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Home My WebLink AboutUNDERGROUND TANK FILE #1 D March 31, 1999 FIRE CHIEF RON FRAZE ADMINISTRA'FIVE SERVICES · 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 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Mr. Brett Cowdell 2302 Martin Street, Suite 275 Irvine, CA 92612-1449 CLOSURE OF ONE UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANK LOCATED AT 2677 MT VERNON AVE. PERMIT #BR-0244. Dear Mr. Cowdell: This is to inform you that this department has reviewed the results for the preliminary assessment associated with the closure of the tanks located at the above stated address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. Accordingly, no unauthorized release reporting is necessary for this closure. If you have any questions regarding this matter, please contact me at (661)326-3979. Sincerely, Ralph E. Huey, Director Office of Environmental Services REH/dlm cc: Y.Pan, RWQCB S. Underwood S:\USTFORMS\UST.LI Underground Tank' Removal storage For Econo Lube And Tune (#117) At 2677 Mt. Vernon Avenue Bakersfield, California 93306 (City Of Bakersfield 'Permit No'. BR-0244). _Tel: 818/782-9934 I Fax: 818-/782-9689 Project No.: TRCll7 February 12; 1999 14666 Titus St~ #17 il.--:~17',I Van Nuysr C:A 9.14~2 :';; ~' I I I I I I I I I I I ! I I City Of Bakersfield Office Of Environmental Services' Attn: Mr. Howard H. Wines 1715 Chester Avenue Bakersfiled, CA 93301 Tel: 805/326-3979 Fax: 805/ - Site: Econo Lube & Tune #117 2677 Mt. Vernon Avenue Bakersfield CA 93306 Subject: Documents for One 500 gal Waste Oil Underground Storage Tank (UST) Removal at the Subject Site City Of Bakersfield Permit No. Br-0244 Dear Mr. Wines, Cal-Ace Environmental Engineering, Inc. (Cai-Ace) is enclosing underground storage tank (UST) removal documents including soil analysis result, chain-of-custody, UST destruction certificate, rinsate disposal manifest as follows: One 500 gallons UST closure Permit No. BR-0244 of the City was issued for the UST removal, grab soil sampling by Cal-Ace (see Appendix 1. Permit). One-500 gal waste oil UST was removed on November 25, 1998 under the direction of the City Fire Department. The UST was removed by off-site abandonment method as a non-hazardous tank. Non-hazardous tank removal was performed via following procedures: obtained a permit from the agencies, cut the pavement, removed waste asphalt, excavated the soils, disposed all liquids, triple rinsed/washed the tanks, and disposed all tank/piping to Golden State Metals in Bakersfield (see Appendix 2.) And all rinsate from the tanks was transported to a 'transportation, storage, disposal (TSD) facility by Grayson Services Inc. as shown in manifest (see Appendix 3). Remotes fill piping was plugged by cement slurry after rinsing. After 'UST was removed, grab soil sampling was conducted at the former tank location as shown in Figure (1) Site Plot Plan by Cal- Ace at the same UST removal day. Soil sample number 1AUT and 2AUT at the removed tank pit 10 feet and 12 feet below ground surface level (bgs)were obtained under the inspector'.s approval. The samples were obtained by a 2" diameter brass sleeve. The brass sleeves were capped, labeled and placed in an ice cooler. It was transported to Department of Health Services (Cal-DHS) certified 2 I I I I I Laboratory (CHEMTEK Environmental Lab) with a chain-of-custody (See Appendix 4) located in Santa Fe Springs, California. In the process of the soil sampling, groundwater or perched water was not encountered at a depth of 12 feet below, existing surface. The soils were visually classified as mainly consisting of brown · sandy silts with few gravels. The soil samples were analyzed total recoverable petroleum hydrocarbon (TRPH) and chlorinated hydrocarbon by EPA method 418.1, and 8010. The analYtical results of TRPH was revealed non-detectable level (ND) and 43.8 ppm at the sample number 1AUT-10 feet and 2AUT-12 feet bgs by CHEMTEK Lab. Chlorinated hydrocarbons were identified ND as shown in Appendix 5. If you have any questions, please feel free to contact Cal-Ace (General Contractor) Jeff J. Lee at 818-782-9934. Sincerely, Principal Engineer of Cal-Ace 3 I I I I I I I I I I I cal'-Ace. Engineering, Inc. Site Address: ~o.77 1,6-T. S I I' I I I I Appendix 1. I I I I I I I I I I I Perm/t And Inspection Document 11/13/98 11:53 ~'805'326 t. .-. .. DIV ~002 I . ~ CITy OF BAKERSFIELD l'~k 1/ ~ " . .OFFICE OFENVH1ONMENTAL SERVICES' I ~ 1715 Chester Ave'., Bakersfield, CA (805) 326-3979 I REMOVAL OF AN UNDERGROUND STORAGE TANK I ;I I I SITE INFORMATION .t , . SITE.~_.~7.L:i~O J- o~e..r'Tu.~ /,$tC,.ADDR_F_.SS '~l~'"J '7 $vl~. gF..P~L~IO ZIPCODE q 33°~APN FACILITY NAME ~ce~c L~f. ~T~% CROSS STREET ~l~tl) ~_Z~CC/~ TANK OWNER/OPERATOR ~Cok)O L.~-'1~. '~ "V~:°C- PHONE NO. MAILING ADDRESS ~{J ~jRc~ ST C~ ~g~ ~o~ ~t~ cA ZiP flZ~G~. CONTRACTOR I~VORMATION COMPANY ADDRESS I INSURANCE CARRIER O,..~k C. ~ ~,- pHONENO.~tlY):~g~-$939 LICENSE NO. {',.,~/-O~:) ate U,,°,A/U,:.,~· C.~ -zip q WORKMENS~PNO. {;0 c oq'Z. ~'t.~.. PRELIMINARY ASSP-~SMgNT iNFORMATION COMPANY' C^Tff .~su~'~l~,,¢~... ~f.~.v,¢f-. PHONENO. LlCENSENO. L~7OO~o2-- ADDRESS '3q~O tA,,,LS, d~aC L-"$j~;J) CITY Lv5 1~O~,~l~ ZIP~ INSURANCE CARRIER ('la, iL, (O~f': ..l:$"~"'~n~cf,... WORK.ME~S COMP NO ~,O~ Oci"L. ¢~q7. I I I I TANK CLEANING INFORMATION COMPANY Cat--V~¢ ' ~,.O~SO.(%Z) qql,, '~qqq WA~ TRAN~R~R IDENTIHCAHON ~Eg. 3 ~ ~O . -~ __ ... NAMEOFRINSA~DIS~SAL~~--~R05~? ~ OVE'~T°~ ~'"c'.4 ZIP FACILI~ ID~IFICA~ON~ER C fig 0 I~ O1~ [5~1 ~ b~q ~ TANK TRANSPORTER INFORMATION ADDRESS ~ Ji~O~ ~o~RK(~ Cl~a r~ Sr~C-~ zmqo~'70 TANK DESTINATION TANK IINFOR,MATION I I I I I CHEMICAL DATr~ CHEMICAL TANK.,L NO. 'AGE VOLUME,5.OO~,C .' L~~ ~~ , { STORED PREVIOI~SLYk.or.~ T~ STOREDo F,,~' Oflic~.t LIm: Oal~ '. .................................... .'.:.' ........ . - .... -- .. ...... ~... :~;~?~``:~:~.:~:;`~::~:~`::~.:~:~:~:~:~`~i~.~:~.s:~r.:~.`~;~;~!~?~.~.~?2~:`~``~?.~.~.`~;~ ;';?.'~::~::.:L:::~::.':?.rl I ' -PP~,'~ "" r;":' :' '; :''':) ' "::'T:~' ::"'"~ ~:?t~""'~:~:'?~'¥":'""' "~ ............ -. ;::,;...-..2Z :~.<>.~;.::.::. d.::" :.: :....:':-~-~.:.~?: TI I1: APPI.ICAN'I I I~ ~{CEIVEI), I~I'A~, ~D ~, ~,Y ~1I.I ~tE A'I*I'ACI~D CONI)H1ONS OF ~ lis I'ERMff AND ANY O'Jl IER STA'IE, I,~ ~D FEDE~t ~ TH~ APPL~A~ON BZCOMZ A PERMIT WHEN APPRO~O W RX:g6OObps 98'/11/13 13:02 By:The Tribe Conect P.O02 BAKERSFZELD FZRE DEPARTH~NT OFFZCE OF ENVIRONNENTALSERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 CERTIFICATION sTATEMENT OF TANK DECONTAMINATION ' 'Contractin~ Co. an authorized agent of here by attest under penalty of perjury that the tank(s) located at Z67-2 P~l~'~/~e~ and Address being removed under permit# ~-O~-~- has been cleaned/decontaminated properly and a LEL (lower explosive limit) reading of no greater than 5% was measured immediately following the cleaning/decontamination process. D~te · '~ame ( print Signature City of Bakersfield I I I I I Appendix 2. :1 I I I I I I i I I I Tank Destruction Certificate · ' '? ·;,"'"* '~ WEIGHMASTER CERTIFICATE . · ER'rlI=Y tl~t'the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recbgnized · '; ~utJlority':~i~Cc~Jra'Cy~ ~s p~'escribed'by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division · ~f M'e~i~u~e~nt·standards of the Ca fern a Department of Food and Agr culture I~ O L D E N S T ,~- ~ .... . . , !8..'."I.'":'W' .'. =/..~-. ,' ~ ~:.~.~',~;,~eh"t. axa68E6 [ ~ t 3x868~6 [ c f 7908 Driver Order ] Custoeer ~;~'," ~.'/~S~ ,':'~ ;-~;~,~.;~.Z~._.;~_z ................................................................ ~, : . ,;. ....~.-.~..,~*. . . - ............................................. ' '. ~ ...'-~;/:~'~'6ROSS.=~E[6H~STER: OEPUTY:NORIE6~OEBR~ T~RE ~EIBH~STER: OEPUTY:NOR[E6A.OE~RA ~ Oate In t11~5/98 INET TONS :- ~ .....%..,' ~....::..-,. ~: ~, - ~ ' · .i %': .. -' · '. ~;;~'.:.';.:."~' }~A~,SCACE-I:..' '..8~SCALE e · C~SCALE 3 D~SCALE ~ H~HANUAL MEIGHT . ; .;..:~:~'~ :':.l~ '~? ;'~/' ::~'- '"; '.""/'. :' ' ' NOT REFUNDABLE MORE THAN 90 DAYS FROM DATE ABOVF ' ' ~ ~ ~:~' ';~;-* ~I~~YE~'~"~L~D HARMLESS AGREEMENT Se er w ndemn ~ and hold buyer BILL OF S~E' wa~t ~8t lam the owner or ~neKs re resen~ti~ of ~e ' 7~'~ ~":. ;' "n~~~t~? ~r~'~at'~lu~less ?om damages,, deman? an~ liabilities, including reasonable mateda, d~d~ her.n and have ~e dg~[ to se .me~th~, t ~n~ns .o . ' ', . ' . ~, '-,[ ~n~[es ~a na~ ~n cm~ea mr aismanuing / a~orney's Tees resu z ng Trom the preach of any warran~ hereunder and h~us ~te~ as defin~ ~ F~em or State aw and that ~r payment ~ -" ~ ':':l'with?theDepa~ent°fM°t°rVehicles- /driveragreest~beresponsibefordamagetovehiceduringunloadng hem~ ~ ~d~nveytfletoGOLDENSTATEM~ALS. ~ ' ~," j /* - · / ' ,_ ......... , L,/'., ........ - .'t , · .... - .... ' i i aq,,~"~rib/el'accuracy, a,s prescril:ed by' Chaplel 7 (commencing ~ ,~,.~c~i~ 12700) ol D'~,isicn 5 o~ the California 6uS;inoss and Profes~'~3ns Code, admin'~le~ed by' the Divisi(~ . ;.F '~*i':';~.'i!,"/*.;?''*- :.; ~ ., ..:. ' oibleasumr~entSlar~areboftheCalilomiaD, epartmentcl'Fondar~lAgdcul'~ure. GOLDEN STATE PIETALS RC#'7551 -,.>....,. * * * CASH RECE!PT i RECEIPT #: 907859 RECEIPI DATE: iII~5i~ TOTAL ~ ~ 6UPt~IER: NET TONS .~eoo N0I REFTJNDAJgLE &lORE THAN g(] :DAY~. FROM DATE "" 03 ¢ I Appendix 3. I Mani fe s t i I I I I I I I I I . WASTE HAULER RECORD DISPOSAL FACILITY I I I 81/27/1999 17: Bi CVC P~GE 03 8t3~8333315 , ~1 U"~" H~DOU~ ~ . ~--,r '. . ' , .~ , ~. ~ "; '~"~Y- '""' 'a,' ;' ;' / i 7 Tr~l~r2 C~pany Name .... .- ~i.-~ ....... . _ ~ I _ . "~ r~ ~ ~.~ ........... J . ~i:~;~ Facil~Nome and 5,e~*~e~ ~0 US EPA ID ~;.--L__ " , ......... - - ~1~ - ' I I-' 1 ~ ~ ~ end ~m I *an a~rd g~n a~ ~l~t ~ ~st wa~e ma~ge~nt m~hod that Pri~ .T~ - . ~ DTSC ~22A 8700--22 I I i I I I Appendix 4. I I I I I ,I I I Chain-Of-Custody / Ty~,' See key below '., Sampledescription' , Appendix 5.. Analysis Lab Results CHEMTEK ENVIRONMENTAL LABORATORIES "An environment-friendly company" 14140 E. Alondra Blvd. Suite A, Santa Fe Springs, CA 90670. Tel. (562) 926-9848 FAX (562) 926-8324 CA Dept of Health Accredited. (ELAP No. 1435) INC. CERTIFICATE OF ANALYSIS- Job No. 811065 Date: 12-03-98 This is the Certificate of Analysis for the following samples: Client Contact person Project No. Project Project site Date of. sample Date received : CAL-ACE Engineering Inc. : Jeff Lee : : Econolube & Tune #117 : 2677 Mt. Vernon, Bakersfield, CA 93306 : 11-25-98 : 11-25-98 Number of samples : 2 Sample type: : Soil Sample condition : Good Samples were labeled as follows: SAMPLE IDENTIFICATION LABORATORY NUMBER iA UT @ 10' 2A UT @ 12' 811065-01A 811065-02A Reviewed and Approved: Michael C.C. Lu Laboratory Director I I I I I I I I I I I I I I I I i I C~TEKENVIRON~NTAL LAB. LABORATORY ANALYSIS REPORT Client : CAL-ACE Engineering Co. Project No. : Project : Econolube & Tune #117 Project site : 2677 Mt. Vernon, Bakersfield, CA 93306 Job No. : 811065 Date: 12-03-98 Analysis: EPA 8010(Chlorinated solvents) Sample ID : See below Sample type : Soil Sample date : 11-25-98 Analysis date : 11-30-98. lA UT @ 10' 2A UT @ 12' 0lA 02A (~.g/kg) (~,g/kg) Dichlorodi f luoromethane ND ND Chloromethane ND ND Vinyl chloride ND ND Bromomethane ND ND Chloroethane ND ND Trichloro f luoromethane ND ND 1, ! -Dichloroethene ND ND Methylene Chloride ND ND trans-1, 2-Dichloroethene ND ND 1,1 -Dichloroethane ND ND Chloroform ND ND 1,1,1-Trichloroethane ND ND Carbon tetrachloride ND ND 1,2 -Dichloroethane ND ND Trichloroethene ND ND 1,2 -Dichloropropane ND ND Bromodichloromethane ND ND 2 - chloroethylvinyl ether ND ND cis - 1,3 -Dichloropropene ND ND trans-1,3-Dichloropropene ND ND 1,1,2-Trichloroethane ND ND Tetrachloroethene ND ND Dibromochloromethane ND ND Chlorobenzene ND ND Br omo form ND ND 1,1,2,2-Tetrachloroethane ND ND 1,3 -Dichlorobenzene ND ND 1,4 -Dichlorobenzene ND ND 1,2-Dichlorobenzene ND ND Unit: ~/kq Blank (~g/kg) ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND Detection Limit (~g/kg) 20 20 20 20 20 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 ND: Not detected at the specified limit. ! ! I I I I I I I I I I I I I i I C~MTEK ENVIRONMENTAL LAB. LABORATORY ANALYSIS REPORT Client : CAL-ACE Eng'g. Inc. Project No. : Project : Econolube & Tune #117 Project site: 2677 Mt. Vernon, Bakersfield, CA 93306 Job No. : 811065 Date: 12-03-98 Analysis: EPA 418.1 (TRPH) Unit: mq/kq Sample ID : See below Sample type : Soil Sample date : 11-25-98 Analysis date: 11-30-98 Sample IDs DF TRPH Client Lab (mg/kg) lA UT @ 10' 0lA 3 ND 2A UT @ 12' 02A 3 43.8 Method Blank 1 ND Method Detection Limit: 10.0 DF: Dilution Factor. TRPH: Total Recoverable Petroleum Hydrocarbons. ND: Not detected at the specified limit. I I I I I I I I I I I I I I I I I CW~94TEKENVIRON~P~TTAL LAB. LABORATORY ANALYSIS REPORT 0A/0C REPORT EPA 418.1 (TRPH) Unit: mg/kg Job No. : 811065 Lab Sample ID : 811065-Blk Date Performed : 11-30-98 Analyte ORIG SPK MS % MSD % % ACP ACP Result CONC MS MSD RPD %MS %RPD TRPH ND 80 88.9 111.1 78.5 98.1 12.4 80-120 0-20 C~RMTEK ENVIRON~r~qTAL LAB. LABORATORY ANALYSIS REPORT OA/OC REPORT EPA 8010 Unit: ~g/kg Job No. : 811065 Lab Sample ID : 811065-02A Date Performed : 11-30-98 ORIG. SPK % ANALYTE RESULT CONC MS MS MSD 1,l-bCE ND 20.0 22.6 113.0 19.4 TCE ND 20.0 22.0 110.0 19.6 Chloro- ND 20.0 21.2 106.0 19.0 benzene % MSD 97.0 98.0 95.0 RPD 15.2 11.5 .10.9 ACP %MS 80-120 80-120 80-120 ACP RPD 0-20 0-20 0-20 FII E 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 TRAINING DMSION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Econo Lube N Tune 2677 Mt. Vernon Bakersfield, CA 93306 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 Permit to Operate Hazardous Materials/HaZardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE iir~ * ' .~.,?~~.. This permit is issued for the following: ..~?.~ .;.~..~ ........ ~ ............ ~::.? .... ~'H~ s Materials Plan .~,~ ~ .=~=,:~: ,~,~,~. ~,~,,~ ~,~,~, ~,,. ~.=~nde[ground Storage of H~rdous Materials PERM~ ID~ 015~21001165 : ~: t ~ ~.~?~? _::::;~::~.?.~:.?c~.~:::;::..,~,~::.~k;:Ma~agement Program ECONO LUBE N TUNE ,.~.~ ~..~, .,~. ~.....~:~? ........ ~' ~,~Y ~- ~.~. ,l~ '~'" ~:s'- ~ · · ' ~,.",'~_-~7 -~~ j j~ ~s~.'' e,,.%.'~.m,~- . -.. j r ~ ~. '~ '~--.'~ LOCATION . 2677 ' MT VERNO~-.'~';~,~'/7 B~:SI ~LD CA. :~ '... "- .. =-~ ~ ~ .". s ',',:" ~ ~.7'--~ · ,..... Z~ .~ ..?. ., ,, . ~..', ~ -"..'"'~ ~3q ~~ ~"~'f t ~ ~ [~ ~.'-'--~ ~..~-...- ~.. ... , ~ ":<~. . . :'.....~ ~.......- . .~ ........... , ';-,,"'~ ~..., ~- :.: ,: .: ,-.. ~.:~ .~. Tan H~RDOus suBstancE c~~, ~.~aL (,~~~ ~~:~ ~anK ~. ~ Tank PIPING PIPING PIPING PI '~:':::::.;~ ~;?, ~T~~'~ '~aTE~ ~ou~or .~oN~TOr ~PE ~PE mEtHOD O · ,.- ....... , ~ ..... .~,,, ~ .,'~,., ... ...... ,. , ~ ~003 wASTE OIL ~,~0 GA~ ;.'":~:>~w s z:~lR ~,..'"',,.'~' sw GAL G~VI~ · ~.::-~ .~:.s ,,..~..., · ,~, /,, -.,'~ ?...-...~ . ,~ '-: ~,. · 1715 Chewer Ave., 3rd Flor B~e~l~ CA ~o~. {~0~~ December 22, 1'998 ' F~. (805) ~2~S76 Expiration Date: !1:53 ~805 326 0576 BI~ UAZ MAT DI¥ ~002 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., ·Bakersfield, CA (805)326-3979 PERMIT APPLICATION FOR · REMOVAL OF ~ UNDERGROUND STOOGE TANK SITE INFORMATION .t 'rANK OWNER/OPERATOR ~.CoL~O L.,., I~: ~ 'T~'-'f,- PHONE NO. ~'I'U MAILINGADDRE$S /~il ~j0,¢O~ ST' CITY Jg~ ~o~.~' ~_Ac~J CONTRACTOR IbJFORMATION. COMpANy C. c~[- A~ p~ ADDRESS I ~,~,Co INSURANCE CARRIER PHONE NO.~/~r'g~ - ~73~ LICENSE NO. /'n ~ · c~Ty UA~ AJuu:s ~ -zip WOmCML;NS C~P ~. ~J c pRELIMINARY ASSE~MENT INFORMATION COMPANY ~.~ T[~' ADD.SS INSU~NCE CA~ER uc~s~. NO. G7 O0 ~ 2.. CITY' Lb~ AVC~I~E - ZIP~ WORKMENS COMP NO. t~c Oq~ ~q-z ~. TANK CLEANING 'NI~ORMATION WA~ TRANS~R~R IDENTIRCA~ON ~ER ~ H ~O NAMEOFRINSA~DIS~SALF~C~ eRoS~y ~ OU~R~i~ ' . ADDRESS I1~o ~ I~"S~ ' c~ Lo~ B('RcL4 zip FACILITY IDE~IFICA~ON~ER '~"~0 oq~q~flOl~ ~ /gb2) ~3'~ ENq [ TANK TRANfPORTER INFORMATION NO~ COMPANY ~ ~L V Rk PHO~ TANK DESTINATION TANK INFORMATION CHEMICAL DATES CHEM1CAL TANK NO. AGE VOLUME. ' 'STOI;~:D , ! STORED PREVIOUSLY STORED . .' :'.,, - .': ..i::':?<~:;~::~:~.'..:~.:~;~,~fi~: ......... , ...... :" ' :;?>, .:: ..~...~'~-,.v.;:-::q.! ~ij.~i : ' ' '-';P'..; ....... - '" ' ~: :'-'~'."~'" J APPLICATION DA~: .:...::-:....:..::::...:.::..~.~:?~.~:.:?:.~.,:~~-:~. :..;.:.:~:~.:.U.~:.:::.?::::..~:~.