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Home My WebLink AboutUNDERGROUND TANK FILE #2 UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME =\ .?X0Që:::2 ___5-Qª__\___£:i\c:;>~\ ~,\~_ ----- ".'---,,'--' INSPECTION DATE INSPECTION TIME _____,_ ... i .wQ4-:---- ., ,,______ ù.... , NE No. No. of Employees . . .Lt~.JJ _~7..-l31Q.'J__ z--- _ "3 Business ID Number I 15-021- ADDRESS FACllITYCONTACT Section 1: Business Plan and Inventory Program (] Routine )< Combined n Joint Agency D Multi-Agency n Complaint n Re-inspection c V ( C=Compliance ) V=Violation OPERATION COMMENTS Ä.~. ApPROPRIATE PERMIT_~~.~~~~__ ~ n BUSINESS PLAN CONTACT INFORMATION ACCURATE )( n VISIBLE ADDRESS )i__ ,!:! CORRECT OC~U~~~~Y__ ____ _____, _ ... _...,_,_ .___ 'Ø 0 VERIFICATION OF INVENTORY MATERIALS -~ 0 VERIFICAT~~~-~~~~~~~I~'~~'-------- .,. --,,-..., ~m 0 VERIFICATI~~-~~- ~~~A~I~~-----' ,. þ( (] PROPER SEGREGATION OF MATERIAL ')( 0 VERIFIC~~~~~-~-~~~-~~:~~;I~-~----_'--'m.. -.. .'.-.'. -....----. __-·-0---_-__.....-.. ______0"____,__._..____ ¡ --- ~t-- . t--'-' ---,-" mOO ..- ---- ·l~-::-·· - __ ___ ___.._·___.u __ _..___.__._._____....__...... _______n ___._ -.--.------ ... .-.- - u ___ ____.______.__.__ .. --.---------. -.--.---.- --.--.-------..- ------.-----..--- - - - .----. ------ o VERIFICATION OF H~AT TRAINING . - - --------- -_..._--------------_...._-------_.._~_.--_._-_.__.._-.--. _.~_.__._---- ------. -.. -_.._--_._~----- --. -'-'~- - - ----.------- ~~- ~::~:~~N~O~~~:~N~::A~~ ANO_~~E~RES & 0 CONTAINERS PROPER~Y_~B~L~~ ~ 0 ~OUSEKEEPING o ~ _~'RE PROTECTION ~ 0 SITE DIAGRAM ADEOUATE & ON HAND _ u _.______.__. ...... ..__.._ _.__ - -------.. - - -- - --- ------- 4,- .--- I I .,lm ..~. --,- ····h\'1;ìi-i.VJT-~· f2<:~çð'ñ¡Y--fi (ee· ¡;".t"'~i6 ..,-, -j---'---',.-,.,-., ___...,__.____.___ ,..,." ._, .. ___nn... ..... .,._ -....-- --. ----- -....-...-.-.- ND ICYY>l)e ( o YES (NO CN 2; IÅ J)¡1>t--"'- (\.ee d ;;;;; A : \06c: ',("\ o~ ANY HAZARDOUS WASTE ON SITE?: EXPLAIN: ~) TH /iNSPECTION? PLEASE CALL US AT (661) 326-3979 X-,-_-,n Yellow ' Slation Copy Pink . Business Copy /'ï. (" ,t" , " '< F E ¡J u I . 1 4. 2 0 0 4 í 3: 1 6 P M LC SERV¡CES RE: PREVENTION (661) 8SZ-¿,N_o: ~844 p. 2 2 p. .PERM1T APPUCATION FOR REMOVAL OF AN UNDERGROUND STORAGE TANK Bakentleld nn Dopt. EDviroøment&t Seme.. 1715 Chester Ave Bakersfield, CA 93301 Tel: (661 )326-3979 Page 10f1 r Permit No _B7 ýZ -- 0 ~;.L c¡ TANIC No. AØE D.\TES STORED a..Il:AL. P¥VIOUSLY STOR.fC ~ NAME CPRINn LAJfUJY 6AlrN£¡( THlSA.PPUCA11ON WILL BECOME A PERMIT WHeN APPROVED CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 ,~' FACILITY NA M E___ \ eXç>---C<::;; INSPECTION DATE 9/ZLr/D4-' I Section 2: Underground Storage Tanks Program o Routine ~ Combined 0 Joint Agency Type of Tank OW P Type of Monitoring A\ 6 o Multi-Agency Number of Tanks Type of Piping o Complaint ç Dv.-Jr ORe-inspection OPERA TION C V COMMENTS Proper tank data on file X Proper owner,operator data on file X Permit fees current X Certification of Financial Responsibility ~ Monitoring record adequate and current J( Maintenance records adequate and current >< Failure to correct prior LJST violations )(' Has there been an unauthorized release? Yes No K Section 3: Aboveground Storage Tanks Program TANK SIZE(S)__. Type of Tank AGGREGATE CAPACITY Number of Tanks OPERATION Y N COMMENTS SPCC.available SPCC on tile with OES Adequate secondary protection Proper tank placardll1g/labeling Is tank used to dispense MVF? If yes, Does tank have overfill/overspill protection'? C~Compliance V cc'Violation Y~Yes N~NO O'::2y, \C\. 0 L\-' U2.---\ T Pink, Business Cpry " ' ~ 127834 STOCKDALE TEX 5321 STOCKDALE HWY. BAKER~3F I ELD , CA. 81iJ515iJ7805007 AUG 24, 2004 2:18 FM I N\/ENTOR'i REPORT T 1: 87 REGULAR VOLUME 3737 GALS ULLAGE 6079 C;ALS 9œ; ULLAGE= 5097 GALS HEIGHT 37.33 INCHES WATER VOL 0 GALS WATER 0.00 INCHES TEMP 93.6 DEG F T 2:89 PLUS \/OLUlv1E ULLAGE 90% ULLAGE= HEIGHT WATER 'JOL L,JATER TEMP T 3: PREI"l I Ulv1 VOLUME ULLAGE 90% ULLAGE= HEIGHT WATER "jOL WATER TEl"lP T 4:DIESEL VOLUI"1E ULLAGE 90% ULLAGE= HEIGHT WATER VOL WATER TEMP 6263 GALS :3553 GALS 2571 GALS 5f, . 05 INCHES o GALS 0.00 INCHES 102.0 DEG F 91 50:36 GALS 4780 GALS 37'38 GALS 46.95 INCHES o GALS 0.00 INCHES 99.2 DEG F 2642 GALS 7174 GALS 6192 GALS 28.92 INCHES o GALS 0.00 INCHES 98.0 DEG F * * * * * END * * * ~ * 01/30/2004 13:17 408971~~35 555 INC -.... ~- ~~~"T "''''I;> ,;~~t-LU 1-.1fõ!E PREVENTION (1561)852·2172 PAGE 04 p.2 / d--I '?J I '1 , CITY OF BAKERSFIELD OFF1CE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326..3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION FACIUTY ~ \-€ TaC-\(" t) ADD.R.SSS 5 ~ \ S-\t¥:Y r\r, \.(?) --ro y p r~ ~ e \r\. M Q _~~ 'OPERATORS NAME...8:lðteYa.t\~ . . OWNERS NAME l(ð.,n~\~ Dl \ (\.1), NAME OF MONrrOR MANUFAC'IUREIL \I ~ë:cle t"" 'Bee.\- DOES FACIUTY HA VB DISPENSER PANS? YB..~ NO_ ( TANK. VOLUME =ft;~ , ..lD;-()r'D ._- ':¡ lO,\~OD - 3 Jñ} (Yx') ~r~'l - L\ \ a \ [\(Jl') , NAME OFTBSTING COMPANY_~Wce ~\+\ Ì-\C'0 S::p~i~ \ J::"rc. CONJ'RACTORS UCENSE# ~ I K: . NAME&PHONBNUMBEROFCONTAcrPERSON~.b.h\P J.,( )r~J+~ "30.! ~'1'~- )JI3- DAT.E "TIME TÊST IS TO'BE CONDUCTED ~/q / c 3 .. ),' ()(::, f-.. tÍ< (~r#J { APPROVBDBY , /-31J ~{)t/ DATE i).JLL: ~ . -- SIGNA'I'URB OF APPl.ICANT ~ j, Mar.29, 2004 5:00PM \y L\ ~ERVICES No.1564 p. 2/2 MONITORING SYSTEM CERTIFICATION For U'e By All Jurisd~tión3 Within tM Stau olCalWmJa , Authority Cited: Chapter 6. 7. Health and Srifety Code; Chapter 16, Divisi<m J, mEt 23. CalijonaÙl Cotk ojlùgulazÚ)Ts This form must be u~ to document testing and se.tvicilJg of monitmi.og equipment. A separate œrd ficarioø or reÐOrt must be Dn!Pared for each monitoring SJ'nom çontròl panel by the techniJ:ian who performs !be wodt. A copy of Uû& Conn must 1». provided to the tank ~ystcm owner/operator. ~ owner/opc.ralDr must submit a copy of this fonn to the loca1 age.ocy regulating UST sy5tcms within 30 days of te.l:t date, . A. General ~rJI1atloq _ ' Facility Name: '... E1l A,J) - l)...\ ~ 7 q Bldg. No.: Site Address: ~~\ ..s~~\~ ~'-"-''( City: ~.5.fì~ ß~p: q~3Q.5 Facility Contact Person: ~CA..\ Contact Phone No.: (b~ ).:ß3" _ \ ~~ Make/Model of MOIÙtOriOg System: y.~~ J?o~, ~ - 3:rv Date ofTcsting/Scrviciog: 3...Jfu~ B. Inventory of Equipment Tested/Certified ChKI.t _ ro rl8M boD. to C 101 tedlstniœd: T~D: TaakI.D: e.r [nrl'í"nk Gauging 1:01x=. Model: C ÚI.. Taak OauJiq Prob., Mo&¡: ¡y"""~ar Space or Vault Sensor. M~ I:J Annular Spaœ (Ie Vault SenSOJ. Model; !J"'1'ipin~ Sump I Tltucb SQllSor(¡). :ModeJ: C Pipia¡ Sump I Treøc:b Scnsoc('). Model: tJ Fill Sump Scuor(s). Modc:1: Q Fi!1 SUIIIp SclllOE(I). Model: q M~hanica1 J....Iac Leek Daca.or, ModèJ: [J MecbIlÐlcal Uuc: Leak Detector. Model: [J EI~tronk: ~ L¢a.k Dœåor. Model: (J Bled:ronicl.ille l.eIk Dctcctot. Mode!: [J Tank OvcriiU I Hig~Lcvel Sensor, Model: Q Tuk 0vcttiI1/ Hi¡b.Level Scusor. Model; I:J OIher { I:C' ui t t and modd in SeelioQ E OQ Pa 2. 0 Otbcr ( ment and D,(J(cl in Seed!)) B on P 2). Tank ID: Taak m: [J 1,1\' Tank Gauging Probe. Model: 0 MI-TIUIk Oaugiog P.robe. Mode]; [J AnnulIII' S~ or V Wt $~sor, Model: I;J AiIJIuJar Spaœ or Vault Sc:mor. Modd; [J Pipmg Sump I Trench SQll5OC{$). Model: C Piping Sump J Trench. Swsor(s). M~ IJ Fill Sump SeJlSor('). Model: . C Fill Sump ScD$Ot(s). Model.; Q Mecbauical LIne ~ D.tector. Model: I:J Ma;haDical Litu: Leak ~r. Modol: I:J Ell!èuon.Îc Unc I..eat DeteetOt. Mod<;J: IJ BleeltOClic LiI:Ic Leak Dccector. Model: o 1àn'k Ovmlll f HliJI-L.evt.l SCIWU'. Model: I:J TIIDk 0w:d1Il/ Hlgh-LcveJ Seosor. Modd: {J Other (s' . t and modol in Secri.OQ a on Pa c 2 . Q Other . ui and mode{ In Scc:tioa E 01;1 c Z . D~r ID: Dispeuser ID: Q !?)spenser Contain t SCl;\so*). Model: Q DisperIset Cob.uúnmcnt Seo.sot($). Model.: er~Qt Va1ve($). Q SbearVa1vo(s). B"'PiSI DK:r Cootainment Q Di$ Containment PlOllt S ,and DlsptII5er m': D.ispèllSe&" ID: IJ Di$pcn.~a Containmcn SCIlIOr(S), Mooel: IJ Dispcu.ser ContalUlDCI1t Seusor(s). Model: -B"'Sjut Va1VQ(s). a SIIwValw:(,). er"biSDC serCootainmcnt I t(s and Chain(s), Q Pi" Contai~tDènlFloa.t(1 IIIId Q¡aìn(I). Dispense; JJ); DI5peDser ID; {J PBpenser ConwomC:1I S.ÌISOr(s), ModeJ; 0 Dìape~ Containment SCOlOr(I). Mode.!: .ef'"§.¡aJ: Valve(s). C Sh\IaIt VI1~s). 215iSDC< Coøtainmcnt Float s WId O18in 5), a ~ reI' Conwpmcm FIo& I} Uld allua(s . ·If the facility contains more taIIb 01.' dbpcusc:rs. copy Ibis Corœ. luc1udo InfonnalÍOQ rot .very d~ at the fIci1ùy. C. Certification -1 œrW'y that the equipmem idenW1ed in this document was ins pidellnes. AUåChed &0 IhIs Certifiatioo Is 1ntormafion (t..J. manutaciurors' C Correct and a Plot Pian Ihowlng the !afOOt or monitoring tqllipm.ent. For any p attacbed a çoP1 or tbe repo¡t; (~~("k aU that .ap/ly): ,.. I A. 0 System set.up T~hniciao Name (print): ~E'ù$F ~E~ SîfPlature: CertifiC::iltion No.: OOb- 0 ~- - Ob ï b Testing Company Name: l- C'... se\P.JJ ~ t ~ Site,Mátess: ~~\...~B \.\.'uJ\( Phooe No.: (S)<\ L.:!,~ \.{. .... \ 1 '>0 Dale of TestinglServicing: :3LJ ~/ !2Y... }\lortitorln¡ System. Certification P.a¡:e 1 oI3 03101. 03-30-04 05:01pm From-TAIT ENViROMENTAL 714-560-8237 T-679 P.Ol/05 F-048 ~p 25 2002 lO:~2 BKSFLD FIRE PR£VEMTION (E¡Sl)B52-2172 p.~ CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Cbester Ave., Bakersfield, CA (661) 326-3979 APPLICA nON TO PERFORM FUEL MO~JTO~~G CERTIFIC.A TION . . ." , ..i ....... I~... . '.. . . . , ~'.... .: '. , FACII.J.T'( S 8 c.- ADDRESS I 'f I B N1 5 +~ý'.e.,€- -(- OPERATORS NAME 5 B C. O\VNERSNAME· S Be.. ...'. ,..., " '. NAMBOF MONITORMANUFA~Q-~~~a~~··i·'· DOES FACD.JTY HA VB DlSPENSER,PANS~ .YES~'. '- .' NO_ IJ I /I- . _. . ',. ,...f' '" Io.,..¡'t. CONTBNTS .. '.. ' J;/.oP S"~ ',' ." ,. TANK. M 1/ 30J . yo~\ItdE "2 'o".n· 0 ,_0. ""W" ... .t' . .... .. ... . ............. - ,.. ..... " w..... ,_ . . -. ". NAMEOPTESTINOCOMPANY ·~':1Jt.ir'_ GNV 5Ý5~ S CoNTRAC'fORS UCENSB' Ç.ê ß'~ð'18 . NAME & PHONE NUMBER OF CONTACT PERSON A~ Thr¿K.lrm()"~ 7/~/5b7G'II¿; DATB&TIMETESTISTOBECOr,muCTED t¡--¡ ¿..) - a ij e -' ~~ ... . ....... . . . ." ~~4- S~GN:ôTURB OF APPUCANT . .. .. .w' .__ APPROVED BY ,.. .... ...._._~__.. pATE ..--......---....,... .. 03-30-04 05:01pm Frog-TAIT ENVlwO~NTAL 714-580-8237 T-879 P.02/05 F-048 (661)852-2172 F·2 ~ 25 2002 10:52 BK5FLD FIRE PREVENTION CITY OF BAK;ERSFlELD OFFlCE OF ENVIRONMENTAL SERVICES 1715 Cbest.et Ave., Bakersfield, CA (661) 326-3979 APPUCATION TO PERFORM FUEL MON~rO~;NG ÇERTIFlC,A TION . , ~. I ..... ..... , '0 .. . .. . . . . I .. . . ..... FACD..1TY 5 t1 C ADDRESS 3 ~p I Co I ú..1YJ b V\.. ç b.t¿". OPERATORS N,AM]; 5 B C oWNERSNAMR' '2BC ,.....,.,...., ' NAME OF MoNrrOR MANUFA~- ,. ~/~~'~-Róo ·r' DOES FACILITY HAVE DISPENSER. PANS ? YES.. ..'-... ," - IV Ill- NO_ TANK # '3 -¡f , Y~~µ:ME '// ·'t)t)O· . ' CQNTBNTS . .. .' ,j) I.-e..f.e-/ . ': ... '\ ......,..........,... .. . ............. . ........ It T ..... ..._,.... .of NAME QFTESTINO COWI.P~··:;¡-;;r·..&-.uv,;~,;;k/ Sy.5~ 5 CONTRACTORS UCENSE#. $~f?~pq ß NAME &PHONBNUMBER OPCONTACfPERSONßvA71! nY"'/.;h'JA/~,¡{J 7/~§'67-6Ý/1P DATE & TIMB TEST IS TO BE CONDU~ q..... I t( -C> 'I .... .....' ~~~~ ~ONð"f.O'Ré OF APPlJCANI' " ........-.. APPROVED BY n ... _.,_,,__.__ pAm .......----.---.... ..... . . 03-30-04 05:01pm Frcø-TAIT ENVIRO~NTAL 714-560-8237 T-679 P.03/05 F-048 (SSlJe52-21?2 p.2 ~ 25 2002 10:52 BKSFLD FIRE PREVENTION CITY OF BAKERSFIELD OFF1CE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326·3979 APPLJCA TION TO PERFORM FUEL MO~.TOmNG CERTIFJCA TION . . .. ..' ....... ... , I"~.. . ~. . , . . .... . ' ". . FACIUTY 5 B C ADDRESS 1/ th 01 £Ð~edð./..e, fI~ý OPERATORS NAME 58 C OWNERS NAME' sac ",' ,-: ~"'.' ," NAME OF MONITOR MANUFA~'- ~j~~", ()!;;ö'T DOES PACD.J.TY HA VB DISPENSER-PANS"? .YBS~. _. . NO_ AJI/1 TANKN 335" . VOLUME i ·;·tJO{) . .. coNTBNTS hIe. ~4 . ': " .~ . no" .......:'7..... . - .. .._1 . . .. ...... ,... - . . _. ....- .... ..-.........- NAME OP TESTING COMP~·,,;¡¡;r·,'6.vvu·~~/ S$/.5 ~ oS CONTRACI'ORS UCENSB fA. .5 ø fl' ":fÇ>q a NAME & PHONE NUMBER OFCONTACf PERSONg.t-Ao1I ny...'v)ín?/J/~AJ 71'1567-6 s//~ DATE & TJMB TEST IS TO BE cONDUCTED t/ -11./-0 0/ . .... ..... ~~~~~ ~ONb'f.URB OF APPUCANT .. .......~. ," APPROVED BY ", ... _...~.,,__~, PA'I'E .......-......_.._.~....... 03-30-04 05:01pm From-TAIT ENVIKUMENTAL 714-560-8237 T-679 P.04/05 F-048 (661)652-2172 F·2 ~ 25 2002 10:52 BKSFLD FIRE PREVENTION CITY OF BAKERSFIELD OFFICE OF ENVIRO!\1J\1ENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326..3979 APPLICA TION TO PERFORM FUEL MONITORING CERTIFICATION . . ...." tf.!: ,",.: ,0.:, ~. . ,; . . ¡ .. I .. . . ... FACn..rrY 5 13 C ' ADDRESS= 3 r;.. z-_l 5. .\Jd N sr T ~ OPERATORS NAME. 58 C oWNERSNAMB 2BC ' . '" '.,""" '. NAME OF MONITOR MANUFA~" ÿ~~.~,-~ :i- DOES FACIllTY HAVE DISPENSER-PANS? .YES~. .,. . .. " NO_ /'V I /f TANK 1# ~~3 . yo~UME . .. 5: i?bO , . . .; .~ ,'_'''' ~....:tIf,. . ',~ CONTENTS "Dle,~ '. . . . _.', .. ..... ............... NAME OFTBSTING COMP~':;¡-¡;··r:'-6.u¡/I;~~1?~j~(/ Sy.s4rls CONTRACTORS UCENSB' 5ø.Ø·~oq 6 NAME &. PHONE NUMBER OF CONTACT PERSON.Æ-¿..A,tI n1J"ð".Ir~~/k I 7/0/ S6 7-6 ý/~ DATE & TIME TEST IS TO BE CO~UF'fBD t{ - I t/ -0 ~ . ',I . ~.¿L~~ S~GNbruRB OF APPLICANT .. .- ....-. APPROVED BY . . _.._..----.. pATE .. . .-........ ..._--------"..... . . 03-30-04 05:02pm From-TAIT ENVI~OMENTAL EP 25 ~002 10;52 BKSFLD FIRE PREVENTION 714-580-8237 T-879 P.05/05 F-048 (661)852-2172 p.2 CITY OF BAK;ERSF1ELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester A \1e., Bakersfield, CA (661) 326...3979 APPLICATION TO PERFORM FUEL MO~JTOJ.µNG ÇERTIFICATI()N . . .,...' ..Ii ... . ~ . l '. '. . . .:.... ~ . I ",.. . . .. FACn..ITY 5 li C , ADDRESS III 0 I wA {'!-eo- ~aA) L OPERATORS NAME .5 B. C. , OWNERS NAME 5 BC ,." ,.;, ,....., " NAME Of MONITOR MANUFA~" V~~·~,-.eóO ·r· DOES FACILtrY HA VB DISPENSER-FANS? .¥BS~'. ,", . .. NO_ N7/f TANKH 'ietO . ~~~1)1\Œ '''-'''000 .~ . -, . ",./... .... ...... ... Æ ...- . :; /. ," coNTBNTS Þ I ~-e-/ .. ...... '.' ..... ,.._....... NAME OFTESTINO COMP~', ;¡¡þ.r:··I:::.ui/II'~:';b/ Sy.s4n- s 'CoNTRACTORS LICENSE '- 5 ø.'8--:"!,pq a NAME & PHONE NUMBBR.·OPCONTAcr PERSONß.t-A?11 7Z¥ð/j'kI&:lA/~ 7/0/ S67-6 ý/~ DATE: &. TIME TEST IS TO BE CO~UCTED ij -/ ¥ --00/' . ... . - ..... ~$~ ~GN^~ OF APPUCANI' . .. ...-..-., APPROVED BY "'. .... ....._._..... PATE .. ...-.---...,--.....- . ~ FEFeb.24. 2004 IO:39AM LC SERVICESIRE PREVENTION (66'1)85Z-No.9725 p, 3 p. 1 , CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION FACILITY TqAc l' ADDRESS {":.J -< 1ST 0 Cf( 0,,4 L. é ¿( I.A;"' r O~TORSNAME éQy1vA OWNERS NAME .s ¡.{L l /... 0 I L NAME OF MONITOR MANUFACI'URER Vf.. t: dE/, A () ~ T DOES PACnnY HA VB DISPENSER PANS? YEs v"". NO_ ( TANK # VOLUME ~l 10", OD '0 ~ If)~ DQo,) I 10:D\:)0 I /~rot'Jt;) CONTENTS il Ie; '11 (Ui!tl- NAMEOPTBSTINO COMPANY ..(c. StÂI/IC.t.f CONTRACTORS UCENSB## :?"'J~..2 "7 NAME & PHONE NUMBER OF CONTACT PERSON DATE&TIMBTESTISTOBECONDUCTBD 3-3 -0 l/ 9"oöA~ _J, d£U~r[) -./ ( APPROVED BY ~ -rJ<f-~ <f DATE " '~-fK'~M'.~ "". , SIGNATURE OF APPLICANr A.t.Tf.Jì(¡../1j /J/éJ!L S r/l jc.)/"'f/ O,..IL. Y: 'sE./lytl.£ .sr471 åW Sr-I'Ti¡t,f /#_ff¿LJ L:v£~t7I1INt; Lt.f£', ~ ::r ITI ITI ru U1 ..J] I"'- U.S. Postal ServiceTM . CeRTIFIED MAILTM RECEIPT. (Domestic Mail Only; No Insurance Coverage eel) ,- " ' . ., Ii' \ i I Postage $ Certified Fee Postmark Return Reciept Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) ::r CJ CJ CJ CJ ..J] ru ru Tota: Pc ITI CJ Sent To CJ I"'- SireåCAp or PO 80> citÿ: 'šiã¡ë Texaco (Stockdale Texaco) 5321 Stockdale Hwy. Bakersfield, CA 93309 :" . II , See Reverse for Instructions D. · 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 carel to you., . · Attach this card to the back of the mailpiece, or on the front if space pennits. 1. Article Addressed to: C Express Mail CRetumRecelptforMerchandIse CC.O.D. Restricted Delivery? (Extra Fee) C Yes 2260 0004 7652 3. ServIce 1ÿpe )! CertIfIed Mail CReglstered C Insured Mail 4. Tezaco (Stockdale Texaco) 5321 Stockdale Hwy. Bakersfield, CA 93309 3348 - 10259!f102,M-1540 7003 Domestic Return Receipt 2. ArtIcle Number (rransfer from setVice label) PS Fonn 3811, August 2001 UNITED STATES POSTAL SERVICE First-Class Mail Postage & Fees Paid USPS Permit No. G-10 I II .. I I · Sender: Please print your name, address, and ZIP+4 il1 this box · Bakersfield Fire Department Prevention Services 1715 Chester Avenue, Suite 300 Bakersfield, CA 93301 fill ",,,.11.1. I.1f It 1.1" ,. I " I If. ..1I.1l 11.1 \.$ FIRE CHIEF RON FR'IZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326,3941 FAX (661) 395'1349 SUPPRESSION SERVICES 2101 "W Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAX (661) 395,1349 PREVENTION SERVICES FIR[ SAFm SERVICES' ENYlRONIENTAI. 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 FAJ( (661) 326,0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 VOICE (ç61) 399'4697 FAX (661) 399·5763 December 12, 2003 CERTIFIED MAIL Texaco (Stockdale Texaco) 5321 Stockdale Hwy. Bakersfield, CA 93309 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 (Unifonn 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 dOOIways 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) Constructed of steel, not less than 4 inches in diameter, and concrete fi lIed. 2) Spaced not more than 4 feet between posts, on center. ". 'h/'(t("/tp ~, CC"'Wt/NN/I//f/ . /""/' . I¿,.../,,.., ./k//I . ~I 'Cr:/lh/~r ~~ Letter tlJ 10: Owner/Operators of Propane Exchange Sy~._.ns Re: Propane Exchange Program Dated: December 12.2003 Page 20f2 3) Set not less than 3 feet deep in a concrete footing of not less than a 15 inch diameter. 4) Set with the top of the posts not less than 3 feet aboveground. 5) 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 pennit to verify compliance. All existing facilities will be checked and when compliance is confinned, a pennit 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 confinned, each exchange system will be issued a pennit, which will be placed on the exchange system. Sites not confonning 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, I/' r/ /' ~ )L{~ Steve Underwood Fire InspectorlPetroleuml Environmental Code Enforcement Officer 03/04/2004 11:02 4089710..~j SSS INC PAGE 02 Monitoring System Equipment Certification Fur Use ßy 1/11 Juruciictions Within Th~ Stale ofCalifornìa Awhol'ir.11 Cited: Chapter 6.7, Heal,}¡ {¡nd Safely Code: Chapter 16, Division J. Tille 23, Ca/ifol71ia Code of ReguhltiOf/$ Th¡~ form muse be used to document testing and servicing of nJonitoring equipment. A separate certification or ~port must be prepared for each monitori1:le S)lstçm contI'OI Danel by the technician who peñotn1." the work. A copy ofrhis forDl must be provided to the tank S)/sCCm owner/Cfg,UscrNQ.Tne, TIlL; uwm:r/Cfs.UserName mUSt submit a copy of this form to the loca.l agcl1,cy regulating UST s within 30 days oftesr date. A. General Information Facility Name: Stockdale Texaco Sit~ Ac1dtes~: 5321 Stockdale @ New Stine Rd. }<acility Contact Person: Rosanna Make/Model of Monitoring System: VIR Siml?licity ß. lnvcntOfy uf Equipment TestcdfCeJ-til1ed Che(k thl: Jlppl'oprillte boXCi to indicate spccilie C(ulpm~nt hll~dedl~Q",iced: Rlttg. No.: City: Bakersfield, CA Zip: 93309- Ccmtaçt PhÙI1t: Nu.: (001) 837-1389 Date of Testing/Servicing; 2/4104 Tank ID: 01 . Reou Tank ID: 02 . Plu5 o In - Tønk Gáusing I'rob~, Model: Vft !l47390'107 1:1 111- Tank Gau¡ing f>robe. Modcl: VRM7:aIO'107 III AI111u1ur SXlce Or Vault SeniOr. Modd: VR r'43'~D9 I Annular S~cc or Vault Sen50I'. Mod~l: VR 71431004011 O!I I'¡¡ling SLImp \ Trench S~n~or (~). Model, VI>7q.~ ill Pi,iul:\ 3ulllp \ "fl'\:nen sen~r (5), Model: VR 794380~O8 1:1 Fill SLim) Sel'sur (s). Model: _ None [J FiJJ Sump Sena",. (5). Madel: lIone [J Mcchal\ical Une Leak ùcteetOl", Model: Nð"" o M,,'Ç hanical Line Leak D~t~~tor, Model: Nðna I!I Elcelrnllic Line J..c:aJc DetoctL)T. Mudd: \1ft Serres 84U II!I Eleot"","¡" l.iI1C u,_I.. o.,;t~clur. MOdel: v~ 5.,1.. MI4 o lank O\'erlill \ Hlgh·Lwel Sen50l', Model: Nol'Ia o T¡¡nk ()verfil1 \ ¡'Jigl1-l.evcl Scnwl', Model: None [J Oth~r ( ~p.:city.ec¡uipJT1I."'t Iype anclnl0cle1 in S"'Ctíon Eon f>8ge 2). o (¡,her (Spt:cify cqllipm~nllype and model in So:clion Eon ..agc 2). Tank ID: 03· "'1:111 Tank ID: 04 - Diesel D In· Tank Guuging f'l'obe. Model: VR 8473'0-107 D In· Tank Gau:¡init I'robe. Moder: VI!. 8473'0'107 IIJ Annular Sp.'~t: ur Vault Sensur, Mudel: \1Ft 714380.40t II!I Al1I1uar Space or Vault Sen501.. Mnct~I' VR t!loL'\AnoOlll'l l1li I'¡pin& S'""I' I Tl\m~h !¡~1'50r (S). MO(el: VIIt 794380-_ I!I Piping Sump \ Trench Sensor (5). Model: VR 7142.0-208 [J FiJI SUl'nl) Se.l¡;or (5). Model; None - [J FiJI Sump Sensor (s). Mode!; None [J Mechanical Line L¡:I¡I¡ Detector, Modd: No~e [J M~hQ.licul Une Leuk I.)etector, Moo!:!l: None III f:""lronic Line: r..c.