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HomeMy WebLinkAboutUNDERGROUND TANKPrevention Services Unified Permit SUBJECT TO CONDITIONS OF' PERMIT Issued by: THIS PERMITIS ISSUED FORTHE FOLLOWING: .... ,,.-~. ;' 7~ ;..' ." '..-~'.-.'?'~'..,,~,~. [] Hazardous Materials Plan r~r~mBl.-r ~m --~,~=n,~4 ~'~n,)~d'~ ..,~:,? ' ';; ..~.~, ........ .~:.~ -'..?..%. ~ Underground Storage of Hazardous Materials r~n~m~ ,u ~, ~, ~, ~ _.?..~"~ ~. ~:' ~?'::~% ~ ~'?; ~:%,:.:. '. :~ ...... 0 California Accidental Release Program ~.. ~. ~ ~..~:::, ~,~ ~..~ , ........ ~. ..... =%. 0 Hazardous Waste Generator and/or Treatment COSTCO 0688 ~',, ~ ~ .¢' ~,~',~EEj ....~';:;~.~ ......... :'... :~ 75'~.:.:,,~?~-; ~ '-: ." ":~:.. ~ Above ground Storage Storage of Petroleum ~ ,. ~. =~. .- ,. ,, ....... ,.. > · . .... .... ~ P Y 3800 ROSEDALE HWY. ~. ~'. 95 ~, .~' ~.v- ' "~" , '~.;~'~.~ ~,:~'";~.%' ~. D Industrial Hood Suppression System ~-, .... BAKERSFIELD. CA 93301 2. ~ular unlade, 20~- 3. premium unlade, 20k'7 ~nk DWI. -~ . ....~? :~; . ~,.~.. , ~...~.:~"' ~4 ~ 5~ , .... .~. %~"' · . '~c~.:.':.. .-.. .'' Bakersfield Fire Department OFFICE OF PREVENTION SERVICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 852-2171 Approved by: Expiration Date: ph Huey, Director Prevention Services June 30, 2006 Id17: Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This i)ermit is issued for the following: E] Hazardous Materials Plan [3 Underground Storage of Hazardous Materials [3 Risk Management Program PERMIT ID # 015-021-002412 [3 Hazardous Waste On-Site Treatment COSTCO, WHOLESALE ' LOCATION:' 3800 ROSED^I.E ~ ~? Li~ BA~ ~ CA 93308 :~ , ~ ,~. ..... ~ ~, ,.~ ~. ,~, Re~, Reg~..U~ -.~ ..... , Issued by: Bakersfield Fire Depa~ment OFFICE OF EN~RONMENTAL SER ~CES' '11 ~ ~s Chester Ave., 3rd Floor Approv~by: ~ . ~ ~P~ ~ Issue ~te Bakersfield, CA 93301 ~~-- ( > - Exp~'io, Date: ~D I CA Cert. No. 28511 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (66 I) 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 information may be added as deemed necessary by the local agency. This permit is issued on this 30th day of July 2002 to: COSTCO WHOLESALE Permit #015-021-002412 3800 ROSEDALE HWY Bakersfield, California 93308 March 16, 2004 Bakersfield Fire Department 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 Re: Evidence of Financial Responsibility for the Costco Wholesale Corporation gas station No. 688 - 3800 Rosedale Highway, Bakersfield, CA 93301 Costco Wholesale Corporation is changing the type of financial assurance mechanism for their gas stations in California from a financial test of self-insurance to an insurance certificate. To that end, I have attached a Zurich American Insurance Company "Certificate of Insurance Storage Tank Systems". The insurance mechanism is effective until July 1,2004. If you have questions, please call me at (425) 427-7653. Thank you, Costco Wholesale Corporatio_9.Q~ Dennis Bock Compliance Manager C: W688 Gas Station Supervisor Gas Operations File 999 Lake Drive · Issaquah, WA 98027 · 425/313-8100 · www. costco.com Certificate Of Insurance Storage Tank Systems ZURICH Policy No. USC 5392991 Eft. Date of Poi. Exp. Date of Poi. I Eft. Date ofEnd.I Producer 06/01/03 07/01/04 [06/01/03 [ 18-35,6-000 111,915.00 Add'l Prem. Retum Prem. Named Insured and Mailing Address: COSTCO WHOLESALE CORPORATION 999 LAKE DRIVE ISSAQUAH Producer: Sub-Producer: MARSH INC (WA) 1215 FOURTH AVENUE WA 98027 SEATTLE WA 98161 CERTIFICATE: 1. Zurich American Insurance Company, the Insurer, as identified above, hereby certifies that it has issued liability insurance covering the following underground storage tank(s): Per Attached Scheduled Locations and Scheduled Storage Tank(s) Systems for taking corrective action and compensating third parties for bodily injury and property damage caused by accidental releases; in accordance with and subject to the limits of liability, exclusions, conditions, and other terms of the policy; arising from operating the underground storage tank(s) identified above. ' The limits of liability are $ 10,000,000 each occurrence and $ 50,000,000 annual aggregate, exclusive of legal defense costs which are subject to a separate limit under the policy..'This coverage is provided under Policy # USC 5392991 ... The effective date of said policy is 06/01/03 2. The Insurer further certifies the following with respect to the insurance described in Paragraph 1: a. Bankruptcy or insolvency of the insured shall not relieve the Insurer of its obligations under the policy t6 which this certificate applies. b. The Insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of corrective action or a damaged third party, with a right of reimbursement by the insured for any such payment made by the Insurer. This provision does not apply with respect to that amount of any deductible for which coverage is demonstrated under another mechanism or combination of mechanisms as specified in 40 CFR 280.95-280.102. c. Whenever requested by a Director of'an implementing agency, the Insurer agrees to furnish to the Director a signed duplicate original of the Policy and all endorsements. d. Cancellation or any other termination of the insurance by the Insurer, except for non-payment of premium or misrepresentation by the insured, will be effective only upon written notice and only after the expiration of 60 days after a copy of such written notice is received by the Insured. Cancellation for non-payment of premium or misrepresentation by the Insured will be effective only upon written notice and only after expiration of a minimum of 10 days after a copy of such written notice is received by the insured. e. The insurance covers claims otherwise covered by the Policy that are reported to the Insurer within six (6) months of the effective date of cancellation or non-renewal of the Policy except where the new or renewed policy has the same retroactive date or a retroactive date earlier than that of the prior policy and which arise out of any covered occurrence that commenced Copyright © 1999 by Zurich American Insurance Company U-ENVL-151-A CW (1/99) Page I of 2 All fights reserved. No part of this document covered by the 'copyrights hereon may be reproduced or copied in any form by any means - graphic, electronic, or mechanical, including photocopying, taping or information storage and retrieval systems - without written permission of the Zurich American Insurance Company. 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, or eligible to provide insurance as an excess or surplus lines insurer, in one or more states. Roger E. Brenner Assistant Vice President Authorized Representative of Zurich American Insurance Company One Liberty Plaza, 53ra Floor New York, New York 10006 U-ENVL-151-A CW (1/99) Page 2 of 2 Endorsement # Scheduled Storage Tank System(s) Retroactive Date(s) ZURICH Policy No. USC 5392991 Eff. Date of Poi. 06/01/03 Exp. Date of Poi. Eff. Date of End. Producer 07/01/04 06/01/03 18-356-000 Add'l Prem. Return Prem. Named Insured and Mailing Address: COSTCO WHOLESALE CORPORATION MARSH lNG (WA) 1215 FOURTH AVENUE 999 LAKE DRIVE ISSAQUAH SEATTLE WA 98161 WA 98027 Producer: Sub-Producer: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided by the following: Storage Tank System Third Party Liability And Cleanup Policy In consideration of the payment of premium and thc Deductible by you and in reliance upon the statements in the Application made a pa~ hereof, we agree with you, subject to all the terms, exclusions and conditions of the policy, that the Declarations shall be amended to include the following "scheduled storage tank system(s)": SEE ATTACHED SCHEDULE The "retroactive date" shall be the earliest date that a "release" can occur for coverage to be provided under the policy. If no entry appears in the "retroactive date" then the "retroactive date" shown in the Declarations shall apply or if N/A appears in the "retroactive date" then a "retroactive date" shall not apply to the policy or that specific "scheduled storage tank system(s)". All other terms and conditions of the policy shall apply and remain unchanged. Signed by:. Authorized Representative Date Copyright © 1999 by Zurich American Insurance Company U-ENVL-158-A CW (1/99) Page I of 1 All rights reserved. No part of this document covered by the copyrights hereon may be reproduced or copied in any form by any means - graphic, electronic, or mechanical, including photocopying, taping or information storage and retrieval systems - without written permission of the Zurich American Insurance Company. Storage Tank Systems Quote # 080155705 Named Insured: COSTCO WHOLESALE CORPORATION Policy# USC 5392991 ID# NAME ADDRESS 006 COSTCO 1160 SAXON DRIVE TANK# TP INSTALL RETRO LIMITS DED 00 UST 04/02/98 04/02/98 10,000,00/50,000,00 50,000 01 UST 04/02/98 04/02/98 10,000,00/50,000,00 50,000 02 UST 04/02/98 04/02/98 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 ID% NAME ADDRESS 010 COSTCO 330 W DIMOND BLVD TANK# TP INSTALL RETRO LIMITS DED 00 UST 09/11/01 09/11/01 10,000,00/50,000,00 50,000 01 UST 09/11/01 09/11/01 10,000,00/50,000,00 50,000 02 UST 09/11/01 09/11/01 10,000,00{50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 CITY SEATTLE CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY ANCHORAGE · CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 013 COSTCO 10000 MICKLEBERRY RD SILVERDALE TANK# TP INSTALL RETRO LIMITS DED CONTENTS CAPACITY 00 UST 12/11/97 12/11/97 10,000,00/50,000,00 50,000 UNLEADED GASOLI 20,000 01 UST 12/11/97 12/11/97 10,000,00/50,000,00 50,000 UNLEADED GASOLI 20,000 02 UST 12/11/97 12/11/97 10,000,00/50,000,00 50,000 UNLEADED GASOLI 20,000 ID# NAME ADDRESS 017 COSTCO 2828 CHAD DRIVE TANK# TP INSTALL RETRO LIMITS DED CONTENTS CAPACITY 00 UST 10/25/00 10/25/00 10,000,00/50,000,00 50,000 UNLEADED GASOLI 30,000 01 UST 10/25/00 10/25/00 10,000,00/50,000,00 50,000 UNLEADED GASOLI 30,000 02 UST 10/25/00 10/25/00 10,000,00/50,000,00 50,000 UNLEADED GASOLI 30,000 ID# NAME · ADDRESS 019 COSTCO 4299 MERIDIAN ST CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 INSTALL RETRO LIMITS DED UST 03/07/01 03/07/01 10,000,00/50,000,00 50,000 UST 03/07/01 03/07/01 10,000,00/50,000,00 50,000 UST 03/07/01 03/07/01 10,000,00/50,000,00 50,000 TANK# TP 00 01 02 ID% NAME 022 COSTCO TANK# TP INSTALL RETRO LIMITS DED 00 UST 05/11/99 05/11/99 10,000,00/50,000,00 50,000 01 UST 05/11/99 05/11/99 10,000,00/50,000,00 50,000 02 UST 05/11/99 05/11/99 10,000,00/50,000,00 50,000 ID% NAME ADDREss 025 COSTCO ADDRESS 14601 VALLEY CENTER DR CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 2200 HARVARD WAY TANK# TP INSTALL RETRO LIMITS DED 00 UST 12/19/98 12/19/98 10,000,00/50,000,00 50,000 01 UST 12/19/98 12/19/98 10,000,00/50,000,00 50,000 02 UST 12/19/98 12/19/98 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 30,000 UNLEADED GASOLI 30,000 UNLEADED GASOLI 30,000 ADDRESS 222 MARTIN LUTHERKING BLVD CONTENTS CAPACITY UNLEADED GASOLI 30,000 UNLEADED GASOLI 30,000 UNLEADED GASOLI 30,000 ID% NAME 035 COSTCO TANK# TP INSTALL RETRO LIMITS DED 00 UST 06/21/97 06/21/97 10,000,00/50,000,00 50,000 01 UST 06/21/97 06/21/97 10,000,00/50,000,00 50,000 02 UST 06/21/97 06/21/97 10,000,00/50,000,00 50,000 CITY EUGENE CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY BELLINGHAM CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY VICTORVILLE CITY RENO CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY LAS VEGAS CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 041 COSTCO 1900 SANTA ROSA AVE SANTA ROSA TANK# TP INSTALL RETRO LIMITS DED ST ZIP WA 98188 ST ZIP AK 99515 ST ZIP WA 98383 ST ZIP OR 97408 ST ZIP MI 48823 ST ZIP CA 92392 ST ZIP NV 89502 ST ZIP NV 89106 ST ZIP CA 95407 CONTENTS CAPACITY CONSTRUCTION 1 684 COSTCO 1701 DALLAS PKWY TANK~ TP INSTALL RETRO LIMITS DED 00 UST 09/27/01 09/27/01 10,000,00/50,000,00 50,000 01 UST 09/27/01 09/27/01 10,000,00/50,000,00 50,000 02 UST 09/27/01 09/27/01 10,000,00/50,000,00 50,000 CONTENTS UNLEADED UNLEADED UNLEADED CAPACITY GASOLI 20,000 GASOLI 20,000 GASOLI 20,000 ID# NAME 685 COSTCO ADDRESS 801 S PAVILLION CENTER DR TANK# TP INSTALL RETRO LIMITS DED 00 UST 10/03/01 10/03/01 10,000,00/50,000,00 50,000 01 UST 10/03/01 10/03/01 10,000,00/50,000,00 50,000 02 UST 10/03/01 10/03/01 10,000,00/50,000,00 50,000 CONTENTS UNLEADED UNLEADED UNLEADED CAPACITY GASOLI 20,000 GASOLI 20,000 GASOLI 20,000 PLANO CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY LAS VEGAS CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 686 COSTCO 9404 CENTRAL AVE MONTCLAIR CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 TANK# TP INSTALL RETRO LIMITS DED 00 UST 12/10/01 12/10/01 10,000,00/50,000,00 50,000 01 UST 12/10/01 12/10/01 10,000,00/50,000,00 50,000 02 UST 12/10/01 12/10/01 10,000,00/50,000,00 50,000 CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 688 COSTCO 3800 ROSEDALE HWY BAKERSFIELD CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 TANK# TP. INSTALL RETRO LIMITS DED 00 UST 08/08/02 08/08/02 10,000,00/50,000,00 50,000 01 UST 08/08/02 08/08/02 10,000,00/50,000,00 50,000 02 UST 08/08/02 08/08/02 10,000,00/50,000,00 50,000 CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 689 COSTCO 5611 UTSA BLVD SAN ANTONIO TANK% TP INSTALL RETRO LIMITS DED 00 UST 11/02/01 11/02/01 10,000,00/50,000,00 50,000 01 UST 11/02/01 11/02/01 10,000,00/50,000,00 50,000 02 UST 11/02/01 11/02/01 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 ID# NAME 690 COSTCO ADDRESS 27220 HEATHER RIDGE RD TANK% TP INSTALL RETRO LIMITS DED 00 UST 06/05/02 06/05/02 10,000,00/50,000,00 50,000 . 