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Home My WebLink AboutUNDERGROUND TANKN amily entistr_y~ Perimeter Chain Link Fence (Vacant Lot) 3,000 Gallon Gasoline USgi~ Driveway Power Pole ROSEDALE HIGHWAY Kern Co. i Fire Dept Sta. 65 ~ Title: UST Location - Pearman Family 9500 Rosedale Highway, Bakersfield, CA Scale: None Date: 08/95 Drawn By: Betsy Dunkel Revised: KERN ENVIRONMENTAL SERVICE Post Office Box 5337 Bakersfield, CA 93388 Figure No. 00lIKES Project No. 94-3410B R.E. HUEY HAZ-MAT COORDINATOR (805) 326-3979 FIRE SAFETY SERVICES & OFFICE OF ENVIRONMENTAL SERVICES 1715 CHESTER AVE. · BAKERSFIELD, CA *, 93301 September 28, 1995 R.B. TOBIAS, FIRE MARSHAL (805) 326-3951 Duane Crosby, Agent Pearman Construction 3202 Eanes Circle Austin, TX 78746 CLOSURE OF 1 UNDERGROUND HAZARDOUS SUBSTANCE LOCATED AT ~9:50-O---~-O-SEDAEE_-EIWY-~ N BAKERSFIELD. PERMIT # BR-132. STORAGE TANK Dear Mr. Crosby: This is to inform you that this department has reviewed the results for the preliminary assessment associated with the closure of the tanks located at the above stated address. Based upon laboratory data submitted, this office is satisfied with the assessment performed and requires no further action at this time. If you have any questions regarding this matter, please contact me at (805) 326- 3979. Sincerely, Howard H. Wines, III Hazardous Materials Technician HHW/dlm cc: Jason Castillo, RWQCB KERN ENVIRONMENTAL SER¥1CE REPORT OF UNDERGROUND STORAGE TANK CLOSURE FOR PEARMAN CONSTRUCTION 9500 ROSEDALE HIGHWAY BAKERSFIELD, CALIFORNIA RECEi~/ED Submitted To: Bakersfield City Fire Department Hazardous Materials Division - UST Program 1715 Chester Avenue Bakersfield, California 93301 Prepared By: Kern Environmental Service Post Office Box 5337 Bakersfield, California 93388 KES Project No. 94-3410B September 19, 1995 Post Office Box 5337, Bakersfield, California 93388 · (805) 589-5220 In California · (800) 332-5376 '1 I I I I '1 I I ! 1 II. III. Vie TABLE OF CONTENTS Background .............................................. 1 A. Site Description ..................................... B. Permits ............................................ 1 Tank Removal ............................................ 2 A. Tank Preparation .................................... 2 B. Observations ........................................ 2 Soil Sampling ............................................ 3 A. Sample Procurement and Analysis ....................... 3 B. Laboratory Chemical analysis Results ..................... 3 Conclusions and Recommendations ............................ 4 Appendix A - Regulatory Documentation Appendix B - Chain of Custody and Laboratory Chemical Analysis Results I I I I ! I I I I I I I I I I REPORT OF UNDERGROUND STORAGE TANK CLOSURE 9500 ROSEDALE HIGHWAY BAKERSFII~.D, CALIFORNIA Background A. Site Description Pearman Construction previously operated one 3,000 gallon capacity underground storage tank of single wall steel construction with dispenser at 9500 Rosedale Highway, Bakersfield, California. The tank was used for the storage of gasoline. The site is currently vacant with exception of natural vegetation. Also present on the property was a septic tank which served the former construction office building. Abandonment of the septic tank was incorporated into the scope of work to be completed. As a measure of compliance with the current City of Bakersfield underground storage tank (UST) regulations, Pearman