~.;~'~. : :~:~ .J l'l I1': APIq,ICANT I1~ ~':C~IVEI), J~'A~, ~D ~, ~,Y ~1tl ~tF, ATI'AC[~D CONDH1ONS OF TI PI,:RMFr ~l) ANY O'il IER s'rATI~, I,~ ~D FEDEX, ~0~'11~. TI I1~ FORM [~AS BEEN C~.PLI~TI'~D ~I)ER PENALTY OF P~J~Y, AND TO ~ I~EST OF M~N~I,I~;E I~ '~lll~ - ~~ ~PI~ICANT NA~ (PRINT) ~ ~ APPI.IC~A~IC]NATt~JE ~TH~ APPLICA~ON BECOME A PERMIT WHEN APPRO~O RX:gOOObps g8'/11/13 13:02 B~:The Tribe Cone(:t P.O02 _ [ 9~o6 N MAIL TO: CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD, CA 93303 CITY OF BAKERSFIELD CALIFORNIA PREMISES MUST CONFORM TO ZONING, BUILDING, FIRE AND HEALTH CODES. CHANGE OF D NEW [~ OWNERSHIP BUSINESS CHANGE OF ADDRESS [] APPLICATION FOR BUSINESS TAX 'CERTIFICATE PURSUANT TO ORDINANCES OF THE CITY OF BAKERSFIELD BUSINESS NAME BUSINESS LOCATION ~ PLEASE TYPE OR PRINT LEGIBLY IN INK (Separate Certificate Required For Fact1 location) ' STREET MAILING ADDRESS '~'~' ~ CITY ST ZIP STREET CITY KIND OF BUSINESS OR PROFESSION F_WWROlVM~IZ'~L ~J~/,,V~/~ CO. NAMES AND ADDRESSES OF ALL OWNERS/CORPORATIONS LIST OFFICERS - INCLUDE TITLES ST ZIP TELEPHONE ,,~/~" ~22' ~ NAME HOME ADDRESS STREET CITY ST ZIP STREET CITY ST ZIP STREET CITY ST ZIP TELEPHONE TYPE OF ORGANIZATION: PARTNERSHIP [] CORPORATION INDIVIDUAL [] NAME DATE COMMENCED BUSINESS IN BAKERSFIELD CALIFORNIA STATE CONTRACTOR'S LICENSE NUMBER, IF ANY FEDERAL EMPLOYER IDENTIFICATION NUMBER S3- ALESTAX PE.M,T.O. ALPHA NUMERI(~ sUB' Sales or use tPx may apply to your business activities. You may seek written advice regarding the application of tax to your particular business by writing to the nearest State Board of Equal.lzatlon office, For general information, please call the Board of Equalization at 1-800-400-7115 ESTIMATED ANNUAL GROSS RECEIPTS IN BAKERSFIELD ! SWEAR UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT, Signature Owner, Partner, Agent or Officer (if Corporationl, License Code Sect. NO. STATEMENT OF COMPLIANCE FOR Name of Business I understand that having a Business License/Tax Certificate Application from the City of Bakersfield does not authorize me to conduct a business and I must fulfill all obligatiOns for obtaining permits or approval to establish a business. The business premises must conform t° zoning, sign, building, fire and health cOdes. I will expeditiously comply with the requirements to obtain the permits that are applicable for the type of business covered by the Business License/ Tax Certificate Application before starting business. I have accurately disclosed the kind of business or profession and the location on the License/Certificate Application. · The Business License Section must be notified in writing if there are changes in any of the following: Business Location Mailing Address Ownership Mail to: City of Bakersfield P.O.' Box 2057 Bakersfield, CA 93303 Wastewater Discharge: In accordance with Federal and State mandated regulations, the City of Bakersfield developed a Pretreatment Program to regulate industrial wastewater discharges within the City's sewer servi~e area in order to protect the public health and the environment. Any wastewater that is discharged to the City's sewer system shall meet all ·the requirements in the Bakersfield Municipal Code, Chapter 14.12. Contact City Wastewater at 835-0364. Print Name /dz~/,,M-/~ ~/. Z~ Title ,4D/,-//z/, ¢"/",~'~,~- Signature Date The following are agencies most commonly involved in revieWing new business in Bakersfield. They will be glad to review your plans with you. City Wastewater City Environmental Services Alcoholic Beverage Control Air Pollution Control Board California Water Service 326-3249 County Environmental Health 326-3979 County Weights & Measures 395-2731 Franchise Tax Board 861-3682 State Board of Equilization 396-2400. (Sales Tax) 861-3636 Utilities: 861-2418 So. Cal. Gas (800) 752-2820 852-5711 P.G.E. (800) 743-5000 395-2880 Pac. Telephone (800) 244-4515 Original: B/L File Yellow: Applicant PARAGON PRINTING (. Tel: 818/782-9934 Fax: 818/782-968? Eng/neer/n~o, 'C/IL --ACE E~fl~ I RO~f~ENTA L ENGINEERING SAFE, OPE]P.3tT IoNs FOR ? ~ &HEALTH CO_ PLAN 14666 Tiros Sh ltl7 Van Nuys, CA 91402 * DEPARTMENT OF 'INDUSTRIAL RELATIONS..".. .', DIVISION OF"ocCUPATIoI~iAL~:'~A'~E~Y AND tiEALTH ."(insert Em'player ~t:: ~'~?~'H~:~'~'~,.'~'H. TeZei~h'ot~e No.):[~ - .:'::, 14666 Titus S'~':.'~ No. 17 Van Nuys~' CA,:.: 91402 J ' . 8'18-782-9,~3.4'~ Type of'Permit -TRENCH ~AND/OR 'EXCAVATION :'~. -']'"" : "!' Region _ ~1 .... ~, Distrid Tel. 818-90!-5~t03 Pursuant to Labor C6de Sedions 6500 'and 6502,'this. Permit is issued to ~e obovemo:med employer for the projects'described below. · - ,..:?.~' . License Number Description of Proj~d Loc~io~ Acldres~ .: .... · VARIOUS ' ' ', ' '. S?A?gW]:DE S~AT~,~:]:.Dg .. .,:, -:. . ': 1. Tha't the work is'Performed by the same employer. If this is an annual permit the oppropriote District Office· shall be notified, in writing, of dates,, and. location of job site prior to commencement. ' '..: c, '~ 2. That' emPloYer Will c°mply With all occupational safety' and health standards or orders plicable to the above projects, and any other Imdul orders of.the Division. 3. That if any-, unforeseen condition causes deviation fr'0i~'qthe'plans or' statements contoined the Permit Application Form the employer will notify the ·Division immediate!y. 4. Any variation from the specification and assertions of .the Permit.Applicatl°n Form or violation of safeb~ orders may be cause to revoke the permit.' .'~f-:;;': This permit'shall be po. sted at or near each place of employment as provided in 8 CAC 3:¢1.4, /Re<ei~ed From Re~elwd By ' -' ', -- ~ ~ 4557 I$~00.00 'l 09LZ0-98 · AC~OgNTI~ C:OPY~Y II£CdON coF/--~4r~ : S-~--~o (Rev. 2-e~) ' ' ' ' ' ',-" I understand thatthis'hal~db'0°k i's intended to provide an o~,~/:view of the Company's policies arid does not necessarily rep{eient all such policies in force.'5i;ffhe Company may at any time add, change, o~ rescind anyPoli%' or practice at its sole discreti6'~'~thout notice. · ' ~ have received a company Safe Operation'-i~i~ual.: I agree to read and abide by these instructions in the interest of preserving the well being'P.f myself, fellow employees, and EmploYee Name (Please Print) ' Emp~nature i/_~ Supervisor Name' (Please Print) Supervisor Signature. 2 Date Date ; Po 1 i ce :/.Non~E~ergency Fire:,· N0n2E~erg~nsy Hospital -uSC HOspital Poison ', contrOl ~icenter National ReSpOnse Center & SPills '' Water & Electric SCAQMD '~ ' OccuPati°naI:~Safety (Cai-OSHA) RESOURCE DIRECTORY · EMERGENCY TELEPHONE NUMBER /Ambulance (NRC)/ ToxicS,Chemical and Health Adminis~'ration Box' 7246 .~i.;'BeattY;< NV .40258 ' ::' -,' '. · '-.'. ,,,' 'c°ntractor-Em~gency Phone Number Chemical'Transportation Emergency Center ( CHEMTREC ), --." - *' Slightly ~'ontaminated Waste Rinsate~!II<'':~'', '" -.Chem-Tech System, Inc. 3650 E?',26th Street. .,.<:~::. Vernon, .'CA ·90023 * Drummed'Waste 'Treatment and Disposa!;"F.acility . American .Recovery, Inc. .',: ':'"!:3033 West:Mission Road . " Alhambra,~.CA 91803 ' EPA.',ID:Number, CAD089446710' 911 213)266-2622 (800)544--4404 (800)424-8802 (800)DIAL-DWP (909)403-6000 (213)861-9993 (800)424-9300 (213) 268-5055 (213)458-.2222 *.Heavy Metal. Contaminated Concrete and Wood Frame/debris '~', ,.,US Ecology, Inc. :i<'q"' · (800)999-7160 ,(818)782-9934 Pager(7!4)967-5586 S/IFETY.POLICY STATEMENT .The managemen~'O~f~h(~ Company is committed to the safety':ofits employees and Others and the · protection of equipment and hcilities for which we are respo.nsi,ble. In order to do the Work have contracted for in 'an'efficient manner, it is essential that We perform in the safest manner possible. -.. / ,," " ': · By establishing safe working conditions and by providing information, training and inspection we can.achieve our goal of safe performance without the inj~.iry and financial loss that affects you, your family andthejob.:: :' It is our intent tO operate this business within the parameters established by Federal and State ~'~ to protect the safety'and health of our employees and ensure compliance with the standards which regulate'our industry, i.,., .. Failure to comply with this company's general work policies, Safe operating rules and Federal or Cai,OSHA orders may be ground for disciplinary action up tO and including discharge. We encourage each of you whether management or hourly empl. o~,ees to actively support our safb, ty effort and polic~,, to prOteCt yourself and fellow employees. 'SA FE OPERA TING REGULATIONS INTRODUCTION . · ,wi'rich Pertain to.safe performance at the worksite. ~::'iii'...i,. . 'The instructions and o'rders represent the minimum acceptable standars to preserx, e These rUles are general in nature and do not purport to be complete or specific. Supervisor and foreman as well as hourly employees are encouraged to familiarize themselves with ~!1 regulations health of employees of this company. i,~,.~ v the safety and 2.0 Company, state, County, City and Federal Orders ~.:..: · 'J1.'l '. 'All equipment shall be installed, maintained and .Operated in accordance with company, state and federal safety orders. "-! Supervisor: ResPonsibility :: New employees shall be given training or instruction in the hazards associated with any. particular task before being assigned duties.'.. 2.2 Ail levels of supervision are responsible for the instruction and guidance in con-ect work procedure to be given to employees under their direct supervision. 2.3 · All levels of supervision shall inspect the tools, equipment and working site to ascertain that there are no obvious safety h~ard'sl 2.4 Supervisors or foreman shall request a copy of clients Safety Rules and enforce those rules where they apply to his project. Note: If rules are in ~ company rules, use the more stringent to ensure employee safety. All levels of supetwision shall enforce the regulations set forth in this document which.applTto the job o~' site forwhich they a:re responsible. 3.0 Employee R~spo'nsibilities 3.1 Employees shall reacl and become fi. trniliar with the contents of this manual. 3.2 ,Each employee will abide by these r~les and regulations. F_,ach employee shall fbllow company written instructions and verbal instn.~ctions of "authorized personnel to ensure safe performance on his job. . If you are in doubt or do not nnderstancl how to safely accomplish a task assigned ' you, consult with your supervisor. ' :. 5 4.0¸ - !nju es. 4.1 Any injury, no matter how slight, must be rep0:rted to your foreman or supervisor as quickly as possible and, in any case, on the day that it occurs. Supervisors Report of Injury form stiall be completed in its entirety and turned in immediately. , In tile event ora fatality or the injured is hospitalized more than 24 hours, fbr off,er than observation, the accident must be called i~n to the local Cal-OSHA office. "PERSONAL, PROTECTIVE EQU~?MENT 5.0 HardHat's -5.1 Approved hard hats shall be worn wI'..enever employees are engaged in work where there is a haZard to employees fi'om objects being dropped from above or the nature or the work would subject them to head injuries fi'om striking or bumping overhead projections. Eye Protection · 6.1 . Appropriate goggles shall be worn when grinding, buffing, cutting wirel, ine, - chipping, welding, burning or handling chemicals. 6.2 Welders and burners shall wear dark goggles and/or face shields. Shoes and Clothing "' 7.1 - Heavy dutYwork shoes with hard toes are recommended, and should be worn. :.. -- '7.2 Proper attire includes long pa2ts ~i~ shirt with Sleeves buttoned. Unifbnns can be .'?:~' :7', :. '" ' · ':. 7.3 ' Gloves appropriate fbr the work oeing performed should be worn. :~:,~.-~e~[}:77' .'".4 ..:;',::" . .' 7.4 -Required safety coveralls are provided at no cost to the employee and shall be ~-~}~}~:; .'. ?-,' "" '8.1 ' ;:'Safety belts and/or hm,nesses shall be prowdedand maintained m a safe con&t~on. ~'.'8~:'~. 7'~;.:'-Belts sl~all b~ inspected prior to time of each use. TOOLS AND EQUIPMENT 9.0 ' Hand Tools and Equipment 9.1 .' Hand toes are to be used for the purpose designed and lnaintained in a sate condition or discarded and replaced. · 9~2 Ladders are to be inspected befbre being used and if defective, they must be "repaired or replaced or reported to foreman. · 9.3 ' Damage to ladders, scaffolds or supporting-type structures must be reported to " '" your foreman and repaired or replaced prior to use. 10.0 "Machinery and Power Tools 10.2 Machinery or devices with belts or chain drives shall be properly guarded anti shall not be operated unless guards or other protective devices are in place. Gasol.ine. engine driven machinery shall not be refueled while in operation or if the manifold is hot. 10.3' Repairing engines, pumps, compressors, etc.' .1014 10.3.1 No repairs or lubrication shall be attempted on any machines, engines, etc., until provisions have been made to prevent revolving or reciprocal parts from turning over accidentally; The power source should be locked out or the prime mover made· immobile. Portable electric tools, 10.4.1 10.4.2 Portable electric tools shall be properly grounded or conductive case type. Portable electric tools shall not be used in areas or locations where combustible gas may be present unless the area has been tested and a Hot Work Permit is in force. -': ~i, i 1.0 ·..;Portable Cranes, Shovels, Heavy Equipment ' . .. _.11.1 ".'The placement or operation of this equiprnentShall be so governed as to prevent ...::- .. any. part of it fi'om coming within 10' of any energized high voltage overhead lines. ':-."i {~2 ;' Where buried lines are indicated, call the appropriate company representative for assistance. 1 i.3 11.4 11.5 Use hand shovels if in doubt as to location. 'Operators °fthis equipment and other personnel are to use extreme c;~re to pre,/ertt accidents arising out of body proximity to crushing between moving parts and the . 'ground. Heavy equipment will be inspected by the operator prior to use and if defective in any way that may compomise the safety of the operator or other employees on the project, he will red4ag and have defect corrected before operating. MISCELLANEOUS 12.0 Confined Spaces · 12.1 12-.2 A confined space is any vault, manhole, excavation, tank, vessel or compartment where toxic or flammable gas o[' lack of oxygen may exist. Before entry into a confined space, the area must be tested for: · S 12.2.1 Toxic Gas -, Ff2~., or ot:het' potential toxic gas 12.2.2 Flammability or combustibility. '12.2.3 Oxygen 12.3 12.4 . If working'for an oil company or chenScat plant, request a test and Hot Work or ' Entry Permit befbre commencir~g actMty. Work is not to be perFom'ted wl'~en: · .::'. 12.4.1 .,. '12.4.2 5 ,12.4.3 i2.5 ' 'eliminate the hazard, in accordance with AQMD and other applicable rules. 12.6 Connecting lines or ducts from tank to tank or vault to vault must be ohnded, · ',~ ,:::disconnected and disaligned or effectively sealed to prevent communication '-':~!:': "unsafe or comnremised areas to the s[~ace which will be entered· .Toxic gas excees permissible TLV Presence of flammable gas is indicated Oxygen level is less than 19.5% by volume. If the confined space is co:~taminated, forced-ventilation or blowers shall be used to 12.7 ' ,Spaces which cannot be i'reed of toxic gas or which are oxygen deficient may be entered provided workers: 12.7.1 Wear appropriate respiratory equipment. 13.0 12.7.2 Employee who enters ;'~' equipped with harness and lifk line consistent with State Safety Orders. 12.7.3 12.7.4 Welding 13.1 At least one otimr employee is present as an observer. Observer must be provided respiratory e¢luipmen~t. Observer is trained in resuscitation procedures. · Responsibility for safe welding is vested in the person responsible for the job. He must see that personnel have been given proper instruction in correct work . procedures and that there are no obvious safety hazards. 13.2 !n areas or locations where combustible gas may be present, tests will be performed to eliminate the potential for ignition, Hot Work Permits must be provided in Refinery or Chemical Plant locations by' the · operator before welding is commenced. )'When wleding is required h: locations v,,,here combustibles such as oil,, wood, grass, etc., are present or adjacent, a stanby fire watch shall be provided with: ..13.4.1 Appropriate fire extinguishing equipment '.Appropriate personal protective quipment shall be used by welders and helpers. 13.5.1 Screens should be p~'ovided where adjacent workers may be subject to " radiation due to welding procedures. '13.6' 'When arc welding, the ground shall be attached to the line or equipment being ' ' welded and firmly attached proximate to the welding operation. .'Trenching, Excavations, Bell Holes, etc. ' i'1"4.1 ' :"'A permit issued by Cal.-OSHA is ~'equh-ed to start to working on excavations, ,L }.5, ::trenches or bell ho~es which are 5' deep or more into which employee may be · '- required to enter. '14.2' 'i. The local Col-OSHA'office must be notified of' intent to work prior to excavation. 15.0 1'4.3 14.4 14.5 14.6 14.7 14.8 Lifting . The wall and face of excavation 5' c;r more in depth nmst be shoreci or sloped in accordance with/u-dole 6 of Ca!-OSHA-Constmction Safety Orders Sections 1540 through 1547. Spoils shall be set back to p~-eve, nt si~d~ng offGce into the excavation. In no case shall spoils be placed closer titan 2 'f~et from the edge of excavation. Excavation or trench will be inspected daily before entry to ensure shoring or sloping integrity. Ladders shall be provided at 25' inter~'als in running trenches. kules. ,r, nt~ v_., ,._ _uroceuurcs --- see ~,,,~,~, Open holes or trenches in areas of traffic, both pedestrian and vehicular, must be effectively guarded, barricaded or roped-off. 15.1 Lifts shall not be attempted by one person ,,,',,hen the toad is obviously heavy or -" awhvard.. 15.2 15.4 The use of mechanical assist shall be substituted for manual lifting when load exceeds ability or size of'object precludes safe handling. If mechanical assist is not available, two or more people shall cooperate to 'accomptish the lift in a safe manner. Lift shall be slow, with 'the feet slightly apart on a firm, fiat sur£ace. Spine shoukt be straight, and the load suspended fi'om arms. Use the leg muscles to lift keeping the back in as near' vertical position as possible. Avoid awkward positions or turning at waist when lifting or carrying toad. High Work and Elevated Structure 7<t17:?:::':': 16.2 . Ladders, stairways, ramps, etc. wfii ~'~ constructed conslstent with :'~77."~, .. :. J. Oener~t h, dustpy and Cot struction Satiety Orders ~xicte 17. {~J;'i?{~::}:~}:}' ?"'i.,';:J: ' i6::3 ehey snail be appropriately guarded with stair-rails and guardrails and toe boards 5;-;..'