Loading...
HomeMy WebLinkAboutUNDERGROUND TANK-C-02/11/92NORTH SCALE:· BUSINESS N~ME: :' FLOOR: OF BARBER~PoNTiAC'COMPAN~.~ DATE:06/22/87 FACILITY NAME: ' CoMpANY;!,.:~.,i..UNIT 3: OF BARBER PONTIAC · (CHECK ONE) ,I. RESIDENCE RESlDENC~ · i S~O~ROOM ~? ', , ' ~/' ~..~ 500 OAK :STREET FIRE DEPARTMENT S.D. JOHNSON FIRE CHIEF . CI T Y of BAKER SFIEL D "WE CARE" 'Bill Wright Toyota - '- C/O Mary Majors, ~ontroller 5100 Gasoline Alley'Drive Bakersfield Ca. 93313 Dear 'Ms. Majors: NOTICE OF VIOLATION.AND SCHEDULE FOR COMpLiANCE ===== ........... ...... ...... In the inspectionlthe property leased by your company, located at 901 Oak street, Bakersfield, Ca 93304 on 6/12/92 the following hazardous materials regulation violations were identified:' 1) Various Hazardous Materials not ssociated with the a ~ current business were on.hand, however no Hazardous Materials Business plan was'bn file. VIOLATION OF CH. 6.95 CALIFORNia HEALTH 'AND SAFETY CODE SEC..25503.5 (a)' Any 'business, except as provided in subdivision (b), which ~'andles a. hazardous material or mixture containing a hazardous material which has a quantity.at' any one time during the reporting year equal to, or greater than, ia total weight of 500 pounds, or a total volume of 55'gallons, or 200 cubic feet 'at standard temperature and pressure for a compressed gas, shall eStablish andlimplement a business plan for emergency response to a'release or threatened release of a hazardous material in accordance with the standards in the regulations adopted pursuant to Section 25503. 2) Containers of H&zardous Materials on site were not prOperly labeled. ~ VIOLATION OF OSHA 1910.1200 · f (1) The chemical manufacturer, importer, or distributor shall ensure that each container of 2101H STREET BAKERSFIELD, 93301 326-3911 hazardous dhemicals leaving the workplace is labeled, tagged or ~arked with the following, information (ii)Identity of the hazardous chemical(s) (ii)Appropriate hazard warnings; and (iii)Name and'address of the chemical manufacturer, importer, or other responsible party. (4) ExCept as provided in paragraphs (3) and (4) the employe~ shall ensure that each container of hazardous c~emicals in the workplace is labeled, tagged, or marked with the following information: (i)Identity of the hazardous chemical(s) contained therein; and (ii)Appropriate hazard warnings. (5) Th~ employer may use signs, placards, process sheets, batch tickets, operating procedures, ~or other such~writte~ materials in lieu of affixing labels to individual Stationary process containers,~ as long as the alternativelmethod identifies the containers to which it is applicable and conveys the information required by paragraph (2) of this section to be on label. The written materials shall be readily accessible t° the' employees in their work area throughout each work shift. (7) Th~ employer shall not remove of deface existing labels on incoming containers of hazardous chemicals, Unless the Container is immediately marked with the reqUired infOrmation. (8) Thel employer shall ensure that labels or other forms of wamnings are legible, in English, and prominently idisplayed on the container, or readily available in! the. Work area throughout each work 'shift. Employers hauing employees who speak other languages may add the info~mation in their language to the material presented, as long as the information is presented in English as well. 3) Various containers containing What appear to be ~azardous Waste were. abandohed on site. VIOLATION!OF 40 CODE OF FEDERAL REGULATIONS SUB PART C, PART 262.34, Accumulation time Except as provided in paragraphs (d), (e), and (f)'of -this section, a generator may accumulated hazardous waste on-site for 90 days or less without a permit or without having interim status, provided that: (1) The waste is placed in containers and the gener~tQr complies with Subpart I of 40-CFR Part 265, or the waste is placed in tanks and the generator complies with Subpart J of 40 CFR Part 265, eXcept 265.1'97(c) and 265.200. In addition, such a generator is exempt from all' the requirements in Subparts G and H of 40 CFR Part 265, except for 265.11 and 265.114. (2) The date upon which each period ~f accumulation begins is clearly marked and visible for inspection on each container. (3)' While being accumulated on,site, each container and tank' is labeled or marked clearly with the. words, .'Hazardous Waste", and (4) The generator complies with the requirements for owners or operators in Subparts C and D in 40 CFR Part 265 ~and with 265.16. (b) A generator'who accumulates hazardoUs waste for more than 90 days is an operator of~'a storage 'facility and ~is subject to the requirements of 40 CFR Parts 264 and 265 and the permit requirements of 40 CFR Part 270 unless he has been granted an extension to the 90 day period. Such extension may be granted bY EPA is hazardous wastes must remain on-site for longer than 90 days due to 'Unforeseen, temporary, and uncontrollable circumstances. an extension of up to 30 days may be granted at the discretion of the. Regional Administrator on a case-by- case basis. 