ù; Dc;II>\.·wr. Moclcl: "It ,.;qr1n B484 Q ElcctrQnÎC Lint: L.eal, De~ll)r. Model: VRSI1f1eo;IJ4I14 [J Tank Ovcrtill \ J-ì~h·l.t\'el S"n!i()L Ml1del: None D Tank Ov~rnll I High-Level Sensor, Model: No,.. o O11cr ( speéiCy eq~¡;pl11eI11 type and model in SO)Ctic~l F. on f'¡jgt.> 2). ¡j Other ( sp~ify cqu¡pll1enllypc and mouel in Section !:: On !':lee 2). Dispenser ID: 01.02 Dispenser ID.:.. 03-04 C OispensrT C"nl11a in 111<m I Sensor (s), Mod,,!; None o Di¡¡pen5~r Conlllinmcnt Sen~oT (s). Model: None I!'iI Shear V~lve (.). IIa ,....h,.~r V~ly~ ($), III l)iBpcns,¡r C'ontninnlelll ~IOCIt (5) o¡ld (:hain (5). I!'iI Dispel)SC1' Conlainment Floo! (5) and Chain (5), Di5pel1$cr ID: 05~6 Di~enser ID: 07-08 i:I 1)¡6p~l1elll' Co"tQinnl~nt $~nsor (5), MvlltlL Hum, D 'spenser COnt.u.inTl1cnt S~n50r (5), Model; None I!I She~I' Valve (s). III Shear Valve (5). 1151 DiSpenser Containment Float (s) and Chail1 (s), I!I ¡)i~pcnsc,. Contailll1\ent Flœt (s) and Chain (9), JJispense.- ID: Dispem¡er ID: o t)i~pcl1s~I' ('()n1~inmen[ SI.'11~OI' (5). Model: D Dispc:ns"'r Containml.'T1t SensOr (¡¡). Model: D Sh~ar Valve (s), o She,,. Va)V(; (s). o )¡sl'clI~~r C011tIl!lln¡em rlnat (5) and C."hain (S), I:J DjSptnsçr Comainrnc"! FIoal (Ii) and Chain (s), 91f Ihe lilcility CtH)IIIÍI,s 11101'(; lanks or di~pc:nSCI"5, copy thi51btm, Include int'ormlllinn for e\''''Y lank and dispenser al the f:¡çility C_ Ce}-t.ification - I certlf}' that tile equipment Identified in thi~ duc:umtut WIIS In$pectedl..rvic:od in .~I'lIan« with the 111anufo!:turor's guidelines. Atlil~hed to this C..rtificlltkJn I.. Inrormlltiun (e.g. mllllufactul"CI' checklists) nL"'I!SSry to vcrir)' chllt thi~ ¡nrnr"'~tlou ¡. "Dn·.ct Rlld a 1'1.., Plan .hDwing ,h~ lli"..,..1 uC IIMIRltllrlnjl equipment. t'ur !IllY equlpm~nf CApabl¡, uf generotill~ such 1'''\tIrt!;. I hav" 1\15u attuhed a ellPY of the; (cl,,~clt 1111 '''"1 IlPp/jo): l1li Sy~tJ:m ~-up [J Alatln hi'tory rl.'lMlrt Tcçhnki<Ju NalUt: (print): SS$-RauIS CCI"Cifjci1tioJ1 NQ,: 560~80~0788 TesUng (;ompany .Name: :::¡er. Sta. Sy.. Site Address: 5321 Stockdale @ New Stinl;? Rd. Signature; Original on file at SSS License. No.: 48S184 Phone No,: (408) 971-244~ Date ofTestil1~/SelviciDg: 2/4/04 03/04/2004 11:02 4089710..."j 555 INC PAGE 03 Monitorìn~ System Certification - p,¡ege 2 01'.3 Site Address: 5321 Stockdale @ New Stine Rd. Date QfTestingl~ervid~: 2/4/04 D. Results of Testing / Servicing SofiwaJ'e Version 1n.~t¡¡lIed: Ç0l1101cte the rOIlOWin!! checklist: all Yes o No'" Is the audible alarm operational'? III Yes o No'" h 'he visual al;mn ~rati01UlI'? II Yes !:JNo* Were all sensors visually inspected. functiollally tested, and confirmed operational'! CJ Yes II No1lt Were all seDliors installed at lowest point of secondary containment and positioned SO that other equipmenl will nOt Imerfere with their proper QPcratiOJÛ l1li Yes o No· IfalawlS are relayed to a remote monitoring station, is all conununications equipment (e.g. modl,.'IU) ONIA operational? all Yes o No* Fat' pressu:rized piping systems, does the turbine automatically shut down if the piping secondary containment o NfA monitOring system detects Ii le¡¡Ie, fails to operate, or is electrically disconnected? If yes: wlúch SenSOl'S initiate pu~iLive shul-dOWll'l (Check. lIll thai apply) II SUlTlplTrench Sensors; CJ Dispel1ser Contair.unenl Sensors. Did you confirm positive shul-down due to leaks and sensor failure/disconnection? .III Yes i:JNo DYes [) No' For tank systems that utilize the monitoring ~y.~'t:m as the- primary tank overfill "''I1ming dcvjçç (j,e:, uu all N/A mechanical overfill prevention valve is installed), is the:: overfill warni,ng alann visible and audible at the lank fill point(s) ¡¡nd operating pr01Jerlv? If so, at what percent oftanlc: capacity does the alarm.lrigger? 0 % arJYes" CJ No WQ3 Iln)' monitorhlg CYl.liP1Jlt:Ut œpla.ced? If yes, identify $pecific: sensors, probes, Or other equipment replaced and list the manufacturer name and model for aU replacemen.t parts ìn Section E, below. II Yes' (J No Was liquid found inside any secondary containment systems desienl'!t1 jf: dry 'y£w:rm7 (Ç/cck all that apply) III Product; 0 Water, If yes, describe causes in Section E, below. II Yes [J No· Was monítorinl:! system set-up rcviewed to ensure -proper settings? (Attach .~ct-Ul) reTJorts. ifa'JTJlicable,) IIIIYe,; nNo* I~ an monitoring eq\lipmunt opcration41 per 1l141wf4¡;iulI:r·s specIfications? · 111 Section E below, describe how and when thef;e deficiencies were Or will be corrected. E. Comments: Placed diesel sump sensor at the bottom of the sump after replacing the senSQr and removing appx 1/2 gallon of fuel. The flex pipe is seepinO. will contact the contractol" for repolr. 03/04/2004 11:02 4089710.1...>5 555 INC PAGE 04 MonitorIng System Certification - Plgc 3 or3 Site Address: 5321 Stockdale @ New Stine Rd. Date ofTcstinglServicin¡: 2/4104 ,F. In - Tank Gauging I SIR Equipment: III Check this box ihank gauging is used only for inVentory control, [J Check this box it no tauJc gau¡ing or SIR equÎpment is installed. This section must be completed ifin-tank gauging equipment is used to perfonn leak detcction monitol'inz c I l th fi Jl kI' t oml) e~ e 0 ow n~ c l~ JS : o Yes o Nu· Has. i111l inpul wîrtng been In.~pected for proper entry aod ternúnation, inc1uding testing for ground fault!';'! DYes o No. Were all tank gauging probes vjsuaIly inspected for damage and residue buildup? oYe:¡ o No· Was a.ççw"acy Qr~yslt:rn product level readings tested'! [J Yes [J No· Was accuracy of system water level rl:!adings t~ted? eYe:¡ IJ No· We~ all P!'Q!)I;S [t;iustI:lIJed properly'? DYes o No* Were all items on the equipmen.t manufacturer's mailltenance checklist completed? '" In Section H below, dçec:ri~ how and wlum U[l..~ detJclenCles were or WiI! be corrected. G. Line Leak Detectors (LLD): D Check this box ¡fLill's arc l]ot insta1led, c Jttbfill kif t .omple e C 0 OWID2 C lec 5 : IIIYe~ n'1\lo* For equipl'nent ¡¡tart up 01' Qn.l1ual equipmeL1t CCa tjJj¡,;¡Híuu was a leak S1rnulared to verity LLD perfonnance? CN/A (Check ,¡If that tlppi» Simulated leakreatc: III 3 g,p.h. (1.); 00.1 g.p.h. (2.); [J 0.2 g.p.h. (2.). Notes: 1, Required for equipment start-up cenification anc:\ annual certification. 2. Unless n'ial1dated by local agency. cenlfication required only for electronic LLD start-up, III Yes o No" Were all LLD's confirmed operational and accurate within regulatory reql,lirements'! !liVes I:] NQ. WQ.$ the testing app.uatus )!'u~ll'y clI.1ibrated? DYes o No· For nlechanical LLD's, docs the LLD restrict product flow ifit detects a leak? III N/A - ØD Yes [J No· FOl' electronic LLD's, does the turbine automatic",lly shut off if lhe LLD detects a leak'? ON/A III Yes tJ No'" I"or electronic LLD's, does the tlu"bine automatically shut off if any ponion ofth~ monitoring systen1 is disabled o N/A or discoJU'lected'! III Yes [J No. Fol' ~11':~t"(:mic liD's:, doe!: rhe turbine Q\ltol11~tjçall:y ~h"t off jf tauy JUnion of the mOnitOring system oN/A maJfunctions or fails a lest? IIIYC5 ONo* For elt:ctronic LLD's, have all accessIble wirin.¡: connections been visually inspected'! C N/A III Yes D No· Were all items 011 the equipment manUfacturer's maintenance checklist completed'! · 1n Section II belo'Wt deKdu~ huw and when these dehciencics we.·e or will be corrected. H. Comments: 03/04/2004 11:02 40S9710d5 555 INC PAGE 05 Monitoring System Certification UST Monitoring Site Plan 5321 Stockdale @ New Stine Rd. in Bakercfield 1/30/04 :~:: <::... " ~ " ~. ~.".~.. .. , . " , ~. . , <:..:," 1-. :f " . :~~ : !;\~: "£~.. . . , . , .. . . .~. . , .'if-., P\S:~~i.' : .--e. , :..9. ~...,. . , .F. ~. _. -,... ~. ~ .~. , , .-~. /1 " ", 'J. . . . Á:~:: :~~:::::. ~. ,~. '-' . ~ . , . · . . . , . . . . , . ':'7c.¿ . '10\" . , " .. ..." ~. '<V~. · . . . ~. 9"'Z:,. , . :: :v~~: ·0'" " . ~~. --. . .~~ . . , . .~. · ~ - .. : em .;,~ : . . , . :.Y. . . .. . :®:~~ . .. ~VJ . . /. " . .¢". '/, . ."'>. ' ,~ ~ . '"7 , ,~~.. .,. '1· . .~, ÞS: -- :.:(~~. ./(;\. .. ~ Date map was drawn: 1-/--1./~ Instructions On yOur site nl~n, ~hnw the general layout of tanke Md piping. Clearly identify loc.atlOI1$ or UltI rullowing equIpment, if installed: monítoring system control panels; sensors monitoring tank annular spaces, sumps. dispenser pans, spill containers, or other secondary containment 2Irea5: mech¡;¡nir.rll or ~Iectronic Jin~ leak datedtor&; and in-tQnl< liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. '.~ 03/04/2004 11:02 40S9710u5 SSS INC PAGE 06 "ANNUAL TEST RESt.JL TS FOK THE PRODUCT AND VAPOR OVERFILL CONTAINMENT Stockdwc l'ex~o 2-4.04 S3Z1 Stockd~le Hwy - Bakersfield, CA. 'J3309 Test Method Developed By: , 0 Spill Bucket Manufacturer [g] Industry Standard 0 Professional Engineer U Other (Spedfy) Test Method Used: ŒJ Hydrostatic a OtllCT (Specijÿ) TEst Equip.ment Used; lneon Tester Bucket Capacity in gallons: Bucket Depth: Wait time between tillÏ11g with ·watcr and startin test: Test Start Time: initial Reading (R): TesL End Time: final Reading (R,,): Test Duration: Change in Reading (R,,-R¡): Pass/Fail Threshold Or Criteria: Test Result: "I ,I : .. !tl~::~~~1t;: Spill Box N Spill Box # Spill Box iI Spill Box # 5 5 S 5 5 5 5 5 l1'lÌ!1 5 min 5 m.iJl 5 min 5 min 5min 5 min 3:54 pm 3:51 pm 3:32 plTl 3.32 ,)II ~:20 pm 3:Upm 5.6605 5.2577 4.8718 3.7645 4.8596 4.8114 4: 10 pm 1:10pm 3:48pm J;48 Jill 4:35 pm 3:26 pm 4,6598 5.2570 4.8717 3,7648 4.8590 4.8097 15 min 15 min 15 mÎn 15 min 15 WÜl l' mln ZERO T f)~~ ZERO LOSS ZERO LOSS ZER,O LOSS III Pass [K Pass ŒI Pass IX! Fail Comments -:-- (includt! ill ormation em re ¡rs made ,.¡or If) t~tin~. ,,'uf "rJéCJmnumdød follow U OF" ailed te:,~/$) Diesel will not hold if leak occurs, it will be contained inside sealed sump. Tested By: Service Station Systen1s) Inc. Contractor License: 485184 Technician: Dan P. f:,C;, ¿:L' H'JU c'F 1'1l};;;~\,;r: Ii I ::oAHU:I.' f,UTC' [I\HL HLAF:I"l ,;r~1U!' D d: \/LEI!F:F: F:C":)l .; --ll;;' ! !', Ti-ìl'-H: hLAF~ll,=3 ALL: LEr-'1K ALHF:r'l ALL: HI ':;H 1..,)i-ìTE!< H[,fAr:!"! ALL:OVERFILL ALHRM ALL: U)!..J F'F:OLi\ h.l 1\!.i1F:l1 tiLL: :3UÜDEI', l.c,r-:;;c.: i,LHF:I"l ALL: HIGH F'r:,:;{ilJCT HLHF:l1 ALL: I N\/f\L ~ U FUEl L [\/[1. ALL: PF:C'BE ':)IIT ALL: HI ,:;H 1..,IATEF: I,JHF:I' ilK: ALL:DELIVER: NEEDED i,Ll, :!"1H': If:·;:{¡[II'T HLHH"! ALL : ';RO~,c;;':~ lE:~rl 1"H 1 I. AI,L: PEF: 1 (:'L'II' TD;1 h\ I L ALL:ANNUAL lEST FH!L HLL : F'FR T~3T NEEDI::I' I..J}<N ALL: PER TSl NEEllED AU'1 HLL : N(:' I;::.:LD I DI,E T 1I"1E riLL : Cf:~LI' 1 NCF: F:ATE i/JhPI~ HL!, :fV>'IJ.,_,:'HART CHL ["IHF:I,j ALL: F:EC(:,¡-. 1,,JARi" I NG ALL: RECON ALAF:!"1 HLL : LO[.,) TEt'lP 1,'.Ir~RN! ["K; r~LL, : GROf;f:~ FA ILL I¡,[ [t',a: LIQUID SENSOR hU1R AL.L : FUEL A!,AF:!"1 fiLL : E;D~,:;;OR ,:)UT ALi~P\'l ALL: f;HORr AU~F:¡'1 fiLL :r.."If1TEF: i-ìLARt"l ALL :,'"IATEF: OI.lT f1LAF:!"1 i-ìLL:HIGH LIQUID ALHm1 ,iLL: 1::)1,.] L I QIJ 1 (i ALnkf'l I'tLL : l. I 01.1 I D I.."IAF-:N [ I',¡',; f.:F:E I \iER ALAF-:I't:;~ SEf.:VICE kEPORT WARN HLA¡':~1"1 l.'LEt-iF: l.,iAkN! N'; PRESSIJHE LINE LEAK hLL:GROSS 1.INt:: Fi-ìI!. i-iL.L:ANNUHl. LINE Ff-1IL. AL.L : PH: TbT ¡'-!EErIE!' HUi AI.L:r~LD OPEN ALARM ALL:UNKNOWN ALHRM f~LL : I.JI\n~I¡':)[."IN ALi-ìRI'1 ALL:IJNKNOWN ALAF:M ALL: P'ER [OU I I" L II'Œ FH] 1. ;-iLL. : i\I,J',J T~3T r',H:EfJLU HI,¡"¡ Al.L : UJI"I FF:D:.:,,:UI<E HL.n¡':¡"¡ HLL: UNKNOl..,IN AL;-iF:¡l ALL :C\:'NT HANDLE nUl f~LL. : FUEL OUT ~~LL : LN EOIJ IF Fi-ìULT liIJi I I~ -Tf-1NK :':SETI.JP T..l : :::.7 REGLlLHF: PF:()DIJI'T ';ODE T HEEf'lHL C\ŒFF TMJK D 1 Hr"1ETER Tf1NJ: ¡:'¡;':()FILE F LlLL "j(:{. ["JETER DATA FLOAT ;:.; I ZE : L,J~1TER ,'JAPN II'K; : HIGH I..IATH: L 1r'1! 1 : MHXOF: LABEL VOL: ':i\/ERFILL L 11'111' HIGH PF:OÜLlCI rJEL I \iEF:'{ L I III T L(:,I..,I FRODi.JI~T : LEAK ALARM LIMI'r: SUDDEN LOSS LIMIT: TANK TILT l'IHt'~ I F':;.I"DED TANI>: T tt: 1"Kd.Jt,: LEAK t"1 I N PER I OD I" : LEAl: 1"1 IN i\NNUHL 1 : .liUU',!ilJ '1,-' . 111'1 1 IT 'j,:3 It, ["¡':,:' ,¡ . LI 11"J. U.d ] . 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CH. \J 1 rJ~~115ur/:::lCJ5Li07 Hue: 1:,. ~'IKU 2: 1.:: 1-11 FuLL r"lH['~AI;Hn:]H ~-:::E[ Ill' DEL 1 \/EV'" 1....IHfc'N Dn\':3: II. I J AUTU ¡:"P.[NT: D[~':;;-\E:Lf:L1 T 1: tJ'? J;:[GULi;1R" ~.._ ,~, T' ii',./G :3HLH3 f3U!": 1 t./:'U I:HI. 1-1\/1,-,: :::3iiLE:'::;-I"K:'N: "'X:7 ',I1L (,\.1(; ::::I11,.£t;- TU[ : ~'':',':,b ,:;fiL 1;\/1..: SHLE:':;I,IELI: ':'4::11 13iil. 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U I I', D I H U:N: ~'Ilil ILLJ 3.1.1 II'J D I H l.EN: II FELï D . 211 ':;PH TEST: kfJ'lT 1 T I ",' U. 10 (;]'H TE=,:T: 11111,;, :',;HUTnC;.[.,JN }.'ATE: .11 1 ;¡i1 U)I,,1 PfŒ:=:;:,.:U¡·Œ '=:HUI,,;.IF: Ii':' LOI."I ['F:ESf=;IIRF: I J F:Co 1 (¡ :.::: '}1 T :~: 89 PLU~'::; [II E~PEN;3£ 1"lODE: ~'::;THNDAF:[' fÆI',¡,,;oR: NOI',¡-".iEIH'I]¡ ¡>F:Ef3f:LWE ,:';.FF:::LT: 1";, Ill':: j ro,'p: c.' . ¡J ::;. U I I', I· I bJ :1-:';\ .n;:::, 2.0IN DIA U:I',¡:c.:UIJ FEEl 3.0IN DIH LEN: II FEEl' o . 2D (;PH TC'H: ¡'::Err,T 1 I 1',,' 0.10 GPH TEST: HIITO SHUTUOWN RATE: 1.0 GPH U)I"J FF:E:3f:UPE i:::HII'I\ ;,fj- : I'C' 1,0[,..[ PFŒ,3SIJPE: Cl Pi: [ (~ ~?: :39 ,2;,/~=:~'lÐ'l ::':F;UF:] T'/ l.'ODE : CiO[lOUI,] EURO PF:C'l":)o)::,L F'F:EF [ , " t__I FŒ --{J I FŒCT LC{'AL fR 1 ['jo: :'IIT D I E:ABLED H,PF:(:'I'Oi);:;'L DA1A n,-'¡<I"ln'J' HEIGHT FREC [H 101"J Tn;,r DI J¡'::¡;T 1 ,; :'I, HOUF:f=;: 504 0.21.1 GPH LINE TE~r AUTO-CC:'I',F I F:r"l: ENHE:l,[[1 0,10 GPH LINE TEsr AUT,;j,COI'.f I Rr"1: EI"HBL.EI I DAYLIGHT SI1VING TIME ENABLED STAF:T DHTE APR klED: I ;:.:III', ~HA¡.(r T I 1"lE 2: CIlI AI '1 END DATE OCT l"JEEK t'.. f3UI' END T II"IE 2: 00 !V'! TEMP COMPENSHTION \/ALlJE 0: DEG F :': t,U , 1.1 i'H I CK HE I GHT Ol,r:~.:['r D I ~:3ABLED PR I NT TC ",/i)LUI'IE:'3 D I ::;:!iBL£[1 LINE PER TST NEEDED WPN DISABLED LINE ANN Tsr NEEDED WRN DISABLED LINE FŒ-'EI'-ABLE IJETH':..:L' PASS L I r'.JE TESI' ,3H 1FT B l!i' PR 1I'{j0:)I.JTH D] f':;HBLED DA I L\' B I 1-;' ¡'Fe: I 1'J'l\·IIT:,,: D] i3ABLED T]CKETED DEL.]VERY ENABLED TC T I C)ŒTEL' I lEI.] "~,if};"~ D I f:;A8I.ED CLOSE DAY OF WEEK SUN DA I Lo,' DI."/\' "iAR F:PT::) DISABLED I,JEEKLo,' DI."io,' ',,,,,!..¡,:: ¡":¡':'T:,: D] ~=-';ABL£D PER I OD] C.' DL\"",' "iHF: F:PI:c: D I E;ABLEf.i DAILY 800K VAR R]TH D I ~':::!1BLED I...,.IEEI:I,\' Be":.:'I: \/AF: kPT:: D I BABI.ED PERIC'V]':.' 8\:":)1: \.iAk RI'T:: D I i3HBLErj DH I L\' \/fiE HI'lii,\ ¡.::vr;:,; DISABl.ED I....IEEJ<L..... \lAF: hl"i..1 'i fi'Vn; fl I ;:;ABLED PEt:: I 0[1 I C ",/HF: f,NHLi ¡,,:j''[';j DISABLED TANJ< PER T::;T NEE I lEU .,II<i D ] S!1BLEIJ TANK ANN T~'r NEEDED WRN DISABLED ,:) : CHI hll j) I HH8LEI' D [ ,c:AHI ,En 1,IHHE:[,[[' SHifT TIME SHIFT TIME 2 SHIFT TIME 8 SHIFT TIME 4 I 278:3'~ ~:.:'I\:;":I:r'ALE T1-.< 5:3~' I ~'::;TOll:[JALE HtJy. Bi1)ŒF:f:3F I ELD. C¡.è¡. 81 CI515D7B[I':'dJiT/ - ,.,,,, ~ 1"10 I'-J [)[¡'{ii\' H H : 1"11'1 : ;':,":. [,[ LINE LEfil: LO::" ï>: :,IJ1 :,:EJI If' u.:{'!J¡uT f::;C~HEUULE [In I L\ i::TriF:T T 11'IE: D I :c;ril::LEL, ;=:;T(:+ T II"1[ : D I ,:;f-1E~LEU L I I) 1.11 [i :c;rr't:;:c+: :~;£T III- L I: if? :',; UI 'I!: , TI<: I ,:cn'hTE .; :"IIJI:U,: [-l,I,'hl CHTfi3C:+:'l : ~::n' :':;UI''IF L ~': ::; Lj :::; UI'1!' TkISTriLE ¡SINGLE FLOH1¡ C'HIlô';O}:\' : ::nI' :',:1".1111 L :J: ':JI :3UI"IP IF: I ,,,:THTE ': :::: I I"V;U FU:'HT:, CHTI~C;Cìl":\' : ::::Tf ",;, UI''IJ L 4: [i I n;EL ::::UI'1F TF: I ,t;T HTE .; f; I I,,I;U'~ FIf>HT i,~ATb):)¡'{''' : ::nt' :';1,11''11' L q: :::',7 !1NI'JUU\E TF: I -8THT£ ': :'--; I Ni;lL FLohl;. Cf\TEG:)R'l : AI'.J!"JULHE ~:;rH~F: L I iJ : U'j HNNULAF: ['F: 1'~c;THTE ': b [[¡,;f,1-:: FJ.' ;.,,1.. CP1TEGC'¡'('l : A 1',Jf"ULH¡': :'H'f,"E LlI : q 1 nl',JNULnF: TF: I i,;:,mTE ': :31 Ni;l.1: ll.':'Hl i CP1TEG(¡F:''l : AI"Jf',I ILHk :,:I-HIE L12:DIESEI. ANNULHR TF: I -t::TATE .; t3 INGLE FI.'::'Hl:' CATEGORY : AN~ULAF: SPN~E L 1 :3 : I..Jf\~3TE (; I L TF: I':::;TATE .; :::; ¡ I"J';¡E l-U;'HT:' ,:;¡::;TEGOR'l : {> I P I Ni,; ~::UI'1!' MONIT\_ .aING SYSTEM CERTIFIl i. TION For Use By All Jurisdictions Within the State of California Author':y Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This form must be used to document testing and servicing of monitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must submit a copy of this form to the local agency regulating UST systems within 30 days of te A. Gen Texaco Facility!\ 5321 Stockdale Hwy Bakersfield, CA. Site Addr N02581 Facility C MakeIModel of Monitoring System: Bldg. No.: City: Zip: Contact Phone No.: ( O (Io ) Íi 4lo . q ~ 'ßO Date of Testing/Servicing: ~ I'¡;/ () 3 ~. B. Inventory of Equipment Tested/Certified Check the a ro riate boxes to indicate s ecific e ui ment ins ectedlserviced: Tank ill: , /t.t~ C9-1n-Tank Gauging Pr-obe, Model: 'f;}4'7-\ 66 - /6? 0-"Annular Space or Vault Sensor. Model: lZl-Piping Sump / Trench Sensor(s). Model: c>}'9 9'.J ?'~- JA V o Fill Sump Sensor(s). Model: o Mechanical Line Leak Detector. Model: ~lectronic Line Leak Detector. Model: t/Il j-tltft../ o Tank Overfill / High-Level Sensor. Model: o Other s ecif e ui ment t e and model in Section E on Pa e 2). Tank ill: " '~!!:J o In-Tank Gauging l'fobe. Model: 8-c.¿!l~.ðC- Æ::<) I:3-'1\nnular Space or Vault Sensor. Model: ' E3--Píping Sump / Trench Sensor(s). Model: 6"J 9q- :]"i'ð .....L.é r o Fill Sump Sensor(s), Model: o Mechanical Line Leak Detector. Model: C!l-Electronic Line Leak Detector. Model: {¿,£ "jtI~{r' o Tank Overfill / High-Level Sensor. Model: o Other (s eci e ui ment e and model in Section E on Pa e 2 . Dispenser ill: f I o Dispenser Containment Sensor(s). Model: Œl-Shear Valve(s), I:l..L>i:s enser Containment Float(s) and Chain(s). Dispenser ill: 3 / L/ o Dispenser Contafnment Sensor(s). Model: I]J.-Shear Valve(s), Q...Dis enser Containment Float(s) and Chain(s). Dispenser ill: ~/ L o Dispenser Contamment Sensor(s). Model: UYShear Valve(s). 's enser Containment Float(s) and Chain(s), *If the facility contains more tanks or dispensers, copy this form. Tank ill: ~- Tank Gauging Probe. Model: f't ~ ~ -ðð ';k ') ~nular Space or Vault Sensor. Model: ~ing Sump / Trench Sensor(s). Model: <3'~7'13Çð '-2e>¿;:' o Fill Sump Sensor(s). Model: o Mechanical Line Leak Detector. Model: !3-'Electronic Line Leak Detector. Model: V,{ W~?' . o Tank Overfill / High-Level Sensor. Model: o Other (s ecif e ui ment t e and model in Section E on Pa e 2). Tank ill: /J.p/ t' Ý ( f4l.-In-Tank Gauging Probe. Model: ,çqfJ3'<!o /~,) ~nnular Space or Vault Sensor. Model: Œl-Piping Sump / Trench Sensor(s), Model: at) '1 (/'JYð "l..cY'- o Fill Sump Sensor(s). Model: o Mechanical Line Leak Detector. Model: IJ;I-.Electronic Line Leak Detector. Model: U 11 -8 ~-p 1-' o Tank Overfill / High-Level Sensor. Model: o Other s eci e ui ment e and model in Section E on Pa e 2 . Dispenser ill: o Dispenser Contain ent Sensor(s). Model: CLShear Valve(s). . enser Containment Float(s) and Chain(s). Dispenser ill: o Dispenser Containment Sensor(s). Model: o Shear Valve(s). o Dis enser Containment Float(s) and Chain(s). Dispenser ill: o Dispenser Containment Sensor(s). Model: o Shear Valve(s). o Dis enser Containment Float(s) and Chain(s), Include information for every tank and dispenser at the facility. C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also at~a~hed a copy o~ the report; (check all that apply): ~stem set-up CJ-A:1aW history .leport ,.' . . ~ Techmclan Name (pnnt): ':~;7 ~'7' ~5 SIgnature: '"7~--:¡o 7/~ Certification No.: L)£~~_ License. No.: 500 ~WS- Phone No.:( q (t- ) & y¡, - 9b Õ () Date of Testing/Servicing: 1/ 6'7 cl Testing Company Name: Site Address: ¿¿.~ V /L <!. r h r,~,/ I Page 1 of 3 03/01 Monitoring System Certification D. Results of Testing/Servicing Software VersiAn Installed: Com lete the followin checklist: ~es D No* Is the audible alarm 0 erational? Cü-¥es D No* Is the visual alarm 0 erational? [lJ..-¥es D No* Were all sensors visuall ins ected, functionall tested, and confirmed 0 erational? ~s D No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro er 0 eration? If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~ump/Trench Sensors; D Dispenser Containment Sensors. Did ou confirm ositive shut-down due to leaks and sensor failure/disconnection? 19-Yes; D No. D No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no ij)...-N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill oint(s) and 0 eratin ro erl ? If so, at what ercent of tank ca acit does the alarm tri er? % Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. ~ ~ Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) D Product; ~ter. If es, describe causes in Section E, below. []..