.::(7'. ' 'L :. "f where tools or e}iuipment failing to working area below present a hazarcl to other .1611' ' Work on any structure 15' or more above ground level requires safe access and/or platform or scaffbids, , 't?; 16.4 PlatForms and sca[~'olds shall hv~vc guardrails, midrails and toe boards. Scaffblding shall be construci;ect and maintained in accordance with Construction SalTe~y Order Article 2!, 22 and 23 Cai~OSHA. 16.6 Floor, roof and wall openings 16.6.1 16,6,2 Shall be effectively guarcted to prevent falling from perimeter or through openings. 16.6,3 Alt guardrails shai! be eap?,ble of withstanding 200 lbs. applied pressure in any direction. Provision shall be made to avoid injuring personnel by 15Mling objects from direcdy ovechead activity. 17.0 . Hoisting anti or Crane 17.1 The operato:' o£ t!~c crane or, TM,O'~-.'~,''O'' -'~ ,ce is responsible for the safety o£this operation. 17.1.! Only those people whose duties require them to be in the immediate area of lift or motion are permitted. 17.1.2 17.1,3 A signal man ,,viii be used where the safe operation of the device requires assistance. Only one qualified person rising standard hoisting signals and authorized to do so will bo used unless two or more cranes lifting require additional authorized signal men. Qualifications of operators. },7.2.1 Only employees authorized by management and proven to be qualified in the safe operation ot:.' cranes or hoisting apparatus shall be permitted to operate this equipment. All cranes and hoisting devices three ton capacity or more shall be inspectedt.,'~" certified, with certificates readily avMiabte, aad current in a tbrm acceptable by regulatory authorities. A preventative maintenance program shall be established to ensure the safe operating conditiorm o£ cranes and hoisting devices (see Construction SafELy Orders 1588.6 and 1588.7) 11 18.0 -Pipe Cutting and Repairs 1'8.1 18.2 Cutting 0n pipe lines last conmbfing gas or hydrocarbon products is not to be attempted without the express approva! of the client and only after a Hot Work ?ermit has been issued fbr that particular task. Where possible the linc vvili be taken out of service, flushed or inerted to remove any residual product or poss!olhty ora flammable mixture being present. · 18.3 The first cut on any line should be a cold cut regardless of service to ensure product and pressure safety. MOTOR. VEI--tlCLi~, OPER~Zi':[ON 19.0 19.1 Responsibilities The driver is responsible For: .19.1.1 Operating in a sar% and lawful manner 19.1.2 'The safety o£his passengers 19.1,3 19.I.4 The safety of employees helping to load or unload unless another supervisor is in ,-' ' complete charge of loading or unloading activity. Seat belt or harness will be worn at all times 20.0 ' Licenses Ihiding on beds of trucks is prohibited unless seats or benches with safety belts are. provided, .20.1 . Ail drivers of'company I ~,~ ~ as ve,~ c,e~, shall hold a valid Class 1, 2 or 3 driver's license required by law. ~;'20.21 'All drivers ofheaW equipment shall hold an appropriate license for that class of' 21.1 [. Al! vehicles are to be inspected and maintained in a safe and law~dl condition. :721.2 ~5 ':' ~y defects observed that would compromise the safe driving must be 'reported ':;' · ' and corwected before operating. 22.0 ' Tools and Equipmenl: 22.1 22.2 23.0~'.:Forklift (Not Applicable) 24.0' ' Accident Re~:~orting 24.1 '24.2 Tools and equipment sl,a!, no~ be le?r i'~:~se in the cab or passenger compartment of car's or tracks. MdSc!es loads shall be properly pla. ced and secured with projections flagged with red flag. Ir~ the event of ar{ inN%' ~ccidcr~t> "1'~.,~ driver will: 24.1.1 Notify the nearest authority,,:. 24.i .2 Render help and/or call fbr ambulance. 24. i.3 Remain at {'he scene umtil police report is made. 24.1.4 If no injm-y, report accident to s'upe~wis0r immediately. 24.1.5 Complete autornotive accidept report form at scene ifpossib!e. An automotive accident report l'N'ln will be kept in eve~ company vehicle. 24.2.1 This report is to be il!led out and returned to the Safety Representative ~-,C,,.,Tf El, .t, DO NOT MiGUE WITH THE OTt'.~i.R PARTY, POSSFBLE. DO NOT ~'~MIT ]iAB[LrrY OR OFFER TO SEI' INDUS~AL INJU]~'LY' RESP ONS D~i'L!TZES ~?" tnjdred Employee et First ~d if available 22-,i~t~.epon acck'ient or injuO: to Supemsor immediately. ~ ,' -~, ~t ~ r - 4~S~;:If treated by a physician: Supervisor or Foreman l!..'~L'Provide First Aid to injured. Request return to'work order o~ release. Ifunable to return to worl,:, call Supervisor and advise him of condition or diability. . Pre~ent M.D. ~ele.?.se for work slip when you return. 2]-:!,7tf emergency~ ca!! P:aramedhzs or transport injured to c:losest emergency :,'? receiving hospitnl. ·' 3.':.']'Complete and submil' ' '-" inju~ Report fbrm at erid of you shift. 4/'. Ifinju~ is serious requiring hospitalization or a fatality: -.[::.a. Call management immediately and advise. :;~ b. Do not alter sit< eclu~rnent, ormove evidence. 5]?'Do not give statement~_p~'~2~_~5~dia, outside investigators or insurance ':'representatives without management approval. 6.'~Cooperate with the police, fire depmment, or CaI-OSI~ giving only fhcts, Do not speculate as to the cause of accident or admit hult. with fine. ~ ";"0',~ , ....'~ ..... * .... ' = fines which a s.q es.'-;e d EMPLOYEES OF SUB-CONTRACTORS - INJURY OP, ACCIDENT ' A. Project Foreman or SupervisOr of this company Will: ' 1. Arrange for medical help 'ffrequired.i.' 2. Notify injured's employer by telephone if Sub-Contractor senior representative is not present or aware of the accident. 3. Attempt to preserve existing conditions until investigation is complete.. 4. Investigate immediately and report accident to management by telephone. 5. Follow up with a written narrative report to manag6ment. 6. Do not give statements to.anYnews-media reporters, investigators, or insurande representatives, without express approval .of company management. 7. "Cooperate with police, fire department, or Cai-OSHA. Give only facts - not ' opinions. Do not speculate on cause of accident or admit responsibility. B. Management 1. Ifaccldent is serious or possible liability may exist, call insurance carder. PROPERTY DAMAGE In the event that propdrty owned, leased, .or operated by this company is damaged by a sub-contractor or a third party, .any employee of this company is required to:' Identi~t the party responsible for the damage and obtain name of employer.. Report verbally'or in written form to your Supervisor. ·. A written report will be made by the'company senior representative on the site Details ornarrative of how damage' occured. Estimate of cost of repairs 6r replacement. Photographs if possible t'o sUPPort claim. Bo Report is submitted to company management for action or recovery of loss. Repairs are not to be made Without m~agement approval. Management Will: 1. Notify insurance carrier or responsible party of claim. PROPERTY DAMAGE (others) 1. Person responsible will: a.. Notify his Supervi.sor immediately. supervisor will: a. Advise company management. b. 'Advise client and proje6t manager. Investigate and provide narrative report of injury or property damage stating facts to company management. NOTE: Secure area and prevent fu~er damage if necessary. IN'ANY ACCIDENT 1.' Report ALL injuries (including minor scrapes, etc. that require any form of first · aid application or medical attention) to your immediate Supervisor. 2. 'ReCords regarding injuries, first aid application, and medical attention are kept . in personnel office. . : IMPORT~i":'-;"iThe quesfi°n of fault should be avoided-just state facts not 'Opinions.' Employees' oftNs company are not authorized to give statements to insurance investigators or adjuster without the express approval of management, Under NO circumstances will this" company authorize a ~ettlement or deal without management approval. "' ", . ". :' '.. EMERGENCY TELEPHONE N-U~BER$ Emergency Police / Fire / Ambulance Police: .NonTEmergency Fire: Non-Emergency Hospital - Irvine Medical Center · Poison Control Center National Response Center OqRC) / Toxic Chemicals & Spills Water & Electric SCAQlVlD .,. 911 (714) 724-7200 (714) 538-3S01 (714) 753-2000 (800) 544-4404 (800) 424-8802 (800) DiaI-DWP (310) 403-6000 · . -. . Title8 PI,ATE A 2 SUGGESTEI') SAt.~TY PROGRAM FOR · CONTRAC'I'ORS ' 1. Demonstrate your interest in safety by establishifig a final and posit' live accident prevention policy di,gt inclUdes file supplying of tangible iter~:s.like hard huts. good ladders, fir~ ald materials, and .safety devices. 4m equipment. ' " ..' \ 2. Provide that capable, responsible supen'i.~)rs make re~.,ular inspec-' ti(ms of all excavations, forms, scaffolds..stairs, ladders, structures, ma, chinery, and equipment ut frequ~t in:eh'als: take inm:ediate corrective measures to eliminate ilar. aMs directlyunder control of file employer. re[x)rt violations of Safety Orders and safe practice.,; lo the responsible' employer .'4. Make certs in that file foremen amume their .'share of file responsibil- ity fi)r qccidents, and require a writ:ell refx~rt from them on each. Requir~ fi:at each rclx)rt suggests a feasible means of avoiding future accidents of a similar nature. ' lion to safety, and thus is hi,fly erie.cliVe in nrakin~ file operation .safe " and efficient. . . . · I. Safe Access and Movement ar . , .... ' p (a) Workers (I).Adequale work areas. : i" ."-'~ 'i '.. (2'J Adequate walkways and renways. · ' .. ' : '. · (3) Adequate ladders, stairways, or elevators'.', (4) Work areas and passagewUyi; clear" of rubbish.·debris, nails, etc.. (5) Protection fi~r floor and rmff openings.: :' · '*. ':, .. ' (6) Adequate illumination. .': "'" (b) Vehicles .',' '. - (I) O~r~d roads.. : (A) Adequate turn space. . ..- .. · (B) Adequate parking area. '- .... · .. · (C) Free from excessive mud and dump areas. ~ (2) ,Separate materials storage areas and dump ureas.' (3) Adequate simms, si,:reals, elc.. to route vehicles on job. (4) Maintenance :md repair of vehicles. .': 4.Monfill. y. or more frequent, meetings of all fi~remen .4:ould be field (c) l.ocation of Utilities and Service · . ' under direction of file superintendent fi~r a di.~ussion of ~l'cty problems ( I ) l.ocale ~w. t'ool sheds, office, etc.. in a safe. convenient place. and accidents fi:at have occurred, l lave son:ell:lng specific ready for dis- (2) Consider location ofh¥1 voltage lines. cession, such as safety regulations, or any changes in equipment and (A) Arrange to move. de-energire, orerectbarrier, ifcontactisapossi- reef:teds ti:at are to he adopted for safety reasons. . bility. 5. Display ~fety posters and warning siLms. A si~ indicating how (3) I.ocate .,unitary facilities, drinking water, power, etc.. for ~fety many conseculive accident -free days have pas.~d is often worfilwhile, and convenience. 6. Consider file advisability of posting a list of all fi)remen who have... 2. Schedule Work for Safety kept fileir crews accident free fi~r a certain period of time. 7. Consider the advisability of establishing various fi~rms of safety competition, including suitable rewards or reco.mition lo individuals and crews wifil good records. 8. Require foremen to give individual .safety instructions and orders. as needed, to new workers and ~ho.~ found to be working unsafely. 9. Consider file advisability of having file foremen call short "toolbox" or "tail gate" safety meetin~,s with fi:git crews about once a week on file job. to emphasize .some parlicular safety problem that needs special atten- tion. l(k Keep track of your .~fety record and keep everyone posted as to progress. A graph or chart, indicating gains or h)sses, is good fi)r this pur- pose. I l. F. ncourage safety suggestions from all workers and. if file sugges- lion cannel be Ibllowed promptly, explain why to file worker. 12. Consider the advisabilily of giving each worker a copy of certain intrx)rtant safety rules that they are expected to 13. Arrange for frequent and regular field safely inspections. Non'-. Authority cited: Section 14Z3. I.alx~r Code. Reft:fence: .,;et-t hm 142.3. I.a- bet Code. I. Amendment liled 4 3 g3. el'lL'cti~,'e thirtieth da)' there'-diet (Re,is:er No. 14t. 2. C,'hanee without regulatory et]~et de'~ling appendices' introduction and index and a~¢ntling Iqat¢ A I liled 6 14 93 pursuanl Itt lille I..~ction I(gl. Calilbr- nia Code of Regulations {Register 93. No. 231. : PLATIi A 2 u ADVANCI': PI,ANNING SUGGESTED FOR CONSTRU(.q'IC)N WORK Each operation of a construction job should'be pi'armed in advance. Such planning is needed ut ail stages or:he project. It should staff with thc estimators, prior to preparations of bids. and continue filmu~out file job. with superintendents and fores:es doing their share. Construction planning will eliminate ~me accidents :,aromatic;lily. bycreatinga well. organized job. But expert planning gives special alien' Page 254 (a) Ilave .~t fcty materials on job when needed, i.e.. per.renal protective equipment, shoring, first aid. etc. (b) Plan work so that too many trades arc not in a small area at the same 3. Work Procedures (a) Materials I landling (1) Methods of elevating and handling materials, i (A) Adequate space. · (B) Proper auxiliary equipment, i.e.. cranes, hoists, elevators, trucks. etC. No'If.': Authority cited: Section 14? 'q l,aMa' Code. Reft:fence: Sootier 142.3. l,a- bet Code. ! hsToR's' . , I. Amendment filed 4 3 RS: girl:clive lhh'tieth day thereafter (Regislet RS. No. PI,ATIi A 2 h (2) Methods of loading and unh)ading. (A) Adequate sp.qce. . (B} Proper auxiliary equipment, i.e.. power shovels, cranes, rigging. fi:rk Iii'Is. etc. (b) Tools and I:.qu ipnlcnt ( I ) Repair. maintenance, and care. (2) Inspection. (3) Adequate supplies of the ri~:t t(x)ls for each part of job. (c) Workers and Foremen ( I ) Proper job placement. (2} Adequate training and supervislcm. (3) Adequate mania:wet. (4) Plans for maintaining interest in safety. (A) Sat'ely bulletins, record churls, and [x)sters. (B) Reco,smitlon for groups or individuals with .safety records. (C) Investigation and re[x~rting on all accidents. (I)) Knowledge of ~fcly orders. (E) Safety meetings. " Rs.g;.hnq~'.%o. 31.1t I q? T!tle 8 Construction Safety Orders § 1938 A RULI.; IlREAKI'~R IS AN ACCIDI.;N'I'MAKER NOlT:: Authority cited: Section 14Z3. Labor Ct'de. Re fi:rence: Section 142.3. La- bor Code. i l,s'mav I. New NOTE tiled 4.3-85: effective thirtieth day thereafter (Register 85. No, 14L PI.ATE A- 3 COl)l:. OF SAI:I'; PRACTICES (Th is is a suggested code. it is general in nature and intended as a basis for preparation by the contractor of a code that fits his/her operations more exactly.} GENERAl. I. All persons shall follow Ihese safe practices rules, render every pos- sible aid to safe operations, and report all unsafe conditions or practices to the foreman or superinten&nl. 2. Foremen shall insist on employees observing and obeying every rule. regulation, and order as is necessary to the safe conduct of the work. and shall take such action as is necessary lo obtain observance. 3. All employees shall be given frequent accident prevention instruc- tions. Instructions shall he ~vcn at least every I0 working days. When applicable, the accident prevention instructions shall also include specif- ic instruction on the ~fe use. care and maintenance of fall protection equipms:nt (i.e. fall arrest systems, positioning device systems, safety nets. etc.) used at rite johsile. 4. Anyone known In be under the influence of drugs or intoxicating substances which imp;lir the employee's ;,bility tn safely peri'omi the si~tmed duties shall nol bc allqwed nn rite job while in thai condition. 5. I lorseplay..~u filing, and other acts which tend to have an adverse hflluence on the safety or well being of Ibc employees shall be prohib- ited. 6. Work shall be well planned and supervised to prevent injufi~s in the h;mdling of materials ;md in working tngether with equipment. 7. No one shall knowingly be permitted i~r required to work while thc emplnyce's ability or alermcss is so intpaired by fatigue, illness, or other causes that it miOtt unnecessarily eXlX~Se thc employee or others to inju- · ry. 8. F. mplo.vees shall nol enter manholes, underground vaults, cham- bers. ~;mks. silos, or other similar places that receive little ventilation, un- less it has been determined that it is safe to enter. -' 9. l~ntployees shall be instructed lo ensure that all ~ards and other pro- tective devices ;,re in prnpcr places and :,djusted. and shall report deft- . cicncics promptly to the foreman or superintendent. I0. Crowding or pushing when boarding or leaving any vehicle or oth- er conveyance .shall be prohibited. I I. Workers shall not handle or tamper wilh any electrical equipm6m machinery, or air or waler lines in a manner~ol within the .~ope of the duties, unless they have received instmclions from their foreman. 12. All injuries shall be reported promptly to the foreman or superin- 4endenl so that arrangements can be made for medical or first ;fid treat- ment. ! 3. When lifting heavy objects, file large mu.~les of the leg instead tile smaller muscles of the back shall be u.~d. i 4. Inappropriate foolwear 0r shoes with thin or badly worn soles shall not be worn. 15. Materials. tools, or other objccls shall not be thro~vn from buildin or structures until proper precautions are taken to pmtecl odlers from thc failing objects. No'n;: Authoritycited: Section 142.3. Lab~wCtxle. Reft:rem:e: Section 142.3. I.a- · [mr Code. Ihs'rosy ' I. Amendment filed 4-3-85: effectlv¢ thirtieth day ther¢-',fter (Register ~5. No. 14L 2. Amendment of la'st paragraph and proviskm number 3. liled ? -30 97: opera- tire 8-29-97 (Register 97. No. 31 t. PLATE A -3 -a 16. Employees shall cleanse.thoroughly after handling hazardous sub- stances, and follow special instructions from authorized sources. 