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HomeMy WebLinkAboutMITIGATION 12/30/2003Hazardous Materials/HazardOus Waste Unified Permit .~ CONDITIONS..OF, ~ PERMIT~., .~ ON REVERSE SIDE · '~ .7. v-' ."'"" .-",: ~ i ' ~. -::;:. '~*:' 'i ' ' This narmit is Issued for the followin_a: Permit ID #:: 015-000-001395 DELIMART ' ~:. LOCATION:~ 9628 ROSEDALE HWY [] Hazardous Materials Plan [] UndergrOund Storage of Hazardous Materials ' C3 Risk Management Program C:) Hazardous Waste On-Site Treatment Issued by: Issue Date Bakersfield Fire Department ' * · OFFICE OFENVIRONMENTAL SERVICES' Bakersfield, CA 93301 · . · Voice (6615 326-3979 .: ' ~.,,.x (66~.~ 3,6-0576 · Permit to Operate Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS 'OF PERMIT ON REVERSE SIDE ........ ,~,~,~,~,~,,,~,,,,~,~,~,~,~,~,~ ............... This permit is issued for the following: DELIMART TANK "~A~OUS SUBSTANCE CAP~Ci~ GAL ~{~?:~]~;~;;;;~ '::~K TX~'K .??' T~r PIPING PIPING PIPING ' ?.:...:.~:9~.. ".0.. INST~E;;':' ~PE MATE~ MONITOR TYPE METHOD MONITOR Issu~ by: ~, B~,rsfield Fb, Depa~ment Approv. by:  O~CE OFE~R ONME~AL S~ ~CES ~ph Hu~~ 1715 Chewer Ave., 3rd Floor Office of ~~1 S~i~ B~ers~el~ CA 93301  ~ Voice (805) 326-3979 ' F~ (805)326-0576 Expiration Date: ~un~ ~0. ~000 84/27/2800 82:81 GG15899440 DELIMART TEXACO PAGE 81 City of Bakersfield Office of Environrnent~! Services 1'715 Che~tcr Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrac;o compliance oortiflcete hae Men Issued in connection with the operating permit for tho facility indicated below. The certificate number on this facsimile matches tho number on tho certificate diopleyed at tho facility. ' ;n a mc Use thc s ace below to cmer the folloMng mformahon In the format of ~s'tructionstotheissu' g 8 Y: P ' ' ' ' ' your ch?ic~: ,ri. arno of owner; name of operator; name or' facility; street address, city, and zip code of facility; facility ;dcrttlfloetion number (from Form A); name of isSuifl8 ag~:ncy; and date of issue, Other idcntifyinS information may be added as deemed necessary by ~hc local agency. This permit is issued on this 2'~ day of November, 1998 to: DELIMART Permit #015-021-001395 9628 Rosedale Hwy Bakersfield, California 93312 ICACert. No.' City of Bakersfield Office of Environmental Services 1715 Chester Ave., Suite 300 Bakersfield, California 93301 (805) 326-3979 An upgrade compliance certificate has been issued in connection with the operating permit for the facility indicated below. The certificate number on this facsimile matches the number on the certificate displayed at the facility. Instructions to the issuing agency: Use the space below to enter the following information in the format of your choice: name of owner; name of operator; name of facility; street address, city, and zip code of facility; facility identification number (from Form A); name of issuing agency; and date of issue. Other identifying information may be added as deemed necessary by the local agency. This permit is issued on this 2nd day of November, 1998 to: DELIMART Permit #015-021-001395 9628 Rosedale Hwy Bakersfield, California 93312 C--29--0~ MON 1 2 W~ FROM t~ . S . S . R _ BSSR, l.n¢. ' 6630 Rosodale Hwy,, # B, Bakersfield, CA 93308 Phone (661 ) 588.2777 Fax (661') 58~786 MONITORING SYSTEM CERTIFICATION 't~s t'orm must b~ " ' . ~ ...... x~-,,,-who-~rfon~owor~ Ab6~yoft~i~ · onimdna system co11~Ol Da~o~ I~ l~Bm,,~[ua · v ' ;" ' · '. :. ~.~9~[~ch m , ~-': --' :-~:'~/~r~mr taus it a copy of ~is form to ~e'[0cal agent .. ~s~-.t~k System o~ertop~ator. :iae own.. r .... : .~ .. ~'~1~ ~0. ~ys of ma dam. · · :v~:~j:~eaera! InformatiOn . .. ',?,'...' .... '. , ' .;:)mcit /Cer~ed/ : "}~:'~ Vault S~sor. Modc~l:' ' r.Line L~k Detector. Model: :____ Deifier. Model:~ .'~uglng Prob~'. .~:nsor. Sensor(s). ; Le~k Detector. M6dd: ..... M~lel:: ' Sensor, Model: ...... and modal in Section I~ on ttainment Sensor(~)'. Mq<lct: dnme~t ~nsor(s), Modal;. tO: , Probe. ' ' Annular Spa~ or Vault Seni~r'..':'i Pipirq~ Sump I Trench M~hanical bln~ Leak Dat~tor~. Tank ~fill / High~Levd Tank ri tn-Tank Gauging Probe. '..~! 12 Annular ~pace or Vault Sensor, ': ' 12 Piping Sump / Trench Sens6r(s)?,? Mi CI Fill Sump Sc~or(s), ' ": i': O Mechanical Line Leak Oct~t~tor, ,:'.!. i' ,Mi ri Electronic Line Leak Detector.. 'i' ,!' ri Tank Ovcrfilt / High-Level Sen~.r': Dispenser iD: Iiil~hear Valve(s). Dispenser ID: GgShcar Valve(s). Containr~nt , $em;or(~i)." Dispenser ID: '.:' 0 Dispensar Containment Sensor(s) 12 :Shear Valv~(I;). ":,'::C ':'* el; ch.__ !el: ___ d:'_ in Se~tlon B on ! tel: .., Containment Containment Ploa~ ~'iti~; re,tilter'cent.alas tnor. eianks or dl~pcn~,,e, ts.. copy ~b ~ Include information ~ cvcw ~nk ~d dispen~(at, . ,, ,._. ~.;Cerfification - x ec~y ~et the ~u~ment ~entifl~ la this document was ':' ~' .~5aa~f~urm' guid~n~ A~achcd to this C~ifl~fion Is information (e.g, ~flafacture~*. ': :[rf~rm~tlon ~ ~tct and a Plot Plan showing tho ~yout of monitoring cquipmeu; .,. re~s~ i bavt a~o at~c~d ~ copy of ~e repo~; (d~eck all that ~pply)~ ~ C~l'.~ification No.: ~_~ ~ License. No.: Page I of 3 P/~onttoring System Certification le fneilirff, I.a ac.cor,~ance with the to:: verify that this ; sudi 03tOt MON 12 4 FROM ~-$.$.R. ~ P.O~ F. ln-'l'auk Gauging / SIR Equipmeut: . ~ C~cck Itus bux il'tank gauging is uzcd only for invcnto~ con~oL 0 Ch~ck this box ii' no rank gauging or SIR equipment is installed, Tt~ s~ction must be completed ifin-~nk gauging equipment i~ u~¢d to pcrlbrm le~ d~tection moni~ring, widn.g.been, inspected for .p. r~_p.?r ?3x~ and termi?~jpE, including ~st~g for g~d fauJ? I 1 'gauging probes qi~u'aiiY ins~ctea for damage and residue buildup? aeouracy otsyst~m, wa~r level ~dings tested? .aerie~ ~e e~U~m~t ~n~'s ~ten~ee cheekier eomple~d? d~ibe how and When ~e deficiencies were or will be ~rrected. · [R~h~ck thi~ box ifLLDs aro uot Lustalled. i th~ following checklists ~:~?.N/A (~k all'~ply) $~mla~ leak rote: O 3 g.p.k; O 0.1 g.p.h; 0 0.2 g.p.h. :~ 'N/A , '4" ' ,I :.:~. N/A ~o/x H, belo'w, delcribe how and when these defldencics were or will be cor,'ecicd. Page 3 of 3 o3/o! I10N 1 ~t5 FRO~ ~ - $ . $ . R . ~¢ . D~. ~ults of Testing/Servicing $o:~'tw~ ¥~r~ton Installed= _~~ ? ~ NOs ~ ~s ~ r~la~ to a ~0tg mouitor~g .~aon, is all ~nunica~ons equipment .(e.g. positiV~ shut-down~ ~eCl afl ~ ~pZy) ~um~mach~ns°~! 0 D~[~Ir ,?..:<.: .?=. .... . ..... . ". ' ........ rc~xt of ~nk capac~ do~ ~c alum ~ ........ . ........ i ' qt ta~d? If es, iden~y s~iflc ~ors, p~bes, or o~ ~mp~ut Ii; b~OW, describe hOW and when these deflclen~s were or Page 2 of 3 I) EC--29--0:~ MON' I 2 6 FROM l) m S m $ m R m M~.n~.~g System Cortiftcatton UST Monitoring Site Plan ~,~..~ ,,_., , ~.<.,' ~;: ... '~' ......... . ~" ~"" :: .... "' ~ : ................. I '" .... ?,~r:?:c-.-~ :'~:. :. :.: ................................. .' ........... ::...: ......... ~ .......... :~...,~ ; · '.::c ?"~ ~ E'"'. . ....... . . . . ...................... ' ........... ,' ........... ............ : ........................ .... ~ .................. f:~'?'~ .... ~ ~ :] : : : 0 · '" ....... : [ i [::::: '. [~~'*~:: ]: :~. .......... - , · , · . . . .... ' ' System C~tifi~a.ti?n. c~ your stye plan, snow, me general layout .iO~.~.i~'{cjli.~:.~f(h¢ following'eqUipment,: ir ins~lled: moni~nng system vont~ol pan~ls; sensors monitoNn$ tank ~lnular ~'~a~ii'~d in-'~nk liquid level probes (tfus~d for icaK oetc~uon/. Page ~ of 0~00 OC.T i i P. 02 PREVEI~IT [ 01'i '~'~,~,' , /~'~~ CITY OF BAKF._,.R~FIELD · [~-'...'~: <-~I. o~nc~ o~ ~vmo~~r~[ s~awc~s . .~~~' 1715 Chester Ave,, Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION AI~PROVED BY DATE Postage $ Certified Fee r--~ Postmark ~ I--1 Return Reclept Fee ,~ ~ (Endorsement Required) Here -~ =~ - I-"1 Restricted Delivery Fee ._D (Endorsement Required) Total Post~ ~ [~'~c~,'~'~ 9628 Rosedale Hwy. '"'t orPOBoxI~ Bak ' · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: sedale Hwy. kersfield, CA 93312 2. Article Number A. Signature [] Agent H B,~Recelved by (.Printed Name) lC. Dateof Delivery I1 -*- !1 D. IsdeliYery~ldre~diffemntfromit~ml[? [] Yes ,,,/I 3. Service Type ~ URegistered [] Return Receipt for Merchandise J 4. Restricted Delivenj? (Extra Fee) [] Yes (rrensferfromsen4celabet) 7003 2260 0004 7652 2914..J I~ PS Form 381 1, .August 2001 Domestic Return Receipt 102595-02-M;1540 I UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid USPS Permit No. G-10 · Sender: Please print your_ p,a~me, address, and ZIP+4 in this box · Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES · ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 D December 12, 2003 CERTIFIED MAIL DeliMart 9628 Rosedale Hwy. Bakersfield, CA 93312 RE: Propane Exchange Program Dear Owner/Operator: The purpose of this letter is to advise you of current code requirements for propane exchange systems, such as "Blue Rhino" or "Amerigas." This does not apply to large propane tanks, only propane exchange systems. Over the past two years this office has noted a dramatic increase in the propane exchange system in the city of Bakersfield. It has also been noted, with great concern, that many of these installations are a clear violation of the UFC (Uniform Fire Code) and represent a danger to public health and safety. ACcordingly, procedures for storage of propane cylinders awaiting use, resale or exchange, have been adopted through BMC (Bakersfield Municipal Code) and adoption of the 2001 UFC. The procedures are as follows: Storage outside of building for propane cylinders (1,000 pounds or less) awaiting use, re-sale, or part of a cylinder exchange point shall be located at least 10 feet from any doorways or openings in a building frequented by the public, or property line that can be built upon, and 20 feet from any automotive service station fuel dispenser. (Note distance from doorways increases when cylinders are over 1,000 pounds cumulatively.) Cylinders in storage shall be located in a manner which minimizes exposure to excessive temperature rise, physical damage or tampering (Section 8212, California Fire Code, 2001 Edition). When exposed to probable vehicular damage due to proximity to alleys, driveways or parking areas, protective crash posts will be required as follows (Section 8001.11.3 and 8210, California Fire Code, 2001 Edition): 1) 2) Constructed of steel, not less than 4 inches in diameter, and concrete filled. Spaced not more than 4 feet between posts, on center. 1 Letter to To: Owner/Operators of Propane Exchange Systems Re: Propane Exchange Program Dated: December 12. 2003 Page 2 of 2 3) 4) 5) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. Set with the top of the posts not less than 3 feet aboveground. Located not less than 5 feet from the cylinder storage area. Exceptions: Cylinders storage areas located on a sidewalk which is elevated not less than 6 inches above the alley, driveway or parking area, with not less than 10 feet of separation between the curb and the cylinder storage area. "No Smoking" signs shall be posted and clearly visible (Section 8208, California Fire Code, 2001 Edition). Resale and exchange facilities must be under permit to verify compliance. All existing facilities will be checked and when compliance is confirmed, a permit will be issued. All new propane exchange systems must be permitted prior to installation. You will have 90 days (March 4, 2004) to comply with the procedures outlined. Once compliance has been confirmed, each exchange system will be issued a permit, which will be placed on the exchange system. Sites not conforming to current code, will be "red tagged" and must be taken out of service immediately. You should contact your Blue Rhino representative, Mr. Taylor Noland, or your local Amerigas representative. They are aware of current code requirements. If you do not have a propane exchange system, please disregard this letter. Should you have any questions, please feel free to contact me at (661) 326-3190. Sincerely, Steve Underwood Fire Inspector/Petroleum/ Environmental Code Enforcement Officer FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program Routine ~l Combined Type of Tank .tl 0J L. Type of Monitoring [] Joint Agency [] Multi-Agency [] Complaint ~., ~,P. ~. Number of Tanks __~ l~"['ro Type of Piping [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data onfile / Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance rec°rds adequate and current Failure to correct prior UST violations k..... .--' 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=Viol~n/ Y=Yes Inspector: _~k~ ~ Office of Environmental Services (661) 326-3979 N:NO While- Env. Sves. Pink - Business Copy UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. · Enironment al SerViCes i~.~757~?~ 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPE/CTION/DATE INSPECTION TIME A~D'~R--~gi ..................................................................................................... "HONE ~o. -"-- :~Ta~pl~5~i~ ..... 15-021 - Section 1' Business Plan and Inventory Program Routine ~, Combined {~ Joint Agency ~ Multi-Agency I~ Complaint I"! Re-inspection ~ C=Compliance '~ OPERATION COMMENTS \ V=Violation APPROPRIATE PERMIT ON HAND BUS~NESS PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS CORRECT OCCUPANCY VERIFICATION OF INVENTORY MATERIALS VERIFICATION OF QUANTITIES VERIFICATION OF LOCATION PROPER SEGREGATION OF MATERIAL VERIFICATION OF MSDS AVAILABILI~E VERIFICATION OF HAT MAT T~INING VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES EMERGENCY PROCEDURES ADEQUATE CONTAINERS PROPERLY ~BELED HOUSEKEEPING ................................................ ...... .................... ANY HAZARDOUS WASTE ON SITE?; ~ YES 1'3 NO EXPLAIN: QUEST,ONS,/r~GARD,NG/~,SJ~SPECT,ON? PLEASE CALL US AT (661) Inspector Badge No., While - Environmental Services 326'39791 .............. ~" Yellow. ~ation Copy Pink - Business Copy -i State a er Resources Cont BOard Winston H, Hickox Division of Clean Water Programs : ?~:, Secretary for Environmental · 1001 I Street, Sacramento, California 95814 ,. · '": Protection P.O. Box 944212, Sacramento, California 9424~ ~ .!, (916) 341-5855~ FAX (9!6) 341-5808 · www.swrcb.ca, gov .... The energy challenge facing California is real. Every Californian needs to take immediate action to reduce energy consumpti[m. For a list of simple ways you can reduce demand and cut your energy costs, see our website at www. swrcb, ca.gov GERTIFIED MAll NO. 700i 2§i0 000i i882 @702 MAY 2 9 2OO2 Ms. Diana Meyer, Owner/Operator :]" ~ Delimart Texaco 9628 Rosedale Hwy ?' Bakersfield, CA 93312 Dear Ms. Meyer: Gray Davis Governor APPROVAL OF REQUEST FOR RECONSIDERATION OF ENHANCED LEAK DETECTION (ELD) TESTING This letter is in response to your March 25, 2002 request for reconsideration Of.the requirement to perform ELD testing. We have reviewed your request and the supporting docUments yoU provided and have consulted with the local permitting agency. As a result, we have determined that your underground storage thnk (UST) facility is not subject to the ELD testing requirement. B'ased on the enclosed information, your request has been' approved for the reason(s) indicated below. UST system(s) is incorrectly located in Geotracker. Public drinking water (Wheeler well owned by Vaughn Water Company) was. destroyed September 15, 1999. ?,~'.'~'/ If you have any queStions, please contact Mr. Ahmad Kashkoli at (916) 341-5855. Sincerely ............ Elizabeth L. Haven, Manager Underground Storage Tank Program Enclosures (basis for the decision) Cc: Mr. Howard Wines . City of Bakersfield fire Department 1715 Chester Avenue, Third Floor' Bakersfield, CA 93301 California Environmental Protection Agency Recycled Paper From: "Howard Wines" <Hwines@ci.bakersfield.ca.us> To: <kashkola @ cwp.swrcb.ca.gov> Date: 3/29/02 9:49AM Subject: Re: Delimart Texaco, 9628 Rosedale Hwy, Bakersfield, RequestforReconsideration I checked on each item Delimart sent SWRCB for ReconSiderati~)~ and Delimart is correct in every material Point. Therefore, Delimart is not within 1000 ft of .a well, nor consequently subject to ELD. GeoTracker $ https://geotracker, swrcb.ca.gov/SCRIPTS/...79E-02&MAP_SIZE= 1 &IDSH= 1SH3 l&x=197&y=146 GeoTracker Home I Contact Site Administrator ! Road Maps by iETA K Well and LUFT site positions are approximate. Locational accuracy will improve as state agencies and responsible parties obtain and report new information. 1 of 1 5/29/02 8:38 AM UST~Details' ? .. http~e°tracker'swrcb'ca'g°v/rep°rts/ust'asp?identify= 14479 9628 ROSEDALE HWY' · BAKERSFIELD, CA 93312-2101 ~ Facility ID: 215-000-001395 Local Agency: BAKERSFIELD, CITY OF Water Svstem Name 1 of I 5/29/02 8:39 AI~ FAK 66J5597438 DIRECTOI~.S ROBERT ~L,~RDEI'TE ART NAVARRE~ GARY NtKKEL MARY LOU FALMER FLOYD ~. ,r~AR$ONS VAUGHN B'ATER CO YAUGHN WATER C.:ONIpANy, ~INC. 1001,i Glem, ~;t:reet Bakersfield, CA 93312-27~3 Phone (6ill) $89-2931 FAX (661) $8%7438 {:.'~ate :' To: At'tn: Mr. Ahmad Fax No:_(_9~_6_~.~41-5808 ___ Su bject:_~he~eler_5?eet Well Number of pages (including coversheet):.__ From: Van Gra_y.~L_ Comments: Here enclosed is another cop_y, The vauoL.h. Ln__~/at___e_r_C_o_n_)Lp__an~'_.w_ej] ' · located at 2325 Wheeler Street in Bakersfield} CA. Was 'dest~py_.e_d on We do, not Plan to drill a new well on this site. ]'he iarLd/p..rpp, e._r~.,j~_fp.r,,5'_al_%_If_~ .... yo_u have an~- g_u_estion~ do not hesitate to (~'ti.- IF YOU DO NOT RECEIVE D~E CORRECT NIJMB£R OF PAC£S OR THEY ARE ILLY..GtBLF., PLEA.SE C;4LL (66'*,.)589-293 !, AS .gOON AS POSSIBLE. D January 22, 2003 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ~H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES Frae S*.FE~ SEmnCES, EHwom~r~rr~. sEmncEs 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661 ) 326-0576 PUBLIC EDUCATION 1715 Chester Av~). Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (66i) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 DeliMarat 9628 Rosedale Hwy Bakersfield CA 93312 RE: Upgrade Certificate & Fill Tags Dear Owner/Operator: Effective January 1, 2003 Assembly Bill 2481 went into effect. This Bill deletes the requirement for an upgrade certificate of compliance (the blue sticker in your window) and the blue fill tag on your fill. You may, if you wish, have them posted or remove them. Fuel vendors have been notified of this change and will not deny fuel delivery for missing tags or certificates. Should you have any questions, please feel free to call me at 661- 326-3190. Steve Underwood Fire Inspector/Environmenta! Code Enforcement Officer Office of Environmental Services SBU/dc 0¥--25--02 ~ION I 0 : 49 FROP1 I~ . $ . $ . R . I NC . Inc. 6~30 Rosedale H~,, ~ B, B~e~field, CA 9~308 Phone (661) 588-2777 Fax (661) 588-2786 MONITORING SYSTEM CERTIFICATION P. 02 · ~l~i~.'~(o..rm. must be used to document testing and servicb~$ of mo~titoting eqmpment. A~sevarate certification' or t~o~ must ~ . ~ .;..,.: ~~ e~h monitor~e svstem_co~ol ~ancl by ~e technic~n who ~ffo~ the work, ~ copy of this 'fo~ must b~'~vi~:~~ ;~:-~:.:'~:~.~ s~tem'~et/bpe~r.' ~e.'o~ne~/~tor must ~bmi~ a copy of ~is fo~ to ~o local agency tcgulat~g.~ST syste~ ' ': ?'W~M'3'0 flay~ ofica~ date. ' ~ .I . ,.' ,, :.: . . - , ' ~' [ ....... ' '1 :Tested/Certified ~a-'ln.Ta~k OaugJna ~obe. ' ~ Annular S~ce or Vauh S~sor, Mbd~: O~ipin8 Sump / T~nch Se~). Mod~: M~I;' ~ Sump Se~so~s). ~ ~ M~I: ........ ~ Mechanical ~ine L~ Dcicctot. Leak Detector.. Sen~or, ' Yault ~nsor. S.~sor(s), '5 T e Line Leak DetectOr. Detector. Medel: ' ~odel: ~'~aOH 5~r%OoOoob Modal: :' ~ .... " Sensor. Model: in Section B on rt £1cct~nic Line Leak Detector. Model: , . C3 Tank Ove~ll / High-Levd SeDtmt, Mo'dali :""~ ~dcl . Tank ID~ .... ' M~cI: O ln.T~k Oaugin8 Pmk. M~cl: ..... ~el: ' ~ Annul~ Sp~e or Vault M~I: " O Pipi~ Sump / ~ ~s). M~el; ___¢..:' "~ Mb~d: ~ . ..... ~ Mechankal Line L~k D~teclor, Mod~l: ' ' ~ El~l~n~ Line LI~ Detector. M~el: ., ·,, - " -- 0 Tank ~fill / High-~el~r, M~I: ""-' '' '~' 'i"~- ~ M~d:, ,': . ,,.. ~ar valves). . .~ntaim~'ient Model: ,~ r, Dictator Containment Sensor(s).. Q Shca~ Valve(s). Model: r. iD:'"_': finment Se6sor(s). Dispenser ID: i~'odcl:,' CI Dispenser Containment Sensor(s). Modal; Q Shear Valve(s), ~.ifdcility Contains more tani~ or disi*e~r~ e~p,/this fon~. ~elu~e in~ati~ for cv~ lank ~d disp~ ~ the "~/~.~*ifieatinn . ! cefl~Y ~at the ~uloment IdeAflfled In taa doenmut ~ hSpect~ls~ic~ ~ accor~A~ wltb,. M.o.n!.t. orlng System Certification Page I of 3 03/Ol NOV--25--02 ~ON I 0 : 58 FROM I~. $. $. R. I tq~. P · 05 la:l'auk Gauging / SIR Equipment: n Check this box ii' t~l~k gauging i~ used only for invcnto~ consol.. ' ' 0 ~eck this box if no t~ gauging or SIR cquipmcnt is inslallcd. T~ gction must be complctod if in-~,gauging equipmont is ~od to portb~ 1~ detection mo~toflng. ......... '.'KI No* I'~ all ln~.t Wiri~'~ ~o~,¢n inspected for 10rOp~: entry n~d tm'mtnatmn, tucludmg ~tmg .... . W~-alI t~ gaug~ p~b~ v~y inked for da~ge ~d ': :~'~ =.~cOqn H, belovO,' deSi:~be how artd when ~ese daf ...:G, .,;.~.e:Leak Detectors (LLD): tg"Cl~c~ this box if LLDs are not installed. ~.t~te.the follo~19~ che, e~ist: . ..., ............... -~= .:, ,- ' ~-' ". - -' ......... '.: ~ '?':: :.'?. ~ :, ~ N/A (~A'~ taat a~/ ~a~a le~ ra~: ~ · g.p~,, ~ ~.- ~-r- , · ~'~' ' . . . -'.-'. - -~ .... :-: -~ ~-, .... ,~, . ........  '"0: .N/A ' , ......... , . ~-~ '~'-- ~ ~ ~ No*. F~ elec~c LLD~, ~' ~ ~ ~uM~ly shut off ~r any pomon of ~e ~_~.,~ ~ .... --- - , OF ~.==~a? ' , ,,, ... ........ /- - ,. ~-...L.i....: ~; .... =~% %; .... - ..... · ' ' ' ' ~ .... ]~ ; <~.:.L '.~ N~· F~ e[ec~c ~, bye sll ~se~ w~g c~Oons bc~ v~lly ~- below, describe hmv and When these d were Pnge 3 of 3 ,03/01 , .:. NOV--~O~ MO~ 1 0 -= ~5 1 F' ROl'! ]~. ~;. ~. R. I t'.lC:. P. ~4 Results of Testing/S, erviciug $o .2~;~¢ Vc~$ion Installed: ,, ' ..... so d~t o~cr eqmpment not ~fe~ wtt tcir p,o~_~_ ~c~atign? ............. d..e,~..b..~..~w,' ~nd .whb'6 the~e deik4encl~s were or will Page 2 of 3 ~1 HOV--2~--02 HOH UST Monitoring.Site Plan ':::: :~-, .T/(~:~ :F: ................... .,, l/ ~*' ..... '--' .... ~'~'~ ................. ~ ..... ~.-_." /.--~.~"'i ..................... .. ........ ' * 0 ........ ~~ ....... ~.'e', ........... ' 06"'~L~'' ." ~ : : :: .... · . : : ,,~ ........ c~ ............. . . . . ~ ~ve a dia~ ~t. showz all re~ i~ormafion, you may include,i~, ~ t~ ~ pa~, wi~ yo~ '~q~!k ~ - - ~-~- ~-~ ~ ~o~ si~ ~1~, ~ow ~e ~ne~l layout of ~n~ ~d piping. CIndy idon~ · ~' :~ ~ the ~llowi~ ~uipm=nt, if ~ialled: ~ni~rmS Ostem con~l pan~l~; ~so~ mom~r~S ~ ~nul~ ' ~'~V~ "' s~ in'~nk Nq~d ]evol p~ (ifus~ ~r 1~ dot~). ~ ~e s~ce ~o~d~, no~ ~e date &~s S~te ~lan ~~ ... - .... Page of ~0 ?--02 T HU I 2 : $ 8 FROM I~ . $ . $ . R = I NC . .B,:S..SR, Inc. 6630 Roscdal¢ Hwy., ii B, Bakersfield, ¢~ '~3308 Phone (661 ) 588-:777 Fax (661 ) 588-2786 MONITORING SYSTEM CERTIFICATION · : ' ' ' * ' ut mcxlt A. ~e arate certification or r~)ort mustb~ must. be u~_d .0 ...: ....... ,~__,c.~,k. tcc~ici~who oerfo~s~o work. Acopy of~s form must~c.providcd ~ Information ~ldNo~ ~Equipment'T~i~Certffied Probe. , ' Model: ~uJt Sensor. ' 'Mi~'~l! Line Leak Detector. , . L~4~k I)¢t~tor. : ..: Mode[: - I ' ,,' I~MeI':--.'"' .... Probe. Model: Sensor. Model: I O~tor. ~d: ~.'~..~', ....... ' . in ~egon R bn land Kainment Sensor(s). MMeh ' I MOd~l: ..... I .... Tank ID: ~,GroiiJ~'l''1 ... in'In-Tank Oauging ~ob~. ~ Annular S~cc or Vault Smlsor. O~ipin6 Sump / T~h 8~lso~s). ~ Sump Sonso~a). ~ ~ ~ Mec~nical Linc L~ ~t~tor. ~ ~lecuonic Linc ~ Detector. Tank Overfill t Nigh-Level Sensor. Model: ........... ih Section E on Taok ID: 0 la-Tank Gauging Pr0b~. CI Annular Spao~ or Vault Sensor, C3 Ptpin$ Sump / Trench Sensor{s). 0 Fill Sump ~s0r($), ill M~anical Line Le~ D~tector. Modoh Modch - " Electronic Line Leak Detector. Model:' 'i' Tank Overfill / High-Level Sensor, Modch ' ... '.,,~;!, · SectiOn E et Dispenser Centainmcnt S~:n.~0r($), MooeK "!;7 .... .--'-- r Contai , and ~ .' Dispenser ID: Dispenser Containment Sensor(s). Modal: '-'; Shear Valve(s). ' Dispenser ID; : . · O Dispenser Containment Sensor(s), Model: , .. r'l Shear Valve(s). cbntai~ mOre t~..ks'0r itispeh~rs, Copy thLi form. Include information for over,/t~nk and d;spen~er at ~e Taeility. · v. (' · I certify th&t t~c equlpm [~t identified in this document w~s inspected/serviced In accordance with ~t' :uldcl~cl. A~tached to this Ce~mc~Uo. Is ~form~fio. 5i IS eort;ect and n Plot' ~;lan. showlng the layout of monitoring equlpm~t, For any equipment espaMe o! gan ..e~un~ SUCh Ibavcalsoattat. h~da~.opy, of~a~reporti(~e~k~iltl, atWl'i~ty): CI $~tem. _spt-up ,.,0 AL~ rm hi.story repo.rt Page I of 3 03~0t .:M.O,~itor~ng System Certiflcation NOV-- ?--0~ THU I 2 : $9 PROM I~. $. $. R. I NO. P. 02 i~..:.~u!tB of Testingt~¢rviclng I'.~ :'.-:'~ , ~: ~]~'.~ '~ "~o* W~ all ~rs ~lled at lowest po~t of ~n~ con~i~ent ~ posiffoncd so ~t o~cr equ~ent ~1 dell~ were or will be corrected, Page 2 of 3 NOV-- ?--02 THU I 2 -' 40 · .lq,.T. aak Gauging / SIR Equipment: FROM I~. $. $. R. I NC. P. 0~ O Check this box it' ta~k gauging is u.~ed only for inv~nto~ con~ol, ~ Chock ~ts ~x if uo t~k ~u~in~ or SIR equipment is installed. must be completed if in-tank ga.t .xging equipmeixt, is usea:l to perlbrm 1~1~ detection monitoring. checklist.* ' 'fro* X-Ins ~il iapi~t ~h*fag been iaspe~t;d f0~ d mnfination, including testtu$ for ~mund fnult~? No* W~ all ~ ga~ging probes'vf~ually i~spe.C~d for da,ma~, and residue buildupS_.' HO.= ~/a.qI at.ney of system product lcv?!.~adings l~stcd? ........................ ~-lXT0~71Was' ad¢~ir~cy or system watct lq~.v, el readings aU prob~ ~tallod prol:~'dy? ' . .......... . *So*~°?' 1~/~*t~We~' aU ltcmS!'o~ ~h~ cqa¥.m~.*' t man. ufac~!,* ~'_~nance ohe!lei~t.c°mple~, d. ?. ~"- ~ti0i~ ~ bdos~, d~s6rlb~' how ~nd when th~se deficiencies w~*o or will be corrected, i.~;.~L:l~ ~eak Detectbrs (LLD): C~'Chcck. thi~ box ifLLDs are not instaUed. ~;.--'iz-;~h~i~ .....--~ t3' ~o,. For ¢q~t s*uu*t-u2'or ax~__,~! ~u~ ~5~o~ ~ a ~'~' [=*' ~'~ :'J:: '~' ~X '(Che~ ~1 that'~ply) g~la~ ~k n~: M 3 g.p~; 0 0 1 g,p.h; ~ 0.2 g.p,h. ~'~;~.,~'~*. ' ~.. ~o,:~ ............. ....... ... , . .... ~,. ,Y~ .: ....................... . ......................... q:,..:,*.: *. i':j;,~" N/~ ~.~..~..~ .fro' ~r elboWS' ~Ds, d~'~e ~b~ a~aa~aUy shut bff ff ay ~a of ~ ~nito~ sys~ ~ ~bied ' ,). ~ .... * .... ' ~'i.'.~{:~ 2,~' ~o~ P~ elec~ LLDs,'have ail acc~sible w~g co~e~o~ been vhuelly "' ' .-O'~/A ~:~ -: ..., .... . . . ' '2';___ - ........... ';? tn"t]i~'~q tl0*n H, below, describe*how and whon thee deficiencies w corr¢ -' I .t ' '*'s~?, *.I ' ' ....... i',. 'i,; ...... ' ' ]Page 3 of 3 .0~/01 7--02 THU 12:=4 1 FROM THC. UST Monitoring Site Plan i'":" "':::'': ..... ~'-----~'' n"t ..... ~',,/---* -------E.. · ; 2. L:' 2_'.. :.; ;;;.:; ;.:_::: ,':'., I:.!'_:i :"._ ..' .................. .~ .... , ~ ~, ~ ,, :: ' : , ':. :::.... .... . ..... :...T': ':-:-:-: .-: .--.'::'. :':::::::: :..:.. .: . i '~ ......... ~=q .... · , ..... :, · .'/,~,: . · · :::::::::::::::::::::::: · ' ' ~ ....... ~¥&~,~ 'i'~ ...... 'f~f~"!i' .................... · '. . ", ,0 ......... . , . . , . 0.,'~.~: :::::: ~.-:~: :: ..... 0',~',~,; ;.: ' ' ~' ..... '¥"'~'~'~ .... .~.,i q :'':'' :~ . , ~.,?, t . . ,.._( · · ~Pi! 'cady havo a dia~m), that sh.ows al! rcqu .i~,~ information, you may includ~ it, rather than tl~s page, w!~ yo_ur i~.'~ followin~ equipment, if installad: momtorin8 system control ~i~'?'"': ?ii~! in-"t~nl~ liquitf lcvrJ probes (ff used for leak detection), b~ the space provided, note the date this Site Pl0n Page =_._ of: OS/OO NOV-- 6--0'~ WE]~ 1 1 ". 1 5 FROM ~ . $ . S . R . I NC . P . OCT 1~f5 2002 9039 BKI~FL[I FIRE PREVENTION p.1 Cfl~Y OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION COi~NT$ NAME & PHONIB NUMBER OF CONTACT PBRSON. ' ~]',~. I / 5-~'~.. _~'.'9' 7....)_, DATE & ~ TEST IS TO BE COI'~UcrP_.D_~_ :.. APPROVED BY DATE SIONATUP~ OF APPLICAI'f£ FACILITY NAME CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3ra Floor, Bakersfield, CA 93301 INSPECTION DATE Section 2: Underground Storage Tanks Program [] Routine [~Combined Type of Tank ,~0.) Type of Monitoring Joint A ency [] Multi-Agency [] Complaint Number of Tanks ~ Type of Piping ~t33 ~ [] Re-inspection OPERATION C V COMMENTS Proper tank data on file ~,/ Proper owner/operator data on file t. Permit tees current Certification of Financial Responsibility L. ,,,. Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY' Type of Tank Number of Tanks OPERATION Y N COMMENTS sPcc available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V~Violation Y--Yes N=NO / Inspector: ~ Office of Environmental Services (805) 326-3979 White- Env. Svcs. Pink - Business Copy &ss~~~e Party CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME I)c~_~,- ADDRESS q~ ~ FACILITY CONTACT INSPECTION TIME INSPECTION DATE {[' ~-~ '-~. PHONE NO. ~c-~- ~ q(9 BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES ] C~ Section 1: Business Plan and Inventory Program Routine [~]~ombined [~ Joint Agency ~ Multi-Agency [.,] Complaint [~] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand ~, · Business plan contact information accurate L ~' Visible address ~ ~/ Correct occupancy ~ Verification of inventory materials L J Verification of quantities ~ Verification of location c- J Proper segregation of material '/ ~ Verification of MSDS availability ~ Verification of Haz Mat training / Verification of abatement supplies and procedures / Emergency procedures adequate ~ Containers properly labeled / Housekeeping Fire Protection ~'/ Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes ~ No Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy -'B"usiness ~i~sp//~,i ~/Party Inspector: · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: : DEL IHART 9628 ROSEDALE ~ BAKERSFIELD CA 93312 ~~7002 0660 0000 1641 7367 PS Form 3811, August 2001 ~ Domestic Return Receipt-' If YES, enter delivery address below: [] No 3..;.~rvice Type L'-'-~ Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise []lnsu dMail []C.O.D. 4. Restricted De very? (Extra Fee) [] Yes 102595-02-M-0835~ UNITED STATES POSTAL SERVICE IFirst-Class Mail Postage & Fees Paid USPS Permit No, G-lO · Sender: Please print your, nameF-address, and ZIP+4 in this box · E~AKERSFUELD FiRE DEPARTMENT OFF~CE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, SuJte 300 Bakersr~d, CA I~8;~ rr--.I Certified Fee = Returr~ Receipt Fee r ~n (Endorsement Required) ri.I 'rohal Po~g~ & Postmark Here · Apt. No.; .................................................................... · · ~,, ., ,, B/~IJ~F-.R$1*IELD C~ 93]12 ...... ~! October 21, 2002 · Delimart 9628 Rosedale Hwy Bakersfield, CA 93312 CERTIFIED MA~ FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H' Street Bakersfield, CA 9,3,301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SN:E~ SER'f~E$ · ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Avb. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-469'Z FAX (661) 399-5763 NOTICE OF VIOLATION & SCHEDULE FOR COMPLIANCE RE: Failure to Submit/Perform Annual Maintenance on Leak Detection System Dear Underground Storage Tank Owner: Our records indicate that your annual maintenance certification on your leak detection system was past due on October 11, 2002. You are currently in violation of Section 2641(J) of the California Code of Regulations. "EquiPment and devices used to monitor underground storage tanks shall be installed, calibrated, operated and maintained in accordance with manufacturer's instructions, including routine maintenance and service checks at least once per calendar year for operability and running condition." You are hereby notified that you have thirty (30) days, November 21, 2002, to either perform or submit your annual certification to this office. 'Failure to comply will result in revocation of your permit to °perate your underground storage system. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Ralph Huey Director of Prevention Services Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services cc: Walter H. Porr Jr., Assistant City Attorney MON I 2 : 50 FROM I~. $. $. R. INC. P. 01 BSSR, Inc. ' 6630 Rosedalo Hwy., # B '?B.akersfield,.CA 93308 Phone # 661-588-277'7' F...ax # 661-588-2786 To; F~ ~ 7- 09__ Ph~s~ P~ply 9c~- ?--02 NON 12:5 I FROM ~. $. S. R. I C. P , .. ' SECONDARY sYSTEM CERTIFiC.ATION FO~vl · 'DATE~ '.. '~ACiLITYIO;'.'.,O~I; ~.~.~ - ~-'~ c ~ ' /d~.. · FA~Y ~D~ '~ ~...g_..~o.> ~'.~> d / ~ ...... -7- · Tank I Tank 2 Tank 3 Tank 4 : B~ Pr~e Ce~ifl~flon 1 ' Pag~ I of. ~CT-- ?--02 MON 12 : ~ I FROM ~ = S . S . R = THC. .. . SECONDARY SYSTEM CERTIFICATION FORM Turbine' Suql. ps '~,Sump 1 Sump :2 Sump 3 Sump 4 Star~ ~;tme Initial Height ofw .a~er Time Water Height Time Water Height Water Height Certification OverflU Buckets 0ye .rf~,'* ! Overfill 2 Overfill 3 _.s~r~. ~ ~'. / 6 ........ lnl~ Hei~ Ti~ ~: / ~ .......... ....... ., Tim· 2 - ~ ~ ........ .Wa~r ~t ,~ :.~ / .............. ~~flon ~ ~ ' "' Page 2 of_ OCT-- ?--02 M ON I 2 .' 52 FROM I~ . $ . $ . R . I N C . P = ~4 SECONDARY SYSTEM CERTIFICATION FORM FACILITY ID ,O,~./..~.,~ ,.~ ,.-,'7'-~ W'~'~'~ c ~ FACILITY ADDRESS~ ~e2/g ,~o~s,~-'.~, / c. UDC TESTING .... DISPENSER DISPENSER DISPENSER DISPENSER START TIME ~_~: 20 INITIAL HEIGHT OF WATER '7- / WATER WATER CERTIFICATION (SIGNATURE) ....... ff ,f-'~ ........ · .. DISPENSER DISPENSER DISPENSER DISPENSER START TIME INITIAL HEIGHT OF WATER TIME WATER HEIGHT TIME WATER HEIGHT CERTII~ICATION (~IGNATURE) Page roof m OCT -- '?'~ 0 2 MON 12 -' ~52 FROM INC. P. 05 TESTER ROSEDAL£ H,~¥ EAI(ERSFIELD CA StJl~ L ER~ TEST RE::POI;rr TE~'r ~rAETED 2138 PM B£~N L.CUEL 7.124~ IN ~'Nf) TIME 2=~ PM ENO O~TE 10/04/2P~2 ~ND L, EU£L 7.1241 IH LEAK THR~SHOLD ~902 IH Tn~T ~SULT PASSED 'BSSR, Inc. 6630 Rosedale Hwy., # B Bak. ersfield,.CA 93308 Phone # 661-588-2777' Fax # 661-588-2786 Z~IC. Fax; ............. $EP--29--02 SUN $ : 1 1 FROM :I~ . S . S . R . I NC . p . 0 '-:> ' SECONDARY SYSTEM CERTIFIC ,ATION FORM FACILITY ADD~S_~g UST Annular Space "' Tank I Tank 2 Tank 3 Tank 4 Start Time Initial Pressure End Time . Ftnal Pre ure Certification ,,,~,, Line 1 Line 2 Line 3 Line 4 End Time · ~' ff~ ~ B ~ ~~k , , Final P~sure ~ It~ !~.. 3 ~, /85. ~ ~' Certification ~7~ ~ ~< ~'~.'~< Page 1 of_ SUN 8 : 1 1 FROM 1) . $ . $ . R . I NC: . P . 0~ · SECO,~ARY SYSTEM CERTIFICATION FORM 2. Sump 1 Sump 2 Sump 3 [ Sump d ~i~i Height ov,.*nu x o,,a~, 2 ov,,ra~ ~ O~n 4 Overfill Buckets ....... (.~)...., ......... ~..,..~.... ..... (?__.?. Page 2 of_ $EP--2~--02 SECONDARY SYSTEM CERTIFICATION FORM Turbine Su .raps ,. Sump 1 Sump 2 Sump 3 Sump Start Time Initial Height of Water Time W~ter Height Time Certification .(Sly,~r~) .......... Overfill Buckets .~¢r.,~'~ ~_ ,3 o'c .~_..~..____ Overfill 1 Overfill 2 Overfill 3 Overfill 4 Start Time Initial Height of Water ...~.. ~c~ . Time Water ~teight .. ~ ~.~_.~ ............... _4~,_~___z.~ .:~:~* ! ......................... Time <s,~-~ ~r/~ '~/x~ ~/~ _. .............. $EP--29--02 SUN :8 : i $ FROM ~ . $ . $ . R . I NC: . P. 05 . SECONDARY SYSTEM CERTIFICATION FORM DATE.ff"/_~ ' FACILITY FACILITY ADD~S~_ff~ ~ UDC I~,STING DISPENSER DISPENSER DLgPENSER DISPEN._q~R. ~TIAL HE~G~ OF WATER .......... ........ DISPENSER DISPENSER DISPENSER DISPENSER ~ITIAL itEiG~ OF · ~ .................... ¢_~ ~ * ................... WAT~ ~!OaT ~,:? ~ I ...... TIME 3:/o WAT~ Page __of __ $EP--29~02 SUN FROM THC. P. 06 e7 STP TE~T ~'fART¢~ 12:$1 EN~ TI~E 12~46 PM END ~flTE 09/17/2002 · .:.:~LEU£L 5.626,9 IN TEST STARTED lt:3:~ T~ST BEOIN eND TI.M~ tl=4a END DAT . ENO L~V~ ' L~ts~I(TH~HOLD T~I' RESULT r'fljLED TEST 8TflRTED ee/z~2ae2, [~ LEUEL, 6.21~2 DI ,.E~K THRESHOLD 8d~2 IN TEST, RESgLT F~ZLED PAN TE$9' STARTED . 18:22 BEOIH LEUEL ENO TIME 10:37 ENO D~I'E 09/'17/2002 END I.£VEL 7. LE, AK'TH~4OLD 8, B02 IN %SST RESULT , ! SEP--~--O~ SUN 8:14 FROM 'rNc. P.{BT , . .,,, i" , .~;~..~ ...,.'ko~'.,,-,..:.. .' ,:~ !~, . ,. · ~'., ~ . . ~.' ~,~, '. ......... ~.....~,..~.:,~ , ..,, .~..:~R~T~R, · . , T~ R~.ULT F.,L~D ' - BEGIN, ~VEl.. L~K THRE~OLO ~ST RESULT Pfi~SED END LEUEL ~.6815 I~i : T~ST RESULT TEST STflRTED ~:e4 ~:, TZST , Ifl~fEO ~9xi7/28~ ~'J END DATE CND' L~U~L .LE~X.~T~HOLD TES~ RE~LT D::,L FIL, '!: i:ll T~T .~TRRTED 0g/tT/201B2 F.I~G~N L:JUEL 5,9574 IN END TIME 4,~11 PM T~ST RF.'~U; I' ~~EP--29--02 SUN 9 : 22 FROM I~. $. $. R. BSSR, inc. 663..0 Rosedale Hwy., # B Bakersfield, .CA 93308 Phone # 661-588-277'7' Fax #, 661-588-2786 INC. P. 01 SEP--~--O~ SUN · SECONDARY SYSTEM CERTIFICATION FORM DATE '_~~__2__- ~ 9-, ',FACILITY ID ,Oa't-LT~..~ ~-'"F - 'C2.'.~,C~ ¢ o FACILITY .ADDRF.~'-- ~-9,. ~..~o_~izOM_~/~....~.~.f~,,~. ......... _. UDC TESTING ~..,~_.~.~I ~'~ ~ .~ ....... DISPENSER DISPENSER DISPENSER ~ISPENSER '. w~r~ ~d,~g~ ~. 7/~ , . 7.~3~ ,....__. Wt~R a~x~ ,,,_ ,, , ~. ~ ~ o ~, 7 t-z'7.2 ,~ ~ DISPENSER DISPENSER DISPENSER DISPENSER START TIME INITIAL ' ~iGaT OF WATER WATER HEIGHT TIME .WATER Page ~of ~ / SE P--2/?J--O 2 / ~;UN FROM IN(;:. P. 0~: 'JILL; ,~hRT "' ~KER~FX~D ~ LE~ ~EST REPOR] T~ST ~flRTED END TIME E~ ~TE E~ I. EUEL 6.7116 L[RK T~ESHOLD TE~T RESLIt. T PflSSED TEST STRRTED L~.'ZOx2002 ~GTN L~SUEL 7.23','7 ~N END T~ME 9:53 RM ~D L~UEL 7.1~9 ~ T~T RESULT F~IL,FD CITY OF BAKERSFIELD OFFICE OF ENVIRONMeNTAL.SERVICES 1~15 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TEST/ '~ SECONDARY CONTAINMENT TESTING .. pERMIT TO OPERATE #. ,, NUMBER OP TANKS TO BE TESTE~. 