4) Empty 55 gallon drums not properly, stored. VIOLATION OF 80.301 (b)~. Empty containers and tanks. Empty containers and tanks previously used for the storage of hazardous materials shall be free from residual material and vapor as defined by D.O.T., R.C.R.~A. or other regulating authority or maintained as specified for the storage of the hazardous material.· 5) Class I flammable liquid (racing fuel) improperly stored. VIOLATION OF UFC 79.405 The storage area shall be graded in a manner to divert possible sPills away from buildings or other · exposures or shall be surrounded.by a curb at least 6 inches high. When curbs are used, provision~ shall be made for draining of accumulations of groundwater or rainwater Or spills of liquids. Drains shall terminate at 'a safe location and shall be accessible to operation under fire. conditions. The above violations mUst be corrected by June 30,.1992 The department will schedule a re-insPection of your facility to verify compliance. If you have any questions rggarding this notice, please contact Ralph Huey at 326-3979. Sincerely, Hazardous Materials Coordinator cc: Barber Pontiac (Property Owner) .. California Custom Detailing (Current sub lessee) M,~N: A~ IN~8 ~C.?~Oh %'I ,. ~o,x~C~Tv Plot Plan must.~show the following 3. 4. 5. 6. 7. PLOT PLAN Roads and alleys buildings location of tanks, piping, and dispensers utilities SCALE water wells (if on' site) any other relevent information H /0~ ooo ~--V.~L.Co rO ~akersfield Fire Dept~ ~ ~RDOUS MATERIALS DIVI,%iOI~ UNDERGROUND STORAGE TANK PROGRAM pERMIT No. PERMIT APPLICATION FOR REMOVAL OF-AN UNDERGROUND STORAGE TANK APN (805)834-3400 ZIP CODE 93313 SITE INFORMATION SITE Oak Street Car Wash ADDRESS 600 Oak ZIP CODE 93304 FACILITY NAME Oak Street Car Was~CROSS STREET Dracena TANK OWNER/OPERATOR J.O. Barber Trust PHONE No. MAILING ADDRESS 4600 Wible Rd CITY 'Bksf CONTRACTOR INFORMATION COMPANY Triple J ADDRESS 1232 Fairview Ave INSURANCE CARRIER Golden .Eagle Construction PHONE No. (209) 686-620~iCENSE No. A569 970 CiTY Tulare ZIP CODE 9J 7.'/a WORKMENS COMP No. ,. W(~'- 80482751 PRELIMANARY ASSEMENT INFORMATION COMPANyAnders. on & Assoc ADDRESS 4830 Columb~s"~.4una INSURANCE CARRIER state PHONE No. 876,9586 LICENSE No. CITY Bksf ZIP CODE 93306 WORKMENS COMP No. 1238156-91 TANK CLEANING INFORMATION COMPANY Whitten Excavation PHONE No. 631-8455 ADDRESS P.O. Box -70488 CITY Bakersfield ZIP CODE 93387 WASTE TRANSPORTER IDENTIFICATION NUMBER 000083121 NAME OF RINSTATE DISPOSAL FACILITY Gibson Refinery ADDRESS 2401 Gibson Oil CITY Bksf ZIP CODE '93308 FACILITY INDENTIFICATION NUMBER CAD980883177' ~ TANK TRANSPORTER INFORMATION COMPANY Whitten Excavation PHONE No.631-8455 LICENSE No. 501739 ADDRESS P.O. Box 70488 CITY Bakersfield ZIPCOD83387 TANK DESTINATION Golden State Metal TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES CHEMICAL STORED STORED PREVIOUSLYSTORED 1 13 Yr 10,000 Unleaded.Gasoline - 0/78-6/91 THE APPLICANT H~S RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED coNDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS .... THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. ~PPRO~Eo BY: ~ 'APPLICANT NAME (PRINT) ~ ~CANT SIGNATURE · THIS APPLICATION BECOMES A PERMIT WHEN APPROVED BAKERSFIELD FIRE DEPARTM! BUREAU OF FIRE PREVENTION. APPLICATION 18 I~ay0 1979 X19 Dote Application NO. In conformity with provisions of pertinent ordinances, codes and/or regulations, application is made by: R.L.T~. ~_u~mvrim 3100 Block Draeean Name of Company Address to display, store, install, use, operate, sell or handle materials or processes involving or creating con- ditions deemed hazardous to life or property as follows: · e~lzeg~m to tn~tnl! one 8,000 ~t. gus o~ ~. ~~ ~ ~ Author,zed Represer~ative · . {c!?...j.G .Permit denied ..... -~.U~.-~:-y~e~/ ..... ..... By ....... ..'--~F'...,,~......'::¥,es~..,~.'