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Home My WebLink AboutUST-CERT. FINANCIAL RESP. 6/8/2004June 8, 2004 Environmental Mana¢ West Region P.O. Box 5095 Room 3EO00 San Ramon. CA 94583-0995. 877.823.983] Phone 925.9?3.0584 ...... 925.8670241 City of Bakersfield - CUPA Attn: Ralph E. Huey, Director Fire Department 1715 Chester Ave, Third Floor Bakersfield, CA 93301 RE: Certification of Financial Responsibility - Underground Storage Tanks Please find the enclosed copy of the annual State of California Water Resources Control Board's Certification of Financial Responsibility form to demonstrate financial responsibility for SBC/Pacific Bell and its affiliate's underground storage tanks. Also enclosed is a list, Exhibit A, of SBC/Pacific Bell sites that have underground storage tanks on the premises in your area of jurisdiction. I can be reached at (925) 823-6161 if you have questions regarding this correspondence. Andrew Taylor Senior Environmental Manager SBC Environmental Management Attachment: Certification of Financial Responsibility Exhibit "A" 2004 Financial Test of Self Insurance (Certificate of Insurance) EXHIBIT A - ' 2004 UST FINANCIAL RESPONSIBILITY ~ ' KERN COUNTY Agency l Location ' , '' City l Site Contact Bakersfield Fire Dept 3221 So. "H" Street Bakersfield Linda Porter Bakersfield Fire Dept :1918 "M" Street Bakersfield ' ' Linda Porter Bakersfield Fire Dept 3501 Columbus Ave Bakersfield . Linda Porter Bakersfield Fire Dept ~.1609 Rosedale Hwy Bakersfield Linda Porter Kern County Health Dept 925 Jefferson St Delano Linda Porter Kern County Health Dept 8313 E Segrue Road !Lamont Linda Porter Kern County Health Dept 1023. California St Oildale Linda Porter ~t4.1'lt~'l~A'l'l~ OF In~UI~cL~ ~ Issue Date: 06-09-2004 Certificate Number: . 20208 _.. .INSURED:. ............... ' ............ !This (s to. certify.that p~oli¢ es of insurance listed belo~ have. been issued to ~he named-insured- for ~e - -- policy period indicated. Notwithstanding any requirement, term or condition of any contract or other SBC COMIVlUNICATIONS INC. document with respect to which'this'certificate-may be issued or may peKain, the ir~§~¢ar~ce'aCforded by PACIFIC BELL TELEPHONE COMPANY the policies described herein is subject to all the terms, exclusions, and conditions of such policies 175 E. HOUSTON - : .~ -. .. SAN ANTONIO, TX 78205 This certificate is issued as a matter of information only and confers no rights upon the ce~t~cate holder. This certificate does not amend, extend or alter the coverage afforded by the policies described below. TYPE OF INSURANCE '. '.'pOLICY . EFFECTIVE EXPIRATION LIMITS OF LIABILITY COMPANY AFFORDING COVERAGE :.. ' NUMBER DATE DATE OTHER Gateway Rivers Insurance Co. 409-lUST001 12/31/2003 12/31/2004 PER OCCURRENCE $ 500,000 Environmental Impairment ANNUAL AGGREGATE $1,000,000 Liability for Underground and Above Ground Storage Tanks DESCRIPTIONOF'OPERATIONS'..-.;.i'..'.;'!:.i:.i."..'.-':,~..:::'.'~;~i: ":';"i i.;",": :' 'i' ' SEE ATTACHMENT FOR CERTIFICATION LANGUAGE. CANCELLATION. ' ' .,: · Should any of the above described policies be cancelled before the expiration date thereof, the insurance company will endeavor to mail 30 days wdtten notice to the certificate holder named below. Failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. CERTIFICATE HOLDER PRODUCER CONTACT STATE OF CALIFORNIA Amedcan Risk Management Requested By STATE WATER RESOURCES CONTROL BOARD P.O. Box 1530 ANDREW TAYLOR DIVISION OF CLEAN WATER PROGRAMS Burlington, VT 05402-1530 Requestor's Phone P.O. BOX 944212 925-823-6161 SACRAMENTO, CA 94244-2120 Issued By , DJ AUTHORIZED REPRESENTATIVE ...... For State Use Only State or' Calitbniia .State Water. Resources-Control Board .................................................... Division of Clean Water Programs P.O. Box 944212 Sacramento, CA 94244-2120 CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM h. [ am required to demonstrate Financial Responsibility in the required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: [] 500,000 dollars per occurrence [] I million dollars annual aggregate or AND or [] I million dollars per occurrence [] 2 million dollars annual aggregate B. Pacific Bell Telephone Company hereby certifies that it is in compliance with the requirements of Section 2807, (mine ona~ o,,',,= or O~,~oO Article 3, Chapter 18, Division 3~ Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Name and Address of'Issuer Mechanism Coverage · Coverage Corrective Third Party Type Number Amount Period Action Compensation Certificate of' Gateway Rivers insurance 409- $500,000 Per 12/31/2003- Yes Yes Insurance Company