01 UST 06/05/02 06/05/02 10,000,00/50,000,00 50,000 02 UST 06/05/02 06/05/02 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 ID#. NAME ADDRESS 691 COSTCO 10000 W MCDOWELL RD TANK# TP INSTALL RETR0 LIMITS DED 00 UST 10/10/02 10/10/02 10,000,00/50,000,00 50,000 01 UST 10/10/02 10/10/02 10,000,00/50,000,00 50,000 02 UST 10/10/02 10/10/02 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY LAGUNA NIGUEL CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD CITY AVONDALE CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 694 COSTCO 1051 HUME WAY VACAVILLE TANK#. TP INSTALL RETRO LIMITS DED 00 UST 12/05/02 12/05/02 10,000,00/50,000,00 50,000 01 UST 12/05/02 12/05/02 10,000,00/50,000,00 50,000 02 UST 12/05/02 12/05/02 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD ID# NAME ADDRESS CITY 760 COSTCO 7251 CAMINO ARROYO GILROY TANK# TP INSTALL RETRO LIMITS DED 00 UST 02/28/03 02/28/03 10,000,00/50,000,00 50,000 01 UST 02/28/03 02/28/03 10,000,00/50,000,00 50,000 02 UST 02/28/03 02/28/03 10,000,00/50,000,00 50,000 CONTENTS CAPACITY UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 UNLEADED GASOLI 20,000 21 CONSTRUCTION FIBERGLASS CLAD FIBERGLASS CLAD FIBERGLASS CLAD TX 75093 ST ZIP NV 89144 ST ZIP CA 91763 ST ZIP CA 93308 ST ZIP TX 78249 ST ZIP CA 92677 ST ZIP AZ 85323 ST ZIP CA 95688 ST ZIP CA 95020 August 4, 2004 Mr. Joe Isles Costco g0688 3800 Rosedale Hwy. Bakersfield, CA 93308. FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3911 FAX (661) 852-2170 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661 ) 85'2-2170 PREVENTION SERVICES FlEE SAFETY SJlVlCF~ · ENVIRONJ~ENTA), SEIIVICES 900 Truxtun Ave., Suite 210 Bakersfield. CA 93301 VOICE (661 } 326-3979 FAX (661) 852-2171 FIRE INVESTIGATION 1715 Chester Ave., 3'u Floor Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 852-2172 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661J 399-5763 REMINDER OF NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Dear Mr. Isles: Our records indicate that your annual maintenance certification on your leak detection system will be past due on 08-26-04 You will be 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 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 SBU/db Cozt:c:o b,Jholes,ale 688 3800 Rc, zedal e B,aker'~f' i e 1 d.. CA HAR 24.. 21104 2:35 i:'H S¥'STEf,.,1 STATUS REI::'O~T ALL FUNCTIONS NORHAL I N'v'ENTOR'g REPORT T l:Unleaded VOLUNE =' I 1'748 GALS ULI ~,E;E = 8203 GALS 915 JLLAGE= 620'7 GALS TL~,LUHE = 11585 GALS HEIOHT = 67.68 INCHES I.,,JATEF: ",,"GL = 0 GALS T, iEPI}:' = ?'9.7 ~T ~_.aJt-,l eaded VOLUHE = 11983 GALS ULLAGE - 7968 GALS 98~.g ULLAGE~ 5972 GALS TC VOLUHE = 11813" " HEIGHT = 68.77 INCHES kilTER VOL = 0 GALS MATER = O. O0 INCHES TEHP = 80.2 DEG"F' T 3 :~t-'erni Mm VOLUHE = 9016 o' -, ULLagE = 1093~ 90~ ULLAGE= 8989 c','" osLS TC VOLUHE = 8944 HEIGHT = 55.21 INCHES MRTER VOL = 0 G~LS .~RTER = 0.00 INCHES TENP = 71.3 DEG F SECTION 1. Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 v _ PHONE No. No. of Employees 't4 7 FACtLITYCONTACT Business ID Number 15-021- ~.Combined [] Joint Agency ~ Multi-Agency [] Complaint [] Re-inspection Routine C V (' C=Compliance '~ OPERATION ~. V=Violation [. [] APPROPRIATE PERMIT ON HAND ,j~ [] BUSINESS PLAN CONTACT INFORMATION ACCURATE .~ [] VISIBLE ADDRESS ~L [] CORRECT OCCUPANCY [~ [] VERIFICATION OF INVENTORY MATERIALS .~ [] VERIFICATION OF QUANTITIES j~r [] VERIFICATION OF LOCATION  [~ PROPER SEGREGATION OF MATERIAL  [] VERIFICATION OF MSDS AVAILABILITYE ~ [] VERIFICATION OF HAT MAT TRAINING ~.. [] VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES  [] EMERGENCY PROCEDURES ADEQUATE ,,,~' [] CONTAINERS PROPERLY LABELED ~ [] HOUSEKEEPING ~L [~ FIRE PROTECTION ,~ ~ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: [] YES ,~No EXPLAIN: COMMENTS QU~INSPECTION? PLEASE CALL US AT (661) 326-3979 White - Environmental Services Yellow - Station Copy Pink - Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CllECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE ~/Z~'dk'/O'4'' Section 2: Underground Storage Tanks Program Routine /~Combined I~ Joint Agency Type of Tahk Type of Monitoring [21 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 tile ~-N Permit tees current ~ Certification of Financial Responsibility < Monitoring record adequate and current ~ Maintenance records adequate and current )~ Failure to correct prior UST violations [,/ Has there been an unauthorized release? Yes No 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 A'd~quate secondary protection Proper tank placarding/labeling |s tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C=Compliance V=Violation Y=Yes N=NO Office.~m:n~"al-Se-rvi~,J1, 3F3~.....' W~i,e-Env. Svcs. Pink - Business Copy Business Site Responsible Party Postage Certified Fee Postmark r-1 Return Reclept Fee Here  (Endorsement Requirod) Restricted Delive~J Fee (Endorsement Required) ILl Total Postag?~ ~/~.,'''-° , cos,~co 1 ~- r~5~:~z'? 3800 Rosedale Hwy. '1 ~'~[~;;~-;}~'~ Bakersfield, CA 93308 - · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address_~n the reverse so that we can return the c-.,~to YO~- · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: [] Agent [] Addressee Date of Delivery D. Is delivery address different from Item 17 [] Yes ff YES, enter delivery address below: [] No Costco 3800 Rosedale Hwy. Bakersfield, CA 93308 2. Article Number J ~..,ertlfied Mail [] Express Mail . ~ [] Registered [] Return Receipt for Merchandise l [] Insured Mail [] C.O.D, 4. Restricted Delivery? (Extra Fee) 7003 2260 0004 7652 nyes ~ 102595-02-M-1540 PS Form 3811, August 2001 -- ~om~uc Hetum Ret~ip[ ,/~-~ ~ ~! II II I~~r~,~,o~.~.,~,o:d · Sender-~ Please print yo , address, and ZIP+4 in this box · Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 D December 12, 2003 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 SERVICES · ENVIRONMENT/~ SERVICES 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 CERTIFIED MAI1, Costco 3800 Rosedale Hwy. Bakersfield, CA 93308 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, re-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. Letter to To: Owner/Operators of Propane Exchange Systems 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 · 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: COS,~i, EO ~- ,380? ROSEDALE HWY &AKERSFIELD CA 93308 B. Received by (Printed Name) D. Is delivery address different Eom item 17 If YES, enter delivery address below: I-1 Yes [] 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) PS Form 3811, August 2001 7002 3150 Domestic Return Receipt 0004 9985 3646 102595-02-M- UNITED STATES POSTAL SERVICE · Sender: Please print YOU~dress, and~ZlE+4 in this box~ Postage,& Fee~s Permit No. G-10 Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 69/24/2883 04:3.1 TED ~CNEELY PAGE 0~ MONITORING SYSTEM CERTIFICATION For Use By ,411 Jurisdictions Within th~ State of California Authority Cited: Chapter 6. 7, blealth and gq. faO, Code; Chapter 16. Divtsion 3, Title 23, CalOrornla Code of R,gulations This form must be used to document testing and servicing et' monitoring equipment. A_..separat¢ certification or reDgrt..must be prepared for each monitoring system contm_l_panel by the technician who performs the work. A copy orthis form must be provided to the tank system owner/operator. Tho owner/operatx)r must submit a copy of this form to the Inr.~l a~enc, y rep, ulnting I JRT .nystem.~ within 30 days of test date. A. General Information Facility Name: Gost¢o Wholesale i~a88 Site Address: 3800 Resedale Hwy Facility Contact Person: Sherry Poulton Make/Model of Monitoring System: Veeder Root TLS-3S0 B, Inventory of Equipment Tested/Certified Cheek tbc ap. proprlate box~ ~o iodi~, ate specific equipment inspeeh:d/servleed Tank ID: 87a [] In-Ta~k Gauging Probe. [] Annular Space or Vault Sensor. r~l Piping Sump / Trench Sensor(s). [] Pill Sump Sensor(s). r-I MeChanical Linc Leak De, eater. O Electronic Line Leak I~t~ctor. Model: 8473-90-109 Model-' 794,~80-301 brin~ Model: 794380-352 discrim Model: 794380-352 diuerim Model: Model: [] Tank Ovcrfill/ High-Level Sen~or. Modch 8473-90-109 _1~ Other ( .~Oe~.U~ ~?ipm~nt~.y~e and model in Sc,o~ion E on Pa~e 2). Tank ID: 87b [] In-'rank Gauging Probe. I~q A,,ulm SI. roue or Vault ~r. ~ Piping Sump / Tr~ch ~Fill Sump ~ Mcuhuni~l Lir~ I.~ 0 ~lco~onic L~ne I~ D~ect~, Modal: 8473-90-109 M~xioi: 794.380-301 brine Model: 794380-352 disorim Model: 794380-352 di.~crim Model; Modul; I~ Tank Ov,'-rfll] /High-Level Sensor. Modl;I; 8473-90-109 Dbpen~r ID: I~ ~ I)i~r CouChant ~}, M~el: 79438~208 float ~ Sh~ Valv~). ~ Disp~sbv Conminn~nt FIo~s) and ~ Oi~a~ Containment Senso~s). Modch 7~38~208 ~ She~ Valve(a). ~ DIsp~ ~on~inm=nt Plo~s) m~d Chul.(a~. , ........ Dispenser iD: 9/10 ~ Di~pens~ C~minmcnt Scn~s). Model; 7943~-26~ ~ Sh~r Valve0. ~ bis~n~ ~ont~inmen(~[o~s) ~d Chain(s~. ~ Dispen~r Cent~nm~t S~SO~s), M~el: 7943g~208 ~ Sh~ V=lvc(s). City: Bakersfield Zip: 93308 Contact Phone No.: (661! 6364)822 Date of Testing/S=rvi¢ing: 08/26/03 Tank : 91 [] la-Tank Gauging Probe. [] Annular Space or Vault Sensor. I~] Piping Sump ! Trcnch [] Fill Sump Scnso~(~). C] Mechanical i.ine Leak Dctc~tur. O Elcc4xonie Line Leak Oet~or. [] Tank Overfill / High-l~vd Sensor. Mo:tek 8473.90-109 O Otb. or (specify o_auioment tyne and modcl in Sc~-'tion E on Pg.~:e 2), Model: 8470-90-109 Model: 794380-301 bdnc Model: 794.380-352 dir~rim Model: 7943g0.3~2 di~rim Modci; Modc]: Tank iD: N/A O In-Tank Oaugiog Probe. Model: I~ Annular Space or Vault ~onsor. Model; CI Piping Sump I Trench Senso~($). Model: C~ Fill Sump Sensor(s). Modok ~ M~nlo~ Line ~k Dot~r. Model: ~ ~lecWonic l,ine I.~ O~or. M~cl: C~ Tank Overfill / 14igh-Devel Sensor. Model: ,, .[~ Otlmr (spcclf~' cquipm_o__nt typc and model i~ ~ion ~ on P~e 2?' Dbpeo~r lO: 3/4 ~ l)isp~r Con~nm0nt S~SO~s), M~oI: 794380-208 fl~ ~ Sh~ Valves). Di~ac~ C~?~nmcnt Floa~s~ and C~ain~s}. _ . Ob~r ID: 7/g ~ Dispcns~Containmcnt Sonar(s). Model: 7~3~208 tloat O Dispenser Conlainment Fl~s) ~d Chain(s). DiS~naer ~: 1'1/12 ~ Di~¢na~r Con~nm~t ~s). M~eI: 794380-208 ~ She~ Valve(s). O D~p~r Con~nm~t Float{s~ and Diaoeaser ID: 13/16 ~ Dispens~ Containment Sensor(s). Model: 79438~2~ fl~ ~ ~ Valves). I~ .Diaponaer Conl~_'nment l:laat(s) ~ C~in(s). OJs~ Cont~nment Y]oe~{g) and *[¢lhe I~ility ~nmins more ~b or dis~nse~ copy this f~. Include i~r~ti~ for eve~ ~k ~d ~sp~scr ~ t~ fa=ili~ C. Ce~ificatlon - I ~rtify ~at the equipment identifi~ in this document wan im~/servieed in accordance with ~e manufa~ure~' guideline. AUacbed to this Certifi~tlon ia infection (e.g, m~ufactumrS' ~Mi~s) ne~ssa~ to veri~ that this int~rma~ ~s corre~ and a Plot Plan Showing the layout of ~nltoring equipm~t. For any ~uipmeut ~pable or genermfin~ such repo~ I have ~ao a~ched a c~y of me r~o~; (dt~ alIt~t ~pty); ~ System ~t-up ~ Alarm hiato~ rgpo~ T~hnic~ Name: Ted McN~iy Si~atm~: HaM Copy $ign~ C~ification No.: 006~5-02~ Licen~ No.: Te~ting Company Name: (M,E,C,) McNooly Environmental ~mp~mn~ vno~ NO.: Page I of 3 PAGE 03 Site Address: 3800 Ro~ednle Hwy, Bakersfield, CA 93308 Dot= of TestinglServicing: 08/26103 Monitoring System Certification D. Results of Testlng/~ervieing Sot~8re Version Installed: 316.03 Complete thc followin~ eheelcUst; Yes CI No* I~ the audible alarm operational~? .... Ye~ ~ No* Is the vis~i ala~ ~per~ional? Yes ~ NO* Wo~ aU ~n~ vlsuall~ inspec~d,_~ncfio~lly tes~d, ~d co~fi~ o~r~onal? Yes ~ No* Were all S~m in~ll~ ~ Iowesl point of m~nda~ containment and ~sitioncd so that other equipment will not Into~cro with their pro~0~mdon?' Yes ~ NO* tf ai~s ~ relay~ to a remote monitoring 'Smtlon, is all communlc~ions ~ui~ment (e.g. ~ NIA ~e~ional? Y~ ~ No* For ~ssuri~d pip'lng systems, does the m~{ne aut~micnlly shut down if the piping ~n~ con~i~ent Q N/A monitoring s~m detec~ a leak, fails to opem~, or is el~ri~lly discomec~? if yes: which sentra initiate pt~;tive shut~o~? (Cimck all tbat applyd ~ gum~ren~h geneor~; ~ Dis~nser Con~inme~ Sentra. Did you.confi~ posi6vc shu~own due to lea~ and ~r failur~di~onne~ion? ~Yes; ~ No. Yes ~ No* Per ~nk ~ems that utili~ tho monitoring system as ~e ~m~ ~k ove~ll w~ing devi~ (i.e. no ~ N/A moth.ica[ oveffill prevention va[ve ~s m~lled), is the ove~ll wamln~ ala~ visible and ~ible at thc rank flu points) and operating pro~r[y? lf~, at wh~ ~nt of~ cap~i~ d~m ~e n[~ ~i~e~ 90% Ye~* ~ No W~ ~y monitorin8 equipment repl~d9 Ifye~ identi~ specific sensors, probe, or other equipment repl~ed aM list ~ m~u~urer name and model for ali ropl~m~t p~ in ~ction E~ ~low. Yes* ~ No W~ liquid found insi~ aw sec~d~ con~inment sysmms desired Pmdu~; ~ Water. If~es, describe ~uses In Section ~, below. Yes Q N~* W~ monitoring,syst~ s~-up reviewed ~ ensure Pm~r ~in~?'A~.~ s~ up repods. {fappl~able Yes Q No* I. all m~itoring ~uipm~t o~mtlonal per ma~.~ctumr's ~cifications? , ,, * In Section E below describe how and when these deficiencies were or will be corrected. E. Comments: N/A Pal~: 2 ul'3 03~1 '~ ~0'54B4~5 09/24/2003 04:11 TED MCNEEL¥ PAGE 04 Site Address: 3800 Ro~edale Hwy, Bake~field, CA 93308 Date of'Testing/Servicing: 08126/03 F. In-Tank Gauging / SIR Equipment: ~ C~ck ~hls ~x if rank gauging is used only for invento~ control, This ~fion must ~ comple~d if ~. ~ ~ug~ equipment is used ~ p~fo~ leak detection monito~ng. Complete tl~e followin cheekier: C) Yes ~ No* Hun all input wiring been inspected for prop~'m~try and termination, including testin§ for ground faults? CI ¥6 [] NO* Were all tank gauging probes visually inspected for danmge and residue buildup? rt Yes [] No* Was accuracy,, of system product level readings tested? C) Yes vt No* Was accuracy of system water level'readings tested? L.i ~/es Ci NO" Were all probes reinstalled properly7 CI Yes CI No* Wcrc all items o~ the cqUipmen, t manufaoturer's maintenan,,c,,e cfi~cklist completed? ... * la the SectiOn H, below, describe how and whc. tl,r. ac dcl3ciencie~ were o,' will be corrected. G. Line Leak Deteetom (LLD): [] Check this box ifLLOs are not installed. Complete the following checklist: Yes {~ No" For equipment sl~z~-up or annual cquipmvm u~rtificcatio,, 'was a leak simulated to v~i~ LLD pe~aecc? O N/A (C~lt~pp~) Simulat~leakr~e: ~3g.p.h.: O0.1 g.p.h; O0.2g.p.h. ~Yca O No* ~cm ali LLDs con~cd o~erafion~ a~ a~um~ wi~in rcgulato~ requirements? .... Yes O No* Was ~e test~g ~mtus pro~rly calibm~d? Yes 'O No* For mcch~ioal LLDs, does the I..I.D ~5~ict product flo~ i'f ~t'~t~ts a leak? 0 N/A Vo$ ~ No; For oloe~nio LLDo, d~o the lupine ~utomsfi~lly shut offif~e LLD detee~ a leak~ ~ N/A Yes O No' For elec~onic LLD~ does ~ ~bine automat~lly shut off ~f any pOSen of ~e monitoring s~m ~S dialed ~ N/A or disconn~t~? Yes ~ No* For c]~tmnic LLDs. d~s *c turbinc'automati~ll~ ~hut ~ffi~ ~nio~ of*c monitoring ~m malfunctions Yes ~ No* For el~nlc LLDs, have all accessible ~ring conne~ions been vis~lly ~pe~edP Yes O No* Wg~ all itgm$ on ~e equipment m~u~tmr's maintenance checklist complet~P * lo the Section H, below, describe how and when these deficiencies were or will be corrected. II. Comments.' testing oomplctc Page 3 of 3 ~I ~se~ RightFAXUser Host: FAX Class: Fax Job: !Q_HAZl I 081241200@ 06:25 805 155 TEl) IvlCNEEL¥ ........ PAGE 01 RUG 21 20u3 13=16 BKSFLD FIRE PREVENT[OH ..£_~Rllfl~-~l?p .......... ~,~ ._. CIT OFFICE OF L. APPLICATION TO PERFORM FUEL MONITORING CERTI~CATION N~ o~ rSSr~NO co~r~ 7~ ,,~x~ ¢ co~c~Rs uc~ss, '~v ~,,~ .............. API~ROVI~ BY Ma~ 19 03 05:47a REX 306-1933 MRY 19 2003 8:23 BKSFLD FIRE PREVENTION (661}852-~]?~ p.~ OFFICE-OF ENVIRONMENTAL SERVICES 1715*Chester Ave,, Bakersfield, CA (66I)_3~6-3979 FACILITY · ...APPLICATION TOPERFORM FUEL MONITORING CERTIFICATION NO TANK # VOLLRvIE CONTENTS ' SIGNATUR.]~ OF APPLICANT C3 Certified Fee ~ Retum Reclept Fee ' Poslmark (Endorsem? Required) Here ~ ._Resblcted Delivery Fee L~ ~r.n~orsement Required) IT1 Total Postage & Fees $ ILl S r~ ent To , ~ , r~ r~;;-,~,z~? ......... i ~ ........................ -r .......... i'~,;-~;;; ~;~cAr ...... '-'_.4-~--~'-~- -+':=~--~(::c:~ 4 _~_o..~...j FIRE CHIEF 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 SERVtCES o ENVIRONMENTAL SERVtCES 1715 Chester Ave. Bake ,r~/ield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Av~. Bakersfield, CA 93,301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93.,'.'.'.'.'.'.'.'.~)1 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 August l 1, 2003 Joe Isles Costco 3800 Rosedale Hwy. Bakersfield, CA 93308 CERTIFIED MAIL NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE Dear Mr. Isles: Our records indicate that your annual maintenance certification on your leak detection system was past due. 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 rufining condition." You are hereby notified that you have thirty (30) days, September 8, 2003, 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 yours, Ralph E. Huey Director of Prevention Services ,~ . Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SBU/db ~~ MSY 19 2003 8:23 BKSFLD FIRE PREVEMTIOM [$6118S2-217P p.2 p.1 CITY OF. BAKERSFIELD OFFICEOF ENVIRONMENTAL SERVICES 1715CImster Ave,, Bakersfield, .CA (66!)32.6-3979 · APPLI .CATION TO PERFORM FUEL MONITORING CERTIFICATION OPERATORS NAME . ~ o £ '~ q-~ ~o D~ FAC~Y ~ DISPENS~ PANS? NO TANK # VOLUME Z% CO~ DATE ' ' SIGNA_TLIRE OF APPLICANT 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 FACILITY NAME tINSPECTION DATE INSPECTION TIME FACILtTYCONTACT Business ID Number 15-021- Section 1: Business Plan and Inventory Program [] Routine "~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection [ C=Compliance ~ OPERATION COMMENTS x. v=violation APPROPRIATE PERMIT ON HAND VISIBLE ADDRESS VERIFICATION OF INVENTORY ~TERIALS VERIFICATION OF QUANTITIES VERIFICATION OF MSDS AVA~[AB~U~E VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES EMERGENCY PROCEDURES ADEQUATE HOUSE~EE~N~ ANY HAZARDOUS WASTE ON SITE?: [] YES ~ No EXPLAIN: QUESTIO REGARDIN / HI SPECTION? PLEASE CALL US AT (661) 326-3979 Inspector Badge No,, White - Environmental Sen4ces Yellow - Slation Copy Pink - Business Copy C,.-.,~co Whol ea:al e 688' 3800 Ro--:edale H~,.~ Balqer':: f' i e I ,-J., C~ APR :30.. 200:':I 1:11 PPI SYSTEH STATUS REPORT ~LL FUNC:T I OIqS I',K':,RP1AL I N\/ENTC>F&' REPORT T 1 :Unlea,-.led VOLUP1E = 9476 GALS ULLAC;E = 10475 GALS '313'i:.,: LILL~GE= 8479 (.';r,' S T,'." ".."OLLIP1E = 9412 F~ ~.; HE l(-:t-tT 57.30 I~qrS~-IES t,.iFfi'i:R \,,'OL = 0 GFiLS t,I~I'ER = 0.00 INCHES 'fE['IP = 69.5 DEG F -- T 2:'th'il'e.~::l~dTM · - ',JOL LIP1E = 9381 GgLS IJLL/K;E = 10570 GaLS 90::.;; ULLAGE= 8574 GALS TC VOLUHE = 9317 GALS HEIGHT = 56.87 INCHES L,,IaTER VOL = 0 O'''-''n', bJaTER = O. O0 I~IES TEP1P = 69.7 DEG F T 3:Pr-emium VOLUP1E = 16495 GaLS LILLaG£ = 3456 GaLS 90'..'~ ULL~,_-;E= 1460 G~LS TO 'qC,]..LII'IE = 16418 GaLS HEIGHT = 91.16 INCHES bJaTER \/OL = 0 G~LS I,J~T£R = O. O0 INCHES TEP'IP = 66.6 DEG 'F PlaNIF'OLr)ED TANKS I NVENTC, Ry TOTALS T 1 :Unleaded T 2 :Unl eade,J VOLUI,'IE = 18856 GaLS TC VOLIJHE = 18727 G~.S ~ ~ ~ :*: ~ END ~ ~ ~ FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CitECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE q-30'05 Section 2: Underground Storage Tanks Program Routine ~ Combined [] Joint Agency Type of Tank ~kkl {"- Type of Monitoring t~t.t/A [] Multi-Agency [] Complaint Number of Tanks ~ Type of Piping ' ~tJ3{~ [] Re-inspection OPERATION C V COMMENTS Proper tank data on file ~' Proper owner/operator dala on file Permit tees current / Certification of Financial Responsibility t' 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 Office of Environmental Services (661) 326-3979 N:NO White - Fnv. Svcs. Pink - Business Copy L'~usmess Site Responsible P~'ty March 03, 2003 WAYNE PERRY, INC. Environmental Remediation, Construction and Consulting Mr. Steve Underwood Bakersfield Fire Department 1715 Chester Avenue, 3rd Floor Bakersfield, CA 93301 SUBJECT: SB 989 COMPLIANCE TESTING AT COSTCO STATION 3800 ROSEDALE & GIBSON, BAKERSFIELD, CA 93308. SITE NUMBER 688. Dear Mr. Underwood: Below please find documentation of the SB 989 testing for the above-referenced site. A summary of the components tested and results are listed in the table below. Included with is submittal are the following: CONTRACTOR: Wayne Perry, Inc.; License No: 300345 TECHNICIAN: Alberto Rodriguez · SB 989 Testing Results & Procedures CompOnents Tested Component Date Tested Type of Test Pass / Manufacturer Performed Fail Regular Annular - Tank A Owens Coming NA - Wet Annular NA NA Regular Annular -Tank B - Siphon Owens Coming NA - Wet Annular ' NA NA Premium Annular Owens Coming NA - Wet Annular NA NA Regular Secondary Product Environ 2/26/03 Pressure Pass Regular Secondary Product - Siphon AO Smith 2/26/03 Pressure Pass Premium Secondary Product Line Environ 2/26/03 Pressure Pass Manifolded Secondary Vapor Return Line AO Smith 2/26/03 Pressure Pass & Vent Line Regular Turbine Sump A Fluid Containment 2/26/03 Hydrostatic Pass Regular Turbine Sump B (siph°n) Fluid Containment 2/26/03 Hydrostatic Pass Premium Turbine Sump Fluid Containment 2/26/03 Hydrostatic Pass Regular Fill Sump A Fluid Containment 2/26/03 Hydrostatic Pass Regular Fill Sump B (siphon) Fluid Containment 2/26/03 Hydrostatic Pass Premium Fill Sump Fluid Containment 2/26/03 Hydrostatic Pass Dispenser l&2 Environ 2/26/03 Hydrostatic Pass Dispenser 3&4 Environ 2/26/03 Hydrostatic Pass 8281 Commonwealth Ave. Buena Park, California 90621 Phone (714) 826-0352 Fax (714) 523-7880 SB 989 Compliance Testing Costco Station 3800 Rosedale & Gibson Bakersfield, CA Site 688 Page 2 of 2 Components Tested Component Date Tested Type of Test Pass / Manufacturer Performed Fail Dispenser 5&6 Environ 2/26/03 Hydrostatic Pass Dispenser 7&8 Environ 2/26/03 Hydrostatic Pass Dispenser 9&10 Environ 2/26/03 Hydrostatic Pass Dispenser 1 l&12 Environ 2/26/03 Hydrostatic Pass If you have any questions regarding this submittal, please contact me at (714) 826-0352. Sincerely, Wayne Perry, Ina Construction Superintendent / Manager Attachments Cc: Dennis Bock - Costco Wholesale, Inc. 8281 Commonwealth Ave. Buena Park, California 90621 Phone (714) 826-0352 Fax (714) 523-7880 SWRCB, January 2002 Page ~ of '~ Secondary. Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for ail components tested. The completed form, written test procedures, and printouts from testS (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACIIJTY INFORMATION Facility Name: (~O~T-C_~ ~ ~8~ I Date of Testing: ~- E.~-O~ Facility Contact: Mt3C I Phone: Date Local Agency Was Notified of Testing: c'~'~ jL~ --C~ ~-~ Name of Local Agency Inspector (if present during testing): ~ t~ ~.. b ~i~ ll O~r~ l~ tO~'[- 2. TESTING CONTRACTOR INFORMATION 3. SUMMARY OF TEST RESULTS Not Repairs Component Pass FailNot Repairs component !PassFailTestedMade Tested Made mt ~um.p ~ o o o o o o o' q~l ~ump ~ o o o o o o o,,, - I-~ ~ 0 o 0 o 0 0 o ~-q ~ o o o o o o o ~-~ ~ 0 0 0 o 0 0 0 7-~ ~ o 0 0 0 0 0 0 -I q-tO ~ o 0 o 0 0 0 o tt -I~ ~ o o o o o o o If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal, requirements Technician's Signature: .......... ~~~- Date: ~_~ ~_.~ - O -~ COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. WPI- Job No. #034002 Page ~.~ of 7 SWRCB, January 2002 - R TESTING ~ Tank Manufacturer '~lndustry Standard [] Professional Engineer Test Method Dcvelopod 0 Other (Spec/~) Test Method Used: [] Pressure "~Vacuum [] Hydrostatic . o other ($~ec®) Is Ta~k Exompt From Testing?~ ~5~Yes 0 No '~ Yes ~ No ~Yes [] No [] Yes 0 No Tank Manufacnxu'er: Q~ ~DP-satt~ i ! ! t .... Product Stored: W~t time between app~_ng pressur~vacuun~water and starting tese ~"'/ Initial Reading (Ri): Final Re_ading (RF): Test Duration: Change in Reading (l~-Pq): Was sensor removed for tesfing? rnYes [3No ONA [3Yes [3No ONA DYes [3No BNA OYes ONo ONA WaS sensor propcrly replaced and DYes lnNo BNA [3Yes ENo [3NA [3Yes UNo [3NA [3Yes ONo ONA verified functional after testing? Comments -- (inch;de information on repairs made prior to testing, and recommended follow-up for failed tests) COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. WPI- Job No. #034002 ~ Secondary containment systems where the continuous monitoring automatically monitors both the primary and secondary containment, such as systems that are hydrostatically monitored or under constant vacuum, are exempt from periodic containment testing. {California Code of Regulations, Title 23, Section 2637(a)(6)} SWRCB, January 2002 Page ~ of 7 ' ~RY PIPE TESTING Test Method Developed By: [] Piping Manufacturer ~4ndustry Standard Professional Engineer ~ Other (SVec®) ~Pressure [] Vacuum D Hydrostatic Test Method Used: · [] Other (Specify) Piping Material: Piping Manufacturer. [';,J Vi('~Di~ /~ .O -%Pf(T-t4 ~:lO %t i~P~OI-3 P~,O ~3~ fT~+' .. Length of Piping Run: Product Stored: Method and location of piping-run isolation: Wait time between applying pressure/vacuum/water and ~ ----- ---- - "' starting test: Test Duration: Change in Reading (R.v-R0: O C~ O {:53 Comments - ('include information on repairs made prior to testing, and recommended follow-up for failed tests) COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. WPI- Job No. #034002 SWRCB, 1anuary 2002 Page ~ of '7 6. PEPING SUMP TESTING Test Method Developed By: [] Sump Manufacturer ~industry Standard [] Professional Engineer [3 Other (Specify) Test Method Used: [3 Pressure [] Vacuum ,)~Hydrostatic . [] Other (Specify) . Test Equipment Used: ~L~ C'~.~4~(~[1~ ~.O~ f~ bi 8 7-~-~ Sump # g 7- ~_ I Sump # '1 1 Sump # Smnp Diameter. t.] ~ ~ sump Depth: D- q" 6/g" 6 q Sump Mated ' ~ ' Height l~om T~mk Top to Top of i! Highest Piping Penetration: 2- q Height from Tank Top to Lowest ; ~ Electrical Penetration: ~Z Condition of sump prior to testing: (-~ OOO Does turbine shut down when d sump sensor detects liquid (both DYes [3No ~IqA []Yes rqNo ~NA [3Yes [3No ~NA [3Yes []No '~NA p _rodu~-t and water)?* Turbine shutdown response time Is system programmed for fail-safe [3Yes []No ~qA ayes ~No ~t~NA ayes [5No ~NA []Yes []No ~NA shutdown?' operational?* , Wait time between applying . pressure/vacuum/water and starting 70 tq/~l t/~ test: Test Start Time: I '7-..~, ~--Ct Initial Reading (Ri): /5- 5-77/ Ii .63t 2~ t Z, 27__37 Test Duration: ! ~ ~j i,21 , Changein Reading (RriO: 0 · 0~250 0,~ Pass/Fail Threshold or Criteria: 0, CY~- 0 Yes [3 o yes Was sensor properly replaced and []No DNA. verified functional after testing? Comments - [include information on re~airs made prior to testing, and recommended follow-up for failed tests) ~ If the entire depth of the sump is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an asterisk (*) is "NO" or ''NA", the entire sump must be tested. (.q~. ~ r'n r r-._ ~ ~r~x COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. SWRCB, January 2002 Page_,~ of 7 7. UNDER-DISPENSER CONTAINMENT (U-DC) TESTING Test Method Developed By: [] UDC Manufacturer Standard [] Professional Engineer [] Other (Specify) ~ . ... Test Method Used: [] Pressure [3 Vacuum ]~Hydrostatic [] Other (sp~ify) Test Equipment Used: ~ 6~'{L(~E6~ ~ ~ ('e .~ffl~ip.~ I Equipment ReSOlution: ~ Manufacturer:. .~-~-J ~ t P-qD t.~ , ~ t ¢ t UDC Material: P~LA ~'F'~ c,.. , ~ ~ ~ ~ UDC Depth: ,~ 7--~' ~ 6 ' 2,~' ~'~, Height from UDC Bottom to Top ;~ / I of Highest Piping Penetration: / ~ r~ ~' g~t' Height from UDC Bottom to ~t Lowest Electrical Penetration: t t" t i o t ! / t Condition of UDC prior to testing: ~ 00 O . [ ! I Portion of UDC Tested1 L[~ht~ [~e~ ~lg.~ ~¥"~ It I{ tl Does turbine shut down when UDC sensor detects liquid (both 13Yes []No ~NA []Yes []No 7NA []Yes •No ~NA EYes []No product and water)?' Turbine shutdown response time OYe []Yes omo []Yes 'safe shutdown?' operational?* Wait time between applying pressure/vacuum/water and ~ 0 tr~-1 ~} l I l{ starting test Test Start Time: Z--~rZ2 I [ 5' ~ ~'. '.~'~ 3: FinalReading(Rv):_lq~.