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UNDERGROUND TANK FILE 1
Permit -~ Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE 0002 ~UNLEADED GASOLINE 10,0~0:00 GAL"?,~: ,. '~'?:?,?':~W F ?;:CLM .?~"'-~='~,~ ~" DW F PRESSURE CED [ssu~ O~CE OFE~R ONME~AL 1715 Chewer Ave., 3rd Floor B~ersfiel~ CA 93301 u ..... ~ ~c~ Voice (805) 326-3979 F~ (805) 326-0576 Expiration Date: ~~ ~0 ~000 ICA Cert. No. OOSO1 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying intbrmation may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: VALLEY PLAZA ARCO (AM PM #583) Permit #015-021-001007 3220 Ming Ave Bakersfield, California 93304 ~ent & By: FIEDLERGROUP; 213 381 1517; Jul-1 9:02; Page 2 TO: ATTN: PHONE: fiedlergroup Cit~ of Bakersfield Office of Environmental Svca. 900 Truxton Avenue "- ate. 210 Bakemfleld. CA Inspector Steve Underw ,op, ,d,,,, DATE: PROJECT: LOCATION: JOB NO: Jul~ 15, 2004 Arco #0583, 3220 Min~ Ave Arco ~tt3054~ 1129 Union Ave Arco ft3090; 3333 union Ave Arco tt5365, 4010 Wible Rd. 661/326-3190 REGARDING: I~ LOS ANGELES OFFICE [~ IRVINE OFFICE Amendment to Permit ~.B1-0312; B1'0318i BI-032,0' & BI-0315 CONCORD OFFICE WE ARE TRANSMITI'ING FOR YOUR THE FOLLOWING ACTION I-I Per your request I~ Approval I~ Prints [~1 Approve &'Return (~1 As requested by; [~ Revision/COmments I~ Sepias ~ Approve Corrections & I~ Use ~ Originals Return ~ Submittecl Via: I~1 Distribution I~1 Disks ~ Correct & Return ~]1 Information/Filas I~] Other. :~ ~:~;~ ~-; ::'" ::~.: :::-'. :'",:~ %?-':~ .~:~': '~' ~:;'~*:~:. :.:: ~-.',-"-~;..~.;"-'~ ;: :: :: '~ ;~ '"' '~ I~J~:~i~!~!~ ':~ ?TM ~ '.';:~ :: ", ~ ;~-'"' '".:'~'-~: .-' ~:-~ ~ :'"--.'-": ~ ~ ~ ~.., ~';';;~-:.; .... .,,,., .,. ,..-~,,.,,.. ,,. ................................... . ........ :,. ....... ,.-..~ ~._..~ 4 EA Permits wi scope of w~,k added (Veecler Root TLS-3,~ Monotorlng) of each site Ila~KI above, : ' -- ,'4,r,~: co,~,tmction i~ iflatod to ;;ommerK;e Ute week o1' JulY' 26, 2004. ' REMARKS: Insp. Underwood: Per our conversation, please amend the permits listed above and fax me copies at 2131381-1517. COPIES TO: Joe Mal~dale,n.,.o,,,,GIobal Alliance ,, FROM: Sharon D. Haywood LA Office - 2322 West Third Street * Los Angeles. Ca~'r~l190067-1906 - Ph: 213-381-7891 * Fax: 213-381-1517 Irvine Office · 2500 Mir_,h$i~o~ Drive, ~,ite 460 - k-vine, California 92612-I$29 · P'm 949-851-2700 · Fax: 941).86t-2770 Concerti Off/ce - 1390 Wi#ow Pass Road. Sul~ 606 * Co~rd. California 94520,7905 · Ph: 926-~91-4444 · F~x: 925-691-4441 fledl~g~outt O 2004 I:~Drafting~J~CO~7 13 04 LOT Bakemfleid Fire. DOC FTEDLERGROUP; 213 381 1517; Jul. 9:03; Page 8/6 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES · 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT AP~I. JCATION TO CONb'"TRUCT/MODI~Y'UHD/~RGROUND STORAGE TANK [ SfflJ. PR~L"y~q110~ CO.tirOL ~ COUN'rl~ MEASUR~ PLAN' ON' FIL~. ~ TANK NO. T~nC~O. VO.~t~S , FO~. OFFICIAL,L~. E ONt. Y . , All~LtCJi.TION DATE ..... FACtL,ITY NO. NO, OF THF., ~PI, ICANT HA~ R~CEIV~), UND~AND~ A~D WILl, COMPLY ~VITH ~ ATTA~"14P.,D CONDIT[O~ OF THiS yl[~dlT AND ANY OTH_mt STATE, LOCAL AND PSD6P4~t. R,~ULAT[ON~. ...AS SSa. COa~.~O U..U.~L~'O~--~UUaY. Tills APPI, I[CATIOI~ BF. COM]ES A I'KBMIT Wi~N APPROVED PRESSURE LINE LEAK ALARM ~ 2:89 PLLD SHUTDOWN ALARM AUO 10, 2004 8:02 AM ..... SENSOR ALARM ..... L 9:89 TURBINE STP SUMP FUEL ALARM AUG 10, 2004 8:02 AP1 PRESSURE L~NE LEAK. ALARM, Q 2:89 PLLD SHUTDOWN ALARM AUG 10, 2004 8:03 AM ..... SENSOR ALARM L 8:89 FILL OTHER SENSORS FUEL ALARM AUG I0, 2004 8103 AM PRESSURE LINE LEAK ALARM Q 2:89 PLLD SHUTDOWN ALARM AUG 10.. 2004 8:04 AM ..... SENSOR ALARM ..... L 7:89 ANNULAR ANNULAR SPACE FUEL ALARM AUG 10, 2004 8:04 AM PRESSURE LINE 'PEAK ALARM Q 3:91 PLLD SHUTDOWN ALARM AUG 10, 2004 8:04 AP1 -~'~- SENSOR ALARM ': LF'.2~91 TURBI NE ST1~, $UMP AUG 1 O, 2004 8:04 AP1 PRESSURE LINE LEAK ALARM O 3191 PLLD SHUTDOWN ALARM AUG 10, 2004 8105 AM ..... SENSOR ALARM Lll:91 FILL OTHER SENSORS FUEL ALARM AUG 10. 2004 8:05 AM PRESSURE LINE LEAK ALARM Q 3191 PLLD SHUTDOWN ALARM AUG 10, 2004 8:06 AM ..... SENSOR ALARM ..... LlO:91 ANNULAR OTHER SENSORS ___ FUEL ALARM AUG 10, 2004 8106 AM PRESSURE LINE LEAK ALARM Q 2:89 PLLD SHUTDOWN ALARM AUG 10, 2004 8:07 AM 3' ~ 1 ~ ~ ~g LEAK. ALARH PLLD SHUTDOWN ALARM AUG lO. 2004 8:07 AM L19'Di~NSOR ALARM ..... ' , 13114 D/SPENSER PAN FUEL A~A~M. 2:89 ~ ~LARM · PLLD SHUTDOWN ALARM AUG 10, 2004 8:0? AM PRESSiJRE LINE LEAK ALARM Q '3191 PLLD SHUTDOWN ALARM AUG 10, 2004 8:07 AM ..... SENSOR ALARM L18:DISp 11-12 DISPENSER PAN FUEL ALARM AUG 10, 2004 PRESSURE LINE LEAK ALARM Q 2:89 PLLD SHUTDOWN ALARM AUG 10, 2004 8:08 AM PRESSURE LINE LEAK ALARM Q 3191 PLLD SHUTDOWN ALARM AUG 10, 2004 8:08 AM ..... SENSOR ALARM L15:DISP 5-6 DTSPENSER PAN FUEL ALARM AUG 10, 2004 8108 AM PRESSURE LINE LEAK ALARM Q 2:89 PLLD SHUTDOWN ALARM AUG I0, 2004 8:09 AM PRESSURE LINE LEAK ALARM Q 3191 PLLD SHUTDOWN ALARM AUG 10, 2004 8:09 AM ..... SENSOR ALARM L14:DISP 3-4 DISPENSER PAN FUEL ALAR~ AUG 10. 2004 8:09 AM G' I: 87 LEA],( ALARM PLLD SHUTD©WN ALARM AUG 9,"2004 12:39 PM ..... SENSOR ALARM ..... L 1:87 MASTER ANNULAR ANNULAR SPACE FUEL ALARM AUG 9, 2004 12:39 PM PRESSURE LINE LEAK ALARM ~ 1:87 PLLD SHUTDOWN ALARM' AUG 9, 2004 12:40 PM ..... SENSOR ALARM L 2:87 MASTER FILL OTHER SENSORS FUEL ALARM AUG 9, ~oo~..lg:~o PM PRESSURE LINE LEAK ALARId G 1:87 - PLLD SHUTDOWN ALARM AUG 9, 2004 12:41 PM SENSOR ALARM L 3:87 MASTER TURBINE STP SUMP FUEL ALARM AUG 9, 2004 12:41 PM PRESSURE LINE LEAK ALARM G 1:87 PLLD SHUTDOWN ALARM 'AUG 9, 2004 12:41-PM S£NSOR ALARM ..... L 4:87 SLAVE ANNULAR ANNULAR SPACE FUEL ALARM AUG 9, 2004 12:41 PM pRESSURE LINE LEAK G 1:87 PLLD SHUTDOWN ALARM A~G 9, 2004 ~2:42 PM FUEL ALAR PM ~~004 12: 42 PRESSURE LINE LEAK ALARM ~ 1:87 PLLD SHUTDOWN ALARM AUG 9, 2004 12:53 PM ..... SENSO~~RM L 3:8? MASTER TURBINE STP SUMP FUEL ALARM --AUG .9. 2004 12:53 PM PRESSURE ii NE LEA}( ALARM G 1:87 PLLD SHUTDOWN ALARM AUG 9, 2004 12:54 PPI ..... SENSOR ALARM L 2:87 MASTER FILL OTHER SENSORS FUEL ALARM AUG 9, 2004 12:54 PM PRESSURE LINE LEAK ALARM G 1:87 PLLD SHUTDOWN ALARM lO'55 AUG 9, 2004 ~' PM ..... SENSOR ALARM L 1:87 MASTER ANNULAR ANNULAR SPACE FUEL ALARM AUG 9, 2004 12:55 PM PRESSURE LINE LEAK ALARM G 1:87 PLLD SHUTDOWN ALARM AUG 9, 2004 12:56 PM ..... SENSOR ALARM L 6:87 SLAVE TURBINE PIPING SUMP FUEL ALARM AUG 9, 2004 12:56 PM Q 1:87 c UTDOWN ~L~RM ' PLLD SM . AUt~ 9, 2004 12:56 PM -- SENSOR ALARM ..... L 5:87 SLAVE FILL OTHER SENSORS FUEL ALARM AUG 9, 2004 12:56 PM PRESSURE LINE LEAK ALARM G 1:87 PLLD SHUTDOWN ALARId AUG 9.. 2004 12:59 PM ..... SENSOR ALARM ..... DISPENSER PAN FUEL ALARM AUG~ '9,'2'004 12:5-8 ~M PRESSLIRE LI NE LEA~M~ G 1':-87 PLLD SHUTDOWN ALARM .... .3~o, :_ PM~ LI?:DISP 8-10 DISPENSER PAN FUEL ALARM AUG 9, 2004 12:58 PPI PRESSURE L~NE LEAK G 1:87 PLLD SHUTDOWN ALARM AUG 9, , 2oo4~.qq PM ..... SENSOR ALARM LI6:DISP 7-8 DISPENSER PAN FUEL ALARM AUG 9. 2004 1:00 PM PRESSURE LINE LEAK ALARM Q 1:87. PLLD SHUTDOWN ALARM AUG 9, 2004 1:00 PM ..... SENSOR ALARM L13:DISP 1-2 DISPENSER PAN FUEL ALARM AUG 9, ~DP3 12~]__o PM, .... -IN-TANK ALARM T 2:87 SLAVE OVERFILL ALARM -'~LLCa-~%~'°-OO4 1:03 PM, IN-TANK ALARM T 2:8? SLAVE PROBE OUT AUG 9, 2004 1:04 PM IN-T~LARM ..... T 1:87 MASTER OVERFILL ALARM AUG 9, 2004 1:05 pM I N-TANK ALARM T 1:87 MASTER PROBE OUT AUG 9, 2004 1:05 PM .... I N-TANK ALARM ..... T 3:89 HIGH PRODUCT ALARM AUG 9, 2004 1:06 PM ~ /~~;~Bakersfield Fire Dept. JOB CARD ! ~'Prevention Services ,'Dst :! 900 ' ~~~r Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME~ OWNER ADDRES~ ~ ..... . . ~ ~ - ADORESS _ ~zo yw,~ Ave ~.~._ __ ~_0_~ ~(~t ~ CITY .......... ~ .... ~P ..... ..~.s~,~o 9~O~ ..................................... ~ ............. PHONE No. PERMIT NO. 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 ONE. DO NOT COVER WORK FOR ANY NUMBERED GROUP UNTil ALL ITEMS IN THAT GROUP ARE SIGNED OFF BY THE PERMITTING AUTHORITY. FOLLOWING THESE INSTRUCTIONS WILL REDUCE THE NUMBER OF REQUIRED INSPECTION VISITS AND THEREFORE PREVENT ASSESSMENT OF ADDITIONAL FEES. INSPECTION DATE I INSPECTOR I BACKFILL OF TANK(S) SPARK TEST CERTIFICATION OR MANUFACTURES METHOD CATHODIC PROTECTION OF TANK(S) PRIMARY PIPING SECONDARY PIPING TYPE Of PIPING [~ FLEX I~ FIBERGLASS CATHODIC ~ROTECTION SYSTEM-PIPI'NG ' ' DISPENSER PAN CONTINUOUS VAPOR MONITORING ENHANCNED LEAK DETECTOR TEST i ................................................ :--: ....................... ----- ..... ,-'-,--' ;~-. .......... '- MONITORING WELLS, CAPS & LOCKS FILL BOX LOCK AUTHORIZATION FOR FUEL DROP CONTRACTOR ................................................................................................ LICENSE No. CONTACT ...................................................................................................... pHONENo. fd 1743 Section 2: Underground Storage Tanks Program CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra FlOor, Bakersfield, CA 93301 INSPECTION DATE Routine ~ Combined [21 Joint Agency Type of Tank ,~la0 Type of Monitoring ~ Multi-Agency Number of Tanks Type of:Piping Complaint Re-inspection OPERATION C V' COMMENTS Proper tank data on file Proper owner/operator data on file X Permit fees 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 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? Business Site Responsible Party Pink - Business Copy VEET~ER-ROOT TLS-258 TANK LEVEL SENSOR' !NVENTORY REF'ORT .hiAR i6, 2884 i 2' 2~3 ~'~'~ = I" I'I TANK SUPER 3964 · ~ ,"-'20 38. i5 0.0 70.7 ij.NLEADED GALLONS FUEL GALS LiLLRGE iNCHES FUEL iNCHES NRTER DEGREES K TANK 2 REGULAR i::]29 GALLONS YdEL 7855 GALS ULL~GE 8i.79 iNCHES FUEL 8.8 iNCHES WRTER 6i.i DEGREES F UNLEADED :-_, ,-, ,,-,28 GALLr~NS FLiEL 5L:',r:,4 P '" '-' -. ~HL.:, ULLRGE 37. i2 iNCHES FUEL 8.8 iNCHE'.--: WRTER · _ 66.7 DE F;F.'.EE S,~_~ TANK 4 UNLEADED 4888 5484 48.43 8.8 68.7 GALLSNS FuEL GALS LILLRGE · iNr:HES FUEL i NCHE.'--; i.4RTEF.: DEGREEF; F .hiANiFOLDED TANKS iNVENTORY TSTAL'-'.. , i CNLEADED 8899 GALLONS FUEL Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave SECTION 1. Business Plan and Inventory Program Bakersfield, CA 9330l Tel: (661)326-3979 ADDRESS PHONE No. No. of ~..tlyees FACILITYCONTACT Business ID Number 15-021- ventory Progra ~ ': ": ': ~' ~ Secti°n i~ BUsiness plan and In m [] Routine '~,C°'mbined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection C V {C=Compliance) OPERATION \ v=violation ~, [] APPROPRIATE PERMIT ON HAND ,~ [] BUSINESS PLAN CONTACT INFORMATION ACCURATE ~ [] VISIBLE ADDRESS [] CORRECT OCCUPANCY [] VERIFICATION OF INVENTORY MATERIALS 1~ [] VERIFICATION OF QUANTITIES [] VERIFICATION OF LOCATION [] [] PROPER SEGREGATION OF MATERIAL VERIFICATION Of MSDS AVAILABILITYE VERIFICATION OF HA~MAT TRAINING [ ~ [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~. [] EMERGENCY PROCEDURES ADEQUATE ~ [] CONTAINERS PROPERLY LABELED [] HOUSEKEEPING [] FIRE PROTECTION ~ [] SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?; [] YES ~No EXPLAIN: COMMENTS IS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector ~~ Badg--~ No. BuSiness S~e White - Environmental Services Yellow - S~ation Copy Pink - Business Copy · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: ~M/PM (Valley Plaza Arco) 3220 Ming Avenue lakersfield, CA 93304 I A. Signature X x"l /~/ .. /'-- [] Agent B. Re~;c=~ved by ( Printed Name) I C. Date of Delivery D. Is delivery address different from ite~ 1 .~' [] Y~s ..... If YES, enter delivery address below: [] No 3. Service Type '~-Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. Article Number (Transfer from service label) 7003 2260 0004 7652 2709 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540 /~.~-~-~ c.i,, II II 7.,/?,-'~ I Postage &-Fees P_aidl /~" ~.. '1 _\11 II ..~ J/'....';>-'I;usPs,' :~ ~;~t I {~': ~'1~ lfJI II "~/IPe~'mitN°.'G-'~°?~ I Sender: Please pr, n1 y~~~ress, 8nd Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 ~ Tait Environmental Systems UST Construction · Design · Maintenance · Compliance January 13,2004 Certified Mail - Return Receipt Requested City of Bokersfield Cedified Unified Progrom Agency (CUPA) Fire Depodmenf ] 7] 5 Chester Avenue, Third Floor Bokersfield, CA 9330] Re: Arco SS #0583 3220 Ming Avenue Bakersfield, CA To Whom It May Concern: Enclosed for your files is the Acurite Single Line Test Data Sheet for the above- referenced location. Feel free to call if you have any questions. Very Truly Yours, TAIT ,~.V~ON M/~N,~L SYSTEMS BRIAN RARMON ComplianCe Specialist BH: clb :\jds\arco\letters\arc 0583-01 Enclosures CA Lic #588098 · AZ Lic #095984 · NV Lic #0049666 1863 North Neville Street · Orange, California 92865 · 714.560.8222 ° 714.685.0006 Fax 3283 Luyung Drive ° Rancho Cordova, California 95742 · 916.858.1090 · 916.858.1011 Fax www. SB989.com ACURITE Single Line Test Data Sheet Location: Operator: I "~ I~ j~.,~:~ta I ~ ~~F/~Lh ~e licened ~ tester ~t si~ ~s dot--em ce~ifies ~m all of~e ~o~mion con. ned here is ~e ~d acetate. Product Pump Manufacturer Isolation Mechanism ~ump) (I I/2 times working press~e) Test Pressure Initial Cylinder Level 0CL) F~al Cylinder Level ~CL) Leak Volume = ICL - FCL Time Completed Total Test Time (3Omin. minimum) (If ~ailable.....) Tank Leak Rate at Sta~ of Test (If ~ailable....O Tank Leak ~te at End of Test Comments: 12-17-03 05:Z4pm From-TAIT ENVIROIvENTAL 714-$$0-8257 T-OSg P.03/05 F-Z?'? APPLICATION TO PERFORM A TANK TIGHTNF~S TEST/ SECONDARY COI~A~ENT TESTING/IItACER TF_~G mm, I December 12, 2003 CERTIFIED MAIL 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 FIRE SAFETY $ER~lCES * ENVIRONMENTAL SEIWtCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 AM/PM (Valley Plaza Arco) 3220 Ming Avenue Bakersfield, CA 93304 RE: Propane Exchange Program Dear Owner/Operator: The purpose of this letter is to advise you of current code requirements for propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not apply to large propane tanks, only propane exchange systems. Over the past two years this office has noted a dramatic increase in the propane exchange system in the city of Bakersfield. It has also been noted, with great concern, that many of these installations are a clear violation of the UFC (Uniform Fire Code) and represent a danger to public health and safety. Accordingly, procedures for storage of propane cylinders awaiting use, resale or exchange, have been adopted through BMC (Bakersfield Municipal Code) and adoption of the 2001 UFC. The procedures are as follows: Storage outside of building for propane cylinders (1,000 pounds or less) awaiting use, mm-sale, or part of a cylinder exchange point shall be located at least 10 feet from any doorways or openings in a building frequented by the public, or property line that can be built upon, and 20 feet from any automotive service station fuel dispenser. (Note distance from doorways increases when cylinders are over 1,000 pounds cumulatively.) Cylinders in storage shall be located in a manner which minimizes exposure to excessive temperature rise, physical damage or tampering (Section 8212, California Fire Code, 2001 Edition). When exposed to probable vehicular damage due to proximity to alleys, driveways or parking areas, protective crash posts will be required as follows (Section 8001.11.3 and 8210, California Fire Code, 2001 Edition): 1) 2) Constructed of steel, not less than 4 inches in diameter, and concrete filled. Spaced not more than 4 feet between posts, on center. i r',-- Postage $ ~_-I- ~ r--i Certified Fee ~ r'-'l Postmark Return Reciept Fee Here ! (Endorsement Required) i r-1 Restricted Delivery Fee ,-O (Endorsement Required) I FM Total Post~/ ~ I Sent TO '~1 ~ [ AM/PM (Valley Plaza Arco) .---1 , r,- [~t-r~-ac~;:~ . '--- _o_~.~.o.~ox~ 3220 Ming Avenue ....] Lett~To: Owner/Oper~tor~ of Prop~n~ Exchange Re: Propane Exchange Program Dated: December 12, 2003 Page 2 of 2 3) 4) 5) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. Set with the top of the posts not less than 3 feet aboveground. Located not less than 5 feet from the cylinder storage area. Exceptions: Cylinders storage areas located on a sidewalk which is elevated not less than 6 inches above the alley, driveway or parking area, with not less than 10 feet of separation between the curb and the cylinder storage area. "No Smoking" signs shall be posted and clearly visible (Section 8208, California Fire Code, 2001 Edition). Resale and exchange facilities must be under permit to verify compliance. All existing facilities will be checked and when compliance is confirmed, a permit will be issued. All new propane exchange systems must be permitted prior to installation. You will have 90 days (March 4, 2004) to comply with the procedures outlined. Once compliance has been confirmed, each exchange system will be issued a permit, which will be placed on the exchange system. Sites not conforming to current code, will be "red tagged" and must be taken out of service immediately. You should contact your Blue Rhino representative, Mr. Taylor Noland, or your local Amerigas representative. They are aware of current code requirements. If you do not have a propane exchange system, please disregard this letter. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincerely, Steve Underwood Fire Inspector/Petroleum/ Environmental Code Enforcement Officer MONI NG SYSTEM CERTIFI TION 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 report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ARCO PRODUCTS COMPANY Service Station No.: 0583 Site Address: 3220 Ming Avenue City: Bakersfield Zip: 93304 Facility Contact Person: Contact Phone No.: Make/Model of Monitoring System: "~-o~-~ ¥,~'l(~ ~ B. Inventory of Equipment Tested/Certified Check the appropriate boxes to indicate specific equipment inspected/serviced: - Tank ID: c~ 7 I-lin-Tank Gauging Probe: Model: [J~zmular Space or Vault Sensor: Model: [i~'Pipin§ Sump/Trench Sensor (s): Model: [~e1 Sump Sensor (s): Model: chanical Line Leak Detector. Model: I-]Electronic Line Leak Detector Model: FITank Overfillgrtigh-level Sensor: Model: t..S-7 cs -3. Date of Testing/Service: F1Other, Specify equip, type and model in Section E on Page 2 Tank ID: ~ 7 ~ ! I-lin-Tank Gauging Probe: Model: [~'~nnular Space or Vault Sensor Model: [~l~iping Sump/Trench Sensor (s): Model: [~11 Sump Sensor (s): Model: ' F1Mechanical Line Leak Detector. Model: I-1Electronic Line Leak Detector Model: []Tank Overfill/High-level Sensor: Model: Tank ID: ~_~r,~ I-lin-Tank Gauging Probe: [~'Annular Space or Vault Sensor: l_~]lSiping Sump/Trench Sensor (s): J~!ll Sump Sensor (s): [2~echanical Line Leak Detector. [']Electronic Line Leak Detector F1Tank Overfill/High-level Sensor: Model: Model: Model: Model: Model: Model: Model: g_O;;3ooo I-1Other, Specify equip, type and model in Section E on Page 2 Dispenser ID: ~ - '~ F1Dispenser Containment Sensors: Model: J~] Shear Valve(s). ~Z]Dispenser Containment Float(s) and Chain(s) Dispenser ID: ~'-'.-- (~ FIDispenser Containment Sensors: Model: ~] Shear Valve(s).. [~Dispenser Containment Float(s) and Chain(s) Dispenser ID: FlDispenser Containment Sensors: Model: [] Shear Valve(s). FgDispenser Containment Float(s) and Chain(s) to lqln-Tank Gauging Probe: Model: []~nnular Space or Vault Sensor Model: ~'-7' . [~ffiping Sump/Trench Sensor (s): Model: I~l~ill Sump Sensor (s): Model: [~echanical Line Leak Detector. Model: I-1Electronic Line Leak Detector Model: F1Tank Overfill/High-level Sensor: Model: r'lOther, Specify equip, type and model in Section E on Page 2 Dispenser ID: "aa,'" ~ I--IDispenser Containment Sensor(s): Model: DShear Valve(s). ispenser Containment Float(s) and Chain(s) Dispenser ID: 7 ~ []Dispenser Containment Sensor(s): Model: ~] Shear Valve(s). ~Dispenser Containment Float(s) and Chain(s) Dispenser ID: []Dispenser Containment Sensor(s): Model: [] Shear Valve(s). FlDispenser Containment Float(s) and Chain(s) Monitoring System Certification Page 1 of 3 03/01 *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at this facility. C. Certification - ! certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): ~42ystem :et ur. _~ .~2ar.,n. h.~st~ry te41gt;t Technician Name (Print): ~ ~ Signature: Certification No.: "1~O O O ~{,O J License No.: 588 098 Testing Company Name: TAIT ENVIRONMENTAL SYSTEMS Phone No.: (714) 560-8222 Tank ID: ~tr F1Other, Specify equip, type and model in Section E on Page 2 Site AddresS: SS/10583, 3220 Ming Avenue, Bakersfield D, Results of Testing/Servicing SoftWare Version Installed: Complete the following checklist: Date of Testing/Servicing: 12~Y~s [] No* Is the audible alarm operational? I~yes [] No* Is the visual alarm operational? ~/Yes FI 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? es [] 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~r is electrically disconnected? If yes: Which sensors initiate positive shut-down? (Check all that apply) [~Smnp/Trench Sensors; [] Dispenser Co~xtainment Sensors. Did you confu'm positive shut-down due to leaks and sensor failure/disconnection? [~Yes; [] No. [] Yes ~No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no [] N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank f fill point(s) and operating properly? If so, at what percent of tank capacity does the alarm trigger? ????%. [] 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. ~ ~l~;es [] No* Was monitoring system set-up reviewed to ensure proper settings? [~Yes [] No* Is all monitoring equipment operational per manufacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/01 Site Address: SS/10583,.3220 Ming Avenue, Bakersfield Date of Testing/Servicing: IO-~.? .-o~ 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? [] 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: [~FYes [] No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [] N/A (Check all that apply) Simulated leak rate: 1~3 g.p.h.~; [] 0.1 g.p.h.2; [] 0.2 g.p.h.2 Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. [~Yes [] No* Were all LLDs confirmed operational and accurate within regulatory requirements? [~Yes [] N°* Was the testing apparatus properly calibrated? [Zf ~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 off if the LLD detects a leak? [2~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 malfunctions [~N/A 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 03/01 Site Address: SS//0583, 3220 Ming Avenue, Bakersfield Monitoring System Certification Date of Testing/Servicing: UST Monitoring Site Plan Date map was drawn: to / Z~/~ . Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page--L of / 05/00 · n~'ARCO Products Company Mechanical Leak Detector Test Data Sheet Date Test Information Product Manufacturer Model Full Operating Pressure (psi) Line Bled Back (~) Trip Time (sec) Metering ~ess~e ~si) Fm Holing ~ess~e ~si) Test ~ Ra~ (~n) (gph) PASS or ra~ Replaced All Failed Leak Detectors Yes No If No, Replacement To Be Completed By (Date) / / This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor Technician Lic# Signature FFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE Facility Address City, Zip INSTRUCTIONS: Please call tbr an inspector only when each group of inspections with the same number are ready. They will run in consecutive order beginning with number I. DO NOT cover work tbr any numbered group until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce the number of required inspection visits and theretbre prevent assessment of additional fees. TANKS AND BACKFILL Backfill of Tank(s) Spark Test Certification or Manufactures Method Cathodic Protection of Tank(s) PIPING SYSTEM Piping & Raceway w/Collection Sump Corrosion Protection of Piping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) Cathodic Protection System-Piping Dispenser Pan SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annual Space-D.W. Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwater FINAL Monitoring Wells, Caps & Locks Fill Box Lock Monitoring Requirements Type Authorization i'br Fuel Drop CONTRACTOR ~ ~,~_~ LICENSE# 08-Z$-03 0!:28pm From-TAIT ENVIR~I~NTAL 25 ~_002 ZO:~R BKSFL]3 FiRE ?14-5110-SZ3'r T-467 P.03/06 F-SIt? CITY OF BAKERSFIELD OYFICE OF ENVIRONI~ENTAL SERVICES 1715 Chester Ave., Bakers,eld, :CA (g4il) 326-3979 T~# CONTRACTORf NAME & PHON] DATE& TIM~I APPLICATION TO PER~0RM Olt ~A.~' . ' "~ ' -- ;tAVE DIS~IiR.?ANS't .yJ~_~J.'...'... NO_._._. VOLLWIE CO~ APPRO~ ID BY ... DATE CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY [~]MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATIOlq AT EXISTING FACILITY STARTING DATE PROPOSED COMPLETION DATE FACILITY NAME~?c C ~ t~b,x _/'~} B~. EXISTING FACILITY PERMIT NO. FACILITYADDRES_b~'~.~ b,~,~Ktia ~k}~::: CITY TYPE OF BUSINESS ~M~'~ ~T ~[ ~ ~n~o~ APNg TANKO~E~ ~ ~_S~ ~,~ ~qo~o~ ADDRESS ~~g~O~i~ ~. %~ CITY ~ p~ ZIPCODE~ CO~OR ~ ~% ~ f~etldt~ CA LICENSE NO. ADD.SS ~ ~ ~ ~6~ ~n C~ PHONE NO?'~ ~ - ~1 O- ~ ~ ~ ~ B~RSFmLD C~TY ~US~NESS HCENSE NO. WOMAN COMP NO. In O~ ~ a - ~ ~ ~NSmER BRIEFLY DESCRIBE THE WO~O BE DONE WATER TO FACILITY PROVIDED BY DEPTH TO GROUND WATER NO. OF TANKS TO BE INSTALLED t~ ~,.- ARE THEY FOR MOTOR FUEL ~/ YES SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ,-- YES NO 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) (IF KNOWN) FOR OFFICIAL USE ONLY IAPPLICATION DATE FACILITY NO. NO. OF TANKS FEES $ THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDE~L REOULATIONS. T.IS ~RM HAS BEEN COMPLETED UNDER ~[*V O~ ~Ju~v, ~o ,o,.~ ~s, o~ ~v ~ow[~oo~, ,s · ~u~p co~. ~ APF~OVED BY . APPLICANT NAME (PRINT) APPLICA~SI~URE THIS APPLICATION BECOMES A PERMIT WltEN APPROVED · · .:, . · ~0~ ~ I V~ T~ S~ ~ ~ 1711T-~ 1711T-~ j 3" X 12' ~T O~ ~-31~ ~L-31~ ~ ~ I ~ '~ I ~, · ' / ~L ~ w/~ I ~ ~ APP~ V~ -- Z ~ ~ .'~ ~KERSF, E D F,~ ~ DEPA~ENT O ~1 ICE OF ENVIRON! lEgAL SER~C~ ~. // / } ~ E ~ ~ ~'~ ~ I : A~ ~lle to plans ~ su~ F~ ~ ~ / ' ~ ~ N ~ ~ ~; I c~ ~ i ~or construc~ and/, r ,nstallation thereon. ~--E ~ ~--' ~"-- c--~ ts.o. .~ ~> o ~ PJ.C. U~T ~ ~ 1 STAGE I VAPOR RECOVERY A FILL DETAIL (GASOLINE) ..~ ~ P~ L~ ~'-0' ~0'26~ I' ~ 4~]2' L ~ .... ~ ~Zo NOTES: MING AVENUE ~ ~A ~ ~T~ N~ ~ ~ ~ ~c ~ I .. ~ ~ ~K ~o ~ K~ *~ ~ T~. ~ ~-~.-8 ~. 2 OVERFILL A~RM..T.~ TYPICAL TURBINE ELEVATION ..T.~ 1-800 ~ELING 8 <~.~ ~ ~ ~ ~em .T~. ~ ~ e~) ~a~ONS ~.~[~~~T m 00.583 227-2600 ~~ ~~~ .ozz~s ,~ -=~ TK 1 - 1 ~ ~RKING OA~ BEFORE ~ DIG M'ay i~,'".2~)~3'..':"..:'.'..;:,:'.'::'.":':'.. "..'.;'.;'.',...'.'-; :. .... -. ':;..., :..';¥:., ;:. :..:- .:.--- ::;,..:-:. :.;.,..v .'.':.,. .' -~,:." ,. :~.;,' ' ' . ,:.:'.,L: . .. :'~:,.,. . .... ,,' ' ' ': .":- .;"1' ":': :-;~' SENT V~ US MAIL 7002 0860 0005 4756. 5803 Steve Underwood Bakersfield Fire Department 1715 Chester Ave., Third Floor Bakersfield, CA 93301 Re: Ronan Monitoring System Investigation Dear Mr. Underwood, This letter is written to inform you of an investigation BP West Coast Products LLC (BP) is conducting related to Ronan monitoring systems. We currently utilize Ronan equipment for leak detection at sites within your jurisdiction. A list of these site locations is attached for your reference. Specifically, we · have discovered isolated cases of underground storage tank interstitial probe failures where the Ronan probe has exhibited deformation, rendering it inoperable. We have an affected unit undergoing testing. We'are, working directly with Ronan to discover the cause of the deformation so that, if necessary, we can prepare a plan to address the situation. Although we consider the discovered cases to be isolated and we continue to consider the Ronan monitor our primary monitoring system, we have decided to conduct additional leak detection while this investigation proceeds. We will begin using Statistical Inventory Reconciliation (SIR) as a backup to the Ronan monitoring system wherever we utilize Ronan equipment. In addition, over the next few weeks, we will perform an inspection of each Ronan interstitial probe to ensure that it is in good working condition and functioning as designed. We will provide you with the results of our investigation and an outline of any future plans related to our monitoring systems as such information becomes available. If you have any questions or require additional information, please do not hesitate to contact me directly at (714) 670-5321. Environmental Compliance Specialist BP West Coast Products LLC 4 Centerpointe Drive La Palma, CA 90623 Attachment cc: Deborah Perfetti Felt, Esq. Ronan Investigation 1.doc RONAN MONITORING SYSTEM 00583 3220 MING AVE BAKERSFIELD CA APl Ronan X76 BAF 03054 1129 UNION AVE BAKERSFIELD CA APl Ronan X76 BAF 03090 3333 UNION AVE BAKERSFIELD CA APl Ronan X76 BAF 05365 4010WIBLE RD BAKERSFIELD CA APl Ronan X76 BAF UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITYCONTACT i~, ess O Numbe · I 15-021 - Section 1' Business Plan and Inventory Program [] Routine ~L. Combined [] Joint Agency ~ Multi-Agency I'1 Complaint I~ Re-inspection C V d~C=C°mpliance'~ OPERATION COMMENTS ~, V=Violation APPROPRIATE PERMIT ON HAND -~/0--' ~-~-~,.-~ ~-~-~-~-.-~ :. ~.-~-~',-.Z.-~;~; ~--~-~-~.7 .................................................................................................................. --~-..--~ ,~,~ .~ ~.~- ............................................................................................................................................ CORRECT OCCUPANCY VERIFICATION OF INVENTORY PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILI~E VERIFICATION OF HAT MAT TRAINING EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY ~BELED ~.~"--~o~,~ ............... ~ .......................... ~/ ~ FIRE PROTECTION ~/ HAZARDOUS WASTE ON SITE?: [~ YES ~__~O ANY EXPLAIN: QUESTIONS~EGARDING~rHIS~NSPECT)ON? PLEASE CALL US AT (661} .... ~ ~_~ .............. _¢___ ............ Inspector Badge No.. 326-3979 ................ ~ Business Site Responsible Party White - Environmenlal Services Yellow - Slation Copy Pink - Business Copy FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CltECKLIST 1715 Chester Ave., 3~a Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage 'ranks Program Routine [~1 Combined [] Joint Agency Type of Tank Type of Monitoring [] Multi-Agency . [] Complaint Number of Tanks c/ Type of Piping /f)(OI~ [] 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 t./' / Failure to correct prior UST violations r./'/ 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 ff V=Violation Y=Yes Inspector: /./~ (~ Office of Environmental Services (661) 326-3979 N=NO White- [:nv. ~,vcs. Pink - Business Copy Business Site Responsible Party For Use By ~Ill 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 report must be prepared for each monitoring, system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: ARCO PRODUCTS COMPANY Site Address: 3220 M1NG AVE Facility Contact Person: ~ i ~ Make/Model of Monitoring System: City: Contact Phone N o.: Service Station No.: 0583 BAKERSFIELD Zip: 93304 ] lq~ ~1 o~ Date of Testing/Service: /0-~ B. Inventory of Equipment Tested/Certified Check the appropriat~ boxes to indicate specific equipment inspected/serviced: Tank ID: ~"/ Tank ID: Flln-Tank Gauging Probe: I~Annular Space or Vault Sensor: [~Piping Sump/Trench Sensor (s): I~Fill Sump Sensor (s): [~Mechanical Line Leak Detector. FIElectronic Line Leak Detector [3Tank Overfill/High-level Sensor: Model: Model: Cf"7 Model: C[-r/ Model: I~'~ Model: /2. ff 242r-o Model: Model: [3Other, Specify equip, type and model in Section E on Page 2 Tank ID: I-lin-Tank Gauging Probe: nnular Space or Vault Sensor: iping Sump/Trench Sensor (s): [~Fill Sump Sensor (s): ~lMechanical Line Leak Detector. FIElectronic Line Leak Detector [-]Tank Overfill/High-level Sensor: Model: Model: Model: Model: Model: Model: Model: IDOther, Specify equip, type and model in Section E on Page 2 Dispenser ID: /'/.. [3Dispenser Containment Sensors: Model: ~. ~ Shear Valve(s). I~Dispenser Containment Float(s) and Chain(s) Dispenser ID: ]' 7' [3Dispenser Containment Sensors: Model: [] Shear Valve(s). I~tDispenser Containment Float(s) and Chain(s) Dispenser ID: f'- {- FIDispenser Containment Sensors: Model: [3 Shear Valve(s). I-lin-Tank Gauging Probe: Model: 1-41Annular Space or Vault Sensor Model: ['-qPiping Sump/Trench Sensor (s): Model: ~Fili Sump Sensor (s): Model: Lf- I--IMechanical Line Leak Detector. Model: C1Electro,nic Line Leak Detector Model: [2Tank Overfill/High-level Sensor: Model: F1Other, Specify equip, type and model in Section E on Page 2 Tank ID: q / Flln-Tank Gauging Probe: []Annular Space or Vault Sensor [~Piping Sump/Trench Sensor (s): ~Fill Sump Sensor (s): ~Mechanical Line Leak Detector. I-IElectronic Line Leak Detector FITank Overfill/High-level Sensor: Model: Model: Model: Model: Model: Model: Model: FIOther, Specify equip, type and model in Section E on Page 2 Dispenser ID: [3Dispenser Containment Sensor(s): Model: [] Shear Valve(s). ~Dispenser Containment Float(s) and Chain(s) Dispenser ID: I"lDispenser Containment Sensor(s): Model: ~ Shear Valve(s). [~]Dispenser COntainment Float(s) and Chain(s) Dispenser ID: F3Dispenser Containment Sensor(s): Model: [] Shear Valve(s). ~Dispenser Containment Float(s) and Chain(s) ~Dispenser Containment Float(s) and Chain(s) *If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at this 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; (chefik allthat app~ 121 System set-up I-I Alarm history~ ~ Technician Name (Print): t,)ot~eyh~x ~-~,-,,,~ Signature: Certification No.: ~ q ],OJ' License No.: 588 098 Testing Company Name: TAIT ENVIRONMENTAL SYSTEMS Phone No.: (714) 560-8222 Page I of 3 03/01 Monitoring System Certification Site Address: SS 4/0583, 3220 MING AVE,.BAKERSFIELD D. Results of Testing/Servicing Date of Testing/Servicing: Software Version Installed: ~cklist: complete the IOIIUWtlI~ ~ 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? I~ 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 cormnunications equipment (e.g. modem) I~ N/A operational? [~ Yes [] No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment [] N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~ Sump/Trench Sensors; [] Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? [~Yes; [] No. [] Yes [] No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no [t~ 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? ????% ~ 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. U~' Yes [] No* Was monitoring system set-up reviewed to ensure proper settings? 1~] 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 Site Address: SS #0583, 3220 MING AVE, BAKERSFIELD Date of Testing/Servicing: tt~- ~ ~ e'L F. In-Tank Gauging / SIR Equipment: [] Check this box if tank gauging is used only for inventory control. I~ 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 me lOIiOWillg Cll~t:kll~t; [] Yes [] No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? [] Yes [] No* Were all tank gauging probes visually inspected for damage and residue buildup? [] Yes [] No* Was accuracy of system product level readings tested? [] Yes [] No* Was accuracy of system water level'readings tested? [] Yes [] No* Were all probes reinstalled properly? [] Yes [] No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be co~ G. Line Leak Detectors (LLD): [] Check this box if LLDs are not installed. complete the IOllOWlll~ CllgCkil3t; I~ Yes [] No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [] N/A (Check all that apply) Simulatedleakrate:~3g.p.h); [] 0.1g.p.h.2; []0.2g-p.h-2 Notes: 1. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. ~] Yes [] No* Were all LLDs 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 offifany portion of the monitoring system malfunctions [~ N/A or fails a test? [] Yes [] No* For electronic LLDs, have all accessible Wiring connections been visually inspected? [] N/A ~t 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: ~ rv).C.~9. :~..,~la,..e,~, Page 3 of 3 03/01 gite Address: SS #0583, 3220 MING AVE, BAKERSFIELD Date of Testing/Servicing: ilo ' '] o ' ~ Monitoring System Certification UST Monitoring Site Plan Date map was drawn:/"c43 / Peo/o~ . Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. Page __ of __ 05/00 ARCO prOducts Company Mechanical Leak Detector Test Data Sheet Station # Address 0583 Date /o ~ jl 3220 MING AVE,BAKERSFIELD__ 2O o/_ Test Information Product Manufacturer Full Operating Pressure (psi) Line Bleed Back (ml) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) Test Leak Rate (ml/min)(gph) PASS or FAIL Comments: This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge tree and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor TAIT ENVIRONMENTAL SYSTEMS Technician 3,b14uO~ ~'3 Signamre ~/~-- ~ Lic# Revision 5/01 ~'~ _--_~__~--~_ / 8ELSHIRE / E~VIRONMENrAL __ -- /SERVICES, INC. PMB 269 25422 Trabuco Road #105 Lake Forest, CA 92630-2797 (949) 450-1010 Fax (949) 450-1177 November 7, 2002 City of Bal~ersfield Fire Department 1715 Chester Avenue, 3rd Floor Bakersfield, CA, 93301 ATTENTION: Steve Underwood VIA UPS 2~ Day Air RE: SECONDARY TESTING RESULTS - SB989 COMPLIANCE ARCO Facility No.: Facility Address: 00583 3220 MING AVE, BAKERSFIELD, CA 93304 Per California Water Resources Control Board requirements, attached are results from secondary containment testing performed at the subject facility. Please note all secondary components have passed testing requirements. Test Date Pages 08/22/02 2 09/24/02 1 09/30/02 2 10/24/02 1 ARCO is committed to the compliance of all environmental laws that govem the safe operations of its facilities. Should you have any questions or concerns regarding testing activities at this facility, please do not hesitate to call Michael D. Wilson, BP Environmental Compliance Specialist for this facility at (714) 670-5321, or myself at (949) 450-1010. Sincerely, Pro t Manager _Pro_ ~e~.t Manager Belsl/ire Environmental Services, Inc. Underground Storage Tank System Sccon~lm'y'Coatainment Certification Form Tanks, Piping, & Spill Buckets Page of Testing Contractor: Contractor Address: ~ UST Annular S~ race Tank gl Tank #2 Tank #3 Tank #4 Test Star, Time Test End Time _Final Pressure v TestResuits Pass Fail Pass Fail Pass .Fail Pass Fail Signature S_pill Buclcets Overfill gl I __Overfill #2 Overfill #3 Overfill #4 Product {~89 91 D ~89 91 D 8~9l D 87'89~D Manufacturer ~ ~ ~ S{ar{ Time (~o) ~ :~'~ ~ ',~0 ~'.'~ Water Levcl ~~ ~ ~ Water Level~ ~ ~ Water Level~ ~ ~ Time (tm) ~: ~~:'$~ ~: ~ Water Level ~ ~ ~ ~ Rev. 11/01 'White - Original Secondary Pipin$ .,, Line gl Line #2 ~ Line #3 Line #4 Product 87 89 91 D ..87= 89~? 87 89 91 D ~89 91 D Manufacturer J~j~~ ~._~< 0..~ 4L~kA.'~ Test St,ri Time ~. ~- ~'. ~ q .~ ~ Te.t E~d Time ~'.~ ~'. ~0 ' Final Pressure -~~ ~ ~. ~~ SecondaryPipin, Line Product 87~)91 D 87 89(~D 87 89 91 D 87 89 91 D Manufacturer Test Start lniti~! Te~t ~nd Time Final Pressure ~ Pass ~ Pass Fail Pass Fail Test Results Pass Yellow - Arco Environmental Compliance Pink - Contractor Underground ~torage Tank System Turbine Sumps, 'Fill Sumps and Under Dispenser Containment Secondary Co,ntainment Certification Form Page of ~ Turbine Sumps ID (no~h, slave, etc.) Manufacturer Start Time (to) ~. ~ ~ ~' '~ ~ ~ .r ~ ~.~ ~"' Water Level · Water Level Water Level Time (~) Water Level Testgesulb Pass Manufacturer Water Level Wa ter Level Time (t~) Water Level. Waler Level Water Level Test gesults::~ Pass Rev. 1 VOl White - Oriainal FilISumps ~ 89 91 D ~ 89 91 D 87 ~ 91 D g7 89 91 D _ID (north, slave, etc.) Manufacturer ~lf ~._~q Start Time (to) ~ ~ % ~ Y~ ~ ~ O~ Water Level ~ ~ ~ ~ __ Water Level ~5 ,~ ~~ ~ Time (t:) ~ q ~ ~: ~L Time (t,) ~- ~8 ~ ~ 15 Water Level ~ ~ UDC Manufacturer Start Time (to) Water Level Time {t:) Water Level Time Water Level Yellow - Arco Environmental C:omnliance Pink - Contractor Tanks, Piping, & Spill Buckets Underground Storage Tank System Secondary Contalnmen! Certification Form Page~ of · Testing Contractor: _.~\( ~.~. ~.e~Ot- ~ Oko~/'l_ 'rest Date: UST A nnular S~ race Tank #I f 'rank #2 '~"~ank-----~ Tank #4 Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D I Capacity J~l P~sure ~Tc~ulis ' Pass Fail · Pass Fail Pass Fail Pass Fail Sign31ure S_pill Bud(ets Product Manufaetnrer Start Time (lo) Water Level Time Water Level Ti,ne (h) Waier Level Time 03) Water Level Time (tn) Water Level 2'est Results Signature Overfill #1 Overfill #2 87 89 91D Pass Fail 87 89 91D Pass Fail Overfill #3 Overfill #4 87 89 9I D 87 89 91 D Line ~1 Line ~2 Line ~3 Line g4 Pruduct 87.~91 D 87 89~D ~89 91 D 87 89 9~ D Manufacturer - Test Start Tin,e ~,. L ~ ~ .' ~ ~.' ~ ~ ..,. ¢ :tO 7.'30 · 7'/0 Final Pressure ~ ~ ? %~ ~ 5'~ f Tes: Resnlts ~ Fail ~ Fail ~t Fail Pass Fail Secondary Pipbti~ Rev. I 1/01 White - Original Fail Pass Fail Line #5 Line #6 Line #7 1 Line #8 Product 87 89 91 D 87 89 91 D 87 89 91 D , 87 89 91 D Piping Type Primary Siplmn Primary Siphon Primary Siphon Primary Siphon Manufactnrer -- Test Start Time Initial Pressure Test End Time Final Pressure Test Results Pass Fail Pass Fail Pass ["ail Pass Fail Signature Yellow-- Arco .Environmental Compliance Ph~k - Contractor Underground Storage Tank System Tanks, Piping, & Spill Buckets Secnndary Containment Certification Form ' Contractor Address UST /lnnular Space Prncluct Capacity Manufacturer Test Start Time Initial Pressure Test End Time Final Pressure Test Results Signalure Pass Fail Pass Fail Tank #3 87 89 91 D Ta ak #4 87 89 91 D Pass Fail Pass Fail Overfill #3 Ovierfiil I/4 Bucketx ~verfiii #1 Overfill #2 Product 91 D Manufacturer Start Ti~ne (to) Water Level Time Water Level Time (h) Water Level Time (h) Water Level ] Water Level 'rest Results 0o0 Signature Secondary Pipin~ Line #I Line #2 Line #3 Line #4 Product ~'~89.91 D .87(~91 D 87 8~ D ~____~89 91 D PipingType ~ Siphon ~Sipho,, ~3Slpho,, pri,na~) Manufacturer -- Initial Pressure ~~ ~~r ~f~ _ Te.tResult, :a Fail ~~ ~' Fail Pass Fail '. . Secondary Pipin~ lane #5 Line #6 Line #7 Line #8 Product 87 89 91 D 1t7 89 91 D 87 89 91 D 87 89 91 D Piping Type primary Siphon Primal3' Siphon Primary Siphon PrimaD' Siphon Manufacturer Test Start Time Initial Pressure Test End Time Fiuai Pressure Test Results Pass Fail Pass Fail Pass Fail Pass Fail Signature Kev. ti/01 White - Original Yellow- Arco Environmental Compliance Pink - Contractor Underground Storage Tank System Secondary Containment Certification Form ' Tu}'bine Sumps, Fill Sumps and Under Dispenser Containment Page of Turbine Sumps s7 89 g7 C~ 91 D ~ 89 91 O "89 91 D ID (north, slave crc.) M~nufacturer O ' ' Water Level ~3 ~~ Water Level.~./ . UDC Manufacturer Water Level Water Level Water Level Time(t,) Water Level Signature [:~~~~ Rev. I I/(11 White FillSumps 89 91 D ~ 89 91 D 87 119 OD 87 89 91 D ID (north, slave, etc.). Manufacturer Start Time(lo) Water Level Time(h) -I;~ {~1 i ~.'~ Time(h) Water Level Time (h) Water Level Time(h) /L;3~ ["~' - ID (IlL 3/4, etc.) Manufacturer Start Time (to) ~ Ct.: l~..~ Water Level Water Level Water Level Water Level Test Results ~ Fail Fail Pass Fail Pass 'VMln,.v _ Area l~'nw;rrmr, ap,~tnl F'n~l: ..... n:_~. c-, ....... Tanks, Piping, & Spill Buckets Underground Storage Tank System Sccondary Containment Certification Form Facility #: City: ~ U,¥T /tnnular 3 lace Page of Tank #1 Tank t/2 Tank #3 Tank #4 Ca..~pacity / ~/) ' Manufacturer Spill Bttcl~ets Overlill #1 _ Overfill #2 Overfill #3 Overfill #4 _Product 87 89 91 D' 87 89 91 D 87 89 91 D 87 89 91 D Manufacturer Start Time (to) Water Level Time Water Level Time Water Level Time (tn) Water Level Time (tn) Water Level T___est Results Pass Fail Pass Fail Pass Fail Pass Fail Signature z: lLev. I I/0l White - Original Secondary Pipittl Line #1 Line /t2 Linc #3 Line #4 Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D PipingType Primary Siphon I'rima~ Siphon Primary Siphon Primal, Siphon Manufacturer Test Start Time Initial Pressure Test End Time Final Pressure Test Results Pass Fail Pass Fail Pass Fail Pass Fail Signature S. econdary Pipin~ Line #5 i Linc #6 Linc #7 Line #8 Product 87 89 91 D 87 89 91 D 87 89 91 D 87 89 91 D Piping Type Primary Siphon Primal, Siphon Primary Siphon .Primary Siphon Manufacturer ' Test Start Time Initial Pressure Test End Ti~ne Final Pressure Test Results Pass Fail Pass l"ail Pass Fail Pass Fail Siguature ! Yellow - Arco Environmental Compliance Pink - Contractor L D January 22, 2003 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 UH' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES RRE SAFETY SERVICES · ENVIRONMENT&L SER'dtCES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Av~e. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Valley Plaza Arco 3220 Ming Ave Bakersfield CA 93304 RE: Upgrade Certificate & Fill Tags Dear Owner/Operator: Effective January 1, 2003 Assembly Bill 2481 went into effect. This Bill deletes the requirement for an upgrade certificate of compliance (the blue sticker in your window) and the blue fill tag on your fill. You may, if you wish, have them posted or remove them. Fuel vendors have been notified of this change and will not deny fuel delivery for missing tags or certificates. Should you have any questions, please feel free to call me at 661- 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/dc ARCO July 10, 2002 Inspector Steve Underwood Bakersfield Fire Department 1715 Chester Ave. 3rd Floor Bakersfield, CA 93301 BP West Coast Products LLC 4 Centerpointe Drive La Palma, California 90623-1066 Mailing Address: Box 6038 Artesia. California 90702-6038 Fax Subject New Environmental Specialist Dear Insp. Underwood: Per our phone conversation today, this letter is to advise you that I will be handling any Environmental issues relating to the ARCO stations in Kern County. I have attached a list of stations that fall under my responsibility. If you need further information do not hesitate to call on me. Please feel free to contact me with any questions or concerns. Sincerely, Michael D. Wilson Office (714) 670-5321 Cell (714) 815-2455 UNDERGROUND STORAGE TANK SB 989 COMPLIANCE REPORT 11 11 711 711 711 CAR WASH ' EET ARCO 711 AT&T A-1FOOD STORES AIRPORTBUS OFBKSFLD AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM AM/PM PLAZAARCO[ B.A.R.C. INDUSTRIES BAKER STATION MOBIL BAKERSFIELD AUTO SPA BAKERSFIELD CITY SCHOOLS BAKERSFIELD HEART HOSPITAL BAKERSFIELD MEMORIAL HOSP BAKERSFIELD POLICE DEPT BAKERSFIELD P.O.P. BAKERSFIELD REGIONAL REHAB 301 481 8O7 808 1885 817 1884 806 1274 2203 145 1220 1880 564 629 1415 1416 563 566 1899 417 1898 265 1903 1007 1402 917 920 34TH ST. 102 34TH ST. 1701 PACHECO RD 4647 WILSON RD 9600 BRIMHALL RD. 3601 STOCKDALE HWY. 4101 CALLOWAY 525 W. COLUMBUS 1520 20TH STREET 1200 'H' STREET 1800 GOLDEN STATE HWY 3333UNION AVE. 2301 'F' ST. 4010 WIBLE RD. 6450 WHITE LN 4800 FAIRFAX RD. 900 MONTEREY 4203 MING AVE 1129 UNION AVE. 2800 PANAMA LN. 1701 BRUNDAGE LN. 3125 CALIFORNIA AVE. 2698 MT. VERNON AVE. 7851 ROSEDALE HWY, 2240 SO. UNION AVE, 631 BAKER ST, DWFS DWF 2 SW 3 DWFCS DWF 3 DWFCS DWF 2 DWFCS DWFCS DWFCS DWFCS DWFCS DWFCS DWF DWF DWF DWF DWF DWF DWF DWF DW FLEX 3 DW FLEX 3 DW FLEX 3 DW FLEX DW FLEX DWF DWF DWF DWF DWF DWF DWF DWF DWF YES / 1998 NONE YES / 1997 YES / 2001 YES / 1998 YES / 2001 YES / 1998 3 YES / 2001 I N/A YES / 2001 1 YES / 1990 4 YES / 1998 3 YES / 1998 4 YES / 1993 3 YES / 1999 3 YES / 1995 3 YES / 2001 4 YES / 1999 4 YES / 1997 YES / 1999 YES / 2001 YES / 1998 YES / 1990 YES / 1998 YES / 1997 DWF DWF 4 DWF DWF 4 DWF DWF 3 SWFSC SWL 2 DWFCS DWF 3 DWF DWF 4 DWFCS DWF I SWF 7/10/2002 6/5/2002 6/1 6/2002 YES 6/13/20O2 5/26/2002 NO NO YES / 1996 5/16/2002 3 YES 5/1 6/2002 3 YES/1996 2 YES/2002 2 N/A 2 N/A I YES/2000 I N/A I N/A I YES / 1998 3 YES / 1998 4 4 YES / 1996 5/29/2002 3 YES / 2000 5/30/2002 1843 2378 7987 1121 1050 131 1021 606 281 1085 572 1756 BARBER HONDA BEACON LIQUORS BILL WRIGHT TOYOTA BP OIL BROOKSIDE MARKET BROOKSlDE MARKET AT THE OAKS CAL MAT 2197 579 IN~PEC~TOR S. UNDERWOOD 7/2;~2002' 1 0~5 ~ 5201 STOCKDALE HWY DWF DWF 1501 FELIZ ST. 3001 SILLECT AVE 420 34TH ST. 1601 TRUXTUN AVE. 715 SUMNER ST. 5001 COMMERCE CENTER 4500 WlBLE RD. 6495 S. UNION AVE. 5100 GASOLINE ALLEY 2 OAK ST. 4700 COFFEE RD, 8803 CAMINO MEDIA 529 DOLORES DWF DW FLEX DWFCS DW FLEX DWF DWF DWF DWF DWF DWF DWF DWF DWFCS DW FLEX DWF DWF DW FLEX DWFCS DWF DWBSF DWF DWFCS FLEX NONE S:IUNDERGROUND STORAGE TANK REPORTSIUNDERGROUND STORAGE 04:33pm From-TAIT ENVIRO~NTAL ?14-560-SZ3T T-]61 P.06/08 BF-.P 25 2OOZ 1Q;5~. ]~KSFL]] FIRE pREVEHTIOH F-565 p.2 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES _ 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CER~CA,TION ..... : . ~ 1~,'.,~ ;'l'-~:.', : -'~,' '"" ' : ' ' F AODE~.SS ~'2..2-~ ' ~ ~ VOLUME CONTENTS APPROVI~D BY ...... 10-4 Sep 2~ 02 02:56p Fax~: p.1 No. of Page~ bp ~ Li~-FTAv~jfc_~ ss 9as TESTING PROGRAM ~L- ~/Z~/D~ AGENCY NOTIFICATION SHE~ NoOn, on Da~: . Requested Test Date: ARCO ~: ~ S~te: NoUfcati0n For:. Initial Test: Repairs; Re-test: Agency Name: Notifmation Method: Person Contacted: Time Contacted Comments/Requirements E-mail: Verbal: T~stin~ Scone (~e~ a# ;=r~o~..ms ~at ap~ Tank Afinular . Fill Sumps Secon~ Piping __ Spill Bucke~ Turbine Sum, ~ UDC Repair Scope (~'fbe component~ and a~ticipated ~pai~) Phone: OMt~u~,*on: OriginaJ t~ Agency CITY OF BAI4~.RSFIELD. ' '~2, ~---' . o cE oF SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 I'{~,MIT API~CAI~ON TO ¢owS'1FeUC~/I~OO~'~r ttNO~O~ STOlC~GE TAWK T^NK. NO. VOLUM~ ,~bq" _ .'" AVI~TtON T, AIqK NO. YOLUME CH~AL, ~ CAS NO. , C-l~ p ~USL¥ STORED THiS FORM ~ BEEN C(~P LL~ UNI)F~ PENALTY OF PERJURY, AND TO THE BEST OF ~ K~~ I~ ,,' , , , ./ ~ ','~ ~ ~CA~ON B~O~ A p~ ~N ~RO~. . . TInS ~,e~r ~ sm, crt m~st s'r^~ ~ ~o r~o~.,,~ m~ Ices. D August 30, 2002 AM / PM 3220 Ming Avenue Bakersfield, CA 93304 REMINDER NOTICE 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: Necessary secondary containment testing requirements by December 31, 2002 of underground storage tank (s) located at the above stated address. Dear Tank Owner / Operator, If you are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last four months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services FEB ~ 8 ZOOZ Ry CITY OF BAKERSFIELD · OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 · %5-o,,,,,4 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTLNG OPERATORS NAME ~"'C~ OWNERS NAME ~ NUMBER OF TANKS TO BE TESTED IS PIPING GOING TO BE TESTED TANK # VOLUME CONTENTS %- NAME & ,HON~.NL~:R OF CONTACT~ERsoN~'~-(f-~/[0 gil V<~'_~ DA~ & ~ ~ST ~ TO BE CO~U~ . . ~ _ APPROVED BY DATE Au~; 1'2 132 05:21p p.2 No. of Pages: bp SE~ 989 TESTING PROGRAM AGENCY NOTIFICATION SHEET ~otificafion Date: Requested Test Date: ~.RCO Fac~'. ~ddress: city: State: Agency Name: >erson Contacted: rime Contacted :ommentslRequirements NotJfcation For: Initial Test: __~ Repairs: Re-test: Nofifcafion Method: Fax E-maiM: VerbaJ: ~.j~.q._~;~.~ (check all c.~mponen~ that apply) Tank Annular _ ~7 _ Fill Sumps ~',_ Secondary Piping ~ Spill Buckets ~ Turbine Sumps ~ UDC /~,,. (describe component~ and anticipated Contractor Name: Contractor Phone: Nol~fication Made By: ARCO Contact: {l~l'~r~e of ~ndiw'i'~uafJ ~ .~'~ Phone: Distribution: Original to Agency Copy to gle.~hire Environmental Services CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITYNAME [k[[~:~ pI(£Z& INSPECTION DATE .'7 "-~ ~' 0 ~_ Section 2: Underground Storage Tanks Program [] Routine [~ombined [] Joint Agency Type of Tank ~t3) ~' Type of Monitoring d:/_/*x [] Multi-Agencyt, [] Complaint Number of Tanks Type of Piping ~tJI [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees 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 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 CITY OF BAKER-SFi.~ELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ADDRESS FACILITY CONTACT INSPECTION TIME INSPECTION DATE PHONE NO. ,_~q~ '0L~O BUSINESS ID NO. I:5-210- NUMBER OF EMPLOYEES.. Section 1: Business Plan and Inventory Program Routine [~ombined [~ Joint Agency [~ 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=Compliancc V=Violation Any hazardous waste on site?: Explain: Yes ~No Questions regarding this inspection? Please call us at (66 i ) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Business ~i~esp:y~,)e Party ',' EE]'~ER-ROOT TL'" -:'-250 TANK LEVEL SENSOR IN,.LN~uRy REPORT · _iLl[. 2.'_--,'., 2002 TANK i SUPER LiNLEADED 858 GALLONS FUEL ,--,~s.~ ~ ~ALS LILLAGE i2.67 iNCHES; FUEL · 0.0 iNCHES WATER 98.0 DEGREES F ..... " REGULAR ii56 .'--"528 ~Z 76 0.0 9.5.'-, TANK 3 UNLEADED i T". 77 GALLONs FUEL GALS ULLAGE iNCHES FUEL iNCHES WATER DEGREES F GALLONS FUEL GALS ULLAGE iNCHES FUEL iNCHEs WATER DEGREES F TANK 4 UNLEADED i689 ,--"995 28.59 0.0 96.9 GALLONS FUEL GALS ULLAGE iNCHES FUEL iNCHES WATER DEGREES F .MANIFOLDED TANKs I/'../:ENiuRY TOTALS; UNLEADEi-I 3058 GALLONS FUEL Jun i4 02 04:50p ~ p.3 CITY OF BAJ(EI~FIELD -(~ ~~O"[I,~;~J '-(' OFFICE OF ENVIRO~ENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 PERMIT APPLICATION TO CONSTRUCT/I~ODIFY UNDERGROUND ~'TORAGE TANK [ ~ ~^cJrrrr M~oomc~r~o~ o~ ~^oLrr¥. [ )~-w TAXX ~sr~u~ao~ ^~ ~asr~q~ STARTING DATE ..... PROI~O~ED COMPLETION DATE PHO~ NO. ~.-~,~c, ......... B~~ ~Y B~. ~SE NO, -_~ FI~ wxr~Ac~~~Y ~"' ,,,,"' ' ~S~CTIO~ lrOR MOTOR ~ VOLUME UNLEADED ItEG~cJ P~ NON ~S O?OR F~.~ ~OR~C.~ TANXS T,~C ~O. VOLUan~ Chtl~ STOR~ C.~S ~o. DIESEL AVIATION CHEMICAL PREVIOUSLY STORED ~ APPUCATION BECOMIgS A PERMIT W!~_ .N APPROVED THIS FOI~ RA~ itF~ ~C'~IP LETi~ UM)F_.lt PENALTY 01: P~.FJURY, ANO TO THI~ BEg? OF MY KNOWLEDGE, IS _ FOR ~[AL USE ONLY , ,mrk~o~wr~.. , ~,~awi~o. ' ~: NO. wT.,k,,,~.. . n~ss - T~ ~PLIC~ ~ ~~, ~T~, ~D W~L CO~LY W~ A~A~D CONDffIONS ~ ~S FE~ ~ ~ ~ ~A~ L~ ~D ~ ~O~T IONS. D June 30, 2002 AM / PM (Valley Plaza Arco) 3220 Ming Avenue Bakersfield, CA 93304 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 REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 3220 Ming Avenue. Dear Tank Owner / Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, t° ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 will be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 will be tested by January 1, 2003 and every 36 months thereafter. REMEMBER.* Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661)326-3190. Fire Inspector/Environmental Code Enforcement Officer ....... Environmental Services SU/kr D May 29, 2002 Valley Plaza Arco 3220 Ming Avenue Bakersfield, CA,93304 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: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 3220 Ming Avenue REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002. section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1,2001 shall be tested by January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office, and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincere Steve Underwoo Fire Inspector/Environmental Code Enforcement Officer SBU/kr enclosures MONiTOR.lNG SYS IEM CERTIFICATION For U~ By All JaHsdlctionc Within the State of Californla Authority Cited: Chapter 6.7, Health and Safety Code: Cb~zpter 16~ Divisiott 3, Title 23, California Code of R~$~dations This form mtat b~ uacd to ciocumont t~ting and servidn$ of moni;oring equipment. A seca(ale_certification or rep.ort_mtlsLbe vr~_~are.d ~l'_each monit, od.ne system cvl).trol partcl by tire technicia~ who Ice(forms the work. A copy of tili~ form must be provided ~o tM tank system owner/operator. The owoedopem~or mus~ s~bmit a cop~ of this form to the local agency regulating UST systems within ~0 B. Inventory of Equipment Tested/Certified Check th~ a~?,roprlate boxes ~o indicate specific equipment ins?,r~at~emd~ ds , ..... li:l'~-Tank Gauging Prob= MOdel: t~'.~-,O: I Bldg, No.:_._ Cky:/~/-g'(C_~__j~6~?.O Zip: Contact Phone No.: r ). Da~ of T~tin~S~iciag: ~Ff~nnalar Spca,' or Vault Ser~or. Modch ~ 7 [?[3~.p. iping Sump / Trench Sensor(~). _ Pill Sump Sensor(s). M~*i: ~ ~ ~hmical Linc ~ Dctcctor. Modal: ~ ~ ~ EleCtrOnic Llne ~a~ Detector. Modal: Ting Overall ~ High-Lew{ 8c~*or. Modal: Other (sr~elfy equipmeqt type and model in Section E On Pa,~e 2). -- ' /o'c ,, . '- ~nul~ Spacm Or Ult S~nsor. Mod 1: - _ ~ing Sump / T~nch $cn~ot(s). Model: ~ ~J ~iI1 5amp $emor(0, Modal: ~ ~- , ~M~chanical ~ae Le~ Dct~tor. Model:_ ~ O~ ~ 81ea~onic ~na ~ De~t~. Mod~: :r w: ,/-o tC [l;An-Tank Gauging Probe. Model: ~' ~_/ nalar Space or Vault Sensor. Mod,hm~ ? ~iping $ump/ Tr~ch $cn$o~s). M~cl: ~1 Stop Modch..~' ~l"Mechanicel Line Leak Detector. Model: _~_~ Electronic Linc L~ak De~ctor. Model: Tank Ovcdill I High-Level Sensor. Modal: fpenser Containmen~ Sensor(,). Model: r Valve(s). enscr Contd~men~ Float(s) and Chain(s). p,~n~er ID: B~spen~et Cont~nment Scnso~). Model:_ car va~wO), ,~sp~nscr Comainmam ~oat(s) r't Other (specify cq.aipment rvpc and model in S¢ctio~ E on Parc 2). ~Tan~agin~ Pmbc~ Model: ~d~ $pa~6 or VaSt S~or. Mofid: ~ping Sump /Tmch Seaso~s). Mo~: ~11 Sump $~or(s), Mo~el: ~ Mechmi~ ~ne L~ D~t~o~r. Mod~l: ~ ~lcc~oni¢ Line ~ak Detector. M~: ~ Ta~ Ov~dl / ~gh-Lovel S~0r. Modch ~ Oth. r (~p.~fy ~ui~cnt t~pa md model in Saction [] D~ispcnscr ¢ontalnmumt Scn~or(s). Mode. l: ~J~ar Valve(s). _~Di.~pcns.cr ContainmEnt Float(a) and Chai~trs). Dispenser ID: "~ ' ~' Cl ~spcrmcr Containment Sensor(s). Model: __ ~l~tsDcrls~ Contalnmem Float(s) and Champs). Dbper~er ID: __ ~ -_~ -Dispenser ID: ~_,r' - ~1 Dispenser Containment $cnsor(s). Model: Q~ispcnse¢ Contnlnment Sensor(~). M~el: Valve(a}, ~.~_lla'Shear vd'~e(s), . ~ ~,I l.:i~pense Contalnm~m ~]o~(.~) and Chun(). ~penser ~ontalnmcnt F~gat(s) and ~hain(s),, .. _ %ff tho facili~ contains moro ranks or dispc~e~, copy ~is fo~ Include info~aUon for e~ ~k and dispcoacr at {he facility. C. Certification. I cerfi~ ~t the ~aip~nt idmtffied in t~t document wa$ i~speeta~$ervieed in aeeoc~aee ~th the gulOalin~, Ai~ed to ~s ~erfigeafion ~ information {a,g, m~aetar~s' chte~) nec~a~ to very ~al ~0 info~afion correct and a Plot Plan showing ~e layout of moMto~g eqatI,~t. For any equig~e~ c~aOle of genga~g such report, I have attuned o ~py of ~e repor~ (check a~ ~,~ appl~): ~ S rst~ set. up ~ M~istoW report Technician Nam~ (}fin0: J~S~l~ $i~a~: C,rtifica~on No.: Lice~c. No.:/ q Tc~ng CompayName:~t CO. of ~!io~e_. Phone No.:( ~ n ) nq~-~aa~ Monltor/ng System Certification ]~age 1 ors o~/0! l/E'd B~I'OH OD IIODS NdOa:9 EOOE'SE'a3J MONITORXNG SYSTEM CERTIFICATION For Use By All Jurisdiction-~ Within the State of California Authority Cited: Cl~pt~r 6.7, Health and Safety Code; Chapter 16, Div~ion 3, Title 25, CalifOrnia Code of Reg. ulatlon~ Th~ form must be us~cl to document t~tiag and s:rvici:tg of moni toting e, quipmcnt, A_~eoarate cemfi~allon or r~r~_ r_t must. fpp or, eared for.each mo. fiitoring svstem_¢_ontml, alanel by tho technician wino p~ffon'ns th= work. A copy of ~his form must be provided to the tank System owner/opera~°.r, The ownedoperator must submit a copy of ~fi'fis fo= to ~ac local agency regulating UST systems witMn 30 days of' test date. A, General Information Facility N ames Site Address: Paeilky Contact Person: Make/Model of MoMtodng System: B. Inventoxy of~Equip'mant Tested/Certified- Ch~=k~h~ a~prupriat~ boX~ te in~l~ca~ ~i,~;,:lfl~: ~uig~ Tank ~: · - , ~ ln-TankGau~nff Probe. MoOch ~ Annol~ 5pace or Vaalt ~e~sor. Mod~: ~ Piping 5a~ / Trench 5cn~o~s). M~d: . . . ~ Fill 5~mp S~or(a). Mod~: ~ Mec~ani~l Line Lc~ Detector. Mo~cl: ..... ~ ~lc~o~c Line ~ak De~ctot. 'Tank ~: ~ In-ToOk Gaaging Probe. Mo~el: O A~nulg gp~ or Vault 5~n~or. Mo~I~ O Pi~in~ Sump / Tt~ch S~nso~). Modfl: ~ Fill 5~mp 5c~otO). O ~lectro~c Li~e Le~ Dc~tor. Mod~: ~ Tank ~e~ll / H]gh-~wl 5c~or. Model: ~ Omer ~p~ci~V equi~ ~pe and ,m~?~..i~ 5~c~on S o~..~e 2). m: .... /J pcnscr Coat,ampi $e~sor(~). Model: . -. ~er Containment ~oaga) an~ C~i.nfs).. Dispenser ID: ~ DispcnseeComainm~nt Sensors). Mo~l: ~ ~ 'Shear Valve(s). D Dispc~ser ComaJ~gcnt ~oatfs) an~ Chain(s). Dispm~er ID: ~ DiSpenser Comainmcnt Sensors). Mo8~l: Bldg. No.: City: ~ip: Contact Phone No,: C ) Date of Testing/Sc, tricing: 'nmk m: /_--/ In-Tank Oaagin8 Probe. Model: Annt~lar Space or Vault Se~or, Model: Piping 8~mff / Tr~ch S~nSo~s), M~ch Fill Sump SeroUs), Model: Mccha~ic~ Line ~ Dctcaton M~cl: Electm~i~ ~ne Lc~ Detec~r. Mo~: Tank Ow~ilJ / High-level S~n~. Mo~l: O~her ~ape~f~ ~ui~ment ~ a~d mod~ in Tan~ ~: Shear Valve(s), ODispcnse. r, Containment Eoat(s) and Chain!s). O,_ Dispenser Co.minment Flo~, ~1 and Chain(s)., th~ facilky contains mom Umkz or dispenser~, ~opy this form. Include information l%r every tank sad dispenser ar the facility. ~ecrig.n E on P~c {~ In-Tank Gauging Probe. Model: O Anmllar Spa~ or Vault Serisor, Model: ~ ~ping $Omp /Tmch SeroUs). M~cl: ~ M~ha, ic~ ~ne Lc~ ~mtor. Mod~ ~ Elcc~nic Linc Leak Detector. Mod~: 0 T~ Ov~tll / ~-Lcvel Sense, Mod~: ~ Oth:t_~S. pe~fy ~pment ~apd mod~ in $~oa E on Pa~e 2)3. Disposer ~: -~ Valve(s). , qs~r Contm~mcn~ Float(s) ~ Chain(s). ,,., Dispenser ~: .. ~ Dispenser Con~inmcn~ SenSor(s)· Mod~l:, ~ Disp~ser Co~t~inment PlO~t(~) ~nd Chain(s). , D~p~nser ~ ~ Dispcnse~ Cont~inm~n~ S~sor(s). Mo~el: , aff~ehcd a copy of the report; (check all tlmt aFpl2): Technician Name (print):.._~ohn S_ct~ellpJ-~ac]~ Signature: Certification No.: Lic~se- No-: Testing Company Name: $i~ Ad dr~,.~: Certification - l c~rUry that the equipment ldenrJ§ed in tM~: documen~ w~ in~e~serviccd ~ acco~ance ~th ~e man~acturer$' guideilne~ Attuned to ~s Ce~fieatlon [~ info~a~on (e.g. ~act~rc~' che~B~) nec~n~ to vefi~ ~at ~ i~o~fion i~ correct and a Plo{ Plan showing the layout of mo~to~ng equi~ m~nt, For say equipm~t capable of g~n~g Such repo~, I ha~e ~o ~ Sltstm set-up ~ Alarm h~to~ report 1844~_n Date of Testing/Sc:vicing: .___~.._.._/~ Monitoring System Certification 0~/01 Z/~'d 8~I'ON OD I±ODS WdIE:9 E00E'SE'a3A ~ ~ D. Resnlts of Testing/Servicing 5oftW~m ¥orsion im~tall~: Complete ~lle ~OliOwln~ CIlecl~lSI: ~ ~ ..... '--- - ~ ~ No*' Were ail s=nsors vitally i~pccted~ ~ncfic~7 t~Ste~, ~d conf~ o~emtion~? -~eS ~ No* Wer~ 'all sens~rs.ins~llcd at low,sc point cf sccond~ cont~nm~nc and po~i~oned ~o ~[ ~'~cr cqmpmcnt will not inr~ferc with choir ~rop~ up,ration? .... If ala~ ~ relayed to a ~mo'~ moaitoring station, h ill' coFaunications equipment (c,g. modem) ~Y~ ~ No* For pr~s~ur~eO piping syst~, 0ocs th~ t~bin~ ~uto~ically s~ut ~own if ~c p~ping seconda~ cont~nm~nt ~ N/A monkor~g sys~m d=~cts a 1=~, fails to operator b =lco=ically disconmct=d? If yos: which sensors initiate positive shut-down7 (Check =tt t~t =~pty.~ ~ump~r~no~ ~ensors: ~ Di~c~r Containment Se~mn. ~ Did you confi~ pmitive shut.do~n du~ tc 1~,~ ~nsor failur=/disoonF~ction? ~s: ~ No. ~Ym ~ No* For ~nk sysm~ ~= afiliz~ ~ moniw~g system ~-~ 'pr~. lank owrfill w~g ~=vic~ (Lc. no ~ ~A m~chanical ow~ll prevention v~ve is initall~d), is &e ov,~ll w=ning flare visibl, ma audible at tho mar fill ~in~(s) ~d up=rating p~ly? If so. at.w~t ~rc~nt of Unk capaci~ do~ ~e al~ ~gg=? . % .... ~ Y~* ' ~o Was 'any monitoring o~uipm~nt replac=a't If yes, identify spo&ific s~nsors, pmb,s, or oth~r ~quipm~nt ~plac=~ _ ~ and ~st th~ m~Ufactur= name ~d model tot ~11 ~plac~m,~t parts in Section ~, b~low: '-~- Yes* ~No Was liquid ~ounO tnsia~ any seconda~ co,t~nm~t sys~ms doslgn=d as ~ system? (Chec~ alt that appiyj ~ ~ ~rodoct; ~ War=. If y,s, de~fib, ca~ in S~8on E. belgw. ~Y~- ~ No* Was monitonng s~st~m s~-u~ mv~e~d tc c~u~ nro~r sett~gS~ Attach ~=t up mp~'rts, if a?pltcab'ic __ ~ ~ No* Is all monitodn~ oqui~m~nt o~ational p(r manaf~tu~er's ~=cifi=afions? ' ' .., ...... .~, , ' , '- ... ~ - ' '. .... ~d .... a * In Sect/on E below, describe how and when the~e deficienci.~ were or ,,rill be corrected. ~E. Comments: l%ge 2 of 3 o;y~l Z/S'd 8~I'ON 03 ±103S WdIa:9 In-Tank Gauging / SIR Equipment: ~ C'~eck this box if ~a~k gauging is used only for inventor~ control. [] Ch~ck ~i~ box if no ta~k gauging or 5IR ~quipment is inst~ll~d. This section must be completed if in-tank gauging equi~ meat is used ~:o peffo.rm leak det~¢tio-a monitoring. Co. replete the ~llowing caecz, ils;: ......... . . ,.~. , ~"~es []' ~o* H~s ~1 inp'~ wiring ~n inspec~ for pro~' ~n~ ~nd' te~n~0on, in~lu~ng ~s~in~ for ~ound f~ul~? -~ ~ No* Were ~1 t~k gau~ng pro'~'~s vitally in,pecked.for da~e and residu~ ~uilUup? ... -~es O No* Was accuracy of -~s O N~'~ W~ ~cc~r~cy of sys~m wuter lcv~l r~dlngs ~es~ -- ~ ~ No* W~rc ~11 probes ~imc~lled pro~rlyV Yes O No* Wem'~ll ~te~ on ~e equipment m~nufictu~r'~ ~aintenmce chcckl~t c~mplete~? .. * In the Section It, below, describe how and ~hen these cleflcie ~cie. s were o~ G, Line Leak Detectors (LLD): ~1 Check this box: flJ..Ds ~ not installed. Com' ere the tollowin hecklist: ~,t c~:ilicafion, wna a leak simulated t~*¢tif~ LLD perfc;~llce? IZr~g,p,h.; [] 0,1 g.p.h; ~l 0.2 g.p.h. -[a"TYes = No~' Fo~ cquiprnent stari-up or annual e~{uipm~ C1 N/A (Check all char a~ply) Simulated leak '~y~i. ~ No~' W~re ~1LLDs confi=ed opcration'al and a :~t~ wi&in regulatory requiremenU? ~. ~ No* WaS ~e ta~ng apparatus p~periy ~s ~ No* For ~e;hanical LLDs, do~s a; LLD msMc product flo~ if it d;t~cts a ~ N/A .... Yes ~ For ~eceoaic ~s, do~ ~ m~in¢ aurora ~cally shut off if ~ ~D y~ ~ ' For el~c~onic LLDs,'docS ~e t~bine au[~r~a~c~ly shut off if =y portion of t~e moMtoclng syst~ i$ ~sabled- ~ or ~isconnect~d~ Ycs ~ For clcc~nic ~D~, doe~"~hc ~rbiu'e ~ot ,y ~hU[ offif any per,on of ~e mo~oring sys~m ~func~ or f~ls n ~t~ -- Y~" ~ For el~ni~ LLDs~ h~v~ ~1 ~c~sibl~ wl g connections ~e~ ~su~ly insp~d~ '~Y~_ ~ No* Wc~ ~11 i~cms on the equ[pme~ ~mnufn~?eFs mnlntcnanc~ checklist completed? .. .- In -" ' ~-1o,~ ~cribe ho~ ~ad when ~e de~c~mci~ ~ere or will be correcte& ~he Section ~ ~ Commen~: Page :l of 3 Z/9'd 8PI'OM OD IIOOS NdI~:9 ~00a'fi~'833 n~rARCO Products Company Mechanical Leak Detector Test Data Sheet st..,tion # -6"3 /- 7-o 20 Test I~ formation Manufacturer Model Full Operating Pressure (psi) Linc Bleed Back (mi) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) Test Leak Rate (ml/min) (gph) Replaced All Failed Leak Detectors Yes If No, Replacement To Be Completed By (Date) __ [_ ~ / ... This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturer~ lXocedures and lim/tations and the results as listed are to my knowledge true and correct, The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor__~~7' Technician Signature Lic# APC-.3a25 (12/00) Z/Z'd 8P'I: ' OH OD J_J_ODS HdIE :9 EI20~'~'SSq · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: CAP. OS RODRIGUEZ ICg: 3220 [tING, 1129 UNION, 900 H(~TEREY 2. Article Number (Copy from service label) 7000 1530 0006 3456 3409 [] Agent [] Addressee D. Is delivery address different from item 17 [] Yes If YES, enter delivery address below: [] No 3. Service Type ~] Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid USPS Permit No. G-10 ° Sender: Please print your name, address, and ZIP+4 in this box ° ~RSF1ELD FiRE DEPARTMENT OFF~CE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 _n Postage ITl Certified Fee Return Receipt Fee (Endomement Required) Restricted Delivery Fee (Endorsement Required) I-1 Total Postage & Fees .34 2.i0 1.50 3.94 Postmark Here 113 u'lI Sent To ~[ CA~Los ~OD~Z mJ P 0 BOX 6038 February 20, 2002 Carlos Rodriguez Arco P O Box 6038 Artesia, CA 90702-6038 CERTIFIED MAIL 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 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Failure to Submit/Perform Annual Maintenance on Leak Detection System at Valley Plaza Arco, 3220 Ming Ave., Bakersfield, CA., AM/PM, 1129 Union Ave., Bakersfield, CA., AM/PM, 900 Monterey, Bakersfield, CA Dear Mr. Rodriguez: Our records indicate that your annual maintenance certification on your leak detection system is past due.. January 29, 2002, January 30, 2002, February 9, 2002. You are currently in violation of Section 2641(J) of the California Code of Regulations. "Equipment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, March 22, 2002, to either perform or submit your annual certification to this office. Failure to comply will result in revocation of your permit to operate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney MONITORING SYSTEM CERTIFICATION For Use By Ali Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, Health artd 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 report must be prepared f~"r each monitorine system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must subm/t a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Inforroation Facility Name: ,/'/f~C-,..~ ,_,<.,<>"'~",.~ Site Address: Facility Contact Person: Make/Model of Monitoring System:/ B. Inventory of Equipment Tested/Certified Check the a[~[aropriate boxes to indicate specific eq. uipment inspected/serviced: 'TanklD:' I~'"~n-Tank Gauging Probe. Model: ~/,~ r'''D' t li~F'~nnular Space or Vault Sensor. Model: ~ '7 iF. ping Sump / Trench Sensor(s). Model: I1 Sump Sensor(s). Model: l~lechanical Line Leak Detector. Model: El Electronic Line Leak Detector. Model: iD Tank Overfill / High-Level Sensor. Model: [] Other (specify equipment type and model in Section E on Paue 2). ank Gauging Probe. ' Model: nular Space or Vault Sensor. Model: lng Sump / Trench Sensor(s). Model: Sump Sensor(s). Model: echanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High-Level Sensor. Model: [] Other (specify equipmept type a_nd mode,[ in Secti_.o,g E,on Ps.ac 2). Dispenser ID: //" ~ penser Containment Sensor(s). Model: r Valve(s). enser Containment Float(s) and Chain(s). Dispenser ID: ~ ' ~ [] Dispenser Containment Sensor(s). Model: ~}~t:al' Valve(s). (3"IJ[~spenser Containment Float(s} and Chaimrs). Dispenser ID: '~ ' ~'~'~ [] Dispenser Containment Sensor(s). Model: C~Le a r Valve(s). O'D~spenser Containment Float(s} and Chain(sL Bldg. No.: City:/~/' ~'cur~,..~/~'d,- ~, 0 Zip: Contact Phone No.: (~.). Date of Testing/Servicing: {' /__ 7/02- Tank ID: ,/~5' ~ An-Tank Gauging Probe. Model: (,'..,~/ca i nular Space or Vault Sensor. Model: FPiping Sump / Trench Sensor(s). Model: ill Sump Sensor(s). Model: ~Mechanical Line Leak Detector. Model: ~..~ 2.0.0 [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor.· Model: O Other (specify equipment type and model in Section E on Pace 2). Tank Gauging Probe. Model: nular Space or Vault Sensor. Model: ff-- Gi~ping Sump / Trench Sensor(s). Model: le~F"lll Sump Sensor(s). Model: [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: [] Other (specif,v equil~ment type and model in Section E on Pa~e 2). Dispenser ID: ..? ~ C/' [] DispcnserContainment Sensor(s). lvlodel: .... [3'~ar Valve(s). ' El'"T)ispenser Containment Float(s) nnd Chain(s}. Dispenser ID: "~7 []' Dispenser Containment Sensor(s). Model: ~ar Valve(s). []"~ispensec Containment Float(s) and Chain(s}. Dispenser ID: ///' "t/~', lffshispenser Containment Sensor(s). Model: ear Valve(s). ~isoenscr Containment Float(s} and Chain(si. *if the facility contains more tanks or dispensers, copy this lbrrn. 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' correct and a Plot Plan showing the layout of monitoring equipment. For any equipment c~pable of generating such reports, I have also attached a copy of the report; (check all that apply): [] System set-up [] Al, afl~istory report Technician Name (p?int): 0'olqrl $chellenbach ' Signature: Testing Company Name: Sr. zc:~k':, q._',, . ................. ' , MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, PLealth attd 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 report must be orepared for each monitorin~ system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of test date. A. General Information Facility Name: Site Address: Facility Contact Person: Make/Model of Monito?ing System: B. Inventory of Equipment Tested/Certified Check the app ro p.riate., boxes to indicate specific er[uioment, inspected/serviced:. Section E on Paue 2). Tank ID: 7'1 In-Tank Gauging Probe. Model: t-'l Annular Space or Vault Sensor. Model: [] Piping Sump / Trench Sensor(s). Model: [] Fill Sump Sensor(s). Model: Cl Mechanical Line Leak Detector. Model: [] Etectronic Line Leak Detector. Model: I'"l Tank Overfill / High-Level Sensor. Model: CI Other (specify equipment type and model in Tank ID: I-I In-Tank Gauging'Probe. Model: [] Annular Space or Vault Sensor. Model: [] Piping Sump / Trench Sensor(s). Model: r-'l Fill Sump Sensor(s). Model: [] Mechanical Line Leak Detector. Mgdel: [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: [] Other (soacifv ecluipment t,vpe and model in Section E on Parle 2). I~isper~ser ID: ppenser Containment Sensor(s). Mod~:l: ar Valve(s). anser Containment Float(s) and Chain(sL Dispenser ID: [] Dispenser Containment Sensor(s). Model: [] Shear Valve(s). [2 Dispenser Containment Float(s] and Chain(s). Dispenser ID: [] Dispenser Containment Sensor(s). Model: [] Shear Valve(s). []Dispenser Containment Float(s) and Chain(s). Bldg. No.: City: ' ' Zip: Contact Phone No.: (__3 Date of Testing/Servicing: Tank ID: [] In-Tank Gauging Probe. Model: [] Annular Space or Vault Sensor. Model: [] Piping Sump / Trench Sensor(s). Model: [] Fill Sump Sensor(s). Model: [] Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: [3 Other (st>ecify equipment type and model in Tank ID: Section E on Pa,~e 2). [] In-Tank Gauging Probe. Model: [] Annular Space or Vault Sensor. Model: [] Piping Sump /Trench Sensor(s). Model: iD Fill Sump Sensor(s). Model: [] Mechanical Line Lcak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: i[] Other (s~e¢ifv equipment t¥1ae and model in Section E on Pa~e 2). 'ispe ser .... /.%'r< ........ ~ __,~pcnser Containment Sensor(s). Model: _ {~l~S h~.~l Valve(s). ,l~t-Dispenser Containmcnt Float(s) and Chain(s). Dispenser ID: [] Dispenser Containment Sensor(s). Model: [] Shear Valve(s). ~ Dispenser Containment Float(s)and Chain(s). Dispenser ID: iD Dispenser Containment Sensor(s). Model: [] Shear Valve(s). [] Dispenser Containment Float(s) and Chain(s). "if the facility contains more tanks or dispensers, copy this loan. Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the report; (check all that apply): Technician Name (print): John Schellenbach 12 System set-up 12 Alarm history report Signature: D. Results of Testing/Servicing Software Version Installed: Corfir)lete the followina checklist: ffl'~Yes [] No* } Is the audible alarm operational? - es [] No* llsthevisualala=o?erational? Y,,es [] No* Were all sensors visually inspected, functionally t,ested, and confirmed operational? l~'""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? VI Yes ~N~9* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? ~Y-~s [] 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~r is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) [3~3ump/Trench Sensors; V1 Dispenser Containment Sensors. ~ Did you confirm positive shut-down due to leaks and sensor failure/disconnection? I~I~-es; [] No. dyes [] 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 operatin~ properly? If so. at what percent of tank capacity does the alarm trigger? % [] Yes* [;F'lq/o 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* [~t'"~No Was liquid found inside any secondary contaim'nent systems designed as dry systemi? (Check all that apply) [] ~ Product; [] water. If yes, describe causes in Section E, below. ..[21/Y.~· [] No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, if applicable .:l;~'~Yes [] No* Is alt monitoring equipment operational. per manufacturer's specifications~ .... * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: F. In-Tank Gauging / SIR Equipment: ~1 C~heck this box if tank gauging is used only for inventory control.' UI Check this box if no tank gauging.or SIR equipment is installed. This section must be completed i£ in-tank gauging equipment is used to perform leak detection monitoring. Corpulete the followin.o checklist: s cq No* Has all input wiring been inspected for proper entry and ten'nination, including testing for ground faults? ~3'~,..Y..es [] No* Were all tank gauging probes visually inspected for damage and residue buildup? Yes [] No* Was accuracy of system product level readings tested? es [] No* Was of level tested? accuracy system water readings s ~ No* Were all probes reinstalled properly? "/'es [] No"" Were all items on the equipment manufacturer's maintenance checklist completed7 * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): El Check this box if LLDs are not installed. Complete the followine checklist: ~:~s [] No* Fo? equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? [] N/A (Check all that apply) Simulated leak rate: li!~g.p.h.; [] 0. I g.p.h; UI 0.2 g.p.h. li~y)3 [] No'" Were all LLDs confirmed operational and accurate within regulatory requirements? ~."~y~. t-I No* Was the testing apparatus properly calibrated7 ~t"'5'es [] No* For mechaoical LLDs, does the LLD restrict product flow if it detects a leak7 [] N/A [] Yes []r'~a* For electrooic LLDs, does the turbine automatically shut off if the LLD detects a leak? [] Yes [] No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled [21~A or disconnected? El Yes D~ Fo,' electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions [~N/A or fails a test? [] Yes ~Ns~* For electronic LLDs, have all accessible wiring connections been visually inspected? t.t;;F'Yes i UI No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Sectiqn H, bglow, describe how and when these deficiencies were or will be corrected. H. Comments: '~~ARCO Products Company Mechanical Leak Detector Test Data Sheet Station # ~-<~"3 Date Address 3 ? ~ ?~q r/./~_ /~/? Ct_-TS r'?(z~ t/~ 7- o '~ 20 Test Information -' Product Manufacturer Model Full Operating Pressure (psi) Line Bleed Back (ml) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) Test Leak Rate (mi/rain) (gph) PASS or FAIL Replaced All Failed Leak Detectors Yes __ If No, Replacement To Be Completed By (Date) No N/A / / This letter certifies that the annual leak detector tests were. performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my APC-3325 (12/00) UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION Page of FACILITY ID # (Agency Use Only) BUS1NESS NAME (Same as FACILITY NAME or DBA - Doing Business As) ARCO Facility No. 00583 BUSINESS SITE ADDRESS 3220 Ming Avenue I. IDENTIFICATION I 1. BEGINNiNG DATE 100. ENDiNG DATE 01/01/02 3. I BUSINESS PHONE (661) 398-0303 101. 102. 103. CITY lO4. CA ZIP CODE 1o5. Bakersfield 93304 09-720-0401DUN & BRADSTREET lO6. 5541sic CODE (4 digit #) lo7. COUNTY 108. 'Kern BUSINESS OPERATOR NAME 1o9. BUSINESS OPERATOR PHONE 11o. Edmond Nassar (661) 398-0303 II. BUSINESS OWNER OWNER NAME BP West Coast Products LLC OWNER MAILiNG ADDRESS P. O. Box 6038 111. [ OWNER PHONE 112. I (714) 670-5402 113. CITY 114. I STATE 115. ZIP CODE 116. Artesia I CA 90702-6038 IH. ENVIRONMENTAL CONTACT CONTACT NAME 117. { CONTACT PHONE 118. Carlos Rodriguez I (714) 670-5402 CONTACT MAILING ADDRESS 119. P.O. Box 6038 CITY 120. STATE 121. IZIP CODE 122. Artesia CA J 90702-6038 -PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY- NAME 123. NAME 128. Edmond Nassar ARCO MAINTENANCE '1 ITLE 124. TITLE 129. Franchisee MAINTENANCE BUSINESS PHONE 125. BUSiNESS PHONE 130. (661) 398-0303 (800) 272-6349 24-HOUR PHONE* 126. 24-HOUR PHONE* 131. Same (800) 272-6349 PAGER # 127. PAGER # 132. N/A N/A ADDITIONAL LOCALLY COLLECTED INFORMATION: 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 true, accurate, and complete. SIGNATURE OF OWNER/OPERATOR OR DESIGNATED REPRESENTATIVE DATE 134. I NAME OF DOCUMENT PREPARER 135. ~'~-~ --~ ~>'~'e~e~'~r 12/26/01 [ Rachel Gross NAME OF SIGNER (print) 136. TITLE OF SIGNER 137. Carlos Rodriguez Environmental Compliance Specialist * See Instructions on next page. UPCF hwf2730 (1/99) - 3/29 http://www.u nidocs.org Rev. 04/17/00 TYPE OF ACTION (Check one item only) PROGRAM CONS¢ TANKS UNDERGROUND STORAGE TANKS - FACILITY (One page per site) Page of [] 1. NEW PERMIT [] 3. RENEWAL PERMIT [] 5. CHANGE OF INFORMATION [] 4. AMENDED PERMlT (Specify change) Name Change [] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED SITE [] 8. TANK REMOVED 400. I. FACILITY/SITE INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3. FACILITY ARCO Facility No. 00583 ID# NEAREST CROSS STREET 4ol. Wible Road BUSINESS [] 1. GAS STATION [] 3. FARM [] 5. COMMERCIAL 403. TYPE [] 2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER FACILITY OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 3. PARTNERSHIP [] 4. LOCAL AGENCY/DISTRICT* [] 5. COUNTY AGENCY* [] 6. STATE AGENCY* [] 7. FEDERAL AGENCY* 402. TOTAL NUMBER OF TANKS 404. Is facility on Indian Reservation 405. * If owner of UST is a public agency: name of supervisor of division, section or 406. REMAINING AT SITE or trust lands? office which operates the UST. (This is the contact person for the tank records.) 4 [] Yes [] No H. PROPERTY OWNER INFORMATION PROPERTY OW2qERNAME 407.I PHONE 408. BP West Coast Products LLC I (714) 670-5402 MAIL1NG OR STREET ADDRESS 409. P.O. Box 6038 CITY 410-I STATE 4..IZIP CODE 412. Artesia CA 90702-6038 PROPERTY OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY 413. [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY TANK OWNER NAME BP West Coast Products LLC III. TANK OWNER INFORMATION 414. I PHONE (714) 670-5402 MAILING OR STREET ADDRESS 416. P.O. Box 6038 CITY 417. STATE als. ] ZIP CODE 419. Artesia CA { 90702-6038 TANK OWNER TYPE [] 1. CORPORATION [] 2. INDIVIDUAL [] 4. LOCAL AGENCY/DISTRICT [] 6. STATE AGENCY 42o. [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY 415. IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER WY (TK) HQ 44- I [ I I I I I Call (916) 322-9669 if questions arise 42i. V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(s) [] 1. SELF-INSURED [] 2. GUARANTEE [] 3. INSURANCE [] 4. SURETY BOND [] 5. LETTER OF CREDIT [] 6. EXEMPTION [] 7. STATE FUND [] 8. STATE FUND & CFO LETTER [] 9. STATE FUND & CD [] 10. LOCAL GOV'T MECHANISM [] 99. OTHER: 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 424. [ PHONE 425. ~.~ ~ ,ttr'.,,:~e.~_ 12/26/01 [ (714) 670-5402 426. 427. NAME OF APPLICANT (print) Carlos Rodriguez STATE UST FACILITY NUMBER (Agency use only) (See Data Element 1, above. 428. TITLE OF APPLICANT Environmental Compliance Specialist 1 998 UPGRADE CERTIFICATE NUMBER (Agency use only) 429. UPCF hwf2730 (1/99) - 4/29 http://www.unidocs.org Rev. 04/17/00 ....." 01-ARE-003: Bakersfield Site List ,12/27/01 00371 2698 MT VERNON COLUMBUS/MT VERNON BAKERSFIELD CA 93306 90583 c~32_2[?_M__II~_G-_AV_E ~ WIBLE RD/MING AVENUE BAKERSFIELD CA 93304 01960 11701 BRUNDAGE I'ANE "H" ST/BRUNDAGE BAKERSFIELD-ICA 93304 03054 1129 UNION AVE CALIFORNIA/UNION AVE BAKERSFIELD CA 93307 - 33090 3333 UNION AVE 34TH/UNION BAKERSFIELD CA 93305 :)5365 4010 WIBLE RD WHITE LANEANIBLE RD BAKERSFIELDCA 93309 :35420 6450 WH~-TE LANE ASHE/WHI_TE LANE BAKERSFIELD CA 93309 :)5496 4800FAIRFAX AUBURN/F~RFAX BAKERSFIELD CA 93306 35526 1900 MONTEREY BEALE/MONTEREY iBAKERSFIELD !CA 93305 r 05751 2800 PANAMA LANE DENNEN/PANAMA BAKERSFIELD CA 93313 06218 4203 MING AVE !STINE/MING AVE BAKERSFIELD CA 93309 06353 3125 CALIFORNIA AVENU CALIFORNNOAK BAKERSFIELD CA 93302 06356 2301 F STREET 24TH/F BAKERSFIELD CA 93301 Page 1 CERTIFICATE OF INSURANCE Name & Address: Policy Number: Period of Coverage: Name of Insurer: Address of Insurer: Name of Insured: Address of Insured: See Attachment 7.A and 8.A for names and addresses of each covered UST location. Contact facility representative or Jeff Hall at ~L~RSH (312-627-6000) for copies of all UST waste facility liability endorsement policy~ numbers. - January 2002 through January 1, 2003 Insurance Company of North America 195 Broadway, New York, NY 10007 BP America Inc. 200 E. Randolph Drive, Chicago, IL 60601 Certification: Insurance Company of North America, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s): (see Attachments 7.A and 8.A) for taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases arising from operating the underground storage tank(s) identified above. The limits of liability are $ 1,000,000 per occurrence and annual aggregate $ 2,000,000, exclusive of legal costs, .which are subject to a separate limit under the policy. This coverage is provided under (policy number). The effective date of said policy is January 1, 2002. The Insurer further certifies the following with respect.to the insurance described in Paragraph 1: ao Co Bankruptcy or insolvency of the insured shall not relieve the Insurance Company of North America of its obligations under the policy to which this certificate applies. The Insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged thirdparty, with a right of reimbursement by the insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95280.102. Whenever requested by (a Director of an implementing agency), the Insurer agrees to furnish to (the Director) a signed duplicate original of the policy and all endorsements. do Cancellation or any other termination of the insurance by the Insurer, except for nonpayment of premium or misrepresentation by the insured, will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the insured. Cancellation for nonpayment of premium or misrepresentation by the insured will be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured. ~ The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of the ~ effective date of cancellation or nonrenewal of the policy except where the new or renewed policy has the same retroactive date earlier than that of the prior policy, and which arise out of any covered occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or termination date. Claims reported during such extended reporting period are subject to the terms, conditions, limits, including limits of liability, and exclusions of the policy. I hereby certify .that the wording of this instrument is identical to the wording in 40 CFR 280.97(b) (2) and that the Insurer is licensed to transact the business of insurance in one or more states. Authorized Representative of Insurer December 21, 2001 195 Broadway, New York, NY 10007 Address of Representative Obp Attachment 8.A Financial Assurance for Corrective Action and Third Party Compensation for Underground and Aboveground Storage Tanks Owned, Operated or Guaran~ed by BP Amoco Corporation or Subsidiaries Regulated by State Administered Programs Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: BP Amoco Chemical Company Chocolate Bayou Storehouse Alvin, 2,600 gallons FRP Diesel Fuel 1982 BP Amoco Chemical Company Chocolate Bayou Administration Alvin, TX 2,000 gallons Steel Emergency Diesel Fuel 1982 BP Amoco Corporation Naperville Site Naperville, IL (see tank listing at office) Amoco Production Company 4502 E. 41st. St. Tulsa, OK 40,609 gallons Diesel Fuel Amoco Production Company Tulsa, OK 10,000 gallons Diesel Fuel 1991 Amoco Production Company 7575 N. Lakewood Tulsa, OK 3,000 gallons Diesel Fuel Amoco Production Company, Westlake ! 501 Westlake Park Blvd. Houston, TX 10,000 gallons Fiberglass Diesel Fuel 1982 Page 17 2001 Financial Assurance 12/28/01 BP Amoco Chemical Company Chocolate Bayou Storehouse Alvin, TX 4,000 gallons FRP Gasoline 1969 BP Oil Company Toledo Refinery Oregon, OH 10,000 gallons Fiberglass 1990 Amoco Production Company 4502 E. 41st. St. Tulsa, OK 40,609 gallons Diesel Fuel Amoco Production Company 4502 E. 41st. St. Tulsa, OK 500 gallons Waste Oil and Oily Water Amoco Production Company Earth Science Lab 11611 West Little York Houston, TX 4,000 gallons Fiberglass Diesel Fuel 1984 **Shirley Tse, MARSH, maiataias copies of ALL UST facility liability eadorsemene policies. 312-62T-6247.* Attachment 8.A (continued...) Financial Assurance for Corrective Action and Third Party Compensation for Underground and Aboveground Storage Tanks Owned, Operated or Guaranteed by BP Amoco Corporation or Subsidiaries Regulated by State Administered Programs Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Construction Material: Substance Stored: Installation Date: Location: Capacity: Constn~ction Material: Substance Stored: Installation Date: ARCO California, Nevada, Washington, Arizona, Utah and Oregon UST facilities (see tank listing at regional office) BP Exploration (Alaska) Inc. Anchorage, Alaska 15,000 gallons Fiberglass 1984 BP Chemicals Green Lake Facility Port Lavaca, TX 7,600 gallons Fiberglass reinforced plastic Unleaded Gasoline 1981 BP Amoco Chemical Company Joliet Truck Terminal Joliet, IL 10,000 gallon Fiberglass Diesel Fuel 1993 BP Exploration (Alaska) Inc. Anchorage, Alaska 4,000 gallons Fiberglass 1984 Amoco Pipeline Bryan, Texas (see regional office for tank listing) BP Chemicals Green Lake Facility Port Lavaca, 7,600 gallons Fiberglass reinforced plastic Diesel Fuel 1981 **Shirley Tse, F~%RSH, maintains copies of ALL UST facility liability endorsement policies. 312-627-6247,* Page 18 2001 Financial Assurance 12/28/01 Name: Address: Policy Number: Period of Coverage: Insurer: Address: Name of Insured: Address of Insured: Endorsement Number 4 Underground Tank Endorsement Per list attached Claims Made PLIG 20308175 1/1/2002- 1/1/2003 INA Surplus Insurance Company 1601 Chestnut Street Philadelphia~ PA 19101-1484 BP America Inc. Mail Code 2304 200 East Randolph Drive Chicago, Illinois 60601-7125 This endorsement certifies that the policy to which the endorsement is attached provides liability insurance coverage for the following underground storage tanks in: Per list attached for taking Corrective action and/or compensating third parties for bodily injury and property damage caused by either sudden accidental releases or non-sudden accidental releases or accidental releases. The limits of liability are $ l~000t000 each occurrence $2,000,000annual aggregate exclusive of legal defense costs This coverage is provided under policy number Claims Made PLIG 20308175 The effective date of said policy is January 1, 2002 The insurance afforded with respect to such occurrences is subject to all of the terms and conditions of the policy, provided however, that any provisions inconsistent with subsections (a) through (e) of this Paragraph 2 are hereby amended to conform with subsections (a) through (e). Co eo Bankruptcy or insolvency of the insured shall not relieve INA Surplus Insurance Company of its obligations under the policy to which this Endorsement is attached. INA Surplus Insurance Company is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged.third-party with a right of reimbursement by the insured for any such payment made by INA Surplus Insurance Company. This provision does not apply with respect to that amou~nt of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280-102. Whenever requested by a director of an implementing agency, INA Surplus Insurance Company agrees to furnish to the Director.a signed duplicate original of the policy and all endorsements. Cancellation or any other termination of the insurance by INA Surplus Insurance Company will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the insured. The insurance covers 'claims for any occurrence that commenced during the term of the policy that is discovered and reported to INA Surplus Insurance Company within six months of the effective date of the cancellation or termination of the policy. I hereby certify that the wording of this instrument is identical to the wording in 40CFR 280.97Co) (1) and that INA Surplus Insurance Company is licensed to transact the business of insurance or eligible to provide insurance as an excess or surplus lines insurer in one or more states. 'Rbbin.R. Soss Assistant Vice President ACE Excess & Surplus Insurance Services, Inc. 1601 Chestnut Street Philadelphia, PA 19101-1484 RICH ENVIRONFLENTAL 5643 BROOKS CT BAKERSFIELD, CA. 93308 OFFICE (805) 392-8687 & FAX (805) 392-0621 ALERT 1000 UNDERFILL AND ALERT 1050 ULLAGE SYSTEM Precision Underground Storage Tank Sy_~stem LD~.k Test TEST RESULTS/ _._~_. ....... Test Date: 10/30/2001 / ........... ~, BILLING:ORANGE CO.TANK TESTING /SITE:ARCO #583 225 NORTH/LOARA ST / 3200 MING AVE ANAHEIM, ~dA. 92801 ~ BAKERSFIELD, CA. PRODUCT VOLUME %FULL WETTED NON-WET~ PRODUCT LEAK/" WATER IN (GAL) PORTION PORTION~--L/NE _-~DE~CTOR TANK MASTER UNL-87 10000 77% +.033-PASS PASS -.005-PASS PASS 0" SLAVE UNL-87 10000 79% +.014-PASS PASS SHARE-PASS SHARE 0" UNL-89 10000 73% +.027-PASS PASS -.002-PASS PASS 0" PREM-92 10000 65% -.018-PASS PASS -.009-PASS PASS 0" COMMENT: WATER BALANCE Measurements showed that water in the backfill area at the time of testing was below tank bottom, and therefore not a factor 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 i:' 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 Testw~ertified B~: ~ d~'tate cert~9'O-1072 ALERT TECHNOL OGLES PLOT OF ULLA GE TEST DA TA M I N U T E S 0 75 3 ARCO #583 3200 MING AVE. BAKERSFIELD, CA lO000 GALLON MASTER-87 TANK J2KHz AMPLITUDE RATIO 15 750+ 0 75 M I N U T E S 25KHz AMPLITUDE RATIO '1 5 750+ 12KHz DETECTION RATIO = .999 25KHz DETECTION RATIO = '1.00 TEST RESULT = PASS DATE AND TIME OF TEST' '10/30/01 '12: 33P BEGINNING BOTTLE PRESSURE = 100 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING BOTTLE PRESSURE = 100 ENDING TANK PRESSURE = 1.5 PSIG iii:: :::::::::::::::::::::::::::::: ii::i:: i i :ii::::: i ~iiiii iliii }:::::::: :: :::: ii::}::::i :: :: :: :: :::::::::::::::::::::::::::::::::::::::::::: ::i !::i::::ii :: } :: i :: :: :: :: :: i i ::::::::::::iii:: ::i:::. ::i :: :: }::i:::: :: :: :.5:.:.:.:.:. :.:.7:.:.5}5:. :.!5:.:.!:.:.:.:.!::.:. :. ! :. :. :.: ! :. :. :. :. } :. :. :. :.:. :J :. :. :.:.i!!!!:.:. :. 5 :. :. 5 :. 5 :. :. :J :. ! :. :. !!::.:.:.!: :.5}}5!:.! 5:. }i:.:.5:.:, :.:.:.:.:2. :J }:J :.:. :. :. 55!!:.:.:.:.:.:.:.:.:.:.!:.!:.:. 5:.:.:.:.:.:. ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA M I N U T E S 0 75 5 ~2KHz AMPLITUDE RATIO ARCO #583 3200 MING AVE. BAKERSFIELD, CA 10000 GALLON SLAVE-87 TANK 750+ 0 75 M I N U T E S 25KHz AMPLITUDE RATIO J5 750+ 12KHz DETECTION RATIO = .999 25KHz DETECTION RATIO = .991 TEST RESULT = PASS DATE AND TIME OF TEST' 10/30/01 01' 39P BEGINNING BOTTLE PRESSURE = 100 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING BOTTLE PRESSURE = JO0 ENDING TANK PRESSURE = 2.5 PSIG ALERT TECHNOL OGLES PL 0 T OF ULLA GE TEST DA TA M I N U T E S 0 75 3 5 ~2KHz AMPLITUDE RATIO ~5 ARCO #583 3200 MING AVE. BAKERSFIELD, CA JO000 GALLON UNL-PLUS TANK 750+ 0 75 M I N U T E S 25KHz AMPLITUDE RATIO ~5 750+ 12KHz DETECTION RATIO = . 998 25KHz DETECTION RATIO = .988 TEST RESULT = PASS DATE AND TIME OF TEST' ]0/30/01 1' 13PM BEGINNING BOTTLE PRESSURE = ~00 BEGINNING TANK PRESSURE = J.5 PSIG ENDING BOTTLE PRESSURE = JO0 ENDING TANK PRESSURE = ~.5 PSIG ALERT TECHNOL OGLES PLOT OF ULLAGE TEST DA TA M I N U T E S 0 75 5 12KHz AMPLITUDE RATIO ARCO #583 3200 MING AVE. BAKERSFIELD, CA 10000 GALLON PREMIUM TANK 750+ 0.75 25KHz AMPLITUDE RATIO ~5 750+ 12KHz DETECTION RATIO = 1.0l 25KHz DETECTION RATIO = 1.00 TEST RESULT = PASS DATE AND TIME OF TEST: 10/30/01 1' 39PM BEGINNING BOTTLE PRESSURE = 100 BEGINNING TANK PRESSURE = 1.5 PSIG ENDING BOTTLE PRESSURE = ~00 ENDING TANK PRESSURE = ~.5 PSIG RICH ENVIRONMENTAL 5643 BROOKS CT BAKERSFIELD,CA.93308 OFFICE(661)392-8687 & FAX (661)392-0621 AES MODEL PLT-100R HYDROSTATIC PRODUCT LINE TESTE[~ W/0#: Product Line Type (Pressure, Suction, Gravity)_ PRODUCT START TIME END TIME TEST VOLUME RESULT /READING /READING PRESSURE RATE PASS/ 00: 00/ML 00: 00/ML (PSI) (GPH) FAIL Tech: JAMES J. RICH Signature: ~..z~ State License: # -__~~ 1 certify that the above line tests were conducted on th;is date accordin9 to the equipment manufacturer,s procedures and limitations and the results as listed are to my knowledge true and correct. The test pass/fail is determined using a threshold of 1~0 ml per hour (0.05 GPH) rate at 150% working pressure or 50 psi which ever is less. The GPH rate is calculated as: ml/ 0.00106. RICH ENVIRO ENTAL 5643 BROOKS CT BAKERSFIELD,CA. 93308 OFFICE(661)392-8687 & FAX (661)392-0621 MECHAlqICAL LEAK DETECTOR TEST WQRK SHEET W/0#: Facility Name: A~CO ~ 5~ Product Line Type (Pressure, Suction, Gravity) PRODUCT LEAK DETECTOR TYPE TEST' TRIP PASS SERIAL NUMBER BELOW PSI OR $ GPH FAIL S~.~IAT. # /-./:~ F'I T' ~o FAIL SERIAL # ~ _~ ! ? No - LID L/D TYPE YES PASS SERIAL # NO FAIL I certify the above tests were conducted on this date according to Red Jacket Pumps field test apparatus testing procedure an limitations. The Mechanical Leak Detector Test pass / fail is determined by using a low flow threshold trip rate of 3 gallon per hour or less at 10 PSI. I acknowledge that all data collected is true and correct to the best of my knowledge. Tech: JAMES J, RICH Signature/~,d-'~'~/ , ! State License: ~ 99-1072 Date: /O-- ~--O 'PEi MIT STATEMENT RECEIVED FROM .~. ?/3,~f'f~q,h~fl, .g.~J, .- Bakers~d Fire Dept. 171 ~hcstcr Ave. Bakersfield, CA 93301 AMOUNT UST/AST PERMIT 82 STATE SURCHARGE 86 TANK TESTING 83 COPIES/REPORTS 89 AMOUNT TENTS, LPG 84 FIREWORKS, POWDER, 84 OTHER PERMITS OTHER TOTAL DUE ~::> ~L~ .__ City of ~r: VD4VI~ Type: OC Draft: 1 32~¢ MI~6 AVE T~ndet detail ~}~ cH.Cg 3114 Total 'tendered Tra~e date: t~/23t0! Ti~e: I3:52:23 09:34 '~"805 ~325 0676 BFEI ITA2 MAT DX¥ ~002 oJ,7:zcE oF BHVI~ · 1715 ~Ce~ A~., ~~l~d, ~ 93301 (805} 326.3979 ~PLZ~~ ~ P~ A TZ~S DA~ & 'l"lliO/~S'I" Z$ TO BE: CGHIX,'C~'E~ fol:z.q/~, / / '- APPP~ BY: C ,~J~R, RECTIO N NOT~.. E BAKERSFIELD FIRE DEPARTMENT N° 1 0 5 4 Sub Div. 3g~O ~q .. Blk. Lot You are hereby required to make the following corrections at the above location: Cot. Ho Completion Date fo,' Corrections/'],,~'/2.-/,~//~ FACILITY NAME L,]t~l[cxl ADDRESS ,e3,_23 0 FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd FIoor,.Bakersfield, CA 93301 INSPECTION DATE la[o t PHONE NO..%'.'.q~ ~ O~O3 BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES 7 Section 1: Business Plan and Inventory Program [~l Routine [~l Combined [~ Joint Agency [~ 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?: [~l Yes [~ No Explain: Questions regarding this inspection? Please call us at (661 ) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE Section 2: Underground Storage Tanks Program Routine [~l Combined [] Joint Agency Type of Tank Type of Monitoring [~ Multi-Agency .~[] Complaint Number of Tanks Type of Piping /~Ot-~ [] Re-inspection OPERATION C V COMMENTS Proper tank data on file ~ Proper owner/operator data on file k~, · Permit fees current I/ Certification of Financial Responsibility V Monitoring record adequate and current V Maintenance records adequate and current V Failure to correct prior UST violations t./ Has there been an unauthorized release? Yes No V/ 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: ~1 [~J~_ _ _~_g_ ~/?~ Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy B-u~iness S~e Re~ op~sible Party ~~ARCO Products Company M~tor Certification Inspection This letter certifies that the monitor(s) is/are in place, the probes are in correct position and the system is operating properly. Station # _5-0%3 Date /-a¢- o / 19 Address ~ 2.. Z o ~ ,.,o-~ ~ ,,-,_.- Type Inspection: /~ ~ ~---~ ,= / ~.-t <~ Annual ,---"" Permit Recheck Leak Type & Model of Monitor System Function Tanks Annular Space In Tank Fail N/A Pass Fail Pass Regular t.--" Midgrade z..--' Supreme t.-"- Waste Oil t.--'" Other Product Lines Turbine Sump In-Line Fill Sump Pass Fail N/A Pass Fail N/A Pass Fail Regul ar t,/ /./' Midgrade ,---' 3--'" Supreme '-"" /-'"' t,--"" Waste Oil z/ '-'/' Other ~ ~"" N/A N/A When monitor is turned off or in alarm, is there positive shutdown of turbines? Yes . If No, were precision product lithe tests performed? Yes~ No Monitor Panel Is the monitor panel m/0'unted and labeled correctly? /(5 Does monitor alarm horn function properly? ~ Is panel accessible and visible to station personnel? ,V'cT No.m Replaced all failed probes? Yes ~ No If No, probes to be replaced/repaired by (Date) N/A / / Inspected By: APC-3324 (8/96) Contractor Technician Signature n~'ARCO Products Company Mechanical Leak Detector Test Data Sheet Station # ,ff-~3 Date Address / -35 - o / 19' Test Information 1 2 3 4 5 Product Manufacturer Model Z.o zo,~o /_~ 2000 ~0 2voO ',,(.. Full Operating Pressu~'~ (psi) Line Bleed Back (ml) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) ~ 7~ ~ ~' / -3 _ Test Leak Rate (mlh/fin) (gph) PASS or FAIL Replaced Ail Failed Leak Detectors Yes If No, Replacement To Be Completed By (Date) , No "N/A f,/ / / This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor .3 ~ ~ ~-~ Technician d ~' r~~/~~zc~:7~/~/~ Lic# Signature APC-3325 (8/96) n~rARCO Products Company Mechanical Leak Detector Test Data Sheet Station # / 5' Address / 7 19 Test Information Product Manufacturer Model Full Operating Pressui'e (psi) Line Bleed Back (ml) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) Test Leak Rate (ml/lhin) (gph) PASS or FAIL Replaced Ail Failed Leak Detectors Yes If No, Replacement To Be Completed By (Date) No_ N/A g~'/ / / This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor Technician Signature Lic# APC-3.32§ ' 'ARCO Products Company Mo~nitor Certification Inspection This letter certifies that the monitgr(s) is/are in place, the probes are in correct position and the system is operating properly. Station # / ~'~' D Address / 7 o t /~zZ~,~Z~4 Type & Model of Monitor System Function Tanks Annular Space Pass Fail N/A Daie l-) ?- 0 / 19 Type Inspection: Annual ~ Permit Recheck Leak Regular Midgrade Supreme Waste Oil Other Product Lines Turbine Sump In-Line Pass Fail N/A pass Fail N/A Regular Midgrade Supreme Waste Oil Other Pass In Tank Fail N/A Fill Sump Pass Fail N/A // When monitor is turned off or in alarm, is there positive shutdown of turbines? If No, were precision product line tests performed? Monitor Panel Is the monitor panel r~jounted and labeled correctly? Does monitor alarm horn function properly? Is panel accessible and visible to station personnel? Yes_ No Yes z./ No__ Replaced all failed probes? Yes -- No If No, probes to be replaced/repaired by (Date) N/A / / Inspected By: APC-3324 {8/96) Contractor Technician Signature '~'ARCO Products Company Monitor Certification Inspection This letter certifies that the monitor(s) is/are in place, the probes are in correct position and the system is operating properly. Station# -~ ~'5'5/ . Address / / 9--'~ c,/.,,o,., ..~ v'e- Type & Model of Monitor System Function Tanks Pass Regular t..--'"' Midgrade ' Supreme Waste Oil Other Date / - x ~- o( 19. Type'Inspection: Annual 1~ Permit Recheck Leak Annular Space Fail N/A Pass In Tank Fail N/A Product Lines Turbine Sump In-Line Pass Fail N/A Pass Fail N/A Pass Regular I.-'" /,-'" /.--"' Midgrade ~ .... ~ ~,-'"' Supreme Waste Oil ~.-'"" Other Fill Sump Fail N/A / ....-- When monitor is turned off or in alarm, is there positive shutdown of turbines? If No, were precision product line tests performed? Monitor Panel Is the monitor panel ~ounted and labeled correctly? Does monitor alarm horn function properly? Is panel accessible and visible to station personnel? Yes ~ No~ / ~ /~ / Yes /--'/'" No .~ Replaced all failed probes? Yes -- No If No, probes to be replaced/repaired by (Date) N/A / / z,../ Inspected By: APC-3324 (8/96) Contractor Technician Signature ~~ARCO Products Company Mechanical Leak Detector Test Data Sheet Station # ~ 0,5'~ Date [-] 0-o/' 19.' Test Information 1 2 3 4 5 Product Manufacturer ~ rt..t r ~.-,~ / ~,,~ / Model Full Operating Pressure'(psi) Z ~> Z 6 ~ 0 Line Bleed Back (mi) 7_. O / / o ~ 5'-' Trip Time (sec) ~ ~. O ff' ~ "..~ Metering Pressure (psi) F/E Holding Pressure (psi) / Test Leak Rate (mien) (gph) PASS or FAll. Replaced Ail Failed Leak Detectors Yes __ If No, Replacement To Be Completed By (Date) No ~ N/A_ / / avo /o/ This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Inspected By: Contractor ---~ '~-~ ~ Technician (.J~ef~O ~C,~'-7-v/4/4cr~ Lic# Signature ? APC.3325 (8/96) n~'ARCO Products Company Mechanical Leak Detector Test Data Sheet Station # .~ O-~/ Date / - ,3 o- o / 19. Address //2 ? c~,.~, o~ /~w~:-, /~/~cv¢.5~/6~--~ Test Information Product Manufacturer Model Full Operating Pressure'(psi) Line Bleed Back (ml) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) Test Leak Rate (rnl/~n) (gph) PASS or FAIL Replaced All Failed Leak Detectors Yes £ .~No __ N/A If No, Replacement To Be Completed By (Date) / ! This letter certifies that the annual leak detector tests were performed at the above referenced facility according to the equipment manufacturers procedures and limitations and the results as listed are to my knowledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Contractor Technician Signature Inspected By: Lic# APC-3325 (8/96) ~~'ARCO Products Company Monitor Certification Inspection This letter certifies that the monitor(s) is/are in place, the probes are in correct position and the system is operating properly. Station # ~'O'&o Date /- ? o- o! 19 Address ~ 9 5-0 u_.,/-//r-e- c,w Type Inspection: /_?r~ rc oz.5 ,=~c-'-c o Annual t,--'"' Permit Recheck Leak Type & Model of Monitor System Function Tanks Pass Regular /-"'"' Midgrade Supreme t.--'"' Waste Oil "'"' Other t..---" Product Lines Turbine Sump Pass Fail N/A Pass Regular Midgrade '"" ,-"' Supreme Waste Oil ,.-'" Other Annular Space In Tank Fail N/A Pass Fail · In-Line Fail N/A Pass N/A r.---'" Fill Sump Fail N/A When monitor is turned off or in alarm, is there positive shutdown of turbines? Yes _ If No, were precision product li~e tests performed? Monitor Panel Is the monitor panel n:}c;untizd and labeled correctly? Does monitor alarm horn function properly? Is panel accessible and visible to station personnel? Yes~ No.~ J Nom Replaced all failed probes? Yes -- No -- If No, probes to be replaced/repaired by (Date) Inspected By: APC-3324 (8196) Technician Signature ~~'ARCO Products Company Mechanical Leak Detector Test Data Sheet Station # -C'C/gO Date /- ~ o - o ~' 19 Address ~ a/,Tc) L.-'///~'c- L-,,~ /"~,~ ~c-~73/-%,'t:z,o Test Information Product Manufacturer Model Full Operating Pressu~ (psi) Line Bleed Back (ml) Trip Time (sec) Metering Pressure (psi) F/E Holding Pressure (psi) Test Leak Rate (~n) (gph) PASS or FAIL Replaced All Failed Leak Detectors Yes __ If No, Replacement To Be Completed By (Date) No_ N/A r~ / / This letter certifies that the annual leak detector tests were performed at the above referenced facility · iiacgording to the equipment manufacturers procedures and limitations and the results as listed are to my 'k~owledge true and correct. The mechanical leak detector test pass/fail is determined using a low flow threshold trip rate of 3 gph at 10 PSI. Contractor Technician Signature Inspected By: Lic# APC-3325 {8196) 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 Valley Plaza Arco 3220 Ming Ave Bakersfield Ca 93304 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 plans 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 C(jlRRECTION NOTRE BAKERSFIELD FIRE DEPARTMENT N°- 971 Location 0/i[~? PJ~L'7..~L_ ~t"'C~ Sub Div. ~)~0 ~[~ ~ Blk. . Lot You are hereby required to ~nake the following corrections at the above location: · Completion Date foi' CorrectionS/ Inspector 326-3979 FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE ~,/c~ ~/(}O Section 2: Underground Storage Tanks Program Routine ~"ombined [] Joint Agency Type of Tank Type of Monitoring [] Multi-Agency [] Complaint Number of Tanks /-// Type of Piping /')ia/f:: [] Re-inspection OPERATION C V COMMENTS Proper tank data on file [,,/ Proper owner/operator data on file L/ Permit fees current b/ Certification of Financial Responsibility b,/' Monitoring record adequate and current ~/' Maintenance records adequate and current V/ Failure to correct prior UST violations b/r 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: ~ (/~x~ Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy ~es(s ~t~V'Responsible Party ~,.-; r_. IL .LI ~ ~.. - f':. U I-I T iL.:,-,'-._,O · :, E I".1.:, L ~. -Af'.iK LEVEL -' '-'-'""' TAHK i SiJPER i_iFiLEADE'h ,:, c, 4 RALLOHS FUEL ~,:,H~ ,~ML.:, _LLAGE ~. ,..:, Z NCHE::; r_..-- 0.0 iHCHEF; WATER ',..02, ..4- DEGREES F TANK 2 REGULAR .k....,,~ 9 5 :_:: 4.7i 0.0 95.5 TANK :3 U ;.t-..I L E A i'~ E r._l :_': ;-' 5 ~, , '½ ;-_, ::,, :,_--~. ,_-i. ::,, 0.0 90:6 GALLOHS FUEL GAL:_--; ULLAGE iNCHE::; FUEL iHCHES WATER DEGREES F GALLOHS FiiFi GALS ULLAGE INCHES FUEL iNCHES WATER DEGREES F TANK 4 UNLEADED 3642 GALLOHS FLiEL 6042 GALS ULLAGE · :,5 .... ' INI]:HES FUEL · _ , C,~ 0.0 iNCHES WATER 90,0 DEGREES F I"1A"r.:Fi F A L D E i'l T A H K :--; I N',,,'Ei'-.ITFIRY TOTALS Ij i'--i L E PI D E i'l 689::: GALLI]NS FLiEL CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 FACILITY NAME ADDRESS ._3~,~ 0 FACILITY CONTACT INSPECTION TIME INSPECTION DATE PHONE NO. 3 ~'g '~0 31~ ' BUSINESS ID NO. 1.5-210- NUMBER OF EMPLOYEES ~_~ Section 1: [] Routine Business Plan and Inventory Program [~C/ombined [~1 Joint Agency ~ Multi-Agency Complaint Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate 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 Fire Protection ~/' Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes ~No Questions regarding this inspection? PleaSe call us at (661) 326-3979 White- Env. Svcs. Yellow - Station Copy Pink - Business Copy Busir~ss Site/~esponsible Party Inspector: ~_, ~-~0 :tRCO Products Company Monitor Certification Inspection certifies that the monitor(s) is/are in place, the probes are in correct position and the system ating properly. Type lnspectionL.,.....,~ Annual_ ~ Permit Address Recheck .... __ Leak Type & Model of Monitor System Function Tanks .~jjular Space In Tank Pas Fail N/A Midgrade Supreme Waste Oil Other _ __ ~// Product Lines Turbine Sump In-Line Fill Sump Regular ~ail N/A Pass Fail N/A Pass Fail N/A Supreme Waste Oil ~,.,"~ ~ ----- / Other N/A When monitor is turned off or in alarm, is there positive shutdown of turbi/nes? y If No, were precision product line tests performed? Yes , No Monitor Panel -"~ Is the monitor panel mounted and labeled correctly? x~ Does monitor alarm horn function properly? Is panel accessible and visible to station personnel? Replaced all failed probes? Yes - No ~ if No, probes to be replaced/repaired by (Date) .... Inspected By: APC-33~.4 (~96) MARK ONLY [~ 1 ONE ITEM [] 2 INTERIM PERMIT STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM A COMPLE~ITE NEW PERMIT ~ 3 RENEVVAL PERMIT ~ 4 AMENDED PERMIT "[~5 CHANGE OF INFORMATION [~ 7 PERMANENTLY CLOSED SITE ] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFC RMATION & ADDRESS- (MUST BE COMPLETED) DBA OR FA,~LITY NAME NAME. OF QPERATOR ~'~ fi~ 0 ~ ~ NEAR STCRO~ STR~T~~~ ~ RARCEL,(O~NAL) CI~ NAM STATE ZIP CODE SITE PHONE ~ WITH AREA CODE T ~ INDIVIDUAL ~ P~TNERSH[P ~ L~AL-AGENCY ~ COMfY-AGENCY ~ STATE-AGENCY ~ FEDE~L-AGE~Y D~TRICTS EMERGENCY CONTACT.PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY). optional JJ DA.Y~: ..NAME (LAST, FIRST)/,'-~ ./~/V~ ~L/~'- I {~: ~/~'~ i~~'-''- PHONE # WITH AREA CODE ~'~J~ '~"- ,.-~ ~0~ ~ .J~/"~3 J DAY~:Q//~.~)~..j~ ~ ~'~..- ,~NAME(LAST'FIRS'r) '~ '/ ~- V~' - "~J~;~'PHONE # WITH AREA CODE J JV'~'~J~"~/N~C~t'~S: NAME (LAS'J' FI[~,~T) ~- &' ,~'~ i~/~ ~/-.-- ' - /t (~'~ ~"- 3 90J~ -- / ~yPHONE # WITH AREA CODE ./ J NIGHTS:i~) '~'~ ~l"~t+~:J'4'l OE'~-~NAM'~-(LAST' FIRST) '~J / ~ --/~0 ~)" ~""~ /~'PHONE # WITH AREA CODE I1. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) MA~L'I[IG OR STREET AD~'RI::SS ~E)~ ~.,F ADDRESS INFORMATION ~ O. ,~box to indicate ~ INDIVIDUAL [--'J LOCAL-AGENCY [~g CORPORATION ~ PARTNERSHIP [~ COUNTY-AGENCY STATE-AGENCY FEDERAL-AGENCY PHONE # Wl_'l'a AREA CODE cg I oY-3 3oo III. TANK OWNER INFORMATION - (MUST BE COMPLETED) NAM E"DF OWNER/b I C~),I~E OF ADDRESS INFORM~IJON MAILING OR STREET ~ESS ~ ' ~x ~i~ ~ INDIVIDUAL ~ ~ LOCAL-AGENCY ~ STATE-AGENCY Cl~ NA~~ - ST~ ZIP~DE I PHONE ~ WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 if questions arise. TY(TK) HQ -I l lol o t~ v. LEGAL NOTIFICATION AND BILLING ADDRESS legal notification and billing will be sent to the 18nk owner unless box I or Il is checked. j~:~FORM HAS SEEN COMPLETED UNOER PENALTY OF PERJURY, ANO TO THE SEST OF MY KNOWLEO~E. IS TRUE ANO CORRECT APF~IC/~'rs aME ~PRIN'I~& SIG~ATUF~T~ _ I ApPLICANtS ~LE. ~ ~ , DATE MONTH/DAY. EAR LOCAL AGENCY USE ONLY~A R/> ~-~P~ K ~ U COUN~ ~ JURISDICTION ~ FACILI~ ~ LOCATION CODE - OPTIONAL CENSUSTRACT#-OP~ONAL SUPVISOR - DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION . FORM B, UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FORM A (9-90) FOROO33A-R2 INfflnR.UCt~ONS FOR COMPI,I~IlNG FORM (; <qI~gAI, IN~gI~IJCrlONS: 1. 2. 3. 4. 5. One FORM "A" shall be completed for all NEgO' P~!lZCg~. I.'S, PTgRI'.2T~' CHANG~ or any FACI~/SrlI{ hN~RMA~[1ON CllANGI~. SUBMH' ONLY ONE (1) I~RM "A~ f~)r a FadliW/Site, regardless of the number of lanks l~ated at the site. ~is form should be completed by either xhe PERMYr APP[i(~Igi' or the I~CAL AGENC~ UNDERGROUND TANK Please ts?e or print clearly all requested information. Use a hard point writing instrument, you are making 3 copies. TOP OI~* ]FOR1VZx ~I~RK ONLY ONE 1. Mark an (X) in the box next to the }tern that best de,ribes the reason the form is being completed. L I[5ACTI~I~r/Sli'~ FNFX)RaMATI()N & ADDRI!kgS' 1. Record name and address (phs~icaI kx:afion) of the underground tank(s). N(YIq2:.: Address MUST have a valid ph)~ical location including cily, state, and zip P.O. I~X ~MBE~ ARE N(~' A~AB~ Include nearest cross street and name of the o~mtor. 2. Phone number must have an area code. If the night number is the same, write ~S;kME" in proper location.- 3. Check the appropriate box for '[TPE OF BUSIN[kgS ()WNEI~SlllP (ex. CORPORA;I'ION, INDIVIDUAL,"etc.) 4. Check thc appropriate box for ~I~'PE OF BUSINESS. 5. I[ Facility/Site is located on land within an indian reservation or other indian trust lands, check the box marked 6. Indicate the NUMBER of 'DkNKS at this srllL 7. Record the E.P.A. ID f/- or write "NON[? in the space provided. 1L PROPE~YP;[ OWNER INI'{)RMATION & AI)DRJ[&~kg (MtJ,~F BE CX)i)~.Pt,IJIE!)) 1. Complete all items in this secti¢m, unless all items are the same as SECPION t; if the same, write ~ME AS Srll? across this section. Be sure to check PROPERTY OWNERSHIP 't~/t'E box. lgL TANK OWN]ER INFORMATION & ADDRI'¢Kg (MUSW 1. Complete all items in this section, unle~ all flems are the same as SECHON 1; If the same, write across this section. Be sure to check TANK OWNER.%I~IP TYPE box. ~V BOARD OF F~UALITZATION Lk.SW ffI*ORAGE FEE A(XX)UbZI' NUMBER OV1US'F BE (X)MPLLrI'EI)) Enter. your Board of l!2tualization (BOE) US~I' storage fee account number which is required before your permit a. pplication can be processed. Registration w"ith the BOE will ensure that you will receive a quarterly storage fee return in reporting the $0.006 (6 mills) per gallon fee due on the number of gallons placed in your USTs. The BOE will code persons exempt from paySng the storage fee so returns will not be sent. If you do not have an account number with the BOE or if you have any questions regarding the fee or exemptions, please cal'l the BOE at 916-739-2.582 or write to the BOE at the following address: Board of Equalization, Environmental Fees Unit, P.O. Ik~x 942879, Sacramento, CA 94279-000t. V. LEGAl, NCYFII[tf(~x~[ION AND BILIING ADDR[kqS '1. Check ()NIi*, BOX for thc address that will he used'.for BOqTi-tl LFJ3AL AND BILLING NO~i!IqCA~I1ONS. APPI~CAI~r MUg[' SIGN AND DNI~ ']~IIE I',X)P.M AS tNDICdED!iD. IN,S~I{YRucr~ON FOR 'I'HI] LL)CdXL AGENCIIL~; The county and jurisdiction numbers are predetermined and can be obtained by calling the State Board (916)739-2421. The facility number may be assigned by the local agency; however, this number must be numerical and cannot contain an alphabet. If the local agency prefers the State Board to a~sibm the facility number, please leave it blank. [117 DS 'i~l~ RILRPONSIBILEI"Y OF '~DlE IX~.CAL AGF. NCY THAT INSPECI$ 'IIlE FAC3I[.1TY TO VERIFY 'IIlE AC£XJRACY OF THE INItORMATION. THIS APPLI(~¥FION CANNOT Big PROCIkSSED IIt 'IIIE IK)E ACCOUNt AGENC~ US~] ONLY" INFO~A'I2ON ~)X AND ;'~R ~<)KWA~)ING ONE t~RM oA~ AND A~C~'II'~D I~)RM "B~(s) ~IB ~DIE t~I.LOW~G ADDRF2~ 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 [] 1 NEW PERMIT [] 3 RENEWAL PERMIT ~ CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED I I. TANK DESCRIPTION COMPLETE ALL ~TEMS -- SPECIFY ~F UNKNOWN A. OWNER'S TANK LD.# /' C. DATE INSTALLED (MO/DAY/YEAR) II. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. [~1 MOTOR VEHICLE FUEL ] 2 PETROLEUM [] 3 CHEMICAL PRODUCT B. MANUFACTURED SY:~.~,~..~.,,~_ D. TANK CAPACITY IN ~GALLONS: /O,/O~O [] 4 OIL [] 80 EMPTY ~"~1 PRODUCT [] 95 UNKNOWN [] 2 WASTE O. [F (A ;. :S NCT MARKED. E"~TE~ %AME CF SUBSTANCE STORED ~"~a REGULAR C. ~ UNLEADED [] lb PREMIUM UNLEADED [] 2 LEADED DIESEL [] 6 AVIATION GAS [. [] 7 METHANOL GASAHOL -- JET FUEL OTHER ~O~SC~¢BE ,N ;TEM O .~ELC',',"! III. TANK CONSTRUCTION MARK ONE iTEM ON~.Y IN BOXES A, S, AND C, AND ALL THAT APPLIES IN BOX O A. TYPE OF ~" 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 9S UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANIO [] ~ OTHER e. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL ~ 3 FIBERGLASS . [] MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] (PrimlryTink) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC S 100% METHANOL COMPATIBLE W/FRP gg OTHER ' [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING C, INTERIOR ~ UNING 5 GLASS LINING [] 8 UNLINED [] 9~ UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 100'/. METHANOL.? YES/~ NO__ ] 4 PHENOLIC LINING ] gg OTHER D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] :3 VINYL WRAP ~ 4 FIBERGL,A~S REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 96 UNKNOWN [] ~ O~ER IV. PIPING INFORMATION C~RC~ · ~ ABOVE BRUNO OR U ~ UN~.O~UNG, ao~ ~ ~CmA~ A U 1 SUCTION A~2 PRESgURE A U 3 Q~Vl~ A U ~ O~ER A U 1 SINGLE WALL A~2 ~UBLE WALL A U 3 LINED TR~H A U ~ UN~O~ A U ~ O~ER A U 1 ~ STEEL A U 2 STAINLESS S~EL A U 3 ~LWINYL CHLORI~(PVC)~ 4 FIBERG~S PIPE A U 5 ~UMINUM A U 8 ~NCRE~ A U 7 STEEL WI ~ATI~ A U 8 1~ ME~ANOL ~MPATIBLEW/FRP A U. g ~LVANI~D S~EL A U 10 CAT~DICPROTECTI~ A U g5 U~O~ A U ~ O~ER ~1 AUTOMATICLINELE~DE~CTOR ~ 2 LINE T~H~ESS TESTING ~'3 ~ A. SYSTEM TYPE B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION V. TANK LEAK DETECTION [] ,, .o.E [] ,, u. ow. [] . OTHER 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] $ GROUND WATER MONITORING 6 TANK TESTING VI. TANK CLOSURE INFORMATION LOCAL AGENCY USE ONLY THE STATE I.D,.NUMBER IS COMPOSED OF THE FOUR NUMBE~ BELOW COUN~ ~ JURISDICTION ~ FACILI~ ~ TANK STATE I,D.¢ ~ I IIIII I111 III PERMIT NUMBER j PERMIT APPROVED BY'ATE J PERMIT ;XPI~T~N FORM a (~ THIS ~RM ~ST BE AC~IED BY A PER~ ~PUCA~ON · FORM ~ ~LE~ A CURRE~ FORM A H~ BEEN FI~D. FORmn4B.R4 · ' ~ STATE WATER RESOURCES CONTROL UNDERGROUND STORAGE TANK PERMIT APPLICATION · FORM B ~,~,.L4/v ~ ,-, u- j COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM, MARK ONLY [] I NEW I~IT [] 3 RENEWAL PERMIT ~ CHANQ~ OF INFOIqMATKSN [] 7 la~RMANENTLY CLOSED ON SITE ONE ITEM ~ 2 INTERIM PERMIT [] 4 NdENDED PERMIT ~ a TEMPORARY TANK CLOSURE [] B TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ITEM$ - SPECIIrYlFUNKNOWN IA' °wNER's TANK '' o'' / /~~_ I c. DATE INSTALLED (MO/DAY/YEAR)-r..~ o fl II. TANK CONTENTS ,~A-~ IS MARKED, C.,OMPLETE ITEM C. a. MANUFACTURED O. TANK C/d~AClTY IN ~SALLON~: [~1 MOTOR VEHICLE FUEL [] 4 OIL [] 2 PETROLEUM [] ~0 EMPTY ~'1 PRODUCT ~ 3 CHEMICAL PRODUCT [] 9~ UNKNOWN [] 2 WASTE I ~l REGULAR C. UNLEADED [] lb PREMIUM UNLEADED [] 2 LEADED 3 DIESEL ~ e AVIATION GAS 4 GA~AHOL ~ __ '-- $ JET FUEL I__.J 7 METHANOL IlL TANK CONSTRUCTION MARK ONE ITEM ON~Y IN BOXES &. B. ANOC, ANO ALL THAT APPLIES IN BOX O A. TYPE OF ~ s DOUELE W~J.L SYSTEM ~ a S~NCSLE WALL B. TANK [] 1 &~,RESTEEL MATERIAL [] s CONCRETE (Pdm~Tlnk) [] 9 ERON2~ I~ 3 SINGLE WAU. WITH EXTERIOR LINER [] gS UNKNOWN [] , SECONDARY CONTAINMENT (VAULTED TANIO [] ~ OTHER [] 4 a¥~.~L CIAO W/FtBERQLA~ REINFORCED PLASTIC [] I lOl~& ME'/~IANOL COMPATiBlE W/FRP ~ ~ OTH&R ' B. CONSTRUCTION c. MATERIAL AND CORROSION PROTECTION O. CORROSION [] I POLYETHYLENE W.~ [] Z COATiNG [] S VINYL WRAP ~] 4 FIEERGL,A~8 REINFORCED ~STIC PROTE~ON ~ S CAT~ P~TECT~ ~ 91 ~ ~" U~ ~ . O~R IV. PIPING INFORMATION c~ A. SYSTEM~PE A U ~ ~T~ A~; PnEssunE A U 3 ~v~ A U ~ O~En A U 1 ~STEEL k U 2 9TNN~ ~ A U ~ ~W~ ~OR~~4 FIBE~ PiPE A U S ~UMI~M A U I ~ A U 7 ~Y~A~ A U I I~ ~L ~MPATIBLEW/FRP ~ ~V~DS~ A U 10 ~P~ A U ~ U~ k U ~ O~ER O. LEAK O~E~N ~ ~T~A~LI~~C~R ~ ~ ~ O~ER V. T~K LEAK D~E~ION ! VI. TANK CLOSURE IN~~ THIS FORM HAS SEEN COMPLETED UNDE~ OF PENURY, I APPLICA~NTS NAME ~ ~ LOCAL AGENCY USE ONLY THE STATE LO. NUMBER IS COMPOSED OF THE FOUR NUMBERed BELOW STATE I.D.# PERMIT NUMBER FORM E (g-gO) AND TO THE BEET OF MY KNOWLEDGE, I$ TRUE AND CORRECT COUNTY ~l JURISDICTION ~ FACILITY · TANK I~ PERMIT APPROVED BY/DATE I PERMIT EXPIRATION OATE THIS FORM MUST BE .IK~OM~ANIED BY A PERMIT NHKJCATION · FORM A, IJNLF3~ A CURRENT FORM A HA~ BEEN FILED. STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARKONLY i~--~. 1 NEW PERMIT [] 3 RENEWAL PERMIT /~ 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ONSITEI ONE ITEM ~ 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED I, TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNO~ [ I1. TANK CONTE~S IF A-1 IS MARKED, COMPLE~ ITEM C. [ ~ 1 MOTOR VEHICLE FUEL ] 2 PETROLEUM [] 3 CHEMICAL PRODUCT [] 4 OIL ] 80 EMPTY [] 95 UNKNOWN [:~' 1 PRODUCT [] 2 WASTE ~ la REGULAR C. ~ UNLEADED ] lb PREMIUM UNLEADED [] 2 LEADED 3 DIESEL [] 6 AVIATION GAS 4 GASAHOL ~-~ 7 METHANOL ~ 9g OTNER (DESCg~i~E ,N ;TEM 0 ~ELC','," O. !F (A.~, iS NOT MAR~',;EO. z_"lTad~ ',;AME OF SUESTANCE STORED III. TANK CONSTRUCTION MARK ONE ITEM ON~Y IN BOXES A, Pt, ANDC, AND ALL THAT APPL[E$1N BOX D A, TYPE OF 1 DOUBLE WALL L._J 3 SINGLE WALL WITH EXTERIOR LINER SYSTEM 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) ] g5 UNKNOWN ] ge OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimmryTmnk) [] gl BRONZE ] 2 STAINLESS STEEL ~;~'3 FIBERGLASS [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] g6 UNKNOWN ] 4 STEELCLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLE W/FRP ] ge OTHER []_I RUBBER LINED [] 2 ALKYD LINING C, INTERIOR 5 GLASS LINING [] B UNLINED lINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? [] 3 EPOXY LINING ] g6 UNKNOWN YE$.~ NO__ ] 4 PHENOLIC LINING ] ge OTHER O. CORROSION [] I POLYETHYLENE WRAP [] 2 COATING PROTECTION [] S CATHODIC PROTECTION [] gl NONE [] 3 VINYL WRA~ '~ 4 FIBERGLASS REINFORCED PLASTIC [] ge UNKNOWN [] ge OTHER IV. PIPING INFORMATION A. SYSTEM TYPE A U I SUCTION B. CONSTRUCTION A U 1 SINGLE WALL CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE ~,,)2 PRES$URE A U 3 GRAVITY .A U 99 OTHER A~.)2 DOUBLE WALL A U 3 LINED TRENCH A U ge UNKNOWN A U ge OTHER C.'MATERIAL AND A U 1 8ARE STEEL CORROSION A U 5 ALUMINUM PROTECTION A U g GALVANIZED STEEL D. LEAK DETECTION W1 AUTOMATIC LINE LEAK DETECTOR A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)(/~4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 10 CATHOOIC PROTECTION A U g5 UNKNOWN A U ge OTHER [] 2 LINE TIGHTNESS TESTING ~3 INi~$ili~U.MONffORmNO [] ge OTHER V. T~K LEAK DETECTION [~1 VISUAL CHECK ,[~]~2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING ~ 7 INTEI~TITIAL MONITORING [] 91 NONE [] ge UNKNOWN [] ge OTHER VI, TANK CLOSURE INFORMATION I1, ESTIMATEO DATE LAST USEO (MO/D~Y/YR) 2. ESTIMATED QUANTITY OF 9. WA~ TANK FlU. ED WiTH ~ ~ YES NO SUBSTANCE REMAINING GALLON8 INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDE~:~'NA~ TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APRelCAN~'S NAME ( , ) (P D & SIGN4 ~ ~ LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER I$ COMPOSED OF THE FOUR NUMBERS BELOW STATE I.D.# PERMIT NUMBER FORM B (g-go) COUNTY # JURISDICTION it FACILITY it TANK it PERMIT APPROVED BY/DATE PERMIT I=XPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATiOH · FORM A, UNI. ES~ A CURRENT FORM A HAS BEEN FILED, STAT~ OF CAUFORM& STATE WATER RESOURCES CONTROL BO UNDEFIGFIOUND STOFIAGE TANK PEFIMIT APPUCATION · FOFIM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT ,~ $ CHANO~ OF INFORMATION [] 7 P~RMANENT1.Y CLOUD ON SITE I ONE ITEM ~ 2 INTERIM PERMIT [] 4 AMENOEO P~RMIT [] a TEMFORARY TANK CLO~URE [] S TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ~TEMS ~ SPEC~ ~F UNKNOWN I A. OWNER'S TANK LO. It ~,~ ~)~..~..~ C. DATE INSTALLED (MO/DAY/YEAR) ~./~ / II. TANK CONTENTS ~FA-~ ,SMAR~D. COMPLETE,TEM C. [ ~, 1 MOTOR VEHICLE FUEL [] 2 PETROLEUM ~ 3 CHEMICAL PRODUCT [] 4OIL B. ] 60 EMPTY [] 96 UNKNOWN /-- ~- O. TANK C~J~;TY '~1 PIK3OUCT [] 2 WA,tTE ~ l& REGULAR C. ~ UN[F. ADGD [] lb PREMIUM UNLEADED [] 2 LEADED O~ESEL [--:, 6 AWAT~ON GAS GA~AHOL ~ 7 METHANOL JET FUEL ~ IlL TANK CONSTRUCTION MARK ONE ITEM ON~.¢ IN BOXES & 8, ANDC. AND ALL THAT APPLIES JN SOX D A. ~PEOF ~ ~ ~UBLE w~L SYSTEM ~ 2 SINGLE W~ ~ i 3 SINGLE WALL WiTH E~ERIOR LINER [] g6 UNKNOWN [] 4 SECONDARY CO~TAINMENT (VAUL'r~OTANIO [] m o*rHER B. TANK [] 1 SARE STEEL MATERIAL [] S CO~CRETE (PdmaryTank) [] g 8RON2~ [] 2 STAINLESS ST~. ~3 [] 10 ('~&LVANIZI:O STEI'~ [] . UN#~OWN [] 4 aykkl. CLAD WI PIBERGLA.q,9 REINFORCED PLABT1C [] I 100~ METHMIOL COMPATIBLE [] gl OTHER 0. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECT]ON [] $ CATHODIC PROTECTION [] ~1 NONE [] $ VINYL WRN~ ~ 4 FI~EI~$ REINFORCED PLASTIC IV. A. SYSTEM TYPE & U 1 ~L~'I'I(~M B. CONSTRUCTION A U ~ SINGLE WALL C. MATERIAL AND A U I ~AR~ STEEL CORROSION & U s ALuMe~uu PROTECTION A U e G'aU.VAN~ZEO STEEL D, LEAK OETECTiON ~-t PIPING INFORMATION C~RCLE JL~ PRESSUPE A U 3 ~V~ A U ~ O~ER A~ A U 2 STNN~ ~ A U 3 ~WI~ ~OR~~4 FIBE~ PIPE A U e ~ A U 7 ~A~ A U e I~ ~L ~MPATIB~W~RP A U 10 ~P~T~ A U M U~ A U m O~ER . _ ~ ~ ~ O~ER V..TAI~iK LEAK DETECTION ] 8 TANK TEBTIN('~ I1~ NTO~ RECONCILIATION [] 3 VAPOR UONITORII~ [] 4, AUTOMATI~ TANK (~d~ING [] S GROUND WATER MONtTORIN~ I INI~R~'rI'~MONITO~IN~ [] 81 NON~ [] gl UNI~ [~ gO OlldER I VI. TANK CLOSURE INFORMAllON I1. ESTIMATED DAT~ LAST USEO (MOIOAYheI~ 2. ESTIMATED OUANTITY OF I ~I. JEITANC~ REMAININ(] ~ I TANK FILLED WrTT. I ~NE~T MA~? YES [] ~ [] THIS FORM HAS BEEN COMPLETED UNOE~J.t:~'FY OF PERJURY. AND TO TNE BEST OF MY KNOWLEDGE, I$ TRUE AND CORRECT APR~AN'~'S.AME ( - ) ~ ,---. LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUM~_I:FI~ BELOW STATE I.D.# ~--] I I Il I I I I I I I I I I I }11 I IPERMIT NUMSER FORM IPERMIT APPROVED EY/OATE PERMIT EXPIRA'rION OATE THIS FORM MU~I' BE ACCOMPANIED BY A PERMIT ANqJCA'riON · FORM & UNLF~ A CURRENT FORM A HA~ BEEN FILED. STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT DBA OR FACIUTY NAME WHERE TANK IS INSTALLED: COMPLETE A SEPARATE FORM FOR EACH TANK SYSTElYL 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN C. DATE INSTALLED (MO/DAY/YEAR) II. TANK CONTENTS iF A-1 IS aAR~D, COMPLE~ ITEM C. D. TANK CAPACITY IN t~ALLON~: /~/0~)~) '1 MOTOR VEHICLE FUEL ] 2 PETROLEUM [] 3 CHEMICAL PRODUCT " la REGULAR F-~ 4 OIL B. c. UNLEADED [] 80 EMPTY ~ I PRODUCT [] lbPREMIUM UNLEADED [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED NOT ~,~ARK~O. --_NT~;~ NAME OF SURSTANCE STORED 3 DIESEL [] 6 AVtATtON GAS 4 GASAHOL ~'~ 7 METHANOL [] s ~ETFUEL -- [] 99 OTHER ~D~SC~BE ,N ;T-_-~ 0 ~LC'"'I III. TANK CONSTRUCTION MARK ONE iTEM ONlY IN BOXES A, B, AND C, ANO ALL THAT APPLIES IN BOX D A. TYPE OF ~ 1 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] g5 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL ~ 3 FIBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE'~--] 7 ALUMINUM (Primal/Tank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] g~ UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLE W/FRP ] gg OTHER ~' [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING C. INTERIOR '~5 GL~SS LINING [] 8 UNLINED [] g~ UNKNOWN UNING ~ IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES NO__ [] 4 PHENOLIC LINING [] g~ OTHER D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATINg3 PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] s v,,,L WRAP .[~ , F,BE~s REINFORCED PLASTIC []. UNKNOWN [] gg OTHER IV. PIPING INFORMATION A. SYSTEMTYPE 4 U B. CONSTRUCTION A U CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE 1 SUCTION A~2 PRESSURE A U :3 GRAVITY 1 SINGLE WALL ~)2 DOUBLE WALL A U 3 LINED TRENCH C. MATERIAL AND CORROSION PROTECTION D, LEAK DETEC'FION V. T~EAK DETECTION I ~ , viSUAL CHECK [] A Ugg OTHER A U g5 UNKNOWN A U g9 OTHER A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVlNYL CHLORIDE (PVC)A~4 FIBERGLASS PIPE A U S ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U B 100% METHANOL COMPATIBLEWIFRP 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U ~ UNKNOWN A U 99 OTHER . 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING ~['1~'3 MONITORINGII~rERSTITIAL [] gg OTHER 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING 7 INTERSTITIAL MONITORING [] 91 NONE [] e~ UNKNOWN [] ~e OTHER I VI. TANK CLOSURE INFORMATION ESTIMATED DATE LAST USED (MO/OAY/YR) 2. ESTIMATED QUANTITY OF 3. WA~ TANK FILLED WITH YES ~ NO I SUBSTANCE REMAINING GALLONS INERT MATERIAL ? I THIS FORM HAS BEEN COMPLETED UNDER ~OF PERi~RY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I AP/~I~cANI'sNAME - ~. X / t \~ f~ DATE PERMIT NUMBER FORM S (g-gO) LOCAL AGENCY USE ONLY THE STATE I.D, NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# ~ I I I I I I I I I I I I I I I III I PERMIT APPROVED BY/DATE I PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATiON · FORM A, UNLESS A CURRENT FORM A HA~ BEEN FILED, ~TATE OF CAUFORNI& ~ STATE WATER RESOURCES CONTROL lBO UNDEFIGROUND STORAGE TANK PERMIT APPLICATION - FORM MARK ONLY [] ~ NEW I~rR~IT [] 3 RENEWS. PERMIT ONE ITEM [] 2 INTERIM P~RMIT [] a, AMENDED PERMIT I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN ow, .sCc-I C. DATE INSTALLED (M~DAY~EAR) '~ ~/- '~ L ~ 1 MOTOR VEHICLE FUEL [] 2 PETROLEUM [] 3 CHEMICAL PRODUCT COMPt. ETE A SEPARATE FORM FOR EACH TAN~ SYSTEM, /5 CHANGE OF INFORMATION [] 7 PERMANENTLy CLOSED ON SITE 6 'r~MI:~RARY TANK CLOSURE [] S TANK REMOVED a,,.. , o. TAN,; c~,,c,w ,. ,Gu.o": /~ ~0 [] 4 OIL I 8. [] .. UN~W. [] 2 w,~TE III. TANK CONSTRUCTION MARKONE,TEMON~.¥1NBOXESA, S, ANOCoA,NOALLTNATAPPLIE$1NSOXD A. TYPE OF ~ ~ OOUaLE WALL ~ 3 SSNGLE W~" W~ EX"tERrOR UNEI~ [] eS UNKNOWN SYSTEM E~ 2 SINGLE WALL [] 4 SECONOARY CONTAINMENT (VAULTEO TANIO [] m OTNEIR S. TANK L_a 1 ~REST~I=L MATERIAL [] s CONCRETE [] 2 STAINLESS STEEL ,~ $ FISERQI. A~ [] , POLWINYL CHLORIDE ~ 7 ~UM~ ] A ~¥~,L CLAD WI FIgER(~,.A~ REINFORCED PLASTIC [] I I(XP& METHANOL COMPATIBLE W~:RP [] ~ OTHER D. CORROSION [] 1 POLYETHYLENE WRA~ [] Z COATINQ PROTECTION [] 6 CATHO01C PROTECTION [] 65 NONE [] s ~ w.~ ~ , Fi.E.e.A. RE,NFO.CED P~ST~= []. u..,,o,,,, [] ,. IV. PIPING INFORMATION c,.C, = A IPA~OV~(~ROUNOOR U U:: UNmRORC)UNO. B(}'n41FAPPLICJI~L~ A. SYSTEM~PE A U ~ ~T~ A~)Z PRESSURE A U 3 ~v~ A U ~ O~ER O. CONSTRUCT~N A U I sl~ w~ ~ 2 ~BLE W~ A U 3 L~ T~ A U ~ UN~ A U ~ C. MA~RIALAND A U 1 ~ST~L A U 2 STNN~S~ A U 3 ~I~OR~A~4 CORROSION A U s ~UM~M A U e ~ A U 7 ~A~ A U I ~ ME~L ~MPATIBLEW~RP PROTE~ION ~ 9 ~V~D ~ A U qO ~P~ A U N U~ A U N O~ER V.,T~EAK D~E~ION 2 INV~N'T'OI~ RECONCILIATION [] S VAPOIR MONITORIN~ [] 4 ~dTOM&T~ TANK ~AU~IN~ [] 6 (SROUNO WATER MONITORING VI. TANK CLOSURE INFORMATION I1. ESTIMATED DATE I.A~T USED (MO~OAY/YI~ 2. FJTIMATED QUANTITY OF INERT MATERL~ ? 8UESTANC~ REMAININQ THIS FORM HAS BEEN COMPLETED UNDER J~I~'"~OF PEF~I~.RY, L~AL AG ENCY USE ONLY THE STATE I.D. NUMBER ~ COM~ED OF THE FOUR NU~E~ BELOW J COU~ · JURISDICTION ~ FAC~ ~ TANK ~ STATE .D. I I I I I I I II I I I I II I . PERMIT NUMBER AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT FORM PERMIT APPROVED 8WOATE t PERMIT EXPIRATtON DATE THIS FORM I&JST BE ACCOMPANIEO BY A PERMIT APPUCA110N · FORM A, LINLrr.q~ A CURRENT FORM A HA~ BEEN FILED. 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 ~ 1 NEW PERMIT [] 3 RENEWAL PERMIT ~]- 5 CHANGE OF INFORMATION ONEITEM [] 2 iNTERIM PERMIT [] 4 AMENDED PERMIT ~?'~ 6 TEMPORARY TANK CLOSURE I. TANK DESCRIPTION COaPL~TE ~ ~T~S -- SP~CtFY ~ UNKNO~ C. DATE ~NSTALLED (MO/DAY. EAR) -7' [] 7 PERMANENTLY CLOSED ON SITE [] 8 TANK REMOVED B. MANUFACTURED BY~~ D. TANK CAPACITY IN O0 II. TANK CONTENTS IF A*I IS MARKED, COMPLETE ITEM C. A. ~ 1 MOTOR VEHICLE FUEL [] 4 OIL B. [] 2 PETROLEUM [~ 80 EMPTY ~ 1 PRODUCT [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE D. iF (A.i. :S NOT MARK--__D. --_NTER ',FAME CF SURSTANCE STORED ~ la REGULAR C. . , UNLEADED .[~ lb PREMIUM r~ UNLEADED E~] 2 LEADED ~ 3 DIESEL [] 6 AVIATION GAS I , GAS~OL ~ 7 M~H*"OL I [] 5 JET FUEL -- I ] 99 OTHER ~DESC~BE ,N ;TEM O. ~ELC',',"I III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D A. TYPE OF 1 DOUBLE WALL L__J 3 SINGLE WALL WITN EXTERIOR LINER SYSTEM 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT ~AULTEDTANK) [] I BARE STEEL [] 2 STAINLESS STEEL ~'3 FIBERGLASS B. TANK MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE?~[] 7 ALUMINUM (PrimaryTank) [] g BRONZE [] 10 GALVANIZED STEEL [] g5 UNKNOWN ~'~[] 1 RUBBER LINED [] 2 ALKYD LINING ~ [] 3 EPOXY LINING c, INTERIOR [::~5 []~96 UNKNOWN UNING GLASS LINING [] 6 UNLINED IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YEB ~ NG__ [] 95 UNKNOWN [] ~ OTHER ] 4 BTEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLE W/FRP [] 99 OTHER ' [] 4 PHENOLIC LINING ] ~ OTHER D. CORROSION [] I POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION [:~ 5 CATHODIC PROTECTION [] 91 NONE [] 9~ UNKNOWN FIBERGLASB REINFORCED PLASTIC OTHER IV. PIPING INFORMATION C;RC, ~ A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF AF~LICABLE A. SYSTEM TYPE A U 1 SUCTION ~i~,~2 PRESSURE A U 3 Q~VtW A U ~ O~ER B. CONSTRU~ION A U 1 SINGLE WALL A~2 ~UBLE W~ A U 3 LINED TR~H A U M UN~O~ A U ~ O~ER C. MATERIAL AND A U ~ ~STEEL A U 2 STAINLESS S~EL A U 3 ~L~INYL CHLORI~(P~)A~4 FIBERG~S PiPE CORROSION A U 5 ~UMINUM A U 6 ~RE~ A U 7 STEEL WI ~AT~ A U 8 1~ ME~ANOL COMPATIBLEW/FRP ' PROTE~ION A U ~LVANI~O S~EL A U 10 CAT~D~PROTECT~ A U ~ U~O~ A U ~ O~ER O LEAK DETE~ION ~ AUTOMATIC LINE LEAK DE~CTOR ~ 2 LNET~H~ESSTESTING 3 Im~m~ ~ O~ER V. 7~EAK D~E~rON ' I v,..AL ~N~NTORY RE~ILtAT~N ~ 3 VAPOR MONITOR'" ~ 4 ~'OMAT~ TANK ~UGI. ~ , GROUND WA~R MONITORING ~6 TANK. TESTING ~ ' IN~TITIALMONITORI~ ~ '1 ~; ~ . UN~ ~ . O~ER VI. TANK CLOSURE INFORMATION I 1. ESTIMATED DATE LAST USED (MO/QAY/YR) 2. ESTIMATED QUANTITY OFsuBSTANCE REMAINING GALLONS I3' WAs TANK FILL[=D wITHINERT MATERIAL ? YES r"-'-~ No[] THIS FORM HAS BEEN COMPLETED UNDER P~F PERJ~J~Y, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I ABISL~CANTSNAME '~ ~ ~' ~ '~'~ ~ ~ .. I DATE. LOCAL AGENCY USE'ONLY STATE I.D.# PERMIT NUMBER FORM B (9-90) THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY tit TANK # PERM IT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATiON · FORM A, UNLE~,I A CURRENT FORM A HAS BEEN FILED. STATE OF CAUFOINA ~ STATE WATER RESOURCES CONTROL BO UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM B t~ '~ COMI~-ETE A SEPARATE FORM FOR EACN TANK SYSTEIL MARK ONLY ~ 1 NEW PERMIT [] a RENEWAL PERMIT ,[~5 CHANGE OF INFORMATION ONE ITEM ~ 2 INTERIM PERMIT ~ 4 AMENDED PERMIT '~ $ TEMPORARY TANK CLOSURE DBA OR FACILITY NAME WHERE TANK IS INSTALLED: ~:~::;~ C)~C ~ /~ -- # I. TANK DESCRIPTION COMPLETE AU. ~TEUS - SPECifY ~F UNKNOWN C. DATE INSTALLED (M(:~OAV~YEAR) '~./~ I F II. TANK CONTENTS IFA. 1 ,SMAR~O.C~PLETE~TEMC. [] 7 PERMAJ'dENTLY CLOSED ON S~TE I [] 8 TANK REMOVED a. MANUFACTURED aY: o. T~.< c..,c,w ,. c~.LoNs: ~ II REeULAR ~ 3 DIESEL ~__ E. (3. ~ UNI.EAO~D ~1 PROOUCT ~ lb PREMIUM ,[~ 4 G~AHOL ~ UNLEA~D 5 JET FUEL , [] 2 WA~RTE . [] 2 LEADED ' ~ OT~ER ::)c. SC-~:aE [] 2 PETROLEUM ~_j 3 CHEMICAL PRODUCT [] aO EMPTY [] 95 UNKNOWN ;3. .,: ~,.'. ~- ~C? '.'A;-'--_2. -_-~'=_'A ',~ME C~ SL:RS'A~,CE IlL TANK CONSTRUCTION MARKONEiTEMON~.~INI~OXESA,~.ANOC, A~OALLTNATAPPLIESINBOXD A. TYI~ OF ~ 1 DOUBLE WALL ~ 3 SINGLE WALL WITH EXTERIOR LINER ~ ~ UN~WN SYSTEM ~ ; Sl~LE W~ [] 4 SECONDARY CX)NTNNMENT (V,~.AUI.TEO TANKI B. TANK [] 1 EARESTEEL [] 2 STAINLES~ STEEL ,~'3 FIEERGI.A~I MATERIAL [] 5 CONCRETE [] e FOLW~NYt. CHLOR~' E'--] ? ~.uue~uu (PdmarV?aak) [] g aRONZ~ [] ~o (3~vANIZ~=O STEEL [] e~ UN~OWN [] ~ OTHER [] 4 ~T~,I. ~ W/FIEERGI~ REINFORCED PLASTIC [] I 100~, IA~L COMPATIBLE W/FRP [] ~ OTHER '" C. INTERIOR [] 2 RURaER LINED [] ~ ~.~YO LNNG [] 3 EFOXY Lame liNING [:~ ' (3~ LININ(3 ~--"--I ' UNLINED ~ ~ UN~WN IS LININO MATERIAL ~PATIBLE WITH 10(~ METI-~ANO[ ? YEI NO__ O. CORROSION [] ~ POLY[THYLENE WmU~ I'"--I 2 CO(TINO [] 3 VWYL Wink" PROTECTION [] s CATHOOK:: P~OTECTK:)N [] e~ NONE [::~'M UWNOWN [] 4 PNENOLIC LININ~ [] ~ OTHER 4 FIEERQI.A~8 REINFORCED PLASTIC ~ OTHER IV. PIPING INFORMATION c~.cLE A ~FA~OV~G.OUNOOR u A. SYSTEM~PE k U ~ S~T~ ~ PRE~U~ A U 3 ~v~ A U ~ O~ER B. CONSTRU~N A U ~ SIDLE W~ A~ ~ ~8~ W~ A U 3 L~ T~ k U M UN~ A U ~ O~E~ C. MA~RIALANO A U 1 ~TEEL A U 2 ~88 ~ A U 3 ~1~ ~ORI~A~4 FtBE~8 PIPE CORROSION A U 5 ~UMI~M A U e ~ A U 7 ~Y~k~A~ A U I 1~ ~L ~MPATIBLEW;RP PROTE~ION A U ~V~l~O D LEAK D~E~DN ~ ~T~A~UNE~C~R ~ 2 U~T~T~ ~-= ~'~ ~ ~ O~ER ' f~ r ~ ~ ~ · V. ~EAK D~E~ON 1 / VI. TANK CLOSURE INFORMA'IION I1. ESTIMATED DATE LAST USED (MOiOAY/YR) 2. E.IT1MATEO QUANTrrY OF I~' WAI TANK F~LEO wrTN YE~ [] NO~-~ r ~U~TANCE REMAININQ (NM.LONI INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER P~ PEFU~IY. AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT LOCAL AGENCY USE'ONLY THE STATE I,D. NUMBER I~ COMPOSED OF THE FOUR NUM~_rRg BELOW COUNTY e JURISDICTION · FACILrrY · TANK · STATELD.# F-i--] I t I I I I I I I I I I I I Ill I PERMIT NUMBER I PERMIT APPROVED BY/(3ATE I PERMIT EXPIRATION OATE THIS FORM IIJST BE ACCOMPANIED BY A PERMIT NqKJCAllO# · FORM A, IMLF~ A CURRENT FORM A HA~ BEEN FILED, STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM g COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION r~/7 PERMANENTLY CLOSED ON SITE ONE ITEM ~ 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE .~ 8 TANK REMOVED O.A OR AO,., .AME W.ERE TANK ,S ,.STALLEO: ? 3.7,~F I. TANK DESCRIPTION COMPLETE ALL ~TEUS -- SPEC;FY ~F UNKNOWN I1. TANK CONTENTS IF A-~ ~S UARKED. COUPLETE ITEU C. R. MANUFACTURED BY: (~/~.f/~x.~'/~ D. TANK CAPACITY IN GALLONS: 1 MOTOR VEHICLE FUEL [] 4 OIL 2 PETROLEUM [] 80 EMPTY [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN '~ 1 PRODUCT [] 2 WASTE /~la REGULAR C. UNLEADED [] lb PREMIUM UNLEADED [] 2 LEADED 3 DIESEL [] 6 AVIATION GAS 99 OTHER (DESC;~BE ,N ;TEM g. IF (Al. ;$ NOT MARK~O, E'*~TER %AME O~ SURSTANCE STORED III. TANK CONSTRUCTION MARK ONE iTEM ONlY IN BOXES A, B, AND C. A~D ALL THAT APPLIES IN SOX O A. TYPE OF 1 DOUBLE WALL L~ 3 SINGLE WALL WITH EXTERIOR LINER SYSTEM 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] g5 UNKNOWN [] 9e OTHER B. TANK [] 1 BARE STEEL MATERIAL [] s CONCRETE (PrimaryTank) [] g BRONZE [] 2 STAINLESS STEEL ..~ 3 FIBERGLASS [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM 10 GALVANIZED STEEL [] 95 UNKNOWN [] 1 RUBBER LINED r-'-'1 2 ALKYD LINING c. INTERIOR [-'-'] 5 GLA88 LINING 8 UNLINED UNING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? D. CORROSION [] 1 POLYETHYLENE WRAP [~ 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100~ METHANOL COMPATIBLE W/FRP ] 99 OTHER ' ] 3 EPOXY LINING [] g~ UNKNOWN YES~ NOF [] 3 VINYL WRAP []~ UNKNOWN [] 4 PHENOLIC LINING [] 99 OTHER [] 4 FIBERGLASS REINFORCED PLASTIC [] g9 OTHER IV. PIPING INFORMATION CmCL~ A IFABOVEGROUNDOR U IF UNDERGROUNO, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A ~)2 PRESSURE A U 3 GRAVITY A U g9 OTHER B. CONSTRUCTION A~,~ 1 SINGLE WALL A U 2 DOUBLE WALL A U 9 LINED TRENCH A U ~ UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS' PIPE A U 5 ALUMINUM A U B CONCRETE A U 7 STEEL WI COATING A U 8 100%, METHANOL COMPATIBLEW/FRP A~ g GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U OTHER [] 1 AUTOMATIC LINE LEAK DETECTOR *~ 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] ' VISUAL CHECK ~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] S GROUND WATER [] 6 TANK TESTING [] 7 '"TERSTITIALMONITORINQ [] 91 NONE []" UNKNOWN [] gg OTHER VI. TANK CLOSURE INFORMATION 2. ESTIMATED QUANTITY OF /'P"t :3. WAS TANK FILLED WITH SUBSTANCE REMAINING ~ GALLONS INERT MATERIAL ? YES ~0 THIS FORM HAS BEEN COMPLETED UNDEPt~P-E-NA-~L~ OF PEI~IURY, AND TO THE BEST OF MY KNOWLEDGE; IS TRUE AND CORRECT H IAPP~iJCAN~S NAME ~ ~. '~, /' ~ ~,~ t'~ ~,~'~ ~ LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# ~-~ I I I I I I I I I I I I I I I III I PERMIT NUMBER FORM S {~-~0) PERMIT APPROVED SY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPMCATiON · FORM A, UNLES,~ A cuRRENT FORM A HAS BEEN FILED. FOI~B-R4 ~TATE OF CAUFORMA STATE WATER RESOURCES CONTROl. SON'IF UNDERGROUND STORAGE TANK PEFIMIT APPLICATION · FOFIM El COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY [] 1 NEW PERMrt [] ONE ITEM ~ 2 INTERIM PERMIT [] * AMENOED PERMIT [] 6 TEMPORARY TANK CLOSURE,~ S TANK REMOVED DBAOR FACILITY NA&~ WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPETE ALL ~TEMS - SPECIe' ,F UNKNOWN BY: II. TANK CONTENTS ~F~.~ ~s.*R~o. COM.cE'r~ ~TEM C. MOTOR VEH~LE FUEL [] 4 OIL PETROLEUM [] 80 EMPTY CHEMICAL PROOUCT [] 95 UNKNOWN 7 I~RMANENTLY CLOSED ON SiTE '~ 1 PRODUCT [] 2 WA.qTE C. ~ 1& REGULAR UM.EADED ] lb PREMIUM UNL, EAOEO [] 2 LEADED III. TANK CONSTRUCTION MARKONEiTEMON~.YiNBOXESA.~.ANOC. ANOALLTHATAPPLIESINBOXD A. TYPE OF ~ ~ ~OUeLE W~L SYSTEM ~ 2 $~NGLE W~J. F-q 3 S~NGLE WA" W,~ ;XTER,OR S. TANK [] ! I~REST~I:L [] 2 STAINLESS STEEL MATERIAL [] s CONCRETE [] s POLYV,NYL CHLOm~ [] 7 (Pl'hlll.~lfT~11~ [] ' SRO~ ~ 10 (3~LVANIZ~D 8T~L"I I'~ "UNK~IOWN C. INTERIOR UNING [] 1 RUE~R LINED ~--']. 2 ALKYD LINING [] [] 5 (2L,A88 LINING ~ 8 UNLIN~ ~ 18 LINI~ MATER~ ~PATI~ ~ 1~ ME~ ? Y~ O. CORROSION PROTECTION ] 4 8TE~L CL~O W/FIBERGLAS8 REINFORCED PLA,,RTIC ] I 100~ M~FNANOL COMPATIBLE W/FRP ] ~e OTHER e E~OXY LININO UNKNOWN [] 4 I~NOt. IC LINING [] ~ OTHER [] 4 FIBERGLAS8 REINFORCED I~STIC ] ~ OTHER IV. PIPING INFORMATION c,.c,~ A ,I:~OVEGROUNOOR U Lg UNOSRO.qOUNO.~OTH ~*J~.ICaJLE A. SYSTEM~PE A U ~ ~ A~2~R~SU~ A U 3 G~vl~ B. CONSTRU~N A~ Sl~ w~ A U ; ~e~ w~ A U 3 LI~ T~ A U ~ OTHER A U ~ UNKNOWN A U ~ OTHER C. MATERIALANO A U ~ BAREatEEL A U ~ ~I'NNLE~,~ STEB. A U 3 POLYVINYL CHLORIOEpaVC)A U 4 ;IEERGLk~$ P;PE CORROSION A U s N. UMINUM & U S C~3NCI~TE A U 7 ~'I'EELW/COAT1N~ A U I 1~ ME'I'ldANOL COMPATIELEW/FRP PROTECTION Ai~f'~) 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U ~ UNIG~OWN A U ~ OTHER O. LEAK DETECTION [] MONII'ORI~] [] 9e OTHER V. TANK LEAK DETECTION [] , TAN~ TEsTING [] I VI. TANK CLOSURE INFORMAllON THIS FORM HAS SEEN COMPLETED IAPP.~iCANT'S NAME LOCAL AGENCY USE ONLY STATE I.D.# PERMIT NUMBER · J~TANCE REMAININ(31 ~ QALLONI INERT MATERIAL ? YE~ , AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT FORM THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBEI~J BELOW COUNTY # JURISDICTION il FACILrl'Y It TANK · ~E~MIT A~FF~vED EY/OA~ PERMrr EXPIRATION THIS FORM MUST 8E ACCOll)ANIED BY A PERMIT APPLICATION. FORM A, UNLESS A CURRENT FCHU A HA~ BEEN RlrO. 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 [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEI ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE .~ 8 TANK REMOVED I. TANK DESCRIPTION COM?~ETE ALL ITEMS -- SPECIFY IF UNKNO~%I c. DATE ,NSTALLED (MO,DAY~E^R)' II. TAN K ~I~ENTS ,F A-1 IS MARKED. COMPLETE ITEM C. A. ~ 1 MOTOR VEHICLE FUEL [] 4 OIL L_~ 2 PETROLEUM [~ 80 EMPTY [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN O. Z- (Al'. :S NOT MARKED. ENTER NAME OF SUBSTANCE STORED B. MANUFACTURED BY: L.~TA~.~/~-~v D. TANK CAPACITY IN GALLONS: B'~I PRODUCT [] 2 WASTE ~'~'~ a REGULAR C. ~ UNLEADED [] lb PREMIUM UNLEADED [] 2 LEADED [~ 3 DIESEL [] 6 AVIATION GAS 4 GASAHOL ~'~ 7 METHANOL ~ 99 OTHER :]DESCB~BE ~N ;TEM O SELC',',"! III. TANK CONSTRUCTION MARK ONE [TEM ON~¥1N BOXES A, B, ANDC, AND ALL THAT APPLIE$1N BOX D A. TYPEOF 1 DOUBLE WALL ~ 3 SYSTEM 2 SINGLE WALL [] 4 SINGLE WALL WITH EXTERIOR LINER [] g5 UNKNOWN SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 MATERIAL [] 5 CONCRETE [] 6 (PrimaryTank) [] g BRONZE ~ 10 STAINLESS 8TELL [] 3 FIBERGLASS POLWINYL CHLORIDE [] 7 ALUMINUM GALVANIZED STEEL [] 99 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100~ METHANOL COMPATIBLE W/FRP [] 99 OTHER '~ [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR ~:i/s UNING [] 5 GLASS LINING UNLINED [] 99 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NG__ O. CORROSION [] 1 POLYETHYLENE WRAP ~ 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLA~S REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 99 UNkg~K3WN [] 99 OTHER IV. PIPING INFORMATION C~RC,~ A IFABOVEGROUNOOR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~ 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A~(..~ 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U g5 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U 1 SARE STEEL A U 2 STAINLESS STEEL A U 3 POLWINYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE A/.-~U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A ~ g GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER [] 1 AUTOMATIC LINE LEAK DETECTOR ~' 2 LINE TIGHTNESS TESTING [] 3 INTERS'm'IN..MOfllTORii~ [] 99 OTHER V. TANK LEAK DETECTION [] ' VISUAL CHECK ~:~'2 INVENTORY RECONCILIATION ~13 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] , GROUN~,~fl'~/ [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] ,1 NONE [] 99 UNKT~IOWN [] 99~ VI. TANK CLOSURE INFORMATION I ,.EST, MATEOr. TE LAC, /UBEO_ 2. ESTIMATED QUANTITY OF 3. WA~ TANK FILLED WITH ~ I LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION it FACILITY it TANK # STATE I.D.# ~ I I t I I I I t I I t I I I I Ill I PERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLES.q A CURRENT FORM A HAS BEEN FILED. SUBSTANCE REMAINING ~ ~LONSt INERT MATERIAL ? THIS FORM~AS BEEN COMPLETED UNDER P~NA'I:TY~F PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT PERMIT NUMBER FORM B (g-gO) ~TATE OF CAUFORNIA STATE WATER RESOURCES CONTROL I UNDERGROUND STORAGE TANK PERMIT APPLICATION · FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ~ ~ NEW PERMrr [] 3 RENEWS. PERMIT [] S CHAN(~ OS INFORMATION [] 7 PERMANENTLY CLOSED ON S,T~ I ONE ITEM ~ 2 INTERIM PERMIT [] 4. AMENDED PERMIT [] S TEMPORARY TANK CLO~URE ~ , TANK REMOVED I. TANK DESCRIPTION COM.~ET~ *eL )TEMS - S,ECI~Y ~F UNKNOWN II.T~ENTS ,F*.,,SMAR~D. COMPLETE,TEMC. ~;~Ti""~C'~UL~R 3 D,~SEL ~ e *V,AT,ONGAS I III. TANK CONSTRUCTION MARK ONE ITEM ON~.Y IN I~:}XES A. i},ANDC. ANO ALL THAT API3LIES tN BOX D A. TYPE OF ~, 1 DOUBLE WALL SYSTEM ~ 2 SINGLE WALL B. TANK [] I ~AREST~EL MATERIAL [] s CONCRET~ (P.m.ryT.nk) [] e BRONZ~ ~-~ 3 SINGLE WALL WITH EXTERIOR LINER [] ge UNKNOWN [] ~, SECONOARY CONTAINMENT (VAULT~OTANIO [] ge OTHER [] 2 STAINLESS STE~L [] 3 FIBER~I.~81 [] 8 POLYVINYL CHLORID~ [] ? 4I-UMINUM C. INTERIOR [] I RUB~R LIN~:) []/2 AU<YO liNiNG [] S QLA..q8 LININO ~ S UNI-,I~ [] ge UNI~IOWN 18 UNING MATERI~. COMPATI~.E WITH 10~11, O. CORROSION [] I POLYE'TI"IYLENE WRA~ ~' 2 COATIN~ [] S ~ ~ PROTECTION [] 5 CATHO01C PROTECTION [] 91 NON~ [] ge UNKNOWN [] 4 ~¥~6.L Ct. AD w/FIBERGLA~ REINFORCED PLASTIC [] I 1~% METHANOl. COMPATIBLE W/FRP [] ge o'ri,~R [] 4 FI~RGI.~S8 REINFORCED PLASTIC ~ ge OTHER A U ge OTHER A U ge UNKNOWN A U ge OTHER Co MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U '1 GARESTEEL A U 2 STNNLE~ STEEl- A U 3 POLYVINYL. CI,,ILORIO~{PVC)A U 4 FIBERGLbd8 PIPE A U S ,4LUMINUM A U e C::C)NCRETE A U 7 ~Ii-~I-VWCC)ATING h U I 100'/, METAL COMPATIBLEW/I:RP A ~ g OdU..VANIZED STEEl. A U 10 CATHODIC PROTECTION A U ge UNKNOWN A U ge OTHER [] 1 AUTOMATICLIN~LEAKOG.~C'T'OR ~ 2 LIN~TIGHTHE88TEBTING [] 3 Ri~aHii4L V. TANK LEAK DETECTION THIS FORIV~AS BEEN COMPLETED UNDER P~NAL TY~F PERJ~Y, AND TO THE BEST OF MY KNOWLEDGE, I$ TRUE AND CORRECT LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBEI~ BELOW COUNTY # JURISDICTION tl~ FACILIT~ II TANK # STATE .D.# I--I--] I I I I I I I I I I I I I Iii I "ERMIT NUMBER I PERMIT APPROVED BY/DATE I PERMIT EXPIRA*rION DATE FORM 8 (~-~ THIS FORM IAJST BE ACCOMPAHIED BY A PERMIT APPUCA'rION · FORM A, UNLESS A OURRENT FORM A HA.q BEEN FILED. STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM El COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARKONLY [] [] 1 NEW PERMIT [] [] RENEWAL [] 3 PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONEITEM 2 INTERIM PERMIT 4 AMENDED PERMIT 6 TEMPORARY TANK CLOSURE /,~e TANK REMOVED I. TANK DESCRIPTION COMPLETE ALL ~TEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # '~ C, DATE INSTALLED(MO/DAY/YEAR) Il. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. B. MANUFACTURED BY: ~.,,~,~:~a,.4.~_v D. TANK CAPACITY IN GALLONS: /~ [~:~1 a REGULAR A. 1 MOTOR VEHICLE FUEL [] 4 OIL S. C. ~[~ UNLEADED [] 2 PETROLEUM [] 80 EMPTY [] 1 PRODUCT [ I lb PREMIUM ~ UNLEADED ~ 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED D, IF (A.;, :S NOT ,"ARKEO --_~TER ~,;AME OF SUBSTANCE STORED [~ 3 DIESEL [] 6 AVIATION GAS 4 GASAHOL ~ 7 METHANOL ~ 99 OTHER fDESCRIBE ~N ;TEM O. '~ELC',',"! III. TANK CONSTRUCTION MARK ONE ITEM ON~.Y IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D A. TYPE OF 1 DOUBLE WALL L~ 3 SYSTEM 2 SINGLE WALL [] 4 SINGLE WALL WITH EXTERIOR LINER [] g5 UNKNOWN SECONDARY CONTAINMENT (VAULTED TANK) [] gg OTHER B. TANK [] 1 BARE STEEL [] 2 MATERIAL [] 5 CONCRETE [] 6 (PrimmryTank) [] 9 BRONZE ~ 10 STAINLESS STEEL [] 3 FIBERGLASS POLYVINYL CHLORIDE [] 7 ALUMINUM GALVANIZED STEEL [] 95 UNKNOWN [] 4 STEEL CLAD WI FllaERGLAS$ REINFORCED PLASTIC [] S 100% METHANOL COMPATIBLE W/FRP ] ~ OTHER [] 1 RUBBER LINED ~ ~ 2 ALKYD LINING C. INTERIOR [] 5 ~ LINING ~ ~ 6 UNLINED UNING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? [] 3 EPOXY LINING [] 4 PHENOLIC LINING [] 95 UNKNOW. [] 950THE. YES__ NO__ D, CORROSlON [] 1 POLYETHYLENE WRAP ~/2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] S VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC [] 95 U.~OWN [] . OTHER IV. PIPING INFORMATION CmCL~ A IF ALCOVE GROUND OR U IP UNOERGROUNO. 80TH11 IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~,.~ 2 PRESSURE A U 9 GRAVITY B. CONSTRUCTION A ~)1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U ~ OTHER A U 95 UNKNOVVN A U gg OTHER C.' MATERIAL AND CORROSION PROTECTION O. LEAK DETECTION A U 1 gARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORICE(PVC)A U 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U B 100% METHANOL COMPATIBLEW/FRP A'U~,~9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A Ugg OTHER [] 1 AUTOMATIC LINE LEAK DETECTOR '~ 2 LINE TIGHTNESS TESTING [] 3 INTERS~ITIN. MONITORING [] ~ OTHER ~ V. TANK LEAK DETECTION [] 1 VISUAL CHECK [~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] S GROUND WATER MONITORING [] 6 TANK TESTING [] 7 INTERSTITIALMONtTORING [] 91 NONE [] g~ UNKNOWN [] gg OTHER r"~~, ~ VI. TANK CLOSURE INFORMATION 2. ESTIMATED QUANTITY OF SUBSTANCE REMAINING THIS FORM HAS SEEN COMPLETED UNDER ~EI~A~L~ OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL A'GEI~CY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW STATE I.D.# PERMIT NUMBER ~ (~ALLONS INERT MATERIAL ? ES [] NO COUNTY # JURISDICTION # FACILITY It TANK It FORM IPERMIT APPROVED BY/DATE PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOI&aANIED BY A PERMIT APPECATION · FORM A~ UNLE~ A CURRENT FORM A HA~ BEEN FILED. STATE OF CAUFOI~IA STATE WATER RESOURCES CONTROL Bi UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM MARK ONLY [] 1 NEW 'PERMIT ~ 3 RENEWAL PERMIT [] $ CHANGE O~ INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM ~ 2 INTERIM PERMIT [] 4 NdENDED PERMIT [] $ TEMPORARY TANK CLO~URE ~'~8 TANK REMOVED I. TANK DESC~I~ION CO~E~ *LL ~TE~S - SPEC~ ~F u,~ IA. OWNER'STANKLD., ':~ C. DATE ,NSTALLED (MO/DAY/YEAR) II. TANK CONTENTS ~; A.~ ~S MARKED. COMPLETE ~TEM C. PETROLEUM [] ~O EMPTY I CHEMICAL PRODUCT ~ ~ UN~ B. MANUFAC'I!JRED BY: ~ O. TANK CAPACITY IN GALLON~: ~ r i'~,~ a REGULAR I -' ~ UNLEADED 1 PROOUCT lb PREMIUM __ UNLEADED L_J ~ w,sTE [] ~ L~AOEO III. TANK CONSTRUCTION MARK ONE ITEM ON~.Y IN GOXES A. E. ANOC, ANOaLLThATAPIDLiESINEOXO A. TYPE OF ~ 1 DOUBLE WALL SYSTEM {~ 2 SINGLE WALl. L_~ 3 SINGLE WALL WITH EXTERIOR LINER [] 4 SECONOARY CONTAINMENT (VAULTED TANK) [] ~ UNKNOWN [] ~ OTHER 9. TANK [] ~ ~ARESTEEL MATERIAL [] 5 CONCRETE (Primrf Ta~k) [] a [] 2 STAINLESS STEEL [] 3 FIBERGlaI,$S [] , .OLYVIN.. C.LOR~O~ [] 7 aLUMS. ~ 10 GALVANIZED STEEL [] . UNKNOWN [] 4 ~TEEL CLAD WI FIOERGLA~.R REINFORCED PLA~I'IC ] I 100~ METHANOL DOMPAT1EI. E W/I=RP [] ~ OTHER "' D. CORROSION [] 1 mLYEI'I. IYLENE WR~ ~ COATIN~ PROTECTION [] 5 CATHODIC PROTECTION [] el NO~ [] s vINYl. ¥~M) [] ~, UNla~OWN [] 4 FIOERGLA.9I REINFORCED I:~STIC [] m OTHER IV. PIPING INFORMATION C,RCL~ A ~*"OV~m~OUNOO. u ~FUN~ROROUNO."Om~AP~.C*EL~ A. SYSTEM TYPE A U ~ suc*no~ A~ a PRESSURE A U 3 GRakvrTY A U m O~ER 6. CONSTRUCTION A ~1 SINGLE WALl. A U 2 DOUBLE WaLL A U 3 LI/~ TRENCH A U ~ UNKNOWN A U W OTHER Co MATERIAL AND CORROSION PROTECTION O. LEAK DETECTION A U I GARE~TEEL A U 2 STAINLESS STEEL A U 3 POLYViNYL GHL.ORIO~(PV~A U 4 ;19E~8 PiPE A~U 5 ~UMI~M A U 8 ~ A U 7 ~A~ k U I 1~ ~L ~MPATIBLEW;RP k~9 ~V~l~OS~ k U 10 ~P~ A U ~ U~ A U ~ O~EA ~ 1 ~T~A~LI~~C~R ~ 2 LI~T~EBSTEBTI~ ~ 3 ~i~m~ ~ ~ m O~ER V. TANK LEAK DETECTION [] 1 VISUAl CH~CK ~2 IN~NTOI~f R~CONCILIATI~ E~ 3 V. Ad~RMONITORINGE'~, AUT(:~&TIOTANK(~AL)('tlNG [], i3ROUND WATER MONITORING ~ ' TANK TE~TING [] ? INT~R~TmALMO.ITORIN~ [] ,1 ~ [] . UNI~ [] . OTHER VI. TANK CLOSURE INFOI~TION I 1' ESTIMATED D&TEMOIO ¥/YR} L i THIS FORM HAS BEEN COMPL~D UNDER ~ OF PENURY, AND ~ ~E BEST ~ ~ KNO~DGE, IS ~UE AND CORRECT L~AL AG E~CY USE ONLY THE STATE I.D. NUMBER ~ COM~ED 0F THE FOUR NU~E~ BELOW I COU~ · JURI~ICTION t FA~IL~ · TANK · STATE I.D.~ ~ III [ FORM e (~m T~ ~RM ~ BE A~IED BY A P~ ~A~N · FORM ~ ~ A ~R~ FORM A ~ BE~ R~D. ~TATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDEI{GFIOUND STOl{AGE TANK PEI{MIT APPLICATION- FOI{M B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTENL MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITE ONE ITEM ~,, 2 INTERIM .PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ~8 TANK REMOVED 3. I, TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # V C, DATE INSTALLED (MO/DAy. EAR) j I / ~ I II. TANK CONTENTS ~F A.1 IS MARKED, COMPLETE ITEM C. 8. MANUFACTURED BY: D. TANK CAPACITY IN GALLONS: [] 2 PETROLEUM {~ ~0 EMP~ [] , PRODUCT [] ,,PREM,UM UNLEADED [] 6 JET FUEL -- I ~ 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED ~ 99 OTHER (OESCg~BE ,N ;T~M 0. ~ELC',',"I O, !F (A~', :S NOT MARKED. ~NTE~ ~;AME OF SUBSTANCE STORED C.A.S. ·: j III. TANK CONSTRUCTION MARK ONE ITEM ON~Y IN BOXES A, a, ANDC, ANO ALL THAT APPLIES IN BOX D A, TYPEOF [] 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL ~ 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 EARESTEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (Primary Tank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC [] 8 100% METHANOL COMPATIBLEW/FRP [] 99 OTHER [] 1 RUBBER LINED ~ 2 ALKYD LINING ~r-~ 3 EPOXY LINING INTERIOR C. [] 5 GLASS LINING 6 UNLINED [] 95 UNKNOWN MNING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO__ [] 4 PHENOLIC LINING [] 95 OTHER D. CORROSION [] 1 POLYETHYLENE WRAP ~/2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] el NONE [] 3 VINYL WRAP [] 4 FIBERGLA-~B REINFORCED PLASTIC [] 95 U.~W. [] 99 OTHER IV. PIPING INFORMATION C~RCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF AI~LICABLE A. SYSTEM TYPE A U 1 SUCTION AG 2 PRESSURE A U 9 GRAVITY B. CONSTRUCTION A~) 1 'SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 99 OTHER A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION O, LEAK DETECTION A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE ~)S9 ALUMINUM A U 6 CONCRETE A U 7 STEEL WI COATING A U 8 100% METHANOL COMPATISLEW/FRP GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 96 UNKNOWN A U 99 OTHER [] 1 AUTOMATIC LINE LEAK DETECTOR [~ 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL aof~rroR~Ne [] 9e OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK [~ 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [~] 4 AUTOMATIC TANK GAUGING [] 6 QROUND WATER MONITORINGI [] 6 TANK TESTING [] 7 'NTER~TITIALMONITORING [] g' NONE [] 95 UNKNOW~I [] 950TH~ VI. TANK CLOSURE INFORMATION I 1. ESTIMATED DA_.._TE LAST_.USED (MO/OAY/YR) I 2. ESTIMATED QUANTITY OF ~r~.-- ~/ I SUBSTANCE REMAINING (_~,~ GALLON~ INERT MATERIAL ? '--4- '' '-,~/I ~ J THIS FORM/HA'~EEN COMPLETED UNDER PENAL-~<,OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT ( PHI & $1GNATU E ~ LOCAL A'GENC~ USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK STATE .D,# FT-] I I I I I I I I I I I I I I t111 [ PERMIT NUMBER FORM S (9-~(}) PERMIT APPROVED BY/DATE I PERMIT EXPIRATION DATE [ THIS FORM MUST BE ACCOMPANIEO BY A PERMIT APPUCATION · FORM A, UNLEB~ A CURRENT FORM A HAS BEEN FILEO. STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL B( UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEI~ MARK ONLY i,_..J 1 NEW PERMIT [] 3 RENEWAL PERMIT ONE ITEM ~ 2 INTERIM P~RMIT [] 4 AMENDED PERMIT OMA OR FACILITY NAME WHERE TANK IS INSTALLED: "~'~ ~,, (..~Jrl, q,~.~/,~. ~ / ~ ~ I. TANK DESCRIPTION COM~.ETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. O. I V B. MANUFACTURED C. DATE INSTALLED (MO/DAY/YEAR)' ~ / / ~::> / D. TANK CAPACITY iN GALLON.q: /./~::)0 0 II. TANK CONTENTS ~FA-, IS MARKi:O, COMPLETE tTEM C. ~ I MOTOR VEHICLE FUEL ~'~ 2 PETROLEUM ~ 3 CHEMICAL PRODUCT [~ eO EMPTY ] 95 UNKNOWN ] I PRODUCT [] 2 WASTE [] $ CHANGE OF INFORMATION [] 7 PERMANENTI.y CLOSED ON SITE [] e TEMPORARY TANK CLOSURE NS TANK REMOVED c. [] la REGULAR ~ 3 O~ESEL ~ 6 AVIATION GAS l UNLEADED I I 4 jEC~TANOL [] ,bPREMIUM ~ 7 M~H~OL UNL~O ~ 5 ETFUEL ~ 2 L~D ~ ~ O~ER DESCmaE h ;TEM ~ III, TANK CONSTRUCTION MARK ONE iTEM ON~.Y IN BOXES A, (~, ANO C, AND ALL THAT APPLIES IN BOX O A. TYFE OF L__J ~ OOuELE W*LL SYSTEM [] ; S~NOLE WALL g_.J 3 SINGLE WALL WITH EXTERIOR LINER [] gS UNKNOWN [] 4 SECONDARY DONTNNMENT (V&ULI'EDTANIO ~ ee OTHER 8. TANK [] ~ ~-ARESTEEL [] 2 STAINLESS ST~:I, [] 3 FISEI~31,~I MATERI~L [] 5 CONCRETE [] 6 POLYVINYL CHLORI0~ [] 7 ALUMINUM (Primaqra~k) [] g gRONZE [] 10 Ga/.VANI:Z:EO STEEL [] . UNI~WN [] 4 STEEL CA.AD W/FISERGLA~,.R REINFORCED PLASTIC ] I l(X~& IM'?I.UI, NOL COMPATIBLE W/FRP ~ g~ OTHER [] 1 RUBBER LINED E~. 2 ALKYO LINING [] 3 E]~OXY LININ~ C. INTERIOR UNING [] ~ ~ LININQ ~ I UNLINED [] IS UNING MATERUU. COMPATIBLE ~TH 100~ METHANe. ? YEI [] 4 I~,I~NOt. IC LINING [] ~ OTHER O. CORROSION [] , POLYETHYLENE WRN~ [~/~' CO~TING PROTECTION ~] s CATHOOIC PROTECT~3N [] ~ ~ [] ~ UNXNOWN [] 4 FIBEr8 REINFORCED PLASTIC ~ g~ OTHER A U ge OTHER A U g6 UNI~WN A U g~ OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETEC¥ION V. TANK LEAK DETECTION,, IE~ 1 VlSU~. CHECK ~ 2 INV~N'I~RY R~:::ON~IUATION E~ 3 VAPORMONITO~IN~E'"~ 4 AUTOM&TiCT~d~K(~Mj~'3iNG E~ ' e~UNOWAm. MONITORING i VI. TANK CLOSURE INFOI~IA'nON '-"""'"'"'" C> THIS FORM~EEN COMPL~ UN~ER P~F PENURY, AND m ~E BEST ~ ~ ~O~E, 18 ~UE AND CORR~T L~AL ~GEN~ USE ONLY THE STATE I.D. NUMBER ~ C0M~ED 0F~ FOUR HU~EM BELOW STATE I.D.# PERMIT NUM.a-ER COUNTY e JURISDICTION # FACILITY e TANK FORM PERMIT APPROVED 8Y~ATE I PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERUn' APPUCAllON · FORM A, UNLE~ A CURRENT FORM A HAS BEEN FILED. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I, SITE LOCATION STREET FACILITY #583 3220 MING AVE. CITY BAKERSFIELD KERN COUNTY II. INSTALLATION (mark all that apply): [] The installer has been certified by the tank and piping manufacturers. [] The installation has been inspected and cedified by a registered professional engineer. [] The installation has been inspected and approved by the implementing agency. [] All work listed on the manufacturer's installation checklist has been completed. [] The installation Contractor has been certified or licensed by the Contractors State License Board. [] Another method was used as allowed by the implementing agency. (Please specify.) III. OATH I certify that the information provided is true to the best of my belief and knowledge. / . Tank Owner/Agent ARCO // . _ _~(,L. Date Print Name CYNTHIA KE~HART Phone (310) 407-2606 Address 17315 STUDEBAKER RD., CERRITOS, CA 90701-1488 LOCALAGENCYUSEONLY STATE COUNTY # JURISDICTION # FACILITY # TANK,.D.# IOI L/I I TANK # REGULAR FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FORO035C7 INSTRUCTIONS FOR COMPLETING FORM "C": TANK INSTALLATION CERTIFICATION GENERAL INSTRUCTIONS o Each tank system must be in compliance with the federal and state technical standards, contained in law and regulations, for tank and piping installation. This certification shall be completed by either the UST owner or representative. One certification is required for each tank system. make the required certification. This form shall be used to Please type or print clearly all requested information (for printing, please use a hard point writing instrument). Submit the completed certification to the appropriate Local Implementing Agency. I. INSTALLATION: ~ARK ALL OF THE iTEMS THAT APPLY TO INDICATE THAT THE INSTALLATION REQUIREh3ENTS ARE MET. II. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE SIGNATURE. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION STREET FACILITY #583 3220 MING AVE. CITY BAKERSFIELD KERN COUNTY II. INSTALLATION (mark all that apply): [] The installer has been certified by the tank and piping manufacturers. [] The installation has been inspected and certified by a registered professional"engineer. [] The installation has been inspected and approved by the implementing agency. All work listed on the manufacturer's installation checklist has been completed. The installation Contractor has been certified or licensed by the Contractors State License Board. [] Another method was used as allowed by the implementing agency. (Please specify.) III. OATH I certify that the informatiAn provided is true to the best of my belief and knowledge. Tank Owner/Agent ARCO Date Print Name CYNTHIA KEPHART Phone ( 310 ) 407-2606 Address 17315 STUDEBAKER RD., CERRITOS, CA 90701-1488 LOCALAGENCYUSE ONLY STATE COUNTY # JURISDICTION # FACILITY # TANK # TANKI.D.# ~ I0 I L/ I le /'lrsf] I I I I I 12 ' ~G~AR FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FORO035C7 INSTRUCTIONS FOR COMPLETING FORM "C": TANK INSTALLATION CERTIFICATION GENERAL iNSTRUCTIONS 1. Each tank system must be in compliance with the federal and state technica~ standards, contained in law and regulations, for tank and piping installation. 2. This certification Shall be completed by either the UST owner or representative. 3. One certification is required for each tank system. This form shall be used to make the required certification. 4. Please type or print clearly all requested information (for printing, please use a hard point writing instrument). 5. Submit the completed certification to the appropriate Local Implementing Agency. I. INSTALLATION: fVlARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE INSTALLATION REQUIREiVtENTS ARE MET. II. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE SIGNATURE. STATE OF CALIFORNIA ~ - STATE WATER RESOURCES CONTROL BOARD CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION FACILITY J/583 STREET 3220 MING AVE. CITY , BAKERSFIELD COUNTY KERN II. INSTALLATION (mark all that apply)' [] The installer has been certified by the tank and piping manufacturers. [] The installation has been inspected and certified by a registered professional engineer. [] The installation has been inspected and approved by the implementing agency. All work listed on the manufacturer's installation checklist has been completed. The installation Contractor has been certified or licensed by the Contractors State License Board, [] Another method was used as allowed by the implementing agency, (Please specify.) III. OATH I certify that the information,Rrovided is true to the best of my belief and knowledge. Tank Owner/Agent A~CO"(_.~/,~ ' ~:~/~,/{..~ ''~ Date--~~~~ I Print Name CYNTHIA ~RT Phone (310) 407-2606 Address ' 17315 S~DEB~ER ~., ' CE~ITOS, CA 90701-1488 LOCALAGENCYUSEONLY STATE COUNTY # JURISDICTION # FACILITY # TANK # TANK,.O.# .. I' I l fIT REGULAR FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FORO035C7 INSTRUCTIONS FOR COMPLETING FORM "C": TANK INSTALLATION CERTIFICATION GENERAL INSTRUCT~ONS 1. Each tank system must be in compliance with the federal and state technical standards, contained in law and regulations, for tank and piping installation. 2. This certification shall be completed by either the UST owner or representative. 3. One certification is required for each tank system. This form shall be used to make the required certification. -- 4. Please type or print clearly all requested information (for printing, p~ease use a hard point writing instrument). 5. Submit the completed certification to the appropriate Local Implementing Agency. I. INSTALLATION: MARK ALL OF THE ITEi~IS THAT APPLY TO INDICATE THAT THE INSTALLATION REQUIREIV]ENTS ARE MET. II. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. THE PERSON'S NAIVIE SHOULD BE PRINTED UNDER THE SIGNATURE. STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL BOARD* CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION FACILITY #583 STREET 3220 MING AVE. CITY BAKERSFIELD KERN COUNTY II. INSTALLATION (mark all that apply): [] The installer has been certified by the tank and piping manufacturers. The installation has been inspected and certified by a registered professional engineer. [] The installation has been inspected and approved by the implementing agency. All work listed on the manufacturer's installation checklist has been completed. The installation Contractor has been certified or licensed by the Contractors State License Board. Another method was used as allowed by the implementing agency. (Please specify.) III. OATH I certify that the informati/9~ provided is true to the best of my belief and knowledge./ Tank, Owner/Age nt "ARCO U~{ j _/t~_ ~j..' I~/4'')/~4''~~ Date~"/~//'/.~ Print Name CYNTHIA IQ~PNART Phone (310) 407-2606 Address" 17315 STUDEBAKER RD., CERRITOS, CA 90701-.1488 LOCALAGENCY USE oNLY STATE COUNTY # JURISDICTION # FACILITY # TANK # SUPER IOl [t t I . ,Lol/1 I I I 14 FORM C (7/91) THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FORO035C7 INSTRUCTIONS FOR CO~PLETING FORM "C": TANK INSTALLATION CERTIFICATION GENERAL INSTRUCTIONS Each tank system must be in compliance with the federal and state technical standards, contained in law and regulations, for tank and piping installation. 2. This certification shall be completed by either the UST owner or representative. One certification is required for each tank system. This form shall be used to make the required certification. · Please type or print clearly all requested information (for printing, please use a hard point ~riting instrument). 5. Submit the completed certification to the appropriate Local Implementing Agency. I. INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE INSTALLATION REQUIREIV1ENTS ARE MET. II. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE SIGNATURE. GROUNDWATER TECHNOLOGY, INCi 4101Alken Street. Suite B-I, Bakersfield. CA 93308 (805) 589-8601 Fax: (805) 589-860:> June 20, 1991 Ms. Flora Darling Hazardous Materials Specialist Kern County Resource Management Agency Department of Environmental Health Services 2700 M Street, Suite. 300 Bakersfield, California 93301 RE: Drill Cuttings .Disposal, 'ARCO Facility #0583, 3220 Ming Avenue,. Bakersfield, California Dear Ms. Darling: Concentrations of gasoline hydrocarbons in samples of drill cuttings and wash water generated from assessment at the aboVe-referenced site were not detected by laboratory analysis (see attached laboratory reports). The cuttings are presently stored at the site in two 55-gallon drums. The water is also stored on-site in one 55-gallon drum. Because the concentrations of gasoline in the soil cuttings were not detected, ARCO requests County approval to transport the soil to unpaved ARCO property at 1701 Brundage Lane in Bakersfield. ARCO also requests approval to dispose of the wash water in the nearest municipal storm drain. If you have any questions, please contact me at (805) 589-8601. Sincerely, GRO~U_U]3LD-VCATER TECHNOLOGY, INC. ~_~'-__~ ~. ,2' ..~ '"-'? , '''/'" ' '"'- .... ~tephan A.,Bork Project Geologist cc: Kateri Luka, ARCO Products Company Officcs throughout the U.S.. Canada and Overseas ,0 L D February 9, 1999 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICE8 2101 "H' Stroot Bakemfleld, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICE8 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-O576 ENVIRONMENTAL 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 Arco AM PM 3220 Ming Ave Bakersfield, CA 93304 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 BAKERSFIELD FIRE DEPARTMENT HAZARDOUS MATERIAL DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3979 APPLICATION TO PERFORM A TIGHTNESS TEST FACILITY A/~-~Q "~ 5~ PERMIT TO OPERATE % OPERATORS NAME · NUMBER OF TANKS TO BE TESTED ADDRESS OWNERS NAME A~O P~2ODc/~r5 IS PIPING GOING TO'BE TESTED TANK% VOLUME CONTENTS TANK TESTING COMPANY ,~V~C--~n4~- ~ I~t.-. ADDRESS TEST METHOD NAME OF TESTER STATE REGISTRATION DATE & TIME TEST IS TO BE CONDUCTED DATE Te~ -o~7 I-~7-q9 · i'oo ?~ POFAPPLICANT FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program Routine [] Combined [] Joint Agency 1~1 Multi-Agency [~l Complaint Type of Tank DII/F Number of Tanks q Type of Monitoring ('cOx Type of Piping 01,o/= [] Re-inspection OPERATION C V COMMENTS Proper tank data on file ~. Proper owner/operator data on file ~ Permit fees current tL~ Certification of Financial Responsibility ~ 1~ Monitoring record adequate and current O,~ Maintenance records adequate and current ~_~ Failure to correct prior UST violations ~_..,~..,,-~o, do~ % [~o,ck. e3'lo.~t*,4' ~- Has there been an unauthorized release? Yes No tvt~ 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 dt~ffff~ Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Site Responsible Party FACILITY NAME 4,t'¢o ADDRESS 33.~0 li, l,l~ FACILITY CONTACT INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 II INSPECTION DATE PHONE NO. ,3 IR '0~0 3 BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program Routine [221 Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact intbrmation 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?: [~l Yes [21 No Explain: 14dt'~ Questions regarding this inspection? Please call us at (805) 326-3979 White- Env. Svcs. Yellow- Station Col)), Pink - Business Copy Business Si~,~¢sponsible Party Inspector: _m Division o! AtlanticRicl~lield(~ompar~y Emergency Procedure Check Li, Period Ending ---~.. ..... no. -. ! '- ' ~ "'" IFacility IType: Date ,.~/ ' / ' ICily, State ~ _ c ' o ~m~te, ch~k ~e a~ropdate angers. Explain ~y ex~plions at end of c~k list. am/PnT~ SmogPros Conventional [] Kiosk What Monitoring & Response Plan(s) is currently used? (Reference Dealer's current "Operation of Underground Storage Tanks" amendment and answer b~ Plan(s) No: , , No Electronic Monitoring - Regulatory Requirements if not applicable, indicate here and proceed to item 3. To determine that regulatory requirements are being met at facilities equipped with electronic monitoring review the items below: a. Daily Visual Underground Storage Monitoring Logs are being completed properly ~L~ r~ on a daily basis ........................................................... b. Records are kept for required retention period (refer to Monitoring Plan) .................. [~ c. ARCO Maintenance was made aware of any alarm conditions ........................ [~ d. Documentation was made in the Recordable Discharge Log of alarm conditions ............ ['--] ~] ]~ e. The Alarm panel is now operational and shows no alarm condition ..................... :~ ~-~ Inventory Reconciliation - Regulatory Requirements (includes S.l.R....Statistical Inventory Reconciliation) If not applicable, indicate here and proceed to item 4 .......................................... '-- To determine that inventory reconciliation is being performed correctly, review the supporting documents. a. Gasoline Activity Meter Reading Worksheets and Monthly Inventory Reconciliation Summaries are being completed properly on a daily basis ........................... ~-~ [--1 b. Calculations are being performed to determine if actual variation exceeds allowable variation ................................................................ ,~--, c. Records are kept for required retention period (refer to Monitoring Plan) ..... -~.. .......... d. ARCO Mainlenance was made aware of actual variations that exceeded allowable variations ........................................................ e. Documentation was made in the Recordable Discharge Log of the reportable variation ....... f. (Calif. Only) An Annual Inventory Reconciliation Report has been submitted to the local UST Agency and ARCO, and a copy is maintained at the facility .............. [] [] Indicate Month Submitted: Automatic Tank Gauge (ATG) - Regulatory Requirements ................... ~ If not applicable, indicate here and proceed to item 5 ....................... a. Tank tests are performed each month during the first 10 days of the month and copies submitted to ARCO by the 15th of each month ...................... [] [~ b. Test records are kept on site for required retention period (refer to Monitoring Plan) ......... ~-~ ,~ Distribution: White - ARCO Environmental Administrator; Canary - ARCO Sales Representative; Pink - Stays at Facility APC-247-H (2-95) Page I of 2 I~1,~ Uti It/l~llM.~l ~,l~iMylll~l~ - Igl(ItUly rlG~IUIIGIIIt~IlI..t1t~111~..~ I. Illly wall used oil tank). If site has no used oil tank or an e ectron[c monitored used oil tank,, indicate here and proceed to Section 8 .......................................... a. Gauging Logs are being completed properly on a weekly basis ....................... [] [] b. Used oil inventory variations are in accordance with manual tank gauging measurement (refer to Monitoring Plan) ......................................... c. Records are kept for required retention period (refer to Monitoring Plan) .................. ~-~ [] d. ARCO Maintenance was made aware of actual variations that exceeded allowable variations ............................................................... [] ~--~ e. Documentalion was made in Recordable Discharge Log of the reportable variations ......... [--] [] 1. The Hazard Communications Program (HCP) Kit is readily available on site at all times ........................................................... [--[ 2. Employee training has been conducted, documented and kept in HCP Kit (upon employment and annually thereafter) .............................................. 3. (Calif. only) A current Business Emergency Response Plan (BERP) ism the Hazard.-- - Communicalions Program Kit (update required every 2 years) ..... ~'.i-.-~!7~.°. ./.1.../~/~./. ~. ...... ~ [~ [-'-] 1. Is the UST Permit current and posted? ................. ~. :.'~. ;!q"?~;. - ~ ......... ~ 2. Is the Air (APCD, AQMD, etc.) Permit currenl and posted? ... ~--< .~.!'~'"' j.'"'i ~... ~ [--] 3. Were any citations, inspection findings, or notices of violation issued since last Check List? (required by PMPA Lease to advise ARCO immediately, with COpy to follow in 5.da ys) .... :.:__ .................................. .......................... · ,. · . . ~. ,.. :Il . . . · , 1. Are bOth fill and vapor caps tight and gaskets present on all products? .................... 2. Are overfill boxes clean (no debris, leaves, etc. to clog drain)? .......................... "~' 3. Does each overfill box drain valve lunction properly (open & close)? ...................... Item No. Expla,in any "No" ch,ecked items and indica!_e_il "Default" was issued (if not, why not?} If you have any questions regarding this procedure, call your Environmental Compliance Administrator. This is Io certify that on the above date, I have reviewed the above items with Dealer/Franchisee and hereby verify the all items are in accordance with our lease/franchise agreement and federal/state regulations, or that the Dealer/Franchise~ Dealer Signalure ,."" Page 2 of 2 CERTIFICATION OF FINANCIAL RESPONSIBILITY The Atlantic Richfield Company (ARCO) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR Part 280. The financial assurance mechanism used to d~'nonstrate financial responsibility under Subpart H of 40 CFR Part 280 is as follows: Mechanism: Financial test of self-insurance, Alternative I Coverage: · Effective date: February 10, 1997 · Amount: At least $1,000,000 per occurrence and $2,000,000 annual aggregate Covers the costs of taking corrective action and compensating third parties for bodily injury and propen-y damage caused by sudden accidental releases and nonsudden accidental releases Signature Name Kenneth R. Dickerson Tit/e Senior Vice President Date February 10, 1997 Witness Signature Witness Name Eugene R. Mancini Date ARCO Records Custodian: Eugene R. Mancmi ARCO 444 S. Flower Street.-ALI: 3427 Los Angeles, CA 90071 (213) 486-7290 CITY OF BAKERS~LD OFFICE OF ENVIRONMENTAL SERVICES. 1715 Chester Ave., Bakersfield, CA (808') 326-3979 INSPECTION RECORD POST CARD AT JOB SITE Phon~ No. INSTRUCTIoNs: Pl~aa~ call for an ~ only wh~ each gro~ ofins~tiom with th~ aam~ numb~ am nady. Th~ will run in ~ ordar ~b~im~ wifla numb~ I. DO NOT cover work for any numb~ group un~l all it~ma in ~hat groupat~sign~doffbylh~P~mn$~. Followingthmaim~malimmwill _r_,yg___._~_ thanumb~of r~quit~d impe~on ~ and th~'o~ ~ azs~aamt of additional TANKS AND BACKFILL INSPECTION [ DATE INSPECTOR Backfill of Tank(s) Spark Test ~c~tion or M~mffactur~ Method Cazhodic Protection of Tan~s) PIPING SYSTEM Piping & Raceway w/Coll~mion Sump Corrosion Prot~-lion of Pipin~ Joints. Fill Pip~ ?~ ~ SECONDARY CONTAINME.N~. OVERFILL Liner Inrallalion - Tank(s) Liner Im-tallation - Piping Vault With Product CompaUble Sealer Level Gauges or Senao~ Float Vent Valves Produc~ Compatible Fill Box(ca) Product lAnc ~ Dctccmns) Leak Det~orfs) for Armuai Spac~.D.W. Tank(s) Momtoring Well(s)/Sum~s) - H20 Tes~ Spill Prevention Boxes t' .,Oit~ , FINAL Monitoring Wells, Caps & Locka Fill Box Lock Momtormg Requirements Type CONTRACTOR CONTACT :)/~.~'i o,~:Z;i '~'805 32._6 0576 III"D IIAZ MAT Dig' CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA ($05) 326':3979' PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE_OF APPLICATION (CHECK) [ ]NEW FACILITY [~MODWICATION OF FACILITY ST^RTINO t~^TE. FACILITY NAME ,-~ FACILITY ADDKESS .3 Z. Z. 0 TYPE OF BUSINESS TANK OWNER ADDRESS CON'mACTOR ADDRESS :~$o [ ]NEW TANK INSTALLATION AT EXISTING FACILITY , PROPOSED COMPLETION DATE EXISTING FACILrrY PERMIT NO. CITY t~a..O~,e.,c.~ ZIP CODE APN # PHONE NO, ?t~ CITY CiTY "-~o ZIP CODE~~=~ PHONE NO,(~o9) ~7.'5'-'2 ',.~o Z, B~F~D C~ BUS.SS UC~SE N~ WO~CO~NO. N~d q~tl"'O'O ~S~.,,~o~oe~ ~ B~YDESC~E~WO~TOBE~ -~o~ ~ (8) ~~ ~~ WATER TO FACILITY PROVIDED BY. DEPTH TO GROUND WATER SOIL TYPE EXPEC'I'ED AT SITE NO. OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL SPILL PREVENTION CONTROL AND COUNTER MEAS~S PLAN ON FILE YES .NO YES NO SECTION FOR MOTOR FUEL TANK NO. VOLUME UNLEADED REGULAR PREIVIIUM DIESEL AVIATION TANK NO. VOLUME .SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STOKED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BKAND N,~v~) ~ KNOWN) FOR OFFICIAL USE ONLY ," .. :.~:'::"~:~'.i:i:!.:'"": ..' THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMIaLy wrI~ THE ATI'ACHED CONDITIONS OF TH/$ PERMIT AND.ANY OTHER STATE, LOCAL AND FEDERAL REOULATIONS. THIS FORM HAS BEEN COMlaLETED UNDER PENALTY OF PERJURY, AND TO TI-rE BES.T. OF MY KNOWLEr~E, IS TRUE A~ CO.CT. CITY of BAKERSFIELD "WE CARE" HAZARDOUS MATERIAL RELEASE REPORT FOR FiRE DEPARTMENT S.D. JOHNSON FIRE CHIEF Company Name Address Chemical Name Notify CA O.E.S. (800) 852-7550 2101H STREET BAKERSFIELD, 93301 326-3911 Hazard Level - Low Moderate High Extreme (Acute) Estimated Quantity of Release Time ~:9'-~:uo(b ~.. Date Duration of Release Medium into which release occurred: Date Health risks know or anticipated: Proper Precautions: Contact Person Telephone Number HAZARDOUS MATERIAL RELEASE FOLLOW UP REPORT Number of People Affected by Release Extent of Any Health Related Problems: Dates of Cleanup Contractor Contractor' s Respre-~entative Time of'Contractor Arrival Description of Extent of Contamination soil Water Air Other Description of Cleanup Procedures .Used Qaulity of Hazardous Materi<als~ Removed (identification procedures, lab results if available) Registered Hauler Utilized ~./~ Material Transported to Time and Date Job was Completed Hauler # Manifest Current Status of Site Report Byr Agency. ~DRRECTION N'O~ C E BAKERSFIELD FIRE DEPARTMENT Sub Div. . · · ..... Blk. . Lot You are hereby required to make the following corrections at the above location: Cot. No :' ~ \ Completion Date fo,' Corrections ~:,,;,,./~ ....... Inspector 326-3979 ~-w u.I 0 ILl r~ ~8 Hazardous Materials Storage Facility CONDITION,S !~ ::::p:~!!~::~,.ii~~I: ;;~!!~~~EVERSE SIDE Tank Hazardous G.~ii'6:?::::~'~::.::::?.... Ye.a~iii!i~ .... :~ :~.~Tank ...... :~:~:~ki~i;:~i;:::!:!:::~!!!~. Piping Piping Number Substance C~iP~i~i{~%.::?~' In'~ {~:ii:~!a?.::::. ~i.i~ ~::T y p e M o h~ { ~:~:~:~.'.::~':~':::~:. Type Method ~, u~ ~..~ i~b:~:~:.:.~:' .:?~::::~.~.~.~:~'~-. '::" ~ .~/:~:':':":?:":~'~L _ ~:'... q: :~ ............... :~:'.~: ' ....................... ::::::::::::::::::::::::::::::::::::::::::::::::::::::: !.":.. ...... "~;:.......']~::. ".:.:': .... :.....:.-...:: .... Issued By: - :~: ;.'.~ } ~¢~[i¢]~ ~it¢ Dept. ===============================::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: HAZARDOUS MATERIAL8 DIVISION ............... ;~;~:~:~::~`:~.:::~:::~;;:~:;::~::]~.~:~;;:~::~:::::?]~.?:~:~:~:~:~ 1715 Chester Ave., 3rd Floor v~'eT k~ R~ ~q~ P~ Bakersfield, CA' 93301 (805) 326-3979 Piping Monitoring Approved by: Ralph E. Huey, Hazardous Malerlals Coordinalor *ARCO Products Com Environmental Health & Safety 17315 Studebaker Road Cerritos, California 90701-1488 Telephone 310 404 5300 i~ailing Address: Box 6038 Ar~esia, California 90702-6038 August 2, 1993 Bakersfield Fire Dept. 2101 "H" Street Bakersfield, Ca. 93301 RECEIVED HAZ. MAT. DIV. Re: Hazardous Materials Business Plan Emergency Contact Information Update Gentlemen: Attached find an Emergency Contact Information Update for the following facilities: Arco Fac.~ Location 0583 3220 Ming Avenue, Bakersfield 93304 If you have any questions I can be reached at (310) 407-2604. Very truly Will~/ Environm~t Administ~Q.~ attach cc: T. Reeder - Copy attached for Dealer Yellow Haz. Comm. Kit ARCO Products Company is a Division of AtlanticRichfieldCompany APPC-7116 (6-92) ARCO Products Compa --~-"~'/~15 Studebaker Road Cerritos, California 90701-1488 ~'elephone 310 404 5300 Agreement Number greement Sequence Facility Number Customer Number AR Number Agreement Type 0001607 003 0058~ 0558130 0558130 PMAMPM DATE: BUSINESS EMERGENCY RESPONSE PLAN HAZARDOUS MATERIALS HANDLER EMERGENCY CONTACT INFORMATION OPERATOR CHANGE/OR UPDATED ARCO FACILITY NO: 00582 BUSINESS NAME: EDMOND NASSAI~ BUSINESS ADDRESS: 3220 MING AVE Number Street BAKERSFIELD CALIFORNIA 93304 BUSINESS PHONE: PRIMARY CONTACT: City State Area Code Phone Number ZIP Title TYPE OF BUSINESS OPERATION: NO. OF EMPLOYEES: HOURS OF OPERATION: EMERGENCY CONTACT INFORMATION (AFTER BUSINESS HOURS) EMERGENCY CONTACT: ALTERNATE CONTACT: SIGNATURE: First Name Last Name Area Code Phone Number ,// First Name Last Name Ar~a Code Phon~ Number EDMOND NASSAR DATE: APPC-7076-B (1/92) PARS80 ARCO Products Company is a Division of AtlanticRichfieldCompany ARCO Products Corn Environmental Health & Safety 17315 Studebaker Road Cerritos, California 90701-1488 Telephone 310 404 5300 i~ailing Address: Bo× 6038 Artesia, California 90702-6038 August 2, 1993 Bakersfield Fire Dept. Haz. Mat. Division 2130 "G" Street Bakersfield, Ca. 93301 Re: Owner/Operator Agreement for operation of UG Tanks with Monitoring Procedure Used RECEIVED HAZ'. MAT. DIV. Gentlemen: Enclosed, for your records, is a current copy of the new subject Agreement which is currently in effect for the following facilities: Fac. Num. Address Arco Plan(s) 0583 3220 Ming Avenue, Bakersfield 93304 I Very truly~ours, ~ EAn;ijOn~str~or Compliance encl APPC-71 16 ARCO Products CompaNy is a Division of AtlanticRichfieldCompany (6-92) A, RCO Products CompanY'S, jDivision of Atlantic Richfield Company '~' Agreement Number 0001607 reement Sequence 003 Facility Number 00583 Customer Number 0558130 AR Number 0558130 Agreement Type PMAMPM AMENDMENT TO LESSEE PMPA FRANCHISE AGREEMENT/DEALER/PREMISES LEASE OPERATION OF UNDERGROUND STORAGE TANKS CALIFORNIA This Amendment, dated I ~-,~' / , 19 ~, is attached to, incorporated in and made a part of the Lessee PMPA Franchise Agreement/Dealer/Premises Lease ("PMPA Agreement"), in effect as of the date of this Amendment or, if applicable, to become effective concurrently with this Amendment, between Atlantic Richfield Company, a Delaware Corporation, through its division ARCO Product Company, ("ARCO"), and EDMOND NASSAR , ("Franchisee"), covering premises located at 3220 MING AVE BAKERSFIELD CALIFORNIA 93304 In return for good and valuable consideration, each party's receipt of which is hereby acknowledged, the parties agree as follows: 1. The parties have entered into this Amendment in accordance with legal requirements imposed on ARCO and Franchisee concerning operation of the underground storage tanks at the above-referenced location. 