--Y'es D No* Was monitorin s stem set-u reviewed to ensure ro er settin s? Attach set u [].--Yes D No* Is all monitorin e ui ment 0 erational er manufacturer's s ecifications? * In Section E below, describe how and when these deficiencies were or will be corrected. ~ D No* D N/A D No* D N/A IJI...-"'{es DYes D Yes* s-I'í 0 E. Comments: h~/ 4(~~¿c/ /%,..j Ii- ¿).r -r -1 ><C ~ d:~ ~ Page 2 of 3 03/01 F. In-Tank Gauging / SIR Equipment: o Check this box if tank gauging is used only for inventory control. o Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perfonn leak detection monitoring. c Itth~1I h kr t omple e e 0 OWID~ C ec IS : ~es 0 No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? UJ.-Yes 0 No* Were all tank gauging probes visually inspected for damage and residue buildup? [!)-yes 0 No* Was accuracy of system product level readings tested? ill-Yes 0 No* Was accuracy of system water level readings tested? ~es 0 No* Were all probes reinstalled properly? eJ.--Y'"es 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): o Check this box if LLDs are not installed. c h ~ II h kr omplete t e 0 OWID~ C ec 1St: [9-"Yés 0 No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? 0 N/A (Check all that apply) Simulated leak rate: ~g.p.h.; 00.1 g.p.h; 00.2 g.p.h. B-'Yes 0 No* Were all LLDs confirmed operational and accurate within regulatory requirements? I::!t-'res 0 No* Was the testing apparatus properly calibrated? DYes o No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? [3-'N'/ A 9-1"ês 0 No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? 0 N/A Ol-""Yes 0 No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled 0 N/A or disconnected? EíYes o No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions o N/A or fails a test? g...-y-es 0 No* For electronic LLDs, have all accessible wiring connections been visually inspected? 0 N/A ¡¡:¡;--yes 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03/01 S~p 24 03 02:30p Ti~ ~ood50n 09/Z4/Z003 WED 14:08 FAX 707- ,¿8-5762 p.2 iii 001/003 MONITORING SYSTEM CERTIFICATION F/J' UsrlJ) A fl Jwn',diaum" Wir¡jn the Srall! øl Cali[Qmiø A/IlhQriry Cilu/: C}¡aprtJ' ð. '1. ritfIJlrlt d'ld $.1/6" CI)f/r~ CJaRplcr J6. Division J, TitÙ123. Ctllí/r1TnUJ CCldt! 01 R,gula1ion.r '11Iis !oñn nmst be used 10 dOCumclllleitiDg and &CoI'vicÌIJ& of monitotil1t: equipment. À1.~_ II. çc: ¡ On for each JIIO\iforint ~s:t~ lòontroJ n:lnel by tIM! locJ)wciAII whu parturJtl; the: WC'rk, ^ copy af tlUs fO/m mllSI be: PfovicJed to the lank S}'t>lc.tU UIIrJ)trlopa'illor. The tl'WDr.rfopt'.nItor must submIt a copy of !his form t(I the kw::.l apncy re~laliDe UST sy¡te.lns witbin 30 dpys ofee . ;; HIP ,,r:. E!) ~f?~' '. 1.:,..2 A. Gel! Texaco Facility 1\ 5321 Stoc:.ltdDlo Hwy Baterrfitld, CA, SiœAddrN02.'iR1 F;aci]il.l C MIIJ."CIMocie.I of M.oni[ocíøg Sy5tcm: B. ID"entof1 of Eq1dpmcnt Te.stid/C.wtified CIoMIc duo ......... .....t4i 6 ~, TÞk1D: , ~~ YUIll ID; &Ie- TUlk GMÌItiDI ~bc. ~: ~ ~ ~.LØ':¡__ ~·T_ CAuciPr PrelIM. Mo4oI: f'f "J _e -.... L a--....nn\lJar s.- or Yault SenJOl. Nodcsl: ~III. s~ 01 Vlnllt SbIDor. Modd: ~ Sump I TJalCh SCßIor(I). Model~.bW f..J ~ -~f;:"" ¡g...rrpi~ SlDIIpl 'J'reDc:h SWSóf(i), Mo~f; <1~9~Wt' .~.2.e.F g p¡n SUmp SIlllOlt~). Mødd: ~ C Fill s-P SelllUl'(i). ModcJ: '.. . H_ e Mcc:lœaicd Linç Lcllk DeIaCfDl', ~. 0 M.d\;aúC3l LiDII Uak: Dtœaot. ModtI: 1!HDðor001iC:Li..LAakDelegIOl, ModeI:d'l4'$Ù ~LiDDløIklklcctw. MadeJ: vI( W'~ a T;mk CMrfUll Hia:b-Ltvel SID$O~. Model: C "hall; OYIdiD I Wrh.LeveI Seml'lr, Model: o 0IÞcr I uJ II model ÎD Seel.icm E on P:t 2). C Oth... . f j IIJI'JJÍ. IIDcI naada.I ¡u ScçIioa E oa PI! 2, TIqk 11). TaIdt roo I".J...( fi:- / C JB-T_OIQiDc ModcJ~ ~2\DI""-ø4.L QJn-Tallkc..p,PrÒ1Ic. 11(_1: ~~1.o /oC\o) liiI"'MIIularap.œ ot "1I..luomOl', ~. r I'!r'XDmaI;v ~1*IOCIr V¡au1UIDIDt. MocIcJ: ~.Surøp/TRlndlSeIt-<s), Mode~ ~It~...~ ~ tD-IIïp;"8~'TtoiMihSèhaar(.~ Model: "Q'ld"~ -~~ C FiJI Scamp ScuIOf(¡).~: I;) ñJI Sumø ScuGr(s). Model: C Uecb:MIIlc:al Un. Lak Deœcmt. Nodd: C Mec.baniCill Une Leak DeteaGr. MGdId: ....--.: .. ~ I.iM Leak Deteø.or. Model: tJ,£ "fUU" ~bOIIic 1.ÜI81.aJr.~. McMI: ~ !!~"p, C TlmkO¥afiD/JticboLneISeIISQf. Modd: C TIllkOvoiWlBieb-LevlllSeDSot. MÓdd: [J 00Iet 1 e' I md modd ia Sfo.cdG'G J! 08 2 , a 011_. ' " an,moðcI i. SocIiOll E on IJåpcnw m: (..., þ¡.¡~ J1): C Diar-sll!l' CœcUDIZKSI SeMor(c). MOdel.: 0 ~ 1!I-4I"-r ViMes). Q.Shear Valvc(c). ~ IUÇr s :wi Chail '). - ser CoaúiDmCDt Flo ~ un:! Ch' 5. ~m: 3/-V DiipcucrID. Q Ullpenser~NIII$eIUOI'(a). MocIc1: a DispeasarC'-";~Sensor(l). Mad8h ~. V."YoO(.). 0 $haIr VI1I~C5). IIsK ("..anllli 0 Db CœiaDImoDl Jõ1DIIt s IUId ~W: ~m; o ~ C~II SCII$Uf(J). YadiJ: C I)qpnar ~lIIIUt Scntor(s). Model: ~Valw(s). 0 SJ.:.rv.aYII(J). n:rCOIItlimDcDt FlCW(.) 3IId CI' :I, Q~. s ;md OUO II .)·It rJx kJlù)' cmlllDllIIOR tlllts ell'dlspeews. tðl1 Iht$lMa. Inchide iúo~ Car Cfåy WIt ~ dispc!ÞJr:I Ii the fiM:j)jly. C. CertiØe.tiCJD. I œrdf¡ that ..... ~ui~t idett&ificd in UIIs Goc".."c .ulltlpaolc","",ieed ì.. IIIC~ willl"'lINMIIIfuhlnd" .......... AttMMtt to .... Cer1iØCt14ioa ¡, w.....-. (e.c- 1IIIIIAIlIIctaht'.s" ùcddiaÞ) --110 Wl'ify ~ &bb ~ü. Î5 ewnø IInd 1I'lol ØAa ..Wille 1M 111,II1II tJllBðllltori., ftIIIÏpIIIl!nt. ror any cqul¡llMal capùlc of ae-radlr&: sudl NpeRt¡:, J ......, . .u..cW. COPJ .. tM ~&e,* tllllAqt øwb'); t:tSJstom let..., ~ ~)'eþOJ'1 AIi!--; TccJlftiOiu Name (piAI)1 ~ .... I!P'~ ..1 Sípuatwo: ~~ CcrWICd¡)ft No.; ø ~ 3 '1... Lic;c::nlè. No.; ~QØ ~ "It)- ... TCStiA. Comp:any Na.m.!... I..L-< ~'... ot!. A.....-;...... PboncNo.:( q~ J ~f¡" ~ ~() Sue Addrc.u:~ Due ofTtitin&,Scrviciøc; ...Jl:J..ß:J tl Bldt. No.: City~ Zip: CoDractPhoncNo.: ( O(I¡, ) (.,%-:q¿:~ D~k: of Tcsting/SenriciDlr ...ß I J;;u D) 2). -, Me.ko...., 51...... c.t'urlC:Jltk... PIIt\" J.on O:NOJ S~p 24 03 02:30p Tim Wood50n 01/24/2003 WED 14:10 FAI 707-..,28-5762 p.3 IiII002/00:J D. Rdulu of TcslinglScnicing Software Version ]osU&lIcd: clledclid: Is th~ audible .alArm o YÎJ\¡ù a hum 0 üonltl? W...lllsanlllJr5 vj¡¡1II1I1 ¿ led Iuuc:tianan kshd. auld cooflfmCd onioaa1? Wetc aU semOn illlltaned :11 lo1Wl:( po¡Dt 01 'ðCOnd..-y comniGmcm and ~tiQncd '0 Uaat oth... eq\1Îpmeat Will . willa fbcir lion? If llal1lll are Jd~ ID a rcmoh: monilOring .anon. is all cammunicatioJq eqWJMlllml. (-..c. aaáðøn) opm-atioaal? For prcss.uriu4 pípill s)'srcms. docs die turbÎ1lc ~ili:aD, shut dDwn if thl!! pipina ~II)' I:OØÞIÍDmaIt mooitcriD& system dc&ecU ..Ieak. taiJft 10 Opeß.te. Of is ckctricaIJ)' dålCC*nccowI? If ya.: which RI1$OrS Ûlitiace poIÏbve shur-doWD? (Ckd: IIllllalll "IIP") IiI-&1mpfrreø:. Sc:uIors: C Di&pcnsar Canrainmcnr ScIIIors. Did c:oJdlnn 'Ii~ ~ dœ to leaks !IØWM' failureld~? !tTC.Ii; e No. e Yea e No- JW t.DIe 'yettms that utilize du: mDIIåtOrinS I)tSfBQI .. !be primary rank ovå'Íill -mill dcvk:c (i.e.. no QHvA mecbaaiea1 overfill pn:vaaåon vaJw is _JalJed). ÏI the! ovmi1J OW.-S aJatm vi5ibJc _ wdibJo at !he IIInk filJ . s:l.Ød . Iho. u ..m.. 1aDk ei!y' dCCUho alarm tri ,., a YDI· a--Ro W$ MY I,\IQ"Wrin& c.quipmcnl replaced! If yes. ideœlfy 'P«=l1Jc SONOrI, pmba. or 0CIIcr ~t n:pIaced and ile Cho ma.out4c:turer DIUIIC end modd fat III _lit iD Sec'iOR below. .t!IiiÎI1II" w.. ÜlfUW fouad i1IIide ~)' .-=oacS-.y COIaIIinnacnl ayIIemI d.abþiM M dry ~_? (C/I"" Q/l lINt øpp~) Product: ~. If . dea:riIIe C8DR$ iu Sec:tion Ii below. e No· Wa¡ Kl-ú n:*'Md 10 eM". ? At a C No· I' all moni atiOG;\l r mllni:6chlrllr'.5. ·fiä.l~" · III ScctiGa B hIow. dMcrihe _w ... ....... tIM!Iie dd"orÑ'Ddes "" or -W Ite COI'I"eCœd. CI C No· IJ NJA a No· D NJA ¡¡..yes Eo CODIØIeDtsz . Cs- ({..,I ;, k. h_/~ ~/6--- . L. ~. , 'r'/) C « II./~~« /~I ¿ ðJ..-:-t~ ~ À:f,I"f ~ --..-.... ....- r.to~orJ Ø3Itl S~p 24 03 02:30p Tim Wood~on U~/~4/~UU~ W~ 14:1U fAX 707- ...28-5762 p.4 ~003/003 F. la·TftDk Gan:i~C I SIR EqujpØl~nt: Q Check tbis box if t\r\1.: þla8ÏnB i... U$ed cmJy ÍOi' iß'YCnlt'ry COllhul. o Check Ibis box if no lank pveiftt or SIR cquipnJenl ¡¡¡ ¡lIItAlIed. 11ùs section must be completed it jn-tank g:mging equipmcnr is used to pelfolm leak delection monitoring. Conmlete th. tollDWÏDr dlectJi&t: ~e¡ Q No'" HIS III inp.t ~ri1l1 bccA inspected fIX PIVp= entr)' aM te.rmiaacion. iDç1udit14 tosIióJ fm around r.uh.' Ií)..:V GIS C No·' Wen: All tank þugìn¡ ptobe5 vÌ5ua!Jy iJ1llpCCred tor d~~e aDd ft:Sidue bWJdup? ß.Jres o No'" Wa¡ accuracy 0'1 QltlZQ procIucIlovol roadÖlt- 1GIfcd? cg..yes C No. W~ ,,",ncy of 1)'9k:m WÙCI' Icvol Radings 1CSIéd? i:!t"'Y c. C No· Were all probes ..imtaUocJ )M'opcdy? ~ o No· Were an irems DD me UW,prDenl IIWIlICI\CNtà"$ 1D8iDœn.nee dasck1lsc complcllld? · In 0. Seed_ H,kJow, tIeccribe t.ow aDd wbca .... dcØ~ wè.-e 01[' 1IriII1M: c.ornctecL G. Une Leak Dalt!etors (LLD): C Check thÏ$ box ifll.Ds Art IWtt ¡n¡talled. ComDld thç folio .... chIIc:kk Cl-"f"a o No· Pur eq~11'IiInt Itl1rt-up or AIWLal equipmlmc certáfic~ was a Jo.k IÎmulll1ed to ycrif)r J.LD pedOlmaUCC'1 eN/A (Cl..:ck crllllfqJ Ppply) SimullllCd 1c:at I'å; ~p.h.: 0 O.ll'P.h; 00.2 ø.p.b. et""TB CNo" w.o all UJ)s .t:aatiIillo....d. opID'atioa;) lWeI .llca.arl: widñD.eplatory req~? ct-"Y. Q No· W.s chç CCItÎDC ~ pmp:rly QUbr.ltcId? a YQJ o No" For mec:tIID1eaI u.ns. does f.bc UD re.strict produc& fto. it it dc:c.:clll .11!:IIJr.' I3"N1A ~e¡: o No· POt e~ UDi. docr dI~ tutbiroc: ~y ¡b\K oft' 1f_ J..LD detccUla Ied:? [} N/A I:I"'T. C No" Few eIr.c:1rDDic u.Ds. ðC)e$ &be curbiac alltWlWiI:õdJy .. off jf aD)' portion of the moajloriD3 sylED:m i¡ diubTed eN/A. or disconncdcd? l:I"""Yeft Q No- for cJccIroòie l.LDI. doa 1M turbjœ aluomatigUy shUt off if tury portion of Ibc 1DODiraia& system JDI1t\mcdoa¡ C N/A or faiJ.c a 1eM7 g-yq C No" For dcctronic u.n.. have all ACCCI$ÍII.\e WirinC CODN:èIÎùNi bIIIm viluall)' ias¡poc:&cxI? Q N/A ~cS o No· Wc:rc .a itmIu 011 1M lIqulpmeDI lUa.~IIaI'IIr·'lQIIÏat_ ch.md;.t ~ "Ia the: Scerion H~ below. de.:ribe Iaow _ ....1IeD llu:&'ø d.&leÞdes were .. .01 be correctccl. . H. Comments: P~c3ot3 t)/tl 05/16/2003 FRI 17:23 FAX ~~~~ ¿& LVU~ ¿~.~, U~~I ~u r~~~ r~~V~"I&UI' lbb! J tjlO~-~l"i::: ~ 0021004 P.2 BI - C 111 CITY OF BAKERSFIELD ,. OFFICE OF ENVIRONMENTAL SERVICES 7(L{~ 1715 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TESTI SECONDARY CONTAINMENT TESTINGlI'RACER TESTING FACILITY <2-~!I 0 ~ ADDRESS Sê>Q....\ ~Y'.\¿ e\cJ..l. \-\v..::> ~ "Y~,,-~V"o:;-R€~ct, erA PERMIT TO OPERATE 1/ OPBRATORSNÅME ~~ 0\\ ~~pa.~ OWNERS NAME ~t ~ c;\ \ ( µ. . NUMBER. OF TANKS TO BE TESTED IS PIPING GOJN<;:t ~ BB TESTED_ TANK # --L. 'VOLUME SSb CONTENTS \..~~ (") ~ l TANKTBSTINGCOW:ANY l~'6'N.. ~£~(',C. . " MAIIJNG ADDRESS. .~ ~ r-... 'Av-~, ,S........ ~.' ~c..1".t':'-J'M...vd:i::.\ CA QS-8"''3'8 NAMB&PHONENUMBEROPCONTACTPER.SON""ßr~)1"\ ~~ì~ QIi4--iJ;,-/(,..qft:,[s-o TESTMImIOD Ai;.oJ~(,,--\-.-d \-\-~~ ~-\- _ ~_ NAME OFTBSTER OR SPECIAL INS 0 e.q: t"iA-~ CERTIFICA'I10N# 3.0b'~""(S- DAm2:1: ~rs TO BBCOND~crm c:; /~p,ID ~ ~ "':""'" qf - ,"".:- s j/'i;ð3 ~)-, 'I' ,-",,-..J APPROVBDBY DATE' S A OFAPPUCANT M.r Ii 03 12:59p , S·0. Bruce T. Marubashi 209-577-5964 p. I .~,:.." ";, -< ': :" ;: . .!~ ..: ,':~, -~-,", :,;~' ,: '-",."" ",-:~._" Shell Oil Products US Northwest Region 3468 Claremont Avenue Modesto, CA 95350 TO: R ø.. ( rill LL .r 7?d<..c rS [¡Coli F Þ DATE: "2/,1 I 0'.] ¿ (. ( J z., I) oS '7 , FAX#: FROM: Bruce T. Marubashi Shell Oil Products Northwesl Region blmarubashi@equiva.com Phone #: (209) 577-5960 Fax #: (209) 577-5964 FAX TRANSMITTAL NUMBER OF PAGES INCLUDING THIS PAGE 4- IF YOU DID NOT RECEIVE AI.L OF THE PAGES, PLEASE CALL (209) 577-5960 COMMENTS: 2003 EOUILON - SHF.LL OIL COMPANY (1) UST FINANCIAL LIABILITY DOCUMENT (2) LIST OF SHELL BRANDED FACILITIES COVERED BY THIS DOCUMENT PLEASE FORWARD TO THE APPROPRIATE SHELL INSPECTOR'S. TO A VOID THE NUMEROUS REOUESTS FOR THIS DOCUMENT. ¡S,"k~.Þ·:Ct1C fA. J 1<1 r7~ I""~f THANKS! CALL ME IF ANY PROBLEMS. Bruce T, Marubashi HSE Analyst - NWR, Bay Area -'-- "---. "-' t1·r 1 l' 03 12: 59p Bruce T. t1arubashi 209-577-5961- p.2 UNDERGROUND STORAGE TANK UABlllTY ENDORSEMENT . Named Insured . T Endorsement Nuiñbe~ -_. t ..She~º-i!. CompðÐ,L ; Pollc:y Number rp01iC;Ÿ Pèriöd'- U I ! GL093079S0-00. ¡January 1, 2003 to Jal~u.~_ry"l".200"1 r'lssued bf (Name ofÏnsuranoe Company) . n -., --,- ¡-etfêëiiÿë-öãtë-õ"Ëitdo'rSeiUënt i I January 1,2003 Zurich American Insurance Company 11-00 Amerlœn lane Schaumbury, It. 60196-1056 1-800-382-2150 Inst!rt the pÕiicŸ'''¡umbë,. . 'The remãttidV'ëi'tj,,!',niàTi;¡,bon IS to be completed only when thiS I!f1dOl'5ell1t!ntiS-¡Sued suœeQUêñïÏôttïe- preparation at \tie øoIlcy, THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. This endorsement modifies Insurance provided under the tcllowlng: COMI1éRClAl GENERAl. UA8JUIT CERTIFICATION ENDORSEMEPIT FOR SCHEDUlfD TANKS l , This endorsement certifies that the policy to which the endorsement is attached provides iiðbility insurance covering the following Underground Storage Tanks: Schedule of Tanks attached ror taking corrective action, and/or compensating third parties for Mbodity injury" and Mproperty damage" caused by either "sudden accidental releases" or "'nonsudden acddental releases" or .. accidental releases"; in accordance with and subject to the limits of liability, exdusions, conditions, and other terms of the poflcy; arising from operating the underground storage tank(s) Identtfied above. The limits of liability are: Each Occurrence Annual Aggregate $1,000,000 $2,000,000 exclusive of legal defense costs, which are subject to a separate limit under the pollçy. This coverage is provided under GL093079So-00. The effective date of said policy Is January 1, 2003. 2. The insurance afforded with respect to such occurrences is subject to all of the terms and conditions of the policy; provided, however, that any provisions inconsistent with subsections (a) through (e) of this Paragraph 2 are hereby ðmended to conform with subsections (a) through (e); a, Bankruptcy or insolvency of the insured shall not relieve Zurich Arnerican Insurance Company of its obligations under the policy to which this endorsement is attached. /). Zurich American Insurance Company is liable for the payment of amounts within any deductible appliClJbfe to the policy to the provfder ot corrective action or a damaged third-party, with a right of reimbursement by the insured for any such payment made by Zurich American Insurance Company. This provision does not Mar 11' 03 12:59p Bruce T. Marubashi 209-577-5964 p.3 apply with respect to that amount of any deductible for which coverage IS demonstrated under another mechanism or combination of mechanisms as spedfled in 40 CFR 280.95-280.102. <.:. Whenever requested by a Director of an implementing agellC)l, Zurich American Insurance Company agrees to furnish a signed duplicate original of the policy and all endorsements. d. Cancellation or any other termination of the insurance by the Zurich American Insurance Company, except for non-payment of premIum or misrepresentation by the Insured, will be effective only upon written notice and only afl:er the e(plration of 60 days after a copy of such written notJee is received by the insured. Cancellation for non-payment of premiUm or mlsrepresentatlon by the insured will be effective only upon wlitten notice and only after expiration of a minimum of 10 days after a copy of such written notice Is received by the insured. I hereby certify that the wording of this instrument is identical to the WOrding 40 CFR 280.97(bXl) and that the ZUrich American Jnsurance Company is licensed to transact the business of Insurance or eligible to provide insurance as an exœss or surplus lines Insun!r In one or more states. ~~- T A~# Authorized Representative for Zurich American InSLlrance Ccmpany Name: Title: Address: Duncan Plaskett Vice President Marsh USA, Inc. 1000 Louisiana - Suite 4000 Houston, TX. 77002 ZIP 93301 93304 93308 93309 93309 93309 93308 93309 93308 93243 93239 State CA CA CA CA CA CA CA CA CA CA CA UST Financial Responsibility - Year 2003 Shell Oil Products· Shell & Texaco Branded Facilities Bakersfield Market Brand Address TEXACO 2401 N OAK ST 2600 WHITE LN 3605 ROSEDALE HWY .. . Q.. County KERN City BAKERSFIELD KERN KERN KERN KERN KERN KERN KERN KERN KERN KINGS BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD 3621 CALIFORNIA AVE 3698 MING AVE 4050 GOSFORD RD 5300 OLIVE DR 5321 STOCKDAlE t-rNY 6439 ROSEDALE HWY SHELL SHELL TEXACO TEXACO TEXACO TEXACO TEXACO TEXACO TEXACO SHELL .. CD 11) ll) I ['0. ['0. ll) I 0) o N BAKERSFIELD BAKERSFIELD 9069 GRAPEVINE ROAD WE LEBEC 25712 WARD DR KETTLEMAN CITY HS&E Analyst Bruce T. Marubashi Shell Oil Products - Northwest Region 209-577-5960 (fax5964) '... .c WI IV ,g :J L IV J: I- GI o :J L tQ Q.. o o .. .... o (I) o .... .... L IV J: FIRE CHIEF ,;;;ON F::::;\ZE, ADMINISTRATIVE SERVICES 2101 "H' Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395·1349 SUPPRESSION SERVICES 2101 "W Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAX (661) 395-1349 PREVENTION SERVICES FFlE SAFm SERVICES. ENVFIOHIENTAl SERVICES 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3979 FAX (661) 32EHD576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 32EHD576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3951 FAX(661)326~76 TRAINING DIVISION 5642 VIctor Ave. Bakersfield, CA 93308 VOICE (661) 399-4697 FAJ( (661) 399-5763 January 22, 2003 Stockdale Texaco 5321 Stockdale Hwy Bakersfield CA 93309 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. Si"2 Steve Underwood Fire InspectorlEnvironmental Code Enforcement Officer Office of Environmental Services SBU/dc ~~.7~ de ?!?£YNhuuu7p .¥O/" .A0Pe .r~ A W~" 12', H:·¡ :,;¡..',j ['I ìi t it t:':_::~·~'l ;:':1'1 "t]íhLF ~~L,¡ [:1;/1.1·:;,;1' ¡ EL L'. 'i" C:¡ 1 ¡,I~'l ~_~I·.J'/::;(:~~¡j~¡!.~_I/ DE" .,'. ,'I Ii I~' 11.1: ,j ¡ ,., r1' ¡ J f'r/FrU'k/ HrC,F, r T ! I,'"IL .,:E ULU\'Æ ',~CI ULL.MI.:!:: HEjl;HT ¡".lHTEr: './";'l ¡',IHTEr,. TEt'IF T ~,. U'; f I ik.; ".iC'LI. W'Ii ULLhl;[ ':;¡}:, II!.:h'.¡ HEICHf ¡,lhTI'.}': ·"..L 1.,li,'I'!:h' TEll!' T::: :.~ 1 I!:UI ¡ ! .'11 ,,}\";'J i 1["'1f UI. L ':-11,"1. ¡iLl i,':;¡:~ HE j 1;IiT ¡,.IiiTFf-:.. .t i,.Iii T EF' TErH: T ,-1:]1 I L.n. /.:';"i"i[··'E ! LI.ri!~r '~-'jU" iJLi :lí.~L t-Il' I 1";I,;'i ¡·.In fEk ¡,.Ii,TEk' TEflI ,I '! k'[l;111 hF. 1-. _I r... ; ~ t,·_, --:: '- :~: I ~ 1 ., II '~-I ; j ':;':-11.:; '.1r'd_.:.. . 1'._ ,¡:-Ii.. t.' III:H[: 1" '.r'! I-I - '/ ;:: '/ (. . 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CITY OF BAKERSFlEtD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 171S Chester Ave., 3rd J"loor, Bakersfield, CA 93301 FACILITY NAME S+Odc~ .:%~ ADDRESS t),1~( .s\ tlL \ F ACILITY CONTACT INSPECTION TIME INSPECTION DATE 1'2-' Î-"O Z PHONE NO, Ç3ì ~ (3 ~1 BUSINESS 10 NO. 15-210- NUMBER OF EMPLOYEES L{ Section I: Business Plan and Inventory Program o Routine rJ;ttombined o Joint Agency o Multi-Agency o Complaint ORe-inspection OPERA TION C V COMMENTS Appropriate pennit on hand \.... / Business plan contact infonnation accurate / oJ , V" Visible address Correct occupancy t.. / Veri fication of inventory materials v / Verification of quantities l ,/ Verification of location -- / Proper segregation of material ./ Verification of MSDS availability '- / Verification of Haz Mat training \.. ,/ Verification of abatement supplies and procedures \.... / Emergency procedures adequate ...... ,;' .Containers properly labeled ,// Housekeeping / <;/ Fire Protection I Site Diagram Adequate & On Hand r' C=Compliance V=Violation Pink - Business Copy Any hazardous waste on site?: Explain: DVes QNo Questions regarding this inspection? Please call us at (661) 326-3979 White - Env, Svcs, Yellow· Station Copy Inspector: CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.. 3rd Floor. Bakersfield. CA 93301 FACILITY NAME~Oc~Ji1.(L ~\(.({ <9 INSPECTION DATE (2 r ;1. . 0 è Section 2: Underground Storage Tanks Program o Routine [S(éombined 0 Joint Agency Type of Tank OwÇ Type of Monitoring tf t. W'\ o Multi-Agency 0 Complaint Number of Tanks S Type of Piping /1)( UF ORe-inspection OPERA TION C V COMMENTS Proper tank data on tilc V / Proper owner/operator data on tile v " Permit fees current V / Certitication of Financial Responsibility V- I Monitoring record adequate and current V Maintenance records adequate and current .., . Failure to correct prior UST violations .J Has there been an unauthorized release? Yes No V Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank AGGREGATE CAPACITY Number of Tanks OPERA TION Y N COMMENTS SPCC availablc SPCC on tile with OES Adequate sccondary protection Proper tank placarding/labeling Is tank used to dispcnsc MVF? If yes, Does tank have overfill/overspill protection? C=Compliance V=Violation Y=Yes N=NO In,p'''''' ~, (IN ~ J:ë() Oftïce of Environmental Services (805) 326-3979 White, Fnv. Svcs. Business Site Responsible Party Pink, Business Cory ~)Y ;,,~ WC""Y MONITuRING SYSTEM CERTIFICAiION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This fonn must be used to document testing and servicing of monitoring equipment. A s~arate certification or report must be prepared for each monitoring: system control panel by the technician who performs the work. A copy of this form must be provided to the tank system owner/operator. The owner/operator must subnút a copy of this fonn to the local agency regulating UST systems within 30 days of test date.'