17. Hod carriers should avoid the use o f extension lad&rs when carry- lng loads. Such lad&rs mayprovide adequate strength, but the rung posi- tion and rope arrangement make such climbing difficult and hazardous for this trade. 18. Work shall be so arranged that employees are able to face ladder and use bolh hands while climbing 19. Gasoline shall not be used for cleaning purposes. 20. No burning, welding, or other source of iici.ilion shall'be applied lo any enclosed tank or vessel, even if flmre are some openings, until it has I~st been determined that no possibility of explosion exists, and au- thority for the work is obtained from the foreman or .~perintendent. 21. Any damage to scaffolds, falsework, or other support in g structures shall be immediately reported to thc foreman and repaired before usc. USE OF TOOLS AND EQUIPMENT 22. All tools and equipment shall be maintained in good condition. 23. Damaged tools or equipment shall be removed front .~rvicu and tagged "DF. FI';Cq'IVIL" 24. Pipe or Still~n wrenches shall not be used as a substitute for other wrenches. 2.5. Only appropriate tools shall be u.~d for the job. 26. Wrenches shall nol be altered by the addition ofhandle extensions or "cheaters." 27. Files shall be equipped with handles and not used to punch or pr.,,'. 28. A .~ruwdriver shall not be u~d as a chisel. 29. Wheelbarrows shall not be pushed with handles in an upri~lt post. lion. 3(I. Portable electric tools shall not be lifted or lowered by means of the power cord. Ropes shall be u~d. 31. Electric cords shall nol be cxpo.,~d to damage from vehicles. 32. In locations where thc use ora portable power tool is difficult. tool shall be supported by means ora rope or similar support ol'adequate strength. . · - MACIIINERY AND VEIIICI,ES 33. Only authorized persons shall operate machinery or equipmcnl. 34. [a.,,ose or frayed clothing, or long hair. dangling tics. finger rings. elc.. shall not be worn around mov lng machinery or other sources of en- tanglement. 35. Machinery shall not ~e serviced, rep.'tired or adjusted while in oper- ation. nor shall oiling of moving parts be attempted, except on equipment that is desired or fitted with safeguards to protect tile person performing the work. § 1938- BARCLAYS CALIFORNIA CODI~ OF REGULATIONS Title 8 No'If:: Authoritycited: Section 142.3. I.ahor Code.Reft:ronco: S¢~km 14~3. l.a:; bor Code. " : I hSTORY '. .' I. Amendment Iiled 4 3 85: ¢l'lbetiv¢ thirtieth day Ihereaftcr (Reeister No. 14l. H,ATE A. 3-b - $. Kettle covers d~ould be equipped with'a handle that projecls at least · fourteen inches (I 4") away from the surface of the covcr tlr lid... 6. Kettle covers shall be closcd and latched when in transit, and the kettle should be slop .proof when cover is closed. 7. When parked, means ~.all be provided to prCycnt inadvertent mfve- merit'of the kettle. ' .... · 8. Ladders should be used with ~reat caution, and rcx)f ~mtters should 36. Wltcre appropriate, lock (tut pnx:edums .droll be used.' ~ 37. Employees shall not work under vehicles supix)rted by jacks or: not he depended upon [~r .support..'.. ' ·-. : - chain hoists, without protective bk)Cking that will prevent injury ifjac.'ks; 9. Workers handling buckets ofh0t tar should not carry anytlting that or homts sliould fail. will inlcrfcre with thc safety of this operation. ' ' I 0. The tallows frame shall be .~curely anchonxl before hoisting ma- 38. Air hoses shall not be disconnected at compressors until ho.~ line has been bled. · 39. All cxcavatious shall he visually inspected before backfilling. ensure that it is safe to backfill. 40. l!xc.'~vating equipment shall not be oper:tted near tops of cuts. banks, and cliffs if employees are working below. 4 I. Tractors. bulkklzers, scrapers and carryalls shall not operate wher~ there is rn)ssibility of overiumhtg itl dangerous areas like edges of deep filN. cut banks, and steep slopes. 42. When loading where there is a probability of dangerous slides or movement of material, the wheels or treads of Ioadifig equipment, other than that ridingon rails..'should be turned in the direction which will facil- itate escape in case of danger, except in a situation where this position of thc wheels or treads would cause a greater operational hazard. BLASTING ()PI';RATIONS 1. Cases that have contained explosives shall be destroyed bybuming out of dm)rs, l)o not hum in a stovcor furnace. 2. Shoes with nails or metal plates shall not be worn in magazines or near explosives. 3. Blasting caps .'~all only be carried in approved containers. 4. Tile least amount of proper strcngfl) explosive that will do thc job effectively shall be used. 5. Detonators and printers shall be separated from the explosives until. ii is necessary to. bring them together in preparing for the blasl. 6. i loles loaded during a shift should be fired during that shift. 7. The oi~ralions of loading and firing' should be carried out with as few wnrkcrs as possible. 8. Drill holes shall be blown out and made ready before explosives are brought to thc site. 9. In tamping explosive~, steady, even pressure should be u~d. I0. For electric blasting, the following shall apply: (a} Tight electrical connections. (b) No short circuits or breaks itt rite wires. (c) Enough current to fire all shots. (d) A strong, properly applied force when using.a blasting machine operated by physical el'fi)fL (c) Care not m dan)age the insulation nr wires when tamping charges. I I. If mislircs occur, thc liccn.~d blaster shall bc cnntactcd. N~)'rl-'.: Authority cited: Section I ~!.3. I.abor Code. Re Ii:fence: .%ctlnn 142.3. I,a- bet Code. lhs'tc)~'~ I. Amendment tiled 4 3 85; el'fi:clive thirtieth day thereafter (Rc.eistcr 85, No. 14~. 2. Amendment filed 8 29 KS: till:clive thirtieth day there:i flor (Rcglstcr 39). PI,ATE A 3 c ROOFING OPERATR)NS I, Knotted hand lines should not be used. tcrials. I I. Only muscular power .'4mil be us~,4 to hoist materi:tls by me:uts of a gallows frame. A winch or power hoist shall not be u.~d. NoTF.: Authority cited: Section 142.3. Labor Code. Reti:r?o:: SeCtion 142.3. her Code. HISTORY I. Repealer of Item No. $8 and renumheriog ol'ltem No~. $9 61 filed 6 6 gO: el:. fective thirtieth day thereafter (Register 80. No. 23). 2. Amendment filed 4-3-$$;.effective Ihirtieth day thereafter (Register 85. No. 14). Appendix B Handy Construction Data; Facts; .and ~formation Plate B-I Handy Things to Know (a} the circumference cfa circle, multiply the diameter by 3.1416 (ap- . prox. 3 1/7). (b} thc diameter of a circle, multiply the circumfcrcncc by .31831. (c) the area of a circle, multiply the square of the diameter by .7854. (d) the area of a triangle, multiply the base by !/2 the pcrrr,,'ndicular height. (e) the volume of a sphere, multiply cube of the diameter by .5236. A gallon of water weighs 8 1/2 pounds. A gallon of water contains 231 cubic inches. A cubic foot of water contains 7 !/2 gals.. 1728 cubic inches and weighs 62 I/2 lbs. In board measure all boards are assumed to be ! inch thick. Area cfa lineal foot multiplied by length in feet will give the surface contents in square feet. PLATE B ! a SANrrATION OF PERSONAl, SAFF, TY DIiVICES (except respiratory protective equipment) Thorough mmbbingwith soap andhot water is ordinarily adequate for cleaning purlings. When additional cleaning appears m:cessary, one the f011owing treatments slumld be u.~d. in additinn to lite .map and water scrubbing (!) Immerse for ten (lO} minutes in a solution of formalin made by placing one (I) part of forty percent (40~:{) fomtaldehyde .,afiution itl nine (9) paris of water. 2. Root'crs tcnding kettles, or carrying buckets of hot tar. shall wear gloves that fit snugly at the wrists, and long sleeved shirts fastened at the oughly rin.~d with water and hung up to dry. · 'Such items that have been in contact with the skin of the wearer must wrists. 3. At no tinte should a roofer, while handlin e or exp°scd t° injury fr°m be replaced if they caunot be cleaned as de<ribcd. ~ , No'n=.: Authoritycited: Section 142.3.I.abor Cc, de. Reference: Section 142.3.La- hot tar. work without a shirt or appropriate footwear, her Code. 4. Appropriate portable I'lre extinguishers shall be kept at or near the HIrroav . · kettle, attached, if practicable, to the tongue ofthe kettle, awayfn)mthe' I. Amendmentol'l'lateB I allied I 17 ISO; effective thirfieth day thereafter danger zone. i (Register 80. No. 3~. (2) Dip in a three percent (3%) solution of carbolic acid. two percent (2~) solution ofl,y~l ora s~:venty percent (7()eh) solution of denatured . alcohol. (3) lnm~ersc in boiling water for five (5) minutes. (4) The method recommended by the manufacturer for cleaning and .. sterilizing. After following any of thc~ procedures, the equipment should be thor- RECORD OF TELEPHONE CONVERSATION Location: -'?_¢'7'7 ID#m Business Name: Contact Name: Business Phone: Inspector's Name: Time of Call: Datei /%/"w ,,/~ FAX: 6'~ - / ~ Z-2 Time: _ # Min: Type of Call: Incoming [ ] lOutgoing ~ Returned ~'. Content Of Call: ~)t-.-(-s ¢¢~o/.k~ _~f.:J: ~ 1~. ~ ~ ¢~1~'~' Actions Required: Time Required to Complete Activity # Min: ~RSF~ELD F~RE DEPARTMEN~~'' ....... v ENVIRONMENTAL SERVICES ~: 1715 Chester Ave., Bakersfield, CA 93301 (805) 326'-3979 TANK REMOVAL INSPECTION FORM FACILITY ~ Lo6e ~~ ADDRESS ~7 ~ OWNER ,/ PERMIT TO OPERATE~-o~4O CONTRACTOR CONTACT PERSON~ LABORATORY C~~7~ #OFSAMPLES TEST METHODOLOGY -~n~F~ ~ ~Ht~,w~~uj~j~ PRELIMANARY ASSESSMENT CO. CONTACT PERSON CO~ RECIEPT ?O~t~ LEL% ~b 0~% PLOT PLAN Cai,Ace E~9. eer~E, l~c. Siie Address: ZG77 ~. VF--KI4o~4 Van Nuy~, CK.91402 Date: ~ ,/q/9 ~ Job No. · -.'~.i:~: ;.,~:..~' ..~ i~. N CONDITION OF TANKS CONDITION OF PIPING CONDITION OF SOIL COMMENTS (s~- DATE INSPECTORS NAME SIGNATURE 11:53 ~805 326 0576 III~.IIAZ ~AT DIV 002 CITY OF BAKERSFIELD I~~ ~ J~ OFFICE OF ENVIRONMENTAL SER¥1CES ! 71 $ Chester Ave., Bakersfield, CA (805) 326-3979 pERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION FAOuTY na~ ~c~ CONTRACTOR IbJgORMATION COMPANY C.o[-/¥~'e_ ADDRESS l INSURANCE CARRIER PHONE NO.~/~):~°~ -~93~t LICENSE NO. /',~ :7c-O'O G<.,~ WOmCMm~SC~P~O. ~0 c oBT_ g~. ~ TANK CLEANING INI~ORMATI0N co ^Nv c -va¢ . iql, ADDRESS .j~ '~J~o~~ C~ ~T~ F~ SPR~ Z~ ~0~'7~ WA~ TRAN~R~R IDENTIRCA~ON ~ER ~ M ~O .. v TANK TraNsPortEr m~ormA~on COMPANY (~ i~lI- V ~ ~ P~O~ N~)~ ~b"q~LICENSE NO. ~l C aDDReSS ~ 1~0~ ~Ot~aK(~ c~~a F~ sf~;~ zm~o~O TANK DES~NATION ~D~S .~ ~ I ~ C~ TANK INFORMATION CHEMICAL DATES CHEMICAL TANK NO. AGE VOLUME, b~r , STORED PRE'VIOl/SLY ST~), ~R~ -.. .-. ', · ,. ~ ~.,.,,<~s,;~ :~.~::;,',~;~:~.:::~* ::'~-T~ <,~ ;t:.::.~~ ...:~::~'~,~5~'~:-~'~.~ ..'2..~.:.-.::...;,., :,' :,' ' ;'"' ' ~:~"~: ,~ x::~¥ ' 1 a ........ ,~..~,~'~-.~. ~ , ~..~..~'~...,:, .......... ~..O~T~ ..... ~ -. ! j ' " · .. ', . ::.?'..: -~ :..~::~.:,~:~::~.~V<'::~ TI !1.: APPI,ICANT I I~ ~cEIVEI), ~'A~, ~D ~, cO~,Y ~l~I ~tF, KI'I'ACI~:D CONI)I'I1ONS OF Tl IlS I'l~liM[l' AND ANY O'H IER STA'I'E, I,~'~ TI I1~ FORM I I&s BI~EN C~.PLI(T an~,:~ :. / // // ,/ ~TH~ APPLICA~ON BECOME A PERMIT WHEN APPRO~D RX:g~OObps g8'/11/13 13:02 By:The Tribe Conect P.OO2 .' '! iCnl~-Ace'Engineering, Inc. Site Address: Z~.7''/ I'~T. ~'~_-.-F.~::~,,I .: I l!~6;,~.s, S~ '#'r7 ... ' ~$ F,e. LO, .. J.Van.NuYs;i?~.,.:,i914o2 . Date: ~ ~/'q/q $ "J0~ .No. N L D October 28, 1998 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 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) 395-1 349 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 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 · UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: Having difficulty getting a return phone call from underground storage tank contractors? Are contractors telling you that they are booked until February and March of 19997 Has your price, that you were quoted six months ago, almost doubled? These are some of the concerns voiced by tank owners who are now trying to meet the compliance deadline. With less than 53 days left, many will fall short of being upgraded by December 22, 1998. This office has started issuing compliance stickers to those owners who have upgraded or replaced their underground storage tanks. We regret that you will not be receiving one. For those' who will not make the deadline, this office suggests that you start preparing for closure.' Your facilities will not be permitted to pump fuel after December 22, 1998. For information regarding compliance or tank closure, please feel free to contact this office at (805) 326-3979. Steve Underwood Underground Storage Tank lnspec, tor . Office of Environmental Services SBU/dm cc: Ralph E. Huey, Director D FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 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) 395-1 349 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) 325-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 September 30, 1998 UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: One month from today, this office will start issuing compliance stickers to those owners who have upgraded or replaced their underground storage tanks. We regret you will not be receiving one. On December 23, 1998, your current underground storage tank(s) will become illegal to operate. Current law would require that your permit be revoked and, without a compliance sticker it will be illegal for you to receive fuel deliveries after January 1, 1999. After 90 days of closure, your tank will be considered illegally abandoned and We will take action to properly close these tanks. If you do not comply with our tank closure requirements, we will find it necessary to take legal action, including, but not limited to citation and/or injunctive relief. Time is running out, you have 83 days before the deadline arrives. If this office can be of assistance, please do not hesitate to call me at 326- 3979. Sincerely, Steve Underwood Underground Storage Tank Inspector Office' of Environmental Services cc: Ralph E. Huey, Director L D August'31, 1998 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 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 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: The City of Bakersfield wishes to.congratulate those tank owners who have upgraded, removed or replaced their tanks in the second quarter of 1998. This office is expecting an even bigger third quarter result. This commitment, has helped this office achieve an 84% compliance average for the underground storage tanks within the City. For those who have still not upgraded, time is running out. December 22, 1998 is just three months away!! If this office can be of any assistance, please dO not hesitate to call me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector SBU/dm cc: Ralph Huey, Director,'Office of Environmental Services FIRE CHIEF MICHAEL R. KELLY ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805] 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 [805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 BAKERSFIELD FIRE DEPARTMENT July 29, 1998 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Ave Bakersfield, CA 93306 UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: You have been receiving monthly updates from this office, regarding the underground storage tank compliance deadline, since December of 1997. I feel we must inform you of how serious an impact non-compliance will be to your business. On December 23, 1998 (December 22, 1998 deadline) this office will be forced to revoke your permit to operate, effectively shutting down your fueling operation. On January 1, 1999, Senate Bill 1491 takes effect, banning fuel deliveries for those who have not met the compliance upgrade. After 90 days of closure, your tanks will be considered illegally abandoned and we will take action to properly close these tanks. If you do not comply with our tank closure requirement, we will find it necessary to take legal action, including, but not limited to citation and/or injunctive relief. It is this offices sincere hope, that we do not have to pursue such action, which is why we continue to update you. Time is running out, contractors are booking 6-8 weeks in advance, and costs are climbing at an alarming rate. If this office can be of assistance, please do not hesitate to call me at 326- 3979. Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm FIRE CHIEF MICHAEL R, KELLY ADMINISTRATIVE SEI~VICES 2101 'H' Street Bakemfleld, CA 93,~1 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SEIiVlCES 2101 "H" Street Bakersfield, CA 93,301 (805) 326-3941 FAX (805) 395-1349 PREVEN11ON SEllVICES 1715 Chester Ave. Bakersfield, CA 93,301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SEl~q~ 1715 Chester Ave. Bakemfleld, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 BAKERSFIELD FIRE DEPARTMENT June 30, 1998 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Ave Bakersfield, CA 93306 UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: The City of Bakersfield and Kern County Environmental Health will hold a Underground Storage Tank Workshop. This will be the final opportunity, before the December 22, 1998 deadline, to ask questions regarding upgrade, removals, financing, and other related requirements. The workshop will be held on Friday, July 17, 1998, from 8:00 a.m. - 12:00 Noon. The location' will be the Kern County Environmental Health Services Department, 2700 "M" Street, First Floor Conference Room. Enclosed' is a registration form. Please fill out and mail or fax befOre the registration deadline, July 17, 1998. I look forward to seeing you there. Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure cc: Ralph Huey, Director, Office of Environmental Services BAKERSFIELD FIRE DEPARTMENT May 31, 1998 RRE CHIEF MICHAEL R. KELLY ADMINIS1RA11VE SERVICES 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93,301 (8O5) 326-3941 FAX (805) 395-1349 PREVEN11ON SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (80,5) 326-3979 FAX [805) 326-(]576 TRAINING DIVISION 5642 Victor Street BakerSfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 Saleh Rahimi Econo Lube N Tune · 2677 Mt. Vernon Ave Bakersfield, CA 93306 UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: The City 0fBakersfield wishes to congratulate those tank owners who have upgraded, removed or replaced their tanks in the first quarter of 1998. This office is expecting an even bigger second quarter result. This commitment, has helped this office achieve a 75% compliance ax~erage for the underground storage tanks within the City. This is a very "good start". For the benefit of those who have not yet upgraded, the City of Bakersfield and Kern County Environmental Health, will conduct a Underground Storage Tank Workshop scheduled for Friday, July 17, 1998, from 8:00 a.m. - 12 noon. Look for our June letter for more details. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector SBU/dm cc: Ralph Huey, Director FIRE CHIEF MICHAEL R. KELLY ADMINISTI~IIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93,308 (805) 399-4697 FAX (805) 399-5763 BAKERSFIELD FIRE DEPARTMENT February 24, 1998 Saleh Rahimi Econo Lube N Tune 2677 Mt Vernon Ave Bakersfield, CA 93306 UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: The City of Bakersfield has some exciting news regarding loan monies, which has just become available through the Small Business Loan Association (SBA). Pollution Control loans, thru the SBA, are intended to provide loan quarantees to eligible small businesses for the financing of planning, design, or installation of pollution prevention controls, which includes underground storage tank facilities. The vast majority of businesses are eligible for financial assistance from the SBA. The SBA defines an eligible small business as one that is independently owned and operated and not dominant in its field of operation. For those applicants that meet the SBA's credit eligibility standards, the agency can quaranty up to eighty percent (80%) of loans of $100,000. Seventy five percent (75%) of loans above $100,000. Lynn Knutson, Chief of Finance for the SBA says, "If customers apply immediately, and meet the requirements, funding is'available". The City of Bakersfield hopes all of our underground storage tank owners take advantage of this opportunity. For more information on SBA, Pollution Control Loans, please call or write to: Lynn Knutson, Chief Financial Officer Small Business Loan Association 2719 North Air Fresno Drive, Suite 200 Fresno, CA 93727 Phone # (209) 487-5785, Ext 130 Don't delay, start today!!! Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services cc: Ralph Huey BAKERSFIELD FIRE DEPARTMENT January 29, 1998 FII~ Cltlr~ MICHAEL R. KELLY ADMINI,S'11~,nVE ~ 2101 'H' Street Bakersfletd, CA 93,301 (805) 326-3941 FAX (805) 395-1349 SUlIFI~ESSlON SE~A/ICES 2101 'H" S1Teet Bc]kersfle~, CA 93301 (806) 326-3941 FAX (8O5) 395-1349 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIEONMENI'AL ~ 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0~76 TRAINING DIVISION 5642 Victor Street BakeJsfteld, CA 93308 (805) 399-4697 FAX (8O5) 399-5763 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Avenue -Bakersfield, CA 93306 UNDERGROUND STORAGE TANK UPDATE Dear Saleh Rahimi: The City of Bakersfield wishes to congratulate those tank owners who have upgraded, removed or replaced their tanks in the month of January. During the month of January, our office had six sites (14 tanks) which are now in compliance. This is a very big "first step". For those who have not yet upgraded, I would like to share some thoughts on why it is so important to act right away: 2. 3. 4. Licensed contractors are booking up fast, in some cases, up to three months in advance. Supplies (pumps, dispensers, leak detection equipment) may be scarce. The cost for upgrading or removing could go up as demand increases. Assembly Bill 1491 will ban fuel deliveries after January 1999 to non-upgraded owners. The good news, is there is still time!!! If there is anything this office can do to assist you in your planning, do not hesitate to call. Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services cc: Ralph Huey, Director, Office of Environmental Services BAKERSFIELD FIRE DEPARTMENT December 18, 1997 FIRE CHIEF MICHAEL R. KEM.Y ADMINISl~ATIVE SERVICES 2101 'H" Skeet Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SEEVICES 2101 'H' Street Bakersfield, CA 93,301 (805) 326-3941 FAX (805) 395-1349 PEEVENTION SEIIVICES 1715 Chester Ave. Bakersfield, CA 93,301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAl SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 Dear Mr. Rahimi: You will be receiving this letter on or about December 22, 1997. One year from today, December 22, 1998, your current underground storage tank will become illegal to operate. Current law would require that your permit be revoked and, would make it illegal for any fuel distributer to deliver to any non upgraded tank. However, in reviewing your file I see that you do plan to remove your tank by April 1998. We congratulate you on your decision to remove your tank and simply want to offer any assistance we can in meeting your target date. Please remember to contact this office for permits well in advance of your anticipated start date. As we get closer to the December 22, 1998 date, I would expect construction lead times to become extended, as well as costs for tank removals. " Sincerely, Ralph E. Huey Hazardous Materials Coordinator REH/dm cc: Kirk Blair, Assistant Chief CONTRACT ENVIRONMENTAL SERVICE TEST CERTIFICATE 2058 N. MILLS AVE., STE. 107 CLAREMONT, CA 91711 (909) 445-1266 (800) 554-3458 AUG 1 CUSTOMER: ECONO LUBE N' TUNE #22 6820 LANKERSHIM ADDRESS: PHONE: 818-982-0627 CITY: NO. HOLLYWOOD STATE: CA ZIP: 91605 ..... L6CATION ADDRESS: ECONO LUBE N' TU~E-#ll~, 2~677 MT. VERNON pHONE: 805-872-5770 CITY: BAKERSFIELD STATE: CA ZIP: 93306 TEST REQUESTED BY: SALEH DATE: 8-8-97 ITEM OR SYSTEM TESTED TANK ID# CAPACITY TANK TEST TANK TEST LINE TEST LINE TEST LEAK RESULTS- GAL/H RESULTS- GAL/H DETECTOR' P/F P/F P/F #l-WASTE OIL 550 GAL. PASS +.0314 PASS ** N/A REMARKS: **LINES TESTED AS PART OF ULLAGE TEST. TYPE OF TANK TESTs US TEST 2000 U/P TYPE OF LINES: GRAVITY THIS IS TO CERTIFY THAT THE ABOVE TANK(S) AND ASSOCIATED PIPING SYSTEM(S) ARE "TIGHT" AND MEET THE CRITERIA ESTABLISHED._ BY THE NFPA PAMPHLET 3_29._ CERTIFICATION DATE 8-8-97 ANTONIO DOM~EZ : 2R77 ~IiNT VR'RN~N ~'P. -- 5n %A.75 't '2. 7~.q~75~ R(!~'hNt'l T,JtRR-'N-'-PHNR J~2'2 F, 9. Q!'t T,ANNRR,qHTM ,~T,VI']. RFt(],N~ T,iTP~R-N'-~Tt'IINR ~1 I 7 '2677 h~f'lJ)'NrP V~."F~Nf'~N ,~rp. Nf). ~FIT,I',¥~C1CJF] CA. q ! F,(l r~ RAKRR~TRT,i] PF~f~NR J~: ROS\R72-577~q F~¥TRRRNq~ RPA ,~,~PANI}AR'.~,~ I]TC'_L~A~PR ?.qA'P F~D'R ilNP, RD~I~I~Iifi'D ~'i'iV.T, q-'ANK.q. ~P~-~i MA~TMIIM AT,T,(DWAT~T,R T,RA~f/[~ATi~] 'RAq~R CJV~R q~TRR PRRTcDF] c-11~ C)NV.' I4FliJR T,q .1fl ('-ITT, '-PAN7{ T~ ff'T¢4T-Trp. .Fl%1~,q, FI ~.P.Flo ¢4ATN ~A~PR T,T~RN~R ~4-I 15 10 5 -5 -15 -~;~ ~. ~TARI' T1~:17:5~:46:69 CIJRR~T TIHE:~8:~:36:86 - C1: .88240 ~TE' .63139 G]:~! ~ IH Piti, I,J]ER~ IOH 1,29 ~ ' 0 15 30 ~Z)9666§'7. T~T..§ TIME (MINUTES'~i ,{ , I 8O CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES UNDERGROUNI) STORAGE TANK PROGRAM 1715 Chester Ave., Bakersfield, CA ($05) 326-3979 .APPLICATION TO PERFORM A TANK TIGHTNESS TEST ADDRESS PERMIT TO OPERATE,,-. OPERATOKS NAME: Ed ow~-~s NAM~ NL~XB~-a O~ Z.~XKS .T0 T~ ~ VOLL~ / TANK TESTING COMP.&¥Y ~O/~-~',--a c4- d~Jnv i' ~or, m~.-.~.-a ~ ~e_.:~- v,'c.~. MAILrNGADDRESS .~o.5~ ~. ~;I)s .~., ~c. 1o7~ ~[i~~. ~ O/Wi CERTIFICATION # 9 L/'__ / g-~/ ~ DATE & ~ TEST IS TO BE CON-DUCTED / I A.,,-,X/_- S' DATE SIGNATURE OF APPLICANT BAKERSFIELD FIRE DEPARTMENT nl~ C~ll~ MICHAEL R. KELLY 2101 'H' Street Ba~e~f~etd, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPffi~S~N ~EVICF. S 2101 'H" SITee! Bakers~la, CA 93301 (805) 326-3941 FAX (8O5) 395-1349 PltEVEN11ON SERVICES 1715 Chester Ave. Bakersfietcl, CA 93301 (805) 326-3951 FAX (805) 826-0576 ENVII1ONMENTAL SERVICES 1715 Chest~ Ave. Bokersfiela, CA 93301 (80,5) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersflelcl, CA 93308 (805) 399-4697 FAX (805) 399-5763 January 31, 1997 Saleh Rahimi Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 Underground Storage Tank located at Econo Lube N Tune, 2677 Mt. Vernon. Dear Mr. Rahimi: As I am sure you are aware, all existing single walled steel tanks that do not meet the current code requirements must be removed, replaced or upgraded to meet the code by December 22, 1998. Your tank does not currently meet the new code requirements and therefore falls into the remove, replace or upgrade category. Your current operating permit expires on or before that date and of course will not be renewed until appropriate upgrade of your tank system is accomplished. In order to assist you and this office in meeting this fast approaching deadline, I have attached a brief questionnaire addressing your plans to upgrade this tank. Please complete this questionnaire and return it to this office by Monday, February 17, 1997. If you have any questions concerning your tanks or if we can be of any assistance, please do not hesitate to contact this office. Sincerely, Hazardous Materials Coordinator Office of Environmental Services REH/dlm attachment B A K E R S F"i E L D. FIRE DEPARTMENT December 11, 1996 FIRE CHIEF MICHAEL R. KELLY ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 .- ' - SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave, Bakersfield, CA 93301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 Hrant Mikaelian Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 Underground Storage Tank-located-at Econo Lube N Tune, 2677 Mt. Vernon. Dear Mr. Mikaelian: ' As'I am sure you are aware, all existing single walled steel tanks that do not meet the current code requirements must be removed, replaced or upgraded to meet the code by December 22, 1998. Your tank does not currently meet the new code requirements and therefore falls into the remove, replace or upgrade category. Your current operating permit expires on or before that date and of course will not be renewed until appropriate upgrade of your tank system is accomplished. In order to assist you and this office in meeting this fast approaching deadline, I have attached a brief questionnaire addressing your plans to upgrade this tank. Please complete this questionnaire and return it to this office by Friday, December 27, 1996. If you have any questions concerning your tank or if we can be of any assistance, please do not hesitate to contact this office. Sincerely, Hazardous Materials Coordinator Office of Environmental Services REIaddlm attachment BAKERSFIELD FIRE DEPARTMENT .. - December 11,1996 FIRE CHIEF MICHAEL R. KELLY ADMINIS~TIVE SERVICES 2101 'H" Street Bake~fleld, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805] 326-3979 FAX (8D5) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 Hrant Mikaelian Econo Lube N Tune 2677 Mt. Vernon Avenue Bakersfield, CA 93306 Underground Storage Tank located at Econo Lube N Tune, 2677 Mt. Vernon. Dear Mr. Mikaelian: As I am sure you are aware, all existing single walled steel tanks that do not meet the current code requirements must be removed, replaced or upgraded to meet the code by December 22, 1998. Your tank does not currently meet the new code requirements and therefore falls into the remove, replace or upgrade category. Your current operating permit expires on or before that date and of course will not be renewed until appropriate upgrade of your tank system is accomplished. In order to assist you and this office in meeting this fast approaching deadline, I have attached a brief questionnaire addressing your plans to upgrade this tank. Please complete this questionnaire and return it to this office by Friday, December 27, 1996. If you have any questions concerning your tank or if we can be of any assistance, please do not hesitate to contact this office. Sincerely, Hazardous Materials Coordinator Office of Environmental Services REH/dlm attachment ,JUN 5 1996 CONTRACT ,[:iN'~ !P,C.qM >:iN"FA L SERVICE 404~ C, UF:STI Ri}, ONTAP""~.,, CA, 9!761 800.-554--3458 CITY: LOCATION ADDRE'.S$: 2677 MT., VERNON B~r~.E,k..~,r ~ . .uD STATE: CA £AME STATE: TEST REQUESTEO BY: HklCTOR TAN} ZIP: 933C6 PHONE; ZIP: DATE: 5-21.-96 #1-WASTE OIL REMARKS: **LINES TESTED AS PART OF OVERFILL TEST, TYPE OF TARK 2N'£EGRITY j/lEST: ~ORNER ~Zi{ C8EK I Tflx}': OF LINES: GRAVITY THIS IS T,'}C~'_~RiIF,."' " THAT THE ABOVE TANK(S} A!.ID A'~SOCIATE~ PIPING ,~a'VSTEM(S}~ ARE MEET THE C~I'[ERIA ESTABliSHED BY TNE NFPA PRMPHI,ET 329~ "- OPE~70~ /~ ..... -- ~ ~ '~' , ANTONIO DOH i N6UE.~) " 5-2 ' t-iL==- ...... ~.?: .......... GONT~J~CT ENVIROnS'MENTAL SERVXCE 4045 GUASTI RD, ~211 ONTARIO CA, 91761 390-8i44 1-S00-554-3458 FAX (909) 390-8'!47 9]LLilaG ECONO LUBE N' TUNE #117 ~ 26'f? ~F. VERNON 8AKERSF IELO, CA 93306 TANK TEST DATA SREET DATE: 5'21-96 TI~E: 1630 O~TACI PER~: I~DTE; HECTOR ON THE DAY TEST WAS PERFORMED, TH~ TANK WAS 101% FULL. TANK AND WATER DATA TA,~K SIZE 550 Jt, AI'ERIAL TOTAL D,EPTN 73 FILL LENGTH TAILK' DiA. 43.00 ST,/U:&) PIPE TEST NEIGItT = [TOTAL DEPlfl + $'[AJ~ piPE] TEST PRESSURE = Ht.A WELL #o: N/A DEPTH tO G~D. ELEV: DATE I~Oll I TID~ Y/If N~E ~FACT~ER ~L TESI'~ y/~ AOURITE LINE TEST DATA ~ SYSl(~ GRAVITY l~. ~CH: TEST P.S.I. TZ~ ~Gi~ ~L. L~L TI~ E~ C~L. L~L PASS ~ 'TANK No. 1 ST 3O 0 103.000 3,275 PRODUCT DATA DO~)E~TS WASTE OIL APl ,~. Gr. 28.6 I'~RAI'URE 73.3 AP[ @ 60°F 27.7 ~FICIENT OF EXP,~SI~ .4359 /1~ ~i ~XG~T = (1~1.5/(~1.5+~))*(.0~) 0.0318 FAfT~ lB] = T~K Si~ x ~FICIENT OF EXP. 0.~397 IIEGIN B~GI# BEGI~ TEST CALIBRATION (if used) t4 E~D 53 = 16 : EI~D ,~ 53 15 Ek~ 53 LINE LEAK DETECTOR DATA 1~30EL Mo: SERIAL ho: 'JEST L~ RATE CI'E'#ING TItlE ~IOI.i)I~G 39. 0000 ~7, 0000 3.8.0000 0.0007 FACTOR A N/A ~ {'RACT EMV i ~IOmI~ENTAL SERV i CE TAMK '{'EST DA'I'A 5.NEET LUBE N: TUNE #117 SITE:' 2677 MT VERNON° BM:ERSFIELD, CA 93306 DATE: 5-21~96 30 30 29 -1 28 - - 28 26 -2 ' :0'.00!4 24 2~ -3 -': 18 -1 :o. Oo°7 17 15 -Z '. ~5 15 o o.oco° FACTOR Iii] ,2397 0.114 .117 0.003 .j 0.0007 0.117 .121 0.004 0.121 0.~2~ .124 0.003 .1'28 0.004 .13~ 0.005 0.133 .137 0.004 0.137 .t41 0.004 0~141 .1~9 0.008 0.0010 · 0.0007 6.0OLO 0.0010 O.oo'io 0.0019 0.149 .159 0.0t0 .0,0024 o,~9 ,1~ 0,002 -.O,°oo5 0.161 .168 0.007 ' 0.'00'17 -0.0021 -0.0021 -0.0017 -0.0017 -0.0026 -0.0024 -o, 0031 -0.0019 -0.0017 MONITOR PERIOD RESULTS LEAKAGE INDICATED -0,0278 lll~ STARI EMD GAIX.+ LOSS- 15 55 55 0 20 55 54 -! 25 __ 5~. '~ . 53 _:1 35 52 51 40 51 50 45 50 $7 37 0 55 37 37 ~ 0 2000 37 36 05 36 35 10 35 32 TEST PERIOD RESUL' T~ST CRITERIA PASS/FAIL ' £HAMG{E START El, ID · 0.0000 .168 ' ' -0. 0007 0.170 · -0,0007 O. ! 7~ . ~70 -0,0007' 0.1T0 "-0,0007 0.170 -0,0007 O. 169 0.0000 0.169 0.0ooo 0.167 .0,0007 0,167 LOSS- CONTIU~CTION-' .170 0.002 0.0~05 .171 0.00? 0,0002 -0.001 -0.00~0" ;0.0002 .t70 0.000 0,0000 .169 -0.001 -0.0002 .'o.oooo 169 0.000 .167 -0.002 -0.0005' . 167 0. 000 O. 0000 0.1~5 .'lb& 0.000 0.0000 :0~0021 0.lb& .16d 0.000 0.0000 PASS -0.0007 -0.0005 -0.0007 -0 -0.0007 0.0005 0.0000 -0.0005 -0.0007 -0.0~21 -0.0073 LEAKAGE INDICATED STANDARD DEVIATION +/- ,0006 ..................................................................... ~ akersfie!d Fire Dept. PER~I~, STATEMENT ~ .~:.,~* ',:<." ?'.: .... -, . .... ~,...?:..:~r~,~..~t~.~,,.:~.c~:~~:?:~m~'~:~ ,,¢ __~ ~ c~. ~ ..,... ,~ AMOUNT STATE SURCHARGE : i ~ OT~iS~ pERM)TS .......................... CONTRACT ENVIRONMENTAL SERVICE 4045 GUASTI RD, #211 ONTARIO CA, 91761 909-390-8144 800-554-3458 TEST CERTIFICATE RECEIVED HAZ. MAT'. DIV. CUSTOMER: ADDRESS: CITY: ~oCATioN ADDRESS: CITY: TEST REQUESTED BY: ECONO LUBE N' TUNE #117 2677 MT. VERNON BAKERSFIELD STATE: SAME PHONE: 805-872-5770 CA zIP: 93306 PHONE: STATE: ZIP: HECTOR DATE: 5-21-96 ITEM OR SYSTEM TESTED- TANK ID# CAPACITY TANK TEST TANK TEST LINE TEST LINE TEST LEAK RESULTS- GAL/H RESULTS- GAL/H DETECTOR P/F P/F P/F #l-WASTE OIL 550 GAL. PASS . .-.0073 PASS ** N/A REMARKS: **LINES TESTED AS PART OF OVERFILL TEST. TYPE OF TANK INTEGRITY TEST~ HORNER EZY CHEK I TYPE OF LINES: GRAVITY .... THIS IS TO CERTIFY _THA~.~HE_ ABOVE TANK(S) AND_ASSOCIATED PI~ING SYSTEM(.S) ARE "T.IGHT"_._A~_.p MEET THE CRffERIA ESTABLISHED BY THE NFPA PAMPHLET 329. OPERATOR /~L..~ , , ,,- .., LICENSE'~0-1571 ANTONIO DOMINGUEZ~' CERTIFICATION DATE 5-21-96 CONTP. ACT ENVIR~ENTAL SERVICE 4045 GUASTI RD, $211 ONTARIO CA, 91761 (909) 390-8144 1-800-554-3458 FAX (909) 390-8147 TANK TEST DATA SHEET CUST(~ER: ECONO LUBE N' TUNE #117 BILLING 26;7 MT. VERNON /~DRESS: BAKERSF[ELD, CA 93306 DATE: 5-21-96 TINE: SITE ADDRESS: SAME 1630 COlITACTPERSOIi: NOTE: HECTOR PhOll~- 805-a72-57'/0 ...... ' ...... ON THE DAY TEST WAS PERFORMED, THE TANK gAS 101% FULL. TANK No. I TANKANDWATERDATAII PRODUCTDATA TANK SIZE 550 NRTERIAL ST CONTENTS WASTE OXL APl Sp. Gr. 28.6 TOTAL DEPTH 7'3 FILL LENGTH 30 TENPERATURE 73.3 APl ~ iS4)°F 27.7 TANK DIA. 43.00 STNID PIPE 30 COEFICIENT OF EXPANSION .4359 /lOOO NDH IN TANK 0 GROIJND NOH 0 PROOtJCT HEIGHT = [141.51¢131.5+APz)]*¢.O~6) o.0318 TEST HEIGHT = [TOTAL DEPTH + STAND PIPE] 103.000 FACTOR Lli] = TANK SIZE x COEFIClENT OF EXP. II O.2397 TEST PRESSURE = Nt.xt/t.