' BOX ~ INDIVIDUAL TO INDICATE ~PARTNER, SHIP LOCAL AGENCY [~ STATE AGENCY [~ COUNTY AGENCY [~ FEDERAL'AGENCY PHONE No. WITH AREA CODE E)6- 5q 3-- 7 oo o III. TANKOWNER INFORMATION (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION Hill ..~AILING OR STREET ADDRESS CITY NAME ' -- - ! ~' BOX [~ INDIVIDUAL TO INDICATE  Zip CODEP RTNERSHIP LOCAL AGENCY [~ STATE AGENCY [~ COUNTY AGENCY [~ FEDERAL AGENCY PHONE No. WITH AREA CODE OWNER'S TANK No. DATE INSTALLED DO YOU HAVE FINANCIAL RESPONSIBILITY? VOLUME · !~OOO IAooo Y/N TYPE PRODUCT IN STORED SERVICE YIN YIN Fill one segmen~ constructed of ut for each tank~ unless ah.tanks and piping are same materials, style ar~ype, then only fill ~, o~ne segment out.- please identify tanks by owner ID #. TANK D ESCRIPTI0N COMPLET,E ALL ITEMS -- SPECIFY IF UNKNOWN C. DATE INSTALLED (MO/DAY/YEAR) I O. TANK CAPACITY IN GALLONS: I o~OO(..,) '. III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXO A, TYPEOF [] 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL 3 SINGLE WALL WITH EXTERIOR LINER ] 4 SECONDARY· CONTAINMENT (VAULTED TANK) ] 95 UNKNOWN ] 99 OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 6 POLYVlNYL CHLORIDE [] 7 ALUMINUM . [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC [] ~ 100"/. METHANOL COMPATIBLE W/FRP ] 99 OTHER [] 1 RUBBER LINED [] .2 ALKYD LINING [] 3 EPOXY LINING C. INTERIOR ~ 5 GLASS LINING r"-'l 6 UNLINED ~ 95 UNKNOWN LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ .NO__ [] 4 PHENOLIC LINING [] 99 OTHER D, CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECTION [] 5 CATHODIc PROTECTION [] 91 NONE .." [] 3 VINYL WRAP :!;.[~ 4 FIBERGLASS REINFORCED PLASTIC "' .E~'95 UNKNOWN ,-[] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFuNDERGROUND, BOTH IF APPLICABLE -" A, SYSTEMTYPE A U 1 SUCTION .'A(~)2 PRESSURE A U 3 GRAVITY A U 99 OTHER B, CONSTRUCTION 'A U 1 SINGLE WALL A U 2 DOUBLE WALL A(~3 LINED TRENCH ' A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A-U 3 POLYVINYL CHLORIDE(PVC)A~)4 FIBERGLASS PiPE CORROSION AU 5 ALUMINUM A U 6 CONCRETE . A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A IJ 95 UNKNOWN · A U 99 OTHER D, LEAK DETECTION [] ~ AUTOMATIC LtNE LEAK DETECTOR [] 2 LINE T)GHTNESS TESTING [] 3 INTEHS¥1([AL ' MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] , v,SUAL CHECK ,NV NTORY RECONC,L,AT,O. VAPORMON,TOR,NG [] [] TANK TESTING [] ,NTERST.T,ALMON.TORtNG [] ,, NO.E [] UN .OWN [] 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK L Dm # B. MANUFACTURED BY: C. DATE INSTALLED (MO/DAY/YEAR) D, TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE tTEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPEOF [] 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE C, INTERIOR LINING [] 3 SINGLE WALL WITH EXTERIOR LINER . [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER ] 2 STAINLESS STEEL [] '[] 6 POLYVINYL CHLORIDE [] [] ,o GALVAN,ZED STEEL [] [] 1 RUBBER LINED [] 2 ALKYD LINING [~ 5 GLASS LINING [] 6 UNLINED IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? 3 FIBERGLASS 7 ALUMINUM 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC [] '8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER D, CORROSION [] I POLYETHYLENE WRAP [] 2 COATING PROTECTION [~ S CATHODIC PROTECTION [] 91 NONE [] 3 EPOXY LINING [] 4 PHENOLIC LINING [] 95 UNKNOWN [] 99 OTHER YES~ NO__ [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED' PLASTIC [] 95 UNKNOWN [] 99 OTHER IV. PIPING I'NFORMATION C,RCLE A IFABOVEGROUNDOR U IFUNDERGROUNO, BOTH IF APPLICABLE A, SYSTEMTYPE A U 1 SUCTION A U 2 PRESSURE A U ~ GRAVITY A U 99 OTHER B, CONSTRUCTION A U I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C, MATERIAL AND A U 1 BARE STEEL · CORROSION A U 5 ALUMINUM PROTECTION A U 9 GALVANIZED STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4. FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL W/ COATtNG A U 8 10~/o METHANOL COMPATIBLEW/FRP A U' 10 CATHODIC PROTECTION A U 95 UNKNOWN A U '99 OTHER D, LEAK· DETECTION [~] i AUTOMATIC LiNE LEAK DETECTOR ~ 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING rml 99 OTHER V. TANK LEAK DETECTION [_l--~J 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [~ 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING Jaco Oil Company 3101 State Road Bakersfield, California 93308 TelePhone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303-1807 Bakersfield City Fire Department Haz Mat Division 2130 "G" Street Bakersfield, Ca. 93301 ATTN: Ralph Huey July 15, 1987 Dear Mr. Huey: Along with the packages John Kerley delivered to your office last week, there was another sheet which should have been included in each package. These sheets explain the relation- ship between the actual owner of the store and who owns the