~S { q ~8~qB tqsig5 t-~, o~,0i Test Duration: t ,~'- m , ~,-~ . i ~ it It Change in Reading (Rr-R0: O.O00.f.I . . (_~). O0 J i~ 0. OO(flGqg/ Pass/Fail Threshold or Criteria: 0,0[J~ 0.0DZ. 0 ',L'~2_... Was sensor removed for tesfing? ~¥e, •No DNA '~es UNo [3NA ~Yes ENo [3N'A ~Yes EINo [3NA Was sensorproperlyreplacedand ~l~Yes [3No ENA ~es [5No 0NA ?Yes °No []NA ~Yes °No ~NA vexed ~c~onal ~er ~s~g? t Comments - (include information on repairs made prior to testing~ and recommended follow-up for failed tests) ~ If the entire depth of the UDC is not tested, specify how much was tested. If the answer to ~ of the questions indicated with an asterisk (*) is "NO" or'~NA", the entire UDC must be tested. (See SWRCB LG-160) COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. WPI- Job No. #034002 SWRCB, January 2002 Page_~_ of 7 7. UNDER-DISPENSER CONTAINMENT (UDC) TESTING ~ [3 Other (Specify) Test Method Used: [] Pressure [] Vacuum ~Hydrostatic [] other Test Equipment Use& ~. 0,~7~/I.U~. -~,~'! 10bi tQ ~,J'~ I Equipment Resolution: UDC Manufacturer:. ~ i ~o.t.3 UDC Material: iOLAsL?--t (. ~ J UDC Depth: 2- q Height from UDC Bottom to Top of Highest Piping Penetration: '7" 7" Height fi~m UDC Bottom to ~ ~ Lowest Eleclxical Penetration: t I Condition of UDC prior to testing: C~ Oo O Does turbine shut down when product and water)?" Turbine shutdown response time ' Is system programmed for fail- DYes DNo ~(NA []Yes []No ~[NA []Yes DNo .~NA DYes DNo ~NA safe shutdown?" operational?* wait time t~tween applying pressure/vacuum/water and ~ 0 tq%t ~ starting test Test Start Time: 3 ' O ~ Test End Time: _'~: { ~- ~ina~ Rea~g 0%): ~ ,?O5-/ Test Duration: I ~' r~ ~ ~ Change in Reading (RF-Rr): 0 ' 0(30 ~ i'~ssfVaivrkreshold or Criteria: 0,007/' - O.O~,Z 0.002.. O, COZ verified functional alter testing? F Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) ~ Lethe entire depth of the UDC is not tested, specify how much was tested. If the answer to any. of the questions indicated with an asterisk (*) is "NO" or "NA", the entire HDC must be tested. (See SWRCB LG-160) COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. WPI- Job N~ SWRCB, January 2002 Page 7.. of 7 gR CONTAINMENT SUMP TESTING Facility is Not Equipped With Fill Riser Containment S-raps O FillRiser Cotatainment S, rmps are Present, but were Not Tested [] Test Method Developed By: [] Sump Manufacturer ~8~ndustry Standard ,rq Professional Engineer [] Other (Specify) Test Method Used: [3 Pressure [] Vacuum ~Hydrostatic [] Other (Specify) Test Equipment Used: {Z{- ~-4'4"0.~[~{J -~v~ ~'~'f'0~.~beDgO' [ Equipment Resolution: ~~ FillSnmp#T~7-,~ ] FillSump#~'~-i~. FillSump# ~t FillSump~ Snmp Diameter: ~ .~" , ¢ Stop D~th: ,,,5 7" O-Z_ o- t" Height from Tank Top to Top of mghest Piping Penetration: ~_~q" ~Z.~." 2/4 ,' Height from Tank Top to Lowest . Z t/ 't t Electrical Penetration: ~. l t' ~2- ~ e Condition of sump prior to / t Portion of Sum? Tested ..n~l~}~ ~e~10rg: ~6'~ R it ti . Sump Material: Wait time between applying pressuredwaommAvater and. ~t.B~(~/_D ~t /t ~! starting test: Test Start Time: / 0: 2_~ n t O ~ ~ t ~ : ~ 7 Initial Read/rig (R~): iff 76'~' I d>'L~5~ ~O f~/ Test EndTime: I O ' /.~ t O' ~ [ j T_.; O 2-- FinalRe~d~ng (Rz): ~ 5,-. ?~ oq i G . .~ ~ ~2_ tq q7 L~ Test Duration: [ ~"~ t~4 s tO ~ ~ Changein Reafling (Rv-R~): O ' ~O ~ 7~ ~, {)~O~ ~, [~ QO-- Pass/Fail Threshold or Criteria: 0-,~0 7.. ~ .0 ~ 2- 0,0 0"~ 0 .~ Is there a sensor in file sump? ~Yes []No '~Yes []No ~¥es [~No -~Yes []No Does the sensor alarm when either product or wat~r is [~Yes UNo ~iNA UY= []No ~}NA []Yes UNo '~gNA =Yes •No detected? Wa se=o =mo¥ £orte g: ges p¥= []So [3So •Sa Was.sensorpropcrlyr~pla~edand ~Yes •No UNA ~55es []No []NA ~CYes [2No ~NA ~es =No []NA verified functional at~er t~sting? Comments - (inclurl~ information on repairs made prior to testing, and recommended follow-up for failed tests) COSTCO # 688 3800 Rosedale/Gibson Bakersfield, CA. Secondary Containr~nt Test Panel Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 Product Type Test Start Time [Wed, Feb 26, 2003 12:29 PM Test End Time I_VV_~d, Feb 26, 2_00_3_1_2:__44_ Length (min) Limit (in) .[15 _ i t0-0020____. Test Result /_Test passed. Comments Test Status Status ISaving... Pass/Fail Change PASS..~,i /0.00004 Test Results Function Menu [Restart] I S ve..] 12:29:59 PM 12:33:00 PM 12:36:00 PM 12:39:00 PM 12:42:00 PM 12:44:59 PM 02/26/2003 02/26/2003 02/26/2003 02/26/2003 02/26/2003 02/26/2003 Test Time Secondary Contain~l~nt Test Panel Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 ........ Product Type lTank Sump Turbine Test Start Time '[Wed, Feb 26, 2003 12:30 PM Test End Time [_W__ed, Feb_2__6,_. 2_?_03_ 12:4_5 nM Length (min) Limit (in) ~5_ ......... ! - l?.:o o~2_o ..... Test Result ~_e__st P_ a?_s_e_d._ .......... Comments Test Status Status ,ISaving... Change 10.00006 Test Results Pass/Fail ~Ass,,.I 11.6315- 11.6314- 11.6313- 11,6312 12:30:07 PM 12:33:00 PM 02/26/2003 02/26/2003 Function Menu [Restart] ~ Savet ReturnI 12:36:00 PM 12:39:00 PM 12:42:00 PM 12:45:0'/PM 02/26/2003 02126/2003 0212612003 02/26/2003 Test Time Secondary ContaimJl nt Test Panel Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 Product Type ~[T_a_n_k Sump Turbine Test Start Time IWed, Feb 26, 2003 1:24 PM Test End Time I_W~d,__F_e b _2_6,_2 0_ 0_3_1:39._PM Length (min) Limit (in) la) _ , lo.oo20 Test Result IT_est p_a_s_se_d._ Comments Test Status Status [Saving... Change .I0.00020 Pass/Fail PASS....:J Test Results Function Menu IRestar,[ [Ab°d'] SaveI IReturn I 12.2240- 12.2239- 12.2237- 12.2236- 01:24:51 PM 02/2612003 01:30;00 PM 01:33:00 PM 01:36:00 PM 01:39:51 PM 0212612003 0212612003 0212612003 0212612003 Test Time Secondary Contaim Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 ',nt Test Panel Test Status Status .[Saving... Change /0.00128 Product Type Tank Sump Fill Test Start Time IWed, Feb 26, 2003 10:23 AM Test End Time lWed~, Fe_b_26,_20_0310:38_AM _ Length (min) Limit (in) 1_~5 ~ [0:_00_20 ..... Test Result [Test passed Comments Pass/Fail . PASS I Test Results Function Menu I RestartI ~ ,SaveI ReturnI 10:23:46 AM 10:27:00 AM 10:30:00 AM 10:33:00 AM 02/26/2003 02/26/2003 02/26/2003 02/26/2003 Test Time 10:36:00 AM 10:38:46 AM 02/2612003 02/26/2003 Secondary Contain i nt Test Panel Test Parameters Test Site Costco 13800 Rosedale 'l~akersfield, CA 93_308~ Product J87-~ Test Status Status ISaving... Change I0.ooo18 Test Results Pass/Fail PASS.,,~I Type JTank Sump Fill Test Start Time 'Wed, Feb 26, 2003 10:26 AM Test End Time JWed, Feb 26:__2_00_ Length (min) Limit (in) I15 I 100020 Test Result Comments Function Menu Save .1 Return 12.5153- 12.5151-'¢ 12.5150- 10:26:50AM 10:30:00AM 10:33:00AM 10:36:00AM 10:39:00AM 10:41:50AM 02/26/2003 02126/2003 02/26/2003 02/26/2003 02/26/2003 02/26/2003 Test Time Secondary Contain F. nt Test Panel Test Parameters Test Site Costco 3800 Rosedale , B_a_k e_r_s_f_i e I d~, _C_A__9_ 33_ O_8- ............. Product Type lTank Sump Fill Test Start Time [Wed, Feb 26, 2003 11:47 AM Test End Time [Wed, Feb_26 Length (min) Limit (in) [1_5_ ............. Test Result ITest pas_sp__d: Comments Test Status Status Pass/Fail JSaving... PASS [ Change ,~.00000 Test Results Function Menu ] RestartI ~ Save. ,] Return 11;47:59^M 11:51:00AM 11:54:00AM 11:57:00AM 12:00:00PM 12:02:59PM 02/26/2003 02/26/2003 02/26/2003 02/26/2003 02/26/2003 02/26/2003 Test Time Containment Test Panel Test Parameters - Test Status Function Menu Status . Test Site ~t ~ Pass/Fad Restart , c~-~oo 13800 Rosedale 1 *Chang; PASS lB a ke -rsf-ie Id~' ?~A - -9-3~30-8--~ ..... !t ~ ....... ,Save I l Return ,1 Product UDC ............ ~l Test Results Type ] 11.4859- I ti t!l! II III I Il!Il Iq-I I Test Start Time .. t ,,.4858- ~.~~,~ 1-~. ?~' ~.- IWed, Feb 26, 2003 2:34 PM l Comments , t /tliii~lltl~gi iiii-t i 0212612003 0212612003 0212612003 0212612003 0212612003 ..................... T~t Time. Secondary Secondary Containle. nt Test Panel Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 Product [U_D_C_ Type [Dispenser 3 & 4 Test Start Time [Wed, Feb 26, 2003 1:58 PM Test End Time n~_ e_d,__F_e~ 26.~2__0~3 ~: 1_3_PM_._ Length (min) Limit (in) !5 Test Result IT_e?! .................................passed. Comments Test Status Status fSaving... Change ,f0.00118 Pass/Fail PASS...l Function Menu I Restartt ~ Save] tReturn I Test Results "~s2-kLI I t I'tittl 14.366°-I¥I-I~T?~- 14.3046-~ 14.3844-~ 14.3842-5+ I 4.3840- 1! l! IJIll ! 11 !I It ti t tftttl !tli Il t II JJJ JJlJ!J 14.3836- lllilltll! itlilllilllllilitll!l!i!lt!t!lIllii 01;58;43 PM 02:03:00 PM 02;06:00 PM 02;09;00 PM 02;13;43 PM 02/26/2003 02/26/2003 02/2612003 02/26/2003 02/26/2003 Test Time Secondary Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 Product Lu_p9 ........ Contain~Fnt Test Panel Type /Dispenser 5 & 6 Test Start Time IWed, Feb 26, 2003 2:33 PM Test End Time ~.ed, _F~eb~6, 2003 2~487M Length (min) Limit (in) l!.~ ....... J ,lo.o_o_2o Test Result ~es_U~ass~_~_._, ........ ' Test Status Comments Status .[Saving... Change [0.00004 Test Results 14.3227- 14,3226~ I-- 14,3225- 14,3224- 02:33:44 PM 02/26/2003 Pass/Fail Function Menu I Restart t ~ Save '] Return[ Secondary ContainlBe~ nt Test Panel Test Parameters ~ Test Status Function Menu Test Site I Status . Costco ii ~ Pass/Fall ~ I Ab°rt 1 13800 Rosedale i ~ Change PASS [UDC i'/Test Results DIS enser7&8 ~,~,,~i ~,~i~ 1 Wed, ~b 26, 2003 3:00 PM I ~ Test End TWme t ~ Wed Feb 2~ 2003 3'1~ P~ ~ · I~II II II' II IIIIi*~'~*''' '~ '~' 7 ' I! Length (m~n) L~m~t (In) t . ~.,~_~, ,, ,,,,, ~,,, t I ........... ~ I__~ ................. ' r ' I i i 1I Ii Itt 11 II!l II ttltt Ilii Ii I!t_ Comments t ~'"'Ii"'" t" I [ J 1~ ~R~R-I / I't 0212612003 0212612003 02~26~2003 0212612003 0212612003 0212612003 ' ........................... ] Test Time Secondary Containl ent Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 Product IUDC Type Dispenser 9 & 10 Test Start Time Feb 26, 2003 3:00 PM Wed, Test End Time Wed, Feb _2__6 ,~ _20_ 0_ ~ _3;'_15_pM ............ i Length (min) Test Result ITest passed. Limit (in) 'o.o_O .o Comments Test Panel Test Status Status fSaving... Change /0.00015 Pass/Fail · Function Menu rRestart] ~ saveI Returnt Test Results 8.7052-1 t t t I I t I I I I t I I t t I [ t t t t I I I t I I 11 11 I I I t I i i I t I J 8.7050- ,,~ I- 8.7049- 8.7048- 03:00:39 PM 02/26/2003 03:06:00 PM 03:09:00 PM 03:12:00 PM 03:15:39 PM 0212612003 02~26~2003 0212612003 0212612003 Test Time Secondary Containl ent Test Parameters Test Site Costco 3800 Rosedale Bakersfield, CA 93308 Product Type IDispenser 11 & 12 Test Start Time IWed, Feb 26, 2003 3:00 PM Test End Time [W_e__d,~F_e_b_2_6,__2_O0_~'3115 PM ___ Length (min) Limit (in) Test Result ~Test passed Comments Test Panel Test Status Status Pass/Fail .Saving... PASS [ Change ,,.-.~ ~.00015 Test Results 10.0503- Function Menu 10.0502- 10.0501- 10.0500- 10.0499- 03:00:28 PM03:03:00 PM 0212612003 02~26~2003 !tlttt!t11112 tllilliilltJ~_ 03:06:00 PM 03;09;00 PM 03:12:00 PM 03;15:28 PM 0212612003 02/26/2003 02/26/2003 02126/2003 Test Time Work Plan, 1-15 Secondary Containment Testing Of Underground Storage Tank Systems Contractor: Wayne Perry, Inc. Update& 7/12/02 Qualifications: · WPl currently holds business license number CA 300345 - A B C61 / D40 Haz (available upon request) · Information regarding Worker's Compensation and Employers' Liability (available upon request). · WPI is licensed to perform work in the referenced city/county (available upon request). · WPI provides HAZWOPR training for employees. WPI develops a site-specific Health and Safety Plan w/Confined Space Permit for each testing location (available on-site, on day of testing). · WPI is certified by component manufactures. Certification's were updated at a training seminar held at Shields/Harper, March 18th through 20th, 2002 (available upon request). Test Equipment: · WPI utilizes third party certified hardware and software for all hydrostatic tests (attached). · Pressure Gauges are dual redundant (two gauges per line test), 0-15 psi pressure range, 2.5- inch diameter, glycerin-filled, with manually set test pressure verification needle. · Vacuum Gauges are dual redundant (two vacuum gauges per annular test), 0-30 in-hg vacuum range, 3-inch diameter. Test Procedures: · Local CUPA will be notified of testing schedule a minimum of 48-hours before the test is scheduled to begin. · Sump Cleaning and Preparation. WPI will steam clean all turbine sumps and dispenser pans. WPI will utilize FM 186 as an injected additive during steam cleaning. The water and waste generated during the cleaning process will be left on-site in a labeled drum for proper classification and disposal. Once the site has been cleaned, it will be ready for testing. Page 1 of 3 · Tank Annular Space. For tanks less than 20,000 gallons capacity, apply a vacuum of 10" mercury to annular space. After establishing a stable vacuum, maintain this vacuum for 60 minutes. At the end of the test period, if the vacuum reading has not changed from the established test vacuum, the test is complete and has achieved a "pass". For tanks greater than or equal to 20,000 gallons capacity, apply a vacuum of 10" mercury to annular space. After establishing a stable vacuum, maintain this vacuum for 120 minutes. At the end of the test period, if the vacuum reading has not changed from the established test vacuum, the test is complete and has achieved a "pass". If the tank does not maintain the test vacuum, the contractor may re-test the annular space. If, after the second test the tank does not achieve a "pass", the secondary containment must be considered not liquid tight. Repairs may be made by the tank manufacturer or authorized representative per the requirements of the local CUPA. · Product Piping Secondary Containment. An inert gas shall be used. The secondary containment shall be made airtight with either the rubber test boot or fiberglass test fitting installed at time of installation. If the test boot is missing or damaged, an approved replacement test boot or fiberglass test fitting may be installed. Pressurize secondary containment piping to 5 psig and allow to stabilize for 