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UNDERGROUND TANK
MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority. Cited: Cha~ter 6. Z Health an~ Safety Code; Cha~ter 16. Division 3, T'a~e 23, California Code of Regulmions This form must I~ used to docoment testing and servicing of monitoring equipment. A seoarate ceflit~¢~t~on or reoort must be preoared for e~_eh ~r~n_ !~orin~ system control mmel by the technician who performs the work.-~ c~py of this form must be provided to the tank system ownedoperator. The ownedoperator must submit a copy of this form to the local agency regulating UST systems within 30 days of test dam. A. General Information ~~l of ~o.ito~g sy~m: · ,, Bldg. No.: ._ Com~hO~o.: ~ ~'~/~ B. Inventory of F, quipm~nt Tested/Certified C~---:---": the ::;:i~ '~,.-"-~ ~?, to .... :~ '"i-=~' '. '," T~n,: -ri I~"Annular S~ of Vault Sensm'. Model: CI Fdl ~-..~ ...,---.-,st. - C3 Mechanical 12ne Leak Demetor. Model: Valve(s). Model: ~'.~'_~. ' Model: ~ Model: Mod~l: Model: Model: in Section E on ~r Vault Sensor. Model: :Sump I Trench Sensor(s). Model: Fdl Sump Senses). Model: Tank Ovm~tll / High-Level Sensor. Model: lin Sensor(s). Model: £f/,d~ · Valve(s). D. Resulls of Testing~er~in~ Soflwar~ Version Installed: ~- ~ ~ ~1~.,~ Cl No* Is the pudlbl¢ alnrm operational? ~Y~s C] No* Is the v/.~unl nlnrm oFerafiannl? ~ O No* Were all ~ visunll~ inR~,-rl, func~onally tested, and confirmed opef-dtional? [2"~es C] No* Were nil sensors installed nt lowest point of secondnry contninment and positioned so that'other equipment will not i~te~fefe with _the. ir proper operation? If alnrms are relayed to a remote monitoring station, is nH communications equipment (e.g. modem) Yes 12~.fl* ~ l~A operat/onal? I~s C] No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary contninm~iit o WA monito~g system detects a ~eak, fa~s to opera~.t~x is elect~caUy ct~o~? tf yes: .which sensors ini~ate positive shut-down? (¢hec/~ all that apply) ~l-Sump/Trench Sensors; [~q31spenser Containment :sensors. Did you cfln~rm poRitive shut-down d_~ to leaks and sensor failure/disconnection? ~ [~ No. Yes CI No* For tank systems that utilize the monitoring system as the primnry tank overfill warning device (i.e. no J~I~A mechanical overfill prevention valve is installed), is the overfill warning alnnn visible and audible nt the tank Rll point(s) nna opern6n~ properly? If so, nt whnt percent of tank cnpacity does the nlarm trigger? __% Yes* ~o Was any monitoring equipment replnced? If yes, identify specific sensors, probe~ or other equipment replaced nmi list the mnm_~__fac_-_fl~rer nnm~. nna model for aH replacement parts in Section F., below. Yes* [~"l~o Was liquid found inside any secondary contninmeRt systems desigRed as dry systems? (Check all ~hat apply) [~ Pw,~_ ,ct: f=' Water. If yes, describe causes in Section ~ below .... I~es Cl No* Wns mnnitorin~ sy=~__e~ set-up reviewed to ensu~ proper settings? Attach set up reports, if applicable ,~]~/es f=l No* Xs all monitoring equipment operational per manufacturer's specifications? * In Section E bdow descrlbe h°w nnd when these ~ weFe oF will be coFFected* E. Comments: Page2~3 F. In.Tank Ga~ I SIR Eq~t: This section must be completed if in-tank gauging equipment is used to p~form leak detection nmnitorin~ I~.~r~s ~1 No* Was accuracy of system water level ~ ~ed? ,, Yes ~ No* W~eallitcm~out~cequipme~~smaint~aanccchccifli~con~lc~cd? Line Leak Detettors (l.!.l~): ~"~O~cck this box if LLDs arc not installed. Yes ~ No* For equipm~t start-up or ~d equipment certification, was a leak ~nuta~ m ve~_fy ~LD perform-ce? ~ N/A (Check a//~ app/y) ~mn~n~d leak ra~ ~ 3 g.p_h.; ~ 0.1 ~p_h; O 0-~ g~p~. Yes ~l' No* W~all!!'i~s~ol~alio~lz~l~w~r~damrYr~luit~m~s? ,,, Yes ~l No* W~~~~y~~ O ~A ~a~7 Y~ O No* W~~~~~s~~~~~? P~e3~3 ~l Monitoring System Cerflfleation UST Monitorin Site Plan lnstFuctions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certificalion. On your site plan, show the general layout of lanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containe~ or oflaer secondary condiment areas; mechanical or eleclronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. S~TEM SETUP ~UG 10. 2004 :3:2~ PM S~S~rEM UNITS U.S. SYSTEM LANGUAGE ENGL l F~TR l P 2698 ~L ~K~F I E~-~ 93306 661-872-8781 ~HIFT TIME I : DIALED SH[~ TI~ 2 : DI~B~ SHIFT TIME 3. : DI~L~ SHI~ Tl~ 4 : DI~L~ PERIODIC T~ ~ENI~ D I ~LED ANNUL ~ ~NI~ D I ~D ~ SECUR I CODE : PRINT TC VOL~ E~BLED T~IP C~P~T I ON V~UE (DEG F ): 60.0 COM~UN IC~T IONS SETUP IN-TANK SETUP T I:U~---'"~---~)., PRODUCT CODE : l THERPtz~COEFF :.000700 TANK DIAMETER : 96.00 TANK PROFILE : I PT FULL VOL : 12000 FI.O~T 8IZ~: 4.0 ~TER ~NING : 2.0 HIGH ~ LIMIT: 3.0 ~ OR ~ VOL: 12000 O~FI~ LIMIT : 9~W : 10800 HIGH P~D~ : : 11400 D~IVE~ LIMIT : : 120 P~D~ : 700 ~LIMIT: 99 S~DEN L~ LIMIT: 99 TANK TILT : 0.00 ~NIFO~ TR~ T~: ~ PERIODIC T~T ~PE 8TANDARD PERIODIC TEb-~T FAIL ALRK~ D I F~BLED GROI~ T~ F~IL A~ D I ~BL~' PER T~ AV~I~: OFF TRNK T~T ~TI~: OFF T~ T~ ~ I P~N BR~ :OFF D~IVE~ DE~y : 15 ~IN T 2 :PLU~ PR~DFEF : · 2 T~L CDEF . OOOgOO T~I-'DIAMET? ' 96. O0 TANK PROFIL I PT FULL VOL 12000 .... 4.0 I NCHE.9 i,~T£~ r,I~aRNI~ : 2.0 HIGH:.W~'I~iR,L1MIT:-' 9.0 I"IRXOR LP~BEL VOL: 12000 OV~FI~ LIMIT : 9~ : 10800 HIGH P~D~ : 9~ : 11400 DELIVEr/ LI~IT : IX : 1~0 L~P~D~ : ~00 ~ ~ LI~IT: 99 ~DEN L~ LI~IT: 99 T~ TILT ' 0.00 T~: ~ ~IODIC ~T ~E ~a~RD P~IODIC T~ F~IL ~ DI~LED G~T~F~IL ~ DI~B~D PER T~ ~V~I~: OFF T~NK T~ ~TI~: OFF 'TNK ~ SIP~N B~K:O~ PORT SETTI~: ~ BOARD : I (E5-232) BAUD RATE ; 9600 PARITY : NONE STOP BlT : I STOP D~TA LENGTH: 8 r,~TA AUTO TRANSMIT St-."TTING~: AUTO ~ ~d. RRI"I LIMIT D I SRBLED AUTO HIGH ~TER LIMIT D I S~BLED AUTO OVERF ILL L I M I T D I SRBLED AUTO LOW pRODUCT D 1 SABLED AUTO THEFT LIMIT D 1 SABLSD aUTO DEL I VERY .START D 1 S~BLED AUTO DEL I VERY END DISABLED AUTO EXTERNAL I NPUT./O,~ D I SABLED aUTO tDiTERN~L INPUt%' OFF D I SABLE1) AUTO SENSOR FUEL ALARM DISABLED T 3:PREHIUH :. 000700 T~N~ DIAHETER : 9~.00 T~NK PROFILE ; I PT FULL VOL : ! 2000 FLOAT SIZE: 4.0 INCHE~ t~TER WARN I NG : 2.0 HIGH kilTER LIMIT: 3.0 PI~ OR L~BEL VOL: 12000 OVERF/LL LIPIIT : : 10800 HIGH PRODUCT : 95~. : 11400 DELIVERY LIMIT : : 120 LOW PRODUCT : 700 LF~: AI..~RM LIHIT: 99 SUDDEN LOSS LIMIT: 99 TANK TILT : 0.00 NANIFOLDED TANKS Tit: NONE PER I OD I C TEST TYPE ,STAND~RD PERIODIC TEST FAIL ALARM D I F:~BLED OROSS TEST F~ I L ~ D I ~L~ PER T~T ~i~; OFF T~NK ~T ~TI~: O~ T~ T~ SIP~N BR~:O~. D~IVE~V~E~y : 15 ~IN T 4 :DII~~ PRODUCT CODE : 4 THERMAL COEFF ' :,000450 TANK DII¥~C'TF~ : 96,00 TANK PROFILE : I PT FULL VOL : .12000 FLO~T SIZE: 4.0 INCHES [~TEE WARN 1 Nfl; : 2.0 HIGH t~TER LIMIT: 3,0 _.~ ~..OR I~BEL~.VOL: .12000 .... 'OtERFI~"LI M I T : ' : 10800 HIGH PRODUCT : : 11400 LOW PRODUCT : 700 LF_~X AI. ARH LIMIT: 99 SUDDEN LOE~ LIMIT: 99 TANK T I LT : 0, O0 HRN IFOLDED TANKS TO: NONE PER I OD I C TE,~T TYPE STAND~RD PERIODIC TEST FAIL ~ D I BARLED GROSS TEST FA I L ALPd~5~{ D I .%qBLED pER TEBT..~I~: OFF TANK. TI~T NOT I F-~: OFF TN{( ~ SIPHON BRF_~K:OFF DELIVE{~ DF_J.~¥ : 16 HIN LiOUID SE'N~.ETUP L I: UNL b--'TP TR I -STATE ( S I t~3LE FLO~T C~TEGORY : STP SUMP L 2:UNL ANN TRI-STATE (SINGLE FLOAT) CRTF. GORY: ANNUI.~R SP~E L 3:PLU~ STp TRI-STATE (SINGLE FLO~T> CATEGORY : STP SUMP L 4:PLLB ANN TRI-b~ATE (SINGLE FLOAT> C~TEGORY : ANNULP~SPACE L 5:PREM STP TRI-STATE (SINGLE FLO~T) ¢'~TEGORY : b'TP SIJi'IP L 6:PREM ANN TRI-STATE (SINGLE FLOAT) CATEGORY : ANNUIJ:~R SPACE L 7:DIESEL STP TRI-STATE (SINGLE FLOAT> CATEGORY : STP' SUMP L 8:DII~EL ANN TRI--S'rA'II~ (SINGLE FLOAT) C~TEGORY : ANNULAR SPACE L 9:DISP 1-2 TRI-STATE (SINGLE FLOAT) C~TEGORY : DISPENSER PAN T~ HONTI-ILY : ALL TANK WI~r..K I MON ST~6~'I'TllgE : 2:00AM TEST DURATION LIO:DISP 3-4 TRI-STATE (SINGLE FLOAT) C~qTEGORV : DI~PEN~ER PAN LII:DI~P 5-6 TRI-STATE (SINGLE FLOAT) C~TEC, ORY : DISPENSER P~N LI2:DISP TRI-STATE (SINGLE FLOAT> CATEGORY : DISPENSER PAN LI3:DISP 9-10 TRI-STATE (SINGLE FLOAT) CATEGORY : DISPENSER PAN OUTPUT RELAY SETUP R I:UNL TYPE: STANDARD NORI~LL¥ CLOSED N-TANK Al_REMS T I :LF~K ALARM L I QU I D SENSOR ALPE~ L I :FUEL RLRRPI L 2 :FUEL AlaRM L 9 :FU~ LIO:F~ ~ Ll 1 :F~ R~ LI 2 :FU~: LI3:FU~' L I :S~RT ~ L 2:SHORT ~ L 9: SHORT L l 0 :SHORT ALARM Lt I :SHORT LI 2:SHORT LIB:SHORT ALRER R 2 :PLI.~ TYPE: NORMALLY CLOSED' N-TANK RLRRPE~ T 2: LEAK LIQUID SENSOR ALMS L 3 :FUEL L 4:FUEL ALLAH L 9:F~ fl~ LIO:FU~ LIt :FUEL R~ LI2:FUEL LI3:F~ ~ L 3:S~ ~ L 4:S~ ~ L 9 :SHO~ ~ LI O:SHO~ ~ Ltt :B~ R 3 :PREM TYPE: STANDARD NORi~LL¥ CLOSED IN-TANK T 3:~ LIGUID SENSOR AI.~S L 5:FUEL ALARM L 6:FUEL ALRRH L 9:FUEL ~ LID:FUEL ~ L1 1 :FU~ ~ LI2:F~L LI3:FUEL ~ L 5:S~RT L 6:S~ ~ L 9:~RT ~ LI 0:~ ~ R 4:DIE,,qEL T'¥'PE: No~ND~RD ~ m"a~LL¥ CLO~ED HISTORY RFJ>ORT SENSOR ~ ..... L i :UNL ~ 5'l'P SUMP FUEL AUG tO, 2004 3:26 ALP&afl HIb~TOR¥ REPORT ...... SEN~ORA[~RM ..... L 2:UNL ANN ANNUI..~J~ SPP~E FUF. J. ALREM AUG 10. 2004 3:30 Piti ALARM HIb-'TORY REPORT ..... SEN~OR ALARM ..... L 3:PLUS STP STP SUMP FUEL ALARM AUG 10. 2004 3:27 ~ RLR~ HIb--'TORYREPOET ..... SENSOR RLRRH ..... L 4:PLUS ANN ANNULAR SPACE FUEL RLAE~ AUG lO, 2004 3:30 PPi ALAEM HISTORY REPORT ..... SENSOR ALARM -'-,I- L 5:PREH STP STp SLIHP FUEL RLRRH AUG tO. 2004 3:28 PM %RM H tSTORy~T _-- SENE~)R t~4..~M ..... G :PR~ ANN INU~R SP~E IEL ~ lO, 2004 3:31 PM RLAB~ 14 ISTORY REPORT ..... SENSOe AU~41 ..... LII:DISP 5-6 I b I SPENSER PAN I AUG 10. 2004 3:35~PM %L~RM HISTORY REPORT ..... s£~OR ALARM ..... L ?:DIESEL STP FUEL RLARM RUG 10, 2004 3:29 Pti ALR~ HISTORY REPORT ..... SENSOR ALARM ..... LI2:DISP ?-8 DISPENSER PAN . FUEL AI.,AR~ AUG lO, 2004 3:36 ~1 p,I.~RM HISTORY REPORT ..... SENSOR ALARM ..... L 8:DIESEL aNN RNNULAR SPACE FUEL RLARM AUG 10. 2004 3:32 PM FUEL RI.~ 4 alk3 6. 200 3:39 PM ...... HIb-"TORY REPOi~ ~ SENSOR RI-~ LI3:DISP 9-10 DISPEN~BER PAN FUEL RUG 10o 2004 3:37 PI"I ALARM H1STORYREPORT ..... SENSOR AL,~H ..... L 9:DISP 1-2 DISPE~ER pAN FU~L aLARm RUG lO. 2004 3:34 PM ALARM HISTORY REPORT ..... SENSOR RI..~Pt ----- LIO:DISP 3-4. DISPENSER PRN FUEL &LIG !0. 2004 3:35 PM Ru~ 08 04 O?:3Gp Ron Ro~eps~ ".,cri~OF~ OFFI~ OF ENVIRO~.a,~. EERVIC~ 1715 Oaester Ave., B~__k~-rslileld, CA (661) 326.3979 a~PI~C~T/ON TO Pl~ll~Ol~ FUEL MONITORll~G CI!IR.~~TION DATE&TiMEIt!S1, iSTOBB~...ONDUCTI't]~ ~..__/'0--~.~.'. / O0.~,a.. SIGNATURE OF APPI. J. EANT HaZardous Materials/HaZardous Waste Unified Permit ON REVERSE SIDE ~ :~ Thle _~ermit ia iee__-~_ for the followin~: , [] H,,-,,~lou$ Materials Plan n Underground Storage of HazardOus Materials n Risk Management Program [3 Hazardous. Waste On-Site Treatment' Permit ID #:: 015.000.000622 FASTRIP FOOD STORE #26 LocATION: 2698 OSVVELL ST · TANK 015-000-000622-0001 015-000-000622-000; 015-000-000622-000: 015-000-000622-000, ISSued by: HAZARDOU REGULAR GASO DIESEL FUEL #2 PREMIUM GAS( UNLEADED PLU; Bakersfield Fire Department D~SPE 'IUTOFF lNG {UTOFF ~UTOFF ~ ~..~, OFFICE OF ENVIRONMENTAL SER VICES' , · 1715 'Chester Ave., 3rd Floor " .:::;'· .ApOrooedby: ' Issue Dale Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID//015-021000622 FASTRIP FOOD STORE #26 LOCATION 2698 OSWELL HAZARDOUS SUBSTANCE REGULAR GASOLINE DIESEL FUEL #2 PREMIUM GASOLINE~ REGULAR GASOLINE .D CA S S This permit is issued for the following: .... Js Materials Plan round Storage of HazardoUs Materials .... Program Waste TTT PIPING PIPIN METHOD ONIT PRESSURE ALD PRESSURE ALD PRESSURE ALD PRESSURE ALD Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENT. d L SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 Approved by: Expiration Date: December 22, 1998 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. This permit is issued on this 2na day of November, 1998 to: FASTRIP FOOD STORE #26 Permit #015-021-000622 2698 Oswell St Bakersfield, California 93306 CORRECTION NOTI. BAKERSFIELD FIRE DEPARTMENT N~ . 0 ~'~'1 You are h'ereby required to make the following cor~ctions at the above l~ation: Cot. No Completion Date for Corrections ~/7.//~'~ 'i'" :: ii "~'- ' "Inspector :'. .... "326-3979' ..~...., FA;-3TR I t::' 2698 OFJWELL BKFD CA 661 =~'72-8781 JUL ?, 2004 3:08 PP1 SYSTEM ~TATtJ~ REPORT ALL FUNC. T I ©l',l~ NORMAL INVENTORY REPORT T I :UNLEADED VOLUP1E = 4257 GAL,Cj ULLAGE = 7775 GALS 90~: ULLAGE= 6571 GALS TC:. VOLUPIE = 4175 GRLFJ HEIGHT = 36,BB INCHES WATER VOL -: 0 GALS WATER = 0. O0 INCHES TEHP = 87.4 DEG T 2 :PLU~ VOLUME = 5459 GALSi LLR~E = 6573 GAL~ 90~ ULLAGE= 5389 GALS TC VOLUP1E = 5357 GALS HEI_,HT = 44.51 INCHEB WATER VOL = 0 GAL~ WATER = 0.00 INCHES TEPlP = 86.7 DEG F T 3:PREMION VOLUNE = 3518 GAL~ ULLAGE = 8~14 GAL~ 90~.; ULLAGE= 7310 GALB TC VOLUP1E = 3455 GAL~ HEIGHT = 32.05 INCHES WATER VOL = 0 WATER = 0.00 INCHES TENP = 85.4 DEG F T 4 ;DIEBEL VOLUME = B217 GALS ULLAGE = 90~.~ ULLAGE= 2611 ~L~ TC VOLUP1E = 8105 HEIGHT = 62.00 INCHE~ ~TER VOL = WATER = 0.96 I NCHE~ FACILITY NAME CITY OF BAKERSFIEI,D FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.,.3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program Routine '~ Combined ~1 Joint Agency Type of Tank ,..~IK] [z~ O,, ~> Type of Monitoring O..L.- ~ [21 Multi-Agency ~._C0mplaint Number of Tanks Type of Piping ]L-')VO ~ Re-inspection OPERATION C V . COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Office of~ronmer~t~l ~erv(~(6~6-3~i,¢ _ inv. Svcs. Pink - Business Copy xN~tnes~TSite Respon~/ble Party Bakersfield Fire'Dept. Enironmental SerViCes ~1715"~h~ster Ave. Bakersfield, CA 93301 Tel: (661)326-3979 ADDRESS ..... . ........ . p~oyee~ .......... FACILITYCONTACT ............................................................... ~'~n'~-s~'~'l~e r 15-021 - · ~ :' :/~-f~: :% ":" '"'7:1~: :i .section i: ~Business Plan and invento.ry Program' [] Routine ~Combined ~ [] Re-inspection [] Joint Agency [] Multi-Agency [] Complaint C V ~ C=Compliance ~ OPERATION ~. V=Violation [] APPROPRIATE PERMIT ON HAND .~ PLAN CONTACT INFORMATION ACCURATE BUSINESS COMMENTS VISIBLE ADDRESS [-[' VERIFICATION OF INVENTORY MATERIALS [] VERIFICATION OF QUANTITIES [] VERIFICATION OF LOCATION [] PROPER SEGREGATION OF MATERIAL ['1 VERIFICATION OF MSDS AVAILABILITYE OF ABATEMENT SUPPLIES AND PROCEDURES VERIFICATION [] EMERGENCY PROCEDURES ADEQUATE [] CONTAINERS PROPERLY LABELED FIRE PROTECTION ANY HAZARDOUS WASTE ON SITE?: ~ YES [~ No EXPLAIN: QUESTIONS RE~SPECTION? PLEASE CALL US AT (661) 326-3979 Wfl~e - Environmental Services Yellow - S~ation Copy Pink - Business Copy TYPE OF APPLICATION (CHECK) E3 NEW FACILITY ~1 MODIFICATION OF FACILITY STARTING DATE June, 2004 FACILITY NAME Fastrip FACILITY ADDRESS Bakersfield Fire Dept. Environmental Service 1715 Chester Ave Bakersfield, CA 93301 Tel: {661)326-3979 NEW TANK INSTALLATION AT EXISTING FACILITY PROPOSED COMPLETION DATE June, 2005 CIIY Bakersfield EXISTING FACILITY PERMIT NO. ZIP CODE 93306 2698 Oswell Street TYPE OF BUSINESS APN Cf Gas Station PHONE NO TANKOWNER Jaco- Hill 393-7000 CITY ZIP CODE ADDRESS 3101 State Road Bakersfield 93308 CONTRACTOR Kern County Construction ADDRESS CITY P.O. Box 6096 Bakersfield PHONE NO. BAKERSFIELD CITY BUSINESS LICENSE NO. WORKMAN COMP NO. INSURER 634-9950 0319165 3848-2003 State Fund CA LICENSE NO. 481053 ZIP CODE 93386 BRIEFLY DESCRIBE THE WORK TO BE DONE UPGRADE PHASE 1 VAPOR RECOVERY SYSTEM TO MEET EVR-102-D WATER TO FACILITY PROVIDED BY California Water Company GROuNDDEPTH TOwATER150+/- SOIL TYPE EXPECTED AT SITE Clay Sand NO. OF TANKS ARE THEY FOR MOTOR FUEL TO BE INSTALLED 0 [~ YES [] NO SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ~ YES [~ NO THIS SECTION IS FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION THIS SECTION IS FOR NON MOTOR FUEL STORAGE TANKS TANK NO. VOLUME CHEMICAL STORED (NO BRAND NAME) CAS NO (IF KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFICIAL USE ONLY APPLICATION DATE FACILITY NO. The applicant has received, understands, and will comply with the attache of the permit and any/o?he state, local and federal regulations. This form has been under penalty of perjur~n_flt, p/he/~est of my knowledge, is true and correct. ~.~-'~' ~-¢/~'- //, /. Mark Blackburn APPROVED BY: ~ APPLICANT NAME (PRINT) APPLICANT SIGNATURE NO. OF TANKS FEES $ ,., ~onditions cz> State of California AIR RESOURCES BOARD Executive Order- VR-102-D OPW Phase I Vapor Recovery System WHEREAS, the California Air Resources Board (ARB) has established, pursuant to California Health and Safety Code sections 39600, 39601 and 41954, certification procedures for systems designed for the control of gasoline vapor emissions d~ring the filling of underground gasoline storage tanks, in its CP-201, Certification Procedure for Vapor Recovery Systems at Gasoline Dispensing Facilities (Certification Procedure) as last amended October 8, 2003, incorporated by reference in title 17, California Code of Regulations, section 94011; WHEREAS, ARB has established, pursuant to California Health and Safety COde sections 39600, 39601 and 41954, test procedures for determining the compliance of Phase I vapor recovery systems with emission standards; WHEREAS, OPW Fueling Components, Inc. (OPW) requested and was granted. certification of the OPW Phase I Vapor'Recovery System (OPW system) pursuant to the Certification Procedure by Executive Order VR-102-A, first issued on September 26, 2002, and reissued on October 10, 2002; WHEREAS, OPW requested a further modification to the certification to include additional components of the OPW system; WHEREAS, the requested modifications to the certification of the OPW system have been tested and evaluated pursuant to the Certification Procedure; WHEREAS, the Certification Procedure provides that the ARB ExecutiVe Officer Shall issue an Executive Order if he or she determines that the vapor recovery system, including modifications, conforms to all of the applicable requirements set forth in the Certification Procedure; WHEREAS, G-01-032 delegates to the Chief of the Monitoring and Laboratory Division. the authority to certify or approve modifications to certified Phase I and Phase II vapor recovery systems for gasoline dispensing facilities (GDF); and WHEREAS, I, William V. Loscutoff, Chief of the Monitoring and Laboratory Division, find that the OPW Phase I Vapor Recovery System, including modifications, conforms with all of the requirements set forth in the Certification Procedure, and results in a vapor recovery system which is at least 98.0 percent efficient as tested in accordance with test procedure TP-201,1, Volumetric Efficiency for Phase I Systems;. NOW THEREFORE, IT IS HEREBY ORDERED that the OPW system is certified to be at least 98.0 percent efficient when installed and maintained as specified herein and in the following exhibits. Exhibit 1 contains a list of the certified components. Exhibit 2 -2- contains the performance standards and specifications, typical installation drawings and maintenance intervals for the OPW system as installed in a gasoline dispensing facility (GDF). Exhibit 3 contains the manufacturing specifications. IT IS FURTHER ORDERED that compliance with the applicable certification requirements, rules and regulations of the Bivision of Measurement Standards of the Department of Food and Agriculture, the Office of the State Fire Marshal of the Department of Forestry and Fire Protection, and the Division of Occupational Safety and Health of the Department of Industrial Relations are made conditions of this certification. IT IS FURTHER ORDERED that OPW shall provide a warranty for the vapor recovery system and components to the initial purchaser and each subsequent purchaser within the warranty period. The manufacturer of components not manufactured by OPW shall provide a warranty for each of their components certified herein. This warranty shall include the ongoing compliance with all applicable performance standards and specifications, and shall comply with all warranty requirements in SectiOn 9.2 of the Certification Procedure. OPW may specify that the warranty is contingent upon the use of trained installers. Copies of the warranty for the system and components shall be made available to the GDF owner or operator. IT IS FURTHER' ORDERED that the certified OPW system shall be installed, operated, and maintained in accordance with the ARB.Approved Installation, Operation and Maintenance Manual for the OPW Phase I Vapor Recovery System. A copy of this Executive Order and' manual shall be maintained at each GDF where a certified OPW system is installed. IT IS FURTHER ORDERED that equipment listed in Exhibit 1, unless exempted, shall be clearly identified by a permanent identification showing the manufacturer's'name and model number. IT IS FURTHER ORDERED that any alteration in the equipment, parts, design, installation or operation of the system certified hereby is prohibited and deemed inconsistent with this certification unless the alteration has been submitted in writing and approved in writing by the Executive Officer or Executive Officer's delegate. IT IS FURTHER ORDERED that the following requirements be made a. condition of certification. The owner or operator of the OPW system shall conduct, and pass, the following tests no later than 60 days after startup and at least once every three (3) years after startup testing, using the latest adopted version of the following test procedures: TP-201.3, Determination of 2 Inch WC Static Pressure Performance of Vapor Recovery Systems of Dispensing Facilities, TP-201.1 B, Static Torque of Rotatable Phase I Adaptors and depending on the system configuration, either TP-201-1 D, Leak Rate of Drop Tube Overfill Prevention Devices and Spill Container Drain Valves; or TP-201.1C, Leak Rate of Drop Tube/Drain Valve Assembly. Shorter time periods may be specified in accordance with local district requirements. Notification of testing, and submittal of test results, shall be done in accordance with local district requirements and pursuant to the policies established by that district. Alternative test procedures may Cbe used if determined by the Executive Officer, in writing, to yield comparable results. OPW PHASE I VAPOR RECOVERY SYSTEM - VR-102-D -3- Testing the PN valve will be at the ol~ti.on of the loCal districts. If PN valVe testing is required by the district, the test shall be conducted in accordance with TP-201.1 E, Leak Rate and CraCking Pressure of Pressure/Vacuum Vent Valves. IT IS FURTHER ORDERED that the OPW syStem shall, be compatible with fuels in · common use in California at the time of certification and any modifications to comply with future California fuel requirements shall be approved in writing by the Executive Officer or Executive Officer's delegate. IT IS FURTHER ORDERED that the certification of the OPW Phase I vapor recovery system is valid through September 30, 2006. IT IS FURTHER ORDERED that Executive Order VR-102-C, issued on january 9, 2004 is hereby superceded by this Executive Order. Executed at Sacramento, California, this Z~'/~ay of April 2004. William V. Losc"~. CSief ,./~/ ) Monitoring and Laboratory Divisioj~d'~,,/ Attachments: Exhibit 10PW Phase I Vapor Recovery System Equipment List Exhibit 2 Installation, Maintenance and Compliance SpecificatiOns Exhibit 3 Manufacturing Performance Standards and Specifications OPW PHASE I VAPOR RECOVERY SYSTEM -VR-102-D Executive Order VR-102-D OPW Phase I Vapor Recovery System Exhibit 1 OPW Phase I Vapor Recovery System Equipment List Equipment ManufactureflModel NUmber Pressure/Vacuum Vent Valve Husky Model 4885, 2-Inch Threaded OPW 623V, 2 and 3-inch Threaded Spill Containers and Covers OPW TTT-21WWWX-YZZZ TTT indicates spill bucket material/cover type: (not required with sump configuration lid) 1 = Aluminum 1C = Cast iron 1SC = Sealable aluminum cover with an expandable seal. WWW Indicates bucket size: 00 = 5-gallon 15 =.15-gallon 00E = 7.5-gallon (deep bucket model) X indicates bucket base type C = Cast Iron No letter indicates composite base Y indicates drain valve or plug ZZZ indicates special configuration EVR -- Standard SH = Self supporting container without ring and cover Sump Configuration Lid ~ Pomeco 5XX XX indicates spill bucket material/cover type: 11= Composite base, bolt down cover..... 21= Composite base, roto-lock cover' 61= Cast iron base, bolt down cover 71= Cast iron base, roto-lock cover Fibrelite FL-36 inch Replacement Drain Valve Kit Dust Caps OPW 1DK-2100 OPW 634TT-EVR (Product) OPW .1711T-EVR (vapor) OPW 634LPC (product) OPW 1711LPC (vapor) Product Adaptor Vapor Adaptor Extractor Assembly OPW 61SALP-EVR OPW 61VSA-EVR OPW 233 Ball Float Vent Valve OPW 53VML OPW 30MV Jack Screw Kit OPW 61JSK-4400-EVR oPW 61JSK-4410 OPW 61JSK-44CB Face Seal Adaptor OPW FSA-400 OPW FSA-400-S Drop Tube OPW Drop Tube Overfill Prevention Device OPW 61T (various lengths) 1 61SO-XXXC-EVR Where XXX - 400, 410,. 412,420 or 440 Tank Bottom Protector OPW/Pomeco 6111-1400-EVR Tank Gauge Port Components ~ Morrison Brothers 305XPA1100AKEVR (cap & adaptor kit) Morrison Brothers 305-0200AAEVR (replacement adaptor) Morrison Brothers 305XP-110ACEVR (replacement cap) Ever-Tite 4097AGBR Adaptor Ever-Tite 4097AGM BRN L Adaptor Ever-Tite 4097MBR Cap Veeder-Root 312020-952 (cap & adaptor) Component optional for vapor recovery; may be required by other applicable regulations. The 53VML and 30MV includes both the 2" and 3" models Executive order VR-102-D, OPW Phase i Vapor Recovery System, Exhibit 1, Page 2 Table 1 Components Exempt from Identification Requirements Component Name Manufacturer Model Number Replacement Drain Valve OPW 1-DK-2100 61JSK-4400-EVR Jack Screw OPW 61JS K-4410 (~lJSK-44CB 305XPA1100AKEVR (cap & Tank Gauge Port Component Morrison adaptor kit), 305-0200AAEVR (Cap and Adaptor) Brothers (replacement adaptor, and 305XP-110ACEVR ('replacement cap). Drop Tube Opw 61 -T, 61 SO OPW FSA-400 Face Seal Adaptor OPW OPWFSA-400-S Executive Order VR-102-D, OPW Phase Vapor Recovery System, Exhibit 1, Page 3 Table 2-1 Gasoline Dispensing Facility Compliance Standards and Specifications Component Test Method / Standard or Specification Minimum, 360-degree rotation Rotatable Phase I TP-201.1B Maximum, 108 pound-inch average static Adaptors torque Overfill Prevention TP-201.1D <0.17 CFH at 2.00 in. H20 Device Spill Container Drain TP-201.1C or <0.17 CFH at 2.00 in. H20 Valve TP-201.1 D Positive pressure setting: 3.0_+ 0.5 in. H20 P/V Valve~' TP-201.1E Negative pressure.setting: -8.0 + 2.0 in. H20 Positive Leakrate:' 0.05 CFH at 2.0 in. H20 ~ Negative Leakrate: 0.21 CFH at-4.0 in. H20 Gasoline Dispensing TP-201.3 As specified in TP-201.3 and/or CP-201 Facility . Leak Connections and fittings Detection No leaks · certified without an Solution or allowable leak rate Bagging Table 2-2 Maintenance Intervals for System Components Manufacturer Component Maintenance Interval Husky Pressure/vacuum Vent Valve Annual Morrison Brothers Tank Gauge Components Annual OPW Pressure/Vacuum Vent Valve Annual OPW Dust Caps (all models) Annual OPW 61-T Straight Drop Tube Annual OPW Ball Float (all models) Every 3 years OPW Rotatable Phase I Adaptors Annual OPW Drop Tube overfill Prevention Valve Annual OPW~Pomeco Spill Containers (all models) Annual 4. Compliance determination is at the option of the district. Executive Order VR-102-D, OPW Phase Vapor Recovery System, Exhibit 2, Page 5 Figure 2A Typical Product Installation Using OPW System OPW 1-2100 . $[ OPW 634TT-EVR (Product) Dust Cap OPW 1DK-2100 Replacement Drain Valve Kit OPW 61SALP-EVR Product Adaptor OPW 61JSK-4400-EVR Jack Screw Kit OPW FSA-400 Face Seal Adaptor OPW 61SO-EVR Dro[ Prevention Device (Optional) OPW/POMECO 6111-1400-EVR Tank Bottom Protector (Optional) 6 inch Max. Executive Order VR-102-D, OPW Phase I Vapor Recovery System, Exhibit 2, Page 6 Figure 2B Typical Vapor Installation Using OPW System OPW 1-2100 Spill Container OPW 1711T-EVR (Vapor) Dust Cap . OPW 233 Extractor Assembly (Optional) OPW 61VSA-EVR Vapor .Adaptor OPW 53VML Ball Float Vent Valve (Optional) Executive Order VR-102-D, OPW Phase I Vapor Recovery System, Exhibit 2, Page 7 Figure 2C Typical Vent Pipe Manifold [ ~~ ' Vent Valve T __!'"'-'"- 2" Threaded Nipple Approx. 4" Threaded Fittings - 3 Places -- Steel Nipple (6 places) Steel Coupler "Varies .... Varies" (3 - 12" Typ) (3 - 12" Typ) Existing Steel Vent Pipes 1" x 1/4" Steel Flat Bar Or Equivelan! Bolted in Place 2 places minimum (Sway Control / Alignment Purposes) Note: This shows only one typical configuration; other manifold configurations may be used. For example, a tee may be located in a different position, or fewer pipes may be connected, or more than one P/V valve may be installed on the manifold. · Executive Order VR-102-D, OPW Phase Vapor Recovery System, Exhibit 2, Page 8 Executive Order VR-102-D OPW Phase I Vapor Recovery System Exhibit 2 Installation, Maintenance and Compliance Standards and Specifications This exhibit contains the installation, maintenance and compliance standards and specifications applicable to an OPW system installed in a gasolin~dispensing facility (GDF). General Specifications 1. Typical installations of the OPW system are shown in Figures 2A and 2B. The OPW system shall be installed, operated, and maintained in accordance with the ARB-Approved Installation, Operation and Maintenance Manual for the OPW Phase I Vapor Recovery System. Any repair or replacement of system components shall be done in accordance with the ARB.Approved Installation, Operation and Maintenance Manual for the OPW Phase I Vapor Recovery System. The OPW system shall comply with the applicable performance standards and performance specifications in CP-201. Compliance of the system and all components shall be demonstrated in accordance with TP-201.3, Determination of 2 Inch WC Static Pressure Performance of Vapor Recovery Systems of Dispensing Facilities. There shall be at least one vapor recovery connection, throughout all Phase I deliveries, between the cargo tank and the GDF storage tank into which fuel is being delivered to ensure that vapor is returned to the cargo tank from the underground storage tank system. Pressure/Vacuum Vent Valves For Stora.qe Tank Vent Pipes 1. No more than three certified pressure/vacuum vent valves (PA/valves) listed in Exhibit 1 shall be installed on any GDF underground storage tank system. 2. Compliance determination of the following P/V valve performance specifications shall be at the option of the districts: The leak rate of each PN valve shall not exceed 0.05 cubic feet per hour (CFH) at 2.00 inches of H20 positive pressure and 0.21 CFH at 4.00 inches negative pressure as determined by TP-201.1E, Leak Rate and Cracking Pressure of Pressure/Vacuum Vent Valves. The Positive pressure setting is 3.0+ 0.5 inches of H20 and the negative pressure setting is -8.0 + 2.0 inches of H20 as determined by TP-201.1E, Leak Rate and Cracking Pressure of Pressure/Vacuum Vent Valves. A manifold may be installed on the vent pipes to reduce the number of potential leak sources and P/V valves installed. Vent pipe manifolds shall be constructed of steel pipe or an equivalent material that has been listed for use with gasoline. If a material other than steel.is used, the GDF operator shall make available information demonstrating that the material is compatible for use with gasoline. One example of a typical vent pipe manifold is shown in. Figure 2C. This shows only one typical configuration; other manifold configurations may be used. For example, a tee may be located in a different position, or fewer pipes may be connected, or more than one P/V valve may be installed on the manifold. The vent pipe manifold shall be installed at a height not less than 12 feet above the grade used for gasoline cargo tank delivery operations and shall conform to all applicable regulations. Each P/V valve shall have permanently affixed to it a yellow or gold-colored label with black lettering stating the following specifications: Positive pressure setting: 3.0 + 0.5 inches H20 Negative pressure setting: -8.0 + 2.0 inches H20 Positive Leakrate: 0.05 CFH at 2.0 inches H20 Negative Leakrate: 0.21 CFH at-4.0 inches H20 Rotatable Product and Vapor Recovery Adaptors Rotatable product and vapor recovery adaptors shall be capable of at least 360-degree rotation and have an average static torque not to exceed 108 pound- inch (9 pound-foot). Compliance with this requirement shall be demonstrated in aCcordance with.the latest adopted version of TP-201.1 B, Static' Torque of Rotatable Phase I Adaptors. The vapor adaptor poppet shall not leak when closed. Compliance with this requirement may be verified by the use of commercial liquid leak detection solution, or by bagging, when the vapor containment space of the underground storage tank is subjected to a non-zero gauge preSsure. (Note: leak detection solution will detect leaks only when positive gauge pressure exists.) Vapor Recovery and Product Adaptor Dust Caps Dust caps with intact gaskets shall be installed on all Phase I tank adaptors. Executive Order VR-102-D, OPW Phase Vapor Recovery System, Exhibit 2, Page 2 Spill Container Drain Valve. 