gasoline equipment. The locations I a'm enclosing are: C~J & F Liquors, 2805 Edison Highway, Bakersfield, Ca. Fastrip Food Store, 805 34th St., Bakersfield, Ca. " " " 2698 Oswell, Bks , Ca Howards Mini Mart, 4201 Belle Terrace, Bks., Ca. White Lane Fastrip Food Store, 6401 White Lane #112, Bks, Ca. Fastrip Food Store., 6401 South "H" Bks Ca " " " 3501 Mt Vernon, Bks , Ca Howards Mini Mart, 3300 Planz Rd., Bks., Ca. Fastrip ~ood Store, 4013 South "H" Bks Ca " " " 37-01 Ming Ave., Bks , Ca Howards Mini Mart, 1332 Bernard, Bks., Ca. Fastrip Food Store, 4901 So. Union, Bks. Ca. EXPLANATION OF SITE FACILITY/BUShiNESS/OWNERS At this particular location the actual owners of the business are shown on Form .2A Section 1 Part A. Please be advised that the owners of the business do not own the gasoline facility'portion of-their business. The gasoline tanks and equipment are owned by: JAMIESON HILL CO. P. O. BOX 1807, Bakersfield, Ca. 93303-1807 (mailing) 3101 Stale Road, Bakersfield, Ca. 93308 (location address) John Kerley, Operations Manager, (805) 393-7000 office The'business owners completed the total package with the exception of items 1 through 10 on form 4A-1 (being the description of the Hazardous Materials Inventory sheet). The store owners operate the gasoline facilities for JAMIESON HILL CO. on a commission basis and they (store owners) provide the employees who have control over the gasoline pumps. JAMIESON HILL CO. makes the arrangements to have the gasoline delivered to the location and also provides maintenance on the gasoline equipment for major repairs. Normal routine maintenance of the gasoline equipment is the responsibility of the store owner. Howards Mini Mart, ~-3~Bernard, Bakersfield, Ca. EXPLANATION OF SITE FACILITY/BUS~NESS/OWNERS At this particular location the actual owners of the business are shown °n Form 2A Section 1 Part A. Please be advised that the owners of the business do not own the gasoline facility portion of their business. The gasoline tanks and equipment are owned by:J. T. Company P. O. BOX 1807, Bakersfield, Ca. 93303-1807 (ma.iling) 3101 State Road, Bakersfield, Ca. 933.08 (location ~ddress) John Kerley, Operations Manager, (805) 393-7000 office The business owners~ qompieted the total package with the exception of i.tems 1 through 10 on form 4A-1 (being the description of the.Hazardous Materials Inventory sheet). The'store owners operate the gasoline facilities for J. T. COMPANY on a commission basis and they (store owners) provide the emploYees who have control J. T. COMPANY over~ the gasoline pumps. makes the arrangements to have the gasoline delivered to the location and also provides maintenance on the gasoline equipment for major repairs. 'Normal routine maintenance of the gasoline equipment is the responsibility of the store owner. J & F LIQUORS ~805 Edison' Hwy., Bakersfield, Ca. EXPLANATION OF SITE FACILITY/BU$'~NESS/OWNERS At this particular lOCation the actual owners of the business are shown On Form 2A Section 1 Part A. Please be advised that the owners of the business do not own the gasoline facility portion of their business. The gasoline tanks and equipment are owned by: JACO HILL CO. P. O. BOX 1807, Bakersfield, Ca. 93303-1807 (mailing) 3101 State Road, Bakersfield, Ca. 93308 (location address) John Kerley, Operations Manager, (805) 393-7000 office The 'business owners completed the total package with the exception of items 1 through 10 on form 4A-1 (being the description of the Hazardous Materials Inventory sheet). The store~owners operate the gasoline facilities for JACO HILL CO. on a commissi~6n basis· and they (store owners) provide the employees who have control over the gasoline .pumps. JACO HILL CO. makes the arrangements to have the gasoline delivered to the location and also provides maintenance on .the gasoline equipment for major repairs. Normal routine maintenance of the gasoline equipment is the responsibility of the store owner. White Lane Fastrip Food St'ore, 6401 White Lane, #112, B~kersfield TYPE OF INSTALLATION ( ) 1. In-Tank Level Sensor 1. IN TANK LEVEL SENSORS (v~' 2. Leak DeteCtor (v~) 3. Fill Box Number of Tanks List By Tank ID Name of-System Manufacturer & Model Number Contractor/Installer 2. LEAK DETECTORS Number of Tanks List By Tank ID Manufacturer & ho&el Nu~nbe~ Contractor/Installer :3. FILL BOXES Number of- Tanks List By Tank ID Name of System Manufacturer a Model Number Contractor/Installer /OPERATOR DATE .Jaco Oil Company 3101 State Road Bakersfield, California' 93308 Telephone: (805) 393-7000 Facsimile: (805) 393-8738 Post Office Box 1807 Bakersfield, California 93303-1807 June 27, 1990 Kern County Environmental Health Department 2700 '~" Street, Suite 300 Bakersfield, Ca. 93301 Ms. Amy Green: Please be advised that the attached forms are those forms that we have requested that all of our operators in Kern County utilize in completing underground tank monitoring. Please advise us if you have any problem with these forms. La~.rcence Henson Gasoline Opera~ions Tolal Finish Tolal Slarl TOTAL Pump · Tesls TOTAL SALES JACO OIL COMPANY, p.O. BOX 1807, BAKERSFIELD, CALIFORNIA 93303, (805) 393-7000 LEAOED PREMIUM r.