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HomeMy WebLinkAboutUNDERGROUND TANKHazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE .......... ~,.~,,~,,~,~,~,,;~,,~ ,,,,~ ._ This permit is issued for the following: PERMIT ID # 015-021-001952 ~L~'"i~?"?? :!i i'~ ':i ??,iiil;iiiiiiiiiiiiiiiii:iiiiiiill i?!i?i!~i!~Hazardous Materials Plan FASTRIP FC~OD ~wcm~ ~a9 ::~,,~,,~:"??"(.~,!I~ i~'":'"~iiiiiiii!ii,,, .,,~ iii~,~ ill ~'~'~ ! ~ U~e[ground Storage of Hazardous Mateflals ~ii~:~"i'' .",.~i i!,,:iL TANK HAZARDOUS SUBSTANCE TANK PIPING PIPING PIPING 0001 Regular Unleaded 0002 Premium 0003 Mid Grade 0004 Diesel 0005 Premium 0006 Regular Unleaded 0007 Diesel TYPE METHOD MONITOR DWF PRESSURE ALD DWF PRESSURE ALD DWF PRESSURE ALD Issued by: DWF DWF 12,000 CLM DWF 12,000 CLM DWF Approved by: Expiration Date: Bakersfield Fire Department OFFICE OF ENVIR ONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 PRESSURE PRESSURE PRESSURE PRESSURE ALD ALD ALD ALD June 30, 2000 D ICA Cert. No.. 00886 City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to thc issuing agency: Usc thc space below to enter thc following information in 'thc 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 2n~ day of November, 1998 to: FASTRIP FOOD STORE #642 Permit #015-021-001952 12851 Rosedale Hwy. Bakersfield, California 93312 City of Bakersfield Office of Environmental Services 171 $ Chester Ave., Suite 300 Bakersfield, California 93301 (sos) 320-3970 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 inthe 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 2nd day of November, 1998 to: FASTRIP FOOD STORE #642 Permit #015-021-001952 12851 Rosedale Hwy. Bakersfield, California 93312 KERI; CO~ F.,.-~ItO~3LT~ HF. JLT.,!L~I SE;I.VZCES DE12A~,,HEh'~, 'r'~';S~ GA'~T 0~,1 ~:LECO;.D oo ADDRESS ZNVESTZGA'I~ZOS ' RECO~Z) OWNER DBA ADDP. ESS OF VIOLATZON~ ASSESSOKS' PAKCEL #"' SPECIALIST/TECHNICIAN CHRONOLOGICAL RECOi~D OF' INVEsTiGATION KERN COUNt/. ENVIRONMENTAL HEALTH SERVICES DEPAI~TMENT DBA ADDKESS OF VIOLATION.. A~SESSO~ ' PAP. eEL # SPECIALIST/TECHNiCIAN INVESTIGATION RECORD ~D~SS CT CHRONOLOGiC&L RECORD OF' INVESTIGATION TIME~ · DATE ( HR · .~ .// . . '~ t ' ~1 April 4, 2000 FIRE CHIEF RON FRAZE ADMINISTRATIVE 8ERVICF.8 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941. FAX (805) 395-1349 SUPPRESSION SERVlCF.8 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICE8 1715 Chester Ave. Bakemf'~ld, CA 93301 VOICE (805) 326-3951 FAX (8O5) 326-O576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAJNING DMSION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 3994697 FAX (8O5) 399-5763 Jaco Oil Mr. John Kerley P O Box 1807 Bakersfield CA 93303 1807 Dear Mr. Kerley: You have been identified as the compliance coordinator for the facility/facilities referenced in the attachment. The permits to operate this facility/facilities will expire on June 30, 2000. However, in order for this office to renew your permit, updated forms A, B, & C must be filled out and returned prior to the issuance of a new permit. Please make sure that you are sending the updated'forms which are indicated by the date 7/99 in the lower left hand comer. Please complete and return to this office by May 15, 2000. Failure to comply, will result in a delay of issuance of your new permit to operate. Should you have any questions, please feel free to call me at 661-326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dam attachment Facility Fan'ells Fastr/p Fastrip Fastrip Fastrip Fastrip Fastrip Fastrip Faatrip Fastrip Fastrip Wholesale Fuels Chris Liquors Howards Howards Howards Address 6401 White Lane, Bakersfield, Ca 93309 8001 White Lane, Bakersfield, Ca 93309 1200 Coffee Road, Bakersfield, Ca 93308 4901 S. Union Ave., Bakersfield, Ca 93307 2698 Oswell Street, Bakersfield, Ca 93306 1640 S. Chester Ave., Bakersfield, Ca 93304 805 34* Street, Bakersfield, Ca 93301 ~sed~-~Bakersfield, Ca 93312 4013 S. "H" Street, Bakersfield, Ca 93304 6401 S. "II" Street, Bakersfield, Ca 93304 2200 E. Brundage Ln., Bakersfield, Ca 93307 2732 Brundage Ln., Bakersfield, Ca 93304 3200 Panama Lane, Bakersfield, Ca 93312 4201 Belle Terrace, Bakersfield, Ca 93309 3300 Planz Rd., Bakersfield, Ca 93309 COJ~ECTION NOT I C. iJj BAKERSFIELD FIRE DEPARTMENT N~ 029~1 Sub Div./~~'5'! /"~0~d'~J~_ /'/'~/~lk. Lot You are hereby required to make the following corrections at the above location: Cot. No Date ~7-~ ~~?-'~ ~~ Inspector 326-3979 FACILITY NAME ~'r,b ~'O0d ADDRESS l~l ~5' [ /2~scd'~k FACILITY CONTACT ~0~ INSPECTION TIME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 9330 i INSPECTION DATE 7 %/ PHONE NO. 3~3- 7OOco BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: [~Routine Business Plan and Inventory Program [] Combined [] Joint Agency [] Multi-Agency Complaint ~.] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact in/brmation accurate Visible address Correct occupancy Ir/ Verification of inventory materials Verification of quantities Verification of location Proper segregation of material V Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping , Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: [] Yes [] No Questions regarding this inspection? Please call us at (805) 326-3979 While- Env. Svcs. Yellow- Station Copy Pink - Business Copy FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 INSPECTION DATE r-/~.~ fit ~ ~r Section 2: Underground Storage Tanks Program [~Routine [] Combined [] Joint Agency Type of Tank Type of Monitoring [] Multi-Agency Number of Tanks "7 Type of Piping ,5~ F [] Complaint [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Iff Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: ~d~ ~ Office of Environmental Services (805) 326-3979 White- Env. Svcs. Pink - Business Copy 0P4 368 3 Receipt for ' ~ Certified Mail No Insurance Coverage Provided Do not use for International Mail {See Reverse) Postage .32 Certified Fee 1.10 Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to VVhom & Date Delivered ]. o ].1 Return Receipt Showing to Whom Date, and Addreseee's Address TOTAL Postage & Fees Postmark or Date $ 2.5: June 8,1999 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-39~1 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (805) 325-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 325-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAINING DMSION 5642 Victor Ave, Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 John Kerley JACO Oil Company P.O. Box 1807 Bakersfield, CA93303-1807 CERTIFIED MAIL RE: Failure to Make Corrections SECOND NOTICE OF VIOLATION AND SCHEDULE FOR COMPLIANCE Dear Mr; Kerley: This office is very concerned with the lack of response from your company with regard to several correction notices issued at Fastrip's, located within the city, the are as follows: Fastrip at 6401 "H;' Street was issued a correction notice on April 20, 1998 for the following: Failure to provide annual maintenance on leak detection system, per Section 2641 (J) of the California Code of Regulations Title 23, Division 3, Chapter 16, underground storage tank regulations & failure to service fire extinguishers per UFC (1994 Edition). Fastrip at 4013 South "H" Street was issued a correction notice on April 2.0, 1998 for the following: Failure to provide statement of Financial Responsibility, per title 23, CCR. Copies of form A,B&C, replace missing "No Smoking" "Turn off Engine" sign on dispenser island. Additionally, you were given personally, a business plan and related underground storage tank forms on March 2, 1999 for the Fastrip at 12851 Rosedale Hwy, which still has not been 100% completed. You are hereby requested to appear at a hearing on this matter. The hearing will be held at 10:00 a.m. on Thursday, July 6, 1999 at: City of Bakersfield Fire Department Office of Environmental Services 1715 Chester Avenue, Suite 300 (3~ Floor) Bakersfield, CA 93301 At this hearing, you may present your plans for compliance. In the event that you are unable to attend this hearing as scheduled, you may reschedule to a later date, by calling this office as soon as possible. Failure to appear, will result in additional enforcement action. If you have any questions, please feel free to call me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental services SBU/dm cc: Walt H. Pon', Jr.~ Assistant City Attorney State of Califom,a State Wirer Resources Cor~trol Boar~ OM~ort of C~eln Wlte~ Programs P.O. BOx 944212 Sacramento. CA 94244-212(3 (l~m~c~lo~ on reverse) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM ---']500,000 dolla'~ I~U me ["-~--]1 million dollu~ per occurrence L"~l million dollam aanual a~'esate or ['---'~2 million dollax~ aanua] a&~'~$at¢ C. Mechanism Type State :Fun(:] Jaco Oil Company Art/cie 3, Chapter la D~ision 3, ~He 23, California Code of Regulations. The me~ani~s used to demons~te financial msponsibili~ as required by Sec~on 2807 am as follows: Self Insurance hereby certifies that it is in compliance with the requirements of Section 2807, Name and Address of Issuer Mechanism . Coverage Number '.' 'Amount State of Calif. $990,000 I$10,000 Coverage t Corrective Perfod ACtion' .. Cont I Yes Jaco Oil Company P.O. 'Box 82515 Bakersfield, CA 93380-2515 Note: If you are using the State Fund as any part of your demonstration of financial responsibility your execution and submission Third Party .comp. Yes of this certification also certifies that you are in compfiance w~th all conditions for ~ation in the Fund. i Fastrip #642 :~ '. ' " ' I 12851 Rosedale Hwy., Bakersfl'dl. F~ I":::'=n'"L acca T.J. Jamieson General 't FILE: Ong,nal. Local Agency' Copies - Facility/Site(s) Partner  State of California -- ~ i State of Water Resources Control Board Division of Clean Water Programs P.O. Box 944212 Sacramento, CA 94244-2120 (Instructions on reverse side) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM A. I am required to demonstrate Financial Responsibility in the Required amounts as specified in Section 2807, Chapter 18, Div. 3, Title 23, CCR: ['~ 500,000 dollars per occurrence ~ 1 million dollars annual aggregate or AND or I-Q-] I million dollars per occurrence [~] 2 million dollars annual aggregate B. 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, Cafifornia Code of Regulations. The mechanisms used to demonstrate financial responsibility as required by Section 2807 are as follows: C. Mechanism Mechanism Coverage Coverage Corrective Third Party Type Name and Address of Issuer Number Amount Period Action Comp State Fund State of California $990,000 Cont. Yes Yes Self Insurance Jamieson Hill Co $10,000 P.O. ~ox- 82515 Bakersfield, CA 93380-2515 Note: If you are using the State Fund as any part of your demonstration of financial responsibility, your execution and submission of this certification also certifies that you are in compliance with all conditions for participation in the Fund. D. Facility Name Facility Address Fastrip Food Stores #642 12851 Rosedale Hwy. Bakersfield, CA 93312 Facility Name Facility Address Facility Name Facility Address E. Signature~~oi' Tank Owner or,Operator Date Name and Title of Tank Owner or Operator ~-~~,/,, T.J. Jamieson - General Partner Signtur~/o~ "~~ ~ ~'~ _ Date Name of Witness or Notary C~ 04/95) ~ · FII.E: Original - Local Agency Copies- Facility/Site(s) SUNSET MECHANICAL 3812 PANORAMA DR. BAKERSFIELD CA. [805] 322-0m0 Continuous Monitoring Devic6 Certification MAKE AND MODEL OF MONITORING SYSTEM Contents of Tank Capacity of Tank Type of Product Line: (Gravity, Suction, pressure). MONITORING SENSORS TESTED BY PLACING A YES OR NO IN APPLICABLE BOX: Annular Space Sensor Sump Sensor Dispenser Contal. nment Sensor .. . Electronic Overfill I Leve Electronic In-Line Leak Detector Mechanical Line Leak Detector In Tank Gauging Device INDICATE THE FOLLOWING BY PLACING A YES OR, NO iN APPLICABLE BOX: peas the monitoring system have audible and visual alarms? ,~. ~ ~ Does the turbine automatically shut-down if the system detects a leak, fails t,o operate or i~ electronically disconnected? /~; ~ ~ Is the monitoring system Installed to prevent unauthorized tampering? /(~ ~ ~ Is the monitoring system operable as per the manu[acturer's specifications? ~' ~'"'~"~ ~ VVhich continuous moni',oring devices lnitiat~ positive shut-down of the ~IGNATURE OF CERTIFIED TECH.~IICIA'N ~[ r r-.,.,/.u r~-,...: ,.,. C:_~TI.'-;~.3 T.'.CH';: ..... T~.STIH~ COM~A:.tY I".-'.:,;E ~.; 'rc. LE?;-! ','.-- ;'.'- ~ASTRI?-642 1,2851ROSEDALE Ht4Y. BKFD. CA.93912 -805-588-2799 28, 1999 9:22 AM SYSTEM STATUS REPORT i' :TN\-,':A~-I~ FUEL LEVEL INVENTORY REPORT .1' I :UN1.EADED-707 V,3,I., UME = 5998 GALS t ii_.LA(;E = 6 '3F_i!:.:!: ULLAGE= 4927 GALS '['C VOLUME = 5804 GALS HEIGHT = 55.00 IIqCHES [,lATER VOL = 0 GALS %!ATER = 0.00 INCHES TEMP = 89.7 DEC; F T 2:UNL. PLUS-70? \lie = 6~19 GALS L~E = 5743 GALS 9ri.:..0 ULLAGE= 4536 GALS TO VOLUME = 6.,193 GALS HEIGHT = 57.84 INCHES WATER \,,'OL WATER = 0.?~ INCHES TEM!::' = t-3:-3' .4 DEC; F T 3:PREM. UNL.-70?' VOLUME = 4S96 '..,ALo ULLAGE = '7169 GaLS __..z90% -ElL ,LAGS 'I"3 VOLUME = 4'799 GALS HEIGHT = 4'7.48 INCHES t,,,IRTER \.,'OL = 0 GALS t,,IATER = 0.00 INCHES TEMP = S:~, 1 PEG F T 4 :DIESEL-NO \/OLUPlE = 4~24 GALS '-'"".q a GALS ULLAGE = ,' ~'- '- 90% XULLAGE= 6031 GALS TC~Lt_iME = 4755 OALS H' T 0 GALS TEMP = 91.4 DEG F T 5 :UNLEAI-)ED-708 VOLUME = b8 ,,' o GALS ULLAOE = 512? (;ALS 90':",~ ULLAGE= 3927 GALS TC VOLUME = 6744 GALS HEIGHT = 53.22 INCHES EIATER VOL = 0 GALS t,~IATER = O. O0 INCHES TEMP = 86.8 DEG T 6:I>REPIlUhl UNL.-'708 \/OLUP1E = 4161 (.';ALS ULLAGE = 7939 GALS O..b ULLAGE= 6639 GALS TC \/OLUME = 408:3 GALS HEIGHT = 36.14 INC. HES t,~IATER VOL = 0 GALS klA~ = O. O0 INCHES TEl = 86.7 DEG F T 7:DIESEL N0.2-708 '.,'C, LUME = 56 l 0 GALS ULLAGE = 6390 GALS 90% ULLAGE= 51913 GALS _.,5,: b GALS TC VOLUME = a o.- HEIGHT = 45.31 INCHES WATER VOL = 0 GALS WATER = 0. O0 INCHES TENP = 9.3.9 DEG F .~ ~ ~ ~ ~ END ~ ~ ~ ~ ~ T I: UNLEAD£D-70'7 f N\/ENTOF?~,' 1 NCREASE , 1 NC..REASE START MAY 26.. 1999 11:55 AM · VOLUME = 3790 ~}ALS W~TER = O. O0 INCHES TEMP ~ ?7.6 DE6 F I NCRE~E END ["I~Y 26.. 1999 12:27 PM VOLLIME = 8853 GALS W~TER = O. O0 INCHES TEMP = 81.9 DEG F GROSS f NC:K'EASE= 5063 TO NET [ NCF:EA',~E= 4974 T 3:PREM. UNL.-70? INVENTORY [ NCREt4SE INCREASE START MAY 26, 1999 12:14 PPI VOLUME = 592 GALS WATER = O. O0 INCHES TEMP = ?9.2 DEG F INCREASE END MAY 26, 1999 12:43 PM VOLUME = 4713 GALS WATER = 0.00 INCHES TEP1P = 84.8 DEG F {:~R'J'SS INCREASE= 4121 TC; NET l NC;RE&SE= 4047 .......... SENSOR ALAFd'I ....... --L ':~ LU'.IE'. :7?08 -~,LRt:~ ] 5_i'['f, S I..IMF. FUEL ALARM MAY_ 26. 19'.a. 9 4:01 tb'l } ....... SENSOR ALARM ....... LIO:UNL.-708 ANNULAR ANNULAR SPACE FUEL ALARM ~"I~Y 26. 1999 4:02 PM ..... ,--4: r'~,=,OR ALARM ....... I_,l 1 :PP, EM. UNL. <?08 SUMP STP SUMP FUEL ALARM MAY 26, 1999 4:03 PM ...... 'Z-;E NSOg:: ,~ L,~',RI"I ...... ~-~L.-1-2-:-PI~'EM;-I.~NL-. -908 ANN, - ANNULAR SP&CE FUEL ~LARM MAY 26, 1999 4:04 PM ..... SENSOR ALARM ..... LI3:DIESEL-?08 SLIMi:, STP S UMI:' FUEl_. ALARM MAY 26.. 1999 4:05 PM ....... SENSOR ALARM ...... L,i 4 :D t ESEI.-?08 ANN. RNNULAR SP'RCE FUEL ALARM HAY 2E,.. 1999 q:O? PPI iCITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 Page ~ of TYPE OF ACTION (Check one gem only) [] I. NEW SITE PERMIT [] 4. AMENDED PERMIT ~ 3. RENEWAL PERMIT (~oecify mason - [or locel use only) BUSINESS NAME (Same as FACILITY NAME ~ DBA - Doing Businesa As) LOCATION WITHIN SITE (Oiot~na/) TANK ID # DATE INSTALLED (YEAR~MO) 432 435 [] 5. CHANGE OF INFORMATION) E] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE (~oecify change, for local use only) '~1 8. TANK REMOVED I. TANK DESCRIPTION TANK MANUFACTURER TANK CAPACITY IN GALLONS 433 436 COMPARTMENTALIZED TANK [] Yes ~i No If "Yes'. complete o~e page fm each compartment. NUM~F-~ OF COMPARTMENTS ? 430 I 431 434 437 ADDITIONAL DESCRIPTION (For local use only) 438 II. TANK CON'rENT~ '" TANK USE 439 ~ 1. MOTOR VEHICLE FUEL (if marked, complete Petroleum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PRODUCT [] 4. HAZARDOUS WASTE (Includes Used 0#) [] 95. UNKNOWN PETROLEUM TYPE J~la. REGULAR UNLEADED [] 2. LEADED [] 5. JETFUEL [] lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL [] lc. MIDGRADE UNLEADED [] 4. GASOHOL []99. OTHER COMMON NAME (from Hazatt~o~ Matottels Invenlory page) 441 CAS # (from Hazardous Mate~fals Inventory page) 442 TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL wrrH 'Check one gem o~/y) [] 2. DOUBLE WALL EXTERIOR MEMBRANE LINER [] 4. SINGLE WALL IN A VAULT [] 5. SINC-.-.-.-.-..~E WALL wrrH INTERNAL BLADDER SYSTEM [] gS. UNKNOWN [] 99. OTHER TANK MATERIAL - I)dmary tank Check one/tern only) [] 1. BARE STEEL [] 2. STAINLE~ STEEL [] 3. FIBERGLASS / PLASTIC [] ~ 4. STEEL CLAD W/FIBERGlASS [] REINFORCED PLASTIC (FRP) TANK MATERIAL - secondary tank [] 1. BARE STEEL (Check one item only) [] 2. STAINLESS STEEL [] 3. FIBERCd. ASS/ Pt. ASTIC [~14: STEEL ~CLAD W/FIBERGLASS REINFORCED PLASTIC (FRP) E]S. CONCRETE S. CONCRETE [] 95. UNKNOWN 8. FRPCOMPATIBLEWI100% METHANOL []99. OTHER [] 8. FRp COMPATIBLE WIIOO% METHANOL []95. UNKNOVVN [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER f-] 10. COATED STEEL 44S I TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY UNING OR COATING [] 2. ALKYD LINING [] 4. PHENOUC LINING 'Check one item only) [] S. GLA~S UNING [] 95. UNKNOWN 446 DATE INSTALLED r~ 8. UNLINED ' [] 99. OTHER (For loca/ use only) 447 OTHER CORROSION [] 1. MANUFACTURED CATHODIC ~3. FIBERC4.ASS REINFORCED PLASTIC [] 95. UNKNOWN PROTECTION IF APPLICABLE PROTECTION [] 4. IMPRESSED CURRENT [] 99. OTHER 'Check one item only) [] 2. SACRIFICIAL ANODE DATE INSTALLED 449 (For local use only). SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 J~j 2. DROP TUBE ~2,,~ .;'* {~ 2. BALL FLOAT ~,~ [] 4. EXEMPT '~ 3. STRIKER PLATE 453 IF ~UB~ WALL T~K OR TANK ~TH B~DDER (Check o~e gem only): 4~ IF SINGLE WALL TANK (Check ail that apply): [] 1. VISUAL (EXPOSED PORTION ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 3. CONTINUOUSATG [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) +' BIENNIAL TANK TESTING [] $. MANUAL TANK GAUGING (MTG) [] 6. VADOSE ZONE [] 7. GROUNDWATER [] 8. TANK TESTING ' [] 99. OTHER [] 1. VISUAL (SINGLE WALL IN VAULT ONLY)  2. CONTINUOUS INTERSTITIAL MONITORING 3. MANUAL MONITORING - V~ TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 45~ '~'ANK FILLED WITH INERT MATERIAL? 457 gall01~S [] Yes [] NO iUPCF (1/99) Formerly SWRCB Form B CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SE ~715 Cheerer Ave., Bakersfield, CA 93301 (661) 326-~979 U~T. TAHK PAGE 2 VI. PIPING CONSTRUCTION (Cl~eckallmatseply) -:' ~ ':'!!?i:/~--. UNDERGROUND PIPING ABOVEGROUND PIPING ['-1 1. PRESSURE [] 2. SUCTION {:::] 3. GRAVITY 459 YSTEM TYPE ~ [] [__ I. PRESSURE CONSTRUCTION/i~ 1. SINGLE WALL MANUFACTURER [] 2. DOUBLE WALL MANUFACTURER [] I, BARE STEEL MATERIALS AND CORROSION PROTECTION [] 2. SUCTION [] 3. ~VITY 450 lt3. LINED TRENCH [] 99. OTHER 460 [] 9S. UNKNOWN 461 [] 6. FRP COMPATIBLE WI 100% METHANOL [] 2, STAINLESS STEEL [] ?. GALVANIZED STEEL [] I, SINGLE WALL [] 95, UNKNOWN 462 [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER 463 [] 1, BARE STEEL [] 2. STAINLESS STEEL [] 6, FRP COMPATIBLE W/100% METHANOL [] ?. GALVANIZED STEEL [] 3, PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] ~ 4. FIBERGLASS [] 8. FLEXIBLE(HDPE) [] 99. OTHER [] [] 5. STEEL WI COATING [] 9. CATHODIC PROTECTION 464 [] 3, PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) 4. FIBERGLASS [] 9. CATHODIC PROTECTION 5. STEEL WI COATING [] 95. UNKNOWN UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 467 [] 99. OTHER 465 '::'~:% ?:::. SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUI~:~ SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 ~ TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRfTY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): 7. SELF MONITORING GRAVITY FLOW: [] 9. BIENNIAL INTEGRrrY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND i(C, hec~ one) ~ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS J~ h. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF ' -" . 11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) W/TH FLOW SHUT OFF OR RESTRICTION 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ~] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATOR~q ONLY (C~eck all lltat [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH~IT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 .GPH TEST wr'rH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTE~ TEST (0.1 [] 4. DAILY VlSUAL CHECK CONVENTIONAL SUCTION SYSTEMS (~k 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 {hat apply): [] 8. DALLY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 Gl=H) SECONDARILY CONTAINED PIPII~G 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. AUT(~MATIC LEAK'bETECTO~R [] 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 [] 17. DALLY VISUAL CHECK ..... ,,- ...... . .~,,~.~,.-.-~. -.~-,.~,'~ ....... ~:: ........ ~ · :: i'~'~ :'::!:!:::"..~:.~~':~:- .;~ ~': ..', :..~.:~:::~:~:: .," '~:: ~ ~: h::',::'~:~;'~'!~ ' ~': ~ :~ :,.,~; :~;:~:::: .,.:~.r~*:~.?~,.~.~.D~N~C~TAINME~.:,,..,,,,:.:~,,::~.* ,...:~:..:~, .: ~ ::.: .~..~.~. ~ ..... .~:: .,:~,: ~: DISPENSER ~NTAINME~ ~ 1. FLOAT ~C~ISM ~T ~S 0~ SH~ V~ ~ 4. DAILY VISUAL ~ECK DATE INSTALLED 4~ ~ 2. ~INUOUS DI~NSER P~ SE~R + AUDIB~ ~D VISU~ ~MS ~5. TREN~ LINER / ~N~ORI~ ~ 3. CO~INUOUS DI~NSER P~ SEN~R ~ A~O SHUT OFF FOR DISPENSER + AUDIBLE ~D VISUAL A~ D 6. ~NE .. ~9 · ~.~ .-', .IX. OWNER/OPERATOR SIGNATURE $1G NA T U R E 0 F OWN ERIO;~~v:,.. :~,.,,,,.:../.~.:y//,~.../-.I certify that the infon'nalion provided hereini~i · an~-,~'~/~"~V~o..______.__~e best ............. DJ' my knowtedge.~ DATE . ~ /~./,~ Permit NumOet (For local use only) 473 Permit Approved (For/ocli use on/y) 470 472 4741P~,;[ Exl)iratlon Date (Forlocel use only) 475 'I UPCF (1/99) Formerly SWRCB Form B CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 Page TYPE OF ACTION [Check one item only) [] I. NEW SITE PERMIT [] 4. AMENDED PERMIT ~] 3. RENEWAL PERMIT (Sl~ecify mason, for local use only) BUSINESS NA~me aa FACILITY NAME ~ DBA - Doing Business As) LOCATION WITHIN SITE (Ol~tional) TANK I0 # ~ -- ~ 432 DATE INSTALLED (YEAR/MO) 435 ADDITIONAL DESCRIPTION (For /ocal use on/y) ['-] 5. CHANGE OF INFORMATION) [] 6. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLosED ON SITE (,~oec/fy change, for local use only) [] 8. TANK REMOVED I. TANK DESCRIPTION .' TANK MANUFACTURER COMPARTMENTALIZED TANK [] Yes ~:] NO TANK CAPACITY IN GALLONS if "Yes". complete one page for eac~ c~npa~ment. 430 1 431 l 436 NUMBER OF COMPARTMENTS 437 434 438 TANK USE 439 ~ 1. MOTOR VEHICLE FUEL (If marked, complete Peb=leum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PRODUCT [] 4. HAZARDOUS WASTE (Includes Used 0#) [] ~s. u.~owN II. TANK CON'/~NI'S ' ' PETROLEUM TYPE 440 [] la. REGULAR UNLEADED ["] 2. LEADED [] 5. JET FUEL [~ lb. PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL r'l lc. MIDGRADEUNLEADED [] 4. GASOHOL r-199. OTHER TANK MATERIAL - secondary lank [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEWI100% METHANOL r"195. UNKNOWN [~ 4. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORRODIBt. E JACKET [] 99. OTHER REINFORCED Pf,.ASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE 445 TANK INTERIOR LINING I--] 1. RUBBER UNED [] 3. EPOXY UNING [] 5. Gt. ASS UNING [] 95. UNKNOWN 446 DATE INSTAm~LFO 447 OR COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING ~ 6. UNLINED [] 99. OTHER __ (For focal use o~y) I PROTECTION IF APPLICABLE [] 1. MANUFACTURED CATHODIC l~}3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN 448 DATE INSTALLED 449 PROTECTION r-I 4. IMPRESSED CURRENT [] 99. OTHER [] 2. SACRIFICIAL ANODE (For local use only) SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (Forlocal use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 (Check all thatal~ply) ~ 1. SPILL CONTAINMENT YP ~' 1. ;ALARM ¢~2 ~;~3. FILL TUBE SHUT OFF VALVE ~' 2. DROP TUBE ~;2~.~ [~/2. BALL FLOAT ~'~ J--] 4. EXEMPT s'r., R TE , .....,'. :'..:' ,...: ':,~.~:~;~'~:e>:;~;~.';,'~J~:~;,'.::;:'~:~':~:?~'L~.'.:,~ ?:'~:~;:X:::-~:';:, ~;:~::::.~.. ::~::'i;:.:,,;~',-~,-L,":~!~,Y.::~? ~:~:!..,4~, ~,~, ~.~,~ ,-,~;~;~;.:~:~'.~..'.~'.S.~..?.,~:~×,:;~,?~ ::::::::::::::::::::::::: :. > > ;': ~ ~':~?;'~' ~'. ":, .;:':..: ': :;.'.":'::~:.-::.:;:'=~ "' '~Z~,~:~;'.~;:~::':'' IF SINGLE WALL TANK (Check 88 tltet apply): [] I. VISUAL (EXPOSED PORTION ONLY) [] 2. AUTOMATIC TANK GAUGING (ATG) [] 3. CONTINUOUS ATG [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING [] 5. MANUAL TANK GAUGING (MTG) [] 6. VADOSE ZONE [] 7. GROUNDWATER [] 8. TANK TESTING [] gg:.' OTHER IF .IX)UBLE WALL TANK ,Q.R TANK WITH BLADDER (Check one item only): 454 [] 1. VISUAL (SINGCE WALL IN VAULT ONLY) [~. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CI:OSURE INFORMATION/PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? - 457 ,gallo~ [] yes [] NO (1/99) Formerly SWRCB Form B CITY OF BAKERSFIELD -- OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 U~I'. TANK PAGE 2 Pa~e __ of UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEMTYPE i~ 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION ; CONSTRUCTION/~] 1. SINGLE WALL ~ 3. LINED TRENCH [] 99. OTHER 460 MANUFACTURERIL.-I"--' 2. OOUBLE WALL i MANUFACTURER ;El 1. BARE STEEL MATERIALS AND [] 2. STAINLESS STEEL CORROSION [] 95. UNKNOWN 461 [] 6. FRP COMPATIBLE WI 100% METHANOL [] 7. GALVANIZED STEEL PROTECTION I[:::] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN i~' 4. FIBERGLASS [] 8. FLEXIBLE (HDPE) [] 99. OTHER I [] 5. STEEL W/COATING [] 9. CATHODIC PROTECTION 464 [] 3. GRAVITY 459 [] I. SINGLE WALL [] 95. UNKNOWN '462 [] 2. DOUBLE WALL [] 99. OTHER MANUFACTURER [] 1. BARE STEEL [] 6. FRP COMPATIBLE W/100% METHANOL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION ' [] 5. STEEL WI COATING [] 95. UNKNOWN 465 ..:. VlLPiPINGLEAKDETECT1ON(CheckalUmte~op~.) :: .. .!.:..,.::.::~,. UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 466 S/NGLE WALL PIPING 467 PRESSURIZED PIPING (Check all that apply): 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 (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 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. ALARM~ AND 1ec~ one) a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS b. ~y~C.~OI~NI~C.~i~I' OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM [] c. NO AUTO PUMP SHUT OFF  11. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITH FLOW SHUT OFF OR RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARM~ EMERGENCY GENERATOR~ ONLY (Check al that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOI, IT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WlTHOl~ FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DALLY VISUAL CHECK [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PU'MP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL AI.ARM~ [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DALLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Cl~ck ~!1 U~t apl:)ly): [] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 8. TRIENNIAL INTEGRITY TEST (0.1 SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check al that apply): [] 8. DALLY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARJLY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): : 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (cttec~ on~) [] a. AUTO PUt~v~, SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DiSCONNECT .10N [] 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 al that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL At. ARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK OATE INSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN S~R + AUDIBLE AND VISUAL ALARMS ~. TRENCH LINER / MONITORING ~-~ [] 3. CONTINUOUS DISPENSER PAN SENSOR wTTH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6, NONE 469 IX. OWNER/OPERATOR SIGNATURE that/he in;,:,,T~&;;o,~ ~rovidecl hi,-i;~ ie true and an~Nt~te to ~e best o~ my knowledge. SIGNATURE OF OWNE~ I DATE P-~[ Num~ ~For ~ca/ ~e on~) 473 7~-~it ~ (~ ~ ~ o~y) 470 472 474 [ Permit Expiratlan Oate (Forlocal use only) 475I UPCF (1/99) Formerly SWRCB Form TYPE OF ACTION CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 NEW SITE PERMIT [] 4. AMENDED PERMIT RENEWAL PERMIT (Specify reason, for local use only) BUSINESS NAME (Saree as FACILITY NAME or DBA - Doing Business As) LOCATION WITHIN SITE [] 5. CHANGE OF INFORMATION) (Specify change - for local use only) 3 Page ~ of [] 6. TEMPORARY SITE CLO.S_URE [] 7. PERMANENTLY CLOSED ON SITE [] 8. TANK REMOVED 430 TANK ID # DATE INSTALLED (YEAR/MO) ADDITIONAL DESCRIPTION (For local use only) I. TANK DESCRIPTION 432 435 TANK MANUFACTURER TANK CAPACITY IN GALLONS 433 436 [] COMPARTMENTALIZED TANK Yes ~o If "Yes'. complele o~e page for eacfl compartment. NUMBER OF COMPARTMENTS 434 437 PETROLEUM TYPE 440 [] la. REGULAR UNLEADED [] 2. LEADED [] 5. JET FUEL [] 11). PREMIUM UNLEADED [] 3. DIESEL [] 6. AVIATION FUEL ~ lc. MIDGRADE UNLEADED [] 4. GASOHOL [] 99. OTHER TANK USE 439 ~ 1. MOTOR VEHICLE FUEL complete Petroleum Type) [] 2. NON-FUEL PETROLEUM [] 3. CHEMICAL PRODUCT [] 4. HAZARDOUS WASTE (Includes Used Oil) [] 951 UNKNOWN COMMON NAME (from Hazardous Materials Inventor/page) 441 CAS ti (from Hazan~ous Matetfals Inventor/page) 442 · "'.'