~ ....... .......................... ~ ~ Fire Marshal FIRE DEPARTMENT S.D. JOHNSON FIRE CHIEF CITY of BAKERSFIELD "WE CARE" February 11, 1992 2101H STREET BAKERSFIELD, 93301 326-3911 J. O. Barber Trust 4600 Wible Rd. Bakersfield, CA 93313 CLOSURE OF 1 UNDERGROUND HAZARDOUS sUBSTANCE STORAGE TANKS LOCATED AT 600 OAK STREET (BEHIND OAK STREET CAR WASH), IN BAKERSFIELD, CALIFORNIA.PERMIT # BR0018 Dear Sirs, 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 off!ce is satisfied with the assessment performed and requires no further action at this time. '' This letter does not relieve you of any liability for past, present, or future operations. In addition, any future changes in site use may require further assessment or mitigation. It is the property owners responsibility to notify this department of any changes.in site usage. If you have any questions regarding this matter, please contact me at (805)-326-3797. Sincerely~ Hazardous Material SpecialJist Underground Tank Prggram Bakersfield Fire D, HAZARDOUS MATERIALS DIVISION UNDERGROUND STORAGE TANK PROGRAM 876-9586 LICENSE No. CITY Bks£ · .'ZIPCODE 93306 · WORK'lENS COMP I~1o. 123815~ PERMIT No. PERMITAPPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATIO~ SITE Oak Street Car Wash ADDRESS 600 Oak .ZIP CODE 93304 APN FACILITY NAME Oak Street Car Was~CROSS STREET Dracena -- -- TANK OWNER/OPERATOR J.O. Barber Trust -_____ PHONE No. (805) 8~ MAILING ADDRESS --4600 Wible Rd CITY Bksf ZIP CODE 93313 .CONTRA'CTOR INFORMATIOH -- COMPANY Triple j C~nstruction PHONE No. (209).686_620~ICENSE No. A569 970 ADDRESS ~232 Fairview Ave _ INSURANCE CARRIER ~ e ~ ZIP CO..DE. 9jz/,~ - WORKMENS COMP No. WCG 8048275]. P_RELIMANARY ASSEMENT INFORMATION .' . COMPANyAnderson & Assoc ADDRESS ~ '~4 PHONE No. INSURANCE CARRIER a e Un Golden State PHONE No.. 631'8455 CITY Bakersfield ZIP CODE 93387 000083121 - TANK CLEANING INFORMATION COMPANY Whitten Excavation ADDRESS P.O. Box 70488 WASTE TRANSPORTER IDENTIFICATION NUMBER NAME OF RINSTATE DISPOSAL FACILITY Gibson Refinery_ ADDRESS.._ 2401 Gibson Oil CiTYBksf FACILITY INDENTIFICATION N-~B~ CAD980883177 TANK TRANSPORTER INFORMATION COMPANY _Whitten Excavation ADDRESS P.O. Box 70488 TANK DESTINATION ZIP CODE 9 3 3 0.___.__.~_8 PHONE No.631-8455 LICENSE No. 501739 CITY Bakersfield ZIP COD83387 Metal TANK No. AGE VOLUME 1 '13 Yr 10,000 TANK INFORMATION CHEMICAL STORED Unleaded Gasoline DATES CHEMICAL STORED PREVIOUSLY STORED 0/78-6/91 THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE AI'I'ACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS, THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TOTHE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. PPROYED BY: ~ APPLICANT NAME (PRINT) ,,..j Ax~P~CANi~SI~NA~U~-~--- THIS APPLICATION BECOMES A PERMIT WHEN APPROVED BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 · CERTIFICATION STATEMENT OF TANK DECONTAMINATION name an authorized agent of contracting co. here by 'atteSt under penalty of perjury that the tank(s) located at address and being removed under permit# ',~)~-~Jc~ 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.. namW (print) ~ {~ignatur-e- BAKERSFIELD FIRE DEPARTMENT . HAZARDOUSMATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301' (805) 326-3979 ~ O ~9~ ~/ TANK.REMOVAL INSPECTION FORM ~u~%'~u'l'u~/~~ j ~~'. . CONTACT PERSON ~O~TORY TEST ~THODOLOGY CO= RECIEPT 'PLOT PLAN CO ITION OF TANKS CONDITION OF PIPING ~- CONDITION OF SOIL .3(9 ~ /~ ~-~ COMMENTS DATE July 9, 1991 A,s'd .... ..... Ralph. E. Huey Hazardous Materials Coordinator Hazardous Materials Division 2130 "G" Street Bakersfield, CA 93301 Dear Mr. Huey, Following our telephone conversation on July 8, 1991, I am returning the Underground Tank Questionnaire to you. The questionnaire was sent to Bill Wright Yugo at 911 Oak Street, the Yugo Dealership has been closed for over two years and the tank in question is not in use. Also, the property owner and the tankowner is Mr. John Barber of Barber Pontiac. Thank you for your assistance in this matter, i_p.a_r_ts/M/Jack A) Weimer, anager ~Ll-t'~Wright Toyota, Inc. oo Io~ JAW/paw Enclosure 5100 GASOLINE ALLEY DRIVE P.O. BOX ~0100' BAKERSFIELD~'CA.9338~-0100 (805)398-8697 STATE OF CALIFORNIA - STATE WATER RESOURCES CONTROL BOARD · UNDERGROUND STORAGE TANK PERMIT APPLICATION. FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] I NEW PERMIT' [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE I. TANK DESCRIPTION COMPLETE ALL ~TEMS - SPECIFY ~F UNKNOWN ] 7 PERMANENTLY CLOSED ON SITE _..~;~TANK REMOVED A. OWNER'S TANK I. D. # / C. DATE INSTALLED (MO/DAY/YEAR) · B. M.ANUFACTURED BY: "--"-- D. TANK CAPACITY IN GALLONs: II.TANKCON. N_T. ENTSIFA-11SMARKED. COMPLETEITEMC.":Z." - - · ,= Y~'L: ~.~-';; . / '~ ...... A. I MOTOR VEHICLE FUEL [] 4 OIL .- B .... C ~'"'1~'f~REGULAR  ':" :' *::'~ ; : ,': · ~ '-~ ' UNLEADED PETROLEUM [] 80 EMPTY :-'~.~';I~UCT :¢!' E~' lbPREMIUM [] 3 CHEM,CALPRODUCT [] 95 UN~OWN I[] ~ w^sTE. *'.'""1 ;'. [] 2 UNLEADEDL~DED 3. D!ESEL ' =., r~ 6 AVIATION GAS ' · ."