~ Gallons Money REGULAR @ NO LEAD @ Gallons Money Gallons Money I I I I I I I I' I I i I '. TOTAL GALLONS Beg. inv. I I I I I I I I I I ! I I I 1 I I ! Add flcPts. I I I I I I I I I I I sub. Sales I I I i I I I · 1 I I Book Inv. Month UNLEADED PREMIUM @ Gallons - 1 Money , I f, I I ~ I I I I I I I I ' I ' I I I I I I I I I Inches Gallons. + or - Leaded Premium · Regular · NO Lead · Unleaded Premium · Oiesel · TOTAL · UNI[ PRICE REMARKS: I STATION NAME: ICITY: Day lg ,, DIESEL GallOns ! ! I i/ I PRODUCT Reg. No NIL ~em. Die~el Tolal Lesl Ct. q · CASH SALES Month year PRODUCT: DAYS GALLONS SOLD OVER SHORT 1 2 3 4. 5 ~6 7 TOTALS 8 9 11 12 13 14 TOTALS .15 16. 17 20 21 TOTALS 22 23~ 24. 25 26 TOTALS 30 31 _~TOTALS MONTHLY GRAND -TOTALS (TOTAL TOTAL Gals.' s01d X 100t Variation B. Does amt. over/sho~t exceed 350 gals? ~ NO - Continue MmUtorin9 __ Yes - Report within 24 hfs ofiiscover Does the variaticm exceed -- NO - Continue routine monitoring -- Yes - Report to Permitting AuthoriLy w~b~ x within 24 hfs of discover~ A. Galr- over/short TOTAL Gals. sold X 10~lt Variation S. Does amt. over/short exceed 350 gals? ~ NO - Continue Monitoring __ Yes - Report within 24 hfs o~i~cove, r Does the variation exceed -- NO - Continue routine monitoring -- Yes - Report to Permitting Authority within 24 hfs ot discovery Gals over/short TOTAL Gals. sold X 100t Variation [~s amt. over/short exceed 350 gals? ~ NO -' Co~tinee Monitoring ~ Yes - Report within 24 hfs d i SCore r y Doe~. the variation exceed -- NO - Continue routitle -- Yes - Report to Permitting Authority within 24 hfs ct discovery A. Gals over/short TOTAL Gals. s01d. I 100t vari-tio. ooes amt. over/short exceed ]50 gals? __. NO - ~tin~ ~itori~ .__ Yes - Re.ri ~i~in 24 hfs o~i~very ~s t~ variati~ e~ 5%7 -- Yes - Re~rt to ~rmltti~ Aut~rity ~ithin 2~ h~s o[ di~very NTH ~NO Gala over/ahot~ · OTA~ Gala. sold Have your shortages exceeded chart amount~ No ' ..~1f Yes, report"~o Kern County ~ No, continue monitoring X 100t Variatam Does Variation exceed 1.5t? ~ NO - Continue Routine Monitoring __ Ye'~ - Report to Permittin~ Autl~rity withi~ 24 hfs of dic, c~very PRODUCT: DAYS GALLONS SOLD OVER SHORT ~ TOTALS 8 9 10. 11 12 13 14 TOTALS 16 18 19 20 TOTALS 22 23 24 25 26 27 28 -- TOTALS - 'TOTALS MONTHLY GRAND TOTALS (TOTAL llave your shortages ~xceeded chart amount? Yes No If ~es, report"to Kern County If No, continue monltorinq Gala. over/short TOTAL Gals. sold X 100t variatio~ ' B. ~OeS met" over/l~t'exceed 350 gala~ ~s ~ Variat[~ e~ St? ' ~-e' pith{~ 24 hfs of *TOXAL Gals.. sold " *'~ 100t Va~lation O. ~ ~t. ~r/~rt e~ 350 gale A. *': '~-Gals over/abort "?OTAL Gals. sold - X 100~ Variation B. OO~ amt. over/l~oct ezueed 350 ga~? -' __ Xes , ~ to Nmitt~ ~t~{ty " within 24 his o~ dl~'' [,' TOTAL Gals. sold Yes - ~} vi~ 24 ~s ~a't~ vhriatlm ~ St? Yes - ~ ~ ~tti~ . . 24 ~s og dis~'..'; ',,, ' . :~ -. ;.,.' - , ' ' X 100~ VarlitlQ" ~,~ ' ~'lth,h'24'hra nf diary - .: ' FILE CONTENTS SUMMAR~ FACILITY: ~-m.~Lr~' 0 ADDRESS :.A/ ~x[] ~9~f)~r PEP, MIT #: ENV. SENSITIVITY: Activity Date #.Of Tanks · Comments / / I 1700 FLOWER STREET BAKEI~gFIELD, CA 93305 I~{0NE (805) 861-3636 INS~IONS: Please call for an inspector only when each group of inspections with the sa~e number are ready. They will run in consecutive or~er beginning with number 1. DO NOT cover work f~x any numbered group until all it.s in that group are signed, off by. the Pemitting ~thority. Following these instructions will reduce the number of required insPeCtion visits ~ therefore [arevent asses~nent of additional fees... - TAN~S & BACKFInn - INSPECTION DATE INSPBCTOR · Spark Test Certificatio. Cathodic Protection of Tank(s) '. - PIPING SYSTEM .-  Pipin~ & Raceway w/Collection su~ ~g-~'- 67 Z.~,%'. Corrosion Protection of Pi~in~, Joints, Fill Pi~e Cathodic Protection S~rst~n-Pipin~ - SECONDARY CONTAINMENT, OVERFILL PROTfETION, LEAK DETECTION - Liner Installation- Tank(s) Liner Installation - Pi~ing ~-/..