~:: .~' .'.~:, ?.' i~.:'.:~;:i --.: !.,111; TANK CONSTRUCTION"::"...::: ::! :'. ' .' - · ...:~.~:iii~'!:::ii?i~:.:::i~i!.~.: ' TYPE OF TANK [] 1. SINGLE WALL [] 3. SINGLE WALL WITH [] 5. SINGLE WALL WITH INTERNAL BLJU3DER SYSTEM 443 [~ EXTERIOR MEMBRANE UNER [] 95. UNKNOWN · 2. DOUBLE WALL [] 4. SINGLE WALL IN A VAULT [] 99. OTHER TANK MATERIAL - pdma~y tank [] 1. BARE STEEL [] 3. FIBERGLASS/PLASTIC , [] 5. CONCRETE I-I ga. UNKNOWN 444 [] 2. STAINLESS STEEL ~ 4. STEEL CLAD W/FIBERGLASS [] 8. FRPCOMPATIBLEWI100%METHANOL []99. OTHER -. REINFORCED PLASTIC (FRP) TANK MATERiAL-sec~'tda~tank [] 1. BARESTEEL [] 3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEWI100% METHANOL [-195. UNKNOWN item only) [] 2. STAINLESS STEEL ~!~ 4. STEEL CLAD W/FIBERGLASS [] 9. FRP NON-CORRODIBLE JACKET [] 99. OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL [] 5. CONCRETE 445 DATE INSTALLED . 447. (For lo~l uae only) TANK INTERIOR LINING [] 1. RUBBER LINED [] 3. EPOXY LINING [] 5. GLASS LINING [] 95. UNKNOWN 446 OR COATING [] 2. ALKYD LINING [] 4. PHENOLIC LINING 1~6. UNLINED [] 99. OTHER PROTECTION IF APPLICABLE [] 1. MANUFACTURED CATHODIC 1~'3. FIBERGLASS REINFORCED PLASTIC [] 95. UNKNOWN PROTECTION )"1 4. IMPRESSED CURRENT [] 99. OTHER · FI 2. BACRIFICIALANODE - DATE INSTALLED 449 (For local use only) SPILL AND OVERFILL YEAR INS~r,~ED 450 TYPE (For local usa only) ,pply) [~'1. SPILL CONTAINMENT / ~ I:~ 2. DROPTUBE IF SINGLE WALL TANK (Check s# that apply): [] I, VISUAL (EXPOSEO PORTION ONLY) Fl 2. AUTOMATIC TANK GAUGING (ATG) [] 3. CONTINUOUSATG [] 4. STATISTICAL INVENTORY RECONCILIATION (SIR) 81ENNIAL TANK TESTING [] 5. MANUAL TANK GAUGING (MTG) [] 6. VADOSE ZONE [] 7. GROUNDWATER r-1 8. TANK TESTING [] 99. OTHER 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 ~] 1. ALARM ~2 a 3. FILL TUBE SHUT OFF VALVE F~'''~ El' 2. BALL FLOAT /,~ [] 4. EXEMPT 453 IF DOUBLE WALL TANK OR TANK WIT~'I)LADDER (Check one ~rn ~n/y): 454 [] 1. VISUAL (SINGLE WALL IN VAULT ONLY) [~)2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CLOSURE INFORMATION I PERMANENT :LOSURE IN PLACE ESTIMATED DATE LA~qT USED (YR/MO/DAY) 455 ESTIMATED QUANTrTY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? 457 [] Yes [] No JPCF (1/99) Formerly SWRCB Form B CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1'715 Chelter Ave., Bakersfield, CA 93301 (661) 326-3979 UST - TANK PAGE 2 Page ~ of VI, PIPING CONSTRUCTION (chec~ al t/mt apply) "' ~ : ' L. . . UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE I~ 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 459 CONSTRUCTiON/i~I. SINGLE WALL [~ 3. LINED TRENCH [] 99. OTHER 460 [] 1. SINGLE WALL [] 95. UNKNOWN _ . 462 MANUFACTURERIE:] 2. OOUBLEWALL [] 95. UNKNOWN [] 2. OOUBLE WALL [] 99.'OTHER i MANUFACTURER 461 MANUFACTURER 463 [] 1. BARE STEEL MATER ALS AND i [] 2. STAINLESS STEEL CORROSION PROTECTION [] 6. FRP COMPATIBLE WI 100% METHANOL [] 7. GALVANIZE{:)STEEL [] I. BARE STEEL [] 2. STAINLESS STEEL [] 6. FRP COMPATIBLE ~'~1 ~00% METHANOL [] 7. GALVANIZED ~TI~EL tD 3. PLASTIC COMPATIBLEWlTH CONTENTS 095. UNKNOWN i1~ 4. FIBERGLASS [] 8. FLEXIBLE (.DPE) [] 99. OTHER I [] 5. STEEL WI COATING [] 9. CATHODIC PROTECTION 464 [] 3. PLASTIC COMPATIBLE WITH CONTENTs [] 8. FLEXIBLE (HOPE). [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 95. UNKNOWN 465 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 46~ PRESSURIZED PIPING (Check all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.1~ GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DAILY VISUAL MONITORING OF PUIvlPtNG SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW: [] 9. BIENNIAL INTEGRITY TEST (0.1 SECONDARILY CONTAINED PIPING ' PRE~SSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAl. ALARMS AND  Che~ o~e) _ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCUR,~ h. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF 1AUTOMATIC LINE LEAK DETECTOR GPH TEST) WITH FLOW SHUT OFF OR 1. (3.0 RESTRICTION [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: ~"'"~3. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARM~ EMERGENCY GENERATOR~ ONLY (Check ~ ghat app/y) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHQI, rF FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) SINGLE WALL PIPING 467 PRESSURIZED PIPING (C~eck all that apply): [] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST wrrH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION +AUOIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL INTEGRFPt' TEST (0.1 Gl=fl) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that ap~ly): [] 5. 0ALLY 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 Ihat apply): [] 8. DAILY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPf. I) SECONDARILY CONTAINED PIPI, I,~G PRESSURIZED PIPING (Check all that apply): :~...'.': * 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (cttectx 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 PUM? SHUT OFF [] 11. AUTOMA~C LEAK'DETECTOR [] 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VlSUAL ALARMS EMERGENCY GENERATORS ONLY (Checkall thotappty) [] 14. CONTINUOUS SUMP SENSOR wT'rH(~¥T AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK OETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 17'. DAILY VISUAL CHECK · '.' .' 'U' :.:.:-...:.'r.'~:.~:./.:. ::¥~.::.i ~i:':.~%'~:?~!:,~:"~/'~' -'~'~'~'''' .~-;~?~::.~:.:,:,::~'":. ............ .-, ..................... ~: ~.:.' ::~': ............ ~.~.~:~= t:~~~NSEE CONTAINMENT .... DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 4. DAILY VISUAL CHECK DATE iNSTALLED 468 [] 2. CONTINUOUS DISPENSER PAN ~R + AUDIBLE AND VISUAL ALARMS [~) 5. TRENCH LINER / MONITORING ~'~ [] 3. CONTINUOUS DISPENSER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS 6. NONE 469 IX. OWNER/OPERATOR SIGNATURE SIGNATURE OF OWNER/OPER~TO_J~// .,~"~/~ ~ ~ DATE 471 TITLE OF OWNERIOP~RA_TOR _ _ _ Permit Numl~er (For local use only) 473 Permit Approval (For Iocll u.le only) 470 472 47 41Permit ExpiraUon Date (For local use only) 475I UPCF (1/99) Formerly SWRCB Form B CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 Page __ of TYPE OF ACTION [~] 1. NEW SITE PERMIT [] 4. AMENDE0 PERMIT (Check one ~tem only) [] 3. RENEWAL PERMIT (~pecify mason - for local use only) BUSINESS NAME~Ac,,~Ty NAME ~ DBA - Doing 8us~n,~ As) LOCATION WITHIN SITE TANK ID # DATE INSTALLED ADOITIONAL DESCRiPTiON (For local use only) 432 435 [] 5. CHANGE OF INFORMATION) (S~ecify change - for focal use only) 3 I FACILITY ID # TANK MANUFACTURER [] e. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE r~ 8. TANK REMOVED 430 TANK CAPACITY IN GALLONS If 'Yea'. complete o~e page f~ each ceml~artme~t. 436 NUMBER OF COMPARTMENTS 437 II. TANK CONTENTS ' ;" ' ': TANK USE 439 Fq= ~ ~OLEUM TYPE  1. MOTOR VEHICLE FUEL [] la. REGULAR UNLEAOED [] 2. LEADED [] 5. JET FUEL (l~marked. cor~olete Peboleum Type) [] lb. PREMIUM UNLEADED ~ DIESEL [] 6. AVIATION FUEL [] 2. NON-FUEL PETROLEUM [] lc. MIDGRADE UNLEADED [] 4. GASOHoL [] g9. OTHER [] 3. CHEMICAL PROOUCT [] 4. HAZARDOUS WASTE (Includes COMMON NAME (from ;~,~N~ Mate~ala lnv~nton/ pa~e) 441 CAS # (f~om Hazardous Matetfals lnvento~ page) 442 Used 08) [] 95. UNKNOWN '"?. : '.' ,'~. i,:;:,;:;.;-:.' ,:,t'~,:..,III;-~ANKCON~[~UCTION,::,: :."" :.:i,': . ' ' ' ':...':,'..il;~;~!i-':C:~i;':;;:::~ir' i T~PE OF TANK [] ~. SINGLE WALL [] 3. SINGLE WALL wrm [] s. S~N~LE WALL wrm INTERNAL BLADDER SYSTEM 443 1 o~ly) ~1~2. DOUBLE WALL EXTERIOR MEMBRANE LINER [] gs. UNKNOWN [] 4. SINGLE WALL IN A VAULT [] gg. OTHER TANK MATERIAL - pdmary ta~k [] 1. BARE ~bbL [] 3. FIBERGLASS / PLASTIC r'] 5. CONCRETE [] gs. UNKNOWN 444 [] 8, FRP COMPATIBLE WI100% METHANOL [-1 g9. OTHER ~nly) [] 2. STAINLESS STEEL TANK MATERIAL - secondary tank [] 1. BARE STEEL [] 2. STAINLESS STEEL  1~4. STEEL ClAD W/FIBERGLASS REINFORCED P~.ASTIC (FRP) [] 3. FIBERGLASS/PLASTIC [] 8. FRPCOMPATIBLEW/100% METHANOL r~gs. UNKNOWN ~i~.4. STEEL CLAD W/FIBERGLASS [] g. FRP NON-CORRODIBLE JACKET [] 99, OTHER REINFORCED PLASTIC (FRP) [] 10. COATED STEEL E] 5. CONCRETE 445 TANK INTERIOR LINING [] 1. RUBBER LINED [~] 3. EPOXY UNING [] 5. GLASS UNING DATE INSTALLED 447 OR COATING [] 95. UNKNOWN 446 ~ 2. ALKYD LINING I"1 4. PHENOLIC LINING [~ UNLINED I-I 99. OTHER (For focal use onl~t~ OTHER CORROSION E] ~. MANUFACTURED CATHODIC ~;~3. FIBERGLASS REINFORCED PLASTIC [] gs. UNKNOWN 448 PROTECTION IF APPLICABLE DATE INSTALLED PROTECTION [~] 4. IMPRESSED CURRENT E] 99. OTHER only) E] 2. BACRIFIClALANODE (Forlocal use only) 449 SPILL AND OVERFILL YEAR INSTALLED 450 TYPE (Forlocal use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED STRI RPLATE : ""/ ~::~?`?~:~!~?~`~:~:?~;~::::~:~;~`m~:!~.~`~``~;`~:~:: .~.:~'~,;..,~....,,.~ -. .... . ..... .~.,.~,~....., ~,,~ ~ ~.~ ~ . .. .. ~.... ~... ~-~.:~,..... ~, ~ :,:~:.~; ~.:,.: :' .: :-~,~ :,.~ · .~-~ ':. . ~; ' , ~,~;.~,~:~.~ .:~,:,.~ ,. ~F S~.e~ W~L ~.K (C~e~ ~ e~t ~ly): ~3 J IF ~UaLE W~LC TANK 0 ~ 1. VISUAL (~SED ~R~ON ONLY) ~ 5. ~NU~ T~K ~UGING (~G) ~ ~ 1. VISUAL (SINGLE WALL IN VAULT ONL~ ~ 2. AUTO~TIC T~K ~UGING (ATG) ~ 6. VALSE ZONE ~'~2. ~NTINUOUS INTERSTITIAL ~NITORING ~ 3. CONTINUOUS ATG ~ 7. ~OUNDWATER ~ ~ 3. ~UAL ~NITORING ~ 4. STATISTI~L I~ENTORY RE~NClL~TION (SIR) + ~ 8. T~K TESTING BIENNIAL TANK TESTING ~ ~ OTHER ~ V. TANK CLO~URE INFOR~ON I PER~NENT CLOSURE IN P~CE ESTIMATED DATE LAST USED (YR/MO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 458 TANK FILLED WITH INERT MATERIAL? gallo~s [] Yea [] No 457 iPCF (1/99) Formerly SWRCB Form B CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave.. Bakersfield, CA 93301 (661) 326-3979 VI. PIPING CONSTRUCTION (chec~ M mat ~y) & UST · TANK PAGE 2 SYSTEM TYPE CONSTRUCTION~ MANUFACTURER MATERIALS AND CORROSION PROTECTION UNDERGROUND PIPING !; 1. PRESSURE [] 2. SUCTION r"] 3. GRAVITY 458 /~I. SINGLE WALL ~ :3, LINED TRENCH 99. OTHER 460 r-] 2. DOUBLE WALL [] 95. UNKNOWN MANUFACTURER 461 [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 6. FRP COMPATIBLE W/100% METHANOL [] 7. GALVANIZED STEEL [] 1. PRESSURE ABOVEGROUND PIPING [-] 1. SINGLE WALL [] 2. OOUBLE WALL MANUFACTURER [] 2. SUCTION I-] 3. GRAVITY 459 r'-i 1. BARE STEEL [] 2. STAINLESS STEEL [] 95. UNKNOWN [] 99. OTHER [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] [i~i~4. FIBERGLASS [] 8. FLEXIBLE (HOPE) [] 99. OTHER [] [] 5. STEEL W/COA'I~ING [] 9. CATHODIC PROTECTION 464 [] [] 6. FRP COMPATIBLE WI 100% METHANOL [] 7. GALVANIZED STEEL 46z 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HOPE) [] 99. OTHER 4. FIBERGLASS [] 9. CATHODIC PROTECTION 5. STEEL WI COATING [] 95. UNKNOWN 463 UNDERGROUND PIPING SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all gha! apply): [] I. ELECTRONIC LINE LEAK DETECTOR 3.0'GPH TEST WITH AUTO PUMP SHUTOFF FOR LEAK, SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS [] 2. MONTHLY 0.2 C43H TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW: [] 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all ghat apply): lO. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ~ AND (Chec~ one) · , ~[~ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ~, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF ~W-TT'/AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) W~. FLOW SHUT OFF OR RESTRICTION· [] 12. ANNUAL INTEGRITY TEST (0.1 Gl=H) SUCTION/GRAVITY SYSTEM: ~ CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARM~ EMERGENCY GENERATOI~ ONLY (Check ell Iflat 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) ABOVEGROUND PIPING WALL F-i~-iNG 467 PRESSUR .IrT. ED 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. MO~n'.LY 0.2 C~ TEST r-I 3. ANNUAL INTEGRITY TEST (0.1 C4:~) ...... [] 4. DALLY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check ell 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 (C/-,eck all that apply): [] 8. DALLY VISUAL MONITORING . . [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIllING )RESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (checi; 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 ail ghat apply) [] 14. CONTINUOUS SUIv~ SENSOR WTrHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) ~_1~' d~rate to II~e best of my knowledge. DP~ ~,,t~,/~ ~ ,,,..,, ,471 / I P~it NumD~ (For ~cal use on~) 473 P~it Ap~t~ (~r ~ u~ o~y) [] 17. DALLY VISUAL CHECK [] 17. DAILY VISUAL CHECK .:::..'! ..-.:.' !:!!:. :~i:~!:!::`~`r~::;:~::~:~::::¥<~;`~;~:~:~:~.~:~::~`~'~`.~"~/~`~`~` ,,........,. . .... . . , ........... DISPENSER CONTAI~ ~ 1. FLOAT ~C~ISM ~T ~UTS OFF SH~ V~ ~ 4. DAILY VISU~ CHECK DATE INSTALLED 4~ ~ 2, ~I~OUS DIS~NSER P~ SEN~R + AUDIB~ ~D VISUAL A~MS ~TRENCH LINER / ~N~ORING ' ~ ~E~OPE~TOR SIGNA~RE TITLE OF OWNER/OPERATOR 470 472 Formerly SWRCB Form B UPCF (1/99) CiTY OF BAKERSFIEi OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST Tank TYPE OF ACTION Check one item only [] 1 NEW SITE PERMIT [] 3 RENEWAL PERMIT [] 4 AMENDED PERMIT BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) LOCATION ( Optiona/j Page __ of __ [] 5 CHANGE OF INFORMATION (Stale type of change) [] 7 PERMANENTLY CLOSED ON SITE [] 6 TEMPORARY SITE CLOSURE [] 8 TANK REMOVED 429 I. TANK DESCRIPTION TANK lO # ,~.~ DATE INSTALLED (YEARJMO) ' /4 ADDITIONAL DESCRIPTION (For local use only) 430 433 TANK MANUFACTURER TANK CAPACITY IN GALLONS / 52/do, o 431 COMPARTMENTALIZED TANK Yes /~k.] N6 If 'Yes", complete one form foe each compartment. 432 434 NUMBER OF COMPARTMENTS 435 .) TANK USE 437 ~xl MOTOR VEHICLE FUEL (if marked, complete Vehicle Fuel Type) [] 2 USED OIL [] 3 CHEMICAL PROOUCT [] 4 HAZARDOUS WASTE [] 95 UNKNOWN II. TANK CONTENTS VEHICLE FUEL TYPE 438 "'i.-~ ', ~EGULAR UNLEADED [] 2 LEADED E] 5 JET FUEL '~lb PREMIUM UNLEADED [] 3 DIESEL [] 6 AVIATION FUEL [] lc MIDGRADE UNLEADED [] 4 GASOHOL [] 99 OTHER 439 COMMON NAME (from Hazardous Materials Inventory page) CAS # (from Hazardous Materials Inventory page) 440 III, TANK CONSTRUCTION TYPE OF TANK Check one item only TANK MATERIAL (primary tank) Check one item only TANK MATERIAL (secondary lank) Check one item only [] I SINGLE WALL "~2 DOUBLE WALL [] 3 SINGLE WALL WITH EXTERIOR MEMBRANE LINER E] 4 SINGLE WALL IN A VAULT [] 1 BARE STEEL ~4 STEEL CLAD WI FRP [] 2 STAINLESS STEEL E] 3 FIBERGLASS [] I BARE STEEL ~lx4 STEEL CLAD WI FRP [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 5 CONCRETE [] 5 INTERNAL BLADDER SYSTEM [] 95 UNKNOWN [] 99 OTHER [] 5 CONCRETE [] 8 FRP COMPATIBLE WI100% METHANOL [] 8 FRP COMPATIBLE WI100% METHANOL [] 9 FRP NON-CORRODIBLE JACKET [] 10 COATED STEEL [] 95 UNKNOWN [] 99 OTHER [] 95 UNKNOWN [] 99 OTHER 441 442 443 INTERIOR LINING OR COATING Check one item only [] t RUBBER LINED [] 3 EPOXY LINING ' [] 5 GLASS LINING [] 95 UNKNOWN [] 2 ALKYD LINING [] 4 PHENOLIC LINING ]~6 UNLINED [] 99 OTHER 444 OTHER CORROSION PROTECTION IF APPLICABLE Check one item only [] 1 MANUFACTURED CP [] 2 SACRIFICIAL ANODE ,~ 3 FIBERGLASS REINFORCED PLASTIC [] 4 IMPRESSED CURRENT [] 95 UNKNOWN [] 99 OTHER 445 SPILL AND OVERFILL Check all that apply SPILL CONTAINMENT INSTALLED(YEAR), DROP TUBE ~] Yes [] No STRIKER PLATE ~ Yes [] No OVERFILL PROTECTION EQUIPMENT INS'F.~LLED (YEAR) 448 ~ 448 ~.,,1 ALARM 449 "~ 2 BALL FLOAT 1~]3 FILL TUBE SHUT OFF VALVE 447 IV. TANK LEAK DETECTION IF SINGLE WALL TANK (Check all that apply): [] 1 VISUAL (EXPOSED PORTION ONLY) ~ 2 AUTOMATIC TANK GAUGING (ATG) [] 3 CONTINUOUS ATG [] 4 STATISTICAL INVENTORY RECONCILIATION (SIR) BIENNIAL TANK TESTING El5 MANUALTANK GAUGING(MTG) [] 6 VADOSEZONE [] ? GROUNDWATER E]99 OTHER IF DOUBLE WALL TANK (Check one item only): 450 [-1 8 VISUAL (SINGLE WALL IN VAULT ONLY) /~9 CONTINUOUS INTERSTITIAL MONITORING V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USEO (YRiMOIOAY) 451 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 452 GAS TANK FILLED WITH INERT MATERIAL? 453 gal [] Yes E] No Form B : 3~-~979 Page Of CONSTRUCTION CORROSION PROTECTION [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 3 PVC COMPATIBLE WITH CONTENTS [] 95 UNKNOWN [] 4 FIBERGLASS [] 8 FLEXIBLE [] 9g OTHER [] 5 STEEL W/COATING [] 9 CATHODIC PROTECTION 455 VI. PIPING CONSTRUCTION ABOVEGROUND PIPING INFORMATION [] 1 SUCTION PRESSURE [] 3 GRAVITY 454 [] 1 SINGLE WALL [] 95 UNKNOWN .... . ~ DOUBLE WALL [] gg OTHER 450 [] 1 BARE STEEL [] 6 FRP COMPATIBLE W/100% METHANOL (Ch__e~k_..all t___hat appy.)._ UNDERGROUND PIPING INFORMATION E] 1 SUCTION ~ 2 PRESSURE [] 3 GRAVITY 455 [] I SINGLE WALL [] 3 LINED TRENCH [] 9g OTHER ~-L2 DOUBLE WALL [] 95 UNKNOWN 454 [] 1 BARE STEEL [] 2 STAINLESS STEEL [] $ PRP COMPATIBLE W/100% METHANOL [] 7' GALVANIZED STEEL [] 3 PVC COMPATIBLE WITH CONTENTS ~ 4 FIBERGLASS [] 8 FLEXIBLE [] 5 STEEL WI COATING [] 9 CATHODIC PROTECTION [] 95 UNKNOWN ["] 9g OTHER 456 ABOVEGROUND PIPING INFORMATION SINGLE WALL PIPING PRESSURIZED PIPING (Check all thai apply): 457 [] 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST .WITH AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION .*. AUDIBLE AND VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 3 ANNUAL INTEGRITY TEST(0.1 GPH) [] 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all Ihal apply): [] 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM [] 6 TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: [] 7 SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8 DALLY VISUAL MONITORING [] 9 BIENNIAL INTEGRITY TEST(O.1 GPH) SECONDARILY CONTAINED PIPING ESSURIZED PIPING (Check all that apply): ~, 10 CONTINUOUS TURBINE SUMP SENSOR WITH AUD BLE 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 thai apply) [] 14 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF · AUDIBLE AND VISUAL ALARMS [] 1.5 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 16 ANNUAL INTEGRITY TEST{0.1 GPH) [] 17 DAILY VISUAL CHECK DISPENSER CONTAINMENT Yes[] No UNDERGROUND PIPING INFORMATION · SINGLE WALL PIPING 456 PRESSUI~iZED PIPING (Check all thai apply): [] 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST.WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION · AUDIBLE AND VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 3 ANNUAL INTEGRITY TEST(0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 4 DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: [] 5 SELF MONITORING GRAVITY FLOW: [] 6 BIENNIAL INTEGRITY TEST{0.1 GPH) ' SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all Ihat apply): ~ 7 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 [] 8 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 9 ANNUAL INTEGRITY TEST (0.1 GPH) EMERGENCY GENERATORS ONLY (Check all that apply) [] 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 11 AUTOMATIC LINE LEAK DETECTOR (30 GPH TEST) [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) [] 13 DALLY VISUAL Ch[ CK VIII. DISPENSER C_ONTAI_____NMENT [] ! FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ~,,3 CONTINUOUS DISPENSER PAN SENSOR .WITH AUTO SHUT OFF FOR DISPENSER [] 2 CONTINUOUS ELECTRONIC SENSOR + AUDIBLE AND VISUAL ALARMS + AUDIBLE AND VISUAL ALARMS [] 4 DAILY VISUAL CHECK I ce~llfy Ihat IX. OWNER/OPERATO_R SIGNATURE .... Ihe information p~ovided herein.,~4f'ue & accurate to the beat of my knowledge. ~" ;~G~_RE OF OWNER/OPE~ / DATE 462 464 Form TYPE OF ACTION Check one item only [] 1 NEW SITE PERMIT CiTY OF BAKERSFIE OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST Tank - 1 Page ~ of [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION (State lype o[ change) [] 7 PERMANENTLY ~LOSED ON SITE [] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE [] 8 TANK REMOVED 3 FACILITY ID # '"~' ~" BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) LOCATION ( Optiona/j TANK ID # [,~ DATE INSTALLED (YEAR/MO) ADDITIONAL DESCRIPTION (For local use only) I. TANK DESCRIPTION 430 TANK MANUFACTURER 433 TANK CAPACITY IN GALLONS / ~ 431 434 COMPARTMENTALIZED TANK [] Yes ~ No I! 'Yes', complete one form for each compartmenL NUMBER OF COMPARTMENTS .) 429 1 432 435 436 II. TANK CONTENTS TANK USE 437 ~, MOTOR VE.,CLE FUEL marked, complete Vehicle Fuel Type) [] 2 USED OIL [] 3 CHEMICAL PRODUCT [] 4 HAZARDOUS WASTE [] 95 UNKNOWN VEHICLE FUEL TYPE ./~', tEGULAR UNLEADED L.J lb PREMIUM UNLEADED [] lc MIDGRADE UNLEADED [] 2 LEADED [] 3 DIESEL [] 4 GASOHOL 439[ [] 5 JET FUEL [] $ AVIATION FUEL [] 99 OTHER 438 COMMON NAME (from Hazardous Materials lnvenlory page) CAS # (from Hazardous Malerials Inventory page) 440 III. TANK CONSTRUCTION TYPE OF TANK Check one item only TANK MATERIAL (primary tank) Check one item only TANK MATERIAL (secondary tank) Check one item only [] 1 SINGLE WALL '~2 DOUBLE WALL [] 1 BARE STEEL [] 2 STAINLESS STEEL [] I BARE STEEL [] 2 STAINLESS STEEL [] 3 SINGLE WALL WITH EXTERIOR MEMBRANE LINER [] 4 SINGLE WALL IN A VAULT []5INTERNAL BLADDER SYSTEM F-~95UNKNOWN [--]99 OTHER ~4 STEEL CLAD WIFRP [] 3 FIBERGLASS [] 5 CONCRETE [] 8 FRP COMPATIBLE WI100% METHANOL Jk4 STEEL CLAD WI FRP [] 3 FIBERGLASS [] 5 CONCRETE [] 8 FRP COMPATIBLE WII00% METHANOL [] 9 FRP NON*CORRODIBLE JACKET [] 10 COATED STEEL [] 95 UNKNOWN [] 99 OTHER [] 95 UNKNOWN [] g9 OTHER 441 442 443 INTERIOR LINING OR COATING Check one item only [] 1 RUBBER LINED [] 3 EPOXY LINING [] 5 GLASS LINING [] 95 UNKNOWN' [] 2 ALKYD LINING [] 4 PHENOLIC LINING '~6 UNLINED [] 99 OTHER. 444 OTHER CORROSION PROTECTION IF APPLICABLE Check one item only [] I MANUFACTURED CP [] 2 SACRIFICIAL ANODE ]~ 3 FIBERGLASS REINFORCED PLASTIC [] 4 IMPRESSED CURRENT [] 95 UNKNOWN [] 99 OTHER 445 SPILL AND OVERFILL Check all that apply SPILL CONTAINMENT INSTALLED (YEAR) DROP TUBE ~] Yes [] No STRIKER PLATE 'J~ Yes [] No OVERFILL PROTECTION EQUIPMENT INSTALLED (YEAR) 446 448 ~.,1 ALARM 449 '~ 2 BALL FLOAT ~3 FILL TUBE SHUT OFF VALVE 447 IF SINGLE WALL TANK (Check all that apply): [] 1 VISUAL (EXPOSED PORTION ONLY) · ~ 2 AUTOMATIC TANK GAUGING (ATG) [] 3 CONTINUOUS ATG [] 4 STATISTICAL INVENTORY RECONCILIATION (SIR) BIENNIAL TANK TESTING IV. TANK LEAK DETECTION IF DOUBLE WALL TANK (Check one item only): 450 [] 5 MANUAL TANK GAUGING(MTG) E] 6 VADOSEZONE [] 7 GROUNDWATER E]99 OTHER [] 8 VISUAL (SINGLE WALL IN VAULT ONLY) /~9 CONTINUOUS INTERSTITIAL MONITORING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATEO DATE LAST USED (YR/MOIDAY) 451 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 452 GAS TANK FILLED WITH INERT MATERIAL? 453 gal [] Yes [] NO Fo*,m B ; CITY OF BAKERSFIELD OFFICE QF ENVIRONMENTAL SERVI( 1715 Chester Ave.. Bakersfield. CA 93301 (805) 326-3979 UST - TANK PAGE 2 Page , Of VI. PIPING CONSTRUCTION ABOVEGROUNO PIPING INFORMATION ~¥~ '~151~' '-- [] 1 SUCTION PRESSURE [] 3 GRAVITY 454 [] 1 SINGLE WALL [] 95 UNKNOWN CONSTRUCTION Z DOUBLE WALL [] 99 OTHER 450 ~,~,~'~A-[~'A~ [] 1 BARE STEEL [] 6 FRP COMPATIBLE WI 100% METHANOL CORROSION · · PROTECTION [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 3 PVC COMPATIBLE WITH CONTENTS [] 95 UNKNOWN [] 4 FIBERGLASS [] 8 FLEXIBLE [] 99 OTHER [] 5 STEEL WI COATING [] 9 CATHODIC PROTECTION 455 VII. PIPING LEAK DETECTION ABOVEGROUND PIPING INFORMATION , 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 SINGLE WALL PIPING 457 Check all that aP_P!Y~ UNDERGROUND PIPING INFORMATION [] 1 SUCTION ~ 2 PRESSURE [] 3 GRAVITY 455 [] I SINGLE WALL [] 3 LINED TRENCH [] gg OTHER J~2 DOUBLE WALL [] g5 UNKNOWN 454 [] 1 BARE STEEL [] 6 FRP COMPATIBLE W/100% METHANOL [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 3 PVC COMPATIBLE WITH CONTENTS ~ 4 FIBERGLASS [] 8 FLEXIBLE [] 5 STEEL WI COATING [] g CATHODIC PROTECTION Check all that apply) UNDERGROUND PIPING INFORMATION [] 95 UNKNOWN [] 99 OTHER 456 [] 2 MONTHLY 0.2 GPH TEST [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) [] 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply); [] 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM [] 6 TRIENNIAL INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS: [] 7 SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8 DAILY VISUAL MONITORING [] 9 BIENNIAL INTEGRITY TEST (O.1 GPH) ' SECONDARILY CONTAINED PIPING · ESSURIZED PIPING (Check all that apply): SINGLE WALL PIPING PRESSURIZED PIPING (Check all Ihat apply): [] 1 ELECTRONIC LiNE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PI.~MP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION + AUDIBLE AND 456 VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 4 DALLY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) ,~, 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 DISCONNECT[ON [] c NO AUTO PUMP SHUT OFF [] 11 AUTOMATIC LEAK DETECTOR [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) S UCTION/GI~,VITY SYSTEM: [] 13 CONTINUOUS SUMP SENSOR ,'- AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that al:)bly) [] 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(O.1 GPH) [] 17 DAILY VISUAL CHECK SAFE SUCTION SYSTEMS: [] 5 SELF MONITORING GRAVITY FLOW:' [] 6 BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): ~ 7 CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) [~a AUTO PUMP SHUT OFF WHEN A LEAK OCCURS '~Z~L b AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c NO AUTO PUMP SHUT OFF [] 8 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 9 ANNUAL INTEGRITY TEST (0. I GPH) EMERGENCY GENERATORS ONLY (Check all thai apply) [] 10 CONTINUOUS SUMP SENSOR WITHOUT. AUTO PUMP SHUT OFF * AUDIBLE AND VISUAL ALARMS [] 11 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) [] 13 DAILY VISUAL CHECK VIII. DISPENSER CONTAINMENT DISPENSER CONTAINMENT ~j~[ Yes ~ No [] 1 FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [] 2 CONTINUOUS ELECTRONIC SENSOR ~- AUDIBLE AND VISUAL ALARMS 3 CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 4 DAILY VISUAL CHECK IX. OWNER/OPERATOR SIGNATURE I cattily Ihat the information provided herein.~.~f~e & accurate ID the besl o! my knowledge. Permil Number (For local use only) _RE OF, OWNERJOPERAT,~ 463 DATE TITLE OF OWNERJOPERATOR IPerml! Approved Permit Expiration Date 462 464 Form B : TYPE OF ACTION [] 1 NEW SITE PERMIT Check one ilem only CiTY OF BAKERSFIEi OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UST Tank - 1 Page [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION (State type of change) [] ? PERMANENTLY CLOSED ON SITE [] 4 AMENDED PERMIT [] 6 TEMPORARY SITE CLOSURE [] 8 TANK REMOVED BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) LO(~ATION ( OlJtiona~ TANK ID # 430 DATE INSTALLED (YEAR/MO) ADDITIONAL DESCRIPTION (For local use only) 433 I. TANK DESCRIPTION TANK MANUFACTURER TANK CAPACITY IN GALLONS / ~/auo 431 COMPARTMENTALIZED TANK [] Yes ,~ No If 'Yes', complete one {om~ for each compartment. 429 1 432 /" 434 NUMBER OF COMPARTMENTS 435 II. TANK CONTENTS 438 TANK USE 437' ~1 MOTOR VEHICLE FUEL (If marked, complele Vehicle Fuel Type) [] 2 USED OIL [] 3 CHEMICAL PRODUCT [] 4 HAZARDOUS WASTE [] 95 UNKNOWN VEHICLE FUEL TYPE /;'1 ,,, ~EGULAR UNLEADED LJ lb PREMIUM UNLEADED [] lc MIDGRADE UNLEADED [] 5 JET FUEL [] 6 AVIATION FUEL [] 99 OTHER [] 2 LEADED [] 4 GASOHOL COMMON NAME (from Hazardous Materials Invenlory page) 439 I CAS # (from Hazardous Materials Inventory page) 440 III. TANK CONSTRUCTION [] I SINGLE WALL [] 3 SINGLE WALL WITH [] 5 INTERNAL BLADOER SYSTEM 441 "~2 DOUBLE WALL [] 95 UNKNOWN EXTERIOR MEMBRANE LINER [] 4 SINGLE WALL IN A VAULT [] g9 OTHER TYPE OF TANK Check one item only TANK MATERIAL (primary tank) Check one item only TANK MATERIAL (secondary tank) Check one item only INTERIOR LINING OR COATING Check one ilem only [] I BARE STEEL [] 2 STAINLESS STEEL [] 1 BARE STEEL [] 2 STAINLESS STEEL '~4 STEEL CLAD Wl FRP [] 3 FIBERGLASS [] 5 CONCRETE [] 8 FRP COMPATIBLE W/100% METHANOL ~[,4 STEEL CLAD WI FRP [] 3 FIBERGLASS [] 5 CONCRETE [] 8 FRP COMPATIBLE W/100% METHANOL [] 9 FRP NON-CORRODIBLE JACKET [] 10 COATED STEEL [] 95 UNKNOWN [] 99 OTHER [] 95 UNKNOWN [] g9 OTHER [] 1 RUBBER LINED [] 3 EPOXY LINING [] 5 GLASS LINING [] g5 UNKNOWN [] 2 ALKYD LINING [] 4 PHENOLIC LINING ]~6 UNLINED [] 9g OTHER 442 443 444 OTHER CORROSION PROTECTION IF APPLICABLE Check one item only [] 1 MANUFACTURED CP [] 2 SACRIFICIAL ANODE ~3 FIBERGLASS REINFORCED PLASTIC [] 4 IMPRESSED CURRENT [] 95 UNKNOWN [] g9 OTHER 445 SPILL AND OVERFILL Check ail that apply SPILL CONTAINMENT INSTALLED (YEAR) DROP TUBE ~] Yes [] No STRIKER PLATE "~ Yes [] NO 446 448 449 OVERFILL PROTECTION EQUIPMENT INSTALLED (YEAR). ,~].I, t ALARM '~ 2 BALL FLOAT ~]3 FILL TUBE SHUT OFF VALVE 447 IV. TANK LEAK DETECTION IF SINGLE WALL TANK (Check all that apply): [] 1 VISUAL (EXPOSED PORTION ONLY) ~ 2 AUTOMATIC TANK GAUGING (ATG) [] 3 CONTINUOUS ATG [] 4 STATISTICAL INVENTORY RECONCILIATION (SIR) BIENNIAL TANK TESTING []5 MANUALTANKGAUGING(MTG) []6 VADOSEZONE [] ?GROUNOWATER [-']99 OTHER IF DOUBLE WALL TANK (Check one item only): 450 [] 8 VISUAL (SINGLE WALL IN VAULT ONLY) ,~9 CONTINUOUS INTERSTITIAL MONITORING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED DATE LAST USED (YR/MOIDAY) 451 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 452 GAS TANK FILLED WITH INERT MATERIAL? 453 gal [] Yes [] No Form B ; VI. PIPING CONSTRUCTIO __(_Check all that apply3 Page ,., Of ....... ABOVEGROUND PIPING INFORMATION SYSTEM 'I~P~ * -~ - ~.-~ ................ ', i L_J 1 SUCTION ' PRESSURE [] 3 GRAVITY 454 ~;ONSTRUCTION I [] 1 SINGLE WALL [] g5 UNKNOWN J . ~ ~_J?