-[Ht. of NOii*.036] 3.275 TEST CALIBRATION (if used) BEGIN 14 END 53 = 39.0000 BEGIN 16 END 53 = 37.0000 HELL No: N/A DEPTH to HOH GRND. ELEV: DATE NEASR: BEGIN 15 END 53 = 38.0000 NONITOR Y/N NONE NANUFACTURER CALIBRATION ReD .025 + 38.000 = 0.0007 NODEL TESTED Y/N FACTOR A ACURITE LINE TESTDATA LINE LEAK DETECTOR DATA PtJHP SYSTEN GRAVITY 14ANUFACTURER I~DEL No: HANUFACTURER ISOL. NECH: TEST P.S.I. SERIAL No: TEST LEAK RATE TINE BEGIN CYL. LEVEL OPENING TINE BOLDI#G P.S.I. TINE END CYL. LEVEL NETERING PSI RESILIENCY CONTRACT ENVIROIO4ENTAL SERVICE ' HORNER EZY-CHEK ] TANK TEST DATA SHEET CUST(]4ER: ECONO LUBE N~ TUNE #117 SITE: 2677 MT VERNON, BAKERSFIELD, CA 93306 DATE: 5-21-96 FAC'Tm r.A] .0007 ~ FACTOR Iai .2397 ! NET V0LUI4E START END GAII~ :::::::::::::::::::::::::::::::::::::::::: START END GAII~ LOSS- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: LOSS- ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 1815 35 33 -2 i::i::i::i::i::i::i::i::iii::i::ii~::~:.ii~;i ii?:ii .111 .114. O. 003 ,,,, ..... :,. -0.0021 20 33 3'1 -2 ::iiiiiiiii::i::iiiiiiiii::i~i~!i::~i::i::i O. 114. .117 O. 003 ::::i::iii::i::i::i::::iiiiiii::i::iiii::iiDi~iO00~i::i -0.0021 25 31 30 - 1 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: O. 117 .121 O. 004. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: .:.:.; :.:.:.:.: :.:.:.::.:,:,:.:,: :.:.:.:.:.:.:.:.:.:.:.:.:.:.~ 30 30 29 - 1 ::::::::::::::::::::::::::::::::::::::::::::::::::: O. 121 .124 O. 003 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: -O.O01& 35 29 28 -1 i?:i::ilili::i::ili::i::i::i::i~i~ii::~tit~::i::i 0.124. .128 0.004 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: -0.00'17' ... .......... .......... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: · ........................,....,.,..., ..., ............. 45 26 24 - 2 iiiiiiiiiiiili::i::i::i::i:;i~iDi!:.~(~i~l~i::i::i O. 133 .137 O. 004 iii::iii::iiiiiiiiiiiii::i::i::?:i::i!~i!i~:?i~iiiii: - O. 0024 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: *.-...*.-..............., :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ss 21 18 -3 iii!i~:i~:ii?:i~:i~:i~:i~:i::?:~ ~:.ii00 ~ ~i::i::i 0.141 .149 0.008 ?::::::?::::?::::?::?::::::??:?::: ::::: ::?::::::: -o.oo~o 1900 18 17 -1 ::i::i::i::i::i::i::i::i::iiiiiii~i0ii::Ooo~::?: 0.14.9 .~s9 0.010 :::::::::::::::::::::::::::::::::::::::::::::::::::::: -0.003'1 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ....................................................... os 17 is -2 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 0.1s9 .161 0.002 :i;.i~.i~.i~.i~.i~i~.iii::i::iiiii!i;:i!i;:(~!:oo ~s:.::::i:::: -0.00~9 10 1~ 15 0 ::i::iiiii::i::iiiii::iiiii::i::ii~ii~ ~:i::i:: 0.161 .1~ 0.007 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: -0.0017 MONITOR PERIOD RESULTS LEAKAGE INDICATED -0.02?8 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: TEST PERIOD RESULTS LEAKAGE INDICATED -0.0073 TEST CRITERIA PASS/FAlL II PASS STANDARD DEVIATION +/- .0006 PERMIT STATEMENT RECEIVED FROM ~--~Bakersfield Fire Dept. 1715 Chester Ave. Bakersfield, CA 93301 AMOUNT UST/AST PERMIT 82 STATE SURCHARGE 86 TANK TESTING 83 COPIES/REPORTS 89 by AMOUNT TENTS, LPG 84 - FIREWORKS, POWDER, 84 OTHER PERMITS OTHER FD1595 51217% el RECEIIR: ee23527: ~O~ItT ' ' s55,ee: 83 IU:I~ "~'~Uo ~Zb Uo{b ~U HAL 31Al ULt' t.q.d, uu>' BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 67- O%uO APPLICATION TO PERFORM A TIGHTNESS TEST FACILITY ~d'~r~ kube A/'~ ~u~%%~7 ADDRESS ~-~ '~0o~'~, ~/e~0-n PE~IT TO OPE~TE ~00( {6~ ~Eo3e ~ ~ OPE~TORS N~E~tQ~% ~,~J%o~ OWNERS N~E ~~ ~KqeJ;G~ ~BER OF T~KS TO BE TESTED [ IS PIPING GOING TO BE TESTED~ TANK# VOLUME CONTENTS TANK TESTING COMPANY C~-~ ,t ~vir~ne~W ADDRESS qlTbl ·EST ~ET~OD H<~¢t~ E%,~ C~¢ i~ ~ ! NAME OF TESTER,4~-o~;o _]) c, ~ '. -,-, c, ~, ¢~_ CERTIFICATION DATE'& TIME TEST IS TO BE CONDUCTED DATE SIGNATURE OF AP~L~I~ANT ate Underground Hazardous Materials Storage Facility Issued By: CONDITION: :::P: EVERSE SIDE · :::.., , -..::.:.: ::: : ::" .... · ...... . - ~... .':: .. '..: .::.:.'.' .::" :.' · :~::..'.' ".. ¥~.. "...."... ..:..:.' 1715 Chester Ave., 3rd Floor &eo~o ~.~ ~ ~e Bakersfield, CA' 93301 ~7 ~ ~~ (805) 326-3979 ~ k~ ~ ~O ~ Piping Monitoring Approved by: Ralph E. Huey, Hazardous Materials Coordinator Valid from: to:. 'I CITY of BAKERSFIELD "WE CARE" January 30, 1995 FIRE DEPARTMENT M. R. KELLY FIRE CHIEF WARNING! 1715 CHESTER AVENUE BAKERSFIELD, 93301 326-3911 CERTIFICATION OF FINANCIAL RESPONSIBILITY REQUIRED 2 i 5-~?.]00-001 i 85 ~CON[] LUBE N TUNE 2677 M"l' VERNON AV :E~AKERSF ];ELi], CA C43306 Dear Underground Storage Tank Owner: Our records indicate that your business does not have a Certification of Financial Responsibility on file with this office. Please forward either a copy of your existing State approved mechanism to show financial responsibility or else complete the attached Certification of Financial Responsibility form. An attached letter from the State Water Resources Control Board lists the approved financial responsibility mechanisms required to pay for corrective actions resulting from leaking underground fuel tanks. Remember, most tank owners only have to show financial responsibility for at least $10,000 of clean up liability. The Underground Storage Tank Clean Up Fund (USTCF) may be used as the mechanism to cover the remaining accidental release liability. The total amounts of financial responsibility required (check boxes from section A of form) are as follows: If you don't sell product from you tanks, and you pump less than 10,000 gallons per month, check "$500,000 per occurrence". Else, or if you are in the business of selling from your tanks, check "1 million dollars per occurrence". For owners of 101 or more petroleum underground storage tanks, check the "2 million dollar annual aggregate" box. All others need only check the "1 million dollars annual aggregate" box. Please be aware that failure to provide the financial responsibility document to this office within 30 days will result in your Permit to Operate being revoked. (25285.1 (b) California Health & Safety Code). If you have any questions, or would like help in completing the Certification of Financial Responsibility, please contact Howard Wines, Hazardous Materials Technician, at 328~3979. Sincerely, Hazardous Materials Coordinator REH/dlm ..... CERTIFICATION OF'FINANCiAL FOR 'UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM iA. _ .~ · '~1 million dollars per occurrence F:{ESPONSIBILII¥ I am required to demonsn'~te Financial Respousii~ity in the required amoun~ as specified in Section 2807. Ch~p~ 18. Div. 3, Tide Z3. CCR= [~"'] 500,000 doi]av~ per oecur~nc~ ~ ! million do.ara aa=.i a~resate or AND or f minion dollars annual (Hame ot Ta~t O~n ~r or Article 3, Chapter 18, Division 3, F/tie 23, California Code of Regulations. The mechanisms t.~ to demonstmm financ~l res~nsi~il~ as r~uir~ ~y Section 2807 aro as ~llo~: Note: If you are ~ing the ~ate Fund as any ~ ot your de~t~n official re~ib~(~ ~ur ex~n ar~ subm~n hereby certifies that it ~s in complianCe with the requirements of Section 2807, Fan'lit~ Name ,; Fn¢~i~Name Faci~ ty Name ~ required for each site. DOCUNENT iNFORNATION ':' A. Ammmt Recluirod - Check theappropriate boxes.. .B. TNSTRUCTTON8 ~. '. -_ .. ... , .. · CER.TZFIC,~TION OF FIN~NCI,~,L I~SPONSZBILITY FORM Please type or'print clearly att information on Certification Of Financial IlesPanSibility for~. lit UST facilities and/or sites owned or operated may bo listed on one form; therefore a.separate certificate is not Name of T~O,ner - Full naae of either the tank owner or the operator. orOp erator ~is~ Tp - Indicate Which State approw-d =hanism(s) are boing ueed to show finsncial responsibility either as contai~ in the federal r~ulations, 40 CFR, Part 280, s~rt H, sections 280.90 through 280.103 (Sue Finsnciat Rponsibility Guide, for mere information), ~r'Sect~on 2802.1, Chapter 18,0ivtsion 3, Title Pi, CCE. -. .~. #ame._.~_.._._of ~Issuer~_..~?:_,_._:' .~List_..~.~a[l names and addresses of companies and/or, individuals is~uing coverage. or fi~e n~r as indicated on bond or document. (If using State Cleanup Fund (state Fund) leave blank.) Covi~rNe Period - ,.C~rrective Action - ThirdParty-' FaciLity - lnfommtion Indicate amount of coverage for each type of mechanism(s). If more than one mechanism is indicated, total must equal 100~ of financial responsibility for each facility. Indicate the effective date(s) of at[ financial mechanism(s).. (State Fund coverage would be continuous as long as you maintain compliance and remain eligible to continue participation in the Fund.) Indicate yes or no. Does the specified financial mechanism Provide coverage for corrective action? (If using State Fund, indicate "yes".) Indicate yes or no. Does the specified financial mechanism provide coverage for · third party compensation? (If using State Fund~ indicate "yes".) Provide all facility and/or site names'and addreSses. Provide signature and date signed'by tank owner or operator; printed or t)q)ed n~ and title of tank owner or operator; signature of witness or notary and date signed; and printed or typed name of witness or notary,(if notary signs as witness, please place notary seat next to notary's signature). E. Signature Btock- Where to limit Certification: Please send originet to your local agency (agency who issues your UST permits). Keep a copy of the ~uestions: If yOU have questions on financial responsibility requirements or on the Certification of Financial ' Responsibility Form, please ¢ontmct the State UST Cleanup Fund at (916) 739-~475. Note: Ponaitiue' for Fmilure to r~mpi¥ with Fi~imi lies~,~ibility II~uir~mmonts: Failure to comply ~y result in: (1) jeopardizing claimant eligibility for the State UST Cleanup Fund, and (2) liability for civil penstties of up to $10,000 dollars per day, per underground storage tank, for each' day of violation ms stated in Article ?,.Section 25299.76(a) of the California Health and Safety Code. [de ,T..he PeOple Bksfld 1-805-835-'9493 '' Feb 08,95' 1'6.'~4 No.O02 P:02 i_ , . ,:~. ::' ,,' ' ;:I:~::~:: ...... ' .......... """~'.'::"~::"~';:'"'"" ':i~.d?%'"'"'~',i:''''' "!~ "~ ' ~:"¢".-'-,,;::::.,.,':'. ' .:.. ";'. ......... "' '~. ', "' . ~.',',,.: ~.' ', ...... F::::.: ............ :../.:.:, ';' , . . - ..... , .... ......... ..... i¢,, ~. , , . .':' .:,. . . , : ,.,' CON]F~R! NO RIGHTS UPON THg C{~RTIFICATE ilOLDI~, TIHI{ CERTi~C&TE x ,~R&#Ce StRWCES DOF~OTAMEND, EXTEND OR ALTER THE COVE//AGE AFFORDED BY THE :' I,'l?OO E. COPLEY DRIVE, #100 POL[CIE~BELOWo - · IDIAHOND liAR, CA .............. . ........ ' ..... ' : 'I?~'~.' , ......... ..' _ co~m~ ~o~. ~ cov~e· ...................... . :'",~;';~'"~ .................................................... . ...................... ..... [~ .... . ..................................... ; ~,,_,,,~ ~¢~ -,~_s · IfmNO Um #~:'~ruNe co~Po~'rE i ......................................................................... ' ......... . ........ [ATT#~ C#RISTINA ~H[ . · O~ll,,~Y ~ ._.-' · [~911 illR¢ll STREET . ' ; UnTi~ '"- ' .... - INE~T BSACH,, CA ." .............................................................................................. r: .......... . ..... iL~rrn .... i .............. i ! D,',~(M~/Y'.O ..*~(mvo~'v-,,) : Lum~ ................ i .................... · .....iiiiI Ii I ,.,..~.,'; ............... - ! ~ i ~'a~~~!' AO0. ,1 ~..'::::-.,.',,~ :cua4s~um: ' oc, ct~,: . :. f~,'~;;;..g, ~;,'~;;;;; ....... ~ ............. .......... ow,n"~,, m,'r~c,mr~ ~oT : . :~ ~ 'i~"-' ~ .................................... :~ .......................... ~ ' ~ ,: , ............... ........................... ; i ! ;m'~'~;:~'~'"'"'i~ .......... ."""'....... -.. : AUI~'.'.~Z'.~Lll IJalrll.~y .......... T '~ : : ............. * ........ :'--' : .... : ; :~~ ~* · ~u~ ': ~ ~~~__, ....... ..... ..~._.~;~_ ~ "._. ~. .... . j',~'~,','/,'.7.'}~.'.!/.' ...... A ;~LLUTI~'-' . UGT ~657 *. ~ 07t20/9~ : 07/20195 ?' 1,0~,0~ . EACH LOl~/ $500,0~ DEFEH~ ~T$ LIKIT . . - ' . IN THE E~NT OF N~PA~NT A 10 DAY NOYICE OF ~N~L~TI~ WILL ~EflCEbE. ~' * PR~F PROVIDED FOR2 SITE J117~26~ HT. V~RgOH, ~RSFIG~ ~ 9~06 * , ' ........ ..... ,:.,,,~.,:.., ,.,:,,, ..~.:.:::.:,:.:.:.:.:,:...~.:..:: ................. .~,,.:~,**,*,:.:......:,: .:,,,.,..:~.`~.~`.~:.`:.`:~:.:~:.:.:~:~¢:::~:..~`~:::~:~:::.:::.:::.~.~:.:::.:.:.~:~:~:.~.:.:~::~:.:~:.:~::::f:~:/*:'::~:~:::~:E:~*~:~:.:~:.:~2~¢*:*R`~ ............ .. ,.,:...~ · { ~ ~o~ Dam ~, ~zss~o m~.~ ~voa ~ ,, ...................................... ~ .,,.~. ;..;.~; ............. , ..... . ~ , . .....%~..~ ................... ~ I. - - , ' ' " ' ..~,,:~,,~.2'~;2.~: :~>~:'.~,..:..~ ,,.,,,,,,,.,.:¢,~.,..::..E:':::':';:~E'}'~, '¢'. ~:.:.:::4,~,.:...:..,.,.:,.,,:,:.::.,:,.*:::::.;¢~:;<::.;::¢~ .,,.,, ,~, z:w.;;: :::~:a:*~:::~::$~a:¢:;¢:~:¢::~:;¢~i~,,,..: ........... :..' ........ ' ............. :'": ............... ~ '" ~.~:~1~.:.:~..: .............. ~:'.~::: :'-'.','-','-:'~.?::'.':'~:',~'.,.:...~: ............... :.,~:=,~'~..'**~.:.:*:.:;::.::~:.::=.~.:: BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 1715 CHESTER AVE., 'BAKERSFIELD, CA (805) 326-3979 93304 APPLICATION TO PERFORM A TIGHTNESS FACILITY PE~IT TO OPERATE OPERATORS NAME N~SSa OS Tm~r~S ~0 ADDRESS OWNERS N~S .~~ IS PIPING GOING TO'BE TESTED~_~ TANK~ VOLUME I ~o ~ CONTENTS ~..64-&~---~- OiL TANK TESTING COMPANY .~.,Tt.u~c.~a ADDRESS TEST METHOD /~oK/-v.~u,~ ~7-y C~-~ / N~E OF TESTER ~o~,o CERTIFI~TION ~ STATE REGIST~TION ~ ~--/ g~ / ~s ~ ~ ~s~ ~s ~o ~ co~uc~n ~-/3~?~ 0 --/~-7/ SIGNATURE OF L~ SERVICE 360 EAST KING~ POMONA, CA. 91767 714/623-4400 By. TEST CERT I F I CATE CU~: GARY'S ECONO LUBE N, TUNE PHONE: 805/872-5770 (ADDRESS) 2677 MOUNT VERNON CITY: BAKERSFIRI~ STATE: CALIF. ZIP: 93301 LOCATION ADDRESS: SAME 'PHONE: CITY: STATE: ZIP: TEST REQUESTEDBY: NAME: HECTOR DATE: 1/21/92 ITEM OR SYSTEM TESTED TANK ID# CAPACITY TANK TEST TANK TEST LINE TEST LINE TEST LEAK RESULTS- GAL/H ~TS- GAL/It DETECTOR P/F P/F P/F #1'WASTE OIL 550 GALS PASS -.0318 N/A N/A N/A REMARKS: THIS IS TO CERTIFY THAT THE ABOVE TANK(S) AND ASSOCIATED PIPING SYSTEM(S) ARE "TIGHT" AND MEET THE CR~IA ESTABLIS~_~BY~ ~A PAMPHI~f~29. OPERATOR~~~-~ ~~.~~'~.,~ LICENSE # 91-1440 II , 1,/2~/92 ~1 CONTRACT E~NMENTAL 4055 GUASTI RD, #102 ONTARIO CA, 91761 SERVICE (909) 460-6020 1-800-554-3458 . FAX (909) 460-6016 CLIST(~IER: ECONO LUBE N' TUNE DATE: 02/09/94 TINE: BILLING 2677 MOUNT VERNON SITE ADORESS: SAME ADDRESS: BAKERSFIELD, CA. 93306 1900 HRS CONTACT PERSON: INSTRUCTIONS: HECTOR PHONE: 805/872-5770 TANK No. i TANK AND WATER DATA PRODUCT DATA TANK SIZE 550 GAL MATERIAL STEEL CONTENTS WASTE OIL APl Sp. Gr. 28.5 TOTAL DEPTH 72.5 FILL LENGTH 30.5 TENPERATURE 60.5 APl g 60°F 28.3 TANK DIA. 42.00 STAND PIPE 25" COEFICIENT OF EXPANSION .4381 /1000 HOH IN TANK N/A GROUND HOH 0 PRDOUCT UIEGHT = [141.5/(131.5+API)]t(.036) 0.0318 TEST HIEGHT = ['rOTAL DEPTH + STAND PIPE] 97.500 FACTON [BI = T.q~IK SIZE x O:)EFICIENT OF EXP. 0.2410 TEST PRESSURE = Ht.x Ut.-[Ht. of HOH*.0~6] 5.101 TEST CALIBRATION. (if used) BEGIN 43 END 70 = 27.0000 BEGIN 27 END 52 = 25.0000 I~LL No: DEPTH to HOH GRND. ELEV: DATE MEASR: BEGIN 20 END 48 = 28,0000 MONITOR Y/N MANUFACTURER CALIBRATION ROD .025 + 26.667 = 0.0 0 0 9 NOOEL TESTED Y/N FACTOR A ACURITE LINE TEST DATA LINE LEAK DETECTOR DATA PU~P SYSTEN GRAVITY MANUFACTURER HODEL No: MANUFACTURER ZSOL. NECH: TEST P.S.I. SERIAL'No: TEST LEAK RATE TIME BEGIN CYL. LEVEL OPENING TINE HOLDING TIME END CYL. LEVEL NETERING PSI RESILIENCY CONTRACT ENVIRONMENTAL SERVICE 4055 GUASTI RD, #102 ONTARIO CA, 91761 909-460-6020 800-554-3458 TEST CERTIFICATE CU~: ECONO LUBE N' TUNE PHONE: 805/872-5770 (ADERRESS) 2677 ~,'T V'~P~ON CITY: BAKERSFI-~ D STATE: CA ZIP: 93306 IDCJkTION ADDRESS: SAME PHONE: CITY: STATE: ZIP: TEST RtgQUESTED BY: HEC/OR DATE: 02/09/94 ITEM OR SYSTEM TESTED TANK ID# CAPACITY TANK TEST TANK TEST LINE TEST LINE TEST LEAK RESUIR~- GAL/H RESUL%~- GAL/H DETEC/OR P/F P/F ~/F #1 Wk%~FE OIL 550 GAL PASS -.0248 N/A N/A N/A P~: r~is ts ~o C~F~ n-~T r~m ~ovE T~'~(s) ~-D ASSOC~T~D ~I~G SYST~(S) 02/09/94 CONTRACT ~NMENTAL 4055 RD, #102 ONTARIO CA, 91761 SERVICE (909) 460-6020 1-800-554-3458 FAX (909) 460-6016 Bill To: ECONO LUBE-N-TUNE #117 2677 MOUNT VERNON BAKERSFIELD, CA 93306 Date Invoice 16 Feb 94 9402042 BALANCE DUE: 22 5.00 PO Number Terms Project Due on recpt Quant ity Descript ion Rate Amount 1 TANK INTEGRITY TEST(S) 170.00 170.00 1 PERMIT FEES 55.00 55.00 Thank you for your business. TOTAL: 225.00 BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST ADDREss ~g 77 PERMIT TO OPERATE OPERATORS NAME NUMBER OF TANKS TO BE TESTED . OWNERS NAME ~. is P~PI~ ~i~ TO' BE TESTS. D~:S~'~"tO :i TANK% VOLUME CONTENTS TEST ~ET~O~ 7'~-/-/! °/-.~/C ~,~E OF TESTE~'~,~S 'T?