Construction elected to abandon the tank by removal. Pearman Construction engaged the services of Kern Environmental Service (KES) to coordinate the removal activities, obtain permits, take soil samples, and prepare a report of findings. The underground storage tank installation had no reported history of leakage. Permanent closure by removal, as presented in the City of Bakersfield options for UST closure, was chosen as appropriate for the UST removal operation. B. Permits On August 21, 1995 permit number BR-0132 was issued by the Bakersfield City Fire Department, Hazardous Material Division, Underground Storage Tank Program, for removal of one (1) 3,000 gallon capacity underground gasoline storage tank. Preparation of the underground gasoline storage tank for removal was performed per the City of Bakersfield recommendations for removal of UST's. On August 24, 1995 permit number 95-03931 was issued by the Bakersfield City Building Department for abandonment of the septic tank. A copy of the permits for the septic tank abandonment and fuel tank removal are included in Appendix A - Regulatory Documentation. I I I I I I I I I I I I I I I UST CLOSURE REPORT PEARMAN CONSTRUCTION KES PROJECT NO. 94-3410B SEPTEMBER 19, 1995 PAGE 2 II. Tank Removal A. Tank Preparation On August 31, 1995 all residual contents from the underground gasoline storage tank were removed with a vacuum truck for transfer to a permitted recycling facility. A pressure washer was employed to accomplish decontamination of any associated lines and the interior of the tank. Internal tank vapors were monitored until satisfactory lower explosive limits (LEL) and oxygen content levels were achieved. All rinseate and residual contents were transported to Gibson Environmental for final disposition. The waste was accompanied by Uniform Hazardous Waste Manifest Number 93336464. A copy is included in Appendix A. No fuel dispenser was present at the time field operations commenced. According to Mr. Steve Pearman, the dispenser used to be located directly above the existing tank location. Excavated soil from the underground fuel storage tank was stockpiled near the excavation. No evidence of contamination was noted to be present (i.e., visual or olfactory). After removal of the UST and collection of required soil samples, the excavation was backfilled with the excavated soil, additional clean soil was imported to restore the UST excavation to grade. Soil overlying the septic tank was excavated and the top of the septic tank removed. The interior of the concrete tank was noted to have been previously emptied of all pumpable waste contents. A backhoe was employed to break the bottom of the concrete tank. The concrete top to the septic tank was mechanically reduced and placed into the interior of the existing tank. The remaining void was filled with soil and brought to the same grade as the surrounding soil surfaces. B. Observations On August 31, 1995, the fuel tank and associated piping was removed from the excavation. Said removal and associated soil sampling was witnessed by Bakersfield City Fire Department representative, Mr. Mark Turk. I I I I I I ! I I I I I I I I UST CLOSURE REPORT PEARMAN CONSTRUCTION KES PROJECT NO. 94-3410B SEPTEMBER 19, 1995 PAGE 3 II. The tank and associated piping was placed on a truck for transport to Golden State Scrap metal, Bakersfield, California for disposal as scrap. Certificate of Tank Disposal/Destruction