2. ARCO has provided Franchisee a copy of: (a) California Health and Safety Code Section 25299 or an approved summary concerning civil and criminal penalties for violating terms of any permit to operate these underground storage tanks and relevant statutory and regulatory requirements; (bi the following listed documents, a copy of which is attached-and initialed by Franchisee: Monitoring and Response Plan - 1 with Attachments CA (t192) PARS8V 3. Where ARCO has provided Franchisee with a copy of the permit to operate the underground storage tanks, Franchisee has read and understood its responsibilities as operator under the permit and agrees to comply with each of the provisions of the permit. Irrespective of whether Franchisee has received and reviewed a copy of the underground storage tank operating permit, Franchisee hereby expressly agrees to do the following: (a) monitor the underground tanks as required by law; (bi maintain all required records and make such records available to the federal, state and local government agencies and to ARCO at all reasonable times; (c) follow all reporting procedures as required by law; (d) mail, when submitted, to ARCO, at the address specified in paragraph I of the PMPA Franchise Agreement/Dealer/Premises Lease, a copy of all reports submitted to government agencies; 1 of 2 (e) follow all operating procedures specified by ARCO; (f) immediately report to ARCO all suspected or confirmed releases from the tanks and connected piping system, unusual operating conditions, release detection signals and environmental conditions suggesting a release may have occurred, and any spills and overfills that are not contained and cleaned up; {g) properly close the underground tanks as required by law; and, (h) comply With all federal, state and local legal requirements relevant to the operations of the underground tanks and all amendments to any permit to operate. 4. With respect to the operation of the underground storage tank system and monitoring equipment, Franchisee hereby acknowledges and agrees: that ARCO has provided Franchisee with training on each of the items described in the attached Monitoring and Response Plan, that Franchisee understood the content of the training, and asked any questions necessary to facilitate his understanding, that Franchisee indicated to ARCO at the time of training any subjects addressed by the training which Franchsee did not fully understand, and that Franchisee received complete training and information necessary for Franchisee to fully understand the subject of operating underground storage tanks. 5. ARCO has provided Franchisee a copy of and Franchisee agrees to maintain on the Premises the Certificate of Financial Responsibility (as required by the United States Environmental Protection Agency in Subpart H, 40 CFR, Part 280 and California Health and Safety Code, Chapter 6.7, Section 25292.2). 6. Except to the extent they conflict with, or are less rigorous than the terms of this Amendment, all of the terms and conditions of the PMPA Agreement, as previously or hereafter amended or supplemented, remain in full force. IN WITNESS WHEREOF ARCO and Franchisee have executed this Amendment. WITNESS: ARCO Products Company a division ol~ Atlantic Richfield Company ARCO By: WITNESS EDMOND NASSAR Franchisee's Name EDMOND NASSAR DATE: CA (1/92) PARS8W 2 of 2 MONITORING AND RESPONSE PLAN - I ARCO PRODUCTS COMPANY FACILITY WITH SECONDARY CONTAINMENT OF UNDERGROUND STORAGE TANKS & pRODUCT LINES 583 3220 Ming Ave. ARCO Facility Address Bakersfield, CA 93304 This plan is designed to meet the monitoring and response requirements of Section 2634, Article 3, Title 23, CCR. MONITORING EQUIPMENT Secondarily contained storage tanks and lines at this facility are monitored by a continuous electronic leak detection system which consists of an alarm panel, sensors and associated electronics. Liquid sensors are installed in the annular space of each double wall tank and product line piping sump. Whenever a sensor detects the presence of a liquid there is both a visual and audible alarm at the control panel. Automatic line leak detectors are installed on the secondarily contained pressurized product piping. The line leak detector will detect a loss of pressure in the product lines and restrict the flow of product. An annual tightness test will be performed on the product lines. 2. MAINTENANCE SCHEDULE OF MONITORING EQUIPMENT The continuous electronic leak detection system including line leak detectors will be inspected according to the manufacturer's instructions by an outside contractor once during each calendar year. 3. ROUTINE MONITORING PROCEDURE On a daily basis the facility operator shall: Inspect the control panel for visual and audible alarm signals to confirm that the unit is operating. B. Inspect island and tank fill areas for signs of spillage or petroleum sheen. Record the inspection observations on the Daily Visual Monitoring Log (Form APPC- 765: attached.) DEALER INITIALS: --~-~-~ I:IESPONSE PLAN OPERATOR RESPONSIBILITIES A. LEAK RECORDING AND REPORTING PROCEDURE Whenever an alarm is activated, station personnel are to immediately: Contact ARCO Maintenance or its designated agent by using the telephone number previously provided. b. If any visible indications of petroleum products or vapors are noticed call 911. c. Make an entry in the Recordable Discharge Log (Form APPC-765-1' attached) indicating the action taken. Complete the Recordable Discharge Log when and as the source of the alarm is known. ARCO RESPONSIBILITIES METHOD OF REMOVING AN UNAUTHORIZED RPl FASE FROM THE SECONDARY CONTAINMENT Any unauthorized release into the secondary containment system of a product tank will be removed by pumping. Uncontaminated product may be returned to the tank. Contaminated product may be returned to the refinery to be recycled or may be disposed of following procedures in accordance with California Health and Safety Code requirements. In the event of an emergency, a pumping contractor or truck will be available immediately. In all other cases, equipment availability will be within 12 hours. ARCO Maintenance~ will be responsible for authorizing and selecting contractors for the work to be performed. TRAINING In addition to the training covering subjects mentioned in Sections 3 and 4 above, training needed for the operation of the tank system and monitoring equipment includes: How to: - Take tank level measurements - Read dispenser meters - Inspect equipment - Recognize warning Signs: dispenser hesitations, meter spins and odors - Manually close dispenser impact valve Replace dispenser filters DEALER INITIALS: ]'I:IAINING CONTINUED Shut down the system with and location of: ARCOmatic switch, electrical panel breakers, and emergency shut off switch Test the electronic monitor RECORDS RETENTION Written records of all monitoring, testing, and maintenance performed shall be maintained on-site or off-site at a readily available location for a period .of at least 3 years. These records must be made available, upon request within 36 hours, to the local agency or the Board. PARTY RESPONSIBLE FOR PERFORMING THE MONITORING 'l~tle 8. pARTY RESPONSIBLE FOR MAINTAINING EQUIPMENT ?~o~.. ARCO Products ComPa · Division Of Atl&ntlcRichfleldComl:)ln) DEALER Daily Visual Underground Storage Tank Monitoring Log ARCO facility no. Dealer/Franchisee Month/Year System condition Inspector Comments Day Operational Alarm* initials 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25. 26 27 28 3O 31 *NOTE: IF ALARM CONDITION EXISTS IMMEDIATELY NOTIFY ARCO MAINTENANCE OR ITS AGENT DESIGNATED AND MAKE ENTRY ON ALARM ACTIVATION/DISCHARGE LOG APPC-765 (5.89) ARCO ]ucts Company , of AtlanllcRIchfleldCompany RECORDABLE DISr" * RGE LOG DOUBLE CONTAINMENT UN GROUND STORAGE TANK SYSTI:M ARCO Facility no. Dealer/Franchisee Date/Time Reported to Date/Time Description of conditions Corrective action taken of Discovery APPC-765-1 (5-89) , DEALER INITIALS CALIFORNIA HEALTH AND SAFETY CODE DIVISION 20, CHAPTER SECTION 25299 (e,) Any operator of an underground tank system shall be liable for a oMI penally of not less than five hundred dollars ($500) or more than five thousand dollars ($5,000) for each underground storage tank tor each day of violation for any o! the following violations: ( 1 ) Operating an underground rank system whl~, has not bean Issued a permit, In vblatton 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 re(~orcls, as required by this chapter. (4 } Failure to report an unauthorized release, as required by Seotlons 25294 and 25295. ( 5 ) Failure to propert~ ~ose an underground tank sys~m, 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 13oard pulsuant to Seolion 25299.3 (?) Failure to permit inspection or to perform any monitoring, testing, or repotting required pursuant to Section 25288 or 25289. (8) Maldng any false statement, representation, or cerlJfioatlon in any appliGatlon, reoord, report, or other document submitted or required to be maintained pumuant to this chapter. ( b ) Any owner 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) per day for each underground storage lank, for each day of vlolatlan, for any of the following vioiatlons: ( 1 ) Failure to obtain a permit as specified by this chapter. ( 2 ) Failure to repair or upgrade an underground tank system in a(~orclance wfth this chapter. ( 3 ) Abandonment or improper closure of any underground tank system subject to this ohEiptar. ( 4 ) Knowing failure to take reasonable and neos~sary steps to assure compliance with this chapter by the operator of an underground tank system. ( 5 ) Violation of any applloable requirement of the permit Issued for operation of the underground tank system. ( 6 ) Violation of any applicable requirement of this ohapter of any regulation adopled by the board pursuant to Section 25299.3. SDEALER INITIALS:-~?-~~/' (7) Failure to permit inspection or to perform any monitoring, tasting, or reporting recluired pursuant to Section 25288 or 25289. (8) Malting any false statement, representation, or cert~catlon in any applioation, record, report, or other document submitt, ed or required to be maintained pursuant to this Ghaptet, ( c ) Any person who Intentionally falls to notify the board or the local agency when required to do so lay this chapter or who submits false Information in a permit application, amendment, or renewal, pursuant to Section 25286, Is liable for a civil penalty or not more than five thousand dollar~ (~,000) for each underground storage tank for which notification is not given or false Information is submilled. o (d) Any person who falsifies any monitoring moon:Is required by this chapter, or knowingly falls to report an unauthorl=ed release, shall, upon conviction, be punished by a fine of not less than five thousand clollars ($5,000) or more.than ten thousand dollars ($10,0000, by Imprisonment in the county Jail for not to exceed one year, or by Ix)th that fine and Imprisonment. (e) (f) (g) In determining both the civil and criminal penalties imposed pursuant to this section, the COurt shall consider all relevant Gir~mstanoes, Including, but not limited to, the extem of harm or potential harm caused ~ the violation, the nature of the violation and the period of time over which It occurred, the frequency of pest violations, and the corrective action, if any, taken by the person who holds the permiL Each civil penalty or criminal fine Imposed pursuant to this section for any separate violation shall be separate, and in addition to, any other civil penalty or criminal fine imposed pursuant to this section or any other provision of law, and ~all be paid to the treasury of the local agency or state, whichever is represented by the office of the oily attorney, district attorney, or Attorney General bringing the action. All penalties or fines collected on behalf of the board or a regional board bY the Attorney General shall be cleposited in the State Water Pollution Cleanup and Abatement ,a~count in the 8tats Water Quality Control Fund, and am available for expenditure by the boarcl, upon appropriation, pursuant to Section 13441 of the Water Code. This section shall become operative on Janumy 1, 1991. (Added by Stats. 1988, o. 296 Section 3, operative Jan. 1, 1991. Amended by Stats. 1969, o. 11397, Sec'don 19, operative Jan. 1, 1991.) -~-~. ,~ ~. ' ~ Bakersfield Fire Dept.~ · ~~ · ~\~ ~_ARDOUS MATERIALS DI~J~ON ' {~~ ~~~3~ ~ Street, Bakersfield, CA 93301 , ~1 ~~ UNDERGROUND TANK QUESTIONNAIRE /I. FACILI~/SITE NO. O~.TANKS ~ ~ ~ NEAREST CROSS STREET PARCEL No.(OPTIONAL) STATE ZIP CODE EMERGENCY CONTACT PERSON (PRIMARY) DAYS: NAME (LAST, FtR~1) PHONE No, WITH AREA CODE NIGHTS: NAME (~--_...~ PHONE No. WITH AREA CODE EMERGENCY CONTACT PERSON (SECONDARY) optional DAYS: NAME (LAST, FIR~'r) pHONE NO. WITH AREA CODE NIGHTS: NAME (LAST, FIRST) PHONE NO. WITH AREA CODE II. PROPERTY OWNER INFORMATION (MUST BE COMPLETED) NAME i / MAILING OR STRE~ ADDRESS CI~ NAME CARE OF ADDRESS INFORMATION ~ BOX ~CO~Op INDIVIDUAL [~ LOCAL AGENCY O STATE AGENCY TO INDICATE ~ PARTNERSHIP ~ COU~ AGENCY ~ FEDERAL AGENCY STATE ZIP CODE PHONE No. WITH AREA CODE III. TANKOWNER INFORMATION (MUST BE COMPLETED) NAME MAILING OR S~RE~ ADDRESS I ~ t~- CI~ NAME CARE OF ADDRESS INFORMATION ¥ Box .~'Co~O.O~N0W~DUA~ QLOCA~ A~NCY OS~A~ A~"C~ ~O INDICATE ~ PARTNERSHIP ~ COUNW AGENCY ~ FEDEX[ AGENCY STATE [ ZIPCODE ~ PHONE No. WITH AR~ CODE OWNER'S TANK No. TANK SIZE DATE -V-eL-i=I~E,~ PRODUCT IN INSTALLED STORED SERVICE .2/I&/q I I0, oOo.~l LA~lcac[e~ CT~SOI,~P._ ~ N YIN Y/N DO YOU HAVE FINANCIAL RESPONSIBILITY? (~/N TYPE ~ Fill one segment_i for each tank, unless all&%nks and piping are ~ constructed of th~same materials, style andw~e, then only fill one segment out. please identify tanks by owner ID #. I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN I. A. OWNER'S TANK ..D., 3- , III. TANK CONSTRUCTION aARKON~m~ONLY~N~XESkS, ANGC,~DALL~TAP~ESlNSOXD A. TYPE OF [] 1 DOUBLE WALL SYSTEM [-'-i 2 SINGLE WALL ] 3 SINGLE WAll WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE ] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED S~I~EL [] 95 UNKNOWN ] 4 STEEL CLAD WI FIBERGLASS REINFORCED pLASTIC ] 8 100% METHANOL COMPATISLEW/FRP ] 9g OTHER ] 1 RUBBER LINED L-J 2 ALKYD LINING C. iNTERIOR [] 5 GLASS UNING [] B UNLINED UNING iS UNING MATERIAL COMPATIBLE WITH 1~0% METHANOL ? [] 3 L,NING [] . PHE.OLIC L,N,NG [] 95 U.KNOW. [] 95 OTHER YEs~X NG~ O. CORROSION [] .I POLYETHYLENE WRAP [] 2 COATING PROTECTION [] S CATHODIC PROTECTION [] 95 NONE · [] 3 vINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC [] 95 u. ow. [] 99 OTHER IV. PIPING INFORMATION C~RCL~ A IFABOVEGROUNDOR U IFUNDERGROUND, BOTH IF APPUCABLE A. SYSTEM TYPE A U 1 SUCTION A (~ 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U I SINGLE WALL A(~ 2 DOUBLE WALL A O 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIOE(PVC)A{~) 4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL Wl COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION A U 1 BARE STEEL A U 5 ALUMINUM A U 9 GALVANIZED STEEL D. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING ~ 6 TANK TESTING [] 7 ,NTERSTIT]ALMONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # B. MANUFACTURED BY: C. DATE INSTALLED (MO;DAY/YEAR) D. TANK CAPACITY IN GALLONS: III. TANK cONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. S. ANOC. ANDALLTHATAPPLIESINBOXD A. TYPE OF ~-~ 1 DOUBLE WALL SYSTEM '~, 2 SINGLE WALL [] 3 SINGLE WALL WITN EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANI0 [] 99 OTHER TANK ~l 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] .7 ALUMINUM (PrimaryTank) ~ g BRONZE [] 10 GALVANIZED STEEl. [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPAT1BLEW/FRP ] 99 OTHER ~ 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING C, INTERIOR LINING ~ 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ ] 4 PHENOLIC LINING ] 99 OTHER D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOWN ] 4 FIBERGLASS REINFORCED PLASTIC [] 99 OTHER IV. PIPING INFORMATION C~RCL~ A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 I(X~o METHANOL COMPATI;~LEW/FRP GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 iNTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION I .... 7 1 VISUAL CHECK L~2 INVENTORY RECONCILIATION .~ 3 VAPOR MONITORING [~"] 4 AUTOMATIC TANK GAUGING [] , GROUNO WATER MONITORING ; R TANK 7~gT;NC, , ; 7 iNTERSTITIAL MONITORING . . 91 NONE ~"~ 95 UNKNOWN ~ 99 OTHER CERTIFICATION OF FINANCIAL ~Nsmr~ ~ The Atlantic Richfield Company (ARCO) hereby certifies that it is in compliance with the requirements of Subpart H of 40 CFR Part 280. The financial assurance mechanism used to demonstrate financial ~espo-~bility under Subpart H of 40 CFR Part 280 is as follows: Mec_h~ni_~m: PJnancial t~t of ~el/'.in~trance, *Efl'ect~ve date: Janusry 24,1989 *Amount: At bast ~1,000,000 per occurren~ and $2,000,000 annual q~ate third parties for bodily injury and ~ dnma~ caused by sudden accidental ruleases and nonsudden accidental releases EufeneR. ~ ARCO 515 & Flower Street I~ Aaseles, CA ARCO.~ ARCO Products Com 17315 Studebaker Road Cerritos, California 90701-1488 Telephone 213 404 5300 I~iailing Address: Box 6411 Artesia, California 90702-6411 MAY 7, 19~1 County of Kern Environmental Health Div. 2700 "M" Street Suite #300 Bakersfield, Ca. 93301 Attn: Ms. Amy Green Dear Ms. Green: SUBJECT: ARCO Fac. #583 3220 Ming Ave. Bakersfield, Ca. Attached are Froms "A" and "B" on the above ARCO Facility where we recently replaced the U.S.T's. Also enclosed is ARCO's Certification of Financial Responsibility. Could you please make sure that we receive all invoicing for the Permit to Operate at or Cerritos Address as well as a copy of the Permit when it is issued or renewed. Very truly yours, Environmental Compliance Administrator 0C~ \ APPC-7076-B ARCO Products Company is a Division of AtlanticRichfieldCompany (7-88) ARCO Products Com 17315 Studebaker Road Cerritos, California 90701-1488 Telephone 213 404 5300 iVlailing Address: Box 6411 O~tol~.r~ RECEIVED OCT 1 6 t991 HA7 I~)IAT, DIV. Bakersfield Fire Department Hazardous Materials Division 2130 "G" Street Bakersfield, Ca. 93301 Re: Owner/Operator Agreement for operation of UG Tan,ks with Monitoring Procedure Used Gentlemen: Enclosed is a current copy of the Agreement between the Owner/Operator for the operation of the Underground Storage Tanks and Monitoring Procedure used at the following facilities for your records. SS//583, 3220 Ming Ave., Bakersfield, California 93304 Very truly yours, E~nv~ Compliance Administrator encl APPC-7076-B ARCO Products Company is a Division of AtlanticRichfieldCompany (7-88) ARCO Products Compa, B D~ws~on of Atlantic Richfield Compa~l REGULATORY AGENCY: BAKERSFIELD FIRE DEPT. SS#583 AMENDMENT TO LESSEE PMPA FRANCHISE AGREEMENT/DEALER/PREMISES LEASE OPERATION OF UNDERGROUND STORAGE TANKS This Amendment, dated OCT 10 1993 ,19 , is attached to, incorporated in and made a part of the Lessee PMPA Franchise Agreement/Dealer/Premises Lease ('PMPA Agreement'), in effect as of the date of this Amendment or, if applicable, to become effective concurrently with this Amendment, between ARCO Products Company ('Franchisor') and _ Edmond Nassar ('Franchisee'), covering premises located at '3220 Ming Ave. ~ Bakwrsfield CA 93304 The parties agree as follows: t. The parties have entered into this Amendment to comply with legal requirements imposed on Franchisor and/or Franchisee in order to operate the underground storage tanks at the above-referenced location. 2. Franchisor has provided Franchisee a copy of:. (a) Califomia Health and Safety Code Section 25299 or an approved summary concerning civil and criminal penalties for violating terms of any permit to operate these underground storage tanks and revelant statutory and.regulatory requirements. (b). The following listed documents, a copy of which is attached and initialed by Franchisee: 3. Where Franchisor has provided Franchisee a copy of the permit to operate these underground storage tanks, Franchisee has read and understood its responsibilities as operator under the permit and agrees to do the following: (a) Monitor the underground tanks as specified in the permit to operate and otherwise required by law; (b) Maintain appropiate records as required by the permit to operate and make such records available to the federal, state and local government agencies and to Franchisor; PARSSA T. Reeder 8/19/91 lof2 (c) Follow all reporting procedures as required by the permit to operate and as otherwise required by law; (d) Mail, when submitted, to Franchisor, at the address specified in paragraph 1 of the PMPA Agreement, a copy of all reports submitted to government agencies; (e) Follow all operating procedures as provided by Franchisor; (f) Immediately report to Franchisor all suspected or confirmed releases from these tanks and connected piping system, unusual operating conditions, release detection signals and environmental conditions suggesting a release may have occurred, and any spills and overfills that are not contained and cleaned up; (g) Properly close the underground tanks as required by the permit to operate and as otherwise required by law; and (h) Comply with all federal, state and local legal requirements relevant to the operations of these underground tanks and all amendments to any permit to operate. 4. Except as herein amended, all of the terms and conditions of the PMPA Agreement. as previously amended or supplemented, remain in full force. IN WITNESS WHEREOF, Franchisor and Franchisee have executed this Amendment. WITNESS: ARCO Products Company a clivision of Atlantic RichfielO Company Franchisor By: .... WITNESS Edmond Nassar Franchisee's Name DATE: UST ~ Les-# (3~1.) PARSSB 2 of 2 SS~i5~3- E Nassar Initials: Dealer 25299 (a) Any Ol~ratog of an undlrgTound Itoragt ~ shall~l?a~r~ for a civil penalty of not less than five hundred dollk~ ($50-~-)~ or more ~han five thousand dollars ($5,000) per day for anM of ~.l~e following: (1) Operates an underground storage tank which has not been issued a permit. (2) Fails to monitor ~he underground storage tank, as required bM ~Ae 'permit. (3) Fails to mainta£n records, as required by Section 25286. (4) Faile to repo~c an unauthorized releaee, as required by Sectione 25294 and 25295. (5) Fails to properly [lace an underground storage tank, as required My Section 25298. (b) lnyovne= of an unde~ound storage ~an~shall ue l~a~e fo~ a civil penalty of not less ~Aan five hundred dollars (SSOQ) or more than five ~Aoueand dollars ($5,000) per dam for any of the following: (l) Failure to obtain a permit as specified by ~hie chapter. (2) Failure to repair an underground ~ardc in accordance wi~J~ this chapter. (3) Aba~dorment or iB~ro~er closure o~ any undeFcj~ound ~o~age ~ank (4) Enowing failure to take reasonable and necessary steps to assure ~ompl4an~e ¥i~.A ~J~la chapter by ~he opera,or of an undsr93:otmd storage tank (c) Any parses vho £alatfies aa~ soat~ring r~cords r~quired by thie ch&prat, or knovingl~ fails to r~po~t an una~thori:ad r~leas~, shall, upo~ convictioa, be punished b~ a £tas of not lese than fivt thous&ad dollere ($5,000) or ~ore than ten thousand dollars ($10,000), or by imprisonment ia th~ county ~ail for not to ex[mad one ~ea~, or by both th&t finm and (d) Any person sub~ect to Section ~5~93.1 ~ho fails to transmit the information as required by Section ~5~93.1 shall be liable for a civil penalty of not more than one thousand dollars ¢$1~000). (e) In determinin9 both the civil and criminal penalties imposed pursuant to this section, the court shall consider all relevant circumstances~ including~ but not limited to the extent of harm or potential harm caused by the violation, the nature of the violation and the period of time over ~hich it occurred~ the frequency of past violations and the corrective action, if any~ taken by the person ~ho holds the permit. (f) Each civil penalty or criminal fine imposed pursuant to this section for any separate violation shall be separate and in addition to any other civil penalty or criminal fine imposed pursuant to this section or any other provision of la~ and shall be paid to the treasury of the local agency or state, ~hichever is represented by the office of the city attorney~ district attorney~ or Attorney General bringing the action. (g) In addition to the state and any city or county implementing this chapter pursuant to Section ~5R83, a city or county specified in subdivision (a) of Section ~5~9~.1 may also levy and collect penalties under this section. (h) This section [specifically subsection (d)] shall remain in effect only until January 1~ 1991, and as of that date is repealed, unless a later enacted statute ~hich is enacted before January 1, 1991 deletes or extends that date. HAZARDOUS MATERIALS. MONITORING pLAN ~ Deale~ ARCO PRODUCTS COMPANY FACILITY WITH ~ DOUBLE CONTAINMENT UNDERGROUND STORAGE TANKS ARCO FAC 583 ADDRESS 3220 Ming Ave. Bakersfield CA 93304 1. MONITORING METHOD Underground storage tanks(UST's) and lines are monitored by a continuous electronic leak detection system which consists of an alarm panel, sensors and associated electronics. Liquid sensors are installed in the annular space of each tank and product line piping sump. Whenever a sensor detects the presence of a liquid there is both a visual and audible alarm at the control panel. 2. ROUTINE MONITORING PROCEDURE On a dally basis the facility operator shall: Inspect the control panel for visual and audible alarm signals and that unit is operating. Inspect island and tank fill areas.for signs of spillage or petroleum sheen. Record the inspection observations on the Daily Visual Monitoring Log (Form APPC-765 attached). 3. LEAK RECORDING AND REPORTING PROCEDURE Whenever an alarm is activated station perso~el are to immediately: Am · Contact ARCO Maintenance or its designated agent' by telephone. If any visible indications of petroleum products or vapors are noticed call 911. Make an entry in the Recordable Discharge Log (Form APPC-765-1 attached). 'D. Complete the Recordable Discharge Log when and as the ,source of the alarm is ~nown. 4. RECORDS RETENTION All monitoring and leak recording logs are to be retained at the facility for three years. HMMP 5/z1/89 ARCO Products q~hpsny ~) SS#583-E. Nassar Daily Visual Undergroun( Storage Tenk Monitoring Loc. Dealer ARCO f&Cillty riO, Dillei, IFr&flGhi~e Syltem cG~,G;i~on Inll)eCtOf' Day Ol:)trltloflll AIIrm' Iflitilll Gommefltl 1 2 3 4 7 10 11 12 13 !' 14 17 ' 21 24 27 ~ ' 'NOTE: IF ALARM CONDITION EXISTS IMMEDIATELY NOTIFY ARCO MAINTENANCE OR ITS AGENT DESIGNATED AND MAKE ENTRY ON ALARM ACTIVATION/DISCHARGE LOG AFPC.~I~ (SM) ARCO Pro~' 'Company RECORDABLE DISCHI : LOG DOUBLE CONTAINMENT UNDERt,,~OUND STORAGE TANK SYSTEM c4 DIKov~y Rel~led Io O&lYTime Oe~c~tpllon o~ condilionl Co~ecllve action liken SS#583 - E. Nassar CALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS M ouMil~ed ly tM .aee~lPe~ otePele iaaa euae~ ~e t~ (d) belies ~J ~ tail aPtieXe deoePlteo tM oaauX PeoePt ~e) bett~ ~e ~ tMO ~leJe oBelriee mditi~e tut mt Be Mt t~ oo u~lPe~d otePole teaa eueP ~ee P~ueotiol tP~e oee~l O~loim r~ oa~ lare~ati~ oeMitt~ M ue o~eirieo l~ tM X~ol ~eoeh ~ Stele leoff, eP Initials: Dealer 10.1 (3) CS) (6) (?) (8) C9) (&) (B) (C) vhoro tM uodePlrOuhd ItOrllO took Il 2melted smd type underground ItOrlgt monk operotor and JO-hour emergency · ontlct Person. ?he nome end telephone numDor of the Person mekLnl the Deoor~ptioo or tho underground otorsge tnn~ including, neheduXo. XB tho ease or eom umdoriroumd ltOrlle tlail Itmmdlrdl lot rofti in Suhoeettoo ~631(m) end (J)(1) Bad (2) or iftlolo 3 or maim suPoBlptof, or, applicable, Suhnmotiom 2S33(0)(1) end (~) or irtiolo 3 s~oodlrdo set refer is SmRmeetseo 2631(e) smd (J)(3) Article 3 er trim muJeBlptef. to, typo sad talekeom· or Jflllfy containment, type sad sod methodic protlOtlOO methods tho Xooltion or tbs underlround ItOrlle tint vtth fOlpent to huSZ~Jnls of other Z8ndllrkl. The delnrlptiofl or the proposed mooXtoring progrnm Uodefifoumd sterile mink tooting or promodufooG SSf~583 - E. Nassar ini%ials: Dealer, A~CO 10.2 SS#583 - E. Nassar (O) Sello z.ep~,l ~eeo~olo ,ad on,node sad CE) Vodoss zoos osaoZLlf ~oefllooo sod ISi~odl lsd ool~1111 Oroeedures; CF) Ground voter -ell(o) ~eeotioos. ooootrue~oo end ~omp~etios ISthOdl. llllZ~ol, lsd Iroeedureoa sod tan amme or tee sumervioor er tee division, seetiee, or o~riee uS~el emorstel tea uadersrouad steroil tee~. (i) & t~leellll eoeeutive errle,p s, ue x,,ez or OlSaej~ D) ?ne o~oliostios onslZ 1o seeoaooa~ed Uy lee Fee eel Oy ia) As i eeadl~ol er lB/ ~OPll~ tO O~Srltt sa uaderlroun4 10.3 Cb) enemies &a the Uelle of any uflderlrouad ItOrlle tanK, ~nQ~ud~nS: (~) Chlfliel ~fl IoflitOr~Ol prooedure; or underlrouod Itorlle tl·k. · &erase tlek, the Peru&tree ·hllZ report to tho loel~ ilenoy amy unauthorized re~ee·e ooourrenoe·, II der&amd &e &retake SuOeeotione 26S2(b) eed (o) of Artie%e S or thi· eubehepter. ZooiZ gloomy may rmqu~ro Stlto Baird, aP duZy lutBor~zod rolrooentltive u~l dmlnd Lae%ude~ reoord·j (3) The roeu%te of e·y vi·u·1 ob·ervetioue~ (q) %eboretory or &o tho rio%d, &me%ud&nl %abet·tory date C5) Tho %ese or m%% rood&nlm or leUlee or other moo&tar&ns re·uZt·; (6) The reaul&e or inventory roldinp and._reeooai%&etion·. per~lt to operate eu uaderfrouud erotism te·~ uetil tho Aoeal ·seamy lcepeeSe the undersrouhd etorele tank and SSf~583 - E. Nassar lnl'&la.L$; . the provLeLone of these resulatLona~ The undarsrouad atorasa tank ouser shill apply to the loss! lianny for pereit reneu·l it le··t 180 dnyl prior to t~e expiration the ParBLt. Ce) The looal elenny shall have'-1~...e elaiNe ~f~if~ ee~ll~2abel · (~) Pem~l Bay be ~ranarerred ~o nee undersrouad s~orale sunera L~ ~he nee undersround a~orale ~anK ouner doel o~anfe any oondL~/ona o~ ~he PereL~, ~he ~rena~er ~a e~anse Lo ouner,hip, and any necessary aodirioet/ona are Bade to the infornaCLoa in the initial ~rnLt due to the ohanse lo ounera~p. A~ lanai ISeoay say revise, Bodily, or tees!sate the pereLt to operate the undersround 8torase tank upon reoeivinB the ounereh/p transfer request. (~) The local aseney shall not reneu an undersround atorase tank pe~t unless t~e undersround atorase tan~ has been Xnapeoted utthin t~e prior 3 year· and the revealed that the uodersround atorase tank empliea Article ] or q of this 8ubehapter, ii aPpl~oable, lad all eziik~nl Perm~k oond~t~onl. The ~ni~ot~on Ihill be oonduo~ed aa 'apeoXgL~ lo Cbs appropriate lubaeot~oo at Chapter 6.7 or gtv~i~on 20 or the Health and 3atety Code. Zt the Xnipeot~oo revealed nonoolplianoe then the looal alenoy lUI~ vertt7 by I tailor-up ~nipeoCioo ~ha~ ~equired oorreo~ono have ~een ~aPleeen~ed be~ore reneuLnS (~) ~h~o ~0 days or reoe~v~ns an ~napeoC~on repor~ ~roe eL~her ~he lanai BEans7 or' ~he spaniel ~napeo~or, ~he pe~L~ ~older s~all ~le ut~h ~he looal asenoy a plan and ~ee sohedule lepleeen~ any requLred eodl~ioa~on8 ~o ~e underground a~orase ~aa~ or ~o ~he eoni~or~ns plan seeded ~o aoh~eve o~l~anae u~C~ e~her Ar~Lole 3 or Ar~ole ~ o~ au~o~ap~er, aa appropriate, or ~e pereZ~ oond~lon8. plan and ~ee aahedule a~all ales ~e~leeen~ all o~ ~he reoooenda~Lona o~ ~e apea~al lnapeo~or. T~e looel asenoy Bay ezmp~ ~he ~epleeen~a~on or any o~ ~he apeo~al lneaeo~or's Peoo~enda~Lona baaed os a deeons~ra~lon ~y ~e pemi~ ~older ~o ~he Zonal asenoy,a aa~La~ao~on ~ha~ ~he ~ai2ure ~o ~apleeen~ ~e reoo~enda~on u~ll nsc abuse an unauChor~zed release.: Authority: H&3C aererenae: U&SC 2528~, 2528S, 25288, 25289, 25293 10.5 SS~583 - E. Nassar Dealer 8~.'20.'91 07:31 FAX 1 213 371 8720 6,T,E.L. COSt-It'" ~!rand fax transmitta~ memo 7¢i I~o, aas_-s, ~. -- ~' Phone ~ ~ Fax ~ Client Number: GTlYe.ARC01 Fac;!ity Nun:b.~r: 0593 Aroo ~epresenta[ive: Kateri Luka Work Order Number; TI06009 Table 1 (Continued) ANALYTICAL RESUL'i'S Aromatic Volatile Organics and Total Petroleum Hydrocarbons as Gasoline in BPA Methods 8020 and modified 8015a GTEL sample ['iumber! 13A 14A Client Identlfica'iionl B-5-C'~MP B-8-~;OMP ..... Date Sa.mpledl 5-31'-9t 5-31-91 _ Date Ex-tracled ...6-6-9~ 6-6-91 !.. ~ Date Analyzed I 6-6-Sl j 6-~-gl J Detection Anal~e .. Urnit, rog/Kg Concentration, .mg/K.'gb .,. ~e,~ . o.oo~ <'~.'oo51 ~0.oo~I ' ' o.o0 i:" .. ' Ethyl Benzen~ f~0.005 <fl.005 <0.005 ...... Xylene (tOtal) 0.0i5 j <0.015 <0.015 J BTEX(tcta,) .. ]'--- I ! - '" TPH as Gasoline !0 < ~ 0 < ~ 0 Percent So!ids, % _. 88.6 ] 86.5 I . . Te~t Methcds ~or P'-v~lua:Jn~ Solid Waste, $W-84~3, Third 5~iti~n, Revision O, US EPA Ndvember 19~8;Methanolic oxtr;~t~n EPA Method 5~0 (pur9~ and tr~p) fo~ arom~t:c veist::e org.~n:cs; mo:;',{ ~t s~ for TPH ~ 9aso!?ne aS ~er C~llf~rai~ State W~ter R~sources Conirc~ Baard LU~' Mamcal prOt,~cois. MA'/ 1988 revision. GTEL Torrance, CA T106009. DOC Page 5 of 5 GTEL 13: 05 FAX t 371 ( 872f G.T.E.L. Client Number:. GTI78.ARc01 Facility Number: 0583 Arco Representa£ive: Kateri LuNa Work Order Number: T106009 Table 2 ANAL ,vTICAL RESULTS Aromatic Volatile Organics in Water Modified EPA Method 8020a Client Identification WASH Date Sampled 5-31-01 ' - , Date Analy~ed 6-10-91 Detection . . Analyte Umit, ug/L Concentration, ug/L eenlene 0.3 <0.3 ]'- 1 -,.Toluene. 0.3 <0.3 I Ethyl Benzene .., 0.3 < 0.3 . XCene (total) , , 0.6 <0.6 .'.} .... . " ,,, BT~X (tota{) - _..Detection Limit Multiclier., 1 I Test Method~ for Evaluating Solid Waste, SW ~..~,4.6, Third Eclition, R~vision 0, US EPA Nc'.,emDer 1956; ~<tr.%--tian by EPA Mo:hod 5030 (purge ana trap). GTEL Torrance, CA T10600g. DOC Page 6 of 6 GTE'L ,~RCO Dima~o~ u~ AIonllcFh-"hlie dC, c,rnpany Soil V, rale~ Othe~ Task Order No. Projecl ConsuU. ant) : Telep~'.one n Teleprlc, n~ ~ Address . (C~nsulLantl ZTX/O / Ptes~rvalion i Ice ~z:id ' ] Condition el /'i // (/ [ Dal~/ ] . Tim,, t 7_L O T~me 'iempecature received: Received by R~,cruived bs' I · . J uisho~ ~ Da~a . j c/_/ ~ ~./7// .' r, in~ribuli~: W~i~ cop?' ~ L~boraterf; C~r.a~ cop,/~ ARCO E~¢~ronment~l Engi~oenng; Pin~; ~py ~nsutl~nt Chain of Custody Laboralory nEune /telnod ol shipment Special dateclJon LimiVreponing ITime -~1~ Tt~rnarotm-d hmo Rush Bus,ness Day Rush 2. Business Days E~pediled 5 Business Days Slandard 10 Business Days FACILZTY.. ~CO ADDRESS .. ~ ~_~ 2 ~_~ FILE CONTENTS SUMMARY ENV. SENSITIVITy: Activity Date # Of Tanks Comments RANDALL L. ABBOTT DIRECTOR DAVID PRICE II! ASSISTANT DIRECTOR RESOURCE MANAGEMENT AGENCY Environmental Health Services Department STEVE McC~,I ! Fy, RE/iS, DIRECTOR Air Pollution Control District WILLIAM J. RODDY, APCO Planmng & Development Services Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT April 30, 1991 Kateri Luka ARCO Products Comp'any P. O. Box 6411 Artesia, CA 90702-6411 Location Known As Permit~ # : 3220 Ming Avenue, Bakersfield, CA ARCO AM/PM #583 : 270010 Dear Ms. Luka: Our Department has reviewed the site characterization workplan submitted by Groundwater Technology, Inc. The workplan addressing soft sampling constituents to be analyzed is acceptable, and health and safety, considerations are also acceptable, for investigation of extent of contamination present at this former underground tank site. Please notify this office 48 hours prior to retrieving soil samples. Within thirty (30) days after sampling and laboratory analyses are completed, a comprehensive report describing extent of the site contamination must be submitted to this office for review. The report must describe remedial alternatives available and professional recommendations for the most feasible one. If you have any questions you may contact me at (805) 861-3636. Sincerely, Flora Darling, R.E.H.S. / Hazardous Materials Specialist Hazardous Materials Management Program FD:cas cc: Groundwater Technology, Inc. k270010-h.m14 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 RANDALL L. ABBOTT DIRECTOR DAVID PRICE !II ASSISTANT DIRECTOR RESOURCE MANAGEMENT AGENCY Environmental Health Servk:es Department STEVE McCALLEY, REH$, DIRECTOR Air Pollution Control District WILLIAM J. RODDY, APCO Planning & Development Services Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT April 19, 1991 Kateri Luka Arco Products Company 17315 Studebaker Road Cerritos, CA 90701-1448 Re: Arco AM PM #583 3220 Ming Ave., Bakersfield, CA Permit #: 270010 Dear Ms. Luka: Our letter of March 15, 1991, describing work necessary to characterize the known contamination at the above-referenced site has remained unanswered. Handbook UT-35 clearly outlines the information required to be reviewed by this office before work may commence and reasonable time guidelines for submittal of workplans. ' Yofi should contract with an environmental contractor possessing the necessary qualifications immediately with instructions to submit a site characterization workplan to this office for review. The workplan should reach my desk within 15 days of receipt of this letter. If you have any questions contact me at (805) 861-3636, Ext. 549. Sincerely, FD:ch darling~lulm.let 2700 "M" STREET, SUITE 300 Flora Darling, R.E.H.S. Hazardous Materials Specialist Hazardous Materials Management Program BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 RANDALL L. ABBOTT DIRECTOR DAVID PRICE I11 ASSISTANT DIRECTOR Envirom~ental Health Sennces Department STEVE McCA! I Fy, REHS, DIRECTOR Air Pollution Control District WILLIAM J. RODDY, APCO Planning & Development Services Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT March 8, 1991 John Tully ARCO Products Company 17315 Studebaker Road Cerritos, CA 90701 SUBJECT: Location: Known as: PERMIT #: 'Dear Mr. Tully: P 540 626 147 RECEIPT FOR CERTIFIED MAIL NO iNSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) J ·Sent to ARCO PRODUCTS COMPANY 17315 STUDEBAKER ROAD CERRITOS, CA 90701 Cerhfied Fee Speclat Dehvery Fee Restricted Detivery Fee Return Receipt showing to whom and Date Delivered Return Receipt showing to whom, Date, and Address of Dehvery TOTAL Postage and Fees S Postmark or Date 2700, "M" STREET, SUITE 300 3220 Ming Avenue Bakersfield, CA 93304 ARCO AM PM #583 270010 dce to inform you that the property described above has been Environmental Health Services Department to be the site of t hazardous materials from an underground storage tank. This our records indicate that you are a responsible party for this try OSENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your'address in the "RETURN TO" Space on the reverse side. Failure todD this will prevent this card from being returned to you. The,return receipt fee will provide you the name of the person delivered to and the date of delivery, For additional fees the following services are available. Consult postmaster for fees and check box(es) for additional service(s) requested. 1. [] Show to whom delivered, date, and addressee's address. 2. [] Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: JOHN TULLY ARCO PRODUCTS COMPANY 17315 STUDEBAKER ROAD CERRITOS, CA 90701 5. Signature - Addressee x (. Signature -- Agent 7. Date of Delivery MAR1 3 1991 / PS Form 3811,'Apr 1989 ,/J.S.G. RO. 1989-238-816 4. Article Number Type of Service: [] Registered [] Insured o [] Certified [] COD ] ..... ['-I Return Re~:eipt txpress Mau ~--J for Merchlndis.e Always obtain signature of addressee or agent and DATE DELIVERED. L . 8. Addressee's Address (ONLY if requested and fee paid) DOMESTIC RETURN RECEI: FAX: (805) 861-3429 John Tully March 8, 1991 Page 2 site remediatiOn, and Ongoing monitoring is not covered by any fees or permits. These costs are recovered by Kern County Environmental Health Services Department in one of the two methods described below. It is your responsibility to select the method of oversight cost recovery under the terms of (A) State contract or (B) County of Kern Local Agreement Option. These options pertain only to costs associated with oversight. (A) STATE CONTRACT The State Leaking Underground Storage Tank Pilot Program provides a mechanism for the State to reimburse the County for County oversight. The County will conduct the necessary oversight and bill the State Water Resources Control Board under this State contract. The State will then charge you, a responsible party, for the costs incurred by both the County and the State, pertaining to your site, under the State terms explained below: Whereas the federal Petroleum Leaking Underground Storage Tank Trust Fund provides funding to pay the. local and state agency administrative and oversight costs associated with the cleanup of releases from underground storage tanks; and Whereas the Legislature has authorized funds to pay the local and state agency administrative and oversight costs associated with the cleanup of releases from underground storage tanks; and Whereas the direct and indirect costs of overseeing removal or remedial action at the above site are funded, in whole or in part, .from the federal Trust Fund; and Whereas the above individual(s) or entity(ies) have been identified as the party or parties responsible for investigation and cleanup of.the above site; YOU ARE HEREBY NOTIFIED that pursuant to Title 42 of the United States Code, Section 699Ih(h)(6) and Section 25360 of the Health and Safety Code, the above Responsible Party or Parties shall reimburse the State Water Resources Control Board not more than 150 percent of the total amount of site-specific oversight costs actually incurred while overseeing the cleanup of the above underground storage tank site, and the above Responsible Party or Parties shall make full payment of such costs with/n 30 days of receipt of a detailed invoice from the State Water Resources Control Board. (B) COUNTY OF KERN LOCAL AGREEMENT OPTION Kern County Environmental Health Services Department is providing this option for those who prefer to pay the County directly and avoid the addition of State costs. Prior to the County's performance of services, this option requires your deposit of $1,000.00 (one thousand dollars) with the County to be held in the Local Option Trust Account. Charges for County'oversight are made against this account. In this option, a responsible party must enter into a County agreement, Attachment "B". The environmental sensitivity (Attachment "C") of this site has been reviewed by Environmental Health Services Department to determine the potential threat for groundwater contamination. Only sites determined to be non-environmentally sensitive may enroll in the Local Option Agreement. The site described above is not in an environmentally sensitive area and may be enrolled in the Local Agreement Option; John Tully March 8, 1991 Page 3 however, the County of Kern reserves the right to cancel any Local Agreement Option should it be discovered that groundwater contamination or a unique, complex hydrogeological condition exists. In such cases, Environmental Health will' utilize the State contract to pay for County oversight activities. The County of Kern reserves this right for any site even when the site is located in a non-environmentally sensitive area. It is necessary for you to respond, in writing, within ten (10) calendar days of receipt of this letter to advise Kern County Environmental Health Services Department of your choice: either the State contract or the County's Local Agreement Option. If you select the County's Local Agreement, please complete and sign the Local Agreement (Attachment B), and return it with your check for $1,000.00 (one thousand dollars) made payable to the County of Kern, addressed to Kern County Environmental Health Services Department, 2700 M Street, Suite 300, Bakersfield, CA 93301, Attention: Accounting - Local Agreement Option. If you select the State contract, please indicate, in writing, that you have made this selection and that you have read the above official notification. Failure to respond within ten (10) calendar days to this notice will automatically result in oversight cost recovery for your site(s) to be placed under the terms of the State contract for Leaking Underground Storage Tanks. If you should have any questions regarding this matter, please contact Susan Gonzales at (805) 861-3636, Extension 510. Sin,oe~ely, ^ f _...--'~t~e McCalley, Director ( ~ Environmental Health Services D~tment SMC:cas Attachments ~270010.clt Attachment "B" KERN COUNTY LOCAL AGREEMENT OPTION BETWEEN KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT (Kern County Underground Storage Tank Permitting Authority) AND JOHN TULLY Responsible Party. for Underground Storage Tank for: ARCO AM PM #583 Permit #270010 This facility has experienced an unauthorized release of hazardous substances' from an underground storage tank. Action is necessary to protect the public health and the environment of the County, pursuant to Chapter 6.7 of the California Health and Safety Code and Chapter 8.48 of the Kern County Ordinance Code. THE WITNESS FOR THE COUNTY AND SIGNATURE(S) FOR A RESPONSIBLE PARTY OF THE SUBJECT FACILITY DESCRIBED ABOVE DO HEREBY AGREE THAT: Kern County Environmental Health Services Department shall act as the lead agency for regulatory oversight for the: a) Site characterization: the study of a site, including sampling of subsurface soil and water where contamination is found in order to fully assess its extent and threat to the environment. It shall include a discussion of the relative risk to biological receptors and possible pathways of exposure. It may include removal or in-place closure of the tank, disposal or on-site treatment of contaminated backfill or adjacent soil, removal of hazardous substances floating on groundwater, and the drilling of groundwater monitor wells. b) Feasibility study: the identification and evaluation of feasible alternatives for cleaning up the site and remedying threats to public health and safety. c) Remedial action plan: the most cost-effective, appropriate plan to lessen, alleviate, abate, correct or clean-up the effects that a release of hazardous substances may have on the environment, based on the feasibility study. d) Remediation: the action chosen by the responsible party and approved by Kern County Environmental Health Services Department for the mitigation and clean-up of contamination resulting from an unauthorized release of hazardous materials and any ongoing monitoring of the site. The responsible party shall do the following: Conduct all work as directed by Kern County Environmental Health Services Department pursuant to State and local law and in conformance with appropriate regulations to assess and remediate the contaminated site. bo Deposit with the Kern County Environmental Health Leaking Underground Storage ~Tank Local Option Trust Fund the sum of $1,000.00. 'The Department's oversight activities will be charged against this account at the rate prescribed by Kern County Ordinance Code Chapter 8.04 (currently $50.00 per hour). Monthly statements will be prepared detailing the activities and services prOvided and the remaining credit balance. Kern County Environmental Health Services Department shall provide the following septices: ao Oversight of all activities to characterize the site's threat to the environment and/or the groundwater, and coordination with the appropriate State, County and local regulatory agencies. bo Serve as the single contact point for the responsible party's representatives and other regulatory agencies for the activities described in 'a' above. If during the Department's review of the site characterization/remedial .action plan, it is determined that a permit may be required by another agency, the responsible party shall be referred to that permitting agency. Co Review reports, conduct inspections, and oversee monitoring until the site poses no further environmental or public health threat. An official certification letter shall be given to the responsible party when the site is determined to no longer pose a significant threat to the environment. The responsible party will be officially notified by Kern County Environmental Health Services Department when: Necessary oversight is completed. A final statement will be provided to the responsible party. If there remains an unexpended balance of the deposit made by the responsible party in the Leaking Underground Storage Tank Trust Fund, a refund for the unexpended balance will be issued; - or - Fourteen (14) hours of billable time has been reached. This will give notice that the available funds will be exhausted after six (6) additional hours of billable time, at which time the agreement will expire. A statement estimating the amount of time necessary .to complete any remaining oversight work will be sent. The responsible party will then have another opportunity to renew his agreement with the County. Failure to enter into another agreement shall require Kern County Environmental Health Services Department to utilize the State Water Resources Control Board Pilot Project for which the responsible party may be billed by the State directly for the cost of County services as well as State costs. Kern County Environmental Health Services Department reserves the right to cancel this agreement at any time for any reasons, including groundwater contamination or a uniquely complex hydrogeological condition. If an unexpended balance remains on deposit from the responsible party under the terms of this agreement, a refund for the unexpended balance will be issued and the agreement terminated. Once the agreement is cancelled, you, as a responsible party, will be enrolled in the State Leaking Underground Storage Tank Pilot Program; see Attachment "D". This agreement may be cancelled any time by either party by certified registered return receipt letter to the other party within five days of said notification. I, (responsible party), have read and agree to the conditions of this agreement for the contaminated site described as: Site Name Site Address City_ Zip Owner's Address City Zip Telephone Telephone Attn: Operator Billing Address Permit # In order for this agreement to be executed, it must be signed and accompanied by the deposit of one-thousand dollars ($1000.00). Responsible Party: Date: For the County of Kern: Date: .Double, '"~au .... To: I~slal~alion Supervisor From: Xerxes Corporation 2 Subj: Installation Checklist Read the preceding Tank Installation Instructions, then fill in the information below. As the t~nk installation progresses, fill in each applicable inspection, testing and installation checklist item below, inili~ling the items as its conditions are satisfactorily met. (Refer to Installation Instructions lor details.) The tank's U.L. number can be found on the U.L label next'to the lifting lug. When the checklist is complete, tear off at the dotted line and mail to: XERXES CORPORATION, 7901 Xerxes Avenue South, Minneapolis, MN 55431. INSTALLATION DATE(S) SITE OWNER ./~,~ TANK'S U.L. NUMBER SITE ADDRESS INSTALLATION CONTRACTOR INSTALLATION SUPERVISOR :~/~,~\,,[ ~L.~/,,/~', PRIOR TO INSTALLATION: A. Visual inspection. No evidence (holes, cracks, deep scrapes) in domes, or flats of damaee to the tank from physical abuse or a blow from a hard object. B. Physical testing. Completed in accordance with current Xerxes Double Wall Installation Instructions (5 psig pressuri- zations and soap test). C. Backfill material (indicate material type). 1. Pea Gravel per specification in Installation Instructions. 2. Crushed Gravel or Stone per specification in Installation Instructions. 3. Other (requires specific approval by Xerxes rep.) Describe: D. Excavation hole size. Hole dimensions are correct per Installation Instructions for stable and unstable walls. E. Hole conditions (select one): 1. Dry hole. Ground water elevation not anticipated to reach tank and area not subject to flooding. (Dry hole installation) 2. Wet hole. Ground water elevation expected to reach tank or area subject to flooding. (Wet hole installation) E Traffic load (select one): 1. Traffic loading anticipated. (Requires deep burial per Instal!ation Ir~trucfions.) 2. No traffic loading. (Allov/s normal burial per Install~tion Instructions.) DURING INSTALLATION: A. Backfill material bed is level and at 12" (300mm) minimum depth over native soil or stab prier to setting tanks in place. B. Tanks set in place with correct spacing from wall and other tanks. C. Deadmen and tie downs positioned and secured in accordance with Installation Instructions. (Wet hole installation) D. Backfill material tamped and compacted to fill all voids around tank. E. Tank properly ballasted during backfill. (Wet hole installation only.) Never fill secondary (external) tank with ballast. F. Tank(s) buried at proper depth to conform to wet oi' dry hole; traffic or no traffic conditions. INSTALLATION 'I:'ESTIN G: All tanks with manways must be i~spected from the inside after installation. Visually inscect the tank for any s~gns (cracks, holes, indentations) of physical damage, ' MEASUREMENT OF DEFLECTIONS: A. All tanks must be measure'd to determine vertical tank deflection during instatlaticn. tntenor diame!er of tankI , Inter,or diameter of tank · ,'- - (a) Maximum Allowable Deflections: Tank Diameter Deflection 4' :,,'~" 6' - , , :; ,,/"8~"i l?t." /¢,¢,,"..~ ~i., "/ 2: r, ~, -~o.~ iv:" Vertical defiec:ion in excess ol these va!ues indicates improper installation and voids the tank v,'arranty. Ver~ied bv: PLANT LOCATIONS 34250 Mills Road Arch, OH 44011 ., ,.:..:- 1- :.ur) i Route 3 Box 1060 Wilfia,'nspcrt, MD 21795 (301) 222-&333 1911 Midland Road Rock Hill, SC 29731 5-I5 West South St. Tipton, IA 52772 (319) 386-6'172 XE::~XES CCF?CF:.:.TE CFFiCTE :.[:.::,':,,~::f:.':Ai'z,, >,i:", ,~ :.': . .':", (: '. 2) 2 ,:2 7.-", [2:7 0 Double Wall To: Installation Supervisor From: Xerxes Corporation Subj: Installation Checklist Read the preceding Tank Installation Instructions, then fill in the information below. As the tank installation progresses, fill in each applicable inspection, testing and installation checklist item below, initialing the items as its conditions are satisfactorily met. (Refer to Installation Instructions for details.) The tank's U.L. number can be found on the U.L label next to the lifting lug. When the checklist is complete, tear off at the dotted line and mail Io: XERXES CORPORATION, 7901 Xerxes Avenue South, Minneapolis, MN 55431. INSTALLATION DATE(S) ': -- '~ ~'''' ¢['/ · ~ 2 SiTE OWNER "¢)/:~/'~' TANK'S U.L. NUMBER ,4 ,,, _ ",,., ' SITE ADDRESS ~-' ~:. '"'-' " · · .... ' INSTALLATION CONTRACTOR ~/~ ~-,;N~",., ~-~' ~" ~ ~/~ ,~ sa,~ z,~ INSTALLATION SUPERVISOR_ PRIOR TO INSTALLATION: A. Visual inspection. No evidence (holes, cracks, deep scrapes) in domes, or flats of damage to the tank from physical abuse or a blow from a hard object. B. Physical testing. Completed in accordance with current Xerxes Double Wall Installation Instructions (5 psig pressuri- zations and soap test). C. Backfill material (indicate material type). 1. Pea Gravel per specification in Installation Instructions. 2. Crushed Gravel or Stone per specification in Installation Instructions. 3. Other (requires specific approval by Xerxes rep.) Describe: Excavation hole size. Hole dimensions are correct per Installation Instructions for stable and unstable walls. Hole conditions (select one): 1. Dry hole. Ground water elevation not anticipated to reach tank and area not subject to flooding. (Dry hole installation) 2. Wet hole. Ground water elevation expected to reach tank or area subject to flooding. (We',, ho.e installation) F Traffic load (se!ect one): 1. Traffic loading anticipated. (Requires deep burial per Installation Instructions.) 2. No traffic loading. (Allows normal burial per Installation Instructions.) DURING INSTALLATION: A. Backfill material bed is level and at 12" (300mm) minimum deCh over native soil or slab prior to ~etting tanks in place. B. Tanks set in place with correct spacing from wall and oilier tanks. C. Deadmen and tie downs positioned and secured in accordance with Installation Instructions. (Wet hole installation) D. Backfill material tamped and compacted to fill all voids around tank. E. Tank properly ballasted during backfill. (Wet hole installation only.) Never fill secondary (externa!) tank with ballast. E Tank(s) buried at proper depth to conform to ,,vet or dry hole; traffic or no traffic conditions. INSTALLATION TESTING: Att tanks with manways must be inspected from the inside aiter installation. Visually inspect the tank for an,,,, signs (cracks, holes, indeniations) of physical damage. ME:",SUREMENT OF DEFLECTIONS: A. Ail tanks must be measured to determine vertical tank deflection during installation. !ntenor c~ameter of tank In:erlor diameter of lank (A) ,a,--- - (B~ , = M~imum A?,cwabte Deflections: Tank Diameter Deflection 4' .1.,/2' , ~/~ ~ /,3~/. , t; 1 ~,/.~" Verified by: ::, Vertical defiect;,on in ex.~..,~'o~o of these values indicates improper !nstafiation and ye!ds the tank ',','arrant.,,: PLANT LOCATIONS Sz£50 Mills Read L'.'~'i~ 014 '~'~n~I '2! .-'.) ':"':: '..'::::..:.:.)'-t Route 3 So× ICE0 V"./iiliarv, scert. ,LiD 2! 7F::5 1911 Midland Rsad Rock i-..';il. Su ',, C 'd ,-: ,l . 515 West South St. TiFtcn. iA 52772 :', :2.'~ ;( :E ::; C C .7 :--"; F ,:.':' ::'_-: £ ': .-'; C :F . :;',':,: z:.::.'):::, , ':.: ::.i..:.?'~ ' ': ';'t: ':: 7. '::;.: i; Double Wall To: Installation Supervisor From: Xerxes Corporation Subj: Installation Checklist Read the preceding Tank Installation Instructions, then fill in the information below. As the tank installation progresses, fill in each applicable inspection, testing and installation checklist item below, initialing the items as its conditions are satisfactorily met. (Refer to Installation Instructions for details.) The tank's U.L number can be found on the U.L lapel next to the lifting lug. When the checklist is complete, tear off at the dotted line and mail to: XERXES CORPORATION, 7901 Xerxes Avenue South, Minneapolis, MN 55431. INSTALLATION DATE(S) , .... , -tANK'S U.L. NUMBER SITE OWNER ~:I/~: O:~ ~" INSTALLATION CONTRACTOR INSTALLATION SUPERVISOR PRIOR TO INSTALLATION: A. Visual inspection. No evidence (holes, cracks, deep scrapes) in domes, or flats of damage to the tank from physical abuse or a blow from a hard object. B. Physical testing. Completed in accordance with current Xerxes Double Wall Installation Instructions (5 psig pressuri- zations and soap test). C. Backfill material (indicate material type). 1. Pea Gravel per specification in Installation Instructions. 2. Crushed Gravel or Stone per specification in Installation Instructions. 3. Other (requires specific approval by Xerxes rep.) Describe: D. Excavation hole size. Hole dimensions are correct per Installation Instructions for'stable and unstable walls. E. Hole conditions (select one~: 1. Dry hole. Ground water elevation not anticipated to reach tank and area not subject to flooding. (Dry hole installation) 2. Wet hole. Ground water elevatio~ expected to reach tank or area subject to flooding. (Wet hole installation) F Traffic load (select one): 1. Traffic leading anticipated. (Requires deep burial per Installation Instructions.) 2. No traffic ~o~ding. (Allows normal burial per lnstali~tion Instructions.) DURING INSTALLATION: A. Backfill material bed is level and at 12" (300mm) minimum depth over native soil or slab prior to setting tanks in place. B. Tanks set in place with correct spacing from wall and other tanks. C. Deadmen and fie downs positioned and secured in accordance with Installation Instructions. (Wet hole installation) D. Backfill material tamped and compacted to fill all voids around tank. E. Tank properly ballasted during backfill. (Wet-hole installation only.) Never fill secondary (external) tank with ballast. E Tank(s) buried at proper depth to conform to wet or. dry hole; traffic or no traffic conditions. INSTALLATION TESTINg: A~I tanks with mamvays must be inspected from the inside a~er installation. Visuaily inspec~ the tank for any signs (cracks, holes, indentations) o~ physical damager MEASUREMENT OF DEFLECTIONS: A. All tanks must be measured to determine vertical tank deflection during installation. prior(A) ~o ea:*:t,:i*aa.. ~ ~ _ a~er(B) ~acKldiing;O.~. s~raa~.,~. De~iect~6n M~imum Allowable Def'.ect~ons: Tank Diameter Deflection 4' ,,.~" 1 Verified bv: Vertical dei'.ection in excess of these values indicates improper installation and voids the tank warranty. .... ",,-,~ PL**-,NT LOC,:,TiONS 34250 :'dills Road Avcn. CH ::4011 (2-', 2) ? 27-S,:5: Route 3 Sox 1080 1911 Mid!and.Fond Rock Niil. SC 29731 (S03) 3~8-5115 ?%;?z!n. "..*X '.'."~-; ~::: 515 West South St. 52772 S,3~-5'i72 C:I?:':,: C 2,:.';E OFFICE Double Wall - To: Installation Supervisor From: Xerxes Corporation Subj: Installation Checklist Read the preceding Tank ,Installation Instructions, then fill in the information below. As the tank installation progresses, fill in each applicable inspection, testing and installation checklist item below, initialing the items as its conditions are satisfactorily met. (Refer to Installation Instructions for details.) The tank's U.L. number can be found on the U.L. label next to the lifting lug. When the checklist is complete, tear off at the dotted line and mail to: XERXES CORPORATION, 7901 Xerxes Avenue South, Minneapolis, MN 55431. INSTALLATION DATE(S) /-- ~ ~-/ .4 ,,~ TANK'S U.L, NUMBER SITE OWNER SITE ADDRESS ~_¢-"~ ~ INSTALLATION SUPERVISOR .~!,~[ ~.~.1~ PRIOR TO INSTALLATION: A. Visual inspection. No evidence (ho'les, cracks, deep scrapes) in domes, or flats of damage to the tank from physical abuse or a blow from a hard object. B. Physical testing. Completed in accordance with current Xerxes Double Wall Installation Instructions (5 psig pressuri- zations and soap test). C. Backfill material (indicate material type). 1. Pea Gravel per specification in Installation Instructions. 2. Crushed Gravel or Stone per specification in Installation Instructions. 3. Other (requires specific approval by Xerxes rep.) Describe: D. Excavation hole size. Hole dimensions are correct per Installation Instructions for stable and unstable walls. E. Hole conditions (select one): 1. Dry hole. Ground water elevation not anticipated to reach tank and area not subject to flooding. (Dry hole installation) 2. Wet hole. Ground water elevation expected to reach tank or area subject to flooding. (Wet hole installation) E Traffic load (select one): 1. Traffic Ioad~ng anticipated. (Requires deep burial per Installation Instructions.) 2. No traffic loading. (Allows normal burial per Installation Instruct¢ons.) DURING INSTALLATION: A. Backfill material bed is level and at 12" (300mm) minimum depth over native soil or slab prior to setting tanks in place. B. Tanks set in place with correct spacing from wall and other tanks. C. Deadmen and t~e downs positioned and secured in accordance with Installation Instructions. (Wet hole installation) D. Backfill material tamped and compacted to fill ail voids around tank. E. Tank properly ballasted during backfill. (Wet hole installation only.) Never fill secondary (external) tank with ballast. F Tank(s) buried at proper depth to conform to wet or dry hole; traffic or no traffic conditions. INSTALLATION TESTING: All tanks with manways must be inspected from the inside after inst~llafion. Visually inspect the tank for any signs (cracks, holes, indentations) of physical damage. MEASUREMENT OF DEFLECTIONS: A. All tanks must be measured to determine vertical tan~ deflection during installation. prior to bac.~fiil:na. ., art, er bacxfiil~,~ t':~Cu~:gfade. Deflection Maximum Allo',vab!e Deflections: T~nk Diameter Oeflection 4' ~ ~.¥' ¢'~'-~~z"~'/,.,- ~- ':~. ~i~ , & '" ~5' 1,.,~" Verified by: Vertical deflection in excess of these values indicates improper ins:ailation and voids the tank warranty. X:=RXF--S ?LANT LOCATIONS ,34250 ?,'lif!s Road Avon. OH 44011 ( 21 :.-'..) 327-.~05 i . :: ',L'" ~:::.: .:/.': aout'e 3 Sox !060 '?./i[i':ams:scr'.:. ~,ii) 2!72.5 {S31) 1911 Midland Road ~oc',', :4iii. SC 29731 (.30,3) .355-5~'; 5 515 West South St. Tipton, IA 52772 RESO JRCE MANAGEMENT AGENCY F~NDALL L. ABBOTT DIRECTOR DAVID PRICE II! ASSISTANT DIRECTOR Environmental Health Services Department STEVE McCALLEY, REHS, DIRECTOR Air Pollution Control District WILLIAM J, RODDY, APCO Planning & Development Services Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT March 15, 1991 JoeTully ARCO PRODUCTS COMPANY 17315 Studebaker Road Cerritos, CA 90701'1488 SUBJECT: Location: Known As: Permit #: 32~0 Ming Avenue, Bakersfield ARCO AM PM #583 270010 Dear Mr. Tully: The intent of this letter is to inform you of the necessary deadlines for work required at the property described above. As a responsible party for a leaking underground storage tank, you'have previously received a letter from this Department notifying you of the required work necessary to identify the extent of the contamination. We are now requesting that this work, outlined in Handbook UT-35, be done in a timely manner. In accordance with California Health and Safety Code, Chapter 6.7, and Kern County Ordinance Code, Chapter 8.48, the Kern County Environmental Health Services Department requires a determination of the threat to the environment. Accordingly, you must select an environmental contractor and submi~ a site characterization workplan proposal to this office within 30 days from the date of this letter. The workplan must be approved by this Department before any work is started. If you should have any questions regarding this matter, please contact me immediately at (805) 861-3636 ext. 549. Sincerely, ~ //~~ Hazardous Materials Specialist Hazardous Materials Management Program FD:jg 2700 "M" STREET, SUITE 300 · BAKERSFIELD, CALIFORNIA 93301 (805) 861-3636 FAX: (805) 861-3429 WATER RESOURES CONTROL BOARD DIVISION OF WATER QUALITY UST CLEANUP PROGRAM SITE SPECIFIC QUARTERLY REPORT CONTRACTOR NO: SITE NO: SITE NAME: ADDRESS: CITY/ZIP: CASE TYPE: 15000 SOURCE OF FUNDS: 270010 FEDERAL EXEMPT: ARCO AM PM #583 3220 MING AVE. BAKERSFIELD, CA 93304 SiTE STATUS S CONTRACT STATUS: 4 N RP SEARCH: S PRELIMINARY ASSESSMENT: C REMEDIAL DATE UNDERWAY: INVESTIGATION: REMEDIAL ACTION: DATE UNDERWAY: POST REMEDIAL DATE UNDERWAY: ACTION MONITORING:' ENFORCEMENT ACTION TYPE: TAKEN: DATE UNDERWAY: 02/01/91 DATE UNDERWAY: 01/31/91 / / / / / / SUBSTANCE: 12034 PETROLEUM: Y DATE REPORTED: 02/01/91 DATE CONFIRMED: 02/01/91 MULTIPLE R.P's: N EMERGENCY RESPONSE: DATE COMPLETED: 02/01/91 DATE COMPLETED: 03/01/90 DATE COMPLETED: / / DATE COMPLETED: DATE COMPLETED: DATE TAKEN: LUFT FIELD MANUAL CONSIDERATION 2, S, C (CATEGORY 1, 2, 3, PLUS H, S, C, A, R, W, G, OR O AS APPLICABLE) CASE CLOSED: DATE EXCAVATION STARTED: / / CONTACT NAME: COMPANY NAME: ADDRESS: CITY/STATE: PHONE #: JOE TULLY ARCO PRODUCTS CO. 17315 STUDEBAKER RD. CERRITOS, CA 90701 (213) 404-5360 DATE CLOSED: / REMEDIAL ACTIONS TAKEN: RESPONSIBLE PARTY SPECIALIST: SENSITIVITY: NES ABANDONMENT #: A1366-27 DATE OF REPORT: 03/01/91 LEAK REPORT: Y RANDALL~L ABBOTT ~DIRECTOR DAVID' PRICE !!! ASSISTANT DIRECTOR RESOIdRCE MANAGEMENT AGENCY Environmental Health Services Department STEVE McCALLE¥, REHS, DIRECTOR Air Pollution Control District WILLIA~ J. RODDY, APCO Planning & Development Semices Department TED JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT. F A C [ L I T Y A D O R E S S: ...... ..~.....~...~.~......~>... ............. ~.~.~,~ ..........~:~.f,~.~' ................. .~,~.]~,,~.~l.z~. ........... C~-:-~. ............................................ ONN ER' S NAME: ....... J~.C~ ............. ~...,,~oL~..~,.,,"."~-.~ ............... ~'/--,~ .................................................................................................................................. ACTIVITY BEING TRACKED BY THIS FORM: F.~c.-._~ .~-->+~_'___~_~_2c~J _c~- _EF~.._ ~~___~ ~ ,~A/ ;'~ ~/ I t _. COiv!,PANY PERFORMING THE FUNCTION: i,~i'~"T'/'~ ,"_,.,~.'::: ........... '.Z...:.:.!... ! ...: ....................... :-? -~>~,...,.,~,.~,,:~::.. 2700 "M" STREET, /SUITE 300 BAK~'RSFIELD, CALIFOR~b~ .~0! .................................. (805)"86I:3636 ..... FAX: (805) 861-3429 i STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACILITY/SITE MARK ONLY [] 1 NE-W PERMIT [] 3 RENE~NAL PERMIT ONE ITEM [] 2 INTERIM PERMIT ~ 4 AMENDED PERMIT .~5 CHANGE OF iNFORMATION ~ 7 PERMANENTLY CLOSED SITE I ' [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) NAME OF OPERATQR NEAREST CROSS STREET P~::iCEL # (OFTIONAL) STATE ZIP CODE / SITE PHONE~# WITH AREA CODE DBA OR FAClLITM NAME ADDRESS · CITY NAME . co. RA o. ,.o,v.o.AL TYPE OF BUSINESS [~ 1 GAS STATION L-~ 2 DISTRIBUTOR . ~ 3 FARM '~' ~ 4 PROCESSOR ~ 5 OTHER . --.. '" .. ,'. · · F_M;RGENCY CONTACT PERSON (PRIMARY) ':: ' [ DAYS: NAME (LAST. FIRST) . ' ' I -PHONE # WITH AREA CODE ':- I ' .'"' NIGHTS: NAME (LAST, FIRST) PHONE #~/ITH AREA CODE LOCAL-AGENCY ~C~NCY I---] STATE-AGENCY [---] FEDERAL~GENCY 01STRICTS ' ' ~ ~/ iF iNDiAN I# OF TANKS AT SITE I E.P.A.I.D.#('-~-~;-"-~/) RESERVATION . .:.....,..'~: ', ~,, .': _ ..~ .. OR TRUST L~NDS '= ' r_M;RGENCY CONTACT PERSON (SECONDARY) - °ptlona DAYS: NAME (LAST. FIRST) ' i" . ....~.. ~PHONE # WITH AREA CODE ..:~ NIGHTS: NAME (LAST, FIRST) · - PHONE # ~H AREA CODE II. PROPERTY OWNER INFORMATION - (MU~T BE COMPLETED) NAME - / CITY NAME . CARE OF ADDRESS INFORMATION ,~ boxl~i~=t~ r--1 INDNIDUAL I---] LOCAL.AGENCY ~ STATE-AGENCY ~ CORPORATION ~ PN¥i'NERSHIP i--] COUNTY-AGENCY ~ FEDERAL-AGENCY STATE I ZiP CODE I PHONE # WITH AREA CODE II1. TANK OWNER INFORMATION - (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION NAME OF OWNER ,~, ~'~ ,'?~ ,~'~ ' ~ ~' ~ 'q/~'~/~!"~' '? ~'~''j~/ I ~/ ~b°~['i~='' ~ INDIVIDUAL I'-"] LOCAL-AGENCY I--'] STATE-AGENCY MAILING OR STREET ADDRESS / I / ~ [~"CORPORATION ~ pN~'NERSHIP ['"--] COUNTY-AGENCY ~ FEDERAL-AGENCY STATE I 7.JP CODE I PHONE # WITH AREA CODE CITY NAME IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 if questions arise. V. LEGAL NOTIFICATION AND BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. ICHECK ONE BOX INDICATING ~,-IICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT IAPPLICAN'PS NAME (PRINTED & SIGNATURE) LOCAL AGENCY USE ONLY to COUN ,'TY # CATION CODE - OPTIONAL IAPPLICANT'S TITLE I DATE MONTH/DAY/YEAR JURISDICTION # . FACILITY # SUPVISOR - DISTRICT CODE . OPTIONAL [~ENSUS TRACT # o 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. FOR0033A-RZ FORM A (9-90) STATE OF CAUFORNIA STATE WATER RESOURCES CONTROl. BO UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B MARK ONLY [] 1 NEW PERMIT ONEITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EACH TANK SYSTENL [] 3 RENEWAL PERMIT [~5 CHANGE OF INFORMATION [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 7 PERMANENTLY CLOSED ON SITE J [] 8 TANK REMOVED DBA OR ' FACILITY NAME WHERE TANK IS INSTALLED: ~!, ~-//" :"', ~1 I, TANK DESCRIPTION / COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN I A. OWNER'S TANK I. D. # ' B. MANUFACTURED BY: / C. DATE INSTALLED (MO/DAY/YEAR) .~ ///_// / ~ .~ D.' TANK CAPACITY IN GALLONS: II.TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C., [~[ la REGULAR [] 3 DIESEL A. [~; MOTOR VEH,CLE FUEL [] , O,L B. ~:.~..' C. , , ~.U~L~DED [] 6 AWAT~ON GAS [] 2 PETROLEUM [] 80 EMPTY t~'l ~ ~RODUCT ~bPREMIUM ~ 4 ~S~OL ~ 7 M~OL ~ UNLADED ~ 5 J~FUEL ~ ~ c.~,c.~..Douc~ ~ ~ u.~ow. ~ ~ w.s~ ~ ~ ~ ~ ~ O~E. (D~SC.~aE ~. ~ ~. aLLow D. tF(A.1) IS NOT MARKED. EN~R NAME OF SUBSTANCE STORED C.~S.~: .... ' 77~'~'~";:';/;~ "; ' '~ III. TANK CONSTRUCTION MARK ONE I~M ONLY IN BOXES ~ B. ANDC.~DALL~ATAPPLIESINBOXD ~' '~ ;~' ~.~ ' %'' ~:: ';' A. TYPEOF [~ 1 DOUBLE WALL [] 3 SINGLE. WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK} [] 99 OTHER B. TANK [] 1 BARE STEEL, MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC 8 100=/. METHANOL COMPATIBLE W/FRP 99 OTHER. [] 1 RUBBER LINED [] 2 ,ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING ~UNLINED [] 95 UNKNOWN [] 99 OTHER UNING I$ LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ] 3 VINYL WRAP [~"~"FIBERGLASS REINFORCED PLASTIC [] 95 uNKNOwN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IFUNDERGROUNO, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A(U.~'2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A(~:~...~2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A'U~'4 F~BERGLASS PiPE ALUMINUM A IJ 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A IJ 99 OTHER INT E~RSTITL~L AUTOMATIC LINE LEAK DETECTOR [-~ LINE T~GHTNESS TESTING ~ MONITORING [] 99. OTHER V. TANK LEAK DETECTION I--] v,SUAL CHECK [] INVENTORY RECONO,LIAT,ON VAPOR MON,TORING I -A TOMAT'C TANKGAUG,NG GROUNDWATER MONITORING I ~ 6 TANK TESTING [~' ,NTERSTITIALMONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER ' I VI. TANK CLOSURE INFORMATION I1.ESTIMATED DATE LAST USED (MOIDAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH SUBSTANCE REMAINING GALLONS INERT MATERIAL ? YES [] 'NO [] I THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICANT'S NAME DATE (PRINTED & SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK STATE I.D.# ~ I t I..-:"1 PERMIT NUMBER- }"" ' ' '? ' II PERMIT APPROVED, BY/DATE. ~/' ,I PERMIT EXPIRATION DATE THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM B (9-90) FOROO348-R4 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 [] 1 NEW PERMIT [] 3 RENEWAL PERMIT E~CHANGE OF INFORMATION E~ 7 PERMANENTLY CLOSED ON SITE/ ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS INSTALLED: ~i.,*~q//~ ,, '~ *.--~' ,* ', .... I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# C. DATE INSTALLED (MO/DAY/YEAR) ~ ? /;*'.v/ ..~'~ / D. TANK CAPACITY IN GALLONS~/.,... _~, ?_. :...~.~ II. TANK CONTENTS IFA-1 IS MARKED, COMPLETE ITEM C. A. E~' MOTOR VEHICLE FUEL [] 4 OIL B. ~R*' C. [] laUNLEADEDREGULAR [] 3 DIESEL .:.[] 6:AVIATION GAS ''[] 2 PETROLEUM '* r-~ 80 EMPTY ' ODUCT j-'-'] lb PREMIUM [] 4 GASAHOL ~ .i?i [] 7 METHANOL ~OED [] s -'ET"UEL ...... '-, [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE L~ 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. BELOW D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S. #: '.. III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B. ANDC, ANDALLTHATAPPLIESINBOXD '~ :':; *~ · '~.. A. TYPE OF E~ DOUBLE WALL [] :3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN . SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. MANUFACTURED BY: .~-/,.~\.~¥~.,.~_~'~_, I B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLE W/FRP [] 99 OTHER [] I RUBBER LINED [] ,,~,*ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING E~ 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING I$ LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? 'YES_ NO__ O. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION [~] 5 CATHODIC PROTECTION ~ 91 NONE [] 95 UNKNOWN [] 99 OTHER E~FIBERGLASS REINFORCED PLASTIC IV. PIPING INFORMATION C~RCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION A~I-~2 PRESSURE A U 3 GRAVITY ~. U 99 OTHER B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION SINGLE WALL A:U '2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U ~9 OTHER BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A 1~ ;"4 FIBERGLASS PIPE ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP G* GALVANIZED STEEL A U 10 CATHODICPROTECTtON A U 95 UNKNOWN ~*~ A U 99 OTHER D. LEAK DETECTION r-~--~ ~ AUTOMATIC LINE LEAK DETECTOR [~2 LINE TIGHTNESS TESTING r~3 INTERSTITIAL ~ MONITORING [] 99 OTHER V. TANK LEAK DETECTION ~.,~ [] lw.VISUAL CHECK ~,_~ ~ENTORY RECONCILIATION [~ 3 VAPOR MONITORING E~ AUTOMATIC TANK GAUGING [~ 5 GROUND WATER MONITORING J--~ TANK TESTING ~ 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION. { 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OFsuBSTANCE REMAINING GALLONS I3' WAS TANK FILLED WITHINERT MATERIAL ? YES[] NO[~ I THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT (PRINTED & SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # STATE I.D.¢/' ~ I I I I PERMIT NUMBER -'.? PERMIT APPROVED BY/DATE FACILITY # TANK # / '% ,~ ;''~ I I'~ '"' ......: / , , ~ ' THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORM B (9-90) FOROO34B-R4 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERUIT APPLICATION - FORU B MARK ONLY [] 1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. · t [] 3 RENEWAL PERMIT ~ CHANGE OF INFORMATION [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE ] 7 PERMANENTLY CLOSED ON SITE ] 8 TANK REMOVED DBAOR FAClLITY NAME WHERE TANK IS lNSTALLED: /~;'~¢~ .~ ,;"~//~,'Y7 = -.'-~' ;.7-~, I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN - / c. DATE INSTALLED (MO/DAY/YEAR) ~ /. /L/ ~:~ / D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS ~F A-1 IS MARKED, COMPLETE ITEM C. ~'~'M y' ~"'~ ~'a REGULAR [----~ 3 DIESEL J'~ 6 AVIATION GAS A. OTOR VEHICLE FUEL [] 4 OIL B,[~1 PR C. ~ UNLEADED [] 4 GASAHOL [] 2 PETROLEUM [] 80 EMPTY ODUCT [] lb PREMIUM [] 7 METHANOL UNLEADED [] 5 JET FUEL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE *[] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. BELOW D. {F (A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.#: , III. TAN K CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B, AND C, AND ALL THAT APPLIES IN BOX O A. TYPE.OF ~r~ DOUBLE WALL SYSTEM [__J 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 4 SECONDARY CONTAINMENT (VAULTEDTANk3 B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [~FIBERG~S MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (Primary'rank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 95 UNKNOWN ] 99 OTHER ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 10~/o METHANOL COMPATIBLEW/FRP [] 99 OTHER [] 1 RUBBER LINED [] 2 ,~..[3~.INING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING [~ UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ O. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 3 v,.~L w. AP I~t'~BERG~B RE,.FORCED PLAST,C [] 99 U.KNOW.[] 99 OTHER IV, PIPING INFORMATION C~RCL~ A IF ABOVE GROUND oR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION A U 1 SUCTION A/I~2 PRESSURE A U 3 GRAVITY A U 99 OTHER A U I SINGLE WALL A,~uL~. 2 DOUBLE WALL A U 3 LINED TI~ENCH A U 95 UNKNOWN A U 99 OTHER A U 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A 04 FIBERGLASS PIPE A U 5 ALUMINUM A IJ 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GAL~VANIZED STEEL A U 10 CATHODIC P.ROTECTION A U 95 UNKNOWN... A U 99 OTHER D. LEAK DETECTION [~UTOMATIC LINE LEAK DETECTOR [~'~2 LINE TIGHTNESS TESTING r-7-/-/~'3qNTE~STITIAL ~ MONITORING [] 99 OTHER V. TANK LEAK DETECTION .~- ~ [] ~.v,SUAL CHECK [] ~ ,NyENTORY RECONC.L,ATmON [~ VAPOR MON,TOR,.G E2~ ~TOMAT,C TANK GAUG,NG [] ~ GROUND WATER MON,TORm. G ~ TANK TEST,NG I~'¢T~TERSTITIALMO"ITORING [] ~, NONE [] B, UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) 2. ESTIMATED QUANTITY OF GALLONS 3. WAS TANK FILLED WITH YES [] NO [] i *? SUBSTANCE REMAINING INERT MATERIAL ? THIS FORM HAS BEEN COMPLETED UNDER PENALTY O'F PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANT'S NAME I DATE (PRINTED & SIGNATURE) LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION.# FACILITY # TANK # STATEI.D.# ~ ] [ ~] 2.-~0~ / OI PERMIT NUMBER ~-':. .i/' ~ ~ PER~T APPROVED BY/DATE.,...,'., , .: ,,/,5..., ~ PERMIT EXPIRATION DATE FORM B (9-~) THIS FORM MUST BE AC~MP~IED BY A PERMff ~PLICATION. FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR00348-R4 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION- FORM B MARK ONLY [] 1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EACH.TANK SYSTEM. ,.~-~ [] 3 RENEWAL PERMIT [~'~ CHANGE Of iNFORMATION [] 7 PERMANENTLY CLOSED ON SITE [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE' [] 8 TANK REMOVED DBAOR FACILITY .AME WHERE TANK IS INSTALLED: ~.~,,?/,d. / ~ .,-~,~/ ~'; ~,-*,,-~" ,,~* / ' I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN I A. OWNER'S TANK I. D. ~ ~ B. MANUFACTURED BY: ~:'/~ ?::3 . ~-*- I c. DATE INSTALLED / / / t ,, ,. II. TANK CONTRAS ~A-~ is MARKED,~MPLE~ITEM C. / ' . / ~"T~la REGULAR [] 3 DIESEL [] 6 AVIATION GAS A. [~ MOTOR VEHICLE FUEL [] 4 OIL B..F-'/~ 1 P' c. [_._1 UNLEADED [] 4 GASAHOL., :=:E~ 7 METHANOL [~ 2 PETROLEUM [~ 80 EMPTY RODUCT - [] lb PREMIUM UNLEADED [] 5 JETFUEL ."~ : . .-. . [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] 99 OTHER (DESCRIBE IN rrEM O. BELOW] D. IF(A.1)IS NOTMARKED, ENTER NAME OF SUBSTANCE STORED C.A.S.#: , ,',:,: -:~ ./ :. -' ,',~ IlL TANK CONSTRUC~ON MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXD '~' *' :' ~' ~'' '!.-'*:'::'.':'i: "~:::' J:':':":"" ..... :: ' A. TYPE OF ~'~ DOUBLE WALL SYSTEM [] 2 SINGLE WALL B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAUI~TEDTANIO [] 99 OTHER [] 2 STAINLESS STEEL E~FIBERGLASS [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] ,o GALVANIZED STEEL [] 9~ UNKNOWN [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC [] 8 100% METHANOL COMPATIBLEw/FRP ] ~ OTHER [] 1 RUBBER LINED c.._~ ~...--[] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING c. INTERIOR [~UNLINED [] 99 OTHER LINING [] 5 GLASS LINING [] 95 UNKNOWN IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO~ O. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [~'~FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE [] 95 UNKNOwN [] 99 OTHER IV. PIPING INFORMATION C~RCL~ A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~.~ 2 PRESSURE A U 3 GRAVI3¥ ~, U 99 OTHER B. CONSTRUCTION A U I SINGLE WALL A~UU~-'~2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A(~4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100'/= METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER ~ INTERSTITIAL ~'"'~. AUTOMATIC LINE LEAK DETECTOR ['~-T'2 LINE TIGHTNESS TESTING ~ 99 OTHER MONFrOR[NG V. TANK LEAK DETECTION f--q?-wsuAL CHECK [] 6 TANK TESTING '"TERSTITIALMONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) · 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES ~ NO F-'-i I SUSSTANCE REMAINING GALLONS INERT MATERIAL ? I THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICANT'S NAME I DATE (PRINTED & SIGNATURE) LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION # FACILITY # TANK # PERMIT NUMBER.~*'~.., .... , ,' ,,. ;" ,' ~ PERMIT APPROVED;..L-JBy/DATE, ,'t~ '~',/J"~. I, PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FORO(334B-R4 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM E! MARK ONLY [] 1 NEW PERMIT ONEITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE L_J 7 PERMANENTLY CLOSED ONSITE [~.,-8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # ._,:,~_,~ C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: I. TANK CONTENTS ~FA-~ is MAF{KED, COMPLETEITEM C. A. E~; MOTOR VE.ICLE FUEL []., O,La. ...~' C. [] ,.REGULAR [] 3 D,ESEL [] 6 AVlAT,ONGAS U,~DED [] ~ ~S~O~ ~ 3 CHEMICAL PRODUCT ~ ~ UN~OWN . ~ 2 WAS~ ~ 2 L~DED ~ ~ O~ER (DESCRIBE IN ~M DJ BELO~ O. IF (A.1) IS NOT MARKED. EN~R NAME OF SUBSTANCE STORED C.~S.~:. "~'?:'-~' *.. ~-' ~%¥ ~ *~:.~. ":" III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C; AND ALL THAT APPLIES IN BOX D ' ~''* .....; ~'""::"; '"" "'~ '~;' ' ''* " .... A. TYPE OF ,_..~.~,~__UBLE~ WALL SYSTEM ~ 2 SINGLE WALL B. TANK [] I BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE E~] 3 SINGLE WALL WITH EXTERIOR LINER [] ,~ SECONDARY CONTAINMENT (V~..~DT~K) ] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER C. INTERIOR UNING O. CORROSION PROTECTION [] 1 RUBBER LINED ~~L_J~~'~INING [] 5 GLASS LINING ~'"'6 UNLINED IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? [] 3 EPOXY LINING ] 95 UNKNOWN YES__ NO__ [] 1 POLYETHYLENE WRAP [] 2 COATING [] 5 CATHODIC PROTECTION [] 91 NONE ] 3 VINYL WRAP [] 95 UNKNOWN ] 4 PHENOLIC LINING ] 99 OTHER [~FIBERGLASS REINFORCED PLASTIC [] 99 OTHER IV. PIPING INFORMATION A. SYSTEM TYPE B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND. BOTH IF APPLICABLE A U 1 SUCTION A~/U.,,/2 PRESSURE A U 3 GRAVITY A U 99 OTHER Af'~ 1 SINGLE WALL A U 2 DOUBLE WALL A LI 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)~4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELWlCOATING A U 8 100% METHANOL COMPATIBLEWIFRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U g9 OTHER [-~ I AUTOMATIC LINE LEAK DETECTOR ~ LINETIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION ... I ~-~ 1 ylSUAL CHECK [~"' 2 INVENTORY RECONCILIATION ~'] 3 VAPOR MONITORING ~-~ 4 AUTOMATIC TANK GAUGING [~1 5 GROUND WATER MONITORINGI ~-~TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION ~/ .,~. ~_~;/,'~ / SUBSTANCE REMAINING/ GALLONS 'NERTMATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICANT'S NAME DATE I (PRINTED & SIGNATURE) LOCAL AGENCY USE ONLY TH~ STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW STATE I.D.# COUNTY # JURISDICTION # FACILI ,TY # TANK # I PERMIT APPROVED BY/DATE [ PERMIT EXPIRATION DATE FORM S (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B-R4 Si'ATE OF CAUFORNIA - t 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 ~ CHANGE OF INFoRMATIoN ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE DBA OR FACILITY NAME WHERETANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL iTEMS -- SPECIFY IF UNKNOWN [] 7 PERMANENTLY CLOSED ON SITE [~8 TANK R, EMOVED I I B. MANUFACTURED BY: , C. DATE INSTALLED (MO/DAY/YEAR) ~ . .. ,~:. [ D. TANK CAPACITY IN GALLONS: /' ~' 'r' '~ F'" ,,. TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. A. [~'1 MOTOR VEHICLE FUEL [] 4 OIL B. .~.~.- C. [] la REGULARuNLEADED [] 3 DIESEL [] 6 AVIATION GAS [] 2 PETROLEUM [] 80 EMPTY ~'1 PRODUCT ~[~-~'i~PREMIUMuNLEADED '[][] 45 GASAHOLjETFUEL [] 7 METHANOL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] g9 OTHER (DESCRIBE IN ITEM D. BELOW~ D. IF(A.1) IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED III. TAN K CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. R, AND C, AND ALL THAT APPLIES IN BOX D A. TYPE OF ~-~__~,I~:X)UBLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN . .. '.' ..:- .:... :' ~: :.. " SYSTEM ~ 2~.S.[NGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER '" ;: :: ' ' B. TANK ~ BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95. UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING 'C. INTERIOR [] 5 GLASS LINING ~ UNLINED [] 95 UNKNOWN LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO__ ] 4 PHENOLIC LINING ] 99 OTHER D. CORROSION [] I POLYETHYLENE WRAP [] 2~_COATING PROTECTION [] 5 CATHODIC PROTECTION [::~1 NONE [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC [] B5 UNKNOWN [] ~ OTHER C. MATERIAL AND CORROSION PROTECTION IV. PIPING INFORMATION C~RCL~ .~ IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 ·SUCTION AL_U.U..~2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A/*U'~I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN .~ U 99 OTHER A/U~..~!I BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A tJ 4 FIBERGLASS PiPE A U 5 ALUMINUM .& IJ 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR L~2 LINE T~GHTNESS TESTING [] 3 tNTERSTITIAL MONITORING [] 9g OTHER V, TANK LEAK DETECTION ?' I [~6SUAL[]TANK TESTINGCHECK [-~ 2 INVENTORY RECONCIUATION [] 3 VAPORMONITORING [] 4 AUTOMATICTANKGAUGING [] 5 GROUNDWATERMONITORING~ 7 INTERSTITIALMONITORING [] 99 OTHER ] 91 NONE [] 95 UNKNOWN VI. TANK CLOSURE INFORMATION i ,/ ~_. L~__~// ~_~ ~ SUBSTANCE REMAINING . GALLONS INERT MATERIAL ? TH/S FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW , COUNTY # JURISDICTION # FACILITY # TANK # STATE I.D.# ~ .tc lOl ;t01 c1¢..tlol2.l PE M,T N M,ER.2 0 //.) I PERM,T APPROVED SY,DA,E t PERM,T EXP,RATIO, DATE. FORM B (g-go) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APpliCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO348-R4 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B MARK ONLY [] 1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EA~C.H-TANK SYSTEM, [] 3 RENEWAL PERMIT E~'~ CHANGE OF INFORMATION [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 7 PERMANENTLY CLOSED'ON SITE ~,--'8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I.D.# ~ % B. MANUFACTURED BY: C. DATE INSTALLED(MO/DAY/YEAR)/~,1 t ~* t"~'~ D. TANK CAPACITY IN GALLONS: II. TANK CONTENTS ~FA*~ ISMARKED, COMPLETEtTEM C. ~R-EGULAR ~ 3 DIESEL [] 6 AVIATION GAS A.~L~_J 1 MOTOR VEHICLE FUEL [] 4 OIL B.E~PR~O C.L.~.J UNLEADED 4 GASAHOL [] 2 PETROLEUM [] 8O EMPTY DUCT [] lb PREMIUM UNLE*DED [] [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED ';i-~ 99 OTHER (DESCRIBE"iN i~M'O. BELOW) O. IF(A.1) IS NOTMARKED. ENTER NAME OF SUBSTANCE STORED ' C.A.S.#: III, TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, AND C, AND ALL THAT APPLIES IN BOX D SYSTEM ~ 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER ] 4 SECONDARY CONTAINMENT (VAULTED TANK) ] 99 OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 2 STAINLESS STEEL [~:~"FIBERGLASS [] ~0 ~LVANIZED STEEL [] ~ UNKNOWN ] 4 STEEL CLAD WI FIBERGLASS RE~NFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER [] 1 RUBBER LINED [] 2..ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING INTERIOR [] 5 GLASS LINING ~Tr'6 UNLINED [] 95 UNKNOWN [] 99 OTHER lINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO__ D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ~] 95 UNKNOWN [~iBERGLASS REINFORCED PLASTIC ] 99 OTHER IV, PIPING INFORMATION C~RCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION A~'U ?2 PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A,*t~"~ SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER MATERIAL AND CORROSION PROTECTION A U 1 BARE STEEL A U 2 STAINLESS STEEL ,~ U 3 POLYVINYL CHLORIDE (PVC)A(,'U,~ 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL Wl COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [-'~2 LINE T!GHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION ..~ ' I[] .t~visuAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING ~]'~6 TANK TESTING [] 7, 'NTERSTITIALMONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MOIOAY/YR) 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED 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 T~UE AND CORRECT (PRINTEO & SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW J COUNTY # JUR, ISDICTION # FACILITY # TANK # STATEI.D.#~ OL I©I I PERMIT NUMBER '"~ * ,,7/~ / I PERMIT APPROVED BY/DATE I "~ ×" ': "/,/'.2 I PERMITEXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B-R4 . STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B MARK ONLY [] 1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT COMPLETE A SEPARATE FORM FOR EACHTANK SYSTEM. [] 3 RENEWAL PERMIT ~---~'~5 CHANGE OF INFORMATION [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [] 7 PERMANENTLY CLOSED ON SITE E/8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN I . ~. ¢ B. MANUFACTURED BY: A. OWNER'S TANK I.D.# :.~ ~,-- C. DATE INSTALLED (MO/DAY,YEAR) ,,.// .,,. ~. ~.,.-..~.. D. TANK CAPACITY IN GALLONS: ~.~/ II. TAN K CONTENTS' IF A-1 IS MARKED. COMPLETE ITEM C [] 2 PETROLEUM [] 80 EMPTY RODUCT [] lb PREMIUM ' UNLEADED [] 5 JETFUEL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM D. BELOW D. IF (A.1) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S. #: IlL TANK CONSTRUCTION A. TYPE OF [] I~,,,~USLE WALL SYSTEM [~ SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANIO [] 99 OTHER E BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 STEELCLAD W/FIBERGLASS REINFORCED PLASTIC B. TANK MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLE W/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] , RUBBER L,NED UNL,NEDL'N'"G [] 95 EPO U. .OWN .,N,NG C. INTERIOR [] 5 GLASS LINING L~ 6 [] LINING IS LINING MATERIAL COMPATIBLE WITH ICX)% ME~ANOL ? YES_ NO__ ] 4 PHENOLIC LINING [] 99 OTHER D. CORROSION [] 1 POLYETHYLENE WRAP ~ ~ATING · L/~91 PROTECTION [] 5 CATHODIC PROTECTION NONE [] 3 VINYL W~AP [] 4 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A .~U.x. 2 PRESSURE A IJ 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A .~J~l SINGLE WALL A LJ 2 DOUBLE WALL A LJ 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION O. LEAK OETECTION A ~J'~l BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVlNYL CHLORIDE (PVC)A U 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A ti 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A [I 10 CATHODIC PROTECTION A U 95 UNKNOWN A IJ 99 OTHER [] 1 AUTOMATIC LINE LEAK DETECTOR [~ LINE T~GHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK ~ INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] [] ~ ,NTERST,T, AL MON,TOR,NG [] 9~ NONE [] 95 UNKNOWN [] 99 OTHER I E~ TANK TESTING VI. TANK CLOSURE INFORMATION [ ,] ~ ~ -~ /~ ...~t SUBSTANCE REMAINING GALLONS INERT MATERIAL? THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICANT'S NAME DATE (PRINTED & SIGNATURE~ LOCAL AGENCY USE ONLY THE STATE I.D, NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW I COUNTY # JURISDICTION # FACILITY # ' TANK # [ PERMIT NUMH~R"~'/' i//~ ///' PERMIT APPROVED BY/DATE ,-;,,( ,/ /'_' / ,/ r,/ r/ ,/ ,/ I PERMIT EXPIRATION DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION. FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED, FOROO~4B*R4 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROL BOARD UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. --/ [] 7 PERMANENTLY cLOSED ON SITE MARK ONLY [] 1 NEW PERMIT [] 3 RENEWAL PERMIT ~ 5 CHANGE OF' INFORMATION ONEITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE [~/'8 TANK REMOVED DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN 8. MANUFACTURED BY: ~,~ ? ) ~,. IA. OWNER'S TANK I.D.# ~ C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: ~, ,.. ~, - ~ ,11. TANK CONTENTS iF A-1 IS MARKED, COMPLETE ITEM C. I A, [] 1 MOTOR VEHICLE FUEL [] 4 OIL ....... [] 2 PETROLEUM I---I ~0 EMPTY [] 3 CHEM,CALPRODUCT [] 95 U.KNOW" D. ,F (A.,),s NOT MARKED. ENTER ,AME o~ SUBSTANCE STORED B. E~I PRODUCT ] 2 WASTE 4 GASAHOL ": ~ 7 METHANOL []SJETFUEL :'-- ' "' '- [] 99 OTHER (DESCRIBE IN ITEM D. BELOW) C. [] laREGULAR UNLEADED ] lb PREMIUM UNLEADED IlL TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B. AND C, AND ALL THAT APPLIES IN BOX D A. TYPE OF [~ :...~3UBLE WALL SYSTEM ~ 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] [] 4, SECONDARY CONTAINMENT (VAULTED TANK) [] 95 UNKNOWN -'. !' 99 OTHER B. TANK [~' ~ BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 4 5i~-LCLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] S 100% METHANOL COMPATIBLEW/FRP ., (PrimaryTank) [] g BRONZE I~ 10 ,GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING [~'6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING YES__ NO__ IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? D. CORROSION [] 1 POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION [[~] 5 CATHODIC PROTECTION [~/91 NONE [] 95 'UNKNOWN [] 99 OTHER IV. PIPING INFORMATION C~RCL~ A IFABOVEGROUNDOR U iFUNOERGROUNO, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A/..UU~) 2 PRESSURE A U '3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U' 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U g9 OTHER C. MATERIAL AND A~. ._U~' 1 BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PiPE CORROSION PROTECTION 13. LEAK DETECTION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEELW/COATING A U 8 100% METHANOL COMPATISLEW/FRP A U g GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 9g OTHER [] 1 AUTOMATIC LINE LEAK DETECTOR ~'~i. 2 LiNE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] gg OTHER V. TANK LEAK O~- I ~-CTION ./ [] 1 VISUAL CHECK [~" 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER VI. TANK CLOSURE INFORMATION 1. ESTIMATED DATE LAST USED (MO/DAY/YR) [ 2. ESTIMATED QUANTITY OF 3. WAS TANK FILLED WITH YES [] NO [] ~ . ' '. ,L..~' / SUBSTANCE REMAINING GALLONS iNERT MATERIAL ? THIS FORM HAS BEEN coMPLE. TED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT [ APPLICANT'S NAME (PRINTED & SIGNATURE) ~ . LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW I COUNTY # JURISDICTION # FACILITY # TANK # I PERMIT NUMBE'-~'~ - ' , L TPERM'TAPPROVEDSY'DATE ERM,TE×P FORM B (9-~0~ THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPMCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B-R4 INSPECTION RECORD POST CARD AT JOBSITE 1700 t!'LO ,,,zl~ STREET BAKERSFIELD, CA 93305 PHONE (805) 861-3636 FACILITY ADDRESS 2??0 Nin? Dca4 C I TY P, akersfi e}d.. CA PHONE NO. (9,0~) 292-0203 PERMIT # 270010 ]OWNER ADDRESS CITY ~P£O PRODUCTS'COP'PP~,~ 1.7315 Studebaker Road Cerrito$. CA (213) 404-5300 INSTRUCTIONS': Please call for an inspector only when each group of inspectio3 with the same number are ready. They will run in consecutive order .beginnir with number 1.. DO NOT cover work for any numbered group until all items. ~ that group are signed off by the Permitting Authority. Following 'thee : instrutions will reduce the .number of required inspection visits and therefor prevent assessment of additional fees. · · '..:).'.}:f.'~ - TANKS & BACKFILL - : INSPECTION DATE INSPEC .] Backfill of Tank(s) ]_ Span Test - PIPING SYSTEM - 2 Piping & Raceway w/Collection Sump 2 Co~ro~ion Protection of Piping 3pints, Fill 2 Elect. ica/ Isoia'tion of Piping From Tank(s) ~:~~~i~~~g [2 Pri~., pipinc Presage/Span Test ~ Secondan, Pipinq Press,~e/Soap Test - SECONDARY CONTAINMENT. OVERFILL PROTECTION LEAK DETECTION - 3 Level Gauges or Sensors~ Float Vent Valves 2~ -'. .... 3 Product Compatible Fill Box(es) 3 Product Line Leak Detector(s) 3 Leak Detector(s) for Annular Space-D.W. Tank(s) ~/~/~l' 3 Monitoring Well(s)/Sump(s) ~/~l -w? .h m '-- ' 1! .." 3 Leak Detection De~ice(s) For Vadose/Groundwater t 31Monitoring Wells. Caps il! .Box ~ock ' i 3tMon-{torin~ Requirements & Locks - FINAL - Pactll.ty; Standard Compliance Check /F-Z T Oe~ / O £qulpment to be installed: .,,Z-?/ Tank(s), ._~_~ Ft. of CT [-]Suction surized [-]Gravity, Plp~ Req'd Approv~ed~' j// Proof of Contractor's License - License .~.~ ' Type of License t Proof of Contractor's Worker's Compensation Insurance Primary Containment ~lberglass (FRP) iberglass-clad steel [']Uncoated steel [~Other: Comment: Make & Model j><~.,,d~ ,~ ix_), Make & Model Make & Model Make & Model Additional: Inspection: Secondary,Containment of Tank(s) ~Double-walled tank(s) Make & Model ~<~~ [-]Synthetic llner Make & Model [-]Lined concrete vault(s) Sealer used ["]Other Type .Make & Model Comment: Additional: Inspection: Secondary Containment Volume at Least 100% of Primary Tar Volume(s) Comment: Additional: Inspection: Secondary Containment Volume for More Than One Tar Contains 150~ of Volume of Largest Primary Containment 10% of Aggregate Primary Volume, Whichever Is Great Comment: Additional Inspection: Standard Compliance Check Equlpm'ent to be installed: Tank(s), ~, Ft. of [-]Suction surized ~]Gravity, Pip! Req'd App r o v~}~' !~ Proof of Contractor's License - License # ~/~/~ '-' Type of License ~ Proof of Contractor's Worker's Compensation Insurance Primary Containment Flberglass (PRP) Fiberglass-clad steel [~Uncoated steel [~]Other: Comment: Make & Model~6~.~ Make & Model Make & Model Make & Model Additional: Inspection: Secondary.Containment o[ Tank(s) ~Double-walled tank(s) Make & Model y~y~z~_~ []Synthetic liner Make & Model [']Lined concrete vault(s) Sealer used [-]Other Type .Make & Model Comment: Additional: Inspection: Secondary Containment Volume at Least 100% of Primary Taz Volume(s) Comment: Additional: Inspection: Secondary Containment Volume for More Than One Tar Contains 150~ of Volume of Largest Primary Containment ( 10% of Aggregate Primary Volume. Whichever is Great, Comment: Additional Inspection: Req'd Apprqved Secondary Containment Open to Rainfall Must Accommodate flour Rainfall Total Volume Comment: Additional: Inspection: Secondary Contalnmen~ is Product-Compatible Product ~'Ac~Q/,','3~__///lq~.'tT-/,3,~,~.( Documentation Comment: Additional: Inspection: Annular Space Liquid is Compatible with Product Product Comment: Additional: Annular liquid Inspection: Primary. Containment of Piping ~Fiberglass piping ~]Coated steel piping ~Uncoated steel piping OOther Size & Make Size & Make Size Comment: Additional: Inspection: L/~ Seco ntatnment of Piping n~You~e-wa 1 ]ed pipe Size & Make~-~('?, [~Synthettc liner in trench Size & Make~ ' -- ' [~Other Comment: Additional: Inspection: Corrosion Protection [~Tank(s) []Piping & fittings ~-]£1ectrtcal Isolation Comment: Additional: i/ii Inspection: anufacturer-Approved Backfill for Tanks & Piping Type ~C~/~ -~"{~Ac)~I Comment: Req'd Approved Additional: Inspection: Tank(s) Located no Closer than 10 Feet to Building(s) Comment: Additional: Inspection: Complete Monitoring System Monitoring device within secondary F']Liqutd level indicator(s) ["]Liquid used · OTher.al conductivity~s~sor(s) ~Pressure sensor(s) .._ ~]Vacuum gauge s u · p ( s ) ~~ ~ ~ ~ Gas or vapor detector(s) Manual inspection & sampling S V tsual inspection Other containment: Comment: Additional: Inspection: Other Monitoring ~]Perlodic tightness testing Method ~Pressure-reducing line leak detector(s) ~.~ ~,~'T-- E]Other Comment: Additional: Inspection: Overfill Protection [-]Tape float gauge(s) loat vent valve(s) apacltance sensor(s) ~']High level alarm(s) [-]Automatic shut-off control(s) oFtll box(es) with 1 ft. 3 volume perator controls with visual level monitoring Other Comment: - 3 - Approved Additional: Inspection: Monitoring Requirements Additional Colments Inspection: Inspector Date - 4 - Extra Inspectlons/Relnspectlons/Consu]tatlons Date: Purpose: Connent: Date: Tine Utilized Purpose: Connent: Date: Tine Utilized Purpose: Comnent: Date: Tine Utilized Purpose: Comnent: Invoice Date: Inspector - 5 - Time Utilized Total Tine: Date: Permit Application Checklis~ Facility Name Facility Address Applicatiop-"'Category: ~Standard' Design (Secondary Containment) Motor Vehicle Fuel Exemption Design (Non-Secondary Containment) Appro~ Permit Application Form Pr~perl~ Completed Deficiencies: ,J 3 Copies of Plot Plan pepictinq: Propert~-llnes Area encompassed by. min'imum 100 ~oot rad'ius around tank(s) and piping Ail tank(s) identified by a number and product to be stored Adequate scale (minimum 1"=16'0'' in detail) North arro, w Ail structures within 50 foot ra'dius 'of tank(s) and piping Location and labeling of all product piping and 'dispenser islands Environmental 'sensi~ivfty d~ta including: ~ *Depth to first groundwater at site ~C~ *Any domestic or agricultural water well within 100 feet of tank(s) and piping *Any surface water in unlined conveyance within 100 ~eet of tank(s) and piping *All utility lines within 25 feet of tank(s) and piping (telephone, electrical, water, sewage, gas, leach lines, seepage pits, drainage systems) *~Stkri~ked i'~ems:' appr'opri~te' documentation ~f/pk~m'i'tt-ee seeks a motor vehicle fuel exe~pti6n ~rom ~econdary containment Comments: ApproX. 3 copies of construction Drawings Depicting: Side View of Tank ~n--~ailati0n'with Backfill, Raceway(s), Secondary Containment and/or Leak Monitoring System in Place Top View of Tank Installat'ion 'with Raceway(s), Secondary Containment and/or Leak Monitoring System in Place Materials List (indicating those used in the construction): Backfill Tank (s) Product ~ipin~ Sealer(S) Secondary Contai'nment Lea'k Detector(s) Overfi'll Protecti'on 'l Gas or Vapor Detector(s) Sump(s) , ~r_.~_ c> m ~ ~% ,%...~--.~ ~ .,,D~__ ~ ,~,~ <~ Monitoring Well(s) ~t J ~'Ac, %~ .C~-,'-~..~~-- Additional: Documentation of Product Performance Additional Comments Reviewed By SITE INSPECTION: Comm en ts: Approved Disapproved Inspector Date Facility Na~e /4/-~._~, ?-,~/A,'., -~ 0~.~ _. / PINAL IN.~PECTION ClIECKLIST N Plot plan notes 1. All new and existlng tanks located on plot plan? 2. Does tank product correspond to'product labels on plot plan? 3~.. .... Was there no modifications identified which were If "No" described ------~~__ ...... ~ ...... Yes No Are Ionitoring wells secure and free of water and product in sump? 5. Is piping system pressure, suction or gravity? 6. Are Red Jacket subpumps and ail line lea' det tot accessible?' Type of line leak detector If any Yes No Overfill containment box as specified on :.~pl£catlon? 'If "No", what type and model number: a) c) Identify type of monitoring: Is fill box tightly sealed around fill tube? Is access over water tight? Is product present in fill box? a) Are manual monitoring instruments, produc~ and water finding paste on premises? b) Is the fluid level in Owens-Corning liquid level mo~-i-t-o-r~ng--rt~ervoir-'and alarm-panel--in-proper- operating condition? c) Does the annular space or secondary containment liner leak detection system have self diagnostic capabilities? If "Yes", is it functional If "No", how is it tested for proper operating condition? 9. Notes on any abnormal, conditions: FROrN~GTI B~KER.F 01,~0,199~1:05. HO, 5 P, 1 / GROUNDWATER TECHNOLOGY, INC. 410! Alkcn Street, Suite B-l, g ~kt r s,~elJ, CA 93308 F~.,¢: (8051 FACSIMILE COVER SHEET Attn:_ ~'~,~ Ay Company Name: Locat[on:. FAX No,: Job Name: Job No.: Cover + P~ge$ Phone No.: FAX No.: (805) (805) 589-8~05 COMMENTS: FROM GTI B~KERSFIELD /. .... 01130,19 11:05 NO, 5 P, 2 GROUNDWATER TECtt OLOGY, I C. 4101Alken Street, Suit~ B-l, BaRer$fidd, CA 92~308 (805) 589-8601 Fax', (805) 589-8605 ~anuary29, 1991 Mr. Wesley Nicks Hazardous Materials Specialist Kern County Resource Management Agency Department of Environmental Health Services 2700 M Street, Suite 300 Bakersfield, California. 93301 RE:. Soil Pile, ARCO Facility #0583, Ming Avenue and Wible Road, Bakersfield, California Dear Mr. Nicks: ' Whitten Excavation would llke to transport soil generated during tank excavation activities at the above-referenced site to a Class III landfill in Bakersfield. Groundwater Technology proposes the following sampling scheme in an effort to characterize the soil. Sampling will be done within a 20-foot by 20-foot grid as shown in figure 1. Each block will be divided into four quadrants and a sample will be collected from each quadrant. The four samples for a given block will be. composited in the laboratory (40 samples composited into 10). Each composite will be analyzed for BTEX and TPH as gasoline. Laboratory analyses will be eXpedited and the results forwarded to the County upon receipt. ~ A separate soil pile in the southeast corner of the property is suspected of containing This soil was generated from excavation near the service islands and the hydrocarbons~ n southern porUo of the tank pit. ARCO has made arrangements with Falcon Environmental for the. disposal of this soil to the GSX facility in Buttonwillow. If you have any questions, please contact me at (805) 589-8601. Sincerely, Groundwater Technology, Inc. ~an D. Parker, R.G. Project Manager cc: Kateri Luka, ARCO $ig~ Fooling New ~----~ '- Building .... Ming Ave~e New ~ IlO I (3nE ~g LEGEND N I I 20' O li0' 2(3" IJ3~ # 215 Arco SS i/~058.~ pso 06.05 uric, ;5220 Ming Avenue Bakersfield, California ]Ym S~mpling Grid o GROUNDWATER TECHNOLOGY, INC. 410i Alken Street. Sulfa B.1. B,kor.~fi¢ld. CA 9.3508 ($05) 5S9.,~601 FACSIMILE COVER SHEET · Company Name: Location:_ FAX No.:_._k~(~.t · Job Name: A-~.~,,, ~;s ~,¢<%:A_ Job No.: Cover + 75 Pages Phone No.: FAX No' (805) 589-8601 (805) 5S9-8605 SMC Anal>.tica] Che!~ ~:.stry Groundwater Technology Inc. 4080 Pine Lake Concord Ca. 94520 A%{ent,,~on t Jori Parker D~e samples received ~ 1-31-91 D~e a. nalyS~s completed~ 2-01~91 P~,.'.,~C:Ct Name~ Arco Service Station ~ 0583 ProJoct, i~ , :215-350-0605 9=:~,r,I.TS OF ANALYSIS: Composite of %'s. 538, 539, 540,~41 ID: EI,E2,E~,E4 Benzene ND Toluene ND Ethylbcnzene ND p-X¥1ene ND m-Xylene ND o-Xy!ene 0.00g Isopropyl~enz~ne ND TPH (Gasol'[ne) ND (Diesel' #2) MDL,ugm/gm 0.005 0.005 0.005 0.005 0.00§ 0.005 0.005 1.0 70.7 10. M~',,',4 of Analysis for BT~/TP~ (Sasollne)~ 5030/8020 Met]'~C,~ of Analysis for ?PH (Diesel)~ 5030/8020 (PID) MI)L = Minimum Detection Level TP[{ = Total Petroleum Rydrocarbons ND = None Detected Ar.~3~'~,~cal Chernis~ 315.5 Pegasus Drive · ~.~kersfield, CA 93308 P.O. l~k>x 80835 · Bakersfield, CA 93380 · (805) 303.3507 (805) 393-3523 SMC Analytical Che:¥' istry Groundwater TechnoLogy 4080 Pine Lake Concord Ca. 94§20 A. tto~b~on I Jori Parker D~I'~ anaZ~$~$ completed: 2-0!-9! D~- of report : 2-01-91 P~ ~..~.:, Name: Arco Service Station $ 0583. P].'cje~.~ $ . 215-$$0-0605 R~'::'.L:'f,T$ OF ANALYSIS~ Compo.~e of $'s 534,~5,536,537 ID~ D1,D2,D3,D4 u~/~m M~L,ugm/gm Benzene ND 0.005 Toluene ND 0.005 ~bhylbenzene ND 0.005 D_Xylene ND 0.005 ~-Xylene ND 0.005 o-Xylene ND 0,00~ Tsopro~yl~nzene ND 0.005 rPH (¢.~ol~ne) ND 1.0 · l'P~ (Diesel $2) 11.6 10. ~e~h~,a of An~ly$~s for BTX/TPH (Gasoline): ~030/8020 Me~b,':d of Analy$~$ for TPM (Dte$~l): 5030/8020 (PID) M~, = M~n~.mum Detection Level T:...'i~ = To~al Petroleum Rydrocarbon8 u.!~!'.../~m .~ m~crogr~ms per gram (pp.m) 3155 Pegasus F3rtva · B~aktrsfl,!!d, CA 93308 P.O. 8o~ 8f)835 + Ba'<ari~,eid. CA 93380 (805) 393-3597 FAX (805) 393-3623 I"1 0 SMC Analytical Ch(::',', ;' tly Cl{~nt Mame~ Groundwater Technology X,.~.:r~'.ss { 4080 Pine Lake Concord Ca. 94520 Af.I.~ntton ~ Jori Parker I]%C, r:~:~' .s~mple~ 'received : I~31-91 D.::.~ analysts completed: 2-01-9! D.,,.e of re~or~ ~ 2i01-91 ~*,:,J¢,¢~ Name~ Arcg Service SbaSton ~ 0583 p~:'<r'l.T$ 0P ANALYSES: Cnmpoatte of %'s 546,547,548,549 .ID~ ~I,~2,G3,G4 ugm/gm MDL,ugm/§m 'Fenzene ND 0.00~ Toluene ND 0.005 E%hylbenzene ND 0.00S p-X¥1ene ND 0.005 m,X~lene ND 0.00~ o-Xylene ND 0.005 Isopropyl. benzene ND 0.005 · 3'P I1' (Gasoline) ND 1.0 {Diesel #2) ND I0.0 of Analysis for BTX/TPH (Ga~oliqe): 5030/8020 of Analysts for TP~ (DieseI)~ 5030/8020 (PIS) M~n~mum De%cotton Level Total P~%roleum E~drocar%ons m m~cr~r~m~ pe~ gram (p~m) ~one DetecLed <PID) $ +..', :) Comer '~ A~.~;.~lytical Chemisb P.O. Ec.,x 80835 · Bakersfie)d, CA 93308 E~:kersfield, CA 93380 ·(805) 393.3597 FAX (805) 393-3623 SMC. Laboratory Analytical C~'nb Name~ Groundwater Technology Inc. Ad,~r,~ ~ 4080 Pine Lake Concor~ Ca.. g4~20 A~.L~.r,~oton t Jori P~rker samples r~ceived ~ 1-31.-91 analysis completed: 2-01-91 of ~epor~ , 2-01-g! ~.,~r.-e% ~ame:-A.r¢o service Stab, ion % 0583 R¥'~,~;],1'$ OP ANALYSIS: O~mposite of 9's 542,543,544,§4§ ID~ F1,F2,F3,F4 ugm/gm MDL,ugm/gm Benzene ND o 0.005 Toluene ND 0..005 ~hylbenzene. ND 0.005 p-Xylene ND 0,005 m-Xylene ND 0.005 o-Xylene ND 0.005 r~opropyl~enzene ND 0.005 (gasoline) ND 1.0 ~'mH (Diese~ ND 10.0 M~.LI',Od of Analysis for BTX/TPM (Gasoline), 5030/8020 Mr~h~"~d of Analysis for TPH (Diesel)~ 5030/8020 (.PID) MT,~.'= Minimum De~ection Level Ti.~I · Total Petroleum H~drocarbons u~/~m = micrograms per gram (ppm) N~, ~ None De~e¢~ed · Bakersflel4, CA 93308 393..3.597 393.3623 SMC Laboratory Analytical Name: Groundwater Technology : 4080 Pine Lake Concord Ca. 94520 parker D^~ ~a~ples receive~ ~ 1-31-91 D,,~ analysis completed: 2-01-91 D~t,:? of repor~ ~ '2-01-91 Pr.','.J,.~.ct Name: Arco Service $~atton $ 0583 Prc, J~,cr., $ , 215-350-0605 R,t"':,Lii,TS 0P ANALYSIS: Composite of $'$ 550,551,552,553 ID: Jt,J2,J3,J4 ugm/gm MDL,ugm/gm Bet~zene ND 0.00~ Toluene ND O. 005 ~'.L. hylbenzene ND 0. 005 p-Xylene ND 0,005 m-Xylene ND 0. 005 o-Xylene ND 0. 005 ? .~$ ap ropy lbe~ zene ND 0. 005 TPH (Gmsoline) ND 1.0 (Diesel #2) 91.7 ~0.o Me~bc4 of Analysis for BTX/TPM (Gasoline): 50D0/8020 M~!,~,:,,~ of Analysis £or T~N (Diesel): 5030/8020 (PID) Mr,{. = Minimum Detection Level T;'~; = Total Pebroleum Mydroearbons u!~v'gm = m~crog~am$ Per gram (ppm) Nr~ -: None Detected Stan Comer 3155 Pegasus Drive P,O, Box 80835 · · L:~l<ersfldd, CA 93308 ~kersfie!d, CA 93380 . ·(805) ~93-3597 FAX (80.5) 393-3623 AtlanticRIchfleldCompany Facsimile Transmission Out~oin~ ID:ARCO PETROLEUM PROD From --'1-'-' TEL N0:213 484 5~42 ( Cost center LOCation From ~579 PO1 Incoming Time Comment,~ ~. I~l'uml;)ar of Pa{ill Time Comments Ir"t 1.m. 1:3 p.m. OI3erator's inlfilll 66-6 initials