10 minutes. Maintain test pressure of 5 psig for 60 minutes. At the end of the test period, if the pressure reading has not changed from the established test pressure, the test is complete and has achieved a "pass". If the piping does not maintain the test pressure, the contractor may tighten clamps and fittings, if necessary, and re-test the piping. If, after the second test, the piping does not achieve a "pass", the secondary containment must be considered mot liquid tight. Repairs may be made by the piping manufacturer or authorized representative per the requirements of the local CUPA. · Containment Sumps and Under Dispenser Containment. The containment sump shall be free of dirt, debris and residual petroleum product. Place test fluid in the sump a minimum of 2-inches above the highest piping penetration, including all electrical penetrations. Piping shall include primary/secondary product piping, vent piping, vapor recovery piping and siphon piping. After test fluid has stabilized for 30 minutes, the liquid level shall be measured using test equipment third party tested to below .0007-inches. The test period shall be one 15-minute test (per the third party certification). At the end of the 15-minute test period, the test ~2~3 equipment must confirm a hydrostatic change in level no greater than .002-inches in order to achieve a "pass". If the containment sump does not pass the test, the contractor may re-inspect the sump, tighten penetrations/clamps and fitting, and re-test. If after the second test the containment sump does not achieve a "pass", the secondary containment must be considered not liquid tight. Repairs may be made using the sump manufacturers procedures per abiding by the requirements of the local CUPA. Reporting: A final report documenting secondary containment testing shall be submitted to the local CUPA within 30 days of the completion of the test. The report must include all data collected as part of the testing and indicate any deviation from the approved Work Plan. All reports shall be evaluated for the completeness and accuracy. Failure to submit a satisfactory report will result in test results not being accepted and may require additional testing. The draft Secondary Containment Testing Report Form created by the State Water Resources Control Board shall be used. Page 3 of 3 TYPE OF ACTION (Check one item only)  FIED PROGRAM CONSOLIDATED FO~ UNDERGROUND STORAGE TANKS - FACILITY (one page per site) Page of [] 1. NEW SITE PERMIT [] 3. RENEWAL PERMIT [] 5,CHANGE OF INFORMATION [] 7.PERMANENTLY CLOSED SITE [] 4. AMENDED PERMIT specify change local use only [] 8. TANK REMOVED [] &TEMPORARY SITE CLOSURE TANKS 400 I. FACILITY / SITE INFORMATION Bakersfield Costco Gasoline Station # 688 1 5 0 2 1 0 0 2 4 1 2 i NEAREST CROSS STREET 401 Camino Del Rio Court BUSINESS [] 1. GAS STATION [] 3. FARM [] 5. COMMERCIAL TYPE [] 2. DISTRIBUTOR [] 4. PROCESSOR [] 6. OTHER 403 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 Is facility on Indian Reservation or *If owner of UST is a public agency: name of supervisor of division, section or office which REMAINING AT SITE tmstlands? operates the UST (This is the contact person for the tank records.) Three 404 [] Yes [] No 405 406 II. PROPERTY OWNER INFORMATION PROPERTY OWNER NAME 4o7 I PHONE 408 Costco Wholesale Corporation I (425) 313-8100 MAILING OR STREET ADDRESS 409 999 Lake Drive (.~[ITy 410 STATE 411 I ZIP CODE lssaquah WA 198027 PROPERTY OWNER TYPE [] 1. CORPORATION 412 [] 2. INDWIDUAL [] 4. LOCAL AGENCY / DISTRICT [] 6. STATE AGENCY [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 7. FEDERAL AGENCY III. TANK OWNER INFORMATION TANK OWNER NAME 414 PHONE 415 Costco Wholesale Corporation Attn: Dennis Bock (425) 313-8100 MAILING OR STREET ADDRESS 416 999 Lake Drive CITY 417 I STATE 418 I ZIP CODE 419 WA I 98027 TANK OWNER TYPE [] 2. INDIVIDUAL [] 4. LOCAL AGENCY / DISTRICT 420 [] 3. PARTNERSHIP [] 5. COUNTY AGENCY [] 1. CORPORATION [] 6. STATE AGENCY [] 7. FEDERAL AGENCY 44- IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER 19 I1 10 10 I Call(916) 322-9669 ifquestions arise V. PETROLEUM UST FINANCIAL RESPONSIBILITY 421 INDICATE METHOD(s) [] 1. SELF-INSURED [] 2. GUARANTEE [] 3. INSURANCE [] 4. SURETY BOND [] 7. STATE FUND [] 5. LETTER OF CREDIT [] 8. STATE FUND & CFO LETTER [] 6. EXEMPTION [] 9. STATE FUND & CD [] 10. LOCAL GOVT 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 I or 2 is checked. [] 1. FACILITY [] 2. PROPERTY OWNER [] 3. TANK OWNER 423 VII. APPLICANT SIGNATURE Certification..r- I certify that the infom~ation nm.v_ided herein is true and accurate to the best of m, knowledge. SIG~,AT""~UREO--~'"A~PLICANT ~ A NAM L:~h~v~PP~LICANT (prini) 426 Dennis Bock STATE UST FACILITY NUMBER (For local use only) 428 DATE 424 PHONE Sept. 17, 2002 425-427-7653 TITLE OF APPLICANT Compliance Manager- 1998 UPGRADE CERTIFICATE NUMBER (For local use only) 425 427 429 Formerly SWRCB Form A UPCF (1/99 revised) 8 .._,..FLED PROGRAM CONSOLIDATED FC.~ TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION / [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER Environ Geoflex-D 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/loo% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE {HDPE) [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 1. BARE STEEL ~ [] 2. STAINLESS STEEL [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 4. FIBERGLASS [] 5. STEELW/COATING [] 6. FRP COMPATIBLE W/100%METHANOL [] 7. GALVANIZED STEEL [] 8. FLEXIBLE(HOPE) [] 99. OTHER [] 9. CATHODIC PROTECTION [] 95. UNKNOWN 465 "~VlI:;p!P NG EEAK~DETECT ON,'(C~cka that appy)(A..de .s. crpton, of~the:mpotorngprogram::sha ~b.e~submttedtothe oca agenoy) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PiPiNG (Check all that apply): [] I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) CONVENTIONAL SUCTION SYSTEMS [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES iN BELOW GROUNDPIPING): [] 7. SELF MONITORING GRAVITY FLOW [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION Dc. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUSSUMPSENSOR+AUDIBLEANDVlSUALALARMS EMERGENCY GENERATORS ONLY (Che~k all that apply) [] 14. CONTINUOUSSUMPSENSORWITHOUTAUTOPUMPSHUTOFF+AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPHTEST [] 3. ANNUAL INTEGRITY TEST (0JGPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION i-lc NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH} SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR+AUDIBLE ANOVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK 468 [-I1. D2. []3. DISPENSER CONTAINMENT FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE INSTALLED CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 2002 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 SIGNATU%~-WN~. ~1 certify that the information provided herein istrueand acc_~,t~J~ii.J~4.he~est of my,r ~ knowledge. J DATE Sept. 17, 2002 NAME OF O~PR~OR (print) TITLE OF OWNER/OPERATOR Dennis Bock Compliance Manager Permit Number (For local use only) 473 Permit Approved (For local use only) Permit Expiration Date (For local use only) 475 470 472 IPP. F [1/~1~1 r~ui~pd~ Fnrmc~rlv RWRP. R Fnrm R {~FIED PROGRAM CONSOLIDATED FO~ · TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page __ of TYPE OF ACTION [] 1 NEW SITE PERMIT [] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Check oneitem only) [] 7 PERMANENTLY CLOSED ON SITE [] 3 RENEWAL PERMIT (Specify reason - for local use only) (Specify reason - for local use only) [] 8 TANK REMOVED 430 I I I01 I I01012141 12 LOCATION WITHIN SITE (Optional) 431 3800 Rosedale Highway, Bakersfield, CA 93308 ::!'~,'!~i~T~ANK: DESC~!~!,O,,~,~!~ 'S~,~ :~l~t:~'C)J~rf~itl~;:.th:~':!b:~t ~f::th~U,~§t~i~l~dih~ buildin~j~'~ir~d:land~i~ks,:s~ 1~se ~db~ tted~:to: tH'~~: ocal::::::::;~~' ~, ~ ~ ,~ ~ ~ ~ ,: ~" : ::'":;:~'!o :~ '~ '~ :~' ' : '~i~ :'~,~.~, ~" ~ : : TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 1 Containment Solutions ~f "Yes". complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 2002 / August 20,000 one ADDITIONAL DESCRIPTION (For Ioca~ use only) 438 TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4. HAZARDOUS WASTE Refinery Blended Motor Gasoline 86290-81-5 (Includes Used Oil) [] 95. UNKNOWN :; i:::::;: :: : :: ::?; I I~i:,~TANK'CONS~RUC~ION~,; ;;;,< :'::::::: ~-;,~''':::: :: :: TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 2. DOUBLE WALL [] 4. SIGNLE WALL IN VAULT [] 99. OTHER TANK MATERIAL-primary tank [] 1. BARE STEEL [] 3. FIBERGLASS/PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL - secondary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 DATE INSTALLED 447 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] 1 MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER Check one item only) [] 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 Check all [] I SPILL CONTAINMENT that apply) 2002 [] 1 ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2002 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 2002 IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] I VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (S/R) BIENNIAL TANK TESTING [] 99 OTHER · " ' IVFTANK CLOSURE NFORMATION /PERMANENT CLOSURE ;IN PLACE REMAINING TANK FILLED WITH INERT MATERIAL? NA NA gallons [] Yes [] No I IP~I: ('1/_cl.q r~,~,,i~;Rct/ I~nrm~rlv .C;WRC. R Fnrm R PROGRAM CONSOLIDATED TANK UNDERGROUND STORAGE TANKS - TANK PAGE 2 :' : - V ?'PIPING= 'ONSTROCTION ~,'~e~],ii]~a~i~,;i::: :' ;:::'::]: : :'; ::::i Page of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION / [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER Environ Geoflex-D 461 MANUFACTURER 463 [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 4. FIBERGLASS [] 5. STEEL W/COATING [] I. BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HOPE) [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 6. FRP COMPATIBLE W/100%METHANOL [] 7. GALVANIZED STEEL [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 9. CATHODIC PROTECTION [] 95. UNKNOWN 465 VII. PIPING. LEAK DE~EC~ION (Check a :that apply) (A d~scept!on of,~he momtonng program shall be s¢~m ~ted to the oca agency ) :::: ::-:: UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) CONVENTIONAL SUCTION SYSTEMS [] 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [] 7. SELF MONITORING GRAVITY FLOW [] 9. BIENNIAL INTEGRITY TEST {0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION []c. NOAUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION [] 12, ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMPSENSOR+AUDIBLEANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUSSUMPSENSORWITHOUTAUTOPUMPSHUTOFF+AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR {3.0 GPH TEST) WITHOUT FLOW'SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) [] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION []c NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT DATEINSTALLED [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DALLY VISUAL CHECK [] 2. CONTINUOUS DISPENSER PAN SENSOR * AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 2002 [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + [] 6. NONE 469 AUDIBLE AND VISUAL ALARMS 468 certify that the in.~oforma,tion~.~provided herein is ,~e-.em:t-~rate t~the best of my kno~edge. SIG~A--7'ET]~E OF OWNF--.~(OPERATOR' ~. / DATE ~ ~~~ ~ i Sept. 17, 2002 NAME CE~P~TOR (print) TITLE OF OWNE~OPERATOR Dennis Bock Compliance Manager Permit Number (For loci use only) 473 Permit Approved (For Io~1 use only) Permit Expiration Data (For ~o~1 use only) 475 I IP~F (1/~ 470 472 Fnrm~rlv RWR~R Fnrm R J FIED PROGRAM CONSOLIDATED FOI~ TANKS UNDERGROUND STORAGE TANKS - lANK PAGE 1 (two pages per tank) Page __ of __ TYPE OF ACTION [] 1 NEW SITE PERMIT [] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Check oneitem only) I-1 7 PERMANENTLY CLOSED ON SITE [] 3 RENEWAL PERMIT (Specify reason- for local use only) (Specify reason- for local use only) [] 8 TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 5 0 2 I 0 0 2 4 1 2 Costco Wholesale Corp. Gas Station #688 LOCATION WITHIN SITE (Optional) 431 3800 Rosedale Highway, Bakersfield, CA 93308 '::: /iLTANK: DESCR PT ON :(A sca ed P otP ~::~ ti1 t~':lb~tiC)i~' 6f:tl~:'US~,~t~'~ii~Kidii~' biJil~i~§:'::~dd~lahdmark§~§h~lli§~§db~itt~d :to:th'~ I~1:: ::: ': :;;:::: : :::::::::::::::::::::::::::::::::::::::::: -::::;: :: ::~ :~: : ::::::::::::::::::::::-.-~: - :::: ::::: :: :: ::::: :::: ::: . ::,:: :: TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 2 Containment Solutions ~f "Yes", complete one page for each compartment. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 2002 / August 20,000 one ADDITIONAL DESCRIPTION (For local use only) 438 TANK USE 439 PETROLEUM TYPE 44o [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER__ [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4. HAZARDOUS WASTE Refinery Blended Motor Gasoline 86290-81-5 (Includes Used Oil) [] 95. UNKNOWN TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 2. DOUBLE WALL [] 4. SIGNLE WALL IN VAULT [] 99. OTHER__ TANK MATERIAL - primary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL -secondarytank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] 1 MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER (Check one item only) [] 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all [] 1 SPILL CONTAINMENT that apply) 2002 [] 1 ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2002 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 2002 ~ '~' ~ I~: ~AN K' L'EAK DE~EC~ION!