Form No. 10653 is included in Appendix A. The fuel tank was observed to be in excellent condition with no evidence of leakage or failure at any point in the system. Soil Sampling A. Sample Procurement and Analysis A total of two (2) soil samples were collected as directed by the local implementing authority on August 31, 1995 following UST removal activities. A backhoe was used to excavate a representative sample of native soil from depths of two and six feet below the bottom center of the tank. The samples were brought to surface grade for collection. No soil samples were collected from the vicinity of the septic tank. Soil sample locations are presented in the Figure in Attachment B. Soil samples were collected by Kern Environmental Service Senior Project Development Specialist, Steve Howard. The soil samples were collected in strict accordance with the City of Bakersfield guidelines for soil sampling. The soil samples were analyzed by BC Laboratories, a California Department of Toxic Substances Control certified lab located in bakersfield, california. The samples were handled and transported in accordance with EPA SW-846. The soil samples were tested for total petroleum hydrocarbons (TPH) as gasoline by DOHS/LUFT Manual Method, Modified EPA 8015, for benzene, toluene, ethylbenzene, and xylenes (BTEX) by Method 5030/8020. Sample collection times and dates are recorded on the Chain of Custody Record (See Appendix B - Chain of Custody and Laboratory Chemical Results). B. Laboratory Chemical Analysis Results Laboratory results indicated that all samples were non detect for all analyses. The laboratory analysis is consistent with field observations. UST CLOSURE REPORT PEARMAN CONSTRUCTION KES PROJECT NO. 94-3410B SEPTEMBER 19, 1995 PAGE 4 V. Conclusions and Recommendations This underground storage tank removal has been conducted in accordance with the City of Bakersfield Fire Department guidelines. Results of laboratory chemical analysis and field observations indicate that the tank site is apparently free of hydrocarbon contamination. The local implementing authority will most likely not require any further action at this location. This closure report has been prepared for the exclusive use of Pearman Construction as it pertains to the property described as 9500 Rosedale Highway, Bakersfield, California. The findings and conclusions rendered in this report are opinions based on chemical testing of soil samples collected during the course of this study. Work has been performed in accordance with generally accepted industry standards. Thank you for this opportunity to be of service to Pearman Construction. If you have any questions regarding this report or the information contained herein, please feel free to contact this office at (805) 589-5220. Sincerely, FRANK R. ROSENLIEB, R.E.A. ~ ~l~- ,, ..... ~6;1~ )~ Manager ~"~~]. ~/ FRR:bd ~ I I I I I I I I i ! I I APPENDIX A REGULATORY DOCUMENTATION PERMIT APPLICATION FOR ~OV~ OF ~ ~ERGRO~ STOOGE T~ Site Infromation Code 933~2 ~N Site Address 95~ ~seda~e ~ .