~ I I 7 METHANOL 5 JETFUEL . ~ I · [---~ 99 OTHER (DESCRIBE IN ITEM D. BELOW)I C.A.~.#: .,I O. IF IA.l)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANOC, ANOALLTHATAPPLIESINBOXDANDE A. TYPE OF [] 1 DOUBLE. WALL ' SYSTEM .~2 SINGLE WALL ~.~. B. TANK .~BARE STEEL · [] * 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN' [] 4 SECONDARY CONTAINMENT (VAULTED TANIO [] 99 OTHER [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEEL CLAD W/FiBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE (PdmaryTank) [] 9 BRONZE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP [] ,0 GALVAN,ZED STEEL [] gs UNKNOWN ' F-~ 99 OTHER C. INTERIOR LINING [~ 1 RUBBER LINED [] 2 ALKYD LINING [] [~5 GLASS LINING ,~-.~'~LINED [] IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES 3 EPOXY LINING [] 4 PHENOLIC LINING 95 UNKNOWN [] 99 OTHER __ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION [] 5 ·CATHODIC PROTECTION ~E [] 95 UNKNowN ] 4 FIBERGLASS REINFORCED PLASTIC ~ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEA,q) IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A~I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B, CONSTRUCTION A {~ SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U, 99 OTHER C. MATERIAL AND A{~ BARE.51'EEL A U 2 STAINLESS STEEL A U 3 POLYVlNYL CHLORIDE (PVC)A U 4 FIBERGLASS PiPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATfNG A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U g GALVANIZED STEEL A U 10 CATHODIC PROTECTION A IJ 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 'LINE TIGHTNESS TESTING [] 3 INTERSTITIAL ' MONITORING V. TANK LEAK DETECTION I[]~ v,SUAL CHECK [] ~ ,NVENTORY RECONC,L,AT,O,* ~_~:~E ~DN,TOR,NG [], AUTOMAT,C TANK GAUG,NG []~ GROUND WATER MONITORING [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING ~ 91 NC~E [] 95 UNKNOWN 1 ] 99 OTHER J VI. TANK CLOSURE INFORMATION I THIS FORM HAS BEEN COMPLI=~I=D UNDER PENALTY OF PERJURY,,~,D TO THE OF MY KNOWLEDGE IS TRUE'AND CORRECT APPLICANT'S NAME '~ ~ J ..-- ~ ~ , ' r~ (PRINTED & SIGNATURE) ~ L~ -- ~] ~ ~..."~)_ /// // J DATE __ ~ ~ ~J I AGENCY .,,JmP _. c/'/UIM"P~(~:)C~/%'~'~Cx'"~.~/----'~"~'"'~-'~'~'~-//~.__ ~~I-~/~~/, , / LOCAL USE ONLY COUN~ 8 JUR~D~N ~ FACIL~ ~ TANK ~ PERMIT NUMBER ' PERMIT APPROVED BY/DATE , - ~ pERMIT EXPIRATION DATE FORM a ~-~1') THIS FORM MUST BE ACCOMPANIED BY A PERMff APPUOATION - FORM A, UNLESS A CURRENT FORM A HAS SEEN FILED. FORp~34B-R5 ' "" ' FILE CONTENTS INVENTORY ' ' ' Date. "~Perm~ to abandon~ · . No. of Tanks Date " "" "' ~e ~' ~b~ndonmen~/C~osu~e ~epo~ ~HV~ Comp~n~e Che~k (Ne~ ConsL~u~Lon ~5~D ComptL~n~e Che~k (Ne~ Construction Che~k~s~) I ~HV~ P~n Check {Ne~ Construction) ~MVF Plan Check (Existing Facility) ~S~ Plan Check (Existing Facility) ~"Incomplete ~Application- ~Permit Application Checklist · ~Permit Instructions ~Dis'ca~ded ~Tightness Test ~esults Date Date Da te ~ , ~Monitor[~ Well Construction Data'/Permi'ts " "~Envtronmental Sensitivity Data= '." ~'Groundwate~ Drilling, Boring Logs . ~Location of Water Wells ~Statement of Underground Conduits ~ ~Plot Plan Featuring Ail Environmentally Sensitive Data . ' .':'"' :' ~phot°s Const'~uctton O~awings Location ~Ha~ shee~ sho~tng da:e rece~ve~ and ~at~y oe tnspecLton :tme~ eta '~ ' ' ~tscet~aneous . .... . Kern County Ileal'th Depa~ ,t : Division of Environment altb 1700 Flower Street, BakerSfield, CA _(80§) 861-3636 AG )lication Date 93305 . ' APPLICATION FOR PERMIT TO OPERATE UNDERGROUND .... · .. HAZARDOUS SUBSTANCES STORAGE FACILITY . Type Of Application (check): ,. ' .: ,.. ~]New Facility OModification Of Facility ~Existing Facility ~TranSfer Emergency 24-ltour Contact (name,. area c°de,' phone): Days (~) ' No. Of Tanks Type Of Business (check): ~Gaso]ine Station ~Other (describe) ,~0~ .',-Is Tank(s) Located Ou An Agricultural Farm? .:~,, .... '~ ~ .~Yes ~No, k ~ Is Tank(s) Used Pr~mari~r AFriculturaJ. PurpOseS? '.~(:s Facility Address , ~ '~.~-~~ Nearest Cross St. ~. ,.-' R SEC · (Rut'al 'Locations Only)-' .... :-, ~ '_-,-:" -,.~:~ · ,. " · ',' ...:- Owner ~r.0. ~[~P.I/~F~ -T~T' ''' '- Contact person"l~q~g~ ~:l~~. Address ' ~ ~ ~ z ~ ' ZiP ~~ : Telephone '~Z~- I~ -' ': Operator '~~ ~~ ~D~(~ Contact Person ~ · ... ddress zip q. Oq Telephone i/~.~.· ". :: :. · ..,. ".: .... -... ~ ...' -. .:: ._~ ;.:-.,. .. .... -: ,~:.~;.~ ......... :::~:~.~':-~:,'.~:~,.~., .