lUST00! Occurrence & 12/31/2004 76 St. Paul St., Ste. 500 $1,000,000 Burlington, VT 05401-4477 Annual Aggregate Note: [£ you are using the State Fund as any.part of your demonstration of financial responsibility, your executionand submission of this certification also certifies that you are in compliance with all, conditions for participation in the Fund. D, Facility ~n~ Facilir/Address Pacific Bell Telephone Company See Attachment Facility Naro~ Facility Facility Name Facility A~ress Facility Name Facility Facility Nan~ Facility Adch'~ Facility Nam~ Facility "Facility Name Facility Ad~ress -/~)- Paul ~/. Stephens, Director & Executive Vice President S ~mit original to iocaiX¥ST regulatory agency. Keep a copy at eaeh. UST facility. (Instructions on Reverse) UN-049 - 112 wv~w.unidocs.org 01/29/02 40 CFR, 280.97 tb)(2) Cer~ifi~ate of Insurance Name: [name of each covered locationl: See attached schedule Address: [address of each covered location], See attached schedule Policy Number: 409-lUST001 Endorsement (if applicable): Not Applicable Perio~ of Coverage: I2/31/2003-12/31/2004 Name of Insurer: Gateway Rivers Insurance Company Address of Insurer: 76 St. Paul Street, Suite 500, Burlington VT 05401-4477 Name of Insured: Per Certificate of Insurance Address of Insured: Per Certificate of Insurance Certification: Pacific Bell Internet, Svcs. Inc. i. Gateway Rivers Insurance Co., the "Insurer", as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s): See Attached for "taking corrective action" and/or "compensating third parties for bodily injury and property damage caused by" either "sudden accidental releases" or "nonsudden accidental releases" or "accidental releases"; in accordance with and subject to the limits of liability, exclusions, conditions, and other terms of the policy; if coverage is different for different tanks or locations, indicate the type of Coverage applicable to each tank or location] arising from operating the underground storage tank(s) identified above. The limits of liability are $500,000 for "eagh Occurrence" and $1,000,000 "annual aggregate", limits of the insurer's liability; exclusive of legal defense costs, which are subject to a separate limit under the policq. This coverage is provided under 409-lUST001. The effective date of said policy is 12/31/2{)03- 2) The insurer further certifies the following with respect to the insurance described in Paragraph 1: a. Bankruptcy or insolvency of the insured shall not relieve the insurer of its obligations under the policy to which tiffs certificate applies. b. The insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third-party, with a right of reimbursement by the insured for any such payment made by the insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. c. Whenever requested by a Direc.tor of an implementing agency, the insurer agrees to furnish to the Director a s!gned duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the insurer, except for non-payment of premium or misrepresentation by the insured, will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the insured. Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration ora minimum of l0 days after a copy of such written notice is received by the insured. e. The insurance covers claims otherwise covered by the policy that are reported to the insurer within six months of the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits of liability, and exclusions of the policy. I hereby certify that tlxe wording of tkis instrument is identical to the wording in 40 CFR 280.97(b)(2) and that the insurer" is "licensed to transact the business of insurance," or "eligible to provide insurance as an excess or surplus lines insurer, in one or more states". Signature of authorized representative of Insurer: Type Name: Title, Authorized Representative of Insurer: Address of Representative: Paul W. Stephens Director & Executive Vice President Gateway Rivers Insurance Co. 175 E~ Houston, 7-P-60 San Antonio, Texas 78205 ~ Tait Environmental SYstems UST Construction · Design · Maintenance · Compliance May 5, 2004 CERTIFIED MAIL - RETURN RECEIPT REQUESTED E-Certified Nc' 91 7108 2133 3930 8585 733~ Mr. Ralph Huey City of Bakersfield Fire Department 1715 Chester Avenue, Third FlOor Bakersfield, CA 93301 RE: Pacific Bell Sites & CLLC Codes: 1918 "M" Street, Bakersfield Geo Par: SA-004 CLLC: BKFDCA12 Dear Mr. Huey: Enclosed are the following forms for the above-referenced facilities: Monitoring System Cedification Spill/Overfill Containment Form Feel free to call if you have any questions. Very Truly Yours, TAIT ENVIRONMENTAL SYSTEMS ALAN THROCKMORTON Compliance Manager AT:clb Enclosure :\tes\pb2004\letters\kem\huey.r CC: Andy Taylor Linda Porter (Post At Site) CA Lic #$88098 · AZ I. ic #09,5984 · NV Lic #0049666 1863 North Neville Street · Orange, California 92865 · 714.560.8222 · 714.685,0006 Fax 3283 Luyung Drive · Rancho Cordova, California 95742 . 