!' A. General Infor Facility Name: Site Address: \~ d , I Bldg. No.: City: ~J¿J7+1IJ Zip: Contact Phone No.: ( ¡,,, I) J>? '7... / ?I!L Date of Testing/Servici; J? / 1(, /.f);} Facility Contact Person: , Model: Model: Model: Model: Model: Model: ~..---- I I i , 1 I I I I ¡ Model: ModeJ: Model: Model: Model: Model: C. Certification -I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. AttàcÌ1ed to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, 1 have also , at~~hed a copy o~ the report;Jtileck all that appjy): ~ System ~t-up ~m h;tory report rechmclan Name (pnnt): ULV-t"1A KP1.IA{ŠIJ1/¡ð Signature: ~ L ---:a.... Certification No.: 16¡?;;) License. No.: . ~ L . t. · _..A d/""'lA.ir-<:..( Phone NO.:( 5""'5"f> Dale of Testing/Servicing: Testing Company Name: Site Address: !\'Ionitoring System Certification Page 1 of 3 03/01 I I I I I i -.I _._.~._._-_..._--..__..- ------- I I l I i ¡ ! I I 4*'. "..D. Results of Testing/Servicing Software Version Installed: Com tete the [ollowin checklist: Yes 0 No· Is the audible alarm 0 rational? Yes 0 No· Is the visual alarm 0 rational? o No· Were aU sensors visuaU ins ted, functionall tested, and confmned 0 erational? o No· Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will 1'Iot interfere with their 1'0 er 0 ration? If alarms are relayed to a remote monitoring station, is all communications equipment (e,g. modem) operational? For pressurized piping systems, does the turbine automatically shut down if the piping..econdary containment monitoring system detects a leak, fails to ope~r is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check aLL that apply)~umprrrench Sensors; a Dispenser Containment Sensors. Did ou cOnfllffi sitive shut-down due to leaks and sensor failure/disconnection? ayes; a No. D Yes D For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. 110 mechanical overfill prevention valve is installed), is the overfiJl warning alarm visible and audible at the tank fill oint(s) and 0 ratin ro erl ? If so, at what rcent of tank ca acit does the alarm tri er? % D Yes* Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all re lacement arts in Section E, below. DYes * Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) D Product; a Water. If es, describe causes in Section E, below. o No· Was monitorin s stem set-u reviewed to ensure 0 r settin s? Attach set u es 0 No* Is all monitorin ui ment 0 ational r manufacturer's ifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of3 03/01 .,I'. '1 .t!t -~~ to- :'~~ F. In-Tank Gauging I SIR Equipment: a Check this box if tank gauging is used only for inventory control. a Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak: detection monitoring. Com lete the {ollowin checklist: o No* Has all input wiring been inspected for proper entry and temùnation, including testing for ground faults? o No* Were atl tank gauging probes visually inspected for damage and residue buildup? o No* Was accuracy of system product level readings tested? o Nø* Was accuracy of system water level readings tested? a No* Were all probes reinstalled properly? o No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): o Check this box if LLDs are not installed. h ~ II h klis Complete t e 0 owml! c ec t: .2'Yes o No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? o N/A (Check all that apply) Simulated leak rate~.p.h.; Cl 0.1 g.p.h; a 0.2 g.p.h. ..e:r Y es 0 No* Were all LLDs continned operational and accurate within regulatory requirements? .Ji!t'Yes 0 No* Was the testing apparatus properly calibrated? o Yes o No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? - .-e:r--NI A ,;i!f' Yes o No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? .- o N/A . .Ji!t"Yes o No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is disabled o N/A or disconnected? ,Jërlí es o No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions o N/A or fails a test? .ZYes 0 No* For electronic liDs, have all accessible wiring connections been visually inspected? 0 N/A ~es 0 No* Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03101 ;¡¡t , J 1 08/13 2002 09:06 4441735 \tJ I,I,·.:..VU" H;j4 'd'6t1!"O:¡U571.S I\.. (\.., . LC SERVICES BF'l) HAl .MAT lH V PAGE 02/02 Ii(,jUU' " . .. . CITY OF BAKERSFIELD \ OFFICE OF ENVlR.ONMENTAL SERVICES 171S Chester Ave., Bakersfield, CA (661) 326...3979 APPLICATION TO PERFORM FUEL MONITORING CERTIFICATION '. ~ FACD.1TY f~CO '2J379 ADDRESS 5321 STOCKMt.£ HuH., ~R:;F'£U)1 CA q~q OPERATORS NAME ECCUfLD!V Ewr· ÚL. . OWNEB~SNAMB £CûUIWN ~ðæ UJ:- NAMB ()jiI MON1TOR MANUFAcrtJRER VE£~ - ~T· DOBSFACDJTYHAVEDISPENSERPANS? YBSL NO_ TANK. , I 2- .3 - '-I VOLUME t 01000 l 0 J 000 '0 J 000 . J ().on!) CONTENTS E3 7 IJN~t> B9 UNL-J) q I UNLD l¿J£S€L #2 NAME OF 1ESTING COMPANY L C- S€~V'Cf£S CONTRACTOR.S UCENSB * 7 7 ~ 1 ¥ttA Z- NAME,~ PHONE NUMBER OF CONTACT PERSON S K.f P Û;)( ssq. -<¡qJ..J-t 730 DAm & TIME TEST IS TO BE CONDUCfED g - I (p - 0 2 @ 09.30 '. APPROVED BY . ~-(3-()è s-!Þ0 DATE SIONA~OF APPUCANT ¡'/~ V / :/ WAYNE PERRY, INC. Environmental Remediation, Construction and Consulting July 18, 2002 Certified Unified Program Agency Steve Underwood 1715 Chester Ave., Third Floor Bakersfield, CA 93301 '\ ë--t(,\.l 0 SUBJECT: SB 989 COMPLIANCE TESTING AT SHðIl, 5321 Stockdale Hwy., Bakersfield, CA 93309 Dear Steve: Below please find the secondary containment testing results for the above-referenced site. These results are being sent to you per the requirement of SB 989. If any of the secondary containment components failed or were not tested at this facility, repairs will be made within 30 to 120 days. If, for some reason, the repairs will take more than 120 days, your Agency will be immediately notified. CONTRACTOR: Wayne Perry, Inc.; License No: 300345 TECHNICIAN: Scott Happ Components Tested Component Date Type of Test Pass / Fail Manufacturer Tested Performed Tank Sump - Diesel American 6/21/02 Hydrostatic Pass Containment Tank Sump Turbine - 87 American 6/21/02 Hydrostatic Pass Containment Tank Sump Turbine - 89 American 6/21/02 Hydrostatic Pass Containment Tank Sump Turbine - 91 American 6/21/02 Hydrostatic Pass Containment Dispenser 1 & 2 UDC Bravo 6/21/02 Hydrostatic Pass Dispenser 3 & 4 UDC Bravo 6/21/02 Hydrostatic Pass Dispenser 5 & 6 UDC Bravo 6/21/02 Hydrostatic Pass Dispenser 7 & 8 UDC Bravo 6/21/02 Hydrostatic Pass Diesel - Sinqle Wall Pipinq AO Smith N/A N/A 87 - Sinqle Wall Pipinq AD Smith N/A N/A 89 - Sinqle Wall Pipinq AD Smith N/A N/A 91 - Single Wall Piping AD Smith N/A N/A Tank Annular Testinq Dry Annular 6/21/02 Vacuum Pass 30 Main Ave. Suite 5 Sacramento, California 95838 Phone (916) 646-9680 Fax (916) 646-9683 SB 989 Compliance Testing Shell / Texaco 5321 Stockdale Hwy Bakersfield, CA Page 2 of 2 If you have any questions regarding this submittal, please contact me at (916) 646-9680. Sincerely, Wayne Perry, Inc. Brandon Smith Project Manager Attachments SB 989 Testing Results & Procedures Cc: Perry Pineda - Shell Oil Products US 30 Main Ave. Suite 5 Sacramento, California 95838 Phone (916) 646-9680 Fax (916) 646-9683 Test Start Time HH:MM (12 Minute Duration) 1 :2-~' < \(0 S8 989 Test Log Forms 2.0 Test Finish Level H-Test TCI or American Cntmt (Beige or White Gel coat): ~ I OC or Fluid Cntmt (Beige w/ Spiral Winding):1 I Environ (Green, HOPE PlastiC):' I Containment (Blue, HOPE PlastiC):' , Tota Western Fiberglass Phil Tite (Green Outside, White Other Xerxes (Red):' I (Grey): r' nside):1 I :, , ,..JOp..J~ - - Monitoring Sensor Model #: O¡.j f2. Monitoring Sensor Sump Information Grade: Manufacturer: 87 / 87 Slave / 89 / 91/® / M85 . . Fue Sumps Date: (g~ "0(-'0 ¿, Turbine Containment 58 989 Test Testing Contractor: Log Test CShell 5321 Stockdale Hwy Bakersfield, CA N021163 - SB Test ] S8 989 Test Log Forms 2.0 Test Finish level Differentia VDlióv or American Cntmt {Beige or White Gel Coat):fX] OC or Fluid Cntmt (Beige w/ Spiral Winding): I I Environ (Green, HOPE Plastic):1 f Containment (Blue, HOPE Plastic):' r Tota Phil Tite Other (Green Outside, Xerxes (Red):1 I Western Fiberglass (Grey):' f' White Inside):' r :, r ~ TC Monitoring Sensor Model #: IV 0 f'JL Monitoring Sensor Manufacturer: @ I 89 / 91 / 0 I M85 o ¡..J r= Sump Information . . Fuel Grade: / 87 Slave Turbine Containment Sumps S8 989 Test Testing Contractor: Log Shell 5321 Stockdale Hwy Bakersfield, CA N021163 - SB Test Test Date: =:J sa 989 Test Log Forms 2.0 Test Start Time HH:MM (12 Minute Duration) Test Finish level Differentia OeD (p I or American Cntmt (Beige or White Gel Coat):1 x.. I OC or Fluid Cntmt (Beige w/ Spiral Winding):D Environ (Green, HOPE PlastiC):' , Containment (Blue, HOPE Plastic):' , Tota Phil Tite Other (Green Outside, Xerxes (Red): r Western Fiberglass (Grey):D ' White Inside):' I :I I r ~ TC Monitoring Sensor Model #: ;JOø-.)f=; Monitoring Sensor Manufacturer: Sump Information . . Fue Grade: 87 / 87 Slave Test Date: /@/ 91/ 0 / M85 Turbine Containment Sumps 58 989 Test Testing Contractor: Log Shell 5321 Stockdale Hwy 8akersfield, CA N021163 - S8 Test ~ sa 989 Test Log Forms 2.0 Test Start Time Test Finish H-Test HH:MM (12 Minute Duration) level Differential Pass I Fail Condition (Repair Notes) "[ : 1.;?Y : t{.r~ i oOD1 j /' .}~ Pa~/lr)lfl~ WI::' <::.coll. 4U I D':a.JFTh~"ï.n JC' vJ~T1+ M~ '0..0\ Pol"" - ;¡¡.- . Pass / Fail Pass I Fail . Pass / Fail Pass / Fail 58 989 Test Log [ ~;e~ 1 StocKdale 'r1wy Testing Contractor: . BaKersfield, Cf' . est N021163 - SB 1 \ Turbine Containment Sumps Test Date: It?-Z{ -D-z--.- Sump Information: Fuel Grade 87 / 87 Slave / 89 /~/ 0 / M85 Monitoring Sensor Manufacturer: N 0 µ E.... Monitoring Sensor Model # NOt-.JF - TCI or American Cntmt (Beige or White Gel Coat):1 X I Xerxes (Red):J f OC or Fluid Cntmt (Beige w/ Spiral Winding):1 I Western Fiberglass (Grey):1 , Environ (Green, HOPE Plastic):1 f Phil Tite (Green Outside. White Inside):' J Total Containment (Blue. HOPE Plastic):1 r Other I f I I JOlfJO I I :(::>!UOJPSI3) JOo~ JOPOOA I I :(::>!UOJPSI3 UJSpoV\l) neoJpnea8 Iì< 1 :(lBOI~ IB::>!UB4::>aV\l) OAeJ8 1 I :(JOSua~ l4ô!1 ')::>nd )::>818 illS) neaJpnea8 :uo!}ewJoUf Josuas BUIJO¡IUOII\I I r: ,1': JalfJO :(1 dsaa 'ap!slno uaaJÐ 'ap/sul al!4M) OJ!l ULJd 1 ':(1 daea 'ÆeJÐ) s~ef&Jaq!~ uJoJsaM :(dwns daea '::>nS8Id) oAeJ8 I f:(sS8IÔJaq!~) Juawu!e¡uo::> le¡Ol :(dwnS daea 'SS8IÔJaq!~) oAeJ8 1 I:(d~ea 'sap!s lLÔ!8JlS 'el!4M) sa~!d MdO ,7'. :(UBd MOBLS 'leelS) OAeJ8 1 deaa / daea '/ ~ :adÆl dwnS - -Z-I :JaqwnN Jasuads!a :uonewJOUI dwnS ----z. 0- '2 - Cj :a¡ea ¡sal ¡UaWUle¡uo:) JasuadSla JapUn lS81 8S - 89 ~ ~GON :Jo¡:>eJ¡uo::> BU!Jsal 'V':J 'Pla!lSJ8>"e8 ÆMH 8SP)::>OlS ~ G89 601 ~sal 696 as 11848 1!8~ / SS8d I!B~ I SSBd I!B~ I SSBd I!B:f I SSBd Q()OOO ~ w,'CICJa: 7.. I : Q le!¡uaJaJ.!Q laAal (uoneJna a¡nuJIJ\I Z~) IJ\IU\I:HH lfS!U!:f ¡SOl aW!l :µetS ¡sal O'Z SWJO~ 501 }sal 696 88 ¡salSS -£9~~ZON ] "TJ':J 'Pla!!sJa)\BS ÁMH aIBp)\~O¡S ~Z£S \1848 :.loJ::>eJJuo:) 6unsaol 601 }sa1686 as I I: I ':(1 deaa I 1:(SS816JaQI.:l) I I:(daaa 'sap!s daaa I~ :adÁol dwnS ~o-/Z- atea tsal tuawu!etuo::> Jasuads!a JapUn Ja.syads!o UOneWJOUI dwng D: J (:(~!UOJPaI3 UJapoV\J) neaJpnea8 I f :(JOSua~ 146!l '~pnd }~818 wS) neaJpnea8 :uoneWJ01UI JOSuag 6UIJOtlUOW :(1 daaa 'ap!slno uaaJÐ 'ap!SUI al!4M) aJ!.l :(dwnS daaa '~!lS8Id) oAeJ8 :(dwnS daaa 'SS816J8Q!.:I) oAeJ8 y :(~8d MO84S ',ealS) oAeJ8 1 daaa 1 146!8JIS 'al!4M) sa::>!d MdO :JaqwnN Juswu!eJuo:) leJOol u°nlPUO:) I I :(~!UOJpaI3) JOo~ Japaa^ I '/< I :(1801.:1 18~!U84::>aV\J) OAeJ8 ÁaJÐ) SSeI6Jaq!:I uJaJsaM JaljJO JaljJO !Lld Jssol-H O·Z SWJ0.::l 5011SB16B6 88 !8:11 SS8d !8:11 sS8d 1 SS8d CXJG() leJuaJall!O laAal ljS!U!:I ¡saol I§ : srz; b (uoneJno aJnu!1I\I Z~) aW!l :µe¡s Jsal S8 989 Test Log Forms 2.0 I Test Start Time Test Finish H-Test HH:MM (12 Minute Duration) Level Differential Pass I Fail / Condition (Repair Notes) q', ~ 't 45A,t'\ . OOOCY:J qpa~_ WI;:- .,So¡; A-i- 2.. cL.EITiZ Ic~L ~ C\~c>()cTS. . ~/Fail Pass I Fail . Pass / Fail Pass I Fail 58 989 Test Log [Shell =:J 5321 Stockdale Hwy Testing Contractor: . Bakersfield, CA N021163 - SB Test Under Dispenser Containment Test Date: ~-2-l-0'"L-- Sump Information: Dispenser Number: 5-c::' Sump Type: ~/, Deep I Deep L - - Bravo (Steel, Shallow Pan): I >'-.... OPW Pices (White, Straight Sides, Deep):1 I Bravo (Fiberglass. Deep Sump):I. Total Containment (FiberglaSS):1 I Bravo (Plastic, Deep Sump): I Western Fiberglass (Grey, Deep L): I f Phil Tite (White Inside, Green Outside, Deep L): I Other : J , Monitoring Sensor Information: Beaudreau (Sm Black Puck, Light Sensor): I I Bravo (Mechanical Float):1 ~ I Beaudreau (Modern Electronic): I I Veeder Root (Electronic): I I Other :0 SB 989 Test Log Forms 2.0 Test Start Time Test Finish HH:MM (12 Minute Duration) Level Differential Condition (Repair Notes) :),,1 :, ~ ,(Joor w E. ~EA'- z.. ~ICI:tL,> ~o '-H:>Vc:.'Cs Pa s / Fail Pass / Fail Pass / Fail Pass / Fail S8 989 Test Log CShell 5321 Stockdale Hwy Testing Contractor: Bakersfield, CA N021163 - SB Test Under Dispenser Containment Test Date: b-ZJ -C)L.-, Sump Information: Dispenser Number: :-8 Sump Type: @ /, Deep / Deep L - Bravo (Steel, Shallow Pan): W OPW Pices (White, Straight Sides, Deep):1 I Bravo (Fiberglass, Deep Sump):. . I Total Containment (Fiberglass):1 Bravo (Plastic, Deep Sump):' I Western Fiberglass (Grey, Deep L):I , Phil Tite (White Inside, Green Outside, Deep L): I Other :J I Monitoring Sensor Information: Beaudreau (Sm Black Puck, Lfglil Sensor): J f Bravo (Mechanical Float): I ')L. I Beaudreau (Modern Electronic): I I Veeder Root (Electronic): , I Other : I I S8 989 Test Log Forms 2.0 Test Start Test Finish P-Test HH:MM I Pressure HH:MM I Pressure Pass I Fail Condition (Repair Notes) I I Pass / Fail . I I Pass I Fail I I Pass / Fail I . I Pass I Fail I I Pass I Fail 58 989 Test Log Shell 5321 Stockdale Hwy Testing Contractor: Bakersfield, CA N022156 - sump Product Piping Secondary Containment Test Date: to -- z.. í -D-z:-, Line Information: Fuel Grade:' 87 I 87 Syphon Line / 89 I 91 @I M8S I WO Remote F Type: ~le~1 Double Wall Primary Piping: Secondary Piping: AO Smith (GOld):[X] AO Smith (GOld):D Am~ron (Red):' I Ameron (Red):' , Environ (Green', Flex):D TCI (Grey, Plastic):D CTC (Black, Flex):D CTC (Orange, Plastic):D Western Co-Flex'(Grey, F,ex):D CTC (Blue. Plastic):D Other 0 Other 0 Shell 5321 Stockdale Hwy Bakersfield, CA N022156 - sump Log ng Contractor 58 989 Test Testi ing Secondary Containment Pip Product - C>'?- (s,~'2- Date Test (ij) I G ra de Fue on Une Informati WO Remote F / M8S I D 91 I I 89 I Line I Double Wa n 87 Sypho Type Other Test Start Test Finish P-Test HH:MM I Pressure HH:MM I Pressure Pass I Fail Condition (Repair Notes) I I Pass I Fail -c- I I Pass I Fail I I Pass I Fail I I Pass I Fail I I Pass I Fail (Gold) th AOSm (Red) Ameron (Grey, Plastic) TC (Orange. Plastic) CTC CTC (Blue. Plastic) :l~ I :0 ·11 . ~ '0 o o Primary Piping :0 :0 :0 o o o Secondary Piping AOSm (Gold) th (Red) (Green. Flex) Ameron Environ (Black CTC Flex) (Grey, Flex) Western Co-Flex Other SB 989 Test Log Forms 2.0 SB 989 Test Log Forms 2.0 Test Start Test Finish P-Test HH:MM I Pressure HH:MM I Pressure Pass I Fail Condition (Repair Notes) / / Pass / Fail -c- . / / Pass / Fail / I Pass I Fail / , / Pass I Fail / / Pass I Fail SB 989 Test Log Shell 5321 Stockdale Hwy Testing Contractor: Bakersfield, CA N022156 - sump Product Piping Secondary Containment Test Date: (0 - è ( -0 ""Z--' Une Information: Fuel Grade: . ,87 I 87 Syphon Line / (j§) I 91/ 0 / M8S / WO Remote Fill Type; Primary Piping: Secondary Piping: AO Smith (Gold):0 AO Smith (GOld):D Am~ron (Red): I Ameron (Red): I , Environ (Green', Flex):D TCI (Grey, Plastic):D CTC (Black, Flex):D eTe (Orange, p,astic):D Western Co-Flex'(Grey. F,ex):D eTC (Blue. Plastic):D Other 0 Other 0 Shel 5321 Stockdale Hwy Bakersfield, CA N022156 - sump Log Testing Contractor S8 989 Test ng Secondary ContaInment Pip Product -ð~ Date I@I Test Fue on ne Informat L I WO Remote F / M8S I D 89 I 87 Syphon Line I Double Wa I 87 G ra de Type (Blue. Plastic) Test Start Test Finish P-Test HH:MM I Pressure HH:MM I Pressure Pass I Fail Condition (Repair Notes) I I Pass / Fail I I Pass / Fail I I Pass I Fail I I Pass 1 Fail I I Pass I Fail (Gold) th AOSm (Red) Ameron Grey, Plastic) TC (Orange. Plastic) CTC D I I D D D D AOSm (Gold) th Red) (Green. Flex) Secondary Piping CTC Other GG o o D D o Primary Piping Ameron Environ CTC (Black Flex) (Grey, Flex) Western Co-Flex Other Log Forms 2.0 S8 989 Tes S8 989 Test Log Forms 2.0 I V-Test Test Start Test Finish HH:MM I Vacuum HH:MM I Vacuum Pass I Fail Condition (Repair Notes) f~ I 5 ~ 3 /4-r,. 2;~~ I -5·3 < ';"-Pä~ Fail û.JE. ,JfE..~~ Ft- C'A.~ t') W . r RE A~µtJtAF' . I . "-J I Pass I Fail U£)...ll...... Z II ('ftp I I Pass I Fail / / Pass / Fail / / Pass / Fail 58 989 Test Log Shell 5321 Stockdale Hwy Testing Contractor: Bakersfield, CA N021163 - SB Test Tank (Annular Testing) Test Date: '" .- Z-i -0 '2..-- Tank Information: Fuel Grade: 87 I 87 Slave I 89 I 91 /®/ M85 I WO Type: Single Wall ~bl~~ -------- Annular Monitoring Method: Wet (No Testing Necessary) /, y (See Testing Notes B ¡ Modern Welding (Red, Smooth Walls):D Xerxes (Red, Square RibS):D Owens Corning (Beige, Smooth WallS):lKJ Joor (Blue. Smooth Walls):D Owens Corning (Beige, Round RibS):D Other 0 SB 989 Test Log Forms 2.0 I Test Start Test Finish V-Test HH:MM I Vacuum HH:MM I Vacuum Pass I Fail Condition (Repair Notes) 7"20 I fj·3 H&t Ç{~? I 5'3~ ;::. Pas§ßFail tA- .v, -...J .....7 I I Pass / Fail I I Pass / Fail I I Pass / Fail I I Pass / Fail 88 989 Test Log Shell 5321 Stockdale Hwy Testing Contractor: Bakersfield, CA N022156 - sump Tank (Annular Testing) Test Date: ~-2( ~o 2- Tank Information: Fuel Grade: (fj)/ 87 Slave / 89 / 91/ 0 / M85 / WO Type: Single Wall ~ble ~ Annular Monitoring Method: Wet (No Testing Necessary) / ~ting Notes Below Modern Welding (Red, Smooth WaIlS):O Xerxes (Red, Square RibS):O Owens Corning (Beige, Smooth WaIlS):lKJ Joor (Blue. Smooth Walls):O Owens Corning (Beige, Round RibS):O Other :0 58 989 Test Log Forms Test Start Test Finish V-Test HH:MM I Vacuum HH:MM I Vacuum Pass I Fail Condition (Repair Notes) z.o 5·3 5'. Jj "TIt t: A. /oJ J\lI-Ak.. iff;' f¡- 7 I I WE f-J ~~ I I Pass 1 Fail Z IJ {I I I Pass 1 Fail I I Pass 1 Fail I I Pass 1 Fail Modern Welding (Red, Owens Corning (Beige Smooth WaIlS):O WaIlS):OC] Round RibS):O Xerxes (Red, Square RibS):O Joor (Blue. Smooth WaIlS):O Other :0 Annular Smooth Monitoring Method Wet (No Testing Necessary) 1 Type Single Wa I S8 989 Test Log Testing Contractor: Tank (Annular Testing) Tank Information Fuel Grade 87 1 87 Slave I@I 911 o I M85 I WO Test Date Shell 5321 Stockdale Hwy Bakersfield, CA N021163 - 5B Test 58 989 Test Log Shell 5321 Stockdale Hwy Testing Contractor: Bakersfield, CA N021163 - SB Test Tank (Annular Testing) Test Date: ~-2{-ð "'-- Tank Information: Fuel Grade: 87 / 87 Slave / 89 /@ 0 / M85 / WO Type: Single Wall ~Ubl~ - ~ Annular Monitoring Method: Wet (No Testing Necessary) /, V (See Testing Notes Belc jY --- -- Modern Welding (Red, Smooth Walls):D Xerxes (Red, Square Ribs):D Owens Corning (Beige, Smooth WallS):W Joor (Blue, Smooth WaIlS):O Owens Corning (Beige, Round RibS):D Other :0 Test Start Test Finish V-Test HH:MM I Vacuum HH:MM I Vacuum Pass I Fail Condition (Repair Notes) - 53 ~E.. ,..JE.E..C> A~P Pass I Fail 2. H C!. 