~ Vault With Product Compatible Sealer '- Level .Gauges or Sensors, Float Vent Valves Product C~,~atible Fill Box (es)  Product Line Leak Detector (s) Leak Detector(s) for Annular Space-D.W. Tank(s) Monitoring Well (s)/Sunp(s) Leak Detection Device(s) For Vadose/Groundwater ~Monitoring'Wells, Ca~s & Locks Fill Box Lock Monitoring,Requirements CONTACT /__,,,z~ ~.../qt;r ~ hlCf~qSE ~ ]~iVI~H~SIT~A HEALT~ DI% /~) 1700. ~ STREET BAKERSFIELD, CA 93305 F~{ONE (805) 861-3636 INSTRUCTIONS: Please Call for an inspector only whe~ each group of inspections with the s~ne number are .ready. They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered' group until all items in that group are signed off by the Pezmitting Authority. Following these instructions will redUCe the 'number of required inspection visits a~ therefore prevent assessment of additional fees. - TANKS & BACKFILL - -~. ::. ~j ' .. INSPECTION DATE INSPfL'TOR Backfill of Tank (s) .... ~ Spark Test Certification ~ .... '" '~ Cathodic Protection of Tank(s) ' - PIPING SYSTEM- Piping & Racewa~ w/Collection Sump ~ .~ Corrosion Protection of Pipinp, Joints, Fill Pipe ~ ~. Electrical Isolation of PipingFromTank(s)~ ~_~ Cathodic Protection S~st~ml-P.iping - SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION - [~Liner Installation - Tank(s) Liner. Installation - Piping Vault With Product Ccmpa_tible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annular Space-D.W. Tank(s) Monitoring Well (s)/Sump(s) Leak Detection Device(s) For Vadose/GrOundwater - FINAL- Monitoring Wells, Ca~s & Locks Fill Box Lock Monitoring Requir~nents ,- ~'' iNam~ of Carrier } ~.ECEIV%D, sub{eot to the classifications and farlffs in effect on. the date of the issue of this 8ill of Lading, Shipper's No. / Carrier's No. 12104 _ FRESNO, CALIFORNIA 93711 1-2,i 19 S7 From MODERN WELDING COMPANY, INC. ]onsicjned fo ,~'L1C 0 ~ Destination .... .., : S ~' :,:'- e t. cl State ~oute 5400 (Mail ur street address of conslgne~--For purposes of notification only.) County Delivery Address ~- 5.:-i'~:'! :~, [I ~t., (~ To be tilled in only when shipper desires and governing tariffs provide for delivery thereat.) )eliverlnc Corrier ~ Car or Vehicle Iniflak No No. Kind of Package, Descr;ption o! Articles. Special I, (Sublet to ' g 1 -/~, ''~' ~._,O.,;O Sin e ~,',~ail GLASTEEL To'aK ::~ 523872v ~,JO !)1'I E I. i)CO ,~<) Volt [Ioli,iav '?as'~ .... .~zLn("ssod MODERN WELDING COMPANY, INC. ShiDDer. Permanent post-office address of shipper, FRESNO, CALIFORNIA 9371 ]..?~- ..... ' ~ Agent must detach and retain, this Shipping Order'and must s,qn the Original Bill of Lading. 1 (Name of Carrier) -~' ~(ECEWED, subject fo the classifications and tariffs in effect on the data of the issue of this Bill of Lading, FRESNO, CALIFORNIA 93711 1-21 19 ,S7 From MODERN WELDING COMPANY, INC. ig '' '" Cons ned to ..; : ~ C ,: ...... :i ! ~ (Mall ur street address of consignee--For purposes of notificet;on only.) Cqunfy ' ' ' ~''' . ~' {'k To be filled in only when sh;pper desires and governing tariffs provide for delivery thereof.) Dellvering Carrier ,,/-"~/-~.'d~c'?y~) Car or Vehicle Initials .No. 7~'''~ No. Kind at' Package, Description ct Artlcies, Special *w[:~¢:i{T Class Check Sub}ecl t~ 5etlon 7 o~ Comlttton. c Packages Marks, and ~ceptions (Su~J~ to Correction) or Rate Column applicable bill ~ ladlnff, E this nhlpn)en ~ ] ';' "' : ': ' ' ' T ,~ ~7 ,-~31-; [ ~ L ' · , st~or s~ ol~ the followtn~ a~temenl Standard Compliance Check Facility: Equipment to be installed:. ~ Tank(s), ./~O ft'. of Dsuction []pressurized piping Req' d Approved Primary Containment DFiberglass (FRP) Make & Model ~Fiberglass-clad steel Make & Model · ~Uncoated steel Make & Model [']Other: Make & Model Comment: Additional: Inspection: Secondary Containment of Tank(s) DDouble-walled tank(s) Make & Model []Synthetic liner Make & Model ~ ~ ~Lined concrete vault(s)' Sealer used' ~Other Type Make ? Mpd~/ Comment: (~)h ~ ,~l ' ,.~ I~d;~f-~,~ '~ ~ f'~'~." ~ Additional: . Inspection: Secondary containment volume at least 100% of primary tank vol uae (s) Comment: Additional: Inspection: Secondary containment volume for more than one tank contains 150% of volume of largest primary containemnt or 10% of aggregate primary volume, whichever is greater Comment: Additional: Inspection: Secondary containment open ~o rainfall must accomodate 24 hour rainfall Total Volume Comment: Approved Additional: Inspection.- Secondary containment Product MY ~ Comment: . Additional: Inspection: is product-compatible Documentation Annular space liquid is compatible with product Product Annular liquid Comment- Additional: Inspection: 1Z Primary Containment of Piping [~Fiberglass piping Size & Make Y]Coated steel piping size & Make DUncoated steel piping Size DOther Comment: · Additional: Inspection: Secondary Containment of Piping ~ []Double-walled pipe [~Synthetic liner in trench []Other Size & Make Size & Make C°mment: Additional: Inspection' Corrosion Protection , ^ [~Tank(s) · ~Piping & fittings []Electrical isolation Comment: Additional: Inspection: 1Manufacturer-Approved Backfill for Tanks & Piping · Type · ~~, Comment: Req,d~ Approved