916.858.1090 · 916,858,1011 Fax www. SB989.com ' MONITi I ING SYSTEM CERTIFII iTION For Use By All duril'dictions Within the State of California Authority Cited.'- Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations I I This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. ] A. General Information Facility Name: SBC OEO PAR # SA-004 CLLC Code: BKFDCAI2 Site Address: 1918 "M" STREET Facility Contact Person: LINDA PORTER City: BAKERSFIELD Zip: Contact Phone No.: 818-908-6044 Make/Model ofMonitoring System: B. Inventory of Equipment T~stmt/C~rtifl~l Check the appropriate boxes to indiCate specific equipment in Tank ID: 1139 []In-Tank Gauging Probe: NlAnnular Space or Vault Sensor: []Piping Sump/Trench Sensor (s): []Fill Sump Sensor (s): F1Mechanical Line Leak Detector. []Electronic Line Leak Detector []Tank Overfill/High-level Sensor: VEEDER-ROOT TLS-350 Model: 847390-109 Model: 794390-420 Model: 794380-208 Model: 794380-352 Model: Model: Model: 790091-001 []Other, Specify equip, type and model in Section E on Page 2 Tank ID: Flln-Tank Gauging Probe: Model: []Annular Space or Vault Sensor: Model: F1Piping Sump/Trench Sensor (s): Model: []Fill Sump Sensor (s): Model: []Mechanical Line Leak Detector. Model: []Electronic Line Leak Detector. Model: []Tank Overfill/High-level Sensor: Model: []Other, Specify equip, type and model in Section E on Page 2 Dispenser ID: []Dispenser Containment Sensor(s): Model: [3 Shear Valve(s). F1Dispenser Containment Float(s) and Chain(s) Dispenser ID: [2Dispenser Containment Sensor(s): Model: [] Shear Valve(s). []Dispenser Containment Float(s) and Chain(s) Dispenser ID: []Dispenser Containment Sensor(s): Model: [] Shear Valve(s). Date of Testing/Service: ~ected/servieed: Tank ID: 4/14/04 []In-Tank Gauging Probe: Model: []Annular Space or Vault Sensor Model: []Piping Sump/Trench Sensor (s): Model: F1Fill Sump Sensor (s): Model: []Mechanical Line Leak Detector. Model: []Electronic Line Leak Detector Model: []Tank Overfill/High-level Sensor: Model: []Other, Specif7 equip, type and model in Section] E on Page 2 Tank ID: . ' []In-Tank Gauging Probe: Model: []Annular Space or Vault Sensor Model: []Piping Sump/Trench Sensor (s): Model: []Fill Sump Sensor (s): Model: []Mechanical Line Leak Detector. Model: []Electronic Line Leak Detector Model: []Tank Overfill/High-level Sensor: Model: []Other, Specify equip, type and model in Section E on Pal~e 2 Dispenser ID: [3Dispenser Containment Sensor(s): Model: [] Shear Valve(s). []Dispenser Containment Float(s) and Chain(s) Dispenser ID: []Dispenser Containment Sensor(s): Model: [] Shear Valve(s). []Dispenser Containment Float(s) and Chain(s) Dispenser ID: []Dispenser Containment Sensor(s): Model: [] Shear Valve(s). []Dispenser Containment Float(s) and Chain(s) []Dispenser Containment Float(s) and Chain(s) *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): [-I System set-up O Alarm history report Technician Name (Print): DONS. THOMPSON Signature: ~ ~ ~[_ ..,~,,,a Certification No.: 3354 License No.: 588q3~1~ '"~' "'"'~"¥"'-- "~' Testing Company Name: TAIT ENVIRONMENTAL SYSTEMS Phone No.: (714) 560-8222 Monitoring System Certification Site Address: 1918 "M" STREET, BAKERSFIELD, of Testing/Servicing: 4/14/04 D. Results of Testing/Servicing Software Version Installed: 123.01 Complete the following checklist: [] Yes [] No* Is the audible alarm operational? [] Yes [] No* Is the visual alarm operational? [] Yes [] No* Were all sensors visually inspected, functionally tested, and confirmed operational? [] Yes [] No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? [] Yes [] No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) [] N/A operational? [] Yes [] No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment [] N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) [] Sump/Trench Sensors; [] Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? [] Yes; [] No. [] Yes [] No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no [] N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point(s) and operating properly? If so, at what percent of tank capacit~ does the alarm trigger? 