'Å ..p Pass / Fail Pass I Fail Pass / Fail 58 989 Test Log Forms 2.0 58 989 Test Log Forms 2.0 Owens Corning - Test Start Test Finish Pass V-Test Pass I Fa i (Beige, Modern Welding (Red, Owens Corning (Beige, Smooth S):O IS):W Round RibS):O Wa Other Joor Xerx.es (Blue, (Red, Smooth Square RibS):O IS):O :0 Wa Annular Smooth Monitoring Method: Wa Wet (No Testing Necessary) I S8 989 Test Log Testing Contractor: Tank (Annular Testing) Tank Information: Fue Type Single Wa , Grade ~I 87 Slave / 89 / 91 / o / M85 /~ Date -21-0·2-, Test Shell 5321 Stockdale Hwy Bakersfield, CA N022156 - sump FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 oW Street Bakersfield, CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 oW Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAX (661) 395-1349 PREVENTION SERVICES FIRE SAFETY SERVICES. ENVIRONIENTAI. SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3979 FAX (661) 32€H0576 PUBLIC EDUCATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3696 FAX (661) 32€H0576 FIRE INVESTIGATION 1715 Chester Ave. Bakersfield, CA 93301 VOICE (661) 326-3951 FAJ( (661) 326-0576 TRAINING DIVISION 5642 Victor Ave. Bakersfield, CA 93308 .vOICE (661) 399-4697 FAJ( (661) 399-5763 July 30, 2002 Stockdale Texaco 5321 Stockdale Hwy Bakersfiedl CA 93309 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 I Operator: If you are receiving this letter, you have not vet 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. Si~~ Steve Underwood Fire Inspector Environmental Code Enforcement Officer ~~7~ de W~ ~OP ~0P6!Y~ A W~'I'I 06/13/2002 THU 13:13 FAX 916 646 9683 Wayne Perry Inc. Utl/lJ/V¡: 11:4.S 'Q"ti151 ;¡:::15 U5ïl:l ~F) HAL MAT U1\' I4J 004/006 l~o04 /~ Y ?Dr _651;2..- ?d '~0;L. CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1115 Chester Ave., Bakersfield, CA (661) 326-3979 APPLICATION TO PERFORM A TANK TIGHTNESS TESTI SECONDARY CONTAINMENT TESTING F ACILITY ~~a..c..-ü ADDRESS 13"?~ "S~~ e. H'tV~. PERMIT TO OPERA 1E # OPERATORSNAME r~vî() 0 Wi\\~ OWNERsNAME~vin 0 WiU~ NUMBER OF TANKS TO BE TESTED~ IS PlP1NG GOING TO BE TESTED Y TANK # VOLUME CONTENTS \ t 0 ~ t)lA k 0.11( 7- it) r M\¿{ Ç¡ ''Cui ':J (.!) Y _ ~(LM( t/iAÃ- 4 f ale. (Jl (~c- ( TANK TESTING COMPANY W~D'¿ (/P.Ñr~ t~' MAILING ADDRESS 8D ~IU{\ St· ~ = ~ Ú\ ~ NAME & PHONE NUMBER OF CONTACT PERSON 11 Jo. l(p ~ai(P~_ 'f~f c~ TESTMETHOD ACt~wa*ed p{ì)œ -res-r NAME OF TESTER OR SPECIAL INS:PECTOR ..s~p CERTIFICATION # DATE & TIME TEST IS TO BE CONDUCTEDB -l . t 1Il ct~Jff) C -(l(-o-¿ ~ APPROVED BY DATE j'"~ 2-11 20~?_ _ ~ ! U"Ù Q..v\\. (J..Jý ( ( "o....l 'ifk. ~l.e. ~L S NA11JRE OF APPLICANT FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 oH" Street Bakersfield. CA 93301 VOICE (661) 326,3941 FAX (661) 395·1349 SUPPRESSION SERVICES 2101 oH" 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 Stockdale Texaco 5321 Stockdale Hwy Bakersfield, CA,93309 RE: Necessary Secondary Containment Testing Requirement by December 31, 2002 of Underground Storage Tank located at 5321 Stockdale Hwy REMINDER NOTICE Dear Tank Owner/ Operator: The purpose of this letter is to inform you about the new provisions in California Law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1,2002. section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter, to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1, 2001 shall be tested upon installation, six months after installation, and every 36 months thereafter. Secondary containment systems installed prior to January 1,2001 shall be tested by January 1, 2003 and every 36 months thereafter. REMEMBER!! Any component that is "double-wall" in your tank system must be tested. Secondary containment testing shall require a permit issued thru this office, and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience, I am enclosing a copy of the code for you to refer to. Once again, all testing must be done under a permit issued by this office. Should you have any questions, please feel free to contact me at (661) 326-3190. Si7f; ~ Steve Underwood Fire Inspector/ Environmental Code Enforcement Officer SBU/kr enclosures ~~.7~ de W~ .¥tye .A0P6 .r~ A W~" FIRE CHIEF RON "RAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAJ( (661) 395-1349 SUPPRESSION SERVICES 2101 oH" Slreel Bakersfield, CA 93301 VOICE (661) 326-3941 FAJ( (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 April 17. 2002 Stockdale Texaco 5321 Stockdale Hwy Bakersfield CA 93309 RE: Necessary Secondary Containment Testing Required by December 31. 2002 REMINDER NOTICE Dear Tank Owner/Operator: The purpose of this letter is to inform you about the new provisions in California law requiring periodic testing of the secondary containment of underground storage tank systems. Senate Bill 989 became effective January 1.2002. Section 25284.1 (California Health & Safety Code) of the new law mandates testing of secondary containment components upon installation and periodically thereafter. to ensure that the systems are capable of containing releases from the primary containment until they are detected and removed. Secondary containment systems installed on or after January 1.2001 shall be tested upon installation. six months after installation. and every 36 months thereafter. Secondary containment systems installed prior to January 1.2001 shall be tested by January 1.2003 and every 36 months thereafter. Secondary containment testing shall require a permit issued thru this office. and shall be performed by either a licensed tank tester or licensed tank installer. Please be advised that there are only a few contractors who specialize and have the proper certifications to perform this necessary testing. For your convenience. I am enclosing a copy of the code for you to refer to. Once again. all testing must be done under a permit issued by this office. Should you have any questions. please feel free to contact me at 661-326-3190. sin2~ Steve Underwood Fire InspectorlEnvironmental Code Enforcement Officer SBUldm enclosures ~~y~ de W~ YOP .A0P6 .r~ ..Æ W~?" EQUILON _ENTERPRises LI.C Doll . T..... _lal r....... February 8, 2002 ~~\ \ \.J./ \ú/ ~ e.\()t '"J\ ~ j\ ~J; City of Bakersfield Fire Department 1715 Chester Avenue, Third Floor Bakersfield, CA 93301 Re: Equilon Enterprises LLC/Shell/Texaco Stations Change of SH&E Compliance Coordinator To Whom It May Concern: The stations listed on the attachment have been reassigned to another region. Responsibility for underground tank matters, permits, etc. has been transferred to: Tim Woodson, SH&E Compliance Coordinator Equilon Enterprises LLC 2401-A Waterman Blvd 4-257 Fairfield, CA 94533 Telephone: 925-766-3494 209-577-5960 (alternate) 925-766-3498 (cell) Please direct all future correspondence to Tim. Thank you. Yours truly, P erya[ S arrafian 6y 1(5. Watson Feryal Sarrafian SH&E Compliance Coordinator P.O. Box 7869 Burbank, CA., 91510-7869 _. C K CORO CIBK ,CORO CIBK CORO CIBK : RORO CIBK ¡ ---, !R.9R9 ;C;IBK jCORO :CIBK 1~~9~,ED tc:IBK ¡ CLOSED: CIBK iCi.:OSEDCIBK \'-'-'--'" --, ..._, - COROCIBK 61-325-3388 61-834-2822 : 661·833-4002 '661-837-1389 ,661-832-4801 .',.. ,.... ..........-.....-... 1661-326-8792 ! 661-764-5931 too·- , - -----. --- .. i 661-726·7954 .. ~.._---.-.--~- !661-322-0792 TS61'-637.1-817 CALVIN WILLS __u._._____.___,._._. GLENN HENRY ~____~___.,_·.~__m_~__~.,__.., SHAWN SHIRLlA _.._._--~-------_._. PERM CLOSE 4/12/01 _,,_______·____·_~~_v_··_.__·.·.,,'__· TEMP CLOSED GLENN HENRY (~rm close ~--~ 6/27) KERN KERN BAKERSFIELD BAKERSFIELD BAKERSFIELD ..__.'U"__.____·__·.. BAKERSFIELD __.m._._.__..__.~____·_'··___ BAKERSFIELD ...._~-------- BAKERSFIELD ......-.......__._---- BAKERSFIELD BAKERSFIELD 9 135074: 101 S. UNION/BRUNDAGE ---~--... .. 135075:3623 CALIFORNIA/REAL 1 '¿'i:·:',:·\ :,T:'''Î'L'i,i!..I~ n,' ~.I:_-:"., 1 ~·~:,'1'.'1 Lt1hLI-' H!,.,i'~'. biil: 11<:'.1 i ELl'· I"ii. :e': I u'~, \ 1 :::II'-,I:,'.!'/ li}-\ ¡,¡, .:'DIJ\ I U: ¡ ,¡ ,,¡'i ¡ í~\lU,'I\ ,+" f:H,:,f:T T 1: I:: ',..\,:¡,'I!IH-" LitLe" 'C F:SI,:ULHF' -*,Lc'/ ÇJ:3 f-:: .:~ , r,' I.,r-Il.,-_: ;HI,,-.: '-~jU .i-i:.~t_-_= .:\'~Clr/ I-¡HL~-., c '\:", ,h" ¡ ¡"J' ' tit '.- H1:.1:,;"1 :".li-\1 Lj-c: Ili,l Ef.-: TfJ II '",'",'L ~ 1 J '_~HL~-; U .::::1.: ] 1ji"'HE':, tA...\ [:1:-); l-' T ::': ,..1" I'Ll},,: """lI:I'lE UlU"',[ ')L(, \_\l__Lr-1I_'~[,~ HEI',ill Liei LT-r·: \/',)L L,_1h'fE,k lU II ,: "-, ,¡ I I,i'11.::, ~_:., .:' '7 i-, :-~t1L~- ~ ~I .-1 ':~ .-:.\ I_;¡ -il_.~=::. .:"', . :::':, ] 1J¡'Hl:: ~ U j_-¡HL~-::L 1.1 ,III: ¡ [J¡'11f:: 'ie:.') rlE'~ F ::: 'j I t- EFJ'! 1 un .2 I~j ~_.t 1 (,.;HL~~~ r:.\:::i':~~:\ 1~;Hl.~--: ¡":I'--::! 1 ,j 1,--~t--1l_ f-~ ':: 1 . 1 I I ¡l·r1L.:: II ¡':rií::, II 1:11'1 ] I'J' Î1L:: 'i,' . I ¡,I:),; F ,,[ill1£. UU" ,(:;[ :<li, I II LI-"_;):> tit" ,1 1,1,-\"'::'\ I,Jii n¡. run ,; .L,¡UÆL UIIH:: uU ri,;E ',II,' iILLH':;E= HE1',;H'1 i.L'-1Tl:J' \,"'.\L = I,I¡..,U':¡", 'n:I!' ,:71-.".) ...riL, 7U~I.-' '·.;r-1L~::1 ~~.\~I'/jJ I-;¡.:,¡LI.~' ~:) ,:":e, 1I"I':'HL',:; IJ I:,,.,L;_: (.. . Ii''! \ ["JI'HL=:" '7::' . ',:' \lEt; f· .. .... .. .. " EI'.JLI' .. ... .. .. CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd I;'loor, Bakersfield, CA 93301 INSPECTION DATE I JH «IOf PHONE NO. ~ 57 - ( 1!d¡ . BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES '".:J FACILITY NAME~~dJL 1Z'lAt(fJ ADDRESS ¿çJ,J ( FACILITY CONTACT INSPECTION TIME Section I: Business Plan and Inventory Program o Routine ø· Combined o Joint Agency o Multi-Agency o Complaint D Re-inspection OPERA TION C V COMMENTS Appropriate permit on hand It V Business plan contact information accurate L- V Visible address Iv V Correct occupancy t..- V Verification of inventory materials 11/ V Verification of quantities t... V Verification of location y Iv Proper segregation of material / '/ Verification of MSDS availability 1./ /' Verification of Haz Mat training l / Verification of abatement supplies and procedures v /' Emergency procedures adequate /" /' .Containers properly labeled 0 / Housekeeping G / ./ Fire Protection V' ./ Site Diagram Adequate & On Hand ,./ C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes ~ While· Env. Svcs. Yellow· Station Copy Pink - Business Copy Inspector: Questions regarding this inspection? Please call us at (661) 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~cliÍliLJC '{.ó. ( n INSPECTION DA TE-.1.1/1 if G ( Section 2: Underground Storage Tanks Program o Routine Q}Combined 0 Joint Agency Type of Tank jCklJr Type of Monitoring ATt, o Multi-Agency .-D Complaint Number of Tanks ç Type of Piping ()cJlF ORe-inspection OPERATION C V COMMENTS Proper tank data on tile V / Proper owner/operator data on tile t/ / Pennit fees current /' 1/ Certification of Financial Responsibility (,., /' Monitoring record adcquate and current V V /' Maintenance records adequate and current ~ ./ Failure to correct prior UST violations V Has there been an unauthorized release? Yes No 1/ Section 3: Aboveground Storage Tanks Program TANK SIZE(S) Type of Tank OPERA nON Y N COMMENTS SPCC available SPCC on file with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? I f yes, Does tank have overfill!overspill protection? AGGREGATE CAPACITY Number of Tanks White, Fnv. Sves. Pink, Business Copy C=Compliancc Y=Yes N=NO Inspector: Office of Environmental Services (805) / r\..J / '<.' ~~ q. J. Myers & Co., Ir .... 'hNVIRONMENTAL COMPLIANCE CONTRAC1"OR 451 CONSTITUTION UNIT E CAMARILLO, CA 93010 805-383-9244/805-383-9245 FAX SUBJECT: ¥fiual Electronic Leak Monitoring System Inspection and Certification DATE: S/S #: 7/10/01 Texaco 121379 / Jj>CATION: i \ \\ 5321 Stockdale Hwy Bakersfield, CA 93309 .""'-,-....." To Whom it May Concern, Enclosed are the reports for the annual inspection of the existing Monitoring System that was perfonned at the above referenced facility. The method used to test the electronic and mechanical monitoring systems is approved by and exceeds the specifications according to the manufacturer. R. J. Myers & Co., Inc. has been contracted by Equiva Services LLC to insure that their facilities comply with all the rules and regulations that govern the operation of underground storage tanks and product lines. If you have any questions, please call. Sincerely, R. J. MYERS & CO., INC. ð~·1J1c¡;M)¡r President RJMJrf CONT. LIC. #330631 (B-061) SERVING THE PETROLEUM INDUSTRY SINCE 1967 R. J. MYERS & CO., INC. ENVIRONMENTAL COMPLIANCE CONTRACTOR 451 CONSTITUTION UNIT E CAMARILLO, CA 93010 805-383-9244/ 805-383-9245 FAX DATE OF SERVICE: 7/10/01 5.5. I: Texaco 121379 w. O. I: TECHNICIAN: Jason Nonnweiler SERVICE REQUESTED BY: Feryal Sarrafian BILL TO: Equiva Services LLC P.O. Box 7869 Burbank, CA 91510 PROBE I.D. #: In Tank SetuD T1 Regular T2 Plus T3 Premium T4 Diesel PLLD SetuD 01 Regular Q2 Plus 03 Premium Q4 Diesel Liauid Sesnor SetuD L 1 Regular Annular Space L2 Plus Annular Space L3 Premium Annular Space L4 Diesel Annular Space L5 Waste Oil Annular Space SERVICE REQUESTED· Annual leak monitor inspection and certification. DESCRIPTION OF WORK: Inspected and tested all leak sensors for proper operation. Verified proper operation and calibration of all TLM probes. All systems normal. MODEL I: Veeder-Root TLS-350 Simplicity SERIAL I: 8105150785007 SYSTEM CERTIFIED e NO SYSTEM PSD @NfA SYSTEM RUNNING NO ~ NO NOTE: No Over Fill WASTE OIL Protection On Waste 011. (!9 NfA NO SYSTEM SEALED ~ ~ NO va I I:..VI....I:..I l..a"I:" IIVN KI:..VK I STATION ADDRESS: 5321 Stocke. ,iwy CITY: Bakersfield STATE: California SAP NUMBER: BRAND NAME: 121379 Texaco Tank Product Tank Type Tank SID UST or AST Tank CorroIIIon Type UneTvDe Une Corrosion Typ R = Regular M = MId Gracia OWF "' 00u~1I Fiberglass Circle the conect F"Flberglass DWF = DoubIawaß Fiberglass F = Fiberglass P = Premium D"'DieseJ SWF = SJnglewall Fiberglass Nominal Gallons type of lank. L = Uned SWF " SlngIewaII fiberglass IC = Impressed Curra U = Used 011 K = Kerosena SW5 " Slnglewall Steel Underground SJorage IC = Impressed Currant SWS = SingIewaJI Steel A = Anode DWS = Doublewall Steel or Aboveground A = Anoda FDW = Flexible Doublewall P " Plastic Flex DFS '" Double fiber Steel Storaãe 1 Reaular DWF 10000 UST Fiberglass SWF Flberalass 2 Mid Grade DWF 10000 UST Fiberglass SWF Fiberglass 3 Premium DWF 10000 UST Fiberalass SWF Fiberalass 4 Diesel DWF 10000 UST Fiberglass SWF Flberalass 5 Used on DWF 550 UST Fiberglasa Comments: TANKS AND LlNI!S PRODUCT TANK MONITORING SYSTI!M PoslIIYa Fall Qty TVDe Shut Down Safe ODer8tlonaI Manufacturer and Model Number SW Tanks With Interstitial Senso,. 4 Dry Yea Yes Yes Veeder-Root TL5-35O Simplicity #409 Automatic Tank Gauge Probes (ATG) 4 Programmed: CSLD Yes Yes Yes Veeder-Root TL5-350 SimDücitv Maa '1 Groundwater Sensors FIIWapor Recovery Riser E1M (ATG) Sump Comments: T Interstitial Monitor (DW lanks) D Sensor In Fill Sump Fill Sump Monitor ETM TG) Probe Comments: No overfill alarm on tsnk. USI!D OIL TANK AND LlNI! MONITORING SYSTI!M (UST Only) Manufactu_ and Model Number o rational Yea Veeder·Root TL5-35O Sim Ii' #407 Manufactu_ and Model Number o rational EIactronlc Sensor In Fill Sum 4 Electronic Une Pressure Sensors Electronic Sensor In Turbine Sum Electronic Sensors In Contained Trench Yes Yes Yes Veeder·Root TLS-35O Sim Ii PLLD Comments: No Fill Sump or STP Sensora. I certify that the ebove information III accurate and the equipment Is functioning according to manufactural's llpeclficatlons un.... otherwllle Indicated. '" SIGNATURE: ~~ COMPANY: R. J. Myera & Co., Inc. PRINTED NAME: Jason Nonnweller DATE: 7/10101 flllgt1cU Spill Containment Spill Containment Tank Product Size Drain Operational Remote Fill -L Qular 5 Yes No 2 Mid Grade 5 Yes No 3 Premium 5 Yes No 4 Diesel 5 Yes No ¡comments: Vent CaD TVD8: Remote P.....ure Cap, Vapor Recovey Vapor Tank Product Rein Cap, Nona Type Recovery 1 Reaular Dual Point No 2 Mid Grade Dual Point No 3 Premium Dual Point No 4 Diesel Comments: TANK FILL AREA Caps and OverfIll Prot8ctIon I DID Stick Protection Gaskets In bI!I.: Ball Float, 18: StrIke Plata, Spill Containment on Good FIIIUd FIIILkI Product Flapper, Both, Nona Basket Cage, Both or Remote FlU CondItlDn Condition Painted IdenUflcatlon Dr Unable to Verify None None Yes Good Yes Yes Basket Caae None Yes Good Yes Yes Basket Caae None Yes Good Yes Yes Basket Cage None Yes Good Yes Yes Basket Cage STAGE I VAPOR RECOVERY AREA Caps and Vapor Is There A Spin Gasketa In Recovery Containment Box Dry Break In Good Good Lid IdentlfJcatJon Around Each VR Spill Containment Operating Condition Condition Lid Painted I Condition Tag P_nt Point Drain Operational Yes Yes Yes Good Yes Yes None Yes Yes Yes Good Yes Yes None --y!!s Yes Yes Good Yes Yes None - ,.ZaU Test BootlDraln Plua: Flex Connector !Ink. Permit Required Turbine Head Have test boobs been ProtectJon: Plastic: MIoIm!!I: Is Ara there Confined Space ProtectJon Tvoe: backed off secondary Flex, Booted, Taped, theprocluct any Are thenI top _I 01 Identification Contained Sump, containment piping, or Sump, Anode, manifolded observation Ara the side seal adapters Ara there Intamal or Tag or Decal Rigid Soli BarrIer, Is The drain plugs removed fOI ImptWSled Cunønt, betwMn wells In the products Turbine on the tank fill exl8mal drains on the Tank Product P_nt Liner, None Sump Dry proper drainage? Unable to Verify tanka? tank area? blending? FIItar? pipes? spill contalmnent ? 1 Reaular No Contain Sumo Yes No Sumo NlA No No No Too Seal Intemal 2 Mid Grade No Contain Sumo Yes No Sumo NlA No No No Too Seal Internal 3 Premium No Contain SUmD Yes No Sumo NlA No No No Too Seal Intemal 4 Diesel No Contain Sumo Yes No Sumo NlA No No No Too Seal Intemal Comments: TURBINI! ARI!A STATION ADDRESS: 5321 Stockdale,Hwy CITY: Bakersfield STATE: California SAP NUMBER: 121379 BRAND NAME: Texaco DATE: 7/10101 UST EQUIPMENT INSPECTION REPORT '_d 01 3 Eme aencv Shutoff ESOI Car Wash 011 . Water Seøarator Automatic Tank Gauøe Strip Reclaim Drain Simplicity (S), If a remote Sump Needs to Attach A Printout Of The Tank Monitor Does the water level PoIeCat(P)or monitor Is Needs to be Set-Up and Most Recent Test Results shown on the ATG match Neither (N) Installed, 18 It be Pumped Pumped B: Service Bay Needs to be (SWF Tank locations). Is a PrIntOut what Is shown on a Installed on operating Operational Qty Out? Out C: Car Wash Pumped Out Attached To This Form. manual stick readlna? ATG. correctly? Exterior Ves 1 N/A N/A Car Wash No Ves Ves SlmDlicitv NIA Interior Yes 2 Comments: TOTAL #- OF NOZZLES: Comments: GENERAL INFORMATION DISPENSER ARI!A 1m Mechanism Imøact Tvoe: Mechanical Staae II VaDOl' Valve or Recovery Tvoe: Motion Balance, Vacuum Sensor or Assist, None ~ Vacuum Assist MV Vacuum Assist MV MV MV Dl8penser Numbers Manufacturer 1/2 Gllbarco Gllbarco Gllbarco Gilbarco 3/4 516 7/8 14 ~ Gallons per Oldest mlnulø being Date on pumped by Securely I Dispenser Number 0'1 closest nozzle. Anchored? Fuel Filters N~es I Reg Mid Pre Yes 416101 ~ Yes 4/6/01 l Ves 4/6101 ~ Yes 4/6101 4 Vacuum Assist Vacuum Assist Ves Ves Yes Yes Securely Anchored Flex Connector I Protection: Boot, Tape, Mechanical Contain Sump, Anode, Valve Impressed Current, Operational Unable To Verify Ves Unable To Verify Yes Unable To Verify Yes Unable To Verify Yes Unable To Ver!fï.. §J .!!I!!!!l Contelnment Sensor Tvoe: SumD Tvoe: Mechanical, Deep, Shallow, Electronic, None None Mechanical Mechanical Mechanical Mechanical Shallow Shallow Shallow Shallow Yes Yes Yes Sump SemIors Operational? Ves Dispenser DIs.E!!.,nser Containment STATION ADDRESS: 5321 Stockdale CITY: Bakersfield STATE: California SAP NUMBER: 121379 BRAND NAME: Texaco DATE: 7/10101 UST EQUIPMENT INSPECTION REPORT MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This fonn must be used to document testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be Dl"epared for each monitoring svstem control panel by the technician who performs the work. A copy of this fonn must be provided to the tank: system o\Vß.er/operator. The owner/operator must submit a copy of this fonn to the local agency regulating UST systems within 30 days of test date. Instructions are printed on the back of this page. A. General Information Facility Name: Texaco 121379 Site Address: 5321 Stockdale Hwy City: Facility Contact Person: Calvin Make/Model of Monitoring System: Veeder-Root TLS-350 Simplicity Bldg. No.: Bakersfield Zip: 93309 Contact Phone No.: (661) 837-1389 Date of Testing/Servicing: 7/10/01 B. Inventory of Equipment Tested/Certified Check the a ro riate boxes to indicate s ecific e ui ment ins ected/senriced: Tank ID: Regular Tank ID: Plus I8IIn-Tank Gauging Probe. Model: Veeder-Root Mag #1 I8IIn-Tank Gauging Probe. I8IAnnular Space or Vault Sensor. Model: Veeder-Root #407 I8IAnnular Space or Vault Sensor. DPiping Sump / Trench Sensor(s). Model: DPiping Swnp / Trench Sensor(s). DFill Sump Sensor(s). Model: DFill Swnp Sensor(s). DMechanical Line Leak Detector. Model: DMechanical Line Leak Detector. I8IElectronic Line Leak Detector. Model: Veeder-Root PLLD I8IElectronic Line Leak Detector. I8ITank Overfill / High-Level Sensor. Model: OPW 61S0 I8ITank Overfill / High-Level Sensor. DDispenser Containment Sensor(s). Model: DDispenser Containment Sensor(s). I8IShear Valve(s). I8IShear Valve(s). I8IDispenser Containment Float(s) and Chain(s). I8lDispenser Containment Float(s) and Chain(s). DOther s eci e ui ment e and model in Section E on P e 2 . DOther s eci e ui ment and model in Section E on Pa e 2 . Tank ID: Premium Tank ID: Diesel I8IIn-Tank Gauging Probe. Model: Veeder-Root Mag #1 I8IIn-Tank Gauging Probe. I8IAnnular Space or Vault Sensor. Model: Veeder-Root #407 I8IAnnular Space or Vault Sensor. DPiping Sump / Trench Sensor(s). Model: DPiping Swnp / Trench Sensor(s). DFill Sump Sensor(s). Model: DFill Sump Sensor(s). DMechanical Line Leak Detector. Model: DMechanical Line Leak Detector. I8IElectronic Line Leak Detector. Model: Veeder-Root PLLD I8IElectronic Line Leak Detector. I8ITank Overfill / High-Level Sensor. Model: OPW 61S0 I8ITank Overfill / High-Level Sensor. DDispenser Containment Sensor(s). Model: DDispenser Containment Sensor(s). I8IShear Valve(s). 