Additional: Inspection: Tank(s) Located Comments: Additional: No Closer .Than 10 Feet to Building(s) Inspection: ComPlete Monitoring System Monitoring device within secondary containment: [~Liquid level indicator(s) []Liquid used [Thermal conductiv'itY sensor(s) []Pressure sensor(s) [2IVac uum gauge ['~Sump (s) /-__~ ~Gas or v~ detector(s) ~Manual inspection & sampling ~Visual inspection Comments: ~ ie~ Additional: Inspection: Other Monitoring [~Periodic tightness testing ~Pressure-reducing 'line leak []Other Method detector(s) Comment- Addit'ional: Inspection: Overfill Protection [-]Tape float gauge(s) [Float vent valve(s) [-]Capacitance sensor(s) ~High level alarm(s) '. DAutomatic shut-off control(s) [-~Fill box(es)'With 1 ft.3 volume ~,,~ [%( ~]Operator controls with visual level monitoring Other Comment: '3 .Req' d Approved Additional: Inspection: Monitoring Requirements Additional Comments Inspection: Date ELtra Inspections/Reinspections/Consultations Da te: Purpose: Comment: Date: Time'Utilized · Purpose: Comment: Da te: Purpose: Tfme Utilized Comment-: Date: Time Utilized Purpose: .Comment: Invoice Date: InsPector Time Utilized Total Time: Date: 4 Permit,ApPlication Checklist Facility Name. Facility Address Applicatio~ Category: ~. ~tandard Design .. ·' (Secondary Containment) ' Motor Vehicle Fuel Exemption Design -- (Non-Secondary Containment)· Approved 'Permit Application Form-Properly Completed Deficiencies:- Copies of Plot Plan Depicting: Property lines Area encompassed 'by minimum 100 foot radius around tank(s)and -piping ~1i tank(s) identifi.ed by a number and Pr~guct to be stored Adequate scale (minimum 1''=16'0"' in detafl) North arrow .~ All structures within 50 foot radius of tank(s) and piping. Location and labeling of all product piping and dispenser isla'nds Environmental sensitiuity data including: *Depth to first groundwater at site *Any domestic or agricultural water well within ~00 feet of tank(s) and piping *Any surface water·in unlined conveyance within 100 feet of tank(s) and piping *All utility lines within 25 feet of tank(s)· and piping (telephone, electrical, water, sewage, gas, leach lines, seepage pits, drainage systems) *Asterisked items: appropriate documentation if permittee seeks a motor vehicle fuel exempti6n '~rom secondary containment Comments: Approved Copies of Construction Drawings Depicting: Side Vi~-~ of Tank Installation wi'th''Backfill, Raceway(s), Secondary Containment and/or. Leak Monitoring System in Place Top View. of Tank Installat'ion with Raceway(s), Secondary Containment and/or Leak Monitoring System in Place A Materials List (~ndicating those used. in Backfill '~-~-.~ Tank(s) ~- i=ooo~' ~~ Product Piping ~.~_~~ ~:F~'~~ Raceway(s) ~ ~ the construction).- Sealer(s) Secondary Containment r~e'ak Detector (s) ~, e~_~ ~-~ - ~ Overfill Protection Gas or Vapor Detector(s) Sump(s) Monitoring Well(s) Additional: Documentation of Product Per.formance Additional Comments Reviewed By ~ ~ SITE INSPECTION: Comments: Date Approved Disapproved Inspector Date 1700 Flower Street Bakersfield, California 93305 ' Telephone (805) 861-3636 PF, RMIT TO CONSTRUCT UNDERGROUND STORAGE FACILITY FACILITY NAME/ADDRESS: Fastrtp South "H" ~treet and Panama Lane Bakersfield, CA KERN COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH DIVISION HEALTH OFFICER Leon M Hebertson, M.D. DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Relchard PERMIT ~310056B OWNER[S) NAME/ADDRESS: Jaco Oil '3101 State Road · ? Bakersfield, CA 93303 IX__X} NEW BUSINESS {__l CHANGE OWNERSHIP .{ I__l RENEWAL · l I MODIFICATION I I OTHER PERMIT EXPIRES APPROVAL DATE APPROVED BY -October 17, 1987 October 17 ', 1986 -JO~ Canas ..................... POST ON PREMISES. . . . . . .............. CONDITIONS AS FOLLOWS: 1. All pertinent equipment and materials used in this' construction are subject to identification, and approval by the Permitting Authority prior to construction. This permit is issued contingent upon guaranteed compliance with the guidelines as determined by the Permitting Authority. 2. All c oalstruction to be as per facility plans approved by this department and verified bY inspection by Permitting Authority.. 3. Permittee must contact Permitting Authority for on-site inspection(s) with 48 hours advance notice.. 4.Construction inspection record card is included with permit given to Permittee. This card must be posted af 3obsite prior tO initial inspection. Permittee must' contact Permitting Authority and arrange for, each group of required inspections numbered as.per instructions on card. Generally, inspections will be made of: a. Tanks and backfill b. Piping'system with secondary.containment b. Overfill protection and leak detection/monitoring c. Any other inspection deemed necessary by Permitting Authority.. 