3 TANK # " VOLUIVI~ IS PIPING GOING TO BE TESTED ..... CONTENTS . sod TANK TESTING COMPS,. MAn.lNG ADDRESS , NAME & PHONE NUMBER OF CONTACT PERSON ~Mm~oD, ~-~ NAME OF TESTER OR SPECIAL INSPECTOR ,{/~l'l~ CERTIFICATION # ~,?,o APPROVED BY DATE SIGNATURE OF APPLICANT N~cl 8-Z' · ,:13-1..TW~ l]l]:':';3}i i'.-331 t4I .....t, .. 'tq..('~39 C.g~,L]/,.:'. !/ii, G }]ib',C ,:iFil: C00g/ZN"6e ,:]3i;~]W!S i82! p1010120.jpg (1280x960x24bjpeg) plO 10124.jpg ( 1280x960x24b jpeg) CITY OF BAKI~SFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (6//1) 326-3979 !NSPE(~'TION RE(~ORO POST CARD AT JOB SITE INSTRUCTIONS: Please call for an inspector only when each group of inspections with the same number am ready. They will mn in consecutive order beginning wilh number I. DO NOT cover work for any numbered ~oup until all items in that group am signed offby the' Permitting Authority. Following these instructions will reduce the number of requi~'d inspection visits and thereforo prevent assessment of additional fees. TANKS AND BACKFILL {NSPECTION { DATE [ iNSPECTOR Backfill of Tank(s) Spark Test Certification or Manufactures Method Cathodic Protection of Tank(s) PIPING SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETE( 71'ION Liner Installation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(ea) % Product Line Leak Detector(s) Leak Detector(s) for Annual Space-D.W. Tank(s) " Monitoring Wcll(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwatcr Spill Prevention Boxes r'"~ ~ ~ )'-----~....~/ ~ Monitoring Wells, Caps & LOCks ~ t.._ ' r . ~( ~ Fill BOx Lock ~ Monitoring Requirements Type Authorization For Fuel Drop CONTRACTOR CONTACT LICENSE// CITY OF BAKERSFIELD · 'OFFICE OF ENVIRONMENTAL SERVICES .. 1.715 Chester Ave., Bakersfield, CA (661)326-3979 · PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK Typ, E OF A~PPLICATION'(CI~CK). [ !NEW FACILITY ~MODIF[CATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE ".~ q-- ~ 2~' PROPOSED coMPLETION DATE~/'O-- ~- ~ L.~ . FACILITY NAME ~{l'~$~r~"~( EXISTINO~FACILITYPE.RMITNO. · ~-~ ~ ..... FACILITY ADDRESS C~6ZY I~.se-~le 14~ CITY '~t~c-~z~eco :ZI,P~CODE _~/y o~ ADDRESS O"~ ~.i~ " CITY' ZIP CODE PHONE NO. ~.t - 25"~V- '~Q-~ ~ BAKERSFI]~LD C}TY I~USlNESS LICENSE NO. ~ ./~r SPUEFLYDESCPaSETHEWOP.~TOSEUO~ /~0~?~i~ 'Cd 3-~C~_~/Oa~, c~~- ~y, cm-e~ / WATERTO FACILITY PROVIDED BY ~ DEPTH TO GROUND WATER-G4o tcAt.)'cz~ SOIL TYPE EXPECTED AT SITE , ~ NO. OF TANY~ TO BE INSTALLED ' O ARE THEY FOR MOTOR FUEL '~ .YES SPILL PREVENTION CONTROL AND COUNTER MEASURES PLAN ON FILE )< YES NO .... ,NO sz, c'rlo~ ~OR M OT0~ TANK NO,' VOLUME UNLEADED REGULAR ' PREMIUM DIESEL 2. I0 } ,,, AVIATION TANK NO. VOLUME sgcr~o~ tn~R,n0~ M OTOR ~EL SrORAOE TANI~S, CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAMe) (iF KNOWrO FOR OFFICIAL USE ONLY ~,A~~. '?'"~."::"=,"" "" '~ ' ' ' IAPPLiCATIONDATE ' ' ..... : '. 'NO. OFTANK~ .. FEF~$ ' ''" i THE APPLICANT HAS RECEIVED, UNDERST ANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE, LOCAL AND FEDERAL REGULAT IONS. TI[IS FO~M HAS BEEN COMP LETED UNDER PENALTY OF PERJURY, AND. TO THE BEST OF MY KNOWLEDGE, IS TRUE glllD CORREC~r. ';' APPROVED BY'.'-" APPLICANT NAME (PRINT) APPLICANT SIGNATURE THIS APPLICATION BECO1VIF~ A PERMIT WHR. N APPROVED D August 30, 2002 Delimart 9628 Rosedale Hwy. Bakersfield, CA 93312 REMINDER NOTICE FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ~H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION. SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399*4697 FAX (661) 399-5763 RE: Necessary secondary containment testing requirements by December 31, 2002 of underground storage tank (s) located at the above stated address. Dear Tank Owner / Operator, If you are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last four months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the revocation of your permit to operate. This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services 07/29/2002 21: 43 6615899448 DELIMART TEXACO :: PAGE 81 87/29/2882 21:43 6615899440 DELIMART IEXACO PAGE 82 ~= ........................... ~ ~ ~~ -. -~. ~-. ...... ~~: ........... ~{~R DAYA ~A~x ~ O-~L ... S~ NO~ ~ .............. ~~' .~ - 9 .... 07/29/2002 21:43 ~15899440 DELIM/~RT TEX~CO . £L,,E,,,CTRJ¢,4L_ SERI/1'¢E$, !,N¢. P~GE O3 Tex"~o D~U a copy of yom' a.m~u~ ~t~od.lc proration su~'~ r~o~ of ~n sys~m ~ o~a~ ~ ~i~d. U you have ~y , Y~4NT~4 F~ SPI~gN~$. CAZIFORNIA 9o6?0 tsttONg: ~$~;2) 92J-9~2~ F.4X: ~$62~ ~31~P.$ CA. 1.4'CE~ C-lO ~71s 87/29/2882 21:43 6615899440 · 0?/30/02 TUE tO;ZT FAX.~~.~. 'iI': ,, £L~CT~, C~, ,S,, .~ ~, ~CE$. '*NC. DELIM4RT Face.lie Transmittal Cov~ Street Tha~ you! ~ive ail page3. IE OF THIS F~ 18 FOR ~ING -- Q~TE G~O, FOR ~ DAYG ON~Yll'. July 30, 2002 Delimart 9628 Rosedale Hwy Bakersfield CA 93312 ,-':IRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H · Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES · ENVIRONMEII'TAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 326-0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 REMINDER NOTICE RE: Necessary Secondary Containment Testing Requirements by December 31, 2002 of Underground Storage Tank (s) Located at the Above Stated Address. Dear Tank Owner / Operator: If you are receiving this letter, you have not yet completed the necessary secondary containment testing required for all secondary containment components for your underground storage tank (s). Senate Bill 989 became effective January 1, 2002, section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to insure that the systems are capable of containing releases from the primary containment until they are detected and removed. Of great concern is the current failure rate of these systems that have been tested to date. Currently the average failure rate is 84%. These have been due to the penetration boots leaking in the turbine sump area. For the last four months, this office has continued to send you monthly reminders of this necessary testing. This is a very specialized test and very few contractors are licensed to perform this test. Contractors conducting this test are scheduling approximately 6-7 weeks out. The purpose of this letter is to advise you that under code, failure to perform this test, by the necessary deadline, December 31, 2002, will result in the ~, , revocation of your permit to operate. , .~, ~,, This office does not want to be forced to take such action, which is why we continue to send monthly reminders. Should you have any questions, please feel free to call me at (661) 326-3190. Fire Inspector Environmental Code Enforcement Officer D June 30, 2002 Delimart 9628 Rosedale Hwy Bakersfield, CA 93312 REMINDER NOTICE FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 9628 Rosedale Hwy. Dear Tank Owner / Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1, 2002, section 25284.1 (Califomia Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, tO ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1,2001 will be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1, 2001 will be tested by January 1, 2003 and every 36 months thereafter. REMEMBER! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to rdfer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661)326-3190. Sincere ~ . Steve Underwood Fire Inspector/Environmental Code Enforcement Officer Environmental Services SU/kr · TO IMPLEMENT ENHANCED LEAK DETECTION TESTING This is a formal notification that your underground storage tank (UST) system is subject to a new requirement .for Enhanced Leak Detection (ELD) testing, based on information in the State Water Resources Control Board's (SWRCB's) Geographical Information System (GIS) mapping database ("GeoTracker"). Finding: Our information indicates that your UST system is subject to ELD testing because it . has a single-walled component and is located within 1000 feet cfa public drinking water well. Based on this inf0rmation,_the oxvner-or operator is~required.to submit and have aprogram of ELD testing approved by your local permitting agency within six months ~om the date ofthis formal notification. An approved prograra of ELD testing must be implemented no later than. ~SJ- months following this formal notification. Your UST svstem will be subject to this requiremem eve~ three years thereaRer, or until you replace all sin~le-walled components with double-walled components. Information Sources: Local permitting agencies provided information regarding UST systems, including single-walled components, to the SVfRCB. The Department of Health Serv.lees and' water districts provided information regarding locations of public drinking water wells to the SWRCB. Both UST system information and well location information are available on the GeoTracker web site (httn://~eotratker,swrcb,ca. gov). Due to recent security- concerns, the well locations are not available to the public. To view well locations, you will need ~o enter the Facility. ID and PIN numbers, which are located next to the address block on Enclosure 1, following web page: ~acker.swreb.~.,gov/opust. The SWRCB has attempted to improve the accuracy of the information in the GeoTracker database. However, the database may still require updating to make it current and complete. As described below, if you believe GeoTracker's information regarding your UST system or nearby public drinking water wells is inaccurate, you may request reconsideration. Authority: ELD ~esting is required by Section 25292.4 of the Health and Safety Code and bY the SWRCB's implementing regala~ions (California Code of Regulations, Tire 23, Sections 2640. and 2644. I-see Enclosure 2, Local Cn~dance Letter 161). These regulations require ELD testing for UST systems with one or more of the following: single;walled tavak, single-walled pressurized piping, or single-walled ¢or, ventiotml suction piping. The regulations also require ELD testing if the UST system has any dispensers that do not have under-dispenser containment, or if the UST system has any turbines that a~c not secondarily contained. However, vent or tank riser Piping, vapor recovery piping, and "safe" or "European" suction piping are not considered single-walled components if they meet the applicable criteria in the regulations [California Code of Regulations, Tire 23, Section 2636(a)]. Alternative to ELD Testing: To avoid ELD testing, you may upgrade your UST system so that it does not have a single-walled component, according to the regulatory criteria discussed above. For example, if your UST system has double-walled tanks and under-dispenser containment, but has single-walled piping, you can avoid ELD testingby installing dOUble~. walled piping. If you decide to replace single-walled components with double-Walled components in order to avoid ELD testing, you should notify, both the SWRCB and your local ;Delimart Texaco 9628 Rosedale Hwy. -Bakersfield, CA. '93312 569-5640, 589-0369 State water 'Resources Control Board Division of Clean Water Programs ELD Request for Reconsideration P.O. Box 94412 Sacramento, CA. 94244 March '17, 2002 Dear Elizabeth Haven, I received the "Formal Notification" 'letter this month. 'The following are reasons I 'believe we should not be required to do these tests. 'The water well on ~Wheeler'Street'is over'900 yards fi'omDelimart's tanks. I contacted the Vaughn water people, to find the exact location of the well. At that time, they informed me that the well on Wheeler was destroyed in September of 1999. Another well, ( g L204~0'1), 'located north of Delimart, is over 1'000 'feet 'from our Single containment tanks. It was not highlighted on the GeoTracker map you sent to me, so you may already know this. We 'have just completed two very expensive tests at our facility. Our tank 'linings were tested and inspected, and the lines were tightness tested. Mr. Steve Underwood from the Bakersfield Fire Dept. supervised these tests. Please note that we do 'have the Under-Dispenser Containment, and all the *lines'have secondary comainment. Everything has secondary containment except the tanks. The tanks are single wall, 'lined. -We passed our first 'five-year-inspection of the tank'lining-last week, no repairs were necessary. I respectfully ask your reconsideration of implementation of mandatory ELD testing at our facility. Thank you. Sincerely, Diana Meyer Owner/Mgr. Delimart ! Req uest for Reconsideration For--m BUSINESS NAME.t~C~LrrY STREET ADDRESS : II. NAME AND ADDRESS OF OWNER/OPERATOR SUBMYITING REQUEST TITLE OF APPLICANT ~ i PHONE MAILinG ADDRESS CITY STATE T ZIP CODE Please check reason(s)why you believe thru th.e California Stute Water Resources Control Board (SWRCB) notification is in eh'or. If the request for reconsideration is based on evidence that the USX systera in question is greater than ~ ,000 feet from a public drinking water weI1, include a demonstration that the center of the well hea~ is more than 1,000 feet from the closest component of the UST system, If the request is based on evidence that the UST system does not have a single-wailed component, include supporting documentation. INCLUDE ALL SUPPORTING DOCUMENTATION YOU WiSH THE SWRCB TO CONSIDER WHEN REVIEWING YOUR REQUEST. REQUESTS FOR RECONSIDERATION ARE ~UBJECT TO 'VERIFICATION. 1. ( ) I am not the owner or operator of a UST system. Check applicable ( ) Change.of owner or operator. ( ) No UST system(s) present. 2. (,) UST system ts permanently closed. 3, ( ) UST system is exempt from regulation, according to Section 2528i(x) (I)(A)-{D) of~e Health and Saf~ Code, or Section 2621 of Title 23 of tho California Code of Regulations. For example, certain farm tanks and heating oil m:fl~s are exempt. 4. ( ) No single-walled component in UST system(s), 5. (~ Closest component of UST system is greater than i,000 feet from well head of any public &'ii:king water well. Check applicable reason(s): (.,~J UST facility in¢orrac~ly located in GeoTracker database ( ) PublicDrimking Water Well(s) incorrectly located in GeoTracker database 6. (~other(explain)__bOhedtr S4Irt~/_~ dec~y~,ff ;r~ /~',~. (Set d~~~ NOTE: SUBMITTAL INSTRUCTIONS ON REVERSE SIDE OF THIS FORM IH. APPLICANT SIGNATURE Certification - I certify that t~ t~fforn~tlon provided her~ln is true and accurate to the b~t of my I~o,nl~die. Knowtngty submitdns s r~qu~t for r~cowider~tion ba~ed on falr,~ or ml~l~ding information may b~ ¢oastderod a violation of Health and Safety Co~e, Section 25299, punishable by fine up to SS000. PHONE GeoTracker Page I of! (- Zoomln ~ Layers ILUFT Sites lUST Sites ZoomOut~ C~ Pan ~ Identify~ Show [~!! ...... ~ sitss within ~ of public wells, Click ('.~ thc selected actiom · Public Wells ~' Highways ~' Major Roads ,'"Minor Roads //USGS Quads [[Surface Water IWatemhede Il[OW Basins 6REE~N_ACnE~ DR :. lVulnsrability Map Size: Street: } G*_C~TL~.k_c!_H~o~_~ I Colttact ~tto AdminisI~!o~93~ Ma~s by ~T~K Well ~d L~T site ~sitions are approximate, Locationa! ~curacy will improve ~ state agenci~ ~d r~ponsible p~ies ob~in ~d mpo~ aew in~bmatioa. https://geotracker.arsenaulfleggcom/S CRIPTS/ESRI MAP.DLL?NA3~E=MOSERVER&cmd~... 2/25/02 Business Name DELIMART Facility ID 215-000..001395 PIN MtZ~09 Water Purveyor BAKERSFIELD, CITY OF DHS rD 29s/27E-19J02 M 1000 BUENA VISTA RD BAKERSFIELD CA 93311 Well Name WELL 1.21M.01 - TREATED Water Purveyor VAU~,2~'L~q~IN~ ST, ' DHS ID 29S./27F~29DO, M~ LG-I:61 · What must be included in the request for reconsideration? The request must include, in writing: · · .The nam~ and address of the subject facility; · Thaname :and address of the owner/operator submitting the request; and · The:reason(s) why the requester believes the SWRCB's notification was in error. If the request is based on evidence that the UST system in question is gr~t~ than. : 1,000 f~t from a public drinking water well, the request shall include a .:demonstration that the center of the wellhead is more than 1,000 feet: from tho closest component of the UST system. If the request is based on evidence that the -subject UST system does not have a SW componem, the request shall include supporting documentation adequate to 'allow the SWRCB decision. [Cal. Code ' Regs., tit'. 23, § 2640, subd. (e)(3).] Owners/Operators. should submit, their reqge_s_t_(_s)_ fo_r reconsideration to both their local agency at the appropriate address and to the SWRCB at: ' - - State Water Resources Control Board Division of Clean Water Programs Attn: Elizabeth Haven, UST Program Manager ELD Request for Reconsideration PO Box. 944212 Sacramento, CA 94244 What if the request for reconsideration is inadequate to make a dectSion? Upon receipt of a request for reconsideration that does not include all of the requi~red information,' the UST Program Manager will advise the requester of the mariner in which the request is incomplete and allow a reasonable time within which an amended · request may be submitted. If the UST Program Manager does not receive an adequato ' arnendod petition within the time allowed, the request for reconsid, ration may be denied. ~t does itmean if the ELD test results indicate that the UST system has "failed,,~ No~: TI~ following information is based upon the Enhanced TracerTight test performed by ___ Tracer Research Corporation (IRC). As other test_methods hec_o_m_e ay~la_b!e, ~we will_prepaxe -- ad~onal intimnation if appropriate A "fail" t~st result indicates that a substance that is not a component of the fuel formulation stored in that UST system (referred to as a "tracer" by TRC) has escaped from the UST system. Baaed · upoa thed;istfibution and concentration of tracer detected in the soil gas samples col!ecmd around the UST systom, TRC is able to infer the location, relative size, and type of release (liquid versus vapor). California Environmental Protection Agency ORecycled Paper Delimart Well L204-01 located in 9400 block of Seabeck. 'Seabeck Street-is close to ~¼ mile north of the pumps, and the wellis roughly 400 feet pumps. Formula I used; Rt anlge to find lenght ofhypot. A sq + B sq= C sq 1300ft squared =1690000.0 400ft squared = 160000.0 Total =1850000.0 Distance is about 1350 ft. From pumps/tanks east Of the 03/11/02 14:43 FAX 6615 '438 VAUGHN WATER CO Phone (661) 862-8700 " i .... ~PLIC~ION FOR PE~T TO CONSTRUCTION, RECONSTRUCT, DEEPEN OR DESTROY A WELL APPLICATION DATE: . Sept, ~...1999 OWNER: .. VAUGHN WATER COMPANY i'ff014 Glenn Street PACIFIC IRRIGATION, INC. Mailbag Address: DRILLING ' CONTRACTOR Ad'ess: P.O. BOx. .225. 11845 School Street ~ UB,.,ONTRACTOR. nona Ad.ess: 30B SITE: PROPERTY DESCRIPTION: SiTE ADDRESS if available: DIRECTIONS to Well Site: PROPOSED STARTDATE Sept.~, .15, 1999 Phone: 589-2931 Ci~ Bakersfield Zip: 93312 366-5555 Conli'aetot" s License 471615. Phone: C~y: Edison ............ Phofie: City: ....... S~. 99 -40Acr~Sub SW NW NW Zip: 93220 __ Zip: T~ 79 R 27 2325 Wheeler St. TOTAL ACRES: · 1 block east of Calloway on Rosedale Itw7. to Wheeler 1 block south on we~t ~do of Whaeler St. . TYPE OF WORK TO BE DONE: (ch~:k one) m New Well [] Deepen [] R~onsumetion ~ Destruction INTENDED USE: D Domestic/private.( 1 corm~tion)_ m Domesfidnonpublic (2.-4 connections) ~ Domes'dc/public (5 or more Conn.) m Agricultural _. -m-TestHole~ --=-- .-~- _m Monitoring re. Cathodic Protection m Other SEALING MATERIAL (check one) ~ Neat Cement m Cement C~out [2 Concrete [] Other GRAVEL PACK: (check one) ~ Ye~ n No From To Feet PROPOSED WELL co~STRuCT~O~ ~SPZ~D Max. ~00~ Feet Mba, Feet PROPOSED PERFORATIONS OR SCREEN: From ~ To -- Feet From To Feet CONSTRUC~ON METHOD: Reverse Rotary ~Rotaty Air Rotary Other v PROPOSED CASINO: Type Diameter 14" Gauge/Wall ,25.0 Conductor Depth unknown PROPOSED ANNLrLAR SEAL DEPTH: Unconsolidated r Hardrock PENETRATES TWO OR MORE AQtnFEKS m Yes cXN~o PROPOSED WELL DESTRUCTION SEAL DEPTH DEPTH OF.WELL TO BE DESTROYED 300 ' 50' 03/11/02 14:43 F.~k% 6615897438 Kem County Environmental Health Services Department 2700 "M'"Street, Suite 300 · Bakersfield, CA 93301 Phone (661) 862-8700 -' F.kX (66t) 862.8701 VAUGHN LOCATION WATER CO Parcel/Map/Tract parcel No. Assessor's Parcel No. Indicate-.below the exact-location of well with respect to the following items: property lines, water bodies or eouv. drainage pattern, roads, existing wells, structures, sewers or private disposal systems. Include dimensions. LOCATION OF WELL WI'I'HIN SECTION LINES - Locate well by measuring from proposed site in relation to secti lines or half section linoS. Section No.: D!C BiA ; El F O' MiL Ki J O~ Mile - I W54 Paga $ o State of Cafifornia---Environmental Protection Agency 0 ~(D ~ R ~ ~ ]. 4 ]. ~ ? ~ Deparlment of Toxic Subslances Control A,i,~av.a O~ No. 20.~-0039 (~pires 9--~0-991 ::'.~;, ', See Instructions on back of 6. ~,, Sacramento, California ~ri~j or type. Form designed for use on elite (12-pitch) ~ .... ~ .... ~ Document No. '~ UNIFORM HAZARDOUS 1. Generator's US EPA ID No.,Manifes~~ 2. Page 1 Informalion in the shaded areas · is not required by Federal law. WASTE MANIFEST 4. O~erator'sP~ne( J 588-~777 EH~RGENCY CONTACT~ BOX . I cJ, J nj el el ~J 3J 8J ~J 0J ~J 7. Transporter 2 Com~ny Na~ 8. US EPA ID Numar ONYX ~NV SVC~ L~C AZUSA 1704 WEST F~ST ST ]2. Comainers 13: Tolal ~4. Unit ] ~. US ~T Descrlpfio. (including Pro~r Shipping Name, Haza~ ~ass, and ID Numar) No. ~yee ~ua.~ Wt/Vol a..~, 'WAST~ FLA~A'BL~ LI~UIDS,N.O.S. c. II I III. I S~ i PPER. pLACARDS P~0V[DED BY CA~R[ER/~HIPPER YES/NO DRIVER $IGNRTUEE 16. ~NE~TOR'~ ~R~FI~ON: I hereby ~lare lhat ~e cOn.nfs ok this consignment are ~lly and accurate y de~ribed above by pro~r shipping name and are class;fled, packed, markea, and labeled, and are in all re,ch in proper conditiOn for ~ansport by highw~ according to applicable internafio,al and nalio~J government regulations. if I am a large quanti~ g~m~ I certi~ ~at I h~e a program in place ~ reduce the ~lume and toxici~ of ~ste generat~ to the degree I h~e determined to ~ e~nomicalJy pracfi~ble'and ~f I ~e ~1~ ~e pra~icable melh~ d ~ent, s~rage, or dls~saJ cu~en~y available to me which mini%iz~ fhe .p~senf and ~fure Ihreaf to and ~e environment; OR, if I ama small quanfi~ generator, I h~e made a g~ faith ef~ff ~ minimize my was~.genemtion aha sel~t,ffie oest was~ maqagement metnoa mat ~ailabJe ~ me and that I' can affbrd. ' Print ~ ~ed Name Sign~'l ~ ~ ~nth Day Yem 18. Transpormr 2 4cknowledgeaent of R~ipr0~ Mal~ials Printod/Typea Name ' J Siona~re Month ' Day Year 19. Discrepan~ tndicolJon Space 20. Facil~ ~ner or ~rotor Cedi[italian of r~qipt d hazards m~ri~s covered by this mani~st excep~ as no~ in item 19. Prlnted~y~d Name ' ' Month ~y Y~r DO NOT WRITE BELOW THIS LINE. DT$C: 8022A (1/99) YeJlow: GFN'ERATOR RETAINS EPA 870~22 ORDER' ~ Z1415:? State of Ca ifornia-.-Environmenta[ Protection Agency Form Appr0~ed OMB No. 20.50-003.9.(Expires 9-..30-99! ; See Instructions on back of 6. . Department Of Toxic Substances Conlrol Please prin, t, or type. Form designed ~or use on elite ~.~' ' ~. Sacramento, California uNIFORM HAZARDOUS, ' is nbt required by Federal law. BAKERSF;I~LD, CA 93312 5~ Trans~r~r 1 Core.ny Name 6. US EPA ID Number 9. ~s~nat~ ~cili~ Name a~ Si~ Address 10. US EPA ID Number 1704 WEST FIRST ST O. Rq, W~STE'FLA~ABLE LIQUIDS,N.O.S. b. II I I,III 15. S~i~Handlinglnswudi~and~diffo~ll~rmati~ W~AR APPROPRIATE PROTECTIVE GEA~--WHEN HANDLING. E~ERGENCY CONTACT: CHE~YREC: 1-800-424-9300. CALLER MUST IDENTI~Y VOPAK USA SHIPPER. PLACARDS PROVIDED BY CARRIER/SHIPPER YES/NO DRIVER S~,GNATURE 16. GENE~T~'5 CE~IFI~gON: I hereby d~lare t~ ~e contenb d th s consignment are fully and accumb~ deeded able by pro~r shipping name and are classifi~; p~, marked, a~ labeled, and are in all respecb in pr~r c~dlfion for ~an~off~y highway according to applicable international ~d national ~ernmenf regula~ons. ' ~.8 ~ e.~nment; OR, i} I om ~ small q.on~g genera~r, I h~e m~e o goo~ ~1~ e~ to minimize ~ailable fo ~ and fhaf I con a~rd. Prin~d~T1 )ed Namer ~ ' I Sign Month D~' Y~r ] 9. ~scr~an~ Indlcotion 5~e 20. Focili~ ~ner or O~ Ce~ficotlon o~ receipt o~ ~a~r~ m~feHols ~ ~ ~is manifest except DO NOT WRITE BELOW THIS UNE. DTSC 8022A 11/99) EPA Blue: GENERATOR SENDS THIS cOpy· TO DTSC. WITHIN 30 DAYS. P.O. Box 400, Sacramento, CA' 95812-0~.00 ONYX ENVIRON~ SERVICES A (~nerator Name: ~.t ~LV~ EPA ID # (¥~..~~~-~ State Manifest 1. E ~e ~.a ~ (~ ~.C~ 2~.2) ~ ~ ~ ~ ~e ~e ~e(s~ Pmffie · ~ T'~A~I~ ~ ~-~e ~er~ ~ 8 ~f~ e~ ~e ~at ~ies) (~ ~ CFR ~ ~ ~) 1~)03~ R)25 UgN onds K1~6 Not Rmem Rns. P092 Lo RMERC Res. , D003 Wate~ ~ ~ F02S Spe~t ~er K106 >260 ppm Hg P092 Not Ino'RMERC Res. D(X~ O~her Reaslives KGO6 Anh~ PO47 Nonsalts __ U15I Le RMERC Fk~ DIX)6 Baltedes K069 Cak~um 8uffate P065 Lo Inc. Ras. U151 Lo N~ RMERC Ras. The su~ fo~ DO18-O043 waste is 'treated in nonCWNnonSDWA facirdy" unless the following box is checked: E] 'treated in CWA/SDWA facili¥ , U151 I~ Hg , ,. U2402,4D , U240 2, 4 asts~s & ,~alts 3. COMMON CODES (Place appropriate letter'from section 8 before each code that applies) __D0~4~. P012 --~CI4~O6 1~51 --~0(~ P105 FO06 F007 R308 __FIXIg F010 __FOIl 'F012 ~DQ~ ~D010 ~DOIt ~0012 ~m13 ~DOt4 ~1~015 m~6 ----D017 U007 ~U044 __ __U072 "-"U080 -~U108 ~U117 ~'-U122 -'~U123 ---U136 '~U154 ~U188 __U213 -"--U220 ADDmONAL CODES (F.n~ all code~ not identir~ a~xwe which are assodated wire waste) s. HOW'MUST THE WASTE 4. USEPA ~ROOUS WASTE S. TREATMENT ST~AR0S FOR NO~-PHASE, STATES (~No~c^TE THE APPUCAm.E ~AGED? EN~R THE t~z,u~ COOE(S) TREATMENT STN~ARD ~4~, ~.~ OR SPE~F~ED TECHNOLOGY Sa.OW) FROM BELOW ~F019 ~F039 D018 --'T0~ 2-1~roproflane Py~r~e Te~-ac~doroeU~yterm __ T~uefle __ 1,1,1T~ 1, 1, 2-T~ ...... I, 1, 2-T~eNm'o, 1,2, 2-tdfl~ Tdchleroe~ylene ,~ Xylenas · (States auihodzed by EPA to.mansge lite LDR program may have mgelato~y citaUons different from the 40 CFR citations listed below. Where Ihese regulatory citations differ/your L2 L4 ce~ifica~l wlll'be deemed'to rofer to those state citations instead of the 40'CFR citations.) RESTRICTE~ WASTE REGUIRES TREATMENT C] Fo~ Haza~d~(~s Oel~is: 'ThisJ~;g;ardous del~is is subject to the alternative treatment standards of 40 CFR 268.45.' RF..STfllCTEO WASTE TREATMENT TO PERFORMANCE STANDARO$ I cedify under penalty of law that t have persona~y ~ '~ and am ~amlllar with the {teatmen{ technoingy and ~ ~ ~ ~ ~ss u~ ~ s~n ~ ~r~. ~ on my tnquby of Iho~e incavidtmis immediats~y ~ for obts~ning this infonna0on, I belisve that the Imatment pro~ess has been of~ra~ed and maimained propedy se as to comply with the Imatment standan~s ~ in 40 CFR 268.40 without Impem~.~a'bla dilution of ~he prohiMtod waste. I am aware Ihat there are significant penalties fer submitting a Calse cemT~ca~n, indu<~ng the ix~,ibirey of'a tine and imprisonment' (CERTIFICATION RGMOVED BY IlflAS~ IV) GOOD FAITH AND AHALYTIGAL CERTI~CATION - FOR INCINERATED ORGANICS on-my Inqui~ of those individuals tmme~atety res~x)na'ble for ot~tainlng this Informa~on, I believe that the nonwastewater on3anic consfituems have been treated by combustion units as ~ in 268.42, Table 1. [have been unable to detect the nonwastew~tor organic cQnsti~uents, despite having used best good faith efforts to anaJyze for such consU~uems. ! am aware DECHARACTE~ _Tl~'n WASTE REQUIRES TREATMGNT FOR UNDERLYING HAZAROOUS CONSTITUENTS '1 ns~Ky under I~alty.of law ~ the waste has been ~mated in accordance with the requirements of 40 CFR 268.40 to remove the hazardous characto~stic. This decharactedzed waste contains unclen~ng hazardous ~stituents Ihat require forther treatment to meet universal treatment sts~larcls, I am aware that them am significant penalties for submitting a false ce~liflcatiea, including the ix~ of fine a~dimpdsonmenL° RESTRICTED WASTE SUBJECT TO A VARIANCE This waste is sub~ to a national capacity variance, a tmalabtlity vGu'iance, or a case-by-case exto~sinn. Enter Ihe effecdve da~e of prohibition in column 5 above. For hazardous debds: 'Thls hazardeas debds is sublect to the. alternative treatment standa~ts of 40 CFR 268,452 - - RESTRICTED I~ASTE CAN BE LANO OlSPOSEO WITHOUT FUI~THER TREATMENT '1 ce~.under penaJty of law that I have persona~ examined and ~nt ~ with the waste through arians and testing or through knowledge of the waste to suppert this cedit'm, adon that 0re waste coe~ v~th the lmalment standards specified in 40 CFR Part 268 ~ O. I be~eve that the in~ormatton I submitted is true, accurate and complete, t ant awa~e that there are significant penalties fo~ submitting a false ce~tificadon, including the possibility of a fine and imlxisonmant' WASTE NOT CURRENTLY SUBJECT TO PART 268 RESTRICTIONS This waste Is a newly iden6fled wasts that ts not cuffenUy subiect to any 40 CFR Part 268 mst~:tions. GENEi ATOR COPY RECYCLI G/TSD HANDLING' AGJ EEMENT ~ - -~ (G~ATOR AND RECYCLING/MD CON~R) - - · WHEREAS, Ge~rator produces spent chemicals which may be considered to be "hazardous" or "toxic" within the meaning of appl~able federal and s~te laws ("~ent Chemicals") ~d which t~mfom must ~ transported, stored, disposed of, recycled, treated or re-used .("Handled") in aCcprdance with applicable laws pedaining to h~us or toxic chemicals; WHEREAS, Rec~cling/TSD Contractor owns or controls facilities wbi~ am capable of Ha~ling Spent C~micals in accord- ~e with.all applicable laws ~d~ning to soch activities; WHER~S,' the padies ,?sim to enter into an arrangement for the Handling of Spent Chemic~s, all on the terms and conditions hereinafter set forth; NOW, ~EREFOR~ in consideration of t~ covenants and agr~ments contained heroin, t~ undemigned agree to the following terms and conditions of this Recycling/TSD Handli~ Agreement as well as to the S~ndard Terms and Conditions Governing the Handling of Spent Chemicals ("Standard Terms and Conditions"), which am aEached to the Generator copy of this Agreement and am incorpora- ted heroin by reference. All capitalized terms not otherwise defined heroin shall have the meanin~ set fodh in the Standard Terms a~ Condi- tions. 'SpeNT CHEMICALS SHIPMENT. The completed Uniform Hazardous Waste Manifest or appropriate state m~ifest ~ich ~ ~entified by t~ reference numar app~dng in a space below the signatures to this Agreement and Which pertains to t~ ~ent C~micals Ship~nLHandled under this Agreement is hereby i~orporated herein by reference. Such manifest descries cedain Spent Chemicals which Generator hereby agrees to ship to Recycling/~D ~ntractor and which ReCyCling/TSD ~ntractor agrees to Handle at the facility named in such m~ifest ("Designated Facility"). 2. COLLE~ION, ~HS~AT~ON, STOOGE AHD DEUVERY. All Spent Chemicals Shipments shall be transported to Recycling/TSD Contra~or by' Van Waters & Rogers Inc., a Washin~on Corporation ("VW&R"), or an entity des~nated by VW&R to provide transpo~ation and temporary storage services. 3~ . PAYMENT. It is underwood that VW&R shall pay Recycli~g/TSD Contractor for Handling t~ Spent Chemicals Shipment (or, where'mgney is owed to Generator, VW&R sh~l pay Generator for the Spent Chemicals Shipment) according to the terms of a certain Master Spent Chemicals Handling Agreement betw~n Recycling/TSD Contractor and VW&R. Recycling/TSD Contractor shall not look to Generator for payment for ,Handling the ~ent C~micals Shipment, ex. pt for ce~ain extraordinary charges incurred in connection w~h Non- conforming Spent~Chemicals as set fodh in t~ S~ndard Terms a~ ~nditions. 4, INDEMNIFIED PA~Y. ~ used in the Standard Terms and ~nditions, the term "Indemnified Party" shall mean either Recycling/~D ~ntra~or or Generator, depending upon which party claims indemnification under this Agreement. 5. GENERATOR INDEMNIFICA~OH. Generator shall defend, indemnify and hold harmless Recycting/TSD Con- tractor, its past. present and future officem, directom, employees, agents, insurem and successors (hereinafter in this Paragraph referred to collectively ~ "Recycli~/~D Con:raZor"} ~om a~ against any and all Loss which Recycli~/~D Contractor may sust~n or incur, ~ respon- sible for or pay out as a m~lt of: ~ . ~ (a) Generator's broach of any representation, warranty, term or provision of this Agreement; or (b) T~ n~ligence or intentional miscond~t of Generator, its ~mployees, agents, representatives or subcontrac- tom in the performance of this Agreement, provided that such indemnification shall not ap~ly to the extent suc~ liabilities result from Recy- cling/TSD Contractor's negligence or intentional misconduct or from a broach of this Agreement by Recycling/-TSD~Contractor. 6. NAMES AND ADDRESSES OF PERSONS TO WHOM N~ICE IS TO'BE GIVEN. The name of the per- son to whom notice is to be given on behalf of Generator appeam on the Uniform Ha~rdous Waste Manifest i~lt~m 16 or the appropriate state manifest. The name of the pemon to whom notice is to be given on behalf of Recycling/~D Contractor appears on the Uniform Hazardous Wa~e Manffe~ in Item 20 or the appropriate state m~Eest. The addresses of ~e ~mons to whom notice is to be given appear on the Uniform Hazard.s W~te ManEest u~er Item 3 (for Generator) and Item 9 (for Recycling/~D Contractor) or the appropriate state manifest. ; RECYCUNG/~D HANDLING AGREEMENT (GENE~TOR AND RECYCLING/~D CONT~CTOR) The undemigned hereby agree that, upon exec~ion of this Recycling/~D Handling, Agreement, them is a binding contract bet~en them acco~ing to the ~ove terms and conditions, as of the day and year appearing below. GENERAYOR EPA ID-:~-~CO 0,~~ ~ RECYCLING/~D CONT~CTOR: ~ME ~f ~,~f~/ TTLE~ ~~~ SIGNATURE: ' ' · , ~//~/~ .~ RECYCLING ,~D CON.ACTOR SIGNATURE: t ~ ~ DATE: SHIPME~ APPROVAL NUMBER 1~'~ ......... ' ~' UNIFORM ~AR~s W~TE ~NIFEST DOCUME~ NUMBER: '~STAT~RD?U$.WA~E ~IFEST DOCU~EN~ NUMB~R~ ~ ~ ~' ;,'' , ' ' . ' . ~,~ ? ' ~ . ¥-'~' ~ ':~,. PAYMENT. It is understood that VW&R shall pay Recycling/TSD Contractor for Handling the Spent Chemicals Shipment (or, where money is owed to Generi~gkr, VW&R shall pay Generator for the Spent Chemicals Shipment) according to the terms of a certain Master Spent Chemicals Handling Agr~nt between Recycling/TSD Contractor and Vii~. Recycling/TSD Contractor sh, all not. look to '~ner'a{0r~ for payment for Handling the Spent'qb~emicals Shipment, except for certain extraor~ry charges incurred in connection w~th Non- conforming Spent_Chemicals as set forth in the Standard Terms and Conditions. 4. INDEMNIFIED PARTY. As used in the Standard Terms and Conditions, the term "Indemnified Party" shall mean either Recycling/TSD Contractor qr Generator, depending upon which party claims indemnification under this Agreement. 5. GENERATOR INDEMNIFICATION. Generator shall defend, indemnify and hold harmless Recycling/TSD Con- tractor, its past, present and 'future officers, directors, employees, agents; insurers and'successors (hereinafter in this Paragraph referred to collectively as "Recycling/TSD Contractor") from and against any and all Loss which Recycling/TSD Contractor may sustain or incur, be respon- sible for or P.ay out as a result of: (a) Generator's breach of any representation, warranty, term or provision of this Agreement; or '(b) The negligence or intentional misconduct of Generator, its employees, agents, representatives or subcontrac- tors in the performance of this Agreement, provided that such indemnification shall not apply to the extent suc~h liabilities result from Recy- cling/TSD Contractor's negligence or intentional misconduct or from a breach of this Agreement by Recycling/TSD_Contractor. 6. . NAMES AND ADDRESSES OF PERSONS TO WHOM NOTICE IS TO'BE GIVEN. The name of the per- son to whom notice is to be given~on behalf of Generator appears on the Uniform Hazardous Waste Manifest in Item 16 or the appropriate state manifest. The name of the person to whom notice is to be given on behalf of Recycling/TSD Contractor appears on the Uniform Hazardous Waste Manifest in Item 20 or the appropriate state manifest. The addresses of the persons to whom notice is to be given appear on the Uniform Hazardous Waste Manifest under Item 3 (for Generator) and Item 9 (for Recycling/TSD Contractor) or the appropriate state manifest. RECYCLING/TSD HANDLING AGREEMENT (GENERATOR AND RECYCMNG/TSD CONTRACTOR) The undersigned hereby agree that, upon execution of this Recycling/TSD Handling. Agreement, there is a binding contract between them according to the above terms and conditions, as of the day and year appea~ing below. GENERATOR EPA ID#:(. ~'~(~ ~ ~')~) ~ ~:' C'" ' ...... .------ _.~.' ~ .... .,- RECYCLING/TSD CONTRACTOR: ' ~ . PRINT David LaCoste TITLE: Vic~ ~e~dent of Sales and M~keting FACILITY: ~ ~ ' ~"~ '~.~'~' V"~" NAME: SIGNATURE: ~t/;¢~ ~' -~'~i DATE: ..... S"~ENT ~OVAL NUMBER UNIFORM ~S WASTE MANIFEST ~CUMENT NUMBER: ~ ~ ~ ~ ~ -, ..-- -, IDES- TRANSPORTATION / HANDLING AGREEMENT (GENERATOR AND VW&R) The undersigned hereby acknowledge that Generator and Recycling/TSD Contractor have entered into the above Recycling/TSD Handling Agreement. The undersigned hereby agree that, upon execution of this Transportation/Handling Agreement, there is a binding contract between them according to the terms and conditions appearing on the reverse sid(~, hereof, effective on the-same date as the Recycling/TSDGENERATOR EPA ID# 'Handling Agreement.