/,g,'ck,'~',~E~TZFIC~TZON ~ 9'1-- STATE REGISTRATION % DATE & TIME TEST IS TO BE CONDUCTED DATE SIGN~ATt~ OF APPLICANT COI'g-fl:i/~CT EIq-~r I ROi",llVlF-NTA 1 . SERV I CE 360 EAST KINGSLE$ POMONA, CA. 91767 714/623-4400 INVOICE -DATE: 01/21/93 CUSTOMER: ADDRESS: CI'I~f: GRAY'S ECONO LUBE N' TUNE INVOICE NUMBER: 2677 MOUNT VERNON 93-01002 BM<W_tkSFIELD STATE: CALIF. (~ST. P.O.: VERBAL PLEASE ACCEPI' TtiIS INVOICE FOR SERVICES AS SHOWN BELOW: JOB LOCATION: SANE UNIT EXTENSION DESCRIPTION 1 1. TANK INTEGRITY TESTS ] 1 EA. I 170.00 2. PRODUCT LINE TESTS 3. LINE LEAK DETECTOR 2~STS I FA. 55.00 .t70. OO Ii 4. OTI{ER (SPECIFY) TELSTING PERMIT # ELF-0085 I PLEASE PAY TF~IIS AI~O~ OO TERMS: INVOICE IS DUE UPON RECEIPT. A SERVICE CHARGE OF 1. t % PER ~DNTH CHARGED ON ACCOUNTS OVER 30 DAYS. SITE AND INVENTORY AUDIT ECONO LUBE N' YUNE 2677 MOUNY VERNON BAKERSFIELD, CA. SI?E: SAME ADDRESS: LOCATION: P O O REMARKS GENERAL :~P?~ARANC= TANK AREA VENT PIPE & AREA DISPENSER AREA OVERFILL CONTAINMENT MONITORING SYSTEM ELECTRONIC-TYPE/MODEL LiHES ~4ONITORING HELLS LINE LEAK DETECTORS iNVENTORY CONTROL MONITOR HTICK READINGS TANK CHART DISPERSER READINGS FREQUENCY RECORDS KNOWLEDGE OF REGULATIONS SAFETY EQUIPMENI FIRE EXTINGUISHER(S) EMERGENCY SHUT OFF REMARKH: ZX xx CUSTOMER: ECONO LUBE N~ TUNE ENVIRONMENTAL SERVICE TEL-A-LEAK TEST SYSTEM TANK TEST DATA SHEET SITE: BAKERSFIELD DATE: 1/21 MONITOR PERIOD RESULTS TANK NO. 1 ~ACTOR A I ,oo16,I ~ACTOR ~ .2~88 PRODUCT LEVE~ ~EASURE TE_~PE___~ATURE CO~PE, NSATTON TI~E ST~T END ~ ST~T ~U~ ~ 11 ~fl I 1810 ~0 28 -i2__._ -0,0168 0.536 ,5~4 O,0N 0,0067 1816 __ ~8 11 -17 ] -0.0238 0,564 ,580 0.016 0,0038 1822 55 46 -9 -0,01,26. 0.580 ,586 0,006 0.0014 -0.0140 1828 46 42 _ -4 -0,0056 0 · 58!__~ ,591 0,005 0.0012 i834 66 56 __ -10 -0,0140 0,59i .596 0,005 0.0012 -0,0152 ,i8.40~ 56 47 -g -0.0126 0,596 .... ,601 ~,005 0,0012 -0,0138 1846 47 42 -5 -0,0070 0,601 .60~_ j,O0~ 0,0012 -0.0082 i852 42 38 -4 -0,0056 0,606 ,6!1 0,00~ O.O01l ,., -o.oo6, L m !858 71 m~ ~9 -2 -0.0028 0.611 .614 0,003 m ]m0'0007 -0.0035 MONIIOR PERIODm RESULIS LETHE INDICATED m TEST PERIOD RESULTS TANK No. 1 TIME II I+ {{+/-CHANGEGAL III I I e 4H.+ {! II I I III I I !904 .... 69 66 .[l -3 -0.0042 0:614] l~ '615 0.00i 0,0002 !91~ 64 63~ -1 -0.001] !=6~7 .618 0.001 0.0002 1922 63 $1 -2 -0.0028 {_ 0.$18 ,620 0.002 0.0005 ........... s~J~.~__ 19~4 59 57 -~ -o,oo2~ 0.623 .~z~ ___O.=~o~_ o,ooo7 -o.oo3s 1946 55 54 -! -0.0014 ~=.!.~ ........ ,633 .......... ~=!.02_ !.000! i952 54 53 -1 -0,0014 ~_ :[~! ......... .~ .......... !=~.~J ............. O=~.~J._" 0.634 ,636 0.002 0.000S -, , -o,oo4:~[ 1958 53 I Sm0 ~H~ ~ m ~ ~ ' TEST PERIOD RESULTS LEgAGE INDICATE TE~_~I~¢~IA ]}- PASS STANDARD UEVIATION +/- COI~[IYL~CT EbB~IROb~]~.brrBI- SERVICE 360 EAST KINGSLEY 714/623-44OO TANK DATA SHEET CU$'I~: E(2DNY) LUBE N' TUI~ Di~ 1/21/93 BILLING 2677 ~ VF~N SITE ADDRESS: BI)DRESS: B~FIEID, CA. TIME 18OO CONTACT PERSON: INSTRUCTIONS: HECIYDR PHONE: 805/872-5770 PERMIT = (Ti~ CHECK) 99 TO HWY 178/ROS5I~ HWY, 3 TO 4 MILES TO MT. VF_~N EXIT. TUI:hN LF_~. CAN SEE SIGN FROM HWY 178. TANK No. 1 TANK AND WATER DATA Il PRODUCT DATA SIZE 550 TOTAL LENGTH 73 ,n.. DIA, 43,0 H0H iN TANK N/A HATERIAL STEEL CONTENTS '~ASTE OIL API SD. Gr. 27.5 ,, TEST HIEGHT: = {TOTAL LENGTH + STAND PIPE} TEST PRESSURE = Ht.~ Wt,-(Ht, oi HOH*,036) PUMP SYSTEM: NONE WELL Ito,: DEPTH TO HOH: GRND. ELEV.: DATE MEASR,: BEGIN TEST CALIBRATION ( if used) TANK COVER: ASPH/CONC 32 BEGIN 25 COMMENTE: NEED PERMIT FROM BAKERSFIELD FIRE DEPT. BEGIN 13 , PE,~IT ~ BT-0085 SEND RESULTS TO FIRE DEPT. CALIBRATION ROD TO [ 49 TO t 44 , ,TO_ 18,3333 17.0000 19.0000 19,0000 FACTOR A COMTRACT EHV]RONI4E#TAL SERVICE NORNER EZY-CHEK TANK TEST DATA SHEET CUSTDMER: ECONO LUBE N'TUNE #117 SITE: 2677 MT. VERNON-BAKERSFIELD DATE: 02/09/94 HOH'J:TOR PRRZOD RRSULTS---TAHK FACTOR IAI · 0 0 0 9 I FACTOR lei .2 410 NET VOI..IJ4E START END GAIN+ ::iii?:i ifil?GM: [i:3N S :! :: :::: START END GAIN+ LOSS- LOSS- :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: i ~ilif:f:f:f.i?jll :: f:i iiii :: ::::i :: :it i:: :::::::::::::::::::::::::::::::::::::::::::::::: 2021 25 25 0 :::::::::::::::::::::::::::::::::::::::::::::::::: .649 .663 0.014 i:.i::iJ :.::!:::.iJjJ i:.i:::::.! i 0]~ {:)034::!?: -0.0034 :: :::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::.:.:~ ============================== ::::::::::::::::::::: :::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::: 26 25 27 2 ::::::::::::::::::::::::::::::::::::::::::::::::::::: 0.663 .677 0.014 :: :: i :: :: :: :: :: i :i?:ii::/: :.iiiiiOi200 ~if.! -0.0016 :::::::::::::::::::::::::::::::::::::::::::: :: 31 27 27 0 i~ii::i::i::::f ii :? 0 !0000 ~: 0.677 .691 0.014 ii;: ii ! ;:: :.~ ! 0:037; :.:: -0.0034 36 27 28 1 o. 691 . ?os o. 01 ~ ;:i bi~i~3~i - o. 0025 41 28 29 1 : i ?:f:f:~i :?~ ~0:~:0009: ~ O. 705 .719 O. 014 :'iiii i :0~ Oi~3:~iiiii - O. 0025 /,6 29 30 1 0.719 .732 0.013 ::;!:::'::i..:':0'~00317: -0.0022 51 30 30 0 0. ~2 .74. S 0. 013 ':' 0:210031 iii -0. 0031 ~:::::::::::::::::::::::::::::::::: ~ ::f.::f:iill i':~i:::::::::::::::::::::::::::::::::::::::::: 56 so 28 -2 ; ~::::i:::.:.~: ~: -:0;00:~8 ~:: o. ;'45 . ?s? o. 012 2101 28 23 - s ~ i:i::i:.:ii::i::ii~::::i~io :00~S ~?:: o. ~57 . ?68 o. 011 :.i::ii ?:? ::::.i:::.O~0027 i -0.0072 ,:.;::: ::::: .:.:.: ..: :: .: ... :.:: .::: :.:'.:: : :. :::: ::: ===================== :::::::::::::::::::::::::::::::::: 11 25 24 - 1 : i i!::::::i:: ::i i ?:0 :: 0009: ii: 0.779 .789 0.010 ih::; ::ii: i :::~0'~ 002~ii:.i-0.0033 ?t~?:::~i::{i:.::: :.:.i::i~: ::~: ~: ~:; ~:~: ::~f: ::::::~ .... 16 24 30 6 ::::i i::i::iii~iii::::i~!iii0?005'~ if: 0. 789 .799 0.010 :::::::::::::::::::::::::::::::::::::::::::::: 0.0030 MONZTOR PI~.lq. ZOD RESULTS I'.~..AI~AGlq T~DIOATED -0 · 03'18 TRST I"'RR,I:OI:) RRSULT8 TINE START END GA/N+ START END GA]N+ ?::EXpANSX~ ::: NET VOLUME LOSS- iiiii:~i ~:. G~LijONS:! i LOSS- !!ii!~i~T:[ON ~i::i::i CHANE 2121 30 31 1 ::::::::::::::::::::::::::::::::::::::::::::' '" "000'~? :: .799 .808 0. 009:':':" ' i::';;:: 0~0:02:2iiii -0.0013 26 31 30 -1 ::!::ii i i!::'?ili:?.Oi' O:e0:9:! 0.808 .817 0.009 :::::::::::::::::::::::::: -0.0031 [:!!!!!:: :!:ii[i!'::iiii: ',i :: .:: : i :: : .: :[: :':" : ::: :"" ;' 31 30 28 '2 ii :;i i?01:'0018::::0.817 .827 0.0~0 i'::i"':i:i::': d:i:bd2:~i:::i~i -0.0042 36 28 28 O, :::!:il :i ::~:'~:00001 0.827 .836 O. 009 i: :::: :.:ii:i :" ': :~:i!db~ iiii -0. 0022 ':?;.:::.::::: :::::: ::: :: 41 28 28 0 ?. ::.f:f:f:f.~i~:i:iO:~O000 : , 0.836 .845 0.009 ::!~::::: i..:.:0~0022:::. -0.0022 46 28 28 0 i::ii i :.::::iiii:ili!~ ~:0 ~ 0'0 0.845 .854 0.009 -0.0022 51 28 26 -2 :::::::::::::::::::::::::::::::::: 0.854 .862 0.008 ;ii0100:i9; -0.0037 56 26 29 3 f:f:? ?:i?:f:f:f.f: ::i0 ~:002 ?:?: 0.862 .869 0.007 f:ii i~: ii:::i:i:. ~: :.i::::012100 l:?~:if: 0.0010 2201 29 27 -2 !!:::::! ! ~:b~! 00i:8 0.869 .877 0.008 :.fili::i ::/i ii:: :i:0: 00 ;i:.9 iiii -0.0037 :~: ?::=::::i i ~i.:i.::::i;i:i :::::::::::::::::::::::::::::::::::::::::::::::::: ....... 06 27 26 -1 ililil ii?:iiiii:?.0:00og:.::.: 0.877 .885 0. 008 i= ::i:.i i: : :;::' i:. i:i!~:i0:~ 00:1:9=i::::] -0.0028 ~1 2~ 28 2 ~ i~:i~:?i~ :: ~::?~i ~: d'ii:bb ~:d:: ::: 0.885 .892 0.007 ::i:: !:~::.i: ::.~: io~!iOo~i;~::: 0.0001 :: i::i:.: :ii::: :::::iii ':.:::: ::: : ii i:i:i:. :i.::- i::..:: ::: 16 28 29 1 i ij:.::::::j j:= J] i 0 ~ 0009:1 0.892 .898 0.006 ::ii:.. i!:::::i::::: :0 :.!00 i ~.!:)i: -0.0005 TIqST PERZOD REBUT,TS T,I~.AKAGE ZNDZCATleD -0.0248 TEST CRITERIA PASS/FAIL II PASS STANDARD DEVIATION +/- II ~PR--~?--9~ ~ED ~8:49 .Contract Env i ronmen~ll 9~9 46~ '~16 P. ~1 CONTRACT ENVIRONMENTAL 4055GU~TZ ~,#102 0~T~I0 ~,91761 909-46G-6020 800-554-3458 COMPANY/AGKNCY CONTACT NAME: APR--2?--94 WE~ ~8:5~ Conm~c~ Environmental 989 460 4.~,i~ .... P. ~2 CONTRACT ENVIRONMENTAL SERVICE '4055 CaJASTI RD, #102 CANTAI~IO CA, 91761 909-460-6020 800-554-3458 TEST CERTIFICATE ciTY: ~ES'T RE~3ESTED BY: EC0NO IlJ~ N' TUNE 2677 ~ VERNON BAKERSFIEID STATE: CA ZIP; 93306 SAME FAGNE: STATE: ZIP: ~%.mE: 02/09/94 #1 ~ OIL 550 GAL PASS -.0248 N/A N~A NZA THIS IS TO CERTIFY THAT THE ABOVE TANK(S) AND A~S~J%T~D PIPING SYSTf~(S) ~ TH~ CRI~E~_ ESTABLISHEp BY THE NFI~A 0PERA~_, !~'4 ~ ~ ~~ ~ ~i~Ti I~ 02/09/94 APR--2?--94 WE~ 08:50 Con~r~¢~ Environmental 909 460 4016 CONTP2%CT ~-NVZRONtL~NTAL 405§ ~ RD, %102 (~T~ARIO CA, 91761 (909) 460-6020 1-800-554-3458 ' F~ (909) 460-6016 P.03 CUSTONER: ECONO tUBE Ii' TUllE DATE: ' 02/09/9& BILLING 2677 lqCU#T VER#OW SITE ADDRESS: 1900 HRS CONTACT PERSON: HECTOR PHONE: I#$TRUc~I~S~ TAN]{ No. I TAJi~ SiZE 550 GAL NATERIAL STEEL J'YI~TEBTS L t, JASTE OIL APl Spo Gr. 28.5 TOTAJ. DEPT, 72.5 FILL LENGTII $0.5 TFJ4PERATUP~ 60.3 APl ~a 6G'F 28.3 TANlc DIA. 42.00 STAND PIK 25" COEFZCIENT OF EXPANSICI~ .&~81 /1000 JlOil IN TAN[ N/A GiKIJND BOll 0 PJKIXJCT WIEGHT; [141.5/C131.5+API)]'(.036) 0.0318 TEST HIEG#T - CTOTAL DEPTH * STAND PIPE] 97.500 FAC:TtR [BI = TANK SIZE x C~FICIEIIT OF EXP. 0.243.0 TEsT P~$~URE = #t.x Ut.-[#t. of HOH'.03~I 3.101 TEST CALIBRATION (if used) BEGIW 43 END 70 = 27.0~ B~GIN 27 ~ 52 -- 25.~C)00 I~LL Ilo: D~PTIi to GEl). ELEV: DATE NEASR: BEGIN 20 END 40 [] 20.0000 ii , 14GIJITOK yl# NAIdUFAC'rUREJl CALIBRATIOII RCO .OrS -t- ~6.667 ~ O. 0009 GEL TESTED Y/N FACTQE A ACUI{ITE LINE TEST DATA LINE LEAK D~TECTOR DATA Pt.lqP SVSTEIq GRAVITY 14,10~FACTi~ER GEL No-" NAHUFACI"U~ER ISOL,. NEC:H: TEST P.S.I. SFJ~IAL Ko: TEST LEAK RATE TIHE BEGIN CTL, LEVEL (]FEllING TIRE I~ING P,$.I. TIRE EiLO CYI.. LEVEL NETEI~ING PSI RESILIE.CT APR--2?--94 WE~ 88:51 Contr~¢~ Environment~! 989 468 4016 COliTBACT 1~I4VI I~OIt~IITAL T~IIIC TEST OA'fA S#EET ECONO LUI3E #'TUNE #117 SITE: 267'? 14T. V~R#CM-SAIC£K-qFI£LB DATE: 02/09/94 II III II III I II IIIg II_ _ I ~...-L....., ........... i II II I I Il~ I II t I III I IIIIIIII r I III IIII I I I I TRST }RILTC~ I~SULT8 im ii II : :~.;'~ ,: ~.:..:..::,,:. VA'~:': ~.~ ',:..' :,}~,%,~.:~.,~;~ .: .~, ~:~,~ ~ ,..,.,:. .................. ,., TE~T PERIOD ~EBULT8 LEA~OE INDICATED -0.0248 TEST CRITERIA PA88/FAZL ~ P~S 5T~D~ DEVIATION +/- .0016 02/09/94 2130 .G ~ee~, ~ake~s~$eld, ~ 93301 (80~) 326-3979 A~PLICATION TO PER~0RM A TIGHTNESS TEHT OPERATORS NAME NUMBER OF TANKS TO BE T~ST~D__ IS PIllING GOING TO BE TESTED TA~K# VOLU~E , CONTENTS TANK TESTING COMI:~A-NYA"~,,'t ra~u~/.~,,tae. AuDRESS_~+c., v-,'c~; C,~ ._ q! 7~/ ~ost-W' brand fax transmittal memo 7671 / IphOne f/ · . FIRE DEPARTMENT S. D. JOHNSON FIRE CHIEF. CITY of BAKERSFIELD. "WE C.4RE" January 26, 1994 2101 H STREET BAKERSFIELD, 93301 326-3911 Mr. Hrant Mikaelian Econo Lube N Tune 2677 Mt. Vernon Bakersfield, CA 93306 RE: Monitoring requirements for underground Storage tanks. Dear Mr. Mikaelian: Our records reveal that no. precision tank testing has been performed on your underground storage tank located at 2~77 Mt. Vernon. Section 2643 2(A) of Article 4; Title 23, Div. 3, Chapter 16, CCR., requires that all underground tanks that do not utilize automated leak detection shall have a precision tank test annually. Please make arrangements to bring the tanks into compliance with state law. If you have any questions, please call me at '(805) 326-3.979. R~l~t:>h ~. H~'-"-' -Hazardous Materials Coordinator Underground Tank Program BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST OPERATORS NAME NUMBER OF TANKS TO BE TESTED OWNERS NAME ~s ~N~ ~0~N~ TO'SE TESTED TANK~ VOLUME CONTENTS .I 5'£~ ~ , TEST METHOD NAME OF TESTER~,u~$~,~,'Ck~ERTIFICATION ST~TE ~E~STRAT~ON D~TE ~ T~E ~SST ~S TO SE C0N~UC~ED ~/~Z/~$ !~~ CITY of BAKERSFIELD "WE CARE" FIRE DEPARTMENT ' S. D. JOHNSON · FIRE CHIEF January 26, 19'94' 2101H STREET BAKERSFIELD, 93301 326-3911 Mr. Hrant Mikaelian Econo Lube N Tune 2677 Mt. Vernon Bakersfield, CA 93306 RE: Monitoring r~equirements for underground storage tanks. Dear Mr. Mikaelian: Ou.r records reveal that no precision 'tank testing has been performed on'your underground storage tank located at 2~77 Mt. Vernon. · Section 2643 2(A) of Article 4; Title 23, Div. 3, Chapter 16, CCR., requires that all underground tanks that do not utilize automated leak detection shall have a precision tank test annually. Please make arrangements to bring the tanks into compliance with state law. If you have any questions, please call me at (805) 326-3979. Sinc, p~rely, ,/ ~ph ~. H~,~ ..... - Hazardous Materials Coordinator Underground Tank Program FIRE DEPARTMENT S. O. JOHNSON FIRE CHIEF CITY of BAKERSFIELD "~FE CARE'" i /:z%/ . Ap~iz ~-a, 1993 2101 H STREET BAKERSFIELD, 93301 326-3911 xxXxxxxxxxxxxxxxxxxxx ¢h~:. 14r¢c,,~'r /~'~;k¢,¢1 ~,~,~ XXXXXXXXXXXXXXXXXXXXX 'e-6 ?'"f m~- XXXXXXXXXXXXXXXXXXXXX 5~~1~ j C~ ~%~0_ .XXXXXXXXXXXXXXXXXXXXX RE: Monitoring requirements for'underground storage tanks. Dear XXXXXXXXXXXXXX: ~D~, Our records· reveal that no precision tank· testing · performed -on XXXXXXXX~undergr. ound sfiorage tank~ located at XXXXXXXXXXXXXXXX. ~? ~+. Section 2643 2(A) of Article 4; Title 23, Div. 3, Chapter 16, CCR., requires that all underground tanks that do not utilize automated leak detection shall have a precision tank test annually. · a~so have t~ be ~==t~f~ed t~ ~- ' ..... '-' ..... -~=~==~-- ~ ............ 1 Please make arrangements to bring the tanks into compliance with state law. If you have any questions, please call me at (805) 326-3979. Sincerely, Ralph E. Huey Hazardous Materials Coordinator Underground Tank Program UNDERGROUND STO~I~E TANK INSPECTION ~i.!i ~l~ersfield Fire Dept. , ' Ha~ous Materials Division Date Completed /.//~?z7~ . Operating Permit: ///o,~' Business Name: /'c..~,,,,~ Z,d:~ /v Location: ~.('~ 77 /33 ~. V~.-,~,,-. Business Identification No. 215-000 Number of Tanks. I Type: Containment: =~?, ~,.,~A[~ CONTACT. INFORMATION (Top of Business Plan) Lines: G~,~'~ / F~ 7~ -~5-77~ Emergency Contacts: Monitoring Program Adequate Inadequate RECORDS Maintenance Testing Inventory Reconciliation RESPONSE PLAN Emergency Plan 0/<-. White - Haz Mat Div All Items O.K. Correction Needed Pink, Business Copy PERMIT TO OPERATE UNDERGROUND HAZARDOUS STORAGE FACILITY Permit No.: 1165 State ID No.: 1165 Issued to: Location: ECONO LUBE N TUNE 2677 MT. VERNON AVE. BAKERSFIELD, CA 93306 Operator. ECONO LUBE N TUNE INC. 4911 BIRCH ST. NEWPORT BEACH, CA 92658 JAMES COLLINS 2677 MT. ,VERNON AVE, BAKERSFIELD, CA 93306 Facility Profile: Year Tank No. Substance Caoacit~ Installed 1 WASTE OIL 500 GAL 1987 YES This permit is 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 Issue Datei JULY 1, 1991 Expiration Date: JULY 1, 1994 POST ON PREMISES NONTRANSFERABLE BAKERSFIELD FIRE DEPARTMENT , HAZARDOUS MATERIAL DIVISION PERMIT TO OPERATE UNDERGROUND HAZARDOUS STORAGE FACILITY Permit No,: 1165 State ID No.: 1165 Issued 'to: ECONO LUBE N TUNE Location: 2677 MT. VERNON AVE'. BAKERSHELD, cA 93306 Owner: Operator: ECONO LUBE N TUNE INC. 4911 BIRCH ST. NEWPORT BEACH, CA 92658' JAMES COLLINS 2677 MT. VERNON AVE. BAKERSFIELD, CA 93306 Facility Profile: Tank No. Substance CaPacitY, 1 WASTE OiI, 500 GAL Year Installed Is Piping 1987 YES This permit is 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 Materials Coordinator / Issue Date: JULY 1, 1991 Expiration Date: JULY 1, 1994 POST ON PREMISES NONTRANSFERABLE Bakersfield Fire Depi~ HAZARDOUS MATERIALS DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3970 I. FACILITY/SITE UNDERGROUND TANK QUESTIONNAIRE. r~ ,~t)o)?. HA7. ~' D~V. /~_~AClLIIY NAME .' / ' ~ NAME OF OPERATOR ~ J// ' I ~ "~ ~ ~ -~;- :'~ - ~~ "- ~ /~ I PARCEL No.(OP~ONAL) I 77, ~1~ E '-- / ~ ~'7 "~ ..... STATE ZIPCODE ~BOXTOINDI~TE ~CO~ON ~INDIVIDUAL ~PA~NERSHIP ~[~ALAGENCYDIS~IC~ ~COUN~AGENCY ~STA~AGENCY ~FEDE~LAGENCY [~3 FARM [~ 4 PROCESSOR Q5 OTHER TO OPERATE No. EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) optional DAYS:_.NAM~(}~A/ST. FIRST) PHONE No. WITH AREA CODE ' t .DAYS: NAME (LAST. FIRST) PHONE No, WITH AREA CODE NIGHTS: N.A.ME (LAST, FIRST) PHONE No. WITH AREA CODE ~?~/ I .NIGHTS: NAME (LAST, FIRST) PHONE No. WITH AREA CODE II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION ~' BOX J~ INDIVIDUAL TO INDICATE [~ PARTNERSHIP III. TANKOWNER INFORMATION (MUST BE COMPLETED) NAME CARE OF ADDRESS INFORMATION MAILING OR STREET ADDRESS LOCAL AGENCY J~STATE AGENCY [~ COUNTY AGENCY [~ FEDERAL AGENCy PHONE No. WITH AREA CODE CIIY NAME V" BOX [~ INDIVIDUAL TO INDICATE (~ PARTNERSHIP STATE ZIP CODE LOCAL AGENCY [~ STATE AGENCY ~ COUNTY AGENCY [~ FEDERAL AGENCY PHONE No. WITH AREA CODE OWNER'S DATE VOLUME PRODUCT STORED IN SERVICE Y/N Y/N 'YIN Y/N Y/N DO YOU HAVE FINANCIAL RESPONSIBILITY? Y/N TYPE · ' ~ ~. ~ Fill one segment out for each tank, constructed of ~ same materials, · one segment out--please identify tanks by Owner I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN I ' A. OWNER'S TANK I. D, # · ~///~'- a. MANUFACTURED BY: , C. DATE INSTALLED (MO/DAY/YEAR) D, TANK CAPACITY .IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. S, ANDC, ANDALLTHATAPPLIESINBOXD unless a~tanks and piping are style an~ype, then only fill ID ~. TYPE OF J~ 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER A. SYSTEM /[--'1. 2 SINGLE WALL E~' 4 SECONDARY CONTAINMENT (VAULTED TANK~ ] 95 UNKNOWN ] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [~ 95 UNKNOWN / [] ~ RUSBER L,NED I~ 2 AL~D L,.,NG [] 3 EPOX~ L,N,"G C. INTERIOR ~ 5 G~ LINING 6 UNLINED LINING ~ ~ 9S UN~OWN ~s UN~N~ ~*TER~*L ~aPAT~aL~ ~TH ~ a~ANOL ? ~S ~ NO~. ] 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100"/, METHANOL COMPATIBLEW/FRP ] 99 OTHER [] 4 PHENOLIC LINING ] g9 OTHER D. CORROSION [].~ POLYETHYLENE WRAP [] 2 COATING PROTECTION [~ 5 CATHODIC PROTECTION [] 91 NONE. [] 3 vINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC i".i--I g~ U.KNOWN [] 99 OTHER IV. PIPING INFORMATION C,RCLE A ,FABOVEGROUNDOR U ,FUNDERGR.O~N~E.~L'CABLE A~ SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE ~ Il 3 GR~.~.~Vi"I'Y A U ~...~.._~O~ER B. CONSTRUCTION A U I SINGLE WALL A ~ 2 DOUBLE WALL ~, U 3 LINED TRENCH ~ IJ 95 UNKNOWN_.....