~i9 .... .,. ntractor Info,at,on C° ..... ~'L_._e ~-~ (8os)s89-s~o License~ Ad,ess Pos~ Otttce ~x >~>- - ~ ' -- ~13652 Insurance Carrier Tol~- a Wtker Wor~ans Comp · ~5 .. Preltma~a~ Assement Info~ation _ . . m an Ke~ S~t~,ta~ ~tce Phone (805)589-522° License~ a3237~ . Co P Y ...... - ~t:v ~ersft~dZip Cod~ 93~88 Ad, ess Post office ~x ~. ~' ~ - ' - Insurance Carrier To~- a wt~r Wor~ans comp · ~s ~5 . Tank Cleaninq Info~atio~ ' om an ~em s~tro~,t,~ ~tce Phone ~ ._P Y ...... x s337 Ci:y ~ersfteldZip Code ~3388 Address ~rctat Strut · City ~ . ~ - FaciLiCy Iden:ifica:ion N,~mher ~ ~80 ~3 ~77 . . Tank Transporter Info~atto~ ' ' ~°mDany ~s Trans~rtatton, ~,c. Pho,e (805)589-5220 TA~ INFO~TIO~ ' a e Volume ~hemical Da:es Stored Chemical Tank ~ g S:ored · Previo~ly Sto~ ~ LP~ ~ gal ~oline .... 19~ ~e - '" ~ ~ ElS ~PLICATION BECO~5 A PE~IT EEN ~PROVED . I I I I I I I ! I I I I I Perimeter Chain --~! Link Fence (Vacant Lot) 3,000 Gallon Gasoline UST iRosedale · Family I~Dentistry I, Driveway Power Pole l?:i?:i Building ??~iiiii::,.i:l /!~'K'~'- r"~Fire CO.Dept ] ROSEDALE HIGHWAY Title: UST Location - Pearman Family 9500 Rosedale Highway, Bakersfield, CA Scale: None IDrawn By: Betsy Dunkel Date: 08/95 'lRevised: KERN ENVIRONMENTAL SERVICE Post Office Box 5337 Bakersfield, CA 93388 00lIKES Project No. 94-3410B Figure No. I BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL. SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 CERTIFICATION STATEMENT OF TANK DECONTAMINATION '' Name an authorized agent of ury that the tank(s) located at gO--Od) .... ed under permit#. ~'~2~'~/r~O'~-~'&~ here by attest under'penalty of Contracting Co. ~(P~;~ '//~/ and '. Address has been Lci'eaned/decontaminated properly and a LEL (lower explosive limit) of no greater than 5% was measured immediately following .he~: cleaning/decontamination process. :~:'.~ ?" ., .., %. Name (print) Signature of Bakersfield Gibson. Environmental ~tlg~at~ 31, ~.gg5 I I ~BAMAN COHSTRU~TZON 0500 ROBBDALBImY BAKBRBFZBLD, CA 93308 I B~X~ ~{kC00X0?l$$4 (02S388) This letter'is to inform ~ou that Gibson Environmental has the appropriate permits ~nd/or interim status and has accepted I Your material for recycling, Gibson certifies that the material- received on the manifests indicated below has boen properly treated and recycled. I Date Manifest aovement Quantity uoH o8/31/95 933364g~ 0011X474 50 GAL I Zf this information dogs not agree with your records, please notify us within ten days so we can resolve any discrepancies. Generators, know your wastestream. Gibson Bakersfield is only pe~mitted to accept tho following vestee_that are varying . _ , combinations of oil; water and sol~ds under Oaliforn~a wasve ~oaos 22X, ~22, ~23, 241, ~n addition, Gibson at Bakersfield may &ooept waste codes D004 ~hrough D043. I I I I I I I For information as to approved codes for ~ibson,s Wilmington and Redwood City Eacilit~es, please call (800) 582-393S. This notice iH recruited by thb ~epartment o£ Toxic substancb ~ontroX.. ....... ".". ". ~.','...-~'..~'":~ .... ":...'. -..'.~ -'"" '~' "'.' : :-' '~-.'~ ' ' '" :"i- ~ Gibson Environmental Customer Service 3300 TrUxtunAvenue Suite 20O Bakersfield, CA93301 (80S) 3~7-04~3 I I A Su~{di~y of V.L.S.. Inc. ~300 T~Atun Avenue. ~uile 200 · Bake;afield. CA 93~0! * 80S; ~27~413 * 800; ${2-3935 · Fax 805 / 861-0m29 ~ R-~ydcd Paper State ,of Califomla~a~enmemal Protection ~.gency Form'Approved OMB ~. ~9 (~km 9-~94) P~ pr~ ~ ~. ~ ~ ~ ~ ~ ~ (1~) r UNI~RM HA~RDOUS WASTE MANIFEST 3..~r~or's Name ~d Mailing Address See Instructions on back of~ge 6. US EPA ID No. Manifest Document No. 2. Page I of '1 5. Transporter I Company Name 7. Transporter 2 Company Name 6. US EPA ID Number 8. US EPA ID Number I~em of Toxic ~st~e~'~l Sac ra~eeto, California Infom~atiafl in the shaded orec~ is not required by Federal law. '~ ii':' 9. Designated Facility Name and Site Address 10. US EPA ID Number 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number). 