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Home My WebLink AboutUNDERGROUND TANK FILE #1 Permit to Aba,ldo,i Permit to Coqstruct Permit to Operate Application to Abandon Applicatlou to Co,~struct ~Appllcatlon to Operate Amended Permit Co,~ditions Annual Report Forms Tank( s ) Tank Sheets . Da~'e Date Date Date Plot Plans Copy' of Written Cosstract Between.Owner & Operator InSpegtlon Reports Correspondence - Received Date Date Date Date Date Correspondence - Mailed Date Date Date Date Date Unauthorized Release Reports Abandonmeut/C losure Reports Sampll~tg/Lab ReporLs ~VF Co~pJ ~ance Check (New Construction CheckJ 1st J STD Compliance Check (New Construction Checklist) MVF Plan Check (New Construction) STD Plan Check {New Construction) MVF Plan Check (Existing Facility) STD Plan Check {Existing Facility) "Incomplete Application" Form Permit Application Checklist Permit Instructions . Dlscardcd Tightness Test Results. Date Date Date Monitoring Well Co,structlon Data/Perm/ts Environmental Sen~ltlvlty Data: Groundwater Ol'llllng, ~orlng bogs Location of ~ate~ Wells Statement of U.derground C-,,tults Plot Plan Featuring All Em' -onme.utally se~sitlve Data Photos Constructloa Dua~- ~,gs .Lo,arian: MI sce I I aneous 1700 Flower Street, Bakersfiei'L~, C~L 93305 ' (805) 86~-3636 " APP~ICATION FOR PERMIT TO OPERATE UNDERGROUND' ~AZARDOUS SUBSTANCES STORAGE FACICITY T~pe Of Application (check): A. Emergency, 24-Hour Contact (name, area code, phone): Days ~ ~ Type Of Business (check}: ~as~fin~ Station ~her (describe} Is Ta~(s) Located On An ~rtcultural Farm? ~Yes ~o Is Tank(s) Used Primarily For A~icultural Purposes? ~Yes ~o T R SEC (Rural Locations Only) Co Operator ~-/* /~,' ,1~-~ "itl- ' Address ~'Z~' HI. !/~,~ C~ £~ zip Water/To Facility Provided BY Soil Characteristics At Facility Basis For Soil Type and-Groundwater Depth Determinations Contractor A/fA Address Proposed Starting Date ~orker~s Compensation Certification No. D. If This Permit Is F%r~ Modification Modifications Proposed~ R ' ?~o 7 T,e..lephon.e C'~r )S2Y-~ r Depth to aroundmater'~'~O ! CA Contractor's License No. Zip Telephone Proposed Completion Date Insurer Of An Existing F~cility, Briefly Describe E ' Tank(s) Stor6 (check all that apply): Tank ~ Naste Product Motor Vehicle Unleaded Regular Premium Diesel ~aste ~Uel Oil I [] [] [] [] [] o. '0 .0 [] ~ [] [] [] [] [] [] [] [] 0 [] [] '0 [] [] [] [] [] [] [] [] [] F. Chemical ComPosition Of Materials Stored (not necessary for motor vehicle fuels) Tank # Chemical Stored (non-commercial name) CAS # (if known) Chemical Previously Stored ,, · .. ? (i.f different) Transfer O_~f Ownershi. /~//lA Date Of Transfer Previous O~ner Previous Facility Name I, accept fully all obligations of Permit No. issued to I understand that the Permitting Authority may review and modify or terminate the transfer of the' Permit to Operate this underground storage facility upon receiving this completed form. This form has been Completed under penalty of perjury and to the best of .my knowledge is true and correct ~ Signature ~j ~..,,~l~.~_/~"-'~._. Title 5~i'/ ~fJ//~ [)ate Facility Name ~ANK # I (FILL OUT SEPARATE FORM POR EACH TANK.) " ~FOR CACti SECTION, UIIECK ALL APPROPRIATE BOXES 1. Tank is: [']Vaulted [] Non-Vaulted Double-Wall '- gle-Wall 2. Ta_~Matertal [~ Carbon Steel ['] Stain]ess Steel ['] Polyvlnyl Chloride [] FtberglassTClad Steel [] Fiberglass-Reinforced Plastic C] Other (describe): 3. Primary Containment Concrete ~] Aluminum [~] Bronze [~]'Unknown .,Date Installed Thickness (Inches) 4.1~ank Secondary non Capacity {Oallons) Manufacturer ~] Double-Wall [] Synthetic Liner f'l Lined Vault one []'Unknown ~] Other (describe): Manufacturer: Material Thickness (Inches) Capacity (Gals.} 5.'Tank Interior Lining ~] Rubber [] Alkyd []Epoxy []Phenolic [~ Glass [~ Clay [] Unlined ~/Vnknown O Other (describe): " 6. Tank Corrosion Protection [~]/Oalvanlzed [] Fiberglass-Clad [].Polyethylene Wrap Fl Vinyl Wrapping [~ Tar or Asphalt ~ Unknown ~] None [] Other (describe): ~ ~'~ Cathodic'ProtectiOn: ~/None [] Impressed Current System D Sac~tftcial Anode System [] Describe System & Equipment: ?. LeaK, Detection, Monitoring, and {ntercept~on a. Tank: C] Visual (vaulted tankk only) [] Groundwater Monitoring Well-(s) [] Vadose Zone Monitoring Well(s) [] U-Tube Without Liner ~] U-Tube with Compatible Liner Directing Flow To Monitdring Well(s)*' ~] Vapor Detector *[] Liquid Level Sensor * ~'l Conductivity Sensor.