_O~OU_BLE WALL [] 99 OTHER i~-A f['~A--C~A-'~6, .......... __ _~ 4S0 CORROSION ~ ~ 1 BARE STEEL ~ 6 FRP COMPATIBLE W/100% PROTECTION ~ ~ 2 STAINLESS STEEL ~ 7 GALVANIZED STEEL METHANOL [] 95 UNKNOWN [] 8 FLEXIBLE [] 99 OTHER I [] 5 STEEL W/COATING [] 9 CATHODIC PROTECTION 455 VII. PIPINg_LEAK DETECTION ABOVEGROUND PIPING INFORMATION SINGLE WALL PIPING PRESSURIZED PIPING (Check all thai apply): 457 [] 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTION; AUDIBLE AND VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) [] 4 DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all thai apply): [] 5 DAILY VISUAL MONITORING OF PUMPING SYSTEM [] 6 TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: [] 7 SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8 DAILY VISUAL MONITORING [] 9 BIENNIAL INTEGRITY TEST (O. 1 GPH) SECONDARILY CONTAINED PIPING ESSURIZED PIPING (Check all that aDply): ~1, 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. t 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 OAILYVlSUAL CHECK Yes [] NO UNDERGROUND PIPING INFORMATION [] 1 SUCTION ~ 2 PRESSURE [] 3 GRAVITY 455 [] 1 SINGLE WALL [] 3 LINED TRENCH [] 99 OTHER ~.2 DOUBLE WALL [] 95 UNKNOWN 454 [] 1 BARE STEEL [] 6 FRP COMPATIBLE WI 100% METHANOL [] 2 STAINLESS STEEL [] 7 GALVANIZED STEEL [] 3 PVC COMPATIBLE WITH CONTENTS D g5 UNKNOWN ~ 4 FIBERGLASS [] a FLEXIBLE D 99 OTHER [] 5 STEEL WI COATING [] 9 CATHODIC PROTECTION 456 (Check a .! that a.p~yl ) UNDERGROUND PIPING INFORMATION · SINGLE WALL PIPING 456 PRESSUF~iZED PIPING (Check all Ihal apply): [] 1 ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE. AND SYSTEM DISCONNECTioN ~. AUDIBLE AND VISUAL ALARMS [] 2 MONTHLY 0.2 GPH TEST [] 3 ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 4 DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS: [] 5 SELF MONITORING GRAVITY FLOW: [] 6 BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all thai apply): ~ 7 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 [] 8 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 9 ANNUAL INTEGRITY TEST(0.1 GPH) EMERGENCY GENERATORS ONLY (Check all that apply) [] 10 CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 11 AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) [] 12 ANNUAL INTEGRITY TEST (0.1 GPH) [] 13 DAILY VISUAL CHECK VIII. DIS P E N S__E R___C_ONTAIN M ENT [] t FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE 1~ 3 CONTINUOUS DISPENSER PAN SENSOR _WITH AUTO SHUT OFF FOR DISPENSER [] 2 CONTINUOUS ELECTRONIC SENSOR + AUDIBLE AND VISUAL ALARMS + AUDIBLE AND VISUAL ALARMS i [] 4 DAILY VISUAL CHECK I cedi~y that Ihe information provided hereln~,~{fue & accurale to the besl ol my knowledge. I '-~r~RE OF OWNER/OP~T~ '] ~mi~ (~ ~al use only) ~ IX. OWN I'[R/OPE RAT_O_~R SIG_N.ATU R E DATE __. 463 TITLE OF OWNER/OPERATOR Penni! Approved Permit Expiration Date 462 J Form 1715 Chester Ave., Bakersfield, CA 93301 ~ r~#m ~ (661) 326-3979 I. FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Buslnes~ As) =ACILITY ID # ~,,"~'~-, ~"~-. '-~- i ~ I ~ ..~ I I I 1 TANK ID # -~c- I'(!'/il~l~'_~_lq__~¢l,~ ~ i I I I / ~c_,..-~.__:_ ~ .~_~_~_ ___: ........................... UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE One form per tank I1. INSTALLATION " Check all that apply ~ The installer has been certified by the tank and piping manufacturers. The installation has been inspected and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. The installation contractor has been certified or licensed by the Contractors State License Board. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Iden[ify method; III. TANK OWNER/AGENT SIGNATURE cedi~y t~al the Infon'natlon provided herein I~..t~_ & accurate t~ the best of my k~wledge ~g~E b~ fA~ ~[~ '"~ ............................... ~"b~fE- ............................................................. ~ ........................... ................................................................ i Fom~ C CITY OF BAKERSFIELD .~o OFFli OF ENVIRONMENT. AL SE~CES 1715 Chester Ave., Bakersfield, CA 93301 I~ ~mz I (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE I. FACILITY IDENTIFICATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) FACILITY ID # One form per tank ,.ge .~ o, II. INSTALLATION .' Check all that apply The installer has been certified by the tank and piping manufacturers. The installation has been inspected and certified by a registered professional engineer. The installation has been inspected and approved by the City of Bakersfield Office of Environmental Services. All work listed on the manufacturer's installation checklist has been completed. The installation contractor .has been certified or licensed by the Contractors State License Board. Another method was used as allowed by the City of Bakersfield Office of Environmental Services. Identify method: III. TANK OWNER/AGENT SIGNATURE certll~ that:~ ~the infomnallon provided herein is Irue_&_ a_~curate to the best of my knowledge .................... TLE OF TANK OWN[~"~[~I'~ .......................... 468. ......... Fom~ C STATE OF CAUFORNIA STAI'~ WAIER RESOURCES CONTROL BO.~ID UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM A COMPLETE THIS FORM FOR EACH FACIUTY/SITE MARK ONLY ~ 1 NEW PERMIT ONE ITEM [] 2 INTERIM PERMIT [] 3 RENEWAL PERMIT E~] 4 AMENDED PERMIT [] 5 CHANGE OF INFORMATION E~] 7 PERMANENTLY CLOSED SITE [] 6 TEMPORARY SITE CLOSURE I. FACILITY/SITE INFORMATION & ADDRESS - (MUST BE COMPLETED) DBA OR FAClLL[-Y NAME ~ [ .~,. NAME OF OPERATOR ADDRESS NEAREST CROSS STREET PARCEL # (OFTIONAL) CITY NAME .... . /' . / STATE · ZIP CODE SITE PHONE # WITH AREA CODE .~;,,~,~ ~.~.?. ~/~,-/ CA G,'~5/~ TO INDICATE RPORATION E~ INDIVIDUAL E~ PARTNERSHIP r--] LOCAL-AGENCY E~ COUNTY-AGENCY [~] STATE.AGENCY [~] FEDERAL-AGENCY DISTRICTS E~] 3 FARM r--] 4 PROCESSOR E~] 5 OTHERI OR TRUST LANDS I <~'~/ I EMERGENCY CONTACT PERSON (PRIMARY) IDAYS.: NAME (LAST, FIRS*!~..,,~. NIGHT~: NAME (LAST, FIRST~ _ PHONE # WITH AREA CODE PHONE at WITH AREA ~ II. PROPERTY OWNER INFORMATION - (MUST BE COMPLETED) MAILING OR STREET ADDRESS T:.), ....% IlL TANK OWNER INFORMATION- (MUST BE COMPLETED) EMERGENCY CONTACT PERSON (SECONDARY) - optional PHONE # WITH AREA CODE IDAYS: NAME (LAST, FIRST) NIGHTS: NAME (LAST, FIRST) PHONE # WITH AREA CODE JCARE OF ADDRESS INFORMATION box ~.indicate ["-'1 INDIVIDUAL RPORATION r'-I PARTNERSHIP ZIP CODE ' I ~,.3'~ LOCAL.AGENCY E~ STATE-AGENCY COUNTY-AGENCY [~ FEDERAL, AGENCY; PHONE # WIT.H. AREA CODE ~,~"' ,-~,Z~-~ :5-?OOO. NAME OF OWNER J:T~o 0,1 " MAILING OR STREET.~DRESS ~--~,.~ CI~NAME .-*~ I ~. I I_ .v~..CARE OF ADDRESS INFORMATION 'G~'~!= box t~indicate ~ INDIVIDUAL ~ LOCAL-AGENCY I-'-I STATE-AGENCY aq[~ CORPORATION F-] PARTNERSHIP COUNTY-AGENCY E~] FEDERAL-AGENCY STATE . ZIP CODE . pHONE #.WITH AREA CODE IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 if questions arise. V, LEGAL NOTIFICATION ANB BILLING ADDRESS Legal notification and billing will be sent to the tank owner unless box I or II is checked. ICHECK ONE BOX INDICATING WHICH ABOVE ADDRESS SHOULD BE USED FOR LEGAL NOTIFICATIONS AND BILLING: THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT LOCAL AGENCY USE ONLY COUN ,";'Y # JURISDICTION # FACILITY # I0 I0 Io I~ Ir b Io [_~ I?' I LOCATION CODE - OPTIONAL CENSUS TRACT # - OPTIONAL~... SUPVISOR - DISTRICT CODE - OPTIONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMIT APPLICATION - FORM B~ UNLESS THIS IS A CHANGE OF SITE INFORMATION ONLY. FOR00~A*R2 FORM A (9-90) STATE OF CAUFORI~A STATE WATER RESOURCES CONTROL UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY ,~ 1 NEW PERMIT ONE ITEM 2 INTERIM PERMIT [] 3 RENEWAL PERMIT [] 4 AMENDED PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D, # ~ II. TANK CONTENTS ~F A-1 IS MARKED, COMPLETE ITEM C. [] 5 CHANGE OF INFORMATION [] 7 PERMANENTLY CLOSED ON SITEt [] 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED B. MANUFAC RED D. TANK C~AC~TY ~N OALLONS: /~- A. ~ MOTOR VEHICLE FUEL L_J 4 OIL ' B. C. J~<:~'laREGULAR [~ 3 DIESEL ~ UNLEADED [] 6 AVIATION GAS [] 2 PETROLEUM [] 80 EMPTY ~_[~;~ PRODUCT [] lb PREMIUM 4 GASAHOL [] 7 METHANOL' UNLEADED [] 5 JET FUEL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN ~ 2 WASTE [] 2 LEADED r'~ 99 OTHER (DESCRIBE IN ITEM D. BELO D. IF (A.1)IS NOT MARKED, ENTER NAME OF SUBSTANCE STORED C.A.S. #: W)1 CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B. AND C.'AND ALL THAT APPLIES iN BOX D A. TYPE OF [] 1 DOUBLE WALL ~ SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B, TANK [__J 1 BARE STE. t:L [] 2 STAINLESS STEEL L_.J 3 FIBERGLASS .~.4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLE W/FRP (13rimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN ~ 99 OTHER C. INTERIOR [] 1 RUBI~ER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING [] 5 GLASS LINING .~$ UNLINED [] 95 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES~ NO~ [] 1 POLYETHYLENE WRAP [] 2 COATING D. CORROSION ] 3 VINYL WRAP ,~___.4 FIBERGLASs REINFORCED PLASTIC ' PROTECTION [~ 5 CATHODIC PROTECTION ~--~ 91 NONE ~"]95 UNKNOWN [~] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A(_.~ 2 PRESSURE A U 3 GRAVI1Y A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 .,D~UBLE WALL A(~3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A~)4 FIBERGLASS PIPE' CORROSION A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION~,~ AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING ~;~_.3 INTERSTITIAL f MONITORING [] 99 OTHER V. TANK LEAK DETECTION . [] 6 TANK TESTING 7 INTERSTITIAL MONITORING ~ 91 NONE [] 95 UNKNOWN ] 9g OTHER VI. TANK CLOSURE INFORMATION SUBSTANCE REMAINING GALLONS INERT MATERIAL ? YES [] NO [] THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORFIECT LOCAL AGENCY USE ONLY STATE I.D.# ,!PERM'TNuMSER THE STATE I.D. NUMBER IS COMPOSED OFTHE FOUR NUMBERS BELOW COUNTY #JURISDICTION # FACILITY # TANK # loP] Idl lobbl¢ IOPlolo ol J FORM B (g-g0) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO~4B-R4 STATE OF CAUFORNIA STATE WATER RESOURCES CONTROl UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY J~l NEW PERMIT [] 3 RENEWAL PERMIT [] 5 CHANGE OF INFORMATION ONEITEM ~"E~ 2 INTERIM PERMIT [] 4 AMENDED PERMIT [] 6 TEMPORARY TANK CLOSURE DBAOR FAC~U~.AMEW,ERETA.K.Si. STAL,ED= ~-'l':,.,~/,.,p /~d ~31'~,'e ~b I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN [] 7 PERMANENTLY CLOSED ON SITE~ F--) 8 TANK REMOVED C. DATE INSTALLED(MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: II.TANK CONTENTS IF A-1 IS MARKED, COMPLETE ITEM C. A. ~ MOTOR VEHICLE FUEL [] 4 OIL B. C. [] laREGULAR [~ 3 DIESEL [] 6 AVIATION GAS [] 2 PETROLEUM [] ,0 EMPTY -~ PRODUCT [] lb PREM,UM [] 7 M~H~OL UNLEADED [] 5 JET FUEL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED J~' 99 OTHER (DESCRIBE IN ITEM D. BELOW o. ,F <A.,, ,S NOT MARKED. ENTER .AME OF SUBSTANCE STORED or31ec~[ec[ ~lc~-,~ C.A.S.,: III. TAN K CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B. ANO C, AND ALL THAT APPLIES IN BOX O A. TYPEOF [] 1 DOUBLE WALL SYSTEM [] e SINGLE WALL SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY coNTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] g BRONZE [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 6 POLYVlNYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] ~ STEELCLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLEW/FRP ] 99 OTHER [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR. LINING [] 5 GLASS LINING .~6 UNLINED [] 95 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITH IO(P~ METHANOL ? YES__ NO__ D. CORROSION [] I POLYETHYLENE WRAP [] 2 COATING [] 3 VINYL WRAP ,,~. FIBERGLASS REINFORCED PLASTIC PROTECTION ~ 5 CATHODIC PROTECTION [] ~1 NONE [] 95 UNKNOWN F~m 99 OTHER IV. PIPING INFORMATION C~RC~E A IFABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U 1 SUCTION A~) 2 PRESSURE A U 3 GRAVITY A U 99 OTHER A U 1 SINGLE WALL A U 2 DOUBLE WALL . A~)3 LINED TRENCH A U 95 UNKNOWN A U g9 OTHER A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVlNYL CHLORIDE(PVC)A.~ 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING ~ INTE,AS¥iiiAL ,~ MONITORING [] 99 OTHER B. CONSTRUCTION C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION V. TANK LEAK DETECTION [] 1 VISUAL CHECK ] 6 TANK TESTING INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING I INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER I VI. TANK CLOSURE INFORMATION i' ESTIMATED DATE LAST USED (MO/DAY/YR, I2' ESTIMATED QUANTITY OFSUBSTANCE REMAINING GALLONS I3' wAS TANK FILLED WITHINERT MATERIAL ? YES[] NO[] THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, A'ND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT I APPLICAN'PS NAME DATE I (PRINTED & SIGNATURE) LOCAL AGENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY #JURISDICTION # FACILITY # TANK # STATEI.D.# ~ tpPlo J l?'loloL 17 ,po oloP ,-1- PERM,T NU.BER '*~ ~J~:-C"~ I PERM,TAPPROVED BY,DATEPERM,T EXP,RAT,ON DATE FORM B (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPUCAllON - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOR00348-R4 STATE OF CAUFORMA De'* STATE WATER RESOURCES CONTROL BOAR UNDERGROUND STORAGE TANK PERMIT APPLICATION. FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM. MARK ONLY .,~E~' 1 NEW PERMIT [] 3 RENEWAL PERMIT ~ 5 CHANGE OF INFORMATION ' [] 7 PERMANENTLY CLOSED ON SITEt ONE ITEM [] 2 INTERIM PERMIT [] 4 AMENDED PERMIT ~ 6 TEMPORARY TANK CLOSURE [] 8 TANK REMOVED DBAOR FACILITY NAME WHERE TANK IS lNSTALLED: *~5~£ )4,7 -~4:r._3C~ '~.~ L~('L. ~ ~ ~ I. TANK DESCRIPTION COMPLE~ ALL ITEMS - SPECIFY IF UNKNO~ ~A. OWNER'STANKI. D., ,~/~ '.MANUFAC,RE,,y: ~, ~,~~ ~ C. DATE ~NSTALLED (MO/DAY. EAR) D. TANK C~ACI~ IN G~LONS: ~ ~ II. TANK CONTRAS IFA-1 IS MARKED. COMPLETE ITEM C. ' A. ,,~1 MOTOR VEHICLE FUEL [] 4 OIL B. C. [] la REGULAR [~ 3 DIESEL UNLEADED [] 6 AVIATION GAS [] 2 PETROLEUM [] S0 EMPW ~ PRODUCT _J~lbPREMIUM 4 GASAHOL "'~ UNLEADED [] 5 JETFUEL [] 7 METHANOL [] 3 CHEMICAL PRODUCT [] 95 UNKNOWN [] 2 WASTE [] 2 LEADED [] 99 OTHER (DESCRIBE IN ITEM O. BELOW D. IF (A.I) IS NOT MARKED. ENTER NAME OF SUBSTANCE STORED C.A.S.#: II1_ TANK ~Ctld(=Tr~llf,'rln~,l .......... MARK ONE ITEM ONLY IN BOXES A. B. AND C. AND ALL THAT APPLIES IN BOX D A. TYPE OF [] 1 DOUBLE WALL .,~,~__~'-3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] ~ BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS ~ 4 STEEL CLAD W/FIBERGLASS RBNFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL ~ 95 UNKNOWN [] 99 OTHER C. INTERIOR [] 1 RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING LINING [] 5 GLASS LINING ,,~S UNLINED [] aS UNKNOWN [] ~9 OTHER ,s L,N,NG MATER,AL COM.AT LE W,T..00. METHANOL? YES__ NO__ [] ' "OLYET ENE W.AP [] 2 COAT,NO D. CORROSION [] 3 VINYL WRAP ~ FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTi°N ~-~ 9f NONE [] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION C~RCLE A IFABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION A*~'PRESSURE A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL C. MATERIAL AND A U 1 BARE STEEL CORROSION A U s ALUMINUM PROTECTION A U 9 GALVANIZED STEEL A U 2 DOUBLE WALL Ad LINED TRENCH A U 95 UNKNOWN A U 99 OTHER A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A(~4 FIBERGLASS PIPE A U 6 CONCRETE A U 7 STEEL W/ COATING A U 8 100% METHANOL COMPATIBLEW/FRp A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER O. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING I~.,~T~;:INTERSTITIAL / ~ MONiTORING [] 99 OTHER V. TANK LEAK DE ~ ~-CTION I[] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING ~:~i:~7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN ] 9g OTHER VI. TANK CLOSURE INFORMATION SUBSTANCE REMAINING GALLONS INERT MATERIAL ? YES [] NO [] THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT [ APPLICANTS NAME I I (PRINTED & SIGNATURE) DATE LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW COUNTY # JURISDICTION iV FACILITY iV TANK # FORM i (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMIT APPLICATION - FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO34B. R4 MARK ONLY STATE OF CAUFORMA STATE WATER RESOURCES CONTROL B(~ UNDERGROUND STORAGE TANK PERMIT APPLICATION . FORM B COMPLETE A SEPARATE FORM FOR EACH TANK SYSTE~ NEW PERMIT INTERIM PERMIT [] 3 RENEWAL PERMIT ONE ITEM [] 4 AMENDED PERMIT DBA OR FACILITY NAME WHERE TANK IS INSTALLED: I. TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # ~' C. DATE INSTALLED(MO/DAY/YEAR) II. TANK CONTENTS ~;A-~ IS MARKED. COMPLETEITEM C. A. /,,~',1 MOTOR VEHICLE FUEL [] 5 CHANGE OF INFORMATION r'~ 7 PERMANENTLY CLOSED ON SIT1 [] 6 TEMPORARY TANK CLOSURE r--'-I 8 TANK REMOVED [] 2 PETROLEUM a. MANUFACTURED aY: O. TANK CAPACITY ~N GALLONS: /,2, 004::) II 4 OIL "l B~, [] 80 EMPTY PRODUCT ~ 95 UNKNOWN ~'F-J 2 WASTE [] 3 CHEMICAL PRODUCT D. IF (A.1)IS NOTMARKED. ENTER NAME OF SUBSTANCE STORED III. TANK CONSTRUCTION MARK ONE iTEM ONLY iN BOXES A, B. ANDc. ANDALLTHATAPPLiESiNBOXD A. TYPE OF [] 1 DOUBLE WALL ~j~3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN SYSTEM [] 2 SINGLE WALL [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLAS~° ~ STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 8 100% METHANOL COMPATIBLEW/FRP (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] 99 OTHER C. INTERIOR [] I RUBBER LINED [] 2 ALKYD LINING L__J 3 EPOXY LINING [] 4 PHENOLIC LINING LINING [] S GLASS LINING ~::~ UNLINED [] 95 UNKNOWN [] 99 OTHER IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES~ NO~ [] I POLYETHYLENE WRAP [] 2 COATING ] la REGULAR ,~:DIESEL [] 6 AVIATION GAS · UNLEADED ] 7 METHANOL UNLEADED [] [] 2 LEADED F-] 99 OTHER (DESCRIBE IN ITEM D. BELOW) C.A.S.#: D. CORROSION ] 3 VINYL WRAP FIBERGLASS REINFORCED PLASTIC PROTECTION [] 5 CATHODIC PROTECTION [] 9! NONE r-~ 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION C)RCLE A IF ABOVE GROUND OR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION ~ A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL ~ LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND A U 1 BARES~EFL A U 2 STAINLESS STEEL A U 3 POLYVlNYL CHLORIDE(PVC) ..~ FIBERGLASS PIPE CORROSION A U 5 ALUMINUM A U 6 CONCRETE . A U 7 STEELW/COATING A U 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PRO:FECTiON A U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ AUTOMATIC LINE LEAK DETECTOR r--j2 LINE TIGHTNESS TESTiNG IA~ [] 99 OTHER V. TANK LEAK DETECTION ~ I ' [] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING ~ INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN ~ 99 OTHER VI. TANK CLOSURE INFORMATION il. ESTIMATED DATE LAST USED (MO/DAY/YR) 2, ESTIMATED QUANTITY OF SUBSTANCE REMAINING GALLONS 3. WAS TANK FILLED WITH I INERT MATERIAL ? YES [] NO [] THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORt IECT I APPLICANt'S NAME I (PRINTED & SIGNATURE) DATE ., LOCAL AG ENCY USE ONLY THE STATE I.D. NUMBER IS COMPOSED OF THE FOUR NUMBERS BELOW I COUNTY # JURISDICTION # FACILITY # TANK # · STATEI.D.# ~ I,.:-l l lolsrfl I01ol01ollot'/1 !' ERM'TNUMSE. i "ERM'TA"PROVED BY.ATE PERM'TEXP'RAT,ON DATE ' FORM a (9-90) THIS FORM MUST BE ACCOMPANIED BY A PERMrT APPUCATION · FORM A, UNLESS A CURRENT FORM A HAS BEEN FILED. FOROO~48.R4 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION STREET II. INSTALLATION (mark all t,ha! app!y): [~"The installer has been certified by the tank and piping manufacturers. [] The installation has been inspected and certified by a registered professional engiQeer. ~;~'"'r'he installati?' h*.~ be~ ~hS~eCted ah~ ~pproved by the imple~e~tin ' ~ ufa~urer s installation checkhst has been Completed ~he installation Comractor has been ce~ifi ....... '; -:~'~*~?~"'"-*: ' ' ~u or .censea by the Contractors State 'License Board. ~ Another method was used'as allowed by the implementing agency. (Please specify.)... III, OATH I certify that the information provided is true to the best of my belief and knowledge, Tan____kOwner/.Agen~ - (~);'~ C'~'"-~" - Date '~-\\-Q~"~ Print Nam~ Phone -'( ~-~ ,.~, Address ~0. ~: ~~ LOCALAGENCYUSE ONLY STATE TANKI. D.# FORM C (7/91) COUNTY # JU~RISDICTION # FACILITY # TANK # '=== THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FOR~ A & B UNLESS THEY ~AVE SEEN ~ILED PREVIOUSLY FORO0~5C7 STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL Be " CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C ..... COMPLETE A SEPARATE FoRM FOR 'EACH'TANK SYSTEM I. SITE LOCATION · / CITY ,i."~.. :, ' I ~' '~' i' -: ~ II. INSTALLATION (mark all that apply): ' : '.' '",.'.'";'. :. ;i = ':'. F~q The installer has been certified _by the'tank and piping manufacturers. ". ":;:r;'';' .*~ ..'The install~t'ion h'~.~:i~'~'.~j~-~l~-~i~-d'~r~a.~,~'~::rO~-~i~;~;:L~-.-. ".~:';;..:.' '~ .:~::'.'~ }j: ~?.:/?:{~ ,?.:.."':'~:~:f,-:~}'~: '.- ~.:'. I "~ .... '. '". ' "-':~ ' ';'-~," w'--.'~'~.'-~'.'.~,~ . .. ff~ ~..uy~.u .Hp~emenlino aa' ~v' ~-'"~':.?.".'.:-~- ' "'".~':-- ' '1 ':" All ' ": -" · " ............... J .... ~ ~.-~--"~'~'~'~<=~."-' ....... -'-."='"-'"'~':-~"' ~,?~"'"-'-" .... - ' '-- ~ wo~ hsted on the manufa~urer's in · ..... *~ '. .... ~" ","~"' ":'~- ~'~:.:~'-~.'~"<'?~:',',..';:-'...~'~ '.' ':'. ...... . -. .. , . .... stallabon checkhst has been C ' '- · . . - . . · '-.--;~;-::'A~... :' ' ,. :':: ;.. ':. :':.'"-,r :"??'?-:~:"~r;:x:P.?;'.' ? ": c':'~ :: "~'.? ~ The mstallahon Contractor has been cedified or licenSed bY th~ Contractors state Lic~'~e B~a'rd.' ' '. ':" Another methodwas used as allowed by the implementing agency. (Please specif~.) ,. ,~ '.~ r ~ i ';f,~ ' ' ' · "' ..... ...-,:..~': , ., ~ ~ .- , .~ .... ~ ...... _ ;¢' .~' ., · :" ' """= "=';;~:"~":::'"t :* ''? ~ ' '- %'' ':' '~ ....... III. OATH I ceMify that the information provided is trUeto the best'°f my belief and knowledge':' ~'' Print ~~~/~ Address ;f:.~. ~ j ~7~,'.? LocAL AGENCy USE ONLY STATE TANK I.D. # FORM C (7/91), COUNTY # JURISDICTION # FACILITY # TANK # THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A l B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FOR00~SC7 ' STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL I CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION · COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM " I. SITE LOCATION II. INSTALLATION (mark all that apply):. The installer has been certified by the tank and piping manufacturers. ..~ "~4.::.,: ":.': : ~ ' ' .' . *.~ '-"': .i ~'" ':: "~: "-!::ii~','.;, :~, :, .* .! .; '.L ....... ;..' '.~'?-~" . * ...... ",'~. ....... ' ........ ' ........ ." Z.'.' '].. ' ; :.: · .'l':q The installation has be~.,n'ihsPe~ted .,and c~qified by a'r~istered p~'ofessional,engineer.':.L,: ,;~i?i:;':, .: :**i' ! :: i ~ . - . · · . .:;~;;~?~;~%'::~'-::' ?.~:.,;,.,:vq?:... ' r~:~:-;';?-T~;,'t~*.';...been. Ce~p!.~ted>?~:::~t~:;;:;,:-;.-;':;: .;-t.* .-:,h'.: "..;.:. :.:*'.., '. ~:'-:. ~ T~e ,~s~,at,on Contractor h~S' ~ee~ citified or ,oe~Sed by t~e co~tr~o~°~ ~tat~':~"~::':':X': '~'~'~::Z~': ::' "~::/~ :'}" ' ' ' . cense o.,?' -.. I" ~ Another method was used as alloWed by the implementidg agency. '(Please speCify.) '.: ;:'~:.'}.:~..:~; ? III. OATH I cagily that the information provided is true to the best of my belief and kn°wledge.' Tank Owner/Agent~ LOCAL AGENCY USE ONLY STATE COUNTY # JuRIsI~ICTION # FACILITY # TANK # THIS FORM MUST BE ACCOMPANIED BY PERMIT APPLICATION FORMS A & B UNLESS THEY HAVE BEEN FILED PREVIOUSLY FORM C (7/91) STATE OF CALIFORNIA STATE WATER RESOURCES CONTROL " CERTIFICATION OF COMPLIANCE FOR UNDERGROUND STORAGE TANK INSTALLATION FORM C · COMPLETE A SEPARATE FORM FOR EACH TANK SYSTEM I. SITE LOCATION STREET /':~ ,,~ , II. INSTALLATION (mark all that applY): ~ , -.....: :::.. :: ..:.. :.., .: ... ,. . ......... · [~ ' ,, ,~. ;,. ?,:. · The installer has been cer:tified by the tank and piping manuiacturers.' ' ' ":"':' '[] "The installation;has'b~en:in~'~ec{ed:a~d Ce'~ified bya >[e~iste'red Professional engineer .-:~ ' ::' "':":::' ' ' ..' ~ .":The'.ihs/allatio~';~'~ ~'~'~'~:~cte'~';';~:~:'~:~:~:':~.~:;?:':~:".~?.:?:':" :":~'. "....' ~.' '~ .~-v .: '..::-~.~ .... ~,' ..... - ':':: - . . .. '~ '~" '::: .-': .... ::':;t;~:':~:-::::::::::::::::::::::::::::::::~; ~, ~:~-~::?,: g~ ~-~:,~.~'~e~ti~g ag~n~y:'.:-:,.::~ '.-.' .H:: .... ' ........ ... ,-.. .~ ' ' . .... .,' . '- ....:~,~.~ ~ ' · '~ ' .'. ~ ........ -' "- · .............. ~o~u".~?-'.,.' ...... '-. ::7.:":~ :::.,.'. .'.'~. Co,,r. o,or s : '" ' .... ' . ac[ors ~tate License BO~'~.''.' '~ ' ~ Another.method'was used as allo~ed by the implementing agency. (Please specify.)-.. III. OATH.,.. I certify'that the information provided is true to the best of my belief and knowledge. Tan'i~ owner/Agent~.-~'. ~.,. ~I C: C ,' "l /'(...,~ ,.--- ~ - STATE COUNTY # JURISDICTION # FACILITY # · "- ZI . .. lolo FORM C (7,~) THIS FORM MUST BE ACC~MPAN'~D BY PERMIT~PPLICA~ION FOI~MS A & B UNLESS THEY HAVE BEEN FIL~=~ pR~USL~ F(~0035C? CITY OF BAKE ELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 3263979 ~,~ ~o. 3q3 INSPECTION RF. COItD POST' CARD AT SOB 8FTE [NSTR[I~?rlONS: Pleu~ ~all for m imp~mr~tdywl~l~h 8n~upofimp~ai~m ~~ ~~. Th~will ruuiu ~a~miv~on~gb~imi~ilhma~l~r { INSPECTION [ DATE I~Jdill of Trak(a) PIPING SYSTEM SECONDARY CONTAINME.'S-I'. OVERFILL PROTECTION. LEAK DETECTION Liner Ins~l~ion - Tank,s) Liner In..qall~i~ - Piping './~- bO Vault Wi~ ~ C~bim ~ C~bl~ Fill ~) ~ ~e ~ ~s) ..... ~ ~s) for ~ S~D.W. T~s) / Permit No. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILrrY [ llViODIFICATION OF FACILrrY D,~N'EW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE ~[ /~$~='/~ PROPOSED COMPLETION DATE FACILITY NAME ~ ~_~a~ EXISTI~FACILITYP~NO ..... FACiLITYADDKESSi~1651~- ~-,z~13~.~,~o~uCITY t~--~:~..~z~:~t-t~ ZIPCODE TYPE OF BUSINESS _ ~/~ i ~'~ t~-'t' ~ ~ ~ 't T' ~ ~ ~ ~ # TANK OWNER ~,Lo ~ ~ ~_-~,A~-~-'-~ PHONE NO. ~ctB ADDRESS .~ttm t ~< 'rc+'~r~ ~2) CITY t~:~,~'=.,'~ ZIP CODE CONTRACTOR ~.~..u~.~.-t-- u~t~c t4~,c..e ~..-- CA LICENSE NO.~ ADDRESS ~£D- ~o~,nnv,, "~z_ CITY ¥~C~=-~::;,=~-~ ZIPCOD~--q.:-'-'-'-'-'-'-'-'~o PHONE NO.F~3-/ ,~O2-O/o& ~ WORKMAN COMP NO..~r~ t-~E ~x~ ~ BRIEFLY DESCRIBE THE ~Q _RK TO BE DONE. ~ '~d~-~ t~- WATER TO FACILITY PROVIDED BY ~'~/-.- DEPTH TO GROUND WATER {~.S-- '-~- BAKER~FIELI) ~:ITY BUS .n~ESS LICENSE NO. INSURER ~H- O7..~ ! SOIL TYPE EXPECTED AT NO. OF TANKS TO BE 1NSTAL/.g:D ARE THEY FOR MOTOR FUEL "~ YES SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE ~' YES SECTION FOR MOTOR FUEL. TANK NO. VOLUME UNLEADED REGULAR. PREMIUM DIESEL AVIATION TANK NO. VOLUME SECTION FOR NON MOTOR FUEL STORAGE TANKS, CHEMICAL STORED CAS NO. CHEMICAL PREvIOUSLY STORED (NO BRAND NA~m) 0~ KNOWN) FOR OFFICIAL USE ONLY - ............................................. ...: ................................................... :..: ........ ~.~'ui"~!i~i~i........~ ............ :.. :......:.:.:..:.~:::..'.u~'~:~i~:::i:::::.! i: ":::' ::'~ "::.~!~;i?. THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATrACHED CONDITIONS OF THIS PERMn" AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST~OF.~.,~?)NLEDGE, IS TRUE AND CORRECT. , //jr // . f THIS APPLICATION BECOMES A PERMIT WHEN APPROVED CA Cert. No. 06285 Kern County Environmental Health Services Department Steve McCalley, R.E.H.S., Director 2700 M Street, Suite 300 Bakersfield, CA 93301-2370 Voice (805) 862-8700 FAX (805) 862-8701 E-Maih eh@co.kern.ca.us 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 &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. Facility: FASTRIP FOOD STORE g42, 001716 Location: 12851 ROSEDALE HWY BAKERSFIELD, CA 93312 Owner: FASTRIP OIL CO. c/o JOHN KERLEY P. O. BOX 82515 BAKERSFIELD, CA 93380-2515 UST Site ID: 380037 BP Site ID: 001729 Issue Date: September 1, 1998 98C-4 Kem County Environmental Health Services Department Certified Unified Program Agency 2700 "M" Street, Suite 300, Bakersfield, CA UNIFIED HAZARDOUS MATERIALS I WASTE FACILITY PERMIT Phone: FAX: (805) 862-8700 (805) 862-8701 FACILITY NAME: LOCATION: Key Map No.: FASTRIP FOOD STORE//42, 001716 12851 ROSEDALE HWY. BAKERSFIELD, CA 101~25 OWNER'S NAME: FASTRIP OIL CO P O BOX 1807 BAKERSFIELD, CA 93303 ISSUED FOR THE FOLLOWING ACTIVITIES: Underground Storage Tanks (Permitted) 380037C 12000 GAL., JACKETED, UNLEADED, PRESSURE 12000 GAL., JACKETED, UNL PLUS/MIDGRADE, PRESSURE 12000 GAL., JACKETED, PREM UN-L/SUPER, PRESSURE 12000 GAL., JACKETED, DIESEL, PRESSURE Haz Material Business Plan/RMPP (Authorized) ~ Site ID #: 001729 ..... · 3 HaTardous Waste Generator NOT AUTHORIZED Above-Ground Storage Tanks NOT AUTHORIZED THIS PERMIT IS GRANTED SUBJECT TO THE CONDITIONS LISTED ON THE BACK Issue Date: November 1, 1997 - POST ON PREMISES - NONTRANSFERABLE Expiration Date: November 1, 2000 A007 - END OF DATA NEXT-FUNC: KIPS #PROPINQ KEY: NAME/ADDRESS SELECTION DATA ENTRY P22245 MOVE THE CURSOR TO THE DESIRED PROPERTY AND ENTER AN 'X' TO SELECT ROLLINQ 'B' TO SELECT BILLINQ ATN/ Location Sel File Number Name 496-050-05-01 12851 ROSEDALE HY BAKERSFIELD JAMIESON HILL CO 496-050-05-02 12851 ROSEDALE HY BAKERSFIELD WELLER RICHARD B & PAUL A PFI=HELP 3=RTRN 6=ROLLINQ 7=BKWD 8=FWD PF9=BILLIDX PF10=TOP ll=BOT 22=PRT 09-'02 SA MW KS DM IM 01/31/97 10:00 II Si S10A1660 KB NEXT-FUNC: KIPS #ROLLINQ ATN 496 050 05 01 4 File No Lgnd ~~i~~~ Lgl C RSDLE B 4 L 3-5 SITE 12851 ROSEDALE HY BAKERSFIELD Owner JAMIESON HILL CO Bill 3101 STATE RD BAKERSFIELD CA 93308-4931 RBP 97 96-1360639-00-1 TRA-No 116 002 116 002 CHG DT Chg Type Mineral Land/PI Imprvment Other Imp Pers Prop Exmp Amt Net Value KEY: SECURED ROLL INQUIRY ACTIVE Acres Doc KEY DATA PROMPT P22241 Roll 1 Use Code 1403 AG Presv NO .55 CPest BPS 1 SD 3 UF 95-1364864-00-0 116 002 266,115 260,898 258,034 281,769 276,245 273,213 407,189 407,189 440,395 60,434 60,434 68,297 1,004,766 1,015,507 1,039,939 PFi=HELP 2=MENU 3=RTRN 4=TOG 9=BILL 10=UFL ll=BUS 12=EVTSEL PF13=NEW 14=APN HIST 15=OWNERS 16=EXEMPT 17=SUPPL 18=ADDR 19=ROLL CORR PF20=PREV YR 21=NEXT YEAR 22=PRT 23=NEXT 24=PREV 01/31/97 10:01 04-10 SA MW KS DM IM II Si S10A1660 KB F~LE CONT£.