~,: Soil Characteristics At Facility - ~ ~ ,. ...... J Basis For Soil Type and Groundwater Depth Determinations -- C. ConLractor ' ~ CA ConErac~or's License No... Address ~0 ~. ~t~ Zip ~0~ . Telephone . [ Proposed Starting Date -M]~ Proposed Completion Date ~orker's Compensation Certification No. ~/~ Insurer D. If This Permit Is For Modification Of All Existing Faci ] ity, Briefly Descri! Modifications Proposed Tank(s) Store (check all tt~at apply): Tank It ~aste Product Motor Vehicle Fuel O 0 0 Chemical Composition Of Materials Stored (not necessary for motor .vellic]e ' fuel. s) Tank # Chemical Stored (non-commercial name) CAS # (if known} Chemical Previous~.~i Stored ~ A~OLI~J~ (~[M(~)~) (if different) Transfer 0__[~ Ownership Date Of Transfer Previous Facility Name I, Previous Owner accept fully all obligations of Permit No. issued t I understand that the Permitting Authority may review modify or terminate tile transfer of the Permit to' Operate this underg,-ound stora? facility upon receiving this cOmpleted form. This 'form has been completed uoder p*~.n;~;ty of perjury and to the best of my knowledF, e is trm Signature l'J.l:le 0 . l)ate ~ ~ q'ANK # t. Ta~.__3k i_~s: [~] Vautt!ed · ~ Ca.I)on Steel [] Fi berglass-Re.i n Ifovced PIas t.ic ['-] Other (describe): Primary_ Containment' ' Date Installed Thickness'(Inches) [] SLa:ir~less S~ee] [] l'°lyvinyl Chloride~'..E] Fiberfflass'Clad Stee. [~[ COlLCret:e [-1 Aluminum .~ Bronze ~'Unknown CapaCity (Gallons · :' 72k: Manufacturer. '" 4,. 'l'unk Se. condupz (Junta.inmenL ,. ~ l)oubl, e-Wall ~ Synthetic Liner D Lined Vault ~ NOli'~':}?~ Unknown .;:'."'::~.:'~;:": . ~ Other- (describe): MonufactureL.' - . Material Thickness (Inches) '.~5~:¢¢~¥.Capacl-ty (Gals.) · :' ' ' :5. 'Tank Interior Lin/ny ~" . · I" ~, Rublmv ~ A.lkyd ~ Epoxy ~ Ph'enolJ. c [~ Glass ~ 'Glay. ~ Unlined ~ Unknm, . ,. . . '~% .. ~ O~t her' (describe): ':~' ''" 6 Tank Corrosion ProLection '" '' ' -" : ":%~b "" -' ~ ' "' .~ 6alvanized ~ Fiberglass-Clad ~ l'o'iyethyle]m Wrap 2~;~yinyl Wrapping . ~ Tar oP Asphal~ ~ Unknown ~ None ~ Other (descPt'be).: ' .. ... Cathodic lh-o~ection: ~ None ~ Impressed Curreat System "~:?.~Sacriflcial Anode Systc [~ Describe System ~ Equipment: ...... ~..~.~.~ ..... .,'?,. L~a]( ?eCectJml, Monitoring, and Interce~q ..- - ' ~+?.; ~j:...;..:~,.~.::.-, ::~:.~-,; .... "a. ~? ~ Vlsaal (vaulted .tanks only) ~ 6round~va't'e~?gi~'~i'~'inZ'Well(s) ":::.,:~.:','..' ~ Vadose Zoue Monito[-.Ing We]..[(s) ~ [J-Tube Without CJner. -[:] Il-Tube wik:h COJ, l)atibJe I,iner Dir,cl:.inl[ F[mv To ~onltoring Well(s)* ~ Vapor lle~ectov *~ Liquid here1 Seas,r* ~ Conductivity Sensor* ~ Pressure Sensor In Annular Space Of Double Wall Tank * ~ Liquid Retrieval & InspecClon From U-Tube, ~lonito~ii~g Well Or Mmulav Space p~il)atly Gauging, & Inventory Reconciliation ~ Periodic Tightness Testing Nune ~ Unknown ~ Other ' " b. ny: ~ Flow-Restricting Leal< Detector(s) FoP Pressurized Piping* [~ Monitoring Sump With Raceway ~ Sealed ConcreCe Raceway ~ [lalf-CuC Compatible Pipe Raceway ~ Synthetic Ciner Raceway ~ None [_'~[ Unl<nown [-~J Other *l)escvibe Make & Model:. 8, 'rani< llas This Tank Been 'ri ghtness 'l'e~ ted? /)ate Or Last Tightness Tes~ 9. Tank Rel)ai[' Tank Repair'ed? [~[ Yes ~No. [~] Date(s) Of Repair(s) llascril)e RepaJ rs ~ 10, Over~ill Protection Yes [] No [] Unknown TesLiag Company ()l)(:ral:or Fil.ls, Cuul:t'(Jls, & V.isu~]lly M~)nJl:ol's I,evel Tape Float Gauge ~ Float VenL Valves [~ Auto Shut-Off'Controls Capacitance Sensor ~ Sealed Fill Box ~ None [~ Uul<nown Other: / List Make & Model For Above Devlc, 11, piping a. Undergr'ound I'lpinL~: ._J~ Yes [-[ No ~ Unlqmwn. Material ~~ 'rh/ckness (inches). ~~" Dia,,e~' ~' Maaufacturer ! [~ l'ressure ~ Suct:ion ~ Gravity Al)proximate Length Of Pipe l{un b, Underground Pi. ping Corrosion Protection: ~. Ga!vanized ~ Fibet'glass-Clad [~ Impressed Current ~ Sa'crlficial Ano ~ Polyethylene Wrap ~ E[ec[t'ical isolation ~Viagl Wrap ~ Tar or Aspha ~ Unknown ~ None ~ OCher (describe): Underground Piping, Secondary Containment: '~ Double-Wail ~ Synthetic Liner System ~ None' ~. Unknown' ~ Other (describe): cae...v~ · RE$OLI RCE .'Iv~NAGEMENT A'GEN.~ ,'l HEALTH SERVICES OEPA/NT/. ~" M" ~,'S~E~ ;~ ]sOITE 300, (805)861-3636 .'' ....;' ,.' 3~'k'~ .~ "':' c. 'Modified Invento¢y COntrol I :d. '.;In-tank Level S~sing Device '2. SECONOARY CONTAINMENT MONITORING: a. Liner b. Double-Walled tank c. Vault 3. PIPING MONITORING: '~. Pressurized Suction c. Gravity 4. OVERFILL pRoTECTION: TIGHTNESS TESING NEW CONSTRUCTION/MODIFICATIONS CLOSURE/ABANDONMENT UNAUTHORIZED RELEASE' MAINTENANCE, GENERAL SAFETY, AND OPERATING CONDITION OF FACILITY 2700 "M" Street, Suite 275 .... ·, . :..'." ::,.,:_"i';~ .:- .'