5. All underground metal product piping, fittings, and connections must be wrapped to a minimum 20-mil' thickness with corros'ion-preventive, gasoline- .... resistant tape or otherwise protected from corrosion. 6. Spark testing (35,000 volts) required at site prior to installation of tank(s). Test(s) must be certified by the manufacturer, and a copy of test certifications supplied to the Permitting Authority. 7. Liner shall be installed by a trained experienced liner contractor and installation at site approved by Permitting Authority. 8. All equipment and materials in this construction must be installed accordance with all manufacturers' specifications. 9. No product shall be stored in tanks until apprOval is granted by the Permitting Authority. 10. Monitoring requirements for this facility will be described on final "Permit to Operate." Division~'o~ Environmehtal Health Appl~ca'~'lo~u . 1700~Fl°~r Street, Bakersfiel[?= ~, . .. ~.:" 93305 (7¥... ~ ~O~~~ '- ~PLI~TION FOR PE~IT '~ OPE~TE ~DE~R~D' ~~US' SUBST~CES ~S~E FACILI~ T~ of Application (ch~k): ~N~ Facility ~ificatton of Facility ~isti~ Facility ~ansfer of ~ership ae f~mergency 24-Hour Contact (name, area code, phone.): Days ~ 5 7oO O Nights ~ ~ % 7oo.o. Facility Name . ~.~W-~ ~ . . No. of Tanks Type of Business (cheCk): ~Ga's01ine Station ~Other (describe) Is Tank(s) Located on an Agricultural Farm? [-]Yes ~No Is Tank(s) Used Primarily for ~jricultural Purposes? ~Yes Facility Address ~.MJ. ~0~ .5-..~.~- ~ ~v~/W~ ~'. Nearest Cross St. T R SEC (Rural Locations (~ly) Owner ~'J-~ ~_o ~, ~_, ~ ~. Contact Person. Ce Address · ~ 0 1 ~-r~ ~-u, ' .... Zip ~ Telephone ~rator Con.ct ~r~ ~dress Zip , Tele~ne ~ll ~aracteristics' at Facility " hsis for Soil ~ a~ Gro~ter ~p~ ~teminatto~ .' Contractor ~o ~ ~o. ~ ~ntrac~or's ~ce~e ~. Address · ~. ~ ' , , --- '~ . Zip Telel:~Ons Proposed Startin~ Date ---l Proposed c~npletion Data ~b e e ~ Z~'-~ ~ Worker's Com~nsation Certification ! Insurer , ' D. If ~is ~mit Is. For ~ification Of ~ ~isti~ ~cility, Briefly ~ri~ ~ifi~tt~ , E. Tank(s) S~re (~eck all ~t a~ly): Tank t '~s~ Pr~uct '~tor Vehicle Unlead~ R~ular Pr~i~ Die~l ~ste o u , u F. ~1~1 ~sltlon of ~tertals Stor~ (~t ~ces~ry for ~tor v~tcle f~ls) T~k 9 Ch~t~l Stor~ (n~c~rc~al ~e) ~ % (If kn~) ~lcal Pr~lously S~rc~ (if different) Transfer of Ownership Date of Transfer Previous Facility Name I, Previous Owner accept fully all' 66f£gati~ns of l~rmit NO. issued, tc I understand that the Permitting Authority may review ar~ modify or terminate the transfer of the facility upon receiving this c~mpleted form. Permit to Operate this ~dergro~d Storag~ This fora has been completed under penalty of "periury and to the best of my knowledg true and correct. ~ .' Facility Name TANK _~ (' (FILL OUT SEPARATE F EACH TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES ' 1. Tank is: [2-Vaulted [] Non-Vaulte.d [] Double-Wall gle-Wall g. Tank Material [~ Carbon steel [] Stain]ess Steel [] Polyvinyl Chloride~ Flberglass-Clad Steel [-i Fiberglass-Reinforced Plastic [] Other (describe): 3. Primary Containment Date Installed Thickness (Inches) 4. Tank Secondary Contaipment [] Double-Wall [~ynthetic Liner [] Lined Vault [], Other (describe): Material Thickness (Inches) [] Concrete [] Aluminum [] Bronze [] Unknown capacity (Gallons) Manufacturer [] None [] Unknown Manufacturer: Capacity (Gals.) 5.'Tank Interior LininK / ..[-] Rubber [] Alkyd Iq Epoxy [] Pheuolio [] Glass [] Clay~Unlined [~ Unknown [] Other (describe): 6. Tank Corrosion Protep~on [] Galvanized ~Fiberglass-C~ad [] PolyethYlene W~ap [~ Vinyl Wrapping [] Tar or Asphalt [-] Unknown [] None [] Other (describe): Cathodic Protection: [] None [] Impressed Current System [] Sacrificial Anode System ~ Describe System & Equipment: .?. Leak DetectiOn, Monitoring/ and Interception a. Tank: [] Visual (vaulted tanks only) [] Groundwater Monitoring Well(s) [] Vadose Zone Monitoring Well(s) [] U-Tube Without Liner v -TUbe with Compati.~te Liner Directing Flow To Monitoring Well(~)* apor Detector~*[~LiqUid Level Sensor* [] Conductivity Sensor E] Pressure sensor In Annular Space Of Double Wail Tank * ' ' [] Liquid Retrieval.& Inspection From U-Tube, Monitoring/Well Or Annular SpaCe [~ Daily Gauging & Inventory Reconciliation [] Periodic Tightness Testing [] None__.~ Unknown [] Other ~ b. Piping: ~ Flow/Restricting Leak Detector(s) For Pressurized Piping* '- []Monitoring Sump With Raceway [] Sealed Concrete Raceway [] Half-Cut Compatible Pipe Raceway [] Synthetic Liner Raceway [] None []Unknown [] Other · 'Describe~Make & Model:,. /_4~#._'--t,q-- ~'t~."'