95% [] Yes* [] .No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. [] Yes* [] No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) [] Product; [] Water. If yes, describe causes in Section E, below. [] Yes [] No* Was monitoring system set-up reviewed to ensure proper settings? [] Yes [] No* Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 Site Address: 1918 "M" STREET, BII~RSFIELD F. In-Tank Gauging / SIR Equipment: D~f Testing/Servicing: 4/14/04 [] Check this box if tank gauging is used only for inventory control. [] Check this box if no tank gauging or SIR equipment is installed. · This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Com ~iete the followin checklist: [] Yes [] No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? [] Yes [] No* Were all tank gauging probes visually inspected for damage and residue buildup? [] Yes [] No* Was accuracy of system product level readings'tested? [] Yes [] No* Was accuracy of system water level readings tested? [] Yes [] No* Were all probes reinstalled properly? [] Yes [] No* Were all items on the equiPment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G, Line Leak Detectors (LLD): [] Check this box ifLLDs are not installed. Corn )lete the followin checklist: [] Yes [] No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [] N/A (Check all that apply) Simulated leak rate: Ul3g.p.h.~; [] 0.1g.p.h.2; Fl 0.2 g.p.h.2 Notes: 1. Required for equipment start-up certification and. annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. [] Yes [] No* Were all LLDs confn-med operational and accurate within regulatory requirements? [] Yes [] No* Was the testing apparatus properly calibrated? I [] Yes [] No* For mechanical LLDs, does the LLD restrict product flow'if it detects a leak?' N/A [] Yes No* For electronic LLDs, does the turbine automatically shut offifthe LLD detects a leak? ~ [] N/A [] Yes [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled [] N/A or disconnected? [] Yes [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring systeTM [] N/A malfunctions or fails a test? [] Yes [] No* For electronic LLDs, have all accessible wiring connections been visually inspected? [] N/A [] Yes [] No* Were all items on the equipmentmanufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. CommentS: Site Address: SBC, 1918 "M" STREEIKERSFIELD Monitoring System Certification Date of Testing/Servicing: APR ~ 4 200~ UST Monitoring Site Plan ~¥? c._y .............. Date map was drawn: . Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detectiOn).. In the space provided, note the date this Site Plan was prepared. Page __of Seconc Containment Testing Repoti om · This form is intended for use by contractors per~rming periodic testhag of UST secondary con01~nent systems. Use the appropriate pages of t~his form to report results for all components tested. The completed form. written test procedures, and printouts from tests (if applicable), shoul¢ 'be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION CLLC: BKFDCA12 GEO PAR: SA-004 Facility Name: SBC [ Date of Testing: 4/14/04 Facility Address: 1918 "M" STREET, BAKERSFIELD Facility Contact: LINDA PORTER [ Phone: 818-908-6044 Date Local Agency Was Notified of Testing: 48 HOURS PRIOR Name of Local Agency Inspector (if present during testing): BAKERSFIELD FIRE TESTING CONTRACTOR INFORMATION Company Name: TAIT ENVIRONMENTAL SYSTEMS Technician Conducting Test: DON S. THOMPSON Credentials: [] CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: A ASB HAZ B C-10 [ License Number: 588-098 Manufacturer Trainint Manufacturer Component(s) Phil-Tite Date Training Exp..ires. 3. SUMMARY OF TEST RESULTS Not Repairs component Pass Fail Tested Not Repairs Made Component Pass, Fail Tested Made Diesel Fill [] If hydrostatic testing was performed, describe what was done with the water after completion of tests: Left on site in a 5 gallon dram - yellow label CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ~ .~, ~,v~A/~_ Date: 4/14/04 ' ' 4. ~qVERVII~L .C_ONT^INMENT BOXE~' l~acility is Not Equipped With Spill/Overfill C/~l~iinment Boxe'--~ --,~ ,~pill/Overfill Containment Boxes are Present, but were Not T~t~d -~est Method Developed By: Spill Bucket Manufacturer [] Industry Standard' Professional Engineer Other (Specify) Test Method Used:· Pressure Vacuum [] Hydrostatic Other (Specify) , Test Equipment Used: MARKER/VISUAL ] Equipment Resolution: N/A Spill Box it Spill Box it Spill Box # Bucket Diameter: Bucket Depth: Wait time between applying pressure/vacuum/water and starting test: Test Start Time: Initial Reading (R0: Test End Time: Final Reading (RF): Test Duration: Change in Reading (RF-R~): Pass/Fail Threshold or Criteria: · Test Result: 12" 27" 10 MINUTES 10:30 20" 11:30 20" 1 HOUR 0 0 ~ []:~:Pass ~ Fail~ ~' PaSs Fail Pass Fail · ' ~ .pass Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests)