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HAZ-BUSINESS PLAN 2001/2002
HAZ~)OUS MATERIAI.S ~/ISION TIME CHARGED BUSINESS/DEAPRTMENT NAME: ADDRESS: PROIECT DESCRIPTION: PROJECT NUMBER: DATE: .,"7 TIME CHGD: COMMENTS: '5, hr PROIECT COMPLETION: DATE: · 'he l OUp ~ Corporati°n 3452 East Foothill Boulevard, 9th Floor Pasadena, CA 91107-3159 Tel. 626.304.]500 Fax. 626.535.9076 A Member ot' The IT Grot~p December 26, 2001 IT Project 828248/10600000 Mr. Howard H. Wines, HI City of Bakersfield Fire Department Environmental Services 1715 Chester Avenue, 3rd Floor Bakersfield, CA 93301 Re~ AB2886 GEOTRACKER REQUIREMENTS Former Texaco Service Station 3698 Ming Road at Real Road Bakersfield, California Dear Mr. Wines: On behalf of Equiva Services LLC (EQUIVA), the IT Corporation (IT) is submitting this letter to inform you that the above referenced site is not listed in the Geotracker Database (Geotracker) on the intemet. As such, IT is unable to upload laboratory analytical data to Geotracker for this site, as required by AB2886. IT requests this site be listed on Geotracker. Please notify IT upon listing this site on Geotracker so data uploaded can proceed. If you have any questions regarding this site, please contact Mr. Bradley Clark (IT) at (626) 304- 1520. Sincerely, IT Corporation Brad]~ey E. Clark, P.E. Project Manager cc: Ed Paden, Equiva E:hMing (3698) ~Real Rd-152',2001-12-262EDF.Agency-Letter~2001 - 12-26_EDF Agency Letter.doc 1)UM PSTER / ............... DEI]RIS PII.E I I I I .< I U N D I(;.R G R.O U N D S'I'()RAG [(i TANKS '\, T-lB-16 T-I B-20 T-lB-25 T-IA, T-la. T-2A. . T-2A. T-3^ T-3A BB-1 \ · \\, / T-2A-16 . ;.. / / T-2A-20 fO'- ....... ~ ...... ', / T-2B-25 · - ................ ~/ BB-3 ............... -~ · .~-' ............... - D-l-6 1~ T3 ~ T-3B-16 ~T-3B-20 . - ............... .BB~_10_ T-3B-28 T-4, ~ T-3B-33 .· D-3-2 BB-5 / ¢ T-4B-16 BB-9 T-4B-20 T.-4B-25 BB-4 S'¥A'FION BUll..I) ING S I I)EWA I.,K " ............. WASTI:'! Oli.. TANK WO-l-9 ~. BB-7 · %B-12 D26 '"x, D-4-2 BB-6 x> DISPENSER // ISLANDS // /, MING ROAD I I 0 BBII · T-2A-16, ~ 20 SCALE IN FEET LEGEND SOIL BORING LOCATION AND DESIGNATION (JANUARY 11 - 12, 2000) SOIL SAMPLE LOCATION AND DESIGNATION (JULY 25, 2001) PROPOSED SOIL BORING LOCATION AND DESIGNATION 40 EQUIVA SERVICES LLC TEXACO SERVICE STATION BAKERSFIELD, CALIFORNIA FIGURE 2 SITE PLAN 598 MING ROAD AT REAL ROAD BAKERSFIELD, CALIFORNIA · ~ Corporation 3452 East Foothill Boulevard, 9th Floor Pasadena, CA 91107-3159 TeL 626.30¥..1500 ~x. 626.535.9076 A Member ot' The IT Group December 12, 2001 IT Project 829248 Mr. Howard H. Wines, III City of Bakersfield Fire Department Environmental Services 1715 Chester Avenue, 3rd Floor Bakersfield, CA 93301 Re: Work Plan for Additional Subsurface Assessment Former Texaco Service Station 3698 Ming Road at Real Road Bakersfield, California Dear Mr. Wines: IT Corporation (IT), on behalf of Equiva Services LLC (EQUIVA), has prepared the following work plan for additional subsurface assessment at the site referenced above. The need for additional assessment was outlined in the City of Bakersfield Fire Department Environmental Services (CBFDES) letter dated October 24, 2001 (Appendix A). The purpose of the assessment is to more fully define the vertical and lateral extent of petroleum hydrocarbons beneath the site. This plan has been prepared to comply with the California Code of Regulations, Title 23, Division 3, Chapter 16, Article 11, Section 2722. All work will be performed under the supervision of a California-registered geologist and/or professional civil engineer. BACKGROUND Site Description The subject site is a former Texaco service station located on the northeast comer of the intersection of Ming Road and Real Road, in Bakersfield, California (Figure 1). The former service station consisted of three gasoline underground storage tanks (USTs), one diesel fuel UST, one waste oil UST and two dispenser islands (Figure 2). Previous Environmental Activities On January 11 and 12, 2000, seven soil borings (BB-1 through BB-7) were drilled during a baseline environmental site assessment investigation. The borings were drilled December 12, 2001 Page 2 to total depths ranging from 20.5 feet to 40.5 feet bgs using a direct-push technology (DPT) Geoprobe drill rig. Total petroleum hydrocarbons as gasoline and diesel (TPH-g and TPH-d), ·benzene, and methyl tea-butyl ether (MtBE) were not detected in any of the soil samples collected and analyzed as part of this investigation. Total recoverable petroleum hydrocarbons (TRPH) were detected in four samples collected from boring BB-7 (near the waste oil UST), ranging from 11 milligrams per kilogram (mg/kg) at a depth of 20 feet bgs, to 18 mg/kg at a depth of 5 feet bgs. Historical soil analytical data is presented in Table 1. Soil boring locations are shown in Figure 2. On July 25, 2001, IT supervised the removal of four gasoline USTs, one waste oil UST, product piping and dispensers. Soil sampling was conducted by IT beneath the five USTs, product piping, and product dispensers. TPH-g was detected beneath the west side of T-2 and beneath D-l, at concentrations of 0.83 mg/kg and 0.92 mg/kg, respectively. MtBE was detected in soil samples from the east sides of T-2, T-3, and T- 4 and beneath D-I, at concentrations of 0.036 mg/kg, 0.18 mg/kg, 0.10 rog/kg, and 0.27 mg/kg, respectively. Benzene was not detected in any of the soil samples collected on July 25, 2001. IT performed limited contaminated soil over-excavation based on field observations during UST removal activities. Over-excavation was done beneath the east side ofT-l, T-2, and T-3. Approximately 75 cubic yards of soil was removed. The confirmation soil sample collected from the bottom of the over-excavation beneath T-2 was non- detect for TPH-g, TPH-d, benzene, and MtBE. The confirmation soil sample collected from the over-excavation beneath T-3 had a TPH-g concentration of 980 mg/kg and a TPH-d concentration of 1,100 mg/kg. MtBE was not detected in the confirmation soil sample collected from the bottom of the over-excavation beneath T-3. Historical soil analytical results are presented in Table 1. Soil sample locations are shown in Figure 2. Geology and Hydrogeology The geologic conditions in the site vicinity are characterized by alluvial deposits underlain by marine and non-marine sedimentary units, metamorphic rocks, and crystalline basement material. Surface and near-surface soil is designated by the U.S. Geological Survey (USGS) as older alluvium, deposited in northwest-dipping alluvial fans resulting from outwash from the Sierra Nevada mountain range to the east. This alluvium is composed primarily of poorly graded and unconsolidated sands, sandy gravels, and occasional discontinuous lenticular bodies of sandy clay and silt. Regionally, the surface of these old alluvial fans is undulatory, with a distinct dip toward the Kern River to the northwest of the site. The site itself is located along one of the crests of the land surface 'ripples', at an elevation of approximately 390 feet above mean sea level (MSL). The total thickness of the alluvial N:\data~PROJEC%705-equiva~Vling (3698) ~Real Rd-152\829248\Work Plan for Addiitional Subsurface Assessment - Dec 2001 #2.doc December 12, 2001 Page 3 fan deposits is estimated to range from approximately 600 feet west of the site to over 4,000 feet near the Sierra Nevada Mountains. The site lies within the Edison hydrogeologic sub-area of the Edison-Maricopa area. Uppermost groundwater within this area occurs within the old alluvial fan deposits. In the site vicinity, deeper aquifers of limited areal extent are present in the consolidated non-marine sedimentary units and within fracture zones of the crystalline basement rock. The most prominent subsurface features controlling the groundwater flow direction are the groundwater barriers formed by the northwest-to-southeast trending Edison fault and subparallel splays of this fault, located south and north of the site, respectively. Site Specific Geology and Itydrogeology Lithology encountered beneath the site is predominantly Recent alluvium composed of silty sand and silty sand with gravel, with interbedded well- and poorly-graded sand with gravel, and well graded gravel with sand, to the total depth explored of 40.5 feet bgs. Groundwater was not encountered during site assessment activities, but the depth to groundwater is estimated to be over 150 feet bgs, with a southerly flow direction. PROPOSED SCOPE OF WORK IT will oversee the drilling and sampling of five on-site soil borings (BB-8 through BB-12) located around the former tank complex, western dispenser islands, and waste oil tank. The proposed boring locations are presented in Figure 2. Pre-field Activities IT will visit the site to mark the boring locations, contact Underground Services Alert 48 hours prior to drilling, arrange the drilling schedule, and mobilize drilling equipment and materials. IT will prepare a site-specific health and safety plan prior to initiating field activities. Notifications regarding the field activities will be made in advance to the appropriate agencies. If required, permits will be obtained for the proposed borings. Field Activities The five borings will be advanced to a minimum depth of 50 feet bgs or 20 feet beyond hydrocarbon impacted soils as defined by the PID readings, or until groundwater is encountered, whichever is first. Prior to drilling with a hollow stem auger rig, the exploratory boring locations will be cleared by hand-auger equipment to a depth of five feet bgs. Soil samples will be collected at five-foot intervals using a 2-inch diameter California modified split-spoon sampler. At each sampling interval, the soil samples will be logged using the Unified Soil Classification System, and a 2-inch diameter brass or N:\data~ROJECT~705-equivaXMing (3698) ~Real Rd-152\829248\Work Plan for Addiitional Subsurface Assessment - Dec 2001 #2.doc December 12, 2001 Page 4 stainless steel sleeve will be retained for analysis. The sleeve will be sealed at each end with TeflonTM -lined plastic end caps, labeled, and stored on ice for transport with the appropriate chain-of-custody documentation to a state-certified analytical laboratory. At each sampling interval, soil samples will be field-screened for the presence of volatile organic compounds (VOCs) by headspace analysis using a photoionization detector (PID) calibrated to 100 parts per million by volume (ppmv) of isobutylene. Once the boring total depth is reached and all samples collected, each boring will be backfilled with bentonite chips and plugged with asphalt patch, Concrete, or soil to match the existing surface cover. Equipment Decontamination All down-hole sampling equipment will be washed between samples in a non-phosphate detergent and rinsed with potable water. Soil Cuttings and Rinsate Disposal Soil cuttings and rinsate generated during drilling activities will be placed in Department of Transportation (DOT)-approved 55-gallon drums. The drums will be sealed and labeled in accordance with the appropriate protocols and each drum will be identified on a waste inventory form. The drums will be temporarily left on-site, pending transport and disposal by Equiva's waste management contractor. Disposal of drill cuttings and rinsate at appropriate disposal or recycling facilities in Southern California will be coordinated by Equilon Enterprises LLC (EQUILON). Laboratory Analysis Soil samples collected during site activities will be analyzed for TPH-g and TPH-d by EPA Method 8015 Modified; and for benzene, toluene, ethylbenzene and total xylenes (BTEX compounds), and MtBE by EPA Method 8260B. Sample Preservation and Transport. All samples designated for chemical analyses will be placed on ice until delivered to the laboratory for analyses. Chain-of-custody documentation will be maintained throughout the sample collection, transport, and analysis process. Report Once the assessment data has been received and reviewed a report will be prepared detailing the complete results of the investigative activities. The report will include the boring logs, a site location map, a table summarizing laboratory analytical results, laboratory repons, and chain-of-custody documents. Following internal review and revision, a final copy of the site assessment report will be submitted to the CBFDES. N:\dataLPROJECT',705-equivahMing (3698) ~Real Rd-152\829248\Work Plan for Addiitional Subsurface Assessment - Dec 2001 #2.doc December 12, 2001 Page 5 SCHEDULE OF PROPOSED WORK IT is prepared to initiate field activities upon approval from the CBFDES. A technical report detailing the results of the investigation will be submitted to the CBFDES within 30 days after completion of the field activities. If you have any questions regarding this work plan, please contact Mr. Bradley Clark at (626) 304-1520. Sincerely, IT~Corporatioq. Ryan Haughy Staff Geolog~ Bradley E. Clark, P.E. Project Manger Attachments: Table 1 - Historical Soil Analytical Data Figure 1 - Site Location Map Figure 2 - Site Map Appendix A - CBFDES Letter dated October 24, 2001 cc: Mr. Ed Paden, Equiva Services LLC N:\data~PROJECTx705-equivahMing (3698) ~Real Rd-152\829248\Work Plan for Addiitional Subsurface Assessment - Dec 2001 #2.doc TABLE FIGURES i:'-- ~ .... > '~ ' ~ ' ' ~ ~ ' t, ~ ~1~' ' : ~ ~ ~~'~,~ ~ I ' ' .. I;~ ~ " "~ '' " ~ " , ~ ~ ' ' "'" ' '< . '"' Ill .:.__...,, ,. ,. ~ ... . ..., ,..,,,., .... ' ~ ' r Hi h 5ch ~ · ~ ~- ' ~' ,,~ ~ ., .~,, I ,. ~ ~:~,-' / { EQUIVA SERVICES LLC IN FEET TEMCO SERVICE STATION I I BAKERSFIELD, CALIFORNIA 2000 0 2000 IT FIGURE 1 SITE LOCATION MAP REFERENCE: 7.s U~U~[ USeS ~O~OG~P~C Ua~ O~ GOS[O~, C~[O~ Oua~Gc[ 3~8 MInG ROAD AT RfiAk ~OAD DATE: 19~, PHOTOREVlSED: 1968 AND 1973 BAKERSFIELD, CALIFORNIA SCALE= 1:24000 APPENDIX A CBFDES LETTER DATED OCTOBER 24, 2001 FII[I UI ,~i~llll I-IUIII--r. IIUI ¥1~ 4cK~ IL~ r Mr, Edward P~[den Equllon EnteR)rises LLC P 0 Box 7869 BufoIInk, CA 91510 7~6B vOK;8 M1) ~o41,~t r.~x mn) ,aBr,..t:W r*,x Mm) ~oIN ~x t~e~) ~ . RE: Lal:~.~l~ry msulta ~ prelirDInary....~l~asseeemem oonduot~d at the Ming Avenue Texaco #121176 at 3608 Ming Ave In l~Wcersfield. Permit Dem' Mr P~bn: Upon revfew of the recently submitmd fal3omtory resulm from your facility, ~ls offioe has determined ttmt the extent of the aontamlnation plume, a~soclatecl with ttm underg round storage tank previously located on your prope~, .h.as' not been adequamly defined, ' - · Tht~ office requires (in aocotdance with' Gh~pter 6.7 of the C~llfomi~ HeaJth and $aJety Code and Chapter 16, '1'1tie 23 of the Cedifomia Code of Regulations) that furltter ~ent be done to define the vertical and horlzontaJ ~l~m of the contamination plume. Plea,se eubmit ii 'w'o~k plan for further dulmaem'nent, to offioe, within 30 days from receipt of thl~ lettm'. The workplan ~hould follow guidelines found In: ~ndb( A -Re_cx)rts~.~r J~;;~l~:J__~t~ff__R.m=..o. mmen_d~fio~ :[or Pre]IffY_nm_tV. evalua.flort and !nves'tlg~on_ ot Under~. 03und Tank .:~JlgBi; July 6, 1 AadltJone~ny, be advised tibet overnight COSt for this project will be billed to you alt a rate of $80.00 per hour. you have any questions, please o~li me at (661) 326-3979. HHW/cIIm Sincerely, Howard H. Wines, fir Hazardous Materi~ls Specialist Regletered Qeologi~'t No. 7~9 Office of Environmentaj Senac~ EO_UILON ~1 ENTE;IPRI~E~ Skdl b TelUlCO WOCI~blI November 16, 2001 City of Bakersfield Fire Department Environmental Services 1715 Chester Avenue, Third Floor Bakersfield, CA 93301 Re: Linmar #15 3698 Ming @ Real Road Bakersfield, CA 93309 Updated Owner/Operator Agreement, Tank Monitoring, Leak Response Plan and CUPA forms To Whom It May Concern: Enclosed is an updated Owner/Operator Agreement, Tank IVlonitoring and Leak Response Plan along with CUPA forms to. reflect current equipment and emergency information. Please replace your copies currently on file with this. Should you have any qUestions, please don't hesitate to call me at 818-736- 5078. Thank you. Yours truly, Feryal Sarrafian SH&E Compliance Coordinator P.O. Box 7869 Burbank, CA., 91510-7869. BUSINESS EMERGENCY PLAN CHEMICAL INVENTORY OWNER/OPERATOR AGREEMENT TANK MONITORING AND LEAK RESPONSE PLANS LINMAR #15 3698 MING @ REAL ROAD BAKERSFIELD, CA 93309 (661) 834-2822 COST CENTER #121176 Revised 11/16/2001 TABLE OF CONTENTS 1. Owner Operator Agreement California Health and Safety Code, Section 25299 Dealer Responsibility Letter 2. Business Owner/Operator Identification 3. Facility Identification 4. Business Plan and Contingency Plan 5. Employee Training Program Individual Training Record forms 6. Hazardous Material Disclosure 7. Monitoring Procedure 8. Leak Response Plan 9. Site Map Reviews and Revisions This plan was created to comply with section 25503.5 of the California Health and Safety Cods. It is required to be revised within 30 days of any significant change in quantities of hazardous chemicals or operations at the facility. In addition plans are reviewed every two years and Inventory Disclosure is submitted annually to the local administering agency. A revision is also required if there is a change in Business Owner, operator, or address. Certification This plan must be reviewed by the Business owner to ensure that it is complete and accurate. After signing this plan, a copy must be kept on-site and available for review (the best place is in the SH & E Reference Book aka the BLUE BOOK). In addition a copy is maintained by the tank owner, and a copy is sent to the local administering agency in your name. Revised 8/31/01 '~ost Center Nbr 121176 BUSINESS PLANS AS A SERVICE TO YOU, THIS BUSINESS PLAN WAS PREPARED BY WEST COAST COMPLIANCE SERVICES, INC. IN ORDER TO COMPLY WITH THE CALIFORNIA HEALTH AND SAFETY CODE (CHAPTER 6.95, ARTICLE I, SECTION 25503.5). BY ACCEPTING THIS PLAN, YOU ARE ACKNOWLEDGING THAT THERE ARE NO REPRESENTATIONS OR WARRANTIES THAT THE INFORMATION CONTAINED IN THIS BUSINESS PLAN WILL PRODUCE ANY PARTICULAR RESULT WITH REGARD TO THE SUBJECT MATTER. OWNER/OPERATOR AGREEMENT OPERATOR: As operator of the underground storage tanks, I hereby certify that I understand the monitoring and reporting requirements contained in Title 23, of the California Code of Regulations and I have received a copy of Section 25299, chapter 6.7, California Health and Safety Code. OPERATOR NAME: BUSINESS NAME: LOCATION #: LINMAR PETROLEUM LINMAR #15 121176 OWNER: As the owner of the underground storage tanks, EQUILON ENTERPRISES LLC certifies that we have provided the operator a copy of the monitoring and reporting requirements contained in Title 23, of the California Code of Regulations. Equilon certifies that we have provided the operator with a copy of the penalties of noncompliance as specified in Section 25299, chapter 6.7 of the California Health and Safety Code. SIGNATURE: Equilon Enterprises LLC 121176 Ming_Real November 16, 2001 EO_UILON ENTERPRISES LI.C Slid! b Teuca Wo~biI ToI~M November 16, 2001 Dear Shell Dealer/Texaco Retailer: The underground storage tanks located at your facility must be monitored in accordance with the Permit to Operate issued by the local agency and article/s of your Motor Fuel Station lease. The following excerpt from the California Health and Safety Code, Division 20, Chapter 6.7 defines the penalties for violating the Permit to Operate or other applicable regulations. Section 25299. Violations; civil and criminal penalties; operative date. (a) Any operator of an underground tank system shall be liable for a civil penalty of not less than five hundred dollars ($500) or more than five thousand dollars ($5,000) for each underground tank for each day of violation for any of the following violations: (1) Operating an underground tank which has not been issued a permit, in violation of this chapter. (2) Violation of any of the applicable requirements of the permit issued for the operation of the underground tank system. (3) Failure to maintain records, as required by this chapter. (4) Failure to report an unauthorized release, as required by Sections 25294 and 25295. (5) Failure to properly close an underground tank system, as required by section 25298. (6) Violation of any applicable requirement of this chapter or any requirement of this chapter or any regulation adopted by the board pursuant to Section 25299.3. (7) Failure to permit inspection or to perform any monitoring, testing, or reporting required pursuant to Section 25288 or 25289. (8) Making any false statement, representation, or certification in any application, record, report, or other document submitted or required to be maintained pursuant to this chapter. (d) Any person who falsifies any monitoring records required by this chapter, or knowingly fails to report an unauthorized release, shall upon conviction, be punished by a fine or not less than five thousand dollars ($5,000) or more than ten thousand dollars ($10,000), by imprisonment in the county jail for not to exceed one year, or by both that fine and imprisonment. Please contact your Retail Marketing Consultant if you have any questions regarding this Section of the California Health and Safety Code or article/s of your IVlotor Fuel Station Lease agreement. Equilon Enterprises LL C P.O. BOx 7869 Burbank, CA., 91510-7869 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., CA 93301 (661) 326-3979 BUSINESS OVVNER / OPERATOR IDENTIFICATION FACILITY INFORMATION 1. FACILITY IDENTIFICATION [CiLi"( io~ / I ~'-~ [~~ IYear Beginning 1/1/2001 ~51NE:~5~5 NAMP_ (Same as FACILITY NAME or DBA- Doing BusinewAs) LINMAR #15 SITE ADDRESS 3698 MING ~ REAL ROAD loo I Year Ending Iol I 12/31/2001 3 I BUSINESS PHONE 102 I 661-834-2822 CITY BAKERSFIELD lo4 CA DUN & 'm~ BRADSTREET COUNTY KERN lO3 ZIP 93309 ~o~ SIC CODE ll07 (4 Digit #) 5541 108 OPERATOR NAME LINMAR PETROLEUM 11. OVVNER INFORMATION OWNER NAME SAME AS ABOVE 1o9 j OPERATOR PHONE 661-834-2822 OWNER PHONE 661-834-2822 110 1,2J OWNER MAILING , ADDRESS PO BOX 7869 A'l-FN: SH&E COMPLIANCE COORDINATOR BURBANK 114 I STATE CA us ZIP93309 116 '" Ill. 'ENVIRONMENTAl_ CONTACT 117 I CONTACT PHONE Ila CONTACT NAME CONTACT MAILING ADDRESS FERYAL SARRAFIAN PO BOX7869 818-736-5078 119 I CIIY BURBANK 12oJSTATE CA 1211 ZIP 91510-7869 122 -PRIMARY- ,IV. EMERGENCY CONTACTS -SECONDARY-. NAME MARSHA HOYT ,23 NAME FRANK HUTCHINS 129 TITLE MANAGER.' ,2s TITLE STATION SUPERVISOR BUSINESS PHONE 661-834-2822 126 BUSINESS PHONE 661-834-2822 ,31 24-HOUR PHONE ~27 24-HOUR PHONE 661-619-9423 CELL/PAGER 132 PAGER# 661-394-5939 ~2s PAGER# 133 :'V. CERTIFICATION ... Certification: Based on my inquiry of those Individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted In this inventory and believe the Information Is true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR .AMES OFOWNEPUOPEI:~Tb~ FERYAL SARRAFIAN 136 DATE 134 NAME 'OF DOCUMENT PREPARER 11 / 16/01 ' ROBERT S. WATSON TITLE OF OWNER/OPERATOR SH&E COMPLIANCE COORDINATOR 135 137 City of Bakersfield OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY TYPE OF ACTION j (Check on@ item only) [] I. NEWSITE PERMIT [] 3. RENEVVAL PERMIT [] 4. AMENDED PERMIT [] 5. CHANGE OF INFORMA'RON (Specify, change". local use only). [] 6. TEMPORARY SITE CLOSURE I. FACILITY / SITE INFORMATION BUSINESS NAME (Some as FAClLFDY NAME or DBA, - Doing Business An) 3 FACILITY ID 0 LINMAR # 1 NEAREST CROSS STREET 401. CALIFORNIA ~ REAL ROAD BUSINESS [] I. GAS STATION [] 3. FARM [] 5. COMMERCIAL TYPE [] 2. DISTRIBLJTOR [] 4, PROCESSOR [] S. OTHER 403. FACILITY OWNER TYPE ] I. CORPOR. ATION ]2. INDIVIDUAL ]3. PARTNERSHIP IIII Pago Of [] 7. PERMANENTLY CLOSED SITE [] S. TANK REMOVED [] 4.4. LOCAL AGENCY/DISTRICT- [] 5. COUNTY AGENCY* [] 6. STATE AGENCY- [] 7. FEDERAL AGENCY* TOTAL NUMBER OF TANKS Is facility on Indian Reservation or · if ovmer of LIST a public agency name of supervisor of REMAINING AT SITE tmstlands? division, section or office - which the MST. (This is the contact person for for tank records.) 404. [] yes [] No 405. 4 IL PROPERTY OWNER INFORMATION PROPERTY OWNER RAW 407. I PHONE ~' EQUILON ENTERPRISES, LLC 1 818-736-5078 MAILING OR STREET ADDRESS 4 PO BOX 7869 CiTY 410. STATE 411. ZIP CODE URBANK CA 91510-7869 PROPERTY OWNER TYPE [] 2. INDMDUAL [] 4. LOCAL AGENCY/DISTRICT [] S. STATE AGENCY 41 [] I - CORPORATION [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY ,oo TANK OVVNER NAME · 14. PHONE SAME AS ABOVE AILING OR STREET ADDRESS 4 ITY 417. J STATE · 18. ZIP CODE 411 I [] 4. LOCAL AGENCY I DISTRICT 42 [] 5. COUNTY AGENCY ANK OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 3. PARTNERSHIP [] 6. STATE AGENCY [] 7. FEDERAL AGENCY IV'. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Y(TK) HO V. PETROLEUM UST FINANCIAL RESPONSIBILITY DICATE METHOD(S)) [] 10. LOCAL GOV'T MECHANISM [] 99. OTHER:. [] 1. SELF-INSURED [] 4. SURETY BOND [] 7. STATE FUND [] 2. GUARANTEE [] 5. D- ~ ~ ER OF CREDIT [] S. STATE FUND & CFO LE ~ I ER [] 3. INSURANCE [] 6. EXEMPTION [] 9. STATE FUND& CD 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS eck one box to Indicate which address should be used for legal notifications and malting. [] 1. FACILITY [] 2. PROPERTY OWNER [] 3. TANK OWNER 423. gal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. VII. APPLICANT SIGNATURE - difa::ation: I certify that the information provided heroin Is true and accurate to the best of my knowledge. NATURE OF APPLICANT ME OF APPLICANT (print) FERYAL SARRAFIAN DATE 424. J I~HUN~ ~'~\ I (,~ 1818-736-5078 · 20. TITLE OF ,~t:~PLI~.~NT SH&E COMPLIANCE COORDINATOR 4Zt). 42/. ,q Il- US I FACILITY NUMBER (For local use only) 420. I I UPGRADE CERTIFICATE NUMBER (r0r local use 0nly) CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 2. 3. 4. 5. To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be as brief and concise as possible. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION 1. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: LINMAR #15 LOCATION: 3698 MING ~ REAL ROAD, BAKERSFIELD, CA 93309 MAILING ADDRESS: EQUILON ENTERPRISES, PO BOX 7869 CITY: BURBANK STATE: CA PRIMARY ACTIVITY: RETAIL GASOLINE SERVICE STATION ZIP: 91510 PHONE: 661-834-2822 OWNER: LINMAR PETROLEUM MAILING ADDRESS: PO BOX 7869, BURBANK, CA 91510-7869 PHONE:661-834~2822 EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE I. MARSHA HOYT MANAGER 661-325-3388 661-834-2822 2. FRANK HUTCHINS STATION SUPERVISOR 661-325-3388 661-834-2822 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION Il. I - DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: STATION IS EQUIPPED WITH VEEDER ROOT TLS-350R CONTINUOUS MONITORING SYSTEM. AN ALARM WILL SOUND AND THE SYSTEM WILL AUTOMATICALLY SHUT DOWN IF THERE IS A LEAK. IF THE ALARM SOUNDS, THE MANAGER WILL BE NOTIFIED AND WILL DETERMINE THE NATURE OF THE PROBLEM. IF NECESSARY, THE FACILITIES ENGINEER AND/OR MAINTENANCE CONTRACTOR WILL BE CONTACTED FOR DISPATCH OF A REPAIR MAN. B. EMPLOYEE AND AGENCY NOTIFICATION: STATION EMPLOYEE WILL NOTIFY THE MANAGER OR DEALER WHO WILL THEN INVESTIGATE. THE MAINTENANCE CONTRACTOR WILL BE NOTIFIED IF DETERMINED THAT REPAIRS ARE NECESSARY. THE LOCAL AGENCY WILL BE NOTIFIED IF A LEAK HAS OCCURRED. IF THE SPILL IS SERIOUS, EMPLOYEE WILL CALL 9-1-1 AND THEN THE MANAGER AND SUPERVISOR OR SH&E COMPLIANCE COORDINATOR WHO WILL NOTIFY THE OFFICE OF EMERGENCY SERVICES AT 800-852-7550. C. ENVIRONMENTAL RESPONSE MANAGEMENT: EMPLOYEE ON DUTY WILL NOTIFY THE MANAGER OR SUPERVISOR WHO THEN WILL CONTACT THE SH&E COMPLIANCE COORDINATOR. IF NECESSARY, THE FACILITIES ENGINEER WILL BE CONTACTED WHO THEN WILL CALL THE CONTRACTOR, L.C. SERVICES TO EFFECT REPAIRS. D. EMERGENCY MEDICAL PLAN: ON SITE FIRST AID KIT WILL BE USED AS NEEDED. IF INJURIES ARE SERIOUS AND REQUIRE MORE THAN BASIC FIRST AID, THE INJURED PARTY WILL BE TRANSPORTED TO THE NEAREST MEDICAL FACILITY. MERCY HOSPITAL 661-632-5000 FIRE DEPARTMENT 911 POLICE DEPARTMENT 911 PARAMEDICS 911 OFFICE OF EMERGENCY SERVICES 800-852-5502 HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 11.2' RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: EMPLOYEES ARE TRAINED IN THE SAFE AND PROPER HANDLING OF HAZARDOUS MATERIALS AND EMERGENCY PUMP SHUT DOWN PROCEDURES. FIRE EXTINGUISHERS ARE LOCATED NEAR THE CASHIER AND EMPLOYEES ARE TRAINED IN THE PROPER USE. B. RELEASE CONTAINMENT AND/OR MITIGATION: EMPLOYEES ARE TRAINED TO USE KITTY LITTER, ABSORBENT SOCKS OR SIMILAR MATERIALS TO CONTAIN MINOR SPILLS. MAJOR SPILLS ARE TO BE CALLED TO 9-1-1. C. CLEAN-UP AND RECOVERY PROCEDURES: MINOR SPILLS ARE CLEANED UP WITH KITTY LITTER AND/OR ABSORBENT SOCKS. MAJOR SPILLS ARE CLEANED UP BY THE CONTRACTOR, L.C. SERVICES. THE FIRE DEPARTMENT IS NOTIFIED IF THE SPILL IS MAJOR. UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: INSIDE PANEL WATER: SIDEWALK TOWARD REAR ENTRY ALONG REAL ROAD SPECIAL: l.ab LOCK BOX: YESQ IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAIl,ABILITY A. PRIVATE FIRE PROTECTION: ON SITE FIRE EXTINGUISHERS Bo WATER AVAILABILITY (FIRE HYDRANT): AT POINT HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 5 MATERIAL SAFETY DATA SHEETS ON FILE: 3-RING BINDER IN CASHIER AREA BRIEF SUMMARY OF TRAINING PROGRAM: SENIOR EMPLOYEE OR MANAGER IS RESPONSIBLE FOR TRAINING NEW EMPLOYEES. THE NEW EMPLOYEE IS TAKEN ON A TOUR OF THE STATION AND IS SHOWN THE LOCATIONS OF AND HOW TO USE FIRE EXTINGUISHERS, KITTY LITTER/ABSORBENT SOCKS, EMERGENCY SHUTOFF (ON BUILDING AND ON CONSOLE) AND THE PROTOCOL TO FOLLOW FOR HANDLING EMERGENCY NOTIFICATIONS AND CALLS. THE NEW EMPLOYEE IS INFORMED ABOUT SAFE HANDLING OF GASOLINE AND PORTABLE GAS CONTAINERS SAFETY. A TRAINING CHECK LIST IS KEPT ON FILE AND PERIODIC FOLLOW UP TRAINING IS CONDUCTED ON A SCHEDULED BASIS. CERTIFICATION I, FRANK HUTCHINS CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. STATION SUPERVISOR TITLE 11/16/01 DATE HAZ MAT MNGMNT PLAN & INSTRUC 4 Individual Training Record Employee Name Acknowledgement: By signing this form, I hereby acknowledge that I have attended the training sessions listed, and I understand the content and my responsibilities in these areas. Date Training Topic Employee's Trainers Signature Name Required HazCom (Hazard Communication) Hazwoper (Hazardous Waste Operations and Emergency Response) Lockout/Tagout (Control of hazardous energy sources) RCRA (Resource Conservation & Recovery Ac0 RECOMMENDED Freon Recycling (as applicable) Spill Containment & Control Robbery Deterrence Waste Management Safe lifting Accident Reporting Fire Prevention & Evacuation Plans Personal Protective Equipment TSCA (Toxic Substance Control Act) Safe Food Handling (as applicable) Service Bay Safety (as applicable) Civil Disturbance response Natural Disaster Response Use of Fire Extinguishers Individual Training Record Date Training Topic Employee's Signature Trainer's Name UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION (FORM 273 1) (Onc pagc pcr material pcr building or arca) [~DD [--]DELETE [--]REVISE REPORTING YEAR 2001 ~0 [ p~g~ of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) L1NMAR #15 CHEMICAL LOCATION 204 | CHEMICAL LOCATION CONFIDENTIAL UST SOUTHEAST~QUADRANT OF PROPERTY[ (EPCRA) [] YES [] NO FAC~Y IDJ I J I I I I I [ [ I ]Ii~, (opUona0 ~ GRID# (o~on*0 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET [ I Yes [] No PETROLEUM HYDROCARBONS .... bj CASS/ g00-61-9 ~ *IfEHS is "Yes", all amounts below mast be in lbs. FIRE CODg: HAZARD GLASSgS ¢¢om~*t* m,n~r,d ~ cu~,A) 1 HAZARDOUS MATEILIAL [] a. PURE [] b. MIXTURE [] ¢. WASTE 2H RADIOACTIVE [~Y~s ~ .... CURIES TYPE (Check o~¢ i~¢m PHYSICAL STATE [] a. SOLID [] b. LIQUID [] ¢. GAS ~ LARGEST CONTAINER /c~o.~, .... ,~ 12,000 FED HAZARD 216 CATEGORIES [] a. FIRE [] b. REACTIVE [] c. PRESSURE RELEASE [] d. ACUTE HEALTH [] e, CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 2~, ANNUAL WASTE AMOUNT 2 I~ [ STATE WASTE CODE 1 S,000 36,000 N/A [N/A 22~ DAYS ON SITE; z22 U~T? [~.~ALLONS []b. CUBiC~EET [--I~.POU~DS [--I,.TONS 365 ~QheFk one imm oply) * IFEHS, amount mus~ be in pounds. [] a. ABOVEGROUND TANK [] ¢. PLASTIC/NONMETALLIC DRUM [] i. FIBER DRUM [] m. GLASS BOTTLE [] q. RAIL CAR [] b. UNDERGROUND TANK [] f. CAN r'Ij. BAG [] n. PLASTIC BOTTLE [] r. OTHER [] c. TANK INSIDE BUILDING [] g, CARBOY [] k, BOX [] o. TOTE BIN [] d. STEEL DRUM [] h. SILO [] 1. CYLINDER [] p. TANK WAGON STOI~E PRES SURE [] .. AMBIENT [] b. ABOVE AMB~I~rF [] c, BELOW AMBIENT STORAGE ?EI~PERATURE [] a. AMBIENT [] b, ABOVE AIvIBIENT [--] c. BELOW AMBIENT [] d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixtu~ or waste only) EHS CAS # 1 ~ =~ METHYL TERT BUTYL ETHER .... [] Y~ [] No =~ 1634-04-4 2 15 ~° TOULENE ~' []Ye~ []No ~= 108-88-3 ~ 21 ~ XYLENE ~ []Yes []No ~ 1330-20-7 . ~ =~ BENZENE =~ [--]xes []No 2.o 71-43--2 ~ 5 ~ 1,2,4 TRIMETHYL BENZENE ~' []Yes []No ~. 95-63-6 if rno~ h~.an:lou$ component~ ~m present at gma~er ~ha n 1% t~ w~ht if non-esmin ogenic, or O, ~ % t~ weiohi if can:~n o~eni~, attach artditional sheets of p~ per c~piufln~ 0m required ~f~nnation, ADDITIONAL LOCALLY COLLECTED INFORMATION 2~ IfEPCRA, Please Sign Here (Facilities reporting Chemicals subject to EPCP~4 reporHng thresholds must s~gn each Chemical Description page for each EPCI~ reported chemical.) OFFICIAL USE ONLY I DATE RECEIVED [ REVIEWED BY o,v I I [ I ICUPA [ PA 1 7 HHMD.HM SKF .PK G ,OCT OBER., 2000 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION (FORM 273 1) (One pagc pcr matcrial pcr building or arca) ~DD I~DELETE ["[REVISE REPORTING YEAR 2001 ~0 I Page of 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 LINMAR #15 CHEMICAL LOCATION 201 [ CHEMICAL LOCATION CONFIDENTIAL 202 UST SOUTHEAST QUADRANT OF PROPERTY ] (~.PCRA) [] 'ms [] NO II. CHEMICAL INFORMATION ~ CHEMICAL NAME PETROLEUM HYDROCARBONS 205 TRADE SECRET [ I Yes I~]No 6~)~I~1~.~.~ 207 EHS* [] Yes []No 208 CAS# 68476-34-6 ~o0 *IfEHS is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES ¢com~e~,,~,~reu ~w cup,~l 1 210 213 T~ (Ch~k onc it~ PHYSIC~ STA~ ~ a. SOLID ~ b. LIQUID ~ c. GAS ~4 L~G~T CO~ CA~ES ~ a. FI~ ~ b. ~EACTIFE ~ c. P~SSU~ ~LEASE ~ d. ACU~ HEAL~ ~ e. CHRONIC HE~TH A~GE D~LY 6,000 UNITS* (Check one item 9HIY) ~ DAILY AMOUNT 12,000 GALLONS ~o. CUBIC FEET [] ¢. POUNDS [] d. TONS ' IfEHS, amount must be in pounds. :ta9 [ STATE WASTE CODE ~ q. ~aL CA~ [] r. OTHER 222 :~s [ ANNUAL WASTE AMOUNT nl DAYS ON SITE: 365 STOB~GE CONTAIi~ER ~B~ T~ APPROP~ BOX BELOW D ~ ~O~GRO~ T~ ~ c, PLAS~O~T~IC DR~ ~ i. ~B~ DR~ ~ m. GLASS BO~E ~ C. T~ ~S~E B~G ~ g, CA~OY ~ k. BOX ~ o. TO~ BIN D ~ S~L DR~ ~ h. SILO ~ I. C~ ~ p. T~ WAGON STOOGE PRESSURE ~ a. ~IE~ ~ b. ~O~ ~ ~ c. BELOW ~ STO~S ~S~eS~Tg~ ~ a. ~m~ ~ b. ~O~ ~ c. e~LOW ~m~ ~ U. ~YO~C %WT ~US CO~ ~or ~ or ~ o~y) EHS CAS 99.5 DIESEL FUEL []Yes I~]No 229 68476-34-6 91-20-3 NONE 240 244 0.5 Bo NAPHTHALENE ~, []yes I~INo ~ PETROLEUM DISTILLATES ~s [] Yes []No =, If more hazan~ous components am present at greater than 1% by weight if non-caminogenic, or O.1% by weight if caminogenic, attach additional sheets of paper capturing the required Infen'nation. ADDITIONAL LOCALLY COLLECTED INFORMATION 24~ If EPCRA, Please Sign Here (Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCRA reported chemical.) OFFICIAL USE ONLY DIV I DATE RECEIVED ] REVIEWED BY 17 HHMD.HMSRF.PKG. OCTOBER.2000 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION (FORM 273 1) (One pagc pcr material pcr building or a~ca) ~ADD [~DELETE [--]REVISE REPORTING'YEAR 2001 ~0 ] vase or 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) LINMAR #15 CHEMICAL LOCATION ~oi I CHEMICAL LOCATION CONFIDENTIAL JST FRONT OF BUILDING (THERE BUT NOT IN USE) 1 (LYCRA) [] YES [] NO FACILITY ID MAP# (optional) 203 ] GRID# romona0 # 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 [ TRADE SECRET [ [ Yes D(]No PETROLEUM HYDROCARBON I .... ~ ....... r~ .... ~[~R Om ~ El-IS* [-1 Yes ~No CAS# 8002-05-9 a~ *IrEHS ~s "Y~", ~'~ ~o~ts ~,o .... t ~ in ~,s. 208 FIRE CODE HAZARD CLASSES (comp*m* r~r*qui,ed by CUPA) lJ.l-J~ 210 HAZARDOUS MATERIAL [] ,. PUR~ [] b. MIXTURE [] ¢. WASTE 211 ] RADIOACTIVE DYes ~q .... C-ORIES 213 TYPE (Check one item only) I PHYSICAL STATE [] a. SOLID [] b. LIQUID [] c. GAS :,4 LAROEST CONTAINER $ 5 0 Check one item only) FED HAZARD 216 CATEGORIES [] a. FIRE [] b. RF_~CT1VE [] e. PRESSURE RELEASE [] d. ACUTE HEALTH [] e. CHRONIC HEALTH o $/^ [~ q. RAIL CAR [] r. OTHER 222 ~ DAYS ON SITE: tn~Ts, I~.OALLONS D,. CUEXC FEET Cl~.~otnms D~.TONS 365 (Check one item only) o I£EHS, amount must ~ in ~. STOOGE ~A~ ~D~ T~ APPROP~ BOX BELOW ~ ~ ~O~GRO~ T~ ~ c. PLAS~O~T~LIC DR~ D i. FIBER DR~ ~ m. GLASS BO~E ~ b. ~o~ TA~ ~ r. C~ ~j. ~A~ ~.. P~SUC ~O~ ~ ~ S~L D~ ~ h. SILO ~ 1. C~I~ ~ p. T~ WA~N ST0~Gg PRESSURE ~ a. ~IE~ ~ b. ~O~ ~ ~ c. BELOW ~ $TO~Gg Tg~Pg~TURE ~ a. ~IE~ ~ b. ~O~ ~ ~ c. B~OW ~[~T ~ d. ~YOG~C %WT ~US CO~ flor ~ or ~ o~y) EHS CAS 100 MOTOR OIL, USED I-I¥~ [~lNo 1,19 .... D~s []No S ..... OYes DNo If mom hazardous components am present at greater than 1% by weight if non-caminogenic, or O.1% by weight if carcinogenic, attacfl additional sheets of paper capturing the required informafon. =s 8002-05-9 :,, Dye~ DNo ADDITIONAL LOCALLY COLLECTED INFORMATION If EPCILa., Please Sign Here (Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCRA reported chemical.) OFFICIAL USE ONLY I DATE RECEIVED [ REVIEWED BY DIV [fiN [ S TA I OTHER [ DISTRICT[ CUPA I PA 17 HHMD.HMSRF.PKG.OCTOBF. R.2000 UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION (FORM 273 1) (One page pcr matcrial per building or area) ~ADD ['-]DELETE I~REVISE REPORTING YEAR 2001 20O I Page o£ 1. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) L1NMAR//15 [CHEMICAL LOCATION 201 I CHEMICAL LOCATION CONFIDENTIAL ALES ROOM AND STOREROOM . (EPCR~) [] Ym [] NO l 3 II. CHEMICAL INFORMATION CHEMICAL NAME PETROLEUM HYDROCARBON 205 TRADE SECRET [~ Yes [~] No []Ye, []No CAS# 64742-65-0 20~ *IfEHS is "Yes", all amounts below must be in lbs. FIRE CODE I-I,~RD CLASSES (complete Ifrequlred by CUPA) III-B 210 HAZARDOUS MATERIAL [] a. PURE [] b. MIXTURE [] c. WASTE 21, RADIOACTIVE []Y,.... ICURIES 213 TYPE (Check onc itcm only) I 215 PHYSICAL STATE [] a. SOLID m[~ b. LIQUID [ [ c. GAS 2~4 LARGEST CONTAIN'ER ~e.m o.~y) QUART (Ch~t,k FED HAZARD 216 CA~GOm~S [] a. FIRE [] b. a~cr;r£ [] e. PRESSURE PmLEASE [] a. ACUTE ~EALTH [] ~. C~aONIC HEALTH ((5~h~ek sl that nil Ir'I AVERAGE DAILY AMOUNT 217 MAXIMUM DAILy AMOUNT ltl ANNUAL WASTE AMOUNT l t~ [ STATE WASTE CODE lt2o 150 GAL 250 GAL r~ q. RAIL CAR [] r. OTHER aa~ [ DAYS ON SITE: UNITS* ~a. GALLONS [~. CUBIC FEET ["~ ¢. POUND$ r~d. TONS 1365 (Ch~k one item on~ · IFPS, ~o~t m~t ~ in ~. STOOGE CO~A~ER COD~ T~ ~PROP~ BOX B~OW ~ & ~O~GRO~ T~ ~ c. PLAS~O~T~LIC DR~ ~ i. FIB~ DR~ ~ m. GLASS BO~E ~ c. T~ ~E B~G ~ g. CA~OY ~ k. BOX ~ o. TO~ BIN ~ ~ S~L DR~ ~ h. SILO ~ I. C~ ~ p. T~ WAGON STO~G~ PRES SURE ~ a. ~IE~ ~ b. ~O~ ~ ~ c. B~OW ~ STO~Gg T~PE~TURE ~ a. ~IE~ ~ b. ~O~ ~ ~ c. BELOW ~I~ ~ d. ~YOG~C %WT ~US CO~ flor m or m o~y) CAS 100 PETROLEUM HYDROCARBON 231 64742-65-0 EHS []Y~ []No []Yes [] NO []Yes []No ~s ~ []Yes []No a4o 2n~ If mom hazardous components am present at greater Ihan 1% by weight if non-carcinogenic, or 0.1% by ,weight if ca~nogenic, attach additional sheets of paper capturing the required inforrnal~on. ADDITIONAL LOCALLY COLLECTED INFORMATION 24~ If EPCRA, Please Sign Here (Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCI?,4 reported chemical.) OFFICIAL USE ONLY DATE RECEIVED [ REVIEWED BY DIV 17 HHMD.HMSRF.PKG.OCTOBER,2000 WRITT[ q MONITORING PROCEI S UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring, prograr~ must be kept at the U_.ST locatign.a.t all times The information on this monit, oring program are conctltions otthe operating permit. The permit holder must notify the Office of Environmental,- Services within 30 days of any changes.to the monitoring procedures, unless required to obtain approval before making_the Change. Required by Sections 2632(d) and 2641(h) CCR. Facility Name LINMAR #iS Facility Address 3628 MING ~ REAL ROAD, BAKERSFIELD, CA 93309 A. Describe the frequency of performing the monitoring: Tank CONTINUOUS REMOTE MONITORING IS PROVIDED BY VEEDER ROOT TLS-350R SIMPLICITY PROGRAM. Piping SAME AS ABOVE Be What methods and equipment, identified by name and model, will be used for performing, the monitoring: Tank VEEDER ROOT TLS-350R SIMPLICITY. Piping SAME AS ABOVE Ce Describe the lOcation(s) where the monitoring will be performed (facility plot plan should be attached): MONITORING EQUIPMENT IS IN THE CONTROL BOX IN THE STORE ROOM. (SEE PLOT PLAN) Do List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: MARSHA HOYT, MANAGER OR FRANK HUTCHINS, STATION SUPERVISOR Eo Reporting Format for monitoring: Tank TRANSMITTED ELECTRONICALLY TO OFFICE IN CONNECTICUT WHERE ANALYZED. Piping WRITTEN REPORTS AND ANNUAL CERTIFICATION. Describe the preventive maintenance schedule for the monitoring equipment. Note: Maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. ANNUAL CERTIFICATION BY MAINTENANCE AND/OR TESTING CONTRACTOR. Go Describe the training necessary for the operation of UST system, including piping, and the monitoring equipment: THE OPERATORS RECEIVE INITIAL AND ANNUAL REFRESHER TRAINING 1N ACCORDANCE WITH THE MANUFACTURER'S RECOMlVlENDATIONS. REFER TO THE STATION'S SH&E BLUE BINDER. EMPLOYEE TRAINING SECTION, LOCATED AT THE CASHIER COUNTER, FOR MORE DETAILED INFORMATION. EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 263 2(d) and 264 1 (h) CCR- Facility Name LINM~R #15 Facility Address 3698 MING ~ REAL ROAD,, BAKERSFIELD, CA 93309 If an unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorate the secondary containment, then the Office of Environmental Services must be notified within 24 hours. ATTENDANT WILL USE KITTY LITTER AND/OR ABSORBENT SOCKS TO CONTAIN AND CLEAN UP THE SPILL. MATERIAL WILL BE PLACED IN A CLOSED CONTAINER UNTIL PICKED UP BY CONTRACTOR. IF SPILL IS MAJOR, THEN THE FIRE DEPARTMENT WILL BE NOTIFIED AND L.C. SERVICES, FRESNO WILL BE CALLED FOR CLEANUP. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substance. KITTY LITTER AND ABSORBENT SOCKS. CONTRACTOR, L.C. SERVICES WILL REMOVE CONTAMINATED ABSORBENT MATERIAL. Describe the location and availability of the required cleanup equipment in item 2 above. MATERIAL IS LOCATED JUST OUTSIDE THE CASHIER'S AREA. Describe the maintenance schedule for the cleanup equipment: CLEANUP EQUIPMENT IS REPLENISHED ON AN AS NEED BASIS. MANAGER WILL PERIODICALLY CHECK TO ENSURE ADEQUATE SUPPLIES ARE ON HAND. List the name(s)) and title(s) of the person(s) responsible for authorizing any work necessary under the response plan: FRANK HUTCHINS, STATION SUPERVISOR OR LEAD EMPLOYEE ON DUTY. FERYAL SARRAFIAN, SH&E COMPLIANi2E COORDINATOR WILL BE NOTIFIED IF SPILL IS MORE THAN MINOR. Center Nbr 121176 SERVICE STATION MONITORING PROCEDURE Title 23 of the California Code of Regulations (CCR) requires that a written monitoring procedure be established for all underground storage tanks. This form is used to satisfy the information required in Section 2632 & 2641, Title 23, CCR. A Copy of this form will be maintained on-site (located inside the Equilon's Marketing Service Station Health, Safety and Environmental Manual also known as the Red Book) and a copy will be submitted to the local administering agency (inside of the Business Plan and inventory disclosure). Facility Name LINMAR #15 Facility Address: 3628 MING ~ REAL ROAD BAKERSFIELD, CA 93309 Facility Telephone Number: (661) 834-2822 Tank Owner: EQUILON ENTERPRISES LLC ATTN: SH&E DEPARTMENT P.O. BOX 7869 BURBANK, CA 91510-7869 Telephone Numbers: (818) 736-5078 or (714) 992-0689 As Operator, I am responsible for monitoring the underground storage tank system in accordance with Title 23, CCR. The following pages outline the specific monitoring procedures as required in Section 2632 or 2641. My signature below confirms that I have read and understand my responsibilities as they pertain to tank monit~ reporting, ~t.r,e~ds ret/q/ltion. Operator Signature Underground Storage Tank/Line and Monitoring Information Tank Type: Tank Material: Monitoring Type: Tank Monitor Mgr: Double Wall Fiberglass ( X ) Interstitial ( X ) Wet ( ) Dry ( X ) Electronic Tank Monitor Veeder Root Model Nbr: TLS-350R Line Type: Line Material: Monitoring Type: Line Monitor Mgr: Double Wall Fiberglass ( X ) Interstitial ( X ) Electronic Line Pressure ( ) Mechanical Veeder Root Model Nbr: TLS-350R 121176 Ming_Real November 16, 2001 ~ost Center Nbr 121176 Dispenser Information: Containment Box Mgr: Containment Sump Type: Sump Liquid Sensor Type: Positive Shut Down: PISCES (X) Deep ( ) Shallow ( ) None ( X ) Electronic ( ) Mechanical ( ) None (X)Yes ( )No REPORTING REQUIREMENT Any monitor that is discovered in Alarm (RED Lights On) or audible alarm is sounding or any monitoring that cannot pass the daily inspection test must be reported immediately to: Equilon Enterprises LCC SH&E Compliance Coordinator (818) 736-5078 Maintenance Coordinator (714) 992-0689 Training by Company Personnel Per manufacturer guidelines, the authorized installation contractor performs the training necessary to operate the tank and line monitoring system. The location is also responsible for daily inspections of the monitoring panel, alarm Panel Test Log and corrective actions. Operator/Manager Each Individual alarm system is determined and located at the service station premises. Visually inspecting the alarm panel lights and pushing the appropriate audible alarm button activate each Individual alarm system. No impromptu repairs, changes, adjustments, etc. will be made to the monitoring equipment at the station. .~ Designee · [] It shall be the responsibility of the operator/manager to train the designee to perform alarm panel tests. It shall be the responsibility of the operator/manager to train the designee to perform physical inventories. Additional Releases Safety Features at the Service Station Inventory reconciliation as def'med by Article 6.3 of the Equilon Motor Fuel Lease and Title 23, CCR. Equilon must be notified if the absolute value of the monthly variations exceeds a variation of 1.0 percent of the total m6nthly input to or withdrawals from the tank plus 130 gallons, the variation shall be investigated in accordance with subsection (e) of Paragraph 2646 · Electronic Monitoring systems described above I-'l Annual Tightness Testing of Single Wall Lines (If required by the Local Implementing Agency ) [] Physical Inventory · Annual UST Equipment Certifications 121176 Ming_Real November 16, 2001 Center Nbr 121176 Double wall tanks are monitored by in tank gauging probes and there is a continuous electronic monitoring of the annular interstice space in each tank. A monthly status report of the annular space condition in each tank is submitted to the station at the end of each month. Hard copies of all test data will be maintained on-site in the ETM Results binder. Single wall tanks with Electronic Tank Monitors (ETM) will at a minimum comply with Section 2643, CCR: Electronically test each tank at least once per month after product delivery or when tank is filled to within 10% of highest operating level during previous month. The system is capable of detecting a release of 0.2 GHP. A Hard copy of all test data will be maintained on-site in the ETM Results binder. Single wall tanks with no eletronic monitoring equipment will be tested annually using the volumetric testing guidelines specified in Section 2643, CCR. Lines · All lines, Single wall or Double wall, are monitored by Pressure Line Leak Detection probes (PLLD). The sensor at 3 GPH every time the dispenser is used, and a 0.2 GPH leak rate once a month according to CCR, Title 23, Div 3, chapter 16 UST Regulations. Also the monitor is capable of a 0.1 GPH leak rate test once a year if mandated by the City Ordinance or Municipal code from Local Regulatory Agency. All product lines have Positive Shut Down and will stop the flow of product through the lines in the event of a leak. Some Double Wall lines are also monitored with either interstitial or sump sensors. Double wall fiberglass lines will have continuous sump monitors and line pressure monitors which are certified annually. Single wall lines: All single wall lines will be pressure tested annually according to Section 2643, CCR. And will be monitored with a line pressure device (mechanical or electronic) that is certified annually Tank / Line Testing or Certification Results: The Simplicity System Installed at this location provides continuous electronic leak detection of the product tanks pressurized product lines. The system provides audible and visual alarms along with automatic notification through the Veeder-Root system in the event that a leak is detected. Hard copies of the UST System test results are to be mailed to the station the first week of each month. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certification results will also be sent to the local agency by certified mail as required, Tank and line testing will be conducted by a qualified contractor and results of these tests will be maintained on-site and available for inspection. Fuel Tanks Veeder-Root TLS-350R The Simplicity System Installed at this location provides continuous electronic leak detection of the product tanks pressurized product lines. The system provides audible and visual alarms along with automatic notification through the Veeder-Root system in the event that a leak is detected. Hard copies of the UST System test results are to be mailed to the station the first week of each month. 121176 Ming_Real 4 November 16, 2001 Center Nbr 121176 These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certification results will also be sent to the local agency by certified mail as required. Veeder-Root TLS-350 On a daily basis the operator / manager / designee will push the RED alarm test button which will indicate that the remote sensor and the monitor control panel are working as well as the condition of the alarm and that ALL FUNCTIONS ARE NORMAL. The RED and YELLOW lights will be observed to be OFF. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications results will also be sent to the local agency by certified mail as required. Dealer Inventory Rec. Inventory reconciliation as def'med by Article 6.3 of the Equilon Motor Fuel Lease and Title 23, CCR. Equilon must be notified if the absolute value of the monthly variations exceeds a variation of 1.0 percent of the total monthly input to or withdrawals from the tank plus 130 gallons, the variation shall be investigated in accordance with subsection (e) of Paragraph 2646 Fuel Lines Veeder-Root TLS-350R The Simplicity System Installed at this location provides continuous electronic leak detection of the product tanks pressurized product lines. The system provides audible and visual alarms along with automatic notification through the Veeder-Root system in the event that a leak is detected. Hard copies of the UST System test results are to be mailed to the station the first week of each month. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certification results will also be sent to the local agency by certified mail as required. Veeder-Root TLS-350 On a daily basis the operator / manager / designee will push the RED alarm test button which will indicate that the remote sensor and the monitor control panel are working as well as the condition of the alarm and that ALL FUNCTIONS ARE NORMAL. The RED and YELLOW lights will be observed to be OFF. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications results will also be sent to the local agency by certified mail as required. Red Jacket All electronic monitoring devises will be inspected for operation in accordance with section 2632, CCR. A log will be maintained on-site showing daily documentation of inspections and maintenance requirements. The monitoring will be tested daily in accordance of manufacturer instructions. Copies of the UST Testing and certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications will also be sent to the local agency 121176 Ming_Real 5 November 16, 2001 - Cost Center Nbr 121176 Dispenser Containment Dispensers are contained with: PISCES Bravo containment boxes. Bravo boxes are equipped with float switches to detect liquid under the dispenser. When liquid is detected the float switch engages the shear valve shutting down product flow to the dispenser. Beaudreau sensors. These boxes are equipped with a mirror liquid sensor system, which detects liquid by light refraction. When liquid reaches are set level the mercury sensor switch is activated which engages the shear valve and shuts down product flow to the dispenser. The Simplicity System Installed at this location provides continuous electronic leak detection of the product tanks pressurized product lines. The system provides audible and visual alarms along with automatic notification through the Veeder-Root system in the event that a leak is detected. A sump liquid sensor will cause the fuel supply to the dispenser to be shut off in the event the liquid level reaches a prescribed height. In some cases an alarm will sound. In the event of a shut down or an alarm is activated, it will be the Operator's responsibility to investigate the cause and to notify an Equilon Representative if any further action is required If an under dispenser leak occurs, the fuel supply to the dispenser will be shut off. It shall be the responsibility of the dealer or designee to remove the dispenser cover and visually check to determine source of leakage. The environmental contact and/or facility engineer plus the designated maintenance contractor shall be called to make repairs as needed and before returning dispenser to service. Waste Oil Tank Veeder-Root TLS-350R The Simplicity System Installed at this location provides continuous electronic leak detection. The system provides audible and visual alarms along with automatic notification through the Veeder- Root system in the event that a leak is detected. Hard copies of the UST System test results are to be mailed to the station the first week of each month. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certification results will also be sent to the local agency by certified mail as required. Veeder-Root TLS-350 On a daily basis the operator / manager / designee will push the RED alarm test button which will indicate that the remote sensor and the monitor control panel are working as well as the condition of the alarm and that ALL FUNCTIONS ARE NORMAL. The RED and YELLOW lights will be observed to be OFF.These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications results will also be sent to the local agency by certified mail as required 121176 Ming_Real November 1'6, 2001 6 Dealer Inventory Rec. Cost Center N-br 121176 Inventory reconciliation as defined by Article 6.3 of the Equilon Motor Fuel Lease and Title 23, CCR. Equilon must be notified if the absolute value of the monthly variations exceeds a variation of 1.0 percent of the total monthly input to or withdrawals from the tank plus 130 gallons, the variation shall be investigated in accordance with subsection (e) of Paragraph 2646 On a daily basis the dealer takes a physical inventory (stick reading) of the levels of the tank. Each day he subtracted sales from and added deliveries to the book inventory. His daily inventories are compared to the "book" inventory to give the dealer a cumulative reading. At the end of each month the dealer will compare his daily inventories to net his overage or shortage for the month-to- date and make a monthly report. These reports will be maintained on-site at the station and available for review during inspection. A copy of the report will be sent to the local agency by certified mail as required. 121176 Ming_Real November 16, 2001 Center Nbr 121176 UNDERGROUND STORAGE TANK LEAK RESPONSE PLAN Tank Owner: EQUILON ENTERPRISES LLC ATTN: SH & E DEPARTMENT P.O. BOX 7869 BURBANK, CA 91510-7869 Telephone Numbers: (818) 736-5078 or (714) 992-0689 0 If a Leak Detection Alarm or System is Activated: 1. Determine which tank system is involved. 2. Shut off pump and discontinue operations. 3. Call the Tank Owner Immediately. '4. Persons responsible for contacting the leak response unit / company and authorizing any work necessary. SH&E Compliance Coordinator (818) 736-5078 Maintenance Coordinator (714) 992-0689 5. Notify the local agency: CITY OF BAKERSFIELD FIRE DEPARTMENT Phone: (661) 326-3979 Fax #: (661) 326-0576 6. Call 911 (if necessary): The Methods and Type of Equipment Used for Removing Hazardous Substances. All unauthorized releases will be removed from the secondary containment by vacuum track. A licensed hazardous waste contractor will be called to perform the clean up and removal of hazardous substances. The location and Availability of Cleanup Equipment: Major Spills: A local licensed hazardous waste contractor. Minor Spills: A spill kit with absorbent is to be maintained and supplied by the operator. To dispose of small generated hazardous waste, the operator / dealer will call Equilon's Contractor for proper disposal A copy of this response plan should be maintained near the electronic monitoring system. A copy is also sent to the local agency. 121176 Ming_Real November 16, 2001 ~ost Center Nbr 121176 SERVICE STATION MONITORING PROCEDURES Product Information Volume Regular Unleaded 12,000 Regular Unleaded 12,000 Premium Unleaded 12,000 Diesel 12,000 M-85 Waste Oil Tank 550 Total Number of Tanks on Site: 5 Persons Responsible for Performing Monitoring: MARSHA HOYT, MANAGER OR FRANK HUTCHINS, STATION SUPERVISOR Preventive Maintenance Schedule Daily Operator / Manager / Designee will perform equipment checks to ensure that monitors are operational. The Alarm Panel Test Log must be initialed by the person performing the daily equipment check. Annual - (A) All monitoring equipment will be inspected and certified operational, according to manufacturer's specifications, by a licensed tank tester who is authorized and trained by the manufacturer. (B) Operational status will be reviewed on site by the Equilon SH&E Representative using the Equilon Service Station Audit Check List once a year. Records Retention All records associated with inspecting, certifying, testing, monitoring, and maintaining the UST system must be on site and available to Equilon / Agency auditors for a period of not less than three (3) years. Operating status of the monitors will be recorded DAILY on the Alarm Panel Test Log (as mentioned above.) Physical Inventory will be recorded daily on the Inventory log. 121176 Ming_Real 9 November 16, 2001 Center Nbr 121176 Tank and Line Testing Guidelines: All Simplicity monitors are continuously being monitored at a central office In Connecticut. Simplicity operators will notify each dealer and Equilon in the event that an alarm goes on at a station. They will also dispatch a service contractor to investigate those alarms and notify an Equilon Representative if any further action is required. Gas tanks are monitored by in-tank gauging probes. These probes are capable of testing at 0.1 and 0.2 leak rate. TLS-350R controller is programmed for Continuos Statistical Leak Detection CSLD which tests the tanks at 0.2 GPH leak rate. Hard copies of all test data will be maintained on-site in the ETM Results binder. In the event that an alarm is activated it will be the Operator's responsibility to investigate the cause and to notify an Equilon Representative if any further action is required. Gas tanks are monitored by in-tank gauging probes. These probes are capable of testing at a 0.1 to 0.2 GPH leak rate. Hard copies of all test data will be maintained on-site in the ETM Results binder. In the event that the Operator finds a reconciliation variance during physical inventories greater then the allowable variation, the Operator will begin the inventory discrepancy investigation procedures. The Operator will be responsible to notify an Equilon Representative if any further action is required. Inventory is taken on daily basis. Each month will have a monthly report which will be maintained on-site. As Operator, I am responsible for monitoring the underground storage tank system in accordance with Title 23, California Code of Regulations. My signature below con£n'rns that I have read and understand my responsibilities as they pertain to leak response, reporting, and records retention. FRANK HUTCHINS Print Name of Operator/Dealer 121176 Ming_Real November 16, 2001 10 SHOPPING CIENTEP Z ,~.~ ,"( ,"( × ;: X ;.' .", ;: X ;.' X ;: ,': X Xt × i-.---TI~ASIA I_ I=L[~3- ISLAND W/ DISF:'ENSE~S (TTP,) \ MING I~OAD SI--lOPPING CENTIE~ TEXACO BEFININ~ & ]~AR~TING INC, 3698 MING ~OAD [ I:L~EAL I~OAD BAKIE~SI:=IELD, CALIFOI:i)NIA 93309 CITT OI:= BAKEI~SI=:IELD 51-O58'-O7OO SCAL~, ~ - ~,O'-0' "1'5265 NS MAP SYMBOLS PE PESO ® ® ,m.,..mm-.- ~ t=11;~ P_..XTIN G'A. JI$1-il--'~ PI~E HYDPANT P..,_.ME.~GP..,NCY SNI JT-OF'I= EVACUATION/STAGING MSDS STO~AG~ LOCATION BUSN~SS PLAN LOCATION ,SPILL CONTI~OL EQL,IPMF;=NT P..,LECTI21CAL SI--IUT-OPP WATE~ SNUT-OPP GAS SHUT-OF=F= EVACUATION ~'OUTE PP_NC..~/BAI~I~..~ STOI~M DI~AIN UNDERGI:~OLJND TANK PLAMMABLE LIQUID TYPE OF ACTION [] 1. NEW SITE PERMIT Check one item only) [] 2. INTERIM PERMIT BUSINESS NAME (Same as FACILITY NAME or DHA) LINMAR #15 NEAREST CROSS STREET 3698 MING @ REAL ROAD BUSINESS IX] 1. GAS STATION II 3. FARM [] 5. COMMERCIAL TYPE [] 2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER 403 TOTAL NUMBER OF TANKS REMAINING AT SITE 5 404 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - FACILITY (one page per site) Page 1 of l l [] 3, RENEWAL PERMIT [] 5,CHANGE OF INFORMATION [] 7.PERMANENTLY CLosED SITE [] 4. AMENDED PERMIT [] 6, TEMPORARY SITE CLOSURE [] 8. TANK REMOVED 400 1. FACILITY / SITE INFORMATION 40~ FACILITY OWNER TYPE [] 4. LOCAL AGENCY/DISTRICT [] 1. CORPORATION [] 5, COUNTY AGENCY* [] 2. INDIVIDUAL [] 6. STATE AGENCY' [] 3. PARTNERSHIP [] 7. FEDERAL AGENCY* 402 IS facility on Indian Reservation or · If owner of LIST is a public agency: name of supen/isor of division, section or trustlands? office which operates the LIST (This is the contact pemon for the tank records.) [] Yes [] No 405 406 II.PROPERTY OWNER INFORMATION PROPERTY OWNER NAME E(~UILON ENTERPRISES LLC MAILING OR STREET ADDRESS PO BOX 7869 CITY BURBANK PROPERTY OWNER TYPE PHONE 1818-736-5o78 4~o STATE 4. [ ZIP CODE 4,2 CA [91510-7869 [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY [] 3. PARTNERSHIP [] 5. COUNTY AGENCY D 7. FEDERAL AGENCY 4t3 TANK OWNER NAME SAME AS ABOVE MAILING OR STREET ADDRESS ' III TANK OWNER INFORMATION /HONE 4Is A CITY TANKOWNERTYPE [] 1. CORPORATION 4=~ ] STATE 4~. [ ZIP CODE [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [--~6. STATE AGENCY 4=o []7, FEDERAL AGENCY IV. BOARD OF EQUALIZATION DST STORAGE FEE ACCOUNT NUMBER TY(TK)HQ44- I 0[ 3l 9 I o[ 2 [~6 Call (916) 322-9669 if questions arise V, PETROLEUM DST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) [] 1. SELF-INSURED [] 4. SURETY BOND [] 7. STATE FUND [] 10. LOCAL GOV7 MECHANISM [] 2.GUARANTEE [] 5. LETTER OF CREDIT [] 8. STATE FUND &CFO LETTER [] 99. OTHER: [] 3.INSURANCE [] 6. EXEMPTION [] 9. STATE FUND & CD 422 VI. LEGAL NOTIFICATION AND MAILING ADDRESS Check one box to indicate which address should be used for legal notifications and mailing. Legal notifications and mailings will be sent to the tank owner unless box 1 or 2 is checked. [] 1. FACILITY [] 2. PROPERTY OWNER [] 3. TANK OWNER 423 VII. APPLICANT SIGNATURE Certification - I certify that the information provided herein is true and accurate to the best of my knowledge. SIGNATURE OF APPLICANT DATE NAME OF APPLICANT (print) FERYAL SARRAFIAN 426 TITLE OF APPLICANT 424 [ PHONE 818.736.5078, ,, SH&E COMPLIANCE COORDINATOR OFFICIAL USE ONLY [ DATE RECEIVED [CUPA STATE LIST FACILITY NUMBER 1998 UPGRADE CERTIFICATE NUMBER DISTRICT/INSPECTOR UP Form (1/2000 Full Version) THE CUPAS OF LOS ANGELES COUNTY 29 LAC~: UPFORMI-3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS _ TANK PAGE I 2 OF {t~vo pages per tank/ ~'a~le TYPE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5.CHANGE OF INFORMATION [] 7.PERMANENTLY CLOSED SITE (Check one item only) [] 2. INTERIM PERMIT [] 4. AMENDED PERMIT [] 6. TEMPORARY SITE CLOSURE [] 8. TANK REMOVED 430 LOCATION WITHIN SITE (opuonal) 431 1, TANK DESCRIPTION (A scaled plot plan with location(s) of LIST system(s) includin9 buildings and landmarks shall be submitted to the CUPA or PA.) TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 91 XERXES .'vec,,. ~om.let .... .a~ ~or om DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 43~ NUMBER OF COMPARTMENTS 437 UNKNOWN 12,000 N/A ADDITIONAL DESCRIPTION (Forlocal uso only) 438 11. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 44o ; [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2.LEADED [] 5. JET FUEL (if markod complete Petroloum Typo) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4.GASOHOL [] 99. OTHER: .~ [] 3. CHEMICAL PRODUCT COMMONNAME 44t CAS~ 442 (from Hazardous Materiels Inventory page) (from Hazardous Materials inventory page) [] 4. HAZARDOUS WASTE (includeo Used OII) [] ~s. UNKNOWN UNLEADED GASOLINE 8006-61-9 III. TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH L.~ 5. SINGLE WALL WITH INTERNAL BLADI~ER ((Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN 443 [] 2. DOUBLE WALL [] 4. SlGNILE WALLIN VAULT [] 99. OTHER TANK MATERIAL - primary tank LJ 1. BARE STEEL IX~ 3. FIBERGLASS/PLASTIC LJ 5. CONCRETE LJ 95. UNKNOWN {(Chock one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8, FRP COMPTIBLE WI1 00% METHANOL [] 99. OTHER 444 REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank L~ 1. BARE STEEL D~ 3. FIBERGLASS I PLASTIC L.J 5. CONCRETE [X~ 95. UNKNOWN ((Check one Item only) E] 2. STAINLESS STEEL []4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPTIBLE W/100% METHANOL [] 99. OTHER 44S REINFORCED PLASTIC (FRP) [] 10. COATED sTEEL TANK INTERIOR LINING [] 1, RUBBER LINED L~ 3. EPOXY LINING LJ 5. GLASS LINING LJ 95. UNKNOWN DATE INSTALLED 447 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER 446 (For local use only) Check one Itom OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN DATE INSTALLED 448 PROTECTION (IF APPLICABLE) PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER ~ 448 (For local uso only) Check olle Itom Only) . [] 2 SACRIFICIAL ANODE I SPILL AND OVERFILL (Check all that apply) ~EAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 [] I SPILL CONTAINMENT 2001 [] 1 ALARM [] 2 DROP TUBE 2001 .., [] 2 BALL FLOAT [] 3 STRIKER PLATE 2001 [] 3 FILL TUBE SHLrr oFF VALVE 200] { E]4EXEMPT IF SINGLE WALL TANK (Choc~ a, that aptly) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one itom only) [] 1VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6VADOSEZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING (SIR) + BIENNIAL TANK TESTING [] 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 [ ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456ITANK FILLED WITH INERT MATERIAL? 457 [] Y., [] NoI [] Y~ [] No IOFFICIAL USE ONLY UP Form (1/2000 Full Version) INSTRUCTIONS FOR THE UNIFIED PROGRAM (UP) FORM 31 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION (Check all that apply/ Pa~e ~ of ] ] UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1 .PRESSURE [] 2. SUCTION [~]3. GRAVITY 458 [] I.PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION [] 1. SINGLE WALL [] 3. LINED TRENCH [~]99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95, UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER -- 481 MANUFACTURER / ~3 MATERIALS AND [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/I 00% METHANOL cORROSION METHANOL PROTECTION [] 95. UNKNOWN [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL ~2. STAINLESS STEEL [] 7. GALVANIZED STEEL []3. PLASTIC COMPATIBLE [] 8. FLEXIBLE (HOPE) [] 95. UNKNOWN [] 3, PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HOPE) W/CONTENTS [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 99. OTHER 484 [] 5. STEEL W/COATING [] 99. OTHER 465 VII. PIPING LEAK DETECTION {Check all that apply) IA description of the monitoring program shall be submitted to the local agency.I UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4~ SINGLE WALL PIPING PRESSURIZED PIPING (Cheek all that apply): PRESSURIZED PIPING (Chenk all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP [] 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WJT-H AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3, ANNUAL INTEGRITY TEST (O.IGPH) [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Che~k all that apply) CONVENTIONAL SUCTION SYSTEMS (Che~k all that apply) · [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.11 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION'SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7 SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW (Cheek al that apply): []9. BIENNIAL INTEGRITY TEST (0.1 GPH) ~8. DAILY VISUAL MONITORING ~9, BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Cheek all that apply): PRESSURIZED PIPING (Cheek all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WU AUDIBLE AND VISUAL 10, CONTINUOUS TURBINE SUMP SENSOR ~8U AUDIBLE AND VISUAL ALARMS AND (Check eom} ALARMS AND (Cheek [] a. AUTO PUMP SHUT OFF VVHEN A LBAK OCCURS [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND [] b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM SYSTEM DISCONNECTION DISCONNECTION [~c. NO AUTO PUMP SHUT OFF Dc NO AUTO PUMP SHUT OFF [] I 1. AUTOMATIC LEAK DETECTOR (3.0 GPH TEST) WITHIPLOW SHUT OF/.= [] I 1. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply} EMERGENCY GENERATORS ONLY (Cheek all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * AUDIBLE AND VISUAL ALARMS AUDIBLE AND VlSUAL ALARMS [] 15. AUTOMATIC LEAK DETECTOR (3.0 GPH) W/THOU FLOW SHUT OFF [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH UNER / MONITORING [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFf=FOR [] 6. NONE 469 200 ! PISCES DISPENSER + AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certlty that the information provided heroin Is true and accurate to the best of my knovAedge. SIGNATURE OF OVVNER/OPERATOR DATE ,~?o 11/16/01 NAME OF OWNER/OPRATOR (print) TITLE OF OWNER/OPERATOR 47z FBRYAL SARRAFIAN SH&B COMPLIANCE COORDINATOR OFFICIAL USE ONLY [ Permit Number UP Form (1/2000 Full Vemion) THI= ~11PA.~ OF LOS ANGELES COUNTY 33 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS _ TANK PAGE I 4 OF ! 1 {;two pa~les per tanK/ Pa~e or TYPE OF ACTION [] 1, NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5,CHANGE OF INFORMATION [] 7. PERMANENTLY CLOSED SITE (Chec~ one item only) [] 2. INTERIM PERMIT [] 4. AMENDED PERMIT [] 6. TEMPOF~RY SITE CLOSURE [] 8. TANK REMOVED 430 LOCATION WITHIN SITE (op~on~) 431 1. TANK DESCRIPTION (A scaled pict plan with location{s) of LIST system{s) including buildings and landmarks shall be submitted to the CUPA or PA.) TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 02 XERXES ~f'Yes". complete one page for each compartmenL DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 43s NUMBER OF COMPARTMENTS 437 UNKNOVvqN 12,000 N/A ADDITIONAL DESCRIPTION (For k)ca~ uso on~y) 438 11. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 [] 1, MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2.LEADED [] 5. JET FUEL (If marked Campier® Petroleum Type) [] lb, PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MI•GRADE UNLEADED [] 4.GASOHOL [] 99. OTHER ,~ [] 3. CHEMICAL PRODUCT COMMONNAME 441 CAS~ 442 (from Hazardous Materials Inventory page) (from Hazardous Materials Inventory page) [] 4. HAZARDOUS WASTE {inoludes Used Oil) [] 9s. UNKNOWN UNLEADED GASOLINE 8006-61-9 III. TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH I I 5. SINGLE WALL WITH INTERNAL BLADnER ((Check one Item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOVVN 443 [] 2. DOUBLE WALL [] 4. SIGNILE WALLIN VAULT [] 99. OTHER ~ TANK MATERIAL - primary tank [] 1. BARE STEEL ~ 3. FIBERGLASS/PLASTIC I I 5. CONCRETE I 1 95. UNKNOWN ((Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPTIBLE WI1 00% METHANOL [] 99. OTHER 444 REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tankl I 1. BARE STEEL ~ 3. FIBERGLASS / PLASTIC LJ 5. CONCRETE iX] 95. UNKNOWN ((Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPTIBLE W/100% METHANOL [] 99. OTHER 445 REINFORCED PLASTIC (FRP) [] 10. COATED STEEL TANK INTERIOR LINING LJ 1. RUBBER LINED J I 3. EPOXY LINING I 1 5. GLASS LINING I I 95. UNKNOWN DATE INSTALLED 447 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER 448 (For local uso only) (Check one Item cai},I OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC D~3 95 UNKNOWN DATE INSTALLED 448 PROTECT(ON (IF APPLICABLE) PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER I 448 (For local use only) (Check one Item Onl}~ [] 2 SACRIFICIAL ANODE I SPILL AND OVERFILL Check all that apply) YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 [] I SPILL CONTAINMENT 2001 [] 1 ALARM [] 2 DROP TUBE 200! [] 2 BALL FLOAT [] 3 STRIKER PLATE 2001 [] 3 FILL TUBE SHUT OFF VALVE 2001 I •4EXEMPT IV. TANK LEAK DETECTION (^ d.~p~on of~ mon.o,ng p.~m aha, bo submi~ed ~ ~o ~o~ IF SINGLE WALL TANK (Chec~ ali that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only) [] I VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] I VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AU'rOMATIC TANK C--~UGING (ATG) [] GVAOOSEZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING (SIR) + BIENNIAL TANK TESTING [] 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 I TANK FILLED VVITH INERT MATERIAL? 457 IOFFICIAL USE ONLY DATE RECEIVED ] CUPA PA DISTRICT/INSPECTOR UP Form (1/2000 Full Version) INSTRUCTIONS FOR THE UNIFIED PROGRAM (UP) FORM 31 LAC4:UPFORML3 m UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION {Check all that apply} Pa~e .~of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1 ,PRESSURE [] 2, SUCTION 1-13. GRAVITY 458 [] I.PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION [] 1. SINGLE WALL [] 3. LINED TRENCH r~99. OTHER 48o [] 1. SINGLE WALL [] 95. UNKNOVVN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95, UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER ~ 4ot MANUFACTURER ~ 463 MATERIALS AND [] 1. BARE STEEL [] 6. FRP COMPATIBLE w1100% [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/t oo% METHANOL CORROSION METHANOL PROTECTION [] 7. GALVANIZED STEEL [] 95. UNKNOWN [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL ~2. STAINLESS STEEL r']3. PLASTIC COMPATIBLE [] 8. FLEXIBLE (HOPE) [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HOPE) W/CONTENTS [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING ~ 99. OTHER 484 r'=) 5. STEEL W/COATING [] 99. OTHER 465 VII. PIPING LEAK DETECTION {Check all that apply) (A descrij)tion of the monitorin~l pro, ram shall be submitted to the local ai~ency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 4es SINGLE WALL PIPING PRESSURIZED PIPING (Che~ all that apply): PRESSURIZED PIPING (Chalk all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WJT-H AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM SHUT OFF FOR LEAI~ SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (O.IGPH) [] 3. ANNUAL INTEGRI'rY TEST (0.1GPH) [] 4. DALLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Ch~k all that apply) CONVENTIONAL SUCTION SYSTEMS (Che~k all t~at apply) [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.11 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ,[] 7 SELF MONITORING [] 7. SELF MONITORING IGRAm FLOW GRAVITY FLOW (Che~ all that apply): ! [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) ~8. DALLY VISUAL MONITORING []9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Che~t( all that apply): PRESSURIZED PIPING (Cheek all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WM AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR -I~M AUDIBLE AND VISUAL ALARMS AND (Che~k one) ALARMS AND (Ch~k one) [] a. AUTO PUMP SHUT OFF VVHEN A LEAK OCCURS [] a AUTO PUMP SHUT OFF WI'-IEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND [] b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM SYSTEM DISCONNECTION DISCONNECTION ~c. NO AUTO PUMP SHUT OFF []c NO AUTO PUMP SHUT OFF [] I 1. AUTOMATIC LEAK DETECTOR (3,0 GPH TEST) WITHIPLOW SHUT OFF [] I 1. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Cheek all that apply) EMERGENCY GENERATORS ONLY (Chack all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * [] 14. CONTINUOUS SUMP SENSOR WITHOU ,AUTO PUMP SHUT OFF * AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LEAK DETECTOR (3.0 GPH) WITHOU FLOW SHUT OFF [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DALLY VISUAL CHECK [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 48a [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFFFOR [] 6. NONE 2001 PISCES. DISPENSER + AUDIBLE AND VISUAL ALARMS IX, OWNER/OPERATOR SIGNATURE certity that the Information provided herein is true and accurate to the best of my knovAedge. GNATURE OF OWNER/OPERATOR DATE 4?0 ll/16/Ol TITLE OF OVVNEPJOPERATOR ~72 NAME OF OWNEPJOPRATOR (print) IFERYAL SARRAFIAN SH&E COMPLIANCE COORDINATOR IOFFICIAL USE ONLY I Permit Number UP Form (1/2000 Full Version) THI= ~..I IPA.~ C3F I {'iR AN~FI far ('~OtJNTY .~73 I Permit Approved 474 [ Permit Expirabon Date 33 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS _ TANK PAGE 1 6 oF ]1 (;two pages per tan~ ~a~e o~ TYPE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5.CHANGE OF INFORMATION [] 7.PERMANENTLY CLOSED SITE (Check one item only) [] 2. INTERIM PERMIT [] 4. AMENDED PERMIT [] 6. TEMPORARY SITE CLOSURE [] 8. TANK REMOVED 430 LocATION WITHIN SITE (optional) 431 1, TANK DESCRIPTION (A scaled plot plan with location(s) of LIST system(s) includin~l buildings and landmarks shall be submitted to the CUPA or PA.) TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 03 XERXES ~f 'Yes". complet .... page fo .... h compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 43~ NUMBER OF COMPARTMENTS 437 UNKNOWN ]2,000 N/A ADDITIONAL DESCRIPTION (Fo~ ~cal use only) 438 11. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 44o [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2.LEADED [] 5. JET FUEL (if marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4.GASOHOL [] 99. OTHER: [] 3. CHEMICAL PRODUCT COMMONNAME ~4, CAS~ 442 (fram Hazardous Materials Inventory page} (fram Hazardous M~terlals Inventory page) [] 4, HAZARDOUS WASTE (includes Used Oil) [] 95. UNKNOWN UNLEADED GASOLINE 8006-61-9 III. TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH LJ 5. SINGLE WALL WITH INTERNAL BLADRER ((Check one Item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN 443 [] 2. DOUBLE WALL [] 4. SIGNILE WALLIN VAULT [] 99. OTHER TANK MATERIAL - primary tank LJ 1. BARE STEEL IX~ 3. FIBERGLASS/PLASTIC LJ 5, CONCRETE I I 95. UNKNOWN ((Check oneltem only) []2. STAINLESS STEEL •4. STEEL CLAD W/FIBERGLASS F'~8, FRPCOMPTIBLEW/100%METHANOL []99. OTHER444 REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank [~ 1. BARE STEEL D~ 3. FIBERGLASS / PLASTIC I 1 5. CONCRETE [X~ 95. UNKNOWN ((Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8, FRP COMPTIBLE W/100% METHANOL [] 99. OTHER 445 REINFORCED PLASTIC (FRP) [] 10. COATED STEEL ~'ANK INTERIOR LINING U 1, RUBBER LINED L.J 3. EPOXY LINING U 5. GLASS LINING U 95. UNKNOWN DATE INSTALLED 447 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER 448 (For local use only) {Check one item only1 OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC IX~ 95 UNKNOWN DATE INSTALLED 448 PROTECTION (IF APPLICABLE) PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER I 448 (For local use only) , (Check one item Oni~} [] 2 SACRIFICIAL ANODE I SPILL AND OVERFILL (Check all that apply) YEAR INSTALLED 450 TYPE (local usa only) 45~ OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 [] I SPILL CONTAINMENT 2001 [] I ALARM [] 2 DROP TUBE 2,0.01 [] 2 BALL FLOAT [] 3 STRIKER PLATE 2.001 [] 3 FILL TUBE SHUT OFF VALVE 2001 I [~4EXEMPT IV. TAN K LEAK DETECTI ON (^ .e=ption of.~ monitoring program shall be submitted to the lOCal agency.) IF SINGLE WALL TANK (check a, that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] I VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6VADOSEZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING (SIR) + BIENNIAL TANK TESTING [] 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 TANK FILLED V~TH INERT MATERIAL? 457 0¥. [] No I-Iy,~ [] No I OFFICIAL USE ONLY DATE RECEIVED CUPA ] PA DISTRICT/INSPECTOR UP Form (1/2000 Full Version) INSTRUCTIONS FOR THE UNIFIED PROGRAM (UP) FORM 31 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION {Check all that apply) Pa~e ~'~of 11 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1 .PRESSURE [] 2. SUCTION []3. GRAVITY 458 [] I.PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION [] 1. SINGLE WALL [] 3. LINED TRENCH [-]99. OTHER 48O [] 1. SINGLE WALL [] 95. UNKNOWN 482 MANUFACTURER [] 2. DOUBLE WALL [] 95, UNKNOWN [] 2. DOUBLE WALL [] 99, OTHER MANUFACTURER ~ 461 MANUFACTURER ~ 463 MATERIALS AND [--~ 1. BARE STEEL r-~ 6, FRP COMPATIBLE w/100% [] 1, BARE STEEL [] 6. FRP COMPATIBLE w/1 0o% METHANOL CORROSION METHANOl. PROTECTION [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL []2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 95. UNKNOWN ~]3. PLASTIC COMPATIBLE [] 8. FLEXIBLE (HOPE) [] 95, UNKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HOPE) W/CONTENTS [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION r~ 5. STEEL W/COATING r'~ 99. OTHER 464 r'] 5. STEEL W/COATING ~] 99. OTHER 485 VII. PIPING LEAK DETECTION {Check all that apply) IA description of the monitoring program shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING ~ SINGLE WALL PIPING 4s7 PRESSURIZED PIPING (cheek all that apply): PRESSURIZED PIPING (Check all that apply): [] 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP [] 1. ELECTRONIC UNE LEAK DETECTOR 3,0 GPH TEST WJT-H AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (O.IGPH) [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (cheek ell that ap~ly) CONVENTIONAL SUCTION SYSTEMS (Che~k all that apply) [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.11 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOWGROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7 SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW (Che~k al that [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) []8. DAILY VISUAL MONITORING []9, BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Cheek all that apply): PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WIVI AUDIBLE AND VISUAL 10, CONTINUOUS TURBINE SUMP SENSOR ~SM AUDIBLE AND VISUAL ALARMS AND (Cheek or~) ALARMS AND (Cheek one) [] a. AUTO PUMP SHUT OFF VVHEN A LEAK OCCURS [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND [] b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM SYSTEM DISCONNECTION DISCONNECTION ~c. NO AUTO PUMP SHUT OFF E~]c NO AUTO PUMP SHUT OFF [] 1 I. AUTOMATIC LEAK DETECTOR (3.0 GPH TEST) VVITHIPLOW SHUT OFF [] I 1. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apFly) EMERGENCY GENERATORS ONLY (Cheek all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * AUDIBLE AND VISUAL ALARMS ' AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LEAK DETECTOR (3.0 GPH) W1THOU FLOW SHUT OFF [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17, DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED 4ea [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 200 ! PISCES [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [] 6. NONE DISPENSER + AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I cert/ly that the information provided herein is true and accurate to the beat of my knovAedge. SIGNATURE OF OWNER/OPERATOR DATE 470 11/16/01 NAME OF OWNER/OPRATOR (print) TITLE OF OWNER/OPERATOR 4?2 'FERYAL SARRAFIAN SH&E COMPLIANCE COORDINATOR IOFFICIAL USE ONLY I Permit Number UP Form (1/2000 Full Version) THE CUPAs OF LOS ANGELES COUNTY 33 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS _ TANK PAGE 1 8 of 1] ~two pages per tank! ~a~le or TYPE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5. CHANGE OF INFORMATION [] I'PERMANENTLY CLOSED SITE (Check one item only) [] 2. INTERIM PERMIT [] 4. AMENDED PERMIT [] &TEMPORARY SITE CLOSURE [] 8. TANK REMOVED 430 LOCATION WITHIN SITE (opttonal) 431 1. TANK DESCRIPTION (A scaled plot plan with location(s) of LIST system(s) includinF/buildin~]s and landmarks shall be submitted to the CUPA or PA.) TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] YeS [] No 434 04 ×E]~ES ,, was". complet .... page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 43~ NUMBER OF COMPARTMENTS 437 2001 12,000 N/A ADDITIONAL DESCRIPTION (For local use only) 438 1t. TANK CONTENTS TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2.LEADED [] 5. JET FUEL {if mad(ed complete Petroleum 'l~pe) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] 1c. MIDGRADE UNLEADED [] 4.GASOHOL [] 99. OTHER: ~ [] 3. CHEMICAL PRODUCT COMMONNAME 44t CAS~ 442 (from Ha~.arclous Mateltals Inventory page) (from Hazardous Materials inventory page) [] 4. HAZARDOUS WASTE (includes Used Oil) [] 95. UNKNOWN AUTOMOTIVE DIESEL 68476-34-6 III. TANK CONSTRUCTION TYPE OF TANK [~ 1. SINGLE WALL [~ 3. SINGLE WALL WITH I I 5. SINGLE WALL WITH INTERNAL BLADrlER ((Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN 443 [] 2. DOUE~LE WALL [] 4. SIGNILE WALLIN VAULT [] 99. OTHER .- TANK MATERIAL - primary tank LJ 1. BARE STEEL IX] 3. FIBERGLASS/PLASTIC I I 5. CONCRETE I I 95. UNKNOWN ((check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPTIBLE WI1 00% METHANOL [] 99. OTHER 444 REINFORCED PLASTIC (FRP) TANK MATERIAL -secondary tank[] 1. BARE STEEL D~ 3. FIBERGLASS / PLASTIC LJ 5. CONCRETE I 1 95. UNKNOWN ((Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPTIBLE W/100% METHANOL [] 99. OTHER 445 REINFORCED PLASTIC (FRP) [] 10. COATED STEEL TANK INTERIOR LINING U 1. RUBBER LINED I I 3. EPOXY LINING LJ 5. GLASS LINING IX] 95. UNKNOWN DATE INSTALLED 447 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER 448 (For local use only) ICheck one item only) OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC I)0 95 UNKNOWN DATE INSTALLED 448 PROTECTION (IF APPLICABLE) PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER I 448 (For local use only) (Check one item Only) [] 2 SACRIFICIAL ANODE I SPILL AND OVERFILL (Check all that apply) YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 [] I SPILL CONTAINMENT 2001 [] 1 ALARM [] 2 DROP TUBE 2001 [] 2 BALL FLOAT [] 3 STRIKER PLATE 2001 [] 3 FILL TUBE SHUT OFF VALVE 2001 I F'14EXEMPT IV. TANK LEAK DETECTION (^ descrip~on of the monitoring program shall be submitted to the local agency.) IF SINGLE WALL TANK (check a, that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] I VISUAL (E. XPOSED PORTION ONLY) E] 5 NIANUAL TANK GAUGING (MTG) E] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6VADOSEZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING (SIR) + BIENNIAL TANK TESTING [] 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 I TANK FILLED VVITH INERT MATERIAL? 457 []Yes [] NO} []Yes [] No I OFFICIAL USE ONLY J DATE RECEIVED CUPA IPA DISTRICT/INSPECTOR INSTRUCTIONS FOR THE UNIFIED PROGRAM '(UP) FORM UP Form (1/2000 Full Version) 31 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI. PIPING CONSTRUCTION {Check all that apply) Pa~e ¢~ of 1 ] UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1 .PRESSURE [] 2. SUCTION [~. GRAVITY 458 [] I.PRESSURE [] 2. SUCTION [] 3. GRAVITY' 459 CONSTRUCTION [] 1. SINGLE WALL [] 3. LINED TRENCH ~99. OTHER 480 [] 1. SINGLE WALL [] 95. UNKNOWN 482 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER -- 461 MANUFACTURER ~ 463 MATERIALS AND r'~ 1. BARE STEEL [-] 6. FRP COMPATIBLE w/100% [~1. BARE STEEL r'] 6. FRP COMPATIBLE w/f o0% METHANOL CORROSION METHANOL PROTECTION [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL ~2. STAINLESS STEEL [] 7. GALVANIZED STEEL [--~ 95. UNKNOWN ~3. PLASTIC COMPATIBLE [] 8. FLEXIBLE (HOPE) [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HOPE) W/CONTENTS [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 99. OTHER 464 [] 5. STEEL W/COATING [] 99. OTHER 465 VII, PIPING LEAK DETECTION {Check all that apply) {A description of the monitoring program shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING ~ SINGLE WALL PIPING 4~7 PRESSURIZED PIPING (che~k all that apply): PRESSURIZED PIPING (ch~k all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST W1TH AUTO PUMP [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST wJm-H AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (O. IGPH) ~ 3. ANNUAL INTEGRITY TEST (0.1GPH) r~ 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Cheek all that apply) CONVENTIONAL SUCTION SYSTEMS (Cheek all that apply) ~ 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING [~ 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.11 GPH) D 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7 SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW (che~ ell that apply): [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) r~8. DAILY VISUAL MONITORING r~9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Cheuk all that apply): PRESSURIZED PIPING (Cheek ell fiat apply): 10. CONTINUOUS TURBINE SUMP SENSOR WU AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR ~8U AUDIBLE AND VISUAL ALARMS AND (Chee. k one) ALARMS AND (Cheek one) [] a. AUTO PUMP SHUT OFF VVHEN A LEAK OCCURS [] a AUTO PUMP SHUT OFF VVHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND [] b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM SYSTEM DISCONNECTION DISCONNECTION Dc'NO AUTO PUMP SHUT OFF I-lc NO AUTO PUMP SHUT OFF [] I 1. AUTOMATIC LEAK DETECTOR (3.0 GPH TEST) V~THIPLQW SHUT OFF [] 1 1. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Cheek all that apply) EMERGENCY GENERATORS ONLY (Cheek all that apply) [] 14. CONTINUOUS SUMP SENSOR VVITHOU AUTO PUMP SHUT OFF * [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LEAK DETECTOR (3.0 GPH) WITHOU FLOW SHUT OFF [] 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DALLY VISUAL CHECK DATE INSTALLED 4~a [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 200] PISCES [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [] 6. NONE 46g DISPENSER + AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I certify that the Information provided heroin Is true and accurate to the beet of my knovAedge. SIGNATURE OF OVVNER/OPERATOR DATE 470 11/16/01 NAME OF OWNER/OPRATOR (print) TITLE OF OWNER/OPERATOR 472 FERYAL SARRAFIAN SH&E COMPLIANCE COORDINATOR JOFFICIAL USE ONLY I Permit Number UP Form (1/2000 Full Version) THE CUPAs OF LOS ANGELES COUNTY ~73 I Permit Approved 33 474 I Permit Expirabon Date 475 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS _ TANK PAGE I ]0 OF (two pa~les per tank] ~a~le or T~PE OF ACTION [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5.CHANGE OF INFORMATION [] 'i'PERMANENTLY CLOSED SITE (Check one item only) [] 2, INTERIM PERMIT [] 4. AMENDED PERMIT [] &TEMPORARY SITE CLOSURE [] 8. TANK REMOVED 43o LOCATION WITHIN SITE (opaona) 431 1. TANK DESCRIPTION (A scaled plot plan with location(s) of LIST system(s) including buildings and landmarks shall be submitted to the CUPA or PA.) TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 95 OWENS CORNING ,,'¥os". ~mp,ot .... paoo,o,' oa~ DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 43~ NUMBER OF COMPARTMENTS 437 UNKNOWN 550 N/A ADDITIONAL DESCRIPTION (For ~ use only) 438 11. TANK CONTENTS TANK USE 439 PETROLEUM TYPE [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2.LEADED [] 5, JET FUEL (if marked complete Petroleum Type) [] 1 b. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4.GASOHOL [] 99. OTHER: OIL [] 3, CHEMICAL PRODUCT COMMONNAME 44~ CAS~ .... 442 (from Hazardous Materials Inverltory page) {from Hazardous Materials inventory page) [] 4. HAZARDOUS WASTE (includes Used Oil) [] Ss. UNKNOWN WASTE O[L 8002-05-9 III. TANK CONSTRUCTION TYPE OF TANK [] 1. SINGLE WALL [~] 3. SINGLE WALL WITH L] 5, SINGLE WALL WITH INTERNAL BLADI'IER {{check one Item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN 443 [] 2. DOUBLE WALL [] 4. SIGNILE WALLIN VAULT [] 99. OTHER ~ TANK MATERIAL - primary tank L~ 1. BARE STEEL [] 3. FIBERGLASS/PLASTIC LU 5, CONCRETE LJ 95. UNKNOWN {{Check one Item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPTIBLE W/1 00% METHANOL [] 99, OTHER 444 REINFORCED PLASTIC (FRP) TANK MATERIAL- se~neary ttnk [] 1, BARE STEEL (~ 3. FIBERGLASS I PLASTIC I I 5, CONCRETE I 195. UNKNOWN {{Check one item only} [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8, FRP COMPTIBLE W/100% METHANOL [] 99. OTHER 445 REINFORCED PLASTIC (FRP) [] 10.'COATED STEEL TANK INTERIOR LINING L] 1. RUBBER LINED LJ 3. EPOXY LINING L.J 5. GLASS LINING I I 95. UNKNOWN DATE INSTALLED 447 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER 446 (For local uae only) OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN DATE INSTALLED 448 PROTECTION (IF APPLICABLE) PROTECTION [] 4 IMPRESSED CURRENT [] ~ OTHER I 448 (For lOcal use only) Check one item One/) [] 2 SACRIFICIAL ANODE SPILL AND OVERFILL (Check all that apply) YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT YEAR INSTALLED 452 [] I SPILL CONTAINMENT [] I ALARM [] 2 DROP TUBE [] 2 BALL FLOAT [] 3 STRIKER PLATE [] 3 FILL TUBE SHUT OFF VALVE I [] 4EXEMPT IV. TAN K LEAK DETECTION (^ dea~p~on of th .... ,o,.~ ~o~r~m aha, ho aubm,~.d ~o tho ~o~ IF SINGLE WALL TANK (check a~l that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 4s4 {check orle item only) [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] I VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6VADOSEZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINuous ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING (SIR) + BIENNIAL TANK TESTING [] 99 OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YP-JMO/DAY) 455 J ESTIMATED QUANTITY OF SUBSTANCEREMAINING 456 I TANK FILLEOVV~TH INERT NtATF_RI,'~.? 457 I OFFICIAL USE ONLY I DATE RECEIVED CUPA I PA DISTRICT/INSPECTOR I UP Form (1/2000 Full Version) INSTRUCTIONS FOR THE UNIFIED PROGRAM (UP) FORM 31 LAC4:UPFORML3 UNIFIED PROGRAM (UP) FORM UNDERGROUND STORAGE TANKS - TANK PAGE 2 VI, PIPING CONSTRUCTION {Check all that apply) Page ~ [ of 1 1 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1 .PRESSURE [] 2. SUCTION []3. GRAVITY 458 [] I.PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION [] 1. SINGLE WALL [] 3. LINED TRENCH []gg. OTHER 460 [] 1, SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER ~ 461 MANUFACTURER ~ 463 MATERIALS AND [] 1. BARE STEEL [] 6. FRP COMPATIBLE wi100% [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/1 00% METHANOL CORROSION METHANOL PROTECTION [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL' []2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 95. UNKNOWN ~]3, PLASTIC COMPATIBLE [] 8. FLEXIBLE (HOPE) [] 95, UNKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 8. FLEXIBLE (HOPE) W/CONTENTS [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 99. OTHER ,. 484 [] 5. STEEL W/COATING [] 99. OTHER ~ 465 VII. PIPING LEAK DETECTION {Check all that al3pl¥1 (A description of the monitorin~l ~ro~lram shall be submitted to the local agency.) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING ~ SINGLE WALL PIPING 487 PRESSURIZED PIPING (check all that apply): PRESSURIZED PIPING [Che~k all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WJT-H AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (O.IGPH) [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) CONVENTIONAL SUCTION SYSTEMS (che~k all that [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM INTEGRITY TEST (0.11 GPH) [] 6. TRIENNIAL INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOWGROUNDPIPING): SAFE SUCTION SYSTEMS (NO VALVES IN BELOWGROUND PIPING): [] 7 SELF MONITORING [] 7. SELF MONITORING GRAVITY FLOW GRAVITY FLOW (cl~k all that apply]: [] 9, BIENNIAL INTEGRITY TEST (0,1 GPH) []8. DALLY VISUAL MONITORING []9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PiPiNG SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that al~ly]: PRESSURIZED PIPING (Che~k all that 10. CONTINUOUS TURBINE SUMP SENSOR WM AUDIBLE AND VISUAL 10. CONTINUOUS TURBINE SUMP SENSOR ~8M AUDIBLE AND VISUAL ALARMS AND (check ~ne) ALARMS AND [Che~k [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND [] b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM SYSTEM DISCONNECTION DISCONNECTION ~c, NO AUTO PUMP SHUT OFF ' r"Jc NO AUTO PUMP SHUT OFF [] 1 1. AUTOMATIC LEAK DETECTOR (3.0 GPH TEST)WITHIPLOWSHUT OFF [] I 1. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY {Cheek all that apply) EMERGENCY GENERATORS ONLY {Ch.~k all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF * [] 14. CONTINUOUS SUMP SENSOR WITHOU AUTO PUMP SHUT OFF AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LEAK DETECTOR (3.0 GPH) WITHOU FLOW SHUT OFF [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DALLY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED , 4ea [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR [] 6. NONE DISPENSER ~- AUDIBLE AND VISUAL ALARMS IX. OWNER/OPERATOR SIGNATURE I cenlty that the Information provided herein Is true and accurate to the best of my knovAedge. SIGNATURE OF OVVNEP./OPERATOR DATE 470 NAME OF OWNER/OPRATOR (pdnt) TITLE OF OVVNER/OPERATOR 472 FERYAL SARRAFIAN SH&E COMPLIANCE COORDINATOR IOFFICIAL USE ONLY Permit Number 4z3 [ Permit Approved 4z~I Permit Expirabon Date 47sI UP Form (1/2000 Full Version) 33 LAC4:UPFORML3 TH~= ~..I IPAn C)F I C),~ ANRFI ES COUNTY SI--lOPPING CIENTE!~ Z F T~ASIA ENCLOSL.~E NT~OL/ AI~/VVA'TIE~ -u _--~_L ( ~o,ooo FL ) I ' -,..,~,, I ( O,O00 FL ~ ~ I (~OOFL) I I ( ~,000 FL ) I I_ ISLAND W/ g D~S~ STOMAS[ ~.~ T~S D~IVE Z LU O ® z MING ROAD SPlOPPING CENTER TEXACO REFINING & MARKETING INC. 3698 MING E'OAD I[ I;;a~AL ROAD EtAIc::E~SI=II~LD, CALF'O~INIA 93309 CI~ DP B~E~SP~D ~58~7OO SCA~, I - 40'-0' .~5265 ~ R.J. Myer & Co., l c. ENVIRONMENTAL COMPLIANCE CONTRACTOR ' 451 CONSTITUTION UNIT E CAMARILLO, CA 93010 805-383-9244 / 805-383-9245 FAX SUBJECT: DATE: S/S #: Annual Electronic Leak Monito~ng-gy~~_nd Certification ~LOCA 11/5/01 TION: 3698 Ming Texaco 121176 Bakers~ To Whom it May Concern, Enclosed are the reports for the annual inspection of the existing Monitoring System that was performed at the above referenced facility. The method used to test the electronic and mechanical monitoring systems is approved by and exceeds the specifications according to the manufacturer. R. J. Myers & Co., Inc. has been contracted by Equiva Services LLC to insure that their facilities comply with all the rules and regulations that govern the operation of underground storage tanks and product lines. If you have any questions, Please call. Sincerely, R. J. MYERS & CO., INc. President RJM/rf CONT. LIC. #330631 '(B-061) SERVING THE PETROLEUM INDUSTRY SINCE 1967 R. J. MYERS & CO.,. INC.' ENVIRONMENTAL COMPLIANCE CONTRACTOR 451 CONSTITUTION UNIT E CAMARILLO, CA 93010 805-383-9244 / 805-383-9245 FAX DATE OF SERVICE: 11/5/01 S.S. #: Texaco 121176 W.O. #: TECHNICIAN: Jason Nonnweiler BILL TO: Equiva Services LLC P.O. Box 7869 · Burbank CA 91510 SERVICE REQUESTED- Annual leak monitor' inspection and certification. DESCRIPTION OF WORK: inspected and tested all leak sensors for proper operation. Verified proper operation and calibration of all TLM probes. All systems normal. MODEL #: Veeder-Root TLS-350 Simplicity SERVICE REQUESTED BY: Fen/al Sarraflan SERIAL PROBE I.D. #: In Tank Setup T1 Unleaded TLM T2 Plus TLM T3 Premium TLM T4 Diesel TLM Pressure Line Leak Setup Q1 Unleaded PLLD Q2 Plus PLLD Q3 Premium PLLD Q4 Diesel PLLD Liquid Sensor Setup L1 Unleaded Annular Space 1.2 Unleaded Fill Sump L3 Unleaded STP Sump L4 Plus Annular Space ' L5 Plus Fill Sump L6 Plus STP Sumo L9 Premium Annular Space L10 Premium Fill Sump L11 Premium STP Sump L12 Diesel Annu!ar Space L13 Diesel Fill Sump L14 Diesel STP Sump 80649154805002 sysTEM CERTIFIED SYSTEM PSD ~__~) NO Y~ N/A NO WASTE OIL YES (~ NO SYSTEM RUNNING SYSTEM SEALED · UST EQUIPMENT INSPEGI'ION REPORT STATION ADDRESS: 3698 Ming SAP NUMBER: 121176 CITY: Bakersfield BRAND NAME: Texaco STATE: Callf0mia TANKS AND LINES Tank Product Tank, Type, Tank Size UST or AST Tank Corrosion Type Line Type Line Con*nelon R ='RegUlar M = Mid Grade DWF = Doublewall Fiberglass Circle the correct F = Fiberglass /~INF = DOuble,Vail Fiberglass F = Flbergla: P = Premium D = Diesel SWF = Singlewall Fibe~glass Nominal Gallons type o1 tank. L = Lined SWF = Singlewall FIbe~lass lC = Impressed ( U = Used OII K = Kerosene SWS = $1nglewall Steel Underground Storage lC = Impressed Current SW$ = Singla~all Steel A = Anode DWS = Doublewall Steel or Aboveground A = Anode FDW = Flexible Doublawall P = Plastic Fi . . DFS = Double Fit~or Steel Storage .... I !.Regular DWF 12~000 UST Fiberglass DWF Fiberglas; . 2. iMi(~ Grade DWF 12,000 UST F berglass DWF Fiberglas; 3 !Premium DWF 12~000 UST Fiberglass DWF Fiberglas; 4 !Diesel DWF 10~000 UST Fiberglass. DWF Fiberglas~ Comments: PRODUCT TANK MONITORING SYSTEM Pos~Jve Fall ' Qt~ T),pe Shut ~ Safe Operutio~al . Maat~a,;-~t~' ami ~ ~m~.. SW Tan~ ~ Int~l ~m 4 W~ Yes Yes Yes V~er-R~t ~S-350 Simpli~ ~1 . . A~ma~c Tank Ga~e Pm~s (ATG) 4 P~mmm~. CSLD Y~ Yes Yes Ve~er-Root TL~350. Simpli~ ~g*l Gmun~ator Sentra FIl~a~ Re~ Ri~r Coming: ~J. ~em pr~mmm~ In ~ I~ V~de~ ' USED OIL TANK AND LINE MONITORING SYSTEM (UST Only) Manufacturer and Model Number Q~ Ty~ O;eratkmal Interstitial Monitor (DW tanks) Sensor In Fill sump - ~ Fill Sump Monitor ~ ETM (ATG) Probe ~, , , Comments: PRODUCT LINE MONITORING SYSTEM Positive Fall Manufecture~ and Model Number Q~: T~ Shut Down Safe Operational , ,, IVle~h. anita, Leak Detector ~ ~ .. 4 Electronic Sensor In Fill Sump Yes Yes Yes Veeder-Root TLS-350 Simplicity ~208 . 4 Eta<~.ro~lo Line Pressure Seneem ..... Yes Yes yeS Veeder-Root TLS-350 Simplicit~ PLLD · 4 Electronic Sensor in Turbine Sump Yes Yes Yes Veeder-Root TLS-350 Simplicity #208 Electronic Sensors In Contained Trench (TLM) CommentS: Sensom were not in lowest part Of sump, R.J.Mysm fixed. ' ..... I certify that the above Information Is accurate and the equipment Is functioning according to manufacturers specifications unless otherwise ir~d~ged. SIGNATURE: .~~~ "COMPANY: R.J. Myers & Co., Inc. PRINTED NAME: Jason Nonrrweiler DATE: 1115/01 UST EQUIPMENT INSPECTION REPORT STATION ADDRESS: 3698 Ming CITY: Baker~fteld STATE: California SAP NUMBER: 121176 BRAND HAME: Texaco DATE: 1tl5/01 Test Boot/Drain Pitm: Flex Connector Tank Permit Required Turbine Head Have test boots been Protection: Plastic Manifold: is Are there Confined Space Protection Tv~e: backed off secondary Flex, Booted, Taped, the product any ~'e there top seal ol Identification Contained Sump, containment piping, or Sump, Anode, manifolded observation Are the side seal edaptam Am thoro internal or Tag or Decal Rigid Soil Barrier le The drain plugs removed fm Impressed Curront, between wells in the products Turbine on the tank fill external drains on the Tank Product . Present Liner, None Sump Dry proper drainage? Unable to Varify tanks? tank ara~? blen.d, ing? Filter? pipes? spill containment I Regular No Contained Sump Yes Yes. Sump N/^ No No No Top Seal Internal .2 Mid Grade N~ Contained Sump Yes Yes Sump N/A No No No Top Seal Internal 3 Premium No Contained Sump Yes Yes Sump N/A No No No Top Seal Internal 4 Diesel No Contained Sump Yes Yes Sump N/A No No No Top Seal Internal Comments: TANK FILL AREA Ca, pa and ·1 Overfill Protection , DIo Stick Protection Spill Gaskets In Tv~e: Ball Float, Tv~e: Strike Plats, i Containment Spill Containment Spill Containment on Good Fill l. ld Fill Lid Product Flapper, Both, Non; Basket Cage, Both or Tank Product Size Drain Operational Remote Fill~f~~ Remote Fill Condition Condition Painted identificati(m or Unable to Verify None I Regular 5 Ye~ No ~ None Yes.. Good Yes '/'es. Unable.To Verify Strike plate . 2 Mid Grade .. 5 Yes No ~ None Yes Good Yes Yes Unable To Verify Strike Plate 3 Premium 5 Yes NO ~ None Yes · Good Yes Yes Unable To Verify S~ke Plate. 4 Diesel 5 Yes No ~ None Yes Good Yes Yes Flapper Strike Plate. ~:ommeots: No remote elnm~ for overfill. STAGE I VAPOR RECOVERY AREA Cape and vapor ts There A Spill Vent Ca= Tvoe: Remote Gaskets In Recovery Containment Box Pressure Cap, Vapor Recov~y Vapor ~ Dry Break In Good Good Lid Identification Around Each VR Spill Containment Tank Product Rein Cap, None Type Recovery ~ Operating Condition Condition Lid Painted Condition Tag present Point Drain OPerational i' t R__eguier Pressure Cap Dual Point No ~ Yes Yes Yes Good No Yes None 2 Mid Gr.ade Pressure Cap Dual Point No ~ Yes Yes Yes Good No Yes . None ~3 P~mmium Pressure Cap DUal Point No ~ Yes Yes Yes Good No Yes None 4 Diesel Rain Cap ~ Comntents: ~,2,. STATION ADDRESS: 3698 MinE; CITY: Bakersfield STATE: California UST EQUIPMENT INSPECTION REPORT SAP NUMBER: 121176 BRAND NAME: Texaco DATE: 11/5/0t DISPENSER AREA Dispenser Nozzles Impact Mechanism D!-_~M__qser Containment Impact Tv~e: Gallons per Mechanical Flax Connector Sum;) Liquid Oldest minute being Staae II Vcoor Valve or Protection: Boot, Tape, Containment Sensor Tyne: Date on pumped by Recovery Tyne: Motion Mechanical Contain Sump, Anode, Sumo Tvoe: Mechanical, Sump Dispenser Securely Dispenser Number of closest nozzle. Balance, Vacuum Sensor or Securely Valve Impressed Current, Deep, Shallow, Electronic, Sensors Numbers Manufacturer Anchored? FuelFIIters Nozzles Rag Mid Pre Assist, None Both Anchored Operational Unable ToVerify , None None Operational? ,, 1/2 . Gilbarco Yes No Date. 2 Balance MV Yes Yes , Contain Sump Deep Electronic Yes 3/4 Gilbarco Yes No Date 4 8.4/7.6/8.0 Balance MV , Yes Ye.s, Contain Sump Deep Electronic Yes 5/6 Gilbarco Yes No Date 2 Balance MV Yes Yes Contain Sump Deep Electronic Yes 7/8 ,. Gilbarce. Yes No Date 4 Balance MV Yes Yes Contain Sump Deep Electronic . Yes TOTAL # OF NOZZLES: 12 Comments: GENERAL INFORMATION Emergency Shutoff I ESO) Car Wash Oil - Wa~er Separator Automatic Tank Gauge Strip Reclaim Drain Simplicity (S), If a remote Sump Needs to Attach A Printout Of The Tank Monitor ~ Does tho water level PoleCat (P) or monitor is Needs to be Set-Up and Most Recent Test Results ' shown on the ATG match Neither (N) Installed, Is it be Pumpe~ Pumped 13: Service Bay Needs to be (SWF Tank Locations). is a PrintOut what is shown on a installed on operating Operational Qty Out? Out C: Car Wash Pumped Out Attached To This Form. manual stick reading? ATG. correctly? Exteri0rI Yes I N/A N/A N/A NIA Yes Yes Simplicity .. N/A Interior Yes 2 Comments: MONITORING SYSTEM CERTIFICATION- For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or rgpQrt 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 owner/operator must submit a copy of this form to the local agency regulating UST systems the tank system owner/Operator. within 30 days of test date. A. General Information Facility Name: Texaco 121176 Site Address: 3698 Ming Facility Contact Person: Marsha Make/Model of Monitoring System: VeederoRoot TLS-350 Simplicity B. Inventory of Equipment Tested/Certified · .~heek.~[he approp~ate boxes to indicate specific equipment inspected/sera!ced: Tank ID: Unleaded 15~In-Tank Gauging Probe. [5~Annular Space or Vault Sensor. [5~1 Piping Sump / Trench Sensor(s): [] Fill Sump Sensor(s). [] Mechanical Line Leak Detector. [] Electronic Line Leak Detector. Model: Veeder-Root Mag Model: Veeder-Root #302 Model: Veeder-Root #208 Model: Veeder-Root #208 Model: Model: Veeder-Root PLLD [] Tank Overfill / High-Level Sensor. Model: Veeder-Root Mag #I [] Other sci e ui ment e and model in Section E on Pa e 2. Tank ID: Plus [] In-Tank Gauging Probe. Model: Veeder-Root Mag # 1 [] Annular Space or Vault Sensor. Model: Veeder-Root #302 [] Piping Sump / Trench Sensor(s). Model: Veeder-Root #208 [] Fill Sump Sensor(s). Model: Veeder-Root #208 [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: Veeder-Root PLLD [] Tank Overfill / High-Level Sensor. Model: Veeder-Root Mag #1 [] Other (s cci e uipment e and model in Section E on Page 2 p .fyq typ ). Dispenser ID: #1/2 [] Dispenser Containment Sensor(s). Model: Beaudreau #500 [] Shear Valve(s). [],Dispenser Containment Float(s) and Chain(s). . , Dispenser ID: #5/6 [] Dispenser Containment Sensor(s). Model: Beaudreau #500 [] Shear Valve(s). · ..[~_Dispenser Containment Floa. t~s.) ap.d Chain(s).. ........... Dispenser ID: [] Dispenser Containment Sensor(s). Model: [] Shear Valve(s). · []Dis enser Containment Float s and Chain s. Bldg. No.: City: Bakersfiled Zip: 93309 Contact Phone No.: (661) 834-2822 Date of Testing/Servicing: 11/05/01 Tank ID: Premium , [] In-Tank Gauging Probe. ' Model: Veeder-Root Mag #1 [] Annular Space or Vault Sensor. Model: Veeder-Root #302 [] Piping Sump / Trench Sensor(s). Model: Veeder-Root #208 [] Fill Sump Sensor(s). Model: Veeder-Root #208 [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: Veeder-Root PLLD [] Tank Overfill / High-Level Sensor. Model: Veeder-Root Mag #1 [] Other s cci e ui ment and model in Section E on Pa e 2. Tank ID: Diesel [] In-Tank Gauging Probe. Model: Veeder-Root Mag #I [] Annular Space or Vault Sensor. Model: Veeder-Root #302 [] Piping Sump / Trench Sensor(s). Model: Veeder-Root #208 []Fill Sump Sensor(s). Model: Veeder-Root #208 [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: Veeder-Root PLLD [] Tank Overfill / High-Level Sensor. Model: Veeder-Root Mag #1 [] Other (specify equipment type and model in Section E on Page 2).' ' Dispenser ID: #3/4 [] Dispenser Containment Sensor(s). Model: Beaudreau #500 [] Shear Valve(s). [] Dispenser Containment Float(s) and Chain(s). , Dispenser ID: #7/8 [] Dispenser Containment Sensor(s). 'Model: Beaudreau #500 [] Shear Valve(s). [] Dispen¢. ,e.r,,con,tainment..F, loat(s) and C, hain(~). Dispenser ID: [] Dispenser Containment Sensor(s). Model: -' [] Shear Valve(s). ["-IDis enser 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; (checl~ all that apply): 1~ System set-up [~ Alarm history report Technician Name (print): Jason Nonnweiler Certification No.: 559491195 Test/rig Company Name: R. J. Myers & Co., Inc. Signature: License. No.: Jason Nonnweiler Phone No.: (805) 383-9244 Page 1 of 3 03/01 Monitoring System Certification D. Results of Testing/Servicing Software Version Installed: 121.00 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? [] Ye.s; [] 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 capacity does the alarm trigger? 94 % [] 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? Attach set up reports, if applicable [] 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 03/01 F. In-Tank Gauging / SIR Equipment: [] Check this box if tank gauging is used only for inventory control. [] Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: [] 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? 15~' 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. Complete the following checklist: [] Y~s [] No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [] N/A (Check ali that apply) Simulated leak rate: [] 3 g.p.h.; [] 0.1 g.p.h; [] 0.2 g.p.h. [] Yes [] No* Were all LLDs confirmed operational and accurate within regulatory requirements? [] Yes [] No* Was the testing apparatus properly calibrated? [] 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 system [] 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 equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 o3/01 Monitoring System Certification UST Monitoring Site Plan Site Address: 3698 Ming, B .akersfil,d ............ PV Valves . . ~'O O .................... Cashier Store [-']~VRelays eeder-Root ®0o ®0o Date map was drawn: ' 11/0 5/01 ' 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-t_~nk liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. CALM-02 Page I of 1 ~ 11/15/99 RICH ENVIRONFIENTAL 5643 BROOKS CT BAKERSFIELD,CA. 93308 OFFICE (661) 392-8687 FAX(661)392-0621 ALERT 1000 UNDERFILL & 1050X ULLAGE SYSTEM & ACURITE TM Precision Underground Storage Tank System Leak Test TEST RESULTS Test Date:il-13-2001 BILLING:R.J.MYERS & CO.INC. 451 CONSTITUTION UNIT E , .CAMARILLO, CA 93010 PRODUCT VOLUME %FULL WETTED (GAL) PORTION SITE:TEXACO 3698 MING AVE BAKERSFIELD, CA NON-WETTED PRODUCT LEAK WATER IN PORTION LINE DETECTOR TANK UNL-87 12000 73% +. 005-PASS PASS -. 005-PASS N/A 0" UNL-89 12000 69% +.020-PASS PASS -.005-PASS N/A 0" PREMIUM 12000 73% +.012-PASS PASS -.005-PASS N/A 0" DIESEL 10000 81% +.008-PASS PASS -.005-PASS N/A 0" WATER BALANCE Measurements showed that water in the backfill area at the time of testing was below tank bottom, and therefore hot a facter in test determination. A monitoring well or a well point was driven in the backfill area to determine that there is no water in the backfill at tank bottom. A precision test was performed on tanks at the above location using the 'Alert 1000 underfill system and the Alert 1050 ullage system. I have reviewed the data produced in conjunction with this test for purpose of verifying the results and certifying the tank systems. The testing was performed in acorrdance with Alert protocol, and therefore satisfies all requirements for such testing as set forth by NFPA 329-92 and USEPA 40 CFR part 280. The results of testing are shown on the following page, and indicate whether the wetted and non-wetted portion passed or failed. Included with the report are reproduction of data compiled during the test which formed the basis for these conclusion. This information is stored in a permanent file if future verification of test results is needed. AL\NC' 040 Test Certified By: ~mes J. kWlch . State cert#90-1072 A L ER T TECHNOL 0 GIES PLOT OF ULLAGE TEST DA TA 0.75 AMPLITUDE RATIO :15 TEXACO 3698~MING AVE BAKERSFIELD, CA :12000 GALLON UNL-87 TANK 750+ 0 75 M I N U T E S 25KHz AMPLITUDE RATIO :15 750+ ~2KHz DETECTION RATIO = .997 25KHz DETECTION RATIO = .998 TEST RESULT = PASS DATE AND TIME OF TEST: :1:1/:13/0l :10: 06AM BEGINNING 80TTLE PRESSURE = 3400 BEGINNING TANK PRESSURE = ~.5 PSIG ENDING BOTTLE PRESSURE = 2800 ENDING TANK PRESSURE = J.5 PSIG ALERT TECHNOL OGLES PL 0 T OF ULLA GE TEST DA TA .M T N U T' E -S O. 75 3 5 TEXACO 3698 MING AVE BAKERSFIELD, CA 12000 GALLON UNL-89 TANK t2KHz AMPLITUDE RATIO I 5 750+ 0 75 M I N U T E S 25KHz AMPLITUDE RATIO 12KHz DETECTION RATIO = · 999 25KHz DETECTION RATIO = t.00 750+ TEST RESULT`= PASS DATE AND TIME OF TEST: ~'~OAM BEGINNING BOTTLE PRESSURE = 2300 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING BOTTLE PRESSURE : JBO0 ENDING TANK PRESSURE = 1.5 PSIG ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA .M I N U T E S TEXACO 3698 MING AVE BAKERSFIELD, CA 12000 GALLON PREM-9~ TANK 0 75 3 ~2KHZ AMPLITUDE RATIO ~5 750+ 0.75 25KHz AMPLITUDE RATIO ~ 5 -E ~2KHz DETECTION RATIO = .996 25KHz DETECTION RATIO = J.O0 750+ TEST RESULT = PASS DATE AND TIME OF TEST: ~/~3/01 11:29AM BEGINNING BOTTLE PRESSURE = 2800 BEGINNING TANK PRESSURE : 1.5 PSIG ENDING BOTTLE PRESSURE = 2300 ENDING TANK PRESSURE = ~.5 PSIG lOO]~ ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA M I N U T E S 0.75 J2KHz AMPLITUDE RATIO J5 3 5 TEXACO 3698 MING AVE BAKERSFIELD. CA ~0000 GALLON DIESEL TANK 750+ 0.75 S 25KHz AMPLITUDE RATIO ~5 750+ J2KHZ OETEC,TION RATIO = ~.00 25KHz DETECTION RATIO = TEST RESULT = PASS 1.00 DATE AND TIME OF TEST: ~/~3/01 12:00PM BEGINNING BOTTLE PRESSURE = 1800 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING BOTTLE PRESSURE = 1400 ENDING TANK PRESSURE = ~.5 PSIG RICH ENVIRONMENTAL 5643 BROOKS CT BAI{ER~FIELD,CA.93308 OFFICE(661)392-8687 & FA=X (661)392-0621 ACURITE TM PIPELINE TESTER WORK SHEET DATE: W/0#: Facility Name: Facility Address: Product Line ~e (Pressure, Suction, Gravity): ~ Manufacturer: ~-~ Isolation Mechanism: PRODUCT ST~d~T TI~IE END TIME TEST VOLUblE RESULT /READING /READING PRESSURE RATE PASS/ O0: 00/GPH 00: 00/GPH (PSI) (GPH) FAIL I certify that the above line tests were conducted according to the equipment manufacturer's procedures. The results as listed are to my knowledge true and correct. The test pass/fail is determined using a threshold of 190 ml per hour (0.05 GPH) rate at 1 1/2 times working pressure or 50 psi which ever is greater. Tech: JAMES J. RICH Signature: ~.,~ ~/~ State License:¢ MFG.CERTIFICATION:~ 99-1072 601.LT TESTING SUMARRY REPORT S/S: ADDRESS: Texaco 121174 3698M~g Bakersfield, CA DATE: 11/5/01 TP201.3: Reason For Failure: PASS X FAIL N/A TP201.4: Reason For Failure: PASS X FAIL N/A TP201.6 Reason For Failure: PASS X FAIL N/A Electronic Monitor Results: PASS Reason For Failure: X FAIL N/A Drop ,Tubes: PASS Drop Tubes That Were Replaced: X FAIL N/A 87 89 Reason For Failure: 92 Diesel Siphon Tank None X Containment Box Report: Reason For Failure: PASS X FAIL N/A Manufacturer: In Ground Type Phil Tite X ReWofittable Safe Lite FRC CNI OPW Sizg: 5 Gallons Pomeco EBW CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE Section 2: Underground Storage Tanks Program Routine [] Combined [] Joint Agency Type of Tank ,0 OdE Type of Monitoring d/.. [] Multi-Agency [] Complaint Number of Tanks ,o Type of Piping OcOI~- [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current / Certification of Financial Responsibility Monitoring record adequate and current k..,' Maintenance records adequate and current Failure to correct prior UST violations to, Has there been an unauthorized release? Yes No~'--''''' Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy · lt[usiness Site ResponsibOarty {~)" l ~ ,' c,~4 TE::<:~C:C;. 121176 3698 M1NG AVE. BAI;::ERSF I ELD. C~. 80649154805002 I',gl',,V E, .. 200 i 8: 56 AI'.'I I NVE NTOE'~.' ~EPC, ET T I :REGIJLhR UNLEADEEF- ",/OLUHE = 4569 ULLAGE = 695:3 GF:~LS 90% LIL.L~L-;F,= 5805 G~LS t4EIQHT = 37.54 INCHES L.,~ATER VOL = 0 GALS LJATER = 0.00 INCHES TEHP = ?9.t DEG F T 2:PLtJS UNLEADED VOLUHE = 9312 (_-;ALS ULLAGE = 1 ? l 5 (_-;ALS 90>; ULLAGE= 562 GALS ttEIGHT = ?1.24 INCHES b,l~ffER VOL = 0 GALS t4~TER = O. CiO INCHES TEHP = ?2.3 [~EG F !' :i :I:"REMI Lll"I UNLEADED ',./t:,l. L $1E = 762? C' 90'~<; LILL~GE= 274? hlEIGHT = 56.40 INCHES I,,gATER VOL = 0 GALS k,JATEt,~ = O, O0 [NCHES TEPIP = ?5.2 DEC; T 4: l')1ESEL VOLLIHE = 8348 (3ALS ULLAGE = 1:336 C;RLS 90>;!; ULLAGE= :7.46? I";RLS HEI(-iHT = 72.20 INCHES L,.IATER VOl, = 0 GALS klATER = 0.00 INCHES TEMP = ??.9 DEG F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME /~td,~ '~'~gtlCd3 ADDRESS FACILITY CONTACT INSPECTION TIME INSPECTION DATE lt/~/fO/ PHONE NO. g3q~c~ 1~3~ BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES ~'/ Section 1: Business Plan and Inventory Program Routine [~ Combined ~] Joint Agency [~ Multi-Agency ~ Complaint [~ Re-inspection OPERATION C V COMMENTS Appropriate permit on hand L, Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials ~,, / Verification of quantities / Verification of location Proper segregation of material / Verification of MSDS availability / ' Verification of Haz Mat training Verification of abatement supplies and procedures ./,., Emergency procedures adequate Containers properly labeled Housekeeping L.,,/' Fire Protection Site Diagram Adequate & On Hand ,/ C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes N'~No Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy ,0 D October 24, 2001 Mr. Edward Paden Equilon Enterprises LI_C P O Box 7869 Burbank, CA 91510 7869 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Laboratory results from preliminary site assessment conducted at the Ming Avenue Texaco #121176 at 3698 Ming Ave in Bakersfield. Permit #BR-0279. Dear Mr Paden: Upon review of the recently submitted laboratory results from your facility, this office has determined that the extent of the contamination plume, associated with the underground storage tank previously located on your property, has not been adequately defined. This office requires (in accordance with Chapter 6.7 of the California Health and Safety Code and Chapter 16, Title 23 of the California Code of Regulations) that further assessment be done to define the vertical and horizontal extent of the contamination plume. Please submit a work plan for further assessment, to this office, within 30 days from receipt of this letter. The workplan should ' follow guidelines found in: Appendix A -Reports, Tri - Regional Board Staff Recommendations for Preliminary evaluation and Investigation of Underqround Tank Sites; July 6, 1990. Additionally, be advised that oversight cost for this project will be billed to you at a rate of $80.00 per hour. If you have any questions, please call me at (661) 326-3979. Sincerely, Howard H. Wines, III Hazardous Materials Specialist Registered Geologist No. 7239 Office of Environmental Services HHW/dlm S:\USTFORMS\UST.L2 D October 24, 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 Mr. Edward Paden Equilon Enterprises LLC P O Box 7869 Burbank Ca 91510 7869 RE: New Landowner Notification and Participation Requirements for Ming Avenue Texaco #121176 at 3698 Ming Avenue in Bakersfield, Ca Dear Mr. Paden: This letter is to inform you of new legislative requirements pertaining to cleanup and closure of sites where an unauthorized release of hazardous substance, including petroleum, has occurred from an underground storage tank (UST). Section 25297.15(a) of Ch. 6.7 of the Health & Safety Code requires the primary or active responsible party to notify all current record owners of fee title to the site of: 1) a site cleanup proposal, 2) a site closure proposal, 3) a local agency intention to make a determination that no further action is required, and 4) a local agency intention to issue a closure letter. Section 25297.15(b) requires the local agency to take all responsible steps to accommodate responsible landowners' participation in the cleanup or site closure process and to consider their input and recommendations. For purposes of implementing these sections, you have been identified as the primary or active responsible party. Please provide to this agency, within twenty (20) calendar days of receipt of this notice, a complete mailing list of all current record owners of fee title to the site. You may use the enclosed list of landowners form (sample letter 2) to comply with this requirement. If the list of current record owners of fee · title to the site changes, you must notify the local agency of the change within twenty (20) calendar days from when you are notified of the change. Landowner Notifiaction Page 2 If you are the sole landowner, please indicate that on the landowner list form. The following notice requirements do not apply to responsible parties who are the sole landowner for the site. In accordance with Section 25297.15(a) of Ch 6.7 of the Health & Safety Code, you must certify to the local agency that all current record owners of fee title to the site have been informed of the proposed action before the local agency may do any of the following: 1) consider a cleanup proposal (corrective action plan) 2) consider a site closure proposal 3) make a determination that no further action is required 4) issue a closure letter You may use the enclosed notice.of proposed action form (sample letter 3) to comply with this requirement. Before approving a cleanup proposal or site closure proposal, determining that no further action is required, or issuing a closure letter, the local agency will take all reasonable steps necessary to accommodate responsible landowner participation in the cleanup and site closure process and will consider all input and recommendations from any responsible landowner. Sincerely, Howard H. Wines, III Hazardous Materials Specialist Registered Geologist No. 7239 Office of Environmental Services HHW/dm enclosures S:\UST~FORMS\UST. L4 Sample Letter (2): List of Landowners Form Date: City of Bakersfield Fire Department Office of Environmental Services c/o Howard H. Wines, III 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 RE: Certified List of Record Fee Title Owners for Site address Fill out item 1 if there are multiple site landowners. 1 and fill out item 2. Site name If you are the sole site landowner, skip item In accordance with section 25297.15(a) of Chapter 6.7 of the Health & Safety Code, I, Name of primary responsible party certify that.the following is a complete list of current record fee title owners and their mailing addresses for the above site: 2. In accordance with section 25297.15(a) of Ch. 6.7 of the Health & Safety Code, I, Name of primary responsible party certify that I am the sole landowner for the above site. Sincerely, Signature of primary responsible party Name of primary responsible party Sample Letter (3) Notice of ProWled Action Submitted to Local Agency Date: City of Bakersfield Fire Department Office of Environmental Services c/o Howard H. Wines, III 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 RE: Notice of Proposed Action Submitted to Local Agency for Site name Site address In accordance with section 25297.15(a) of Ch. 6.7 of the Health & Safety Code, I, , certify that I have notified all Name of primary responsible Party responsible landowners of the enclosed proposed action. Check space for applicable action(s): Cleanup proposal (corrective action plan) site closure proposal local agency intention to make a determination that no further action is required. local agency intention to issue a closure letter. Sincerely, Signature of primary responsible party Name of primary responsible party CC: (Names and addresses of all record fee title owners) PRESSURE LINE LEAK ALARM G I:REGULAR UL PLLD PLLD SHUTDOWN ALARM OCT 10, 2001 4:09 PM SENSOR ALARId -/ L12:DSL ANNULAR ANNULAR SPACE FUEL ALARM OCT 10, 2001 4:13 PM PRESSURE LINE LEAK ALARM G I:REGULAR UL PLLD PLLD SHUTDOWN ALARM, OCT lO, 2001 3:30 SENSOR ALARP~/- L 1:87 ANNULAR ? ANNULAR SPACE FUEL ALARM OCT 10, 2001 4:09 PM PRESSURE LINE LEAK ALARM ~ 2:PLUS UL PLLD PL~D SHUTDOWN ALARM OC' '0, 2001 4:11 PM 127824 TEXACO 121176 3698 MING AVE. BAF-~SFIELD, CA. 80k__~,I54805002 OCT lO, 2001 4:14 PM SYSYEM'STATUS REPORT ALL FUNCTIONS NORMAL SENSOR ALARM ..... L 3:REGULAR UL STP SUMP STP SUMP FUEL ALARM OCT 10, 2001 3:30 PM 127824 TEXACO 121176 3698 MING AVE. BAKERSFIELD, CA. 80649154805002 OCT 10, 2001 3:31 PM SENSOR ALARM ---/- L 4:PLUS UL ANNULAR ANNULAR SPACE FUEL ALARM OCT 10, 2001 4:11 PM PRESSURE LINE LEAK ALARM Q 4:DIESEL PLLD PLLD SHUTDOWN ALARM OCT---t-O~ 2001 4:13' PM PRESSURE LINE LEAK ALARM Q 3:PREMIUM UL PLLD PLLD SHUTDOWN ALARM OCT 10, 2001 4:15 PM ..... SENSOR ALARM -/- L 9:91 ANNULAR AN AR SPACE FUn~/ALARM OCT 10, 2001 4:15 PM SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL PRESSURE LINE LEAK ALARM Q 2:PLUS UL PLLD PLLD SHUTDOWN ALARM OCT 10, 2001 3:33 PM SENSOR ALARM ..... L 6:PLUS UL STP SUMP STP SUMP "- FUEL ALARM OCT 10, 2001 3:33 127824 TE×A_..O''¢' 12 1176 3698 MING AVE. BAKERSFIELD, CA. 80649154805002 OCT 10, 2001 3:34 PM SYSTEM STATUS ALL FUNCTIONS NORMAL PRESSURE LINE'LEAK'~L~-~M Q 3:PREMIUM UL PLLD PLLD SHUTDOWN ALARM OCT 10, 2001 3:35 PM ..... SENSOR ALARM ..... Lll:91 STP STP SUMP FUEL ALARM OCT 10, 2001 3:35 PM pRESSURE LINE LEAK ¢ 2M ~ 4:DIESEL PLLD ~ PLLD SHUTDOWN ALARM OCT 10, 2001 3:37 PM L14:DSL STP STP SUMP FUEL ALARM OCT 10, 2001 3:37 PM OCT ....... SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL INVENTORY REPORT T i:REGULAR UNLEADED VOLUME = 7323 GALS ULLAGE = 2405 Gf 90~ ULLAGE= 1432 GCr=~/ HEIGHT = 64.16 INCHES STK HEIGHT= 63.69 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 86.3 DEG F __T 2:PLUS UNLEADE~ ULLAGE = 6293 GALS 90% ULLAGE= 5320 GALS HEIGHT = 35.71 INCHES STK HEIGHT= 36.05 INCHES WATER VOL = O GALS WATER = 0.00 INCHES TEMP = 85.7 DEG F T 3:PREMIUM UNLEADED VOLUME = 1346 GALS ULLAGE = 8382 GALS 90~ ULLAGE= ?409 GALS HEIGHT = 18.78 INCHES STK HEIGHT= 18.89 INCHES WATER VOL = 0 GALS WATER = 0,00 INCHES TEMP = 86.2 DEG F 127824 TEXACO 121176,.._.y 3698 MING AVE. BAKERSFIELD, CA. 80649154805002 OCT 10, 2001 3:36 PM 127824 TEXACO 121176 3698 MING AVE. BAKERSFIELD, CA. 80649154805002 '0,. 2001 3:37 PM T 4:DIESEL VOLUME = 1699 GALS ULLAGE = 8029 GALS ~_90~ ULLAGE= 7056 GALS HEIGHT = 21.97 INCHES STK HEIGHT= 22.62 INCHES WATER VOL = 0 GALS WATER = 0.00 INCHES TEMP = 86,5 DEG'~ ~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ SYSTEM STATUS REPORT ALL FUNCTIONS NORMAL CITY OF BAKI~IELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 P~oneNo. INSPECTION RECORD POST CARD AT JOB SITE INSTRUCTIONS: Please call for an inspector only when each group of inspections with the same number are ready. They will run in consecutive order beginning with number 1. DO NOT cover work for any numbered group until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce thc number of required inspection visits and therefore prevent assessment of additional fees. TANKS AND BACKFILL INSPECTION [ DATE [ INSPECTOR I Backfill of Tank(s) ~(L ~ ~ 9(~ "~,J t SparkTcstCcrtificati°n°r~ufacturesMff.._%.th°~(~tl~--~-~.- ~.~c ge. ~ {~ Cathodic Protection ofTank(sT' ~)l,O-f..-.~ ' ~' "0-0 "<9 f PIPING SYSTEM ~, Piping & Raceway w/Collection Sump ~,~ f.~,6~ ~-I~ ,~ ~/~. ~/W/~ / El~cal Isolation of Pip~g From T~k(s) SECONDARY CONTAINMENT, OVERFILL PROTECTION, l [ DETECTION Liner Installation - Tank(s) Liner Installauon - P~pmg Vault With Product Compatible Sealer ~_ Level Gauges or Sensors, Float Vent Valves ~ Product CompatibleLinc Leak Fill Box(es) ~ Product Detector(s) ~r- Leak Detector(s) for Annual Space-D.W. Tank(s) c~ Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwater I Spill Prevention Boxes Monitoring Wells, Caps & Locks 'x,.._.__~ ' ' Fill Box Lock CONTRACTOR ~ C,- 5 (~'t)~. &,~ LICENSE # '~'7 7 ~' C '~ __ CONTACT ,-~U¢~.~ PHONE# ~' ffqq' 1730 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK SITE , ' ..... ADDRESS 3{~J8 /yllnc~ ~.. Zi~COOE~I~'~O'I~N ~^clLTt~-N-~~~Oe:~ _ff:~rAYl~:z)fl ~_..~ ~ROss STRE~Y ..... ~g~ .... .- .~ T.~NK OWNEW0P~RAT()~ ~ ~ J ~ ........... PHONE NO. ~ c.~n'rR^cTOr m~ormaTlOn INSUm^NCE c^rm~r _.~T'A~, 'I:::M'~I~ worro, m~s co~ No,_~ I_~,o~t , PR£LIM INA r¥ A$~S~$$M~NT~I.N. FO~ATION COMPANY PHONE ADDRESS "' LICENSE NO. CITY~, ZiP wOmO~ENS COrm NO. ~i~7---~-q q' WASTE TRANSPOR~R IDENTIFICATION ~ER . FACILITY [DE~IFICATION T4,~ ~ NSPORTER [~.~ORMATION TANK NO. C14EMICAL DATES CI-L~MICAL APPL!' AOE VOLUME STORED STORED ' PREVIOUSLY STORED qON ' :~ "' ' ~' ~ ~ ~' .... -~:,~,~e,~,. ;~:,:~,;.~:.: ,- -.-.~ .... : "; ......... ~"~'*~.~; 9; ~ ~:f::?;~ ...... ~' .~?~ .... TI IE APt'l .ICAN'I' I fas RF. CEI vED, IJ~ql)ERS': ' ,t ~. AND W~{, CO~i,Y WFI'I i ...... ','FI'ACt lED CONI)FI'IONS Ol;' TI lis Iq.:RMI'[' ANI ) &NY O'i1 II(R STA'fI{, IX)CAL AND I:I.~I)I{RAL REOULA'I'IONS. TtlI~ iPP~C~TIO~ ~COM~ · ~M[T ~E~ lPPR{I~ [ '' ,. I 1715 Chester Ave., Bakers£teld, CA 93301 (805) 326-3979 TANK RENOVAL INSPECTION FORM CONTRAC~R k,< ,4c~',~,J% LABORATORY ~'~At, gcl. o~r~ ADDRESS ,?&~£ · PERMIT TO OPEI~A.TE9 CO~AC~ PERSON ~ oF S~LES ~q ~ST ~ODO~GYT~G ~'~P~ ~ , P~LI~Y ~SESS~ CO. ~ &~o0o CO.ACT PERSON PLOT PLAN CONDITION OF PIPING CONDITION OF, SOIL COMMENTS OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326;'3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ }NEW FACILrl-Y [ ]MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACR/rY STARTINO DATE. 3.~ I ~" ~t ..... PROPOSED COMPLETION DATE I '~ I ' (~ Z FACILITY NAME 'T~~ ~T~ EXISTING FACR.ITY P_ERMIr .NO .........~_ .... T~E OF BUSm'SSS ~--~'f~'T~ ~ i ' APN # , ,', , TANKOWNF.~ ~-n~'O~'~t ' PHONENO.~I~'~A~ . COWmACrOR /,, ~,. ~E~,~C'~ [ - . ..CA UCENSE NO.~ PHO~ra NO, ~,b~ 1 ~ ~ - t ~/8~ BArmP, SFmLD crrv SUS~N~SS ucmws~ NO. B~Y DESCRIBE THE woRK TQB~E,I~O~NI~. ~OO~ ~ ~W~5~' w^Tz~ TO ~^cna'r~ ~,ROVmm a~ NO. OF T~ TO BE ~ST~ ~ . ~ ~Y FOR MOTOR ~ "'~ ~"~ .... ~' .'" NO S~L ~~o~ COBOL ~ CO~a ~~ ~ O~ ~ ~ ~O SE~ON FOR MOTOR FUEL- TANK NO~ VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION TANK NO. VOLUME __SECTION FOR NON MOTOR FI/gL STORAGE T ,,,At, KS (~O Bi.wa NAMe) CAS NO, 0~ KNOWN) CHEMICAL PREVIOUSLY STORED FOR OFFICIAL USE ONLY ~ ~P~C~ ~S ~CE~, ~T~, ~ ~ CO~LY ~ ~ A~AC~D CO~ONS OF ~ PE~ ~,~ O~R STA~, L~ ~ ~DE~ ~G~ONS. ~ FO~ ~ BEEN CO~~ ~ P~TY OF P~Y,~ TO ~ B~T OF ~ ~~~ THIS APPLICATION BECOMES A PE~T WHeN 'PRO¢~ ~_. . FACILITY ID tlED PROGRAM CONSOLIDATED FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION BUSINESS NAME Cs~e ~s FACILITY NAME or DBA - Doing Business As LINMAR g I ~ BUS.SS SI~ ~D~SS 3698 M~G ~ ~AL H C~Y BA~RSFIELD DUN & BRADSTREET COUNTY BUSINESS OPERATOR NAME LINMAR PETROLEUM Pa~e of 1. IDENTIFICATION BEGINNING DATE Ioo ENDING DATE ~o~ 1/15/01 12/31/01 s BUSINESS PHONE 661-834-2822 103 ZIP CODE los 93309 106 SIC CODE (4 digit #) 5541 108 II. BUSINESS OWNER ,o91 BUSINESS OPERATOR PHONE 1 661-834~2822 11o OWNERNAME III I OWNER PHONE LINMAR PETROLEUM I 661-834-2822 OWNER MAILING ADDRESS PO BOX 7869 CITY 114 STATE IlsI ZIPCODE BURBANK CA I 91510-7869 III.ENVIRONMENTAL CONTACT CONTACT NAME I17 [ CONTACT PHONE FERYAL SARRAFIAN [ 818-736-5078 CONTACT MAILING ADDRESS PO BOX 7869 CITY ~2o STATE 121 I ZIP CODE BURBANK CA I 91510-7869 -PRELIMINARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 12~ NAME FRANK HUTCHINS FERYAL SARRAFIAN TITLE 124 TITLE 120 STATION SUPERVISOR SH&E COMPLIANCE COORDINATOR BUSINESS PHONE w BUSINESS PHONE 1.~o 760-743-8787 818-736-5078 126 131 24-HOUR PHONE 661-619-9423 (CELL,PAGER) PAGER # SAME AS ABOVE ADDITIONAL LOCALLY COLLECTED INFORMATION: 127 24-HOUR PHONE 310-489-6296 (CELL) 128 PAGER# 132 NONE 133 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is tree, accurate, and complete. SIGNATURE OF OWNER/OP~.~E~ATED REPRESENTATIVE [ DATE 134 NAME OFDOCUMENT PREPARER 133 IAMEoFSlGNER(orint)'~'~"~ N~ ~~ ,~__7'- ,36I-'Lx~[ I R'S'WATSON TITLE OF SIGNER 137 FERYAL SARRAFIAN SH&E COMPLIANCE COORDINATOR UPCF ( 1/99 revised) 4 OES FORiM 2730 (1/99) D January 22, 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 Texaco 3698 Ming Ave Bakersfield Ca 93309 RE: Dispenser Pan Requirement December 31, 2003 Underground Storage Tank Dispenser Pan Update Dear Underground Storage Tank Owner: You will be receiving updates from this office now, and in the future with regard to the Senate Bill 989, which went into effect January 1, 2000. This bill requires dispenser pans under fuel pump dispenserS. On December 3 l, 2003, which is the deadline for compliance, this office will · be forced to revoke your permit to operate, effectively shutting down your fueling operation. ~ It is the hope of this office, that we do not have to pursue such action, which is why this office plains to update you. I urge you.to, start planning now to retro-fit your facilities. If your facility has upgraded already, please disregard this notice. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Steve Underwood, Inspector Office of Environmental Services SBU/dm CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE Section 2: Underground Storage Tanks Program 1~1 Routine ~]/~ombined [~ Joint Agency [] Multi-Agency [21 Complaint Type of Tank _'~tO ~ Number of Tanks Type of Monitoring /q-T-(,, Type of Piping .~01t [21 Re-inspection OPERATION C V COMMENTS Proper tank data on file iff/ Proper owner/operator data on file Permit fees current /~ Certification of Financial Responsibility ~,// Monitoring record adequate and current ~ Maintenance records adequate and current J / Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance // V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (805) 326-3979 White- Env. Svcs. Pink - Business Copy · B~ssiness/'Site Responsible Party 4 PM &[_IC; 28.. 2000 1:°:~' SYSTEM S'I'a'I' LI;~ ALL FUNCI'I,:)N'S NORMAL I I',iVE NTORY REPORT T I :FREI'"1[ LIM' UNLEADED VOL UME = 5'2. '2 E GALS ULLROE = 4502 GaLS 90,'¢4 ULLAGE= 3529 GaLS HEIGHT = 48.58 INC'HES STK HEIGHT= 48.69 INCHES I,,JRTE~, V©L = 0 GaLS ._~ = '91,3 [,EG F T ':': PLUS I_II"ILERDED , ~.JI"IE = 6496 G~LS 9 0!:',, ULLAGE.:: 2259 ..H.~;IC;HT = 57.80 INCHES '% HEIGHT= 58.14 iNCHES 'x,._t, '~ VOL ;= 0 (_-;aLS I,,,IA.._~F: = O. O0 I NC'HES TEMt::' = 92.5 DEG F T 3: UI',ILERI)EI) ~'EGULAR ",/';}IL, UI'.'IE = 649:3 ,;]aLS ULLa,:3E = 3235 (_'-;aLS 90% UI..LRGE=, 2262 C-;ALS HEIGHT = 5'7.?8 INCHES STK HEIGHT= 5'7.31 INCHES 1.4ATEP, = 0.00 I NI-;HES TEMI::' = 91.2 DEG F 7' 4:D1ESEL VOLUME = 4933 GALS UI_LAGE = 4'795 GALS 90t:-;~ LJLLAGE= 3822 GRI_,S HEIGHT = 46,49 INCHES ~.:*'.u.', HEIGHT= 47,14 INCHES ~ ER 'v'OL = 0 GaLS TEMI:' = 92,g DEG F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES FACILITY NAME ADDRESS FACILITY CONTACT INSPECTION TIME Section 1: Business Plan and Inventory Program [21 Routine ~ombined [21 Joint Agency [21 Multi-Agency [21 Complaint [2] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand / Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate . Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [~ Yes [~ No Explain: Questions regarding this inspection? Please call us at (661) 326-3979 White - EnD. Svcs. Yellow - Station Copy Pink - Business Copy insB~ctor: OFFSidE OF ENVIRONMENTAL SF VICES 1715 Cheer Ave., Bakersfield, CA 93301W61) 326-3979 UNDERGROUND STORAGE TANKS - UST FACILITY TYPE OF ACTION (Check one ~lern only) [] I. NEW SiTE PERMIT ~.~.. RENEWAL PERMIT [] 5. CHANGE OF INFORMATION (Speeif~ change. [] 4. AMENDED PERMIT local use only). [] 6. TEM~RY SITE CLOSURE NEAREST CROSS STREET f 401. ~ FACILI~ O~ER ~PE ~PEBUSINESS."- ~ L GAS STATION ~ 3. FARM ~ 5. COMMERCIAL ~ ~ 3. PARTNERSHIP [] 7. PERMANENTLY CLOSED SITE [] 8. TANK REMOVED 40,3. ! I I : I [] 4, LOCAL AGENCY/DISTRICT' [] 5. COUNTY AGENCY* [] 6. STATE AGENCY' [] 7. FEDERAL AGENCY' TOTAL NUMBER OF TANKS REMAINING AT SITE Is facility on Indian Resec,'atlo~ o¢ I'If owner of UST a public agec~cy: name of super'dso¢ of trustlands? dl'.4SJoch section (3' ofrice wnic~ opecales the UST. (This is the ~tact pe~.c~ t'~ the tank recocds,) DYes J~No 405. · II. PROPERTY OWNER INFORMATION 407. I PHONE ,40~. ::'ROPEr'FY OWNER NAME 'vt~lklNG OR STREET ADDRESS 31TY ~ 410. ! STATE 411. j ZIPCODE 412. ~ROPERTY OWNER TYPE [] 2. INDI¥IDUAL, [] 4. LOCAL. AGENCY/D~STRICT [] ~ t. CORPORATION [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7, FEDERALAGENCY IlL TANK OWNER INFORMATION 'ANK OWNER NAME ,L,N?A S EETADORESS ;ITY 'ANK OWNER TYPE ~[1, CORPORATICN 414. I PHONE 415. [] 2. IND~IDUAL [] 3. PARTNERSHIP 417. i STATE 418, ] ZIPCODE i ' [] 4. LOCAL AGENCY I DISTRICT [] 6. STATE AGENCY [] 5, COUNTY AGENCY [] 7. FEDERAL AGENCY 416. 419. ¥ (TK) HQ IOlCATE METHOD(S) iV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER V. PETROLEUM UST FINANCIAL RESPONSIBILITY 421. [] 10, LOCAL C_~DV'T MECHANISM [] 99. OTHER:, ~I. SEL,F-INSURED [] 4. SURETY BOND [] 7. STATE FUND ~ 2. GUARANTEE [] 5. LE'Vi'ER OF CREDIT [] 8. STATE FUND &CFO LETrER [] 3. INSURANCE [] §, EXEMPTION [] 9. STATE FUND & CD 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS beck o~e box to indic, ale which address should be used fcc legal notiflcelione and mailing. [] 1. FACILITY [] 2. PROPERTY OWNER .~ 3. TANK OWNER 423. ~al nofiflcati~s and mailings w~ll be sent to t~e tank ow,nec unless box 1 o¢ 2 is cheer(ed. VII. APPLICANT SIGNATURE erlllicatlon: I ce.,11fy ~al the Infocmatlon provided herein Is true and accurate to the best of my knovdedge. IGNATURE OF APPL,ICANT ~~ ~'~ AME' (~F'APPLICANT (print) ~"~~ 428. ,2. ..................... 424. I PHONE 42.5. TITLE OF APPLICANT 427. rATE UST FACILITY NUMBER (Forlocal use only) 428. 1998 UPGRADE CERTIFICATE NUMBER (For local u~e only) CF (7/99) S:\CU PAFORMS\swrcb-a.wpd CITY OF BAI~ERSFIELD OFFId~OF ENVIRONMENTAL SEI~ !CES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS-TANK PAGE 1 r'YPE OF ACTION [] I. NEW SITE PERMIT [] 4. AMENDED PERMIT ICheck one dam only) ~3. RENEWAL PERMIT (Spec~y mason - tor local use only) [] 5. CHANGE OF INFORMATION} LOCATION WITHIN SITE (Optional) [] 6. TEMPORARY SITE CLOSURE [] ?. PERMANENTLY CLOSED ON SITE (Spec~fychange. lorlocal use only) [] 8. TANK REMOVED 430 ...... i ...................... , /~ .,' ,~._ ~._L_~ ..... ,. I. TANK DESCRIPTION -'t:,kNK ~D Ct 432 ;, TANK MANUFACTURER 433 '"[~,~TE INSTALLED (YEAR/MO) 435 i TANK CAPACITY IN GALLONS 436 COMPARTMENTALIZED TANK [] Yes ,~ No Ii' 'Yes'. complele one page fc~' each compa.'-iment. NUMBER OF COMPARTMENTS 434 ,437 AOOITIONAL DESCRIPTION (For local use only) 438 II. TANK CONTENTS 4-40 TANK USE 439 \~., , ~1. MOTOR VEHICLE FUEL "(If marked, complete Pet/oleum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PROOUCT PETROLEUM TYPE ~,~a. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] lc. MIDGRADE UNLEAOED [] 4. GASOHOL [] 9<:J. OTHER [] 4. HAZARDOUS WASTE (Includes Used Oil) [] 95. UNKNOWN COMMON NAME (from Hazardous Materials lnvent~ry page) ~--l~ -r-op.. ~,~ o ,-, ,-,,~ 441 J CAS Ct (from Hazardous Mate,'fals Inventory page) TYPE OF TANK ~"1. SINGLE WALL (Check one item only) [] 2. DOUBLE WALL TANK MATERIAL - primary lank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL TANK MATERIAL - secondary, tank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL · IlL TANI~ CONSTRUCTION [] 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER [] 4. SINGLE WALL IN A VAULT ,~. FIBERGLASS / PLASTIC [] 4. STEEL CLAD W/FiBERGLASS [] 8. REINFORCED PLASTIC (FRP) [] 3, FIBERGLASS/PLASTIC [] 8. [] 4. STEEL CLAD W/FIBERGLASS [] 9. REINFORCED PLASTIC {FRP) [] 10. [] 5. CONCRETE [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM [] 95. UNKNOWN [] 99. OTHER CONCRETE FRP COMPATIBLE WI100% METHANOL FRP COMPATIBLE W/100% METHANOL FRP NON-CORRODIBLE JACKET COATED STEEL [] 95. UNKNOWN [] 99. OTHER ~¢5. UNKNO~ [] 99. OTHER 443 445 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. OR COATING [] 2. ALKYD LINING [] 4. (Check one item only) OTHER CORROSION [] 1. MANUFACTURED CATHODIC PROTECTION IF APPLICABLE PROTECTION [] 4, (Check one item only) [] 2. SACRIFICIAL ANODE EPOXY LINING [] 5. GLASS LINING ~95. UNKNOWN PHENOLIC LINING [] 6. UNLINED [] 99. OTHER __ 446 FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN IMPRESSED CURRENT [] 99. OTHER 448 DATE INSTALLED (For local use only.) DATE INSTALLED (For local use on/y) 447 4.49 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (Forlocal use only) 451 (C~eck~,,,hatep,,,y) '~,. SP,LL CONTA,,MENT --~ ~ ~"-- ~ ~ ~3. STRIKERP~TE ~~W ~ IF SINGLE WALL TANK (Check all that apply): [] 1. VISUAL (EXPOSED PORTION ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) ,~3. CONTINUOUS ATG [] 4. STATISTIC, AL INVENTORY RECONCILIATION (SIR} + BIENNIAL TANK TESTING [] 5. MANUAL TANK GAUGING (MTG) [] 6. VADOSE ZONE [] 7. GROUNDWATER [] 8, TANK TESTING [] 99. OTHER 453 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED ~I. ALARM ~~3. FILL TUBE SHUT OFF VALVE [] 2. BALL FLOAT ~ [] 4. EXEMPT 452 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 4.57 ,gallcx~s [] Yes [] NO ESTIMATED DATE LAST USED (YR/MO/DAY) flPCF (7/99) S:\CU PAFORMS\SWRCB~B.WPO CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 17~l~hester Ave., Bakersfield, CA 93301 (661) 326-3~!~ - UST . TANK PAC,~ ............. . Page ~ o, ~ lj .... VI. PIPING CONSTRUCTION (Check aa ~t apply) UNDERGROUND PIPING ~ ABOVEGROUND PIPING SYSTEM TYPE 1. PRESSURE [] 2. SUCTION [] 3. CRAVIT~ 458 i [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY CONSTRUCTION/~l~t' SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 I [] I, SINGLE WALL [] 95. UNKNOWN MANUFACTURER;[] 2. DOUBLEWALL [~95. UNKNOWN ! [] 2. OOUBLEWALL E]99, OTHER ' MANUFACTURER MANUFACTURER :[] 1, BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL ~[] 1. BARE STEEL ' [] 6. FRP COMPATIBLE W/ 100% METHANOL VIATERIALS AND i["-] 2, STAINLESS STEEL [] 7, GALVANIZED STEEL CORROSION =ROTECTICN 462 463 I[] 2. STAINLESS STEEL [] 7. GALVANIZED. STEEL i['-'~ 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99. OTHER !,~4. FIBERGLASS [] 8. FLEXIBLE (HOPE) [] 99. OTHER j [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL Wt COATING [] g. CATHODIC PROTECTION 464 ~[] 5. STEEL WICOAT[NG [] 95. UNKNOWN 465 UNDERGROUND PIPING "" ' VII. PIPING LEAK DETECTION (Check e# that apply) ABOVEGROUND PIPING SING LE WALL PIPING 466 SSURIZED PIPING (Check all that apply): 1, ELECTRONIC L NE LEAK DETECTOR 3.0 GPH TEST?ITH. AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS -] 2. MONTHLY 0.2 GPH TEST X3,ANNUAL INTEGRITY TEST (0.1 GPH) :ONVENTIONAL SUCTION SYSTEMS: ~] 5. DALLY VISUAL MONFrORING OF PUMPING SYSTEM ~. TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) :AFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND FIPING): "] 7, SELF MONITORING ;P,A VITY FLOW: ~ 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING RESSURIZED PIPING (Check ail that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chec~ one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF ] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) W1T~ FLOW SHUT OFF'OR RESTRICTION '] 12. ANNUAL INTEGRITY TEST (0.1 GPH) LICTION/GRAVITY SYSTEM: ] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS ] ! 5. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION : SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): I [] 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS /["~ 2. MONTHLY 0.2 GPH TEST / [] 3. ANNU~. ~NTEGRm~ TEST ~0.1 [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 8. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW'GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST(O.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (c~eck one) [] a. AUTO PUMP SHUT OFF W~EN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUTOFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTE~ [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 16, ANNUAL INTEGRITY TEST (0.1 GPH) ] 17. DAILY VISUAL CHECK [] 17. DALLY VISUAL CHECK '., ~ · ~"~',' .-~ .~.'; ,'-' *. ~:~ .. :',~' .. '¢~'&~'~.. '.:.~¢,/~*-'. ~." ..... ' '~' ~" ' ' ' · .... ~ ," '. _ . .~' .... ~ .... ~ ~ .......... ~·,.:~-', ',,~-.~:.:--~-¥',.:,t~..,~;,~,~5~..:~ ,VI I;OlSPENSER CONTAINMENT ',': ...... ' SPENSER CONTAINMENT ~ 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 3ATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALJU~MS DAILY VISUAL CHECK [] 5. TRENCH LINER / MONITORING [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE certify II, al Ihe informallon pmvicied herein ia tie and a~rate Io the b~[ of my kn~ge. :I~N~ OF OWN~OPE~~ I~ d~NE~O~TOR (P~nO 471 ........ 'ermi! NumDer (Fo/' k~ce/use on/y) 473 J Pe,'ml! /keproved (For~cal use only) 474 I Pem3II F. xplralio~ Dale (For local use only) 415 'CF (7/99) S:\CUPAFORMS\SWRCB-B.WPD CITY OF BAKERSFIELD OFF~E OF ENVIRONMENTAL SLUICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS-TANK PAGE 1 '¢YPEOF ACTION C~ 'ii NEW SITE PERMIT ~] 4. AMENDED PERM1T [] 5. CHANGE Of INFORMATION) (Check one dam only) ~3. RENEWAL PERMIT (Spec~y ma~ . lot local u~e only) (Spec~ cnan~e . for local u~e o~ly) LOCATION WITHIN SITE (Optional) E} 5. TEMPORARy SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE [] 8. TANK REMOVED I. TANK DESCRIPTION TANK ID # 432 ;, TANK MANUFACTURER 433 "~.~-E-ii(l~"~,~.'~.-ED (YEAI~MO) 435 i TANK CAPACITY IN GALLONS 438 ADDITIONAL OESCRIFTION (For local usa only) COMPARTMENTALIZED TANK [] yes-~~° -'-'~ Ii' 'Yes", complete one page fo~ each-' ~compartrnenL NUMBER OF COMPARTMENTS 43 438 TANK USE 439 ~1. MOTOR VEHICLE FUEL (if marked, complete Pet/o/eum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PRODUCT II. TANK CONTENTS pETROLEUM TYPE 441 [] la, REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL '~lb. PREMIUM UNLEADED [] 3. DIESEL [] 8. AVIATION FUEL [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 9g. OTHER [] 4. HAZARDOUS WASTE (includes Used Oil) [] 95. UNKNOWN COMMON NAME (f/om Haza~u$ Ma~daI$ Inventory page) TYPE OF TANK . SINGLE WALL (Check one item only) [] 2. DOUBLE WALL TANK MATERIAL- phmary tank [] 1. BARE STEEL (Che~ck one item only) [] 2. STAINLESS STEEL TANK MATERIAL - secondary, tank [] 1, BARE STEEL (Check one item only) [] 2. STAINLESS'STEEL · Ill. TANK CONSTRUCTION 441 i CAS # {f/om Hazardous Mate,'fat$ Inven~ry page) [] 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER [] 4. SINGLE WALL IN A VAULT .,~. FIBERGLASS / PLASTIC [] 5. SINGLE WALL WITH INTERNAL BLADOER SYSTEM [] 95. UNKNOWN [] 9~. OTHER [] 5. C4DNCRETE [] 95. UNKNOWN [] 4. STEEL CLAD W/FIBErGLASS [] s. REINFORCED PLASTIC (FRP~ [] 3, FIBERGLASS/PL.A~TIC [] 8, [] 4. STEEL CLAD W/FIBERGLASS [] 9. REINFORCED PLASTIC (FRP) [] 10. [] 5. CONCRETE FRP COMPATIBLE W/100% METHANOL FRP COMPATIBLE W1100% METHANOL FPJ~ NON-CORRODIBLE JACKET COATED STEEL [] 99. OTHER ~"95. UNKNOWN [] 99. OTHER 443 445 TANK INTERIOR LINING OR COATING {Check one ~fem only) OTHER CORROSION PROTECTION IF APPLICABLE (Check one item only) [] 1, RUBBER LINED [] 3. EPOXY LINING [] 5. [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] 5. [] 1. MANUFACTURED CATHODIC ,.~ 3. FIBERGLASS REINFORCED PLASTIC PROTECTION [] 4. IMPRESSED CURRENT [] 2. SACRIFICIAL ANODE GLASS LINING [~-~qS. UNKNOWN UNUNED [] 9g. OTHER [] 95. UNKNOVVN [] 9g. OTHER 448 446 DATE INSTALLED (For local use only) DATE INSTALLED (For local use only) 447 4-4g SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (Foriocal use only) 451 (Check all Hat app,y) '~1. SPILL CONTAINMENT '~ (~ ~-" ~ ~'& ~3. STRIKER P~TE ~~T ~ IF SIDLE WALL TANK (Check afl ~at ap~ly): 453 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED [] 2. BALL FLOAT ~ [] 4. EXEMPT 452 IF DOUBLE WALL TANK OR TANK WiTH BLADDER (Ch,~ck one item only): 454 [] 1. VISUAL (EXPOSED PORTION ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) ~3. CONTINUOUS ATG [] 4, STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING [] 5. MANUAL TANK GAUGING (MTG) [] B. VADOSE ZONE [] 7. GROUNDWATER [] 8, TANK TESTING [] ~9. OTHER [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. CONTINUOUS INTERSTmAL MONITORING [] 3. MANUAL MONITORING V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 .gallo~$ [] Yea [] NO ESTIMATED DATE LAST USED (YPJMO/DAY) JPCF (7/99) S:\CU PAFORMS\SWRCB-B.WPD CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES ,/ Chester Ave., Bakersfield. CA 93301 (661) UST. TANK VI. PiPiNG CONSTRUCTION (Check a# that ap/~,) UNDERGROUND PIPING ~ ABOVEGROUND PIPING SYS~'EM TYPE t. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 i [] 1. PRESSURE [] 2. SUCTION [] 3, GRAVITY CONSTRUCTION/]~l. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 I [] i. SINGLE WALL [] 95. UNKNOWN MANUFACTURER;~'I 2. DOUBLE WALL [] 95, UNKNOWN ![--] 2. DOUBLE WALL [] 99. OTHER ~ I ........ ' MANUFACTURER 461 ~[:.~_~ MANUFACTURER :[] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL~ . ~--~ STEEL [] 8. FRP COMPATIBLE W/10~% METHANOL ViATERIALS AND :;[] 2. STAINLESS STEEL [] 7, GALVANIZED STEEL [] 7. GALVANIZED. STEEL CORROSION =ROTECTION 46 i[] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN i,~4. PIBERGLABS [] S. FLEXIBLE (HDPE) [] 99, OTHER ][] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION [] 2, STAINLESS STEEL [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 4. FIBERGLASS [] 5. STEEL W/COATING [] 8. FLEXIBLE (HOPE) [] 99, OTHER [] 9, CATHODIC PROTECTION [] 95. UNKNOWN 46: :' ~' ' ' VII. PIPING LEAK DETECTION (Check all ~hat appiy) ABOVEGROUND PIPING UNDERGROUND PIPING SINGLE WALL PIPING 466 SSURJZED PIPING (Check all that apply): 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH. AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION ~' AUDIBLE AND VISUAL ALARMS -] 2. MONTHLY 0.2 GPH TEST X3, ANNUAL INTEGRITY TEST (0.1 GPH) :ONVENTIONAL SUCTION SYSTEMS: ] 5. DAILYVISUAL MONITORING OF PUMPING SYSTEM .~ TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) ;AFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): '] 7. SELF MONITORING iRAVITY FLOW: ] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING RESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ~] h. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUTOFF 11. AUTOMATIC LINE LEAK DETECTOR (3 0 GPH TEST) WITH FLOW SHUT OFF 'OR RESTRICTION ' "' 12. ANNUAL INTEGRITY TEST (0.1 GPH) ;JCTION/G/:~VITY SYSTEM: 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION SINGLE WALL PIPING 46; PRESSURIZED PIPING (Check all that apply): [] 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TESTWITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION ~- AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) J SAFE SUCTION SYSTEMS (NO VALVES IN BELOW'GROUND PIPING): [] 7, SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (c~ec;k o~e) [] a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c, NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12, ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check ali that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR I3.0 GPH TEST) ] ~6. ANNUAL INTEGRITY TEST {0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) ] 17. DAILY VISUAL CHECK [] 17. DALLY VISUAL CHECK SPENSER CO~AINME~ ~ 1. FLOAT MECHANISM THAT SHUTS OFF SH~R VALVE DATE INSTALLED 468 ~ 2. CO~INUOUS DISPENSER PAN SENSOR + AUDIBLE ~O VISUAL A~ ~ 3. CO~INUOUS DISPENSER PAN SENSOR ~TH A~O SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL A~MS 4. DALLY VISUAL CHECK [] 5. TRENCH LINER / MONITORING [] §. NONE 48g IX. OWNER/OPERATOR SIGNATURE certih/Ihal Ihe infocmalion provic~ed herein la True and accurate ~o Ihe be~[ of my knowledge. 471 ................ .h ............................................ TITLE OF OVVNEPJOPERATOR 47'2. 'ermi~ Number (For k~cel use only) 473 j Permit Approved (Forlocal use only) 474 Penni[ Expiration Dale (Forlocal uae only) 475 I 'CF (7199) S ~CUPAFORMS\SWRCB-B WPD _ CITY OF BAKERSFIELD OFI~E OF ENVIRONMENTAL SLUICES I715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STOF~GE TANKS-TANK PAGE 1 TYPE OF ACTION [] t, NEW SITE PERMIT E~ 4. AMENDED PERMIT (Check one ~tem only) ~3. RENEWAL PERMIT (Spec~ reason./or local use only) BUSi~E~§'S'NAM~'(~'~';;"~,'~.iLi~--~,E~or DBA- Oei~g B~,in~ ~s) LOCATION WITHIN SITE [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE (Spectfy change ./or local use only} [] 8. TANK REMOVED 4 FAC' 'D 'F-Fq[IF-i .... i"'i: ....... i ....................... 4 TANK ID # ;ADOITIONAL OESCRIPTION (Forlocal use only) ; I. TANK DESCRIPTION 432 ;, TANK MANUFACTURER 435 i TANK CAPACITY IN GALLONS · tO\ca:pO 433 436 COMPARTMENTALIZED TANK [] Yes .,J~ No 4: Ii' "Yes'. complete o,'le page to~ each compartme~L NUMBER OF COMPARTMENTS 43¸ TANK USE 439 ~1. MOTOR VEHICLE FUEL (If marked, complete Petroleum TjCe) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PROOUCT [] 4. HAZARDOUS WASTE (Includes Used Oil) [] 95. UNKNOWN II. TANK CONTENTS PETROLEUMTYPE Ella. REGULAR UNLEADED []2. L.EADED []5. JET FUEL ["]lb. PREMIUM UNLEADED []3. DIESEL E~6. AVIATION FUEL .~1c. MIOGRADE UNLEADED [] 4. GASOHOL [~. OTHER COMMON NAME {from Haza~'Jou$ Materials Inven~ry page) TYPE OF TANK ~"'1, SINGLE WALL (Check one ~tem only) [] 2. DOUBLE WALL TANK MATERIAL - primary tank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL TANK MATERIAL - secondary tank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL · IlL TAN~ CONSTRUCTION [] 3, SINGLE WALL WITH EXTERIOR MEMBRANE LINER [] 4, SINGLE WALL IN A VAULT ,~. FIBERGLASS / PLASTIC [] 4. STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC (FRP) [] 3. FIBERGLASS / PLASTIC [] 4, STEEi. CLAD W/FIBERGLASS REINFORCED PLASTIC (FRP) [] 5, CONCRETE 441 J CAS # (from Hazardous Matexfal.~ lnven~q, page) [] 5. SINGLE WALL WTTH INTERNAL BLADDER SYSTEM [] 95. UNKNOWN [] 99. OTHER [] 5. CONCRETE [] 95. UNKNOWN [] 8, FRPCOMPAT]BLE W/100% METHANOL [] 99, OTHER [] 8. FRP COMPATIBLE W1100% METHANOL ~9;. UNKNOWN [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER [] 10. COATED STEEL TANK INTERIOR LINING OR COATING .[Check one item only) OTHER CORROSION PROTECTION IF APPL)CABLE (Check one item only) [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] $, [--] 1, MANUFACTURED CATHOOIC ~ 3. FIBERGLASS REINFORCED PLASTIC PROTECTION [] 4. IMPRESSED CURRENT [] 2. SACRIFICIAL ANODE GLASS LINING 1~,~95. UNKNOWN UNLINED [] 9S. OTHER [] 95. UNKNOWN [] gg. OTHER 448 446 DATE INSTALLED (For local use only) DATE INSTALLED {For local use only) 447 4-49 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 {Check all that apply) '~ 1. SPILL CONTAINMENT ~ ~ I~,-- ~ '~'-h ~*. STRIKER P~TE ~r ~ OVERFILL PROTECTION EQUIPMENT; YEAR INSTALLED ~1. ALARM ~ ~[~3. FILL TUBE SHUT OFF VALVE ~ [] 2. BALL FLOAT [] 4. EXEMPT 452 IF SINGLE WALL TANK (Check all ~hat apply): [] 1. VISUAL(EXPOSED PORTION ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) ~3. CONTINUOUS ATG [] 4, STA~TISTICAL INVENTORY RECONCILIATION (SIR) BIENNIAL TANK TESTING E~5, MANUALTANKGAUGING(MTG) [] 6. VADOSE ZONE r-'~7. GROUNDWATER [] 8. TANK TESTING ~:]~. OTHER 453 IF DOUBLE WALL TANK OR TANK wrrH BLADDER (Check one item onlyJ: 454 [] 1. VISUAL (SINGLE WALL IN VAULTONLY) [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED (YPJMO/DAY) JPCF (7~99) S:\CUPAFORMS\SWRCB-B.WP( CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES Chester Ave., Bakersfield, CA 93301 (661) Page , VI, PIPING CONSTRUCTION (Checka# matep~) UNDERGROUND PIPING SYSrEMTYPE ~1. PRESSURE CONSTRUCTION/,~1. SINGLE WALL MANUFACTURER:['-] 2. DOUBLE WALL ' MANUFACTURER :r'-I 1. BARE STEEL 'vtATERIALS AND i[~ 2. STAINLESS STEEL :~ROTECTION [] 2. SUCTION [] 3. GRAVITY 458 [] 3. LINED TRENCH [] 99. OTHER 460 [] 95. UNKNOWN 461 [] 6. FRP COMPATIBLE W/10<)% METHANOL [] 7'. GALVANIZED STEEL i [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN i 4. FIBERGLASS [] 8. FLEXIBLE(HDPE) [] 90. OTHER J:F~ 5. STEEL wi COATING [] 9. CATHODIC PROTECTION 464 i ABOVEGROUND PIPING ............. [] 1. PRESSURE [] 2. SUCTION [] 3, GRAVITY ~5q [] 1. SINGLE WALL [] 95. UNKNOWN 462 [] 2. DOUBLE WALL [] 99, OTHER MANUFACTURER -.--.-.___.___ 483 [] 1. B~RE STEEL [] 8. FRP COMPATIBLE W/100% METHANOL [] 2, STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE VV~TH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER i [] 4, FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEELW/COATING [] 95. UNKNOWN 4[55 UNDERGROUND PIPING Vii. PIPING LEAK DETECTION (Check all ~at apply) SINGLE WALL PIPING 466 SSURIZED PIPING (Check all that apply): 1, ELECTRONIC LINE LE. AK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS '"] 2. MONTHLY 0.2 GPH TEST 3. ANNUAL INTEGRITY TEST (0.1 GPH) :ONVENTIONAL SUCTION SYSTEMS: ~ 5. DAILY VISUAL MONFFORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) ;AFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): '"] 7. SELF MONITORING ;RAV1TY FLOW: ~ ~. BIENNIAL INTEGRITY TEST(0.1 GPH) SECONDARILY CONTAINED PIPING RESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF 'OR RESTRICTION 12. ANNUAL INTEGRITY TEST (0.1 GPH) ~ICTION/GRAVITY SYSTEM: 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check afl ~hat apply) 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF +. AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR {3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION 16. ANNUAL INTEGRtTY TEST (0.1 GPH) 17. DALLY VISUAL CHECK ABOVEGROUND PiPiNG SPENSER CONTAINME~"~ vz~ 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ~4. DALLY VISUAL CHECK DATE INSTALLED SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST W~TH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILYVISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all ~hat apply): ! [] 5. DAILY VISUAL MONFORING OF PIPING AND PUMPING SYSTEM [] B. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PtPtNG): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONrl'ORJNG [] 9. BIENNIAL INTEGRITY TEST(O.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR W1TH AUDIBLE AND VISUAL ALARMS AND (chec~ o~e) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c, NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12, ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST {0A GPH) [] 17, DAJLY VISUAL CHECK i 468 ~ 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE A~O VISUAL ALARMS [] 5, TRENCH LINER I MONITORING ~ 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER .,. AUDIBLE AND VISUAL ALARMS [] 6. NONE 489 IX. OWNER/OPERATOR SIGNATURE ce,-[ify lhal [he infocmaflon proviOe~ herein is flue and a..ccurale ID Ihe best Gl my know~edge, 471 TITLE OF OWNERJOPERATOR ,~__~_ ~.~ 472 'ermit Number (For local use on/y) 473 i Permit A~proved (Forlocal use only) 474 I Permlt Exoira¢on Dale [FOr local use enly) 475I ~CF (7/99) S :\CU PAFORMS\SWRCB.B.WP D CITY OF BAKERSFIELD OFF E OF ENVIRONMENTAL SLUICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS-TANK PAGE 1 ['YPE OF ACTION [] t, NEW SITE PERMIT [] 4. AMENDED PERMIT i'(.~t~eCk one dam only) ~3, RENEWAL PERMIT (Spec,fy macon. ID( local use only) LOCATION WITHIN SITE (OpEonal) [] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE (Specl~ change, for k~cal use only) [] 8. TANK REMOVED 4 I TANK iD # DATE INSTALLED (YEA~MO) I. TANK DESCRIPTION 433 i COMPARTMENTALIZED TANK [] Yes ~ Ii' 'Yes'. complete one page for eachc~ar~men 't. 432 i TANK MANUFACTURER i TANK CAPACITY IN GALLONS 435 436 ~ NUMBER OF COMPARTMENTS ; AiDOITIONAL DESCRIPTION (Fo(local use only) ; I 43t TANK USE 439 , ~1. MOTOR VEHICLE FUEL : (If marked, complete Pet/oleum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PRODUCT II. TANK CONTENTS PETROLEUM TYPE 4.4 [] la. REGUlar UNLEADED [] 2. LEADED [] 5. JET FUEL [] 1D. PREMlUM UNLEADED [~ 3. DIESEL [] 6. AVIATION FUEL [] 1c. MIOGRADE UNLEADED [] 4. GASOHOL [] gg. OTHER [] 4, HAZARDOUS WASTE (includes Used Oil) [] 95. UNKNOWN COMMON NAME (from Haza~ou$ Mat~rial$ Invenlory page) 4~1 I CAS # (from Hazardous Mate/fais lnvenlory page) TYPE OF TANK " " ~1. SINGLE WALL (Check one ilero only) [] 2. DOUBLE WALL TANK MATERIAL - prfmary tank [] 1, BARE STEEL (Check one ~em only) [] 2. STAINLESS STEEL TANK MATERIAL -secondary, lank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL IlL TANF cONSTRUCTIoN [] 3, SINGLE WALL WITH EXTERIOR MEMBRANE LINER [] 4. SINGLE WALL IN A VAULT ,,~. FIBERGLASS / PLASTIC []5. [] 4, STEEL CLAD W/FiBERGLASS [] 8. REINFORCED PLASTIC (FRP,I [] 3. FIBERGLASS/PLASTIC [] 8, [] 4. STEE~. CLAD W/FIBERGLASS [] 9, REINFORCED PLASTIC {FRP) [] 10. i'-I 5. CONCRETE [] 5. SINGLE WALL W1TH INTERNAL BLADDER SYSTEM [] 95. UNKNOWN [] 9g. OTHER CONCRETE FRP COMPATIBLE W/100% METHANOL FRP COMPATIBLE W/100% METHANOL FPP NON-CORRODIBLE JACKET COATED STEEL [] 95. UNKNOWN [] 99. OTHER ~95. UNKNOWN [] 99. OTHER 4.43 445 TANK INTERIOR LINING OR COATING {Check one item only) OTHER CORROSION PROTECTION IF APPLICABLE (Check one item only) [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] 6, [] 1, MANUFACTURED CATHODIC ,~ 3. FIBERGLASS REINFORCED PLASTIC PROTECTION [] 4. IMPRESSED CURRENT [] 2. SACRIFICIAL ANODE GLASS LINING [~5. UNKNOWN 446 DATE INSTALLED UNMNED [] 99. OTHER (For local usa on/y) [] 95. UNKNOWN [] 99. OTHER 448 DATE INSTALLED (Fo(local use only) 447 4.49 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 45t (Check all thai apply) ~ 1. SPILL CONTAINMENT '- ':"~r,:,~:~ff'~;';~;..~~ ,~:,, ..,: ,.' .~;-:'~:~;~, "- ' ';'? ':';'.~.~,~,~ ,ffE.':~'..'~.'. IF SINGLE WALL TANK (Check all ~at apply): 453 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED ,~ 1, ALARM __ ~3. FILL TUBE SHUT OFF VALVE ~ [] 2, BALL FLOAT [] 4. EXEMPT 452 IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 [] 1, VISUAL (EXPOSED PORTION ONLY) [] 2, AUTOMATIC TANK GAUGING (ATG) ~3. CONTINUQUS ATG ~ 4, STA. TISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING [] 5, MANUAL TANK GAUGING (MTG) [] 6, VADOSE ZONE [] 7. GROUNDWATER [] 8. TANK TESTING [] ss. OTHER [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTFY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 gallons [] Yes [] No ESTIMATED DATE LAST USED (YPJMO/DAY) ~PCF (7/99) S:\CUPAFORMS\SWRCB-B.WPE CITY OF BAKERSFIELD O OFFICE OF ENVIRONMENTAL SERVICES Chester Ave,, Bakersfield, CA 93301 (661) Page Vl. PIPING CONSTRUCTION (Check m# mot apl:~/) UST - TANK PAGt UNDERGROUND PIPING SYSTEM TYPE X1. PRESSURE CONSTRUCTION/~1. SINGL;V~/ALL MANUFACTURER:[-') 2. DOUBLE WALL ~ MANUFACTURER :['-I I. BARE STEEL vLATERIALS AND i['~ 2. STAINLESS STEEL 2ORROStON =ROTECTION [] 2. SUCTION [] 3. GRAVITY 458 [] 3. LINED TRENCH [] 99. OTHER 460 [] 95. UNKNOWN [] 6. FRP COMPATIBLE W/100% METHANOL [] 7. GALVANIZED STEEL ir'-j 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95, UNKNOWN i~4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER J,['-'] 5. STEEL W/COATING [] 9. CATHODIC PROTECT$ON 464 ~ ABOVEGROUND PIPING [] 1. PRESSURE [] ~. SUCTION [] I. SINGLE WALL [] 95. UNKNOWN [] 3. GRAVITY ~5~ [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER 463 · [] 1. BARE STEEL ......... ~]' 8. FRP COMPATIBLE W/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE~ WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/ COATING [] 95. UNKNOWN 465 UNDERGROUND PIPING Vll. PIPING LEAK DETECTION (Check all ~tet apply) ABOVEGROUND PIPING SINGLE WALL PIPING RSSURIZED PIPING (Chock all that apply): 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION '" AUDIBLE AND VISUAL ALARMS -'J 2. MONTHLY 0.2 GPH TEST X3.ANNUAL INTEGRITY TEST (0.1 GPH) :ONVENTIONAL SUCTION SYS"I'EMS: -] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRI'I"Y TEST (0,1 GPH) ;AFE SUCTION SYSTEMS {NO VALVES IN BELOW GROUND PIPING): "] 7. SELF MONITORING ;RAVITY FLOW; "l g. BIENNIAL INTEGRFFY TEST (O.i GPH) SECONDARILY CONTAINED PIPING RESSURIZED PIPING {Chock all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chec~ one) ~ [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] {~. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF ] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ~ '] 1,2. ANNUAL INTEGRITY TEST(0.1 GPH) ;..taCTIC N/GRAVITY SYSTEM; ] 13. CONTINUOUS SUMP S,ENSOR + AUDIBLE. AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (ChecX alt that apply) ] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF 4- AUDIBLE AND VISUAL ALARMS ] 15. AUTOMATIC LINE LEAK DETECTOR {3.0 GPH TEST) WITHOU~T FLOW SHUT OFF OR RESTRICTION 466 : SINGLE WALL PIPING 467 IPRESSURIZED PIPING (Chock all that apply): [] 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITI,J_ AUTO PUMP SHUT OFF FOR LEA~, SYSTEM FAILURE, AND SYSTEM DISCONNECTION *' AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3, ANNUAL INTEGRITY TEST (O.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check ail that apply): [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6, TRIENNIAL INTEGRITY TEST(0.1 GPH) BELOW'GROUND I S AFE SUCTION ,SYSTEMS (NO VALVES IN [] l'. SELF' MONITORING GRAVITY FLOW (Check all that appty): I[] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL JNTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PiPiNG (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WI'ri-i, AUDIBLE AND VISUAL ALARMS AND (c)heck one} [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12, ANNUAL INTEGRITY TEST(0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SE. NSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR {3,0 GPH TEST) ] 16, ANNUAL INTEGR TY TEST (0.1 GPH) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) ] 17. DAILY VISUAL CHECK [] 17. DAILY VISUAL CHECK SPENSER CONTAINMENT ~ 1, FLOAT MECHANISMTHAT SHUTS OFF SHEAR VALVE '3ATE INSTALLED 468 ~ 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AMD VISUAL ALARMS [] 3, CONTINUOUS DISPENSER PAN SENSOR WiTH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6, NONE 409 IX. OWNEPJOPERATOR SIGNATURE certify Ihal Ihe intocmatlon proviOed herein is flue and accurate. ID the be~t of my knowledge, lAME OF OWNEP. YOPERA TOR (print) 471 DATE / .' ........ 470 LE OF OWNE~O E .............................. ~ ................. 4~' 'ermil Number (For local use only) 473 J Permit Approved (Forlocal use on/y) 474 J PermltExpirallonDate(Forlocaluseonly) 475I 'CF (7/99) S:\CU PAFORMS\SWRCB-B,WP D CITY OF BAKERSFIELD OFFICI~)F ENVIRONMENTAL SER 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS-TANK PAGE 1 TYPE OF ACTION [] I. NEW SITE PERMIT FI 4. AMENOED PERMIT lC, hock one ~tern Only) ~[~3. RENEWAL PERMIT (Spec/fy reason -/or local use only) BUSINESS NAME (Same as FACILITY NAME o¢ OBA- Ooing Business A~) [] 5. CHANGE OF INFORMATION) LOCATION WITHIN SITE (Optional) Page _LO [] 6. TEMPOPARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE (Specdy change, for/coal use on(y) [] 8, TANK REMOVEO 430 431 I. TANK DESCRIPTION TANK lO # 432 ! TANK MANUFACTURER 433 ! COMPARTMENTALIZED TANK [] Yes ~---'~ 434 ~ If 'Yes'. cornplele c~e page for eac~ compartment. "bate INSTALLED (YEAR/MO) 435 i TANK CAPACITY IN GALLONS 436 F-~,I-I.)~"~-~-F~-P-~T~v~T-~ ........ 437 ADDITIONAL DESCRIPTION (For local use only) 438 II. TANK CONTENTS 4~O TANK USE 439 [] 1. MOTOR VEHICLE FUEL 'If marked, complete Peboleum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PRODUCT ~4. HAZARDOUS WASTE (Includes Used Oil) [] 95. UNKNOWN PETROLEUM TYPE [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JETFUEL [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] lc. MIDGRADE UNLEADED [] 4. GASOHOL ,~'gg. OTHER ~/~ COMMON NAME (flora Haza/dou$ Materials Inventory page) 441 CAS # (from Hazardous Mate/fal$ Inventory page) 442 [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL W1TH INTERNAL BLADDER SYSTEM 443 ~'~2. DOUBLE WALL EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TYPE OF TANK 'Check one item only] TANK MATERIAL - primary tank (Check one item only) [] 1. BARE STEEL [] 2, STAINLESS STEEL J~ 3. FIBERGLASS / PLASTIC [] 4. STEEL CLADW/FIBERGLASS REINFORCED PLASTIC (FRP) TANK/vtATERIAL - seco,qdary lank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL ~ 3. FIBERGLASS / PLASTIC [] 4. STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC (FRP) [] 5. CONCRETE [] 5. CONCRETE [] 95. UNKNOWN [] 8. FRP COMPATIBLE W/100% METHANOL [] 99, OTHER ~ 8. FRP COMPATIBLE W/100% METHANOL [] 9. FRP NON-CORRODIBLE JACKET [] 10. COATED STEEL [] 95, UNKNOWN [] 99, OTHER 445 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING J~',5. GLASS LINING [] 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING [] 6. UNLINED [] 99, OTHER __ £C_heck one item onlF) (For local use only) OTHER CORROSION PROTECTION IF APPLICABLE Check one item only) [] 1'. MANUFACTURED CATHODIC PROTECTION [] 2. SACRIFICIAL ANODE ~3. FIBERGLASS REINFORCED PLASTIC [] 4. IMPRESSED CURRENT [] 95. UNKNOWN [] 99. OTHER 448 DATE INSTALLED 449 (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 2. CROP TUBE ~2. BALL FLOAT .... ~ 4. EXEMPT ~ 3. STRIKER P~TE IF SINGLE WALL TANK (Check all ~at apply): 453 [ IF DOUBLE WA~ TANK OR TANK ~ B~DDER (Check one item only): 4~ ~ 1. VISUAL {EXPOSED ~RTION ONLY) ~ 5. ~NUAL TANK ~UGING {~G) ~ ~ ~. VISUAL (SINGLE WALL IN VAULT ONLY) ~ 2. AUTO~TIC TANK ~UGING (ATG) ~ 6. VALSE ZONE ~ ~ 2. CO~INUOUS ~ERSTITIAL ~NITORING ~ 3. CO~tNUOUS ATG ~ 7. GROUNDWA~R ~ ~ 3. ~NUAL ~NITORING ~ 4. STATISTI~L I~E~ORY RECONCILIATION {SIR) + ~ 8. TANK TESTING 81ENNIAL TANK TESTING ~ ~. OTHER V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 456 TANK FILLED WITH INERT MATERIAL? [] Yes [] No ESTIMATED OATE LAST USED (YPJMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING ,gallons ]PCF (719g) S:~.CUPAFORMS/SWRCB-8.WPD 1715 CITY OF BAKERSFIELD FF1CE OF ENVIRONMENTAL SERVICES ~ter Ave,, Bakersfield, CA 93301 (661) 326-397~. / J MST. rA.~< ~;,~ Page ~ ol.. VI. PIPING CONSTRUCTION (Check e# that apply) UNDERGROUND PIPING YSrEM TYPE [] ! PRESSURE [] 1. SINGLE WALL ONSTRUCTION/ ANUFACTURER~.2. DOUBLE WALL ~ MANUFACTURER :J~ I. BARE STEEL ATERIALS AND ![] 2, STAINLESS STEEL [] 7. GALVANIZED STEEL ORROSION ~ ROTECTION jr'-] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN i,J~4. FIBERGLASS [] 8. FLEXIBLE (HOPE) [] 99. OTHER !r-'] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 . . . i ABOVEGROUN.O.PIpI?G GRAVITY 458 i [] I. PRESSURE [] 2. SUCTION [] 3, GRAVITY ~Sg [] 95. UNKNOWN 462 [] 99. OTHER 463 [] 6. FRP COMPATIBLE WI I0~% METHANOL [] 7. GALVANIZED STEEL [] 2, SUCTION [] 3. LINED TRENCH [] 99. OTHER 460 i [] t. SINGLE WALL [] 95. UNKNOWN I [] 2. DOUBLE WALL 461 ~ MANUFACTURER [] 6. FRP COMPATIBLE W/100% METHANOL [] t. B~E STEEL [] 2. STAINLESS STEEL ~ 3. PLASTIC COMPATIBLE WITH CONTENTS [] 6. FLEXIBLE tROPE) [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/ COATING [] 95. UNKNOWN 465 " VII; PIPING LEAK DETECTION (Check ell [hat apply) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 :~ESSURIZED PIPING (Check afl that apply): 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE ,AND VISUAL ALARMS 2. MONTHLY 0.2 GPH TEST 3. ANNUAL INTEGRITY TEST (0.1 GPH) 3NVENTIONAL SUCTION SYSTEMS: 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM · TRIENNIAL PIPING INTEGRITY TEST (0.I GPH) SUCTION SYSTEMS (NO VALVES IN BELOW GRCUND PiPiNG): 7. SELF MONITORING :~JWITY FLOW: ~,~g. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING :{ESSURIZED PIPING (Check all that a~ply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUTOFF 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION ~,,12. ANNUAL INTEGRITY TEST (0.1 GPH) JCTION/GRAVITY SYSTEM: 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST} WITHOUT FLOW SHUT OFF OR RESTRICTION 18. ANNUAL INTEGRITY TEST (0.1 GPH) 17. DAILY VISUAL CHECK SINGLE WALL PIPING 467' PRESSURIZED PIPING (Check all ~hat apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRrI'Y TEST (0.1 GPH) [] 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST(0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES 1N BELOW GROUND PIPING); [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPR) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WI._...~.~ AUDIBLE AND VISUAL ALARMS AND (chec~ one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUTOFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c, NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12, ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ~- AUDIBLE AND VISUAL ALARMS [] 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16, ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK SPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER * AUDIBLE AND VISUAL ALARMS [] 4. DALLY VISUAL CHECK [] 5. TRENCH LINER / MONITORING [] 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE ceclify thai the informall~n provided her~n la Irue and accurate [o the be~t o~ my knowledge. 'I~N'~'~;U-I~ O F OWNER/O P ERA TO R ~_~~ ~M~. ~ (~WNERIOPERA TOR (pdn0 ........ 471 j TITLE OF OWNEPU....O.OPERATOR ~ ' .................... --'-~'~- ~ermit Number (For local use only) 473 PermII Approved (For k~cal use only) 4T4 Permtl Expiratto~ Dale (For local use only) 475 ~CF (7/99) S:\CUPAFORMS\SWRCB-B.WP D April 4, 2000 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H' Street 8ake~fleld, CA 93301 VOICE (805) 326-3941 FAX (8O5) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bake~'leld, CA 93301 VOICE (805) 326.3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bake~fleld, CA 93301 VOICE (805) 326-3951 FAX (~o5) 326,.0576 ENVIRONMENTAL 8ERVICE~ 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 3260576 TRAINING DM$1ON 5642 Victor Ave. Bakemrmld, CA 93308 VOICE (805) 399.4697 FAX (805) 399-5163 Equilon Enterprises LLC Ms. Feryal San'arian 255 N. Ontario St #208A Burbank CA 91504 Dear Ms. Sarrafian: You have been identified as the compliance coordinator for the facility/facilities referenced in the attachment. The permits to operate this facility/facilities will expire on June 30, 2000. However, in order for this office to renew your permit, updated forms A, B, & C must be filled out and returned prior to the issuanceof a new permit. Please make sure that you are sending the updated forms which are indicated by the date 7/99 in the lower left hand comer. Please complete and return to this office by May 15, 2000. Failure to comply, will result in a delay of issuance of your new permit to operate. Should you have any questions, please feel flee to call me at 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment Facility California Ave Shell Cleo Reyes Shell White Lane Shell Formerly Macias Shell Ming Ave Shell Shell Service Station Stockdale Texaco Texaco Gas ' Texaco Texaco Texaco Star Mart Texaco Star Mart Address 3623 California Ave, Bakersfield, Ca 93301 3605 Rosedale Hwy, Bakersfield, Ca 93308 2600 White Lane, Bakersfield, Ca 93309 101 S. Union Ave., Bakersfield, Ca 93305 3700 Ming Ave, Bakersfield, Ca 93309 3130 24th Street, Bakersfield, Ca 93301 5321 Stock'tale Hwy, Bakersfield Ca 93309 2401 Oak Street, Bakersfield, Ca 93301 c3fi9_~g-Avenuo, Bakersfield, Ca 93309 4050 Gosford Lane, Bakersfield, Ca 93309 3621 California Ave, Bakersfield, Ca 93301 2601 White Lane, Bakersfield, Ca 93304 ' sTATE OF CALIFORNIA STATE WATER RESOURCES CO RO .OARD UNDERGROUND STOEAGE TANK PERMIT APPLICATIOI -FORM; - COMPLETE THIS FORM FOR EACH SITE I~Cy I MARK ONLY [] 1. NEW PERMIT [] 3. RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED SITE ONE ITEM [] 2. INTERIM PERMIT n 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS-(MUST BE COMPLETED) DBA OR FACILITY NAME ]V[ing Texaco INAME OF OPERATOR Equilon Enterprises LLC NEAREST CROSS STRE~eal PARCEL # (OPTIONAL) ADDRESS 3698 Ming Ave. CITY NAME Bakersfield V/ BOX [] CORPORATI ON [] INDIVIDUAL [] PARTNERSHIP [] LOCAL-AGENCY [] COUNTY-AGENCY [] STATE- AGENCY [] FEDERAL-AGENCY TO INDICATE DISTRICTS *If the owner of t~e UST is a pubic agency, complete the following: name of supe~isor of division, sect/on or office which operates the UST TYPE OF BUSmESS [] G SSTATION [] 2 DISTRIBUTOR I [] I#OFTANKSATSlTE I E.P.A. m (O,tional) I RESERVATION 4 [] 3 FARM [] 4 PROCESSOR [] 5 OTHER OR TRUST LANDS I .EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY) -optional IDAYS: NAME (LAST, FIRST) Grady, Marcia NIGHTS: NAME (LAST, FIRST) (661) 834-2822 DAYS: NAME(LAST, FIRST) Long, Fred (661-326-4326 NIGHTS: NAME (LAST, FIRST) Grady, Marcia (661) 624-2472 Long, Fred (661) 333-2123 II. PROPERTY OWNER INFORMATION-(MUST DE COMPLETED) NAME OF OWNER EQUILON ENTERPRISES LLC MAILING OR STREET ADDRESS P.O. Box 4453 CITY NAME Houston III. TANK OWNER INFORMATION-)MUST BE COMPLETED) NAME OF OWNER EQUILON ENTERPRISES LLC MAILING OR STREET ADDRESS ?.O. Box 4453 CITY NAME Houston CARE OF ADDRESS INFORMATION P.O. BOX 7896, Burbank, CA. 91510-7869 ~/b__ox to indicate [] INDIVIDUAL [] LOCAL AGENCY [] STATE AGENCY [] CORPORATI ON [] PARTNERSHIP r'] COUNTY-AGENCY ['1 FEDERAL AGENCYI STATE ZIP CODE I PHONE # WITH AREA CODE TX. 77210-4453 I (713) 277-7000 CARE OF ADDRESS INFORMATION P.O. Box 7869 Burbank, CA. 91510-7869 ~/_~oxto ~nchcate [] INDIVIDUAL •LOCALAGENCY [] STATE AGENCY I~ CORPORATI ON [] PARTNERSHIP [] COUNTY-AGENCY [] FEDERAL AGENCY STATE ZIP CODE PHONE # WITH AREA CODE TX. 77210-4453 (713) 277-7000 IV. BOARD OF EQUALIZATION MST STORAGE FEE ACCOUNT NUMBER- Call (916) 322-9669 if questions arise, TY('rK)HQ ~ -IOl31 ~1Ol2161 V. PETROLEUM UST FINANCIAL RESPONSIBILITY-(MUST BE COMPLETE)-IDENTIFY METHOD(S) USED I'~boxtoindicate~al SELF-INSURED [] 2GUARANTEE []3INSURANCE 1"14 SURETYBOND []5 LETTER OF CREDIT [] 6 EXEMPTION [] 7 STATEFUND I [] 8 STATE FUND & CHIEF FINANCIAL OFFICER LETTER [] 9 STATE FUND l CERTIFICATE OF DEPOSIT [] 10 LOCAL GOVT. MECHANISM [] 99 OTHER I VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. I CHECK ONE BOX iNDiCATiNG WHICH OF THE ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTiFiCATiONS AND BiLLiNG. i.r'l ll. Sil Ill.[] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT TANK OWNER'S NAME (PRINTED & SIGNATURE ~ ["\~ \ I TANK OWNER'S TITLE EQUILON ENTERPRISES LLC ~ c~_~__l~H & E Compliance Coordinator LOCAL AGENCY USE ONLY I°ATE~..c~IMON]'H/DAY/YEAR(~c:~ .~# JURISDICTION # FACILITY # LOCATION CODE-OPTIONAL CENSUS TRACT ~- OPTIOAL SUPERVISOR-DISTRICT CODE -OPTIONAL THIS FORM MUST BE ACCOMANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION.FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY, OWNER MUST FILE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS BUSINESS EMERGENCY PLAN (Hazardous Materials Management Plan and Disclosure/Inventory) AGEi C¥ EQUILON ENTERPRISES LLC Ming Texaco 3698 Ming Ave. & Real Bakersfield, CA. 93309 121176/61-058-00700 (661) 834-2822 REV: 05/06/99 TABLE OF CONTENTS 1. Owner Operator Agreement ................................. Section 1 California Health and Safety Code, Section 25299 2. Business Emergency Plan .................................... Section 2 3. Hazardous Material Disclosure ............................. Section 3 4. Monitoring Procedures ..................... r .................. Section 4 Leak Response Plan Emergency Response Procedures Training Log 7-1 5. Site Map Site Map Symbols Reviews and Revisions This plan was created to comply with section 25503.5 of the California Health and Safety codes. It is required to be revised within 30 days of any significant change in quantities of hazardous chemicals or operations at the facility. In addition plans are reviewed every two years and Inventory Disclosure is submitted annually to the local administering agency. A revision is also required if there is a change in the business owner, operator, or address. Certification This plan must be reviewed by the business owner to ensure that it is complete and accurate. After signing this plan, a copy must be kept on-site and available for review. In addition a copy is maintained by the tank owner, and a copy is sent to the local administering agency in your name. THIS STATION IS OWNED AND OPERATED BY: EQUILON ENTERPRISES LLC. EO_UILON Dear Equilon Marketer: The underground storage tanks located at your facility must be monitored in accordance with the Permit to operate issued by thg local agency and article 6.3 of the Shell Motor Fuel Station Lease. The following excerpt from- the California Health and Safety Code, Division 20, Chapter 6,7 defines the penalties for violating the Permit to Operate or other applicable regulations. Section 25299, Violations; Civil and criminal penalties; operative date. (a) Any operator of an underground tank system shall be liable for a civil penalty of not less tan five hundred dollars ($500.00) or more than five thousand dollars ($5,000) for each underground tank for each day of violation for any of the following violations: (I) Operating an underground tank that has not been issued a permit, in violation of this chapter. (2) Violation of any of the applicable requirements of the permit issued for the operation of the underground tank system. (3) Failure to maintain records, as required by this chapter. (4) Failure to report unauthorized release, as required by Sections 25294 and 25295. (5) Failure tO properly close an underground tank system, as required by section 25295. (6) Violation of any applicable requirement of this chapter or any requirement of this chapter or any regulation adopted by the board pursuant to Section 2599.3. (7) Failure to permit inspection or to perform any monitoring testing, or reporting required pursuant to Section 25288 or 25289. (8) Making any false statement, representation, or certification in any application record, report or other document submitted or required to be maintained pursuant to this chapter. (d) Any person who falsifies any monitoring records required by this chapter, or knowingly fails to report an unauthorized release, shall upon conviction, be punished by a fine of not less than five thousand dollars ($5,000) or more than ten thousand ($10,000), by imprisonment in the County jail for not exceed one year, or by both that fine and imprisonment. Please Contact your Equilon Representatives if you have any questions regarding this section of the California health and Safety Code or article 6.3 of the Equilon Motor Fuel Station Lease agreement. Equilon Enterprises LLC ~ City of Bakersfield Envffi~hmental Health Services DeparYl~ent 1715 Chester Avenue, Third Floor Bakersfield CA. 93301 (805) 326-3979 Business Name Ming Texaco Owner/Operator Name Equilon Enterprises LLC Business Address 3698 Ming Ave. & Real City Bakersfeild State CA. Phone: (661) 834-2822 Zip 93309 Environmental Contact: Feryal Sarrafian Mailing Address P.O. Box 7869 SH & E Compliance Coordinator Phone: (818) 736-5078 City Burbank State CA. Zip 91510-7869 Biennial Review and Recertification I certify that the Business Plan has been reviewed and the information contained in it is accurate and complete as of date below. I certify that I have reviewed the previously submitted Business plan and have updated the following items on the attached pages. [] Emergency contacts names and phone numbers [] Site/facility map [] Other Updates Annual Inventory Update [] Inventory Forms are correct for the upcoming reporting year. No changes Necessary. [] Inventory Forms required updating. Replace previous inventory with attached inventory. I certify under penalty of law, that I have personnally examined and I am familiar with the information submitted in this and all attached documents, and based on my inquiry of those individuals responsible for obtaining the information, I beleive that the submitted information is tree accurate an dcomplete. ~~~ Name Equilon Enterprises LLC-Feryal Sarrafian Signature Title SH & E Compliance Coordinator Date {O '-' '2~(~ .~C[(~. City of Bakersfield Environmental Health Services Department 1715 Chester Ave. Third Floor Bakersfield, CA. 93301 (805) 326-3979 Your business is required by State Law to provide immediate notification of any release or threatened release of hazardous material to 1) local fire emergency response personnel, 2) the office of Emergency Services (OES) and 3) this administering agency. If you have a release or threatened release of hazardous materials, immediately call: FirelParamedicslPolicelSheriff Phone: 9-1-1 Individual responsible for calling 9-1~anager or Senior Employee After the local emergency response personnel are notified, you shall then notify the administering agency (HMDO) and the office of Emergency Services (24 hours a. day) State Office of Emergency Services: AND: (800) 852-7550 OR (916) 427-4341 Local Administering Agency (805) 326-3979 Individual responsible for calling this Administering Agency and State OES: Manager or SH & E Compliance Coordinator 2. List the local emergency medical facility that will by used by your business in the event of an accident or injury caused by release or threatened release of hazardous materials. Hospital / Clinic Mercy Hospital Address: 2215 Truxtun Ave., Bakersfield Phone: (661) 632-5000 3. Does your business have a private on-site emergency response team? If yes describe what policies and procedures your business will follow to notify your on-site emergency response team in the event of a release or threatened release of hazardous materials? (attach additional pages if necessary) EMERGENCY RESPONSE .~3NTINGENCY PROCEDURE ~°~--AND PLAI~' 1. PREVENTION- Describe the types of hazards associated with the materials present at your facility What actions are taken to prevent these hazards from occurring? Please See Attachment 1 2. MITIGATION- What actions will your business take to lessen the harm or damage to persons, property, or the environment, and prevent what has occurred from getting worse? Please See Attachment 1 3. ABATEMENT - What will your business do to stop the hazard? Please See Attachment 1 ATTACHMENT 1 PREVENTION ( prevent the hazard)- Describe the kinds of hazards associated with the hazardous materials present at your facility. What Actions would your business take to prevent these hazards from occurring? You may include a discussion of safety and storage procedures. The types of hazards present at the facility are: 1) Small spills during fuel delivery 2) Small spills during customer fueling or due to hit dispenser 3) Major spills Actions taken to prevent hazards from occurring are: 1) Small spills during fuel delivery- Inventory is verified prior to fuel delivery to prevent overfills; Spill containment boxes installed at each fill; Drivers are trained in proper off loading techniques to prevent spills 2) Small spills during customer fueling or due to hit dispenser- impact shut- off valves; automatic shut-off nozzles; emergency shut-off switch. Mitigation (reduce the hazard) Describe what is done to lessen the harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a leak, fire, explosion, or airborne release at your business? The senior employee on site will institute immediate spill control measures with the site spill kit for minor product release and will immediately stop the source of the spill and prevent the flow of the spill material off-site, if this can be done safely. Stopping the spill may involve turning off pumps and closing valves Any spill greater then 55 gallons may be turned over to an outside firm. Mitigation continued- Employees will respond to small fires with the sites fire extinguisher and attempt to contain it before it gets out of control. In the event of a dispenser drive over or a fire the employee will immediately shut down the tank turbines with the emergency shut-off switch. The goal of the on site employee is to stop or contain any immediate threat and to summon the appropriate City Agencies (i.e. Fire Department) and Equilon contractors to follow up with damage assessment and cleanup. ABATEMENT .(remove the hazard)- Describe what you would do to stop and remove hazard. How do you handle the complete process of stopping a release, cleaning up, and disposing materials at your facility? What aspects of the response are beyond your ability and need to be handled by others? Tanks and lines are set up to automatically shut down when a leak is detected. For small releases the spill control kit contains absorbent material and absorbent "sausages" for containment damming. Equilon contracts with a number of State Licensed Abatement Contractors to properly clean the site and ready any generated wastes for hauling to an approved landfill. The State Licensed Abatement Contractor will manifest, haul and dispose of the material at an approved landfill or other approved disposal site. The station manager will resume responsibility for directing cleanup activities. He will summon to scene the manpower and equipment needed to respond to incident, and will direct their activities for the duration of the response. He will contact any support groups whose assistance is needed in the response effort, such as Police or Fire Departments. Notification of regulatory agencies, should it be required, will be handled in accordance with notification procedures above. Once the spill has been isolated from possible sources if outside discharge, and the source of the spill has been eliminated, efforts will be directed towards containment of the smallest area possible. After the bulk of the spilled material has been removed, final cleanup of the area will be conducted. This will include decontamination of the area and equipment used for the cleanup. EVACUATION- Describe how you will immediately notify and evacuate your facility. What communications or alarms are used? How will you operate these during power failure? Also specify emergency exits, alternatives and staging areas. In the event of an emergency situation, fire or spill, site personnel are notified verbally. The on-site manager is also notified verbally. The station manager will at this time assess the situation and determine whether outside notification is required. In the event of an emergency which would require total evacuation of the facility, notification will be made verbally by the senior person in the affected area. The routes ,.of evacuation to be taken noted on the facility map. Once evacuated, personnel will assemble at a safe distance, away from the facility (conditions permitting, wind direction, other risks) and the station Manager will notify the surrounding businesses by phone or door-to-door means. EARTHQUAKE- Identify the area and equipment in your business which would require immediate attention following an earthquake. Check for equipment such as gas cylinders, piping, drums, ect., that may need to be secured or spillage that may require mitigation. In event of an earthquake equipment such as tanks, piping and dispensers would need to be checked immediately. For small releases, the spill control kit contains absorbent material and absorbent "sausages" for containment damming. 4. EVACUATION- How will your business handle evacuation? Please See Attachment 1 Your business is required by required by law to keep a copy of Business Plan, including the chemical inventory and site map. Describe where the copies will be kept in your business. Where will other copies be maintained? The business plan is located in the cashier area or back office. Equilon Enterprises also maintains a copy at their office. Equilon Enterprises LLC SH&E.Compliance Coordinator P.O. Box7869 Burbank CA., 91510-7869 6. Describe where you keep other records required by this plan, such as employee training records, (including drills) release records, persons responsible for maintenance/safety and their records, and emergency phone numbers. Other records required by this plan, such as employee training records, release report records, persons responsible for maintenance/safety and their records, and emergency phone lists are located either in the SH & E book found in the cashier area. EMPLOYEE TRAINING 1) Describe the training new employees receive in handling and using hazardous materials and waste that are part of your operation. Please See Attachment 2 2) How are employees trained to react to emergency situations? See Attachment 2 3) Describe how new employees are trained in the use of safety equip, ment and supplies needed to stop leaks or fires. See Attachment 2 CERTIFICATION We have demonstrated reasonable care in preparing our Business Emergency Plan. This statement certifies that our EmergenCy Business Plan has been implemented and should be adaquate in the event of an emergency involving our hazardous materials. Document Prepared By: SERVICE STATION SERVICES Signature Date Business Owner/Operator Equilon Enterprises LLC-Feryal Sarrafian Signature Date ATTACHMENT 2 EMPLOYEE TRAINING PROGRAM .Describe the training your business conducts for all employees in safety procedures in the event of a release or threatened release of hazardous materials. By law, this training shall include, but not be limited to, the following: New employee training, annual training, periodic refresher courses, and familiarization with Section B (Emergency Plans and Procedures) of this Business Emergency Plan. Within 90 days of their hire date, new employees are trained in the safe handling of the hazardous materials they will be using. This training is completed using OSHA hazard communication regulations. When the new employee has completed the "Right To Know" training, it will be documented in the employee's files. This training covers the labeling, MSDS and hazards associated with the materials they are working with. The station manager is self-trained in the contents of the business plan, which outlines the procedures that are to be followed in dealing with the initial response to an emergency. A work shift is not allowed to operate without someone trained in the procedures to follow during initial response to emergencies. The training consists of the instructor reviewing the plans line by line and answering the employee might have. Once the employee has been trained and verified competent in the contents of the plan, a notation is made on the employee's records that they have completed training required to handle initial response. All employees are trained thoroughly with the emergency response plans and procedures,-with annual refresher training. Refresher training is completed as noted above, and once the training is completed, a notation is made in the employee's records. The refresher training consists of reviewing the evacuation and spill notification procedures. A record of this training will be noted in the employee's record. Any amendments to the plans are relayed to the personnel required to carry out the plans as soon as those amendments are known. ~l~ City of Bakersfield ~ Env~l~nmental Health Services Department 1715 Chester Avenue, Third Floor Bakersfield CA. 93301 (805) 326-3979 FACILITY INFORMATION- CALIFORNIA BUSINESS & OWNER/OPERATOR IDENTIFICATION YEAR BEGINNING- 1-98 ENDING 12/98 BUSINESS NAME: Ming Texaco BUSINESS PHONE (661) 834-2822 SITE ADDRESS: 3698 Ming Ave. & Real CITY Bakersfield DUN & BRADSTREET OPERATOR NAME Equilon Enterprises LLC STATE CA. zip 93309 SIC CODE OPERATOR PHONE (661) 834-2822 OWNER INFORMATION OWNER MAILING ADDRESS P.O. Box 7869 CITY Burbank STATE CONTACT NAME Feryal Sarrafian OWNER INFORMATION Equilon Enterprises LLC OWNER PHONE (818) 736-5078 CA. ENVIRONMENTAL CONTACT ZIP 91510-7869 CONTACT PHONE (818) 736-5078 MAILING ADDRESS P.O. Box 7896 CITY Burbank STATE CA. ZIP 91510-7869 PRIMARY EMERGENCY CONTACTS SECONDARY NAMEMarcia Grady TITL ,p~anager BUSINESS PHONE(661) 834-2822 24-HOUR PHONE(661) 624-2472 NAMEFred Long TITLE Facility Engineer BUSINESS PHONE (661) 326-4326 24-HOUR PHONE(661) 333-2123 Cellular Certification: I certify under penalty of law that I have personally examined and am familiar with the information submitted in this inventory and believe the information is tree, accurate, and complete. Document Preparer: Service Station Services-Shirley Ogletree Signature Of Owner/Operator: Ci }MIC, AL INVENTORY r(1) ADD DELETE REVISE (2) PAGE OF (3) fi4) BUSINESS NAME ing Texaco (5) CHEMICAL LOCATION Southern area of the lot (6) MAP # (7) GRID # (8) CHEMICAL NAME Petrol (9) COMMON NAME Regular Unleaded (1o) CAS # 8006-61-9 (14) TYPE: PURE MIXTURE WASTE (11) TRADE SECRET C]v [n~N (12) EXTREMELY HAZARDOUS SUBSTANCE [--]Y [~N I iF BOX IS "Y" ALL AMOUNTS MUST BE IN POUNDS. (13) FIRE CODE HAZARD CLASSES ] (17) PHYSICAL STATE' SOLED LIQUID GAS [ ] (15)RADIOACTIVE ~--] Y ~ NI] (I6)CUR1ES[] [] [] (18) FEDERAL HAZARD CATEGORIES: FIRE REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH 419) STATE WASTE CODE /A 3~) DAYS ON SITE (21) LARGEST CONTAINER 10,000gal. (22) UNITS [] GAL [] CU FT [] LBS [] TONS if an Extremely Hazardous SubstanceIRegulated Substance, amounts must be in pounds A. ABOVE GROUND, TANK [] G. METAL CONTAINER M. CYLINDER [] S. CARBOY [] (23) MAX DAILY AMT 10,000gal. (24) AVG DAILY AMT 5,000 gals I~y~ANNUAL WASTE AMT (26) STORAGE CONTAINER B. UNDERGROUND TANKB C PRESSURIZED TANK [] D. MAGAZINE [] E. DRUM [] F. PLASTIC CONTAINER H. VAT L IN MACHINERY [] J. ON TRUCK [] K. BAG [] L BOX N. GLASS CONTAINERT. TOTE BIN B U.0' VARIOUSTANK WAGON [][] v.P' RAIL CAROTHER [--[ Q. SILO [-I R. TANK INSIDE BUILDINCL (27) STORAGE PRESSURE 1. AMBIENT (normal) 2. ABOVE AMBIENT (pressure) 3. BELOW AMBIENT (vacuum) (28) STORAGE TEMPERATURE 4. AMBIENT (normal) 5. ABOVE AMBIENT (heated) 6. BELOW AMBIENT 7. CRYOGENIC [] [] [] [] 95-99.99 Gasoline [] Y [] N Mixture 10-19.99 Methyl-T-Butyl Ether [] Y [] N 1634-04-4 10-19.99 Ethyl-T-Butyl Ether [] Y [] N 637-92-3 []y[]N D Y I-IN (33) ADDITIONAL LOCALLY COLLECTED INFORMATION I ALPHA BETA GAMMA (a) IF THIS MATERIAL IS RADIOACTIVE, WHAT TYPE OF EMITTER IS IT? [] [] [] (b) IS A WASTE PRODUCED OR LEFT OVER AFTER PROCESSING? [] Y [] N (¢) IF YOU MARKED YES, HOW IS THE MATERIAL DISPOSED OF? (Refer to Table #2, page 19 of the green pages) (d) HOW IS THE MATERIAL USED/WHAT IS THE MATERIAL USED FOR? Motor Fuel Sales Date of Print 6~98 Page 47 FOR OFFICE USE ONLY [] UNDER [CARCEXPI [] 1[ I-I Ex - tV lCgV I--I, C] iICALINVENTORY (1)[~DD DELETE R~VISE ]~ [] (2) PAGE OF (3) I fi4) BUSINESS NAME ihg Texaco (5) CHEMICAL LOCATION 5outhem area of the lot (6) MAP # I (7) GRID # (8) CHEMICAL NAME Petrol (9) COMMON NAME Power Plus o o) CAS # 8006-61-9 {14) TYPE: PURE MIXTURE WASTE (11) TRADE SECRET [-]y []N (12) EXTREMELY HAZARDOUS SUBSTANCE ['-IY ~]N IF BOX IS "Y" ALL AMOUNTS MUST BE IN POUNDS. 03) FIRE CODE HAZARD CLASSES ] (17) PHYSICAL STATE. SOLED LIQUID GAS [ ] (15)RADIOACTIVE [-] Y [] N[[ (16) CURIES[] [] [] (18) FEDERAL HAZARD CATEGORIES: FIRE REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH [] [] [] [] [] /A19) STATE WASTE CODE (20) DAYS ON SITE 365 . (21) LARGEST CONTAINER 10,000gal. .6. ABOVE GROUND, TANK G. METAL CONTAINER M. CYLINDER S. CARBOY (23) MAX DAILY AMT (22) UNITS 10,000gal. [] GAL [] CU FT (24) AVG DAILY AMT [] LBS [] TONS 5,000 gals I if~n Ex~meIy H=~d°u~ Sub~nc~*a S~' ]~/~A~UAL WASTE AMTamounts must be in pounds (26) STORAGE CONTAINER I B. UNDERGROUND TANK[] C PRESSURIZED TANK [] H. VAT [] L IN MACHINERY [] N. GLASS CONTAINER [] 0. VARIOUS [] T. TOTE BIN [] U, TANK WAGON [] D. MAGAZINE [] E. DRUM [] F. PLASTIC CONTAINER J. ONTRUCK [] K. BAG []LBOX P. RAIL CAR [] Q. SILO [] R. TANK INSIDE BUILDIN(~ v. OTHER (27) STORAGE PRESSURE 1. AMBIENT (normal) 2. ABOVE AMBIENT (pressure) 3. BELOW AMBIENT (vacuum) (28) STORAGE TEMPERATURE 4. AMBIENT (normal) 5. ABOVE AMBIENT (heated) 6. BELOW AMBIENT 7. CRYOGENIC 95-99.99 Gasoline [] Y [] N Mixture 10-19.99 Methyl-T-Butyl Ether [] Y [] N 1634-04-4 10-19.99 Ethyl-T-Butyl Ether [] Y [] N 637-92-3 •yDN []Y[]N (33) ADDITIONAL LOCALLY COLLECTED INFORMATION I ALPHA BETA GAMMA (a) IF THIS MATERIAL IS RADIOACTIVE, WHAT TYPE OF EMITTER IS IT? [] [] [] (b) IS A WASTE PRODUCED OR LEFT OVER AFTER PROCESSING? [] Y [] N (c) IF YOU MARKED YES, HOW IS THE MATERIAL DISPOSED OF? (Refer to Table #2, page 1 9 of the green pages) (d) HOW IS THE MATERIAL USED/WHAT IS THE MATERIAL USED FOR? Motor Fuel Sales FOR OFFICE[ [] use l El UNDER ICARCEXPI I~l 1 exmmlcae us! Fi 3 Date of Pdnt 6/98 Page 47 Ci MICAL INVENTORY (1) ADD DELETE REVISE (2) PAGE OF (3) (4) BUSINESS NAME ,Ming Texaco (5) CHEMICAL LOCATION Southern area of the lot (6) MAP it I (7) GRID it (8) CHEMICAL NAME Petrol (9) COMMON NAME Power Premium (1 o) CAS it 8006-61-9 (14) TYPE: PURE IVflXTURE WASTE (11) TRADE SECRET [--]y [~N (12) EX'IREMELY HAZARDOUS SUBSTANCE [--]Y [~]N IF BOX IS "Y" ALL AMOUNTS MUST BE IN POUNDS. (13) FIRE CODE HAZARD CLASSES I [ (17) PHYSICAL STATE' SOLED LIQUID GAS [ ] (15)RADIOACTIVE I~1Y [I~1NI ](16) CURIES[] [] [] (18) FEDERAL HAZARD CATEGORIES: FIRE REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH [] [] [] [] [] 19) STATE WASTE CODE /A 3~) DAYS ON SITE (21) LARGEST CONTAINER 10,000gal. A. ABOVE GROUND, TANK ~ G. METAL CONTAINER I I M. CYLINDER [] S. CARBOY [] (23) MAX DAILY AMT (22) UNITS 10,000gal. [] GAL []CU FT I(24) AVa DAILY AMT [] LBS [] TONS 15,000 gals if an Exh-emely Hazardous Substance/Regulated Substance, ](25) ANNUAL WASTE AMY amounts must be in pounds I (26) STORAGE CONTAINER ] B. UNDERGROUND TANK[] C PRESSURIZED TANK [] H. VAT [] L IN MACHINERY [] N. GLASS CONTAINER [] 0. VARIOUS [] T. TOTE BIN [] U. TANK WAGON [] D. MAGAZINE [] E. DRUM [] F. PLASTIC CONTAINER J. ON TRUCK [] K. BAG [] L BOX P. RAIL CAR [] Q. SILO [] R. TANK INSIDE BUILDIN~ V. OTHER (27) STORAGE PRESSURE 1. AMBIENT (normal) 2. ABOVE AMBIENT (pressure) 3. BELOW AMBIENT (vacuum) (28) STORAGE TEMPERATURE 4. AMBIENT (nomml) 5. ABOVE AMBIENT (heated) 6. BELOW AMBIENT 7. CRYOGENIC 95-99.99 Gasoline [] Y [] N Mixture 10-19.99 Methyl=T=Butyl Ether [] Y [] N 1634-04-4 10=19.99 Ethyl-T-Butyl Ether [] Y [] N 637=92-3 F'l y I-I N U'I Y []N (33) ADDITIONAL LOCALLY COLLECTED INFORMATION ALPHA BETA GAMMA (a) IF THIS MATERIAL IS RADIOACTIVE, WHAT TYPE OF EMITTER IS IT? [] [] [] (b) IS A WASTE PRODUCED OR LEFT OVER AFTER PROCESSING? [] Y [] N (c) IF YOU MARKED YES, HOW IS THE MATERIAL DISPOSED OF? (Refer to Table #2, page 19 of the green pages) (d) HOW IS THE MATERIAL USED/WHAT IS THE MATERIAL USED FOR? Motor Fuel Sales rou omcEI [] t sE ONLy ID UNDER ICARCEXPI ['-[ 1 rxme ca , usl 3 Date of Pdnt 6~98 Page 47 CI MICAL INVENTORY (1) ADD DELETE REVISE (2) PAGE OF (3) ~/~4) BUSINESS NAME ing Texaco ~(5) CHEMICAL LOCATION entral area of lot (6) MAP # I(7) GRID # (8) CHEMICAL NAME Waste Oil 9) COMMON NAME aste Oil ~v~l o) CAS # ixture (14) TYPE: PURE MIXTURE WASTE I I (17) PHYSICAL STATE. SOLED LIQUID GAS (11) TRADE SECRET r-]Y [~N (12) EXTREMELY HAZARDOUS SUBSTANCE [~Y []N IF BOX IS "Y" ALL AMOUNTS MUST BE IN POUNDS. (13) FIRE CODE HAZARD CLASSES I [ (15) RADIOACTIVE I~Y [] NII (16)CURIES (18) FEDERAL HAZARD CATEGORIES: FIRE REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH [] [] [] [] [] STATE WASTE CODE 3~) DAyS ON SITE (2 l) LARGEST CONTAINER 550 gal A. ABOVE' GROUND, TANK ~ G. METAL CONTAINER I I M. CYLINDER [] S. CARBOY [] I (23) MAX DAILY AMT (22) UNITS [550 gal [] GAL [] CU FT (24) AVG DAILY AMT [] LBS [] TONS 5 gal I 'Va" E"='metY H=~rd°u$ Sub~=~e~ulated Substa"~' I ~2(~t)ANNUAL wAsTE AMTamounts must be in pounds 1 (26) STORAGE CONTAINER [ B. UNDERGROUND TANK[] C PRESSURIZED TANK [] H. VAT [] L IN MACHINERY [] N. GLASS CONTAINER [] 0. VARIOUS [] T. TOTE BIN [] U. TANK WAGON [] D. MAGAZINE [] E. DRUM [] F. PLASTIC CONTAINER J. ONTRUCK [] K. BAG []LBOX P. RAIL CAR [] Q. SILO [] R. TANK INSIDE BUILDIN~ V. OTHER (27) STORAGE PRESSURE 1. AMBIENT (normal) 2. ABOVE AMBIENT (pressure) 3. BELOW AMBIENT (vacuum) (28) STORAGE TElvIPERATURE 4. AMBIENT (normal) 5. ABOVE AMBIENT (heated) 6. BELOW AMBIENT 7. CRYOGENIC [] [] [] [] 1-99 Used Lubircating Oil [] Y [] N Mixture 1-99 Inert Filters [] Y [] N Mixture 0-2 Gasoline [] Y [] N !Mixture •yF1N EIY[]N (33) ADDITIONAL LOCALLY COLLECTED INFORMATION ALPHA BETA GAMMA (a) IF THIS MATERIAL IS RADIOACTIVE, WHAT TYPE OF EMITTER IS IT? [] [] [] (b) IS A WASTE PRODUCED OR LEFT OVER AFTER PROCESSING? [] Y [] N (c) IF YOU MARKED YES, HOW IS THE MATERIAL DISPOSED OF? (Refer to Table #2, page 19 of the green pages) (d) HOW IS THE MATERIAL USED/WHAT IS THE MATERIAL USED FOR? Waste Oil IFOROFFICEI [] USEONLY } [][~ UNDER ICARCEXPI [] 1{ co ., p,, [] '/ EXEMP CGP as/ Ui 31 Date of Print 6/98 Page 47 C]~4ICALINVENTORY I(1) ADD DELETE REVISE (2) PAGE OF (3) fi4) BUSINESS NAME ing Texaco (5) CHEMICAL LOCATION Central area of lot (6) MAP # (7) GRID # N(8) CHEMICAL NAME ew Motor oil N(~/CsOMMON NAME tore Room (lO) CAS # 8020835 (14) TYPE: P~RE MIXTURE WASTE [[] [] (11) TRADE SECRET ]-']y [~N (12) EXTREMELY HAZARDOUS SUBSTANCE [---[Y []N IF BOX IS "Y" ALL AMOUNTS MUST BE IN POUNDS. (13) FIRE CODE HAZARD CLASSES (18) FEDERAL HAZARD CATEGORIES: FIRE REACTIVE PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH /l 9) STATE WASTE CODE A 3~2~) DAYS ON SITE (22) UNITS [] GAL [] CU PT [] LBS [] TONS '(21) LARGEST CONTAINER 200 gal. if an Extremely Hazardous Substance/Regulated Substance, amounts must be in pounds (26) STORAGE CONTAINER A. ABOVE GROUND, TANK ~ B. UNDERGROUND TANKB C PRESSURIZED TANK [] G. METAL CONTAINER L..I H. VAT L IN MACHINERY [] M. CYLINDER [] N. GLASS CONTAINER [] 0. VARIOUS [] S. CARBOY [] T. TOTE BIN [] U. TANK WAGON [] (23) MAX DAILY AIvIT 200 gal. (24) AVG DAILY AMT 100 gal /25) ANNUAL WASTE AMT A I D. MAGAZINE [] E. DRUM [] F. PLASTIC CONTAINER J. ONTRUCK [] K. BAG [] LBOX P. RAIL CAR [] Q. SILO [] R. TANK INSIDE BUILDINCL-~ V. OTHER (27) STORAGE PRESSURE 1. AMBIENT (normal) 2. ABOVE AMBIENT (pressure) 3. BELOW AMBIENT (vacuum) (28) STORAGE TEMPERATURE 4. AMBIENT (normal) 5. ABOVE AMBIENT (heated) 6. BELOW AMBIENT 7. CRYOGENIC [] [] [] [] 100gal Motor Oil [] Y [] N 8020835 DYDN []yl-1N Dy[]N DY[]H (33) ADDITIONAL LOCALLY COLLECTED INFORMATION ALPHA BETA GAMMA (a) IF THIS MATERIAL IS RADIOACTIVE, WHAT TYPE OF EMITTER IS IT? [] [] [] (b) IS A WASTE PRODUCED OR LEFT OVER AFTER PROCESSING? [] Y [] N (e) IF YOU MARKED YES, HOW IS THE MATERIAL DISPOSED OF? (Refer to Table #2, page 1 9 of the green pages) (d) HOW IS THE IvIATERIAL USED/WHAT IS THE MATERIAL USED FOR? New Motor oil Date of Print 6/98 Page 47 IFOR OFFICE USE ONLY [] UNDER ICARCEXP[ [] 1[ [] [] r-] EXEMP~CGP RSI ["] 3[ 121176 BUSINESS PLANS 61-058-00700 AS A SERVICE TO YOU, THIS BUSINESS PLAN WAS PREPARED BY SERVICE STATION SERVICES, 1NC. IN ORDER TO COMPLY WITH THE CALIFORNIA HEALTH AND SAFETY CODE (CHAPTER 6.95, ARTICLE I, SECTION 25503.5). BY ACCEPTING THIS PLAN, YOU ARE ACKNOLEDGING THAT THERE ARE NO REPRESENTATIONS OR WARRANTIES THAT THE INFORMATION CONTAINED IN THIS BUSINESS PLAN WILL PRODUCE ANY PARTICULAR RESULT WITH REGARD TO THE SUBJECT MATTER. OWNER/OPERATOR AGREEMENT OPERATOR: As operator of the underground storage tanks, I hereby certify that I understand the monitoring and reporting requirements contained in Title 23, of the California Code of Regulations and I have received a copy of Section 25299, chapter 6.7, California Health and Safety Code. OPERATOR NAME: BUSINESS NAME: LOCATION #: Equilon Enterprises LLC Ming Texaco 121176/61-058-00700 OWNER: The owner of the underground storage tanks, EQUILON ENTERPRISES LLC certifies that we have provided the operator a copy of the monitoring and reporting requirements contained in Title 23, of the California Code of Regulations. Equilon certifies that we have provided the operator with a copy of the penalties of noncompliance as specified in Section 25299, chapter 6.7 of the California Health and Safety Code. Equilon Enterprises LLC 121176 SERVICE STATION MONITORING PROCEDURE 61-058-00700 Title 23 of the California Code of Regulations (CCR) requires that a written monitoring procedure be established for all underground storage tanks. This form is used to satisfy the information required in Section 2632 & 2641, Title 23, CCR. A Copy of this form will be maintained on-site (located inside the Equilon's Marketing Service Station Health, Safety and Environmental Manual also known as the Red Book) and a copy will be submitted to the local administering agency (inside of the Business Plan and inventory disclosure). Facility Name: Facility Address: Facility Telephone Number: Tank Owner: Telephone Numbers: Ming Texaco 3698 Ming Ave., Bakersfield, CA. 93309 (661) 834-2822 EQUILON ENTERPRISES LLC ATTN: SH&E DEPARTMENT P.O. BOX 7869 BURBANK, CA., 91510-7869 (818) 726-5078 or (661) 326-4326 As Operator, I am responsible for monitoring the underground storage tank system in accordance with Title 23, CCR. The following pages outline the specific monitoring procedures as required in Section 2632 or 264 I. My signature below confirms that I have read and understand my responsibilities as they pertain to tank monitoring, reporting, and records retention. Operator Signature Underground Storage Tank/Line Information Tank Type: Single Wall Tank Material: Fiberglass Monitoring Type: TLS-350 Monitor Manufacturer: Veeder Root Line Type Single Wall Line Material: Fiberglass Monitoring Type: TLS-350 Line Leak Detector: PLLD Monitor Manufacturer: Veeder Root Waste Oil Tank: None 121176 61-058-00700 REPORTING REQUIREMENT Any monitor that is discovered in Alarm (RED Lights On) or audible alarm is sounding or any monitoring that cannot pass the daily inspection test must be reported immediately to: Equilon Enterprises LCC SH&E Compliance Coordinator (818) 736-5078 Maintenance Coordinator (661) 326-4326 Training by Company Personnel Per manufacturer guidelines, the training necessary to operate the, tank and line monitoring system is performed by the authorized installation contractor. The location is also responsible for daily inspections of the monitoring panel, alarm Panel Test Log and corrective actions. Operator/Manager Each Individual alarm system is determined and located at the service station premises. Each Individual alarm system is activated by visually inspecting the alarm panel lights and pushing the appropriate audible alarm button. No impromptu repairs, changes, adjustments, etc. will be made to the monitoring equipment at the station. Designee It shall be the responsibility of the operator/manager to train the designee to perform alarm panel tests. It shall be the responsibility of the operator/manager to train the designee to perform physical inventories. Additional Releases Safety Features at the Service Station Inventory reconciliation as def'med by current lease. Equilon must be notified if the month end cumulative variation exceeds 1% sales and 130 gallons of monthly throughput. · Electronic Monitoring systems described above Physical Inventory · Annual Tightness Testing of Single Wall Lines (If required by the Local Implementing Agency ) · Annual UST Equipment Certifications 121176 61-058-00700 Double wall tanks are monitored by in tank gauging probes and there is a continuous electronic monitoring of the annular interstice space in each tank. A monthly status report of the annular space condition in each tank is completed at the end of each month. Hard copies of all test data will be maintained on-site in the ETM Results binder. Single wall tanks with Electronic Tank Monitors (ETM) will at a minimum comply with Section 2643, CCR: Electronically test each tank at least once per month after product delivery or when tank is filled to within 10% of highest operating level during previous month. The system is capable of detecting a release of 0.2 GHP. A Hard copy of all test data will be maintained on-site in the ETM Results binder. Single wall tanks with no eletronic monitoring equipment will be tested annually using the volumetric testing guidelines specified in Section 2643, CCR. Lines · All lines, Single wall or Double wall, are monitored by Pressure Line Leak Detection probes (PLLD). The sensor at 3 GPH every time the dispenser is used, and a 0.2 GPH leak rate once a month according to CCR, Title 23, Div 3, chapter 16 UST Regulations. Also the monitor is capable of a 0.1 GPH leak rate test once a year if mandated by the City Ordinance or Municipal code from Local Regulatory Agency. All product lines have Positive Shut Down and will stop the flow of product through the lines in the event of a leak. Some Double Wall lines are also monitored with either interstitial or sump sensors. Double wall fiberglass lines will have continuous sump monitors and line pressure monitors which are certified annually. Single wall lines: All single wall lines will be pressure tested annually according to Section 2643, CCR. And will be monitored with a line pressure device (mechanical or electronic) that is certified annually Tank / Line Testing or Certification Results: The Veeder Root System Installed at this location provides continuous electronic leak detection of the product tanks pressurized product lines. The system provides audible and visual alarms to notify the operator in the event that a leak is detected. Hard copies of the UST System test results will be completed at the station the first week of each month. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certification results will also be sent to the local agency by certified mail as required. Tank and line testing will be conducted by a qualified contractor and results of these tests will be maintained on-site and available for inspection. 121176 61-058-00700 Fuel Tanks Veeder-Root TLS-350 On a daily basis the operator / manager / designee will push the RED alarm test button which will indicate that the remote sensor and the monitor control panel are working as well as the condition of the alarm and that ALL FUNCTIONS ARE NORMAL. The RED and YELLOW lights will be observed to be OFF. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications results will also be sent to the local agency by certified mail as required. Ronan All electronic monitoring devises will be inspected for operation in accordance with section 2632, CCR. Copies of the UST Testing and certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications will also be sent to the local agency Red Jacket All electronic monitoring devises will be inspected for operation in accordance with section 2632, CCR. Copies of the UST Testing and certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications will also be sent to the local agency Dealer Inventory Rec. On a daily basis the dealer takes a physical inventory (stick reading) of the levels of the tank. Each day he subtracted sales from and added deliveries to the book inventory. His daily inventories are compared to the "book" inventory to give the dealer a cumulative reading. At the end of each month the dealer will compare his daily inventories to net his overage or shortage for the month-to- date and make a monthly report. These reports will be maintained on-site at the station and available for review during inspection. A copy of the report will be sent to the local agency by certified mail as required. Fuel Lines Veeder-Root TLS-350 On a daily basis the operator / manager / designee will push the RED alarm test button which will indicate that the remote sensor and the monitor control panel are working as well as the condition of the alarm and that ALL FUNCTIONS ARE NORMAL. The RED and YELLOW lights will be observed to be OFF. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection, UST Test/Certifications results will also be sent to the local agency by certified mail as required. 121176 61-058-00700 Ronan All electronic monitoring devises will be inspected for operation in accordance with section 2632, CCR. Copies of the UST Testing and certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications will also be sent to the local agency Red Jacket All electronic monitoring devises will be inspected for operation in accordance with section 2632, CCR.. Copies of the UST Testing and certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications will also be sent to the local agency Waste Oil Tank Veeder-Root TLS-350 On a daily basis the operator / manager / designee will push the RED alarm test button which will indicate that the remote sensor and the monitor control panel are working as well as the condition of the alarm and that ALL FUNCTIONS ARE NORMAL. The RED and YELLOW lights will be observed to be OFF. These copies of the UST Testing and Certifications will be maintained on-site at the station and available for inspection. UST Test/Certifications results will also be sent to the local agency by certified mail as required Dealer Inventory Rec. On a daily basis the dealer takes a physical inventory (stick reading) of the levels of the tank. Each day he subtracted sales from and added deliveries to the book inventory. His daily inventories are compared to the "book" inventory to give the dealer a cumulative reading. At the end of each month the dealer will compare his daily inventories to net his overage or shortage for the month-to- date and make a monthly report. These reports will be maintained on-site at the station and available for review during inspection. A copy of the report will be sent to the local agency by certified mail as required. 121176 61-058-00700 UNDERGROUND STORAGE TANK LEAK RESPONSE PLAN Tank Owner: EQUILON ENTERPRISES LLC ATTN: SH&E DEPARTMENT P.O. BOX 7869 BURBANK, CA., 91510-7869 Telephone Numbers: (818) 736-5078 or (661) 326-4326 If a Leak Detection Alarm or System is Activated: 1. Determine which tank system is involved. 2. Shut offpump and discontinue operations. 3. Call the Tank Owner Immediately. 4. Persons responsible for contacting the leak response unit / company and authorizing any work necessary. SH&E Compliance Coordinator (818) 736-5078 Maintenance Coordinator (661) 326-4326 5. Notify the local agency: City of Bakersfield Fire Department Phone-(661) 326-3979 6. Call911 (if necessary): The Methods and Type of Equipment Used for Removing Hazardous Substances. All unauthorized releases will be removed from the secondary containment by vacuum track. A licensed hazardous waste contractor will be called to perform the clean up and removal of hazardous substances. The location and Availability of Cleanup Equipment: Major Spills: A local licensed hazardous waste contractor. Minor Spills: A spill kit with absorbent is to be maintained and supplied by the operator. To dispose of small generated hazardous waste, the operator / dealer will call Equilon's Contractor for proper disposal A copy of this response plan should be maintained near the electronic monitoring system. A copy is also sent to the local agency. ~ 121176 SERVICE STATION MONITORING PROCEDURES 61-058-00700 Product Information Volume Regular Unleaded 10 Plus Unleaded 10 Premium Unleaded 10 Diesel 10 M-85 Waste Oil Tank Total Number of Tanks on Site: 4 Persons Responsible for Performing Monitoring: Manager Preventive Maintenance Schedule Daily Operator / Manager / Designee will perform equipment checks to ensure that monitors are operational. The Alarm Panel Test Log must be initialed by the person performing the daily equipment check (sample attached). Annual - (A) All monitoring equipment will be inspected and certified operational, according to manufacturer's specifications, by a licensed tank tester who is authorized and trained by the manufacturer. (B) Operational status will be reviewed on site by the Equilon SH&E Representative using the Equilon Service Station Audit Check List once a year. Records Retention All records associated with inspecting, certifying, testing, monitoring, and maintaining the UST system must be on site and available to Equilon / Agency auditors for a period of not less than three (3) years. 121176 61-058-00700 Tank and Line Testing Guidelines: All Simplicity monitors are continuously being monitored at a central office In Connecticut. Simplicity operators will notify each dealer and Equilon in the event that an alarm goes on at a station. They will also dispatch a service contractor to investigate those alarms and notify an Equilon Representative if any further action is required. Gas tanks are monitored by in-tank gauging probes. These probes are capable of testing at 0.1 and 0.2 leak rate. TLS-350R controller is programmed for Continuos Statistical Leak Detection CSLD which tests the tanks at 0.2 GPH leak rate. Hard copies of all test data will be maintained on-site in the ETM Results binder. In the event that an alarm is activated it will be the Operator's responsibility to investigate the cause and to notify an Equilon Representative if any further action is required. Gas tanks are monitored by in-tank gauging probes. These probes are capable of testing at a 0.1 to 0.2 GPH leak rate. Hard copies of all test data will be maintained on-site in the ETM Results binder. In the event that a Operator finds a reconciliation variance during physical inventories greater then the allowable variation, the Operator will begin the inventory discrepancy investigation procedures. The Operator will be responsible to notify an Equilon Representative if any further action is required. Inventory is taken on daily basis. Each month will have a monthly report which will be maintained on-site. Individual Training Record Employee Name Acknowledgement: By signing this form, I hereby acknowledge that I have attended the training sessions listed, and I understand the content and my responsibilities in these areas. Date Training Topic Employee's Trainers Signature Name Required HazCom (Hazard Communication) Hazwoper (Hazardous Waste Operations and Emergency Response) Lockout]Tagout (Control of hazardous energy sources) RCRA (Resource Conservation & Recovery Act) RECOMMENDED Freon Recycling (as applicable) Spill Containment & Control Robbery Deterrence Waste Management Safe lifting Accident Reporting Fire Prevention & Evacuation Plans Personal Protective Equipment TSCA (Toxic Substance Control Act) Safe Food Handling (as applicable) Service Bay Safety (as applicable) Civil Disturbance response Natural Disaster Response Use of Fire Extinguishers Individual Training Record Date Training Topic Employee's Signature Trainer's Name SI-lOPPING CF:NTEI~ Z i---TI~ASI4 . ~ I .ENCLOSUI;21= t0.00o ~L ) I0,000 I=L ) i=L '~ .:~ .... . IO,OOO FL ) I ' , ~.ooor~ ', \ ¢1¥P.) \ TANKS D~IVE rv LU Z LU 0 MING ROAD SI-lOPPING CENTIE~ TEXACO REFINING & MARI~R~TING INC. 3698 MING ROAD I~ I~E~AL I~OAD BAKEI~E~IIELD, CAI..tF'O~NA 93309 ClTT OP BAKEI~SI=IELD 51-O,58-O7OO SCALE, I - ,4.O'-O' T5265 NS SITE MAP SYMBOLS F I;~:~ EXTINe~IJI$1-11--~ EME. I~GENCY S-IUT-OPt= EVACUATION/$TAGIN(.~ AliSA MSD$ STO~AGI~ LOCATION BIJSN~SS PLAN LOCATION ISPILL "l ,C0NT~O~-I SPILL CONTI~OL EQUlP~ EL.~CTDCAL S4UT-OPP WATE~ SNUT-OPP GAS $1-4UT-OI=P EVACUATION ~OUTP-. P STORM D~AIN UNDErGrOUND TANK FLAMMABLE LIQUID STATE OF CAUFORI~tA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A Location Number 610580700 COMPLETE THIS FORM FOR EACH FACILITY/SITE MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] ? PERMANENtlY CLOSED. SITE ONE ITEM [] 2 INTERIM PERMIT E~] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) ADDRESS 3698/MING AND REAL CI'TY' NAME BAKERS FI ELD NAME OF OPERATOR Darrin Halbrook STATE ZiP CODE CA 93309 PA.~a. ~ (OP110N,~ v' BOX [~ CORPORATION ~ iNDIVIDUAL E~ PARTNERSHIP ~ LOCAL*AGENCY ~ COUNTY.AGENCY' ~ STATE-AGENCY ° ~ FEDERAL.AGENCY' TO INDICATE 01STRICT$ ' if o~mer nt MST [sa pubic ~ency. cnm01ete the followinG: name N supe~mor o~ divi.~, secti~ or DE, Ce whic~ o~emtes the UST TYPE OF BUSINESS [~ 1 GAS STATION ~'-] 2 DISTRIBUTOR= 3 FARM = 4 PROCESSOR ~ $ OTHER [ ~ ,/ ,F iNDIAN ,, OF TANKS AT SITE I E. P.A.I.D.,(o, otiona,)~oRRESERVATIONTRuST LANDS ,' ~- EMERGENCY CONTACT PERSON (PRIMARY} EMERGENCY CONTACT PERSON (SECONDARY} - optional DAYS: NAME (lAST. FIRST) PHONE ~ WITH AREA COOE DAYS: NAME (LAST. FIRST) ~ PHONE ~ WITH AREA CODE Darrin Halbrook 805.834.2822 ~._~%--k~-~, ~-~-~ ~o~-~F..%~-- ~..~ NIGHTS: NAME (LAST. FIRST"; PHONE ~t WITH AREA COIDE NIGHTS: NAME (LAST, FIRST') PHONE ~t WITH AREA CODE II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) NAME C~O~'~,O~niversal City, CA 91608 Equilon Enterprises LLC MAILING OR STREET ADDRESS v' i~x ~o kxf~.ate ~ ~ND~ ~ L~-AG~Y ~ STA~.AG~Y P.O. Box 4453 ~ CORPORATION ~ PA~S"IP ~ ~U~'~Y ~ ~'~ CI~ NAME STATE III. TANK OWNER INFORMATION - (MUST 8E COMPLETED) NAME OF OWNER CA~O~NF~Nuniversal City, CA 91608 Equilon Enterprises LLC MAILING OR STRE~ ADDRESS ~ ~x t0 ~te ~ ~DIVIDU~ ~ L~AL-AGE~Y ~ STA~-AG~CY P.O. Box 4453 ~ CO~.O~ON Cl~ NAME STATE Houston TX IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 322-9669 if questions arise. TY(TK) HQ [~'~-~ I-~ I~ ~1~ I V. PETROLEUM UST FINANCIAL RESPONSIBILITY - (MUST BE COMPLETED) - IDENTIFY THE METHOD(S) USED v' ~]toindlo~te ~ 1 SELF.iNSURED ~ 2 GUARANTEE E~ 3 INSURANCE [~ 4 $1JRETYSONO [--'1 5 I.ETTEROFCREDFF E~ 6 EXEMPTION E~ 7 STATEFUNO [--"] 8 STATEFUNO&CHIEF FINANCiALOFFICERLETTER ~ 9 STATEFUNO&CERT'.FICATEOFOEPO$IT ['-'] tO LOCALGOV'T. MECHANISM ~ 99 O"{%IER, VI. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ITANX OWNER'S NAME (PRINTED & SIGNATURE) ~%, I TANK OWNER'S TITLE I SH&E Coordinator LOCAL AGENCY USE ONLY -- COUNTY it JURISDICTION it LOCATION CODE - OPTIONAL FACILITY CENSUS TRACT # - OPTIONAL I 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. OWNER MUST RLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM A Location Number 610580700 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK MARK ONLY [] 1 NEW pERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 7 PERMANENTLY CLOSED ON SITE1 ] 8 TANK REMOVED DBA OR FACIIJ3Y NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION coMPLETE AU_ ~TEMS - SPECIFY IF UNKNOW. ~. OWNER~ TANK I.O., C. DATE INSTALLED (MO~AY/YEAR) D. TANK CAPACITY IN GALLONS: '1 0 ~, 0 0 0 II. TANK CONTENTS ~F ^4 ,s MARKED, COMPLE-m ITEM C. A. [] 1 MOTOR VEHICLE FUEL [] 4 OIL B. C. [] la REGULAR UNLEADED ~ 3 DIESEL [] 6 AV1ATIONGA~ [] 3 CHEMICALPROOUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] 99 031-1ER(DE$CRISEINFrEMD. BEL0W) O. IF (A.I) IS NOT MARKED. ENTER NAME OF SUBSTANCE ~TORED C.A.S.#: IlL TANK CONSTRUCTION a~J< ONE ITEM ONLY IN BOXES A. B, AND C, AND ALL THAT APPUES IN BOX O AND E A. TYPE OF [] 1 DOUBLE WAIL [] 3 S~NGLE WALL ~ EXTFJ~IOR LINER SYSTEM [~ 2 SINGLE WALL [] , SINGLE WALL I. A VAULT [] 5 I~ BLADi~-.R SYSTEM [] 95 UNI<]'KTNN ] 99 OTHER B. TANK [] I BARE S'r~EL [] 2 STAINLESS STEEL [] 3 FIBERGLASS MATERIAL [] $ CONCRETE [] 6 POLY~NYL CHLORIDE [] 7 ALUMINUM (Prillla~Taltk) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 S'rEEL CLAD WI FIBERGLASS REINFORCED PI.~ST[C ] 8 100% METHANOL COMPATIBLE W/~RP ] 99 OTHER C. INTERIOR [] ! RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY UNING LINING OR [] 5 GLASS UNING [] $ UNUNED [] 95 UNKNOWN COATING is UNING MATERIAL COMPATIBLE WITH 100% METHANOL? YES ~ NO~ ] 4 PHENOliC UNING [] 99 OTHER D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING CORROSION PROTECTION [] s CATHOOICPROTEC'nON [] 9~ NONE SPILL CONTAINM~TALLEq (YEAR) F- SPILL AND OVERFILL, etc. DROP TUBE YES ,/ -~ NO ~- [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED Pt. ASTiC [] 95 UNKNOWN [] 99 OTHER OVERFII..~p~.EVENTION EQUIPMENT INSTALLED (YEAFI) NO ~:: STRIKER PLATE YES ~ NO - DISPENSER CONTAINMENT YES ~ IV. PIPING INFORMATION CIRCLE A IF ABOVE GRQUNO OR U IF UNDERGROUND. SeTH IF APPUCABLE A. SYSTEMTYPE A U 1 SUCTION A U~2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING B. CONSTRUCTION /4('tJ/)~ SINGLE WALL A U 2 DOUBLE WALL A U 3 UNED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION BARE STEEL A U 2 STAINLESS STEEL k U 3 POLYYtNYL CHLORIDE (PVC~/A~U)· FIBERGLASS PiPE ALUMINUM A U 8 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP GALVANIZED S'F~EL A U 10 CATHOOICPROTECTION A U 95 UNKNOWN A U 99 OTHER O. LEAK DETECTION V. TANK LEAK DETECTION [ [] , VISUAL CHECK [] 2 MANUAL INVENTORY I---] 3VADOZE [] 4 AUTOMATIC TANK []5 GROUND WATER [] 6 ANNUAL TANK [ RECO<,UA~,ON MO.,TO",.~ ~U~'NG MO.,TOR,NG TES~NG ~ , coN~.uous,.TERSTI~AL [] , si. [], W~<LY ~.UAL [] ,o MO.~LY ~ANK [] 95 u. KNow.' [] ~ OTHER , . MO.,TOR,.~ ~'AN,~eA~,NG TESTING VI. TANK CLOSURE INFORMATION (PERUANE~ CLOSURE IN-PLACE) 1. ES33MATEO DATE LAST USED (MO/OAY/YR) 2. ESTIMATED QUANTITY OF ~ 3. WAS TANK FILLED WITH YES ~ NO r'~ SUBSTANCE REMAINING GALLONSI INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I TANK OWNER~ NAME · ~ r, ~ ~ I (PR~n~&Sm.A~ Feryal Sarrafian / Fred Long LOCAL AGENCY USE ONLY THE STATE I.D, NUMBER IS COMPOSED OF THE FOUR NUMBERS BEL0~ I COUNTY # JURISDICTION I~ FACILITY # TANK # I I THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN RLED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT Pt. AH. RtE TI. IlS FORM ~ THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TAHK REGULATIONS FORM 8 (6-95) Location Number 610580700 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICAIION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] ONE ITEM [] 2 INTERIM I~RMIT [] , A,'WENOED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 7 PERMANENT1.Y CLOSED ONSITE~ 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COa~=TEAU. iTE~S-SPECI~rl;UNKNOW. A. OWNER*~ TANK I. O. # C. DATE INSTALLED (MO~AY/YF_AJ:I) IB. MANUFACTURED BY: D. TANK CAPACITY IN GALLONS: 1 0 ~ 0 0 0 II. TANK CONTENTS ,; A-1 Is MARKED. COMPLETE ITEM C. ~ , ~OTOR v~,c,~ ~EL [] , OIL ,. c. [] '" "~" ~"-~= ~ ~ ~'~ss~ ~ ' *~*~"~ ~ 3 C"~IC~PRO~CT ~ ~ UN~O~ ~ 2 W~ ~ 2 ~ED ~ ~ D. IF (~1) IS ~T ~. E~R ~E ~ SUB~E ~ORED C. ~ $. I: IlL T~K CONS~UC~ON ~ONEI~ONLYIN~XES~B, ANDC,~D~AT~PUESIN~XD~DE A. TYPE OF [] 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR UNER [] 5 INTERNAL BL~e~:)OER SYSTEM [] 95 UNKNOWN SYSTEM ~' 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT [] 99 OTHER a. TANK [] 1 Sa,qE STEEL [] 2 STAINLESS STEEL ~' 3 FIBERGLASS [] 4 STEEL CLAD W/mBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLY¥1NYL CHLORIDE 'C...-~ 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (Prill~l~Tallk) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [~ 1 RUBBER UNED [] 2 ALKYD LINING [] 3 EPOXY UNING [] 4 PHENOuC UNING UNINGOR ~ s GLASS lINING [] 8 UNLINED [] 95 UNKNOWN [] 99 OTHER COATING ~S UNING MATERIAL COMPATIBLE vvm-i 10o% METHANOL? YES~ NO~ O. EXI~RIOR [] 1 POLYEmYLENE WRAP [] 2 COATINO [] 3 V,N'~. WR~ ~ * mBERGLASS R~:JNFORCED ~C CORROSION PRO~C~ON ~ 5 CA~OOICPRO~C~ ~ 91 NONE ~ ~ UN~O~ ~ ~ O~ER SPI~ CO~NNM~T~D ~R) OVERR~E~ON EQUIPMENT IN~ED (Y~) E SPILL AND OV~FILL, ~c. DROP ~BE YES ~ NO : ~I~R P~ YES / ~ NO.., DISPENSER CO~AINME~ YES NO X IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~ 2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER 8. CONSTRUCTION 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 UNED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION BARE STEEL ALUMINUM GALVANtZED STEEL A U 2 STAINLESS STEEL A U 3 FOLY~nNYL CHLORIDE(PVC)Jt~ 4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL WI COATING AY 8 100% METHANOL COMPATIBLEW/FRP ALI 10 CATHOOICPROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [~1~ ~ET~CT~It~CHNaCAL U~ ~ ~.~~ ~-]3 ~MO~T~G ,NTERSTm~ ~ ~=CTR~ICD~E'CTOR~ ~5 AUTOMATlC~ mJM~ [] 9~ OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK [] 2 MANUAL INVENTORY [] 3 VADOZE [] 4 AUTOMATIC TANK []S GROUND WATER [] 6 ANNUALTANK I RECONCI"ATION MD.lTD"lNG GAUGING ~ONITORINO TESTINGI [] . CO.~.UOUS~N,TOR,.~ ,.~S~TI*~ [] , s,R [] * TA.KW~<LYGAU~,.GMANUAL [] '0 TES~.G~'O~L¥ TAN~ [] ~. U.KNO~' ~ ~ O~ER J VI. TANK CLOSURE INFORMATION (PER~ANENT CLOSURE ,N-PLACE) 1. ESTIMATED DATE LAST USED (MO/OAY/YR) I 2. ESTIMATED QUANTITY OF I3' wAS TANK F1LLEo wITH YES[] NO[] SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT 1 (PR~I~D&S~a~.E% Feryal Sarrafian / Fred Long 6-11-98 LOCAL AGENCY USE ONLY T~E STATE I.D. NUMBER ~S COMPOSED OF mE FOUR NUMB~ COUNTY t~ JURISDICTION ~ FACILITY ~ TANK # 't~ STATE I.D.'# ~ I I I I [I I I III t I [ THIS FORM MUST RE ACCOMPANIED 8Y A PERI, lIT API~lCATION - FORM A, UNLESS A CURRENT FORM A NAS BEEN FILED. FORM ¢ MIJST BE COMPLETED FOR EiSTALLA'I1ONS. THIS FORM ,~OIJLD BE ACCOMPANIED aY A PLOT PLAN. RLE THIS FORM wm,I TNE LOCAl. AGF. J~Y IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B (6..~5) Location Number 610580700 -- STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERUiT APPLICAIION -FORU B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION ONE rrF,.M [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ] 7 PERMANENTLY CLOSED ON SITE~ ] 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION co~"'~rE ~_ ~TEMS - SPECI~ ~F UNKNOW. C. DATE INSTALLED (MO/13AY/YEAR) 0. TANK CAPACIT~ IN GALLONS: 1 0 ~ 0 0 0 II. TANK CONTENTS ~F A*~ IS ~ED, COMPS'rE ITEM C. III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, AND ALL THAT APPUES IN BOX D AND E A. TYPE OF [] ~ ~ousLE w~J. SYSTEM ~ 2 StNGCF. w~LL ] 3 S~NGLE WALL WITH EXTERIOR UNER ] 4 StNGI. E WALL IN A VAULT [] 5 INTERNAL ELA~DER SYSTEM [] 95 [] 99 OTHER B. TANK [] 1 BARE STeEL MATERIAL [] s CONCRETE (Primm'yTa~lk) [] 9 BRONZE [] 2 STAINLESS STEEL [-X--] 3 FIBERGLASS [] 6 POLYV1NYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLAb'~C ] 8 100% METHANOL COMPATIBLE W/FRP ] 99 OTHER C. INTERIOR LINING OR COATING [] ~ RUEEER UNEO [] 2 AL~O UN,NG ~ 5 GLASS UNING [] 6 UNENEO IS ENING MATERIAL COMPATIBLE WfTH 100% METHANOl? [] 3 EPOX~ lINING [] 4 PHENOLIC lINING [] 95 u.~.ow. [] 95 oTHER YES~ NO~ D. EXTERIOR CORROSION PROTECTION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 5 CATHO01C PROTECTION [] 91 NONE SPILL CONTAINMEI~,,,INSTA~D, (YEAR) F_ SPILL AND OVERFILL, etc. DROP TUBE YES ~ NO.'L [] 3 VIN'~. WRAP ~] 4 FIBERGLASS REINFORCED PLASTlC [] 95 UNKNOWN [] 99 OTHER OVERFILk~REVENTt~N EQUIPMENT INSTALLED (YEAR) STRIKER PLATE YES ~ NO ,x_ DISPENSER CONTAINMENT YES ~ IV. PIPING INFORMATION CtRCLE A IF ABOVE GROUND OR U IF UNDERGROUNO. BOTH IF APPLICABLE A. SYSTEUTYPE A U 1 SUCTION A~,.,)2 PRESSURE A U 3 GRAVITY B. CONSTRUCTION ~/U,/1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 4 FI_EXlBLEPIPING A U 99 OTHER A U 95 UNKNOWN A U gg OTHER C. MATERIAL AND A U 1 BARE STEEL CORROSION A U 5 ALUMINUM PROTECTION A U 9 GALVANIZED STEEL A U 2 STAINLESS STEEL A U 3 FOLYVINYL CHLORIDE (PVC)A U~.~ 4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 10 CATHOOIC PROTECTION A U 95 UNKNOWN A U 99 OTHER V. TANK L~K D~C~ON ~NITORING T~K GAUGING TES~NG VI. TANK CLOSURE INFORMA~ON (PERM~E~ CLOSURE IN-P~ II. ESTIMATED DATE ~ USED (MO/OAY/YR) SUBSTANCE REMAINING GALLONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT Sarraf~an / Fred Long °~-~11-98 (.R~ & ~m.*~Rm Feryal ' LOCAL AGENCY USE ONLY THE STATE LO. NUMBER IS COMPOSED OF THE FOUR NUMBERS B~ COUNTY # JURISDICTION it FACILITY # TANK it '/ STATE I.D.'# ~ II I I PERMIT NUM,ER j PERMIT,~P.OVED I I ~ SE A~OMP~I~ BY A P~T ~ R~ ~ ~ ~ ~E L~ AG~Y ~p~ ~E ~ROUND STO~GE T~K REGU~ Location Number 610580700 -_ STATE OF CAUFORNIA STATE WATER RESOURCES coNTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORU B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEVi/ PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] ONE rTEM [] 2 INTERIM P~RMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 7 PERMANENTLY CLOSED ON SJTEI 8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION co~-TE Au. ITEMS - SPECIFY IF UNKNOWN IA. OWNER~ T~K I. D. ~ I B. ~UFAC~RED BY: C. DA~ IN~ (~AY~) ~ D. T~K C~ACI~ IN ~ONS: 1 0 ~ 0 0 0 II. TANK CO~S ~ ~-~ ~s ~D, couP~ ~M c. A. [] ' MOTOR VEHICLE FUEL [] 4, OIL B. C. [] 1, REGUtAR UNI. EN3ED ~ 3 DIESEL ~ , A~A~O~ III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B. ANDC, ANOALLTHATAPPUESINBOXDANOE TYPE OF [] I DOUBLE WALL [] 3 S~NGLE WALL ~ EXTERIOR UNER SYSTEM ~[ 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT ] 5 INTERNAL BLAD(3ER SYSTEM [] 95 ] 99 OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (Prtmary Tank) [] 9 BRONZE [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 6 POLY~NYL CHLORIOE [] 7 ALUMINUM [] lO ~LVAN,ZED s'r~EL [] 95 UNKNOW ] 4 STEEL CLAD W/F~BERGLASS REINFORCED PLAS~C ] 9 100% METHANOL COMPATIBLE W/FRP ] 9~ OTHER C. INTERIOR [] 1 RUBBER LINED [] 2 AU<YO UNING [] 3 EPOXY UNING [] 4 PHENOUC LINING LINING OR [] 5 GLASS UNING ['~ 6 UNLINED [] 95 UNKNOWN [] 99 OTHER COATING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL? YES~ NO~ D. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYl. WRAP CORROSION PROTECTION [] 5 CATHODIC PROT~CTION [] 91 NONE [] 95 UNKNOWN [~4 FIBERGLASS REINFORCED PLASTIC ] 99 OTHER SPILL CONTAINMENT~'ALLED Ct'EAR) OVERFI~:L~REVENT1ON E,&QUIPMENT INSTALLED (YEAR) __ NO /~ E- SPILL AND OVERFILL, etc. DROP TUBE YES ~*~ NO' ~ STRIKER PLATE YES ~ NO. :~ -- DISPENSER CONTAINMENT YES IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM~PE A U 1 SUCTION A(~'~2 PRESSURE A U 3 GRAVITY A U 4 FLEXIBLE PIPING A U 99 OTHER B, CONSTRUCTION ~1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND C0RROSION PROTECTION A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A~'O~ 4 FIBERGLASS PIPE A U S ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A'0' 8 100% METHANOL COMPATIBLEW/FRP A U g GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER V. TANK LEAK DETECTION [] , v,su^L C.ECK [] . ~.UAL ,.VENTORY [] ~ V~OZE []. AUTOMATIC TANK [] 5 GROU"O WATE. [] s ANNUALTANK .EOONC.'^TIO. MO..ORING ~*UG~ MON.ORIN~ TE~NG i ~] 7 CONTINUOUSMONiTORING INT~:'clST~TIAL [] 8 SIR [] ~ TANKWEEKLYGAuGINGMANUAL [] 10 TESTINGMONTHLY TANK [] 95 UNKNOVVN ' [] 99 OTHER VI. TANK CLOSURE INFORMATION (PERMANENT CLOSURE IN-PLACE) I1' ESTIMATED DATE LAST USED (MO/OAY/YR) THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I TANK OWNER'S NAME DAT~ (PR~TEO&~A~IJ"m Feryal Sarrafian / Fred Long 6-11-98 LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER iS COMPOSED OF THE FOUR NUMBERS BELOW"' COUNTY PERMIT NUMBER I PERMIT APPROVED BY/CATE I PERMIT EXPIRATION OATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPliCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM C uUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD BE ACCOMPANIED BY A PLOT PLAN. RLE THIS FORM WITH THE LOCAL AGENCY IMPLEMENTING THE UNDERGROUND STORAGE TANK REGULATIONS FORM B Location Number 610580700 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] I NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ONs l ONE FrF. M [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED i DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION coMPLETE AU. ITEMS - SPECIFY ~F UNKNOWN A. OWNER~ TANK 1. O. t ~,. MANUFACTURED BY: C. DATE INSTALLED (MO/DAY/YEAR) O. TANK CAPACITY IN GAU.ONS: 5 5 0 II. TANK CONTENTS iF A-, IS ..~KED, COMF' '-:'m ITEM C. III. TANK CONSTRUCT3ON ~UU~K ONE ITEM ONLY I. BOXES A. B. AND C, AND ALL THAT APPLIES IN BOX O AND E A. TYPE OF [] 1 DOUBLE WAll [] 3 aNGLE WALL WTT~I EXTERIOR UNER SYSTEM [] 2 SINGLE WALL [] 4 SINGLE WALL IN A VAULT ] 5 INTERNAL BI.a/:X:3ER SYSTEM [] 95 UNI<NO~N ] 99 OTHER B. TANK [] 1 BARE STEEL MATERIAL [] ~ CONCRETE (Primal'yTattk) [] 9 BRONZE [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] $ POLY%/tNYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PL.AS~C ] 8 100% METHANOL COMPATIBLE W/FRP ] 99 OTHER C. INTERIOR [] 1 RUBBER UNEO [] 2 ALKYD UNING UNING OR [] 5 GLASS LJNING [] 6 UNUNED COATING ~s LINING MATERIAL COMPATIBLE WITH 100% METHANOL? [] 3 EPOXY UNING [] 4 PHENOLIC UNING [] 95 UNKNOWN [] 99 OTHER YES__ NO__ 0. EXTERIOR [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC CORROSION PROTECTION [] 5 CATHOOIC PROTECTION [] 91 NONE [] 95 UNKNOWN [] 99 OTHER SPILL CONTAINMENT INSTALLED (YEAR) OVERFILL PREVENTION EQUIPMENT INSTALLED (YEAR) E. SPILL AND OVERFILL, etc. CROP TUBE YES __ NO STRIKER PLATE YES __ NO DISPENSER CONTAINMENT YES NO IV. PIPING INFORMATION CIRCLE A IF ABO__VE~_G..ROUNO OR U 'FUNDERG/,,R,?,~D. BOTH IF APPUCABLE B. CONSTRUCTION ~2 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 UNED TRENCH A U 4 FLEXIBLE PIPING A U 99 OTHER A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION A U 1 BARE STEEL A U $ ALUMINUM A U 9 GALVANIZED STEEL A U 2 STAINLESS STEEL A U 3 POLYV1NYLCHLORIDE(PVC)A U 4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 10 CATHOOIC PROTECTION A U 95 UNKNOWN A U 99 OTHER O. LEAK DETECTION [] ~ MEC~C~ U~ ~ [] 2 u< nc~T~r~ss [] 3 ~ ~ ~ 4 ~ ~ ~ S A~ ~ ~ ~ O~,R V. TANK LEAK D~C~ON ~ 1 VISUAL CHECK ~ 2 ~U~ [~E~ORY ~ 3 V~ZE ~ 4 AUTOMA~C TANK ~ 5 GROUND WATER ~ 6 ~NUALT~K ] ONIT ,NG u ,NG .ITOR,. ~ 7 CO~NUOUSIN~S~ ~ , SIR ~ ' ~LY ~U~ ~ 10 MOLLY TANK ~ 95 UNKNOt' ~ ~ O~ER ~NITO.,NG T~ GA~,~ TES=N~ VI. TANK CLOSURE INFORMA~ON (~RM~ CLOSURE 'N-"~a SUBSTANCE REMAINING GAllONS INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT 6-11-98 ~ TANK OWNERS NAME ~ % ~ ~, I (Pn~&s~.m.m Feryal Sarrafian / Fred Long ~ ,~~ LOCAL AGENCY USE ONLY ~E ~Am I.D. NUMBER IS COMPOSED 0F mE FOUR N~S~ 1 I COUNTY # JURISDICTION It FACILITY # TANK i~ I STATE I.D.'# ~ I I I I I I I I I I I I I I I ll ll ! THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPIJCATION - FORM A, UNLESS A CURREHT FORM A HAS 8F.E~ FILED. FORM C MUST BE COMPLETED FOR INSTALLATIONS. THIS FORM SHOULD SE ACCOMPANIED BY A PLOT PLAH. FILE 11.11S FORM WITH THE LOCAL AGENCY IMPLEMEHTIHG THE UNDERGROUND STORAGE TANK REGULATIONS FORM S (6..05) 8-82-1999 9:02AM FROM R.J. MYERS CO. INC. 8187026~84 P. 1 DATE: TO: FROM: R. J. Myers & Co., Inc. ENVIRONMENTAL COMPLIANCE CONTRACTOR P. O. BOX 191 CANOGA PARK, CALIFORNIA 91305 818-702-6470/818-702-6484 FAX NUMBER OF PAGES: MESSAGE: IF YOU DO NOT RECEIVE THE SPECIFIED NUMBER OF PAGES, PLEASE CALL US IMMEDIATELY AT 818-702-6470. CONT. LIC. #330631 (B-C61) SERVING THE PETROLEUM INDUSTRY SINCE 1967 .~ 8-~2-1999 9=O~AM FROM R.J. MYERS CO. INC. $187026484 ENVIRONMENTAL COMPLIANCE CONTRACTOR P. O. BOX 191 CANOGA PARK, CA 9'1305 818-702-6470 / 818-702-6484 FAX TO: FROM: RE: Bakersfield Fire. Butch Karn R. J. Myers & Co.,'lnc'. Testing Scheduie R. J. Myers and Co., Inc. will be performing the following tests at the location listed below on Monday..Auqust 9 . .,1999 at 10:00 A.M. Texaco Service Station: 3698 Ming' Bakersfield,' Ca. Tests to be performed: Monitor Certification If you have any questions, please call me at (818) 702-6470 or Fax (818) 702-6484. Thank you, Butch Karn Project Supervisor CONT. LIC//330631 (B-C61/HAZ D-40) SERVING THE PETROLEUM INDUSTRY SINCE 1967 D February 9, 1999 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICE8 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENI/IRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAINING DMSION 5642 VIctor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Texaco 3698 Ming Ave Bakersfield, CA 93309 RE: Compliance Inspection Dear Underground Storage Tank Owner: The city will start compliance inspections on all fueling stations within the city limits. This inspection will include business plans, underground storage tanks and monitoring systems, and hazardous materials inspection. To assist you in preparing for this inspection, this office is enclosing a checklist for your convenience. Please take time to read this list, and verify that your facility has met all the necessary requirements to be in compliance. Should you have any questions, please feel free to contact me at 805-326-3979. Sincer/~y, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure CITY OF BAKE]~Io IELD OFFICE OF ENVIRONMENTA I, SERVICES 1715 Che~ter Ave., Bakersfield, CA (805) 326-3979 POgT CARD AT JOB SITE , c~.z~p Pemit # I_NSTil.UCJ'IONS: PI~ carl for an ~czflywl~e~hN~,oup of~ ~tl~mu~mml~r ~r~vmdy. Thoywili nmin~~,d~rla~mi~withmmhr Eloc~c...q lsols,.fia~ of Piping Fr~n Tzni~s) C,O~ic Prot~tio~ S.v~xem-Piping D isper..~x P~ SECONDARY CONTAINMENT. OVERFR. L PROTECrlON. LEA~ D~ON Vault With Product l.~vel Oau$cs m' Semo~ Dim Vcra Valves Product ¢ompuible Fill Product Li~ Leak Deu~o,s) ~ [X. tect~s) for Annt~l Spa~-D.W. 'lank(s) Monitoring Well(s)/Sum~s) - H20 ~ Dg~.ccion Device(s) for Vulo~~ Spill Prevention Boxes FINAL CONTRACTOR CO,'ffTACT MOmtOnng Well& Caps Fill Momtormg Requimr. a~u Typ~ , . LICENSE # PHONE # CITY OF BAKE~IELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 rNSFECTION RECORD POST CARD AT SOB SITE ci~.Zip ~¥ ~ ~ 1%. INSPECTION DATE l~c. kfill of Tank(s) Spark Tes~ ~on ~ ,Vlanufa,nm~ M~xl Cathodi~ Prote~on of TankJs) PIPING SYSTEM Piping & ~y w/ColMmon Sump Con'm, im Prot~ion of Piping, Joints. Fill Pipe Elec~ical L~olntion of Piping From Tank(s) Cathodic Protection System-Piping Dispem~ Pan SECONDARY CONTALN.'MENT. OVERFILL PROTECTION. LEAK DETECTION Liner installation - Tank, s) Vault With Product COmpa~ble Sealer L~el C~uges or Serno~. Ho~t V~ V~ ~ C~ble Fill ~) ~a ~e ~ ~s) .... ~ ~s) for ~ S~D.W. T~s) M~t~g Weli(s~S~s) - H20 T~ ~ ~ ~s) f~ V~~ Spill ~i~ ~ FIN~ MO~Utonng Well~. C~os & ~ Fill Box Lock MOmtormg Requu'em~'n~ Typ~ ,, , ONTRACTOR O,'qTACT LICENSE # PHONE # CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY ~ODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE ~' i ~ (~ ., PROPOSED COMPLETION DATE C~.._ ~/~ 7~ FACILn'Y NAME 7-~=,W~__.,~ :~-.,-",~O,V EmST~O FACmrrY ?ERMrr NO. FACILITY ADDRESS c~k~(:~ ,~"Y~/,q~ ~'~CITY ~~~f..~ ZIP CODE TYPE OF BUSINESS ~ ¢~r;~;~C)'q' -- TANK OWNER "~ PHONE NO. ADDRESS/z~ ~/,,;/V_ .,~._4:Zz/,or~/ucrn,/./z;I V~~ ~ ~ CODE CO~CTOR ~ ~.~~/2~ ~ _ ~ ~AUC~ENO. ~D~SS/~ ~~~~ ~ C~W~~ ~ ~CODE PHO~ NO. ~ ~~ ~~ B~~).~C~U~SS UC~SE NO. WO~ CO~ NO.~~ S~~1 ~S~ ~U ~, ~~ ' B~YDESCmn~WO~TOBE~ ~t~ ~,~~~ ~~ ~t~ '~~, WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE NO. OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE .YES. NO .YES NO SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION TANK NO. VOLUME SECTION FOR NON MOTOR FUEL STORAGE TANI~ CHEMICAL STORED CAS NO. CHF2vIICAL PREVIOUSLY STORED (NO BRAND NAME) (n: KNOWN) FOR OFHCIAL USE ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY wrrH THE ATrACHED CONDrrIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS THIS APPLICATION BECOMES A PERMIT WHEN AffPROVED"'~. \ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ INEW FACR,ITY ~MOD1FICATION OF FACILITY [ J1VEW TANK INSTALLATION AT EX~STING FACILITY' STARTING DATE ~" FACILITY NAME '7"~~ r~';'F(D,6/ EXISTING FACILITY PERMIT NO. FACILITY ADDRESS ~'Y TYPE OF BUSh, mSS ~ r%-r~;vzC~,,f APN # ADDRESS/~ ~,///~~~_.~ ~ CONTRACTOR /~. ~7.~-~,,~-flL~ ~ , i ~ALICENSENO.~ ADD.SS/..'? ~ ~~ ~,~ cnv~,~,/~O~a,, ZZ~C ZmCOD~ PHONE NO. ~:~; Z.~'~'~. ~'~?~ BAX~P, SFmLD crr~u~I~SS LIC~E~.SE NO. - WOP, r, MA~ COMP NO.Af .?Z,~ 1 Bmmm.¥ DESCRm~- THE WO~ TO WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT srrE NO. OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE __YES NO SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREMIUM DIESEL AVIATION TANK NO. VOLUME SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) ~ KNOWN) FOR OFFICIAL USE ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERM1T AND ANY OTHER STATE, LOCAL AND FEDERAL KEGUI~TIONS. TH~S FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS THIS APPLICATION BECOMES A PERMIT WHEN AI~PROVED'"~ -- ROUNDWATER - IVI NAG EU ENT Tank Upgrades Compliance Testing Soil & Groundwater Sampling CERTIFICATION Test Date: A2ri{ L 1998 Job #: 98-0016 COMPANY: Texaco Refining and Marketing Inc. 3663 Gibson Street Bakersfie[d CA 93308 SITE: Texaco #:61058000700 3698 Ming/Rea{ Ba[tersfie{d CA 93309 TANK NUMBER.. TANK PRODUCT: TANK SIZE: TANK INOCULANT: TANK RESULT: 1 Premium I0,000 Al7 Pass 2 Unleaded I0,000 C66 Pass 3 Un{eaded I0,000 R39 Pass 4 Diese[ I0,000 W12 Pass Gar~ Swenson Licmscd Technician 97-1428 Liccnsc Number: P.O. BOX 8400 · MESA, ARIZONA 85214 · (602) 926-3000 · (800) 639-5151 ° FAX (602) 926-0331 APR-09-1998 15:56 TRACER RESEARCH 5~02931~06 T~ac~r Research ;Iob No, 300332 Page 2 Sampl~ Date: 4/7/98 Location CONDENSED DATA Compound Concentration(mg/L) 001 A 001 C 00I R ~1 W 00I TVHC 002 A 002 C 002 R 002 W 002 TVHC OO3 A O03 C 003 R 003 W 003 TVHC 004 A 004 C 004 R 004 W 004 TVHC 005 A 005 C 005 R OO5 W 005 TVHC 006 A 006 C 006 R 006 W 006 TVHC 0.0000 0.0000 0.00(X) 0,0000 0.0000 0.0000 0.0000 0.0000 0.0000 0,0000 O.O(OX) 0.0000 0.0000 O.O0(X) 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 O.O000 0.0000 O.CK)O0 0.0000 0.0000 0.0000 0.0000 0.0000 TVHC (Total Vohtile Hydrocarbons) values reported in t~aler (mi/L). Tracer values ruporr~d in milligrams/liter (rog/L). 0.0000 = Not DetecteA -999999,9999 = No sampl~ ~PR-09-1998 i5:56 TRACER RESEARCH 52029~1506 P.08 Tracer Research Sob No. 300332 Page 3 Sample Date: 4/7/98 Location CONDENSED DATA Compound Concentration(mg/L) 007 A 007 C 007 R 007 W 007 TVHC 0.00(0) 0.~ 0.0000 0,0000 TVHC (Total Volatile Hyckocarbons) values reported in milligrams/liter (rog/L), Tracer values reported in milligrams/liter (rog/L). 0.0000 = Not Detected -999999.9999 = No sarr~l~ 7 10,000 gel ~ Premium ~-~ ~ ~ ?racer [Al Tank 2 10,000 gal Tracer Icl 4. Tank 3 ,o.ooo. ® Unleaded Tracer Tank 4 Diesel Tracer [W] oooo BUILDING Dispensers Dispensers EXPLANATION Sampling Probe Loca[ion { e e 10 I 04--08--98 300332 T'EXAC 0 # 61058000700 3698 MII~G/RE,L B AXE R S F fig LI) , ¢ A LIF 0 R N IA 9 3 8 0 9 I SAMPLING LO CATI 0 N SI' Figure 1 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES UNDERGROUND STORAGE TANK PROGRAM' 1715 Chester Ave., Bakersfield, CA (805) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST FACILITY ADDRESS' 3~ PERMIT TO OPEKATE # '1.~' o OPERATORS N,&ME OWNERS NAME NUMBER OF TANKS TO BE TESTED IS PIPING GOtNG TO BE TESTED TANK # VOLUME CONTENTS T.~NK TESTING COMPANY N~ & PHO~ ~ER OF CONTACT TEST ~THOD ~ ~xc~)r ~r~ N~ 0F TESTER Mx~ DATE & T~ TEST IS TO BE CO~UC~D 2/' c~ DATE SIGNATURE OF APPLICANT . I ,NAGEM ENT: T'~ n/c- apg~aaes Compliance Te?ting Soil & Groundwater Sampling April 14, 1998 Fred Long Texaco Refining and Marketing Inc. 3663 Gibson Street Bakersfield , CA 93308 Dear Mr. Long, Groundwater Management Southwest has performed precision tank tightness tests on the underground tank systems listed on the attached report. The testing was.performed in accordance with the manufacturer's protocol as required by federal, state, and county regulations for compliance. The testing 'results, as shown on the attached certification page, indicates whether the tank and associated piping passed or failed compliance. Included with the certification is a report containing the supporting data. If you have any questions regarding the attached results or need help in any way, please do not hesitate to call us at (800) 639-5151 or (602) 926-3000. Sincerely, Office Manager gJ Attachments P.O. BOX 8400 · MESA, ARIZONA 85214 · (602) 926-3000 ° (800) 639-5151 · FAX (602) 926-0331 FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program [~Routine [] Combined [] Joint Agency Type of Tank Type of Monitoring [] Multi-Agency Number of Tanks .fi" Type of Piping ,5o0 [] Complaint [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No pro Section 3: Aboveground Storage Tanks Program TANK SIZE(S). AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: d /~~'~ Office of Environmental Services (805) 326-3979 White - F. nv. Svcs. Pink - Business Copy Business Site Responsible Party CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME IcYato ADDRESS :36 qq tg,lq FACILITY CONTACT INSPECTION TIME INSPECTION DATE BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~ Routine [] Combined [] Joint Agency I~1 Multi-Agency [~ Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: [] Yes [] No Explain: Questions regarding this inspection? Please call us at (805) 326-3979 While - Env. Eves. Yellow - Station Cop)' Pink - Business Copy Business Site R. esponsible Party Inspector: _~.~. 03/11/98 ~$:39 '~'805 326 0576 BFD HAZ MAT DIV ~002 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES UNDERGROUND STORAGE TANK PROGRAM 1715 Chester Ave., Bakersfield, CA (805) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST FACILITY TF~aca ~' bloS$OOO-tO0 ADDRESS 3~'~' I~:~t-t / PERMIT TO OPERATE # OPERATORS NAME l)/~gx~ flaLr3Eool~ NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED TANK # VOLUME i IO~o0 o CONTENTS TANK TESTING COMPANY N~ & PHO~ ~ER OF CONTACT TEST ~OD ~en;r~ rx;~r N~ OF TESTER ~ S~$~ ...... CERT~ICA~ON ~. ~' I~tY DATE & T~ TEST IS TO BE CO~UC~D ~,02- ~12~. 3000 DATE SIGNATURE OF APPLICANT BAKERSFIELD FIRE DEPARTMENT February 13, 1998 RIlE CHIEF MICHAEL R. KELLY ADMINISI'EAm/E SEEVlCr~ 2101 'H' Street Bakersfield, CA 93301 (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SEEVICF.~ 2101 'H' Street Bake~fleld, CA 93301 (805) 326-3941 FAX (805) 395-1349 PREVENTION SEEVlCE$ 1715 Chester Ave. Bakersfield. CA 93301 (805) 326-3951 FAX (805) 3264]676 ENVIEONMEN~AI. SEItVlCF.$ 1715 Chester Ave. Bakersfield, CA 93301 (805) 326-3979 FAX (805) 32(:,,0576 TRAINING DIVISION ,5642 Victor Street Bakersfield, CA 93308 (805) 399-4697 FAX (805) 399-5763 Texaco Ming 3698 Ming Avenue Bakersfield, CA 93309 RE: "Hold Open Devices" on Fuel Dispensers Dear Underground Storage Tank Owner: The Bakersfield City Fire Department will commence with our annual Underground Storage Tank Inspection Program within the next 2 weeks. The Bakersfield City Fire Department recently changed its City Ordinance concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire Department now requires that "hold open devices" be installed on all fuel dispensers. The new ordinance conforms to the State of California guidelines. The Bakersfield Fire Department apologies for any inconvenience this may cause you. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey HAZARDOUS MATERIALS INSPE(J~)N ~i~kersfield l~re Dept. OFFJ~II. OF ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Date Completed Business Namei "T'¢Y~e~ Location: Business Identification No. 215-000 Station No. Shift (Top of Business Plan) Inspector Arrival Time: Departure Time: Inspection Time: Address Visable Correct Occupancy Verification of Inventory Materials Verification of Quantities Verification of Location Proper Segregation of Matedal Comments: Adel~ate Inadequate1.1 Verification of MSDS Availablity Number of Employees:, Verification of Haz Mat Training Comments: r'l Verification of Abbatement Supplies and Procedures Comments: Emergency Procedures Posted Containers Properly Labled Comments: Adel~te Inadequate Verification of Facility Diagram Housekeeping Fire Protection Electrical Comments: UST Monitoring Program Comments: Permits I~ E! Spill Control I~ ffl Hold Open Device ~ [] Hazardous Waste EPA No. Proper Waste Disposal Secondary Containment Security Special Hazards Associated with this Facility: Violations: C_.~',/ ~O~c:d- ~"------~u;iness Owner/Managb' PRINT NAME '~,..._..~,,,,'/- S~GNATURE ' - All Items O.K Correction Needed White-Haz Mat Div. Yellow-Station Copy Pink-Business Copy UNDERGROUND STORAGE TANi SPECTION Bakersfield Fire Dept. Office of Environmental Services Bakersfield, CA 93301 FACILITY NAME ~Y, oco ,_'~OL~. BUSINESS I.D. NO. 215-000 I¢OG FACILITY ADDRESS 3G?$ ~lm~ .~a~,, CITY ~['~- ZIP CODE FACILITY PHONE No. 95~/'- ~.~,.~ ~D~ ~D~ ~D~ INSPECTION DATE ~ · Product Product Product TIME IN TIME OUT OC ~ /~.z. Plo_~ l~.v.'. ~- I)~l I£~.1~. tot'{ Inst Dale Ins1 Dale Inst Dale INSPECTION TYPE: t ¢ ~.5" / ¢ fL.~ /? g~' Size Size Size ROUTINE i// FOLLOW-UP ~ 1( ~A-') ~ X/G~ ~'.5'O ~e, REQUIREMENTS yes no n/a yes no n/a yes no n/a 1 a. Forms A & B Submitted '~) [// 1 b. Form C Submitted ,V/ lc. Operating Fees Paid V/ ld. State Surcharge Paid le. Statement of Financial Responsibility Submitted 1 f. Written Contract Exists between Owner & Operator to Operate UST 2a. Valid Operating Permit 2b. Approved Written Routine Monitoring Procedure Y 2c. Unauthorized Release Response Plan V/ 3a. Tank Integrity Test in Last 12 Months y 3b. Pressurized Piping Integrity Test in Last 12 Months 3c. Suction Piping Tightness Test in Last 3 Years 3d. Gravity Flow Piping Tightness Test in Last 2 Years 3e. Test Results Submitted Within 30 Days 3f. Daily Visual Monitoring of Suction Product Piping V/ 4a. Manual Inventory Reconciliation Each Month 4b. Annual Inventory Reconciliation Statement Submitted 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks 6. Monthly Statistical Inventory Reconciliation Results 7. Monthly Automatic Tank Gauging Results 8. Ground Water Monitoring 9. Vapor Monitoring 10, Continuous Interstitial Monitoring for Double-Walled Tanks 11. Mechanical Line Leak Detectors 1// 12. Electronic Line Leak Detectors 13. Continuous Piping Monitoring in Sumps V/ 14. Automatic Pump Shut-off Capability V 15. Annual Maintenance/Calibration of Leak Detection Equipment 16. Leak Detection Equipment and Test Methods Listed in LG-113 Series 17. Written Records Maintained on Site V 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days V/ 19. Reported Unauthorized Release Within 24 Hours i,/' 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 1/' 22. Secured Monitoring Wells v/ ~ ' 23. Drop Tube FD 1669 (rev. 9/95)