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HomeMy WebLinkAboutHAZ-BUSINESS PLAN 12/10/2002HAZARDOUS MATERIALS DIVISION ~ TIME CHARGED BUSINESS/DEAPRTMENTNAME: ~.<,~N~. ~'44~-vree.~ ADDRESS: PROJECT DESCRIPTION: PROJECT NUMBER: 577 TIME DATE: NAME: CHGD: COMMENTS: PROJECT COMPLETION: DATE: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE · This ~ermit is issued for the following: [] Hazardous Materials Plan E] Underground Storage of HazardOus Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment PERMIT ID # 015-021-000577 ;-;,,' ..... *' · ~ "~ BASHAAR NAJDAWI LOCATION 2301 r.~ ~ ~ TANK HAZARDOEJS SUBSTANC 015-000-000577-0001 ~LEADED PLUS GASOLIN~ ~o,ooo m~v. v~..s¢~so~ w/vos s.uxovv OI 5-000-000577-0002 ~GULAR ~[AD~:GASQ[INE'~'''-:.; lO,O00 ,,. 7DISP. ~ENSOR W~OS SHUTOFF ooc~s.;~an ~h ~..~ '-,?-~ ~-~ ~%~ i*~ a~],0 0~..~2 DISP P ~ SENSOR W~OS 015-000-000577-0003 ........ ~ .... Ao~L,..,~:~.~ ~,,~ ..... . ~ .... ..... Q~ [~ ..,...~ SHUTOFF Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: Expiration Date: OfficeofEv~Services * APR 3 0 2001 Issue Date 'june 30; 2003 j' CA Cert. No. 28503 City of Bakersfield Office of Environmental Services t 715 Chester Ave., Suite 300 Bakersfield, California 93301 (661) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information inthe format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 27th day of April, 2001 to' BASHAAR NAJDAWI CHEVRON Permit #015-021-000577 2301 Panama Ln Bakersfield, California 93307 2:301 t:'RIq~HA LN BAKEI~'SF'] ELD C:A. 9:3:]0'? MAR 9. ::u!JI 12:0q PH ~I.,L FIjNt;TIOI,]S NC, i~'I'tAL l N",/ENTORY ]' 1: SUt:'EF: VOLIJME = 1989 GmL,S ULLAGE = 7991 GF~L~: 90~-;; ULLAGE= ~i,':~q:2 GAI..~ TG VOLUI',iE = ,";ALS HE Iq:HT INCHES ~'~ u. 8',:: I NC::HE~ - 85.9 DEC; F ~ : t:'1.. LJ;:i ",."OL OME -= 1 5L-15 LII.I..,F~(;E = 2482 OaL~ 91]:::.;; ULL,F'~QE= 2083 TO: 'v'OLUME ; 1503 GALS HEIGHT = ;30.56 II',/' I.,,d~TER "YOI~ = 6 I.,,J~'[EF? = 13.76, I NCHEE', TEr'.'IP = 80.0 DEG F '1" 3 :!_INI.,I~:A[:~E[:~ V,;)L I.IP1E = 58;31 (}ALS ULLAGE = 4149 GALB 91]:~t~ LILI_,A,SE= :31 51 GALS TO VOLiJME =- 5827 HEIGHT = 53.81 INCHES W~TER ',YOL = 14 ~L~ f,,J~TER = O. Se, I NCHE~ TEMP = ~7.8 DEG F SECTION I Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 9330! Tel: (661)326-3979 FACILITY NAME PHONE .No., No. of Employees FACILITYCONTACT Business ID Number ................ 15-021- ~ ,, ~ :.;..~. ~,, '~:~i . ' '. ' .? ;~ '., .'. . - , , . , [] Routine ,~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection C V (C:Compliance ~ OPERATION v=Violation ! 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 AVAILABILITYE ~ [] VERIFICATION OF HA~;F_.MAT TRAINING ~ [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES  [] EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY LABELED I~ [] HOUSEKEEPING ~ [] FIRE PROTECTION COMMENTS ,J~ [] SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: [] YES /~No EXPLAIN: QUESTIONS REGARD, I~JG THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 "..,._J White - Environmental Services Yellow - S~ation Copy Business Site~'/s~nsible Party Pink - Business Copy FACILITY NAME CiTY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 Section 2: Underground Storage Tanks Program Routine [~Combined [~1 Joint Agency Type of Tank Type of Monitoring ,g~X"'~ I~l Multi-Agency l~l Complaint Number of Tanks '~ Type of Piping ~ b~ F 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 A'd~quate secondary protection Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Office Or-o;m~-ntal~e~v~61) ~'~-3979 While - Env. Svcs. Pink - Business Copy Business,Sfil~e Responsible Party · 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 card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1..Article Addressed to: BASHAR NAJDAWI BASHAR NAJDAWI CHEVRON 2301 PANAMA LANE B^K RSFmi D C^ 93307 A. ~, i_I Agent ~,,,_~'~ X ~r-I Addressee B. Received by ( { C. Date of DeliverY I D. Is deliverY address different from item 17 [] Yes if YES, enter delivery address below: [] No 3. Service Type [] Certified Mail [] Express Mail i [] Registered [] Return Receipt for Merchandise ii/ [] Insured Mail [] C.O.D. · 1 4. Restricted Delivery? (Extra Fee) [] Yes : 7002 2410 0002 1974 9541 I PSForm 3811, August 2001 Domestic Return Receipt 2ACPRI-03-Z-0985 p- '1~' ~-~ Postage ~$ r-~ Certified Fee Return Reclept Fee ( r-'l (Endorsement Required) / L Restricted Delivery Fee ~ (Endorse?~,~ha~a/~kadl_[ Postmark H~re ru 'rota~,j BASHAR NAJDAwI mm ~ BASHAR NAJDAWI CHEVRON m I ......2301 PANAMA LA ~ ~'~'~ BA NE "':'"'1 D March 1, 2003 Bashar Najdawi Bashar Najdawi Chevron 2301 Panama Lane Bakersfield, CA 93307 CERT]I=IED MAIL 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 FIRE SAFETY SERV1CES · ENWRONM~.NTN. SERVICES 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) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Failure to Perform/Submit Annual Maintenance on Leak Detection System at the Above Stated Address. Dear Business Owner: Our records indicate that your annual maintenance certification on your leak detection system was past due on February 21, 2003. 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, April 1, 2003 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 D January 22, 2003 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 F~R~ s~'~ s~mnc£s. £mnao,~. s;;~cEs 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Av~. 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 Bashaar Najdwawi Chevron 2301 Panama Lane Bakersfield CA 93307 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. Sincerely, St~~ Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc 661 - 811r2- 45.t, 1- HE [ Gtcr - , HE t ,i~ © CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME filtdalr~ iq/J~-0to'~ ADDRESS 0 gO I t7tl h~.l~,_ L.~ FACILITY CONTACT INSPECIION IIME INSPECTION DATE !"/(z,-O 3 PHONE NO. $.~3" q.t;~' ! BUSINESS ID NO. 15-210- NLIMBER OF EMPLOYEES ~3 Section 1: Business Plan and Inventory Program Routine [~ Combined 1~ Joint Agency [~ Multi-Agency [,~ Complaint {~l Re-inspection OPERATION C Vi COMMENTS Appr. opriate 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 J Emergency procedUres adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand Any hazardous waste on site?: Explam: C=Compliance V--Violation Business S~e Jtesponsible. Party . White- Env. Svcs. Yellow-Station Copy Pink-Business Copy Inspector: ~. ,~'~j Questions regarding this inspection? Plense call us at (661) 326-3979 FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program Routine ~ Combined [] Joint Agency Type of Tank .~hJa. Type of Monitoring AvP(o I~[ Multi-Agency [] Complaint Number of Tanks Type of Piping [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit 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=Violatio. n Y=Yes N=NO Inspector: Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Site Responsible Party SECONDARY SYSTEM CERTIFICATION FORM DATE 9-25-2002 FACILITY ID Bashaar Chevron FACILITY ADDRESS 2301 Panama Lane, Bakersfield, CA 93307 UST Annular Space -.T49~k 1 unl 87 Tank 2 plus 89 Tank 3 Prem 91 Start Time ~. J~ Initial Pressure ~0 ~ ~ ~ ~g End Time~....-~'"'-"~--"~. ~ Final Pr~ure ~~ ~ Ce~lfl~tion ~ / ~ ~ (Si~ature) Single Wall Secondary Piping'. Line 1 Unl 87 Line 2 Plus 89 Line 3 Prem 91 Line 4 Start Time 3: 30 PM 3: 35 PM 3:/40 PM Initial Pressure 5 psi 5 psi 5 psi End Time 4: 30 PM 4: 35 PM 4: 40 PM Final Pressure 5 psi 5 psi 5 psi Certification Pass pass // Pass (Signature) Page I of__3 C SECONDARY SYSTEM CERTIFICATION FORM DATE 9-25-2002 FACILITY ID. Bashaar Chevron FACILITY ADDRESS 2301 Panama Lane, Bakersfield, CA 93307 Turbine Sumps Sump 1 unl 87 Sump 2 Plus 8c. Sump 3 Prem 91 Sump 4 Start Time 4: 10 PM 4: 10 ~M 4: 10 PM InitiaiHeight 5.761 in 6.127 in 5.581 in of Water Time 4:15 PM 4:15 PM 4.tl5~PM Water Height 5.761 in 6.127 in 5.581 in Time 4:20 PM 4:20 PM 4:20 PM Water Height 5.761 in 6.126 in 5.580 in Time 4:25 PM 4:25 PM 4:25 PM Water Height 5.761 in 6.126 in 5.580 in Certif]catioll Pass Pa~ Pass (Signature)~ J, ~'/~. 7~ Overfill Buckets Pasf Overfill 1 Unl 8~ Overfill 2 plus ~3Overfiil 3 Pvem c. 1Overfill 4 Start Time 4: 35 PM 4: 35 I~ 4: 35 PM lnitial Helght 2.134 in 1.795 in 1.012 in - of Water Time 4:40 PM 4:40 PM 4:40 PM Water Height 2.134 in 1.795 in 1.012 in Time 4:45 PM 4:45 PM 4:45 PM Water Height 2.134 in 1.795 in 1.012 in Certification Pass Pass ,F Pass ~age 2 of 3~ SECONDARY SYSTEM CERTIFI'CATION FORM DATE 9-25-2002 " FACILITY ID, Bashaar Chevron FACILITY ADDRESS 2301 Panama Lane, Bakersfield~CA 93307 UDC TESTING 't',r,. 