~(A de~cnpt'°n:°f the rnon'tPr'ng: pr°gram*shall he~sqb~'tted t° t~!0~! ~g~pey~) ..... iii iii ::.:: IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] 1 VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [] 99 OTHER ':~'~?' ~': :'~i:" ' :':. i, .,'~ IV. TANK~CEOSURE:~:INF~RMATION'I~'PERMANENT CI~OSUREIN p~CE' ..... · !: ESTIMATED DATE LAST USED (YR/MO/DAY) 455 I ESTIMATED QUANTITY OF SUBSTANCE 456 457 REMAINING TANK FILLED WITH INERT MATERIAL? NAI NA gallons [] Yes [] No I IPP..F [1/.q.q rc~li~.c~rl~ J~nrmc~rlv .c;WRC. R Fnrrn R FIED PROGRAM CONSOLIDATED FOI~ TANKS UNDERGROUND STORAGE TANKS - TANK PAGE 1 (two pages per tank) Page __ of __ TYPE OF ACTION [] 1 NEW SITE PERMIT [] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION [] 6 TEMPORARY SITE CLOSURE (Check one item only) [] 7 PERMANENTLY CLOSED ON SITE [] 3 RENEWAL PERMIT (Specify reason- for local use only) (Specify reason - for local use only) [] 8 TANK REMOVED 430 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 5 0 2 1 0 0 2 4 1 2 Costco Wholesale Corp. Gas Station #688 LOCATION WITHIN SITE (optional) 431 3800 Rosedale Highway, Bakersfield, CA 93308 I TANK: DESCRIE~ION:: fA,:~l~ ::~l~t::~ ~iY:~tti th~ 0~t ~::~f:t~b' US~S~Stem nc Ud ~:~:lsii d ri~:~i~cl~ ~dd~a~l~§'§ti~ ~l~L~brn tted:tC:tl~: Iocal::~ TANK ID # 432 TANK MANUFACTURER 433 COMPARTMENTALIZED TANK [] Yes [] No 434 3 Containment Solutions If "Yes", complete one page for each compartr'r~nt. DATE INSTALLED (YEAR/MO) 435 TANK CAPACITY IN GALLONS 436 NUMBER OF COMPARTMENTS 437 2002 / August 20,000 one ADDITIONAL DESCRIPTION (For local use only) 438 TANK USE 439 PETROLEUM TYPE 440 [] 1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL (If marked complete Petroleum Type) [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER__ [] 3. CHEMICAL PRODUCT COMMON NAME (from Hazardous Materials Inventory page) 441 CAS# (from Hazardous Materials Inventory page ) 442 [] 4. HAZARDOUS WASTE Refinery Blended Motor Gasoline 86290-81-5 (Includes Used Oil) [] 95. UNKNOWN TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLADDER SYSTEM 443 (Check one item only) EXTERIOR MEMBRANE LINER [] 95. UNKNOWN [] 2. DOUBLE WALL [] 4. SlGNLE WALL IN VAULT [] 99. OTHER__ TANK MATERIAL - primary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 444 (Check one itemonly) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE W/ [] 99. OTHER REINFORCED PLASTIC (FRP) 100% METHANOL TANK MATERIAL - secondary tank [] 1. BARE STEEL [] 3. FIBERGLASS / PLASTIC [] 5. CONCRETE [] 95. UNKNOWN 445 (Check one item only) [] 2. STAINLESS STEEL [] 4. STEEL CLAD W/FIBERGLASS [] 8. FRP COMPATIBLE [] 99. OTHER REINFORCED PLASTIC (FRP) W/100% METHANOL [] 5. CONCRETE [] 10. COATED STEEL DATE INSTALLED 447 TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 OR COATING [] 2 ALKYD LINING [] 4 PHENOLIC LINING [] 6 UNLINED [] 99 OTHER (Check one item only) (For local use only) 448 DATE INSTALLED 449 OTHER CORROSION [] I MANUFACTURED CATHODIC [] 3 FIBERGLASS REINFORCED PLASTIC [] 95 UNKNOWN PROTECTION IF APPLICABLE PROTECTION [] 4 IMPRESSED CURRENT [] 99 OTHER (Check one item only) [] 2 SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (local use only) 451 OVERFILL PROTECTION EQUIPMENT:YEAR INSTALLED 452 (Check all [] 1 SPILL CONTAINMENT that apply) 2002 [] 1 ALARM [] 3 FILL TUBE SHUT OFF VALVE [] 2 DROP TUBE 2002 [] 2 BALL FLOAT [] 4 EXEMPT [] 3 STRIKER PLATE 2002 /~ ;I~/{;'TANK EEAK:DE~EC~ON (Adescdp~k~nT&({~emoniiori~pr:o~ram~h~ilbesubmittedtoth~l~l:'-~¢¢e~;i;: :' , : ; '~,' IF SINGLE WALL TANK (Check all that apply) 453 IF DOUBLE WALL TANK OR TANK WITH BLADDER 454 (Check one item only) [] I VISUAL (EXPOSED PORTION ONLY) [] 5 MANUAL TANK GAUGING (MTG) [] 1 VISUAL (SINGLE WALL IN VAULT ONLY) [] 2 AUTOMATIC TANK GAUGING (ATG) [] 6 VADOSE ZONE [] 2 CONTINUOUS INTERSTITIAL MONITORING [] 3 CONTINUOUS ATG [] 7 GROUNDWATER [] 3 MANUAL MONITORING [] 4 STATISTICAL INVENTORY RECONCILIATION [] 8 TANK TESTING + (SIR) BIENNIAL TANK TESTING [] 99 OTHER ...: :*';': -'., ;:", IV TANK CLOSURE NFORMA~ ON /: PERMANENT CLOSURE NPEACE': '" ,:: ~,:;:~.~'. .i';:: : ESTIMATED DATE LAST USED (YPJMO/DAY) 4551ESTIMATED QUANTITYOFSUBSTANCE 45~I 457 REMAINING TANK FILLED WITH INERT MATERIAL? NA NA gallons [] Yes [] No I IPC. F (1/~ rc~vi~Hl Parmarlv .clWRC, R Farm FI TANK PROGRAM CONSOLIDATED UNDERGROUND STORAGE TANKS - TANK PAGE 2 < ' , : -;::: :: MI~PIEING:;~NSTRUCTION(check:~i~h~tap'ply):~,~,~;~,: ',, · ; : , ~ Page _ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTION / [] 1. SINGLE WALL [] 3. LINED TRENCH [] 99. OTHER 46o [] 1. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER [] 2. DOUBLE WALL [] 95. UNKNOWN [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER Environ Geoflex-D 461 MANUFACTURER 463 [] 1. BARE STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] UKNOWN [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 99. OTHER [] 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 3. PLASTIC COMPATIBLE W/CONTENTS [] 4. FIBERGLASS [] 5. STEELW/COATING [] 6. FRP COMPATIBLE W/100%METHANOL [] 7. GALVANIZED STEEL [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 9. CATHODIC PROTECTION [] 95. UNKNOWN 465 ~: ~%~,:~,~!f~,:~;~,7~;~,::, :~!~MII.:P:IPING:LEAK;DE~EC~ION:::(Check all that apply)(A description of:the:mon~tonng~program shall be subm~tted,,to UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): [] I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1GPH) CONVENTIONAL SUCTION SYSTEMS [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALUES IN BELOW GROUNDPIPING): [] 7. SELF MONITORING GRAVITY FLOW [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WiTH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION r'lc. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUTOFF OR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH} SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUSSUMPSENSOR*AUDIBLEANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply} [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LiNE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DALLY VISUAL CHECK SINGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS. [] 2. MONTHLY 0.2GPH TEST [] 3. ANNUALINTEGRtTY TEST(0.1GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply) [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL iNTEGRITY TEST {0.1 GPH) SAFE SUCTION SYSTEMS {NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [] a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION I-lc. NO AUTO PUMP SHUT OFF [] 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM [] 13. CONTINUOUS SUMP SENSOR+AUDIBLE ANDVISUALALARMS EMERGENCY GENERATORS ONLY (Check all that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT DATEINSTALLED [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DALLY VISUAL CHECK [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER / MONITORING 2002 [] 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 468 I certify that the information provided herein,~r.~ accurat,,e/!,o the best of my knowledge. , OWNER/OPERATO~ DATE 17, 2002 (print) TITLE OF OWNER/OPERATOR Dennis Bock )liance Manager Permit Number (For local use only) 473 Permit Approved (For local use only) Permit Expiration Date (For local use only) 475 47O 472 I IPC'.I= (1/~ r~/i~cl~ I~nrm~rlv .C;WI~R Fnrm R WRITTEN MONITORING PROCEDURES UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the USTlocation at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections 2632(d) and 264(h) CCR. Facility Name: Costco Wholesale Corporation Bakersfield .qas station #688 Facility Address: 3800 Rosedale Highway, Bakersfield, CA 93308 1. Describe the frequency of performing the monitoring: Tank- Continuous monitoring by Veeder Root. A Veeder Root 350R tank monitor can the product level by a push of a button. A hydrostatic monitoring system constantly monitors 100% of both the inner and outer tanks. Piping- The product pipes are continuously monitored by in-line leak detectors and liquid level sensors within the secondary containment sumps. What methods and equipment, identified by name and model, will be used for performing the monitoring: Tank- Veeder Root 350R monitor console with Veeder Root hydrostatic sensor VR 94980-301 for secondary containment monitoring. Piping- FE Petro Submersible turbine with Red Jacket FX line leak detector for in-line product pipe monitoring and Veeder Root 350R monitor console with Veeder Root sump sensor VR 794390 for secondary containment monitoring. o Describe the locations(s) where the monitoring will be performed (facility plot plan should be attached): Veeder Root console is located within the controller enclosure; the liquid level sensors are located below grade and within the secondary containment sumps located at each; dispenser, turbine (~tanks), and gasoline fill riser/vapor recovery riser (@tanks). The product piping is monitored at the tank submerged turbine sumps and each dispenser sumps. List the name(s) and title(s) of the people responsible for performing the monitoring and/or maintaining the equipment: Mr. Joe ILes, Bakersfield Warehouse #688 Manager; Mr. Dennis Bock, Compliance Manager, Costco Wholesale Corporation. o Reporting format for monitoring: Tank Written Remote Monthly Monitoring Status Reports by a third party service provider of the operation status of the tank interstitial liquid level. Piping Written Remote Monthly Monitoring Status Reports by a third party service provider of the operation status of the pipe interstitial space sensors located in the dispenser & submerged turbine pump sumps. 6. Describe the preventive maintenance schedule for the monitoring equipment. Note: maintenance must be in accordance with the manufacturer's maintenance schedule but not less than every 12 months. Monitoring equipment is checked once/year minimum or as required: MAG 1 probe, VR 94980-301, VR 350R, VR 79340. 7. Describe the training necessary for the operation of the UST system, including piping and the monitoring equipment: Gasoline attendants are required to demonstrate knowledge of facility policies and procedures regarding; spill cleanup and disposal; emergency spill response and notification; daily, weekly and monthly inspections; monitoring equipment operation; pump shutoff equipment; and first aid. EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the USTlocation at all times. The information on this monitoring program are conditions of the operating permit. The permit holder must notify the Office of Environmental Services within 30 days of any changes to the monitoring procedures, unless required to obtain approval before making the change. Required by Sections2632(d) and 264(h) CCR. If a leak occurs, how will the secondary containment be 'cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion hazard, are not cleaned up from the secondary containment within 8 hours, or deteriorates the secondary containment, then the Office of Environmental Services must be notified within 24 hours. Incidental spills: incidental spills and observable leaks are isolated, contained with absorbent socks or other on-site absorbent materials. Attendants are instructed to not flush any spills with water into the environment. A.E. Schmidt Environmental, Inc. or similar cleanup contractor utilized is for Emergency Spill Response. Describe the proposed methods and equipment to be used for removing and properly disposing of any hazardous substances: Absorbent materials are used to isolate and contain releases with used absorbent material stored onsite in approved DOT containers with transfer and disposal by Belshire Environmental, Inc. or similar TSDF contractor. Describe the location and availability of the required cleanup equipment in item 2 above. Absorbent materials, container and protective equipment are strategically placed at the fueling area and also stored at the control enclosure directly adjacent to the dispenser islands/canopy area (fueling area). Describe the maintenance schedule for the cleaning equipment. Full used absorbent containers are removed from the site promptly. List the name(s) and title(s) of the persons(s) responsible for authorizing any work under the emergency response plan: Name: Mr. Dennis Bock Job Title: Costco Gasoline Compliance Manager Name: Mr. Mike Gibson Job Title: Costco Bakersfield Assistant. Warehouse Manager Name: Mr. Joe ILes Job Title: Bakersfield Warehouse Manager LETTER FROM CHIEF FINANCIAL OFFICER I am the chief financial officer for Costco whOlesale, 999 Lake Drive, Issaquah, WA 98027. This letter is in support at'the use of the Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective action and/or compensating third parties for bodily injury and property damage caused by an unauthorized release of petroleum in the amount of at least $1 million ger occurrence and $2 million annual aggregate coverage. Undergrou,nd storage tanks at the following facilities are assured by this letter: Costco Wholesale 1601 Coleman Avenue Santa Clara, CA 95050 Costco Wholesale 12700 Day street Moreno Valley, CA 92553 Costco Wholesale 2001 E. Ventura Blvd. Oxnard, CA 93030 Costco Wholesale 7981 E. Stockton Blvd. Sacramento, CA 95823 Costco Wholesale 14601 Valley Center Drive Victorville, CA 92392 Costco Wholesale 895 E. "H" Street Chula Vista, CA 91910 Costco Wholesale 1311 ! Peyton Drive Chino Hills, CA 91709 Costco Wholesale 480 McKinley Street Corona, CA 91719 Costco Wholesale 6100 Sepulveda Blvd. Van Nuys, CA 91411 Costco Wholesale 1220 Foothill Blvd. Azusa, CA 91702 Costco Wholesale 198 Plaza Drive Vallejo, CA 94591 Costco Wholesale 4605 Morena Blvd. San Diego, CA 92117 Costco Wholesale 150 Laxvrence Station Rd. Sunnyvale, CA 94086 Costco Wholesale 1556 E1 Camino Real S. San Francisco, CA 94080 Costco Wholesale 2030 N. Imperial Ave. E1 Centro, CA 92243 Costco Wholesale 13463 Washington Blvd. Marina Del Rey, CA 90292 Costco Wholesale 18649 Via Princessa Santa Clarita, CA 91351 COstco Wholesale-Loc#126 11000 Garden Grove Blvd. Garden Grove, CA 92843 Costco Wholesale 2751 Skypark Drive Torrance, CA 90509 Costco Wholesale 220l Veme Roberts Circle Antioch, CA 94509 Costco Wholesale 3101 Gilmore Ave. Bakersfield, CA 93308 Costco Wholesale 1755 Hacienda Drive Vista, CA 92083 Costco Wholesale 2345 N. Mission City Pkwy San Diego, CA 92108 Costco Wholesale 2207 W. Commonwealth Alhambra, CA 98103 999 Lake Drive · Issaquah, WA 98027 · 425/313-8100 · www. costco, com LETTER FROM CHIEF FINANCIAL OFFICER - PAGE 2 Costco Wholesale 10l Town Center Pkway. Santee, CA 92071 Costco Wholesale (#454) 1.15 Technology Drive W Irvine, CA 92618 Costco Wholesale 650 Gateway Center Drive San Diego, CA 92102 Costco Wholesale 2300 Middlefield Road Redwood City, CA 94063 Costco Wholesale-Loc (#488) 2345 Fenton Parkway San Diego, CA 92108 Costco Wholesale 14501 Hindu Ave. Hawthorne, CA 90260 Costco Wholesale 3801 Pelandale Ave. Modesto, CA 95356 Costco Wholesale 72 - 800 Dinah Shore Dr. Palm Desert, CA 92211 Costco Wholesale (#679) City of Industry 17550 Castleton Street City of Industry, CA 91748 Costco Wholesale (//690) 27220 Heather Ridge Road Laguna Niguel, CA 92677 Costco Wholesale (//659) 5901 Redwood Drive Rohnert Park, CA 94928 Costco Wholesale 1900 Santa Rosa Ave. Santa Rosa, CA 95407 Costco Wholesale 951 Palomar Airport Rd. Carlsbad, CA 92009 Costco Wholesale ! 