~ITS SUMMARY ENV. SENSITIVITY: ~-._~ Activity Date # Of Tanks Comments &/ IN RECEIPT ORDER Permfft no: 131299-IN Customer name: JACO OIL-COMPANY Line No. Fee Code 1 USTO01 2 3 Receipt number: Receffpt date: Description 3398 UNDERGROUNDTANKS ANNUAL FEE EH CUSTOMER NO = 20-JACO4 DEPOSIT NO = 03698 0'11519430F 01/15/97 Amount 600.00 0.00 0.00 TOTAL $ 600.00 <E$c> to Exit OR <PageUp> or <PageDown> to vffew next detail record. /~ S~ale of California · ' r~ s~ u. o~.. ' ~'~ F'_~4:.\ c,a ....... · .... . .... - . ; ~&/~ u~iofl of Clean Waler Pm"~ms ' '"" '::' ' ' ~ ' ~ :':' '~"':: ~ '" ~:':"::":":; "::':" ':'::"' ::'::~' ' CERTIFICATION OF FINANCIAL RESPON8iBILI ~ ~ FOR UHDERGROUND STOOGE TANK~ONTAINING P~ROLEU i~ ] ~ ~cqmrcd to dgmo~ata F~ R~ ~ .... --- M ~ "' ~.:~ ~ , ' , ~ ~' ' ~ o~ ' ~ ~ ] million doll~ ~i ~ '::" ' "~2 million doll~ ~ ag~a ' ~ ~a~eso~ ~ill Co.. . .=r . here y ce~ifies that it is in compliance with the m u/rem · ~ ~icle 3, Ch~ter IE, O/vision 3 ~lle 23 'California C~ ....... ~ q ents of Secbon 2807, ~~;~;~ility a, required b ' Sec i /~. Mechamsm: ' . Name and Addr .... z '"'~~ion 2807 are a~ follow~: ~ "' '' '"" :' ':'.:::: :: ' ivle~a~lS~ · ~ . .. j -" . .... . .. ~u~ssuer ........ ~~;~-. ~ ~ ~ . ' .... .::"....:::-..:.?.;...:~.::: .:: .:.;: ....... :.~ ...~:...,:~ ............ ].:.Cove, age...' ' ~ ........ ~~~.~. ~ mm.~any State UST State US~ Clea~u~ ~um ~/A fo=." 995,000 .' /Yes ~Fund P.O. Box 944212 .UST Cleanup per ~°ntinuo s ~ Sacramento, CA 94244 'Fund ' "..' )ccurenc, ~~ ..~ . . ~nd annu,31 ' Chief Jamieson Hill Co. N/A for this 5,000 Financial P.O. Box 1807 mechanism Yes No Officer Bakersfield, CA per ~ontinuo] s Letter ,ccurren. :e ~nd annu~l ~ ~ggregat~ t..: .~,0u are ~,~.,ng t~e State Fumd ~ a~y ~a~ of your ~emo~trahom '~,~/~c~iom also ceci5es that ,,ou ar-: ...... amoral re~sonmOflily, your execufiom am~ $ubmi$~iom~ ' ~ ~: ~ ~ ~ ,,, uumo~mmce wilh all comditiom~ for ~aCici~atiom in th- ~ - ] See attached list. Notary' Public The Chief Financial Of-tic= or the owner or or)erator must sign. under pertain, of perjuD', a letter worded EXACTLY as iollows or'you may complete this lener by filling in the btar~:s with appropriate information: LETTER FROM CHIEF FINANCL4L OFFICER I am the Chief Financial Officer Jmmlo_.qon lll]] Car '~ln'l .qt-~t-~ ~r]. Rakar~qfio_]d, (Business nan~e, busm~s address, and co~'~csponficncc address o~ owner or opera:or; 93308. P.O. Box 1807t Bakersfieldt CA 93303 This letter is in suppor~ of the use of the Underground Storage Tank Cleanup Fund to demonstt~{~' financial respormibilis' for taking corrective action and/or compensating third par~ies for bodily injury, and property, damage caused by an unauthorized release of petroleum in the amount of at leas/ $ CA 5, '000 per'occurrence and 5;' 5, (Dollar Amount) (Do!!ar Amount) annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter: g~ ~t-.t-ao. bo_d 1 i -qt.. (Name and address of caen facility/or which financial responsibiiiry is being demonstrated.) Amount of annual aggregate coverige being assured by this letter ................................ ' ...................... Total tangible assets ............................................ Total liabilities ................................................... Tangible net worth (subtract line 3 from line 2. Line 4 must be at l~ast 10 times line 1) ..................... 5,000 5,687~710 3,344,910 2,342 800 , I hereby certifv 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 true and correct to the best of my knowledge and b,.l.~.r. Executed at Bakersfield, CA (Place of Execution) On October 22, 1996 (Da~e; Brian Busacca (PrinledName) Chief Financial Officer (T~tle) CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS"~ONTAINING PETROLEUM i A. I~'n :cqulrcd to demons~'atc Fi~c]=l Rupons]bilily in d~c rcqarcd ~mounts is spccificd in Section 2807, C~p~r i 8, Div. 3, Title 2~. CCR; L-'~$00,000 doll~ ~ occurt~nca or ~_.1 million dollars per occuncnca _[~_. I million dolla's ~nAu~J or ['~2 million doll~r~ arm,,,i ~=. Jamieson Hill Co. hereby certifies that it is in compliance with the requirements of Section 2807, Article ,3, Chapter 18, Division 3, Title 23, California Code of Regula#ons. i T'he mechanisms used to ~lemonstrate financial responsibility as recluired by Section 2807 are as follows: lC. Mechanism · .. Name and Address o'f Issuer :.:": .!::.i':..ii!:i:!::.':..::i :.Mechanism ':.:-. Coverage".'..' 'Coverage Type State UST Fund State UST Cleanup Fun( P.O. Box 944212 Sacramento, CA 94244 Chief Jamieson Hill Co. Financ.ial P.O. Box 1807 Officer sfield, 'CA Letter N/A 'for.'-" .UST Cleanup Fund N/A for this mechanism 'Amount ' 995,000 per )ccureno ~nd annu. qgreqat. 5,000 per )ccurren. ~nd annu. tggregatl Period :0ntinuo' 1 Action .' Yes is Yes :ontinuotLs ~e '..'ore: /; you a:e us:nL the State Fun~ as any pa/~ of your demonstration of financial resz~on$/bility, your execution ant1 submission of this ceff,/ficat/on also cer;,ifies that you are in comofiance with eft conditions for oarticioation in the Fund. See attached list. a(, ,. 0 ~ -- 'FILE; Original - Local Agency Cooies T~ii~d Pa~y -:.;.:.; ..'.'¥..... 'Comp. No No T.J. Jamieson Partner *'~;~;;;"'~osent[no, Notary' Pub}] ic - Facility/Site(s) . TANKNOLOGY CORPORATION Certificate of Tightness Service Order #- 142141 lest Date' :'04/19/95 .... ¥~ . ' Underground storage tank system(s) tested and found tight for' Tank Owner: 3ACO OIL COHPAN¥ Test Site No.: 7 0 7 Test Site Address: aACO OZ~, COt~PAN¥ F~,STRI? BAKERSFIELD, CA 93312 Tank(s) only, 4 Line(s) only, Tank sizes & products tested: #642 4 Leak D~t~.?ctor(s)only. ~;~- Lines Tested: lA REG, 2A PLU, 3A SUP, 4A DIE Leak Detectors Tested: 40693-9602 XLD 40693-9620 XbD 40693-9624 XLD 40693-969.7 Unit Mgr. Certificate Number & Name 231 TODD L. PARKER 1487 TODD L. PARKER 04/96 10/96 Valid only with . Corporate Se~l U.S. Patent #4462249, Canadian Patent # 1185693. European Patent Appl. # 169283 TANKNOLOGY & VacuTecl are Irademarks el TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank Identification & site location drawing. 01/3i,)96 R E C E i PT KERN CO RESOURCE MANAGEMENT AGENCY 2700 'M' S~ree: BaRersfield, OA 93301 Type of Order CAGE 154516 ,,.,AAH REGISTER' JACO OIL COMPANY' I wt:r, By I Or'der' Date ~¢ustomer P.O'~ I 20081-IN I . CSR I 01/3!/98 L rte DescripTion ~ 3398 UNDERGROUNDTANKS ANNUAL FEE EH ':~.' 3398'UNDERGROUNDTANKS ANNUAL FEE EH UST001 '"'REF: 120080-IN; HP ~440013C Sh~p D'a~e I Via 01/31/96 120-JAC04 Quant~y 4 Ter'ms NT Price Unit Disc 150.00 E 7 8 3398 UNDERGROUNDTANK$ ANNUAL FEE EH UST001 REF: 120079-IN; HD ~110016C 3398 UNDERGROUNDTANKS ANNUAL FEE EH UST001 REF: 120078-IN; HR ~58001~C ':~' 3 150.00 'T'o~a~ $00o00 · 450.00-. 4 150.00 -E 600.00 3 !59.00' E 450.00 THANK YOU ! 'Or'der' To~a] '2100.00 Amount Due P_~ymemt M~d¢ By Check 2100.00 "~0'3 00 TIGHTNESS TESTING REPORTS Date tightness test reports Were submitted: Date tightness tests were completed:~~ Facility Permit Nmnber:~ ' Number of Tanks Tested at the site: numbers if provided) , Was the method · a [est of the entire tank system, piping alone, or just th'e facility tanks? (describe) "~r'/~ Did the.facility pass all tests: }>~P Yes " No (if no, provide the lcak..rate and a de~ription of the tank(s) that.failed the test) > 0.1 gaI per. hour) ' .;":.5 .. The facility will do the following to investigate the failed test: · ' :,>'ii.:- The test method certification that is submitted to the state specifies that each test method be completed in a certain manner. Is there anything within the results w~.ch~h~Would suggest that the tank test was improperly completed? Yes ~ No (describe) Information has been reviewed and placed within the database:_ S Date entered within the database: ~-~/~:?*/~....~-~ ...: HM2~ Entered by (name),, ~._.~ Qbservations Sits vacant? [] Yes ~_ No Tanks in use? ~ Yes [] No Tanks monitored as required? ,~ . ~ Yes, · ~ No O~z_9 ! . Monitoring method being utilized? ~~/~ ~/~/~ /~ ~ ~ ~erspill boxes insta~ed around fills? -~ Ye~ ..... ~-N~~~~~/ Automatic li~ 1~',.~ detector installed? ~ Yes ~ ~' '/' ~~ Doc~entation that ~ust b~ submitted: Annual Report Financial Responsibility Certification Tank or line test results Response Plan Monitoring Records ReinsDections .required? Information Documented in database? DATE  Yes ~ No Yes ~No [] Yes ~ No 'AYes No ~ Yes [] No 14RI~BEU OE IV}~K2 AE~,I~.i~D3: ,:,E2&',.; ~40~J ~[iE A¥C¥~.L~: .,~ ::3 \ t[EBI,1 C O[IM-I i 01/23/95 2:08 pm ~'. RECEIPT KERN CO RESOURCE MANAGEMENT AGENCY 2700 "M' Street Bakers~f.eld, CA 93301 Invoice Nbr. 1 TyDe of Order CASH REGISTER · JACO HILL ~356 }'J~USt°mer P.O.~":~,Ntn By JO~der Date I' Sh'lp Date J Via :.1'.109434-IN & I .CSR I 01/23/95 I 01/23/95 Line Description Quantity 1 3398 UNDERGROUNDTANKS ANNUAL FEE EH 4 UST001 REF: 109434_!N/110016C_1995 UST PMT 4 5 6 ? 8 FAC NM: FASTRIP FOOD sTORE ~356 3398 UNDERGROUNDTANKS ANNUAL FEE EH REF: 109435~995 UST PMT FAC NM: FASTRIP FOOD STORE ~707 3398 UNDER~ROUNDTANKS ANNUAL FEE EH " UST001 REF= 109436-IN/440013C-1995 UST PMT .FAC NM: T~W~ & COUNTRY LIQUORS ~1~3'~ CK: 174984]~A~O OIL COMPANY · 120-JAC04 I I P~ce Un~ Disc 150.00 E 4 150.00 E THANK YOU! 3 150.00 E Order- Total Amount Due PaYment Made By Check PAGE 1 136855 Terms Total 600.00 600.00 450.00" "'? 1650.00 16.50~. O0 00. 3101 State Road Jaco 0il Company Bakersfield, C. aJifomia 93308 cee p O. Box 1807 Bakersfield, California 93303-1807 '" · Phone: 805 393-7000 · Fax: 805 393-8738 August1,1994 LETTER FROM CHIEF FINANCIAL OFFICER 2. 3. 4. I am the chief financial officer for Jamieson Hill Co.. This letter is in support 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 $10,000 per occurrence, and $10,000 annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter. Fastrip #642, 12851 Rosedale Hwy., Bakersfield, CA 93312 Amount of annual aggregate coverage being assured by this letter: $10,000 Total tangible assets: $7,042,119 Total liabilities: Tangible net worth $3,268,429 $3,773,690 I hereby certify that the wording of this letter is identical to the wording specified by subsection 2801.1(d)(1), Chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the fOregoing is true and correct to the best of my knowledge and belief. Executed at Bakersfield, California on Date AU~ 0 '~ lg~/t Signature ~ Name: Brian Busacca Title: Chief Financial Officer BB:jlc MONITOR WELLS Well Number 1 2 3 4 5 6 7 8 9 10 11 12 Well Depth Depth to Water Product Detected AMOUNT in inches Standard Symbols for diagram below: (~)Fill (~) Vapor Recovery O V.R. w / Ball Float l~ Monitor Well ~ Observation Well (Outside Tank Bed Area) (Inside Tank Bed Area)  'Ball Float (~) Tank Gauge 0 Vent Manway ITl Iron CrOss ~ Turbine LoCation Dipgram .-In.c~u.de .the. Vapor. Re. coyery Syst.em: ~. · 8, .st_._3 D [':'--1 " ! Yap( r Recovery System I Vents were tested with which tank? Part:L· and Labor used General Comments ' When OWNER or local regulations require immediate reports of system failure-Complete the following: REPORTED NAME" DATE TIME Phone# OWNER or Regulatory Agency FILE NUMBER ,R~.~ C=~;;e~ Te~ Name Vacutect~, Certifica~on Number ~ ,--i-~~o .=~.o~ Certified Testers Sigratum Date Testing Completed G,y VacuTect TEST REPORT ~ Date ~; i~, 4 / ? ~ JACO OIL CC. Site#'70? Phone i~ <S.D > 393-7000 ~Name/Address JACO OIL CO. 3101 STATE RD. BAKERSFIELD, CA 93308 Attn: AC'~'[OUNT pAyABLES : JACKIE :. TANKS LINES Leak Dot l T~~4KS and LINES Tested' to CFR-40 Parts Ullage , 0-281 & NFPA 329 Spec's.' ~!, ,' . Tank Dipped Dipped Probe Water Bubble Air Line Final Exist '~E~ .,, !. , Dia. & Water Product Water · ingress Ingress Ingress TANK · Line. Delivery LINE LINE Leak LINE LD(s) NEW ~k Material Level Level Level Detected Detected Detected · Material Syst. Type TEST TEST Rate · Pass/ LD(s) ST/ · · · · · · Tight · , · · · · Tight Fail/ Tested 01 ier: START START or ST/ START END or or & ~ Yes/No Yes/No Fail Line # FRP PS/SS/GS TIME TIME GPH Fail NONE PASS FRP/ START Tank Tank Lined END END END Yes/No Product Capecity · Nl~-~/2nd LD SN/MDLJMFG: D~ Shear Val~s Slad ~me: Time et Test: ~ ~ , N~ LD SN/MD~MFG: Matefi~ Sta~ ~me: Ti~ of Test: ~ ~meter  ~'~ ..... N~/2nd LD SN/MD~MFG: ~nd LO SNIMD~MFG: ' Tankn01ogy Corporation International ',IOLOGY Region: ~,,~ESTE]~.N REG I ON Unit # 41 6 State Lic. #157 7 State: CA 52~5 Hollister St., Houston, TX 77040 Original VacuTect Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. (800)i 888-8563 * FAX (713) 690-2255 TIGHTNESS TESTING REPORTS · EVALUATION FORM · Specialist reviewing the ti~mess test repom .... ' ' ' Date ti~tness test repo~s were sub~t~ Date tightness tes~ were completed:~ Facili~ Pe~t-Nmber: O0~ . .'. Nmber of T~ Tested at the site:_ (~t the t~ by the~ t~ numbers ~ pro~ded)~ Did the facility pass all tests: ' , · (if no, provide the leak rate and a desoI~'ption of~-he tank(s), that failed the test) (failure is > 0.1 gal per hour) . , ..-~,.~ ~.~ The facility will do the f°llOw/ng to investigate the failed test: ~e test method ce~6n aat ~ sub~tted to the state species aat each' tes{ me'od be completed ~ a cen~ m~er..h ~ere an~g ~t~ the resul~ w~ch wo~d surest that the t~ test was ~proper~ completed? Yes (descdbe)~ - ~ No Date entered within the database: ~M,~ Entered by (name) .:- '~ "' . Information has been reviewed and placed within the database:_ _'/_~S NO TANKNOLOGY CORPORATION INTERNATIONAL 5225 Hollister, Houston, Texas 77040-6294 Phone (800) 888-8563 FAX (713) 690-2255 Certificate of Tightness Service Order #: 126020 Test Date: Underground storage tank system(s) tested and found tight for: Tank Owner: JACO OIL CO. 707 Test Site Address: JACO OIL CO. FASTRIP 12851 BAKERSFIELD, CA 93308 Tank(s) only, 4 Line(s) only, lank sizes & products tested: 08/04/94 ROSEDALE 4 Leak Detector(s) only. Lines Tested: 1Ai~RE~', 2A PLU, 3A SUP, ~4A DIE Leak Detectors Tested: 40693-9602 XLD 40693-9620 XLD Unit Mgr. Certificate Number & Name 40693-9624 XLD 338 CHARLES T. BUONANNO 01/96 Validonlywith 1577 CHARLES T. BUONANNO 04/97 Corporate Seal U.S. Patent #4462249, Canadian Patent # 1185693, European Patent Appl. #169283 TANKNOLOGY & VacuTec! are trademarks of TANKNOLOGY CORPORATION INTERNATIONAL Note: See VacuTect Report for tank Identification & site ' location drawing ~... .. ~r~ · .~-~ I Jamieson-Hill Company 3101 State Road Telephone (805) 393-7000 Post Office Box 1807 Bakersfield, California 93308 Bakersfield, California 93303-1807 January 21, 1994 Ms. Laurel Funk COUNTY OF KERN ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2700 "M" STREET BAKERSFIELD, CA 93301 Subject: FASTRIP FOOD STORE g42 ROSEDALE AND ALLEN ROAD. BAKERSFIELD, CA PERMIT NUMBER 380037 Dear Ms. Funk: Attached please find copies of the results of the integrity tests which were performed on ~he newly installed Joor Elutron jacketed secondarily contained underground storage tanks at this location for your files. Testing was performed December 27, 1993, by Tanknology Corporation International. Review of the results indicate that all tanks were tight. Should you have any questions or require additional information, do not hesitate to contact me at (805) 393-7000. Jr,/jk attachments Owner JACO OIL CO. InvoiceName/Address JACO OI'L CO. 3101 STATE RD. BAKERSFIELD, CA 93308 Name/Address .................. rn~'z'tiit' ttOSEDALE & ALLEN BAKERSFIELD, CA TANKS See ' Ullage Diag. Tank Dipped Dipped ~robe Water Bubble Air For Dia. & Water Product Water Ingress Ingress Ingress TANK .Loc. Material Level Level _evel Detected Detected Detected · ~_. · Tank Tank FRP/ START START TART ' or # Product Cal~acity Lined END END END Yes/No YSS/No Yes/No Fail 1 SUPR 12000 Oiame'~00.000 065.00 0.J.170 N N N T UNL 11100.000 065.00 00.170 Material Start TIine: 12: 22 ~,; , Fi,, a, Pum fim~ot~,: ' 61.0 ~RED JACKET 2~ ~-T6'6T'~ ?_o. 380 1,°6~7°-6 90.~3°01 PLUS Maleria, S,.,~me: 12 :22 Time o' T,,,: 61 . 0 ~RED JACKET _o_o. ooo N 111o0.000 Io69.oo oo. 7ol Material · nmeo~r.s,: 62 0 RED JACKET ank UN[, 111~0.000 1098 O0 O0 i6o Material ~. nmeo~T,t: 88 0 Pure, ' · Mt;.: RED JACKET T~ P~l:- 40 ' Pro~ Malerial Start Time: t ~ff~P End Time: ~[a~ll p~[; I Probe Incllnc.T,e;ei I Er~try;, Malerial Start Time: t Pump I Probe En~ llF~: Test PSI; I EqlrY; I Inclinometer Dears§; TANKNOLOGYRegion: WESTERN REGION Unit # 015 State Lic.# ~OTE: Orisinal VacuTecl Data recordings are reviewed by Tanknology's Audit Control Department and maintained on file. T~K -01 [MONITOR WELLS '~<~o' P~ ~ ~ov~-v ~ 4,~.~ o~,,J=r,,~_ ~~ , Well Numar I 2 3 4 5 '6 ' 7 8 g ' 10 11 12 Well Depth _ Depth, to Wa~r P~u~ Deter, ~OUNT in i~ Standard'Symbols for diagram below: ~11 ~ 'Vapor Recovew ~ v.R.~w / Ball Float ~ Monitor Well ~ Obse~ation Well ' (Outside ~nk Bed Area) (Inside Tank Bed ~a) ~ Ball Float ~ Tank Gauge ~ Vent .'~ Manway ~ Iron Cross ~'.Turbine Location DiagramT~n~u~e ~he. Vapo[ R~CoYew Syst~m~. .4~-~. .. ; ~ ~;: ..~ ,, .. , .. '~ '~Z~ IZ~ tZ~ 0 TIGHTNESS TESTING REPORTS EVALUATION FORM Specialist reviewing the tightness test report:.~~.r~r Date tightness test reports were submitted:/~~~~ Date tightness tests were completed: Facility Permit Number:__~.~..~~~~ Number of Tanks Tested at the site:_ od// numbers if provided)~ _(list the tanks by their tank Was the method a test of' the entire tank system, alon.~_or just the (describe)~ piping facility tanks?- Did the facility pass all tests' tz'O ,, :: :'~ ' .... - "-": ~ i · · - r- -- x es .... · · ( f no, provide the leak rate and a desc~i~tio- --~, ~L .__~;.., . . . ...., No . . v "~-u,~ ~(s) mat tailea t~e test) (failure The facility will do the folloWing to 'investigate the failed test: The test method certification that is submitted to the state sPeCifies that eaCh iesi'.method be completed in a certain manner. Is there anything within the results which would suggest that the tank test was improperly completed?. Yes (describe)_____ .- , ~ No Information has been reviewed and placed within the datab.ase:~~ YES Date entered within the'databaSe: H~2~'Entered bY (name) Water Resources ¢ Board CERTIFICATION OF FINANCIAL RESPONSIBILITY I am required to demoustra~ Financial l~x)u~b~it~ in the required amounu au SlM~W~d in S~ioa 2~F;. C~ I~ l~', 3. Tiib 23. CCR: ~ $00.000 dollars per oocunencm AND ~-~ t mi~m doflars an~md qpqmo . B. ~ ' .. ' ~v,~ r,~ o,~ ~O~.r,,~ _hereby cer~ifles ffJat it is in compliance wi~ ff~e requiremer~ of ,,eec~n 2a07, Article 3, Chapter 18, Division 3, T/Ne 23. California Code of Regulations. Ci':i!iMechanism.?i ~i<.:~i.:.~Narne and:Address:of:lssuer.::~::~:::, ~.:~?:~:.. ~n Sta~ Fund Self Insurance State of California d~nieson-Hil 1 ~.y P.O. Box 1807 Bakersfield, CA 93,30.3-1807 2807am ~ follo~e: $ 990,000.0CJ C~"rt $ 10,000.~ R E C E [ P T PAGE I 12:32 am KERN CO RESOURCE NANAGENENT AGENCY 2700 'M' S~ree~ Baker'sfJe]d, CA 93301 Type .....;..:-..+ ~ . CASH REGISTER JACO OIL COMPANY Customem P.O.~ I Nth By IOrde. r Date ' Ship Date I Via IF~i~ .............. 8052IN J RAR I 03/11/94 03/11/94 120-JACO~ I NT Order Total Price Unit Disc Total 600.00 E 600.00 6oo. Oo THANK YOU! Amount Due Payment Made By Check soo. Oo 600.00 R E C E I P T PAGE 1 -6~'2~'~'2.~'~, .......................................................... ~[nvo-fce Nbr'. 1 I 16458 12:25 am KERN CO RESOURCE MANAGEMENT AGENC;¢ 2700 'M' Street Baker*sfffeld, CA 93301 Type of Order W CASH REGISTER JACO OIL COMPANY .'.;.. -I 7774IN I RAR 03/11/94 .I 03 / 11/94 ¢i,: ,"J 20-J ACO.~/~ I NT :.: ...... ,...., ........ I ................ I ................ I ................ 'i?~1~_ ....... L ........... t ....... ....... . .... '_ 1 2 5730 UN DE RG ~O~ N DT~E SU RCH EH 1 224,00 E 22400 Ol*der Total -.; 224.00 THANK YOU ! Paymen~ Amount Due Made By .Check 224.00 224.00 3101 State Road Bakersfield, California 93308 April 4, 1994 Ms. Laurel Funk. KERN COUNTY ENVIRONMENTAL HEALTH SERVICES DEPARTMENT 2700 "M" STREET BAKERSFIELD, CA 93301 Jamieson-Hill Company · Telephone (805) 393-7000 Post Off]ce Box 1807 Bakersfield, California 93303-1807 SUBJECT: FASTRIP FOOD STORE # 42 12851 ROSEDALE HIGHWAY BAKERSFIELD, CA 93308 Dear Ms Funk: Attached please find the Monitoring Response Plan prepared for the above referenced site. A copy of the plan has been forwarded to the facility manager to be immediately implemented. All store employees will be required to read the plan, and instructed in the procedure to follow should the tank monitor indicate any alarm conditions. Additionally, the facility manager will be advised to perform the required daily checks, and to record his findings on the daily check sheet. This check sheet will be maintained at the facility for inspection. Should you have any questions or require additional information, do not hesitate to call me at (805) 393 7000. ~hank Y~u,/ J jk attachments: Monitoring Plan cc: facility files KERN COUNTY ENVIRONMENTAl HEALTH SERVICES DEPARTMENT UNDERGROUND STORAGE TANK PROGRAM ELECTRONIC LEAK DETECTION SYSTEM ALARM RESPONSE PLAN INFORMATION SHEET Facility_ Information 'A. Facility Name: FASTRIP FOOD STORE ~ 42 Permit Number: 3800 ~ 7 Leak Detection System (Make and Model): T L S- 3 S 0 VEEDER-ROOT B. Facility Diagram (see next page) II. Contact Information Ae Facility Contact Days: JOHN KFRI EY 39S-7000 (name and phone number) Evenings:.d0HN KERLEY 393-7000 Kern County Environmental Health Services Department: (805) 861-3636 Electronic Monitoring System Servicing: Company Name: JAC0 0IL COMPANY Phone Number: ( 8 0 5 ) 3 9 3 - 7 0 0 0 Electronic Monitoring System Manufacturer: Company Name: VEEDER-ROOT ENVIRONMENTAk Phone Number: ' (203 ) 651 - 2700 PRODUCTS HM33 (page 1 of 2 pages) ROSEDALE HIGHWAY · . DEIV~AY o ~ .....,, ° ® .... I ~ o ..... ~, I IlI I IiI ~ , Illl ~,llll ~ ~ ~ ~ll ' iiI III ~ III DISPENSER I1~1 I Il / ~GENCY IS~ND ~ ~ I', o ~ SHUT-OFF III - III GAS METER > c MAIN ~ ~LgCTRICAL ~ SHHTOFF ST TANK MONITOR PLAN FASTRIP FOOD STORE 12851 ROSEDALE H/GHWAY BAKERSFIELD, CALIFORNIA SUBMITTED TO COUNTY OF KERN DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES 400 "M" STREET BAKERSFIELD, CALIFORNIA 93301 PREPARED BY JAMIF. SON-HILL COMPANY P.O. BOX 1807 BAKERSFIELD, CALIFORNIA (805) 393-7000 MARCH, 1994 · ( ( TABLE OF CONTENTS FACILITY INFORMATION EMERGENCY PHONE NUMBERS DAILy INVENTORY RECONCILIATION TANK MEASUREMENT SYSTEM INTEGRITY LINE MONITOR SYSTEM UNDERGROUND STORAGE TANK SYSTEM TESTING SPILL CONTAINMENT AT FILL RISERS TANK MONITOR PLAN UNDER6ROUND TANK PROGRAM Fastrip Food Store #37 12851 Rosedale Highway Bakersfield, California 93309 (805) 589-4441 FACILITY DE$(~RIPTION Convenience Store with Gasoline Dispensers. OPERATING SCHEDULE 24 hours a day, 365 days a year Jamieson=Hill Company P.O. Box 1807 Bakersfield, California 93303-1807 (805) 393-7000 EMERGENCY CONTACT Mr. John Kerley Operations Manager (805) 393-7000 _UNDERGROUND STORAGE TANKS Tank Capacity Product 12,000 uNL PLUS 12,000 UNLEADED 12,000 SUPERUNL 12,000 DIESEL pIPELINE LEAK DETECTION Material Double Construction Wall ELUTRON Yes ELUTRON Yes ELUTRON Yes ELUTRON Yes Red Jacket .... XLD mechanical line leak detectors with annual precision testing of lines. STORAGE TANK MONITORING Liquid sensing probes located in piping sumps Continuous electronic monitoring of annular space with liquid sensing probes. EMER EN Y TELEPH NE ERS' Jamieson-Hill Company (John Kerley) ................. (805) 393-7000 Police ............................ Fire Department: ................ 9-1-1 Permitting Agency: Kern County ........................... 9-1-1 .... ~ ...... ' .................. (805) 861-3636 _SYSTEM INTEGRITY2 Storage tank and line integrity shall require further investigation under the following circumstances: Jamieson-Hill Company requests investigating; The electronic tank monitor detects the presence of liquid in the annular space of the secondary containment and a maintenance technician dispatched by Jamieson-Hill Company finds no equipment malfunction. The mechanical line leak detectors are activated by a pressure loss in the product lines. Inventory reconciliation for any motor vehicle storage tank exceeds 0.5% of throughput at any time during a 30 day period. If inventory reconciliation indicates excess variation of the stored materials as specified above, the operator shall implement the following: Within 2 hours of completion of the daily reconciliation which indicates the excess variation, the operator shall review the inventory records to determine if an error exists, correction of which would cause the variation to be less than that specified as excessive. Upon completion of the verification of excess inventory variation, the operator shall immediately notify Jamieson-Hill Company of the fact that inventory reconciliation indicates a variation greater than allowable of stored material or gain of water. In the event that operator has immediately notified Jamieson-Hill Company of the excess variation.,Jamieson.Hill Company will, within 24 hours, perform a complete review of all inventory records from the last time a zero loss of allowable variation existed. Jamieson-Hill Company will also conduct a new inventory reconciliation at least eight hours after the 2 reconciliation which triggered this evaluation. If the review of inventory records and new reconciliation confirm a variation greater than allowable, Jamieson-Hill Company will, within 24 hours of completion conduct an 8-Point check. 8 - POINT CHECK Inspect all fill caps for gaskets, proper seal, and signs of spillage. Gauge tank for water and record. Inspect each submersible pump and pit for leakage from gaskets, pipe swing joints or flexible connectors. .Test product lines and leak detectors on remote (submersible) pump systems and monitor probes in secondary containment. Inspect piping at each dispenser or computer pump for leakage at dresser couplings, unions, meters, strainers, impact valves and other points. Check operation of self-contained computer pumps for indications of line leakage. Calibrate all pumps of dispensers, record the meter variation before adjustment and 'the amount of product used for calibration. Report results to Maintenance Analyst who records the report. If a pressure loss in the product lines is indicated and the dispatched maintenance technician determines that there is no equipment malfunction, 'Jamieson-I-lill Company will implement the following: The product system (tanks and pipelines) will be shut down until a final determination is made. The piping system will be isolated and hydro-statically pressure tested to 50 psi or greater. If liquid in the secondary containment is indicated by an alarm and the dispatched maintenance technician determines that there is no equipment malfunction, Jamieson-Hill Company will implement the following: Use of tanks and associated piping will be discontinued until a final determination is made. The liquid will be evacuated from the secondary containment by a positive displacement pump. The suction side of the pump will be attached to a small diameter flexible tubing which will be manipulated from ground surface. A determination will be made as to the type of liquid found in the secondary containment. If water is found the secondary containment will be tested. If hydrocarbon, the primary container will be precision tested. VEEDER ROOT TLS-350 Underground storage tanks for motor vehicle fuel hav been equipped with a Veeder-Root TLS 350 Continous Electronic Tank Monitor. This system monitors the product level in all tanks and monitors for the presence of liquid in the interstitual space of the tanks and piping sumps. The monitor will alert the operator if an alarm condition exists at any of the monitoring points. LINE LEAK DETECTORg The underground product lines for motor vehicle fuels have been equipped'with Red Jacket XLD Leak Detectors. If a loss of pressure in the piping system is detected the flow of product will be automatically limited to 1-1/2 to 3 gallons per minute. Upon activation of a line leak detector, the operator will notify Jamieson-Hill Company and advise what product line system is affected. Jamieson-Hill Company will dispatch a maintenance technician to investigate the problem. If no equipment failure is found, a precision test of the suspected piping will be scheduled by Jamieson-Hill Company. The suspected system(s) will be taken out of service until the problem is resolved. AdditionallY, piping sumps are monitored for the presence of liquid in the sumps. Sould liquid be detected, an audible alarm will be sounded to alert the operator of the condition. TEST MODE The operator shall chack to ooperation of the monitor on a daily basis. The results of the system check shall be recorded on the form provided and retained at the location for inspection. Should any malfunctions be discovered, the operator shall immediately notify Jamieson-Hill Company. A technician shall be dispatched to investigate the cause of the problem and correct any malfunction. UNDERGROUND STORAGE TANK TEST: When testing is required, Jamieson-Hill Company will utilize a method capable of detecting leak rates of 0.05 gallons per hour. The operator will coordinate with Jamieson-Hill Company' representative delivery of motor 4 vehicle fuel required to start the testing of each individual storage tank system. Complete shutdown of the dispensing facilities by operator will be required during the test. When circumstances warrant, an isolated tank test will be performed. Jamieson-Hill Company will arrange to have the tops of all storage tanks exposed, disconnecting all piping, to isolate each individual tank testing. In the event test results indicate a leak rate loss of 0.05 gallons per hour or higher, Jamieson- Hill Company will implement the following procedures: Determine source of leak. Empty any tank found leaking. Positively shut down any leaking product system until repaired or replaced. Within 24 hours, Jamieson-Hill Company will notify the local Permitting agency. Within 5 working days, Jamieson-Hill Company will submit to the local Permitting agency a full written report to include all of the following information which is known at the time of filing the report: List of type, quantity, and concentration of any substance released. The results of all investigations completed at that time to determine the extent or soil or ground water or surface water contamination due to release. Method of clean-up implemented to date, proposed clean-up, actions and approximate cost of action taken to date. Method and location of disposal of the release, any contaminated soils or ground water or surface water. Proposed method of repair or replacement of the tank. Facility operator's name and telephone number. Until clean-up is complete, Jamieson-Hill Company will submit reports to the local and state Permitting agencies every 3 months or at a more frequent interval specified by a responsible agency. SPILL CONTAINMENT AT TANK FILL RISERS: All underground storage tank. fill risers are equipped with a spill containment system which 5 surrounds the fill pipe. By opening the valve assembly, excess liquid is allowed to drain into the storage tank. ENVIRONMENTAL HEALTHERVI E DEPARTMENT IN-TANK LEVEL SENSOR LEAK RATE DETECTION RECORDING FORM Facility Name: Permit #: Date of Last Calibration: HM31 DATE OF TEST / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / TIME INIT. PASS (le~s than 0..Z ~ph) TANK LEAK RATE or FAIL (greater than NO. (GAL/HR) 0.2 gph) COMMENTS (8/27/91) VEEDER-ROOT SYSTEM OPERA~I~fNG INSTRUCTIONS Technical Manual Issued: 4/91 Supenm/~: 3/~I TLS-350 UST MONITORING SYSTE'M Manual Number 576013-610 VEEDER-ROOT ~ Environmental Products POWDER FORESr DR SiMSBURY CTO6070-2003USA 12031651-2700 TABLE OF CONTENTS SECTION 1. INTRODUCTION ................... 