~,,_~t ~,(~. FACILITY: GE'~IERATOR COPY Van Waters & Rogers Inc. A ROYAL PAKHOED COMPANY FACILITY: P.,NT 1t . SIG~TURE: 9628 /5 ~r. rsfi;e2& Friday, April 12, 2002 To Whom it may concern, B.S.S.R. Delimart, in regard: These drams are th has been given authority m act as sigr~g agent of ~to the disposal of hazardous waste drums. res~flt of the March £uel tank cleaning. If you have any que Thank you. Diana Meyer dons; please contact Diana Meyer at Delimart. i: t CITY OF BAKl~FIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 INSPECTION RECORD POST CARD AT JOB SITE Address INSTRUCTIONS: Please call t'or an inspector only when each group of inspections with the same number are ready. They will run in consecutive order beginning with number I. DO NOT cover work for any numbered group until all items in that group are signed offby the Permitting Authority. Following these instructions will reduce the number of required inspection visits and therefore prevent assessment of additional fees. TANKS AND BACKFILL INSPECTION I DATE I INSPECTOR Backfill of Tank(s) Spark Test Certification or Manufactures Method Cathodic Protection of Tank(s) PIPING SYSTEM Piping&Racewayw/C°llecti°nSump&~.h~ ].,{~,.'g ~//Lt.M.~t,¢-, ~[( ~/['/~}'~'~ ~ ~~ Co.sion Proration of Piping, Joints, Fill Pi~ El~tfical Isolation of Piping From T~k(s) CathodiC Proration System-Piping Dis~nser P~ SECONDARY CONTAINMENT, OVERFILL PROTECTION, LEAK DETECTION Liner Ir;stallation - Tank(s) Liner Installation - Piping Vault With Product Compatible Sealer Level Gauges or Sensors, Float Vent Valves Product Compatible Fill Box(es) Product Line Leak Detector(s) Leak Detector(s) for Annual Space-D.W. Tank(s) Monitoring Well(s)/Sump(s) - H20 Test Leak Detection Device(s) for Vadose/Groundwater .Spill Prevention-Boxes FINAL Monitoring Wells, Caps & Locks % Fill Box Lock Monitoring Requirements Type Authorization for Fuel Drop LICENSE # CITY OF BA~RSFIE.LD OFFICE OF ENVIRONMENT~ SERVICES 171~ Chester Ave., Bakersfield, CA (661)326-3979 APPLICATION TO PERFORaM A TANK LINING REINSPECTION PE~ML~T TO OPEIL.\TE # 5'2 7 ~/- ! - 2 NUNfaER OF TAzNKS TO BE TESTED_ .'~ _ i$ PIPff4G GOING TO BE TESTED. A) TANK # VOLUME CONTENTS APPROVED BY 02- II-0,,2 DATE SIGNATURE OF' .~PPL1CANT 4ete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: RoS~,F,,DALE DELI liAR~ 96~ ROSEDALE m~ BAKERSFIELD CA 93312 A. Received by (Please Print Clearly) D. Is delivery address different from item If YES, enter delivery address below: [] Agent Addressee [] Yes [] No 3. Service Type ~3 Certified Mail [] Express Mail [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. 4. Restricted Delivery? (Extra Fee) [] Yes 2. A~Number (Copy from service label) ~1~)0 1530 0006 3456 3201 102595-00-M-0952 PS Form 3811, July 1999 Domestic Return' Receipt First-Class ~ea~i d UNITED STATES POSTAL SERVICE Postage & F USPS Permit No. G-10 J · Sender: Please print your name, address, and ZIP+4 in this box · BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, Suite 300 ~ake~field., CA 93301 ,.I3 Postage -~' Certified Fee Return Receipt Fee I:~ (Endorsement Required) r-1 Restricted Delivery Fee r-'t (Endorsement Required) 1.50 Postmark Here Total Postage & Fees ~/ 9628 ................................................................. D February 1, 2002 FIRE CHIEF RUN FRAZE ADMINISTRATWE SERVICES 2101 "H" Streel Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakeo:field, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 Crreg Meyer Rosedale Deli Mart 9628 Rosedale Hwy Bakersfield CA 93312 CERTIFIED MAIL RE: Mandatory Interior Lining Inspection on (3) 12,000 Fuel Tanks Located at 9628 Rosedale Hwy FINAL NOTICE Dear Mr. Meyer: This letter will serve as a final reminder that you have until March 13, 2002 to have your tanks inspected. SectiOn 2663(h) of the California Code of Regulations, Title 23, Division 3, Chapter 16 of the Underground Storage Tank Regulations requires the following actions: "Within 10 years of the lining, and every five years thereafter, a coatings expert or special inspector must conduct an evaluation of the tank lining. Written certification of the inspection shall be provided by the tank owner and the party performing the inspection to the local agency within 30 calendar days of completion of the inspection. The inspection shall include all of the following: 1) Determine that the tank has been cleaned so that no residue remains in the tank. 2) Determine that the tank has been vacuum tested at a vacuum of 5.3 inches of rig for no less than one minute. 3) Testing the entire tank interior using a thickness gauge on a one- foot grid pattern with metal wall thickness recorded on a form that identifies the location of each reading in order to verify that average metal thickness is greater than 75 percent of the original wall thickness. 4) Testing for thickness and hardness of the lining in accordance with nationally-recognized industry codes to verify that the lining meets the standard under which the lining was applied. 5) Testing the lining using an electrical resistance holiday detector in accordance with nationally-recognized industry codes. The owner or operator shall have all holidays repaired and checked in accordance with nationally-recognized industry codes. 6) Certification from the special inspector or coatings expert that: a) The tank is suitable for continued use for a minimum of five years. b) The tank is suitable for continued use for a minimum of five years only if it is relined or other improvements are made. c) A lined tank shall be closed in accordance with Article 7 at the end of its operational life." Therefore, prior to March 13, 2002 you shall have your tanks inspected conforming to the above-mentioned code requirements. As a courtesy, this office is giving you advanced notification so that you mayprepare accordingly. Should you have any questions, please feel free to call me at (661) 326- 3190. Sincerely, · Steve Underwood, Fire Inspector/Environmental Code Enforcement Officer Office of Environmental Services SU/dlm · CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., yd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE it[O~[Ot Section 2: Underground Storage Tanks Program Routine [] Combined Type of Tank ,~L0 t Type of Monitoring Joint Agency /IT& [] Multi-Agency [] Complaint Number of Tanks 3 Type of Piping Or0 f:: [] Re-inspection OPERATION C V COMMENTS Proper tank data on file / Proper owner/operator data on file Permit tees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current Failure to correct prior UST violations Has there been an unauthorized release? Yes No . Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY T of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: .._~' ~~ Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business kite Respo'[~ble Party © CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME 1'~, ADDRESS FACILITY CONTACT INSPECTION TIME INSPECTION DATE ft(a g/c t PHONE NO. ~'~ ~ -030~/ ' -' BUSINESS IDNO. 15-210- NUMBER OF EMPLOYEES c790 Section 1: Business Plan and Inventory Program Routine x~ Combined Joint Agency Multi-Agency ~.~ Complaint Re-inspection OPERATION C Vi COMMENTS Appropriate permit on hand Business plan contact information accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities ~ f ! Verification of location Proper segregation of material {..,,., Verification of MSDS availability -']i:~?' / Verification of Haz Mat training [,,,' Verification of abatement supplies and procedures Emergency procedures adequate [,,,/ Containers properly labeled L,, Housekeeping - Fire Protection t.,' Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: Yes [~ No Questions regarding this inspection? Please call us at (661 ) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy B~si~ess Site ~J)Slat~si~leJ'arty Inspect°r: ' ~[~ SSSR, inc. 663.0 ....... Ros~dale· Hwy., # B, Bakersfield, CA 93308 Phone (661) 588-2777 Fax (661) 588-2786 MONITORING SYSTEM CERTIFICATION This' form must be used to document testing and servicing of monitoring equipment. A seoarate cer0fieafion or r~ort must b,, prenared for each monitoring system control pn~e~l by the technician who performs the work. A-copy o~ this form must be provided ~ ~he tank system owner/operator. The owner/operator must submit a copy of this form to ~e loc~ agency regulating UST. systems within 30 days ofte~t date. A. General Information Facillty Name: ~ Facility Contact Person: ~ _~_ .~..//y~ )/~/~ ~. ~ (.1~-~ ' Contact Phone No.: Make/Model of Monitoring System: ~h i[~,~tu~gq~agt ~f~m~g ~ .~}dtb .~6v~--~5'. B. Inventory of EquipmentTested/Certified Bldg. No.: Date of Testing/Servicing: [ ~) / ti./,, Check the appropriate box~ to._l~d!ea~e spec/fie equipment Tank ID: ' _"~)i {?~a~.~ ' [] In-Tank Gauging Probe, Model: [] Annular Space or Vault Sensor. Model: /M iping Sump / Trench Sensor(s). Model: ill Sump Sensor(s). Model: echanical Line Leak Detector. Model: - [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: [] Other (Specify equipment type and model in Section E on Page 2). Tank ID: ~..~ 0 In-Tank Gauging P/obe. Model: [] Annular S .l~_..e _or. Vault S~ensor_-Model:  Piping Sump 1 Trench Sensor(s). Model: Fill Sump Sensor(s). Model: ~1 Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: [] Other (specify equipment type and model in Dispenser ID:,,, ~ |/~. [] Dispenser Containment Sensor(s). Model: I~-S'hear Valve(s). O Dispcnse,t Containment Float(s) ~nd Chain(s). DisPenser ID: ~L ~,//_~ ~ []:Dispenser Containm~t Sensor(s). Model: D'Shear Valve(s). [] Di .spenser Containment Float(s) and Chain(s). Dispenser ID: [] :.Dispenser Containment Sensor(s). Model: 1~ Shear Valve(s). Section B on Page 2). Tank ID: . '~ce__m ~ !l.fY') [] In-Tank Gauging Probe. [] Annular Spa~e or Vault Sensor. Piping Sump / Trench Sensor(s). Fill Sump Sensor(s). [2 Mechanical Line Leak Detector. Model:Model: Model: Model: Model: [] Electronic Line Leak DeteCtor. Model: j [] Tank Overfill/High-Level Sensor. Model: [2 Other (specify equipment ty~e and model in'Section E on Page 2). Tank ID: - [] In-Tank Gauging Probe. Model: [] Annular Space or Vault Sensor. -Model: [] Piping Sump / Trench Sensor(s). Model: [] Fill Sump Sensor(s). Model: {2 Mechanical Line Leak Detector. Model: [] Electronic Line Leak Detector. Model: [] Tank Overfill / High-Level Sensor. Model: i[] Other (specify e.c]uipment type and model in S~tion E on Page 2). Dispenser ID: -~ ~/_L/' ' ' [] Dispenser Containment Sensor(s). Model: 13FShear Valve(s). [] Dispenser Containment Float(s) and Chain(s). Dispenser ID: [] Dispenser Containment S-ensor(s). Model: I~Shear Valve(s). ~ Dispenser Contai_nment Float(s) and Chain(s). Dispenser ID: [] Dispenser Contalnmer~t Sensor(s). Model: [] Shear Valve(s). []Disp,enser Containment Float(s) and Chain(s). I~. Dispenier Containment Float(s) and Chain(s). *If the facility contains more tanks or dispensers, copy this fOrm. Include information tfor every tank ~nd dispenser at the facility. C. Cerl~¢atioll - I certify that the. equipment identified in this document w~ lfispected/servieed in aeenrd~mce with the manufacturers' guiieline~. Attach~ to this Certifie~tion is Information (e.g, manufacturers' checklists) necessary to veri~ that this Information is correct and a Plot Plan showing the layout of monitoring equipmenL For~any equipment capable of generating such reports, I have also attached a copy of the report; (ckeck.a//t/tat apply): O~yst.em set-up. {~1 Alarm history report rectmiemnName(print): ~" ~.~i' ~,.a~.[~l.[l'O Signature: ~x~,~, ~'1o~_ Co, l t~_k~(_A~_ 2ertificafion No.: I O .resting Company Name: lite Address: ~'"o~ O License. No.: Page I of~ ~ PhoneNo.:(~t_~.) ~"~ a 777 Date of Testing/Servicing: [0 / t ! / 0 03~0 Results of Testing/Servicing Software Version Install~cl: dete he followin cheeklist: ~Yes ~! No* Is the ~t~_dible s~ op~'rational? ,, I~t~Yes Cl No* Is the visual alarm operational? ~Yes r~ No* Were all sensors vis~_~y i_nspected, functionally tested, and conf'nvned operational? ~Yes C2 No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with theh' proper operation? I~r'~es ~ No* If alarms are relayed to a remote monitoring' station, is ail communications equipment (e.g. modem) ca N/A operational? ca Yes' I~i No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment Cl N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Gheck all that apply) ~! Sump/Trench Sensors; Ca Dispenser Containment Sensors. Did you confirm positive shut-down d~_~e to leaks and sensor failure/disconnection? Cl Yes; Cl No. I~ffes I~i No* For' tank. systems that utiliz~ the monitoring system as the primary tauk overfill warning device (i.e. no ca N/A mechanical overfill prevention valve is installed), is the overfill warning alarm vis~le and audible at the tank fill point(s) and oper~tln~ properly? If So, at what percent of tank capacity does the ~arm trigger? c~ ~ % r'l Yes* I~ No Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equlpment'replaced and list the rnam]facturer name and model for all rep!aczment parts in Section E~ below. ~! Yes* ~ No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) ~ Product; ~ Wat~, If yes~ describe ouse-s in Section E~ b~low, , t~t~Yes ~1 No* Was monitoring system set-up reviewed to ensure proper se~n~Es? Attach set up reports, if ~pplicablc., (~"~cs ~! No* Is ali monitorln~ eq-~nment operational per mam~facturer's specifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. 'Comments: Page 2 of~. 03/01 In-Tank Gauging / SIR Equipment: El Check this box if tank gauging is used only for inventory control. ~ Check this box ff no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak det~tion monitoring. Corn dote the~following checklist: ' ~Y~s El No* I~'s all input wiring been inspected for proper entry and terminafion,,"m¢luding testing for ground faults? I~-'s/es' El NO* Were all tank gauging probes Visually inspected for da.~ge and reSidue buildup? .. ~l/Yes [2 No* was ageu~acy of system product level readings tested? CiF'Yes [] No* Was accuracy of system water level readings tested? lit/Yes. [2 No* Were all probes reinstalled properly? l!t/yes [] No* Were all it*ms on ~he equipment manufaszturer's maintenance cheol~list completed? .. * In the Section H, below, describe how and when these defldencies were.or will be corrected. G. Line Leak Detectors (LLD): ~t~--hcck this box ffLLDs are not installed. Corn dete the followi~ eheeldi~: I~i Yes El No* For equipment start'up or annual eqm'pmeni certification, was a l~ak simulated to verify LLD performance? El N/A (Cheek all that apply) Simulated leak rate: El3g.p.lz; rq0.1g.p.h; El 0.2 g.p.h. [2 Yes [l No* Were all l.l.Ds confirn~d operational a~.d acCUrate within r~gulatory reqairem~nis? El Yes. El No* Was the testing apparatus properly cah'brated? vi Yes ~i' No* For mechanical LLDs, does the LLD rosa'let product flow if it detects a leak? [] N/A El YeS El No* For electronic LLDs, does the ~urbine automatically shut off if the LLD detects a leak? ~ N/A ' [] Yes [] No* For eleclronic LLDs, does the turbine automatically shut off if any portion of the monRof, ng syst~ai is disabled [2 N/A or dis¢onneotod? .. []-YeS [2-No* 'For electronic/. LLDs,- does the-turbine automatically shut off if any .portion of the monitoring system [2 N/A malflmetions or fsils a teSt? [] Yes [] No* For eleclronic LLDs, have all access~le wiring connections been visually inspeoted? [2 N/A [] Yes [2 No* Were all items on the equipment mamffacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of ~ 03/01 / Monitoring System Cerfifieafion Site Address: .ct (~.~ UST Monitoring Site Plan Date map was drawn: If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other se~ondary containment areas; mechanical or electronic line leak detectors; and inLtank liquid level probes (if used for leak detection). In the space provided,.note the date this Site Plan was prepared. ~L.~ ]~i,~ FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2'101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 · VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 May 3, 2001 Mr. Greg Meyer Delimart 9628 Rosedale Hwy. Bakersfield, Ca 93312 Dear Mr. Meyer: Enclosed, please find the Site and Facility Diagram Instructions packet. When your Hazardous Materials Management Plan and Inventory were submitted it was lacking the diagram portion. Please draw and submit the diagram(s) of your facility by June 8, 2001. The diagram should include the following: 1) 2) 3) 4) 5) 6) 7) 8) 9) name of your business; business address; indicate which direction is North; the cross streets neighboring business addresses (within 300 feet) entrances and exits location of utility shut-offs; location of the nearest fire hydrant; portions of the building protected by automatic sprinkler system; and most importantly the location of the hazardous material(s). If you have any questions, please feel free to call me at (661) 326-3658. Thank you for your assistance. Sincerely, RALPH E. HUEY, DIRECTOR OFFICE OF ENVIRONMENTAL SERVICES Esther Duran, Accounting Clerk II Office of Environmental Services ED\db Enclosures · Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: {(0SEEDALE DELI lvlART 9628 RO~EDALE ~ B~RSF~ELD CA 93312 A. Received by (Please Print Clearly) C. Signat¢~ Addressee D. Is ~'eliv;ry-address differ~nt-from~t~¢l? [] Yes If YES, enter delivery address bellow: [] No ! 3. Service Type ~ Certified Mail [] Express Mail { [] Registered [] Return Receipt for Merchandise [] Insured Mail [] C.O.D. { 4. Restricted Delivery? (Extra Fee) [] Yes Number (Copy from service label) 286 958, 'PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789 ~,TA-EsPOSTALS . E ~=~'~-~ II III ,'~'' ! Postage&Fe,e~ ERVIC First-Class Mail UNITED ~TAT * Sender. BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Avenue, Suite 300 Bakersfield, CA 9,3301 -- Z 410 286 95,~1~ US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail (See reverse Sent to ~ GP..EG HEYER P°~I~t~l~°d~:A 93312 Postage $ .3 3 Certified Fee 1.10 Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to 1.10 Whom & Date Delivered Return Receipt Showing to Whom Date, & Addressee's Address TOTAL Postage & Fees Postma~ or Date FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Streel Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfietd, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 December 7, 2000 Greg Meyer Rosedale Deli Mart 9628 Rosedale Hwy Bakersfield CA 93312 CERTIFIED MAIL RE: Dispensing Af~er Hours Without an Attendant on Site FINAL NOTICE Dear Mr. Meyer: December 15, 2000 is the deadline for compliance for facilities who wish to dispense motor vehicle fuel after normal store hours without an attendant on site. (First notification sent on October 11, 2000). Prior to December 15th, you must provide a written Routine Monitoring Procedure for unsupervised dispensing. You were given a sample form on October 11, 2000. As of this writing, we have not received a returned form. If you have multiple stations, we need a list of those who plan to participate, along with the required monitoring procedure. If a facility is not planning to continue unsupervised dispensing, they must discontinue after hours dispensing, starting December 15,.2000. Failure to comply will result in a written citation and court appearance. Should you have any questions, please feel free to call me at 326-3979. Sincerely, Ralph E. Huey, Director Office of Environmental Services by: Steve Underwood, Inspector Office of Environmental Services SBU/dm MOH 10 .' 35 FROM :]~ . S . S . R . INC. TESTED BY [~ ~'.~i~t~dn~',!$Y~tem have audtb!e and vlsUa.l...a.]arms?..::;~!, t..:, ....... ~....., . ...... : .......... · '.. [4:~,~,~f~'~:~/~'~'~,i'?.':'?~;,~?:,~?,!~"" ~:" '...,, .' ':' ',',,, ' ? ~' :',', '. ":, ,¢.. ~ , ,., , ,.. ~,~, - ~:~'~~?~l~~afl~llY ~hu~ow. If ~e system detect. , ~~,t~ ": ..... ~t~':O~ el~ .... ~,y'dlsmhn~t~d?' ~.a_ . ~.og ,~_=..~. ~ .... . . ., .... ~ ~,' ,'r~', ,, .............. ~ , . , , ...~, BAKERSFIELD FIRE DEPARTMENT N__ 1 0 1 4 Location ~( f ~r~.,'~- Sub Div. You are hereby required to make the following corrections at the above location: Cot. No DateCO~{p?:ill;~te for Correcti~__~. 1~./~~ InspectOr 326-3979 CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME _~,~ Section 2: Underground Storage Tanks Program [] Routine [~Combined [] Joint Agency Type of Tank Type of Monitoring INSPECTION DATE [] Multi-Agency [] Complaint Number of Tanks ..~ [] Re-inspection Type of Piping OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current v/ Certification of Financial Responsibility Monitoring record adequate and current la/ Maintenance recordsadequateandcurrent V/ t/~taO~ {P~q~ mO'C.- Failure to correct prior UST violations x~-- Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy Business Site Responsible Party CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3r~ Floor, Bakersfield, CA 93301 FACILITY NAME ADDRESS FACILITY CONTACT ~SPECTION TIME INSPECTION DATE PHONE NO. BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [] Routine 4~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Appropriate permit on hand Business plan contact information accurate L~ / Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures L/ Emergency procedures adequate Containers properly labeled Housekeeping i// Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: [] Yes [] No Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink - Business Copy B/us~n~s Site~/esponsibJ~ P~rty Inspector:,.~ ~ D October 11, 2000 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 ~H" Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAX (661) 326-0576 ENVIRONMENTAL SERVICES 17 f 5 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX~661) 326-0576 TRAINING DIVISION 5642 Victor Ave, Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 C-reg Meyer Rosedale Deli Mart 9628 Rosedale Hwy Bakersfield CA 93312 Dear Mr. Meyer: Your facility has been identified by our department as dispensing motor vehicle fuel aiter normal store hours without an attendant on site. Current Uniform Fire Code and guidelines, set forth by the Bakersfield Fire Department, Office of Environmental Services does allow for unsupervised dispensing under the following conditions. These conditions are as follows: Unsupervised dispensing is allowed when the owner or operator provides, and is accountable for daily site visits, regular equipment inspection and maintenance, including any unauthorized release or spills, posted instructions for the safe operation of dispensing equipment, and posted telephone numbers for the owner or operator. Signs prohibiting smoking, prohibiting dispensing into Unapproved containers and requiring vehicles engines to be stopped during fueling shall be conspicuously posted within site of each dispenser. In addition, a sign shall be posted in a conspicuous location reading: In case of spill or release: 2. 3. 4. Use Emergency Pump Shut-off Report the accident Fire Department telephone number Facility address During the hours of operation, stations having unsupervised dispensing shall be provided with a fire alarm transmitting device. A telephone not requiring a coin to operate is acceptable. The fuel leak detection system must have a remote or phone modem to insure off site monitoring during hours ofunsupervised dispensing. During hours of darkness, sufficient lighting must be maintained so that all.signs associated with fueling operation are conspicuous and readable. A 5 gallon container of an absorbent material used for spills must be made available to the public during hours of unsupervised dispensing. A fire extinguisher with a minimum 2 A 20 BC rating, must be located on dispenser island during hours of unsupervised dispensing. In addition to the above requirements, the following information is required: ,~ Emergency Response Procedures Employee Procedures Sample forms, (see attachment) shows all the necessary information which must be provided to the City of Bakersfield, Office of Environmental Services. You may use any format you wish, provided that all the information requested is supplied. OPERATOR GUIDELINES EMERGENCY RESPONSE PROCEDURES CARDLOCK OR UNSUPERVISED DISPENSING Daily Inspection: 2. 3. 4. 5. 6. 7. Cheek for small spills Place absorbent on the spill immediately Clean up absorbent within one hour Check for hoses lying on the ground Look for other tripping hazards and remove Ensure fire extinguishers are in place and inspect daily Check quantity of absorbent material daily Spill: 2. 3. 4. 5. 6. 7. o Determine the source of spill or release Stop the flow of product Hit emergency shut-off valve Stabilize the area Extinguish any smoking material Locate nearest fire extinguisher Use absorbent or spill pack to keep any product out of water source or sewers Isolate the hazard area-deny entry to non-emergency personnel. Containment: 2. 3. 4. 5. Contain the spill totally with a spill pack and/or absorbent Never use water If larger than can be immediately contained, go to step #4 Contact the local fire department. 9-1-1. Notify company management personnel Fire:, 2. 3. 4. 5. 6. Gasoline fire exttngulshers located on dispenser islands Remove Pin Point to the bottom of the flame and squeeze handle Call fire department even if fire is put out. (9-1-1) Isolate and deny entD', except for emergency personnel Notify company management personnel Earthquake Response: Make sure gasoline inventories are secure If there are any signs of structural damage to the control room or island canopy, keep everyone away from the. danger area. If danger is imminent, shut down facility operations until it has been deemed safe to continue. CARDLOCK/UNSUPERVISED DISPENSING EMPLOYEE TRAINING GUIDELINES Employee Training: 3. General The Maintenance Supervisor/Health & Safety Director or designated person will train all new employees on the safe handling of hazardous materials, proper emergency response coordination, and the use of emergency response equipment and supplies. Additionally, the manager will coordinate refresher training programs for all employees on an annual basis. 4. Procedures for Safe Handling of Hazardous Materials ao Employees will be informed of the health and safety hazards involved with the handling of gasoline and diesel. Employees will be careful not to spill gasoline or diesel onto themselves or on the ground. Employees will not smoke, light matches, cause sparks, or take action which could ignite flammable liquids or vapors. Procedures for Emergency Response Coordinator- a. Employees will be familiar with the emergency response procedure outlined in company emergency response plan. Employees will know the location and operation of electrical shut-offswitches dispenser shut-offvalves. Employees will know the location of how and when to use dry chemical fire extinguishers that are located on the premises. Employees will know the location of the nearest storm drain(s) and the location of absorbent materials to be used to prevent spills reaching the storm drain(s). Employees will be familiar with the kinds of emergency situations, which will warrant immediate evacuation of the premises. Any gasoline, diesel or other type of fire. Any spill, leak or vapor leak that has the potential for igniting or exploding. Any spill or leak when employees or customers notice gasoline vapors or spills. Employee Training Records: The manager or Health and Safety Supervisor will be responsible for documenting and retaining the types and dates of the "training"for at least 5 years. By this letter, you are hereby notified that you have thirty (30) days, November 1 l, 2000, to conform to the guidelines set forth. Failure to comply may necessitate further enforcement action up to, and including, citation and injunctive relief. Should you have any questions, please feel free to call me at 661-326- 3979. Sincerely, Ralph E. Huey, Director Office of Environmental Services by: Steve Underwood, Inspector Office of Environmental Services attachments S:\OCT 2000~I. JEL DISPENSING LET~ILWPD WRITTEN ROUTINE MONITORING PROCEDURE FOR CARDLOCK/UNSUPERVISED DISPENSING SAMPLE FORM Facility Name: Facility Address: Facility Telephone No.: Tank Owner Name: Tank Owner Address: Tank Owner Phone No.: ~A) Identify all equipment used to monitor the underground storage tanks on site. and model of leak detection system. Include make m) Identify all equipment used to monitor the underground spill containment on site. Include leak detection system, type and placement of liquid sensors, type of leak detectors and, does system have dispenser containment. 2) Identify the name(s) and title(s) of the person(s) responsible for performing the monitoring and/or maintenance of equipment. 3). Identify the location of the monitoring equipment. Include where remote monitoring will be conducted and name of company assigned to monitor and report name of company and phone number if other than operator. Identify how frequently the monitoring equipment is tested/checked for operational status. Indicate each piece of equipment separately. 4) Identify how often the tank(s) are monitored on site (i.e. daily, continuously). Describe the training needed to provide to the operator(s) of the underground storage tank for the proper operation of both the tank system and the monitoring equipment.' 5) S) 9) All equipment used in implementing the monitoring program shall be installed, calibrated, operated and maintained in accordance with manufacturers instructions, including routine maintenance and service checks. You must develop a reporting format/log that incorporates the following information: 0 g) h) Verification of Equipment Testing Reporting/Recording when Alarm is Indicated Maintenance Performed These reports/logs must be submitted to the Bakersfield Fire Department on a annual basis. Written records of equipment calibration/maintenance shall be kept on site for at least 3 years. In the event of a release, emergency equipment is limited to fire extinguishers and absorbent material maintained on site. Please discuss contingency plans for additional cleanup personnel and or contractor/clean up consultants. S:\PROCEDURE MANUAL\GUIDELINES FOR CARDLOCK ~~~04Z05/2000 02:34 66155SS440 DELIMART TEXACO ~ PAGE~.04..,~ I' '- 15rFFICE OF ENVIRONMENTAl'SERVICES · 1715 Chester Ave., Bakersfield, CA 93301 (661) 32.6-3979 UNDERGROUNO STORAGI~ TANKS -UST FACILITY ~ TYI~ OF ACTION [] ?,Nlw,lrrlffll~T ~ ~ ~ M I~ ¢. MqO ~ )ow ~e one), I"I s, TANK ~IM0Ve0 413. 418. ;IIK:F (?lee) ,';' ' ' ' ...... ~fl:tCU PAFORM,q'~M'd)~ .~ 04/~05/2000 02:34 66:15899448 DELTHART TEX~CO PAGE 02 OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALU~TION CERTIFICATE OF COMPLIANCE ,L,, .,, . _, ,,, .... ,,, One form p .er tank - I. FACILITY IDENTIFICATION Iu~lu N~ .~.~KCl,rtY ~ ~t o1~ ..;)~/~ ~ ~) ................................... ...... ............. II, tlI~TALLATION ~"/"'- The in~ttdter tins been cetl~ed by the lank t, nd piping manufacturem. ~1~].~ The Inslallation has been In~pec~d and ce~fled by a registered professional englneer. The InstlllMion hl~ been Insl:#m~d' end approved by the City of Bakersfield Of~e of Environment, al Servlce~. All work Illted on Ihs n~nufedumr'$ InMallatJon checklist has been oompleted. ~//The Inatelkl~3n (3onlmoMr he~ been oertllted or licensed by the Continents $~te Lk:erme Board. Another method wls used aS allowed by Ifte Ci~y of Bakemfleld Office of Envlronmenlal Services. III. TANK OWNER/AGENT 81ONATURE 04/05/2000 02:34 S615899440 DELIN~RT TEXACO PAGE 02 , CITY OF BAKERSFIELD --'-- 1718 Cheet®r Ave., Baker.field, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE IIII I I _ .I III .. II One form per tank II. IN8TALLATION The intt~ler h~ been cerllfled by ~ ~ ~ ~pi~ ~n~~. ~e ~a~ ~ ~en ~~ and ~ by a ~is~ p~io~l e~r, ~ l~l~ ~ ~n ~~'a~ ~~ by ~ CI~ of ~k~d ~ of En~n~l All work ~ on Ihe rr~nuf~Muref$ Installation =herJdi~t has been ~ompleled. The Inetall~lon oonlmctor he~ been =ertllled or licensed by the Contractors Slate Lk~nse Board. Another method will used aa ~1lowed by the City of Bakersfield Office of Environmental ~ervices. III. TANK OWNER/AGENT 810NATURE 84/85/2888 82::34 66:1.5899448 DELIMC, RT TEXACO PAGE. 82 ,~ ' ~1) CITY OF BAKERSFIELD 17tS Chelter Ave., Baker.field, CA 93301 (e61) 326.3970 UNDERGROUND STORAGE TANKS - INSTALLATION CERTIFICATE OF COMPLIANCE .,, , __., .., ..... , One form per lank I)l~e ~ M I. FACILITY IDENTIFICATION The Irmeller hat been ce~'lled ~ ~ ~ ~ p~i~ ~n~~. ~e ~~ ~a ~n I~~ end ~ by 8 ~is~ p~lonal e~r. ~ ~ ~ ~ ~ ~n~8 ~~n ~M ~8 ~ ~mp~. ~o~ m~ ~e u~ ~ ~1~ by ~ C~ ~ Ba~mfle~ ~ of En~mn~l gl. TANK OWNBR/AGENT 81ONATURE 0 e. OM,,Y~qiU~LMMm'iXIm~ 1. MJI~MATIC M OEIIGTO# ' 0 ti. NMUAL~~r~t (~H) ~:I~UPAF~411~w~,~.WPB e4/os/__2eoo 02::34 ~615899440 DELTH~RT TEX..ACO PAGE 133I _?~L~.._. 1715 Chester Ave., Bakersfield, CA 93301 (66X) 326-3979 UNDeRGrOUND STORAGE TANK$. TANK PAGE 1 f'l s. ~ O~r (NIroAwr~N} ~ ~'. ~M&N~N'n.¥ e~.o~o ON ~T~ CITY OF BAKERSFIELD__ OFFICE OF ENVIRONMENTAL SLUICES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 '--' UNDERGROUND STORAGE TANKS- TANK PAGE I TYPE OF ACT~N (Check one ;tern only] r-] I. NEW SITE PERMIT 1--13. RENEWAL PERMIT J"] 4. AMENDED PERMIT for ~.M u~ on/y) C:] ,i. CHANG~ OF INFORMATION) BUSINESS NA.M~ (~ame al FACILITY NAME a~ D~A. Deing B~minela Al) LOCATION WITHIN SITE FACIUTY ID # r-1 e. TEMPORARY SITE CLOSURE [] 7. PERMANENTLY CLOSED ON SITE [] 8. TANK REMOVED TANK ID * DATE INSTALLED (~ [ 43~ I.~TANK DESCRIPTION TANK MANUFACTIJRE. R TANK CAPACITY IN GALLONS COMPARTMENTALIZED TANK [] Yes I~, NO 43~ If 'Yes'. compline o~e page for eac~ cg3mpmlme~L NUMBER OF COMPARTMENTS 437 TANK USE 439 ~ 1. MOTOR VEHICLE FUEL marked, complete ~ Type) r-] 2. NON4:UEL PETROtEUM [] 3. CHEMICAL PRODUCT [:3 4. HAZAROOUSWASTE tax,adc4 Used M) []95. UN~NGWN ~"1 11. REGULAR UNLEADED [] 2. LEADED [] S. JET FUEL  11}. I=REklLIM UNLEAOEO 3. DIESEL 6, AVIATION FUEL [] ~c Mmc, RAoe UN~.AOEO [] 4. Ca,SONGL [] es. OTHER 442 r'l 1.8INGLE WALL I~ 2. IX)UBLE WAU. [] 3. SJNGLE WALL WITH EXTERIOR MEMBRANE UNER [] 4. SlNCd. E WALL IN A VAULT [] S. SINGLE WALL WII'H INTERNAL SLADOER SYSTEM C]o~o UNmOWN []~0. O'n.~ TANK MATERIAL - pdmMy tank rC~ O~ ~ ~ [] 3. FIBERGLASS/PLASTIC I~ 4. STEEL CLAD W~RBERGLASS REINFORCED I:R.ASTIC (FI~ TANK MATERrAt.- ~:emtw/tm~ C] 1. BARE STEEL (Cheek one /mm on*y) I-1 2. STA~NLESSSTEEL [] S. CONCRETE [] Ce. UNXNOWN [] 8. FRP COMPATIBL~ Wll00~ METHANOL [] g9. OTHER [] 3. FII~.RGLAS~ I ~C [] 8. FRP COMPATIBLE W1100% IvlETHANOL [] 95. UNKNOWN RFJNFORCED PLASl~C (FRP) [] tO. COATED STEEL O so Co,ciarrE TANK II~rERIOR LJ~INO OR COATING OTHER CORROSION PROTECTION IF ~ 'Check one imm only) I-],s. G~SSuNu~ C]M. UNKNOWN 0 · ~ 0 ~. OTHER __ [] ~. OTHER DATE JNSI')J LFO' 447 DATE INSTALLED 449 (For)ocal uM on/y) SPILL AND OVERFILL (Check all ~et apply) IF ~INGLE WALL TANK (Che~ d that apply).. [] ~. VISUAL (EXPOSED PORTK)N 0~ ~ 2. AUTO~TIC T~ ~ (ATE) ~ 3. ~IN~U9 ATE ~ 4. STATISTI~ I~O~ ~IL~T~N (SIR) 81ENN~ T~ ~1~ YEAR INSTALLED 450 TYPE(For/oca/uMonty) 451 · :.~.:.,..,,~.:.~ .: ..: ~. ::.i.~.',~ .,~ ~.: .,.~ :.~ ..,...: ~....~ ~...,-~,;::~;., :!.;. ~ :TANK LEAK ~~: [] ~. MANUAL TANK GAUOINO (MTO) [] e. VADOSEZONE [] 7. eeOUNOWATER [] e. TANK TESTING Cite. oTHe~ OVERFILL PROTECTION EQUIPMENT: YEAR II, Lql'ALLED 452 ,J~l. ALARM q ~ [] 3. FILL TUBE SHUT OFF VALVE ~ IF DOUBLE WALL TANK OR TANK V+aTH BLADOER (Caeek one Rem on/y): 454 r-] 1, visuAL (81NGI..E WALL IN VAULT ONLY) [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CLO~URE INFORMATION I PERMANENT CLO~URE IN PLACE ESTIMATED OATE LAST U~.O (YR/MO/OAY) 45~ E~TIMATED QUANTT~ OF SUBSTANCE REMAJNINQ 4~6 TANK FILLED WITH INERT MATERIAL? OY# [] NO UPCF (7/99) S:&CU PAFORMS~WRCB-B.WPD ~ ,~,~'~I! ' ~ UST - TANK PAGE 2 Vl; PIPING CONSTRUCTION (C~ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE ~. 