Loading...
HomeMy WebLinkAboutUNDERGROUND TANKDate Application No. BAKERSFIELD FIRE DEPARTMENT BUREAU OF FIRE PREYENTION APPLICATION Jn conformity with provisions of pertinent ordinances, codes and/or regulations, application is made 700 W. PI~,,~ Name of Company Address to'display, store, in~tall, use, operate, sell or handle materials or processes involving or creating con- ditions · deemed hazardous to life or property as follOWs: PER'I[ TTl~ NG AN g ][ NSPEC;Tl[ ON$ DATE [ ACTIVITY INITIALS TIME % / Fo~m Approv.ea (~'MB No 2050---0039 (Expires 9.3(3.91) Pleuse prlnl or ~ype. (Form Qesigned for ~2.pltcn typuwrdur) -- Documem N~ 3. Generator's Name and Marling A0dress ' ~ ' "" ' ' ' ' 4. Generator's Phone ( 80~ 326-3724 5. Transporler 1 Company Name 6. US EPA ID Number Placer Tractor Service ?, Transporter 2 Company Name Designated Facility Name and Site AdDress Evergreen Environmental Services 6880 Smith Avenue IC!AIDI9 ~8,'2 !0!4101210i~ 8 US EPA IO Number 10. US EPA lC) Number 'toxic SunstattCes Control Oivm~on 1~ of 1/Is not required by Federal law A. State Mandeat Document Number C. State Transporter's ID O. Trsnaporter's Phone 916-652- 5535 E. State Tranaporter'a ID F. Trensporter's Phone G. State Facility's ID H. Facility's Phone Newark, CA 94560 iCjAID,9 8,0 6 9 5 71¢11 800-972-5284 12. Containers 13, Tolal I. US DOT Description (Including Proper Sh~pp~ng Name. Hazard Class. an0 l0 Number) Quantity No Petroleum Fuel Oils J. Additional Descriptions for Materials Lisle0 Above Wa:er/ Rinseate/ Petroleum fuel oils 15. Special Handling Instructions and Additional Information EPA/Other K. Handling C~es for Wastes Lisled Above OR-,1 C. ; d. Wear Gloves · ~%ation ~5 18. GENERATOR'S CERTIFICATION: I hereoy ~eclare that the conlems o~ m,$ cons~gnmenl are ~ully and accurately 0eacrd0ed above 0y proper stopping name and are classified, packed, marked, and Isoelso. and are ,n all respects ~n proper conOidon lot Irans0ort Dy highway according ID apl3hcabls international and national government regulations. If I am a large Quantity generator, f certify that I have a program m place iD reduce me volume and IOx~Clty' Of waste generated to the degree i have determined to be economically practicable and that I have selected the practicable melhocJ of trealment, storage, or disposal currently evadable to ma wh~¢ll minimizes tile present en(~ f'dt,dre threat to humar~ health and the enwronmenf; OR. ff I am a small quantity generator. I have made a good faith effort to minimize my waste generation and select the besl waste management method thai ~S avadacle ID me and that I can afford Printed/Typed Name S~gnature Month Day Year 17. Transporter 1 Acknowledgement of Race,pt ot Mater,als I i I i I L Printed/Typed Name Signalure Month Day Year i8. Tranaportar 2 Acknowlet'lgement Of Race,p! ot MaIer,als I ' I I I Printed/Typed Name [ S,gna~ure Month Day Year 19. 0iacra.a"Cy '.~icat,O. S~.C. l il I I I '~0. Facility Owner or Operator Ce~ificat~on et receipt el nazarOous materials covers0 by lhl8 manifest except aS OOteO in item Ig (Printe~/Typed Name ~ 5~gna[ure Month Oey Yea~ T R A N 0 OHS 8022 A (t/88) EPA 8700~22 (Rev. 9.68) Previous editions are obsolete. Do Not Write Below This Line F SFRVICFS NVIRONMENTAL 6880 SMITH AVE., NEWARK, CA 94560 A DIVISION OF CALIFORNIA OIL RECYCLERS, I~' I NVO,CE 16 2 217 (800) 972-5284 EPA ID# CAD980695761 i DA. rE: ( P.O.~ C N~. ~ NAME ~ ~ ~ ~ CI~ ~ATE ZIP CO Cl~ ~ATE ZIP CO PHONE NO. E PLEASE PAY FROM THIS INVOICE TERMS: NET 7 DAYS GALLONS PRICE' PRODUCT MANIFEST # ~/VASTE PETROLEUM OILS COMBUSTIBLE LIQUID NA1270 ~ ?,~"~'/~'~".~.~,~'. WASTE ANTIFREEZE NONCOMBUSTIBLE LIQUID UNl132 HAZARDOUS WASTE LIQUID ORM-E UN9189 WASTE OIL WITH > 1000 PPM HALOGENS OTHER: TSDF EVERGREEN OIL, INC. (415) 795-4400 TOTAL,'CHAR 6880 Smith Ave EPA ID # CAD980887418 Newark, CA  112 ~THE DRIVER GENERATOR'S 17OO Flower Street Bakersfield, California 93305 Telephone (805) 861-3636 KERN COUNTY HEALTH DEPARTMENT HEALTH OFFICER Leon M Hebertson, M.D. · · ENVIRONMENTAL HEALTH DIVISION DIRECTOR OF ENVIRONMENTAL HEALTH Vernon & Reichard Kern County Permit # · UNDRRGROUND TANR DISPOSITION TRACKING RF. CORD .? This form Is to be returned to the Kern County ltealth Depar'~:ment~thln 14 days of acceptance of tank(s) by disposal or recycling facility. The holder of the permit with number noted above is responsible 'for insuring that this form is completed and returned. " Facility Name Section I - T~o .be filled out by tank removal contractor: Tank Removal Contractor: - Address .................. Phone 7200 Wetis Ave. Zip Date Tanks Removed C No. o nks 8ecttoa 2 - To be ellled out ~ contractor "decontaminating tank(s):' ~ank "Decontamination" ContPacto~ ~CERY~CTORS~CE ' 7~ W~b AuChorize~.reure~n~8~{ve~'~Oa~ractor certifies by si~nin~ below that tank(s) ~ve been decontaminated in accordance with Kern County Hea{th De~a~m~t~ requi~n~s. Signature Title Section 3 -To be filled out and signed ~ a~ authorized representative of the treatment, storage, or disposal facility accepting tank(s}: Da~e Tanks R~cetve~ , ~ / ~ /90 No. of Tanks * * * ~IAILING INSTRUCTIONS: Fold in half and staple. Postage and mailing label have already been affixed to outside for your convenience. (Form #tiMMP-150) DISTRICT OFFICES D,,lan~, . Lamont Ye I~b,,lla Mojave . Ridgecrest Shafter ' Taft FACILITY: ADDRESS : FILE CONTE.~TS SUMMARY ENV. SENSITIVITY: Activity Date # Of Tanks Comments ! ! RI ORcE MANAGEMENT AI _-x CY RANDALL L. ABBOTT.' Director Enwr mmwntal H~'alt h STEVE McCALLEY. REHS, DIRECTOR Wnl.lAM J. RODI~Y. AP('() PI.minn.