'The spill container drain valve Shall be configured to drain liquid directly into the drop tube and shall be isolated from theunderground storage tank ullage space. The leak rate of the drain valve shall not exceed 0.17 CFH at 2.00 inches H20. Depending on the presence of the drop tube overfill prevention device, compliance with this requirement shall be demonstrated in accordance with the latest adopted version of either TP-201.1 D, Leak Rate of Drop Tube Overfill Prevention Devices and Spill Container Drain Valves; or TP-201 .lC, Leak Rate of Drop Tube/Drain Valve Assembly. _Drop Tube Overfill Prevention Device_ 1. The Drop Tube Overfill Prevention Devi,ce (overfill device) is designed to restrict the flow of gasoline delivered to the underground storage when liquid levels exceeds a specified capacity. The overfill device is not a required component of the vapor recovery system, but may be installed as an optional component. Other regulatory requirements may apply. 2. The leak rate of the overfill device shall not exceed 0.17 CFH at 2.00 inches H20 when tested as in accordance with the latest adopted version of TP-201.1D, Leak Rate of Drop Tube Overfill Prevention Devices and Spill Container Drain Valves. Face Seal Adapto_r The Face Seal Adaptor shall provide a machined surface on which a gasket can seal and ensures that the seal is not compromised by an improperly cut or improperly finished riser. A Face Seal Adaptor shall be installed on the following required connections. As an option, the adaptor may be installed On other connections. a. Product Spill Container (required) b. Tank Gauging Components (required) c. Vapor Recovery Spill Container (optional) d. Rotatable Adaptors (optional) Ball Float Vent Valve. A Ball Float Vent Valve (ball float) is designed to restrict the flow of a gasoline delivery by using back pressure when the storage tank levels exceed a specified level. If installed for overfill prevention, a ball float must be installed at each vapor and vent connection to the tank. Ball floats are not required components of the vapor recovery system, but may be installed as optional components for vapor recovery; other requirements may apply. Executive Order VR-102-D, OPW Phase I Vapor Recovery Sysiem, Exhibit 2, Page 3 Vapor Recovery RiSer Offset 1, The vapor recovery tank riser may be offset from the tank connection to the vapor recovery Spill Container provided that the maximum horizontal distance (offset distance) does not exceed twenty (20) inches. One example of an offset is shown in Figure 2D. The vapor recovery riser shall be offset up to 20 inches' horizontal distance with use of commercially available, four (4) inch diameter steel pipe fittings. Tank Gau.qe Port Components The tank gauge adaptor and cap are paired. Therefore, an adaptor manufactured by one company shall be.used only with a cap manufactured by the same company. Connections and Fittin,qs All connections 'and fittings not specifically certified with an allowable leak rate shall not leak. The absence of vapor leaks may be verified with the use of commercial liquid leak detection solution (LDS), or by bagging, when the vapor containment space of the underground storage tank is subjected to a non-zero gauge pressure. (Note: leak detection solution will detect leaks only when positive gauge pressure exists). Maintenance Records Each GDF operator/owner shall keep records of maintenance performed at the facility. Such record shall be maintained on site or in accordance with district requirements or policies. The records shall include the maintenance or test date, repair date to correct test failure, maintenance or test performed, affiliation, telephone number and name of individual conducting maintenance or test. An example of a Phase I Maintenance Record is shown in Figure 2E. Executive Order VR-102-D, OPW Phase I Vapor Recovery System, Exhibit 2, Page 4 Figure 2D Typical VaporRec°very Riser Offset Vapor Riser'j Threaded Elbow TOTAL CFFSE Not To Exceed 20 Inches Threaded NipplJ Threaded Cap (typical) /--Extractor or Tee ~Thr~aded to Riser or direclty into tank ~Vapor Riser or Fitting /threaded directly into /tank bung Note: This figure represents one instance where a vapor recovery riser has been offset in order to construct a two-point Phase I vapor recovery system. The above figure illustrates an offset using a 90-degree elbow. However, in some instances, elbows less than 90 degrees may be used. All fittings and pipe nipples shall be 4-inch diameter similar to those of the spill container and rotatable Phase I adaptors in order to reduce back pressure during a gasoline delivery. Executive Order VR-102-D, OPW Phase'l VaPOr Recovery System, Exhibit 2, Page 9 Figure 2E Example of a GDF Phase I Maintenance Record Date of Repair Name' of Individual Telephone Maintenance/ Date To Maintenance/Test/Inspection Affiliation Conducting Test/Inspection/ Correct Performed and Outcome Number Failure Test " Maintenance or Test Failure Executive Order VR-102-D, OPW Phase I Vapor Recovery System, Exhibit 2, Page 10 Executive Order VR-102-D OPW Phase I Vapor Recovery System Exhibit 3 Manufacturing Performance Standards and Specifications The 0PW system and all components shall be manufactured in compliance with the .performanCe standards and specifications in CP-201, as Well as the requirements specified in this Executive Order. All components shall be manufactured as certified; no change to the equipment, parts, design, materials or manufacturing process shall be made unless approved in writing by the Executive Officer. Unless specified in Exhibit 2 or in the ARB-Approved Installation, Operation and Maintenance Manual for the OPWPhase I Vapor Recovery System, the requirements of this section apply to the manufacturing process and are not appropriate for determining the compliance status of aGDF. Pressure/Vacuum Vent Valves for Stora.cje Tank Vent Pipes Each pressure/vacuum vent valve (PA/valve) shall be 100 percent performance tested at the factory for cracking pressure and leak rate at each specified pressure setting and shall be done in accordance with the latest adopted version of TP-201.1E, Leak Rate and Cracking Pressure of Pressure~Vacuum Vent Valves. Each PN valve shall be shipped with an card or label stating the performance specifications listed below, and a statement that the valve was tested to, and met, these specifications. ac The pressure settings for the PN valve Positive pressure setting of 3.0 + 0.5 inches H20. Negative pressure setting of-8.0+ 2.0 inches H20. bo The leak rate for each PN valve, including connections, shall not exceed: 0.05 CFH at 2.0 inches H20. 0.21 CFH at-4.0 inches H20. Each P/V valve shall have permanently affixed to it a yellow or gold label with black lettering listing the positive and negative pressure settings specified above. The lettering of the label shall have a minimum font size of 20. Rotatable Product and Vapor Recovery Adaptors 1. The rotatable product and vapor recovery adaptors shall not leak. 2. The product adaptor cam and groove'shall be manufactured in accordance with the cam and groove specifications shown in Figure 3A of CP-201. The vapor recovery adaptor cam and groove shall be manufactured in accordance with the cam and groove specifications shown in Figure 3B of CP-201. Each product and vapor recovery adaptor shall be 100 percent performance tested at the factory. Each adaptor shall have affixed to it a card or label stating the performance specification listed below, and a statement that the adaptor was tested to, and met, the following specifications. ao The average static torque for the rOtatable adaptor shall not exceed 108 pound-inch average static torque when tested in accordance with the latest adopted version of TP-201 ,lB, Static Torque of Rotatable Phase I Adaptors, The rotatable adaptor shall be capable of rotating at least 360 degrees when tested in accordance with the latest adopted version of TP-201.1B, Static Torque of Rotatable Phase I Adaptors. Spill Container and Drain Valves Each Spill Container Drain Valve shall be 100 percent performance tested at the factory. Each Spill Container Drain Valve shall have affixed to it a card or label stating the Performance specifications listed below, and a statement that the valve was tested to, and met, the following performance specification. The maximum leakrate shall not exceed 0.17 CFH at 2.00 inches H20 when tested in accordance with the latest adopted version of either TP-201.1C, Leak Rate of Drop Tube/Drain Valve or TP-201.1D, Leak Rate of Drop Tube Overfill Prevention Devices and Spill Container Drain Valves. Drop Tube Overfill Prevention Device Each Drop Tube Overfill Prevention Device shall be 100 percent performance tested at the factory to verify that it does not exceed the maximum allowable leak rate. Each Drop Tube Overfill Prevention Device shall have affixed to it a card or label stating the performance specifications listed below, and a statement that the device was tested to, and met, the following performance specification. The maximum leak rate shall not exceed 0.17 CFH at 2.00 inches H20 when tested in accordance with the latest adopted version of TP-201.1 D, Leak Rate of Drop Tube Overfill Prevention Devices and Spill Container Drain Valves. Executive Order VR-102-D, OPW Phase I Vapor Recovery System, Exhibit 3, Page 2 Table 3-i Manufacturing component Standards and Specifications -Component Test Method standard or Specification ~ Minimum, 360-degree rotation Maximum, 108 pound-inch average static Rotatable Phase I TP-201.1 B Adaptors torque Cam and Groove Specifications Rotatable Phase I Micrometer (CP-201) Adaptors ' Overfill Prevention TP-201.1D <0.17 CFH at 2.00 inches H20 Device. Spill Container Drain TP-201.1C or <0.17 CFH at 2.00 inches H20 Valve TP-201.1 D Positive Pressure: 3.0 +0.5 inches H20 Pressure/Vacuum vent TP-201.1E Negative Pressure: -8.0 +2.0 inches H20 Valve Leak rate: < 0.05 CFH at +2.0 inches H20 Leak rate: < 0.21 CFH at -4.0 inches H20 . Executive Order VR-102-D, OPW Phase I Vapor Recovery' System, Exhibit 3, Page 3 · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the camhto.you. · Attach this card to the back of the ma~piece, or on the front if space permits. 1. Article Addressed to: Fastrip 2698 Oswell Street Bakersfield, CA 93306 \- X ' !I [] Agent [] Addressee D. I~d;l~en/addressdifferentfromitern'l? [] ges If YES, enter delivery address below: [] No Il 3. Service Typo ~Certifled Mail Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restflcted Delive~j? (Extra Fee) [] Yes ::'2. Article Number (Transfer from serv/ce/abe0 PS Form 3811, August 2001 7003 226.0 ,0004. 7652 2952 Domestic Retum Receipt Postage I$ Certified Fee Postmark Return Reclept Fee (Endorsement Required) Here Restricted Delivery Fee (Endorsement Required) s°"r°i Fastrip ' -- ~!__ [ °~'~"~ 2698 Oswell Street i .... ' ~ Bakersfield, ~ FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakemfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SER~ICES · ENVIRONMENTAl SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBUC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 12, 2003 CERTIFIED MAI1, Fastrip 2698 Oswell Street Bakersfield, CA 93306 RE: Propane Exchange Program Dear Owner/Operator: The purpose of this letter is to advise you of current code requirements for propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not apply to large propane tanks, ~ propane exchange systems. Over the past two years this office has noted a dramatic increase in the propane exchange system in the city of Bakersfield. It has also been noted, with great concern, that many of these installations are a clear violation of the UFC (Uniform Fire Code) and represent a danger to public health and.safety.' Accordingly, procedures for storage of propane cylinders awaiting use, resale or eXchange, have been adopted through BMC (Bakersfield Municipal Code) and adoption of the 2001 UFC. The procedures are as follows: Storage outside of building for propane cylinders (1,000 pounds or less) awaiting use, re-sale, or part of a cylinder exchange point shall be located at least 10 feet from any doorways or openings in a building frequented by the public, or property line that can be built upon, and 20 feet from any automotive service station fuel dispenser. (Note distance from doorways increases when cylinders are over 1,000 pounds cumulatively.) Cylinders in storage shall be located in a manner which minimizes exposure to excessive temperature rise, physical damage or tampering (Section 8212, California Fire Code, 2001 Edition). When exposed to probable vehicular damage due to proximity to alleys, driveways or parking areas, protective crash posts will be required as follows (Section 8001.11.3 and 8210, California Fire Code, 2001 Edition): I) 2) Constructed of steel, not less than 4 inches in diameter, and concrete filled. Spaced not more than 4 feet between posts, on center. Letter to To: Owner/Operators of Propane Exchange Systems Re: Propane Exchange Program Dated: December 12, 2003 Page 2 of 2 3) 4) 5) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. Set with the top of the posts not less than 3 feet aboveground. Located not less than 5 feet from the cylinder storage area. Exceptions: Cylinders storage areas located on a sidewalk which is elevated not less than 6 inches above the alley, driveway or parking area, with not less than 10 feet of separation between the curb and the cylinder storage area. "No Smoking" signs shall be posted and clearly visible (Section 8208, California Fire Code, 2001 Edition). ................. Res~l~-'and'ex~hange facilities must be under permit to verify compliance. 'All existing facilities will be checked and when compliance is confirmed, a permit will be issued. All new propane exchange systems must be permitted prior to installation. You will have 90 days (March 4, 2004) to complY with the procedures outlined. Once compliance has been confirmed, each exchange system will be issued a permit, which will be placed on the exchange system. Sites not conforming to current code, will be "red tagged" and must be taken out of service immediately. You should contact your Blue Rhino representative, Mr. Taylor Noland, or your local Amerigas representative. They are aware of current code requirements. If you do not have a propane exchange system, please disregard this letter. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincerely, Steve Underwood Fire Inspector/Petroleum/ Environmental Code Enforcement Officer ._~~U. 1715 Chester Ave., Bakersfield, CA 93301 (661)326-3979 UNDERGROUND STOOGE TANKS - UST FACILITY ~PE OF ACTION ~ Pago [] 3. RENEWAL PERMIT [] 4. AMENDED P~RMIT E OF iNFORMATION (S,o~¢d'y c/range.. lOCal u~a only/. [] 6. TEMPORARY SITE CLOSURE [] 7 PERMANENTLY CLOSEO SITE [] 8. TANK RE~VED BUSINESS NAME (Same a~ FACILITY NAME or DBA -OOng 8uanee~ ·NEAREST CROSS 3~'REET ' .. 8US~NESS ~1~S STATION TYPE [] 2. DISTRIBUTOR TOTAL NUIVI~ER OF TANKS REMAINING AT SITE I. FACILITY I SITE INFORMATION [] 4. LOCAL AGENCY/~ISTRICT· 3 FACILITY ID B 401. FACILJ~t OWNER 'Fh'PE [] 1. CORPORATION [;~DNIDUAL [] 3. FARM [] 5. COMMERCIAL E] 1. PARTNERSHIP [] 4. PROCESSOR [] $. OTHER 403, la ~,;i.'.';~, on Imlla'~ Reeermtk:~n or 9~ o~et o/UST a public ajee¢-~, aa,me al' ~l~",.eaot oN' ('This i~ the cenlact ~,.~n for the rani[ record.) [] 5. COUNTY AGENCY* [] 6. STATE AGENCY' [] 7. FEDERAL AGENCY" 402. II. PROPERTY OWNER INFORMATION PROPERTY OW~* ['-] 1. COR'C4~RATION ~'~ARTNERSHIP I STATE ZIP CODE 412. [] 4. LOCALAGENC'Yt D~"'TRICT [] 6. STATE AGENCY 413. [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY IlL TANK OWNER INFORMATION 414. '~r' PHONE ~,. 415. ' CITY ~ TANK OWNER TYPE /~] 1. CORPORATION 416. [] 2. INDIVIDUAL ,~3. PARTNERSHIP E] 4. LOCAl. AGENCY/DISTRICT [] 6. STATE AGENCY [] S. COUNTY AGENCY [] 7. FEDERAL AGENCY 419. 420. IV. BOARD OF EQUALIZATION UST STORAGE FEE AccoUNT.NUMBER [ 44 I ' ~)1 / 1~7 -~**~ Cai, (916, 322-9669 if quesUons arise TY (TK) HQ V. PETROLEUM UST FINANCIAL RESPON$iBIu"r¥ ";." INDICATE METHOD(S) J~'. SELF-INSURED [] 4. SURETY BON~ E] 7. STATE FUND 421. [] I0. LOCAL ~V'T MECHANISM [] 99. OTHER: [-"1 2. GUARANTEE [] 5. ~.ETTER OF C.qEDIT [~ 8. STATE FUND a C~O LETTER [] 3. INSURANCE [] 6. EXEMPTION [] 9. STATE FUND & CO ~ 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS- ~ ' " Chec~ one b(~ to irgllcate which addre$,~ sttould ~ used for leK]al r~iflc3tion~ and mail~. Legal notifications ami mallJng~ wili I~e :~.~'~t tO the tank ownor unle~ Dox 1 or 2 is ohec~v, ed. [] 1. FACILITY . [] 2. PROPERTY OWNER ~'"~K OWNER 423. VII. APPLICANT SIGNATURE ', ¢~iltcaUoa: I c~lify thai the inf,o~nat~o~ provided h~n is ~e ~d ~mte Io ~e b~ ~ my ~ge. 428. J TITLE 424. PHONE .425. 427. STATE uST FACILITY NUMBER (Fro'local use only) 428.. r 1998 uF~.d~AOE CERTIFICATE NUMBER (Fotlocal usa only) uPcF (7/99) . S:\CUPAFORMS~swrcb-a.wpd .... ~, -,~ C'ITY OF BAKERSFIELD , ~,,~ OFF~ OF ENVIRONMENTAL S~ ICES 1715 CheSter Ave., Bakersfield, CA 93301 (~61) 326-3979 UNDERGROUND STORAGE TANKS- TANK PAGE i IlL TANK C~I~'NUGI~N r, rl='E OF EXT~X~ ~ LJNER r~ 4. ~NOL.EWAL~I4AVA~LT 0 & ~co~,^~.~.~oo.~u~,~,~. 0~. ~LLA~:)OV~I~qU. YEARII~rAU.ED 4~0 TYPE(F~..MMM~)') ~t 0~. o'm~ V. T)~K ~l~ INli'CX~MAT~N / PlRt~NINT (~,O~JRE IN PLACE ',MTN · CF (7/~0) S:~CU pApORM~.qVVRC,~'~'WP ° O~FN:~ O~' ~NVIRONMENTAL 3ERVICE3 Ave.. ~,Ker,~e~d. CA f'J , ~mESSURE I--I Z. SUCT~N C~ 3. GRA~--~'~- 0 I '~ WALL ~ ~. U~ O 2. ~U~E WALL ' ~ ~. OTHER ~FAC~RER C] 2~ STAINI-E~ STEEl. ~ r. ~V~ ~ .-- ~. . AL.AR~ TEST(Od s~cE SUCT~N SYST~.~ (NO V~V~_S ~N a~Low aRou~o Pl=~'3: [] 4.' DaJLY'Vt~UAL ~C:)C 46~ C] 2. ~OkIPEJ'4~EAPANO~N~OR*AUCXSLEAJ',qOVtSU.AI-~ r"'! S. ~La, F.R/~ORJi'a3 ~ 3. CONTII',4~<)UI ~ PAN ~ WiTH Au'ro SHUT OFF FOR OL,.~PENSF. R * AUO~tLE ANO VI.qUAL ALA,RM~ 0 & NO~ Mg IX, O~NER/OPERATOR SIGNATURE Pen.dNum~(F~caluMo~/) 473 J P~MAN)i'Q,M(F41'/0cI/weonfy) JPCF (7/~) 471 .CITY .0,F BAKERSFIELD ' OFFI~ OF' £N¥ IRONMENTAL S~VICES 171S Chest~ Ave., Bakersfield, CA 93301 ~61) 326-3979 l~~.W~~) ?A~K 0 m ,, ,, O~s. u~,~ T'YI~ 0~ TA~I( [] 4. ~wALLm~xva~a.? ~47 {:3#. V, T.UIK CI.4~/M ~IFORI~TIOIi I PlIII/ANIh'T CLOIURE Ig PI, A¢~ . , TA/'4C FILLlO WITIq INERT ~I:~CUPAFORM3.~~'~c 0ATEtN~TAU..EO 4~ [] 2. ClOt~I'~8~P~J~t~8¢~*ALK~ANOV~LAL~ ~ 4. OA~.YV~,JAL 3CF (7/99) O~TE 471 474 'I · oFFI~ii~ OF E~ IRONM£NTAL 1715 Chest~Ave., Bakersfield, CA 93301 ~: 1) 326-3979 ~ O~c T~K 0 ~. JET FI.J~. 0~. o'n.~ C] 3. ~/Pt. AST~ n 3. Cl s. coec~ DATE e4~l'.u ~ Fn 447 0.. 449 Y'E/~I',~TALL~D 4~0 T'YP~IFo(~) 4~1 O~rJ~F/LLpt~OTECTIONE~Uii~dENT:YEAR~I,~UL~_n C] 2. &~. ~UOAr iF (7/'99) 8:~CUPAFORM3~.~'w~c ~ 2. SUCTK~N [] <~. OTNER [] 4. ~tAJLYVt~UALC~.IEC3,( [] s. ~ SIC.,N,~ TU R E OF IX, OWNIIRK)PERATOR $10NATURE 471 Ti'TL~ OF. S:~,CUPAFOR~C~.B.VVP C 7.15..Chest~"A ye,, Bakersfield, CA 93301 ~"61) 326-3979 UNDERGROUND ,,STORAGE TANK3'? TANK ~AGE t TANK Ta~K U~ ~e O~. on.~ 0 ~. ~ROU~ O ~. ccx~ 0~o. C~TTD STEB. '. 0 ~. 0 t CI'N. on.e. " . 4M r~ F~u.~o wrr~ u~en' ~T~.J~q.? . ~ 0~., O~ ~-- . S:~CU~',~"OR~Ca'a'w~c [] 2. O~um.E wau. [] ~. OTHER OATEINST,aJ.L,.EO 46~ [] 2. C~NTI~UO~8~PAN~ENt3~*AUOi~.EAJ~O~/~-AL-APJ,~ l"'] 4. D,~.YV18~AL Ci-~C~ · IX, OWNER/OPERATOR ~SIONATURE 471 I [. I.~ ]~/.-i q i'm..E OF OV,,WER,~OP~RATOR $:\CUP'AFORM.,~WRCI~'B'VvPC 2698 OSWELL BKFD OA 661-872-8781 OCT 9, 2003 1:34 PM SYSTEM STa'ros REPORT ALL FUNCTIONS NORMAL INVENTORY REPORT T 1 :UNLEADED VOLUME = 4085 ULLAGE = 7947 90~'~ ULLAGE= 6743 TO VOLUME = 40i6 GALS HEIGHT = 35.?7 INCHES laATER VOL = 14 GALS [~ATER = O. 75 I NCRES TEMP = 83.8 DEG F T 2 :PLU~ VOLUME = 3860 GRLS ULLRGE = 817 ': <",",:c- ~:C~LLRt.;E = 6968 GRL~ TC VO~E~3790--GAkS~ HEIGHT = 34.30 INC:HE~ ~RTER VOL = 0 GRL~ ~RTER = 0.00 I NCHE~ TEMP = 85.7 DEO F T 3:PREMIUM VOLUME = 1617 GaLS ULLAGE = 10415 c',",' 90~ ULLAGE= 9211 TC VOLUME = 1588 GaLS ~TER VOL = '", ~TER = O. O0 I N~ TEMP = 87.3 DEO F T 4;DIESEL _ _ ..... ?OLIJ[,'IE~ 3252 G~LS UL~OE = 8780 90.4 ULLAGE= 7576 G~LS TO VOLUME = 3209 HEIGHT = 30.27 INCHES bJATER VOL = 19 GALS laaTER = O. 94 INCHES TEMP = 89.2 9EO F ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE [ O " q "'(,O ~ Section 2: Underground Storage Tanks Program Routine [~]kl2ombined [] Joint Agency Type of Tank l)LOt~e~.S Type of Monitoring ~'C0v, [] Multi-Agency Number of Tanks q Type of Piping ~ Complaint Re-inspection OPERATION C V COMMENTS Proper tank data on file · Proper oxvner(ot~el'ator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations t/ Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES A'd~quate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? if yes, Does tank have overfill/overspill protection? C=C°mplian;~' ~ V=Vi°lati°n' ~~/~3 Y=Yes N=NO Inspector: ~ Office of Environmental Services (661) 326-3979 \Vhi~e- Env. Svcs. Pink - Business Copy Busines~k,~it~ ~,-cs~n~ib~ Pa;t~ UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FAC ILITYCONTACT INSPECTION DATE I INSPECTION TIME PHONE NO. t NO. o~f Employees Business ID Number 15-021 - · Section 1' Business Plan and Inventory Program Routine '~Combined [] Joint Agency [] Multi-Agency I~ Complaint ~ Re-inspection C V (' C=Compliance '~ OPERATION Y v=violation .~ ~/[] APPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCURATE .................................................... COMMENTS VERIFICATION OF INVENTORY MATERIALS .................. VERIFICATION OF LOCATION PROPER sEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILITYE s,T~ DIAGRAM ADEQUATE & ON HANg ANY HAZARDOUS WASTE ON SITE?: J~J YES I~o EXPLAIN: QUESTIO/~REGARDI~/ T~ INSPECTION? PLEASE CALL US AT (661) 326-3979 .spector Badge No,. ' .............. ~-U"~"~S~e White - Environmental Services Yellow - Station Copy Pink. Business Copy FE'CH : 'BUHSET hlE,]lq~:~H j 1715 Chester .Ave. Bake~-'sf:i;ekL CA,, (661)326-3979 !-~ ULL MON~T,OI;~ N~-% OF MDN~OP. M'A. NUFACTURE~R DOES FAC/i~iX'Y i:-[AV.i~ E;'[SPENSE,}~'. PANS? TANK // _..~r~_¢¢_ ....... aL~RI'I' H 1ST©RY RE[,('~RT ........ SYSTEM aL~RI"I ......... PaP'ER OUT aUG 8.. 200:3 10:58 al"l PR] l,fr~R ERROR ~UG S, 200:3 10:58 BATTERY IS OFF ........ SENSOR ALARM ........ L 8: I:~IiUS SUM[" STP SIJPI[~ FUEL ~LARM ALJC; 12.. 200:3 8:12 ~P1 ......... SENSOR ~L~RI'.'I .......... L ?:DIESEL SUMP ST.I:' SUMP FUEL ~'~L ARI"I &U,:_-; 12, 200:3 8:12 AM ....... SENE;OR ALARM ....... L 5: FREI'.'11 UP1 SUMP ST[:' SUMP FUEL ~LaRI"I aUG 12. 200:3 8:! ....... SENSOR ALF~RI'.'I ...... L I:U-L SUMP STP:' SUMP '~ FLiEL A LF~F2I','I Al.J(] 1 2. 2013:3 8: 1 2 AM ........ SENS©R ALARM ...... L 2: [J--L ANNULAR ANNULAR ~PACE FUEL ALARM AUG 12.. 2003 8:15 AM ...... SENSOR ALARM ...... L 8:D1ESEL ANNULAR ANNULAR SPACE FUEL ALARM AUG 12.. 200',3 8:15 AM ....... SENSOR ALARM ....... L 6:PREMIUM ANNULAR ANNULAR S~::'ACE FUEL ALARM AU,:] 12.. 2003 8:15 AM ....... SENSOR ALARM ........ L 4 :F:'LtJS RNI'4UL, RR AI,ih!ULAR SPACE F;I_IEL AI.ARM AUG 12.' 2003 8:16 AM ALf:fl~l'.l H ! STORY REP©RT ..... I N-TF~NK F~LfiRPI ..... , T 1 :L, NLE~DED O',,.,,'ERF ILL ~L~RI'I JUL 11. 200:3 6:41 JUL 9,. 20~3 1:22 AN FEB 17. 2003 9:15 SUDDEN LOSS ALARI'.I JUN 2, 2002 3:53 AI't NAY 5. 2002 3:23 JAN 6.. 2002 :3:24 AP1 H I GH PRODUCT ALARP1 DEC 29.. 2002 8:47 PI'.1 AUG 14. 2002 9:30 Piti JUL 8, 2~02 9:51 PPI INVALID FUEL LEVEL JUL 19, 200:3 1 44 · JUL 19, 2003 1 43 PI'.I JUL 19, 2003 1 36 PN PROBE OUT OCT 1.. 2001 12:11 Piti OOT 1. 2001 11:57 AP1 J~N 30, 2001 :3:45 Piti DEL I'qERY NEEDED SEP 15. 1995 !0:16 AN t:~LARPI H I STORY' P, EPORT ...... SENSOR ALARI't ...... L I:U-L SUMP STP SUP1P FUEL ALARP1 AUO 7, 2002 9: 46 AI'.'I FUEL. ALARI"I O{I;T 1, 2001 11:47 Aid FIJEL ~qLARI',] SE!::' 22 .. 2000 12 ::3'7 PI'.'I ALARI'.I HISTOR'7 REPORT .......... SENSOR ALF~RI'I ..... gl: FASTR I P:' 2698 ,'3SUELL BKFD CA 661-872-8781 AUG 12, 2003 8:03 AM SYSTEM STATUS REPORT ALL FUNCT[(:,NS NORMAL SYSTEM SETUP AUG 12., 2OOS 8:04 AM SYSTEM UNITS U.S. S'¥'STEM LANGUAGE ENGL I SH FASTRIP 2698 OSWELL BKFD CA 661-872-8781 SHIFT TIME 1 SHIFT TIME 2 SHIFT TIME 3 SHIFT TIME 4 DISABLED DISABLED DISABLED DISABLED SYSTEM SECURITY CODE : 000000 PRINT TI] VOLUMES ENABLED TEMP COMPENSATIOIq VALUE (DEG F 5: 60.0= 'PERIODIC TEST WARNINGS DISABLED ANNUAL TEST WARNINGS DISABLED C;OMMUN I CAT I OMB SETLJP PORT SETTINGS: NONE FOUND RS-222 SECURITY CODE : 000000 RS-232 END OF MESSAGE DISABLED 1N-TANK sETuP T I:UNLEADED PRODUCT CODE THERMAL OOEFF TANK DIAMETER TANK PROFILE FULL VOL 1 .000700 96.00 1 PT 12022 FLOAT SIZE: WATER WARNING HIGH WATER LIMIT: MAX OR LABEL VOL OVERFILL LIMIT HIGH PRODUCT DELIVERY LIPIlT LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT: TA~q}::[ T 11_;r : MaN I ~"<T'~: '-I'4,~tT- ' ":~ ~ ' ' PER 10Di'-:. TEST TYPE PERIODIC TEST FAIL 4.0 INCHES 2.0 ~.0 12032 90)g 10828 95% 11430 1% 120 1 99 50 0.00 ~:IU I ALARM DISABLED (-,n,.-,c,c, 'TEST ~A I L ALARM i-)ISABI,ED PER ]'EST AVERaG I i',iG; OFF TANI< TEST NOTIFY: OFF TNK TST SIPH©N BREAK:OFF [ELI\ER~ BELAY : 15 MIN T .v: PL US I:'~Ol-)UOT CODE'' 2 THER'/"I~qL COEFF . O007L]O TANK DI,?IETE~? 96. O0 T~NK P~OFILE 1 PT FULL VOL 12032 FLOAT ~/ZE: q.0 INCHES HIGH ~,.,.I~TE~ LIMIT: NaX O~ LABEL VOL: 120;32 OVE~FI LL LIMIT : : 10828 HIGH PRODUCT : 95?4 : 11430 : 120 LOW P~ODUCT : 1 LE~K ~L~R/'.'I LIMIT: 99 SUDDEN LOSS LINIT: 50 T~NK TILT : 0.00 ~'"l~t',I I FOLDED T~NKS T~: ["/ONE PER I OD I "" T o' ..... g,o F TYPE QL IC}.: PE~IODfC :T o EoT F~IL ALA~P] D ISABI.EI) ':3ROSS TEST F'B1L ' -'- aLa~t'.,/ D l Pg~ TEST AVERAC; 1 t'lC;; OFF TANK TEST NOTIFY: OFF TI'd( TBT SIPHON BREAK:OFF DELIVERY DEL~"~" : 1~ MIN T 3: I::'REMI UM PRODUCT G©DE THERMO~L C. OEFF TANK D I TANK PROFILE FULL VOL ,000700 96.00 1 PT 12032 FLOAT SIZE: 4.0 INCHES [,,JATEP~ WARN1NG : 2.0 HIGH WATER LIMIT: 3.0 Pla× C,R LABEL VOL: 12032 OVERFILL LIMIT : SOX: : 10828 HIGH PRODUCT : 95% : 11430 DEL[VERY LIMIT : 1~ : 120 LOW PRODUCT : 1 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 T6NK TILT : 0.00 MAN I FOLDEr) TANKS T~t: NONE PERIODIC TEST TYPE PERIODIC TE~T FAIL GUICK ALARM DISABLED GROSS 7'EST FAIL ALARM DISABLED P'E~: TEST At/ERA(ii N(]: OFF 'Y'Al'd, TEST N.~:,T I~"~": OFF TNK 'Ff~:T S [ PRON BRE&};:: :OFF DE[,I'v'ERY DEL~Y : 15 MIN T 4 ;DIESEL I:~ROD LJCT CODE THERMAL C©EFF TANE DIAMETER TANK PROFILE FULL V©L :,4 · 000450 '96.00 1 PT 12032 FLOAT SIZE: 4.0 INCHEfi: kJATER' I.,~J~RN I N(~ HIOH .,JATER LIMIT: 3.0 PI~).< OR L~EL VOL: 120:32 OVERFILL LIMIT : 90~, : 10828 HIOH PRODUCT : : 11430 DEL I'qERY /,IMIT : 120 LO~d PRODUCT : 1 LEal( ~L~RI'-'I LIMIT: 99 ~UDDEN LO~S LIMIT: 50 T~NK TILT : 0.00 M~N I FOLDED T~: NONE PER I OD I C TE~T TYPE PERI©DIC TEST FAIL '.Q' U I ALARM DISABLED GI,;:OF_;S TEST FA I L ALARM DISABLED PER 'FEE;T AVERAGING: OFF TANK TEST NOTIFY: OFF TI',IE TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MIN LEAl( ]"E:2;T P1ETHOD TEST PIONTHL'~" : ~4LI_, TAN}( (,dEEK I STRRT TII"IE 2:00 AP1 TEST R~TE 0.20 O~L....."HR DURST l ON 2 HOUR~ LIQUID SENSOR BE'TUP : U-L SUI"I? -STATE (S1 NGLE FLOAT (;&TE(;ORY : STP E;UI'IP L 2:U-L ANNULAR '¥R I -STATE ( ~ I NGL, E FLOAT ) C;&TEOC:,RY : RNI',IUL~R L 3: PLUt-3 SUP1P TR I -E;T~4TE ,:: S I NOLE FLOAT ::, CATEGORY : STP SLII'qP L 4:PLUS ~NNULAR T~ I -STF~TE ( ':_i I I',IGLE FLOAT ) Ot4TEG©R'¥ : RNI',IUL~R SPACE L 5 :PREHI UP1 SUP'It::' TR I .-STATE (S INGLE FLOAT) (;~TEGORY : STP SUPII::' - L -6-: I:'REPII ~lrq aNNULAR -- - TR I -STRTE ( S INGLE FLO~T) C~TEOOP."~". : AI',INULAI;t SPACE L 7:DIESEL SUI"IP TR I -STATE < SI NGLE FLOAT CATEG©RY : STP ff31Jl"lP L 8:DiE:'~;EL ANNULAR TR I -E;T~TE ( ,c31 I,I(3I~E FLO~T ) C~TEt3OR"~,' : ANNULAR f3PACE OUTPUT RELAY SETUP R 1 :lJ-L TYPE: STANDARD NORMALLY CLOSED LI):~IUID SENSOR ALMS L 1 :FUEL ALARM L 2:FUEL ALARM L 1 :SENSOR OUT ALARM L 2:SENSOR OUT ALARM L 1 :SHORT ALARM L 2 :SHORT--AL-ARM - R 2 :PLUS TYPE: STANDARD NORMALLY CLOSED LI~:~IUID SENSOR ALMS L :3:FUEL ALARM L 4:FUEL ALARM I., :3:SENSOR OUT aLaRM L 4:SENSOR OUT ALARM L :3:SHORT aLaRM L 4:SHORT ALARM R :3:PREMIUM TYPE: STANDARD NORMALLY LI~:~-iUID SENSOR ALMS L 5:FUEL ALARM I_ 6:FUEL ALARM L 5:SEIqSO];: OUT ALARM L 6:SENSOR OUT ALARP1 L 5:SHORT ALARM L S:SHORT aLARM R 4 :EtI ESEL TYPE: ST~4 IqDARD NORMALL"ff CLOSEI'I LIGILIID SENSOR ALMS L 7:FUEL ALARP1 L 8:FUEL aLARM t ? SENSOR C:,UT ALARM L 8 SENSOR OUT aLARM L 7 SHORT ALARM L S SHORT ALARM ; 0~'/28/01 07:45 'Z~oe 26 0576 BFD HAZ ~IAT. D ~ 002 MONITORING SYSTEM CERTIFICATION : [''or Use By All Jurisdictum~' Within th~' State of California Attthori(y Cited: Chapter 6. 7. Health and Sa. fety Code: Chapter 16. Division 3, Title 23, Ccdij~rnia Code of Regulations' This form must be used to document testing and servicing or' monitoring equipment. A separate certification or repo~ must be prepared For each.~mg.nitoring system control p.p.l~el by the technician who performs thc work. A copy of this tbrm must be provided to the tank system owner/operator. Thc owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 Tank W: 7-/ ~In-Tank Gauging Probe. Model: ~Annular Space or Vault Sensor. Model: ~Piping Sump / Trench Sensors). Model: Fill Sump Sensor(s). M~eh Mechanical Line Le~ Detector. Model: Elec~onic Line Leak Detector. Monet: days of test date. A.. General [nf~rm23,tion Facility Name: Facility Contact Person: Make/Model of Monitoring Sysiem: ~)~.t_~ ,,,~.~'~' B. Inventory of EquiPment Tested/Certified Check the appropriate boxes to ind!cate s~ecifl.c, e~ulpment inspected~serviced: ~1 Tank Overfill i High-Leyel Sensor. Model: g Other (sDecif~' equipment type and model in Section E on Pa~:e 2). ,, Tank ID: _'~_,~ ~--'~'X ~'qn-Tank Gauging Probe. Model: ~ / ~lnul~ Space or Vault Se'nsor. Model: ~~ Bldg. No.: City: ,~.~0 Zip: ~...~._,~, contact Phone N'o.: (~) -~ Date ofTesting/Se~icing: ~//~/ lil'~ping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model:' Electronic Line Leak Detector. Modch ' Tank Overt'ill/.High-Level Sensor. Model: Other(specify equi?mcnt tjx'pc and model in Section E on Pa~c 2). ~,~innular Space or Vault Sensor. Model: ping Sump / Trench Sensor(s). Model: ~,1~:>- ~l"'Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model': Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: __ Tar, k Overfill / High-Level Sensor. Model: Other (specify equipment type..gnd model in Vispe, w: ' //.,o ... Section E on Pa~e 2). ~ Fill Sump Sensor(s). Model: [] Mechanical Line Leak Detector. Model: ~ Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: [] Or_her (specify. equipm, ent t~,De and...m, odel in SectiOn E on Pa~e 2). DisPenser ID: ~'/~ (~shiSpenserContainment Sensor(s). Model: ear ¥ al,,'ets). Dispenser Con~in~,e~nt Float(s)and Chain(s). ~1 Dispenser Containment Sensor(s). Model: lh'~hear Valve(s). '21 Dispenser Containm.en!.F. lost(s) and Chain(s,). Dispenser ID: ~//tO ~1 Dispenser Containmem'Sensor(s). Model: i~'~Shear Valve(s). _Dispenser Containment Sensor(s). Model: ~".S he ar Valve(s). Dispenser Cont.ai.n.{n,ent Float(s) and Chain(s). ~ Dispenser· Containment Float(s) and Chain(s). Dispenser ID: ~& Dispenser ID: _ Dispenser Containment Sensor(s)~ ~lodel: O~penser Cont~nment Sensor(si. Model: ~hear Yah'ets). ~St,ear Valve{s). .~Dispenser Containment Float(s) and Clmin(s). ~ Dis?pact Cont~nment F'loat(s~ and Chain(~). .-If the facili~ contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification · I certi~ that the equipment ldent%fied in thls dr,cument was lnspected/servlced in accordance with the manufacturers' gtddelines. Attached to this Certification is trfforn'mtion (e.g. manufacturers' checklists) necessary to verify that th. is information is correct and a Plot Plan Showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the repo._rt; (checkoff that apply): ,ll"System se(.up ~A~rm htstora,r~j,..~ Technician Nm-ne (print): -.~--~.~~'"~ O Signature:~.~-- ~"-J"~ -~"~ Certification No.: t~t~'ZN"~ Li,:e'n~e. No.: ~ ~' Testing Compa;y Name'~..~-,-~-~' ,,~.~:~e~/~ Phone No.:(~,/ _)~,:~.~ Site AOdress: '~,~ ',~,6/~ ~ Date of Testing/Servicing: Monitoring System Certilication Page I oF3. 03/0t UY/28/0! 07:46 "~6 326 0576 BFD HAZ ~tAT ~003 D. Results of Testing/Servicing Software Version Installed: Corn dete the followin checldist: ~ Yes ~ O No* J Is the audible al'a~____~perational?' ' -- _ C3 Yes ~ No'~ ~ Is the visual alarm o_Rperational? ~ ~ Were all sensors visu~_ected, functionall~ested, and confirmed_~:~erational? ~ Yes j Q No* Were ail sensors installed at lowest point of secondary containment and positioned so that other eq~ no~ interfere wi'tll their proper operat/on? ~ Yes Q No'" If alarms are relayed to a remote monitoring station, is all communications equipment e---e.g, modem) J]r N/A operational? -- ~ Yes ~ No* For pressurized piping systems, does the turbine automniically shut down if the piping secondary containmen ~ N/A I monitoring system detects a leak. fails [o operate, or is electrically disconnected? If'yes: which sensors initiate positive shut-down? (Check all that apply) i~Sump/Trench Sensors; ID Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks an,~d sensor failure/disconnection? J~'Ycs: [2 No. ~ Yes ]~[ No* For tank systems that utilize the monitoring system as the primary tank ove~ll warning device (i.e. N/A mechanical overfill prevention valve is installed), is ~¢ overfill warning alarm visible and audible at the tank fill point(s) nn__d~? If so, at what percent of tank ca ac.p..~y_does the alarm ~ '~1 Yes* J~"No Was any monitoring equipment replaced.'? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer.name and model for all replacement parts in Section E, below, Ci Yes* il ~ No Was liquid found inside any secondary, containment systems designed as dry systems? (Check all that apply) ~ __ J Product; ~ Water. If ~ causes in Section E, below. ,m' Yes ^ti.oh u- e-o, s i .... ~'Yes O ~-~";~,,'T .... ' , ~a ucaote * In Section E below, describe how and when these deficionc;.~ w ..... ~4n k corrected, Page 2 of 3 03/0t o09/28/01 07:47 · 326 0576 BFD HAZ 004 F. In-Tank Gauging / SIR Equipment: ,id' Check this box it' tank gauging is used only t'or inventory control. ~ Check this box it' no tank gauging or SIR equipment is installed. · This section must be completed it' in-tank gauging equipment is used to perform leak detection monitoring. Com the followin checklist: i. ~ Y~s 'D No:,'! His ali input wiring b~"e'n__inspec'teci' tbr proper entry and terminaiion, i'n~iuding testing for ground faulls? -- ~' Yes O No* Were all tank gauging probes visually inspected for damage and'residue buildup? ~l' Yes il No* Was accuracy of system product level readings tested'? - ~ Yes C2 No* Was accuracy ct' system water level readings, tested? ~ ~ Yes ~ No* Were all probes reinstalled property'? -- nJzr' Yes ~ No* Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how'and when these deficiencies were or will be corrected. G, Line Leak Detectors (LLD): ~ Check this box it' LLDs are not installed. Corn dele the following checklist: Yes 'il No* For equipment start-up or annual 'equiPment certification, was a leak simulated to verify LI~D performance? 121 N/A (Check all that apply) Simulated leak rate: F13g.p.h.: i210.1g.p.h; I.~0.2g.p.h. ..: Yes ~ No* Were all LLDs confirmed operational and ~curate witkin regulatory requirements? Yes ~ No* Was the testing apparatus properly calibrated? Ye~ IZl-No* For mechanical LLDs, does the LLI5 restrict p~'oduct flow' if it detects a lea"~k~ ,-i N/A Yes .~1 No* For electronic LLDs, does the turbine automatically ~hut off if the LLD detects a leak? ~ N/A Yes ~ NO* For electronic LLDs, does the 'i~rbine"automati'cally shut off if any portion of the monitoring system is disabled ~ N/A or discormected? Yes ~ No* For electronic LL~,"does the turbine automatically shut off if any pc~Jion of the monitoring system atalfunctions ~ N/A or fails a test'? Yes ~.Ne* For electronic LLDs, have all accessible wiring connections been'visually inspected'?. Z] N/A ~f'es .2 No* Were all items on the equipment manui'acturer's ~aintenance checklist completed? In the Section H, below', describe how and when these deficiencies were or.will be corrected. H. Comments: Page 3 oi'3 0a/0t Monitoring System Certification Site Address: UST Monitoring Site Plan ..... ~..~...". ~:..: ~. ~ ~~*~~ .~-,'~'.~':-: :.. :. :..:::: Date map v,'as drawn: Instructiong If you already have a diagram that shows all re~lUired informatioi~, .y0u m~y'iii~'clude'it,~ ra~h~r' than~,,~'.s ~g'e, w/th your Mo' nit'ring S'y.~i~'C'~ifi- ~ ~'~i'~? locations, of the"foii0~ng equip~e~it, if installe~i~:'~;hii6firi~"s.'~:~tem' ~;f'~l'~?~i~ '~$h'ii6~'~"~ annular spaces, sumpS', disperis'er' pans; spill containers,: or '°iher S~c°nda!~'6'bhtai~hi~ ireas:, 'mechaia!6~l ~)r"~leet~6nic line leak detectors; and in-tank liquid level probes (if used for leak detection), In th~ SPace provided, note the date this Site Plan ..... . , [. ~,:... ' . -....~:4..: .... :.- · ;.- :-. . .... !-- ' ':' ' was prepared. ~a~e"~ / .of/:':/:":.:'~:~'~.: :.i~ i¢ ~: ::5 -..'::- -:' · %':: ::. -"'[i':" ..C. , . ".~':~,;'..J~¥': .. :?~[".'..:':::.."..-'.-¥~.:~q~:..~¢.?~'$:¢¢~"*J.i~?'. ?.'i "::?: ?':' ;; ."':" · ':f.."; ...... '-' :..i · ,:._.: z.".,: .r.~.:.:..~.:.:;,,. · ':: "7.'4 :: :; ?..,;~r .,,. '..: ;~:~.::.?:,;..:::'~?~:.~.~,¢~.~.~.~.~.?'...:. . ..'¢ .. .. _ . ~'..: :..::...~?..-.'.,....~.;~.~.:. · ....~::....:.. :. .... ~ ........ .~.:.:~ .: <;....,..:~:.-..... ...... . . ,: , . O510O FIRE CH EF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 sUpPRESSION SERVICES 2101 UH" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES · ENVIRONMENTAL SERI~CES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 17 i 5 Chester Avb. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 January 22, 2003 Fastrip 2698 Oswell Street Bakersfield CA 93306 RE: Upgrade Certificate & Fill Tags Dear Owner/Operator: Effective January 1, 2003 Assembly Bill 2481 went into effect. This Bill deletes the requirement for an upgrade certificate of compliance (the blue sticker in your window) and the blue fill tag on your fill. You may, if you wish, have them posted or remove them. Fuel vendors have been notified of this change and will not deny fuel delivery for missing tags or certificates. Should YOu have any questions, please feel free to call' me at 661- 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of-Environmental Services SBU/dc CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program Routine ltd Combined [] Joint Agency Type of Tank .~d ~ Type of Monitoring cA t-/,~ ' [] Multi-Agency [] Complaint Number of Tanks t./' Type of Piping 003~' [] Re-inspection OPERATION C V COMMENTS Proper tank data on file [_, / Proper owner/operator data on file Permit tees current ,~, Certification of Financial Responsibility Monitoring record adequate and current o/ / Maintenance records adequate and current t'~ / Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY' Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: _"~i ~ Office of Environmental Services (805) 326-3979 White - Env. Svcs. stfl~s S~te Responsible Party Pink - Business Copy 07:45 ~661 0576 BFD " MONITORING SYSTEM CERTIFICATION For Use By All Jurisdicntm. s Wt't/ti,,~ Ua' State of California A uthurl'ty Cited: Chap,'er 6. 7, Health ant] Sql'cry Code: Chdpter 16. Divisirm ), Title 23, CuliJbrnia Code of Regulations T~is form must be used to document testing and servicing or' monitoring equipment. A separate certification or report must be prepared for each monitoring syste_.m, control p~_ne._J by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this fom~ to the local pliancy regulating UST systems within 30 days of test date. ' A. General Information Facility Name: ,~"/4'-J 77:2. Site Address: '..i(,::~q 'i"' Facility Contact Person: /O bK,.Y'~4 ~-~,,q-- Make/Model of Monitoring System: B. Inventory of Equipment estedlCertlfied Check th.e appropriat,e boxes to indic?.e s~aee, i.~c equipment iaspected/setwiced Tank ID: '~[ ~n-Tank Gauging Probe. ' Model: ;L~/ ~mul~ Space ~r Vault Sensor. Model: ~q~o ~Piping Sump / Trench Sensors). .Model: '~ ~ Fill Sump Sensor(s). M~el; ~ Mechanical Line Le;& Detector. Model: ~ Elec~onic Line Leak Detector. Modeh -- ~ Tan~ Overfill /High-Level Sensor. Modeh ~ Other (specify equipment t~e ~d model in Section E on Pa~e 2). · ' ~ In- rank Gauging Probe. Modeh .~ ~mul~ Space or Vault Sensor. Model: '~ ~Piping Sump / Trench Sensor(s). Model: '~ Y'~O ~ Fill Sump Sensor(s) M~el: ~ Mechanical Line Le~ Detector. Model: ~ Elec~onic Line Le~ Detector. Model: ~ ~ Took Ore, Il / High-Level Sensor. Model: ~ ~ Ot~e~,(s~cify equipment type and model in Section E on Page 2). Dispe~ser ID: ~ ..... penserCom~nment Sensor(s). Model: ar VMve(s). ' ~U Dispens?~ontainment ~oat(s) and Chain(s). Bldg. No.: Contact Phone N'o.: ( ~&/ ) ~,4aZ"z-. -'~¢a2.~ r'-~A, nnular Space or Vault Sensor. ~Piping Sump / Trench Sensors), ~ Fill Sump Sensor(s). ~ Mech~ical Line Leak Detector. ~ Elco=chic Line ~ Detector. ~ Tank Ove~lll / High-Level Sensor. Model: U Other (s~ci~v equipment t~e ~d model in Section E on Page 2). ~[n-T~k G~ugi~g ~obe. MOdeh ~Annul= Space or Vault Sensor. Model: '7~q~g~o t-t ~ - ~Piping Sump / Trench Sensor(s). Model: ~ Fill Sump Sensor(s).' Model: " D Mechanical Line Le~ Detector. M~el: Elec=onic Line ~ Detector. Model: Tank Ove~ll / High-Leve! Sensor. Model; Other (~peci~v equipment type and model in Seciion E on Pa~e 2~. Dis~nser ID: ~spenser Containment Sensor(s). Model: Shear V~ve(s). Dispenser Cont~nment Float(s) ~d Chain(9. D~spenser ContaJnmen: Sensor(s). Model: ~ear Valve(s). Dispenser Containment Float(s) and Chain(s). Dis~n~r ID: Dispenser ComMnment Sensor(s). Model: She~r Waive(s). Dispenser Cont~nment Float(s) and Chain(s). Dispenser ID: _._~ p-' ~ D~penser Containmdnt Sensor(s). Modeh eD'Shear Vah'e(sL '7,,J Dispenser containment Float(s) and Cha 'Dispenser ID: ' .... 5'""~._ .... ' ]] 9...Pispenser C°ntainment Sensor(s), Mode-'~": ~ Shear Valve(s). . ' "'qDispenser Contninmem Float(s) and Chain(s). Model: Model: Model: Model:' Modeh 002 ~[f the faciliLy contains more tanks or dispensers, copy this form. Include infom~ation for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was Inspected/serviced in accordance with the manufacturers' guadelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessaD, to verify that this :information is correct and a Plot Plan showing the layout of monitoring eqtfi~ment. For any equij~:nent capable of generating such reports, I have also attached a copy of the repgj~(check al!JJ4at apply): -~]'8¥'stem se~-up [JAla, r~ hlsto3r~report · Technlcmn Name (print):_ .~-.~'k~. /C~.~_~5-~. Signature: ._ ~ ~ · C r,, c:t on Xo- 7.Z3 e . · , .... U .... - ' , L,i:en~e. ,:~o.: Testing Compa~,N.~ame: ._~T,'~<5i:-'7'~ /'5"/~(,,,2 fi' .~ . Site Addl'ess: ff IfJ.// / ~___~,;,/' Date of Testing/Servicing: __~/_~/_ O '7_._ Monitoring System Certification Page I tff 3 03/0 t 09/28/01 07:46 '~661 326 0576 BFD HAZ bi,iT DII ~]003 D. Results of'Festing/Servicing Software Version Installed: dete the fotlowin Yes No.* No* No* No* checklist: No*' . Is the audible alarm o_9_perational?' Is the visual atarm operational? Were all sensors visually insp. ected, functionallytested' and confirmed operational? · Were ail sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ~rgper~peration? If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? For pressurized piping systems does the turbine automatically shut down if the piping secondary containme Yes Yes* ~ N/A _No* No No* monitoring system detects a t r icaJly d~sconnected? If yes: which sensors initiate positive shut-down? (Check ~ .. p Sensors; ~J Dispenser Containment Sensors. ' ~ou confirm positive shut-down due to leaks and sensor failure/disconnection?~es; ~ No. For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention valve is installed) is the overfill warning alarm visible and audible at the tank >int(s) and ope_rating properly': /.f so. at what percent of tank capacity does' the alarm et'? Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment re and list the manufacturer name and model for all replacement parts in Section E. below. Was liquid found inside any secondary, containment systems designed as dry systems? (Check all that ~pplv) ~ Water. If 'e~escribe causes in Section E, below. · . Was monitorin~_q,.~Ly, stem set. uE..reviewed to ensure ~s? Attach set~licable Is all monitorln Fs * In Section E below, describe ho,,,' and when these deficiencies were or will be corrected, C m" s? Page 2 Of 3 o~/0t 09,/'28/01 07: 47 0576 BFD HAZ 3fAT DIV 00'4 In-Tank Gauging / SIR Equipment: ~eck this box if tank gauging is used only for inventory control. Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank o~ o' o equipment is used to perform leak detection monitoring. ~ lU~ln~ Co~oplete the followin~ checklist: ' .,~1 ryes I Cl. No" [ Has all input wiring been 'inspected for proper entD' a,d ter~nation, includin testi,~ for round t~ults? ~ Yes { ~ No* i Were all tank ~augin~;;es visuall~ inspected for damage and 'residue build~ * ~ g ~ Yes 'I ~ No* [ Were all probes reinstalled proper;v~ ~ Yes I = N0? ~ Were all ,em~..on the equipment manufacturer's maintenance ch;cklist comple'~ed? * In the Section H, below, describe how ~'r~d when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): i~Check this box ifLLDs are not installed. Corn dote the followin checklist: Cl Yes 121 No* 1 For equipment start-up or annual 13/N/A (Check all that app!y) Simulated k Yes ~ No* Were all L'LDs confirmed operatior Yes Cl No* Was the testing apparatus properly Yes . a yO* { Pot mecha,ical LLDs, dg~s the LL] ~" Yes ~ N~;'~ ~r electronic LLDs, does the turbi~ ~N/A Yes ~o* For el~nic LLDs, do~s the turbi ~ N/A or disco~ected? %s ~o* For eledeonic L~DZ does the turbin ~ N/A or fails a test? Yes ~ No* 1 For electronic ~L5' ~ . LLDs, have all access Y~s' ~o* / We;e all items on the equipment mm eqmpment certification, was a leak simulated to verify LLD performance? leak rate: ~ 3 g.p.h.: i3 0. I g.p.h; [..] 0.2 g.p.h. . m~d accurate within regulatoff requirements? -. calibrated? restrict product flow if it detects a leak'.9 e automatically Shut off if the LLD detects a leak? tne automatically shut off if any pon/on of the monitoring system is disabled automatically shut off if any portion of the monitoring system malfunctionst )to wiring connections been visually inspected? aturer's maintenance checklist completed'?" * In the Section H, below, des'tribe h~>w and when. these deficiencies were or will be corrected. H. Comments: Page 3 of 3 o 3/o I Moaitoring System Certification USS?Monitoring Site Plan c} g.?,c) 6 Date map was drawn: ~ / ;7102- Instruetion~ if you already have a diagram that shows all required information, You may'i/ielUde it, raiher than'this ~age, with your Monitbring system cirtificii~iafi':? ,: On y°Ur" si{~ :"~i~;i'show' locations of t...he 'follOwing equipment, if installed/??!':~nit°fiagS~stem.~'~i~'~i~';:'S~i{ibi:i '~i~ili6'~;~ annular spaces, sumps; dispenser pans, spill containers, or'other Secondary ¢ontai~h{ areasi mechanical or":ile~tr~fii¢ linC'leak detectors; and in-tank liquid level probes (if used for leak detection), In thO' space provided, 'note the date this Site Plan was prepared. ' ......... . - ":":" '.ii~""'::i ...... ii ' :'""'"'":' :'" ' ' Page" "' of :' :' ':'"::':::ii'i,:'i i';: '5:=?''!'; ,.:;..;."' ..i' :.i;:':: /":::" :i . :~:.'i · ' " .' -. . ....... · .'.. :: · '..c~ ,::;"..'5;..5: '.: .': , .'.(:,5 --': .i~:<~:h:?i?k:.,-,i~.& .-~.,.~.:.::.~.~ . 05/I)0 WORK ORDER LOCATION OF JOB N~,~ .F-,~'~¢ .7~'7 ...... ADDRESS ~..6, 9 ,~ ~----~:~/~q-- ~'* CITY ~'~ CONTACT PERSON PHONE NUMBER DESCRIPTION OF WORK TO BE PERFORMED: ASSIGNED TO' ..~',.,~-M.5 ¢ ~' ,,'~ DATE: . WORK P ~,/~RM~D: _~ ~._~} .MATERIALS USED: MATERIALS USED: MATERIALS USED: MATERIALS USED: VENDOR: VENDOR: VENDOR: VENDOR: 2002 August 07.max T 2:PLUS 'PRODUCT CODE THERMAL COEFF TANK DIAMETER, TANK PROFILE FULL VOL .000900 96.00 1 PT 12032 FLOAT SIZE: WATER WARN I NG : · HIGH. WATER LIMIT: MAX OR LABEL VOL OVERFILL LIMIT HIGH PRODUCT DELIVERY LIMIT LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN.LOSS LIMIT: TANK TILT : 4.0 INCHES 2.0 ·3.0 12032 10828 11430 120 1 99 0.00 MANI FOLDED TANKS T~: NONE PERIODIC TEST TYPE QUICK PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:~FF DELIVERY DELAY : I N-TANK SETUP T I:'uNLEADED' PRODUCT CODE THERMAL COEFF TANK DIAMETER TANK PROFILE FULL VOL 1 .000700 96.00 1 PT 12032 FLOAT SIZE: 4.0 INCHES WATER WARNING : 2.0 HIGH.WATER LIMIT: 3.0 MAX OR LABEL VOL; 12032 OVERFILL LIMIT .: 90% : 10828 HIGH PRODUCT : 95% : 11430 DELIVERY LIMIT ; 1~ : 120 LOW PRODUCT : LEAK ALARM LIMIT: SUDDEN LOSS LIMIT:· TANK TILT : MANIFOLDED TANKS TI: NONE PERIODIC TEST TYPE 1 99 5O 0.00 QUICK .PERIODIC TEST FAIL ,ALARM DISABLED G~OSS TEST FAIL .... :ALARM DISABLED PgA TEST AWERAGI NG: oFF TANK TEST NOTIFY: OFF TNK 'TST ~IPHON BREAK:OFF DELIVERY DELAY : 15 MIN SYSTEM ~ETUP AUG 7, 2002 10:03 AP1 SYSTEM UNITS U.S. SYSTEM LANGUAGE ENGLISH FASTR I P 2698 OSWELL BKFD CA 661-872-8781 SHIFT TIME 1.: DISABLED SHIFT TIME 2 : DISABLED SHIFT TIME 3 : DISABLED SHIFT TIME 4 : DISABLED PERIODIC TEST WARNINGS D I SABLED ANNUAL TE~T WARNINGS D ! SABLED SYSTEM SECLJR ITV CODE : 000000 PRINT TO VOLUMES E N,~_LED - TEMP COMPENSAT I ON 'VALUE (DEC F ): 60.0 COMMUNICATIONS SETUP PORT SETTINGS: NONE FOUND RS-232 SECURITY CODE : 000000 RS-232 END OF MESSAGE 'DISABLED ~LIQUlD SENSOR SETUP L I:U-L SUMP TRI-STATE (SINGLE FLOAT) CATEGORY : STP SUMP L 2:U-L ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE L 3:PLUS SUMP TRI-STATE (SINGLE FLOAT) CATEGORy : STP SUMP L '4:PLUS ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY : ANNULAR SP~CE L 5;PREMIUM SUMP TRI-STATE .(SINGLE FLOAT) CATEGORY :' STP SUMP L 6:PREMIUM ANNULAR TRI-STATE (SINGLE FLOAT) CATEGORY :: ANNULAR SPACE L 7:DIESEL SUMP TRI-STATE (SINGLE FLOAT) CATEGORY · STP SUMP L 8:DIESEL ANNULAR TR I -STATE (S INGLE FLOAT) CATEGORY : ANNULAR SPACE T 4:DIESEL PRODUCTCODE THERMAL COEFF TANK DIAMETER TANK PROFILE ' FULL VOL 4 .000450 96.00 I PT 12032 FLOAT SIZE: 4.0 INCHES WATER WARNING ': 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: 12032 OVERFILL LIMIT : 90%' : 10828 HIGH PRODUCT : 95~ : 11430 DELIVERY LIMIT : 1~ · : 120 LO~ PRODOCT : : LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 T~NK TI~T" : 0,00 MAN!FO~DED TANKS T~: NONE PER:ODIC '?EST TYPE QUICK PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARId DISABLED PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MIN REMIUM P~ODUCT CODE THERMAL;COEFF TANK DIAMETER TANg PROFILE FULL VOL 3 .000700 96.00 1 PT 12032 FLOAT SIZE: 4.0 INCHES WATER WAR,NING : 2.0 HIGH WATER LIMIT: 3.0 MAX OR LABEL VOL: OVERFILL LIMIT HIGH PRODUCT DELIVERY LIMIT 12032 90~ 10828 95Z 11430 120 LOW PRODUCT : 1 LEAK ALARM LIMIT: 99 SUDDEN LOSS LIMIT: 50 TANK TILT : O.OO MANIFOLDED TANKS T~: NONE PERIODIC TEST TYPE PERIODIC TEST FAIL QUICK ALARM DISABLED GROSS TEST FAIL ALARM DISABLED PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY : 15 MIN LEAK TEST METHOD TEST MONTHLY : ALL TANK WEEK I SUN START TIME : 2:00 AP1 TEST RATE :'0.20 GAL/HR DURATION : 2 HOURS ,:,}N-TANK DIAGNOSTIC PROBE DIAGNOSTICS T 3: PROBE TYPE MAG2 SERIAL NUMBER 087556 ID CHAN = OxCO01 QRADIENT = 352,1900 MUM SAMPLES = 20 1336,4 C01 9077.0 COB 9077.2 CO5 COO C02 C04 C06 9077.0 C08 9077.0 C10 9077.0 C12 9594.6 C14 9334,9 016 9918.6 C18 45523.9 9077.0 9077.0 9077.0 CO7 9077.0 C09 9076.9 Oil 45521.4 C13 9143.7 015 9590.3 017 11234,8 SAMPLES READ =198366496 SAMPLESUSED =198360292 I N-TANK .D ITAGNOST I C PROBE ~IASNOSTICS T 4: PROBE TYPE MAG2 SERIAL NUMBER 087662 ID CHAN = OxCO01 GRADIENT = 351.9300 MUM'SAMPLES = 20 COO' 14~5;9 CO1 8451.8 C02 8452,0 C03 8451,3 004 8451,8 005 8452,0 C06 8451,9 C07 8451,7 C08 845~,0 C09 8451,9 CIO 8452.0 Cll 43961;6 012 8474.5 013 8632.3 C14 8879.0 C15 9012.7 016 9934.0' Cl? 10758.3 C18 43963.,3 SAMPLES READ =195250418 SAMPLES USED =195245398 ALARM HISTORY'REPORT ..... SENSOR ALARM L I:U-L SUMP STP SUMP FUEL ALARM AUG 7, 2002 9:46 AM FUEL ALARM OCT 1, 2001 11:47 AP1 FUEL ALARM $EP 22, '2000 12:97 PM SOFTWARE REVISION LEVEL VERSION .8.05 SOFTWARE~ 3495DO-OOS-F CREATED - 95.07.06.08.33 NO SOFTWARE MODULE SYSTEM FEATURES: PERIODIC IN-TANK TESTS ANNUAL IN-TANK TESTS IN-TANK DIAGNOSTIC PROBE DIAGNOSTICS' T 1: PROBE TYPE MAG2 SERIAL NUMBER 087576 ID CHAN = 0xC001 GRADIENT = 952.2400 NUb'SAMPLES = 20 COO 1371.0 C01 18790.4 C02~"187~0.3 C03 18790 6 C04 18790.7 C05 18791 0 C06"18~]0J7 C07 18790 9 C08 18790.8 C09 18790 7 ClO 18790.6 Cll 49806 4 012 8164.0 C13 8204 9 014 8603.7 C15 9170 2 O16 9494.,3 C17 9517 6 018 ~3807.6 S~MPLES ~E~D =205388579 SAMPLES USED =205358531 I G OSVICS T 2: PRO~E TYPE MAG2 SERIAL NUMBER 087564 ID CHAN = 0xC001 GRADIENT = 352.5000 MUM SAMPLES = 20 CO0 1370',0. COl 17376,3 C02' 17976,4 CO3 17976.3 C04 17376.3 C05 17376,2 C06 17375,7 007 17375,8 C08 17375,6 C09 17976.0 CIO 17376,1 CI1 43988,7 C12 8274,1 013 7930,6 C14 8212,5 015 8464,3 C16 8563,3 C17 9119,2 C1S 43990,1 SAMPLES READ =202151392 SAMPLES USED.=202143637 O.UTPUT RELAY SETUP· R I:U-L TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L I:FUEL ALARM L 2:FUEL ALARM L I:SENSOR OUT ALARM L 2:SENSOR OUT ALARM L I:SHORT ALARM L 2:SHORT ALARM R 2:PLUS TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 3:FUEL ALARM L 4:FUEL ALARM L 3:SENSOR OUT ALARM L'-4:SENSOR OUT ALARM L 3:SHORT ALARM L 4:SNORT ALARM R 3:PREMIUM TYPE: STANDARD NORMALLY CLOSED LrQgID fiENSOR ALMS L 5:FUEL ALARM L 6:FUEL ALARM L ~5:SENSOR OUT ALARM L 6:SENSOR OUT ALARM L 5:SHORT ALARM L 6:SHORT ALARM R 4:DIESEL TYPE: STANDARD NORMALLY CLOSED LIQUID SENSOR ALMS L 7:FUEL ALARM L 8:FUEL ALARM L 7:SENSOR OUT ALARM L 8:SENSOR OUT ALARM L 7:SHORT ALARM L 8:SHORT ALARk $11115f!' 3812 PanOrama Drive Bakersfield, CA Phone: 661-322-0660 Fax: 661-871-1788 CA... License # 589517 Secondary Testing Certification Facility Address Operators Name Owners Name Secondary Test Passed I/''' ' Failed Notes: c~ Name of Tester t~.e:eo Tester License# ~2~,'2q-Q Name of Contact Person Phone # of Contact Person _~ Date & Time Test 'was Conducted Date: ~-- t:z2--o'~ Time: Signature of Tester 3812 Panorama'Drive Bakersfield, IIA 93306 Phone: 661-322-0660 Fax: 661-811-1788 SECONDARY. SYSTEM CERTIIqCATION FORM DATE ~'- i'3- O 2; FACILITY ID ',3%'~ FACILITY NAME & ADDRESS TURBINE SUMPS SUMP-1 Start Time .............................. ~O~; Initial Height of Water ........... Stop Time .................. 9-'. Final Height of Water Results .................. l~g~ Certification (Signature) .... SUMP-2 sUMP-3 SUMP-4 ~ '0~5 '~:'* ,ct: t46. ¢,c, ;3: q~ ~'~ OVERFILL BUCKETS OVERFILL-1 OVERFILL-2 OVERFILL-3 Start Time ............... Initial Height of Water rt. q~ ~ ~ q ', Stop Time ................... Final Height of Water ........... ~, Ot Gq" Results ................................ Certification (Signature) .... OVERFH.,L-4 UST ANNULAR SPACE ' Tank-1 Start Time ........................... 'Initial Vacuum Pressure ....... Final Vacuum Pressure Results Certification(Signature) Tank-2 Tank-3 Tank-4 SECONDARY PIPING Start Time ................ : Initial Height of Water ....... Stop Time ................. Final Height of Water ........ Results ................ Certification (Signature) ... L~E-2 L~E-4 >-,'UM~° L. Eh;< i%ST REPORT ']EST ST~RTED TEST ST¢~RTE[:, E~8/!3/2002 :--;E;])" i.4 L[UEL 4.4164 ENP T]~E :-.-!'.~I) (:,aTE ~}8/13,"2982 ENr., !..EUEL 4.4154 tN .... ::.,'-,k. "rl-;RESHOLD 8.~-302 IN , rt.,-.,: RESULT OTB 2 TEST ST?¢F..:TE[:, i i ':..r,, '.:~TC~RTED 08./Z3/2C'Et2 BEGIN LEt,tEL 5. 8334 'EN[' D~]TE 08/13/2002 ~-.-;'4~) L.EUEL 5.8532 LEflE THRESHOLD 'r'ES? ~:ESULT P~qSSED :.:aSTRi P 347 2698 OSI4EL.L. $~'aK. ERSF I ELD 02 t-aM -322-8666 LE¢~K TEST RE¢'ORT SUNP 3 T~.%T STr-~RTED 3:46 TEST ST,~RTED E!8,."13/2002 9EG I?'! L..EUEL 2.72S5 ......... I-"-' ~ TM EN;} LEVEL 2.7294 ;_ Z~K TMRESIqOLD TES'r RESULT PfqSSED .::,_,tl- 4 TEST STf~RTED 3:46 P~ ,"rFST STP~R'fED 08/13.."2F~02 BEGIN LEUEL 4.3473 Il'; END r~ME 4:.21 ?H El,ID r)~'rE 08/13/2002 qNO ..... 4.3474 LErqK THRESHOLD 0.k~02 IN .............. :..r,..,=T F'I~SSED ::¢~E;¥,..q: i P 3,47 269'7: :::',i:fi'r'...c..i<?;!- .~ ~:.'._L~ ,.,n g8/'~3/2~02 '-' ....!..'.:]qK '7''~ ?E'F'gR.T ]-,,ES? C:Ti~fiRT',:-.[:, ]::;~'.ltS F'!'I :: F..S: !',' LEUEL 6. 8705 Et.E:, TI?dE 2:28 E ',0 t P. TE ~d:--,/.~.::,,' ..-.(¢5.~ EH.P..' LEUE',._ 6,87.96 If"; TEST r~,-,',, t' v' "'"'.q'-'r'D ' SU~'!P :2 T?.-~ ,"Z~'"";-'''', - 05 ..... ,: 7.,.r F, ~b.' ]'tEST STtqRTED 98/t3/2982 BEGIW LEUEL 6.4E193 E','4D T i'."tE 2:28 END DhTE 68/13/2FJ82 E~4E !...EL~EL 6, 4894 LEf~K THRESHOLD T',:%T PESULT P~SSED i::6STRIP 347 2698 OSWELL ?,¢iK~ZRSF I ELD CA 93386' i.-661-52.2-0668 ,- .......... - ...... w',''~" TEST ST~aR'I'E[:., ~.),::,, .,.._,... z.~:,~..,..: ,:":,-m..: ' ~"'-' -' RF.,FI9 ii"~ F' ,r', ~" ~.1"" ...... ,r. r'Fc','F -,-.,.-r...--,. ,-.-, END LEVEL ; ~...:~i RESULT PF~SSED 3,SP ~)SL TEST STARTED t8:25 ~ TEST STARTED 88/t5/2002 BEGI~ LEVEL 6,5917 IN ~NO TI~E ~0:40 ~ END PATE 08/!3/200£ ENO'L. EUEL 6.5917 IN LE~K THRESHOL~ 0.002 IN ~698 OSWELL. 8AKE~SFiELD C~ 95306 -i..-~,61-322--0660 0~/t3/200~ 8:55 ~Fi ;.~K TEST REPORT %CST STRRTED 8:39 ~M TEST STARTED 08/~3/2882 -, ..... · ' ~FL 4.212~ END TIME. 8:54 A~ END D~TE 08/:1.3/2002 END L.EUEL 4.1906 iN i..iECK T!~RESHOLD 8,002 IN 'TEST RESULT FAILED' OFB 2 TE~T STARTED 8:39 fir T~ST STARTED 08/13/2082 BEGIR LEUEL 0.64~6 iN '.Ei4~ TIHE 8:54 ~M · END DATE 08/!5/200~ E~O LEVEL Z 8.6105 IN LEAK THBESHOLD 8,082 IN TEST q£SULT ~ILE~ OFB 3 'rEST STARTED 8:39 AM TEST STCRTED 08/t3/2002 R~n~N.:_E..iEL 4,3674 IN ............ 8:54 ~ END T!blE END O~TE 08/~S/2002 ENO L.EUEL 4,~668 IN LE~K THRESHOLD 0.002 ZN TEST ~ESULT PASSED OFB-4 TEST STARTED 0:~9 AM YEST ST~RTEO 08/1~/2002 BEGIN LEUEL 5.7575 IN 'ENO T~ME 8:54 ~M END ~TE 08/t5/2082 FNO :.Et)EL 5,7573 iN LE~K THRESHOLO 0,002 tN · TEST RESt~L]' PASSEO 07./31/02 08:50 '~661 326 0576 BFD HAZ ~IAT DIV 01 CITY OF B~RSFIELD OFFICE OF ENVI[RON/VIENTAI; SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING FACIT,.ITY. Fastrip #34 7 ADDR~-$S:""' 2698 Oswel£ Street P~ TO oPERATE # OPERATORS NA. NiE. OWNERS NAME 622 jaco Oil Company Jato-Hill NUMBER OF TANKS TO BE T~ TANK# 2 3 4 VOLUME 12000 IS PIPING GOING TO BE TES'rEDY£s.' CONTEFrrs MVF MVF MVF MVF F2000 F2000 F2000 TANK TESTING COMPANY, M~G ADDRESS 3'812 NAME & PHONE NIJlVlBF_.~. OF CONTACT PERSON Mark TESTMEq/-IOD Hydro'static & VacuUm NAME OF TES~ OR SPECIAL INSPECTOR Ken Brus APPROVED BY OA~ SUNSET MECHANICAL Panorama Drive 93306 Blackburn 322-0660 / Ron Rogers 08/13/O~,8:00AM-700pM . SIGNATURE OF APPLICANT CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION FACILITY Fastrip #347 'Site ID #622) ADDRESS 2698 Oswell Street OPERATORS NAME Jaco Oil Company OWNERS NAME Jaco-Hi£1 NAME OF MONITOR MANUFACTURER DOES FACILITY HAVE DISPENSER PANS? Veeder-Root YES X NO TANK # VOLUME I 12000 2' 12000 3 ~2000 4 ~2000 CONTENTS MVF MVF MVF MVF NAME OF TESTING COMPANY SUNSET MECHANICAL CONTRACTORS LICENSE # CA 5 8 9 5 [ 7 NAME &PHONE NUMBER OF CONTACT PERSON Mark Blackburn DATE & TIME TEST IS TO BE CONDUCTED 08/07/02 DATE APPROVED BY 322-0660 [I:OOAM-12:3OPM t Si[GNATURE OFAPPLiCANT L D FIRE r July 31, 2002 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 '1-1' Slree! Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES S,U:ETf S~RW:ES · rdemmmF, m',u. srdmcEs 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3696 FAX (661) 326-O576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield. CA 93301 VOICE (681) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 David Palmer Jaco Oil Co. P.O. Box 1807 Bakersfield, CA 93380 CERTIFIED MAIl, RE: Annual Maintenance on Leak Monitoring Systems REMINDER Dear Mr. Palmer: This letter is to advise you that the following Jaco Oil sites are coming due for annual maintenance on their leak monitoring systems. They are as follows: Howards Mini Man 3300 Planz Road Due 08-17-02 Mt. Vernon Fastrip 3501 Mt. Vernon Duc 09-04-02 Fastrip/1622 4013 S. "H" St Due 09-06-02 Fastrip #641 1200 Coffee Rd ,.-. Due 09-07-02 Chris' Liquors 2732 Brundage Ln Due 09-07-02 Fastrip #6 1640 S. Chester Due 09-07-02 Ming & Real Fastrip 3701 Ming Ave Due 09-07-02 Fastrip #19 4901 S. Union Due -0-07-02 Fastrip #640 8001 White Lane Due 09-19-02 Wholesale Fuels 2200 E. Brundage Due 09-27-02 Fastrip/t621 805 34a~ Street Due 10-01-02 Fastrip g26 2698 Oswe_lL_.. Duc 10-01-02 Harris Market 1701 Union Ave Due 10-01-02 Howards #6 4201 Belle Terrace Due 10-15-02 Farrells Fastrip 6401 White Ln #112 Due 10-15-02 Howard's #4 3200 Panama Ln Due 10-15-02 Fastrip #633 6401 S. H Street Due 11-01-02 As a courtesy, this reminder has been sent formal "Notices of Violation" will be sent of testing has been received. to you. No further reminders will be sent, and 10 days after the due date, unless documentation Should you have any questions, please feel free to call me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc July 30, 2002 Fastrip 2698 Oswell Street Bakersfield CA 93306 FIRE CHIEF P, ON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES * EI~IRONMENTAL SER1/tCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-O576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA ~8 VOICE (661) 399-4697 FAX (661) 399-5763 REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2002 of Underground Storage Tank (s) Located at the Above Stated Address. Dear Tank Owner / Operator: If you are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last four months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Sincerel~ ' Steve Underwood Fire Inspector Environmental Code Enforcement Officer D May 29, 2002 Fastrip 2698 Oswell Street Bakersfield, CA,93306 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661 ) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 2698 Oswell Street REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002. section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every. 36 months thereafter. REMEMBER!! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office, and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures D April 17, 2002 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Fastrip 2698 Oswell Bakersfield CA 93306 RE: Necessary Secondary Containment Testing Required by December 31, 2002 REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002. Section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 shall be tested by January 1, 2003 and every 36 months thereafter. Secondary containment testing shall require a permit issued thru this office, and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize ~nd have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer SBU/dm enclosures 1,,~-29L2001 2:SlPM FROH JACO_O[L_COHPANY E~139387:38 .'i I:>. 9 ~?~"~a-' 11~~ MONITORING SYSTEM CERTIFICATION For Use By Afl Ju~fsdic~on$ Hfithin the State of California ,,' ' Authority Cited: Chapte~ 6,7, Health and Safety Code; Chapter 1~, ~'v~sion 3 Title 23, California Code of Regule~ons T~hls form must be used lo document le~ing and ~t;vicing of monitoring eqUlprnem. Jf mom than'one monito~ng system control panel is in.ailed at the facility, a ~-pafat~ ~cdif'~ation or report m~st be pYepamd fo~ each monlto~ing s ,y'~, m control panel b)'·xtra te~=hnictan ~o performs the work. ,A.c,~.py of this .town m. u.s~ be provided to the tank system owner/opemt'or,'The oW~ler/el~rator must submit a ~py ofth.~s to~ t0the local agency regulating UST sy.~terns wthm 30 days el lest (~a[e. A. General Information Facility Name: FASTRIP City BAKERSFIELD CA Zip: 93306 Site Address: 2698 OSWELL STREET Contact Phone No:$72.~.~Z9 ·" Date of Testing/service: 10/01/20Ol Facility Contact Pemon: MANAGER Make/Model of Monitoring System: GILEARCO EMC Worl~ Order Number: 3118964 B. Inventory of Equipment TestedlCe~'tified Check the appropriate boxes to [ndLCate specific equipment inspected/sen'iced Tank ID: 1 . nkID: 2 In-Tank Gauging Probe. ..... ' Modeli ' MAG-1 ,~ tn. Tank Gauging Probe. Model; MAG-1 Annurar Space or Vault Se~=~,or. Model: 420 .~.~...I Annular Space oy Vault Sensor. Model: 4~:3 Piping SumP/Trench Senso~s). Model; 208. .~,.~..1~ Piping SUmp/Trench Sensor(s), Model: 20~ Fill Sump Sensor(s). Model: Mechanical Line Leak Deteclor. Model: Electronic Line Leak Deteclor, Model: Tank Overtill/High--Level Sensor. Model: MAG-1 Fill Sump Senso~(s). Model: Mechanical Line Leak Detector, Model: Electmnlo Line Leak Dmector. Model:. Tank Ovel'fill/H~gh-Le~el Sensor. Me'lei: MAG-1 ' [] lanK IIJ: 3 Other (~peolfy equipment type'and model in Section E on page ~). Other (sl;~:if~ equipment tyl~ and n-,~lel in Section E on p~ge 2). [] In-Tank Gauging Probe. M~lel: MAG-I ] Annular Space or Vaul~ Sensor. Model: 420 ] Piping Sump/Trench ~ FSI Sump Senso~s). · M~el: ~ Me.angel Line L~k ~ector. ~ E~t~io Line L~k O~or. M~el: ~ Tank ~l~H;g~Level Sen~r. M~el: MA~-! ] other (,Sl:~'~ify equipment type end m~:lel in Section E on page Dispenser iD; l'/Z rs[-~ Dispenser comainment Sensor(s) Me'lei;NO SENSORS [] Shear Valve(s). [] Dispenser Containment Float(s) and Chain(s), ,'Di-SP~ nser ID: Disl~nserConlatnmentSensor(s) MOdel:NO SENSORS'. Shear vaive(s). Dispenser Co~tain~nt R~t(S) and Chain(s).. I a~qK IL): 4 In-Tank Gauging Probe, Model: MAG-1 Annular Space or Vault Sen~or, · Model', 4~0 Piping Sump/Trench Sensei(s). MOdel; 2C~, Fill Sump Sensor(s)· Model: M~'chanical Line Leak De, actor. Model: FX1 'E~ectronic Line Leak Oeteclor. Mo,~el: [] Tank Ovsrlilt"High-Level Sensor, Model: MAG-1 ] Other (specif~ equipment type and model tn Sev-tbn E on page 2). Ml~penser 1u: [] DismnserContainment Sensor(s) Modal: NO SENSORS Sh~r VaNe(e) ~. Dis~nser ~ain~m Fl~(s) and Chain(s). ~' Ois~nser. C0nlainmenl ~enso~s). M~I: NO SENSORS· ~ Shear Vabe(s). Dis~nse~ Co. inure Ro~(s) and Chain(s). Dispenser ID; ] Dispense~'Contair~ment Sensor(s). Model: [] Shear Valve(s). [] DiSpenser Containment F!oat(s) and Chain(s). Dispenser ID: 5/6 ~'] DispenSer Corrlainrnent Sen~on[s), Modal; NO SENSORS "x"I [] Dispenser Containment Float(s) and Chain(s), * If the facility contains more tanks or dispensers, copy this form, Include information for every tank and dispenser at the facility, C. Cellificatlon ' .-. I ce~lify that the equipment identified in this document was inspected/sewiced in ac~°rdatlce with the manufacturers' guidelines. Attached to this certification is information (e.g manu~ctumrs' checklists) necessary to verify that this information is correct. and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (Check all that apply): System set-up report; · F X'] Alarm history report E~ ,'~.'.~'" ,.-/" ,' ::' ' sIGNATuRE; ""~Z ':':'?: '~'"? ':' PRINTED NAME:RICHMOND PHILLIPS COMPANY: Tanknology PHONE NO: (800) $00-4633 page 1 of 3 Based on CA form dated 03/01 1~-2g-200']. 