1. PRESSURE I--] 2. SUCTION [] 3. GRAVITY 458 [] I. PRESSURE [] 2, SUCTION [] 3. GRAVITY 459 [] I. SINGLE WALL 1'"] 3. LINED TRENCH [] 99. OTHER 460 [~] 1, SINGLE WALL [] 95. UNKNOWN 462 CONSTRUCTION/ MANUFACTURER ~'2. DOUBLE WALL [:] 95. UNKNOWN [] 2. DOUBLE WALL [::::] 99. OTHER MANUFACTURER 461 MANUFACTURER 463 CITY OF BAKERSFIELD -~9 OFFICE OF ENVIRONMENTAL SERVICES Chester Ave., Bakemfleld, CA 93301 (661) 326 MATERIALS AND CORROSION PROTECTION [] 1. BARE STEEL [] B. FRP COMPATIBLE WI 100% METHANOL [] 2. STAINLESS STEEL r-] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 95. UNKNOWN [] 4. FIBERGLASS ~ 8. FLEXIBLE (HOPE) [] 99. OTHER [~ 5. STEEL W/COATING I--~ 9. CATHODIC PROTECTION 464 [] 1. BARE STEEL [] 2. STAINLESS STEEL [] 6. FRP COMPATIBLE w/100% METHANOL [] 7. GALVANIZED STEEL [] 3. PLASTIC COMPATIBLE WITH CONTENTS [] 8. FLEXIBLE (HDPE) [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION [] 5. STEEL W/COATING [] 95. UNKNOWN 465 UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 467 SINGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ~] 1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ~ 2. MONTHLY 0.2 GPH TEST r-] 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DAILY 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: I-'1 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WTrH AUDIBLE AND VISUAL ALARMS AND (Check o~e) I~ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION [] c. NO AUTO PUMP SHUT OFF ~] 11. AUTOMATIC LINE LEAK DETECTOR (3.0 ~ TEST) WITH FLOW SHUT oFF OR RESTRICTION ~ 12. ANNUAL INTEGRITY TEST (0.1 ~) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATOR~ ONLY (Check g/that app/y) r'"l 14. CONTINUOUS SUMP SENSOR WTTHOUT 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) '1"'[ 17. OAILY VISUAL CHECK DISPENSER CONTAINMENT ~ 1. FLOAT MECHANISM THAT SHUTS OFF ~-IEAR VALVE DATE INSTALLED 468 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 I-I 2. MONTHLY 0.2 GPH TEST [] 3. ANNUAL ;NTEGRrrY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DALLY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0,1 Cd:q-I) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAVITY FLOW (Check all that apply): [] 8. DALLY VISUAL MONITORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (chec* all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR ~1'rH AUDIBLE AND VISUAL ALARMS AND (check'~ne) I~] 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 i~l 11. AUTOMATIC LEAK DETECTOR [] 12. ANNUAL INTEC-RITY TEST (0.1 GPH) SUCTION/GRAVTTY SYSTEI~ [] 13. CONTINUOUS SUMP SENSOR + AUDISI.E AND VISUAL ALARMS EMERGENCY GENERATORG ONLY (check all that appty} [] 14. CONTINUOUS SUMP SENSOR WTTHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL [] 15, AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST} [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VlsuAL CHECK [] 4, DAILY VISUAL CHECK [] 2. COI,,FrlNUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER I MONITORING '~3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS [] 6. NONE 469 IX, OWNER/OPERATOR 81GNATURE I ¢eflify that the inf~matlm'~ provided ~etein il true ~ accurate to the I)est of my knowle(Ige. 470" SIGNATURE OF OWNER/OPERATOR DATE ~).,~ -- ,~,~ NAME OF OWNER/OPERATOR (p~fnt), 471 IPm'm~t Numi~er (For local use only) 473 Permit Approved (Fo~/o¢l/uae only) 474 PermilExpiratlo~Date(ForlocaluSeonlY) 475 i UPCF (7/9g) S:\CUPAFORMS\SWRCB-B.WP D __ CITY OF BAKERSFIELD-- OFF~E OF ENVIRONMENTAL SLUICES. 1715 Chester Ave., Bakersfield, CA 93301 (661) 326 3979 UNDERGROUND STO~OE TANKS - TANK PAaE 1 TYPE OF ACTION (Chec~( ore ~tem or, h/) ~ I. NEW' ~ITE PERMIT l"] 4. AMENDED PERMIT 1""] 3. RENEWAL PERMIT (,.~oec~ ma~on, fa'/eta/u3e on/,/) i BUSINESS NAME (S~m~ m FACILITY NAME or O~A. ~ W A~) LOCATION WITHIN SITE (OpM)ne/) /=~ge ~ of [] S. CHAN~ OF ;NFORIVlATION) I-'1 e. TEMPORARY SITE CLOSURE' r-I 7. PERMANENTLY CLOSED ON SITE (..Soe~c/~gl. ~(~'/o~/u.~lof~,) ~1 8. TANKREMOVEO 43C I. TANK DESCRIPTION 432 I TANK MANUFACTURER 435 TANK CAPACITY IN GALLONS COMPARTMENTALIZED TANK I--I Yes ~[~No 434 ff 'Yes', c~mplele ofle page for each compaf~le~l. NUMBER OF COMPARTMENTS 437 TANK U$~ 439 ~[ I. MOTOR VEHICLE FUEL (If roamed, compteM Peb~eum Type) r-I 2. NONa=UEL PE'motEUM [] 3. CHEMk:AL e~OOUCr [] 4. HAZAROOUS WASTE (ax:a~a~ea U~ed O~ C:] 9~. UN~,3WN PETROLEUM TYi~ 1--]11. IR~GI,R. AR~O [] 2. LEAOEO [] 5. JETFUEL 'r~.;Ib. I:~F..MIUMUNLEAOEO ,~3. DIESEL [] 6. AVIATION FUEL C] lc. MI~UNLEADED I-] 4. GASOHOL 1""199. OTHER /._~ COIVMON NAME (from Hazan~oua MaW tnvena~y page) m TANK ~ISTRtJ~RO~ 441 C, AS # (from HaZamk~L1MaMr'mb/nvena~/page) 442 TYPE OF TANK I-1 3. ~IGLE WALL WITH EXTERIOR ~ UNER I-1 4. Sea3LEWALL~NAVAULT [] s.S.m~EWAU. WrrHWm~NALm.~3Oe~SYS~--~.M [] ~. UNXNOWN 0 ~. OTHE. TANK IvlATERIAL - (C/'~.k one/mm Cl 2. S'TAea..ESS STEEL [] 3. FIBER([kIS I Ft./kfTIC '~ 4. STEEL CLAD W/FIBERGt. A88 REINFORCED PLASTIC (FRP) TANK MATERIAL - I~ tank r-] 1. BARE STEEL 'Caeck one ~em o~y) I--i 2. STAINLESS STEEL C] s. CONC~'TE n ~. UN,NOW [] 8. FRP COMPATIBLE W1100% IVlETHANOL [] 99. OTHER I'"'1 3. FIBER~/PLASTIC [] 8. FRPCOMPATIBLEW/100% METHANOL I--]95. UNgNOWN ~ 4. STEEL CCAO W~;eERC=CA,~ [] ~. FeP NON-CORROO;et.e JACr, EI' [] sg. OmER. R~;NFORCEO PtASTIC (FRP) [] 10. COATED STEEL TANK INTFJ~O~ UNINO [] 1. RUBMR UNED 1~-3. EPOXY UNING OR COATING 0 z Au<Youm~ O 4. e~.Nouc UNe~ OTHERCORROS~ON I-1 t. MANUFAC1'UREDGATHODIC C] 3. I~BERGLASSREINFORCEDPLASTlC PROTECTION IF APPI.ICAB~ P~OTECl"ION [] 4. I~D CURRENT DATE IN~'~ 0 ~. aL~ss ~SN~ 0 ~. ~N~OW 44e [] e~ ~ O ~. OTH~ ~ C] ~. OTHE~ 447 DATE INSTALLED 449 IF ~N6LI! WALL TANK (c/m:~ [] ~, v~s~ (~ ~N 0~ ~2. AUTOmaC T~ ~ (ATQ) ~ 3. ~u~ ArQ ~ 4. ~ATISTI~ I~O~ ~IL~T~N (SIR) 6~E~ T~ ~ [] 5. MANUAL TANK GAUGING (MTG) [] 6. VADOSE ZONE [] ?. GROUNDWATER [] a. T,Ua<TES~NG OVERFILL PROTECTION EQUIPMENT: YEAR IN~TALLFp 452 0 2" ~ ~.O^T t cl~: [] ,. ~ IF DOUBLE WALL TANK OR TANK WITH 8LADOER (C, hec~ one Rem only]: 454 0 1. VISUAL (SiNOLE WALL IN VAULT ONLY) [] 2. CONTINUOUS INTERSTITIAL MONITORING [] 3. MANUAL MONITORING V. TANK CLO~URE INFORMATION I PERMANENT CLOSURE IN PLACE E8TIMATED OATE LAST USF. D (YR/MO/OAY) 4M) E~TIMATEO QUANTITY OF SUBSTANCE REMAJNINO 4~e TANK FILLED WITH INERT MATERIAL? 45? C]Y# UPCF (7/99) S:~CUPAFORMS~SWRCB-B.WPO ~. '~" ~ OFFICE OF ENVIRONMENTAL SERVICE ~ Bakersfield, CA 9330~1 (661) TI"r5 Chester Ave., 6- UBT - TANK PAGE 2 I I ~ Page -- ~ VI. PIPING CONBTRUCTTON (Ch~ e; t/mt a~/') - ':~ UNDERGROUND PIPING ABOVEGROUND PIPING SYSTEM TYPE !,~ 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 458 [] 1. PRESSURE [] 2. SUCTION [] 3. GRAVITY 4.59 CONSTRUCTiON/iC~ 1. SINGLE WALL ~[~3. LINED TRENCH [] 99, OTHER 460 [] I. SINGLE WALL [] 95. UNKNOWN 462 MANUFACTURER~=J, 2. DOUBLE WALL [] 95. uNKNOWN [] 2. DOUBLE WALL [] 99. OTHER i/r MANUFACTURER 461 MANUFACTURER 463 .[] I. BARE STEEL [] 6. FRP COMPATIBLE WI100% METHANOL C:] 1. BARESTEEL [] 6. FRPCOMPATIBLEWl 100%METHANOL 2. STAINLESS STEEL [] 7. GALVANIZED STEEL [] 2. STAINLESS STEEL [] 7. GALVANIZED STEEL MATERIALS AND CORROSION I~ [] 99. OTHER PROTECTION' j LJ 3. PLASTIC COMPATIBLE/ WITH CONTENTS [] 95. UNKNOWN [] 3. PLASTIC COMPATIBLE WITH CONTENTS r'l 8. FLEXIBLE (HDPE) ' !C] '4. FIBERGLASS ~, 8. FLEXIBLE (HDPE). [] 99. OTHER [] 4. FIBERGLASS [] 9. CATHODIC PROTECTION I~.[~] $. STEEL WI COATING [] g. CATHODIC PROTECTION 4~4 5. STEEL W/COATING []- 95. UNKNOWN 465 · - "' : .": VIL PIPING LEAK DETECTION (C_.~ckailU~ta~y) UNDERGROUND PIPING ABOVEGROUND PIPING SINGLE WALL PIPING 467 ~INGLE WALL PIPING 466 PRESSURIZED PIPING (Check all that apply): ~ 1. ELECTRONIC LINE LEAK DETECTOR 3.0 C.-,Pfl TEST ~ AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ,~ 2. MONTHLY 0.2 C-,PH TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: [] 5. DAILY 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 Cd=H) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Chect( ~ a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS [] 0. 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~'H FLOW SHUT oFF OR RESTRICTION 1~12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORG ONLY (Check a8 that apply) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS [] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 ~ TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION [] 16. ANNUAL INTEGRITY TEST (0.1 Gl=H) [] 17. DALLY VISUAL CHECK DISPENSER CONTAINMENT [] 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DATE 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 GPfl TEST [] 3. ANNUAL INTEGRITY TEST (0.1 GPH) [] 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): [] 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM [] 6. TRIENNIAL INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES iN BELOW GROUND PIPING): [] 7. SELF MONITORING GRAvrrY FLOW (C,~ck ail mat app/y): [] 8. DAILY VISUAL MONffORING [] 9. BIENNIAL INTEGRITY TEST (O.1 GaN) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (chect(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 I~ 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: [] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATOR~ ONLY (Check a//that appty) [] 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL [] 15. AUTOMATIC LINE LEAK OETECTOR (3.0 GPH TEST) [] 16. ANNUAL INTEGRITY TEST (0.1 GPH) [] 17. DAILY VISUAL CHECK [] 4. DAILY VISUAL CHECK 468 [] 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS [] 5. TRENCH LINER I MONITORING 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL A~ I'~ 6. NONE 469~ iX. OWNER/OPERATOR SIGNATURE I certify that the information provided herein il true and eccurale to the best o~ my knowledge. SIGNATURE OF O~I~IER/OPERATOR NAME OF OWNER/OPERATOR (print) 471 Permil Numbs' (For local use only) 473 Permit A~prov~l (For lose/~ only) 470~ TITLE OF OWNER/OPERATOR 472 474 ~,Tn,~;E;~;r&~c.-,Oate(Forloceluseonly) 475~ UPCF (7/g9) S:\CUPAFORMS\SWRCB'B,WP D 84/27/2888 82:81 661589~. ,48 DELIMART TEXACO RAGE 82 $6158 DELIMART PAGE 84 ~ t v u~ UAgU:;K~I.' ~ OFFICE OF ENVIRONME~AL SERVICE~ 171~ Ch~mr A~., Ba~rsfl~l~ CA 93301 (661) 326-3979 L PAClUTY I mrnl M~MMTIMI - 04/27/2080 02:01 OFFICE OF ENVIRONMENTAl. SERVICES 1715 Cheiter Ave., Bakerefleld, CA 93301 CERTIFICATE OF COMPLIANCE - . ---. L~,AC,.r~iDEN'mCA_~_~.~ _ ._ - IL TANK OWNER/AQINT 8tO~qATURI 04/85/2008 02:34 6~1~8994, DELIHART TEXACO PAGE. 82 Cl~ OF BA~RSFIELD ~ 1718 Ch~ter Ave., Bake~fleld, CA 93301 ulMJKim~ $'ralt4~l ?Ll~. I~TAU, A~# CERTIFICATE OF ¢OMFUANCE I II .... IIII I I Iii .... iii " I. FAOIUTY IDENTIFICATION IL INiTALLATION The ~ Ira. bMn In~piM end MWlIM by i mgisteld pm~lonel ~. AJi mXk Md MI Ihe mlnukl~$ ~ ddM MI been mnlp~. IK TANK OWN .L~III/AGENY 81GNATURE mmi~mlmm m ~lmmm~l~ml ~ ~._~_.~.~ mmlmI~ Imm Iimtid ~ kmmIm~ · ' C,/" ~' ' I ""-'"'"~ ,! .--T.'TE CF CAUFOR~A ITATE WATER ~ESOURCE$ CONTROL BOAR~ 'Z ~ UNDERGROUR~"STORAGE TANK PERMIT APPLlbATIO~ FORM A COMPLETE THIS FORM FOR EACH FA~UTY~rrE MARK ONLY ,r~ 1 NEW PERMIT [] 3 RENEWN. PERMrT ONE ITEM [] 2 INTERIM PERMIT ~ 4 AMENDED PERMrT I. FAClLFrY/SITE INFORMA31ON & ADDRESS - (MUST BE COMPLETED) [] 5 CHANGE OF INFORMATION [] 7 PERMANENTt.y CLOSED SrTE ~-~ 6 TEMPORARY SfTE CLOSURE A~',DRESS C;~ NAME T0 IN,CATE ~OR~ ~ I~V~UAL ~ P~T~HIP ~PE OF BUSINESS ~1 ~ STAIN ~ 2 DISTRIBUTOR ~ 3 FARM ~ 4 PRaEtOR EMERGENCY CONTACT PERSON (PRIMARY) EMERGENCY CONTACT PERSON (SECONDARY). optimal ~AY.S: NAME (LAST. FIRSTt.._.__ . PHONE # WITH AREA CODE H~ I ~AY~: NAME (LAST. FIRS~ PHONE · WITH AREA CODE ~ ~.~: N~E (~T,~,RS._~.. ~NE. W,TH AR~A ~E ..:~TS: N~ME (~t. ~,..~..) -'---' ..a~. wrr. AREA CO~ I1. PROPERTY OWNER INFORMATION - {MUST BE COMPLETED! "i CARE OF ADDRE~ INFORMATION l-~ STATE-AC. IG~Cy IPHONE · ~ AREA CODE IlL TANK OWNER INFORMATION - (MUST BE COMPLETED) MAILIN-"~R STREET ADDRESS ICARE OF ADORE~ INFORMATION ' STATE 7.JP (,x;~ I PHONE # ~TH AREA ~ IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER. Call (916) 739-2582 it que~l~on~ ?." .- , ,-i0!Gbt3! lfl-!i---TK HK 44 006334 ?" '' TY HQ V. LEGAL NOTIFICATION AND BILLING ADDF _ i . ~less box I or II is checked:' ICHECK ONE BOX INDICATING WH~H A~OVE ADDRESS SHOULD SE USED FOR LEGAL NOTIFICATIONS AND BILL,G: THIS FORM HAS BEEN COMPLETED UNDER PENAL TY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT IAPPLICANT'S NAj~4,/,/~ P RIN TED f S~J~TURE'I I A;i3LICAN'PS TITLE I DATE MONTH/DAY/YEAR LOCAL AGENCY USE ONLY iOUN;.Y # LOCATION CODE * OPTIONAL JURISDICTION # FACILFrY # CENSUS TRACT · - OPTIONAL SUPVISOR - DISTR~T CODE - OPT/ONAL THIS FORM MUST BE ACCOMPANIED BY AT LEAST (1) OR MORE PERMFr APPLICATION - FORM B, UNLESS THIS IS A CHANGE OF SEE ~FORMATION ONLY. FORM A (9-90) FOR0~33A~R2 EMERGENCY RESPONSE PLAN UNDERGROUND STORAGE TANK MONITORING PROGRAM This monitoring program must be kept at the UST location at all times. The information on this momtoring program are conditions of the operating permit. The permit holder mu~t notify the Office of Environmental Services w~thin 30 days of any changes to the momtormg procedures, unless require~ to o~tain appwval before making the eh~n§e. ~ by. Sections 2632(d) and 2641(h) CCR. Facility Address /gan unauthorized release occurs, how will the hazardous substance be cleaned up? Note: If released hazardous substances reach the environment, increase the fire or explosion baTard, are not cleaned up from the secondary, containment within 8 hours, or deteriorate the secondary containmem, then the Officq of Environmental Services, must be notified within 24 hours, '~J~ Lt.~f~ ~2~ li.~ ~_ Describe the proposed methods and equiRment to be used for removing and properly disposing of any hazardous substance. ~?.~ ~ [) ~t~e De.be the location ~d av~ab~w of the ~quked cl~up equipmem m i~m z apove. ... ~ ~ce ~_~oen 60 o.nd Io0 De.be the m~?n~ce s~hedule Fo: the ~l~up equipment: List the name(s) and title(s) of the person(s) responsible for~ any work necessary under the response plan: WRn~N MONITORING PROCE~RES UNDERGROUND STORAGE TANK MONITORING PROGRAM This momtormg program must be kept at the UST location at aH times. The ixtformntion on thi~_ ~ program ar~ conditions of the operating permit. The permit holder must notify the Office ~f E ..nVimnn~lal Scrviges within 30 days of a~y challg~ to thc momtormg procedures, unless t~luired to o~ain ~ ~fo malting thc challg¢. Reqllil~[ by Sections 2632(d) and 2641(h) CCR. Facility Name Facility Address Ao Bo Co Describe the frequency ofperforr~.' g the mqnitori~,g:_ , t~. ,__, Tar~ lZ)c~i\V ~t m~ods ~d ~pm~ ~d~ by the mo~to~g: DCacfib¢ ~ io~fion(a) whCr~ th~ moMto~g ~ b~ p~om~ (f~ plot p~-~d" be a~ached): List the ~s) ~d title(s)of the people responsible for p~o~g ~e mo~o~ Eo Fo Go Reporting Format for monitoring: Piping - ~ I ~0~_(~. ' ' esc~0e me preventive m~te~ce sched~e for ~e mo~to~g.eq~Pm~t. ' Maintenance must be in acco~ance with the m~ufa~s m~~ ~~e butnotlessthaneve~l~months. ~ .l~ · Desc~be the tr~ nece~ for the operation of UST mo~o6nseq~pment: ~J~O~ ~e~ ~A~ WAlrr. R I~SOURCFJ CONTROL 80ARO UNDERGROUNO STORAGE TANK PERMIT APPLICATION - FORM B COMPLE~ A SF.J~ARATE FORM FOR EACH ?~ SYSTE.~ MARK ONLY ~ ~ NEW PEnMfT ONE ITEM z t~TERlU PERUn' ~ ,~ ,,UaE~OEO ~R~C ~ e ~u~ T~K CL~U~; ~ DBAOR FACl~ NA~ WHEflETANK tS ~0: ..... ~ ~ ~~ " B~~9628~se~z' I. TANK DESCRIPTION c~PtET~ ~. rreas - sfEc~r~ IF u.~ il. TANK CO~E~S ~r A-1 IS MAR~O.~PL~ ~TE~C. A I MOTOR VEH~LE ~UEL ~ ~ O~L ~ ~. PRODUCT WA.~TE B. MANUFACTURED BY: O, TANK CN~ACITY N GALLONS: ~ 11= FREME,'M UNLEAOED [] TANK REMOVED IlL TANK CONSTRUCTION MARKONEITEMONL¥';Ni~OXESA'g'ANDC'AN{:)ALL~"~"~ATARI3LIESINI~'O~ ~..// ' SYSTEM ~ ~ sINGLE W~L ~"-__~ ~ S~CONGAR¥ CONTAINMENT NA~DT~ MATERI~ L~ s c~aE~ ~Prlm~y T~) qTERIOR ,,_.._j~ s ~ L,N~N~ ~ e U,t!NEO ~ ~ U~4~OWN LINING YES ~ I~0_ iS LINING MATERIAL COMPATI;JLE WlT,N 1,~% METHANOL ? E~ 4 STEELCLAD W/F~ERGLA~REINFORCEDPI.,~TIC [] B 100% METHANOL COMPATI~LEW~RP [] 99 OTHER [---] 4 PHENOLIC LINING [] gg OTHER 3 VIHYL WRAP ! CORROSION PqOTECTION [] 4 FiaERGLAS$ REINFORCED iKA3TIC [.~ 9~ OTHER 1V, PIPING INFORMATION cmo~ A iFAaOVEO~OUNI:)OR U IF UNDERGROUNO. laOTH IF AF~UCABLE A. SYSTEM TYPE A U ~ SUCTION A_ 2 PRESSURE CONSTRUCTION A O 1 SINGLE WALL l_ MATERIAL AND A U I EAR~ STEEL CORROSION A U s ~LUU~NUU PROTECTION A U g GALVANI~D STEEL LEAK DETECTION {~ A U 3 Gt:~.vITY A U 9~ OTHER A ~ 200UI~LE WALL A U 3 LINED TRENCH A U g$ UNKNOWN A U 99 0114ER A U 2 STAINLESS STEEL A U 3 ~LWI~L CHLORI~ (P~A ~ 4 FIBE~ P~E ~ U ~ CCNCRE~ A U 7 S7~ELWI~AT~NQ A U 8 t~~L~MPA~B~W~RP A~ 10 CATNOOiC PROT~CTION ~ ~ ~S UNSOWN A U ~ O~R AuTOMAT~ LINE LEAK DETECTOR~ 2 LJNE T~H~ESS TESTING ~ 3 ~Nff0RtNG~T~L ~ ~ O~R V. TANK LEAK DETECTION --~ ~ 2 [NVENTORY ~ECQNC~L.~ATION -- 3 VAPORMONITORIN~L'-~4 AUTOMATIC TANK ~'~UG~NG L.~$ GROUND WATER MONITORING ,-- ~ VISUAL CHECK ~ ~ .? 6 TANK TESTING ~ 7 INTERSTITIAL MONiTORiNG __~ 91 NONE [] 95 UNKNOWN [] g~ OTHER VI. TANK CLOSURE INFORMATION 3. WASTANKFILLEDWITH YE.R, E~ NO['-"] GALLONS INERT MATERIAL ? SUPSTANCE REMAINING :. ESTIMATEO OA'rE LAST USED (MO, DAY/YR1 2. ESTtMATEDQUANTI'Pf O; COMP. L. ETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT THIS FORM HAS BEEN .... I DA~ tFRINTEO ~ S;GNATURE) ....... CAL AG ENCY US SED OF THE FOUR NUMBERS BELOW COUNTY STATE 1.0,# I'~RMIT NUM~"~ I PERMIT EXPIRATION DATE FORM i PERMITAPPROVED 8YiDATE l THIS FORM MUST BE ACCOMPANIEO BY A PERMIT APPUCATION · FORM A. UNLESS A CURRENT FORM A HAS BEEN ~ATE C~* CAIJRWIa.~ mATE WATER RESOURCE~ CONTROL BOARD UNDERGFIOUHD STORAGE TANK PERMIT APPLICATION * PC)flU B CO~LIETE A SEPARATE FORM FOR EACH TAI~ SYSTEM. !MARK ONLY [] 1 NEW PERMR' ~IT [] $ C~ O1= INFORMATION ~ OBA WHERE TANK IS ~A~ IF0: ~ ~~ 9628 ~se~ H~. 0g FACi~ ~A~ TANK REMOVED BY: 11. TANK CONTENTS ir A-1 tS MARK~O.C~PL£T~ iTE~t C, i ~ 2 PETnOLEUM ~ aC EI~P~TM. ~ 3 CHEYlCALPROOUCT ~ fi' UNK>XDWN ~":'-D~ 1 PRODUCT ~ 2 W~STE C, [] ~ R-=GULAR UNLF,~D [] lb PREMEJM UNLEADED D. IF (A,11 IS NOT MARKED, ENTER NANE O~' SIJ~STANCE :STORED ill TANK CONSTRUCTION iCA.RKONEtTEMON%Y{NBOX~$A. 8, ANDO, A,NOALLTHAT-IJ:'PtlESlNSOXO A. TYPE OF F~ 1 DOUBLE WALL ~_:} ~ SINGL; WALL WITH EXTERIOR LINE,~ ~ 95 UNKNOWN SYSTEM ~ 2 SINGLE WALL F--'~ 2 STAINLESS STEEL ~ 3 FIBEI:W~ ~ 4 $TEELCLAD W/FISER~REINFORCEOPt. ASTIC TANK L ~ 7 ALUMINUM [] 8 100~ METHANOL COMPATISLEW/FRP MATERIAL :Prima'yra,'~) ~ g BRONZE F**"'~ ~o C, ALV.~V~IZ~.O STEEL ~,; ~ UN,',a~OWN ~ ~ omen TERIOR '--' ~ ~ UN.3,,~OWN [] 99 o'rHE~ LIN1NG YES J~_.~. NO ~ $ ~ LINING ~ 5 UN~INED IS LININO MATERL&t. C_,OMPATI{~.E W~TH ~00% IdETHANO,. ? O. CORROSION '-~,.___ ~ POLYETHYLENE WRAP ~__~ 2 ¢OA~NG ~ 3 VINYL WRAP d FIREROLAS$ REINFORCED PtJL~T1C PROTECTION -t~' :5 CATHOO!C PROTECTION F_-'_-: ,~t NONE __~ 05 UNX]~OWN F~_~ 9~ OTHER lV. PIPING INFORMATION I A. SYSTEM TYPE __ .B. CONSTRUCTION CIRCLE A ~l: ASOYE GROUND OR U iF UNOERGROUND. BOTH · APPLICABLE SUCTION A U~ PRESSURE A U 3 GRAVITY A U ~g' OTHER SINGLE WALL A ~ 2 0OUBLE WALL A U 3 LINED TRENCH J U gs UNKNOWN A U gg OTHER BARE STE~L .& .:~ 2 STAINLESS STEEL A 13 3 POLYVINYL CHLORIC~ (PV~ A ~ 4 FIBEI~31.JL~ PiPE ALUMiNL;M A U 8 CCNCRE,~E A U 7 ST~LWI~ATIt~ A U 8 1~ ~L~MPA~B~W~RP ~LVANI~O S~EL A ~ ~0 CATHOOIC PROTECTION R U 95 UN~WN A U ~ O~R AuTOMAT~LINELEA~ETECTOR ~ 2 UNET~H~ESSTESTING ~ 3 ~T~L C. MATERIAL AND CORROSION PROTECTION D. LEAK DETECTION V, TANK LEAK DETECTION I VISUAL CHECK ~ 2 :I',/VENTORY RECONC4LIAT{ON ~ ~ VAPOR MONITORING ~'~Z'''~1 AUTOMATIC TANK GAUGING ~S G~UNOWA~RM~ITO,I~ .~ 6 TANK TESTING L_~ 7 IN~RSTiTIAL~ONITOR~NG~----~ Gl NONE ~ 95 UNSOWN ~ ~ O~ER VI. TANK CLOSURE INFORMA'~ON J 2. ESTIMATED OUANTiTY OF i :~' WAS TANK FILLED WITH ESTIMATED CATE LAST USED iMO/DAY/YRt i SUBSTANCE REMAINING GAl t ONS, INERT MATERIAL ? THIS FORM=, HAS BEEN C~PLETED UNDER P.r.:NALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE. IS TRUE AND CORRECT AGENCY USE 6NLY THE STATE ,.O' ~U"~eER~fS COMPOSEO OF THE FOUR NUMBERS BELOW COUNTY ~ JURISOICTION# FACILITY ~t TANK II STATE I.D,# __u__:~"~ '' ' } , ['1 I I , FORM THIS FORM MUST BE ACCOI/~ANIED BY A PERMIT A~PLICATION - FORM A. UNLESS A CURRENT FORM A HA~ BEEN fiLED. ~Al1~ WATEg I~.S0URCES C0~rl~OL UNDERGROUND STORAGE TANK PERMIT APPLICATION - FORM COMPLETE A SEPARAI'~ FORM FOR EAC~ TJU4( SYS*tEM, ONE ITEM ~ 2 ~N~RW ~E~rT MARK ONLY [] 1 NEW pE~urr ~--._~ 4 AMENOED PE. RMff DBA OR FACIL.JTY NAME WHERE TANK IS ~ISTALLEO: I. TANK DESCRIPTION co~-TE ALL II'E~S - SPECIFY IF: UNKNOWN PROOUCT WASTE TEMPOI:UkqY TANK CLOSURE [] 9628 Rosedode H~ . B. MANUFACTURED BY: O. TANK CAPACITY IN GALLONS: IZ,j ~]r0~:) ~ la REGULAR C. ~ uNLEADED ~b PREMIUM ~__a UNLEADED ~ 2 LEADED 7 ~cm~ANENTt. Y CCOm:D ON StaTE 8 TANK REMOVED DIESEL [] , I 0.~8.1: ,. II. TANK CONTENTS ~; A-1 I$ MAR~EO. OO~IPL~ iT~!~ C. m 3 CNEM~AL pRaT ' , ~ UN~ IlL TANK CONSTRUCTION UA~K ONE tTEu ONLY iN BOXES A, I~,ANoC,,ANDALLTHATAPP'LIL:$1Ni~OXO /,4,,// ' A. TYPEOF [~] , DOUBLE WALt. [] .'t SINGLE WALL W0a EXTERIOR Lt~R ~ 05 uNKNOWN -':~'( SYSTEM ~ ~J 2 SINGLE WALL 4 S~C,~NDA,qY CONTAINMENT ~VAULIEDTANK) TANK ~ t BARE STEEL MATERIAL ~ s CONCRETE ~Prim~'yTutk) '---q 9 BRON'Z~ L_~ = STAINLESS STE~. ~~ 3 ;]BERGLA, SS ~-'~ ~ ~L~t~L CHLORI~ ~ 7 ~UMI~ ~TERIOR ~ ~] 8 UNLINED ~ ~ U~ IS LINI~ MATER~ ~PATI~E ~TH 1~ ~E~A~ ? YES ~ ~__ ~ ~ ~L~LEN~ W~ ~ ~ ~AT:~Q ~ 3 VI~L WRA~ CORROSION ~ --~ PqOTECTION ~ 5 CATHODIC PROTECTION F~ {~ NONE __~ gS UN~ ~ 4 STEELCd. AO W/FIGERGI.~REINFORCEDPI.ASTIC L_Q] 8 I00~ METHANOL COMPATI~LEW/FRP E_~ 99 OTHER ] 4 PHENOLIC LININ~ ~ g9 OTHER [] 4 ;;BERGLASg RE~O~ PLASTIC ~ g9 OTHER L lV. PIPING INFORMATION cmc'~ A ~ABOVEOROUNOOR U ,FUNDERGROUND. BOTHIF AP~UCAgLE TYPE A U t SUCTION A~'~-'~2 PRESSURE A U 3 G~VI~ A U ~ O~ER A. SYSTEM B. CONSTRUCTION A U 1 SINGLE WALL A~',~ 2 ~GLE WALL A U 3 LINED TR~ A U g5 UN~ A U ~ O~R [~ MATERIAL AND A U 1 ~R~STEEL ~2 STA!NL[SS STEEL A g 3 ~L~I~L CHLORI~ (P~ ~ 4 FIBE~ P'E CORROSION A U 5 ~UMLNUM A U 6 CONCRE~ A g 7 ST~LWI~ATI~ A U 8 1~ ~L~MPA~B~W~RP PROTECTION A U 9 ~LVAN~D $~EL 10 CATHOO~CPROT~CTION A U gS UN~WN A U ~ O~R LEAK DETECTION (~ AUTOMAT~LINELEA~T~CTOR ~2 [IN~~T~TJNG ~3 .T~L ~NffOR~NG ~ ~ O~R V, TANK LEAK D~ECTION VAPOR MONITOR:NG ~ 4 AUTOMATIC TANK GAUGING [::~'/S GROUND WATER MONITORING -~ ~ VISUAL CHECK 2 INVENTORY ~ECONCIOATiON :: ---~ 91 NONE ~ 95 UNKNOWN [] g~ O~-IER ? 6 TANK TESTING ~ 7 IN'~RSTITIAL MONITORING ~ VI. TANK CLOSURE INFORMA~ON 2. ESTIMA~OOUANTI~OF 3. WASTAN~Ft~EDW~ YEg ~ ~ ~ ESTIMATED CATE LAST USED (MO, DAY~R] ~ SUGSTANCE REMAINING ~ONS INN RT MA~RI~ ? THIS FORM HAS BEEN C~A~fPLETED(UNDEF? PENALTY OF PERJURY, AND TO 77~E BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT APPLICANTS NAME J/ :AL AGENOY USE ONLY THE ST~TE LO. NU~ER I~CO~POSEOOFTHE FOUR NUMBERS BELOW COUN~ STATE I.O.~ I , j pERMITAPPROVED 9Y/DATE I THIS FORM MUST BE ACCOMPANIED I~Y A PERMIT APPUCAT10N -'FORM A. UNLESS A CURRENT FORM A HA~ BEEN FILED. March 29, 2000 DeliMart 9628 Rosedale Hwy Bakersfield, CA 93312 Dear Underground Tank Owner: Your permit to operate the above mentioned fueling facility 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 arrangements to have the new forms A, B & C completed and returned to this office by May 15, 2000. For your convenience, I am enclosing all three forms which you may make copies of. Remember, forms B & C need to be filled out for each tank at your facility. Should you have any questions, please feel flee to contact me at (661) 326-3979. Sincerely, Steve Underwood, Inspector Office of Environmental Services SU/dlm Enclosure .'T A f.i k: i i_INLER -.OED 5 9 9 7 G A L S G R n S :E; .~ ,'-, ,:, .-, ........ ,'- F; '" ~ '-' HFT · ~d,-,~ GA~ ,-' i ~ -', 47 ~,8 T~.~CHI:-.S r~,_-L :3 9. .. F..: Ah: E S F 'T A N ~::; 2 S El .'.FIE F~; i ~.{, U~:~L:.':; GF.:n::-;:_:; '¢ 1 '-'.: 6 GALS NET 97'4:3 GALS ULLAGE 22,72 iNCHI.'S FUEL 0,0 iNCHI.-S HATER 92,6 DEGRI"ES F '-RNK 3 DIESEL i7i9 i677 10217 iq.i= 0,0 G R L S R F.: I-I :E; S GALS NET GALS LiLLP~GE i NCHI"'S FUEL .T. i".ICHI--S HATER i-~EGRI--ES F CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY N~ME ~ ADDRESS q~R D.o,qet[a[e.. FACILITY CONTACT INSPECTION TIME INSPECTION DATE PHONE NO. ~'~? - BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES Section 1: Business Plan and Inventory Program [~Routine l~l Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V' COMMENTS Appropriate permit on hand ~/ / Business plan contact intbrmation accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of location Proper segregation of material ~/ / Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures ~,/ / Emergency procedures adequate r 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 Business Site.,4Respontsible Party Inspector:~_L~ ~~,~ CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME INSPECTION DATE Section 2: Underground Storage Tanks Program ~Routine [] Combined {~][ Joint Agency Type of Tank ~3tOk Type of Monitoring PtTCo [~1 Multi-Agency Number of Tanks Type of Piping RO [] Complaint [] Re-inspection OPERATION C V COMMENTS Proper tank data on file Proper owner/operator data on file Permit fees current Certification of Financial Responsibility Monitoring record adequate and current Maintenance records adequate and current / Failure to correct prior UST violations i// Has there been an unauthorized release? Yes No Section 3: Aboveground Storage Tanks Program TANK SIZE(S) AGGREGATE CAPACITY' Type of Tank Number of Tanks OPERATION Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO Inspector: Office of Environmental Services (805) 326-3979 White - Env. Svcs. Pink - Business Copy ~ssiness Site-Respons~le Party D February9,1999 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Deli Mart 9628 Rosedale Hwy Bakersfield, CA 93312 RE: Compliance Inspection Dear Underground Storage Tank Owner: The city will start compliance inspections on all fueling stations within the city limits. This inspection will include business plans, underground storage tanks and monitoring systems, and hazardous materials inspection. To assist you in preparing for this inspection, this office is enclosing a checklist for your convenience. Please take time to read this list, and verify that your facility has met all the necessary requirements to be in compliance. Should you have any questions, please feel free to contact me at 805-326-3979. Sincere/ly, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure D FIIf E r January28,1999 FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 'H' Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 SUPPRESSION SERVICES 2101 'H" Street Bakersfield, CA 93301 VOICE (805) 326-3941 FAX (805) 395-1349 PREVENTION SERVICES 1715 Chester ,ave. Bakersfield, CA 93301 VOICE (805) 326-3951 FAX (805) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (805) 326-3979 FAX (805) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (805) 399-4697 FAX (805) 399-5763 Greg Meyer Delimart 9628 Rosedale Hwy Bakersfield, CA 93312 RE: Rectifier Inspection Records Dear Sir: Our records reveal that your facility was recently modified to meet 1998 upgrade requirements. Our records also show that your facility uses cathodic protection using an "impressed current system." California Code of Regulations Title 23, Division 3, Chapter 16 Section 2635(a) requires that all impressed-current cathodic protection systems shall be inspected no less than every 60 calendar days to ensure that they are in proper working order. Since cathodic protection is a vital part of your monitoring system, this office will be verifying that your logs and inspection records are up to date. To assist you, this office is providing you with' a "Rectifier Inspection Sheet" for your convenience. Should you have any questions with regard .to your cathodic protection system or record keeping requirements, please do not hesitate to call ine at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector Office of Environmental Services SBU/dm enclosure cc: R. Huey, Director, O.E.S. CITY OF BAKERsFiELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 rNSPECTION RECORD I~ST CARD AT .lOB 81T~ cay, z¥ ~kf~, q_73/2. INSTRUCTI[ONS.'. Pleme call for an ' ~L"'~----~: otdywi~noach ~roupofimlxa:ti~ withth~ aam°numi~at~r~dy' Th~ywill runin otamzuti~~~~ 1, D~N~Tc~v~.workfor~nym~w~d~`~upunti~1itmminth~t~up~m~igned~byth~Pm~itting~. Followin~~'~''in~mcfiemwillr~'''th~number°f TANKS AND BA~ INSPECTION DATE ~R 13sd~fill of Tank(s) Spark Tm C. mifi~fion or M..,.e.,~,.~ Mg~od C,_,h.~ai¢ Pr~o~ of T~s) PIPING SYSTEM SECONDAI~ VMENT. OVERFILL PROTECTION. Liner [o~=ll~tio~. T~k(s) Lm~r In~,l!,!jon- Piping CONTRACTOR CONTACT Vault With Prodn~t Co .m~nble ~asl~ Level G~ug~s or gemors. Flo~l Veto V~ives Product Comp-_~b~e Fill Product Line L~.slt L~ak ~s) For ~,,-~ S~D.W. T~s) ~to~g Well(sySu~.s) - H20 T~ Le~k ~ ~s) f~ V~'~d~ Spill Prevention FINAL Momtormg Wells, C-~ & L-~-k-· Fill Box L_~ck MOmtormg R~,,~'e.,.'.,,. Typ~ LICENSE # PHONE # CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (805) 326-3979 PERMIT APPLICATION TO CONSTRUCT/MODIFY UNDERGROUND STORAGE TANK TYPE OF APPLICATION (CHECK) [ ]NEW FACILITY [ ]MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE ~//-2/' F~ PROFOSED COMPLETION DATE '~t'-Z ~"~ FACILITY NAME ~ ~/~/" J'~'~-~ ~ EOGSTING FACILITY PERM1T NO. FAcILrr¥ ADDREss ~._z~f.~ff,{,~z,_ ~,--~, cnv ~'~f~' z~ CODE TYPE OFBUSINESS -~'~,~f~,'~ ~,~_ J'f~'~Tk~ ~,~z,-~t,~/ z~-~,~MfAz~-~7' APN# TANK OVTN~R ~)~AJ,~f ,~'~-~'~,~ ADDRESS ~'~' ~,~Z~_. g~' ~,' CITY c~,~"~_f',~:~'~/~_,~e~.ZIPCODE~'~o CONTRAC'i~OR ~' ~'~ ,~,~-~ ~(~ Zr~_~_~' ~ CA LICENSE NO. ~'~gf, ~,.,z.~-- - ADDRESS,ff,~ J'~, .~'-~-~(~ ~'~ -~'.~/CITY,~f/f"~z~"~Z~ ZIPCODE PHONE NO. ~~g,~. -3/.Z ~ -' BAKE~F~.!.D CITY BUSINESS LICENSE NO. -~u~_.~ WORKMAN COMP NO.~/.Z- 2Z.?Yo Y'? INSURER -~'7-~ 7-~ BRIEFLY DESCRIBE THE WORK TO BE DONE A~'~g',~ ~_- ~ ~'/~',~ ~ W-ATE~ TO FAcmrrY P~OV~D B~ ~d,/. ~.,,~ ~'z~,~-- DE~rH TO ~OU-~D WATE~ ~oo ~,' SOIL TY~E ~X~ECTED AT S~ ~~ . No. OF T~ TO BE ~ST~LED ~~ ~ ~ FO~ MOTO~ ~ ~~~ ~- NO SP~L P~ON COBOL ~ CO~ ~~S P~ ON ~E ~ NO SECTION FOR MOTOR FUEL TANK NO. VOLUME / REGULAR PREMIUM DIESEL AVIATION TANK NO. VOLUME SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) (IF KNOWN) FOR OFFICIAL USE ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATtAcHED CONDITIONS OF THIS PERM1T AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. TI-IlS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJlYRY, AND TO THE BEST OF MY KNOWLEDGE, IS ~' ~APPLiCATiON ~L~CoA~E~p (;Z; WHEN A~/~I~T;IGNATURE ~e/..,' ~,,,.,¢,,e._.7 7"bX.~ep /\ 0 3000 South Che .~lAvenue, #31 Baker~r;eld, CA 93304. (805) 834-3f39 CA Lic ft742735.A P. DISPENSER 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 FACIL1TY [ ]MODIFICATION OF FACILITY [ ]NEW TANK INSTALLATION AT EXISTING FACILITY STARTING DATE y-2/'' ~;;?~ PROPOSED COMPLETION DATE Z/'-Z ~'"'~?~:~ FACILITY NAME _/) ~/~' /~'-~',~ ~ EXISTING FACILITY PERMIT NO. FAcmrn' ADDRESS _9'4~,g,O~,4~Z-- Z,',--o' crn' ,4',,;,,('"~',,c zip CODE PHONE NO,, - ADDRESS 9'~ Z,q Ro H ~ ~b~ Z ~ ~--, ~' CITY ~,~'~r~, ~-~Z)., ~,~. zmCODE~. _ ~- _ COm~AC?OR~'C" Z~,OT'~,e, :r~" _ . ~ .. CA riCE,SE NO. ~r~Z_~J. _? PHONE NO. ~_Y'-~ ~,,r/--~'/~ 9' BAKE~FmLD_CrrY ~usn~_ S LICENgE ~O. y'N- WO~ COMP SO.7/~- Z/.~P'-P'? ~SURE~ -~'7~ ~e~. ~.,~,-~ W~ATER TO FACILrrY PROVIDED B"/' dS,/.Z. -~.,,,~ 7 D~m-~TOa~O~I, rOW^TE~ aoo ,~Z' SOILm'E~.XPECTEI~^rSm. NO. O~ T,~rZS TO BE I~ST, m~-~ ~ ~ r,-~Y ~0~ MOrO~ ~ :r,,/,~-~/~' ~O StoL ?~via, moN co~-moI. ~ co~,rI~ MP. ASU~S ?L~',~ ON ~ ~ ~O SECTION FOR MOTOR FUEL TANK NO. VOLUME / REGULAR PREMIUM DIESEL AVIATION TANK NO. VOLUN~ SECTION FOR NON MOTOR FUEL STORAGE TANKS CHEMICAL STORED CAS NO. CHEMICAL PREVIOUSLY STORED (NO BRAND NAME) OF KNOWN) FOR OFFICI.M. USE ONLY THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY wrrH THE ATrACHED CONDITIONS OF THIS PERMIF AND ANY OTHER STATE, LOCAL AND FEDERAL REGULATIONS. TI-RS FORM HAS BEEN COMPLETED UNDER. PENALTY OF PERJURY. AND TO THE BEST OF MY KNOWLEDGE, IS "'" ' /2 d. -~A~//~~THIS APPLICANT NAME (PRINT) APPLICANT SIGNATURE PPLICATION BECOMES A PERMIT WHEN APPROVED 6 BAKERSFIELD FIRE DEPARTMENT February 13, 1998 REE CHIEF MICHAEL R. KELLY 2101 'H' Sheet BaSe~dleld, CA 93301 (805) 326-394 I FAX (805) 395-1349 2101 'H' Street Bakersfiem, CA 93301 (805) 326-3941 FAX (805) 395-1349 PI~'VENI1ON SEEVICE$ 1715 Che~ter Ave. [k:~eMetd, CA 93301 (805) 326-3951 FAX (805) 326-0576 ENVIEONMENi'AL SEilVlCE$ 1715 Chester Ave. Bakersfield, CA 93301 (8~) 326-3979 FAX (805) 326-0576 IEAINING 5642 Victor Sheet Bakersfield, CA 93308 (80~) 399-4697 FAX (806) 399-5763 DeliMart 9628 Rosedale Hwy Bakersfield, CA 93312 RE: "Hold Open Devices" on Fuel Dispensers Dear Underground Storage Tank Owner: The Bakersfield City Fire Department will commence with our annual Underground Storage Tank Inspection Program within the next 2 weeks. The Bakersfield City Fire Department recently changed its City Ordinance concerning "hold open devices" on fuel dispensers. The Bakersfield City Fire Department now requires that "hold open devices" be installed on all fuel dispensers. The new ordinance conforms to the State of Califomia guidelines. The Bakersfield Fire Department apologies for any inconvenience this may cause you. Should you have any questions, please feel free to contact me at 326-3979. Sincerely, Steve Underwood Underground Storage Tank Inspector cc: Ralph Huey FCS FUEL CONTROL SERV1. C~~ dba: Champion Tank Tes~in~ 9781 Highdale Rd. Santee, CA 9207q INVOICE INVOICE NO:6244 DATE: April 30, t997 Bill To: Deli-Mad 9628 Rosedale Hwy. Bakersfield, CA. 93301 Site: Same : { SALES~'ERSONbg P'O'verbaiNUMBER I DATE4/21OF'T'EST/97 SHIPPED VIA ....... F.O.B. POIN'I; TERMSnet 30" QI.J,~NTITY DESCRIPTION GNIT PRiCI ' AMOUNT I Monitor Maint & Functional Systems test. 285.00 285.00 1 Cathodic Protection Certificati0r~ I 100.00 100.00 SUBTOTAL 385.00 SALES TAX SHIPPING & HANDLING TOTAL DUE $385.00 Make all checks payable to: FUEL CONTROL SERVICES If you have any questions concerning this invoice, call: 619 562-3255 TERMS: NET 30 DAYS. Finance charge of t.$% on past due accounts. This is an annual rage of 18 %. WE APPRECIATE YOUR BUSINESSi INC. BAKERSFIELD SERVICE STATION REPAIR $6~0 ROSEDALE HIGHWAY, # B BAKERSFIELD. CA 93308 (805) 5~27T/(BSSR) FAX (~OS) TO' '"',f LOOAT;Of, i / ....... lFinish (money) Finish (gallons) Totallzer~___ _ ~ Readtng~art (money) Stad (gallons) .WORK ORDER DEPARTURE TIME Product Finish (money) TotaltzerL Readings!Start (money) Return to Storage (gallons) I Finish (money) Totalizer[ Reading1 Start (money) Finish (gallons) Start (gallons) Checked Fast Adjusted To [] Yes [] No Calibration: I Fast Checked [ Adjusted' Fast To I Slow Slow E] No Product Return to Storage (gallons) Totalizer Sealed [] Yes [] No L3 No Finish (gallons) (gallons) Product ' ---l~l~eter Sealed J[] Yes jSlow Meter Sealed ~3 Yes lSlow Slow I Meier Sealed [] Yes 0 Finish (money) Readings~ Start (money) [o. o0 Return to Storage (gallons) Finish Calibration: [ Fast Checked Adjusted [ Fast To Tolalizer Sealed Lq Yes [] No Calibration: I Fast Checked [ I Adjusted IFast Slow Slow [~ No Start (gailons) 0.o0 Product Return to Storage (gallons) Totalizer Sealed l Meter Sealed 'J.~'~tCt"l~ ~ ~ b't~-~'~-~(-- -~.00 ~ [] Yes [] No [ [J Yes ~ No REPORTED PROBLEM: DESCRIPTION OF WORK: LABOR 1 QUANTiTYJ PARTS NEEDED l .... J!-.-b ,,.I000 LE-.~¢... b~-r'e:C' -rorZ TRAVE~L~ . PRICEi TOTAL HRS. RATE L_.~.%-----AMOUNT; ~ AMOUNT TOTAL LABOR HEREBY ACKNOWLEDGE THE SATISFACTORY COMPLETION OF THE ABOVE TOTAL MATERIAL TOTAL MILEAGE TOTAL TAX TOTAL Champion Precision Tank Testing License No. 73848 P O. Box 13059 S,~cramcnto CA 95813--3059 CA 800-660-9~43 NV 800-949-9443 t-916-927-1557 Fax: (9t6) 027-7345 DATE OPERATOR LOCATION ANNUAL MONITOR MAINTENANCE & SYSTEMS FUNCY!©NAL TEST C?,ECK LIST · .~ONITOR MAINTENANCE & SYSTEMS FUNCTIONAl- TEST r.,10 N IT O R __~.~.~-_t~: R/~-g~ _.T~-----o~_-~__~-~?-~AT-~.~:---~ .... ~STAL~TION AND SAFETY REQUIREMENTS '2ED VISUAL CHECK OF COMPONEN'TS AND CONNECTIONS '.::O AND CLEANED TANK PROBES UEL AND WATER LEVELS IN TANK WITH DIP STICK __~ .... OUT SYSTEM AND TANK SET-UP WtLUES '¢" DIAGNOSTIC PROBE VALUES %~"' ;:ED STICK READINGS WFFH PROBE VALUES O ALL PROGRAMMING FOR A ACCURATE AND CO~PLET~ DATA _..~::c:i; ............................. '."~S iS OPERAT ONAL /' SYSTEMS tS NON-OPE~T~ONAL- ~.~AD DIAMETER f/Z/ . ' ~'. Sacramenlo. CA 95813-3059 CA 800'660-9443 NEV 800-949-9443 [916) 927-1557 Fax: {9161 92: Precision Leak Detector Test XLD PIN 116036.5 DLD PIN 116017-5 XLP PIN 116035-5 PLD PIN 116030-5 BFLD (XL Model) P/N 116039-5 BFLD PIN 1~ 6012-5 Direct;ons: RESILIENCY TEST PASS FAIL PRODUCT AND TANK # Tank SERIAL NUMBERI OPENING TiME Tank Tank #__~_~ Technician· LEAK RATE METERING P.S.!. ,/' FCS Fuel Control Services 9781 Highdale Rd. Santee, CA 92071 Customer', Site Address City, State, Zip: CATHODIC PROTECTION CERTIFICATION .... TYPE: ~"/4 P~--5 ~g TANK TYPE: S VOLTAGE: /. OPERATION:___ COMMENTS: Technician: DATE: BOE-501.'FK REV. 4 (12-96) PO BOX 9J~ SACRAMENTO. CA 94279-0030 , i~i~RGROUND STORAGE TANK FE_~E RETURN ~I~UE ON ~R ~ 10/2.5/97 FOR JULY Mail To: USTC RVTK01 :3797 - SEPTE,~BER, 1997 lAccount Number TK HQ ~,~,-00833~ STATE BOAR0 OF EQUALIZATION FUEL TAXES DIVISION DELIHART PO BOX 942879 9628 ROSEOALE HWY SACRAHENT0 CA 9~279-6151 BAKERSFIELD CA 9628 ROSEOALE HWY 93308 STATE OF CALIFORNIA BOARD OF EQUALIZATION (916) 322-9669 BOARD USE ONLY REG RR Pr1 TR AUD NR ' REF QD PI FILE EFF lEAD INSTRUCTIONS IEFORE PREPARING Make changes if nemo or address is incorrect, GENERAL INFORMATION · , Every owner of an underground storage tank who is required to_ obtain a permit to own or operate a tank under Section 25~_84 of ,- the He~1th and S~fet~/' Code sh~ll i5~y a"$~-0rage -~ee'f0r each gallon of petroleum products placed in the tank. DEFINITIONS OWner is defined to include any person as wetl as any city, county or district or any agency, including departments thereof. Owner does not include the state government, federal government, or an operator who is not an owner. Petroleum is defined as crude oil or any fraction thereof, which is liquid at standard conditions of temperature (60 degrees Fahrenheit) and pressure 04.7 pounds per square inch). )Underground storage tank means any one or combination of tanks, including pipes connected to the tanks, used for the storage of petroleum and located substantially or tot~,/ty beneath the surface of the ground. The fee does not apply to petroleum products placed in underground storage tanks that: 1. Are located on a farm or residence, used to store motor fuel for noncommercial purposes and have a capacity of 1,100 gallons or less; or 2. Store heating oil for consumption on the premises where stored. FILING REQUIREMENTS Every owner of an underground storage tank shall file a quarterly storage fee return. This includes tanks that are temporarily empty or not in use. The return is due on or before the 25th day of the month following the end ct the reporting period. Late payment results in a penalty of 10% and interest at an adjusted rate established under Section 6591.5 of the Revenue and Taxation Code. The return must be filed even though you have no liabi!ity for the fee. If you have sold any of your tanks or have moved, please notify this office. If you are not the tank owner, please indicate the current owner and their mailing address on an attachment and forward along with this return. INSTRUCTIONS: Enter total gallons of petroleum placed into all tanks A B C ownod by you in Column A; multip/y by the rato in Column B; ~nd WHOLE RATE OF FEE TOTAL FEE DUE enter that number in Column C. (DO not report on capacit'~,~,) GALLONS ONLY (Column A x B) 1 Total gallons of petreloum placed in all tank, owned by you 1. · .. 