181 Shear Valve(s). I8IDispenser Containment Float(s) and Chain(s). I8lDispenser Containment Float(s) and Chain(s). DOther s ci ui ment and model in Section E on Pa e 2 . DOther s ci ui ment e and model in Section E on Pa e 2 . Model: Veeder-Root Mag #1 Model: Veeder-Root #407 Model: Model: Model: Model: Veeder-Root PLLD Model: OPW 61S0 Model: Model: Veeder-Root Mag #1 Model: Veeder-Root #407 Model: Model: Model: Model: Veeder-Root PLLD Model: OPW 61 SO Model: C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (check aU that apply): I8ISystem set-up report; I8IAlarm history report. Technician Name (print): Jason Nonnweiler Testing Company Name: R. J. Myers & Co., Inc. Cert./Lic. No.: 555491195 Signature: Jason Nonnweiler Phone No.: (805)383-9244 CALM-Ol Page 1 of 4 11/15/99 MONITORING SYSTEM CERTIFICATION For Use By All Jurisdictions Within the State of California Authority Cited: Chapter 6. 7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code of Regulations This fonn must be used to docwnent testing and servicing of monitoring equipment. If more than one monitoring system control panel is installed at the facility, a separate certification or report must be DreDared for each monitoring system control panel by the technician who perfonns the work. A copy of this fonn must be provided to the tank system owner/operator. The owner/operator must submit a copy of this fonn to the local agency regulating UST systems within 30 days of test date. Instructions are printed on the back of this page. A. General Information Facility Name: Texaco 121379 Site Address: 5321 Stockdale Hwy City: Facility Contact Person: Calvin MakelModel of Monitoring System: Veeder-Root TLS-350 Simplicity Bldg. No.: Bakersfield Zip: 93309 Contact Phone No.: (661) 837-1389 Date of Testing/Servicing: 07/10/01 B. Inventory of Equipment Tested/Certified Check the a ro riate boxes to indicate s Tank ID: Waste Oil DIn-Tank Gauging Probe. I8IAnnular Space or Vault Sensor. DPiping Sump / Trench Sensor(s). DFill Sump Sensor(s). DMechanical Line Leak Detector. DElectronic Line Leak Detector. DTank Overfill / High-Level Sensor. DDispenser Containment Sensor(s). DShear Valve(s). DDispenser Containment Float(s) and Chain(s). DOther s i e ui ment e and model in Section E on Pa e 2 . Tank ID: DIn-Tank Gauging Probe. DAnnular Space or Vault Sensor. DPiping Sump / Trench Sensor(s). DFiIl Sump Sensor(s). DMechanical Line Leak Detector. DElectronic Line Leak Detector. DTank Overfill / High-Level Sensor. DDispenser Containment Sensor(s). DShear Valve(s). DDispenser Containment Float(s) and Chain(s). DOther (s ci e ui ment e and model in Section E on Pa e 2 . Model: Model: Veeder-Root #407 Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: ected/serviced: Tank ID: o In- Tank Gauging Probe. DAnnular Space or Vault Sensor. DPiping Sump / Trench Sensor(s). DFilI Sump Sensor(s). DMechanical Line Leak Detector. DElectronic Line Leak Detector. DTank Overfill / High-Level Sensor. DDispenser Containment Sensor(s). o Shear Valve(s). DDispenser Containment Float(s) and Chain(s). DOther s ed e ui ment e and model in Section E on Pa e 2 . Tank ID: DIn-Tank Gauging Probe. DAnnular Space or Vault Sensor. DPiping Sump / Trench Sensor(s). DFill Sump Sensor(s). DMechanical Line Leak Detector. DElectronic Line Leak Detector. DTank Overfill / High-Level Sensor. DDispenser Containment Sensor(s). DShear Valve(s). DDispenser Containment Float(s) and Chain(s). DOther s i e ui ment e and model in Section E on Pa e 2 . Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: Model: C. Certification - I certify that the equipment identified in this document was inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this information is correct and a Site Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy of the (check all that apply): Technician Name (print): Jason Nonnweiler Testing Company Name: R. J. Myers & Co., Inc. CALM-Ol I8ISystem set-up report; I8IAlarm history report. Cert./Lic. No.: 555491195 Signature: Jason Nonnweiler Phone No.: (805)383-9244 Page 2 of 4 11/15/99 Instructions for Equipment Testing and Certification General Instructions 1. Equipment that monitors underground storage tank systems containing hazardous materials must be tested/serviced annually, or on a schedule specified by the manufacturer, whichever is more ftequent. 2. This certification form must be used to document the following activities: 1.) Periodic testing as described above; 2.) Testing of new monitoring systems upon installation; 3.) Testing of replacement sensors, probes, or other system components; and 4.) Testing of repaired sensors, probes, or other system components. 3. As noted on Page 1, a separate certification form must be completed for each individual monitoring system control panel. For example: If one control panel monitors in-tank gauging probes and another panel monitors electronic line leak detectors, two certification forms are required. 4. Except in the case of emergency repairs, many local agencies require that a permit be obtained prior to installing new monitoring systems or components (i.e. installation of new or different equipment, rather than using parts identical to those replaced). Check with your local agency for their requirements before starting work. Section B 1. In the Tank ill sections, describe which tanks you worked on (e.g. Diesel Tank, North Tank, Middle Tank). 2. For compartmented tanks, list each compartment as a separate tank. 3. Where "Model" is asked for, the name of the manufacturer and the manufacturer's specific model name or number, as referenced in the "List of Leak Detection Equipment and Methods for Underground Storage Tanks" (i.e. LG-113) must be specified. 4. Hands-on functional testing of individual leak detection components to confirm operability to manufacturer's specifications and state regulations is required. This includes verifying any mechanical or electronic automatic shut-off features (e.g. dispenser floats and chains). In the case of sensors that can not be non-destructively tested, contact your local agency that regulates UST systems to see if they will approve alternate testing methods (e.g. testing of representative samples). Section C 1. Certification must be made by a licensed and certified technician as per 23 CCR § 2. All work associated with testing/servicing of equipment must be performed by or under the direct supervision of the certifying technician. Section D 1. When testing operability of positive turbine shut-down, you must: 1.) verify shut-down by simulating a leak; and 2.) verify shut-down by disconnecting the sensor. Attachments 1. Site Plan - You must attach a drawing showing 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, and other secondary containment areas; mechanical or electronic line leak detectors; and in- tank liquid level probes (ifused for leak detection). Note the date the Site Plan was prepared. 2. System Set-Up Report - If the monitoring system or diagnostic equipment used in testing is capable of generating a hard- copy report describing system set-up, you must include a copy of the report with this Certification. 3. Alarm History Report - If the monitoring system is capable of generating a hard-copy alarm history report, you must include a copy of the report with this Certification. Relevant alarms that should appear in this report include overfill, high water, and leak detection equipment-related alanns. This report should be printed before you test any sensors. CALM-Ol 11/15/99 Monitoring System Certification Site Address: 5321 Stockdale Hwy, Bakersfield Date of Testing/Servicing: 07/10/01 D. Results of Testing/Servicing Software Version Installed: 121.00 lete the followin checklist: No· Is the audible alarm 0 erational? No· Is the visual alarm 0 tional? DNo· Were all sensors visuall ins cted, functionall tested, and confirmed 0 rational? DNo· Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their ro 0 ration? If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) operational? For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut-down? (Check all that apply) ~ Sumpffrench Sensors; 0 Dispenser Containment Sensors. Did you confirm positive shut-down due to leaks and sensor failure/disconnection? ~ Yes; 0 No. D Yes For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill oint s and 0 ratin ro erl ? If so, at what rcent of tank ca aci does the alarm tri er? % D Yes· Was any monitoring equipment replaced? If yes, identify specific sensors, probes, or other equipment re laced and list the manufacturer name and model for all re lacement arts in Section E, below. Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; 0 Water. If es, describe causes in Section E, below. Was monitorin s stem set-u reviewed to ensure ro r settin s? ~ Yes 0 No· Is all monitorin ui ment 0 rational r manufacturer's s ecifications? * In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: CALM-Ol Page 3 of 4 11/15/99 Monitoring System Certification Site Address: 5321 Stockdale Hwy, Bakersfield Date of Testing/Servicing: 07/10/01 F. In-Tank Gauging / SIR Equipment: DCheck this box if tank gauging is used only for inventory control. D Check this box if no tank gauging or SIR equipment is installed. . This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. c I h ~ II hklis omp ete t e 0 OWIDI!: C ec t: ~Yes DNo· Has all input wiring been inspected for proper entry and termination, including testing for ground faults? ~Yes DNo· Were all tank gauging probes visually inspected for damage and residue buildup? ~Yes DNo· Was accuracy of system product level readings tested? ~Yes DNo· Was accuracy of system water level readings tested? ~Yes DNo· Were all probes reinstalled properly? ~Yes DNo· Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): D Check this box if LLDs are not installed. C h omn ete t e followioe: checklist: ~Yes DNo· For equipment start-up or annual equipment certification, was a leak simulated to verify LLD DN/A performance? (Check all that apply) Simulated leak rate: 1:813 g.p.h.t; D 0.1 g.p.h.2; D 0.2g.p.h.2 Notes: I. Required for equipment start-up certification and annual certification. 2. Unless mandated by local agency, certification required only for electronic LLD start-up. ~Yes DNo· Were all LLDs confirmed operational and accurate within regulatory requirements? ~Yes DNo· Was the testing apparatus properly calibrated? DYes DNo· For mechanical LLDs, does the LLD restrict product flow if it detects a leak? ~N/A ~Yes DNo· For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? DN/A ~Yes DNo· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system is DN/A disabled or disconnected? ~Yes DNo· For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system DN/A malfunctions or fails a test? ~Yes DNo· For electronic LLDs, have all accessible wiring connections been visually inspected? DN/A ~Yes DNo· Were all items on the equipment manufacturer's maintenance checklist completed? * In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: CALM-Ol Page 4 of 4 11/15/99 Instructions for Testing Line Leak Detectors Section G 1. Line leak detectors should be tested in-place, not removed. 2. The functional elements of the mechanical LLD are the piston and the diaphragm. To ensure that these elements are functioning properly, the submersible pump can be started and the time that the piston or diaphragm takes to move into a position to enable full flow of the product noted. The range of allowable opening times is specified by the manufacturer and is available in the equipment manual. 3. The presence of air pockets in the system will result in longer opening times since air is much more compressible than product 4. Thermal expansion and compression may be a problem in areas where there are large temperature variances between day and night The difference between product temperature and air temperature may be significant enough to create an expansion or contraction as the product is pushed up the line into the LLD. 5. The purpose of the relief valve is to ensure that the LLD can function properly and is not damaged by an excessive build-up of pressure behind the piston or diaphragm. If the pressure is excessive, the relief valve will vent into a copper tube that leads back to the tank. The connections to this tubing should be checked for leaks. CALM-01 11/15/99 Monitoring System Certification UST Monitoring Site Plan Site Address: 5321 Stockdale Hwy. Bakersfield . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . . . · . . .. ....... . '. . . . . . . . . ·0 O· O~ PV Valves. .. .. . . . . . .. · . . . Food Mart .....:~: · . . . · . . . Veeder- Root Cahier · . . . · . . . Waste Oil o . . . . . . . . . . . . . . . . . Annular. . . . . . . . . . . . . .1 . . . . . . . . . .. . . . Fill. . . . . . . ::I:J · . . . . . .. .... 89 87 91 Diesel 0~~~ @@@ o 0 0 . . . . . . . . . . . . . . .. . '~"'r;;l .' LJ' . . . LJ·.. ..D:~reak . · . . .... . . . . Fil . . . . . . . . . . . . . · . . . . . . . . . . . . . . . . . . . . . . . . . . Date map was drawn:....srz.... ~...QL. Instructions If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in-tank liquid level probes (if used for leak detection). In the space provided, note the date this Site Plan was prepared. CALM-02 Page 1 of ....!- 11/15/99 A. Q. M. D. SUMARRY REPORT S/S: Texaco 121379 ADDRESS: 5321 Stockdale Hwy. Bakersfield, CA DATE: 7/10/01 TP201.3: PASS FAIL N/A X Test not required at this time. PASS FAIL N/A X Test not required at this time. PASS FAIL N/A X Test not required at this time. PASS X FAIL N/A Reason For Failure: TP201.4: Reason For Failure: TP201.5: Reason For Failure: Electronic Monitor Results: Reason For Failure: Drop Tubes: Drop Tubes That Need To Be Replaced: PASS X FAIL N/A 87 89 92 X Diesel Siphon Tank None Reason For Failure: Containment Box Report: Reason For Failure: PASS X FAIL N/A Manufacturer: Size: 5 Gallons In Ground Type Retrofittable CNI X Pomeco Phil Tite Safe Lite FRC OPW EBW "'-./ !:J !:J !:J L '~$ gaB:! 'B a6e¡gOd e¡oJ. 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CA 93301 VOICE (661) 326,3941 FAJ( (661) 395'1349 SUPPRESSION SERVICES 2101 OH" 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 Juh II. 2()() Ms Georgina DiMario 'Equilon LLC P.O, Box 2154 Fullerton, CA 92837 Re: Stockdale Texaco #121379 5321 Stockdale Hwy" Bakersfield Certified Letter Georgina: This letter will confirm our conversation yesterday, July 1 0, 2001. I was asked to accompany R 1. Meyers to the above-mentioned facility to render an opinion based on Title 23 C.C.R (California Code of Regulations) regarding monitoring requirements, My observations are as follows: 1) Apparently work was performed on or about July 31, 2000, approximately one year ago. Based on observations it appears that a significant amount of concrete was broken out and new electrical conduits ran, This was done without a permit from our Department. We would appreciate finding out the scope of work that was performed, 2) The waste oil tank at the facility must be equipped with a Overfill Alarm per Title 23 C.C.R Also sensors are required in turbine sumps. 3) It is also noted that during my inspection in November of 2000, you had three 55 gallon drums of a hazardous waste in back of shop area, These drums are still there, Mr. Willis, the Store Manager, has manifestly documented his attempts to be relieved of these drums, The accumulation date is July 31,2000 which is almost a year. These dntms must be removed and properly disposed of immediate Iv. The other items mentioned must be corrected within 30 days, August 11, 2001. Should you have any questions, please feel free to call me at (661) 326-3979, Sincerely, RALPH HUEY, DIRECTOR OFFICE OF ENVIRONMENTAL SERVICES ,~(~£ By: Steve Underwood, Fire [nspectorÆnvironmental Code Enforcement Officer Office of Environmental Services RH/SU/db cc: Teresa Smith, R 1. Meyers s 'Jt J. Y 2UO'.gl )IMano 1:llIIll'lI n.: Sfot:kdak T~xat:o '\J21 Sloàd.aJc -',1 Jru..h.:rwd r .\'H.wpd 1010. (hJ"/Y/If/ a;/ Y;"'''/I/N///U/? . /,y . 11,,,/,,.-, . /,,1;//1 . /, '(:"'/i////'ý''' 8e .LH~) I NG I ~.,J 38N IS 3n~ SHnOH þ~ A3~d 'J::I:-:~=:~\:1d ~~{U:~::U J(ì ::i381~JmJ ~3~:;\-':I ["J\~C, ':" : :3 I [I CI (' . fJ I 1/1 r : 1.S:U JS\:11 :SllnS3~ HH 1H~ n'~ 6:3: ,3 r) lIl-c'j IM]?:'::'I II]O;~'¿:I é:'k!\-J ~":::H1 I..\-'Ci(!: /, 1[1[1,3' S I ~dH :SlllìS3d ::iH 1\:18 [lI'n '=::,:~H'1 ',kIC''; rJ I 100(: L ::id\-< '.,::=::\j,j ¡"ld9:::: ¡ , 1[10;::: '[; I ::idH , :~·~~¡Y·'f ["J\::ILlI : g IIJO~ , ¿ ,,\ti[.,) ::':C::;H,i [,,]j':;O ¡ ¡ 1[10,::; "6~ ..'\\--11,,1 ~:::~::;~~.j 1..1\;1':11' (, I lOCI;::: C) I f,jnf ::-~t-:Hd 1M,':" ¡ I IOU;::: IJ,3 Nrl[ :c::::\-!j "j\!¿:::: t; 100:::: 'þ;':: rIm [' :=::'=::\1'1 1,,,:!f::I- ¡ ¡ 10UE 'R:-: t-.Jn¡" :::c:.~Hd [j\! ¡~; I 100;::: þ 'mf :~::~Hj [,,]\1[1:', ¡ ¡ 1.10,::; '8 '111 [' :':~llll"::-rd HH "'IH~~'1 O? C! bl LH~INaIW 3~~jS S~l !3dn()H ÞZ A3~,j IFF::~Hd :';,U:;::U .:fc) d3G,.lnr,, :3:3H,j 1,,H:=:,-:r:1 IOO,~"I:II '111r : l:=G.L J.:3H I :::::a'III:33d ,''in '1"~:~! ',;':~ ¿8: r ('I :c:1TI,=::3::1 1.:3]1. :;L~.:rl cn) ¡ 1 ]2H¡;3:=::3:j:! ¡ !~! :~: 1 ('¡r-l,~_~ C'I] I "1nr' o 4:D8L 8.0 GAL/HR RESULTS: LAST TEST: ,JUL j O. 2001 7: 46Ar'1 PASS NU~'lBER OF TESTS PASSED PREV 24 HOURS 10 SINCE MIDNIGHT 1 0.20 GAL/ HR RESULTS: .JUL 8,2001 8: 12Afv1 f-'ASS JUL 4.2001 12: 47F'r"1 PASS ,JUN 30,2001 1 1 : :31 Ar'1 PASE; JUN 26,2001 12:56Pf"1 PAS:3 JUN 22,2001 1 1 16Ar1 PASS ,JUN 18.2001 8:22Ar'1 PASS JUN 14.2001 10: 41 Ar"l PAE:~S JUN 10.2001 :3 : 03pr"1 PASS fvlAY 19,2001 12: 24prvl PAS~~ APR 27,2001 10: 51 Ar", r S~3 I~I . 10 GAL'H¡":: FŒSUL TS : APF: 4,2001 10:41Pfvl ¡:'AS~=:; * * * * * END * * * ~ * :~~S'dd I·J\::If:8: (: !OOc '9 ~,:I\::I :SllnS3~ ~H /l\::1~1 01 '0 SS\;Id 1.j\::l99 : I 100;::'9 ~d\::l ~:S\;I,j I,J\::I L.O : 9 IOOG ' U ~d\::l SS~!d ¡"JdIr: I ¡ ¡ODC:'6[ ..\\::I["J ~:::S\;Ij l"j\::lr:, I :9 ¡OOG'Ol Nrlf SS\::Id [,J\::I8v:,::: I 1000 . 9 ¡ Nllr ::=:S\::Id ~,J\-i I I I 100(:·œ ~Jnr SS\::Id 1,\;I9 E: : 9 IClOc'v'::: ~.Jn r- SS\;Id 1"JdèO: I I IOO;::'8e Nilr ~~~~~d ¡·j\::l88 : I IOO(:'v lilr ~3FH(j [,·.\::IrD: E: 100':::'8 lnf :~alíS3~ ~H/l\::l~1 OG'O ~~ IHDINOIW 38NIS I S~nOH ÞG A3Hd Œ3SS\::Id 81831 dO ~3BWnN S8\-id W\::I9¿::8 100G'or lllr : 1~331 1S\::I1 : :::Uln~:3~ ~H l\::l~) O· [: 16: C fl ::O::::;'1d ¡,j\::lt> I ~.:.. ¡OO(: '.'- ~d\:l =1 :3J:1IlS32i 2iH /l\:l~! 0 I 0 S¡:;\:Id ¡·)\::I'39 : I 100(: ·'9 ~dY S~~I;:-;Id ¡"J\:I'J [I , ,- !OOe .. ¿G 21d\1 .", SSHd kJY8 [: : 9 100G '6 I lNt"J SS~d f,,)tl ¡ ?; : 3 100::;'0 1 Nrw ~:::::\:I,:I !..Jtlþþ '.:.' ¡ 100(: '9 I Nile ~::~Sbld ¡.)tll] I : I !OO'::: ·0(: Nllr SS~,d [..J\:I9[: 9 IOOG 'Þ(: Nllr SSlr7d: I·Jd¿ I : I I 100(: '8(: Nllr ~::~S'7d 1·,)\::19,::; : ¡ 100(: 'Þ 1/l[' SSHd 1"JtlI [: I 100;:: ·8 lnr- : r:u In:3321 ~H/ltf~~) [1(:; [I 1 ~','::::_:..¡ ::n,:,:o''f:['i-iLE TE< ':'::':'1 :-:;T(:'I"f-:l',:.;LE Iii.!". l-:hi:FP:3F I EU,. CH. 8] ~~ii-,:, J 1:¡J,J'/dCJ5UU,/ ,JU! lU. 2CIC,I} H:,it-¡ ;-i["1 i,::::LI, 1T:.òT PE:c:ULT:3 .JUI 10., 2DOI :::::.:10 rirl I I: 8'~' F:EGULriF-: ~PC-BF, :c':IERl r-,L 11111'1 :C¡:.c: I 'i ,¡: Ci,:: ':;/iL·' HF: Inn PER: JUL lu. 200] friSS T :': 8'j f '!.i. I:':: PROOE SERIHL N~1 38!'lIJ CI ,;2 '.,;riL HF: T£:3T PEP: JUL 10, 2001 PHSS Tj ;; I F¡;':FJI I Ul'] F'¡"";)BE ;':;E::E J HL f"WI'3:':' J '/:C'! C.i ,2 ';hL·· HE' lE::':T f'EF:: JuL ILL :"'L)I:11 h1:::~::' T cj: f' ¡ E~c'::EI. PROBE SERli-iL N~1 J81'i1"¡ Ii . ::' ',;¡.;L rl¡': 1[, .:T fER: Ji.H, I D. 20111 hi;c~::-; ~ .~ ~ ~ A E~[J * . ,..::c¡ ::,í';",'!:ì!F¡J.1: TL. ,','L J ::"1'(:,,'î11h[ E Hi",I/. f:ê1ÌT¡.·:::r I [LL'. '_h. i~:i I : -: 1.