2:B2PH FF~OH JACO_OIL_COMPANY ~;13938738 'q it' ingSy ' on or stem Certification 2698 OSWELL STREET Site Address: Date of Testing/Service:' 10/01/2001 P. 10 D. Results of TestinglServici'ng So/t,,vare version Installed: n/a Complete the following checklist: [] Ye~, ,,..O NO . · Is the audible alarm operational? ,, [] Yes [] No ' iS the visual alarm operational? [] Yes [] No * Were all sensors visually inspected, functionally tested, and confirmed operational.'? Were all .Sensors installed a~ lowest poin! of Secondary co~ainment and poSl[ioned so that other equipment will not P~Yes E]No' interfere with their proper operation7 .... [] Yes [] No * L~ WA' If alarms are relayed to a remote monitoring station, is all communications equipment (e,g. modem) operational7 For pressurized piping systems, does the t'urbi~e automatically shut down if th~ piping secondary containment [] Yes [] No" i[~ NiA monitoring system detects a leak, fails to operate,, or is electrically disconnected? If yes: which sensors initiate positive shut:down? (check all that apply) [] Surnp/Tmnch Sensors;. [] Dispenser Containment Sensor~. Did you confirm positive shUt-down due to leaks an._.~d sen~r failure/Oisconnection?, ,rJq Yes [;;;] No ..... F6r.tank systems tl~t utilize the monitoring system is the primarY tank overfill warning device (i,e,: no mechanical [] Yes [] No' [] NIA overfill prevention valve is installed), is the ovefftll warning alarm visible and audlbte' at the tank fill point.(s) and operating properly? If so, at what.percent of tanY. capacity does the alarm trigger? 9O [] Yes* [] No ' Was"any monitoring equipment replaced? If yes, identify specific ~ensors, probes, or other equipment' replY'ced and list the manufacturer name and model for all replacement parts in Section E, below. ~ No Was liquid found inside any sec(andary contain'merit systems aesigned as dry systems7 (cheCk all that apply) [] Product; Yes* L_J [] Water, If yes, describe causes in SecZton E, below. ..,.. :,. [] Yes [] No ~i Was monitoring system set-up reviewed to ensure proper settings? Attach set-up reports, if applicable, [] Yes E~ No °! . "' Is all monitoring equipment operational per manufacturer~;'';pacifications? * Ir1 Section E below, descdbe how a~d when these det~ciences wen~ or will be corrected. E. commentS: page 2 of 3 10-29-2001 2: 52PM FROH JACO_OIL_COMPANY 6613938738 P. 11 MonitOring System Certification Site Addre~: 2698 OSWELL STREET F. In-Tank Gauging I SIR Equipment *Date of. Testing/Service: 10/01/2001 [~. Check this box if tank gauging is used only for irwentory control, [] CIieck this box if no tank gauging or'SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perlorm leak detection mOnitoring, Complete the following checklist: . [] Yes [~ No" Has all input wiring been inspected for proper entry and termination, including testing for ground faults? j~ Yes [] No * Were all tank gauging probes visuai'ly inspected for damage and residue buitdup? ' ' '. F-I','e,, IZI No' was of sy';te,',', p,odu ,',,,;dings te d? E~]Yee.~ [] No * Wa'$'accuracy of system waier level readings tested? _{~ Yes ' [] No'! Were all probes reinstalled proi:~erly? "' .... [] Yes E~ No" Were all items on the equipment manufacturers' maintenance checklist completed? * In the Section H. below, describe how and when these deflciencie6 were or will be corrected, G, Line. Leak Detectors (LLD) · [] Check this box if LLDsare not installed, Complete the following checklist; ~J' Ye~ ~ [] No" [] N/A For equipment start-up or annual equipme'~t certiflcationl was a teak sim~llated to verify LLD per/ormance? (Check all that'apply) Simulated teak rate: [] 3.g,p,h E~ 0.1 g.p.h E~0.2 g.p,h [~Yes E] No" Were all LLDs confirmed operational and accurate within regulatory requirements? [] Yes [] No' Was the testing apparatus properly calibrated? [~'Yes [~)No* [] N/A For mechanical LLDs, does the LLD restrict product flow if it detects a teak? [] Yes r-]No- [] N/A For electronic LLDs, d~es the turbine automat[c'~lly Shut off if the LLD detects a le~k? [] Yes []No' J~ N/A I~ For electronic LL!:~, does the turl~i'ne automatically shut off if any portion of the monitoring system is disabled or dis~onnected? [] Yes" ["~No* [] N/A For electro'nic LLDs, does the turbine ~utomatically shut off lt~.any portion of the monitoring system maidS'ions or fails a test? [] Yes [~No* 'b N/A= For electronic LLD~, have all a~ce~ibie wiring'connections been visually .inspected? [] Yes ~'lNo * were all items on the equipment manufacturers' maintenance checklist completed? ' In the Seu-"tJon H, below, describe how and when these deficiencies were or will be corrected. H. Comments: page 3 of 3 · i 0~29-2001 2: B3PH TEST DATE: Z0/01/01 CLIENT:JACO OSL CO. .FROH JACO_OIL_COMPANY 66139387'38 SITE DIAGRAM 8900 SHOAL CREEK; BUILDING 200 AUSTIN, TEXAS 78757 (512) 451-6334 'FAX (512) 459-14~9 WORK ORDER NuMBER31"t 8964 SITE: FASTRIP P..12 C-STORE S~__T.~/ 12K ' PREM ' ~'"~ 12K PLUS %_..2 : 12K UL 'DSL Printed 10/03f2001 12:$7 KOHLMEYER CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ! INSPECTION DATE Section 2: Underground Storage Tanks Program [] Routine [~l Combined [] Joint Agency [] Multi-Agency [] Complaint Type of Tank ~IU.t~-C~ 4 Number of Tanks t.( , Type of Monitoring 4(_~tA. Type of Piping ~2~' [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file ~ / Permit tees current Certification of Financial Responsibility Monitoring record adequate and current ~,,/ Maintenance records adequate and current Failure to correct prior UST violations L,/ Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS sPcc available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance /~ V=Violation Y=Yes N=NO Inspector:~ ']~' ~./ZO_, _~ Office of Environmental Services (805) 326-3979 White- Env. Svcs. Pink - Business Copy Busin-~s~gi~e- Responsible Party FACILITY NAME tC&54r,;n ADDRESS 0(-, q~9 ./tl~_r {]'t~i't,,t~d ~'~ FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE PHONE NO. ~?o'l' 3ooq BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program Routine [~ Combined [~ Joint Agency [~ Multi-Agency ~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy ~, / Verification of inventory materials L, / Verification of quantities k.~ Verification of location Proper segregation of material Verification of MSDS availability ~. / Verification of Haz Mat training ~ ' Verification of abatement supplies and procedures / Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand Yes [~ No C=Compliance V=Violation Any hazardous waste on site?: Explain: Questions regarding this inspection? White - Env. Svcs. Please call us at (661) 326-3979 Yellow - Station Copy Pink - Business Copy OCT 4. 200! 9:03 WATEP. = 8. O0 INCHES TEMP = 90.6 DEG F OCT 4.. 2001 9:25; ",./OL UI"iE = 424'2' GaLS I,.JATEF: = O.t]O INCHES TEMP = 9028 DEG F _,R ........ I NCI~EASE2 1 683 ']'C NET I NCI,?E'ASE~, 1646, FaSTF: I P 2698 B}:.'.FD 885"-87'2.-.3029 OCT 4. 206-; T 1 :LINLEal)FJD 'v'OI_ UME = 9 L] ?'2 90% UI.,LA,:X:E~ 1'75F P"' e TC '%;}LLiIi.,1E = 8881 GALS HEIt3HT = 67.72 INCHES 14~TER VOL = 0 G~LS 14ATEFt = ' TEMP = T .... ,L .PIE I. JLL~qGE 90~;-~ I. []LAGE: TC: ',,,,',:}l_l_lP1E O.CIO INCHES 90.0 DEG F 4685 GALS '7 :]::{~ ? {gALS 6193 GALS 4537 GALS HEIGHT = 39.30 IN(?HES I.,.IATEI.? 'v":}l. = 0 GALS WATER = 0,00 INCHES TEMP = 90.EI [:,E']3 F T :121: [::'.l;l;'Et...I 1' I.II.'1 '~/'"'i_, LiHI{{ - .':, <, o = 4 ....... G~hLF-~ LILLA,3E = 7?99 F;'"'~ o ..qE :i': UI..I.AE.;i~i.6595 TC VOI..iJH~:i = 414.5 HE 1,3HT = ;36. ?'2 }-tEl.-'_; WATFF: ".."OL := 0 ~ .... I,,,li::t]"E~ = O, 00 INCHES T 4: [:, 1 ESEI_ V,31.. I_iHE = 501 '3 UI.I..&i(gE = '7ili18 ':3AJ_.;-il 90.%; IJLLAGE= .5809 GALS TC 'v'OLLIHE = 494:3 (]ALS; .... HEIC;HT = 41 .73 INCHES WATER -VOL =.: 20 GALS b. IAT£I~ = 0.97 I NCt~ES 'rB"IP =,, 93,4 DEG ,ere items 1,2, and 3. AIsd complete 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: John K~rley Jaco Oil P O Box 82515 · d ~ Bakersflel Ca 93380 RE: Fastrip #26 2698 Oswell 2~ Article Number (Copy from service, label) 10. 0520 0021.96,10 8124 3811, Postage Certified Fee Return Receipt Fee (Endorsement Required) Rest~cted Delivery .Fee~ {Endo~ement RequJrea~ Tot,. Po.t..° & F~ $ City, S~ate, ZJP+ 4~. .~ Da~ers]: le±o Ca Addressee : from item 17 [] Yes Jelivery address below: [] No Service Type Mad ' l~ Certified Mail [] Express ' [] Registered [] Return Receipt for Merchandise~] [] Insured Mail [] C.O.D. '_~'~Ili Restricted Delivery? 'Extra Fee) [] Yes " 1025q -9-~,, '.1789 D September 27, 2001 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326o3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 . TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 John Kerley, Jaco Oil P O Box 82515 Bakersfield Ca 93380 Certified Mail NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Failure to Submit/Perform Annual Maintenance on Leak Detection System at Fastrip #26, 2698 Oswell, Bakersfield Dear Mr. Kerley Our records indicate that your annual maintenance certification on your leak detection system is past due. September 22, 2001. You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, 'including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, October 27, 2001, to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services by: Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cC: Walt Porr, Assistant City Attorney D · September 10, 2001 FiRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 ~H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" SJreet Bakersfield, CA 93301 'VOICE (661) 326-3941 FAX (661) 395-1349 pREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL' SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. ' Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 John Kerley Jac0 Oil Company P.O. Box 1807' Bakersfield, ca 93380 cERTIFIED MAIL · NOTICE OF EXPIRATION ON MONITORING CERTIFICATION Dear Mr. Kerley: . The following Ja¢o sites are currently due/past due on annual monitoring certification. These sites are as follows: Site Address Due Date 2. 3. 4. 5. 6. 7. 8; 9~ 10. 11. 12. 13. 14. 15. 16. Farrells Fastrip, 6401 White Lane Chris Liquors, 2732 Brundage Lane FastriP #640, 8001 White Lane Wholesale Fuels, 2200, Brundage FasU'ip #19, 4901 S. Union Fastfip #621,' 805 34~ Fastrip #6, 1640 S. Chester' Fastrip, #26, 2698 Oswell Street Howards g4, 3200 Panama Lane Fastrip #622, 4013 "H" Street Ming & Real Fastrip, 3701 Ming Ave Fastfip #641,120OCoffee Road Howard's #6, 4201 Belle Terrace Howard's, 3300 Planz Road Harris Market, 1701 Union Ave Mt. Vernon Fas~p, 3501 Mt. Vernon 9-04-01 9-05-01 9-05-01 9-12-01 9-12-01 9-20-01 9-22-01 9-22-01 9-23-01 9-27-01 9-27-01 9-28-01 9-28-01 9-28-01 9-30-01 10-2-01 Failure to perfoma or submit monitoring certification within 30 days of due date will result in' revocation of your Permit to Operate. Should you have any questions, please feel free to contact me at 661-326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement office Office of Environmental Services ' SBU/dm D AUgust 3,2001 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 · FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Fastrip 2698 Oswell Street Bakersfield Ca 93306 RE: Deadline for Dispenser Pan Requirement December 31, 2003 REMINDER NOTICE Dear Underground Storage Tank Owner: You will be receiving updates from this office with regard .to Senate Bill 989 which went into effect January 1, 2000. This bill requires dispenser pans under fuel pump dispensers. On December 3 l, 2003, which is the deadline for compliance, this office will be forced to revoke your Permit to Operate, for failure to comply with the regulations. It is the hope of this office, that we do not have to pursue such action, which is why this office plans to update you. I urge you to start planning to retro-fit your facilities. If your facility has been upgraded already, please disregard this notice. Should you have any questions, please feel free to contact me at 661-326- 3190. Sincerely, Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dm FACILITY NAME ~"~134'~,~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r° Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program [] Routine [~ombined [] Joint Agency Type of Tank ~ Type of Monitoring [] Multi-Agency [] Complaint Number of Tanks 6/ Type of Piping 00J ('~ [] Re-inspection OPERATION C V COMMENTS / Proper tank data on file V / Proper owner/operator data on file t// Permit tees current [-~/ // Certification of Financial Responsibility t,,,/ / Monitoring record adequate and current ~/' Maintenance records adequate and current ~ Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling / Is tank used to dispense MVF? / If yes, Does tank have overfill/overspill protection? C=Compliance ffV=Violation Y=Yes N=NO r/// l Inspector: ~ ~.~~r~ Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Site Responsible Party CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME r~.3~r~_~r~_~: ADDRESS. ~gf~q~ .tVttt.' t~rNal'~ FACILITY CONTACT INSPECTION TIME INSPECTION DATE lO/.1 q/O0 ' PHONE NO. ~)~ "~0,~4 ' BUSINESS IDNO. 151210- NUMBER OF EMPLOYEES q Section 1: Business Plan and Inventory Program [] Routine ~"~mbined [] Joint Agency [] Multi-Agency [21 Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials · Verification of quantities Verification of location Proper segregation of material / Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate . L~ / Containers properly labeled Housekeeping L/ · Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: [] Yes [] No Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink- Business Copy Business ~nsi.ble arty 'Inspector: _~,' ~ I~onst;r'u ct~ion MECHANICAL Continuous Monitorin( TEST DATE FACILITY NAME ADDRESS (661) 871-1788 Device Certification FACILITY NUMBER CONTACT PERSON J O ~ ~ ~'e r' I ~ TELEPHONE ~G,1- :~,/'~,- '7000 ZIP CODE ~ ,.,~'~ o',',~"7 MAKE AND MODEL OF MONITORING SYSTEM TANK I TANK 2 TANK 3 TANK Contents of Tank Capacity of Tank Type of Product Line (Gravity. Suction. Pressure) INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING A YES OR No IN THE APPLICABLE BOX: Annular Space Sensor ,,~ ~ ~. ~ Sump Sensor ,,/~s - --T,, Dispenser Containment Sensor ,,~ ~ --> Electronic Overfill/Level q 5 o~ ~/~S ~ :~ Electronic In-Line Leak Detector r~ o --.-. ~ Mechanical Line Leak Detector ,,/~ ,/~ ~' ~ 0 'y~5' In-Tank Gauging Device V ~ 5 ~ ~ INDICATE THE FOLLOWING BY PLACING A YES OR No IN APPLICABLE BOX: Does the Monitoring System have audible and visual alarms? Does the turbine automatically shut down if the system detects a leak, fails to operate or is electronically disconnected? "'~§' - Is the monitoring system installed to prevent unauthorized tampering? Is the monitoring system operable as per the manufacturer's specifications? ~.~$ Which continuous monitoring devices Initiate positive shut down of the turbine? CERTIFIED TESTER'S ID# SIGNATURE OF CERTIFIED TECHNICIAN PRINTED NAME OF CERTIFIED TECHNICIAN TESTING COMPANY NAME & TELEPHONE DATE C/-~ ~. 0-0 CERTIFICATION DATA Crrv oF 1715 Chester IAve., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS -UST FACILITY TYPE OF ACTION [-I 1. NEW SITE PERMIT [Cl~ect~ one ttem only) [] 3. RENEWAE PERMIT .~4. AMENDED PERMIT [] 5. CHANGE OF INFORMATION (~oec~y c/~ange. local use on/y) [] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED SITE [] 8. TANK REMOVED I. FACILITY / SITE INFORMATION BUSINESS NAME (Same a~ FACILITY NAME NEAREST CROSS STREET FACIMTY OWNER TYPE I4~1. ~'?- INDIVIDUAL BUSINESS ~,1. GAS STATION [] 3. FARM [] 5. COMMERCLAL [] 3. PARTNERSHIP [] 2. DISTRIBUTOR [] 4, PROCESSOR [] 8. •TH,ER 403. [] 4. LOCAL AGENCY/DISTRICT* [] 5. COUNTY AGENCY* [] 0. STATE AGENCY' [] 7. FEDERAL AGENCY* 40?_ TOTAL NUMBER OF TANKS /,~ Is facility on Indian 'lf ovme~ o~ UST a public agency:, name o~ SUl3e~3¢ o~ di~4ion, section or o~ce w~im op~a~e~ uhe UST. (ThIs i~ I~e con[act bemon for the lank recess.) IL ,PROPERTY OWNER INFORMATION OWNER NAME 410. '~" I ~"ONE¢¢!- STATE 411. J ZIP COOE c ~ [ q -~ 412. PROt:~r. RTY OWNER TYPE [] 2. INDIVIDUAL [] 4. LOCAL AGENCY/OIS~l~ D 6. STA~AGENCY 413. ~11. T~K ~ER INFOR~ T~K O~ER~ 414. ~ ~NE 415. ~ILING OR ST~ ~ 416. CI~ 417. I STATE 418. J ZIP~DE 419. T~K O~ER ~ ~ 2- INO~ ~ 4. LOlL AGE~Y I OlSmlCT ~ 6. STATE AGENCY 4~. 0 ,. ~T~. .~3. ' P~R~IP ~ 5. ~U~AGENCY ~ 7. FEDE~AGE~Y IV. BOARD OF EQU~J. IZATION U~T STORAGE FEE ACCOUNT NUMBER V. PETRO, LEUM MBT FINANCIAL RESPONSIBILITY INDICATE METHOD<S) [~1. SELF. iNSURED [] 4. SURETY ~ONO [] 7. STATE FUND 421. [] 10, LOCAL GOV'T MECHANISM [] 2. GUARANTEE [] 5. I.~m itROFCREDff 0 3. INSURAHCE [] S. EXEMPT ,K)N [] 8. STATE FUND & CFO L~ I I bR [] 9. STATE FUND & CD [] 99. OTHER: 422. VI. LEGA~ NOTIFICATION AND MAILING ADDRESS // C~ec~k one box to in,~lte w'nim add~,e~ s~:xM be uled for leg,at no~ft,c:adons amJ ,~ailing. Legal noUflcafion$ and mail ~ be ~t to t~e t~nk ~ unle~ ~z 1 or 2 L~ c~, ecked. [] I. FACILITY [~, P~OPERTY OWNER [] 3. TANK OV~q~ER 42:3. y~-~ VII. APPLICANT SIGNATURE ' I SIGNATURE 0 ~~~ DATE ~ME OF A~N~(pmO J 426. TITLE OF A~I~NT 424. PHONE 425. 427. STATE u~T FACILITY NUMBER (Foe/Dca/use on/y] 428.. [ 1~ UPO~E CERTIFICATE NUMBER (Forlocal use only) UPCF (7/99) S ACM PAFORMS~swrcb-a-wpd . CITY OF' BAKERSFIELD · OF~CE OF ENVIRONMENTAL~RVICES 1715 Chester Ave., Bakersfield, CA 9330T(661) 326-3979 UNDERGROUND STORAGE TANKS- TANK PAGE 1 ~.OCA non WITHIN ~11 [] ~. ~ O~ ~NFOI~<AI'ION) C~ ?. ~MA.N~NTLY CLO~o ON ~rE VI e. r,o~ L TANK ?ANK I0 $ !- (~ U~d Or) C] S. ~IqC)t. EWALLWm41NT'ElqNALM.,~kCN3e~S'YnJYI~M 0 · ~P cx:n, mA'r~w~oo~ uE~?~4cx. C]m. OT~R J~& untMo 0~. or~e. 447 · ~LLANOOVE/U;IJ. Y~RIN~TALLEO 450 TYPE (Foe' JoeM uae o~/) 4~! OVE/~IU,.PROTECTIONEQUIPMENT:Y~ARII'~T)J[Fr~ 452 i-- ~S~3LIWAu.'rA~(C~M,~. ~a3 ,~OOU~WAU.?A~<ONT,Ua<wm~m. AOOe~(~meM~ 464 :'JTtMATIO O),TI LAI'T UI40 ~Y) 4M llTli,9,TlO QUAHTTTY Of' ~UIIr~'gl ~ 4~ TANK FR.L~O WITH e~Rq' MATERIAL? F (7,'9g) S:~CUPAFORMSL.qWRC~.WPD crl~ OF BAKER.IFIELD _.~. OfFiCE OF ENVIRONMENTAL. SERVI~ Cheater Ave.. ~aker~fleld. CA 93301 (,Ml)~J[r~-3g7g uNOE/KLqOUNO ~P~NG AaOVEGROUNO Fi~,;a3 O 2. ~ICTK~i 1'1 3. GRAVITY 458 r-] ~. I:~E$SURE C] 2. SUCTION ir1 ]. GRA~TY ~ SYSTEM TYPE J~ t. ~tE~URE I'"] 3. uNEO TRENC~ I--I nee. ;ID ~. a~E STEEL ', ~m~u~.s*~o',O 2. s'rAa~.aSS STEEL ,, CORROSK~N ~ F~TECTION r'l ~. FRPCOt~ATI~L~IM 100% ME"~L 1'1 ~. 3~NGLE w)d.t. I--1 g~. uea(JMOWN , ' '.L~%?J FACTURER · ~"1 1. 8A.qE ~FEEL 0'-1 a. FRPCC'---~AT~u--FWI t00% M~ 2. STAINLESS STEEL 0'I ?. GALVANIZED STEEL 3. al.)~r~: COMPA~qat~ wn~ CONTENTS I--! & FLEX~LE (HOI~) I-1 ~. OTteR 4. FIMRC, LA~ [] 9. CAT14001C PtK)TECrION s. STEEL W/~TING [] g~. UNFd~OWN ~1. ~ L~.~a-K DeleCTION (C:a~r ag M a~.~ UN~UND ~ ii W/d.L iiLelNG 4~ P~qESSUR~E0 PU~NO (CMc~ ag ~' 1. ELECTR0~UNELEAKOL=TEG'rO~3.0OPH TE~T't~AUTOPUIla~HUTOFF FOR' 0'1 2. 4M [] ~/COm'eajOt~OmP~J,~MRPA~NaO~+AUOm~ANOWSUALALAP'~ . I-I ~. 'matC~U~J~/MONn'Of~l~ 1~3. CONTI,K)O~8 ~---,~r--...~ PAN ~ wn'H AUTO ~ OFF FOR 01SPEN~ AUOI6LE AM3 W~U~L. ~ 0-1 e, NON~ ~ SIGNATURE uPCF (7/99) IX. O~14ERA~ERATOR ~IONATURE __------- ~l~.~.-... 1715 Chester Ave., Bakersfield, CA 93301 (661)326-3979 · OAF£ INST~O (YF. AJ~I~O) . 435 L TANK OESCI~m'FI(3~ TANK k4,~J~UFACTURER rl 3. [] 4. r-] 3. FM~_I~GLA331~ r'l $. c~ [] & FRPCO&,~ATtgLEV~100% k~'Tt4A.N(~ 13:,. u,u,~ O.. ~ 0 4. ~~ Oge. OTHr~ 5P/LL A,NO OV~6RF1U. , ~',,,~k .,t a,~t V. TANK CLOIURE INFO~MA110~ I PlRlt,~qlJ~ Ct. OIURI IN PLACE ~ qTl~ TEo OAT~ LAST UI~[O ~flq~.dO,~AY~ 4.~ I ITiUATlO OU.'9/TrTY OP ~:~STA,~..,I ~ ~4~ TA.~4FILI.~OWITH~ERTMATERM~? -'CF (7~) 3 :XCIJ PAF O RM ~5~'WI~:,,wPC CITY OF 8AKER3FIELD OFFICE OF ENVIRONMENTAL ~ERV4~i~3 1715 ¢~ter Av~., B~kertfleld. CA $3301 (W26-357g SYSTEM rY~ .~h I:~IES3URE [] 2. SUCTK~N I:~ 3. GRAVn'Y 45a r'-i 3. UNEO T~..HCH [] 9~. OTHER r"l ~. [] 2. OOUBLE WALL [] 9~. OTHER' I~FACTURER [] [] U,',OERC,/~OU~ I:~:~NG P~ESSURLZEO P1P~NG (~ a/ifil ~ 1. ELE~~ LEA~D~P~CTOR3.0 Gl:~'l TES'TWr[~ALFOp~t4~I'~ITOFFFOR LF_A~ SYS'TEM F/JI. UR~/a'~lO ~rY3TEM [] 2. ~ONT~t.Y0.2Gm-iT'F...ST co~ SL~-noN SYSTEMS: l'-] S. OA~.¥VkSUALUONrrOP, m~OO~ ,PU TEST (0.1 C.d:~) SAFE ~ ~ (~ V~ UPCF (7~) 47C 474 · ' I S \CU PAFORMS~qWRC~.V91:: ., CITY OF BAKERSFIELD '2;i: ~ OFFICE OF ENVIRONMENTAI4~ERVICES ~]! 1715 C~ter Ave;, Bakersflel¢ ca 93~ (661) 326-3979 ' . UNDERGROUND $TO~aE TANKS- TANK PAGE 1 ~ 6S~dy~./~OC~,M~,y) r'l m. rAN~a~MOV~O TA~< t~ 435 C]~. I::::1 z m,z~ 0 5. Jerme. r'l 4. a/~x. O 9~. OVSaa , 441 r',~ocr~ C] 1. ~LEW~I [] 3. SaNOt~w/dJ. wrra 1-1 4. ~aNOt~WAt. LINAVA~t.T F1 ~. r'l s. coscat~ I~1~ INSTALLEO .-- 447 SPILL ..... '~'" ' ' "i"",'~'~ C] S. MANL~LT~~(~O) C::I ~. orca [] 3. CON'~N~<~Ua ATe q~. 'r ~ ~q,,..-.. ~,..'. ,... ' ' · ~, ...... I~ 0ou~L~ WALL TANK 0 R TANK IMT14 ~I.AOO~R (~ one Mm O~J~: ~ I'1 I. V~UN.(S~O4~WN.LmNVAUtTOi~.Y} . ~ : ..... '~ r'l 3. ~a,~'UAL MONn'on~No -'CF (7~) CITY OF 8AKER3FIELD OFFIC~ OP ENVIRONMBNTAL 3ERVICj~ 1715 Ch~ter Ave., ~kerlfleld, CA ~3301 (M~II&.SgT~ UNOERG.q~UND P',PING F~ESSUR~ED P1P1NO (~ M ~"~t ~ 1. ELECT~DN~:t. AN~ LEA~DL=T~CTOR 3.0 GI~'I TES'TW~THNdTOPUI,~"I~rOFFFO~ LEAK. ~ FAJLUR~_ A.'~O S'Y~TEM ~ * ~ ~ ~ [] 2. .[] $. TEST (0. ! C, Pt.I) SAFE SUC"rX:~ S'Y'ST'EX~ (NO VALVE3 tN BELOW [] 7. SELF ,J~, i3. AUTO PUt,,~ SHUT OFF FO~ L.EAY,~ SYSTEM F~ ~ SY3TEM ~N [] [] ~ NOAUTO PU~P SHUT OFF ~. Au'r'o~4ATX:: UNE LEAK DETECTOR O.0 G,oH TEST) WfTH ;t,OW sHLrr CAlF OR [] ~2. ~,e~L~TES'r(0.~ 04~f) ~ 13. CON'T~LX~I33~P~*A/~J~E.~SVI~JA~AI~d~ F..M~ ENCY 0E]~RATO~I O~LY (C~ ~ ~ ~ [] 1~. AUTOMAT'IC~L~DL~'"ECTOR(3,0(~:)H ~WTTHOU'TFU~UTOFFOR RESTRK:TION [] 10. AHNUALtNTEGRITYTESTC0.1 Ggf'4) IX. OIWNER,K)PERATOR ~IONATURE 0ATE 471 TITLE OF OW'J~I.E/:I.,'OPERATOR UPCF (7,~) C~es CITY OF BAKEi~FIELD93~0 '= 1715 ter Ave., Bakersflel~ CA I (661) 326-3979 UNDERGROUND STOOGE TANKS-TANK PAGE 1 TAt"a< ~ 43~ IL TANK CC~I~(~K~ r'n~o~ T,,,~ 0 1. aa~3tawnx C] 3. S3NO~V~J.~'m [] 4~ [] 3. r-I s. ~ JIlL U~L.~ 0~. om~ ~F ~bN<] L~ W)JJ. TA~I( (C:h4M M ~4( ~L. V. TANK CLOJUM INFORMATION ! PIRkUd'IJlNT CLOIURI[ IN PLAC~ .". $ ?~k,~A r I O OA TI LA,6T ~ (YR,t,,IOtOAy) ~ I $TtMATIO OUANTTT'Y C~ 34J 68 T),,NC~ R~U. AJI, ig, I~ ,M4 TA,NK FIL.L~ 0 wrrl-t ea~Tl' MR 1T.P. IAL? -.'CF (7~) CITY OF BAKERSFIELD OFFIC~ OF ENVIRONMENTAL ~ERVI~ 1715 Cheerer Ave., Bakerlfleld, CA $33431 (~2~3879 UNOE~3ROUNO ~mPfNG COhtSTRUCT~)N/,J/'-"]. I. 'qINC_~ WALL ~""} 3. LINED TR~,N~'I ~'] g'O. OTHER · MANUFACTURER!~:2. ~U~E WALL ~ ~. U~ [ ~FACTURE~ [] I. P~ESSURE C::] I. ~iNC,~E WALL [] 2. DOUBLE WALL MAJ'~FACT'URER [] t. ILA.qE .,eTEEL [] 2. ST/MNLE~ STEEL [] 3. PI.A. ST~C COMPATIBLE V~rTH CON'r'ENT,~ [] 5. STEEL W/COATING VI. PN)I40 L~Ai( DEI'ECTION ~ PRESSURb"~O mP~NG (~eck u ~¢ J~ 1. EL£~ L/,NE LEAK DETECTOR 3.0 Gi:~I TEETWTTI. f~/TO PIJI,~,KfTOFFFOR LF..AX..SY3TEM FAZ. URE., ANO SY'STEM DI~COeeeECTX~ * N,X)8..E AND VISUAL TEST (0.1 [] 7. SELF PRESSURtZED PIPING (C. hKk ~ ~t a~oly): , · : ' '~'~ i ':; ~ ( ~'~ : . .j ~. ~ P',~; r[:t=;t ~'.r' j ,', ,:,~,~': f: · ' ; "~' :' i ~ 1% ~o~~o~ . . ,? :~ ~,. :.. ~~~ ~ ~ · ~'r ?'" :~7 .... r .' . ~:~.';.' 15. ' ?~1 :~ hl. ~: ,~'i~'.~, IX, OWNEI~OPERATOR SIGNATURE 471 TITLE OF O~J~LEIq~OPERATOR upcp cITY OF BAKERSFIELD I'~. OI~CE OF ENVIRONMENTAL ~VICES 1715 Chester Ave., Bak. ersfleld, CA 93301 · (661) 326 3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE :One .forryi. jse~ tank .- I, FACILITY IDENTIFICATION 8USINES~/,~UIdE (S~m~ Il FACII.~"Y N,A~E et' ~ - ~ ~ A~) ................................. FAC~UTY Oil i '~ :- ! ~ II. INSTALLATION Check all that apply ~ The installer has been certified by the tank and piping manufacturers. The installation has been insped,~l 'and certified by a registered professional engineer. The installation has been Inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. The installation contractor has been certified or licensed by the Contractors State License Board. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify_ method; III. TANK OWNER/AGENT SIGNATURE TITLE OF TANK OWNER/AGENT F~ C CITY OF BAKERSFIELD OI~CE OF ENVIRONMENTAL ~VICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 BUSINESS NAME (Same UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE I. FACILITY IDENTIFICATION One form per tank II. INSTALLATION Che~ a/I that app/y * The Installer has been certified by the tank and piping manufacturers. The installation has been insped~l and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. The installation contractor has been certified or licensed by the Contractom State License Board. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify method: III. TANK OWNER/AGENT SIGNATURE TITLE OF TATS< OWNER/AGENT I~m C CITY OF BAKERSFIELD OFt :E OF ENVIRONMENTAL SiVICES 1715 Chester Ave., Bakersfield, C'A 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE 8U$1NES3 NAME (Same al FACILITY I. FACILITY IDENTIFICATION One form per tank II. INSTALLATION Check all that apply The Installer has been certified by the tank and piping manufacturers. The installation has been insped~l and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. The installation contractor has been certified or licensed by the ContraCtors State License Board. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. III. TANK OWNER/AGENT SIGNATURE CITY OF BAKERSFIELD ~ OI~CE OF ENVIRONMENTAL.VICES ~ 1715 Chester Ave., Bakersfield, C'A 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE I. FACILITY IDENTIFICATION One form per tank II. INSTALLATION Check all ~at apply · The Installer has been certified by the tank and piping manufacturers. The installation has been insped~l and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. The installation contractor has been certified or licensed by the Contractors State License Board. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify method: III. TANK OW~IER/AGENT SIGNATURE ~e~ C NmE D April 4, 2000 FIRE CHIEF RON FRAZE ADMINI~TRAllVE SF..R~CF..~ 2101 'H' Street Bakersfield. CA 93301 VOICE (8O5) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICE8 2101 "H' Street Bakersfield. CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICE~ 1715 Chester Ave. Bake~fleld, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakemfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-O576 TRNNIN$ DMSION 5642 Victor Ave. Bakersfield. CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Jaco Oil Mr. John Kerley P O Box 1807 Bakersfield CA 93303 1807 Dear Mr. Kerley: You have been identified as the compliance coordinator for the facility/facilities referenced in the attachment. The permits to operate this facility/facilities will expire on June 30, 2000. However, in order for this office to renew your permit, updated forms A, B,'& C must be filled out and returned prior to the issuance of a new permit. Please make sure that you are sending the updated forms whiCh are indicated by the date 7/99 in the lower left hand comer. Please complete and remm to this office by May 15, 2000. Failure to comply, will result in a delay of issuance of your new permit to operate. Should you have any questions, please feel free to call me at 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment Facility_ Fan'ells Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Wholesale Fuels Chris Liquors Howards Howards Howards Address 6401 White Lane, Bakersfield, Ca 93309 8001 White Lane, Bakersfield, Ca 93309 1200 Coffee Road, Bakersfield, Ca 93308 4901 $. Union Ave., Bakersfield, Ca 93307 ~OsWe~akersfield, Ca 93306 1640 S. Chester Ave., Bakersfield, Ca 93304 805 34* Street, Bakersfield, Ca 93301 12851 Rosedale Hwy, Bakersfield, Ca 93312 4013 S. "H" Street, Bakersfield, Ca 93304 6401 S. "II" Street, Bakersfield, Ca 93304 2200 E. Brundage Ln., Bakersfield, Ca 93307 2732 Bmndage Ln., Bakersfield, Ca 93304 3200 Panama Lane, Bakersfield, Ca 93312 4201 Belle Terrace, Bakersfield, Ca 93309 3300 Planz Rd., Bakersfield, Ca 93309 · ' ...... .STATEOFP,,A/JFORNIA*~.~' .-*' · . UNDERGROUND STORAGE TANK PERMIT APPLI MARK ONLY ~'~ · ONE ITEM [] ~2 IN'~RIM.PERMIT i"~' 4 AMENOED P~RMIT [] S TEMPoRARy'SITE'CLOsURE*' '"" "':"..'.*.:.'. · NEW'PERMIT .... F'~,3 .RENEWAL ~PERMIT I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FACILIT~ NAME NAME OF OPERATOR l, // ~ CI~ NAME ~ · -- STA~ ZIP ~DE 81~ PHONE t Wl~ AR~ ~DE . ~ ~ ~X ~ TO INDICATE ~ COR~RA~ON ~ INDIV~UAL ~TNERSHIP ~ L~AL-AG~CY ~ ~U~GE~Y ~ ~A~-AG~ ~ F~E~Y D~TRICTS RESERVATION ~ 3 FARM ~ 4 PRaEtOR ~ 5 OTHER ORTRUST~ I I EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional NIGI..~rs: 'NAME (LAST, ~'IR~T) . PHONE # WITH AREA CODE PHONE # WITH AREA CODE I DAYS: I~AME (LAST, FIRST'J / PHONE # WITH AREA.CO_DE NIGH~'S: NAME (LAST, FI[:~ PHON[# WITH AREA CODE II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION · ./ box I~indicate [~ INDIVIDUAL ~ LOCAL-AGENCY ~ STATE-AGENCY CORPORATION ~ ~"P3.RTNERSH1P [~] COUNTY-AGENCY ~ FEDERAL-AGENCY STATE~ z,Pco~,~.~o_~. IPHONE # WITH AREA CODE III. TANK OWNER INFORMATION - (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION NAME OF OWNER / ~/ ~x ~ i~icate ~ INDIVIDUAL [---] LOCAL-AGENCY [--] STATE-AGENCY r---] CORR3RAT1ON 41~[~_PARTNERSHIP ~ COUNTY-AGENCY J-~ FEDERAL-AGENCY ZIP CODE ]P/.,.~3N_ E # WITH AREA CODE IV. BOARD OF EQUALIZATION MST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 if questions arise. TY(TK) HQ IT -I V. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notificmion and billing will be sent tO the l~nk owner unless box I or II is checked, lCHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD SE USED FOR LEGAL NOTIFICATIONS AND BILLINO: II1.'1-~ THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL COUh ,'TY # JURISDICTION # FACILrI'Y # LOCATION CODE - OPTIONAl. CENSUS TRACT# . OPTIONAL SUPVISOR - DISTRICT CODE - OPTIONAL THIS FORM MUST SE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B~ UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FORM A (9-90) FOR0033A-~2 MARK ONLy * [] ·i NEW PERMIT .', ~Wa4ANENTLY.~Ct.~SS~'O ~sm 'ONE ITEM : [] 2 INTERIM :. I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPEC[FY tFUNKNCWN~ A. OWNER'S TANK I. [3. ~ C. DATE iNSTALLED (MC/OAY/'YEAR) II. TANK CONTENTS ~FA-~ ISMARKEO. COMPLETEITEM C. ><- -- A. : MOTOR VEHICLE FUEL ~ ~ 4 OIL 2 PETROLEUM , ~80 EMPTY 3 CHEMICAL PRODUCT [ ig5 UNI~IOWN O. iF!AU IS NOTMARKED. ENTER NAME CF SUBSTANCE STORED C. ~ ~a REGULAR ~ ~NLEACED PRODUCT t IIb PREMIUM ~ UNLEADED WASTE ~ 2 LEADED i-"-~ 3 DIESEL ~ ~ AVIAFCNGAS I t.~1 4. GASAHOL ~1 7 MET'HANCL I I---i 5 JET FUEL ~ OTHER (DESCRIBE IN ITEM D..~ELO',~I C. A. S. ~: IlL TANK CONSTRUCTION MARKONEITEMCNLYiNBOXESA. a. ANOC. ANOALLTHATAPPLIESINSOXO A. TYPE OF ~ ~ 1 DOUBLE WALL . ~ 3 SINGLE WALL WITH EXTERIOR LINER ~ 95 UNKNOWN SYSTEM 2 SINGLE WALL ~: ,t SECONDARY .CONTAINMENT (vAULTED TANIO L__.J. 99 OTHER ---"; 1 ~ARE STEEL TANK. -- ~ 5 CONCRETE MATERIAL .__; '~PrimaryTank) ~ 9 BRONZE STAINLESS STEEL ~ 3 FtaERGLASS POL,',',',',',',',','YVINYL'CHLORIDE !--'~__ 7 ALUMINUM GALVANIZED STE~L ',---~ 95 UNKNOWN ~ 4 STEELCLAD W/FIBERGlASS REiNFORCED;=LASTiC ~i. a 100% METHANOL COMPATIBLE W~1=RP ~ 99 OTHER '-'~ i RUBBER LINED ;'--"~ 2 ALJ~fO LIN~G ~ 3 EPOXY LINING [] 4 PHENOUC LINING C. INTERIOR ~ ~ UNING _._.i5 ~ LINING ~6 UNLINED ~ 95 UNKNOWN ~ ~ O~ER iS LINING MATERIAL COMPAT~g~ ~ 1~. ME~ANOL ? YES~ NO CORROSION ~ I POLYETHYLENE: WRAP ~ 2 COATING ~ 3 VINYL .WRAP ~ .4 FIBERGLA-~.~ REINFORCED PLAS33C PROTECTION "'-'-~' 5 CATHODIC PROTECTICN ~ 91 NONE ~ UNKNOWN ~ 9g OTHER IV. PIPING INFORMATION C~RCU~ A IFAB0¥EGROUNOOR U IFUNCERGRouND. BOTH IF ,~'I~-PLJ~BLE .'"' A. SYSTEM TYPE 'A U~ SUCTION ~ ' ...... ~'~ESSURE - A U 3 GMAvm~. ~.~' ':' U ~INGLE WALL- 'A U 2 DOUBLE WALL A 'U 3 LINED TRE~H '. A*U 95 UN~WN A U 1 ~RE STEEL ' A U 2 STAINLESS STEEL A U 3 ~LWINYL, CHLORIDE t i~. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION 0. 'LE~'I( DETECTION VISUAL CHECK : -~ · ~- 2 .INVENTORY. RECONC.:LIATICN ~ 3 IAPOR MONITORING ~.[ 4: AUTOMATIC:I~,~NK GAUGING.~ 5 ;~RQU~O..~A~R ~ONITOR1NG 'COMPLETE-~ - A SEPARATE' FORM FOR EACH,TANK SYSTEM' I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPEC:FY iF UNKNOWN~ C. CATE ;NSTALLED{MC/~AY,'YEAR} B. MANUFACTURED BY: ~'"~~ D. TANK CAPACITY IN GALLONS: /~ II. TANK CONTENTS ~A-~ IS MARKED, COMPLETEiTEM C. · l A. ~; ~.~OTOR VEHICLE FUEL ,--~ 4 OIL 2 ,~ETRCLEUM ~ aO EMPTY 3 CNEMICALPRODUCT ~ ~5 UNKNOWN PRODUCT WAST; C. ~ 1.3, REGULAR UNLEADED lt3 PREMIUM UNLEADED [] 2 LE. ADED ,~"3 DIESEL ~ 6 AVIAI',CNGAS I ~ 4 GASN.-~L [] 7 UET~ANCL 5 JETFUEL ~ ~ O~ER (oEscR~E iN ~M O. ~ELO~ O. ,F !A.I) IS NOTMARKED. ENTER NAME CF SUBSTANCE STORED C.A.S. ~: I 111. TANK CONSTRUCTION MARK ONE ITEM ONLY ~N ~OXES A. a. ANOC. AND ALL THAT APPLIES IN SOX D ~ ! DOUBLE WALL ~ 3 SINGLE WALL WITH EXTERIOR LINER ~ 95 UNKNOWN A. TYPE OF ~ ~ ~ SYSTEM 2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT {VAULTED TANI.0 .Il 9g OT~ER -- I ~ARE STEEL ~ 2 STAINLESS STEEL ~ 3 FIi~ERGLASS TANK ~ -- MATERIAL __ 5 CONCRETE ~ ~ ROLYViNYL CNLORIOE ~ 7 ~UMINUM ~PrimaryTan~) ~ 9 aRON~ ~10 ~LVANI~D STEEL ~ g5 UN~OWN L_._J 4 STEEL CLAO W/FIBERGLASS REINFORCED PLAS~C ~ 8 lC47Y. METHANOL CCMPATIBLEWrFRP 99 OTHER ~ ~ RUBBER LINED [--'~ 2 ALKYD LINING ~ 3 EPOXY LINING ~-~ 4 PHENOL~ LINING C. INTERIOR -- ~ -- UNING __ 5 G~ LINING 6 UNLINED ~ 95 UN~WN ~ ~ O~R . ;S LINING MATERIAL COMPATIBLE ~TH I~. ME~ANOL ? YES __ NO__ D. CORROSION ~ I ~LYE~YLENE WRAP ~ 2 COATING ~ 3 VI~L WR~ ~ 4 FtBERG~S REINFORCED ~S~C PROTECTION "~ 5 CATHODIC ~ROTECT:CN ~ 91 NONE ~ UNKNOWN ~ ~ O~ER IV. PIPING INFORMATION C~.CLS A ~FABOVEGRO~NOOR U IFUNCE~GROUNO. BO~tFAPPLICA~ A. SYSTEM TYPE 'A U 1 SUCTION ~ ~RESSURE A U 3 GRAVIW' . . ~:~-,,.