.:, :: ,. i :.:.,, · -~'2~ "" ,', ..Bakersfield CA. ,93301 ' , '" ' · · 7. ~ow UMITER (EW) ~ .. ,t :" ' % 1. HOSE CONDITION p ~i ' 0 3. CONFIGURATION ~ - R 4. SWIVEL '" H 0 5. OVERH~D RETRACTOR S E .6. POWER/PILOT ON 7.' SIGNS POSTED ~ * Key to system types: Key to deficiencies: NC= ~t cedified, B= broken BA=Balance HE =Healey M= missing, TO= torn; F= flat, TN= tangled RJ =R~ Jacket GH=Gulf Hasselmann AD= needs adjustment, L= long, LO= Joose, HI =Hi~. HA =Hasstech S= shod MA= mi~ligned, K= kink~, FR= frayed. INSPECTION RESULTS Key to inspection results: Blank= OK, 7= Repair within seven days, T= Tagged (nozzle tagged out-of-order until repaired) · U= Taggable violation but left in use. COMMENTS: - VIOLATIONS: SYSTEMS MARKED WITH A "T OR U" CODE IN INSPECTION RESULTS, ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 412 AND/OR 412.1. THE CAMFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH DAY OF VIOLATION. TELEPHONE (805~,861-3682 CONCERNING FINAL RESOLUTION OF THE VIOLATION. . ~ .. NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, REQUIRES THAT THE ABOVE MSTED 7-DAY DEFICIENCIES BE CORRECTED WITHIN 7 DAYS. FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION i~ .,, ~' .~.~ i~.,!~:.. 'KEI ouNTy AIR POLLuTioN CON' ~DiSTRICT .i ' . '-;~" · '~ -' - "'" ""-2700 M"street, Suite275 .... "~:.~"' ' .- '" .:.~-~ ..... ':. .... · · Bakersfield, CA. 93301' :. - ,. . ' . . ,.,:,. , ',*. . .¢ i .' ~: ::::?::::~:~:~-~ :: ~mp~y Maili~ Add.ss" ....... BROKEN OR MI~IN6 R~ CAP .7 V~R C~S NOT "RS~ERLY S~TED 8. ~SKB MISSING BOM R~ CAP 9. ~SKET MISSING FROM VAPOR CAP 11. VAPOR ~APTOR NOT TIGHT 12. ~SKET BE~EEN ADAPTOR & FI~ ~BE MISSING / IMPROPERLY SEATED 13. DRY BR~K ~SK~ DETERIO~TED 14. EXCESSIVE VE~ICAL p~y IN COAX~L FI~ ~BE 15. COAX~L FI~ ~BE SPRING MEC~NISM DEFEC~VE 16.. TANK DEPTH M~UREMENT 17. ~BE ~NG~ M~SUREMENT 18. DIFFERENCE (SHOU~ BE 6" OR ~SS) 19. O~ER ~. COMME~: · ~' WARNING: SYSco-MS MARKED WITH A CHECK ABOVE ARE IN VIoLATIoN OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 209, 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,0OO.00 PER DAY FOR EACH VIOLATION. TELEPHONE (805) 861-3682 cONCERNiNG FINAL RESOLU- . ~¢r'~-,A- 'lION OF THE VIOLATION(S) ¢rCr~,~.CrC~Cr~rCr,~C~,~.~,~,~,A,~C,,Cr~Cr~,A,~~~~ 9149-1010 APCD FILE SMC Laboratory Analytical Chemistry~ Client'Name: Anderson Geotechnical Address : 4701 Columbus Suite 4 Bakersfield, Calif. 93308 Attention : Mr. Richard-Anderson Date samples received : 10-23-91 Date analysis completed: 11-05-91 Date of report : 11-07-91. Project Name: Oak Street Car Wash Project ~ : N/A P.O. ~ : N/A RESULTS OF ANALYSIS: ~3989 ID: South End 2 ug/g MDL,ug/g Benzene .0080 .0050 Toluene .028 .0050 Ethylbenzene .0052 .0050 o-Xylene .0085 .0050 m,p-Xylene .026 .0050 Isopropylbenzene ND .0050 TPH (Gasoline) ND 1.0 Method of Analysis .for BTX/GASOLINE: 5030/8015M FID MDL = Minimum Detection Level TPH = Total Petroleum'.Hydrocarbons ug/g = micrograms per gram (ppm) ND = None Detected Analytical Chemist 3155 Pegasus Drive · Bakersfield, CA 93308 · (805) 393-3597 P.O. Box 80835 · Bakersfield, CA 93380 ° FAX (805) 393-3623 RESULTS OF ANALYSIS: ~3990 ID: South End 6 Benzene Toluene Ethylbenzene o-Xylene m,p-Xylene Isopropylbenzene TPH (Gasoline) ugm/g .0068 .020 ND ND .012 ND ND MDL,ugm/g .0050 .0050 .0050 .0050 .0050 .0050 1.0 ~3991 ID: North End 2 Benzene Toluene Ethylbenzene o-Xylene m,p-Xylene Isopropylbenzene TPH (Gasoline) ugm/g ND .059 .037 .12 4.8 .11 9.9 PQL, ugm/g .025 .025 .025 .025 .025 .025 5.0 ~3992 ID: North End 6 Benzene Toluene Ethylbenzene o-Xylene m,p-Xylene Isopropylbenzene TPH (Gasoline) ug/g ND ND ND ND ND ND ND MDL,ug/g .0050 .0050 .0050 .0050 .0050 .0050 1.0 Robert J. Michels Analytical Chemist CUSTODY iR.ECORI) Location of Samm!inq Name: Te!eohone: ( ) Collector Address: Telephone SMC laboratory 3155' Pcg~ Ddve Bakcm~el~ CA 93308 Telephone: (805) 393-3597 FAX: (805) 393-3623 $S~mo!in~ Method: Samo!e No. Date Samo!e Tvoe: Preservation Methods: Time Descriotion I Ana!vsis Reeuested' I Laboratory No. R---nqu_sn_d By: l_.._ciu,sn__ By: Company: Date: Received By: Company: Date: Re!in_~uished By: Company: Date: ~Received By: Company: Date: Sheet 'of .......... i .... [y ot accuracy as prescribed b h g o, mea.s, ureo, or counted by a wei hmas ' ' s c ' administered by the Division of Me~sure =-~ ~,- y C_apter 7 !comme_nctng w~th Section 12700 · · ~ ter, who,se,, mgn. ature Is on th ertif cate, wh · m ....... ndards u, the Ca!,fornia Uepartment of Food and Ag~lc°ufltuD~'.s'°n5 of the Cahforma Bus,ness and Professions ~ol~ea," GOLDEN STATE I,'IETi:iLS. ;[Iq[.:, 2000 i.E..:. BRLJNDAGE L.~::INE:: BAKERSF I EL,.D., CA WH i · HHITTEN ESCAgA-t-ION TICKET 38589 Corem od i t y T A NK L:'~ W e i g h t P r. i c e .100% 4.59 ~01 Amount . 05 .9 W e i g h t s N e t 44300 POUNDS ~lc.