12. Containers 13. Total I ~,Special Harsdling Instructions and Add'~anal Inform.ati~n. ~ , *'. ~:~ - ~..::,. :/'4- Tq /~ ~.~ 16. GENERATOR'S CERTIFICATION: I hereby declare that. the contents of the ~:ons~gnment are fully and accurately described above by proper shipping nome and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway accordin~ to applicable federal, state and international laws. if I am a large quantity generator, I ce~fy that I have a program in place.to reduce'the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the prec~cable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best method that is available to me and that I Can afford. Printed/Typed Name Signatur~dur~--,~ Month Day ! Receipt of Materials ~/'"~~ / PriqJe"~l~d ~ame ."'O J Signatur 2 Acknowledgement of Receipt of Materials Printed/Typed Name Signature Month Day Year 19. Discrepancy Indication Space Owner or Printed/Typed Name DTSC 8022A (7192) EPA 8700~22 .of receipt of hazardous materials covered by this manifest except as noted in Item 19. I Signature . ..... / .... DO NOT WRITE BELOW THIS Green: /~onth Day Year HAULER RETAINS :~' I I 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: N? i~653 TANK DISPOSAL FORM Date~--~~. I ,19 Q~ ' Contractor'sl License No. Contractor's Phone No. JOB SITE: DESTINATION: G.S.M. · 2000 E. BRUNDAGE LANE COUNTY: &PECTION DRY (ACCEPT), OR .~~/RESIDUALS PRESENT (REJECT) DISPOSAL FEE SCRAP VALUE ~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 · ~B~KERSFIELD, cA 93387U ILICENSE NO: QTY GALLONS SERIAL NO. NET TONS 250 .14 ::: ::::::::::::::::::::::::::::::::'"'"'"'"'""" ~[! '"'"'"'""'"":!::$ :,:.:.:.:.:.:.:,:,:,:.:,:,:.7~'~'~'.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:,:.:.:.:.:.:,:: ::::: 550 .24 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ........... 1000 - 6 ft .61 :::::::::::::::::::::::::::::::::::::::::::::::::::: ................................. 2000 .97 ~ ................ ;oo; ......................................... ;':';~ .............. 5000 2.42 7500 3.28 9000 3.82 !.i,i.i.i ~i 12000 4.93 TOTAL TOTAL .--. CERTIFICATE OF TANK DISPOSAL / DESTRUCTION mHl~/~S T'~3/~RTIFY THE RECEIPT AND ACCEPTANCE OF THE TANK(S) AS SPECIFIED ABOVE. ALL MATERIAL SPECIFIED WILL BE COMPLETELY "IE~TRO~ED FOF~ ~CRAP RE~C~CLING PURPOSES.C~Y. . ic 5. AUTH~-I~IZED REP.... ~ ~ *~ -- I D,~TE ~' / CITY~iUILDING DEPARI~I ENT INSPECTION RECORD POST In a Conspicuous Place at the Jo..b Site for Duration of Work. I DO NOT remove this Card until Final Building Inspection has Been Signed. PHONE 326-3728 PLAN CHECK ,UNDER FLOOR PIPING __ ~ / /. '"SEWER ..FOUNDATION g~ ORIENTATION ' (./ N E S W ,CONCRETE FLOOR --FOUNDATION INSULATION R- DO' NOT Pour Concrete until 'above has been si ned. 326-3728 ~I'OP OUT PLUMBING w I ROUGH ELECTRIC BROUGH MECHANICAL IFRAMING _ROOFING ,FLOOR JOIST ': ~ mEXT. WALLS SEALED ..FLOOR INSULATION R- ,WALL INSULATION R- '-CEIUNG INSULATION R- ..GLAZING S D T ~AIR INFILTRATION S T --SOLAR · .DUCT INSULATION DO NOT Cover Work until above has been ' ned. PH '28 ruilding Address ........ ...~?...~ ract ........................ Block .......... Lot .......... BLATH INTERIOR mLATH EXTERIOR .SHADING E S W ~ INEATHERSTRIP 'ELECT. S/R BOXES GASKETED ~FIREPLACE ~,UTO SETBACK THERMOSTAT A/C MODEL .CMANUFACTURER ~/V-:' ~ = B--~--~KET : R- THERMAL MASS K E D I~ n, lb ~PRESSURE TEST- GAS BSRADING CURB, GU'ri'ER, SIDEWALKS fINAL PLUMBING IB:INAL ELECTRIC ALL IMPROVEMENTS SHALL BE INSTALLED, FINAL MECHANICAL COMPLETED AND ACCEPTED BY THE ~FIRE DEPARTMENT /~ j PUBLIC WORKS DEPARTMENT PRIOR TO I~FINAL BUILDING ~ ~)/:~/c~ ~-~ OCCUPANCY OF ANY STRUCTURE SI~ FT Bldg. Permit No ................... ,. Else. Permit No. ~5: ~ .~. :~. ~,.: ~,' Plumb. Permit N Mech. Permit-No ................... I I I ! ! ! ! I ! ! I ! ! ! ! APPENDIX B CHAIN OF CUSTODY AND LABORATORY CHEMICAL ANALYSIS RESULTS II I I I I I I I I I I I ;I I I I ! I I I_~BORATORI ES, IN C. Septen%ber 18, 1995 STEVE HOWARD KERN ENVIRONMENTAL SERVICES P O BOX 5337 BA/{ERSFIELD, CA 93388 Dear Steve, The samples(s) listed on the Chain of Custody report were received by BC Laboratories, Inc. on 09/01/95. Enclosed please find the analytical data for the testing requested. If you have any questions regarding this report please contact me at (805)327-4911, ext. 204. Any unused sample will be stored on our premises for 90 days (excluding bacteriologicals) at which time they will be returned or disposed of upon your request. "' '~"'" ' Please refer to submission number 95-10675 when calling for assistance' ': Sincerely, Maltby -~ Ck~ient Services BC Laboratories, Inc. 4100 Atlas Ct. · Bakeesfield. CA 93308 · (805) 327~4911 · FAX (805) 327-1918 I I I I I LABORATORIES Purgeable Aromatics and Total Petroleum Hydrocarbons KERN ENVIRONMENTAL SERVICES P 0 BOX 5337 BAKERSFIELD, CA 93388 Attn: STEVE HOWARD 589-5220 Date Reported: Date Received: Laboratory No.: Sample Description: PEARMAN 94-3410B: SOIL SAMPLED BY S. HOWARD Sample Matrix: Soil Date Collected: Date Extracted-8020: Date Analyzed-8020: Date Extracted-8015M(g): Date Analyzed-8015M(g): Page 09/13/95 09/01/95 95-10675-1 08/31/95 ® 01:20PM 09112/95 09/12/95 09/12/95 09/12/95 I I I ! I I I I I I I I I Constituents Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas). Surrogate % Recovery Practical Analysis Reporting Quantitation Results Units Limit None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg 1. 115. % 70-130 TEST METHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA 8015 Individual constituents by EPA Method 5030/8020. California D.O.H.S. Cert. Department Supe~isor '~" All results listed in this report are for the exclusive use of the submitting psrty. BC Laboratories, Inc. assumes no responsibility for report alteration, separation, detachment or third p,~rty Interp~tion. 4100Atlas Ct. -.Bakersfield. CA 93308 · (805) 3~_7-491 I · FAX (805) 327-1918 LABORATORIES Purgeable Aromatics and Total Petroleum Hydrocarbons KERN ENVIRONMENTAL SERVICES P 0 BOX 5337 BAKERSFIELD, CA 93388 Attn: STEVE HOWARD 589-5220 Date Reported: Date Received: Laboratory No.: Sample Description: PEARMAN 94-3410B: SOIL SAMPLED BY S. HOWARD Sample Matrix: Soil Date Collected: Date Extracted-8020: Date Analyzed-8020: Date Extracted-8015M(g): Date Analyzed-8015M(g): Page 09/13/95 09/01/95 95-10675-2 08/31/95 ® 01:25PM 09/12/95 09/12/95 09/12/95 09/12/95 I I I I I I I I I I I I I Constituents Benzene Toluene Ethyl Benzene Total Xylenes Total Petroleum Hydrocarbons (gas) Surrogate % Recovery Practical Analysis Reporting Quantitation Results Units Limit None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.005 None Detected mg/kg 0.01 None Detected mg/kg 1. 