/" 8. Tank Tightness /%/~:~ Has This Tank Been Tightness Tested? [] Yes' ., Date Of Last Tightness Test Test Name 9. Tank Repair Tank Repaired? ~,Yes [~ No Date(s) Of Repair(s) Describe Repairs [] No [] Unknown Results Of Test Testing Company E]Unknown 10. Overfill Protection ~ Operator Fills,'Controls,-& Visually Monitors Level [] Tape FloatGauge [] F,l.~gat, Vent Valves [] Auto Shut-Off Controls [] Capacitance Ser~or ~ Sealed Fill'Box [] None [] Unknown [] Other: /~.4~.~ List Make & Model For Above Devices 11. Piping .. a. bo Co Underground Piping: [~"~es [] No UnknoWn Material Thi_~ess (inches) Diameter [] Manufacturer ~t¢ ['q Pressure [] Suction [] Gravity Approximate Length Of Pipe Run underground Piping Cor~sion Protection: [] Galvanized ~Fiberglass-Clad [] Impressed Current [] Sacrificial Anode ~ Polyethylene Wrap ~Electrical Isolation [] Vinyl Wrap []Tar or Asphalt ~. Unknown ~ None [] Other (describe): underground Piping, S~ndary Containment: [-]' Double-Wall [~Synthetic Liner System [] None [] Unknown [] Other (describe): Facilit~ Name Ho .. FOIl EACtI SECTION, CHECK ALL APPROPRIATE BOXES 1. %ank i_~s: [~ Vaulted [] Non-Vaulted [] Double-Wall ngle-Wal.1 2. Tank Material [] Carbon Steel [] Stain]ess Steel [] Polyvinyl Chloride [_~ Fiberglass-Clad Steel [] Fiberglass-Reinforced Plastic [] Concrete [] Aluminum [] Bronze [']Unknown [] Other (describe): 8. Primary Containment Date Installed Thickness (Inches) c~Pacity (Gallons) Manufacturer 4. Tank Secondary ContaSnment [] Double-Wall [~Synthetic Liner [] Lined Vault [] None [] Unknown [~ Other (describe): Manufacturer: -/~ ' Material Thickness (Inches) Capacity (Gals.) 5.'Tank Interior Lining . [] Rubber [] Alkyd []Epoxy [-]Phenolic [] Glass .[-] Clay~'~nlined ~ Unknown [] Other (describe): 6. Tank Corrosion Protection [] Galvanized [~'~Fiberglass-Clad [] Polyethylene Wrap [] Vinyl Wrapping ~ Tar or Asphalt [~ Unknown [] None [] Other' (describe}: Cathodic Protection: [] None [] Impressed Current System-[-] Sacrificial Anode System [] Describe System & Equipment: 7. Leak Detection, Monitoring, and Interception a. Tank: [] Visual (vaulted tanks only) [] Groundwater Monitoring Well/s) [] Vadose Zone Monitoring Well(s) [] U-Tube Without Liner v -TUbe with Compati.~e Liner Directing Flow To Monitoring Well(s)* apor Detector'*[~'Liquid Level Sensor.* [] Conductiv2ty Sensor* [-]' Pressure Sensor In Annular Space Of Oouble Wail Tank,* [-] L.~i~uid Retrieval.& Inspection From U-Tube, Monitoring Well Or Annular Space [~Daily Gauging & Inventory Reconciliation ~ Periodic Tightness Testing. ' '- [] None_J~LUnknown [] Other .' b. Piping: [~['Flow-Restricting Leak Detector(s) For Pressurized Piping* []Monitoring Sump With Raceway [] Sealed Concrete Raceway C] Half-Cut Compatible Pipe Raceway []Synthetic Liner Raceway O-None []Unknown [] Other~ ,8. Tank Tightness Has'This Tank Been Tightness Tested? [] Yes ., Date Of Last Tightness Test Test Name 9. Tank Repair AI~ Tank Repaired? []Yes [] No Date(s) Of Repair(s) Describe Repairs []Unknown [] No [] Unknown Results Of Test Testing Company 10. Overfill Protection [] Operator Fills, Controls,.& Visually Monitors Level [']. Tape Float Gauge [2] Float Vent Valves. [] Auto Shut-Off controls .[-] Capacitance Sez~sor ~'~ealed Fill Box [] None [] Unknown [] Other: /"~4~ · ' List Make & Model FOr Above Devices 11. Piping, a. Underground Piping: ~'~es [] No' [] Unkqown Material q-a,~$ ' · Thickness (inches) Diameter Manufacturer ~'~Pressure []Suction [] Gravity Approximate Length Of Pipe'Run Underground Piping Corrosion Protection: [] Galvanized ~"l~berglass-Clad [] Impressed Current [] Sacrificial Anode [] Polyethylene Wrap [] Electrical Isolation [] Vinyl Wrap []Tar or Asphalt []. Unknown [] None [] Other (describe): Underground Piping/ Secondary Containment: [""] [)mlble-Wa] 1 FTI-"~w.Y} ot-ln Lit,or qw~-o,, r--I ~Tn,~ ~l ~t,,u.~n, ~ Facilit~ Name ~"~S~~ Permit No. TANK # (FILL OUT SEPARATE FORM Fo~ EACH TANK) FOR EACH SECTION, CIIECK ALL APPROPRIATE BOXES 1.. Tank i_A: []Vaulted '[] Non-Vaulted 2. Tank Material [] Carbon Steel [] Stainless Steel Fiberglass-Reinforced Plastic [] Other (describe): 8. Primary Containment Date Installed Thickness (Inches) 4. Tank Secondary ~ontai. nment [] Polyvinyl'Chloride ~Fiberglass-Clad Steel [] Concrete [] Aluminum [] Bronze [~ Unknown c&Pacity (Gallons) /2, [] Double-Wall [~Synthetic Liner [] Lined Vault [-] None [~], .Other (describe): Material Thickness (Inches) 5.'Tank Interior Lining [] Rubber [] Alkyd []Epoxy []Phenolic [] Glass [] Other (describe): 6. Tank ,Corrosion Protef.~ion ....-~::,;, ~-[ Galvanized ~Fiberglass-Clad [],Polyethylene Wrap [-['~9inyl Wrapping [] Tar or Asphalt [] Unknown [] None [2] Other' (describe): Cathodic Protection: [].None [] Impressed Current System [] Sacrificial Anode System Iq' Describe System & EquiPment: 7. Leak Detecti6n, Monitoring, and Interception a. Tank: [] Visual.