0.01~ ~. Penalty [multiPly line ~, ~ofumn C, by 10% (, 10)if payment is made after PENALTY 2. due date shown above] -3. INTEREST OF ]2~ PER ANN~J;,~ (0.0]00OO PER RONTH) INTEREST 3. IS DUF IF PAY,flFNT IS NADE AFTER THE DUE DATE, 4. TOTAL AMOUNT DUE AND PAYABLE (add lines ?, 2 and 3) 4. I t~ereDy cortlly treat Itlt$ return, ¢ncluchng any accompanying examined by me and to tho best o~ my knowledge and ~lief NAM~ AND T~LE. 61G~ PHON~ NUMBER ( ) MARE UH~R'0H MUN:Y UHU~H FRYAUL: DATE UNDERGROUND STORAGE TA .N~SPECTION Bakersfield Fire Dept. Office of Environmental Services Bakersfield, CA 93301 FACILITY NAME ~)e.l,~mc"{ BUSINESS I.D. No. 215-000 t3'/~ ~,DDRESS ~'~ ~'~/(-- /~ CITY t~[~r~tc[r.l' ZIP CODE ~',~1 'Z.. . FACILITY PHONE No. ~'$ ~' ' dGq'(9 ~ t ~o~z~ ~O~.3, INSPECTION DATE ~/~/~ ? P/gduct Product Product TIME IN TIME OUT nsf Date Inst bate Insl Date INSPECTION TYPE: Size Size Size ROUTINE if'"' FOLLOW-UP REQUIREMENTS yes no n/a yes no n/a yes no n/a la. Forms A & B Submitted V/' lb. Form C Submitted 1 c. Operating Fees Paid V~' 1 d. State Surcharge Paid 1/' 1 e. Statement of Financial Responsibility Submitted lf. Written Contract Exists between Owner & Operator to Operate UST 2a. Valid Operating Permit V 2b. Approved Written Routine Monitoring Procedure 2c, Unauthorized Release Response Plan V~ 3a. Tank Integrity Test in Last 12 Months V/ 3b. Pressurized Piping Integrity Test in Last 12 Months .~' 3c. Suction Piping Tightness Test in Last 3 Years V' 3d. Gravity Flow Piping Tightness Test in Last 2 Years ~. Test Results Submitted Within 30 Days 3f. Daily Visual Monitoring of Suction Product Piping ~/,. 4a. Manual Inventory Reconciliation Each Month V 4b. Annual Inventory Reconciliation Statement Submitted V" 4c. Meters Calibrated Annually V/ 5. Weekly Manual Tank Gauging Records for Small Tanks ~/' 6. Monthly Statistical Inventory Reconciliation Results V 7. Monthly Automatic Tank Gauging Results ~/' 8. Ground Water Monitoring V 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Double-Walled Tanks 11. Mechanical Line Leak Detectors V/ 12. Electronic Line Leak Detectors V/ 13. continuous Piping Monitoring in Sumps 14. Automatic Pump Shut-off Capability 15. Annual Maintenance/Calibration of Leak Detection Equipment ~{~9 16. Leak Detection Equipment and Test Methods Listed in LG-113 Series I~1~ [ ~1~C 1// 17. Written Records Maintained on Site 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days 19. Reported Unauthorized Release Within 24 Hours 20. Approved UST System Repairs and Upgrades L/ 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tube RE-INSPECTION D~TE ~ RECEIVED BY: F[:i 1669 (rev. 9195) Business Namei ,¢e[,~ac'F ~akersfield l~ire Dept. OFF1L"E OF ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield, CA 93301 Date Completed ?/077/¢7 Location: ~4~' Business Identification No. 215-000 Station No. Shift Arrival Time: (Top of Business Plan) Inspector ~5'tz:(,,~ L)ct~fcra_~ Departure Time: Inspection Time: Address Visable Correct Occupancy Verification of Inventory Materials Verification of Quantities Vedfication of Location Proper Segregation of Matedal Adel~te Inadequate r'l Comments: Verification of MSDS Availablity Number of Employees: Verification of Haz Mat Training~ [] Comments: Verification of Abbatement Supplies and Procedures Comments: Emergency Procedures Posted Containers Propedy Labled Comments: Adel~,ate Inadequate [] Verification of Facility Diagram!~ [] Housekeeping ~ [] Fire Protection rl Electrical 13'" ~1 Comments: UST Monitoring Program Comments: Permits ~ l'1 Spill Control Hold Open Device ~ Hazardous Waste EPA No. Proper Waste Disposal I~/ [3 Secondary Containment ~ El Security ~ [] Special Hazards Associated with this Facility: Violations: Business OwnedManager PRINT NAME --SigNATURE - t ~ All Items O.K Correction Needed VVhite-Haz Mat Div. Yellow-Station Copy Pink-Business Copy 'round Hazardous Materials Storage Facility CONDiTiONS :.: t ~, EVERSE SIDE Tank Piping Piping Number Method Monitoring Issued By: Approved by: HAZARDOUS MATERIALS DIVISION 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 (805) 326-3979 Ralph E. Huey, Hazardous Malerlals Coordinator ~CORR:E CT[j~,N N'O TIC E BAKERSFIELD FIRE DEPARTMENT Sub Div. Blk.. Lot You are hereby required to make the following corrections at the above location: Cor. N? [ Completion Dale fo,' Corrections /~/~[/~ -'--~k Inspector ~ 326-3979 ~ ~:~BAKERSFIELD, CA 'g3308 ,~--, (80.5~ 588-2777 BiLLTO: DELI MART~ 962'8 ROSEDALEI~qY BAKERSFI~, CA 93312 DATE '-. INVOICE 26 Sep 94 3675 . VIA F,O.B. PROJECT Due on recpt 26 Sep 94 39?3 QUAN3]3~ ITEM CODE DESCRIPTION, PRICE EACH t AMOUNT l. 25 LAB, LABOR 35.00 43.75 10 . MI]~ MILEAGE 0.40 4,00' TESTED THE SENSORS AND ~%DE THEM GO INTO AN ALARM. THE~ CLEANED .~THE ALARM AND RAN A PRINT-OUT. GAVE TEE PRINT-OUT TO DIANA. TOTAL ........... '' ;.. 47:75 BALANCE DUE: 47.75 'L assR INC BAKERSFIELD SERVICE STATION REPAIR 8630 ROSEDALE HIGHWAY, # B BAKERSFIELD,' CA 93308 (~OS) S~-~'~7'/(aSS.) · FAX (sos) saa-2?so, , 0 ey) TotelizerL___.~ ~ Start (mone~ Product (gallons) Checked Adjusted To Storage (gallons) T_otallzer Product (money) (gallons) to Storage (gallons) (gallons) to Storage (gallons) (gallons) Storage (gallons) Totalizer Readl~ (money) Product .' Product Sealed [] Yes [] No Checked Adjusted Fast To [] Yes [] No Checked Adjusted Fast To Sealed [] Yes [] No Checked Adjusted To Sealed [] Yes [] No Sealed -- [] Yes ~ ,~ QUANTIT' PART..~_S NEEDED PRICE AMOUNT RATE TOTAL LABOR TOTAL MATERIA TOTAL L.....___ TOTAL HRS. Iow ' - ' Slow Seal~c [] Yes ..... Slow Sealeu [] Yes .~. Slow Sealea -- [] Yes u .... Slow BAKERSFIELD FIRE DEPARTMENT COl'. Blk.-----------' Lot-- Sub Div. You are hereby required to make the following corrections at the above location: Completion Date for CorrectionS, .~ i ' - Inspector 326-3979 Bakersfield Fire Dept. Hazardous Materials Division Bakersfield, CA 93301 FACILITY NAME ~)P~I; -/T)~r~ BUSINESS I.D. No. 215-000 FACILITY ADDRESS ~../_,,.9.~ ~[~c.o_~,~_., ,t~.,~ CITY ~_~:~4,A.~.-~,te~& ZIPCODE~5)r~,, / FACILITY PHONE No. .~[A03- ,~'~z{E:> / ,mD~ ID~ ID~ INSPECTION DATE ~/_9-1 ./'<::~']'~ Product Product Produol TIME IN TIME OUT Inst Date Inst Date Insl Date Size Size Size REQUIREMENTS yes no n/e yes no n/a yes no la. Forms A & B Submitted 1 b. Form C Submitted lc. Operating Fees Paid ld. State Surcharge Paid le. Statement of Financial Responsibility Submitted lf. Written Contract Exists between Owner & Operator to Operate UST 2a. Valid Operating Permit 2b. Approved Written Routine Monitoring Procedure 2c. Unauthorized Release Response Plan 3a. Tank Integrity Test in Last 12 Months 3b. Pressurized Piping Integrity Test in Last 12 Months 3c. Suction Piping Tightness Test in Last 3 Years 3d. Gravity Flow Piping Tightness Test in Last 2 Years 3e. Test Results Submitted Within 30 Days 3f. Daily Visual Monitoring of Suction Product Piping ·(~/~ (~),{;~7,-, L,~ 4a. Manual Inventory Reconciliation Each Month ~v' 4b. Annual Inventory Reconciliation Statement Submitted 4c. Meters Calibrated Annually 5. Weekly Manual Tank Gauging Records for Small Tanks ~ ~ 6. Monthly Statistical Inventory Reconciliation Results 7. Monthly Automatic Tank Gauging Results 8. Ground Water Monitoring 9. Vapor Monitoring 10. Continuous Interstitial Monitoring for Double-Walled Tanks 11. Mechanical Line Leak Detectors 12. Electronic Line Leak Detectors ~:~ 13. Continuous Piping Monitoring in Sumps 14. Automatic Pump Shut-off Capability 15. Annual Maintenance/Calibration of Leak Detection Equipment 16. Leak Detection Equipment and Test Methods Usted in LG-113 Series 17. Written Records Maintained on Site 18. Reported Changes in Usage/Conditions to Operating/Monitoring Procedures of UST System Within 30 Days lg. Reported Unauthorized Release Within 24 Hours 20. Approved UST System Repairs and Upgrades 21. Records Showing Cathodic Protection Inspection 22. Secured Monitoring Wells 23. Drop Tube RE-INSPECTION DATE , RECEIVED BY: INSPEcToR: .~-~_~'_/~'_ _/'~,~._..~/~.,~- OFFICE TELEPHONE No. FDI~9 FILE CONTE.~ITS PERMIT SUMMARY ENV. SENSITIVITY: Acttv'ity Date'' # 'Of Tanks 'Comments SYATE WATER RESOURCES BOARD P 0 BOX 944212 SACRAMENTO, CA. 94244-2120 June 1,' 1994 Dear Sirs, I am the chief financial officer for Delimart, 9628 Rosedale Hwy, Bakersfield, Ca. 93312. This letter is in support of the use of the Underground Storage Tank Clean-up 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 o~ at least $990,000 per occurence and $990,000 annual aggregate coverage. Underground storage tanks at the following facilities are assured by this letter; Delimart, 9628 Rosedale Hwy, Bakersfield, CAo 93312. Amount of annual aggregate coverage being assured by this letter ............................. $10,000 Total tangible assets ........ ........... $500,000 Total liabilities ....................... $200,000 (if any of the amount on line 2 is included in the total liabilities, you may deduct that amount from this line~ and add that amount to line 4) Tangible net worth (must be 10 times line 1) $300,000 I hereby certify that the wording of this letter is identical to the wording specified in subsection 2808.1(d)(1), chapter 18, Division 3, Title 23 of the California Code of Regulations. I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge at Delimart on June 3, 1994. Partner/ Manager DELIMAR~ 9628 Rosedale Hwy~Bakersfield, CA Witnessed y__ Robin Rolfson CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR UNDERGROUND STORAGE TANKS CONTAINING PETROLEUM ~ 1 8m required to demous~xale Ftamnclal Re,pousibai~ h ~e required omounu as s~ed h ~on ~7. ~p~r tS. Div. 2. ~de Z3. CC~ ~ 5~.~ dolla~ ~r ~n~ ~ l minion dollars annual a~resate or ~D / ~ . or ion dollars ~r ~en~ ~ 2 miBion dollan a~l o~esate Addle 3, C~pter I8, D~n 3, T~/e 23. Ca/~orn~ ~e of ~gulat~. ~ ~n~ ~ to de~t~te fl~! res~ibi/~ as r~uir~ by ~t~n 2807are as fo//o~: Note: If ~u are ~/ng t~ ~ate Fu~ as any ~ or.ur de~t~t~n of fl~/ re~/bil~, ~ur ex~n a~ subm~s~n of th~ ce~at~n a/so ce~es t~t ~u are/n com~e ~h a// ~~ for ~K~/~t~n /n t~ Fu~. INSTRUCTIONS, CERTIFICATION OF FXNANCXAL I[ESPONSXBXLXTY FORM PLease type or print 'clearly et[ 'information On Certification of Financial Responsibility form. All UST facilities and/or sites owned or..operated may be Listed on one form; therefore a separate certificate is not required for each site. ~ Check the appropriate boxes. Full name of either the tank owner or the operator. DOCUMENT INFORMATION A. ~t Required - B. #ame of Tar~ O~ner - or Operator C. gechonism Type - Indicate which State approved mechanism(s) are being used to show fi'nanoiai reuponsibtLity either as contained in the federal regulations, &O CFR, Part 280, .. Subpart H, Sections 280.90 through 280.103 (See Financial Rponsibi[ity Guide, for mere information), or Section 2808.1, Chapter 18, Division'3, Title 23, CCR. Name d~'i~sUer'-- List ~l names and add6e~se~ of co~nies and/or individuals issui'ng,coverage. 'Hechanisa Nmber- List identifying nurber fo~ each mechanism used: Exempt'e: insurance I~otic~'~ber ~' fi[e"~umber as indicated on bond or d~c~ta~e, nt~ (If using State CLeanUp Fund · (State Fund) Leave blank.> C~verageAa~xa~t - Indicate amount of coverage for each type of mechanism(s). If more than one mechanism is indicated~ total must equal 100~ of financial responsibility for each facility. Coverage Period r Indicate the effective date(s> of at[ finanoia[ mechanism(s). ·(State Fund coverage would be continuous as Long as you maintain comp[iance and renmin eligible to continue participation in the Fund.) Corrective Action - Indicate y~s or no. Does the specified financial mecha~isw provid~ Foverage for corrective action? (~f using State Fund, indicat& "yes".) Indicate yes or no. Does the specified finanoia[ mechanism provide coverage for third party compensation? (if using Sta~e Fund, indi.cate "yes!'.) Provide all facility and/or-site names and:addresses. Thlrd Party - Compensation D. Facility -. Information E. Signature Breck Provide signature and date signed by tank owner or operator; printed Or typed name and title of tank owner or operator; signature of witness or notary and date signed; and printed or typed name of witness or notary (if notary signs as witness, please place notary seal.next to notary's signature>. : Uhere to Mai[ Certification: Please send original to your local agency (agency who ~ssues your UST permits). Keep a copy of the ,certification at each faci[itY*orsite Listed on the form. I f you ~ave ,qu~St,~onsuon financial responsfbi[ i.ty requirements on [.o~2the.:e~:~,~ation of Financial Responsibility Form, PLease contact the 'State UST CLeanup Fund ~91~['~'~= ~Note:Penatties for Failure to comply with Financial Responsibility Requirea~w~ts: Failure tO comply may ,result in: (1) jeopardizing claimant et;igibi[ity for the State UST CLeanup Fund, .and (2) :Liability for civil penalties.of up to $~O,O00.do[tars.per day,:per underground storage ~ank, ~or:each day.of vioLati'on as stated in-Article ?, Section 25299.76(a) of .the California Health andSafety Code. INSPECTION RECORD POST CARD AT JOBSITE ADDRESS ~? ~~ -~C)~z ADDRESS CITYPHONE NO.~'~~'~ · -- ICITY INSTRUCTIONS: Please call for an inspector only when each group of insPections with the same number are ready. They will run in consecutive order beginning with number' 1. DO NOT cover work for any numbered group until all items in that ..... group . are signed off by the Permitting Authority. FolloWing these tnstrutions will .:reduce the number.of required inspection visits and .therefore prevent:asSessment-'of additional'fees. .... : - .'.i'"~::: z,.. ~{}'~ -:,::~.;~f.~.. "-- ~ ' ' ' ' ~ : ,<...:,.:_~....::~:. , .,:;.:.i :'~ >'.:- ,. 3, ~',:. , . .... '- .... - '' - TANKS & BACKFILL - INSPECTION DATE INSPECTOR <. Backfill of Tank(s) Spark Test Certification .,~Cat. hodic, Protection of Tank(s) - PIPING SYSTEM - Piping & Raceway w/Collection Sump ,~//7/~21 ~¢~.~ ./..~/~_..~_~---~/ - Corrosion Protection of Piping, Joints, Fill Pipe Electrical Isolation of Piping From Tank(s) ~//~ ' ' Cath6dic Protection System-Piping .. ~,~~.~~~ - SECONDARY CONTAINMENT OVERFILL PROTECTI~. LEAK DETECTION - r Liner-tr.~tal lation - Tank ( s ) Liner Inst'--~!ation - Piping iVault 'With proUdeSt Compatible Sealer 0 Level Gauges or Se~s, Float Vent Valves q?~/r~ ~~ ~ Product Compatible Fili~(e~) · · ~/~/~ t~~~ ',~ [PrOduct Line..Leak Detector(~)~ _ . ~/~/f~ ~ k/~~ ~L~k~Bege.e.tor(s) for ~nnular SpaceZD~a¢,k(s) ' ~'/~ Beak DetectSon Device{s) ~or Vadose/Ground~ater - FINAL - t Monitoring Wells¥ Caps & Locks Fill Box Lock Monl toring Requirements CONTPOkCTOR CONTACT LICENSE # PH # eBakersfield Fire DePtl~ HAZARDOUS MATERIALS DIVISI~N UNDERGROUND-STORAGE TANK, PROGRAM · ~,'.. ~-:~ ~ ;... ~ -. .. ,. :'i/' ~-~.-;.-:-~pERMiT AppLiCATiON TO CONSTRUCT/MODIFY UNDERGROUND STORAGE:TANK-_~:~'.;' ~ · . T-~'N~ FACILITY I~MODIFICATION.OF. FACILITY. [3 NEW.TANK INSTALLA.TIO .N AT EXISTING FAC. ILI.T~,.? '-.'.~.:~:~::~;~?~,i WATER TO FACILI~ PROVIDED BY.. V~U~ "Wh~':.~, ' ' ' DEPTH TO GROUND WATER ~Ox SOIL ~PE EXPECTED AT SITE. ~M~ ~o. OF TANKS TO BE INSTALLED - ~ . ARE .THEY' FOR.MOTOR FUEL -~YES ~ .Q NO - ' TANK No. VOLUME ' UNLEADED. REGULAR . - "-~PREMIUM :;'-'~DIESEL - AVIATION :. ""~ 'SECTION FoR'NON MoTO""FuELsTORAGE TANKs ''I~:' TANK No.. VOLUME CHEMICAL STORED CAS No. : (no brand'name) (if known) CHEMICAL PREVIOUSLy STORED FOR OFFICIAL USE ONLY THE'APPLICA NT HA'S RECEIVED, UNDERSTANDS. AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS PERMIT AND ANY OTHER STATE. LOCAL AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT. APPLICANT NAME (PRINT') THIS APPLICATION BECOMES A' PERMIT.WHEN APPROVED, FACILITY/SITE Bakersfield Fire Dept~ HAZARDOUS MATERIALS DIVISION 2130 G Street, Bakersfield, CA 93301 (805) 326-3970 /\°°/ UNDERGROUND TANj~QtJES-TIQN,NA~:IE- No. OF TANKS JUl. ~ 6 1~1 HAZ, MAT. DIV. DBA OR FACILITY NAME NAME OF OPERATOR PARCEL No.((;~PT1ONAL) STATE ZIP CODE ~' BOX TO INDICATE [~CORPORATION. [~INDIVIDUAL ~PARTNERSHIP [~ LOCAL AGENCY DISTRICTS [~COUNIYAGENCY (~ STATE AGENCY [~FEDERALAGENCY /2GI EMERGENCYCONTACT PERSON (PRIMAR~ EMERGENCY CONTACT PERSON (SECONDAR~ optional -t~ fl DAYS: NAME (~ST. FIRS~ PHONE ~. WITH AR~ CODE [~O5~ I DAYS: NAME (~ST. F~ P,ONE ~. W,m AR~ CODE II. PROPER~ OWNER INFORMATION (MUST BE COMPLETED) NAME CITY NAME ' [~INDIVIDU~L O LO~CAL AdENCY ~ STATE AGENCY ' TO INDICATE [~ PARTNERSHIP I~ COUNTY AGENCY [~ FEDERAL AGENCY ZIPCODE I PHONE NO. WITH AREA CODE II1.. TANKOWNER INFORMATION (MUST BE COMPLETED) CARE OF ADDRESS INFORMATION ~' BOX [~ INDIVIDUAL TO INDICATE I[~"'~RTNERSHIP STATE ZIP CODE NAME De./imor MAILING OR STREET ADDRESS z Ros,:, ale CITY NAME · ~ LOCAL AGENCY [~ STATE AGENCY [~ COUNTY AGENCY ~ FEDERAL AGENCY PHONE No. WITH AREA CODE OWNER'S DATE TANK No. INSTALLED Iq0 t VOLUME PRODUCT STORED DO YOU HAVE FINANCIAL RESPONSIBILITY? ON TYPE IN SERVICE ¥/N 'Y/N Y/N ~~- {~2_77 ® R ichor'd Le~ You - 'B~ch q-oaks and -~ Fill one segment~each tank, unless al~anks and piping are constructed of t~same~/~aterials, style and~pe, then only fill one segment out. '~ identify tanks by owner ID #. OWNER'S TANK I D # "$ c. DATE,NSTALLEOIMO,GA;4A", Iq% ' D. TANK CAPAC' 'N G LONS I oO0 III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. R, ANDC. ANDALLTHATAPPLIESlNBOXD A. TYPEOF [] 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER B. TANK [] 1 BARE STEEL [] 2 MATERIAL [] 5 CONCRETE [] 6 (PrimaryTank) [] B BRONZE [] 10 STAINLESS STEEL [] 3 FIBERGLASS' POLYVINYL CHLORIDE [] 7 ALUMINUM GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEELCLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATIBLE W/FRP ] 99 OTHER r---] 1 RUBBER LINED ~26 ALKYD LINING '~3 EPOXY LINING J---] 4 PHENOLIC LINING C. INTERIOR ' LINING [] 5 GLASS LINING UNLINED 95 UNKNOWN [] 9g OTHER IS LINING MATERIAL COMPATIBLE WITH 10(P~ METHANOL ? YES ~ NO__ D. CORROSION POLYETHYLENE WRAP [] 2 COATING . : ' _[] 3 VINYL WRAP , [] 4 FIBERGLASS REINFORCED PLASTIC PROTECTION CATHODIC PROTECTION 1 NONE ,.- [] 95 UNKNOWN - [] 9g OTHER IV. PIPING INFORMATION C~RCLE A IFABOVEGROUNDOR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEMTYPE A U 1 SUCTION . A ~(~2 PRESSURE . A U 3 GRAVITY A U 99 OTHER B. CONSTRUCTION A~ SINGLE WALL ~-'~2 DOURLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A IJ 99 OTHER C. MATERIAL AND A U 1 BARESTEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A(~t FIBERGLASS PIPE CORROSION A IJ 5 ALUMINUM A U 6 CONCRETE A IJ 7 STEEL W/ COATING A IJ 8 100% METHANOL COMPATIBLEW/FRP PROTECTION A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTtON ~5 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~1 AUTOMATIC LmNE LEAK DETECTOR ~ 2 UNET)GHTNESSTESTmi~G m--j3 INTERSTFF~L~NITOmNG [] 99 V. TANK LEAK DETECTION ,-{' · I ?~,~'ISUAL CHECK [] ~ INVENTORY RECONCILIATION []3 VAPOR MoNIToRING~,.4 AUTOMATIC TANK GAUGING [---')5 GROUND WATER MONITORING L~ 6 TANK TESTING [] 7 INTERSTITIALMONmTORING [] 91 NONE [] 'S UNKNOWN [] 99 'ER MONITORING I I. TANK DESCRIPTION COMPLETE ALL ITEMS -- SPECIFY IF UNKNOWN A. OWNER'S TANK I. D. # S. MANUFACTURED BY: C. DATE ,NSTALLED /MO, OAY,YEAR, j, ma . IqB! D. TA"KCAPAC, ,.G LONS: II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. S, ANDC, ANDALLTHATAPPLIESlNnOXD A. TYPEOF [] 1 DOUBLE WALL SYSTEM ~ SINGLE WALL . [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 9g OTHER B. TANK [] 1 BARE STEEL MATERIAL [] 5 CONCRETE (PrimaryTank) [] 9 BRONZE [] 2 STAINLESS STEEL [] 3 FIBERGLASS [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM [] 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD W/FIBERGLASS REINFORCED PLASTIC ] 8 100'/o METHANOL COMPATIBLEW/FRP ] 99 OTHER ~[-'--] I RUBBER LINED [] 2 ALKYD LINING [] 3 EPOXY LINING [] 4 PHENOLIC LINING C. INTERIOR [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. C0RROSION [] 1 POLYETHYLENE WRAP [] 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ] 3 VINYL WRAP ] g5 UNKNOWN ] 4 FIBERGLASS REINFORCED PLASTIC [] 99 OTHER IV. PIPING INFORMATION CIRCLE A IFABOVEGROUNDOR U IFUNDERGROUNO, BOTH IF APPLICABLE A. SYSTEM TYPE A U I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U gg OTHER B. CONSTRUCTION A U 1 SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U g5 UNKNOWN A U gg OTHER C. MATERIAL AND CORROSION PROTECTION A U 1 BARE STEEL A U 5 ALUMINUM A U 9 GALVANIZED STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE (PVC)A U 4 FIBERGLASS PiPE A. U 6 CONCRETE A U 7 STEEL W/COATING A U 8 10~o METHANOL COIVIPATIBLEW/FRP A U 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER O. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIAL MONITORING [] 99 OTHER V. TANK LEAK DETECTION .... I 1 VISUAL CHECK [] 2 INVENTORY.RECONCILIATION [~] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUG,NG [] 5 GROUND WATER MONiTORING i ] 6 TANK TESTING [~ 7 INTERST'TIALMONITORING ~ 91 NONE [] g5 UNKNOWN '[]]] 99 OTHER I. TANK DESCRIPTION COMPLETE EMS - SPECIFY IF UNKNOWN A. OWNER'S TANK L D. # B. MANUFACTURED BY:' C. DATE INSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLoNs: II1. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A. B. AND C, AND ALL THAT APPLIES IN BOX D A. 'PfPE OF [] 1 DOUBLE wALL SYSTEM [] 2 SINGLE WALL [] 3 sINGLE WALL WITH EXTERIOR LINER * [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANIO [] 99 OTHER TANK [] .1 BARE STEEL [] 2 STAINLESS STEEL [] 3 FIBERGLASS MATERIAL [] 5 CONCRETE [] 6 POLYVINYL CHLORIDE [] 7 ALUMINUM (PrimaryTank) [] 9 BRONZE [] 10 GALVANIZED STEEL [] 95 UNKNOWN [] i RUBBER L,NED [] 2 AL~D LINING [] 3 ~o~ L,.ING C. INTERIOR [] 5 GLASS LINING [] B UNLINED [] 95 UNKNOWN UNING IS LININg'MATERIAL COMPATIBLE WITH 100% METHANOL ? YES_ NO__ D. CORROSION PROTECTION ] 4 STEEL CLAD WI FIBERGLASS REINFORCED PLASTIC ] 8 100% METHANOL COMPATISLEW/FRP ] 99 OTHER ] 4 PHENOLIC LINING ] 99 OTHER [] I POLYETHYLENE WRAP [] 2 COATING /' :.~[~'] 3 VINYL WRAP [] 4 FIBERGLASS REINFORCED PLASTIC [] 5~,..CATHODIC PROTECTION [] 91 NONE ~:..~..~ . ¥~[] 95 UNKNOWN [] 99 OTHER IV. PIPING INFORMATION C~RCLE. A, SYSTEM TYPE A ~,1~ .1 SUCTION ....... A U 2 PRESSURE .... .~ U 3 GRAVITY ,~ U 99 OTHER B. CONSTRUCTION .~ U' I SINGLE WALL A U 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER * C. MATERIAL AND CORROSION PROTECq'ION A U 1' BARESTEEL .;A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE A U 5 ALUMINUM A, U 6-CONCRETE .. ~:'A U? 7 STEEL WI COATING A U 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A; U* 10 CATHODIC PROTECTION A U 95 UNKNOWN A U 99 OTHER ,* D. LEAK DETECTION [] 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 II~'ERs'm'!AI: MONITORING [] 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUND WATER MONITORING [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER I, TANK DESCRIPTION COMPLETE ALL ITEMS - SPECIFY IF UNKNOWN A, OWNER'S TANK I. D, # B. MANUFACTURED BY: C. DATE iNSTALLED (MO/DAY/YEAR) D. TANK CAPACITY IN GALLONS: III. TANK CONSTRUCTION MARK ONE ITEM ONLY IN BOXES A, B, ANDC, ANDALLTHATAPPLIESINBOXD A. TYPEOF [] 1 DOUBLE WALL SYSTEM [] 2 SINGLE WALL [] 3 SINGLE WALL WITH EXTERIOR LINER [] 95 UNKNOWN [] 4 SECONDARY CONTAINMENT (VAULTED TANK) [] 99 OTHER El. TANK [] 1 BARE STEEL [] MATERIAL [] 5 CONCRETE ' [] (PrimaryTank) [] 9 BRONZE [] 2 STAINLESS STEEL [] 3 FIBERGLASS 6 POLYVINYL CHLORIDE [] 7 ALUMINUM 10 GALVANIZED STEEL [] 95 UNKNOWN ] 4 STEEL CLAD 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 [] 5 GLASS LINING [] 6 UNLINED [] 95 UNKNOWN [] 99 OTHER LINING IS LINING MATERIAL COMPATIBLE WITH 100% METHANOL ? YES__ NO__ D. CORROSION [] I POLYETHYLENE WRAP [] 2 COATING PROTECTION [] 5 CATHODIC PROTECTION [] 91 NONE ] 3 VINYL WRAP [] 95 UNKNOWN ] 4 FIBERGLASS REINFORCED PLASTIC [] 99 OTHER IV. PIPING INFORMATION C~RCL~ A IFABOVEGROUNDOR U IF UNDERGROUND, BOTH IF APPLICABLE A. SYSTEM TYPE A IJ I SUCTION A U 2 PRESSURE A U 3 GRAVITY A U 99 OTHER B, CONSTRUCTION A U 1 SINGLE WALL A IJ 2 DOUBLE WALL A U 3 LINED TRENCH A U 95 UNKNOWN A U 99 OTHER C. MATERIAL AND CORROSION PROTECTION A U I BARE STEEL A U 2 STAINLESS STEEL A U 3 POLYVINYL CHLORIDE(PVC)A U 4 FIBERGLASS PIPE A U 5 ALUMINUM A U 6 CONCRETE ~. U 7 STEEL W/ COATING A tJ 8 100% METHANOL COMPATIBLEW/FRP A U 9 GALVANIZED STEEL A U 10 CATHODIC PROTECTION ,~ U 95 UNKNOWN A U 99 OTHER D. LEAK DETECTION ~ 1 AUTOMATIC LINE LEAK DETECTOR [] 2 LINE TIGHTNESS TESTING [] 3 INTERSTITIALMONiTORiNG ~'~ 99 OTHER V. TANK LEAK DETECTION [] 1 VISUAL CHECK [] 2 INVENTORY RECONCILIATION [] 3 VAPOR MONITORING [] 4 AUTOMATIC TANK GAUGING [] 5 GROUNDWATER MONITORING [] 6 TANK TESTING [] 7 INTERSTITIAL MONITORING [] 91 NONE [] 95 UNKNOWN [] 99 OTHER :':R E$OU RC:E:: ~q"t~[4. AG EM EN t HEALTH SERVICES DEpA'RT~-'' SUITE 300, BAKERSFIELD, UNDERGROUND ~.,.93301 (805)861-3636 HAZARDOUS SUBSTANCE STORAGE FACILITY * INSPECTION REPORT * PERMI 'TIME IN .., ................... TIME OUT TYPE OF INSPECTION: NUMBER OF TANKS: 3 YES NO ..................... ~SPECTION DATE: ~l~l~'7 ...................... FACILITY ADDRESS:9628 ROSEDALE HIGHWAY SAKE S ,IE , CA OPERAToRsONNERS NAME:MEYER,. --~,-~----~--~GREGORY &.DIANA NAM:=£~£.E~ .......... S~ ..................................... . ..................................................................................................... COMMENTS: ............................................................ .~,,, .............................................................................................. : .................................................................................... ITEM PRI"ARY CONTA[NMENT MONITORING: a. Intercepting an directing system (~ Standard Inventory'Control c. Modified Inventory Control d. tn-tank Level Sensing Device e. Groundwater Monitoring f. Vadose Zone Monitoring ¸I. 2. 'SECONDARY CONTAINMENT MONITORING: a. Liner- ~ b. Double-Walled tank c. Vault PIPING MONITORING: .Pressurized Suction c. Gravity OVERFILL PROTECTION: 5. TIGHTNESS TESING 6. NEW CONSTRUCTION/MODIFiCATIONS 7. CLOSURE/ABANDONMENT 8. UNAUTHORIZED RELEASE ' VIOLATIONS/OBSERVATI ONS AGENC v,- .+-o g. MAINTENANCE, GENERAL SAFETY, AND OPERATING CONDITION OF FACILITY COMMENTS/RECOMMENDATIONS AIR POLLUTION CCi 2700 "M" Street, Suite 275 Company Mailing Address .Date ~/-7/~ / 3: 4. 5. 6. 7. 8. 9, 12. Bakersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR RECOVERY INSPECTION FORM .Location (~ b ')'~ Ch c~O~. ~,jL,/ / City PRODUCT (UL, PUL, P, or' R) TANK LOCATION REFERENCE· . BROKEN OR MISSING VAPOR CAP BROKEN OR MISSING FILL CAP BROKEN CAM LOCK ON VAPOR CAP FILL CAPS NOT PROPERLY SEATED VAPOR CAPS NOT PROPERLY SEATED GASKET MISSING FROM FILL CAP GASKET MISSING FROM V~POR CAP FIL~-~,~iSTOR NOT TIGHT ;. VAPOR ADAPTOR NOT TIGHT GASKET BETVVEEN ADAPTOR & FILL TUBE MISSING / IMPROPERLY SEATED DRY BREAK GASKETS DETERIORATED EXCESSIVE VERTICAL PLAY IN COAXIAL FILL TUBE ". COAXIAL FILL TUBE SPRING MECHANISM DEFECTIVE 20. COMMENTSi 17. TUBE LENGTH MEASUREMENT TANK DEPTH MEASUREMENT' 18. DIFFERENCE (SHOULD BE 6" OR LESS) ~' 19. OTHER " WARNING: SYSTEMS MARKED WITH A CHECK ABOVE ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 209, 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OFUP TO $1,000.00 PER DAY FOR EACH VIOLATION. TELEPHONE (805) 861r3682 CONCERNING FINAL RESOLU- ' ' ;~';'";~,PCD FILE ::?~' ,' ;' ; ~:~::'"".~:!?' '~' :~ ':?:~ .': ".:.' .' i ~" ':: TM :' ~?:'"'~":":" System_-Type: Sep. Riser/ Notice Rec~'d By' · TANK #1 TANK #2 . TANK #3 TANK#4 AIR POLrUTION CONTR ._ TRICT 2700 "M" Street, Suite 275 '-" Bakersfield, CA. 93301 Station Location Contact ~ ~ ~ Phone ~ -- 7~ ~ Inspector ~~ F~J Date ~/7/ ~/ .. (805) 861-3682 . PHASE II VAPOR RECOVERY INSPECTION FORM P/O &~"~(~ Zip City System Type: Notice Rec'd By . B./: RJHI//3_HE ~ NOZZLE-# GAS GRADE · .- / NOZZLE TYPE · ?- I1- l-V v HA COMMENTS: Key to inspection results: Blank= OK, 7= Repair within seven days, T= Tagged (nozzle tagged out-of-order until repaired) U= Taggabie violation but left in use. VIOLATIONS: SYSTEMS MARKED WITH A "T OR U" CODE IN INSPECTION RESULTS, ARE IN VIOLATION OF KERN COUNTY'-- AIR POLLUTION CONTROL DISTRICT RULE{S) 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,0OO.00 PER DAY FOR EACH DAY OF VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLUTION OF THE VIOLATION. NOTE: CALIFORNIA HE/~LTH & SAFETY CODE SEG::FI~ON 41960.2, REQUIRES THAT THE ABOVE LISTED 7-DAY DEFICIENCIES BE.CORRECTED WITHIN 7 DAYS. FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION 9149- lo'15 APCD FILE ............ INSPECTION RESULTS .' 1. ~ERT. NOZZLE : 2. CHECK VALVE N O 3. FACE SEAL Z Z 4. RING, RIVET E 5. BELLOWS 6. SWIVEL(S) 7. FLOW LIMITER (EW)' 1. HOSE CONDITION . ... ' ' V ~ A 2. LENGTH . P O 3. CONFIGURATION : R 4. sWIVEL H ~' O 5. OVERHEAD RETRACTOR .' S E 6. POWER/PILOT ON 7. SIGNS POSTED Key to system typeS: Key to deficiencies: NC= not certified, B= broken BA=Balance HE =Healey M= missing, TO= torn, F: flat, TN= tangled RJ =Red Jacket GH=Gulf Hasselmann AD=needs adjustment, L= long, LO= loose, HI =Hirt HA =Hasstech S= short MA= misaligned, K= kinked, FR= frayed. RANDALL L. ABBO~I' Agency Director (805) ,861-3502 STEVE Mc CALLEY Director RE SOURCE MANAGE:M.E NT : ~'~' .¥i-: .', - ~- ~., . DEPARTMENT OF ENVIRONMENTAL HEA[TH SERVICES 2700 M streetJ s~ite 300 Bak~rsfleld, CA 93301 Telephone (805) 861-3636 Telecopier (805) 861-3429 AGENCY October 16, 1990 'Mrs. Diana Meyer Delimart 9628 Rosedale Highway Bakersfield, CA 93308 Dear Mrs. Meyer: Thank you for the recently submitted underground storage tank inventory control records. These records do not indicate any problems existing at this facility at this time. The majority of these documents are being returned to you, since all inventory records must be maintained on site for a minimum of three years. In the future, it will not be necessary to submit all these records. At this time, we require only the Tank Facility Annual Report (including a summary of maintenance and repairs) and any paperwork associated with reportable volume gains or losses as required in UT-10, the inventory control handbook. Thank you again for your complete and accurate recordkeeping. Please call me at 861-3636, Extension 564, if you have any questions or need a copy of UT-10. Since~ y, /. / y /' , // Chris F~nberg Hazardous Materials Specialist Hazardous Materials Management Program CF:jrw' Enclosures (hazmat\finberg\delimar t.ltr) Environmental Sensitivity ......... ction Time UNDERGROUND HAZARDOUS SUBSIANCE STO~AGE FACILITY *._[~SPECTION REPORT * · ~ ~ .~. .~,.: , _ ~. ~. .,..;,~ :, ~ , ..~ Facility Nam6- No. of Tanks '. Type of Inspection: \Comments: ITEM Primary Containment Monitoring: . a. Intercepting and Directing System Standard Inventory Control Monitoring c. Modified Inventory Control Monitoring d. In-Tank Level Sensing Device e. Groundwater Monitoring f. Vadose Zone Monitoring 2. Secondary Containment Mon.itoring: a. Liner b. Double-Walled Tank c. Vault ~3./Piping Monitoring: a. Pressurized Suction c. Gravity Overfill Protection 6. New Construction/Modification 7. CIo~ure/Abandonment 8. Unauthorized Reiea~ 9. Maintenance, General Safety, and Operating Condition of Facility ' Reinspection sc"heduled? ~" Yes No .~.' ..Q? ~ ,,' INSPECTOR: ./"~,'/~ .(j / ;.,~ : Healtalk'580 4113 170 (7-87) Approximate Reinspection Date O/L~ , ;~, , ,.."/ ,"~' 0 Y Bakersfield, CA. 93301 . (805) 861-3682 PHASE II VAPOR RECOVERY INSPECTION FORM Contact _~_¢/~/.~_z~__..,~_~..P_..~Z_,_../.~/_.~.... Phone .~_~....Z,~.~..~. ............... System Type: BA .HI , ,.~E.c' GH (~ NOZZLE ~t GAS GRADE NOZZLE TYPE 1. CERT. NOZZLE & RACK 2. CHECK VALVE ~:N 0 3. FACE SEAL .4. RING, RIVET, SPRING L E 5 BELLOWS SWIVEL(S) FLOW LIMITER (EW) HOSE CONDITION LENGTH CONFIGURATION H 4 SNIVEL 0 S 5. OVERHEAD RETRACTOR E 6. PONER\,PtLOT ON (HI) Key to system types: I Key to defffcffencies: ~C= not certfff!ed, B= broken SA=Balance HE=Healey IN= mffssing, TO= torn, F= tier, TN= tangqed RJ=Red Jacket .GH=Gu]f Hesse]mann I AD= needs adjustment, L= ]ong, LO= loose, ~HI=Hirt HA=Hasstech [] S= short, MA= misa]figned, K= kinked, 'FR= frayed'. 1t b tl'il' '1t1'I'', I'~SpEcTION RESULTS * m~ ~ ~< ~ ~ ¢~ I - Key to inspec%ion eesu]ts Ok = Ok, ?= Repain within seven days, T = Tagged (nozm]e tagged out un~ff] mepaffrs completed.) NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, RE~IR~S'THAT THE ABOVE LISTED 7-DAY DEFICIENCIES BE CORRECTED WITHIN ? DAYS. FAILURE TO COMPLY NAY RESULT IN LEGAL ACTION ........ KE '¢Y 'AI'F~ ' POLLUTICN' 2700 "M" St:feet:; Suite 225 "':~ "~ Bakersfield, CA. 93301 (805) 861-3682 PHASE I VAPOR RECOVERY INSPECTION FORM T~ ~1 TANK ~2 TANK ~3 TANK ~. PRODUCT (UL, ~L, P, or R) . ~Z ~ 2. T~K L~AT~ON REFERENCE ~ ~ /~ 3. BROKEN OR MISSING VAPOR CAP 4. BROKEN OR MISSING FILL CAP 5. BROKEN CAM LOCK ON VAPOR CAP FILL CAPS NOT PROPERLY SEATED ?. VAPOR CAPS NOT PROPERLY SEATED 9. GASKET MISSING FROM FILL CAP 9. GASKET MISSING FROM VAPOR CAP 10. FILL ADAPTOR NOT TIGHT 11. VAPOR ADAPTOR NOT TIGHT !2. GASKET BETWEEN ADAPTOR & FILL TUBE MISSING / IMPROPERLY SEATED 13. DRY BREAK GASKETS DETERIORATED !4. EXCESSIVE VERTICAL PLAY IN COAXIAL FILL ,'TUBE 15. COAXIAL-Y FILL TUBE "BUMP" TURNED IN THE WRONG DIRECTION 16. COAXIAL FILL TUBE SPRING MECHANISM DEFECTIVE !?. TANK DEPTH MEASUREMENT 18. TUBE LENGTH MEASUREMENT 19. DIFFERENCE (SHOULD BE 6" OR L_ESS) 20. OTHER 21 . COh~ENTS: · :~*:*:* NOTE: A CHECK ABOVE INDICATES A VIOLATION OF KCAPCD RULE 209. RECEPT OF GASOLINE ~ PRIOR TO CORRECTION MAY FURTHER CONSTITUTE A ¥IOLATION OF KCA~D RULES 209 & 412. ~ TAN~K FAC I L I TY ,~NUAL REPORT "-~-~[]~'~;~' ~b~ have not done any major modific~tion~ to this facility during the the ~ermitting Authority. 2. I have done major modifications for ~hich. I obtained Permit(s) to Construct f=om Permitting Authority ~ Signature Permit to Construct ~ Date 3. Repair and Maintenance Summary Attach a s~mary of all: --Routine and required maintenance done to this facility's tank, plping, and monitoring equipment. --Repair of submerged pump~ or suction pumps. --Replacement of flo~-restricting leak detectors ~ith same. --Repair/replacement of dispensers, meters, or nozzles. --Repair o:f electronic leak detection components, or replacement with same. -- Installation of ball float valves. --Installation or repair of vapor recovery/vent lines. ' Include the~date of each repair or maintenance activity. NOTE: All repairs or replacements in .response to a leak require a Permit to Construct from the Permitting Authority as do all o~her~ modifications, to tanks, piping or monitoring equipment not listed .here. 4. Fuel Changes - Allowed for Motor Vehicle Fuel tanks 0nly. List all fuel storage changes in tanks, noting: Date(s), tank number(s), new fuel(s) stored. 5. .In~entorg control aonitorin~ is requSred for this facilit~ on the ~er~tt ~o O~erate, and I have not exceeded ang reportable l~aits as l~sted in 'the appropriate ~n~ent.or~ control aonStoring handbook during the last t~elve ~onth~ {if not applicable, d~sregard). ~ Signature · ~. Trend ~algSis Su~ar~ Please attach ~nnual Trend ~nal~sis Su~ar~ for the lasZ 12 perlods. g. ~eter Calibration Check Please attach current, completed ~eter Calibration Check 8or~ , · ... ~ ~ ' ~ .~ ~ . 1~ 1~ I~ ~ ~' ~,'~ 1~ · ' ~2 ~ ..... · '~,~ '[?~.~?}t"-~E(~ION, CHECK ~ APPROPRIATE BOXES 2. ~ Mate[ iai  Car~n Steel- ~5tainless Ste=l ~l~iny10Roride ~Fi~rqlass~l~ Steel Fik~rglass-Reinforc~ Plastic ~Concrete ~minm ~Bronze ~Other (descri~) 3. Pr imr~ Coatai~nt . ~te' Installed ~ic~ess (Inches) Ca,city (Gallons)' ~nufactdrer 4. Tank Secondar~ Contal~ent ~le-Wa%l ~thetic Liner ~ ~Lin~ Vault ~ne ~o~ ~Other (descri~): Manufacturer: ~terial ~ Thic~ess (Inches) Ca,city (Gals.) 5. Tank Interior Lini~ ~~r ~kyd ~xy ~enolic ~Glass ~Clay '~lin~ ~o~ ~Other (descri~): 6. Tank Corrosion Protection  Gal'Vaniz~ ~ass-Cl~ ~l~thyle~ Wrap ~Vinyl ~a~i~ Tar or ~p~lt ~k~ ~No~ ~Other (de~ri~): Cath~ic Protection: ~ne ~pres~ ~rrent Syst~ ~ciificlal ~e ~ri~ System & Equi~ent: 7. Leak Detection, ~nitori~, and Interception . a. Tank: ~Visml (vault~ tanks only) ~Grou~ter ~nitori~ ~ll(s) ~Vadose Zone ~nitori~ ~ll(s) ~U-T~ Wi~ut ~ner ~U-~ wi~ C~tible Liner Dir~ti~ Flow to Monitori~ ~ Va~r ~t~tor* ~Li~id ~vel ~n~r* ~ Cond~tivit~ ~ Pressure Sen~r in ~ular S~ce of ~uble Wall Tank- ~ Liquid ~ri~al & Ins~ction Frm U-T~, Monitori~ ~11 or ~ar ~ily Ga~i~ & I~entory Reconciliation ~ri~ic Tigh~e~ Testi~ ~None ~o~ ~her b. Pipit: Fl~-Restricti~ ~ak ~tector(s) for Pressuriz~ ~nitori~ S~p with ~ce~y ~al~ C~crete ~ce~y ~lf-Cut C~tible Pi~ ~ce~y ~ S~t~tic Liner ~y [] Unknown [] Other *Describe Make & Model: Tank Tightness i l~-~is Tank' Been Tightness Tested? Date of Last Tightness Test Test Name Tank ~ ~ Tank Repaired? {-]Yes ~{~No [-]Unknown Date(s) of Repair(s) Describe Repairs [] Ye s ~ No [] Unknown Results of Test Testing Company 10. Overfill Protection Ta rato~ Fills, Controls, & Visually Monitors k~vel pe Float Gauge [-]Float Vent Valves [] Auto Shut- Off Controls []Capacitance Sensor []Sealed Fill Box []None []Unknown []Other: List Make & Model For Above Devices 11. Piping a. Underground Piping: ]~Yes [-]No [2]Unknown~ Material ~ Thickness (inches)~Diameter _2J-~ Manufacturer ~ [,]PressureI []Suction ~]Gravity Approx'imate L~ngth of Pipe ~ Underground Piping Corrosion Protection.: []Galvanized []Fiberglass-Clad []Impcessed Current [~]Sacrificial Anode [~]Polyethylene Wrap .