-:) 1 ~=I i J ~.';j C! ~,J I...! t,I~" FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 oH' Street Bakersfield, CA 93301 VOICE (661) 326·3941 FAJ( (661) 395-1349 SUPPRESSION SERVICES 2101 oH" 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 January 22, 2001 Stockdale Texaco 5321 Stockdale Hwy Bakersfield Ca 93309 RE: Dispenser Pan Requirement December 31, 2003 Underground Storage Tank Dispenser Pan Update Dear Underground Storage Tank Owner: You will be receiving updates from this office now, and in the future with regard to the Senate Bill 989, which went into effect January 1, 2000. This bill requires dispenser pans under fuel pump dispensers. On December 31, 2003, which is the deadline for compliance, this office will . be forced to revoke your pennit to operate, effectively shutting down your fueling operation. It is the hope of this office, that we do not have to pursue such action, which is why this office plans to update you. I urge you to start planning now to retro-fit your facilities. If your facility has upgraded already, please disregard this notice. Should you have any questions, please feel free to contact me at 661-326-3190. Sincerely, Jc~ Steve Underwood, Inspector Office of Environmental Services SBU/dm ~\~~ ~ g:'onl/~ .970P ./¡g0P6 .r~ A W~.,., CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave.. 3rd Floor. Bakersfield. CA 93301 FACILITY NAME 6{f\l'~Jd.(L K'{.¿\.('n INSPECTION DATE ut 2~/(Yô Section 2: Underground Storage Tanks Program o Routine gj Combined Type of Tank -1)lJJF Type of Monitoring o Joint Agency o Multi-Agency 0 Complaint Number of Tanks ~ Type of Piping tJtL' F ORe-inspection ATG OPERA TION C V COMMENTS Proper tank data on ti!è J Proper owner/operator data on tile V Permit fees current V Certitication of Financial Responsibility t/ Monitoring record adequate and current t/ Maintenance records adequate and current J Failure to correct prior UST violations ¡,...;'" Has there been an unauthorized release? Yes No ~ Section 3: Aboveground Storage Tanks Program AGGREGATE CAPACITY Number of Tanks TANK SIZE(S) Type of Tank OPERA TION Y N COMMENTS SPCC available spec on tile with OES Adequate secondary protection Proper tank placarding/labeling Is tank used to dispense MVF? If yes, Does tank have overtilI/overspill protection? C=Compliance VccViolation Y=Yes N=NO ["peo',,, _Æ (~HÜ Office of Environmental Services (805) 326-3979 White, ¡'nv. Sves. D,~~ Business Site Responsible Party Pink, Business Copy CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME J\~(~&.l ìë~t"t'1 ADDRESS C) ~ ( ~~~ 'alL tfut~ FACILITY CONTACT INSPECTION TIME INSPECTION DATE-m;. f1!()O PHONE NO. ~3ì - 13 g e¡ BUSINESS ID NO. 15-210- NUMBER OF EMPLOYEES '7 Section 1: Business Plan and Inventory Program D Routine 1:þr Combined D Joint Agency D Multi-Agency D Complaint D Re-inspection OPERA TION C V COMMENTS Appropriate penn it on hand \. / 'V 7 Business plan contact infonnation accurate Visible address V / Correct occupancy V L- 7 Verification of inventory materials Verification of quantities V / Verification of location L.- V . Proper segregation of material L- 17 Verification of MSDS availability \.IV Verification of Haz Mat training /" U v 7 Verification of abatement supplies and procedures Emergency procedures adequate iT V Containers properly labeled vi V 17 Housekeeping II Fire Protection v '/ v Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardous waste on site?: Explain: DYes DNo J), L~ Business Site esponsible Party Questions regarding this inspection? Please call us at (661) 326-3979 White - Env. Svcs. Yellow - Station Copy Pink, Business Copy Inspector: ~ 1 1 I V rot-\. I'-..£. 1:'\.:) r 1 J:'., L V OFFJr'E OF ENYIRON[\iIENTAL SFoYICES !ÿftJ1q 1715 Che~l.er Ave., Bakersfield, CA 93301 "ù61) 326-3979 UNDERGROUND STORAGE TANKS.. UST FACILITY Page L of o 7. PERMANENTLY CLOSED SITE o 8. TANK REMOVED 1\ SUŠiÑESS-k;f------ TYPE ¡.a L GAS STATION o 2. DISTRIBUTOR rÖTAL NUMBER OF TANKS REMAINING AT SITE ...--- .!::> ~. RENEWAL PERMIT 0 5, CHANGE OF INFORMATION (Specify change .. o 4, AMENDED PERMIT lOcal U5e only) ._.._,_.,._,... '. ...m 0 6, TEMPORARY SITE CLOSURE '''_''_ C; ~ :; ( ---.5E;~t1~L0-.:ï1~~'-I--~. ;~;;~;~l SITE JNFORMATION BUSINES~ME (Same a5 FACILITY NAME or DBA, Doing Bufn-~¡r- 3 I FACILITY 10 . 5' '"\"0 c....'C.. QA L.E --r-¿-y. AC D ! NÊAREsTëROSS Sï'REET-- 401, í FACILITY OWNER TYPE \-.\<=-'-J.J 5 I' N ¢: I ~ 1, CORPORATION ~ 0 2, INDIVIDUAL o 3. FARM D 5. COMMERCIAL I D 3, PARTNERSHIP D 4. PROCESSOR D 6, OTHER 403 I I 'If owner of UST a public agency: name of supe1Visor of division, sectioo or office w!1ich operales the UST. i (This is the contact person for the lank records.) 405. ; 400 riPE OF ACTION (Check one 1Iam only) D 1. NEW SITE PERMIT --'.'-"-- -- ----- -~--------- ".'-- ...------.... 1_,:, 1111, ; Tj-G,·-T-----, . - '. , . I ¡ I !! ! I I ! ! : _._:__1--_ ' :"'___'" I _ D 4, LOCAL AGENCYlDlSTRICr o 5, COUNTY AGENCY' o 6, STATE AGENCY' D 7. FEDERAL AGENCY' 402. Is fadlity 00 Indian Reservallon or truslland.s? 404. Dyes ~NO 406, II. PROPERTY OWNER INFORMATION ¿ \--.\. '"T ¿:..g ~ R. \ :5 C!S LLC 407, PHONE 400, 616-'"13"'- 5076 PROPERTY OWNER NAME -- t.::::Qv \. '-ON MAILING OR STREET ADDRESS Po 60)<, 7 'f:;Jroq CITY 0V~\2IA~'C- PROPERTY" OWNER TYPE ~ 1. CORPORATION 409, D 2. INDNlDUAL o 3, PARTNERSHIP 410. ! STATE ¡ QA I D 4, LOCAL AGENCY I DISTRICT D 5, COUNTY AGENCY 411. ZIP CODE Q,510 - ~8ro9 o 6, STATE AGENCY o 7. FEDERAL AGENCY 412, 413, III. TANK OWNER INFORMATION rANK OWNER NAME r- E::::- V\. '-O~ c:::: 'I--lT¿o(('~.Q \ ðC..Æ::> -AA1lING?Ei STREETr'iDDRESS "",,0 QOX 1f 8f.:::;.q ::ITY . . _J2>..;J~0AN~ 414, PHONE 415, L. L c.. f3\6 - ~ :?:>f.:::>-.5078 416, 417, ; STATE 418, OA ZIP CODE c::¡ S\ 0 - ~Bb9 o 6. STATE AGENCY D 7. FEDERAL AGENCY 419', 'ANK OWNER TYPE ~ 1, CORPORATION D 2. INDNIDUAL o 3. PARTNERSHIP o 4, LOCAL AGENCY I DISTRICT D 5, COUNTY AGENCY 420. IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER -y (TK) HQ Call (916) 322-9669 if questions arise 421. V, PETROLEUM UST FINANCIAL RESPONSIBILITY ,"OICATE METHOD(S) 1, SELF-INSURED D 2, GUARANTEE D 3, INSURANCE o 4. SURETY BONO o 5. LETTER OF CREDIT D 6, EXEMPTION D 7. STATE FUND D 8. STATE FUND & CFO LETTER o 9, STATE FUND & CD o 10. LOCAL GOv-T MECHANISM o 99. OTHER: 422. VI. LEGAL NOTIFICATION AND MAILING ADDRESS :tIeck one box to indicate w!1ich address should be used (or legal notifications and maitlng. egal notifications and mailings will be sent to the tank owner unless box 1 0< 2 is checked, D 1. FACILITY D 2, PROPERTY OWNER 15:( 3, TANK OWNER 423. VII. APPLICANT SIGNATURE ertlficatloo: I certl(y thaI the Information provided herein Is true and accurate to Ihe best of my knowledge, IGNATÜRÊOFAPPLICANT ~<Q\ -_ ~ S-lòlW___42~r~~~~__';~:-5~7; "'ME OF APPLICÃÑl'ï¡;;;ntj'--- -.-... -:;;J 428J......-1 ,""õe.¡tJà,-- a m ~¿; 12,,~ ..~,~_..,,;?_AARê:,:f;u0\_bl.___.____, ......,_ 6 'd,..ª ,~__aj,.J\_~I....,!~LB,~¿,.. ___2gP\~~:I<?~ 428, 11998 UPGRADE CERTIFICATE NUMBER (For local use only) 429. TATE UST FACILITY NUMBER (Porlac.1 U58 only) CF (7199) S:ICUPAFORMSlswrcb-a, wpd -. ij:~k~( ~Þ-- ~ ...._.... ~ A~· CITY OF BAKERSFIELD OFFIC. )F ENVIRONrvlENT AL SER' ::::ES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 ~ 1.... 01 I \ Page tYPE OF ACTION I Clwel< Qoe dem only) o 6, TEMPORARY SITE CLOSURE o 7. PERMANENTLY CLOSED ON SITE (Specrfy reason ,for local use only) (SpeCIfy change, for local use only) 0 8, TANK REMOVED BUSINES·SNAME(Same;;FÂëlllTY-NÄMEorÕsÄ.D-;"-;:'¡iiü;;;;;;;,;'As)" , -,-- -'3-: FACIUTYIO# r-~'I" ,-, -- 'g"_. '. - LÖêÄTIOÑ'W~SI~E~~~_O~A'::-:..ª"__",-,_(_~~-Ac..~_dL,_- -,- ,~L .'-.'-.~-,~, o 1 NEW SITE PERMIT 0 4. AMENOED PERMIT o 5. CHANGE OF INFORMA TION) ~ RENEWAL PERMIT 430 ..----------.- ----- 431 I. TANK DESCRIPTION 433 COMPARTM~~-:;:-AlIZED'~ AN;--'-~-;;;;-'~--:;-;; If 'Yes', complete one page for each compartment "rÀNKio#' 432 TANK MANUFACruRER DA TË-INSTÃLCED(YEARlMÕj---' TANK CAPACITY IN GALLÕNS ·---¡3¡¡-".¡ÚMBE'R OfCOM-PAR"TMENTS : I __. "___ ___n_ 435 437 \0\000 438 ADDITIONAL DESCRIPTION (For local use only) II. TANK CONTENTS TANK USE 439 è(' 1. MOTOR VEHICLE FUEL (If marí<ed. complele Petroleum Type) o 2. NON,FUEL PETROLEUM o 3, CHEMICAL PRODUCT o 4, HAZARDOUS WASTE (Includes Used Oil) o 95, UNKNOWN PETROLEUM TYPE ~ 1a, REGULAR UNLEADED o 1b. PREMIUM UNLEADED o 1c, MIDGRADE UNLEADED 440 o 2, LEADED o 3, DIESEL o 4. GASOHOL o 5, JET FUEL o 6, AVIATION FUEL o 99. OTHER COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Matenals Inventory page) 442 TYPE OF TANK o 1, SINGLE WALL þ('2. DOUBLE WALL ~o\o.R.. QAe.o,-,,\'~<: III. TANK CONSTRUCTION o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER o 4, SINGLE WALL IN A VAULT (Check one nem only) o 2. STAINLESS STEEL 3. FIBERGLASS I PLASTIC o 4. STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC FRP 3, FIBERGLASS I PlASTIC o 4. STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC (FRP) o 5. CONCRETE o 3. EPOXY LINING o 4, PHENOLIC LINING o 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM o 95. UNKNOWN o 99. OTHER o 5, CONCRETE o 8, FRP COMPATIBLE WI100% METHANOL 443 (Check one nem only) (Checf< one nem only) o 1. BARE STEEL o 2. STAINLESS STEEL o 95, UNKNOWN o 99, OTHER 444 TANK' MATERIAL, primary tank -.---'-- o 8. FRP COMPATIBLE WI100% METHANOL o 9, FRP NON-CORRODIBLE JACKET o 1 O. COATED STEEL o 95, UNKNOWN o 99. OTHER 445 TANK MATERIAL· secondary tank 0 1. BARE STEEL TANK INTERIOR LINING OR COATING o 1. RUBBER LINED o 2, ALKYD LINING o o 5, GLASS LINING o 6, UNLINED 18:r95, UNKNOWN D 99, OTHER 446 DATE INSTALLED 447 (For local use only) DATE INSTALLED 449 (For local use only) .fCheck one nem only) OTHER CORROSION PROTECTION IF APPLICABLE (Check one item only) SPilL ANa OVERFILL 1, MANUFACTURED CA THOOIC )(( 3. FIBERGLASS REINFORCED PLASTIC PROTECTION 0 4, IMPRESSED CURRENT o 2, SACRIFICIAL ANODE ,95, UNKNOWN o 99, OTHER 448 ¡Check alllhat apply) ~1. 'g¡ 2, ~3, YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 SPILL CONTAINMENT /5 (.i"'.... K( 1. ALARM _ ~ 3. FILL ruBE SHUT OFF VALVE - DROP TUBE ~~AT"~.y....( ið(2, BALL FLOAT _ 04. EXEMPT ø~"G£-r ~¿ t:.::)'¡'~;,~;0ff<' ·~r'IV.;~:fAijl<: LEAK DEiêëTtoN': .é~'~. ,. ,,' ,..., . ." . ~53 .. IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): 454 05, MANUAL TANK GAUGING (MTG) 0 1. VISUAL (SINGLE WALLIN VAULT ONLY} o 6, VADOSE ZONE g 2. CONTINUOUS INTERSTITIAL MONITORING o 7, GROUNDWATER 0 3, MANUAL MONITORING o 8. TANK TESTING o 99, OTHER STRIKER PLATE 01, 02, 03, 04. IF SINGLE WALL TANK (Check all that apply): VISUAL (EXPOSED PORTION ONLY) AUTOMATIC TANK GAUGING (ATG) CONTINUOUS ATG STATISTICAL INVENTORY RECONCILIATION (SIR) + BIENNIAL TANK TESTING V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 456 TANK FILLED WITH INERT MATERIAL? 457 ESTIMATED DATE LAST USED (YRlMO/DAY) 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING gallons Dyes oNO . --'--'-- _... ._---_._.~" ..._,~._.- .-.--------. -..-,.,. .--......------..-- --,. .._-,._------_.-_.---'-~ - - ._--~ ---.. ...-.----.-.------- UPCF (7/99) S :\CUP AFORMS\SWRCB·B, WPO 171 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES .ester Ave., Bakersfield, CA 93301 (661) 326-39ì . USTo. TANK p~¿, ,__,______ _,_ _,_,_~51'!._, _ :?", _':~ ~1-,.., / ,.-_.._------~~-- .-. ABOVEGROUNO PIPING ..--------.-----.--- VI. PIPING CONSTRUCTION (ChacK an that apply) PRESSURE 0 ., SUCTION 0 3 GRAVITY 458 ,.c=J 1. PRESSURE SINGLE WALL 0 3, LINED TRENCH 0 99 OTHER 460 I 0 1. SINGLE WALL OOUBLE WALL 0 95. UNKNOwN I 0 2. DOUBLE WALL ; MANUFACTURER .q_"'___ ' ..", __n_ ,_~1_L ___,' ,~N~~~~~~~~~, ,. o 1. BARE STEEL . 0 6. FRP COMPA TlBLE WI 100% METHANOL i 0 1. BARE STEEL MATERIALS AND 0 2 STAINLESS STEEL 07. GALVANIZED STEEL I' 02, STAINLESS STEEL CORROSION ' . PROTECTION i 0 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN i 0 3, PLASTIC COMPATIBLE WITH CONTENTS :'3..4. FIBERGLASS 0 6. FLEXIBLE (HDPE) 0 99. OTHER I 0 4, FIBERGLASS : 0 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 I 0 5. STEEL WI COATING V1I. PIPING LEAK DETECTION (ChecK a/I that apply) UNDERGROUND PIPING $YS rEM TYPE ~ 1 CONSTRUCTlON/'~ I. MANUFACTURER.O 2. --...-----.---.--.----- ...-- -------- ---. o 2 SUCTION o 3. GRAVITY 459 o 95, UNKNOWN o 99, OTHER 462 ._ _, _'" __ __ '.. _,.__ ..,_ 463 o 6, FRP COMPATIBLE WI 100% M¿';';:;-~~~~ h o 7, GALVANIZED STEEL o 6, FLEXIBLE (HOPE) 099. OTHER o 9, CATHODIC PROTECTION o 95. UNKNOWN 465 SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Checl< one) - o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF j 0 11, ~~W~~I~~INE LEAK DETECTOR (3.0 GPH TEST) ~ FLOW SHUT OFF OR I 0 12, ANNUAL INTEGRITY TEST (0,1 GPH) ; SUCTION/GRAVITY SYSTEM: ! 0 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS ! EMERGENCY GENERATORS ONLY (Check all that apply) : 0 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND ! VISUAL ALARMS - ¡ 0 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) ~ FLOW SHUT OFF OR ; RESTRICTION j 0 16. ANNUAL INTEGRiTY TEST (0,1 GPH) 0 16, ANNUAL INTEGRITY TEST (0.1 GPH) i 0 17, DAILY VISUAL CHECK 0 17, DAILY VISUAL CHECK L.-:::.. '\'~J'; ·,:,f"~;~;.:,:·.~~~\i~l;;i;;~~,~~~;~~'''~J''::~vjni,Rlsp.E~~E~ CON,T AI,N~J;NT~ .',. 1 DISPENSER CONTAINMENT 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DA TE INSTALLED 468 0 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS o 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS - --~---_. UNDERGROUND PIPING --'-,·------"--'---'SiNGLEWÁi.L PIPIm;--- 466 PRESSURIZED PIPING (Chock all (hat apply): ø: 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNEëTiõÑ + AUDIBLE AND VISUAL ALARMS o 2. MONTHLY 0,2 GPH TEST ~ 3. ANNUAL INTEGRITY TEST (0,1 GPH) CONVENTIONAL SUCTION SYSTEMS: o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MONITORING GRAVITY FLOW: o 9. BIENNIAL INTEGRITY TEST (0.1 GPH) ABOVEGROUND PIPING 'sjNGLEWALLPiPiÑ~-----'---- 467 PRESSURIZED PIPING (Chock all that appty): o 1, ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS o 2, MONTHLY 0,2 GPH TEST o 3. ANNUAL INTEGRITY TEST (0.1 GPH) o 4. DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check all that apply): o 5 , DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM o 6, TRIENNIAL INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MONITORING GRAVITY FLOW (Chock all that apply): o 8, DAILY VISUAL MONITORING o 9. BIENNIAL INTEGRITY TEST (0,1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Chack all that apply): 10. CONTINUOUS TURBINE SUMP SENSOR ~ AUDIBLE AND VISUAL ALARMS AND (checl< one) o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b. AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM DISCONNECTION o c. NO AUTO PUMP SHUT OFF o 11, AUTOMATIC LEAK DETECTOR o 12, ANNUAL INTEGRITY TEST (0,1 GPH) SUCTIONlGRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR + AUOIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (ChoCk all that apply) o 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) :.'~ .",: :'~'-: -"0 o 4. DAILY VISUAL CHECK o 5, TRENCH LINER I MONITORING o 6. NONE 469 .-.--.--.--.-..- IX. OWNERlOPERA TOR SIGNATURE I' certify Iha! Ihe inlormallon provided herein is lrue-;;ñëjm'rale 10 Ihe besl 01 my knowledge. , ,-...--' ' - ,---"... --" ,-...--------- "<iN,,",, 6' 6WN'''''''AA''''-C~\-~~~ - - -T -ÕÁ"--.s=L---l-~-i ~__..,'_ . u ,_,_ ,'..__"." _ 4:0, NAME OF ~RiOPËRÃTOR (prln¡¡'-'--' ~-'------471"I" Tí:¡Ù~(jF-ö>ìvNÉRI~ptRATÒR . Q ,-,--- -'-~72 .._~£ '-I,~L;:__2~9~..ð';:= \~~_"uL? M_,~__~u.__a~,,^~.\..l,J4:t~~-_..___og-º-l ~ AT"!2t:: PerIni! Numbt!f (For /ocsl use only) 473 I Permll Approved (For locs' use only) 474 I Permll 8p¡raUon Dale (For locs/ use only) 475 UPCF (7/99) S :\CUP AFORMS\SWRCB·S.wP [ CITY OF BAKERSFIELD OFFICE .. ENVIRONIVIENT AL SERV!~S 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page 4--01 n o 6, TEMPORARY SITE CLOSURE o 7. PERMANENTLY CLOSED ON SITE (Specify reason ,Iar local use only) (Specdy change . lor local use only) 0 8. TANK REMOVED uSI':é'-SNAME(Sa~è;;FAÒÚÍÝ-NÃMEOîõàA"ÔQ¡-;'çiB~;;¡;;~-As)""" --,-- '-'3-'TFACïLïTYIÕÏI--I'-~']-I" ,., .. __I' ,,- ,..., .. .. ....'.._,...... h - ----- : I . I I _,_",__ ,;:?.._~ 0 <:"'<::._'9 A L..¿ ___=..~_~~,..AC.?: I ,~ ~ ,,' i.. .__'_'~, OCA TlON WITHIN SITE (OpliÕ;:;alj- .. -'--". '--- PE OF ACTION o I. NEW SITE PERMIT 0 4. AMENDED PERMIT o 5. CHANGE OF INFORMATION) ":8CX ond ,(em only) ~. RENEWAL PERMIT 430 431 I. TANK DESCRIPTION .ô;itINSTÃLCED (YEARiMO) --, 435 TANK êÃPACITY IN GALlÕ¡'¡S 433·: COMPARTMENTAlIZED'TAN~--Õ Yes '~--;-;:; If "Yes", complele ooe page for earn compartment. ---436r-ÑÜMBER OF COMPARTMENT-S -..---- ! J 437 i,NKiõ"#------ 432 TANK MANUFACTURER \O¡DOO 438 :;¡OITIONAL DESCRIPTION (For local use only) II. TANK CONTENTS PETROLEUM TYPE o 1a, REGULAR UNLEADED ]&.1 b. PREMIUM UNLEADED o 1c, MIOGRADE UNLEADED 440 TANK USE 439 (' 1. MOTOR VEHICLE FUEL f marked. complete Petroleum Type) ] 2, NON,FUEL PETROLEUM J 3, CHEMICAL PRODUCT ] 4, HAZARDOUS WASTE (Includes Used Oil) ] 95. UNKNOWN o 2, lEADED o 3. DIESEL o 4, GASOHOL o 5, JET FUEL o 6. AVIATION FUEL o 99, OTHER COMMON NAME (from Hazardous Materials Inventor¡ page) 441 CAS # (from Hazardous Materials Inventor¡ page) 442 \-1\o-roR. QA:::>O'-'~¿- ,heck one item only) o 1. SINGLE WALL þ('2. DOUBLE WALL III. TANK CONSTRUCTION o 3. SINGLE WALL WITH EXTERIOR MEMBRANE LINER o 4. SINGLE WALL IN A VAULT o 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM o 95, UNKNOWN o 99, OTHER 443 1?E OF TANK o 1. RUBBER LINED o 2. ALKYD LINING 3, FIBERGLASS I PLASTIC o 4, STEEL CLAO WIFIBERGLASS REINFORCED PLASTIC FRP 3, FIBERGLASS I PLASTIC o 4, STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC (FRP) o 5, CONCRETE o 3. EPOXY LINING o 4, PHENOLIC LINING o 5. CONCRETE o 8, FRP COMPATIBLE WI100% METHANOL o 95, UNKNOWN o 99. OTHER 444 INK MATERIAL, primary tank 0 1. BARE STEEL .heck one item only) 0 2, STAINLESS STEEL --, I.NK MATERIAL, secondary tank 0 1. BARE STEEL bsck one item only) 0 2. STAINLESS STEEL 08, FRP COMPATIBLE WI100% METHANOL o 9. FRP NON-CORRODIBLE JACKET 010, COATED STEEL o 95. UNKNOWN o 99. OTHER 445 ..NK INTERIOR LINING t COATING o 5, GLASS LINING o 6, UNLINED M'95, UNKNOWN o 99, OTHER 446 DATE INSTALLED 447 (For local use only) DATE INSTALLED 449 heck one item only) "HER CORROSION WTECTION IF APPLICABLE heck one ¡teft' only) o 1. MANUFACTURED CATHODIC PROTECTION o 2, SACRIFICIAL ANODE '¡z( 3. FIBERGLASS REINFORCED PLASTIC o 4, IMPRESSED CURRENT . . .. 95, UNKNOWN o 99, OTHER 448 (For local use only) 'iLL AND OVERFILL YEAR INSTALLED 450 TYPE (For local use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 ~ 1. SPilL CONTAINMENT /5 at>¡..... ~ 1. ALARM ~ 3. FILL TUBE SHUTOFF VALVE _ ~ 2. DROP TUBE ~h:.cA-r~ñ?-=.c. ~ 2. BALL FLOAT 0 4. EXEMPT ~ 3. STRIKER PLATE B~'G.€-r CAG;¿;:- IF SINGLE WALL TANK (Cheek aI/ that apply): 453 VISUAL (EXPOSED PORTION ONLY) 0 5, Iv4ANUAL TANK GAUGING (MTG) AUTOMATIC TANK GAUGING (ATG) 0 8, VADOSE ZONE CONTINUOUS ATG 0 7, GROUNDWATER STATISTICAL INVENTORY RECONCILIATION (SIR) + 0 8, TANK TESTING BIENNIAL TANK TESTING 099. OTHER V. TANK CLOSURE INFORMATION / PERMANENT CLOSURE IN PLACE 455 ESTIMA TED QUANTITY OF SUBSTANCE REMAINING 458 TANK FILLED WITH INERT MA TERIAL? IF DOUBLE WALL TANK OR TANK 'MTH BLADDER (Check one item only): 01. VISUAL (SINGLE WALL IN VAULT ONLY) g 2, CONTINUOUS INTERSTITIAL MONITORING o 3, Iv4ANUAL MONITORING 454 !leek al/lhat apply) ] 1. :J 2. ] 3, :J 4, 457 ,STIMA TED DATE LAST USED (YRiMO/DAy) gallo,,. Oy"" ONO --_.~ _._- --..,.--------- ...-.----------.--.. -".---..--.-.-.-.,. ._.......~._----- -.-.-.-,---------..-...-..-- ---------.--.-- .... ...-....-.--.--..--. ~CF (7/99) s:\CU P AFORMS\SWRCB-B. WPD 171- CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES ,lester Ave., Bakersfield, CA 93301 (661) 326-39' UST,TANKP¡¿' '_:....'_'_---'- ,___,_~,~__ .,~__~~._bL:· / .- ...-..-------.--- ABOVEGROUNO PIPING VI. PIPING CONSTRUCTION (ChecK an that apply) S'IS rE1v1 TYPE ~ 1 PRESSURE 0 2. SUCTION 0 3. GRAVITY 458 ,..CJ I PRESSURE CONSTRUCTION1~ I. SINGLE WALL 0 3, LINED TRENCH 0 99. OTHER 460; 0 1. SINGLE WALL MANUFACTURER. 0 2, DOUBLE WALL 0 95. UNKNOWN I 0 2, DOUBLE WALL i ___ . MA~U~.CTU.~~~.,__ . .. __,_. __' _:~I..L "'_,___" MAN~~~~~~~~R., ' o 1. BARE STEEL tJ 6. FRP COMPATIBLE WI1 00% METHANOL : 0 1. BARE STEEL I MATERIALS AND'O 2. STAINLESS STEEL 0 7. GALVANIZED STEEL II 0 2, STAINLESS STEEL CORROSION ' PROTECTION : 0 3. PLASTIC COMPATIBLE WITH CONTENTS 095 UNKNOWN I 0 3. PLASTIC COMPATIBLE WITH CONTENTS ;~4. FIBERGLASS 0 6. FLEXIBLE (HOPE) 0 99. OTHER i 0 4, FIBERGLASS :0 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 ! 0 5, STEEL WI COATING VII. PIPING LEAK DETECTION (Check all that apply) ~------_. UNDERGROUND PIPING --~,-~--_.-._-_._--_..__. ._-- ._._---.__. o 2 SUCTION o 3. GRAVITY ~5g o 95. UNKNOWN o 99, OTHER 462 .._.. .. ..,...._...., _, ,......... __.. ,_ 463 o 6. FRP COMPATIBLE WI 100% MET;:;-~-;:;O-;:- .. o 7. GALVANIZED STEEL o 8, FLEXIBLE (HOPE) 099. OTHER o 9, CATHODIC PROTECTION o 95. UNKNOWN 465 467 UNDERGROUND PIPING .------- _._u ---. ----------·-SINGLE"WÃLL PIPING 466 PRESSURIZED PIPING (Check all that apply): ~ 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP SHUT OFF FOR LEAK. SYSTEM FAILURE, AND SYSTEM DISCONNEëTiõÑ + AUDIBLE AND VISUAL ALARMS o 2, MCNTHL Y 0,2 GPH TEST ~ 3. ANNUAL INTEGRITY TEST (0,1 GPH) CONVENTIONAL SUCTION SYSTEMS: o 5. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING); o 7, SELF MONITORING GRAVITY FLOW: o 9. BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Ched< one) - o a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTIQ N o c. NO AUTO PUMP SHUT OFF ¡OIl. ~~W~'!fI~~tNE LEAK DETECTOR (3,0 GPH TEST) ~ FLOW SHUT OFF OR I 0 12, ANNUAL INTEGRITY TEST (0,1 GPH) i SUCTION/GRAVITY SYSTEM; I 0 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERG ENCY GENERA TORS ONLY (ChecK all that apply) o 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS - 15, AUTOMATIC LINE LEAK DETECTOR (3,0 GPH TEST) WITHOUT FLOW SHUT OFF OR RESTRICTION 16, ANNUAL INTEGRITY TEST (0,1 GPH) 17 , DAILY VISUAL CHECK ,0 10 ¡ ¡O I [, : DISPENSER CONTAINMENT DA TE INSTALLED 468 ABOVEGROUND PIPING 'ŠiÑGLE WALL PIPING PRESSURIZED PIPING (Check all that apply): o 1, ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LE.A.K, SYSTEM FAILURE, AND SYSTEM DISCONNECTION + AUDIBLE AND VISUAL ALARMS o 2, MONTHLY 0,2 GPH TEST o 3. ANNUAL INTEGRITY TEST (0.1 GPH) o 4, DAILY VISUAL CHECK .-----.- CONVENTIONAL SUCTION SYSTEMS (Check all that apply): o 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM o 6, TRIENNIAL INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING); o 7, SELF MONITORING GRAVITY FLOW (Check all that apply): o 8, DAILY VISUAL MONITORING o 9. BIENNIAL INTEGRITY TEST (0,1 GPH) SECONDAR!L Y CONTAINED PIPING PRESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR ~ AUDIBLE AND VISUAL ALARMS AND (d1ed< one) Oa. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c, NO AUTO PUMP SHUT OFF o 11, AUTOMATIC LEAK DETECTOR o 12, ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) o 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) o 16. ANNUAL INTEGRITY TEST (0,1 GPH) o 17 . DAILY VISUAL CHECK ."'i':;~4~~,~~~~~~"'~>:{~'l.JUiRISp'E~~ER CO~T Ai!4~.~NT' 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS o 3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS "":'--(j' .... o 4. DAILY VISUAL CHECK o 5, TRENCH LINER I MONITORING o 6, NONE 469 ...----.----.--.--.-.'- IX. OWNER/OPERATOR SIGNATURE ..-.--.--" I certify Ihat Ihe intO<matlon provIded herem Is true,me¡ accurale 10 !he best of my knowledge, SIGNATURE OF ÒWÑERlÕPEAArOO-------' ,---' ----, '-',' õ-Á'i'{-'---=---'e'---- ,--- " . ,- ---,-,--" .--, --'-'---;¡¡õ ~... 0' ò_',,^,,""OR ".." ~ ~-- -"'~\~ '¡i¡,~ò,.£,;¿'kJo,I.x!~~- . ~-- ~ ~- ~ Q~--~- ------¡¡; _~ß '{'?-.I-__~~g~~ ,--~N ._".L~ r\_,4,,£,__Q,j.,,^~-'\",lJ4~~;;:-,.,._-.Og_QI N. AT52.{. Permit Number (RJr local use only) 473 I Permit Approved (RJr local use only) 474 I Permit Expirallon Date (For tocal use only) 475 UPCF (7/99) S:\CUP AFORMS\SWRCB-B,WP( ~!) CITY OF BAKERSFIELD OFFICE F ENVIRON~IENTAL SERV'" ~ES 1715 Chester Ave., Bakersfield, CA 93301 (661) 326-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 -- .(/;-0'....... . " ~,~'.J ART'" ....... .AI. --- Page /..pol \\ o 6, íEMPOPARY SlíE CLOSURE o 7. PERMANENíL Y CLOSED ON SiTE (Specify reason· lor local use only) (Specify chango, lor local use only) 0 6. TANK REIvIOVED !USiÑES'SNAMEISä';'e;~FAéiLi'iYNÄ¡"'Eo;ÖSA~O;;'-ñg'B~;'~~Äs')'.,., -'- - '-'3"1 FACILlTYID#-·I'-~---I' --- - 'I' ,-", -- : ,I I I 1 ' ___,,_,_"~_,_\ OC-'C.. "?_A~'é__,.._,_~" ~~_ AC.~_, ¡ ,~_~ _,~, ,----~-~, .OCA TION WITHIN SITE (Opt!o~ãïj'--' o 1 NEW SITE PERMIT 0 4 AMENDED PERMIT o 5. CHANGE OF INFORMATION) 'PE OF ACTION heck one ¡(em only) ~. RENEWAL PERMIT 430 --.---..-.---..- 431 ÀNKIÕ¡¡----- 432 : TANK MANUFACTURER I. TANK DESCRIPTION ,ATE IÑSTÃLLËD(YEARiMO)----43S¡TA"ÑK-ëÄPACITY IN GALLÕÑS I I I --,,------ ~ 433 COMPARTMENTALIZED TANK 0 V;; ~No If "Yes'. complele one page for each compartment. 436-r'i-;TiMBÉR OF COMPARTMENYS --d-,------¡'37 : I 4:>4 \0\000 436 OOITIONAL OESCRIPTION (For local use only) II. TANK CONTENTS PETROLEUM TYPE o 1a, REGUlARUNLEAOED o 1b. PREMIUMUNLEAOED ~ 1 c, MIDGRADE UNLEADED 440 TANK USE 439 ~ 1. MOTOR VEHICLE FUEL ;1 marked, complete Petroleum Type) :J 2, NON,FUEL PETROLEUM :J 3. CHEMICAL PRODUCT :J 4. HAZARDOUS WASTE (Includes Used Oil) :J 95, UNKNOWN o 2. LEADED o 3. DIESEL o 4. GASOHOL o 5. JET FUEL o 6. AVIATION FUEL o 99, OTHER COMMON NAME (from Hazardous Materials inventory page) 441 CAS # (from Hazardous Malerials inventory page) 442 \......1\0 TO -P- QA~O ,-\t-\.¿ iPE OF TANK o 1. SINGLE WALL þ('2. DOUBLE WALL III. TANK CONSTRUCT1ON o 3, SINGLE WALL WITH EXTERIOR MEMBRANE LINER o 4. SINGLE WALL IN A VAULT o 5. SINGLE WALL WITH INTERNAL BLADOER SYSTEM o 95. UNKNOWN o 99, OTHER 443 :heck one ffem only) -\NK MATERIAL, primary lank 0 1, BARE STEEL :/Jeck one item only) 0 2, STAINLESS STEEL 3, FIBERGLASS I PLASTIC 0 5, CONCRETE o 4, STEEL CLAD W/FIBERGLASS 0 6. FRP COMPATIBLE WI100% METHANOL REINFORCED PLASTIC FRP o 95, UNKNOWN o 99. OTHER 444 o 1. RUBBER LINED o 2. ALKYD LINING 3. FIBERGLASS I PlASTIC o 4, STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC (FRP) o 5, CONCRETE o 3, EPOXY LINING o 4, PHENOLIC LINING o 8. FRP COMPATIBLE W/1 00% METHANOL o 9, FRP NON-CORRODIBLE JACKET 010. COATED STEEL o 95, UNKNOWN o 99, OTHER 445 :1:NK MATERIAL, secondary lank 0 1. BARE STEEL ;¡'eck one ilem only) 0 2. STAINLESS STEEL '-NK INTERIOR LINING R COATING o 5, GLASS LINING o 8. UNLINED M"95. UNKNOWN o 99, OTHER 446 DATE INSTALLED 447 (For local use only) DATE INSTAllED 449 :heck one item onl THER CORROSION :;¡OTECTION IF APPLICABLE "'ILL AND OVERFILL YEAR INSTALLED 450 TYPE (Forlocal usa only) 451 OVERFilL PROTECTION EQUIPMENT: YEAR INSTALLED 452 ~ 1. SPilL CONTAINMENT 15 a þ",- K( 1. ALARM _ ~ 3. FILL TUBE SHUT OFF VALVE - ~ 2, DROP TUBE ~\..I-~AT'~~¿-.( ~2. BALL FLOAT 04, EXEMPT ~3. STRIKER PLATE , . '. , Ø~~-r~é :' . '~4~~~;l''*~;';'1f~~~6~~i;~¡¿? ,;,"~:,:':;:;"ê:~f\:;.~:¡;~~:::""~~/;:~'iv.~t~BK,~EÞJÇ DË.:rE¢:ri<?N 'Il~" ," iféqfi~,rt:?;1ff!;:ç~'tC);{f:;;;;' t<c, " IF SINGLE WALL TANK (Check alllhatepply): 453 VISUAL (EXPOSED PORTION ONLY) 0 5, MANUAL TANK GAUGiNG (MTG) AUTOMATIC TANK GAUGING (ATG) 0 8, VADOSE ZONE CONTINUOUS ATG 0 7, GROUNDWATER STATISTICAL INVENTORY RECONCILlA nON (SiR) . 0 8, TANK TESTING BIENNIAL TANK TESTING 099, OTHER V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE 455 ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? o 1, MANUFACTURED CATHODIC PROTECTION o 2, SACRIFICIAL ANODE 3. FIBERGLASS REINFORCED PLASTIC o 4. IMPRESSED CURRENT . I ~ 95, UNKNOWN o 99. OTHER 448 (For local use only) :heck one dem only) :heck all that apply) ~ "'~~>:1~ß'~;~:-:i~~1'ô"y~:<, ::J 1, ::J 2. ::J 3. ::J 4. IF DOUBLE WALL TANK OR TANK WITH BLADDER (Check one item only): o L VISUAL (SINGLE WALL IN VAULT ONLY) g 2, CONTINUOUS INTERSTITIAL MONITORING ! 0 3, MANUAL MONITORING 454 457 ----.-----. :STIMATED DATE LAST USED (YRiMOIDAY) gallons DYes oNO .._n _.__ _...,.__..____ ...-...__________. -"."--. . ._.......______ ______._.________.40------ --.- - ---- --- ..._...._._._--~-- S:\CUPAFORMS\SWRCB-B, WP 0 "'CF (7/99) /1 171 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES ,Iester Ave., BakersfIeld, CA 93301 (661) 326-39' UST, TANK pÞ.¿, ,_~,_..----_.- _,_,_~~__~_~~,_,\,l:" ---..------------ --..--..-------------.---- . .-- .-.-------- ------- VI. PIPING CONSTRUCTION (CheCK an that apply) UNDERGROUND PIPING SYS rEM TYPE ~ ,c:s., 1. PRESSURE 0 2. SUCTION 0 3 GRAVITY 458 LO I. PRESSURE" CONSTRUCTIONJ'~ I. SINGLE WALL 0 3, LINED TRENCH 099 OTHER 460; 0 1 SINGLE WALL MANUFACTURER.O 2, DOUBLE WALL 095. UNKNOWN ! 0 2, DOUBLE WALL i MANUFACTURER ,~..L _,nO" ,~N~~~~r..~~..~, . o ,. BARE STEEL 0 6. FRP COMPATIBLE W/1 00% METHANOL : 0 " BARE STEEL MATERIALS AND '0 2 STAINLESS STEEL 0 7. GALVANIZED STEEL Ii 0 2, STAINLESS STEEL CORROSION ' . PROTECTION iO 3. PU.STIC COMPATIBLE WITH CONTENTS 095. UNKNOWN 10 3. pu.STIC COMPATIBLE WITH CONTENTS !~4. FIBERGLASS 0 8, FLEXIBLE (HOPE) 0 99. OTHER II 0 4. FIBERGLASS ,0 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 ¡ 0 5. STEEL WI COATING VII. PIPING LEAK DETECTION (CheCK all !hat apply) --- UNOERGR0üN6 PIPING . I ,..',_,.. ...... ---.-----..----síNGLEWÃLL 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 ALARMS EMERGENCY GENERA TORS ONLY (CheCK a/1 that apply) o 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF... AUDIBLE AND VISWAL ALARMS - ! 0 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) W1THOUT FLOW SHUT OFF OR , RESTRICTION ! 0 16. ANNUAL INTEGRITY TEST (0.1 GPH) 0 16. ANNUAL INTEGRITY TEST (0,1 GPH) iO 17. DAILY VISUAL CHECK 017, DAILYVISUALCHECK L~. ' ".,.t~i~'~~i.;':J;;B.~·':·:;{~;,,'\·;;;t;113:t~i~~~~f>Ji,v.jU~R!SP'E~~E~ CO~TAi~~,~NT' '. ! DISPENSER CONTAINMENT " FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE DA TE INSTALLED 468 0 2. CONTINUOUS DISPENSER PAN SENSOR'" AUDIBLE AND VISUAL AU.RMS o 3, CONTINUOUS DISPENSER PAN SENSOR ~ AUTO SHUT OFF FOR DISPENSER'" AUDIBLE AND VISUAL ALARMS IX. OWNERlOPERA TOR SIGNATURE ._-----_._---~---- o 2. MONTHLY 0.2 GPH TEST ~ 3. ANNUAL INTEGRITY TEST (0.1 GPH) CONVENTIONAL SUCTION SYSTEMS: o 5, DAILY VISUAL MONITORING OF PUMPING SYSTEM ~ TRIENNIAL PIPING INTEGRITY TEST (0,' GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF IVöNITORJNG GRAVITY FLOW: o 9, BIENNIALlNTEGRITY TEST (0,1 GPH) SECONDARILY CONTAINED PIPING PRESSURIZED PIPING (Check a/l thet apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Checl< ooe) - o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c, NO AUTO PUMP SHUT OFF I 0 11. ~~W~~~~INE LEAK DETECTOR (3.0 GPH TEST) ~ FLOW SHUT OFF OR i 0 12, ANNUAL INTEGRITY TEST (0,1 GPH) j SUCTION/GRAVITY SYSTEM: I 0 13, CONTINUOUS SUMP SENSOR'" AUDIBLE AND VISUAL ALARMS ABOVEGROUND PIPING o 2 SUCTION o J, GRAVITY ~5g o 95, UNKNOWN o 99. OTHER ~62 ",..,__ ,. ..'" ,_... ....... ,_ , ~63 o 6, FRP COMPATIBLE WI 100% MET~A~~~" o 7, GALVANIZED STEEL o 8, FLEXIBLE (HOPE) 0 99. OTHER o 9. CATHODIC PROTECTION o 95, UNKNOWN 465 ABOVEGROUND PIPING 'šiNGLEWALIPíP~-----'--"457 PRESSURIZED PIPING (Check a/l that apply): o ,. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION'" AUDIBLE ANO VISUAL ALARMS o 2. MONTHLY 0.2 GPH TEST o o 3. ANNUAL INTEGRITY TEST (0,1 GPH) 4, DAILY VISUAL CHECK CONVENTIONAL SUCTION SYSTEMS (Check a/I that apply): o 5, DAILY VISUAL IVöNITORING OF PIPING AND PUMPING SYSTEM o 6. TRIENNIAL INTEGRITY TEST (0,1 GPH) SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): o 7, SELF MONITORING GRAVITY FLOW (Check all that apply): o 8, DAILY VISUAL IVöNITORING o 9, BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARJL Y CONT AJNED PIPING PRESSURIZED PIPING (Check a/l that apply): 10. CONTINUOUS TURBINE SUMP SENSOR ~ AUDIBLE AND VISUAL AU.RMS AND (ct1ec1< ooe) o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS. SYSTEM FAILURE AND SYSTEM OISCONNECTION o c, NO AUTO PUMP SHUT OFF o 11, AUTOMATIC LEAK DETECTOR o 12, ANNUAL INTEGRITY TEST (0,1 GPH) SUCTION/GRAVITY SYSTEM: o 13. CONTINUOUS SUMP SENSOR ~ AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check a/l that apply) o 14, CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF... AUDIBLE AND VISUAL AU.RMS o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) '. "": ;'c; ,-; o 4. DAILY VISUAL CHECK o 5, TRENCH LINER I IVöNITORING o 6. NONE 469 ...----.-.--.--.--.-...-- ''1 ë';;¡¡¡YïiiãiUïëinr;""'atlon provided herem Is lrue-;ñd~rale 10 the best of my knowledge, ::::";::::::: c-~-~ ---,,~r=:~~¡Þ-~~--~= .~~~~-~=-:;: ,..~£ '-l~,,-=__~~Ç<~ß .;=: '-_~""\ _'_' L5 r-\ _ª' =- ..,_,aj,"^:!i':..~J,~~~£..- .. ___oR. 'Q \ N. A"T.J2-' Permit Numb.... (For local use only) 473 \ Permit APProved (For IOC81 use only) 474 \ Permit Expiration Dale (For loe81 use only) 475 UPCF (7/99) S :\CUP AFORMS\SWRCB-B, WP[ (/~~.. , . f..".,~'...J. ART" ..... ~ -- -- CITY OF BAKEKSFIELV OFFICE r"':' ENVIRONl\,'lENT AL SERVlr~s 1715 Chester Ave., Bakersfield, CA 93301 (661) JL6-3979 UNDERGROUND STORAGE TANKS - TANK PAGE 1 Page S 01 \\ o 6. TEMPORARY SITE CLOSURE o 7. PERMANENTLY CLOSED ON SITE (Spacrfy reawn . lor local usa only) (Specdy change ,/orlocal use only) 0 8. TANK REMOVED JSINESSNAME(S¡;~~~;FÃëILiT¡ÑÃME¡;õèÃ'~õ-¡"n-;iB~;¡~;;;;-Äs')'---,.. -"-- '-'3--TFACìLïTYIÕÏi-~I-~'--I' ,_. ,- 'I- ,,- ~... -- : ' ¡ \ I I ' _,_,___,_..;?_,_~OC-'C._O_A~E ____,_(_~~_ Ac.o i _,~_' _,~_ _,_~_,~.. ICA nON WITHIN SITE (Op/io-;;aïj'- 'E OF ACTION tick Qne Item only) o 1. NEW SITE PERMIT 0 4. AMENDED PERMIT o 5, CHANGE OF INFORMATION) ~ RENEWAL PERMIT 430 -- - ----. 431 I. TANK DESCRIPTION TË-iNSTÃi.CËD(YEARlMO) -----:ï35[1'ANK CAPACITY IN GALLÔNS I I ! 433 -, COMPARTME~TAlIZED'TAN;---Õ Yes '~No If "Yes", complete one page 10( each comparlmenL '--'¡36¡--N'UMBER OF COMPARTMENTS' : I 434 NK 10# 432 TANK MANUFACTURER 43'7 \OIDOO 438 ,OITlONAL DESCRIPTION (For local use only) II. TANK CONTENTS TANK USE 439 (1, MOTOR VEHICLE FUEL marked, çomplete Petroleum Type) j 2, NON,FUEL PETROLEUM J 3, CHEMICAL PRODUCT ¡ 4, HAZARDOUS WASTE (Includes Used Oil) i 95. UNKNOWN PETROLEUM TYPE o 1a, REGUlAR UNLEADED D 1b, PREMIUM UNLEADED D 1c. MIDGRADE UNLEADED 440 D 2, LEADED '5{3, DIESEL o 4, GASOHOL D 5. JET FUEL D 6, AVIATION FUEL D 99. OTHER COMMON NAME (from Hazardous Materials Inventory page) 441 CAS # (from Hazardous Materials Inventory page) 442 o \ê~ ¿-L. .-- \-0"=:I-..... III. TANK CONSTRUCTION D 3, SINGLE WALL WITH EXTERIOR MEMBRANE LINER o 4. SINGLE WALLIN A VAULT D 5, SINGLE WALL WITH INTERNAL BLADDER SYSTEM o 95, UNKNOWN o 99, OTHER 443 "'E OF TANK D 1, SINGLE WALL 1:8::'2. DOUBLE WALL ",cx one item only) D 1. RUBBER LINED D 2, ALKYD LINING 3. FIBERGLASS I PLASTIC o 4. STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC FRP 3, FIBERGLASS I PLASTIC D 4. STEEL CLAD WIFIBERGLASS REINFORCED PLASTIC (FRP) o 5. CONCRETE o 3. EPOXY LINING D 4. PHENOLIC LINING D 5. CONCRETE o 8. FRP COMPATIBLE W/100% METHANOL o 95, UNKNOWN D 99, OTHER 444 ">lK MATERIAL.. primary tank D 1, BARE STEEL >eek one item only) 0 2. STAINLESS STEEL 'IK MATERIAL, secoodary tank 0 1. BARE STEEL :1IJCk one item only) D 2, STAINLESS STEEL o a. FRP COMPATIBLE W/100% METHANOL o 9, FRP NON-CORRODIBLE JACKET 010, COATED STEEL D 95. UNKNOWN D 99, OTHER 445 '>IX INTERIOR LINING COATING D 5. GLASS LINING D 6. UNLINED ¡gr95. UNKNOWN o 99, OTHER 446 DATE INSTALLED 447 (For local use only) DATE INSTALLED 449 lecX one item ani HER CORROSION :;:JTECTlON IF APPLICABLE ",çk al/ that apply) (if 1, SPILL CONTAINMENT '¡g¡ 2, DROP TUBE ~ 3, STRIKER PLATE .', ".~ +_~~~5~~~~t:~;~#1~~~;:~~':f~;:ífj ..T ~ .:}~'. .~'~~:¿:~:~:~~~:;::J§~~,~:~~ IF SINGLE WALL TANK (Check./I tha/apply): VISUAL (EXPOSED PORTION ONLY) AUTOMATIC TANK GAUGING (ATG) CONTINUOUS ATG (For local use only) 450 TYPE (For Ioçal use only) 451 OVERFILL PROTECTION EQUIPMENT: YEAR INSTALLED 452 /5 (.¡Þ¡.... ~ 1, ALARM 't( 3, FILL TUBE SHUT OFF VALVE - ~'-'-~A"'~o¥".e. ~ 2, BALL FLOAT D 4. EXEMPT ø~~-r o.Gì¿ ;:~~'.:';;iy.'i~~1f.L~ DI::TÊçn~,::~}jt" .' "; '_ ;~'/..f..tJl..iíJ:!/-?"(f' ,~>:i':;i'( ;:~, ~ ',. ...~, ,,:'?~~~U '1~F!.'·P~~··~ ' 453 IF COUBLE WALL TANK OR TANK WITH BLACCER (Check one item only): 454 D 1. VISUAL (SINGLE WALL IN VAULT ONLY) g 2, CONTINUOUS INTERSTITIAL MONITORING o 3, MANUAL MONITORING , " 95, UNKNOWN D 99. OTHER 448 o 1. MANUFACTURED CATHODIC PROTECTION o 2. SACRIFICIAL ANODE YEAR INSTALLED 3, FIBERGLASS REINFORCED PLASTIC D 4, IMPRESSED CURRENT ""çk one item only) ,:lL AND OVERFILL D 5, MANUAL TANK GAUGING (MTG) o 6, VADOSE ZONE o 7, GROUNDWATER o a, TANK TESTING D 99. OTHER V. TANK CLOSURE INFORMATION I PERMANENT CLOSURE IN PLACE ESTIMATED QUANTITY OF SUBSTANCE REMAINING 456 TANK FILLED WITH INERT MATERIAL? ] 1. J 2, ] 3. ] 4. STATISTICAL INVENTORY RECONCILIATION (SIR)' BIENNIAL TANK TESTING --..-----. 457 5TlMA TED DATE LAST USED (YRlMO/DA Y) 455 gallons Dyes DNa ----_._- -.-,--------.. ------- -------. -..-.-"' ,.- ---.- ... .-...-.....- --.-.. --.------------- .-.- --- - - ----.-... ..~. . ..__.'._._----~-- CF (7/99) S :\CUP AFORMS\SWRCB-B. WPD 1715\ CITY OF BAKERSFIELD ~cFICE OF ENVIRONMENTAL SERVICES .ter Ave., Bakersfield, CA 93301 (661) 326·3979 UST, TANK PAve '__________ ___ ,_,_,_~,g~. _3___~~"JL -..------------- ABOVEGROUND PIPING .---------.-----.,----- VI. PIPING CONSTRUCTION (ChðCk an that apply) PRESSURE 0 ., SUCTION 0 3. GRAVITY 458 0 I. PRESSURE SINGLE WALL 0 3. LINED TRENCH 099 OTHER 460 i 0 t SINGLE WALL DOUBLE WALL 095. UNKNOWN ' 0 2, DOUBLE WALL ¡ MA~U~CTU.~'::R.__ . __'" ___,_______' , ____. _,_,4~1,L ___" ,_MAN:!.~~~~~~_~ o 1. BARE STEEL 06, FRPCOMPATIBLEW/100%METHANOL : 0 ,. BARE STEEL ATE RIALS AND 0 2. STAINLESS STEEL 0 7, GALVANIZED STEEL II' 0 2, STAINLESS STEEL JRROSION ' ~OTECTION iO 3. PLASTIC COMPATIBLE WITH CONTENTS 095. UNKNOWN i 0 3. PLASTIC COMPATIBLE WITH CONTENTS ~4, FIBERGLASS 0 8. FLEXIBLE (HOPE) 0 99, OTHER : 0 4, FIBERGLASS ,0 5. STEEL WI COATING 0 9. CATHODIC PROTECTION 464 ! 0 5, STEEL WI COATING VII. PIPING LEAK DETECTION (Check a/I /!Jal apply) I UNDERGROUND PIPING (S rEM TYPE )Ç:, t )NSTRUCTIONI~ I ANUFACTURERO 2. ---------.----- UNDERGROUND PIPING - ,,-,--- --,,--- 'SiÑGLE wÃuPiPïÑG :¡ESSURIZED 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 ALARMS ] 2, MONTHLY 0.2 GPH TEST ( 3. ANNUAL INTEGRITY TEST (0.1 GPH) JNVENTIONAL SUCTION SYSTEMS: ] 5, DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING INTEGRITY TEST (0.1 GPH) "FE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): ] 7. SELF MONITORING RAVITY FLOW: ] 9, BIENNIALlNTEGRITY TEST (0.1 GPH) SECONDARILY CONTAJNED PIPING RESSURIZED PIPING (Check all thaI apply): 10, CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL ALARMS AND (Check one) - o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c, NO AUTO PUMP SHUT OFF ] 1,. ~~W~~g~INE LEAK DETECTOR (3,0 GPH TEST) ~ FLOW SHUT OFF OR ] 12, ANNUALlNTEGRITY TEST (0,1 GPH) UCTION/GRAVITY SYSTEM: ] 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) ] 14, CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL AL,ARMS ] 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) ~ FLOW SHUT OFF OR RESTRICTION ] 16. ANNUAL INTEGRITY TEST (0,1 GPH) ] 17 , DAILY VISUAL CHECK --,._~---------_.----_. "-..--.------..-- o 2, SUCTION o 3. GRAVITY 45Y o 95, UNKNOWN o 99. OTHER 462 463 ---_.- -... - ....--.. --.- -..--. - o 6. FRP COMPATIBLE WI 100% METHANOL o 7. GALVANIZED STEEL o 8. FLEXIBLE (HOPE) o 9, CATHODIC PROTECTION o 95. UNKNOWN o 99. OTHER 465 466 ABOVEGROUND PIPING ~ŠfÑGLE WALL PIPING --- -- 467 Ii PRESSURIZED PIPING (Check all that apply): o " ELECTRONIC LINE LEAK DETECTOR 3,0 GPH TEST ~ AUTO PUMP SHUT OFF FOR LEAK, I SYSTEM FAILURE, AND SYSTEM DISCONNECTION" AUDIBLE AND VISUAL ALARMS o 2, MONTHLY 0.2 GPH TEST I 0 3. ANNUAL INTEGRITY TEST (0,1 GPH) ¡ 0 4, DAILY VISUAL CHECK ! CONVENTIONAL SUCTION SYSTEMS (Check all that apply): ! 0 5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM I I 0 6. TRIENNIAL INTEGRITY TEST (0,1 GPH) I ¡ SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): I 0 7, SELF MONITORING GRAVITY FLOW (Check all /!Jat apply): o 8. DAILY VISUAL MONITORING o 9, BIENNIAL INTEGRITY TEST (0.1 GPH) SECONDARILY CONTAJNED PIPING PRESSURIZED PIPING (Check all that apply): 10, CONTINUOUS TURBINE SUMP SENSOR ~ AUDIBLE AND VISUAL ALARMS AND (check one) o a, AUTO PUMP SHUT OFF WHEN A LEAK OCCURS o b, AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM DISCONNECTION o c, NO AUTO PUMP SHUT OFF o 11, AUTOMATIC LEAK DETECTOR o 12. ANNUAL INTEGRITY TEST (0.1 GPH) SUCTION/GRAVITY SYSTEM: o 13, CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS EMERGENCY GENERATORS ONLY (Check all that apply) o 14, CONTINUOUS SUMP SENSOR ~ AUTO PUMP SHUT OFF + AUDIBLE AND VISUAL ALARMS o 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) o 16, ANNUALlNTEGRITY TEST (0,1 GPH) o 17, DAILY VISUAL CHECK "t;;~i ...~,;;; ':~;{~Z:;~¡1;~i:"~':(i\~ii¡,":1:!,vjllt.R!Sp'E~~ER CON,IAÌ.NM~NT' 1, FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE o 2. CONTINUOUS DISPENSER PAN SENSOR + AUDIBLE AND VISUAL ALARMS o 3, CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR DISPENSER + AUDIBLE AND VISUAL ALARMS QATE INSTALLED 468 ,.':. :'('< ,,' o 4, DAILY VISUAL CHECK o 5, TRENCH LINER I MONITORING o 6, NONE 469 ._._____._..._..ø_______· IX. OWNER/OPERATOR SIGNATURE ï ëë;:¡¡¡YïMllhe irïrÒm1atlon provided herein Is true-~d accurate to the best of my know1edge. ::R::::;'~,:: -9-~T----;-_--.,~l:::~,k~~~=~-- . ~~=-==- ::; u,~£ "'{~L::___ ~~9~ -;::::'-~N_",L~ ~_.~,~",Qj."^,~,\,..-1Jê~~~.., .,---pg-Q\ ~A_rQR_ Permit Number (For locsl use only) 473 I Permit Approved (For local uss only) 474 Permit Expiration Date (Fo( locsl uss only) 475 PCF (7/99) S :\CUP AFORMS\SWRCB-B. WPD