2 SECTION 2. PRODUCT DESCRIPTION A. Monitor Features ............................. 2 SECTION 3. BASIC OPERATING INFORMATION A. Operating Mode .............................. 4 !~ Setup Mode ................................. 4 C. Diagnostic Mode ............................. 4 D. Operating Mode Organization .................. 5 SECTION 4. HOW TO USE THE KEYBOARD A. General ..................................... 6 B. Operating Buttons ............................ 6 C. Alphanumeric Buttons ........................ 6 D. Operating Button Functions ................... 6 E. Alphanumeric Button Functions ................ 7 F. Special Function Button~ ...................... 7 Sys~Oper~'' .g Instructions ~ TLS-350 UST Monitoring System SECTION 5. HOW TO OPERATE THE TLS-350 A. How to View and Print Inventory, Delivery and Leak Test Data .............................. 8 B. How to View and Print Last-Shift Inventory Data. 10 C. How to View and Print Liquid Sensor Status ..... D. How to View and Print Vapor Sensor Status ...... 12 E. How to Start In-Tank Leak Tests ................ 13 F. How to Stop In-Tank Leak Tests ................ 14 G. How to Test Output Relays .................... 15 H. How to View and Print a Full Leak Test Report... 15 I. How to Print Alarm History Reports ............ 16 SECTION 6. WARNING AND ALARM MESSAGES AND WHAT THEY MEAN A. How the TLS-350 Detects Warning and Alarm Conditions .................................. 17 B. How to Recognize Warning and Alarm Conditions. 17 C. What to do When a Warning Alarm Occurs ....... 17 D. How to Shut Off Warning and Alarm Indicators... 17 E. Alarm Reports ........... ~ ................... 17 F. Warning and Alarm Messages .................. 18 SECTION 7. SECTION 8. HOW TO CHANGE THE PAPER ROLL 20 WARRANTY CONDITIONS AND LIMITATIONS OF LIABILITY ........ 21 WARNING: THIS EQUIPMENT GENERATES, USES, AND CAN RADIATE RADIO FREQUENCY ENERGY, AND IF NOT INSTALLED IN ACCORDANCE WITH THE TLS-350 "SITE PREPARATION AND INSTALLATION INSTRUCTIONS," MANUAL NO. 576013-622, AND USED IN ACCORDANCE WITH ~ INSTRUCTIONS FOUND IN THIS MANUAL, MAY CAUSE INTERFERENCE TO RADIO COMMUNICATIONS. IT HAS BEEN TESTED AND FOUND TO COMPLY WITH THE LIMITS FOR A CLASS A COMPUTING DEVICE PURSUANT TO SUBPART J OF PART 15 OF THE FCc RULES, WHICH ARE DESIGNED TO PROVIDE REASONABLE PROTECTION AGAINST SUCH INTERFERENCE WHEN OPERATED IN A COMMERCIAL ENVIRONMENT. OPERATION OF THIS EQUIPMENT IN A RESIDENTIAL AREA IS LIKELY TO CAUSE INTERFERENCE IN WHICH CASE THE USER AT HIS OWN EXPENSE WILL BE REQUIRED TO TAKE WHATEVER MEASURES WILL BE REQUIRED TO CORRECT THE INTERFERENCE. System Operating Instructs :. TLS-350 UST Monitoring System SECTION 1. INTRODUCTION IMPORTANT: This product will.be operated near the highly combustible environment of an underground fuel storage tank. Leaking underground tanks can create serious environ- mental and health hazards~ It is your responsibility to operate this product according to the instructions found in this manual. o This manual describes operating procedures for the TLS-350 UST Monitoring System designed and manufactured by the Veeder-Root Company, 125 Powder Forest Drive, Simsbury, CT 06070-2003. When a vertical bar ~ appears adjacent to text or illustrations, information has been added or revised in this printing. The instructions in this manual describe the procedures to operate all of the monitoring a/id control functions that can be installed in a TLS-350. The exact functions installed in the system you are operating were selected according to the monitoring and control requirements of your site. They can vary from system to system. IF SOME FUNCTIONS WERE NOT INSTALLED IN THIS SYSTEM, it will skip those functions during the operating process. In order to correctly and effectively operate this system, YOU MUST KNOW what inventory monitoring, leak detection, alarm and data communications functions have been installed. SECTION 2. PRODUCT DESCRIPTION The TLS-'350 is an advanced, fully-integrated UST Monitoring System that can provide complete inventory information on fuel stored in underground tanks and can warn of leaks from these tank~ A. MONITOR FEATURES Operation of the system is performed using buttons and the display on the TLS-350 monitor front panel (see Figure 1,"TLS-350 Front Panel Features"). Depending on the features your system is equipped with, you can read or print inventory data, review l?da~stto~Stinr..~l~Sl~ankdtS~stem status information, and start an p' - sts. The TLS-3~0 monitor includes the following features (see Figure 1, ' TLS-350 Front Panel Features"): · A two-line, 24-character-per-line liquid crystal display. · A 24-button keyboard with the operating and data entry functions used to display information, print reports and start and stop leak test~ · Three lamps to provide power-on, warning and alarm indications. · An audible warning and alarm indicator. · An optional printer to provide inventory, leak test, and alarm reports. 1. Monitoring Functions Monitoring functions such as inventory control, in-tank leak detection, interstitial leak sensing and vapor sensing are provided by in-tank probes, interstitial sensors located between the walls of double-wall tanks, sensors in the sumps of double-wall piping systems, and sensors in vapor and groundwater monitoring wells. The system you are operating may have a combination of these functions installed. 2. Input/Output Functions Input functions allow other devices or systems at your location to be connected to the TLS-350. Once connected, these other devices are able to use the alarm, reporting and communications functions installed in the monitor. Output functions are provided by relays installed in the system. They are able to trigger external alarm devices when an alarm condition is sensed by any of the monitoring functions installed in the TLS-350. 3. Communications Functions Communications functions may be installed in your system that allow it to transmit inventory, leak test and alarm information to a computer, point-of-sale terminal or printing device through a modem or directly over telephone line~ IMPORTANT:. Read the WARNING found on page I of ! this manual regarding the use of this product! ! OPTIONAL PRINTER STATUS OPERATING INDICATORS BUTTONS ALPHANUMERIC BUTTONS Figure 1. TLS-350 Front Panel Features. TWO-LINE, 24-CHARACTER- PER-LINE LIQUID CRYSTAL DISPLAY System Operating Instructs · TLS-350 UST Monitoring S-~tem SECTION 3. BASIC OPERATING INFORMATION The TLS-350 functions in three modes -- Operating. Setup and Diagnostic. A. OPERATING MODE The Operating Mode contains day-to-day functions that are essential to on-site operation of the system. Depending on the functions that have been installed in your system, you can view inventory information, check in-tank leak test results, manually Start and stop in-tank leak tests, print reports, and test the system's output relays. During normal operation, the display will show current date and time and a system status message. B. SETUP MODE The TLS-350 was programmed to operate according to the monitoring and leak detection requirements of this site using procedures in the Setup Mode. Unless functions are added to the system or application requirements change at the site, no changes should be made to setup parameters. IMPORTANT! Only qualified pemons following instructions outlined in the "TLS-350 System Setup Instructions," Manual No. 576013-623 should enter or revise setup parameters! C. DIAGNOSTIC MODE The Diagnostic Mode provides valuable system information that is helpful during system troubleshooting and repair In addition, an Alarm History Report and, if your system is equipped with in-tank probes to conduct in-tank leak tests, a full Leak Test Results report are available in the Diagnostic Mode. OPERATING MODE -In-Tank Inventory Data- (by Tank) !-Fuel Volume -Fuel Height __ -Water Height -Fuel Temperature e ~-Temperature- Compensated Fuel Volume -Last Inventory Increase Amount -Last In-Tank Leak Test Result []-Last-Shift Inventory - (by Tank) -Beginning Inventory -Ending Inventory -Gross Change  -Liquid Sensor Status-, (by Sensor) -Sensor Statds tSN°rmal Liquid Alarm ensor Out -Vapor (by Sensor) -Sensor Status fiN°rmal apor Alarm ater Alarm ensor Shod ensor Open Figure 2. Operating Mode Organization D. OPERATING MODE ORGANIZATION The Operating Mode has been organized to make accessing and printing data simple and logical (see Figure 2, "Operating Mode Organization"). In most cases, only a few keystrokes are required to perform a particular procedure. 1. Functions The Operating Mode is broken down into FUNCTIONS or general categories of information or procedures. There are seven FUNCTIONS: · In-Tank Inventory Data · Last-Shift Inventory Data · Liquid Sensor Status · Vapor Sensor Status · Start In-Tank Leak Test · Stop In-Tank Leak Test · Test Output Relays _~l~n O~f~ ting Instructions TLS-~. US~...~onitoring System The exact functions installed in the system you are operating were selected according to the monitoring and control requirements of your site. They can vary from system to system. IF SOME FUNCTIONS WERE NOT INSTALLED IN THIS SYSTEM, it will skip those functions during the operating proces~ In order to correctly and effectively operate this system, YOU MUST KNOW what inventory monitoring~ leak detection, alarm and data communications functions have been installed. Steps Within each FUNCTION are STEPS where particular types of information are accessed or procedures carried out. -Start In-Tank Leak Test~ ~-Test Method LAli Tanks Single Tank ~ -Test Control IsAII Tanks ~-Timed LManual Stop ingle Tank fTank # Timed Manual Stop -Test Duration(s) LAII Tanks ' Single Tank ~-Stad Leak Test ~] -Stop In-Tank Leak.Test ,, -Stop Method LAII Tanks Single Tank L-Tank #'s -Stop Leak Tests  -Test Output Relays (by Relay) -Activate Relay Output ~[] -De-Activate Relay Output System Operating Instructs TLS-350 UST Monitoring System SECTION 4. HOW TO USE THE KEYBOARD A. GENERAL The keyboard consists of 24 buttons arranged in two groupings. The functions of each button have been designed to make operation of the TLS-350 as simple as possible. B. OPERATING BIYlq~NS The twelve left-hand buttons are operating buttons that let you access and print data and start and stop leak tests. C. ALPHANUMERIC BUTTONS The twelve right-hand buttons provide alphanumeric functions and allow you to enter leak test start times and test lengths while in the operating'mode. When a numeric character only can be entered, as is the case in setting leak test start times and lengths, the buttons have only a numeric function. ALARM TEST MODE ! ACKUP TION · ~ ~r' ~ ~' · PRI~ CH~GE STEP PAPER E~ER TANK D. OPERATING BUT1Y)N FUNCTIONS 1. ALARM/TEST a. Shuts off audible alarm. Will not shut off display indicatom or disable alarm function. b. Used to activate and de-activate output relays when OUTPUT RELAY TEST function is used. MODE Select operating modes: Normal Mode, Setup Mode, Diagnostic Mode. If MODE is pressed while in a Function or Step, the system will automatically advance forward to the next Mode. 3. FUNCTION The FUNCTION button is used to scroll through and access functions within a MODE. If FUNCTION is pressed while in a Step, the system will advance to the next Function. 4. STEP Use the STEP button to move from one procedure to the next within a FUNCTION. 5. TANK/SENSOR The TANK/SENSOR button lets you advance by tank or sensor through setup procedures or displayed data. 6. CHANGE Used to enter data, revise existing data or change a selection. 7. ENTER ENTER completes a selection or enters data into a function. It is also used to start certain functions such as leak tests. 8. BACKUP BACKUP lets you move back through STEPS, FUNCTIONS and MODES to access data or entries you have already passed in the normal progression. It eliminates the need to move completely through a function or mode to access a step recently passed. BACKUP will move through the hierarchy of commands as follows: back through STEPS within a FUNCTION to that FUNCTION; then back through FUNCTIONS to MODE; then back through MODES. 9. PRINT Press PRINT to generate inventory, delivery, leak test, status, setup, diagnostic and alarm history reports. E. ALPHANUMERIC BUTTON FUNCTIONS Alphanumeric buttons provide the means to enter data into the system. When a numeric value is required for entry (i.e. leak test start time), the buttons provide only a numeric function. When an entry can accept either alpha or numeric characters (i.e. station headers), the buttons provide both functions. ~em ~ .rating Instructions ~ TI.~q~350 UST Monitoring System 1. Alphanumeric Entries Buttons 0 through 9 provide both alpha and numeric capability by activating each character shown on the button with successive pushes of the button. For example:  When either an alpha or numeric character may be entered, as in a station header, you press//2 button once to enter an "A." Push the button again to change the character to a"B," again to change to a "C" and again to enter a "2." When the correct selection is displayed, press the right-arrow ~ button to move the cursor to the next position and enter the required character as described. When all the characters have been entered, press ENTER. If an incorrect character is entred, you may use the arrow. buttons to move the cursor to that character, and enter the correct character. The period (.) is on button "1." The Zero button has a comma (,) plus two special characters that can be used in making alphanumeric entries. They are: [] = Space (no character) F. SPECIAL FUNCTION Bu'PrONS  The Right-Arrow [] button lets you advance the cursor to the right when making alphanumeric entries such as station headers and when selecting certain parameters such as module configurations. The step-by-step setup ' instructions will identify when this function should be used. The ® (decimal) is used in numeric entries as required. The Left-Arrow ~ button lets you move the cursor to the left when making alphanumeric entries. The +/- is used during setup to enter a plus or minus symbol with the Tank Tilt value. System Operating .Instruct_t~ TLS-350 UST Monitoring System SECTION 5. HOW TO OPERATE THE TLS-350 A. TO VIEW AND PRINT INVENTORY, DELIVERY AND LEAK TEST RESULT DATA IDATE TIME ALL FUNCTIONS NORMAL I lIN-TANK INVENTORY PRESS <STEP> TO CONTINUE I IT1: (Product VOLUME = ~((..i~S) I IT 1: (Product Name) HEIGHT = XX.XX (units) I IT 1: (Product Name) WATER = X.XX (units) I JT 1: (Product Name) TEMP = XX.X DEG (F or C) IT 1: (Product Name) ULLAGE = XXXXX (units) I IT 1: (Product Name) TC VOLUME = XXXXX (units) To view Fuel Volume for other tanks in the system. To view Fuel Height for other tanks in the system. To view Water Height for other tanks in the system. To view Fuel Temperature for other tanks in the system. To view Ullage for other tanks in the system. To view the Temperature-Compensated Volume for other tanks in the system. To pdnt a complete INVENTORY REPORT for all tanks in ~ system. <PRINT> may be pressed while the monih~ II displaying the status screen or while any inventory data foril~ tank is being viewed. TLS-350 .!. VEEDER-ROOT ..-, 125 POWDER FOREST DRIVE "' SIMSBURY, CT 06070 MAR 15, 1991 12:00 PM ALL FUNCTIONS NORMAL INVENTORY REPORT T I:REGULAR UNLEADED VOLUME = 3877 GALS ULLAGE = 6623 GALS 90% ULLAGE = 5573 GALS TC VOLUME = ~)01 GALS HEIGHT = 38.07 INCHES WATER : 0.00 INCHES TEMP = 50.0 DEG F T 2: SUPER UNLEADED VOLUME = 2803 ULLAGE : 7637 90Z ULLAGE = 6647 TC VOLUME = 2820 HEIGHT = WATER : TEMP GALS GALS GALS GALS ~ GALS ~= 2709 GALS .,,,-~m-'II~HT = Z).72 INCHES WATER = 0.00 INCHES TEMP = 50.00 DEG F T 7:SPECIAL UNLEADED VOLUME = 3595 GALS ULLAGE = 6905 GALS 90X ULLAI~ : 5855 GALS TC VOLUME = 3618 GALS HEIGHT = 35.'~) INCHES WATER = 0.00 INCHES TEMP = ~}.0 DEG F T 8:DIESEL VOLUME = 2635 GALS ULLAGE : 7365 GALS 30~ ULLAGE : 6365 GALS TC VOLUME = 2709 GALS HEIGHT = 23.72 INCHES WATER = 0.60 INCHES. TEMP : 50,0 DEG F I T 1: (Product Name) DELIVERY = XXXXX (units) I [~ .' IT 1:'(Product Name) LEAK RATE X.XX (Units)INR -<STEP> to Return to VOLUME OR Press < FUNCTION > to exit In-Tank Inventory. Sy~ O( ,ting Instructions TLS-3~J~ UST Monitoring System ~ To pdnt a complete Inventory Increase Report for the tank To view the Last Delivery Amount forshown. other tanks in the system. TLS-350 VEEDER-ROOT 125 POWDER FOREST DRIVE SIMSDURY, CT 06070 MAR 15, 1991 12:00 PM T I:REGULAR UNLEADED INVENTORY INCREASE INCREASE START MARCH 15, 1991 8:53 AM VOLUME = 2690 GALS WATER = O. O0 INCHES TEMP = 50.0 DEGF INCREASE END MARCH 15, 1991 9:00 AM VOLUME = 3877 GALS WATER = O. 00 INCHES TEMP = 50.0 DEG F GROSS INCREASE = 917 TC NET INCREASE= 922 · -- To print a Leak Test Report of the results from the last leak test To view the Leak Rate from last in-tank conducted in the tank shown. leak test for other tanks in the system. TLS-350 VEEDER-RODT 125 POWDER FOREST DRIVE SIMSBURY, CT 06070 MAR. 15, 1991 7:31 AM LEAK TEST REPORT T I:RECt~LAR UNLEADED TEST STARTING TIME MAR 15, 1991 12:00 AM TEST LENGTH 4 HOURS. STARTING TEMP = 50.0 F ENDING TEMP = 49.6 F LEAK TEST RESULTS 0.2 GAL/HR TEST PASS O. I GAL/HR TEST PASS System Operating Instruct~em (' TLS-350 UST Monitoring B. HOW TO VIEW AND PRINT LAST-SHIFT INVENTORY LASTSHIFT INVENTORY PRESS <STEP> TO CONTINUE I IT 1: (Product Name) [,END INVENTORY 'T 1: (Product Name) GROSS CHANGE: XXXXX ~-.~ ~. -<STEP> fo Return to BEGIN INVENTORY. OR < FUNCTION > to exit Last-Shift Inventory. To view the Last-Shift Beginning Inventory for other tanks in the system. · -- To view the Last-Shift Ending Inventory for other tanks in the system. r TO view the Last-Shift Inventory Gross Change for other tanks in the system. -~ To print a Last-Shift Inventory Report for the Last three shifts of all tanks. SHIFT STARTING INVENTORY II4RCH 15, 1991 .8:00 MI r 1: REGULAR UNLEADED VOLUME = .3877 GALS ULLAGE = 6623 GALS 907. ULLAGE = 5573 GALS TC VOLUNE = :)901 GALS HEIGHT = 30.07 INCHES WATER = 1.1 INCHES TE]'IP = 50.0 DEG F SHIFT ENDING INVENTORY MARCH 15, 1991 4:00 PM TVOi~: Ru~EGULAR' ~ INVENTORY ' HARCH 15, 1991 4:00 PM T 8: DIEGEt. VOLUIdE = 828 GALS ULLAGE = 9172 C.~J_S 907. ULLAGE = B172 GALS TC VOLUME = 851 GAI_S HEIGHT = 13,19 INCHES WATER = 2, ! INCHES TEHP = 50,0 DEG F GROSS CHANGE : -1807 TC NET CHANGE : . -1858 ~ To print a Last-Shift Inventory report for the tank shown. !FT STARTING INVENtoRY------ 15, l~l 8:00 AM 1: REP:t~AR UNLEADED VOL~ = ~77 GALS ULLAGE = 6623 GALS 907. ULLAGE = 5573 GALS I = 30.07 INCHES WATER = l. 1 INCHES TEMP = 50.0 DEG F SHIFT ENDING INVENTORY MARCH 15, 1991 4:00 PM T 1: REGULAR UNLEADED VOLUME- = 3595 GALS ULLAC-E = 6905 GALS 907. ULLAGE = 5855 GALS TC VOLUI, E = 3618 GALS HEIGHT = 35.99 INCHES WATER = 1.1 INCHES TEMP = 50.0 DEG F GROSS CHANGE = -282 TC NET CHANGE = -283 C. HOW TO VIEW AND PRINT LIQUID SENSOR STATUS IUQUID SENSOR STATUS PRESS <STEP> TO CONTINUE (Status Indicator) ~---To view Liquid Sensor Status for other sensors in the system. ~t.e~(~'' ~erating Instructions T~50 b ~T Monitoring System ~'- T° print a complete LIQUID SENSOR STATUS REPORT for all. sensors in the system. Or press < PRINT> while the status for any sensor is displayed to generate the same report. --- LIQUID SENSOR --- STATUS REPORT MAR 15, 1991 7:56 AM L I:TANK 1 SENSOR NORMAL L 2: SUMP 2 LIOUID ALARM L 2:TANK 2 _~ OPEN ALARH ~ L 4: ~UMP~~'~ For up to ~ Senso~ 1. Description of Liquid Sensor Status Indicators STATUS INDICATOR SENSOR NORMAL UQUID ALARM OPEN ALARM CAUSE The sensor is functioning properly and no alarm conditions exist. Liquid is present in the area being monitored by the sensor. The sensor has been disconnected or is not functioning properly. Liquid Sensor Setup was performed incorrectly. ACTION None. Immediately follow the alarm reporting procedures established for your site. Sensor problem must be corrected or sensor replaced. Call for service by following the procedures established for your site. Have a qualified person, following the instructions outlined in the TLS-350 "System Setup Instructions," Manual No. 576013-623, correct the Liquid Sensor setup parameters. 11 System Operating Instru~s TLS-350 UST Monitoring System D. HOW TO VIEW AND PRINT VAPOR SENSOR STATUS I PRESS <STEP> TO CONTINUE Ii ' r~, VAPOR SENSOR STATUS I IV/f: (Location) (Status Indicator) ~-To view Vapor Sensor Status for other sensors in the system. To print a complete VAPOR SENSOR STATUS REPORT ~ al sensors in the system. Or press < PRINT > while the status for any sensor is displayed to generate the same report. --- VAPOR SENSOR .... STATUS REPORT MAR 15, 1731 7:59 AM V 1: WELL 1 SENSOR NORMAL V 2:W£LL 2 FUEL ALARM V 3:WELL 3 WATER ALARM V 4:WELL 4 OPEN ALARM' V 5:WELL 5 ~ For up to 40 Sensors 1. Description of Vapor Sensor Status Indicators a~AlUS INDIChJOH CA(JSE ACTION SENSOR NORMAL The sensor is functioning properly and no alarm conditions exist. None. FUEL ALARM Vapor levels present in the observation well exceed the Vapor AlarmImmediately follow the alarm reporting Threshold established for that well. procedures established for your site. WATER ALARM The sensor is immersed in water and is unable to detect fuel vapors. Call for service following the procedures established for your site. OPEN ALARM The sensor has been disconnected or is not functioning properly. Sensor problem must be corrected or sensor replaced. Call for service by following the ~rocedures established for your site. Vapor Sensor Setup was performed incorrectly. Have a qualified person, following the instructions outlined in the TLS-350 "System Setup Instructions," Manual No. 576013-623, correct the Vapor Sensor setup parameters. SHORT ALARM An internal short has occurred in the sensor. Call for service following the procedures established for your site. S~n Op~ ing Instructions TLS-3*JO UST'Monitoring System E. HOW TO START IN-TANK LEAK TESTS ISTART IN-TANK LEAK TEST PRESS < STEP > TO CONTINUE I START LEAK TEST METHOD ALL TANKS I JTEST CONTROL: ALL TANKS TIMED DURATION SINGLE TANK [] ~ MANUAL STOP [] MANUAL STOP PRESS <STEP> TO CONTINUE DURATION: XX I ~ Enter Test Duration [] PRESS <STEP> TO CONTINUE I START LEAK TEST: ALL TANKS I PRESS < ENTER > , I PRESS < STEP > TO CONTINUE PRESS <FUN~ION> TO CONI I SINGLE TANK I PRESS <STEP> TO CONTINUE I -~ TIMED DURATION TEST CONTROL: TANK (#) JI rLP~Jl MANUAL STOP ITEST DURATION: TANK DURATION: XX I Enter Test Duration [] DURATION: (Time) PRESS < STEP >TO CONTINUE I START LEAK TEST: TANK (#) PRESS <ENTER> I JTEST CONTROL: TANK (#) IN PROGRESS PRESS <TANK> If all selected tank tests have been programmed and started, press < FUNCTION > to exit the "Start In-Tank Leak Test" function. If additional in-tank tests must be programmed, press <TANK> to return to the "TEST CONTROL" screen for the next tank. To select Tank #. MANUAL STOP PRESS <STEP> TO CONTINUE 13 System Operating InstructiO TLS-350 UST Monitoring SysTem F. HOW TO STOP IN-TANK LEAK TESTS STOP IN-TANK LEAK TEST PRESS < STEP> TO CONTINUE i lSTOP LEAK TEST METHOD ALL TANKS I STOP LEAK TEST: ALL TANKS PRESS < ENTER > I lb'TOP IN-TANK LEAK TEST PRESS <STEP> TO CONTINUE ILEAK TEST NOT ACTIVE PRESS < FUNCTION > TO CONT 14. ~iSINGLE TANK PRESS <STEP> TO CONTINUE I ISTOP IN-TANK LEAK TEST:. TANK PRESS < ENTER > I (Stops test and advances to next tank in test) STOP IN-TANK LEAK TEST: TANK (#) PRESS < ENTER > I ISTOP IN-TANK LEAK TEST PRESS < STEP> TO CONTINUE I PRESS <FUNCTION> TO CONT I -~)'lf the desired tank tests have been stopped and others am to ~nue. p~e~ < FUNCTION> to exit "Stop In-Tank Leak Test" function. DO NOT PRESS < ENTER > until correct Tank//is selected using <TANK> button! If all active leak tests have been stopped individually, the system will retum to the STOP IN-TANK LEAK TEST screen. G. HOW TO TEST OUTPUT RELAYS ITEST OUTPUT RELAYS PRESS <STEP> TO CONTINUE ENTER RELAY NUMBER: (E!ter Relay Number) IR 1: NAME , PUSH ALARM/TEST KEY JoRI: NAME N- PRESS ANY KEY (Repeat procedure for additional Relays.) OR Press < FUNCTION > to exit "Test Output Relay" Function. S~m C~'~ ~ting Instructions TLS~J~0 UST Monitoring System H. HOW TO VIEW OR PRINT A FULL LEAK TEST RESULT REPORT IpDIAGNOSTIC MODE RESS < FUNCTION> TO CONT I [] ... JN'TANK LEAK RESULT RESS <STEP> TO CONTINUE To pdnt a Complete IN-TANK LEAK RESULT report for the last leak test for each tank in the system. Or, press < PRINT > while the leak results for any tank is displayed to generate the same report. LEAK TEST REPORT T !: REGULAR UNLEADED TEST STARTING TIME MAR 15, 1991 9:00 PM TEST LENGTH 8 HOURS STARTING TEMP = 50.0 F ENDING TEMP = 50.0 F LEAK TEST RESULTS STARTING VOLUME= 3595 TEST HOIJRS 1-7 0.00 0.00 0.00 0.00 0.00 0,00 0.00 LEAK RATE = 0.00 GAL/HR 0.2 GAL/HR TEST PASS O. l GAL/HR TEST PASS T 1: (Product Label) (Last Test Date & Time) LEAK TEST REPORT r 2:SUPER UNLEADED TEST STARTING TIME MAR 15, 1991 9:00 PM TEST LENGTH 8 ~'~ STARTING TEl'lPg,"" ENDING LEAJ(,~" I For up to eigM Tanks To view the Test Date and Time of the last test for other tanks in the system. T 1:(Product Label LEAK RATE: X.XX To exit"In-Tank Leak Result" function, OR [] To exit Diagnostic Mode. .To view the last Leak Test Results for other tanks in the system. 