& [)ev,.'hH-m'~l S~.rv,c~'~. ])Cl~alflm'~l TED J.,tt~lE$. AI(..'P. ENVIRONMENTAL HEALTH SERVICES DEPARTMENT July 23/ 1990 city of Bakersfield 1501Truxtun Avenue Bakersfield, California 93301 CLOSURE OF 1 UNDERGROUND HAZARDOUS SUBSTANC'E STORAGE TANK LOCATED AT ?00 WEST PLANZ ROAD IN BAKERSFIELD, CALIFORNIA.. PERMIT # A1220-30/300005 This is to adVise you that this Department has reviewed the project results for the preliminary assessment associated with the closure Of the tank noted above. Based upon the sample results submitted, this Department is satisfied 'that the assessment is complete.. Based on current requirements and policies, no further action is indicated at this time. It is impOrtant to note that this letter does not ~elieve yo~ of further responsibilities mandated under the California Health and Safety Code and California Water Code if additional or previously unidentified contamination at the subject site causes or threatens to cause pollution or nuisance or is found' to pose a significant threat to public health. Thank you fo~ your cooperation in this matter. MICHAEL DRIGGS,. ~'AZARDOUS MATERIALS SPECIALIST cc: Placer Tractor Service P. O. Box 170 Loomis, CA 95650 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 RECYCLED PAPER (805) 861-3636 FAX: (805) 861.3429 · Alpha Analytical Laboratories Inc. · 860 Waugh Lane, H-i, Ukiah, California 95482 (707) 468-0401 CHEMICAL EXAMINATION REPORT County of Kern 2700 "M" Street, Suite 300 Bakersfield, CA 93301 Attn: .Michael Driggs Date sampled: Time Sampled: Sampled By: Date Received: Sample Type: 06/13/90 13:35 Lori Thomas 06/20/90 10:00 'Soil Page 1 Method Resu[ ts Uni ts Batch 90-0620-020 consisted of 5 Samples and 21 Tests .SamPle I Bakersfield Fire Station #5 700 W. Planz Road - Tank # 1 - Center 8~ M~L TPH - Diesel Benzene Toluene Ethylbenzene Xylenes LUFT EPA 8020 EPA 8020 EPA 8020 EPA 8020 1.2 ug/g 1 ND ug/g .05 ND ug/g .05 ND ug/g .05 , '. 072 ug/g .05 MOL - Minimum Detection Limit ND - None Detected NOTES: Bruce L. Gove Laboratory Director Date Printed~_rJ~,/06/90 L~,~.) ~ Alpha Analytical Laboratories Inc. · 860 Waugh Lane, H-l, Ukiah, California 95482 (707) 468-0401 CHEMICAL EXamINATION REPORT County of Kern 2700 "M" Street, suite 300 Bakersfield, CA 93301 Attn: .Michael Driggs Date Sampled: Time Sampled: Sampled By: Date ReceiVed: Sample Type: '06/13/90 13:45 Lori Thomas 06~20/90 10:00 Soil Page 2 Method Results Units , MDL Batch 90-0620-020 consisted of 5 SampLes and, 21 Tests Sample 2 Bakersfield Fire StatiOn #5 700 W. Planz Road - Tank # 1 - Center 11' TPH - Diesel Benzene Toluene Ethylbenzene Xylenes LUFT EPA 8020 EPA 8020 EPA 8020 EPA 8020 ND ug/g ND ug/g .44 ug/g ,.1 ug/g '.7 ug/g .05 .05. .05 .05 MOL - Minimun Detection Limit ND None Detected NOTES: Bruce L. Gove Laboratory Director Date Printed: 0~/06/90 PROJ. NO. S'J'A NO J t OATE Ixhr,~/ o~.~-~r. It' CHAIN OF CUSTODY RECORD T&INERS REMARKS Cto- ~)(~ ~,o- 2 0 ~ -2." I t ! I I , i I I PERMIT FOR PERMANENT CLOSURE OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY PER2~iIT NUMBER A 1220-30 ADDENDUM Soil Sample analysis: a. All soil samples retrieved from beneath gasoline (leaded/unleaded) tanks and appurtenances must be analyzed for benzene, toluene, xylene, and total petroleum hydrocarbons (for gasoline). b. All soil samples retrieved from beneath diesel tanks and appurtenances must be analyzed for total petroleum hydrocarbons (for diese~!) and benzene. c. All soil samples retrieved from beneath waste oil tanks and appurtenances must be analyzed for total organic halides, lead, oil and grease. d. All soil samples retrieved from beneath crude oil lanks and appurtenances must be analyzed for oil and grease. e. All soil samples retrieved from beneath tanks and appurtenances that contain unknown substances must be analyzed for a full range of substances that may have been stored within the lank. 10. The following timetable lists pre=and post-tank removal requirements: 11. · ACTIVITY Complete permit application submitted to Hazardous Materials Management Program Notification to inspector li~ted on permit of date and time of closure and soil sampling Al least two weeks prior to closure Two wOrking days ~- Transportation and tracking forms sent to Hazardous Materials Management Program. All hazardous waste manifests must be signed by the receiver of the hazardous waste No later than $ working days for transportation and 14 working days for the tracking form after tank removal Sample analysis to Hazardous Materiah Management No later than 3 working days ogler completion of analysis Program .' Purglng/lnerting Conditions: ~ a. Liquid shall be pumped from tank prior to purging such that less than 8 gallons of liquid remain in tank. (CSH&SC 41700} b. Tank shall be purged through vent pipe discharging at least 10 feet above ground level. '(CSH&SC 41700) c. ~No emission shall result in odors detectable at or beyond property line. (Rule 419) d. No emission shall endanger the health, safety, comfort of repose of any person. (CSH&SC 41700) e. Vent lines shall remain attached to tank until the inspector arrives to authorize removal. RECOMMENDATIONS/GUIDELINES FOR REMOVAL OF UNDERGROUND STORAGE TANKS This department is responsible for enforcing the Kern County Ordinance Code, Division 8 and state regulations pertaining to underground storage tanks. Representatives from this department respond to job sites during tank removals to ensure that the tanks are safe to remove/close and that thc overall job porformancc is consistent with permit requirements, applicable laws and sa/cty standards. Thc following guidelines arc offered to clarify thc interests and expectations for this department. Job site safety is one of our primary concerns. Excavations are inherently dangerous. It is the contractor's responsibility to know and abide by CAL-OSHA regulations. The job foreman is responsible for the crew and any subcontractors on the job. As a general rule workers are not permitted in improperly sloped excavations or when unsafe conditions exist in the hole. Tools and equipment are to be used only for their designed function. For example, backhoe buckets are never substituted for ladders. Properly licensed contractors are assumed to understand the requirements of the permit issued. The job foreman is responsible for knowing and abiding by the conditions of the permit. Deviation from the permit conditions may result in a stop-work order. Individual contractors will be held responsible for their post-removal paperwork. Tracking forms, hazardous-waste manifests and analyses documentation is necessary for each site in order to close a case file or move it into mitigation. When contractors do not follow through on necessary paperwork, an unmanageable backlog of incomplete cases results. If this continues, processing time for completing new closures will increase. OWNER OR AGENT MD:cas \1220-30.ptc GARY J. WICKS Agency Director (805) 861-3502 STEVE McCALLEY Director DEPARTMENTAL PERMIT FOR PERMANENT CLOSURE "'~~~ OF UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY FACILITY NAME/ADDRESS: Bakersfield Fire Station #5 700 West Pla~:~'Road Bakersfield, CA OWNER(S) NAME/ADDRESS: City of Bakersfield 1501 TrUxtun Avenue Bakersfield, CA 93301 Phone: (805) 326-3724 AG 2700 M Street, Suite 300 Bakersfield. CA 93301 Te~,.~one (805) 861-3636 Telecopler (8~5) 861-3429 ENCY PERMIT NUMBER A 1220-30 cONTRACTOR:' · '. Placer TractOr Service P. O. Box 170 Loomis, CA 95650 License #440591 Phone: (916) 652-5535 PERMIT FOR CLOSURE OF _.1 TANK(S) AT ABOVE LOCATION PERMIT EXPIRES August 31, 199{~ APPROVAL DATE May 31t 1990 APPROVED BY ~Micl~el 'Drig~s~ - - f - Hazardous Materials S; '~'-ist ..................................................................................... POST ON PREMISES .......................................................................... CONDITIONS AS FOLLOWS: 1. It is the responsibility of the Permittee to obtain permits which may be required by other regulatory agencies prior to beginning work. (i.e., City Fire and Building Departments) 2. Permittee must notify the Hazardous Materials Management Program at (g05) 861-3636 two working days prior to tank removal or abandonment in place to arrange for required inspections(s). 3. Tank closure activities must be per Kern County Environmental Health and Fire Department approved methods as described in Handbook UT- 30. 4. It is the contractor's responsibility to know and adhere to all applicable laws regarding the handling, transportation or treatment of hazardous materials. 5. The tank removal contractor must have a qualified company employee onsite supervising the tank removal. The employee must have tank removal experience prior to working unsupervised. 6. If any contractors other than those listed on permit and permit application arc to be utilized, prior approval must be granted by the specialist listed on the permit. Deviation from the submitted application is not allowed. 7. Soil Sampling: a. Tank size less than or equal to 1,000 gallons - a minimum of two samples must be retrieved from beneath the center of the tank at depths of approximately two feet and six feet. b. Tank size greater than 1,000 to I0,000 gallons - a minimum of four samples must be retrieved one-third of the way in from the ends of each tank at depths of approximately two feet and six feel. c. Tank size greater than 10,000 gallons - a minimum of six samples must be retrieved on-fourth of thc way in from the ends of each tank and beneath the center of each tank at depths of approximately two feet and six feet. 8. Soil Sampling (piping area): 3, minimum o~ two samples must be retrieved at depths of approximately two feet and six feet for every 15 linear feet of pipe run and under thc dispenser area.' PROVIDE DRAWING OF.~ ;lC I_AXr'Oul L)F t"ACILI-Iyt ~gj. -~E PROVIDED BELOW. ALL OF THE FOLLOWING INFORMATION r~I~i~,T,.,....~..E. INCI dDED IN.ORDER FOR THE APPLICATION 'TO BE PROCESSED: TANK(S), PIPING & OiSPENSER(S), INCLUDING LENGTHS DIMENSIONS. J PROPOSED SAMPLING LOCATIONS DESIGNATED BY THIS SYMBOL NEAREST STREET OR INTERSECTION ANY WATER WELLS OF SURFACE WATERS WITHIN 100' RADIUS OF FACILITY NORTH ARROW \,\ \,\ \\, PUMP & ~ / S~ TANK, Y~?/ NO. 5 DIES~ FUEL) ! [2 4 / / :~ . // , ~... ..I // ~ CUR8 % PLANZ ROAD FZRE STATZON NO, 5 '-- 700 ~EST P~NZ C~ OF BAKERSFIELD ~ ~ 2- ~ ~- 89 ~ ~OV22 CALIFORNIA ~ R.L.T. S~EE~ 70~ 11 ENGINEERING DEPA~E~ ~ J,T.L. KEI~ COUNTY RESOURCE MANAGE~F~IT ACENCY ENVIR~MENTAL HEALTH SERVICES DEPARTMENT 2'/00 "M' STREET, SUITE 300 BAKERSFIELD, CA 93301 (805)861-3636 (FILL OUT ONE APPLICATION PER FACILITY) THIS APPLICATION IS FOR A: FACILI~ IR.cOI~WATI~ P~J~CT cOfrACT: Cathy Thomas INTERNAL ~ ONLY' 'l J ~ OF TANKS TO FT. TO APPLICATION FOR PERMIT FOR PERMANENT CLOSURE/ASANEXZ~MENT OF UNDERGRCUNO HAZARDOUS SUBSTANCE STORAGE FACILITY REMOVAL, OR [] ABANDONMENT IN PLACE FACILIR~: Fire Station No. 5 P~£ I: 805-326-3724 O~ER: Same as above IEN[ I: 8: ~OR II~ATICN lPHONE J: 916-652-553q T/R/S~ (~RAL U:CAIlCNS): J~:700 Planz Road INEAREST ClaSS I STR~'T: ClR:Bakersfield ZiP: 93301 JSo. Chesster Ave ADORE. SS: J STATE: CITY: ZiP: TA/IK REMCNALO:NTP, ACTOR: PA~CER TRACTOR SERVICE I .ss:P.O. BOX 170 lSTATE: CA P~Nf I: 916-652-5535 J CJR:Loomi~ , ZIP~J5650 ~ START ~TE: ~ -~-~ J ~I~IA LI~ ~ & 1: 440591-A l~ S ~TI~ I: BP 23214B ~Tm ~R]~lm ~: ALP.A ~B i ~: 680 Waugh 'Lane CA ~ I: 707-468-0401 O]U: Ukiah Z]~: ~5482 ~'$ ~Tl~ ~: BP 223214B [ 1~: calif. Indemnity LABOIATORY ll~AT NILL ~NN.YZ£ ~ I: SAME AS ABOVE C: CtBIIC~L I)i~IiMATICli CHEMICAL COMPOSTION OF MATERIALS STORED: TANK ~ VOLUME CHEMICAL STORED --5~0 -~.Di~sel DATES STORED CHEMICAL FO~IERLY STORED D: EN~II~I+~TAL N~TER TO F~ILITY PI)OVID6D BY: Unknown NF.~J~EST ~TER I~LL~I~ Ol~NlCl~ IF Wlll~lN 500 FEEl': none BASIS FOR SOIL IYPE .AND 6RCbNDI, IATER DEPI~ DETIEIMINATION: TOT~ ~ OF S:AI'PtJ~S TO BE A/~LYIED: 2 Unknown WITHIN 50 FE'T? Y ~ N Unknown JSOil TYPE AT FACILITY: Unknown JSA/~I:K.~ TO B~ ~4%~LY'ZED F~: TPH & BTX& E £: DIg~gL ~TI~ ~X~I~TI~ PRD~DURIE: Triple rinsed & iced with 20# of dry ice PHCI~(T:gCI~T~IINATI~ ~TOR:,: 9] 6-652-553sPl'ACER TRACTOR SERTVCE )~JV~CJ~TI~ FOJ~]~I~oNMP. NT, NEWABK DISMSGAL ~ FOR TANK(S): Cut ~p as scrap DISMSS~ UT~TION FOR l/~K(S).~Lme~ican Metals ,Ne~ DISI~SAL ~q?lO0 FOR PIPING: Same as above DISPOSAL LDCATIClt FOR PIPING: AMR , Newark **PLEASE ~ETE THE REV~ SIDE OF THIS APPLICATICN BEFORE SUBMITTING FOR REVIEI4~* THIS FORM HAS BEEN CE~PLETED UNDER PENALLY OF PERJURY AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT. ; SIGINATURE: , <~ ~/~~ ~ '"! ""TITLE RECEIPT PAGE 1 05/21/90 4:26 pm KERN COUNTY PLANNING & DEVELOPMENT 2?00 'M' Street Bakersfield, CA 93301 (805') 861-2615 I'nvoice Nbr. I 34211 Type of Order CASH REGISTER PLACER TRACTOR SERVICE ]lCustomer P.O.~ ! Ntn 8y [Order .Date I Ship Date H0521901 I RAR i 05/21/90 I 05/21/90 I I t I Line Description Quantity 1 TANK PLAN CHECK 1 I?0A Vffa 1 Terms ' I Price Unit Disc Total 100.00 E , 100.00 Order T'ota] 100.00 Amount Due 100.00 Payment Made By Check 100.00 THANK YOU! RECEIPT 05/21/90 4:26 pm ...,,. KERN CCUNT~¢ PLANNING & DEVELOPMENT 2700 'M' Street ,. ' Bakersfield CA ,93301 Invoice Nbr. .'.'T,ype'of Order PAGE 1. .34211 '], CASH,..'REG Z sTER )Customer P.O,= ~tm 8~ IOrder Data IH052t901 RAR I 05/21/90 Line Description 1 TANK PLAN CHECK ~TOA Ship Oate I 05/21/90 lDO Quantity 1 Via !Terms i ~ 100.00 ,', ' ! O0 .'00' ' Price Unit¢Disc' 100.00 Order Total Amoun~ Due 100.0'0 Payment: Made By' check 100.00 THANk:, Y©U C' -VALLEY EQuIPMEnT COMPANY . 3500 CEmore Aue. - ~fieM, ~1S~ 93308 Record of Computer TOKHEIM DISTRIBUTORS (gO~) 327-9341 or Meter Change ~ W/M Notified Make anQ Mooei Finish Imoney) Finish Return tO Storage (gallonfl ' Finish (gallons) Totalizar Readings Start (money) Product Make and Model ' 'PUmp Finish (money) Totalizar Readings Start {money) Product Make and Modal Pump Finish (money) Start (money) Totalizer Readings Product ! Make and Model Finish (money) Pump , Totalizer Readings Start (money) Make and MoOel Prodt~:t Pump Finish (money) Totalizer Readings Start (money) Product Pump Finish (money) Totelizer Readings Start Imoneyl Product Start (gallons) Return to Storage (gallons) Serial N umi0er Finish (gallons) Start (gallons) Return to Storage (gallons} Serial NumOer Finish (gallons) Start (gallons) Return to Storage (gallons) Finish (gallons) Start (gallons) Return tO Storage (gallons) raqgecl , ~.;Blue Tag ~m ;'-~ Red ~Green Cahbration: Fast / . J Slow Ch'ck"d aFT. -- ~ Adjusted - Slow To It/1 Y es {~No Tagged [] Red I-]Green CalibratiOn:Checked I Fast Adjusted Fast To Totalizer Sealed i Meter Sealed DY.,' ONo [ Tagged Tag S []Red []Green []Blue Meter S~es ~--~Blue .Tag = JSlow Slow Ca)ib,et'.:Chack. J Fa,t JlS'°w Adjusted Fast· j Slow Totallzer Sealed ' Tagged f--iRed r'~Green r~Blue Calibration: Fast Checked Fast Adjusted To Totalizer Sealed [] Yes [] NO Meter Sealed r-~ Yes Tag a~ Taggecl ["IRed (~]Gr~en I~ Blue Calibration: Fast Checked AdjustedTO Fast Totalizer Sealed [] Yes . Slow Slow Sar:al Numoer Tagged []Red []Green Finish (gallons) Start (gallons) CalibratiOn:checked F ass AdjustedTo Fast Tag ~ Slow Slow Meter Sealed Tag ~ F'~Blue JSlow Slow .Meter Sealed Return to Storage (gallons) Totalizer Sealed [:]Yes [] No [--]No []No Oistr,bution: Original {white) Invoice Copy Duplicate (canary) File Copy Triplicate (pink) Dealer Copy [ Maiqtenance Man's Signature FIRE DEPARTMENT D. S. NEEDHAM FIRE CHIEF CITY of BAKERSFIELD "WE CARE" 2101 H STREET BAKERSFIELD. 93301 326-3911 Bakersfield Fire Station # 5 Permit # 300005c 1/ss - 12/ss Repair and Maintenance Summary Tank tightness test preformed by Redwine-Manley Testing on 2/19/88. The tank tested tight. ~ANNUAL TREND ANALYS I S SUlVI!VI;kRY TANK TIME PER~OD: JAN 1 1988 to ~DEc 1 1988 QUARTER 1' PERIOD 1: PERIOD 2: PERIOD 3: TIME PERIOD: JAN 1 to MAR 31 Total Minuses This Period (Line 3) 7 Action Number for this Period (Line 4) 20 Total Minuses This Period (Line 3) 6 Action Number for this Period (Line 4) 37 Total Minuses This Period (Line 3) 9 Action Number for this,Period (Line 4) 54 QUARTER 2 PERIOD 4: PERIOD 5: PERIOD 6: TIME PERIOD: APRIL 1 to JUNE 30 Total Minuses This Period (Line 3) 1 Action Number for this Period (Line 4)' 69 Total Sinuses This Period (Line 3) 15 Action Number for this~Period (Line 4) 85 Total Minuses This Period (Line 3) 13 Action Number for this Period (Line QUARTER 3 TIME PERIOD: JULY 1 to SEPT 30 PERIOD 7: Total Minuses This Period (Line 3) 14 Action Number for this Period (Line 41 117 Total Minuses This Period (Line 3) 16 Action Number for this Period (Line 4) 133 Total Minuses This Period (Line 3) 12 Action Number for this Period (Line 4) 149 PERIOD 8: PERIOD 9~: QUARTER 4 TIME PERIOD: OCT 1 to DEC 13 PERIOD '10: Total Minuses This Period (Line 3) 19 Action Number for this period (Line 4) 165 PERIOD 11: Total Minuses This P~riod (Line3) 14 Action Number for this Period (Line 4) 180 PERIOD 12: ~otal Minuses This Period (Line 3) 13 -' Action Nu%ber for this Period (Line 4) 196 I hereby certify this is a true and accurate report. signature Date TANK 'FACI LI.T.Y ;%~NNUAL REPORT Facility Bakersfield Fire Sta. 5 1. Permit ~ 300005c Month/Yr..i/89 I have not done any major modifications to this facility during the Note: Ail major modifications ~eguire a-Permit tq Construct from the Permitting Authority. I have done major modifications for which I obtained Permit(s) to Construct. from Permitting Authority Signature Permit to Construct # Date 3. Repair and Maintenance Summary Attach a summary of all: -- Routine and required maintenance done to this facility's tank, piping, and ·monitoring equipment. -- Repair of submerged pumps or suction pumps. -- Replacement of flow-restricting leak detectors with same. -- Repair/replacement of dispensers, meters, or nozzles. -- Repair of electronic leak detection components, or replacement with same. -- InstallatiOn of ball float valves.'- , -- Installation or repair of vapor recovery/vent lines. Include the date of each repair or maintenance activity. :' NOTE: All repairs.or replacements in response to a lear require a · - Permit to Construct from the Permitting Authority as do all other modificatipns to tanks, piping or monitoring equipment not listed here. : Fuel Changes - Allowed for Motor Vehicle Fuel tanks 0nly. List all fuel storage changes in tanks,' noting: Date(s), tank number(s), new fuel(s) stored. Inventory control monitoring is required for this.facility on the Permit to Operate, and I have not'exceeded any reportable limits as listed in the appropriate inventory control monitoring handbook during the last twelve months (if not applicable, disregard). Signature Trend Analysis Summary Please attach Annual Trend Analysis Summary for the last 12 periods~. Meter Calibration Check Form Please attach current, completed Meter Calibration Check Form BAKERSFIELD FIRE DEPARTMENT FUEL INVENTORY RECORDING TANK ~ I - CAPACITY 5.50 Gt PRODUCT DIESEL 4 5 14 6 7 8 9 10 11 12 OPENING CLOSING INVEN"FDRY C~OSING F, ETER DAILY F,~ER TOTAL I~ETER ,;]UGING INVENTORY INVENTORY REI)UCTIDN READINES 18,5 0.0 190.0 -190.0 Ii 19.0 190.0 19B. O -8.0 II 45.5 198.0 550.0 32.0 I} 46.0 550.0 550.0 0.0 il 46.5 550.0 550.0 0.0 Il 46.5 550.0 550.0 0.011 41.5 550.0 5i0.0 40.0 l{ 40.8 510.0 503,0 7.0 Il 40.8 503.0 503.0 0.0 II 40.3 503.0 498.0 5.0 II 40,0 498.0 495.0 3.0 II 36.0 495.0 473.0 22.0 Il 38.2 473.0 474.0 -1.0 II 35.5 474.0 441.0 33,0 Il 35.5 441.0 441.0 0.0 II 35,5 441.0 441.0 0.0 Il ' 35.5 441.0 441.0 0.0 II 35.5 441.0 441.0 0o0 II 34.5 44i.0 4LxJ. O i2.0 i{ 34.3 4~.0 425.0 4.0 II 34.0 435.0 423.0 3.0 II 32,5 432.0 401.0 21.0 Il 32.5 40i.0 401.0 0.0 Il 3~.5 401.0 401.0 O,O'll 3~.5 401.0 401.0 0,0 II 32.5 401.0 401,0 0,0 II 3Z.5 401.0 401.0 0.0 II 3~.5 401.0 401.0 0.0 II 3!.0 401.0 380.0 21.0 Il 31.0 380,0 380,0 0,0 II 3i.0 380.0 380.0, 0.0 II READINGS SALES 67~3.5 6793.5 0.0 Il 6~0'3.7 6753.5 16.2 II 6~09.7 6609.7 O. 0 I I 6603, 7 6809.7 ' O. 0 I I 6~. 7 63[~. 7 O. 0 I I 6B~4.4 6~03. 7 54.7 I I 66~,4 6344.4 0,0 II 664~.4 6844.~ 0.0 6552.5 6844.4 6.1 6~5Z,5 6852.5 0.0 6574J5 6852.5 22.0 687~.5 6874.5 0.0 6903.5 6874.5 ~8.0 6902.5 6903.5 0.0 690~,5 6903.5 0.0 6302.5 6303.5 -0.0 6903.5 690~.5 0.0 {I 6925.8 6902.5 23.3 Il 6925.8 69~5.8 0.0 {I 6~5. G 6325.8 0.0 II 6344.4 6935.8 18.6 II 6944.4 6944.~ 0.0 Il 6944.4 E944.4 0.0 II 694~.4 6944.4 0.0 II 6944.4 6944.4 0.0 l{ 6944.4 6944.4 0.0 tl 67q4.4 6944.4 0,0 Il 6%7.4 69~4.4 23.0 {I ,6957.4 · 6967.4 Q.O Il 6%7.4 6¥67.4 0.0 II £~57.4 69£7.4 20.0 {{ MONTHLY TOTALS -6.0 MONTHLY TOTFI_S i93.9 TROD 'AY-I~.LYSIS PERIO~ 5 iS THERE A REPORTABLE LOSS NO READIHG B~DRE AF)ER PELIVERED ~STPiENTDELIVERYDELIVERYINVENTDNY 0.0 0,0 0,0 0.0 0.0 0.0 0.0 0.0 0.0 176,0 550.0 374.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0,0 0,0 0.0 0.0 0.0 0.0 0.0 0.0. 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0,0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 .0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 TOT~ MINL~SES THIS PERIOD CU)IUI_ATIVE MI~SES F~ PREVIOUS PERIODS IN Iq-liS CYCLE TOT~ MINUSES ACTION N~BER FROil lHiS PEklUD MOIiTH~Y TOT~ 374.0 1o 2O 30 65 ' J::,Ekl',lllr # 16)0009(~ 13 16 1~ 15 16 ~TER A~UNT WEEI~ TDTAL~ WEEK TOTALS WEEK TOTALS GAUGEING OVER DR S~(,DRT INV. REDUCTION METER THRDUGHPUT OVER DR SHORT 190.0 34.~ -23.0 0,0 0.0 34.7 ~0.0 -7.0 6.1 -5.0 19.0 ~9.0 -33.0 0.0 0.0 0.0 23.3 -4.0 15.6 -3i.0 0.0 0,0 0.0 0.0 0.0 ~3.0 0.0 ~0.0 TDTRL t~. 9 WEEK I WEF~ I WEEK 1 -136.0 50.9 '186.9 % VARIATION TREND ANALYSIS WEEK I 367.19 · WEEK ~ WEEK ~ WEEK ~ WEEK 69.0 ' 58.1 -10.9 -18.76 WEEK 3 22.9 WEE~3 WF_E~3 19.0 41.9 WEEK 3 54.65 WEEK ~ WE~ 4 WEEK 4 ~EK /~ 21.0 23.0 2.0 8.70 MONTHLY TDT~S ~- 411.70 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 (. 0 0 0 Low--Throughput Tank Repot t i n.g Out i i ne These" amended permit requirements are oJ{ly app.[icable to tank(~) indibated' below when weekly throughput is _le_s_s than 2000 gallons -and monthly throughput ts. less than 10,000 gallons: Effective Date: Facllity permit # Tank # '1 , Tank # , Tank # Tank # July 19, 1988 300005C 550 gallon diesel tank Amended Permit Requirements: 1,. '~Revised inventory reconciliation monitoring worksheets are to be submitted to the Health Department on a monthly basis. Revised Action Chart is to be posted at facility Ail variations exceeding the following amounts must .be reported as described on page 16, Part "2" of Handbook DAILY - 75 gallons WEEKLY - 150.gallons MONTHLY - 200 gallons TREND ANALYSIS - No change John Patterson July 21, 1988 Page 2 Be advised that this provisional exempt, ion is subject' to ~hange as further data becomes available to the Health Department. If, however, a listed, tank at any time exceeds the defined low-throughput 'amounts, you must revert to compliance with the orig.inal reporting requirements. If you have any questions regarding this correspondence, I Can be reached at (805) 861-3636 betwee 8 am - 9 am. Sincerely, ~ary Kryszak L~ Environmental .Health Specialist Hazardous' Materlais Management Program MK/gb enclosures 2700 M Street BakerSfield, California Mailing Address: 1415 Truxtun Avenue Bakersfield, California 93301 {805) 861-3636 ' COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH DIVISION July 21, 1988 HEALTH OFFICER Leon M Hebertson. M.D. DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S, Reichard John Patterson' 2101 "H~' Street Bakersfield, California 93301 Re: All Bakersfield City Fire Departments Dear Mr. Patterson, This letter is to advise you that all Bakersfield City-'Fire Depart'ments will be-granted a "provisional exemption" from the standard, reporting described in your permit packet/' As we discussed in .our meeting, all facilities will. follow low throughput reporting requirements as stated in the at'tached "Low Throughput Reporting Outline." T~ls Department is currently undertaking a-study of the inventory control problems Of low-throughput tanks. To facilitate this, a copy of reconciliation worksheets for tanks listed on the attached outline must be' sent to this Department monthly so that we may add this information to our data base. Please send all submittals to my attention. Our preliminary information indicates that a change in reportable variations is necessary -when the throughput of a tank is less than 2,000 zallons per week and less than 10,000 zallon~ per month. The .accompanying "Low Throughput Tank Reportinu Outline" describes these changes. A' revised action chart and an example of a changed summary sheet (on the back. of inventory reconciliation worksheet) have also been enclosed for 'your convenience. Please make these changes on your worksheets for weeks in which you have low throughput. [- ~ICT OFFICES Delano · Lamont · Lake Isa! · Mojave · Ridgecrest · Shafter · Taft TANK FACILITY ANNUAL REPORT 'Facility 1. Bakersfield Fire Sta. 5 Permit g 300005C Month/Yr. 3/87 I have not done any major modifications.~9 this facility'during the last 12 months. ~j ~ Signature ~ -~T'C~ k ~ 0 ^~-~ Note: All major modifications qequire a Permit to Construct from the Permitting Authority. I have done major modifications for .which I obtained Permit(s) to Construct from Permitting Authority SignatUre Permit to Construct # bate 3. Repair and Maintenance Summary Attach a summary of all: -- Routine and required maintenance done to this facility's tank, piping, and .monitoring equipment. '.-- Repair of submerged pumps or suction pumps. -- Replacement of flow-restricting leak detectors with same. -- Repair/replacement of dispensers, meters', or nozzles. -- Repair of electronic leak detection components, or replacement with same. · -- Installation of ball float valves. -- Installation or repair of vapor recovery/vent lines. -' Include the date of each .rePair or maintenance activity. .MOTE': All repairs or replacements in response to a lenk require a Permit to construct from the Permitting Authority as do all other modifications to tanks, piping or monitoring equipment not listed here. Fuel Changes - Allowed for Motor Vehicle Fuel tanks Only. List all fuel storage changes in tanks, noting:. Date(s), tank number(s), new fuel(s) stored. Inventory control monitoring is required for this 'facility on the Permit to Operate, and I have not exceeded any reportable limits as listed in the appropriate inventory control monitoring handbook during'the last twelve months (if not applicable, disregard). Signature Trend Analysis Summary Please attach Annual Trend Analysis Summary for the last 12 periods. Meter Calibration Check Form ' Please attach current, completed Meter Calibration Check Form FIRE, DEPARTMENT D.S. NEEDHAM FIRE CHIEF CITY of BAKERSFIELD "WE CARE" '. 2101 H STREET. BAKERSFILED. 93301 326-3911 Bakersfield Fire Station # 5 . Permit # 300005C 3/87- 3/88 Repair and Maintenance Summary R.L.W. Equipment installed a new Tokheim fuei pump with interlock and hose retractor. Replaced fuel nozzle , FacJJitv~: Notc: 1. ^11 meters must bare ca l .t bratt on checks a minimum o~ .~w~s J..clude check~ done by tim Department ~f tqelghts and bleasures. 2. .Before starting ealJbral:ton runs, wet the calibration can with product and l-~1(llpii product to storage. 3. Ibm 5 Eallons'~qltb nozzJe IvJde open Into tim can. Note gallons and cubic inches drawn, and return ,product to storage. 4, R,.m 5 gallons with the 'nozzle bna-bail open Into the can. Note gallons nnd c~btc inches drawu, and rekurn proddct to storage., 5. After ~.ll product for one caJibration' check Is 'returned' to storage, rememlmv ~o record the volume returned to storage lu column 9 of the Inventory Recording Sheet. 6. If the volume measured in a 5-gallon calibration can ts more than 6 cubic inches above or below the 5-gallon ma~k, the meter requires calibratiou by a registered device repatrmau. Date/Time I1.'0o Pump. Tank f~/ F'roduct Fast Flow · 5-tlallon Draft ]~alsCu. Inches 5 -o-- O~vner or Operator Signature Calibrator's Signature Slow Fire, 5-6allon. Draft CU. Inches Volume Returned to Storage Gallons SUB/,IIT /~ COPY OF Tills FORM WITll ANNUAL IH~PO.R'r. Cai ibratton] · Requ t~.r e d_?_ Yes X Device Repairman Used for Calibration Date of Calibrati:)n __llcgt strntion # PERMIT CHECKLIST Permit # This checklist is provided to ensure that all. necessary packet enclosures were received and that the Permittee has obtained all necessary equipment to implement the first phase of monitoring requirements. Please complete this form and return to KCHD in the self-addressed envelope provided within 30 days of receipt. Check: Yes No · A.' The packet .I received contained: 1). Cover Letter, Permit' Checklist, 'Interim Permit, Phase Monitoring Requirements, Information Sheet (Agreement Operator), Chapter 15 (KCOQ #G-3941), Explanation of Equipment Lists and Return Envelope. 2) Standard Inventory Control Monitoring Handbook #UT-10;. 3) The Following Forms: a) Inventory Recording Sheet b) 'Inventory Reconciliation Sheet with summary on reverse c) Trend Analysis Worksheet 4) An Action Chart (to post at facility) I Interim Permit Between Owner and Substance Codes, B. I have examined the information on my Interim Permit, PhaSe I Monitoring Requirements, and Information Sheet (Agreement between Owner and'0perator), and find owner's name and address, facility name and address, operator's name and address, substance codes, and number of tanks to be .'accurately listed. (if "no" is checked, note appropriate corrections on the back.side of this sheet). C. I have the following required'equipment (as describ-~d'on page 6 of Handbook): 1) Acceptable gauging instrument 2) "Striker plate(s)" in tank(s) ~r~ ~-~ ~O¢c~-e~ 3) Water-finding paste ~ D. I have read the information on the enclosed "Information sHee" pertaining to Agreements between Owner and Operator and hereby .state that the owner of this facility is the operator (if "no' is checked, attach a copy of agreement between owner and operator). E. I have enclosed a 'copy of Calibration Charts for.all tanks at this facility (if tanks are identical, one chart will suffice; label chart(s) with corresponding tank numbers listed on permit). F. As required on page 6 of Handbook#UT-10, all meters at this facility have had calibration checks within the last 30 days. and were calibrated by a registered device repairman ~f out of tolerance (all meter calibrations must be recorded on "Meter Calibration Check Form" found in the Appendix of Handbook). G. Standard~nventory Control MonitorinM was started at this facility in accordance with procedures described in Handbook #UT:iO. Date Started. ~- ~t~- ~ if-~ ~ Signature of Person Com~letin~ Checklist: Date: ? ~.~.~- '~ f"J 1',3 r.3 I',3 r,3 r,'j f.3 P'J r,-J rq 1',3 ..... i"'J r'3 t'3 i'.~ 1"3 1'-3 1'-3 r,3 1'3 r,'J .~ -.~ ...'r' -, .~ -.~ .~ ~ -~ -~ .¢ ~ .~ .¢ ,~ ,~ .~ .., ~ ..1-' ~-~ ..~ .~ ). Date/Time METER CALX BR~ '?I ON CIIECI{ FOItlVI_ I Note: _. _ _ 1. All meters must have calibration' check~ a ml___nlmu~ o_~f twice a e.y~_~E, which may include checks doue by the Department of ~elghts and Measures. 2. Before starting callbratioa runs, ~et the calibration can with product and return product to storage. 3. Run 5 gallons with nozzle wide open Into the can. Note gallons and cubl~ inches dra~n, and return product'tq storage. 4. Run 5 .gallons with the nozzle onechair open into the can. Note gallons and cubic inches drawn, and return product'to storage. 5. After all product for one calibration check is returned to storage, remember to record the volume returned to .storage In column 9 of .the Inventory Hecording Sheet.. 6. If the volume measured 'in a 5-gallon calibration can is more than 6 cubic inches above or below the 5-gallon mark, the meter.requires calibration by a registered device repairman. lose Tank #/ Fast Flow Slow Flow Pump # Product 5-Ballon Draft §-Ballon to Stor~egg__/ RequD oallons I Yes 'l Device. RepalFman gse~ for calibration Date of Calibration Owner or Operator Signature calibrator's Signature SUBMIT ^ COPY OF Tills FO~M ~ITll ANNUAL REPORT. Registration 17OO FloWer Street Bakersfield, California 93305 Telephone (805) 861-3636 ENVIRONMENTAL HEALTH DIVISION INTERIM PERMIT TO OPERATE: UNDERGROUND HAZARDOUS SUBSTANCES' STORAGE FACILITY HEALTH OFFICER Leon M Hebertson, M.D. DIRECTOR OF ENvIRONMENTAL HEALTH Vernon S. Reichard 'p E RKv/'r T-,~e 3 OOOO5 C ISSUED: JULY 1, 1986 EXP I RE S: JULY 1, 1989 NUMBER OF TANKS= I FACILITY: $ OWNER: ~ BAKERSFIELD IRE D".PT. STATION CITY OF BAKERSFIELD 700 .W. PLANZ ROAn · I 1501 TRUXTUN AVENU~ . : .. "~.. , :' BAKgRSPIELD, CA ' ' "-I - , ."BAKERSFIELD,:-CA :~:~93301 -"::;?~: ':"~ ....... ' " _ ~ *:" SUBSTANCE CODE .-? ~: PRESSURIZED 'PIPING? ~'~:'>'--~::: ANK · ~ AGE IN YRS -. ........ ~ .... NOTE: NON-- TRANSFERABLE DATE PERMIT MAILED: AUG 2 5 1986 ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT * * * POST ON,"'PREMISES DATE PERMIT CHECK LIST RETURNED: (FILL OUT SEPARATE' FORM FOR EACH TANK). Ho F~-R- EA'~H ~ECTIO~' CHECK ~ APPROPRIATE BOXE.S. Tank is: [-]Vaulted ~qon-Vaulted []Double,Wall [2]Single-Wali ~ Mater ial ~]Carbon Steel [] stainless Steel. []polYVinyl Chloride [] Fiberglass-Clad Steel []Fiberglass-Reinforced Plastic [-]Concrete [~Al~inum [-]Bronze [-]Unknown [] Other .(describe) 3. Primary Containment Date Installed Thickness (Inches) 4. Tank Secondary Containment []Double-Wall [~ Synthetic Liner []Other (describe): [] Ma ter ial Thickness (InChes) 5. Tank Interior-Lining ---~Rubber [-]Alkyd []Epoxy [-]Phenolic [-]Glass .10. Capacity (Gallons) Manufacturer [] Lined Vault Iq None [~bnknown Manufacturer: · Capacity (Gals.) I-]Clay [qt~lined [qOther (describe) :/ Tank Corrosion Protection ---]~G~lvanized'-]_'~]%se~--'~g--~ass-Clad [']Polyethylene Wrap [-]Vinyl Wrapping [-]Tar. or'Asphalt ~l~n~known [-]None []Other (describe): ' ~' Cathodic Protection: []None [2]Impressed Current System [~SacrifiCial ;%node System DesCribe System & Equipment: Leak Detection, Monitoring, and Interception a. Tank: []Visual (vaulted tanks only) []Groundwater Monitoring' W~ll(s) [~Vadose Zone Monitoring Well(s) []-]U-Tube Without Liner [-]U Tube with Ccmpatible Liner Directing Flow to Monitoring Well(s)* [2] Vapor Detector* [] Liquid Level Sensor [] Conductivit~ Sensor [] Pressure' Sensor in Annular Space of Double Wall Tank [] Liquid Retrieval & Inspection From U-Tube, Monitoring Well or Annular Space  Daily Gauging & Inventory Reconciliation [2] Periodic Tightness Testing None [] Unknown [] Other b. 'Piping: Flow-Restricting Leak Detector(s) for Pressurized Piping' [] Monitoring St~np with ~ace~ay '[] Sealed Concrete Raceway '[]Half-Cut Compatible Pipe Raceway []Synthetic Liner Raceway []None [-]Yes []No ~n. known · Results of Test ~esting Company [qNo ~3nknown ~Jnknown [] Other · *Describe Make & Model: Tank Tightness l~is Tank Been Tightness Tested? Date of Last Tightness Test Test Name Tank Repair ~ Repaired? [-]Yes Date(s) of Repair(s) Describe' Repairs Overfill Protection ~Operator Fills, Controls, & Visually Monitors bevel []Tape Float Gauge [qFloat Vent Valves [] Auto Shut- Off Controls Capacitance Sensor []Sealed Fill Box [qNone ~Unknown Other: List Make & M°del For Above Devices 11..Piping a. Underground Piping: ~]Yes []No []unknown Material Thickness.-(inches) ~//f//{ Diameter f//~'Manufacturer [-]Pressure ~suc{i0n []Gravity Approximate bength Of Pipe b. Underground Piping Corrosion Protection : []Galvanized []Fiberglass-Clad I-]Impressed C~rrent [-]Sacrificial Anode []Polyethylene~Wrap ~Electrical Isolation []Vinyl Wrap []Tar or Asphalt ~Jnknown [']None []other (describe) :~ c. Underground piping, Secondary Contai~nent: I-]Double-Wall [-]S~/nthetic Liner System []None /~3nknown Kern County liealth Delmar Division of Environmental Hea .l 1700 Flower Street, Bakersfield, CA ae 93305 Application ( .e Do APPLICATION FOR PERMIT TO OPERATE UNDEF~]ROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type of, appl[cation (check): [-]New Facility [-]Modification of Facility ~q~isting Facility ~]Transfer of Ownership f]mergency 24-Hour Contact (n~ne, area code, phone): Days ~///j</~F~ Nights ~-,~/ _~F,~ FacilityName YT. No. of T,anks / Type of Business ('check): ~]Gasoline Station -J~gther '(des~:-ribe) /~,~ _Is _Tank(s) 'Located' on an Agricultural Farm? [2]Yes ~ ' - · Is Tank(s) Used Primarily for Agricultural Purpoges? [qYes ~ . Facility Address ~ '/~/. /~L//,,6~ ~.,~/..c~/5~F// Nearest ~ross St. T , R SEC (Rural Locate°ns (~1¥) .... Owner · d,,~,,~ ~, z~,,/2;~_~' Contact Person ~>F~'~/ Operator. · Z~, '~<~'~,'~'F~/ ~k~_. ~.//-. Contact Person ~A,,~)~ {~,,~./z/~' · Address 4//0/ -Z-/z~'/A-v'-~'.-'~ ~'~ Zip ~3_~o/ Telephone Water to Facility Provided by Depth to' Groundwater . Soil Characteristics' at Facility ... Basis for Soil Type and Groundwater Depth Determinations Contractor CA Contractor' s License No. Addr ess Zlp Telephone ' ' Proposed Starting Date Proposed Cc~Pl~tion E~te Worker's C~pensati~ .Certifidation ~ - Insure=. ' ..... If This P~rmit Is For Modification Of An Existing Facility, Briefly Describe Modifications ~roposed , . ' GO Tank(s) Store (check all that aPPly).. Tan___~k _~ Wast____e_e Product [] [] E3 [] Moto____~r Vehicle Unleaded Regular Premium Diesel 'Waste Ch~nical Composition of Materials Stored (not necessary, for motor vehicle fUels) Tank ! Chemical'Stored (non-conmercial name~ CAS ! (if known) Chemical Previously Stored . (if different) Transfer of Ownershl~ Date Of- ~-~n~fer Previous Facility Name I, Previous Owner modify or terminate the facility upon receiving this c~mpleted form. accept fully all ObligatiOns 6f Permit' No. issued to · I understand that the Permitting Authority may review a~d transfer of the Permit to Operate this ~derground storage T~ls form has been c~pleted under penalty of trUe and correct. perjury and to the best of my knowledge is Title //6~j~T ~.,~. J~/~Y Date o~-2~'-~,C~ ---~ ,. P:iP~E ' .5-EA,-1-10N "'h~O: 5. .... .~ ~.~.~.~ - ,. Ci~ OF BAKERSFIELD ...~ ~ .A~. .CALIFORNIA '~w. O~IClAL RECORDI O~ N K=RN ~OU~. ~&~iFO~Ni~ ENGINEER! G DEPARTMENT P, EDWIHE-MANLEY' I'ES]'iNG ::,,.R~/IC]~S.~ INC. i: .O. BO! 156'/ BAKERSF: ?]LD, C.a.., 93302 (805) 83~-6075 HO~NER EASY TESTING METHOD WORK SHEET of Bakersfield 4101' Truxt0n BakersfSeld. Ca.. SA~ 9330'9