~ POUNDS 9~0 POUNDS 8/L Caf'tier. License:l~ Dr'i vet I. C. Re m a'r"J~ s ]"LYi'AL DUE > > > > Deduct i on Adj. Net, o POUNes 9180 P~UND,S Date: 10/22/91 Time: 'Gross 14.59 p.m. 'l'ar.e 15. 16 p.m. GOLDEN STA'I'E METAL. S, INC,. Wei ghmast er Gross:LINDA FIAMMOND Tare :LINDA HAMt'4OND CASH P,[ C::E I V ED B Y >>>> //difo/rnia--Health and Wel;sre Agency ./~roved OMB No. 2050---0039 (Expires /~. (Form designed for use o UNIFORM HAZARDS WASTE MANIFEST 600 Oak S~., Bakersfield, CA ~.,.r.~o,'. Pho,.~ 80~ 327-2711 I Company Name n~a] Service 2 Company Name d Facility Name and Site Address Gibson 0il & Refinery 475 S~;aport Blvd., t) See Instructions or ( t2*pitch typewriter), and Front 6. US EPA ID Numbs[ u~ EPA ID Number tO. US EPA ID Number t 1, US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers NOS -ORNE - NA (Liquids) 9189 (Benzene* :k of Page 6 Department of Heallh Service 7' Toxic Subslances Control D/v/sic Sacramento, Cal/forni ~rmation in the shaded areas ~ ~-~; ;~;~, ,aw. A. State Ma~ ........... 8525436' B. State Generator's ID ~ _ ~174~,~,9,3, . .~ 89-4970 _ F. Transporter's Phone ~ State Facility's ID 13. Total Quantity Waste No. 6223 and tu GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aCcurately described above by proper shipping name national government regulaliona. ' ~.~ If I am a large quanlity generator, I cerlify that I have'a program in place to reduce lhe volume and toxicity of Wasfe generaled to the degree I have determined to be economically practicable and that I have selected the practicable method of lrealment, StOrage, or disposal currently available to me which minimizes/he present and future threal Io human health and the environment; OR, if I am a small quantity generalor, I have made e good faith effort to minimize my waste f~J_~ I ~'""eu~_..[Yped Name ~ "-------- -------.-___ ~ e and that t can afford r, -- "' ........ ~ ~rler t cknowledge[dge~menmen/ofJReceipl o~f Materials ........ DHS 8022 A (I/88) EPA 8700--22 (Rev. 9-88) Previous ediUons are obsolete. White: TSDF SENDS THIS COPY TO DOHS WITHIN 30 DAYS To.. P.O. Box 3000, Sacramento,. CA 9,5812 Month - Day Year Month D~ Mon~ GOLDEN STATE METALS, INC. P. O. Box 70158 · 2000 E. Brundage Lane Bakersfield, California 93387 Phone (805) 327-3559 · Fax (805) 327-5749 Scrap Metals, Processing & Recycling r's License No. Contractor'~ N© 10117 DISPOSAL FORM ~CTOR: ~-~--'~-~ _ ~ ~ ---- ~ ~ -- Phone No. DESTINATION: G.S.M. - 2000 E. BRUNDAGE LANE · BAKERSFIELD, CA 93387 QTY GALLONS SERIAL NO. NET TONS TOTAL WEIGHT CERT. NO: .14 COUNTY: 250 550 .24 TANK INSPECTION [~'~AN & DRY (ACC'EPT), OR [] RESIDUALS PRESENT (REJECT) _ LEL READING OXYGEN CONTENT DISPOSAL FEE _ SCRAP VALUE ~ OTHER 1000-6 ~ .61 2000 .97 3000 1.32 5000 2.42 7500 3.28 9000 3.82 120o0 4.93 TOTAL All fees incurred are per Icad unless specified. Terms are i!iiiii!~ iii!iii~ii~=:::=?i!!iiii~ iiiiiii!ii~~~ ............ net 30 days from receipt of tank. Contractor's signature represents acceptance of terms for payment, and confirms lhaltankremovalcomplieswithStatelaws. CONTRACTOR'S SIGNATURE 'CERTIFICATE OF TANK DISPOSAL / D~STRUCTIOI~ -- K(S) AS SPECIFIED ABOVE. ALL MATERIAL SPECiFiED WiLL BETHIS TOC ¥ THE RE TAND ACCEPTAN COMPLETEL' · ' _tdl DATE WHITE-- Con,actor Copy · YELLOW ~ Rle Copy . PINK ~ Perma~nt Copy Bakersfield Fire Dent~. HAZARDoUs MATERIALS DIV*-ISIO'~'N · PERMIT No..-~--L.~' / PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE ·TANK 'SlaTE INFORMATioN ~ SITE Oak Street Car Wash ADDRESS 600 Oak FACILITY NAME _Oak Street Car Was~Ross STREET TANK OWNER/OPERATOR J.O. Barber Trust MAILING ADDRESS 4600 Wible Rd ~CONTRA'CTOR INFORMATION COMPANY Triple j~ C~nstruction PHONE No. (_209) ADDRESS ~232 Fairview Ave - 686-620~ICENSENo. A569 970 INSURANCE CARRIER Golden 'Eagle _ CITY Tular~. _ ZIP C~DE 932/4 - · WORK~ENS CO'MP No. _W~'~ 8~)4'82751. PREL. IMANARY ASSEMENT INFORMATION ~7/- qSP~ ' ~OMPANyAnderson & Assoc - PHONE 8~ ADDRESS ~,# 4 No, ~ 5~ ~ LICENSE No. INSURANCE CARRIER a A ~n CITY _Bksf ZIP CODE 93306 WORKMENSCOMP~o. 1238156-~ ZIP CODE 93304 APN Dracena - _ PHONE No. ~ CITY Bksf ZIP CODE 93313 -- T_ANK CLEANING INFORMATION COMPANY Whitten Excavation i.. ADDRESS P.O. Bn~ WASTE TRANSPORTER IDENTiFi~-~i~-~~R 000083121 NAME OF RINSTATE DISPOSAL FACILITY Glbson Re£i~ery_ ADDRESS 2401 Gibson Oil ------ CITY Bksf FACILITY INDENTIFIC~ CAb98088-~177 TANK TRANSPORTER INFORMATIOn" COMPANY Whitten Excavation PHONE No.631-8455 . ADDRESS P.O. Box 70488 TANK DESTINATION '. Golden State Metal PHONE No. 631-8455 CITY Bakersfield ZIP CODE 93387 ZIP CODE 9330~ LICENSE No. 501739 CITY Bakers field ZIP' COD83387 TANK No. , AGE 1 13 Yr VOLUME 10,000 .TANK INFORMATION CHEMICAL _ STORED Unleaded Gasoline DATES CHEMICAL STORED PREVIOUSLY STORED .0/78-6/91 THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF My KNOWLEDGE, iS TRUE AND CORRECT' APPUCANTNAME(PmNT) ~ ~UCAN~S~GNATORE ~. THIS APPLICATION BECOMES A PERMIT WHEN APPRovED ,/ 15::37 GIBSON OIL & REFINING CO., INC. LIQUID WASTE PROFILE SHEET Effective October 1, 1990 PAGE 82 Pleose fill-In co..mj;j._letely all area8 th~ a ............................................ ~P~ 10 ,.Our material, an a_.p.~l~), not on app,royoll ........ ~ ...... This Is TRANSPORTER CONTACT TELEPHONE .... EPA I.D.# TITLE ..,...~_ EPA I,D.# ACTIVITY PRODUCING WASTE .... DO~8 THIS WASTE CONTAIN OIL? ~ YE8 OR APPROXI~TE ~NCENT~T~NS (~u~ for ' I~ ~ WASTE A RORA TOLP WASTE? ~ YE8 OR IS ~1~ WASTE A RO~ F-, K-, P, OR U- LISTED WASTE? ~ YE~ OR ~ NO ' ' .t: ~ES THIS WA8~ ~NTAIN ANY LEAD, CHROMIUM OR OTHER O A M 17'M IFYES, WHAT SUBSTANOES AND AT WHAT ~/~c~n .. ...... .., , . ETAL8? ~ YES OR ~NO . ~ES Tills WASTE (YES/Np) CONTAIN ANY: REACTIVE CYANIDES~__REACTiVE SULF~OES~~'TOX~_PCB,S ~ ~. PHENOLS ~ .. OR~NIC CHLORIDES. OR OTHER HAL~ENATED COM~UND8_ IF YES. WHAT COMPOUNDS AT WHAT ~NCENT'~T~N (mg~ SPECIAL HANDLING INFOR~T~N ~ t O~ ~:"'":G"'~'g~ o "' ro ~ES'r OF MY KNOWLE~E, I CERTi~ THAT ~E ABOVE INFORMAT~N FACILITY DECISION ACCEPT REJECT COMMENTS: FACILITY MANAGER ---"----'-~-- DATE O Recycled Paper UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK) / CONTAMINATION SITE REPORT EMERGENCY . HAS STATE OFFICE OF EMERGENCY SERVICES ' ¥:AGENC~ii, ~DRESS ~S OI~HARGE BEEN STOPPED ? ~ ~PAIR T~K ~ "EPEE T~K ~S ~ ~ =IFYESDA~. ~. j' ~ ' ~ REPAIR PIpING "~ CH~GEPR~EDURE ~' PJPI~GL~ ~ O~ER ~ ~R<SION . ~K<WN ~ O~ER ~E~ ONE ONLY [] UNDETERMINED ~ONLY-[:~] GROUNDWATER [] .RiNKiNGwATER. (CHECKONLYIFWATERWELLS,AvEAcTUALLYBEENAFFECTED) [] PREI]MINARYSITEASSESSMENTWORKPLANSUBMrn'ED [] POLLUTION CHARACTERIZATION IMINARY SITE ASSESSMENT UNDERWAY [] POST CLEANUP MONITORING IN PROGRESS CLOSED (CLEANUP COMPLETED OR UNNECESSARY) [] CLEANUP UNDERWAy [] EXCAVATE & DISPOSE (ED) [] REMOVE FREE PRODUCT (FP) [] ENHANCED BE) DEGRADATION, [] EXCAVATE & TREAT (ET) [] PUMp &?REAT GROUNDWATER (GQ [] REPLACE SUPPLY (RS) NO ACTION TAKEN [] LEAK BEING CONFIRMED . [] REMEDIATIoN PLAN CHECK APPR. R.R~PRIATE ACTION(S) ? CAP SITE (CD) ' ' [~. CoNTAINMENTBARRIER (CB) [] . VACUUM EXTRACT (VE) [] NO AOTION'REQUIRED (NA) [] OTHER (OT) ] TREATMENTAT HOOKUP iHU) [] VENT,SOlE (VS) MARK ONLY [] STATE OF CALIFORNIA .............. STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A ' COMPLETE THIS FORM FOR EACH FACILITY/SITE 1 NEW PERMIT [] 3 RENEWAL pERMIT [] 5 CHANGE OF INFORMATION ~ PERMANENTLY CLOSED SITE ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS- (MUST BE COMPLETED) ADDI~ESS - ~ -. ~ NEAREST CROSS STREET PARCEL# (OFTIONAL) TO INDICATE J~ CORPORATION~ UAL r---J PARTNERSHIP ~ LO~AL-AGENCY J'-'-J COUNTY-AGENCY J---J STATE-AGENCY E~] FEDERAL-AGENCY DISTRICTS EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON SECONDARY) - optional DAYS: NAME (LAST. FIRST) PHONE # WITH AREA CODE DAYS: NAME (LAST. FIRST) NIGHTS: NAME (LAST. FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST. FIRST) PHONE # WITH AREA CODE II. PROPERTY OWNER INFORMATION- (MUST BE COMPLETED) MAILING OR STREET ADDRESS II1.' TANK OWNER INFORMATION- (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION _ ~/ box to indicate ..,~"~IVIDUAL [~ CORPORATION ~ PARTNERSHIP LOCAL-AGENCY E~ STATE-AGENCY COUNTY-AGENCY . [~] FEDERAL-AGENCY J PHONE # W~TH AREA CODE NAME OF OWNER MAILING OR STREET ADDRESS J CARE OF ADDRESS INFORMATION ~¢..,¢.,/'~II. ,/ box to indicate ~ INDIVIDUAL ' J I'---J CORPORATION [~] PARTNERSHIP STATE ZIP CODE LOCAL-AGENCY ~ STATE-AGENCY COUNTY-AGENCY [~] FEDERAL-AGENCY PHONE # WITH AREA CODE CITY NAME IVl BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 323-9555 if questions arise. TY (TK)HQ I I I I I I V. PETROLEUM UST FINANCIAL RESPONSIBILITY' (MUST BE COMPLETED)- IDENTIFY THE METHOD(S) USED SELF-INSURED ~ 2 GUARANTEE ' ~ 3 INSURANCE E~ 4 SURETY BOND J ~ $ EXEMPTION ~"~"HER I Legal notification and billing will be sent to the tank owner unless box I or II is checked, J~ box t o indicate [---} 5 LE~EROFCREDIT VI. LEGAL NOTIFICATION AND BILLING ADDRESS ICHECK 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, IS TRUE AND CORRECT APPLICANT'SHAME (PRINTED & SIGNATURE) // ~ I APPLICANT'S TITLE ~ . DATE MONT~DAY/YEAR LOCAL AGENCY uSE 0~ ~ . COUNTY # JURISDICTION # FACILITY # LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL 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. FO RM A (5-91 ) FOR0033A-5