~ A .IJ 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A t~ 4 FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP GALVANIZED STEEL A U 10 CATHODIC PROTECTION A I.I 95 UNKNOWN A IJ 99 OTHER AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING ,~ 3 INTERST~TIAL MONITORING [] 99 OTHER /. V. TANK LEAK DETECTION [] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING 7 ,NTERSTIT[ALMONITORiNG [] 91. NONE [] 95 UNKNOWN [] 99 OTHER I, TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN B. MANUFACTURED BY: [__ A. OWNER'S TANK I.D.# C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM 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) [] g ~RONZE ] 3 SINGLE WALL WITH EXTERIOR LINER [] 95. UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER ] 2 STAINLESS STEEL r~ 3 FIBERGLASS [] ~ POLW,NYL CHLOR,DE [] ~ ALUM,NUM []. 10 GALVANIZED STEEL [] 95 UNKNOWN [] ~ RUBBER L,NED [] ~ AL~0 L,N,NG [] 3 EPOX~ LIN,NG C. INTERIOR [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 10(3'/o METHANOL COMPATIBLEW/FRP [] gg OTHER ] 4 PHENOUC LINING · [] 99 OTHER ] 4 FIBERGLASS REINFORCED PLASTIC ] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUND, BOTHIF APPLICAELE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 o'rHER C. MATERIAL AND CORROSION PROTECTION A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVlNYL CHLORIDE (PVC)A IJ 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A IJ 7 STEEL W/ COATtNG A. tJ 8 100"1o METHANOL COMPATI~.LEW/FRP A LI 9 GALVANIZED STEEL A [J 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D, LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE T~GHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] gg OTHER V. TANK LEAK DETECTION L..__J 1 VISUAL CHECK [] 2 INVENTORY REcoNcILiATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING .[] 5 GROUND WATER MONITORING i_-'~, 6-TANK TESTING ~ 7 INTERSTITIAL MONITORING [~ gl NONE [].. g5 UNKNOWN [] gg OTHER . BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G.Street, Bakersfield, CA 93.30! (805) 326-3979 APPLICATION TO OPERATE.ANUNDERGROUND STORAGE TA~ H?APPLICATION IS BEING SUBMITTED FOR THE· FOLLOWI~ REASON: TO OPERATE A NEW FACILITY TO TRANSFER OWNERSHIP ~/__TO-OPERATE AN 'EX PREVIOUS TANK OWNER (i-f. applicable) NEW TANK OWNER PHONE I NOV ADDRESS ~77 ~7~. U~A)OA] ~~. BILLING ADDRESS TANK OPERATOR (if different from owner) NAME PHONE ADDRESS APPLICANTS NAME (if different from owner) NAME PHONE ADDRESS .-' TANK LOCATION . ...FACILITY NAME ~dOA/D ~W[ d~6/4~-ADDRESs PHONE (~SJ '. ~ --~- ~ ~ ~ 0 PE RATORS NAME EMERGENCY CONTACT NAME ADDRES S'~.~f~ PHONE TANK INFORMATION ..... tank% volume date inStalled substance stored ·previous substance Do You Have a HAZARDOUS MATERIAL RESPONSE PLAN? Do You Have an OWNER -'OPERATOR AGREEMENT? Have You ~Filled Out a HAZARDOUS·MATERIAL BUSINESS PLAN? NO NO. NO 'date n~me (print) signature BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST PERMIT TO OPE~TE ~ OPE~TORS N~E ~ER OF .T~S TO BE TESTED . owNERs NAME TANK~ VOLUME CONTENTS / '~£o ~/ u/~._ ~i/ TANK TESTING COMi~ANY~m~;~r~t .~;r,~¢~l ~ DRESS 3~ ~',. k,~o~S~w' , TEST METHOD ~/-~' ~ k N~E OF TESTER~s ~ ~,~[~ERTIFICATION 9 ~/--/~o STATE REGISTRATION ~ . DATE y'-SIGN~AT~R~ .OF APPLIC~T CON'I'RACT ENVI 1RONMF~NTA 360 EAST KINGSLEY POMDNA, CA. 91767 TEST 714/623-4400 CERTIFICATE CUST(IMER: (ADDRESS) 'GARY'S ECONO LUBE N' TUNE 2677 MOUNT VERNON , PHONE: 805/872-5770 93301 1/21/92 CITY: BAKERSFIELD STATE: CALIF. ZIP: LOCATION ADDRESS: SAME PHONE: CITY: STATE: ZIP: TEST REQUESTED BY: NAME: HECTOR DATE: ITEbt OR SYSTE~ TESTED TANK ID# CAPACITY .TANK TEST TANK TEST LINE TEST LINE TEST LEAK RESULTS- GAL/H RESULTS- GAL/H DETECTOR P/F P/F P/F #1 WASTE OIL 550 GAIR PASS -.0318 N/A N/A N/A REMARKS: THIS IS TO CERTIFY THAT THE ABOVE TANK(S) AND ASSOCIATED PIPING SYSTEM(S) ARE "TIGRT" blF~T THE cRI~IA ESTABLISt{ED BY THE I~FPA P~ET 329. OPERATOR LICENSE # 91-1440 II 1/21/92 AND CO--CT ENVIRON~RRrrAI. SERVICE 360 EAST KINGSLEY POb~NA, CA. 91767 .714/623-4400 TANK DATA SHEET CU~: BILLING ADDRESS: ECONO LUBE N' ~ 2677 MOUNT I;IZRNON BAKERSFIELD, CA. D~I'E. i/21/93 SITE ADDRESS: TIME 1800 CONTAC~ P~ON: INSTRUC'flONS: HEC'I~OR PHONE: 805/872-5770 P~T = (TAKE C'HECK) 99 TO~ 178/~EDAI,E~, 3 ~ 4 MII,W.S TO M~. VEPaNON F_,XIT. ~ L~.~T. CAN SW.W. SIGN ~ ~ 178. SIZE 550 ERI STEEL CON~ENTS WASTE 0IL APl Sp. Gr, 27,5 TOTAL LENGTH 73 ,? FILL LENGTh30,0_/" PERATURE 64.5 API ~ 60°F 27.2 TANK DIA. 43.0 STAND PIPE 38 C0EFICIENT OF EXPANSION ,4341 + 1000 HOH IN TANK N/A GROUND H0H 0 PRODUCT WIEGHT = (141,5/(131.5+API))*(.036} 0,0320 TEST HIEGHT: = (TOTAL LENGTH + STAND PIPE) . 111.800 FACTOR B= TANK SIZE x C0EFICIENT OF EXP. 0,2388 TEST PRESSURE = Hr.* Wt.-(Ht, of HOH*.036) 3.552 PUMP SYSTEM: NONE TANK COVER: ASPH/CONC TEST CALIBRATION ( i f used) WELL No.: DEPTH T0 HOH: ~. BEGIN 32 TO 49 = 17,0080 GRND. ELEV,': DATE MEASR,: BEGIN 25 TO 44 = 19.0000 COMMENTS: NEED PERMIT FROM BAKERSFIELD FIRE DEPT. 'BEGIN 13 TO 32 = 19.0000 PERMIT { BT-0085 SEND RESULTS TOFIRE DEPT. CALIBRATION ROD { .025 + 10.3333 = 0.0014 FACTOR A CONTRACT ENVIROS %rfAL SERVICE TEL-A-LEAK TEST SYSTEM TANK TEST DATA SHEET CUSTOMER: ECONO LUBE N' TUNE SITE: BAKERSFIELD DATE: 1/21 MONITOR PERIOD RESULTS TANK No.! FACTOR a ,0014 FACTOR B ,2380 1804 54 40 -14 -0.0196 ,,.,509 .536 0,027 0,00641 ........[] 1810 40 28 -12 -0.0168 0.536 .564 0,0,28 _ 0.0067 -0,0235, 1816 28 11 -17 -0.0238 0,564 ,.580 Q~,,016,, 0,0038 -0.0276 1822 55 46 -9 -0.0126 0.580 { .586 0.006 0.0014 -0.0140 1828 46 42 -4 -0.0056 0.586 .591 0.005 0.0012 -0.0068 1834 66 56 -10 -0.0140 0.591 .596 0.005 0.0012 -0.0152 1840 56 47 -9 -0,0126 0.596 ,601 0.005 0,0012 -0,0138 1846 47 42 -5 -0,0070 0,601 .606 0.005 0.00!2 -0.0082 1852 42 38 -4 -0,00,56 0.606 .611 0,005 0.0012 -0.0068 1858 71 69 -2 -0,0028 0,611 ,614 0.003 0.0007 -0.0035 MONITOR PERIOD RESULTS LEAKAGE INDICATED -0.1454. TEST PERIOD RESULTS TANK No. 1 1904 69 66 -3 -0.0042 0.614 ,615 0.001 0,0002 -0,0044 1910 66 64 -2 -0,0028 0.615 .,617 01002 0,0005 , -0,0033 1922 63 61 '-2 -0.0028 0,618 .620 0.002 0.0005 -0.0033 1928 61 59 -2 -0,0028 0.620 .623 0.003 0.0007 -0.0035 1934 59 57 -2 -0.0028 0,623 .626 0.003 0.0007 -0.0035 1940 57 55 -2 -0,0028 0.626 .6,31 0,005 0.0012 -0.0040 1946 55 54 -1 -0.0014 0.631 ,:6,33, 0.002 0.0005 -0.0019 1952 54 53 -1 -0,0014 0.633 .634 0,001 0.0002 -0.00,!6,, 1958 53 50 __ -3 -0.0042 0,634 .636 0.0,02, 0,0005 -0.0047 TEST PERIOD RESULTS LEAKAGE INDICATE ., -0,0318 · - STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD '~ ~.~~ UNDERGROUND STORAGE TANK PERMIT APPLICATI~N-.FORIVI A, COMPLETETHIS FORM FOR EACH FACILITY/SITE MARK ONLY ONE ITEM .~ I NEW PERMIT ~ 3 RENEWAL PERMIT [] S CHANGE OF INFORMATti~N [] 7 PERMA'NENTLY CLOSED SITE [] 2 ,NTER~M PERM,T [~ ,, AMENDED PERMIT [] 6 TEMPOR^R¥ S,TE CL0SU~,' I. FACILITY/SITE INFORMATION & ADDRESS- (MUST BE COMPLETED) ~ BOX ' ~~ TO INDICATE RATION ~ INDIVIDUAL ~ PARTNERSHIP ~ LOCAL-A~ENCY ~ COU~Y-AGENCY ~ STATE-AGENCY ~ FEDE~L-AGENCY · DISTRICTS ~PE OF BUSINESS ~ 1GAS STATION ~ 2 DISTR,BUTOR ~ ~ RESERVATION~ ,FiNDiAN[~OFTAN~TS,TE [. E.P. Am ,.D.~(optiona/) ~ 3 FARM ~ 4 PROCESSOR ~ OTHER ORTRUST LANDS ' EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - Optional D,~YS.; NAME LAST,.~:~,~S~T) .,.~.~ ~ ,.=.,PHONE # WITH AREA CODE ~ DAYS: NAME ([.~ST. FIRST) . ' I II.PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) ) .zW I MAI~N~ STREETAEDR~ ~ ~ ' ~ ' ~ ~cate ~ iNDiViDUAL II1. TANK O~R INFORMATION- (MUST BE COMPLETED) L~j:~O F OWNER I MA~NG OR Sf~EEI'A~'DRESS CARE OF ADDRESS INFORMATION LOCAL-AGENCY [~ STATE*AGENCY COUNTY-AGENCY ~ FEDERAL*AGENCY PHONE # wITH AREA CODE ~ ~ CORPORATION ~ PARTNERSHIP E~ COUNTY-AGENCY ~ FEDERAL-AGENCY IV, BOARD~)F EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (9'16) 323-9555 if questions arise. TY<TK) HQ V, PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED) - IDENTIFY THE METHOD(S) USED ,,/ box to indicate ,,.,~SELF-INSURED [~j 2 GUARANTEE ~ 3 INSURANCE [~ 5 LETFEROFCREDIT [---I 6 EXEMPTION ~ 99 OTHER SURETY BOND VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE,/S TRUE AND CORRECT LOCAL AGENCY USE O~ COUNTY # JURISDICTION # LOCATION CODE - OPTIONAL CENSUS ~RACT # - OPTIONAL FACILITY # SUPVISOR - DISTRICT CODE - OPTIONAL · THIS FORM MUST BE ACCOMPANIED BY.AT LEAST (1) OR MORE PERMIT APPLICATION· FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FORM A (5-91) FOR0033A-5 · .STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL. BOARD UNDERGROUND'STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY NEW PERMIT ' [] 3 RENEWAL PERMIT , [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ONSlTEI ONE ITEM ~""~2 INTERIM ~ERMIT [~ 4 AMENDE~) PERMIT [] 6 TEMPORARY TANK CLOSURE [~ 8 TANK REMOVED . I I. TANK DESCRIPTION. COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN ~ C; DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS ~ A-1 IS MARKED. COMPLETE ITEM C. A. [~ 1 MOTOR VEHICLE FUEL ~ OIL B, C. [] laREGULAR [] 3 DIESEL [] 6 AVIATION GAS . UNLEADED [] 4 GASAHOL [] .2 PETROLEUM [] 90 EMPTY [] ~ PRODUCT [] ~PREM~UM [] ~ M~HANOL UNLEADED [] 5 JET FUEL ~ :~ CHEMICAL PRODUCT [] 95 UNKNOWN ~TE ~ 2 LEADED [] 99 OTHER (DEscRIBE IN ITEM D. BELOW O. IF (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. #: III. TANK CONSTRUCTION MARKONEITEMONLYINBOXESA, B. ANDC. ANDALLTHATAPPLIESINBOXD A. TYPEOF [] 1 DOUBLE WALL SYSTEM ~ SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) "[] 99 OTHER TANK ,~BARESTEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS' MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER [] I RUBBER LINED [] 2 ALKYD LINING '[] 3 EPOXY LINING INTERIOR ~LINED LINING [] s GLASS UN~NG [] 9S UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 100°/. METHANOL ? YES_ NO__ ] 4 PHENQLIC LINING ] 99' OTHER D. CORROSION [] 1 POLYETHYLENE WRAP ,~'-COATING [] 3 VINYL WRAP PROTECTION [-T"1 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN· [] 4 FIBERGLASS REINFORCED PLASTIC ]' 99 OTHER IV..PIPING INFORMATION · CIRCLE ,A. IF ABOVE GROUND OR U IF UNDERGROUND. B'OTH IF APPLICABLE A. S¥STEMTYPE A U 1 SUCTION .A U 2 PRESSURE J(~3 GRAVITY A IJ 99 OTHER' B. CONSTRUCTION C.' MATERIAL AND · CORROSION PROTECTION SINGLE WALL A U 2 DOUBLE WALL A IJ 3 LINED ;'FRENCH A U 95 ·UNKNOWN A IJ 99 OTHER BARESTEEL A I.I 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U -8 1005'o METHANOL COMPATIBLEW/FRP GALVANIZED STEEL A U. 10 CATHODIC PROTECTION A IJ 95 UNKNOWN A [,I 99 OTHER D. LEAK DETECTION [~ 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIALMoNiTORiNG ~ OTHER,~,~_.~,,/~.,/~. V. TANK LEAK DETECTION I[] 1 VISUAL CHECK ,/~'INVENTORY [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK [] 5 GROUND MONITORING RECONCILIATION GAUGING WATER ~,,,,,r_~ ~ TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION ' I 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES [] NO [] SUBSTANCE REMAINING GALLONS INERT MATERIAL ? ' I THIS FORM·HAS BEEN COMPLETED UNDER PENALTY OF PERJUR.Y~ AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME / /'1 ~ . ~ ' ~,,~ -~, '~ ' ~ I DATE I ~ ~~~ ~ ~~ ' ~ ~/~// d/ STATE I D ~ ' ' PERMIT NUMBER PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE FORM'B (9-90). THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. 'i"~cI' ., MARK ONLY 'ONE ITEM i,STATE OF CAUFORNIA . STATE WATER RESOURCES CONTROL BOARD ' '" ' ' ERGROUND STORAGE TANK PERMIT APPLICATION - FORM A', COMPLETE THIS FORM FOR EACH FAClLffYSrrE '., , ~ ' PERM,T ,.FOR AT .' m. PE.MA.E. LY CLOUD [~ 2 ~NTER~M PERMIT [~ 4 AMENDED PERMIT [] 6 TEMPORARY S~TE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) TO IN~CATE R~ON ~ INDIVIDU~ .~ P~TNE~HIP ~ L~AL-AG~CY ~ ~U~GE~Y OBTRICTS ~ RESERVATION ~ 3 FARM ~ 4 PR~E~OR ~ OTHER · OR TRUST L~DS · 'EMERGENCy coNTACT PERSON (PRIMARY)i., . t - EMERGENCY' CONTACT PERSON (SECONDARY)- optional DAYS: NAME (LAST, FIRS'I) PHONE # WITH AREA CODE CSos) ~?Z-5'~o PHONE # WiTH AREA CODE MAILING OR STREET ADDRESS CiTY NAME /'"/. I1. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) II1. TANK OWNER INFORMATION - (MUST BE COMPLETED) DAYS: NAME (LAST, FIRST) E R. WAECHTER NIGHTS: NAME (LAST, FIRS'r) CARE OF ADDRESS INFORMATION ~/ box Iolndicae r'-'l INDIVIDUAL ~ CORPORATION ['--"] PARTNERSHIP PHONE #WITH AREA CODE PHONE #WITH AREA CODE [~] LOCAL-AGENCY ~ i--'-I STATE-AGENCY [---I COUNTY-AGENCY: I--1 FEDERAL-AGENCY NAME OF OWNER ~ k ' t I [ CARE OF ADDRESS INFORMATION MAILK / [::~'CORPORATION ~ PARTNERSHIP [--'] COU~'Y-AGENCY; ~ FEDERAL-AGENCY ~~~ ~,,. ~, ~_.C~,~L 'STATE ' ZiP CODE PHONE .WITH AREA CODE IV. BOARD OF ~QUALIZATION MST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 if questions arise. -:V. L~GAL I~OTI~CA'I;IO-N A-ND-BII TING-ADDRESS .... l-egal~notificationand~billing:will.be_sent_tp_the tank ownerpnl.e, ss~&x I o:r II is checked. CHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: I. ~' II. r'-] IlL THIS FORM HAS BEEN COMPLETED UNDER PENA~OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT [ APPLICANT'S NAME (PRINTED & SIGNATURE,S' .J .~'/ _ . ~ APPLICANT'S TITLE I DATE MONT ~H/DAY/YEAR R. WAECHTER LOCAL AGENCY USE ONLY~'~'~ . COUNTY It : JURISDICTION # FACILITY # LOCATION CODE-OPTIONAL ICENSUS TRACT#. -OPTIONAL SUPVISOR-DISTRICT CODE- OPT/ONAL ,~ ~i THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1} OR MORE PERMIT APPLICATION · FORM R~ UNLESS IHI$ IS A CHANGE OF slIE INFORMATION ONLY. FORM A (9-9O) FOROO33A-R2 ~..,. c . . . . . ~. . STATE OF CAUFORNIA ' .. .' . .'.. ' . STATE WATER RESOURCES CONTROL BOARD""" ..... "* ' ' ' ' .. . · UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM.B ' .i'.. ;. :',. :.: :.',. , ' :" CoMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, , .".::". ' ...... ' ': MARK ONlY '. ' r-l' 'NEW'PERM'.T · [ f'3 RENEWS_ PERM,T [ f'S CHANGE OF ,NFO.MAT,ON ONE ITEM . [-'-~, 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK ,CLOSURE []'. 7 PERMANENTLY CLOSED ON [] , TAN~ REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ~t-lt7 ~_..~.01.~0 ~.0~[ /~ I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A.' OWNER'S TANK I.D.# '~ I B, MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR) . U~~ O. TANK C~ACI~ IN G~LONS: II. TANK CONTE~S IFA*I IS MARKED, COMPLETE ITEM C. I-~2 PETROLEUM [] ,0 EMPTY [] ', PRODUCT [] ~bPREM,UM [] 7 METH,~OL UNLEADED [] [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN WASTE [] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. BELOW D. ,F(A.,),S,OTM,,RKED. ENTER NAME OF SUBSTANCE STORED UJ4,Sr~ 4UfO C~.~5E o~L~ C.A.S.,: ; k~/pr '111. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC. ANDALLTHATAPPLIESINBOXD ..... A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR I-iNER [~ g5 UNKNOWN SYSTEM ~" 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANI0 ~ 99 OTHER ' B. TANK ~' I BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 2 STAINLESS sTEEL [] 3 FIBERGLASS [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC [] 8 100% METHANOL COMPATIBLE W/FRP [] ~B OTHE, [~] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR ' _~5 UNKNOWN [] 99 OTHER LINING [] 5 GLASS LINING [] 6 UNLINED IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ .~ D. CORROSION [---] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ~"5. UNKNOWN "E~ 'g OTHER ] IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A, SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE GRAVITY B. CONSTRUCTION /~ SINGLE WALL A U 2 DOUBLE WALL' A U 3 LINED TRENCH A U 99 OTHER A U 95 UNKNOWN ',A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)'A U 4 'FIBERGLAS~ PIPE , ALUMINUM A U 6 CONCRETE 7 STEEL WlCOATING~I~U 8100% METI..~ANOL COMPATIBLE W/FRP GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER AUTOMATIC LINE LEAK DETECTOR [~ 2 LINE TIGHTNESS TESTING [] 3MONITORINGINTERSTITIAL E~9 OTHER V. TANK LEAK DETECTION ' ~. - [~ ~T,,NK TEST,NG .... F--~ ,NTERST,T,A~MON,TOR,NG~[~_~_,_~N._ONE . .... i_ _[] B~_UN~__"_OWN ' ' [] B~ O~HER VI. TANK CLOSURE INFORMATION ' · 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF I 3. WAS TANK FILLED WITH J ' I SUBSTANCE REMAINING _GALLONS I INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY~,~ND T~ OF MY KNOWLEDGE IS APPLICAN3'SNAME : ~ %&t&l--~=~ ..... ~~' . J~l ~ I DATE ~'RUE AND CORRECT LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSEt~OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK STATEI.D.# ~ I I I I I I I I I I '1 I L'-I IIl;I PERMIT NUMBER I PERMIT APPROVED BY/DATE PERMIT EXPIRAT.!.ON DATE FoRM B (g.~ THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEENiFILED. FORO(~4B-R4 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BC · CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A sEpARATE F(~RM FOR EACH TANK SYSTEM I. SITE LOCATION STREET CITY II. INSTALLATION (mark all that apply): COU.TY he installer has been certified by the tank and piping manufacturers. [~ The installation has been inspected and certified by a registered professional engineer. · he installation has been inspected and appi'oved by the implementing agency,: [~"~AII work listed on the manufaciurer's installation checklist has been cor~pleted. , ~The installation Contractor has been certified or licensed by the Contractors State Licenst [~ Another method was used as allowed by the implementing agency. (Please specify.) II1. OATH Print Name Address ~'7 ?' r'~'r. Board. I certify that the information provided is true to the best of my belief and knowledg .¢~- /17 ~ L-fC~E- ~/~rf~E'.~ Date ,/'~ Phone ( ¢~'~~~ LOCAL AGENCY USE ONLY STATE' COUNTY # JURISDICTION # FACILITY # TANK # FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FOR0O35C7