15 System Operating Instructic~ f .... TLS-350 UST Monitoring Sys~gm 1. HOW TO PRINT ALARM HISTORY REPORTS Alarm History Reports are available from the TLS-350's integral printer or through the RS-232 interface. They provide you with a record of the last three occurrences of.e. ach tvoe of alarm or warning condition detected by the system. Alarm histories are kept for the system and for each in-tank probe, sensor and input connected to the system. The types of alarm histories available are shown in the procedures diagram below. In-tank, sensor and external input alarm histories must be called up and printed .bY tank, sensor or input number using the <TANK > button. ' DIAGNOSTIC MODE PRESS < FUNCTION > TO CONT I [] ... ALARM HISTORY REPORT ~--[] ,P~ESS <STEP> TO CONTINUE iSYSTEMALARM HISTORY ,PRESS <PRINT> FOR REPORT ~" I IT1: ALARM HISTORY PRESS < PRINT> FOR REPORT ~" J L 1: ALARM HISTORY [PRESS < PRINT> FOR REPORT ~- I JpV1: ALARM HISTORY RESS < PRJNT> FOR REPORT ~[~ l .; [PRESS < PRINT> FOR REPORT [] To return to "System Alarm History" To return to Operating Mode Current System Status Report System Alarm History Report · Battery is Off · Pdnter Error · Paper Out · Too Many Tanks In-Tank Alarm History Report for Tank shown: · Setup Data Warning · Leak Alarm · High Water Narm · Overfill Alarm · Low Limit Alarm · Theft'Alarm · High Limit Alarm · Invalid Fuel Level Alarm Liquid Sensor Alarm History Report for Sensor shown: · Setup Data Warning · Liquid Alarm · Open Alarm Vapor Sensor Alarm History Report for Sensor shown: · Setup Data Warning · Fuel Alarm · Water Alarm · Open Alarm · Short Alarm External Input History Report · Setup Data Warning · Generator On · External Input Closed To access other Tanks in the system. Press <PRINT> for Alarm History Reports. To access other Liquid Sensors in the system. Press < PRINT> for Alarm History Reports. To access other Vapor sensors in the system. Press < PRINT> for Alarm Histo~j Reports. To access other External Inputs in the system. Press < PRINT> for a History Report. Syrian 01(-" ting Instructions TLS _]~[~ US~ ,donitoring System SECTION 6. WARNING AND ALARM MESSAGES AND WHAT THEY MEAN A. HOW THE TLS-350 DETECTS WARNING AND ALARM CONDITIONS The TLS-350 constantly monitors its entire system for warning and alarm conditions including fuel leaks, inventory limit excesses and equipment problems. During normal operation when the system is functioning properly and no warning or alarm conditions exist, the' 'ALL FUNCTIONS NORMAU' message will appear in the system status (bottom) line of the display. If a warning or alarm condition is present, the type and location (tank or sensor number) of the warning or alarm will be indicated by a message on the system status line. If more than one condition exists, the display will alternately flash the appropriate System Status Messages. B. HOW TO RECOGNIZE WARNING AND ALARM CONDITIONS Warning and alarm conditions detected while the TLS-350 is in its normal operating mode are indicated by a combination of an audible beep, warning and alarm lights on the front panel and a message on the display. Display messages will tell you the location and type of warning or alarm. For example, this display with the second line flashing: MARCH 15, 1991 3:00 P.M. I T 3: LOW UMIT ALARM [ indicates that fuel level in Tank//3 has dropped below its Low Level Limit. Abbreviations used to identify the location of a warning or alarm are: T#: "Tank" followed by its number. L#: "Liquid Sensor" followed by its number. Vi: "Vapor Sensor" followed by its number. I#: "External Input" followed by its number. The chart in Section 6.E provides an e~planation of each warning or alarm you can encounter during normal operation. C. WHAT TO DO WHEN A WARNING OR ALARM OCCURS Specific response instructions for each type of warning or alarm condition should be established and clearly posted by the person responsible for your site. BE SURE YOU ARE FAMILIAR WITH THE WARNING AND ALARM RESPONSE PROCEDURES ESTABLISHED FOR YOUR SITE! D. HOW TO SHUT OFF WARNING AND ALARM INDICATORS 1. Audible Alarm Push the ALARM/TEST button to silence the audible alarm. Red Alarm and Yellow Warning Lights Warning and Alarm lights cannot be turned off until the cause of the warning or alarm has been corrected. Once the warning or alarm condition is eliminated, the lights(s) will shut off automatically. Warning and Alarm Display Messages Display Warning and Alarm Messages will appear on the display until the cause of the message(s) has been eliminated. When the cause(s) of the message(s) is eliminated, the' 'AT.I. FUNCTIONS NORMAL" message will appear on the display. E. ALARM REPORTS TLS-350 monitom equipped with a printer will generate an alarm report when a warning or alarm condition is detected. This report will show the type and location of the warning or alarm and the date and time it occurred. VAPOR ALARM SENSOR NUMBER 2 FUEL ALARM WELL 2 MAR 15, 1991 2:01 AM 17 System Operating Instruct~ TLS-350 UST Monitoring S~-'~em F. WARNING AND ALARM MESSAGES SYSTEM STATUS MESSAGES DISPLAY MESSAGE ALL FUNCTIONS NORMAL SETUP DATA WARNING PAPER OUT PRINTER ERROR AUDIBLE/VISUAL INDICATORS None Audible beep. Yellow flashing light. Audible be .cp. Yellow flashing light. Audible beep. Yellow flashing beep. CAUSE System functioning properly. No alarm conditions exist. System setup problem has been detected. Paper roll is empty. Replace with Veeder-Root paper roll, P/N 514100-328. Printer feed roller release is open. Push the release lever (located under the lower right- hand corner of the printer cover) up to the closed position. OR The printer temperature thermistor has failed and service is required. IN-TANK WARNING AND ALARM MESSAGES DISPLAY MESSAGE HIGH WATER ALARM OVERFILL ALARM HIGH LEVEL ALARM LOW LIMIT ALARM LEAK ALARM INVALID FUEL LEVEL (In only systems equipped with Magnetostrictive probes) AUDIBLEMSUAL INDICATORS Audible beep. Yellow flashing, light. Audible beep. Red flashing light. Audible beep. Red flashing light. Audible beep. Yellow flashing light. Audible beep. Red flashing light. Audible beep. Red flashing light. Audible beep. Yellow flashing beep. CAUSE Water collecting in the bottom of the tank has exceeded the programmed High Water Limit. Fuel level in a tank has exceeded the programmed Overfill Alarm Limit during a bulk delivery. Fuel level in a tank has exceeded the programmed High Level Limit. Fuel level in a tank has dropped below the programmed Low Level Limit. Temperature-compensated cumulative product loss has exceeded the programmed Leak Alarm Limit during a leak test. Cumulative product .loss has exceeded the programmed Theft Alarm Limit during a leak test. The fuel and water measurement floats on a Magnetostrictive probe are too close together due to an insufficient amount of fuel in the tank. While this warning condition exists in a tank, fuel height and volume readings and delivery reports are considered to be invalid until enough fuel has been added to the tank to eliminate the warning condition! SysOOpef ag Instructions TLS-35'WUST Monitoring System LIQUID SENSOR WARNING AND ALARM MESSAGES LIQUID ALARM OPEN ALARM DISPLAY MESSAGE AUDIBLE/VISUAL INDICATORS Audible beep. Red flashing light. Audible beep. Red flashing light. CAUSE An interstitial or piping sump liquid sensor has detected the presence of liquid in a tank's interstitial space or piping sump. A sensor has been disconnected or is not functioning properly. VAPOR SENSOR WARNING AND ALARM MESSAGES DISPLAY MESSAGE FUEL ALARM WATER ALARM OPEN ALARM SHORT ALARM AUDIBLE/VISUAL INDICATORS Audible beep. Red flashing light. Audible beep. Yellow flashing light. Audible beep. Yellow flashing light. Audible beep. Yellow flashing light. CAUSE A vapor sensor in an observation well has detected fuel vapor levels that exceed the Vapor Alarm Threshold set for that well. A vapor sensor is immersed in water and incapable of detecting fuel vapors, A vapor sensor is disconnected or is not functioning properly. An internal short has occurred in a vapor sensor. EXTERNAL INPUT MESSAGES DISPLAY MESSAGE EXTERNAL INPUT cLOsED GENERATOR ON (In emergency generator applications only) AUDIBLE/VISUAL INDICATORS None. None. CAUSE A signal is being received from an external device which is wired to the TLS-350's external input interface. A generator whose tank(s) is being monitored by the TLS-350 has turned on. Simulta- neously, the continuous in-tank leak test for that generator fuel tank(s) has ended. When the generator shuts off, a new continuous in- tank leak test will begin automatically. 19 System Operating lnstructi, TLS-350 UST Monitoring System SECTION 7. HOW TO CHANGE THE PAPER ROLL CAUTION: REGULATORY COMPLIANCE AND BUSINESS DOCUMENTATION INCLUDING IMPORTANT INVENTORY, ALARM AND LEAK TEST REPORTS MAY BE STORED ON THE PAPER TAKE-UP SPOOL. DO NOT DISCARD THE PAPER ON THE TAKE-UP SPOOL UNLESS INSTRUCTED TO DO SO! Note: It is NOT necessary to open the printer compartment door to change the paper roll. The TLS-350 uses 2 ~A-inch thermal paper designed for high- speed thermal printers. To order from Veeder-Root, specify: P/N 514100-328, TLS-350 Printer Paper-- Three-Roll Package. To change the paper roll: A. Raise the Printer roll cover. B. Push the paper feed roller release lever down. C. If the .~hke-Up Spool is being used, pull it out of its slot. and separate its two halves by grasping the flanged edge~ and pulling outward. SAVE THE PAPER ACCUMUIATED ON THE SPOOL UNLESS OTHERWISE INSTRUCTED. D. Remove the empty core and switch the roll shaft to the new roll. E. Insert the new roll into slots with the paper tail coming out from under the lower side of the roll. F. Feed the paper taft over the large roller and under the small .feed roller until it Protrudes from the bottom. Pull several roches of paper through the feed roller, then push u th release lever The printer will automaticall adv P ~e paper slightly and Y ance thc a "PRINTER ERROR" message will be printed indicating that the release lever had been opened. G. If the Take-Up Spool is being used, separate its halves and place the paper tail between the shaft halves. Snap the spool halves together to clamp the paper tail in place. Tear off any excess paper from the tail. H. Insert the Take-Up Spool into its slots, and close the printer cover Press the Paper Feed button several times to be sure the paper roll and Take-Up Spool are installed and functioning Properly. ,_,perating Instructions TLS-350 UST Monitoring System SECTION 8. WARRANTY CONDITIONS AND LIMITATIONS OF LIABILITY A. LIMITATIONS OF LIABILITY. We warrant that this including warranties of ME~ILITY and F1TNESS product will be free from defects in material and workmanship for a period of one (1) year from the date of installation or fifteen (15) months from the date of invoice, whichever occurs £w~t. During the warranty period, we or our representative, will repair or replace the product, if determined by us to be defective, at the location where the product is in use and at no charge to the purchaser. We shall not be responsible for any expenses incurred by the user. This warranty applies only when the product is installed in accordance with Veeder-Root's specifications, and a Warranty Registration and Checkout Form has been ~ed with Veeder-Root by an Authorized Veeder-Root Distributor. This warranty will not apply to any product which has been subjected to misuse, negligence or accident; or misapplied; or used in violation of product manuals, instructions or warnings; or modifed or repaired by unauthorized persons; or improperly installed. B. INSPECTION. You shall inspect the product promptly after receipt and shall notify us at our Simsbury office in writing of any clain~ including claims of breach of warranty, within thirty days after you discover or should have discovered the facts upon which the claim is based. Your failure to give written notice of a claim within the time period shall be deemed to be a waiver of such claim. C. LIMITATION OF REMEDY. AND WARRANTY. The provisions of Paragraph A are our sole obligation and exclude all other remedies or warranties, express or implied, FOR A PARTICULAR PURPOSE, whether or not purposes or specifications are described herein. We further disclaim any responsibility whatsoever to you or to any other person for injury to person or damage to or ions of property or value caused by any product which has been subjected to misuse, negligence, or accident; or miSapplied; or used in violation of product manuals, instructions or warnings; or modified or repaired by unauthorized persons; or improperly installed. D. LIMITATION OF DAMAGE~ Under no circumstances shall we be liable for any incidental, consequential or specific damages, losses or expenses arising from this contract or its performance or in connection with the use of, or inability to use, our product for any purpose whatsoever. E. LIMITATION OF ACTION,% No action regardless of form arising out of this contract may be commenced more than one year after the cause of action has accrued, except an action for nonpayment. F. COLLATERAL PROMISES. There are no representations, warranties, or conditions, express or implied, statutory or otherwise except those herein contained, and no agreement or waivers collateral hereto shall be binding on either party unless in writing and signed by you and accepted by us at our Simsbury office. G. INTERPRETATION. Rights and liabilities arising out of any contract with us shall be determined under the Uniform Commercial Code as enacted in Connecticut. Warranty revised March 21, 1991 21 ENVIRONMENTAL HEALTH STEVE McCALLEY, R.E.H.S. DIRECTOR SERVIC' I DEPARTMENT 2700 "M" Street, Suite 300 Bakersfield, CA 93301 {805) 861-3636 (805) 861-3429 FAX Jaco Oil Company P.O. Box 1807 Bakersfield, CA 93308 March 8, 1993 Dear Sir: INSTALI.ATION OF THREE UNDERGROUND STORAGE TANKS LOCATED ON THE S.E. CORNER OF ROSEDALE HWY. AND ALLEN ROAD. FACILITY #380037 The Kern County EnVironmental Health Services Department has received an application for the installation of three (3) underground storage tanks at the facility cited above. The application has been given to a hazardous materials specialist to process. An installation permit will be issued with an inspection card which will summarize the three to four inspections required before the site can be approved for operation. Current requirements specify that the owner or the operator certify that the underground storage tanks and piping have been installed properly. The owner must also apply for a permit to operate before the facility will be given the approval to operate. All forms required by the owner or his agent are included within this packet. P/ease ensure that you have received the following forms: 1. an application for a permit to operate 2. a certificati°n of compliance form for installation of each underground storage tank 3. a certification of financial responsfbility Please complete all forms and return them to me either on or shortly after the program's final installation inspection. If you have any questions, please feel free to call me at (805) 861-3636. LF:ch Enclosures funk~jaco, let Sincerely, Steve McCalley, Director By: Laurel Funk Hazardous Materials Specialist Hazardous Materials Management Program ENVIRONMENTAL HEALTH DEPARTMENT 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 IPERHIT NO. ~ ~ APN U a'ER APPLICATION DATE APPLICATION FOR P~RMIT TO CONSTRUCT/MODIFY ~D~RGROUN~ HAZARDOUS SUBSTANCES STORAGE FACILITY TYpp"Of Apulication (check): .(~New Facility ( )Modification of Facility ( )New Tank Installation at Existing Facility Number of Tanks To Be Installed Type of Business ~o~g~%~C~ Facility Name F~4~-% T R SEC (Rural Locations Only) Nearest Cross Streec~%~ Bo Tank Owner Address ~. Phone i}: ~c~-~.~ OO 0 City/State -~~ , ~ Zip ~%'~0 ~ Co Water TO Facility Provided By VA~~ ~~- Depth To Groundwater~O~ Soil Characteristics At Facility~,4c~. D. Contractor ~)~O 0:\ ~.~-~ CA Contractor's License No.O~--~ /~ Address ~.O. ~_%.~ t~O~ ' City~~~ Zip~%~ Phone ~'~'~ Worker's Compensation Certification ~ Insurer Proposed Starting Date Proposed Completion Date Eo If This Application Is For Modification Of An Existing Tank System, Briefly Describe Modifications Proposed (Excluding New Tank Installation at Existing Facilities) F. Tank(s) Storame (Check All That A~): (Ifm - Complete Section G) Other" Other" (x~ (~) ( ) ( ) ( ) ( ) ( ) ( ) ~- (X) ( ) X~' ( ) ( ) ( ) ( ) ( ) ( ) ~ ~ ~ (x) .~)~ ( ) ( ) ( ) ( ) ~- () () () () () Tank Go Chemical Composition Of Materials Stored (For Products Or Waste Marked With ~) Tank ;} Chemical Stored (noB-commercial name) CAS ~ (if known) Chemical Previously Stored (if different) This form has been completed under penalty of perjury and to the best of my knowledge is true and corr~Z~.' ~/.~ Permit # H. 1, o e o o 10. 11. .HM21 Tank is: TANK INFORMATION FORM ~ OUT SEPARATE FORM FOR EACH FOR EACH SECTION, CHECK ALL APPROPRIATE BOXEa ( ) Vaulted (X) Jacketed .Tank Material ( ) Carbon Steel ( ) Stainless Steel ( ) Concrete ( ) Unknown Primary Containment Date Installed Thickness (Inches) Tank Secondary Containment (~ Double-Wall ( ) Synthetic Liner () () Tank Interior Linir~q (3<;) Unlined ( ) Unknown Tank Corrosiotn Protection ( ) Galvanized (Y0 ( ) Tar or Asphalt ( ) Content~ (. ~ Double-Wall ( ) Single-Wall ( ) Fiberglass-Reinforced Plastic ~ Fiberglass-Clad Steel ( ) Other (Describe). Capacity (Gallons) Manufacturer . IZ, ooo 3o°.- ( ) Lined Vault ( ) None ( ) Unknown Manufacturer:. ~Oor" ~',~o~--o~, Other (describe): ~ ,, Material ~l.~,-.~-.~~~Thickness (Inches) I oo ~-i[~ Capacity (Gallons) ( ) Lined (describe) Cathodic Protection: (X) None ( ) Impressed Current System ( Describe System and Equipment: Leak Detection, Monitorinq, and Interceptiorl * (Must be described below) a. Tank: b. Piping: Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) Unknown ( ) None ( ) Other (describe): ) Sacrificial Anode System ( ) Vapor Detector * ( ) Uquid Level Sensor * ( ) Conductivity Sensor * ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring (~.) Sensor in Annular Space ( ) Vapor ~) Liquid ( ) Pressure ( ) Other ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation ( ) Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model: P,.~,,,,~, X"I ~ L~Jc_.. ()~ Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway (/~) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Haft-Cut Compatible Pipe Raceway ~ Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other *Describe Make &'Model: ~.~ ~..~- L~,,~cT I.~.~.¥_ '~.~_~I~,~ Tank Ti.qhtnees Has This Tank Been Tightness Tested? Date of Last Tightness Test Test Name Tank Repair ( ) Yes Date(s) of Repair(s) ( ) Yes (x;) No Results of Test Testing Company (X) No . ( ) Unknown ( ) Unknown Describe Repairs Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ( ) Float Vent Valves ( ) Capacitance Sensor (pO S~.Jed Fill Box ( ) List Make & Model for all Devices I~..~ *Describe other Protection System Piping bo Co Auto Shut-Off Controls None [=,( ) Unknown ( ) Other * Underground Piping: (X') Yes () No Thickness (inches) Diameter ~.." Type of piping System (X) Pressure ( ) Suction ( ) Gravity Underground Piping Corrosion Protection: ( ) Unknown Material ~ ~'~~ '-~[~.~,~ ~ Manufacturer /3~.~rz_~ f,~ Approximate Length of this Pipe Run ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar__or ~sphalt ( ) Unknown ( ) None (~) Other (describe): ,C"~p Underground Piping, Secondary Containment: () Double-Wall (X) Synthetic Liner System () None _() Unknown -'-_ ( ) Make & Model (describe): ~/,~." ~ I;::)~" "t"~,,~,.,wL L,.r.,~,~"~._. Permit # H. 1. ~M21 o e Be ge Tank is: ( TANK INFORMATION FORM l. ContentsL),~'l<.~,l 4- OUT SEPARATE FORM FOR EACI~:JI~NK) Tank # "z.. FOR EACH SECTION. CHECK ALL APPR~)PRIATE BOXES ) Vaulted (vY) Jacketed ( Double-Wall ( ) Single-Wail ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic ( ) Unknown ( ) Other (Describe) Thickness (Inches) Tank Material ( ) Carbon Steel ( ) Concrete Primary Containment Date Installed Tarlk Secorldary containment Fiberglass-Clad Ste Capacity (Gallons) Manufacturer () () Tank Interior IJninq (~) Unlined ( ) Unknown Tank Corrosion Protection () Galvanized ( ) Tar or Asphalt ( ) Cathodic Protection; Descdbe System and Equipment: Double-Wail () Synthetic Liner () Lined Vault () None () Unknown Other (describe): ~ ~., Manufacturer:. ~C)Ot"ti oA-~_o~-~ Matedai ~', ~ (l~LY'(,J~Thickness (Inches) t (DO -.,-,~ ~ Capacity (Gallons) ( ) Lined (describe), Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) Unknown () None () Other (describe): None ( ) Impressed Current System ( ) Sacrificiai Anode System Leak Detection, Monitorinq, and Interceptiorl * (Must be dascdbed below) a. Tank: ( ) Vapor Detector * ( ) Uquid Level Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visuai Inspection (Vaulted tanks only) ( ) Groundwater Monitoring (~) Sensor in Annular Space ( ) Vapor Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation ( ) Pedodic Tightness Testing ( ) None ( ) Unknown ( ) Other · Describe Make & Model: ~6,.w=~A b. Piping: (~ Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Seaied Concrete Raceway 00 Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway (~ Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other · Describe Make &'Model: ~..~ ( ) Unknown Tank Tiqhtness Has This Tank Been Tightness Tested? ( ) Yes (~ No Date of Le~ Tightness Test Results of Test Test Name Testing Company Tank Repair ( ) Yes ('X) No ( )Unknown Date(s) of Repair(s) Describe Repairs 10. 11. Overfill Protection (Must descdbe below) ( ) Operator Fills, Controls, & Visuaily Monitors Level ( ) Tape Float Gauge ( ) Float Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor (X) Sealed Fill Box ( ) None ( ) Unknown ( ) List Make & Model for all Devices '~o~,~..o t~A~,e[ ;L~.'I.- - ~'~ *Describe other Protection System Pipinq Co de ( ) Other Underground Piping: ('X) Yes () No Thickness (inches) Diameter ;;;z, ~ Type of piping System (X) Pressure ( ) Suction ( ) Gravity Underground Piping Corrosion Protection: ( ) Unknown Material ['~"-I~)t_--~.. ~'>~O~..~,D ~'~- Manufacturer /:3,~ ~_~)~.i Approximate Length of this Pipe Run ~0 ~ ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) SaCrificial Anode ( ) Polyethylene Wrap ( ) Electdcai Isolation ( ) Vinyl Wrap _() Tar or Asphalt ( ) Unknown ( ) None ('X) Other (describe):[~i~P ~[=,, ~ (2' Underground Piping, Secondary Containment: ( ) Double-Wail (~ Synthetic Liner System ( ) None ( ) Unknown ( ) Make & Model (describe): v~.,~ 'I~I~P~ "['~.~ .H Permit # Ho 1, 10. 11. ~ is: ( ( ) Carbon Steel ( ) Stainless Steel ( ) Concrete ( ) Unknown Primary Containment Date Installed Thickness (inches) TANK INFORMATION FORM ,,LL OUT SEPARATE FOR EACH SECTION ) Vaulted (~) Jacketed Contents~ Tank ,! Double-Wall ( ) Single-Wall Fiberglass-Reinforced Plastic 0~, Fibergless. Clad ste Other (Describe) CapaCity (Gallons) Manufacturer Tank Secorldan/Containmefi~ (~ Double-Wall () Synthetic Liner ( ) Other (desoribe): ( ) Lined Vault ( ) None () Unknown ( ) Matedai ~,t<~.~'~_,_._~j.,<{;~.__~Thickness Manufacturer:. ,.~o~. C__ ~ (inches) ~ Capacity (Gallons) Tank Interior Unil~_q (,,~r Unlined ( ) Unknown ( ) Lined (describe) T~ank Corrosion Protectior] - () Galvanized ~) Fiberglass-Clad () Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): C_athedic Protection~ C~ None ( ) Impressed Current System ( ) Sacrificial Anode System - Descdbe System and Equipment: Leak Detectio Monitodn and Interce rio * (Must be described below) a. Tank: ( ) Vapor Detector * ( ) Liquid Level Sensor * ( ) Conductivity Sensor - ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring 04) Sensor in Annular Space ( ) Vapor (X) Liquid ( ) Pressure ( ) Other * ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Dally Gauging & Inventory Reconciliation ( ) Pedodic Tightness Testing ( ) None ( ) Unknown' ( ) Other · Describe Make & Model: ~~~~=~ b. Piping: (X) Flow-Restricting Leak Detector(s) for Pressurized Piping= ( ) Sealed Concrete Raceway (X) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway (x') Synthetic Liner Raceway () Unknown () Other () None T_.[Q~f._j~_q_~ *Describe Make & ~lodel; Has This Tank Been Tightness Tested? ( ) Yes Date of Last Tightness Test (X~ No ( ) Unknown Test Name Results of Test ~ ( ) Yes Testing Company Date(s) of Repair(s) O0 No ( ) Unknown Descdbe Repairs Overfill Protection_ (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ( ) Float Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor (X) Sealed Fill Box ( ) None ( ) Unknown ( ) Li_~ Mak~e & Model fo__r all Devices ~ ~'c..o '' ..... ~ 33 ( ) Other * · Describe other Protection System a. Underground Piping: (X~ Yes ( ) No () Unknown Material~'~t,=,~.."~,,~,e~.~~r~ Thickness (inches) _ Diameter :3.'~' _ Manufacturer~ ~4 ~ b. Type of piping System - ' {3~') Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run J OC) ~ c. Underground Piping Corrosion Protection: ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap () Electrical Isolation () Vinyl Wrap Underground Piping, Secondary Containment: ( ) Double-Wall (~ Synthetic Liner System () Make & Model (describe). ¥=,- I~C>~>E' () None () Unknown Facility: Standard Compliance Check Equlpm'ent to be Installed: Tank(s), //~---~Ft. of Req ' L//f' Approved ['-]Suction /J~ressurlzed ~]Gravlty, Plpl. Proof of Contractor's License - License # Type of License Proof of Contractor's Worker's Compensation Insurance Primary Containment ~]Flberglass (FRP) ~/~_F..lberglass-clad steel O Uncoated steel [']Other: Comment: Make & Model Make & Model Make & Model Make & Model Additional: Inspection: S~ary Containment of Tank(s) uble-walled tank(s) Make & Model ~d~; DSynthetic liner Make & Model ~']Ltned concrete vault(s) Sealer used ~Other Type Make & Model Comment: Additional: Inspection: Secondary Containment Volume at Least 100~ of Primary Tan! Volume(s) Comment: Addlttonal~ Inspection: Secondary Containment Volume for More Than One Tank Contains 150~ of Volume of Largest Primary Containment or 10~ of Aggregate Primary Volume, Whichever is Greater Comment: Additional Inspection: Secondary Containment Open to Rainfal! Nust Accommodate Hour Raln~all Total Volume ~ -- _ Colment: Additional: Inspect/on: Secondary Containment is Product COmment: Additional: InsPect/on: Product~ -Compatible Documentation Annular Space Liquid Product Comment: Additional: Inspection: is Compatlble~t Annular 1/quid Prlmar---~ Containment of PiPing ~J~berglass PiPing ~Coated steel PiPing ~Uncoated steel piping ~Other Comment: Additional: ~ Inspection: Size & Make ~'~~.~_~ Size & Hake -- Size Secondary Containment of Piping ~Double-walled pipe ~Ynthet/c 1/net la trench ~]Other Comment: Additional: ~ Inspection: Corrosion Protection ~Tank(s) ~Plping & fittings ~Electrlca! isolation Comment: Additional: Inspection: Size & Nake Nanufacture_r-Approve.d Type .~~; ~'~-/ B~ Piping - _ Comment: Req'~ Additional: Inspection: Tank(s) Located no Closer than 10 COmment: Additional: Inspection: Feet to Building(s) Complete Monitoring System Monitoring device Within secondary Containment: ~]Ltquid 1eve! indicator(s) ~Llquid Used ~Therma/ conductivity sensor(s) Pressure sensor(s) ~]Vacuum gauge oVM!Sump(s) as or vapor detector(s) nual inspection & sampl~ sua] inspection her Comment: Additional: Inspection: Other Monitoring ~Perlodlc tightness testing Method ~]~~re-reducing line 2eak detector(s) Other COmment: Additional: Inspection: Overfill Protection i TaPe float gauge(s) oat vent valve(s) ~Capacltance sensor(s) ~]Hlgh level alarm(s) [~Automatic shut-off control(s)-~--- ~r]l box(es) with 1 ft 3 Volume · ~ ~]Operator controls w/th visual level--"-~onltoring Other Comment: - 3 - ,~eq' d _ApDroved Additional: Inspection: Nonltorlng Requlresents Additional Comments Inspection: Inspector Date ,3/.~_.~.~_ __ Extra Inspectlons/Relnspectlons/Consultatlons Date: .Purpose: Collent: Date: Time Uttllzed Purpose: Colment: Date: ?lme Utilized Purpose: Coaaent: Date: Time Utilized Purpose: Comment: .Invoice Date: Inspector TtBe Utilized Total Time: Date: - $ - Facility Name ;- ~--~.5/x ,~3 Facility Address /~j~. ~ Application Category: Standard- Design (Secondary Containment) Permit Application Checklist Motor Vehicle Fuel Exemption Design (Non-Secondary Containment) Ap~ved Permit Application Form Prqperly Completed Deficiencies: 3 Copies of Plot Plan Depicting: Property lines Area encompassed by minimum 100 foot radius around tank(s) and piping I Ail tank(s) identified by a number and product to be stored Adequate scale (minimum 1"=16'0" in detail) North arrow All structures within 50 foot radius of tank(s) and piping Location and labeling of all product piping and dispenser islands Environmental sensitivity data including: *Depth to first grpundwater at site *Any domestic 100 feet of or agricultural water well within tank(s) and piping *Any surface water in unlined conveyance within 100 feet of tank(s) and piping *All utility lines within 25 feet of tank(s).and piping (telephone, electrical, water, sewage,.gas, leach lines, seepage pits, drainage systems) *Asterisked items: appropriate documentation if permittee seeks a motor vehicle fuel exemptidn '£rom secondary containment Comments: Approved.. Copies of'Construction Drawings Depictin~ ~ide ~i~-~ bf Tank ins~aIlation-with Backt~ll, Secondary Containment and/or Leak Monitoring Raceway(s), System in Place Top Vie ion wxth Raceway(s), ~-~-6ndary Containment and/or Leak Monitoring System in Place A Materials List (indicati~g~those used Tank(s) - ~;~.n ~' ~,{~ ~ Product ~ipin~ ,~,-on~-~ Raceway(s) ~ in the construction): sea-~) Secondary Lea~ De t e c t--'~6-~ s) ' ~-~ Ore r fi'l'l ' Protection '7~,'' ,~. ,~ q ~_ ~3 /:~,~ IL Gas or Vapor Detector(s) Sump(s) Monitor ~ng Wel s) mance Additional Comments Reviewed By SITE INSPECTION: Comments: Date Approved Disapproved Date Inspector ,, KIEIRN . JNTY IF 11 R IE ID IE PA)RT M IE N T ~44~VlgtofSl. * B41~f~IM4, CA t~lOe · TeM~ftof~(lO~)eel.9('r'i, · TI.IOM.4~ I~. M~"CARTHY AOMINISTRATIVE DEPUTY CHIEF ~CHUYt. ER T. WALLACE OPERATIONS 0EPUTY CHIEFS D~IIEL Q. CLARK CHARleS E. DOWDY CHARLES A. VALENZUELA ADMINISTRATIVE SERVICES OFFICER MICHAEL R. PARKER Plans have been checked in accordance with: OCCUPANCY: TYPE CONSTRUCTION: ( ) U.F.C. 19 ( ) Title 19 FLOOR AREA: ACTUAL ( ) U.B.C. 19 ( ) Title 24 ALLOWABLE: ( ) OTHER: OCCUP~fl~ LOAD: COMPLIANCE LIST: C HNV!~0NMENTAL HEALTH DEPARTMENT 2-700 "M" STREET,' SUITE 300 BAKERSFIELD, CA 93301 APN NUMBER -~. APPLICATION DATE_..._....__ H,AT_.ARDOUS SUBSTANCES STORAGE FACILITY .. . ( )Existing Facility ( )Transfer Of Ownership ~-)'New Facility A. ' Phone # Night~~ .