~]Electrical Isolation [~Vinyl Wrap []Tar or Asphalt Underground piping, Secondary Contsirm~ent: []Double-Wall []Synthetic Liner b~stem ~None [-]Unknown [3Other (dlesc£ibe):__ PHASE I -- INTERIM PERMIT MONITORING REQUIREMENTS MOTOR VEHICLE FUEL TANKS (MVF 1, MVF 2, MVF 3) PERMIT #380012C FACILITY NAME: DELIMART FACILITY ADDRESS: 9628 ROSEDALE HIGHWAY OWNER: MEYER, GREGORY & DIANA OPERATOR: YOUNG, RICHARD THE FOLLOWING ONGOING MONITORING AND~REPORTING REQUIREMENTS APPLY TO THE NOTED TANK(S) AT THE FACILITY DESCRIBED ABOVE. THE FIRST THREE ITEMS MUST BE IMPT,FMENTED WITHIN 30 DAYS. TANK(S) PEP~4iT REQUIREMENTS: 1) Submit completed permit check-list to Permitting Authority. 2) Post Interim Permit ina conspicuous place at the' facility. 3) Perform Standard Inventory Control Monitoring as described in Kern County Health Department Handbook #UT-10. 5) 6) Maintain all monitoring records at the facility for a minimum of ~ years. This facility shall not be modified, closed, or abandoned without first obtaining an amended permit from the Permitting Authority (P.A.). All unauthorized releases or reportable variations shall be reported in accordance with requirements described on page 16 of Handbook #UT-10. 7) Complete an Annual Report on the form provided by the P.A. 8) The term of the Interim Permit is as noted. Permit zees will be paid on'an annual basis. 9)· The Interim Permit to Operate is not transferable. Any change in owner or operator must be"reported to the P.A. within 30 days.. 10) These Permit requirements are to be in effect until super-. seded or augmented by Phase II monitoring requirements. BAKER dELD SER ,E STATION REI ,41R 1230 SO. UNION AVE.. BAKERSFIELD, CALIFORNIA 93307 24 HOUR SERVICE (805) 327-4659 rd'~il'//(',~,~/~'- h Location,~,'"~,~~/j,~. ~). Station Number 'Oa~e~ ~ake and M~el Serial Number Tagged Tag ~ Pum~- -~ ~ Red q Green ~ Blue ( ~ ~ Calibration:Fast Slow/ Finish (money) ~ Finish (gallons) ~ Totallzer ~ ' Checked Readings Sta~ (money) Sta~ (gallons) Adjusted ~Fast . Slow~/ Product ~ Return to Storag;~ll¢) Totalizer Sealed Meter - · C Yes :~No ~ Yes -- No Ma nd Model Serial Number Pump , : Rea ~ Grin ~ ~ue Finish~ Finish (gallons)~ Calibration, F.tx , / Slow 'Totallzer ' Checked ~ ~ Readings Sta~ (money) ~ St~ ..... Fast ~ / Slow A~lus~e~ Proauct ~ ~ ~eturn to stmge (ga,ons) Tota~ize~ Sea~e~ ~ ~ Meter Sea~e~ Finish (money)/ Calibrati Slow ChecXeq ~ Sta~ ~ey) Sta~ (gallons) ~ Adjust~ F.t ~ Slow R~ngs- -- ~' To / Product Return to Storage (gallons) ~ Total~er Sealed ~ Meter Sealed ~ Yes ~ No ~ ~ Yes ~ No QUANTITY AMOUNT OATE COMPLETED PRICE TOTAL LABOR TOTAL MATERIAL MILEAGE TAX LABOR WORK ORDERED BY PAYMENT DUE r l HEREBY ACK/~WLEDGE THEj~I~CTORY COMPLETION OF THE ABOVE WORK Thank You BAKE.SFIELD SE ~ICE STATIO AIR 1230 SO. UNION AVE., BAKERSFIELD, CALIFORNIA 93307 24 HOUR SERVICE ,~ (805) 327-4659 To Location Station Number Date Make and o e Serial Number Tagged ~ Tag ~ Pump ~ Red (_ Green ~ Blue Finish (money) Finish (gallons) Calibration: Fast' Slow Totalizer , Checked Readings Sta~ (money) Sta~ (gallons) :' Adjusted Fast Slow Return to Stor~ (gallons) Totalizer Sealed ' Meter Sealed Pr~uct '; ~ -- Yes =-~ No -- Yes ~ No Make and Model ~~ Serial ~u~'ber/ ~~ Tagged Tag~ Pump ' . // ~ Red ' Green ~ Blue Finish (money) Fin~ gallon~ Calibration: Fast Slow Total~er ~ ;~ ~ Checked Readings Sta~ (money) s) Adjusted Fast Slow · To Product ~turn to Storage (gallons) Totalizer Sealed Meter Sealed ~ Yes ~ No ~ Yes ~ No Make and Model / Serial Number Tagged Tag ~ Pump / ~ Red ~ Green ~ Blue Finish.(mo~y) // k Finish (gallons) Calibration: Fast ~ow Totallzer ./ Checked Fast Slow Readlng~ StaA (money) / StaA (gallons) Adjusted To ~roduct ~otum to Stora~o (~allons) lotalizor Soalod Motor ~ Yes ~ No U Yes ~ No REPORTED PROBLEM: DESCRIPTION OF WORK: QUANTITY PARTS NEEDED PRICE AMOUNT I' LABOR WORK ORDERED BY HRS. / RATE AMOUNT. TOTAL LABOA DATE CC MPLETED TOTAL MATERIAL MILEAGE TAX PAYMENT DUE II HEREBY ACKNOWLEDG~ ThlE SATISFACTQI:~Y CO~IPLETION OF THE ABOVE WORK Thank You BAKEk~FIELD SL /ICE STATION R~.,.'AIR 24 HOUR SERVICE (805) 327-4659 To Pump Totalizer Readings Make and Model Finish (money) Start (money) Product I Make and Model Pump t Finish (money) Totallzer Readings Start (money) Product Location ~~&/ , Station Number Date Seriat Number Finish (gallons) Start (gallons) Return to Storage (gallons) Tagged ! Tag .~ Red Green ~- Blue I Calibration: Fast Checked Fast Adjusted To Slow Pump Make and Model i Finish (mone,,~/ Totalizer Start ! ~r~i~ e/y) Readings ~ . Serial Number Product allons) Totalizer Sealed Meter Sealed - No I ' Yes "No ~-~ Red _-} Green - BlueTn_a= Calibration: { Fast Slow Checked Fast Adjusted Slow To i Totalizer Sealed Meter Sealed ~ Yes ~ No - Yes Tagged Tag # ~ Red - Green ~ Blue Finish (gallons) Calibration: Checked Start (gallons) Adjusted To -¸ No Fast Fast Slow Slow REPOI~.~ROBLEM: Return to Storage (gallons) Sealed Meter Sealed - Yes ~_ No -' Yes -- No DESCRIPTI~.J~F WORK: ¢ ./ / QUANTITY PARTS~EEDED PRICE AMOUNT ' LABQR.-''''''~ f HRS. IRATE AMOUNT ..' TOTAL LABOR< TOTAL MATERIAL MILEAGE TAX ~/ORK ORDERED BY DATE COMPLETED PAYMENT DUE I HEREBY ACKNOWLEOGE THE SATISFACTORY COMPLETION OF THE ABOVE WORK SIGNATURE '~ ,' ~ ~,. \~ ,i ~. '.,.: Thank You ----" '-- -~ I;I..~,n! INC. 'BAKERSFIELD SERVICE STATION REPAIR ' 1230 SOUTHUNION AVE., BAKERSFIELD, CALIFORNIA 93307 (805) 327-4659 J WORK ORDERED BY . . · . Finish ('mdr~ey) ' Totalizerl' '~-/', . Readingl Start ~j °ney) Product ri Finish (money) Totalize : '" '" Reading1 St---~'~-(~ Product / .! I Fin.ish (money)' Totalizer~_ _ . ReadinglStart (money) '-"-""~ Product ./Finish (mo.[~eY) Totalizer[ _ _ Reading1 Start ,(money). Product REPORTED PROBLEM: I LOC.AT'ION ,d' '~ . < ~ ~.,~ . .1 .~-,.., .. ~< P.O. # . ' :inish (gallons) '12','o~ Start (gallons) ~ -- Return to Storage(gallons) Finish (gallons) Start (gallons) ; Return to Storage (gallons) Finish (gallons) Start (gallons) Return to Storage (gallons) Finish (gallonsl Start (gallons) STORE # DATE ORDERED TECHNICIAN DATE COI01P, K..ETED I' Checked Adjusted I~ast To :..4:~ ~' :'-',. Totalizer Sealed [] Yes r~ No Slow Slow .'---'"-~-.- Meter Sealed m ;Yes [] No Calibration: checked Adjusted To Fast Fast Totalizer Sealed E3 .Yes [] No Calibration: Fast Checked Fast. Adjusted To Totalizer Sealed [] Yes []No Calibration: Fast Checked Adjusted Fast To Meter Sealed [] Yes [] No .Sl0w Slow ' -M~ter Sealed '"'~ Yes r- No Return to Storage(gallons) Totalizer Sealed Yes ~ No Slow Slow [] No I Meter Sealed [] Yes DESCRIPTION OF WC RK: ~/, LABOR HRS RATE AMOUNT QUANTITY PARTS NEEDED PRICE AMOUNT ~ ' / I~ ~7'E~ 7 ~A/ , TOTAL MATERIAL TOTAL MILEAGE TOTAL TAX TOTAL HEREBY ACKNOWL .F_D~GE THE SATISFACTORY)COMPLETION OF THE ABOVE WORK. ,:. - . Thank You TO: ',..~ .. IWORK ORDERED BY . otalizerl Finish '(money) Roadingl Start ,mono~) Product ~'~ .. I Finish (money) · TotalizerI Reading1 Start (money) Product J Finish (money) ri T0talize Reading1 Start (money) Product Totalizert Finish (money) Readingl ~'~ BSSR, INC. BAKERSFIELD SERVICE STATION REPAIR 1230 SOUTH UNION AVE., BAKERSFIELD, CALIFORNIA 93307 . (805) 327-4659 J LOCATION Finish (gallons) .3":-o Start (gallons) .' Return to Storage (gallons) Finish (gallons) Start (gallons) Return to Storage (gallons) STORE~.. #. _~/~/,~dDATE ORDERED TE?HNICIA~N DATE COMPLETED 'C~libration: J Fast Checked ' ~ Adjusted Fast~ ~ To Totatizer Sealed ~-Yes' ~ No Finish (gallons) Start (g~Jlons)..~ Return' to Storage (gallons)''''~-. Finish (gallons) Calibration: !Fast Checked i Adjusted Fast ilo Totalizer Sealed Slow ~0w ....... [] Yes [] No Calibration:Checked Fast AdjustedTo Fast Totalizer Sealed ~.. [] Yes [] No Calibration: Fast Checked Fast Adjusted To Meter Sealed · · ~:¥es Slow sI0W Meter Sealed [] Yes · [] No Slow Slow [] No Meter Sealed [] Yes Slow Slow Meter Seal'ed [] Yes [] No Start (gallons) Product Return to Storage (gallons) Totalizer Sealed [] Yes [] No [] No REPORTED PROBLEM: DESCRIPTION OF WORK: ,d',/'_,?'"-" +? ¢'. LABOR HRS RATE AMOUNT QUANTITY PARTS NEEDED PRICE AMOUNT ~ I / z -'/~ .m~.~. ~ For(' TOTAL LABOR ~ /' J~/d~?..,C0 /'-/:"0.~( ~'~-{t~(~, '~ TOTAL MATERIAL ' / TOTAL MILEAGE TOTAL TAX TOTAL HEREBY ACKNOWLED~GE THE SATISFACTORY COMPLETION OF THE ABOVE WORK. SIGNATURE~f '~,/' :' [A~.. :' i .' (?¥, Thank You / ~ .t [.',/,'.,'~, ('~ '/ IWORK ORDERED BY " IFinish (money) ' TotallZ, rl "',~U ~ 9~-,~ . ..~d uct BSSR, BAKERSFIELD SERVICE STATION REPAIR 1230 SOUTH UNION AVE., BAKERSFIELD,.CALIFORNIA 93307 · - ~(80,5) 327-4659 . :' . Finish(~llons) , . . Start (gallons). - .' ' Return~to Storage (gallons) STORE #,' - DATE ORDERED ' "1 "'-' J ~12,f~o ~ ~ ~. "X~'~ I TECHniCIAN t DATE COMPLETED ~ · ., , .' galibration: Fast /, -; J S~: ' ' "' Adjusted I Fast - ' J Slow ' :. : , . Totalizer Sealed · .. - J;;~Yes ,... [] No Meter Sealed ,-~riYes . [] No · ..:;: J Fin!s,h' .(money) . : · :,..:,.'L-t..L Finish (gallons) . Totallzert ~. , : .... -' '.: ..... ' '" :' '"i'i ':' :'-:'.i'1.'1,. Reading1Start (money) - ': . · Start (gallons) Product Return to Storage (gallons) . Finish (money) Totalizerl' · : Readings~ Start (money) / Calibration: Fast ; c~h=ec~ed.' =': .:.. - Adjusted '. Fast Totalizer Sealed ':.: r~Yes ,..:ri NO Calibration:Fast· Checked '~ Adjusted Fast To J : .' : Slow :' · Slow Meter Sealed-' - 'E3 Yes'. [] No J SIow Product . ...JFinish (money) · Totalizer[ ' ' · Reading1 Start (money) Product .. REPORTED PROBLEM: Finish (gallons)/'/ · '.. Return to Storage~cJatlens). Finish (gallons) Staff (gallons) Return to Storage (gallons) Totalizer Sealed ' [] Yes ,[] No CalibratiOn:checked I Fast Adjusted Fast To Totalizer Sealed ri Yes ri No Slow . . · .! . ,Meter Sealed [] Yes [] No ISIow Slow . Meter Sealed :....:. · . ri Yes [] No " DESCRIPTION OF WORK: LABOR HRS RATE AMOUNT QUANTITY 'PARTS NEEDED PRICE AMOUNT .. TOTAL LABOR -. - TOTAL MATERIAL ) · TOTAL MILEAGE : ¢' '-~J')[~ t"~.- Q~t . - TOTAL TAX . TOTAL. ' -) I HEREBY ACKNOWLEDGETHE SATI~SFACTORY COMPLETION OF THE ABOVE WORK. S,GNA*URE ~ -V ~"~'::'" '"-'~ //. (x';:~..? :-::?:?',. i~, ~, ' Thank You ~ -',-,.' ~.~-' '" "/¥. .' ,4 .... WORK ORDERED BY ~/ ~J FinT~h (money) ~ .~ -~otal/i~'~rI .' , ~.. ~--~-'~' Re,dlngl Start (m°ney) ' ~..~. Product /2~!' ..~./j:- ? Finish~/(~oney) TotallzerI R®ading1 Start (money) Product: ' /'/'/Z..... ' Product BSSR, INC. BAKERSFIELD SERVICE STATION REPAIR 1230 SOUTH UNION AVE., BAKERSFIELD, CALIFORNIA 93307 (805) 327-4659 LOCATION? ~ · P.O. # I _ r-inish (gallon~) ,~. ~ Start (gallons) Return to Storage (~q~llons) Finish (gallons) /I STORE # DATE ORDERED ,,%~/ · /VTEC.N~C~AN DATE COMPLETED Calibration: Fast · ' Checked .Adjusted Fast Totalizer Sealed '. [] Yes n Ro Start (gallons) Return to Storage (gallons) Finish (gallons) Start (gallons) Return to Storage (gallons) Calibration: . Fast Checked F Adjusted ast To Totalizer Sealed [] Yes [] No' Fast ~ jJ Z.' o Slow Slow Meter Sealed [] Yes"' " 1Sl°w ", Slow Meter Sealed i/ ',.,,, Slow /' ?w [] No [] No Calibration: Checked Adjusted To / · Meter Sealed [] Ye~s Totalizer Sealed Fast Finish (money) .... Totalizerl '~/:'/ Readings~ Start (money) // Product Finish (gallons) Start [] Yes [] Nb Calibration: Fast/ · / Checked / ' · Adjusted Fa~t To Totalizer Seale~d [] Yes ! [] No ReturnI to Stora~Rns) REPORTED PROBLEM: /_~z. '~' [] No Slow ~, Meter Sealed \ [] Yes [] No~~ LABOR HRS RATE AMOUNT / PARTS NEED, ED PRICE AMOUNT , TOTAL MATERIAL TOTAL MILEAGE TOTAL TAX TOTAL HEREBY ACKNOWLEDGE THE SATISFACTORY COMPLETION OF THE ABOVE WORK. BAKEk.~I:IELD SERVf-' ' STATION~E. AIR 1230 SO. UNION AVE., BAKERSFIELD, CALIFORNIA 93307 · 24 HOUR SERVICE (805) 327-4659 To Location Station Number Date Make and M~ol Serial Number ~ Tag~ ; Tag ~ Pump _ ~ R~ Green ~ Blue Finish (money) Finish (gallons) Calib~tion: ~ Fast j To~l~r Check~ Re~lng. Sta~ (money) ' Sta~ (gallons) Adjust~ Fast I To Pr~u~ Return to Storage (gallons) Totalizer ~aled ~ Meter ~ Yes ~ No ~ ~ Y~ ~ No .~ump Make and M~el S~ her /.~ Tag~ Tag ~ ~ R~ ~ Grin ~ Blue Finish (money) Finish (ga~// ~ Calibration: I Fast To~l~er / ~ Ch~k~ Re~lngs Sta~ (money) Sta Adjust~ Fast S~ To P~ua i ~rn to St~a~ ~ns) Totalizer_ ~al~I[Meter ~_ Yes ~ No ~ Yes ~ No Make and M~el Serial Numar ~ Ta~ J Tag ~ Pump ~... ~ R~ ~ Grin ~ Blue Finish (money) Finish (gallons) Calibration: Fast ~ To~l~er Check~ Re~l~a StaA (money) Sta~ (gallons) Adjust~ Fast To Pr~u~ Return to Storage (gallons) Totalizer Seal~ Meter ~ - Yes ~ No ~ Yes ~ No REPORTED PROBLEM: DESCRIPTION OF WORK: QUANTITY PARTS NEEDED PRICE AMOUNT WORK ORDERED BY ~ i DATE COMP'LEI'ED , .EREBY ACKNOW E E T"E SAT,SFAC ORY WO. . TOTAL LABOR TOTAL MATERtAL MILEAGE TAX PAYMENT DUE Thank You To Totallzer Readings Product Pump./ Totallzer Readings Product Pump Make and Mod~ Start (money) ?(ake and Model BAKEk=FIELD SERVe/' STATION AIR 1230 SO. UNION AVE., BAKERSFIELD, CALIFORNIA 93307 24 HOUR SERVICE (805) 327-4659 · Serial Number Finish (gallons)  ...-~ Start (gallons~;~.. Return to Storable (gallons) .~.~ Senal Number Finish (money) Start (money) Finish (gallons) · Start (gallons) J/J-'---" I Return to Storage (gallons) Totallzer Readings Station Number Date . Tagged i Tag # 7- Red Green - Blue Calibration: Fast Slow Checked ' / . . Fast · Slow / Aoiustea /,~ I/ To ~ \ I,/ Totalizer Sealed .~ ;iMeter Sealed ._ Yes - No\ ' ] .~es - No ] Red £ Green Z E~ue ,' Calibration: I Fast ~ f., Slow Checked \ / To I /\ Totalizer Sealed / \ Meter Sealed 7: Yes ~ No//~t ~ Yes ~ No Tagged ,.' ~ag # ~ Red - Green - Blue Finish (money) Start (money) Product : ' Return to Storage (gallons) REPORTED PROBLEM: Adjusted Fast Slow To Totalizer Seated [ Meter Sealed Yes '- NoI -- Yes ~ No DESCRIPTION OF WORK: ~ ...~ f.;j ~....--.~ /~ r '~' ~ ~'"~'~ /'7/ ~ ' QdANTI~ - PARTS NEEDED / P~CE AMOUNT LABOR HRS. I RATE AMOUNT WORK ORDERED BY OATE COMPLETED II HEREBY ACK~[QiWLEDGE THE SA~'I~F~'I~Y COMPLETIO~}',I OF THE ABOVE WORK g- TOTAL LABOR' TOTAL MATERIAL MILEAGE TAX PAYMENT DUE Thank You pump Totallzer Reedlnge Make and Model Finisl~ (money) Staff'(money) ~.-~, /--~ Pump Totallzer Readings ; /2/7c Make and Model Finish (monet) Staa (money) ~'~/t' Product rMake and Model Pump To Totallzer Readings BAKERSFIELD SERV~,~" STATION t. AIR 1230 SO. UNION AVE., BAKERSFIELD, CALIFORNIA 93307 24 HOUR SERVICE (805) 327-4659 ! Location Serial ~N u~mbe r Finish (gallons) Sta~ (gallons~ l Station Number . I Date Tagged i Tag # -- Red Green :: Blue Calibration: [ Fast [ Slow ToAdjustedChecked 'i Fast ~ S~w Product Finish (money) Stat (money) Return to Storage. (gallons) Serial Number ' Finish (gallons) Star~ (gallon,.~ Return to Storage (gallons) /,. Serial N ~',nber inish (gal!?ns)- ' Return to Storage (gallons) Totalizer Sealed ~cYes - No Tagged :- Red -- Green ~ Blue Calibration: Fast Checked Fast Adjusted To Totalizer Sealed _~,e s '_ No Tagged ~. Red - Green ~ Blue Calibration:Checked Fast ToAdjusted Fast Totalizer Sealed Yes - No Meter Sealed ~.yes Tag # ._~._~Slow Meter Sealed ITag # Slow Slow IMeter Sealed - Yes ~ No ~ No ~- No REPORTED PROBLEM: DESCRIPTION OF WORK: QUANTI~ PARTS NEEDED WORK ORDERED BY LABOR IHRS. RATE AMOUNT HEREBY ACKNOWLEDGE THE SATISFACTORY COMPLETION OF TH~E'.ABOVE WORK SIGNATUR _? _.~---__~-~_~ .~__.~ ~ PRICE TOTAL LABORc TOTAL MATERIAL MILEAGE TAX PAYMENT DUE AMOUNT T]zank ~rOU BAKERSFIELD SER ' .: STATION RI: ,AIR 1230 SO. UNION AVE.. BAKERSFIELD. CALIFORNIA 93307 24 HOUR SERVICE (805) 327-4659 To Pump Totallzer Readings Make and Model Finish (money) ' Start (money) Totallzer Readings Product Make and Model Pump ---'~ Finish (money) Start (money) Product : ~ M akfL>Model Pump Totallzer Readings ', Location I Station Number Serial Number i Finish (gallons) Product Finish (money) Stall (money) Start (gallons).~,,i , Return to Storage (gallons) Serial Number Finish (gallons) Start (gallons~ Return to Storage (gallons) // Serial Humber Finish (gallons) .," Start (gal~ Return to Storage (gallons) Tagged j Tag # - Red Green - Blue ] Calibration: .i Fast I Slow Checked. ! --' - -"-'~-- Adjusted t Fast To ~ I Totalizer Sealed I Meter Sealed ~'Yes - NO I ,'~ Yes Tagged Tag # - Red - Green ~ Blue Calibration: i Fast I Slow Checked ToAdjusted: i Fast Totalizer Sealed Meter Sealed ,~Yes ~ No ~ Yes Tagged Tag # - Red -- Green ~ Blue Calibration: Fast Checked Fast Adjusted To Slow Slow Totalizer SealedYes ~ No 'Meter Sealed_~ Yes Date C No ~ No ~ No REPORTED PROBLEM: DESCRIPTION OF WORK: QUANTITY PARTS NEEDED PRICE AMOUNT WORK ORDERED BY HEREBY ACKNOWLEDGE/HE SATISFACTORY/.C~MPLETION OF THE ABOVE WORK DATE COMPLETED TOTAL LABOR¢ ' TOTAL MATERIAL MILEAGE TAX PAYMENT DUE Thank You BSSF INC. BAKERSFIELD SER¥,JE STATION REPAIR 1230 SOUTH UNION AVE., BAKERSFIELD, CALIFORNIA 93307 (805) 327-4659 IWORK ORDERED J Finish (money) Tolallzer[ __ _ __ Readings~ Start (money) Start (gallons) / Product Return to Storage (gallons) · TotalizerJ Finish (moneY) Reading1 Start (money) Product Totallzer~ (mone___~_y)_ Readingl Start (money) . LocATION STORE # P.O. # / J./'~TECI' Finish (gallons) ToAdjustedCalil~ratiOn:checked J I~ast Fast . Finish (gallons) IDATE ORDERED DATE COMPLETED Start (gallons) Return to Storage (gallons) Finish (gallons) Start (gallons) Return to Storage (gallons) Finish (gallons) Start (gallons) Return to Storage (gallons) Product Finish (money) TotalizerI Reading1 Start (money) Product REPORTED PROBLEM: DESCRIPTION OF WORK: Totalizer Sealed Yes [] No Fast Fast Calibration: Checked. Adjusted To Totalizer Sealed . [] Yes I~ NO Calibration: Fast Checked Adjusted Fast To Slow Meter Sealed . [] Yes [] No J Slow Slow Meter Sealed [] Yes [] No Slow Slow Totalizer Sealed Meter Sealed ~ Yes I- No [] Yes [] No Calibration: I Fast Slow Checked ToAdjusted Fast Slow Totalizer Sealed Meter Sealed ~ Yes ~ No [] Yes [] No LABOR HRS RATE AMOUNT QUANTIT~ PARTS NEEDED PRICE AMOUNT ~ ~ r.~(Z-~ TOTAL MATERIAL TOTAL T~ HEREBY ACKNQy~LEDGE '['HE- SATISFACTORY COMPLETION OF THE ABOVE WORK. IS'G"ATURE. Thank You BSSr INC. .......... BAKERSFIELD SER~,,vc STATION REPAIR 1230 SOUTH UNION AVE., BAKERSFIELD, CALIFORNIA 93307 (805) 327-4659 WORK ORDERED BY P.O. # Totalizerl Finish (mone Reading1 Start (money) Product I Finish (money) I TotalizerI . Reading1 Start (money) Product Finish (money) TotallzerI Reading1 Start (money) Product Totallzerl Finish (money) Reading1 Start (money) Product REPORTED PROBLEM: STORE # DATE ORDERED DATE COMPLETED Finish (gallons) Fast Slow Checked Start (gallons) Adjusted Slow To Return to Storage (gallons) Totalizer Sealed Meter Sealed [] Yes [] No [] Yes [] No Finish (gallons) Calibration:Checked Fast Slow Start (gallons) To Adjusted Fast. Slow Return to Storage (gallons) Totalizer Sealed [] Yes [] No [] Yes [] No Finish (gallons) Calibration:Checked Fast Slow Start (gallons) ToAdjusted Fast 31ow Return to Storage (gallons) Totalizer Sealed lied (gallons) Calibration: Slow~ Checked Sta~allons) To Adjusted [Fast Slow Return :torage (gallons) Totalizer Sealed I Meter Sealed [] Yes [] No [] Yes C: No DESCRIPTION OF WORK: LABOR I HRS RATE AMOUNT QUANTITY PARTS NEEDED PRICE AMOUNT ..~ /d"t-~:~,,~_ ~_//~~;/ TOTAL LABOR ' ,. ' ~/~ - ~' ~-C~z<x.-- -- TOTAL MILEAGE /~ ~-~ ~~~~ ~ ~O~,~,~r TOTAL T~ I HEREBY ACKNOV)/,LEDGE THE ~ATISFACTORY COMPLETION OF THE ABOVE WORK. IS'GNATURE Thank'You WORK ORDERED BY ..~/~ I Finish (money) TotallzerI ~ c"----~ Reading1 Start (money) 'Product ',I? RTe°at~lllinz;t Start (money[ ) Producti I FiniSh (money) TotalizerI ReadinglStart (money) BSSR, INC. BAKERSFIELD SERVICE STATION REPAIR 1230 SOUTH UNION AVE.. BAKERSFIELD. CALIFORNIA 93307 (805) 327-4659 IP.O. # . Finish (gallons) Start (gallons~;~.~ Return to Storage (gallons) Finish (gallons) Re~tStart (~ to Storage (gAllons) /~~_TS/,~TORE # DATE ORDERED ECHNICIAN I DATE COMPLETED /~. ,~ Calibration: IFast Checked Adjusted IFast To ! Totalizer Sealed [] Yes [] No Calibration: Fast Checked Adjusted Fast To Totalizer Sealed [] Yes [] No Finish (gallons) Fast Slow Slow leter Sealed ~ Yes [] No Slow Product Finish (/m~y) Totalizerl ' Reading1 Start (money) Product Start (gallons) Return to Storage (gallons) Finish (gallons) Start (gallons) R~n to Storage (gallons) Calibration: Checked Adjusted To Totalizer Sealed [] Yes Calibration: Checked Adjusted To Slow Fast Fast es [] No Slow Slow ~r Sealed ~ Yes [] No Slow Slow Totalizer Sealed [] Yes [] No Meter Sealed ~ Yes [] No REPORTED PROBLE~L, LABOR HRS RATE I AMOUNT  TOTAL ~BOR - ~. ~ TOTAL MATERIAL TOTAL MILEAGE ~ / ~ TOTAL , *,OV WO. . ~,~.~u.~ A~U ~u~. Thank Yo~ WORK ORDERED BY BSSR, INC. BAKERSFIELD SERVICE STATION REPAIR 1230 SOUTH UNION AVE. BAKERSFIELD, CALIFORNIA 93307 (805) 327-4659 Finish (money) P.O. STORE # Finish (gallons) Calibration: Checked Star{ (gallons) !Adjusted To DATE COMPLETED Fast Slow Fast Slow Product Totallzerl Finish (money) Raadingl S-~"~d ~ Product Return to Storage (gallons) Finish (gallons) Start (gallons) (gallons) I Finish (money) Finish (gallons) Totallzer[__.._ __ Readlngs~ Start (money) Star{ (gallons) / Product I Finish (money) · TotallzerI Reading1 Start (money) Return to Storage (gallons) Finish (gallons) Star{ (gallons) Totalizer Sealed [] Yes [] No Calibration: Checked Adjusted To Fast Meter Sealed [] Yes Slow Fast Slow Mete~: Sealed [] Yes [] No [] No Slow slow Product 'REPORTED PROBLEM: Totalizer Sealed [] Yes [] No Meter Sealed [] Yes Slow Slow Calibration: Fast Checked ed Fast Tot alizer'~aled [] Yes"'"'-.~ No Calibration: Fast ~_ Checked I ~odjusted Fast ' Totalizer Sealed [] Yes [] No [] No Return to Storage (gallons) I Meter Sealed I [] Yes [] No DESCRIPTION OF WORK: LABOR HRS RATE AMOUNT QUANTIT~ PART~ NEEDED ~-./ [ PRICE AMOUNT · . TOTAL MATERIAL TOTAL MILEAGE '~ TOTAL I "EREBY'~CK~/OV~/E'[~G~TH~t,$~TORY COI~PLETION OF THE ABOVE WORK. I IS'GNATURE // /~ ',,' i U/ //112,//, " . i,,,,'-----"--r- Than~ You · I Finish (money) Totali~;er~ Reading1 Start (money) Product Finish (money) Totalizer~ Reading1 Start (money)· Product Totallzerl Finish (money) Reading1 Start (money) Product Totalizerl Finish (money) Reading1 Start (money) BSSR, INC. BAKERSFIELD SERVICE STATION REPAIR 1230 SOUTH UNION AVE., BAKERSFIELD, CALIFORNIA 93307 (805) 327-4659 LOCATION /¢ //,~. L S~ORE # Finish (gallons) /-~ ~alibration , ~ Checked Sta~ (gallons) . Adjusted To DATE ORDEFLED DATE COMPLETED Return to Storage (gallons) Finish(gall0ns) ~ / Start (gallons) V Start (gallons) Return to Storage (gallons) Finish (gallons) Start (gallons) Return to S[orage (gallons) Fast Slow Fast Slow Totalizer Sealed ~_ Yes C No Calibration: Fast Checked Adjusted Fast , To Totalizer Sealed ~ Yes [] No Calibration: I Fast ~ Checked Fast 'Adjusted To~a:i ,.-'er Sealed ~; Yes ~ No ! Calibration: Fast i Checked ;~ Acjus'~ed ' Fast , To i 'Futahzor Sealed ,;~ Yes ~ No I Meter Sealed .,-1 Yes [] No ISlow Slow Meter Sealed -~ Yes [] No Slow Slow Meter Sealed ~ Yes [] No Slow Slow : Product I Meter Sealed ~ Yes [] No REPORTED PROBLEM: DESCRIPTION OF WORK: LABOR ,-:'RS i RATE AMOUNT ~ I QUANTITY PARTS NEEDED PR!CE ~ AMOUNT ~ TOTAL LABOR " i TOTAL MATERIAL j TOTAL MILEAGE j TOTAL TAX t TOTAL I I HEREBYACKNO.,~DGE THE SATISFACTORY CO_.M.Et.,~ON OF THE ABOVE WORK. Thank You ~2~ CERTIFICATE OF INTEGRITY THE UNDERGROUND STORAGE TANKS LOCATED AT DELIMART, 9628 ROSEDALE HIGHWAY, BAKERSFIELD, CALIFORNIA HAVE BEEN CERTIFIED ENVIRONMENTALLY SAFE WITHIN THE GUIDELINES OF THE STATE OF CALIFORNIA BY ~ REDWINE- MANLEY TESTING SERVICES, INC. ON THIS THE DAY 0 F AUGUST 1 9. CERTIFICATION # CA 0183 MEMBER NATIONAL FIRE PROTECTION ASSOCIATION REDWINE TESTING, INC. E Z ¥ - C H E K ]ROUN~..H~?: HONE DIA: 95' P.O. BOX 1567 iANK I]~0 B/T.?NONE FILL: 56' ¥ 0 R K S H E E T · BAKERSFIELD, CA., 93302 LANK H20 A/T: NON.E TOTAL:ISI' (805) 326-0446 TANK TEST I: 2 TEST LEVEL:SYSTEM PRODUCT: UNLEADED SIZE: 12000 4EASURED GRAVTTY: 57.7 PRODUCT TEHP: 94 DEG : COEFF]CiENT: .00056745 CALIBRATION: BAR OR LIQUID? 8AR NO. LIKES CHANGE: 1 20 2 21 3 22 TOTAL 63 / CHART CALC: 0.05 / 21 : 0.002380 IA) TEMP CALC: 0.00056745 X 12000 : 6.8094 lB) PAGE I OF 2 21 ,- TEST s LEVEL LEVEL GAIN + x(A) LEVEL ss TEMP. TEMP. GAIN + x(B) TEMP, ss FINAL - ,,s I s START END LOSS - 'x(A) RESULT ss START END LOSS - x(B) RESULT ss RESULT ss TIME sss :,$ 1 * 70 64 : -6 x 0.002380 : -0.01428 ** 0.04 - 0.043 : 0.003 x 6.6094 : 0.020428 ss :-0.03471" 1521 sss ;SS $ ' $t $I IS ,s; ' s 64 61 = -3 x 0.002380 : -0.00714 ss 0.043 - 0.042 : -0.001 x 6.8094 : -0.00680 ss :-0.00033 ', 1527 ,~,~ -i' ,, " ,, ,,, ~s~ s 61 56 : -5 x 0.002380 : -0.01190 ,s 0.042 - 0.044 : 0.002 x 6.8094 : 0.013618 ss :-0.02552 ss 1548 sss ,ss 4 s 56 56 : 0 x 0.002380 : 0 ss 0.044 0.045 : 0.001 x 6.8094 : 0.006809 "=-0.00680" 1554 ,- 5 s 56 55 · = -1 x 0.002380 = -0.00238 ss 0.045 0.044 = -0.001 x 6.8094 : -0.00680 ss =0.004428 ss 1600 sss =- 6 S 55 54 :, -1 x 01002380 : -0.00238 ss 0.044 0.045 = 0.001 x 6.8094 : 0.006809. ss :-0.00919 ss 1606 sss :SS ~ IS Il IS , 0 - =0.002380 - 1612 sss :ss 7 s 54 - 55 : I x 0.002380 : 0.002380 ss 0.045 0.045 : 0 x 6.8094 : . s,s 8 .l 65 - 56 : 1 '~dkQ02380 ': 0.002360 ~s 0.045 0.047 : 0.002 .x ~6:6094 : 0.013618 4s :-0.01123 ,,s 1618 ,,, 9 t 56 - 57 : I x 0.002380 : 0.002380 ss 0.047 - 0.048 : 0,001 x 6.8094 : 0.006809' ss :-0.00442 ss 1624 ,ss ss* ..'0 s 57 - 59 : 2 x 0.002360 : 0.004761 ss 0.048 - 0.05 : 0,002 x 6.8094 : 0.013618 ss :-0,00865 ss 1630 ss, "0 * 59 - 60 : . I x 0.002380 : 0.002380 ss 0.05 - 0.051 : 0.001 x 6.8094 : 0.006809 - :-0.00442 ,s 1636 sss sss 12 $ 60 .- 63 : 3 x 0.002380 : 0.007142 ss 0.051 - 0.053 : '0.002 x 6.8094 : 0.013618 - :-0.00647 - 1642 ss, ,ss 13 , 63 - 65 : 2 x 0.002380 : 0.004761 ss 0.053 - 0.054 : 0.001 x 6.8094 : 0.006809 ":-0.00204 ss 1648 ,ss ~ss 14 s 65 67 = 2 x 0.002380 = 0,004761 ss 0,054 0,055 = 0,001 x 6,8094 = 0.006809 ss =-0,00204 ss 1854 sss I$I i IS $$ IS SIS sss 15 s 67 69 = 2 x 0.002380- = 0.004761 ss 0.055 0.056 : 0.001 x 6.8094 : 0.006809 ss :-0.00204 ss 1700 sss Il IS I$ lll ~Sl S , ,ss 16 $ 69 70 : 1 x 0.002380 : 0.002360 ss 0.056 0.057 : 0.001 x 6.6094 = 0.006809 ss :-0.00442 ss 1706 sss S · . SS COHPANY: TEXACO DEL]MART DATE: 8-6-89 OPERATOR: LAYRENCE GOLDBERG RESULTS PER HOUR: SEE PAGE 2 ROUND H2e: ANN H20 ANK TEST I' 2 .EASURED GRAVITY: DIA: E Z Y C H £ K FILL: SEE PAGE 1 WORK S H E E T TOTAL: ',EST LEVEL: SYSTEN PRODUCT: UNLEADED 57.7 PRODUCT TENP: 94 DEG SXZE: 12000 COEFHCIENT: .00056745 CALIBRATION: BAR OR LIQUID? 8AR NO. LINES CHANGE: 1 20 2 2l 3 22 TOTAL 63 / CHART CALC: 0.05' / 21 : 0.002380 (At TENP CALC: 0.00056745 X 12000 : 6.8094 (B) PAGE 2 OF 2 3: 21 TEST t LEVEL LEVEL GAIN + x(A) LEVEL ri TERP. TEHP. GAIN * x(B) TENP. It FINAL rl I t START END LOSS - x(A) RESULT rt START END LOSS - x(B) RESULT I -~ 70 72 : 2 x 0.002380 : 0.004761 rl 0.057 0.059 : 0.002 x 6.8094 : 0.013618 rt =-0.00685 rl 1712 s 72 - 74 = 2 x 0.002360 = 0.004761 ii 0.059 0.06 : 0.001 x 6.8094 : 0.006809 Il :-0.00204 rl 1718 t 74 - 76 : 2 x 0.002380 : 0.00476l rl 0.06 0.061 : O.OOI x 6.8094 4 t 16 - 78 : 2 x 0.002380 : 0.004761 It 0.061 0.062 : 0.001 x 6.8094 : 0.006809 tt :-0.00204 II 1730 5 t - : 0 x 0.002380 : 0 it : 0 x , 6.8094 : 0 6 i - : 0 x 0.002380 : 0 ri : 0 x 6.8094 = 0 It: 0 7 s - : 0 x0.002380 : 0 it .: 0 x 6.8094 8 i - : 0 x 0.002380 : O rs - : 0 x 6.8094 9 s - : 0 x 0,002380 : 0 ri - = 0 x 6.8094 · ~ i - : 0 x 0.002380 : 0 rs - : 0 x 6.8094 : 0 ~l~) T - : 0 x 0.002380 :' 0 ri - : 0 x 6.8094 : 0 it 12 i = 0 x 0.002380 : 0 rt - : 0 x 6.8094 : 0 it: 0 88 13 i : 0 x 0.002380 : 0 ri - : 0 x 6.8094 : 0 14 8' : 0 x0.002380 : 0 it - : 0 x 6.8094 : 0 15 i : 0 x 0.002380 : 0 it - : 0 x 6.8094 : 0 16 r : 0 x0.002380 : 0 rl : 0 x 6.8094 : . . 0 CONPANY: TEXACO DELINART DATE: 8-6-89 OPERATOR: LAWRENCE GOLDBERG RESULTS PER HOUR: -0.03647 GPH OU~ H20: - NONE ~KH20 8/T: NOpE NK M20 A/T: NONE NK TES??~: ASURED GRAVITY: DIA: 95' REDWINE TESTING, INC. FILL: 60' P.O. BOX 1567 101AL:155' BAKERSFIELD, CA., 93302 (805) 326-0446 TEST LEVEL: SYSTEM PRODUCT: SUPREME UNLEADED 58.1 PRODUCT TE#P: 92 DEG E Z Y - C H E K CALIBRATXON: BAR OR LIQUID? BAR M 0 R K S H E E T NO. LINES CHANGE: ! 19 2 2O 3 20 TOTAL 59 / SIZE: 12000 CHART CALC: 0.05 / 19.66666 : 0.002542 COEFFICIENT: .00057242 TENP CALC: 0.00057242 X 12000 : 6.86904 ~B) PAGE I OF 2 3: 19.6 LEVEL LEVEL GAIN + x(A) LEVEL *IL TEMP. TEHP. GAIN * x(B) TEMP. ILIL FINAL *IL IL*LTL START END LOSS - x(A) RESULT ILIL START END LOSS - x(B) RESULT ILIL RESULT *IL TIME ILILIL :IL IL 53 - IL 39 - :IL 6 rS 8 '* xil ~IL 9 IL 53' : xiL 12 * ,IL 18 IL; 39 : 24 : 34 30 : 30 25 65 49 = 49 42 = .42 37 : 37 32 : 32 28 : 26 24 = 24 - 21 : 21 18 58 - 55 : 95 - 95 = 95 - 95 : -15 x 0.002542 = -0.03813 *IL 0.468 -14 x 0.002542 : -0.03559 ILIL 0.468 -15 x 0.002542 : -0.03813 ILIL 0.468 -4 x 0.002542 : -0.01016 ,8 0.468 -~ x 0.002542 : -0.01271 *IL 0.469 -6 x 0.002542 : -0.01525 ILIL 0.47 -7 x 0.002542 : -O.OI779.ILIL 0.47 -5 x 0.002542 : -0.01271 *IL 0.47 - -5 x 0.002542 = -0.01271 ,iL 0.471 - -4 x 0.002542 : -0.01016 ell 0.472 - -4 x 0.002542 : -0.01016 $IL 0.472 - -3 x 0.002542 : -0.00762 *IL 0.473 - -3 x 0.002542 = -0.00762 *IL 0.473 - -3 x 0.002542 = -0.00762 ILl 0.473 - ~ x 0,002542 = 0 *IL 0.474 - ~ x 0.002542 = 0 ** 0.474 0.468 : 0 x 0.468 : 0 x 0.468 -' 0 x 0.469 : 0.001 x 0.47 : 0.001 x 0.47 = 0 x 0.47 ': 0 x 0.471 = 0.001 x 0.472 : 0.001 x 0.472 = 0 x 0.473 = 0.001 x 0.473 = 0 x 0,473 = 0 x 0.414 : 0.001 x 0.474 = 0 x 0,474 : 0 x 6.86904 : 0 *IL :-0.03813 ILIL 2036 6.86904 : 0 *IL :-0.03559 ILIL 2042 I1 6.86904 : 0 *IL =-0.03813 *IL 2048 6.86904 : 0.006869 *IL :-0.01703 *IL 2054 6.86904 = 0.006669 *IL =-0.01958 ILs 2100 6.86904 : '0 *IL =-0.01525 ILIL 2106 6.86904 : 0 *IL :-0.01779 *IL 2112 6.66904 : 0.006869 4IL :-0.01958 ** 2118 6.66904 = 0.006869 *IL =-0.01958 ~l 2124 6.86904 = 0 *IL :-0.01016 *IL 2130 6.86904 : 0.006866 ** =-0.01703 88 2136 6.86904 : 0 ILIL =-0.00762 *IL 2142 Il Il 6.86904 : 0 IL* :-0.00162 *IL 2148 6.86904 = 0.006669. ILIL =-0.01449 ILIL 2154 ,IL 6.86904 = 0 *IL: 0 ILIL 2218 6.88904 : 0 *IL: 0 *IL 2224 CONPANV: TEXACO DELINART , DATE: 8-6-89 OPERATOR: tAMRENCE GOLDBERG RESULTS PER HOUR: SEE PAGE 2 ~GR~N~.H2O.: DIA: TANK H20 B/T: FILL: · lANK H20.A/T: TOTAL: TANK TES. T i: I ' NEASURED GRAVITY: SEE PAGE TEST LEVEL: SYSTEM PRODUCT:SUPREME UNLEADED 58.1 PRODUCT TEMP: 92 DEG EZY - CHEK WORKSHEET SIZE: 12000 COEFFICIENT: .00051242 CALIBRATION: BAR OR LIQUID? BAR NO. LINES CHANGE: I 19 2 2O 3 2O TOTAL 59 / CHART CALC: 0.05 / 19.66666 = 0.002542 (A) TENP CALC: 0.00057242 X 12000 = 6.86904 (B) PAGE 2 OF 2 3: 19.6 s,s TEST s LEVEL LEVEL GAIN + x{A) LEVEL ss TEMP. TEMP. GAIN + xIB} TENP. ss FINAL' - sss sss I s START END LOSS - x(A) RESULT -- START END LOSS - xIB) RESULT -- RESULT - TINE sss SSS S S 95 SS ' 95 : 0 x 0.002542 : 0 ss 0.474 - 0.474 = 0 x 45 : 3 x 0.002542 : 0.007627 ss 0.474 - 0.475 : 0.001 x 46 : 1 x 0.002542 : 0.002642 ss 0.475 - 0.475 : 0 x 45 : 0 x 0.002542 : 0 st 0.475 - 0.475 : 0 x 48 : 2 x 0.002542 : 0,005084 ss 0.475 - 0.475 : 0 x 48 = 0 x 0.002542 = 0 ss 0.475 - 0.475 '= 0 x 49 : 1 x 0.002542 = '0.002542 ss 0.475 - 0.476 = 0,001 x 49 : 0 .x 0.002542 : 0 ss 0.475 - 0.476 : 0.001 x 60 : ! x 0.002542 : 0.002542 ss 0.476 - 0.476 = 0 x 50 = 0 x 0.002542 : 0 ss 0.476 - 0.476 : 0 X 51 : 1 x 0.002542 : 0.002542 ss 0.476 - 0.476 : 0 x = 0 x0.002542 = 0 ss - : 0 x = 0 x 0.002542 = 0 ss = 0 x = 0 x 0,002542 = 0 ss = 0 x = 0 x 0,002542 = 0 ' = 0 x = 0 x 0.002542 = 0 ss = 0 x ill , sss .13 $ sss 15 $ sss 16 $ 42 45 46 46 48 48 49 49 5O 5O 6.86904 : 0 ss: 0 ss 2230 sss 6.66904 = 0.006669 ss =0.000758 ss 2236 sss SS SI 6,86904 = 0 ss =0.002542 ss 2242 sss II IS 6.66904 = 0 ss = 0 ss 2248 sss SS Si 6.86904 = 0 ss =0,005084 ss 2254 sss IS SS 6.86904 : 0 ss: 0 ss 2300 sss 6.86904 : 0.006869 ,s :-0.00432 ss 2306 sss 6.86904 = 0.006869 ** :'0.00886 ,s 2312 ,ss 0 ** :0.002542 ss 2318 ss, 0 s,: 0 ss 2324 ss, 0 ss =0.002642 ss 2330 sss 6.86904 6,86904 6,86904. 6,86904 6,86904 6.86904 6.86904 6,86904 0 s,: 0 ss sss 0 Ii : 0 Il II II ltl' 0 ~$: 0 s, sss 0 IS : 0 Il SS IS SIS. 0 SS : 0 SS SSI COMPANY: TEXACO DELINART DATE: 8-6-89 OPERATOR: LAWRENCE GOLDBERG RESULTS PER HOUR: 0.002274 GPH GROUND H20: NONE TAN~.H20 8/~ NONE TANK R~O ~/I:'~ONE TANK TEST 1:.'.3 NEASURED GRAVITY: DIA: 94.5' REDWINE TESTING, INC. E Z Y C H FILL: 57.5' P.O. BOX 1567 W 0 R K Sfl E TOTAL:152' BAKERSFIELD, CA., 93302 805) 326-0 4q TEST LEVEL: SYtTEH PROOUCT: ~G,.,.AR SIZE: 12000 56.1 PRODUCT TEHP: 82 BEG COEFFICIENT: ~00056745 CALIBRATIOH: BAR OR LIQUID? BAR NO. LINES CHANGE: I 9 2 10 3 10 TOTAL 29 / CHART CALC: 0.05 / 9.666666 : 0.005172 (AT TENP CALC: 0.00056745 X 12000 : 6.8094' (BT PAGE I OF 2 9.66 TEST ' LEVEL LEVEL GAIN + x(A) LEVEL ** TENP. TEHP. GAIN + x(B) IEHP. ** FINAL I! * START END LOSS - x(A) RESULT ** START END LOSS - x(B) RESULT ** RESULT ** TiNE 50 60 60 62 65 68 '70 72 74 77 79 81 37 6O *** ! **' 2 **s 4 S St* S s,, 5 ' *SS S *** 6 s 7 * ,ss 10 * 11 s ,,s 12 s ss, 14 , sst 15 s s,s 16 * 60 : 62 : 63, : 65 : 68 : 70 71 .: 72 : 74 : 77 : 79 : 81 : 85 : 39 41 : 10 x 0.005172 : 0.051724 ** 01192 0 x 0.005172 : 0 ss 0.217 2 x 0.005172 : 0.010344 ** 0.217 I x 0.005172 : 0.005172 *s 0.222 - 2 y 0.005172 :. 0.010344 *s 0.223' 3 x 0.005172 : 0.015517 ,s 0.224 - 2 x .~.005172 : 0.010344 s, 0.226 - I x 0.005172 : 0.005172 *s 0~228 - I x 0.005172 : 0.005172 ss 0.231 - 2 x 0.005172 : 0.010344 *s 0.233 - 3 x 0.005172 : 0.015517 ** 0.235 2 x 0.005172 : 0.010344 s* 0.238 2 x 0.005172 : 0.010544 *s 0.239 4 x 0.005i72 : 0.020689 ss 0.242 2 x0.005172 : 0.010344 ,s 0.245 SS 2 0.005172 : 0.010344 ss 0.247 0.217 : 0.217 : 0.22 : 0.223 : 0.224 : 0.226 : 0.228 : 0.231 : 0.233 : 0.235 : 0.238 : 0.239 : 0.242 : 0.245 : 0.247 : 0.25 : tS SS SSS 0.025 x 6.8094 : 0.170235 ss :-0.11851 ss 1312 SS SS SSs 0 x 6.8094 ,: 0 ss : 0 ss 1318 0.003 x 6.8094 : 0.020428 ,t :-0.01008 st 1324 ,ss 0.001 X 6.8094 : 0.006809 ** :-0.00163 ** 1330 0.001 x 6.8094 : 0.006809 ss :0.00~535 ss 1336 sss SS SS 0.002 x 6.8094 : 0.013618 ** :0.001898 *s 1342 0.002 x 6.8094 : 0.013618 ss :-0.00327'*s 1348 *t *$ *ss 0.003 x' 6.8094 : 0.020428 ss :-0.01525 ** i354 sss SS *S 0.002 x 6.8094 : 0.013618 ** :-0.00844 ** 1400 *** SS 'SS SSS 0.002 x 6.8094 : 0.013618- ts :-0.00327 *s 1406 'ts SS 0.003 .x 6.8094 : 0.020428 s, :-0.00491 s, 1412 sss 0.001 x 6.8094 : 0.006809 ** :0.00~535 ** 1418 0.003 x 6.8094 : 0.020428 *s :-O.OiOO8 *s 1424 0.003 x 6.8094 : 0.020428 ss :0.000261 ss 1430 0.002 x 6.8094 :" 0.013618 ** :-0.00327 ** 1436 *** 0.003 x 6.8094 : 0.020428 ** :-0.01008 ** i442 sss COHPANY: TEXACO DELIHART DATE: 8-6-89 OPERATOR: LAWRENCE GOLDBERG RESULTS PER HOUR: SEE PAGE 2 GROUHD H20: TANK H20 B/T: I~NK H20~A/I: TANK TEST I: 3 HEASUREO GRAVITY: DI~: FILL: SEE PAGE TOTAL: TEST LEVEL: SYSTEH P~OOUCT: REGULAR 56.1 PRODUCT TENP: 82 DEG SIZE: 12000 COEFFICIENT: .00056745 NO. LINES CHANGE: I 9 2 10 3 10 TOTAL 29 / CHART CALC: 0.05 / 9.666666 : 0.005172 (A) TEHP CALC: 0.00056745 X 12000 : 6.8094 (B) 9.66 TEST * LEVEL LEVEL GkIN + x(A) LEVEL ** TENP. TENP. GAIH + x(B) TEMP. sss FINAL ss, :sss, I * START ENO LOSS - x(A) RESULT ** START ENO LOSS - x(B) RESULT :sss RESULT ,4 TIH[ :sss4 $ $ : $ 3 s :s 4 s : :s 5 s : 8 s : 9 s : lO * : 11 I : 12 :s : 13 4 : $ 14 :s : 15 :s : 16 :s : $ :s:s, -_.1 :s~a 2 41 44 : 3 x 0.005172 : 0.015517 0.25 0.25~ 44 47 ~ x 0.005172 0.253 0.256 47 49 2 x 0.005172 0.256 0.259 ss:sa :ss:ss ss,ss sas 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 0 x 0.005172 :sa : 0.003 x 6.8094 : 0.020428 *ss :-0.00491 aa 1448 : 0.015517 *a : 0.003 x 6.8094 : 0.020428 :sa :-0.00491 ss, 1454 : 0.010~44 sa : 0.003 x 6.8094 : 0.020428 :sa :-0.01008 sa 1500 : 0 sss : 0 x 6.8094 : 0 :SS -as : 0 Sa : 0 x 6.8094 : 0 : 0 sa : 0 x 6.8094 : 0 : 0 :ss : 0 x 6.8094 : 0 : 0 :sa : 0 x 6.8094 : 0 : 0 ~a : 0 x 6.8094 : 0 : 0 ss : 0 x 6.8094 : 0 : 0 :ss : 0 x 6.8094 : 0 : 0 ss : 0 x 6.8094 : 0 : 0 :sa -- : 0 x 6.8094 : 0 : 0 :sss : 0 X 6.8094 : 0 : 0 ss : 0 x 6.8094 : 0 : 0 ss : 0 x 6.8094 : 0 CONPANY: TEXACO DELINART DATE: 8-6-89 OPERATOR: LAMRENCE GOLDBERG RESULTS PER HOUR: -0.04446 6PH 14. Delimart 9628 Rosedale Hwy. Bakersfield, CA 1/17/87 Name of Supplier, Owner or Dealer 15. TANK TO TEST # 3 East Identity by position _~ Premium Brand and Grade Address No. and Street(s) City State Date of Test 16. CAPACITY Nominal Capacity ] ~ ! ~ ~ ~ Gallons Is there doubt as to True Capacity? [] See Section "DETERMINING TANK CAPACITY" By most accurate capacity chart available 1 1; 9 0 7 Gallons From ] Station Chart [] Tank Manufacturer's Chart ] Company Engineering Data [] Charts supplied with petro TLte ] Other · · 17. FILL-UP FOR TEST Stick Water Bottom before Fill-up -- 0 -- to ~ in. Gallons Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY Tank Diameter Inventory Product in full tank (up to fill pipe) Stick Readings to ~ In. 96" Water Top off Total Gallons Gallons ea. Reading 11,907 -0- -0- +11 1'1,918 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK API Gravity 51.8 See manual sections applicable. Check below and record procedure in log (26). Tamp. 5 5 o Corrected API Gravity 52.4 [] Water In tank [] High water table In tank excavation [] Line(s) being tested with LVLLT VAPOR RECOVERY SYSTEM [] Stage I [] Stage II 19. TANK MEASUREMENTS FOR TSl-r ASSEMBLY Bottom of tank to Grade* .' ............... 