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HomeMy WebLinkAboutUNDERGROUND TANK ENVIRONMENTAL AND GENERAL ENGINEERING Underground Fuel Tank Management Exploratory Drilling & Monitoring Wells Hazardous Waste Site Assessments Bioremediation Remedial Design e Control 3711 Beverly Boulevard. Los Angeles, California 90004-0337 Attention: Mr. Ron Pelham, President LIc #371497 Analytical Testing Hydrogeologic Testing Asbestos Surveys Environmental Audits Regulatory PermiHing RECEIVED ~#AY 1 1 1992 SAMPLE COLLECTION AND REMOVAL OF ONE UNDERGROUND STORAGE TANK DEWEY PEST CONTROL 2138 Q STREET BAKERSFIELD, CALIFORNIA. I I I Dear Mr. Pelham: Enclosed is Excel Environmental and General Engineering (EEGE) final report for sample collection and closure by removal of one (1) underground fuel storage tank, previously in operation at Dewey Pest Control facility, located at 2138 Q Street, Bakersfield, California. The work completed consisted of: (1) excavation, decontamination, removal and disposal of one underground fuel storage tank, (2) soil sample collection and analysis from beneath the storage tank location and, (3) submittal of a final closure report summarizing results of all field engineering and analytical testing. I I Results of laboratory testing of the soil samples collected on April 21, 1992 indicate that the underground storage tank previously in operation at the site did not significantly challenge the surrounding subsurface environment. '15725 Texaco Avenue, Paramount, California 90723 · (213) 529-2511 o Fax (213) 529-2092 I I I I I I I I I I I I I I I I I I I Dewey Pest Control MAY 4, 1992 Page 2 EEGE appreciates the opportunity to provide environmental management services for Dewey Pest Control and Donald F. Ortmann, Inc. Should you have any qUestions or require additional information, please call'me at (310) 529-2511. Sincerely, Klaus P. Wojak, . . ., R.E.A. KPW/tw JCLS2023 cc: Bakersfield City Fire Department Hazardous Material Div. 2130 "G" Street Bakersfield, CA 93301 Attn: Ralph E. Huey, REA I I .I I I I I I I I I I I I I I I I REPORT SAMPLE COLLECTION AND REMOVAL OF A UNDERGROUND STORAGE TANK DEWEY PEST CONTROL' 2138 Q.STREET BAKERSFIELD, CALIFORNIA. Project J0492023 Prepared For: DEWEY PEST CONTROL 3711 Beverly Boulevard. Los Angeles, California 90004-0337 .Prepared By: Excel Environmental and General Engineering 15725 Texaco Avenue Paramount, California 90723 (310) 529-2511 FAX (310) 529-2092 May 4, 1992 I I I I I I I I I I I I I I I I I I I TABLE OF CONTENTS ITEM 1.0 Introduction 1.1 Purpose and Scope of Work 1.2~Background 2.0 Field Engineering '2.1 Tank Closure Operations 2.2 Soil Sampling 3.0 Laboratory Testing 3.1 Method of Analysis 3.2 Results of Analysis 4.0 Conclusions Enclosures: Figure 1 - Site Plan And Sample Collection Locations Appendix A - Laboratory Reports Appendix B - Chain of Custody Documents Appendix C - Hazardous Waste Manifest Appendix D - Tank Disposal Receipt Appendix E - Permits PAGE 1 1 1 1 1 2 2 2 2 3 I I I I I I I I I I I I I I I I I I REPORT SAMPLE COLLECTION AND REMOVAL OF ONE UNDERGROUND STORAGE TANK DEWEY PEST CONTROL 2138 Q STREET BAKERSFIELD, CALIFORNIA. 1.O INTRODUCTION This report summarizes tank closure operations recently completed at Dewey Pest Control, located at 2138 Q Street, Bakersfield, California. 1.1 PURPOSE AND SCOPE OF WORK As per State, and County guidelines governing the storage and handling of regulated materials, the subject site has been.mandated to comply with current regulations regarding the subsurface storage of regulated materials. The work completed consisted of the closure by removal of one underground fuel storage tank. Additionally, two (2) . soil samples were collected to verify if the underground fuel storage tank had challenged the integrity of the surrounding subsurface environment. 1.2 BACKGROUND Dewey Pest Control engaged the services of.Donald F. Ortmann, Inc., to perform the following: (1) rinse, dispose of rinsate and certify the .underground storage tank as non- hazardous, (2) collection of soil samples from beneath the previous tank location and, (3) summarize results of field engineering and laboratory testing in a final tank closure report. Included herewith is a summary of all field engineering and results of laboratory testing for the soil samples colleCted from the subject site. 2.0 FIELD ENGINEERING 2.1 TANK CLOSURE OPERATIONS On April 21, 1992, Donald F. Ortmann, Inc. properly cleaned the underground fuel storage tank at the Subject site. The tank was sufficiently pressure rinsed until satisfactory lower explosive limits and total oxygen content levels were achieved. The tank was then removed and transported to Golden State Metals, Inc., 2000 E. Brundage Lane., -I I I I I I I I I I I I I I I I I I I Dewey Pest Control May 4, 1'992 Page 2 Bakersfield, California. Waste manifests for all tank rin~ate and tank disposal forms have been included in Appendix C and Appendix D respectively. 2.2 SOIL SAMPLING Upon completion of tank removal operations soil samples were collected from the subject site utilizing a backhoe tractor. Soil was recovered from two sample locations under the direction of Ralph Huey, of the Bakerfield City Fire Department. (please see Figure 1 - Site Plan and Sample Collection Locations). All samples were packaged in 250 milliliter Quorpac glass jars, sealed with a Teflon-lined lid, labeled, and immediately placed on ice in an ice chest until received by a state certified analytical laboratory for testing. Laboratory results and Chain of Custody Documents have been included in Appendix A and Appendix B respectively. 3.0 LABORATORY TESTING 3.1 METHOD OF ANALYSIS Laboratory samples were collected, maintained, prepared and analyzed according to Test Methods for Evaluatinq Solid Waste, (SW-846), Third Edition, November 1986. These methods as prescribed by the Environmental Protection Agency (EPA) provide test procedures which determine whether the sample is considered a hazardous waste within the definition of the Resource Conservation Recovery Act (RCRA). Soil samples collected from the subject site were submitted to a state certified analytical laboratory for testing. Samples submitted for testing were analyzed in accordance with EPA test method 8015 and 8020. 3.2 RESULTS OF ANALYSIS Results of laboratory testing for soil samples collected at the subject site indicate that the underground fuel storage tank has not significantly challenged the surrounding environment. Results of laboratory testing are summarized on Table 1: I I I I Dewey Pest Control May 4, 1992 Page 3 TABLE I I I I I I I I SUMMARY OF LABORATORY TESTING DEWEY PEST CONTROL BAKERSFIELD, CALIFORNIA. SAMPLE SOILS 8015 (ppm) (1) 8020(ppb) (2) TRPH B T X EB 1 - Center 6" 2 - Center 2' Notes: (1) ppm: (2) ppb: (3) ND: 1.2 25 23 65 21 ND(2) ND ND 8 ND Parts per million; equivalent to milligrams per kilogram. Parts per billion; equivalent to micrograms per kilogram. None Detected. I I I '1 I I I I For a complete review of all laboratory rePorts for Soil samples submitted for testing, please see Appendix A. 4.0 CONCLUSIONS In accordance with State, and County guidelines for the regulation of regulated materials stored underground, Donald F. Ortmann and EEGE have completed all onsite work necessary to close one underground fuel storage tank at the Dewey Pest Control facility located at 2138 Q Street, Bakersfield, California. Results of soil sampling indicate that the surrounding environment has not been significanly challenged. EEGE appreciates the opportunity to provide Dewey Pest Control and Donald F. Ortmann, Inc. with environmental management services. If you have any questions or require additional information, please call me at (310) 529-2511. I I Dewey Pest Control May 4, 1992 I Page 4 This report, including all related activities, was prepared I or conducted under the direct supervision of State Registered Environmental Assesor. Our professional services have been performed using that degree of care and skill I ordinarily exercised under similar circumstances by other engineers practicing in this field. No other warranty ' I expressed or implied, is made as the professional advice to in this report. Sincerely, , I I I I I I I I I I I I I I I I I I FIGURE 1 SITE PLAN AND SAMPLE COLLECTION LOCATIONS I I I I I I I I I I DEWEY PEST CONTROL 2 138 "Q" STREET BAKERSFIELD, CALIFORNIA 22ND STREET GATE GATE ~ ~ ._STORAGE AREA L~ 1.OO GALLON ~_ OAS TANK Ld Z SAMPLE 1 - 6" BELOW TANK BOT~'OM CENTER SAMPLE 2 - 2, BELOW TANK Bo"FrOM CENTER I COVERED PARKING AREA ADJACENT PROPERTY PROJECT NO.: J0492023 DRAWING NO.: 92DR1023 DATE: M~AY 1, 1992 10 20 30 40 , SCALE IN FEET ' ~' AN D, Field Engineer: W. Woiak GENERAL ENGINEERING Drawn By: K. Wojak ~~~/ 15725 Texaco Avenue, Paramount, CA 90723 Approved By: E. Ancheta '""-]~~ (310) 529-2511 FAX (310) 529-2090 I I I I I I I APPENDIX A LABORATORY REPORTS I I I I I I I I I I I I -F- l ! I I I SCS ANALYTICAL LABORATORY Excel Environmental and General Engineering 15725 Texaco Avenue Paramount, CA 90723 Attn: Klaus P. Wojak Job No.: 0690033 April 28, 1992 Page 1 of 3 2860 %VALNUT AVENUE LONG BEACH. CALIFORNIA 90806 1310) 595-9324 FAX 1310) 595-6709 LABORATORY REPORT I I I I I I I I I I Samples: Two (2) soil samples from Dewey/Bakersfield, received 04/23/92 and analyzed 04/26/92 and 04/27/92. (5 DAY RUSH ANALYSIS) Sample ID EPA 8015 (M) mg/L-~ 1 Center 6" 1.2(G) 2 Center 2' ND Detection Limit 0.5 (M)= Modified (G) = Gasoline ND = Not Detected EPA 8020 - See attached sheets. Loree R. Kenyon'~//'' Chemist Lam V. Ho PhD, REP Vice President excel157.rep I I I I I I I I I I I I I I I I I I SCS ANALYTICAL LABORATORY Addendum Report, EPA 8020 Page 2 of 3 Sample I.D.: 1 Center 6" Date Received: 04/23/92 Date Analyzed: 04/26/92 Matrix: Soil Project ~: 0690033 File #: excel157.rep Compound Benzene Chlorobenzene Ethylbenzene Toluene Xylenes 1,2-Dichlorobenzene 1,3-Dichlorobenzene 1,4-Dichlorobenzene Result D.L. -~g/kg (ppb) 25 5 ND 5 21 5 23 5 65 5 ND 5 ND 5 ND 5 D.L. = Detection Limit ND = Not Detected I I I I, I I I I I I I I I I I I I I I SCS ANALYTICAL LABORATORY Addendum Report, EPA 8020 Page 3 of 3 Sample I.D.: 2 Center 2, Date Received: 04/23/92 Date Analyzed: 04/27/92 Matrix: Soil Project #: 0690033 File #: excel157.rep Compound Benzene Chlorobenzene Ethylbenzene Toluene Xylenes 1,2-Dichlorobenzene 1,3-Dichlorobenzene 1,4-Dichlorobenzene Result D.L. .~g/kg (ppb) ND 5 ND 5 ND 5 ND 5 8 5 ND 5 ND 5 ND 5 D.L. = Detection Limit ND = Not Detected I I I I I I I I I I I I I I I I I I I ................................................. ............................ SCS ANALYTICAL LAIBORATO~Y ~ Quality Assurance Addendum Report Page i of I EPA 8015/8020 Surroqate Spikes Lab ID 8372-0 8372-1 Control limits # Outside limits % Completeness aaa-TFToluene ---% Recovery--- 82 91 50/124 0 100 Matrix Spikes Lab ID 8365-33 Spk. 74 69 8365-33 Spk. Dup. 72 66 RPD 2.7 4.4 Control Limits 54/114 45/122 # Outside Limits 0 0 % Completeness 100 100 Benzene Toluene ...... % Recovery ..... Notes: Note that Matrix Spikes are not project specific. Therefore, spike information shown on this report may not be from the same project; however, they were analyzed in the same analytical batch. Definitions: Spike: A sample from the analytical batch which has been spiked with the parameter(s) of interest at a known concentration and taken through the same preparation and analysis as the samples. Spike Duplicate: A duplicate of the spiked sample, taken from a separate aliquot of the sample. RPD: Relative Percent Difference between a Spike and a Spike Duplicate (or a sample and sample duplicate). RPD = [ (Spike-Spk. Dup. )/Mean] * 100 Where the mean is the average spike recovery of the matrix spike and the matrix spike duplicate. Control limits are calculated by SCS Analytical Laboratory for internal use from existing spike data. Control limits are found by calculating three standard deviations above and below the mean of the population. exce157.qa I I I I I I I .I I I I I I I I I I I I APPENDIX B CHAIN OF CUSTODY DOCUMENTS CHAIN OF CUSTODY RECORD REQUEST FOR ANALYSIS COMPANY NAME: ,,~*..-'.,,..,-~ CARRIER: - ~ ~ TURNAROUND TIME REQUIRED: ADDRESS: ~ 5 ?",',7~ ~'- "'- / ~ / ,'"' ~"";"'~'~ .... ~- ."~ L_~-~- SHIPMENT DATE : "" ,/'"~-~- 5-DAY[~] L.J-- PHONE NUMBER: , ~*/' '-"'~ ~ ..~ -~'~,, ? [ ~ 3-DAY PROJECT NAME : ~,.,.~,.~;~.~,~..,, /' .~.,.~.?..(.~[~.;.~_/~.~_~ ANALYSES REQUIRED LAB ONLY PROJECT ADDRESS: ." PROJECT NUMBER: /~ ~ ~* /'5 SAMPLER NAME AND SIGNATURE:~*~ ~.' , i ~ ~, .~ r , I . ; ~ REPORTSTOBESENTTO: ~.7..;._.;T,.~ , ,,~-- /' / ,..~.. SAMPLE SAMPLE SAMPLE SAMPLE SAMPLE CONTAINER DATE/TIME FIELD FIELD FIELD SPECIAL PROGFIAM '"- ' CONDITION I.D. NUMBER DESCRIPTION MATRIX PRESERVATIVE(S) SIZE/TYPE COLLECTED TEMP. pH EC REQUIREMENTS OR ';' ' UPON EPA. SOP & QAM REF ~ RECEIPT SPECIAL INSTRUCTIONS / COMMENTS: RELINQUISHED. .. ...... BY: (Signature) l('N,.~ ~ .~ DATE: RECEIVED BY: (Signatute),~ RELINQUISHED BY: (Signature) DATE: RECEIVED BY: (Signature) , ~ ' "Z. ~ - %-,~ ,..-~./x.~' ~.~..? coMPANY T ~ ~ ~i TIME: COMI3ANY: COMPANY: TIME: COMPANY: 02 / 91 SCS ANALYTICAL LABORATORY I I I I I I '1 I I APPENDIX C HAZARDOUS WASTE MANIFEST I I I I I I I I I ~lale al Calilornla~aallh and Well.re Agnncy . Form Approve,d~OblB No. 20.50---0039 (E~p]r&a 9-3q;91) See Instructions on Back of Page 6 Deparlme~i of Henlth Servic,~ PI.ale print or tyoe Form deal;/ned for u~e on elite/'"-pitch typewriter). .".. and Front of PaQa 7 ,, . . · ,. Toxic Subatancel Conlrol Dlvie;, ~ k UNIFORM HAZARDOUS'. Jenerator'l US EPA ID No. . ' Manlfeal 2. Page 1, J Information in the ah.dad areal :~ .......... · m an re~pe~a n re e~ canal Y p '.:,~: relent and f - . , . he pra~lcable melhod of treelmenl,'~to ' :, ~ P . ~ur~ threat to hume, heath and the'en~ . , .... _: ... floe. · ' .~' ', oeneraflon aha ee e~ Ih. beat wa.re mane- . ~_ ..... .~ ~R, !f ~ ~ ~ '.mall quant~ oenerat~ I have made ' m~lle.t cap! a..n° ~Rev. -89) Prevloul edltlonn are obnolele.' ' ': ' '; ' . "; -! "~':' '" ':" :: :i: · . ' ~.~; :: ~.. · '. .... ' . , .... : . __ - . . ,~..'. .. · ... ".. : ,' .- ':.':?,,.. ::~!~.., :.; ~,.,.:; : , :~ .:. ~..., ..~ .. · ' ' - · .'.' -' ".~ ..~;.~'-'~j.: .",,,, i~"":'. '..' :.,:'::.,,: v', :.:,".i," ' ." .';::' ?, ' GREEN= HAULER RETAINS . :; . .'.,.,: ",,....'..: .-,,,:. ,'. ..' ,.: ,. ,~:':: :-..":.;:~,.:!~ :,, ~'. Q,. ,:, . ~,:: :,:,..'!',':. ?,::'.' :,.,,.,:,,...;,, ....:.;.::.:::. ':~.,'::,,::.....: .: ... ~,-:..:.;. , . , ,. ' ' .' ," · ..; '.. · .* "~';' .-:,4'~' .".',,' ".' ;:',./,.': ,.'.~." ;'-~ ':."q/.'' ~ ' ~.'.,;~:,!' "~", ,,' .'.:.c:,~',," ,' *'; -.'., :,..,' :":~,.,.': " .,'" ' * ~" · ~ ' · * ~- ' ~ ..... ' ' '~'", : · ' ',~ ~;' ~"~. ,'~' ~ "?'.,, ~,", '~'.,:' '";'; ?7'::: ",'"',,'%, '..' ~'.' '~;':"~! ': GIBSON OIL &~REFINING CO., INC. WEIGHT TAG NUMBER I C ARRIER #1 CARRIER ,., .,,.: 1:.~4.," ...,,,~.;~.<... I ARRIVED TO UNLOAD 3300 TRUXTUN AVENUE, SUITE 200 BAKERSFIEL0,~3A. 93301 ..... (8 13 · i\~t , -..-- .~" '.~ ',::.-. I DESTINATION: GIBSON OIL REFINERy COMMERCIAL DRIVE BAKERSFIELD, CA. 93308 RELEASE # I COMMODITY ZK. > II I I I I I LOADED FROM LOADER'S SIGNATURE REMARKS .. I I I I I AM PM QUAN~TY START TO.UNLOAD AM PM UNLOADED TO DRIVER'S SIG,~IATURE , DATE I~ANIFEST # INVOICE TO: ¥ ,;.,,. ,, ... TEMP. FINISH UNLOADING IGRAV. AM PM PRICE: NET GALLONS/BBLS !SOLIDS % WASHOUT ~A~LONS DEDUCT B S & W % NEf ]ARRELS RECEIPT TICKET 62182 I I I I I I I I I APPENDIX D TANK DISPOSAL RECEIPT I I I I I I I I. I I GOLDEN STATE METALS, INC. P. O. Box 70158 · 2000 E. Brundage Lane Bakersfield, California 93387 Phone (805) 327-3559 · Fax (805) 327-5749 Gc['~p Metals, Processing & Recycling Phone .No. 'N© 10258 TA, K DISPOSAL FORM- Contract°rr~ License No. Contractor's ,_~(~),..,~ _ //~ / DESTINATION: HAULER: ~y~ ~ WEIGHT CERT. NO: '"~ ~._.'~_ 2 ~ G. S.M. · 2000 E. BRUNDAGE LANE · BAKERSFIELD, CA 93387 Iv'l CLEAN & DRY (AccEPT), OR [] RESIDUALS PRESENT (REJECT) LEL READING OXYGEN CONTENT DISPOSAL FEE ~SCRAPVALUE __OTHER QTY GALLONS SERIAL NO. NET TONS 250 .14 550 .24 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ............. :::::::::::::::::::::::::::::::::::::::::::::::::::::::: 1000 - 6 It .61 ~i.i?~!~i~i~i.i.i.i~i.i?~!~i.i~?~!~i~i~!~i.i~i.i.i.~i~~~.~::~:~.~.~:.~:~.~::~::~::~::~:~.~.~.::.::~::~:~i~i~~ 2000 .97 3000 1.32 5000 2.42 7500 3.28 ~~i!iii!!i~i?~:;~!i!!~._...__....... · euu, ~:~ ::::::::::::::::::::::::::::::: ................................... ...... 12000 4.93 TOTAL TOTAL represents acceptance of terms for payment, and confirms that tank removal complies with State laws. CONTRACTOR'S SIGNATURE I ~ CERTIFICATE OF TANK DISPOSAL / DESTRUCTION THIS IS ~O} CERTIFY T~RECEIPT AND ACCEPTANCE OF THE TANK(S)AS SPECIFIED ABOVE. ALL MATERIAL SPECIFIED WILL BE COMPLETELY D~STR~.,y~D FOR SCR~P)RECYCLING PUI~,SES ONLY. I WHITE -- Contractor Copy · YELLOW-- File Copy · PINK-- Permanent Copy FIRE EOU~PM~NT SAFETY EQUIPMENT. ' ~ ' 101 TRUXTUN AVE · 2~F. WA~S (~) 272~ . HYDROSTATIC TESTING,, LICENSES ' ,.' BAKERSFIELD, CA 933u~ ORDER DESK F~ (~) 322~127 ]L~Y~*STATE e~6 'q '. CA. CORP FED. I.D NO.e~-2~ee4tl. OFFI~FAX(~5) 3~ 84842 ~' Oty, : ?, .; ,.- :. Descriplion..=. · . Price Amoun! '/"'* 'DRy ICE'BLOCKS r'l SOLID J2]/'CUT ..~"'(,,) Lb~. ~..'~" .~:3"'~'; ~:'!i;... DRY ICE PROCESS CHARGES .. .~:'~. ~ CO~ BULK WEIGHT TICKET # Lba. i,' '":' CO, CY,LINDERS ." t~. '~" · HELIUM CYLINDERS cu. Fi. ",. ' NITRO.GEN CYLINDERS. cu. CYLS, DELIVERED CYLS. RETURNED HYDROSTATIC TESTS " ,, ,. ~ CASH ' n CHARGE TtIANK YOU' TAX ..!.: ,;. "~'; .:~.~WILL CALL '1-1 DELIVER TOTAL I I I I I I ::."MATERIAL SAFETY DATA SHEET "~"· ',.: AVAILABLE ON REQUEST · REMIT TO: P.O. BOX 1631 BAKERSFIELD, CA 93302-1631 I TITLE TO ALL ABOVE ENUMERATED PERSONAL PROPERTY OR REN~'ALS SHALL REMAIN WHOLLY IN BRAND DRY ICE UNTIL FULLY PAID FOR AND VENDEE.SHALL BE RESPONSIBLE FOR SAME WHILE IN HIS POSSESSION AND i:..WILL SURRENDER SAME UPON DEMAND IF IN DEFAULT. IT IS ALSO AGREED THAT, IF COLLECTION IS MADE BY : . SUIT OR OTHERWISE, I/WE AGREE TO PAY A FINANCE CHARGE OF 1.5% PER MONTH, WHICH IS 18% PER ;~&NNUM AFTER 30 DAYS ALSO COLLECTION COSTS AND NCLUD NG ATTORNEY'S FEES AND WAIVE ALL ':.'* RIGHTS TO ANY CLAIMS EXEMPTED UNDER STATE LAWS. MINIMUM INTEREST CIIARGE $$ 50. '. I :'~i. BABI~ ON WHICH CYLINDER8 ARE LOANED: PROVIDED THAT IF ANY LOANED CYLINDER NOT RETURNED .i WITHIN 30 DAYs FROM DATE OF SHIPMENT THE D S'[RIBU'[OR RESERVES IHE R Gill TO MAKE A RENTAL f,!CHARGE OF $4.00 PER CYLINDER PER MONTH FOR ALL TIME OVER 30 DAYS THAT SUCH CYL NDER S AWAY ':,'* FROM THE DISTRIBUTOR, WHICH DEMURRAGE CHARGE THE CUSI'OMER AGREES TO PAY ON ~EMAND. TIlE ~ CUSTOMER ~HALL PAY P~OMPILY ON DEMAND TO THE DI~TRII}HTOR ES1A[iI.ISHED VAI UATIONS AND llA1E.~ i , ,~FOR LOSS OF OR DAMAGE TO ANY OF SAID CYLINDERS OR FITIING1, S RESULTING F~IC}M ANY CAIJ~,E AFIER ' ."~. DEL VERY THEREOF TO THE CUSTOMER AND UNTIL RETURNED TO TH6 DISTRIBUTOR HEF LL NG OF CYLINDERS ~'?,i~18 PflOHIB TED, , ;'~'~::;~;:.-.~.~':,' . . ' '..~ .. ' I ~,~.,-,- .~'...', .'.L~ . .'L. ' . ' I I I I I I I APPENDIX E ~ PERMITS I I I I I I ,I I I I I I I I I I i I I I I I PERMIT APPLICATION Bakersfield Fire Dept. HAZARDOUS MATERIALS DIVISION UNDERGROUND STORAGE TANK PROGRAM 'PERMIT No. ~~- FOR, REMOVAL OF AN UNDERGROUND STORAGE TANK SITE INFORMATION SITE '~t~p_._~h't~C..~ (1;)t~t~"t~c~\ ADDRESS 2.t'5~ ~ ~. ZIP CODE ~APN FAC~LT~ N~ME~~ ~~ ~b~ CROSS STREET ~ -~ TANK OWNER/OPERATOR ~'~ ~'k~ PHONE No.. MAILING ADDRESS ~ ~ ~' ~. CI~~ ZIP CODE CONTRACTOR INFORMATION COMPAN'f~~ -~. (~r~, ~tIl. t~.~..~. PHONE No~tO~j~,'~L'lr-~ [~ LICENSE NO. ~ ADDRESS ~ ~ ~t~ ~, · ' Cl~~mo~ ZIP CODE INSURANCE CARRIE~~~',~ ~ ~ ~ WORKMENS COMP No.~~-[~ ~ ~ ' 5-1-~- ~-I-~ PRELIMANARY ASSEMENT INFORMATION ~// COMPANY~c~/ PHONE No.A/~ ~27 LICENSE ~o.~ ~ ADD~ESS 2~~ ~~ ~.. CI~/~,~,:,~ZIPqODEF~Z INSURANCE CARRIER -~-',,"--~ ~- TANK CLEANING INFORMATION ~OMPANY ~dk'l) WORKMENS COMP No. PHONE No.~'~ 3~'~- ADDRESS 3Rbb ~, O,,~o._~.v- c~TY ~ ZIP CODE .?.~_Z-~o.~..~ WASTE TRANSPORTER IDENTIFICATION NUMBER ~/~-,7'-" ~0~'~ ~ ~ ~ ~/ ~ NAME OF RINSTATE DISPOSAL~A~I~ ~,;~ ~t [ ADDRESS ~ 0/~/~~~ ~/~, 'Cl~ ~/~-~IP CODE FACILI~INDENTIFICATION NUMBER ~ ~~3~q ~O~ ~-~' TANK TRANSPORTER INFORMATION COMPANY/¥~-z~- - PHONE No. ADDRESS TANK DESTINATION _ff~-~>t/t::~_.~ ~'2~'.~/.~ LICENSE No. · CITY ZIP CODE TANK INFORMATION TANK No. AGE VOLUME CHEMICAL DATES CHEMICAL STORED PREVIOUSLY STORED I I I I · THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE A~ACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. · APPLICANT NAME (PRINT) AFTP[ICA~T SIGNATURE THIS APPLICATION BECOMES A PERMIT WHEN APPROVED MAIL TO: CITY OF BAKERSFIELD CITY Or: BAKERSFIELD P. O. BOX 2057 ' (,. _IFORNIA BAKERSFIELD, CA 93303 ~ . * ,~ LICENSE APPLICATION FOR BUSINESS LICENSE/TAX CERTIFICATE PURSUANT TO ORDINANCES OF THE CITY OF BAKERSFIELD PREMISES MUST CONFORM T.O ZONING, BUILDING, FIRE AND HEALTH APPLICANT SHOULD ALLOW TW~WEI~KL. FOR NECESSARY INSPECTIONS. / CHANGE OF ~ NEW OWNERSHIP ~ BUSINESS I/ ~ CHANGE OF ADDRESS MAILING ADDRESS LOCATION OF BUSINESS ~. L'LV~t_~ TELEPHONE (Separate License Require~ For Each Location) ~ KIND OF BUSINESS OR PROFESSION ,.)Q 'Vt~2 \ '~ _ o C'~ NAMES AND ADDRESSES OF ALL OWNERS (Or Principle Officers, if a Corporation) NAME HOME ADDRESS TELEPHONE -- OFFICIAL USE ONLY -- B INSPECTION RECORD PLANNING DEPT. FIRE DEPT. r'-I BUILDING DEPT. REQUIREMENTS OR CONDITIONS: H.O.P. AUTHORIZATION DEPT. DATE CI APPLICATION CONTINUED' TYPE OF ORGANIZATION: PARTNERSHIP ~ CORPORATION INOIVIDUAL E~ NAME DATE COMMENCED BUSINESS IN BAKERSFIELD FEDERAL EMPLOYER IDENTIFICATION NUMBER C~, SALES TAX PERMIT NO. ~/q E ~"'~ "-~. ESTIMATED ANNUAL GROSS RECEIPTS IN BAKERSFIELD Sales or Use Tax may apply to your business; contact nearest STATE BOARD OF EQUALIZATION OFFIC~ I SWEAR UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature Owner, Partner, Agent or Officer (if.Corporation), License Code Secl. Stml. Frq. Prm. Class Tax Rate 25P0=b