__ _ , Name - Facility Name~?''~=~-'~'~ No. Of Tanks Type Of Business (check): ~ ( )Other (Oescribe) Is Tank(s) Located On An Agricultural Farm? _ ! !.Y. es ~..N.o ed Primaril _For Agricultural I~u_rppses?.. _( )Y. es U~NO.-~., /. ~ ~3~.~ IS Tank(s) Us _ Y-, ..... . ~.--//~-j/' ~ ~J C!~~ Fac,, ~, . , -- - ' nl Nearest~Cross Street ~ Ig' f / ~ , · Locat;ons O y) ' T R____ SEC .. (~ural . Phone #' ~ Tank Ownne~ ~0_~, . ~ip ~.Y,.~D,3 .. Address r.u. ' Address ~ ~ O'7 bOARD OF EQUAUZATION UST STORAGE FEE ACCOUNT NUMBER - Call (916) 739-2582 If questions arise. TY 0'K) HQ L4.1AL-'~ ~ B. Water To Facility Provided By Depth To Groundwater_ Soil Characteristics At Facility, C. Tank(s) Storage ~ All That Ag.g/Y.): (If* - Complete Section D) Qther* Other* _ , .,___, ~. ~ Waste ank# ~ ~ ~rem~um T () () () () ( () () () ~ t () (~ D. Chemical Composition Of Materials Stored (For Products Or Waste Marked With *) Tank # Chemical Stored (non,-commercial name.~. CAS ~·~ Chemical Previously Store_d E. Transfe.r. Of ~ Previous Owner - Date Of Transfer_ ..._- 'Previous Facility Name_ accept fully all obligations of Permit No.~ I, , I understand that the Permitting Authority~ issued to may review and modify or terminate the transfer of the Permit tu Operate this underground storage facility IS TRUE AND CORRECT, ,/./~__ Title[~l~)p~r.0.~%l~)l&.~ ~,.~a~' ~_. j l_ . HM22 ' / JACO OY.b ~C~ 171' ~f 3299 CERTIFICATE ,~' ,x'~ ' 7/14/93 OF INSTALLATION FOR THE PLASTEEL® ELUTRON UNDERGROUND TANK . In compliance with part 280 of Title 40 of the Code of Federal Regulations, this document may be implemented to meet Subpart B, paragraph 280.2 (e), CERTIFICATION OF INSTALLATION....... :, ~ 'The'installer must 'initial all sections below representing that the installer has read, was cognizant of and has com- pleted, as applicable, all sections of the PLASTEEL® ELUTRONr~'Tank Installation Instructions attached hereto. Return completed form to manufacturer to activite warranty. INSTALLATION CHECK-OFF COMPLETION LIST SECTION INITIAL · I. GENERAL II. VISUAL INSPECTION II1. HANDLING IV. EXCAVATION DEPTH, BEDDING AND BACKFILL V. ANCHORING SYSTEMS VI. TESTING VII. VENTING: JACKETED VIII. PLASTEEL® SEALING PROCEDURES · INIEITALLATION oEsCRIPTION DATE INSTALLATION` SITE · · ADDRESS CITY. STATE, PLASTEEL~ TANK OWNER ELUTRONTM TANK DATA The U.L. Label and serial number is on the top centerline of the tank and also listed on the delivery, document. SIZE IN GALLONS - U:L. SERIAILNuMBER · '. 12,000 L-322234 . 12,000 n-322235 12,000 L-322236 12,000 n-322239 INETALLATIO'N. COMPANY~ NAME ADDRESS CITY, STATE, ZIP : .. TELEPHONE . ' . . . : .. INSTALLATION COMPLETIONISUPERVISOR'S SIGNATURE .. . The responsible supervisOr, s Signature below;"" ...... repi'esen~Si'i'?:'i~: ~'~.'. that phases I through VIII5 were properly completed per the PLASTEEL® ELUTRONrM' Installation Instructions: !.:':ii:. SIGNATURE DATE ,.'. PRINT NAME NAME NAME 1189 ~ AVE. ADDRESS ADDRESS ESODI~)IDO, CA. 92029 CITY, STATE, Z~P YOUR PLASTEEL® TANK MANUFACTURER IS: CITY, STATE, ZIP 61~ 745 0971 i .~"~l SIGNATURE DATE TELEPHONE i~ RETURN COMPLETED FORM TO MANUFACTURER TO ACTIVIATE WARRANTY i ~l~..gjI ~ORM INST CERT--0292 !~ ~'.,;-~ ~l~',,,',~r~',,,~r~.,,,-~l-~.,,,-~ll~.,,,-L~-i]~._,;,~[~._,,,.~ ~.,,,.~/ .~..~. _~,~.~H~ , ~.,,, ,~!~.~ .... I~.~L~J~J~H~ .... ~,~.,~-,~, -'SeriaI nO,s of tanks delivered Size Number Serial no's of tanks delivered Size Number HOLIDAY TEST PERFORMED AT DELIVERY ADDRESS WITH NO PINHOLES. Date '~ '//~7/ -- ~ ~ ,~er,orr~e~, ~., ~ By Witnessed ~~ D. Box 81984 Bakersfield, Ca~forr~a 93380 · Business: (805) 322-3381 FAX (805) 322-3237 VACUUM TESTING CERTIFICATION at ENVIRONM STEVE McCALLEY, R.E.H.S. DIRECTOR EJ JI'-AL HEALTH SERvIcL ' DEPAF:JTMENT 2700 "M" Street, Suite 300 Bakersfield, CA 93301 (805) 861-3636 (805) 961-3429 FAX 3. 4. 5. 6. PERMIT TO CONSTRUCT UNDERGROUND STORAGE FACILITY PERMIT NUMBER 380037B, FACILITY Fastrip Food Store S.E. Corner Rose, dale Hwy. and Allen Road Bakersfield, CA .X NEW BUSINESS CHANGE OWNERSHIP RENEWAL MODIFICATION OTHER OWNER(S) NAME/ADDRESS. Jaco Oil Company P.O. Box 1807 Bakersfield, CA 93308 Phone No. (805) 393-7000 PERMIT EXPIRES March APPROVAL DATE APPROVED BY 10, 10. Jaco Oil Company P.O. Box 1807 Bakersfield, CA 93308 License # N/A Phone No. (805) 393-7000 1994 March 199 ~ Laurel Funk Hazardous Materials .............................. POST ON PREMISES. CONDFHONS AS FOLLOW: Specialist Standard Instructions All construction to be as per facility plans approved by this department and verified by inspection by Permitting Authority. All equipment and materials in this construction must be installed in accordance with all manufacturers' specifications. Permittee must contact Permitting Authority for on-site inspection(s) with 48-hour advance notice. Backfill material for piping and tanks to be as per manufacturers' specifications. Float vent valves are required on vent/vapor lines of underground tanks to prevent overfilling. Construction inspection record card is included with permit given to Permittee. This card must be posted at job site prior to initial inspection. Permittee must contact Permitting Authority and arrange for each group of required inspections numbered as per instructions on card. Generally, inspections will be made of: a. Tank and backfiil b. Piping system with secondary containment leak interception/raceway c. Overfill protection and leak detection/monitoring d. Any other inspection deemed necessary by Permitting Authority. Standard Instructions Permit No. 380037B 10. 12. ACCEPTED LF:ch funkLaS0037b.ptc All underground metal connections (e.g. piping, fitting, fill pipes) to tank(s) must be electrically isolated and wrapped to a minimum 20 mil thickness with corrosion-preventive, gasoline-resistant tape or otherwise rotected Primary and secondary containment of h ,o.U,~, ........... P from corrosion. hot ...... "t~ -,au unucrgrouna piping must not be subject to physical or chemical deterioration due to the substance(s) stored in them. Documentation from tank, piping, and seal manufacturers of compatibility with these substance(s) must be submitted to Permitting Authority prior to construction. Spark testing (35,000 volts) required at site prior to installation of tank(s). Test(s) must be certified by the manufacturer and a copy of test certification supplied to the Permitting Authority. No product shall be stored in tank(s) until approval is granted by the Permitting Authority. Liner shall be installed by a trained experience liner COntractor and installation at site approved by the Permitting Authority. Monitoring requirements for this facility will be described on final "Permit to Operate.' DATE: "~' t~ .C~ ~ l~on~,.tOr CONTRA'C', Permits , C. OO Facility Name ~-~r ~ ~ t~'~ Inspector Date PlNAL INSPECTION CURCKLIgT Plot plan notes Plot Diagram All new and existing tanks located on plot plan? Does tank product correspond to product labels on plot plan? Was there no lodlflcatlons identified which were not depicted on the plot plans? If "No" described Yes No 4. Are monitoring wells Secure and free of water and product in sump? 5. Ia plpJng systep~pressur~ suction or gravity? 6.' Are Red Jacket subpumps and all line lea det. tot · accessible7 No Overfill containment box as specified on :.~pl£cation7 If "No", what type and model number: e a) Ia fill box tightly sealed around fill tube7 b) Is access over water tight7 c) Is product present in fill box? Identify type of monitoring: a) Are manual monitoring instruments, product and water finding paste on premises? b) c) Is the fluid level in Owens-Corning liquid level monitoring reservoir and alarm panel in proper operating condition? Does the annular space or secondary containment liner leak detection system have self diagnostic capabilities? If "Yes", la it functional If "No", how is it tested for proper operating condition? 9. Notes on any abnorma} conditions: ENVIRONMENTAL HEALTH SERVICES DEPARTMENT STEVE McCALLEY, R.E.H.S. DIRECTOR 2700 "M" Street, Suite 300 Bakersfield, CA 93301 (805) 861-3636 (805) 861-3429 FAX Permit No.: Issued to: Locatiou: Owner: Operato~ Facility Profile: ~Tank No. 1 2 .3 4 380037C Fastrip Food Store 12851 Roscdale Highway Bakersfield, CA Jaco Oil Company P. O. Box 1807 Bakersfield, CA 93308 JacoOilCompany P.O. Box 1807 Bakemfield, CA93308 PERMIT TO OPERATE UNDERGROUND HAZARDOUS STORAGE FACILITY Substance Tank Tank Year Code Contents Capaci .fy Installed MVF6 MVF 6 MVF 6 MVF 6 State ID No.: 380037 No. of Tanks: 4 Is piping Pressurized? Unleaded 12,000 1993 Yes Unleaded Plus 12,000 1993 Yes Prem-Unleaded 12,000 1993 Yes Diesel 12,000 1993 Yes Issue Date: .~piration Date: J~N:cas \~[arrenk330037h.m13 January 15, 1994 January 15, 1999 This permit Is granted subject to the couditions and prohibitions listed on the attached summary of conditions/prohibitions By St e~'~ ~l~.t~lley Title: Director, Enviromnental Health Services Department -- POST ON PREMISES -- NONTRANSFERABLE au,'v~VlARy OF CONDiTIONS/PROi~iBm~NS KRMIT CON~ 1T~ONS/PR O I-ITR IT~O N,e_.: 1. The facility owner and operator must be fan~l~ar with all conditions specked within t~s pertmt and must meet any additional requirements to monitor, upgrade, or close the tanks and associated piping imposed by the permitting authority. 2. If thc operator of thc underground storage tank is not the owner, then thc °wner shah enter into a written contract with the operator, requLring the operator to monitor the underground storage tank; maintain appropriate records; and implement reporting procedures as required by the Depamnent. The facility owner and operator shaH ensure that the facility has adequate finn~cial responsibility insurance coverage, as mandated for aH underground storage tanks containing petroleum, and supply proof of such coverage when requested by the permitting authority. The facility owner must ensure that the annual permit fee is pnid within 30 days of the invoice date. 'l'ne facttity will be considered in violation and operating without a permit if annual permit fees are not received within 60 days of the invoice date. Thc facility owner and/or operator shall review the leak detection requirements provided within this permit. The monitoring alternative shall be implemented within 60 days of the permit issue date. The facility underground storage tanks must-be monitored, utili~n_g the option approved by the permitting authority, until the tank. is closed under a vali~ unexpired permit for closure. Any inactive underground storage tank which is not being monitored, as approved by the pennJmng authority, is considered improperly closed. Proper closure is required and must be completed under a pernztt issued by the pet~n~tting authority. The facility owner/operator must obtain a modification permit before: a. Uncovering any underground storage tank after faLlure of a tank integrity test. b. Replacement of piping. c. Lhting the interior of the underground storage tank. The tank owner must advise the Environmental Health Services Department within 10 days of transfer of ownership. Any change in state law or local ordtuance may nece~itate a change in permit conditions. The owner/operator will be required to meet new conditions within 60 days of notification. The Owner and/or operator shall keep a copy of all monitoring records at the facility for a mmttnum of three years, or as specified by the pertttittmg authority. They may be kept off site if they can be obtained within 24 hours of a request made by the local authority. The owner/operator ..must .report any. uuauthortzed release which escapes from the seco containment, or from me prtma~T containment if no seconda~, con'"' ...... .... ndaty -: .~umcnt eXiSts, WtilCn lnCTeaSe~ the hazard of fire or explosion or causes any deterioration of the secondary containment within 24 hours of discovery. tO, 11. 12. 13. AEO:jnv (greenq~tm~.p2) MONITORING REOUIREMENTs:(/av~z pr) 1. All underground storage tank~ designated aa MVF 6 on the ~u'st page of thh permit shall be monitored u!ili~ng the following method: bo Each tank shall be equipped with a continuous monitoring device within the interstitial space, which must be connected to an aud~le and visual alarm system within 60 days of the haue date on page 1 of this permit. All piping sumps shall be monitored manually or by utilizing an electronic monitoring device. All pressurized piping systems shall install pressurized piping leak detection .systems and ensure that they are capable of function/ng as specified by the manufacturer. The mechanical leak detection systems must be capable of alerting the owner/operator of a leak by restricting or shutting off the flow of hazardous substances through the piping or by triggering an audible or visual alarm, detecting three gallons or more per hour per square inch line pre~sure within one hour. d. AH pressurized piping systems shall be tested annually unless the facility has installed the following: (2) .(3) (4) A continuous monitoring system within secondary containment. The continuous monitor is connected to an audible and vhual alarm system and the pumping system. The continuous monitor shuts down the pump and activates the alarm system when a release is detected. The pumping system shuts down automatically'if the continuous monitor faih or is disconnected. o The first test shall be completed befon., December 31, 1994 and subsequent tests completed each calendar year thereafter. All equipment installed for leak detection shall be operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks (at least once per year) for operability or running condition. A monitoring response plan shall be developed, and submitted to the department for review and approval within 90 days of the hauance date of this permit. An annual report shall be subm/tted to the Kern County Environmental Health Services Department each year after monitoring has been initiated. The owner or operator shall use the form provided along with the permit, unless another has received prior approval. WORK ORDFR. LOG. RESPONSIBLE - / RP CONTACT= / STATE; RP PHONE NOS.= INSPECTOR= PROGRAM= DESCRIPTION= ( ) 'Hl~P-En£o~cemant HMMP-Permi2tinq LOC~tTI ON: FACILITY COMMENTS RESOURCE MANAGEMENT AGEmCY RANDAll_ L. ABBOTT DIRECTOR DAVID PRICE !11 ASSISTANT DIRECTOR Enviro~nental Health Sendce~ Department STEVE McCA! 1 Fy, REHS, DIRECTOR Air Pollution Control Diatrict WILLIAM J. RODDY, APCO Planning & Development .Setvicea Depazlment TED .JAMES, AICP, DIRECTOR ENVIRONMENTAL HEALTH SERVICES DEPARTMENT April 7, 1992 Jaco Oil Company 3101 State Road Bakersfield, California 93308 CLOSURE OF 3 UNDERGROUND HAZARDOUS SUBSTANCE STORAGE TANKS LOCATED AT 33503 ROSEDALE HIGHWAY IN BAKERSFIELD, CALIFORNIA. PERMIT # A1672-38/380037 This is to advise you that this Department has reviewed the project results for the preliminary assessment associated with the closure of the tanks noted above. Based upon the sample results submitted, this Department is satisfied that the assessment is complete. Based on current requirements and policies, no further action is indicated at this time. It is important to note that this letter does not relieve you of further responsibilities mandated under the California Health and Safety Code and California Water Code if additional or previously unidentified contamination at the subject site causes or threatens to cause pollution or nuisance or is foun~ to pose a significant threat to public health. Changes in the present or proposed land use may require further assessment and mitigation of potential public health impacts. Thank you for your cooperation in this matter. BILL SCHEIDE, HAZARDOUS MATERIALS SPECIALIST cc: Wegener Construction 1710 Calloway Bakersfield, CA 93312 2700 "M" STREET, SUITE 300 BAKERSFIELD, CALIFORNIA 93301 PRINTED ON RECYCLED PAPER (8O5) 861.3636 FAX: (805) 861.3429 ENVIRONMENTAL HEALTH DEPARTMENT 2700 "M" STREET, SUITE 300 BAKERSFIELD, CA 93301 IPE IT NO.A '7 APN NUMBER ~g~'O~/D--~-- APPLICATION DATE 3 "/-- ~,~ APPLICATION FOR pERMIT TO CONSTRUCTfMODIFY UNDERGROUND H~ZARDOUS S~BSTANCES STORAGE FACILITY Tyne'Of Aomlication (check): (~9New Facility ( )Modification of Facility ( )New Tank Installation at Existing Facility mo Number of Tanks To Be Installed ~ Existing Facility Permit Type of Business ~o~%~C~ T R SEC (Rural Locations Only) Nearest Cross Tank Owner ~..~c~c.~ (~- ~ Address ~. O. q-~< ! 5~ O'7 Phone #: ~%~o-~ OOO City/State -~.~%~_9 , ~/% Zip ~O ~ Co Water To Facility Provided By VA~.L ~~'~ Cov~A~ Depth To Groundwater {%0' Soil Characteristics At FacilityS&~4cJ.~. b~lT D. Contractor ~]~O OC\ ~(~-~ cAContractor'. License .o Address ~O. ~-n~ ~, ~0"'~% City ~~-~'v~ Zipq%~9~ Phonl Worker's Compensation Certification #. Insurer Proposed Starting Date Proposed Completion Date Eo If This Application Is For Modification Of An Existing Tank System, Briefly Describe Modifications Proposed (Excluding New Tank Installation at Existing Facilities) Fo Tank(s) Stora~9 (Check All That Apply): Tank # Unleaded ~ ~r~mium 7.. (X) ( ) X~ ( ) ~ 0<) ( ) (x) () () () (Ifm - Complete Section G) Other~ Other~ () () () () () () () () () () () () () () () () () () () () Chemical Composition Of Materials Stored (For Products Or Waste Marked With ~) Tank # Chemical Stored (pon-commercial name) CAS ~ (if know~) ~hem%cal Previously Stored (if different) This form has been completed under penalty of perjury and to the best of my knowledge true and corr~ ~,/. is Permit Ho 1. o 10. 11. HM21 T, ank is: TANK INFORMATION FORM Contents {~,,,t ~ (FILL OUT SEPARATE FORM FOR EACH TANK) Tank FOR EACH SECTION, (~HECK ALL APPROPRIATE BOXES ( ) Vaulted ~,) Jacketed (. i Double-Wall ( ) Single-Wall ( ) Stainless Steel ( ) Unknown Thickness (Inches) Tank Material ( ) Carbon Steel ( ) Concrete Primary Containment Date Installed Tank Secondary Containment ( ) Fiberglass-Reinforced Plastic ( ) Other (Describe). Fiberglass-Clad St Capacity (Gallons) Manufacturer ~ Double-Wall () Synthetic Liner () Lined Vault () None () Unknown Manufacturer:. ( ) Other (describe): ( ) Material C--,t~,..~2-~--_~_M,,,Thickness (Inches) i co ~,~t> Capacity (Gallons) Tank Interior Lininq (3<) Unlined ( ) Unknown ( ) Lined (describe). Tank Corrosion Protectio.n. () Galvanized (y.,,) Fiberglass-Clad () Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): Cathodic Protection: (X) None ( ) Impressed Current System ( ) Sacrificial Anode SYstem Describe System an~qqJl~ment:-'~ Leak Detection, Monitorin.q, and Interception * (Must be described below) a. Tank: ( ) Vapor Detector * ( ) Liquid Level Sensor * ( ) Conductivity Sensor * ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring (~') Sensor in Annular Space ( ) Vapor 00 Liquid ( ) Pressure ( ) Other * ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation ( ) Periodic Tightness Testing ( ) None ( ) Unknown ( ) Other · Describe Make & Model: ~-.~,,-t,,,,~, X"-'i ~ L, Vc_... b. Piping: (),,) Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway (~ Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Haft-Cut Compatible Pipe Raceway (X) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other · Describe Make &'Model: ~, ,~*~-.~._~' L.~,,~' !.~.~ Tank Tiqhtness Has This Tank Been Tightness Tested? Date of Last Tightness Test Test Name '- Tank Repair ( ) Yes '" Date(s) of Repair(s) ( ) Yes (;K) No Results of Test Testing Company (X) No ( ) Unknown ( ) Unknown Describe Repairs Overfill Protection (Must descdbe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ( ) Float Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor (20 S.~ed Fill Box ( ) None ~( ) Unknown ( ) List Make & Model for all Devices I'G~..~ *Describe other Protection System Pipinq a. Co do ( ) Other * Underground Piping: (X) Yes ( ) No Thickness (inches) Diameter ~" Type of piping System (;x) Pressure ( ) Suction ( ) Gravity Underground Piping Corrosion Protection: ( ) Unknown Material ~1o~.,'~..~ ~o~.~L "~.-,~- Manufacturer A~rz_~ ~ Approximate Length of this Pipe Run CoO' ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tabor ,Asphalt ( ) Unknown ( ) None (~) Other (describe): Underground Piping, Secondary Containment: () Double-Wall (X) Synthetic Liner System () None () Unknown ( ) Make & Model (describe): ~/~ '~ ~ ~:>~" "T'a.e~,~.~¥.L Permit ~., H, 1. o 10. 11. '.--IM21 Tank is: .Tank Material ( ) Carbon Steel ( ) Concrete Primary Containment Date Installed TANK INFORMATION FORMO Contents.Cl,~ [~ (FILL OUT SEPARATE FORM FOR EACH TANK) Tank FOR EACH SECTION, CHECK ALL APPROPRIATE BOXE~ ( ) Vaulted 0<) Jacketed ( ) Double-Wall ( ) Single-Wall ( ) Stainless Steel ( ) Fiberglass-Reinforced Plastic ( ) Unknown ( ) Other (Describe) Thickness (Inches) Tank Secondary Containment Fiberglass-Clad S. Capacity (Gallons) Manufacturer () () Tank Interior Lininq (,)~' Unlined ( )Unknown Tank Corrosion Protection ( ) Galvanized ( ) Tar or Asphalt ( ) Double-Wall ( ) Synthetic Liner ( ) Lined Vault ( ) None ( Unknown Other (descdbe~: Manufacturer:. Matedal ~',~'t-~,~~Thickness (Inches) \ OO ~ ,~l.~ Capacity (Gallons) ( ) Lined (describe). Fiberglass-Clad (.') Polyethylene/Vinyl (Wrapped or Jacketed) Unknown ( ) None ( ) Other (describe): Cathodic Protection: (X) None ( ) Impressed Current System Descdbe System acd,,Equ, ip. ment: ..,~ Leak Detection, M0nlti3rinq, and Interception a. Tank: b. Piping: Has This Tank Been Tightness Tested? Date of Last Tightness Test Test Name .. ~ () Yes ... Date(s) of Repair(s) Describe Repairs ( ) Sacrificial Anode System * (Must be described below) ( ) Vapor Detector * ( ) Liquid Level Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring (~) Sensor in Annular Space ( ) Vapor ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation ( ) Pedodic Tightness Testing ( ) None ( ) Unknown ( ) Other *Describe Make & Model:'~._n,A~,l - '~"l (o L~/r._ (X) Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway (X) Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway (x) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other *Describe Make &'Model: ~--,.z~ ( ) Yes (X] No Results of Test Testing Company. {X) No ( ) Unknown ( ) Unknown Overfill Protection (Must descdbe below) Co ( ) Other ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ( ) Float Vent Valves ( ) AUto Shut-Off Controls ( ) Capacitance Sensor (X) Sealed Fill Box ( ) None ( ) Unknown ( ) ListUake&UodelforallDevices'~o~-c_o I'~¢,A~-[ -~.-1-~.-~ *Describe other Protection System Piping a. Underground Piping: (X~ Yes ( ) No ( ) Unknown Thickness (inches) Diameter :3.'¢ Manufacturer A~r~.o,,.I Type of piping System 00 Pressure ( ) Suction ( ) Gravity Approximate Length of this Pipe Run lOC)r Underground Piping Corrosion Protection: ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap () Ta~(r or Asphalt ( ) Unknown ( ) None (X) other (describe): F~::~ 't",t~,,.~c,- Underground Piping, Secondary Containment: () Double-Wall (X) Synthetic Liner System () None () Unknown ( ) Make & Model (describe): Y~,, ~C:,~'E' '-t-r~,,~,oc.~ Permit ~ 2. o o 10. 11. .'-tM21 T. ank is: ( Tank Matedal ( ) Carbon Steel ( ) Stainless Steel ( ) Concrete ( ) Unknown Primary Containment Date Installed Thickness (Inches) TANK INFORMATION FORM ContentsLJ, u J,~.,~ ~- (FILL OUT SEPARATE FORM FOR EACH TANK) Tank #-z_ FOR EACH SECTION. CHECK ALL APPROPRIATE BOXE~ ) Vaulted 00 Jacketed ( Double-Wall ( ) Single-Wall ( ) Fiberglass-Reinforced Plastic ( ) Other (Describe), Capacity (Gallons) Fiberglass-Clad Tank Secondary Containment (~) Double-Wall () Synthetic Liner () Lined Vault Manufacturer ( ) Other (de_scribe): ( ) Matedal.~--,~, I~----~,..~J~,,~JL¥~,{,Thickness (Inches) Tank Interior Lining (~) Unlined ( ) Unknown ( ) Lined (describe) Tank Corrosion Protection ( ) Galvanized ( ) Tar or Asphalt ( ) Cathodic Protection: b. Piping: () None ~i Unknown Manufacturer:.. ,~oOt"' o .--,~ ~ Capacity (Gallons) Fiberglass-Clad ( ) Polyethylene/Vinyl (Wrapped or Jacketed) Unknown ( ) None ( ) Other (describe): None ( ) Impressed Current System ( ) Sacrificial Anode System Descdbe System aoct Equipment: Leak Detection, Uon~(~rinq, and Interception * (~ust be dascribed below) a. Tank: ( ) Vapor Detector * ( ) Liquid Level Sensor ( ) Vadose Zone Monitoring Well(s) ( ) U,Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring ~ Sensor in Annular Space ( ) Vapor ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Dally Gauging & Inventory Reconciliation ( ) Pedodic Tightness Testing ( ) None ( ) Unknown ( ) Other · Describe Make & Model: '~-6,,~,,.~ ~ '] (,:, L."~ C.. ~ Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway 00 Monitoring Sump with Raceway ( ) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway (X) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other · Describe Make &Model: Tank Tiqhtness Has This Tank Been Tightness Tested?: Date of Last Tightness Test .Test Name .. Tank Repair ( ) Yes -.. Date(s) of Repair(s) ( ) Yes (~ No ( ) Unknown Results of Test Testing Company ('X) No ( ) Unknown Describe Repairs Overfill Protection (Must descdbe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ( ) Float Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor (X) Sealed Fill Box ( ) None ( ) Unknown ( ) List Make & Model for all Devices ~o~'~...o pA~,e~. ~.3_'1_ - ~ *Describe other Protection System piping a. bo Co do ( ) Other * Underground Piping: (X) Yes () No Thickness (inches) Diameter ;z. o' Type of piping System (30 Pressure ( ) Suction ( ) Gravity Underground Piping Corrosion Protection: ( ) Unknown Material Manufacturer Approximate Length of this Pipe Run ~O' ( ) Galvanized ( ) Fiberglass-Clad ( ) Impressed Current ( ) Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap or Asphalt ( ) Unknown ( ) None ('X) Other (describe): ~'R~J Tar Underground Piping, Secondary Containment: () Double-Wall (~ Synthetic Liner System () None () Unknown ( ) Make & Model (describe): -I. 1. Tank is: E. o 10, 11. :M21 TANK INFORMATION FORM Contents ~\ (FILL OUT SEPARATE FORM FOR EACH TANK) Tank FOR EACH SECTION. CHECK ALL APPROPRIATE BOXES ( )Vaulted ~,Jacketed ( )Double-Wall ( ) Single-Wall ( ) Stainless Steel ( ) Unknown Thickness (Inches) ',//~ri, Tank Matedal (~ Carbon Steel ( ) Concrete Primary Containment Date Installed ( ) Fiberglass-Reinforced Plastic ( ) Other (Describe). Capacity (Gallons) Tank Secondary Containment I~ Double-Wall () Synthetic Liner ( ) Other (describe): ( ) Material Tank Interior Lininq ( ) Unlined 00 Unknown Tank Corrosion Protection ( ) Lined Vault ( ) Fiberglass-Clad Steel Thickness (Inches) ( ) Lined (describe) Manufacturer ,. ( ) None ( ) Unknown Manufacturer: Capacity (Gallons) () Galvanized 0~ Fiberglass-Clad () Polyethylene/Vinyl (Wrapped or Jacketed) ( ) Tar or Asphalt ( ) Unknown ( ) None ( ) Other (describe): Cathodic Protection: ~,) None ( ) Impressed Current System ( ) Sacrificial Anode System Describe System and Equipment: Leak Detection, Monitoring, and Intemeption * (Must be described below) a. Tank: ( ) Vapor Detector * ~ Liquid Level Sensor * ( ) Conductivity Sensor * ( ) Vadose Zone Monitoring Well(s) ( ) U-Tube with Liner ( ) U-Tube without Liner ( ) Visual Inspection (Vaulted tanks only) ( ) Groundwater Monitoring ( ) Sensor in Annular Space ( )Vapor ( ) Liquid ( )Pressure ( )Other* ( ) Regular Monitoring of U-Tube, Monitoring Well or Annular Space ( ) Daily Gauging & Inventory Reconciliation ( ) Periodic Tightness Testing ( ) None ( ) Unkno_..wn ( ) Other · Describe Make & Model:' {)~?~,~ b. Piping: (y,,) Flow-Restricting Leak Detector(s) for Pressurized Piping* ( ) Sealed Concrete Raceway () Monitoring Sump with Raceway ~) Complete Containment Liner with Sumps ( ) Half-Cut Compatible Pipe Raceway ( ) Synthetic Liner Raceway ( ) None ( ) Unknown ( ) Other · Describe Make & Model: ~--~.,.~.. 3,~_L~,.._~- Tank Tiqhtness ' Has This Tank Been Tightness Tested? Date of Last Tightness Test Test Name Tank Repair ( ) Yes Date(s) of Repair(s) ( ) Yes (:~ No ( ) Unknown Results of Test Testing Company 0~ No ( )Unknown Describe Repairs Overfill Protection (Must describe below) ( ) Operator Fills, Controls, & Visually Monitors Level ( ) Tape Float Gauge ~ Float Vent Valves ( ) Auto Shut-Off Controls ( ) Capacitance Sensor (2~ Sealed Fill Box (). None ( ) Unknown ( ) List Make & Model for all Devices '~o,v~ ~.--,._c, ~ ~ 1. ~ *Describe other Protection System Pipin,q a. ( ) Other * Underground Piping: ('~ Yes () No Thickness(inches) Diameter "2_. ~' Type of piping System ~ Pressure ( ) Suction ( ) Gravity Underground Piping Corrosion Protection: ( ) Unknown Material ~t~ ~ Manufacturer ~. O. ~.,~.{--~. Approximate Length of this Pipe Run () Galvanized '~ Fiberglass-Clad () Impressed Current () Sacrificial Anode ( ) Polyethylene Wrap ( ) Electrical Isolation ( ) Vinyl Wrap ( ) Tar or Asphalt ( ) Unknown ( ) None ( )Other (describe): Underground Piping, Secondary Containment: () Double-Wall ~X~~icLiner S, ystem () None () Unknown ( ) Make & Model (describe): CONSTRUCTION MAROH 51, 1992 COUNTY OF KERN ENVIRONMENTAL HEALTH SERVICE DEPT. 8ILL SCHEIDE 2700 "M" STREET BAKERSFIELD, CA. 9550i RE: PERMIT ~A1672-58 JACO OIL 55505 ROSEDALE HWY. BAKERSFIELD, OA. 95512 PLEASE FIND ENCLOSED THE FOLLOWING DOCUMENTS, IF ANY ADDITIONAL INFORMATION IS NEEDED PLEASE CONTACT ME. 2. 5. 4. 