15 2" Add 30" for 4" L ................. Add 24" for 3" L or air seal ....... Total t0bing to assemble Approximate ......... 1 7 6 20. EXTENSION HOSE SETTING Tank top to grade". ................................. 5 6 Extend hose on suction tube 6" or more 19 below tank top ..................................... 'If Fili pipe extends above grade, use top of fill. 26. LOG OF TEST PROCEDURES 29. 21. TEMPERATURE/VOLUME FACTOR (a)TO TEST THIS TANK Is Today Warmer? [] Colder? [J ° F Product in Tank -.--° F Fill-up Product on Truck __° F Expected Change ( + or - ) 30. HYDROSTATIC PRESSURE CONTROL Standpipe Level Thermal-Sensor reading after circulation digits Digits per iF in range of expected change 313 digits 10923 55°/56° .oF Nearest 11918 x .00055964 total quantity in full tank (16 or 17) coefficient of expansion for Involved product _- 6.66978952 volume change In this tank per °F gailons 6. 66978952 + '313 volume change per °F (24) Digits per °F In test Range (23) .021309231 Volume change per digit. Compute to 4 decimal places. This Is test factor (a) 31. VOLUME MEASUREMENTS (V) * RECORD TO .001 LIL. 32. Product in Product '34, TEMPERATURE COMPENSATION USE FACTOR (a) 37. 38. NET VOLUME CHANGES EACH REA01NG Temperature 39. ACCUMULATED CHANGE At High Level record 27. "'. 128. D~TE ! Record details of setting up / '1 ? 7 ~ '7 and running test. (Use full ~' length of line if needed.) 1125 IPump primed and runninq Reading No. in In,has Beginning I Level to of I which Reading r Restored ;et '..s land 35. Thermal Sensor Reading Graduate Replaced (-) Before After Product Reading Reading Recovered (+) )ipe at 42" mtrk 40. A.G. 36~hang I Higher Computation (c) ~< (a)= Expansion + Contraction - Adjustment Volume Minus Expansion (+) or Contraction (-) #33(V) -- #37(T) Total End Deflection At Low Level compute Change per Hour (NFPA criteria) A Fact( r .0213 0213 1215 First sensor reading 42 " 10923 1230 Started high level test 1 39.1 42 .920 .700 -.220 10932 + 9 +.192 -.412' !1245 Cont'd high level test 2 38.9 42 .770 .580 -.190 10944 +12 +.256 -.446 1300 " " " 3 38.5 42 .990 .810 -.-180 10947 + 3 +.064 -.244 1315 " " " 4 38.2 42 .810 .640 -.170 10952 + 5 +.107 -.277 1330 " " " 5 39.6 42 .990 .910 -.080 10961 + 9 +.192 -.272 1345 " " " 6 40.6 42 .910 .840 -.070 10970 + 9 +.192 -.262 1400 " " " 7 41.6 '42 .840 .820 -.020 10973 + 3 +.064 -.084 1415 " ." " 8 42.0 42 .820 .820 .000 10975 + 2 +.043 +.043 1.420 DropPed .~o '.1'.2" ~na'~,k 12 10983 1435 Low level test cont'd 1 12.1 12 .250 .255 +.005 10984 + 1 +.021 -.O16 -.016 ,~1450 " " " 2 12.4 11 .255 .275 +.02¢ 10985 + 1 +.021 -.001 -.017 ~505 " " " 3 12.1 12 .275 .285 +,0lC 10986 + 1 +.021 -.011 -.028 1520 " " " 4 12.9 12 .285 .325 +.04¢ 10988 + 2 +.043 -.003 -.031 Tank :este~ tight -.031 ;PH Lines test,_=d tiqh- 1/17/:~7 14. Delimart 9628 Rosedale Hwy. Bakersfield, CA Nome of Supplier, Owner or Dealer Address No. and S~reet(s) City State 12/13/86 Date of Test 15. TANK TO TEST #1 West Identity by position _ Rogt]lar Bland and Grade 16. CAPACITY Nominal Capacity 1 2,0 0 0 Gallons · IS there doubt as to True Capacity ? [] See Sec!ion "DETERM RING TANK CAPACITY" By most accurate capacity chart available 1 1 r 9 0 7 Gallons From ] Station Chart ] Tank Manufacturer°s Chart Company Engineering Data Charts supplied with petro Tlte [] Other 17. FILL-UP FOR TEST Stick Water Bottom before Fill-up -- 0 -- to Y~ In. Gallons Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY Inventory Tank Diameter 9 6" Product In full tank (up to fill pipe) Stick Readings to ~ in. · 96" Water Top off Total Gallons Gallons ea. Reading 11 -0- -0- '+20 11,927 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK API Gravity 55.8 See manual sections applicable. Check below and record procedure in log (26). Temp.. 5 0 ° COrrected API Gravity 57.0 [] Water in tank [] High water table in tank excavation [] 'Line(s) being tested with LVLLT VAPOR RECOVERY SYSTEM [] Stage I [] Stage II 19. TANK MEASUREMENTS FOR TSTT ASSEMBLY Bottom of tank to Grade* .................... 15 3 ,, Add 30" for 4" L ................. ,, Add 24" for 3" L or air seal ....... .,, Total tubing to assemble Approximate ......... 1 80 ,, 20. EXTENSION HOSE SE'I-rING Tank top to grade". ................................. 5 7 ,, Extend hose on suction tube 6" or more below tank top ..................... 1 0 ,, *If Fili pipe extends above grade, use top of fill. 26. LOG OF TEST PROCEDURES  28. Record details of setting up and running test. (Use full 8.6 length of line if needed.) 1700 IArrived test location 21. TEMPERATURE/VOLUME FACTOR (a) TO TEST THIS TANK Is Today Warmer? [3 Colder? (3 __° F Product in Tank __° F 22. Thermal-Sensor reading after circulation · 119 91 digits 23. Digits per °F in range of expected change 3 1 8 24. digits Fill-up Product on Truck ° F Expected Change ( + or - ) 58°/59° oF Nearest 11,927 x .00059230 = '7.0643621 total quantity in coefficient of expansion for volume change in this tank full tank (16 or 17) involved product per °F 25. 7. 0643621 318 volume change per °F ~24) Product Replaced (-) 30. HYDROSTATIC 31. PRESSURE CONTROL 32. Product i0 ag in laches Graduate· Reginning I Level to of I which Before J After ' Reading Restored Reading Reading VOLUME MEASUREMENTS (V) RECORO TO .0~1 GAL. Digits per °F in test Range (23) Thermal Product Recovered (+) ' - · 22214975 TEMPERATURE COMPER~TION USE FACTOR (a) Volume change per digit. Compute to 4 decimal places. 3~hange J Higher + Son.r· t to~r- Reading 37. Computation (c) x (o)= Expancion + Contraction - 38. NET VOLUME CHANGES EACH READING Temperature Adjustment Volume Minus · Expansion (+) or Contraction (-) · 33(V)-- #37(T) A Fact¢ gallons This is. test · 0222 factor (a) --. 39. ACCUMULATED CHANGE At Hip Level record Total End Deflection At [ew Level compute Change per Hour (gFPA criterio) ~ .0222 Set up test equipment with 12" mark set ~t 39" above rade 2000 Pump primed and running fo~- ci ~culation 2100 Started high level test 42 1199] 2115 Cont'd high level test 1 33.2 42 -·~990 .450 -.540 12032 '-.-+41 +.910 '1.450 2130 " " " 2 32.0 42 ·,930 .260 -.670 12050 +]8 +.400 -1~070 2145 " " " 3 32.0 "~2 1.000 ~320 -.680 12065 ··+15 +.333 -1.013 2200 " " " 4 35.0 42 1.000 .620 -~380 12080 +15 +.333 - .713 2215 " " " 5 36.2 41 .620 ·.330 -.290 12095 +15 +.333 - .623 " " . A facto~ 2230 " 6 38 8 42 1.000 .850 -.I50 12110 +15 +.332 - .482 changed, 022 2245 " " " 7 ~40.2 4__2 .850 .78____Q_0-.070 12122 +12 +.265 - .335 2301 Drop to low level test 2305 Started low level test 12 12132 2320 Cont'd low level test 9 14.0 12 .780 .870 +.090 12137 + 5 +.111 - .021 -.021 2335 " " " 10 20.0 12 .330 .770 +.440 12155 +18 +.398 + .042 +.021 2350 " " " 11 16.5 12 .770 .970 +.200 12163 + 8 +.177 + ..023 +.044 2405 " " " 12 16.0 12 .770 .950 +.180 12172 + 9 +.199 - .019 +.025 Tank ~este(~ tight +.025 (PH . Lines tesbod tight 12/13/ 86 14. Delimart 9628 Rosedale Hwy. Bakersfield, CA '1/17/87 Name of Supplier, Owner Or Dealer Address No. and Street(s) City State Date of Test 16. CAPACITY 15. TANK TO TEST Center Identity by position Unleaded· Stand and Grade Nominal Capacity 12; 0 0 0 Gallons IS there doubt as to True Capacity ? [] See Section "DETERMINING TANK CAPACITY" 17. FILL-UP FOR TEST ' ~' Stick Water Bottom before FIII-u'p -- 0 -- " '~* -- 0 -- to r,/. in. Gallons Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY Tank Diameter : 9 6" 18. 19. TANK MEASUREMENTS FOR TSTr ASSEMBLY Bottom of tank to Grade* .................... 1 5 3 Add 30" for 4" L ................. Add 24" for 3" L or air seal ....... Total tubing to assemble Approximate ......... 17 0 By most accurate 1 1 ,tl~"/ capacity chart available_-J.-~ ~J / Gallons Stick Readings to r,~ In. Inventory 96" Water Product in full tank (up to fill pipe) From ] Station Chart ] Tank Manufacturer's Chart ] Company Engineering Data [] Charts supplied with I~_troT~t_-e [] Other Gallons -0- Total Gallons ea. Reading 11,907 --0-- 11;917 SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK 'API Gravity 55.0 Temp. 39 o See manual sections applicable. Check below and record procedure in log (26). Corrected ApI Gravity 5 7.6 [] Water In tank ~ '[] High water table In tank excavation [] Line(s) being tested with LVLLT VAPOR RECOVERY SYSTEM [] Stage I [] Stage II (24: 20. EXTENSION HOSE SETTING Tank top to grade*. ................................. Extend hose on suction tube 6" or more below tank top ..................................... 'If Fili pipe extends above grade, use top of fill. LOG OF TEST PROCEDURES 7~28. Record details of setting up 8 7 and running test. (Use full  . length of line if needed.) I Arrived test location 29. Reading,' No. bot~ om ~ 57 10 30. HYDROSTATIC II 31. PRESSURE II CONTROL II Standpipe Level II32. Beginning I Level to It ,f tagk II 21. TEMPERATURE/VOLUME FACTOR (a) TO TEST THIS TANK is Today Warmer? [-I Colder? [~ ° F Product in Tank __° F Fill-up Pr'oduct on Truck __° F Expected Change 22.Thermal-Sensor reading after circulation10 0 7 9 5 2 ° / 5 3 e .°F Nearest digits 307 digits Digits per °F in range of expected change 11,917 x .'00059656 = 7,10920552 - total quant!ty in coefficient of expansion for volume change In this tank full tank (16 or 17) involved product per °F 7.10920552 + 307 volume change per °F (24) Digits per °F in test Range (23) 34. VOLUME MrdISUR[MENTS (V) RECORD TO .001 GAL. 35. Product in Product Graduste Replaced (-) Thermal Senior Before After Product Reading Reading Reading Recovered (+) +or-) .023157021 Volume change per digit. Compute to 4 decimal places. gallons Thio ia test factor (a). 0 2 3 2 TEMPERATUIE COMPENSATION USE FACTOR (a) 36. Change Higher + Lower - (c) 37. Computation (c) . (el = Expansion + Contraction - 38. NET VOLUME CHANGES EACH READING Temperature Adjustment Volume Minus Expansion (+) or Contraction (-) #33(V)-- #37(T) A Fact 39. ACCUMULATED CHANGE At HiBh Level record Total End Deflection At Low Level compute Change per Hour (NFPA criteria) )r = . 022 2 9515 S~_~ up t~_s~ ~quipment 0545 Pump primed and running f¢,r c: rcul~Ltion 0645 Start high level test 42 10079 0700 Cont'd high level test 1~ 39.0 42 .790 .530 -.260 10102 +23 +.534 -.794 0715 ,, " " 2 40.0 42 .530 .340 -.190 10103 + 1 +.023 -.213 0730 ,, " " 3 40.5 42 .930 .790 -.140 10110 + 7 +.162 -.302 0745 ,, " " 4 41.2 42 .790 .740 -.050 10119 + 9 +.209 -.259 0800 · ,, " " 5 41.5 42 .740' .715 -.025 10121 + 2 +.046 -.071 ~815 ,, " " 6 42.0 42 .715 .715 .000 10135 +14 +.325 -.325 ~830 ,, " " 7 42.5 42 .715 .750 +.035 10148 +13 +.302 -.267 ~45 " , ,, ~ 4~2- 9 __42_~__ _.75__0 .810 ,~. 0___6~0 10__15__~_2 +__ 4___ +. 09~3 -. 03__~_3 ]846 Drop to 12" level ]850 Start low level test 12 10160 ]905 Cont'd low level test 1 14.0 12 .340 .510 +.170 10167 + 7 +.162 +.008 +.008 9920 ,, " " 2 13.8 12 .510 ~ 645 +.135 10173 + 6 +.139 -.004 +.004 ~935 ,, " " 3 113.9 12 .19'0 .340 +.150 10180 + 7 +'.162 -.012 -.008 ~950 ',, " " 4 14.0 12 .340 .470 +.130 10186 + 6 !+.139 -.009 -.017 Tank teste( tiqht -.017 6PH Line t estec tiqht 1/17/8~ lA' Delimart 9628 Rosedale Hwy. Bakersfield, CA 1/17/87 ~iame et Supplier, Owner or Dealer Address No. and Street(s) City State Date of Test 15. TANK TO TEST # 3 East identity by position Unleaded Premium Bread and Grade 16. CAPACITY Nominal Capacity 1 '~... ~J~ (~ Gallons Is there doubt as to True Capacity ? [] See Section "DETERMINING TANK CAPACITY" By most accurate capacity chart available 11,907 Gallons From ] Station Chart ] Tank Manufacturer's Chart Company Engineering Data [] Charts supplied with petro~l__fe 'lANK TESIEO ] Other 17. FILL-UP FOR TEST Stick Water Bottom before Fill-up -- 0 ..... 0 -- to r,/. In.. ' Gallons Fill up. STICK BEFORE AND AFTER EACH COMP,~RTMENT DROP OR EACH METERED DELIVERY QUANTITY Tank Diameter 9 6" Inventory Product In full tank (up to fill pipe) Stick Readings to ~ In. 96" Water Top off TOtal Gallons Gallons ea. Reading -0- 11,907 --0-- +11 11,918 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST'THIS TANK ApI Gravity 51.8 See manual sections applicable. Check below and record procedure in log (26). Tamp. 5 5 o Corrected API Gravity 52.4 [] Water In tank [] High water table In tank excavation [] Line(s) being tested with LVLLT VAPOR RECOVERY SYSTEM [] Stage I [] Stage II o 0 I (0 26. D JOE TIME . (24 hr'.) 1125 3.13 ~ 19. TANK MEASUREMENTS FOR TSTT ASSEMBLY Bottom of tank to Grade* ' . ................ ]- 5 2" ,, Add 30" for 4" L ................. " Add 24" for 3" L or air seal ....... ', Total tubing to assemble Approximate ......... 17 6 ,, 20. EXTENSION HOSE SETrlNG Tank top to grade*. ................................. 5 6 ' Extend hose on suction tube 6" or more below tank top ..................................... 19 ,, 28. 7 Pump 'If Fili pipe extends above grade, use top of fill. LOG OF TEST PROCEDURES Record details of setting up and running test. (Use full length of line if needed.) primed and running 21. TEMPERATURE/VOLUME FACTOR (a) TO TEST THIS TANK Is Today Warmer? [] Colder? [] __° F Product in Tank __° F FiU-up Product on Truck __° F Expected Change ( + or - ) 22. Thermal-Sensor reading after circulation .1 0 9 2 3 5 5 o / 5 6 ° . oF digits Nearest 23. Digits per °F in range of expected change 313 digits 24. 11918 x .00055964 = 6.66978952 ge.one' total quantity in coefficient of expansion for volume change in this tank full tank (16 or 17) involved product per °F 25. 6.66978952 + 313 = .021309231 volume change per °F (24) Digits per °F in test Volume change per digit. ............. . Range (23) ............ Computeto 4 decimal. )laces. Ilnnmg Level to of which ading Restored b".s and VOLUME MEASUREMENTS RECORD TO .001 GAL. Productia Graduate Product Replaced (-) Product Recovered (+) mfrk 40 35. 36~hanoe Thermal ~ Higher + Sensor I Lo;~r - Rendin0 30.' HYDROSTATIC II 31. II PRESSURE 29. II S,n.dpi. L.,, 32. Reading il--- in Inchna j.0. IIR, L.u.,,0 d Before After Reading Reading ~ipe at 42" This is test factor(a)' 0213 34, TEMPERATURE COMPERS,UJOR 38. NET VOLUME 39.. CHANGES ACCUMULATED USE FACTOR (a) EACH READING CHANGE 37. Temperature At High Level record Computation Adjustment Total End Deflection (c) x (a) = Volume Minus Expansion + Expansion (+) or At Low Level compute: Contraction - Contraction (-) Change per Hour #33(V) -- #37(T) (NFPA criteria) A Fatter .0213 !Started circulation 1215 First sensor reading ~-2 -1-0-9-2-3- 1230 Started high'.level test' 1 39.1 42 .920 .700 -.220 10932 + 9 +.192 -.412 1245 Con%'d high level tes~ 2 38.9 42 .770 .580 -.190 10944 +12 +.256 -.446 1300 " " " 3 38.5 42 .990 .810 -.18C 10947 + 3 +.064 -.244 1315 " " " 4 38.2 42 .810 .640 -.17£ 10952 + 5 +.107 -.277 1330 " " " 5 39.6 42 .990 .910 -.08£ 10961 + 9 +.192 -.272 1345 " " " 6 40.6 42 .910 .840 -.07C 10970 + 9 +.192 -.262 1400 " " " 7 41.6 42 .840 .820 -.02C 10973 + 3 +.064 -.084 1415 " " " 8 42.0 42 .820 .8.20 .000 10975 + 2 +.043 +~.043 1.420 Dropped .~o'.~2" m~k 12 10983 1435 Low level test cont'd 1 12.1. 12 .250 .255 +.005 10984 + 1 +.021 -.216 -.016 1450 ,, ,, ,, 2 12.4 11 .255 .275 +.02C I0985 + 1 +.021 -.001 -.017 1505 " " " 3 12.1 12 .275 .285 +.0lC 10986 + 1 +.021 -.011 -.028 1520 " " " 4 12.9 12 .285 .325 +.04C 10988 + 2 +.043 -.003 -.031 Tank Eeste~ tiqht -.031 ;PH Lines test,~d tiqh~ 1/17/: :7 I PLEASE PRINT 1. OWNER Property Tank(s) 2. OPERATOR 3. REASON FOR TEST (Explain Fully) 4. WHO REQUESTED TEST AND WHEN 5. WHO IS PAYING FOR THIS TEST? 6. TANK(S) INVOLVED 7. INSTALLATION DATA 8. UNDERGROUND WATER 9. FILL-UP ARRANGEMENTS 10. CONTRACTOR, MECHANICS, any other contractor involved Data for Tank System Tig iss Test ........ petro Ti_re TANK TESTER Delimart 9628 Rosedale Hwy. Name Address Greg Meyers · 589-5640 Representative Telephone Name Address Representative Telephone Name Address Telephone Test requeste~ Greg Meyers Delimart 12/13/86 Name Title Company or Affiliation Date 9628 Rosedale Hwy. ~ Address Telephone Company, Agency or Individual Person Authorizing Title x Telephone Billing Address City State Zip Attention of: Order No. Other Instructions Identify by Direction ~1 West 2 Center Capacity 12,000 12,000 12,000 Brand/Supplier Texaco Texaco Grade Regular Unleaded Prm. Unld. Approx. Age 5 yr. 5 yr. 5 yr. Steel/Fiberglass Steel Steel ~3 East Texaco Steel Location N North inside driveway, Rear of station, etc. Cover l=ConCrete :2=Concrete 3=Concrete Concrete, Black Top, Earth, etc. Siphones Which tanks ? Vents Size, Manifolded Fills Size, Titefill make, Drop Pumps Re mo to Remote Remote Suction, Remote, Make if known Is the water over the tank ? Depth to the Water table -- 0-- " [] Yes [~ No Tanks to be filled __ hr. Date Arranged by Name Extra product to "top off" and run TSTT. How and who to provide ? Consider NO Lead. Telephone Terminal or other contact for notice or inquiry Company Name T~lephone Tank Testing, Inc. 11. OTHER INFORMATION OR REMARKS Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors or observers present during test etc. Tests were made on the above tank systems in accordance with test procedures prescribed for P~tro Tl__t~ 12. TEST RESULTS as detailed on attaclied test charts with results as follows: Tank Identification Tight Leakage Indicated Dat'e~ested 91 ~'~est Yes +. 025 ~2 Center yes -. 031 t/.17/.87 ~3 ~.~-~ Ye~ -.017 1~17/87 13. CERTIFICATION 6/26/86 Date 1563 - Serial No. of Thermal Sensor This is to cartier that these tank systems were tested on the date(s) shown. Those indicated as "Tight" meet the criteria established by the National Fire Protection Asociation Pamphlet 329. Mike Redenius National Tank Testing, In .~__~_~' .~ 4 f~~ ~ ~.~.st~n~]..Contractor or Company. By: Slgnatu · Bob Earnshaw ..L~U ~ ~or~ Rd Technicians Address Kern County Health Department -Divi-sion-o£ Environmental Health 1700 Flower Street, Bakersfield, CA 93305 Application Date APPLICATION FOR PERMIT TO OPERATE UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY Type of Application (check): [-]New Facility [~Modification of Facility ~Existing Facility [~Transfer of Ownership Emergency ,4-Hour Contact (name, area 'code', phone), Days ~~,. i*~1~4~. ~ ~_~ Nights Facility Name l~elim~¢_~ NO. of Tanks Type of Business (check)i -[~Gasoline' Stat[on ~(~cher (describe) Is Tank(s) Located on 'an Agricultural 'Farm? [']Yes ~No Is Tank(s) Used Primarily for Agricultural Purposes? []Yes [~No '~acility Address q,~,~ ~D[~l ~- ~3'~ Nearest Cross St. T R SEC (Rural Locations Cnly) &~f-~ Owner Lo~'g~¢u ~ue~' ~ D~A~o~ ~ Contact Person Address -;~0~P~.~,~ ~ ~k~.' Zip ~o~ Telephone .~g-.~[~ ~OWl)I~_J~ Rlc~fd k,/~u, fa. Contact Person q2)~ · .Address ~d0~ 0~da.~4--. 'l'~k.~ ZiP 9%30~ Telephone ~B~!i.'Water to Facility Provided by ~ ~'&~ ~0~ ~, Depth to' Grour~lwater Soil Characteristics' at Facility' Basis for Soil Type and Groundwater Depth 'PetenUinati°ns Contractor ~[~ ~. p~D~M~ Address ~'~00 ~O~D~I.~_ Hi~)V Proposed ~tar~in~ Date / Worker's C~~ti~ Certificatf6~ ~ CA Contractor' s License No. '~/~-' Zip 4~g~Z Telephone '" ~~ Ccmpletton Dete I~ ~'~- / '~/:~ Insurer Ce If This Permit Is For Modification Of An Existing Facility, Briefly Describe Modifications Proposed De OTank(s) Tank Store (check all that apply): %~aste Product Motor Vehicle Unleaded Regular Premium Diesel Waste' ~-uel " "' -'~ '"' I o [] [] O [] O Fe Cheuical Composition of Materials Stored (not necessary for motor vehicle fuels) Tank ~ Chemical Stored (non-co~uercial name) C~_c ! (if kn=~n) Chemical Previously Stored (if different) m G. Transfer of Ownership ,-' Date of ~-ansfer Previous Owner Previous Facility Name I, modify or terminate the accept fully all obligations of Permit No. __ issued to · I understand that the Permitting Anthority may review and transfer of~ the Pemit to Operate this ~derground storage facility upon receiving this c~mpleted form. This fca has .beep_~completed under penalty of true and cor.~. ~ pe£~ury and to the best of my knowledge is 1700 Flower Street RN COUNTY HEATH DEPARTM ~ Bakersfield, California 93305 ~lephone (805)861-3636 ENVIRONMEN~L HEATH DIVISION T O O P E R A T E UNDERGROUND HAZARDOUS SUBSTANCES STORAGE FACILITY FACILITY: I OWNER: DELIMART ] MEYER, GREGORY & DIANA 9628 ROSEDALE HIGHWAY I 9628 ROSEDALE HIGHWAY BAKERSFIELD, CA I BAKERSFIELD, CA 9331-2 HEALTH OFFICER ! Leon M Hebertson, M.D. DIRECTOR OF ENVIRONMENTAL HEALTH Vernon S. Reichard PERMI T~3 8 O0 1 2 C I S SUE D : JULY 1, 1986 g MM I RE S .~ULY 1, 1989 NUMBER OF TANKS= 3 TANK # ~lIN yRS1 SUBSTANCE CODE PRESSURIZED PIPING? 1-3 UNK MVF 2 UNK NOTE: ALL INTERIM REQUIREMENTS ESTABLISHED BY THE PERMITTING AUTHORITY MUST BE MET DURING THE TERM OF THIS PERMIT NON--TRANSFERABLE *** 'POST, ON PREMI SES DATE PERMIT MAILED: SEP 0 6 1,986 DATE PERMIT CHECK LIST RETURNED: PLEASE PRINT 1. OWNER PtoperW [] Tankl~) [] Data l l):.rt for Tank System Tigh )-- s ............. petro Ti_t TANK TESTER Test Delimart 9628 Rosedale Hwy. Greg ~yers 589-5640 Name Address Representative Telephone Name Addr~'$[ Bepreeentatwe Telephone. 2. OPERATOR' 3. REASON FOR TEST (Explain Fully) 4. WHO REQUESTED TEST AND WHEN 5. WHO IS PAYING FOR THIS TEST? -6. TANK(S) INVOLVED 7. INSTALLATION DATA 8. UNDERGROUND WATER 9. FILL-UP ARRANGEMENTS 10. CONTRACTOR, MECHANICS, any other contractor involved 11. OTHER INFORMATION OR REMARKS 12. TEST RESULTS 13. CERTJFICATION 6/26/86 1563 Sens~ Test requested C~r~g Meyers - Delimart 12/13/86 Name Title Company or Affilia#orl Pate 9628 Rosedale Hwy. Address Telephone Company. Agency or Individual Person Autholizi~lg Title Telephone Billing Address City State Zip Identify by Direction fl West ~2 Center ~3 East Capacity 12,000 12,000 12,000 Brand/Supplier Texaco Texaco Grade Regular Unleaded Prm. Unld. Approx. Age 5 yr. 5 yr. 5 yr. i Steel/Fiberglass Steel Steel Texaco Steel Location N North inside driveway, Rear of station, etc. Cover l=Concrete ".2=Concrete 3=Concrete Concrete, Black Top. Earth, etc. Siphones Vents Size. Manifolded Flills 4" 4" 4" Size, Titefill make, Drop tuOes, Remote Fills Pumps Remote Remote Remote Suction, Remote. Is the water OVer the tank? Depth ,o the Water table -- 0 ~ [] Yes ~ No Tanks to be filled ~ hr, Date Arranged by Name Extra product to "top oil" and run TS'Ca'. How and who to provide ? Consider NO Lead. Telephone Terminal or other contact for notice or inquiry Company Name Teleprione Tank Testing, Inc. Additional information on any items above. Officials or others to be advised when testing is in progress or completed. Visitors or observers present during ·test etc. Tests were made on the above tank Systems in accordance with test procedures prescribed for petro T~_te as detailed on attached test charts with results as follows: ,~, ,i~;~ Tank Identification I Tight Leakage Indicated ~.1 $'~es t C~) Yes +.025 ~2 Center .(U~ Yes -.031 ~3 W.~.~ t (.P'¢, EN~\ I Yes -.017 Date Tested 1'/-17/87 1717787 This is to certify that these tank systems were tested on the date(s) shown. Those indicated as "T~ght" meet the criteria established by the National Fire Protection Asociation Pamphlet 329. . .//'~ ~ / Mike Redenius ' National Tank Testing., In/~_~~ ...... Tesu~_Conrtactor of CoreD&ny. By; Sl~n;'lul~ / ~J Bob Earnshaw 14u ~: Norris Rd · · Bak~r_~fi~] d: CA 14. Delimart 9628 Rosedale Hwy. 12/13/86 Dale of Test Name of Supplier, Owner o! Deale! Address No. and Slfeel(s) Bakersfield, CA. . Cil¥ Siate 15. TANK TO TEST #1 West Idenlit¥ by position Bland and Glade 16. CAPACITY Nominal Capacity 1 2, 0 0 0 Gallons IS there doubt as to True Capacity ? [] See Section "DETERMINING TANK CAPACITY" By most accurate capaciW chad available 11, 9 07 Gallons From i 'J Station, Chart I Tank'~danulacturer's Chart i. ] Company Engineering Data ~ Charts supp;ind wi,h peer9 Tale L] giber 17. FILL-UP FOR TEST Stick Water Boftom before Fill-ulp -- 0 -- --0-- Inventory to ~ In. Gallons Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY OUANTITY Tank Diameter 9 6" Product in lull tank (up to fill pipe) Stick Readings to ~ in. 96" Water Top off Gallons Total Gallons ea. Reading 11,907 --0-- +20 11,927 ~Z 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK API Gravity 55.8 Temp. 50 ° See manual sections applicable. Check below and ,ecord p,ocedure in mdg (26). Corrected AP I Gravity 57.0 [] Water in tank [] High water table In tank excavation [] Line(a) being teated with LVLLT VAPOR RECOVERY SYSTEM D Stage I [] Stage II 0 0 I 19. TANK MEASUREMENTS FOR TSTT ASSEMBLY BoUom of tank to Grade* .................... 15 3 ,, Add 30" for 4" L ................. Add 24" for 3" L or air seal ....... " 180 ,, Total tubing to assemble Approximate ........ 20. EXTENSION HOSE SE]q'ING Tank top to grade'. ................................. 5 7 " Exlend hose on suction tube 6" or more 10 . below lank lop ..................................... '11 Fill pipe extends above grade, use top of till. 27. DAZE liME (24 hr.) 1700_ 21. TEMPERATURE/VOLUME FACTOR (al TO TEST THIS TANK Is Today Warmer? I I Colder? ~ ] __° F Producl in Tank __° F Fill-up Ptocluct on Truck __° F Expecle0 Change ( + or - ) 22. Thermal-Sensor reading after circulalion · 119 91 5 8 o / 5 9° oF d,g~ts Nearest 23. Digits per °F In range of expected change 318 d~gds 24'. 11,927 x .00059230 total quantity in coeflicienl of expansion for tull tank (16 or 17) involved product 25. 7 · 0643621 ~. 318 30. HYDROSTATIC LOG OF TEST PROCEDURES PRESSURE CONTROL 28. 29. Standpipe Level · Record details of setting up in Inches Readms __ '~ ' 8 6 and running test. (Use lull No. Beginning Lev,l to length of line if needed.) I gl which · ' / Reading Restored / Arrived test location '.1,:,~,:~:ll-~,~ -c;-vF. ~;~ ,--~.; r',,~ ,t-.,~,~,'F,'m ,-,,,i ~n:~ .'-~ volume change per °F (24) Digits per °F in test Range (23) 31. VOLUM[ MEASURiMEMFS fY) RECORD 10.0~l GAL, 32. Product in Graduate Product fl,plec,d (-) Bolero Altar Product Reading ReadiAg Recovered ( 34, 35. Thermal Sensor Reading I[MPERUURE C0MPER,U, IION USE FACTOR Em) 36. 37. Change Computation Hioh'l + I Icl x (al = LU~c~r - = 7.0643621 g.ito,s volume change in thai tank per °F .22214975 Volume change per digit. Compute to 4 decimal places. 38.NET VOLUME 39. CHANGES ACCUMULATED EACH READING CHANGE Temperature At H,Ih La~el record Adjustment. total [ad Deflection Volume Mmus Expansion ( + ) Or At Low Level compute Contraction (-) Chaale pr Root' //33(V)- #37(T) (NFfl criteria) This is tea, . 0222 Factor (al 27. 28~- 29. st,,dpip, L,,,I 32. Product in Product 35. 36. 37. ]tmpelalufe At High I. aval record Change Computa6on Adiustment [oral [nd Dlllection g~J[ Record details of setting up needing in Inches Graduate Replaced (-) Thermal Higher + (c) x (a) = Volume M~nus " and running test. (Use full No. Beginning Level to Saflsoc Lowal - Expansion + Expa,3sion (+) or Al Low Level compute 2./_.1~ ' 8 6 length of line if needed.) gl which Before After Product Reading (c) Contraction - Conlraclion (-) Cha,,le per Hour TIM[ (NFPA crileria) (~'4 b.j Reading Restored Reading Raiding Recovered (+) #33(V)- #37(1) .... I I A Fact¢ r . 0222_ 17~ Arrived test location Set' up test equipment with 12" mark set ~t 39" above rade _ 20_Q~Pump primed and running fol~ ci .~cula~ion 210/k Started high level test. 42 11991 2115~Cont'd high.level test 1 33.2 42 --990 .450 -.54'0 12032!-.---+41 +.910 -1.450 2130 " " " 2 32.0 42 . .930 .260 -.670 12050 +18 +.400 -].070 2145 " " " 3 32.0 42 1.000 .320 -.680 12065 +15 +.333 -1.013 2200 r, " " 4 35.0 42 1.000 .620 -.380 12080 +15 +.333 - . 713 2215 ,, ,r , 5 36.2 41 .620 .330 --.290 12095 +15 +.333 -- .623 A factor 2230 ,, ,~ ,, 6 38.8 42 1.000 .850 -.150 12110 +15 +.332 - .482 chanqed 022~~ 2245 " " " 7 40.2 42 .850 .780 - 070 12122 +12 +.265 - .335 1.2.300 ,, ,, ,, 8 42.5 42 .780 .780 .000_ ]21 30 + 8 +.]77 + .177 2301~ Drop to low level test 2305 Started low level test 12 12132 2320 Cont'd low level test 9 14.0 12 .780 .870 +.090 12137 + 5 +.111 - .021 -.021 2335 " " " 10 20.0 12 .330 .770 +.440 12155 +18 +.398 + .042 +.021 2350 " " " 11 16.5 12 .770 .970 +.200 12163 + 8 +.177 + .023 +.044 " 2405 " " " 12 16.0 12 .770 .950 +.180 12172 + 9 +.199 - .019 +.025 Tank -estef~ tiqht +.025_(PH Lines test~.d t'iqht 12/13, 86 14. Delimart 9628 Rosedale Hwy. Bakersfield, CA 1/17/87 Name of SupplieL Owner of Dealer Address No, and SIleerts) City Stale Dale gl Tesl 15. TANK TO TEST __~2_CanJ~ e r Identily by position Unleaded 16. CAPACITY Nominal Capaci,~ 1 2,0 0 0 Gallons Is there doubt as to True Capacil¥? [] See Section "DETERMINING TANK CAPACITY'* By most accurate capacity chart available~l,L~.O 7 Gallons From i ...] Tank hianufaclurer*s Chart Company Engineering Data ;.~ Charts supplied with pelto TIt__e 17. FILL-UP FOR TEST Stick Water Bottom : before Fill-up -- 0 -- '" -- 0 -- to '/s In. Gallons : Fill up. STIcK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY Inventory Tank Diameter 96" Product in full tank (up to fill pipe) SLick Readings lo I/a in. 96" Water Top off Gallons -0- Total Gallons ea. Reading 11,907 --0-- +!0 -18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK API Gravity 55.0 See manual sections applicable. Check below and record procedure in log (26). Tamp. 3 9 o Corrected API Gravity 57.6 [] Water In tank [] High water table In tank excavation I-~ Line(s) being tested with LVLLT VAPOR RECOVERY SYSTEM [] Stage I [] Stage II 19. TANK MEASUREMENTS FOR TSTT ASSEMBLY BoUom of tank lo Grade* .................... 1 5 3 ," Add 30" for 4" L ........... Add 24" for 3" L or air seal ....... " Tolal tubing to assemble Approximate ........ 1 7 0 ,, 57 20. EXTENSION HOSE SET[lNG Tank top to grade* .................................. Ex~end hose on suction tube 6" or more below lank top ................... ~ ................. i 0 'Il Fill pipe extends above grade, use lop of fill. 26. LOG DF TEST PROCEDURES 27. 128. o~Jl / ' Record details of setting up , 1/ 1 '7/]~ '7 and running test. (Use full " ' length 0l line if needed.) 0500 I Arrived test location '9510Jl Measured for water on bott 30. HYDROSTATIC PRESSURE CONTROL Standpipe Level in Inches Beginning Level to 21. TEMPERATURE/VOLUME FACTOR (a)TO TEST THIS TANK Is Today Warmer?; J Colder? { I --° F Product in Tank __° F Fill*up Product on Truck __° F Expected Change ( * or *- ) 22. Thermal-Sensor reading after circulation 1.0 079 52 ~ / 53 o °F d~g,ls Nearest 23. Digits per °F in range of expected change 3 0 7 dig~tS 24. 11,917 x .00059656 = ~.L0~)~.52 gaRo.s total quantity in coefficient of expansion for volume change in this tank full tank (16 or 17) involved product per "F 25. 7. 10920552 .... + 307 volume change per °F (24) Digits per °F in test Range (23) .023157021 Volume change per digit. Compute to 4 decimal places. This is test factor (a). 0 2 3 2 31. VOLUME MEASUREMENTS RECORD 10.001 GAL. 34. 35. 32. P,oduct in Product Graduate Replaced (-) Thermal SlnsOf Before After Product Reading Reading Reading Recovered (+) IEMPERUURE COMPENSATION USE FACIOR (a) 36. 37. Change Computation Higher + (c) x (al = Lower - I Expansion + (c) [ Contracliofl - 38. NET VOLUME CHANGES [ACH READING Tlmpltaturl Adia~tmsnt Volume Minu~ Expanspon ( + ) or Contraction ( - ) ~33(V) -- #37(1') A Fact 39. ACCUMULAIEO CHANGE at Hilh Level record lotal [nd Deflection At Low Level compatl Change pit Hoar I#FrAu~aria) )r = .02 ;2 gUN I ItOL 27. ;28. :29. st,,dpip, t,v,f 32. Product iA Product ' 35. 36. 37. hmp,,,t,,, At in laches Change Computation Adjustment Iota! End Deflection OAT! Record details o! setting up Readind Graduate Replaced (-) Thermal Riohef + (cI x fa) = Volume Minus &t Low Level compute 1/12 8 7 and running test. (Use full Ilo. 8oginninO Lovol to Sonso, L .... - Expansion + Expansion (+) or " liNE lenoth of line if needed.) of which Before After Product Reoding (c) Contraction - Contraction (-) (:haole per Hour (N k~.l Reading Restored Reading fleodino Recovered (+) #33(V)- d~37(T) (NI:PA criteria) I A 'Fact }r = ..02_;2 ]500 Arrived test location ]510 Measured for water on bottom ~ f ta]~k ' __ 15J_5_ $~ t~p ~_~s~ ~quipm~n~_ ' ' ]545 Pump primed and running f(r c rculi.tion _ ]645 Start high level test " 42 10079 ]700 Cont'd hiqh level test 1 39.0 42 .790 .530 -.260 101.'02 +23 +.534 -.794 )715 " " " 2 40.0 42 .530 .340 -.190 10103 + 1 +.023 -.213 ]730 " " " 3 40.5 42 .930 .790 -.140 10110 + 7 +.162 -.302 ]745 " " " 4 41.2 '42 .790 .740 -.050 10119 + 9 +.209 -.259 )800 ,r " " 5 41.5 42 .740 .715 --.025 10121 + 2 +.046 --.071 J815 " " " 6 42.0 42 .715 .715 .000 10135 +14 +.325 --.325 0830 " " " 7 42.5 42 .715 .750 +.035 10148 +13 +.302 --.267 0845 " " " 8 42.9 42 .750 .810 +.060 10152 + 4 +.093 --.033 0846 Drop to 12" .level 0850 Start low level test 12 10160 0905 Cont'd low level test 1 14.0 12 .340 .510 +.170 10167 + 7 +.162 +.008 +.008 0920 " " " 2 13.8 12 .510 ' 645 +.135 10173 '+ 6 1+.139 -.004 +.004 0935 " " " 3- 13.9 12 .190 .340 +.1501 10180 + 7 +.162 -.012 -.008 0950 " " " 4 14.0 12 .340 .470 +.130 10186 + 6 +.139 -.009 -.017 Tank leste( tiqht -.017 G?H Line %ested tiqht 1/17/87 14. Delimart 9628 Rosedale Hwy. Bakersfield, CA 1/17/87 o? O Name of Supplier, Owner or Dealer Address No. and Street(s) 16. CAPACITY 15. TANK TO TEST ~ 3 East Idnnlity by position Unleaded Premium Brand and G~ade Nominal Capacity ] 2: ~ {"J 0 . Gallons IS there doubt as to True Capacity ? [] See Section "DETERMINING TAHK CAPACITY" capacity chart available 11,907 Gallons Slate Date of Test From ~*~ S,a,ion Char, [:~] Ta.k Ma.u0ac,u,e,'s Cha,, [~.-~ Com'p,any Engineering Da~, ~ Charls supplied with ~tro ~ Other 17. FILL-UP FOR TEST Stick Water Bottom before Fill-up -- 0 -- -- 0 -- to V. in. Gallons Inventory Flil up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUAN. TITY Tank Diameter 96" Product In tull tank (up lo fill pipe) Slick Readings to ~ in. 96" Water Top off Total Gallons Gallons ea. Reading -0- 11,907 +11 11,918 * 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK API Gravity 51.8 Temp. 55 ~ See manual sections applicable. Check below and record procedure in log {26). Correc ted AP I Gravity 52.4 [] Water in tank [] High water table In tank exc,vaflon [] Uae(s) being re,ted with LVLLT VAPOR RECOVERY SYSTEM [] Stage I [] Stage II 19. TANK MEASUREMENTS FOR TSTT ASSEMBLY Bottom of tank to Grade*.: .................. 1 5 2" Add 30" for 4" L ................. Add 24" for 3" L or air seal ....... Total tubing to assemble Approximate ........ 17 6 20. EXTENSION HOSE SET[lNG 5 Tank lop to grade'. ................................. O Extend hose on suction tube 6" or more 1 Q below tank top ..................................... 'If ~:ill pipe extends above grade, use top of fill. 26. LOG OF TEST PROCEDURES 21. TEMPERATURE/VOLUME FACTOR (a) TO TEST THIS TANK Is Today Warmer? IJ Colder? [ ] __° F Product in Tank __° F Fig-up Ptoducl on Truck __° F Expected Change ( + or - ) 30. HYDROSTATIC · PRESSURE CONTROL Thermal-Sensor reading alter circulation d~g,ts Digits per °F in range of expected change 313 10923 55°/56° °F 11918 total quantity in tull tank (16 or 17) X digits .00055964 coefficient of expansion for involved product 6.66978952 + 313 volume change per °F (24) Digits per °F in test Range (23) Nearest 31. VOLUME MEASUREMERTS RECORD TO .001 GAL. = 6.66978952 ge,,o.a volume change in this tank per °F · 021309231 Thiu iS Volume change per digit, test Compute to 4 decimal places, factor (a) 34. FEMPERAIURE COMPENSAIION use EAClOR (a) 38. NTT VOLUME CHANGES EACH READING 39. ACCUMULATED CHANGE 27. 128. PATE / Record details of setting up /17/ ~ ,-7 and running test. (Use full ~ ' length 0f line if needed.) TIME. I ]125 Ipump primed and runninq I LL3.0_lS.tar_ted_cir. cula.t ion 29. Standpipe Level in Inches Reading I Restored :.Ia;; 32. P,oduct in · Graduate Ralora Alter Reading Reading ~ipe at 42" Product Replaced (-) Product Recovered (+) 35.' Tharmal SlfllOt Roadiog 40 3 A.G. 36. 37. Chan0e Computation Higher + I (c) x (a) = Lowar - I Eapantio. + (c) B Coniraclion - 1 Adjuetment Volume Minus Expansion (+) et Contraction (-) # 33(v) - ~,37(1) A Fact~ At H~tll Level record total End Oeflection Al Low Level compute ChaflSO per Hour (NTPA criteria) r .0213 0212 · If Fill pipe extends above grade, use lop of fill, J Range (23) Compute Io 4 decimal places, lacier (a) 26. 30. HYDROSTATIC 31. 34. 38. NET VOLUM( !39. LOG OF TEST PROCEDURES PRESSURE ' VOLUME MEASUREMENTS tV) IEMPERAIURE C0MPER~IION CHANGES ACCUMULATED CONTROL RECORD I0.001 GAL. USE EACTOR la) EACH READING . CHANGE 27: 28. 29. Standpipe L,v,I 32. 35. 36. 37. Temperature ' At Hath Level record Product in Product Change Computation Adjustment lelel End Deflection E Record details of setting up ieedinl in Inches Graduate' Replaced (-J Thermal Higher + (cJ x (el = Volume Minus ~ 7 and ~'unning test. (Use full Do. Till[ length of line if needed.) BeginningLevel to SeAlol Lower - Expanaion + Expansion (,,) or At Low Level compute of which Before After Product Beading (c) Contraction -Contractmn (-)ghiflle per Hour (;4 ~.) Reading Restored Reading Reading Recovered (+) ~,33{¥) -- ~37(1) INFPA criteria) _____ I ~ Fact(r .0213 112~5 Pump primed and running ;e~ s2and ~ipe a! 42" m~rk 40. 3 A.G. ~ ~_tarted circulation [215 Fi___rst sensor reading 42 10923 [230 Started high level test 1 39.1 42 .920 .700 -.220 10932 + 9 +.192 -.412 [24____5_5 Cont'd high level test 2 38.9 42 .770 '~580 -.190 10944 +12 +.256 -.446 [300 " " " 3 38.5 42 .990 '.810 -.180 10947 + 3 +.064 -.244 L31____~5_ ,, " " 4 38.2 42 .810 .640 -.170 10952 + 5 +.107 -.277 L33___~0_. ,, " " 5 39.6 42 .990 .910 -.080 10961 + 9 +.192 -.272 [_3_45__ " !' " . 6 40.6 42 .910 .840 -.070 10970 + 9 +.192 -~262 ~400 " '~ " 7 41.6 42 .840 .820 -.020 10973 + 3 +.064 -.084 .415 ,, ,, n 8 42.0 42 .820 .820 .000 10975 + 2 +.043 +.043 .42___~0Dropped .bo i]:2" ma'~.k 12 10983 ~L3~Low level test.cont'd 1 12;1 12 .250 .255 +.005 10984 + 1 +.021 -_.O16 -.0t6 .4~ " " " 2 12.4 11 .255 .275 +.02( 10985 + 1 +.021 -.001 -.017 ~505 ' " 3 12.]1 12 .275 .285 +.01£ 10986 + 1 +.021 -.011 -.028 .52_~0 ,r " " 4 12..S 12 .285 .325 +.04( 10988 + 2 +.043 -.003 -.031 .. Tank :este~ tiq_ht -.031 ;PH 0213 METER CALIBRATION CHECK FORM Facility: Note: 1. 3. 4. 5. DELIMAR'Ti g~28 ROSEDALE HWY. Permit # ~0 I 2- 0 All 'meters must have calibration checks a minimum o__f_f twice ~ year, which may include checks done by the Department of Weights and Measures. Before starting calibration runs, wet the calibration can with product and return product to storage. Run 5 gallons with nozzle wide open' into the can. Note gallons and cubic inches drawn, and return, product to storage. Run 5 gallons with the nozzle one-half open into the can. Note gallons and cubic inches drawn, and return product to storage. After all product for one calibration check is 'returned to storage, remember to record the volume returned to storage tn column 9 of the Inventory Recording Sheet. If the volume measured in a 5-gal.lon calibration can is more than 6 cubic inches above or below the 5-gallon mark, the meter requires calibration by a registered device repairman. q Hose or Tank #/: Fast Flow Slow Flow Volume RetUrned Calibration DeviCe Repairman Date of Date/Time Pump # Product! 5-Gallon Draft 5-Gallon Draft to Storage Required? Used for Calibration Gals Cu. Inches Gals Cu. Inches Gallons Yes No Calibration 7 ~. ~ + z s~ ~ z ~ o.o k. eft. q S,BMIT A COPY OF TillS FORM WITH ANNUAL REPORT. Location Serial Number Make and Model I Meter Change Contractor Coml3uter Change. [] W/M Notified Tagged I Tag a~ [] Red []Green []Blue :Record 'Of Computer Or Meter Change Totalizer Product Totalizer Readings Finish (money~) ~ Start (money) i Make and Model Finish (gallons) Star~ (gallons) Return tO Storage (gallons) Finish (money) Start (r~o~ev) Serial Number Finish (gallons) Start (gallons) Product Totalizer Readings Product Make and Model Finis~ .(moneyj Start (money) Return to Storage (gallons) Serial Number Finish (gallons) Start (gallons) Return to Storage (gallons) Serial Number Checked ~ Adjusted Fast , Slow To Totalizer Sealed I Meter Sealed Tagged Tag ae [:]Red []Green- •Slue Calibration: Checked Adjusted To F as( ' Fast TaggedT°talizer[]yesSeated []No []Red []Green []Blue Calibration: Fas~ Checked c~ F asr Adjusted S,ow' / Meter Sealed· ~--~ Yes [] NO Tag ~ ISIow Slow Totalizer Sealed Meter Sealed r-] Yes [] NO [] Yes [] NO Make and Model Totalizer Readings, Finish-(money) cf: o Start (money) Finish (gallons) Start (gallons) I--~ Red I--IG teen [--~Blue calibration: Fast Checked Fast Adjusted Tag ~lr I ,ow / Slow Product Totalizer Readings Product Make and Model Finish (money) Start (money) Totalizar Readings Make and Model Product Dealer's Signature Distribution: Re',urn to Storage (gallons) '5'o Serial Number Finish (gal??s) Start (gallons) .<-~ Return to Storage (gallons) Serial Number Finish (gallons) Start (lonely) Start (gallons~) Return to Storage (gallons) Totalizer Sealed Meter Sealed r-[ Yes f-[ NO [] Yes Tag []Red[]Green nBlue calibration: Fast I Slow Checked .-~9 Adjusted Fast To Totalizer Sealed [] Yes ['-] No Tagged ["]Red ~lG~een It:]Blue Meter Sealed [:::] Yes Tag ~t I o I Slow , CalibratiOn:checked Fast -'. ~-- AdjustedTo I Fast Totalizer Sealed I Meter Sealed E]Yes []No [ I--lYes Signature /~ []No ['"1 No [~No . Location Totllizer Readings Product T~talizer Readings Mek~ and Model Finish (mone~) Start (money) Make and Model Finish (money) '~o Start ( ney) Totalizer Reading~ IStation number Product Serial Number Finish (gallons) pump(~'' Start (gallons) Return to Storage (gallons) Serial Number Finish (gallons) .:~. Start (gallons), Z Return to Storage (gallons) Make and Model Serial Number Finish .(money) '~.'S'-~ Start (money) Make-and Model Finish (gallons} Start (gallons) Return to Storage (gallons) Serial NumDer Finish (money) Finish (gallons) c,/: o ~ ~-..~.. Totalizer Readings Start (money) Product Totalizer Readings Make and Model Pum~'~ Finish (money) Start (money) Product .Start (gallons) Re',urn to ~torage (gallons) 5'0 Serial Number Finish (gal_!9,ns) Start (gallons} Return to Storage (gallons) .. Make and Model Serial Number Pu mp(.~ Finish (money) _. Finish (gallons) moralizer · q' ''~ '-~ .5-- ~ Product [3ealer's Signature . Distribution: Start (gatlons_)~) Return to Storage (gallons) Date Record: of ComPuter Or Meter Change: I~ Meter Change IC°ntract°r . El Computer Change [] W/M Notified Tagged I Tag ~. I I--1Red ' i-'lGreen I Fast ~ ISI°w Calibration: .:?' . Checked ' I Slow Adjusted F.ast To Totalizer Sealed Meter Sealed []--]Yes [] NO [] Yes Tagged Tag ~ [:::]Red []Green. []Blue Calibration: Fast I Slow~ . Checked "]" J "/' AdjustedTo Fast. ~ I S Totalizer Sealed Meter Sealed~ [] Yes [] NO [] Yes. Tagged Tag ~' i-]Red []Green []Blue Totalizer Sealed Meter Sealed [] Yes [] No [] Yes Tagged Tag # [:::]Red []Green []Blue ' CalibratiOn:checked, Fast '~' ~ I Stow, / Fast ~ Slow Adjusted Totalizer Sealed Meter'Sealed []Yes r~No r'lYes Tagged Tag # []Red []Green []Blue Calibration: Fast Slow Checked *'~" '--' Adjusted Fast ............ _~!_O_~w_.__ To Totalizer Sealed Meter Sealed [] Yes [] NO [] Yes Tagged Tag ~ []Red' I--IG~een []Blue Calibration: I Fast I Slow Checked - . Adjusted ] F alt Totalizer Sealed I Meter Sealed Maintena~-& Man's S i g~l alu r · .,~.~,..,-~- ~ . )'-]No ~]No []No []No []No DEPARTMENT OF .WEIGHTS AND MEASURES. COUNTY OF KERN STATE OF CALIFORNIA 1116..East California. Avenue Bakersfield-93307 -'~ Telephone (805) 861-2418 Certificate of Inspectiond 16866 This :is to certify that 'in accordance: with the Iow, I have. tested the scales, weights and measures, said to be the property of, or used by OWNER FORMER NAM~ ~~ ~ aa NO. DESCRI~ION AND R~ARKS ~" ~ ~ / tiM[ x ". I~ ,r' , R; ~IME AGENT OF OWNER OF pROPERTY INSPECTED1  . out Vernon L Lowe, Director r.: A DE~ / INS~O ~'~.. CUoTOI'IER '-'"'~ '-'- ..... - *1~0835 10:57 i~f'1 .1 I-1;3-87'-' HOSE ~ .............. 05 PRODUCT .............. 2 PER G~LLON ...... $0.85S: GRLLONS ........ 0 t 0. OOC, TOTAL C:SH S~,LE... ~0008. C:USTOMER '-'""' "-':~ ""-'- one,-.- RECEir ~ ~0854 10:40 ~M II ~'-' '-'~' HOSE ~ .............. 07 PRODUCT .............. 2 PER G~.LLON ...... T[]T~L C:SH SALE... :;0OO8 · 5'.;: DELIM~RT 'g%00 ROSED~LE HWV. 8~KERSFIELD, C:~. 93308 STATION ~0000000t ~_.U- T0,1:¢. :~RLES RECE~r, ~''''''' ~0832 10: .']~=,.: ~ ~'1 I 1-18-o,':'-' HOSE ~f .............. 02 PRODUCT .............. 2 ~ ~.. G~LLDH ...... '*-: .-~.-'.? G~LLDNS ........ 0 ~ 0.00 TOTAL C:SH SALE... '~O00S. 5'.;' DELIM~RT 9600 ROSED~LE HbY¢. BSKERSFtELD, C:~. 95308 ST~TIDH ~0()000001 HOSE ~ .............. PRODUCT .............. PER G~LLOt4. ~'-' ~--'~, TOTAL CSH [.-,EL I MC~F.'.T B~KER'.BF I ELD.- C:F~. ,- .... ~"~ RECEIPT C:USTOflER o~Lr-~ ~0845 II:08 ~M 11-I~-87 HDSE ~) ......... ' ..... CIG pRf]DUCT .............. PER G~LLDN ...... $0. ? ~'.;: G~LLONS ........ 0 ~ 0. 000 TDTC~L CSH SHLE,..$000'7':. I'.;' CUSTDMER '-'""' '""'- .... ~ .... on=.,-._~ ~,-- _.,-. ~ p-f' ~0838 10:51 ~M i~-18-87 Hr]o,- ~· · ......... -...,_,.~ PRODUCT .............. I PER GRLLDN ...... :~0. ';:!'?. G~LLDNS ........ 010. OC 0 TOTRL '-"-" . . -~,..,~ .... ..-. "..:: .... -~H SF~LE. '*"-"-"-'"-' ' I [)EL I .... ; I ~,m.: T :.:'GOCI ~-' ':q .... ~, ,-- 8~KEF..::DF I ELD., C:~.. :3T~T I ON '"' - .... ,,-,- - - ,, CU'STDMER S~LES REC:EIPT ~0841 10:5';, ~t'l 11-i'-' - HOSE ~ PRODUCT .............. PER G~LLBH ...... $0. 719 G~LL,~NS ........ 0 t 0.00 TP, T~L F:SH E."EL '""' "' = " '..';'G 0 fi RD'-~EE; ...... '-=,~k,E~.:."_~F I ELD., C:F~. STF~T I Dht .... . - -; - CUSTrlMER SF~LE:3 #0842 REL-:E I F'T HF1SE :~ ............ 0'.-.-: PRnD~ ~C'"' ' ' PER ~RLL~N ...... RL,_,']N~ F~ i F~. CiO0 TDTF~L C.':~H SF~LE *--'-- - - · . sL[L:Lr.~:. I '~ ...... ._~L. =.._-, RECEIPT C. UoTO~IEn. ' ..... '-"' 1 1: 15 AM i 1- ~,_-~-~.' '-' q'~, HDSE~ .............. 08 PRODUCT .............. 3 PER GRLLDN ...... $1.019 GALLONS ....... '.0!0.002 TOTAL CSH SALE...$OOIO. I'D [)EL I MART '.---'600. ROSED~LE ..... BF~KERSF i ELI), C.:P~. '.-.-'3508 STAT t DN. ~O'C~OC~00C~ i C:USTDMER S~LES. ~:_.=~ ,'-'~l ~0844 ii: I2 ~M 11 '- '-~ HOSE ~ .............. 05 ,- RD[; L,L. , ............... -, PER G~LLO~'-I ...... $ ~' , 01 '~; GALLONS ........ 010. 002 TDTF~L C:SH SF~LE...~0010. 19 S: 0 Vaul ted O~n-Vaul t~t O~uble-Wal 1 ~Si~le~al 1 ,ate~ ial tr~n Steel ~ Stainless Steel ~ ~l~inyl Ctaoride ~ Pi~rglass<l~ Steel ~rolass-Reinfiorc~ Plastic ~Concrete ~in~ ~Bronze her (descr i~) X Contai~nt c~ess ~nstalled ~i ~" (Inches) Ca.city (Gallons) ~nufact~rer 12 00 _ ,econdary Cont'dl ~e~t ~uble-Wall ~ ~thetic Liner ~Lin~ Vault ~..~ne ~o~ ~he[ '(descri~): Manufacturer: ~terial Thic~ess (Inches) Ca.city (Gals.) ~nterior Lini~ ~r ~kyd ~xy ~enOlic ~Glass ~Clay ~lin~ ~o~ ~her (descri~): ~orrosion Protection ~lvaniz~ ~Fi~rgiass-Ci~ ~i~thyle~ Wrap ~Vinyl ~r or ~p~lt ~k~ ~No~ '~Other (de~ri~): ]ic Protection: ~ne ~pres~ ~rrent Syst~ ~crific~al ~e ~ri~ System & Equi~ent: )etection, ~nitori~, and Interception tnk: ~Vis~l .(vault~ tanks only) ~Grou~ter ~nitori~' ~ll(s) :~VadOse Zone ~nitori~ ~ll(s) ~U-T~ Wi~out ~ner ~U-~ wi~ C~tible Liner Dir~ti~ Flow to Monitori~ ~l(s)* ~Va~r ~t~tor* ~ Li~id ~vel ~n~r* ~ Cond~tivit~ ~r ~ Pressure Sen~r in ~ular S~ce' of ~uble Wall Tank ~ Liquid ~tri~al & Ins~ction Fr~ U-T~, Monitori~ ~11 or ~ar ~ily Ga~i~ & I~entory Reconciliation ~Peri~ic Tlgh~e~ Testi~ ~None ~o~ ~her xpi~: Fl~Restricti~ ~ak ~tector(s) for pressuriz~ : ~nitori~ S~p with ~ce~y ~ ~al~ Concrete ~ce~y i~lf~ut C~tible Pi~ Race~y' ~S~t~tic Liner ~y ~Unkno~ ~her ~ri~ ~ke & M~eI: Tightness his ~ ~en Tigh~ess ~st~? ~Yes ~ ~kno~ of ~st Tightne~ Test Results of Test ~e ~sti~ C~ny ~e~ i r ~~? ~Yes ~ ~kno~ s) of ~ir(s) i~ Re. irs ill Protection ~rator Fills,' Controls, & visually Monitors ~vel ~a~ Fl~t Ga~e ~Fl~t Vent Valves ~Auto Shut- Off Controls ~citance ~r ~al~ Fill ~x ~ne. ~o~ her: List ~ke & ~el For ~[~e ~ices derground Piping: ~Yes []No [-]Un.known Material ickness (inches)~t~4 40 Diameter _7~J' Manufacturer [-]Pressure I-]sUCtion - I-]Gravity Approximate Length of PiPe nderground Piping Corrosion Protection : [-]Galvanized [2]Fiberglass-Clad Dlmpressed Current []-]Sacrificial Anode [-]Polyethylene Wrap []-]Electrical Isolation C]Vinyl Wrap []-]Tar or Asphalt [-]Unknown [']None ~Other (describe): _%l)~_~fLO ~/9(tq~.OlL nderground Piping, Secondary Contair~nent': [~]Double-Wall ~Synthetic Liner System ~kNone [2]Unknown ~E~LD ~. ~ 2. Ta~- Rater  Car~n Ste~l ~Stainless Steel ~l~iny~ C~oride ~i~rglass~ S~eel Fi~rglass-ReinEorc~ Plastic ~Concrete ~in~ ~Bronze ~ Other (descr i~) 3. pri~rZ Corita i~nt ~e ~nsta~led ~ic~ess (inches)- Ca.city (Ga~ons) I'z 0 o o ~le-Wall ~ ~thetic Liner ~ Lin~ Vault ~.~ne ~o~ ~Other (descri~): Manufacturer: ~terial Thic~ess (Inches) Ca.city (Gals.) 5. Tank Interior Lini~ ~R~r ~kyd ~xy ~enolic ~Glass ~Clay ~lin~ ~o~ ~Other (descri~): 6. Tank Corrosion Protection G~lganiz~' ~Fi~rglass-Cl~ ~l~thyle~ Wrap ~Vinyl Wra~i~ Tar or ~p~lt ~k~ ~No~ ~Other (de~ri~): . Cath~ic Protection: ~ne ~Press~ ~rrent S~t~ ~crf~iclal ~e ~t~ ~ri~ System & Equi~ent: 7. Leak Detection, ~nitori~, and Interception ~ ~ ~is~l (vault~ tanks only) ~Grou~ter ~nitori~' ~ll(s) ~Vadose Zone ~nitori~ ~ll(s) ~U-T~ Wi~ut ~ner ~U-~ wi~ C~tible Liner Dir~ti~ Flow to Monitori~ ~l(s)* ~ Va~r ~t~tor* ~ Li~id ~vel ~n~r* ~ Cond~tivit~ ~ Pressure Sen~r in ~ular S~ce of ~uble Wall Tank ~ Liquid ~tri~al & Ins~ction Fr~ U-T~, Monitori~ ~11 or ~ar ~ily ~i~ & I~entory Reconciliation ~ri~ic Tigh~e~ Testi~ ~None ~o~ ~her b. Pipit: Fl~-Restricti~ ~ak ~tec~or(s) for Pressuriz~ Pipit' ~nitori~ S~p with ~ce~y ~al~ Concrete ~ce~y ~lf~ut C~tible Pi~ ~ce~y ~S~t~tic Liner ~y ~N~e ~Unkno~ ~her *~ri~ ~ke & M~el: 8. Tank Tightness ~is ~ ~en Tigh~ess ~st~? ~Yes ~ ~kno~ ~te of ~st Tightne~ Test Results of Test Test ~e ~sti~ C~ny 9. Tank Re. ir Ta~ ~~? ~Yes ~ ~kno~ ~te(s) of ~tr(s) ~ri~ 'Re. irs 10. ~erfill Protection rator Fills, Controls, & Visually Monitors ~vel Ta~ Fl~t Ga~e ~Fl~t Vent Valves ~Auto Shut- Off Controls ~citance ~r ~al~ Fill ~x ~ne ~kno~ ~Other: List ~ke & ~el For ~e ~ices Manufacturer 11. Pipers:3 a. be Ca Underground Piping: ayes r-]No [~Unknown Material Thickness (inches)~ Diameter ~.~ Manufacturer · ~ DPressure I-]Suction ' I-]Gravity Approximate Length of Pipe RLI~__ Underground Piping Corrosion Protection : IT]Galvanized I-]Fiberglass-Clad [-]Imp~essed Current [-]Sacrificial Anode [_-]Polyethylene Wrap DElectrical Isolation C]Vinyl Wrap [-]Tar or Asphalt [-]Unknown [-]None ~Other (describe): _~.~?P~_D %~/~L~IL Underground Piping, Secondary Contair~nent: I-]Double-Wall ~]Synthetic Liner System ~None ~]Unkn0wn ~-]Other (describe): DELIMAR1 '¥;e~ ~ (FILL. C)t~'l' :;~C~'AI{ATE F()RM ...:H T~K) ~Kf~ ~~- [~-~'I,'C)~ .... E~H GEt. ION, CHECK ~L APPROPF{IATE BOXES H. 1. Tank is: ~ Vaul t~d ~n-Vaul [~ ~uble-Wal 1 ~Si~le~al 1 2. Tank Mater iai --~Car~)n Ste~l OStainless Steel O~l~inyl C~oride OFi~rglass<l~. Steel Fi~rglass-Reinforc~ Plastic OC°ncrete O~in~ OBronze O~k~ ~Other (desc[i~) 3. Priory Conta i~nt ~ic~ess I ~te Installed- ~'~ (nches) Ca~ci~y~,~ 0 ~ o(~ll°ns) ~nufacturer~oo~ 4. Tank Secondary Cohtai~ent ~le-Wall ~thetic Liner ~Lin~ Vault ~.~ne ~o~ ~Other (descri~): Manufacturer: ~terial Thic~ess (Inches) Ca.city (~ls.) 5. Tank' Interior Lini~ ~R~r ~kyd ~xy ~enolic ~Glass ~Clay ~lin~. ~o~ ~Othe[ (descri~): · 6. Tank Corrosion Protection ~G~ ~ass-Cl~ ~l~thyle~ ~ap ~Vinyl ~a~i~ ' ~Tar or ~p~lt ~k~ ~No~ ~Other (de~ri~): Cath~ic Protection: ~ne ~press~ ~rrent S~t~ ~cri'~'icial ~e ~t~ ~ri~ System & Equi~ent: 7. Leak Detection, ~nitori~, and Interception a. Tank: ~Vis~l (vault~ t~ks only) ~Grou~ter ~nitori~' ~ll(s) ~.Vadose Zone ~nitori~ ~ll(s) ~U-T~ Wi~out ~ner ~U-~ wi~ C~tible Liner Dir~ti~ Flow to Monitori~ ~l(s)* ~ Va~r ~t~tor* ~ Li~id ~vel ~n~r* ~ Cond~tivit~ ~r' ~ Pressure Sen~r in ~ular S~ce of ~uble Wall Tank ~ Liquid ~tri~al & Ins~ction Fr~ U-T~, Monitori~ ~11 or ~ar ~ -~ily Ga~i~ & I~entory Reconciliation ~ri~ic Tigh~e~ Testi~ ~None ~o~ ~her b. Pipit: Fl~-Restricti~ ~ak ~tector(s) for Pressuriz~ Pipit' ~nitori~ S~p with ~ce~y ~al~ C~crete ~ce~y ~lf-Cut C~tible Pi~ Raceway ~S~t~tic Liner ~y ~N~e ~Unkno~ ~her · ~ri~ ~ke & 'M~el: 8. Tank Tightness ~is ~ ~en Tigh~ess ~st~? ~Yes ~ ~kno~ ~te of ~st Tightne~ Test Results of Test Test ~e ~sti~ C~ny 9. Tank Re. ir Ta~ Re~ir~? ~Yes ~ ~kno~ ~te(s) of ~ir(s) ~ri~ Re. irs 10. ~erfill Protection ~rator Fills, Controls, & Visually Monitors ~vel ~Ta~ Fl~t Ga~e ~Fl~t Vent Valves ~Auto Shut- Off Controls ~citance ~r ~al~ Fill ~x ~ne ~kno~ ~Other: List Make & Model For Above Devices 11. Pipzr~g be Ce Underground Piping: ayes [-]No ~]Unknown Material ~n~ , Thickness (inches)~~_ Diameter ~.~' Manufacturer [qPressure [2]Suction ' F]Gravity Approximate Length of Pipe Underground Piping Corrosion Protection : [-]Galvanized ~[-]Fiberglass-Clad [-]Impressed Current [-]Sacrificial Anode [']Polyethylene Wrap .[-]Electrical Isolation ~Vinyl Wrap [-]Tar or Asphalt [-]Unknown [-]None ~Other (describe): ~ ~O ~)/d/t~ ~.~)l[- /-~l~. Underground Piping, Secondary Contair~nent: [-]Double-Wa]l [-]Synthetic Liner ~stem ~None [-]Unknown [-~Other (describe): PERMIT CHECKLIST Permit # ~:~00 ! z.(~ This checklist is provided to ensure that all necessary packet enclOsures were received. and that the Permittee has obtained all necessary equipment to implement the first phase of monitoring requirements. Please .complete this form and return to KCHD in. the self-addressed envelope provided within 30 days of receipt. Check: Yes No ./ A. The packet I received contained: 1) Cover Letter, Permit Checklist, Interim Permit, Phase Monitoring Requirements, Information Sheet (Agreement Operator), Chapter 15 (KCOC #G-3941),- Explanation of Equipment Lists and Return Envelope. 2) Standard Inventory Control Monitoring Handbook #UT-10. 3) The Following Forms: a)f!nventory Recording Sheet b)v~nventory Reconciliation Sheet with summary on reverse c)~Trend Analysis Worksheet 4) An Action Chart (to post at facility) I Interim Permit Between Owner and SUbstance COdes, B.'I have examined the information on my Interim Permit, Phase I Monitoring Requirements, and Information Sheet (Agreement between Owner and Operator), and find owner's name and address, facility name and address, operator's name and address, substance codes, and number of tanks to be accurately listed (if "no" is checked, note appropriate corrections on the back side of this sheet). C. I have the'following, required equipment (as described on page 6 of Handbook): 1) Acceptable gauging instrument 2) "Striker plate(s)" in tank(s) 3) Water-finding paste D. I have read the information on the enclosed "Information Sheet" pertaining to Agreements between Owner and Operator and hereby state that the' owner of this facility is the operator (if "no" is checked, attach a copy of agreement between owner and operator). E; I have enclosed a copy of Calibration Charts for all tanks at this facility (if tanks are identical, one chart, will suffice; label~qhart, l~) w~ corresponding tank numbers listed on permit).~..' ' '' ' r ~" ,~\~ F. As required on page 6 of Handbook #UT-10, all meters at this facility have had calibration checks within the last 30 days and were calibrated by a registered device repairman if out of tolerance (all meter calibrations mus!-be recorded on "Meter Calibration Check Form" found in the Appendix of Handbook). G. Standard Inventory Control Monitoring was started at this facility in accordance with procedures described in Handbook #UT-10. Date Started 7 ..50 ' ' 27943380 3978 446_ -. :?...,...,, : ,.,- r.~.oA .,1'- ' 49 ' O0 . ' " .... 68, 3478" ' 078.' 79 ':." ~o/.-.:.'...,,',,,,- 4 . 7&.-. ~ 108. 121 . 5! - . &" 58LL '!":'.. '" 1 8 '345 - 395 $$ : ~6221' -' '7].0! .... .572 3900 4 g :~ ...... ~ · 61.4 691. 857' 97& 60 3490' 4231. 4963 557 ].3 433 - 524 · ~7043 · · ' ' 81. ? 4271. 5059 $679 ... ~ ' 582 684 768 952 lO 6L 355 . 8194 i~ ~~~ ~__o_t .L~]! I 6__4 3757 4558. ~_~) ~._~_~! : -'-~': - ~L .~..Lsl ~_s_ 3.~7: ~._~_~!.-~..~]!...o~.~.. ~7c~'-," ~70~' 1142 ~79 1586 1808 .. &). 3952 479I' 5621. - 630? .,,,, ~,,,' · '' lots 4870 :$711 ::. ~ -' !]~.? -'~: "327 t'~ll~ ~8~ _""'~[~)_ -[.F~57 2427 2760 74 4:)82 53].2 6232 ':.': 69~_7 - -.-28 1.292.1.565 1.836 2063 25 2920 75 · /~t.3 $38& 63:t~ -,,mqA ~ 1.927 2t60 26 -~$8 7& _ __'..~ 29 1.353 1.6 . 13 .... '.:.:· · :- 3:5 175421.2) . . -- ' : "" 775)' "9623 "' · 36.. '- 6975 .- 7829 ., 9 . - " 259L. 29]2 36]2 4~& '83 --4860--$891, 691.0~-- · - .-. - - .. 1.82l) 2209- - - .-- 71.0 · 1.1.070 . -" 31 '--1.890229O 2688 301.7 3742 - ~262 84.... ~904 . 59~ - ~-"-' ': 27853t29 :3881. 4~21, 8S . 4951.- 600~ 70~ 7__9~),.-. . :~': 3~ 1.960- 2~7~ - - ' " L >-~' " ' 2~35& 2n:) 32:38 40~ . 4575 86-:- 499:) 605~... 7'0_~_8.._797 "' '" '.' ,." 3~-: ' 2028 . - .... ' '~ · " " O:M, '".~ 996), · 1. ...- --'-. -'" - : 82 33:5L · &LS~i - . 4736 87 - - -$032 ' 609(J 71.55 ~ 8 .... .,.:.-- ~--('~0' 209~J- 2,540~ 29 .. ':' ', '-- · ~' - 9A"- ~' 1.003~J -' .-1.1.450 ".<.' ' ' 262 308t 346L ' · 4293 -. ~684~ ' 8&. · :" '5070 - 61.&-,~ 7200 ... 80 , .-. - :)~. , :'.'il..-'- 21.68. 4~ . - .' ,- --' ' - ~. -10].08 .... ~:~"'- ' ' 271.031.80 3571 .'-4alL--50~)' 8) .... , 51.05: 61.8e 7253.--8 .-. ".-' :'.'::+:. il~ ,-' '-. 5].:38- 622o: ~300... 820) .,: [~-'--' q.~, ~" ...... '- ' . ,' - - ' -~ -" ' ' · · '.. ,. 6 2878 3378 3793 4704r $36,~ 91 - 5168 ' 6264 {349 823 '. - -i -,~' ~ .~__68~__ B' 93-'-'.<~- 5213' 6323:' 7~1.8'"..832~'-'-: t0330_'"..': Permit Questionnaire Normally, permits are sent to facility Owners .but since many Owners live outside Kern County, they may choose to have the permits sent to the Operators of the facility where they are to be posted. Please fill in Permit # and check one of the following before returning this form with payment: I. Send all information to Owner at the address listed on in:~oice (if Owner is different than Operator, it Will be Owner's responsibility with - pertinent Owner at the to provide Operator information). 2. Send all information to following corrected address: S. 1Send all information to Operator: Name: Address: (Operator can make copy of permit Owner). for }~OS~J)gLE H~Y DEC 1 4 1988 EAv/~m?emnta! He~tl'l Div. Kern Cou.ty.H~alth De~t. FAC ILI TY /kblNUAL REPORT Permit ~ 3~00 ( ~C.~ Month/Yz 1. I have not done any major modifications to this facili S i gnatur e Note: All major modifications require a ~ermit to Co ~. I have done major ~odifications for which I obtained Permit(s) to Construct from Permitting Authority Signature Permit to Construct # Repair and Maintenance Summary Date Attach a summary of all: -- Routine and required maintenance done to this facility's tank, piping, and monitoring equipment. -- Repair of submerged pumps or suction pumps. -- Replacement of flow-restricting leak detectors with same. -- Repair/replacement of dispensers, meters, or nozzles. ~F~JF -- Repair of electronic leak detection components, or replacement with same. -- Installation of ball float valves. -- Installation or repair of vapor recovery/vent lines. Include the date of each repair or maintenance activity. NOTE: All repairs or replacements in response to a leak require a Permit to Construct from the Permitting Authority as do all other modifications to tanks, piping or monitoring equipment not listed here. Fuel' Changes - Allowed for Motor Vehicle Fuel tanks Only. List all fuel'storage changes in tanks, noting: Date(s), tank number(s), new fuel(s) stored. Inventory control monitoring is required for this facility on the Permit to Operate, and 'I have not exceeded any reportable limits as listed in the appropriate inventory control monitoring handbook during the last twelve months Signature 1~7, disregard). Trend Analysis Summary Please attach Annual Trend Analysis Summary for the lasl 12 periods. Meter Calibration Check Form Please attach current, completed Meter Calibration Check Form ANNUAL TREND ANALYSIS SUMMARY TANK QUARTER 1 ' I ~ /~7 PERIOD 1:"/ ~ QUARTER 2 PERIOD 4: QUARTER 3 PERIOD 7: TIME'PERIOD: q/ 7 to Total Minuses This Period (Line 3) Action_.NBmber for this Period (Line 4) PERIOD 2: Total Minuses This Period .(Line 3) Action Number for this Period (Line 4) PERIOD 3: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) TIME PERIOD: } to Total Minuses This Period (Line 3) Action Number for this Period (Line 4) PERIOD 5: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) PERIOD 6: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) /O / TIME PERIOD: --~/~ .~ to ~/~ Total Minuses This Period (Line 3) Action Number for this Period (Line 4) //~ 'PERIOD 8: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) PERIOD 9: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) QUARTER 4 TIME PERIOD: ~/~ to PERIOD 10: Total Minuses This Period (Line 3) Action Number for"this Period (Line 4) / PERIOD 11: Total Minuses This Period (Line 3) /~-~ Action Number for this Period (Line 4) PERIOD~12: Total Minuses This Period (Line 3) /~ Action Number for this Period (Line 4) /~ I hereby certify this is a true and accurate repor-[M~ @R~A~ Signature ANNUAL TREND ANALYSIS SUMMARY QUARTER 1 TIME PERIOD: ~/~ q~ PERIOD 1: PERIOD 2: PERIOD 3: QUARTER 2 PERIOD 4: PERIOD 5: PERIOD 6: QUARTER 3 PERIOD 7: PERIOD 8: to Total Minuses This Period (Line 3) Action Number for this'Period (Line 4) Total Minuses This Period.(Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) ActiOn Number for this Period (Line 4) TIME PERIOD: 7~/~, to Total Minuses This Period (Line 3) Action Number for this Period (Line 4) · Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) ~' Action Number for this Period (Line 4) /~/ TIME PERIOD: ~-/~ to Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This'Period (Line ~) Action Number for this Period (Line 4) Total Minuses This Period (Line ~) Action Number for this Period (Line 4) PERIOD 9: QUARTER 4 TIME PERIOD: ~ / ~' to PERIOD 10: Total Minuses This Period (Line 3) Action Number for this Period '(Line 4) PERIOD 11: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) PERIOD 12: Total Minuses This Period. (Line 3) Action Number for this Period (Line 4) I hereby certify this is a true and accurate report~(~R~/.,,' Signature /, ~:"---( ./~[..; //"?f'~o ~ Dar ~. ANNUAL TREND ANALYSI S SUMMARY TANK ~ 3- ~r~ QUARTER 1 PERIOD 1: PERIOD 2: PERIOD 3: TIME PERIOD: PERIOD: to TIME ! Total Minuses This Period (Line S) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) QUARTER 2 PERIOD 4: PERIOD 5: PERIOD 6: / TIME PERIOD: / ~ / ? ~7 to Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) QUARTER a TIME PERIOD: . ~ ' ,to PERIOD ?:- Total Minuses This Period {Line a) Action Number for this Period (Line 4) PERIOD 8: PERIOD 9: Total Minuses This Period (Line 3) Action Number for this Period (Line 4) Total Minuses This Period (Line 3) Action Number for this Period (Line 4) tl7 /¥9 QUARTER 4 TIME PERIOD: /ag/ to / / PERIOD 10: Total Minuses This Period (Line a) /~/' Action Number for this Period (Line 4) / PERIOD 11: Total Minuses This Period (Line 3) /~/ Action Number for this Period (Line 4) PERIOD 12:~Total Minuses This Period (Line 3) / Action Number for this Period (Line 4) / I hereby certify this is a true and accurate report. BAKERSFIELD SERVIC~'"ATION REPAIR . ,23o so. UN,ON Record Of Compute r 24 HOUR SERVICE Or Meter Change · Contractor ~ W/M Notified Make and Mo~el Serial NumOer Tagged Pump ~ ~Red ~Green ~Blue Finish (money) Finish (gallons) Calibration: Fast Slow R~dings Star~(mon;v) Fast Slow ~ Start (g811~ AdiustedTo Product [ Return to Storage (ga(Ions) Totallzer Sealed Meter Sealed i Make and Model Serial Number Tagged Pump~ ~Red ~Green ~Blue t Finish (money) Finish (gallons) Calibration: = Fas~ Slow '" F asr Slow Re~i~s Start (money) Start (gallons) Adiusted Product' Return to Storage (gallons) Totalizer Seale~ Meter Seele~ ~ke and Mode Serial Number ragged Tag Pump~ ~Red ~Green ~Blue Finish (money) Finish (gallons) Calibration: i Fas/ Totalizer ~'/O ~, O Checked . Fast Slow Re~ings Star~ (money) Start (gallons) Adjusted Return to Storage (gallons) Totalizer Sealed Meter Sealed Make and Model Serial Number Tagged Tag PumP ~ ~ReO ~Green ~Blue Finish (money) Finish (gallons) Calibration: Fast~ Slow Fast Slow Readies Start (money) Start (gallons) Adjusted Product Re,urn t~reS~o ge (gallons) Totalizer Sealed Meter Seale~ Make and Model Serial Number Tagge~ Tag Pump~ ~Red ~Green ~Blue Finith (money) Finish (gallons) Calibration: Fast Slow F asr Slow Re~i~s Start {mdney) Start (gallons) Adjusted Product Return to Storage (gallons) Totalizer Sealed Meter Seale~ Me~ ~nd Model Serial Number Tagged Tag Pump~ ~Red ~G~een ~Blue Finish (money) Finis~ (gallons) Calibration: Fast Slow ~ro~uct~ ~.~C~ ~)~/' ~ Return to Storage.~l(gallons)~ IMal .... ~ce ~n'sSio~T°talizer~Yes ~NoSealed !~ IMeter,,,Sealed~Yes . ~No Oealer's ~.i~atu re · Distribution: DAKERSFIELD SERVIC~'q'ATION 1230 SO. UNION AVE., B^K~I~ .D. CA 93307 ' 24 HOUR SERVICE 180SI 327-4659 REPAIR Record. Of Computer Or Meter Change Location IStat,on number Make and'Model Totalizer R#din~s Finish (money) Serial Number Finish(gallons) Product Pump~ Start (money) Totaiizer Readings Product Totalizer Readings Product Totalizer Readings Finish (money) Start (money) Mak~ and Model Finish (money) Start (money) Make ahd IVfd-del Product Pump Totalizer Finish (money) Start ('mone~y) ~. Finish (money) Readings Start (money) Product Make end Model Pump Finish (money) Totalizer · Readings Start (money) Product 'Oeeler'~,Signature Oiltrib~tion; Start (gallons) Return to Storage (gallons) Serial Number Finish (gallons) Start (gall•hal Return to St')rage (gallons) Serial Number Finish (gallons) Start (gallons) Return tO Storage (gallons) Serial Number Finish (gallons) Start (gallons) / Re,urn to Storage (gallons) Serial Number Finish (gallons) Start (gallons) . Return tO Storage (gallons) Serial Number Finish (gallons) Start (gallons) Return to Storage (gallons) [~ Meter Change [] Computer Change [-~ W/M Notified Ta~ged I Tag ~ I Checked . ""~ Adiusted Fa I Slow To ,~, IContractor Totalizer Sealed I Meter Sealed OYes ['-]No Tagged ['-]Red [::~ G r e'en . Calibration; ! asr Checked~F Adjusted ass To Totalizer Sealed [] Yes [] No 'Fagged I--~ Red []Green []Blue [] Yes [] NO Slow Slow Meter Sealed ~--I Yes [~No Tag # Slow []No Calibration: Fast Checked ~ Adjusted Slow To Totalizer Sealed Meter Sealed [] Yes [] No [] Yes Tagged Tag {-'~ R ed [--]Green I--~ Blue Calibration: Fast ~_~ I Slow Checked I ~ J AdjustedTo ~"~"~~1 ' Fast ..Slow Totalizer Sealed Meter Sealed l--lYes I']No [-}Yes Tagged Tag ~it []Red []Green []Blue Tagged []Red r-'}G~een []Blue ONe []No Adjusted Fast Slow To Totalizer Sealed ] Meter Sealed OYes [:::]No I i E:] Yes Tag ~ Calibration:'Checked IFas! ISlOw Adjusted I Fast Slov~ TO /' , Totalizer Sealed I Meter Sealed {:]Yes I'~No I []Yes ~,ii-, ' BAKERSFIELD SERVICllETATION 'REPAIR : i ~,. ;,L:~..;.:. 1230 SO. UNION AVE., BAI~IF D. CA 93307 '* '.'. · ~'-'i:.:;.'.- 24 HOUR Finish (money) Start Imonevl O0 aka and Modal -" ..... Make and Model ¢?: '!':' ':~.a;,:,:'::i:~;~?;.I Finish (money) C' ~)~ RMi~.~ll Stert (money) . It ¢..,:::,¥-~'~;;.b~:,~,s;~L:. Finish (money) ~ ". ~... ,~ I1~:~' ': '~'~ ': ,... .,:, ~,:~,:: Flnl~ lin•ri.y) ~;' :"" RillS' Stirs (money) / 1805l 327-4659 . .__ Serial Number Finish(gallons) I0.0 Start (gallons) Return to Storage (gallons) Serial Number Finish (gallons) /0, 0 Start (gallons) Return to Storage (gallons) Serial Number Finish (gallons) St.rs (ga,,o/.sp. 0 Return to Storage (gallons) · /0, o Serial Number o Start (gallons) Re, urn to Storage (gallons) · ' 1o. 0 Serial Number Finish (gallons) 10,.0 Start (gallons) Return to StOrage. (gallons) , lO,O Serial Number Start (gallons) Return to ~ Record Of Computer ..... Or Meter Change [] Meter Change I Contractor [:::]Computer Change I ~ W/M Notified ' Tagged ) Tag # r-]Red r']Green ['-}Blue I Adjusted ISlow Totalizer Sealed · Meter Sealed ~., UNo I ~., aN• Tagged J Tag # Calibration: I Fast I Slow Adiu,tad I Fe,t. is,ow Totatizer Sealed I Meter Sealed es [] NO [~e$ [] NO Tagged Tag # ~ I~Red []Green []Blue Totalizer Sealed I Meter Sealed Tagged Tag # .r~ Red [-']Green [:::]Blue Calibrati°n:~.~asr Checked Adjusted ass To Totalizer Sealed [~es r-IN• Slow Meter Sealed -'~' es [] N o Tagged Tag # []Red []Green []Blue Calibration: I Fast Checked I Adjusted I Fast To ~ Totalizer Sealed -~es []No Tagged []Red []G~een []Blue Slow Calibration: Fast -1 Checked Adjusted Fast Slow Meter Sealed ~No Tag # Totalizer Sealed es [] NO Slow SIo.w Meter Sealed •No :~?~·'BAKERSFIELD SERVla~i~ STATION REPAIR · 1230 SO. UNION AVE.~ 'FIELD, C_~ 93307 24 HOU~I~' .CE ~Procluct ~ 327-4659 Make and Model v) . .oo Start (money) Serial N u m~,~ Finish (gallons) tO, O Sfart (gallons) Model Return .tO Storage (gallons) /0.'0 Serial Number Finish (gallons) [0, 0 ~,f Li~'L · Make and Model Fihish (money) Start (money) · ' ~.~ Make and MOdel· Finish (m ~,y) '?:~"~' '' O(~) v) Start (gallons) Return to Storage (gallons) Serial Number Finish (gallons) Start (ga.o{¢' Return to Storage (gallons) . ./0, 0 Serial Number Finish (gallons) ld.'d (gallons) Re,urn to Storage (gallons) odel and Model Finish (money) Y) Start (gallons) ' Return to Storage (gal Finish '(gallons) Start (gallons) Return to Storage (gallons) '~.~1)-' ' Record Of ComPUter Or Meter Change Tagged nRed [~Green nBlue I Calibration: [ Fa::.~ . I Slow Adjusted I Fast Slow To ~-T----- Totalizer Sealed Meter Sealed d~es' ~No E~es E]No Tagge Tag ~ · [-]Red r-IG teen nBlue Calibrati°n! I Fa~.. Checked I Adjusted I Fast To ~ [] Meter Change I Contractor [] Computer Change C:] W/M Notified Meter Sealed Tag # Totalizer Sealed · /~Yes [] No Tagged []Red F-IG reen [::]Blue Ca!ibratioa: IFast ISI°w Checked J I Adjusted I Fast Totalizer ~-ealed Meter ISealed Tagged Tag #' []Red []Green []Blue Calibration: J Fast Slow Adjusted Fast Slow Totalizer Sealed Meter Sealed Tagged Tag # I']Red ["lGreen [::]Blue Calibration: F asr Checked F asr To Totalizer Sealed []Yes []No Tagged [-]Red []G~een []Blue Slow Meter Sealed [] Yes Tag # ISlow . Meter Sealed [] Yes !No Calibration: Fast Fast To Totalizer Sealed [] Yas [] NO 000 000 10.59~* 10-61 · . ~ ~ 9-59 9-59 8-99 8-99 8.99 ...... DATE OWNER ........ ~" ' ~ · .NAME. g628 Rosed41e H~. 3800~2 ,' couN~f ~F KERN ...]:~- ~*TE OF_CALIFORNIA - '- ,: ...-'.:.~ ..... ~J°rnlu'Ave'~ue Bukersfleld-~3307 Telephone (805) 861-2418 " t~t, in ~c~ with t~' I~, .I ~e ~u~s mid ~ ~ the ~ of ~ u~d ~:.' -- ' ' ' ': '" : . - -...~.~ (OWNER Monty c. Modified Inventory Control d. In-tan~ Level Sensing Device e. G~oundwate~ Nonf~or~ng f. Vadose Zone SECONDARY CONTAINMENT MONITORING= a. Liner b. Double-Nailed tank c. Vau]t PIPING MONITORING: Suct~¢n OVERFILL PROTECTION: 5. TIGHTNESS TESING 5. ~IEW NSTRUCTiON/MODiFiCATiON 7. CLOSURE/ABANDONMENT UNAUTHORIZED RELEASE 2700 "'M" STn~-- aL~H SERVICES"'~'~'~'~- "'A~E~MI~N , ~cc/, SUZ~E 30~ ..... Um~AETMENT. ~. (805)861-' °A~$FZELD. CA.93301 -3636 UNDERGROUND HAZARDous SUBSTANCE STO~AGE FACILITY ~ INSPECTION REPORT * Co. - " - ..... 2"700 "M" Street, Suite,r275 ~ :: Bakersfield, CA. 93301 (805) 861-3682 PHASE II VA~POR RECOVERY Company<Address- ~3)'2(~ A~, ~ ~ ~ ~¢ Contact ¢ ~t ~ ~ Ins~octor. ~ INSPECTION FORM City Phone[~l~)~) "~ ¢''zJ '''/(o ~ System Type: BA RJ ~F. (V~9-JL~ .Date '"7/t~'j~] -NoticeRec'dBy ~<~'(~' NOZZLE # GAS GRADE Zip HI HE GH NOZZLE TYPE HA 1. CERT. NOZZLE 2. CHECK VALVE O 3. FACE SEAL Z 4. RING, RIVET / ' 6. SWIVEL(S) V 7. FLOW LIMITER (EW) 1. HOSE CONDITION V A 2. LENGTH P O 3. CONFIGURATION R 4. SWIVEL O 5. OVERHEAD RETRACTOR s E 6. POWER/PILOT ON 7. SIGNS POSTED Key to system types: Key to deficiencies: NC= not certified, B= broken BA=Balance HE =Healey M= missing, TO= torn, FTMflat, TN= tangled RJ =Red Jacket CH=Gulf Hasselmann AD= needs adjustment, L= long, LO= loose, HI =Hirt HA =Hasstech S= short MA= misaligned, K= kinked, FR= frayed. INSPECTION RESULTS COMMENTS: Key to inspection results: Blank= OK, 7= Repair within seven days, TTM Tagged (nozzle tagged out-of-order until repaired) ,A., '~1! {~L= Tag%v~l~On but left in use'' 1~.. V//~ ~ ~ ~ VIOLATIONS: SYSTEMS MARKED WITH A "T OR U" CODE IN INSPECTION RESULTS, ARE IN VIOLATION OF KERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S) 412' AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH DAY OF VIOLATION. TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLUTION OF THE VIOLATION. NOTE: CALIFORNIA HEALTH & SAFETY CODE SECTION 41960.2, REQUIRES THAT THE ABOVE LISTED 7-DAY DEFICIENCIES · BE CORRECTED WITHIN 7 DAYS. FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION 9149-10 }5 ' APCD FILE , '- ' " %"~'-~KER LINTY AIR POLLUTION CON ISTRICT '2700 "M" Street, Suite 275 Bakersfield, CA. 93301 (805) 861-3682 · ';',,... . Station · .cdmpany Mailing Address. 10. 11. -i2. 1. PRODUCT (UL, PUL, P, or R) .. 2.. TANK EOCATION REFERENCE 3 .... BROKEN OR MISSiNG.VAPOR CAP 4. BROKEN OR MISSING FILL CAP 5. BRO~,~I~ CAM LOCK ON VAPOR CAP 6. FILL CAPS NOT PROPERLY SEATED 7. VAPOR CAPS NOT PROPERLY SEATED 8. GASKET MISSING FROM FILL CAP 9. '"GASKET MISSING FROM VAPOR CAP FILL ADAPTOR NOT TIGHT VAPOR ADAPTOR NOT TIGHT GASKET BETWEEN ADAPTOR & FILL TUBE MISSING / IMPROPERLY SEATED ' 13. DRY BREAK GASKETS DETERIORATED 14C? EXCESSIVE VERTICAL PLAY IN COAXIAL FILL TUBE 15. COAXIAL FILL TUBE SPRING MECHANISM DEFECTIVE _Phone · System Type:. Sep. Riser/CoaxiaI ii. ~~ N°tice Rec'd'By ~~"- ~¢K"~~ ; TANK #1 · TANK. C2 , .TANK,C3 TANK¢4 : 16. TANK DEPTH MEASUREMENT 17. TUBE LENGTH MEASUREMENT 18. DIFFERENCE (SHOULD BE 6" OR LESS) 19. OTHER WARNING: SYSTEMS MARKED WITH A CHECK ABOVE ARE IN VIOLATION OF'~(ERN COUNTY AIR POLLUTION CONTROL DISTRICT RULE(S)209, 412 AND/OR 412.1. THE CALIFORNIA HEALTH & SAFETY CODE SPECIFIES PENALTIES OF UP TO $1,000.00 PER DAY FOR EACH VIOLATION. · TELEPHONE (805) 861-3682 CONCERNING FINAL RESOLU- ~ TIONOFTHEVIOLATI,.ON(S) ~~~~~~~~~~ ' ~" · ' '- ,..-.~i:/ 'i:.APCD FILE v¢~-:¢~.',",~:'~ ~',~.I.,'.~'~.-'- ~'~.'~-'~;.'~:7%.~;~ ' '~":~'~'~"~" ~'' "' '~""~' '