2 3 & 4 5 & 6 7 & 8 DISPENSER 1 DISPENSER 2 DISPENSER 3 DISPENSER 4 STARTTIME 5:00 PM 5:00 PM 5:00 PM 5:00 PM INITIAL · .HEIGHTOF 2.472 in 3.124 in 2.175 in 1.797 in WATER TIME 5:05 PM 5:05 PM 5:05 PM 5:05 PM WATER HEIGHT 2.472 in 3.124 in 2.175 in 1.797 in TIME 5:10 PM 5:10 PM 5:10 PM 5:10 PM WATER HEIGHT 2.470 in 3.124 in 2.175 in 1.797 in CERTIFICATION Pass Pass~ Pass Pass DISPENSER $ DISPENSER 6 DISPENSER 7 DISPENSER 8 START TIME INITIAL HEIGHT OF WATER TIME WATER HEIGHT TIME WATER HEIGHT CERTIFICATION (SIGNATURE) Page 3 of_.3 ACE P ri~OL~UM szlr¢Ic~ .11~ ~i)ICE 6305 Hes :~ ~ve ,, (~1) 63~ ,9611 lm~ ~ 8 ~ T~ ~ V~ ~ AT V~R ~ ~ ~. ~ ~F~ T~ ~0~ ~o~ ~. 0.~ Tm~l 0 ~v~ (P~ ~) ~ ~.~ ~ ~. 40.~ Sal~ Tax (7.~%) ~.~ , To~I 12/26/2002 11:11 6618363177 REDWTNE TESTING PAGE .. . .. ,........~;.,,.....-'... .... . . . . , ,~ . ~ .,t ", . ' . . : ..., . , E TESTING' SERVIC. E$i:. ":,' '.' ' ,. .,,"2 ". . ..... '."...2.,i.,.% ,, . . , .'..,....'," ,, ' ' ,',,' .",, '~.~' ,,,d,-',",,.'. :" . :, . : .~ ... ' ,: ~'. ,?;. .' . ~ ,, .. · .. ,..~', .,... ~. ,.'.;,..:q :;.:'. . ,,'., ,.. , ...... -!,..=~! ..= ': . ' . !, '.".' .. ... . .......:.,.- .~ :,;:.~:. < ' . · .' ...'.".... ~.., '.'i.::::~'.. i . .. ' .... ' ." ..'.." . . . ...'"<".:,i.',. '.. :'.." :'" !'..:.' .": '. .... . .... ..."':.. ' .':..'.". :.:i:i ::.' i'... .. ~' .., ... ' · ." '""" ".'." .:":"-V.. :' .,.. ' :' :' "'~' ' · · ' ." :' ;' .:27~.". ' '. .' .'. '".' " , ,!.: ,.: , . , . .:~.~.,...: . , · ,, · .;'. = .,, ',......,, ~' .. 0! 12/26/2002 11:11 6618363177 REDWINE TESTING .'": '" .~ :'...' "" .'~:"i!'~"..~i ' ' '"' .:" '~" · ' ":'" ' . . 'S~0~:~["SYST~M C~n~,CA~O~ Fo"~:.'' ..:::',".,. D*~- ..*-~s-?o0~.:.,:...:.::i..,_~ '. '..~_:ii;.:::.?~.!.'..' '..' '.. '. ': '.:.: :'...'.... FACILITY ID.."l~Sl'~'ar_ :~~.:, , , : :.': .',.-. '.s' ' ' '' .' '"":' .'. :~'..'9,L'"'....!.. :~":!~ ' ' ' ." . . "' .... :i?i;'.". · ' ". . i%' t~T. Ann.~,.. sp=*.'"' .'.":...i i"' .':"'.":/:' ?!.:: .:!',' .. '". . :'..~" ..' .. ' , ,' :_..,:?,~ ...... '-..'.:.,,,.~ib..~..~ ... '.. 89 ~ · .. . . - ,;,~, ~ ~ ' . Pa~e I of._3 PAGE 82 12/26/2882 11:11 6618363177 REDWINE TESTING · :, ~>.: ..:....;. ...../:' ~ .. . . ..:.._ .. .. ::~;.~' .. . . .. ......... :.' ..:.....":;' ?, ". . ~. :.,'.~.~ . [... .'..'.'.'. : Tlm~ slartTim ;'.'.?",':t: "..,":~:%:?.':'. :' 4:~5 P~4 ' '"": ' ,., . , . . . .. ,. ,¥ :,, ..,,, . ~ . . ,.. e. 4'.:..35'. ' ' .'. · Pl~.i:~ .:~ .': 4:35 ~I "":' · , ' '"' '. . '":. ':'?'~;C.,. - Inltlal'.ttel~ht ........ ~: : " ..... ' ,' 2...I'3~i" ':" i'.... ' .' 1.795 in 1.012 in . '.,: ofw,,t,r' .i i.:':'~ i ":'::d: ,::..,:.i/: .. . .. . .....': : '...:.u (' '. '.~;'..,Tj.:",b "i "': ' ' Time ' '):~';~Oi]~il.;i..i.,·:]'.'.:4,40 m 4.:40 m :'.. ..'.. " :~." :..: .:.(7..,';?.:";-."1: ".'. - ..... ' ..'. ".. :..' Wat~Heip, ht, ',.~,:'~34'(:':~i:.'..?: ." 1.795 in 1.0.12 tn '., ...... ".; "'% , "' ',.';~ ~q~""' ;.i - " ' ' "' T,m. . ": ~!} !i;'. ~,~ ~ 4,~ ~ . ,~....~..,:... , . .:.~,iqg:) ;;: i,: .' .;, ..... , ......:. · . Wa"rHelgll' ':i'i":.'~:';i~.i',!!~!~i~:[ 1.795 in 1.012 in . ::'."' '" C~flifle.~flon .' "."[ "" i~"~ra.: "':,'i:i.. :':?'... !(', ': Pa7 ?n$$,~. "'.. ;".. '.]" :....: .. ' : <%,,~,,).. ......::..-',:.....: :.....:.......~:::~,. ?:.. ! ~__ :' .... : . .... '....-,.';'~ .,. ._~ . ' - ' . · ".'::~:t":," _':":'~'~_!i ~' ' '__~_'~,~.-'~ ' ~ ...... ' ......... '" ' .... 2 of ~_.' PAGE 83 12/26/2862 il:il GG183G3177 REDWINE TESTING " '... ' .~.".-'.,;.'..A. ' "' '.' .. " '' ' ' "".:'." ;."i:':':'~.~"." (' ' ":' :" '/'" '" i" ' · . ." . ... ........~;...f~,~..~ .. . .? !~j ' . · .,. ~. ~.~,.,,, .... ~ . . . . . '. :· SI~~~:;SYSTI!IM CERTIFICATION ZOO'.'.")'.';.:" ".'~ . .. . , ." c~...:~.~:~ /:' .. . .~.. '.~: .. ..:: ~.g~:'... :.. ' . DA~".:'~.'. '..'~:~i'~:~: .":~".' ... . ZA L Y . . : . ~';,.'. ...,..?~:~.., :'... ' : ~ ."... - .. ~ ~T~G .. :?...,., ., ' ' .. ., ,.,,., ... ~,., .,.,.>.~ ~'.' " 3 ~'4 ~, " '.7 ~ 8 . ... .. :...~ ~.~,.....: -?.~?~.~.;~:'?.~ .. · . . .... ... ~ ~. J ~ .~' ~L. . ...... '.'. :: '?~'.~ .,'. Wl~R ' ,' ' ,',' ..... ' ............ ",': ." ~' ' . ,. ,'.":..' , .,~.<~(SX: ..?.. . .... PAGE 84 TRACER TIGHT(g) TEST RESULTS Shirley Environmental LLC 1928 Tyler Avenue, Suite K South E1 Monte, CA 91733 Testers St Lic. No: 95-1594 SYSTEM STATUS 10/22/2002 Job No: 02-13093-86 Bashaar Chevron 2301 Panama Lane Bakersfield, CA 93307 SYSTEM# PRODUCT SIZE TRACER TRACER DETECTED? Tank 1 Unleaded 10,000 C Tank 2 Plus 4,000 W Tank 3 Premium 10,000 A YES YES YES Soil permeability is greater than 41.6 darcys. GROUND WATER AND PRODUCT INFO AT INOCULATION 09/24/02 AT SAMPLING 10/02/02 SYSTEM# H20 PROD H20 PROD (in) (in) (in) (in) Tank 1 0.00 36.00 0.00 62.00 Tank 2 0.00 35.00 0.00 36.00 Tank 3 0.00 47.00 0.00 23.00 DEPTH FROM GRADE WATER TANK TANK TABLE BOTTOM TOP (in) (in) (in) >144 143 47 >144 131 35 >144 141 45 SITE COMMENTS Backfill in tank pit consists of sand. Backfill in piping trench is 'A to ¼ inch pea gravel. Ground cover over tanks and piping trench is concrete and asphalt. TEST EVENTS INSTALLATION 09/24/02 INOCULATION 09/24/02 FILL RISER- SPILL BUCKET TEST SAMPLING 10/02/02 ANALYSIS 10/11/02 TANK# Tank 1 Tank 2 Tank 3 PASS/FAIL Fail Fail Fail Submitted by: Larry Schenmeyer Lab Director Tracer Research Corporation CA tank tester Lie. No.: 93-1560 Tracer Research Corporation Test Comments General Tanks 1 through 3 are lined single walled steel. Product distribution lines are flex pipe from tank to split pit, then double walled fiberglass to dispensers. Vent lines are single walled fiberglass. Vapor recovery lines are balance coax drop tubes. Tank 1 Significant release of tracer C was detected. Tracer concentrations are correlated, suggesting a common source or sources. Normally tanks share the same vapor recovery piping, which can serve as a common source, and allows commingling of tracers. Tracer and TVHC concentrations are consistent with a vapor only release. The most probable source is in the area of tank #2's sump, and possibly another source in the area of probe 5. Tank 2 Low level release of tracer W was detected. Tracer concentrations are correlated, suggesting a common source or sources. Normally tanks share the same vapor recovery piping, which can serve as a common source, and allows commingling of tracers. Tracer and TVHC concentrations are consistent with a vapor only release. The most probable source is in the area of tank #2's sump, and possibly another source in the area of probe 5. Tank 3 Significant release of tracer A was detected. Tracer concentrations are correlated, suggesting a common source or sources. Normally tanks share the same vapor recovery piping, which can serve as a common source, and allows commingling of tracers. Tracer and TVHC concentrations are consistent with a vapor only release. The most probable source is in the area of tank #2's sump, and possibly another source in the area of probe 5. Submitted by: Anthony Ptak Tracer Research Corporation Tracer Research Job No. 02-13093-86 Page 3 of 5 Sample Date: 10/11/02 CONDENSED DATA Location Compound 001 A 001 C 001 W 001 TVHC 002 A 002 C 002 W 002 TVHC 003 A 003 C 003 W 003 TVHC 004 A 004 C 004 W 004 TVHC 005 A 005 C 005 W 005 TVHC 006 A 006 C 006 W 006 TVHC 007 A 007 C 007 W 007 TVHC 008 A 008 C 008 W 008 TVHC 009 A TVHC (Total Volatile Hydrocarbons) values reported in milligrams/liter (mg/L). Tracer values reported in milligrams/liter (rog/L). 0.00000 = Not Detected -999999.99999 = No sample Concentration(mg/L) 0.00029 0.00002 0.00012 0.41700 0.00140 0.00155 0.00006 13.95500 0.00000 0.00000 0.00000 0.30100 0.00000 0.00000 0.00000 0.12900 0.00126 0.00149 0.00005 6.95000 0.00044 0.00004 0.00000 1.08100 0.00000 0.00000 0.00000 0.51000 0.00005 0.00000 0.00000 0.50300 0.00000 Tracer Research Job No. 02-13093-86 Page 4 of 5 Sample Date: 10/11/02 CONDENSED DATA Location Compound 009 C 009 W 009 TVHC 010 A 010 C 010 W 010 TVHC 011 A 011 C 011 W 011 TVHC 012 A 012 C 012 W 012 TVHC 013 A 013 C 013 W 013 TVHC 014 A 014 C 014 W 014 TVHC 015 A 015 C 015 W 015 TVHC 016 A 016 C 016 W 016 TVHC 017 A 017 C TVHC (Total Volatile Hydrocarbons) values reported in milligrams/liter (mg/L). Tracer values reported in milligrams/liter (mg/L). 0.00000 = Not Detected -999999.99999 = No sample Concentration(mg/L) 0.00000 0.00000 0.11700 0.00000 0.00000 0.00000 0.08500 0.00000 0.00000 0.00000 0.13200 0.00000 0.00000 0.00000 0.05700 0.00000 0.00000 0.00000 0.05300 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.00000 0.06400 0.00000 0.00000 0.00000 0.05100 0.00000 0.00000 Tracer Research Job No. 02-13093-86 Page 5 of 5 Sample Date: 10/11/02 CONDENSED DATA Location 017 017 Compound W TVHC 018 A 018 C 018 W 018 TVHC 019 A 019 C 019 W 019 TVHC Piping Sump A Piping Sump C Piping Sump W Piping Sump TVHC Plus Sump A Plus Sump C Plus Sump W Plus Sump TVHC Unleaded Sump A Unleaded Sump C Unleaded Sump W Unleaded Sump TVHC Pre Sump A Pre Sump C Pre Sump W Pre Sump TVHC Concentration(mg/L) 0.00000 0.06200 0.00000 0.00000 0.00000 0.47600 0.00000 0.00000 0.00000 0.05200 0.00000 0.00000 0.00000 0.08100 0.00161 0.00075 0.00371 2.50000 0.00006 0.00005 0.00001 9.97900 0.00001 0.00000 0.00000 6.120OO TVHC (Total Volatile Hydrocarbons) values reported in milligrams/liter (mg/L). Tracer values reported in milligrams/liter (mg/L). 0.00000 = Not Detected -999999.99999 = No sample Tracer Research Corporation ° 13 Building ooo vents Tank 2 ~ 4,000 gal ~ 10 /~ 2 .. · z ~ - - _ ~' / Plus I' 16 1 ' ~ ~ Tank 3 7 10,000 gal Premium Tracer [A] EXPLANATION °1 Sampling Probe Location Approximate Pipeline Location Monitoring Well Location size :a 0 e e t 15 02-13093-86 B a s h a a r C h e v r o n 2 3 0 1 PANAMA LANE BAKERSFIELD. CALIFORNIA S a M P L I N G L O C A T I 0 N S Figure 1 (ND) (ND) Tracer Research Corporation · 13 (ND) (ND) (ND) Building Tank 2 (ND) (0.00140) (ND) 4,000 gal ///~x~~-/~ / Tracer [WI j ~ ~ O~ Tank 1 (o.oooo5) ~ ~ / '~ 10,000 gal ' ~ N Tank 3 7 (~) 10,000 gal Premium Tracer [A] OQO Vents [- ............................. 19 18 17 (ND) (ND) (ND) E X P L A N A T I O N (0.00002) (ND) Sampling Probe Location Approximate Pipeline Location Monitoring Well Location Tracer A Sample Value (mg/L) Non Detect size :A e e t 15 02-13093-86 B a s h a a r C h e v r o n 2 3 0 1 PANAMA LANE BAKERSFIELD, CALIFORNIA Tracer [ A ] Distribution Figure 2 Tracer Research Oorporation (ND) (ND) (ND) (ND) Building O(DO Vents L ............................. 19 18 17 (ND) (ND) (ND) Tank 2 ~ (ND) (ND} (0.0~015s} 4, 000 gal ". V ,~ ..... ~ /',.o~ / Plus . , /Tracer [W] ~1 i (0.00002) (ND) 9 ~ (~)0~~ Tank 1 (ND) ~ ) 5~/ ~ 1U0~ ~ e0 0a ladl (0. 00149 "16 (ND) ~ ~ Tracer[C] ° '"',/ ~ Tank 3 7 (ND) 10, 000 gal Premium Tracer [A] EXPLANATION (0.00002) (ND) ArC: 13093 - 05 Sampling Probe Location Approximate Pipeline Location Monitoring Well Location Tracer C Sample Value (mg/L) Non Detect Size:a Date:10-23-02 15 02--13093--86 B a s h a a r C h e v r o n 2 3 0 1 PANAMA LANE BAKERSFIELD, CALIFORNIA Tracer [ C ] Distribution Figure 3 Tracer Research Corporation Dispensers ~ 15 14 (ND) (ND) "13 (ND)  Dispensers --~ ............... 12 11 (ND) (ND) Building O~DO vents L ............................. 19 18 17 (ND) (ND) (ND) Tank 2 (ND) (ND) (0.0~006) 4, 000 gal ///~J_~i-/~ / Tracer [W] xxx~ ) 1 (0.000121 ~ ~.~0~) ~ Unleaded ~ ~ Tracer[C]  ~ ~ Tank 3 (~) 10,000 gal Premium Tracer [A] E X P L A N A T I O N ,1 Sampling Probe Location Approximate Pipeline Location Monitoring Well Location Tracer W Sample Value (mg/L) Non Detect Size:A Date:10-23-02 e e t 15 02-13093-86 B a s h a a r C h e v r o n 2 3 0 1 PANAMA LANE BAKERSFIELD, CALIFORNIA Tracer [ w ] Distribution Figure 4 (0.06400) (ND) Tracer Research Oorporation [ · 13 (0.05300) ~ Dispensers ~ 12 11 (0. 05700) (0.13200) Building Tank 2 ~ ~ (13 . 95500} 4,000 gal ~ (0. 08500) (0.12900) 2 ". ~? ~-~---~ /'..o / Plus / ' /~4 --/~'~ /Tracer [W] XXX~\ 0B1 1 (0.41700) ~ (0.3 : j ~ ~ O~ Tank 1 I1" 16(0.05100) Tracer [C]  ~ ~ Tank 3 (0.5i000) 10,000 gal Premium 0~0 vents [_ ............................. (0.05200) (0.47600) (0.06200) Tracer [A] E X P L A N A T I O N ,1 (0.00002) (ND) File: 13093-05 Arc: 13093-0S Sampling Probe Location Approximate Pipeline Location Monitoring Well Location TVHC Sample Value (mg/L) Non Detect Size:A Date:10-23-02 f e 02-13093-86 B a s h a a r C h e v r o n 2 3 0 i PANAMA LANE BAKERSFIELD, CALIFORNIA T V H C Distribution Figure 5 SECONDARY SYSTEM CERTIFICATION FORM DATE 9-25-2002 FACILITY ID Bashaar Chevron FACILITY ADDRESS 2301 Panama Lane, Bakersfield, CA 93307 UST Annular Space '"" ..-~.,k 1 Unl 87 Tank 2 Plus 89 Tank 3 Prem 91 Start Time ~'"'-- Initial Pressure 10 Hg ~'"--t~0.~g' .~- ...~"1~ Hg , , End Time ~..~-~/ Final Pressure ,....--~'"'-~ ~ -.... Certification (Signature) Single Wall Secondary Piping Line 1 Unl 87 Line 2 Plus 89 Line 3 Prem 91 Line 4 StartTime 3:30 PM 3:35 PM 3:40 PM Initial Pressure 5 psi 5 psi.~ 5 psi EndTime 4:30 PM 4:35 PM 4:40 PM Final Pressure 5 psi 5 psi 5 psi Certification Pass Pass ~ Pass (Signature) Page I of_3 SECONDARY SYSTEM CERTIFICATION FORM DATE 9-25-2002 FACILITY ID,, Bashaar Chevron FACILITY ADDRESS 2301 Panama Lane, Bakersfield, CA 93307 Turbine Sumps Sump 1 unl 87 Sump 2 Plus 89 Sump 3 Prem 91 Sump 4 StartTlme 4:10 PM 4:10 pM 4:10 PM InitlalHelght 5.761 in 6.127 in 5.581 in of Water Time 4:i5 PM 4:i5 PM 4.~i5 PM Water Height 5.761 in 6.127 in 5.581 in Time 4:20 PM 4:20 DM 4:20 Water Height 5.761 in 6.126 in 5.580 in Time 4:25 Water Height ,,5.761 in 6.126 in 5.580 in (Signature) Overfill Buckets Overfill 1 Uni 8; Overfill 2 plus ~Overfill 3 pvem q 1Overfill 4 Start Time 4: 35 p~q 4: 35 PM 4: 35 PM Initial Helght 2.134 in 1.795 in 1.012 in of Water Time 4:40 PM 4:40 PM 4:40 PM Water Height 2.134 in 1.795 in 1.012 in Time 4:45 PM 4:45 PM 4:45 PM Water Height 2.134 in 1.795 in 1.012 in Certification Pass Pass .~ pass e2of! SECONDARY SYSTEM CERTIFICATION FORM DATE 9-25-2002 " FACILITY ID, Bashaar Chevron FACILITY ADDRESS. 2301 Panama Lane, Bakersfield,CA 93307 ~C T~TING ]&~ 3&4 5&6 7&8 DISPENSER 1 DISPENSER 2 DISPENSER 3 DISPENSER 4 STARTTIME 5:00 PM 5:00 PM 5:00 PM 5:00 PM INITIAL HEIGHTOF 2.472 in 3.124 in 2.175 in 1.797 in WATER TIME 5:05 PM 5:05 PM 5:05 PM 5:05 PM WATER HEIGHT 2.472 in 3.124 in 2.175 in 1.797 in TIME 5:10 PM 5:10 PM 5:10 PM 5:10 PM WATER HEIGHT 2.470 in 3.124 in '~' 2.175 in 1.797 in CERTIFICATION Pass Pass ~ Pass Pass DISPENSER 5 DISPENSER,.,6 DISPENSER 7 DISPENSER 8 START TIME INITIAL HEIGHT OF WATER TIME WATER HEIGHT TIME WATER HEIGHT CERTIFICATION (SIGNATURE) Page 3 of__3 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING FACILITY Bashaar Chevron ADDleS 2301 Panama Lane, Bakersfield, CA 93307 PER2~ TO OPERATE # Ol 5-021-000577 OPERATORS NAI~[E Bashaar NfiJdawi OWNERS NAM~ Bashaar Najdawi NI3MBER OF TP~NKS TO BE TESTED 3 TANK # VOLUM~ IS PEPING GO[NO TO BE TESTED Yes' CO~S 1 .,10t000 Gallon 2 4,000 Gallon 3 10,000 Gallon Reqular Plus Sup. TANK TESTING COMPANY MArISNGADDKESS p.o. ~ox 1567, Bakersfield, NAME & PHONE NL~BER OF CONTACT PERSON TEST NLETHOD Incon NPdV[E OF TESTER OR SPECL~L [NSPECTOR James J. Rich CERTIFICATION # Contractors License 532878 A HAZ DATE & TI2~ TEST IS TO BE CONDUCTED Redwine Test. lng Servic. es, Inc. CA 93302-1567 Dugan Turner 661-834-6993 90-1072 APPROVED BY Wednesday, September 25th ~ 1:00 P~ DA7~ ..',..., :.;'J Environmental Testing, L.L.C. September 15, 2002 Bakersfield Fire Department Environmental Code 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301_ _ _ Attention: Steve Underwood Reference: Enhanced Leak Detection Bashaar Chevron 2301 Panama Lane Bakersfield, CA 93301 Ti ¢ : gild 4ng'i ':'ohr work plan for performing Enhanced Leak Detection (ELD) testing on thrle i35"tinde/ground'*st6iage :tanks (UST)..-Shirley-Environmental Testing, ~LC will p?ovide' Enhanced: Leak Dete6tion services to Bashaar Chevron.at the abox~e~ i~'erenced'' location. Shiiley Environmental Testing,'LLC, is a licensed affiliate of Tracer'Research Corporation providing Enhanced Leak Detection services throughout California. The scheduled work plan is to provide Enhanced Leak Detection services (0.005 gg.h sensitivity) to the above referenced facility with a technological method that meets, the,' requirements set forth in SB 989. According to the information provided by Bash~...' Chevron, there are three (3.) UST's containing motor vehicle fuel. The tanks will be inoculated with an individual Tracer. Inoculation is to be performed following strict guidelines established by Tracer Research. We would like to start the first phase of the two-day project as soon as possible. Eight probes, numbered 1 thru 8, will be installed around and between~.the-tanks to a depth of approximately 10 feet below grade. An additional 10 probes numbered 9 thru 18,. will be ~instalied't0 a depth of 12 inches to 1'8 inches below grade, along 'the vent lines ~.and..piping runs. s/tmPles may also be taken from any opplicable tank or piping"'~nmflar ' ~Pa~es (#1'9, &C.).' P.O. Box 219 · Nebraska City, NE 68410 (402) 873-4077 · Watts (800) 447-3490 · Fax (402) 873-4094 Steve Underwood Bakersfield Fire Department Page 2 of 2 Eighteen (18) discreet gas samples will be collected from the probe locations approximately 7 to 10 days from the date of inoculation. These will be collected following strict guidelines of the Tracer Research Corporation laboratory in Tucson, Arizona. The samples will be analyzed as discreet samples in addition to the spill buckets being water tested. If_you should_ha,v.e.any qu~es_tio_ns .oL r~eq~!re_ _fu~h~r jnformat, ion~ please do not hesitate to call me at 800-533-4030 or 213-610-3649. Very truly yours, Gary R. Kelly Regional Manager Shirley Environmental Testing, LLC GRK/jk CITY OF BAKERSFIELD ~ OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326"3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING FACILITY Bashaar Chevron ADDRESS 2301 Panama Lane, Bakersfield, CA 93307 PERMIT TO OPERATE # 015-021-000577 OPERATORS NAME Bashaar N6 j.dawi OWNERS NAME Bashaar Najdawi NUMBER OF TANKS TO BE TESTED 3 TANK # VOLUME 1 . 10r000 Gallon 2 4,000 Gallon 3 10,000 Gallon IS PIPING GOING TO BE TESTED, Yes' CONTENTS Regular Plus Sup. TANK TESTINGCOMPANy Redwine Testing Services, Inc. MAR/NGADDRESS P.o. Box 1567, Bakersfield, CA 93302-1567 NAME& PHONE NUMBER OFCONTACTPERSON Dugan Turner 661-834-6993 TEST METHOD Incon NAME OF TESTER OR SPECL~L INSPECTOR James J.Rich CERTIFICATION # Contractors License 532878 A HAZ 90-1072 DATE & TIME TEST IS TO BE CONDUCTED APPROVED BY DATE Wednesday, September 25th ~ 1:00 P~ SIGNATURE OF APPLICANT L D July 30, 2002 Bashaar Najdawi Chevron 2301 Panama Lane Bakersfield CA 93307 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 FIRE SAFETY SERVICES · ENVIRONMENTAL SERIRCES 1715 Chester Ave. Bakersfield, CA VOICE (661) 326-3979 FAX (661) 326-O576 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) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakmsfleld, CA 93308 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. Sincerely, , Steve Underwood Fire Inspector Environmental Code Enforcement Officer D June 30, 2002 Chevron (Bashaar Najdawi Chevron) 2301 Panama Lane Bakersfield, CA 93307 REMINDER NOTICE 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 2301 Panama Lane. 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 will be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 will 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. Sincerel2~ ·, ................ Fire Inspector/Environmental Code Enforcement Officer Environmental Services SU/kr · 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 card to you. · Att, ach this card to the back of the mailpiece, or on the front !f space permits. 1. Article Addressed to: BASHAAR NAJDAWI NAJDAWI CHEVRON ,"'~'~,1::, PANAt~ LANE BAKERSFIELD CA. 93307 A. Received by (P/ease Print Clear/y) [] Agent [] Addressee D. Is deliver from item 17 [] Yes If YES, enter delivery address below: [] No 3. Service Type ~]'Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (Copy from servi~e /abe/) 7000 1530 0006 3456 3348 PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 .34 ri -- Postage $ I~ Certified Fee 2 o 10 Postmark Return Receipt Fee 1.50 ~ (~ndorsement Required) Here r-1 Restricted Delivery Fee (Endorsement Required) ~o~ ~o~go & Foo, $ 3.94 u-I I Sent To I r-3[ "ASHAAE NAJDAWI / r~/~i~;if;~;~,'tTk~?&"Pb"~;,i,'~b; ........................................................... 2 ol ] ~ aii~,f~Z ........................................................................................ D February 20, 2002 Bashaar Najdawi Najdawi Chevron 2301 Panama Lane Bakersfield, CA 93307 CERTIFIED MAIL FIRE CHIEF 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 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 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Failure to Submit/Perform Annual Maintenance on Leak Detection System at Najdawi Chevron, 2301 Panama Lane Dear Mr. Najdawi: Our records indicate that your annual maintenance certification on your leak detection system is past due. December 28, 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, March 22, 2002, 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 Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney BSSR, Inc. -7 a'x 6630 Rosedale Hwy., # B, Bakersfield, CA 93308 Phone (661) 588-277 (661) 588-2786 MONITORING SYSTEM CERTIFICATION. This form must be used to document testing and servicing of monitoring equipment. A separate certification or report. ~ust be prepared for each m0.nitoring system control panel by the technician who performs the work. A copy o£ this form must be provided to the tank system owner/operator.~ The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Contact Person: Contact Phone No.: ( 6 {~ i ) Make/Model of Monitor/ns System: I~ MC / {:)flOg_.6Y.. ~ ~,OOOO'O c Date of Testing/Servicing: B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: {i2,~-Tank Gauging Probe. Model: ?lqO 2 6 5oq~o lOC) ~ffh-Tank Gauging Probe. Model: ~0iO2. CI Annular Space or Vault Sensor. Model: O Annular Space or Vault Sensor. Model: Ii~'Piping Sump / Trench Sensor(s).~hModel: PI~O'I Scl 9_00CIO I O iii'Piping Sump / Trench Sensor(s). x/~ Model: ~1~O2 121 Mechanical Line Leak Detector. Model: D Mechanical Line Leak Detector. Model: ~ Electronic Line Leak Detector. Model: [3 Electronic Line Leak Detector. Model: CI Tank Overfill / High-Level Sensor. Model: [1 Tank Overfill / High-Level Sensor. Model: El Qthq'(specify ~quipment type and model in Sec.tion E on Pag~ 2): Gl Other. . (specify ..... equipment type m3. d model in'Section E on Page 2). {~'[n-Tank Gauging Probe. Model: ~1~O26.5~q 60 iOO 121 ImTank Gauging Probe. Model: El Annular Space or Vault Sensor. Model: . Gl Annular Space or Vault Sensor. Model: ~15~ping Sump / Trench Sensor(s)~Modei: i:'1~}2 ~cl :Z 0/~-I O Model: ~ Sump Sensor(s). ~X ? -'"~qvlodel: L~'- ~ ~ Mechanical Line Leak Detector. Model: D Electronic Line Leak Detector. Model: D Tank Overfill / High-Level Sensor. Model: .CI Other (sp,ec!fy equipn~en.,t, type and mode,.!,,i,n. Section E on Page 2). .S.e,c[io..n, E on. Page 2)-. Dispenser ID: I -~O., ~O ~ Q Dispenser Containment Sensor(s). Model: [ii'Shear Valve(s). D Dispenser Containment Float(s) and Chain(s). .~. ~ Dispenser Containment Sensor(s). Model: ~]{~Shear Valve(s). .Gl .Dispenser Contaifiment .Float(s) and Chain(s).- . - _ . _ , _. Dispenser ID: Ci Dispenser Containment Sensor(s). Model: [3 Shear Valve(s). CIDispense[ Containment Flo,at(s) an, d Ch,,ain(s)' , , *If the facility contains more tanks or dispensers, copy this form. Include information 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' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this 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 report; (check all that apply): ffl Sy~ste .m set-u~p ~ Alarm history report Certification No.: ~ O ID -~ ~-[ " License. No.: {3~[ ;2.~ ~ ~- Testing Company Name: 12~5~}~, i~C, Phone No.:( /3(3 [ ) ~_~)'~/ Site Address: ~0~O [-~O <~IE~ iq L~ Pit/Q'/ ~i~ I-~ DateofTesting/Servicing: D Piping Sump / Trench Sensor(s). D Fill Sump Sensor(s). Model: UI Mechanical Line Leak Detector. Model: 121 Electronic Line Leak Detector. Model: 121 Tank Overfill / High-Level Sensor. Model: [~ 0t.h,.e.r (s~e?Jfy equip.,ment tYpe.~md model in Dispenser ID: Q Dispenser Containment Sensor(s). Model: [i}'S~ear Valve(s). D Dispens.er Containment Float(.s) and Chain(s). Dispenser ID:. C! Dispenser Containment Sensor(~'). Model: I~hear Valve(s). 121 Dispenser-Containment Float,s) a~.,d .C.,,hain(~),. Dispenser ID: D Dispenser Containment Sensor(s). Model: CI Shear Valve(s). [3 ?ispenser Containment Float(s) and Chain(s)_ Page 1 of 3 03/01 Monitoring System Certification O; Results of Testing/Servicing · Software Version Installed: Com )let~ the following checklist: {~"Y~s~ [2 No* Is the auch'ble alarm operational? [i}'~es [2 No* Is the visual alarm operational? ill'Yes [2 No* Were all sensors visually inspected, functionally tested, and confirmed operational? [~"'Yes [2 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? {2~Yes [2 No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) [2 N/A operational? Ill'Yes [2 No* For pressurized piping systems, does the turbine automatically shut down if the piping Secondary containment [2 N/A monitoring system detects a leak, fails to operat~or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that app'ly) [5'Sump/Trench Sensors; [2 Dispenser Containment Sensors. Did you confh'm positive shut-down due to leaks and sensor failure/disconnection? [~I%s; [I No. {/Y'~es [2 No* For tank_ systems that utilize the rtionitoring system as the primary tank overfill warning device (i.e. no ~_~___N/A _mechanical overf~ll_.prevent_ion _rally_ye ~_~s_talled), _is the ovedill_~gLai~_~ax~__vi~le.~d~audible_at_the~t~nk. ........... fill p~int(~ anal ~i~rating pr°Peri,t? If. so, at what percent of tank capacity does the a!arm trigger? ct ~ · % Yes* ~ No Was any monitoring equipment rephced? 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. Yes* [i/' No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) [2 Prgduct; [2 Water. If yes, descn'be causes in Section E~ below. [~'-Yes 121 No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable. {i]~fes [2 No* Is all monitoring equipment operational.per,,manufacturer's sp.ecifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/Ol Monitoring System Certification -._.Site Address: '_~,~01 PF"I~'-~F,('/,g:t UST Monitoring Site Plan ::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::: ......... ::::::::::::::::::::: ............................. ~l~ ~o~? .................... Date map was drawn: ~ /2 1 ./0 ~/.. Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and 'piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic 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. Page of__ o5/oo 121 Check 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 gauging equipment is used to perform leak detection monitoring.. ~ ':: Complete the following checklist: {~l~t'}s [] No* H~s all' input wiring been inspected for proper entry and termination, including t'esting for ground faults? [~es [] No* Were all tank gauging probes visually inspected for damage and residue buildup? 13t/Yes [] No* Was accuracy of system product level readings tested? [~l~Yes I-I No* Was accuracy of system water level readings tested? [~l~es [] No* Were all probes reinstalledp;operly? ' ' ~es [21 No* Were all items on the equipment manufacturer's maintenance checkiist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): [gl~eck this box if LLDs are not installed. Comple,te the following checklist: [] N/A (Check all that apply) Simulated leak rate: []3g.p.h.; []0.1g.p.h; [] 0.2 g.p.h. [] Yes [] No* Were all LLDs confirmed operational and accurate w/thin regulatory requirements? [] Yes. Q No* Was the testing apparatus properly cab'hinted? 121 Yes 121 No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? Fl N/A [] Yes Fl No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak? [] N/A , [] 'Yes 121 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled FI N/A or disconnected? I-I yes ~ No* 'For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring SYstem Fl N/A malfimctions or fails a test? 121 Yes Fl No* For electronic LLDs, have all accessible wiring connections been visually inspected? Fl N/A Fl Yes Fl No* Were all items.on the equipment manufacturer's maintenance checklist completed? * In the Section Il ~below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 o3/ot B~hE;H,4~:~RE; C:HEVRC,,N RT 2' 2;301 :.'~N,:d'.'l~ Ll,] B&KERE;F I ELD C&. 93:3/]7 661--832-4551 ,JAN :31. 2002 ,'-]-~-"q'l.' EM EF[P(I' Li.C3 I NWEI',ITOIg¥' REPORT T 1 :SUPER VOLUME ULI..&GE 905~ ULLAGE TC; VOLI.IME = 2401 HEIGHT W~TER VOL I.,,IFtTER TEMF. = 64 ,:3 DEC; F T '.2'; PL LI~:; VOLUME = 2722 ULL&GE = 126,5 90S; ULLAGE= 866 C;A1.E; HEIGHT = 48.94 INi;;HES [46~TER VC:,L = 0 D,J&T~ = 13. 013 TEP~ = 56,0 PEG F T :3: UN1..E~IbED VOLIJME = 4'?40 UL, L/~GE = 5240 90:'.'~ ULI.,~¥]E= 4242 TO ',Y,OLL.IME ~ 47:31 HEIGHT = 45.63 INC:I.tE$ ~4t4Tt-~R VOl_ = 0 C;/:~ILS WATER = 0.00 I I'4C;HE;~ TEMF' = 62.7 DEG F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~.~a r- ADDRESS ~3~3~ ~a ~u_t,~,~ FACILITY CONTACT INSPECTION TIME CJ,c~ INSPECTION DATE [[ PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program Routine I~ Combined [~ Joint Agency I~ Multi-Agency [...-] Complaint I~ 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 L,~ Proper segregation of material Verification of MSDS availability L, 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 C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy ~ Busine~tc ~esponsiblc Party Inspector: _~/~, ~'~r~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ~0 ~'~' Section 2: Underground Storage Tanks Program [] Routine ~ Combined [] Joint Agency Type of Tank Type of Monitoring INSPECTION DATE [] Multi-Agency [] Complaint Number of Tanks 2~ [] Re-inspection Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owneffoperator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate arid current k,, / Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS sPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: ~'/ Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Sit/~esponsible Party 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 Bushaar Najdawi Chevron 2301 Panama Lane Bakersfield Ca 93307 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 l, 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 REOWINE TESTING S CES, INC. P.O. BOX 1567 BAKERSFIELD, CA 93302-1567 PH. (661) 326-0446. .;. Fax (661) 326-0453 Email: redwineteSt@prodigY, net' Tank and Pipeline Experts License No. 532878 Testing · Installation · Removal · Closure HG No. 415 Monitor and Cathodic Protection Testing RG No. 5761  ~'~~ CURENT CATHODIC PROTECTION CERTIFICATION SITE:/ S_t_e_warl~s Chevron ~'~. " DATE: 1/26/00 ( _2301 Panama Lane ~ CONTACT: David Stewart  PHONE: 661-832-4551 JOB #: CONTACT: OWNER: David Stewart C P. Installation Date: t Soil Potential Readings for Previously Installed Systems [System Structure to TANK TANK' Fu~I--' Prc~J-uct Vent S or E End Center NUMBER SIZE Type Line Line at Tank of Tank of Tank Conduit 1 1 OK 87 N/A N/A -0,512 -0.519 -0,587 -0.587 2 4K 89 N/A N/A -0,65 -0,618 -0,562 -0,562 3 10K 92 N/A N/A -0.585 -0.487 -0.579 -0.579 ""' Structure to Soil Potential Readings fc~r ~evi0uSl~ installed sy'st~Eds' (System on)' .'-" . 'F .,'.j:~' TANK TANK Fuel ...., ._ Product Vent S or E End Center N or W End Electronic NUMBER ' SIZE - ' 'TyPe Line Line of Tank of Tank of Tank Conduit "1 10K - 87 N/A N/A -0,991 -0.909 -1,159 -1.159 2 4K 89 N/A N/A -1,115 -0.926 -1.413 -1,413 3 1 OK 92 N/A N/A -0,924 -0.904 -0,889 -0,889 I hereby certify that the minimum system potential reduirements ct Impressed Current C ~.cj~nodic Protection: J x JHavebccnmet Have not been met tor the systems referenced above: taken in accordance with the minimum standards of the National Association of Corrosion Engineers. and as done to comply with EPA and State Directives ct Signc~Redwine Testing Services~, Inc. Technician . . Model # JSAYSL 50-12 IN S/N # 96UT2562 ' :~ ..... ' ' Product Lines & ven~s are Fil:~er(~lbSs ' : Hours 20277 . Volts 4.5 Amps 35 LEADING THE INDUSTRY SINCE 1986 ~ CITY OF BAKERSFIELD ~FFICE OF ENVIRONMENT~SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY Page __ of __ TYPE OF ACTION [] I. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5. CHANGE OF INFORMATION ($pec/fy change - [] 7. PERMANENTLY CLOSED SITE local use only). [] 8. TANK REMOVED 400. (Check one item only) f~ 4. AMENDED PERMIT [] 6. TEMPORARY SiTE CLOSURE '..:.' .::.: :' '..' ?:::.:::::::i~,: .:::::: !'~i~ BUSINESS NAME (Same es FACiLrrY NAME or OBA - Dolng Business As) 3 NEAREST CROSS STREET 401. FACILITY OWNER TYPE [] 4. LOCAL AGENCY/DISTRICT' Ol. CORPORAT,O. O,.COU AGE,CY' · ,1~' 2. INDIVIDUAL [] 6. STATE AGENCY* BUSINESS , O 5. COMMERCIAL TYPE '"~. GAS STATION [] 3. FARM [] 3. PARTNERSHIP [] 7. FEDERAL AGENCY* 402. [] 2. DISTRIBUTOR [] 4. PROCESSOR O 6. OTHER 403. TOTAl. NUMBER OF TANKS Is facility on Indian Reservation ~ *If owner of UST a public agency: name of supervise' of REMAINING AT SITE tmstlands? div{sion, section o~ office wi?ich.op.~a!es the ~US, T. I · MAILING OR STREET ADDRESS CITY 410. STATE 411. ZIP CODE 412. PROPERTY OWNER TYPE [~3~"2: INDNIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY 413. [] 1. CORPORATION PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY T/~,At~I~ OWNER NAME ~ILING OR S~E~ ~DRESS 416. 418. ZIPCODE 419. CI~ 417. STA~ TANK OWNER TYPE ~2. INDIVIDUAL [] 4. LOCAL AGENCY I DISTRICT [] 6. STATE AGENCY 420. [] 1. CORPORATION [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY TY (TK) HQ 4 4 : Call (916) 322-9669 if questions arise - . ' . 421. INDICATE METHOD(S) [] 1. SELF4NSURED [] 4. SURETYBOND [] 7. STATE FUND [] 10. LOCAL ~V'T MECHANISM [] 2. GUARANTEE [] 5. LE'R'ER OF CREDIT [] 8. STATE FUND & CFO L~ ~R [] 99. OTHER:. 422. 1~.3: ,.suP.~CE I:] 6. EXE~m,O. [] g. S~ATE FU.O & CD Chec~ one box to Indicate which address should be used f~ legal notifications and mailing. 1~ 1. FACILITY [] 2. PROPERTY OWNER [] 3. TANK OWNER 423. Legal notifications and mailings will be sent to the tank own~ unless box 1 (~ 2 is chanked. Cefllflcatlon: I certify that the Information provided herein Is true and accurate to the best of my knowledge. / NAMe: OF APPL~q" (print), 426. ISTATEUSTFACILITYNUMBER(Forlocaluaeonly) DATE 424. PHONE ~S,~ - L2/'~C' 5 / 425: I. 7o z - TI~E OF APPLI~ 4~. 428. 1998 UPGRADE C~'~<¥iFiCATE NUMBER (For local use only) 4''I UPCF (7~99) S:\CUPAFORMS~swrcb-a.wpd Complete the UST - Facility page for all new permits, permit changes or any facility information changes. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any changes. Submit one UST - Facility page per facility, regardless of the number of tanks located at the site. This form is completed by either the permit applicant or the local agency underground tank inspector. As part of the application, the tank owner must submit a scaled facility plot plan to the local agency showing the location of the USTs with respect to buildings and landmarks [23 CCR 32711 (a)(8)], a description of the tank and piping leak detection monitoring program [23 CCR 32711 (a)(9)], and, for tanks containing petroleum, documentation showing compliance with state financial responsibility requirements [23 CCR 32711 (a)(11)]. Refer to 23 CCR 32711 for state UST information and permit application requirements. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER - Leave this blank. This number is assigned by the CUPA. This is the unique number which identifies your facility. 3, BUSINESS NAME - Enter the full legal name of the business. 400. TYPE OF ACTION - Check the reason the page is being completed. CHECK ONE ITEM ONLY. 401. NEAREST CROSS STREET - Enter the name of the cross street nearest to the site of the tank. 402. FACILITY OWNER TYPE - Check the type of business ownership. 403. BUSINESS TYPE - Check the type of business. 404. TOTAL NUMBER OF TANKS REMAINING AT SITE - Indicate the number of tanks remaining on the site after the requested action. 405. INDIAN OR TRUST LAND - Check whether or not the facility is located on an Indian reservation or other trust lands. 406. PUBLIC AGENCY SUPERVISOR NAME - If the facility owner is a public agency, enter the name of the supervisor for the division, section or office which operates the UST. This person must have access to the tank records. 407. PROPERTY OWNER NAME - Complete items 407- 412 for the property owner, unless all items are 408. PROPERTY OWNER PHONE the same as the Owner Information (items 111-116) on the Business 409. PROPERTY OWNER MAILING OR STREET ADDRESS Owner/Operator Identification page (OES Form 2730). If the s. ame, 410. PROPERTY OWNER CITY write "SAME AS SITE" in this section. 411. PROPERTY OWNER STATE 412. PROPERTY OWNER ZIP CODE 413. PROPERTY OWNER TYPE - Check the type of property ownership. 414. TANK OWNER NAME - Complete items 414- 419 for the tank owner,, unless all items are the 415. TANK OWNER PHONE same as the Owner Information (items 111-116) on the Business 416. TANK OWNER MAILING OR STREET ADDRESS Owner/Operator Identification page (OES Form 2730). If the same, 417. TANK OWNER CITY wdte "SAME AS SITE" in this section. 418. TANK OWNER STATE 419. TANK OWNER ZIP CODE 420. TANK OWNER TYPE - Check the type of tank ownership. 421. BOE NUMBER - Enter your Board of Equalization (BOE) UST storage fee account number. This fee applies to regulated USTs stodng petroleum products. This is required before your permit application can be processed. If you do not have an account number with the BOE or if you have any questions regarding the fee or exemptions, please call the BOE at (916) 322-9669 or write to the BOE at: Board of Equalization, Fuel Taxes Division, P.O. Box 942879, Sacramento, CA 94279-0030. 422. PETROLEUM UST FINANCIAL RESPONSIBILITY CODE - Check the method(s) used by the owner and/or operator in meeting the Federal and State financial responsibility requirements. CHECK ALL THAT APPLY. If the method is not listed, check ^other= and enter the method(s). USTs owned by any Federal or State agency and non-petroleum USTs are exempt from this requirement. 423. LEGAL NOTIFICATION AND MAILING ADDRESS - Indicate the address to which legal notifications and mailings should be sent. The legal notifications and mailings will be sent to the tank owner unless the facility (box 1) or the property owner (box 2) is checked. SIGNATURE OF APPLICANT - The business owner/operatOr Of the tank facility, or officially designated representative of the owner/operator, shall sign in the space provided. This signature certifies that the signer believes that all the information submitted is accurate and complete. 424. DATE CERTIFIED - Enter the date that the page was signed. 425. APPLICANT PHONE - Enter the phone number of the applicant (person certifying). 426. APPLICANT NAME - Enter the full pdnted name of the person signing the page. 427. APPLICANT TITLE - Enter the title of the person signing the page. 428. STATE UST FACILITY NUMBER - Leave this blank. This number is assigned by the CUPA as follows: the number is composed ' of the two digit county number, the three digit jurisdiction number, and a six digit facility number. The facility number must be the same as shown in item 1. 429. 1998 UPGRADE CERTIFICATE NUMBER - Leave this blank. This number is assigned by the CUPA. CITY OF BAKERSFIELD ~rFICE OF ENVIRONMENT~ SERVICES;. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326 3979 UNDERGROUND STORAGE TANK:B - TANK PAGl: 1 C~ ~. ~,w 5fie PERM? I~. Ak(ql~O PERImT C] 3. I~E/~WAL PERUT (.Ta~.O saae~ · ~. ~ use a~q,/ C] t. ~ 0F iNFORMATION) [:~ $. rEMPORARY ~4TI~ CL0~JI~ C] ~. ~W~eN~ o. oaeo ON f"l 4. T'Vl~ OF TAra( IL TANK (~'RUCTION rq ~. AWAnOa FUe. BARE EXTEmOR ~ ~ I-1 4. ~NOLE WALL IN A VAULT I"I s. ~ 0~. uu~ovm ~- ri k FRPCO&t~A'TIBL~WflO0~ METI"IA/'~:~ Og~. ~ OR COATING 447 ome~ ~ SPILL ANO OV[J~rlLL ri ~. MA~TA/~<OAUOINOIMI'O) 0 ~, 0~. V. TANK ~LOIUIII INIIOIIMATION I PIIIIIANINT G,OIURI IN H. ACI TANK FILLEO WIl'H INERT MAI'E~AL? OY# O~ ;pCP (7~gg) 8:~CUPAPORM~,gWRCB'fl'WPO i iii CITY OF 8AKER3FIEL. O (N~FIC~ OP ENVIRONMENTAL :]El~E3 1715 Ch~tm' A~., BaKertfleld, CA t3301 ~) 32~7g $1NGL'~ WALL WALt. l"1 3. UNEO TRENCt~ Cl., u~ C:] I. SINGLE WALL C:] 9:~. UNI<~¥N [:::] 2. 0OUm. E w~L [] 9g. OTHER MANUFACTURER /'l h I~,RE STEEL r-I 2. STAINLE~ STEEL ~'~ 3. PLASTIC COMPATIBLE wfrH CONTENTS [~ 5. STEEL W/COATING WI. P#qNG LEAK 0 8. FRPCOt, t~ATIBLEWI '~O0%IV~'1i4ANC, I--] T. GALVANIZ~O STEEL I-I e. R~uece (N~) ~ ~. o~ ~] g. CATHOOK: I~OTECTION UNOEROROUNO ~INGLI! WALL : PRESSUfllZEO I:~P~NO (C,~m~ M alat sawN),): r'] i. ELECTRONlCUNELF-AAOeq'EcroR3.0OPH~Wm'IAUTOPUI4a~t/TOFFFOR C:] ~' MONn~.YOJ~TEaT I-! 3. ~~~.~ o~.r) "~. AUTO I:RJI~ ~.R~r OFF WHIgq A LEA~ OCCURS I-1 c, NO AUTO F~tMP SHUT OFF A~UAL ~TEGRrrY TEST (0.1 ~ '" SUCT~N~d~A~qTY SYSq~J~ [] 13. G0~reaJ0~d~aEN~OReAUOI~EAI~VISU~L~I~ E~IEROENCY OE~ERATO~I ONLY (Gheck M M MW~) A~OVEGROUND P~NG · ~N~t.~ WALL ~R~D ~ (~ ~ ~t ~' ~ 1. ~U~~3.0~~~~F~ ~ F~U~ ~ ~ ~~N*~~ ~.~ ~ · ~Y02~ ~ 4. ~Y~~ ~ e. ~~~(o.~ ~ ~ ~N ~ (~ V~ ~ ~W ~U~ ~ 7. ~o~ ~ ~ (~ u ~t ~): ~ a. ~Y~~O~ ~ g. ~~~(O.t ~) ~R~ ~ (~ ~ ~1 ~ ~ a. A~O ~ ~ OFF ~ A ~ ~U~ ~ b. A~O ~ ~ OFF ~ ~. ~ F~U~ ~ ~. ~O~~OR 14. 15. A~O~ LINK L~ ~E~OR (3.0 ~ ~ 17. D~LY VI~ ~E~ 4~ [] ~. CONTINUOU~OL~=e~.RPANS~O4~,,AUO~LBANOVISUALALARMS ~i[ $. GONTINUOU~ O~ER PAN ~ WITH AUTO ~4UT O~F FOR OISP~NS~R * AUOIBLE ANO VI~UAL AL.ARM,.9 I"1 4. OA~YVLIUALC~ECK [] ~. T~.NCHLmm. R/Mo~a'romNO IX. OWNER~PERATOR SIGNATURe' TITLE OF OWNER/OPERATOR $:~CUPAFORMS~WRCB'~.WP O t .:._~,'~ CITY OF BAKERSFIELD Imce / ~~~ 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 ;':~' ~ '~' UNOERGROUNO STOOGE TANKS- TANK PAGE 1 --- M eUSINE3,~ ~ (~4f~,l ,Il FACIUT'Y NAk4~ o~ O~A. O~me~ ~flM$ Al) (~ $. CHANGg 0F ~NFORMAI'K)N) ~ $. rEMPORARY ~T~ CI.0~UR~ (.~.~yct~g~.~'~acM~y) I-1 a. rx.~eF.~0vEO L TANK DESCRIPTION ; I'ANK I0 ~4~2 J TANK MAMJFACTURER I O,~rEsN~T)U.~O( ) ~ j TMKC, APAcnY~NC~U. ONS NUMBER OF COMPARTMENTS O 3. o~.se. 441 rlm. o'n~ 0 ~. ~I~L~II. WI~N EXTERIOR ~ LJNI~ i--I 4. ~/~3LEWALL~IAVAULT C] & ~NGLEWALJ. WlTHIN'~BL~$'YS~ r~'~ WTERIOR ~ OR COATINO O&~ O~om~ 448 DATE IN81'AJ I Fn 447 OVERFILL PROTECT]ON EQUII~.NT: YEAR IN~TA~ tFn 1. ALARM ~ 3. F~LL TUM. SHUT OFF VALVE 2. AUT~MAT~ TANK 1. CONT1NUOUe ATO ~ 4. STATISTICAL ~I~ICONGaJATION(~Lq) 0 I. VI,~UAL(~NOL~WALLINVAULTOM. Y) C~ ~. CONTINUOUtl INTF~qSTITI~L MONITORIN~ [] 3. MA/~JAL MONITORING V. TANK CLOIUIII IIIIORMAI'I(~ I PlRMANINT CI.OIUIII IN PLAC~ 411 IIT1MATIO QU~ OF 3UeBTN, ICl ~ M~ TA/~IK FILLIO WITH ~ MA~? Or# O~ JPCF (7/gg) 3NCUPAFORMB~WRCB'O'WP 0 CITY OF BAKERSFIELD OflqCl Of ENVIRONMENTAL 171~ Cll~t~ Ave., Bakerlfleld, CA 93301 32~3979 UNOER~NO PIPINg3 SYSTEM ~P'~'[.L]~, PRESSURE CONSTRuCTIOI~'! SINC~.E WALL MANUFACTURE~. 2. O(3U~LE WALL I LL ,AC .E. r"'l 3. UN~D t~NC~ [] ce. O~ER 4~0 ABOvECd~OUNO ~ 2. SUCTION [] I. SINGL-= WALL r"l 93. UNKNO~ O 2. 0OUaLE WALL [] 9g. O~E~ MANUFACTURER t r'-] ~. ~ STEEL [] a. F~P COMPA1qm.~ ~ I00~ M~rl'HANOL ~ATER~-SANOt[] 2, STAJM,.E~qSTgEL ~ 7. GALVA.NIZ~.DSTEF. L CORROSION P,~OTECTION ii,-] 3. F~,.ASTICCOMPATI~L~flTI,~COI'~TE/~r~ I""~g~. UNKNOVfl~I 4. ~1~ [] ~ ~ (Ha~') [] ~. O~E~ S. ~I'EEL WI COATING r'l 9. CATHO~C PROTECTION 4~4 [] ~. 8A~E STEEL [] 2. STAINI.E~ STEEL PRESSURIZEO PIPfN(3 (C.~ec~ M ~t (-1 I. ELECTROMCUNELEAI<OETECTOR3~Ol=HlIL~wrI~AUTOFLMaaI~ITOFFFOR I--I 2. MONTH~YO~C~HT~T CONV~J~nONAL SUCTIC~I ~ [] 3. DAILYV1SUALMONfi'OR/NGOFPUMP~NGSYSTEM''TRIg~IALPIPII~R31h'TE(~UI'Y TEST (0. ! G~) SAFE SUCTION SYSTEM~ (NO VALV-r..9 ~N _~-~__CWV C~K)UNO [] 7. SELF MONfi'ORING GP~vITY FLOW:. [] g. Bl~ WT'EGRnY ~ (0.1 a. AUTO o. AUTO ~ c ~A~O~~F ~ Is. A~O~~~.0~~~~ SZ ~~(0.S ~) 14. ~~ ~ ~R~~ ~ 5..A~O~ L~ 16. ~NU~ I~ST(0.1 I Z. DALLY ~5~ DATE IN,~)TAJ..LED 4~ [] 2. CONTINUOfJ8 DI~PEN~t=-R PAN ~ e, ~ AND V~UAL ALARM~ ~ ' ~' ~'"/ ~ 3. CON~,~UOUS DI~P~N~R PAN ~ W~TH AUTO 8HUT OFF FOR DISPENSER * AUDIBLE AND VI~UAJ,. ~ IX, (3q~OPERATOR 8IONATUI~E [] 4. ONLY VISUAL [] S. T~ENC~ UN~_a/~3Nn'OmaO l"'] & NOI~ uPcF (7/99) 471 TITLE OF OWNER~OPERATOR 474 S:\CUPAFORMSL.qWRC"II4t'WP D CITY OF BAKERSFIELD VlC ,S 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE I ACTION 1. NEW SITE PERMIT "~ 4. AMENDED PERMIT (Check one item only) [] 3. RENEWAL PERMIT' (Specify mason - for local use only) BUSINESS HA,* M.= (Same as FACILITY NAME or DBA - Doing B~;ness As) LOCATION ~/ITHIN ~TE (O~_~_.qel) ~ [] 5. CHANGE OF INFORMATION) (Specify change, for local use only) 3 Page ~ of [] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE [] 8. TANK REMOVED 431 I 432 / TANK MANUFACTURERuy~t~,~,~ 433 / ~A~E~IZED TANK DATE INSTA~L~ ~l~ ~5 T~K ~AC~ IN ~ONS ~6 NU~ER OF ~MPAR~E~S ~7 ADOmO~L DE~CRI~I~N~r ~/use o~) - T~K USE ~9 p~m~ EOM ~PE 1. ~TOR~HIC~ ~EL ~ la. REGU~ UNL~ED ~ 2. ~ED ~ 5. J~FUEL (~ed, ~e~leum T~e) D lb. P~MIUMUNL~ED ~ 3. DIESEL ~ 6. AValON FUEL ~ 2. NO~EL~OLEUM ~1c. MIDG~DE UNLADED ~ 4. ~SOHOL ~. O~ ~ 3. CHEMI~L ~ODU~ ~ ~M~N~(~mHa~us~lsl~) ~1 ~S~(~mHaza~usMa~lsln~n~ . ~2 4. ~R~US WAS~ (l~ludes ~ ~) U~d o#) ~ 1. SING~ WA~ ~ 3. SING~ WA~ ~ ~ 5. SlNG~ W~ ~ I~L B~ER SYS~M ~3 (Checkone ~mon~) ~ 2. ~UB~ WALL ~RIOR ~NE LINER ~ gS. UN~ ~ 4. SING~ WA~ IN A VAULT D ~. OmE. [] 4. STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC (FRP) [] 8. FRP COMPATIBLE WI100% METHANOL 'Check one item only) [] 2. STAINLESS STEEL TANKMATERIAL-?-~:~ryIank [-] 1. BARE~¥~'L [] 3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEWI100% METHANOL J-195. UNKNOWN (Check one item only) ' [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE TANK INTERIOR LINING. r-/1. RUBBER LINED ~ 3. EPOXY LINING [] 5. GLASS LINING r'195. UNKNOWN 446 DATE INSTALLED 447 OR COATING 'Check one/tern only) [] 2. ALKYD UNING [] 4. PHENOLIC LINING [] 6. UNLINED r"199. OTHER (For local use only) [] 99. OTHER 445 OTHER CORROSION [] 1. MANUFACTURED CATHODIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION IF APPLICABLE Check one item only) SPILL AND OVERFILL [] 3. FIBERGLASS REINFORCED PLASTIC PROTECTION ~ 4. IMPRESSED CURRENT [] 99. OTHER [] 2. SACRIFICIAL ANODE (For focal use only) YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED (Checke..,ete,~,~ly)~ ~. SP~U. CONTAINMENT ~,{q) IF ~NGLE W~L TANK (Ch~k a8 ~at app.): 453 [] ,, V,SUAL~EX~SEOPORTIO. ~;-2. A~MATICTA.KGAUG,.G (AT?) [] :3. CONTINUOUSATG [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING [] 5. MANUAL TANK GAUGING (MTG) [] 6. VADOSE ZONE [] 7. GROUNDWATER [] 8. TANK TESTING ~99. OTHER [] 1. ALARM [] 2. BALL FLOAT ~ ~ 3. FILL TUBE SHU~ OFF VALVE ~/(~2 ~ [] 4. EXEMPT IF DOUBLE WALL TANK OR TANK IMTH BLADDER (Check one item only): 454 [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 []Yas •No UPCF (7/99) S:\CUPAFORMS~SWRCB-B.WPD UST -Tank Page 1 Complete the UST - Tank pages for each tank for all new permits, permit changes, closures and/or any other tank information change. This page must be submitted within 30 days of permit or facility information changes, unless approval is required before making any changes. For compartmentalized tanks, each compartment is considered a separate tank and requires completion of separate tank pages. Refer to 23 CCR )2711 for state UST information and permit application requirements. (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify Whether the submittal is complete and if any pages are separated. 1. FACILITY ID NUMBER - Leave this blank. This number is assigned by the CUPA. This is the unique number which identifies your facility. 3. BUSINESS NAME - Enter the full legal name of the business. 430. TYPE OF ACTION - Check the reason the page is being completed. For amended permits and change of information, include a short statement to direct the inspector to the amendment or changed information. 431. LOCATION WITHIN SITE ' Enter the location of the tank within the site. 432. TANK ID NUMBER - Enter the owner~ tank ID number. This is a unique number used to identify the tank. It may be assigned by the owner or by the CUPA. 433. TANK MANUFACTURER - Enter the name of the company that manufactured the tank. 434. COMPARTMENTALIZED TANK - Check whether or not the tank is compartmentalized. Each compartment is considered a separate tank and requires the completion of separate tank pages. 435. DATE TANK INSTALLED - Enter the year and month the tank was installed. 436. TANK CAPACITY - Enter the tank capacity in gallons. 437. NUMBER OF TANK COMPARTMENTS - If the tank is compartmentalized, enter the number of compartments. 438. ADDITIONAL DESCRIPTION - Use this space for additional tank or location description. 439. TANK USE - Check the substance stored. If MOTOR VEHICLE FUEL, check box I and complete item 440, PETROLEUM TYPE. 440. PETROLEUM TYPE - If box 1 is checked in item 439, check the type of fuel. 441. COMMON NAME - For substances that are not motor vehicle fuels (box 1 is NOT checked in item 439), enter the common name of the substance stored in the tank. 442. CAS # - For substances that are not motor vehicle fuels (box 1 is NOT checked in item 439), enter the CAS (Chemical Abstract Service) number. This is the same as the CAS # in item 209 on the Hazardous Materials Inventory - Chemical De§cription page. 443. TYPE OF TANK - Check the type of tank construction. If type of tank is not listed, check Aothem_- and enter type. 444. TANK MATERIAL (PRIMARY TANK) - Check the construction matedal of the tank that comes into immediate contact on its inner surface with the hazardous substance being contained. If the tank is lined do not reference the lining matedal in this item. Indicate the type of !ining material in item 446. If type of tank matedal is not listed, check ^othe~ and enter material. 445. TANK MATERIAL (SECONDARY TANK) - Check the construction matedal of the tank that provides the level of containment external to, and separate from, the pdmary containment. If type of tank material is not listed, check Aother-_- and enter material. 446. TANK INTERIOR LINING OR COATING - If applicable, check the construction matedal of the intedor lining or coating of the tank. If type of intedor lining or coating is not listed, check Aother= and enter type. 447. DATE TANK INTERIOR LINING INSTALLED - If applicable, enter the date the tank intedor lining was installed. This is to assist the CUPA to develop an inspection schedule. 448. OTHER TANK CORROSION PROTECTION - If applicable, check the other tank corrosion protection method used, If other corrosion protection method is not listed, check Aothe~ and enter method. 449. DATE TANK CORROSION PROTECTION INSTALLED - If applicable, enter the date the tank corrosion protection method was installed. This is to assist the CUPA to develop an inspection schedule. 450. YEAR SPILL AND OVERFILL INSTALLED - Check the appropriate box and enter the year in which spill containment, drop tube, and/or stdker plate was installed. CHECK ALL THAT APPLY. 451. TYPE OF SPILL PROTECTION - Enter the type of spill containment, drop tube, and/or stdker plate. FOp, CUPA USE ONLY. 452. YEAR OVERFILL PROTECTION EQUIPMENT INSTALLED - Check the appropriate box and enter the year in which overfill protection was installed orwhether there is an exemption from overfill protection. CHECK ALL THAT APPLY, unless tank is exempt. 453. TANK LEAK DETECTION (SINGLE WALL) - For single walled tanks, check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ALL THAT APPLY. If leak detection system is not listed, check Aothem and enter system. 454. TANK LEAK DETECTION (DOUBLE WALL) - For double walled tanks or tanks with bladder', check the leak detection system(s) used to comply with the monitoring requirements for the tank. CHECK ONE ITEM ONLY. '455. ESTIMATED DATE LAST USED - For closure in place, enter the date the tank was last used. 456. ESTIMATED QUANTITY OF SUBSTANCE REMAINING IN TANK - For closure in place, enter the estimated quantity of hazardous substance remaining in the tank (in gallons). 457. TANK FILLED WITH INERT MATERIAL - For closure in place, check whether or not the tank was filled with an inert material pdor to closure. ATTACHMENTS - 1. Provide a scaled plot plan with the location of the UST system, including buildings and landmarks. 2. Provide a description of the monitoring program. ~;iYY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICE,~t 715 Chester Ave., Bakersfield, CA 93301 (661) 3~979 SYSYEMTYPE CONSTRUCTION/ MANUFACTURER MATERIALS AND CORROSION PROTECTION UNDERGROU.DP~PING ~1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE ABOVEGROUND PIPING []2. SUCTION [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL 1~-2. DOUBLE WALL [] 95. UNKNOWN MANUFACTURER []95. UNKNOWN 461 [] 1. BARESII:;~-L , [] 6. FRP COMPATIBLE W/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN 1~4. FIBERGLASS [] 8. FLEXlBLE(HDPE) [-199. OTHER [] 5. STEEL WI COATING [] 9. CATHODIC PROTECTION 464 UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST :- [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW: [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WiTH AUDIBLE AND VISUAL ALARMS AND (Chec~ one) '~a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF 11. ~E~OT~iic~iCoNLINE LEAK DETECTOR (3,0 GP. TEST) WITH FLOW SHUT OFF OR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) Wr'FHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VlSUAL CHECK []2. DOUBLEWALL []99. OTHER MANUFACTURER UBT - TANK PAGE 2 Page of [] 3. GRAVITY 462 [] 1. BARE STEEL [] 6. FRP COMPATIBLE WI 100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W! COATING [] 95. UNKNOWN 465 AEOVEGROUND PIPING SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all ~hat apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (chec~ [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS ' EMERGENCY GENERATORS ONLY (Check all that apply) [] 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GI~H) [] 17. OAILYVISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 4~8 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING ~'--~--'~7 [:~3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDiBLE AND ViSUAL ALARMS D 6. ~NE ~9 certify that the info,~ation provide<l h~,-~;,~ L~ true and accurate to the best of my TITLE OF OWNER/OPERATOR 471 474 470 472 Permit F. xl~'atlon Date (Forlocal use only) 475 I UPCF (7/99) S:~CUPAFORMS~SWRCB-B.WPD ~ UST-Tank Page 2 (Note: the numbering of the instructions follows the data element numbers that are on the UPCF pages. These data element numbers are used for electronic submission and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary.) Please number all pages of your submittal. This helps your CUPA or local agency identify whether the submittal is complete and if any pages are separated. 458. PIPING SYSTEM TYPE (UNDERGROUND) - For items 458 and 459, check the tank=s piping system 459. PIPING SYSTEM TYPE (ABOVEGROUND) information. CHECK ALL THAT APPLY. 460. PIPING CONSTRUCTION (UNDERGROUND) - Check the tank=s piping construction information. CHECK ALL THAT APPLY. 461. PIPING MANUFACTURER (UNDERGROUND) - Enter the name of the piping manufacturer. 462. PIPING CONSTRUCTION (ABOVEGROUND) - Check the tank=s piping construction information. CHECK ALL THAT APPLY. 463. PIPING MANUFACTURER (ABOVEGROUND) - Enter the name of the piping manufacturer. 464. PIPING MATERIAL AND CORROSION PROTECTION (UNDERGROUND) - For items 464 and 465, check the 465. PIPING MATERIAL AND CORROSION PROTECTION (ABOVEGROUND) tank=s piping material and corrosion protection. 466. PIPING LEAK DETECTION (UNDERGROUND) - For items 466 and 467, check the leak detection system(s) used 467. PIPING LEAK DETECTION (ABOVEGROUND) to comply with the monitoring requirements for the piping. 468. DATE DISPENSER CONTAINMENT INSTALLED - If applicable, enter the date that dispenser containment was installed. 469. DISPENSER CONTAINMENT TYPE - Check the type of dispenser containment mohitOring system. SIGNATURE OF OWNER/OPERATOR - The owner or agent of the owner shall sign in the space provided. This signature certifies that the signer believes that all the information submitted is true and accurate. 470. DATE CERTIFIED -' Enter the date the page was signed. 471. OWNER/OPERATOR NAME - Print the name of signatory. 472. OWNER/OPERATOR TITLE - Enter the title of the person signing the page. 473. PERMIT NUMBER - Leave this blank, this number is assigned by the CUPA. 474. PERMIT APPROVED BY ' Leave this blank, this is the name of the person approving the permit. 475. PERMIT EXPIRATION DATE - Leave this blank, this is completed by the CUPA~ EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Service~ within 30 days of any changes to the momtoring procedures, unless required to obtain appwval before making the change. R~quired by Sections 2632(d) and 264 l(h) CCR. Facility Address - If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up fi.om the secondary containment within 8 hours, or deteriorate the secondary contain_ ent,.then the Office ofEnvi, ronmemal Services, must be nqtified within24hours. O~e~dl~ ~ ~.._, Al~Jr~ ~. ~U/~d~'~ Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substance. .['a~, ~, gte- Describe the location and availab~ty o,f t,he required c~,anup .equipment in item 2 above. Describe the maintenance schedule for the cleanup equipment: List the name(s) and title(s) of the person(s) responsible for authorizing any work neces~y under the respo.se plan: /b ~-~. S ~ ~ /t/~ ~ dZ~-,/,, f2~ WI~fEN MONITORING PR~EDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM Facility F~-~ility Address Describe the frequency of performing the monitoring: Be What methods and equipment, identi~ed by name and model, will be used for peffomin~ the monitoring.'. Piping Lc it Describe the location(s) where the monitorin~ will be performed (facility plot plan should be attached): List the name(s) and dUe(s) of the people responsible for per~rming the monitorin~ and/or maimaining tho equipm~t: Eo Reporting Format for monitoring: Tank Piping Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance w~i~h t/h~ man.ufa .em~. ~, maintenance sehednl. but not le~s than every 12 months. ~ Describe the training necessary for the~pera}ion ofUST syste~t,~ inclu,ding pipin~ 'and the monkoringequipment: .Ott}~r '~ttt~dcnr- k.~,~, h_~t,~ "t'O cO~dt CERTIFICATION OF FINANCIAL' RESPONSIBILITY F""""1% mm~ doUmrm per amm~m~ ~ :% mialom do&lAtin mm~J mlin~mnm hereby certifies that it i~ in compliance with the ~fl~kemen~ af ~eeetion 2807, Article $, Chapter 18, Oivi~ion 3, T~tle 23, California Code of Regulations. The rnechani~r~ ~ to ~te ~1 resl~or~ibil~ as r~qui~ed by Section 2807' are as follow~: ~t_~: ff yoU am usi~g tl~ Stmte Fur~d a~ any payt of j~ur demormtration of ftnancia/re~pons~ ~ ~ ~ ~ of thi~ ce~.___t~_rt al~o ce~ifie~ that you are in compliance with all conditions for particlpatton in the Fund. ~ tfmm PLease ~ o4' prfflt ctwty eta ~M~tfm m Certlflcatt~ of Fl~iet l~ibiLl~ f~' ALL fKftltf~ ~ site W g ~lt. My ~ tiit~ ~ ~ fern; therefore r~l~ for e~ alta. g. i ~ T~ W - FuLL ~ of either the tank o~r or the Gaiter. r~fbltiW either as Cmtllm in the fret ~tlti~, art N, SKein 2~.~ thr~ 280.10~ (aN FI~IiL R~fbiLl~ ~1~, for mrs infomti~), or SKtt~ 2~2.1, ~ter 18, / ~ I~ - List ILL ~ ~ ~rflses of c~ifl ~or f~ivl~ts is~i~ ~rlge. or file ~ as I~lclt~ ~ ~ or ~t. (State F~) let. bL~.) ~ K - l~icite ~t of c~rige'~*for e.~ t~ of ~im fa f~icat~, total ~C mt 1~ of at--fat, r~fbftl~ for ~ ~i~ - l~icate the effKgive dageCs) of at L fi~iaL ~i~s). (STate F~ cMrfle ~td ~ cmti~ as t~ as y~ min~atn ~tf~e ~ rmin eLigibLe to c~Cf~ ~rtfci~tf~ in the F~.) corr~tl~ ~tJ~? (If ~J~ State F~, J~Jcate ~".) ~CJ~ thi~ ~rty ~atJ~? (If ~J~ State F~, J~Jcate ~".) ProvJ~ aLL f~TtJty ~/or site ~ 8~ ~rm~. Ce O. FaciLity - lMtlm E. SJgrmture lLoc~ - Pro~fde signature and date signed by tank miner or operator; printed or typed name and title of tank mr or operator; signature of .Jtflass or no(fry ~fld date signed; and printed or typed nome of witness or notary Cfi notarY signs as witness, please place notary seal next to flotary~s signature). Mute to NaIL Certification: PLease sixl original to your Local egeflcy Cegeflcy ~ho Issues your UST permits). certiffcatJo~ it each foclilty or site Listed on the form. ICcp · copy of the Quietens: if you have questions on financial respc,-~ibiLity recluireamflts or on the Certification of Financial geolxxMibf.iJt¥ Form, please contact the State UST CLeanup F~rxd at C916) 739-2475. _Note: 7~---Ltle for FaiLure to C_~--'!v with Financial Ile~slbitftY I~eouirmante: FaiLure to camiy my result iff: (1) Jeopardizing ciaJmoflc eLigibiLity for the State UST CLeanup FLg~d, ~ (2) LiabiLity for civil penalties of up to S10,000 doLLars per clay, per ~Jergrou~J storage tank, for each cloy of violation as stated in ArticLe 7, Section 25299.76(a) of the CaLifornia HeLth and Safety Ced~. https:/, Summary Screen ~Poli~ywid® Ciptions/Additional Coverages Auto iService Plus Endorsement LlaMIity Himd Auto Non.ned Auto Building Covemgo8 Building 1 230 ~anama Lane, Bakersfield, CA, 93313 Building Limit: $175,0~ Replacement Cost Additional Buildlflg Covoragos Liquor Liabili~ Coverage BPP Limit: Limit Limit Limit TOTAL Premier Businessowners Premium $2,393 b2.alliedir~ urance, eom/e°mmercial/VirtualHTML/ARA020print.htm Included $1,000,000 $1,000,000 $60,000 $1,000,000 Page 2 of 2 Quo ht~ps:Z ~ SummarylScreen ~' To prtnt, olick here, then FILE, PRINT. Allied Insurance Commercial Account Quote Summary Prepared For: DBAi Quo~,e Number: Effective: Bashaar Najdawi Bashaar's Chevron Bakersfield, CA 93313 ACP7800916671 05112/2001 TO 05/1 2/2002 By: Ska/Stockdale Insurance Agency 05670 Coverage Type Premium Premier Business Owners $2,393 TOTAL $2,393 Allledioffers flexible payment plans to meet your needs. If you choose the flexible payment option, the down payment needed to issue this account is 25% of the total annuaJ premium. For the quote provided above the down payment would be $595. This~is only a quotation, coverage is not bound, Issuance of this account is subject to the following: -Underwriting review and approval -Acceptable inspection of operations Thank you for chooalng Allied for your Commercial Insurance needs. Premier Business Owners Quote Summary Policl wide Coverages Liabili' Limit Per Occurence $1,000,000 Aggregate $2,000,000 Medical Payments Per Person $1,000 Prope~ ~y Deductible $500 ~b2.alliediniurance.com/commercial/VinualHTML/ARA020pfint.htm Page 1 of 2 5/11/01