1260 White Rock Rd. Rancho Cordova, CA 95742 Costco Wholesale 1600 Expo Parkway Sacramento, CA 95815 Costco Wholesale 1099 E. Hospitality Lane San Bernardino, CA 92408 Costco Wholesale 1445 "R" Street Merced, CA 95340 Costco Wholesale 2800 Independence Drive Livermore, CA 94550 Costco Wholesale 26610 Ynez Road Temecula, CA 95210 Costco Wholesale (#686) 9404 Central Avenue Montclair, CA 91763 Costco Wholesale (//453) 5101 Business Center Drive Fairfield, CA 94585 Costco Wholesale (#148) 2201 Senter Road San Jose, CA 95 112 Costco Wholesale 4801 Central Avenue Richmond, CA 94804 Costco Wholesale 2660 Park Center Drive Simi Valley, CA 93065 Costco Wholesale 1144 Broadway Chula Vista, CA 91911 Costco Wholesale (#135) 380 W. Ashlan Avenue Clovis, CA 93612 Costco Wholesale (#479) ! 3463 Washington Blvd. Marina del Rey, CA 90292 Costco Wholesale 2400 Monument Blvd. Concord, CA 94518 Costco Wholesale 1900 Davis Street San Leandro, CA 94577 Costco Wholesale 1051 West Burbank Blvd. Burbank, CA 91506 Costco Wholesale (#678) 11800 - 4th Street Rancho Cucamonga, CA 91730 Costco Wholesale (#658) 3250 W. Grantline Road Tracy, CA 95377 Costco Wholesale 7100 N. Abbey Street Fresno, CA 93720 LETTER FROM CHIEF FiNANCIAL OFFICER - PAGE 3 Costco Wholesale (#688) 3800 Rosedale Highway Bakersfield, CA 93308 Amount of annual aggregate coverage being assured by this letter ............................................................................................... $ 3,000,000 *2. Total tangible assets .............................................................................. $11,103,812,000 *3. Total liabilities ...................................................................................... $ 5,620,598,000 *4. Tangible net worth ................................................................................. $ 5,483,214,000 I hereby certify that the wording of this letter is identical to the wording specified in subsection 2808.1 (d) (1), Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is tree and correct to the best of my knowledge and belief. Executed at Issaquah, WA on: Date: Name: Richard A. Galanti Title: Executive VP/CFO *Note: Balances are as of 5-12-02 (3rd Qtr, FY02), the last reported financial data for Costco Wholesale. State of California State of Water Resources Board Division of Clean Water Programs P.O. Box 94-4212 Sacramento, CA 942~-2120 (Insu'uctions on reverse side) For State Use Only CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR ULNDERGROL:'ND STORAGE TAJNKS CONTA. EghNG PETROLEUM I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ! I 500,000 dollars per occurrence ['"-] 1 million dollars annual aggregate or AND or ~t million dollars per occurrence ~__~_ million dollars annual a~gregate hereby certifies that it is in compliance with the requirements of Section 2807, (Name of Tank Owner or Operator) Article 3, Chapter 18, Division 3, Title 23, California Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Type Name and Address.of Issuer Mechanism Number Coverage Amount Coverage Period Corrective Action Third Party. Comp Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission cf this certification also certifies that you are in compliance with all conditions for participation in the Fund. Facility Name C,o~co ~,3~o~3a~' C~o~ Facility Name Facility Name Facility Address Facility Address Facility Address Signatu Tan r O er or Signtu [ gate ~late FILE: Original - Local Agency Name and Title of Tank Owner or Operator Name of Witness or Notary CFR (Revised 04/95) Copies - Facility/Site(s) APPUCATION I:OR UNDERGROUND ~EtRAGE TANK MAINTENANCEFEEACCOUNTNUMBER T-374 P. 014/0Z0 F-Z6; BOARD O~ £QIJAZ.JZATION ~4 SECTION I1: FORMER OWNER INFORMATION ('C~n~u~ an rewrae) Sep-16-ZOOZ 1Z:l, Gam From-DI)G. +018TgZO446 T-374 P-OT3/OZO F-Z69 B. INDIVIOUAL TANK i~ESCRII~TION AT SITE - (must be com~et~] for each ~e) C. SITE PROPERTY OWNER INFORMATION - (muet be comMeted Yor each ---- Il I I I I I I II Ill III _Ill I _ II_.LII I _ . I I I I Illll I I I I SECTION W.' cERTIRcATIoN. (fore Pm~nerJh~p, MIa~ ~u~t~n sJg~ed by M Om~'M padnefs; for o ~~, ~e ~; w,d r~ · t,~ ~.~ ~a~ ~ ~ ~~ ~ a~ the ~ ~O ~s ~W to ............ ,~ m~. ~~ ~. ~.~,~'~~ ~ ~ ' " Site Address: Costco Cc, "" Id Gasoline Station #688, 3800 Rosedal,~J"~qhway, Bakersfield, CA 93308 Date Map Drawn: Sept. 17, 2002 Map Scale:1 inch = 40 ft (appx) Page:_ Of:__ ~ Fil~/VapOr ,~ LRecovery sumps,) (typ.) ~ 5spenser (ty~.)_~ lDispenser sumps/ (typ,) / 'Emergency Shut-'~ Emergency Sh ut-Off Switch, Audible & Visible Alarm .~~ctrical Panel, FEI) lO 2003 16:3~ BKSFLD FIRE PREVEMTIOH (661)852-2172 CITY OF BAKI~.RSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-39?9 p.2 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ SECONDARY CONTAINMENT TESTING]TRACER TESTING OWNERS NAME TANK # VOLUME CONTENTS 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 "H' Street Bakerstield, CA 93301 VOICE (661) 326o3941 FAX (661) 395-1349 PREVENTION SERVICES RRE SAFETY SERVtCES* ENVI~MENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VO)CE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93.301 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 Costco 3800 Rosedale Hwy Bakersfield CA 93308 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 Ru: 2 1 O2 08: 59a ENV~IRONMENTAL INC. 46~ ~,~/. Jennifer, :~uice i0i, FresnO, CA 93?22 (559) 277-9378 / Fax (559) 277-0106 License No. 605.:!.42 A-Haz IO.1 FAX COVER LETI'ER DATE: TO: COMPANY: FAX NO: FROM: NUMBER OF PAGES (ZNCLUOES COVER SHEET): TIME SENT: SENDER: BAKERSFZELD · BAY AREA · FRESNO · LOS ANGELES · MODESTO · SACRAMENTO Ru~ ~ O2 08:59a MONITORING SYSTEM CERTIFICATION For Use By .4tl Jurisdictions I, Fithin the Stare of California Authori~ Cited: Chapter 6. 7, Health a~d Safeo' Code; Chapter 16. Division 3, Title 23, California Code of Regulations Th. is form must be used to document testing and se~'icing of monitoring equipment. A separate certification or report must be prepared for each monitorino~ system control ¢anel 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 systerns within 30 days of test date. A. General Information Facility Contact Person: t~l Make/Model of Monitoring S¢stem: B. Inventory of Equipment Tested/Certified Cheek the appropriate boxes t~ }.~fl~S~t~_~Eeeific equipment?spec, ted/serviced: ~ In-Tank Gau~i;g Probe. Model: ~~ ~Annular Space or Vault Sensor, Modeh ~~ iping Sump t Trench Sensor(s). Modeh itl Sump Sensor(s). Modeh ~ lechanical Line Leak Detector. Model: ~~ ~ Electronic Line Leak Detector. Model: ~ Tank Overfill / Fligh-Levcl Sensor. Model: ~ Other {specify equipment t~pe and model in Section E on Pag5 Tank ID: q.[ ~ in-Tank Gauging Probe. Modch ~ ~ Annular Space or Vault Sensor. Model:~ ~ Piping Sump / Trench Sensor(s). Model: ~ Fi/lSumpScnsor(s). Modc~::~~~ ~ Mechanical Line Leak Detector. Model: Q Electronic Line Leak Detector. Model: ~ Tank Overfil[/ High-Level Sensor. Model: Q Other (specif7 equipment bne nnd model in Section E on P.~gS..2)- ~penser Contain' ' h~nt Sc- nsor(s). Model: : ~ ~ispenser Co~inment Float(s) and Chain(s). spenser Containmen{ Sensor(s). Modch ~ ear Valve(s). ~ Dispenser Co,tainment Float(s) and Chain(s}. ~spenser Containment Sensor(s). Model: %~-~C ~ Shear Valve(s). ~Dispenser Containment Float(s) and Chain(s). Contact Phone No.: (~ ~'~ tO ~ O~ ~-"~ Date ofTesting/Setwicing: _..~_/~/ Tank Gauging Probe. ' Model: ~ nnular Space or Vault Sensor. Model: qi~,iping Sump / Trench Sensor(s). Model: itl Sump Sensor(s). Modeh lechanical Line Leak Detector. Model: ~lectronic Line Leak Detector. Modeh Tank Overfill / High-Level Sensor. Modeh Other (specify equipment t>>e and model in Section E on Pq?, ~). : ~Probe. Model: Ann~r S~ce or~nsor. Mod~ F~~ ~rench S~ ~Shear % alve(s). Dispenser Containment Float(s) and Chain(s). DispOser ID: ~ q/Ia ~Shear Valve(s), Dispenser Containme0t Float(s) and Chain(s). Shear Valve(s). Dispenser Containment Float(s) and Chain(s). *If the facility contains more tanks or dispensers, copy this form. Include intbrmation for every tank and dispenser at the facility. C. Certification - l certify that the equipment identified in this document was inspected/sen'iced 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 ~:opy of the reporIg.J~eck all that ap£1)9: , ~ System set-up Technician Name (print): ,-/~]._~:5~l~ _J~-a'~,~/,'t Signature~ Certification No.: ..~2.,~-~/',~' -~'Z License. No.:. ~'~"/,~'",~----~' Testing CompanyName: '~\\ ~r ~,~j.~. Phone No.:(~) Site Address: 3a~O ~'_~_J~5~/~"/~.~-~ 6*q)~[~'~O~DateofTesting/Servici;g: 7 Page I of 3 03f01 Monitoring System Certification Ru~ 2J 02 08:59a D. Results of Testing/Servicing Sofnvare Version Installed: C~/f~plete the following checklist: ee} 0 No* Is the audible alarm operational'? 0 No* Is the visual alarm operational? I,~l~/Y~e,s O No* Were all sensors visuall7 inspected, functionally tested, and confirmed operational? ~ xes 12 No* Were all sensors installed at lowest point ofsecondar3' contairLment and positioned so that other equipment will not interfere ~'ith their proper operation'? [] Yes [] ' * If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) ~ operational? [~'/~res [] No* For pressurized piping systems, does the turbine automatically shut do,ma if the piping secondary containment [] N/A monitoring system detects a leak, fails to operat~or is electrically disc?rm.,~ted? If yes: which sensors initiate positive shut-doxx.a~? (Check all that apply) 5t"Sump,rI'rench Sensors; [2t"Dispenser Co~ainraent Sensors. Did you confirm positive shut-down due to leaks and sensor failure/discormection? ~Yes; [-I No. ~ Yes r-I/No* For tank systems that utilize the monitoring system as the primary tank overfill ~varning device (i.e. no gl' N/A mechanical overfill prevention valve is installed), is the overfi[l warning alarm visible and audible at the tank ,/ fill point(s) and operating properl? If so, at what percent of tank capacity does the alarm trigger'? . % ~ Yes* {B/No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced ,.,- and Ii.st. the manufacturer name and model for all replacement parts in Section E, below. ~ Yes* [~t'~No Was liquid found inside any secondary containment systems designed as dr), systems? (Check all that apply) [] Product: 12 Water. If yes,. describe causes in S.e~t. ion E, below.  Ye~ ~ No* Was monitoring system set-up reviewed !q.cnsure proper settings? Attach set up reports, if applicable ~ No* Is all monitoring equipment operational per mamtfacturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: &~['~/~5' r"C~' ' >1~~ ,7~¢ ~~~)] Page 2 of 3 03/01 2~! 02 08:59a IO.4 Fo In-T~nk Gauging / SIR Equipment: ~Check this box if tank gauging is used only fox inventory comrc)L 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. Co ete t . ~ ' cies were or will be corrected * In the Section H, below, describe how and when these deficien ' ' G. Line Leak Detectors (LLD): ~Check this box ifLLDs are not installed. Complete the following checklist: ' [] Yes [] No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? F1 N/A (Check all that apply') Simulated leak rate: [3 3 g.p.h.; UI 0.1 g.p.h; U! 0,2 g.p.h. gl Yes [] No* Were all LLDs confirmed operational and accurate x~4thin regulatory requirements? ID Yes [] No* Was the testing apparatus properly calibrated? [] Ye'---'--~ [] No* -~or mechanical LLDs, does the LLD restrict product flow ifit detects a leak'? Cl N/A · ID Yes [] No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? U} N/A ID Yes CI No*. For electronic LLDs, does the turbine atttomatically shut off if any portion of the monitoring system is disabled [] N/A or disconnected'? ~ FI No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions [] N/A or fails atest'? [] Yes [] No* For electronic LLDs, have all accessible wiring connections been visually inspected'? [] N!A [] Yes ~1 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. Page 3 of 3 03101 Rug 23 02 09: OOa Monitoring System Certification UST Monitoring Site Plan 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 fotlowing equipment, if installed: monitoring system control panels; sensors monitoring tank ann~tlar spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and irt-tank liquid level probes (if used for leak detection). In the space provided, note the date th~s Site Platt was prepared. Page }'~ of ~ 05/00 Auff-l$-2002 01 :$-gam From-DDG. +818?828445 T-ZOg P. 002/004 F-DS7 LETTER FROM CHIEF FINANCIAL OFFICER I am r~c chief finaucial officer for Costco Whole~ale, 99~ Lake Drive, Issaquah, WA 98027. This letter is in suppor~ of thc use of the Underground Storage Tank Cleanup Fund to demonstrate financial responsibility for taking corrective action and/or compensating third parties for bodily injury and property damage caused by mi