(vaulted tanks only) [] Groundwater Monitoring Well(s) [] Vadose Zone Monitoring Well(s) [] U-Tube Without Liner' v2 TUbe with Coapat~k~l'e Liner Directing Flow To Monitoring Well(s)* pot Detector.*~Liquid Level Sensor* [] Conducttvi~ Sensor* [] Pressure Sensor In Annular Space of Double Wall Tank~ [].J//~quid Retrieval.& Inspection From.U-Tube, Monitoriq~ Well Or An~ular Space [~Daily GaUging & Inventory Reconciliation [] Periodic Tightness Testing .-[] Nond_~JUnknown [] Other .' b. Piping: [~Flow-Restricting Leak Detector(s) For Pressurized Piping* [~]Monitoring Sump With Raceway [] Sealed Concrete Raceway [-] Half'Cut Compatible Pipe Raceway []Synthetic Liner Raceway [] None []Unknown [] Other *'Describe Make & Model:, /~-~}~--- /~-- ~'7' 8. Tank Tightness /~.,~ Has This Tank Been Tightness Tested? Date Of Last Tightness Test 'Test Name 9. Tank Repair /4'~-3 Tank Repaired? Iq Yes [] No Date(s) Of Repair(s) Describe Repairs [] No . [] Unknown Results Of Test Te~ting Company Yes ~']Unknown Manufacturer [-] Unknown Manufacturer: Capacity (Gals.) fq ClaY ~'~nlined [2] Unknown 10. Overfill Protection [] Operator Fills, Controls,.& Visually Monitors Level [] Tape Float Gauge [] F_~Laat Vent Valves [] Auto Shut-Off Controls [] Capacitance Sen}or [] Sealed Fill Box -Iq None [] Unknown [] Other:. f-~~ List Make & Model For Above Devices 11. Piping, a. Underground Piping: s [] No [] Unknown Material fv L~ Thickness (inches) Diameter Manufacturer ~4 [] Pressure [-]Suction [] Gravity Approximate Length Of Pipe Run ~ b. Underground Piping Co~osion Protection: [~ Galvan'ized [~'Fiberglass-Clad [] Impressed Current [] Sacrificial Anode ' [~ Polyethylene Wrap [] Electrical Isolation [] Vinyl Wrap []Tar or Asphalt []~ Unknown [] None [] Other (describe): Underground Piping, S~ondary Containment: [] Double-Wall [~]'Synthetic L~ner System [] None [] Unknown· Facilit~ Name- 'TANK ,# Permit No. (FILL OUT ~EPARATE FORM FOR EACH TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BO~ES 1. Tank is: []Vaulted [] Non-Paulted '[2] ~ouble-Wall glo-Wall J 2. Tank Material [] 'Carbon Steel [] Stain]ess Steel [] Polyvinyl Chloride .[~ Fiberglass-Clad Steel [] Fiberglass-Reinforced Plastic [] Concrete [] Aluminum [] Bronze [] Unknown [] Other (describe): 8. Primary Containment Date 'Installed Thickness (Inches) c~Pacity (Gallons) Manufacturer 4. Ta~k Secondary Contai~ment , iQ Double-Wali [~ynthetic Liner [] Lined Vault [] None [] Unknown [],. Other (describe): Manufacturer: .Material Thickness (Inches) Capacity (Gals.) 5.;%an~ Interior Lining ~ Rubber [~] Alkyd [2]Epoxy []Phenolic [2] Glass .[] Clay ned [] Unknown [] Other (describe): 6. Tank Corrosion Protection [] Galvanized ~iberglass-Clad [] Polyethylene Wrap [] Vinyl Wrapping [] Tar or Asphalt [] Unknown [] None [-] Other (describe): Cathodic Protection: [] None [] Impressed Current System [] Sacrificial Anode System [] Describe System & Equipment: 7. Leak Detection, Monitoring, and Interception a. Tank: [] Visual (vaulted tanks only) [] Groundwater Monitoring Well(s) [] Vadose Zone Monitoring Well(s) [] U-Tube Without Liner,' v U-Tube with Compatib~le Liner Directing Flow To Monitoring Well(s)* apor Detector'*~iquid Level Sensor* [] Conductivity Sensor* []' Pressure Sensor In Annular Space Of Double Wall Tan~~ [] Liquid Retrieval.& Inspection From U-Tube, Monitorihg Well Or Annular Space _ [~aily Gauging & Inventory Reconciliation [] Periodic Tightness Testing [] None__/~ Unknown [] Other b. Piping: [] Flow-Restricting Leak Detector(s) For Pressurized Piping* .[]Monitoring Sump With Raceway [] Sealed Concrete Raceway Fl Half2Cut Compatible Pipe Raceway [-]Synthetic. Liner Raceway [2] None []Unknown [] Other *"Describe Make & Model:.. /--~t~---~ 8. Tank Tightness --~d~-- , Has This Tank Been Tightness Tested? ['] Yes []Unknown No [] Unknown Results Of Test Testing Company Date Of Last Tightness Test Test Name 9. Tank Repair -"- ~4~.~-- Tank Repaired? ~Yes [] No Date(s) Of Repair(s) Describe Repairs 10. Overfill Protection [-7 Operator Fills, Controls,.& ViSually Monitors Leyel [] Tape Float Gauge [2] Float Vent Valves [] Auto Shut-Off Controls [] Capacitance Sensor ~"~ealed Fill Box [] None. [] unknown ~] Other: ~~_~ List Make & Model For Above Devices 11. Piping, a. Underground Piping: ~/~es [] No [] Unknown Material d~(~/~ · Thickness (inches) Diameter ~L" Manufacturer /~ ~.~. ~ ~ Pressure Fq Suction [] Gravity Approximate Length Of Pipe Run ~O~ b. Underground Piping Corrosion Protection: [] Galvanized ~/~iberglass-Clad [] Impressed Current [] Sacrificial Anode [] Polyethylene Wrap [] Electrical Isolation [] Vinyl Wrap []Tar or Asphalt Fl Unknown [] None [] Other (describe): c. Underground Piping, S~fleoondary Containment: