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Home My WebLink AboutUST-REP 10/16/92SITE ~ HMMP DIAGRAM PLA~ MAP FACILITY DIAGRAM Bus 2..- Name North Name a~ Aro-a: ~e.-f-M,~L¢ V:;R,&,[ ~ J'^ Dennis C. Fidler Building Director (805) 326-3720 Fax (805) 325-0266 BAKERSFIELD Development Services Department Jack Hardisty, Director May 14. 1997 Stanley C. Grady Planning Director (805) 326-3733 Fax (805) 327-0646 TO: SUBJECT: Responsible, Trustee, or Other Interested Agency Notice of Public Hearing and Draft Negative Declaration Conditional Use Permit No. P97-0322 The City of Bakersfield as the Lead Agency under the California Environmental Quality Act (CEQA), has determined that a Negative Declaration is appropriate for the project identified in the attached Initial Study. We would appreciate your agency's comments regarding the scope, content and adequacy of the environmental infbrmation about the proposed project. Your agency may need to use this Negative Declaration when considering any permits or other approvals required for this project. The comment period begins on May 19, 1997 and ends June 9, 1997. To consider your comments regarding this project, please send vour response to me before the comment period ends at the address shown below. If a response is not received from your agency, we will assume that you have no comment on the proposal. We also give notice according to the Planning and Zoning Law of the California Government Code, that the City of Bakersfield Board of Zoning Adjustment (BZA) will hold a public hearing accepting comments regarding the proposed project and environmental determination at a public meeting. The BZA will hold this meeting TUESDAY, June 10, 1997, beginning at 5:30 p.m. in the Council Chambers at City Hall, 1501 Truxtun Avenue, Bakersfield, California. Any interested person or agency representative is welcome to attend. agcy_ltr, bza Sincerely, Louise Palmer Project Planner City of Bakersfield · 1715 Chester Avenue · Bakersfield, California · 93301 PUBLIC HEARING NOTICE NOTICE OF PUBLIC HEARING BEFORE THE BOARD OF ZONING ADJUSTMENT OF THE CITY OF BAKERSFIELD The Board of Zoning Adjustment is giving notice that they will hold a hearing beginning at 5:30 p.m., TUESDAY~ June 10, 1997, in the Council Chambers of City Hall. 1501 Truxtun Avenue, Bakersfield. Califorma. to accept public testimony regarding the following request: Project description: (File No. P97-0322) A Conditional Use Permit to allow the partial demolition, reconstruction and addition of 700 square feet to a crematorium at an existing cemetery located in an R-1 (One Familv Dwelling) zone district. Project location: 730 Potomac Avenue Project applicant: Union Cemetery Association Post Office Box 3066 Bakersfield, CA 93305 The Board of Zoning Adjustment is also gMng notice that th~' will accept public testimony regarding the potential effect of this prOJect on the environment. Following the regulations of the California Environmental Qualit?' Act (CEQA), an initial studv has been completed describing the degree of possible environmental impact of the project. This study has concluded that the proposal will not significantly affect the environment: therefore, the Board proposes to approve a Negative Declaration. You mav review and/or obtain copies of the initial studv and Negative Declaration at the Planning Department (contact Louise Palmer) in the Development Services Building at 1715 Chester Avenue. Bakersfield. California. or by telephoning the department at (805) 326-3733. The Board of Zoning Adjustment will consider all public comments regarding the proposed project and the environmental determination at the public hearing. They will also accept written comments but they must receive them on or before the hearing date. Written comments must refer to the file number and be directed to the City of Bakersfield Board of Zoning Adjustment. c/o Planning Department. 1715 Chester Avenue, Bakersfield. California. 93301. If you challenge the action taken on this proposal in court, you mav be limited to contesting only those issues raised at the public hearing or in the xmtten correspondence received bv the Board. DATED: May 12, 1997 nph0322 STANLEY GIDDY. / Planning Director J POSTED: May 19. 1997 CONDITIONAL USE PERMIT P97-0322 I ~M1 ~'"---....M2~~~~"~ / u-1 M 1 /7/'"/ R-3 .-1 ~ _~ ~ - /R-3 R-3 R-2 COUNi'Y ~' M- 1 R2 I ~Pr ~u~ot~/.E ..-7 r'---_~/~7 u-~ t~ ~ ~ ~ ~ '--.. _J / -"'--.,-?-.... _ I /7~-' //~-'-~'F/ /f~-' //,~-~/ ~-' 7/ "-' //'~ EAST CALIFORNIAAV[NUE R--2 M-1 ' -- 1 11'1-1 KItV~, JR, R-2 R-2 C21 R-2 : ,. :C21 R-2 I , =_AST 5TH 5'rREET I~ C2 R2 ' · '~ ~_A. ST EES~ OW~IV5 R-2 R-2 R-2 ~'- R-2 R-2 C -I INITIAL STUDY/ NEGATIVE DECLARATION The City of Bakersfield Planning Department has completed an initial study of the possible environmental effects of the following described project and has determined that a Negative Declaration is appropriate. This determination has been made according to the California Environmental Quality Act (CEQA), the State CEQA Guidelines, and the City of Bakersfield CEQA Implementation Procedures. PROJECT NO: CONDITIONAL USE PERMIT NO. P97-0322 APPLICANT: Mr. Hugh Sill, President Union Cemetery Association Post Office Box 3066 Bakersfield, CA 93305 LOCATION: 730 Potomac Avenue PROJECT DESCRIPTION: A Conditional Use Permit to allow the partial demolition, reconstruction and addition of 700 square feet to a crematorium at an existing cemetery located in an R-1 (One Family Dwelling) zone district. The expansion is necessary to permit installation of a new retort that will reduce the levels of emmissions generated by the cremation process. ENVIRONMENTAL SETTING: The site is located on the east side of Bakersfield one block south of California Avenue. The topography of the area is relatively flat. The site is completely developed with all necessary public facilities and improvements in place. MITIGATION MEASURES - Included in the proposed project to avoid potentially significant effects (if required): (None Required) nd_is.cpg Project No. P97-0322 I. ENVIRONMENTAL CHECKLIST Soils X X Compatibility X X Geologic Hazards X X General Plan/Zoning X X Erosion/Sedimentation X X Growth Inducement X X Topography X X Prime Ag Land Loss X X Quality/Quantity Police X X - Groundwater X X Fire X X - Surface Water X X Schools X X Flooding/Drainage X X Parks/Recreation X X AIR Solid Waste Disposal X X Air Quality X X Facility Maintenance X X Climate/Air Movement X X UTILITIES ::i~!ii ~ iiii: ill iili i i i; i ! i i!!i i ! ! :~ ??~ !?i !i :i iiiii!~ il !i ~ iiiiiiii?~i?i?iiiiiiiii~iiiiiiiiii Odors X X Water X X BIOLOGICAL RESOURCES Wastewater X X Plants X X Storm Drainage X X Animals X X Natural Gas X X Rare/Endangered Species X X Electricity X X Habitat Alteration X X Communication X X S = Significant (NOTE: DISCUSSION REGARDING THE ABOVE IMPACTS IS ATTACHED.) P = Potentially Significant I = Insignificant/No Effect Y = Yes N = No ORD = Ordinance Requirement APPENDIX I Conditional Use Permit No. P97-0322 I. ENVIRONMENTAL IMPACTS Earth Soils - Construction of the proposed project will result in 700 square feet of soil to be insignificantly disrupted,, compacted,, displaced: over covered and Uncovered by trenching and other ground preparation activities necessa~, for building construction. These soils are not considered "prime" for agricultural purposes by the State Department of Conservation. Standard ordinance compliance includes the requirement for soils and grading reports prior to issuance of building permits and adherence to applicable building codes. Geologic Hazards - The terrain of the site is not considered a unique geologic or physical feature. The site is currently developed. The proposed project would not create an unstable earth condition or cause changes to an), geologic substructure. The project will not expose people, structures, or property, to major geologic hazards such as landslides, mudslides or ground failure. Erosion / Sedimentation - No rivers, streams, canals or beaches are near the project site to be impacted by the proposed development. Typical ordinance requirements ensure that erosion, siltation or deposition of soils from the site by water nm-offwill not occur through development of the project, nor through drainage of the site after construction. Wind erosion and fugitive dust may occur during the construction process; however, normal use of water spraying will control wind erosion impacts and should not be considered significant. Topography - The slope of the natural terrain on-site is flat. Project development will not result in a change to the topography and/or ground surface relief features of the area to a significant degree. Wa~er Water Quali[y / Ouanti _ty - Groundwater - The project will not alter the direction or rate of flow, or substantially deplete the quantity of groundwater resources, either through direct additions or withdrawals, or through interception of an aquifer by cuts or excavations. The project will not contaminate a public water supply, substantially interfere with groundwater recharge or substantially degrade water quality. Water service would be provided for the development by California Water Service; however, the cumulative impact to the water table would be negligible and insignificant. Surface Water - The project will not result in discharge into any surface water, alter surface water quality to a significant degree, including but not limited to temperature, dissolved oxygen or turbidity. The proposal will not contaminate any public water supply. As the site is not located adjacent to or contains any rivers, streams or canals, the proposal will not result in changes in currents or the course or direction of surface water movements. Flooding/Drainage - The project will not result in changes to the course or direction of fresh water currents, or result in changes to the amount of surface water, as the site does not contain, nor will the proposal impact., any rivers, streams or canals. The site is not in an area subject to flooding, therefore the proposal will not expose people or property to water-related hazards such as flooding or tidal waves. The Appendix I Page 2 project will not result in significant changes in absorption rates, drainage patterns, or the rate and amount of surface water runoff. Current development standards require the project to comply with adequate drainage facili .ty design, complete preconstmction soils and grading studies, and compliance with the City Public Works or Building Departments. Air Air Quality - There will not be a substantial increase in air pollution emissions, nor will there be a substantial deterioration of ambient air quality through development of this project. The proposal will not violate any ambient air quality standard, contribute substantially to an existing or projected air quality violatiom or expose sensitive receptors to substantial pollutant concentrations. The Air Pollution Control District was informally contacted regarding the proposal. The Distnc:I personnel responded that they did not have an.v substantial concerns regarding the project, however the applicants will be required to obtain permits an approval from APCD. Climate/Air Movement - The crematorium expansion will not significantly alter air movement, moisture, temperature and/or result in any change in climate, either locally or regionally. Odors - The existing cremation equipment, which is not being altered, expanded, or changed in conjunction with this project, emits faint odors during normal operation. These odors are noticeable only in the immediate vicinity (100 feet) within the cemetery boundaries when the air is very still. The proposed project includes replacement of an existing retort that has been in operation for a number of years with a new retort. The proposed newer equipment will reduce emissions below the levels produced by the existing equipment. Biologica~ Resources Plants - The project site is currently developed, and consists of the domestic plant species and ornamental landscaping. No new plant species will be introduced as a result of the project. No new barriers will be created to the normal replemshment of existing plant species, as the site is already completely developed. Animals - New animal species, such as domesticated dogs and cats, will be introduced as a result of occupying the site with urban uses. A barrier would be created to the normal replenishment of existing animal species, as the site would be completely developed. Although existing species of animals on-site would be removed through urban development, the proposal will not entirely eliminate a wildlife community or substantially diminish or significantly reduce wildlife habitat. These effects of urban development are not deemed significant. Rare/Endangered Species - Permits and approvals for development associated with this project will be subject to the terms of the Metropolitan Bakersfield Habitat Conservation Plan and associated 10(a)(1 )(B) and 2081 permits issued to the City by the U.S. Fish and Wildlife Service and State Department offish and Game, respectively. Terms of the permit require applicants for development projects to pay habitat mitigation fees, excavate known kit fox dens and notify agencies prior to grading. The Metropolitan Bakersfield Habitat Conservation Plan may be reviewed at the following location: City of Bakersfield, Planning Department, 1715 Chester Avenue, 2nd Floor, Bakersfield, CA, 93301, (805) 326-3733. Appendix I Page 3 Habitat Alteration - The project will not result in the creation of new barriers to the migration or movement of animals from the surrounding land. The impacts to wildlife habitat from land development are considered in the Final Environmental Impact Report for the Metropolitan Bakersfield Habitat Conservation Plan (MBHCP), and are not considered significant for the project proposed. The proposed project is not "significant" per CEQA, and a Certificate of Fee Exemption has been made with the Cahfomia Department offish and Game. The project will not individually or cumulatively have an adverse effect on wildlife resources, as defined in Section 711.2 of the Fish and Game Code. See attached De Minimis Impact Findings. Transportation Traffic/Circulation - The proposed project will not generate additional vehicular movement, will not cause an increase in traffic which is substantial in relation to the existing traffic load (volume) and capacity of the street system, and will not substantially impact existing transportation systems. The project will not significantly alter present patterns of circulation or movement of people and/or goods. Parking - Existing parking facilities will not be affected, nor will there be a demand for new parking through the proposed development. Traffic Hazards - There would be no significant increase in traffic hazards to motor vehicles, bicyclists, or pedestrians as a result of the proposed project. Ak/Water/Rail Systems - The project will not affect waterborne, rail, or air traffic. Cultural Resources Archaeological/Historical - It is not 'known if archaeological resources are located on the site. This cemetary is the site of £mal disposition of several historical figures, however, no remains will be distmbed as a result of this project. This Initial Study will be transmitted to the Archaeological Information Center (AIC) housed at California State University Bakersfield for their review, comments and recommendations. All measures indicated by the AIC will be completed prior to any ground disturbance. Land Use Compatibili _ty - The proposed project is an expansion to an existing crematorium building. The existing land uses surrounding and adjacent to the project site include single and multi-family residences, and a public school., which are indicated in Table A. These uses are compatible with proposed land uses. The proposed project will not conflict with adopted environmental plans or goals of the community, disrupt or divide the physical arrangement of an established community, or create a significant land use compatibility problem. Appendix I Page 4 TABLE A Land Uses and Zoning of Adjacent Properties LAND USE ZONING LOCATION DESIIGNATION DISTRICT LAND USE NORTH HMR, PS, GC R-2 Single and Multi-Family Residences, Public School SOUTH HMR, GC R-2, C-1 Single and Multi-Family Residences, Grocery. Store EAST HMR R-2 Sinsle and Multi-Family Residences WEST HMR R-2 Single and Multi-Family Residences General Plan/Zoning - The present land use designation on the site is OS, with existing zoning of R-1. The proposal will not result in a substantial alteration of the present or planned land use of the area, as no land use amendments or zoning changes are proposed with the project. The proposal is consistent with the Metropolitan Bakersfield 2010 General Plan policies and implementation measures and will not significantly conflict with established recreational, educational, religious or scientific uses of the area. Growth Inducement - The proposed project will not induce substantial growth. Prime A~m'icultural Land - No agricultural crops currently exist on site and the site does not contain prime agricultural soils. There is no removal of land through the proposed project that would convert prime agricultural land to nonagricultural use or impair the agricultural productivit3.' prime aghcultural land. Public Services Police - The proposal will not affect City Police protection in the area, as no new residents would be included in the City. Fire - The proposal will not affect City fire service for the area, as no new residents or structures will be included in the City. Schools - The proposed project would not impact school facilities to a significant degree. Parks / Recreation - The project proposes no increase in population .for the areas and would not result in an impact upon the quality or quantity of existing recreational oppommities or create a substantial need for new parks or recreational facilities. Appendix I Page 5 Solid Waste / Disposal - The proposed project would not result in a need for significant new or substantial alterations to existing solid waste disposal systems. The development will not breach published national, state or local standards relating to solid waste or litter control. Facility Maintenance - The improvements from the proposed development will not result in an increase in maintenance responsibility for the Ci~' of Bakersfield. Utilities Water - The proposed development would not result in a need for significant additional systems or substantially alter the existing water utilities in the area. Wastewater - The proposed development would not result in a need for additional systems or substantially alter the existing wastewater utilities in the area. The proposed project will not require the extension of any sewer trunk line that will serve new development. Storm Drainage - The proposed building expansion would not result in a need for additional systems or substantially alter the storm drainage systems in the area. Natural Gas - The proposed development would not result in a need for significant additional systems or substantially alter the natural gas systems in the area. Electriciw - The proposed development would not result in a need for additional systems or substantially alter the electricity systems in the area. Communications - The proposed development would not result in a need for additional systems or substantially alter the communications systems in the area. Population / Employment / Housing The proposed project will have no effect on population, employment or housing in the area. Health Hazards / Public Safety No health hazards or potential hazards to people or plant or animal populations will be created as a result of the proposed project. The proposal does not involve a risk of explosions or releasing hazardous substances (including but not limited to oil, pesticides, chemicals, or radiation) in the event of an accident or upset conditions. The project will not attract people to an area and expose them to hazards found there, nor will the project interfere with emergency response plans or emergency evacuation plans. The project is not on the most current hazardous wastes and substances site list pursuant to Section 65962.5 of the California Government Code. Noise Appendix I Page 6 Ambient noise levels will not be affected by the proposed projec'[. Typical development standards including building setbacks, walls, and landscaping will prevent substantial increases in the ambient noise levels of the adjoining area, will not expose people to severe noise levels, and would reduce noise impacts to less than significant. Aesthetics The proposed building expansion will alter the open space qualities of the area to an insignificant degree. The proposed project is not intending any uses or development in the area that would result in the obstruction of any scenic vista or view open to the public, nor will the proposal result in the creation of an aesthetically offensive site open to public view. The project will not Mve a substantial, demonstrational negative affect. Light and Glare The proposed project will not inu'oduce any new sources of light or glare. Site plan review of the proposed development will evaluate building location, material selection, lighting design, parking and signage placement to buffer proposed light impacts from surrounding developments. Natural Resources No non-renewable or other natural resources exist on-site to be used or depleted through the proposed project. Enerev Usaee The proposed development would not result in significant irreversible environmental changes, including uses of nonrenewable energy, resources, during the initial and continued phases of the project. The project x~ill not result in significant energy requirements or lack of energy efficiency by amount or fuel type of a project's life cycle. The proposal will not result in significant effects on local and regional energy supplies or on requirements for additional energy capacity or sources, nor will the project result in significant effects on peak and base period demands for electricity and other forms of energy. The project will not conflict with existing energy standards, nor will it encourage activities which result in the wasteful or substantial use of significant amounts of fuel, water, or energy. The project will not result in significant effects on projected transportation energy requirements or in the project's overall use of efficient transportation alternatives. Appendix I Page 7 II. MANDATORY FINDINGS OF SIGNIFICANCE The project does not have the potential to degrade the quality of the environment, substantially reduce the habitat ora fish or wildlife species, cause a fish or wildlife population to drop below self-sustaining levels, threaten to eliminate a plant or animal community., reduce the number or restrict the range of a rare or endangered plant or animal, or impact important examples of the major periods of California history or pre-history. The project does not have the potential to achieve short-term environmental goals, to the disadvantage of long-term, environmental goals. The project does not have impacts which are individually limited, but cumulatively considerable or for which the incremental effects of an individual project are considerable when viewed in connection with the efforts of past projects, then current projects, and possible future projects. The project does not have environmental effects which will cause substantial adverse effects on human beings, either directly or indirectly. Reference List Metropolitan Bakersfield 2010 General Plan and Appendices. City. of Bakersfield, Kern County, Kern COG, Golden Empire Transit, March 1990. Metropolitan Bakersfield 2010 General Plan DEIR. The Planning Center, July, 1989. Metropolitan Ba'kersfieM2010 GeneralPlan FEIR. SCH/18907032, City of Bakersfield, County of Kern, KCOG, Golden Empire Transit, September, 1989. FEIR Metropolitan Bakersfield Habitat Conservation Plan, Thomas Reid Associates for the City of Bakersfield and Kem County, March 1991. Metropolitan Bakersfield Habitat Conservation Plan. Advisory Notice to Developers. 10(a)(1)(B) and 2081 permits, 1994. 6. Title 17, Zoning Ordinance, Bakersfield Municipal Code. il. FINDINGS OF DETER [ ATION (Projects where a Negative Declaration or EIR has not been previously prepared, or where a previous document will not be utilized.) ON THE BASIS OF THIS INITIAL EVALUATION (check one): X It has been found that the proposed project COULD NOT have a significant effect on the environment; therefore, a NEGATIVE DECLARATION will be prepared. It is been found that although the proposed project could have a significant effect on the environment, there will not be a significant effect in this case because MITIGATION MEASURES, as identified in the Discussion of Environmental Impacts, have been incorporated into the project; therefore, a NEGATIVE DECLARATION will be prepared. It has been found that the proposed project MAY have a significant effect on the environment, and an EIR (ENVIRONMENTAL IMPACT REPORT) will be prepared. PREPARED BY: DATE: May 12, 1997 CALIFORNIA DEPARTMENT OF FISH AND GAME CERTIFICATE OF FEE EXEMPTION De Minimis Impact Finding Project Title/Location (include County): Conditional Use Permit No. P97-0322 730 Potomac Avenue Project Description: A Conditional Use Permit to allow the partial demolition, reconstruction and addition of 700 square feet to a crematorium at an existing cemeten~' located in an R- 1 (One Familv Dwelling) zone district. Findings of Exemption (attach as necessary): No evidence was presented before the City of Bakersfield that indicated significant impacts on wildlife resources could occur as a result of the project. Based upon an initial environmental assessment, it has been determined the proposed project will not significantly affect the physical environment or existing residential development in the area and the issuing of a negative declaration for the project is adequate. No evidence has been presented to indicate that the proposed project will have potential for an adverse effect on wildlife resources or habitat upon which the wildlife depends. The site is surrounded by urban development and has been rough graded in preparation for development. Certification: I hereby certify that the public agency, has made the above findings and that the project will not individually or cumulatively have an adverse effect on wildlife resources, as defined in Section 711.2 of the Fish and Game Code. (Planning Official) Title: Assistant Planner Lead Agency: City of Bakersfield Date: May 14, 1997 D May 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 Union Cemetery Association 730 Potomac Avenue Bakersfield, Ca 93307 Dear Business Owner: Enclosed, please find the Site and Facility Diagram Instructions packet. When your Hazardous Materials Management Plan and Inventory were submitted it was lacking the diagram portion. Please draw and submit the diagram(s) of your facility by June 8, 2001. The diagram should include the following: 1) 2) 3). 4) 5) 6) 7) 8) 9) name of your business; business address; indicate which direction is North; the cross streets neighboring business addresses (within 300 feet) entrances and exits location of utility shut-offs; location of the nearest fire hydrant; portions of the building protected by automatic sprinkler system; and most importantly the location of the hazardous material(s). If you have any questions, please feel free to call me at (661) 326-3658. Thank you for your assistance. Sincerely, RALPH E. HUEY, DIRECTOR OFFICE OF ENVIRONMENTAL SERVICES Esther Duran, Accounting Clerk I1 Office of Environmental Services ED\db Enclosures FIRE DEPARTMENT S. D. JOHNSON FIRE CHIEF CITY of BAKERSFIELD "WE CARE" October 16, 1992 2101H STREET BAKERSFIELD, 93301 326-3911 Union Cemetery Association. 730 Potomac Street Bakersfield, CA 93307 Attn: Manager CLOSURE OF 2 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANKS LOCATED AT THE UNION CEMETERY, 730 POTOMAC STREET, IN BAKERSFIELD~ CALIFORNIA. PERMIT # BR0050 Dear Association, This is to inform you that this department has reviewed the results for the preliminary assessment associated with the closure of the tanks located at the above stated address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. This letter does not relieve you of any liability for past, present, or future operations. In addition, any future changes in site use may require further assessment or mitigation. It is the property owners responsibility to notify this department of any changes in site usage. If you have any questions regarding this matter, please contact me at (805)-326-3797. CC: Bud McNabb RLW Equipment 2080 S. Union Ave. Bakersfield, CA 93307 A. Dunwood~J ardous Material Specialist Underground Tank Program STATE OF CALIFORNIA STATE WATER RESOURCES CONTROl. BOARD UNDERGROUND S:ORAGE TANK PERDita' APPLDOAYDON ~ FORDJ: A COMPLETE THIS FORi~ FOR EACH FACILITY/SITE ~ I NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [~'~ PERMANENTLY CLOSED SITE MARK ONLY ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS o (MUST BE COMPLETED) DBA QR 6ACILITY NAME / NAME OF OPERATOR AD O R E S S/~,,//~.,,~.,. '~. :~/~/'¢¢¢1'~~ . NEAREST CROSS STREET PARCEL # (OPTIONAL) CITY NAME3 ~/ ~ J~' ! /~ STATE ZIP CODE SITE PHONE # W~TH AREA CODE TOINDICATE ~v VIDUAL E~ PARTNERSHIP ~ LOCAL-AGENCY E~ COUNTY-AGENCY ~-~ STATE-AGENCY ~ FEDERAL-AGENCY DISTRICTS TYPE OF BUSINESS [~ 1GAS STATION [~ 2 DISTRIBUTOR [~RESERVATION'/'FINDIANI#OFTANKSATSITEI~ E.P.A. LD.#(optional) , OR TRUST LANDS [~ 3 FARM ~ 4 PROCESSOR,.,.~*"5-OTHER EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) - optional DAYS: NAME (LAST, FIRST) PHONE # WITH AREA CODE DAYS: NAME (LAST, FIRST) NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE NIGHTS: NAME (LAST, FIRST) II. PROPERTY OWNER INFORMATION o (MUST BE COMPLETED) INAME / MAILING OR STREET ADD~ESS /' ~ III, TANK OWNER INFORMATION - (MUST BE COMPLETED) NAME OF OWNER CITY NAME PH(3NF # WITH ARFA ~r)l: PHO~ # WITH ARF-.AJT~DE CARE OF ADDRESS INFORMATION v" box to indicate ~ INDIVIDUAL ~ LOCAL-AGENCY ~ STATE-AGENCY PORATION ~ PARTNERSHIP ~ COUNTY-AGENCY ~ FEDERAL-AGENCY CARE OF ADDRESS INFORMATION ¢ ~x~indicate ~ INDIVIDUAL ~ LOCAL-AGENCY ~ STA~-AGENCY ~ COR~RATION ~ PARTNERSHIP ~ COU~Y-AGENCY ~ FEDE~L-AGE~Y STATE ZIP CODE PHONE # WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUIVtBER - Call (916) 323-9555 if questions arise. TY(TK) ,Q 17171-1 t I I I I I V. PETROLEUM UST FINANClAL~..~Fr~DPONSIBILITY - (MUST 8E COMPLETED) - IDENTIFY THE METHOD(S) USED ¢ box to indicate JSELF-INSURED [~] 2 GUARANTEE [~ 3 INSURANCE ~ []~] 5 LElq'ER OF CREDIT ~ 6 EXEMPTION E~] 99 OTHER ~-~ 4 SURETY BONO VI, LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. ICHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT A~PLICAN~'S NAME (PRINTED & SIGNATURE)~,/ APPLICANT'S TITLE DATE MONTH/DAY/YEAR LOCAL AGENC ._ COUNTY # JURISDICTION # FACILITY # LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL / SUPVISOR * DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION. FORM B~ UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY, FORM A (5-91) FOROO33A-5 Si'ATE ~ATER RESOURCES CONTROL BOARD CO~PL.~?~ A SEPARATE FORM FOR EACH TAN[( SYSTE~£~ [] 3 RENEWAL PERMIT ] 7 PERMANENTLY CLOSED ON SITE TANK REMOVED MAR,KONLY [~ 1 NEW PERMIT ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE DBA OR FACILITY NAiViE WHERE TANK IS INSTALLED: U/j/~t'd/~ I. TAN;( DESCRIPTiO~ COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN [] 5 CHANGE OF INFORMATION I A. OWNER'S TANK I.D.# ~ C. DATE INSTALLED(MO/DAY/YEAR) B. MANUFACTURED BY: D, TANK CAPACITY IN GALLONS: .-~,,, C~ ,. TAN× CO~TE~S ~FA-~ IS MARKED, COMPLETE ITEM C. [~-'~'r~"~EGULAR C. ~ UNLEADED A. MOTOR VEHICLE FUEL 2 PETROLEUM [] 3 CHEMICAL PRODUCT ] 4 OIL ] 80 EMPTY ] 95 UNKNOWN ;~I~ PRODUCT ] 2 WASTE [] lb PREMIUM UNLEADED [--~ 2 LEADED [] 3 DIESEL [] 6 AVIATION GAS ] 4 GASAHOL [] 5 JET FUEL [] 7 METHANOL ] gg OTHER (DESCRIBE IN ITEM D. BELOW) C.A.S.#: D. IF (A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED iii. TANK CO~S'?JLiC'."!O~ MARKONEITEMONLYINBOXESA, B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPE OF ~ DOUBLE WALL SYSTEM [] 2 SINGLE WALL ] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER S, TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS ~ATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimilryTan~[) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN ..,~'~'4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING C. INTERIOR [] 5 GLASS LINING ~ UNLINED [] 95 UNKNOWN LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ ] 4 PHENOLIC LINING ] 99 OTHER D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ] 3 VINYL WRAP ~ FIBERGLASS REINFORCED PL~.S~C J~Z] 95 UNKNOWN [] 99 OTHER ;V. ~lp[~ ~OR~I~'[O~ CIRCLE ~ IF ABOVE GROUND OR U IF UNDERGROUND, BOTH If APPLICABLE A. SYSTE~TYPE ~(~ SUCTION ~, U 2 PRESSURE ~ U 3 GRAVITY /~ U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~,~2 DOUBLE WALL J~ U 3 LINED TRENCH .~ U 95 UNKNOWN ~. U 99 OTHER C. il/iATERIALAND A U 1 BARESTEEL A U 2 STAINLESS STEEL J~ U 3 POLYVINYL CHLORIDE(PVC)A(~.II~.~ FIBERGLASS PiPE CORROSION ~, U 5 ALUMINUM ,8, U 6 CONCRETE £~ U 7 STEEL W/ COATING ,~, U 8 100% METHANOL COMPAT[BLEW/FRP PROTECTION A U 9 GALVANIZED STEEL ~ U 10 CATHODIC PROTECTION ~, U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTIO~,~,[~,~ AUTOMATIC LINE LEAK DETECTOR .....J~'"'2~L'INE TIGHTNESS TESTING [--~3 INTERSTITIAL MONITORING J~ 99 OTHER 6TISUAL CHECK ~ INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING ~ 5 GROUND WATER MONITORING ANK TESTING '~ 7 INTERSTITIALMONITORING ................. ~ 91 NONE ~ 95 UNKNOWN ~ 99 OTHER VI. T~X C/.OSU~E~ :~' ":' ~ ' 1.ESTIMATED DATE LAST USED (MO/DAY~R) 2. ESTIMATED QUANTI~ OF ~ ~LLONS INERT MATERIAL ? SUBSTANCE REMAINING TH/S FOR~ HAS BEEN COMPLETED UNDER PENAL~ OF PERJURY, AND TO THE BEST OF ~Y KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY US~ ONLY THE STabBER IS C0~POSED OF THE FOUR FlU~BERS B~L~E FORM B (9-90) TANK # PERMIT APPROVED BY/DATE / PERMIT EXPIRATION DATE . u~, ~, UNLF~SS A CURRENT FOR~.~ A HAS BEEN FILED. FOROO34B-R4 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERmiT APPLICATION ~ FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. IMARK ONLY ~ 1 NEW PERMIT [~ 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION ONEITEM [] 2 INTERIM PERMIT [~ 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE DBA OR FACILITY NANIE WHERE TANK IS INSTALLED: ~/'~ j~ ~.~-~ ~,~,'[ ~;)-~/~,~ 8PERMANENTLY CLOSED ON SITE1 TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN I A. OWNER'S TANK I.D.# / C. DATE INSTALLED (MO/DAY/YEAR) B. MANUFACTURED BY: D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS IFA-1 IS MARKED, COMPLETE ITEM C. _ ~la REGULAR A. ,,[~1 MOTOR VEHICLE FUEL [] 4 OiL B. L;'JI UNLEADED [][] 43 GASAHoLDIESEL [] 6 AVIATION GAS I [~ 2 PETROLEUM [] 80 EMPTY ~ PRODUCT [] lb PREMIUM ~ 7 METHANOL UNLEADED [] 5 JET FUEL -- F~ 3 CHEMICAL PRODUCT [~ 95 UNKNOWN [] 2 WASTE [~ 2 LEADED [] 99 OTHER (DESCRIBE IN iTEM D. BELOW_)I I D. IF (A,1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C, A, S, #: III. TANK CONSTRUCTION MARKONEITEMONLYINBOXESA, B, ANDC, ANDALLTHATAPPLIESINBOXDANDE A. TYPE OF ~ 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [~ I BARE STEEL [] 2 STAINLESS STEEL [] 3 FtBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 10~/o METHANOL COMPATIBLE W/FRP ] 99 OTHER ~ 1 RUBBER LINED ~-~ 2 ALKYD LINING ~ 3 EPOXY LINING ~--~ 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING ~ UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. CORROSION ~ 1 POLYETHYLENE WRAP J--'-] 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN E~ 99 OTHER E. SPILL AND OVERFILL SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) __ IV, PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U iF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEMTYPE ~[~_..~1 SUCTION A U 2 PRESSURE ALI 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL ~ DOUBLE WALL A U 3 LINED TRENCH ALI 95 UNKNOWN ALI 99 OTHER C, MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U~,..U...~.~ FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE ALI 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A [J 95 UNKNOWN A U 99 OTHER ~'~XUTOMATIC LINE LEAK DETECTOR ~LINE TIGHTNESS TESTING F-~3 INTERSTITIAL MONITORING [] g9 OTHER V. TANK LEAK DETECTION ~V6 TAISUAL CHECK,~ 2 INVENTORY RECONCILIATION [] 3 VADOZE MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING NK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICANT'S NAME ~ !~H~ST~ATE I D ~ ISCOMPOS' CE~/~ F~TH~O ~~S BEn'LOW (PRINTED & SIGNATURE)Jo ~ ~ LOCAL AGENCY USE ONLY u~ COUNTY # JURISDICTION # FACILITY # PERMIT NUMBER PERMIT APPROVED BY/DATE IDATE I PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM B (7-91) FOROO34B.R~ BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM OWNER ~,-~-,~/~..~ , PERMIT TO OPERATES ~///-' CONTRACTOR ~/. ~f/ CONTACT PERSON .~ ~ ~ LABORATORY S OF SAMPLES ~ TEST METHODOLOGY _~'~'/_~7< //~//~..u PRELIMANARY ASSESSMENT CO .~.~ .~.':~= ~'~ CONTACT PERSON,i/~.~ CO~ RECIEPT ~ LEL%- O2% PLOT PLAN COND~T~0N O~ TAN~S ~-~ ~ CONDITION OF PIPING CONDITION OF SOIL COMMENTS ~- INSPECTORS N~E/ ~ I GNATURE I. FACILITY/SITE AzABakersfield Fire DeP~l~ RDOUS MATERIALS DI~JI~iON 2130 G Street, Bakersfield, CA 93301 (805) 326-3970 UNDERGROUND TANK QUESTIONNAIRF NO. OF TANKS DBA OR FACILITY NAME ~ NAME O! ADDRE~~. ' ~ - ~A~E ~BOXTOINDICA~ ~COR~ON ~IND~IDUAL ~PA~ERSHIP ~L~ALAGENCYDI~IC~ ~COUN~AGEN~ ~A~AGENCY ~FEDE~LAGENCY TYPE OF BUSINE~ GAS STATION [~ 2 DISTRIBUTOR .~ FARM [~ 4 PROCESSOR~OTHER IKER. COU.TYPER~c : ~ ~ ~, 7 EMERGENCY CONTACT PERSON (PRIMARY~ DAY,S: NAME (LAST. FIRSl~ PHONE No. WITH AREA CODE GHTS: NAME (LAST, FII~SI~ PHO~-E No. WITH AREA CODE II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED) NAME CARE OF ADDRES~ INFORMATION MAILING OR STREET ADDRESS / ' / EMERGENCY CONT.~CT PERSON (SECONDARY~ optional DAYS: NAME (LAST. FIR~I~ PHONE No. WITH AREA CODE ~ld~S: NAMe, FI~ ..... ~ONE ~ ~ AR~ CODE ' ' ~' BOX [~ INDIVIDUAL ~ LOCAL AGENCY (~ STATE AGENCY TO INOICATE ~ PARTNERSHIP [""'1 COUNTY AGENCY [~ FEDERAL AGENCY TANKOWNER INFORMATION (MUST BE COMPLETED) NAME MAILING O~R ~T~EET ADDRESS- CITY NAME CARE OF ADDRESS INFORMATI.ON /" BOX ~ INDIVIDUAL ~ LOCAL AGENCY C~ STATE AGENCY j TO INDICATE ~ PARTNERSHIP a COUNTY AGENCY [~ FEDERAL AGENCY I ~TATE J ZIPCODE j PHONE No. WITH AR~ CODE OWNER'S DATE TANK No. INSTALLED VOLUME PRODUCT IN STORED SERVICE Y/N Y/N Y/N DO YOU HAVE FINANCIAL RESPONSIBILITY? Y/N TYPE Y/N ~ Fill one segment~t for each tank~ unless all_.tanks and piping are ~ constructed of t~ same materials, style an~pe, then only fill one segment out° please identify ta~ks by owner ID #o I. TANK DESCRIPTION COMPLET~ALL,TEMS- SPEC,FY,~UNKNOWN ~-~ '~.~'~/-~ .~ III. TANK CONSTRUCTION MARK ONE ll'~M ONLY IN SOXES k a, ANOC, ANO ALL THAT APPLIES IN SOX D TYPE OF '~ 1 'DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN A. SYSTEM [~ 2 SINGLE WALL [] 4' SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER [] 1 BARE STEEL [] 2 STAINLESS STEEL ~L~3 FISE~GLASS B. MATERIALTANK [] 5 CONCRETE [] 6 POLYVINYL CHLORIDEE~] 7 ALUMINUM {PrimaryTank) ~ 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP [] 99 OTHER [] 1 RUSBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING C. INTERIOR [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN lINING IS UNING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO__ ] 4 PHENOLIC LINING ] 99 OTHER D, CORROSION r~ 1 POLYETHYLENE WRAP [] 2 COAT[NC PROTECTION [~ S CATHODIC PROTECTION [] 91 NONE .... [] 3 vINYL WRAP . ~ 4 FIRERGLASS REINFORCED PLASTIC [] UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE B, CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER SINGLE WALL A~ 2 DOUBLE WALL A [J 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER RARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A~4 FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A IJ 8 100% METHANOL COMPATISLEWfi:RP GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER ~ 3 INTERSTITIAL [] 99 OTHER AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING ~ MONFCORING · V. TANK LEAK DETECTION [] 6 TANK TESTING 7 ,NTERST TIALMON'TOR'NG [] [] UNKNOWN' [] 99 OTHER DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN VNER'S TANK I. ~, ~ III, TANK A. TYPE OF SYSTEM B. TANK MATERIAL (PrimaryT:~nk) [] 9 BRONZE [] 10 GALVANIZED STEEL 95 UNKNOWN [] 99 OTHER 8. MANUFACTURED BY: (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: RUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C, AND ALL THAT APPLIES IN BOX D DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER 95 UNKNOWN ~ 2 WALL [] 4 SECONDARY CONTAINMENT [] 99 OTHER [] 1 BARE [] 2 STAINLESS STEEL [] 3 ~ [] 4 STEEL CLAD W/FIgERGLASS REINFORCED PLASTIC [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] [] 8 100% METHANOL COMPATISLEW/FRP [] 1 RUSBER LINED 2 ALKYD LINING [] 3 EPOXY LINING C. INTERIOR ~-~ 5 GLASS LINING [] 95 UNKNOWN LINING IS LINING MATERIAL COMPATISLE WITH YES__ NO__ [~ 1 POLYETHYLENE WRAP [] [] 3 VINYL WRAP [] 5 CATHODIC PROTECTION NONE [] 95 UNKNOWN CIRCLE ~,BOVE GROUND OR U IF L BOTH IF APPLICABLE D. CORROSION PROTECTION IV, PIPING INFORMATION A. SYSTEMTYPE A u B, CONSTRUCTION A U ] 4 PHENOLIC LINING ] 99 OTHER ] 4 FIBERGLASS REINFORCED PLASTIC [] 99 OTHER A U 2 PRESSURE A U VlTY A U 99 OTHER WALL A U 2 DOUBLE WALL A U 3 TRENCH A U 95 UNKNOWN A U 99 OTHER A U 2 STAINLESS STEEL A U 3 A U 6 CONCRETE A U 7 A C. MATERIAL AND V. TA~E~ DETECTION ,, ~ I ~1 VISUAL CHECK ~ 2 INVENTORY RECONCILIATION ~ 3 VAPOR MONITORING ~ 4 AUTOMATIC TANK ~UOING ~ ~ LRr :~VC)A U 4 FIBERGLASS PIPE A U 8 100% METHANOL COMPATISLEWIFRP MONITORING akersf~eld ]{ ~re De~ HAZARDOUS MATERIALS DIV'I~I~N'"~ UNDERGROUND STORAGE TANK PROGRAM FOR REMOVAL OF AN.UNDERGROUND. STORAGE TANK PERMIT APPLICATION SITE INFORMATION '. CONTRACTOR INFORMATI'ON COMPANY, ~Z ~ ~, ,v" pHONE.No; PRELIMANARY ASSEMENT INFORMATION ., . : INSURANCE CARRIER //=/~¢~'~'~.~¢w~¢Ar ~¢,. WORKMENS COMP No. ¢.~ TANK CLEANING INFORMAT'ION ; .... FACILI~INDENTIFICATIONNUMBER ' ~ 4 ~ CP~ ~,/,7~. . ~FFzf-/] ~ o LICENSE CITY ;~= ,~_.,.,,,. ~..?,~ ZIP CODE WORKMENS COMP No. TANK' TRANSPORTER INFORMATION ' COMPANY 7~ ~ fa) ' <f~,? ' PHONE No; ADDRESS~r~ ~o .~'. 6~/v/'¢~ '.~,*-c TANK DESTINATION' ~f~ ~'¢ ,~¢~, -p ~ ~ TANK INFORMATION ~-//~ o LICENSE No;~-,-~ .~ ? CITY ¢_.~,,r_.C,,'//ZIP CODE TANK No. AGE. VOLUME CHEMICAL DATES CHEMICAL STORED STORED PREVIOUSLY STORED THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATrACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIOblS. M RAS SEEN cOMPLETED UNDER /APPRC~VED BY: ~' ' ' THIS PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. APPLICANT NAME (PRINT) ~ AF;PLI'E~ANT'Si(~NATORE APPLICATION I~ECOMES'A PERMIT WHEN APPROVED '..buildlng's .... . .' .. location of tanks, pi!~ing, and dispensers utilities : SCALE . .~ . .. wa'ter wells (if on sitE:) any other re. le~,8nt ir'iformation BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 CERTIFICATION STATEMENT OF TANK DECONTAMINATION If '~'~ name j.~/w~ an authorized agent of ' contracting co. perjury that the tank(s) located at ~3C., here'by 'attest under penalty of address and being removed under permit~ ~',~--CgO.~-d~ has been cleaned/decontaminated properly and a LEL (lower explosive limit) reading of no greater than 5% was measured~immediately following the cleaning/decontamination process. name (pr~l nt ) s i g~{atur e -.n,,,~m, ....... '.,. ',.,: ,,u,.,-.~ ~5<ee inr;tructions on Back'ol Page b .... , ..... B No. 2050--0039 (Expires 9-30-I and Front of t~ b 7 - Toxic SubslancJ,s ~..o,,I,.hl~,vm~, · Form designed for use on elite'l~l~-pitch typewriter). I~~. Sacramento, Cellforn, ~ ~A~A~H~ ~ 1. Generator's US EPA ID No. Manifest 2. Page 1 v~,-, , ,~,,~v~ i~ -' ~ . ' - --- ' --o ument No.I Informalion In the shaded areas · . ,WASTE MANIFEST I(l~glg, l~l~/~gl~l~l~y~.,Id~l~lt o, / ia not required by F.deral lR.. ~. Generator's Nape'and Mailing Address . A. State Manlfe~ Document Number . -. 90527636 5. Transpoder I Company Name __ . '. , :~._ - . US EPA ID Number C. State T~n,~,,', 7. Transpolar 2 ~ompany Name . 8. ' US EPA ID Number' E. 8tats T~n~o~er's ID ' - I11 III1'II III ~9, Deel0~aled Facility Name and Site Address 10, U8 EPA ID Number ~. 8~'ate Facile) ID '" ~ 12. Containers, 13. Total 14. I. 11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) . . Quantity Unit Waste No. No. Type Wt / Vol a. State b. EpA/~her · ' I I I I I I I c. State EPA / ~her state EPA t ~her I I I' I I I I l J. AddEi~al Descrlpt~n8 for Mat~al8 Li~ed Above . :: K. Handling ~e f~ Wastes Listed Above 0- / ,.'.: ::'. '.'" :' .'" " ' , ;5. Speci. I Handltn0 Inalruclion8 '~nd Additio.81 I'~t~m.tlon ........... eENERATO~'8 CERTIFICATION: I hereby declare that th~ c~ntents of this consignment are tully and accurately described above by proper shl~plng name and are claeslfied, packed, marked, and labeled, and are In all reapecta In.proper condition for transpo~ by highway accordin~ applicable inlernaflonal end national government ~egulaflons. If ~ am a large quant ty generator,.l ce~l~ that I have a program In place to reduce the volume and toxicity of waste generated to the degree I h~ve determined tO be economic~lly practicable snd that I have selected the practicable method of treatment. 8forage, or dispoaal currently available to me whl~h minimi~ ~h~ preaenl and ~uture threat to human health and the environment; 0~, tf I am a 8mall quantity generator, I have made a good faith eflo~ to minimize my wasle generation 8nd eelect the beat waste management method that 18 available to me and that I can afford. Printed/Typed Name . Sign al~[.a~; i ~onth D~y .Ye~ ~ C,TWe ~ ~ ' i 17. Tr8n8poder 1 Acknowledgement of Receipt of Malerisle Printed/Typed Name/ "IJ Signature. '?."'. . ~" ./'-' .~...... Month O,y Year PrlnledlTyped Name I Signature ' Month D~y YRRr ' I I I I I I 19. Discrepancy Indication Space 20, Facility Owner or Operator Certification of receipt of hazardous materials covered by this manliest except as noted In Item 19, ~{T~ed Name ~. Signalure ' . /" '~/~ Month ~ay Year 'DHS 8022 A EPA 8700--22 (Rev. 6-89) Previous editions ere obsolete. Do Not Write Be'low This Line Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAY~ State of California---Health and Welfare Agency ~, See lnstructiorls on :k of Page 6 Department of Health Services Toxic Substances Control Division Form Approved OMB No. 2050~0039 (Expires 9-~ . and FrOnt 7 Please print or type.. Form designed for use on ehT~"(12-pitch typewriter). Sacramento, California WASTE MANIFEST -,I I I I~/1!:1 I~1 I f-;IP~l~ll o, is not requirod by Fodoral law. 3. Generator's Na..,me and Mailing Address ; !?~; state Manifest Document Number ~t o~..C'~ ~.1~' .7~-~ <.~ , i 5. ~anspoHer , Company Name 6.., U~ EPA ID Number ~ 'C. State Trs, sP~er:, ID ~ J ~ ~ (}~q/}tu 17,/V~dt.~v~4 '.~u/~ l(~J/]li~lC '1~'101~I/<~17~9 IZI ~ ~,,,~o,,r,~., ~ .-~. 7. Transporter 2 Company Name ' 8. . US EPA ID Number , :E{=.[stat~ ~m~r~s"lD. 9. Designated Facility Name and Site Address 10. US EPA ID Number =~G[ 9tato F~'il~ ID'" ............ , · ~ ~H: ~EBCttltg'~~ ~e':~: .. 12. Containers 13. Total 14. . I. 11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) ' Quantity Unit ' Waste N0. ' No. Type Wt/Vol ~. , State G E b. 'State. R . ) ~ ..?... A EP~/~her · ".' T o I I I I I I I , .. R c. State. ;. , '. , I I I I I I I · d. State -~ ',0~. ,'cil~-.~,,.~.~ ~i;_: ~ '=~. I I I I I I I · J; Add~ionaFDescriPt~naforMateralS~Elsted;~bove:':~ '~::: ::. ::~L~:::..:: .':...:' ~:.~: ~:. '~ ~,, ..: .=:~:~:: ~: ~:~:': :' ,'~'::..~'::?:' >: :':.: : ~:~:~?~ :~k::''~.: =.:'' :. .. :.~Z' . '~<~ ~' ~' :?~: ~: ':~ ~:.~= : ' ¥~. ~.. ·I b 15. Sp~i~l H~ndli~g In~truofion~ ~nd Additional Information * /:,t? (..U'Tzz GENERATOR'S CERTIFICATION: I hereby declare that the cont*nts of this consignment ar~ fully and accurately described above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects in proper condition f~r transpo~ by highway according to applicable international and national government regulations. I; I sm a large quantity generator, I ce~ify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the practicable method of treatmentq storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I Can afford. T 17. Transpolar 1 Acknowledgement of Receipt of Materials R A Printed/Typed Name ~ Signature ~ ./~ ~' Month Day Year N ,,~ / / -- · . '[ ,. ,, ~,, ~ ,,~ ..~Y"]' ~" . O 18. Transpolar 2 Acknowledgement~f Receipt of Materials ~ ~ ~ .... ~' ....... ' ~ Printed/Typed Name [ Signature ] Month Day Year E[ 8 ~ I ~ I ~ I I 19. Discrepancy Indication Space I ' F , A. C i ' L I 20. Facility Owner or Operator Ce~ification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T y Printed/Typed Name ~ Signature ~ Month Day Year I DHS 8022 A EPA 8700--22 (Rev. 6-89) Previous editions are obsolete. Do Not Write Below This Line YELLOW: GENERATOR RETAINS Petroleum Hydrocarbons RLW EQUIPMENT 2080 S UNION P O BOX 640 BAKERSFIELD, CA 93302 Attn.: BUD 834-1100' Date of Report: 07/17/92 Lab $: 6174-1 Sample Description: T~JNK REMOVAL, EAST T~NK 2' DEPTH 12' UNDERTANK. S~i~PLE WAS TAKEN ON 07-13-92 ® 10:46AM BY LONNY SAUNDERS. TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 07/13/92 Constituents Benzene Toluene Ethyl Benzene o-Xylene m & p-Xylene Total Petroleum Hydrocarbons (gas) Date Sample Received @ Lab: 07/13/92 Date Analysis Completed: 07/15/92 Minim~n Analysis Reporting Reporting Results Units Level None Detected mg/kg None Detected mg/kg None Detected mg/kg None Detected mg/kg None Detected mg/kg None Detected mg/kg 0.005 0.005, 0.005 0.005 0.005 California D.O.H.S. Cert. ~1186 epartment S~ cc: UNION CEMET3tRY 4100Atlas Ct. - Eiake~*sfield, r_;A 93308 · (805) 327-491 I · FAX (8(3~ 327-1E)I 8 Petroleum Hydrocarbons RLW EQUIPMENT Date of 2080 S UNION Report: 07/17/92 P 0 BOX 640 Lab ~: 6174-2 BAKERSFIELD, CA 93302 Attn.: BUD 834-1100' Sample Description: TANK REMOVAL, EAST TANK 6' SAMPLE 16' I/NDERTAi~K. SAMPLE WAS TAKEN ON 07-13-92 ® 10:58AM BY LOITNY SAUNDERS. TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 07/13/92 Constituents Date Sample Received ® Lab: 07/13/92 Date Analysis Completed: 07/15/92 Analysis Reporting Results Units Minimum Reporting Level Benzene None Detected mg/kg 0.005 Toluene None Detected mg/kg 0.005 Ethyl Benzene None Detected mg/kg 0.005 o-Xylene None Detected mg/kg 0.005 m & p-Xylene None Detected mg/kg 0.005 Total Petroleum Hydrocarbons (gas) None Detected mg/kg 1. California D.O.H.S. Cert. ~1186 De cc: UNION CEMET~RY 4100Atlss Cc. · E~akersfield, OA ~3:30~ · (805) 327~4~1 I · F~X (~-) 327-1 Petroleum Hydrocarbons RLW EQUIP~IENT 2080 S UNION P 0 BOX 640 BAKERSFIELD, CA 93302 Attn.: BUD 834-1100' Date of Report: 07/17/92 Lab ~: 6174-3 Sample Description: TANK REMOVAL, WEST TANK 2' UNDER PEE GRAVEL 12' UNDERTANK. SAMPLE WAS TAKEN ON 07-13-92 @ ll:10AM BY LONNY SAUNDERS. TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 07/13/92 Constituents Date Sample Received ® Lab: 07/13/92 Date Analysis Completed: 07/15/92 Analysis Reporting Results Units Minimum Reporting Level Benzene None Detected mg/kg 0.005 Toluene None Detected mg/kg 0.005 Ethyl Benzene None Detected mg/kg 0.005 o-Xylene None Detected mg/kg 0.005 m & p-Xylene None Detected mg/kg 0.005 Total Petroleum Hydrocarbons (gas) None Detected mg/kg 1. California D.O.H.S. Cert. ~1186 Department Superviso~ cc: UNION CEMETARY 4100 Acl~s 0c. · E)akersfield, 0A ~330L~ · [E)OS) 327-4~11 · FAX (E~--) 327-1 LABORATORIES Petroleum Hydrocarbons RLW EQUIPMENT Date of 2080 S UNION Report: 07/17/92 P 0 BOX 640 Lab ~: 6174-4 BAKERSFIELD, CA 93302 Attn.: BUD 834-1100- Sample Description: TANK REMOVAL, WEST TANK 6' LINDER PEE GRAVEL 16' UNDERTANK. SAi~PLE WAS TAKEN ON 07-13-92 ® ll:17AM BY LONNY SAUNDERS. TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. Sample Matrix: Soil Date Sample Collected: 07/13/92 Constituents Date Sample Received ® Lab: 07/13/92 Date Analysis Completed: 07/15/92 Analysis Reporting Results Units Minimum Reporting Level Benzene None Detected mg/kg 0.005 Toluene None Detected mg/kg 0.00~ Ethyl Benzene None Detected mg/kg 0.005 o-Xylene None Detected mg/kg 0.005 m & p-Xylene None Detected mg/kg 0.005 Total Petroleum Hydrocarbons (gas) None Detected mg/kg 1. California D.O.H.S. Cert. $1186 cc: UNION CEPIET/LqY 4100Atlas CC. · E~ake~sfield, OA E)330~ · (805) 327~4S)1 I · FAX (E~Z)b~ L~27-I S)1 E) Report To' o,'~ Analysis Requested Name:0p(~~ C'F~¢.-~-%~.~ Project: '"F"4¢¢_ ~tZ.,,,~.4.<~ ~' Address: ~ ~~ ~; Project ~: / City: ~ Sampler Name~.~~ Sta~e: ~ Zip: ' ~ Other: Phone: ~4 - l~co La~ Sample Description ~ Date & Time Sampled . Comment: Billin~ Inlo: Name: ~L¢ ~o,,~ ~ ~~;~ Recoi~d by: (Signatur~ ~. [~ Date: Time: Cit~~m State ~ Date: Time: A~entio.: ~D ~d' ¢~- ~ ~oli.quished bY: (Signature) ~ocoived by: {Signature) Date: Time: MiloS: ~olinquished by: (Si~aaturo) ~ocoivod by: (Signature) Data: Time: Sample Disposal ~.O.~ ~ [~ Bolinquishod by: (Signature) ~ocoivod by: (Signature) Date: Time: ~¢ ~isposal ~ 5.~ ~ ~otum to cliont