* [] Pressure-Sensor In Annular Space Of Double Wall Tank'* [] Liquid Retrieval & Inspection From U-Tube, Monitoring Well Or Annular Space [] Dally Gauging & Inventory Reconciliation [] Periodic Tightness Testing [] None ~Unknown ~'] Other'. ' ' b. Piping: [],Flow-Restricting Leak Detector(s) For Pressurized Piping* E]Monttorlng Sump With Raceway [] Sealed concrete Raceway El/Half-Cut Compatible Pipe Raceway. []Synthetic Liner Raceway []~ None [~Unknown [] Other *Describe Make & Model:, 8. Tank Ttghtnes~ Has This Tank Been Tightness Tested? Date Of bast Tightness Test Test Name ,9. Tank Repair ./ Tank Repaired? .~]Yes Date(s) Of Repair(s) Describe Repairs [] Yes [~]Unknown ~No []' Unknown Results O~ Test Testing Company 10. OverS111 'Protection ~/ Opera'or F-~, Controls, & Visually Monitors Level ~'] Tape Float Gauge [] Float Vent Valves ~ Auto'Shu'tTOff C~ntrols ~] Capacitance Sensor [~] Sealed Fill Box [~] None C]'Unknown . [] Other: List Make & Model For Above Devices 11. 'Plying a. Underground Ptptng~ [] Yes [] No [~//Unknown Material '' 'Tht_~ness (Inches.fi_ ._ Diameter Manufacturer t~Pressure ~S~ction [] Gravity Approximate Length Of Pipe Run Undersround Piping Corrosion Protection: [] Galvanized [] Fiberglass-Clad ['] Impressed Current [] Sacrificial Anode Polyethylene-Wrap' [-]-Electrical Isolation [].vinyl Wrap []Tar or Asphalt Unknown ['] None ~]Other (describe}: Undergr~and Piping, Secondary Containment: ~ [] Double-Wall ~ Synthetic Liner System [] None Unknown rm Other (describe): I bl~ tk 3o 20oo ~Oj~ce Memorandum TO ~ D AT]/: Telephone G.$.5.580 1151 395-5005 (Rev. 4/87, '~' T U E BANDALL 'L, AB~DTT DIRF..CTOR DAVID PRICE P.02 ENVIRONMENTAL HEALTH $£RVICE$ DEPARTMENT UNDERGaOUND $TOI~Gg TANK DERMIT UPDAI~ QUESTIONNAII~ THIS' QUESTIONNAIRE HUST BE COHPLETEO AND RETURNED HlTtI YOUR INVOICE PAYI~NT. FACILITY I ~ i I ~ I I ~ I I I I I I I l.I I I I W I I I I ~ I I I ~ ~ I I ~ I I I ~ I I AO0RESS ' !1~ A TRANSFER OF OWNERSilI~ HAS TAKEN CO.LETS TH~ DATE OF T~HSFER~ ~NTH ......... - ..... OAY ....... ~--- ~ "' -' ' .... PREVIOUS' OWNER: ' " PR~V[OU~ FACILITY H~[ (iF C~ANGEO)I MY KNOWL~GB IS T[~ AND CORRECT, IF YOU HAVE ANY QUESTIONS p~E~SE CA~b JANE Ch NM4 27~ "M" ST~,gT, SUIT~ 3~ BAKERSFIELD, CALIFOBNLR 93301. FAX: TYPE OF INSTALLATION ( ) 1. In-Tank Leave1 S~sor ( ) 2~ Leak Detector () 3. Fill Box CONTACT PERSON IN TANK LEVEL SENSORS 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 Name of System Manufacturer & MOdel Number Contractor/Installer 3. FILL BOXES Number of Tanks List By Tank ID Name of System Manufacturer & Model Number Contractor/Installer DATE RANDALL L. ABBOTT DIRECTOR DAVID PRICE ili ~.~.~IS'rANT DmECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT' TO: ' Underground Storage Tank Owners DATE: December 27, 1990 , RE:... Deadline for upgrade requirements for your underground tank facility · ;..' Dear sir/Madam: .... . :/ Our' records Indicate that you own at least one underground storage tank which has fUel distributed through pressurized product lines. Recent changes in state and federal regulations ' ;:i;?. require that all pressurized piping must be equipped'with an' automatic fine leak detection System " by December 22, 1990, and' tightness tested annually. :These requirements are more fully" described in the code of Federal Regulations, part 280 and 281; California's Health and Safety · Code as modifij~, O~iober 1 ~uu; ancl ualiTorn~a's ~r~att Hegula~ons for undergrouncl st6rag~'~-,.~ tanks. ([,U~ ~ c~. ,~~ 4'.~¥c~. /~,1 .~-,..j~/'~¢~JZ,,,c~ In addition the e/~uipm~nt'~at' i~ to""i~e 'i~st-~'ll~d ~t y"o-u~' fa'c-~iity m'~st be able to alert the owner · or operator of the presence of a leak. by restrlcfinn n, ,,-..-,-= ............ :: :.;. :~, ~azardous · substance thra, ,~i., +~..- -:"- -- . of three gall <~::~I,.~,, ' -~ "One hour, lur local lurrently as certified ~ uidelines line leak sed, and lave not mpanies ;tandard annual for operatior detection eq return it to 1 installed sucl on the cost described. ~ Inspections. The Departm, specify monit .' ....... conditions ,,&'il ":' ordinance to I · in draft form. .. .... o .....~,=.,=m~n[s wnlch-~ill-~fect your facility,: and a..,.,o, ~uu ~n omaining information to comply with those requirements. Please continue prompt payment of permit fees and feel free to call the Kern County Environmental Health Permitting and Inspections Program if you have any questions. Sincerely, · . .- 1. (~, / ( 'J I / Hazardous(.b[laterials Stpeciali~t ' . Hazardous Materials Management Program AEG:ch green\cleaclllne 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861:3429