98. % 70-130 TESTMETHOD: TPH by D.O.H.S. / L.U.F.T. Manual Method - Modified EPA Individual constituents by EPA Method 5030/8020. California D.O.H.S. Cert. ~1186 Stuart O. Buttram Department Supervisor All results listed In this report are for the exclusive use of the submitting party. BC Laboratories, Inc. assumes no responsibility for report alteration, separation, detachment or third party Inteq)retatlon. >. Report To: KF.~,O ,¢~/,'a~,,~',,,~.¢~, ~ Analysis Requested N a m e ;.~';r~/,LF' ~,~.~ ~ Project: ~ ~ Address~ ~ Project ~: ~-~/~ o ~ City~~O~/~ Sampler Name~ ~~ ~ ~ ~ State:~ Zip:~ Other: '~ ~ ~ ~ ~ =~ ~ E= '~c z Attn:~v~ ~ ~ i~ '~ ~ k ~ Lab~ Sample Description Date & Time Sampled ---/ ~x 8~ Comment: Billing Info: R li uished :(Si nature) ~eivedby: Name:'~ ~¢~ ~~ ~inquished by: (Signature) ~c~ived by: ~ignature) D~te: Time: Ad~ress~ ~X ~? Cit~~ ~ ~z~-~ State ~ Relinquished by: (Signature) Received by: (Signature) Date: Time: A~ention:~ ~HAO Relinquished by: (Signature) Received by: (Signature) Date: Time: Time: Miles: Relinquished by: (Signature) Received by: (Signature) Date: Time: Sample Disposal P.O.~ Relinquished by: (Signature) Received by: (Signature) Date: Time: ~ BC Dis~sal ~ 5.00 ea. , ~ Return to client ~RSFIELD FIRE DEPARTMENT --~1~NVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (805) 326-3979 TANK REMOVAL INSPECTION FORM .FACILITY ~~ ~~ _ ADDRESS ~-~ ~~._ OWNER - ~~~~ PE~IT TO OPE~TE~ CO~CTOR ~ / CO.ACT PERSON ~,~ ~3~ LABO~TORY '~ ~OF S~PLES ~ ~- TEST METHODOLOGY PRELI~NARY ASSESSMENT' CO. ~ CONTACT PERSON~_.~ CO2 RECIEPT w/ LEL% 02% PLOT PLAN CONDITION OF TANKS CONDITION OF PIPING CONDITION OF SOIL COMMENTS DATE INSPECTORS NAME SIGNATURE HAZARDOUS MATERIAL DIVISION UNDERGROUND STROAGE TANK PROGRAM PERMIT APPLICATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK Site Infromation Site Address 9500 Rosed-le .iRhway Zip Code 93312 APN Facililty Name va~.t (Pen-~- Construction) CROSS Street Callowa7 Tank Owner/Operator ~aman p~-ily-~u~ne Crosby~P~h~ne (512)495-7~82 Mailing Address 3202 Zsnes Circle Ci~Austin~ Texas Zip Code 787q6 Contractor Information. Company. Kern Environmental Service Phone (805)589-5220 License~ Address Post Office Box 5337 City BakersfieldZip Code Insurance Carrier To,man & Wiker Workmans Comp # 432372 93388 W951113652 432372 Preli_m..anary Assement Information Company. Kern E.virn~ental Service Phone (s05)589-5~20 License~ Address Post office Box 5337 City ~kersfieldZip Code Insurance Carrier Toe-in & Wiker Workmans Comp ~ 93388 W951113652 Information Tank Cleaninq Company Kern Envirom~ental Service Phone Address Post Office Box 5337 City BakersfieldZip Code Ware Transporter Identification Number cao 982 495 608 Name Of Rinsate Disposal Facility Gibson Environmental Address co~ercial Street City BakersfieldZip Code Facility Identification Number CAD 98O 883 ~77 (805)589-5220 93388 93308 Tank Transporter Information Company ~s Tr~u.~portation, Inc. Address Post Office Box 5337 Tank Destination Golden State Metals Phone (805)589-5220 City. BakersfieldZip Code 93388 Tank ~ age Volume 1 1954 3 ~,000 gal TANK INFORMATION. Chemical Dates Stored Chemical Stored Previously Stored Gasoline 1990 NoRe iFor Official Use Only-- Application Date ~{/qS--Facility ~ % of Tanks__ FeeS__ T~I applican= has recieved, und~lm~, u~ will comply w~ ~l a~ac~ed condl:iOnl of ~l per~= and any other S~a:o, Local and Federal :~gula:lonl. ec~l Frank R. Rosenlieb Approved By: Applicant Name(print) ~ppliCant Signature THIS APPLICATION BECOMES A PERMIT WHEN APPROVED