~:; ....... . :-.=. -_ a. CONSTRUCTION ~ SINGLE WALL A U 2 DOUBLE WALL ' A U 3 LINED'TRE~H A U 99 OTHER C. MATERIAL AN0 A U I ~ARE STEEL A U 2 STAINLESS STEEL A U 3 POLY~/INYL CHLORIDE CORROSION A U 5 ~UM~NUM A U 6 CONCRETE A U 7 STEEL WI ~ATING PROTECTION . ~ ~LVANI~O sTE~ A U 10 CAT~OO~C PROTECTION 0. LEAK DETECTION' ~ AUTC~AT~C UNE LEAK QE~CTQR ~ 2 UNE T~HTNESS TESTIS' .'. ~-I -:E S.? M ATE O DA T.E i:AS T; I. TANK DESCRIPTION A. OWNER'S TANK 1. O. # COMPLETe. ALL ITEMS - sPEC:FY I1:: UNKNOWI'~ II. TANK CONTENTS ~ A.~ ~S MARKED. CCMPLET~ ITE,V C. t A. ~I MOTOR VEHICLE FUEL 2 PETROLEUM ' 3 CHEMICAL PRODUCT I B. MANUFACTtJRED BY: . ,~,~..~ J : O. TANK CAPACITY IN GALLONS: /~ j ~ 4 OIL B. C. ~ I~,REGULAR ;'--"~; 3 DIESEL ~ 8 AVIA1-,CNGAS J ~ · -- UNLEADED I--~ 5 JETFUEL __ ~ ~ ~NKNOWN J iF~A.t)JSNOT,'VIARKED. ENTER NAME CF SUBSTANCE STORED C.A.S.#: O. [II. TANK CONSTRUCTION 'JARK C.NE ITEM ONLY !N BOXES A. B. ANOC. ANDALLTNATA~PLIE$INBOXO ---": , J A. T'YPE OF ~ DOUBLE ',*/ALL ~ 3 SINGLE WALL ',',/IT'd EXTERIOR LINER ~ 95 UNKNOWN :'"--'l .----' SYSTEM ,.,,,,'~'~;~ SINGLE WALL L___ 4 SECONDARY C~NTAINMENT (VAULTED TANK) .) i 99 OTIHER B. TANK --~ t BARE STEEL ~__ 2 STAINLESS STEEL :~ 3 FIBERGLASS ~-- 4 STEEL CLAD W/FIBERGLASS REiNFORCED PLAS~C MATERIAL ,__~ 5 CONCRETE ~ $ POL,'PVINYL CNLORJCE ]--'~ 7 ALUMINUM ~.~ S tCO% METHANOL CCMPATIELEWfl=Rp Primar',Tani~ ~'~ 9 BRONZE j~' I0 GALVAN,ZED STEEL '.~_~__j g5 UNKNOWN ~ g9 OTHER "-~ t RU88EFI LINED i'-'---] ::' AL~r'D LINING ~ 3 EPOXY LINING L._~. 4~ PHENOLXD LINING C, INTERIOR ~ '~ · UNING ~ 5 ~ LINING ' 6 UNLINED ~ UNKNOWN ~ ;S LINING MATERIAL COMPATIBLE Wl~ 1~. ME~ANOL ? YES__ NO__ '"-~. 1 POLYETHYLENE WRAP ~ 2 COATING ' ~ 3 VINYL WRAP D. CORROSION 4 FIBERGLASS REINFORCED PLAS~C PROTEC~ON '~ 5 CATHODIC PROTeCTiON ~ 91 NONE ~ UNKNOWN ~ ~ O~ER IV. PIPING INFORMATION CreOLE A IF ABOVE GROUNO OR U IFUNCERGROUND. BOTHIF APPLICABLE · __ A. SYSTEM TYPE A u 1 SUCTION- PRESSURE A U 3 GRAVITY . B. CONSTRUCTION ~u~ SINGLE WALL A U 2 CGUBLE WALL A g 3 LINED TRENCH' A U 99 OTHER -...:- . · .~; U g5 UNKNOWN OTHER ' C. MATERIAL AND A u ~ BARE STEEL A U 2 STAINLESS STEEL A U' 3 POLYVINYL CHLORIOE (PVCIA U 4 FIBERGLASS PIP~ CORROSION A u 5-ALUMINUM A U 6 CONCRETE A U 7 STEEL WI ~ATING A U 8 ~'ME~A~'~MPAT~BLEW~RP PROTECTION ~ ~LVAN[~O STEEL A U 10 CATHOOiCPRQTECT~QN A U 95 U~O~ :.. - ~. U ~ O~ER.~:.=:~?-:~;~; -.:-. ..... '~.: O, LEAK' DETECTION ~ AUTOMATIC LINE LE~ OE~CTO~ :~,~ 2 L~NE T~HTNESS ~STING. -- ~ 3,.~NffORi~aT~STIT~L ....... .. ~ ~ O~ER_ ~:~.~T:~"::~ ~:.~' :~. VISUAL CHECK ~ 2 INVENTORY RECONCILIATION ~ 3 VAPOR MONITORINGj----~.~.~ 4 AUTOMA'~.,CTANKGAUG~NG j'--'~ 5 .GROUN~WA'I'ERMoNITQRINO J TANK TESTNO ~ 7 IN~STI~ALMONITO.ING ~ gl NONE ' I g5 uN~WN ' '" 0~ER':'¥';'~': ..... "~ · ' I .. ' '.._.' ._.- _ '.. "_ .':...'-r:':: ' .... I ...... .... . ....:...._~ ................. : - , .--7 : -.~=u .~ : :.~ THIS FC~M MUST =~E .~C,..~.,~,~M1:EC BY .~ ~£~MIT .~7-:L?C~TiC:,I'. FC,qM ,t. UNL-'SS .~ .... ";"~-' :.NT FC~M ~ H.~S'BEEN Fii,-E-'~D. STATE OF CAUFORI~A STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~-~ 1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT ~ 3 RENEWAL PERMIT [] 4 .AMENDED PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: [] 5 CHANGE OF INFORMATION ~"~ . P~RMANENTLY CLOSED ONSITEI ] 6 TEMPORARY TANK CLOSURE TANK REMOVED I. TANK DESCRIPTION A1 OWNER'S TANK I. D. I COMPLETE ALL ITEMS ~ SPECIFY IF UNKNCWN~ C. CATE INSTALLED (MO/DAY/YEAR) II. TANK CONTENTS ~FA., ISMARKED. COMPLETEITEM C. A. ~X~: MOTOR VEHICLE FUEL ~ 4 OIL B, PETROLEUM ~-~ 80 EMPTY CHEMICAL PRODUCT ~ 95 UNKNOWN PRODUCT WASTE B. MANUFACTURED BY: O. TANK CAPACI'P,f IN GALLONS: C *'"G;;;;;;~ a REGULAR · ~ UNLEADED ] lb PREMIUM UNLEADED [] 2 LEADED i~ 3 DIESEL [] 6 AVIATION GAS L__I 7 METHANOL 5 JET FUEL [] 99 OTHER (DESCRIBE IN I~M O. BELO'~ O. IF iA.l) IS NOT MARKED· ENTER NAME OF SUBSTANCE STORED C.A.S. ·: j II1. TANK CONSTRUCTION UA"KONE~TEMONLY~NBOXESA. a. ANOC. ANDALLTHATAPPUES~NSOXD A. TYPE OF '--; 1 DOUBLE WALL i~ 3 SINGLE WALL WllH EATER!OR LINER ~ 95 UNKNOWN SYSTEM 2 SINGLE WALL i ', 4 SECONDARY CONTAINMENT (VAULTED TANK) ,I i gg OTHER ?"-~ 1 BARE STEEL ~ 2 STAINLESS STEEL !-'-'~ 3 FIBERGLASS B. TANK '-- -- [] 4 STEELCLAO W/FIBERGLASS REINFORCED PLASTIC MATERIAL .---'~5 CONCRETE iz $ POLYVINYL CHLORIDE ~ 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRp :Primary Tank) ~ 9 BRONZE ,~' 10 GALVANIZED STEEL I~_j g5 UNKNOWN [] gg OTHER C. INTERIOR ~ LINING ._.j 5 GLASS LINING ~6 UNLINED ~ 95 UNKNOWN [] gg OTHER iS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO~ O. CORROSION ~ I POLYETHYLENE WRAP [] 2 COATING ---~ 3 VINYL WRAP PROTECTION "__~ 5 CATHODIC PROTECTION ~ 91 NONE ~ UNKNOWN ~--']' 4 FIBERGLASS REINFORCED PLASTIC g9 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IFUNOERGROUNO. BOTH IF APPLICABLE A. SYSTEM TYPE 'A U 1 SUCTION /~ PRESSURE A U 3 GRAVITY B, CONSTRUCTION ~ SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 99 OTHER A U g5 UNKNOWN A U 99 OTHER C. MATERIAL AND A U ~ BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 ~IGERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION ~ GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U g5 UNKNOWN A U 99 OTHER O. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR~--..~i----~ 2 L~NE T~GHTNESS TESTING L~ 3 MONITORINGiNTERSTITIAL [] gg OTHER V. TANK LEAK DETECTION . ~ VISUAL CHECK iNVENTORY RECONCILIATION L~ 3 VAPOR MONITORING ~ 4 AUTOMATIC TANK GAUGING L.~ 5 GROUND WATER MONITORING ~ TANK TESTING INTERSTITIAL MONITORING ~ ~ {_~1 91 NCNE [] 95 UNKNOWN [] o~ OTHER VI. TANK CLOSURE INFORMATION' , SUBSTANCE REMAINING GALLONS I INERT MATERIAL 7 THIS FORM HAS BEEN COMELETED. . UNDER..~_ ..PENAL ;"Y~OF~ I PE~JUR~I'_ ',~_ , AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ~,,......~ ~'e,~" - - · ¢,,- " LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS 8ELOW COUNTY # JU,qlSDICT;CN # FACILITY # TANK # ISTATE I.D.# ~E,~MIT PE,qMtT AP~qOVED B'-' CATE PERMIT EXPiRATiON CATE ; :.:~ ?.HIS FORM MUST ~E AC~.%~A,NIIED BY A pc- *~,: .... , ,..,,~-. · ..-,MIT .,,-,-:.,.., 04 - FORM A. UNLESS A ,.,.~-.':NT FORM A HAS BEEN FILED. . '.. :' : STAT1E WATER RE.~URCF~ i~3NTR'~i: j~)'i; :~"- ,_ ._..... ._ COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I, SITE LOCATION STREET CITY COUNTY 11. INSTALLATION (mark all that apply)' ~ The installer has been certified by the tank and piping manufactur'ers. ~ The installation has been inspected and certified by a registered professional engineer. ~..~'~"The installation has been inspected and approved by the implementing agency. ~'~AII work listed on the manufacturer's installation checklist has been completed. --- The installation Contractor has been certified or licensed by the Contractors State License Board. _-- Another method was used as allowed by the implementing agency. (Please specify.) Ill. OATH I certify that the information provided~to the best .of my belief and knowledge. " "' .......... :'~";"~' '"' ....... : ; . ": :-' :-~,:;(.:s:' '; : LOCAL AGENCY USE'ONLY .'-" ': .'. 5- :.::; ,' '::: '- "' ' ........ .... ..:...-,..~:.,: ....... ~:.. ......... : ....... ~.~.-.:...,: :....: :'.,' .... .- ..,~,,~:;:. - ...... ,_; :: ;.:--;:::.':.."'.:... :. ...... STATE,. TANK · TANKLO. = ..: ' . .... , COrM O THIS FORM MUST BE'ACCOMP~NIED BY PERMIT APPLICATION FORMS A_& B'U'NLES$ THEY HAVE BEEN FILED PREVIOUSLY: =c~oe35c7 : ,,' '-.~.-'" ;-' STATE WATER RESOURCES CONTROL BOARD .; -' . FOh:LifibERGJ~OUND:~..6~,~E!:f~~ALLATIoN .:...~-.:-~:;..,- ....... ':_%;:4'_~:..'{.2:~';?.....-7~.%,.~:~,~::~-:;_~' .- FORM C '-'.-::. .... 'COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. ~iTE LOCATION STREET i~,. !HSTALLATION (msr~ aii "'-'~, ,.=~ ar_.otvt', , ,, -- The installer has aeen cec. ified b'/.'.ne (an~ and 0iping manufacturers. -- The installation has h_.een insoec.:ed and ce,relied by a registered professional engineer. ~T;:e installation has been inspected ~nd sr~croved by the imc. lememing agency. __'"~Atl wor~< liste;3 on the manufacturers installation checklist has been completed. ~he instaiisdon Contractor has been ,,,rt,n,.d or licensed by the Contractors Slate License Board. _ .-.,,ot,,~r method ,,vas used as ailowed by the implementing a~encv. (Please specify.) t11. OATHTank ~wne r/Ag eat '-'~"-/~"~--'O"/"7~/--,~-~ certify that the information provided~,~~~is t.r,d~to the best of my belief and knowledge.Date :.. LOCAL AGENCY USE TANK I.D. = . --~ =o~ c (7,'9~) -" THIS FORM ~UST BE ACCC~,IPANIED BY PERMIT APPLICATION FOR~ A & B UN.SS ~EY HAVE BE~ FI~'PRE~OU$[Y-~t:~:'::' ': '; .' ~'~:' i. SITE LOCATION ST~E=T COUNTY /'1/'~ 4'} I!. INSTALLATION (mark ail '~'~' ~, ,=: a.c. pi,/): installer has been certified by the tank and piping manufacturers. -- The installation has ~een inspected and certified by a registered professional engineer. installation has been; ~o,'~ '" ,nspec,~ and a~proved by ,,, ,e implementing-,=,n~.,~,~= ,',,. work liste~ on the manufacturer's installation checklist has meen completed. -- The installation Contractor has been certified or licensed by the Contractors State License Board. Another method ,,vas used as allowed by the implementing agency. (Please specify.) . Print Name ,~'/,f.//~:~..~-~ Phone ¢o~u c (7,'9~ .... :"THIS FORM'~UST 8E'ACSCl~pANIED'.BY:PERr,~IT APPLICATION FORMS A & 8 UNLESS THEY COMPL~E A SEPARATE FORM ~R ~CH T~ SY~TM 1. SITE LOCATION STREET CITY COUNTY /'f"~---7~/1// iNSTALLATION (msr:~ ail *,--r~, ~. a~piy): The installer has been certified by ,h~ tank and Oil:lng manufacturers. -- The installation has been insDected and cs,qified by a registered professional engineer. ~The installation has been inspected and a.~croved by the implementing agency. work liste;d on the manufacturer's installation checklist has been completed. The installation Contractor has been certified or licensed by the Contractors State License Board. __ Anott~er method ,,vas used as allowed b'/~,he implementing agency. Please specify.) Print Name Address .... TANK I.D. = .... c ~7,~,) -'~ :::*~lS ~ORMM~T ~E AC~CUPANiED' Be PERMIT APPLICAT ~N'~OR~' ~"gB U~'~SS'~EY HAVE SUNSET MECHANICAL 3812 PANORAMA DR. BAKERSFIELD CA. p~-] 322-0em Continuous Monitoring Devic6 Certification MAKE AND MODEL OF MONITORING SYSTEM ~ - ~ ' r"" Contents of Tank /~/. (x'. ,~. ,,~, Z~/, ~,' Capa~ of Tank Type of Product Line: (GraviS, SUction, pressure). INDICATE LOCATION OF THE MONITORING SENSORS TESTED BY PLACING AYES OR NO IN APPLICABLE aOX: Annular space Sensor Sump S;nsor /~5 - - "'"~ Dispenser Containment Sensor .. .............. ..... Electroni, Overfill I Level , _ Electronic In-Line Leak Datector Mechanical Line Leak Detector In Tank Gauging Device , ,~ .- INDICATE THE FOLLOWING BY PLACING A YES OR NO IN APPLICABLE I]OX: .Does the monitoring system have audible and visual alarms? Does the turbine automatically shut-.down if .the system detects a leak, fails [o operate or iS electronically disconnected? is the monitoring system Installed to prevent unauthorized tampering? Is the monitoring system operable as per the manul*acturer's specifications? VVhich continuous moni',oring devices Initiate positive shut-down of the turbine? ~//,~,,~'/'~.") (.~E~/b'f,%o~.__ ~ I) February 9, 1999 FIRE CHIEF RON FRAZ. E ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield. CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersf'mld, 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 Fastrip Food Store #26 2698 Oswell Street Bakersfield, CA 93306 RE: Compliance Inspection Dear Underground Storage Tank Owner: The city will start compliahce 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 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 Larry Henson JACO Oil P.O. Box 82515 Bakersfield, CA 93380-2515 RE: 2698 Oswell 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 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 B A K.E R S F I E L D FIRE DEPARTMENT June 30, 1998 Larry Henson JACO Oil P.O. Box 82515 Bakersfield, CA 93380-2515 RE: 2698 Oswell UNDERGROUND STORAGE TANK UPDATE Dear Underground Storage Tank Owner: The City of Bakersfield and Kem 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. 87 Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure cc: Ralph Huey, Director, Office of Environmental Services capacity Of rnnk Type of Prbduct.,... l.i,e: (GraHty, 8ucticn,,.Fmssure). · ' . :: , , .,,, · . ," :. , : · .':?,L~t¢~t::¢:., v, , :;-,':,.:..':- .,, : .. '~ '. J., , ,~:.. - .,. ,..- , INDICA1E LOCAliOlt: OF Tile MONI'IORIt-lg Si:~lsons [ESl'ED fly PLACING A YES Off NO Sump Sensor Dis~ensei~ Col~tainme~t Sensor Elechcnic Overfil! / Level .................................... Eleclrank: tri. Line t.eah Me.r:ha~ficai Line t.e~k Detecter I, Ta:~k Gnuging Devict", Itlb!C,~'l'E II IE FOLLO','~IHO El f FL&CIII,~ A YES Or, Does ti~e fi~onih~,ing cystem have ¢.udible and visua! ~la~ms? Doe'.., th.-. turbine nu[oma!i¢~tly shut,do',',ll if tt]e ~ys!,;.m detect~ n In~k, fails lo el'¢erat.~ or I~ lh~ meflilcdr~y SyStem hmlall~?.] to FEe', ?nt unnuthori~ed l~mrering? .~... ~ , . WRITTEN MONITORING PROCESS UNDERGROUND STORAGE TANK MONITORING PROGRAM Tiffs monitoring program must be kept at the UST location at all times. The informntlon on lhln ~ program a~ condition~ of the.operating permit. Tlz perm/t holder mast notify the Office ~f Envlmnmm~ Se.l'vices within 30 day~ of ally chnn~ tO the monitorill$ p~ tllll~ reqtlired to ob~nln ~ ~ making the change. Requ/red by Sections 2632(d) and 2641(h) CCIL Describe the ~equency of performing the monitoring: - ! Be What methods and equipmefit, identified by nam.e and model, will be used for perfo~ the monitoring: .~. '~-~:~A~ ! ! - .~-<"~ Tank ": ' ..... ' Piping ~.,.;~\ e~ Co Describe the location(s) where the monitoring will be performed (fadh'ty plot plan should be attached): List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: ' LI~ ,] / '~'q~\ Fo Reportinfl/Format [or monitoring: ' Piping ~,~\~ ~Xct~ Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance ~ith the ~nanufacturer's m ,ai, ntenanee schedule but not less than every 12 months. Describe the training necessary for the operation of UST system, .including piping, and the monitofingequipment: ~t~c. vqc. c,.,~-..vv,~[~ \jv,~ot'~oyelk~e lte.[t~,r C~RRECTION N OT~C E BAKERSFIELD FIRE DEPARTMENT N° 651 Location f~.~,~O ~ Sub Div. c~ 1~ (~[J Blk. . Lot ~;?~ '-?/)~? You are hereby required to ~nake tile following corrections at the above location: Cor. No Completion Dat~ Date 0/~/~'~ Inspector 326-3979 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3'~ Floor,. Bakersfield, CA 93301 FACILITY NAME ~a~'t~ ADDRESS ~o q ~ FACILITY CONTACT INSPECTION TIME INSPECTION DATE PHONE NO. g'?'~_.30~ BUSINESS IDNO. I$-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~]/Routine ~ Combined ~ Joint Agency I~ Multi-Agency [~ Complaint [~] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accumt~ Visible address Correct occupancy V Verification of inventory materials Verification of quantities Verification of location V Proper segregation of material Verification of MSDS availability Verification of Haz Mat training ~/ ' Verification of abatement supplies and procedur~ Emergency procedures adequate Containers properly labeled Housekeeping v Fire Protection Site Diagram Adequate & On Hand C=Complianee V=Violation Any hazardous waste on site?: I~ Yes [~] No Explain: Questions regarding this inspection? Please call us at (805) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Businea.n Copy Business .SiTesponsible Party Inspector: _~ ~ FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program Routine [] Combined [] Joint Agency [] Multi-Agency [] Complaint Type of Tank ~0._.6 Number of Tanks Type of Monitoring d~t-fl, X Type of Piping [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file ~_~ Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: .__.~ (/~//J~ - Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy ~ sB~a~L s~ite Responsible Party BAKERSFIELD FIRE DEPARTMENT May 3 l, 1998 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) 326-394t FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3951 FAX (805) 32643576 ENVIRONMENTAL SERVICES ! 715 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 Larry Henson JACO Oil P.O. Box 82515 Bakersfield, CA 93380-2515 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 first quarter of 1998. This office is expecting an even bigger second quarter result. This commitment, has helped this office achieve a 75% compliance average 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 ADMINISTRATIVE SEIi~/ICES 2101 "H' Street Bakersfield, CA 93,T,X) 1 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICF~ 2101 'H" Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENTION SEll. ICES 1715 Chester Ave. Bakersfield, CA 93301 (805) 3263951 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 February 24, 1998 Larry. Henson JACO Oil P.O. Box 1807 Bakersfield, CA 93303-1807 RE: Fastrip, 2698 Oswell Street 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 February 13, 1998 R~ CHIEF MICHAEL R. KELLY ADMINISTRATIVE ~ 2101 'H' Street Bakersfield, CA 93301 (8O5) 326-3941 FAX (805) 395-1349 SUPPI~ESSlON SEIiViCES 2101 "H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (8O5) 395-1349 ~llEVEN11ON SBtVICES 1715 Chester Ave. Bakersfield, CA 93301 (8O5) 326-3951 FAX (8O5) 326-0576 ENVIRONMEFRAL SERVICES 1715 Chester Ave. Bakersfie{d, CA 93,301 (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 Fastrip Food Store #26 2698 Oswell Street Bakersfield, CA 93306 RE: "Hold Open Devices" on Fuel Dispensers Dear-Underground Storage Tank Owner: The Bakersfield City Fire Department will commence with our annual Underground Storage Tank Inspection Program within the next 2 weeks. The Bakersfield City Fire Department recently changed its City Ordinance concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire Department now requires that "hold open devices" be installed on all fuel dispensers. The new ordinance conforms to the State of California guidelines. The Bakersfield Fire Department apologies for any inconvenience this may cause you. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey RI~ CHIEF MICHAEL R. KEU.Y ADMINIS1RA~VE SERVICES 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPI~.SSlON SEEVlCES 2101 'H' Street Bake~fleld, 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 SEEVICES 1715 Che~ter Ave. Bakel~fletd, CA 93301 (805) 326-3979 FAX (805) 326-0576 IRAINING DtVlSlON 5642 Victor Skeet Bakersfield. CA 93308 (80~) 399-4697 FAX (805) 399-5763 BAKERSFIELD FIRE DEPARTMENT January 29, 1998 Larry Henson JACO Oil P.O. Box 1807 Bakersfield, CA 93303-1807 RE: Fastrip #26, 2698 Oswell Street UNDERGROUND STORAGE TANK UPDATE Dear Mr. Henson: 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 at~er 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 22, 1997 FIRE CHIEF MICHAEL R. KELLY ADMINISTRAI1VE SERVICES 2101 'H' Street Bake~fleld, CA 93.301 (805) 326-3941 FAX (805) 395-1349 SUPPRE,~ION 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 93801 (805) 326-3979 FAX (80.5) 326-0,576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (80,5) 399-5763 Fastrip $$26 2698 Oswell St Bakersfield, CA 93306 Dear: Larry Henson Last summer, you answered a survey, conceming your underground storage tank(s) stating that you would be (re~misVing, rePlaCing,.i~) your tank(s). However, you did not give us a targei'~aie! In N0vetnl~er, we invited you to a free underground storage tank workshop, where State representatives discussed both the regulations and altematives that you as a tank owner will have. - ..... You did not attend! - - - We are concemed! You will be receiving this letter on our about December 22, 1997. One year from today, December 22, 1998, your current underground stOrage tank(~.~ will become illegal to operate. Current laws and code requirements would require that if your tanks are not (~~!:~i~",~i~d~d) by that date, your permit to operate would be revoked, - - it will be illegal for any fuel distributer to deliver fuel to your tank(s)}' - - and your tank(g~ would then be considered illegally abandoned and require that action be taken within ninety (90) days to remove the tank(S)i Of course, we have no interest in pursuing this route. We would like to have your tanks properly handled prior to this December 22,1998 deadline. Please review your situation and reply within two weeks as to the current (realistic) plans for your existing tank(~)~ As we get closer to the December 22, 1998 deadline, I would expect' construction costs, as well as lead times to increase considerably. If there is anything this office can do to assist you in your planning, do not hesitate to call. Sincerely, Ralph E. Huey Hazardous Materials Coordinator REH/dm R,E. HUEY HAZ-MAT COORDINATOR (805) 326-3979 CITY of BAKERSFIELD FIRE DEPA R TMENT FIRE SAFETY SERVICES & OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE. * BAKERSFIELD, CA * 93301 December 8, 1995 Mr. Larry Henson JACO Oil Company P.O. Box 1807 Bakersfield, CA 93303-1807 R,B, TOBIAS, FIRE MARSHAL (805) 326-3951 RE: Fastrip Store No. 347 at ~B_g_8LO_~ l l ;. .S, tt~_ee~t.Tin Bakersfield, Ca. Dear Mr. Henson: This is to inform you that this department has reviewed the result of the Tank Removal Report dated October 27, 1995 associated with the underground tank replacement. Based upon the information provided, this department has determined that appropriate response actions have been completed, that acceptable remediation practices were implemented, and that, at this time, no further investigation, remedial or removal action or monitoring is required at the above stated address. Nothing in this determination shall constitute or be construed as a satisfaction or release from liability for any conditions or claims arising as a result of past, current, or future operations at this location. Nothing in this determination is intended or shall be construed to limit the rights of any parties with respect to claims arising out of or relating to deposit or disposal at any other location of substances removed from the site. Nothing in this determination is intended or shall be construed to limit or preclude the RegiOnal Water Quality Control Board or any other agency from taking any further enforcement actions. This letter does not relieve the tank owner of any responsibilities mandated under the California Health and Safety Code and California Water Code if existing, additional, or previously unidentified contamination at the site causes or threatens to cause pollution or nuisance or is found to pose a threat to public health or water quality. Changes in land use may require further assessment and mitigation. If you have any questions regarding this matter, please contact me at (805) 326-3979. Sincerely, Howard H. Wines, III Hazardous Materials Technician HHW/dlm cc: R. Huey J. Castillo, RWQCB ~tl~ersfield l~ire Dept. OFF1C~E~ OF ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Business Namei ~-~, I' Location: ,~, ?~' O.5(uc ~( Date Completed Business Identification No. 215-000 ~Z 'z. (Top of Business Plan) Station No. Shift __ Inspector Arrival Time: ~; Fo ~. Departure Time: Inspection Time: Address Visable Correct Occupancy Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Material Adeq~e Inadequate [] Comments: Verification of MSDS Availablity Number of Employees: Verification of Haz Mat TrainingI~ [] Comments: Verification of Abbatement Supplies and Procedures ~ [] Comments: Emergency Procedures Posted Containers Propedy Labled Comments: Adel~te Inadequate [] Verification of Facility Diagram Housekeeping Fire Protection Electrical Comments: UST Monitoring Program Comments: r"l Permits Spill Control Hold Open Device Hazardous Waste EPA No. [] Proper Waste Disposal Secondary Containment Security [] [] Special Hazards Associated with this Facility: Business OwnedManager PI~INT NAME All Items O.K SIGNATUR~:-~' White-Haz Mat Div. Yellow-Station Copy Correction Needed Pink-Business Copy UNDERGROUND STORAGE TANI ISPECTiON Bakersfield Fire Dept. Hazardous Materials Division Bakersfield, CA 93301 FACILITY NAME r~'~',~-, i/) TIME OUT FACILITY ADDRESS FACILITY PHONE No. INSPECTION DATE TIME IN INSPECTION TYPE: ROUTINE 1//' FOLLOW-UP REQUIREMENTS la. Forms A & B Submitted lb. Form C Submitted lc. Operating Fees Paid ld. State Surcharge Paid le. Statement of Financial Responsibility Submitted lf. Written Contract Exists between Owner & Operator to Operate UST 2a. Valid Operating Permit 2b. Approved Written Routine Monitoring Procedure 2c. Unauthorized Release Response Plan 3a. Tank Integrity Test in Last 12 Months 3b. Pressurized Piping Integrity Test in Last 12 Months CITY 3c. Suction Piping Tightness Test in Last 3 Years 3d. Gravity Flow Piping Tightness Test in Last 2 Years 3e. Test Results Submitted Within 30 Days 3f. Daily Visual Monitoring of Suction Product Piping 4a. Manual Inventory Reconciliation Each Month 4b. Annual Inventory Reconciliation Statement Subm~ed 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks 6. Monthly Statistical Inventory Reconciliation 7. Monthly Automatic Tank Gauging Results 8. Ground Water Monitoring 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Do~b!~We!Led_ Tanks 11. Mechanical Line Leak Detectors 12. Electronic Line Leak Detectors 13. Continuous Piping Monitoring in Sumps 14. Ab;~,,atic Pump Shut-off Capability 15. Annual Maintenance/Calibration of Leak Detection Eq,_,!pment 16. Leak Detection Equipment and Test Methods/i~t _-~_ in LG-113 Series 17. Written Records Maintained on Site 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days 19. Reported Unautho~.ed Release Within 24 Hours 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tube RE-INSPECTION BUSINESS I.D. No. 215-000 Inst Date Size ZIP CODE ? ~?~1 C_ Insl Date Insl Dale Size Size FDI~9 B A K E ,R S 'F I E .L D FIRE DEPARTMENT' FIRE cHIEF MICHAEL R. KELLY ADMINISTRATIVE SERVICES 2101 'H' Street Bake~field, 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) 32643576 TRAINING DIVISION 5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 December 6, 1996 JACO Oil. P.O. Box 1807 Bakersfield, CA 93303 RE:- Underground Storage Tanks loCated at Fastrip Food Store #26, 2698 Oswell Street in Bakersfield. . Dear JACO Oil: 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 tanks do not currently meet the new code requirements and therefore fall 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 these tanks. Please complete this questionnaire and return it to this office by Monday, December 23, 1996.' 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, Ralph E. Huey . Hazardous Materials Coordinator Office of Environmental Services REH/dlm attachment CITY of BAKERSFIELD FIRE DEPA R TMENT FIRE SAFETY SERVICES & OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE. · BAKERSFIELD, CA · 93301 R.E. HUEY HAZ-MAT COORDINATOR R.B. TOBIAS, (805) 326-3979 FIRE MARSHAL (805] 326-3951 September 25, 1995 Dear Underground Storage Tank Owner: Enclosed is your updated Permit to Operate for the underground storage tank(s) located at the referenced place of business. Please take a moment to review the information printed on the permit to make sure everything is correct. If any corrections need to be made, please call the discrepancies to our attention immediately. Your Permit to Operate is a legal document and its accuracy determines whether you are in compliance with the law, If you are the tank owner and not necessarily the tank operator at the site, please make a copy of this permit for your own files. Forward the original permit to the tank location so that it may be conspicuously posted on site. If you have any questions regarding the Permit to Operate or your responsibilities as an underground storage tank owner, please call the Office of Environmental Services at (805) 326-3979, or write to us at the letterhead address. Sincerely, Hazardous Materials Coordinator Enclosure el' ate Underground Hazardous Materials Storage Facility State I.D. No. 000307 .............................................. CONDITION::. P ....... . .... EVERSE SIDE Tank Hazardous :::::::::??:?:?::::::::?: Ye:a~i~:i?~ii::::::.::::.. :? ?.:~Tank '::~:;::;:T:a~;~:?'::!!!:!:%: Piping Piping Piping Number Substance C a:pabi~:~:~?:.:::::? in's t ~ll'~:~i:'::-...:.. :} ? ?Type M o nit:6;~:i0:~:{.::::::!:?~i~. Type Method Monitoring ..... . .................. · ..... ..... ~::::~: :: ... '.:::::::::::::::::::::::: 01 SUPREME 02 UNLEADED PLUS 03 UNLEADED 04 DIESEL Issued By: Approved by: "~;ii:~'~n di~i:~a;::~ bjeC~:":to cha~ge~in:!:.~g ulatiO~!i? .... ~::~;:;:~;;.;ii:'.:::::::!!::::-::;;;;:;;;:i::'::;!i!i~:' ..? ":~?~:.'":ii?~ii ???~???~i:?i::: :::::::::::::::::::::::::::: .i:::?:'issued To: Bakersfield Fire Dept. ======:====:======:===========?========?:?=======?=====:===?=:======:= === ?========:?=?= ===??==: ....... PRESSURE ALD PRESSURE ALD PRESSURE ALD PRESSURE ALD HAZARDOUS MATERIALS DIVISION 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 (805) 326-3979 JACO JAMIESON FASTRIP FOOD 'STORE 2698 :SWELL STREET BAKERSFIELD, CA 93306 ~/'Ralpl( E. Huey~3a~Materials Coordinator Valid Ir:m: 09-19-95 09:-19-00 to: Iq'lONE NO. HAZARDOUS MATERIALS DIVISION INSPECTION RECORD POST CARD AT JOBSITE TANKS AND BACKFILL Beddlil of Tank(i) ~ Protlc~m o/Tank(I) Piping & P. eciway w/Cokctlon Sump Com~km Pmt. ctk)n of PIMm. joem, R. i~pa PIPING SYSTEM E~ ~ of ~ From Tank(l} , ~ Prot.ct~n Symem-Plping SECONDARY CONTAINMENT, OVERFIM. PROTEC'rlON, I__Ee.K DETEC'rlON Liner Installation - Tank(s) Liner In.taJlalion - ~mng Vault W#h Product Compatible Sealer Level Gauges or Sensom, Float Vent VaNes Product Compatible Fill Box(es) Product Line Leak Detector(e) Leak Detector(e) for Annular Space-D.W. Tank(s) Monitoring Well($)/Sump(8) - ~ Test Leak Detection Device(8) for Vadose/Grouno'w&t~r Monitor/rig WelM, Cape & Loct~ FINAL RII Box ~ Monitoring Requlrement~ ..... SENSOR ~L~R["I ..... L ?:[)IESEL SUMP STP S U~,lp FUEL SEI::' 19, 1995 3:15 ..... SENSOR ALaRI'.'I L S:DIESEL ANNULAR aNNULaR SPACE FUEL aLaRlvl SEP 19. 1995 .'3:15 ..... SENSOR aLaRI..,1 ..... L 8:DIESEL aNNULaR aNNULaR SI::'aCE FUEL RL~Rlvl SEP 19, 1995 3:17 PI~I ..... SENSOR ALaRI','I ..... L 7:I-IIESEL SUM]~:l STP S Ulvlp FUEL ~4Lt4RI"I SEP 19. 1995 3:21 ..... SENSOR ALaRI"I ..... L I:U-L SUMP STP SUI~Ip FUEL aLRRI~ SEP 19.. 1995 3:23 PM ..... SENSOR L 2:U~L ANNUJ ANNULAR SPRC~ FUEL ALARI~ .~EP~l.9---1..995~S.:.24.PI'~1 ..... SENSOR ALARM ..... t 4:PLUS ANNULAR ANNULAR SP~C;E FUEL ~L~RM SEP !9, !995 :3 :'25 PPI ..... SENSOR ALARM ..... L :3:PLUS SUMP STP SUMP FUEL AL~Rr"I SEP !9. 1995 :3:2E, PM ..... SENSOR ALARM ..... L 6:PREM!UM ANNULAR ANNULAR SP~C;E FUEL ~L~RI'"I SEP 19. I995 3:27 PM ..... SENSOR ALARM ..... L 5:PREMIUM SUMP STP SUMP SENS,'._'~R OUT ALARM SEP !9. 1995 :3:28 PPI FASTR 1 ]::' 269,90SWELL BKFD CA 805-8?2-:3029 19. 1995 :3::31 PM ~;"~"STEI',I STATUS REPORT T 2:!N'v'~L!D FUEL LEVEL L 5:SENSOR OUT ALARM CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVENUE BAKERSFIELD, CALIFORNIA 93301 __ - ~ .... :3==.;~-mus~b~'l~gibl¥ filled ,n~ ,n Lnk, m~,nde~-bJeP, e~cd or , ; .- . ~_.~.._ . Thie~Shlnnlng uroer~-~ · . ~ - .> - ~. ~' ana;retaihed by the~agen~ ~ ~- .... ''~is Sh ~ ~ Order ~ ~ · ' ~'~'; ~'~ '~;>~ * ~. ~ ~ ' RE~EIV~ ~ubject t~ the cla~fi~?oq~ ~Pay. a~',~.".'~t ;~t~d~{~o~t~t~;~n~ bb~itio~ 0?~n~ents ~r~{, c~a~'a'~'r;;;~ %'~r-~?t'~-{s-~'s;~i~'~- 0~aelivery at sa d ae{tination if oWits~outm_ othe~is:e ' ' ~ ' re er~ ~descr bed.beto~;~in appamnt'g~.°~u??- ~ ~rs~n or~c0f om~ion id p0ss~ssion et. the properw -~ _ the P Y - ' ' as meamng anypq ..~ . P ~ ..... ~-~arrier of arleen, any of sa~ properw overall'or-any portiod 6~'said r6ute t0 destination; and as to.each ~a~y.at~an~:ti~ ~;~:understood thTough~?:~Ls,.c~r~.~_~ ~estnation~lths mutually agreed;-~>~u~,"-7 ~:;~ .o-a th~.mr~ndcondifions of the UnEorm Domestic Str~}ght'Bill:of Lading set.~o~h 7~ ~.~ to another-~arrier: ?P [~e;rou~e ~ ~;~ .~w c~t6~E~ormed'he[euqde~ s~p~,pe.suu~.~__. Ar 2 n the a6~licable motor carrier classification.or tarinif.thisqs~a-motor c?r~er shipment._ ~ id:a or an~of'~sa d'Pr°~?~Pt~7~:=;~;~at~6f 'if th s is a~rafl:o~a~r~[:~?~e'~ ~o those ~h the back ~f set f0~h n the aassificat on or. tarff which governs ~'~=~ ~d Illino s Freight Classif C~ions in .?]~.~,,:~,~. ~an~*c6nd t ons~of~e~sam m~[ ~[.~, ;.:_~.~y. ~Si"~S ' ' ~ - -. /;/i~From '~D~N Y~:~~Y~*~~'T':~ * ;'~:.i~~; ' ~-~- =', *";~- ~-~ : Total - ' Pieces?. i-~./.~, t '-'.This is to -- ;- ~ . i ) 7'of-cohditiodg, * ; 'allon'D.oublb Wall Glast ,i. ned UnderRround .ta~ U 'L 'Lab.el# L66~50.40',Vac-at (Subject ta Coi'r.) merit is.to be delivered to the con- signee;.~vitho~J{ recourse on the con~' signor, the consigno, r shell sign.the following statement: of th ssh pment without payment of · fre ght and all other'la~u! .charges; to apply in prepayment ~of. the charges on the proper~¥ described O0 y¢l'~ t ;ssed' b packaged, marksd arid Ifib .~d.~and are in proper ~..... -~.. - ,... .~.~ . - _, ~.- ~.j..,~.. . .% . ,' .: ..... ,.wate'r, ~he iew r&:luires that the bill of lading,~hali st~e wt~ether ~t m "carners or shipper s welgh.t.... Lading approved bY:the Departme_~t of Transportation~ .- .'. , ' - e al~ i~pers":are requ ?ed to state'~cificall9 in writing the agreed 0~.declared value of the property. ': - TOL/-'" ' . ' -: "- ",". '*-: '~:-'-cq:'..,~'~? .-::'-:~ ' ' ' - - (The signature .hme ~ Charges Advanced:'-. ' ~. . :C~OiD. SHIPMENT '. - -..-.:: '7? ' .- C.O,O.-.A,m.t: .' - ~'Shi~iha-Order' ~ust'~.le~b~il~i~n~,~n~; n-indelblePencdorqnCar~:)on,~ r. ~ ;~ - ~ . . ~ _ . - ' -- ' .~ .;~. -- ~ '. · · .', and,~etained;~y-'th~La~en~.. ~ ,' - * ~' .~ ~ ..... , .' :.- . .: RECEIVE. subject to,the classifications and lawfully filed,tariffs id'eff~bt o~ t~ da{e ~f the. issue 6f ~is. Shipping Ord~r,'~ -.~, .... ~' - · ~ *~ ....... .[. -',- .- ' ~h~ prope~y des~n~ed b?o~,t~sapp~[en~ good order, except,as noted (c~tepts ~nd condit)on o~ ?~teo~s_~f Packages unknown), marked, consigne~, and ~ as in~a~d belgw:~hibh {a d¥~r (the .word cart er interested, in all or any.of said p[ope~y, t~at,every so.ice to 5e.pe~o~e~ ~ereuqder shale.be sq~je~t to. all the terms ano.cpnditions of the Uniform'Domestic Strmght'81il of Ladng set fo~h (.1)'n Officml Southern --S~p~r hereby ce~fles ~at he is familiar w~ all the terms and cond~ ons ~ ~e ~d bdl of adi~, nc ud ~ those on t~ back.~er~f,,s~ ~h in the dassific~ion or t~iff w~ch governs ~e ~ans~ion. of ' FrOm ,r ~~ ~~ ~A~ ~ CA~~ !~~ J ,.L.-'' . ~ ~ "~S'S"~ W"~ ~NX . -. Date 8 - _ . 4141-~~A~E ,' ' * -: -;' :" ' ~ * ~ '~ . , ' '. ' . 'At; FRESh, ~-~ ' . ': ' · '~, .-' ~ - - ' .BY TRUCK ~ FREIGHT ~ Shipper s .No. Carrier'* > . . m-(S.CAC) Carrier's.NO: Consi~j~d to- - ,lac;o 0ii Co '-' 'DeStination Bake r s f.i eld -- <-. -.~-iState .Ca County - :'~ Route -- -'~ 'DeliVery Address* , , ' '.. - -.- : ~.~ ' ":- .' ' : { * To be filled in only whe~[ sl~pp~ de.res a~ad gove~ tattf~ ~o~ fm.ddiv~ ~t.I '. -Delivering Carrier ve"}cle~0;' Car'lnitial ..... 2 ~:,~ .12,0.00 gallon:Double ~a,tl Glasteel- II .10,500~ . signor, the ~nsignor ~Sall sign. the ': ., -. :: ~ ': '- ' - ~" ', ' ' ' ' ' - ' .; .... , The ~rder sh~ I not mak~ de :..-. ] .... ._[Secondary. Contained-Under,round tanks. - : [~ ;1 [ o,~,sshi,me.twthobtpaymen~6,... · - -.' -' . ' -- ' '~ ~ '~ : ·.' ~-' .: ~: ~ ~ '. ' · ' J ' ' ' r;'. · · ' '""-I'>l: .',:. :'-..:: ':5'. . . ': : ' . -. ' , '" ' ' ' ' ' '' - ' ~/~J//I I ~ ~ I ~ /~ /~/~ ch~ges on ~e prope~y descend. /Oral ' 3 5 ....."'' ' '" '" '"' ' ' ' ' ' ~ ' ~7 - ' Ag ..... Cash er- holida -test'- i-eaesoed by:. )[ . I _ . .I This ~s to ~l~ that-the above nam~ materials ~re]~oper ~ c ass f ~,-descr bed packaged ma~ed a~labeled, and are n proper,cond t on for t a ~o~at on, accor~ng to the I {~he signature here a~r.~ applicable mgdlations of ~e;Depa~ent of Transpo~atio~;" .' ' . ~' i - ' - '. t' [ only the amount prepaid ~ ~2he ship~pqt moves betw~n two po~s by;~ ~rfier by[water_t~e law requires that the bill ~f ad ng sha =state whether t s/ca}ier's or sh pper's we ght.' .... ' · [ - ~. :. - ~'. ' ' N~E ~hpre-th6Y~e i~.dependent~n xalue; shippers are required to state-s~ifically in wdti~g the a~-or d~&la~ value of the prope~y "~ ' - ; ~· $ ' . ' . ; ....... ' * -, ' '.* - .7;. .. - . - -. - ~ · .C.O.D.,SHIP. EH I [ The agreed or declared.value of. the.prope~y s hereby ~ecifi~lly stated ~y the shipper to b~not exceed ~g " ' . - ' ' ~Em~C.O:D'.TO: '" .... :" ""':":" ' '-'~':'J ':: ::'~' · ' ' -' -~"" : ' I.c.o.~-Amt.' ." ":'l - _ ' .. ,'-..-'. ..... ":. . / · ~ '~f I ' ' , ~p ~' ~ ~ ..~ ~~~.'~CA~~'~ -..'-, ""-. ~-~~~/ ~' ~mN~'O,~'AU9. ~UST S~N' THE' · : ' :- - ' " .... '- ' '-'..-.'Pe, 112]~Y~ ~ OmG~NALmL~OFLAmNG. · ". - Perm ;' ~ ~ ~ ~r~' . anent p~st offide ad.ess of shipper . * - ' ~ . _~ .... ~ . ' . ?- . .-: ' MARK WITH ';X'; .TO DESIGNATE HAZARDOUS MA:~ERIAL:A~; DEFINED IN 'tITLE 49 OF THE CODE oF FEDERAL REGULATIoNs: >:- ' ~' "' ... -.. ::. -_~.,,,. . ~ ~" 2130 G Street, ,~ ~_~ .~ ' Bakers,field, CA 93301 ~ T~ REMOV~ INSPECTION.FO~'' O~R ~ ~I~ ~00P~~ CO~C~OR ~/~ CO~AC~ ~RSO~ ~BO~TORY ~ , ~OF S~LES TEST ~ETHODOLOGY ~ ~ '~ PREL~ARY ASSESS~E~ CO. ~ CO.ACT PERSON~ CO~ REC~EP~ ~ LEL~ ~..~ .~. ~ O2~ PLOT P~N-' CONDITION OF TANKS CONDITION OF PIPING 'CONDITION OF SOIL '- DATE 60' 20' AUBURN STREET ,' EXISTING C ar DRIV~ 1lAY / rr L ,. I ,o. J-~-. !- II II II ////////////////~ LANDSCAPE .... -] SCALE: 1 "=20' D(ISTING C k G o VICINITY MAP N.T.$ OflU BLUEPRINT SERVICE AZARDOUS MATERIAI-~ DIVIS~I .... UNDERGROUND STORAGE TANK PROGRA/~/~ PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANF sM I.FORMA O. FACILITY NAME ~t~'~ . ~Z./'7 . ~.~.SS STREET TANK OWNER/OPERATOR ~,-J/~Z~z_ PHONE NO. MAILING ADDRESS ~, O. ~,5~ /SFD~') CITY ~ ZIP CODE CONTRACTOR INFORMATION / COMPANY ~/9/,~_ ) AJ~-'/~ ~/~,? 6~.~--P H O N E NO. ADDRESS ~ INSURANCE CARRIER . _~:~:F.-~~' LICENSE No. ~ CITY,'" ZIP Co,~r,~ WORKMENS COMP No. PRELIMANARY A$$EMENT INFORMATION COMPANY ~,~JS"~Tb) ~;iiD~~/,~ PHONE NO. ADDRESS ' ~,-'~/,~ INSURANCE CARRIER ~7~,/C 9 ~{.~-J~ ' LICENSE No. CITY~,"----~_.-¢/~'-4:? ZIP CODE WORKMENS COMP NO. TANK CLEANING INFORMATION COMPANY C---~,..~, ~C--' FHONE i'qO.:~'~''~' ADDRESS ~0{ ~~ ~y Cl~ ZIP CODE~O~ WASTE TRANSPORTER IDENTIFICATION NUMBER NAME OF RINSTATE DISPOSAL FACILI~ , ADDRESS ~/T ~~ FACILI~ INDENTIFICATION NUMBER C~ ~ ~/~ 7 TANK TI~ANSPORTER INFORMATION COMPANY ~Z~;~', ,..~::~C. PHONENo.,~'"'-~/~ LICENSE No. ~"O~,~=~ ADDRESS ~/_~~ ~. CIW~~~_ ZIP CODE TANK DESTINATION ~Oc~~~~~ / ~o~ ~ ~~p~ TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES :CHEMICAL STORED ,STOREQ PREVIOUSLY STORED / / - .-- THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. APPROVED BY: APPLICANT NAME (PRtND APPLICANT SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVEn / H]IF_a,R DO US. MATERIALS D IVISlO ~ ~ PERMIT APPL/CATIC)N TO CONSTRUCT/MOO[FY UNDEBGROUND STORAGE. TANK TYPH OF HP~LICAT'ION (CHEC]Q ~ NEW FACiLiTY C3 MOOIFi'C'A'TION OF FAC:L[i'Y ~'4E',rV TANK INSTALL.AT[ON AT F_XISTiNG FAC!LIP,/ FAC',UTY NAME ~~, 3,~.'7 S(IST[NG FAC',LiTY PERMIT No. TYPE OF' BUSINESS - C-~-~D/~'- b~,)/~,~' APN TANK OWNER _ ~-/~/7'~--~ ~.' PHONE No. CONTRACTOR ~ ,A;~//..~./~ CA LICENSE~j.N.~i:." . ADDRESS / C:TY /ZIP PHONE NO.. / BAKERSFIELD CiTY ~USINEiS LICc:IS~ No. WORKMAN COMP. NO. INSURER DEPTH TO G~OUND WATER /~)~7~ SOIL TYPE E<PECTED... AT SITE ND. OF ~NKSTO BE!NSTALLED ~ ~R~THEYFOR MOTORCU=~ .~5S ~NO / SECTION FOR MOTO~ FUEL TANK NO. VOLUME UNLEADED ¢..;.,.=. U L,-.~( PREMIUM_ OIES$.L AVtAiiON SECTION FO!~ NON MOTOR FUELSTORAGETANKS TANK No. VOLUME CHEMICAL STORED CAS No. (no brcnc nome) (it' k.f.nown) CHEMICAL ?RE',/ICUSLY STORED TH6 ,,qP,mLICA Nf HAS ~ECS~E'2. UNOERSTANOS. ANO WILL COMPLY 'WITH THE Ail'ACHED C~NOITi(2 NS CF ~q41S I=E~MIf ANO ANY CfH~] ~TAf~. LOCAL ANO F=.'.~ E~AL .~PPgCVE,..3 ~Y: A?PUCANf NAME (PR{ND APPUCANr SiGNA[URE THIS A?PLICATiCN BECOMES A PERMIT WHEN APPRC)VED STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [--"]' 8 TANK REMOVED ' I. TANK DESCRIPTION COMPLETE ALL ~TEMS -- SPECIFY ~F UNKNOWN C. DATE INSTALLED(MO/DAY/YEAR) i O. TANK CAPACITY IN GALLONS: ~'~3~,~O O{~ . II. TANK CONTENTS ~FA.~ ISMARKED, COMPLETEIFEM C. ~ MOTOR VEHICLE FUEL I~ 4 OIL r-- 2 PETROLEUM ~ 80 EMPTY 7--- 3 CHEMICAL PRODUCT ~ 95 UNKNOWN PRODUCT WASTE ~ REGULAR C. ~-~" UNLEADED ] lb PREMIUM UNLEADED [] 2 LEADED [ =~3 D,ESEL [] 6 AV'AT,ONGAS I 4 GASAHOL ~ 7 METHANOL [] 5 JET FUEL ~ [] 99 OTHER (DESCRIB"':' IN ITEM D. BELOW) C.A.S.#: D. iF ,:A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC. AND ALL THAT APPLIES IN BOX D A. TYPEOF ,~1'~1 DOUBLE WALL ~__~ 3 SYSTE~ . ; 2 SINGLE WALL 4 SINGLE WALL WITH EXTERIOR LINER SECONDARY CCNTAINMENT (VAULTED TANK~ [] 95 UNKNOWN 9g OTHER B. TANK i~ 1 BARE STEEL ~ 2 ~ 5 CONCRETE ~ S MATERIAL :-.~ ~ ~PrimaryTank) ~ 9 BRONZE ~,'-'--~ 10 STAINLESS STEEL .i___J 3 FIBERGLASS POLYVINYL CHLORIDE ~'~ 7 ALUMINUM GALVANIZED STEEL [] 95 UNKNOWN STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER C. INTERIOR LINING RUBBER LINED ~ 2 ALKYD LINING ~ 3 EPOXY LINING [] 4 PHENOLIC LINING GLASS LINING ~ UNLINED [] 95 UNKNOWN [] 99 OTHER D. CORROSION PROTECTION '.___~ 1 POLYETHYLENE WRAP [] 2 COATING I~ 3 VINYL WRAP F_~_.~ 5 CATHODIC PROTECTION ~ 91 NONE [] 95 UNKNOWN '~---'~FIBERGLASS REINFORCED PLASTIC ] gg OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNOOR U ,FUNOERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A(U'~ PRESSURE A U 3 GRAVI3'~ A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL J(~)2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A~ FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ ~ AUTOMATIC LINE LEAK DETECTOR ,'~"~.,-'~ L:NE T~GHTNESS TESTING ~ ~NTERST~T~L ~ ~ MONITORING [] 99 OTHER V. TANK LEAK DETECTION ~ TANK TEST,NG ~ ~ ,N~.ST,T,ALMON,TOR,.G ~ ~. NO.E [] ~ UNKNOW. [] "" OTHE. VI. TANK CLOSURE INFORMATION ~.WAS TANK P" ' ED W,TH YES [] N~" 1 GALLONS INERT MATERIAL ? 2. ESTIMATED QUANTITY OF SUBSTANCE REMAINING THIS FORM HAS BEEN CO,,,MPLETED,,,UNDER PENAL ~,~'Y OF P_E..RJUR~, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I I I LOCAL AG ENCY USE ONEY THE STATE I.D. NUI~BER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # STATE I.D.# ~ I J FACILITY # TANK # ~ERMIT NUMBER I PERMIT APPROVED BY, CATE i PERMIT EXPIRATION DATE FORM B ,g-~ THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. STATE OF CAUFOI~A STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION MARK ONLY ~ 1 NEON PERMIT ONE ITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ] 3 RENEWAL PERMIT ] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION ] 6 TEMPORARY TANK CLOSURI 0BAOR WHERE TANK ,S ,NSTA .ED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # C. DATE INSTALLED (M~AY~EAR) II. TANK CONTE~S ~A-~ is MARKED. COMPLETE ITEM C. FORM B~' !~ [] 7 PERMANENTLY CLOSED ON SITE r'"-~' 8 TANK REMOVED A. ~ I MOTOR VEHICLE FUEL ,,'___j 2 PETROLEUM ~ 3 CHEMICAL PRODUCT ~ 4 OIL B. [] 80 EMPTY ~PRODUCT [] g5 UNKNOWN i [] 2 WASTE UNLEADED .~'I'~PREMIUM ~ 4 GASAHOL ~--~ 7 METHANOL - ~ UNLEADED [] 5 JET FUEL [] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. 8ELOW)~ t C.A.S.#: O. IF {A.1)IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B.ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF ,,,,,,~,~"'~ ~ DOUBLE WALL ~ 3 SINGLE WALL WITH EXTERIOR LINER SYST~_M !.'~,' 2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAULTED TANK) B. TANK ?~i~i 1 BARE STEEL [] 2 STAINLESS STEEL j___~ 3 FIBERGLASS MATERIAL ,,~ 5 CONCRETE ~ 6 POLYVINYL CHLORIDE [] ~PrimaryTank) L.~ 9 BRONZE ~ 10 GALVANIZED STEEL ~ ] 95 UNKNOWN [] 99 OT~ER BTEEL C~D W, F,BER~S~ RE~NFORCED P~T~C ~ ~.UM,NUM[] 0 ,~. MEmANO[ COMPAT, BLEW,FRP C. INTERIOR LINING ~ 1 RUBBER LINED [] 2 ALKYD LINING is ~,NING MATER,AL COMPAT,BLE W,TH ,~. METHANOL 3 EPOXY LINING ~ 4 PHENOLIC LINING 95 UNKNOWN ~ [] 99 OTCi~ER __ NO__ D. CORROSION PROTECTION POLYETHYLENE WRAP r-~ 2 COATING ~ 3 VINYL WRAP '~'"~;;;;;~,,,4 FIBERGLASS REINFORCED PLASTIC CATHODIC PROTECTION ~ 91 NONE ~ 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION A. SYSTEM TYPE B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE SUCTION A(~"~2 PRESSURE A U 3 GRAVITY A U 99~ OTHER SINGLE WALL A DOUBLE WALL A U 3 LINED TRENCH A U 95~ UNKNOWN A U 99 OTHER BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC) FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE A U 7 STEEL Wl COATING A U 8 100% METHANOL COMPATIBLEW/FRP GALVANIZED STEEL A U 10 CATHOOIC PROTECTION A U 95 UNKNOWN A U 99 OTHER AUTOMATIC LINE LEAK DETECTOR ~ LINE TIGHTNESS TESTING .;~3 MONITORINGtNTERSTITIAL [] 99 OTHER V. TANK LEAK DETECTION ~ TAN~ TESTING [] ~ INTERSTITIALMONITOR,NG ~ gl NONE [] ~ UNKNOWN VI. TANK CLOSURE INFORMATION ] 99 OTHER 2. ESTIMATED QUANTITY OF ~"~'~J'~GA 3. WAS 'FANK FILLED WITH LLONS INERT MATERIAL ? SUBSTANCE REMAINING THIS FORM HAS BEEN CO,~fPLETED U~NDER PENALTY DE'PERJURY, AND TO THE BEST OF MY KN ] 5 GROUNDWATER MONITORING DWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK STATE I.D.//' PERMIT NUMBER I PERMIT APPROVED BY/DATE I PERMIT EXP{RATION DATE FORM THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. STAI~ OF CAUFORMA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY .~1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT [] 3 RENEWAL PERMIT ] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE [] 6 TEMPORARY TANK CLOSURE ["'-']' 8 TANK REMOVED OBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNO~NI I A. OWNEr'S TANK ,. o., ~A ) ~,~ ~'0 i II. TANK CONTENTS~^.~ IS MARKED. COMPLETE ITEM C. PETROLEUM [] 80 EMP'P~ CHEMICAL PRODUCT [] 95 UNKNOWN O. IF t'A.1) IS NOTMARKED. ENTER NAME OF SUBSTANCE STORED UNLEADED B..,1~1 PRODUCT C. [] laREGULAR [] lbPREM~UM ~ UNLEADED [] '2 WASTE '[----I 2 LEADED "D,ESEL [] 6 AV,AT,ONGAS I GASAHOL ~ 7 METHANOL 5 JET FUEL ~ I [] 99 OI3-tER (DESCRIBE IN ITEM O. BELOW) C.A.S.#: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. ANDC, AND ALL THAT APPLIES IN BOX D A. TYPEOF ~.~1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM i.--'~ 2 SINGLE WALL ~ 4 SECONDARY CONTAINMENT (VAULTEDTANIO [] 99 OTHER B. TANK i__J ' 1 BARE STEEL ~ 5 CONCRETE MATERIAL ~PrimaryTank) ~ 9 BRONZE [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 6 POLYVINYL CHLORIDE ~ 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER C. INTERIOR LINING -~ [] ;~ 1 RUBBER LINED 2 ALKYD LINING i_.~___~ 5 GLASS LINING ~ UNLINED I 3 EPOXY LINING [~! 05 UNKNOWN YES__ NO__ ] 4 PHENOLIC LINING ] 99 OTHER D. CORROSION i'__j i POLYETHYLENE WRAP [] 2 COATING PROTECTION ~ 5 CATHODIC PROTECTION [] 91 NONE [] 3 V,NYL WR*. ~ F,aE.G~SS RE,NFORCED PLAST,C [] g. UNKNOWN [] .. OTHER IV. PIPING INFORMATION A, SYSTEM TYPE B, CONSTRUCTION C, MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR ~2 LINE TIGHTNESS TESTING CIRCLE A IF ABOVE GROUND OR U IF UNOERGROUND. BOTH IF APPLICABLE A U 1 SUCTION A~[~22 PRESSURE A U 3 GRAVITY A U gg OTHER A U 1 SINGLE WALL A~2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A(U:) FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A'U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A IJ 99 OTHER ~MONrrOR,NG'NTERSTITIAL [] 9g OTHER V. TANK LEAK DETECTION ~-_~ ~ v,SUAL C~ECK ~'~<; ,NVENTORY RECONC,L,AT,ON ~3 VAPO, MDN,TOR,N~>~'~ AUTOMAT,CTANK~,,~ ~ ~O~,~W~,~O,,~O~,~ 1 VI. TANK CLOSURE INFORMATION , SUBSTANCE REMAINING GALLONS INERT MATERIAL ? ~ I TH/S FORM HAS BEEN COMPLETED UNDER P~N. AL ?Y, Cf PERJURY~AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOC~ AGENC~ USE ON' ~ TH% STATE ,.O.~COMPO~-O; ;~E FOuR N~M,ERS ,ELOW ' STATE I.D.# COUNTY # JURISDICTION # FACILITY # TANK # PERMIT NUMBER I PERMIT APPROVED BY,CATE ! PERMIT EXPIRATION DATE FORM THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION- FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. STATE OF CAUFORMA · STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. ] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION MARK ONLY ~ NEW PERMIT ] 7 PERMANENTLY CLOSED ONSITEI [] ' 8TANt( REMOVED ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENOED PERMIT [] 6 TEMPORARY TANK CLOSURE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY 1F UNKNOWN A. OWNER'S TANK I. O. # C. CATE INSTALLED (MOnDAY/YEAR) II. TANK C~ONTENTS ~F A.1 IS MARKED, COMPLETE ;TEM C. A. '.,~I~,~ 1 MOTOR VEHICLE FUEL i__dl 2 PETROLEUM ,--7 3 CHEMICAL PRODUCT ] 4 OIL [] 80 EMPTY L~ 95 UNKNOWN · ~ PRODUCT [] 2 WASTE C, [] la REGULAR UNLEADED ] lb PREMIUM UNLEADED [] 2 LEADED III. TAN K CONSTRUC~ON MARK ONE ITEM ONLY IN BOXES A. B. AND C, AND ALL THAT APPLIES IN BOX D A. TYPE OF ~ DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER SYSTEM ~.~ 3 DIESEL [] 6 AVIATION GAS 4 GASAHOL r--] 7 METHANOL ~ JET FUEL ~ 99 OTHER (DESCRIBE IN ITEM D. BELOW) C.A.S.~: ] 95 UNKNOWN ,.~ 2 S~NGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) ] 99 OTHER B. TANK ~ 1 BARE STEEL [] 2 STAINLESS STEEL ~ 3 FIBERGLASS MATERIAL ,~.._~ 5 CONCRETE ~ 6 POLYVINYL CHLORIDE I'--'-] 7 ALUMINUM ~PrimaryTank) ~ g BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN '~'~TEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP [] 99 OTHER ~ 1 RUBBER LINED ~-~ 2 ALKYD LINING ~ 3 EPOXY LINING C. INTERIOR ~ 5 GLASS LINING ~ UNLINED [] 95 UNKNOWN LINING -- iS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. CORROSION i~; I POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION F--] 5 CATHODIC PROTECTION I~ 9! NONE [] 95 UNKNOWN ] 4 PHENOLIC LINING ] 99 OTHER ~ FIBERGLASS REINFORCED PLASTIC ] gg OTHER iV. PiPiNG INFORMATION A, SYSTEM TYPE B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION .~,~"~-AUTOMATIC LINE LEAK OETECTOR CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A U 1 SUCTION ~ PRESSURE A U 3 GRAVITY A U 99 OTHER A U 1 SINGLE WALL A U(~ DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC) U.J(.U~ FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATli~LEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U g5 UNKNOWN A U 99 OTHER ~,~-~ LINE TIGHTNESS TESTING ~__~...-~'ff~ERSTITIAL '~-~ MONITORING [] 99 OTHER V. TANK LEAK DETECTION I!~__=, viSUAL O~EO~ ':~INVENTOR~ RECONCILIATION ~ VAPOR MON'TORIN~AUTOMATIO TANK GAUG,NG ~. GROUNDW*TE. MONITORING ~ TANK TESTING [] 7 INTERSTITIAL MONITORING ~ gl NONE [] g5 UNKNOWN ] 99 OTHER VI. TANK CLOSURE INFORMATION 2. ESTIMATED QUANTITY OF ~ SUBSTANCE REMAINING GALLONS 3. WAS TANK FILLED WITH N,.,.,~ 1 INERT MATERIAL ? YES [] THIS FORM HAS BEEN DOM, PLaTE?. ?N..~ER Pf~IALTY O. FJ~ERJU~ A. Nt) ~O THE BEST OF MY KNOWLEDGE, IS TRUE AND LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # STATE I.D.# ~ PERMIT NUMBER JURISDICTION # FACILITY # TANK i PERMIT EXPIRATION DATE PERMIT APPROVED BY/DATE FORM THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. US NATERIAL DIVISION - 2130 G Street, Bakersfield, CA 93301 · (805) 326-3979 T~iK RENOVAL INSPECTION FORH FACILITY ~a~2:~ ADDRESS OWNER ~ PERMIT TO-OPERATE# CONTRACTOR 5i~/C~al CONTACT PERSON LABORATORY ~q;71~ , ~ # OF S,AMPLES TEST METHODOLOGY ~h-~ _-~,~ ~,~/r~ ' PRELIMANAR¥ ASSESSMENT CO. :~J~_' · CONTACT PERSON~ CO: RECIEPT ~/~ LEL% ~..,_~.4. ~ PLOT PLAN .' ~,~/ ¥..,,', j, i~ui-,~ ~. ?.~.~.~ , 9~'~ ,: CONDITION OF TANKS CONDITION 0F PIPING CONDITION OF SOIL AUBURN STREET l "~. " I ~l~ 0 i~ 0 ~ 0 I .... I ' I ' " " " " " 6 ...... [~ ~'- , ,~. ~ · ~ ~///////Y/////// ; ~ 2 ~. -~'~:.v / / ,- , ~ ~ / /t ~ " 0 , .,~ ~ VICINi~ MAP ,o' / /~'~ _ j_ , / ~ il' / '1 / '/ ~1 ~ ~' ~ ~'. ~ ~ ~ :, . 20' ~':~ BLUEPRINT SERVICE AUBURN STREET t .... f ~ ~ ' t,,,tZ i= 40" ~ ~ ~ SCALE: 1'=20' I I F I ~ ~ ~' " ' : 0 , ~ i , ~ o~I~ ~,~ , (4)-~2.oo°'~AL. o' '~ r ,o' 8' r, --~ ~~1 ~i~';I I~ 17' D~LE ~L STOL ~ ~; ~:~,o~e~ ~ ~., t / ' ~ ~ p~~/ ~ i i ~ ~ 0 / / .,~o ~ Z o ViCiNi~ MAP / .0' / eul~lne / J "' ~. / / J_ I ¢ ¢I[ ---- i / /~- ' ,, / / : ', , : ..... ~' :~ ~e' ~ ~ ~ ~0' Z , ~__~__ HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM FACILITY OWNER CONTRACTOR LABORATORY TEST METHODOLOGY PRELIMANARY ASSESSMENT CO. CO2 RECIEPT ADDRESS ~-~ ~ O~C~ PERMIT TO OPERATE# CONTACT PERSON #OFSAMPLES {~ CONTACT PERSON LEL% 02% PLOT PLAN CONDITION OF TANKS CONDITION OF PIPING CONDITION OF SOIL 6jo~c~6 ~ ~3/ 3c~r ~,.~,/-~-~... Co~c~ DATE INSPECTORS NAME SIGNATUR~ USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: osWELL FASTRIP #26 STATION #: '347 COMPANY NAME: JAC0 OIL ADDRESS: 2698 OSWELL STREET CITY: BAKERSFIELD STATE: CA ZIP: 93306 PHONE: PERIOD ANALYZED:.MAY, 1995 DATE OF REPORT: 06/14/95 PART A: Data Tank ID: Tank and Lines Status: Product: Quality: Dels: Sales: 02 04 05 00 TIGHT TIGHT TIGHT TIGHT 02 -UNL #1 04-FS D#2 05-FS MID 00-FS PRE POOR POOR POOR POOR 51356 6650 21418 10800 55958 5744 23315 14020 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery. discrepancies which were accounted for as part of.the.SIR analysis. Tank ID: Comments and Recommendations: 02 04 05 00 iajority of o/s exceed +/-100 -> review sticking procedures 5/2/1995: -162} {511011995 -208} {5/ll/1995:DEL -624 5/23/1995:DE~,-203} {5/29/!99~:DEL 9644} {513111995: -3581 Tajority of o/s exceed +/-100-> review sticking procedures 511o11995: 269} {511411995: -102} {512311995: 120} 51211995: -268} 5/30/1995: 142~ 5/6/1995: -4248} 5/17/1995:DEL 495} 5/29/1995:DEL 3451} I5/9/1995: 129} {5/14/1995: -145} 513111995: -100} IS/7/1995:DEL 4023} {5/16/1995: -139} 5/18/1995: -419} {5/26/1995: -3311} USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: OSWELL FASTRIP #26 STATION #: 347 COMPANY NAME: JACO OIL ADDRESS: 2698 OSWELL STREET CITY: BAKERSFIELD STATE: CA ~ ZIP: 93306 PHONE: PERIOD ANALYZED: APRIL, 1995 DATE OF REPORT: 05/15/95 PART A: Tank ID: Tank and Lines Status: Product: Data Quality: Dels: Sales: 00 02 04 05 ~TIGHT TIGHT TIGHT TIGHT 00-FS PRE 02-UNL #1 04-FS D#2 05-FS MID FAIR FAIR FAIR FAIR 20892 56335 4463 25076 18430 56217 5341 22499 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 00 {4/2/1995:DEL-420} {4/13/1995: -137} {4/17/1995: {4/23/1995:DEL -244} -235} O2 04 I4/2/1995:DEL5735} {4/16/1995- -304) {4/17/1995:DEL 386) 4/18/1995: -468} {4~19~1995;DEL 267} {4/30/1995:DEL -329} I4/4/1995: 154} {4/9/1995:DEL 197} {4/26/1995:DEL 143} 4/30/1995: -127} 05 I4/2/1995:DEL -447} {4/9/1995:DEL 2591 {4/10/1995: -402} 4/23/1995:DEL 198~ {4/27/1995: -270 For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. USTMAN SIR SYSTEM Monthly Statistical Inventory Reconciliation (SIR) Report STATION NAME: OSWELL FASTRIP STATION #: 347 COMPANY NAME: JACO OIL ADDRESS: 2698 0SWELL CITY: STATE: CA ZIP: 93306 PHONE: PERIOD ANALYZED: MARCH, 1995 DATE OF REPORT: 04/17/95 PART A: Data Tank ID: Tank and Lines Status: Product: Quality: Dels: Sales: 00 TIGHT 00-FS PRE POOR 19332 19739 02 TIGHT 02-UNL #1 POOR 58715 59792 04 TIGHT 04-FS D#2 POOR 5560 4337 05 TIGHT 05-FS MID POOR 23600 24578 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. Tank ID: Comments and Recommendations: 00 02 04 05 I 3/14/1995: 226} I3/22/1995: 3/30/1995: 107} 3/31/1995: I 3/2/1995: 269} {3/14/1995: 3/19/1995:DEL -732} {3/28/1995: -370} 203} {3/28/1995:DEL 1174} I3/5/1995: 469} 3/21/1995: -116} 165} {3/15/1995: 118} -297} {3/31/1995: -5351} I3/6/1995: -350} 3/31/1995: -192} {3/19/1995:DEL 243} Majority of o/s exceed +/-100 -> review sticking procedures {3~2~1995:DEL -587} I3/5/1995: 483} I3/6/1995: _234} {3/14/1995: -130} 3/15/1995: 189} 3~19~1995:DEL 532} {3/22/1995: -139} 3/29/1995: -117} 3/30/1995: -204} {3/31/1995: 710} For regulatory compliance in California, a piping integrity test ate Underground Hazardous Materials Storage Facility CONDITION P EvERSE SIDE 01 UNLEADED 02 UNLEADED 03 DIESEL 04 PREMIUM Tank Hazardous 6::~!i~7%?.:?:':'" Y.e..:a~:~iiiii~¢¢i::i,~:~::.. :;! [.~Tank ...... ::;Ta~i~!;i~.i:~;i:;:.:i::.!!!!i::~:~ Piping Piping Piping Number Substance C~:.~:~!~%.:]::' I n"~'i'~ii~?., ii :?'.?T y p e M o hifei~i'~?;:'!i;:!:.!~i~: Type Method Monitoring i:i".. "-. '--::: ======================= :::"-:' · -~. :- '. '. ::~::~:: ":~ ;:~. ".:.:.:.:::$~F:.:~ '~." '- ....":~: ':::E ;'"' .:':::: '::: ::: :::;;~¢::~;::::~:::::~:;::'::::::~?:::~;;~;~;~:':::';;;;:'":;;;'; ..... :]:):' "~::'"'""':'"';:~:::' :~:............::~:. ..:..:.. ....;;:;..::::?~?;. ,...:::::? Issued By: Approved by: · .:,::.Condit~o. ns:;su.b..ject, to chang.e..i?!n.:r..egulat~o~s~::?::' .... ~;:;~;;;~;ii;:'.::.::.::!:.?:.i;?.;i;:.?: .?' ":?~?~!!ili: i!ili;;;;iii!!!!...:iiii?~:::- .:.~:?;;:::;;::::"~"i .?::bsued T o HAZARDOUS MATERIALS DIVISION 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 (805) 326-3979 Ralph E. Huey, Hazardous Materials Coordinator Valid from: PRESSURE ALU PRESSURE ALU PRESSURE ALU PRESSURE ALU JACO JAMIESON FASTRIP FOOD STORE 2698 OSWELL STREET BAKERSFIELD, CA 93306 12-22-93 to: 12-22-98 3101 State Road Jaco Oil Company Bakersfield, California 93308 m p O. Box 1807 Bakersfield, California 93303-1807 · Phone: 805 393-7000 · Fa~c. 805 393-8738 August 1, 1994 LETTER FROM CHIEF FINANCIAL OFFICER I am the chief financial officer for Jaco Oil Company, general partner of Jaco Hill Co.. This letter is in support of the Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective action and/or compensating third parties for bodily injury and property damage caused by an unauthorized release of petroleum in the amount of at least $10,000 per occurrence, and $10,000 annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter. Fastrip #26, 2698 Oswell St., Bakersfield, CA 93306 1. Amount of annual aggregate coverage being assured by this letter: $10,000 2. Total tangible assets: $5,869,372 3. Total liabilities: $1,737,100 4. Tangible net worth $4,132,272 I hereby certify that the wording of this letter is identical to the wording specified by subsection 2801.1(d)(1), Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge and belief. AIJ o SignatureEXecuted a ..~ _sfiel~~. on Date Name: Brian Busacca Title: Chief Financial Officer BB:jlc ' C'oRPoRATION INTERNA" 5225 Holli~ter, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Tight of. ness Service Order #: 115650 Test Date: i'r0und storage tank system(s) tested and found tight for: JACO OIL COMPANY INC. 347 JACO OIL COMPANY INC. BAKERSFIELD, CA 93306 4 Line(s) only, )wner: :lress: only, FASTRIP #26 AUG 11994 products tested: -1',2'0 0 0 DiE ?~":'12.000 'SUPR UNL 2 12000 REG UNL 4 Leak Detector(s)onlyl 3 12000 NO. 07/.20/94 ' LEAD Detectors 'reSted: 66,74 XLD 3A NO , 4A SUP 41093-5663 XLD XLD : !gr, Certificate Number & Name 312 DAVID TOHIR 10/95 .1315 DAVID TOHIR 12/96 Canadian Patent #1185693. European Patent Appl. #169283 IKNOLOGY,& VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL =* SEAL Valid only with Corporate Seal Note: See VacuTect Report for tank identification & location drawing.. Owner JACO OIL COMPANY Invoice Name/Address UsTMAN Site Name/Address INC · INDUSTRIES, .. INC. JACO~OIL COMPANY INC. VaCuTect TEST REPORT ' Site # 347 12265 W'. BAYAND AVE. #i10 LAKEWOOD, CO 80228 FASTRIP #26 2698 OSWELL'STREET BAKERSFIELD, CA 93306 s.o. Date Phone Attn: ' 11'5650 0?/20/94 <800.> 2'5'3-8054 BRucE McDUFFY ; TANKS' LINES " : Leak bet See Ullage TANKS and LINES Tested to CFR-40 Pads Diag. Tank Dipped Dipped Probe Water Bubble - Air · Line . Final Exist 280-281 & NFPA'329 Spec's. , ' Fo~ Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE ILD(s) NEW Loc. Material Level Level Level Detected Detected Detected · Material Syst Type TEST TEST Rate · Pass/ Lb(s) ST/ · · · · · · Tight · · ' · · · Tight' Fail/ rested Other: 'Tank Tank FRP/ START. START START or ST/ START END or or & Product Capacity Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail NONE PASS ' " · New/2nd LD SN/MDL/MFG: S~ EndTime: ~ ; ~9 Tank --~ O0 Probe Inclinomet~3 Test PSI: · D~qr~s: ~ 200 Dispenser Shear Valves . . Entw: ~ Z ~ ~ . I Operate ~es/no~ ~ , r I - ,0 000 10 9.00 0°. ......... ........ ............ ' ' ' ' New/2nd LO SN/MDL/MFG: Material StadTime: ~ 02 Percent of Fill at ~ 0 Mfg.: ~'~'~:~'/'-~",~':'~;~' ,5¢~?,,~ '~,~;~:~*'~ Time of Test: Pump : ;' ,-¢:<~%'-;:::?.~',-~,~¢*~.'¢ ' >' ~-~:' ~; ~'~: ~ '~; LINE TEST. PSI 5 0 ~ ~ End Time: [ 5 = 4 3 Tank Probe Inclinomet~ ~ TestPm:-- 2 ,00 ~[~ , 000 .i,~ ..... Enid; . De~r~s: Dye,ale ~res/no~ New/2nd LD SN/MDL/MFG: Time of Test: . 5 0 · 0 0 ~T EndTime: &5; ~3 Tank --Z · MU Probe ~'&~D Inclinomet~ ~ T~st P~I: ~l IEnt~: D~r~s: I'~ OperateDiSp .... ~yes/no~Shear Vel .... y ~ ~M~ IZ~'~U Diameter~)~,~M~ ~,(3(~ U~{J~ ~ ~ N -. T ~A ~i¢ ~2,4, ~. ~i~ ~?~ ~ ~O!O~;~ ~~ P - ExistLDSN/MDL/MFG XLD ' New/2nd LD SN/MDL/MFG: Time of Test: Pump 3 ~ ~ ~ ~'~' ~" ~ ~¥ ~/~ T~' ~ T End Timg: ~ ~ ~ 2 ~' Tank -- ~ Probe Inclinomet~ ~st.~: - OO YILL 800 ~ ..... ' Entry: Deor~: ' Operate ~es/no~ Y Dameter )~ '-~;: ~ Exist LD SN/MDL/MFG: , ;&~2~.~ · . ~r~ent of Fill at Pump ~'~?~;~:'~'~ ;~;;'~'~?':~-~',~:~ ~:~/~ ..~j~'~ ~;~ Material Sta, Time: Time of Test: Mfg.: . ~; j,;, ~;,L:L:: ;;~ ;~ ..... LINE TEST PSI: End Time: T~ PSI: ~ntw: De~r~: Operate ~es/no~ , : New/2nd'.LD sN/MDL/MFG: End Time: T~ P~l: En~; I Dtqr~: Operate I :rANKNOLOGY Region: WESTERN REGION Unit # 037 State Lic. #1315 NOTE:' Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. TAK-01 Tankn°logY CorporatiOn International State: CA 5225 HO]lister St., Houston, TX 77040 (800) 888~8563 · FAX (713) 690-2255 ~,~;~ :~:?Well' Nu~M~ ~w:':""::'~::~:, .. ell~.Depth~: mber i.:.,: 1:-" '2 ;?:3 '4,~ 5 6 · 7' " ' 'i ~n~d Symbols fordlagmm below: .:'.: .' 'f~ll ,? V.R.,w ~Ball Float ~ ~. ,,~ .. ~ ~,.~, .~ ~... ,, ....... ~. ~ ,..,~ ~ .... .. Monitor Well. :~(~B},~ · ~ -~r ~:~:;;~:':. '-,~ ', , :'~' ~" ::(G~ ' : ..~.~,, .,~ ........ ..~,~.~,-~.. ~.. .... ,.:... ? ~ .., .: :Tank Gau e '"~' "" '. ' ...... : ':" '1~':~· > '~1~'~ .. , ,.~.,~ :..~ ~ ~ ~. t 2. ~ ~ . : ',. ~ ~ . . - , , , . , - . · , ,, , . . ./~ '. . . ~. ~ ~e~,. h tank .. ..... ...... ' ~ ~ :~ ' J': ':,' ~' ,4' ' '.:, ~,~:~:"b~'~ ~r:l~'l "re~ul~tion's '~qdi}e i~m'ediate rePo'rtS' 6f R. EPO~TED :~ne~ ..-,~::- .:: .,:....~¢.,. ,. OWNER or R~ulato~ ~en~ ~,>..~:..:,.~... %,, ....... ~.....,: , ~ ...... . .... 9330~ A~PLICATION TO PERFORM A TIGHTNESS TEST PEN. HIT TO OPERATE $ OPEF, ATOP~ 51AM~ NUMBER OF TANKS TO BE TESTED TANI<~ VOLUME ~ /z~ '~ .........., .......... /~.- ~ STATE REGISTR/~TION $ DATE & TIME TE.$T IS TO BE CONDUCTED DATE S IGIIATURE~ Of-A. PLICANT ENVIRONMENTAL. HEALTH SERVi .... STEVE McCALLEY, R.E,H.S. DEPARTMENT .... Z?O0 *M" Stre~.t.' Suit~300 i~er~fieid, CA 95301 [805} 861-3635' {~,05) $01-~42-9 FAX TANK: iNTEGRITY TESTING, INSPECTION FORM' ._%HIS FORM .M[gST BE COMPLETED AT TIME _OF'INTEGR~ %E.$_T BY'~. TECHNICIAN O.N._.$_FI~_ Alx)~ SI_IBM'rTTED ~ ~...TA~.~,GR~ ~T E_~.~TS TO ~ ...KERN. CO~.._E~O~~ ~~ SER~S Fadlity Perm/t to Operate Number. Facility Permit to Tightness Test Number Facility. Name Have you complied with the following saSety requirements stated in UT-20, Section 25? ........ The area 'within 25 feet of any underground storage tank opening is ~ree of smukir~g, open flame~, and any other source of igan/tion. Legible sigas with the words %10 SMOKING" are posted in conspicuous locafium around thc tc~t~g area. ~/r~_..~ ..... The general public is restr/¢tecl ~om the testing area by rope, flags, cones, and "fi. dark" a fluol'escent bari-Jer. · Fire protection in the form of a 2A/20BC ~e extingUisher i.q located withiri the r'e~[ricted ar, a. 3/7~ Veh/cles ut'ili.~ed dur/ng the testing per/od, or w/thin 25 feet of the underground: s[orage tazfl< opening, have adequate ventilation, and the te~ter' h~. equipment which can be utiI/zed..to .... monitor, the conce...n.!rat!o.n.of, fl~.¢mab..1.e vap.0.~. }.vi.'tkin · ' x//¢~ ~ ....... Personal protective equipment, an eye Wash and gloves, and a site safety'plan' are within, the testing area. .... Yg73 Equipment/materials' is available to absorb and contain any smatl release of te. qtirtg liquid which is discharged as a result of the test. (Examples include DOT-acceptable containers for storage of the absorbent and an adequate' suppl7 o£ absorbent). ... If the answer to any.of th~ above questions is ~__Q, st0p the testing, procedure. IMMEDIATELY COMPLETE REVERSE SIDE.' FROM TANKNOLOGY SOUTHERN CAL TO Perform IntegritY Testing (PTT)? plot plan? Thc number of tanks being te~tecl State Licensed Tec~ician on site State Licensed Teckmcian's ~ the site layout .consistent with the application stare'exceptions for any N,,O, answers to the'above questions: , , I C,ERTII=Y.THAT THE AFOREMENTIONED FACTS ARE TRUE AND coRR'EcT'C......,,- UNDER PENALTY OF PERJURYi (Not valid if not signed and dated.) ., (PRIh~ - Sure ~m~ T~id~ on Site Sig~ed tl~ BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 1715 CHESTER AVE., 8AKER'$FIELD, 'CA (805) 326-3979' 93304 APPLICATION TO PERFORM A TIGHTNESS TEST PERMIT TO OPERATE ~ OPERATORS NAME NUMBER OF TANKS TO BE TESTED TANE~ VOLUME I IS pIpING GOING TO BE TESTED ~'~ CONTENTS ADDRESS NAME OF TESTER CERTIFICATION STATE REGISTRATION DATE & TIME TEST IS TO BE CONDUCTED DATE ~'~ .~ CORRE ION NOTI~E.~, ~: BAKERSFIELD FIRE DEPARTMENT Sub~.mv."zr-~, -~ q. ~ f).,_.~. _ //, . B]k ~ot You are hereby required to make the following corrections at the above location: Cot. ~o! Completion Date for Corrections .,]~/'P./~/~...m o,' Date 326-3979' BAKERSFIELD FIRE DEPT HAZARDOUS MATERIALS DIVISION Operating Permit: r~ Business Name: /~. (~ Location: _~(, ~'~ Business Identification No. 215-000 Number of Tanks: ~ Containment: ~,, '~~(/ Contact Information Owner:'. ~n~ Emergency Contacts: Date Completed E~.'~. (Top of Business Plan) Type: Lines: ~,~l~_~/z~ , Adequate Inadequate Records Maintenance Testing Inventory Reconciliation Response Plan Emergency Plan Violations: B~iness b~vner . All Items OK Correction Needed 3101 State Road Bakersfield, California 93308 Jaco-Hill Company Telephone (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303-1807 January 20, 1994 0 Mr. Ralph Huey CITY OF BAKERSFIELD UNDERGROUND TANK PROGRAM 2101 "H" STREET BAKERSFIELD, CA 93301 Subject: FASTRIP FOOD STORE 2698 OSWELL STREET BAKERSFIELD, CA RECEIVED 2 4 1994 HAZ. MAT. DIV. Dear Mr Huey: To comply with the monitoring program requirements outlined in the State Underground Storage Tank Regulations, Jaco-Hill Company utilizes Statistical Inventory Reconciliation (SIR) with tank integrity testing as a release detection method at the above referenced facility. Current regulations require Jaco-Hill Company to (!) submit a summary to the local agency which indicates the results from the statistical inventory reconciliation reports for the previous 12 months, (2) perform tank integrity tests bi-annually and (3) perform integrity tests on the piping and line leak detectors annually. Attached for your review is the following: The annual summary of the SIR reports for this facility prepared by our SIR vendor, Ustman Industries Inc. Copies of the results of the line and leak detector tests which were performed November 17, 1993, by Tanknology Corporation International. Review of the results indicate the product lines are tight and the leak detectors are functioning properly. Jaco-Hill Company strives to maintain compliance with all state and local regulations at our facilities. Should you have any questions or require additional information, do not hesitate to contact me at (805) 393-7000. Operations Manager JI jk attachments USTMAN'SIR. SYSTEM-- - Monthly Monitoring Re~.~=, DECEMBER, 1993 Report-Date:~ 01/11/94 Company name ~:JACO OIL Station Name:. OSWELL FASTRIP Address: 2698 OSWELL City: Station # : 347 State: CUMU~ATI~VE MONTHLY REPORT -- JACO OIL- 1993. CA LEGEND'--> T - TIGHT ?? - INCONCLUSIVE TANK JAN FEB MAR APR MAY JUN JUL IL - INVESTIGATIVE~ LOSS ND-- NO DATA' SUBMITTED AUG SER OCT NOV' DEC. 347-00 T T T' T T T T 347-02 T T ?? ?? T T T 347-04 T T T T T T T 347-05 T ?? ?? T T T T Tank ID: Product: T T T T"~; T'' " ?? T T T' T T' T T T~ T T T T T T 00 00-FS PRE 02 02-UNL #1 04 04-FS D#2 05 05-FS MID USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods..- For regulatory compliance in California, a piping integrity test every 12 months, and a tank integrity test every 24 months are required in association with SIR monthly monitoring. . 'TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 030695 Test Date 1]./17/93 Certificate of Tightness Service Order # Underground storage tank system(s) tested and found tight for: TANKOWNER: JACO OIL COMPANY INC. 26 TEST SITE ADDRESS: JACO OIL COMPANY INC. 347 FASTRIP 2698 OSWELL STREET BAKERSFIELD, CA [ ] [ [ TANK SIZES & PRODUCTS TESTED 1 REG UNL 2 PLUS UNL 3 DIE 4 SUPR UNL LINES TESTED iA, 2A, 3A, 4A' LEAK DETECTORS TESTED 41093-6659 XLD, DLD, , DLD Unit Mgr. Certificate Number & Name 0 $ $ STEVEN E. U.S. Patent #4462249, Canadian Patent #1185693, EuroDean Patent Appl. #169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL 41093-6671 XLD HAWKINS 06/94 Valid only with Corporate Seal Note: See VacuTect Test Report for tank identification and site location drawing. invoice Name/Address USTMAN INDUSTRIES, INC. ,Site Name/Address JACO OIL COMPANY INC. vacdTect-, TEST REPORT Siie# 26 12265 W. BAYAND AVE. #110 LAKEWOOD, CO 80228 347 FASTRIP 2698 OSWELL STREET BAKERSFIELD, CA S.O. # Date Phone Attn: 030698 11/17/93 <800> 253-8054 BRUCE McDUFFY TANKS LINES L~ak Det See ,r, Ullage ! TANKS and LINES Tested to CFR-40 Parts Diag. Tank Dipped Dipped _~_robe Water Bubble Air Line Final Exist 280-281 & NFPA 329 Spec's. For Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW Loc. Material Level Level Level Detected Detected Detected · Material Syst Type TEST TEST Rate · Pa~s/ LD(s) ST/ · · · · · · Tight · · · · · Tight Fail/ rested Other: kTank Tank Tank FRP/ START START TART . or ST/ START END or or & t)# Product Capacity Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail ~IONE !PASS 1 REG Diameter :' :>: " iA ST PS.~ L5!4~ i~i.i5 .~.000 T. ~ y Ex,stLDS,/MDL/UrG: X0591-3524 DLD UNL ~rcenl of Fill at Pump Material Stad Time: Time of Test: Mf~.: .... UNE TES1PS~ ~ 0 . 0 0 2 PLUS / Pump Stad Time: Time of T~I: , . Mf~.: . :: . -::, ~ ~" ; ..... , ., , LINE TEST PSI 5 0 0 0 End ~m~: Test PSI~ I Ent~: D~r~: I Operale ~es/no~ . , ... L/: 3A ST PS 17: i5 17 J 45 0,000 T F y ExisILDSN/UOL/UF6: DLD ~ P N~'~"~ ~ SNZ~OU~:i 093-- 6671 XLD Material ~roent of Fill at Pump Stad Time: Time of Test: Mf~.: · ~ LINE TEST PSI 5 0 0 0 End ~me: Test PSI: I gnl~; ptflr~: Operate [~es/no uN b ~ New/2nd LD SN/MDL/MFG: %/ Material ~rcent of Fill at Pump L Stad ~me: Time of Test: Mfg. J . .... -,, ,:., ,~ ,' UNE TEST PS~ Material ~rcenl of Fill at Pump Tank I Probe Inclinometer ~ Dispenser Shear Valves End Time: Test ~1: I Ent~: D~r~s: O~erale ~zes/no~ I I ~rcent of Fill at Pump ' Material Stad Time: Tim of Test; Mfs.: 7 ' LINE TEST PSt Tank I Probe .... ' = ' .... ' ~nd Tim~: T~ p~l: I Ep~: IDeor~s:lnclln°meter . O~erateDiSP ..... ~es/no~Shea' Va~v,s State: CA TANKNOLOGY Region: WESTERN REGION Unit # 416 State tic. # NOTE: Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. TAK-01 ,,Tanknology Corporation International 5225 Hollister St., Houston, TX 77040 (800) 888-8563 , FAX (713) 690-2255 IONITOR WELLS Well Numbert I O~ne~r'" J 2 4' Wei i- Depth 1 Depth to Waterl AN~OU~JT in inches, Standard Symbols for diagram below: ["~,' Manway Location Diagram-~nc~ude Monitor Weii. (Outside Tank Bed Area) Tank Gauge. j I;] Iron Cross Site#: 'Vapor RecoVerY' Observation Well. (Inside Tank Bed Area) (~ Vent · ' r~-] Turbine, '/ .the. Vapor. Re. coyery Syst.em,. Vapor Recovery System & Vents were tested with which tank? Parts and Labor used When OWNER or local regulations require immediate reports of system failure-Complete the following: REPOP.,TE D j ~A~';F DATE TI~E FILE NUMBER Vacu~-~cf~'~ Certification NumDer: Date Testing Completed 3101 State Road Bakersfield, California 93308 Jaco-Hill COmpany Telephone (805) 393-7000 Post Oltico Box 1807 Bakersfield, California. 93303-1807" Sanuaxy 20, 1994 Mr. Ralph Huey CITY OF-BAKERSFIELD UNDERGROUND TANK PROGRAM 2101 "H" STREET BAKERSFI~J}, CA 93301 Subject: FASTRIP FOOD STORE 2698 OSWELL STREET BAKERSF~.r), CA Dear Mr Huey: To comply with the monitoring program reqnimmoms outiineA in the State Underground Storage Tank Regulations, Jaco-Hiil Company tltiliTes Statistic~ Illventoly Reconciliation (SIR) with ~nk integrity teeing as a release detection method at the above referenced facility. Currem regulations, require Jato-Hill Company to (1) submit a s, mmmy to the local agency which indicat~ tho-- results from the statistical inventow reconciliation reports for the previous 12 montlx~,. (2) perform tank integrity tests bi-anmmily and (3) perform integrity tests on the piping and line leak detectors ~nmmlly. Attached for your ~view is the following: The nnmlal summaly of the SIR reporm for this facility prepared by our. SIR vendor, Us~mnn lndnsui~s.. Inc. 'Copies of the results of the line and leak detector tests which were performed November 17, 1993, by Tnnknology Corporation International. Review of the results indicate the product, lines are tight and the leak detectors are functioning properly. Jaco-Hill Company strives to maintain compliance with all state and local regulations at our facilities. Should you have any questions or require additional information, do not hesitate to contact me at (805) 393-7000. Mhn Kefley Operations Manager J jk attachments USTMAN SIR SYSTEM Monthly Monitoring Report DECEMBER, 1993 Report Date: 01/11/94 Company name :JACO OIL Station Name: OSWELL FASTRIP Address: 2698 OSWELL City: Station # : 347 State: CUMULATIVE MONTHLY REPORT - JACO OIL- 1993 CA LEGEND --> T - TIGHT ?? - INCONCLUSIVE TANK JAN FEB MAR APR MAY JUN JUL IL - INVESTIGATIVE LOSS ND - NO DATA SUBMITTED' AUG SEP OCT NOV DEC 347-00 T T T T T T T 347-02 T T ?? ?? T T T 347-04 T T T T T T T 347-05 T ?? ?? T T T T Tank ID: Product: T T T T ?? T T T' T' T T T T T T T T T 00 00-FS PRE 02 02-UNL #1 04 04-FS D#2 05 05-FS MID USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol'for SIR methods. For regulatory compliance in California, a piping integrity test every 12 months and a tank integrity test every 24 months are required in association with SIR monthly monitoring. -~TANKNOLOGY CORPORATION INTERNATIONAL. 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Certificate of Tightness Service Order # 030698 Test Date Underground storage tank system(s) tested and found tight for: TANKOWNER: JACO OIL COMPANY INC. 26 TEST SITE ADDRESS: JACO OIL COMPANY INC. 347 FASTRIP 2698 OSWELL STREET BAKERSFIELD, CA [ ] .^.~ o..~, [ ~].,..~s~o..~, [ t'~^~""~"C~O"~S~O"'~' TANK SIZES & PRODUCTS TESTED 1 REG UNL 2 PLUS UNL 3 DIE 4 SUPR UNL LINES TESTED lA, 2A, 3A, 4A LEAK DETECTORS TESTED 41093-6659 XLD,' DLD, 41093-6671 XLD , DLD Unit Mgr. Certificate Number & Name 083 STEVEN E. U.S. Patent #4462249, Canadian Patent #1185693, European Patent Appl. ;~169283 TANKNOLOGY & VacuTect are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL HAWKINS 06/94 Note: See Valid only with Corporate Seal TAK-04 VacuTectTM TEST REPORT s.o. ~ t.~ ~ ,.~ ,~ ~,~~ Date 11/17/93 ;~, uwner JACO OIL COHPANY INc. Site~ 26 Phone <800~ 253-8054 :~' invoiceName/Address USTHAN INDUSTRIES, INC. 12265 W. BAYAND AVE. ~110 LAKEWOOD, CO 80228 Attn: BRUC~ McDUFFY SiteName/Address JACO OIL COMPANY INC. 347 FASTRIP 2698 OSWELL STREET BAKERSFIELD, CA /, TANKS LINES Leak Det 'ti Ullage TANKS and LINES Tested to CFR-40 Parts See Tank Dipped Dipped Probe Water Bubble Air Line Final Exist 280-281 & NFPA 329 Spec's. Diag. Dia. & Water Product Water Ingress Ingress Ingress TANK Line Delivery LINE LINE Leak LINE LD(s) NEW For Material Level Level Level Detected Detected Detected · Material Syst Type TEST TEST Rate · Pass/ LD(s) Loc. ST/ · · · · · · Tight · · · · · TightFail/ Tested Otherl FRP/ START START START or ST/ START END or or & )k Tank Tank Lined END END END Yes/No Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail NONE PASS, Product CapacityI UNL ~ p N'w'2"~SN'MC"'MF~:1093--6659 XLD Percent of Fill at Pump LINE TE?T PSI 5 0 · 0 0 Material Start Time: Time of Test: Mf~.: , , . . , , , ,, . , ......... i. Dispe~se~ Shear Valves Tank I Probe Inclinometer Ope,ate I~'es/no} ¥ Er~ Tim~: T~ ~l; I Entry: Deqrees: Percent of Fill at Pump LINE TE~ST PSI 5 0 0 0 Tank ! Probe Inclinometer Operate!l~,es/no~ End Time: Teat PSi: ~ Entry Degrees: I p N'~/*TCDSN/MCUM~:lO93--6671 XLD Percent of Fill at Pump '~ "~' ~', [.,~ ~ ':i I LINE TEST PSI 5 0 · 0 0 Tank I ProbeInclinometer Operate'l),es/nol I I New/2nd LD SN/MDLIMFG: UNL Material Start Time: Time of Test: Mfg.f ~ , ;; Y t~, .' .., ,', ; ~:, ' ~ Dispenser Shea~ Valves New/2n~d LD SNIMDLIMFG: Percenl of Fill at Pump LINE TEST PS~: Tank I Probe Inclinomeler Operate End Time: Te~t p~l: I Entry: Deorees: Percent of Fill at Pump ,; ,: [ , , ; , ~ . ~ [.; LINE TEST PSI: MatedalStart Time: Time of Test: Mfg.: .. ' · ' ' · - ~ T Dispen~e~ Shear Valves Tank I Probe I Inclinometer O~erate' I~,es/nol State: CA TA~KNOLOGYRegion: WESTERN REGION Unit ~ 416 State Lic. # N~)?E: Original Vaculect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. TAK~ Tanknolo~y Corporation International 5225 Hollister St., Houston, TX 77040 (800) 888-8563 · FAx (713) 690-2255 ........................... · " MONITOR WELLS.· , Well Number: I 2 3 4' 5 6 .7 ' 8 ' 9 10 11-- Well Depth Depth to Water . Product Detected I AMOUNT in inches, Standard Symbols for diagram below: OFill Q 'VaPor RecoVerY: O V.R. w / Ball Float ~ Monitor Well (~ Observation Well. (Outside Tank Bed Area) (Inside Tank Bed Area)-: 'Q Ball Float Q Tank Gauge{ 0 Vent .,.. : ': Manway Iron Cross · Turbine:... . r: -, Location Diagram- nc udethe Vapor Re. coyery Syst.em: ,...: ~ , .. Vapor Recovery System & Vents were tested with which tank? :::':' ' Pa~s and Labor used ~ ~ ~,~ ~~. ~F~ When OWNER or local regulations require immediate repo~s of system failure-Complete the following: REPORTED NAME DATE TIME ;:' · TO: , Phone~ OWNER or R~ulato~ ~en~ FI~.NUMBER - Pdnt C~fi~ Tears N~e V~u~ ~~n Numar,-. g Da~ Tesfi~ Comple~ ~ ':: 3101 State Road Bakersfield, California 93303 Jaco Oil Company Telephone (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303-1807 February l7, 1994 Mr. RalphHuey CITY OF BAKERSFIELD HAZARDOIJSMATERIALS DIVISION 1715 CHESTER AVENUE BAKERSFIELD, CA 93301 Subject: BASIC PROPERTIES BANKERS OIL AND TRUST JAMIESON-HILL COMPANY JACO OIL COMPANY J.T. COMPANY CERTIFICATION OF FINANCIAL RESPONSIBILITY Dear Mr. Huey: Attached please find properly completed CERTIFICATION OF FINANCIAL RESPONSIBILITY forms for UST facilities operated in the City of Bakersfield by the above named entities. Copies of these forms will be maintained at each facility.listed, with an additional copy in each stations comPliance file at our 'main office in Bakersfield. Jaco Oil Company and its affiliates strives to maintain compliance with all state and local regulations at our. facilities. Should you have any questions or require additional information; do not hesitate to contact me at (805) 393-7000. Respectfully, John Kefley attachments State of Calif°mia State Water Resources Control Board CERTIFICATION OF FINANCIAL RESPONSIBILITY. FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonsU'ate Financial Responsibility in the required amounts as specit~ed in ,Section 2.~07, Chapter 18, Div. 3, Tide 23, CCR: ~ 500,000 dollars per occurrence or [-~ 1 milhon dollars per occurrence AND million dollars annual ag~resate of . million dollars annual a~regate B. ,lacm-H i ] ] CoF~a,qy hereby certifies that it/s in compliance With the requirements of Section 2807, (Namo o[ Ta~,k Ov,,ne~, or Operaror) Article 3, Chapter 18, D/vision 3, T-/tie 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: ' C';:f.~:~ Mechanism~:~:~: .':::; ::Name:and::AddresS:Of~lSSUer:~;~:y~. :::::::::::::::::::::::::::::::::::: :~::!.:i t':~;~: ~iC0~erage:~i~ ::COverage:~!~ Corrective:~ :ThiFd::Par Stare Fvnd State of California $ 990,0C<).0{ Cont Y,~_s Yes i ~_~!f !~st.,ranc~Jac0-Hill C.~".-.-.-.-.-.-.U~y $ 10,000.~ P.O. P~k~rsfield, ¢ 93.303-!807 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, /our execution and subm/sston of this certification also certifies that Vou are in compliance with all conditions for participation in the Fund. D. Fad~J ~ Name Fa~i~ Addres~ Fastrip Fc~J Store ~521 Name } FastriD Food STore ~26 ~ Minit Si'a'J FacillW Nam~ i H~ard'_~ Mini Fadlity Name 805 3~th St., Bakersfield Fa~liv] A~ress 2698 0s~ell St., Bakersfield Fa~li~ Addres* 843 E, Fa~ ~ F~ ~erl a~e. Bake~fi~ld February 3. 1_q94 T.J. ,!.amieson Dat~ ' Namo of Witness ~' Notary ~_~'- FILE; Ori~naJ Local ~cy Copies - F~ti~/Site(s) ~ N~me *,nd'l~le of Tank C)w~ or Operator C~J~.~ral P~rtr~r State of Califorma - State Water Resources Control Board CERTIFICATION OF FINANCIAL. RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrat~ Financial Responsibility in the requireA amounts as specified in Section 2~07. Chap~r 18, Div. 3, Tide 23. CCl~ . ~'"~ 500,000 doRars pe~ occurrence ~-~ I m~on dollars annual ag~ogata or AND or ~ I million dollars per occurrence ~-~ 2 milton dollara ann~al ag$reg~t~ B. ,~F~'ni ~q'~r~-Hi l I ,r'.,~ .l~rLV hereby certifies that it is in compliance with the requirerneras of ,~ction 2807, (N~rae of T~alc O~ner or O~ertt~r) . Art~cie $, Ctmpter ~8, Division $, ?-itle £$, California Code of Regulations. The mechanmms usecl to demonstrate financial respons/hility as required by Section £807 are as follows: State Fund gtate of California Self Insurance O~ieson-Hill Cc~any P.O. Box 1807 P~er'sfi. eld, Cq 93303-1807 :!: ::::::.Na~ and ~Address:o! ilSSuec ~: !;!i: :; :. ~ .S 10,[k90.0C Cc~ Yes Yes Note: If you are using the S'tate Fund as any part of your demonstration of financial responsibility, ~our execution and submisston of th/s certification also certifies that you are in compliance with all conditions for participation in the Fund. D. FacilJ ty Name Wofford Heights Liquor Fa~tivy Name Fastrio Food Store ~22 Fac:iii ty Name Fastrip Food Store ~32 Faciilty Name Fastrip Food Store. #23 Fafility Name 5891 Wofford Hts.: ~,~bfford Hts. 4013 S. "ti" St., Bakersfield 3701 Mir~ Ave., Bakersfield Fadli~ ¢~klrc~ 800 Bear Mtn. Blvd,, Arvin State of California - State Water Resources Control Board CERTIFICAI ION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM I A. I am required to demonstrate Financial Responsibility in ~e required amounts as specified in Section 2807. Chapter 18, Div. ~, Title 23, CCR: ~ 500,000'dollars per occurrence ~ 1 minion dollars annual ag~,esate or AND or ~-~ I million doUars per occurrence ~ 2 million dollars annual a~re~ate B. ,laco-H i 1 ] C;~qv hereby certifies that it is in compliance with the requirements of Section 2807, ' Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: ~ St~r~ F:.;nd State of California $ 990,0C0.0( Cont .Yes Yes ~ ?Jr insL, renc¢ J.~co-Hi!l CoTipany $ 10,000.0( :, P.O. Box 1807 ~ ~akersfield, CA 93303-1807 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, ~our execution and submission of this cer~fication a/so ceffifies that you are in compliance with all condit/ons for participation in the Fund. D, Facilit~ Name Farrell's FastriD Fadlity Name Fastrip Fozd Store._ ~31 Fa~lit7 Hame !Howards Mini ~arket Fa~lity Name !Fastrip Food Store Fa~[it7 Nnme Fastri.D Food Store February 3. 1§g4 Dam F,,=hn ~ar'v 3. White Ln., Bakersfield 6401 S. "H" st., t~akersfield China l ak~. ~id?rr~t 8001 White Ln., Bak~fiold State of California - Stat~ Water Re~ouree~ Control Board .... ...................... ============================================================================================= CERTIFICATION OF FINANCIAL RESPONSIBILITY ._,_._.._. FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstral~ Financial Responsibility in the requi~ed &mounts as specified in Section 21107, Chaplet 18, Div. 1 Tide Z3, CCI~ [~ $00,000 dollars per occurrence or ~-~1 million dollars per occurrence AND ~l miR/on dollars annual aggresate [=~12 million dollars annam aggregate B. ,~amip~rn-Hi ] ] C~m ,n~qy hereby certifies that it is in compliance with the requirements of .?~ction 2807, Article 3, Chapter 18, Division 3, 7-rtle 23, California Code of Regulations. The mechanism,, used to ' · C:~i~il;Mechanism~ demonstrate financtal responsibility as required by Section 2807 are as follows: ,.?ii!i:.:ii?:::Ty~ii~ii:i:.!7~ '?::;::i::Narneand:AddmSS:Of. lSSUer i::ii:ii!::i:i;~iiiii::iMechanism:..::~::~: ::~:~ iiiiiii~/emg~i~?i ~!ii!ii~vemge?:!i ]State FUFI~ -~'~'~ of California Self Insurance Jamieson-Hill Cc~an.y P.O. Box 1807 Bakersfield, CA 93303-1807 $ 990,000.0C .i IO,CNSO.O Note: If you are using the State Fund as any part of your dernonstmtion of financial responsibility, your execution and submissaan of this certification also certifies that you are in compliance with all conditions for participation in the Fund. D. iilco'r~tiVe i iTl'~ird~par Yes Yes Howa~'s Mini I~rt FadlityNam~ Fa_~tri~] Food St~era ~$38 Facility Name Fastrip Fo3d Store ~P341 Farillty Name Fastrip Food Store Facility N~e Si~mre~ ~ ,~aT~01 Calif. City Blvd.. Calif. City Facility .S, ddr~$ - -' 2350 H~w. 5S. Moiave 1200 Coff~ Rd., Bake~field 12851 Ros~ale .F~.~ Bake~field Date Name mu[ 'l~le of Tank Owner or ~ ~ R~ur~ry 3, 19~ I~h~ Kerley Stat~ of California - ' - Stat~ Water Resources Control Board -" ERTIFICATION OF FINANCIAL. RESPOI SIBILITY ' ' po ' 'ty' . required amouats as specified ia SectJoa2807, Chapter 18, Div. a, Title Z$. CCl~ ~--~ 500,000 dollars per occurrenee ~=~ 1 m~on dollars annual aggregate or AND or ~ 1 milton dollars per occurrence ~ 2 million dollars annual aggregate B. ~ hereby certifies that # is in compliance with the requirements of Section 2807, Article 3, Chapter 18, Division 3, T'/Ne 23, California Code of Regulations. ~. ..~t~m~t~ En~./lcial responsibility as required by Section 2807are as follov~s: State Fund State of California $ 990,000.~ C~t Yes Yes Self Insurance Bamkers Oil and Trtlst $ 10,000.00 P.O. Box 1807 Bakersfield, C,~ 93303-1607 Note: If you are using the State Fund as any part of your de,T~r~tration of financial responsibil/ty, your execution and submiss~n of th~ cerbfication also certifies that ~ou are in comI_Pliance with all conditions for ~tion in the Fund. Fastrie Food Store Fastrip F,~., Store Facility Name !One Stop ~rk.,e Fa~Jty N~me "t ~00 Ni!es St., Bakersfield 1F_/K) S. Chester Ave. Bakersfield i501 N. China Lake Blvd. ~ Rid,o, ecrest State of California State Water Resources Control Board CERTIFICATION OF FI'NANCIAL RES'PONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM I am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807, Chapter t/k Div. 3, 'riga 2,3, ~ 500.000 dollars per o~eurrenee ~'~ I million dollmm annual ag$regat~ or AND or [~ I million dollars per occurrence ~ 2 million dollars annual aggregate ~ B. J.T. CSITIp~n¥ hereby certifies that it ~s in compliance with the requirements of Section 2807, Article 3, Chapter 18, D/vision $, T'[tle 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: Sta~e FL,~d S~t~ of California $ 990,C00.0 Cont Yes Yes Seif Insurance J.T. Ce~6~ny P.O. B~x 1807 ! Bakersfield, CA 93303-1807 $ 10,000.0~ · Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this cergfication also certifies that you are in compliance with afl conditions for participation in the Fund. ;~ D. Fatally'Name :B & B Country Primo's Liqour Fac~iit~ N~me ~. Fo.~ 13531 Sierra Way, Kemville 3801 FpJitvalle Ave., Bakersfield State of Cali£omia ~ ........... State Water Resources Control Board CERTIFICATION OF FI'NANCIAL RESPON '~. ! am required to dem~E TANKS CONTAINING PETROLEUM ~, ua=ouIty la ~e requ~ed amouau as s~ed in ~cdoa ~07, Cbap~r II Db. 3, ~fle ~, ~ 500,~0 doila~ ~r ~U~n~ ' ' ~ 1 m~on do~ a~ a~Sate or ~D ~ I million doila~ ~r ~u~en~ ~ 2 mi~on doH~s aan~ a~gate ~' ~ ~' ~ g~C~'/ hereby ce~s that ~ ~ /n ~omp/a~e w~h the r~uire~ of ~f~n 2~0~ A~/c/e & Chapter 18, D/v/s/on 3, ~le 23, Ca/~orn/a C~e of Regulat/ons. C. Mes=~m. .: ~~[Ye~ by ~tio, 2~7are as ~11o~: - ~ ~,b~d.t C~t I Yes Yes 93303-1807 J.T. C,a'Ee. any P.O. Box 1807 Bakersfield, CA ~t ~nsurance $ 10,000.00~ /Vote' If you are using the State Fun _ .-~ . . · d as any part of your demonstration of financial responsibility, your execution ~ of this certification also certi~es that oy_E_g_~_re in compliance with all conditions f, .... ~ or~tion tn the Fund. and submission Fa~iimName F.~iirv Name t:ac~iity Name Jaco Oil Company 3101 State Road Bakersfield, California 93308 'Telephone: (805) 393-7000 Facsimile: (805) 393-8738 Post Office Box 1807' Bakersfield, California 93303-1807: 'June 27, 199o ' .:7;' ?_8 PR i9S0 x~ . " ............ ' ......... Kern ~ounty ..... ' ~.. ......... . . Envi~o~ental. H~i th_De~r ~en t ' 2700 '~" Street, Suite 300 Bakersfield, ~. 93301 Ms. Amy Green: Please be advised that the attached forms are those forms that we have requested that all' of our operators in Kern County utilize in completing underground tank monitoring. Please advise us if you have any' problem with these forms. La[.~cence Henson Gasoline Operations Division of Environmental Heat Application 1-700~Flower Street, Bakersfieid, CA 93305 APPLICATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type .o.f Application (check'): [-]New Facility ~]Modification of Facility [~Existing Facility ~]Transfer of Ownership A. ~mergency 24-Hour Contact (name, .area ~code, phone): Days ~-~. <~,~ ........... TyPe 'of BUSineSs (cEe~k~: ~Gasoline Station ~0ther (describe) ............. Is Tank(s) ~ocated on an Ax]ricultural Farm? []Yes ~No Is Tank(s) Used Primarily.for k3ricultural ~urposes? ~Yes ~NO Facility Address ~_~g ~, ~~11 Nearest Cross St. T R ' SEC (Rural Locations Only) ~ddress P,~)~ l'ff~7 ~c(~~'~.I~ Zip ~-~3~ Telel~one Address ~ ~' ~ ~ ~ ~ !-, '~I~ Zip ~,. ~ - e B. Water 'to Facility Provided by (-~ I U/~ ~-- Depth to' Groundwater Soil Characteristics' at Facility ' Basis for Soil Type and Groundwater Dep~ Determ nat 0ns C. Contractor .~ e l~'- CA Contractor's License No. Address ' Zip Telsphor~ "' Proposed Starting Date Proposed C~pI~tion ~ste Worker's Compensation .Certification ! - Insurer D. If This Permit Is For Modificaltion Of An Existing Facility, Briefly I~scribe Modifications ?ank(s) Store (check all that apply): .T.,ank _~ Was____te_te Produc_t Motor Vehicle Unleaded Regular Premium D. iesel Waste Chenical C~mposi~:ion of Materials Stored (not necessary for motor vehicle fuels) ?ank #i Chemical Stored (non-cnm-ercial name) CAS ! (if kno~) Chemical Previously Stored ,,, (if different) Go TransferofOwnership I~ate of-~-~n~fer - Previous Facility. Name I, ~odi fy or terminate faci 1 i rece iv ] Previous Owner accept fully all obligations of Permit No. issu~ to · I understand that the Pemitting Authority~ay review a~d the transfer of the Permit to operate this ~derground storage this c~mpleted form. Tnis form has been completed under penalty of perjury and to the best of my knowledge is true and correct. TANK ~ ~ (FILL OUT SEPARATE FORM .ACH TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: FI-vaulted [] Non-~aul ted [~Double-Wall ,~_.qingle-Wall 2. ~ Material Carbon Steel [] Stainless Steel [] PolYVinyl Chloride [] Fiberglass-Clad Steel Fibe'rglass-Reinforced Plastic [] Concrete [] Altm~inum [] Bronze [-]Unknown [] Other· (describe) 3. Primary Containment · Date.I~stalled Thickness (Inches) Capacity (Gallons) Manufactur?r 4. TanE Seco6dary Containment [~Dohble-Wall ~]Synthetic Liner []Lined Vault ~None [']Unknoua~ Manufacturer: Capacity (Gals.) [-]Other (describe): []Material 5. -Tank Znterior Linin~ ---~[Rubber [[]Alkyd []Epoxy [~Other (describe): Thickness (Inches) []Phenolic []Glass ~Clay ~J~t~lined [][~'no~ '--Tank 'Corrosion--Protection ,-'~Galvanized ~ass-Clad [~Polyethylene Wrap []Vinyl Wrapping '~Tar or Asphalt []Unknown []-]None []Other (describe): ' Describe System &9.quipment: Leak Detection, Monitoring, and Interception a. Tank: OVisual (vaulted tanks only) []Groundwater Monitorirg' Well(s) O Vadose Zone Monitoring Well(s) []U-Tube Without Liner 8. s zS en Tightness ~ested? I'qYes ~No Date of Last Tightness Test Results of Test Test Name Testing Company 9. Tank Re~air Tank Repaired? []Yes ~No [[]Unknown Date(s) of Repair(s) Describe Repairs ~[~U-Tube with Compatible Liner Directing Flow to Monitorirg We.il(s)* Vapor Detector* [] Liquid Level Sensor* [] ConductiVit~ Sensor' [] Pressure Sensor in Annular Space of Double Wall Tank []Liquid Retrieval & Inspection From U-Tube, Monitoring Well or Annular Space ~Daily Gaugzng & Inventory Reconciliation SPeriodic Tightness Testing None[]Unknown [] Other '-' b. Piping: Flow-Restricting Leak Detector(s) for Pressurized Piping' [-]Monitoring Stoup with Race~y []Sealed Concrete Race~y []Half-Cut Compatible Pipe Raceway []Synthetic Liner Ra~e~ay." []None [] Unknown [] Other 10. Overfill Protection []Operator Fills,' Controls, & Visually MonitorS Level [-]Tape Float Gau~e [~Float Vent Valves []Auto Shut- Off Controls []Capacitance Sensor []Sealed Fill Box ~None []Unknown [-]Other: -ListMake & Model For Above Devices 11. Piping a. Underground Piping: [~Yes I-~No I"]Unknown Material Thickness (inches) ~___ Diameter ~&~ ~0 Manufacturer UK/ ~Pressure '. []Suc~Gravity 'Approximate Length of Pipe ~;~-~ ~Underground.. Pipi ng.~ Co~.rosion~-Protect fon,~ r Galvanized []Fiberglass-Clad [-]Impressed' Current [-]Sacrificial Anode Polyethylene Wrap , []Electrical Isolation ~Vinyl Wrap' []Tar or Asphalt []Unknown [']None ~Other (describe): c. Underground Piping, Secondary Contair~uent: []Double-Wall []Synthetic Liner System ~None ._W]unknown []Other (describe): Facil i ty Name · . , ~ ~ __ ION, CHEC -~ ~ TANK) .- -- _ K ALL APPROPRIATE -- - ~ BOXES H. 1. Tank is: [-]Vaulted ~]Non-Vaul ted []Double-Wall ~Single-Wal 1 2.. ~ Material i --~~_ee~l qStainlessSteel [-~Pol~2,' ': _ ~ -~-~eintorced Plas ' ~ ,.lnyl Chlozzde · · i . [] Other (describe) tzc [] Concrete [] Alumin,~ S~FIberglass-Clad Steel ~ J- Primar Co · ~ L~ ~ronze Unk 4. ~ Co~ ,'~. I D";'~7-O:-'.: .... ..... Manufacturer . []Double-Wall~.. _ _ / -- _ · ~ oy~netzc Liner · ' _ .[:]Other (describe~. · Droned Vault F~No-- m.~- · L.~erlal Thl ' Manufacture . 5. Tank Interior--Linin~ _ ckness (Inches) - r: _ ~F~J,~-- -~~ ~ Capacfty (Gals.) . []Other (descrl~_~,.t2~'l~°xY' []Phenolic ~Glass "~ ..... --'------ ~i Tahk-CorrSsiO_._.~_~.;.~..;~_~ u~zay ~L~lined [~kn,~ D Li.,.~'~_~ep~r in ~ular S~ -- -- u~°n~xtivity ~ ~.u ~crl~al & I ...... ~k= u~ ~uble, Wall Tan~" ~ily Ga z Mo '-'- ~ ~er ~rz~zc Tlgn~e~ T~ti~~ ~ ~nltotl ~tectot (s) ~ .... ~uc ~ rib ' ~~ ~crete r-.~ .~ ..... "" ~er - ~x,,u~clc 'Liner ~,. ~.. Test ~e -- _ Results of Test 9. Tank ~~ ~sti~ C~ny ~ _ Yes 0. ~erffll Protecti~ ' -- ---- O~ Controls, ~Ta~ Fl~t ~e ~Fl~t & Vi~lly Monitors ~vel Vent Valves ~Auto Shut- Off Controls ~citance ~r ~al~ Fill. ~x ~ne ~o~ ~Other: . ~~ ~ List ~ & ~el F~ ~. ~ices a. ~dergro~d' Pipit: ~Yes ~ .~o~ ~ter{al · - Thic ne (l hes) -Dieter $ anufa urer / b. ~-Un~~essure ~S~t~on rgr0' ravic ' proxi ....... ~ .... ~'g ~orroslon pr~&-~2~ ........ ,,~p_~ ~Polue,h,,,~- ~Fl~r~ass~l~ ~es~~ '~ , __ ~, ...... ~Electrtcal I~l ......... ~ cr~ficial'~e c. ~un~o~ ~None ~her (de~ri~) *u~ ~v~nyl Wrap ~Tar or ~lt Un~rgro~ ~ipi~, 'Seco~ar,, Cont ' ~l~Wall ~S .... ~ a~n~: ' ~ ~etlc Liner ~stem. ~ne ~Other (descri~): . - ~kno~ · ~(FILL OUT SEPARATE FORM FORgCH TANK) ,. FOR 'EACH SECTION, CHECK ALL APPROPRIATE BOXES [. 1. Tank is: ~] Vaul ted [-]Non-Vaulted E]Doubl~-Wal 1 .~q lng le-Wal 1 2. ~ Mater ial Carbon Steel '[~ Stainless Steel [~Polyvinyl Chloride []Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [] Concrete [~Aluminum [] Bronze []Unknown [] Other (describe) 3. Primary Containment · Date_ IDs~-----~--~------~ickness (Inches) Capacity (Gallons) . Manufacturer 4. Tan[ Se~oddarZ Co~tai'hm~nt /' []Double-Wall []Synthetic Liner []Lined Vault' ~None []Unknown ~Other (describe): Manufacturer: r~Material Thi~'kness (Inches) Capacity (Gals.) 5.. Tank Interior Lining · ---~R~ber [2]Alkyd []Epoxy []Phenolic []Glass []Clay F~Unlined []t~known ~Other (describe): , ,,- ,,, ......... 6:;' ...... Tank' Corros£~n Protection ~Galvanized -~f~-~ass-Clad []Bolyeth¥1ene Wrap l-]Vin¥1 Wrapping ~Tar or Asphalt []Unknown []None []Other (describe): " Cathodic Protection: ~None ~Impressed Current System r~sacrificial )~ode Syst~ Equ i[:ment: e 'Describe System & Leak Detection, Monitoring, and Interception a. Tank:, []Visual (vaulted tanks only) ~]Groundwater Monitorin~' Well(s) []Vadose Zone Monitoring Well(s) [']U-Tube Without Liner []~U-Tube with Compatible Liner Directing Flow to Moni.toring We.il(s)* Vapor Detector* [] Liquid. Level Sensor* [] Conductivit~ Sensor" [] Pressure Sensor in Annular Space of Double Wall Tank Tank Tightness ~is Tan~ Been Tightness Tested? Date of Last Tightness Test Test Name [] Liquid R~trie~al & Inspection From U-Tube, Monitoring Well or Annular Space Daily"lugirg & Inventory Reconciliation [] Periodic Tightness Testing G, None [] Unkno~m !-! Other Piping: Flow-Restricting Leak Detector(s) for Pressurized Piping' [] Monitoring S~p with Race~y [] Sealed Concrete Race~¥ ~Half-Cut Compatible Pipe .Raceway E] synthetic Liner Raceway []None ~ Unknown [] Other *Describe Make & Model: ~r~?_~. []Yes ~NO []Unknown Results o~ Test Testing Company 9. Tank ~ .. ~ Repaired?' []Yes Date(s) of Repair(s) Describe Repairs Overfill Protection []Operator Fills, Controls, & Visually Monitors [~vel [-]Tape Float Gauge []Float Vent Valves [] Auto Shut- Off Controls []Capacitance Sensor []Sealed Fill Box ~J~None []Unknown E]Other: List Make & Model For Above De~,ices ' 11. Pipihg a. Underground Piping: ~Yes []No []Unknown Material 5~e / ~ ThiCkness (inches) ~L Diameter ~ ~0 Manufacturer ~Pressure [-]suc~Gra¥ity ~. "Approximate Length. o'f ................ b; .... Underground'Piping cor~6Sion P~O~te~t'ibn'"~ Galvanized '[]Fiberglass-Clad []Impressed Current []Sacrificial Anode Polyethylene Wrap []Electrical Isolation ' ~Vinyl Wrap []Tar or Asphalt []Unknown []~one []Other(describe): c. Underground Piping, Secondary Containment: []Double-Wall []Syr},,thetie Liner System ~None ~b~kno~n []Other (describe): Facility Name TANK ~. t~. (FILL OUT .~EPARATE FORM FOR EACH TANK) FOR EACH SECTION, CHECK ALL APPROPRIATE BOXES H. 1. Tank is: []Vaulted []Non-Vaulted []-]D°uble-Wall ~ingle-Wall 2. ~ Material Carbon Steel [] Stainless Steel [] Polyvinyl Chloride [] Fiberglass-Clad Steel Fiberglass-Reinforced Plastic [] Concrete []-Alugnintm~ [] Bronze [~Unknown [] Other (describe) 3. Primary Containment __' ...... = Dat~-.~sta 1 led = ....... Thickness:=(.In'ches) . .... .Capacity .(_Gal 1 cms) ......... Manufacturer ..... 4. Tan~ SeCondary Cont'ainm~nt · ~ ' []Double-Wall [~Synthetic Liner []Lined Vault ~None [-~Unknown [] Other (describe): Manufacturer: []Material Thickness (Inches) Capacity (Gals.) 5. Tank Interior Lining ----[~Rubber []Alkyd []']Epoxy []Phenolic [3Glass []Clay ~L~lined []Unknown ..................... D Other (-describe).: ........................................ i ....... '. ............. ...................... .~. ............................ 6. Tank Corrosion Protectfon --~Galvanfzed-l~T6~-~fass-Clad ~Pol~thylene Wrap []Vinyl Wrapping '~Tar or Asphalt [2]Unknown ~None []Other (describe)-- ' Cathodic Protection: ~.ne [~Impressed Current SYStem ['l~a¢'r'ifi¢'ial Anode System e ~--~rib~ System & lmuent: Leak Detection, Monitoring, and Intercep. tion a. Tank: Dvisual (vaulted tanks only) [-IGroundw~ter Monitoring' Well(s) DVadose Zone Monitoring Well(s) []U-Tube Without Liner l-~U-Tube with Compatible Liner Directim~ Flow to Monitoring Well(s)* " [] Vapor Detector* [] Liquid Level Sensor' [] Conductivit~ Sensor* [] Pressure Sensor in AnnUlar Space of Double Wall Tank- [] Liquid R~trieval & Inspection From U-Tube, Monitoring Well or Amnular Space Dail¥ G_au~ing & Inventory Reconciliation J~]l~riodie Tightness Testing None[~ Unknown [] Other b..Piping: Flow-Restricting Leak Detector(s) for Pressurized Pipits' ['~Monitoring Sump with Racewsy []Sealed Concrete Race~y []Half-Cut Compatible Pipe Raceway [] Synthetic Liner Race~ay []None [] Unknown [~ Other .. 8. Tank Ti~h~ess -. -~ -w ~is ~ ~en Tigh~ess ~st~? ~Yes ~ ~te of ~st Tightne~ Test R~sults of Test Test ~e ~sti~ C~ny 9. Tank ~ '~ ~~? ~Yes ~ ~kno~ . ~te(s) of ~ir(s) ~ri~ Re, irs 10~ ~erfill Protection ~rator Fills, Controls, & Vis~lly Monitors ~vel DTa~ Fl~t ~e ~Fl~t Vent Valves ~ Auto Shut- Off Controls D~citance ~r ~al~ Fill ~x ~ne ~o~ ~O~er: List Make & Model For Above Devices '11. Pipir~j a. Underground Piping: ~Yes []No C]Unknown Material 5 ~e / 'Thickness (inches) _~--__Diameter ~.gq0Manufacturer ~.~ ...... : .... ~ ........ ~Pressure .... [r]Suct~on~n~--Gra~ity .... ~.'APp'r°ximate Length-of Pipe. R~ · Underground Pipirg Corrosion protection : Galvanized []Fiberglass-Clad []Impressed Current .[]Sacrificial Anode Polyethylene Wrap [-]Electrical Isolation ~Vinyl Wrap [qTar or Asphalt [3Unknown [3None []Other (describe): c. Underground Piping, .Secondary Contair~nent: [3Double-Wall []Synthetic Liner System ~N°ne [~_bbknown [3Other (describe): 17OO Flower Street Bakerslleld, California 93305 · Telephone (805) 861-3636 UNDERGROUND HAZARDOUS SUBSTANCES '.,~ERN COUNTY HEALTH DEPARTM ,. ,EALm OFFICER Leon M Hebertson, M.D. ENVIRONMENTAL HEALTH DIVISION ~ · ~ - DIRECTOR OF ENVIRONMENTAL HEALTH "?~'~*>i~i~' * ~ ' Vernon S. Reichard · ..'-' .... :': FACILITY: ' I OWNER: - .- ': FASTRIP FOOD STORE #26 I JACO HILL COMPANY .#347. ~ ~ 269~ OSWELL STREET ~ · P.O. BOX 1807 ' .~'.:'"..,~'~.:~-,~,~,..': .B~RSFIELD, CA ~' . .' .' ~ .-.. :,...:BAKERSFIELD, CA ..:.~9330.~ NO N-- T RANS F E }{AB [- E NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT * * * 'POST 'ON :?;PRE'MImES AUG % 5 1986 DATE PERMIT MAIT.'t~F): DATE PERMIT CHECK LIST RETURNED: GITY BAKERSFIELD "I~'£ !~y~e or ~rinn/name) Do hereby e=-t~ ~-- ' ~ _~ that I have reviewem the RECEIVED HAZ. MAT. DIV. attached Hazardous Materials business olan for ' (name of busxness) and that it along with the attached or corrections ,constitute a complete additions and correct Business sx.~na Plan for my facility. date ~SiNESS NAME FASTRIP FOOD STORE' LOCATION 2698 OSWELL ST #626 ID NUMBER 215-000-000622 1 , OVERVIEW LAS /CHANGE 11/16/87 BY ESTER JURIS CODE 215-008 JURIS BAKERSFIELD STATION 08 MAP PAGE 103 GRID 22B FACILITY UNITS 1 HAZARD .RATING 2 RESPONSE. SUMMARY 2A SEC 4) NO PRIVATE RESPONSE TEAM EMERGENCY CONTACTS 2A SEC 2 ) HAL MAT, JEANNIE HARKINS - 872-3029 OR 397-9654 DAVE WHITE - 393-7000 .OR -871-2738 UTILITY SHUTOFFS 2A SEC 3) ~ ~ A) GAS - NW EXTERIOR CORNER OF BLDG FACING AUBURN B) ELECTRICAL - NW REAR INTERIOR STOCKROOM 'ENTRANCE ON SW SIDE C) WATER - NE FRONT EXTERIOR CORNER OF BLDG · D) SPECIAL - NONE E) LOCK BOX - NO NOTIFICATION / PUBL I C EVACUAT I ON LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION AGE 1 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 12/27/88 16:49 BLrSINESS NAME FASTRIP FOOD STORE #626 LOCATION 2698 OSWELL ST 3 . HAZ MAT TRAINING ID NUMBER 215-000-000622 HIGH HAZARD RATING 2 SUMMARY LAST CHANGE / / BY 4 . LOCAL EMERGENCY MEDICAL ASSISTANCE LAST CHANGE 11/16/87 BY ESTER 2A SEC 5) 911 EMERGENCY MEDICAL - MEDI CENTER 820 34TH ST 325-6334 OR - MEMORIAL HOSPITAL 420 34TH ST 327-1792 PAGE 2 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 12/27/88 16:49 BUSINESs NAME FASTRiP FOOD STORE #626 LOCATION 2698 OSWELL ST FACILITY UNIT 01 ID NUMBER 215-000-000622 HIGH HAZARD RATING 2 OVERALL ID TYPE NAME LOCATION HAZARDOUS MATERIALS I.NVENTORY LAST CHANGE 10/09/87 BY ESTER MIXTURE GASOLINE NORTH SIDE OF BLDG ID PERCENT COMPONENTS 1182.00 100.0 GASOLINE CONTAINMENT UNDERGROUND TANKS MAX AMT UNIT HAZARD USE 48000 GAL FUEL HIGH HAZARD LISTS HIGH PROTE C T I ON / WATER SUPPLIES LAST CHANGE 10/09/87 BY ESTER 2A SEC 4) FIRE EXTINGUISHERS I - NORTH SIDE INTERIOR DOORS TO GAS ISLAND 1 - SOUTHEAST INTERIOR STOCKROOM AREA 2A SEC 5) NORTHWEST CORNER OF PROPERTY LINE FACING AUBURN PAGE 3 12/27/88 16:49 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 BU;SINESS NAME FASTRIP FOOD STORE #626 ID NUMBER 215-000-000622 LOCATION 2698 OSWELL ST HIGH HAZARD RATING 2 · D . EMPLOYEE NOTIFICATION / EVACUATION LAST CHANGE / / BY < NO INFORMATION RECORDED FOR THIS SECTION > E o MITIGATION / PREVENTION / ABATEMENT LAST CHANGE 10/09/87 BY ESTER ALL EMPLOYEES SHOULD BE AWARE OF LOCATION OF EMERGENCY SHUT DOWN CONTROLS FOR GASOLINE EQUIPMENT. PROCEDURES TO FOLLOW IN THE EVENT OF AN EMERGENCY ON THE GAS ISLAND ARE.AS FOLLOWS: A) IF A CUSTOMER OVERFILLS A VEHICLE TANK RESULTING IN A SMALL SPILL - HOSE DOWN THIS AREA WITH WATER. - B) IF A CUSTOMER DRIVES OFF WITH GAS NOZZLE IN CAR FILL TANK, RESULTING IN A SUBSTANTIAL FLOW OF GASOLINE - SHUT DOWN ENTIRE SYSTEM, CALL FIRE DEPT., CALL DISTRICT MGR, CLEAR THE GAS ISLAND. C) IF VEHICLE DAMAGE TO ONE PUMP RESULTS IN A LEAK - SHUT DOWN POWER TO THIS PUMP ONLY. HOSE DOWN AREA AND. CALL YOUR DISTRICT MGR. D) IF AN ADJACENT BUSINESS/BLDG. IS ON FIRE, SHUT DOWN THE ENTIRE GAS ISLAND- EMERGENCY CONTROL SHUT-OFF; FIRE DEPT WILL ADVISE WHEN TO RESUME NORMAL GASOLINE OPERATIONS. E) EACH STORE WILL HAVE A LISTING OF EMERGENCY CONTACT PHONE NUMBERS POSTED NEAR THE SALES COUNTER AREA. PAGE 4 12/27/88 16:49 MATERIAL SAFETY DATA SYSTEMS, INC. (805) 648-6800 CITY of'BAKERSFIELD LOCATION: 2-~? (3~,,~,,;e~(( ADDRESS: ~(C)l. '.~:~L~-~ ~L, STANDARD IND. CLASS CODE C~e C~e Mt Mt Est Units m Site ~lth of P~ ~lth (C~A eli t~t apply) - ~lth of P~ ~lth ~t 13 (C~k all t~t apply) H~lth of P~u~ N~lth (C~k all t~t mly) a Y~ee Hazard ~_a ~tiv~ty -- ~la~ [ ~ ~dd~ b~me ~--~ i~tete H~lth of Presume fl~lth Fare and Aqriculture ~ Standard ~.~,ne. HAZARDOUS 'HAT:E RI. ALS 1' NV1;-N?ORY . ¥., " N 0 N -- ']? R A D E S g C R E T S , Page _~__ of .~... ':5',,, Carttficatio~ (Read and sign after completJng all sections) I cartel'fy unde, I~nalty of 1aw that ! have' ~ersonallye,ammed end aa f~milier ,tth the Information submit.ted in tht~ and 'all ett~hed datums, a~l that based on my of tho~e USTMAN SIR SYSTEM Monthly Monitoring Report SEPTEMBER, 1993 Report Date: 10/07/93 Company name :JACO OIL Station Name: OSWELL FASTRIP Address: 2698 OSWELL City: Station # : 347 State: CA PART A: Data Tank ID: System Status: Product: Quality: Dels: Sales: 00 TIGHT 00-FS PRE FAIR 3956 10449 02 TIGHT 02-UNL #1 POOR 36916 67593 ~ 04 .... T-TGHT-'- ............. O4~-FS D#2 .......... FAIR" =~--~--2~076~ ' 29-6-4-1 05 TIGHT 05-FS MID FAIR 18582 22768 USTMAN INDUSTRIES INC. is a certified Statistical Inventory Reconciliation (SIR) release detection vendor. Tank status results for monthly monitoring are based on parameters specified by the EPA protocol for SIR methods. PART B: Comments and Recommendations O/S listed below represent removals, additions or delivery discrepancies which were accounted for as part of the SIR analysis. 00 {9/6/1993: 1952} {9/12/1993: 1902} { 9/26/1993: 1891} {9/21/1993:DEL 186} 02 The o/s for this system were quite large for the month, and this is a continuation of an ongoing trend. However, we have reviewed 60 - 90 days of data to determine this system's status. For information on improving inventory data collection, consult uSTMAN,s "Action Plan for Inventory Discrepancies - Inconclusive." 9/1/1993:DEL-406} {9/6/1993:15279I I9/7/1993: 3935} 9/12/1993: 6582} {9/15/1993: 644o 9/19/1993: 6455} 9/21/1993:DEL 357} {9/26/1993:DEL 3532} {9/27/1993: 497 } 9/29/1993: 383} {9/30/1993:DEL -247 } 04 I9/1/1993: 172} {9/8/1993: 9/30/1993:DEL 259} -176} {9/14/1993: -169} 05 I9/15/1993: -191} {9/19/1993: 9/28/1993:DEL 265} 3070} {9/26/1993: 2833} For regulatory compliance in California, a piping integrity'test every 12 months and a tank integrity test every 24 months are .. FIL£ CONTENTS INV Fac t I i t~ ~Con~cruccion Permlc I DaCe ~PermlC ~o abandonl No. '~f Tank~ DaCe ~ended Permit Cond~ ~Permlc ~pplica~ion Form, ~ Tank shee~s, A ppl-tc a tion..:~-.to:=Aband o~::~-- - =-::: == .... tan ks:(:~ ~Annual Report Forms ' I COpy.~°f Written Contract Between Owner nspection Reports ,, & Operator. ................. ~Cor res~onde~c;e ....... Received ................................................ : , : ' -: Date' Da te ."::" : : I-ICorrespondencs - Nailed Date Date Date I'lUnauthorl~ed Release Reports r'! Abandonment/Closur e Reports .... [:] Sampling/Lab Reports .... I-INVF Compliance Check (New 'Constru~ction' r'lS?D Compliance Check (New Construction I'INVF Plan Check (Hew Construction) i-IS?D Plan Check (New Construction) I'~HVF plan Check ([xisting Facility) I~STD Plan Check (.Existing Facility) · l-I "Incomplete Application" Form ~ [-IPermit Application Checklist I-]Permit Instructions i-]Discarded [~Tightneas Test Results~ Checklist) Checklist) Da te Date Date ~]Honitorin~ Well'Construc'(ion Data/Pe'rmits. ' [-IEnvironmental Sensitivity Data: [] Groundwater Drilling, Boring. Logs Location o~ Water ~ells ~Statement oE Undecground Condu~s ~Plot Plan ~eacucin9 All Envitonmentally Sensitive Da~a ~PhoCos ~C0nsCruc~ion Dra~lnGs Location: ~*/~ ~Hal~ sheet sho~n~ dpte~ rec,e,iv~d and Call~ ,of in, spec~on t~m~ PERMIT CHECKLIST This checklist is provided to .ensure that all necessary packet enclosures were received and that the Permittee has obtained all necessary equipment to implement the first phase of monitoring requirements. Please complete this form and return to KCHD in the self-addressed envelope prdvided .-:--=within-~30:.days-of_ receipt . Check: Yes No A.' The packet I received contained:. 1) Cover .Letter, Permit Checklist, Interim Permit, Phase I Interim Permit ................................ ~ ............ Monitoring.~Requirements ..... Information.. Sheet .(Agreement ..... Between Operator), Chapter 15 (KC0C #G-3941), Explanation of Substance Codes, V// Equipment Lists and Return Envelope. 2) Standard Inventory Control Monitoring Handbook #UT-10. 3) The Following Forms: a) Inventory Recording Sheet b) Inventory Reconciliation Sheet with summary on reverse c) Trend Analysis Worksheet 4) An Action Chart (to p'osi at facility) B. I have examined the information on my Interim Permit, Phase I Monitoring Requirements, and Information Sheet (Agreemgnt between Owner and Operator), and find owner's name and address, facility name and address, operator's nam~ and addresS, substance codes, and number of tanks to be accurately listed (if "no" is checked,' note appropriate corrections on the back side of this sheet). C. I have the following required equipment (as described on page 6 of Handbook): 1) Acceptable gauging instrument 2) "Striker plate(s)" in tank(s) 3) Water-finding paste D. I have read the information on the enclosed "Information Sheet" pertaining to Agreements between Owner and Operator' and hereby state that the owner of this facility is the operator (if "no" is checked, attach a copy of agreement between owner and operator). E. I have enclosed a copy of Calibration Charts for all tanks at this facility (if tanks are identical, one chart will suffice; label chart(s) with corresponding tank numbers listed on permit). F. As required on page 6 of Handbook #UT-10, all meters at this facility have had · calibration checks within the last 30 days and were calibrated by a registered device repairman ~f out of tolerance (ali meter calibrations must be recorded on "Meter Calibration Check Form" found in the Appendix of Handbook). with procedures described in Handbook #UT-10._ ......... : ...................... Date Started ...... [-CT_cm~'~r~-', ..... Signature o£ Person Co.plet~ng Checklist: Title: Date: L~ ~/ ['[ ( G. Standard Inventory Control Monitoring was started at this facility in accordance -OPERATIONAL AGREEMENT FOR UNDERGROUND TANKS !, Jaco H£11, a Gen. Ptnshp. , owner of underground storage tahks .:.~?~:$o~a:a:me~d--a-t--2698_.O. swell St., Bakersfield,..Ca.have-~ntered-~in_~.0:t_h~.~ written contract with Jaco Jamieson, a Gen. Ptnshp. ., the operator of same, to fulfull a requirement of my Permit to Operate, I have provided the operator with a copy of the Permit to Operate .and Chapter 15 of the ~0rdinance. I, Jaco Jamieson , operator of underground storage tanks located at 2698 iOswell St., Bakersfield, Ce.have received from 'Jaco Hill , owner of same, a copy of Permit to nd Chapter 15 of. the Ordinance describing fines and penalties for non-compliance. I have read and'understand my responsibilities under this Permit and agree to do the following: -- monitor the underground tanks as specified in the Permit to Operate. --maintain appropriate records as required by the Permit t° Operate. -- implement all reporting procedures as required by'the~ Permit to Operate. JACO H.ILL Signed BY: Date JACO JAMIESON :.,fperator ~-~ · ' Jaco Oil Company 3101, State Road Bakersfield, California 93308 'Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303-18 ( May 26, 19,87 Kern_..County Health Department 1700 Flower St. Bakersfield, Ca. ATTN: Ann Boyce Dear Ann: Enclosed please find a copy of our revised forms. These forms and procedures will be implemented system wide as of June 1, 1987. · We will be holding meetings in our office on May 28, 1987 at 9:00 a.m. and 11:00 a.m. should you wish to send anyone from your office. Sinc. erely, _ ' Roy F. Saunders RFS:js encl REPORTING PROCEDURES FOR INVENTORY'SHORTS/OVERS ..... "-~' .......... ~-~-h~-~ i'~:~=::~;~-'~'-~--~'S~" ~-e-P~)~'tjb'~e ~nde'r' the ~.:'9-uidel~ine's.-must to the Health Department and Jaco's office. The guidelines for reporting are as follows: 1) A~y shortage or overage on any tank over 200 gallons on ' .a daily basis must be ~reported to the Health Deparmtent and our office. ~. 2) Any shortage or overage over 350 gallons or above .5% by the weekly calculation must be reported to the Health DePartment and our office. 3) On a monthly basis, any shortage or overage over 1½% of monthly throughput must be reported to the Health Department and our office. 4) 'On a monthly basis, if your totJl nUmber of shortages exceeds the action number chart it needs to be reported to the Health Department at once. The HealthDepartment reporting number is: 805-861-3636, 24 hours a day Jaco Oil's office number is: 805-393-7000 The Health Department will nee~ your location and permi~ number for reporting purposes. Jaco Oil Company DAILY REPORT INSTRUCTIONS A) Fi-il in the month, day and year at the top as well as the B)' In Area #1, write down the pump number, total gallons and' total ~ money reading from the console, or the dispenser as the case :nay be. C) Line #2, is the total of all pump readings.. D) Line #1? is the start figure, or totals carried forward from the ~previous. day. : F) Line #9 is for deducting pump tests that Were returned to the " underground tanks. G) Line #15 is the net total sales aft.er adjustments. H) Line #10 is the total sales in gallons for the day. This should be taken from Line #15.' I) Line #11 is the total sales in money, by grade, less pump tests and credit cards, if any, to determine your deposit. J) .Line #4 is the beginning inventory bY the prior days gauging , (Line #5 of prior days report). K) Line #12, receipts are gross gallons received for inventory. These gailons are not to---~temperature.corrected. .L) Line #14, these numbers are in section l0 which cmne from Line 15 of the report. (Total gallons sold by grade of product). M) i Line #5 .is the sum of Line 4 plus Line 12 minus Line 14'to determine Book inventorY. o) r) Q) Line #3 is the inches you gauged the tank at the close of the report. Line #15 is the gallons those inches represent from~the tank chart. Line #16 is the difference between Line 5 and Line l~. Line #15 is your beginning number for Line 4 for the nex~ day. Line #2 becomes Line'17 for the next day. 'Special Notes: 1) Daily tank gauging must take place at the same time that the final shift is cut off for the day. It is imperative that this be done to have accurate paperwork. 2) It is recommended that the gauging be performed by the same people as much as po'ssible. 3101 State Road Bakersfield, California 93308 Telephone: (805) 393-7000 post Office Box 1807 Bakersfield, California 93303 11101 I~o!O 'uJeJd lin Peel ON '~U 'w Jcl ~ :glqYN NOIIY/,~; I I ! I I I I I i ! I I I I ! I I I ! I i i I I I ~UOll~9 JO+ SUOlle5 I I I ! I I I I JNnow~ :lDItld JIN/~ t OlO~ =ldO 1YJOI, H:~dl't~ kO 'lVlOl IASC!0 tun!rue Jcl PaPealulq l peal ON )elfl§aU uJnfuJa~d papeal SNOllV~ lVl01 SglVS 1¥101 SlSel lVJ. O.L llel~ qs!u!:l lelOl Il: I D'd 'ANVdI~IOO '110 ODVf ~ lACe OIL COMPANY . BOX 1807, BAKERSFIELD, CALIFORNIA 93303, (805) 393-7000 Mol:ih ~ ' r ' f', - Gallons Money Money Gallons Money : - ---~- UNLEADED PREMIUM-,M~ Gallons Money I I I I I I I I I I I I I I Gallons Money I I I . I I I ! I ~ I I I I I I I I I I I I I I I I I I I t~ I ~ I I ~ I r I I 1 i I I Total Finish Total Start TOTAL Pump Tests TOTAL SALES I TOTAL GALLONS Leaded Premium Regular No Lead Unleaded ~,~emium TOTAL I I i I I I ~ , ~.. ~ ~.- I : l l Add Rcpts. + or -- ITATION NAME: . / I CITY: ~ , I I I I l l l I I CASH SAI L. Prem. Reg. No Lead NIL Prem. / Diesel Total Less Ct. Cards Less Pump Test DEPOSIT ....... Local]on Month PRODUCT: DAYS GALLONS SOLD OVER SHORT 1 2 3 4 5 7 TOTALS 8 9 10 11 12 13 14 TOTALS 15 16 17 18 19 20 21 TOTALS 22 23 24 25 26 27 28 I!OTALS 30 31 [TOTALS MONTHLY GRAND .TOTALS (TOTAL Gain. ovec/sho~ t TOTAL Gals. sold X 100% Variation B. Doe..' amt. over/short exceed 350 9als? ~ ~o - Continue -- Yes - ~t within 24 hfs o~i~ove~y ~s t~ va~iati~ exc~d A. Cal~ over/short ~ T6TA~ Gals. sold X 10~t Variation ' ~s ~t. over/s~rt e~eed Yes - ~rt within 24 -- Yes - ~rt to ~mitti~ ~t~ity within 24 ~s oi dimU A. 0als over/sho~t TOTAL Gals. mold X 100t Va~ia:ion ~s ~t. ~r/s~rt e~ 350 gals? ~ Yes - ~rt wi~in 24 h~s of di~overy ~s t~ variati~ e~ceed ~ithin 24 hfs c: di~ery A. Gals over/short TOTAL Gals. sold __ X 100% Variation Does amt. over/short exceed 350 gals? ........ --. flu - Continue {~0nitorin9 Yes -.Rel~rt-within 24 'hfs Does t~ va[iati~ ex~ 5%? ~ ~b - Contin~ ~ti~ ~itocing __ Yes - Re~rt to ~cmltti~ Aut~[ity within 24 h~s of di~very ,NTH END A. Gals over/short TOTAL Gala. sold ''=='~=-'=~XC&-~~'==~:-=;~- -- ........... =-mw:=u_==~-- .~._~= ..... ~:---.~.: = --~=.a. :=--.:'-:X ~100% ~a;-iat~o; Have y~; shortages exceeded chart amount~ u. ~s varia~i~ Ye,a No ~ - Omtin~ ~tine ~itoring l~ Ye~, re~rt' to Kern County ~ Yeu - Re~rt to Pezmittin9 ~tl~rity I[ NO, continue monitoring ~ ~ithin 24 h[a o[ di~,very Year PRODUCT: DAYS GALLONS SOLD OVER SHORT Gals. over/short TOTAL Gals. sold £ 2 3 4 5 6 7 TOTALS 8 9 10 11 12 13 14 TOTALS 15 16 17 18 19 20 21 TOTALS 22 23 24 25 26 27 28 =TOTAES ...................................... 29 30 31 TOTALS MONTHLY GRAND TOTALS. (TOTAL SH01~T~0ES) X 100% V&miatio~ ' Does aat[ over/~t'exceet 350 gala{ , No - Contin~.: N~nit~rl~, -- Yes - ~r} within 24 bra o~i~ ~8 ~ Va~iat{~ o~ 5%7 · : ~ithJ~ 24 bra o[ di~ ~ TOTAL Gals. sold ~ mt. ~r/~,~ ,~ ~5o --Ye, - ~J vi~in 24 ~a o{i~ ~ ~ va~lat~m o~d 5%7 ~.. .... ove~/shoz~ ' ~tA~ Gals. sold ~s ~t, ~r/~tt e~ 350 gals?. ' ~ - ~tin~ ~i~i~ -- ' ~S t~ variati~ e~ 5%7 --" Wlthi0 24 hca of di~' Gala ove~/sho~t! TOTAL Gals. sold X 100t ~es- ~ ~ .~tt,~ ~t~,ty --" . .. 24 ~. o~ dis~".'. ............................ , ...... ....~ .~.,:_ tlave your shortages exceeded chart amount? No Yes, repo[t=to Kern C~unty --' No, continue monitorin~ --'-" %~f~.~, ~4~.. ~f'ai~rv · ()VI<R/StlORTS CALCUI,A'?I ONS , * ._ .... 1..,_ ' --- :~ } I I q q ~ r g3 .~ t~ - ~=tinue :-'onitorin~ 4 '"- 5 J } ~ q ~ -- }O q --Ye: - ~rt within 24 hfs o~iaco~ry : --' ~ ~ - Continue routine mnitoring -- within 24 hr,'of dis~va~; 1 4 { ~ 2 ~ {' ~.~' ~s ~e variati~ ~ 5%? ~ }b - ~ntm~ rout~e ~i~r~g ~ TO' __ Yes - ~rt wi~m 24 ~s o~i=m~ry ~ 2 - ~ntinue r~ ~i~ring a. -- lO] ~a!s over/s~orc . 25 I ~05-~ } ~ ~ I = ~9~TOTg Gals- sold 2 8 { ~ I q I -- ~1 B. ~e, ~t. Over/s~rt ~ 350 qa~? ' ~ t~ - ~ntinu~ ~i~i~ ( TOTALS { ~ ~ ~ } ~ ~ } ] % ~ __ Yes - m~rt wi~m 24 ~s o~iz~very T( Yes - Re~rt to Pe~tt~g Authority _ . ~,~.8 GRAND -, ' ~ G ,~q~ TOTAL Gals. sold - ~ ~__ ~ ~ X 100% .Variatio~ n ~ - Continue P~ut~e ~itoring Have your shorta~= exceeded chart amout. Yes . No~ ~ ~ ~ Yes - Re~rt to Pe~itting Authority: S 'OTALS 4 TOTALS 8 9 0 1 TOTALS 22 23 4 5 26 27 28 TOTALS 9 0 31 TOTALS MONTHLY ',RAND TOTALS If yes, PRODUCT:-- GAI,LONS SOLD OVER SHORT -- (TOTAL SH6kTA~ES) Have your shortages exceeded chart amount? Yes No If Yes, report to Kern County Gals. eve r,'"-q};-~'r~ : TOTAl, Gals. X 100% Variation B. Does ,-.-,:t. nver/short exceed 350 gal=? __ ~) - Continue ~;~i~oring Yes - Rc~rt wi~in 24 hfs o~i~overyI - - ....... : ...... ~eS - the.- var iat i~-e~': 5%. =~ ..... lb - Continue routine ~nitoring Yes - F~rt to pe~itting Au~rity -- within 24 hfs of dis~ve~ A. Gals over/short ~ TOTAL Gals. sold X 100B Variation B. ~es ~mt. over/s~rt ~e~ 350 }b - ~nt~ue D~i~r~g Yes - ~rt wi~h~ 2{ hfs -- Yes - ~rt ~ ~tt~g ~ri~ -- wi~in 24 ~s of di~ A. Gal9 over/shogt ~ TOTAL Gals. sold X 100% Variation B. ~es ~t. over/s~rt e~e~ 350 g~s? ~ - ~nt~ue D~i~ring ~ Yes - ~rt withal 24 hrs.o~i=~ve ~s the variati~ e~ 5%? ~ - ~nt~ue rout~e ~i~ring -- y~ - ~rt ~ ~tt~g ~thorit5 -- wi~in 24 hfs of dis~ A. Gals over/short TOTAL Gals. sold X 100~ Variation B. ~es ~t. over/~rt ~ 350 9~? ~ - ~ntin~' F~ni~ring -- Yes - ~rt wi~ 24 ~s o~i~r Does the variation e~ ~ l~ - ~ntinue routine mni~ring -- Yes - Pu~rt to Pe~itting ~t~rity -- within 24 hfs of dis~eery Gals over/short A. TOTAL Gals. sold I X 100% Var iatio! B. Sols Va.-iation ezc:ed 1.5%? kb - Continue P_~utine t.L-nitoring -- Yes - p,~ort to Permitting Authority ---- ,..:" k ~ 24 hfs cf dis~-'Cr7 BULK PLANT 2200 E. BRUNDAGE 'BAKERSFIELD, CALIF.' 93307 , (805) 327-4~00 SHIPPED TO: SOLD TO: WHOLESA 'rJ n -7 ~ ,3 c o DATE / / .- ''-INC. Truck # ACCT# SALESMAN # _ 81L # PART GAUGE UNITS PRICE TOTAL GROSS ' PRODUCT BEFORE AFTER GAL/LBS PER UNIT PRICE 0 ~ ~ rem No Lead Gasoline- Flammable. Liquid UN1203 0 Premium Gasoline. Flammable Liquid UN1203 04" ~: .. ~ :.. Diesel Fuel #2. Combustible Liquid NA1993 pc QTY PKG PART NUMBER ~_ PRODUCT DESCRIPTION :-~ Combustible Liquid [] .. Sub Total Flammable Liquid [] " Nel Drums SalesTax 80 Drums Delivered ( ) Returned ( ) 80 Drums Delivered ( ) Returned ( ) r~ $25 This Invotce includes California and tederst taxes If applicable. Terms: Net by the loth of the Iollow- Freight/DeliverY Differential I lng month. A 1V~% interest will be assessed on past due amounts, which is an annual percentage In the event an act on s.brought by wholesale fuels incorporated for the coltection of-sums ............... due, reasonable a~torney'S fees and costs shall be paid In addition to the au Charge _Check :Check # C.O.D. (Cash) ,- SLUE NUMERIC, ~ "' ;' "':"::' ~.: Fi.:; ! X GREEN· OELIVER~' Delivered by Received by PHASE I VAPOn RECOVERY INSPECTION FORM . ' 4. BROKEN OR MI,~ING FILL CAP 5. BROKE?'I CAM LC~3K ON VAPOR CAP 7. V~R CAPS NOT P~PERL'F S~TED · 8. G~KET M~ING FR~ FILL CAP' 9. ~K~ MZ~ZNG F~ VA~R CAP 10 FZLL AC,~.PTOR ~T -*~M= '1 !. VAPOR AO~.PTOR NCT TI{~T !2. G~KET B~E:N .AOAPTOR ~ FiLL TUBE MI~IFIG / IMP~PERLY S~&TED 13. DRY 9RB'~K C~.SK~S DETERIORATED CO~:AL FiLL TJ~E 15. COAXIAL F~LL TUBE ~P~NG ~ECH~ ~ OEFECT~VE 'lB. T~NK DEP~ ME.~R~M~T ']7~ TdBE L~G~H M~UR~M~tT 1 ~. L; I mr"r, :~,WARNING : SYST~4S MARKED WITH A ~-qECK A~OVE ARE IN VIOL.ATtoN OF KERN COUNTY ,AIR POLLUTION" CONTROL OIqTRICT RUt E(.~} 209 ~12 ~NO/OR 412.1. ]flqE CALIFORNIA HEAL_TH. Jaco Oil Company OVER/SHORT CALCULATIONS. 1) Fill in Permit #, Location, Month and Year. 2) Identify each product you are keeping the recap on. 3) Enter the total sales 5'~' P~-~:?:~-~:':~inb 10 of the Daily Report to the appropriate date line. 4) In the Plus and Minus .columns enter the amount over or short for each day from Line 16 of your Daily Report. 5) Th& weekly total on this form will be the figure you will use as your gallons over or short for the week you are. working ~ith 6') To determine the gallons over or short, you take the gallons over, less the gallon's short, to arrive at a net number. This number can be a negative number. ' 7) The monthly recap will be the total gallons over less the total gallons short. Again, this can be a negative number. This is the total ~nount over or short for the month. INVENTORY CALCULATION !) To complete this portion, you need two numbers: a) The net amount over and short, from recap-of overs and shorts for the week; b) Total weekly sales by the meter reading also is on tns recap. SECTION A: EnSer the net gallons over or short for the Week on the' first line and total sales for the week on the second line. By dividing the gallons short or over by the gallons sold you will have a fraction. By multiplying this fraction by 100 you will have a percentage of variation. SECTION B': : Simply answer the two questions based on the.informatioh you have gathered. At the end of the month a recap of the month (2'8-~1 day period) shall be.calculated using the same format. 3101 State Road Bakersfield, California 93308 Telephone: (805) 393.-7000 ' Post Office Box 1807 Bakersfield, California 93303 · J-aco Oil Company 3101 State Road Bakersfield, California 93308 Telephone: (805) 393-7000 Post Office Box 1807 Bakersfield, California 93303- i ACTION NUMBER CHART In an effort to detect leaks, an "action number" has been developed. For each month you will coun~ the number . of total shortages by product. If a product comes up short .......................... mote "than'~'~the-'ac-tiOn"'number'~"--~.t~-4. ndicates.--a.,-Possible-~-leak~-and4s to be reported at once. This recap will be totaled at the end. of each month. At the bottom of the over/short calculation. ACTION NUMBERS JANUARY 17 FEBRUARY 15 MARCH 17 APRIL 16 MAY 16 JUNE 16 JULY 16 'AUGUST 16 SEPTEMBER 16 OCTOBER 17 NOVEMBER. 16 DECEMBER 17' Location Month PERMIT ~ Year PROD6CT :_ DAYS GALLONS SOLD OVER SHORT TOTALS 8 10 11 12 13 14 TOTALS 1¸5 16 17 18 19 20 21 TOTALS 25 ..i26 27 28 TOTALS 29 30 31 TOTALS MONTHLY GRAND , TOTALS " Yes (TOTAL SHO TAGES Gall. ov~r/gh¢,r t TOTAL Gals. sold X 100% variation B. Does ---~.~. over/short exceed 250 gals? No - C~nt~nue 5~%i~rin9 -- Yes - Rc~rt wi~nL~ 24 ~s o~i~overy ~s ~e variation a~d 5%? ~ - ~ntinue routine ~i~ring -- Yes - Re~rt to Pe~ittin9 Authority within ?4 hfs of dis~ve~ A. Gals over/short TOT~ Gals. sold X 100% Variation B. ~es ~t. over/s~rt e~ed 350 g~s? ' ~ - ~ntinue F~iter~g .. Yes - Re~rt wi~h~ ~4 ~s o~i~covery ~s ~e variati~ ex~d 5%? . ~ - ~nt~ routine ~itorln -- Yes - ~rt to Pe~itting Au~ri~ -- wi~in 24 ~s of dis~ve~ A. Gals over/short TOTAL Gals. sold X 100% ~ariation ~s ~t. over/s~rt ~ 356 -- Y~ - ~t wi~ 24 bzS of -- di~ ~ ~ v~iati~ e~ 5%7 ~ - ~nue r~t~e ~rin~ -- Y~ - ~rt ~ ~tt~g Au~ori~ ~ within 24 ~ of dis~ve~ wE~m 4 A. Gals over/short TOT~ Gals. sold X 100% Variation B. ~es ~t. o~r/~rt e~d 350 ~ - ~t~ue ~i~ring ~ ..... ~ Y~.= ~ .wi~m 24 ~s~ o~i~ve~ ~s ~ ~riati~ ~ 5%? ~ - ~nt~ue r~t~e -- Yes - ~rt to Pe~ttLng Au~rity ~ %.;ith~ 24 P~s of discove~ A, Gals over/shot-t- TOTAL Gals. sold ) [our shp_~..tages, exceeded chart .amount? If Yes,.repor{ to Kern County '~~If~. No, Continue r~nitoring X 100% Var ia'tic: Does Variation' exceefl !. 5t? ,~b - Ccntinu-~ P~utine Fmnitoring '-fas - Report to Permitting Authority within 24 krs of dis--ovary DAYS PRODUCT: GAI,I,0NS SOI, D OVER SHORT --3 I 4 T TOTALS 8 12 13 TOTALS 3.6 ].7 18 2O 21 TOTALS 22 23 24 25 26 27 28 TOTALS TOTALS I ' Have your shd-rtages=-exceeded .chart-amount? Ye s No If Ye~re~r~o Kern Co~ty If No, continue monitoring Gal J- over/'s!~cr t : TOTAL Gals. sold - X 103% V,-rlaticn Doas ~-..t. ~'ver/°h-~rt ex=ced 250 gals? ~ - Csntinue I,'Dni~Orin9 Yes - E:~rt within 24 hfs o~iacovery ~es the variation exceed 5%? ~ - ~ntinue routine ~nitcrin9 . Yes - ~rt to ~e~itting Authority within 24 hfs cf Gals over/short TOTAL Gals. sold x 100% variation ~s ~t. over/s~rt exceed 350 ~ - ~ntinue ~:ni~ring Yes - ~rt wi~in 24 hfs o~is~ve~ ~s ~e variation e~ 5%? ~b - ~t~ue :out~ne ~ni~:in9 ~ Yes - ~rt to ~tting Au~ri~ ~ wi~hLn 24 ~s of discovery f~ ~ Gals o~er/short ~ TOTAL Gals. sold X 100% Variation ~s ~t. over/short e~e~ 350 gals? -- Yes - ~rt wi~ 24 b~s of. ~s ~e ~at~n ~ 5%? ~ - ~n~nue routine ~i~rmg -- wi~in 24 bls cf discove~ Gals oval/short TOT~ GalS. sold X 1~0% variation ~. ~s ~t. ~r/s~rt ~ 350 ga~? ~ - ~ntinue ~itoring ~ Yes - ~rt wi~Ln 24 hfs o~i~~ ~' the v~t~cn ex~fl ~ - ~tinue routine ~nitoring ~ Yes - Re~rt to Pe~ittin9 Auttmrity -- within 24 hfs of dis~very ~ END A. Gals over/short + TOTAL GalS. sold X 100% Var iatiol ~ - Continu~ P~utin~ ~it°rin9 % Yes - Ra~rt to pe~,!t~in9 Autk:rity within 24 hfs cf diL;~very NOZZLE ' :" -: ..... '~":'-'"~ff~ Z ." NOZZLE ' ~ ' 7 FL~ L!M~TER 0 5 OVS~,~0 ,,~, ~&CTOR E ~. ~ERX,.,P!LOT ON VIOL.ATZC~IS: ,5YSTk.-WlS..t4ARKED i,~i,-';d A "T" CCC,-- iN ~NSPF_CT'i~--"~I RF_SULTS, ARE iN ViOLATiON OF z'~'r--'&'~F~~F'AIR POLLUTZON C,O'4T~L OIS. TRICT RULE(S} 412 AND/OR 412.i. TIH,.E CALIFORNIA HEALTH & SAFETY CODE ,~PECIFiF_,S PENAL~ IFS OF UP TO' $I .000,00 P_R DA...--OR ,-~A~ DA, CF VIOLATION. TEL.,,PHONE (805) 881-3682 ~'.,NCE,q~NING FINAL RE,.SOUJTiON OF THE VIOLATION. NOTE~- 'CA.L i'FO,RN IX' "SE~t2'F-ri-'~' 'SAF~ ,,-TY--COOE-'SECT ZOfq--'~Tg6Gr: 2~. --RECtJTRBS-~T'H%T-~ E ~%80V~' OEFiCI;-SNCIES ~E CORRECTED '¢¢1%~i;',4 ? OATS. ',=ALLURE TO CC',MPL': ~A.Y RESULT iN LEGAL Station Name_~'~7~.~-~ ~ Operator's Name. ~ C)~i~ ~ Major Cross Street Telephone No ~'~.- ~,~- ~'o~..?r. ' j Totalizer Reading When Tagged WARNING Use of this device is prohibited by state law and un- authofized removal of this tag o~l .use of this equipment Will constitute a violation of the law PUnishable by a maximum dvil fine of $1,000 per day or a maximum _criminaJ fine of $,500 per day and/or sbt months in jail I declare under penalty of perjury that the device tagged ~s not used, nor was the tag rernov~d, until the required repairs were effected and the district notified. Repaired by, (Please print) Title, Si~natu~,. Date,,, Time Totalizer Reading' at Time 'of Repair Repairs made BEFORE USING THiS DEVl(~LT~p...hc~o~cai air pollution control district at ~L2 · --l~J ~-- If repairs v~re made to the nozzle body you must noti~ the County Department of Weights and Measures. 66385 · Si~tion Name Station Address Major Cross S~e~ Telephone No Totalizer Reading When Tagged ~ ' ~ ~:~ WARNING Use of this device is prohibited by state law and un- authorized removal of this tag or use of this equipment will constitute a 'violation of the law punishable by a maximum civil fine 0f $1.000 per.day or a maximum ............................................... criminal fine 0f'$500 per day and/or six months in jail. I declare under penalty of perjury that the device tagged u~s not used, nor ~es the tag removed, until the required repairs were effected and the disa~ct notified. Repaired by Title (Please print) Signature -' Date Time . Totalizer Reading at Time of Repair Repairs made Totaliz~r' Reading When Tagged 0~- WARNING Use of this device is prohibited by state law and un- autho~.ed removal of this ~ag or use of this equipment will constitute a violation of the law punishable by a .rna~Jmum.ci~il. fine of--$1,O00 per day or--a maximum'- criminal .fine of $500 per day and/or six months in jail. ! declare under pena~ of p~ju~ that the dcwice tagged was not used, nor ~s the tag removed, until the required repairs were effected and the dis~ct notified. Repaired by ~ Title, (Please print) Signature Date __'l~me To~lizer Reading at Time of Repair Repairs made BEFORE USING THIS DEVl~j~el~pho~l~r.l~air pollution control district at ~)O I "~ ~ ~---:.' If repairs were made to the nozzle body you must notifij the County Department of Weights and Measures. 66355 BEFORE USING THIS DE~9~~ 19~al air pollution control district atff~,ff_;)I ~' ~ ~1 ~ . If regairs were made to the nozzle boch7 9ou must notifi7 the County Department of Weights and Measures. 6638'4 ~ER~IT NUMBE~ TYPE OF INSTALLATION ( ) 1. In-Tank Level Sensor (~2. Leak DeteCtor (~. Fill Box FACILITY NAME FACILITY ADDRESS ~_(~,~' CO~TACT PERSON 1 ..... IN TANK 'LEVEL"SENSORS Number of Tanks List By Tank ID Name of System Manufacturer & Model Number Contractor/Installer 2. LEAK DETECTORS Number of Tanks List By Tank ID Manufacturer a Mode~ ~Number Contractor/Installer 3. FILL BOXES Number of Tanks List By Tank ID N~e of system'~©tlqF~;b^ C'r) Manufacturer & Model Number Contractor/Installer BAKER ' IELD FIRE DE ~ ENT HAZARDOUS MATERIAL DIVISION PERMIT TO OPERATE .. UNDERGROUND HAZARDOUS STORAGE FACILITY Peri. it No.: 307 State ID. No.: 307 Issued to: FASTRIP FOOD STORE #26 Location: 2698 OSWELL sTREET BAKERSFIELD, CA 93307 Ownei~. Operator:. JACO HILL P. O. BOX 1807 BAKI~RSFIELD, CA 93303 JACO JAMIESON P. O. BOX 1807 BAKERSFIELD, CA 93303 Facility Profile: Year Tank No. Substance Caoacity Installed I GASOLINE 12,OOO GAL 1983 2 GASOLINE 12,0OO GAL 1983 3 GASOLINE 12,0OO GAL 1983 4 DIESEL 12,0OO GAL 1983 YES YES YES YES This~ermit 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 Date: JULY 1, 1991 Title: Hazardous Material Coordinator Expiration Date: JULY 1, 1994 POST ON PREMISES NONTRANSFERABLE