5. MANIFEST ~ 91044818 GOLDEN STATE METALS TANK DISPOSAL FORM ~10253 PLOT PLAN SMC LABORATORY SMC LABORATORY ANALYTIOAL REPORT SZNOERELY, DOUG WEGENER 1710 CALLOWAY BAKERSFIELD, CALIFORNIA93312 (805) 589-5570 FAX (805) 589-1161 LIC. NO. 413913 ~-orm Al~proveo UMU NO; 2050---0039 (ExDh'ea Please print or type. Form deigned for uae oe el/la (12-p~ch h, PMi~er). · UNIFORM HAZARDOU~ ~' '....to,'. us Ep^,o No. ----- WASTE MANIFEST' 3. GonerltoCa Nlme end Mailing Addmal . . .~: . . . . :;:'.'~?~..?: · ~ '".~.:.:.~.: : 4. uoneralor'l Phone ,(?.Z,,~T,..) , =,,-~ , .., ,,~_._,~ ' ," : .. ' ;/ '". ' ~.~/'*N //"/' /"~ ..... 5. ?ranaporter I Company Name 6. US EPA ID Number. 7. Transporter 2 Company Name 8. US EPA ID Number andFront of Page 7' ~ Plge I 12. Contain~ 9. Designated Facility Name and Site Addre~ 10. U~ EPA ID Number 11. US DOT Dei~ptlon Oncluding Proem ShippMg Name, ~d Ciasa, and ID Numbs) . Toxic Subltancel ~ infon~atJon in the Ihlded IJ~l~..* required by Federal Omlnflty do ?:::'. GENERATOR'8 CERT~qCA~O~.'.,: I hMM)y ded~ · ~ ~KI are ~a~lfled, pad,nd, m~knd, and MbekKI, ond ~ In aM ' ~-:?. ff'l m · mu, qu, nmy'5~;"tO;. ~ ~ tim ~ ~mve · ? h?... .nd'.-- u ........· ,,,.~., :..~m;~,m?. ,u?..~mmmg~ m~hod t~M evli~b~t0 meed .-t~ have made'a = Printed/Typed Name., ..- .',~- "."*"-'.;" ' ..... · · :/" "~",' *.':?~ · .-.:..:'.'*~': -'.--.-.~..--.'..:;..:~z ~' ...'.:!.. . .-:....; '?...:.' ..- ....~.: '...' -,. - :~:_..... .:- _ o GOLDEN STATE METALS, INC. P. O. Box 70158 · 2000 E. Brundage Lane Bakersfield. California 93387 Phone (805) 327-3559 · Fax (805) 327-5749 Scrap Metals. Processing & Recycling ADDRESS:~,~ B ~00 ~ · DES~NA~ON: G.S.M. · 2000 ~ BRUNDAGE ~NE · HAULER: ~ EHSD PERMIT NO: NO_.10233 NK DISPOSAL FORM Contractor's License No. ' Contractor's ~'" o/,/,3 ~- Phone No. OX"/.,,l:~,.~ "7 0 BAKERSFIELD, CA 93387 COUNTY: p//T~NK INSPECTION [~ CLEAN & DRY (AccEPT), OR [] RESIDUALS PRESENT(REJECT) ~LEL READING DISPOSALFEE SCRAPVALUE OTHER All fees Incurred are per load unless specified. Terms are net 30 days from receipt of tank. Contractor's signature' represents acceptance of terms for' payment, and confirms that tank removal complies with State laws. CONTRACTOR'S SIGNATURE TOTAL 250 ' .14 550 .24 1000 - 6 ft .61 2000 .97 3000 1.32 5O00 2.42 7500 3.28 9000 3.82 12000 4.93 TOTAL CERTIFICATE OF TANK DISPOSAL / DESTRUCTION TH~ IS~ CERTIF~HE RECEIPT AND ACCEPTANCE OF THE TANK(S) AS SPECIFIED ABOVE. ALL MATERIAL SPECIFIED WILL BE COMPLETELY ~ 7 -- ~ AUTHORIZED REP. , . , DATE .. WHITE-- Contractor Copy · YELLOW -- Rio Copy · PINK -- Permanent Copy tng fac1 ~ lty,: · ib]e for insur~ ~ To be ft; ~ ed out.-,., Removal Tank( Removed To be fJ 1 led out' dn Tank Size i zed rel~resentat~. have been' Servi :~:RECORD*:~ ,t;'l~:.:3';:: To be f"! 1 led ;. approved d'~ '11:¥ Tank(s) CI-I~%~N OF CUSTODY RECOi:~/D Location of Sampling Company? ~.~,,~.'czff ~~. ' Address: Telephone: ( ) SMC Laboratory 3155 Pegasus Drive Bakersfield, CA 93308 Telephone: ( 805 ) 393-3597 FAX: ( 805 ) 393-3623 Method: SamDl~e: Preservation Methods Relinquished Dy: .6~y':..~,'.,,--'~.~ ~-~,,-'-~) Received By: ./~ .~ ~: Relinquished By: Company: Company: Company: Date: Received By: Company: Date: Relinquished By: Company: Date: Received By: Company: Date: Sheet of CI-I;.IN OF CUSTODY RECORI) Location of Sampling Company: . Te!ephone: ( ) Collector Name: '~ Company: Address: ./ SMC Laboratory 3155 Peg~us Drive Bake~field, CA 93308 Telephone: ( 805 ) 393-3597 FAX: ( 805 ) 393-3623 Method: Samole Tvoe: Preservation Methods: No. T Date ! Time I Description Ann!reis Recuested I Laboratory No. -' .J ~, '"//~"-/i Relinquished By: Received By: . ~ ) Relinquished By: 77./2 I ~33 Company: Company: .... Date: "< "'" "' - .j; - ..-- ~: ,~ Date: Date: i! Company: · Date: Received By: Relinquished By: !, Company: Date: Received By: CompanY: Date: Sheet of CI-L~IN OF CUSTODY Location of Sampling Collector Name: .. Company,: Relinquished By: Received By: Company: SMC Laboratory 3~ P~§~u~ Driv~ B~k~rsfi~ld, CA 93308 Telephone: ( 805 ) 393-3597 FAX: ( 805 ) 393-3623 Preservation Methods: Ana!vsis Recuested Laboratory No. / Company,_ Relinquished By: ' Company:' Date: Received By: Company: Date: Relinquished. By: Company: Date: Received By: Company: Date: Sheet of SMC Laboratory Client Name: Wegener Construction Address: 1710 Calloway Bakersfield, CA 93312 Date Samples Received : Date Analysis Completed: Date of Report : Attn: Mr. Bill Shiede Project Name: Jaco Oil Co. -3-23-92 3-25-92' 3-25-92 Analytical Chemistry APR - I 1992 RESULTS OF ANALYSIS sample % ID 829 W.O. 2' 830 W.O. 6' '" ( Oi 1 and G'r~e~-~'e·) mq/kq MDL, mq/kq ND 5.0 ND 5.0 Method of Analysis: 418.1 ND = None Detected mg/kg = milligrams per kilogram MDL = Minimum Detection Limit A~gela Horton . Analytical Chemist 3155 Pegasus Drive P.O. Box 80835 · Bakersfield, CA 93308 Bakersfield, CA 93380 · ·(805) 393-3597 FAX (805) 393-3623 SMC Laboratory Client Name: Wegener Construction Address: 1710 Calloway Bakersfield, CA 93312 Attention: Mr. Bill Shiede Analytical Chemistry Date Samples Received : 3-23-92 Date Analysis Completed: 3-25-92 Date of Report : 3-25-92 Project Name: Jaco Oil RESULTS OF ANALYSIS ~ample % ID 829 W.O. 2' 830 W.O. 6' TOTAL.LEAD ,uqm/qm ND ~RL,uqm/qm 10. ND 10. Method of Analysis: 3050/7420 MRL = Minimum Reporting Level ugm/gm = micrograms per gram ND = none detected Analytical Chemist 3155 Pegasus Drive P.O. Box 80835 · · Bakersfie!d. CA 93308 Bakersfield. C..'~. 93380 · (805) 393-3597 FAX (805) 393-3623 SMC Laboratory Client Name: Address : Wegener Construction 1710 Calloway Bakersfield, CA 93312 Attention : Mr. Bill Shiede Date Samples Received : 3-23-92 Date Analysis Completed: 3-25-92 Date of Report : 3-25-92 Analytical Chemistry Project Name: Jaco Oil RESULTS OF ANALYSIS .Sample ~ I___~_D 829 W.O. 2' 830 W.O. 6' ND 10 ND 10 Method of Analysis: EPA 9020 MDL = Minimum Detection Level ugm/gm = micrograms per gram ND = none detected A~e'l a Horton Analytical Chemist 3155 Pegasus Drive P.O. Box 80835 · Bakersfield, CA 93308 Bakersfield, CA 93380 · ·(805) 393-3597 FAX (805) 393-3623 RESULTS OF ANALYSIS ~835 ID:Disp2-2 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm ND 0.020 0.0082 0.0088 0.018 0.017 0.0096 20 MDL, ugm/gm 0.005 0.005 0.005 0.005 0.005 0.005 0.005 1.0 %836 ID:Disp2-6 Benzene Toluene ~:~"' ..... ~?:-~Ethytbenzene p-Xylene m,o-Xylenes Isopropylbenzene TPH (Gasoline) ugm/gm ND 0.015 ND 0.021 0.015 0.014 ND MDL, ugm/gm 0.005 0.005 ..... O. 005 0.005 0.005 0.005 1.0 #837 ID:Disp2-14 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm ND ND ND ND ND ND ND ND MDL, ugm/gm 0.005 0.005 0.005 0.005 0.005 0.005 0.005 1.0 Kevin Lagan' Analytical Chemist RESULTS OF ANALYSIS ~831 ID:P. Trench 2 ugm/gm MDL,ugm/gm Benzene ND 0.005 TolUene ND 0.005 Ethylbenzene ND .0.005 p-Xylene ND 0.005 m-Xylene ND 0.005 o-Xylene ND 0.005 Isopropylbenzene ND 0.005 TPH (Gasoline) ND 1.0 ~832 ID:P. Trench 6 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm MDL, ugm/gm ND 0. 005 ND 0. 005 ND 0. 005 ND 0. 005 ND 1.0 ~833 ID:Displ-2 ugm/gm MDL,ugm/gm Benzene ND 0.005 Toluene ND 0.005 Ethylbenzene ND 0.005 p-Xylene ND 0.005 m-Xylene ND 0.005 o-Xylene ND 0.005 Isopropylbenzene ND 0.005 TPH (Gasoline) ND 1.0 Kevin Lagan (~ Analytical Chemist RESULTS OF ANALYSIS %826 ID:T2-W6 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm ND ND ND' ND ND ND ND ND MDL, ugm/gm 0. 005 0.005 · 0. 005 0.005 0.005 0.005 0.005 1.0 ~827 ~828 ID:T2-E2 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ID:T2-E6 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm ND ND ND ND ND ND ND ND ugm/gm ND ND ND ND ND ND ND ND MDL,ugm/gm 0.005 0.005 0.005 0.005 0.005 0.005 0.005 1.0 MDL, ugm/gm 0.005 0.005 0.005 0.005 0.005 0.005 0.005 1.0 Kevin Lagan ~ Analytical Chemist RESULTS OF ANALYSIS ~823 ID:T1-W2 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm MDL,ugm/gm ND 0.005 ND 0.005 ND 0.005 ND .0.005 ND 0.005 ND 0.005 ND 0.005 ND 1.0~ ~824 ID:T1-W6 Benzene Toluene Ethylbenzene p-Xylene m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm MDL,ugm/gm ND 0.005 0.010 ,. !_ .... :0.005~: ND ' · 0.0 0 5':] · ND' ' =:":~'~;"~ ..... ' ~ :"::' '?' '0~'0'05:'''/~:::: 0.0079 0.005, 0.0056 0.005 ND 0.005 ND .1.0 #825 ID:T2-W2 Benzene Toluene Ethylbenzene p-Xylene' m-Xylene o-Xylene Isopropylbenzene TPH (Gasoline) ugm/gm MDL,ugm/gm ND 0.005 ND 0.005 ND 0.005 ND 0.005 ND ... 0.005 ND 0.005 ND 0.005 ND 1.0 Kevin Lagan~ ~ . Analytical Chemist SMC Laboratory Client Name: Wegener Construction Address : 1710 Calloway Bakersfield, Ca. 93312 Attention : Bill Shiede Analytical Chemistry Date samples received :3-23-92 Date analysis completed:3-25-92 Date of report :3-25-92 Project Name: Jaco Oil Co. RESULTS OF ANALYSIS: %821 ID:T1-E2 ugm/gm MDL,ugm/gm Benzene ND 0.005 Toluene ND 0.005 Ethylbenzene ND 0.005 p-Xylene ND 0.005 m-Xylene ND 0.005 o-Xylene ND 0.005 Isopropylbenzene ND 0.005 TPH (Gasoline) ND 1.0 %822 ID:T1-E6 ugm/gm MDL,ugm/gm Benzene ND 0.005 Toluene ND 0.005 Ethylbenzene ND 0.005 p-Xylene ND 0.005 m-Xylene ND 0.005 o-Xylene ND 0.005 Isopropylbenzene ND 0.005 TPH (Gasoline). ND~ 1.0 Method of Analysis for BTX/TPH (Gasoline): 5030/8020 MDL = Minimum Detection Level TPH = Total Petroleum Hydrocarbons ugm/gm = micrograms per gram (ppm) ND = None Detected Kevin Lagan ~ - Analytical Chemist 3155 Pegasus Drive ' · Bakersfield, CA 93308 P.O. Box 80835 · Bakersfield, CA 93380 · ·(805) 393-3597 FAX (805) 393-3623 Oil C) l~' URCE MANAGEMENT~"~ENCY ~  ..L Ke Address: ~ ~ ~ ~ ~ County ==UND~GRO~ND TANK DIS~S~ION T~CKING RECORD~z ~** .~This fora ts;~o ~ r~tumed to the Ke~*'County Envim~ntal.jHealth *~'De=a~ent within 14'.~avs of accedence bf/:~h· t~k(s) by'an ~bp~oved .... or.~cyc]lng ~actllt~.~ The hplder of ~he pemlt vlth the.n~r noted .... resnons~ble for insur~t~g tha~ this fora ts co~n]e~ed and retUrned. ~ ~ To be filled out by t~k r~oval contractor: Address: /~/D ~ /~~ 'U. ', , ~' , ~ho~',: , D~e Tnn~). R~ved. ::~., ~./~/~.~'., ~,"No..o~' Tank(s): , ~, :,'. ~, ~. ~:~,.~.~, , , . . ~-. ,..,:., ..... ?,.:,-?,:,:../ :.. tan ):~ . Address:. /~/~ ~/~d~ ~" ""-- ~ -.~;': ..... Phone ,: Tank SI ze L.E.L. :;~ ' ~?' Tank '.:S 1 ze' ,'~"~'~' '~ *L. E. L. '.'~=; r ,..?;;" ::~'~;?;,,,~:-,,":A'~horizad rep~sehtatt'9~r'~fthe c°nt'ra~Or Ca,tries by sign'S'ag be'l°~ that ;'"'"~ ......... ~ink(s) have':been d~Con[~.inaCed tn accordanca with Kem County Environ~nCal ';::" "' ...... ~~~t~e~ O~j~i~t,~ raqut ~enCs. ' ~ ' "' '~";:J::::~;:'~ ";' ' ~ ~ ~ ] To be ~tlled o~ and signed by an..a~bortzed representative of approved disposal or ~Ycling' facill~7 'accepting ~ba ~ank(s): ' . - Address: ')o~c~ -~~.~ ~ . · ' Phon~: ~~.~ -- ~hor~ed '~,'ReDmsenCattve) · -/~:~ - O': · '' ..~ '~ S~, S~ 3~. ~....~ , ~0 9~01 (~) ...... and F~: (~) z .= HAZLZNG ZNSTRUCTZONS: ~61d ~aPle. DIRECTOR ' DAVID PRICE ili ASSISTANT DIRECTOR 'A-~.~NCY Envimnm. ~ental Healtl STEVE McCAI..LE¥, Air Pollution Control Dist~'t ... 'WILLIAM J. RODDY, APCO · :: ' ' Planning & Development :~" :' '.':. i:~T~ ~,/~c~,, ,.. ~ ..... ',,'.y~,.~: ,/,,-: '.. ,:.:, ¥., !.':'.'i:;i:'. · ,' ', : ;, ,,'-.~, .." '::??:~i': : ' 3." Tank closure 4. -" .It is the c~tra~tor's'r 5. The tank removal pe~nit. 7. ::!. 8. Soil Sampling (piping A minimum, . " ."m~... ,~,, E ~'~ ..... O~ 't~e t~k removal. The tank removal thc way in from thc ~nds of ~ch ~k - ...~ ,~ :'. ,.'.., ~ ...,, ..: ,, .... ,., . ,.. : ,, ~ ~' ...~ c,:..".., .', .'~ .'?'~- ,.~..., ,,,- .: .',; .,. :' '933o~ ~ ~."'"~;-'": ' · · .'.'.... PERMIT FOR PERMANENT CLOSURE OF UNDEROROUND HAZARDOUS SUBSTANCES STORAOE FAC]LfTY 10. Soil Sample analysis: " "'~ , '. · '~ :' ~:.: ': .':'":~'/:::' " a. All soil samples retrieved from beneith gasoline 0ead~t/unleaded) tanks and appurtenanc~s must be analyzed fo~. I:)~azene, toluene, xylen~:~i: b. All soil samples retrieved ~rom ben~t_h.dk~.J t~nks and ~p'i3unenah.~' mt~st be ~ for to',~l petr°l~' h~r~ns (for diesel) a~' c. - , ~ soil samplm retrieved from ~th.~te oil ~tan~s and appurt~ccs mnst~be a .nalyzed for tothl o..~...i~dcs,'lead, oil and e. . All soil samples r~meved ~om I~neath ~ and appur~,ces.t~t~ .cg~.n~ ~?kn_own substances must ~ a~ (~r a fiill range of substan~ .~ . .. -~ .,,/, .:..~'..:.~,~, ~:~.. , ~;,. -,.'..:. ' "~,.,~a~',¥,9~.;.~:.:~'~:'~:~:~.~'~?~.?~.,~C.,:~-. .~',~,~,/~... ,,. . ~i,'~;.?.,..'~'~,~,:<.o.V.'~.. .. ~ , .. that may have been stored within the tank. '.~ .:v? .-.~ · ~ -' ..~v-,~,~..,~ ~?.~.~.~??~.~! '~'.~x.'-' ~: ~-'- .~...~.~:~ ' - ?' ~ ,'~a~'~/, :.'.J-'~'." -:- -=, . . - ' - -.~.' ~.,.~*'~/~--' ~.V ~ - .~:.' ~.' ..... ~,,~-~ ~,'~,~:.~-.'~:,~;*~;:~;,:~.~/ .-~,.:?~. ?.. ' ',~ ', ,-~ ..~',:: · ' , ':" ';~,~ ~, ,=~ ~.';'i~''~. .. .,--;~ ~'~ L All soil samples remeved h'om beneath..t~uks and app .u~. ensnces,that con~uned fu.,'fU~_~, i a]cbh01 r~in must be:~ for phenols, fo~ · and fuffurld alcohol - .;~.!,.'~::;'~¥!~!'~.. ',~,...:~:',..~,'~: id~ ' ??~:~-::-...'~J ~'::!~., =. ,.:':" ~ ..~ .... '~:~i'.,:,' ~ --. :; .~./..". '.;" ' ~ .' .~,:,/;~.,a'.~ ~ ":~ %.-,:' !.:.~:i' ._~.:-~.'/':- '~'"" '~:?,'"'?;;:C:?,", ",. The following mnetable lists pre- and po~t- .tm~, r~moval reqmreme~, ts:, + '/::'.'~'i':.::':':'. '- , ?. '. ~"" ../: '.:,~':::' :" · ' ' RECOMi~ATIONS/OUIDBLII~ 1. Job site'safety is one of our primary concerns.: regulations. The job foreman is responsible for the Crew and an) excavations Or when unsafe COnditionS exist in ar~ 'never substituted for ladder~. '.. '~. 'i , ' .' '~' ,~ , . . " ,:;,? th.~ ~:oudi,ions.:~ ,~ p~.rmi..'c 3.' ~ IndividUal ner~_,y for each site:i~. unmanageable schelde~1672.38.P~a-,, '., abide b~ ~ to ~'~ "' ~ontractors do not' follow through on necessary for completing new .closures Will increase., ,.:, .'./? .:.' . ..~~.. :" "'"'~ :? ,~Y EI~IVIRONMENTAL.. HEALTH SERVICE ~ DEPARTMENT SERVICE AND COMPLAINT FORM Date ........................... ~i.L== .... Time: ...................... .~ervlce Request [] Col'~rlplalnt CT No.. ...................... Assigned to.. I_ocat,on ~'~~ ~ ..................................................................................................... ................................................................................................................... City ............................................................................ .......... ::"' ......- : :r 7Wr: ........................ : ................................................................... ~teportlng Person . ;;'~ ...... Address - . :.- .- ........... r' .................................... .~. .......... Phone property Owner ............................... .-.--:. .............. Address :. ' ........................................................... Phone Reason for Request · .. ~ ' .' : · ~ ' ~- - .... -~- .......................... :; .......................................................... , .............................................................................................. ......~'-' .............. ' : ..........· '£"-'~'" ' ......... '" "~" ........................... " :'~' .................................................................................." - ' Informat on ." - ~ :' ' ' ' .... ~':'"::~.': : · · .'~::.~' ,'".,~"~:='.-,.'. , -: -. Taken by .,{'/ ..... ,-'.-~ ~.,~ ~ : . RE~ULT~ '"'~ ' ~'--'"~·~ -----'--~'-----~ = = - : ' ---- ~-L-z~'"'"~. "" ' ? ,' ~ vr . ' ' ~' ' ~.? :-~':.;~ ,. ' .':.. ,. . ...',.. ..... . - ,~ .--,--. . -- ...... '" ' '.': · . '-'.'.' -' :~':'~T/' ;"L.:'''~: :":". '' ~ ?..T-'~:~ ? ' 'T;; ~-'; ......... '- "'.' - ' '- - - ........ :...L_L.'.; : '.':?'..';,':'?.~ :.'::'.il.i ..... .. '"'.-'.. '. - ' .. ' . · ' . Complainant n~)tlfled'?:':.. :i:" . 7:~:;..':'~?_..};,:,..~,;~; :~-~.:.. .. ' - ..' , .: :; .,.. ,..~ ~:,, ,;.~, ;.,.-~...: .... . ... . . . ~ . o~ ,,,, ~, L~ .." ' ~':/.' ','~.~ti~ ~' ..... .'.. · .: .... . '; ,~:...:.. . - . .'.': ~.7,<.t?t-~-;-%t;--~r.~--..~. . . Y ...-, .' - . '. · ... -~. , · . ; .-: ... ..:- . . .. . , ' ',:~ ".;' "'.':,. ?~.~ ~,-;,.' -..:' .';?-'",.~. :'~,;.;~S~:,';~;:t'.;?~,~:~;Z~'~;?;t-~t~S?~?~ffT~;t~.~-~------;-;~ ............... ,.:.._..;__-., ~ Date ' . ":-'~;~ :;.~:':'-.-'.~','~;~":~::,~;',:'J?:.": ~ ~.' '::r; :;~'~:?-~;;~;~::;'-~ ~; J~:k,',','~;~;':._ .",.:.? ~..~ .:- :?.';';,~';;~:~.=;..'; .: .~,: .= ,'.~: ?..' '~;' - -. ,,' ~.~ :... Enviro~mpntal Health 580 4j 2 ' ;,.,~-.:--:~:;-~,:;:.~,~;;::~-~.;..~,:~::~;?~.~,~,~:,~:<~.?.~.:,: ~ ~; .~:..:,, ...,..,. ~,:.:~9:.(Re~. ' '.' ' .. ) -...'~,~"~ ,~. ' '.. .:'., , .;-'.?~r.~.~.~l,-./. -. '~ '~, :.'. ,z,i~ .,'. '..' 5~ .' ' ~;~';~ ?' ,,'~;~'...L, .- . :.'.?,'~ ? ~-.~;~ './~. "~. "'. :' '../..'?'. ". ' ' -: '> :,:~..'~ FACILITY ADDRESS ' APPLICATION FOR TANK:--V/- A. FACILITY INFORMATION: COMMENTS: ~CLOSURE APPLICATION ~I~-'r'.CKLIST REMOVAL APPROVED 'v'~ PERHIT IP CLOSURE IN PLACE DISAPPROVED CONTRACTOR INFORMATION: APPROVED ,~ DISAPPROVED 1. ALL LICENSES CURRF..HT/CORREC'rT (~)/NO - ......................... ........... 3. ~BO~TORY STA~-APFRO~~ SP~CZ~D ~YSES? ~ HO C® CHEMICAL INFORMATION: APPROVED / DISAPPROVED COMMENTS: / / / ENVIRONMENTAL INFORMATION: APPROVED /' DISAPPROVED E® DISPOSAL INFORMATION: APPROVED COMMENTS: DISAPPROVED F. PLOT PLAN: APPROVED //v' DISAPPROVED COMMENTS: SUMMARY: PLEASE SEE ALL .DISAPPROVED ITEMS AND COMMENTS ABOVE BEFORE RESUBMITTING CORRECTED APPLIC~I. ON: SITE INSPECTION: APPROVED DISAPPROVED COMMENTS: _ INSPECTOR DATE KERN CCLJNTY R~RCEMANAGEHENTAC~Y ENVIRONMENTAL HEALTH SERVICES DEPARTNENT 2700 'M' STREET, SUITE 300 BAKERSFIELD. CA 93301' (805)861-3636 (FILL OUT .(~E APPLICATION PER FACILITY) THIS APPLICATION IS FOR 1: FEILIffiJRg~IIa c~r~: ~,~_o 0;/ Co,. ~ ~: 5q 5 - '700D A~,P~,C,6IZ..C~_.FgR PERNIT FOR PE~'flANENT Luc=uNb/ABANDONMENT OF UNDERGROUND HAZARDOUS SUBSTANCE STORAGE FACILITY ~ REMOVAL, OR (] ABANEONMENT IN PLACE C: OBlcq; l~q~ePfflCN [ T~ '(R.$AL I~TICNS): INE3U~'T ~ ST~: A /I~) ziP: ':7 ~ ;~o~ ICHENICAL CCtflPOSTION.OF MATERIALS STORED. I TANK # ._VOLUME ~ __~O~_~ C~_.EN_IC~L STORED DATES STORED C~I/MICAL STORED · ~Pl.~ C(~4PLETE THE REVERF~ SIDE OI= THIS APPLICATION BEFORE ~I.,~ITTING FOR REVI~_.~: i THIS FORM HAS BEEN C~,LETF. D UNDER PENALTY OF 'PERJURY AND TO ~T~T OF MY .~.,..OWLE .DG£ I$ TRUE AND ,' . I R E C E [ P T PAGE 03/16/92 [nvo~ce Nbr. 12:05 am KERN CO RESOURCE MANAGEMENT A~ENCY 2700 'M' Street Bakersfield, CA ,. 93,301 Type'of Ord®r (805) 881~3~02,'~· ..... . .................. , .... ,,._,-.,,,_..-,",,,,-......'."-'-',----~ ...... CASH REGISTER "HEGENER CONSTRUCTION Cus~omeP P.O.~ ~ Htn By ~O~deP Da~e ~ Sh~p Dace ~ V~a I T®Pm~ *' ' ! HO316921 I GLC I 03/16/92 I-03/16/92 IDF I '.NT ........... i ........I__. ........I ...........I .. __ __'__. _ I .... ~*-.1 1 4751 UNDERGROUND TANKS CLOSE/ABAND. 1 650.00 E USTO02 OPdeP Total' THANK YOU[ Amount Due Payment Made By Check 650,00 ' KERN COU NTY OFFICE MEMORANDUM TO : ACCOUNTING SUBJECT: CLOSURE OF WORK ORDERS WORK ORDER NUMBER WORK ORDER NAME LAST DATE WORK ORDER WAS UTILIZED REASON FOR CLOSURE OF WORK ORDER WORK ORDER LOG ~ fA/v( R~.gPON~'rBr. B RP ADDREHfJ** ; 0t~l ~ t f~ L~ ~ PROGRAM: DEBCRZPTZON: LOCATION** F~C~L~TY 17AHE= COI~ENTS= 116-002 >~ 1 00000 3 .... 02010 78228 ..... ... FROM PARCEL .~ KING LEONARD E RT 8 BX 199 BAKERSFIELD 04 93307 RT 8 BX 199 ,. 14 7000 7,000 16.552 ACTIVE 7,311 ......... 23,552 106-040-02-01-8 BAKERSFIELD CA 93307 TONN OF ROSEDRLE LOTS 7-8-9-10 & PTN BEL ...... 0000 ,~, 003 .... 00000 .92 '" 406-040-0>-0>-4r MOORE BESSIE & ROSALENE 116-002 .... 1 00000 " 3 .... 02020 ..... 712 S CHESTER AV 00/00/00 BAKERSFIELD CA 93304 ,, FROM PARCEL ~. 712 S CHESTER AV ,. ,,. 106-040-02-02-7 BAKERSFIELD CA 93304 ,o. -',. TONN OF ROSEDALE 1002 INT M.P. LOTS 7 TO .... -, 0000 .,. 003 ..... 00000 .: ACTIVE '-' m)6-040-03-00-9C KEMPER LYNN N "' 6231-0637 ~1~-002 .... 1 00000 " 3 22070 78229 ~.. 2604 SPRUCE ST " BAKERSFIELD CA 93301 FROM PARCEL ,, 2~04 SPRUCE ST 106-040-03-00-2 BAKERSFIELD CA 93301 " '" 33513 ROSEDALE HNY .... ' S ,,, 3 .... RSDLE ,, · " 406-040-04-00-2C WIENS RKGL FAMILY PTN ET AL o0000 3 12030 78228 FROM PARCEL 04/21/89 .>. BAKERSFIELD "' 6211-0809 -- 26,483 ACTIVE 26,483 .-. '" 406-04')-05-01-4C .-", 29922 LOS ANGELES AVE 02/22/89 SHAFTER CA 93263 ,, -- 29922 LOS ANGELES AVE ,, SHAFTER CFI 93263 ..... ,'. TONN OF ROSE.OALE LOTS 1-2-PTN NEST AVE. .: 0000 -', 004 ,..~ 00000 DERTINGER BARBARA ANN -' 6551-1785-- 18,782 ACTIVE 5,481 13,301 18,782 ,-, 116-002 .. 1 · 00000 3 .... 16000 86154 ~'. 1041 MIRA LOMA BAKERSFIELD CA 93309 FROM PARCEL '-. 1041 MIRA LOMA I06-040-05-01-7 BAKERSFIELD CA 93309 .... 128~1 ROSEDALE liNY .... · ~ 3-5 " ...... RSDLE 406-040-05-02-3C NELLER RICtiARD B & PAUL A 07/31/91 BAKERSFIELD -' 6249-1162-., 69, 158 ACTIVE 32,686 ......... ,,-.,,-~,., 36, q72 69, 158 .- 116-002 1 00000 3 82020 FROM PARCEL 10G-O40-OS-O2-G 5701 LOGAN ST 05/31,'89 :,, BAKERSFIELD iSA 93308 .. 5701 LOGAN ST .. BAKERSFIELD CR 93308 .. TONN OF ROSEDALE 100:~ INT M.P. LOTS 3-4- 0000 -.. 00~ -- 00000 AC T I VE PAGE 727 F F. I Lll I {OFFICE ADDRESS) HEARING N OTICE NO. CF38000 . ENVIRONMENTA HEALTH.' DEPARTMENT County of Kern DATE Jun~_ 17 ~ 1041 Mira Loma ~O Mrs. Barbara Derringer ADDRESS DBA., ~MCO ADDRESS 12851 Rosedale Hiway Uponinspection oftheabove prope~ywe~undthatyou had not complied with: Failure to respond to directives of the January-9th NOTICE of VIOLATION issued ' by this department. No application for Permit to Operate or Permit to Remove recieved. Therefore, you are hereby requested to appear at a hearing on this matter. It will be held at 9: 30 (A.M.) On July12 ' , 19 91 Pia~i,iKern Countv.,gnvironmen~al Health Departmnnt :300 ' ' Ai.thi{ hearing you may present your plans for correCting the existing violations or reasons for non-compliance. You maY'be rePre- sen{ad By ~ei~ eouh~el. 'FAILURE- T© APPEAR MAY .BE DEEMED:, CAUSE FOR FURTHER LEGAL ACTION. ' : STEVE McCALLEY Director DEPARTWENTAL HAZARDOUS MAT ENT PROGRAM 2700 M Street, Suite 300 Bekerifleld, CA 93301 Telephone (805) 861-3636 Telecopler (805) 861-3429 Date Firm Name "1"'O~o Address Person InterVieWed NOTICE OF VIOLATION AND ORDER T° COMPLY Underground Tank Facility # EPA I.D. # AsSeSsors Parcel # . *., '::,.:. ._, The following conditionSOr practices observed this date are violations of one or more sections of the CalifOrnia Health and Safety Code, Div. 20,.or the California Code of Regulations, Title 22, Div. 4, Chap. 30, relating to the "~toragel handling, transportatiOn, and disposal of.hazardous .waste'' or the Ordinance Code of Kern Countyl Div. 8, "Underground Storage of Hazardous Substancesi" Conditions or' practices must be COrrected Within the times ordered beloW: I , I/ ~ Your signature acknowledges receipt of a copy of this report and collection of any samples described above, and is not an admission of guilt. Failure to fully comply with this "Notice and Order" may result in further legal,action bv"¢ounty or_State officials. -" ' Df/, /'L_ I/ ~ Owner or Authorize, d~epresentattve HazardoUs Materials White -- Original . ' Canary -- Facility file Pink -- Environmental Health 580 4113 120 (Rev. 2,,~O) 'r:*'r -'vii T PROCESSI REVIEW SH.~..'"i PERMIT NUMBER A~,SIGNED TO THE FACILITY,: [ACZ L Z T~ NAME ~"~eDRESS , ,,~ . ..,. ::~, ~,,' , ~ -'~'. .... ~.~...~....= ....... =~ ....... ~..~ .... ~_.~..~.. ~ ~ , . . , "~'>~,,~: , ~'. _ . . ,: ,. .. .., .............. , ...... ~ ..... ~,....:....~,~ ........ ~ .......... ',,.~::' ..'.',. .~.. ~ ~ ~ ~ . · .... ., · ~ , ............................................................................................ ~ ...... ~:. ..... THE NU.eE~ OF ~AN~S S~SPECTED',~ ~ :~ '' ' ' . .... ~ .... ~ .... . S'~FAC[L[TY~ ' " '" NOTES ON CORRESPONDENCE~PHONE-'.~.~':Y~Z~/~ '- ~.: ~'.- . ,. .... : . .... . ...... . .... , ..,. :.~ ~7 ~::~. .,, .. , ~. " "7 '"' · -, '~'~'"~,,,~,~ ': '~ :'.-".' .*' 7 ':.. NUMBER OF ,TANKS ~.ON PER~ APP/~T~ATT~kl ..... TANKS ,WILl" BE .REMOVED '.. . . ,.. ............. TANKS,~NILL BE OPERATED ..., ''" .. ' '~&. ~ ~ ""~'.~'~,~. %L '..-L: ? ' ~. ' ~'""~.""-.,~ '~." , " -' ~ '1'.'. ' ' "7:~:~ PF~GE $1 PRGE S,~ %, ~ 02010 7§Z~U ~ 127~3 HU$[L~ HNy UU/UU/UU '" BRKER'SFIELD CR 93312 ,' MM 7000 - FROMM PKqCEL ' 127~3 ROSED~LE ~ ,- 7.000 10&-0~0-01-00-6 8~E~IELD CR 93312 ~ " ~ 12717 R~ ~ ~ ';AKERSFIEL0 .... 1-' '' ~ ' ACTIVE '~ q06-0~0-02-01-~C KING LE0~q~D E - -- - 00000 . ~ . _ -- 02010 78228 ~ RT 8 BX 19') 00/00/00 -- '" BRKERSFIELO CR ~3307 ,. H 7000 - F~OMM PI:L~CEL . RT 8 BX 1~ ,. ,- 7,000 10&-Oq0-02-01-O BP, K~I:~--~FIELO CR 93307 ~ IS.63~ '- ~ TO~I OF ROSED~LE LOTS 7-8-9-1~'& PTH BEL .... ,, 0000 ,- 003 -- 00000 - .92 RCTIV~ 7,0?8 I S,61 ! 22,639 --~0G-0~0-0Z-02-qC ~ BESSIE & ROS~LENE .. ~ 00000 ~ ~ -- 8~020 ~ 71~ S CHESTER ~/ 00/00/00 B;qKERSFIELD CR 93~ ,, ~0&-0~0-02-0~-7 ~IELD ~ 93~q ~ T~ ~ ~ ~00~ INT H.R"LOTS' 7 TO ~-- ,* 0000 ,- 003 IqCTIVE ~06-0~0-03-00-~C K~IqaER NI~qC, RRET C & LYNHN 11&-002 ~ 00000 - ~ ,-, 22070 *78229 ~ 2&O~ S~RUCE ST W:~.ERSFZELD CA 9330! FRei PPACEL -- 2(,0~ SPRUCE ST 10&-0~o-03-00-Z ~X:ERSFIELD CR 93301 -- 33513 ROS~DflLEHHY ,* 0000 .- 003 -~ 00000 - ~913-039q -- 09/0S/8& -- 'I~KERSF IELD ' ~CTI~ - 00000 -- 12O30 '787.28 10&-0~tO-0't-00-S //] '-- ,~o&-0~o-0s-01-~c / i~ Ilg-OOZ / I ' 00000 [ J = I&000 8&lSq. _ ,': LJFROM PPJ~EI. NIE/~ RKGL FflNILY PTN ET Fi. - 62.1 !-0809-- L~97.~ LOS I~GF. LES ~ Oi 932.63 - - T~ ~ ~ LOTS t-Z~ST 0000 .- 00~ -~ 00000 ~ELD CR ~3~ 10~1 NI~ L~ ~ZELD CR 93~9 -- ~ue-u~o-os-OZ-~ ~LLER RInD I I ~ fl ~ 00000 ~ ~ ~ F~ ~C~ - S701 L~ ST . .. 10&-0~0-0S-0Z-& B~E~IELD ~ 93~8 , · - - T~ ~ ~ 1001 ~ ..R" ----,. 0000 .- 00~ -- 00000 18,055 ~CTI~ 3s.0r~ TRX DEFRULTED 1~90 ACTIVE ..... ~CTIV'E ~0E-0q0-07-00-1C T~ IRENE Y .~ 11&-002 ~ 1 - ~317-006~-- P~GE &6 Pt:16~ 67 ,I FROH PRRCEL ', 23~.7 NELCH 0~ RR 106-090-18°00-! BRKEI~aF IELD CA 9 ..... 2327 I,~LCH O~ "~ q0&-0~O-03-00-~C FRIEOLOS DOI~LO C "116-002 ~ I ~ 010&0 17S -., 1~3~ ~ RD W:#(~d~aF ZELD CA ~ '~R0~ Pf~qCEL - 1~.32 I~lf'RO Ri) 106-2S0-03-00-3 W~IELD CR 9 116-002 ~ _! ' -- '2787 f -- .... Itt'.....'../.; G I 80 /Vote: A//d/e~a o~en: I I I . .~',~. ~__ ~ I I :.: I I I I I I $ I I 2.~8~.c I I I I I I ASSESSORS MAP NO,..4O6-Q,. COUNTY OF KERN RANO~4.1. L. ABBOTT A~e ,_nFy Dir~tor *' (806i 861-3602 'STEVE Mo CALLEY Director RESOURCE M ,' "' "' NT DEPARTM~MENTAL HE~'S 2700 M Street, ~uit~ 300 Bak,ereflekl, CA 83301 Telephone (806) 881-3636 T®lecopler (806) 861-3429 AGENCY September 25, 1990 Thomas & Barbara Dertinger 1041 Mira Loma Bakersfield, CA 93309 RE: 12851 Rosedale Highway, Bakersfield, CA Dear Mr. & Mrs. Dertinger: It has come to the attention of the Kern County Environmental Health Services Department that you own at least one.underground storage tank which is currently not permitted through this department. Current law requires that all owners of existing underground..storage tanks apply for a permit to operate their facilities, unless they meet.exemptions provided in Chapter 6.7 of California's Health.and Safety Code.~ The exemptions'provided in law are listed below: A tank with a capacity of 1,100 gallons or less which is located on a farm and which stores motor vehicle fuel used primarily for agricultural purposes and not for resale. A tank which is located on a farm or at the residence of a person which has a capacity of 1,100 gallons or less and which stores home heating oil for consumptive use on the premises where Stored. e Structures such as sumps, separators, storm drains, catch basins, oil field gathering lines, refinery pipelines, lagoons, evaporation ponds, well cellars, separation sumps, lined and unlined pits, sumps, and lagoons. 4. Tanks not substantially underground. Se Tanks storing substances not designated as "hazardous"; the following liquid and solid substances are considered "hazardous substances": those defined as such in Section 25316 of the Health and Safety Code of the State of California substances on the list prepared by the Director of Industrial Relations pursuant to Section 6382 of the Labor Code of the State of California any substance or material classified by the National Fire Protection Association as a flammable liquid, a Class II combustible liquid, or a Class III-A combustible liquid Thomas & Barbara Derringer September 25, 1990 Page 2 any regulated substance, as defined in Subsection (2)of Section 6991 of Title 42 of the United States Code, as that section reads on January [, 1989, or as it may subsequently be amended or supplemented. OWNERS OF THE FACILITIES NOT DESCRIBED AS EXEMPT ARE CURRENTLY VIOLATING THE LAW AND MUST OBTAIN ONE OF THE FOLLOWING PERMITS IN ORDER TO BRING THE FACILITY INTO COMPLIANCE: A permit for operation A permit for tank removal The owner must submit a completed application to the Kern County Environmental Health Services Department before the permit will be issued. To assist you with compliance, the. Department has included applications and instructions for the proper completion of each application within this packet..Completed forms must be returned within 14 days. The application for the permit for permanent closure' of your tanks is to be submitted IN LIEU OF t~e application for the permit to operate. Failure to obtain a permit may result in fines of five hundred dollars ($500) to five thousand dollars ($5,000) per day per Division 8, section 8.443.480, of the Kern County Ordinance Code. If you have any questions, please feel free to call Jane Warren or Amy E. Green at (805) 861-3636. Hazardous ~ s S p~-~i~J-i~J~5 Iv:rial Hazardous !rials Management Program AEG.' JW: cas Enclosures dertin-h.m82