unauthorized release o£petrol~m in thc amount of at least $1 million per occurrence and $2 million annual aggregaie cowrage. Und~rgrom). d storage tanks at t~e following facilities are assured by this 1.zner: Costco Wholesale 1601 Coleman Avenue Santa Clara, CA 95050 Costco Wholesale 12700 Day Street Morcno Valley, CA 92553 Costco Wholesale 2001 E. Vemtura Blvd. Oxnard, CA 93030 CosU;o Wholesale 7981 E. Stockton Blvd. Sacramento, C,~ 95823 Costco Wholesale 14601 Valley C~ntcr Drive Victorville, CA 92392 Costco 'Wholesale 895 E. "H" Street Chula Vista, CA 91910 Costco Wholesale 13111 Peyron Drive Chino Hills, CA 91709 Costco Wholesale 1220 Foothill Blvd. ,4~usa, CA 91702 Costco Wholasale 480 McKinley St~t Corona, CA 91719 Costco Wholesale 198 Plaz~ Drive Vall~Jo, C^ ~.;~i Cc~tco 'Wholesale 6100 Scpulveda Blvd. Van Nuys, CA 91411 Costco Wholesale 4605 Mor~na Blvd. Costco th'hole, sale 150 Lavamcc Station Rd. Sunnyvale. CA 94086 Costco Wholesale 1556 B1 Camino l~al $. San Francisco, CA 94080 Costco Wholesale 2030 N. Imperial Ave. El Centre, CA 92243 Costco Wholesale "--~ '~ _~2--- I Marina Del Rcy, CA 90292 Costco Wholesale Costco Wholcsa2e-Loc# 126 11 o0d~G, ardar~ Grove Blvd. Costco Wholesale 2751 Skypark Drive Torrance, CA 90509 Costco Wholesale 2201 Veme Roberts Circle Antioch, CA 9.4509 Costco ~olesale 3101 Gilmore Ave. Bak6rsfield, CA 93308 Costco Wholesale Costco Wholesal~ Costco Vista, CA 92083 San Diegot, ~9 Lak~ Drive * Issaauah, WA 98027 * 425/3~3-8~00 o www. costco.com M;-16-ZOOZ O~:55am From-DDG. +BIB?SZ8445 T-Z09 P.003/004 F-967 LBTTF, R FROM CHIBF FI~CIAL OFFICF-~ - PAGE 2 Costco Wholesale 101 Town Center Pkway. Sant~, CA 92071 Costco Wholesale 115 T~hnologY Drive W I.wine~ CA 92618 Costco Wholesale 650 Gateway C~nt~ Drive San Di¢$o, CA 92102 Costco Wholesale 2300 Middl¢ficld Road Redwood City, CA 94063 Costco Whole, sale-Loc (#458) 2345 Fenton Parkway San Diego, CA 92108 Costco Whol~ale 14501 Hindry Ave. Hawthorne, CA 90260 Costco Whok~al¢ 3801 P¢landale Ave. Modesto, CA 95356 Costco Wholesale 72 - 800 Dir~S Shore Dr. Palm Desert. CA 92211 Costco Wholesale Ci~ of Indus.' 1 ?550 Castleton Street City of Industry, CA 9174i Costco Wholesale (#690) 27220 H~athcr Ridge Road Laguna Nig~el, CA 92677 Costco Whol~lo (#659) 5901 Redwood Drive ttohnc~t Parle, CA 94928 Costco Wholesale 1900 Santa Rosa Ave. Santa Rosa, CA 95407 Costco Wholesale 95l Palomar Airport Rd. Carlsbad, CA 92009 Costco Wholr~alc 11260 Whit~ Rock Rd. Rancho Cordova, .cA.~5,742 Costco Wholesale 1600 Exp'o Parkway Sacramento, CA 95815 Costco Wholesale 1099 £. Hospitality Lane San B~rnardino, CA 92408 Costco Wholesale 1445 "R." Street Mcrce, d, CA 95340 Costco Wholesale 2800 Ind~d~c~ Drive Livermore, CA 94550 Costco Wholesale 26610 Yncz Road Temecula. CA 95210 Costco Wholesale 9404 Central Avenue Montclair, CA 91763 Costco Wholesale (~5~) 5101 Business Center Drive Fai.rficld, CA 9,i585 Costco Wholesale (#14~) 2:~01 Sent~r Rnad San Jose, CA 95112 Costco Wholesale 480I Central Avenue Richmond. CA 94804 Costco Wholesale 2660 Pa~k Ccamr Drive Simi V~lley, CA 93065 Costco Wholesale 1144 Broadway Chula Vista, CA 91911 Costco Wholesale (#135) 380 W. Ashlan Avenue Clovis, CA 93612 Costco Wholesale (#~,79) 13463 Washington Blvd. Marina del Ray, CA 90292 Costco Wholesale 2400 Monument Blvd, Concord, CA 945 Costco Wholesale 1900 Davis Street San Lcm~dro, CA 94577 Costco Wholesale 1051 W,~t Burbank Blvd. Burbank, CA 91506 CosmoWholcsal¢(#-678) 11800 P. anchoCucamonga, CA 91730 Costco Wholesale (#65~) 3250 W. Crrantline Road Tracy, CA 9~377 Costco W'l~lesal¢ 7 ~L 00 N- Abbey Street Frraxo, CA 93720 Aui-16-2002 01:56am From-DDG. +8187828445 T-209 P.004/004 F-967 LETTER lzR.OM CHIEF FINANCIAL OFFICEI~. - PAGE Costco Wholesale Amount of armttal aglp~gat. ~ov~ag~ bvin~ a.sS~cl by This letter ............................................................................................... $ 3,000,000 $11,103,812,000 $ 5,620,598,0'00 *:3. Total liabilities ...................................................................................... *4. Tangible net worth ................................................................................. $ 5,493,214,000 I h~rcby ¢~ti~ that thc wording oft. his lc~t~r is icl~ti~al to thc wording specified in subsection 2g0g. 1 (d) (t), Chapt~ lg, Division 3, Title 23 of the California Code of Regulalions. I ~lar¢ under p~alty ofp~ury that t~¢ torcg~ii~ ~=~c--a~"~bn''~ ,u u,¢,,,~i ,,,~- ........ .~-- and belief. I~xecuted a~ Iasaqu~l'h WA on: Date: Name: R,ichanl A. Title: . Executive *Not~: Balanc~ are as of $-1 :l-02 (Srd Qtr, FY02), the last rcportud iinancial ciasa for Costco Wholesale. I ....... :. '~' ~ """, I~1~ I II .~ ~ ..... "~*'=--'~ ...... .= · T 1 :[]NLEADED A VCiLUHE = 17456, GALS ULLAGE = 2495 GALS 90::,"~ tiLLaGE= ' ,:199 GALS TC: VOLUP1E -: 1 '?1182 ,:3~4LS HEIGHT = 97.67 INCHES I...J~TER VQL = 0 GALS bitTER = 0.O0 INCHES TEHP 2, 90.6 DEG F T ~-:I_INLEADE,) ~3 L,'OLUNE = 17367 G~LS LiLL~GE = 2584 G~I_S 90% ULL&GE= 588 G&LS TC- 'qOLIJHE = 16992 G~LS HEIGHT = 97.13 INCHES bJ~'FER VOL ~ 0 GALS -TEHp = '-90.8 DEC; F T 3:PREHIUP1 VObUHE = 17:399 G~L~ ULLAGE .... 5,: 9 CC':' I~LL~GE: 556 T[~ j, LIJP1E = 17059 c-'' ° HE~T 97. :32 I IqC:HES (..,I&TER VOL = 0 GALS Ld~TER = O. O0 INCHES TEHP = 8,7..9 DEG F HAl,II FOLDED TAblES INVENTORY TOTALS T 1 :UNLEADED a T 2:UNLEADED B VOLUP1E = 34828 ,:7;aLS TC; VOLUME = 34074 GaLS L 1 · UNLE&D ~'};ANNLILAR ~NN UL&R 'sPaCE FUEL ~L~RH : ,~:, JUL SI,. 2002" 10:50 aH FL}EL SENSOF/ OIJT aLaRI'.'I ,J~N 1, 1996, 2:15 f ,,, i 'i., .; · ~. ' : · , . .,.: ~,,., :~,'~,'~'.. ,... -.?' . ~,~ ~,i ...... ,.-.., :'. :, - .,. P I P I NG SLIPI~'(/' HIGH LIQUID JUL :31 ~'T - "' HIOH LIOIJID JAN 3.. 1996 1 El: SENSOF: C:'UT aLaRH' JaN I. 1996 '2:i \.' [ , :, :..:4. I ,/--'h ...,,. ,-,~,;~..?,:~,, -,' "l aLt4RP1 HISTORY REPORT,, ,. ...... .-,EN:~oR L :3:UNLEAD a STP " STP SUF'IP .,?. ,~. HIGH " '" LI~IJID JLIL 31.. 2002.10:49 AP1 HIGH LIOUID ~LaRP1 ';' , JaN :3 .. .: .LL}' '. HIGH LIOUID JaN 1.. 1996: 1"~'~ PPI L 4:IJNLEgD B aNNULaR ~PaCE. FUEL aLaRP1 JOL ~1., 2~02 10:52 JUL ~1.. 2002 10:51 ~P1 ~L~RI"I HISTORY REPORT ...... SEN~OR ~L~RM L 5:UNLEAD ~ FILL PIPING ~UHP HIGH LIGUID ~L~RM JUL 91.. 2002 10:5:3 AM HIGH LI~IU[D ALARM J~"~'~'3. 1996 lO:JO AM FUEL aLaRM JaN 1 ...1996, !'0: 09 aI"l aL~F:M H I STORY RE}i;OR,~ ........ SEI'~SOR aLaRM --.+-~-- L 6: UNLE~D B STP ..,, STP SUMP HIGH LIGUID aLaRM JUL :31, 2002'10:49 ~I'"1 HJ "" L1Q'IJID'~LARM J~3, 1996 10:19 HIGH LIQUID ~L~RI"I J~N l, '1996 1 :.:~? t::'PI ALARM HISTORY REPORT ......... SE NSO];: ~LARb'I i ......... L ? :PREI"II UM RNNLILa~I AI?"'L~R SPACE F ~ ALARM ,JI.JE 2~1.. 2002 10:52 AM FUEL ALARM FUEL aLARM JAN 1, 199'6 1: 28 PM 1 H I STORY REt::'(:,R'T ....... SENSOR., ALAR?'I ........ ' L 9: P};;:EM I UM. STP .- STP s,_a~ ..... . JUL '31.. 200'.--.' 10:50 HIGH LI(~iU[D ~L~RM JAN. 3. 1996 10:20 HIGH L1GUID aLARM .J~:" ,1 .. 1996 1: ,33 PM gLaRP1.'HiI~ FOR"~' REPORT S' ' '.. aLa'~"l H I I.:-_;T'~JlR,I~, REPORT · g, _.,:.~ ~ ,:,ENc,~..R a-L~R~'I ¥'- ......... ' ." P~ ftC;' SUMP- ,'~?~ ..~ ...... .L.~ LI~:DISP PAN'I H IC;R ,L I',aU I D,',.:aZaRM .-"'~;" '.L.Y-~: D I SPENSER 'y'a~i ' JUL ~3; - 2~0'2:~10: 5:1;:~[~1.[;.~.~'~'~ ~ FUEL aLaRM" ' .~- ..... '..] ?' v:',..:-'"-~ ,.; ,:;~':,:.'.. ]' :' ' ...... ' JUL ' HItcH L],aU.~.p~4[~'a~:U:'~::~ji "'.'.~,,?~ . -': .'. Ip., z' 'f~' -, ~ · "' - JAN S.: ~1'996 ~O~e~['~l~'~~-:~ F~ ~aLaR[1 l~ --sl l~q~ lO'IS aP1 HIGH LI~3UID ~LRRM '~-' /:-" ' ' JAN. 1.. 1996 1:31 PM I SENSOR out ALARM JAN 1. ,199a~ 1:17 PM ? '.~.' . 6~L6tRI"1 H I ~TOR"~" REPORT ...... F:;E N[-iOR P~LRf,:tM ....... LII:DISP PEN ;3,4 DISPENSER Pgd'4 FUEL JUL ,'31.. 2002 1L]:46 AM F ~L._.2 aLARM JAN 3.. 1996 10:17 SENSOR OUT ,]~N 1, 199E, 1:17 lZ:'M ALARM H!STORY REPORT .... SENSOR ALFd;:~M ........ Li'--g)ISl:;' i:;AN 7..8 DISPENSER PAN FUEL ALARM ,JUL 31 ,-~nrlo 10:47 aM FUEL ~:~LARI"I JaN 3, 1996 10:17 AM FUEL ALARP1 JAN 1. 1'396 1:40 PM i~IL~['"I H I STORY REP,2, RT -a.._~ SEbISOR ~I..ARM .......... L15:I]ISI:~ PAN 11..12 D [ SI;:'E NSEF.' FUEL Jl_ll. 31, 2002 1L]:47 Rl'.'l FUEL ALARM JAN :3.. !99E, 10:14 AM FUEL aLaRM JaN 3, 1998 9:25 RLRRM HISTORY REPORT ...... SENSC'R al, ARM ......... Li:~-.-DISt::' PaN 5..6 P I~._~/f'iSER PAN F LII~"~, ALARM · JUL ;31.. 2002 10:47 FLIEL' ~LRRM JaN :3.. 1996 10:16 al'.'l SENSC'R OUT aLaRM JaN 1, 1996 1: ~L~'I H I STOR'Y REI:"ORT ......... SENSOR ALARM ........ LI4:DIS!> PaN 9',. 10 DI SPENSER PAN FUEL aLaRM FUEL aLaRM gu1 30 0;:' 11:37a .... p.;:' 0'//:)0/02 10:43 ~'$61 0576 BF1) ~IAZ MAT DIV - CITY OF BAKERSFIELD "-~ OFFICE OF ENVIRONMENTAL SERVIC. ES 1715 Chester Ave., Bakersfield, CA (661) 326 3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST TA.X~# VOLUME ooo ~1 CONTENTS ~U~ ~ ~ Oc~ APPROVED BY DATE SIONATURE OF APPLICANT D /. July 29, 2002 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 To Whom It May Concern: Costco has permission to conduct a fuel drop at 3800 Rosedale Hwy. This drop is necessary to conduct a systems check. This system is currently under construction, permit #BI-0214. Should you have any questions, please feel free to contact me at 661- 326-3190. S~l.y~ Steve Underwood Underground Storage Tank Inspector/Environmental Code Enforcement Officer SBU/dc CITY OF BAKI~. SFIELD. OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE City, Zip Phone No. City, Zip Permit # INSTRUCTIONS: Please call for an inspector only when each group of inspections with the same number are ready. They will mn in consecutive order beginning with number 1. DO NOT cover work for any numbered group until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce the number of requi~*d inspection visits and therefore prevent assessment of additional fees. TANKS AND BACKFILL INSPECTION [ DATE [ INSPECTOR Backfill °f Tank(s)T~LL~ .~ a 'c:~ ~ 'O "Z~ ~ Spark Test Certification or Manufactures Mefl~xl Cathodic Protection of Tank(s) PIPING SYSTEM SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETE4 .'i'ION Liner Installation - Tank(s) Liner lnstallat~ion - Piping Vault With Product Compatible Sealer Lc., Ga.g.o. F,oat ve., Va,v. Product Compatible Fill Box(es) Product Line Leak Detector(s) Monitoring Well(s)/Sump(s)- H20 Test e~]~fh- Leak Detection Device(s)/'or Vadose/Groundwater FINAL CONTACT. PHONE # 82:81 gM P.02 1'-1 i)~LM:rz JI, FPLTCA'Z20.N TO CONS'Z'RuC'rJM:OIX[FF ~ rtORAf~ TAI, rJ[ D /. May 3, 2002 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Mr. Bob Becker, RG Soils Engineering, Inc. 4400 Yeager Way Bakersfield, CA 93313 Addendum #! To Remedial Action Report Costco Facility located at 3800 Rosedale Hwy Dear Mr. Becker: I have reviewed the above referenced report and concur with the findings that the oil stained soil discovered in the sewer line trench has been successfully remediated and that the previously undiscovered water well has now been properly abandoned. If you have any questions, please call me at (661) 326-3979. Sincerely, Ralph E. Huey Director of Prevention Services by: · ~ Howard H. Wines, III Hazardous Materials Specialist Registered Geologist No. 7239 Office of Environmental Services HHW/dc D December 17, 2001 Mr. Todd Bartok Costco Wholesale 999 Lake Drive Issaquah, WA 98027 RE: Propo~d Costco Facility at 3800 Rosedale Hwy in Bakersfield FIRE CHIEF RON FR/~Z.E 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 Dear Mr. Bartok: This is to inform you that this department has reviewed the result of the Remedial Action Report dated December 3, 2001 associated with the above referenced site. Based upon the information provided, this department has determined that appropriate response actions have been completed, that acceptable remediation practices were implemented, and that, at this time, no further investigation, remedial or removal action or monitoring is required at the above stated address. Nothing in this determination shall constitute or be construed as a satisfaction or release from liability for any conditions or claims arising as a result of past, current, or future operations at this location. Nothing in this determination is intended or shall be construed to limit the rights of any parties with respect to claims arising out of or relating to deposit or disposal at any other location of substances removed from the site. Nothing in this determination is intended or shall be construed to limit or preclude the Regional Water Quality Control Board or any other agency from taking any further enforcement actions. This letter does not relieve the land owner of any responsibilities mandated under the California Health and Safety Code and California Water Code if existing, additional, or previously unidentified contamination at the site causes or threatens to cause pollution or nuisance or is found to pose a threat to public health or water quality. Changes in land use may require further assessment and mitigation. If you have any questions regarding this matter, please contact me at (661) 326-3979. Sincerely, Howard H. Wines, III Hazardous Materials Specialist Registered Geologist No. 7239 Office of Environmental Services CC: J. Whiting, RWQCB B. Becker, SEI ,9:~JSTI:~DRIvl S\U ST. L8 D October 25, 2001 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Mr. Robert J Becker RG REA II Soils Engineering Inc 4400 Yeager Way Bakersfield Ca 93313 RE: Proposed Costco- Groundwater Well Sampling Report 3800 Rosedale Hwy in Bakersfield Dear Mr. Becker: I have reviewed the above referenced report, dated October 10, 2001, and concur with your recommendations to properly abandon all existing groundwater/monitoring wells on the subject property. Please give this office at least five (5) days notice prior to commencement of work. If you have any questions, please call me ~at (661) 326-3979. Sincerely, Howard H. Wines, III Hazardous Materials Specialist Registered Geologist No. 7239 Office of Environmental Services HHW/dm cc: T. Bartok, Costco